Latest News - Part 4

Canadian HealthCare Mall: Results of Relation Between Neurocognitive Impairment, Embolic Load, and Cerebrovascular Reactivity

Published in Reactivity

On-pump CABGHITS

In the on-pump group, the mean number of HITS was 335.1 ± 333.5 (range, 24 to 1,229), whereas in the off-pump group, the mean number of HITS was 144.7 ± 180.4 (range, 5 to 632). This difference was significant (Z = — 2.698; p < 0.01).

Since all patients were monitored bilaterally, we could compare the HITS detection in the left and right MCAs. For the on-pump group, we counted 179 ± 227 HITS (53%) in the left MCA and 156 ± 151 HITS (47%) in the right MCA. This difference was not significant. In off-pump patients, HITS tended to be more numerous on the right MCA (106 ± 149; 73%) compared to the left MCA (39 ± 62; 27%), although this trend failed to reach significance (p = 0.057). After square-root transformation of the HITS count to obtain a normal distribution, a repeated-measures, multivariate analyses of variance with eight different surgical maneuvers of on-pump CABG as within-subjects factor was performed and revealed a main effect of surgical maneuver (F = 8.128, p < 0.01). When the different surgical maneuvers of on-pump CABG were assessed separately with paired t tests, significantly more HITS were detected immediately after aortic cannulation (Table 2). Significantly fewer HITS were found after cross-clamping. When cumulating the percentage of HITS associated with the different stages of the operation, 13.9% of the total number of HITS was explained.

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Canadian Health and Care Mall: Acute Coronary Syndromes

Acute coronary syndromesWe read with interest the article from Macie et al (May 2004) highlighting the importance of adhering to the correct dosing of enoxaparin for the prevention of ischemic events in patients with unstable angina or non-ST-segment elevation myocardial infarction. The article adds to the current controversy over dosing practices for enoxaparin in obese patients, while discussing the risk factors for increased bleeding. We would like to add the following points:

The optimal dose of enoxaparin for treatment of acute coronary syndromes (ACS) is 1 mg/kg, and this dose should be adhered to—ie, no more and no less. There is evidence that when the dose is adjusted down unnecessarily, survival and efficacy is reduced, thus emphasizing the importance of a correct dosing regimen.

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The Interpretation of Heartburn With the Help of Canadian Health and Care Mall

Published in Heartburn

Respiratory symptomsHeartburn has long been largely trivialized in the medical community. It has had a bit of a Rodney Dangerfield reputation in that it “gets no respect!” Primary care physicians treat symptoms of heartburn quite readily with antacids and varying degrees of acid-suppressing drugs ranging from H2 blockers to proton-pump inhibitors, depending on the severity and refractoriness of the symptom. The generally excellent clinical response to symptoms of daytime heartburn has contributed to a notable lack of interest in nighttime gastroesophageal reflux (GER). It is a common clinical observation that patients who have been successfully treated for heartburn complaints will spontaneously report that they are sleeping better. This observation has focused the attention of both researchers and clinicians on the relationship between GER and sleep, as well as on the importance of sleep in the patient’s quality of life. Despite this, and the burgeoning body of evidence suggesting that sleep-related GER is an important factor in both the esophageal and respiratory complications of GER, the role of sleep in the clinical presentation of GER has been largely ignored.

Considerable clinical attention has more recently been focused on the importance of the symptom of nighttime heartburn, and the concomitant occurrence of nighttime GER. For example, two epidemiologic studies have focused more attention on the occurrence of the symptom of nighttime heartburn. These studies showed remarkable similarity in that they both noted that symptoms of nighttime heartburn are common (about 75% of patients) and that nighttime heartburn was a more bothersome symptom. Furthermore, a portion of these patients reported that nighttime heartburn interfered with their sleep and daytime performance. Other epidemiologic data have shown a strong link between the occurrence of nighttime heartburn (ie, two times a week or more) and respiratory symptoms and sleep disturbance.

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Canadian Neighbor Pharmacy: Discussion of Nasal Intermittent Positive Pressure Ventilation in Patients With Obesity-Hypoventilation Syndrome

Published in PEEP

OHSObesity can have detrimental effects on respiratory function, and it may lead to chronic hypoventilation in some patients. Why some obese patients develop OHS while others breathe normally remains speculative. Contributing factors may include the restrictive pulmonary function defect, increased work of breathing and CO2 production, and altered central respiratory control.- Some available data support a possible role for airway obstruction in the pathogenesis of diurnal hypercapnia in certain patients with OHS and SAS, although this finding has not been confirmed in other studies. We think that most authors would exclude patients with significant COPD from the diagnosis of OHS, and, in this article, we have only considered those patients who did not have an obstructive ventilatory defect, as measured by spirometry. On the other hand, OHS and SAS have frequently been associated,2 and it is not fully understood whether there is a role for SAS in the pathogenesis of the hypercapnia of OHS patients. Some authors have proposed to not include SAS patients in the entity of OHS, because sleep apnea can sometimes induce hypercapnia per se, even in nonobese patients. However, we agree with most authors in not considering SAS as an exclusionary criterion for the diagnosis of OHS.2″ There is a subgroup of patients with SAS and OHS who have persistent nonapneic desaturation on polysomnography even after the elimination of occlusive apneas with nasal CPAP therapy. Despite a reduction in the resistive load against which the ventilatory pump must work by nasal CPAP therapy, hypoxemia and hypercapnia often persist during sleep and wakefulness in those patients. To avoid the confounding effect of hypoventilation as a consequence of SAS, we chose to include in this study only patients with severe respiratory failure because, in this subset of patients, it seems unlikely that upper airway obstruction could be the dominant mechanism of hypoventilation.

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Diagnosis of Cardiac Sarcoidosis: Materials and Methods

Published in Sarcoidosis

Preliminary Experiment
A cylindrical source (diameter, 24 mm) containing Ga (67 MBq per 2 mL) and Tc (67 MBq per 2 mL) was placed on the collimator plane to collect information on the two nuclides simultaneously. An acryl plate with a thickness of 0, 3, or 6 cm was interposed between the collimator and the source. To calculate the scatter ratio, the scatter levels for Ga (collected with an energy of 93 keV) and Tc (collected with an energy of 140 keV) were measured. The influence of the scatter from each nuclide on images was evaluated using a heart phantom (RH-2; Kyoto Kagaku; Kyoto, Japan). First, Ga (15 MBq per 20 mL) was infused into the anterolateral wall and the inferolateral wall, and Ga SPECT scanning was performed. Tc then was infused into the anterior wall, anterior septum, inferior septum, inferior wall, and inferolateral wall at different concentrations (ie, 0, 5, 15, or 30 MBq per 20 mL), with the Tc/Ga concentration ratio therefore ranging from 0 to 2. Dual SPECT scanning was thus performed (Starcam 3000XR/T combined with a Medium Parallel Collimator; GE Medical Systems; Milwaukee, WI). Energy levels of 93, 184, and 296 keV were used for Ga SPECT scanning. For dual SPECT scanning, the energy was 93 keV for Ga and 140 keV for Tc. The window width was set at 20% in all procedures. The data were collected on a 64 X 64 matrix and at a magnification of 2.00. The circular orbit was 180° (32 directions; 60 s per direction). Image reconstruction was performed with a Butterworth prefilter and a ramp backprojection filter, without correction for attenuation. The Ga image was superimposed on the TcROI (TcROI + Ga) in our attempt to locate abnormal Ga uptake in the myocardium. Continue reading this post…

Diagnosis of Cardiac Sarcoidosis

Published in Sarcoidosis

Diagnosis of Cardiac SarcoidosisSarcoidosis is a chronic systemic granulomatous disease ^ of unknown origin. Most deaths from sarcoidosis are attributable to involvement of the heart, making the early diagnosis and treatment of cardiac sarcoidosis essential. However, cardiac sarcoidosis shows no specific clinical symptoms or specific features on ECGs or echocardiograms, making it difficult to diagnose this condition. A definite diagnosis of this condition can be made when testing of an endomyocardial biopsy specimen is positive, but the rate of such biopsy results is low (around 20%).
Nuclear medicine is becoming increasingly important in the diagnosis of cardiac sarcoidosis. The development of single-photon emission CT (SPECT) scanning using I-metaiodobenzylguanidine, Tl (Tl), and 99mTc-sesta-mibi (Tc), has increased the diagnostic sensitivity of nuclear medicine. However, these modalities are not satisfactorily specific to cardiac sarcoidosis. Furthermore, the relationship between positive findings and the activity of the disease remains unclear when these SPECT scanning techniques are used for the diagnosis of cardiac sarcoidosis. Ga (Ga), on the other hand, is highly specific to cardiac sarcoidosis, since it is accumulated in inflamed areas and is expected to be useful in judging the responses of the disease to steroid therapy. Continue reading this post…

Reconcilable Differences: Conclusions

Published in Asthma

An assumption of this analysis is that the excessive use of SA P-agonists is synonymous with asthma control, an assumption that is supported by both the metrics of control included in the current asthma management guidelines and the Asthma Control Questionnaire, and expert opinion. These results are also dependent on the measurement and adjustment for asthma severity. The quantification of severity is complicated by the complex relationship between asthma severity and asthma control, and thus many of attributes deemed explanatory of asthma severity (eg, symptoms, pulmonary function, and morbidity) are also representative of asthma control. Although we agree with Cockroft and Swystyn that ideally asthma severity should be quantified based on the magnitude of treatment required to control symptoms, this was not possible due to the cross-sectional nature of our study. Therefore, it was necessary for us to adjust for asthma severity based on all proposed dimensions of asthma severity including symptoms, pulmonary function, morbidity, and controller medication use. Therefore, the only variable that can truly be used to quantify asthma control in this population is the magnitude of short-acting P agonist use. If adequately controlled, only the most severe, treatment recalcitrant asthmatics should be using more than four doses of short-acting P agonist per week independent of asthma severity. No participant in this study could be considered treatment resistant, and therefore short-acting P agonist use is a valid measure of treatment control in all study participants. Continue reading this post…

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