bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relevance of comorbidities for heart failure treatment in primary care: A European survey
Authors: Sturm Heidrun B. , Haaijer‐Ruskamp Flora M. , Veeger Nic J. , Baljé‐Volkers Corine P. , Swedberg Karl , van Gilst Wiek H. 
Published: August 2005

AbstractAim:To assess the impact of comorbidities on chronic heart failure (CHF) therapy.Methods:The IMPROVEMENT‐HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression.Results:Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one‐, two‐ and three‐drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing β‐blockers more likely. Thus for single drug regimes, MI increased the likelihood for non‐recommended β‐blocker monotherapy (OR 1.3; 95% CI 1.2–1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE‐inhibitors were the most likely single drug, while the most likely second drugs were β‐blockers in hypertension and digoxin in diabetes.Conclusions:Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.
Obese subjects with heart failure have lower N‐terminal pro‐brain natriuretic peptide plasma levels irrespective of aetiology
Authors: Rivera Miguel , Cortés Raquel , Salvador Antonio , Bertomeu Vicente , de Burgos Fernando García , Payá Rafael , Portolés Manuel , Taléns‐Visconti Raquel , Martinez‐Dolz Luis , Valero Ricardo , Sevilla Begoñ , Climent Vicente 
Published: August 2005

AbstractN‐terminal pro‐brain natriuretic peptide (NT‐proBNP) may be useful in the diagnosis of heart failure and ventricular dysfunction. Obesity is an independent cardiovascular risk factor. The purpose of this study was to measure NT‐proBNP plasma levels in obese and non‐obese subjects with heart failure and to compare levels in subjects with ischaemic and dilated aetiology.In this study, obese subjects had 63% lower NT‐proBNP plasma levels than non‐obese subjects (p<0.01). In multivariate analysis, BMI was inversely associated with NT‐proBNP plasma levels (p<0.05) and a 17% decrease in natriuretic peptide levels was attributed to obesity (p<0.036). When we analyzed data according to the aetiology of heart failure, we found that both groups (ischaemic and dilated) had a 65% decrease in NT‐proBNP plasma levels in obese subjects compared to non‐obese subjects.
Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n‐3 polyunsaturated fatty acids
Authors: Macchia Alejandro , Levantesi Giacomo , Franzosi Maria Grazia , Geraci Enrico , Maggioni Aldo Pietro , Marfisi RosaMaria , Nicolosi Gian Luigi , Schweiger Carlo , Tavazzi Luigi , Tognoni Gianni , Valagussa Franco , Marchioli Roberto ,   on behalf of the GISSI‐Prevenzione Investigators
Published: August 2005

AbstractBackgroundSudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI‐Prevenzione, treatment with n‐3 polyunsaturated fatty acids (PUFA) reduced M and SD in post‐MI patients, but their effect in patients with SyD is unknown.Methods11,323 patients with prior MI and NYHA class≤II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data (n=9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted.ResultsCompared to patients with EF>50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60–0.96) P=0.02) and without SyD (RR 0.81 (0.59–1.10) P=0.17) (heterogeneity tests P=0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26–0.67) P=0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41–1.69) P=0.71) in patients with EF>50% (heterogeneity tests P=0.07). There was a significant increase in SD with worsening EF (P test for trend=0.02), the benefit on SD in patients with EF≤40% being 4‐fold higher than in those with EF>50%.ConclusionsIncreasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.
The Modification of Diet in Renal Disease (MDRD) equations provide valid estimations of glomerular filtration rates in patients with advanced heart failure
Authors: O'Meara Eileen , Chong Kwok S. , Gardner Roy S. , Jardine Allan G. , Neilly James B. , McDonagh Theresa A. 
Published: August 2005

AbstractBackground:Glomerular filtration rate (GFR) has major prognostic implications in heart failure. Our objective was to validate the MDRD prediction equations for GFR in patients with advanced heart failure, and to compare their predictive performance to that of the Cockcroft–Gault (CG) equation.Methods:We analysed GFR in 45 patients referred for heart transplantation evaluation. 51Cr–EDTA‐measured GFR was compared to GFR estimates obtained by MDRD1 and MDRD2 equations, CG equation using actual body weight, and ideal body weight. Regression analyses and Pearson correlations were performed, and Bland and Altman plots were drawn. ROC curves were obtained to illustrate each equation's ability to predict a GFR less than 60 ml/min/1.73 m2 (moderate renal impairment).Results:Patients had a mean age of 52 years, and 69% were in NYHA class III. The mean EDTA‐measured GFR was 46.9±17.2 ml/min/1.73 m2. The MDRD1 equation provided the best predictive model (narrowest limits of agreement; r=0.766, p<0.001), and the highest performance in predicting a GFR less than 60 ml/min/1.73 m2 (area under curve: 0.901).Conclusions:MDRD equations, especially MDRD1, adequately predict GFR in advanced heart failure, with higher accuracy than the CG equation. MDRD1 also has higher performance in predicting a GFR less than 60 ml/min/1.73 m2.
Progressive left ventricular hypertrophy after withdrawal of long‐term ACE inhibition following experimental myocardial infarction
Authors: Westendorp Bart , Schoemaker Regien G. , Buikema Hendrik , Boomsma Frans , van Veldhuisen Dirk J. , van Gilst Wiek H. 
Published: August 2005

AbstractBackground:Although discontinuation of chronic ACE inhibitor (ACEi) therapy after myocardial infarction (MI) is common in clinical practice, some clinical studies reported an increased incidence of ischemia‐related events after withdrawal. To further address this issue, we assessed hemodynamic, neurohormonal and vascular consequences of withdrawing long‐term ACEi treatment after experimental MI.Methods:Rats were subjected to coronary ligation to induce MI, and received quinapril (15 mg/kg/day) from 2 weeks to 14 months post‐MI. Subsequently, surviving rats were randomized to sacrifice at 0, 4, and 6 weeks after ACEi withdrawal. Rats were studied for signs of heart failure, hemodynamics and cardiac function, neurohormones, and vascular edothelial function.Results:After discontinuation of ACEi treatment, plasma aldosterone levels increased between 0—4 weeks without further increment thereafter, suggesting persistent RAAS activation. Acetylcholine‐induced aortic relaxation was impaired at 4 and 6 weeks, indicating rapid and sustained development of endothelial vasodilator dysfunction after withdrawal. Moreover, 24% of the rats developed heart failure signs (edema, dyspnea), and 3 rats died, all within 4 weeks after withdrawal. Significantly increased N‐ANP levels and lung weights at 4, but not at 6 weeks suggest a transient volume overload. Finally, LV/body weight ratios significantly increased between 0—4 as well as 4—6 weeks, indicating progressive LV hypertrophy.Conclusions:The observed alterations after withdrawing long‐term post‐MI quinapril treatment in the present study may account for an increased risk for ischemic events. Thus, our findings highlight the potentially harmful effects associated with abrupt discontinuation of long‐term post‐MI ACE inhibition, and imply careful clinical consideration in this matter.
Short‐term effects of levosimendan and prostaglandin E1 on hemodynamic parameters and B‐type natriuretic peptide levels in patients with decompensated chronic heart failure
Authors: Moertl Deddo , Berger Rudolf , Huelsmann Martin , Bojic Anja , Pacher Richard 
Published: August 2005

AbstractBackground:Both levosimendan and prostaglandin E1 (PGE1) have beneficial effects on hemodynamic parameters and outcome compared to dobutamine in decompensated chronic heart failure (CHF).Aims:We compared short‐term effects of levosimendan versus PGE1 on hemodynamic parameters and B‐type natriuretic peptide levels (BNP) in patients with decompensated CHF.Methods and results:73 patients (cardiac index <2.5 L/min/m2 pulmonary capillary wedge pressure (PCP)> 15 mmHg) with decompensated CHF were randomised to treatment with either a 24 h‐infusion of levosimendan (n=38) or a chronic infusion of PGE1 (n=35). Hemodynamic parameters and BNP were measured at baseline, 24 and 48 h, BNP levels were also measured after 1 week. Baseline characteristics including concomitant medication were similar in both groups. Levosimendan and PGE1 increased cardiac output (CO) after 24 and 48 h. Levosimendan increased CO twice as much as PGE1 (24 h: Levosimendan +1.1±0.1 L/min, PGE1 +0.6±0.1 L/min, p>0.001). Both drugs produced a comparable reduction in PCP and pulmonary artery pressure after 24 and 48 h. Levosimendan decreased BNP by 28% after 24 h and 22% after 48 h, but effects disappeared after 1 week. In contrast, PGE1 decreased BNP by 15% after 48 h (no change at 24 h), but a decrease of 20% was sustained at 1 week.Conclusions:The differential beneficial effects of levosimendan (greater increase in CO) and PGE1 (sustained decrease in BNP) may have a potential impact on clinical outcome.
Practical recommendations for the use of ACE inhibitors, beta‐blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice
Authors: McMurray John , Cohen‐Solal Alain , Dietz Rainer , Eichhorn Eric , Erhardt Leif , Hobbs F.D. Richard , Krum Henry , Maggioni Aldo , McKelvie Robert S. , Piña Ileana L. , Soler‐Soler Jordi , Swedberg Karl 
Published: August 2005

AbstractSurveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well‐being and prolong life. This may be due to unfamiliarity with the evidence‐base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta‐blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non‐specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.
Exploring symptoms in chronic heart failure
Authors: Ekman Inger , Cleland John G.F. , Andersson Bert , Swedberg Karl 
Published: August 2005

AbstractSymptoms in patients with chronic heart failure (CHF) are the cry for help, reflecting not only the physical aspects of the disease but the impact on lifestyle, anxiety, depression and expectations of the patient. Studies consistently show a difference in patients' self‐assessed functional classification compared to investigator reported NYHA classification. Moreover, patient self‐assessed symptoms have recently been shown to independently predict hospitalisation and mortality over 5 years. Recognition of symptoms and appreciation of their importance justifies the use of a structured assessment in order to provide optimal medical care for patients with CHF. A model of how to structure symptom assessment equally with signs is presented in this paper.
Surgical left ventricular remodeling in heart failure
Authors: Tønnessen Theis , Knudsen Cathrine Wold 
Published: August 2005

AbstractThe high mortality and morbidity of patients in terminal heart failure are a therapeutic challenge to modern medicine. Surgically, cardiac transplantation is an excellent treatment for many patients. However, lack of donors combined with an increasing number of patients has led to the search for other surgical strategies. Patients with symptomatic large left ventricular aneurysms have been treated with resection of the aneurysm and closure of the left ventricle either directly (linear closure, first reported by Cooley) or by implantation of a patch (endoventricular patch plasty or Dor procedure). Akinetic areas of the left ventricle have also been successfully treated by the latter method. According to the law of Laplace, large dilated ventricles have increased wall tension and thus increased oxygen consumption. Based on this fact, Batista and coworkers have reduced the volume of enlarged left ventricles in patients in terminal heart failure by removing a wedge of myocardium from the apex of the heart towards the base of the left ventricular free wall. Although a favorable outcome has been reported in selected patients, this method is currently not recommended for treatment of heart failure because of high surgical failure rates.The present paper reviews some of the relevant literature regarding surgical left ventricular remodeling in heart failure. Two new techniques (Myosplint and CorCap cardiac support device) are also briefly described.
Orbital Decompression in Graves' Ophthalmopathy by Medial and Lateral Wall Removal
Authors: Sellari‐Franceschini Stefano , Berrettini Stefano , Santoro Amelia , Nardi Marco , Mazzeo Salvatore , Bartalena Luigi , Mazzi Barbara , Tanda Maria Laura , Marcocci Claudio , Pinchera Aldo 
Published: August 2005

ObjectiveThe objective of this study is to describe a technique for balanced orbital decompression and to analyze the results.Methods and MaterialsWe conducted a retrospective study of 140 patients (276 orbits). Orbital decompression was carried out by removal of the medial orbital wall by ethmoidectomy and complete removal of the lateral wall by bringing out the entire sphenoid wing together with part of the zygomatic bone down to the inferior orbital fissure.ResultsOne hundred thirty‐six patients underwent bilateral decompression, 4 patients underwent monolateral decompression. Proptosis was reduced on average by 5.3 mm; 28 (20%) patients showed onset or worsening of diplopia.ConclusionsMedial and lateral approach allows a balanced orbital decompression. As some patients may present different degrees of proptosis and visual impairment, we stress the importance of carefully weighing the preoperative conditions of the individual patient when choosing the surgical approach.
Tongue Base Suspension Combined with UPPP in Severe OSA Patients
Authors: Omur Mehmet , Ozturan Dilaver , Elez Feyzi , Unver Celal , Derman Sabri 
Published: August 2005

Objective:Tongue base surgery in the severe OSA patients may improve the success of uvulopalatopharyngoplasty (UPPP) as the collapse is multilevel. The aim of this study was to evaluate the long‐term objective and subjective effectiveness of the minimally invasive tongue base suspension combined with UPPP in severe OSA patients.Study Design and Setting:We conducted a retrospective analysis of 22 OSA patients undergoing UPPP and the tongue base suspension for the treatment of severe OSA.Results:Twenty‐two men who had their preoperative and postoperative polysomnography had a 54% reduction in the preoperative Respiratory Disturbance Index (RDI), from 47.50 ± 15.74 to a level of 17.31 ± 14.17. The standard surgical cure rate which is a >50% reduction in the RDI and a postoperative RDI of <20 events/hour was 81.81%. All patients had some degree of subjective improvement in their snoring, daytime sleepiness, and the Epworth sleepiness scale.Conclusions:The tongue base suspension combined with UPPP has been shown to reduce RDI better than UPPP alone. This minimally invasive technique is highly successful at 81.81% when combined with UPPP in the severe OSA patients with multilevel airway collapse.Significance:This study shows the benefits of minimally invasive tongue base suspension combined with UPPP in severe obstructive sleep apnea syndrome.
Unilateral Opacification of Paranasal Sinus CT Scans
Authors: Ahsan F. , El‐Hakim H. , Ah‐See K. W. 
Published: August 2005

ObjectivesThe aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology.Study DesignA retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification.ResultsTwenty‐eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease.ConclusionA wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.
Cochlear Implant Magnet Displacement With Minor Head Trauma
Authors: Yun James M. , Colburn Michelle W. , Antonelli Patrick J. 
Published: August 2005

Objectives:Manufacturers have introduced cochlear implants (CIs) with removable magnets to allow for magnetic resonance imaging after placement. The purpose of this study was to describe magnet displacement as a new CI complication and to suggest apossible treatment option to prevent its recurrence.Study Design:Retrospective case series.Methods:The records of 3 young males who experienced CI magnet dislodgement were reviewed and compared against records from the institutional implant database.Results:Magnet displacement was observed only in young males (14% of male children) who received CI with removable magnets. This occurred 13‐14 months after CI placement. Magnets were replaced under general anesthesia, and the scalp was bolstered with a dermal allograft. Recurrent magnet dislodgement was encountered in 1 patient, 6 months later.Conclusions:Magnet displacement may be a relatively common complication after minor head trauma in pediatric patients with certain CIs that have removable magnets.
Bilateral Congenital Vocal Cord Paralysis: A 16‐Year Institutional Review
Authors: Miyamoto R. Christopher , Parikh Sanjay R. , Gellad Walid , Licameli Greg R. 
Published: August 2005

Objective:To review the management and outcome of bilateral congenital true vocal cord paralysis in 22 patients treated over a 16‐year period and to review the role of tracheostomy in these patients.Design:Retrospective chart review.Setting:Pediatric tertiary hospital.Patients:Twenty‐two pediatric patients diagnosed with bilateral congenital true vocal cord paralysis.Interventions:Flexible or rigid diagnostic evaluation, tracheostomy, and vocal cord lateralization procedures.Main Outcomes Measures:Vocal cord recovery and decannulation.Results:With a mean follow up of 50 months, 15 of 22 patients (68%) with bilateral vocal cord paralysis required tracheostomy for airway securement. Of the 15 tracheotomized patients, 10 were successfully decannulated (8 had spontaneous recovery, whereas 2 required lateralization procedures). Eleven of these patients with tracheostomy had comorbid factors, including neurologic abnormalities (midbrain/brainstem dysgenesis, Arnold‐Chiari malformation, global hypotonia, and developmental delay). Of the 7 patients not requiring tracheostomy, 6 recovered vocal cord function (86%).Conclusion:In our series of 22 patients with bilateral vocal cord paralysis, 14 had spontaneous recovery of function. Patients managed with tracheostomy were noted to have a high incidence of comorbid factors. In this series, recovery rates were found to be higher in nontracheostomized patients than in tracheostomized patients. Patients can be carefully selected for observation versus tracheostomy at the time of diagnosis based on underlying medical conditions.
Penicillin Reduces Eustachian Tube Gland Tissue Changes in Acute Otitis Media
Authors: Andersen Henrik , Thomsen Jens , Cayé‐Thomasen Per 
Published: August 2005

Objective:The volume of the mucous paratubal glands and the number of the mucus‐producing goblet cells in the middle ear and Eustachian tube (ET) are increased after experimental acute otitis media (AOM). The present investigation examines a potential effect of penicillin on the changes in goblet cell density and gland structures of the ET during and after AOM.Study Design:Middle ear inoculation of Streptococcus pneumoniae in 50 rats. Two days later, 25 rats were given penicillin V as one daily dose for 5 days. Twenty‐five rats received no treatment. Five animals from each group were sacrificed on days 4, 8, 16, 90, and 180. The ET was dissected and decalcified, followed by paraffin embedding, serial transverse sectioning, and PAS/alcian blue staining. The goblet cell density and the paratubal gland composition and volume were determined in every 20th section, using a light microscope.Results:Penicillin reduced the increase of goblet cell density from day 8 and through 6 months, whereas the increase of the paratubal mucous gland volume was unaffected by treatment.Conclusion:We conclude that penicillin reduces the increase of ET goblet cell density during and after acute otitis media, whereas the paratubal gland volume remains unaffected. An increased mucosal secretory capacity and indicated excessive secretion of mucus may contribute to the deteriorated ET function found after AOM and thus predispose, sustain, or aggravate middle ear disease. This may be prevented by penicillin treatment.