Results Generated From:
Embase <1980 to 2015 Week 21>
Embase (updates since 2015-05-15)
Embase <1980 to 2015 Week 21>
Embase (updates since 2015-05-15)
<1>
Accession Number
2015638915
Authors
Machovec K.A. Jooste E.H. Walczak R.J. Homi H.M. Jaquiss R.D.B. Lodge A.J.
Ames W.A.
Institution
(Machovec, Jooste, Homi, Ames) Division of Pediatric Anesthesia,
Department of Anesthesiology, Duke University Hospital, DUMC Box 3094,
Durham, NC 27710, United States
(Walczak, Jaquiss, Lodge) Division of Cardiovascular and Thoracic Surgery,
Department of Surgery, Duke University Hospital, Durham, NC, United States
Title
A change in anticoagulation monitoring improves safety, reduces
transfusion, and reduces costs in infants on cardiopulmonary bypass.
Source
Paediatric Anaesthesia. 25 (6) (pp 580-586), 2015. Date of Publication: 01
Jun 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background An immature coagulation system coupled with the hypothermia and
hemodilution associated with cardiopulmonary bypass (CPB) in infants makes
the activated clotting time (ACT) an ineffective monitor for
anticoagulation in this population. The Medtronic HMS Plus Hemostasis
Management System (HMS; Medtronic, Inc., Minneapolis, MN, USA) is shown to
decrease thrombin generation and blood product requirements. Aim We
conducted a quality improvement initiative to test our hypothesis that the
use of HMS results in reduced incidence of subtherapeutic ACT values,
blood product usage, and operating room time for infants undergoing
cardiac surgery. Methods Fifty consecutive patients weighing <10 kg having
cardiac surgery requiring CPB had anticoagulation managed by the HMS. Data
were compared to that of 50 consecutive patients weighing <10 kg having
cardiac surgery who had their anticoagulation monitored by the ACT alone.
Comparisons between categorical variables were performed with chi-square
tests. Comparisons between continuous variables were performed with the
Wilcoxon rank-sum test. Statistical significance was defined as two-tailed
P value < 0.05. Results The HMS group had a 61% decrease in incidence of
ACT values <480 s and elimination of ACT values < 400 s at any time on
bypass. The HMS group received fewer blood products and spent fewer
minutes in the operating room after protamine administration, translating
to fewer donor exposures and a savings of 403 in transfusion costs and 440
in operating room time costs. Conclusion Our findings highlight the
benefits of individualized heparinization for pediatric patients
undergoing CPB with a monitored heparinization system.
<2>
Accession Number
2015867773
Authors
Lakkireddy D. Pillarisetti J. Atkins D. Biria M. Reddy M. Murray C.
Bommana S. Shanberg D. Adabala N. Pimentel R. Dendi R. Emert M. Vacek J.
Dawn B. Berenbom L.
Institution
(Lakkireddy, Pillarisetti, Atkins, Biria, Reddy, Murray, Bommana,
Shanberg, Adabala, Pimentel, Dendi, Emert, Vacek, Dawn, Berenbom) Division
of Cardiology, University of Kansas Hospital, 3901, Rainbow Blvd, G-600,
Kansa City, KS 66196, United States
Title
Impact of pocket revision on the rate of infection and other complications
in patients requiring pocket manipulation for generator replacement and/or
lead replacement or revision (MAKE IT CLEAN): A prospective randomized
study.
Source
Heart Rhythm. 12 (5) (pp 950-956), 2015. Article Number: 6106. Date of
Publication: 01 May 2015.
Publisher
Elsevier
Abstract
Background The fibrous capsule around cardiac implantable device
generators is known to promote bacterial colonization and latent
infection. Removal of the capsule during device replacement procedures may
reduce infection rates but may increase hemorrhagic complications.
Objective The purpose of this study was to evaluate the effect of pocket
capsule decortication procedure on infection and bleeding rates in
patients undergoing device replacement procedures. Methods In a
prospective randomized single-blind control study, patients undergoing
device replacement, upgrade, or lead extraction were randomized to Group A
"with pocket revision" (n = 131) and group B "without pocket revision" (n
= 127). Deep and superficial infection rates, bleeding, and prolonged
serous drainage were assessed during 12 months of follow-up. Data were
analyzed according to intention-to-treat principle. Results A total of 258
patients were enrolled in the study. Rates of generator change, upgrade,
and lead extraction/replacement were similar between both groups. There
was no incidence of deep infection in either group at 12-month follow-up.
There was no significant difference in the incidence of superficial
infection between groups (1.5% vs 4.7%, P =.13) during 12-month follow-up.
There was a significant increase in acute hematoma formation in group A
compared to group B (6.1% vs 0.8%, P =.03). Two patients in group A had to
undergo hematoma evacuation. Conclusion There was increased incidence of
hematoma formation in group A with no effect on infection rates. Our study
suggests that there is no benefit to performing empiric pocket revision.
<3>
Accession Number
2015830238
Authors
Christakopoulos G.E. Christopoulos G. Carlino M. Jeroudi O.M. Roesle M.
Rangan B.V. Abdullah S. Grodin J. Kumbhani D.J. Vo M. Luna M. Alaswad K.
Karmpaliotis D. Rinfret S. Garcia S. Banerjee S. Brilakis E.S.
Institution
(Christakopoulos, Christopoulos, Jeroudi, Roesle, Rangan, Abdullah,
Grodin, Kumbhani, Luna, Banerjee, Brilakis) Department of Cardiovascular
Diseases, VA North Texas Healthcare System, UT Southwestern Medical
Center, Dallas, TX, United States
(Carlino) Department of Cardiovascular Diseases, San Raffaele Scientific
Institute, Milan, Italy
(Vo) Department of Cardiovascular Diseases, University of Manitoba, MT,
Canada
(Alaswad) Department of Cardiovascular Diseases, Henry Ford Hospital,
Detroit, MI, United States
(Karmpaliotis) Department of Cardiovascular Diseases, Columbia University,
New York, NY, United States
(Rinfret) Department of Cardiovascular Diseases, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Laval University, Quebec City,
QC, Canada
(Garcia) Department of Cardiovascular Diseases, Minneapolis VA Healthcare
System, University of Minnesota, Minneapolis, MN, United States
Title
Meta-analysis of clinical outcomes of patients who underwent percutaneous
coronary interventions for chronic total occlusions.
Source
American Journal of Cardiology. 115 (10) (pp 1367-1375), 2015. Date of
Publication: 15 May 2015.
Publisher
Elsevier Inc.
Abstract
Successful percutaneous coronary intervention (PCI) for chronic total
occlusions (CTOs) has been associated with clinical benefit. There are no
randomized controlled trials on long-term clinical outcomes after CTO PCI,
limiting the available evidence to observational cohort studies. We sought
to perform a weighted meta-analysis of the long-term outcomes of
successful versus failed CTO PCI. A total of 25 studies, published from
1990 to 2014, with 28,486 patients (29,315 CTO PCI procedures) were
included. We analyzed data on mortality, subsequent coronary artery bypass
grafting (CABG), myocardial infarction, major adverse cardiac events,
angina pectoris, stroke, and target vessel revascularization using
random-effects models. Procedural success was 71% (range 51% to 87%).
During a weighted mean follow-up of 3.11 years, compared with
unsuccessful, successful CTO PCI was associated with lower mortality (odds
ratio [OR] 0.52, 95% confidence interval [CI] 0.43 to 0.63), less residual
angina (OR 0.38, 95% CI 0.24 to 0.60), lower risk for stroke (OR 0.72, 95%
CI 0.60 to 0.88), less need for subsequent coronary artery bypass grafting
(OR 0.18, 95% CI 0.14 to 0.22), and lower risk for major adverse cardiac
events (0.59, 95% CI 0.44 to 0.79). There was no difference in the
incidence of target vessel revascularization (OR 0.66, 95% CI 0.36 to
1.23) or myocardial infarction (OR 0.73, 95% CI 0.52 to 1.03). Outcomes
were similar in patients who underwent balloon angioplasty only or
stenting with bare metal or drug-eluting stents. Compared with failed
procedures, successful CTO PCIs are associated with a lower risk of death,
stroke, and coronary artery bypass grafting and less recurrent angina
pectoris.
<4>
Accession Number
2015827390
Authors
Giannopoulos G. Angelidis C. Kouritas V.K. Dedeilias P. Filippatos G.
Cleman M.W. Panagopoulou V. Siasos G. Tousoulis D. Lekakis J. Deftereos S.
Institution
(Giannopoulos, Angelidis, Deftereos) Department of Cardiology, Athens
General Hospital G. Gennimatas, Athens, Greece
(Giannopoulos, Cleman, Deftereos) Section of Cardiovascular Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Kouritas, Dedeilias) Department of Cardiac Surgery, Evangelismos General
Hospital, Athens, Greece
(Filippatos, Lekakis) Second Department of Cardiology, University of
Athens Medical School, Attikon Hospital, Athens, Greece
(Panagopoulou, Siasos, Tousoulis) First Department of Cardiology,
University of Athens Medical School, Hippokration Hospital, Athens, Greece
Title
Usefulness of colchicine to reduce perioperative myocardial damage in
patients who underwent on-pump coronary artery bypass grafting.
Source
American Journal of Cardiology. 115 (10) (pp 1376-1381), 2015. Date of
Publication: 15 May 2015.
Publisher
Elsevier Inc.
Abstract
The objective of the present study was to test whether a perioperative
course of colchicine, in patients who underwent standard coronary artery
bypass grafting, would result in reduced postoperative increase of
myocardial injury biomarker levels. Patients were prospectively randomized
to colchicine or placebo starting 48 hours before scheduled coronary
artery bypass grafting and for 8 days thereafter (0.5 mg twice daily). The
primary outcome parameter was maximal high-sensitivity troponin T (hsTnT)
concentration within 48 hours after surgery. Secondary outcome measures
were maximal creatine kinase-myocardial brain fraction (CK-MB) levels and
area under the curve (AUC) of hsTnT and CK-MB concentrations; 59 patients
were included. Maximal hsTnT was 616 pg/ml (396 to 986) in the colchicine
group versus 1,613 pg/ml (732 to 2,587) in controls (p = 0.002). Maximal
CK-MB was 44.6 ng/ml (36.6 to 68.8) and 93.0 ng/ml (48.0 to 182.3),
respectively (p = 0.002). The median AUC for hsTnT was 40,755 pg h/ml
(20,868 to 79,176) in controls versus 20,363 pg h/ml (13,891 to 31,661) in
the colchicine group (p = 0.002). AUCs for CK-MB were 2,552 ng h/ml (1,564
to 4,791) in controls and 1,586 ng h/ml (1,159 to 2,073) in the colchicine
group (p = 0.003). The main complaints associated with colchicine were, as
expected, gastrointestinal, with 5 patients (16.7%) in the colchicine
group reporting diarrhea versus 1 control (3.4%) (p = 0.195). In
conclusion, a short perioperative course of colchicine was effective in
attenuating postoperative increases of hsTnT and CK-MB compared with
placebo. This finding, which needs confirmation in a larger clinical trial
powered to assess clinical endpoints, suggests a potential role for this
agent in reducing cardiac surgery-related myocardial damage.
<5>
Accession Number
2015825404
Authors
Verdoia M. Schaffer A. Barbieri L. Suryapranata H. De Luca G.
Institution
(Verdoia, Schaffer, Barbieri, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria Maggiore della Carita, Eastern Piedmont
University, C.so Mazzini, 18, Novara 28100, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Bivalirudin as compared to unfractionated heparin in patients undergoing
percutaneous coronary revascularization: A meta-analysis of 22 randomized
trials.
Source
Thrombosis Research. 135 (5) (pp 902-915), 2015. Date of Publication: 01
May 2015.
Publisher
Elsevier Ltd
Abstract
Bivalirudin has gained ground against unfractionated heparin (UFH) in
percutaneous coronary interventions (PCI), due to a reported better safety
profile. However, whether bivalirudin may provide also advantages in
clinical outcome beyond the known benefits in major bleedings, is still a
debated matter and was, therefore, the aim of present meta-analysis of
randomized trials, evaluating efficacy and safety of bivalirudin as
compared with UFH in PCI. Methods and study outcomes Literature archives
(Pubmed, EMBASE, Cochrane) and main scientific sessions were scanned.
Primary endpoint was overall mortality. Secondary endpoints were: 1)
mortality within 30-days; 2) overall and within 30-days non fatal
myocardial infarction; 3) overall and within 30-days stent thrombosis.
Safety endpoints were major bleedings (per protocol definition or TIMI
classification). A prespecified analysis was conducted according to
clinical presentation (Elective, ACS, STEMI). Results A total of 22
randomized clinical were finally included, involving 40156 patients
randomized to bivalirudin (52.9%) or to UFH (47.1%). Death occurred in
1100 (2.8%) of patients, with no difference between bivalirudin and UFH
(2.7% vs 2.8% OR[95%C] = 0.94[0.83,-.06], p = 0.32, phet = 0.48). The
results did not change according to clinical presentation. By
meta-regression analysis, the effects on mortality were not related to
patients risk profile (r = - 0.38(- 0.89-0.14), p = 0.15) or the reduction
in bleeding complications (r = - 0.008(- 0.86-0.85), p = 0.98). A
significant increase in short-term stent thrombosis was observed with
bivalirudin (OR[95%CI] = 1.42 [1.10-1.83], p = 0.006). However,
Bivalirudin significantly reduced bleedings according to both study
protocol definition (OR[95%CI] = 0.62[0.56-0.69],p < 0.00001; phet =
0.0003) or TIMI major criteria (OR[95%CI] = 0.65[0.53-0.79],p < 0.0001,
phet = 0.95). Conclusions In present meta-analysis, among patients
undergoing PCI, bivalirudin, as compared with UFH, is associated with a
significant reduction in major bleeding complications that, however, does
not translate into mortality benefits. Furthermore, bivalirudin is
associated with higher rate of 30-days stent thrombosis and recurrent MI
among STEMI patients.
<6>
Accession Number
2015823839
Authors
Kobayashi N. Maehara A. Mintz G.S. Wolff S.D. Genereux P. Xu K. Mehran R.
Gibson C.M. Brener S.J. Stone G.W.
Institution
(Kobayashi, Maehara, Wolff, Genereux, Stone) Division of Cardiology, New
York Presbyterian Hospital, Columbia University Medical Center, New York,
NY, United States
(Kobayashi, Maehara, Mintz, Wolff, Genereux, Xu, Mehran, Brener, Stone)
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY,
United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Gibson) Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Brener) Department of Medicine, New York Methodist Hospital, Brooklyn,
NY, United States
Title
Usefulness of the left anterior descending artery wrapping around the left
ventricular apex to predict adverse clinical outcomes in patients with
anterior wall ST-segment elevation myocardial infarction (an INFUSE-AMI
substudy).
Source
American Journal of Cardiology. 115 (10) (pp 1389-1395), 2015. Date of
Publication: 15 May 2015.
Publisher
Elsevier Inc.
Abstract
The relation between left anterior descending coronary artery (LAD)
anatomic features and clinical outcomes in patients with anterior
ST-segment elevation myocardial infarction has not been fully
investigated. The Intracoronary Abciximab and Aspiration Thrombectomy in
Patients With Large Anterior Myocardial Infarction (INFUSE-AMI) trial
randomized 452 patients with anterior ST-segment elevation myocardial
infarctions who underwent mechanical revascularization to intralesional
abciximab versus no abciximab and to manual thrombus aspiration versus no
aspiration. The primary end point was infarct size (percentage left
ventricular mass) on contrast magnetic resonance imaging at 30 days.
"Wraparound LAD" was defined as an LAD reaching the apex and supplying the
apical inferior aspect of the heart. Among complete data available in 338
patients, 258 (76.3%) had wraparound LADs. Global infarct size (17.4% vs
16.1%, p = 0.64) and the left ventricular ejection fraction (49.7% vs
48.7%, p = 0.98) by contrast magnetic resonance imaging at 30 days were
comparable between patients with and those without wraparound LADs.
Regional apical anterior infarct size was comparable (59.5% vs 55.8%, p =
0.559) between the groups; however, apical septal (61.3% vs 48.9%, p =
0.005), apical inferior (19.0% vs 3.7%, p <0.0001), and apical lateral
(12.2% vs 4.8%, p = 0.0584) infarct sizes were larger in patients with
wraparound LADs compared with those with nonwraparound LADs. The incidence
of new-onset severe heart failure at 1 year was significantly higher in
patients with compared with those without wraparound LADs (6.3% vs 0%, p =
0.02). In conclusion, in patients with anterior ST-segment elevation
myocardial infarctions, as compared with the LAD not supplying the
inferior aspect of the heart, a wraparound LAD was associated with a
larger left ventricular apex infarct size, resulting in worse adverse
events at 1 year.
<7>
Accession Number
2015959657
Authors
Berdajs D.A. Muradbegovica M. Haselbacha D. Kofmehl R. Steurer J. Ferrari
E. Held U. Von Segesser L.K.
Institution
(Berdajs, Muradbegovica, Haselbacha, Ferrari) Department of Cardiovascular
Surgery, University Hospital Lausanne, Lausanne, Switzerland
(Kofmehl, Steurer, Held) Horten Center for Patient-Oriented Research and
Knowledge Transfer, University of Zurich, Zurich, Switzerland
(Von Segesser) Department of Surgery and Anesthesiology, Cardio-Vascular
Research, University Hospital Lausanne, Lausanne, Switzerland
Title
Ross procedure: Is the root replacement technique superior to the
sub-coronary implantation technique? Long-term results.
Source
European Journal of Cardio-thoracic Surgery. 46 (6) (pp 944-951), 2014.
Date of Publication: 01 Dec 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
There is controversy over the use of the Ross procedure with regard to the
sub-coronary and root replacement technique and its longterm durability. A
systematic review of the literature may provide insight into the outcomes
of these two surgical subvariants. A systematic review of reports between
1967 and February 2013 on sub-coronary and root replacement Ross
procedures was undertaken. Twenty-four articles were included and divided
into (i) sub-coronary technique and (ii) root replacement technique. The
10-year survival rate for a mixed-patient population in the sub-coronary
procedure was 87.3% with a 95% confidence interval (CI) of 79.7-93.4 and
89.1% (95% CI, 85.3-92.1) in the root replacement technique category. For
adults, it was 94 vs 95.3% (CI, 88.9-98.1) and in the paediatric series it
was 90 vs 92.7% (CI, 86.9-96.0), respectively. Freedom from reoperation at
10 years was, in the mixed population, 83.3% (95% CI, 69.9-93.4) and 93.3%
(95% CI, 89.4-95.9) for sub-coronary versus root replacement technique,
respectively. In adults, it was 98 vs 91.2% (95% CI, 82.4- 295.8), and in
the paediatric series 93.3 vs 92.0% (95% CI, 86.1-96.5) for sub-coronary
versus root replacement technique, respectively. The Ross procedure
arguably has satisfactory results over 5 and 10 years for both adults and
children. The results do not support the advantages of the sub-coronary
technique over the root replacement technique. Root replacement was of
benefit to patients undergoing reoperations on neoaorta and for long-term
survival in mixed series.
<8>
Accession Number
2015972372
Authors
Chang Y.H. Oh T.H. Lee J.W. Park S.C. Seo I.Y. Jeong H.J. Kwon W.-A.
Institution
(Chang) Department of Radiology, College of Medicine, Chungbuk National
University, Cheongju, South Korea
(Oh, Lee, Park, Seo, Jeong) Department of Urology, Wonkwang University
School of Medicine, Institute of Wonkwang Medical Science, Iksan, South
Korea
(Kwon) Department of Urology, Wonkwang University School of Medicine,
Institute of Wonkwang Medical Science, 321 Sanbon-ro, Gunpo, Gyeonggi
435-040, South Korea
Title
Listening to music during transrectal ultrasound-guided prostate biopsy
decreases anxiety, pain and dissatisfaction in patients: A pilot
randomized controlled trial.
Source
Urologia Internationalis. 94 (3) (pp 337-341), 2015. Date of Publication:
25 Apr 2015.
Publisher
S. Karger AG
Abstract
Objective: To determine whether listening to music during transrectal
ultrasound (TRUS)-guided 12-core needle prostate biopsy decreases anxiety,
pain and dissatisfaction among patients and results in a more comfortable
and better tolerated procedure. Patients and Methods: 76 male patients who
underwent TRUS-guided prostate biopsy between March 2013 and June 2014
were randomized into the following groups: no music (group I, n = 38) or
classical music (group II, n = 38) during the procedure. Before
TRUS-guided prostate biopsy, lidocaine gel was instilled into the rectum.
Patient anxiety levels were quantified using the State-Trait Anxiety
Inventory. A visual analog scale (0-10) was used for self-assessment of
satisfaction, discomfort and willingness among patients to have a repeat
TRUS-guided prostate biopsy. Results: Demographic characteristics, mean
age, procedure duration and procedure indications did not differ
statistically between the two groups. The mean anxiety level and mean pain
score of group II were significantly lower than those of group I (p =
0.001 and p = 0.003, respectively). Group II also had a significantly
higher mean satisfaction score than group I (p = 0.007). Before the
procedure, heart rate and systolic blood pressure were similar in groups I
and II; however, after the procedure, levels were lower in group II than
in group I (heart rate, p = 0.014; systolic blood pressure, p = 0.011).
Conclusion: Listening to music during TRUS-guided prostate biopsy
significantly reduced patients' feelings of pain, discomfort and
dissatisfaction. Music can serve as a simple, inexpensive and effective
adjunct to sedation during TRUS-guided prostate biopsy. We recommend
playing music during TRUS-guided prostate biopsy.
<9>
Accession Number
2015020114
Authors
Lameijer H. Kampman M.A.M. Oudijk M.A. Pieper P.G.
Institution
(Lameijer, Kampman, Pieper) Department of Cardiology, University Medical
Centre Groningen, University of Groningen, Hanzeplein 1, Groningen 9700
RB, Netherlands
(Lameijer) Department of Emergency Medicine, University Medical Centre
Groningen, University of Groningen, Groningen, Netherlands
(Kampman) The Netherlands Heart Institute (ICIN), Utrecht, Netherlands
(Oudijk) Department of Obstetrics, University Medical Centre Utrecht,
University of Utrecht, Utrecht, Netherlands
Title
Ischaemic heart disease during pregnancy or post-partum: Systematic review
and case series.
Source
Netherlands Heart Journal. 23 (5) (pp 249-257), 2015. Date of Publication:
2015.
Publisher
Bohn Stafleu van Loghum
Abstract
The risk of manifestations of ischaemic heart disease (IHD) in fertile
women is elevated during pregnancy and the post-partum period. With
increasing maternal age and a higher prevalence of cardiac risk factors,
the incidence of IHD during pregnancy is rising. However, information in
the literature is scarce. We therefore performed a retrospective cohort
study and systematically reviewed the overall (1975-2013) and contemporary
(2005-2013) literature concerning IHD presenting during pregnancy or in
the post-partum period. We report two cases of IHD with atypical
presentation during pregnancy or post-partum. In our review, we describe
146 pregnancies, including 57 contemporary cases (2005-2013). Risk factors
for IHD were present in 80 %. Of the cases of IHD, 71 % manifested in the
third trimester or the post-partum period, and 95 % presented with chest
pain. The main cause was coronary dissection (35 %), or thrombus/emboli
(35 %) in the more contemporary group. Maternal mortality was 8 % (6 % in
the contemporary group), and the main cardiac complication was ventricular
tachycardia (n = 17). Premature delivery rate was 56 %, and caesarean
section was performed in 57 %. Perinatal mortality was 4 %. In conclusion,
IHD during pregnancy or in the post-partum period has high maternal
mortality and morbidity rates. Also, premature delivery and perinatal
mortality rates are high.
<10>
Accession Number
2015957674
Authors
Li B. Xiang J. Li H. Zhang J. Sun Y. Hu H. Miao L. Ma L. Luo X. Chen S. Ye
T. Zhang Y. Chen H.
Institution
(Li, Xiang, Zhang, Li, Zhang, Sun, Hu, Miao, Ma, Luo, Chen, Ye, Zhang,
Zhang, Chen) Department of Thoracic Surgery, Fudan University Shanghai
Cancer Center, Shanghai, China
(Li, Xiang, Zhang, Li, Zhang, Sun, Hu, Miao, Ma, Luo, Chen, Ye, Zhang,
Zhang, Chen) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
Title
Comparison of Ivor-Lewis vs Sweet esophagectomy for esophageal squamous
cell carcinoma a randomized clinical trial.
Source
JAMA Surgery. 150 (4) (pp 292-298), 2015. Date of Publication: 01 Apr
2015.
Publisher
American Medical Association
Abstract
IMPORTANCE: Sweet esophagectomy is performed widely in China, while the
Ivor-Lewis procedure, with potential benefit of an extended
lymphadenectomy, is limitedly conducted owing to concern for a higher risk
for morbidity. Thus, the role of the Ivor-Lewis procedure for thoracic
esophageal cancer needs further investigation. OBJECTIVE: To determine
whether Ivor-Lewis esophagectomy is associated with increased
postoperative complications compared with the Sweet procedure. DESIGN,
SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted from
May 2010 to July 2012 at Fudan University Shanghai Cancer Center,
Shanghai, China, of 300 patients with resectable squamous cell carcinoma
in the middle and lower third of the thoracic esophagus. Intent-to-treat
analysis was performed. INTERVENTIONS: Patients were randomly assigned to
receive either the Ivor-Lewis (n = 150) or Sweet (n = 150) esophagectomy.
MAIN OUTCOMES AND MEASURES: The primary outcome of this clinical trialwas
operative morbidity (any surgical or nonsurgical complications). Secondary
outcomes included oncologic efficacy (number of lymph nodes resected and
positive lymph nodes), postoperative mortality (30-day and in-hospital
mortality), and patient discharge. RESULTS: Resection without
macroscopical residual (R0/R1) was achieved in 149 of 150 patients in each
group. Although there was no significant difference between the 2 groups
regarding the incidence of each single complication, a significantly
higher morbidity rate was found in the Sweet group (62 of 150 [41.3%])
than in the Ivor-Lewis group (45 of 150 [30%]) (P =.04). More patients in
the Sweet group (8 of 150 [5.3%]) received reoperations than in the
Ivor-Lewis group (1 of 150 [0.7%]) (P =.04). The median hospital stay was
18 days in the Sweet group vs 16 days in the Ivor-Lewis group (P =.002).
Postoperative mortality rates in the Ivor-Lewis (1 of 150) and Sweet (3 of
150) groups were 0.7%and 2.0%, respectively (P =.25). More lymph nodes
were removed during Ivor-Lewis esophagectomy than during the Sweet
procedure (22 vs 18, P <.001). CONCLUSIONS AND RELEVANCE: Early results of
this study demonstrate that the Ivor-Lewis procedure can be performed with
lower rates of postoperative complications and more lymph node retrieval.
Ivor-Lewis and Sweet esophagectomies are both safe procedures with low
operative mortalities.
<11>
Accession Number
2015020371
Authors
Singh P. Chauhan S. Jain G. Talwar S. Makhija N. Kiran U.
Institution
(Singh, Chauhan, Makhija, Kiran) Department of Cardiac Anaesthesia, All
India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
(Jain) Department of Anesthesia and Intensive care, Teerthankar Mahaveer
Medical College, Moradabad, UP, India
(Talwar) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi, India
Title
Comparison of Cardioprotective Effects of Volatile Anesthetics in Children
Undergoing Ventricular Septal Defect Closure.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 4 (1) (pp
24-29), 2013. Date of Publication: 2013.
Publisher
SAGE Publications Inc.
Abstract
Background: Volatile anesthetic agents may precondition the myocardium and
protect against ischemia and infarction. Preconditioning by volatile
anesthetic agents is well documented in adults but is underinvestigated in
children. The present study compares the effect of preconditioning in
children by three volatile anesthetic agents along with several other
variables associated with cardioprotection. Method: Eighty children
scheduled for ventricular septal defect closure under cardioplegic arrest
were assigned to preconditioning for five minutes after commencement of
cardiopulmonary bypass (CPB) with one minimum alveolar concentration (MAC)
of one of the following agents: isoflurane, sevoflurane, desflurane, or
placebo (oxygen-air mixture). The plasma concentration of creatine kinase
MB (CK-MB) was determined after initiation of CPB, and again 6 and 24
hours after admission to the intensive care unit (ICU) after surgery.
Duration of inotropic support, mechanical ventilation, and length of ICU
stay in all the groups were also recorded. Results: Preconditioning with
isoflurane, sevoflurane, and desflurane was associated with significantly
decreased postoperative release of CK-MB as compared to placebo group at 6
(group 1: 237.2 +/- 189, group 2: 69.8 +/- 15.8, group 3: 64.7 +/- 37.8,
and group 4: 70.4 +/- 26.7) and 24 hours (group 1: 192.4 +/- 158.2, group
2: 67.7 +/- 25.0, group 3: 85.7 +/- 66.8, and group 4: 50.4 +/- 31.6)
after admission to ICU. No significant differences were observed in the
CK-MB levels among the three volatile anesthetic agents. Duration of
inotropic support, mechanical ventilation, and length of ICU stay were
greater in placebo group as compared to other groups without reaching
statistical significance. Conclusion: Volatile anesthetic appear to
provide definite cardioprotection to pediatric myocardium. No conclusion
can be drawn regarding the best preconditioning agent among isoflurane,
sevoflurane, and desflurane.
<12>
Accession Number
2015971470
Authors
Sacco S. Ornello R. Ripa P. Tiseo C. Degan D. Pistoia F. Carolei A.
Institution
(Sacco, Ornello, Ripa, Tiseo, Degan, Pistoia, Carolei) Department of
Applied Clinical Sciences and Biotechnology, Institute of Neurology,
University of L'Aquila, L'Aquila, Italy
Title
Migraine and risk of ischaemic heart disease: A systematic review and
meta-analysis of observational studies.
Source
European Journal of Neurology. 22 (6) (pp 1001-1011), 2015. Date of
Publication: 01 Jun 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background and purpose: Several studies have assessed the risk of
ischaemic heart diseases in migraineurs, drawing different conclusions. To
define and update the issue, a systematic review and meta-analysis of the
available observational studies was performed. Methods: PubMed and EMBASE
were systematically searched up to April 2014 for observational studies
dealing with the risk of any form of ischaemic heart disease in
migraineurs. Studies assessing migraine as exposure and several types of
ischaemic heart disease as outcomes were included in the analysis. A
random effects model was used to pool the effect sizes. Results: Out of
3348 records, 15 studies (one case-control, one cross-sectional and 13
cohort studies) were identified and were included in the meta-analysis.
The pooled analysis indicated an increased risk of myocardial infarction
(pooled adjusted effect estimate 1.33, 95% confidence interval 1.08-1.64;
P = 0.007) and of angina (pooled adjusted effect estimate 1.29, 95%
confidence interval 1.17-1.43; P < 0.0001) in migraineurs compared to
non-migraineurs. Conclusions: Based on our data indicating an association
of migraine with myocardial infarction and angina and on previous data
showing an association of migraine, and particularly migraine with aura,
with an increased risk for stroke, migraine can be appropriately
considered an overall risk factor for cardiovascular diseases.
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