Effects of intensive versus mild lipid lowering by statins in patients with ischemic congestive heart failure: Korean Pitavastatin Heart Failure (SAPHIRE) study

BACKGROUND/AIMS: This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear. METHODS: The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin. RESULTS: The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371). CONCLUSIONS: Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Bone Cement Augmented Screw Fixation for Severe Osteoporotic Spine: Large Series of Clinical Application

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation for the patients accompanying severe osteoporosis. METHODS: Between February 2004 and August 2007, 157 patients with various spinal diseases including fractures accompanying severe osteoporosis underwent a bone cement augmented screw fixation (947 levels). About 4.8cc of polymethylmethacrylate was injected into the each vertebral body through transpedicular route. We divided the patients into two groups (Group I: Posterior fusion for compression/burst fractures or idiopathic scoliosis, Group II: Interbody fusion for various spinal diseases). Imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate, clinical outcome and complications. The visual analog scale (VAS), Oswestry disability questionnaire and modified MacNab's criteria were used for the assessment of pain and functional capacity. RESULTS: In both groups, a significant improvement in VAS and Oswestry disability questionnaire was achieved. 146 out of 157 patients (93%) were graded as excellent or good result according to the modified MacNab's criteria. None of the patients experienced operative death, screw pullout or cut-up. However, there were two cases of neurologic deterioration as a result of bone cement extravasation. CONCLUSION: Bone cement augmented transpedicular screwing can reduce the possibility of screw loosening and pullout in patients with severe osteoporosis.

Advantages of the Plating for Anterior Cervical Discectomy and fusion: Comparison with Wearing Cervical Collar Without Plate

OBJECTIVE: Most patients wear cervical braces regardless of any anterior cervical discectomy and fusion (ACDF) technique for cervical disc herniation, even in the plating. We compared clinical and radiological results in patients with cervical disc herniations. The purpose of this study was to evaluate the efficacy of plate insertion during ACDF and determine if this could eliminate the need for external cervical braces after ACDF. METHODS: In this study, we evaluated 67 patients treated for single level cervical disc herniation with radiculopathy. The patients were divided into two groups: 30 patients treated with ACDF using a Solis(R) cage with plating who did not wear a cervical brace after the operation (Group I: Plated group), and 37 patients treated with ACDF using a Solis(R) cage without plating who wore a cervical brace for 3 months (Group II: Non-plated group). Clinical outcomes were assessed using the neck disability index (NDI), and visual analogue scale (VAS) for neck and arm pain at different times after the surgery. In addition, modified MacNab's grading criteria were used to assess the subjective patients' outcome at the last follow-up. Fusion was assessed at 6, 12, and 18 months after the surgery using upright AP, lateral, and flexion-extension views. RESULTS: Excellent or good results were achieved in the most patients from both groups. Patients in both groups showed marked pain relief in terms of neck and arm pain scores over all time intervals. The NDI scores in both groups significantly improved when compared to preoperative scores; however, at 1 and 2 months after the surgery, patients in Group I (Plated group) had significantly better NDI scores compared to Group II (Non-plated group). Higher rates of fusion were reported in Group I over all time intervals although none of these were statistically significant. There were two patients who required second surgery for cage subsidence in Group II. CONCLUSION: Our study demonstrates that anterior cervical fusion with plating for cervical radiculopathy is a safe and effective treatment which can eliminate unnecessary need for an external cervical brace.

Acute Cervical Spinal Subdural Hematoma Not Related to Head Injury

We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm3. She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

Hemodynamic Effects of Simulated Ventricular Tachycardia and Supraventricular Tachycardia in Dogs

BACKGROUND AND OBJECTIVES: Tachycardias have various clinical features according to the heart rate, the left ventricular systolic function, the site of origin and the mechanisms of the tachycardias. The primary purpose of this study was to evaluate the role of the origin site and cycle length on the ventricular tachycardia (VT) hemodynamics. Our secondary purpose was to explore the possible hemodynamic differences between the two common supraventricular tachycardias (SVT). MATERIALS AND METHODS: VT was simulated in 18 dogs that had there chests opened by using ventricular pacing (VP) at 3 different sites: the left ventricular apex (LVA), the right ventricular outflow tract (RVOT), and the right ventricular apex (RVA). The mean arterial pressure (MAP), the mean left atrial pressure (MLAP) and the mean pulmonary artery pressure (MPAP) were monitored during VP. To simulate SVT, the right atrial appendage and the right ventricular basal septum were stimulated at different cycle lengths with different ventriculo-atrial (VA) time intervals in another 11 dogs that had their chests opened. The arterial pressure, the pulmonary capillary wedge pressure and the cardiac output was observed during simulated atrial tachycardia (Group I), AVRT (Group II) and AVNRT (Group III). RESULTS: In the VT study, at the same pacing site as of the VP, the MAP was significantly decreased with the VP, and the deltaMAP was significantly increased as the length of the VP cycle shortened. At the same pacing cycle length of the VP, the deltaMAP was significantly greater at the RVA or RVOT than at the LVA. At the same pacing site of the VP, the MLAP and the deltaMLAP were significantly increased as the VP cycle length shortened. In the SVT study, MAP was highest in Group I and it decreased with the decreasing VA interval, but this was not significant. The systolic arterial pressure was significantly higher in Group II than in Group III. The CO was higher in Group I than in the other two groups, with a significant difference, and the CO decreased with shortening of the VA interval, but this was not significant. CONCLUSION: The above results suggest that in addition to the tachycardia rate, the origin site could be an independent factor of the VT hemodynamics. Episodes of AVRT and AVNRT may have a different hemodynamic impact that probably originates from the different timing of the ventricular and atrial contraction.

Chemotherapy including MCNU for the treatment of terminal phase chronic myelogenous leukemia / 대한암학회지

No abstract available.