Results Generated From:
Embase <1980 to 2011 Week 37>
Embase (updates since 2011-09-09)
<1>
Accession Number
2011478563
Authors
Sezai A. Wakui S. Akiyama K. Hata M. Yoshitake I. Unosawa S. Shiono M.
Hirayama A.
Institution
(Sezai, Wakui, Akiyama, Hata, Yoshitake, Unosawa, Shiono) Department of
Cardiovascular Surgery, Nihon University School of Medicine, 30-1
Oyaguchikamimachi, Itabashi-ku, Tokyo 173-8610, Japan
(Hirayama) Department of Cardiology, Nihon University School of Medicine,
Tokyo, Japan
Title
Myocardial protective effect of human atrial natriuretic peptide in
cardiac surgery: "hANP shot" in clinical safety trial.
Source
Circulation Journal. 75 (9) (pp 2144-2150), 2011. Date of Publication:
September 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: We studied low-dose human atrial natriuretic peptide (hANP)
infusion therapy during cardiac surgery and reported the cardiac and renal
protective effects. The efficacy of a bolus injection of hANP (the "hANP
shot") simultaneously with induction of cardioplegia has been proven in
animal experiments. In the present study the clinical effects of this
"hANP shot" were examined. Methods and Results: The subjects were 67
patients undergoing Coronary artery bypass grafting. At the time of
inducing cardioplegia, 1 group received a simultaneous bolus injection of
100 mug of hANP (hANP group) and the other group received an injection of
physiological saline (placebo group). The primary endpoints were (1)
operative mortality and complications, and (2) the creatine kinase
isoenzyme MB (CPK-MB), troponin-I, and human heart fatty acid binding
protein (H-FABP) levels. The secondary endpoints were (1) the incidence of
arrhythmia, and levels of (2) atrial and B-type natriuretic peptides, and
cyclic guanosine monophosphate (cGMP), and (3) renin, angiotensin II, and
aldosterone. Postoperative CPK-MB, troponin-I, and H-FABP levels were
significantly lower in the hANP group than in the placebo group.
Postoperative arrhythmia was significantly less frequent in the hANP group
than in the placebo group. Conclusions: It is possible to achieve
cardioprotective effects based on the safety of the "hANP shot", as well
as from biomarkers of ischemia and results related to arrhythmia. The
"hANP shot" should also be evaluated as a safer and new cardioprotective
method for cardiac surgery.
<2>
Accession Number
2011478553
Authors
Kohro T. Yamazaki T. Izumi T. Daida H. Kurabayashi M. Miyauchi K. Tojo T.
Nagai R.
Institution
(Kohro) Department of Translational Research for Healthcare and Clinical
Science, Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan
(Yamazaki) Department of Clinical Epidemiology and Systems, Graduate
School of Medicine, The University of Tokyo, Tokyo, Japan
(Izumi, Tojo) Department of Cardioangiology, Kitasato University School of
Medicine, Kanagawa, Japan
(Daida, Miyauchi) Department of Cardiology, Juntendo University School of
Medicine, Tokyo, Japan
(Kurabayashi) Department of Medicine and Biological Science, Graduate
School of Medicine, University of Gunma, Gunma, Japan
(Nagai) Department of Cardiovascular Medicine, Graduate School of
Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655,
Japan
Title
Intensively lowering both low-density lipoprotein cholesterol and blood
pressure does not reduce cardiovascular risk in japanese coronary artery
disease patients.
Source
Circulation Journal. 75 (9) (pp 2062-2070), 2011. Date of Publication:
September 2011.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Despite mounting evidence of the benefit of intensive lowering
of low-density lipoprotein-cholesterol (LDL-C) in coronary artery disease
(CAD) patients, it has not been shown that intensive lowering of both
LDL-C and blood pressure (BP) reduces cardiovascular events in these
patients. Methods and Results: 498 patients with hypertension and
hypercholesterolemia with >=75% stenosis in at least one major coronary
artery, were recruited from 17 cardiovascular centers in eastern Japan.
Patients were randomly assigned to conventional therapy (CT) or intensive
therapy (IT). CT aimed to reduce BP to <140/90 mmHg and LDL-C to <100
mg/dl, and IT aimed for <120/80 mmHg and <80 mg/dl, respectively. The
primary endpoint was a composite of all deaths, non-fatal myocardial
infarction, unstable angina pectoris, coronary artery bypass graft
surgery, non-fatal stroke, non-fatal major vascular disease, and
peripheral artery disease. The mean follow-up period was 3.2 years. The
achieved systolic BP was 126.8 mmHg for the CT group, and 121.3 mmHg for
the IT group (P<0.001). The achieved LDL-C was 92.1 mg/dl for the CT
group, and 79.6 mg/dl for the IT group (P<0.001). We detected the primary
endpoint in 18 (7.1%) patients in the CT group, and 26 (10.7%) in the IT
group (hazard ratio 1.53, 95% confidence interval 0.84-2.80, P=0.164).
Conclusions: We could not show that intensively lowering both BP and LDL-C
reduced cardiovascular risks in Japanese CAD patients with hypertension
and hypercholesterolemia (UMIN-CTR UMIN000000571).
<3>
Accession Number
2011487948
Authors
Takagi H. Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Intracoronary stem cell injection improves left ventricular remodeling
after acute myocardial infarction: An updated meta-analysis of randomized
trials.
Source
International Journal of Cardiology. 151 (2) (pp 226-228), 2011. Date of
Publication: 01 Sep 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
<4>
Accession Number
2011483533
Authors
Kim D.H. Park S.Y. Cho H.B. Park S.K. Kang M. Hong Y.S. Hong Y.W.
Institution
(Kim, Park, Cho, Park, Kang, Hong) Department of Anaesthesiology and Pain
Medicine, Ajou University School of Medicine, Suwon, South Korea
(Hong) Department of Thoracic and Cardiovascular Surgery, Ajou University
School of Medicine, Suwon, South Korea
Title
Haemodynamic changes during left anterior descending artery exposure in
off-pump coronary artery bypass: Comparison between use of moist
laparotomy pads and deep pericardial traction sutures for heart
displacement.
Source
Journal of International Medical Research. 39 (4) (pp 1211-1218), 2011.
Date of Publication: 2011.
Publisher
Field House Publishing (6 Sompting Ave, Worthing BN14 8HN, United Kingdom)
Abstract
Haemodynamic changes occurring during heart displacement, using moist
laparotomy pads placed behind the heart (PAD group, n = 26) or deep
pericardial traction sutures (DPS group, n = 25) to facilitate exposure of
the left anterior descending artery during off-pump coronary artery bypass
surgery, were compared. Haemodynamic variables were assessed before and 10
min after displacement of the heart. The central venous pressure, mean
pulmonary artery pressure and pulmonary capillary wedge pressure increased
in both groups. After heart displacement in the PAD group, the cardiac
index, stroke volume index, mixed venous oxygen saturation, right
ventricular ejection fraction and left ventricular stroke work index
decreased significantly, and the systemic vascular resistance and
pulmonary vascular resistance increased significantly; these parameters
remained unchanged in the DPS group. It was concluded that displacement of
the heart using moist laparotomy pads caused significant haemodynamic
derangement compared with that caused by deep pericardial traction
sutures. 2011 Field House Publishing LLP.
<5>
Accession Number
2011482531
Authors
Peiris C.L. Taylor N.F. Shields N.
Institution
(Peiris, Taylor, Shields) Musculoskeletal Research Centre, School of
Physiotherapy, La Trobe University, VIC, Australia
(Peiris, Taylor) Allied Health Clinical Research Office, Eastern Health
Level 2, Box Hill, 5 Arnold St, VIC 3128, Australia
Title
Extra physical therapy reduces patient length of stay and improves
functional outcomes and quality of life in people with acute or subacute
conditions: A systematic review.
Source
Archives of Physical Medicine and Rehabilitation. 92 (9) (pp 1490-1500),
2011. Date of Publication: September 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To investigate whether extra physical therapy intervention
reduces length of stay and improves patient outcomes in people with acute
or subacute conditions. Data Sources: Electronic databases CINAHL,
MEDLINE, AMED, PEDro, PubMed, and EMBASE were searched from the earliest
date possible through May 2010. Additional trials were identified by
scanning reference lists and citation tracking. Study Selection:
Randomized controlled trials evaluating the effect of extra physical
therapy on patient outcomes were included for review. Two reviewers
independently applied the inclusion and exclusion criteria, and any
disagreements were discussed until consensus could be reached. Searching
identified 2826 potentially relevant articles, of which 16 randomized
controlled trials with 1699 participants met inclusion criteria. Data
Extraction: Data were extracted using a predefined data extraction form by
1 reviewer and checked for accuracy by another. Methodological quality of
trials was assessed independently by 2 reviewers using the PEDro scale.
Data Synthesis: Pooled analyses with random effects model to calculate
standardized mean differences (SMDs) and 95% confidence intervals (CIs)
were used in meta-analyses. When compared with standard physical therapy,
extra physical therapy reduced length of stay (SMD=-.22; 95% CI, -.39 to
-.05) (mean difference of 1d [95% CI, 01] in acute settings and mean
difference of 4d [95% CI, 07] in rehabilitation settings) and improved
mobility (SMD=.37; 95% CI,.05.69), activity (SMD=.22; 95% CI,.07.37), and
quality of life (SMD=.48; 95% CI,.29.68). There were no significant
changes in self-care (SMD=.35; 95% CI, -.06.77). Conclusions: Extra
physical therapy decreases length of stay and significantly improves
mobility, activity, and quality of life. Future research could address the
possible benefits of providing extra services from other allied health
disciplines in addition to physical therapy. 2011 American Congress of
Rehabilitation Medicine.
<6>
Accession Number
2011484745
Authors
Zimmerman L. Barnason S. Hertzog M. Young L. Nieveen J. Schulz P. Tu C.
Institution
(Zimmerman, Barnason, Hertzog, Young, Nieveen, Schulz) College of Nursing,
University of Nebraska Medical Center, Lincoln, NE, United States
(Tu) College of Pharmacy, University of New England, Biddeford, ME, United
States
Title
Gender differences in recovery outcomes after an early recovery symptom
management intervention.
Source
Heart and Lung: Journal of Acute and Critical Care. 40 (5) (pp 429-439),
2011. Date of Publication: September-October 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: Despite known gender differences in recovery, few studies have
examined symptom management (SM) interventions or responses by gender
after coronary artery bypass surgery (CABS). Objective: The purpose of
this subanalysis was to describe and evaluate differences in response by
gender to an SM intervention on the presence and burden of symptoms,
physical activity, and physical functioning in elderly CABS patients
during the early discharge period (3 and 6 weeks after CABS, and 3 and 6
months after CABS). Methods: The parent study whose data were analyzed to
examine gender differences involved a two-group, randomized clinical trial
design. The 6-week early recovery SM telehealth intervention was delivered
by the Health Buddy. Measures included the Cardiac Symptom Survey, a
Modified 7-Day Activity Interview, an RT3 accelerometer, an Activity
Diary, and the Medical Outcomes Study Short Form 36. This study was not
powered for a gender x group analysis, and we used descriptive statistics,
chi<sup>2</sup> tests, t tests, and analysis of variance for statistical
analyses. Results: Subjects (n = 232) included 192 men and 40 women, with
a mean age of 71.2 SD, 7 years. The intervention group consisted of 86 men
and 23 women, and the usual care (UC) group consisted of 106 men and 17
women. Data trends suggest that the SM intervention exerted greater impact
on women than on men for symptoms such as fatigue, depression, sleep
problems, and pain. Again, men exhibited higher levels of physical
activity than did women. However, women in the SM group generally had
higher scores than did women in the UC group. Conclusion: Although the
parent study found no effect of an early recovery SM intervention, this
exploratory secondary analysis indicated that women in the intervention
group demonstrated more improvement in measures of physical activity than
did those in the UC group. Further study, using a larger sample, is
necessary to test these preliminary results. 2011 Elsevier Inc.
<7>
[Use Link to view the full text]
Accession Number
2011486009
Authors
Lazar H.L. McDonnell M.M. Chipkin S. Fitzgerald C. Bliss C. Cabral H.
Institution
(Lazar, Fitzgerald) Departments of Cardiothoracic Surgery, Boston Medical
Center, 88 E Newton St, Boston, MA 02118, United States
(McDonnell) Division of Endocrinology, United States
(Bliss, Cabral) Department of Biostatistics, Boston University School of
Medicine, Boston Medical Center, Boston, MA, United States
(Chipkin) Department of Exercise Science, University of Massachusetts
Amherst, Amherst, MA, United States
Title
Effects of aggressive versus moderate glycemic control on clinical
outcomes in diabetic coronary artery bypass graft patients.
Source
Annals of Surgery. 254 (3) (pp 458-464), 2011. Date of Publication:
September 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Objective: This study sought to determine whether aggressive glycemic
control (90-120 mg/dL) would result in more optimal clinical outcomes and
less morbidity than moderate glycemic control (120-180 mg/dL) in diabetic
patients undergoing coronary artery bypass graft (CABG) surgery. Summary
of Background Data: Maintaining serum glucose levels between 120 and 180
mg/dL with continuous insulin infusions decreases morbidity in diabetic
patients undergoing CABG surgery. Studies in surgical patients requiring
prolonged ventilation suggest that aggressive glycemic control (<120
mg/dL) may improve survival; however, its effect in diabetic CABG patients
is unknown. Methods: Eighty-two diabetic patients undergoing CABG were
prospectively randomized to aggressive glycemic control (90-120 mg/dL) or
moderate glycemic control (120-180 mg/dL) using continuous intravenous
insulin solutions (100 units regular insulin in 100 mL: normal saline)
beginning at the induction of anesthesia and continuing for 18 hours after
CABG. Primary end points were the incidence of major adverse events (major
adverse events = 30-day mortality, myocardial infarction, neurologic
events, deep sternal infections, and atrial fibrillation), the level of
serum glucose, and the incidence of hypoglycemic events. Results: There
were no differences in the incidence of major adverse events between the
groups (17 moderate vs 15 aggressive; P = 0.91). Patients with aggressive
control had a lower mean glucose at the end of 18 hours of insulin
infusion (135 +/- 12 mg/dL moderate vs 103 +/- 17 mg/dL aggressive; P <
0.0001). Patients with aggressive control had a higher incidence of
hypoglycemic events (4 vs 30; P < 0.0001). Conclusions: In diabetic
patients undergoing CABG surgery, aggressive glycemic control increases
the incidence of hypoglycemic events and does not result in any
significant improvement in clinical outcomes that can be achieved with
moderate control. Clinical Trials.gov (ID #NCT00460499). 2011 by
Lippincott Williams & Wilkins.
<8>
Accession Number
2011485711
Authors
Imazio M. Brucato A. Rovere M.E. Gandino A. Cemin R. Ferrua S. Maestroni
S. Zingarelli E. Barosi A. Simon C. Sansone F. Patrini D. Vitali E. Belli
R. Ferrazzi P. Trinchero R. Spodick D.H. Adler Y.
Institution
(Imazio, Belli, Trinchero) Cardiology Department, Maria Vittoria Hospital,
Via Cibrario 72, 10141 Torino, Italy
(Brucato, Maestroni, Simon, Ferrazzi) Ospedali Riuniti, Bergamo, Italy
(Rovere, Zingarelli, Sansone) Cardiac Surgery, Ospedale Mauriziano,
Torino, Italy
(Gandino, Barosi) Ospedale Niguarda, Milano, Italy
(Cemin) Department of Cardiology, San Maurizio Regional Hospital, Bolzano,
Italy
(Ferrua) Ospedale Degli Infermi, Rivoli, Italy
(Patrini, Vitali) Humanitas Gavazzeni, Bergamo, Italy
(Spodick) Department of Medicine, St Vincent Hospital, University of
Massachusetts, Worcester, MA, United States
(Adler) Sackler Faculty of Medicine, Tel-Aviv and Misgav Ladach Hospital,
Jerusalem, Kupat Holim Meuhedet, Israel
Title
Colchicine prevents early postoperative pericardial and pleural effusions.
Source
American Heart Journal. 162 (3) (pp 527-532.e1), 2011. Date of
Publication: September 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Background: No preventive pharmacologic strategies have been proven
efficacious for the prevention of postoperative effusions after cardiac
surgery. Colchicine is safe and efficacious for the prevention of
pericarditis. On this basis, we realized a substudy of the COPPS trial to
assess the efficacy and safety of colchicine for the prevention of
postoperative pericardial and pleural effusions. Methods: The COPPS is a
multicenter, double-blind, randomized trial, where 360 consecutive
patients (mean age 65.7 +/- 12.3 years, 66% men), 180 in each treatment
arm, were randomized on the third postoperative day to receive placebo or
colchicine for 1 month (1.0 mg twice daily for the first day, followed by
a maintenance dose of 0.5 mg twice daily in patients >=70 kg, and halved
doses for patients <70 kg). The incidence of postoperative effusions was
evaluated in each study group. Results: Despite similar baseline features,
colchicine significantly reduced the incidence of postoperative
pericardial (12.8% vs 22.8%, P =.019, relative risk reduction 43.9%, no.
of patients needed to treat 10) and pleural effusions (12.2% vs 25.6%, P
=.002, relative risk reduction 52.3%, no. of patients needed to treat 8).
The rate of side effects (only gastrointestinal intolerance) and drug
withdrawal was similar in the study groups with a trend toward an
increased rate of both events for colchicine. In multivariable analysis,
female gender (hazard ratio 1.76, 95% CI 1.03-3.03, P =.040) and pleura
incision (hazard ratio 2.58, 95% CI 1.53-4.53, P <.001) were risk factors
for postoperative effusions. Conclusions: Colchicine is safe and
efficacious for the primary prevention of postoperative effusions after
cardiac surgery. 2011 Mosby, Inc.
<9>
Accession Number
2011485740
Authors
Farquharson A.L. Metcalf R.G. Sanders P. Stuklis R. Edwards J.R.M. Gibson
R.A. Cleland L.G. Sullivan T.R. James M.J. Young G.D.
Institution
(Farquharson, Cleland, James) Discipline of Medicine, University of
Adelaide, Adelaide, Australia
(Metcalf, Sanders, James, Young) Centre for Heart Rhythm Disorders,
University of Adelaide, Adelaide, Australia
(Gibson, Cleland) FoodPlus Research Centre, University of Adelaide,
Adelaide, Australia
(Sullivan) Data Management and Analysis Centre, Discipline of Public
Health, University of Adelaide, Adelaide, Australia
(Metcalf, James) Rheumatology Unit, Royal Adelaide Hospital, Adelaide,
Australia
(Sanders, Young) Department of Cardiology, Royal Adelaide Hospital,
Adelaide, Australia
(Stuklis, Edwards) Department of Cardiothoracic Surgery, Royal Adelaide
Hospital, Adelaide, Australia
Title
Effect of dietary fish oil on atrial fibrillation after cardiac surgery.
Source
American Journal of Cardiology. 108 (6) (pp 851-856), 2011. Date of
Publication: 15 Sep 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
An open-label study reported that ingestion of a fish oil concentrate
decreased the incidence of atrial fibrillation (AF) after coronary artery
bypass grafting (CABG) surgery. However, a general cardiac surgery
population involves valve and CABG surgeries. We undertook a
double-blinded randomized controlled trial to examine the effectiveness of
fish oil supplementation on the incidence of postsurgical AF after CABG
and valve procedures. The primary end point was incidence of AF in the
first 6 days after surgery. Two hundred patients were randomized to
receive fish oil (providing 4.6 g/day of long-chain -3 fatty acids) or a
control oil starting 3 weeks before surgery; 194 subjects completed the
study, with 47 of 97 subjects in the control group and 36 of 97 subjects
in the fish oil group developing AF (odds ratio 0.63, 95% confidence
interval [CI] 0.35 to 1.11). There was a nonstatistically significant
delay in time to onset of AF in the fish oil group (hazard ratio 0.66, 95%
CI 0.43 to 1.01). There was a significant decrease in mean length of stay
in the intensive care unit in the fish oil group (ratio of means 0.71, 95%
CI 0.56 to 0.90). In conclusion, in a mixed cardiac surgery population,
supplementation with dietary fish oil did not result in a significant
decrease in the incidence of postsurgical AF. However, there was a
significant decrease in time spent in the intensive care unit. 2011
Elsevier Inc. All Rights Reserved.
<10>
Accession Number
2011499592
Authors
Kappetein A.P. Feldman T.E. MacK M.J. Morice M.-C. Holmes D.R. Stahle E.
Dawkins K.D. Mohr F.W. Serruys P.W. Colombo A.
Institution
(Kappetein, Serruys) Department of Thoracic Surgery, Erasmus Medical
Centre, PO Box 2040, 3000 CA Rotterdam, Netherlands
(Feldman) NorthShore University Health System, Evanston, IL, United States
(MacK) Baylor Healthcare System, Dallas, TX, United States
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Holmes) Mayo Clinic, Rochester, MN, United States
(Stahle) University Hospital Uppsala, Uppsala, Sweden
(Dawkins) Boston Scientific, Natick, MA, United States
(Mohr) Herzzentrum Universitt Leipzig, Leipzig, Germany
(Colombo) San Raffaele Scientific Institute, Milan, Italy
Title
Comparison of coronary bypass surgery with drug-eluting stenting for the
treatment of left main and/or three-vessel disease: 3-year follow-up of
the SYNTAX trial.
Source
European Heart Journal. 32 (17) (pp 2125-2134), 2011. Date of
Publication: September 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims Long-term randomized comparisons of percutaneous coronary
intervention (PCI) to coronary artery bypass grafting (CABG) in left main
coronary (LM) disease and/or three-vessel disease (3VD) patients have been
limited. This analysis compares 3-year outcomes in LM and/or 3VD patients
treated with CABG or PCI with TAXUS Express stents. Methods and
resultsSYNTAX is an 85-centre randomized clinical trial (n 1800).
Prospectively screened, consecutive LM and/or 3VD patients were randomized
if amenable to equivalent revascularization using either technique; if
not, they were entered into a registry. Patients in the randomized cohort
will continue to be followed for 5 years. At 3 years, major adverse
cardiac and cerebrovascular events [MACCE: death, stroke, myocardial
infarction (MI), and repeat revascularization; CABG 20.2 vs. PCI 28.0, P<
0.001], repeat revascularization (10.7 vs. 19.7, P< 0.001), and MI (3.6
vs. 7.1, P 0.002) were elevated in the PCI arm. Rates of the composite
safety endpoint (death/stroke/MI 12.0 vs. 14.1, P 0.21) and stroke alone
(3.4 vs. 2.0, P 0.07) were not significantly different between treatment
groups. Major adverse cardiac and cerebrovascular event rates were not
significantly different between arms in the LM subgroup (22.3 vs. 26.8, P
0.20) but were higher with PCI in the 3VD subgroup (18.8 vs. 28.8, P<
0.001). Conclusion sAt 3 years, MACCE was significantly higher in
PCI-compared with CABG-treated patients. In patients with less complex
disease (low SYNTAX scores for 3VD or low/intermediate terciles for LM
patients), PCI is an acceptable revascularization, although longer
follow-up is needed to evaluate these two revascularization strategies.
2011 The Author.
<11>
Accession Number
2011488484
Authors
Christensen T.D. Larsen T.B. Hjortdal V.E.
Institution
(Christensen, Hjortdal) Department of Cardiothoracic and Vascular Surgery,
Institute of Clinical Medicine, Aarhus University Hospital, Skejby,
DK-8200 Aarhus N, Denmark
(Larsen) Department of Cardiology, Aalborg Hospital and Department of
Health Science and Technology, Aalborg University, Denmark
Title
Self-testing and self-management of oral anticoagulation therapy in
children.
Source
Thrombosis and Haemostasis. 106 (3) (pp 391-397), 2011. Date of
Publication: 2011.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
Children and adolescents on oral anticoagulation therapy (OAT) present
special challenges in terms of rapid fluctuations in International
Normalised Ratio (INR) values, interruption in daily life due to frequent
hospital/doctor visits, and difficulties and pain in the performance of
venepuncture. Optimised management of OAT improves the quality of
treatment, potentially accomplished by new methods such as patient
self-testing (PST) and patient self-management (PSM). A review was
performed, identifying 11 trials with children and adolescents. All
studies had different methodological problems, predominantly by being
non-randomised trials. A total of 284 patients were included with a mean
follow-up of 22 months, finding a time within therapeutic INR target range
between 63% and 84%. The coagulometers used for estimating the INR values
were found to have sufficient precision and accuracy for clinical use, but
external quality control is probably advisable. It can be concluded that
PST and PSM are at least as good treatment options as conventional
management in highly selected children. Larger studies, preferably
randomised, controlled trials using clinical endpoints, are obviously
needed in order to elucidate whether these new regimens of treatment are
superior to conventional management of oral anticoagulation therapy.
Schattauer 2011.
<12>
Accession Number
2011481510
Authors
Lyons O. Clough R. Patel A. Saha P. Carrell T. Taylor P.
Institution
(Lyons, Clough, Patel, Saha, Carrell, Taylor) Vascular Surgery Unit,
King's Health Partners, London, United Kingdom
Title
Endovascular management of Stanford type A dissection or intramural
hematoma with a distal primary entry tear.
Source
Journal of Endovascular Therapy. 18 (4) (pp 591-600), 2011. Date of
Publication: August 2011.
Publisher
International Society of Endovascular Specialists (PMB 605, 1928 East
Highland Street, #F104, Phoenix AZ 85016, United States)
Abstract
A systematic review was conducted of all published cases of endovascular
repair of retrograde Stanford type A dissection or intramural hematoma to
determine mortality of this less invasive approach to treatment. Using the
PRISMA guidelines, databases were searched for any of the terms
'dissect$', 'IMH', ('aortic ADJ wall'), 'intramur$', 'intra-mur$' in
combination with any of 'stent$', 'perc$', 'endo$', 'TEVAR' in combination
with any of ('type ADJ A'), 'ascend$' and 'retro$.' The search retrieved
3131 titles, 280 abstracts, and 108 papers. Of 23 relevant papers
selected, mortality data could be extracted from 11 studies, representing
60 patients. Overall in-hospital mortality was 1.8% (95% CI 1.2% to 2.4%).
Additional all-cause mortality during follow-up was 5.4% (95% CI 3.5% to
7.2%). The placement of an endoluminal device in the descending thoracic
aorta to treat a DeBakey IIId/retrograde type A aortic dissection or
intramural hematoma may be a safer procedure in the short to medium term
than open surgical replacement of the ascending aorta (with or without the
arch). Open surgical repair in these patients may therefore be
unjustified. 2011 by the International Society of Endovascular
Specialists.
<13>
Accession Number
70525113
Authors
Boyd S.
Institution
(Boyd) Vanderbilt University, United States
Title
Adverse outcomes after maxillomandibular advancement for treatment of
obstructive sleep apnea.
Source
Journal of Oral and Maxillofacial Surgery. Conference: 93rd Annual
Meeting Scientific Sessions and Exhibition of the American Association of
Oral and Maxillofacial Surgeons, AAOMS 2011 Philadelphia, PA United
States. Conference Start: 20110912 Conference End: 20110917. Conference
Publication: (var.pagings). 69 (9 SUPPL. 1) (pp e25-e26), 2011. Date of
Publication: September 2011.
Publisher
W.B. Saunders
Abstract
Statement of the Problem: Several observational case series studies
indicate that maxillomandibular advancement surgery (MMA) may be a
clinically effective alternative therapy for patients with obstructive
sleep apnea (OSA) who are unable to adhere to CPAP therapy. Surgical
treatment involves inherent risks and it is essential to define the type,
severity and incidence of these potential adverse outcomes to determine
the risk benefit ratio of MMA for the treatment of OSA. To date the
adverse outcomes of MMA have not been systematically analyzed or reported.
The purpose of this study is to determine the type, severity and incidence
of surgical and anesthetic adverse outcomes following MMA for treatment of
OSA. Materials and Methods: This is a retrospective cohort study
consisting of 76 patients who underwent MMA for treatment of OSA at
Vanderbilt Medical Center between 1997 and 2007. A comprehensive
systematic review of the surgical, anesthesia/recovery room and progress
notes were completed for each patient to identify all perioperative
complications, as well as post-operative wound healing problems.
Additionally, polysomnography reports were analyzed to determine the
effectiveness of MMA, as measured by changes in the apnea-hypopnea index
(AHI) and low oxygen saturation after MMA. Methods of Data Analysis:
Descriptive statistical analysis was performed for all continuous
variables and reported as mean +/- SD. The number and proportion of
patients with each observed adverse outcome were tabulated. Two-tailed
paired t tests were used to assess changes in the apnea-hypopnea index
(AHI) and low O2 saturations following MMA. For all analyses, a p-value of
<0.05 was considered statistically significant. Results of Investigation:
The majority of patients were obese (BMI +/- 31.2 +/- 6.9) middle-aged
(45.4 +/- 9.9 years) males (80%) with severe OSA (AHI +/- 54.3 +/- 27.0;
low % SaO2 +/- 77.8 +/- 13.0). Pre-operatively, the group had multiple
co-morbid medical conditions including: hypertension (36%), cardiovascular
disease (14%), history of non-fatal cardiovascular events (9%) and
depression (21%). Standardized osteotomy and stabilization techniques were
used to accomplish MMA. Modified hypotensive anesthetic techniques were
used for the majority of patients (93%). There were no observed deaths or
cardiac events. Intra-operatively the airway was managed by intubation in
the vast majority of patients (96%) with tracheotomy performed in only one
patient. 3% of patients required re-intubation for perioperative control
of the airway. The estimated average blood loss was 390.6 +/- 227.1 ml and
5% of patients received a blood transfusion. No patients experienced
complications requiring return to the operating room. Following surgery,
patients required 2.6 +/- 1.7 days of hospitalization. Wound infections
were uncommon (8%) and were effectively treated by local measures and oral
antibiotics, with no patients requiring intravenous antibiotics or
hospitalization. Surgical treatment by MMA resulted in a significant
reduction in AHI in (54.3 +/- 27.0 to 13.3 +/- 11.6, P <.001) and
improvement in minimum oxygen saturation (77.8% to 83.8%, P <.001).
Conclusion: The results of this study indicate that MMA has a very
favorable risk-benefit ratio, as it may provide safe and effective
treatment for patients with moderate to severe OSA who are unable to
adhere to CPAP therapy.
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