2008 November 04

Supraventricular tachycardia–part I.

Nov 042008

Supraventricular tachycardia--part I.

Curr Probl Cardiol. 2008 Sep;33(9):467-546

Authors: Lee KW, Badhwar N, Scheinman MM

Supraventricular tachycardias (SVTs) affect all age groups and are a source of significant morbidity. They are frequently encountered in otherwise healthy individuals without structural heart disease. Advances in the understanding of their mechanisms and anatomical locations have led to highly effective pharmacologic and nonpharmacologic treatment strategies. Recognition, identification, and differentiation of the various SVTs are of great importance in formulating an effective treatment strategy. Developments over the past four decades have made possible the accurate diagnosis of SVTs. Today, advances in catheter design, energy delivery systems, mapping systems, and remote navigation systems have rendered the ablation of most SVTs safe and effective. This monograph provides an in-depth discussion of the history, presentation, mechanism, and treatment strategies of the most commonly encountered SVTs. The monograph is divided into two parts. The first part is presented here.

PMID: 18707990 [PubMed - indexed for MEDLINE]

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Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low-dose aspirin.

Am J Gastroenterol Start a Discussion »

Nov 042008

Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low-dose aspirin.

Am J Gastroenterol. 2008 Oct;103(10):2465-73

Authors: Yeomans N, Lanas A, Labenz J, van Zanten SV, van Rensburg C, Rácz I, Tchernev K, Karamanolis D, Roda E, Hawkey C, Nauclér E, Svedberg LE

OBJECTIVES: Low-dose aspirin is standard treatment for prevention of cardiovascular events in at-risk patients. However, long-term administration of low-dose aspirin is associated with a greater risk of adverse events, including gastroduodenal ulcers. This study determined the efficacy of esomeprazole for reducing the risk of gastric and/or duodenal ulcers and dyspeptic symptoms in patients receiving continuous, low-dose aspirin therapy. METHODS: Patients aged > or =60 yr, without baseline gastroduodenal ulcer at endoscopy, who were receiving aspirin 75-325 mg once daily, were randomized to esomeprazole 20 mg once daily or placebo for 26 wk. The presence of endoscopic gastric and/or duodenal ulcers and esophageal lesions was assessed at weeks 8 and 26. Upper gastrointestinal symptoms were assessed at weeks 8, 16, and 26. RESULTS: The intention-to-treat population comprised 991 patients (esomeprazole, N = 493; placebo, N = 498). Twenty-seven patients (5.4%) in the placebo group developed a gastric or duodenal ulcer during 26 weeks' treatment compared with eight patients (1.6%) in the esomeprazole group (life-table estimates: 6.2%vs 1.8%; P= 0.0007). At 26 wk, the cumulative proportion of patients with erosive esophagitis was significantly lower for esomeprazole versus placebo (4.4% and 18.3%, respectively; P < 0.0001). At 26 wk, esomeprazole-treated patients were more likely to experience resolution of heartburn, acid regurgitation, and epigastric pain (P < 0.05). CONCLUSIONS: Esomeprazole 20 mg once daily reduces the risk of developing gastric and/or duodenal ulcers and symptoms associated with the continuous use of low-dose aspirin in patients aged > or =60 yr without preexisting gastroduodenal ulcers.

PMID: 18637091 [PubMed - indexed for MEDLINE]

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Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess.

Infection Start a Discussion »

Nov 042008

Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess.

Infection. 2008 Feb;36(1):23-30

Authors: Ott SR, Allewelt M, Lorenz J, Reimnitz P, Lode H,

BACKGROUND: Aspiration pneumonia (AP) and primary lung abscess (PLA), are diseases following aspiration of infectious material from the oropharynx or stomach. An antibiotic therapy, also covering anaerobic pathogens, is the treatment of choice. In this study we compared moxifloxacin (MXF) and ampicillin/sulbactam (AMP/SUL) concerning efficacy and safety in the treatment of AP and PLA. METHODS: Patients with pulmonary infections following aspiration were included in a prospective, open-label, randomized, multicenter trial. Sequential antibiotic therapy with MXF or AMP/SUL was administered until complete radiologic and clinical resolution. RESULTS: A total of 139 patients with AP and PLA were included, 96 were evaluable for efficacy (EE, 48 patients in each treatment group). The overall clinical response rates in both groups were numerically identical (66.7%). MXF and AMP/SUL were both well tolerated, even after long-term administration [median duration of treatment (range) in days MXF versus AMP/SUL: AP 11 (4-45) vs 9 (3-25), PLA 30.5 (7-158) vs 35 (6-90)]. CONCLUSION: In the treatment of aspiration-associated pulmonary infections moxifloxacin appears to be clinically as effective and as safe as ampicillin/sulbactam; but, however, having the additional benefit of a more convenient (400 mg qd) treatment.

PMID: 18231720 [PubMed - indexed for MEDLINE]

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Role of fluorodeoxyglucose-PET versus fluorodeoxyglucose-PET/computed tomography in detection of unknown primary tumor: a meta-analysis of the literature.

Nucl Med Commun Start a Discussion »

Nov 042008

Role of fluorodeoxyglucose-PET versus fluorodeoxyglucose-PET/computed tomography in detection of unknown primary tumor: a meta-analysis of the literature.

Nucl Med Commun. 2008 Sep;29(9):791-802

Authors: Dong MJ, Zhao K, Lin XT, Zhao J, Ruan LX, Liu ZF

The objectives of this study were to evaluate the diagnostic accuracy of fluorodeoxyglucose (FDG)-PET and FDG-PET/computed tomography (CT) in the detection of primary tumors in patients presenting with carcinoma of unknown primary (CUP) unidentified by conventional workup, and to compare the statistical difference between the FDG-PET and FDG-PET/CT. Twenty-eight studies (involving a total of 910 patients) published between 1990 and 2007 were reviewed. These studies evaluated the role of FDG-PET and FDG-PET/CT in the detection of unknown primary tumors after physical examination and conventional workup failed to detect a primary tumor. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies as well as to summarize the overall findings of sensitivity, specificity, and detection capacity of the primary tumor. The overall sensitivity and specificity of FDG-PET in detecting unknown primary tumors were 0.78 [95% confidence interval (CI): 0.72-0.84)] and 0.79 (95% CI: 0.74-0.83), respectively. Furthermore, FDG-PET detected 28.54% of tumors that were not apparent after CUP failed to be detected by conventional workup. Data were collected on the locations of primary tumors detected by FDG-PET in 17 studies and detected by FDG-PET/CT in seven studies. Tumors from the base of the tongue accounted for 20.7% (six of 29) of all false-positive FDG-PET scans, corresponding to a false-positive rate of 28.6% (six of 29), much higher than tumors from the others. FDG-PET exhibited a lower sensitivity with respect to the tumors at the base of the tongue and tonsils, which was 68.2 and 76.7%, respectively. In the eight studies with 430 patients diagnosed with CUP by FDG-PET/CT, 31.4% (n=135) of primary tumors were detected. The pooled sensitivity and specificity were 0.81 (95% CI: 0.74-0.87) and 0.83 (95% CI: 0.78-0.87), respectively. FDG-PET and FDG-PET/CT can detect primary tumors that went undetected by physical examination and conventional workup. FDG-PET exhibited lower sensitivity with respect to the tumors at the base of the tongue and the tonsils.

PMID: 18677207 [PubMed - indexed for MEDLINE]

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The comparative safety of various intravenous iron preparations in chronic kidney disease patients.

Ren Fail Start a Discussion »

Nov 042008

The comparative safety of various intravenous iron preparations in chronic kidney disease patients.

Ren Fail. 2008;30(6):629-38

Authors: Anirban G, Kohli HS, Jha V, Gupta KL, Sakhuja V

The relative safety of parenteral iron preparations is a controversial issue in the management of anemia in chronic kidney disease (CKD), as direct head-to-head comparative trials are lacking. In this study, patients of CKD were randomized to receive intravenous low molecular weight iron dextran (ID), sodium ferrigluconate complex (SFGC), and iron sucrose (IS) at doses and infusion rates recommended by the product manufacturer. One time test dose was used only for ID and SFGC. A total of 2,980 injections (n = 339) of i.v. iron was given, and 49 patients (14.45% per patient) and a total of 56 adverse events (1.88% per infusion) were noted. Odds ratios (OR) of serious adverse drug events (ADE; i.e., death, anaphylaxis, or suspected immuno-allergic events) per patient was not significant between ID vs. SFGC (3.566) and SFGC vs. IS (2.129), whereas that between ID vs. IS (7.594) was highly significant (p = 0.034). OR of serious ADE exposure was significantly higher in ID vs. SFGC (OR = 5.670, p = 0.0147) and ID vs. IS (OR = 7.799, p < 0.001). No significant difference was seen between the three groups in terms of non-serious ADEs. Drug discontinuation occurred significantly more often with ID. One patient who developed anaphylactoid reaction with SFGC and ID tolerated iron sucrose well.

PMID: 18661414 [PubMed - indexed for MEDLINE]

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HIV-associated tuberculosis: diagnostic and treatment challenges.

Semin Respir Crit Care Med Start a Discussion »

Nov 042008

HIV-associated tuberculosis: diagnostic and treatment challenges.

Semin Respir Crit Care Med. 2008 Oct;29(5):525-31

Authors: El-Sadr WM, Tsiouris SJ

Tuberculosis (TB) and the human immunodeficiency virus (HIV) are, individually, two of the world's greatest ongoing public health threats. In combination, the two diseases can be even more devastating. HIV significantly increases an individual's chances of reactivation of latent TB infection and progression to active TB disease. HIV's associated immunosuppression makes it more difficult to diagnose active TB due to a higher likelihood of atypical and extrapulmonary presentation and poorer performance of standard diagnostic tools. TB is the major cause of death in individuals infected with HIV, and the combination of both illnesses creates unique treatment challenges for providers due to interactions between antituberculous and antiretroviral medications, overlapping drug toxicities, and the immune reconstitution inflammatory syndrome. Magnifying these challenges even further is the fact that much of the burden of TB/HIV coinfection exists in some of the world's most resource-limited settings. Concerted efforts are needed to identify rapid and accurate diagnostic tools for active TB disease and latent TB infection (LTBI) that are practical and inexpensive and that perform well in individuals with HIV infection. Also needed are effective and feasible strategies to optimize management of both conditions in the coinfected patient.

PMID: 18810685 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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