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<1>
Accession Number
2012420027
Authors
Li L. Wang Z. Ying X. Tian J. Sun T. Yi K. Zhang P. Jing Z. Yang K.
Institution
(Li, Wang, Tian, Yi, Zhang, Jing, Yang) Evidence-Based Medicine Center,
School of Basic Medical Sciences, Lanzhou University, Dong Gang West Road
No. 199, Lanzhou 730000, Gansu, China
(Li, Yi, Zhang, Yang) First Clinical College of Lanzhou University,
Lanzhou 730000, Gansu, China
(Wang, Ying) Second Clinical College of Lanzhou University, Lanzhou
730000, Gansu, China
(Sun) Shanghai Jiao-Tong University, School of Medicine Ren-ji Hospital,
Shanghai 20000, China
(Jing) Institute of Science and Technology Information of Gansu, Lanzhou
730000, China
Title
Preoperative carbohydrate loading for elective surgery: A systematic
review and meta-analysis.
Source
Surgery Today. 42 (7) (pp 613-624), 2012. Date of Publication: July 2012.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Background and objective It is unclear whether the preoperative
administration of oral carbohydrates (CHO) is safe and effective, and
therefore we herein evaluated the efficacy and adverse events associated
with CHO for elective surgery. Methods Comprehensive searches were
conducted to identify randomized controlled trials (RCTs), which evaluated
preoperative CHO for elective surgery. Two reviewers independently
selected the trials, extracted data, and assessed the methodological
qualities and evidence levels. The data were analyzed by the RevMan 5.0
software program. Result CHO increased the insulin and glucose levels on
the first day after surgery higher than those in overnight fasting group
(fifteen RCTs) and i.v. glucose infusion group (three RCTs). The pooled
results of thirteen RCTs showed greater declines in the insulin level at
the induction of anesthesia and a smaller increase in the glucose level at
the end of surgery, and fewer decreases in the postoperative insulin
sensitivity index in the CHO group were observed as compared to the
placebo group. No aspiration was observed in any of the included studies.
Conclusion CHO appears to be safe, and may attenuate postoperative insulin
resistance as compared to placebo. However, the quality of most of the
published trials has been poor, and the evidence levels for most outcomes
were low, so rigorous and larger RCTs are needed in the future. Springer
2012.
<2>
Accession Number
2012405955
Authors
Bille A. Barker A. Maratos E.C. Edmonds L. Lim E.
Institution
(Bille) Thoracic Surgery Department, Guy's and St. Thomas' Hospital,
London SE1 9RT, United Kingdom
(Barker, Maratos) Department of Cardiothoracic Surgery, Papworth Hospital,
Cambridge, United Kingdom
(Edmonds) Library and Knowledge Services, Papworth Hospital, Cambridge,
United Kingdom
(Lim) Department of Thoracic Surgery, Royal Brompton Hospital, London,
United Kingdom
Title
Surgical access rather than method of pleurodesis (pleurectomy or pleural
abrasion) influences recurrence rates for pneumothorax surgery: Systematic
review and meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. 60 (6) (pp 321-325), 2012.
Date of Publication: June 2012.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Aim: Surgery for recurrent spontaneous pneumothoraces is one of the most
commonly performed procedures in thoracic surgery, but few studies have
evaluated the efficacy of the surgical treatment options. We aimed to
evaluate the influence of the type of pleurodesis on recurrence whilst
adjusting for surgical access by systematic review and meta-regression of
randomised and non-randomised trials. Methods: A systematic literature
search undertaken for studies on pneumothorax surgery in MEDLINE, EMBASE,
Cochrane Library, Internet trial registers and conference abstracts
identified 29 studies (4 randomised and 25 nonrandomised) eligible for
inclusion. Meta-regression was performed adjusting for access to screen
for evidence of a difference in recurrence rates. Results: Access remained
the principal determinant of recurrence rates after surgery. The relative
risk of recurrence was 4.731 (2.699-8.291; p<0.001) using videoassisted
thoracoscopic surgery compared to open access. After adjusting for access,
the relative risk of recurrence of pleural abrasion compared to
pleurectomy was observed to be 2.851 (95% CI 0.478-17.021), but this was
not statistically (p = 0.220). Conclusion: Surgical access remains the
most important factor that influences outcome after surgery for recurrent
pneumothoraces. Although the relative risk of recurrence was higher with
pleural abrasion compared to pleurectomy, it was not statistically
significant, and more work needs to be conducted to address this question.
The Japanese Association for Thoracic Surgery 2012.
<3>
Accession Number
2012423303
Authors
Hazavei S.M.M. Sabzmakan L. Hasanzadeh A. Rabiei K. Roohafza H.
Institution
(Hazavei) Department of Health Services, School of Health, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Sabzmakan) Department of Public Health, School of Health, Qazvin
University of Medical Sciences, Qazvin, Iran, Islamic Republic of
(Hasanzadeh) Department of Biostatistics and Epidemiology, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Rabiei) Cardiovascular Research Center, Isfahan Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Roohafza) Cardiac Rehabilitation Research Center, Isfahan Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Title
The effects of an educational program based on PRECEDE model on depression
levels in patients with coronary artery bypass grafting.
Source
ARYA Atherosclerosis. 8 (1) , 2012. Date of Publication: 2012.
Publisher
Isfahan University of Medical Sciences (PO Box 81465-1148, Isfahan, Iran,
Islamic Republic of)
Abstract
BACKGROUND: Depression is among the most important barriers to proper
treatment of cardiac patients. It causes failure in accepting their
conditions, decreases their motivation in following the therapeutic
recommendations, and thus negatively affects their functionality and
quality of life. The present study aimed to investigate the effects of an
educational program based on Predisposing, Reinforcing, Enabling
Constructs in Educational Diagnosis and Evaluation (PRECEDE) model on
depression level in coronary artery bypass grafting (CABG) surgery
patients. METHODS: This was a quasi-experimental study in which 54
post-bypass surgery patients of Isfahan Cardiovascular Research Center
were investigated. The patients were randomly divided into two groups of
intervention and control. The data was collected using two questionnaires.
Primarily, the cardiac depression scale was used to measure the degree of
depression followed by PRECEDE model-based educational questionnaire to
identify the role of the educational intervention on patients. The PRECEDE
model-based intervention composed of 9 educational sessions per week
(60-90 minutes each). The patients were followed up for two months
postintervention. RESULTS: Following the educational intervention, mean
scores of predisposing, enabling, and reinforcing factors, and
self-helping behaviors significantly increased in the intervention group
compared to the control group (P < 0.001). In addition, a significant
difference in mean scores of depression was observed between the two
groups following the educational intervention (P < 0.001). CONCLUSION: The
findings of the current study confirmed the practicability and
effectiveness of the PRECEDE model-based educational programs on
preventing or decreasing depression levels in CABG patients.
<4>
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Accession Number
22415123
Authors
Brindle C.T. Wegelin J.A.
Institution
(Brindle) Wound Care Team, Virginia Commonwealth University, Medical
Center, Richmond, United States
(Wegelin) Department of Biostatistics, Virginia Commonwealth University,
Richmond, United States
Title
Prophylactic dressing application to reduce pressure ulcer formation in
cardiac surgery patients.
Source
Journal of Wound, Ostomy and Continence Nursing. 39 (2) (pp 133-142),
2012. Date of Publication: March-April 2012.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Purpose: The study was designed to determine if application of a
self-adherent silicone border foam dressing would reduce pressure ulcer
incidence when compared to standard preventive interventions among
patients managed in a cardiac surgery intensive care unit (CSICU).
Subjects and Setting: One hundred consecutive patients in the CSICU at
Virginia Commonwealth University Medical Center in Richmond participated
in the study. Fifteen were subsequently excluded due to incomplete data or
failure to remain in the CSICU for at least 48 hours. Of the 100 subjects
consecutively enrolled, 56 subjects were assigned to the intervention
group with attrition of 6 subjects (6/56), and 39 were assigned to the
standard care comparison group with attrition of 4 subjects (4/39). Five
study forms were lost and the group assignment of those subjects is
unknown. Methods: Patients admitted to the CSICU were assigned to either
standard treatment or an intervention group consisting of standard
preventive care plus application of the silicone border foam dressing. The
assignment of subjects to these groups was done in a nonrandom manner, via
prestudy room designation (7 intervention rooms/7 standard practice rooms)
and room availability on call from the operating room. The charge nurse
and bed management staff were unaware of room designation, and staff did
not know which group the subjects were assigned to until they admitted the
patient and opened the bedside chart that indicated group assignment.
Twenty-one covariates were compared between the 2 groups. A Cox
proportional hazards model was computed to compare the hazard (risk per
unit time) of developing a pressure ulcer between these groups. Propensity
score covariate adjustment was performed to adjust for any imbalance
between the groups. Results: Nine pressure ulcers developed during the
course of the study. Eight pressure ulcers developed in 4 out of 35
patients who received standard preventive care; 5 were classified as
suspected deep tissue injuries and 3 were classified as stage II pressure
ulcers. One pressure ulcer developed in 1 out of 50 patients in the
intervention group; it was classified as suspected deep tissue injury. No
statistically significant difference in any covariate was found between
the groups (all P > .058). The group that received standard care had a
hazard ratio of 3.6 in relation to the intervention group, but this
difference was not statistically significant (P = .3). Conclusion:
Pressure ulcer incidence was lower than anticipated over the study period
for both groups. No statistically significant difference in pressure ulcer
incidence between the intervention and control groups was found. A
randomized controlled trial based on a power analysis is needed to more
precisely determine the efficacy of a silicone border foam dressing for
prevention of pressure ulcers in the intensive care unit. Copyright 2012
Wound, Ostomy and Continence Nurses Society.
<5>
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Accession Number
2012413851
Authors
Maureira P. Tran N. Djaballah W. Angioi M. Bensoussan D. Didot N. Fay R.
Sadoul N. Villemot J.-P. Marie P.-Y.
Institution
(Maureira, Villemot) Department of Cardio-Vascular Surgery, CHU-Nancy,
Nancy, France
(Maureira, Tran, Villemot) School of Surgery, Faculty of Medicine, Nancy
University, Nancy, France
(Maureira, Tran, Marie) INSERM, U961, Nancy, France
(Djaballah, Didot, Marie) Department of Nuclear Medicine, Hopital de
Brabois, CHU-Nancy, Allee du Morvan, 54500 Vandoeuvre-les-Nancy, France
(Djaballah) INSERM, U947, Nancy, France
(Angioi, Sadoul) Department of Cardiology, CHU-Nancy, Nancy, France
(Bensoussan) Unit of Cell Transplantation and Tissue, CHU-Nancy, Nancy,
France
(Fay) INSERM, Centre d'Investigation Clinique CIC-P 9501, Nancy, France
Title
Residual viability is a predictor of the perfusion enhancement obtained
with the cell therapy of chronic myocardial infarction: A pilot multimodal
imaging study.
Source
Clinical Nuclear Medicine. 37 (8) (pp 738-742), 2012. Date of Publication:
August 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE: Up to now, there has been limited investigation into cell therapy
in the chronic phase of severe myocardial infarction (MI), and many
questions remain concerning the contribution of the engrafted cells and
especially their impact on the reperfusion of MI areas, when assessed by
objective quantitative imaging techniques. This randomized pilot SPECT,
PET, and MRI study was aimed at assessing the effects of bone marrow
mononuclear cells (BMNCs) when implanted in areas of severe and chronic
MI. MATERIALS AND METHODS: Fourteen patients, who were referred for
coronary artery bypass grafting (CABG) and in whom a screening MIBI-SPECT
revealed severely damaged myocardium (<50% uptake under nitrate), were
randomized between a cell therapy group (n = 7; CABG and injection of
BMNCs within MI areas) and a control group (n = 7; CABG alone). RESULTS:
The MI areas exhibited a posttherapeutic enhancement in the rest-uptake of
MIBI in the cell therapy group [difference between 6-month control and
baseline: +6.8% (5.4%), P = 0.03] but not in the control group [+1.0%
(4.3%)]. However, in a per-patient analysis, this improvement was
significant (> +9%) in only 3 cell therapy patients, whose MI areas before
therapy had a higher FDG uptake [59% (9%) vs 38% (8%), P = 0.03] and a
lower transmural extent at MRI [40% (6%) vs 73% (18%), P = 0.03] when
compared with the other cell therapy patients. CONCLUSIONS: Perfusion
enhancement, obtained with BMNCs in areas of chronic MI, might require an
intermediate level of viability documented with FDG-PET and MRI and that
totally necrotic MI seems refractory to this cell therapy technique. 2012
Lippincott Williams & Wilkins, Inc.
<6>
Accession Number
22730862
Authors
Kruger C. Sidebotham D. Brown A.J. Singh H. Merry A.F.
Institution
(Kruger) Green Lane Department of Cardiothoracic Anaesthesia, Auckland
City Hospital, Auckland, New Zealand.
Title
Timely bolus insulin for glucose control during cardiopulmonary bypass.
Source
The Journal of extra-corporeal technology. 44 (1) (pp 34-38), 2012. Date
of Publication: Mar 2012.
Abstract
Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing
cardioplegia is common; normoglycemia is difficult to maintain and failure
to do so may result in worse outcomes. The purpose of this quality
improvement initiative was to show that a simple timely insulin bolus is
more effective for glucose control during CPB with glucose containing
cardioplegia than conventional (not standardized) glucose management in
historical case-matched controls. A single bolus of insulin (.2
international units per kilogram; iu/kg) was administered, at the time of
aortic cannulation, to 211 consecutive patients undergoing cardiac surgery
with CPB and glucose containing cardioplegia. A further .1 iu/kg bolus of
insulin was given for blood glucose (BG) measurements greater than 10.0
mmol/L (180 mg/dL) during CPB. The control group of 211 historical
case-matched patients had glucose management according to anesthesiologist
preference (insulin as a bolus, bolus plus infusion, infusion only, or no
insulin). The frequency of hyperglycemia (BG > 11.0 mmol/L; 198 mg/dL)
during CPB was significantly less in the study group (22; 10.5%) than in
the control group (117; 55.5%) (p < .0001). Hyperglycemia in the first 6
hours in the intensive care unit was also significantly less frequent in
the study group (5; 2.4%) than in the control group (14; 6.6%) (p = .03).
Severe hypoglycemia (BG < 2.8 mmol/L; 50.4 mg/dL) occurred in one patient
(.47%) in the timely bolus insulin group and five patients (2.3%) in the
control group (p = .09). The timely bolus insulin method is more
efficacious, but equally safe, in preventing hyperglycemia during CPB with
glucose containing cardioplegia, compared with conventional (not
standardized) insulin treatment in historical case-matched controls.
<7>
Accession Number
22730858
Authors
Sievert A. Sistino J.
Institution
(Sievert) Department of Cardiovascular Perfusion, Medical University of
South Carolina, Charleston, South Carolina 29425, USA.
Title
A meta-analysis of renal benefits to pulsatile perfusion in cardiac
surgery.
Source
The Journal of extra-corporeal technology. 44 (1) (pp 10-14), 2012. Date
of Publication: Mar 2012.
Abstract
Multiple studies have evaluated the efficacy of pulsatile flow during
cardiopulmonary bypass (CPB) showing controversial results. Suggested
benefits to pulsatile perfusion include reducing the systemic inflammatory
response syndrome associated with bypass, decreased need for inotropic
support, shortened hospital stay, and superior organ preservation. This
study aims to compare prior studies to determine if there is a significant
difference in post-operative renal function with pulsatile perfusion
compared to non-pulsatile perfusion during cardiac surgery. Studies
included in the analysis were identified by searching keywords--pulsatile
perfusion, pulse, pulsatile flow, cardiopulmonary bypass, and cardiac
surgery. To maintain a homogenous sample, manuscripts were included if
they met the following criteria: research was prospective in nature,
subjects were human, paper contained documented baseline demographics,
outcome data included markers of renal function. A meta-analysis was
performed to compare post-op renal function between pulsatile and
non-pulsatile perfusion groups. A total of 298 articles were screened. Ten
articles met the criteria, of these, 477 patients underwent non-pulsatile
perfusion while 708 received pulsatile perfusion during CPB. There was
insufficient evidence to show a difference in mean postoperative
creatinine or BUN between the groups, however, the pulsatile perfusion
group had significantly higher creatinine clearance (standardized
difference in means = 2.48, p = .004) and lower serum lactate levels
(standardized difference in means = -2.08, p = .012) in the intensive care
unit. This study found that there is great variability among pulsatile
perfusion research. The methods to create and assess effective pulsatility
on bypass varied widely among manuscripts. This analysis suggests that
pulsatile perfusion during CPB is beneficial in renal preservation and
should be considered.
<8>
Accession Number
2012423913
Authors
Moholdt T. Bekken Vold M. Grimsmo J. Slordahl S.A. Wisloff U.
Institution
(Moholdt, Wisloff) K.G. Jebsen Center of Exercise in Medicine, Norwegian
University of Science and Technology, Department of Circulation and
Medical Imaging, Trondheim, Norway
(Moholdt) Department of Public Health, Norwegian University of Science and
Technology, Trondheim, Norway
(Bekken Vold, Grimsmo) Department of Cardiac Rehabilitation,
Feiringklinikken (The Feiring Heart Clinic), Feiring, Norway
(Slordahl) Department of Cardiology, St Olav's Hospital, Trondheim, Norway
(Slordahl) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
Title
Home-based aerobic interval training improves peak oxygen uptake equal to
residential cardiac rehabilitation: A randomized, controlled trial.
Source
PLoS ONE. 7 (7) , 2012. Article Number: e41199. Date of Publication: 18
Jul 2012.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Aerobic capacity, measured as the peak oxygen uptake, is a strong
predictor of survival in cardiac patients. Aerobic interval training
(AIT), walking/running four times four minutes at 85-95% of peak heart
rate, has proven to be effective in increasing peak oxygen uptake in
coronary heart disease patients. As some patients do not attend organized
rehabilitation programs, home-based exercise should be an alternative. We
investigated whether AIT could be performed effectively at home, and
compared the effects on peak oxygen uptake with that observed after a
standard care, four-week residential rehabilitation. Thirty patients
undergoing coronary artery bypass surgery were randomized to residential
rehabilitation or home-based AIT. At six months follow-up, peak oxygen
uptake increased 4.6 (+/-2.7) and 3.9 (+/-3.6) mLkg<sup>-1</sup>
min<sup>-1</sup> (both p<0.005, non-significant between-group difference)
after residential rehabilitation and AIT, respectively. Quality of life
increased significantly in both groups, with no statistical significant
difference between groups. We found no evidence for a different treatment
effect between patients randomized to home-based AIT compared to patients
attending organized rehabilitation (95% confidence interval -1.8, 3.5).
AIT patients reported good adherence to exercise training. Even though
these first data indicate positive effects of home-based AIT in patients
undergoing coronary artery bypass surgery, more studies are needed to
provide supporting evidence for the application of this rehabilitation
strategy. Trial Registration: ClinicalTrials.gov NCT00363922. 2012
Moholdt et al.
<9>
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Accession Number
2012419721
Authors
Er F. Nia A.M. Dopp H. Hellmich M. Dahlem K.M. Caglayan E. Kubacki T.
Benzing T. Erdmann E. Burst V. Gassanov N.
Institution
(Er, Nia, Dopp, Dahlem, Caglayan, Erdmann, Gassanov) Department of
Internal Medicine III, University of Cologne, Kerpener Strasse 62, 50937
Cologne, Germany
(Hellmich) Institute of Medical Statistics, Informatics and Epidemiology,
Department of Medicine, Germany
(Kubacki, Benzing, Burst) Renal Division, Department of Medicine, Germany
(Kubacki, Benzing, Burst) Cologne Excellence Cluster on Cellular Stress
Responses in Aging-Associated Diseases, University of Cologne, Cologne,
Germany
Title
Ischemic preconditioning for prevention of contrast medium-induced
nephropathy: Randomized pilot renpro trial (Renal protection trial).
Source
Circulation. 126 (3) (pp 296-303), 2012. Date of Publication: 17 Jul 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-Contrast medium-induced acute kidney injury is associated with
substantial morbidity and mortality. The underlying mechanism has been
attributed in part to ischemic kidney injury. The aim of this randomized,
double-blind, sham-controlled trial was to assess the impact of remote
ischemic preconditioning on contrast medium-induced acute kidney injury.
Methods and Results-Patients with impaired renal function (serum
creatinine >1.4 mg/dL or estimated glomerular filtration rate <60 mL * min
* 1.73 m) undergoing elective coronary angiography were randomized in a
1:1 ratio to standard care with (n=50) or without ischemic preconditioning
(n=50; intermittent arm ischemia through 4 cycles of 5-minute inflation
and 5-minute deflation of a blood pressure cuff). Overall, both study
groups were at high risk of developing contrast medium-induced acute
kidney injury according to the Mehran risk score. The primary end point
was the incidence of contrast medium-induced kidney injury, defined as an
increase in serum creatinine >=25% or >=0.5 mg/dL above baseline at 48
hours after contrast medium exposure. Contrast medium-induced acute kidney
injury occurred in 26 patients (26%), 20 (40%) in the control group and 6
(12%) in the remote ischemic preconditioning group (odds ratio, 0.21; 95%
confidence interval, 0.07-0.57; P=0.002). No major adverse events were
related to remote ischemic preconditioning. Conclusions-Remote ischemic
preconditioning before contrast medium use prevents contrast
medium-induced acute kidney injury in high-risk patients. Our findings
merit a larger trial to establish the effect of remote ischemic
preconditioning on clinical outcomes. Clinical Trial Registration-URL:
http://www.germanctr.de. Unique identifier: U1111-1118-8098. 2012
American Heart Association, Inc.
<10>
Accession Number
2012418725
Authors
Brun H. Moller T. Fredriksen P.M. Thaulow E. Pripp A.H. Holmstrom H.
Institution
(Brun, Fredriksen, Thaulow, Holmstrom) Department of Pediatric Cardiology,
Oslo University Hospital, 0027 Oslo, Norway
(Moller) Toronto General Hospital, Toronto, ON, Canada
(Pripp) Department of Biostatistics, Oslo University Hospital, 0027 Oslo,
Norway
Title
Mechanisms of exercise-induced pulmonary hypertension in patients with
cardiac septal defects.
Source
Pediatric Cardiology. 33 (5) (pp 782-790), 2012. Date of Publication: June
2012.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
The objective of this study was to investigate mechanisms of
exercise-induced pulmonary hypertension in patients with congenital
cardiac septal defects. This was a randomized, placebo controlled,
crossover drug trial in a single national pediatric cardiology centre that
performs congenital cardiac defect surgery. There were 14 patients with
cardiac septal defects and known exercise-induced pulmonary hypertension.
The intervention consisted of 50 mg oral sildenafil versus placebo.
Measurements included supine bicycle exercise echocardiography and oxygen
uptake. The outcome measure was right-ventricular systolic pressure as
estimated by Doppler tracings of tricuspid regurgitant jet as well as
systolic and diastolic longitudinal myocardial velocities by color tissue
Doppler echocardiography. Sildenafil did not change exercise
right-ventricular systolic pressure during exercise; however, decreased
systemic systolic pressure was seen. Enhanced biventricular longitudinal
function with sildenafil compared with placebo was indicated by greater
tissue Doppler velocities and displacement measurements during exercise.
Finally, a less steep increase of right-ventricular pressure during
exercise was associated with greater left-ventricular diastolic myocardial
tissue Doppler velocity. Exercise-induced pulmonary hypertension in
cardiac septal defects does not seem to have a pulmonary vasoconstrictive
component, but it may be related to left-ventricular filling pressure.
Furthermore, sildenafil improved biventricular systolic performance in
this patient group, possibly related to decreased systemic afterload.
<11>
Accession Number
2012418723
Authors
Ulgey A. Aksu R. Bicer C. Akin A. Altuntas R. Esmaogglu A. Baykan A.
Boyaci A.
Institution
(Ulgey, Aksu, Bicer, Akin, Altuntas, Esmaogglu, Boyaci) Department of
Anaesthesiology, Erciyes University Medical Faculty, 38039 Kayseri, Turkey
(Baykan) Department of Pediatric Cardiology, Erciyes University Medical
Faculty, 38039 Kayseri, Turkey
Title
Is the addition of dexmedetomidine to a ketamine-propofol combination in
pediatric cardiac catheterization sedation Useful?.
Source
Pediatric Cardiology. 33 (5) (pp 770-774), 2012. Date of Publication: June
2012.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Pediatric patients undergoing cardiac catheterization usually need deep
sedation. In this study, 60 children were randomly allocated to receive
sedation with either a ketamine-propofol combination (KP group, n = 30) or
a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both
groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction
of sedation, and the KPD group received an additional 1 mug/kg of
dexmedetomidine infusion during 5 min for induction of sedation and a
maintenance infusion of 0.5 mug/kg/h. In both groups, 0.2 mg/kg of
propofol was administered as a bolus to maintain a Ramsey sedation score
(RSS) greater than 4 throughout the procedure. None of the patients in
either group required intubation. In the KP group, one patient required
mask ventilation. The chin-lift maneuver needed to be performed for eight
patients in the KP group and one patient in the KPD group (p<0.05). Adding
dexmedetomidine to the ketamine- propofol combination decreased movement
during the procedures. The heart rate in the KPD group was significantly
lower after induction of sedation and throughout the procedure (p<0.05).
No significant differences in systolic blood pressure, diastolic blood
pressure, or respiration rates were found between the two groups (p<0.05).
The mean recovery time was longer in the KP group (5.86 vs 3.13 min;
p<0.05). Adding dexmedetomidine to a ketamine-propofol combination led to
a reduced need for airway intervention and to decreased movement during
local anesthetic infiltration and throughout the procedure. The recovery
time was shorter and hemodynamic stability good in the KPD group.
<12>
Accession Number
2012408715
Authors
Steinbruchel A.S. Johansson P.I. Rafiq S. Stensgaard J. Steinbruchel D.A.
Institution
(Steinbruchel, Johansson) Department of Clinical Immunology,
Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 3, 2100
Kobenhavn O, Denmark
(Rafiq, Stensgaard, Steinbruchel) Department of Thoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Denmark
Title
Equally increased hypercoagulability irrespective of using minimized or
conventional ECC systems.
Source
Scandinavian Cardiovascular Journal. 46 (4) (pp 233-238), 2012. Date of
Publication: August 2012.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
Objective. Minimized extracorporeal circulation systems in coronary artery
bypass may have less impairing effect on hematological parameters and
bleeding compared to conventional systems. The aim of this study was to
investigate whether the use of mini systems does result in an increased
postoperative hypercoagulative status. Methods. Patients with increased
risk of postoperative blood transfusion were randomly allocated to
coronary bypass surgery using conventional or minimized extracorporeal
circulation. Serial thrombelastographic analysis was performed
preoperatively, at day 1 and 5. Results. Forty-six patients were included.
In 56% of the patients in the experimental and in 62% in the control group
an activated coagulation system, measured as maximal amplitude above
normal reference was found preoperatively. This was normalized the day
after operation. At day 5 a significant number of patients in the
experimental group (p 0.03) overshooted the preoperative maximal clot
strength compared to the control group (p 0.15); however, a direct
intergroup analysis showed no difference. In both groups, hemoglobin
levels and platelet counts decreased at day one after surgery. At day 5,
hemoglobin was partly and platelets completely normalized. No differences
were found with respect to transfusion needs. Conclusion. Mini systems
seem to induce at least an equal increased state of hypercoagulability
after coronary surgery. No clinical relevant differences could be
demonstrated. This could indicate that patients after using mini systems
are not protected against a postoperative state of increased
hypercoagulability. 2012 Informa Healthcare.
<13>
Accession Number
2012409176
Authors
Mahajan R. Brooks A.G. Sullivan T. Lim H.S. Alasady M. Abed H.S. Ganesan
A.N. Nayyar S. Lau D.H. Roberts-Thomson K.C. Kalman J.M. Sanders P.
Institution
(Mahajan, Brooks, Sullivan, Lim, Alasady, Abed, Ganesan, Nayyar, Lau,
Roberts-Thomson, Sanders) Centre for Heart Rhythm Disorders, University of
Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
(Kalman) Department of Cardiology, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Kalman) Department of Medicine, University of Melbourne, Melbourne, VIC,
Australia
Title
Importance of the underlying substrate in determining thrombus location in
atrial fibrillation: Implications for left atrial appendage closure.
Source
Heart. 98 (15) (pp 1120-1126), 2012. Date of Publication: August 2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Context: The left atrial appendage (LAA) has been suggested to be the
dominant location of thrombus in atrial fibrillation (AF) and has led to
the development of LAA occlusion as a therapeutic modality to reduce
stroke risk. However, the patient populations that would benefit most from
this therapy are not well defined. Objective: A systematic review was
performed to better define subgroups amenable to appendage closure. Data
sources: The English scientific literature was searched using Pubmed
through to March 1, 2011. Reference lists of relevant and review articles
were screened to retrieve additional articles. Study selection: Studies
were only included if they described the location of thrombus in left
atrium. Case reports and case series describing less than 10 thrombi were
excluded. Data extraction: Two reviewers independently extracted data and
assessed quality of each study. Results: A total of 34 studies reporting
on the location of atrial thrombus in patients with AF were included: 17
in valvular AF, 10 non-valvular AF and 8 in mixed valvular and
non-valvular AF. Atrial thrombi were located outside the LAA in 56% (95%
CI 53, 60) of valvular AF, 22% (95% CI 19, 25) in mixed cohorts and 11%
(95% CI 6, 15) non-valvular AF. In non valvular AF, the studies with
higher proportion of thrombi in the left atrial cavity had
non-anticoagulated patients and a greater proportion of ventricular
dysfunction and history of stroke. Conclusion: The location of atrial
thrombus in patients with AF is dependent on the underlying substrate. In
valvular AF, more than half the thrombi are located in the left atrial
cavity. In the non-valvular AF group, a smaller proportion of thrombi were
located outside the appendage. However, in certain subgroups (ie. non
anticoagulated, left ventricular dysfunction or prior stroke) the chances
of left atrial cavity thrombus are higher.
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Accession Number
2012408278
Authors
Lazar H.L. McDonnell M.M. Chipkin S. Fitzgerald C. Bliss C. Cabral H.
Institution
(Lazar, Fitzgerald) Department of Cardiothoracic Surgery, Boston Medical
Center, 88 E Newton St., Boston, MA 02118, United States
(McDonnell) Division of Endocrinology, Boston University School of
Medicine, Boston Medical Center, Boston, MA, United States
(Chipkin) Department of Biostatistics, Boston University School of
Medicine, Boston Medical Center, Boston, MA, United States
(Bliss, Cabral) 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.
<15>
Accession Number
70818895
Authors
Amer A. French J. Jaques B. Manas D. White S.
Institution
(Amer, French, Jaques, Manas, White) Department of Hepatobiliary and
Transplant Surgery, Freeman Hospital, United Kingdom
(Amer, French, Jaques, Manas, White) Level 5 Liver Office, Freeman
Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, United Kingdom
Title
Meta-analysis of fibrin based haemostatic products in liver resection.
Source
HPB. Conference: 10th World Congress of the International
Hepato-Pancreato-Biliary Association Paris France. Conference Start:
20120701 Conference End: 20120705. Conference Publication: (var.pagings).
14 (pp 566), 2012. Date of Publication: July 2012.
Publisher
Wiley-Blackwell Publishing Ltd
Abstract
Introduction: Fibrin Based Haemostatic Products (FBHP's) are widely used
in liver surgery and have been shown to aid biliostasis in experimental
models. Various retrospective and observational studies across
orthopaedic, vascular and cardiothoracic surgery; as well as liver surgery
have suggested that these translate into a real clinical benefit. This
metaanalysis aimed to evaluate the randomised controlled trial (RCT)
evidence of FBHP's specific to liver surgery. Methods: All RCT's examining
the use of FBHP's were identified by a combination of computer literature
searches (MEDLINE, EMBASE, CENTRAL etc.), hand searching and personal
communication. Quantitative data on the benefits and harms of FBHP's was
then pooled using a random effects model. Data analysis was performed
using RevMan Version 5.0 according to the principles of the Cochrane
Collaboration. Results: 11 RCT's (1167 patients) fulfilled the inclusion
criteria and were suitable for analysis. The FBHP's trialled clinically
were Beriplast, Biocol, Quixil (Crosseal), CryoSeal, TachoSil, Tisseel
(Tissucol). Only 3 small trials (169 patients) had a statistically
positive effect on transfusion outcomes. 4 trials (514 patients) reported
on "time to haemostasis" and concluded that FBHP's were beneficial. Our
meta-analysis of published data failed to identify a significant clinical
benefit in transfusion, bile leaks or postoperative complications.
Conclusion: The number and range of commercial FBHP's continues to
proliferate. Although widely used there remains an absence of high grade
clinical trial evidence. The majority of trials in this study were graded
as low quality and there remains an urgent need for RCTs to guide their
effective use.
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