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Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease:A definitive diagnostic test?

World Journal of Gastroenterology 2015年第12期21卷 3619-3627页

作者： Gregory L Falk John Beattie Alvin Ing SE Falk michael magee Leticia Burton Hans Van der Wall Sydney Heartburn Clinic Gastroenterology Concord Hospital University of Sydney Macquarie University Sydney Ryde Medical Centre Sydney Department of Respiratory Medicine Concord Hospital the University of Sydney Sydney Heartburn Clinic Gastroenterology Sydney Concord Nuclear Imaging Clinic

AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication(LF) for chronic laryngopharyngeal reflux ***: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional p H and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after ***: Thirty four patients(20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour p H and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study(50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29%(5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive valueof 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable sideeffect profile. CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.

关键词： Laryngopharyngeal reflux p H studies Oesophageal m

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Is routine measurement of international normalized ratio necessary as part of the investigation of patients with cardiac-type chest pain?

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World Journal of Emergency Medicine 2021年第3期12卷 221-224页

作者： Samuel G.Campbell Kirk magee Ismail Cajee Simon Field michael B.Butler Christine L.Campbell Sarah E.Bryson Charles V.Keating Emergency and Trauma Centre Queen Elizabeth II HSCHalifaxNova Scotia B3H 3A7Canada

Dear editor, Chest pain is a frequent complaint of patients presenting to the emergency department (ED), and many of them are referred to the cardiology service for further investigation. At the Charles V. Keating Emergency and Trauma Centre in Halifax, Nova Scotia, Canada, 4,800 (6.6%) of the approximately 73,000 patients per year register with a complaint of “chest pain”, and 20% of patients are referred to cardiology. Coagulation studies, specifi cally international normalized ratio (INR) frequently part of the “routine” panel of blood tests, are ordered for patients in the ED being investigated or treated for chest pain suspected to be cardiac in nature. Recent calls to examine how much of our practice is likely to benefit patients in any way have led us to question the clinical utility of routine use of these tests.

关键词： routine patients pain

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Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

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World Journal of Emergency Medicine 2017年第3期8卷 165-169页

作者： michael Butler Patrick Froese Peter Zed George Kovacs Robert Mac Kinley Kirk magee Mary-Lynn Watson Samuel G.Campbell Department of Emergency Medicine Faculty of Medicine Dalhousie University Department of Undergraduate Medicine Faculty of Medicine Dalhousie University Faculty of Pharmaceutical Sciences University of British Columbia Department of Emergency Medicine Faculty of Medicine University of British Columbia

BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching ***: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic ***: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not ***: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

关键词： Procedural sedation Atrial fibrillation Electrical cardioversion

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End-tidal capnometry during emergency department procedural sedation and analgesia： a randomized, controlled study

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World Journal of Emergency Medicine 2016年第1期7卷 13-18页

作者： Samuel G. Campbell Kirk D. magee Peter J. Zed Patrick Froese Glenn Etsell Alan LaPierre Donna Warren Robert R. MacKinley michael B. Butler George Kovacs David A. Petrie Department of Emergency Medicine and Anesthesia Dalhousie University Halifax Nova Scotia Canada Faculty of Pharmaceutical Sciences and Department of Emergency Medicine University of British Columbia Vancouver BC Canada Charles V. Keating Emergency and Trauma Centre Halifax Nova Scotia Canada Department of Emergency Medicine Anesthesia and Anatomy Dalhousie University Halifax Nova Scotia Canada

BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of *** endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient ***:Of 986 patients,501 were randomized to usual care and 485 to additional ETC *** this series,48%of the patients were female,with a mean age of 46 *** manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most *** was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant *** found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was *** do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

关键词： Procedural sedation and analgesia Capnography Adverse events Emergency medicine

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Amyloid-beta-dependent phosphorylation of collapsin response mediator protein-2 dissociates kinesin in Alzheimer＇s disease

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Neural Regeneration Research 2018年第6期13卷 1066-1080页

作者： Sara H.Mokhtar Min Joung Kim Kylie A.magee Pei Mun Aui Speros Thomas Maha M.Bakhuraysah Amani A.Alrehaili Jae Young Lee David L.Steer Rachel Kenny Catriona Mc Lean michael F.Azari Antonis Birpanagos Ewlina Lipiec Philip Heraud Bayden Wood Steven Petratos Department of Neuroscience Central Clinical School Monash University Prahran Victoria Australia Department of Biochemistry and Molecular Biology Monash Universityl Clayton Victoria Australia Department of Anatomy & Developmental Biology Monash University Clayton Victoria Australia Department of Anatomical Pathology Alfred Hospital Prahran Victoria Australia School of Health and Biomedical Sciences RMIT University Bundoora Victoria Australia Division of Animal and Human Physiology Department of Biology National and Kapodistrian University of Athens Ilisia Athens Greece The Henryk Niewodniczanski Institute of Nuclear Physics Polish Academy of Sciences Department of Applied Spectroscopy RadzikowskiegoKrakow Poland Centre for Biospectroscopy and Department of Microbiology Monash University Clayton Victoria Australia

Alzheimer’s disease（AD）is a neurodegenerative disorder characterized by accumulation of amyloid plaques and neurofibrillary *** to the development of these characteristic pathological hallmarks of AD,anterograde axonal transport is ***,the key proteins that initiate these intracellular impairments remain *** collapsin response mediator protein-2（CRMP-2）plays an integral role in kinesin-1-dependent axonal transport and there is evidence that phosphorylation of CRMP-2releases ***,we tested the hypothesis that amyloid-beta（Aβ）-dependent phosphorylation of CRMP-2 disrupts its association with the kinesin-1（an anterograde axonal motor transport protein）in *** found that brain sections and lysates from AD patients demonstrated elevated phosphorylation of CRMP-2 at the T555 ***,in the transgenic Tg2576 mouse model of familial AD（FAD）that exhibits Aβaccumulation in the brain with age,we found substantial co-localization of p T555CRMP-2and dystrophic *** SH-SY5Y differentiated neuronal cultures,Aβ-dependent phosphorylation of CRMP-2 at the T555 site was also elevated and this reduced the CRMP-2 association with *** overexpression of an unphosphorylatable form of CRMP-2 in neurons promoted the re-establishment of CRMP-2-kinesin association and axon *** data suggest that Aβ-dependent phosphorylation of CRMP-2 at the T555 site may directly impair anterograde axonal transport protein function,leading to neuronal defects.

关键词： amyloid-beta protein kinases collapsin response mediator protein microtubules kinesin tubulin

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