bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of intravenous amiodarone in acute refractory arrhythmias
Authors: Schmidt A. , König W. , Binner L. , Mayer U. , Stauch M. 
Published: February 2009

AbstractFew data are available on intravenous amiodarone therapy in refractory arrhythmias. This retrospective study in 50 patients (14 with supraventricular and 36 with ventricular tachyarrhythmias) revealed a favorable effect of intravenous amiodarone in the treatment of life‐threatening arrhythmias with an overall success rate of 76%. In the subgroup of patients with ventricular fibrillation and concomitant severe congestive heart failure success rate was low (25%, 2/8), whereas effectiveness in patients with ventricular tachycardias was high (>90%) and proved to be independent of left ventricular function. If patients with recurrent ventricular fibrillation were excluded from the analysis, successful treatment with intravenous amiodarone was achieved in 90%, even in those patients with severely compromised myocardium.
The role of the chest x‐ray in the evaluation of chronic severe heart failure: Things are not always as they appear
Authors: Costanzo W. E. , Fein S. A. 
Published: February 2009

AbstractThe chest x‐ray has become a standard clinical test to aid in the evaluation of patients with chronic severe heart failure. To evaluate just how useful this tool is in the routine assessment of pulmonary venous hypertension secondary to heart failure, we compared the radiologist's interpretation of the chest x‐ray with hemodynamic data obtained from right heart catheterization in a group of patients undergoing protocol evaluation of an experimental treatment for heart failure. Of 23 patients with pulmonary venous hypertension (pulmonary capillary wedge pressure > 20 mmHg) and a complete data base, only 11 had chest x‐rays showing evidence of pulmonary venous congestion or interstitial or alveolar edema. The sensitivity of the chest x‐ray in selecting patients with a pulmonary capillary wedge pressure over 20 mmHg in this setting was only 48%. In other studies, where the radiologist was aware that his or her reading was being compared to hemodynamic assessments, the sensitivity of the chest film has approached 85%. We feel our analysis more closely parallels routine clinical practice. Clinicians should be aware that the chest x‐ray may not be a very sensitive tool for the assessment of pulmonary hemodynamics in patients with severe heart failure.
Spontaneous recovery of left ventricular function following acute anterior myocardial infarction
Authors: Preuss K. C. , Chapman P. D. , Ptacin M. J. , Keelan M. H. , Bamrah V. S. 
Published: February 2009

AbstractFour patients with acute anterior wall myocardial infarction showing spontaneous and marked improvement in systolic left ventricular function are described. All 4 patients showed abnormal Q waves and severe wall motion abnormalities soon after acute infarction. In all 4 patients, at least some regeneration of R‐wave forces occurred and the regional wall motion in the involved area of the left ventricle improved dramatically without coronary angioplasty or surgical revascularization during the intervening period. The improvement in left ventricular function was attributed to spontaneous increase in nutrient flow to the involved area. It is concluded that Q waves and severe wall motion abnormalities do not necessarily indicate irreversible scar formation.
Risk factors and in‐hospital course of first myocardial infarction in the elderly
Authors: Robinson K. , Conroy R. M. , Mulcahy R. 
Published: February 2009

AbstractWe studied 980 patients with a first episode of unstable angina or myocardial infarction (MI), to examine age‐related differences in risk factors and in‐hospital complications and mortality. Of the total group, 52.9% were over 60 years of age and 24.3% over 70 years. The proportion of females rose with increasing age, as did the proportion of ex‐smokers, while the proportion of current smokers fell. Age correlated negatively with total cholesterol levels, and positively with high‐density lipoprotein cholesterol levels. The proportion of hypertensives rose with age, as did in‐hospital systolic, but not diastolic, blood pressure. Older patients were more likely to have diabetes, and to have had chronic angina. There was no relation between age and either size or site of infarction. The proportion admitted with unstable angina fell with age, and, among infarctions, the proportion developing complications rose. Mortality rose from 3.1% in the under 60 subjects to 20.0% in those over 70. Cardiogenic shock tended to become more lethal with advancing age, but the outcome of ventricular fibrillation was not influenced by age. With the current aging coronary care population, management and secondary prevention methods derived from studies confined to younger subjects may be inappropriate.
Coronary hemodynamics during left and right coronary arteriography with an ionic and nonionic contrast medium
Authors: SCHRäDER R. , SIEVERT H. , FREY G. , SCHMIDT T. , KALTENBACH M. , KOBER G. 
Published: February 2009

AbstractThe direct effects of ionic amidotrizoate (iodine content 370 mg/ml, osmolality 2.1 osmol/kg) and nonionic iopamidol (iodine content 370/ml, osmolality 0.8 osmol/kg) on the coronary circulation were intraindividually compared in 10 patients suffering from coronary heart disease. In accordance with a double‐blind, crossover protocol, both contrast media were injected into the left and right coronary arteries (8 ml and 5 ml per injection, respectively). Injections of both dyes into the left coronary artery caused a similar decrease in heart rate. The prolongation in the QT interval was significantly greater after amidotrizoate (p<0.05). Systolic (p<0.01) and diastolic (p<0.05) aortic pressures decreased to a greater extent following amidotrizoate injection. Each contrast agent produced a similar increase in coronary sinus flow, but iopamidol resulted in a smaller decrease in coronary vascular resistance (p<0.05). After right coronary artery injections, both contrast media caused bradycardia and prolongation of the QT interval, a decrease in systolic and diastolic aortic pressure, a rise in coronary sinus flow, and a lowering of coronary vascular resistance. Though most changes were more pronounced following amidotrizoate injection, the differences in the ionic and the nonionic agent were not statistically significant. Thus, after selective coronary arteriography, both contrast media caused a transient drop in coronary vascular resistance and a rise in coronary sinus flow despite a decrease in aortic pressure. The effects of amidotrizoate were more marked, which might be attributed to the higher osmolality of this ionic contrast medium. Coronary hemodynamics, however, usually returned to baseline values within 1 minute. The clinical significance of the differences in the ionic and nonionic agents appears questionable.
Myocardial contractility and performance capacity after magnesium infusions in young healthy persons: A double‐blind, placebo‐controlled, cross‐over study
Authors: Rasmussen H. S. , Videbaek R. , Melchior T. , Aurup P. , Cintin C. , Pedersen N. T. 
Published: February 2009

AbstractTo evaluate the effect of intravenous magnesium (Mg) treatment on the inotropic state of the heart and maximal work capacity, 9 healthy volunteers were entered in a double‐blind, placebo‐controlled, cross‐over study. Separated by an interval of three weeks, the volunteers were tested twice, each time randomly allocated to receive either an intravenou s injection of 10 mmol magnesium chloride dissolved in 100 ml isotonic sodium chloride or placebo of isotonic sodium chloride only. Before and after each infusion myocardial inotropism was evaluated by echocardiography. Mitral‐septal distance (MSA) was used as a measure for ejection fraction. On each test day an ergometer bicycle exercise test was performed, and maximal work capacity was calculated. Magnesium treatment reduced the MSA (from 4.2 to 2.9 mm, p=0.07), while no difference was found after placebo treatment. Likewise, a tendency toward increasing fractional shortening after magnesium treatment was detected, although this difference was not statistically significant (p=0.1). No difference in maximal work capacity between the magnesium and placebo periods was found. Serum magnesium concentrations rose significantly after the infusions (from 0.82 to 1.38 mmol/1, p<0.001). It is concluded that intravenous magnesium does not exert a negative inotropic effect on the myocardium as previously stated. On the contrary, we found a tendency toward a positive inotropic effect. However, the observed differences are of borderline statistical significance and a more extended study, employing invasive measurements of cardiac inotropism appears to be necessary.
Diagnostic accuracy of 2‐D echocardiography for detection of exercise‐induced wall motion abnormalities in patients with coronary artery disease: Comparison to biplane cineventriculography
Authors: Voelker W. , Jacksch R. , Dittmann H. , Karsch K. R. 
Published: February 2009

AbstractTo determine the accuracy of two‐dimensional echocardiography (2‐D echo) for assessment of exercise‐induced wall motion abnormalities in patients with coronary artery disease, the results of stress echocardiography were compared with exercise cineventriculography. In 56 consecutive patients, biplane cineventriculography at rest and immediately after supine bicycle exercise was performed. Cross‐sectional echo was obtained using the apical two‐ and four‐chamber‐views for left ventricular imaging under identical conditions. In 6 of the 56 patients 2‐D echo, in 8 patients cineventriculogram, and in 2 patients both methods were of inadequate quality at rest or during exercise. Of the remaining 40 patients, 34 had coronary artery disease. Local wall motion in 360 wall segments from these patients was analyzed. In 49 segments (14%) in 24 of these patients exercise‐induced ischemic wall motion abnormalities were evident during cineventriculography. Only 24 of these 49 asynergies (49%) were also recognized by 2‐D echo. Using cross‐sectional echocardiography, ischemia‐related wall motion abnormalities were best detected septal, whereas apical asynergies were identified in only 3 of 12 segments (25%). Thus, the clinical value of exercise 2‐D echo as a screening method in patients suspected of having coronary artery disease is limited and restricted to patients where excellent visualization of the left ventricular endocardium is possible.
Accuracy of m‐mode and two‐dimensional echocardiography in the diagnosis of aortic dissection: An experience with 128 cases
Authors: Roudaut R. P. , Billes M. A. , Gosse P. , Deville C. , Baudet E. , Fontan F. , Besse P. , Bricaud H. , Dallocchio M. 
Published: February 2009

AbstractThe accuracy of combined M‐mode and two‐dimensional echocardiography in the diagnosis of aortic dissection was evaluated in 673 patients with a clinical suspicion of aortic dissection, over a six‐year period. In 128 cases, the diagnosis of aortic dissection was confirmed by angiographic, tomographic (CT scan), or autopsy findings, or during surgery. Two echocardiographic features were found to support a diagnosis of aortic dissection: a dilation of at least one segment of the aorta (sensitivity 95%, specificity 51%) and a typical abnormal linear intraluminal echo corresponding to the intimal flap (sensitivity 67%, specificity 100%). This pathognomonic intimal flap was observed in 86 cases, of which three types could be distinguished: (1) a long oscillating flap (n=15), (2) a long but minimally mobile linear echo which was duplicated and parallel to one or two aortic walls (n=64), (3) a short, double linear image with a rapid systolic motion and high frequency oscillations. These features were found to have a high sensitivity in type I aortic dissection (88%), although in types II and III the sensitivity was much lower. In some cases, a fourth type of abnormal image could be detected: a small intraluminal echo moving in parallel to the aortic wall. This feature should be interpreted with caution since its predictive value for a positive examination was low (48%). Out of 23 cases in which the diagnosis of aortic dissection was suspected on the basis of this doubtful abnormal echo, it was confirmed in only 11 patients. The results in these 128 cases of aortic dissection indicate that two‐dimensional echocardiography, which is easily performed at the patient's bedside, could take priority in investigations of this condition. It is extremely sensitive in the diagnosis of ascending aortic dissection, but much less so in the diagnosis of descending aortic dissection.
Thalassemic cardiomyopathy: Echocardiography difference between major and intermediate thalassemia at rest and during isometric effort: Yearly follow‐up
Authors: Canale C. , Terrachini V. , Vallebona A. , Bruzzone F. , Masperone M. A. , Caponnetto S. 
Published: February 2009

AbstractLeft ventricular (LV) performance was studied in young patients with severe chronic anemia due to β‐thalassemia major, intermedia, and in healthy control subjects. M‐mode echocardiograms were recorded in each patient and semiautomatic computerized analysis of the tracings provided data relating to LV performance. Then a statistical analysis of the difference between each specific thalassemic group and the normal subjects was made using Student's t‐test for unpaired data. The study showed that cardiac dysfunction is more serious in major than in intermediate β thalassemia. A follow‐up one year later showed a progressive deterioration of the cardiac indices, in spite of treatment with desferrioxamine. A handgrip test was performed in the follow‐up study, which permitted us to distinguish different groups relative to the changes in LV performance indices. Our findings indicate that echocardiography provides a simple noninvasive means for assessing changes in the cardiac structure and function, which should also prove useful in the serial evaluation of patients at risk of developing myocardial iron deposition.
Radical versus partial nephrectomy
Authors: Zini Laurent , Perrotte Paul , Capitanio Umberto , Jeldres Claudio , Shariat Shahrokh F. , Antebi Elie , Saad Fred , Patard Jean‐Jacques , Montorsi Francesco , Karakiewicz Pierre I. 
Published: February 2009

AbstractBACKGROUND:Relative to radical nephrectomy (RN), partial nephrectomy (PN) performed for renal cell carcinoma (RCC) may protect from non‐cancer‐related deaths. The authors tested this hypothesis in a cohort of PN and RN patients.METHODS:The Surveillance, Epidemiology, and End Results‐9 database allowed identification of 2198 PN (22.4%) and 7611 RN (77.6%) patients treated for T1aN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (RN vs PN) on overall mortality (Cox regression models) and on non‐cancer‐related mortality (competing‐risks regression models).RESULTS:Relative to PN, RN was associated with 1.23‐fold (P = .001) increased overall mortality rate, which translated into a 4.9% and 3.1% absolute increase in mortality at 5 and 10 years after surgery, respectively. Similarly, non‐cancer‐related death rate was significantly higher after RN in competing‐risks regression models (P < .001), which translated into a 4.6% and 4.5% absolute increase in non‐cancer‐related mortality at 5 and 10 years after surgery, respectively.CONCLUSIONS:Relative to PN, RN predisposes to an increase in overall mortality and non‐cancer‐related death rate in patients with T1a RCC. In consequence, PN should be attempted whenever technically feasible. Selective referrals should be considered if PN expertise is unavailable Cancer 2009. © 2009 American Cancer Society.
Reduced tumorigenesis in p53 knockout mice exposed in utero to low‐dose vitamin E
Authors: Chen Connie S. , Squire Jeremy A. , Wells Peter G. 
Published: February 2009

AbstractBACKGROUND:The limited antioxidative capacity of the fetus renders it more susceptible to reactive oxygen species (ROS), and possibly to ROS‐mediated cancer initiation or promotion in utero.METHODS:To test this hypothesis, pregnant cancer‐prone p53 knockout mice were prenatally supplemented with a low dietary dose of the antioxidant vitamin E (VE) (0.1% all‐rac‐α‐tocopherol‐acetate), and the homozygous (−/−) and heterozygous (+/‐) p53‐deficient and wild‐type (+/+) offspring were examined for VE levels, oxidative DNA damage, chromosomal stability, cellular viability and postnatal tumorigenesis.RESULTS:In utero exposure to VE reduced spontaneous postnatal tumorigenesis in p53 +/‐ offspring, and increased VE levels and reduced fetal DNA oxidation in some but not all tissues of p53‐deficient fetuses. Survival of VE‐exposed p53 +/‐ offspring at the end of the study was double that of the +/‐ controls (45% vs 23%). In primary culture of skin fibroblasts from VE‐exposed fetuses, VE did not alter chromosomal ploidy, but reduced cell death, indicating that its protective effect did not involve chromosomal stability.CONCLUSIONS:The tissue‐selective increase in fetal VE levels and reduced DNA oxidation, together with a concomitant reduction in postnatal tumorigenesis, suggest that in utero oxidative stress contributes to some postnatal cancers, and the risk can be reduced by maternal dietary supplementation with low‐dose VE. Cancer 2009. © 2009 American Cancer Society.
Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer
Authors: Chu Edward , Schulman Kathy L. , Zelt Susan , Song Xue 
Published: February 2009

AbstractBACKGROUND:Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.METHODS:Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.RESULTS:In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.CONCLUSIONS:Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.
Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors
Authors: Puget Stephanie , Boddaert Nathalie , Viguier Delphine , Kieffer Virginie , Bulteau Christine , Garnett Matthew , Callu Delphine , Sainte‐Rose Christian , Kalifa Chantal , Dellatolas Georges , Grill Jacques 
Published: February 2009

AbstractBACKGROUND:Children treated for a malignant posterior fossa tumor (PFT) are at risk of intellectual impairment. Its severity is not explained by age and radiotherapy alone. The current study was designed to define the correlations between the anatomical damage and the neurological/neuropsychological deficits in children with a malignant PFT.METHODS:Sixty‐one consecutive children (mean age, 6.0 years) treated for a malignant PFT with surgery, chemotherapy, and radiotherapy underwent a detailed neuropsychological evaluation, including a full‐scale intelligence quotient (FSIQ), on average 5.6 years after the diagnosis. The neurological examination was recorded 1 month after surgery and at the time of the neuropsychological evaluation. Cerebellar and brain injuries were scored based on the magnetic resonance imaging (MRI). Correlation of these injuries with neurological and cognitive outcome were performed after adjustment for other potential risk factors (radiotherapy schedule, age, hydrocephalus, duration of symptoms, socioeconomic status, and surgical complications).RESULTS:Neurological deficits were strong predictors of low cognitive performances irrespective of the other risk factors. The extent of cerebellar deficits and fine motor dexterity impairment were correlated with the degree of damage to the dentate nuclei and inferior vermis. The IQ scores were inversely correlated with the severity of the damage to the dentate nuclei; mean FSIQ was 83 if they were both intact and 65 in the case of bilateral damage (P = .009).CONCLUSIONS:Damage to the dentate nuclei and to the inferior vermis, observed on MRI, predict the degree of impairment of neurological and neuropsychological functions in children treated for a malignant PFT. Cancer 2009. © 2009 American Cancer Society.
CA‐125 change after chemotherapy in prediction of treatment outcome among advanced mucinous and clear cell epithelial ovarian cancers
Authors: Tian Chunqiao , Markman Maurie , Zaino Richard , Ozols Robert F. , McGuire William P. , Muggia Franco M. , Rose Peter G. , Spriggs David , Armstrong Deborah K. 
Published: February 2009

AbstractBACKGROUND:There are limited data regarding unique clinical or laboratory features associated with advanced clear cell (CC) and mucinous (MU) epithelial ovarian cancers (EOC), particularly the relationship between CA‐125 antigen levels and prognosis.METHODS:A retrospective review of 7 previously reported Gynecologic Oncology Group phase 3 trials in patients with stage III/IV EOC was conducted. A variety of clinical parameters were examined, including the impact of baseline and changes in the CA‐125 level after treatment of CC and MU EOC on progression‐free (PFS) and overall survival (OS).RESULTS:Clinical outcomes among patients with advanced CC and MU EOC were significantly worse when compared with other cell types (median PFS, 9.7 vs 7.0 vs 16.7 months, respectively, P < .001; median OS, 19.4 vs 11.3 vs 40.5 months, respectively, P < .001). Suboptimal debulking was associated with significantly decreased PFS and OS among both. Although baseline CA‐125 values were lower in CC (median, 154 μ/mL) and MU (100 μ/mL), compared with other cell types (275 μ/mL), this level did not appear to influence outcome among these 2 specific subtypes of EOC. However, an elevated level of CA‐125 at the end of chemotherapy was significantly associated with decreased PFS and OS (P < .01 for all).CONCLUSIONS:Surgical debulking status is the most important variable at prechemotherapy predictive of prognosis among advanced CC and MU EOC patients. Changes in the CA‐125 levels at the end treatment as compared with baseline can serve as valid indicators of PFS and OS, and likely the degree of inherent chemosensitivity. Cancer 2009. © 2009 American Cancer Society.