At-a-glance, Emergency department surveillance of thermal burns and scalds, electronic Canadian Hospitals Injury Reporting and Prevention Program, 2013. / Aperçu, Surveillance des brûlures thermiques et des échaudures dans les services d'urgence, d'après la base de données électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2013.

INTRODUCTION: Although fatality and hospitalization rates for burns in Canada have declined over time, less serious cases still commonly present to the emergency department (ED). METHODS: The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) is an injury and poisoning surveillance system administered by the Public Health Agency of Canada, operating in emergency departments of 17 hospitals. RESULTS: Overall, cases reported in 2013 were scalds and contact burns from hot objects. The leading direct causes of scalds were hot beverages and hot water. The leading causes of contact burns were stoves/ovens and fireplaces/accessories. While the overall proportion of burns was highest among females, males comprised a higher proportion of burns from all mechanisms except scalds.

INTRODUCTION: Bien que les taux de mortalité et d'hospitalisation associés à des brûlures au Canada aient diminué avec le temps, des cas moins graves se présentent encore couramment aux services d'urgence. MÉTHODOLOGIE: Le Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT) révèle les causes majeures de brûlures thermiques et échaudures en 2013. RÉSULTATS: Au total, la moitié des blessures déclarées cette même année étaient des échaudures et des brûlures résultant d'un contact avec un objet brûlant. Les deux principales causes d'échaudures étaient les boissons chaudes et l'eau chaude. Les deux principales causes directes des brûlures par contact étaient les cuisinières et fours.

Emergency department presentations for hoverboard-related injuries: the electronic Canadian Hospitals Injury Reporting and Prevention Program, 2015 to 2016. / Blessures associées aux planches gyroscopiques traitées dans les services d'urgence au Canada : plate-forme électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2015-2016.

TITRE: Blessures associées aux planches gyroscopiques traitées dans les services d'urgence au Canada : plate forme électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2015-2016.

Childhood overweight and obesity trends in Canada. / Tendances en matière d'embonpoint et d'obésité chez les enfants au Canada.

INTRODUCTION: Excess weight is a key risk factor for chronic disease, and the systematic collection, analysis and reporting of key trends are important to surveillance of overweight and obesity. METHODS: We used univariate analyses to calculate current prevalence estimates of excess weight among Canadian children and youth. RESULTS: Almost 1 in 7 children and youth is obese. Rates vary based on sociodemographic factors such as age, sex, socioeconomic status and place of residence. Overall, the rates of excess weight have been relatively stable over the past decade. CONCLUSION: Ongoing monitoring of childhood obesity will provide useful information to assist with sustained actions to promote healthy weights.

INTRODUCTION: L'excès de poids est un facteur de risque important de maladies chroniques. La collecte, l'analyse et la diffusion systématiques des tendances clés dans ce domaine sont importantes pour la surveillance de l'embonpoint et de l'obésité. MÉTHODOLOGIE: Nous avons utilisé des analyses univariées pour calculer des estimations de la prévalence actuelle de l'excès de poids chez les enfants et les jeunes canadiens. RÉSULTATS: Près d'un enfant ou jeune sur sept est obèse. Les taux varient en fonction de facteurs sociodémographiques comme l'âge, le sexe, le statut socioéconomique et le lieu de résidence. Dans l'ensemble, les taux d'excès de poids sont demeurés relativement stables depuis dix ans. CONCLUSION: Faire le suivi de l'obésité juvénile fournit des renseignements utiles à la prise de mesures à long terme pour la promotion d'un poids santé.

Evidence Brief--Trends and projections of obesity among Canadians.

The prevalence of obesity, defined as body mass index (BMI) of 30 kg/m2 or higher for adults and as 2 standard deviations above the World Health Organization growth standard mean for children, has increased in many parts of the world. Obese adults are at an increased risk of certain chronic conditions, including hypertension, type 2 diabetes, cardiovascular diseases and some cancers, and of premature death. Obese children have increased cardiometabolic risk, including dyslipidemia, insulin resistance and elevated blood pressure. Excess childhood body weight that continues into adulthood can affect quality of life, educational attainment and earnings over the lifecourse. The Public Health Agency of Canada has projected an annual direct health care cost (including physician, hospitalization and medication costs) of those categorized as obese in Canada in constant 2001 Canadian dollars. Calculated as $7.0 billion in 2011, this annual direct health care cost is projected to rise to $8.8 billion by 2021, based on simulated average direct health care costs, which are higher among the obese ($2,283) than the overweight ($1,726), the underweight ($1,298) and those at normal weight ($1,284). Canadian estimates from 2006 and 2008 that used different methodologies place the annual economic burden (direct and indirect costs) of obesity between $4.6 billion and $7.1 billion. The purpose of this evidence brief is to show current Canadian obesity prevalence rates and estimates for the future using objectively measured height and weight to calculate BMI. The use of objectively measured height and weight to derive BMI is strongly recommended, especially for children and adolescents, as self- or proxy-reported height and weight tend to underestimate actual weight and consequently BMI and obesity prevalence.

TITRE: Synthèse portant sur les données probantes - Tendances et projections relatives à l'obésité chez les Canadiens. INTRODUCTION: La prévalence de l'obésité ­ soit un indice de masse corporelle (IMC) supérieur ou égal à 30 kg/m2 chez les adultes ou deux écarts-types au-dessus de la médiane de la norme de croissance de l'Organisation mondiale de la santé chez les enfants ­ a augmenté dans de nombreuses régions du monde. Les adultes obèses sont plus susceptibles d'être atteints de certaines affections chroniques, notamment d'hypertension, de diabète de type 2, de cardiopathies et de certains cancers, ainsi que de mourir prématurément. Les enfants obèses présentent aussi un risque cardiométabolique accru (dyslipidémie, résistance à l'insuline et hypertension artérielle). Un excès pondéral pendant l'enfance qui se poursuit à l'âge adulte peut nuire à la qualité de vie, au rendement scolaire et au revenu tout au long de la vie. L'Agence de la santé publique du Canada a estimé les coûts annuels directs, en dollars canadiens constants de 2001, des soins de santé (coûts liés aux médecins, aux hospitalisations et aux médicaments) pour les personnes classées comme obèses au Canada. Évalués à 7,0 milliards de dollars en 2011, ils devraient atteindre 8,8 milliards de dollars d'ici 2021, d'après un calcul à partir des moyennes actuelles qui font qu'ils sont plus élevés chez les obèses (2 283 $) que chez les personnes en surpoids (1 726 $), les personnes en insuffisance pondérale (1 298 $) et les personnes de poids normal (1 284 $). Des estimations canadiennes antérieures, de 2006 et 2008 et obtenues par des méthodologies différentes, ont évalué le fardeau économique annuel (coûts directs et indirects) de l'obésité dans une fourchette allant de 4,6 à 7,1 milliards de dollars. Cette synthèse fondée sur des données probantes vise à présenter les taux de prévalence de l'obésité au Canada à la fois actuels et projetés, à partir d'un calcul de l'IMC reposant sur des mesures objectives de la taille et du poids. L'utilisation de mesures objectives de la taille et du poids pour calculer l'IMC est fortement recommandée, particulièrement chez les enfants et les adolescents, car lorsque la taille et le poids sont autodéclarés ou obtenus par procuration, le poids réel est généralement sous-estimé, ce qui fait que l'IMC et la prévalence de l'obésité le sont également.

Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada.

INTRODUCTION: Multimorbidity is increasingly recognized as a key issue in the prevention and management of chronic diseases. We examined the prevalence and correlates of chronic disease multimorbidity in the general adult Canadian population in relation to age and other key determinants. METHODS: We extracted data from the Canadian Community Health Survey 2011/12 on 105 416 Canadian adults. We analysed the data according to the number of multimorbidities (defined as 2+ or 3+ diseases from a list of 9) and examined the determinants of multimorbidity using regression analyses. RESULTS: Our findings show that 12.9% of Canadians report 2+ chronic diseases and 3.9% report 3+ chronic diseases. Those reporting 3 or more chronic diseases were more likely to be female, older, living in the lowest income quintile and to have not completed high school. In the overall population, social deprivation is associated with a 3.7 odds of multimorbidity, but when examined across age groups, the odds of multimorbidity were notably higher in middle age, 7.5 for those aged 35 to 49 years and 5.4 for those aged 50 to 64 years. DISCUSSION: As the proportion of Canadians living with multiple chronic diseases increases, we need to assess chronic disease from a holistic perspective that captures multimorbidity and upstream factors, to facilitate broader and more context-appropriate associations with healthy living, quality of life, health care costs and mortality. Special consideration should be given to the role that social deprivation plays in the development of multimorbidity. Canadians living in the lowest socioeconomic group are not only more likely to develop multimorbidity, but the onset of multimorbidity is also likely to be significantly earlier.

TITRE: Prévalence et profils de la multimorbidité au Canada et déterminants associés. INTRODUCTION: La prise en compte de la multimorbidité est de plus en plus reconnue comme un élément fondamental de la prévention et de la prise en charge des affections chroniques. Cette étude porte sur la prévalence et les corrélats de la multimorbidité chez les adultes canadiens en fonction de l'âge et de certains autres déterminants clés. MÉTHODOLOGIE: Nous avons extrait des données portant sur 105 416 adultes canadiens ayant répondu à l'Enquête sur la santé dans les collectivités canadiennes de 2011-2012. Nous les avons analysées en fonction du nombre d'affections concomitantes présentes (deux ou plus ou trois ou plus, sur une liste de neuf) et nous avons cherché à caractériser les déterminants de la multimorbidité à l'aide de régressions. RÉSULTATS: D'après notre analyse, 12,9 % des Canadiens souffraient de deux affections chroniques ou plus et 3,9 % de trois ou plus. Les répondants ayant déclaré souffrir de trois affections chroniques ou plus étaient plus susceptibles d'être des femmes, d'être plus âgés, de faire partie d'un ménage dont le revenu fait partie du quintile le plus faible et dont le niveau de scolarité le plus élevé de l'un des membres était inférieur aux études secondaires. La multimorbidité en lien avec le dénuement social était associée à une cote de 3,7 dans la population en général, mais de 7,5 chez les 35 à 49 ans et de 5,9 chez les 50 à 64 ans, soit la population d'âge moyen. ANALYSE: La proportion de Canadiens atteints de multiples affections chroniques étant en augmentation, nous devons adopter, pour étudier les affections chroniques et leurs facteurs en amont, une approche globale qui tienne compte de la multimorbidité, afin d'agir de manière globale et adaptée au contexte pour favoriser une vie saine et une meilleure qualité de vie et pour réduire les coûts des soins de santé et la mortalité. On devrait particulièrement tenir compte du rôle joué par le dénuement social dans l'apparition de la multimorbidité, car non seulement les Canadiens du groupe socioéconomique le plus démuni sont plus susceptibles de souffrir de multimorbidité, mais celle-ci surgira aussi probablement beaucoup plus précocement.

Metabolic syndrome and chronic disease.

INTRODUCTION: Metabolic syndrome (MetS) is a combination of risk markers that appear to promote the development of chronic disease. We examined the burden of MetS in Canada through its current and projected association with chronic disease. METHODS: We used measures from the Canadian Health Measures Survey 2007-2009 to identify the prevalence of MetS in Canadian adults and examine associations between sociodemographic factors and major chronic diseases. We estimated the projected cumulative incidence of diabetes and percent risk of a fatal cardiovascular event using the Diabetes Population Risk Tool (DPoRT) and Framingham algorithms. RESULTS: After adjusting for age, we found that 14.9% of Canadian adults had MetS. Rates were similar in both sexes, but higher in those who are non-Caucasian or overweight or obese (p < .001 for all three). The importance of MetS for public health was demonstrated by its significant association with chronic disease relative to the general population, particularly for diagnosed (11.2% vs. 3.4%) and undiagnosed (6.0% vs. 1.1%) type 2 diabetes. The ten-year incidence estimate for diabetes and mean percent risk of a fatal cardiovascular disease (CVD) event were higher in those with MetS compared to those without (18.0% vs. 7.1% for diabetes, and 4.1% vs. 0.8% for CVD). CONCLUSION: MetS is prevalent in Canadian adults and a high proportion of individuals with MetS have diagnosed or undiagnosed chronic conditions. Projection estimates for the incidence of chronic disease associated with MetS demonstrate higher rates in individuals with this condition. Thus, MetS may be a relevant risk factor in the development of chronic disease.

TITRE: Syndrome métabolique et maladies chroniques. INTRODUCTION: Le syndrome métabolique (SMét) est un ensemble de marqueurs de risques qui semble favoriser l'apparition de maladies chroniques. Nous avons examiné le fardeau lié au SMét au Canada et son association actuelle et projetée avec les maladies chroniques. MÉTHODOLOGIE: Nous avons utilisé les données de l'Enquête canadienne sur les mesures de la santé 2007-2009 pour déterminer la prévalence du SMét chez les adultes canadiens et pour examiner les associations entre divers facteurs sociodémographiques et les principales maladies chroniques. Nous avons estimé l'incidence cumulative projetée du diabète et le risque, en pourcentage, d'événements cardiovasculaires mortels en utilisant l'algorithme DPoRT (Diabetes Population Risk Tool) et l'algorithme de Framingham. RÉSULTATS: Après ajustement en fonction de l'âge, nous avons pu déterminer que 14,9 % des adultes canadiens présentaient un SMét. Les taux étaient similaires pour les deux sexes, mais ils étaient plus élevés chez les non-Blancs et chez les personnes présentant un embonpoint ou obèses (p < 0,001 dans les trois cas). L'importance du SMét sur le plan de la santé publique découle du fait qu'il est associé de manière statistiquement significative avec des maladies chroniques, en particulier avec le diabète de type 2 diagnostiqué (11,2 % contre 3,4 %) et non diagnostiqué (6,0 % contre 1,1 %). Le taux estimé d'incidence sur 10 ans associé au diabète et le risque moyen en pourcentage d'événements cardiovasculaires mortels étaient plus élevés chez les personnes atteintes de SMét que chez celles qui ne l'étaient pas (18,0 % contre 7,1% pour le diabète et 4,1% contre 0,8 % pour les maladies cardiovasculaires). CONCLUSION: Le SMét est répandu chez les adultes canadiens, et une forte proportion de personnes souffrant d'un SMét ont également des affections chroniques, diagnostiquées ou non. Les estimations projetées du taux d'incidence de maladies chroniques associées à un SMét sont plus élevées chez les personnes aux prises avec ce syndrome. Par conséquent, le SMét pourrait être un facteur de risque pertinent dans l'apparition de maladies chroniques.

Study of lipids, insulin metabolism, and paraoxonase-2-311 polymorphism in patients with different subtypes of Alzheimer's disease (translated version).

OBJECTIVE: To investigate the characteristics of blood lipids, insulin metabolism, and paraoxonase-2-311 (PON2-311) polymorphism among patients with Alzheimer's disease with different types of dementia. METHODS: A total of 84 patients with Alzheimer's disease, according to the National Institute of Neurological and Communicative Disorders and Stroke, and the Alzheimer's disease and Related Disorders Association clinical criteria for 'possible Alzheimer's disease', and with no family history of the condition, were enrolled. They were then categorised into 3 groups (senile dementia, presenile dementia, and mixed dementia) according to the diagnostic criteria of the Chinese Classification of Mental Disorders, third edition. Polymerase chain reaction-restriction fragment length polymorphism analysis was used to determine the presence of PON2-311 polymorphism. Serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and fasting blood sugar were measured. Fasting plasma insulin was measured using chemiluminescence. The basal-state method was used to assess insulin resistance expressed as insulin sensitivity index. The cognitive rating scale of the Mini-Mental State Examination, Activities of Daily Living scale, and Hachinski Ischemic Scale were used to establish the clinical features and severity of cognitive impairment. Differences in PON2-311C/S polymorphism, serum insulin, blood glucose, blood lipids, and neuropsychological score were analysed. RESULTS: The serum triglyceride and cholesterol levels of the presenile dementia group were significantly higher than those of the senile and mixed dementia groups (p < 0.01). The high-density lipoprotein level of the senile dementia group was significantly higher than that of the mixed dementia group (p < 0.05). The serum insulin level of the presenile dementia group was significantly higher than that of the senile (p < 0.05) and mixed dementia groups (p < 0.01). There were no significant differences in distribution of the PON2-311 genotypes C/C, C/S, and S/S between the senile and mixed dementia groups, and no significant differences in C-allele and S-allele frequency between the 2 groups. CONCLUSIONS: The differences in serum triglycerides, cholesterol, high-density lipoprotein, and insulin levels between Alzheimer patients with senile, presenile, and mixed dementia found in this study suggest that patients with presenile dementia should monitor their lipid and insulin metabolism. No significant differences were found for PON2-311 genotypes or allele frequencies in patients with dementia due to Alzheimer's disease.

An efficacy analysis for nasopharyngeal carcinoma screening of different screening intervals.

OBJECTIVE: To evaluate the impact of different screening intervals on screening for nasopharyngeal carcinoma (NPC). METHODS: A Markov model was constructed, based on the natural history of NPC. The 5-year mortality rate of NPC was the major measurement to evaluate the efficacies of 16 screening strategies. Parameters for the model were derived from published literature. RESULTS: Screening reduced the 5-year mortality rate for NPC by 20.4 - 43.3%, compared with the equivalent rate without screening. The 5 year mortality rate and the NPC pick-up rate with strategy A1 (annual screening) were 23.6% and 83.9%, respectively. Compared with strategy A1, strategy B1 (annual screening for seropositive subjects; biennial screening for seronegative subjects) had a similar 5-year mortality rate (24.0%) and a slightly smaller NPC pick-up rate (81.7%), but led to a 39.3% reduction in total screenings. Compared with all other strategies excluding strategy A1, strategy B1 achieved the lowest 5-year mortality rate and the largest NPC pick-up rate. CONCLUSIONS: Strategy B1 had the highest efficacy for NPC screening.

Acetylcholinesterase activities in marine snail (Cronia contracta) as a biomarker of neurotoxic contaminants along the Goa coast, West coast of India.

The measurement of acetylcholinesterase (AChE) activity is used worldwide as a biomarker of environmental contamination due to neurotoxic substances. In the present study the AChE activities was measured in marine snails (Cronia contracta) collected seasonally from six sampling sites (viz. Arambol, Anjuna, Dona Paula, Vasco, Velsao and Palolem) along the Goa coast during the pre-monsoon (April, 2004), monsoon (September, 2004) and post-monsoon (November, 2004) periods. The AChE activities in C. contracta showed wide variation along the Goa coast. It was found to be quite high at the reference site, Palolem (23.97, 21.72 and 24.85) throughout the sampling period (April-November, 2004). The AChE activities in C. contracta decreased significantly at Vasco (44.6-52.4% reduction) followed by Dona Paula (24.9-36.2% reduction), Velasao (10.8-35.9% reduction), Arambol (12.6-37.3% reduction) and Anjuna (0-12.7% reduction). Such a significant variation of AChE activities in the marine snail along the Goa coast can be attributed to neurotoxic substances prevalent in those regions. The high concentration of different neurotoxic metals (lead, cadmium, copper, manganese and iron) and petroleum hydrocarbons in the tissues of the marine snails at Dona Paula, Vasco and Velsao clearly substantiate reduction of AChE activities in C. contracta. The in vitro studies on the inhibition of AChE by different metals and PHC indicated that lead, cadmium and copper are the most predominant inhibitor. Based on the AChE activities in C. contracta the sampling sites along the Goa coast can be classified into three major clusters such as highly contaminated sites (Dona Paula, Vasco and Velsao), moderately contaminated sites (Arambol, Anjuna) and least contaminated site (Palolem).

Novel simulated moving-bed adsorber for the fractionation of gas mixtures.

The separation of propylene-propane mixture is an energy intensive operation commercially practiced using cryogenic distillation. The separation by pressure swing adsorption has been studied as an alternative. A fixed-bed pressure swing adsorption yields the heavy component as a pure product. The product recovery and the productivity are not high. In a moving-bed process, because of the counter-current solid-gas contact, the separation achieved is similar to that of the fractionation by distillation. Although the moving-bed operation offers the upper limit for the performance of a cyclic adsorptive process, due to mechanical complexities in the handling of solids the 'simulated' moving-bed is preferred. By moving the inlet and outlet ports of streams located along the length of the bed, a moving-bed process can be realized in a fixed bed. We describe here a 'moving-port' system which permits injection or withdrawal of the fluid along the axial direction in a fixed bed. A fixed bed embedded with the moving-port systems emulates a simulated moving-bed adsorber. The proposed adsorber can fractionate a binary gas mixture into two product streams with high purities. It is similar to the Sorbex process of UOP but does not have the eluent as an additional separating agent. A parametric study indicates that high purity products and a higher productivity by an order of magnitude can be achieved with simulated moving-beds compared to the fixed beds.

Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis.

BACKGROUND: Percutaneous balloon mitral valvuloplasty has been proposed as an alternative to open surgical commissurotomy for the treatment of rheumatic mitral-valve stenosis. METHODS: We enrolled 60 patients with severe mitral stenosis and favorable valvular anatomy in a prospective, randomized trial comparing the two procedures. All patients underwent cardiac catheterization before the procedure and one week, six months, and three years thereafter. Hemodynamic data were analyzed by investigators who were blinded to the patients' treatment assignments. RESULTS: Mitral-valve areas improved initially in both groups, from a mean (+/- SD) of 0.9 +/- 0.3 cm2 to 2.1 +/- 0.6 cm2 in the balloon-valvuloplasty group (30 patients; P < 0.01) and from 0.9 +/- 0.3 cm2 to 2.0 +/- 0.6 cm2 in the surgical group (30 patients; P < 0.001). Although improvement was maintained in both groups, mitral-valve areas were greater in the patients in the balloon-valvuloplasty group at three years (2.4 +/- 0.6 cm2, vs. 1.8 +/- 0.4 cm2 in the surgery group, P < 0.001). Restenosis occurred in three patients in the balloon-valvuloplasty group and four in the surgery group. One patient in the balloon-valvuloplasty group died of an apparent stroke after 2.5 years; four patients in the balloon-valvuloplasty group had residual atrial septal defects, and three patients (two in the balloon-valvuloplasty group and one in the surgery group) were judged to have severe mitral regurgitation. Seventy-two percent of the patients who underwent balloon valvuloplasty and 57 percent of the surgically treated patients were in New York Heart Association functional class I (i.e., they had no cardiovascular symptoms) at three years. No patient was lost to follow-up. CONCLUSIONS: In the treatment of mitral stenosis, balloon valvuloplasty and open surgical commissurotomy have comparable initial results and low rates of restenosis, and both produce good functional capacity for at least three years. The potential complications associated with balloon valvuloplasty should be noted. The better hemodynamic results at three years, lower cost, and elimination of the need for thoracotomy suggest that balloon valvuloplasty should be considered for all patients with favorable mitral-valve anatomy.

Thrombolysis in left-sided prosthetic valve occlusion: immediate and follow-up results.

Thrombolytic therapy is used increasingly for prosthetic valve thrombosis. Fear of peripheral embolism has limited its use in left-sided valve occlusions. Thirty-eight patients with prosthetic valve occlusion were treated with thrombolytic agents on 44 occasions. Duration of thrombolytic therapy was individualized. Patients were followed up with clinical, echocardiographic, and cine-fluoroscopic evaluation. Average time from onset of symptoms to presentation was 9.7 days. The anticoagulation status was inadequate in 70% of instances. The majority (75%) were in functional class IV, 8 of them being in shock. Overall success was seen in 88.6%: immediate complete success in 18 and partial in 21. Nine of those with partial success had delayed opening of the leaflets. There were nine instances of rethrombosis and one instance of re-rethrombosis; 6 patients received repeat thrombolysis with success in 5. Seventy-six percent (29/38) of the patients were surviving at the time of reporting. In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion. Delayed opening is common in patients with initial partial success. Rethrombosis remains a major problem.

Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. A prospective, randomized trial.

BACKGROUND: We performed a prospective, randomized trial comparing percutaneous balloon commissurotomy with surgical closed commissurotomy in 40 patients with severe rheumatic mitral stenosis. METHODS AND RESULTS: Data were analyzed by investigators who were masked to treatment assignment or phase of study. Patients randomized to balloon (n = 20) or surgical (n = 20) commissurotomy had severe mitral stenosis without significant baseline differences (left atrial pressure, 26.1 +/- 4.2 versus 27.6 +/- 6.2 mm Hg; mitral valve gradient, 18.0 +/- 4.2 versus 19.7 +/- 6.3 mm Hg; mitral valve area, 1.0 +/- 0.2 versus 1.0 +/- 0.4 cm2, respectively). At 1-week follow-up after balloon commissurotomy, pulmonary wedge pressure was 14.3 +/- 7.2 mm Hg; mitral valve gradient was 9.6 +/- 5.1 mm Hg; and mitral valve area was 1.6 +/- 0.6 cm2 (all p less than 0.0001). At 1-week follow-up after surgical closed commissurotomy, wedge pressure was 13.7 +/- 5.4 mm Hg; mitral valve gradient was 9.4 +/- 4.2 mm Hg (both p less than 0.0001); and mitral valve area was 1.6 +/- 0.7 cm2 (p less than 0.003). At 8-month follow-up, improvement occurred in both groups: Mitral valve area was 1.6 +/- 0.6 cm2 in the balloon commissurotomy group (p less than 0.002) and was 1.8 +/- 0.6 cm2 in the surgical closed commissurotomy group (p less than 0.0001). There was no difference between the groups at 1-week or 8-month follow-up (all p greater than 0.4). One case of severe mitral regurgitation occurred in each group; complications were otherwise related to transseptal catheterization. There was no death, stroke, or myocardial infarction. Cost analysis revealed that balloon commissurotomy may substantially exceed the cost of surgical commissurotomy in developing countries, whereas it may represent a significant savings in industrialized nations. CONCLUSIONS: We conclude that percutaneous balloon commissurotomy and surgical closed commissurotomy result in comparable hemodynamic improvement that is sustained through 8 months of follow-up.