2009 July 10

Takotsubo cardiomyopathy: state-of-the-art review.

Jul 102009

Takotsubo cardiomyopathy: state-of-the-art review.

J Nucl Cardiol. 2009 Jan-Feb;16(1):122-34

Authors: Dorfman TA, Iskandrian AE

Takotsubo cardiomyopathy (TC) is characterized by transient, often severe, left ventricular dysfunction and electrocardiographic changes that might mimic acute myocardial infarction in the absence of significant obstructive coronary artery disease. It is often encountered in elderly women after physical or emotional stress. Excessive catecholamine stimulation, metabolic abnormalities, and microcirculatory dysfunction are thought to be responsible for the manifestations of this disorder. This comprehensive review summarizes relevant published data, atypical presentations, pathophysiology, and management strategy. It also includes a review of 789 patients with TC including nine illustrative cases encountered at our institution.

PMID: 19152137 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Lessons from ximelagatran: issues for future studies evaluating new oral direct thrombin inhibitors for venous thromboembolism prophylaxis in orthopedic surgery.

Clin Appl Thromb Hemost Start a Discussion »

Jul 102009

Lessons from ximelagatran: issues for future studies evaluating new oral direct thrombin inhibitors for venous thromboembolism prophylaxis in orthopedic surgery.

Clin Appl Thromb Hemost. 2009 May-Jun;15(3):316-26

Authors: Lazo-Langner A, Rodger MA, Wells PS

Venous thromboembolism is a frequent complication of total hip and knee replacement requiring prophylaxis with anticoagulants. A direct thrombin inhibitor-ximelagatran-did not show advantages over other anticoagulants and it was withdrawn from the market; however, new drugs are being developed. We conducted a systematic review and meta-analysis to identify conditions under which ximelagatran might potentially be superior to current standards. Medline, EMBASE, the Cochrane Library, and grey literature were screened for randomized trials comparing ximelagatran with warfarin or low-molecular-weight heparin for thromboprophylaxis in total hip or knee replacement. Two reviewers independently assessed and extracted data. A meta-analysis with especial attention to statistical heterogeneity was conducted. This study suggested that the risk-benefit profile of ximelagatran-and probably other similar agents-depends on the type of surgery, the initial timing of administration, and probably the dose. These issues should be explicitly explored in future trials evaluating new direct thrombin inhibitors.

PMID: 19028773 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Quality of life in older people with atrial fibrillation.

J Interv Card Electrophysiol Start a Discussion »

Jul 102009

Quality of life in older people with atrial fibrillation.

J Interv Card Electrophysiol. 2009 Jun;25(1):37-42

Authors: Lane DA, Lip GY

This review summarises the literature on quality of life in patients with atrial fibrillation. Since atrial fibrillation is predominantly a disease of maturity, the majority of studies examining quality of life in this patient population have been conducted in older adults people (aged >or=65 years). Almost all studies have demonstrated poorer quality of life among patients with atrial fibrillation compared to age-matched general populations. Rate-control and rhythm-control strategies in highly symptomatic patients have revealed significant improvements in quality of life following the interventions, presumably as a result of the immediate relief of symptoms. Further, randomised controlled trials of rate- versus rhythm-control strategies have shown that some aspects of quality of life improve significantly following either intervention and that neither rate nor rhythm-control is superior in increasing quality of life. Control of the heart rate, rather than restoring sinus rhythm, appears to be associated with better quality of life in more domains.

PMID: 19034639 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Making sense of scoring systems in community acquired pneumonia.

Respirology Start a Discussion »

Jul 102009

Making sense of scoring systems in community acquired pneumonia.

Respirology. 2009 Apr;14(3):327-35

Authors: Niederman MS

The site of care decision is one of the most important in the management of patients with community-acquired pneumonia (CAP). Several scoring systems have been developed to predict mortality risk in CAP, and these have been applied to guide physicians about whether patients should be admitted to the hospital or to the intensive care unit (ICU). However, these tools were initially developed to predict mortality risk, and studies have demonstrated that the risk for death does not always equate with need for hospitalization or ICU care. The most widely studied scoring systems are the Pneumonia Severity Index (PSI) and the CURB-65 (a modification of the British Thoracic Society rule). Each has advantages and limitations, with the more-complex PSI developed to identify low-mortality risk patients, and the CURB-65, which is simpler, being developed to easily identify more severely ill individuals. No scoring system can replace clinical judgement about the admission decision, and prospective studies have shown that physicians still admit at least 30-60% of low mortality risk patients when using the PSI to guide this decision. Limitations of these prognostic tools include their variable utility in the elderly, and their failure to include certain comorbidities (COPD, immune suppression) and social factors, in their calculations. The need for ICU care is also not well-defined by measuring the PSI or CURB-65, and other tools such as those developed by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guideline committee and the SMART-COP rule may have greater utility for this purpose. In the future, measurements of serum biomarkers, such as procalcitonin, may augment the information provided by prognostic scoring tools for patients with CAP.

PMID: 19353770 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Pathophysiology and management of gastroparesis.

Expert Rev Gastroenterol Hepatol 1 Response »

Jul 102009

Pathophysiology and management of gastroparesis.

Expert Rev Gastroenterol Hepatol. 2009 Apr;3(2):167-81

Authors: Khoo J, Rayner CK, Jones KL, Horowitz M

Gastroparesis is characterized by upper gastrointestinal symptoms associated with delayed gastric emptying, without mechanical obstruction. However, symptoms do not correlate well with the magnitude of delay in gastric emptying. Diabetes mellitus and surgery are the most common causes, although more than 30% of cases are idiopathic. Coordination of insulin action with nutrient delivery is important in diabetics, as postprandial blood glucose levels and gastric emptying are interdependent, and gastroparesis probably represents a major cause of poor glycemic control. Scintigraphy is the gold standard for measuring gastric emptying. Current treatment mainly involves the use of prokinetic drugs. Pyloric botulinum toxin injection and gastric electrical stimulation require more evidence from controlled studies before their use can be recommended. Surgical options remain inadequately studied.

PMID: 19351287 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Peripherally inserted central catheter placement with the sonic flashlight: initial clinical trial by nurses.

J Ultrasound Med Start a Discussion »

Jul 102009

Peripherally inserted central catheter placement with the sonic flashlight: initial clinical trial by nurses.

J Ultrasound Med. 2009 May;28(5):651-6

Authors: Wang D, Amesur N, Shukla G, Bayless A, Weiser D, Scharl A, Mockel D, Banks C, Mandella B, Klatzky R, Stetten G

OBJECTIVE: We describe a case series constituting the first clinical trial by intravenous (IV) team nurses using the sonic flashlight (SF) for ultrasound guidance of peripherally inserted central catheter (PICC) placement. METHODS: Two IV team nurses with more than 10 years of experience with placing PICCs and 3 to 6 years of experience with ultrasound attempted to place PICCs under ultrasound guidance in patients requiring long-term IV access. One of two methods of ultrasound guidance was used: conventional ultrasound (CUS; 60 patients) or a new device called the SF (44 patients). The number of needle punctures required to gain IV access was recorded for each patient. RESULTS: In both methods, 87% of the cases resulted in successful venous access on the first attempt. The average number of needle sticks per patient was 1.18 for SF-guided procedures compared with 1.20 for CUS-guided procedures. No significant difference was found in the distribution of the number of attempts between the two methods. Anecdotal comments by the nurses indicated the comparative ease of use of the SF display, although the relatively small scale of the SF image compared with the CUS image was also noted. CONCLUSIONS: We have shown that the SF is a safe and effective device for guidance of PICC placement in the hands of experienced IV team nurses. The advantage of placing the ultrasound image at its actual location must be balanced against the relatively small scale of the SF image.

PMID: 19389904 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

July 2009
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