ARTICLE TITLE: Aprotinin decreases exposure to allogeneic blood
during primary unilateral total hip replacement.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), May 2000, 82(5)
p675-84
AUTHOR(S): Murkin JM; Haig GM; Beer KJ; Cicutti N; McCutchen J;
Comunale ME; Hall R; Ruzicka BB
AUTHOR'S ADDRESS: Department of Anaesthesia, London Health Sciences
Center-UC, University of Western Ontario, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: We concluded that aprotinin is safe and effective for
use as a hemostatic agent in primary unilateral total hip
replacements. In patients who are at high risk of receiving
allogeneic blood, use of aprotinin may be of particular clinical and
economic benefit.
MB: This study is hopeless. I had to look up the full text because
the actual blood loss was not mentioned in the abstract. It was mean
698mls in the placebo group and the means of 3 study groups varied
between 558 & 603 mls. The 603 was in the highest aprotinin group
and that difference was not statistically significant. In any case
the differences is trivial.
ARTICLE TITLE: Recent advances in venous thromboembolic
prophylaxis during and after total hip replacement.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Feb 2000, 82(2)
p252-70
AUTHOR(S): Salvati EA; Pellegrini VD Jr; Sharrock NE; Lotke PA;
Murray DW; Potter H; Westrich GH
AUTHOR'S ADDRESS: Department of Orthopaedics, The Hospital for
Special Surgery, New York, NY 10021, USA. salvatie@hss.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (131 references); REVIEW,
ACADEMIC
ARTICLE TITLE: Anticoagulant treatment of thromboembolism with
intravenous heparin therapy in the early postoperative period
following total joint arthroplasty.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Feb 2000, 82(2)
p207-12
AUTHOR(S): Della Valle CJ; Jazrawi LM; Idjadi J; Hiebert RN; Stuchin
SA; Steiger DJ; Di Cesare PE
AUTHOR'S ADDRESS: Department of Orthopaedic Surgery, New York
University-Hospital for Joint Diseases, New York City 10003, USA.
craigdv@yahoo.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The results of the present study suggest that the use of
intravenous heparin therapy for the treatment of thromboembolism in
the early postoperative period after total joint arthroplasty is
associated with a rate of bleeding complications that is similar to
that associated with the use of prophylactic anticoagulation with use
of enoxaparin alone. One should expect an increased transfusion
requirement and a longer duration of hospitalization for patients who
require intravenous heparin therapy for the treatment of a
thromboembolic event.
ARTICLE TITLE: Preoperative autologous donation for total joint
arthroplasty. An analysis of risk factors for allogenic
transfusion.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Jan 2000, 82(1)
p89-100
AUTHOR(S): Hatzidakis AM; Mendlick RM; McKillip T; Reddy RL; Garvin
KL
AUTHOR'S ADDRESS: Department of Orthopaedics, University of Nebraska
Medical Center/Omaha Veterans Administration Medical Center,
68198-1080, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The efficiency of collection of autologous blood can be
improved by identifying patients who have a very low risk of
transfusion according to the type of arthroplasty, the initial level
of hemoglobin, and age. Patients who have an initial hemoglobin level
of at least 150 grams per liter or an initial hemoglobin level of
between 130 and 150 grams per liter and an age of less than
sixty-five years have a minimal risk of needing a transfusion during
or after a primary total joint replacement. These patients should be
apprised of their low risk so that they can make an informed decision
regarding preoperative autologous donation.
ARTICLE TITLE: Relation of changes over time in ventricular size
and function to those in exercise capacity in patients with chronic
heart failure.
ARTICLE SOURCE: Am Heart J (United States), May 2000, 139(5)
p913-7
AUTHOR(S): Florea VG; Henein MY; Anker SD; Francis DP; Gibson DG;
Coats AJ
AUTHOR'S ADDRESS: Department of Cardiac Medicine, National Heart and
Lung Institute, London, United Kingdom. vioflor@hotmail.com.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: We studied the direction and magnitude of
changes in left ventricular (LV) cavity size and mass over time and
whether these changes were related to those in exercise performance
in patients with chronic heart failure (CHF).CONCLUSIONS: Changes
over time in objective measures of LV dimensions and mass, in
patients with CHF are significantly related to those in exercise
capacity and respiratory efficiency.
ARTICLE TITLE: Beta-blockade therapy in chronic heart failure:
diastolic function and mitral regurgitation improvement by carvedilol
[see comments]
COMMENTS: Comment in: Am Heart J 2000 Apr; 139(4):584-6
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
p596-608
AUTHOR(S): Capomolla S; Febo O; Gnemmi M; Riccardi G; Opasich C;
Caporotondi A; Mortara A; Pinna GD; Cobelli F
AUTHOR'S ADDRESS: "Salvatore Maugeri" Foundation, Institute of
Medical Care and Research, Pavia, Italy. scapomolla@fsm.it.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: The results of this study show that long-term carvedilol
therapy in patients with chronic heart failure was able to prevent or
partially reverse progressive left ventricular dilatation. The
effects on left ventricular remodeling were associated with a
concomitant recovery of diastolic reserve and a decrease of mitral
regurgitation, which have been demonstrated to be powerful prognostic
predictors in such patients. Overall these findings provide important
insights into the pathophysiologic mechanisms by which carvedilol
improves the clinical course of patients with chronic heart
failure.
ARTICLE TITLE: beta-blocker improvement in diastolic performance:
the yin and yang of ventricular function changes [editorial;
comment]
COMMENTS: Comment on: Am Heart J 2000 Apr; 139(4):596-608
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
p584-6
AUTHOR(S): Eichhorn EJ; Grayburn PA
PUBLICATION TYPE: CLINICAL TRIAL; COMMENT; EDITORIAL
MB: It is still a big mystery. They have me on ACE inhibiitors
already. I suppose beta-blockers are next.
ARTICLE TITLE: Design of phase II trials in congestive heart
failure.
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
pS207-10
AUTHOR(S): De Mets DL
AUTHOR'S ADDRESS: Department of Biostatistics and Medical
Informatics, University of Wisconsin-Madison, 53792, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB: I think they are confused.
ARTICLE TITLE: Current perspectives on the design of phase II
trials of new drugs for the treatment of heart failure.
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
pS202-6
AUTHOR(S): Packer M
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: An FDA perspective on antiarrhythmic drugs in phase
II trials.
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
pS197-9
AUTHOR(S): Lipicky R
AUTHOR'S ADDRESS: Division of Cardio-Renal Drug Products, Food and
Drug Administration, Rockville, MD 20852, USA.
lipicky@cder.fda.gov.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Proceedings of a symposium. How should phase II
trials in cardiovascular medicine be conducted? Hilton Head, South
Carolina, USA. October 3-4, 1997.
ARTICLE SOURCE: Am Heart J (United States), Apr 2000, 139(4)
pS131-210
PUBLICATION TYPE: CONGRESSES; OVERALL
ARTICLE TITLE: Ondansetron versus placebo for prophylaxis of
nausea and vomiting in patients undergoing ambulatory laparoscopic
cholecystectomy.
ARTICLE SOURCE: Am J Surg (United States), Jan 2000, 179(1) p60-2
AUTHOR(S): Liberman MA; Howe S; Lane M
AUTHOR'S ADDRESS: Department of General Surgery, Cleveland Clinic
Florida, Naples 34119, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: In patients undergoing ambulatory laparoscopic
cholecystectomy, ondansetron at induction was highly effective in
decreasing postoperative nausea and vomiting and should become the
standard.
ARTICLE TITLE: Are we willing to change? [editorial]
ARTICLE SOURCE: Anaesthesia (England), May 2000, 55(5) p419-20
AUTHOR(S): Aly EE; Shilling RS
MAJOR SUBJECT HEADING(S): Analgesia, Obstetrical
[methods]
MINOR SUBJECT HEADING(S): Analgesics, Opioid; Fentanyl; Meperidine;
Morphine; Pregnancy
INDEXING CHECK TAG(S): Female; Human
PUBLICATION TYPE: EDITORIAL
MB: Pethidine is useless in labour.
ARTICLE TITLE: The implications of HIV for the anaesthetist and
the intensivist.
ARTICLE SOURCE: Anaesthesia (England), Apr 2000, 55(4) p344-54
AUTHOR(S): Avidan MS; Jones N; Pozniak AL
AUTHOR'S ADDRESS: Academic Department of Anaesthesia, King's College
Hospital, Bessemer Road, London SE5 9PJ, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (87 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Recent advances in understanding the actions and
toxicity of nitrous oxide [editorial]
ARTICLE SOURCE: Anaesthesia (England), Apr 2000, 55(4) p311-4
AUTHOR(S): Maze M; Fujinaga M
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Ethics consultation: high ideals or unrealistic
expectations? [editorial]
ARTICLE SOURCE: Ann Intern Med (United States), Jul 4 2000, 133(1)
p55-7
AUTHOR(S): Spike J; Greenlaw J
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Consequences of blowing the whistle in medical
research [news]
ARTICLE SOURCE: Ann Intern Med (United States), Jun 20 2000, 132(12)
p1013-5
AUTHOR(S): Shuchman M
PUBLICATION TYPE: NEWS
ARTICLE TITLE: The tragic events of April 1996.
ARTICLE SOURCE: Ann Intern Med (United States), Jun 6 2000, 132(11)
p911-3
AUTHOR(S): Coulehan J
AUTHOR'S ADDRESS: State University of New York at Stony Brook,
11794-8036, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: In the early 19th century, Port Arthur, Tasmania, was the
site of a notorious prison in a land at the end of the world. In
1996, Port Arthur was also the site of the worst mass murder in
modern Australian history. A gunman with a semiautomatic weapon
stepped into a tourist coffee shop and systematically shot dead 35
men, women, and children. Throughout Australia, an outpouring of
grief, shame, and anger followed this tragic event and led quickly to
more stringent gun control legislation. Several years later,
Australians still remember the mass murder at Port Arthur with shame
and horror as a personal affront, rather than simply a historical
event. In the more violent society of the United States, many
Americans perceive themselves as helpless victims or detached
observers, rather than as persons who are responsible for promoting
change.
MB: I think that is a melodramatic exaggeration. There probably are
still too many guns about.
ARTICLE TITLE: Intravenous magnesium for the treatment of cardiac
arrhythmias.
ARTICLE SOURCE: Aust N Z J Med (Australia), Feb 2000, 30(1)
p54-60
AUTHOR(S): Arnold DJ
AUTHOR'S ADDRESS: John Hunter Hospital, Newcastle, NSW.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (60 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Volume replacement in the surgical patient--does
the type of solution make a difference?
ARTICLE SOURCE: Br J Anaesth (England), Jun 2000, 84(6) p783-93
AUTHOR(S): Boldt J
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care,
Medicine Klinikum der Stadt Ludwigshafen, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (111 references); REVIEW,
ACADEMIC
MB: I could not bring myself to read it completely. If you did not
know what to do to surgical patients before this you would not know
afterward. I (we) converted to sustained hydration (Shires) in 1966.
Shires does not get a mention.
ARTICLE TITLE: Sedation and general anaesthesia in children
undergoing MRI and CT: adverse events and outcomes [see
comments]
COMMENTS: Comment in: Br J Anaesth 2000 Jun; 84(6):713-4
ARTICLE SOURCE: Br J Anaesth (England), Jun 2000, 84(6) p743-8
AUTHOR(S): Malviya S; Voepel-Lewis T; Eldevik OP; Rockwell DT; Wong
JH; Tait AR
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Michigan Health Systems, Ann Arbor 48109-0211, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
We conclude that sedation of children for MRI and CT is associated
with risks of hypoxaemia and of inadequate or failed sedation. These
adverse events were more likely to occur in older children, those
with a higher ASA status and those in whom benzodiazepines had been
used as sole sedatives. For a preselected high-risk group of
children, general anaesthesia may make MRI and CT scans more
successful with minimal adverse events.
MB: Why pre-select? GA looks as though it was much better.
ARTICLE TITLE: Sedation of children by non-anaesthetists
[editorial; comment]
COMMENTS: Comment on: Br J Anaesth 2000 Jun; 84(6):743-8
ARTICLE SOURCE: Br J Anaesth (England), Jun 2000, 84(6) p713-4
AUTHOR(S): Hatch DJ; Sury MR
MINOR SUBJECT HEADING(S): Child; Magnetic Resonance Imaging;
Tomography, X-Ray Computed
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The effects of regional analgesia on the progress
of labour and delivery [editorial; comment]
COMMENTS: Comment on: Br J Anaesth 2000 Jun; 84(6):715-9
ARTICLE SOURCE: Br J Anaesth (England), Jun 2000, 84(6) p709-12
AUTHOR(S): Russell R
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: They have been arguing about this forever.
ARTICLE TITLE: Oesophageal perforation following perioperative
transoesophageal echocardiography.
ARTICLE SOURCE: Br J Anaesth (England), May 2000, 84(5) p643-6
AUTHOR(S): Massey SR; Pitsis A; Mehta D; Callaway M
AUTHOR'S ADDRESS: Sir Humphry Davy Department of Anaesthesia, Bristol
Royal Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Transoesophageal echocardiography (TOE) is being used more
often by cardiothoracic anaesthetists for the perioperative
management of cardiac problems. Reports of iatrogenic oesophageal
perforation by instrumentation of the oesophagus are increasing.
Although TOE is considered safe, it may be more risky during surgery,
because the probe is passed and manipulated in an anaesthetized
patient. It may be in place for several hours so the risk of mucosal
pressure and thermal damage is increased. Patients on cardiopulmonary
bypass are also fully anticoagulated. We describe a case of
oesophageal perforation following insertion of the TOE probe in a
patient with gross cardiomegaly. Oesophageal distortion by cardiac
enlargement may increase the risk of oesophageal perforation.
Difficulty in passage of the TOE probe should be regarded with
suspicion and withdrawal should be contemplated because the symptoms
of oesophageal perforation are often delayed and non-specific. Delay
in investigation, diagnosis and treatment will increase morbidity and
mortality.
ARTICLE TITLE: Reducing stress responses in the pre-bypass phase
of open heart surgery in infants and young children: a comparison of
different fentanyl doses [see comments]
COMMENTS: Comment in: Br J Anaesth 2000 May; 84(5):547-9
ARTICLE SOURCE: Br J Anaesth (England), May 2000, 84(5) p556-64
AUTHOR(S): Duncan HP; Cloote A; Weir PM; Jenkins I; Murphy PJ; Pawade
AK; Rogers CA; Wolf AR
AUTHOR'S ADDRESS: Royal Hospital for Sick Children, St Michael's
Hill, Bristol, UK.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: High-dose opioids are advocated for paediatric cardiac
surgery to suppress stress responses but they can produce unwanted
side effects. There are no data on the dose-dependent effects of
opioids on the stress response on which to base rational opioid
administration. We conducted a dose ranging study on 40 children less
than 4 yr undergoing elective open heart surgery using one of five
fentanyl doses: 2, 25, 50, 100 or 150 micrograms kg-1 before surgery.
The standardized anaesthetic also included pancuronium and
isoflurane. Blood samples were taken at induction, before incision,
after sternotomy, immediately before, and at the end of
cardiopulmonary bypass. Patients in the 2 micrograms kg-1 group had
significant rises in prebypass glucose (P < 0.01), pre- and
post-bypass cortisol (P < 0.01), and pre- and post-bypass
norepinephrine (P < 0.01). No significant rise occurred in
glucose, cortisol and catecholamines in any of the higher dosage
groups. Patients in the 2 micrograms kg-1 group had significantly
higher mean systolic blood pressure (P < 0.02) and heart rate (P
< 0.04). A balanced anaesthetic containing fentanyl 25-50
micrograms kg-1 is sufficient to obtund haemodynamic and stress
responses to the pre-bypass phase of surgery. Higher doses of
fentanyl (100 and 150 micrograms kg-1) offer little advantage over 50
micrograms kg-1, and can necessitate intervention to prevent
hypotension.
ARTICLE TITLE: Opioids in paediatric cardiac anaesthesia
[editorial; comment]
COMMENTS: Comment on: Br J Anaesth 2000 May; 84(5):556-64
ARTICLE SOURCE: Br J Anaesth (England), May 2000, 84(5) p547-9
AUTHOR(S): Booker PD
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: While admitting that you can stop the "stress" response he can't
think why you would bother.
ARTICLE TITLE: Acupressure and prevention of nausea and vomiting
during and after spinal anaesthesia for caesarean section.
ARTICLE SOURCE: Br J Anaesth (England), Apr 2000, 84(4) p463-7
AUTHOR(S): Harmon D; Ryan M; Kelly A; Bowen M
AUTHOR'S ADDRESS: Department of Anaesthesia, Rotunda Hospital,
Dublin, Ireland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: The efficacy of acupressure at the P6 point in the
prevention of nausea and vomiting during and after Caesarean section
was studied. A double-blind, randomized controlled study of
acupressure vs placebo was designed. Ninety-four patients scheduled
for Caesarean section were included. The anaesthetic technique and
postoperative analgesia were standardized. The use of acupressure
reduced the incidence of nausea or vomiting from 53% to 23% compared
with placebo (95% confidence interval (CI) 0.34-0.25; P = 0.002)
during the operation and from 66% to 36% compared with placebo (95%
CI 0.34-0.19; P = 0.003) after the operation. Other variables were
similar between the groups.
ARTICLE TITLE: General versus regional anaesthesia for hip
fracture surgery: a meta-analysis of randomized trials.
ARTICLE SOURCE: Br J Anaesth (England), Apr 2000, 84(4) p450-5
AUTHOR(S): Urwin SC; Parker MJ; Griffiths R
AUTHOR'S ADDRESS: Anaesthetic Department, Peterborough District
Hospital, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: Hip fracture surgery is common and the population at risk
is generally elderly. There is no consensus of opinion regarding the
safest form of anaesthesia for these patients. We performed a
meta-analysis of 15 randomized trials that compare morbidity and
mortality associated with general or regional anaesthesia for hip
fracture patients. There was a reduced 1-month mortality and
incidence of deep vein thrombosis in the regional anaesthesia group.
Operations performed under general anaesthesia had a reduction in
operation time. No other outcome measures reached a statistically
significant difference. There was a tendency towards a lower
incidence of myocardial infarction, confusion and postoperative
hypoxia in the regional anaesthetic group, and cerebrovascular
accident and intra-operative hypotension in the general anaesthetic
group. We conclude that there are marginal advantages for regional
anaesthesia compared to general anaesthesia for hip fracture patients
in terms of early mortality and risk of deep vein thrombosis.
MB: The marginal difference was that GA's were quicker. The other
differences were not statistically significant. The tone of the
'review' was in favour of regional but the evidence is not there.
They even note that other forms of thrombosis prophylaxis are not
mentioned in 7 of the 10 studies included.
ARTICLE TITLE: Preparation for regional anaesthesia induces
changes in thrombelastography.
ARTICLE SOURCE: Br J Anaesth (England), Mar 2000, 84(3) p403-4
AUTHOR(S): Gorton H; Lyons G; Manraj P
AUTHOR'S ADDRESS: St James' University Hospital, Leeds, UK.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL
ARTICLE
ABSTRACT: The effects of crystalloid and colloid infusions on
coagulation measured by thrombelastography (TEG) present a confused
picture. The influence of environmental factors may explain the
disparity between previous studies. We studied two groups of 20 women
presenting at term for elective Caesarean section. In the first
group, TEG analysis was performed before and after infusion of
Gelofusine 500 ml over 15 min. The second group was treated in the
same way except that subjects did not receive fluid. We found
significant changes in r and k values in both groups, suggesting
enhanced coagulation. As hypercoagulable changes were also seen in
the group that did not receive fluid preload, the hypothesis that
moderate haemodilution causes hypercoagulability must be questioned.
The influence of environmental factors can explain differences
reported between in vivo and in vitro studies.
ARTICLE TITLE: Placement of double lumen tubes--time to shed light
on an old problem [editorial]
ARTICLE SOURCE: Br J Anaesth (England), Mar 2000, 84(3) p308-10
AUTHOR(S): Pennefather SH; Russell GN
PUBLICATION TYPE: EDITORIAL
MB: They excluded tubes with hooks. That is their problem.
ARTICLE TITLE: Effects of continuous positive airway pressure on
cardiovascular outcomes in heart failure patients with and without
Cheyne-Stokes respiration.
ARTICLE SOURCE: Circulation (United States), Jul 4 2000, 102(1)
p61-6
AUTHOR(S): Sin DD; Logan AG; Fitzgerald FS; Liu PP; Bradley TD
AUTHOR'S ADDRESS: Sleep Research Laboratory of the Toronto
Rehabilitation Institute, Department of Medicine at the Toronto
General Hospital (University Health Network), University of Toronto,
Ontario, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Continuous positive airway pressure (CPAP) improves
cardiac function in CHF patients with have Cheyne-Stokes respiration
and central sleep apnea (CSR-CSA) but not in those without it.
Although not definitive, our findings also suggest that CPAP can
reduce the combined mortality-cardiac transplantation rate in those
CHF patients with CSR-CSA who comply with therapy.
ARTICLE TITLE: Resuscitation after prolonged ventricular
fibrillation with use of monophasic and biphasic waveform pulses for
external defibrillation.
ARTICLE SOURCE: Circulation (United States), Jun 27 2000, 101(25)
p2968-74
AUTHOR(S): Leng CT; Paradis NA; Calkins H; Berger RD; Lardo AC; Rent
KC; Halperin HR
AUTHOR'S ADDRESS: Division of Cardiology, Department of Medicine, The
Johns Hopkins Medical Institutions, Baltimore, MD, USA.
cleng@mail.jhmi.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: External defibrillation is more efficacious with
Biphasic (BP) countershocks than with monophasic (MP) countershocks.
The lower defibrillation thresholds and shorter resuscitation times
associated with BP waveform defibrillation may improve survival after
prolonged VF arrest.
ARTICLE TITLE: Impairment of ventilatory efficiency in heart
failure: prognostic impact [see comments]
COMMENTS: Comment in: Circulation 2000 Jun 20; 101(24):2774-6
ARTICLE SOURCE: Circulation (United States), Jun 20 2000, 101(24)
p2803-9
AUTHOR(S): Kleber FX; Vietzke G; Wernecke KD; Bauer U; Opitz C;
Wensel R; Sperfeld A; Glaser S
AUTHOR'S ADDRESS: Medizinische Klinik und Poliklinik I,
Universitatsklinikum Charite, Arbeitsgruppe Medizinische Biometrie,
Humboldt-Universitat zu Berlin, Berlin, Germany.
franz-xaverk@ukb.de.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Impairment of ventilatory efficiency in
congestive heart failure (CHF) correlates well with symptomatology
and contributes importantly to dyspnea. METHODS AND RESULTS: We
investigated 142 CHF patients (mean NYHA class, 2.6; mean maximum
oxygen consumption [VO(2)max], 15.3 mL O(2) x kg(-1) x
min(-1); mean left ventricular ejection fraction [LVEF],
27%). Patients were compared with 101 healthy control subjects.
Cardiopulmonary exercise testing was performed, and ventilatory
efficiency was defined as the slope of the linear relationship of
V(CO(2)) and ventilation (VE). Results are presented in percent of
age- and sex-adjusted mean values. Forty-four events (37 deaths and 7
instances of heart transplantation, cardiomyoplasty, or left
ventricular assist device implantation) occurred. Among VO(2)max,
NYHA class, LVEF, total lung capacity, and age, the most powerful
predictor of event-free survival was the VE versus V(CO(2)) slope;
patients with a slope </=130% of age- and sex-adjusted normal
values had a significantly better 1-year event-free survival (88.3%)
than patients with a slope >130% (54.7%; P<0.001). CONCLUSIONS:
The VE versus V(CO(2)) slope is an excellent prognostic parameter. It
is easier to obtain than parameters of maximal exercise capacity and
is of higher prognostic importance than VO(2)max.
ARTICLE TITLE: Gas exchange efficiency in congestive heart failure
[editorial; comment]
COMMENTS: Comment on: Circulation 2000 Jun 20; 101(24):2803-9
ARTICLE SOURCE: Circulation (United States), Jun 20 2000, 101(24)
p2774-6
AUTHOR(S): Johnson RL Jr
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (20 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Health care for all--in Maryland, at least
[news]
ARTICLE SOURCE: Circulation (United States), May 30 2000, 101(21)
pE9040-1
AUTHOR(S): So Relle R
PUBLICATION TYPE: NEWS
MB: I had the greatest difficulty getting this. It was not in the
print version. The librarian took it as a challenge and it took him
about one hour. It sounds as though the State thinks it would be
cheaper to have a comprehensive health service for all.
ARTICLE TITLE: Lack of benefit for intravenous thrombolysis in
patients with myocardial infarction who are older than 75 years
[see comments]
COMMENTS: Comment in: Circulation 2000 May 16; 101(19):2224-6
ARTICLE SOURCE: Circulation (United States), May 16 2000, 101(19)
p2239-46
AUTHOR(S): Thiemann DR; Coresh J; Schulman SP; Gerstenblith G; Oetgen
WJ; Powe NR
AUTHOR'S ADDRESS: Division of Cardiology, Carnegie 568, Johns Hopkins
Hospital, Baltimore, MD 21287-6568, USA. dthieman@mail.jhmi.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ARTICLE TITLE: Thrombolytic therapy for patients with myocardial
infarction who are older than 75 years. Do the risks outweigh the
benefits? [editorial; comment]
COMMENTS: Comment on: Circulation 2000 May 16; 101(19):2239-46
ARTICLE SOURCE: Circulation (United States), May 16 2000, 101(19)
p2224-6
AUTHOR(S): Ayanian JZ; Braunwald E
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Defining diastolic heart failure: a call for
standardized diagnostic criteria [see comments]
COMMENTS: Comment in: Circulation 2000 May 2; 101(17):2020-1
ARTICLE SOURCE: Circulation (United States), May 2 2000, 101(17)
p2118-21
AUTHOR(S): Vasan RS; Levy D
AUTHOR'S ADDRESS: National Heart, Lung, and Blood Institute's
Framingham Heart Study, Framingham, MA 01702, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB: Confusion. CONFUSION!
ARTICLE TITLE: Defining diastolic dysfunction [editorial;
comment]
COMMENTS: Comment on: Circulation 2000 May 2; 101(17):2118-21
ARTICLE SOURCE: Circulation (United States), May 2 2000, 101(17)
p2020-1
AUTHOR(S): Grossman W
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Likely variations in perioperative mortality
associated with cardiac surgery: when does high mortality reflect bad
practice? [see comments]
COMMENTS: Comment in: Heart 2000 Jul; 84(1):7-8
ARTICLE SOURCE: Heart (England), Jul 2000, 84(1) p79-82
AUTHOR(S): Sherlaw-Johnson C; Lovegrove J; Treasure T; Gallivan S
AUTHOR'S ADDRESS: Clinical Operational Research Unit, Department of
Mathematics, University College London, 4 Taviton Street, London WC1H
0BT, UK.
MAJOR SUBJECT HEADING(S): Clinical Competence; Heart Diseases
[mortality] [surgery]
MINOR SUBJECT HEADING(S): Risk Assessment; Surgery
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: Several methods exist for estimating the risk of
perioperative mortality based on preoperative risk factors; graphical
methods such as the variable life adjusted display (VLAD) can be used
to examine how an individual surgeon's performance for a series of
operations fares against what would be expected, given the case mix.
This study aimed to devise a method for assessing the natural
variation in outcome in order to assist with making judgements about
individual performance, in particular whether seemingly poor
performance could have occurred by chance. METHOD: The risk scoring
system has been derived and validated locally for cardiac surgery. A
method is described for calculating the probability that an observed
number of deaths occurs within a sequence of operations if
perioperative mortality is regarded as a chance event with an
expected value derived from the risk score. To illustrate this
method, nested prediction intervals are superimposed onto VLAD plots
for a series of 393 isolated coronary artery bypass and isolated
valve operations performed by a single surgeon. RESULTS: Using the
locally derived risk score, the VLAD plot for the individual surgeon
shows a net life gain of about 6 over the predicted number of
survivors, which is observed to be within the 90% prediction
interval. If the Parsonnet scoring system is used instead of the
locally derived risk score, the net life gain is considerably
overestimated. CONCLUSIONS: The nested prediction intervals are
straightforward to generate and can be integrated into a visually
informative display. As an indication of the inherent variability in
outcome, they have a valuable role in the monitoring of surgical
performance.
MB: Sounds pretty hopeless to me.
ARTICLE TITLE: Cardiac surgical mortality: the tip of the quality
assurance iceberg [editorial; comment]
COMMENTS: Comment on: Heart 2000 Jul; 84(1):71-8; Comment on: Heart
2000 Jul; 84(1):79-82
ARTICLE SOURCE: Heart (England), Jul 2000, 84(1) p7-8
AUTHOR(S): Keogh BE
AUTHOR'S ADDRESS: Birmingham NHS Trust Queen Elizabeth Hospital.
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: Plane crashes are individually studied to see what went wrong. It
would not be much good comparing the crash rates to different
airlines to see if they were due to chance or just the normal crash
rate. That seems to be the approach they are taking in the
post-'Bristol' panic.
ARTICLE TITLE: Fair comparison of mortality data following cardiac
surgery [editorial]
ARTICLE SOURCE: Heart (England), Jul 2000, 84(1) p5-6
AUTHOR(S): Ecochard R; De Gevigney G; Colin C
PUBLICATION TYPE: EDITORIAL
MB: They note that it might take 160 cases to see if a surgeon has an
above normal mortality. That can't be the approach.
ARTICLE TITLE: Non-transplant surgery for heart failure.
ARTICLE SOURCE: Heart (England), May 2000, 83(5) p603-10
AUTHOR(S): Westaby S
AUTHOR'S ADDRESS: Oxford Heart Centre, John Radcliffe Hospital,
Headington, Oxford, UK. swestaby@ahf.org.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (36 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Epidemiology, aetiology, and prognosis of heart
failure.
ARTICLE SOURCE: Heart (England), May 2000, 83(5) p596-602
AUTHOR(S): McMurray JJ; Stewart S
AUTHOR'S ADDRESS: Clinical Research Initiative in Heart Failure,
Wolfson Building, University of Glasgow, Glasgow, UK.
J.McMurray@bio.gla.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (20 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Survival of patients with a new diagnosis of heart
failure: a population based study.
ARTICLE SOURCE: Heart (England), May 2000, 83(5) p505-10
AUTHOR(S): Cowie MR; Wood DA; Coats AJ; Thompson SG; Suresh V;
Poole-Wilson PA; Sutton GC
AUTHOR'S ADDRESS: Cardiac Medicine, Imperial College School of
Medicine at the National Heart and Lung Institute, London SW3, UK.
m.cowie@abdn.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: In patients with new heart failure, mortality is high in
the first few weeks after diagnosis. Simple clinical features can
identify a group of patients at especially high risk of death.
ARTICLE TITLE: The role of the pulmonary artery catheter in the
year 2000 and beyond [editorial]
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2000,
14(2) p111-2
AUTHOR(S): Stocking JE; Lake CL
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Is the placement of a pulmonary artery catheter
still justified solely for the measurement of cardiac output?
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2000,
14(2) p119-24
AUTHOR(S): Sakka SG; Reinhart K; Wegscheider K; Meier-Hellmann A
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care
Medicine, Friedrich-Schiller-University of Jena, Germany.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: The authors compared four clinical techniques of
measuring cardiac output (CO) in critically ill patients: pulmonary
artery thermodilution (CO[PA]), transpulmonary aortic
thermodilution (CO[AORTA]), Fick principle-derived
(CO[FICK]), and continuous pulmonary artery (CCO)
measurements. DESIGN: Prospective clinical study. SETTING: Surgical
intensive care unit of a university hospital. PARTICIPANTS: Twelve
adult patients suffering from sepsis or septic shock. INTERVENTIONS:
All patients were deeply sedated and mechanically ventilated in a
pressure-controlled mode. Each patient received a 7.5F five-lumen
pulmonary artery catheter for the continuous measurement of cardiac
output and a 4F aortic catheter with an integrated thermistor. The
thermistors of the two different catheters were connected to one
computer system (COLD-Z021, Pulsion Medical Systems, Munich,
Germany). Whole-body oxygen consumption was measured by indirect
calorimetry using a metabolic cart (Deltatrac, Datex-Engstroem,
Helsinki, Finland) over a 5-minute period, at the end of which
arterial and mixed venous blood gases were taken and measured by
co-oximetry. During each measuring period, three bolus CO
measurements were performed. A total number of 51 CO measurements was
analyzed. RESULTS: Linear regression analysis revealed the highest
correlation between CO(AORTA) and CO(PA) (r = 0.98), whereas
agreement between these two techniques and CCO was lower (r = 0.92
and r = 0.93). All three techniques correlated comparably with
CO(FICK) (r = 0.85, r = 0.83, and r = 0.83). CONCLUSION: The
correlations among the four CO techniques were high and similar, with
CO(PA) and CO(AORTA) techniques showing the highest agreement.
Because CO with similar accuracy can be obtained from transpulmonary
aortic thermodilution in a less-invasive manner, it appears that the
placement of a pulmonary artery catheter solely for the measurement
of CO is no longer justified, unless continuous CO measurements are
needed.
MB: I don't think it was ever justified only to look at cardiac
output.
ARTICLE TITLE: Clinical and economic effects of pulmonary artery
catheterization in nonemergent coronary artery bypass graft
surgery.
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2000,
14(2) p113-8
AUTHOR(S): Ramsey SD; Saint S; Sullivan SD; Dey L; Kelley K; Bowdle
A
AUTHOR'S ADDRESS: Department of Medicine, University of Washington,
Seattle 98103, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To examine the association between use of
pulmonary artery catheterization with hospital outcomes and costs in
nonemergent coronary artery bypass graft (CABG) surgery. DESIGN:
Retrospective cohort study. SETTING: Fifty-six community-based
hospitals in 26 states. PARTICIPANTS: A total of 13,907 patients
undergoing nonemergent CABG surgery between January 1, 1997, and
December 31, 1997. MEASUREMENTS AND MAIN RESULTS: Discharge abstracts
for each patient were examined. Stratified and multivariate analyses
were used to assess the impact of pulmonary artery catheters (PACs)
on in-hospital mortality, length of stay in the intensive care unit,
total length of stay, and hospital costs. Outcomes were adjusted for
patient demographic factors, hospital characteristics, and hospital
volume of PAC use in the year of analysis. Fifty-eight percent of the
patients received a PAC. After adjustment, the relative risk of
in-hospital mortality was 2.10 for the PAC group compared with the
patients who did not receive a PAC (95% confidence interval
[CI], 1.40 to 3.14; p < 0.001). The mortality risk was
significantly higher in hospitals with the lowest third of PAC use
(odds ratio, 3.35; 95% CI, 1.74 to 6.47; p < 0.001) and not
significantly increased in the highest two thirds of users (odds
ratio, 1.62; 95% CI, 0.99 to 2.66; p = 0.09). Days spent in critical
care were similar; however, total length of hospital stay was 0.26
days longer in the PAC group (p < 0.001). Hospital costs were
$1,402 higher in the PAC group. CONCLUSION: In the setting of
nonemergent CABG surgery, pulmonary artery catheterization was
associated with an increased risk of in-hospital mortality, greater
length of stay, and higher total costs, particularly in hospitals
with low volume of PAC use
MB: I am not surprised..
ARTICLE TITLE: Respecting, protecting, persons, humans, and
conceptual muddles in the bioethics convention.
ARTICLE SOURCE: J Med Philos (Netherlands), Apr 2000, 25(2)
p147-80
AUTHOR(S): Delkeskamp-Hayes C
AUTHOR'S ADDRESS: European Programs, International Studies in
Philosophy and Medicine, Freigericht, Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The Convention on Human Rights and Biomedicine confuses
respect for a person's right to self-determination with concern about
protecting human beings generally. In a legal document, this mixture
of deontological with utilitarian considerations undermines what it
should preserve: respect for human dignity as the foundation of
modern rights-based democracies. Falling prey to the ambiguity of
freedom, the Convention blurs the dividing line between morality and
the law. The document should be remedied through distinguishing
fundamental rights from social 'rights', persons as entitled to the
right to self-determination from born humans as entitled to the right
to life and from members of the human species as entitled to the
morally responsible care of voting majorities. For the cultivating of
the required responsibility, the conditions for an adequate public
debate should be secured.
ARTICLE TITLE: Palliative care versus euthanasia. The German
position: the German General Medical Council's principles for medical
care of the terminally ill.
ARTICLE SOURCE: J Med Philos (Netherlands), Apr 2000, 25(2)
p195-219
AUTHOR(S): Sahm SW
AUTHOR'S ADDRESS: Deutsche Klinik fur Diagnostik, Wiesbaden,
Germany.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: In September 1998 the Bundesarztekammer, i.e., the German
Medical Association, published new principles concerning terminal
medical care. Even before publication, a draft of these principles
was very controversial, and prompted intense public debate in the
mass media. Despite some of the critics' suspicions that the
principles prepared the way for liberalization of active euthanasia,
euthanasia is unequivocally rejected in the principles.
Physician-assisted suicide is considered to violate professional
medical rules. In leaving aside some of the notions customarily used
in the euthanasia debate, e.g., passive euthanasia, the principles
emphasize the obligation of physicians to offer and the right of
patients to receive palliative care. The principles explicitly list
modalities of basic treatment that are indispensable in all cases,
such as the obligation to satisfy hunger and thirst. This statement
is meant to resolve the dispute on nutrition and hydration at the end
of life, as it shifts the focus of care from maintaining
physiological parameters to satisfying subjective needs. For patients
in a persistent vegetative state, artificial feeding is held to be
obligatory. Yet, the principles make reference to recent German
jurisdiction which permit the stopping of artificial feeding if it is
in accordance with the patient's presumed will. Additionally, the
wording concerning this issue is found to remain unclear. Patients'
autonomy is strengthened by explicitly welcoming advance directives
as a means to ascertain patients' wills. The principles mark some
changes compared to earlier documents. They deserve careful analysis
and should be considered in the international debate on issues
concerning the end of life.
ARTICLE TITLE: Comparison of university of wisconsin,
euro-collins, low-potassium dextran, and krebs-henseleit solutions
for hypothermic lung preservation.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2000,
119(5) p921-30
AUTHOR(S): Chien S; Zhang F; Niu W; Tseng MT; Gray L Jr
AUTHOR'S ADDRESS: Jewish Hospital Cardiothoracic Surgical Research
Institute, Division of Thoracic and Cardiovascular Surgery,
Department of Surgery, University of Louisville, Louisville, KY
40292, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: At 4 degrees C, all solutions preserved rat lungs for 4
hours with acceptable function. However, 6 hours of preservation
resulted in damaged pulmonary function in some lungs, and this damage
increased when preservation time was extended. The lungs preserved in
low-potassium dextran solution had the best overall function, but the
lungs preserved in University of Wisconsin solution had less
edema.
ARTICLE TITLE: Transfer of patients receiving advanced mechanical
circulatory support.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2000,
119(5) p1015-20
AUTHOR(S): McBride LR; Lowdermilk GA; Fiore AC; Moroney DA; Brannan
JA; Swartz MT
AUTHOR'S ADDRESS: Saint Louis University, Department of Surgery,
Division of Cardiothoracic Surgery, St Louis, MO, USA.
mcbridlr@slu.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: Improving results with ventricular assist
devices have led to their wider clinical application. Centers can
stabilize, support, and wean or transfer patients to regional
transplant centers. CONCLUSIONS: These data suggest that patients
receiving advanced support can be moved between clinical centers with
acceptable risks. Because 33% of the survivors were weaned,
transplantation is not required for survival.
ARTICLE TITLE: Epidural analgesia for cephalic version: a
randomized trial.
ARTICLE SOURCE: Obstet Gynecol (United States), May 2000, 95(5)
p648-51
AUTHOR(S): Mancuso KM; Yancey MK; Murphy JA; Markenson GR
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, Tripler
Army Medical Center, Honolulu, Hawaii, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Epidural analgesia increased the success rate of external
cephalic version and the likelihood of subsequent vaginal
delivery.
ARTICLE TITLE: Traditional Chinese medicine: an approach to
scientific proof and clinical validation.
ARTICLE SOURCE: Pharmacol Ther (England), May 2000, 86(2) p191-8
AUTHOR(S): Yuan R; Lin Y
AUTHOR'S ADDRESS: Department of Cell Biology and Molecular Genetics,
University of Maryland, 1109 Microbiology Building, College Park, MD
20817, USA. RY11@umail.umd.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (21 references); REVIEW,
TUTORIAL