Community experience of colonic stenting in patients with acute large bowel obstructions

Background

Self-expandable metal stents (SEMS) can provide temporary relief of acute large bowel obstructions. Placement of SEMS creates the opportunity for semi-elective 1-stage surgical resections, use of possible adjuvant therapy or palliative relief of malignant obstructions. Our aim was to assess the likelihood of success and possible complication rates of SEMS insertion in a community hospital setting in patients presenting with large bowel obstructions.

Methods

We conducted a retrospective chart review at a single community-based hospital. This review addressed the technical success in deployment of the SEMS, clinical success defined by relief of the obstruction, procedure-related complications, surgical interventions and completion of adjuvant therapy for patients with large bowel obstructions.

Results

In a 34-month period, 16 patients underwent 16 SEMS procedures. The average age of patients was 69.4 years and 7 (44%) were women. Thirteen patients had intrinsic colorectal cancers, 1 had an extracolonic lesion (ovarian cancer) and 2 had strictures due to diverticular disease. Technical success occurred in all 16 patients, but only 15 (94%) had clinical success. No procedure-related deaths (defined as death within 7 days) occurred. Palliative stenting occurred in 5 patients (31%). Eleven patients (69%) eventually had surgery. Stenting allowed a window for neoadjuvant therapy in 4 patients. Ten of 11 patients (91%) had a 1-stage procedure. One patient had a cecal perforation presenting 2 days after SEMS. This patient received a defunctioning ileostomy.

Conclusion

In appropriate patients with large bowel obstructions, SEMS procedures can be safely and effectively performed in a community-based setting.     

Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation

Outcomes in Patients With AF . Introduction: Atrial fibrillation (AF) adversely impacts mortality, stroke, heart failure, and dementia. AF ablation eliminates AF in most patients. We evaluated the long‐term impact of AF ablation on mortality, heart failure (HF), stroke, and dementia in a large system‐wide patient population. Methods: A total of 4,212 consecutive patients who underwent AF ablation were compared (1:4) to 16,848 age/gender matched controls with AF (no ablation) and 16,848 age/gender matched controls without AF. Patients were enrolled from the large ongoing prospective Intermountain AF study and were followed for at least 3 years. Results: Of the 37,908 patients, mean age 65.0 ± 13 years, 5,667 (14.9%) died, 1,296 (3.4%) had a stroke, and 1,096 (2.9%) were hospitalized for HF over >3 years of follow‐up. AF ablation patients were less likely to have diabetes, but were more likely to have hypertension, HF, and significant valvular heart disease. AF ablation patients had a lower risk of death and stroke in comparison to AF patients without ablation. Alzheimer's dementia occurred in 0.2% of the AF ablation patients compared to 0.9% of the AF no ablation patients and 0.5% of the no AF patients (P < 0.0001). Other forms of dementia were also reduced significantly in those treated with ablation. Compared to patients with no AF, AF ablation patients had similar long‐term rates of death, dementia, and stroke. Conclusions: AF ablation patients have a significantly lower risk of death, stroke, and dementia in comparison to AF patients without ablation. AF ablation may eliminate the increased risk of death and stroke associated with AF. (J Cardiovasc Electrophysiol, Vol. 22, pp. 839‐845, August 2011)     

Sleep Quality,Depression, and Quality of Life in Patients with Pulmonary Hypertension

Pulmonary hypertension is a disabling disease characterized by progressive functional worsening, right heart failure, and death. Although pulmonary hypertension has been associated with poor quality of life, sleep quality has not been investigated in pulmonary hypertension patients. This was a cross-sectional study in which patients (N = 40) were asked to complete standardized questionnaires to assess sleep quality [using Pittsburgh Sleep Quality Index (PSQI)], insomnia, sleepiness, dyspnea, depression, restless leg syndrome, and quality of life [using Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR)] during routine office visits. Baseline hemodynamics, pulmonary function tests, exercise capacity, and transthoracic echocardiogram were analyzed. Pulmonary hypertension functional class was World Health Organization class II [20 (50%)], III [18 (45%)], and IV [2 (5%)], and 29 (72.5%) had poor sleep quality. PSQI score was associated with CAMPHOR symptoms score (R = 0.61, P < 0.001), CAMPHOR activities score (R = 0.38, P = 0.016), CAMPHOR quality-of-life score (R = 0.45, P = 0.004), depression (R = 0.42, P = 0.007), and dyspnea (R = 0.36, P = 0.02). Sleep quality was not associated with age, gender, other comorbidities, pulmonary hypertension etiology, baseline hemodynamics, pulmonary function testing, echocardiographic parameters, or exercise capacity. Poor sleep quality is common in patients with pulmonary hypertension and correlates with depression, dyspnea, and poor quality of life. Improving sleep quality in patients with pulmonary hypertension may improve quality of life.     

Antioxidative status of patients with alcoholic liver disease in southeastern Taiwan

AIM:To investigate the antioxidative status of patients with alcoholic liver disease(ALD) in southeastern Taiwan.METHODS:Our study comprised 27 patients with ALD recruited from Taitung Mackay Memorial Hospital,located in southeastern Taiwan.Patients with ALD included 12 non-aborigines(12 men) and 15 aborigines(11 men and 4 women).According to the severity of ALD,patients with ALD included 10 with hepatitis(9 men and 1 woman) and 17 with cirrhosis(14 men and 3 women).Twenty-two age-and gender-matched healthy...     

Chiral purity assay for Flindokalner using tandem mass spectrometry: method development, validation, and benchmarking

The present work demonstrates the application and validation of a mass spectrometry method for quantitative chiral purity determination. The particular compound analyzed is Flindokalner, a Bristol-Myers Squibb drug candidate for post-stroke neuroprotection. Chiral quantification of Flindokalner was achieved using tandem mass spectrometry (MS/MS) and the kinetic method, a gas phase method used for thermochemical and chiral determinations. The MS/MS method was validated and benchmarked against two separate chromatographic techniques, chiral high performance liquid chromatography with ultra-violet detection (LC/UV) and achiral high performance liquid chromatography with circular dichroism detection (LC/CD). The chiral purity determination of Flindokalner using MS/MS proved to be rapid (3 min run time for each sample) and to have accuracy and precision comparable to the chiral LC/UV and achiral LC/CD methods. This method represents an alternative to commonly used chromatographic techniques as a means of chiral purity determination and is particularly useful in rapid screening experiments.     

Ultrasound detection of blunt urological trauma: a 6-year study

The objective of this study was to assess the utility of emergency ultrasonography in the detection of blunt urological injury. A retrospective review was conducted of all consecutive emergency blunt trauma ultrasonograms (US) obtained at a level I trauma centre from January 1995 to January 2001. Among the 4320 emergency ultrasonograms performed, 596 patients (14%) had intraabdominal injury and, of these, 99 patients (17%) had urological injuries. The sensitivity of ultrasound for all urological injuries was 67%, and specificity was 99.8%. For isolated urological injuries, sensitivity and specificity were 55.6 and 99.8%, respectively. Ultrasound was most accurate in the detection of grade III renal injuries, identifying 14/15 (93%), and 13 underwent laparotomy. For isolated urological injuries, 15 of 25 (60%) patients with a true-positive US underwent laparotomy compared to 3 of 20 (15%) with a false-negative US. Isolated urological injury was significantly associated with an ultrasonographic pattern of free fluid in the left upper quadrant and the left pericolic gutter (odds ratio=55.1; P<0.001), followed by isolated fluid in the left pericolic gutter (odds ratio=8.6; P=0.04). Although emergency ultrasonography is useful in the triage of patients with blunt urological trauma, it may miss significant urological injury requiring further intervention. As most renal injuries may be managed non-operatively, further studies such as contrast-enhanced CT or angiography should be obtained in the stable patient with suspected blunt urological injury.