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<1>
Accession Number
2014077361
Authors
Braggion-Santos M.F. Andre F. Lossnitzer D. Hofmann E. Simpfendorfer J.
Dosch A. Katus H.A. Steen H.
Institution
(Braggion-Santos, Andre, Lossnitzer, Hofmann, Simpfendorfer, Dosch, Katus,
Steen) Department of Cardiology, Angiology und Pneumology, University of
Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
(Braggion-Santos) School of Medicine of Ribeirao Preto, University of Sao
Paulo, Sao Paulo, Brazil
(Steen) Department of Cardiology, Lake Constance Heart Center,
Kreuzlingen, Switzerland
(Steen) Department of Cardiology, Lake Constance Heart Center, Constance,
Germany
Title
Prevalence of different forms of infarct-atypical late gadolinium
enhancement in patients early and late after heart transplantation.
Source
Clinical Research in Cardiology. 103 (1) (pp 57-63), 2014. Date of
Publication: January 2014.
Publisher
D. Steinkopff-Verlag (P.O. Box 100462, Darmstadt D-64204, Germany)
Abstract
Background: Late gadolinium enhancement cardiac magnetic resonance
(LGE-CMR) enables high-resolution myocardial tissue characterization,
showing the results of different injuries, especially in the early period
after heart transplantation (HTX). Objectives: We sought to apply LGE-CMR
to investigate the prevalence and patterns of infarct-atypical myocardial
involvement and associated mechanisms in patients early and late after
HTX. Methods: LGE-CMR was performed on a 1.5-T MRI scanner (Philips, Best,
the Netherlands) in 89 patients: group 1 (48 patients) less than 2.5 years
after operation (1.2 + 0.5 years) and group 2 (41 patients) later this
period (8.2 + 4.2 years). Following LGE-CMR, the presence, distribution,
patterns of infarct-atypical LGE and possible associated mechanisms were
assessed. Results: 71 % of group 1 patients (34/48) showed
infarct-atypical LGE whereas 57 % of group 2 patients (22/41) were
affected (p = 0.25). Fewer segments/patients were involved later after HTX
(1.6 + 2.0 vs. 2.9 + 3.1 segments/patient; p = 0.03), but only diffuse
LGE-CMR pattern decreased significantly (11.5 % of affected segments in
group 1 vs. 6.5 % in group 2; p < 0.001). Group 2 had lower ischemic time
(181 + 53 vs. 208 + 61 min; p = 0.03), the donors were younger (33 + 13
vs. 41 + 13 years; p = 0.01) and fewer donors were Toxoplasma gondii
seropositive (4 vs. 22pts; p < 0.001). Conclusion: Infarct-atypical LGE
was found in a significant number of patients early post-HTX, however,
fewer patients and myocardial segments per patient were affected later
after HTX. Many potential factors seem to be involved, but the exact
mechanisms are still unclear. Future studies are necessary to test
prognostic implications associated with LGE-CMR patterns. 2013
Springer-Verlag Berlin Heidelberg.
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Accession Number
2014083592
Authors
Westerdahl E. Urell C. Jonsson M. Bryngelsson I.-L. Hedenstrom H. Emtner
M.
Institution
(Westerdahl) School of Health and Medical Sciences, Orebro University,
Orebro, Sweden
(Westerdahl, Jonsson) Department of Physiotherapy, Orebro University
Hospital, Orebro, Sweden
(Westerdahl, Jonsson) Department of Cardiothoracic Surgery, Orebro
University Hospital, Orebro, Sweden
(Bryngelsson) Department of Occupational and Environmental Medicine,
Orebro University Hospital, Orebro, Sweden
(Urell, Emtner) Physiotherapy, Department of Neuroscience, Department of
Medical Sciences, Uppsala University, Sweden
(Emtner) Department of Respiratory Medicine and Allergology, Department of
Medical Sciences, Uppsala University, Sweden
(Hedenstrom) Department of Clinical Physiology, Department of Medical
Sciences, Uppsala University, Sweden
(Westerdahl) Orebro University Hospital, Centre for Health Care Sciences,
Box 1324, SE-701 85 Orebro, Sweden
Title
Deep breathing exercises performed 2 months following cardiac surgery: A
randomized controlled trial.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 34 (1) (pp
34-42), 2014. Date of Publication: January-February 2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
PURPOSE: Postoperative breathing exercises are recommended to cardiac
surgery patients. Instructions concerning how long patients should
continue exercises after discharge vary, and the significance of treatment
needs to be determined. Our aim was to assess the effects of home-based
deep breathing exercises performed with a positive expiratory pressure
device for 2 months following cardiac surgery. METHODS: The study design
was a prospective, single-blinded, parallel-group, randomized trial.
Patients performing breathing exercises 2 months after cardiac surgery (n
= 159) were compared with a control group (n = 154) performing no
breathing exercises after discharge. The intervention consisted of 30 slow
deep breaths performed with a positive expiratory pressure device (10-15
cm H2O), 5 times a day, during the first 2 months after surgery. The
outcomes were lung function measurements, oxygen saturation, thoracic
excursion mobility, subjective perception of breathing and pain,
patient-perceived quality of recovery (40-Item Quality of Recovery score),
health-related quality of life (36-Item Short Form Health Survey), and
self-reported respiratory tract infection/pneumonia and antibiotic
treatment. RESULTS: Two months postoperatively, the patients had
significantly reduced lung function, with a mean decrease in forced
expiratory volume in 1 second to 93 + 12% (P< .001) of preoperative
values. Oxygenation had returned to preoperative values, and 5 of 8
aspects in the 36-Item Short Form Health Survey were improved compared
with preoperative values (P< .01). There were no significant differences
between the groups in any of the measured outcomes. CONCLUSION: No
significant differences in lung function, subjective perceptions, or
quality of life were found between patients performing home-based deep
breathing exercises and control patients 2 months after cardiac surgery.
2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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Accession Number
2014072069
Authors
Veronovici N.R. Lasiuk G.C. Rempel G.R. Norris C.M.
Institution
(Veronovici, Lasiuk, Rempel, Norris) Faculty of Nursing, University of
Alberta, Edmonton, Canada
(Norris) Division of Cardiovascular Surgery, Faculty of Medicine,
University of Alberta, Edmonton, AB T6G2G3, Canada
(Norris) Mazankowski Alberta Heart Institute, Edmonton, Canada
Title
Discharge education to promote self-management following cardiovascular
surgery: An integrative review.
Source
European Journal of Cardiovascular Nursing. 13 (1) (pp 22-31), 2014. Date
of Publication: February 2014.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Background: Nurses have a key role in teaching cardiovascular (CV)
surgical patients to manage their post-surgical care after discharge.
There is evidence that effective patient teaching contributes to improved
quality of life, decreased anxiety and depression and fewer post-CV
surgery emergency department visits and hospital readmissions. Despite
this, there are no guidelines or standards for how best to educate CV
surgical patients for discharge. Aim: To conduct a literature review of
published research on discharge education for CV surgical patients to
inform guidelines for educating CV surgical patients. Method: An
exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of
Systematic Reviews, and ERIC was executed using the following search
terms: cardiovascular, cardiac, cardio, heart, surg, transplant,
discharge, self-manage, teach, educat, preop, patient, care. In addition,
an ancestry search of all reference lists was completed. Studies were
included if they were published between 2007 and 2012 and focused on
preoperative CV surgery adult patient education. Results: The search
yielded 20 studies, 12 were excluded because they did not meet the
inclusion/exclusion criteria. Eight studies were included in the final
review. Three studies reported statistically significant decreases in
reported anxiety and depression and increased subjective health. Four
studies had mixed results with both positive and neutral findings. No
studies reported negative findings in relation to preoperative education.
Conclusion: Patients and staff identified that patient education is
essential. Standardized educational tools are appropriate as they can
spare resources, but are only effective if used in conjunction with
individualized education. The European Society of Cardiology 2013.
<4>
Accession Number
2014078894
Authors
Gorji H.M.A. Nesami B.M. Ayyasi M. Ghafari R. Yazdani J.
Institution
(Gorji, Nesami, Ayyasi) Departments of Nursing and Midwifery, Mazandaran
University of Medical Science, Sari, Iran, Islamic Republic of
(Ghafari) Heart Surgery, Mazandaran University of Medical Science, Sari,
Iran, Islamic Republic of
(Yazdani) Biostatistics, Mazandaran University of Medical Science, Sari,
Iran, Islamic Republic of
Title
Comparison of ice packs application and relaxation therapy in pain
reduction during chest tube removal following cardiac surgery.
Source
North American Journal of Medical Sciences. 6 (1) (pp 19-24), 2014. Date
of Publication: January 2014.
Publisher
North American Journal of Medical Sciences (T3330-50-B Charlton Ave,
Hamilton ON L8N A46, Canada)
Abstract
Background: Usually the chest tube removal (CTR) has been described as one
of the worst experiences by patients in the intensive care unit. Aim: This
study aimed to compare the effects of cold therapy and relaxation on pain
of CTR among the patients undergoes coronary artery bypass graft surgery.
Materials and Methods: This single-blinded clinical trial was done on 80
post-cardiac surgery patients in the heart hospital of Sari-Iran. The
patients were assigned to three randomized groups that included cold
therapy, relaxation, and control groups. Data analysis was done by T-test,
Chi-square, generalized estimating equations and repeated measures
analysis variance tests. Results: The groups had no significant
differences in pain intensity before CTR (P = 0.84), but immediately after
CTR there was a significant difference between the treatment (cold
application and relaxation groups) and control groups (P = 0.001). There
was no significant difference between relaxation and cold therapy groups.
Conclusion: Regarding the relaxation and cold application methods showed
relatively equal effects on reducing the pain owing to CTR. Thus, the use
of relaxation because of economics, without side effects, easy to use and
effective is recommended by the authors to the practitioners.
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Accession Number
2014083610
Authors
Grune F. Kazmaier S. Sonntag H. Stolker R.J. Weyland A.
Institution
(Grune, Stolker) Erasmus MC, Department of Anesthesiology, PO Box 2040,
3000 CA Rotterdam, Netherlands
(Kazmaier, Sonntag) Department of Anesthesiology, Critical Care, and
Emergency Medicine, University of Gottingen, Gottingen, Germany
(Weyland) Department of Anesthesiology, Critical Care, Emergency, and Pain
Medicine, Klinikum Oldenburg, Oldenburg, Germany
Title
Moderate hyperventilation during intravenous anesthesia increases net
cerebral lactate efflux.
Source
Anesthesiology. 120 (2) (pp 335-342), 2014. Date of Publication: February
2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Hyperventilation is known to decrease cerebral blood flow
(CBF) and to impair cerebral metabolism, but the threshold in patients
undergoing intravenous anesthesia is unknown. The authors hypothesized
that reduced CBF associated with moderate hyperventilation might impair
cerebral aerobic metabolism in patients undergoing intravenous anesthesia.
METHODS:: Thirty male patients scheduled for coronary surgery were
included in a prospective, controlled crossover trial. Measurements were
performed under fentanyl-midazolam anesthesia in a randomized sequence
aiming at partial pressures of carbon dioxide of 30 and 50 mmHg. Endpoints
were CBF, blood flow velocity in the middle cerebral artery, and cerebral
metabolic rates for oxygen, glucose, and lactate. Global CBF was measured
using a modified Kety-Schmidt technique with argon as inert gas tracer.
CBF velocity of the middle cerebral artery was recorded by transcranial
Doppler sonography. Data were presented as mean (SD). Two-sided paired t
tests and one-way ANOVA for repeated measures were used for statistical
analysis. RESULTS:: Moderate hyperventilation significantly decreased CBF
by 60%, blood flow velocity by 41%, cerebral oxygen delivery by 58%, and
partial pressure of oxygen of the jugular venous bulb by 45%. Cerebral
metabolic rates for oxygen and glucose remained unchanged; however, net
cerebral lactate efflux significantly increased from -0.38 (2.18) to
-2.41(2.43) mumol min 100 g. CONCLUSIONS:: Moderate hyperventilation, when
compared with moderate hypoventilation, in patients with cardiovascular
disease undergoing intravenous anesthesia increased net cerebral lactate
efflux and markedly reduced CBF and partial pressure of oxygen of the
jugular venous bulb, suggesting partial impairment of cerebral aerobic
metabolism at clinically relevant levels of hypocapnia. Copyright 2013,
the American Society of Anesthesiologists, Inc.
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Accession Number
2014083614
Authors
Jeleazcov C. Saari T.I. Ihmsen H. Mell J. Frohlich K. Krajinovic L.
Fechner J. Schuttler J.
Institution
(Jeleazcov, Saari, Ihmsen, Mell, Frohlich, Krajinovic, Fechner, Schuttler)
Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen,
Germany
Title
Population pharmacokinetic modeling of hydromorphone in cardiac surgery
patients during postoperative pain therapy.
Source
Anesthesiology. 120 (2) (pp 378-391), 2014. Date of Publication: February
2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Hydromorphone is a mu-selective opioid agonist used in
postoperative pain therapy. This study aimed to evaluate the
pharmacokinetics of hydromorphone in cardiac surgery patients during
postoperative analgesia with target-controlled infusion and
patient-controlled analgesia. METHODS:: In this study, 50 adult patients
were enrolled to receive intravenous hydromorphone during postoperative
pain therapy. Arterial plasma samples were collected for measurements of
drug concentration. Population pharmacokinetic parameters were estimated
using nonlinear mixed-effects modeling. Results were validated and
simulations were carried out to evaluate results. RESULTS:: Data from 49
patients (age range, 40-81 yr) were analyzed. The pharmacokinetics of
hydromorphone were best described by a three-compartment model. Age was
incorporated as a significant covariate for elimination clearance and
central volume of distribution. Scaling all parameters with body weight
improved the model significantly. The final estimates of the model
parameters for the typical adult patient (67 yr old, weighing 70 kg)
undergoing cardiac surgery were as follows: CL1 = 1.01 l/min, V1 = 3.35 l,
CL2 = 1.47 l/min, V2 = 13.9 l, CL3 = 1.41 l/min, and V3 = 145 l. The
elimination clearance decreased by 43% between the age of 40 and 80 yr,
and simulations demonstrated that context-sensitive half-time increased
from 26 to 84 min in 40- and 80-yr-old subjects, respectively.
CONCLUSIONS:: The final pharmacokinetic model gave a robust representation
of hydromorphone pharmacokinetics. Inclusion of age and body weight to the
model demonstrated a significant influence of these covariates on
hydromorphone pharmacokinetics. The application of this patient-derived
population model in individualized pain therapy should improve the dosing
of hydromorphone in patients undergoing cardiac surgery. Copyright 2013,
the American Society of Anesthesiologists, Inc.
<7>
Accession Number
2014066727
Authors
Tiroch K. Mehilli J. Byrne R.A. Schulz S. Massberg S. Laugwitz K.-L.
Vorpahl M. Seyfarth M. Kastrati A.
Institution
(Tiroch, Vorpahl, Seyfarth) Department of Cardiology, Helios Klinikum
Wuppertal, Universitat Witten/Herdecke, Wuppertal, Germany
(Mehilli, Massberg) Department of Cardiology, Klinikum Groshadern,
Ludwig-Maximilian Universitat, Munich, Germany
(Mehilli, Massberg, Laugwitz, Kastrati) Department of Cardiology, DZHK
(German Center for Cardiovascular Research), Partner Site Munich Heart
Alliance, Munich, Germany
(Byrne, Schulz, Kastrati) Department of Cardiology, Deutsches Herzzentrum,
Technische Universitat, Munich, Germany
(Laugwitz) 1. Department of Cardiology, Medizinisches Klinik Rechts der
Isar, Technische Universitat, Munich, Germany
Title
Impact of coronary anatomy and stenting technique on long-term outcome
after drug-eluting stent implantation for unprotected left main coronary
artery disease.
Source
JACC: Cardiovascular Interventions. 7 (1) (pp 29-36), 2014. Date of
Publication: January 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives This study sought to evaluate the impact of anatomic and
procedural variables on the outcome of the unprotected left main coronary
artery (uLMCA) itself after drug-eluting stent (DES) implantation.
Background There is a controversial debate regarding when and how to
perform percutaneous coronary intervention (PCI) for an uLMCA stenosis.
Methods This analysis is based on a randomized study of 607 patients
undergoing PCI for uLMCA, randomized 1:1 to receive paclitaxel- or
sirolimus-eluting stents. We evaluated the impact of the SYNTAX score,
uLMCA anatomy, and stenting technique on in-stent restenosis (ISR), target
lesion revascularization (TLR), and the 3-year outcomes. Results The
3-year cardiac mortality rate was 5.8%; 235 (39%) patients had a true
bifurcation lesion (TBL), and the median SYNTAX score was 27. TBL was
associated with a higher need for multiple stents (72% vs. 37%, p <
0.001). TBL was a significant predictor of ISR (23% vs. 14%, p = 0.008)
and for TLR (18% vs. 9%, p < 0.001). The need for multiple stents was a
predictor of ISR (22% vs. 13%, p = 0.005) and for TLR (16% vs. 9%, p =
0.005). Culotte stenting showed better results compared with T-stenting
for ISR (21% vs. 56%, p = 0.02) and for TLR (15% vs. 56%, p < 0.001). We
observed a significant association between uLMCA-TLR and SYNTAX scores
(9.2% for scores <22, 14.9% for scores 23 to 32, and 13.0% for scores >33,
p = 0.008). Conclusions PCI of uLMCA lesions with DES is safe and
effective out to 3 years. TBL and multiple stents were independent
predictors for ISR. In the multivariate analysis, independent predictors
for TLR were TBL, age, and EuroSCORE (European System for Cardiac
Operative Risk Evaluation). (Drug-Eluting-Stents for Unprotected Left Main
Stem Disease [ISAR-LEFT-MAIN]; NCT00133237). 2014 by the American College
of Cardiology Foundation.
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Accession Number
2014076527
Authors
Lopez-Medrano F. Cordero E. Gavalda J. Cruzado J.M. Angeles Marcos M.
Perez-Romero P. Sabe N. Gomez-Bravo M.A. Delgado J.F. Cabral E. Carratala
J.
Institution
(Lopez-Medrano) Departamento de Medicina, Instituto de Investigacion
Biomedica 12 de Octubre (i+12), Hospital Universitario 12 de Octubre,
Madrid, Spain
(Cordero, Perez-Romero) Unidad Clinica de Gestion de Enfermedades
Infecciosas, Instituto de Biomedicina de Sevilla, Hospital Universitario
Virgen del Rocio, Sevilla, Spain
(Gavalda, Cabral) Servicio de Enfermedades Infecciosas, Hospital
Universitario Vall d'Hebron, Barcelona, Spain
(Cruzado) Instituto de Investigacion Biomedica de Bellvitge (IDIBELL),
SpaindServicio de Nefrologia, Universidad de Barcelona, Barcelona, Spain
(Angeles Marcos) Department of Microbiology, Barcelona Centre for
International Health Research (CRESIB), Hospital Clinic-Universitat de
Barcelona, Barcelona, Spain
(Sabe, Carratala) Servicio de Enfermedades Infecciosas, Instituto de
Investigacion Biomedica de Bellvitge (IDIBELL), Universidad de Barcelona,
Barcelona, Spain
(Gomez-Bravo) Unidad de Cirugia Hepatobiliopancreatica, Hospital
Universitario Virgen del Rocio, Sevilla, Spain
(Delgado) Unidad de Insuficiencia Cardiaca y Trasplante de Corazon,
Servicio de Cardiologia, Hospital Universitario 12 de Octubre, Madrid,
Spain
Title
Management of influenza infection in solid-organ transplant
recipients:consensus statement of the group for the study of infection in
transplantrecipients (GESITRA) of the spanish society of infectious
diseases and clinicalmicrobiology (SEIMC) and the spanish network for
research in infectiousdiseases (REIPI).
Source
Enfermedades Infecciosas y Microbiologia Clinica. 31 (8) (pp
526.e1-526.e20), 2013. Date of Publication: october 2013.
Publisher
Elsevier Doyma (Traversa de Gracia 17-21, Barcelona 08021, Spain)
Abstract
Background: Solid organ transplant (SOT) recipients are at greater risk
than the general population forcomplications and mortality from influenza
infection.Methods: Researchers and clinicians with experience in SOT
infections have developed this consensusdocument in collaboration with
several Spanish scientific societies and study networks related to
trans-plant management. We conducted a systematic review to assess the
management and prevention ofinfluenza infection in SOT recipients.
Evidence levels based on the available literature are given for
eachrecommendation. This article was written in accordance with
international recommendations on con-sensus statements and the
recommendations of the Appraisal of Guidelines for Research and
EvaluationII (AGREE II).Results: Recommendations are provided on the
procurement of organs from donors with suspected orconfirmed influenza
infection. We highlight the importance of the possibility of influenza
infection in anySOT recipient presenting upper or lower respiratory
symptoms, including pneumonia. The importanceof early antiviral treatment
of SOT recipients with suspected or confirmed influenza infection and
thenecessity of annual influenza vaccination are emphasized. The
microbiological techniques for diagnosisof influenza infection are
reviewed. Guidelines for the use of antiviral prophylaxis in inpatients
andoutpatients are provided. Recommendations for household contacts of SOT
recipients with influenzainfection and health care workers in close
contact with transplant patients are also included. Finallyantiviral dose
adjustment guidelines are presented for cases of impaired renal function
and for pediatric populations. 2012 Elsevier Espana, S.L.
<9>
Accession Number
2014011721
Authors
Yu C. Dong N.-G. Shi J.-W. Yin P.
Institution
(Yu, Dong, Shi) Department of Cardiovascular Surgery, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
(Yin) Department of Epidemiology and Health Statistics, School of Public
Health, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430030, China
Title
Risk factors of secondary tricuspid regurgitation: A meta-analysis.
Source
Chinese Journal of Evidence-Based Medicine. 13 (12) (pp 1482-1491), 2013.
Date of Publication: 2013.
Publisher
West China University of Medical Science (37 Wainan Guoxue Xiang, Chengdu,
Sichuan 610041, China)
Abstract
Objective To analyze and explore the risk factors of secondary tricuspid
regurgitation (TR) after leftsided valve surgery (left cardiac valve
replacement or valvuloplasty) using meta-analysis, so as to provide
evidence for clinical diagnosis and treatment of secondary TR. Methods We
electronically searched databases including PubMed, MEDLINE, CBM, CNKI,
VIP, for literature on the risk factors of secondary TR after left-sided
valve surgery from 1995 to 2012. According to the inclusion and exclusion
criteria, we screened literature, extracted data, and assessed
methodological quality. Then, meta-analysis was performed using RevMan 5.0
software. Results A total of 6 case-control studies were included,
involving 437 patients and 2 102 controls. The results of meta-analysis
showed that, the risk factors of progressive exacerbation of secondary TR
after left-sided valve surgery included preoperative atrial fibrillation
(OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age
(MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to
8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter
(MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function
(OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06,
95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26
to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to
3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary
arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated
with secondary TR after left-sided valve surgery. Conclusion The risk
factors of progressive exacerbation of secondary TR after left-sided valve
surgery include preoperative atrial fibrillation, age, huge left atrium or
left atrium diameter, degradation of left heart function, rheumatic
pathological change, preoperative TR no less than 2+, and MVR.
Understanding these risk factors helps us to improve the long-time
effectiveness of preventing and treating TR after left-sided valve
surgery. 2013 Editorial Board of Chin J Evid-based Med.
<10>
Accession Number
2014082500
Authors
Von Birgelen C. Sen H. Lam M.K. Danse P.W. Jessurun G.A.J. Hautvast R.W.M.
Van Houwelingen G.K. Schramm A.R. Gin R.M.T.J. Louwerenburg J.W. De Man
F.H.A.F. Stoel M.G. Lowik M.M. Linssen G.C.M. Said S.A.M. Nienhuis M.B.
Verhorst P.M.J. Basalus M.W.Z. Doggen C.J.M. Tandjung K.
Institution
(Von Birgelen, Sen, Lam, Van Houwelingen, Louwerenburg, De Man, Stoel,
Lowik, Verhorst, Basalus, Tandjung) Department of Cardiology,
Thoraxcentrum Twente, 7513 ER Enschede, Netherlands
(Von Birgelen, Doggen) Department of Health Technology and Services
Research, University of Twente, Enschede, Netherlands
(Danse, Gin) Department of Cardiology, Rijnstate Hospital, Arnhem,
Netherlands
(Jessurun, Schramm) Department of Cardiology, Scheper Hospital, Emmen,
Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Linssen, Said) Department of Cardiology, Hospital Group Twente, Almelo
and Hengelo, Netherlands
(Nienhuis) Department of Cardiology, Queen Beatrix Hospital, Winterswijk,
Netherlands
Title
Third-generation zotarolimus-eluting and everolimus-eluting stents in
all-comer patients requiring a percutaneous coronary intervention (DUTCH
PEERS): A randomised, single-blind, multicentre, non-inferiority trial.
Source
The Lancet. 383 (9915) (pp 413-423), 2014. Date of Publication: 2014.
Publisher
Lancet Publishing Group (Langford Lane, Kidlington, Oxford OX5 1GB, United
Kingdom)
Abstract
Background: Third-generation, permanent-polymer-based drug-eluting stents
with novel, flexible designs might be more easily delivered than previous
generations of stents in complex coronary lesions, but might be less
longitudinally stable. We aimed to assess the safety and efficacy in
all-comer patients of two third-generation stents that are often used
clinically, but that have not yet been compared, and one of which has not
previously been assessed in a randomised trial. Methods: In this
investigator-initiated, single-blind, multicentre, randomised, two-arm,
non-inferiority trial, patients aged 18 years and older who required a
percutaneous coronary intervention with implantation of a drug-eluting
stent were recruited from four study sites in the Netherlands. We randomly
assigned patients by independently managed computer-generated allocation
sequences in a 1:1 ratio to receive either cobalt-chromium-based
zotarolimus-eluting stents (Resolute Integrity, Medtronic, Santa Rosa, CA,
USA) or platinum-chromium-based everolimus-eluting stents (Promus Element,
Boston Scientific, Natick, MA, USA). Patients and analysts were masked to
the allocated stent, but treating clinicians were not. The primary
endpoint of target-vessel failure was a composite of safety (cardiac death
or target-vessel-related myocardial infarction) and efficacy
(target-vessel revascularisation) at 12 months, analysed by intention to
treat (with a non-inferiority margin of 36%). This trial is registered
with ClinicalTrials.gov, number NCT01331707. Findings: Between Nov 25,
2010, and May 24, 2012, 1811 eligible all-comer patients, with 2371 target
lesions, were enrolled in the study. 370 (20%) patients presented with
ST-elevation myocardial infarction and 447 (25%) with non-ST-elevation
myocardial infarction. 906 patients were assigned to receive
zotarolimus-eluting stents and 905 to receive everolimus-eluting stents.
Ease of stent delivery was shown by very low numbers of patients requiring
treatment other than their assigned study treatment (six [1%] in the
zotarolimus-eluting stent group vs five [1%] in the everolimus-eluting
stent group; p=022). 12-month follow-up results were available for 1810
patients (one patient in the zotarolimus-eluting stent group withdrew
consent). The primary endpoint was met by 55 (6%) of 905 patients in the
zotarolimus-eluting stent group and 47 (5%) of 905 in the
everolimus-eluting stent group. The zotarolimus-eluting stent was
non-inferior to the everolimus-eluting stent (absolute risk diff erence
088%, 95% CI-124% to 301%; upper limit of one-sided 95% CI 269%;
non-inferiority p=0006). We noted no significant between-group diff
erences in individual components of the primary endpoint. Definite stent
thrombosis occurred in three (03%) patients in the zotarolimus-eluting
stent group and six (07%) patients in the everolimus-eluting stent group
(p=034). Longitudinal stent deformation was seen only in the
everolimus-eluting stent group (nine [10%] of 905 vs 0 of 906, p=0002;
nine of 1591 [06%] everolimus-eluting stents implanted became deformed),
but was not associated with any adverse events. Interpretation: Both
stents were similarly efficacious and safe, and provided excellent
clinical outcomes, especially in view of the large number of patients who
presented with acute myocardial infarctions. Funding: Boston Scientific,
Medtronic.
<11>
Accession Number
23986527
Authors
Wikkelso A. Lunde J. Johansen M. Stensballe J. Wetterslev J. Moller A.M.
Afshari A.
Institution
(Wikkelso) Department of Anaesthesiology, University of Copenhagen Herlev
Hospital, Herlev, Denmark.
Title
Fibrinogen concentrate in bleeding patients.
Source
The Cochrane database of systematic reviews. 8 (pp CD008864), 2013. Date
of Publication: 2013.
Abstract
Hypofibrinogenaemia is associated with increased morbidity and mortality,
but the optimal treatment level, the use of preemptive treatment and the
preferred source of fibrinogen remain disputed. Fibrinogen concentrate is
increasingly used and recommended for bleeding with acquired haemostatic
deficiencies in several countries, but evidence is lacking regarding
indications, dosing, efficacy and safety. We assessed the benefits and
harms of fibrinogen concentrate compared with placebo or usual treatment
for bleeding patients. We searched the following electronic databases: the
Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library 2013, Issue 8); MEDLINE (1950 to 9 August 2013); EMBASE (1980 to 9
August 2013); International Web of Science (1964 to 9 August 2013); CINAHL
(1980 to 9 August 2013); LILACS (1982 to 9 August 2013); and the Chinese
Biomedical Literature Database (up to 10 November 2011), together with
databases of ongoing trials. We contacted trial authors, authors of
previous reviews and manufacturers in the field. We included all
randomized controlled trials (RCTs), irrespective of blinding or language,
that compared fibrinogen concentrate with placebo/other treatment or no
treatment in bleeding patients, excluding neonates and patients with
hereditary bleeding disorders. Three review authors independently
abstracted data; we resolved any disagreements by discussion. Our primary
outcome measure was all-cause mortality. We performed subgroup and
sensitivity analyses to assess the effects of fibrinogen concentrate in
adults and children in terms of various clinical and physiological
outcomes. We presented pooled estimates of the effects of intervention on
dichotomous outcomes as risk ratios (RRs) and on continuous outcomes as
mean differences, with 95% confidence intervals (CIs). We assessed the
risk of bias through assessment of trial methodological components and the
risk of random error through trial sequential analysis. We included six
RCTs with a total of 248 participants; none of the trials were determined
to have overall low risk of bias. We found 12 ongoing trials, from which
we were unable to retrieve any data. Only two trials provided data on
mortality, and one was a zero event study; thus the meta-analysis showed
no statistically significant effect on overall mortality (2.6% vs 9.5%, RR
0.28, 95% CI 0.03 to 2.33). Our analyses on blood transfusion data suggest
a beneficial effect of fibrinogen concentrate in reducing the incidence of
allogenic transfusions (RR 0.47, 95% CI 0.31 to 0.72) but show no effect
on other predefined outcomes, including adverse events such as thrombotic
episodes. In the six available RCTs of elective surgery, fibrinogen
concentrate appears to reduce transfusion requirements, but the included
trials are of low quality with high risk of bias and are underpowered to
detect mortality, benefit or harm. Furthermore, data on mortality are
lacking, heterogeneity is high and acute or severe bleeding in a
non-elective surgical setting remains unexplored. Currently, weak evidence
supports the use of fibrinogen concentrate in bleeding patients, as tested
here in primarily elective cardiac surgery. More research is urgently
needed.
<12>
Accession Number
2014063965
Authors
Tanis W. Habets J. Van Den Brink R.B.A. Symersky P. Budde R.P.J. Chamuleau
S.A.J.
Institution
(Tanis, Chamuleau) Department of Cardiology, University Medical Center
Utrecht, Heidelberglaan 100, Utrecht 3508 GA, Netherlands
(Habets, Budde) Department of Radiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Van Den Brink) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Symersky) Department of Thoracic Surgery, Academic Medical Center,
Amsterdam, Netherlands
(Budde) Department of Radiology, Gelre Ziekenhuis, Apeldoorn, Netherlands
Title
Differentiation of thrombus from pannus as the cause of acquired
mechanical prosthetic heart valve obstruction by non-invasive imaging: A
review of the literature.
Source
European Heart Journal Cardiovascular Imaging. 15 (2) (pp 119-129), 2014.
Date of Publication: February 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims For acquired mechanical prosthetic heart valve (PHV) obstruction and
suspicion on thrombosis, recently updated European Society of Cardiology
guidelines advocate the confirmation of thrombus by transthoracic
echocardiography, transesophageal echocardiography (TEE), and fluoroscopy.
However, no evidence-based diagnostic algorithm is available for correct
thrombus detection, although this is clinically important as fibrinolysis
is contraindicated in non-thrombotic obstruction (isolated pannus). Here,
we performed a review of the literature in order to propose a diagnostic
algorithm. Methods and results We performed a systematic search in Pubmed
and Embase. Included publications were assessed on methodological quality
based on the validated Quality Assessment of Diagnostic Accuracy Studies
(QUADAS) II checklist. Studies were scarce (n = 15) and the majority were
of moderate methodological quality. In total, 238 mechanical PHV's with
acquired obstruction and a reliable reference standard were included for
the evaluation of the role of fluoroscopy, echocardiography, or
multidetector-row computed tomography (MDCT). In acquired PHV obstruction
caused by thrombosis, mass detection by TEE and leaflet restriction
detected by fluoroscopy were observed in the majority of cases (96 and
100%, respectively). In contrast, in acquired PHV obstruction free of
thrombosis (pannus), leaflet restriction detected by fluoroscopy was
absent in some cases (17%) and mass detection by TEE was absent in the
majority of cases (66%). In case of mass detection by TEE, predictors for
obstructive thrombus masses (compared with pannus masses) were leaflet
restriction, soft echo density, and increased mass length. In situations
of inconclusive echocardiography, MDCT may correctly detect
pannus/thrombus based on the morphological aspects and localization.
Conclusion In acquired mechanical PHV obstruction without leaflet
restriction and absent mass on TEE, obstructive PHV thrombosis cannot be
confirmed and consequently, fibrinolysis is not advised. Based on the
literature search and our opinion, a diagnostic algorithm is provided to
correctly identify non-thrombotic PHV obstruction, which is highly
relevant in daily clinical practice. 2013 Published on behalf of the
European Society of Cardiology. All rights reserved. The Author 2013.
<13>
Accession Number
2014078526
Authors
Lippi G. Cervellin G.
Institution
(Lippi) U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria
di Parma, Via Gramsci, 14, 43126 Parma, Italy
(Cervellin) Emergency Department, Academic Hospital of Parma, Parma, Italy
Title
Risk assessment of post-infarction heart failure. Systematic review on the
role of emerging biomarkers.
Source
Critical Reviews in Clinical Laboratory Sciences. 51 (1) (pp 13-29), 2014.
Date of Publication: February 2014.
Publisher
Informa Healthcare (69-77 Paul Street, London EC2A 4LQ, United Kingdom)
Abstract
The prognostic significance of cardiospecific troponins and natriuretic
peptides in patients with myocardial ischemia is well established, and
their measurement is now endorsed by the most important guidelines and
recommendations for diagnosis and management of heart failure (HF).
Additional biomarkers have also been investigated to support clinical
judgment and diagnostic imaging in the stratification of risk of cardiac
dysfunction in patients with myocardial infarction (MI). We have performed
a systematic analysis of the current scientific literature regarding the
most important biomarkers of HF, selecting all prospective studies with
adequate sample size (i.e. >100 patients) that have assessed, during the
early phase of myocardial ischemia, the prognostic value of emergent
biomarkers for new-onset HF or deterioration of cardiac function in
patients with MI. This analysis has provided some good evidence suggesting
that, in most cases, the use of diagnostic biomarkers of cardiac
dysfunction does not translate into efficient risk prediction of HF.
However, some notable exceptions were found, including biomarkers of
cardiac fibrosis (especially galectin-3), growth differentiation factor-15
(GDF-15), osteoprotegerin, C-reactive protein (CRP), and red blood cell
distribution width (RDW). Nevertheless, future studies with well-defined
characteristics including the use of larger sample sizes, standardized end
points, and replication populations, along with benchmark analyses against
other consolidated biomarkers (i.e. cardiospecific troponins and
natriuretic peptides), should be planned. Such evaluations will help to
establish whether an integrated approach including biomarkers of different
pathogenetic pathways-for example, apoptosis, stress of cardiomyocytes,
cardiac fibrosis, inflammation, and extra-cardiac involvement-may be cost
effective for identifying patients at increased risk of developing HF, and
who, therefore, may benefit from a tailored therapeutic strategy. 2014
Informa Healthcare USA, Inc.
<14>
Accession Number
2014060524
Authors
Phillips K.P.
Institution
(Phillips) Greenslopes Private Hospital, Heart Care Partners, Newdegate
St, Greenslopes, QLD 4120, Australia
Title
Role of inflammation in initiation and perpetuation of atrial
fibrillation: A systematic review of the published data.
Source
Journal of Atrial Fibrillation. 6 (3) (pp 62-67), 2013. Date of
Publication: October-November 2013.
Publisher
CardioFront LLC (135th St, Ste 264, Overland Park KS 66223, United States)
Abstract
Inflammation has emerged as being strongly associated with AF initiation
and perpetuation, including being implicated as a possible causal factor.
Its role needs further elucidation to assist with the optimal prevention
and treatment of AF using an individualized strategy. In the present
review article the current published data linking inflammation to AF is
summarized.
<15>
Accession Number
24428092
Authors
Wananukul S. Chatpreodprai S. Peongsujarit D. Lertsapcharoen P.
Institution
(Wananukul, Chatpreodprai, Peongsujarit) Division of Dermatology,
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand.
(Lertsapcharoen) Division of Cardiology, Department of Pediatrics, Faculty
of Medicine, Chulalongkorn University, Bangkok, Thailand.
Title
A prospective placebo-controlled study on the efficacy of onion extract in
silicone derivative gel for the prevention of hypertrophic scar and keloid
in median sternotomy wound in pediatric patients.
Source
Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 96
(11) (pp 1428-1433), 2013. Date of Publication: Nov 2013.
Abstract
New topical treatments studied in adults have been published to be
potentially effective in the treatment of hypertrophic scar and keloids.
There is still no study in Thai children. To study the efficacy of 10%
onion extract in silicone derivative gel for the prevention of
hypertrophic scar and keloid in median sternotomy wound from open heart
surgery in pediatric patients. Thirty-nine pediatric patients who had
median sternotomy were recruited in this prospective randomized,
double-blinded, placebo-controlled split-scar experimental study. The
wound in each patient was divided into upper and lower parts, and the
treatment with, either onion extract gel or placebo was randomly applied
by block randomization onto each part of the wound twice daily after the
seventh day postoperatively for six months. The incidence of scars, serial
photographs of the wound, Vancouver Scar Scale (VSS), and adverse effect
were assessed at each visit. Thirty patients with the mean age of 4.3
years completed the 6-month study period. Six patients (20%) in onion
extract gel group had no scar compared to one patient (3.3%) in placebo
group (p = 0.04). Of the 27 patients with hypertrophic scar nine were from
onion extract gel group and 18 from the placebo group (p = 0.02). Keloid
was not statistically significant diferent in both groups (p = 0.29). VSS
was not statistically significant different in all visits. One case had a
pustule on the part of the onion extract in silicone derivative
application at the sixth month. Onion extract in silicone derivative gel
can significantly decreased the incidence of hypertrophic scar from median
sternotomy wound in pediatric patients. Keloid did not show statistically
significant differences in both groups.
<16>
Accession Number
2014007766
Authors
Psota M. Capewell S. O'Flaherty M. Goncalvesova E.
Institution
(Psota) Department of Public Health, Trnava University in Trnava, Slovakia
(Capewell, O'Flaherty) Department of Public Health and Policy, University
of Liverpool, Liverpool, United Kingdom
(Goncalvesova) The National Institute of Cardiovascular Diseases,
Bratislava, Slovakia
Title
The causes of changes in coronary heart disease mortality rates using the
IMPACT model: A systematic review.
Source
Cardiology Letters. 22 (6) (pp 449-458), 2013. Date of Publication: 2013.
Publisher
SYMEKARD s.r.o. (Bardosova 2/A, LUXE, Bratislava 831 01, Slovakia)
Abstract
Introduction: Cardiovascular diseases (CVDs), and among them coronary
heart disease (CHD), are the leading cause of death worldwide and in
European countries including Central European countries. In the last
decades, however, it has been possible to observe decreases in mortality
rates from this group of diseases. It is of great importance to know the
causes that have led to these decreases because a better understanding
will allow us to make evidence-based decisions and so to manage and
allocate resources effectively. Because the development of mortality rates
trend reflects complex determinants, it is difficult to explain it. In
this context mathematical models become important. Aim: This systematic
review describes the results of the IMPACT mathematical model which has
been widely used to explore past CHD mortality rates trends in several
European and non-European countries. Methods: We identified 19 articles
that were published between the years 1999 - 2013 and that were indexed in
the Web of Science, Scopus and EBSCO Discovery Service databases and used
the IMPACT model to explore past trends of CHD mortality rates. Results:
16 articles analysed the decreases in CHD mortality rates and 3 articles
analysed the increases in CHD mortality rates. According to the IMPACT
model estimates the contribution of evidence-based treatments (EBT) on the
fall of CHD mortality rates can range between 23-47%. Risk factor
reduction contributed to the decline by some 44-73%. The articles agree
that it is not possible to substantially decrease the CHD mortality
without a comprehensive strategy that promotes primary prevention
(especially healthy diet, physical activity and reduction of smoking) and
evidence-based medical treatments. Conclusion: The IMPACT model offers an
innovative approach to generate evidence further quantifying the influence
of risk factors and EBT uptake on CHD mortality trends. In the Central
European area the model has been developed only in the Czech Republic and
Poland. We are convinced that it is desirable to also create a Slovak
version of the model.
<17>
Accession Number
24341049
Authors
Straus S. Gerc V. Kacila M. Faruk C.
Institution
(Straus, Gerc, Kacila, Faruk) Heart Center, Clinical Center of University
of Sarajevo, Bosnia and Herzegovina.
Title
Glucosa-Insulin-Potassium (GIK) solution used with diabetic patients
provides better recovery after coronary bypass operations.
Source
Medicinski arhiv. 67 (2) (pp 84-87), 2013. Date of Publication: 2013.
Abstract
Tight blood glucose control has become a therapeutical goal for anesthetic
management for patients scheduled for cardiac surgery, especially if they
are diabetic patients. This study was created to confirm the benefits of
intraoperative GIK solution usage during coronary bypass operation of
diabetic patients. Patients with type 1 and 2 diabetes mellitus (DM)
referred for coronary artery bypass grafting (CABG) were randomized to
receive GIK solution (GIK--study group) in the first 24 hours
intraoperatively or to receive official Clinical protocol without GIK
solution (non GIK - control group). The primary clinical outcome was the
cardiac index (CI) since it represents the most sensitive measure of
cardiac work in the immediate postoperative period, and the secondary
clinical outcomes were the glycemic control, insulin consumption, duration
of mechanical ventilation (MV), potassium level and atrial fibrillation
(AF) appearance. One hundred diabetic patients, divided into two groups,
were included in the study. The cardiac index did not show a significant
difference, although the study group had CI with only minor variations
than those of the controlled group, hence the reason we considered the
study group as the more stable. The atrial fibrillation showed a
difference between two groups, with 14 (28%) patients with postoperative
AF in the control group compared with 3 (6%) patients with postoperative
AF in the study group. As potassium values were stable in study group, we
concluded that it can be one of the reasons for less postoperative AF in
this group. The duration of MV showed a significant difference (0,003)
between the two groups as well. In the study group the average MV time was
534,38 minutes, compared with the control group with 749,20 minutes. The
average value of glucose was 11.1 mmol/l in the control group vs. 9.8
mmol/l in the study group. The study group had less insulin consumption in
order to maintain target glycemia (p = 0.001). In the non GIK group
average insulin consumption was 44 IJ per patient vs. 28.5 IJ in the GIK
group. Intraoperative GIK solution given to diabetic patients with CABG
operation provides more stable CI, shorter time of MV, more stable values
of potassium which provides normal rhythm and less AF onset, less insulin
to maintain target glycemia. All the above mentioned provides more stable
intraoperative hemodynamic and better recovery of diabetic
<18>
Accession Number
71310484
Authors
Tun N.M. Nayak A. Ong K.
Institution
(Tun, Nayak) Hematology and Oncology, Brooklyn, NY, United States
(Ong) Internal Medicine, Brooklyn Hospital Center, Brooklyn, NY, United
States
Title
Effect of aprepitant added to standard antiemetic regimen on delayed phase
after highly emetogenic chemotherapy: A meta-analysis.
Source
Supportive Care in Cancer. Conference: 2012 International MASCC/ISOO
Symposium: Supportive Care in Cancer New York City, NY United States.
Conference Start: 20120628 Conference End: 20120630. Conference
Publication: (var.pagings). 20 (pp S48-S49), 2012. Date of Publication:
June 2012.
Publisher
Springer Verlag
Abstract
Objectives: We performed a meta-analysis of double-blind, randomized,
placebo-controlled trials to investigate the effect of adding aprepitant
to the standard antiemetic regimen on the delayed phase (within 24-120 h)
of chemotherapy. Methods: A PubMed Medline search using the MeSH terms
"aprepitant" filtered by "clinical trial" yielded 73 articles. Outcome
measures are defined as follows: total control=no vomiting, no rescue,
nausea VAS<5 mm; complete protection=no vomiting, no rescue therapy,
nausea VAS<25 mm; complete response'no vomiting, no rescue; no
nausea=nausea VAS<5 mm; no significant nausea=nausea VAS< 25 mm. The
Mantel-Haenszel method with a fixed or random effects model (depending on
the between-study heterogeneity) was applied to calculate the risk ratio
(RR) and risk difference (RD) with 95 % confidence interval (CI). Results:
Seven studies including 2,159 patients (1,081 aprepitantbased and 1,078
standard) were eligible. clear consensus on this issue could not be
achieved. In our country, a study related to physicians' approaches has
not been done. The aim of the study was to determine the chest physicians'
and thoracic surgeons' approaches from different clinics in our country.
Method: A web-based survey consisting of 17questions was delivered via
e-mail groups of the Turkish Thoracic Society and Turkish Respiratory
Society to 1,000 chest physicians and via e-mail groups of thoracic
surgeons to 400 thoracic surgeons. Fifteen of 17 questions were prepared
as multiple choice questions, and in seven questions, marking more than
one option was allowed. Results: A total of 126 physicians including 69
chest physicians and 56 thoracic surgeons answered the survey. One
physician did not report the specialization. The total pleurodesis number
of respondents in a year was 3,441 (mean=30.4+44.3, min=1, max=250), and
the most commonly used agents were talc powder, bleomycin, tetracycline,
and talc solution (78.5, 30, 24.8, and 24%, respectively). A 28- to 32-F
chest tube was the most commonly (67.7 %) used tube for fluid drainage and
pleurodesis, and a <16-F catheter was used by 52.4 % of the respondents.
The utilization rate of the thoracoscopic method for pleurodesis was32.2
%. Of the respondents, 98.3%were applying pleurodesis for the treatment of
malignant pleural effusions other thanmesothelioma; this rate was 57.5%
for mesothelioma. The average time in which 126 physicians evaluated the
success of pleurodesis was 1.7+1.67 (min=1; max=12)months. The question of
"which specialization should make the pleurodesis" was answered by 93.5 %
of the respondents as thoracic surgeons and 63.4 % of the respondents as
chest physicians. Conclusion: It was determined that as well as all over
the world, different trends of physicians on pleurodesis were present also
in our country; the results of our study were found to be consistent with
the literature in general.
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