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<1>
Accession Number
2010235977
Authors
Sadoh W.E.
Institution
(Sadoh) Paediatric Cardiology Unit, Department of Child Health, University
of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Title
Natural history of ventricular septal defects in Nigerian children.
Source
SAJCH South African Journal of Child Health. 4(1)(pp 16-19), 2010. Date
of Publication: 2010.
Publisher
Health and Medical Publishing Group
Abstract
Introduction. Ventricular septal defect (VSD) is a common congenital heart
disease (CHD). Spontaneous closure of the VSD may occur, depending on the
type and size of defects. This study was conducted to determine the
natural history of VSD in a group of Nigerian children. Subjects and
methods. Sixty-one children diagnosed with VSD were prospectively studied
at a tertiary centre in Nigeria until they were 2 years old. They had
regular two-dimensional (2D) and Doppler echocardiography evaluations for
the VSD size and closure. Results. Most (35 - 57.4%) of the patients were
female, their mean age at presentation was 11.2+/-5.2 months, and the most
common type of VSD was the perimembranous (39 - 63.9%). Almost half (28 -
45.9%) of the patients had spontaneous closure. The spontaneous closure
rate was highest in muscular VSD (82.4%) and in small defects (95.0%).
Incidental presence of a murmur, absence of heart failure and
bronchopneumonia were good clinical predictors of closure. Only 3 (4.9%)
patients had surgery abroad. There were 2 (3.3%) deaths from
bronchopneumonia and bacterial endocarditis. Conclusion. Spontaneous
closure readily occurs in small-sized defects and muscular VSDs. However,
most patients with moderate to large VSDs are confined to long-term
medical management, highlighting the need for indigenous surgical capacity
in Nigeria.
<2>
Accession Number
0020231678
Authors
Pisters K.M. Vallieres E. Crowley J.J. Franklin W.A. Bunn Jr. P.A.
Ginsberg R.J. Putnam Jr. J.B. Chansky K. Gandara D.
Institution
(Pisters, Vallieres, Crowley, Franklin, Bunn Jr., Ginsberg, Putnam Jr.,
Chansky, Gandara) The University of Texas M. D. Anderson Cancer Center, PO
Box 301402, Unit 432, Houston, TX 77230-1402, USA.
Title
Surgery with or without preoperative paclitaxel and carboplatin in
early-stage non-small-cell lung cancer: Southwest Oncology Group Trial
S9900, an intergroup, randomized, phase III trial..
Source
Journal of clinical oncology : official journal of the American Society of
Clinical Oncology. 28(11)(pp 1843-1849), 2010. Date of Publication: 10
Apr 2010.
Abstract
PURPOSE Patients with early-stage non-small-cell lung cancer (NSCLC) have
a poor prognosis even after complete resection. Earlier studies of
preoperative (induction) chemotherapy in resectable NSCLC demonstrated
feasibility and encouraging survival data. This randomized phase III trial
compared overall survival (OS) for preoperative paclitaxel and carboplatin
followed by surgery with surgery alone in patients with early-stage NSCLC.
PATIENTS AND METHODS Patients with clinical stage IB-IIIA NSCLC (excluding
superior sulcus tumors and N2 disease) were eligible. Patients were
randomly assigned to surgery alone or to three cycles of paclitaxel (225
mg/m(2)) and carboplatin (area under curve, 6) followed by surgical
resection. The primary end point was OS; secondary end points were
progression-free survival (PFS), chemotherapy response, and toxicity.
RESULTS The trial closed early with 354 patients after reports of a
survival benefit for postoperative chemotherapy in other studies. The
median OS was 41 months in the surgery-only arm and 62 months in the
preoperative chemotherapy arm (hazard ratio, 0.79; 95% CI, 0.60 to 1.06; P
= .11.) The median PFS was 20 months for surgery alone and 33 months for
preoperative chemotherapy (hazard ratio, 0.80; 95% CI, 0.61 to 1.04; P =
.10.) Major response to chemotherapy was seen in 41% of patients; no
unexpected toxicity was observed. CONCLUSION This trial closed prematurely
after compelling evidence supporting postoperative chemotherapy emerged.
Although OS and PFS were higher with preoperative chemotherapy, the
differences did not reach statistical significance. At present, stronger
evidence exists for postoperative chemotherapy in early-stage NSCLC.
<3>
Accession Number
0020387748
Authors
Akbarzadeh F. Kazemi-Arbat B. Golmohammadi A. Pourafkari L.
Institution
(Akbarzadeh, Kazemi-Arbat, Golmohammadi, Pourafkari) Department of
Cardiology, Shahid Madani Cardiovascular Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of.
Title
Biatrial pacing vs. intravenous amiodarone in prevention of atrial
fibrillation after coronary artery bypass surgery.
Source
Pakistan Journal of Biological Sciences. 12(19)(pp 1325-1329), 2009. Date
of Publication: 2009.
Publisher
Asian Network for Scientific Information
Abstract
This study was aimed to compare the results of post operative biatrial
pacing and IV amiodarone in prevention of AF. In a single blind randomized
clinical trial, 210 patients scheduled for elective CABG surgery were
randomized either to receive overdrive biatrial pacing, IV amiodarone or
no intervention. Incidence of AF postoperatively evaluated. Pacing was
successful in 83% of patients and 80% of patients in amiodarone group
could receive their drug. Twenty and one patients developed AF. Incidence
of AF in pace, amiodarone and control group was 10.7, 5.3 and 17.9%,
respectively (p = 0.08). Comparing incidence of AF between pacing and
control group, the difference was not significant (p = 0.2), but the
difference between amiodarone and control groups was significant
statistically (p = 0.03). Patients who developed AF were older but their
left ventricular ejection fraction was not different with patients without
AF. The ICU stay was higher in patients with AF. Use of IV amiodarone was
more effective than biatrial pacing in prevention of post operative AF and
we recommend use of this drug in high risk patients. copyright 2009 Asian
Network for Scientific Information.
<4>
Accession Number
2010069638
Authors
Brown J.R. Toler A.W.J. Kramer R.S. Clive Landis R.
Institution
(Brown, Toler) Dartmouth Institute for Health Policy and Clinical
Practice, Dartmouth Medical School, Lebanon, NH, United States.
(Kramer) Division of Cardiothoracic Surgery, Maine Medical Center,
Portland, ME, United States.
(Clive Landis) Edmund Cohen Laboratory for Vascular Research, University
of the West Indies, Barbados.
Title
Anti-inflammatory effect of aprotinin: A meta-analysis.
Source
Journal of Extra-Corporeal Technology. 41(2)(pp 79-86), 2009. Date of
Publication: June 2009.
Publisher
American Society of Extra-Corporeal Technology
Abstract
It is important to define the extent, and any limitations, of potential
anti-inflammatory regimens used in cardiac surgery to guide the rational
combination of drugs to suppress the systemic inflammatory response.
Aprotinin (Trasylol) is an anti-fibrinolytic agent with reported
anti-inflammatory properties. In this study, we investigated the published
data on aprotinin's effect on acute phase protein and cytokine levels in
cardiac surgery patients. Randomized placebo-controlled trials of
aprotinin published between 1985 and 2007, in adult cardiac surgery using
cardiopulmonary bypass, reporting tumor necrosis factor-alpha (TNF-alpha),
interleukin-6 (IL-6), IL-8, and IL-10 levels were included for review. Two
independent reviewers graded each paper and collected information on
inflammatory markers. RevMan 4.3 statistical software was used to
calculate and plot the weighted mean difference between placebo and
aprotinin groups. Thirteen studies met the review criteria. None of the
inflammatory markers were reduced by high-dose aprotinin treatment.
Low-dose aprotinin significantly reduced IL-10 levels after protamine
administration (?41.3 pg/ mL; 95% CI: ?59.5, ?23.1), but this result was
gone by the first post-operative day. These meta-analyses showed no
significant effect of aprotinin on acute phase proteins or systemic
cytokine markers of inflammation during clinical adult cardiac surgery
using cardiopulmonary bypass. While recognizing that other host defense
systems, such as coagulation and complement, contribute to the overall
systemic inflammatory response, the evidence presented here does not
support the clinical use of aprotinin as an anti-inflammatory agent on its
own.
<5>
Accession Number
2010065040
Authors
Neyt M. Vinck I. Gewillig M. Van Brabandt H.
Institution
(Neyt, Vinck, Van Brabandt) BelgianHealth Care Knowledge Centre,
Kruidtuinlaan 55, 1000 Brussels, Belgium.
(Gewillig) Department of Paediatric Cardiology, University Hospital
Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Title
Percutaneous pulmonary and aortic valve insertion in Belgium: Going for
conditional reimbursement or waiting for further evidence?.
Source
International Journal of Technology Assessment in Health Care. 25(3)(pp
281-289), 2009. Date of Publication: July 2009.
Publisher
Cambridge University Press
Abstract
Objectives: The aim of this study was to assess current evidence
supporting the use of percutaneous heart valves (PHV) in degenerative
aortic valve and congenital pulmonary outflow tract disease, as compared
to conservative medical therapy or traditional surgical valve replacement.
Methods: A systematic review of the literature on PHV was performed.
Results: No randomized controlled trials (RCT) on PHV have been published
so far. Only observational data from series and data presented at
cardiology meetings are available. Both percutaneous aortic valve (PAV)
and percutaneous pulmonary valve (PPV) seem feasible in the hands of an
experienced team. Safety, however, seems to be a problem in PAV, as shown
by the high 30-day and 6-month mortality rates. Conclusions: Due to safety
concerns, PAV reimbursement is not recommended and patients should only be
subjected to PAV insertion within the boundaries of an RCT. In contrast,
PPV implantation seems to be a safe and promising technology for which
reimbursement under strict conditions may be recommended. copyright 2009
Cambridge University Press.
<6>
Accession Number
2010191781
Authors
Axelsson B. Arbeus M. Magnuson A. Hultman J.
Institution
(Axelsson, Arbeus) Department of Cardiothoracic Surgery and
Anesthesiology, Orebro University Hospital, Orebro, Sweden.
(Magnuson) Statistical and Epidemiological Unit, Orebro University
Hospital, Orebro, Sweden.
(Hultman) Thoracic Clinic, Karolinska University Hospital, Stockholm,
Sweden.
Title
Milrinone Improves Diastolic Function in Coronary Artery Bypass Surgery as
Assessed by Acoustic Quantification and Peak Filling Rate: A Prospective
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 244-249),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: To compare the effects of a bolus dose of milrinone, 50 mug/kg,
to placebo on diastolic function (active relaxation) in patients
undergoing on-pump coronary artery bypass grafting (CABG). Design:
Prospective, randomized, double-blind, placebo-controlled study. Setting:
University hospital. Participants: Twenty-four patients with stable angina
and left ventricular ejection fraction >30%, scheduled for elective CABG
using cardiopulmonary bypass (CPB), were included. Intervention: Patients
were randomized to receive either 50 mug/kg of milrinone (n = 12) or
placebo (n = 12) after aortic declamping. Measurements and Main Results:
The diastolic function of the left ventricle (LV) was measured as peak
filling rate (dA/dt [maximal diastolic area change over time]) with
transesophageal echocardiography (TEE) using acoustic quantification (AQ)
before CPB and 10 minutes after termination of CPB. The normalized peak
filling rate (dA/dt)/EDA was also calculated. Active relaxation was
statistically significantly increased in the milrinone group compared with
the placebo group after CPB. Conclusion: Patients undergoing CABG surgery
and treated with milrinone after aortic declamping had better diastolic
function following cardiopulmonary bypass. copyright 2010 Elsevier Inc.
All rights reserved.
<7>
Accession Number
2010191777
Authors
Hasija S. Makhija N. Choudhury M. Hote M. Chauhan S. Kiran U.
Institution
(Hasija, Makhija, Choudhury, Chauhan, Kiran) Department of Cardiac
Anaesthesia, Cardiothoracic Centre, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India.
(Hote) Department of Cardiothoracic and Vascular Surgery, Cardiothoracic
Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi,
India.
Title
Prophylactic Vasopressin in Patients Receiving the Angiotensin-Converting
Enzyme Inhibitor Ramipril Undergoing Coronary Artery Bypass Graft Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 230-238),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of this study was to compare the effects of
continuation versus discontinuation of the angiotensin-converting enzyme
(ACE) inhibitor ramipril and assess the efficacy of prophylactic
vasopressin infusion on hemodynamic stability and vasoactive drug
requirements in patients undergoing coronary artery bypass graft (CABG)
surgery. Design: A prospective, randomized, double-blinded, single-center
clinical study. Setting: Tertiary care hospital. Participants: Forty-seven
patients on the ACE inhibitor ramipril for 6 weeks before undergoing
elective primary CABG surgery on cardiopulmonary bypass (CPB).
Interventions: Patients were randomly divided into 3 groups: group A (n =
16), patients discontinued ramipril 24 hours before surgery; group B (n =
16), patients continued ramipril until the morning of surgery; and group C
(n = 15), patients continued ramipril until the morning of surgery and
received vasopressin infusion (0.03 U/min) from the onset of rewarming
until the hemodynamics were stable without vasopressor agents. The
anesthetic technique and conduct of CPB were standardized for all the
groups. Hemodynamic parameters and vasoactive drug requirements were
recorded for 3 days postoperatively. Measurements and Main Results:
Patients in group A maintained stable mean arterial pressure (MAP) and
systemic vascular resistance (SVR). In group B, MAP and SVR decreased
after the induction of anesthesia and remained so throughout surgery (p <
0.05). In group C, MAP and SVR decreased upon the induction of anesthesia
(p < 0.05) but normalized after CPB. Conclusions: Preoperative ACE
inhibitor continuation predisposed to hypotension upon the induction of
anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin
infusion prevented post-CPB hypotension. Low-dose vasopressin can be
considered as potential therapy in these patients. copyright 2010 Elsevier
Inc. All rights reserved.
<8>
Accession Number
2010065029
Authors
Quenneville S.P. Xie X. Brophy J.M.
Institution
(Quenneville, Xie, Brophy) Technology Assessment Unit, Royal Victoria
Hospital, McGill University, 687 Pine Avenue West, R4.14, Montreal, QC H3A
1A1, Canada.
(Brophy) Department of Medicine and Epidemiology (McGill), McGill
University, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.12,
Montreal, QC H3A 1A1, Canada.
Title
The cost-effectiveness of Maze procedures using ablation techniques at the
time of mitral valve surgery.
Source
International Journal of Technology Assessment in Health Care. 25(4)(pp
485-496), 2009. Date of Publication: October 2009.
Publisher
Cambridge University Press
Abstract
Background: The classic cut and sew surgical Maze procedure has been shown
to reduce atrial fibrillation (AF), and recently newer surgical ablation
techniques with reduced technical complexity have been introduced. This
study sought to systematically review the efficacy and safety of these
newer techniques and to evaluate their long-term cost-effectiveness at the
time of scheduled mitral valve (MV) surgery. Methods: A systematic
literature search and meta-analysis was performed to generate the most
reliable efficacy and safety parameter estimates for a Markov decision
analysis model comparing MV surgery alone to MV surgery plus an ablation
Maze procedure. Both basic and probabilistic sensitivity analyses were
conducted. Results: Based on the six randomized controlled trials (RCTs)
identified, the pooled 1-year estimate of AF after surgery alone was 71
percent (95 percent confidence interval [CI], 64 percent to 78 percent).
The pooled risk ratio of AF after surgical ablation treatment at the time
of mitral valve surgery relative to valve surgery alone was 0.33 (95
percent CI, 0.19 to 0.55). The pooled analyses showed that no statistical
significant increases in operative mortality, permanent pacemaker
implantation, and postoperative bleeding with the ablative Maze
procedures. An ablation-based Maze procedure at the time of mitral valve
surgery had an incremental cost-effectiveness ratio (ICER) of $4,446CAD
($3,850US) per quality-adjusted life-year (QALY) compared with valve
surgery alone. Specifically costs were an extra $900CAD but with improved
clinical outcomes (0.20 QALYs), including a prolonged life expectancy of
0.10 life-years. In one-way sensitivity analyses, survival time after MV
surgery had the largest impact on ICER. Other variables influencing the
ICER included the risk ratio of AF, utility, and cost estimates.
Probabilistic sensitivity analysis suggests that 58.1 percent, 73.9
percent, and 89.3 percent of the simulations of the Maze strategy are
cost-effective at willingness to pay thresholds of $20,000, $50,000, and
$100,000CAD per QALY gained, respectively. Conclusions: Our meta-analysis
suggests that a Maze surgical ablation procedure at the time of MV surgery
is associated with a reduced postoperative AF risk. Our economic model
further suggests that the surgical ablation strategy at the time of mitral
valve surgery is likely a cost-effective intervention, provided patients
have a good long-term postsurgical prognosis. copyright 2009 Cambridge
University Press.
<9>
Accession Number
2010192128
Authors
Landoni G. Turi S. Biondi-Zoccai G. Bignami E. Testa V. Belloni I. Cornero
G. Zangrillo A.
Institution
(Landoni, Turi, Bignami, Testa, Belloni, Cornero, Zangrillo) Department of
Anesthesia and Intensive Care, Universita Vita-Salute San Raffaele, Milan,
Italy.
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy.
Title
Esmolol Reduces Perioperative Ischemia in Noncardiac Surgery: A
Meta-analysis of Randomized Controlled Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(2)(pp 219-229),
2010. Date of Publication: April 2010.
Publisher
W.B. Saunders
Abstract
Objective: Literature increasingly has suggested how beta-blockers could
be associated with reductions of mortality and morbidity in noncardiac
surgery. Recently, the POISE trial showed that beta-blockers could be
harmful in the perioperative period. The authors performed a meta-analysis
to evaluate the clinical effects of esmolol in noncardiac surgery. Design:
Meta-analysis. Setting: Hospitals. Participants: A total of 1765 patients
from 32 randomized trials. Interventions: None. Measurements and Main
Results: Three investigators independently searched BioMedCentral and
PubMed. Inclusion criteria were random allocation to treatment and
comparison of esmolol versus placebo, other drugs, or standard of care in
noncardiac surgery. Exclusion criteria were duplicate publications,
nonhuman experimental studies, and no data on clinical outcomes. The use
of esmolol was associated with a significant reduction of myocardial
ischemia episodes (5/283 [1.76%] in the esmolol group v 16/265 [6.03%] in
the control arm, odds ratio [OR] = 0.16 [0.05-0.54], p = 0.003). The
authors did not observe significant differences regarding episodes of
arrhythmias (8/236 [3.38%] v 22/309 [7.11%], OR = 0.52 [0.23-1.18], p =
0.12) and in the incidence of myocardial infarction (0/148 [0%] v 1/169
[0.59%], OR = 0.23 [0.01-6.09], p = 0.38). Esmolol-treated patients did
not experience more episodes of hypotension (17/384 [4.42%] v 38/439
[8.65%], OR = 0.41 [0.22-0.79], p = 0.17) and bradycardia (25/342 [7.30%]
v 17/406 [4.18%], OR = 1.42 [0.74-2.74], p = 0.42). Conclusions: Esmolol
seemed to reduce the incidence of myocardial ischemia in noncardiac
surgery without increasing the episodes of hypotension and bradycardia.
Large randomized trials are necessary to confirm these promising results.
copyright 2010 Elsevier Inc. All rights reserved.
<10>
Accession Number
2010166060
Authors
Rutter M.K. Nesto R.W.
Institution
(Rutter) Cardiovascular Research Group, School of Clinical and Laboratory
Sciences, University of Manchester, Manchester, United Kingdom.
(Rutter) Manchester Diabetes Centre, Manchester Academic Health Science
Centre, Manchester NIHR Biomedical Research Centre, Manchester, United
Kingdom.
(Nesto) Lahey Clinic, Burlington, United States.
(Nesto) Tufts Medical School, MA, United States.
(Rutter) Cardiovascular Research Group, Core Technology Facility, 46
Grafton Street, Manchester M13 9NT, United Kingdom.
Title
The BARI 2D study: A randomised trial of therapies for type 2 diabetes and
coronary artery disease.
Source
Diabetes and Vascular Disease Research. 7(1)(pp 69-72), 2010. Date of
Publication: 2010.
Publisher
SAGE Publications Ltd
Abstract
The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI
2D) trial randomized 2368 patients with type 2 diabetes (T2DM) and
coronary artery disease to either prompt revascularization or intensive
medical therapy alone; and to either insulin-sensitization or
insulin-provision diabetes therapy. Randomization was stratified by
proposed revascularization method. Five-year survival and major
cardiovascular events (MACE) were similar in study subgroups except in the
coronary bypass surgery (CABG) stratum where there were fewer MACE after
revascularization. There was less hypoglycaemia and weight gain, and
greater apparent benefit from CABG in the insulin sensitization group.
BARI 2D has provided important data for clinicians. copyright The
Author(s) 2010.
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