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<1>
Accession Number
0020146009
Authors
Santana M.J. Feeny D. Johnson J.A. McAlister F.A. Kim D. Weinkauf J. Lien
D.C.
Institution
(Santana) University of Alberta Hospital, Edmonton, Alberta, Canada.
Title
Assessing the use of health-related quality of life measures in the
routine clinical care of lung-transplant patients..
Source
Quality of life research : an international journal of quality of life
aspects of treatment, care and rehabilitation. 19(3)(pp 371-379), 2010.
Date of Publication: Apr 2010.
Abstract
PURPOSE: This randomized controlled clinical trial examined the usefulness
of including an assessment of health-related quality of life (HRQL) in the
routine clinical care of lung-transplant patients. We hypothesized that
the inclusion of HRQL in routine clinical care would improve
patient-clinician communication, affect clinical management, and improve
patients' HRQL. METHODS: At the outpatient clinic, University of Alberta
Hospital, patients were randomly assigned to intervention (completion of
Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) on touch-screen
computer with feedback to clinicians) and control group (completion of
HUI2 and HUI3 on touch-screen computer without feedback). Feedback
involved a graphical representation included in patients' chart. All
clinical encounters were audio-taped. Changes in clinical management
(medication changes, number of referrals and test ordered) were summed to
produce an overall management composite. At the end of every visit,
patients completed the EQ-5D. RESULTS: Two hundred and thirteen patients
were randomized (108 to intervention and 105 to control groups). There
were statistically significant differences between the groups in mean
number of issues discussed per encounter (P = 0.003; Cohen's d = 0.03) and
mean management composite score (P = 0.001; Cohen's d = 0.41). EQ-5D index
was not statistically significant different between the groups (P = 0.48).
CONCLUSIONS: We detected very small effects on patient-clinician
communication and small effects on patient management, without detecting
improvement in patient outcome.
<2>
Accession Number
2010340948
Authors
Cykert S. Dilworth-Anderson P. Monroe M.H. Walker P. McGuire F.R.
Corbie-Smith G. Edwards L.J. Bunton A.J.
Institution
(Cykert, Corbie-Smith, Edwards, Bunton) Cecil G. Sheps Center for Health
Services Research, Chapel Hill, NC, United States.
(Cykert, Corbie-Smith) Division of General Internal Medicine and Clinical
Epidemiology, School of Medicine, University of North Carolina, Chapel
Hill, NC, United States.
(Dilworth-Anderson) Department of Health Policy and Management, UNC
Institute on Aging, University of North Carolina, Chapel Hill, NC, United
States.
(Edwards) Department of Biostatistics, University of North Carolina,
Chapel Hill, NC, United States.
(Cykert) Internal Medicine Program, Moses Cone Health System, Greensboro
Area Health Education Center, Greensboro, NC, United States.
(Monroe) Department of Internal Medicine, Carolinas Medical Center,
Charlotte, NC, United States.
(Walker) Leo Jenkins Cancer Center, Brody School of Medicine, East
Carolina University, Greenville, NC, United States.
(McGuire) Division of Pulmonary and Critical Care Medicine, School of
Medicine, University of South Carolina, Columbia, SC, United States.
Title
Factors associated with decisions to undergo surgery among patients with
newly diagnosed early-stage lung cancer.
Source
JAMA - Journal of the American Medical Association. 303(23)(pp
2368-2376), 2010. Date of Publication: 16 Jun 2010.
Publisher
American Medical Association
Abstract
Context: Lung cancer is the leading cause of cancer death in the United
States. Surgical resection for stage I or II non-small cell cancer remains
the only reliable treatment for cure. Patients who do not undergo surgery
have a median survival of less than 1 year. Despite the survival
disadvantage, many patients with early-stage disease do not receive
surgical care and rates are even lower for black patients. Objectives: To
identify potentially modifiable factors regarding surgery in patients
newly diagnosed with early-stage lung cancer and to explore why blacks
undergo surgery less often than whites. Design, Setting, and Patients:
Prospective cohort study with patients identified by pulmonary, oncology,
thoracic surgery, and generalist practices in 5 communities through study
referral or computerized tomography review protocol. A total of 437
patients with biopsy-proven or probable early-stage lung cancer were
enrolled between December 2005 and December 2008. Before establishment of
treatment plans, patients were administered a survey including questions
about trust, patient-physician communication, attitudes toward cancer, and
functional status. Information about comorbid illnesses was obtained
through chart audits. Main Outcome Measure: Lung cancer surgery within 4
months of diagnosis. Results: A total of 386 patients met full eligibility
criteria for lung resection surgery. The median age was 66 years (range,
26-90 years) and 29% of patients were black. The surgical rate was 66% for
white patients (n=179/273) compared with 55% for black patients (n=62/113;
P=.05). Negative perceptions of patient-physician communication manifested
by a 5-point decrement on a 25-point communication scale (odds ratio [OR],
0.42; 95% confidence interval [CI], 0.32-0.74) and negative perception of
1-year prognosis postsurgery (OR, 0.27; 95% CI, 0.14-0.50; absolute risk,
34%) were associated with decisions against surgery. Surgical rates for
blacks were particularly low when they had 2 or more comorbid illnesses
(13% vs 62% for <2 comorbidities; OR, 0.04 [95% CI, 0.01-0.25]; absolute
risk, 49%) and when blacks lacked a regular source of care (42% with no
regular care vs 57% with regular care; OR, 0.20 [95% CI, 0.10-0.43];
absolute risk, 15%). Conclusions: A decision not to undergo surgery by
patients with newly diagnosed lung cancer was independently associated
with perceptions of communication and prognosis, older age, multiple
comorbidities, and black race. Interventions to optimize surgery should
consider these factors. copyright2010 American Medical Association. All
rights reserved.
<3>
Accession Number
2010299115
Authors
Sustic A. Protic A. Cicvaric T. Zupan Z.
Institution
(Sustic, Protic, Zupan) Department of Anesthesiology, Intensive Care Unit,
University Hospital Rijeka, 51,000 Rijeka, Croatia.
(Cicvaric) Department of Surgery, University Hospital Rijeka, 51,000
Rijeka, Croatia.
Title
The addition of a brief ultrasound examination to clinical assessment
increases the ability to confirm placement of double-lumen endotracheal
tubes.
Source
Journal of Clinical Anesthesia. 22(4)(pp 246-249), 2010. Date of
Publication: June 2010.
Publisher
Elsevier Inc.
Abstract
Study Objective: To evaluate the role of a brief ultrasound examination
(US) in detecting the correct position of the left double-lumen
endotracheal tube (LDLT). Design: Prospective, randomized clinical study.
Setting: Operating room of a university hospital. Patients: 50 elective
adult thoracic surgery patients who required a LDLT during anesthesia.
Intervention and Measurements: Patients were randomized to two groups:
Group A, who underwent clinical assessment of the LDLT position, and Group
B, who were examined clinically and by ultrasound. All 50 patients
underwent the same conventional procedure of LDLT placement. In all
patients, clinical assessment of LDLT positioning was made by observing
chest wall expansion and checking lung compliance by manual ventilation
and by auscultation of both lungs. In Group B, a very brief ultrasound
(15-30 sec) examination was added. Ultrasound examination included
visualization of the pleural movements ("lung sliding") and motion of the
diaphragm from both sides before and after selective clamping of the
bronchial and tracheal limbs. In both groups, a second anesthesiologist
performed bronchoscopy to estimate actual LDLT position. Main Results:
Sensitivity and negative predictive values in detecting proper LDLT
positioning for both methods were 100%. For the clinical assessment alone
(Group A), specificity was 22%, accuracy was 72%, and positive predictive
value, 70%; for the clinical and ultrasound assessment (Group B),
specificity was 50%, accuracy was 88%, and positive predictive value, 86%.
Conclusion: A brief ultrasound examination added to clinical assessment
ensured more precise placement of LDLT than did clinical assessment alone.
copyright 2010 Elsevier Inc. All rights reserved.
<4>
Accession Number
2010337853
Authors
Pokushalov E. Romanov A. Prohorova D. Cherniavsky A. Karaskov A. Gersak B.
Institution
(Pokushalov, Romanov, Prohorova, Cherniavsky, Karaskov) State Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation.
(Gersak) Department of Cardiovascular Surgery, University Medical Center
Ljubljana, Ljubljana, Slovenia.
Title
Coronary artery bypass grafting with and without concomitant epicardial
cardiac resynchronization therapy in patients with ischemic
cardiomyopathy: A randomized study.
Source
Heart Surgery Forum. 13(3)(pp E177-E184), 2010. Date of Publication: June
2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: Epicardial implantation of a cardiac resynchronization therapy
(CRT) system during coronary artery bypass grafting (CABG) may be an
additional treatment method for improving left ventricle (LV) systolic
function and dyssynchrony in patients with ischemic heart failure.
Objective: The objective was to compare the long-term results in patients
with severe ischemic heart failure who underwent CABG alone or CABG
combined with concomitant epicardial implantation of a CRT system.
Methods: One hundred sixty-four consecutive patients with severe ischemic
heart failure and LV dyssynchrony were enrolled into 2 groups: CABG alone
(n = 80) and epicardial CRT implantation during CABG (CABG + CRT) (n =
84). This prospective, randomized, and single-blind study was designed to
compare clinical and echocardiography data after 6, 12, and 18 months of
follow-up. Results: In the CABG group, LV systolic function, dyssynchrony
signs, and quality of life did not change postoperatively, compared with
preoperative data. In contrast, these parameters significantly improved in
the CABG + CRT group. The 2 treatment groups did not differ with respect
to postoperative improvement in Canadian Cardiovascular Society class (P =
.68). The improvement in the New York Heart Association functional class
was much more pronounced in the CABG + CRT group than in the CABG group (P
= .029). In the CABG group, 21 patients (26.2%) had died by the 18-month
follow-up, compared with 9 patients (10.7%) in the CABG + CRT group (P =
.012, log-rank test). Conclusion: Epicardial implantation of a CRT system
concomitantly with CABG facilitates the early postoperative period,
improves LV systolic function, improves the quality of life, and decreases
LV dyssynchrony. Moreover, mortality in the CABG + CRT group was
significantly lower than in the CABG group. copyright 2010 Forum
Multimedia Publishing, LLC.
<5>
Accession Number
2010315982
Authors
Rudolph J.L. Schreiber K.A. Culley D.J. McGlinchey R.E. Crosby G. Levitsky
S. Marcantonio E.R.
Institution
(Rudolph) Division of Aging, Harvard Medical School, Brigham and Women's
Hospital, 150 South Huntington Ave, Boston, MA 02130, United States.
(Schreiber) Stritch School of Medicine, Loyola University Chicago,
Maywood, IL, United States.
(Culley, Crosby) Department of Anesthesiology, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States.
(McGlinchey) Geriatric Research Education and Clinical Center, VA Boston
Healthcare System, Harvard Medical School, Boston, MA, United States.
(Levitsky) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States.
(Marcantonio) Division of General Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States.
Title
Measurement of post-operative cognitive dysfunction after cardiac surgery:
A systematic review.
Source
Acta Anaesthesiologica Scandinavica. 54(6)(pp 663-677), 2010. Date of
Publication: July 2010.
Publisher
Blackwell Munksgaard
Abstract
Post-operative cognitive dysfunction (POCD) is a decline in cognitive
function from pre-operative levels, which has been frequently described
after cardiac surgery. The purpose of this study was to examine the
variability in the measurement and definitions for POCD using the
framework of a 1995 Consensus Statement on measurement of POCD. Electronic
medical literature databases were searched for the intersection of the
search terms 'thoracic surgery' and 'cognition, dementia, and
neuropsychological test.' Abstracts were reviewed independently by two
reviewers. English articles with >50 participants published since 1995
that performed pre-operative and post-operative psychometric testing in
patients undergoing cardiac surgery were reviewed. Data relevant to the
measurement and definition of POCD were abstracted and compared with the
recommendations of the Consensus Statement. Sixty-two studies of POCD in
patients undergoing cardiac surgery were identified. Of these studies, the
recommended neuropsychological tests were carried out in less than half of
the studies. The cognitive domains measured most frequently were attention
(n=56; 93%) and memory (n=57; 95%); motor skills were measured less
frequently (n=36; 60%). Additionally, less than half of the studies
examined anxiety and depression, performed neurological exam, or accounted
for learning. Four definitions of POCD emerged: per cent decline (n=15),
standard deviation decline (n=14), factor analysis (n=13), and analysis of
performance on individual tests (n=12). There is marked variability in the
measurement and definition of POCD. This heterogeneity may impede progress
by reducing the ability to compare studies on the causes and treatment of
POCD. copyright 2010 The Acta Anaesthesiologica Scandinavica Foundation.
<6>
Accession Number
2010338419
Authors
Schwagten B. Witsenburg M. De Groot N.M.S. Jordaens L. Szili-Torok T.
Institution
(Schwagten, Witsenburg, De Groot, Jordaens, Szili-Torok) Department of
Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
Title
Effect of Magnetic Navigation System on Procedure Times and Radiation Risk
in Children Undergoing Catheter Ablation.
Source
American Journal of Cardiology. 106(1)(pp 69-72), 2010. Date of
Publication: 01 Jul 2010.
Publisher
Elsevier Inc.
Abstract
Transcatheter ablation is an effective method to eliminate the
arrhythmogenic substrate in symptomatic children with various types of
arrhythmias. A reduction in the procedure and fluoroscopy time would
decrease the hazardous effects of the ablation procedures. The magnetic
navigation system (MNS) uses atraumatic catheters and facilitates accurate
catheter placement in all regions of the heart for mapping and therapy
delivery. We compared the efficacy and safety between a manual and
MNS-guided approach for mapping and ablation of arrhythmias in a general
pediatric arrhythmia population and in a subgroup of young children aged
<10 years old. A total of 58 pediatric patients (mean age 12.2 +/- 3.2
years) were included in the present study. Of the 58 consecutive patients,
29 were treated with the MNS and 29 underwent conventional manual
ablation. No demographic differences were present between the 2 groups.
Acute success was achieved in 26 of 29 patients and 27 of 29 patients (p =
NS). The mean procedure and fluoroscopy times were comparable in both
study groups (168 +/- 56 minutes vs 183 +/- 52 minutes, p = NS; and 22 +/-
59 minutes vs 30 +/- 29 minutes, p = NS). In young children (aged <10
years), the success rate did not differ between the 2 groups (10 of 11 vs
6 of 8, p = NS). However, significant decreases in the procedure and
fluoroscopy times were achieved (139 +/- 57 minutes vs 204 +/- 49 minutes
and 13 +/- 7 minutes vs 31 +/- 28 minutes, respectively; p = 0.01 and p =
0.04). In conclusion, our data have strongly suggested that using the MNS
for treating young children is advantageous, because it significantly
reduced the procedure and fluoroscopy times without compromising efficacy.
copyright 2010 Elsevier Inc. All rights reserved.
<7>
Accession Number
2010331806
Authors
Venskutonyte L. Malmberg K. Norhammar A. Wedel H. Ryden L.
Institution
(Venskutonyte, Malmberg, Norhammar, Ryden) Department of Medicine, Unit of
Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
(Wedel) Nordic School of Public Health, Goteborg, Sweden.
Title
Effect of gender on prognosis in patients with myocardial infarction and
type 2 diabetes.
Source
Journal of Internal Medicine. 268(1)(pp 75-82), 2010. Date of
Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Venskutonyte L, Malmberg K, Norhammar A, Wedel H, Ryden L (Karolinska
Institute, Stockholm; and Nordic School of Public Health, Goteborg;
Sweden). Effect of gender on prognosis in patients with myocardial
infarction and type 2 diabetes. J Intern Med 2010; 268:75-82. Background.
Diabetes is associated with a markedly increased cardiovascular risk, but
the role of gender on the combined effects of diabetes and myocardial
infarction has been less well explored. Methods. The Diabetes Mellitus and
Insulin Glucose Infusion in Acute Myocardial Infarction 2 (DIGAMI2) trial
recruited 837 men and 416 women with type 2 diabetes hospitalized due to
myocardial infarction and followed for a median of 2.1 years. The effects
of gender on diabetes-specific risk factors and conventional
cardiovascular risk predictors of unfavourable outcome were analysed using
a Cox proportional hazards model. Results. Women were older, more
frequently had hypertension and previous heart failure than men, and were
more often treated with diuretics. More men were smokers. Treatment during
hospitalization, at discharge and during follow-up, did not differ
significantly, apart from the more frequent use of diuretics in women.
Total mortality did not differ between genders, but the combined
cardiovascular end-point of death, re-infarction or stroke was more common
in women (38.9% vs. 32.1%). This difference disappeared after age
adjustment. Age and previous heart failure were independent risk
predictors in both genders, whereas diabetes complications were an
additional risk factor in women only. Blood glucose level at randomization
and updated glucose concentration during follow-up were independent
predictors of poor outcome in men but not in women. Conclusions. Age and
not gender itself explained the increased cardiovascular event rate seen
in women compared with men. A heavier risk factor burden was seen amongst
women. Improved risk factor control instituted before the development of a
myocardial infarction should be attempted as a possible means of improving
the outcome. copyright 2010 Blackwell Publishing Ltd.
<8>
Accession Number
2010330435
Authors
Belcher E. Dusmet M. Jordan S. Ladas G. Lim E. Goldstraw P.
Institution
(Belcher, Dusmet, Jordan, Ladas, Lim, Goldstraw) Department of Thoracic
Surgery, Royal Brompton Hospital, London, United Kingdom.
Title
A prospective, randomized trial comparing BioGlue and Vivostat for the
control of alveolar air leak.
Source
Journal of Thoracic and Cardiovascular Surgery. 140(1)(pp 32-38), 2010.
Date of Publication: July 2010.
Publisher
Mosby Inc.
Abstract
Objective: BioGlue (CryoLife, Europa Ltd, Surrey, UK) is effective in
reducing alveolar air leak after pulmonary resection. However, concerns
exist regarding the use of bovine-derived products. Vivostat (Vivostat
A/S, Alleroed, Denmark) is an autologous fibrin sealant that confers
certain advantages. It shows superior elastic properties, a faster
absorption time, and the absence of risk of transmission of blood-borne
diseases. Methods: We conducted a randomized, single blind controlled
study to compare BioGlue and Vivostat in the control of postoperative air
leak. Primary endpoints were duration of air leak, time to intercostal
drain removal, and length of hospital stay. Secondary endpoints related to
postoperative complications. Results: Between December 2005 and December
2007, 103 patients were randomized. The analysis included 102 patients;
67% were male. Median age was 56 +/- 19 years. Indications for surgery
were primary lung cancer in 41 patients (40%), secondary malignancy in 48
patients (47%), carcinoid in 6 patients (6%), and 7 patients underwent
surgery for benign disease (7%). Bilobectomy was performed in 2 patients
(2%), lobectomy in 41 patients (40%), lobectomy with lesser resection in 3
patients (3%), segmentectomy in 16 patients (16%), precision excision in
34 patients (33%), and 6 patients underwent other resections (6%). Median
duration of air leak was 3 (0-32) days versus 2 (0-33) days for patients
who received BioGlue and Vivostat, respectively (P = .677). Time to
intercostal drain removal was 5 (1-32) days in the BioGlue group compared
with 5 (1-34) days for the Vivostat group (P = .473). Median hospital stay
was 8 (3-22) days versus 7 (2-29) days for the BioGlue and Vivostat
groups, respectively (P = .382). There was no significant difference in
the incidence of complications between the 2 groups (20 patients receiving
BioGlue versus 19 patients receiving Vivostat, P = .839). Conclusions:
There were no significant differences in the 3 clinical outcome measures
of duration of air leak, time to intercostal drain removal, and length of
hospital stay in those patients receiving BioGlue or Vivostat. Given the
inherent advantages of our institutional preference is to use Vivostat in
the control of postoperative air leaks after pulmonary resection.
copyright 2010 The American Association for Thoracic Surgery.
<9>
Accession Number
2010330439
Authors
Tisdale J.E. Wroblewski H.A. Wall D.S. Rieger K.M. Hammoud Z.T. Young J.V.
Kesler K.A.
Institution
(Tisdale, Wroblewski) Department of Pharmacy Practice, School of Pharmacy
and Pharmaceutical Sciences, Purdue University, Indianapolis, Ind, United
States.
(Tisdale) Department of Medicine, Indiana University, School of Medicine,
Indianapolis, Ind, United States.
(Rieger, Hammoud, Kesler) Department of Surgery, Indiana University,
School of Medicine, Indianapolis, Ind, United States.
(Young) Department of Anesthesia, Indiana University, School of Medicine,
Indianapolis, Ind, United States.
(Wall) Department of Pharmacy, Indiana University Hospital, Clarian Health
Partners, Indianapolis, Ind, United States.
Title
A randomized, controlled study of amiodarone for prevention of atrial
fibrillation after transthoracic esophagectomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 140(1)(pp 45-51), 2010.
Date of Publication: July 2010.
Publisher
Mosby Inc.
Abstract
Objective: Atrial fibrillation is common after esophagectomy. The
objective of this study was to determine the efficacy and safety of
amiodarone for prevention of atrial fibrillation after transthoracic
esophagectomy. Methods: Eighty patients undergoing transthoracic
esophagectomy were randomly, prospectively assigned to receive amiodarone
(n = 40) or no prophylaxis (control group, n = 40). Amiodarone-treated
patients received the drug by continuous infusion, initiated at the time
of induction of anesthesia, at a rate of 0.73 mg/min (43.75 mg/h), and
continued for 96 hours (total dose 4200 mg). The primary end point was
atrial fibrillation requiring treatment. Secondary end points included any
atrial fibrillation lasting longer than 30 seconds and postoperative
hospital and intensive care unit stays. Results: There were no significant
differences between the amiodarone and control groups in demographic
characteristics, comorbid conditions, or preoperative or postoperative use
of beta-blockers or calcium-channel blockers. The incidence of atrial
fibrillation requiring treatment was lower in the amiodarone group than in
the control group (15% vs 40%, P = .02, relative risk reduction 62.5%).
There were no significant differences between the amiodarone and control
groups in median hospital stay (11 days vs 12 days, P = .31) or median
intensive care unit stay (68 hours vs 77 hours, p = .097). There were no
significant difference between the groups in the incidences of adverse
effects. Conclusions: Amiodarone prophylaxis significantly reduced the
incidence of atrial fibrillation after transthoracic esophagectomy.
copyright 2010 The American Association for Thoracic Surgery.
<10>
Accession Number
2010329119
Authors
El-Essawi A. Hajek T. Skorpil J. Boning A. Sabol F. Hausmann H. Ostrovsky
Y. Harringer W.
Institution
(El-Essawi, Harringer) Klinikum Braunschweig, Department of Thoracic and
Cardiovascular Surgery, Braunschweig, Germany.
(Hajek, Skorpil) University Hospital Pilsen, Department of Cardiac
Surgery, Pilsen, Czech Republic.
(Boning) University Hospital Giessen and Marburg, Department of
Cardiovascular Surgery, Giessen, Germany.
(Sabol) Pavol Jozef Safarik University Kosice, Heart Surgery Department,
Kosice, Slovakia.
(Hausmann) Mediclin Herzzentrum Coswig, Cardiovascular, Thoracic and
Intensive Care, Coswig, Germany.
(Ostrovsky) Byelorussian Center of Cardiovascular Surgery, Cardiovascular
Surgery, Minsk, Belarus.
Title
A prospective randomised multicentre clinical comparison of a minimised
perfusion circuit versus conventional cardiopulmonary bypass.
Source
European Journal of Cardio-thoracic Surgery. 38(1)(pp 91-97), 2010. Date
of Publication: July 2010.
Publisher
Elsevier
Abstract
Objective: Minimised perfusion circuits (MPCs) are expected to reduce the
side effects of conventional cardiopulmonary bypass (CCPB); however,
conclusive data from sufficiently powered clinical trials are lacking. The
purpose of this study was to evaluate the safety and efficacy of the
ROCsafeRX[trademark] minimised perfusion circuit. Methods: A randomised,
controlled, multicentre clinical trial comparing both perfusion circuits
in patients subjected to elective coronary artery bypass and/or aortic
valve replacement is described. The primary end points of safety, defined
as procedure success without device-related complications, and secondary
end point of efficacy, including reduction of transfusion requirement and
incidence of atrial fibrillation, are analysed. Results: To date, 291
patients have been enrolled and randomised (146 MPC vs 145 CCPB). With the
exception of a significantly higher male population in the MPC group
(83.6% vs 71.0%, p = 0.01), both groups were well matched for demographic
data and type of surgery. There were no device-related complications but a
hard-shell reservoir had to be integrated in one MPC because of a tear in
the right atrium that was managed uneventfully. Total transfusion
requirement (329 +/- 599 ml vs 783 +/- 1638 ml, p [less-than or equal to]
0.001) and erythrocyte transfusion (181 +/- 341 ml vs 434 +/- 798 ml, p
[less-than or equal to] 0.001) were significantly reduced in the MPC
group. The incidence of atrial fibrillation was significantly lower in the
MPC group (7.1% vs 19.5%, p [less-than or equal to] 0.01), while freedom
of major adverse events showed no significant difference. Conclusions:
Lack of device-related complications combined with a significant reduction
in postoperative atrial fibrillation and transfusion requirements have
shown the ROCsafeRX[trademark] MPC to be both safe and efficient for
large-scale use in cardiac patients. Additional data are expected to
confirm these initial findings. copyright 2010 European Association for
Cardio-Thoracic Surgery.
<11>
Accession Number
2010323826
Authors
Talwar S. Sandeep J.A. Choudhary S.K. Velayoudham D. Lakshmy R. Kasthuri
J.M. Kumar A.S.
Institution
(Talwar, Sandeep, Choudhary, Velayoudham, Lakshmy, Kumar) Cardiothoracic
Centre, All India Institute of Medical Sciences, New Delhi, India.
(Kasthuri) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India.
Title
Effect of preoperative administration of allopurinol in patients
undergoing surgery for valvular heart diseases.
Source
European Journal of Cardio-thoracic Surgery. 38(1)(pp 86-90), 2010. Date
of Publication: July 2010.
Publisher
Elsevier
Abstract
Objective: To assess the effects of preoperative administration of
allopurinol in patients undergoing open-heart surgery (OHS) for valvular
heart diseases. Methods: In this prospective randomised double-blind
study, 50 consecutive patients undergoing OHS for valvular heart disease
were randomised into two groups of 25 patients each: (a) control group
received placebo and (b) test group received allopurinol prior to surgery.
Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were
measured prior to the induction of anaesthesia, at the time of aortic
cross-clamp release and 24 h following termination of cardiopulmonary
bypass. Postoperatively assessed parameters were inotropic score, rhythm,
and duration of mechanical ventilation and occurrence of a low cardiac
output state. Results: Significant differences were observed with respect
to inotropic score: median 5 ((0-25) vs 0 (0-25) p = 0.027) and mean 6.44
+/- 6.145 versus 3.4 +/- 5.54, mean duration of mechanical ventilation
(11.1 +/- 4.9 vs 7.5 +/- 2.5 h, p = 0.002, hospital stay (6.35 +/- 1.43 vs
5.04 +/- 0.611, p = 0.001) and maintenance of normal sinus rhythm (NSR)
(18 vs 25, p = 0.004) between the control groups versus the test group,
respectively. There were no significant differences in the levels and
trends of troponin T and CPK-MB between the two groups. Conclusion: The
administration of allopurinol prior to OHS for valvular heart diseases is
associated with increased conversion and maintenance to normal sinus
rhythm, reduced inotropic score and a reduction in the duration of
mechanical ventilation and hospital stay. There was, however, no
significant difference in the blood levels of CPK-MB and troponin T and a
large sample size is required to assess this further. copyright 2010
European Association for Cardio-Thoracic Surgery.
<12>
Accession Number
0020332194
Authors
Gupta A. Hote M.P. Choudhury M. Kapil A. Bisoi A.K.
Institution
(Gupta) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Cardiothoracic Sciences Centre, New Delhi
110 029, India.
Title
Comparison of 48 h and 72 h of prophylactic antibiotic therapy in adult
cardiac surgery: a randomized double blind controlled trial..
Source
The Journal of antimicrobial chemotherapy. 65(5)(pp 1036-1041), 2010.
Date of Publication: May 2010.
Abstract
OBJECTIVES: To determine whether the duration of antibiotic prophylaxis
influences the rate of surgical site infection in patients undergoing
coronary bypass grafting or valve replacement. PATIENTS AND METHODS: Adult
patients undergoing elective coronary artery bypass grafting (CABG) and
valve surgery were included in this randomized double blind study. Between
April 2007 and April 2008, 235 patients were randomly assigned to one of
two groups using random number table and sealed envelope technique. The
groups received prophylactic antibiotic therapy for either 48 h (the 48 h
group) or 72 h (the 72 h group). These patients were monitored for
surgical site infection. RESULTS: The mean age was 52.94 +/- 16.30 and
55.27 +/- 16.63 years, respectively, in the two groups. The incidence of
co-morbid conditions as well as operative conditions was similar between
the groups. During the study period 20 patients developed surgical site
infections and 7 patients other infections. In modified treatment
analysis, the infection rates were 7.6% (9 patients, n = 119) in the group
receiving 48 h of prophylactic antibiotic therapy and 10.2% (11 patients,
n = 108) in the group receiving 72 h of prophylactic antibiotic therapy,
and the difference was statistically non-significant (P > 0.05). In the
per protocol analysis the infection rates were 5% (5 patients, n = 100) in
the group receiving 48 h of prophylactic antibiotic therapy and 8% (8
patients, n = 100) in the group receiving 72 h of prophylactic antibiotic
therapy, and the difference was again statistically non-significant (P >
0.05). The results of Fisher's exact test revealed that the duration of
surgery lasting for >5 h is an independent risk factor for surgical site
infection. CONCLUSIONS: Forty-eight hours of a prophylactic antibiotic
combination using a third-generation cephalosporin and an aminoglycoside
is as effective as a 72 h regimen for preventing surgical site infection
in patients undergoing CABG and valve surgery.
<13>
Accession Number
2010316963
Authors
Damgaard S. Nielsen C.H. Andersen L.W. Bendtzen K. Tvede M. Steinbruchel
D.A.
Institution
(Damgaard, Steinbruchel) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
(Andersen) Department of Anesthesiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Tvede) Department of Clinical Microbiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Nielsen, Bendtzen) Institute for Inflammation Research, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark.
Title
Cell Saver for On-pump Coronary Operations Reduces Systemic Inflammatory
Markers: A Randomized Trial.
Source
Annals of Thoracic Surgery. 89(5)(pp 1511-1517), 2010. Date of
Publication: May 2010.
Publisher
Elsevier USA
Abstract
Background: This study investigated whether intraoperative use of a cell
saver reduces the systemic inflammatory response after coronary operations
using cardiopulmonary bypass (CPB). Methods: The study randomized 29
patients, 15 to cell saving of pericardial suction blood and residual
blood in the CPB circuit after perfusion (cell saver group) vs 14 who
received direct retransfusion of the suction blood and the CPB circuit
blood (control group). Outcome measures were plasma concentrations of the
inflammatory markers interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12,
tumor necrosis factor-alpha, soluble tumor necrosis factor receptors I and
II, and procalcitonin at 6, 24, and 72 hours postoperatively. Results: At
6 hours postoperatively, the cell saver group displayed significantly
reduced plasma levels of IL-6 and IL-8 (p < 0.05). A reduction in IL-10
was also found (p = 0.05), along with nonsignificant reductions in the
remaining markers. At 24 and 72 hours, significant differences between
groups no longer existed. In the cell saver group, the suction blood and
CPB circuit blood were cleared for tumor necrosis factor receptors (p <
0.005), and IL-6, IL-8, IL-10, and procalcitonin were significantly
reduced (p < 0.05). Median intraoperative blood loss was 250 mL in the
cell saver group vs 475 mL (p < 0.02). Immediately postoperatively the
hemoglobin level was higher in the cell saver group (p < 0.03).
Transfusion requirements were similar. Conclusions: The cell saver reduced
the systemic levels of the proinflammatory markers IL-6 and IL-8 at 6
hours after CPB. The role of the anti-inflammatory molecules IL-10 and
soluble tumor necrosis factor receptors is undefined in this setting.
copyright 2010 The Society of Thoracic Surgeons.
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