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https://www.readbyqxmd.com/read/29783184/postoperative-outcomes-in-patients-with-a-do-not-resuscitate-dnr-order-undergoing-elective-procedures
#1
Ethan Y Brovman, Elisa C Walsh, Brittany N Burton, Christine E Kuo, Charlotta Lindvall, Rodney A Gabriel, Richard D Urman
STUDY OBJECTIVE: Do-not-resuscitate (DNR) status has been shown to be an independent risk factor for mortality in the post-operative period. Patients with DNR orders often undergo elective surgeries to alleviate symptoms and improve quality of life, but there are limited data on outcomes for informed decision making. DESIGN: Retrospective cohort study. SETTING: A multi-institutional setting including operating room, postoperative recovery area, inpatient wards, and the intensive care unit...
May 18, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29782862/evaluation-of-cardiac-arrhythmic-risks-using-a-rabbit-model-of-left-ventricular-systolic-dysfunction
#2
Bianca Hemmeryckx, Yuanbo Feng, Liesbeth Frederix, Marleen Lox, Sander Trenson, Rob Vreeken, Hua Rong Lu, David Gallacher, Yicheng Ni, H Roger Lijnen
Patients with heart disease have a higher risk to develop cardiac arrhythmias, either spontaneously or drug-induced. In this study, we have used a rabbit model of myocardial infarction (MI) with severe left ventricular systolic dysfunction (LVSD) to study potential drug-induced cardiac risks with N-(piperidin-2-ylmethyl)-2,5-bis(2,2,2-trifluoroethoxy)benzamide (flecainide). Upon ligation of the left circumflex arteries, male New Zealand White rabbits developed a large MI and moderate or severe LVSD 7 weeks after surgery, in comparison to SHAM-operated animals...
May 18, 2018: European Journal of Pharmacology
https://www.readbyqxmd.com/read/29782383/genetic-testing-of-xy-newborns-with-a-suspected-disorder-of-sex-development
#3
Malika Alimussina, Louise Ann Diver, Ruth McGowan, Syed Faisal Ahmed
PURPOSE OF REVIEW: The current review focuses on the neonatal presentation of disorders of sex development, summarize the current approach to the evaluation of newborns and describes recent advances in understanding of underlying genetic aetiology of these conditions. RECENT FINDINGS: Several possible candidate genes as well as other adverse environmental factors have been described as contributing to several clinical subgroups of 46,XY DSDs. Moreover, registry-based studies showed that infants with suspected DSD may have extragenital anomalies and in 46,XY cases, being small for gestational age (SGA), cardiac and neurological malformations are the commonest concomitant conditions...
May 17, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29782360/a-phase-ii-study-of-celecoxib-with-irinotecan-5-fluorouracil-and-leucovorin-in-patients-with-previously-untreated-advanced-or-metastatic-colorectal-cancer
#4
Emerson Y Chen, Charles D Blanke, Daniel G Haller, Al B Benson, Tomislav Dragovich, Heinz-Josef Lenz, Carlos Robles, Hong Li, Motomi Mori, Nora Mattek, Rachel E Sanborn, Charles D Lopez
OBJECTIVE: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Cyclooxygenase-2 (COX-2) overexpression is associated with increased tumor invasiveness and proliferation in CRC, and COX-2 inhibition has demonstrated chemopreventive activity. This study investigated the addition of celecoxib, a selective COX-2 inhibitor, to the irinotecan, 5-fluorouracil, and leucovorin (IFL) regimen for patients with previously untreated metastatic CRC. PATIENTS AND METHODS: Forty-seven patients enrolled in this single-arm phase II study received celecoxib at 400 mg orally twice daily in combination with weekly irinotecan (125 mg/m), 5-fluorouracil (500 mg/m), and leucovorin (20 mg/m) for 4 weeks every 6 weeks...
May 18, 2018: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29782356/acute-neurologic-complications-during-extracorporeal-membrane-oxygenation-a-systematic-review
#5
Raoul Sutter, Kai Tisljar, Stephan Marsch
OBJECTIVES: We determine the frequency, risk factors, and mortality of neurologic complications in adults on extracorporeal membrane oxygenation and propose an algorithm for preventive strategies. DATA SOURCES: PubMed, Embase, and Cochrane databases. STUDY SELECTION: Screening was performed using predefined search terms to identify cohort studies reporting neurologic complications in adults during extracorporeal membrane oxygenation from 1990 to 2017...
May 18, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29781854/salvage-of-threatened-cardiovascular-implantable-electronic-devices-case-series-and-review-of-literature
#6
Andrew M Simpson, W Tyler Rockwell, Roger A Freedman, W Bradford Rockwell
BACKGROUND: The treatment of infected or exposed cardiac pacing and defibrillator devices is controversial. The conservative and widely accepted management calls for removal of the device and leads with immediate or delayed replacement of new components in a new site. Lead extraction carries a 2% major complication risk. In this article, we describe our experience with device salvage techniques and review the current literature. METHODS: This is a retrospective case series of consecutive patients with infected, exposed, or at-risk implanted cardiac devices that were treated with aggressive surgical debridement, local pocket irrigation, and revision...
May 17, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29781842/application-of-echocardiographic-data-in-patients-with-chronic-kidney-disease
#7
Ruth F Dubin
PURPOSE OF REVIEW: Patients with chronic kidney disease (CKD) are at a high risk for cardiovascular events and mortality, particularly heart failure. Echocardiography is the most commonly used diagnostic imaging modality for heart failure. The purpose of this review is to summarize recent literature that demonstrates how echocardiography may be used to define cardiac structure and function in the CKD population and to identify echocardiographic abnormalities that have utility in predicting clinical outcomes in this population...
May 16, 2018: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/29781836/relationship-between-left-main-coronary-artery-plaque-burden-and-nonleft-main-coronary-atherosclerosis-results-from-the-prospect-study
#8
Takehisa Shimizu, Gary S Mintz, Bernard De Bruyne, Naim Z Farhat, Shinji Inaba, Yang Cao, Steven P Marso, Giora Weisz, Patrick W Serruys, Gregg W Stone, Akiko Maehara
OBJECTIVES: Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. PATIENTS AND METHODS: In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention...
May 17, 2018: Coronary Artery Disease
https://www.readbyqxmd.com/read/29781568/diastolic-dysfunction-is-associated-with-exercise-impairment-in-patients-with-sickle-cell-anemia
#9
Tarek Alsaied, Omar Niss, Adam W Powell, Robert J Fleck, James F Cnota, Clifford Chin, Punam Malik, Charles T Quinn, Michael D Taylor
BACKGROUND: Left ventricular diastolic dysfunction (DD) is an independent risk factor for mortality in sickle cell anemia (SCA) and is associated with increased extracellular volume (ECV) on cardiac MRI (CMR). Exercise impairment is common in SCA, but its causes and prognostic value are not well understood. OBJECTIVE: To study the effects of DD and ECV on cardiopulmonary exercise test (CPET) in patients with SCA. METHODS AND RESULTS: As part of a prospective study to characterize the cardiomyopathy of SCA (NCT02410811), 20 children and adults with SCA underwent CMR, echocardiography, and cycle ergometer CPET (age range 8-43 years)...
May 21, 2018: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/29780726/operative-techniques-for-improving-surgical-exposure-in-basic-cardiac-surgery
#10
Dawn S Hui, Jason M Lizalek, Vikram S Chawa, Richard Lee
Operative exposure is key to ensuring surgical efficiency and patient safety in cardiac surgery. As the population ages and the prevalence of obesity increases, cardiac surgeons will be challenged to consider obese patient physiology and body habitus, surgical exposure and sternotomy closure techniques, and postoperative medical management to ensure optimal outcomes. In this article, we describe techniques to improve operative exposure in both obese and non-obese patients undergoing basic cardiac surgery and highlight the roles of surgical team members to ensure patient safety and provide optimal anesthetic management...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29780725/total-aortic-repair-for-acute-type-a-aortic-dissection-a-new-paradigm
#11
George Matalanis, Shoane Ip
The currently accepted guidelines of open surgical repair for acute type A aortic dissection (ATAAD) include the resection of the primary entry tear, replacement of the ascending aorta and "hemi-arch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim being protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk, while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centres...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29779893/a-new-risk-score-for-ventricular-tachyarrhythmia-in-acute-myocardial-infarction-with-preserved-left-ventricular-ejection-fraction
#12
Seung Hun Lee, Myung Ho Jeong, Ju Han Kim, Min Chul Kim, Doo Sun Sim, Young Joon Hong, Youngkeun Ahn, Shung Chull Chae, In Whan Seong, Jong Sun Park, Jei Keon Chae, Seung Ho Hur, Kwang-Soo Cha, Hyo-Soo Kim, Hyeon Cheol Gwon, Ki Bae Seung, Seung Woon Rha
BACKGROUND: Ventricular tachycardia or fibrillation (VT/VF) is a major cause of sudden cardiac death after acute myocardial infarction (AMI). This study aims to investigate the clinical characteristics and outcomes of VT/VF, to identify the variables associated with VT/VF, and to construct a new scoring system. METHODS: Patients with relatively preserved left ventricular ejection fraction (LVEF) (≥40%) included in the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were enrolled in this study...
May 17, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29779783/readmission-to-the-intensive-care-unit-following-cardiac-surgery-a-derived-and-validated-risk-prediction-model-in-4-869-patients
#13
Rebekah Thomson, Nick Fletcher, Oswaldo Valencia, Vivek Sharma
OBJECTIVE: To derive and validate a clinical risk index that can predict readmission to the intensive care unit (ICU) after cardiac surgery. DESIGN: Retrospective nonrandomized study to determine the perioperative variables associated with risk of readmission to the ICU after cardiac surgery. SETTING: The study was carried out in a single university hospital. PARTICIPANTS: This was an analysis of 4,869 consecutive adult patients...
April 18, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29779622/anticoagulation-during-ecmo-in-neonatal-and-paediatric-patients
#14
Rebecca Barton, Vera Ignjatovic, Paul Monagle
Extracorporeal Membrane Oxygenation (ECMO) is a form of Extracorporeal Life Support (ECLS) which is used frequently in the paediatric and neonatal setting to support either the pulmonary, or both the pulmonary and cardiac systems. Management of ECMO requires the use of systemic anticoagulation to prevent patient and circuit based thrombosis, which in turn increases the risk of haemorrhage. A number of coagulation tests, laboratory and point of care based, are used to monitor anticoagulation, however the evidence for correlation of the test results with level of anticoagulant and clinical outcomes in children remains poor...
May 8, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29779501/marine-n-3-pufa-heart-rate-variability-and-ventricular-arrhythmias-in-patients-on-chronic-dialysis-a-cross-sectional-study
#15
Jesper M Rantanen, Erik B Schmidt, Sam Riahi, Søren Lundbye-Christensen, Jeppe H Christensen
Marine n-3 PUFA may improve autonomic dysfunction by an increase in heart rate variability (HRV) and may reduce the risk of malignant ventricular arrhythmias. Only a few smaller studies have examined such effects in patients on chronic dialysis, who often have autonomic dysfunction and a high risk of sudden cardiac death, which accounts for almost 30 % of all deaths. This cross-sectional study investigated the association between the plasma phospholipid content of n-3 PUFA and 24-h HRV or ventricular arrhythmias in patients on chronic dialysis...
May 21, 2018: British Journal of Nutrition
https://www.readbyqxmd.com/read/29779486/risk-factors-for-prolonged-postoperative-ileus-in-adult-patients-undergoing-elective-colorectal-surgery-an-observational-cohort-study
#16
Andrea Pisani Ceretti, Nirvana Maroni, Marco Longhi, Marco Giovenzana, Roberto Santambrogio, Matteo Barabino, Carmelo Luigiano, Giovanni Radaelli, Enrico Opocher
Purpose Prolonged postoperative ileus (PPOI) after abdominal surgery may effect unfavourably the patient recovery. The aim of this study was to estimate the incidence of PPOI in patients elective for colorectal resection and investigate perioperative variables associated with PPOI. Methods A consecutive series of 428 patients undergoing colorectal resection (median age 72, range 24-92, years; men/women ratio 1.14) were analyzed. Data were extracted retrospectively throughout a five-year period from an electronic prospectively maintained database...
May 20, 2018: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/29779449/continuous-cytokine-haemoadsorption-incorporated-into-a-venoarterial-ecmo-circuit-for-the-management-of-postcardiotomy-cardiogenic-and-septic-shock-a-case-report
#17
Endre Nemeth, Szabolcs Szigeti, Tamas Varga, Laszlo Daroczi, Zoltan Barati, Bela Merkely, Janos Gal
INTRODUCTION: The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. CASE REPORT: A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO...
May 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29779361/palliative-and-end-of-life-care-for-heart-failure-patients-in-an-aging-society
#18
Takahiro Okumura, Akinori Sawamura, Toyoaki Murohara
The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards...
May 23, 2018: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29779046/sex-differences-in-the-long-term-prognostic-value-of-13-n-ammonia-myocardial-perfusion-positron-emission-tomography
#19
Catherine Gebhard, Michael Fiechter, Bernhard A Herzog, Christine Lohmann, Susan Bengs, Valerie Treyer, Michael Messerli, Dominik C Benz, Andreas A Giannopoulos, Christoph Gräni, Aju P Pazhenkottil, Ronny R Buechel, Philipp A Kaufmann
PURPOSE: Evidence to date on the unique female determinants of cardiovascular risk is inadequate. Positron Emission Tomography (PET) is considered to have the highest accuracy for the assessment of myocardial perfusion in patients with suspected coronary artery disease (CAD), but its long-term prognostic accuracy in women has not been established. METHODS: A total of 619 consecutive patients (138 women, mean age 60.0 ± 11.8 years) underwent clinically indicated 13 N-ammonia PET at our institution and were followed up (median 5...
May 19, 2018: European Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/29778924/cerbera-odollam-toxicity-a-review
#20
REVIEW
Ritesh G Menezes, Muhammad Shariq Usman, Syed Ather Hussain, Mohammed Madadin, Tariq Jamal Siddiqi, Huda Fatima, Pradhum Ram, Syed Bilal Pasha, S Senthilkumaran, Tooba Qadir Fatima, Sushil Allen Luis
Cerbera odollam is a plant species of the Apocynaceae family. It is often dubbed the 'suicide tree' due to its strong cardiotoxic effects, which make it a suitable means to attempt suicide. The plant grows in wet areas in South India, Madagascar, and Southeast Asia; and its common names include Pong-Pong and Othalanga. The poison rich part of the plant is the kernel which is present at the core of its fruit. The bioactive toxin in the plant is cerberin, which is a cardiac glycoside of the cardenolide class...
May 9, 2018: Journal of Forensic and Legal Medicine
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