Survival Following Video-Assisted Thoracic and Mini-Thoracotomy Pericardial Fenestration

Objective: Surgical pericardial fenestration (sPF) is more invasive than interventional pericardiocentesis (PC) and requires general anesthesia. Severe complications such as ventricular puncture and chamber lacerations are, however, reported in association with PC and not with sPF. Is survival after sPF only determined by nonsurgical factors? Methods: Between July 2000 and December 2015, data of all patients who had undergone sPF—either thoracoscopically or by anterior mini-thoracotomy—were investigated. The 2 techniques were analyzed retrospectively and the outcome (effectiveness, change in shock index) and the survival were assessed. Results: 32 patients underwent 33 sPF. One-half of the patients had a benign underlying disease; the other half suffered from a malignant tumor. Four procedures were performed thoracoscopically and 29 via mini-thoracotomy. Both techniques were hemodynamically effective (P < 0.0001) in increasing blood pressure and decreasing pulse rate). There was no death due to failure to control the pericardial effusion and no procedure related mortality. Of the 16 patients with benign underlying disease 14 (87.5%) are still alive. Two died due to reasons unrelated to the procedure or the underlying disease. All 16 patients (100%) with malignant underlying disease died due to tumor progression. Conclusions: In our patient cohort minimally invasive thoracic PF was safe and effective. The survival in our study was only related to the nature of the underlying disease. We conclude that sPF is an excellent procedure to treat pericardial effusions: both examined surgical techniques, thoracoscopic video assisted and access via mini-thoracotomy, were equally effective and safe.

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Video-Assisted Pericardial Fenestration for Effusions after Cardiac Surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492309348505 ◽

2009 ◽

Vol 17 (5) ◽

pp. 480-482 ◽

Cited By ~ 5

Author(s):

Georgios P Georghiou ◽

Eyal Porat ◽

Avi Fuks ◽

Bernardo A Vidne ◽

Milton Saute

Keyword(s):

Cardiac Surgery ◽

Pericardial Effusion ◽

Surgical Techniques ◽

Lung Ventilation ◽

Pericardial Window ◽

Invasive Approach ◽

Video Assisted ◽

Institutional Experience ◽

Pericardial Fenestration ◽

Thoracoscopic Technique

Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.

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Haematocrit: Relationships with Blood Lipids, Blood Pressure and other Cardiovascular Risk Factors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648811 ◽

1994 ◽

Vol 72 (01) ◽

pp. 058-064 ◽

Cited By ~ 14

Author(s):

Goya Wannamethee ◽

A Gerald Shaper

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Alcohol Intake ◽

Blood Lipids ◽

The Other ◽

The Relationship

SummaryThe relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening.Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0*18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p <0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p <0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure. It emphasises the role of the haematocrit in assessing the risk of ischaemic heart disease and stroke in individuals, and the need to take haematocrit levels into account in determining the importance of other cardiovascular risk factors.

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ROLE OF THE THYROID GLAND IN DEVELOPMENT AND MAINTENANCE OF RENAL HYPERTENSION IN RATS

Acta Endocrinologica ◽

10.1530/acta.0.xxxiv0411 ◽

1960 ◽

Vol XXXIV (III) ◽

pp. 411-429 ◽

Cited By ~ 3

Author(s):

Melvin J. Fregly ◽

Kenneth M. Cook

Keyword(s):

Blood Pressure ◽

Rate Increase ◽

Renal Hypertension ◽

The Other ◽

Elevated Blood Pressure ◽

Unit Weight ◽

Elevated Blood ◽

Inhibition Of Growth ◽

Testicular Size

ABSTRACT The anti-thyroid drugs, thiouracil, propylthiouracil, and methimazole, prevented both development of elevated blood pressure and cardiac hypertrophy usually accompanying kidney encapsulation with latex envelopes. These drugs also reduced elevated blood pressure of rats with hypertension of 13 to 40 weeks' duration prior to drug administration. Addition of desiccated thyroid powder to diet containing an anti-thyroid drug overcame the anti-hypertensive effect of the latter. Withdrawal of thyroid powder only was followed by return of blood pressure to previous low level within 3 weeks. The results suggest that the anti-hypertensive effect of these drugs is related directly to the hypothyroidism produced rather than to extrathyroidal effects of the drugs. Comparison of potencies of the 3 drugs in terms of anti-hypertensive effect, inhibition of growth rate, increase in testicular size, and increase in thyroid size suggests that propylthiouracil and methimazole are equally potent per unit weight of drug. Thiouracil has approximately half the potency of the other two.

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Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00202 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Michael Ryan ◽

Benton Emblom ◽

E. Lyle Cain ◽

Jeffrey Dugas ◽

Marcus Rothermich

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Failure Rate ◽

Osteochondritis Dissecans ◽

Surgical Techniques ◽

The Other ◽

Return To Play ◽

Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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Effort investment in uncontrollable situations: The moderating role of motivation toward closure

Motivation and Emotion ◽

10.1007/s11031-021-09868-4 ◽

2021 ◽

Vol 45 (2) ◽

pp. 186-196

Author(s):

Paulina Szwed ◽

Małgorzata Kossowska ◽

Marcin Bukowski

Keyword(s):

Blood Pressure ◽

Experimental Studies ◽

The Other ◽

Need For Closure ◽

Extra Effort ◽

Moderating Role ◽

Energy Conservation Principle ◽

Principle Of Energy Conservation ◽

Investment Behaviour

AbstractAccording to the principle of energy-conservation principle, effort investment is usually reduced in situations that are perceived as uncontrollable. This is because when success is recognized as impossible, any effortful actions are no longer justified. However, we predicted that individual differences in uncertainty tolerance, i.e., the need for closure (NFC), may moderate effort investment in uncontrollable situations. We tested this prediction in two experimental studies in which we exposed participants with differing levels of NFC to uncontrollable events, and indexed effort through the assessment of systolic blood pressure (SBP) responses. As predicted, in the uncontrollability (vs. controllability) condition, effort investment decreased significantly among low- but not high-NFC participants. Since gaining certainty and achieving closure is not a critical epistemic goal for low-NFC individuals, exerting extra effort to gain certainty is therefore no longer justified. On the other hand, high-NFC participants do not withhold their efforts, as they are highly motivated to obtain certainty. These results may help to account for contradictory findings in effort-investment behaviour and add substantively to the literature concerning motivation toward closure.

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Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000712 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000712

Author(s):

Tareq Kheirbek ◽

Thomas J Martin ◽

Jessica Cao ◽

Benjamin M Hall ◽

Stephanie Lueckel ◽

...

Keyword(s):

Blood Pressure ◽

Missing Values ◽

Injured Patient ◽

Injury Pattern ◽

Long Bone ◽

Shock Index ◽

Level Of Evidence ◽

Emergent Operation ◽

Serious Injury ◽

Significant Injury

BackgroundThe American College of Surgeons Resources for Optimal Care of the Injured Patient recommends using hypotension, defined as systolic blood pressure ≤90 mm Hg, as an indicator of a full team trauma activation. We hypothesized that an elevated shock index (SI) predicts significant traumatic injuries better than hypotension alone.MethodsThis is a retrospective cohort study analyzing full team trauma activations between February 2018 and January 2020, excluding transfers and those who had missing values for prehospital blood pressure or heart rate. We reviewed patients’ demographics, prehospital and emergency department vitals, injury pattern, need for operation, and clinical outcomes. The primary outcome was rate of significant injury defined as identified injured liver, spleen, or kidney, pelvis fracture, long bone fracture, significant extremity soft tissue damage, hemothorax, or pneumothorax.ResultsAmong 544 patients, 82 (15.1%) had prehospital hypotension and 492 had normal blood pressure. Of the patients with prehospital hypotension, 34 (41.5%) had a significant injury. There was no difference in age, gender, medical history, or injury pattern between the two groups. There was no difference between the two groups in rate of serious injury (41.5% vs. 46.1%, NS), need for emergent operation (31.7% vs. 28.1%, NS) or death (20.7% vs. 18.8%, NS). On the other hand, SI ≥1 was associated with increased rate of serious injury (54.6% vs. 43.4%, p=0.04). On a logistic regression analysis, prehospital hypotension was not associated with significant injury or need for emergent operation (OR 0.83, 95% CI 0.51 to 1.33 and OR 1.32, 95% CI 0.79 to 2.25, respectively). SI ≥1 was associated with both increased odds of significant injury and need for emergent operation (OR 1.57, 95% CI 1.01 to 2.44 and OR 1.64, 95% CI 1.01 to 2.66).DiscussionSI was a better indicator and could replace hypotension to better categorize and triage patients in need of higher level of care.Level of evidencePrognostic and epidemiologic, level III.

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Role of Autonomic Nervous System in Maintenance of Cerebral and Renal Hypertension

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1957.188.2.371 ◽

1957 ◽

Vol 188 (2) ◽

pp. 371-374 ◽

Cited By ~ 2

Author(s):

Sol Rothman ◽

Douglas R. Drury

Keyword(s):

Blood Pressure ◽

Nervous System ◽

Autonomic Nervous System ◽

Renal Hypertension ◽

The Other ◽

Peripheral Vasculature ◽

Blood Pressures ◽

Sympathetic Nervous ◽

Blood Pressure Responses

The blood pressure responses to various drugs were investigated in renal hypertensive, cerebral hypertensive and normotensive rabbits. Hexamethonium bromide and Dibenamine reduced the blood pressures of renal and cerebral hypertensives. Effects in the normal were insignificant. The cerebral hypertensive's blood pressure was slightly affected by benzodioxane. Blood pressure was not reduced at all in the other groups. Blood pressure of the renal hypertensive rabbit was greatly reduced by Veriloid and dihydroergocornine. Blood pressures of cerebral and normal animals were affected to a lesser degree. The results suggest that maintenance of hypertension in the cerebral hypertensive rabbit depends on an overactive sympathetic nervous system, possibly due to the release of medullary pressor centers from inhibitory impulses originating in higher centers; whereas, the maintenance of hypertension in the renal hypertensive rabbit may be attributed to an increased reactivity of the peripheral vasculature to a normal sympathetic tone.

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The Impact of a Health Education Program Targeting Patients with High Visit Rates in a Managed Care Organization

American Journal of Health Promotion ◽

10.4278/0890-1171-17.2.101 ◽

2002 ◽

Vol 17 (2) ◽

pp. 101-111 ◽

Cited By ~ 12

Author(s):

Diana L. Dally ◽

Wendy Dahar ◽

Ann Scott ◽

Douglas Roblin ◽

Allan T. Khoury

Keyword(s):

Blood Pressure ◽

Health Promotion ◽

Health Status ◽

Treatment Group ◽

Health Education ◽

Managed Care ◽

The Other ◽

Care Organization ◽

Significant Change ◽

Health Education Materials

Purpose. To determine if a mailed health promotion program reduced outpatient visits while improving health status. Design. Randomized controlled trial. Setting. A midsized, group practice model, managed care organization in Ohio. Subjects. Members invited (N = 3214) were high utilizers, 18 to 64 years old, with hypertension, diabetes, or arthritis (or all). A total of 886 members agreed to participate, and 593 members returned the initial questionnaires. The 593 members were randomized to the following groups: 99 into arthritis treatment and 100 into arthritis control, 94 into blood pressure treatment and 92 into blood pressure control, and 104 into diabetes treatment and 104 into diabetes control. Measures. Outpatient utilization, health status, and self-efficacy were followed over 30 months. Interventions. Health risk appraisal questionnaires were mailed to treatment and control groups before randomization and at 1 year. The treatment group received three additional condition-specific (arthritis, diabetes, or hypertension) questionnaires and a health information handbook. The treatment group also received written health education materials and an individualized feedback letter after each returned questionnaire. The control group received condition-specific written health education materials and reimbursement for exercise equipment or fitness club membership after returning the 1-year end of the study questionnaire. Results. Changes in visit rates were disease specific. Parameter estimates were calculated from a Poisson regression model. For intervention vs. controls, the arthritis group decreased visits 4.84 per 30 months (p < 0.00), the diabetes group had no significant change, and the hypertension group increased visits 2.89 per 30 months (p < 0.05), the overall health status improved significantly (−6.5 vs. 2.3, p < 0.01) for the arthritis group but showed no significant change for the other two groups, and coronary artery disease and cancer risk scores did not change significantly for any group individually. Overall self-efficacy for intervention group completers improved by −8.6 points (p < 0.03) for the arthritis group, and the other groups showed no significant change. Conclusions. This study demonstrated that in a population of 18 to 64 years with chronic conditions, mailed health promotion programs might only benefit people with certain conditions.

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Epidemiological and clinical characteristics of the first 500 confirmed COVID-19 inpatients in a tertiary infectious disease referral hospital in Manila, Philippines

Tropical Medicine and Health ◽

10.1186/s41182-021-00340-0 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Kristal An Agrupis ◽

Chris Smith ◽

Shuichi Suzuki ◽

Annavi Marie Villanueva ◽

Koya Ariyoshi ◽

...

Keyword(s):

Healthcare Workers ◽

Clinical Characteristics ◽

Age Groups ◽

The Elderly ◽

Underlying Disease ◽

The Philippines ◽

Referral Hospital ◽

Limited Data ◽

Metro Manila ◽

Related Mortality

Abstract Background The Philippines has been one of the most affected COVID-19 countries in the Western Pacific region, but there are limited data on COVID-19-related mortality and associated factors from this setting. We aimed to describe the epidemiological and clinical characteristics and associations with mortality among COVID-19-confirmed individuals admitted to an infectious diseases referral hospital in Metro Manila. Main text This was a single-centre retrospective analysis including the first 500 laboratory-confirmed COVID-19 individuals admitted to San Lazaro Hospital, Metro Manila, Philippines, from January to October 2020. We extracted clinical data and examined epidemiological and clinical characteristics and factors associated with in-hospital mortality. Of the 500 individuals, 133 (26.6%) were healthcare workers (HCW) and 367 (73.4%) were non-HCW, with HCW more likely presenting with milder symptoms. Non-HCW admissions were more likely to have at least one underlying disease (51.6% vs. 40.0%; p = 0.002), with hypertension (35.4%), diabetes (17.4%), and tuberculosis (8.2%) being the most common. Sixty-one (12.2%) died, comprising 1 HCW and 60 non-HCW (0.7% vs. 16.3%; p < 0.001). Among the non-HCW, no death occurred for the 0–10 years age group, but deaths were recorded across all other age groups. Compared to those who recovered, individuals who died were more likely to be older (p < 0.001), male (p = 0.015), report difficulty of breathing (p < 0.001), be HIV positive (p = 0.008), be intubated (p < 0.001), categorised as severe or critical (p < 0.001), have a shorter mean hospital stay (p < 0.001), or have an additional diagnosis of pneumonia (p < 0.001) or ARDS (p < 0.001). Conclusion Our analysis reflected significant differences in characteristics, symptomatology, and outcomes between healthcare and non-healthcare workers. Despite the unique mix of cohorts, our results support the country’s national guideline on COVID-19 vaccination which prioritises healthcare workers, the elderly, and people with comorbidities and immunodeficiency states.

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