Ethical Justification for Deferral of Consent in the AcT Trial for Acute Ischemic Stroke.

The AcT trial (Alteplase Compared to Tenecteplase) compares alteplase or tenecteplase for patients with acute ischemic stroke. All eligible patients are enrolled by deferral of consent. Although the use of deferral of consent in the AcT trial meets the requirements of Canadian policy, we sought to provide a more explicit and rigorous approach to the justification of deferral of consent organized around 3 questions.

Predictors of Initial Revascularization Versus Medical Therapy Alone in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome Undergoing an Invasive Strategy.

Background: Although an invasive strategy is a class I clinical practice guideline for non-ST-segment-elevation acute coronary syndromes, there is wide variation in the proportion of patients who undergo revascularization despite early angiography. We sought to identify the predictors of early revascularization versus medical therapy alone in patients with non-ST-segment-elevation acute coronary syndrome undergoing an invasive strategy and to assess their clinical outcomes.

Methods And Results: We assessed revascularization status by percutaneous coronary intervention or coronary artery bypass grafting within 7 days of the index angiogram in all patients with non-ST-segment-elevation acute coronary syndrome who underwent an invasive strategy in Ontario, Canada, from October 1, 2008, to October 31, 2013, with follow-up through December 31, 2014.

High rate of magnetic resonance imaging stroke recurrence in cryptogenic transient ischemic attack and minor stroke patients.

Background And Purpose: Cryptogenic stroke is common in patients with transient ischemic attack (TIA) and minor stroke. It is likely that the imaging recurrence risk is higher than the clinical recurrence rate. We sought to determine the rate of clinical and radiographic stroke recurrence in a population of cryptogenic TIA and minor stroke.

The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.

Objective: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure.

Options And Outcomes: For persons in whom a high blood pressure value is recorded, a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the approach used to monitor blood pressure (office, ambulatory or home/self), and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment.

Is intravenous recombinant tissue plasminogen activator (rt-PA) safe for use in patients over 80 years old with acute ischaemic stroke? - The Calgary experience.

Background: Acute ischaemic stroke is common in older people. There is one licensed acute treatment, intravenous recombinant tissue plasminogen activator, but little information is available on its safety in over 80 year olds.

Design: Review of prospectively collected data on 62 consecutive patients, aged 80 years and over, treated with recombinant tissue plasminogen activator in a tertiary centre.

Analgesic-associated nephropathy in the West of Scotland: a 12-year observational study.

Background: Analgesic-associated nephropathy (AAN) is an important and preventable cause of chronic renal failure (CRF). Although its incidence is falling in some countries, others are witnessing an increase in the number of new cases.

Methods: The aim of this study was to evaluate the natural history of AAN, determine the correlates of the rate of decline in renal function and examine factors conferring an increased risk of death or dialysis in such patients.

Why patients with ESRD do not select self-care dialysis as a treatment option.

Background: In-center hemodialysis is the most prevalent (and resource-intense) form of dialysis in North America despite many patients being capable of performing dialysis themselves. The purpose of this study is to describe reasons in-center hemodialysis patients choose not to perform self-care dialysis and identify variables associated with a negative attitude toward self-care dialysis.

Methods: We conducted a cross-sectional survey (return rate, 83%) of prevalent in-center hemodialysis patients and combined this with demographic and comorbidity data obtained from our prospectively maintained database.

Antitachycardia pacing therapies and arrhythmia monitoring diagnostics for the treatment of atrial fibrillation.

The case of a patient with frequent episodes of atrial fibrillation that organizes into atrial flutter following implantation of a dual chamber, rate adaptive pacemaker is reported. The atrial flutter was effectively pace-terminated following activation of the atrial antitachycardia pacing therapies in the pacemaker. This resulted in a decrease in atrial fibrillation burden over time.

Comparative effects of nitroglycerin on intestinal vascular capacitance and conductance.

Background: Nitroglycerin (NTG) dilates capacitance veins and resistance arterioles, but its relative effects on veins and arterioles are not known.

Objectives: To compare NTG-induced changes in capacitance and conductance.

Animals And Methods: Aortic, left ventricular and portal venous (P(port)) pressures, portal flow and relative changes in intestinal blood volume (IBV) ((99m)technetium blood-pool scintigraphy) were measured in seven isoflurane-anesthetized, splenectomized dogs.

Recombinant activated factor VII (NovoSeven) treatment of platelet-related bleeding disorders. International Registry on Recombinant Factor VIIa and Congenital Platelet Disorders Group.

Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark), used extensively for the management of hemophilia patients with inhibitors, has also been shown to be effective in the treatment of severe bleeding episodes and for coverage of surgical procedures in patients with platelet disorders. Cases include seven patients with congenital platelet disorders [Glanzmann thrombasthenia (n = 5), Bernard-Soulier syndrome (n = 1), platelet type (pseudo-) von Willebrand disease (n = 1)] and two patients with acquired thrombocytopathy associated with myelodysplastic syndrome and uremia. The clinical efficacy of rFVIIa in functional platelet disorders has been reported as good or excellent, although some cases of ineffectiveness exist.

Recombinant factor VIIa is effective for bleeding and surgery in patients with Glanzmann thrombasthenia.

Recombinant activated factor VII (rFVIIa) was found to be effective and safe in treating 24 bleeding episodes and to prevent bleeding during one bilateral herniorrhaphy in four children with Glanzmann thrombasthenia. One of the patients had alloantibodies to platelet membrane glycoprotein (GP) IIb/IIIa and was refractory to platelet transfusion. rFVIIa was administered at 89 to 116 microg/kg per injection every 2 hours, in association with antifibrinolytic drugs.

Asymptomatic large pituitary adenomas discovered at autopsy.

Background: Pituitary adenomas over 1 inch (2.5 cm) in diameter might seem to warrant surgical intervention by virtue of their inevitable compression and distortion of surrounding neural tissues.

Methods: We report three pituitary adenomas over 1 inch in diameter, causing gross distortion of the optic nerves, chiasm, and tracts, as well as surrounding brain structures.

Passive protection of diabetic rats with antisera specific for the polysaccharide portion of the lipopolysaccharide isolated from Pseudomonas pseudomallei.

Polyclonal and monoclonal antisera raised to tetanus toxoid-conjugated polysaccharide of lipopolysaccharide (lps) and purified lps of Pseudomonas pseudomallei that reacted with a collection of 41 strains of this bacterium from 23 patients are described. The common antigen recognized by these sera was within the polysaccharide component of the lps of the cells. The sera were specific for P pseudomallei in that none of 37 strains of other bacteria, including 20 Gram-negative and three Gram-positive species, were recognized, although cross-reaction occurred using the anticonjugate serum with some strains of Pseudomonas cepacia serotype A, a closely related bacterium.

Psychiatric morbidity in patients with HIV infection.

A psychiatric examination was conducted on 144 patients at various stages of HIV infection and on 29 controls found to be seronegative. One-half of the control group had at least one DSM-III-R Axis I diagnosis, most commonly cannabis abuse, alcohol abuse, or adjustment disorder. Compared to this baseline, HIV-infected subjects had higher rates of adjustment disorder.

Differentiation of human B-cell malignant lymphomas is independent of the octamer lymphoid specific binding factor (Oct-2).

We have shown previously that the presence and action of immunoglobulin gene promoter specific trans-acting factors correlates with the stages of 'differentiation' of human lymphoid neoplasms. The regulatory sequence described by us was located upstream of the octamer motif which is known to bind lymphoid specific trans-acting factor Oct-2. In the present study we attempted to establish if the Oct-2 factor was present in fresh human tissue of B-cell origin and if the levels of Oct-2 also correlated with the stages of human lymphoid differentiation.

Accumulation of trospectomycin by strains of Salmonella typhimurium, Escherichia coli and Haemophilus influenzae.

Trospectomycin, unlike aminoglycosidic aminocyclitols, is accumulated by a nonsaturable, energy-independent, diffusional process in Salmonella typhimurium, Escherichia coli and Haemophilus influenzae. A deep rough mutant of S typhimurium was more susceptible and accumulated the drug faster, and F porin deficient mutants of E coli were more resistant than parental strains. Trospectomycin likely uses both porin and nonporin pathways to cross the outer membrane.

Treatment of advanced Hodgkin's disease with high dose melphalan and autologous bone marrow transplantation.

Twenty patients with Hodgkin's disease which had relapsed at least once after chemotherapy, were treated with melphalan 140-220 mg/m2 i.v. followed by reinfusion of non-cryopreserved autologous bone marrow.