EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 11

Results Generated From:
EMBASE <1980 to 2010 Week 27>
EMBASE (updates since 2010-07-02)

<1>
[Use Link to view the full text]
Accession Number
2010345555
Authors
Veldman A.
Institution
(Veldman) Monash Newborn, Monash Medical Centre, Monash University, 246
Clayton Rd, Clayton 3168, VA, Australia.
(Veldman) Ritchie Centre for Baby Health Research, Monash Institute of
Medical Research, Monash University, Clayton, VA, Australia.
Title
Complications of hydroxyethyl starch in paediatric patients.
Source
European Journal of Anaesthesiology. 27(1)(pp 86-87), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins

<2>
[Use Link to view the full text]
Accession Number
2010345546
Authors
Cui W. Li Y. Li S. Wang R. Li J.
Institution
(Cui, Li, Li) Department of Anesthesia, China.
(Wang) National Center for Clinical Pharmacology, Capital Medical
University affiliated Beijing Friendship Hospital, China.
(Li) Department of Neurobiology Beijing Institute for Neuroscience,
Capital Medical University, Beijing, China.
(Li) Department of Neurobiology and Beijing Institute for Neuroscience,
Capital Medical University, #10 You An Men Wai Xi Tou Tiao, Beijing
100069, China.
Title
Systemic administration of lidocaine reduces morphine requirements and
postoperative pain of patients undergoing thoracic surgery after
propofol-remifentanilbased anaesthesia.
Source
European Journal of Anaesthesiology. 27(1)(pp 41-46), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and objective Remifentanil is being increasingly used as an
analgesic in fast-track surgery, but severe postoperative pain may happen
occasionally. In this study, we evaluated the effects of systemic
administration of lidocaine on postoperative pain and morphine
requirements after propofol-remifentanil-based anaesthesia. Methods Forty
patients undergoing thoracic surgery were randomly assigned to lidocaine
(33.0mugkg-1 min-1) and physiological saline control groups in propofol-
remifentanil-based anaesthesia. The setting of the plasma concentration (C
p) of the target-controlled infusion of propofol was adjusted according to
the bispectral index of the electroencephalogram and blood pressure. The
Cp and effect-site concentration (Ce) of propofol were calculated by
target-controlled infusion pump during the intraoperative period. Pain
scoring includes a four-point verbal rating scale, Riker's
sedation-agitation scale and a visual analogue scale; the morphine
requirement in the postanaesthesia care unit and the morphine consumption
via a patient-controlled analgesia device on the ward were recorded during
the postoperative period.Results Morphine requirements within 30, 30-60
and 0-120 min in the postanaesthesia care unit of the lidocaine group
decreased significantly (P<0.05, nU20 per group)compared with that of the
control group. The four-point verbal rating scale at 30 min in the
postanaesthesia care unit, visual analogue scale at 6 h on coughing and
patient-controlled analgesia morphine consumption during 2-6 h
postoperative time were also significantly (P<0.05, nU20 per group)
reduced in the lidocaine group. In addition, the intraoperative propofol
Ce in the lidocaine group during the periods of intubation, organ
resection, closing of chest cavity and extubation was significantlylower
(P<0.05, nU20 per group) than that in the control group under the same
hypnotic depth. Conclusion Systemic administration of lidocaine could
reduce morphine requirements, postoperative pain and intraoperative
propofol Ce of patients undergoing thoracic surgery after
propofol-remifentanil- based anaesthesia. copyright 2010 European Society
of Anaesthesiology.

<3>
Accession Number
2010350858
Authors
Kowalczyk M. Banach M. Lip G.Y.H. Kozlowski D. Mikhailidis D.P. Rysz J.
Institution
(Kowalczyk, Rysz) Department of Nephrology, Hypertension and Family
Medicine, Medical University of Lodz, Lodz, Poland.
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland.
(Lip) University of Birmingham, Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom.
(Kozlowski) Department of Cardiology and Electrotherapy, Medical
University of Gdansk, Gdansk, Poland.
(Mikhailidis) Department of Clinical Biochemistry, Medical School,
University College London, London, United Kingdom.
Title
Levosimendan - A calcium sensitising agent with potential anti-arrhythmic
properties.
Source
International Journal of Clinical Practice. 64(8)(pp 1148-1154), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Levosimendan is a 'Ca2+sensitiser', which exerts its inotropic effect by
increasing the affinity of troponin C for Ca2+, directly stabilising the
Ca2+-induced conformation of troponin C. It leads to a positive inotropic
effect without impairing diastolic relaxation and causing cytosolic Ca2+
ion overload, which might result in cardiac myocyte dysfunction,
arrhythmias and cell death. Levosimendan may also have significant
anti-inflammatory properties. Data from various studies suggest that
levosimendan might have anti-arrhythmic effects, although the outcome of
clinical trials on the effect of this agent in (for example) atrial
fibrillation (AF) remains controversial. Currently, on the basis of
available data, it is especially worth emphasising the potential role of
this drug in the termination of AF after cardiac surgery, which
significantly influences early- and long-term morbidity and mortality.
This review considers the putative anti-arrhythmic properties of
levosimendan and discusses the potential clinical application of such a
drug. copyright 2010 Blackwell Publishing Ltd.

<4>
Accession Number
2010350843
Authors
Farooqi F.M. Talsania S. Hamid S. Rinaldi C.A.
Institution
(Farooqi, Talsania, Hamid, Rinaldi) St Thomas' Hospital, Guy's and St
Thomas' Hospitals, NHS Foundation Trust, London, United Kingdom.
Title
Extraction of cardiac rhythm devices: Indications, techniques and outcomes
for the removal of pacemaker and defibrillator leads.
Source
International Journal of Clinical Practice. 64(8)(pp 1140-1147), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac rhythm management devices (pacemakers) are being increasingly
implanted worldwide not only for symptomatic bradycardia, but also for the
management of arrhythmia and heart failure. Their use in more elderly
patients with significant comorbidities is rising steeply and consequently
long-term complications are increasingly arising. Such an increase in
device therapy is being paralleled by an increase in the requirement for
system extraction. Safe lead extraction is central to the management of
much of the complications related to pacemakers. The most common
indication for lead extraction is system infection Adhesions in
chronically implanted leads can become major obstacles to safe lead
extraction and life-threatening bleeding and cardiac perforations may
occur. Over the last 20 years, specific tools and techniques for
transvenous lead extraction have been developed to assist in freeing the
lead body from the adhesions. This article provides a comprehensive review
of the indications, tools, techniques and outcomes for transvenous lead
extraction. The success rate largely depends on the time from implant. Up
to 12 months from implant, it is rare that traction alone will not
suffice. For longer lead implant duration, no single technique is
sufficient to address all extractions, but laser provides the best chance
of extracting the entire lead. Operator experience is vital in determining
success as familiarity of a wide array of techniques will increase the
likelihood of uncomplicated extraction. Long implantation time, lack of
operator experience, ICD lead type and female gender are risk factors for
life-threatening complications. Lead extraction should therefore, ideally
be performed in high volume centres with experienced staff and on-site
support from a cardiothoracic surgical team able to deal with bleeding
complications from cardiovascular perforation. copyright 2010 Blackwell
Publishing Ltd.

<5>
Accession Number
2010336579
Authors
Carrier M. Perrault L.P. Fortier A. Bouchard D. Pellerin M.
Institution
(Carrier, Perrault, Bouchard, Pellerin) Department of Cardiac Surgery,
Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada.
(Fortier) Montreal Heart Institute Coordinating Center, Montreal, QC,
Canada.
Title
L-arginine supplemented nondiluted blood cardioplegia: A clinical trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 283-287), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. L-arginine was shown to improve protection of the myocardium during
coronary artery bypass graft (CABG) surgery. The objective of the present
study was to determine the concentration of L-arginine to obtain the most
effective protection of the myocardium during CABG surgery. Methods.
Seventy-five patients undergoing CABG surgery were randomized in 3 groups.
The first group (N.=25) was administered a placebo injection in the blood
cardioplegic solution, the second group (N.=25) received an injection of 4
mmol/L of L-arginine and a third group (N.=25) an injection of 6 mmol/L of
L-arginine in the blood cardioplegic solution. Blood samples from the
ascending aorta and the coronary sinus catheter were collected before,
immediately after and at 20 minutes after aortic cross-clamping. Total
plasmatic nitrite and nitrate ratio and lactate release from the
myocardium in the collected blood samples were measured. Results.
Seventy-five patients averaging 62+/-7 years of age and undergoing 3.1+/-1
coronary bypass grafts during 41+/-17 minutes of aortic cross clamping
time were recruited. Values of total plasmatic nitrite and nitrate ratio
remains non-significant before and after aortic clamping and also between
groups (P=0.9812 and 0.3573 respectively). Myocardial lactate release was
statistically different before and after cross clamping (P=0.0002) and
also between the 3 groups (P=0.0311). Conclusion. Nondiluted blood
cardioplegic solution supplemented with 4 mmol/L of L-arginine was
associated with a significant decrease of myocardial lactate release after
aortic cross-clamping and reperfusion during CABG surgery.

<6>
Accession Number
2010336575
Authors
Wang J. Wu J.J. Ren X.Y. Chen C.L. Qiao J. Abudureheman M. Zheng H.
Institution
(Wang, Wu, Ren, Chen, Zheng) Department of Anesthesiology, Xinjiang
Medical University, No. 1, Li yu Shan Street, Urumqi, Xinjiang, China.
(Qiao, Abudureheman) Department of Cardiac Surgery, Xinjiang Medical
University, Urumqi, China.
Title
Application of low-volume zero-balanced ultrafiltration and its effect on
blood propofol concentration: A randomized controlled trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 257-263), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. The aim of this study was to evaluate the effectiveness of low-volume
zero-balanced ultrafiltration during cardiopulmonary bypass in heart valve
replacement surgery. Methods. This was a randomized, double-blind,
controlled study carried out in the operating room. Forty patients of ASA
grade II-III, elected to undergo heart valve replacement surgery, were
enrolled. All patients were randomly assigned to either a low-volume (35
mL/kg) zero-balanced ultrafiltration group (N.=20) or to a control group
(N.=20). Blood propofol concentrations and entropy index were measured
using cardiopulmonary bypass. Concentrations of plasma tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10),
and cardiac troponin I were measured before and after the end of
cardiopulmonary bypass and corrected according to hematocrit. Results.
Blood levels of cardiac troponin I, TNF-alpha, IL-6, and IL-10 after
surgery were all significantly lower in the ultrafiltration group than in
the control group (P<0.05) after the end of bypass. Blood propofol
concentrations decreased significantly in both groups during
cardiopulmonary bypass and remained significantly lower in the
ultrafiltration group than the control group. However, there was no
significant difference between the two groups in the entropy index
(P=0.5583). Conclusion. Low-volume zero-balanced ultrafiltration performed
during cardiopulmonary bypass surgery significantly decreased post-bypass
levels of the cytokines, TNF-alpha, IL-6, IL-10, and postoperative cardiac
troponin I. Blood propofol concentration was also decreased; however, the
depth of anesthesia was not affected significantly.

<7>
Accession Number
2010289898
Authors
Kim S. Kim H.K. Kang D.-Y. Jeong J.M. Choi Y.H.
Institution
(Kim) Department of Nuclear Medicine, College of Medicine, Korea
University Guro Hospital, South Korea.
(Kim, Kang, Choi) Department of Thoracic and Cardiovascular Surgery,
College of Medicine, Korea University Guro Hospital, South Korea.
(Jeong) Department of Nuclear Medicine, College of Medicine, Seoul
National University, Seoul, South Korea.
Title
Intra-operative sentinel lymph node identification using a novel
receptor-binding agent (technetium-99m neomannosyl human serum albumin,
99mTc-MSA) in stage I non-small cell lung cancer.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1450-1456), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
Objective: In the previous report, to simplify the synthesis and labelling
procedures and to improve the biological properties, we developed a novel
mannose receptor-binding agent, technetium-99m human serum albumin
(99mTc-MSA), for sentinel lymph node detection. This study is the first
clinical trial designed to test the reliability and feasibility of
sentinel node detection using this new radioactive agent in patients with
stage I non-small cell lung cancer. Methods: Forty-two patients (30 men,
12 women; mean age 63.3 +/- 8.9 years) that were candidates for lobectomy
with mediastinal lymph node dissection for stage I non-small cell lung
cancer were enrolled. A total dose of 1 mCi of 99mTc-MSA in 0.2 ml was
administered in one shot at the peritumoural region approximately 3 h
before surgery. The radioactivity in the lymph nodes was counted before
(in vivo) and after (ex vivo) dissection with a hand-held gamma probe. A
sentinel lymph node was defined as any node for which the radioactivity
count was 5 times that of the resected lung tissue with the lowest count
for the ex vivo counts. All harvested lymph nodes were cut into 2-mm
slices and ultimately diagnosed by using formalin-fixed and
paraffin-embedded sections with haematoxylin and eosin staining. Results:
99mTc-MSA was taken up by the lymph nodes and its detection did not change
until 21 h after the injection. The number of dissected lymph nodes per
patient was 22.1 +/- 11.6 (range 4-57). Among 42 patients, the sentinel
lymph nodes could be identified in 40 patients (95.2%). The number of
sentinel lymph nodes identified was 2.3 +/- 1.1 stations (range 1-5) per
patient. Ten out of 40 patients (25.0%) had metastases in 11 sentinel
lymph nodes. Three of these 11 sentinel lymph nodes (27.3%) had skip
metastases. No false-negative sentinel lymph nodes were detected in any of
the 10 patients with N1 or N2 disease (0%). The relationship between in
vivo and ex vivo results for mediastinal sentinel lymph nodes showed
concurrence in 29 out of 40 patients (72.5%). Conclusions: Intra-operative
sentinel lymph node identification using 99mTc-MSA appears to be feasible
and reliable in stage I non-small cell lung cancer. copyright 2010
European Association for Cardio-Thoracic Surgery.

<8>
Accession Number
2010289874
Authors
Ngaage D.L. Bland J.M.
Institution
(Ngaage) Cardiothoracic Centre, Castle Hill Hospital, Kingston-Upon-Hull,
East Yorkshire, United Kingdom.
(Bland) Department of Health Sciences, University of York, United Kingdom.

Title
Lessons from aprotinin: is the routine use and inconsistent dosing of
tranexamic acid prudent? Meta-analysis of randomised and large matched
observational studies.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1375-1383), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
In view of the safety concerns that led to the withdrawal of aprotinin,
should antifibrinolytics be used indiscriminately in cardiac surgery? This
meta-analysis examines the efficacy and safety profile of tranexamic acid,
and in comparison to aprotinin. We identified randomised trials and large
observational studies investigating the use tranexamic acid from January
1995 to January 2009 using Pubmed/Cochrane search engine and included them
in a two-tier meta-analysis. There were 25 randomised trials and four
matched studies with a total of 5411 and 5977 patients, respectively,
reporting tranexamic acid use in varying dosages. Tranexamic acid is
administered intravenously either as single dose, infusion or both,
sometimes added to pump prime or applied topically. Total intravenous dose
of tranexamic acid varies from 1 g to 20 g, administered over a period of
20 min to 12 h. Compared with placebo, tranexamic acid is associated with
a lower mean difference in blood loss (random effect -298 ml, 95%
confidence [CI] -367 to -229, p < 0.001) and decease in rates of
re-operation for bleeding by 48%, transfusion of packed red cell by 47%
and use of haemostatic blood products by 67%. A non-significant tendency
for postoperative neurological events but a decrease in operative
mortality was observed in patients treated with tranexamic acid compared
with non-treatment group. Compared to aprotinin, tranexamic acid has less
effective blood-conserving effect and mortality risk. Given the potential
to increase neurological complications, the current trend towards
indiscriminate use of tranexamic acid for all cardiac patients needs to be
re-evaluated. Further studies are needed to clarify the neurological risk,
appropriate indications and dosing of tranexamic acid. copyright 2010
European Association for Cardio-Thoracic Surgery.

<9>
Accession Number
2010352165
Authors
Armitage J.M. Bowman L. Clarke R.J. Wallendszus K. Bulbulia R. Rahimi K.
Haynes R. Parish S. Sleight P. Peto R. Collins R.
Institution
(Armitage, Bowman, Clarke, Wallendszus, Bulbulia, Rahimi, Haynes, Parish)
SEARCH Study, Clinical Trial Service Unit, University of Oxford, Old Road
Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom.
(Sleight) Department of Cardiovascular Medicine, University of Oxford,
United Kingdom.
(Peto, Collins) Clinical Trial Service Unit, University of Oxford, United
Kingdom.
Title
Effects of homocysteine-lowering with folic acid plus vitamin B 12 vs
placebo on mortality and major morbidity in myocardial infarction
survivors: A randomized trial.
Source
JAMA - Journal of the American Medical Association. 303(24)(pp
2486-2494), 2010. Date of Publication: June 23-30 2010.
Publisher
American Medical Association
Abstract
Context: Blood homocysteine levels are positively associated with
cardiovascular disease, but it is uncertain whether the association is
causal. Objective: To assess the effects of reducing homocysteine levels
with folic acid and vitamin B12 on vascular and nonvascular outcomes.
Design, Setting, and Patients: Double-blind randomized controlled trial of
12 064 survivors of myocardial infarction in secondary care hospitals in
the United Kingdom between 1998 and 2008. Interventions: 2 mg folic acid
plus 1 mg vitamin B12 daily vs matching placebo. Main Outcome Measures:
First major vascular event, defined as major coronary event (coronary
death, myocardial infarction, or coronary revascularization), fatal or
nonfatal stroke, or noncoronary revascularization. Results: Allocation to
the study vitamins reduced homocysteine by a mean of 3.8 mumol/L (28%).
During 6.7 years of follow-up, major vascular events occurred in 1537 of
6033 participants (25.5%) allocated folic acid plus vitamin B12 vs 1493 of
6031 participants (24.8%) allocated placebo (risk ratio [RR], 1.04; 95%
confidence interval [CI], 0.97-1.12; P=.28). There were no apparent
effects on major coronary events (vitamins, 1229 [20.4%], vs placebo, 1185
[19.6%]; RR, 1.05; 95% CI, 0.97-1.13), stroke (vitamins, 269 [4.5%], vs
placebo, 265 [4.4%]; RR, 1.02; 95% CI, 0.86-1.21), or noncoronary
revascularizations (vitamins, 178 [3.0%], vs placebo, 152 [2.5%]; RR,
1.18; 95% CI, 0.95-1.46). Nor were there significant differences in the
numbers of deaths attributed to vascular causes (vitamins, 578 [9.6%], vs
placebo, 559 [9.3%]) or nonvascular causes (vitamins, 405 [6.7%], vs
placebo, 392 [6.5%]) or in the incidence of any cancer (vitamins, 678
[11.2%], vs placebo, 639 [10.6%]). Conclusion: Substantial long-term
reductions in blood homocysteine levels with folic acid and vitamin B12
supplementation did not have beneficial effects on vascular outcomes but
were also not associated with adverse effects on cancer incidence. Trial
Registration: isrctn.org Identifier: ISRCTN74348595 copyright2010 American
Medical Association. All rights reserved.

<10>
Accession Number
2010323724
Title
Association of estimated glomerular filtration rate and albuminuria with
all-cause and cardiovascular mortality in general population cohorts: a
collaborative meta-analysis.
Source
The Lancet. 375(9731)(pp 2073-2081), 2010. Date of Publication:
20100612/18.
Publisher
Elsevier Limited
Abstract
Background: Substantial controversy surrounds the use of estimated
glomerular filtration rate (eGFR) and albuminuria to define chronic kidney
disease and assign its stages. We undertook a meta-analysis to assess the
independent and combined associations of eGFR and albuminuria with
mortality. Methods: In this collaborative meta-analysis of general
population cohorts, we pooled standardised data for all-cause and
cardiovascular mortality from studies containing at least 1000
participants and baseline information about eGFR and urine albumin
concentrations. Cox proportional hazards models were used to estimate
hazard ratios (HRs) for all-cause and cardiovascular mortality associated
with eGFR and albuminuria, adjusted for potential confounders. Findings:
The analysis included 105 872 participants (730 577 person-years) from 14
studies with urine albumin-to-creatinine ratio (ACR) measurements and 1
128 310 participants (4 732 110 person-years) from seven studies with
urine protein dipstick measurements. In studies with ACR measurements,
risk of mortality was unrelated to eGFR between 75 mL/min/1.73 m2 and 105
mL/min/1.73 m2 and increased at lower eGFRs. Compared with eGFR 95
mL/min/1.73 m2, adjusted HRs for all-cause mortality were 1.18 (95% CI
1.05-1.32) for eGFR 60 mL/min/1.73 m2, 1.57 (1.39-1.78) for 45 mL/min/1.73
m2, and 3.14 (2.39-4.13) for 15 mL/min/1.73 m2. ACR was associated with
risk of mortality linearly on the log-log scale without threshold effects.
Compared with ACR 0.6 mg/mmol, adjusted HRs for all-cause mortality were
1.20 (1.15-1.26) for ACR 1.1 mg/mmol, 1.63 (1.50-1.77) for 3.4 mg/mmol,
and 2.22 (1.97-2.51) for 33.9 mg/mmol. eGFR and ACR were multiplicatively
associated with risk of mortality without evidence of interaction. Similar
findings were recorded for cardiovascular mortality and in studies with
dipstick measurements. Interpretation: eGFR less than 60 mL/min/1.73 m2
and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of
mortality risk in the general population. This study provides quantitative
data for use of both kidney measures for risk assessment and definition
and staging of chronic kidney disease. Funding: Kidney Disease: Improving
Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney
Foundation. copyright 2010 Elsevier Ltd. All rights reserved.

<11>
Accession Number
2010338776
Authors
Vlasselaers D. Mesotten D. Langouche L. Vanhorebeek I. van den Heuvel I.
Milants I. Wouters P. Meyns B. Bjerre M. Hansen T.K. Van den Berghe G.
Institution
(Vlasselaers, Mesotten, Langouche, Vanhorebeek, van den Heuvel, Milants,
Wouters, Van den Berghe) Department of Intensive Care Medicine, Katholieke
Universiteit Leuven, Belgium.
(Meyns) Department of Cardiac Surgery, Katholieke Universiteit Leuven,
Belgium.
(Wouters) Department of Anesthesiology, Universiteit Gent, Belgium.
(Bjerre, Hansen) Immunoendocrine Research Unit, Aarhus University
Hospital, Denmark.
Title
Tight Glycemic Control Protects the Myocardium and Reduces Inflammation in
Neonatal Heart Surgery.
Source
Annals of Thoracic Surgery. 90(1)(pp 22-29), 2010. Date of Publication:
July 2010.
Publisher
Elsevier USA
Abstract
Background: Neonatal cardiac surgery evokes hyperglycemia and a systemic
inflammatory response. Hyperglycemia is associated with intensified
inflammation and adverse outcome in critically ill children and in
pediatric cardiac surgery. Recently we demonstrated that tight glycemic
control (TGC) reduced morbidity and mortality of critically ill children.
Experimental data suggest that insulin protects the myocardium in the
setting of ischemia-reperfusion injury, but this benefit could be blunted
by coinciding hyperglycemia. We hypothesized that insulin-titrated TGC,
initiated prior to myocardial ischemia and reperfusion, protects the
myocardium and attenuates the inflammatory response after neonatal cardiac
surgery. Methods: This is a prospective randomized study at a university
hospital. Fourteen neonates were randomized to intraoperative and
postoperative conventional insulin therapy or TGC. Study endpoints were
effects on myocardial damage and function; inflammation, endothelial
activation, and clinical outcome parameters. Results: Tight glycemic
control significantly reduced circulating levels of cardiac troponin-I (p
= 0.009), heart fatty acid-binding protein (p = 0.01), B-type natriuretic
peptide (p = 0.002), and the need for vasoactive support (p = 0.008). The
TGC suppressed the rise of the proinflammatory cytokines interleukin-6 (p
= 0.02) and interleukin-8 (p = 0.05), and reduced the postoperative
increase in C-reactive protein (p = 0.04). Myocardial concentrations of
Akt, endothelial nitric-oxide synthase, and their phosphorylated forms
were not different between groups. Conclusions: In neonates undergoing
cardiac surgery, intraoperative and postoperative TGC protects the
myocardium and reduces the inflammatory response. This appears not to be
mediated by an early, direct insulin signaling effect, but may rather be
due to independent effects of preventing hyperglycemia during reperfusion.
copyright 2010 The Society of Thoracic Surgeons.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 13

Results Generated From:
EMBASE <1980 to 2010 Week 26>
EMBASE (updates since 2010-06-24)

<1>
Accession Number
0020146009
Authors
Santana M.J. Feeny D. Johnson J.A. McAlister F.A. Kim D. Weinkauf J. Lien
D.C.
Institution
(Santana) University of Alberta Hospital, Edmonton, Alberta, Canada.
Title
Assessing the use of health-related quality of life measures in the
routine clinical care of lung-transplant patients..
Source
Quality of life research : an international journal of quality of life
aspects of treatment, care and rehabilitation. 19(3)(pp 371-379), 2010.
Date of Publication: Apr 2010.
Abstract
PURPOSE: This randomized controlled clinical trial examined the usefulness
of including an assessment of health-related quality of life (HRQL) in the
routine clinical care of lung-transplant patients. We hypothesized that
the inclusion of HRQL in routine clinical care would improve
patient-clinician communication, affect clinical management, and improve
patients' HRQL. METHODS: At the outpatient clinic, University of Alberta
Hospital, patients were randomly assigned to intervention (completion of
Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) on touch-screen
computer with feedback to clinicians) and control group (completion of
HUI2 and HUI3 on touch-screen computer without feedback). Feedback
involved a graphical representation included in patients' chart. All
clinical encounters were audio-taped. Changes in clinical management
(medication changes, number of referrals and test ordered) were summed to
produce an overall management composite. At the end of every visit,
patients completed the EQ-5D. RESULTS: Two hundred and thirteen patients
were randomized (108 to intervention and 105 to control groups). There
were statistically significant differences between the groups in mean
number of issues discussed per encounter (P = 0.003; Cohen's d = 0.03) and
mean management composite score (P = 0.001; Cohen's d = 0.41). EQ-5D index
was not statistically significant different between the groups (P = 0.48).
CONCLUSIONS: We detected very small effects on patient-clinician
communication and small effects on patient management, without detecting
improvement in patient outcome.

<2>
Accession Number
2010340948
Authors
Cykert S. Dilworth-Anderson P. Monroe M.H. Walker P. McGuire F.R.
Corbie-Smith G. Edwards L.J. Bunton A.J.
Institution
(Cykert, Corbie-Smith, Edwards, Bunton) Cecil G. Sheps Center for Health
Services Research, Chapel Hill, NC, United States.
(Cykert, Corbie-Smith) Division of General Internal Medicine and Clinical
Epidemiology, School of Medicine, University of North Carolina, Chapel
Hill, NC, United States.
(Dilworth-Anderson) Department of Health Policy and Management, UNC
Institute on Aging, University of North Carolina, Chapel Hill, NC, United
States.
(Edwards) Department of Biostatistics, University of North Carolina,
Chapel Hill, NC, United States.
(Cykert) Internal Medicine Program, Moses Cone Health System, Greensboro
Area Health Education Center, Greensboro, NC, United States.
(Monroe) Department of Internal Medicine, Carolinas Medical Center,
Charlotte, NC, United States.
(Walker) Leo Jenkins Cancer Center, Brody School of Medicine, East
Carolina University, Greenville, NC, United States.
(McGuire) Division of Pulmonary and Critical Care Medicine, School of
Medicine, University of South Carolina, Columbia, SC, United States.
Title
Factors associated with decisions to undergo surgery among patients with
newly diagnosed early-stage lung cancer.
Source
JAMA - Journal of the American Medical Association. 303(23)(pp
2368-2376), 2010. Date of Publication: 16 Jun 2010.
Publisher
American Medical Association
Abstract
Context: Lung cancer is the leading cause of cancer death in the United
States. Surgical resection for stage I or II non-small cell cancer remains
the only reliable treatment for cure. Patients who do not undergo surgery
have a median survival of less than 1 year. Despite the survival
disadvantage, many patients with early-stage disease do not receive
surgical care and rates are even lower for black patients. Objectives: To
identify potentially modifiable factors regarding surgery in patients
newly diagnosed with early-stage lung cancer and to explore why blacks
undergo surgery less often than whites. Design, Setting, and Patients:
Prospective cohort study with patients identified by pulmonary, oncology,
thoracic surgery, and generalist practices in 5 communities through study
referral or computerized tomography review protocol. A total of 437
patients with biopsy-proven or probable early-stage lung cancer were
enrolled between December 2005 and December 2008. Before establishment of
treatment plans, patients were administered a survey including questions
about trust, patient-physician communication, attitudes toward cancer, and
functional status. Information about comorbid illnesses was obtained
through chart audits. Main Outcome Measure: Lung cancer surgery within 4
months of diagnosis. Results: A total of 386 patients met full eligibility
criteria for lung resection surgery. The median age was 66 years (range,
26-90 years) and 29% of patients were black. The surgical rate was 66% for
white patients (n=179/273) compared with 55% for black patients (n=62/113;
P=.05). Negative perceptions of patient-physician communication manifested
by a 5-point decrement on a 25-point communication scale (odds ratio [OR],
0.42; 95% confidence interval [CI], 0.32-0.74) and negative perception of
1-year prognosis postsurgery (OR, 0.27; 95% CI, 0.14-0.50; absolute risk,
34%) were associated with decisions against surgery. Surgical rates for
blacks were particularly low when they had 2 or more comorbid illnesses
(13% vs 62% for <2 comorbidities; OR, 0.04 [95% CI, 0.01-0.25]; absolute
risk, 49%) and when blacks lacked a regular source of care (42% with no
regular care vs 57% with regular care; OR, 0.20 [95% CI, 0.10-0.43];
absolute risk, 15%). Conclusions: A decision not to undergo surgery by
patients with newly diagnosed lung cancer was independently associated
with perceptions of communication and prognosis, older age, multiple
comorbidities, and black race. Interventions to optimize surgery should
consider these factors. copyright2010 American Medical Association. All
rights reserved.

<3>
Accession Number
2010299115
Authors
Sustic A. Protic A. Cicvaric T. Zupan Z.
Institution
(Sustic, Protic, Zupan) Department of Anesthesiology, Intensive Care Unit,
University Hospital Rijeka, 51,000 Rijeka, Croatia.
(Cicvaric) Department of Surgery, University Hospital Rijeka, 51,000
Rijeka, Croatia.
Title
The addition of a brief ultrasound examination to clinical assessment
increases the ability to confirm placement of double-lumen endotracheal
tubes.
Source
Journal of Clinical Anesthesia. 22(4)(pp 246-249), 2010. Date of
Publication: June 2010.
Publisher
Elsevier Inc.
Abstract
Study Objective: To evaluate the role of a brief ultrasound examination
(US) in detecting the correct position of the left double-lumen
endotracheal tube (LDLT). Design: Prospective, randomized clinical study.
Setting: Operating room of a university hospital. Patients: 50 elective
adult thoracic surgery patients who required a LDLT during anesthesia.
Intervention and Measurements: Patients were randomized to two groups:
Group A, who underwent clinical assessment of the LDLT position, and Group
B, who were examined clinically and by ultrasound. All 50 patients
underwent the same conventional procedure of LDLT placement. In all
patients, clinical assessment of LDLT positioning was made by observing
chest wall expansion and checking lung compliance by manual ventilation
and by auscultation of both lungs. In Group B, a very brief ultrasound
(15-30 sec) examination was added. Ultrasound examination included
visualization of the pleural movements ("lung sliding") and motion of the
diaphragm from both sides before and after selective clamping of the
bronchial and tracheal limbs. In both groups, a second anesthesiologist
performed bronchoscopy to estimate actual LDLT position. Main Results:
Sensitivity and negative predictive values in detecting proper LDLT
positioning for both methods were 100%. For the clinical assessment alone
(Group A), specificity was 22%, accuracy was 72%, and positive predictive
value, 70%; for the clinical and ultrasound assessment (Group B),
specificity was 50%, accuracy was 88%, and positive predictive value, 86%.
Conclusion: A brief ultrasound examination added to clinical assessment
ensured more precise placement of LDLT than did clinical assessment alone.
copyright 2010 Elsevier Inc. All rights reserved.

<4>
Accession Number
2010337853
Authors
Pokushalov E. Romanov A. Prohorova D. Cherniavsky A. Karaskov A. Gersak B.
Institution
(Pokushalov, Romanov, Prohorova, Cherniavsky, Karaskov) State Research
Institute of Circulation Pathology, Novosibirsk, Russian Federation.
(Gersak) Department of Cardiovascular Surgery, University Medical Center
Ljubljana, Ljubljana, Slovenia.
Title
Coronary artery bypass grafting with and without concomitant epicardial
cardiac resynchronization therapy in patients with ischemic
cardiomyopathy: A randomized study.
Source
Heart Surgery Forum. 13(3)(pp E177-E184), 2010. Date of Publication: June
2010.
Publisher
Carden Jennings Publishing Co. Ltd
Abstract
Background: Epicardial implantation of a cardiac resynchronization therapy
(CRT) system during coronary artery bypass grafting (CABG) may be an
additional treatment method for improving left ventricle (LV) systolic
function and dyssynchrony in patients with ischemic heart failure.
Objective: The objective was to compare the long-term results in patients
with severe ischemic heart failure who underwent CABG alone or CABG
combined with concomitant epicardial implantation of a CRT system.
Methods: One hundred sixty-four consecutive patients with severe ischemic
heart failure and LV dyssynchrony were enrolled into 2 groups: CABG alone
(n = 80) and epicardial CRT implantation during CABG (CABG + CRT) (n =
84). This prospective, randomized, and single-blind study was designed to
compare clinical and echocardiography data after 6, 12, and 18 months of
follow-up. Results: In the CABG group, LV systolic function, dyssynchrony
signs, and quality of life did not change postoperatively, compared with
preoperative data. In contrast, these parameters significantly improved in
the CABG + CRT group. The 2 treatment groups did not differ with respect
to postoperative improvement in Canadian Cardiovascular Society class (P =
.68). The improvement in the New York Heart Association functional class
was much more pronounced in the CABG + CRT group than in the CABG group (P
= .029). In the CABG group, 21 patients (26.2%) had died by the 18-month
follow-up, compared with 9 patients (10.7%) in the CABG + CRT group (P =
.012, log-rank test). Conclusion: Epicardial implantation of a CRT system
concomitantly with CABG facilitates the early postoperative period,
improves LV systolic function, improves the quality of life, and decreases
LV dyssynchrony. Moreover, mortality in the CABG + CRT group was
significantly lower than in the CABG group. copyright 2010 Forum
Multimedia Publishing, LLC.

<5>
Accession Number
2010315982
Authors
Rudolph J.L. Schreiber K.A. Culley D.J. McGlinchey R.E. Crosby G. Levitsky
S. Marcantonio E.R.
Institution
(Rudolph) Division of Aging, Harvard Medical School, Brigham and Women's
Hospital, 150 South Huntington Ave, Boston, MA 02130, United States.
(Schreiber) Stritch School of Medicine, Loyola University Chicago,
Maywood, IL, United States.
(Culley, Crosby) Department of Anesthesiology, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States.
(McGlinchey) Geriatric Research Education and Clinical Center, VA Boston
Healthcare System, Harvard Medical School, Boston, MA, United States.
(Levitsky) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States.
(Marcantonio) Division of General Medicine, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, MA, United States.
Title
Measurement of post-operative cognitive dysfunction after cardiac surgery:
A systematic review.
Source
Acta Anaesthesiologica Scandinavica. 54(6)(pp 663-677), 2010. Date of
Publication: July 2010.
Publisher
Blackwell Munksgaard
Abstract
Post-operative cognitive dysfunction (POCD) is a decline in cognitive
function from pre-operative levels, which has been frequently described
after cardiac surgery. The purpose of this study was to examine the
variability in the measurement and definitions for POCD using the
framework of a 1995 Consensus Statement on measurement of POCD. Electronic
medical literature databases were searched for the intersection of the
search terms 'thoracic surgery' and 'cognition, dementia, and
neuropsychological test.' Abstracts were reviewed independently by two
reviewers. English articles with >50 participants published since 1995
that performed pre-operative and post-operative psychometric testing in
patients undergoing cardiac surgery were reviewed. Data relevant to the
measurement and definition of POCD were abstracted and compared with the
recommendations of the Consensus Statement. Sixty-two studies of POCD in
patients undergoing cardiac surgery were identified. Of these studies, the
recommended neuropsychological tests were carried out in less than half of
the studies. The cognitive domains measured most frequently were attention
(n=56; 93%) and memory (n=57; 95%); motor skills were measured less
frequently (n=36; 60%). Additionally, less than half of the studies
examined anxiety and depression, performed neurological exam, or accounted
for learning. Four definitions of POCD emerged: per cent decline (n=15),
standard deviation decline (n=14), factor analysis (n=13), and analysis of
performance on individual tests (n=12). There is marked variability in the
measurement and definition of POCD. This heterogeneity may impede progress
by reducing the ability to compare studies on the causes and treatment of
POCD. copyright 2010 The Acta Anaesthesiologica Scandinavica Foundation.

<6>
Accession Number
2010338419
Authors
Schwagten B. Witsenburg M. De Groot N.M.S. Jordaens L. Szili-Torok T.
Institution
(Schwagten, Witsenburg, De Groot, Jordaens, Szili-Torok) Department of
Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.

Title
Effect of Magnetic Navigation System on Procedure Times and Radiation Risk
in Children Undergoing Catheter Ablation.
Source
American Journal of Cardiology. 106(1)(pp 69-72), 2010. Date of
Publication: 01 Jul 2010.
Publisher
Elsevier Inc.
Abstract
Transcatheter ablation is an effective method to eliminate the
arrhythmogenic substrate in symptomatic children with various types of
arrhythmias. A reduction in the procedure and fluoroscopy time would
decrease the hazardous effects of the ablation procedures. The magnetic
navigation system (MNS) uses atraumatic catheters and facilitates accurate
catheter placement in all regions of the heart for mapping and therapy
delivery. We compared the efficacy and safety between a manual and
MNS-guided approach for mapping and ablation of arrhythmias in a general
pediatric arrhythmia population and in a subgroup of young children aged
<10 years old. A total of 58 pediatric patients (mean age 12.2 +/- 3.2
years) were included in the present study. Of the 58 consecutive patients,
29 were treated with the MNS and 29 underwent conventional manual
ablation. No demographic differences were present between the 2 groups.
Acute success was achieved in 26 of 29 patients and 27 of 29 patients (p =
NS). The mean procedure and fluoroscopy times were comparable in both
study groups (168 +/- 56 minutes vs 183 +/- 52 minutes, p = NS; and 22 +/-
59 minutes vs 30 +/- 29 minutes, p = NS). In young children (aged <10
years), the success rate did not differ between the 2 groups (10 of 11 vs
6 of 8, p = NS). However, significant decreases in the procedure and
fluoroscopy times were achieved (139 +/- 57 minutes vs 204 +/- 49 minutes
and 13 +/- 7 minutes vs 31 +/- 28 minutes, respectively; p = 0.01 and p =
0.04). In conclusion, our data have strongly suggested that using the MNS
for treating young children is advantageous, because it significantly
reduced the procedure and fluoroscopy times without compromising efficacy.
copyright 2010 Elsevier Inc. All rights reserved.

<7>
Accession Number
2010331806
Authors
Venskutonyte L. Malmberg K. Norhammar A. Wedel H. Ryden L.
Institution
(Venskutonyte, Malmberg, Norhammar, Ryden) Department of Medicine, Unit of
Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
(Wedel) Nordic School of Public Health, Goteborg, Sweden.
Title
Effect of gender on prognosis in patients with myocardial infarction and
type 2 diabetes.
Source
Journal of Internal Medicine. 268(1)(pp 75-82), 2010. Date of
Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Venskutonyte L, Malmberg K, Norhammar A, Wedel H, Ryden L (Karolinska
Institute, Stockholm; and Nordic School of Public Health, Goteborg;
Sweden). Effect of gender on prognosis in patients with myocardial
infarction and type 2 diabetes. J Intern Med 2010; 268:75-82. Background.
Diabetes is associated with a markedly increased cardiovascular risk, but
the role of gender on the combined effects of diabetes and myocardial
infarction has been less well explored. Methods. The Diabetes Mellitus and
Insulin Glucose Infusion in Acute Myocardial Infarction 2 (DIGAMI2) trial
recruited 837 men and 416 women with type 2 diabetes hospitalized due to
myocardial infarction and followed for a median of 2.1 years. The effects
of gender on diabetes-specific risk factors and conventional
cardiovascular risk predictors of unfavourable outcome were analysed using
a Cox proportional hazards model. Results. Women were older, more
frequently had hypertension and previous heart failure than men, and were
more often treated with diuretics. More men were smokers. Treatment during
hospitalization, at discharge and during follow-up, did not differ
significantly, apart from the more frequent use of diuretics in women.
Total mortality did not differ between genders, but the combined
cardiovascular end-point of death, re-infarction or stroke was more common
in women (38.9% vs. 32.1%). This difference disappeared after age
adjustment. Age and previous heart failure were independent risk
predictors in both genders, whereas diabetes complications were an
additional risk factor in women only. Blood glucose level at randomization
and updated glucose concentration during follow-up were independent
predictors of poor outcome in men but not in women. Conclusions. Age and
not gender itself explained the increased cardiovascular event rate seen
in women compared with men. A heavier risk factor burden was seen amongst
women. Improved risk factor control instituted before the development of a
myocardial infarction should be attempted as a possible means of improving
the outcome. copyright 2010 Blackwell Publishing Ltd.

<8>
Accession Number
2010330435
Authors
Belcher E. Dusmet M. Jordan S. Ladas G. Lim E. Goldstraw P.
Institution
(Belcher, Dusmet, Jordan, Ladas, Lim, Goldstraw) Department of Thoracic
Surgery, Royal Brompton Hospital, London, United Kingdom.
Title
A prospective, randomized trial comparing BioGlue and Vivostat for the
control of alveolar air leak.
Source
Journal of Thoracic and Cardiovascular Surgery. 140(1)(pp 32-38), 2010.
Date of Publication: July 2010.
Publisher
Mosby Inc.
Abstract
Objective: BioGlue (CryoLife, Europa Ltd, Surrey, UK) is effective in
reducing alveolar air leak after pulmonary resection. However, concerns
exist regarding the use of bovine-derived products. Vivostat (Vivostat
A/S, Alleroed, Denmark) is an autologous fibrin sealant that confers
certain advantages. It shows superior elastic properties, a faster
absorption time, and the absence of risk of transmission of blood-borne
diseases. Methods: We conducted a randomized, single blind controlled
study to compare BioGlue and Vivostat in the control of postoperative air
leak. Primary endpoints were duration of air leak, time to intercostal
drain removal, and length of hospital stay. Secondary endpoints related to
postoperative complications. Results: Between December 2005 and December
2007, 103 patients were randomized. The analysis included 102 patients;
67% were male. Median age was 56 +/- 19 years. Indications for surgery
were primary lung cancer in 41 patients (40%), secondary malignancy in 48
patients (47%), carcinoid in 6 patients (6%), and 7 patients underwent
surgery for benign disease (7%). Bilobectomy was performed in 2 patients
(2%), lobectomy in 41 patients (40%), lobectomy with lesser resection in 3
patients (3%), segmentectomy in 16 patients (16%), precision excision in
34 patients (33%), and 6 patients underwent other resections (6%). Median
duration of air leak was 3 (0-32) days versus 2 (0-33) days for patients
who received BioGlue and Vivostat, respectively (P = .677). Time to
intercostal drain removal was 5 (1-32) days in the BioGlue group compared
with 5 (1-34) days for the Vivostat group (P = .473). Median hospital stay
was 8 (3-22) days versus 7 (2-29) days for the BioGlue and Vivostat
groups, respectively (P = .382). There was no significant difference in
the incidence of complications between the 2 groups (20 patients receiving
BioGlue versus 19 patients receiving Vivostat, P = .839). Conclusions:
There were no significant differences in the 3 clinical outcome measures
of duration of air leak, time to intercostal drain removal, and length of
hospital stay in those patients receiving BioGlue or Vivostat. Given the
inherent advantages of our institutional preference is to use Vivostat in
the control of postoperative air leaks after pulmonary resection.
copyright 2010 The American Association for Thoracic Surgery.

<9>
Accession Number
2010330439
Authors
Tisdale J.E. Wroblewski H.A. Wall D.S. Rieger K.M. Hammoud Z.T. Young J.V.
Kesler K.A.
Institution
(Tisdale, Wroblewski) Department of Pharmacy Practice, School of Pharmacy
and Pharmaceutical Sciences, Purdue University, Indianapolis, Ind, United
States.
(Tisdale) Department of Medicine, Indiana University, School of Medicine,
Indianapolis, Ind, United States.
(Rieger, Hammoud, Kesler) Department of Surgery, Indiana University,
School of Medicine, Indianapolis, Ind, United States.
(Young) Department of Anesthesia, Indiana University, School of Medicine,
Indianapolis, Ind, United States.
(Wall) Department of Pharmacy, Indiana University Hospital, Clarian Health
Partners, Indianapolis, Ind, United States.
Title
A randomized, controlled study of amiodarone for prevention of atrial
fibrillation after transthoracic esophagectomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 140(1)(pp 45-51), 2010.
Date of Publication: July 2010.
Publisher
Mosby Inc.
Abstract
Objective: Atrial fibrillation is common after esophagectomy. The
objective of this study was to determine the efficacy and safety of
amiodarone for prevention of atrial fibrillation after transthoracic
esophagectomy. Methods: Eighty patients undergoing transthoracic
esophagectomy were randomly, prospectively assigned to receive amiodarone
(n = 40) or no prophylaxis (control group, n = 40). Amiodarone-treated
patients received the drug by continuous infusion, initiated at the time
of induction of anesthesia, at a rate of 0.73 mg/min (43.75 mg/h), and
continued for 96 hours (total dose 4200 mg). The primary end point was
atrial fibrillation requiring treatment. Secondary end points included any
atrial fibrillation lasting longer than 30 seconds and postoperative
hospital and intensive care unit stays. Results: There were no significant
differences between the amiodarone and control groups in demographic
characteristics, comorbid conditions, or preoperative or postoperative use
of beta-blockers or calcium-channel blockers. The incidence of atrial
fibrillation requiring treatment was lower in the amiodarone group than in
the control group (15% vs 40%, P = .02, relative risk reduction 62.5%).
There were no significant differences between the amiodarone and control
groups in median hospital stay (11 days vs 12 days, P = .31) or median
intensive care unit stay (68 hours vs 77 hours, p = .097). There were no
significant difference between the groups in the incidences of adverse
effects. Conclusions: Amiodarone prophylaxis significantly reduced the
incidence of atrial fibrillation after transthoracic esophagectomy.
copyright 2010 The American Association for Thoracic Surgery.

<10>
Accession Number
2010329119
Authors
El-Essawi A. Hajek T. Skorpil J. Boning A. Sabol F. Hausmann H. Ostrovsky
Y. Harringer W.
Institution
(El-Essawi, Harringer) Klinikum Braunschweig, Department of Thoracic and
Cardiovascular Surgery, Braunschweig, Germany.
(Hajek, Skorpil) University Hospital Pilsen, Department of Cardiac
Surgery, Pilsen, Czech Republic.
(Boning) University Hospital Giessen and Marburg, Department of
Cardiovascular Surgery, Giessen, Germany.
(Sabol) Pavol Jozef Safarik University Kosice, Heart Surgery Department,
Kosice, Slovakia.
(Hausmann) Mediclin Herzzentrum Coswig, Cardiovascular, Thoracic and
Intensive Care, Coswig, Germany.
(Ostrovsky) Byelorussian Center of Cardiovascular Surgery, Cardiovascular
Surgery, Minsk, Belarus.
Title
A prospective randomised multicentre clinical comparison of a minimised
perfusion circuit versus conventional cardiopulmonary bypass.
Source
European Journal of Cardio-thoracic Surgery. 38(1)(pp 91-97), 2010. Date
of Publication: July 2010.
Publisher
Elsevier
Abstract
Objective: Minimised perfusion circuits (MPCs) are expected to reduce the
side effects of conventional cardiopulmonary bypass (CCPB); however,
conclusive data from sufficiently powered clinical trials are lacking. The
purpose of this study was to evaluate the safety and efficacy of the
ROCsafeRX[trademark] minimised perfusion circuit. Methods: A randomised,
controlled, multicentre clinical trial comparing both perfusion circuits
in patients subjected to elective coronary artery bypass and/or aortic
valve replacement is described. The primary end points of safety, defined
as procedure success without device-related complications, and secondary
end point of efficacy, including reduction of transfusion requirement and
incidence of atrial fibrillation, are analysed. Results: To date, 291
patients have been enrolled and randomised (146 MPC vs 145 CCPB). With the
exception of a significantly higher male population in the MPC group
(83.6% vs 71.0%, p = 0.01), both groups were well matched for demographic
data and type of surgery. There were no device-related complications but a
hard-shell reservoir had to be integrated in one MPC because of a tear in
the right atrium that was managed uneventfully. Total transfusion
requirement (329 +/- 599 ml vs 783 +/- 1638 ml, p [less-than or equal to]
0.001) and erythrocyte transfusion (181 +/- 341 ml vs 434 +/- 798 ml, p
[less-than or equal to] 0.001) were significantly reduced in the MPC
group. The incidence of atrial fibrillation was significantly lower in the
MPC group (7.1% vs 19.5%, p [less-than or equal to] 0.01), while freedom
of major adverse events showed no significant difference. Conclusions:
Lack of device-related complications combined with a significant reduction
in postoperative atrial fibrillation and transfusion requirements have
shown the ROCsafeRX[trademark] MPC to be both safe and efficient for
large-scale use in cardiac patients. Additional data are expected to
confirm these initial findings. copyright 2010 European Association for
Cardio-Thoracic Surgery.

<11>
Accession Number
2010323826
Authors
Talwar S. Sandeep J.A. Choudhary S.K. Velayoudham D. Lakshmy R. Kasthuri
J.M. Kumar A.S.
Institution
(Talwar, Sandeep, Choudhary, Velayoudham, Lakshmy, Kumar) Cardiothoracic
Centre, All India Institute of Medical Sciences, New Delhi, India.
(Kasthuri) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India.
Title
Effect of preoperative administration of allopurinol in patients
undergoing surgery for valvular heart diseases.
Source
European Journal of Cardio-thoracic Surgery. 38(1)(pp 86-90), 2010. Date
of Publication: July 2010.
Publisher
Elsevier
Abstract
Objective: To assess the effects of preoperative administration of
allopurinol in patients undergoing open-heart surgery (OHS) for valvular
heart diseases. Methods: In this prospective randomised double-blind
study, 50 consecutive patients undergoing OHS for valvular heart disease
were randomised into two groups of 25 patients each: (a) control group
received placebo and (b) test group received allopurinol prior to surgery.
Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were
measured prior to the induction of anaesthesia, at the time of aortic
cross-clamp release and 24 h following termination of cardiopulmonary
bypass. Postoperatively assessed parameters were inotropic score, rhythm,
and duration of mechanical ventilation and occurrence of a low cardiac
output state. Results: Significant differences were observed with respect
to inotropic score: median 5 ((0-25) vs 0 (0-25) p = 0.027) and mean 6.44
+/- 6.145 versus 3.4 +/- 5.54, mean duration of mechanical ventilation
(11.1 +/- 4.9 vs 7.5 +/- 2.5 h, p = 0.002, hospital stay (6.35 +/- 1.43 vs
5.04 +/- 0.611, p = 0.001) and maintenance of normal sinus rhythm (NSR)
(18 vs 25, p = 0.004) between the control groups versus the test group,
respectively. There were no significant differences in the levels and
trends of troponin T and CPK-MB between the two groups. Conclusion: The
administration of allopurinol prior to OHS for valvular heart diseases is
associated with increased conversion and maintenance to normal sinus
rhythm, reduced inotropic score and a reduction in the duration of
mechanical ventilation and hospital stay. There was, however, no
significant difference in the blood levels of CPK-MB and troponin T and a
large sample size is required to assess this further. copyright 2010
European Association for Cardio-Thoracic Surgery.

<12>
Accession Number
0020332194
Authors
Gupta A. Hote M.P. Choudhury M. Kapil A. Bisoi A.K.
Institution
(Gupta) Department of Cardiothoracic and Vascular Surgery, All India
Institute of Medical Sciences, Cardiothoracic Sciences Centre, New Delhi
110 029, India.
Title
Comparison of 48 h and 72 h of prophylactic antibiotic therapy in adult
cardiac surgery: a randomized double blind controlled trial..
Source
The Journal of antimicrobial chemotherapy. 65(5)(pp 1036-1041), 2010.
Date of Publication: May 2010.
Abstract
OBJECTIVES: To determine whether the duration of antibiotic prophylaxis
influences the rate of surgical site infection in patients undergoing
coronary bypass grafting or valve replacement. PATIENTS AND METHODS: Adult
patients undergoing elective coronary artery bypass grafting (CABG) and
valve surgery were included in this randomized double blind study. Between
April 2007 and April 2008, 235 patients were randomly assigned to one of
two groups using random number table and sealed envelope technique. The
groups received prophylactic antibiotic therapy for either 48 h (the 48 h
group) or 72 h (the 72 h group). These patients were monitored for
surgical site infection. RESULTS: The mean age was 52.94 +/- 16.30 and
55.27 +/- 16.63 years, respectively, in the two groups. The incidence of
co-morbid conditions as well as operative conditions was similar between
the groups. During the study period 20 patients developed surgical site
infections and 7 patients other infections. In modified treatment
analysis, the infection rates were 7.6% (9 patients, n = 119) in the group
receiving 48 h of prophylactic antibiotic therapy and 10.2% (11 patients,
n = 108) in the group receiving 72 h of prophylactic antibiotic therapy,
and the difference was statistically non-significant (P > 0.05). In the
per protocol analysis the infection rates were 5% (5 patients, n = 100) in
the group receiving 48 h of prophylactic antibiotic therapy and 8% (8
patients, n = 100) in the group receiving 72 h of prophylactic antibiotic
therapy, and the difference was again statistically non-significant (P >
0.05). The results of Fisher's exact test revealed that the duration of
surgery lasting for >5 h is an independent risk factor for surgical site
infection. CONCLUSIONS: Forty-eight hours of a prophylactic antibiotic
combination using a third-generation cephalosporin and an aminoglycoside
is as effective as a 72 h regimen for preventing surgical site infection
in patients undergoing CABG and valve surgery.

<13>
Accession Number
2010316963
Authors
Damgaard S. Nielsen C.H. Andersen L.W. Bendtzen K. Tvede M. Steinbruchel
D.A.
Institution
(Damgaard, Steinbruchel) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
(Andersen) Department of Anesthesiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Tvede) Department of Clinical Microbiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Nielsen, Bendtzen) Institute for Inflammation Research, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark.
Title
Cell Saver for On-pump Coronary Operations Reduces Systemic Inflammatory
Markers: A Randomized Trial.
Source
Annals of Thoracic Surgery. 89(5)(pp 1511-1517), 2010. Date of
Publication: May 2010.
Publisher
Elsevier USA
Abstract
Background: This study investigated whether intraoperative use of a cell
saver reduces the systemic inflammatory response after coronary operations
using cardiopulmonary bypass (CPB). Methods: The study randomized 29
patients, 15 to cell saving of pericardial suction blood and residual
blood in the CPB circuit after perfusion (cell saver group) vs 14 who
received direct retransfusion of the suction blood and the CPB circuit
blood (control group). Outcome measures were plasma concentrations of the
inflammatory markers interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12,
tumor necrosis factor-alpha, soluble tumor necrosis factor receptors I and
II, and procalcitonin at 6, 24, and 72 hours postoperatively. Results: At
6 hours postoperatively, the cell saver group displayed significantly
reduced plasma levels of IL-6 and IL-8 (p < 0.05). A reduction in IL-10
was also found (p = 0.05), along with nonsignificant reductions in the
remaining markers. At 24 and 72 hours, significant differences between
groups no longer existed. In the cell saver group, the suction blood and
CPB circuit blood were cleared for tumor necrosis factor receptors (p <
0.005), and IL-6, IL-8, IL-10, and procalcitonin were significantly
reduced (p < 0.05). Median intraoperative blood loss was 250 mL in the
cell saver group vs 475 mL (p < 0.02). Immediately postoperatively the
hemoglobin level was higher in the cell saver group (p < 0.03).
Transfusion requirements were similar. Conclusions: The cell saver reduced
the systemic levels of the proinflammatory markers IL-6 and IL-8 at 6
hours after CPB. The role of the anti-inflammatory molecules IL-10 and
soluble tumor necrosis factor receptors is undefined in this setting.
copyright 2010 The Society of Thoracic Surgeons.

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 16

Results Generated From:
EMBASE <1980 to 2010 Week 25>
EMBASE (updates since 2010-06-17)

<1>
Accession Number
0020464762
Authors
Biancari F. Tiozzo V.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Kajaanintie
52, Oulu, Finland, 90029.
Title
Staples versus sutures for closing leg wounds after vein graft harvesting
for coronary artery bypass surgery..
Source
Cochrane database of systematic reviews (Online). 5(pp CD008057), 2010.
Date of Publication: 2010.
Abstract
BACKGROUND: Surgical site infection (SSI) after saphenous vein graft
harvesting is a complication occurring in up to 18% of patients who
undergo coronary artery bypass surgery (CABG). It is not known whether the
method of skin closure influences the infection rate. OBJECTIVES: To
compare the rates of SSI and wound dehiscence of staples and sutures for
skin closure after saphenous vein graft harvesting for CABG. SEARCH
STRATEGY: We searched the following electronic databases: The Cochrane
Wounds Group Specialised Register (searched 11/3/10); The Cochrane Central
Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010 Issue
1; Ovid MEDLINE - 1950 to March Week 1 2010; Ovid MEDLINE - In-Process &
Other Non-Indexed Citations (Searched 11/3/10); Ovid EMBASE - 1980 to 2010
Week 09 and EBSCO CINAHL - 1982 to March 11 2010. No date or language
restrictions were applied. SELECTION CRITERIA: Trials comparing staples
and sutures for closing leg wounds after vein graft harvesting in patients
undergoing CABG were eligible for inclusion in this review. DATA
COLLECTION AND ANALYSIS: Two review authors independently assessed the
titles and abstracts of references identified by the search strategy
against the selection criteria and extracted data from eligible trials.
Included trials were assessed for the following risks of bias: generation
of random allocation sequence, allocation concealment, blinding,
incomplete outcome data, selective reporting and freedom from other
biases. For dichotomous variables, we calculated the relative risk with
95% confidence intervals (CI). MAIN RESULTS: We included three
prospective, randomised studies reporting on a total of 148 leg wounds
closed with staples and 175 with sutures after vein graft harvesting in
patients undergoing CABG. All trials were of sub-optimal methodological
quality and all trials were at risk of bias. Leg wound infection rate was
10.8% (16/148) after leg wound closure with staples compared with 8%
(14/174) with sutures (relative risk 1.20, 95% CI 0.60 to 2.39). Leg wound
dehiscence occurred in 9.3% (10/108) of patients after leg wound closure
with staples compared with 8.8% (12/137) with sutures (relative risk 1.05,
95%CI 0.43 to 2.53). AUTHORS' CONCLUSIONS: These results suggest that
there is no evidence of a difference in the risk of SSI and wound
dehiscence when staples rather than sutures are used to close leg wounds
after vein graft harvesting during CABG, however more research is needed.

<2>
Accession Number
2010316107
Authors
Sun L. Zhang T. Lan X. Du G.
Institution
(Sun, Zhang, Lan, Du) National Center for Pharmaceutical Screening,
Chinese Academy of Medical Sciences, Peking Union Medical College, 1 Xian
Nong Tan Street, Beijing 100050, China.
Title
Effects of stem cell therapy on left ventricular remodeling after acute
myocardial infarction: A meta-analysis.
Source
Clinical Cardiology. 33(5)(pp 296-302), 2010. Date of Publication: May
2010.
Publisher
John Wiley and Sons Inc.
Abstract
Objectives: The objective was to perform a meta-analysis of clinical
trials that investigated the effects of stem cell therapy on left
ventricular remodeling in patients after acutemyocardial infarction (AMI).
Background: Intracoronary injection of stem cells in the acute phase of
myocardial infarction has been proposed to replace the cardiomyocytes lost
and to prevent deleterious pathological remodeling after myocardial
infarction. Previously published trials have investigated the effects of
cell therapy on left ventricular (LV) remodeling in AMI patients. However,
the sample size of these studies is small and the conclusions are
inconsistent. Methods: Trials were identified in the Cochrane Library,
EMBASE, and Pub Med databases, reviews, and reference lists of relevant
articles. The weighted mean difference (WMD) was calculated for net
changes in LV end-diastolic and end-systolic volumes (LVEDV and LVESV) by
using fixed-effect models. Results: A total of 11 trials (13 comparisons)
with 832 participants evaluated the association between stem cell therapy
and changes in LVEDV. Compared with the control group, stemcell therapy
did not influence the LVEDV changes from baseline to follow-up (WMD: -1.76
mL, 95% confidence interval [CI]: -4.61 to 1.08 mL, P = 0.233). A total of
9 trials (11 comparisons) with 797 participants evaluated the association
between stem cell therapy and changes in LVESV. Compared with the control
group, patients in the cell therapy group had a significantly greater
reduction in LVESV from baseline to follow-up (WMD: -5.08 mL, 95% CI:
-7.80 to -2.37 mL, P < 0.001). Conclusion: This meta-analysis suggests
that cell therapy improves left ventricular contractility, but has no
effect on LV remodeling. copyright 2010 Wiley Periodicals, Inc.

<3>
Accession Number
2010316104
Authors
Naccarelli G.V. Johnston S.S. Lin J. Patel P.P. Schulman K.L.
Institution
(Naccarelli, Patel) Penn State Heart and Vascular Institute, Milton S.
Hershey Medical Center, Penn State University, Hershey, PA, United States.
(Johnston, Schulman) Health Care Divisions, Thomson Reuters, Cambridge,
MA, United States.
(Lin) Sanofi-aventis, Bridgewater, NJ, United States.
Title
Cost burden of cardiovascular hospitalization and mortality in ATHENA-like
patients with atrial fibrillation/atrial flutter in the United States.
Source
Clinical Cardiology. 33(5)(pp 270-279), 2010. Date of Publication: May
2010.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The ATHENA trial (A placebo-controlled, double-blind, parallel
arm Trial to assess the efficacy of dronedarone 400 mg bid for the
prevention of cardiovascular Hospitalization or death from any cause in
patiENts with Atrial fibrillation/atrial flutter) demonstrated that
dronedarone reduced the risk of cardiovascular (CV) hospitalization/death
by 24% (P < 0.001) in patients with atrial fibrillation (AF) and atrial
flutter (AFL). Hypothesis: In order to estimate the cost savings
associated with dronedarone use, we estimated the costs associated with CV
hospitalizations and in patient mortality in a large cohort of ATHENA-like
patients. Methods: In this retrospective analysis, we evaluated the cost
of CV hospitalization/mortality in real-world ATHENA-like patients without
heart failure and with employer-sponsored Medicare supplemental insurance
in the United States. Patients similar to those in ATHENA (age
[greater-than or equal to]70 years with AF/AFL and [greater-than or equal
to]1 stroke risk factor, without heart failure) who were hospitalized
between January 2, 2005, and January 1, 2007, were identified from the
MarketScan databases from Thomson Reuters. Health care costs were
evaluated during the 12 months following the index hospitalization.
Results: The analysis included 10 200 ATHENA-like patients.
Hospitalization for CV causes occurred in 53.9% of patients, with a total
of 6700 CV hospitalizations for fatal/nonfatal causes. Themost common
nonfatal causes of CV hospitalizations were AF/other supraventricular
rhythm disorders (20.2%of all CV hospitalizations), congestive heart
failure (CHF; 14.3%), and transient ischemic attack (TIA)/stroke
(10.7%).Mean costs per CV hospitalization for nonfatal causes were $10908.
Inpatient deaths from CV causes occurred in 264(2.6%) patients; the most
common causes of CV in patient death were intracranial/gastrointestinal
hemorrhage (24.2% of CV deaths), TIA/stroke (17.0%), and CHF (15.9%).Mean
hospitalization costsper CV in patient death were $18 565. Conclusions:
Health care costs associated with CV hospitalizations and inpatient deaths
among ATHENA-like patients in the US are high. Novel antiarrhythmic
therapies such as dronedarone, with the potential to reduce CV
hospitalizations/mortality in similar patients, could decrease health care
costs if adopted in clinical practice. copyright 2010 Wiley Periodicals,
Inc.

<4>
Accession Number
2010313720
Authors
McCarthy G.C. Megalla S.A. Habib A.S.
Institution
(McCarthy, Megalla, Habib) Department of Anesthesiology, Duke University
Medical Center, Box 3094, Durham, NC 27710, United States.
Title
Impact of intravenous lidocaine infusion on postoperative analgesia and
recovery from surgery: A systematic review of randomized controlled
trials.
Source
Drugs. 70(9)(pp 1149-1163), 2010. Date of Publication: 2010.
Publisher
Adis International Ltd
Abstract
Postoperative pain continues to be inadequately managed. While opioids
remain the mainstay for postoperative analgesia, their use can be
associated with adverse effects, including ileus, which can prolong
hospital stay. A number of studies have investigated the use of
perioperative intravenous lidocaine infusion for improving postoperative
analgesia and enhancing recovery of bowel function.This systematic review
was performed to determine the overall efficacy of intravenous lidocaine
infusion on postoperative analgesia and recovery from surgery in patients
undergoing various surgical procedures. We searched the databases of
MEDLINE, CINAHL and the Cochrane Library from 1966 to December 2009. We
searched for randomized controlled comparisons of lidocaine infusion with
placebo in the surgical setting and reporting on postoperative analgesia
and other aspects of patient recovery from surgery. The quality of all
included studies was assessed using the Modified Oxford Scale. Information
on postoperative pain intensity and analgesic requirements was extracted
from the trials and compared qualitatively. Other relevant data such as
return of bowel function, length of hospital stay, intraoperative
anaesthetic requirement and adverse effects were also compared.Sixteen
trials were included. A total of 395 patients received intravenous
lidocaine with 369 controls. In open and laparoscopic abdominal surgery,
as well as in ambulatory surgery patients, intravenous perioperative
infusion of lidocaine resulted in significant reductions in postoperative
pain intensity and opioid consumption. Pain scores were reduced at rest
and with cough or movement for up to 48 hours postoperatively. Opioid
consumption was reduced by up to 85 in lidocaine-treated patients when
compared with controls. Infusion of lidocaine also resulted in earlier
return of bowel function, allowing for earlier rehabilitation and shorter
duration of hospital stay. First flatus occurred up to 23 hours earlier,
while first bowel movement occurred up to 28 hours earlier in the
lidocaine-treated patients. Duration of hospital stay was reduced by an
average of 1.1 days in the lidocaine-treated patients. Administration of
intravenous lidocaine infusion did not result in toxicity or clinically
significant adverse events. Lidocaine had no impact on postoperative
analgesia in patients undergoing tonsillectomy, total hip arthroplasty or
coronary artery bypass surgery.In conclusion, intravenous lidocaine
infusion in the perioperative period is safe and has clear advantages in
patients undergoing abdominal surgery. Patients receiving lidocaine
infusion had lower pain scores, reduced postoperative analgesic
requirements and decreased intraoperative anaesthetic requirements, as
well as faster return of bowel function and decreased length of hospital
stay. Further studies are needed to assess whether lidocaine has a
beneficial effect in patients undergoing other types of surgery and to
determine the optimum dose, timing and duration of infusion of lidocaine
in this setting. copyright 2010 Adis Data Information BV. All rights
reserved.

<5>
Accession Number
2010198050
Authors
Rasmussen K. Maeng M. Kaltoft A. Thayssen P. Kelbaek H. Tilsted H.H.
Abildgaard U. Christiansen E.H. Engstrom T. Krusell L.R. Ravkilde J.
Hansen P.R. Hansen K.N. Abildstrom S.Z. Aaroe J. Jensen J.S. Kristensen
S.D. Botker H.E. Madsen M. Johnsen S.P. Jensen L.O. Sorensen H.T. Thuesen
L. Lassen J.F.
Institution
(Rasmussen, Tilsted, Ravkilde, Aaroe) Department of Cardiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark.
(Madsen, Johnsen, Sorensen) Department of Clinical Epidemiology, Aarhus
University Hospital, Aalborg Hospital, Aalborg, Denmark.
(Johnsen) Centre for Cardiovascular Research, Aarhus University Hospital,
Aalborg Hospital, Aalborg, Denmark.
(Maeng, Kaltoft, Christiansen, Krusell, Kristensen, Botker, Jensen,
Thuesen, Lassen) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark.
(Thayssen, Hansen, Jensen) Department of Cardiology, Odense University
Hospital, Odense, Denmark.
(Kelbaek, Engstrom) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark.
(Abildgaard, Hansen, Jensen) Department of Cardiology, Gentofte University
Hospital, Copenhagen, Denmark.
(Abildstrom) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark.
Title
Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary
stents in routine clinical care (SORT OUT III): a randomised controlled
superiority trial.
Source
The Lancet. 375(9720)(pp 1090-1099), 2010. Date of Publication:
20100327/0402.
Publisher
Elsevier Limited
Abstract
Background: In low-risk patients, the zotarolimus-eluting stent has been
shown to reduce rates of restenosis without increasing the risk of stent
thrombosis. We compared the efficacy and safety of the zotarolimus-eluting
stent versus the sirolimus-eluting stent in patients with coronary artery
disease who were receiving routine clinical care with no direct follow-up.
Methods: We did a single-blind, all-comer superiority trial in adult
patients with chronic stable coronary artery disease or acute coronary
syndromes, and at least one target lesion. Patients were treated at one of
five percutaneous coronary intervention centres between January, 2006, and
August, 2007. Computer-generated block randomisation and a telephone
allocation service were used to randomly assign patients to receive the
zotarolimus-eluting or the sirolimus-eluting stent. Data for follow-up
were obtained from national Danish administrative and health-care
registries. The primary endpoint was a composite of major adverse cardiac
events within 9 months: cardiac death, myocardial infarction, and target
vessel revascularisation. Intention-to-treat analyses were done at 9-month
and 18-month follow-up. This trial is registered with ClinicalTrials.gov,
number NCT00660478. Findings: 1162 patients (1619 lesions) were assigned
to receive the zotarolimus-eluting stent, and 1170 patients (1611 lesions)
to receive the sirolimus-eluting stent. 67 patients (72 lesions) had stent
failure, and six patients were lost to follow-up. All randomly assigned
patients were included in analyses at 9-month follow-up; 2200 patients
(94%) had completed 18-month follow-up by the time of our assessment. At 9
months, the primary endpoint had occurred in a higher proportion of
patients treated with the zotarolimus-eluting stent than in those treated
with the sirolimus-eluting stent (72 [6%] vs 34 [3%]; HR 2.15, 95% CI
1.43-3.23; p=0.0002). At 18-month follow-up, this difference was sustained
(113 [10%] vs 53 [5%]; 2.19, 1.58-3.04; p<0.0001). For patients receiving
the zotarolimus-eluting stent and those receiving the sirolimus-eluting
stent, all cause-mortality was similar at 9-month follow-up (25 [2%] vs 18
[2%]; 1.40, 0.76-2.56; p=0.28), but was significantly different at
18-month follow-up (51 [4%] vs 32 [3%]; 1.61, 1.03-2.50; p=0.035).
Interpretation: The sirolimus-eluting stent is superior to the
zotarolimus-eluting stent for patients receiving routine clinical care.
Funding: Cordis and Medtronic. copyright 2010 Elsevier Ltd. All rights
reserved.

<6>
Accession Number
2010202255
Authors
Lee M.S. Yang T. Dhoot J. Liao H.
Institution
(Lee, Yang, Dhoot) Division of Cardiology, David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, CA, United
States.
(Liao) Boston Scientific Corporation, Marlborough, MN, United States.
Title
Meta-Analysis of Clinical Studies Comparing Coronary Artery Bypass
Grafting With Percutaneous Coronary Intervention and Drug-Eluting Stents
in Patients With Unprotected Left Main Coronary Artery Narrowings.
Source
American Journal of Cardiology. 105(8)(pp 1070-1075), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
The aim of this study was to compare the safety and efficacy of coronary
artery bypass grafting (CABG) with percutaneous coronary intervention
(PCI) using drug-eluting stents (DES) in patients with unprotected left
main coronary artery (ULMCA) disease. The current American College of
Cardiology and American Heart Association guidelines recommend CABG for
the treatment of patients with ULMCA disease on the basis of clinical
trials demonstrating a survival benefit with CABG compared to medical
therapy. DES reduce the rate of target vessel revascularization compared
with bare-metal stents in ULMCA PCI and may be a safe alternative to CABG.
A meta-analysis was conducted of clinical studies comparing CABG and PCI
with DES for ULMCA disease with respect to death; the composite of death,
myocardial infarction, or stroke; and target vessel revascularization at 1
year follow-up. The analysis included 2,905 patients from 8 clinical
studies (2 randomized trials and 6 nonrandomized studies). At 1-year
follow-up, there was no significant difference between the CABG and DES
groups in the risk for death (odds ratio [OR] 1.12, 95% confidence
interval [CI] 0.80 to 1.56) or the composite end point of death,
myocardial infarction, or stroke (OR 1.25, 95% CI 0.86 to 1.82). The risk
for target vessel revascularization was significantly lower in the CABG
group compared to the PCI group (OR 0.44, 95% CI 0.32 to 0.59). In
conclusion, PCI with DES is safe and could represent a good alternative to
CABG for selected cases in patients with ULMCA disease. copyright 2010
Elsevier Inc. All rights reserved.

<7>
Accession Number
2010201608
Authors
Lee M.S. Yang T. Kandzari D.E. Tobis J.M. Liao H. Mahmud E.
Institution
(Lee, Yang, Tobis) Division of Cardiology, University of California, Los
Angeles, David Geffen School of Medicine, Los Angeles, CA, United States.
(Kandzari) Division of Cardiology, Scripps Clinic, La Jolla, CA, United
States.
(Liao) Boston Scientific Corporation, Natick, MA, United States.
(Mahmud) Division of Cardiology, University of California, San Diego,
School of Medicine, San Diego, CA, United States.
Title
Comparison by Meta-Analysis of Drug-Eluting Stents and Bare Metal Stents
for Saphenous Vein Graft Intervention.
Source
American Journal of Cardiology. 105(8)(pp 1076-1082), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
This meta-analysis was undertaken to assess the efficacy and safety of
drug-eluting stents (DESs) compared to bare metal stents (BMSs) in
saphenous vein graft (SVG) interventions. DESs decrease the risk of target
vessel revascularization in native coronary arteries compared to BMSs. The
ideal treatment strategy in patients with SVG disease is unknown. A search
of the published reports was conducted to identify studies that compared
DESs and BMSs in SVG intervention with a minimum follow-up of 6 months. A
total of 19 studies (2 randomized trials and 17 registries), including
3,420 patients who had undergone SVG intervention (DESs, n = 1,489 and
BMS, n = 1,931), met the selection criteria. The mean length of follow-up
was 20 +/- 12 months. Using the fixed effect model, target vessel
revascularization was less frequently performed in patients who had
undergone SVG intervention with a DES than with a BMS (odds ratio [OR]
0.59, 95% confidence interval [CI] 0.49 to 0.72). The incidence of
myocardial infarction was lower in patients with a DES than in those with
a BMS (OR 0.69, 95% CI 0.49 to 0.99). No differences were found in the
risk of death (OR 0.78, 95% CI 0.59 to 1.02) or stent thrombosis (OR 0.41,
95% CI 0.15 to 1.11) between the 2 groups. In conclusion, these findings
support the use of DESs in SVG lesions. copyright 2010 Elsevier Inc. All
rights reserved.

<8>
Accession Number
2010201604
Authors
Parodi G. Migliorini A. Valenti R. Bellandi B. Signorini U. Moschi G.
Buonamici P. Cerisano G. Antoniucci D.
Institution
(Parodi, Migliorini, Valenti, Bellandi, Signorini, Moschi, Buonamici,
Cerisano, Antoniucci) Division of Cardiology, Careggi Hospital, Florence,
Italy.
Title
Comparison of Bivalirudin and Unfractionated Heparin Plus Protamine in
Patients With Coronary Heart Disease Undergoing Percutaneous Coronary
Intervention (from the Antithrombotic Regimens aNd Outcome [ARNO] Trial).
Source
American Journal of Cardiology. 105(8)(pp 1053-1059), 2010. Date of
Publication: 15 Apr 2010.
Publisher
Elsevier Inc.
Abstract
Previous studies have compared bivalirudin and unfractionated heparin
(UFH) plus the routine use of glycoprotein IIb/IIIa inhibitors. They have
demonstrated that bivalirudin can decrease bleeding complications without
a significant increase in ischemic complications, resulting in a better
net clinical outcome, as defined by the efficacy (ischemic complications)
or safety (bleeding complications) end point. The aim of the present study
was to compare bivalirudin and UFH plus protamine in patients undergoing
elective percutaneous coronary intervention and pretreated with
clopidogrel and aspirin. We randomly assigned 850 patients with stable or
unstable coronary artery disease to bivalirudin or UFH followed by
protamine at the end of the percutaneous coronary intervention. The
primary end point was in-hospital major bleeding. The main secondary end
points were the 1-month composite of death, myocardial infarction,
unplanned target vessel revascularization; and the 1-month net clinical
outcome. The rate of major bleeding (primary end point) was 0.5% in
patients randomized to bivalirudin and 2.1% in patients randomized to UFH
(p = 0.033). At 30 days, the rate of major bleeding was 0.9% in the
bivalirudin arm and 2.8% in the UFH arm (p = 0.043). The composite of
death, myocardial infarction, and target vessel revascularization rate and
the net clinical outcome rate was 2.8% and 6.4% (p = 0.014) and 3.3% and
7.8% (p = 0.004), respectively, in the bivalirudin and UFH arms. In
conclusion, in percutaneous coronary intervention patients pretreated with
clopidogrel and aspirin, bivalirudin was associated with less major
bleeding and fewer ischemic complications and a better net clinical
outcome than UFH. copyright 2010 Elsevier Inc. All rights reserved.

<9>
Accession Number
2010310263
Authors
Gregorini C. Cipriano Jr. G. De Aquino L.M. Rodrigues Branco J.N.
Bernardelli G.F.
Institution
(Gregorini, Cipriano Jr., De Aquino, Rodrigues Branco, Bernardelli)
Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Title
Short-duration transcutaneous electrical nerve stimulation in the
postoperative period of cardiac surgery.
Source
Arquivos Brasileiros de Cardiologia. 94(3)(pp 325-331+345-351), 2010.
Date of Publication: March 2010.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Respiratory muscle strength has been related to the
postoperative outcome of cardiac surgeries. The main documented
therapeutic purpose of transcutaneous electrical nerve stimulation (TENS)
is the reduction of pain, which could bring secondary benefits to the
respiratory muscles and, consequently, to lung capacities and volumes.
Objectives: The objective of the present study was to evaluate the
effectiveness of short-duration transcutaneous electrical nerve
stimulation (TENS) in the reduction of pain and its possible influence on
respiratory muscle strength and lung capacity and volumes of patients in
the postoperative period of cardiac surgery. Methods: Twenty five patients
with mean age of 59.9 +/- 10.3 years, of whom 72% were men, and
homogeneous as regards weight and height, were randomly assigned to two
groups. One group received therapeutic TENS (n = 13) and the other,
placebo TENS (n = 12), for four hours on the third postoperative day of
cardiac surgery. Pain was analyzed by means of a visual analogue scale,
and of respiratory muscle strength as measured by maximum respiratory
pressures and lung capacity and volumes before and after application of
TENS. Results: Short-duration TENS significantly reduced pain of patients
in the postoperative period (p < 0.001). Respiratory muscle strength (p <
0.001), tidal volume (p < 0.001) and vital capacity (p < 0.05)
significantly improved after therapeutic TENS, unlike in the placebo
group. Conclusion: Short-duration TENS proved effective for the reduction
of pain and improvement of respiratory muscle strength, as well as of lung
volumes and capacity.

<10>
Accession Number
2010310262
Authors
Succi J.E. Gerola L.R. Succi G.M. De Almeida R.A.C.F. Rocha Novais L.S.
Rocha B.
Institution
(Succi, Gerola, Succi, De Almeida, Rocha Novais, Rocha) Hospital
Bandeirantes em Sao Paulo, Sao Paulo, SP, Brazil.
Title
Ischemic preconditioning influence ventricular function in off-pump
revascularization surgery.
Source
Arquivos Brasileiros de Cardiologia. 94(3)(pp 319-324+339-344), 2010.
Date of Publication: March 2010.
Publisher
Arquivos Brasileiros de Cardiologia
Abstract
Background: Ischemic preconditioning is a method that prepares and
protects cells to tolerate a long period of ischemia with the least
possible injury. Objectives: Evaluate the influence of ischemic
preconditioning over left ventricular function during off-pump myocardial
revascularization. Method: Forty patients with clinical indication for
off-pump myocardial revascularization were randomized in two groups, with
or without ischemic preconditioning. Ischemic preconditioning was carried
out by performing coronary occlusion for two minutes and releasing blood
flow for one minute; two cycles were performed. Left ventricular
contractility was evaluated through transesophageal Doppler by measuring
blood flow acceleration in the descending aorta - Hemosonic 100. The
acceleration measurements were performed at the start of the surgery,
after heart positioning and five and ten minutes after coronary occlusion.
Results: There was no significant difference in left ventricular
contractility between the two groups. At the beginning of the procedure
flow acceleration was 9.37 +/- 2.9m/s2 in the preconditioning group and
12.5 +/- 3.1 m/s2 in no-preconditioning group (p = 0.23); after
positioning of heart, it was 8.47 +/- 3.3 and 8.31 +/- 3.6 m/s2 (p =
0.96); after five minutes - 8.7 +/- 4.1 and 7.94 +/- 2.9 m/s 2 (p = 0.80);
and after ten minutes - 9.2 +/- 4.5 and 7.98 +/- 3.4 m/s2 (p = 0.71).
However, contractility evolution was different throughout time in each
group. The preconditioning group maintained left ventricular contractility
during the entire procedure, since the beginning (0.52), while the group
without ischemic preconditioning presented reduction in left ventricular
contractility (p = 0.0034). Conclusion: Ischemic preconditioning prevented
the decrease in left ventricular contractility during off-pump myocardial
revascularization surgery.

<11>
Accession Number
2010295816
Authors
Jun M. Foote C. Lv J. Neal B. Patel A. Nicholls S.J. Grobbee D.E. Cass A.
Chalmers J. Perkovic V.
Institution
(Jun, Foote, Lv, Neal, Patel, Cass, Chalmers, Perkovic) The George
Institute for International Health, University of Sydney, Sydney,
Australia.
(Lv) Peking University First Hospital, Beijing, China.
(Nicholls) Departments of Cardiovascular Medicine and Cell Biology,
Cleveland Clinic, Cleveland, OH, United States.
(Grobbee) Julius Centre, University Medical Centre, Utrecht, Netherlands.

Title
Effects of fibrates on cardiovascular outcomes: a systematic review and
meta-analysis.
Source
The Lancet. 375(9729)(pp 1875-1884), 2010. Date of Publication:
20100529/0604.
Publisher
Elsevier Limited
Abstract
Background: Several clinical trials have reported inconsistent findings
for the effect of fibrates on cardiovascular risk. We undertook a
systematic review and meta-analysis to investigate the effects of fibrates
on major clinical outcomes. Methods: We systematically searched Medline,
Embase, and the Cochrane Library for trials published between 1950 and
March, 2010. We included prospective randomised controlled trials
assessing the effects of fibrates on cardiovascular outcomes compared with
placebo. Summary estimates of relative risk (RR) reductions were
calculated with a random effects model. Outcomes analysed were major
cardiovascular events, coronary events, stroke, heart failure, coronary
revascularisation, all-cause mortality, cardiovascular death, non-vascular
death, sudden death, new onset albuminuria, and drug-related adverse
events. Findings: We identified 18 trials providing data for 45 058
participants, including 2870 major cardiovascular events, 4552 coronary
events, and 3880 deaths. Fibrate therapy produced a 10% RR reduction (95%
CI 0-18) for major cardiovascular events (p=0.048) and a 13% RR reduction
(7-19) for coronary events (p<0.0001), but had no benefit on stroke (-3%,
-16 to 9; p=0.69). We noted no effect of fibrate therapy on the risk of
all-cause mortality (0%, -8 to 7; p=0.92), cardiovascular mortality (3%,
-7 to 12; p=0.59), sudden death (11%, -6 to 26; p=0.19), or non-vascular
mortality (-10%, -21 to 0.5; p=0.063). Fibrates reduced the risk of
albuminuria progression by 14% (2-25; p=0.028). Serious drug-related
adverse events were not significantly increased by fibrates (17 413
participants, 225 events; RR 1.21, 0.91-1.61; p=0.19), although increases
in serum creatinine concentrations were common (1.99, 1.46-2.70;
p<0.0001). Interpretation: Fibrates can reduce the risk of major
cardiovascular events predominantly by prevention of coronary events, and
might have a role in individuals at high risk of cardiovascular events and
in those with combined dyslipidaemia. Funding: National Health and Medical
Research Council of Australia. copyright 2010 Elsevier Ltd. All rights
reserved.

<12>
Accession Number
2010314228
Authors
Mehilli J. Byrne R.A. Tiroch K. Pinieck S. Schulz S. Kufner S. Massberg S.
Laugwitz K.-L. Schomig A. Kastrati A.
Institution
(Mehilli, Byrne, Tiroch, Pinieck, Schulz, Kufner, Massberg, Kastrati)
Deutsches Herzzentrum, Technische Universitat, Munich, Germany.
(Laugwitz, Schomig) 1. Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat, Munich, Germany.
Title
Randomized Trial of Paclitaxel- Versus Sirolimus-Eluting Stents for
Treatment of Coronary Restenosis in Sirolimus-Eluting Stents. The
ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug
Eluting Stents for In-Stent Restenosis 2) Study.
Source
Journal of the American College of Cardiology. 55(24)(pp 2710-2716),
2010. Date of Publication: 15 Jun 2010.
Publisher
Elsevier USA
Abstract
Objectives: For patients with sirolimus-eluting stent (SES) restenosis
requiring reintervention, we compared a strategy of repeat SES (Cypher,
Cordis, Miami Lakes, Florida) implantation with paclitaxel-eluting stent
(PES) (Taxus, Boston Scientific, Natick, Massachusetts) implantation.
Background: Despite their high anti-restenotic efficacy, the widespread
utilization of SES therapy has led to a significant absolute number of
patients presenting with SES treatment failure. The optimal treatment
strategy for such patients remains unclear. Methods: The ISAR-DESIRE 2
(Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for
In-Stent Restenosis 2) study was a randomized, open-label,
active-controlled trial conducted among 450 patients with clinically
significant in-SES restenosis at 2 centers in Munich, Germany. After
pre-treatment with 600 mg clopidogrel, all patients were randomly assigned
to either SES or PES implantation. The primary end point was late lumen
loss, based on in-stent analysis, at 6- to 8-month follow-up angiography.
Secondary end points were binary angiographic restenosis (diameter
stenosis >50%) at 6- to 8-month follow-up, target lesion
revascularization, the composite of death or myocardial infarction, and
definite stent thrombosis at 12 months. Results: Regarding anti-restenotic
efficacy, there were no differences between SES and PES in late loss (0.40
+/- 0.65 mm vs. 0.38 +/- 0.59 mm; p = 0.85), binary restenosis (19.6% vs.
20.6%; p = 0.69), or target lesion revascularization (16.6% vs. 14.6%; p =
0.52). In terms of safety outcomes, the rates of death/myocardial
infarction (6.1% vs. 5.8%; p = 0.86) and stent thrombosis (0.4% vs. 0.4%;
p > 0.99) were also similar. Conclusions: In cases of SES restenosis,
treatment with either repeat SES or switch to PES was associated with a
comparable degree of efficacy and safety. Drug resistance at an individual
patient level may play a contributory role to the somewhat higher than
expected late loss observed with the SES in the current study.
(Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for
In-Stent Restenosis 2 [ISAR-DESIRE 2]; NCT00598715). copyright 2010
American College of Cardiology Foundation.

<13>
Accession Number
2010311586
Authors
Simes R.J. O'Connell R.L. Aylward P.E. Varshavsky S. Diaz R. Wilcox R.G.
Armstrong P.W. Granger C.B. French J.K. Van de Werf F. Marschner I.C.
Califf R. White H.D.
Institution
(Simes, O'Connell, Marschner) NHMRC Clinical Trials Center, University of
Sydney, Sydney, Australia.
(Aylward) Flinders Medical Center, Adelaide, Australia.
(Varshavsky) Evidence Clinical and Pharmaceutical Research, Los Altos, CA,
United States.
(Diaz) Estudios Clinicos Latino America (ECLA) Collaborative Group,
Rosario, Argentina.
(Wilcox) University Hospital, Nottingham, United Kingdom.
(Armstrong) University of Alberta, Edmonton, Alta., Canada.
(Granger, Califf) Duke Clinical Research Institute, Durham, NC, United
States.
(French, White) Auckland City Hospital, Auckland, New Zealand.
(Van de Werf) Gasthuisberg University Hospital, Leuven, Belgium.
(Marschner) Department of Statistics, Macquarie University, Sydney,
Australia.
Title
Unexplained international differences in clinical outcomes after acute
myocardial infarction and fibrinolytic therapy: Lessons from the Hirulog
and Early Reperfusion or Occlusion (HERO)-2 trial.
Source
American Heart Journal. 159(6)(pp 988-997), 2010. Date of Publication:
June 2010.
Publisher
Mosby Inc.
Abstract
Background: Despite advances in therapy, global mortality due to acute
myocardial infarction remains high. The international Hirulog and Early
Reperfusion or Occlusion (HERO-2) trial of 17,073 patients with ST-segment
elevation myocardial infarction provided the opportunity to explore
international differences in outcomes. Methods: Patient characteristics,
treatment, and outcomes were compared across 5 diverse regions: Western
countries, Latin America, Eastern Europe, Russia, and Asia. In addition, a
representative sample of 1,743 screened patients was compared with
enrolled patients. Results: Larger percentages of eligible patients were
randomized in Eastern Europe, Russia, and Asia than Western countries.
These regions enrolled more patients with anterior myocardial infarction,
Killip class III or IV, and late presentation (>4 hours). More patients
aged >75 years were enrolled from Western countries. Overall risk levels
were similar. Eastern Europe and Russia had lower rates than Western
countries of coronary revascularization (2% vs 18%) and longer hospital
stays (median 18 vs 7 days). Thirty-day mortality was lower in Western
countries; 6.7% versus 10.2% to 13.2% elsewhere, whereas reinfarction was
more frequent (3.2% vs 1.5% to 3.0%; each, P < .001). Regional mortality
differences persisted after adjustment for baseline risk factors,
treatments, or national health and economic statistics (each P < .001).
Conclusions: The variation in mortality and other clinical outcomes across
geographic regions was not adequately explained by risk factors, patterns
of care, or national health statistics. Nevertheless, large international
trials are a better way to assess potential new treatments across many
countries than the alternative of separate smaller trials in each region.
copyright 2010 Mosby, Inc. All rights reserved.

<14>
[Use Link to view the full text]
Accession Number
2010301994
Authors
Joly P. Bastuji-Garin S. Frances C. Lebbe C. Aubin F. Penso-Assathiany D.
D'Incan M. Avril M.-F. Lair G. Barete S. Euvrard S.
Institution
(Joly, Lair) Department of Dermatology, University of Rouen, Rouen
University Hospital, Rouen, France.
(Bastuji-Garin) Department of Clinical Research and Public Health, AP-HP,
Groupe H. Mondor, Albert Chenevier, Universite Paris 12, Creteil, France.
(Frances, Barete) Department of Dermatology, Paris VI University Hospital,
Paris, France.
(Lebbe) Department of Dermatology, APHP, Paris Diderot University
Hospital, Paris, France.
(Aubin) Department of Dermatology, Besancon University Hospital, Besancon,
France.
(Penso-Assathiany) Department of Dermatology, Paris 12 University
Hospital, Creteil, France.
(D'Incan) Department of Dermatology, Clermont-Ferrand University Hospital,
Clermont-Ferrand, France.
(Avril) Department of Dermatology, Paris v University Hospital, Paris,
France.
(Euvrard) Department of Dermatology, Lyon University Edouard Herriot
Hospital, Hospices Civils de Lyon, Lyon, France.
Title
Squamous cell carcinomas are associated with verrucokeratotic cutaneous
lesions but not with common warts in organ-transplant patients. a
case-control study.
Source
Transplantation. 89(10)(pp 1224-1230), 2010. Date of Publication: 27 May
2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Warts are thought to be associated with the development of
squamous cell carcinoma (SCC) in organ transplant patients. We
investigated the association between the different types of warts and SCC
in organ transplant patients. Methods: A prospective multicenter
case-control study was conducted. Cases were patients with a kidney or
heart transplant who were referred for a SCC. Controls were organ
transplant patients without SCC, individually matched for age, gender,
type of organ transplant (heart or kidney), skin phototype, time from
transplantation, and center. Four types of warts: flat warts, verrucae
vulgares (including palmo-plantar warts and common warts), verrucous
papilloma, and verrucokeratotic lesions were compared between cases and
controls using conditional logistic regression. Results: Ninety-nine cases
and 169 controls were included. In multivariate analysis, number of
rejections, azathioprine, prednisolone and anti-lymphocyte anti-serum or
anti-CD3 monoclonal antibodies use, cumulative sun exposure, actinic
keratosis, and verrucokeratic lesions (odds ratio [OR] 16.50; 95%
confidence interval [CI] 2.82-96.80) were independently associated with
SCC, whereas the association with verrucous papilloma was borderline
significant (OR 2.21; 95% CI 0.97-8.15). The association between the
presence of at least one of these two types of warts (verruco-keratotic
lesions and verrucous papilloma) and the occurrence of SCC was highly
significant (OR 18.36; 95% CI 3.03-111) when these warts were located in
the same area than SCC, whereas no significant association was evidenced
when these warts were located in another area (OR 1.02; 95% CI 0.13-5.79).
Conclusion: Verrucous papilloma and mainly verrucokeratotic lesions are
strongly associated with the risk of SCC in organ transplant patients,
whereas the most typical types of warts: verrucae vulgares and flat warts,
are not. Copyright copyright 2010 by Lippincott Williams & Wilkins.

<15>
Accession Number
2010295817
Authors
Staels B.
Institution
(Staels) Universite Lille Nord de France, Lille, France.
(Staels) U1011 Inserm, Lille, France.
(Staels) Universite Droit et Sante de Lille, Lille, France.
(Staels) Institut Pasteur de Lille, 59019 Lille cedex, France.
Title
Fibrates in CVD: a step towards personalised medicine.
Source
The Lancet. 375(9729)(pp 1847-1848), 2010. Date of Publication:
20100529/0604.
Publisher
Elsevier Limited

<16>
Accession Number
2010291688
Authors
Kruis R.W.J. Vlasveld F.A.E. Van Dijk D.
Institution
(Kruis, Vlasveld, Van Dijk) Departments of Anesthesiology and Intensive
Care, University Medical Center Utrecht, Mail Stop F06.149, PO Box 85500,
3508 GA Utrecht, Netherlands.
Title
The (Un)importance of cerebral microemboli.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 14(2)(pp 111-118),
2010. Date of Publication: June 2010.
Publisher
SAGE Publications Inc.
Abstract
Background: The use of cardiopulmonary bypass (CPB) is associated with
cerebral microemboli. Cognitive decline after cardiac surgery has
therefore always been attributed to the use of CPB. However, randomized
studies comparing coronary bypass surgery with and without CPB failed to
establish a clear cognitive benefit of avoiding CPB. The aim of this
analysis was to systematically review the studies that directly assessed
the association between cerebral microemboli and cognitive decline after
cardiac surgery. Methods: The electronic database of PubMed of the
National Library of Medicine from 1980 until 2009 was searched to identify
relevant literature. Search terms related to "cardiac surgery,"
"microemboli," and "cognitive decline" were used. Studies were reviewed
independently by 2 reviewers and relevant articles were included
completely if they matched the selection criteria. This review included
studies in adult cardiac surgical patients reporting both a measure of
cerebral embolic load and cognitive outcomes. Results: The literature
search yielded 423 different titles, of which 22 met the selection
criteria. All 22 studies used neuropsychological tests to determine
cognitive outcome. Seven studies used postoperative (diffusion-weighted)
magnetic resonance imaging (MRI) to detect cerebral emboli and 15 studies
used intraoperative transcranial Doppler imaging. In 1 MRI study and 5
Doppler studies, an association was found between the number of cerebral
emboli and the risk of postoperative cognitive decline. In 15 studies,
such an association could not be established. One study did not assess the
direct relation between microemboli and cognitive decline. Conclusion:
This systematic review could neither confirm nor rule out a causal link
between emboli from CPB and postoperative cognitive decline. copyright
2010 The Author(s).