Asthma Control and Medication Reliance Among Asthmatics in a General Practice Setting - A Questionnaire Based Study.

The main goal of asthma treatment is to obtain and maintain reasonable control of symptoms with current evidence-based protocols. Asthma is one of the chronic diseases, that, if not well controlled, can lead to the development of serious complications involving not only the respiratory, but the cardiovascular system. In this study, we aimed to determine how well intermittent asthma and mild persistent asthma are controlled among patients aged 15 years and above in a general practice setting using Asthma Control Test (ACT) questionnaire.

The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data.

Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions.

Left atrial plication for heart transplantation in patients with giant left atrium.

Giant left atrium occasionally occurs in patients undergoing heart transplantation and causes a technical challenge for the surgeon because of the substantial discrepancy in size between the left atrial cuffs of the recipient and donor. We describe a left atrial plication technique that substantially reduces this discrepancy and allows for a standard left atrial anastomosis to be performed without any other modifications in technique.

Mechanical circulatory support pathways that maximize post-heart transplant survival.

Background: Heart transplant (HTx) recipients reach transplantation through increasing numbers of support pathways, including transition from one pathway to another. Outcomes of patients successfully bridged with various support pathways are unknown. We sought to identify mechanical circulatory support pathways that maximize survival after HTx.

Impact of single-ventricle physiology on death after heart transplantation in adults with congenital heart disease.

Background: Prevalence of univentricular (1V) anatomy over time and whether 1V anatomy is associated with early death after heart transplant (HTx) among recipients with adult congenital heart disease (ACHD) is unknown. We investigated changes in case-mix over time, 1V vs biventricular (2V) status, and the effect of 1V anatomy on death after HTx among ACHD recipients.

Methods: The Nationwide Inpatient Sample (NIS) was used to identify ACHD HTx recipients in the United States aged 14 years or older from 1993 to 2007, divided into era 1 (1993 to 2000) and era 2 (2001 to 2007).

Patient-specific insulin-resistance-guided infusion improves glycemic control in cardiac surgery.

Background: Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistance-guided (IRG) protocol was developed.

Favorable early outcomes for patients with extended indications for thoracic endografting.

Background: Endografts originally designed and approved for the treatment of thoracic aortic aneurysms have rapidly been adopted for nonapproved use in the treatment of disorders of the thoracic aorta, including aortic transection, dissection, pseudoaneurysms, and thoracoabdominal aneurysms. The purpose of this study was to evaluate the early outcomes of patients treated with thoracic endografts for nonapproved indications at our institution.

Methods: The medical records of patients undergoing thoracic endografting at our institution from August 2005 until March 2008 were reviewed.

Improved quality and cost-effectiveness of coronary artery bypass grafting in the United States from 1988 to 2005.

Objective: This study was undertaken to assess the impact of increasing patient complexity and health care cost on coronary artery bypass grafting quality and cost-effectiveness in the United States over an 18-year period.

Methods: A retrospective study was carried out utilizing the Nationwide Inpatient Sample to track the characteristics and outcomes of 5,549,700 patients having isolated coronary artery bypass grafting in the United States from 1988 to 2005. Expected mortality, risk-adjusted mortality, and hospital charges were tracked over this period.

Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass.

Background: Cognitive dysfunction and cerebral vascular accidents remain some of the most devastating problems related to cardiac surgery. Despite the major advances in perioperative care and operative technique in coronary artery bypass, this cohort of patients appears to have poor cerebral physiologic reserve. The aim of this study was to describe regional cerebral perfusion of patients with coronary artery disease referred for coronary artery bypass grafting.

Robotic surgery: the computer-enhanced control of surgical instruments.

Robotic procedures are still in a developmental stage. Studies have shown that many operations can be performed safely with computer-enhanced telemanipulators, but distinct advantages of robotic procedures have not been established. Before third-party payors begin paying a premium for the use of a robot, costs will need to decrease or outcomes will need to be sufficiently better.

Magnitude of the inflammatory response to cardiopulmonary bypass and its relation to adverse clinical outcomes.

Introduction: Cardiopulmonary bypass (CPB) induces an inflammatory response believed to contribute to postoperative morbidity. We hypothesized that the magnitude of the inflammatory response following CPB would be associated with adverse clinical outcomes.

Methods: Twenty-nine patients had plasma TNF, IL-6, IL-8, elastase, histamine, complement C5a, and complement C3a measured by ELISA before, during, and after cardiac operations employing CPB.

Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery.

Background: Most coronary artery bypass grafting (CABG) operations still involve the use of greater saphenous vein (GSV) for one or more grafts, even with the increasing use of arterial conduits for coronary revascularization. Wound complications from GSV harvesting are common, and sometimes severe. In order to reduce the morbidity of this procedure, we adopted a technique of endoscopic vein harvesting (EVH).

Elevated intestinal fatty acid binding protein and gastrointestinal complications following cardiopulmonary bypass: a preliminary analysis.

Background: Cardiopulmonary bypass (CPB) is associated with poorly understood alterations in gastrointestinal (GI) perfusion. Intestinal fatty acid binding protein (IFABP), a cytosolic protein uniquely located in mature small-intestinal enterocytes, has been shown to be a sensitive biochemical marker of early intestinal ischemia when assayed in urine. We hypothesized that if significant small-intestinal ischemia occurs with CPB, then urine IFABP levels should be concomitantly elevated.

The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery.

Background: To evaluate the efficacy of aprotinin at a dose far less than standard.

Experimental Design: Retrospective, case-control study.

Setting: community-based, teaching hospital

Patients: one hundred one patients undergoing primary, non-emergent, coronary artery bypass during two, six-month periods were studied.

Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery.

Background: Atrial fibrillation and atrial flutter (AF) frequently complicate coronary artery bypass surgery (CABG) and increase hospital stay as well as morbidity. Studies of drug prophylaxis to prevent AF with beta-adrenergic blocking agents administered in fixed doses have had conflicting results.

Methods: One hundred patients were randomized to receive metoprolol or placebo following CABG.

Selection of patients for same-day coronary bypass operations.

Between March 15, 1990, and December 31, 1991, we admitted to the Virginia Mason Hospital for isolated coronary bypass operations 175 consecutive patients with chronic, stable angina pectoris who had prior coronary arteriography. One hundred patients were admitted on the same day as their operations, and 75 patients, deemed to be at higher risk, were admitted 1 day before the operation. Postoperative progress of all patients was monitored by means of a clinical pathway form with physiologic and activity measures plotted against postoperative days.

Continuing experience with the automatic implantable cardioverter defibrillator.

The automatic implantable cardioverter defibrillator (AICD) is now used commonly in the management of malignant ventricular arrhythmias. Its use may obviate the need for antiarrhythmic drugs or endocardial resection. We reviewed our continuing experience with the AICD to determine its safety and efficacy.

Mitral valve reconstruction.

Modern repair techniques allow reconstruction rather than replacement of the mitral valve (MV) in the majority of patients requiring operation. Such patients are now older and more likely to have nonrheumatic MV disease than those treated in former years. A continuing experience with MV reconstruction was reviewed to determine its safety and efficacy.

Routine computed tomographic scans, selective mediastinoscopy, and other factors in evaluation of lung cancer.

Routine computed tomographic scan is advocated as the best noninvasive method of evaluating mediastinal nodes for cancer spread. Positive studies should be confirmed histologically. Large size, central location, unfavorable cell type, poor cellular differentiation of the primary cancer, and weight loss also correlate with increased likelihood of mediastinal involvement.

Early experience with the automatic implantable cardioverter defibrillator in sudden death survivors.

Medical management of life-threatening ventricular arrhythmias is difficult because of the toxicity and limited efficacy of antiarrhythmic drugs. The automatic implantable cardioverter defibrillator (AICD) offers protection against malignant ventricular arrhythmias and allows some patients to be managed without antiarrhythmic drugs. We reviewed our experience with the AICD to determine its safety and efficacy.

Introducer insertion of mini-thoracostomy tubes.

Introducer insertion of a small caliber chest tube is easily mastered, fast, and nearly painless. Outpatient management of spontaneous pneumothorax with a 12 F. polyvinylchloride catheter and a Heimlich valve appears both safe and economical in a selected group of patients.

Benign and malignant breast disease: magnetic resonance and radiofrequency pulse sequences.

Thirty patients with suspected abnormality of the breasts on mammography were evaluated with magnetic resonance imaging (MRI) in a blind fashion. Spin-echo (SE) 250/30 msec scans were used to screen the examined breast. At the location of the suspected abnormality, inversion recovery (IR) 1000/30/300, SE 1000/30, and SE 1000/120 scans were performed.

Hormone receptors. An update and application.

The introduction of measurements of hormone receptors in breast cancer tumor specimens provides a major advance in selection of patients likely to have hormone-dependent cancers. Endocrine adjuvant treatment for estrogen-positive breast cancers in both pre- and postmenopausal women has been shown to be effective in delaying recurrence. Whenever possible, estrogen and progesterone receptors should be measured in tumor tissue from all patients with breast cancer.

Antiestrogen-cytotoxic chemotherapy and bacillus Calmette-Guerin vaccination in stage II breast cancer: seventy-two-month follow-up.

A prospective, randomized clinical trial of adjuvant treatment of 312 stage II breast cancer patients with use of chemotherapy, antiestrogen therapy, and immunotherapy is reported after 72 months of follow-up. The stratification of patients was based on nodal involvement and estrogen receptor (ER) assay of the primary tumors. Findings at 72 months indicate that antiestrogen therapy (tamoxifen, Nolvadex) added to chemotherapy with cyclophosphamide (Cytoxan), methotrexate, and fluorouracil (5-Fluorouracil) (CMF) resulted in significant delayed recurrence in ER-positive postmenopausal patients, ER-positive patients with four or more positive nodes, and ER-positive patients with tumors greater than 3 cm in diameter.