ACE inhibitor or angiotensin II receptor blocker use is a risk factor for contrast-induced nephropathy.

Background: The aim of the present study was to assess the influence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography.

Methods: A retrospective case control study was conducted on a total of 201 patients divided into 2 groups (CIN group and control group). CIN was defined as an increase in serum creatinine by more than 25% from baseline within 48 hours of radiocontrast exposure.

Stroke prevention in atrial fibrillation.

Atrial fibrillation (AF) is a common arrhythmia associated with substantial morbidity and mortality, particularly due to thromboembolic strokes, the prevalence of which is expected to rise over the next few decades. This article reviews the complex mechanisms behind thromboembolism, compares the newer risk stratification models for identifying those at risk for stroke or bleeding, and highlights the potential advantages and disadvantages of available therapies. Newer oral anticoagulants like Dabigatran, Rivoroxaban, and Apixiban are discussed.

Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer.

Purpose: Lymph node harvest of >or=12 has been adopted as a marker for adequacy of resection for colorectal cancer. We have noted a paucity of lymph nodes in rectal cancer specimens after neoadjuvant therapy, positing that the number of lymph nodes depends on the response to radiation and may not be an appropriate benchmark. Our purpose was to determine whether the number of lymph nodes harvested after neoadjuvant therapy is a useful quality indicator.

Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy.

Background: This study reports the short- and long-term results for a prospective rectal cancer management program using laparoscopic radical transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) after neoadjuvant therapy.

Methods: A prospective database included 102 rectal cancer patients treated with laparoscopic TATA from 1998 to 2008. Patients with distant metastasis at presentation, patients with a tumor more than 3 cm from the anorectal ring, and patients not undergoing neoadjuvant therapy were excluded, leaving 79 patients (54 men and 25 women) with a mean age of 59.

Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report.

Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein.

Volvulus: small bowel and colon.

Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands.

Redefining contraindications to laparoscopic colorectal resection for high-risk patients.

Background: Patients with major comorbidities often are denied laparoscopic colorectal resections because they are thought to be at too "high risk." Paradoxically, these patients generally have the most to gain from a minimally invasive surgical approach. This study aimed to examine the feasibility and safety of laparoscopic colorectal resection to determine whether it is contraindicated for "high-risk" patients.

The diagnosis of cardiac arrhythmias: a prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring.

Introduction: Ambulatory electrocardiographic monitoring systems are frequently used in the outpatient evaluation of symptoms suggestive of a cardiac arrhythmia; however, they have a low yield in the identification of clinically significant but infrequent, brief, and/or intermittently symptomatic arrhythmias. The purpose of this study was to compare the relative value of a mobile cardiac outpatient telemetry system (MCOT) with a patient-activated external looping event monitor (LOOP) for symptoms thought to be due to an arrhythmia.

Methods And Results: The study was a 17-center prospective clinical trial with patients randomized to either LOOP or MCOT for up to 30 days.

Outcome improvement and cost reduction in an increasingly morbid cardiac surgery population.

Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a lower percentage of patients requiring prolonged ventilation, and a shorter mean postoperative length of hospital stay than the pre-SAS cohort who underwent on-pump coronary artery bypass grafting.

Quantifying the role of factors that limit attainment of K/DOQI urea reduction ratio dialytic goal.

Background: For many ESRD patients who are prescribed a certain level of hemodialysis (HD), delivered dose often does not achieve prescription. While various causes have been well-documented in the literature, there are no available data that may be used in predicting the likelihood of achieving a particular urea reduction ratios (URR) goal based on the number of these factors present. This study evaluated URRs of all patients in an outpatient HD unit for a 6-month period to identify factors significant in attaining goal in order to predict likelihood of goal attainment based on number of factors present.

Sudden death secondary to cardiac arrhythmias: mechanisms and treatment strategies.

Purpose Of Review: This article reviews mechanisms and available therapeutic options for arrhythmias leading to sudden cardiac death in patients with coronary artery disease.

Recent Findings: Intensive efforts have led to a better understanding of the pathophysiology and various treatments of sudden cardiac death. Antiarrhythmic medications have not demonstrated a survival benefit.

Pharmacologic therapies for atrial fibrillation.

Pharmacologic therapy for atrial fibrillation may be used for acute cardioversion or ventricular rate control or for long-term therapy to maintain sinus rhythm or control ventricular rates in atrial fibrillation. Therapies must be tailored to elderly patients, with particular attention to structural heart disease, bradycardia, hypotension, and other comorbidities, including renal or hepatic insufficiency. Such considerations may dictate the use or avoidance of certain agents.

First experience with a Mobile Cardiac Outpatient Telemetry (MCOT) system for the diagnosis and management of cardiac arrhythmia.

Recently, a mobile cardiac outpatient telemetry (MCOT) system has become available that monitors the electrocardiogram continuously, recognizes arrhythmias automatically, and transmits abnormal rhythms instantaneously. MCOT does not require activation by the patient. We report data from the first 100 consecutive patients monitored by this new technology.

Laparoscopic colorectal surgery in the irradiated pelvis.

Background: Heightened interest in minimally invasive surgery and the expanding use of radiation therapy presents surgeons with new challenges. While conventional surgery in the irradiated pelvis represents a significant technical obstacle, indications for laparoscopic colorectal surgery are currently being defined. The purpose of this study is to examine the efficacy of laparoscopic surgery in the irradiated field.

Effectiveness of oral propafenone for the prevention of atrial fibrillation after coronary artery bypass grafting.

The efficacy and safety of oral propafenone for the prevention of atrial fibrillation (AF) were tested in a group of 293 patients who underwent coronary artery bypass grafting. Patients were randomized to placebo or 1 of 2 doses of propafenone. Patients treated with propafenone 675 mg/day compared with placebo had a nonsignificantly reduced incidence of AF and did not have a reduction in length of stay.

Case of polymorphic ventricular tachycardia in diphenhydramine poisoning.

This is the first reported case of torsades de pointes attributable to diphenhydramine, a drug with weak I(Kr) effects. A 26-year-old, healthy man was admitted to intensive care after a diphenhydramine overdose. Results of physical examination, ECG, and electrolytes were normal at admission.

Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.

Background: This study describes a personal experience with the use of transanal endoscopic microsurgery to facilitate surgical access, and to determine the ability of this technique to reduce the need for major abdominal procedure and prevent the need for a temporary or permanent colostomy in select patients with known or suspected rectal cancer.

Methods: The subjects of this study were 43 patients with rectal cancer or tumors who had a high likelihood of malignancy. The 24 men and 19 women comprised two groups: patients with known cancer ( n = 16) and patients with tumors suspicious for cancer ( n = 27), six of whom proved to have invasive malignancy.

Clinical use of stentless aortic valves with standard and minimally invasive surgical techniques.

The stentless porcine aortic valve prostheses have the potential to provide superior hemodynamic function and durability. Our institution was a trial site for the investigational device exemption (IDE) for 2 of the 3 stentless valve bioprostheses and has clinical experience in all 3 valves that are soon to be available. From July 1996 to January 2001, we have implanted 213 porcine stentless valves: the Toronto SPV (159), the Freestyle (20), and the Prima Plus (34) (current IDE).