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<1>
Accession Number
2010173890
Authors
Slaughter M.S. Pagani F.D. Rogers J.G. Miller L.W. Sun B. Russell S.D.
Starling R.C. Chen L. Boyle A.J. Chillcott S. Adamson R.M. Blood M.S.
Camacho M.T. Idrissi K.A. Petty M. Sobieski M. Wright S. Myers T.J. Farrar
D.J.
Institution
(Slaughter, Sobieski) University of Louisville, Louisville, KY, United
States.
(Pagani, Wright) University of Michigan, Ann Arbor, MI, United States.
(Rogers) Duke University, Durham, NC, United States.
(Miller) Georgetown University, Washington Hospital, Washington, Colombia.
(Sun) Ohio State University, Columbus, OH, United States.
(Russell) Johns Hopkins Hospital, Baltimore, MD, United States.
(Starling) Cleveland Clinic, Cleveland, OH, United States.
(Chen) University of Rochester, Rochester, NY, United States.
(Boyle, Petty) University of Minnesota, Minneapolis, MN, United States.
(Chillcott, Adamson) Sharp Memorial Hospital, San Diego, CA, United
States.
(Blood) University of Alabama, Birmingham, AL, United States.
(Camacho) Beth Israel Medical Center, Newark, NJ, United States.
(Idrissi) Columbia University, New York, NY, United States.
(Farrar) Thoratec Corporation, Pleasanton, CA, United States.
Title
Clinical management of continuous-flow left ventricular assist devices in
advanced heart failure.
Source
Journal of Heart and Lung Transplantation. 29(4 SUPPL.)(pp S1-S39), 2010.
Date of Publication: April 2010.
Publisher
Elsevier USA
Abstract
Continuous-flow left ventricular assist devices (LVAD) have emerged as the
standard of care for advanced heart failure patients requiring long-term
mechanical circulatory support. Evidence-based clinical management of
LVAD-supported patients is becoming increasingly important for optimizing
outcomes. In this state-of-art review, we propose key elements in managing
patients supported with the new continuous-flow LVADs. Although most of
the presented information is largely based on investigator experience
during the 1,300-patient HeartMate II clinical trial, many of the
discussed principles can be applied to other emerging devices as well.
Patient selection, pre-operative preparation, and the timing of LVAD
implant are some of the most important elements critical to successful
circulatory support and are principles universal to all devices. In
addition, proper nutrition management and avoidance of infectious
complications can significantly affect morbidity and mortality during LVAD
support. Optimizing intraoperative and peri-operative care, and the
monitoring and treatment of other organ system dysfunction as it relates
to LVAD support, are discussed. A multidisciplinary heart failure team
must be organized and charged with providing comprehensive care from
initial referral until support is terminated. Preparing for hospital
discharge requires detailed education for the patient and family or
friends, with provisions for emergencies and routine care. Implantation
techniques, troubleshooting device problems, and algorithms for outpatient
management, including the diagnosis and treatment of related problems
associated with the HeartMate II, are discussed as an example of a
specific continuous-flow LVAD. Ongoing trials with other continuous-flow
devices may produce additional information in the future for improving
clinical management of patients with these devices. copyright 2010
Elsevier Inc. All rights reserved.
<2>
Accession Number
2010195554
Authors
Rafeey M. Ghojazadeh M. Feizo Allah Zadeh H. Majidi H.
Institution
(Rafeey) Department of Pediatrics, Liver and Gastrointestinal Diseases
Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of.
(Ghojazadeh) Department of Physiology, Children's Hospital, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of.
(Feizo Allah Zadeh, Majidi) Department of Nursing, Children's Hospital,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of.
Title
Use of oral midazolam in pediatric upper gastrointestinal endoscopy.
Source
Pediatrics International. 52(2)(pp 191-195), 2010. Date of Publication:
April 2010.
Publisher
Blackwell Publishing
Abstract
Background: The purpose of this prospective, randomized study was to
compare the safety and efficacy of oral versus i.v. midazolam in providing
sedation for pediatric upper gastrointestinal (GI) endoscopy. Methods:
Sixty-one children (age <16 years) scheduled for upper GI endoscopy were
studied. Patients were randomly assigned to receive oral or i.v.
midazolam. Measurements were made and compared for vital signs, level of
sedation, pre- and post-procedure comfort, anxiety during endoscopy, ease
of separation from parents, ease and duration of procedure, and recovery
time. Results: Patients were aged 1-16 years (mean 7.5 +/- 3.42 years); 30
patients received oral medication, and 31 received i.v. medication. There
were no statistically significant differences in age or gender between
groups. There were no significant differences in level of sedation, ease
of separation from parents, ease of ability to monitor the patient during
the procedure, heart rate, systolic arterial pressure, or respiratory
rate. Oxygen saturation was significantly lower in the i.v. group than the
oral group 10 and 30 min after removal of the endoscope, and recovery time
was longer in the oral than the i.v. group. Conclusions: Oral
administration of midazolam is a safe and effective method of sedation
that significantly reduces anxiety and improves overall tolerance for
children undergoing esophagogastroduodenoscopy. copyright 2010 Japan
Pediatric Society.
<3>
Accession Number
2010149579
Authors
Jovic M. Gradinac S. Lausevic-Vuk L. Nezic D. Stevanovic P. Milojevic P.
Djukanovic B.
Institution
(Jovic, Gradinac, Lausevic-Vuk, Nezic, Milojevic, Djukanovic) Clinic for
Anesthesia and Critical Care, Dedinje Cardiovascular Institute Belgrade,
Milana Tepica 1, 11000 Belgrade, Serbia.
(Stevanovic) Clinical Center Dr. Dragisa Misovic Belgrade, Serbia.
Title
Preconditioning with glucose-insulin-potassium solution and restoration of
myocardial function during coronary surgery.
Source
General Physiology and Biophysics. 28(SPECIAL ISSUES)(pp 262-270), 2009.
Date of Publication: 2009.
Publisher
Slovak Academy of Sciences
Abstract
The administration of glucose-insulin-potassium (GIK) solution has beeen
shown to exert cardioprotective and immunomodulatory properties in
coronary disease. 49 patients (pts.) for coronary surgery were randomly
assigned to receive high-dose GIK treatment (30% glucose, insulin 2 IU.kg
-1.l-1 and K+ 80 mmo/l solution; 1 ml/kg/h); low-dose GIK treatment (10%
glucose, insulin 32 IU l-1 and K + 80 mmol/l solution; 1 ml/kg/h) or
control treatment (Ringer solution 1 ml/kg/h). Haemodynamic measurements
were done for four time points: T1 - after induction of anaesthesia; T2 -
after the operation; T3 - 6 h after the operation and T4 - 24 h after the
operation. Significant recovery of cardiac function was evident in
high-dose GIK (H-GIK) and low-dose GIK (L-GIK) groups after 24 h (cardiac
index improved considerably (p = 0.0002)), with a statistically
significant difference between the groups (p = 0.005). LVSWI covariated
with PCWP, improved over time in group H-GIK (p = 0.0008) and between the
groups (p = 0.046). Oxygen supply-consumption ratio evidently improved in
the GIK groups, while inotropic drug support was used in 5.5% pts. in
group H-GIK vs. 13% in group L-GIK and 31% pts. in control (C) group.
Glucose-insulin treatment has a potential cardioprotective effect in
coronary surgery. The effect is independent of the glucose-insulin
concentration and amount.
<4>
Accession Number
0019444480
Authors
Cronin R.E.
Institution
(Cronin) University of Texas Southwestern Medical Center, Dallas, TX, USA.
Title
Contrast-induced nephropathy: pathogenesis and prevention..
Source
Pediatric nephrology (Berlin, Germany). 25(2)(pp 191-204), 2010. Date of
Publication: Feb 2010.
Abstract
Contrast-induced nephropathy (CIN) is the third most common cause of acute
kidney injury in hospitalized patients. Diagnostic and interventional
cardiovascular procedures generate nearly half the cases. Elderly patients
and those with chronic kidney disease, diabetes, and cardiovascular
disease are at greatest risk. Procedure-related risk factors include large
volumes of contrast and agents with a high osmolality. Renal medullary
ischemia arising from an imbalance of local vasoconstrictive and
vasodilatory influences coupled with increased demand for oxygen-driven
sodium transport may be the key to its pathogenesis. Contrast agents may
also have a direct cytotoxic effect that operates through the generation
of reactive oxygen species. Pre- and post-procedure administration of
normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a
variety of other pharmacologic agents have been used to prevent or
mitigate CIN. While normal saline is generally accepted as protective
against CIN, uncertainty still surrounds the role of sodium bicarbonate
and N-acetylcysteine. Dialytic therapies before, during, and after
exposure to contrast have been tested with mixed results. Logistical and
economic disincentives argue against these modalities.
<5>
Accession Number
0019755337
Authors
Brar S.S. Gray W.A. Dangas G. Leon M.B. Aharonian V.J. Brar S.K. Moses
J.W.
Institution
(Brar, Gray, Dangas, Leon, Aharonian, Brar, Moses) Columbia University
Medical Center, New York, NY, USA.
Title
Bifurcation stenting with drug-eluting stents: a systematic review and
meta-analysis of randomised trials..
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
5(4)(pp 475-484), 2009. Date of Publication: Sep 2009.
Abstract
AIMS: We sought to determine if outcomes differ between provisional
(elective side branch stenting) compared to a routine two-stent strategy
(mandatory side branch stenting) for the treatment of bifurcation stenoses
of the coronary arteries using drug-eluting stents. METHODS AND RESULTS:
We searched Medline, EMBASE, and the Cochrane library from January 2000 to
February 2009 for studies comparing the provisional and two-stent
strategies. Six randomised controlled trials, including 1,641 patients,
were identified. The relative risk (95% confidence interval) for death,
MI, target lesion revascularisation, and stent thrombosis within 1-year of
the index procedure for a provisional vs. two-stent strategy were 1.12
(0.42-3.02), 0.57 (0.37-0.87), 0.91 (0.61-1.35), and 0.56 (0.23-1.35),
respectively. By quantitative coronary angiography, there was no
difference in the difference in means (95% CI) between the provisional and
two-stent strategies for percent diameter stenosis (95% CI) in the main
vessel or side branch, -1.08 (-2.91 to 0.74) and 1.30 (-3.35 to 5.96),
respectively. CONCLUSION: While death, stent thrombosis, and restenosis
were similar between the treatment groups, MI was more common with the
two-stent strategy. Thus, compared to a routine two-stent strategy,
provisional stenting yields similar efficacy with superior safety and
lower costs.
<6>
Accession Number
2010160128
Authors
Todt T. Sederholm-Lawesson S. Stenestrand U. Alfredsson J. Janzon M. Swahn
E.
Institution
(Todt, Sederholm-Lawesson, Stenestrand, Alfredsson, Janzon, Swahn)
Department of Medical and Health Sciences, Division of Cardiovascular
Medicine, Linkoping University Hospital, SE 581 85 Linkoping, Sweden.
Title
Early treatment with abciximab in patients with ST elevation myocardial
infarction results in a high rate of normal or near normal blood flow in
the infarct related artery.
Source
Acute Cardiac Care. 12(1)(pp 10-17), 2010. Date of Publication: 2010.
Publisher
Informa Healthcare
Abstract
There is debate whether early treatment with GpIIb/IIIa inhibitors is of
clinical benefit in primary percutaneous coronary intervention (PCI) for
ST-elevation myocardial infarction (STEMI). This study explored the
effects of early given abciximab on coronary blood flow and major adverse
cardiac events (MACE) in patients with STEMI treated with primary PCI and
adjunctive abciximab. We studied all consecutive patients from our
catchment area with STEMI undergoing acute angiography with the intention
of primary PCI during 2005. Abciximab was given as early pre-treatment
before, (n=133) or at the cath. lab. after a diagnostic angiography
(n=109). Pre-procedural TIMI 23 flow was observed in 45.9 % of patients in
the early group versus 20.2 % in the cath. lab. group, P=0.0001. Mortality
rates were 3.8 % versus 3.7% inhospital and 8.3 % versus 7.3% at one year
in the early respectively the cath. lab. group, both P=NS. The MACE rate
(death, non fatal myocardial infarction, unplanned revascularization) at
one year was 19.5 % (early group) and 26.6 % (cath. lab. group), P=0.19.
CONCLUSION: In this single centre registry study of unselected patients
with STEMI early given abciximab was associated with a significantly
higher rate of TIMI 23 flow compared to abciximab given after the acute
angiography. copyright 2010 Informa UK Ltd.
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