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<1>
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Accession Number
2013110579
Authors
Cholette J.M. Powers K.S. Alfieris G.M. Angona R. Henrichs K.F. Masel D.
Swartz M.F. Daugherty L.E. Belmont K. Blumberg N.
Institution
(Cholette, Powers, Daugherty) Department of Pediatrics, University of
Rochester, Rochester, NY, United States
(Alfieris, Angona, Masel, Swartz, Belmont) Department of Cardiac Surgery,
University of Rochester, Rochester, NY, United States
(Henrichs, Blumberg) Department of Pathology and Laboratory Medicine,
University of Rochester, Rochester, NY, United States
Title
Transfusion of cell saver salvaged blood in neonates and infants
undergoing open heart surgery significantly reduces RBC and coagulant
product transfusions and donor exposures: Results of a prospective,
randomized, clinical trial.
Source
Pediatric Critical Care Medicine. 14 (2) (pp 137-147), 2013. Date of
Publication: February 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE:: To evaluate whether transfusion of cell saver salvaged, stored
at the bedside for up to 24 hrs, would decrease the number of
postoperative allogeneic RBC transfusions and donor exposures, and
possibly improve clinical outcomes. DESIGN:: Prospective, randomized,
controlled, clinical trial. SETTING:: Pediatric cardiac intensive care
unit. PATIENTS:: Infants weighing less than 20 kg (n = 106) presenting for
cardiac surgery with cardiopulmonary bypass. INTERVENTIONS:: Subjects were
randomized to a cell saver transfusion group where cell saver blood was
available for transfusion up to 24 hrs after collection, or to a control
group. Cell saver subjects received cell saver blood for volume
replacement and/or RBC transfusions. Control subjects received crystalloid
or albumin for volume replacement and RBCs for anemia. Blood product
transfusions, donor exposures, and clinical outcomes were compared between
groups. MEASUREMENTS AND MAIN RESULTS:: Children randomized to the cell
saver group had significantly fewer RBC transfusions (cell saver: 0.19 +/-
0.44 vs. control: 0.75 +/- 1.2; p = 0.003) and coagulant product
transfusions in the first 48 hrs post-op (cell saver: 0.09 +/- 0.45 vs.
control: 0.62 +/- 1.4; p = 0.013), and significantly fewer donor exposures
(cell saver: 0.60 +/- 1.4 vs. control: 2.3 +/- 4.8; p = 0.019). This
difference persisted over the first week post-op, but did not reach
statistical significance (cell saver: 0.64 +/- 1.24 vs. control: 1.1 +/-
1.4; p = 0.07). There were no significant clinical outcome differences.
CONCLUSION:: Cell saver blood can be safely stored at the bedside for
immediate transfusion for 24 hrs after collection. Administration of cell
saver blood significantly reduces the number of RBC and coagulant product
transfusions and donor exposures in the immediate postoperative period.
Reduction of blood product transfusions has the potential to reduce
transfusion-associated complications and decrease postoperative morbidity.
Larger studies are needed to determine whether this transfusion strategy
will improve clinical outcomes. 2013 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.
<2>
Accession Number
2013099360
Authors
Asida S.M. Atalla M.M.M. Gad G.S. Eisa K.M. Mohamed H.S.
Institution
(Asida, Gad, Mohamed) Department of Anesthesia and Intensive Care, South
Valley University, Qena, Egypt
(Atalla) Faculty of Medicine, South Valley University, Egypt
(Atalla) Mansoura Faculty of Medicine, Mansoura University, Egypt
(Eisa) Department of Cardiothoracic Surgery, Qena Faculty of Medicine,
South Valley University, Qena, Egypt
Title
Effect of perioperative control of blood glucose level on patient's
outcome after anesthesia for cardiac surgery.
Source
Egyptian Journal of Anaesthesia. 29 (1) (pp 71-76), 2013. Date of
Publication: January 2013.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Background: Blood glucose control is an important factor in improving
outcome of diabetic patients undergoing cardiac surgery. Objective: Is to
estimate the relation between blood glucose control and perioperative
outcomes in these patients. Study design: Prospective cohort study.
Methods: One hundred diabetic patients undergoing cardiac surgery, were
divided equally into group I (control group) in whom no tight glycemic
control was done and group II (study group) in which tight glycemic
control was done. Patients in the study group received intra-operatively
an infusion of rapidly acting insulin according to a modified protocol to
keep blood glucose level between 80 and 110 mg/dl and continued in the ICU
until complete recovery from anesthesia. Patients in the control group
followed the same protocol of insulin infusion only if their
peri-operative blood glucose level exceeded 180 mg/dl. Results: There was
a rise of blood glucose level in the control group patients till the end
of operations (mean level = 227 mg/dl). Mean blood glucose level before
CPB was comparable in the two groups, but was significantly different
after that until extubation. We reported three cases of delayed recovery
in the control group compared to one case in the study group. We also
recorded four cases of cardiac problems in group I compared to one case in
group II (P = 0.044). There was statistically significant difference
between groups regarding renal, neurological and surgical post-operative
complications. Conclusion: Tight glycemic control is recommended for
better patient's outcome after cardiac anesthesia. 2012 Egyptian Society
of Anesthesiologists. Production and hosting by Elsevier B.V.
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Accession Number
2013110580
Authors
Gaies M.G. Langer M. Alexander J. Steil G.M. Ware J. Wypij D. Laussen P.C.
Newburger J.W. Goldberg C.S. Pigula F.A. Shukla A.C. Duggan C.P. Agus
M.S.D.
Institution
(Gaies, Goldberg) Department of Pediatrics and Communicable Diseases, C.S.
Mott Children's Hospital, University of Michigan Medical School, Ann
Arbor, MI, United States
(Langer) Department of Surgery, Maine Medical Center, Portland, ME, United
States
(Alexander, Steil, Duggan, Agus) Department of Medicine, Children's
Hospital Boston, Harvard Medical School, Boston, MA, United States
(Ware) Department of Psychology, Children's Hospital Boston, Harvard
Medical School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard University School of Public
Health, Boston, MA, United States
(Laussen) Department of Cardiology, Children's Hospital Boston, Harvard
Medical School, Boston, MA, United States
(Newburger) Department of Cardiac Surgery, Children's Hospital Boston,
Harvard Medical School, Boston, MA, United States
(Pigula) Department of Cardiac Surgery, Children's Hospital Boston,
Harvard Medical School, Boston, MA., United States
(Shukla) Department of Anesthesia, Children's Hospital Boston, Harvard
Medical School, Boston, MA., United States
Title
Design and rationale of safe pediatric euglycemia after cardiac surgery: A
randomized controlled trial of tight glycemic control after pediatric
cardiac surgery.
Source
Pediatric Critical Care Medicine. 14 (2) (pp 148-156), 2013. Date of
Publication: February 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVES:: To describe the design of a clinical trial testing the
hypothesis that children randomized to tight glycemic control with
intensive insulin therapy after cardiac surgery will have improved
clinical outcomes compared to children randomized to conventional blood
glucose management. DESIGN:: Two-center, randomized controlled trial.
SETTING:: Cardiac ICUs at two large academic pediatric centers. PATIENTS::
Children from birth to those aged 36 months recovering in the cardiac ICU
after surgery with cardiopulmonary bypass. INTERVENTIONS:: Subjects in the
tight glycemic control (intervention) group receive an intravenous insulin
infusion titrated to achieve normoglycemia (target blood glucose range of
80-110 mg/dL; 4.4-6.1 mmol/L). The intervention begins at admission to the
cardiac ICU from the operating room and terminates when the patient is
ready for discharge from the ICU. Continuous glucose monitoring is
performed during insulin infusion to minimize the risks of hypoglycemia.
The standard care group has no target blood glucose range. MEASUREMENTS
AND MAIN RESULTS:: The primary outcome is the development of any
nosocomial infection (bloodstream, urinary tract, and surgical site
infection or nosocomial pneumonia). Secondary outcomes include mortality,
measures of cardiorespiratory function and recovery, laboratory indices of
nutritional balance, immunologic, endocrinologic, and neurologic function,
cardiac ICU and hospital length of stay, and neurodevelopmental outcome at
1 and 3 yrs of age. A total of 980 subjects will be enrolled (490 in each
treatment arm) for sufficient power to show a 50% reduction in the
prevalence of the primary outcome. CONCLUSIONS:: Pediatric cardiac surgery
patients may recognize great benefit from tight glycemic control in the
postoperative period, particularly with regard to reduction of nosocomial
infections. The Safe Pediatric Euglycemia after Cardiac Surgery trial is
designed to provide an unbiased answer to the question of whether this
therapy is indeed beneficial and to define the associated risks of
therapy. 2013 by the Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies.
<4>
Accession Number
2013105185
Authors
Rahe-Meyer N. Hanke A. Schmidt D.S. Hagl C. Pichlmaier M.
Institution
(Rahe-Meyer) Clinic for Anesthesiology and Intensive Care Medicine,
Franziskus Hospital, Kiskerstr. 26, D-33615 Bielefeld, Germany
(Rahe-Meyer, Hanke) Clinic for Anesthesiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(Schmidt) CSL Behring, Marburg, Germany
(Hagl, Pichlmaier) Clinic for Cardiothoracic, Transplant and Vascular
Surgery, Hannover Medical School, Hannover, Germany
(Hagl) Cardiac Surgery Clinic, University Clinic Grosshadern, Munich,
Germany
Title
Fibrinogen concentrate reduces intraoperative bleeding when used as
first-line hemostatic therapy during major aortic replacement surgery:
Results from a randomized, placebo-controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 145 (3 SUPPL.) (pp
S178-S185), 2013. Date of Publication: March 2013.
Publisher
Mosby Inc. (11830 Westline Industrial Drive, St. Louis MO 63146, United
States)
Abstract
Objectives: We assessed whether fibrinogen concentrate as targeted
first-line hemostatic therapy was more effective than placebo or a
standardized transfusion algorithm in controlling coagulopathic bleeding
in patients undergoing major aortic surgery. Methods: In this
single-center, prospective, double-blind study, adults undergoing elective
thoracic or thoracoabdominal aortic replacement surgery involving
cardiopulmonary bypass were randomized to intraoperative fibrinogen
concentrate (n = 29) or placebo (n = 32). Study medication was given if
patients had clinically relevant coagulopathic bleeding, measured by
5-minute bleeding mass, after cardiopulmonary bypass removal, protamine
administration, and surgical hemostasis. Fibrinogen concentrate dosing was
individualized using the thromboelastometric FIBTEM test. If bleeding
continued, a standardized transfusion algorithm was followed. In the
placebo group, all 32 patients received 1 transfusion cycle of
fresh-frozen plasma/platelets, and 30 patients required a second
transfusion cycle; none of these patients received any other procoagulant
therapy. Change in bleeding rate after treatment was compared using t
tests. Results: Mean change in bleeding rate after fibrinogen concentrate
was -48.3 g/5 min, compared with 0.4 g/5 min after placebo (P < .001),
-16.1 g/5 min after 1 transfusion cycle (fresh-frozen plasma or platelets;
P =.003), and -28.0 g/5 min after 2 transfusion cycles (fresh-frozen
plasma and platelets; P =.11). Reductions in bleeding rate were greater
for patients with higher bleeding rates before treatment, especially with
fibrinogen concentrate. Conclusions: FIBTEM-guided intraoperative
hemostatic therapy with fibrinogen concentrate is more effective than
placebo in controlling coagulopathic bleeding during major aortic
replacement surgery. Fibrinogen concentrate is also more effective than 1
cycle of fresh-frozen plasma/platelets and is more rapid than - and at
least as effective as - 2 cycles of fresh-frozen plasma/platelets.
Copyright 2013 Published by Elsevier Inc. on behalf of The American
Association for Thoracic Surgery.
<5>
Accession Number
2013104879
Authors
Dagenais G.R. Lu J. Faxon D.P. Bogaty P. Adler D. Fuentes F. Escobedo J.
Krishnaswami A. Slater J. Frye R.L.
Institution
(Dagenais, Bogaty) Quebec Heart and Lung University Institute, Quebec
City, QC, Canada
(Lu) Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA,
United States
(Faxon, Adler) Department of Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Fuentes) Department of Medicine, University of Texas, Health Science
Center, Houston, TX, United States
(Escobedo) Mexican Institute of Social Security, Mexico City, Mexico
(Krishnaswami) Department of Medicine, Kaiser-Permanente Medical Center,
San Jose, CA, United States
(Slater) Department of Medicine, University-Langone Medical Center, New
York, NY, United States
(Frye) Department of Medicine, Mayo Clinic, Rochester, MN, United States
Title
Prognostic impact of the presence and absence of angina on mortality and
cardiovascular outcomes in patients with type 2 diabetes and stable
coronary artery disease: Results from the BARI 2D (Bypass Angioplasty
Revascularization Investigation 2 Diabetes) trial.
Source
Journal of the American College of Cardiology. 61 (7) (pp 702-711), 2013.
Date of Publication: 19 Feb 2013.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: The purpose of this analysis was to assess in patients with
type 2 diabetes and stable coronary artery disease (CAD) whether the risk
of all-cause mortality and cardiovascular events varied according to the
presence or absence of angina and angina equivalent symptoms. Background:
Data on the prognostic value of symptoms in these patients are limited.
Methods: Post-hoc analysis was performed in 2,364 patients with type 2
diabetes and documented CAD enrolled in the BARI 2D (Bypass Angioplasty
Revascularization Investigation 2 Diabetes) trial to determine the
occurrence of death and composite of death, myocardial infarction, and
stroke during a 5-year follow-up according to cardiac symptoms at
baseline. Results: There were 1,434 patients with angina (A), 506 with
angina equivalents (E), and 424 with neither of these (N). The cumulative
death rates (total 316) were 12% in A, 14% in E, and 10% in N (p = 0.3),
and cardiovascular composite rates (total 548) were 24% in A, 24% in E,
and 21% in N (p = 0.5). Compared with N, the hazard ratios adjusted for
confounders were not different for death in A (1.11; 99% CI: 0.81 to 1.53)
and E (1.17; 99% CI: 0.81 to 1.68) or for cardiovascular events in A
(1.17; 99% CI: 0.92 to 1.50) and E (1.11; 99% CI: 0.84 to 1.48).
Conclusions: Whatever their symptom status, patients with type 2 diabetes
and stable CAD were at similar risk of cardiovascular events and death.
These findings suggest that these patients may be similarly managed in
terms of risk stratification and preventive therapies. (Bypass Angioplasty
Revascularization Investigation 2 Diabetes [BARI 2D]; NCT00006305) 2013
American College of Cardiology Foundation.
<6>
Accession Number
2013104229
Authors
Schou M. Gustafsson F. Videbaek L. Tuxen C. Keller N. Handberg J. Sejr
Knudsen A. Espersen G. Markenvard J. Egstrup K. Ulriksen H. Hildebrandt
P.R.
Institution
(Schou, Tuxen, Hildebrandt) Department of Cardiology and Endocrinology,
Frederiksberg University Hospital, DK-2000 Frderiksberg, Denmark
(Schou, Gustafsson) Department of Cardiology, Heart Centre,
Rigshospitalet, Blegdamsvej 2, DK-2100 Copenhagen, Denmark
(Videbaek) Department of Cardiology, Odense University Hospital, DK-5000
Odense C, Denmark
(Keller) Department of Cardiology, Herlev University Hospital, DK-2730
Herlev, Denmark
(Handberg) Department of Cardiology and Endocrinology, Hillerod University
Hospital, DK-3400 Hillerod, Denmark
(Sejr Knudsen) Department of Cardiology, Vejle University Hospital,
DK-7100 Vejle, Denmark
(Espersen) Department of Cardiology, Aalborg University Hospital, DK-9000
Aalborg, Denmark
(Markenvard) Department of Internal Medicine, Fredericia County Hospital,
DK-7000 Fredericia, Denmark
(Egstrup) Department of Internal Medicine, Funen University Hospital,
DK-5700 Svendborg, Denmark
(Ulriksen) Department of Internal Medicine, Skive County Hospital, DK-7800
Skive, Denmark
Title
Extended heart failure clinic follow-up in low-risk patients: A randomized
clinical trial (NorthStar).
Source
European Heart Journal. 34 (6) (pp 432-442), 2013. Date of Publication:
2013.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
BackgroundOutpatient follow-up in specialized heart failure clinics (HFCs)
is recommended by current guidelines and implemented in most European
countries, but the optimal duration of HFC programmes has not been
established. Nor is it known whether all or only high-risk patients, e.g.
identified by NT-proBNP, might benefit from an extended HFC
follow-up.Methods and resultsIn a multi-centre setting, we randomly
assigned 921 clinically stable systolic heart failure (HF) outpatients on
optimal medical therapy to undergo either an extended follow-up in the HFC
(n = 461) or referral back to their general practitioner (GP) (n = 460).
The primary composite endpoint was death or a cardiovascular admission.
Secondary endpoints included mortality, an HF admission, quality of life,
number of days admitted, and number of admissions. The median age of the
patients was 69 years; 23% were females; the median left ventricular
ejection fraction was 0.30; and the median NT-proBNP was 801 pg/mL; 89%
were in NYHA class I-II. The median follow-up was 2.5 years. Time-to-event
did not differ between groups (HFC vs. GP) (HR: 1.17, 95% CI: 0.95-1.45, P
= 0.149). The two groups did not differ with respect to any of the
secondary endpoints at the follow-up (P> 0.05 for all). In high-risk
patients identified by NT-proBNP >=1000 pg/mL, no benefit from HFC
follow-up was found (P = 0.721).ConclusionIrrespective of the level of
NT-proBNP stable HF patients on optimal medical therapy do not benefit
from long-term follow-up in a specialized HFC in a publicly funded
universal access healthcare system. Heart failure patients on optimal
medical therapy with mild or moderate symptoms are safely managed by their
personal GP.Trial Registration: www.Centerwatch.com: 173491 (NorthStar).
The Author 2012.
<7>
Accession Number
2013091400
Authors
Gui P. Wu Q. Wu J. Yao S.
Institution
(Gui, Wu, Wu, Yao) Department of Anesthesiology, Huazhong University of
Science and Technology, Union Hospital, 1277# Jiefang Da Dao, Wuhan
430022, China
Title
Protective effect of esmolol on myocardial ischemic injury during open
heart surgery in children.
Source
Paediatric Anaesthesia. 23 (3) (pp 217-221), 2013. Date of Publication:
March 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objectives: To investigate the efficacy of esmolol in protecting the
myocardium from ischemia during pediatric cardiac surgery. Background
Esmolol, an ultra-short acting beta 1-adrenoceptor blocker, reduces
myocardial injury in adult cardiac operations. However, this technique is
rarely used in pediatric cardiac surgery. Methods: Thirty children with
ventricular septal defect were randomly allocated to the esmolol group and
the control group. Patients received intravenous esmolol (0.05
mgkg<sup>-1</sup>min<sup>-1</sup> after tracheal intubation, 0.3
mgkg<sup>-1</sup>min<sup>-1</sup> during cardiopulmonary bypass (CPB) and
0.03-0.05 mgkg <sup>-1</sup>min<sup>-1</sup> until the end of surgery) or
placebo, respectively. Results: Plasma levels of creatine kinase-MB,
cardiac troponin I in the esmolol group 2 min after completion of CPB, at
the end of surgery, 4 h after surgery, and the first postoperative day
were significantly lower than those in the control group. Values of heart
rate 10 min after induction, 2 min before institution of CPB, 2 min after
completion of CPB, and at the end of surgery were significantly lower in
the esmolol group; however, mean arterial pressure, CPB time, cross-clamp
time, and the rate of heart spontaneous rebeating were not statistically
different between two groups. Cumulative postoperative dosage of dopamine
in the esmolol group (100.1 +/- 53.1 mg) was significantly less than that
in the control group (171.4 +/- 92.1 mg). Conclusions: Esmolol can protect
the myocardium from ischemic injury during CPB in children and
significantly reduce the use of inotropic drug. 2013 Blackwell Publishing
Ltd.
<8>
Accession Number
2013080474
Authors
Bridgewater B.
Institution
(Bridgewater) UHSM, Southmoor Road, Manchester M23 9LT, United Kingdom
Title
Almanac 2012 adult cardiac surgery: The national society journals present
selected research that has driven recent advances in clinical cardiology.
Source
Egyptian Heart Journal. 65 (1) (pp 43-50), 2013. Date of Publication:
March 2013.
Publisher
Egyptian Society of Cardiology (Egypt)
Abstract
This review covers the important publications in adult cardiac surgery in
the last few years, including the current evidence base for surgical
revascularisation and the use of off-pump surgery, bilateral internal
mammary arteries and endoscopic vein harvesting. The changes in
conventional aortic valve surgery are described alongside the outcomes of
clinical trials and registries for transcatheter aortic valve
implantation, and the introduction of less invasive and novel approaches
of conventional aortic valve replacement surgery. Surgery for mitral valve
disease is also considered, with particular reference to surgery for
asymptomatic degenerative mitral regurgitation. 2012.
<9>
Accession Number
2013086966
Authors
Bond R.T. Cohen J.M. Comerota A. Kahn S.R.
Institution
(Bond) Faculty of Medicine, McGill University, Montreal, QC, Canada
(Cohen, Kahn) Department of Epidemiology, Biostatistics and Occupational
Health, McGill University, Montreal, QC, Canada
(Comerota) Division of Vascular Surgery, Jobst Vascular Institute, Toledo,
OH, United States
(Comerota) Division of Vascular Surgery, University of Michigan Medical
Center, Ann Arbor, MI, United States
(Kahn) Division of Internal Medicine, McGill University, Jewish General
Hospital, 3755 Cote Ste. Catherine, Montreal, QC H3T 1E2, Canada
(Kahn) Division of Internal Medicine, Lady Davis Institute for Medical
Research, Jewish General Hospital, Montreal, QC, Canada
Title
Surgical treatment of moderate-to-severe post-thrombotic syndrome.
Source
Annals of Vascular Surgery. 27 (2) (pp 242-258), 2013. Date of
Publication: February 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Background: Severe post-thrombotic syndrome (PTS) occurs in 5% to 10% of
patients after deep venous thrombosis. Medical therapy such as compression
has limited effectiveness for the treatment of such patients. The
objective of this study was to systematically review the effectiveness and
safety of surgical approaches for the treatment of moderate-to-severe PTS.
Method: A computerized search was conducted using PubMed and reverse
citation searches to retrieve English- and French-language articles,
published after 1980, reporting on the endovascular and surgical treatment
of PTS. Results: Three hundred three titles were retrieved, of which 28
full publications were reviewed. Twelve articles met criteria for
inclusion, reporting on 349 patients. Surgical techniques included vein
dilation and stent placement (two studies), venous bypass grafting (two
studies), endophlebectomy with reconstruction (one study), valve
reconstruction/transplant (six studies), and interruption of perforating
veins (one study). Follow-up periods ranged from 1 month to 5 years.
Eleven of 12 included studies described improvement in PTS after the given
surgical intervention. Seven of 12 studies found improvement in all
anatomic measures assessed (e.g., venous valve competency and patency,
venous filling times, or ambulant venous pressure), and 11 of 12 studies
reported clinical improvement (e.g., improvement in signs and symptoms,
ulcer healing, ability to return to work, or reduced need for elastic
compression stockings), with rates of ulcer healing ranging from 50% to
100%. Eight of 12 studies (representing 264 patients) reported safety
outcomes. Complications reported most frequently were hematoma/seroma
formation and wound infection, with no reported instances of mortality or
pulmonary embolism. Limitations of the studies included a lack of
randomized controlled trials, absence of control groups, small sample
sizes, short follow-up periods, retrospective data collection, imprecise
definition of PTS, heterogeneity of study participants, and, in three
studies, lack of reporting on procedure safety. Conclusion: Surgical and
endovascular treatment of moderate-to-severe PTS could have the potential
to be effective where conservative and medical treatments have failed. Our
review describes studies of surgical techniques to treat PTS, but
highlights important limitations of such studies. Further research using
stricter research methodology is needed to evaluate the potential role of
surgical techniques for the treatment of moderate-to-severe PTS. 2013
Elsevier Inc. All rights reserved.
<10>
Accession Number
2013093382
Authors
van der Sluis P.C. Ruurda J.P. van der Horst S. Verhage R.J.J. Besselink
M.G.H. Prins M.J.D. Haverkamp L. Schippers C. Rinkes I.H.M.B. Joore H.C.A.
ten Kate F.J.W. Koffijberg H. Kroese C.C. van Leeuwen M.S. Lolkema
M.P.J.K. Reerink O. Schipper M.E.I. Steenhagen E. Vleggaar F.P. Voest E.E.
Siersema P.D. van Hillegersberg R.
Institution
(van der Sluis, Ruurda, van der Horst, Verhage, Besselink, Prins,
Haverkamp, Schippers, Rinkes, van Hillegersberg) Department of Surgery,
G04.228, University Medical Center Utrecht, Heidelberglaan 100, Utrecht,
CX, 3584, Netherlands
(Joore) Department of Intensive Care Medicine, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(ten Kate, Schipper) Department of Pathology, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(Koffijberg, Steenhagen) Julius Center for Health Sciences and Primary
Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX,
3584, Netherlands
(Kroese) Department of Anesthesiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(van Leeuwen) Department of Radiology, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(Lolkema, Voest) Department of Medical Oncology, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(Reerink) Department of Radiotherapy, University Medical Center Utrecht,
Heidelberglaan 100, Utrecht, CX, 3584, Netherlands
(Vleggaar, Siersema) Department of Gastroenterology and Hepatology,
University Medical Center Utrecht, Heidelberglaan 100, Utrecht, CX, 3584,
Netherlands
Title
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy
versus open transthoracic esophagectomy for resectable esophageal cancer,
a randomized controlled trial (ROBOT trial).
Source
Trials. 13 , 2012. Article Number: 230. Date of Publication: 30 Nov 2012.
Publisher
BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United
Kingdom)
Abstract
Background: For esophageal cancer patients, radical
esophagolymphadenectomy is the cornerstone of multimodality treatment with
curative intent. Transthoracic esophagectomy is the preferred surgical
approach worldwide allowing for en-bloc resection of the tumor with the
surrounding lymph nodes. However, the percentage of cardiopulmonary
complications associated with the transthoracic approach is high (50 to
70%).Recent studies have shown that robot-assisted minimally invasive
thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the
open transthoracic approach for esophageal cancer in terms of short-term
oncological outcomes. RATE was accompanied with reduced blood loss,
shorter ICU stay and improved lymph node retrieval compared with open
esophagectomy, and the pulmonary complication rate, hospital stay and
perioperative mortality were comparable. The objective is to evaluate the
efficacy, risks, quality of life and cost-effectiveness of RATE as an
alternative to open transthoracic esophagectomy for treatment of
esophageal cancer.Methods/design: This is an investigator-initiated and
investigator-driven monocenter randomized controlled parallel-group,
superiority trial. All adult patients (age >=18 and <=80 years) with
histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal
carcinoma of the intrathoracic esophagus and with European Clinical
Oncology Group performance status 0, 1 or 2 will be assessed for
eligibility and included after obtaining informed consent. Patients (n =
112) with resectable esophageal cancer are randomized in the outpatient
department to either RATE (n = 56) or open three-stage transthoracic
esophageal resection (n = 56). The primary outcome of this study is the
percentage of overall complications (grade 2 and higher) as stated by the
modified Clavien-Dindo classification of surgical
complications.Discussion: This is the first randomized controlled trial
designed to compare RATE with open transthoracic esophagectomy as surgical
treatment for resectable esophageal cancer. If our hypothesis is proven
correct, RATE will result in a lower percentage of postoperative
complications, lower blood loss, and shorter hospital stay, but with at
least similar oncologic outcomes and better postoperative quality of life
compared with open transthoracic esophagectomy. The study started in
January 2012. Follow-up will be 5 years. Short-term results will be
analyzed and published after discharge of the last randomized
patient.Trial registration: Dutch trial register: NTR3291
ClinicalTrial.gov: NCT01544790. 2012 van der Sluis et al.; licensee
BioMed Central Ltd.
<11>
Accession Number
2013096688
Authors
Desch S. Boudriot E. Rastan A. Buszman P.E. Bochenek A. Mohr F.W. Schuler
G. Thiele H.
Institution
(Desch, Boudriot, Schuler, Thiele) Department of Internal
Medicine/Cardiology, University of Leipzig Heart Center, Strumpellstr. 39,
04289 Leipzig, Germany
(Rastan, Mohr) Department of Cardiac Surgery, University of Leipzig Heart
Center, Leipzig, Germany
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Bochenek) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
Title
Bypass surgery versus percutaneous coronary intervention for the treatment
of unprotected left main disease: A meta-analysis of randomized controlled
trials.
Source
Herz. 38 (1) (pp 48-56), 2013. Date of Publication: February 2013.
Publisher
Urban und Vogel GmbH (Aschauer Str.30, Munich 81549, Germany)
Abstract
Objective: We performed a meta-analysis of randomized controlled trials to
compare coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) for the treatment of de novo unprotected left main
disease. Background: Although CABG is accepted to be standard of care for
revascularization of unprotected left main stenosis, PCI is increasingly
being used as an alternative primary approach. Methods: We searched for
randomized, controlled trials comparing CABG and PCI for the treatment of
unprotected left main disease. Major adverse cardiac and cerebrovascular
events (all-cause death, myocardial infarction, stroke, and repeat
revascularization) were analyzed. Results: The search strategy identified
4 randomized controlled trials enrolling a total of 1,611 patients.
Follow-up ranged between 1 and 2 years. There were no significant
differences in the risk of death or myocardial infarction between the two
treatment modalities. While the risk of stroke was significantly lower in
patients undergoing PCI (risk ratio (RR) 0.26, 95% confidence interval
(CI) 0.10-0.69, p = 0.007), the risk of repeat revascularization was
higher among patients undergoing PCI (RR 1.94, 95% CI 1.43-2.61, p <
0.001). No relevant statistical heterogeneity across studies could be
found. Conclusion: In this largest series of randomized patients with
unprotected left main stenosis to date, the risk of death and myocardial
infarction was comparable between CABG and PCI. However, patients
undergoing CABG had a higher risk of stroke, whereas patients undergoing
PCI were at a higher risk for repeat revascularization. 2012 Urban &
Vogel, Muenchen.
<12>
Accession Number
2013090148
Authors
Prado G.F. Lombardi E.M.S. Morais A.M. Martins S.R. De Paula Santos U.
Institution
(Prado, Lombardi, Morais, Martins, De Paula Santos) Divisao de Pneumologia
do Inst. do Coracao (InCor) do Hosp. das Clinicas, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Prado) Instituto do Cancer do Estado de Sao Paulo Octavio Frias de
Oliveira, Sao Paulo, SP, Brazil
Title
Smoking: What has been addressed in Brazilian journals.
Source
Arquivos Brasileiros de Cardiologia. 99 (6) (pp 1171), 2012. Date of
Publication: September 2012.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
The topic of tobacco smoking, in its several aspects, has been receiving
increasing attention among researchers over the past few years, which has
been reflected in more data and more solid scientific literature on the
subject in national journals. This article aims to review the studies that
focused on smoking published between January 2010 and June 2012, in
Arquivos Brasileiros de Cardiologia (Brazilian Archives of Cardiology),
Brazilian Journal of Medical and Biological Research, Clinics (Sao Paulo),
Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology),
Revista da Associacao Medica Brasileira (Journal of the Brazilian Medical
Association) and Revista Brasileira de Cirurgia Cardiovascular (Brazilian
Journal of Cardiovascular Surgery). During the aforementioned period 58
articles were published, 52 of which were original ones, addressing
several aspects of smoking, such as effects on health, epidemiology,
cessation and experimental studies.
<13>
Accession Number
2013077668
Authors
Rasmussen T.B. Zwisler A.-D. Sibilitz K.L. Risom S.S. Bundgaard H. Gluud
C. Moons P. Winkel P. Thygesen L.C. Hansen J.L. Norekval T.M. Berg S.K.
Institution
(Rasmussen, Zwisler, Sibilitz, Risom, Bundgaard, Moons, Berg) Heart
Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
(Rasmussen, Berg) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Zwisler, Thygesen) National Institute of Public Health, University of
Southern Denmark, Copenhagen, Denmark
(Gluud, Winkel, Hansen) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Moons) Centre for Health Services and Nursing Research, KU
Leuven-University of Leuven, Leuven, Belgium
(Norekval) Haukeland University Hospital, Bergen, Norway
(Norekval) Institute of Medicine, University of Bergen, Bergen, Norway
Title
A randomised clinical trial of comprehensive cardiac rehabilitation versus
usual care for patients treated for infective endocarditis-the CopenHeart
IE trial protocol.
Source
BMJ Open. 2 (6) , 2012. Article Number: e001929. Date of Publication:
2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Introduction: Infective endocarditis (IE) is among the most serious
infectious diseases in the western world. Treatment requires lengthy
hospitalisation, high-dosage antibiotic therapy and possible valve
replacement surgery. Despite advances in treatment, the 1-year mortality
remains at 20-40%. Studies indicate that patients experience persisting
physical symptoms, diminished quality of life and difficulties returning
to work up to a year postdischarge. No studies investigating the effects
of rehabilitation have been published. We present the rationale and design
of the CopenHeart<sub>IE</sub> trial, which investigates the effect of
comprehensive cardiac rehabilitation versus usual care for patients
treated for IE. Methods and analysis: We will conduct a randomised
clinical trial to investigate the effects of comprehensive cardiac
rehabilitation versus usual care on the physical and psychosocial
functioning of patients treated for IE. The trial is a multicentre,
parallel design trial with 1 : 1 individual randomisation to either the
intervention or control group. The intervention consists of five
psychoeducational consultations provided by specialised nurses and a
12-week exercise training programme. The primary outcome is mental health
(MH) measured by the standardised Short Form 36 (SF-36). The secondary
outcome is peak oxygen uptake measured by the bicycle ergospirometry test.
Furthermore, a number of exploratory analyses will be performed. Based on
sample size calculation, 150 patients treated for left-sided (native or
prosthetic valve) or cardiac device endocarditis will be included in the
trial. A qualitative and a survey-based complementary study will be
undertaken, to investigate postdischarge experiences of the patients. A
qualitative postintervention study will explore rehabilitation
participation experiences. Ethics and dissemination: The study complies
with the Declaration of Helsinki and was approved by the regional research
ethics committee (no H-1-2011-129) and the Danish Data Protection Agency
(no 2007-58- 0015). Study findings will be disseminated widely through
peer-reviewed publications and conference presentations.
<14>
Accession Number
2013083441
Authors
Wang L.-M. Chang X.-L. Ren X.-L. Lv H.-W.
Institution
(Wang, Chang, Ren, Lv) Department of Anesthesiology, The First Affiliated
Hospital of China Medical University, Shenyang 110001, China
Title
Effectiveness and safety of dexmedetomidine for postoperative sedation in
cardiac patients: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 13 (1) (pp 93-99), 2013. Date
of Publication: 2013.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To evaluate the effectiveness and safety of dexmedetomidine for
postoperative sedation in cardiac patients. Methods Such databases as
PubMed, EBSCO, Springer, Ovid, The Cochrane Library, CBM, CNKI, VIP and
WanFang Data were searched electronically from the date of their
establishment to May 2012, and other relevant journals and references of
the included literature were also searched manually. Two reviewers
independently screened the studies in accordance with the inclusion and
exclusion criteria, extracted data and assessed methodology quality. Then
the meta-analysis was performed using RevMan 5.1software. Results A total
of 8 randomized controlled trials (RCTs) involving 1 157 patients were
included. The Jadad scores of 7 RCTs were more than 3, and only 1 RCT
scored 2. The results of meta-analysis showed that compared with the
control group, dexmedetomidine significantly raised peripheral oxygen
saturation (RR=0.90, 95%CI 0.31 to 0.49, P=0.003), decreased the incidence
of average heart rate (RR=-5.86, 95%CI -7.31 to -4.40, P<0.000 01),
ventricular tachycardia (RR=0.27, 95%CI 0.08 to 0.88, P=0.03), delirium
(RR=0.28, 95%CI 0.16 to 0.48, P<0.000 01) and postoperative hyperglycemia
(RR=0.57, 95%CI 0.38 to 0.85, P=0.006), and reduced the number of patients
who needed vasoactive agents such as epinephrine (RR=0.53, 95%CI 0.29 to
0.96, P=0.04) and beta-blocker (RR=0.60, 95%CI 0.38 to 0.94, P=0.03).
However, it failed to shorten the time of both ICU stay (RR=-1.24, 95%CI
-4.35 to 1.87, P=0.43) and mechanical ventilation (RR=-2.28, 95%CI -5.13
to 0.57, P=0.12), increase mean artery pressure (RR=-2.78, 95%CI -6.89 to
1.34, P=0.19), and well control postoperative nausea, vomiting and
atrial-fibrillation. There were no significant differences between the two
groups in myocardial infarction, acute cardiac failure, acute kidney
failure, and mortality rate. Conclusion For postoperative sedation in
cardiac patients, dexmedetomidine can effectively stabilize hemodynamic
indexes, and reduce tachycardia, delirium, postoperative hyperglycemia and
vasoactive agents. However, it has no marked influence on the prognosis.
For the quantity and quality limitation of included studies, this
conclusion needs to be proved by performing more high quality and large
sample RCTs. 2013 Editorial Board of Chin J Evid-based Med.
<15>
Accession Number
2013079440
Authors
Backes D. Van den Bergh W.M. Van Duijn A.L. Lahpor J.R. van Dijk D.
Slooter A.J.C.
Institution
(Backes, Van den Bergh, Van Duijn, van Dijk, Slooter) Department of
Intensive Care Medicine, University Medical Centre Utrecht, Utrecht,
Netherlands
(Lahpor) Department of Cardiothoracic Surgery, University Medical Centre
Utrecht, Utrecht, Netherlands
(van Dijk) Department of Anesthesiology, University Medical Centre
Utrecht, Utrecht, Netherlands
Title
Cerebrovascular complications of left ventricular assist devices.
Source
European Journal of Cardio-thoracic Surgery. 42 (4) (pp 612-620), 2012.
Article Number: ezs320. Date of Publication: October 2012.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Left ventricular assist devices (LVADs) are increasingly being used as a
bridge to heart transplantation or destination therapy. It is unclear
which antithrombotic regimen should be used to reduce the risk of stroke.
We systematically reviewed the literature on all types of antithrombotic
regimens and stroke in patients with any type of LVADs. Our primary
outcome measure was the mean incidence of any type of stroke. Twenty-six
articles were selected as relevant, comprehending 1989 patients with a
mean LVAD support of 200 days (range 30-621). The mean proportion of
patients affected with stroke was 20% (range 0-55%), with a mean incidence
of 0.74 (range 0-6.91) events/patient-year. Support with HeartMate II and
a regimen of postoperative heparin converted to coumarins, acetylsalicylic
acid (ASA) and dipyridamole resulted in 0.17 (mean; range 0.06-0.29)
strokes/patient-year. HeartMate II support and the same regime without
heparin was associated with 0.07 (mean; range 0.03-0.11)
strokes/patient-year. A Novacor device with heparin, converted to
coumarins, was associated with 3.82 (mean; range 1.03-6.91)
strokes/patient-year, while ASA added to this regime resulted in 0.97
ischaemic strokes/patient-year (mean; range 0.53-1.48). Other combinations
of assist devices and antithrombotic regimes were investigated in one or
two studies only. This systematic review provides risk estimates for
stroke for various LVADs and antithrombotic regimes. Our findings indicate
that the postoperative use of heparin in HeartMate II patients is
doubtful, and suggest an important role for antiplatelet drugs to prevent
stroke in patients supported with a Novacor device. The Author 2012.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.
<16>
Accession Number
70993214
Authors
Pant S. Deshmukh A. Hayes K. Kumar G. Sachdeva R. Mehta J.L.
Institution
(Pant, Deshmukh, Hayes, Mehta) University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Kumar) Emory University, Atlanta, GA, United States
(Sachdeva) Medical College of Wisconsin, Milwaukee, WI, United States
Title
Survival and discharge rates for octogenarians undergoing coronary
revascularization procedures after acute myocardial infarction.
Source
Journal of Investigative Medicine. Conference: American Federation for
Medical Research Southern Regional Meeting, AFMR 2013 New Orleans, LA
United States. Conference Start: 20130221 Conference End: 20130223.
Conference Publication: (var.pagings). 61 (2) (pp 452), 2013. Date of
Publication: February 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of Study: Octogenarians constitute a significant proportion of
total acute coronary syndrome burden. Large randomized trials and
metaanalyses have examined the appropriateness of intervention in patients
less than 80 years but whether these data can be extrapolated to
octogenarians is unknown. This study has been undertaken to evaluate the
survival and discharge rates of octogenarians undergoing coronary
revascularization for acute myocardial infarction (AMI) from a nationwide
database. Methods Used: Using the Nationwide Inpatient Sample (NIS)
database 2007, patients age Q 80 years discharged with the primary
diagnosis of AMI were identified. Outcome variables included in-hospital
mortality, length of stay (LOS), coronary revascularization procedures
performed and discharge disposition. Multivariate regression analysis was
performed using appropriate survey commands in Stata IC, version 11.0.
Summary of Results: of the 117,282 discharges with primary diagnosis of
AMI, 28,429 patients (24.24%) were aged Q80 years. The unadjusted
mortality in octogenarians was 10.4% (vs. 3.7% in non-octogenarians,
p<0.001), as was the adjusted mortality (OR 3.4; 95% CI 3.1-3.6; p<0.001).
The number of procedures performed was 19% in octogenarians (vs. 44.8% in
non-octogenarians, OR 0.35; 95% CI 0.33-0.37; p<0.001). Mortality was
significantly lower in octogenarians undergoing any coronary
revascularization procedure (6.5% vs 11.3%, OR 0.34; 95%CI 0.29-0.40; pG
0.001). Octogenarians undergoing no coronary revascularization procedures
had significantly longer LOS compared to those undergoing
revascularization for AMI (5.7 vs. 4.8 days; p<0.001). Finally,
octogenarians undergoing revascularization for AMI were less likely to be
discharged to a nursing home than those undergoing conservative management
(17.3% vs 33.8%, p<0.001). Conclusions: The ''treatment paradox'' in the
octogenarian needs further exploration given the findings of better
outcomes in octogenarians receiving same degree of aggression in treatment
of acute coronary syndrome as younger population.
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