Duphaston

Ivan Damjanov, MD

(University of Kansas Medical Center)

http://www.kumc.edu/school-of-medicine/pathology/faculty-and-staff/clinical-faculty/ivan-damjanov-md-phd.html

Gastroesophageal refiux nosis in infants and children including eosinophilic esophagitis menopause uptodate buy duphaston 10mg amex. Histologic abnormalities in refiux esophadelayed gastric emptying in childrenwith gastroesophageal refiux womens health 3 week diet buy duphaston 10mg without prescription. The role of extraesophageal in infants and children comparative accuracy of diagnostic methrefiux in otitis media in infants and children women's health hargreaves street bendigo purchase duphaston visa. Pepsin menstruation question order duphaston toronto, a reliable marker of phageal refiux in infants using different feedings during intraegastric aspiration women's health clinic lethbridge buy on line duphaston, is frequently detected in tracheal aspirates from sophageal pH monitoring women's health center waterbury ct buy duphaston 10mg with mastercard. Duodenogastro-esogastroesophageal refiux scintigraphy in suspected childhood asphageal refiux in children with refractory gastro-esophageal refiux pirationfi Treatment of oesophageal bile shown by scintigraphy in gastroesophageal refiux-related respirarefiux in children: the results of a prospective study with ometory disease. Canadian Consensus studied by radionuclide milk scanning and barium swallow roentConferenceon the management of gastroesophageal refiux disease genography. Effect of body position omeprazole in a diagnostic and therapeutic algorithm for chronic changes on postprandial gastroesophageal refiux and gastric cough. Short-term treatment with in formula-fed and breast-fed infants measured with the 13Cproton-pump inhibitors as a test for gastroesophageal refiux octanoic acid breath test. J Pediatr Gastroenterol Nutr 1999;29: disease: a meta-analysis of diagnostic test characteristics. Esomeprazole improves gastroesophageal refiux and hiatal hernia in infants and young healing and symptom resolution as compared with omeprazole in children. Review article: the role of bile and pepsin in the pathoin establishing a diagnosis of gastro-oesophageal refiux diseasefi Detection of gastric pepsin in natural course of gastroesophageal refiux symptoms: a 1-year middle ear fiuid of children with otitis media. Effect of formula regurgitations in the first 2 days of life in human milkand thickened with reduced concentration of locust bean gum on formula-fed term infants. Gastroesophageal refiux in children mized, placebo-controlled parallel group trial in 104 infants with and adolescents. Do thickening late-onset reactions to extensively hydrolyzed formulas in infants properties of locust bean gum affect the amount of calcium, iron with multiple food protein intolerance. Thickentaught in the primary care setting for symptoms suggesting infant ing infant formula with digestible and indigestible carbohydrate: gastroesophageal refiux. Seventeen-hour continuous esophagastroesophageal refiux [published erratum appears in Clin Pegeal pH monitoring in the newborn: evaluation of the infiuence of diatr (Phila). Cornstarch thickened refiux in convalescent preterm infants: effect of posture and formula reduces oesophageal acid exposure time in infants. Comparison of the effect of a cornstarch geal refiux in the 108-reverse-Trendelenburg position in supine thickened formula and strengthened regular formula on regurgitasleeping infants. Effect of cereal-thickened formula and effect on the risk of sudden infant death syndrome. Walking and chewing body positioning on gastroesophageal refiux and gastric emptying reduce postprandial acid refiux. Effects of gum chewing on pharyngeal sleeping environment, and new variables to consider in reducing and esophageal pH. Effect of decaffeination of effects in children with symptoms of gastro-oesophageal refiux. Results of a multicenter, placebo-controlled, refiux: incidence and precipitating factors. Am J Gastroenterol of refiux esophagitis in children: an Italian multicentric study. Treatment of childhood on lower oesophageal sphincter function and acid refiux in healthy peptic esophagitis: a double-blind placebo-controlled trial of volunteers. Do H2 receptor antagonists have a therapeutic role in symptoms of gastroesophageal refiux in women. Parietal cell hyperplasia in treatment of pediatric gastroesophageal refiux symptoms: an children receiving omeprazole. Gastroenterology 1995;108: open-label, multiple-dose, randomized, multicenter clinical trial A110. Gastric histology in children treatments in the short term management of refiux oesophagitis. Therapy with gastric acidity acute liver injury associated with cimetidine and other acid-supinhibitors increases the risk of acute gastroenteritis and commupressing anti-ulcer drugs. Risk of gynaecomastia associated therapy and higher incidence of necrotizing enterocolitis in very with cimetidine, omeprazole, and other antiulcer drugs. Review article: the unmet needs in delayed-release suppressive agents and the risk of community-acquired proton-pump inhibitor therapy in 2005. Long-term use of of gastroesophageal refiux disease: a randomized, open-label proton pump inhibitors and vitamin B12 status in elderly indivistudy. Proton pump inhibitor use and risk of hip pharmacodynamics of lansoprazole in children with gastroesofractures in patients without major risk factors. The role of protein digestibility kinetics of lansoprazole in neonates and infants. Cisapride treatment with symptoms of gastroesophageal refiux disease: a randomized, for gastro-oesophageal refiux in children. Randomized, prospective historical review and description of the modern version of the double-blind trial of metoclopramide and placebo for gastroesosyndrome. Should domperidone be geal refiux assessed by 24h continuous pH monitoring in infants used for the treatment of gastro-oesophageal refiux in childrenfi The current role of laparoscopic surgery for gastroesophagogastric motility and gastroesophageal refiux in children esophageal refiux disease in infants and children. Effect of baclofen on Nissen fundoplication for gastroesophageal refiux in children as emesis and 24-hour esophageal pH in neurologically impaired measured by 24-hour intraesophageal pH monitoring. Long term results of treatment by simple children who underwent laparoscopic Nissen fundoplication. Population-based cimetidine treatment for gastro-oesophageal refiux and peptic epidemiological survey of gastroesophageal refiux disease in oesophagitis. Surgical treatment and aluminum hydroxide in the treatment of gastroesophageal of gastroesophageal refiux in children: a combined hospital study refiux. Laparoscopic Nissen levels in normal infants receiving antacids containing aluminum. Complications and results of primary 100 consecutive laparoscopic antirefiux procedures. Reoperation after medical and surgical therapies for gastroesophageal refiux disNissen fundoplication in children with gastroesophageal refiux: ease: follow-up of a randomized controlled trial. High ventional Nissen fundoplication for gastro-oesophageal refiux risks and unmet goals. Endoscopic therapy of gastroesophageal refiux fundoplication following tracheoesophageal fistula and esophadisease: outcomes of the randomized-controlled trials done to geal atresia repair. Antirefiux surgery outcomes geal refiux symptoms after radiofrequency energy: a randomized, in pediatric gastroesophageal refiux disease. Effectiveness of fundoplicacentral emetic mechanism: recent studies on the sites of action of tion in early infancy. Long-term followconservative therapy for infants with symptomatic gastroesophaup of surgery for gastroesophageal refiux in infants and children. Exposure to tobacco for the relief of symptoms of gastro-oesophageal refiux disease in smoke and infant crying. A critical review of current medical therapy for endoscopic findings in 117 patients with histological diagnoses of gastroesophageal refiux disease. Dig Dis 2008; hypersecretion after long-term inhibition of gastric acid secretion. Prospective proton pump inhibitors in patients on long-term therapy: a doublestudy using split-screen video and pH probe. The crying of infants with controlled study of the efficacy and safety of non-prescription colic:acontrolledempiricaldescription. Long term cognitive patients with non-erosive refiux disease or functional heartburn. Dysphagia in patients with erosive symptoms in patients with normal oesophageal exposure to acid. Clinical and radiologic evaluarefiux disease management the Genval workshop report. Feeding problems in infants Gastroesophageal refiux in infants with a history of near-miss with gastro-oesophageal refiux disease: a controlled study. Gastroesophageal refiux associated with feeding problems in 700 infantsand young childrenpresenting to a respiratory abnormalities during sleep. Gastroesophageal refiux and apnoeic pauses during sleep in infancy no direct refiux and apnea of prematurity: no temporal relationship. Sudden deaths and apparent lifeby hydrochloric acid causes neurogenic infiammation in the airthreatening events in hospitalized neonates presumed to be ways in guinea pigs. Polysomnographic studies of acid increases the bronchomotor response to methacholine and to infants who subsequently died of sudden infant death syndrome. Awake apnea assoof lansoprazole therapy on asthma symptoms, exacerbations, ciated with gastroesophageal refiux: a specific clinical syndrome.

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Overall pediatric nutrirole of nutrients in biological pathways and clinical outcomes menstrual cycle 8 years old generic duphaston 10 mg free shipping. This tional goals can be summarized as follows: chapter describes current nutritional goals and requirements in health 1 women's health center amarillo tx purchase duphaston 10 mg with amex. To maintain positive nitrogen balance women's health physical therapy buy genuine duphaston online, necessary for growth womens health ri purchase duphaston 10 mg fast delivery, tisParenteral Nutrition) sue repair menstrual cycle 8 years old generic duphaston 10mg visa, and subsequent multiorgan functioning menstruation food buy duphaston 10mg with amex. Children are References at greater risk than adults of protein wasting because of a proportionally higher basal metabolic rate and protein turnover. Nutritional goals are different for different interventional appliprogressive muscle weakness, altered respiratory function, impaired immune response, and other hazards of debilitation, cations. For example, goals of nutrition support for therapeutic including cellular and mitochondrial impairments. Evidence in this regard exists for both inand outcantly affects patient response to disease, and consequently outpatients suffering from different diseases (eg, human immunocomes. With regard to the role of nutrition in disease evolution, it is 11,12 deficiency virus, cancer requiring bone marrow transplant). Malnutrition and malabsorption of macroand/or micronutrients and behavioral development is infiuenced by adequate nutrition. The choice of nutrition intervention has a profound patients are at risk (up to 65%) of developing malnutrition. Although difficult to assess and quanappropriate nutrition support3,4: tify, quality of life appears to be enhanced, especially during 1. The clinical course of disease may be improved through avoiding home nutrition support. Happiness, activity, sense of freedom, or correcting macroand micronutrient deficiencies. Improveand willingness to socialize were reported to be improved in chilments involve anthropometric parameters and body metabolism. The primary goal of nutrition support in adults should be to tors are used to set the requirements. Energy is measured in calories (in the United States) with specific nutrition support is based on two different rationales: respect to its individual components: a) To prevent starvation-induced complications (eg, death, infec1. This rationale is indisputable and includes patients who, mal function at the cellular, organ, and systemic levels, and to without nutrition support, would eventually die from starvation maintain homeostasis, body temperature, and heart and respirabecause they cannot eat. Nutrition therapy should be directed toward a specific objective, 33% of total energy expenditure. This is the requires 4%) and lipids (lipids from lipids or glucose require 2% goal in patients who cannot eat for indefinite or long periods: and 28%, respectively). It is have an energetic and structural-functional role, while microapproximately 5 kcal/g of body weight, ranging from 3 to 6 kcal/g nutrients are vital regulators of cellular, metabolic, or structural according to type of tissue. Nutrient requirements have been established according sents a very small part of the total energy requirement. The minimum level of energy compatible with health is termed are set for people with acute or chronic illness that renders their maintenance energy requirement. In disease states, due to higher turnover and Recommendations for the enteral and the parenteral requirements catabolism of endogenous proteins, this balance may become negacan overlap. Given extreme interand intrapersonal variability and difficulties in for supplying energy, they can be used for energy when energy assessing nutrient requirements in studies on healthy subjects, sugintake is insufficient. Lipids are energy dense, facilitate the absorption of fat-soluble vitato refiect advances in knowledge. Requirements have been extenmins and their precursors, and are structural components of cell sively investigated for energy, protein, and some micronutrients. Fiber requirements have been set because of the recently recognized endogenous protein stores by premature infants. Different functional fibers demonutilization ensures growth and minimizes complications. Micronutrient requirements remain largely empirical due to assesssively as an energy source) are achieved with 150 to 200 ment problems and lack of knowledge. If protein intake is suboptimal, (Enteral and Parenteral Nutrition) increasing energy intake will spare protein for lean tissue A. This is not usually possible in the first 1 to 2 weeks include tyrosine, cysteine, and taurine in addition to the of life. Growth parameters are routinely plotted on Babson-Benda other amino acids essential for term infants. Energy intake below or above requirements Standard infant formulas do not provide adequate may lead to growth retardation or excessive fat accumulation, protein. The energy requirement for premature infants is nitrogen accretion is estimated at 3 to 4 g/kg/day, with a approximately 120 kcal/kg/day (50 kcal/kg for mainteminimum concomitant delivery of 60 to 90 nonprotein nance plus 70 kcal/kg for a daily weight gain of 15 g/kg), kcal/kg/day. Azotemia may result from administration of with a range of 105 to 130 kcal/kg/day. Current practice is ponents are extrapolated from the norm to provide adeto initiate amino acids just after birth at variable doses of 1 quate energy for catch-up growth, high energy costs of to 3 g/kg/day. Doing so could decrease subsequent protein thermoregulation and body functions, and inefficient utirequirements for catch-up growth. Because energy is not required for digestion, there are the postprandial amino acid concentrations for the term no absorptive losses, activity is limited, and cold stress is breast-fed infant. After the first 2 weeks of life, energy intake of 90 to taurine, glutamate, aspartate, and cysteine; the reduction 40 A. The following conversion factors apply to: Ca 40 mg=1 mmol=2 mEq; P 31 mg=1 mmol; Mg 24 mg=1 mmol=2 mEq; Na 23 mg=1 mmol= 1 mEq; K 39 mg=1 mmol= 1 mEq; Cl 35 mg=1 mmol= 1 mEq. The N-acetyl-L-tyrosine salt is a because their concentration of bile salts is low. No (d) Functional fibers or prebiotics such as galactooligosacadverse effects have been observed in terms of lung dyscharide and oligofructose may improve the intestinal function. Oligo(1) Diuresis during the first 1 to 2 weeks of life results in a 5% saccharides are present in breast milk but not current to 15% weight loss in premature infants. Carbohydrate is provided as dextrose (D-glucose) in nance of specific gravity between 1. Serum and mature infants are susceptible to both dehydration and urine glucose monitoring provides an indication of fluid overload. Examples that increase requirements minute may result in fatty infiltration of the liver. Glucose without fat increases water Examples that decrease requirements are oliguria and retention and may thereby worsen existing respiratory conditions of neutral thermal range or high ambient compromise. In general, specific formulas and fortified breast tional age) may absorb and use medium-chain triglycmilk supply adequate amounts. For instance, expoterm diuretic use or aluminum contamination of the sure to light or phototherapy destroys ribofiavin. Nutrition recommends intakes of 500 mcg/kg/day vitaDeficiencies of zinc (alteration of the intestine, skin, min A and approximately 3 mg/kg/day of vitamin E, immunity, and growth) and copper (hypochromic anemia, and these should be started just after birth. Zinc requireother intakes are compared with estimates, at the curments may increase in infants with high stool output, rent doses, water-soluble vitamins largely cover the gastrointestinal fiuid losses, or renal failure. Premature infants require higher calcium, formula for zinc, and 10% to 30% for copper. They phosphorus, and magnesium intakes than do term exhibit competition for absorption and may be involved infants to promote intrauterine accretion rates and to in drug-nutrient interactions. An infant in utero accrues 75% of its zinc are 600 to 1500 (up to 3000) mcg/kg/day and for total body calcium from gestation weeks 24 to 40. Due to high urinary sodium presence of cholestasis as indicated by direct bilirubin losses during the first 3 weeks of life, premature infants > 2 mg/dL. Therefore, 5 to 7 mEq/kg/day of need to be omitted in infants with renal dysfunction. After that critical time and Estimates range from 10 and 20, with supplementation up to upon stabilization and growth, premature infants require 30 mg/kg/day without risk of side effects. The following points are emphasized: When illness or physical disability prevent adequate nutrient i) Mineral bioavailability averages 60% for calintake, requirements must be artificially determined considering cium, 70% for phosphorus, and 50% for magnethe disease factor involved. Mineral absorption is improved with the many nutrients are essential, especially for energy expenditure. It is frequently impossible to provide adebirth to adolescence, activity increases during childhood, and quate amounts of these minerals for prevention of growth has two major spikes during infancy and adolescence. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids double-labeled water. Energy expenditure may shift from in healthy individuals of a defined age, gender, weight, growth to the needs of acute illness. The activity-level coefficient is approximately variables included (eg, age, sex, weight, height. Estimates have been extrapolated from Health Organization equations are two examples of energy reported energy intakes and body mass index data, factorial expenditure estimates based on weight, age, and/or sex (see approaches, and measurements of energy expenditure by Tables 2-3 and 2-4). Basal Metabolic Rate Requirement in kcal/Day Based on Body Weight46,47 Kg Male Female Kg Male Female Kg Male Female Kg Male Female 3 150 (120*) 136 (144*) 16 750 747 38 1305 1207 62 1660 1572 4 210 (191*) 205 (191*) 17 780 775 40 1340 1241 64 1690 1599 5 270 274 18 810 802 42 1370 1274 66 1725 1626 6 330 336 19 840 827 44 1400 1306 68 1765 1653 7 390 395 20 870 852 46 1430 1338 70 1785 1679 8 445 448 22 910 898 48 1460 1369 72 1815 1705 9 495 496 24 980 942 50 1485 1399 74 1845 1731 10 545 541 26 1070 984 52 1505 1429 76 1870 1756 11 590 582 28 1100 1025 54 1555 1458 78 1900 1781 12 625 620 30 1140 1063 56 1580 1487 80 1935 1805 13 665 655 32 1190 1101 58 1600 1516 82 1970 1830 14 700 687 34 1230 1137 60 1630 1544 84 2000 1855 15 725 718 36 1270 1173 *From reference 46. Daily Energy Requirements for Pediatric carbohydrates, and proteins should be carefully prescribed. Measurements of resting metabolic expenditure can (5) All formulations contain crystalline amino acids. Glucose infusion rates of 5 to 13 mg/kg/minute are generally Adolescents (11 through 17 years) 0. Above 14 mg/kg/minute, complications such as liver fatty infiltration, hypertriglyceridemia, hyperglycemia, and Reprinted from Task Force for the Revision of Safe Practices for Parenteral Nutrition. Without carbohydrate in the diet, lipolysis, limchildren less than 2 years of age. In children over 2 years of ited ketone accumulation, and transient protein breakdown may age, the American Academy of Pediatrics recommends 30% occur. Fifty to 100 g per day of carbohydrate usually prevents or of calories from fat, with less than 10% from saturated fat, minimizes these effects. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Criteria and Dietary Reference Intake Val(1) High glucose loads expose the patient to fatty liver infilues for Total Fiber by Life Stage Group43 tration and possibly metabolic and respiratory stresses. Fat emulsion infusion rate starts at 1 g/kg/ group Criteria Male Female day with increments of 0. The nutrient content of enteral defined population or subgroup that appears to sustain a defined nutritional status, such as growth rate, normal circulatory nutrient values, or other functional indicators formulations mirrors these recommendations. Sources: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Ribofiavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2004). Other sources of iron in infants (>6 months), especially those with limited expoaddition to cereal may be beneficial after 6 months of age. Harris-Benedict equations (5) If liver or renal complications occur, some trace element Men 66. Dietary Reference fiuid has to be introduced daily regardless of health conditions. Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Factors such as losses and organ dysfunction may require volume individualization. Then appropriate factors can be applied to account calculating energy expenditure and relating this to water for physical activity. The formula is based on c) In the absence of indirect calorimetry capability, various energy expenditure for bed rest and therefore may not be ademethods are used to estimate energy requirements of sick quate for highly active children: patients. See Chapter 28 for a disintake predicted to maintain energy balance in a healthy cussion of this topic. Ireton-Jones Equations for Estimation of fat in many enteral formulas and serve as a readily utilizable Energy Requirements of Hospitalized energy source. Individual differences in the elderly make estimation of energy requirements challenging. Improved equations for predicting energy expenditure in patients: the Ireton-Jones equations. Fluid requirements does not distinguish that infused protein is not to be used a) Typical fiuid requirements for adults are 20 to 40 mL/kg/day or as a fuel source. However, many elderly persons are underhydrated, due at a rate not to exceed 7 g/kg/day (about 5 mg/kg/minute).

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In addition menstruation red tent duphaston 10mg without a prescription, this technique only provides information about a single point in time making it difficult to recognize trends general women's health issues quality 10mg duphaston. Back to Top Date Sent: 8/25/20 639 these criteria do not imply or guarantee approval womens health today cheapest duphaston. Criteria | Codes | Revision History vast amounts of information in the course of everyday life (Watkins menstruation questions answers discount duphaston amex, Connell et al women's health clinic indooroopilly purchase on line duphaston. Even with the aid of these devices womens health magazine recipes buy generic duphaston 10 mg online, maintaining blood glucose concentrations within a suggested optimal range is a constant struggle. Within the pancreas we all have 12 million groups of cells called the Islets of Langerhans which function together to help maintain the blood glucose levels within a quite narrow range (of around 70-160mg/dl). The islets make two main hormones (insulin from the beta-cells and glucagon from the alpha cells) which work together in concert. Whenever the blood goes up (after a meal, for example) the islets increase the amount of insulin that they are secreting from the beta-cells and decrease the amount of glucagon that they are secreting from the alpha cells. Whenever the blood glucose drops below normal the beta-cells turn off completely (so that no insulin is secreted) and the alpha cells crank out lots of glucagon. Glucagon (as well as other hormones like epinephrine, growth hormone and cortisol) stimulate the liver to release glucose into the blood stream (the liver stores about 300 grams of glucose in the form of a kind of starch called glycogen). The insulin and glucagon are released directly into the portal circulation of blood flowing from the pancreas to the liver. In other words, a non-diabetic person is functioning with millions of blood glucose measurements being done every day with the results connected to a continuously variable secretion of both insulin and glucagon released directly into the blood flowing to the liver. Rather than having both insulin and glucagon being released directly into the blood flowing to the liver we have a continuous subcutaneous infusion of insulin alone. The insulin is absorbed out of the subcutaneous fat into the peripheral systemic circulation and only then gets to the liver. Typically, diabetic patients test the capillary glucose level in their fingertips 2-8 times per day. This can give useful information but does not show the constant rising and falling of blood glucose excursions throughout the day. If needle sensors are placed in the subcutaneous tissue this can give a reading of interstitial fluid glucose (similar to plasma glucose) every 10-20 minutes throughout the day and so can show the trends as the blood glucose rises and falls. Back to Top Date Sent: 8/25/20 640 these criteria do not imply or guarantee approval. The person would not need to worry about testing their blood glucose or of thinking about what they eat and when they exercise but could go about their day-to-day life safe in the knowledge that their blood glucose would stay within normal limits. It is because of the practical limitations of the technology (outlined above) that we are still a long way away from that idealized situation. One of these studies compared sensor-augmented insulin pumps to multiple daily insulin injections while two of them compared threshold suspense systems with standard insulin pumps. The continuation phase resulted in a sustained lower mean A1C value for patients in the pump therapy group and decreased the mean A1C values to 7. In another trial, 95 adults and children with type 1 diabetes were randomized to use of a sensor-augmented insulin pump with threshold suspension or a standard insulin pump. After six months, the combined incidence of moderate and severe hypoglycemic events was significantly lower in patients using the pump with the threshold suspension compared with the standard insulin pump (9. This study, however, occurred in a highly controlled environment for short periods of time. While the algorithms may have the benefit of less time in hypoglycemia, this came at the expense of higher mean glucose values when compared to self-management (open loop) and thus, more time spent in hyperglycemia (Luijf, DeVries et al. Back to Top Date Sent: 8/25/20 641 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History Safety and Adverse Events: Safety and adverse events were included as endpoints in two of the four selected studies. Severe hypoglycemia was defined as an episode requiring assistance and was confirmed by documentation of a blood glucose value of less than 50 mg per deciliter (Bergenstal, Tamborlane et al. The change in the glycated hemoglobin level from randomization to study end was not significant in both groups, and the difference in hemoglobin level between groups was only 0. Beyond that, no episodes of diabetic ketoacidosis occurred in either group or no severe hypoglycemic events occurred in the Paradigm group. During the study phase there were seven adverse events thought to be related to the study device which included skin irritation and device malfunction resulting in severe hyperglycemia (Bergenstal, Klonoff et al. Generally speaking, the studies had the advantage of randomization and control, however, the lack of blinding makes the evidence vulnerable to bias. Furthermore, inclusion criteria were extremely selective with few studies including children younger than 12 years. In the same way, the data lack generalizability because management was limited to expert settings and among highly motivated patients. Further limitations include heterogeneity in definitions of hypoglycemia and short duration of follow-up ranging anywhere from 24 hours to 18 months. With many complications of diabetes developing over many years it would be ideal to see results allowing for multiple periods of sensor wear and to evaluate changes in subject needs over time. Articles: the search revealed over 500 articles many of which were commentary, discussion, or systematic review articles. Effect of sensor-augmented insulin pump therapy and automated insulin suspensions vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes a randomized clinical trial. Back to Top Date Sent: 8/25/20 642 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History the use of Artificial Pancreas does meet the Kaiser Permanente Medical Technology Assessment Criteria. Back to Top Date Sent: 8/25/20 643 these criteria do not imply or guarantee approval. Implantation of intrastromal corneal ring segments is identified as part of group 1, investigational, not proven effective or experimental. While use of this procedure has been largely for refractive and thus not medically necessary conditions, there is one notable exception. However, 0099T will continue to be not covered for refractive surgery which is not a Medicare benefit. Back to Top Date Sent: 8/25/20 644 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History Background Keratoconus is a progressive noninflammatory corneal disorder characterized by corneal thinning and protrusion of the central cornea. In the early stages of keratoconus, individuals may be asymptomatic; however, as the disease progresses, there is considerable distortion of vision in the form of myopia and irregular astigmatism. For patients with mild to moderate keratoconus, vision may be corrected with spectacles or contact lenses. However, as the disorder progresses, or when the patients can no longer tolerate contact lenses, they are referred for corneal transplant (penetrating keratoplasty). The outcomes of this surgery are generally favorable; however, the surgery is not without complications. Complications of penetrating keratoplasty include graft rejection, intraocular damage, postoperative astigmatism, recurrence of keratoconus, and side effects from the long-term use of topical corticosteroids (Ambekar 2011, Ertan 2007, Romero-Jimemez 2010). Intrasomal corneal ring segments (Intacs) inserts are an alternative treatment strategy for patients with mild to moderate keratoconus who are no longer able to achieve adequate vision using contact lenses or glasses and for whom corneal transplant is the only remaining option. Intacs inserts are small rings of synthetic material that are implanted in the deep corneal stroma with the aim of generating modifications of corneal curvature in an attempt to improve visual acuity, contact lens tolerance, and prevent or delay corneal transplant. The procedure is performed outside the corneal visual axis and the inserts may be removed or replaced if the desired outcome is not achieved. Intacs inserts should not be used in patients who can achieve functional vision on a daily basis using contact lenses, are younger than 21 years of age, do not have clear corneas, or have corneal thickness less than 450 microns at the proposed incision site. Complications associated with Intacs inserts include patient dissatisfaction with visual quality, discomfort, and ring segment extrusion or migration (Ambekar 2011, Bromley 2010, Ertan 2007, Romero-Jimemez 2010). Case series have potential selection and observation biases as well as other threats to internal validity. The results of these series may indicate some improvement in visual acuity after the implantation of Intacs in patients with keratoconus with a clear central cornea and intolerability to contact lenses. However, the technology was not compared to penetrating keratoplasty or other alternative therapies, and the follow-up duration was insufficient to determine the stability of the observed outcomes and the long-term harms that could be associated with Intacs inserts. All published studies identified were prospective or retrospective case series and had no control groups. Two prospective series on the use of Intacs for the management of keratoconus were selected for critical appraisal. Selection was based on the sample size, duration of follow-up, and quality of study. Evidence tables were created for the following studies: Hellstedt T, Makela J, Uusitalo R, et al. Results from case series should be interpreted with caution as this type of study design is prone to bias. The results of these studies may indicate some improvement in visual acuity after the implantation of Intacs inserts in patients with keratoconus with a clear central cornea and intolerability to contact lenses. Back to Top Date Sent: 8/25/20 645 these criteria do not imply or guarantee approval. Moreover, these studies do not provide evidence to determine if this technology would prevent the progression of keratoconus and eliminate the need for penetrating keratoplasty (Colin 2007, Hellstedt 2005, Siganos 2003). Conclusion: There is insufficient evidence to determine the safety and efficacy of Intacs inserts for the treatment of keratoconus. Articles: the literature search did not reveal any meta-analyses or randomized controlled trials. The largest prospective case series with the longest duration of follow-up was selected for review. Back to Top Date Sent: 8/25/20 646 these criteria do not imply or guarantee approval. The prevalence of the disease increases rapidly with age and is associated with significant morbidity and mortality. Back to Top Date Sent: 8/25/20 647 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History transluminal angioplasty, and surgical revascularization. Drug therapy, even with the most effective agents, was found to result in only a modest improvement. Surgical bypass reconstruction is indicated for severe cases and after failure of other forms of conservative therapy. The interest in using intermittent pneumatic compression was renewed in the late 1970s when researchers observed that intermittent pneumatic compression can temporarily increase the arterial blood flow to the limbs. This outpatient treatment usually performed for three 1-hour sessions per day while the patient is sitting upright. Another potential mechanism also described by the manufacturer involves the release of vasodilating substances as endothelial nitric oxide due to the decreased local vascular resistance. Only a small insignificant change was observed in the control group, and the difference between the two study groups was significant. Back to Top Date Sent: 8/25/20 648 these criteria do not imply or guarantee approval. In conclusion there is insufficient evidence to determine the efficacy of pneumatic compression devices for the treatment intermittent claudication, or more severe symptoms among patients with peripheral artery occlusive disease. Effect of intermittent pneumatic compression on foot and calf on walking distance, hemodynamics, and quality of life in patients with arterial claudication. Back to Top Date Sent: 8/25/20 649 these criteria do not imply or guarantee approval. Multifocal Intraocular Lens Date Sent: 8/25/20 657 these criteria do not imply or guarantee approval. Local Coverage Article None There is insufficient evidence in the published medical literature to show that this service/therapy is as safe as standard services/therapies and/or provides better long-term outcomes than current standard services/therapies. Prostate cancer is the most commonly diagnosed cancer and second leading cause of death in men in the United States. Several studies showed improvement in biochemical progression free survival with radiation dose escalation. With the higher doses being delivered with increased conformity, it is critical that the isocenter of the prostate treatment volume be placed with precision (Kuban 2008, Quigley 2009, Rajendran 2010). Back to Top Date Sent: 8/25/20 734 these criteria do not imply or guarantee approval.

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Nutritional deficiencies in fat-soluble vitamins women's health center in grants pass or cheap duphaston 10mg online, anemia menopause diet plan buy generic duphaston, and secondary hyperparathyroidism were common breast cancer 5 year survival purchase duphaston 10mg with amex. Although nutritional deficiencies and postoperative complications are common menopause 54 years old duphaston 10 mg lowest price, and according to the authors the patient satisfaction remains high women's health clinic dunedin buy duphaston 10 mg cheap. Total bile acid concentrations increased substantially over 5 years after both gastric bypass and duodenal switch pregnancy videos week by week purchase duphaston 10 mg on line, with greater increases in total and primary bile acids after duodenal switch. Higher levels of total bile acids at 5 years were associated with lower body mass index, greater weight loss, and lower total cholesterol. Two hundred seventy-five patients were available in year 1; 275 patients in year 3; 273 patients in year 5; 259 patients in year 7; and 228 patients in year 9. There were significant positive changes in quality of life between baseline and year 1 for most patients. Data showed that after surgery, the resolution of comorbidities continued for the 9 year follow-up period. Weight loss during the first year was well maintained, resolving comorbidities and improving quality of life. According to the authors, rates of surgical complications resemble other bariatric procedures; however long-term nutritional deficiencies are of concern. The primary end point was the rate of diabetes remission at 2 years (defined as a fasting glucose level of <100 mg per deciliter [5. In severely obese patients with type 2 diabetes, bariatric surgery resulted in better glucose control than did medical therapy. Of the remainder, 23 patients underwent revisional surgery and 29 were lost to follow-up. Twenty-three patients had revisional surgery for weight regain (n = 14) or for severe reflux (n = 9) at a mean period of 50 months (9-96). Ten out of the remaining non-converted patients (n = 26) also suffered from symptomatic reflux. Nine cohort studies met the inclusion criteria, with a total of 2280 patients included initially. Some cases are caused by the large compliant stomach being transformed into a long and narrow tube. Other factors are related to dismantling of the anatomical antireflux mechanisms, including disruption to the Hiss angle and resection of the sling fibers in the distal part of the lower sphincter, which results in low esophageal-sphincter pressure. Technical mistakes include narrowing at the junction between the vertical and horizontal parts of the sleeve, twisting of the sleeve, anatomical stenosis, and persistence of the gastric fundus and/or a hiatal hernia that has not been diagnosed before surgery. Bariatric Surgery Page 21 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). The number of nutritional and psychological contacts was predictive of good weight loss results. The authors concluded that endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Thirty-day morbidity included 3 cases of self-limiting nausea and vomiting and 1 case of gastric sleeve stenosis necessitating conversion to gastric bypass. No patients were lost to follow-up but 5 were excluded because they underwent revisions. Improvement or remission of type 2 diabetes was found in more than 70% of patients. Significant improvements were also seen in hypertension and hyperlipidemia, as well as in sleep apnea and joint pain. Blood samples were collected after an overnight fast and in 6 patients in each group after a standard 420 kcal mixed meal. This study is limited by small sample size and short term follow-up; however the strengths are that this is a double blind, randomized study. Bariatric Surgery Page 22 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. There were no postoperative complications, no hemorrhage from the staple line, no anastomotic leakage or stricture, and no mortality. The authors concluded that the procedure evaluated was safe and effective; however, long-term results are still pending. This study is limited by lack of randomization, short follow-up, and lack of comparison to other bariatric surgical procedures. Of the 846 patients, 271 opted for the Band, 216 underwent vertical gastrectomy, 303 had Rouxen-Y, and 56 had duodenal switch operation. In the study, vertical gastrectomy patients experienced a similar rate of weight loss compared to Roux-en-Y and duodenal switch. The authors conclude that long-term efficacy of vertical gastrectomy is unclear but is promising. One late complication of choledocholithiasis and bile duct stricture required a Whipple procedure. One hundred fifty-two patients (39%) out of 227 patients (58%) with long-term complaints underwent revisional surgery. Analysis before revision showed an outlet dilatation (17%), pouch dilatation (16%), and outlet stenosis (10%). The authors concluded that the risk:benefit ratio of these procedures in this series is questionable. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5. There were 248 concomitant procedures such as upper endoscopy, cholecystectomy, etc. There were two cases each of bowel obstruction, transfusions, and deep vein thrombosis/pulmonary embolus, but no deaths or anastomotic leaks. There were no statistically significant differences in complication rates, estimated blood loss, or length of stay between the two groups. There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. The authors concluded that both techniques are comparable in terms of safety, efficacy, and operative and early perioperative outcomes. Bariatric Surgery Page 24 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Several studies showed a lower complication rate with the robotic platform including leaks, hemorrhage and stricture. Another advantage noted by the authors for the use of the robotic system is improved ergonomics and lesser operator fatigue. The authors observed that the use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. With the advent of newer technologies in robotics the authors conclude that it will provide an empowering tool to the surgeons, which can potentially change the way surgery is practiced. Fourteen comparative and 11 non-comparative studies were included in this study, reporting data on 5145 patients. The mean operating time was again significantly shorter for the robotic procedures. The authors concluded that these studies demonstrated the feasibility, safety, and potential superiority of robotic laparoscopic Roux-en Y gastric bypass. In addition, the learning curve may be significantly shorter with the robotic procedure. Further experience is needed to understand the long-term advantages and disadvantages of the totally robotic approach. Three patients underwent conversion to open surgery, and four patients experienced postoperative leaks with no mortality. The variety and distribution of primary bariatric procedures were gastric band (40%), gastric bypass (35. The authors concluded that revisional bariatric surgery can be performed with low complication rates and with acceptable 12-month weight loss, though not with the same safety as primary procedures. Three hundred forty-two laparoscopic gastric bypass operations were performed, 245 were primary, and 97 revisional. The authors concluded that revisional and primary gastric bypass have no statistical differences in terms of morbidity. Bariatric Surgery Page 25 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Indication for conversion was weight loss failure in 34 (67%) patients and band complications in 17 (33%) patients. These differences are particularly notable with regard to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay. Eating and lifestyle behaviors, difficulty in embracing the required lifestyle changes, and reappearance of depressive and anxious symptoms have been associated with failure of weight loss or weight regain after primary surgeries. The authors recommend that particular attention be paid to surgical candidates with a history of difficulties in engaging in healthy eating patterns. Bariatric Surgery Page 26 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. The authors identified that complications were significantly more frequent in revision patients than primary patients (41% v. The rates of remission of diabetes, hypertension and obstructive sleep apnea were 46. Available observational evidence does suggest that revisional bariatric surgery is associated with outcomes similar to those experienced after primary surgery. All patients in the studies reported significant early initial weight loss after revisional surgery. With more primary procedures being performed to manage extreme obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes. At follow-up (over a 3 year period), the authors reported median excess weight loss was 60. Nineteen of the 53 patients (36%) were converted to Roux-en-Y gastric bypass (n=18) or duodenal switch (n=1) due to significant weight regain (n=11), reflux (n=6), or acute revision (n=2) at a median of 36 months. Fifty-one studies included inadequate weight loss or weight regain as an indication for revision: 31/51 (61%) gave no definition of failure, 7/20 quoted <50% of excess weight loss at 18 months and 6/20 used <25% excess weight loss. The authors concluded that the majority of published studies do not define failure of bariatric surgery, and <50% excess weight loss at 18 months was the most frequent definition identified. Refer to the Professional Societies section of the policy for additional information. Bariatric Surgery Page 27 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. Pediatric and Adolescent Bariatric Surgery Adolescent severe obesity is associated with numerous comorbidities, and persists into adulthood. Bariatric surgery is the most effective treatment available, resulting in major weight loss and resolution of important comorbid conditions (Desai et al. According to the authors, combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education appear to have the best overall results. Clinical practice guidelines for pediatric obesity treatment recommend consideration of surgery after failure of behavioral approaches. Careful screening and postoperative management of patients by a multidisciplinary team is required. Obese adolescents are likely to suffer from psychological morbidity, loss of self-esteem, and social exclusion which has the potential for life-long effects. Presently, adolescent obesity is mostly managed by combined lifestyle interventions focusing on behavioral and dietary modifications. These treatments are typically initiated and evaluated by a multidisciplinary team including a pediatrician, dietician, psychologist, and a physiotherapist. While often effective in short term, long-term effects are relatively disappointing. Potential adverse effects on growth and development in prepubertal patients who have not reached full maturity raise concerns. However, bariatric surgery relatively early in life intervenes before comorbidities become irreversible and reduces the risk of surgical complications (Paulus et al. Late adolescents experienced the highest weight loss; resolution rate of comorbidities was lower in adults. Compared with medical therapy, surgical treatment of severely obese adolescents with type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities. According to the authors, these data support the need for a welldesigned, prospective controlled study to define the role of surgery for adolescents with type 2 diabetes, including health and surgical outcomes. Bariatric Surgery Page 28 of 65 UnitedHealthcare Commercial Medical Policy Effective 05/01/2020 Proprietary Information of UnitedHealthcare. The authors concluded that weight loss maintenance over time was significantly associated with improvements in lipid profile over 5 years. When the surgical group was split into maintainers and re-gainers, no differences in weightrelated and eating behaviors, health responsibility, physical activity/inactivity, or dietary habits were observed between groups. One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions).

References

Hamidinia A: Transvasovasostomyoan alternative operation for obstructive azoospermia, J Urol 140(6):1545n1548, 1988.
Tsui JC, Baker DM, Biecker E, et al: Evidence for the involvement of endothelin-1 but not urotensin-II in chronic lower limb ischaemia in man, Eur J Vasc Endovasc Surg 25:443-450, 2003.
Bonow RO, Rosing DR, Bacharach SL, et al: Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy, Circulation 64:787-796, 1981.
Bernheim A, Connolly H, Pellikka P. Carcinoid heart disease. Curr Treat Option Cardiovasc Med. 2007;9:482-489.
Middleton LP, Palacios DM, Bryant BR, Krebs P, Otis CN, Merino MJ. Pleomorphic lobular carcinoma: morphology, immunohistochemistry, and molecular analysis. Am J Surg Pathol. 2000;24(12):1650-1656.
Lucente, V., Cornu, J., Sebe, P. et al. Ajust single incision transobturator sling procedure for stress urinary incontinence I women: one year results, Abstract 775.
Ghoniem GM: Modified pubovaginal sling for treatment of complicated stress urinary incontinence in females, AUA Today 4:5, 1991.
Elahi MM, Osman KA, Bhandari M, et al. Does the type of prosthesis influence the incidence of permanent pacemaker implantation following isolated aortic valve replacement? Heart Surg Forum 2005;8:E396-E400.