Results Generated From:
Embase <1980 to 2011 Week 45>
Embase (updates since 2011-11-03)
<1>
Accession Number
2011602385
Authors
Schapiro-Dufour E. Cucherat M. Velzenberger E. Galmiche H. Denis C.
MacHecourt J.
Institution
(Schapiro-Dufour, Velzenberger, Galmiche, Denis) Service d'Evaluation des
Dispositifs, Haute Autorite de Sante HAS, 2 avenue du Stade-de France,
93218 Saint-Denis-La-Plaine cedex, France
(Cucherat) UMR 5558, Faculte de Medecine Laennec, 7 rue Guillaume Paradin,
69008 Lyon, France
(MacHecourt) Department of Cardiology, France
(MacHecourt) Service de Cardiologie et d'Urgences Cardiologiques, CHU
Grenoble, B.P. 217, 38043 Grenoble cedex 9, France
Title
Drug-eluting stents in patients at high risk of restenosis: Assessment for
France.
Source
International Journal of Technology Assessment in Health Care. 27 (2) (pp
108-117), 2011. Date of Publication: April 2011.
Publisher
Cambridge University Press (40 West 20th Street, New York NY 10011-4211,
United States)
Abstract
Background: In unselected patients, the incidence of restenosis is lower
after placement of drug-eluting stents (DES) than bare-metal stents (BMS)
without difference in safety at a time horizon of 4 years. However, DES
appears less effective in "off label" patients. Objectives: The aim of the
study was to assess available evidence of DES efficacy and safety by
patient category to establish when DES placement may be recommended for
reimbursement by the French national health insurance. Methods: Based on a
systematic review by patient category (January 2002 to August 2009), two
health technology assessment (HTA) reports and thirty-eight clinical
studies not covered by the HTA reports (eleven meta-analysis including
ours, eleven randomized trials and sixteen cohort studies) were selected.
After assessment of the methodological quality, the studies mostly
comparing DES with BMS were reviewed by a panel of health professionals
who defined a priori the most relevant end points of safety and efficacy.
Results: Seven to fourteen patients treated with DES were needed to avoid
one target lesion revascularization (TLR) in patients with lesions >15 mm
long, vessel diameter <3 mm, or diabetes, and with some complex lesions
(total coronary occlusion, BMS in-stent restenosis multivessel disease,
unprotected left main stenosis). DES appeared as safe as other
alternatives over a follow-up of up to 4 years when dual antiplatelet
therapy was continued for at least 1 year, but statistical power remains
limited to conclude for some clinical features. Conclusions: For
reimbursement, DES use should be limited to certain categories of
patients. Treatment of particular cases requires a multidisciplinary
approach. 2011 Cambridge University Press.
<2>
Accession Number
2011600040
Authors
Hayat J. Alizai S. Ahmed R.
Institution
(Hayat, Alizai, Ahmed) Department of Cardiovascular Surgery, Shifa
International Hospital, Islamabad, Pakistan
Title
Combined antegrade/retrograde cold blood cardioplegia for myocardial
protection in CABG patients.
Source
Rawal Medical Journal. 36 (3) (pp 206-209), 2011. Date of Publication:
2011.
Publisher
Pakistan Medical Association (Garden Road, Karachi - 3, Pakistan)
Abstract
Objective To evaluate surgical outcomes and effectiveness of combined
antegrade/retrograde cardioplegia for myocardial protection in patients
undergoing coronary artery bypass grafting (CABG). Patients and Method A
total of 30 patients were randomly retrieved from the cardiac surgical
database that had combined antegrade/retrograde cold blood cardioplegia
for myocardial protection in coronary artery surgery. Pre and post
operative data was then assessed for the case mix and results evaluated
Results Preoperatively, majority of the patients had moderate left
ventricular impairment and had triple vessel coronary artery disease.
There was no in hospital mortality from the combined approach. Five
patients needed inotropic support postoperatively, which was weaned off
within 24 hours. One patient was reopened for bleeding. Mean hospital stay
was 6.5 days. Conclusion Combined antegrade/retrograde cardioplegia is
safe and is particularly useful in preserving myocardium in patients with
impaired left ventricular function.
<3>
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Accession Number
2011594719
Authors
Yoo Y.-C. Shim J.-K. Kim J.-C. Jo Y.-Y. Lee J.-H. Kwak Y.-L.
Institution
(Yoo, Shim, Kim) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University Health System,
Seoul, South Korea
(Jo) Department of Anesthesiology and Pain Medicine, Yonsei University
Health System, South Korea
(Lee, Kwak) Department of Anesthesiology and Pain Medicine, Anesthesia and
Pain Research Institute, Yonsei University Health System, 250 Seongsanno,
Seodaemun-gu, Seoul 120-752, South Korea
Title
Effect of single recombinant human erythropoietin injection on transfusion
requirements in preoperatively anemic patients undergoing valvular heart
surgery.
Source
Anesthesiology. 115 (5) (pp 929-937), 2011. Date of Publication:
November 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: The authors investigated the effect of a single preoperative
bolus of erythropoietin on perioperative transfusion requirement and
erythropoiesis in patients with preoperative anemia undergoing valvular
heart surgery. Methods: In this prospective, single-site, single-blinded,
randomized, and parallel-arm controlled trial, 74 patients with
preoperative anemia were randomly allocated to either the erythropoietin
or the control group. The erythropoietin group received 500 IU/kg
erythropoietin and 200 mg iron sucrose intravenously 1 day before the
surgery. The control group received an equivalent volume of normal saline.
The primary endpoint was transfusion requirement assessed during the
surgery and for 4 days postoperatively. Reticulocyte count and iron
profiles were measured serially and compared preoperatively and on
postoperative days 1, 2, 4, and 7. RESULTS:: Transfusion occurred in 32
patients (86%) of the control group versus 22 patients (59%) of the
erythropoietin group (P = 0.009). The mean number of units of packed
erythrocytes transfused per patient during the surgery and for 4
postoperative days (mean +/- SD) was also significantly decreased in the
erythropoietin group compared with the control group (3.3 +/- 2.2 vs. 1.0
+/- 1.1 units/patient, P = 0.001). The reticulocyte count was
significantly greater in the erythropoietin group at postoperative days 4
(P = 0.001) and 7 (P = 0.001). Conclusions: A single intravenous
administration of erythropoietin and an iron supplement 1 day before
surgery significantly reduced the perioperative transfusion requirement in
anemic patients undergoing valvular heart surgery, implicating its
potential role as a blood conservation strategy. 2011 the American
Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.
Anesthesiology.
<4>
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Accession Number
2011594759
Authors
Antoniades C. Cunnington C. Antonopoulos A. Neville M. Margaritis M.
Demosthenous M. Bendall J. Hale A. Cerrato R. Tousoulis D. Bakogiannis C.
Marinou K. Toutouza M. Vlachopoulos C. Leeson P. Stefanadis C. Karpe F.
Channon K.M.
Institution
(Antoniades, Cunnington, Margaritis, Bendall, Hale, Leeson, Channon)
Department of Cardiovascular Medicine, University of Oxford, John
Radcliffe Hospital, Hedley Way, OX3 9DU, Oxford, United Kingdom
(Neville, Karpe) Oxford Centre for Diabetes Endocrinology and Metabolism,
Athens University Medical School, Athens, Greece
(Antonopoulos, Demosthenous, Tousoulis, Bakogiannis, Toutouza,
Vlachopoulos, Stefanadis) 1st Cardiology Department, Athens University
Medical School, Athens, Greece
(Marinou) Department of Experimental Physiology, Athens University Medical
School, Athens, Greece
(Cerrato) Department of Medicine, Cardiology Division, Karolinska
Institute, Stockholm, Sweden
Title
Induction of vascular GTP-cyclohydrolase i and endogenous
tetrahydrobiopterin synthesis protect against inflammation-induced
endothelial dysfunction in human atherosclerosis.
Source
Circulation. 124 (17) (pp 1860-1870), 2011. Date of Publication: 25 Oct
2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND-: The endothelial nitric oxide synthase cofactor
tetrahydrobiopterin (BH4) is essential for maintenance of enzymatic
function. We hypothesized that induction of BH4 synthesis might be an
endothelial defense mechanism against inflammation in vascular disease
states. METHODS AND RESULTS-: In Study 1, 20 healthy individuals were
randomized to receive Salmonella typhi vaccine (a model of acute
inflammation) or placebo in a double-blind study. Vaccination increased
circulating BH4 and interleukin 6 and induced endothelial dysfunction (as
evaluated by brachial artery flow-mediated dilation) after 8 hours. In
Study 2, a functional haplotype (X haplotype) in the GCH1 gene, encoding
GTP-cyclohydrolase I, the rate-limiting enzyme in biopterin biosynthesis,
was associated with endothelial dysfunction in the presence of
high-sensitivity C-reactive protein in 440 coronary artery disease
patients. In Study 3, 10 patients with coronary artery disease homozygotes
for the GCH1 X haplotype (XX) and 40 without the haplotype (OO) underwent
S Typhi vaccination. XX patients were unable to increase plasma BH4 and
had a greater reduction of flow-mediated dilation than OO patients. In
Study 4, vessel segments from 19 patients undergoing coronary bypass
surgery were incubated with or without cytokines (interleukin-6/tumor
necrosis factor-alpha/lipopolysaccharide) for 24 hours. Cytokine
stimulation upregulated GCH1 expression, increased vascular BH4, and
improved vasorelaxation in response to acetylcholine, which was inhibited
by the GTP-cyclohydrolase inhibitor 2,4-diamino-6-hydroxypyrimidine.
CONCLUSIONS-: The ability to increase vascular GCH1 expression and BH4
synthesis in response to inflammation preserves endothelial function in
inflammatory states. These novel findings identify BH4 as a vascular
defense mechanism against inflammation-induced endothelial dysfunction.
2011 American Heart Association, Inc.
<5>
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Accession Number
2011594721
Authors
Murphy G.S. Szokol J.W. Avram M.J. Greenberg S.B. Marymont J.H. Vender
J.S. Gray J. Landry E. Gupta D.K.
Institution
(Murphy, Szokol, Greenberg, Marymont, Vender, Gray, Landry) Department of
Anesthesiology, NorthShore University HealthSystem, University of Chicago
Pritzker School of Medicine, Chicago, IL, United States
(Avram) Department of Anesthesiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Gupta) Departments of Anesthesiology and Neurological Surgery,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
Title
Intraoperative acceleromyography monitoring reduces symptoms of muscle
weakness and improves quality of recovery in the early postoperative
period.
Source
Anesthesiology. 115 (5) (pp 946-954), 2011. Date of Publication:
November 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: The subjective experience of residual neuromuscular blockade
after emergence from anesthesia has not been examined systematically
during postanesthesia care unit (PACU) stays. The authors hypothesized
that acceleromyography monitoring would diminish unpleasant symptoms of
residual paresis during recovery from anesthesia by reducing the
percentage of patients with train-of-four ratios less than 0.9. Methods:
One hundred fifty-five patients were randomized to receive intraoperative
acceleromyography monitoring (acceleromyography group) or conventional
qualitative train-of-four monitoring (control group). Neuromuscular
management was standardized, and extubation was performed when defined
criteria were achieved. Immediately upon a patient's arrival to the PACU,
the patient's train-of-four ratios were measured using acceleromyography,
and a standardized examination was used to assess 16 symptoms and 11 signs
of residual paresis. This examination was repeated 20, 40, and 60 min
after PACU admission. RESULTS:: The incidence of residual blockade
(train-of-four ratios less than 0.9) was reduced in the acceleromyography
group (14.5% vs. 50.0% control group, with the 99% confidence interval for
this 35.5% difference being 16.4-52.6%, P < 0.0001). Generalized linear
models revealed the acceleromyography group had less overall weakness
(graded on a 0-10 scale) and fewer symptoms of muscle weakness across all
time points (P < 0.0001 for both analyses), but the number of signs of
muscle weakness was small from the time of arrival in the PACU and did not
differ between the groups at any time. CONCLUSION:: Acceleromyography
monitoring reduces the incidence of residual blockade and associated
unpleasant symptoms of muscle weakness in the PACU and improves the
overall quality of recovery. 2011 the American Society of
Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology.
<6>
Accession Number
2011596474
Authors
Siegelaar S.E. Hickmann M. Hoekstra J.B.L. Holleman F. DeVries J.H.
Institution
(Siegelaar, Hickmann, Hoekstra, Holleman, DeVries) Department of Internal
Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam,
Netherlands
Title
The effect of diabetes on mortality in critically ill patients: A
systematic review and meta-analysis.
Source
Critical Care. 15 (5) , 2011. Article Number: R205. Date of
Publication: 13 Sep 2011.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Introduction: Critically ill patients with diabetes are at increased risk
for the development of complications, but the impact of diabetes on
mortality is unclear. We conducted a systematic review and meta-analysis
to determine the effect of diabetes on mortality in critically ill
patients, making a distinction between different ICU types.Methods: We
performed an electronic search of MEDLINE and Embase for studies published
from May 2005 to May 2010 that reported the mortality of adult ICU
patients. Two reviewers independently screened the resultant 3,220
publications for information regarding ICU, in-hospital or 30-day
mortality of patients with or without diabetes. The number of deaths among
patients with or without diabetes and/or mortality risk associated with
diabetes was extracted. When only crude survival data were provided, odds
ratios (ORs) and standard errors were calculated. Data were synthesized
using inverse variance with ORs as the effect measure. A random effects
model was used because of anticipated heterogeneity.Results: We included
141 studies comprising 12,489,574 patients, including 2,705,624 deaths
(21.7%). Of these patients, at least 2,327,178 (18.6%) had diabetes.
Overall, no association between the presence of diabetes and mortality
risk was found. Analysis by ICU type revealed a significant disadvantage
for patients with diabetes for all mortality definitions when admitted to
the surgical ICU (ICU mortality: OR [95% confidence interval] 1.48 [1.04
to 2.11]; in-hospital mortality: 1.59 [1.28 to 1.97]; 30-day mortality:
1.62 [1.13 to 2.34]). In medical and mixed ICUs, no effect of diabetes on
all outcomes was found. Sensitivity analysis showed that the disadvantage
in the diabetic surgical population was attributable to cardiac surgery
patients (1.77 [1.45 to 2.16], P < 0.00001) and not to general surgery
patients (1.21 [0.96 to 1.53], P = 0.11).Conclusions: Our meta-analysis
shows that diabetes is not associated with increased mortality risk in any
ICU population except cardiac surgery patients. 2011 Siegelaar et al.;
licensee BioMed Central Ltd.
<7>
Accession Number
2011593634
Authors
Wagner T.H. Sethi G. Holman W. Lee K. Bakaeen F.G. Upadhyay A. McFalls E.
Tobler H.G. Kelly R.F. Crittenden M.D. Thai H. Goldman S.
Institution
(Wagner, Lee, Upadhyay) Veterans Affairs Health Care System, Palo Alto,
CA, United States
(Sethi, Thai, Goldman) Southern Arizona VA Health Care System, University
of Arizona, Tucson, AZ, United States
(Holman) Veterans Affairs Medical Center, Birmingham, AL, United States
(Bakaeen, Kelly) Michael E. DeBakey VA Medical Center, Baylor College of
Medicine, Houston, TX, United States
(McFalls) Veterans Affairs Medical Center, Minneapolis, MN, United States
(Tobler) Central Arkansas Veterans Healthcare System, Little Rock, AR,
United States
(Crittenden) Veterans Affairs Health Care Center, West Roxbury, MA, United
States
Title
Costs and quality of life associated with radial artery and saphenous vein
cardiac bypass surgery: Results from a Veterans Affairs multisite trial.
Source
American Journal of Surgery. 202 (5) (pp 532-535), 2011. Date of
Publication: November 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: In coronary artery bypass grafting (CABG) surgery, there is
uncertainty about whether the radial artery affects quality of life or
costs relative to the saphenous vein. This study compared the cost and
quality of life for patients randomized to either radial artery or
saphenous vein grafts. Methods: We analyzed the duration and cost of the
index surgery and costs and quality of life (Seattle Angina Questionnaire
and Health Utility Index) at 1 year for 726 participants. Results: The 2
treatment groups had similar baseline characteristics. Using the radial
artery added approximately 31 minutes to the surgery (from skin incision
to skin closure; P <.001) compared with a saphenous vein graft. There were
no significant differences in terms of costs and quality of life after the
index hospitalization or at 1 year. Conclusions: Coronary artery bypass
grafting with the radial artery lasts approximately 31 minutes longer than
with the saphenous vein. However, costs and the quality of life were not
statistically different. 2011 Elsevier Inc.
<8>
Accession Number
2011594962
Authors
Sanders J. Patel S. Cooper J. Berryman J. Farrar D. Mythen M. Montgomery
H.E.
Institution
(Sanders, Patel, Cooper, Berryman, Farrar, Mythen, Montgomery) UCL Centre
for Cardiovascular Genetics, UCL Institute for Human Health and
Performance, University College London, United Kingdom
(Sanders, Patel, Cooper, Berryman, Farrar, Mythen, Montgomery) Department
of Anaesthetics and Critical Care, Heart Hospital, United Kingdom
(Sanders, Patel, Cooper, Berryman, Farrar, Mythen, Montgomery) Division of
Pathology, University College London NHS Foundation Trust, 1st Floor Maple
House, London, United Kingdom
Title
Red blood cell storage is associated with length of stay and renal
complications after cardiac surgery.
Source
Transfusion. 51 (11) (pp 2286-2294), 2011. Date of Publication: November
2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: The association of red blood cell (RBC) storage on morbidity
outcome after cardiac surgery is debated. We sought to clarify the
association of the age of transfused blood on outcome in patients
undergoing cardiac surgery. Study Desing and Methods: Data were drawn from
a prospective, observational cohort study of morbidity outcome in patients
undergoing cardiac surgery. Blood transfusion data were obtained
retrospectively via the Trust blood bank electronic records. Old blood was
defined as more than 14 days old. The primary outcome measure was
postoperative length of stay (PLOS). Secondary outcome measures included
renal failure and morbidity as defined within the postoperative morbidity
survey. Results: A total of 176 (39.6%) of 444 participants received a
blood transfusion. Patients transfused with new blood had a reduced PLOS
compared with patients receiving exclusively old or any old blood (old
blood +/- new blood; 7 days vs. 8 days, p = 0.04 and vs. 10 days, p =
0.002, respectively). In patients who only had 1 unit transfused, PLOS was
longer in those receiving only old blood compared with those receiving
only new blood (8 days vs. 6 days, p = 0.02) with a 3.8-fold risk of
longer stay. Compared with patients receiving exclusively new blood,
patients receiving any old blood had a higher incidence of new renal
complications (65.7% vs. 43.9%, p = 0.008). Each 1-day increase in storage
was associated with a 7% increase in risk of new renal complications.
Conclusion: Our data support previous suggestions of an association
between transfusion of older RBCs and poorer outcome in cardiac surgery
patients. Randomized controlled trials are required to determine the true
causal nature of any such association. 2011 American Association of Blood
Banks.
<9>
Accession Number
2011598427
Authors
Dungan K. Hall C. Schuster D. Osei K.
Institution
(Dungan, Hall, Schuster, Osei) Division of Endocrinology, Diabetes and
Metabolism, The Ohio State University, Columbus, OH, United States
Title
Differential response between diabetes and stress-induced hyperglycaemia
to algorithmic use of detemir and flexible mealtime aspart among stable
postcardiac surgery patients requiring intravenous insulin.
Source
Diabetes, Obesity and Metabolism. 13 (12) (pp 1130-1135), 2011. Date of
Publication: December 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aim: To determine whether an insulin algorithm could be used in a similar
manner in the setting of diabetes and stress hyperglycaemia following
cessation of intravenous (IV) insulin after cardiac surgery. Methods:
Subjects who were clinically stable, requiring >=1 unit/h of IV insulin 48
h after surgery, were randomized to once daily detemir at 50, 65 or 80% of
IV insulin requirements and received aspart according to carbohydrate
intake. Diabetes was defined as any history of diabetes or preoperative
HbA1c 6.5%. Results: The morning glucose in patients with diabetes was 143
mg/dl (n = 61) vs. 124 mg/dl in those with stress hyperglycaemia (n = 21,
p = 0.05) on day 1 and 127 vs. 110 mg/dl over 72 h (p = 0.01). This was
unaffected by adjustment for initial dosing group. At 72 h, 56% of
patients with stress hyperglycaemia reached AM (80-130 mg/dl) and 87%
reached overall (80-180 mg/dl) glucose targets, compared to 90 and 100% of
patients with stress hyperglycaemia, respectively. There was no difference
in hypoglycaemia in patients with stress hyperglycaemia or diabetes. The
percentage of patients with diabetes receiving insulin was 46% on
admission and 77% at discharge, compared to 0 and 42% of patients with
stress hyperglycaemia. Conclusions: Following cardiac surgery, patients
with stress hyperglycaemia may be converted from IV insulin to detemir
with a 50% conversion factor, while patients with diabetes may require a
higher conversion factor. Stress hyperglycaemia may be prolonged; the
intensity and duration of insulin therapy required for optimal outcomes
warrants further examination. 2011 Blackwell Publishing Ltd.
<10>
Accession Number
2011598157
Authors
Goharian V. Tabatabaee S.A. Mozafarhashemi S. Mohajery G. Ramezani M.A.
Shabani F. Motevalliemami Z.
Institution
(Goharian, Tabatabaee, Mozafarhashemi, Mohajery) Department of Surgery,
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Ramezani) Department of Cancer Control and Prevention, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Shabani, Motevalliemami) Institute of Novin Tahlilgaran-e-Nesf-e-Jahan,
Isfahan, Iran, Islamic Republic of
Title
A comparison between subpleural patient-controlled analgesia by
bupivacaine and intermittent analgesia in post-operative thoracotomy: A
double-blind randomized clinical trial.
Source
Journal of Research in Medical Sciences. 16 (9) (pp 1210-1216), 2011.
Date of Publication: September 2011.
Publisher
Isfahan University of Medical Sciences (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
BACKGROUND: The efficacy of subpleural analgesia to reduce postoperative
pain intensity in patients after lateral thoracotomy is controversial. In
this study, we demonstrated the efficacy of two types of subpleural
analgesia. METHODS: This prospective, controlled, randomized, double-blind
trial was performed in Department of Thoracic Surgery of Alzahra Hospital
associated with Isfahan University of Medical Sciences from June 2009
until August 2010. After posterolateral thoracotomy and admission to the
ICU, patients were randomly assigned into two groups of subpleural
patient-controlled analgesia (SPCA) (0.02 cc/kg/h of 0.5% bupivacaine) and
subpleural intermittent analgesia (SIA) (0.1cc/kg/6h of 0.5% bupivacaine).
The data regarding age, sex, visual analog scale (VAS) (at 8, 16 and 24
hours after initiation of analgesia), morphine consumption, systemic
adverse effects, length of ICU and hospital stay, complications, public
health service (PHS) criteria, and cost was recorded. Data was analyzed by
Mann-Whitney U-test, repeated measured test, chi-square test and the
Fisher's exact test. A p < 0.05 was considered significant. RESULTS: The
study population consisted of 90 patients. There were no significant
differences in sex, age, weight, intraoperative analgesics, duration of
one-lung ventilation, and adverse effects between the SPCA and SIA groups.
Although pain scores were significantly reduced at 16 hours after the
first subpleural instillation of bupivacaine 0.5% with patient-controlled
analgesia, comparison between mean pain scores in the two groups at 8 and
24 hours after the first subpleural instillation of bupivacaine 0.5%
revealed no significant difference. In addition, no significant difference
was found in VAS scores at the three evaluated times (p < 0.05).
CONCLUSIONS: Optimal use of SPCA bupivacaine for postoperative pain
treatment is more effective in pain reduction than SIA bupivacaine. The
consumption rate of opioid and bupivacaine was also decreased in SPCA
group.
<11>
Accession Number
2011586430
Authors
Li W.-M. Yang X.-C. Wang L.-F. Ge Y.-G. Wang H.-S. Xu L. Ni Z.-H. Zhang
D.-P.
Institution
(Li, Yang, Wang, Ge, Wang, Xu, Ni, Zhang) The Heart Center, Beijing Chao
Yang Hospital, Capital Medical University, Beijing 100020, China
Title
Comparison of tirofiban combined with dalteparin or unfractionated heparin
in primary percutaneous coronary intervention of acute ST-segment
elevation myocardial infarction patients.
Source
Chinese Medical Journal. 124 (20) (pp 3275-3280), 2011. Date of
Publication: November 2011.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Primary percutaneous coronary intervention (PCI) is the best
treatment of choice for acute ST segment elevation myocardial infarction
(STEMI). This study aimed to determine the clinical outcomes of tirofiban
combined with the low molecular weight heparin (LMWH), dalteparin, in
primary PCI patients with acute STEMI. Methods From February 2006 to July
2006, a total of 120 patients with STEMI treated with primary PCI were
randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group
I: 60 patients, (61.2+/-9.5) years), and dalteparin with tirofiban (group
II: 60 patients, (60.5+/-10.1) years). Major adverse cardiac events (MACE)
during hospitalization and at 4 years after PCI were examined. Bleeding
complications during hospitalization were also examined. Results There
were no significant differences in sex, mean age, risk factors, past
history, inflammatory marker, or echocardiography between the 2 groups. In
terms of the target vessel and vascular complexity, there were no
significant differences between the 2 groups. During the first 7 days,
emergent revascularization occurred only in 1 patient (1.7%) in group I.
Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I
and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%)
in group II died. Total in-hospital MACE during the first 7 days was 4
(6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were
observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in
group II, however, the difference was not statistically significant. No
significant intracranial bleeding was observed in either group. Four years
after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%)
in group II. MACE occurred in 12 (20.0%) patients in group I and in 10
(16.7%) patients in group II. Conclusions Dalteparin was effective and
safe in primary PCI of STEMI patients and combined dalteparin with
tirofiban was effective and safe without significant bleeding
complications compared with UFH. Although there was no statistically
significant difference, LMWH decreased the bleeding complications compared
with UFH.
<12>
Accession Number
2011581436
Authors
Ji Q. Mei Y. Wang X. Feng J. Wusha D. Cai J. Zhou Y.
Institution
(Ji, Mei, Wang, Feng, Cai, Zhou) Department of Thoracic Cardiovascular
Surgery, Tongji Hospital, Shanghai, China
(Wusha) Department of Surgery, Tongji University Medical School, Tongji
University, Shanghai, China
Title
Effect of ischemic postconditioning in correction of tetralogy of Fallot.
Source
International Heart Journal. 52 (5) (pp 312-317), 2011. Date of
Publication: September 2011.
Publisher
International Heart Journal Association (7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan)
Abstract
Inappropriate myocardial protection is considered one of the main causes
of mortality and morbidity in the correction of tetralogy of Fallot (TOF).
Results of previous reports about the effects of ischemic postconditioning
on myocar-dial protection in animals and humans are very encouraging. This
randomized and controlled trial aimed to assess the effect of ischemic
postconditioning on protection against myocardial ischemia reperfusion
injury in TOF patients receiving cardioplegia. From January 2008 to June
2010, 80 consecutive children undergoing correction of TOF were enrolled
and randomly assigned to either a postconditioning group (three cycles of
30 seconds of ischemia and 30 seconds of reperfusion using re-clamping and
de-clamping starting 30 seconds after the initial de-clamping of the
aorta, n = 41) or a control group (n = 39). Cardiac troponin I (cTnI) was
assayed preoperatively, and then 4 hours, 8 hours, 12 hours, 20 hours, and
48 hours after persistent reperfusion. The pre-, intra- and postoperative
relevant data of all selected patients were analyzed. As a result,
ischemic postconditioning reduced postoperative peak release by 45% for
cTnI compared with the control group (0.43 +/- 0.18 ng/mL versus 0.78 +/-
0.15 ng/mL, P < 0.0001). Ischemic postconditioned patients had a lower
peak inotropic score during the frst postoperative 24 hours (5.6 +/- 2.2
mug/kg/minute versus 8.6 +/- 3.6 mug/kg/minute, P < 0.0001), extubation
time (21.5 +/- 7.3 hours versus 30.2 +/- 12.4 hours, P = 0.0002) and
length of ICU stay (43.4 +/- 12.6 hours versus 56.3 +/- 17.8 hours, P =
0.0003), while they had a higher cardiac output on the frst postoperative
day (1.41 +/- 0.26 L/minute versus 1.28 +/- 0.25 L/minute, P = 0.0255) as
compared to the control group. In conclusion, ischemic postconditioning
may to some extent provide myocardial protection in children undergoing
correction of tetralogy of Fallot.
<13>
Accession Number
2011577426
Authors
Suh J.-W. Mehran R. Claessen B.E. Xu K. Baber U. Dangas G. Parise H.
Lansky A.J. Witzenbichler B. Grines C.L. Guagliumi G. Kornowski R. Wohrle
J. Dudek D. Weisz G. Stone G.W.
Institution
(Suh, Mehran, Claessen, Xu, Parise, Lansky, Weisz, Stone) Mount Sinai
Hospital, Cardiovascular Research Foundation, 111 East 59th Street, New
York, NY 10022, United States
(Mehran, Baber, Dangas) Mount Sinai School of Medicine, New York, NY,
United States
(Lansky, Weisz, Stone) Columbia University Medical Center, New York, NY,
United States
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Grines) William Beamont Hospital, Royal Oak, MI, United States
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Kornowski) Rabin Medical Center, Petach Tikva, Israel
(Wohrle) University of Ulm, Ulm, Germany
(Dudek) Jagiellonian University, Krakow, Poland
Title
Impact of in-hospital major bleeding on late clinical outcomes after
primary percutaneous coronary intervention in acute myocardial infarction:
The HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents
in Acute Myocardial Infarction) trial.
Source
Journal of the American College of Cardiology. 58 (17) (pp 1750-1756),
2011. Date of Publication: 18 Oct 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: We aimed to investigate the long-term prognosis of patients
with in-hospital major bleeding (IHMB). Background: The effect of IHMB on
the long-term prognosis of patients undergoing primary percutaneous
coronary intervention (PCI) for ST-segment elevation myocardial infarction
is unknown. Methods: Primary PCI was performed in 3,345 (92.9%) of 3,602
patients in the HORIZONS-AMI (Harmonizing Outcomes With Revascularization
and Stents in Acute Myocardial Infarction) trial; in-hospital
protocol-defined noncoronary artery bypass graftrelated major bleeding
developed in 231 (6.9%). We examined medication use at discharge,
mortality, and major adverse cardiovascular events (composite of death,
reinfarction, stroke, or ischemic target vessel revascularization) at
3-year follow-up in patients with and without IHMB. Results: At 3-year
follow-up, patients with IHMB had higher mortality (24.6% vs. 5.4%, p <
0.0001) and major adverse cardiovascular events (40.3% vs. 20.5%, p <
0.0001). The deleterious effect of major bleeding was observed within 1
month, between 1 month and 1 year, and between 1 and 3 years. IHMB was an
independent predictor of mortality (hazard ratio: 2.80; 95% confidence
interval: 1.89 to 4.16, p < 0.0001) at 3-year follow up. Conclusions:
Patients with IHMB after primary PCI have significantly increased 3-year
rates of morbidity and mortality. Further investigation is warranted to
understand the mechanisms underlying this relationship and to further
improve outcomes in patients with ST-segment myocardial infarction. 2011
American College of Cardiology Foundation.
<14>
Accession Number
2011577422
Authors
Benck U. Hoeger S. Brinkkoetter P.T. Gottmann U. Doenmez D. Boesebeck D.
Lauchart W. Gummert J. Karck M. Lehmkuhl H.B. Bittner H.B. Zuckermann A.
Wagner F. Schulz U. Koch A. Bigdeli A.K. Bara C. Hirt S. Berchtold-Herz M.
Brose S. Herold U. Boehm J. Welp H. Strecker T. Doesch A. Birck R. Krmer
B.K. Yard B.A. Schnuelle P.
Institution
(Benck, Hoeger, Gottmann, Doenmez, Birck, Krmer, Yard, Schnuelle)
University Medical Centre Mannheim, 5th Department of Medicine, Theodor
Kutzer Ufer 1-3, Mannheim 68167, Germany
(Brinkkoetter) Department of Medicine, Centre for Molecular Medicine,
University of Cologne, Cologne, Germany
(Boesebeck) Organ Procurement Organization of Bavaria, Munich, Germany
(Lauchart) Organ Procurement Organization of Baden-Wrttemberg, Stuttgart,
Germany
(Gummert, Schulz) Heart and Diabetes Center North Rhine-Westphalia, Bad
Oeynhausen, Germany
(Karck, Koch, Doesch) University Hospital Heidelberg, Heidelberg, Germany
(Lehmkuhl) German Heart Institute Berlin, Berlin, Germany
(Bittner) Heart Center Leipzig, Leipzig, Germany
(Zuckermann) Medical University of Vienna, Vienna, Austria
(Wagner) University Heart Center Hamburg-Eppendorf, Hamburg, Germany
(Bigdeli) Klinikum Grosshadern, Ludwig Maximilians University of Munich,
Munich, Germany
(Bara) Hannover Medical School, Hannover, Germany
(Hirt) University Hospital Regensburg, Regensburg, Germany
(Berchtold-Herz) University Medical Center Freiburg, Freiburg, Germany
(Brose) University Heart Center Dresden, Dresden, Germany
(Herold, Boehm) German Heart Center Munich, Munich, Germany
(Welp) University Hospital Mnster, Munster, Germany
(Strecker) University Hospital Erlangen, Erlangen, Germany
Title
Effects of donor pre-treatment with dopamine on survival after heart
transplantation: A cohort study of heart transplant recipients nested in a
randomized controlled multicenter trial.
Source
Journal of the American College of Cardiology. 58 (17) (pp 1768-1777),
2011. Date of Publication: 18 Oct 2011.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: We determined the outcome of cardiac allografts from
multiorgan donors enrolled in a randomized trial of donor pre-treatment
with dopamine. Background: Treatment of the brain-dead donor with low-dose
dopamine improves immediate graft function after kidney transplantation.
Methods: A cohort study of 93 heart transplants from 21 European centers
was undertaken between March 2004 and August 2007. We assessed
post-transplant left ventricular function (LVF), requirement of a left
ventricular assist device (LVAD) or biventricular assist device (BVAD),
need for hemofiltration, acute rejection, and survival of recipients of a
dopamine-treated versus untreated graft. Results: Donor dopamine was
associated with improved survival 3 years after transplantation (87.0% vs.
67.8%, p = 0.03). Fewer recipients of a pre-treated graft required
hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF
(15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p =
0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were
not statistically different between groups. Post-transplant impaired LVF
(hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p <
0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001),
and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were
predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12
to 0.89; p = 0.03) after adjustment for various risks affecting mortality,
including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney
function. Conclusions: Treatment of brain-dead donors with dopamine of 4
mug/kg/min will not harm cardiac allografts but appears to improve the
clinical course of the heart allograft recipient. 2011 American College
of Cardiology Foundation.
<15>
Accession Number
21833943
Authors
Whalley B. Rees K. Davies P. Bennett P. Ebrahim S. Liu Z. West R. Moxham
T. Thompson D.R. Taylor R.S.
Institution
(Whalley) Centre for Multilevel Modelling, Graduate School of Education,
University of Bristol, 2 Priory Road, Bristol, UK, BS8 1TX.
Title
Psychological interventions for coronary heart disease.
Source
Cochrane database of systematic reviews (Online). (8) (pp CD002902),
2011. Date of Publication: 2011.
Abstract
Psychological symptoms are strongly associated with coronary heart disease
(CHD), and many psychological treatments are offered following cardiac
events or procedures. Update the existing Cochrane review to (1) determine
the independent effects of psychological interventions in patients with
CHD (principal outcome measures included total or cardiac-related
mortality, cardiac morbidity, depression, and anxiety) and (2) explore
study-level predictors of the impact of these interventions. The original
review searched Cochrane Controleed Trials Register (CCTR, Issue 4, 2001),
MEDLINE, EMBASE, PsycINFO, and CINAHL to December 2001. This was updated
by searching the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE and EMBASE, PsycINFO and CINAHL from 2001 to January 2009. In
addition, we searched reference lists of papers, and expert advice was
sought for the original and update review. Randomised controlled trials of
psychological interventions compared to usual care, administered by
trained staff. Only studies estimating the independent effect of the
psychological component with a minimum follow-up of six months. Adults
with specific diagnosis of CHD. Titles and abstracts of all references
screened for eligibility by two reviewers independently; data extracted by
the lead author and checked by a second reviewer. Authors contacted where
possible to obtain missing information. There was no strong evidence that
psychological intervention reduced total deaths, risk of
revascularisation, or non-fatal infarction. Amongst a smaller group of
studies reporting cardiac mortality there was a modest positive effect of
psychological intervention (relative risk: 0.80 (95% CI 0.64 to 1.00)).
Furthermore, psychological intervention did result in small/moderate
improvements in depression, standardised mean difference (SMD): -0.21 (95%
CI -0.35, -0.08) and anxiety, SMD: -0.25 (95% CI -0.48 to -0.03). Results
for mortality indicated some evidence of small-study bias, though results
for other outcomes did not. Meta regression analyses revealed four
significant predictors of intervention effects on depression were found:
(1) an aim to treat type-A behaviours (B = -0.32, p = 0.03) were more
effective than other interventions. In contrast, interventions which (2)
aimed to educate patients about cardiac risk factors (B = 0.23, p = 0.03),
(3) included client-led discussion and emotional support as core
therapeutic components (B = 0.31, p < 0.01), or (4) included family
members in the treatment process (B = 0.26, p < 0.01) were significantly
less effective. Psychological treatments appear effective in treating
psychological symptoms of CHD patients. Uncertainly remains regarding the
subgroups of patients who would benefit most from treatment and the
characteristics of successful interventions.
<16>
Accession Number
2011593818
Authors
Horbach S.J. Lopes R.D. Guaragna J.C.V.D.C. Martini F. Mehta R.H. Petracco
J.B. Bodanese L.C. Filho A.C. Cirenza C. De Paola A.A.V.
Institution
(Horbach, Martini, Filho, Cirenza, De Paola) Division of Invasive Clinical
Electrophysiology, Department of Cardiology, Universidade Federal de Sao
Paulo, Brazil
(Lopes, Mehta) Duke Clinical Research Institute, Box 3850, 2400 Pratt
Street, Terrace Level, Durham, NC 27705, United States
(Guaragna, Petracco, Bodanese) Division of Cardiology of Pontificia,
Universidade Catolica Do Rio Grande Do sul, Porto Alegre, Brazil
(Lopes, Cirenza, De Paola) Brazilian Clinical Research Institute, Sao
Paulo, Brazil
Title
Naproxen as prophylaxis against atrial fibrillation after cardiac surgery:
The NAFARM randomized trial.
Source
American Journal of Medicine. 124 (11) (pp 1036-1042), 2011. Date of
Publication: November 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Purpose: We sought to assess the effect of naproxen versus placebo on
prevention of atrial fibrillation after coronary artery bypass graft
(CABG) surgery. Methods: In this randomized, double-blind,
placebo-controlled, single-center trial of 161 consecutive patients
undergoing CABG surgery, patients received naproxen 275 mg every 12 hours
or placebo at the same dosage and interval over 120 hours immediately
after CABG surgery. The primary outcome was the occurrence of atrial
fibrillation in the first 5 postoperative days. Results: The incidence of
postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus
7.3% (6/82) in the naproxen group (P =.11). The duration of atrial
fibrillation episodes was significantly lower in the naproxen (0.35 hours)
versus placebo group (3.74 hours; P =.04). There was no difference in the
overall days of hospitalization between placebo (17.23 +/- 7.39) and
naproxen (18.33 +/- 9.59) groups (P =.44). Intensive care unit length of
stay was 4.0 +/- 4.57 days in the placebo and 3.23 +/- 1.25 days in the
naproxen group (P =.16). The trial was stopped by the data monitoring
committee before reaching the initial target number of 200 patients
because of an increase in renal failure in the naproxen group (7.3% vs
1.3%; P =.06). Conclusions: Postoperative use of naproxen did not reduce
the incidence of atrial fibrillation but decreased its duration, in a
limited sample of patients after CABG surgery. There was a significant
increase in acute renal failure in patients receiving naproxen 275 mg
twice daily. Our study does not support the routine use of naproxen after
CABG surgery for the prevention of atrial fibrillation. 2011 Elsevier
Inc. All rights reserved.
<17>
Accession Number
2011593681
Authors
Glineur D. D'Hoore W. De Kerchove L. Noirhomme P. Price J. Hanet C. El
Khoury G.
Institution
(Glineur, D'Hoore, De Kerchove, Noirhomme, Price, Hanet, El Khoury)
Department of Cardiovascular Medicine and Surgery, Cliniques Universitaire
St Luc, Brussels, Belgium
Title
Angiographic predictors of 3-year patency of bypass grafts implanted on
the right coronary artery system: A prospective randomized comparison of
gastroepiploic artery, saphenous vein, and right internal thoracic artery
grafts.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (5) (pp 980-988),
2011. Date of Publication: November 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Saphenous vein, in situ right gastroepiploic artery, and right
internal thoracic artery grafts are routinely used to revascularize the
right coronary artery. Little is known about the predictive value of
objective preoperative angiographic parameters on midterm graft patency.
Methods: We prospectively enrolled 210 consecutive patients undergoing
coronary revascularization. Revascularization of the right coronary artery
was randomly performed with the saphenous vein grafts in 81 patients and
the right gastroepiploic artery in 92 patients. During the same study
period, 37 patients received right coronary artery revascularization with
the right internal thoracic artery used in a Y-composite fashion. All
patients underwent a protocol-driven coronary angiogram 3 years after
surgery. Preoperative angiographic parameters included minimum lumen
diameter percent stenosis measured by quantitative angiography. A graft
was considered "not functional" with patency scores of 0 to 2 and
"functional" with patency scores of 3 or 4. Results: Angiographic
follow-up was 100% complete. A significant difference in the distribution
of flow patterns was observed in the 3 groups. In multivariate analysis,
the use of a saphenous vein graft was associated with superior graft
functionality compared with the other conduits (odds ratio, 6.1; 95%
confidence interval, 2.4-15). Graft function was negatively influenced by
the minimum lumen diameter (odds ratio, 0.11; confidence interval,
0.05-0.25). In the right gastroepiploic artery and right internal thoracic
artery groups, the proportion of functional grafts was higher when the
minimum lumen diameter was below a threshold value in the third minimum
lumen diameter quartile (0.64-1.30 mm). Conclusions: Preoperative
angiography predicts graft patency in the right gastroepiploic artery and
right internal thoracic artery, whereas the flow pattern in saphenous vein
grafts is significantly less influenced by quantitative angiographic
parameters. 2011 by The American Association for Thoracic Surgery.
<18>
Accession Number
2011593546
Authors
Katritsis D.G. Korovesis S. Tzanalaridou E. Giazitzoglou E. Zografos T.
Meier B.
Institution
(Katritsis, Korovesis, Tzanalaridou, Giazitzoglou, Zografos) Demosthenes
G. Katritsis, Department of Cardiology, Athens Euroclinic, Athens, Greece
(Meier) University Hospital Bern, Bern, Switzerland
Title
Spot drug-eluting stenting for long coronary stenoses: Long-term results
of a randomized clinical study.
Source
Journal of Interventional Cardiology. 24 (5) (pp 437-441), 2011. Date of
Publication: October 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Preliminary results of a randomized trial have suggested that
total lesion coverage with drug-eluting stents (DES) is not necessary in
the presence of diffuse disease of nonuniform severity. In the present
study, we report long-term results of this trial. Methods: Consecutive,
consenting patients with a long (>20 mm) coronary lesion of nonuniform
severity and indication for percutaneous coronary intervention were
randomized to full stent coverage of the atherosclerotic lesion with
multiple, overlapping (full DES group, n = 90) or spot stenting of the
hemodynamically significant parts of the lesion only (defined as diameter
stenosis > 50%) (spot DES group, n = 89). Results: At a follow-up of 2-7
years, 30 patients with full DES (33.3%) and 12 patients (13.5%) with spot
DES had a major adverse cardiac event (MACE) (P = 0.015). Cox proportional
hazard model showed that the risk for MACE was almost 65% lower among
patients who were subjected to spot DES compared to those who underwent
full DES (HR = 0.35, 95% CI = 0.18-0.68, P = 0.002). This association
remained significant even after controlling for age, sex, and lesion
length, and the type of stent used (HR = 0.41, 95% CI = 0.20-0.81, P =
0.011). Conclusions: In the presence of diffuse disease of nonuniform
severity, selective stenting of only the significantly stenosed parts of
the lesion confers better long-term results compared to total lesion
coverage with DES. 2011, Wiley Periodicals, Inc.
<19>
Accession Number
2011590254
Authors
Van Der Meij B.S. Van Bokhorst-De Van Der Schueren M.A.E. Langius J.A.E.
Brouwer I.A. Van Leeuwen P.A.M.
Institution
(Van Der Meij, Van Bokhorst-De Van Der Schueren, Langius) Department of
Nutrition and Dietetics, Internal Medicine, VU University Medical Center
Amsterdam, Amsterdam, Netherlands
(Van Leeuwen) Department of Surgery, VU University Medical Center
Amsterdam, PO Box 7057, 1007 MB Amsterdam, Netherlands
(Brouwer) Department of Health Sciences, EMGO+ Institute of Health and
Care Research, VU University, Amsterdam, Netherlands
Title
n-3 PUFAs in cancer, surgery, and critical care: A systematic review on
clinical effects, incorporation, and washout of oral or enteral compared
with parenteral supplementation.
Source
American Journal of Clinical Nutrition. 94 (5) (pp 1248-1265), 2011.
Date of Publication: 01 Nov 2011.
Publisher
American Society for Nutrition (9650 Rockville Pike, Bethesda MD
20814-3998, United States)
Abstract
Background: n-3 (omega-3) Fatty acids (FAs) may have beneficial effects in
patients with cancer or in patients who undergo surgery or critical care.
Objective: Our aim was to systematically review the effects of oral or
enteral and parenteral n-3 FA supplementation on clinical outcomes and to
describe the incorporation of n-3 FAs into phospholipids of plasma, blood
cells, and mucosal tissue and the subsequent washout in these patients.
Design: We investigated the supplementation of n-3 FAs in these patients
by using a systematic literature review. Results: In cancer, the oral or
enteral supplementation of n-3 FAs contributed to the maintenance of body
weight and quality of life but not to survival. We did not find any
studies on parenteral supplementation of n-3 FAs in cancer. In surgical
oncology, we did not find any studies on enteral supplementation of n-3
FAs. However, postoperative parenteral supplementation in surgical
oncology may reduce the length of a hospital stay. For general surgery, we
did not find any studies on enteral supplementation of n-3 FAs, and
evidence on parenteral supplementation was insufficient. In critical care,
enteral supplementation of n-3 FAs had beneficial effects on clinical
outcomes; evidence on parenteral supplementation in critical care was
inconsistent. The incorporation of n-3 FAs in plasma and blood cells was
slower with enteral supplementation (4-7 d) than with parenteral
supplementation (1-3 d). The washout was 5-7 d. Conclusions: This review
shows the beneficial effects of n-3 FA supplementation in cancer, surgical
oncology, and critical care patients. Supplementation in these specific
patient populations could be considered with the route of administration
taken into account. 2011 American Society for Nutrition.
<20>
Accession Number
2011586825
Authors
Dasari T.W. Heroux A.L. Peyton M. Saucedo J.F.
Institution
(Dasari, Saucedo) Section of Cardiovascular Medicine, Department of
Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma
City, OK, United States
(Heroux) Heart Failure and Heart Transplant Program, Division of
Cardiology, Loyola University Medical Center, Maywood, IL, United States
(Peyton) Section of Cardiothoracic Surgery, Department of Surgery,
University of Oklahoma, Oklahoma City, OK, United States
Title
Abdominal aortic aneurysms (AAA) post heart transplantation: A systematic
review of literature.
Source
Annals of Transplantation. 16 (3) (pp 147-152), 2011. Date of
Publication: 2011.
Publisher
Medical Science International (ul. Ustrzycka 11, Warsaw 02-141, Poland)
Abstract
Peripheral vascular disease is highly prevalent post heart transplantation
(HTx). The prevalence of abdominal aortic aneurysms (AAA) post HTx ranges
from 1.1-10%. We performed a Pub Med, EMBASE and Cochrane review search to
identify articles on AAA post HTx. Data gathered from published data
included: risk factors, progression of the aneurysm and clinical outcomes.
Five studies were included in the systematic review. Baseline demographic
data, clinical characteristics, data on AAA prevalence and
characteristics, the treatment strategies and follow up were extracted
from each of these studies. Our systematic review showed that the
prevalence of AAA post HTx ranged from 2-10% in the retrospective studies
and 6.5% in a single prospective study. Rupture rates during a follow up
period ranged from 11-38% and during that time period the mean aneurysmal
expansion rate ranged from 0.78+/-0.41cm/yr to 1.2+/-0.4 cm/yr. Male
gender, ischemic heart disease, corticosteroid use, smoking and improved
hemodynamics and ejection fraction post HTx were reported as possible
associated risk factors in the development of AAA. Open surgical
management was the treatment of choice although endovascular treatment was
used in a minority of patients. AAA is increasingly prevalent post HTx and
may be associated with greater rupture and expansion rates. Meticulous
follow up and further prospective clinical studies are warranted to
determine risk factors, expansion rates and clinical outcomes. Ann
Transplant.
<21>
Accession Number
2011593705
Authors
Caputo M. Patel N. Angelini G.D. De Siena P. Stoica S. Parry A.J. Rogers
C.A.
Institution
(Caputo, De Siena, Stoica, Parry) Bristol Royal Hospital for Children,
University of Bristol, Bristol BS2 8BJ, United Kingdom
(Caputo, Patel, Angelini, Rogers) Bristol Heart Institute, University of
Bristol, Bristol, United Kingdom
Title
Effect of normothermic cardiopulmonary bypass on renal injury in pediatric
cardiac surgery: A randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (5) (pp
1114-1121.e2), 2011. Date of Publication: November 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Hypothermic cardiopulmonary bypass (CPB), although associated
with a reduction in oxygen requirement, has a number of disadvantages
including detrimental effects on enzymatic function, energy generation,
and cellular integrity. Normothermic perfusion is potentially a more
physiologic method to maintain the functional integrity of major organ
systems. One of the aims of this trial was to compare the effect of
normothermic and hypothermic CPB on renal injury in pediatric patients
undergoing cardiac surgery. Methods: Fifty-nine children (median age, 78
months; interquartile range, 39-130) undergoing corrective cardiac surgery
were randomized to either hypothermic (28degreeC) or normothermic
(35degreeC-37degreeC) CPB. Urinary albumin, retinal binding protein (RBP)
and N-acetyl-beta-glucosaminidase (NAG) were measured preoperatively, end
of CPB, 4, and 24 hours postoperatively and were expressed as a ratio of
urinary creatinine. Serum creatinine was measured preoperatively, end of
CPB, and 24 and 48 hours postoperatively. Results are expressed as a
difference in means (normotheric - hypothermic) or as a ratio of geometric
means (normothermic/hypothermic). Results: Baseline characteristics were
similar in both groups. For these biochemical markers no significant
interactions between treatment and postintervention time were found. Serum
creatinine (-2.10; 95% confidence interval [CI], -6.51-2.31), RBP (ratio,
0.96; 95% CI, 0.65-1.41), and NAG (ratio, 0.86; 95% CI, 0.56-1.36) were
similar in the 2 groups (P >=.34), but the urinary albumin was
significantly lower in the normothermic group (ratio, 0.63; 95% CI,
0.42-0.95, P = .03). Conclusions: Normothermic CPB is associated with
similar renal impairment to hypothermic CPB in children undergoing heart
surgery. 2011 by The American Association for Thoracic Surgery.
<22>
Accession Number
2011593693
Authors
Muralidaran A. Detterbeck F.C. Boffa D.J. Wang Z. Kim A.W.
Institution
(Muralidaran, Detterbeck, Boffa, Kim) Section of Thoracic Surgery, School
of Medicine, Yale University, 330 Cedar St, BB 205, New Haven, CT 06520,
United States
(Wang) Department of Epidemiology and Public Health, Yale University, New
Haven, CT, United States
Title
Long-term survival after lung resection for non-small cell lung cancer
with circulatory bypass: A systematic review.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (5) (pp 1137-1142),
2011. Date of Publication: November 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: Resection of locally advanced non-small cell lung cancer using
circulatory bypass is not frequently performed. The objective of this
study was to systematically review the long-term survival associated with
the published studies dealing with the performance of lung resections for
non-small cell lung cancer using circulatory bypass. Methods: A systematic
review of publications dealing with lung resections for non-small cell
lung cancer under circulatory bypass spanning from January 1, 1990, to
December, 31 2010, was performed using a PubMed search with specific
inclusion and exclusion criteria. The primary end point collected was
survival. Several other clinical variables were also collected and
analyzed. Survival curves were calculated using the Kaplan-Meier method.
Univariate comparisons of survival were performed using a Cox proportional
hazard model. Multivariate analysis was carried out using a Cox regression
model. Results: The search algorithm yielded 20 articles for the analysis.
The overall 5-year survival was 37% (median, 36 +/- 6 months). Survival
was significantly higher when placement on bypass was planned (54%;
median, 67+/- 19 months) as opposed to unplanned or emergency placement
(11%; median, 19 +/- 6 months; P = .006). Multivariate analysis
demonstrated that the use of unplanned bypass was prognostic for a worse
long-term survival (hazard ratio = 0.28; 95% confidence interval,
0.09-0.90; P = .033). The 30-day and 90-day perioperative mortalities were
0% and 1%, respectively. Conclusions: The literature over the past 2
decades demonstrates that favorable long-term survival for extended
resections of locally advanced non-small cell lung cancer using
circulatory bypass can be achieved. The use of unplanned cardiopulmonary
bypass, though, seems to be prognostic of unfavorable long-term survival.
2011 by The American Association for Thoracic Surgery.
<23>
Accession Number
2011593682
Authors
Wang W. Buehler D. Feng X.D. Zhang S.Y.
Institution
(Wang, Buehler) Scripps Memorial Hospital, 9850 Genesee Ave, San Diego, CA
92037, United States
(Feng, Zhang) Shanxi Cardiovascular Hospital, Taiyuan, China
Title
Continuous biatrial pacing to prevent early recurrence of atrial
fibrillation after the Maze procedure.
Source
Journal of Thoracic and Cardiovascular Surgery. 142 (5) (pp 989-994),
2011. Date of Publication: November 2011.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objective: It has been suggested that overdrive biatrial pacing may
prevent the recurrence of atrial fibrillation after the Maze procedure. To
further evaluate this hypothesis, we performed a randomized prospective
study in 100 patients undergoing valve surgery concomitant with a full
Maze procedure to determine the effectiveness of biatrial pacing in the
postoperative period to reduce early recurrence of atrial fibrillation.
Method: Between January 2002 and December 2008, 100 patients undergoing
mitral valve +/- tricuspid valve surgery concomitant with the Maze
procedure were randomized into 2 equal groups: the study group using
overdrive biatrial pacing and a control group without pacing. One pacing
wire was attached to the crista terminalis area of the right atrium, and
the other pacing wire was attached to the Bachmann's bundle area located
in the roof of the left atrium. The atria were paced continuously in AAI
mode at a rate of 80 pulses per minute or 10 pulses above the underlying
rate for 5 days. The end points were the onset of recurrent atrial
fibrillation or discharge. Results: The incidence of recurrent
postoperative atrial fibrillation was significantly less in the study
group, with 6 of 50 patients (12%) incurring atrial fibrillation compared
with 18 of 50 patients (36%) in the control group (P < .01). The length of
hospital stay was significantly reduced in the study group (P < .01), and
the mean costs of hospital stay were significantly lower in the control
group (P < .05). Conclusions: Biatrial overdrive pacing is well tolerated
and more effective in preventing the early recurrence of atrial
fibrillation after the Maze procedure. This therapy also results in
shortened hospital stays and decreased hospital costs. However, the
impacts of the long-term results in the Maze procedure require further
study. 2011 by The American Association for Thoracic Surgery.
<24>
Accession Number
2011586915
Authors
Koster S. Hensens A.G. Schuurmans M.J. van der Palen J.
Institution
(Koster, Hensens) Dept. of Cardio Thoracic Surgery, Medisch Spectrum
Twente, Haaksbergerstraat 55, 7500 KA Enschede, Netherlands
(Schuurmans) University of Professional Education Utrecht, Department of
Healthcare, Netherlands
(Schuurmans) University Medical Center Utrecht, Nursing Science, Utrecht,
Netherlands
(van der Palen) Department of Epidemiology, Medisch Spectrum Twente,
Haaksbergerstraat 55, 7500 KA Enschede, Netherlands
(van der Palen) Department of Research Methodology, Measurement and Data
Analysis, Faculty of Behavioral Sciences, University of Twente, Enschede,
Netherlands
Title
Risk factors of delirium after cardiac surgery. A systematic review.
Source
European Journal of Cardiovascular Nursing. 10 (4) (pp 197-204), 2011.
Date of Publication: December 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Background: Delirium or acute confusion is a temporary mental disorder
that occurs frequently among hospitalized elderly patients, but also in
younger patients a delirium can develop. Patients who undergo cardiac
surgery have an increased risk of developing delirium that is associated
with many negative consequences. Therefore, prevention of delirium is
essential. Despite the high incidence of delirium, a paucity of data on
risk factors for delirium exists. Aim: The aim of this study was to
summarize the available information concerning these risk factors.
Methods: A literature research was performed using the PubMed, Cinahl, and
Cochrane Library databases and was limited to the last 10 years. Results:
Our review revealed 27 risk factors; 12 predisposing and 15 precipitating
factors for delirium after cardiac surgery. The most established
predisposing risk factors were atrial fibrillation, cognitive impairment,
depression, history of stroke, older age, and peripheral vascular disease.
The most established precipitating risk factor was a red blood cell
transfusion. An abnormal albumin level was reported as the most
established precipitating risk factor among blood values tested. A low
cardiac output and the use of an Intra Aortic Balloon Pump or inotropic
medication seem to be the most relevant risk factors associated with a
postoperative delirium. Conclusion: A multifactorial risk model should be
applied to identify patients at an increased risk of developing delirium
following elective cardiac surgery. In these patients, if possible,
preventative interventions can be taken and early recognition of delirium
can be realized. This could potentially decrease the incidence of delirium
and negative consequences caused by a postoperative delirium. 2010
European Society of Cardiology.
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