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1.
Transplant Proc ; 39(5): 1571-2, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17580190

ABSTRACT

BACKGROUND: Ventricular assist device (VAD) patients, who are commonly sensitized, can be successfully transplanted using strategies aimed at diminishing antibody burden. However, the impact of these therapies on outcomes for VAD patients on the waiting list is ill-defined. The following study was conducted to ascertain the relationship between desensitization therapies and attrition rate from the waiting list for VAD patients. METHODS: The VAD patients listed between July 1996 and June 2002 were used for this report. Transplant and inpatient pharmacy databases were queried for demographics, date of transplantation, degree of allosensitization, use of desensitization therapy, immunosuppressive strategies, and specific causes of death. RESULTS: Among 232 patients listed for heart transplantation who required bridging to transplantation with a VAD, 79 (34%) died while on the waiting list. Common causes of death included multisystem organ failure in 32 (40.5%), sepsis in 19 (24.0%), and stroke in 10 (12.6%) patients. While nearly 50% of these patients were sensitized at listing, only 5 (6.3%) patients received desensitization therapy following VAD implantation. Therapies included mycophenolate mofetil in 3 (3.7%) and IVIG in 2 (2.5%) patients. Not a single patient underwent plasmapheresis or OKT3 therapy. CONCLUSION: For patients bridged to heart transplantation with a VAD, attrition from the waiting list was associated with factors other than desensitization or induction regimens.


Subject(s)
Heart Transplantation/statistics & numerical data , Heart-Assist Devices/statistics & numerical data , Waiting Lists , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Plasmapheresis , Retrospective Studies , Survival Analysis , Treatment Outcome
2.
Transplant Proc ; 37(10): 4509-12, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16387156

ABSTRACT

BACKGROUND: Long-term survival after heart transplantation is a desirable although challenging goal. METHODS: We analyzed clinical outcomes in the cohort of 170 patients who have undergone heart transplantation at The Cleveland Clinic Foundation and survived >10 years. RESULTS: We found 10-year and 15-year survival rates of 54% and 41%, respectively, in these patients, but there was also a high incidence of complications, such as hypertension, renal dysfunction, transplant vasculopathy, and malignancy. CONCLUSIONS: Long-term survival following cardiac transplantation is possible although complications are frequent. Beyond 10 years, malignancy is a major cause of death.


Subject(s)
Heart Transplantation/statistics & numerical data , Survivors/statistics & numerical data , Adult , Cohort Studies , Female , Graft Rejection/epidemiology , Heart Transplantation/immunology , Heart Transplantation/mortality , Heart Transplantation/physiology , Humans , Immunosuppression Therapy , Male , Middle Aged , Retrospective Studies , Survival Analysis , Time Factors , Tissue Donors/statistics & numerical data
3.
J Thorac Cardiovasc Surg ; 117(6): 1077-84, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10343255

ABSTRACT

PURPOSE: Achalasia is a degenerative esophageal disorder that may result in esophageal failure necessitating resection for restoration of gastrointestinal function. This study evaluates a protocol of esophageal resection and gastric reconstruction for end-stage achalasia. METHODS: Hospital records, radiographic studies, and resection specimens of patients undergoing esophagectomy and gastric reconstruction were reviewed. Patient outcome was defined by an evaluation of symptoms (early satiety, dysphagia, regurgitation, and reflux), dietary restrictions, and ability to maintain or gain weight. Preoperative, operative, and postoperative variables and pathologic features in the resection specimens were analyzed to determine predictors of outcome. RESULTS: In a 10-year period, 32 patients underwent esophagectomy with gastric reconstruction for achalasia; 30 (94%) underwent elective surgery and 2 (6%), emergency surgery. No postoperative deaths occurred. Of 29 patients completing telephone interviews, 24 (83%) had no or mild dysphagia; 21 (72%), no or mild regurgitation; 20 (69%), no or mild reflux; and 19 (66%), no or mild early satiety. Twenty-four (83%) patients had no or minimal dietary restrictions; 26 (90%) had no or minimal social dietary restrictions. Postoperative weight was not different from preoperative weight. Of 30 patients, 26 (87%) felt better after esophagectomy and 25 (83%) would have the operation again. There were few predictors of outcome. Younger patients were more likely to have dysphagia ( P =.03). CONCLUSIONS: Esophagectomy with gastric reconstruction relieves preoperative dysphasia and regurgitation in the majority of patients. Dietary function and weight maintenance are excellent, attesting to the durability of the procedure in patients with end-stage achalasia.


Subject(s)
Esophageal Achalasia/surgery , Esophagectomy , Stomach/surgery , Adult , Aged , Esophageal Achalasia/pathology , Esophagus/innervation , Esophagus/pathology , Female , Humans , Male , Middle Aged , Myenteric Plexus/pathology , Postoperative Complications , Treatment Outcome
4.
J Thorac Cardiovasc Surg ; 120(5): 957-63, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11044322

ABSTRACT

BACKGROUND: Aortic valve replacement in patients with severe atherosclerosis of the ascending aorta poses technical challenges. The purpose of this study was to examine operative strategies and results of aortic valve replacement in patients with a severely atherosclerotic ascending aorta that could not be safely crossclamped. PATIENTS AND METHODS: From January 1990 to December 1998, 4983 patients had aortic valve surgery; of these, 62 (1.2%) patients had a severely atherosclerotic ascending aorta and required hypothermic circulatory arrest to facilitate aortic valve replacement. They form the study group. RESULTS: All patients had hypothermic circulatory arrest, but several different strategies were used to manage the ascending aorta. These techniques included aortic valve replacement with the use of hypothermic circulatory arrest (39%), ascending aortic endarterectomy (26%), ascending aortic replacement (19%), aortic inspection and crossclamping during hypothermic circulatory arrest (10%), and balloon occlusion of the ascending aorta (6%). Duration of hypothermic circulatory arrest was substantially longer for patients having aortic valve replacement with hypothermic circulatory arrest than for all other strategies. Hospital mortality was 14%, and 10% of patients had strokes. Increasing New York Heart Association functional class and impaired left ventricular function were risk factors for hospital mortality. Choice of operative technique did not influence patient outcome; however, no patient who underwent replacement of the ascending aorta had a stroke. CONCLUSIONS: Aortic valve replacement in patients with severe atherosclerosis of the ascending aorta is associated with increased operative morbidity and mortality. Complete aortic valve replacement during hypothermic circulatory arrest, the "no-touch" technique, requires a prolonged period of circulatory arrest. Ascending aortic replacement is a preferred technique, as it requires a short period of hypothermic circulatory arrest and results in comparable mortality with a low risk of stroke.


Subject(s)
Aortic Diseases/surgery , Aortic Valve/surgery , Arteriosclerosis/surgery , Blood Vessel Prosthesis Implantation , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Aortic Diseases/pathology , Aortic Valve/pathology , Arteriosclerosis/pathology , Female , Heart Arrest, Induced , Humans , Hypothermia, Induced , Logistic Models , Male , Middle Aged , Polyethylene Terephthalates , Risk Factors , Statistics, Nonparametric , Treatment Outcome
5.
J Neurotrauma ; 9(1): 33-46, 1992.
Article in English | MEDLINE | ID: mdl-1619674

ABSTRACT

The present study evaluated the effect of the nonglucocorticoid 21-aminosteroid U74006F, an inhibitor of iron-dependent lipid peroxidation, on the development of regional cerebral edema after lateral fluid-percussion (FP) brain injury. Male Sprague-Dawley rats (n = 40) were anesthetized and subjected to FP brain injury of moderate severity centered over the left parietal cortex (2.5-2.6 atms). Fifteen minutes after brain injury, animals randomly received an i.v. bolus of either U74006F (3 mg/kg, n = 21) followed by a second bolus (3 mg/kg) at 3 hr or buffered sodium citrate vehicle (equal volume, n = 15). An additional group of 12 surgically prepared but uninjured animals served as preinjury controls. At 48 hr after injury, animals were sacrificed and brain tissue assayed for water content and regional cation concentrations. With the use of specific gravimetric techniques, no significant differences were observed in posttraumatic cerebral edema between drug- and control-treated animals. However, using wet weight/dry weight methodology, we found that administration of U74006F significantly reduced water content in the right hippocampus (contralateral to the site of injury) compared to saline-treated animals (p less than 0.05). U74006F also significantly prevented the postinjury increase in sodium concentrations in the ipsilateral hippocampus (p less than 0.05) and thalamus (p less than 0.03). Regional concentrations of potassium were unaltered after drug treatment. Administration of U74006F significantly reduced postinjury mortality, from 28% in control animals to zero in treated animals (p = 0.01). These results suggest that lipid peroxidation may be involved in the pathophysiological sequelae of brain injury and that 21-aminosteroids may be beneficial in the treatment of brain injury.


Subject(s)
Brain Edema/drug therapy , Brain Injuries/drug therapy , Lipid Peroxides/antagonists & inhibitors , Pregnatrienes/therapeutic use , Animals , Body Water/metabolism , Brain Chemistry/drug effects , Brain Edema/physiopathology , Brain Injuries/physiopathology , Cations/metabolism , Cerebral Cortex/drug effects , Cerebral Cortex/metabolism , Hippocampus/drug effects , Hippocampus/metabolism , Male , Organ Size , Rats , Thalamus/drug effects , Thalamus/metabolism
6.
Ann Thorac Surg ; 69(3): 957, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10750803

ABSTRACT

Arterial cannulation of the innominate artery for cardiopulmonary bypass offers the advantage of central cannulation with standard cannulating techniques when the ascending and arch aorta are unavailable (eg, redo, aortic dissection, aneurysms). It avoids the difficulties associated with a second incision (axillary artery cannulation) and retrograde perfusion (femoral artery cannulation).


Subject(s)
Brachiocephalic Trunk , Cardiopulmonary Bypass/methods , Catheterization/methods , Humans
7.
Ann Thorac Surg ; 72(3): 725-30, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11565648

ABSTRACT

BACKGROUND: Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI). METHODS: We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine the attack rate, incidence, and impact of nosocomial BSI in patients with LVAD. A nosocomial BSI was defined using Centers for Disease Control and Prevention definition. An LVAD-related BSI was defined as one where the same pathogen is cultured from the device and the blood with no other obvious source. Two hundred fourteen patients were included in the study (17,831 LVAD-days). RESULTS: One hundred forty BSI were identified in 104 patients for an attack rate of 49% and incidence of 7.9 BSI per 1000 LVAD-days. Thirty-eight percent of the BSI were LVAD associated. The most common pathogens causing BSI were coagulase-negative staphylococci (n = 33), Staphylococcus aureus, and Candida spp. (19 each), and Pseudomonas aeruginosa (16 each). A Cox proportional hazard model found BSI in patients with LVAD to be significantly associated with death (hazard ratio = 4.02, p < 0.001). Fungemia had the highest hazard ratio (10.9), followed by gram-negative bacteremia (5.1), and gram-positive bacteremia (2.2). CONCLUSIONS: Patients with implantable LVAD have a high incidence of BSI, which are associated with a significantly increased mortality. Strategies for prevention of infection in LVAD recipients should focus on the drive line exit site until technical advances can achieve a totally implantable device.


Subject(s)
Bacteremia/etiology , Cross Infection/etiology , Fungemia/etiology , Heart-Assist Devices/adverse effects , Bacteremia/microbiology , Bacteremia/mortality , Female , Fungemia/microbiology , Fungemia/mortality , Fungi/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Heart Transplantation , Heart-Assist Devices/microbiology , Humans , Male , Middle Aged , Proportional Hazards Models , Prostheses and Implants/adverse effects , Prostheses and Implants/microbiology , Retrospective Studies , Risk Factors , Survival Rate
8.
Ann Thorac Surg ; 72(3): 753-7, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11565653

ABSTRACT

BACKGROUND: Bioprosthesis durability decreases with time and younger age. However, the time-scale and determinants of durability of the aortic Carpentier-Edwards stented bovine pericardial prosthesis are incompletely characterized. METHODS: Between September 1981 and January 1984, 267 patients underwent implantation of the pericardial aortic prosthesis at four centers. Mean age at implant was 65 +/- 12 years (range 21 to 86 years). Follow-up averaged 12 +/- 4.5 years. The primary end point was explant for structural valve dysfunction (SVD), which was analyzed multivariably in the context of death as a competing risk. RESULTS: Freedom from explant due to SVD was 99%, 94%, and 77% at 5, 10, and 15 years. Risk of SVD increased exponentially with time and younger age (p = 0.0001) at implantation; an increased risk of small valve size was not reliably demonstrated (p = 0.1). Considering the competing risk of death, patients aged 65 years or older had a less than 10% chance of explant for SVD by 15 years. CONCLUSIONS: Durability of this stented pericardial aortic bioprosthesis is excellent and justifies its use in patients aged 65 or older.


Subject(s)
Aortic Valve/surgery , Bioprosthesis , Heart Valve Prosthesis , Actuarial Analysis , Adult , Age Factors , Aged , Aged, 80 and over , Device Removal , Equipment Failure , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis , Prosthesis Design , Risk Factors , Survival Analysis
9.
Ann Thorac Surg ; 66(6 Suppl): S73-6, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9930421

ABSTRACT

BACKGROUND: Pericardial valves have excellent hemodynamic function; however, long-term durability is questionable. To determine the function of the Carpentier-Edwards pericardial valve in the aortic position, the results of 310 aortic valve replacements performed between 1982 and 1985 were analyzed. Mean age was 64.2+/-10.8 years (range, 22 to 95 years); 190 (61.3%) were men. Isolated valve replacement was performed in 135 patients (43.5%). There were 18 hospital deaths (5.8%), none of them valve related. METHODS: Follow-up of 292 survivors was 100% complete at a mean of 8.8 years; 2,556 patient-years of follow-up were analyzed. There were 150 late deaths (51.4%). Survival at 5, 10, and 12 years were 83%+/-2%, 47%+/-3%, and 34%+/-3%, respectively. The 12-year actuarial and actual freedom from thromboembolism was 87%+/-2% and 89%+/-2%, respectively. Freedom from hemorrhage was 91%+/-2% and 92%+/-2%; freedom from endocarditis was 93%+/-2% and 95% +/- 1%; and freedom from structural deterioration was 82%+/-4% and 91%+/-2%, respectively. RESULTS: Actuarial freedom from structural deterioration at 12 years was considerably higher for 153 hospital survivors 65 years or older, 93% (5 explants) compared to 76% (19 explants) for patients younger than 65 years, p = 0.03. Of 24 explanted valves for structural deterioration, leaflet calcification resulting in stenosis occurred in 20 (83%) and 4 were wear-related leaflet tears. CONCLUSIONS: We conclude that the Carpentier-Edwards pericardial valve has a low incidence of valve-related complications, that structural deterioration is infrequent and results from leaflet calcification, and that the low incidence of structural deterioration in patients 65 years or older makes this an increasingly appropriate option in this age group.


Subject(s)
Aortic Valve , Bioprosthesis , Heart Valve Prosthesis , Actuarial Analysis , Adult , Age Factors , Aged , Aged, 80 and over , Aortic Valve/surgery , Bioprosthesis/adverse effects , Calcinosis/etiology , Constriction, Pathologic/etiology , Endocarditis/etiology , Female , Follow-Up Studies , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Humans , Incidence , Longitudinal Studies , Male , Middle Aged , Postoperative Hemorrhage/etiology , Prosthesis Design , Prosthesis Failure , Reoperation , Risk Factors , Survival Rate , Thromboembolism/etiology
10.
J Am Soc Echocardiogr ; 12(10): 866-70, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10511658

ABSTRACT

The diagnosis of intramural hematoma by echocardiography classically requires the presence of an echolucent, crescentic region in the wall of the aorta. Recently we have encountered 2 patients in whom intramural hematoma was characterized only by thickening of the aortic wall, which was circumferential in one patient, thus making the diagnosis difficult to distinguish from common atherosclerotic thickening of the aorta. In one case, computed tomography showed more clearly the abnormal tissue signature of the intramural blood. In summary, absence of an echolucent zone does not exclude the diagnosis of intramural hematoma. Alternative imaging procedures such as computed tomography and magnetic resonance imaging may enhance the diagnostic accuracy.


Subject(s)
Aorta, Thoracic , Aortic Diseases/diagnostic imaging , Echocardiography, Transesophageal , Hematoma/diagnostic imaging , Aged , Aortic Diseases/surgery , Arteriosclerosis/diagnostic imaging , Diagnosis, Differential , Hematoma/surgery , Humans , Male , Middle Aged
11.
Semin Thorac Cardiovasc Surg ; 12(3): 229-37, 2000 Jul.
Article in English | MEDLINE | ID: mdl-11052190

ABSTRACT

We describe our clinical experience with 205 implantable left ventricular assist devices at the Cleveland Clinic between December 1991 and January 2000, along with manufacturers' data submitted to the Food and Drug Administration. In patients with end-stage cardiac failure who are suitable candidates for transplantation, these devices serve as excellent bridges to transplantation. Recent modifications have increased pump reliability and reduced thromboembolic rates. The vented electric HeartMate (Thermocardiosystems Inc, Woburn, MA) and the Novacor (Baxter-Novacor, Oakland, CA) left ventricular assist systems allow patients to be discharged from the hospital while awaiting a donor heart. Experience with long-term support is providing insights into permanent implantation of these devices as destination therapy. Although infection remains a major impediment to long-term support, patient-pump interactions leading to changes in the coagulation and immune systems are being recognized, and these interactions may have important implications with respect to thromboembolism, infection, and sensitization to human leukocyte antigens (HLAs). Better understanding of these factors may eventually lead to the development of permanently implantable pumps as an alternative to transplantation.


Subject(s)
Assisted Circulation/methods , Heart Failure/therapy , Heart-Assist Devices , Ventricular Dysfunction, Left/therapy , Assisted Circulation/adverse effects , Assisted Circulation/instrumentation , Heart Failure/surgery , Heart Transplantation , Heart Valve Prosthesis Implantation , Heart-Assist Devices/adverse effects , Humans , Ohio , Prosthesis Failure , Prosthesis-Related Infections/etiology , Quality of Life , Thromboembolism/etiology , Treatment Outcome
12.
West Indian Med J ; 49(4): 285-9, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11211536

ABSTRACT

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8%) did not complete the study and were excluded from further analysis. Six (13%) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n = 15), [Gp B], oral hypoglycaemic agents, OHAs (n = 17), [Gp C], or insulin (n = 8), Gp D]. In addition, during the run-in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3-month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 +/- 1.1 to 8.4 +/- 0.9 (p < 0.027) and, from 11.0 +/- 1.0 to 8.7 +/- 0.7 (p < 0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 +/- 1.1% to 12.2 +/- 1.0% (p < 0.016) in Gp B, from 14.9 +/- 1.1 to 11.9 +/- 1.1% (p < 0.002) in Gp C, and from 14.1 +/- 1.4 to 11.8 +/- 1.4 (p < 0.02) in Gp D. Twenty-three per cent (23%) of the patients experienced flatulence; 7.5%, changes in bowel habits and 5%, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.


Subject(s)
Acarbose/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Acarbose/adverse effects , Adult , Aged , Diabetes Mellitus, Type 2/diet therapy , Diet , Drug Therapy, Combination , Female , Flatulence/chemically induced , Humans , Hypoglycemic Agents/adverse effects , Insulin/therapeutic use , Jamaica , Male , Middle Aged , Treatment Outcome
13.
J Card Surg ; 15(1): 15-20, 2000.
Article in English | MEDLINE | ID: mdl-11204383

ABSTRACT

After exploring several less invasive approaches for cardiac valve surgery, we have concluded that the partial upper sternotomy is the incision of choice for minimally invasive aortic and mitral valve surgery. From March 1997 to January 1999, 827 patients had cardiac valve surgery using this approach; 462 had mitral valve procedures and 365 had aortic valve procedures. Of those having mitral valve surgery, 87% had mitral valve repair. Aortic valve surgery included replacement with stented bioprostheses (38%), allografts (29%), and mechanical prostheses (10%); in addition, 23% had aortic valve repair. Operative mortality was 0.8%. Conversion to full sternotomy was necessary in 2.4%. Blood use was low with 80% of patients receiving no blood transfusions. We conclude that all primary mitral and aortic procedures can be accomplished safely via partial upper sternotomy.


Subject(s)
Aortic Valve/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Mitral Valve/surgery , Sternum/surgery , Blood Loss, Surgical/physiopathology , Heart Valve Diseases/mortality , Humans , Postoperative Complications/mortality , Survival Rate , Suture Techniques/instrumentation , Treatment Outcome
14.
Acta Neurochir Suppl (Wien) ; 51: 329-30, 1990.
Article in English | MEDLINE | ID: mdl-2089929

ABSTRACT

The present study evaluated the effect of the non-glucocorticoid 21-aminosteroid U74006F on the development of regional cerebral oedema after lateral fluid-percussion (FP) brain injury in the rat. Male Sprague-Dawley rats (n = 20) were anaesthetized and subjected to lateral FP brain injury of moderate severity (2.5-2.6 atmospheres). Fifteen minutes after brain injury, animals randomly received an i.v. bolus of either U74006F (3 mg/kg, n = 11) followed by a second bolus (3 mg/kg) at 3 hours vs buffered saline vehicle (equal volume, n = 9). At 48 hours postinjury, animals were sacrificed and brains tissue assayed for water content using wet weight/dry weight methodology. Administration of U74006F significantly attenuated the increase in water content observed in control animals in the ipsilateral hippocampus (adjacent to the site of maximal injury, p less than 0.05). Administration of U74006F also significantly reduced post-injury mortality from 28% in control animals to zero in treated animals (p less than 0.001). These results suggest that lipid peroxidation may be involved in the pathophysiological sequelae of brain injury and that 21-aminosteroids may be beneficial in the treatment of brain injury.


Subject(s)
Brain Edema/etiology , Brain Injuries/complications , Pregnatrienes/pharmacology , Animals , Body Water/metabolism , Brain/metabolism , Brain Edema/metabolism , Brain Edema/mortality , Brain Injuries/mortality , Lipid Peroxides/antagonists & inhibitors , Male , Rats , Rats, Inbred Strains , Survival Analysis
15.
Curr Cardiol Rep ; 1(4): 318-22, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10980861

ABSTRACT

During the past 5 years, there has been considerable progress in the development of less invasive techniques for heart valve surgery. Both aortic and mitral valve surgery can now be performed through small chest wall incisions. Recent evidence confirms patient benefit with minimally invasive heart valve surgery. Although several approaches can be used, a partial upper sternotomy offers several advantages for minimally invasive heart valve surgery.


Subject(s)
Cardiac Surgical Procedures/methods , Heart Valves/surgery , Minimally Invasive Surgical Procedures/methods , Aortic Valve/surgery , Forecasting , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Humans , Mitral Valve/surgery , Sternum/surgery
19.
West Indian med. j ; 49(4): 285-289, Dec. 2000.
Article in English | LILACS | ID: lil-333442

ABSTRACT

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8) did not complete the study and were excluded from further analysis. Six (13) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n = 15), [Gp B], oral hypoglycaemic agents, OHAs (n = 17), [Gp C], or insulin (n = 8), Gp D]. In addition, during the run-in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3-month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 +/- 1.1 to 8.4 +/- 0.9 (p < 0.027) and, from 11.0 +/- 1.0 to 8.7 +/- 0.7 (p < 0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 +/- 1.1 to 12.2 +/- 1.0 (p < 0.016) in Gp B, from 14.9 +/- 1.1 to 11.9 +/- 1.1 (p < 0.002) in Gp C, and from 14.1 +/- 1.4 to 11.8 +/- 1.4 (p < 0.02) in Gp D. Twenty-three per cent (23) of the patients experienced flatulence; 7.5, changes in bowel habits and 5, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Acarbose , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Treatment Outcome , Acarbose , Diet , Drug Therapy, Combination , Flatulence , Insulin , Jamaica , Diabetes Mellitus, Type 2/diet therapy , Hypoglycemic Agents/adverse effects
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