Saphenous vein graft intervention: a review

Saphenous vein grafts are prone to degeneration and occlusion. Vein graft disease continues to be a significant problem in maintaining long-term benefits after coronary artery bypass surgery. The neointimal hyperplasia and aggressive atherosclerosis that occur in saphenous vein grafts make interventions particularly challenging due to plaque embolization and the no-reflow phenomenon. This review discusses the pathophysiology of vein graft disease and the various percutaneous strategies that have been applied to manage vein grafts. We review the issues surrounding stent selection and various approaches to embolic protection devices. Finally, we discuss the technical steps that optimize success in treating this challenging patient subset.     

Brief interventions for alcohol problems: a review

Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.     

Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review

Aims Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross‐sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect ‘at‐risk’ drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye‐opener, Amnesia, Kut down), T‐ACE [Take (number of drinks), Annoyed, Cut down, Eye‐opener], CAGE (Cut down, Annoyed, Guilt, Eye‐opener], NET (Normal drinker, Eye‐opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT‐C (AUDIT‐consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T‐ACE (69‐88%), TWEAK (71–91%) and AUDIT‐C (95%), with high specificity (71–89%, 73–83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT‐C at score ≥3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life‐time alcohol dependency the AUDIT at score ≥8 performed poorly. Conclusion T‐ACE, TWEAK and AUDIT‐C show promise for screening for risk drinking, and AUDIT‐C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand‐alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.     

Brief intervention for alcohol use in pregnancy: a randomized trial

Aims . To assess the impact of a brief intervention on antepartum alcohol consumption. Design. A randomized clinical trial. Setting. The obstetrics practices of the Brigham and Women's Hospital in Boston, MA, USA. Participants. Two hundred and fifty eligible women initiating prenatal care. Intervention. A comprehensive assessment of alcohol use (assessment only, AO) or the same comprehensive assessment with a brief intervention (BI). Measurement. Demographic background and obstetric history of subjects, current and lifetime use of alcohol and substances, composite Addiction Severity Index scores, and antepartum alcohol use. Findings. Of the 250, 247 (99%) subjects provided information on their antepartum drinking. Both the AO and BI groups had reductions in antepartum alcohol consumption, but differences in reductions by group were not statistically significant ( p > 0.05).Risk of antepartum drinking after either the AO or BI was increased nearly threefold if the subject had any prenatal alcohol consumption before assessment ( p = 0.0001). For the 143 subjects who were abstinent pre-assessment, however, those who received the BI maintained higher rates of abstinence (86% versus 72%, p = 0.04). Conclusions. After a comprehensive assessment of alcohol use, subjects in both the AO and BI groups reduced their antepartum alcohol consumption. The importance of screening for prenatal alcohol use is underscored by the findings that any prenatal alcohol consumption increases the risk of continued antepartum drinking.     

Cerebral hyperperfusion syndrome after carotid intervention: a review

Cerebral hyperperfusion syndrome (CHS) after carotid surgery, although rare, is a well-described phenomenon. Although originally described after carotid endarterectomy, it has now also been described after carotid artery stenting. It is classically described as an acute neurologic deficit occurring several days after a carotid procedure, associated with severe hypertension and preceded by a severe headache. CHS represents a spectrum of clinical symptoms ranging from severe unilateral headache, to seizures and focal neurologic defects, to intracerebral hemorrhage in its most severe form. The exact mechanism leading to CHS is unknown; however, it seems to be related to increased regional cerebral blood flow secondary to loss of cerebrovascular autoregulation. Given the significant morbidity associated with CHS, researchers have been trying to identify which patients are most at risk. This is a difficult task given the rarity of the disease and the multiple confounding factors in the patient population who undergo carotid intervention. The goal was to determine those patients most at risk preoperatively, so that they may be more closely monitored postoperatively to prevent the development of CHS and its associated morbidity. The purpose of this review was to summarize the data currently available in the literature on CHS, with emphasis on pathophysiology, risk factor assessment, diagnostic modalities, and disease management, to provide insight for future research to better elucidate how to reduce the morbidity and mortality caused by CHS.     

Biliary pancreatitis: a review. Emphasizing appropriate endoscopic intervention

Gallstones are a common cause of acute pancreatitis. This article reviews acute biliary pancreatitis and includes natural history, noting the serious nature of some cases; pathogenesis, identifying transient obstruction as the primary pathogenetic event; diagnosis, including biochemical parameters and imaging; assessment of severity, underlining the importance of early prognostic signs, organ failure, and local complications; and management. Management is reviewed in detail, giving a historical perspective to the role of surgery, highlighting the role of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy and paying particular attention to the four prospective randomized clinical trials in suggesting which patients are most likely to benefit from early endoscopic evaluation and therapy. Also discussed are additional clinical situations related to biliary pancreatitis in which endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy play a role. Finally, a suggested endoscopic approach to acute biliary pancreatitis is presented along with an algorithm incorporating severity stratification, principles of endoscopic intervention, and concepts of sterile and infected pancreatic necrosis.     

Visceral adipose tissue: a critical review of intervention strategies.

OBJECTIVE: To review the published literature regarding the effect of caloric restriction, pharmacologic intervention, and exercise to promote the loss of visceral adipose tissue (VAT) DESIGN: A review was conducted of published studies which measured VAT using computed tomography or magnetic resonance imaging before and after caloric restriction, pharmacologic therapy, or exercise. STUDIES REVIEWED: 23 separate studies were reviewed. Men represented 38% and women 63% of the 599 volunteers. There were 17 black volunteers and 30 patients with NIDDM included in these studies. MEASUREMENTS: Data regarding the baseline and change in VAT, body fat, and body weight were collected. RESULTS: Most interventions demonstrated a preferential loss of VAT regardless of the intervention applied. When expressed as percent change in VAT/percent change in body fat, a ratio can be calculated which we call the Selectivity Index (SI). When this index is applied to the literature reviewed, two observations can be made. First, the Selectivity Index is higher when baseline body fat is higher. Second, there is a direct relationship between the Selectivity Index and the baseline visceral fat ratio. These two observations suggest that individuals with greater visceral fat mass, either through an increase in the body weight or the propensity to store fat in the visceral depot, lose more visceral fat when adjusted to the loss of body fat. CONCLUSION: In conclusion, the Selectivity Index is useful to compare the ability of an intervention to specifically target the loss of AT. This simple index can serve as a benchmark for comparing intervention studies to each other.     

Brief intervention for students with methamphetamine use disorders: a randomized controlled trial

This study evaluated the short-term (eight-week) benefits of brief intervention (BI) in students aged 14-19 years old who met the DSM-IV diagnostic criteria for methamphetamine (MA) dependence or abuse. The participants were randomly assigned to receive two 20-minute sessions of BI or one 15-minute session of psychoeducation (PE). Primary outcomes of interest were the decrease of MA use in days of use (per week) units and MA tablets used (per day when used). All outcomes were assessed at baseline (week 0), week 4, and week 8 (endpoint). A total of 48 participants were enrolled in the study (24 on BI and 24 on PE treatment). At week 4, the numbers of dropouts in the BI and PE groups were 7 and 5, respectively. The frequency and amount of MA use decreased significantly in both groups. At week 8, the days of MA use had decreased in the BI group by a significantly larger number than in the PE group (t=2, df=34, p=0.04). BI appears to have some minimal short-term benefits for adolescents with MA use disorders. It may decrease the number of days that MA is used.     

Percutaneous coronary intervention: 2017 in review

In an effort to keep the interventional community up‐to‐date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to December 2017.     

Behavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysis

Aims The prospect of weight gain discourages many cigarette smokers from quitting. Practice guidelines offer varied advice about managing weight gain after quitting smoking, but no systematic review and meta‐analysis have been available. We reviewed evidence to determine whether behavioral weight control intervention compromises smoking cessation attempts, and if it offers an effective way to reduce post‐cessation weight gain. Methods We identified randomized controlled trials (RCTs) that compared combined smoking treatment and behavioral weight control to smoking treatment alone for adult smokers. English‐language studies were identified through searches of PubMed, Ovid MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. Of 779 articles identified and 35 potentially relevant RCTs screened, 10 met the criteria and were included in the meta‐analysis. Results Patients who received both smoking treatment and weight treatment showed increased abstinence [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.01, 1.64] and reduced weight gain (g = ?0.30, 95% CI = ?0.57, ?0.02) in the short term (<3 months) compared with patients who received smoking treatment alone. Differences in abstinence (OR = 1.23, 95% CI = 0.85, 1.79) and weight control (g = ?0.17, 95% CI = ?0.42, 0.07) were no longer significant in the long term (>6 months). Conclusions Findings provide no evidence that combining smoking treatment and behavioral weight control produces any harm and significant evidence of short‐term benefit for both abstinence and weight control. However, the absence of long‐term enhancement of either smoking cessation or weight control by the time‐limited interventions studied to date provides insufficient basis to recommend societal expenditures on weight gain prevention treatment for patients who are quitting smoking.