Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:4.1.1.6 (CAD)
 4,420 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stress echocardiography is an accepted alternative method for non-invasive assessment of coronary artery disease--diagnosis, risk stratification and prognosis. Myocardial ischaemia triggers a cascade of events resulting first in regional relaxation abnormalities (or diastolic dysfunction) followed by regional motion abnormalities (or diastolic dysfunction). The basic principle in stress echocardiography is to provoke myocardial ischemia by exercise, pharmacologic interventions (like dobutamine, dipirydamole, enoximone, adenosine) or less often atrial pacing and subsequently to evaluate regional wall motion abnormalities in segments vascularized by coronaries with flow--limiting stenosis. Myocardial viability can be identified at the low dose dobutamine or dipirydamole stage as a functional improvement in regions with rest dyssynergy and myocardial ischaemia can be recognized at high doses as well motion dysfunction. The ideal test for evaluation of the patient with CAD remains exercise stress testing, pharmacologic stress should be reserved only for those patients in whom optimal workload of stress cannot be obtained. This article reviews the current status of stress echocardiography in clinical practice and assesses the possible indications for the tests in a modern cardiac department.
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PMID:[Stress echocardiography: methods, indications, clinical application]. 1052 23

Breast imaging has a deserved reputation as a very difficult financial proposition for hospitals. Regulation, low reimbursement, costly new technologies and staff shortages all combine to create an operational environment that is difficult, at best. While it may not be possible for every hospital to make breast imaging profitable, it is the obligation of every hospital to make this and all service lines as cost-effective as possible. While the typical care episode in a hospital will include several different services or procedures, the breast-imaging patient is typically in the department or breast center for a single procedure. Consequently, all of the administrative and facility costs of the patient encounter must be borne by the reimbursement for the single procedure. Breast imaging involves relatively expensive technology and highly-trained, and costly, technologists in its delivery. The costs of these inputs are relatively fixed; therefore material improvement can only be realized through the redesign of process. Analysis of the process of care delivery is critical to any discussion of the economics of breast imaging. Breast imaging can basically be divided into two categories: screening mammography and diagnostic procedures. This is a very important distinction, because screening mammography requires only general supervision, while the balance of breast imaging requires the direct supervision of the physician. Decoupling the physician from the examination allows the organization of screening delivery programs in highly efficient, high-throughput systems. On the diagnostic side of breast imaging, the primary economic enhancement that can be realized is from the delivery of more than one procedure during the patient visit. Mammography has high fixed costs (technology and technologist) and, where high fixed costs are found, profitability is determined by process and volume. Where process can be optimized to a level that will allow a positive return for each mammogram, volume becomes a multiplier. Responding to congressional pressure exerted in 2001, CMS increased the 2002 payment rate (global) for screening mammography from $69.23 (2001) to $81.81. The increase, however, was a mixed blessing, as it was all in the professional component ($22.18 to $35.48). In fact, the technical component was actually reduced by $0.74 from $47.07 to $46.33. While the reduction in payment for producing the screening mammogram is unjustified by the costs of producing that exam, the hardest blow was reserved for the payment rates for diagnostic mammography. As previously discussed, improving process and increasing volumes will improve the financial picture, but the problem of a single, low, procedure reimbursement remains. The implementation of CAD, however, has the ability to change that reality. CMS treats CAD as an add-on procedure. It cannot be billed as a stand-alone charge, but it is paid when billed in conjunction with a screening or diagnostic mammogram. The implications of the add-on character of CAD reimbursement are disproportionate to the amount of the payment, because it does not have to carry any costs other than those directly involved in its delivery. Breast imaging in general, and mammography specifically, will continue to present a challenge to the radiology administrator. With proper attention to process and volumes, and the very important contribution of CAD, however, breast imaging has the potential to not only pay its own way but to become profitable.
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PMID:New tools for cost-effective delivery of breast imaging. 1222 54

Therapeutic angiogenesis aims at restoring perfusion to chronically ischemic myocardial territories by using growth factors or cells, without intervening on the epicardial coronary arteries. Despite angiogenesis having received considerable scientific attention over the last decade, it has not yet been shown to provide clinical benefit and is still reserved for patients who have failed conventional therapies. Nevertheless, angiogenesis is a very potent physiologic process involved in the growth and development of every animal and human, and it is likely that its use for therapeutic purposes, once its underlying mechanistic basis is better understood, will one day become an important modality for patients with CAD and other types of organ ischemia. This review summarizes current knowledge in therapeutic angiogenesis research.
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PMID:Protein-, gene-, and cell-based therapeutic angiogenesis for the treatment of myocardial ischemia. 1554 41

Diagnostic testing for CAD is aided by the calculation of the pretest probability using either the Diamond-Forrester score or the Morise score. Patients who have a low risk of CAD should not undergo testing. Exercise ECG testing should be reserved for patients who have pretest probabilities lower than 20%, because a negative test does not adequately reduce the posttest probability of significant CAD. For patients who are at intermediate risk, either nuclear perfusion imaging or stress echocardiography is an acceptable choice depending on local availability and practice. Due to its low specificity, CAC scoring is currently limited in its usefulness for the diagnosis of CAD in symptomatic patients. Currently, screening for CAD among patients at low risk should not extend beyond screening for traditional risk factors. Physicians should use the Framingham Risk Score to stratify patients into levels of 10-year risk for cardiac events. Due to its high rate of false positive tests and low sensitivity, exercise ECG is of limited value in screening. Among patients with higher levels of risk, in whom further risk stratification would be of use in making decisions about risk factor management, measurement of CAC either with EBCT or multidetector row CT scanning is a promising option, but more research is required before its use should become widespread. Measures of endothelial function are in development but lack data to support their widespread use currently.
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PMID:Diagnosis and screening of coronary artery disease. 1632 20

All-ceramic crowns are used as alternatives to conventional metal-ceramic crowns for the restoration of single teeth. Traditionally all-ceramic restorations possessed physical properties that contraindicated their use in many treatment situations. The strength that zirconia ceramics exhibit seems to support the hypothesis that, in specific situations, an all-ceramic crown may be used to restore removable partial denture (RPD) abutments in areas previously reserved for metal or metal-ceramic restorations. Abutments for RPDs may now be fabricated with Procera AllZirkon with the classically prepared guide planes and rest seats. This article provides an overview of a technique for the fabrication of a zirconia-based crown to be used in conjunction with removable partial dentures using the Procera CAD/CAM technology.
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PMID:Removable partial denture abutments restored with all-ceramic surveyed crowns. 1659 59

The objective was to establish and evaluate a method for manufacture of custom trays for edentulous jaws using computer aided design and fused deposition modeling (FDM) technologies. A digital method for design the custom trays for edentulous jaws was established. The tissue surface data of ten standard mandibular edentulous plaster models, which was used to design the digital custom tray in a reverse engineering software, were obtained using a 3D scanner. The designed tray was printed by a 3D FDM printing device. Another ten hand-made custom trays were produced as control. The 3-dimentional surface data of models and custom trays was scanned to evaluate the accuracy of reserved impression space, while the difference between digitally made trays and hand-made trays were analyzed. The digitally made custom trays achieved a good matching with the mandibular model, showing higher accuracy than the hand-made ones. There was no significant difference of the reserved space between different models and its matched digitally made trays. With 3D scanning, CAD and FDM technology, an efficient method of custom tray production was established, which achieved a high reproducibility and accuracy.
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PMID:Application of FDM three-dimensional printing technology in the digital manufacture of custom edentulous mandible trays. 2676 20