Objectives Despite many studies about aortic valve function and aortic root geometry after conservative aortic root repair of acute type A aortic dissection, the results are not always consistent or ...conclusive. This study aims to evaluate aortic root diameter and aortic valve function after surgery for acute type A aortic dissection involving the aortic root. Methods A retrospective review was performed of 196 consecutive patients (age, 56.9 ± 11.4 years; 96 men) who underwent conservative aortic root repair including sinotubular junction resuspension for the management of acute type A aortic dissection involving the aortic root. Results The 30-day mortality rate was 5.1% (n = 10). During a median follow-up period of 45.3 ± 36.4 months, there were 28 deaths and 11 cases of aortic reoperation (proximal reoperation in 1 and distal reoperation in 10). Of the 6-month survivors (n = 177, 90.3%), echocardiography and computed tomography were performed in the late period (>6 months) on 115 (65.0%) and 138 (78.0%), respectively. Significant aortic regurgitation (greater than grade 2+) or root dilatation (>45 mm) was observed in 5 and 19 patients, respectively. Freedom from aortic regurgitation (greater than grade 2+) or root dilatation (>45 mm) at 5 years was 84.6% ± 3.9%. On the Cox regression analysis, the maximal aortic root diameter at initial presentation was the only significant predictor of aortic regurgitation and aortic root dilatation (hazard ratio, 1.10; 95% confidence interval, 1.02-1.19; P = .014). Conclusions Conservative aortic root repair of acute type A aortic dissection demonstrates acceptable long-term clinical outcomes. However, more aggressive approaches should be considered for patients who have aortic root dilatation because of the risk of developing a root aneurysm after surgery.
Abstract Background context Analgesic effect of lidocaine infusion on postoperative pain. Purpose The aim of this study was to evaluate the analgesic effect of lidocaine infusion on postoperative ...pain after lumbar microdiscectomy. Study design This study used a prospective, randomized, double-blinded, and placebo-controlled clinical trial. Patient sample Fifty-one patients participated in this randomized, double-blinded study. Outcome measures The primary outcome was the visual analog scale (VAS) (0–100 mm) pain score at 4 hours after surgery. The secondary outcomes were the VAS pain score at 2, 8, 12, 24, and 48 hours after surgery, the frequency with which patients pushed the button (FPB) of the patient-controlled analgesia system, and the fentanyl consumption at 2, 4, 8, 12, 24, and 48 hours after surgery. Other outcomes were satisfaction scores regarding pain control and the overall recovery process, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay (HS). Methods Preoperatively and throughout the surgery, Group L received intravenous lidocaine infusion (a 1.5-mg/kg bolus followed by a 2-mg/kg/h infusion until the end of the surgical procedure) and Group C received normal saline infusion as a placebo. Results The VAS scores and fentanyl consumption were significantly lower in Group L compared with Group C except at 48 h after surgery (p<.05). Total fentanyl consumption, total FPB, length of HS, and satisfaction scores were also significantly lower in Group L compared with Group C (p<.05). Conclusions Intraoperative systemic infusion of lidocaine decreases pain perception during microdiscectomy, thus reducing the consumption of opioid and the severity of postoperative pain. This effect contributes to reduce the length of HS.
Background A paucity of information exists regarding colorectal neoplasm in asymptomatic, average-risk individuals 40 to 49 years of age. Objective To evaluate the prevalence and risk factors of ...colorectal neoplasms in those in their 40s. Design Cross-sectional study. Setting Results offered to subjects of a health care provider that offers screening services as part of an employer-provided wellness program. Patients A consecutive series of 1761 asymptomatic, average-risk screenees 40 to 59 years of age. Intervention First screening colonoscopy. Results The prevalence of overall colorectal neoplasm in subjects of ages 40 to 44 years, 45 to 49 years, 50 to 54 years, and 55 to 59 years increased significantly with increasing age (13.7%, 20.2%, 21.0%, and 23.8%, respectively; P < .001). The prevalence of advanced adenomas in subjects of ages 40 to 44 years, 45 to 49 years, 50 to 54 years, and 55 to 59 years increased significantly with age (1.9%, 3.0%, 3.2%, and 5.9%, respectively; P = .004). Multivariate analysis of data from the 40- to 49-year age group identified an increased risk of colorectal neoplasm associated with ages 45 years and older (odds ratio OR, 1.68; 95% CI, 1.20-2.35), male sex (OR, 1.76; 95% CI, 1.15-2.69), presence of abdominal obesity (OR, 1.57; 95% CI, 1.12-2.21), and metabolic syndrome (OR, 1.56; 95% CI, 1.03-2.35), whereas for advanced adenomas, abdominal obesity (OR, 2.37; 95% CI, 1.06-5.27) and metabolic syndrome (OR, 2.83; 95% CI, 1.23-6.53) were the independent risk factors. Limitations Single-center study and the cohort composed of ethnic Korean subjects who lived in the same geographic region. Conclusion In average-risk individuals 40 to 49 years of age, men with abdominal obesity or metabolic syndrome might benefit from screening colonoscopy starting at 45 years of age to detect colorectal neoplasm.
Objective Successful arteriovenous fistula (AVF) maturation is often challenging in obese patients. Optimal initial intraoperative blood flow (IOBF) is essential for adequate AVF maturation. This ...study was conducted to elucidate the effect of obesity on IOBF and radiocephalic AVF maturation. Methods Patients with a newly created radiocephalic AVF were included (N = 252). Obesity was defined as a baseline body mass index (BMI) ≥25 kg/m2 , and primary maturation failure was defined as failure to use the AVF successfully by 3 months after its creation. IOBF was measured immediately after construction of the AVF with a VeriQ system (MediStim, Oslo, Norway). Results The mean BMI was 24.1 ± 3.9 kg/m2 , and the prevalence of obesity was 31.3%. Particularly, 8.3% (21 patients) had a BMI ≥30 kg/m2 . Primary maturation failure occurred in 100 patients (39.7%), and an IOBF <190 mL/min was closely associated with the risk of maturation failure (relative risk, 3.05; 95% confidence interval, 1.52-6.11). Compared with nonobese patients, obese subjects had a significantly higher prevalence of diabetes and elevated high-sensitivity C-reactive protein levels, whereas diameters of vessels were similar. When the patients were further divided into three groups as BMI <25, 25 to 29.9, and ≥30 kg/m2 , patients in the higher BMI group showed significantly lower IOBF and higher maturation failure rate. According to multivariate analysis, the statistically significant variables that determined maturation failure were obesity, previous vascular disease, increased high-sensitivity C-reactive protein levels, and IOBF <190 mL/min. Conclusions Obese patients had a significantly lower IOBF, and both obesity and low IOBF contributed to the primary maturation failure of AVF. Obesity-associated inflammation and atherosclerosis might play roles in this association.
The purpose of this study was to evaluate the rate of pathologic complete response (pCR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation therapy (CRT) ...with leucovorin (FL) versus irinotecan/S-1 (IS).
Patients with resectable LARC (clinical stage T3/4, lymph node positive, or both) were randomly assigned to receive preoperative radiation (45-50.4 Gy in 25 to 28 daily fractions) and concomitant chemotherapy either with a bolus injection of FL (400 mg/m(2)/day 5-fluorouracil and 20 mg/m(2)/day leucovorin) for 3 consecutive days every 4 weeks for 2 cycles (FL group) or with 40 mg/m(2) irinotecan on days 1, 8, 15, 22, and 29, and 35 mg/m(2) S-1 twice on the day of irradiation (IS group). Curative surgery was performed approximately 4 to 8 weeks after the completion of CRT. The postoperative chemotherapy regimen was FL with a primary endpoint of a pCR rate evaluation.
One hundred forty-two eligible patients were randomly assigned, and the median follow-up duration was 43.8 months (95% confidence interval, 40.8-46.8 months). One hundred thirty-three patients (93.7%) of 142 underwent total mesorectal excision; pCR was achieved in 11 (16.7%) of 66 patients in the FL group and 17 (25.8%) of 67 patients in the IS group (P=.246). When good responders were defined as patients with Mandard grades 1 and 2, the rate of good responders was significantly higher in the IS group than in the FL group (54.6% vs 36.4%, respectively, P=.036). The preoperative rates of grade 3 and 4 toxicities were higher in the IS group (7.0%) than in the FL group (1.4%, P=.095). The 3-year disease-free survival was not significantly different between the 2 groups (79.7% vs 76.6%, respectively, P=.896).
IS-based preoperative CRT did not increase pCR rate, but it did increase acute toxicities compared with standard 5-FU treatment. Therefore, further investigation is needed.
Abstract Purpose Central venous oxygen saturation has been shown to reflect the adequacy of tissue oxygenation during cardiopulmonary resuscitation (CPR), thereby enabling the assessment of CPR ...quality and the prediction of restoration of spontaneous circulation (ROSC). The femoral vein can be easily accessed during CPR. We determined if femoral venous oxygen saturation (SFV O2 ) values obtained during CPR could reliably predict ROSC in a pig model. Methods After 15 minutes of untreated ventricular fibrillation followed by 8 minutes of basic life support, 19 pigs underwent advanced cardiovascular life support. During advanced cardiovascular life support, femoral venous blood samples were obtained at 4-minute intervals. The abilities of SFV O2 and coronary perfusion pressure (CPP) to predict ROSC were evaluated by calculating the areas under receiver operating characteristic curves (AUCs). Results Eight pigs (42.1%) achieved ROSC. The resuscitated animals had significantly higher CPP ( P < .001) and SFV O2 ( P < .001) values than the nonresuscitated animals, and there was a significant correlation between SFV O2 and CPP values ( r = 0.684; P < .001). The CPPs of the resuscitated and nonresuscitated animals overlapped considerably; however, there was minimal overlap between the 2 groups for SFV O2 . Femoral venous oxygen saturation significantly predicted ROSC with an AUC of 0.997 (95% confidence interval, 0.911-1.000; P < .001), and it had a larger AUC than CPP (AUC, 0.964; 95% confidence interval, 0.855-0.997; P < .001). The AUC difference, however, was not statistically significant ( P = .157). Conclusion In this study, SFV O2 values obtained during CPR exhibited a significant correlation with CPP and reliably predicted ROSC.
Background There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations. Methods An ...interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of CRAB in a medical intensive care unit (ICU) with CRAB endemicity. There was a 14-month control period and 12-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of chlorhexidine bathing on the level and trend of the series of prevalence rates and incidence density. Also, chlorhexidine susceptibility testing was performed on CRAB isolates collected during the chlorhexidine bathing period. Results There was a 51.8% reduction of CRAB acquisition rates after an introduction of daily chlorhexidine bathing (44.0 vs 21.2 cases/1,000 at-risk patient days, P < .001). There was a significant reduction in the level (−0.604; 95% CI, −0.904 to −0.305; P < .001) of incidence density of CRAB, whereas there was no significant change in both level and trend of CRAB prevalence rates. Minimum inhibitory concentration of chlorhexidine against a total of 98 CRAB isolates ranged from 8-64 μg/mL. Conclusion Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.
Centrilobular Cysts of the Lung Hyun, Myung Han; Sim, Jae Kyeom; Oh, Jee Youn ...
The American journal of the medical sciences
351, Issue:
1
Journal Article
Objective To identify the clinical features of elderly-onset rheumatoid arthritis (EORA) and their impact on disease outcome. Methods A total of 3169 rheumatoid arthritis (RA) patients were recruited ...as part of the Korean Observational Study Network for Arthritis, the nationwide cohort of South Korea. Patients were stratified according to age at disease onset: <40 years (younger age-onset RA, n = 1167), between the ages of 40 and 59 (middle-aged-onset RA, n = 1516), and ≥60 years (EORA, n = 486). To evaluate the significance of differences in clinical features among these 3 groups, we performed analysis of variance ( anova ) and the χ2 test. We used multivariable logistic regression analysis to examine the association of onset age with functional disability measured with Health Assessment Questionnaire-Disability Index (HAQDI). Results EORA patients were associated with high HAQDI (≥1) in bivariable analysis odds ratio (OR) 1.36, confidence interval (CI) 1.04-1.77. However, in multivariable analysis, not elderly onset but patients' age, female gender, high disease activity, disease duration over 10 years, and comorbidity with cardiovascular disease were associated with high HAQDI. Only in a predefined subgroup with disease duration <10 years, elderly onset was an independent influencing factor for the functional disability of RA patients (OR 3.04, CI 1.85-5.67: disease duration of <5 years, OR 3.07, CI 1.64-5.74: disease duration of 5 to 10 years). Conclusions Disease onset in older age was associated independently with functional disability of RA patients who have relatively short disease duration.
To evaluate the efficacy of stent placement for the treatment of portal vein (PV) stenosis or occlusion in pediatric liver transplant recipients.
Written informed consent was obtained from a legal ...guardian, and our institutional review board approved this study. Percutaneous (n = 10) or intraoperative (n = 2) stent placement was attempted in 12 pediatric recipients (age range, 6-102 months) via the percutaneous transhepatic or inferior mesenteric vein route. Stents 6-10 mm in diameter were placed. Technical and clinical success, complications, and patency of the PV were retrospectively analyzed.
Technical success was achieved in 10 of 12 patients (83%) and clinical success was achieved in eight patients (67%). Eight of the 10 patients in whom technical success was achieved (80%) remained healthy with a patent PV during the 10-58-month clinical follow-up period. One patient with technical success died of acute rejection without recurrent PV complications and another died of acute rejection after stent replacement as a result of an hourglass deformity of a deployed stent with partial thrombosis. No major procedural complications occurred.
Based on this study in a relatively small number of patients, PV stent placement seems to be a safe and effective method for the treatment of posttransplantation PV stenosis or occlusion in pediatric patients.
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