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Other retained small bowel objects included in this study were nails and fish hooks. Of the 30 enteroscopies, there was only 1 case (3 %) with a complication (perforation). Furthermore, and UpToDate review on ?Overview of deep small bowel enteroscopy (Kita, 2015) lists ?Foreign body retrieval (e. Jeghers syndrome (Chung and Adar, 2016) states that "[s]uccessful small bowel polypectomy using balloon? Endoscopists should be aware of possible challenges in performing double balloon enteroscopy in patients who have had previous abdominal surgery and may have peritoneal adhesions and altered anatomy. Esophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding focus, but capsule endoscopy revealed a bleeding focus in the small intestine. Endoscopic interventions in the small bowel using double balloon enteroscopy: Feasibility and limitations. Double balloon endoscopy in two hundred fifty cases for the diagnosis and treatment of small intestinal disorders. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Detection of neuroendocrine tumors of the small bowel by double balloon enteroscopy. Investigating obscure gastrointestinal bleeding: Capsule endoscopy or double balloon enteroscopy? A prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed double? Current state of double balloon endoscopy: the latest approach to small intestinal diseases. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: An updated meta? Jeghers syndrome and juvenile polyposis: Screening and management of patients and families. Endoscopic approaches for pancreatobiliary diseases in patients with altered gastrointestinal anatomy. Single versus 35 of 37 double balloon enteroscopy for small bowel diagnostics: A systematic review and meta? Jeghers syndrome: Comparing magnetic resonance enteroclysis and double balloon enteroscopy. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither o? This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract.
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Because of its high surface-to-volume ratio, the hair may be easily contaminated by the external environment, by exposure to chemicals in aerosols and smoke or by direct contact with powders;. The chemical and physical properties of the compounds affect their susceptibility to incorporation into the hair structure. In general, small molecular dimensions, high hydrophobicity and the presence of basic ionizable groups tend to favour binding into the hair structure. Among these, a prominent role is exerted by keratin with its carboxyl, amine, phenol, hydroxyl and sulphydril groups, as well as multiple hydrogen bonds. It may be considered to behave like a weak cationic exchanger and consequently tends to bind basic drugs. Cosmetic treatments (shampooing [6], bleaching, dyeing, waving, relaxing or exposing hair to strong bases that may cause hair damage with drug loss or affect drug stability [11]);. External conditions (sunshine, rain or wind can damage the hair shaft, affecting drug concentration [35]);. It is generally observed that drug concentrations decrease along the hair shaft with increasing distance from the root. Pragst and Balikova report that at 12-15 cm from the root, hair can retain only about 4 % of the original drug concentration (23 different drugs or metabolites were tested) in regularly shampooed hair not exposed to cosmetic treatments [35]. Several publications describe a lower drug concentration for opioids, methadone, cocaine, methamphetamine and cannabinoids in scalp hair compared to other types of hair [35]. Therefore, the biological differences between hair sampled from different locations must be considered for a proper interpretation of the results of hair testing. There are considerable variations of growth rate in the different regions of the scalp. Thus, for the sake of uniformity, sampling from the vertex posterior area is recommended. Average values for the anagen stage in scalp hairs are 4-6 years, the catagen stage lasts a few weeks and the telogen stage about 4-6 months, with an overall growth rate ranging from 0. In the interpretation of toxicological results of scalp hair, the following factors should be carefully taken into account:. As the duct of the sebaceous glands discharge directly into the hair follicle, the hair shaft is ?bathed in sebaceous secretions until its emergence from the skin. Beard hairs are thicker, have bigger follicles and have the slowest growth rate (0. Their follicles are characteristic because the sebaceous gland duct exits from the skin in a channel separate from the channel of the hair shaft; thus beard hair may be somewhat less contaminated by sebaceous secretions. However, as the sample is commonly obtained by shaving, inherently, the specimen can be contaminated by pieces of epidermis.
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Other clinically relevant cardiac events recorded by the Zio?Patch after the 24 hours of monitoring, including symptomatic ventricular pauses, led to change in medications or referrals for pacemaker placement. The authors concluded that the Zio?Patch was well tolerated and allowed longer monitoring that resulted in meaningful changes in clinical management. Back to Top Date Sent: 3/24/2020 65 these criteria do not imply or guarantee approval. The other published study (Turakhia et al, 2013) was only a retrospective analysis of data obtained from the device manufacturer. No comparison was made with Holter monitor or any other ambulatory cardiac rhythm monitor. There are no published studies, to date, that compared the Zio?Patch to any of the other longer-term outpatient ambulatory cardiac rhythm monitors. Conclusion: There is weak evidence from one small single-center pilot study that Zio?Patch was well tolerated and allowed longer monitoring than Holter monitoring. There is insufficient evidence to determine the equivalence or superiority of Zio?Patch to any of the other longer-term outpatient ambulatory cardiac rhythm monitors. Articles: the literature search revealed only two published studies on the use of Zio?Patch as a noninvasive monitoring device for arrhythmias in general in one study, and for atrial fibrillation in the other. A retrospective study among 285 patients seen in emergency departments was identified from a review article, but it was not published in a peer review journal; it was only presented in a conference. Use of a noninvasive continuous monitoring device in the management of atrial fibrillation: a pilot study. The use of Zio?Patch the detection of arrhythmias does not meet the Kaiser Permanente Medical Technology Assessment Criteria. Standard techniques for diagnosing syncope include history and physical examination, laboratory testing, exercise stress testing, Holter monitoring, tilt table testing and external loop recording. The device is removed after a diagnosis of syncope is made or at the end of battery life. Two studies evaluating the external loop recorders found point estimates for diagnostic findings of 25% and 36% after approximately one month of recording. Back to Top Date Sent: 3/24/2020 66 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History Articles: Krahn D, Klein G, Yee R, Takle-Newhouse T, Norris C. The use of implantable loop recorder does not meet the Kaiser Permanente Medical Technology Assessment Criteria. Back to Top Date Sent: 3/24/2020 67 these criteria do not imply or guarantee approval.
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Twenty-six of these studies were included in the systematic 41 reviews described above. Studies evaluated valve replacement in the aortic position (n = 22), aortic and/or other valve positions (n = 5), tricuspid position (n = 10), and mitral position (n = 2); 1 study did not report valve position. For the 27 studies evaluating aortic and/or other valve replacements, mechanical vs. Of the 10 studies evaluating tricuspid valve replacement, nine compared mechanical with stented bioprosthesis. Twenty-six of the 40 included studies (65 percent) had 19 a mean followup duration exceeding 5 years. Most studies reported mortality rates, adverse effects, and reoperation rates (Table 12). A complicating issue for a possible systematic review is variability across studies in potential confounders controlled for in the analyses. The single high-quality meta-analysis evaluated 11 studies comparing stented with stentless bioprosthetic valves; we identified an additional four relevant trials and seven observational studies. There is sufficient literature to address other relevant comparisons, such as between mechanical and bioprosthetic valves, and between homografts and bioprosthetic valves, and to make selected within-class comparisons (e. Observational studies with longer-term followup can supplement findings from randomized trials. Systematic reviews will be complicated by heterogeneity in study design, valve position, and valve types. Other challenges include: whether to include studies of valves no longer marketed that may perform differently from modern valves; accounting for changes in anticoagulation targets and thus the risk for bleeding; and accounting for observational studies that vary by whether outcomes are adjusted for potential confounders. A systematic review that carefully develops a conceptual framework and evaluates the association between intermediate outcomes (such as hemodynamic changes) and long-term outcomes of importance to patients would be particularly useful. Studies of Percutaneous Heart Valves Studies Identified A total of 77 published reports were screened at the full-text stage; of these, 15 were excluded. The remaining 62 publications, describing 55 separate studies, assessed the feasibility and short-term safety of implanting percutaneous heart valves and met our other inclusion 42-103 criteria. Important data from these studies, which represent 856 unique patients, are summarized in Tables 13 and 14; detailed abstractions of the included studies are provided in Evidence Table 2 (see Appendix B). Our gray literature scan identified 12 scientific meeting abstracts that presented data on 104-115 11 studies not described in the published reports. These abstracts, which are summarized in Table 15, report data on 923 patients who underwent percutaneous heart valve replacement.
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