bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fragmented Left Sided QRS in Absence of Bundle Branch Block: Sign of Left Ventricular Aneurysm
Authors: Reddy Chatla V. R. , Cheriparambill Kuruvilla , Saul Barry , Makan Majesh , Kassotis John , Kumar Awaneesh , Das Mithilesh Kumar 
Published: March 2006

Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR` pattern or its variant RSr`, rSR`, or rSr`) without evidence of bundle branch block (QRS duration ≤120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR` pattern or its variant) in the left sided leads (I, aVL, V3 to V6) may be a useful sign of LVA. Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30° right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. Results: The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5–9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29–53% and the negative predictive value can be estimated at 95–98%. Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.
Patterns of Atrial Fibrillation After Coronary Artery Bypass Surgery
Authors: Tamis‐Holland Jacqueline E. , Kowalski Marcin , Rill Velisar , Firoozi Kamran , Steinberg Jonathan S. 
Published: March 2006

Background: Atrial fibrillation (AF) is the most common arrhythmia occurring in patients after coronary artery bypass surgery (CABG). The purpose of this study was to determine whether AF characteristics were independently associated with postoperative length of stay (LOS). Methods: Two hundred ninety consecutive post‐CABG patients were examined through a detailed chart review. Baseline, intraoperative, and postoperative variables and the characteristics of AF were recorded. AF episodes were divided into single episodes lasting less than 24 hours (short‐lived AF) and recurrent or prolonged ≥24 hours of AF (recurrent/prolonged AF). Results: AF occurred in 94 (32.4%) patients. Twenty‐six (27.7%) of AF patients had short‐lived AF, and 68 (72.3%) of AF patients had recurrent/prolonged AF. Patients with recurrent/prolonged AF were older (P < 0.001) and more likely to have a history of prior AF (P < 0.001) relative to the other groups. Short‐lived AF did not prolong LOS (7.2 ± 2.1 days) relative to patients without AF (7.5 ± 3.9 days), whereas recurrent/prolonged AF significantly prolonged LOS (10.4 ± 6.1 days, P < 0.001). Multivariate analysis identified postoperative complications, recurrent/prolonged AF, age, and digoxin use as independent predictors of LOS. Recurrent/prolonged AF contributed an additional 1.1 days to LOS after adjusting for baseline clinical differences. Conclusions: There are heterogenous patterns of AF after cardiac surgery. A substantial minority of AF is short‐lived and isolated with no impact on LOS; however, recurrent or prolonged AF significantly affects LOS.
An Evaluation of the Impact of Oral Magnesium Lactate on the Corrected QT Interval of Patients Receiving Sotalol or Dofetilide to Prevent Atrial or Ventricular Tachyarrhythmia Recurrence
Authors: McBride Brian F. , Min Bokyung , Kluger Jeffrey , Guertin Danette , Henyan Nickole N. , Coleman Craig I. , Silver Burton B. , White C. Michael 
Published: March 2006

Background: Intravenous magnesium reduces the QTc interval of patients receiving ibutilide. Whether oral magnesium can reduce the QTc interval associated with oral sotalol and dofetilide is not known. This study was undertaken to evaluate the impact of oral magnesium on the QTc interval and whether an inherent intracellular magnesium deficiency exists among patients with arrhythmias. Methods: Participants receiving sotalol or dofetilide for atrial or ventricular arrhythmias were randomized to receive magnesium l‐lactate (504 mg elemental magnesium daily, Niche Pharmaceuticals, Roanoke, TX) or placebo for 48 hours. A 12‐lead electrocardiogram (ECG) was obtained at baseline, 3 hours, and 51 hours after dosing to correspond to the Tmax after oral ingestion. The QTc interval was measured from the ECGs and compared between groups. Intracellular magnesium concentrations were determined by energy‐dispersive x‐ray analysis at baseline and 51 hours after dosing (Intracellular Diagnostics, Inc., Foster City, CA). Results: The QTc interval reductions from baseline were greater in the magnesium group than placebo at 3 and 51 hours (P = 0.015 and P < 0.001, respectively). Sixty‐three percent of patients (regardless of experimental group) had baseline intracellular magnesium concentrations below the normal reference range of 33.9–41.9 mEq/IU, with an average level of 32.6 ± 2.2 mEq/IU. Conclusions: Oral magnesium l‐lactate raises intracellular magnesium concentrations and lowers the QTc interval of patients receiving sotalol or dofetilide.
Implication from Randomized Trials of Rate and Rhythm Controls on Management of Patients with Persistent Atrial Fibrillation
Authors: Hagens Vincent E. , Van Veldhuisen Dirk J. , Crijns Harry J. G. M. , Van Gelder Isabelle C. 
Published: March 2006

Recently, several randomized trials were published on the issue of rate or rhythm control for patients with atrial fibrillation (AF). Patients were typically minor symptomatic, relatively old, with age above 70, presenting with a recurrence of AF and suffering from only mild to moderate underlying heart disease. The main outcome of these trials is that rate control is not inferior to rhythm control for the management of patients with AF concerning morbidity and mortality. Also patients' quality of life did not differ significantly in follow‐up in these trials. However, rhythm control is not redundant in the treatment of AF. Focus is now on subgroups of patients who could still have benefit being in sinus rhythm. For severely symptomatic patients, patients presenting with the first episode of AF and probably those with severe congestive heart failure, to restore and maintain sinus rhythm should still be the goal. With the failure of antiarrhythmic therapy, nonpharmacological approaches such as pulmonary vein isolation can be performed.Another finding of the randomized trials is that being in sinus rhythm does not prevent from the occurrence of thromboembolic complications. This means that for patients with AF, with risk factors for thromboembolic events, adequate anticoagulant therapy is indicated irrespective of the current heart rhythm. As with antiarrhythmic therapy, the search for new and safer anticoagulant therapy is underway.This review will focus on the key aspects we have learned from the randomized trials on rate and rhythm controls for patients with AF.
Modality options for renal replacement therapy: The integrated care concept revisited
Authors: NESRALLAH Gihad , MENDELSSOHN David C. 
Published: March 2006

AbstractAs the End‐stage renal disease population continues to grow, innovative strategies that optimize patient outcomes while capitalizing on the relative strengths of the existing modalities must be sought. Renal transplantation remains the preferred form of renal replacement therapy, but given the limited supply of donor organs, dialytic therapies will continue to constitute a large part of the modality mix. Matching patients to the most suitable modalities requires that a number of factors be considered. These include the patient's autonomy, medical and social factors, system‐related issues, patient outcomes, and finances. While peritoneal dialysis and hemodialysis (HD) have traditionally been viewed as competing modalities, we propose that they, along with home and frequent HD regimens, may be used in a complementary manner, which is based on current evidence, and may provide optimal outcomes while containing treatment costs. In this review, we attempt to synthesize the current literature describing the various issues that affect modality selection, and offer an approach to achieving a balance between these many competing factors.
Gabapentin‐induced coma in a patient with renal failure
Authors: DOGUKAN Ayhan , AYGEN Bilge , BERILGEN Muhammed S. , DAG Sait , BEKTAS Sevim , GUNAL Ali İ. 
Published: March 2006

AbstractWe describe a 60‐year‐old woman who became comatose after a single dose of gabapentin for right‐sided sciatalgia. The patient was improved by hemodialysis. Gabapentin toxicity should be considered when mental status changes develop in patients with renal failure after even a single dose.
Verapamil and mild hyperkalemia in hemodialysis patients: A potentially hazardous association
Authors: LETAVERNIER Emmanuel , COUZI Lionel , DELMAS Yahsou , MOREAU Karine , MURCOTT Olivier , de PRÉCIGOUT Valérie 
Published: March 2006

AbstractDuring the past 3 years, 3 patients undergoing intermittent hemodialysis (or about to do so) in our hospital developed a third‐degree atrioventricular block while being treated with verapamil for blood pressure or supraventricular arrhythmia. In the 3 cases, mild hyperkalemia was concomitant. The medical history of these patients revealed no intrinsic cause of atrioventricular conduction disturbance. We report herein the 3 cases and draw attention to the risks of atrioventricular block in this particular context.
Evaluation of primary failure in native AV‐fistulae (early fistula failure)
Authors: OHIRA Seiji , KON Tadamasa , IMURA Takashi 
Published: March 2006

AbstractThe most preferable method of vascular access (VA) in maintenance hemodialysis is a native arteriovenous fistula (AVF). Advanced age as well as the rapid increase in underlying diseases such as diabetic nephropathy and nephrosclerosis in these patients also means that the veins and arteries used to establish the AVF have undergone vascular damage, making construction of an AVF more difficult compared with earlier construction. Although there are various conditions under which arterial superficialization or AV graft must be chosen, it remains the rule that the first choice for VA should be AVF whenever possible. To improve postoperative results, it is necessary to reduce malfunctions immediately following surgery. We conducted a survey of 23 dialysis facilities throughout Japan and analyzed data from the past 3 years regarding the functionality of the AVF at initial puncture following construction of 5007 examples of newly constructed AVFs. Upon initial puncture, primary failure (PF) is defined as those cases in which thrombosis or inadequate blood flow occur. Primary failure occurred in 7.6% of the cases in this series, but there was a wide distribution of PF, 0.8% to 23.6%, because of differences in quality among facilities. This difference in PF is probably affected by technical aspects, the main factor being the characteristics of the patient. Survey responses included: (1) vascular damage of the veins and arteries used in creating the AVF and (2) the suitability of the location chosen for construction. In the data collected, many methods were used to repair those primary AFVs in which PF occurred. The salvage rate was 70%. Currently, the most preferable form of VA is AVF adhering to the principle that the proper timing of the choice and construction of AVF should consider the maturation period. To accomplish this, it is vital that vascular mapping be performed preoperatively to construct the AVF. If PF does occur, the cause should be thoroughly investigated and repairs made effectively.
Large variations in prescriptions of gastrointestinal medications in hemodialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
Authors: BAILIE George r. , MASON Nancy a. , ELDER Stacey j. , ANDREUCCI Vittorio e. , GREENWOOD Roger n. , AKIBA Takashi , SAITO Akira , BRAGG‐GRESHAM Jennifer l. , GILLESPIE Brenda w. , YOUNG Eric w. 
Published: March 2006

AbstractLittle is known about proton pump inhibitor (PPI) or H2 receptor antagonist (HA) prescription patterns or regarding use of predictors in hemodialysis patients. Proton pump inhibitor and HA prescribing patterns were investigated in 8628 hemodialysis patients from seven countries enrolled in the prospective, observational Dialysis Outcomes and Practice Patterns Study. Logistic regression examined predictors associated with PPI and HA use, adjusting for age, sex, country, time with end‐stage renal disease, medications, 14 comorbid conditions, and the association between the number of comorbid conditions and the prescription of gastrointestinal (GI) medications. In a cross‐section from February 1, 2000, 3.4% to 36.9% of patients received an HA and 0.8% to 26.9% took a PPI, depending upon the country. From 1996 to 2001, the prescription of HAs declined while PPI use increased. Facility use of HAs and PPIs ranged from 0% to 94% of patients. H2 receptor antagonist or PPI use was significantly and independently associated with age, narcotic use, corticosteroids, acetaminophen, nonsteroidal anti‐inflammatory drugs, tricyclic antidepressants, selective serotonin reuptake inhibitors, coronary artery disease history, cardiovascular diseases other than hypertension or congestive heart failure, peripheral vascular disease, pulmonary disease, and GI bleed. Proton pump inhibitors or HAs were more likely to be prescribed in Italy, Spain, and the United Kingdom than in the United States. The odds of PPI prescription increased if serum phosphorus <5.5 mEq/L or serum albumin <3.5 g/dL. Prescription of GI medications was associated with many comorbidities and use of several medications. Extreme variability of prescription patterns suggests that there is no standard approach in treatment practices.
Cromolyn sodium: A potential therapy for uremic pruritus?
Authors: ROSNER Mitchell H. 
Published: March 2006

AbstractUremic pruritus occurs in up to 50% of patients undergoing chronic hemodialysis. The pathogenesis of this disabling condition is unknown but likely involves multiple pathways involving the peripheral and central nervous system as well as local chemical and inflammatory mediators. Therapy has involved modification of the dialysis procedure, topical medications such as emollients, physical treatments such as ultraviolet light, and several oral medications such as antihistamines, activated charcoal, and gabapentin. Unfortunately, most of these therapies have not been subjected to rigorous clinical trials and clinical success has been variable. Two patients with disabling uremic pruritus refractory to multiple interventions are reported, who showed significant improvement in pruritus severity as assessed by a visual analog scale when they were treated with the mast cell stabilizer cromolyn sodium. Cessation of cromolyn resulted in return of pruritus, which improved with rechallenge with the medication. Cromolyn sodium may offer an alternative therapy for patients with refractory uremic pruritus, and should be subjected to a randomized placebo‐controlled trial.
The salvage of aneurysmal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulators
Authors: MARTICORENA Rosa M. , HUNTER Joyce , MACLEOD Stephen , PETERSHOFER Elizabeth , DACOURIS Niki , DONNELLY Sandra , GOLDSTEIN Marc B. 
Published: March 2006

AbstractWe describe the St Michael's Hospital (SMH) modified buttonhole (BH) cannulation technique as a method that offers a solution for fistulae with aneurysmal dilatation due to repetitive cannulation in a restricted area. This is a prospective cohort study of 14 chronic hemodialysis (HD) patients with problematic fistulae (marked aneurysmal formation and thinning of the overlying skin, bleeding during treatment, and prolonged hemostasis post‐HD) because of repetitive, localized cannulation. Each patient was followed for 12 months. The protocol was as follows: creation of tunnel tracks by 1 to 3 experienced cannulators per patient, using sharp needles. After the tunnel tracks were established and cannulation was easily achieved with dull needles, additional cannulators were incorporated with the guidance of a mentor. Bleeding from cannulation sites during dialysis ceased within 2 weeks and skin damage resolved within 6 months in all patients. Hemostasis time postdialysis decreased from 24 to 15 min. Cannulation pain scores decreased significantly. Access flows and dynamic venous pressure measurements remained unchanged. No interventions were required to maintain access patency. In 2 cases, the aneurysms became much less evident. Complications included one episode of septic arthritis and one contact dermatitis. A third patient developed acute bacterial endocarditis 9 months following completion of her follow‐up. The SMH modified BH cannulation technique can salvage problematic fistulae, prevent further damage, and induce healing of the skin in the areas of repetitive cannulation. This technique can be successfully achieved by multiple cannulators in a busy full‐care HD unit.
Does an alteration of dialyzer design and geometry affect biocompatibility parameters?
Authors: OPATRNÝ Karel , KROUZŽECKÝ Aleš , POLANSKÁ Kamila , MAREŠ Jan , TOMŠŮ Martina , BOWRY Sudhir K , VIENKEN Jörg 
Published: March 2006

AbstractThe aim of the study was to assess the biocompatibility profile of a newly developed high‐flux polysulfone dialyzer type (FX‐class dialyzer). The new class of dialyzers incorporates a number of novel design features (including a new membrane) that have been developed specifically in order to enhance the removal of small‐ and middle‐size molecules. The new FX dialyzer series was compared with the classical routinely used high‐flux polysulfone F series of dialyzers. In an open prospective, randomized, crossover clinical study, concentrations of the C5a complement component, and leukocyte count in blood and various thrombogenicity parameters were evaluated before, and at 15 and 60 min of hemodialysis at both dialyzer inlet and outlet in 9 long‐term hemodialysis patients using the FX60S dialyzers and, after crossover, the classical F60S, while in another 9 patients, the evaluation was made with the dialyzers used in reverse order. The comparison of dialyzers based on evaluation of the group including all procedures with the FX60S and the group including procedures with the F60S did not reveal significant differences in platelet count, activated partial thromboplastin times, plasma heparin levels, platelet factor‐4, D‐dimer, C5a, and leukocyte count at any point of the collecting period. Both dialyzer types showed a significant increase in the plasma levels of the thrombin‐antithrombin III complexes; however, the measured levels were only slightly elevated compared with the upper end of the normal range. Biocompatibility parameters reflecting the behavior of platelets, fibrinolysis, complement activation, and leukopenia do not differ during dialysis with either the FX60S or the F60S despite their large differences in design and geometry features. Although coagulation activation, as evaluated by one of the parameters used, was slightly higher with the FX60S, it was still within the range seen with other highly biocompatible dialyzers and therefore is not indicative of any appreciable activation of the coagulation system. Thus, the incorporation of various performance‐enhancing design features into the new FX class of dialyzers does not result in a deterioration of their biocompatibility profile, which is comparable to that of the classical F series of dialyzers.
Determinants of metabolic acidosis among hemodialysis patients
Authors: SOUDAN Khaldoun , RICANATI Edmond S. , LEON Janeen B. , SEHGAL Ashwini R. 
Published: March 2006

AbstractMetabolic acidosis is frequently present, poorly controlled, and associated with adverse effects among hemodialysis patients. Potential determinants of metabolic acidosis include endogenous acid production, administration of alkali, neutralization of acid by buffers, dilution of serum bicarbonate by interdialytic fluid gain, and loss of bicarbonate in stool. Understanding the relative importance of these determinants may help guide efforts to manage metabolic acidosis. We used chart abstraction, patient interviews, and laboratory testing to assess variables related to acid production (protein breakdown), alkali administration (dialysis dose, missed treatments, dialysate bicarbonate concentration, oral bicarbonate supplements), acid buffering (phosphorus binders), dilution of bicarbonate (interdialytic weight gain), and loss of bicarbonate in stool (diarrhea) for 190 randomly selected patients from 44 hemodialysis facilities. We used multivariate analyses to determine which potential determinants were independently associated with predialysis serum bicarbonate levels. Of all patients, 30% had metabolic acidosis (serum bicarbonate level <22 mEq/L). On multivariate analysis, metabolic acidosis was more likely with increased protein nitrogen appearance (odds ratio [OR] 1.60 per 0.2 g/kg/day, p=0.001) and less likely with increased Kt/V (OR 0.61 per 0.20 increase in Kt/V, p<0.001) and with increased calcium carbonate use (OR 0.38 per 2 g/day, p=0.003). Key determinants of metabolic acidosis among hemodialysis patients are protein breakdown, dialysis dose, and specific phosphorus binders. Further work is needed to develop interventions to address these determinants.
Prevalence and risk factors associated with geographic tongue among US adults
Authors: Shulman JD , Carpenter WM 
Published: March 2006

Objective: To characterize the prevalence of geographic tongue (GT) among US adults.Design: Population‐based case–control studyMain outcome measures: The presence or absence of GT.Subjects and methods: Data from 16 833 adults examined during The Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES III), a study based on multistage probability sampling were analyzed using SAS‐callable SUDAAN 9.0.1.Results: Geographic tongue point prevalence was 1.8% (95% CI: 1.4, 2.3). Multivariate logistic regression showed significant effects of race‐ethnicity, with Whites (AOR = 1.8; 1.3, 2.5) and Blacks (AOR = 1.6; 1.2, 2.1) having greater odds of GT than Mexican‐Americans; current corticosteroid therapy (AOR = 3.7; 1.54, 8.6). Cigarette smokers had lower GT prevalence (AOR = 0.4; 0.3, 0.6). Fissured tongue (FT) was strongly associated with GT among non‐smokers: AOR = 17.5 (7.8, 39.5). We did not find significant associations with age, gender, oral contraceptive use, diabetes mellitus, allergy or atopy, psychological or dermatological conditions as previous research has suggested.Conclusions: Geographic tongue was more prevalent among Whites and Blacks compared with Mexican‐Americans, positively associated with FT, and inversely associated with cigarette smoking.