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 12,436 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The therapeutic approach to children with achalasia of the esophagus is controversial. Both pneumatic dilatation (PD) and Heller esophageal myotomy (EM) are considered effective, while bougienage has been discarded by most authorities. To determine the best place for each in the therapy of achalasia, 19 cases treated since 1964 were reviewed. Ages ranged from 9 months to 17 years (median 11 years), and duration of symptoms ranged from 4 months to 8 years (median 1 year). Three patients had symptoms from infancy. Two patients underwent a successful EM as their sole procedure. Two underwent bougienage as their initial therapy. Dysphagia recurred quickly and both required operation. Fifteen underwent PD under intravenous sedation with a Brown-McHardy dilator placed under fluoroscopy. Seven underwent a single dilatation; seven underwent two; and one underwent four. Relief of dysphagia was achieved in 11 patients, but four required surgery. The patients who experienced adequate relief with dilatation alone were clinically identical to those in whom it failed with respect to age, race, sex, symptom duration, and manometric data. Those who required EM following PD experienced only a brief period of relief following PD (median 1 month) compared with those who enjoyed lasting results (median 18 months). Three patients suffered prolonged chest pain or fever following PD, but without esophageal leakage and with full recovery. Two of eight operative patients developed late postoperative reflux. There were no deaths. Both PD and EM are safe and effective treatments for achalasia. Our results indicate that dilatation is the logical first therapeutic step, but rapid recurrence of symptoms may identify those patients who will require operative myotomy.
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PMID:Pneumatic dilatation and operative treatment of achalasia in children. 361 56

Rough sets (Pawlak Z. Rough Sets: Theoretical Aspects of Reasoning about Data, Dordrecht: Kluwer Academic Publishers, 1991) is a relatively new approach to representing and reasoning with incomplete and uncertain knowledge. This article introduces the basic concepts of rough sets and Boolean reasoning (Brown FM. Boolean Reasoning: The Logic of Boolean Equations, Dordrecht: Kluwer Academic Publishers, 1990). A rough set framework is then set up to investigate the prognosis of cardiac events in a set of patients with chest pain that was earlier studied by Geleijnse et al. (J Am Coll Cardiol 1996;28(2):447-454). That study used logistic regression to find that the single most important independent predictor for future hard cardiac events (cardiac death or non-fatal myocardial infarction) was an abnormal scintigraphic scan pattern. However, performing a scintigraphic scan is a relatively expensive procedure, and may for some patients not really be fully necessary as knowledge of the outcome of the scan may be redundant with respect to making a prognosis. Using an approach based on rough sets, this paper explores how a patient group in need of a scintigraphic scan can be identified for subsequent modelling. Identification of such patients may potentially contribute to lowering the cost of medical care and to improving its quality since, virtually without loss of information, fewer patients may be referred for this procedure.
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PMID:Modelling prognostic power of cardiac tests using rough sets. 1008 80