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PubMed2000

A phase II trial of triamcinolone hexacetanide for symptomatic recurrent malignant ascites.

Ascites is a common complication of advanced cancer and frequently requires paracentesis to reduce symptoms of pain, anorexia, and dyspnea. For many patients repeat paracenteses are required at short intervals. We prospectively studied 15 patients with recurrent ascites of malignancy to determine if intraperitoneal triamcinolone hexacetonide, a slowly metabolized corticosteroid, produced objective and symptomatic responses. After biochemical, radiological, and symptom assessment and the establishment of the interval between paracenteses, patients underwent large-volume paracentesis followed by intraperitoneal triamcinolone hexacetonide 10 mg/kg. Patients were followed after treatment for assessment of symptoms and physical signs of ascites. Repeat paracentesis was performed when symptomatic ascites recurred. Symptomatic ascites recurred in 13 of 15 patients, but the interval between paracenteses was extended from 9.5 +/- 1.6 days to 17.5 days (P = 0.0086). Symptom questionnaire scores assessing well-being, nausea, abdominal pain, dyspnea, appetite, appearance, and change in abdominal size on a scale from 0 to 6 averaged 3.2 +/- 0.3 at entry and 2.5 +/- 0.2 at the 2-week assessment (P = 0.026). Self-assessed symptoms, feeling of well-being, abdominal distention, and physical appearance improved significantly. The mean serum cortisol decreased from baseline, suggesting that some systemic corticosteroid absorption occurred. Thirteen of 15 patients have died, with a median survival of 42 days. Potential adverse effects included 1 episode each of transient abdominal pain, bacterial peritonitis, and localized herpes zoster infection. In patients with ascites of malignancy, intraperitoneal triamcinolone hexacetonide appears to postpone the requirement for repeat paracentesis and improve symptoms of malignant ascites.

Adult↗
PubMedDate not supplied

Sonography and venography of the lower extremities for diagnosing deep vein thrombosis in symptomatic patients.

The purpose of this study was to investigate the efficacy of sonography and the frequency of indeterminate sonographic examinations in the evaluation of patients with suspected lower extremity deep vein thrombosis (DVT). We prospectively evaluated 136 symptomatic patients (157 extremities) with suspected DVT using sonography and contrast-enhanced venography (n=106 patients, 115 extremities). Using venography as the reference standard for diagnosing DVT, the sensitivity and specificity of sonography was 92.8% and 98%, respectively, yielding an accuracy of 96.8%. The frequency of indeterminate examinations for calf DVT was 32.4%. One (0.7%) fatal pulmonary embolus occurred in our patients. The pulmonary embolism (PE) rate was 1.6% after lower extremity sonography with negative results. Sonography is highly accurate in detecting lower extremity DVT in symptomatic patients. Because of the high frequency of indeterminate studies in the calf and the associated possible risk of pulmonary emboli, we urge radiologists exercise additional caution when evaluating symptomatic patients with clinically suspected lower extremity DVT.

Adult↗
PubMed2002

Symptomatic vaginal candidiasis after pivmecillinam and norfloxacin treatment of acute uncomplicated lower urinary tract infection.

The comparative incidence of symptomatic vaginal candidiasis associated with pivmecillinam and norfloxacin treatment in women with acute symptomatic uncomplicated UTI was determined in two randomised, double-blind, clinical trials. Adverse events reported following general enquiry were reviewed. Presence of Candida vaginitis was based upon the specification as such by investigators, the presence of specific symptoms such as genital pruritus and/or the prescription of specific anti Candida therapy. The incidences of Candida vaginitis were as follows; Study 1 pivmecillinam 200 mg tid for 7 days 13 (4.6%), pivmecillinam 200 mg bid for 7 days 7 (2.4%), pivmecillinam 400 mg bid for 3 days 6 (2.1%) and placebo 6 (2.1%), P=0.19. Study 2 pivmecillinam 400 mg bid for 3 days 7 (1.5%), norfloxacin 400 mg bid for 3 days 20 (4.3%), P=0.016. The incidence of Candida vaginitis in women with acute symptomatic uncomplicated UTI given 3 days treatment with pivmecillinam 400 mg bid is similar to that seen with placebo and is significantly less than the incidence with norfloxacin 400 mg bid for 3 days.

Adult↗
PubMed2003

Cerebral blood flow in chronic symptomatic mild traumatic brain injury.

Patients with mild traumatic brain injury (MTBI) challenge physicians' skills and test their patience. Their manifold symptomatology is often not supported by objective neurological findings. We sought to compare regional cerebral blood flow (rCBF) between symptomatic subjects with longstanding MTBI and healthy controls, and to examine the correspondence between neuropsychological deficit and rCBF compromise. Twenty-eight clinically symptomatic male subjects with MTBI and twenty matched controls underwent neuropsychological testing and Tc-99m-HMPAO brain SPECT imaging. Neuropsychological test data were used to categorize subjects into sub-groups according to the presumed location of lesions based on their neurobehavioral deficits. Image subtraction comparisons were made between controls, all MTBI subjects and sub-groups. MTBI patients demonstrated regions of hypoperfusion in frontal, pre-frontal and temporal cortices, and sub-cortical structures. Hypoperfusion in 'frontal', 'left posterior' and to a lesser extent 'sub-cortical' sub-groups was concordant with neuropsychological localization. This was not the case for the 'right posterior' group, where no concordance was found. The rCBF is reduced in symptomatic patients with longstanding MTBI and unremarkable structural brain imaging. Although group analysis is appropriate for the generation of statistically significant differences, the clinical application of brain SPECT imaging in MTBI calls for a capability to associate clinical examination, neuropsychological assessment and cerebral perfusion at the individual subject level. Such competence is still to be attained.

Adult↗
PubMed2004

Histological changes in the symptomatic mediopatellar plica.

One of the causes of anterior knee pain may be symptomatic mediopatellar plica. The pain is usually attributed to the mechanical damage caused by the plica inside the joint, or, more precisely, to the synovitis induced as a result. Recent observations seem to suggest, however, that the pain is, in addition, likely to be engendered by an increased number of nerve-elements present in the substance of the plica. The present study used up-to-date histochemical methods to reveal in the symptomatic mediopatellar plicae nerve-elements that may be made responsible for the pain. Semi-quantitative methods were used to establish the number of nerve-elements in the tissue samples obtained from 21 symptomatic mediopatellar plicae (Group 'A'), exposing them to view with the aid of synaptophysin and neurofilament serum, coupled with routine light microscope as well as polarising microscope examinations following H&E and van Gieson staining. Tissue samples taken from the asymptomatic mediopatellar plica of 11 patients served as control (Group 'B'). A significantly larger number of nerve-elements were found in the substance of the plicae of Group 'A' 6.9 (S.D.+/-2.9) than in Group 'B' 3 (S.D.+/-1.2). Within Group 'A', more nerve-elements were revealed in trauma-related case histories than in those with no recollections of trauma (an average of 9.6 vs. 5.2, respectively). Similarly, the reduction of pain achieved by surgery was greater in the trauma-related group than in the non-traumatic one (3.0 vs. 1.8, respectively). Relying on our observations, we claim that the painfulness of the knee joint plicae is in all probability also attributable to the fact that their tissue substance contains an increased number of nerve-elements. A major trauma in a particular case history contributes, in all likelihood, to an increase in the number of nerve-elements, but further examinations are required to clarify the pathomechanism involved.

Adolescent↗
PubMedDate not supplied

Interpretations and treatment decisions based on MR angiography versus conventional arteriography in symptomatic lower extremity ischemia.

PURPOSE: To determine the frequency with which treatment plans based on findings at magnetic resonance angiography (MRA) match those based on findings at conventional x-ray arteriography (XRA) in the evaluation of symptomatic lower extremity ischemia. PATIENTS AND METHODS: Two-dimensional time-of-flight (TOF) MRA was performed in 42 patients undergoing XRA for evaluation of symptomatic lower extremity ischemia. The blind interpretations and treatment plans based on MRA findings were compared with those based on XRA findings, with use of XRA as the standard of reference. RESULTS: For identification of hemodynamically significant stenosis or occlusion, the sensitivity and specificity of MRA was 100% and 23% for iliac segments, 100% and 82% for common femoral segments, 89% and 67% for superficial femoral segments, 100% and 88% for popliteal segments, and 92% and 91% for tibioperoneal segments, respectively. The treatment plan based on MRA findings matched that based on XRA findings in 41% of patients. CONCLUSION: For evaluation of symptomatic lower extremity ischemia, two-dimensional TOF MRA cannot be considered a reliable substitute for XRA in patients who lack contraindications to XRA.

Angiography↗
PubMed1998

Fetal fibronectin in symptomatic twin gestations.

Objective: To evaluate the negative fetal fibronectin (fFN) assay in patients with twin gestations who are symptomatic for preterm labor (PTL).Study Design: Fetal fibronectin expression in 955 symptomatic patients combined from two prospective multicenter trials was studied. Of the 955 patients, 43 had twin gestations in PTL with intact amniotic membranes at 24 and 35 weeks. Fetal fibronectin expression was evaluated in relation to delivery within 7 days of the symptomatic episode for PTL.Results: Of the 43 eligible patients, 11 had a positive fFN assay and 6 delivered </=7 days (sensitivity 75%, positive predictive value 54.5%). Of the 32 patients who had a negative fFN, two delivered </=7 days of testing (specificity 85.7% negative predictive value 93.7%).Conclusion: The positive predictive value of fFN among twin gestations is higher (54%) compared to singletons (12.7%), while the negative predictive value (93.7%) is comparable to singletons (99.5%). Utilizing the negative predictive value of the fFN assay may allow the clinician and patient to be reassured that delivery is unlikely to occur in the next 7 days and allow clinicians to be more conservative in their treatment of PTL in twins thereby potentially decreasing the risk of morbidity associated with these agents.

Journal Article↗
PubMed2002

Laparoscopic uterine artery ligation for treatment of symptomatic adenomyosis.

STUDY OBJECTIVE: To investigate the effect of laparoscopic uterine artery ligation on symptomatic adenomyosis. DESIGN: Prospective pilot study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Twenty women with symptomatic adenomyosis. INTERVENTION: Laparoscopic ligation of bilateral uterine arteries with hemoclips and electrocoagulation of bilateral uterine ovarian vessels. MEASUREMENTS AND MAIN RESULTS: Patients underwent sonographic measurement of uterine size, and recorded amount of menstruation and dysmenorrhea preoperatively and postoperatively. Six months postoperatively, mean uterine size had decreased by an amount ranging from 0.4% to 74.0%. Two of nine women achieved remission of the mass effect of an enlarged uterus. Thirteen of 16 patients achieved bleeding control and 5 returned to eumenorrhea or hypomenorrhea. Twelve of 16 patients achieved control of dysmenorrhea and 6 were analgesic free. However, nine women experienced nonmenstrual pain after surgery, three of whom underwent hysterectomy later. Treatment was rated as satisfactory by 15% of patients, but 45% were dissatisfied. Seventeen women would have refused to undergo the procedure if they could make the decision again. CONCLUSION: Poor satisfaction in this preliminary study suggests that symptomatic adenomyosis may not be effectively treated by laparoscopic uterine artery ligation.

Adult↗
PubMed2004

Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients who remain symptomatic after treatment with fexofenadine.

BACKGROUND: Currently available oral second-generation antihistamines do not provide adequate symptom relief for many allergy patients. OBJECTIVE: To determine the ability of azelastine nasal spray to improve rhinitis symptoms in patients with seasonal allergic rhinitis who remained symptomatic after treatment with fexofenadine. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled, 2-week study in patients with moderate-to-severe seasonal allergic rhinitis. The study began with a 1-week, open-label lead-in period, during which patients received fexofenadine, 60 mg twice daily. Patients who improved less than 25% to 33% with fexofenadine were randomized to treatment with (1) azelastine nasal spray, 2 sprays per nostril twice daily; (2) azelastine nasal spray, 2 sprays per nostril twice daily, plus fexofenadine, 60 mg twice daily; or (3) placebo (saline) nasal spray and placebo capsules twice daily. The primary efficacy variable was the change from baseline to day 14 in the total nasal symptom score (TNSS), consisting of runny nose, sneezing, itchy nose, and nasal congestion symptom scores. RESULTS: A total of 334 patients who remained symptomatic after treatment with fexofenadine were included in the efficacy analysis. After 2 weeks of treatment, azelastine nasal spray (P = .007) and azelastine nasal spray plus fexofenadine (P = .003) significantly improved the TNSS compared with placebo. Azelastine nasal spray monotherapy was as effective as the combination of azelastine nasal spray plus fexofenadine as measured by the TNSS and individual symptoms of the TNSS. CONCLUSIONS: Azelastine nasal spray is effective monotherapy for patients who remain symptomatic after treatment with fexofenadine and should be considered in the initial management of patients with seasonal allergic rhinitis.

Adolescent↗
PubMed2000

Persistent airway T-lymphocyte activation in chronic corticosteroid-treated symptomatic asthma.

BACKGROUND: A small proportion of patients with asthma have persistent symptoms despite regular treatment with high-dose inhaled and/or oral corticosteroids. There is little information regarding immunopathology in such patients. OBJECTIVE: To compare airway inflammatory changes in subjects with chronic corticosteroid-dependent symptomatic asthma (n = 5) and subjects with asthma that was clinically well controlled on inhaled corticosteroid therapy (n = 9). Subjects in the corticosteroid-dependent group were receiving long-term treatment with oral prednisolone and high-dose inhaled corticosteroids. METHODS: Subjects underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsy. T-lymphocytes subsets and activation markers in BAL fluid and peripheral blood were determined by FACS analysis. Bronchial biopsies were stained immunohistochemically, and numbers of inflammatory cells quantitated. Inflammatory mediators in BAL fluid were measured by immunoassay. RESULTS: There was significantly greater expression of CD25 (P = .02) and HLA-DR (P = .04) by BAL fluid T-lymphocytes in corticosteroid-treated symptomatic asthmatics. In bronchial biopsies there were no significant differences between the two groups in the numbers of AA1+ cells (mast cells), EG2+ cells (eosinophils) or MT1+ T-lymphocytes. Levels of albumin, histamine, tryptase, and eosinophil cationic protein in BAL fluid did not differ significantly between groups. CONCLUSIONS: Chronic corticosteroid-treated symptomatic asthma is associated with persistent airway T-lymphocyte activation. This, however, is not necessarily accompanied by the recruitment and activation of inflammatory cells within the airways.

Administration, Inhalation↗
PubMedDate not supplied

Laparoscopic fundoplication for symptomatic but physiologic gastroesophageal reflux.

Esophageal pH monitoring identifies some patients who have physiologic amounts of esophageal acid exposure but have a strong correlation between symptoms of esophageal reflux events. These patients with symptomatic physiologic reflux probably have enhanced sensory perception of reflux events and may be difficult to control with acid-suppressive therapy. Little is known about the role of fundoplication in such patients. Patients with no endoscopic evidence of gastroesophageal reflux disease and a normal 24-hour pH composite score (<22.4 in our laboratory), but a symptom index (SI = number of symptoms with pH <4/total number of symptoms) greater than 50% were offered laparoscopic fundoplication if acid-suppressive therapy was unsatisfactory. This group comprised 18 (4%) of 459 patients undergoing fundoplication at our institution. Heartburn, dysphagia, and reflux symptoms were scored on a scale of 0 to 10 with patients on and off medicine preoperatively, and at a mean of 7.2 months (range 1 to 32 months) postoperatively. The 18 patients with symptomatic physiologic reflux (6 males and 12 females) had heartburn as a major complaint. Preoperative response to proton pump inhibitors for heartburn was 72% and for all symptoms was 60%. The group had a mean pH composite score of 14 (range 4 to 22). The symptom used to calculate the symptom index was heartburn in 12 patients, regurgitation in three, chest pain in two, and cough in one. An average of 18 symptoms (range 2 to 56) were recorded. The mean symptom index was 82% (range 50% to 100%). A Nissen fundoplication was performed in nine patients and a Toupet fundoplication in nine. Surgery was successful (>90%) in alleviating reflux symptoms in 14 patients and partially successful (>75%) in three of the remaining four patients. Gas bloat and dysphagia were seen in one patient each. Fundoplication is effective at relieving reflux symptoms in carefully selected patients with symptomatic physiologic reflux, with minimal side effects.

Esophagus↗
PubMed2003

Can ultrasonographic findings of perihepatic lymphadenopathy promote investigations to detect possible presence of virus C infection in non-symptomatic subjects?

PURPOSE: Only early detection of non-symptomatic patients is able to arrest the diffusion of the non-symptomatic HCV infection and lead to prompt treatment. Our aim was to attempt to correlate the presence of perihepatic lymph nodes and hepatitis C infection and to assess whether ultrasonography can have a role to promote specific investigations for pre-clinical diagnosis of virus C infection. METHOD: We performed a controlled study on a cohort of 7974 subjects from a town of 27000 inhabitants on the eastern coast of Sicily. Serologic hepatitis A, B and C markers, alanine aminotransferase levels and abdominal ultrasound examination according to size and number of peri-hepatic lymph nodes were performed on blind basis. RESULTS: One or more pathological lymph nodes were present in 684/7974 subjects. Haematochemical tests revealed the presence of anti-HCV positivity in 528/684 subjects with pathological lymph nodes and in 8/7290 subjects without pathological lymph nodes, there being a significant difference (P<0.0001) between the two groups. CONCLUSION: Our results confirm the association between perihepatic lymph nodes and virus C infection. Correct diagnostic assessment of this datum could lead not only to early diagnosis by specific blood test for HCV and consequent prompt aimed treatment, but could pave the way for efficacious territorial prevention and detection of an elevated percentage of likely non-symptomatic carriers.

Journal Article↗
PubMed2001

Verbal working memory storage and processing deficits in HIV-1 asymptomatic and symptomatic individuals.

BACKGROUND: Verbal working memory (WM), which relies on intact functioning of frontostriatal circuits, has been suggested as a cognitive domain that is preferentially affected in HIV-1 infection. Although several studies have found WM impairments in HIV-1 infected patients, Baddeley's classic WM model has not been studied extensively in this population. METHODS: We used two cognitive neuropsychological approaches to examine verbal WM deficits in 18 HIV-1 seronegative, 16 HIV-1 asymptomatic, and 20 HIV-1 symptomatic patients. First, based on Baddeley's WM model of the Phonological Loop, we used the phonological similarity effect and the irrelevant speech effect to evaluate each individual's phonological store, and the word-length effect and the articulatory suppression effect to evaluate the articulatory control process. Secondly, an individual differences approach, which focuses on the capacity limitation of the WM system and potentially integrates the functions of Baddeley's Central Executive component with the Phonological Loop, was adopted. We evaluated each patient's simultaneous storage and processing of auditory material using the Verbal Memory Span test. RESULTS: The HIV-1 symptomatic individuals, but not the HIV-1 asymptomatic subjects, demonstrated impaired short-term storage of verbal material in the phonological store on Baddeley's measures. Although the HIV-1 asymptomatic and symptomatic subjects demonstrated intact rehearsal of speech-based material in the articulatory control process, both groups demonstrated impairment on the Verbal Memory Span test. CONCLUSIONS: These findings suggest that deficits in simultaneous short-term storage and processing occur during both early and later stages of HIV-1 infection.

Adult↗
PubMed2004

Present characteristics of symptomatic Entamoeba histolytica infection in the big cities of Japan.

Medical records, for 2000 and 2001, of symptomatic amoebic patients who were treated at our hospitals in Tokyo, Yokohama and Osaka were studied retrospectively for the purpose of gathering epidemiological data on symptomatic Entamoeba histolytica infection. A total of 58 patients were treated. Fifty-five of them were male, and 96% of the male patients were Japanese. The mean age of patients was 44.9 years old, and 91% of patients contracted the disease in Japan. Fifty-six per cent of the male patients indicated that they were practising homosexuals, and 44% of the male patients denied these practices or left the question unanswered. The serum Treponema pallidum haemagglutination test was positive in 45% of the patients, and antibody to human immunodeficiency virus (HIV) was positive in 45%. Our study revealed that recent symptomatic E. histolytica infection almost exclusively afflicted middle-aged males in the big cities of Japan, that a majority of the patients were probably exposed to the causative organism during homosexual activity, and that an increasing number of patients will be co-infected with HIV.

AIDS Serodiagnosis↗
PubMed1997

Verapamil normalizes the response of left ventricular early diastolic filling to cold pressor test in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy.

The aim of the study was to assess the left ventricular (LV) diastolic filling response to the cold pressor test in asymptomatic or mildly symptomatic patients with nonobstructive hypertrophic cardiomyopathy (HC) before and after verapamil therapy. The cold pressor test-induced alterations in LV filling pattern were additionally compared between HC patients and healthy control subjects. The cold pressor test, producing alpha- and beta-adrenergic stimulation, differentiates paradoxical coronary vasoconstriction due to endothelial dysfunction from the normal endothelium-dependent vasodilation. Such opposite coronary vasomotion at cold pressor test may be reflected by different responses of LV diastolic filling to the cold pressor test. Doppler echocardiography was performed in 10 asymptomatic or mildly symptomatic patients with nonobstructive HC as well as in 10 age- and sex-matched healthy subjects before and immediately after the cold pressor test. In HC patients before verapamil therapy, the cold pressor test induced a significant decrease in LV early filling parameters, contrary to healthy subjects, in whom the cold pressor test improved early filling [changes in early diastolic LV velocity -6.2 +/- 7.3 (-11.4 to -0.98) vs. 7.5 +/- 8.9 (1.13-13.86) cm/s, P = 0.0014, and changes in its acceleration rate -136 +/- 119 (-221 to -51) vs. 252 +/- 181 (122-381) cm/s2, P = 0.0001, respectively]. Verapamil therapy restored the normal pattern of the LV early filling response to the cold pressor test [changes in early diastolic LV velocity -6.2 +/- 7.3 (-11.4 to -0.98) vs. 5.3 +/- 3.4 (2.86 to 7.73) cm/s, P = 0.0003, and changes in its acceleration rate -136 +/- 119 (-221 to -51) vs. 328 +/- 185 (196 to 460) cm/s2, P = 0.0001, respectively]. Verapamil normalizes the LV early filling response to the cold pressor test in asymptomatic or mildly symptomatic patents with HC.

Adult↗
PubMed2003

Symptomatic spinal dissemination of malignant astrocytoma.

OBJECT: Symptomatic spinal dissemination of malignant astrocytoma is rarely found except at autopsy. This study evaluated the clinical incidence and characteristics of spinal dissemination and the effect on outcome. PATIENTS AND METHODS: Patients treated for primary malignant astrocytoma, including 33 with anaplastic astrocytoma and 35 with glioblastoma, at our department between 1997 and 1999 were followed up until April 30, 2001. Head magnetic resonance (MR) imaging of all patients was obtained every 2-3 months. Signs and symptoms of leptomeningeal spread were checked at monthly outpatient examinations. Spinal MR imaging was performed if any symptoms indicating spinal dissemination were found. RESULTS: Median survival times of patients with anaplastic astrocytoma and glioblastoma were 40.5 and 16.0 months, respectively. Seventeen patients (25%) developed intracranial dissemination and 15 of these died. Six patients (8.8%), one with anaplastic astrocytoma and five with glioblastoma, developed spinal dissemination. All patients with spinal dissemination also had intracranial dissemination. Five of the six patients died, despite systemic radiochemotherapy in four patients. All patients died of extensive whole brain and spinal dissemination or nodular mass enlargement at the upper cervical cord, not of local massive tumor progression. CONCLUSIONS: Symptomatic spinal dissemination of malignant astrocytoma is not so rare, and is the cause of death. The relatively high incidence of symptomatic leptomeningeal dissemination must be considered in the treatment of malignant astrocytomas.

Adolescent↗
PubMed2003

Amiodarone prevents symptomatic atrial fibrillation and reduces the risk of cerebrovascular accidents and ventricular tachycardia after open heart surgery: results of the Atrial Fibrillation Suppression Trial (AFIST).

BACKGROUND: Atrial fibrillation (AF) is a common complication after cardiothoracic surgery (CTS). The role of amiodarone added to beta blocker as a preventive strategy in elderly patients undergoing CTS is not known. The Atrial Fibrillation Suppression Trial (AFIST) was a double blind, placebo-controlled trial that evaluated the efficacy of oral amiodarone in patients 60 years or older undergoing CTS. Beta blockers were administered as part of a critical pathway. METHODS: Elderly patients (n = 220, mean age 72 +/- 6.7 years) received amiodarone (n = 120) or placebo (n = 100). Patients enrolled less than 5 days before CTS received 6 g of drug over 6 days beginning on the day prior to OHS. Patients enrolled 5 days before CTS received 7 g of study drug over 9-10 days, starting on preoperative day 4 or 5. RESULTS: Amiodarone treated patients had a lower incidence of AF (22.5% vs. 38%, p = 0.01), symptomatic AF (4.2% vs. 18%, p = 0.001), cerebral vascular accident (1.7 vs. 7.0%, p = 0.04), and ventricular tachycardia (1.7% vs. 7.0%, p = 0.04) vs. placebo. Beta blocker use (87.5% vs. 91.0% ), nausea (26.7% vs. 16%, p = 0.056), symptomatic bradycardia (7.5% vs. 7%, p = 0.89), hypotension (14.2% vs. 10.0%) and 30 day mortality (3.3 vs. 4.0%, p = 0.79) were similar. Amiodarone treated patients receiving the 4/5 day preoperative regimen had a reduced incidence of AF (19.6% vs. 38%, p = 0.013), while those receiving the 1-day preoperative regimen showed a trend (25% vs. 38%, p = 0.06) vs. placebo. CONCLUSIONS: In an elderly population undergoing CTS, Amiodarone prophylaxis reduces AF, the incidence of symptomatic AF, cerebrovascular accident and ventricular tachycardia.

Administration, Oral↗
PubMed2001

Prophylactic urgent revascularization of the internal carotid artery in the symptomatic patient.

BACKGROUND: The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization. PATIENTS AND METHODS: During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances. RESULTS: Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group. CONCLUSION: The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.

Aged↗