A team of scientists from Denmark and Sweden discovered that indoor air polluted with tiny particles that are breathed in and get into the bloodstream
affected the performance of blood vessels, and potentially increased the risk of cardiovascular disease, in elderly people. When the air quality was improved using
filters, their blood vessels worked much better.
The study is published in the American Journal of Respiratory and Critical Care Medicine and was the work of Dr Steffen Loft of the Institute of
Public Health, Department of Environmental Health, Copenhagen, in Denmark, and colleagues.
Scientists already knew that exposure to air pollutants such as the microscopic particles emitted in various types of vehicle, industrial and power plant
exhaust
fumes increased risk factors for cardiovascular disease. This is probably because the endothelial cells that line the walls of all blood vessels
become damaged by the tiny particles once they get into the bloodstream. This study extends that knowledge to indoor air quality.
Loft and colleagues investigated the effect of air particles on three markers of blood vessel health: microvascular function (MVF), oxidative stress, and
inflammation.
They recruited a total of 21 non smoking elderly couples, aged between 60 and 75, to take part in a randomized, double blind, crossover study of two exposure
episodes lasting 48 hours each, both in their homes.
This meant the couples were randomly selected to be exposed either to filtered air first and then to non-filtered air, or the other way around. Double blind
meant that neither the couples nor the scientists who assigned them to their groups knew which exposure came first: filtered or non-filtered air. All the
couples were in good health and lived near busy roads. The exposure was controlled by putting air purifiers in their homes, with and without an air filter
fitted inside.
When the air filter was fitted, it created an exposure in the range of 2,533 to 4,058 particles per cm3. Without the filter the exposure ranged from 7,718
to 12,988 particles/cm3. The concentration, diameter range and mass range, as well as the chemical properties of the particles in the air were also
monitored at all times.
The researchers measured MVF by assessing the artery tone of a finger after applying a blood pressure cuff on the arm (arm ischemia). They also took blood samples to measure a
range of blood materials to assess oxidative stress and inflammation, including hemoglobin, red blood cells, platelets, coagulants, C-reactive protein, and
many others.
The results showed that:
Filtered air significantly improved MVF by 8.1 per cent.
The diameter of the air particles (smaller than 2.5 micrometers) and their mass, had a greater effect than their total number concentration.
MVF was also significantly linked to being exposed to particles containing iron, potassium, copper, zinc, arsenic, and lead.
After applying a test of statistical significance, none of the other biomarkers (oxidative stress and inflammation) varied significantly with particle
exposure.
The researchers concluded that:
"Reduction of particle exposure by filtration of recirculated indoor air for only 48 hours improved MVF in healthy elderly citizens, suggesting that this may
be a feasible way of reducing the risk of cardiovascular disease."
Endothelial cells line the walls of all blood vessels throughout the body from the smallest capillary to the largest artery . They are involved in lots of
important jobs from controlling blood flow, reducing clotting, keeping arteries clear, reducing swelling and forming new blood vessels. They also control
the movement of blood materials like white blood cells into and out of the bloodstream, and in some organs like the kidneys and the brain, they act as a
blood filter.
Endothelial dysfunction therefore affects all these aspects of the cardiovascular system, and often results in atherosclerosis, where arteries get clogged up
with plaques and then swell (and sometimes burst) with the resulting inflammation. This also narrows the arteries and stops the blood getting to the organ
concerned, for instance as in a heart attack.
"Indoor Particles Affect Vascular Function in the Aged: An Air Filtration-based Intervention Study."
Elvira Vaclavik Br?¤uner, Lykke Forchhammer, Peter M??ller, Lars Barregard, Lars Gunnarsen, Alireza Afshari, Peter W??hlin, Marianne Glasius, Lars Ove Dragsted,
Samar Basu, Ole Raaschou-Nielsen, and Steffen Loft.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 419-425, (2008).
First published online October 11 2007 as doi:10.1164/rccm.200704-632OC
Click here for Abstract.
среда, 22 июня 2011 г.
вторник, 21 июня 2011 г.
Cardiovascular Disease Not Prevented By Supplementation With Vitamins E Or C
The risk of cardiovascular events is not reduced by vitamin E or vitamin C supplements, as determined in a large, long-term randomized study of male physicians, according to an article released on November 9, 2008 in JAMA to coincide with the scientific presentation of these findings at the current American Heart Association (AHA) meeting.
Vitamin supplements are a common form of medication in the United States, and according to background information in the article, most adults here have taken them in the last year. There has been previous research into the roles played by vitamin E and vitamin C in heart disease. "Basic research studies suggest that vitamin E, vitamin C, and other
antioxidants reduce cardiovascular disease by trapping organic free
radicals, by deactivating excited oxygen molecules, or both, to prevent
tissue damage." Previous observational studies have indicated that both vitamin E and vitamin C were related to various cardiovascular disease prevention.
In the Physicians' Health Study II, Howard D. Sesso, Sc.D, M.P.H., and
colleagues from Brigham and Women's Hospital, Harvard Medical School
and School of Public Health and VA Boston Healthcare System, Boston, 14,641 male physicians were evaluated for the effects of vitamin E and vitamin C supplements on cardiovascular event incidence. A the inception of the study in 1997, the subjects were 50 years or older, and at low risk for cardiovascular disease. Of the total, 5.1% (754) physicians had cardiovascular disease. Each subject was randomized to recieve 400IU of vitamin E every other day or a placebo; each patient was also randomized to receive 500mg of vitamin C daily or a placebo.
The subjects were followed up for an average of 8 years, during which there were 1,245 confirmed major cardiovascular events. Of these, 511 heart attacks (myocardial infarctions), 464 strokes, and 509 cardiovascular deaths were experienced -- with some men experiencing more than one event. During the follow up period, 1,661 men died.
When comparing the supplemented groups to the placebo, neither vitamin E nor vitamin C had any effects on cardiovascular event incidence. The authors also note: "Neither vitamin E nor vitamin C had a significant effect on total
mortality, but vitamin E was associated with an increased risk of
hemorrhagic stroke."
The authors conclude that vitamin E and vitamin C supplementation should not be indicated for prevention of cardiovascular disease in this group. "In this large, long-term trial of male physicians, neither vitamin E
nor vitamin C supplementation reduced the risk of major cardiovascular
events. These data provide no support for the use of these supplements
for the prevention of cardiovascular disease in middle-aged and older
men," they write.
Vitamins E and C in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Controlled Trial
Howard D. Sesso; Julie E. Buring; William G. Christen; Tobias Kurth; Charlene Belanger; Jean MacFadyen; Vadim Bubes; JoAnn E. Manson; Robert J. Glynn; J. Michael Gaziano
JAMA. 2008;300(18):2123-2133.
Click Here For Journal
Written by Anna Sophia McKenney
Vitamin supplements are a common form of medication in the United States, and according to background information in the article, most adults here have taken them in the last year. There has been previous research into the roles played by vitamin E and vitamin C in heart disease. "Basic research studies suggest that vitamin E, vitamin C, and other
antioxidants reduce cardiovascular disease by trapping organic free
radicals, by deactivating excited oxygen molecules, or both, to prevent
tissue damage." Previous observational studies have indicated that both vitamin E and vitamin C were related to various cardiovascular disease prevention.
In the Physicians' Health Study II, Howard D. Sesso, Sc.D, M.P.H., and
colleagues from Brigham and Women's Hospital, Harvard Medical School
and School of Public Health and VA Boston Healthcare System, Boston, 14,641 male physicians were evaluated for the effects of vitamin E and vitamin C supplements on cardiovascular event incidence. A the inception of the study in 1997, the subjects were 50 years or older, and at low risk for cardiovascular disease. Of the total, 5.1% (754) physicians had cardiovascular disease. Each subject was randomized to recieve 400IU of vitamin E every other day or a placebo; each patient was also randomized to receive 500mg of vitamin C daily or a placebo.
The subjects were followed up for an average of 8 years, during which there were 1,245 confirmed major cardiovascular events. Of these, 511 heart attacks (myocardial infarctions), 464 strokes, and 509 cardiovascular deaths were experienced -- with some men experiencing more than one event. During the follow up period, 1,661 men died.
When comparing the supplemented groups to the placebo, neither vitamin E nor vitamin C had any effects on cardiovascular event incidence. The authors also note: "Neither vitamin E nor vitamin C had a significant effect on total
mortality, but vitamin E was associated with an increased risk of
hemorrhagic stroke."
The authors conclude that vitamin E and vitamin C supplementation should not be indicated for prevention of cardiovascular disease in this group. "In this large, long-term trial of male physicians, neither vitamin E
nor vitamin C supplementation reduced the risk of major cardiovascular
events. These data provide no support for the use of these supplements
for the prevention of cardiovascular disease in middle-aged and older
men," they write.
Vitamins E and C in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Controlled Trial
Howard D. Sesso; Julie E. Buring; William G. Christen; Tobias Kurth; Charlene Belanger; Jean MacFadyen; Vadim Bubes; JoAnn E. Manson; Robert J. Glynn; J. Michael Gaziano
JAMA. 2008;300(18):2123-2133.
Click Here For Journal
Written by Anna Sophia McKenney
понедельник, 20 июня 2011 г.
Ranexa(R) Added To New ACC/AHA Guidelines On Unstable Angina/Non ST-Elevation Myocardial Infarction (UA/NSTEMI)
CV Therapeutics,
Inc. (Nasdaq: CVTX) announced today that new guidelines, developed jointly
by the American College of Cardiology Foundation and the American Heart
Association and published in this week's issue of Circulation, state that,
"ranolazine may be safely administered for symptom relief after UA/NSTEMI."
Ranexa(R) (ranolazine extended-release tablets) is indicated for the
treatment of chronic angina in patients who have not achieved an adequate
response with other antianginal drugs, and should be used in combination
with amlodipine, beta-blockers or nitrates. The product has not been
determined by regulatory authorities to be safe and effective for any other
use.
About CV Therapeutics
CV Therapeutics, Inc., headquartered in Palo Alto, California, is a
biopharmaceutical company focused on applying molecular cardiology to the
discovery, development and commercialization of novel, small molecule drugs
for the treatment of cardiovascular diseases.
CV Therapeutics' approved product, Ranexa(R) (ranolazine
extended-release tablets), is indicated for the treatment of chronic angina
in patients who have not achieved an adequate response with other
antianginal drugs, and should be used in combination with amlodipine,
beta-blockers or nitrates.
CV Therapeutics' clinical and preclinical drug development candidates
and programs, including regadenoson, which is being developed for potential
use as a pharmacologic stress agent in myocardial perfusion imaging
studies, and CVT-6883, which is being developed as a potential treatment
for cardiopulmonary diseases. Regadenoson and CVT-6883 have not been
determined by any regulatory authorities to be safe or effective in humans
for any use.
Except for the historical information contained herein, the matters set
forth in this press release, including statements as to treatment
guidelines, are forward-looking statements within the meaning of the "safe
harbor" provisions of the Private Securities Litigation Reform Act of 1995.
These forward-looking statements are subject to risks and uncertainties
that may cause actual results to differ materially, including operating
losses and fluctuations in operating results; capital requirements;
regulatory review and approval of our products; special protocol assessment
agreement; the conduct and timing of clinical trials; commercialization of
products; market acceptance of products; product labeling; concentrated
customer base; and other risks detailed from time to time in CV
Therapeutics' SEC reports, including its Quarterly Report on Form 10-Q for
the quarter ended June 30, 2007. CV Therapeutics disclaims any intent or
obligation to update these forward-looking statements.
CV Therapeutics, Inc.
cvt
Inc. (Nasdaq: CVTX) announced today that new guidelines, developed jointly
by the American College of Cardiology Foundation and the American Heart
Association and published in this week's issue of Circulation, state that,
"ranolazine may be safely administered for symptom relief after UA/NSTEMI."
Ranexa(R) (ranolazine extended-release tablets) is indicated for the
treatment of chronic angina in patients who have not achieved an adequate
response with other antianginal drugs, and should be used in combination
with amlodipine, beta-blockers or nitrates. The product has not been
determined by regulatory authorities to be safe and effective for any other
use.
About CV Therapeutics
CV Therapeutics, Inc., headquartered in Palo Alto, California, is a
biopharmaceutical company focused on applying molecular cardiology to the
discovery, development and commercialization of novel, small molecule drugs
for the treatment of cardiovascular diseases.
CV Therapeutics' approved product, Ranexa(R) (ranolazine
extended-release tablets), is indicated for the treatment of chronic angina
in patients who have not achieved an adequate response with other
antianginal drugs, and should be used in combination with amlodipine,
beta-blockers or nitrates.
CV Therapeutics' clinical and preclinical drug development candidates
and programs, including regadenoson, which is being developed for potential
use as a pharmacologic stress agent in myocardial perfusion imaging
studies, and CVT-6883, which is being developed as a potential treatment
for cardiopulmonary diseases. Regadenoson and CVT-6883 have not been
determined by any regulatory authorities to be safe or effective in humans
for any use.
Except for the historical information contained herein, the matters set
forth in this press release, including statements as to treatment
guidelines, are forward-looking statements within the meaning of the "safe
harbor" provisions of the Private Securities Litigation Reform Act of 1995.
These forward-looking statements are subject to risks and uncertainties
that may cause actual results to differ materially, including operating
losses and fluctuations in operating results; capital requirements;
regulatory review and approval of our products; special protocol assessment
agreement; the conduct and timing of clinical trials; commercialization of
products; market acceptance of products; product labeling; concentrated
customer base; and other risks detailed from time to time in CV
Therapeutics' SEC reports, including its Quarterly Report on Form 10-Q for
the quarter ended June 30, 2007. CV Therapeutics disclaims any intent or
obligation to update these forward-looking statements.
CV Therapeutics, Inc.
cvt
воскресенье, 19 июня 2011 г.
Evolution Of Optimal Below-Knee Stents Revealed
Choosing the type of endoluminal treatment for infrapopliteal artery lesions can be controversial. Bioabsorbable stents are a new means
to attempt to prevent vessel recoil and eliminate the presence of permanent metal implant.
It is thought the absence of a metallic
implant may permit positive remodeling with lumen enlargement to compensate for the development of new lesions.
Koen Deloose, M.D., Vascular Surgeon at AZ Sint-Blasius Hospital, Dendermonde, Belgium, presented his study, which randomized 117
patients with chronic limb ischemia and with 149 lesions to implantation of an absorbable metal stent, or AMS (60 patients, 74 lesions)
versus a stand-alone percutaneous transluminal angioplasty, or PTA (57 patients, 75 lesions).
The 30-day complication rate was 5.3%
(3/57) and 5.0 % (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively.
On an intentionto-treat basis, the 6-month angiographic patency rate at for the lesions treated with AMS (31.8 %) was significantly inferior (p=0.013) to those treated with PTA (58.0 %).
Although the present study indicates that the AMS technology can be safely applied, it did
not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.
Initial studies show AMS to be a
safe technique, bet design modifications are needed and further studies should be performed before being widely adopted..but the
future looks positive.
VEITH SYMPOSIUM - New York, November 19th to 23rd
Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.
VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.
veithsymposium
Source
Pauline T. Mayer
ptmhcm
to attempt to prevent vessel recoil and eliminate the presence of permanent metal implant.
It is thought the absence of a metallic
implant may permit positive remodeling with lumen enlargement to compensate for the development of new lesions.
Koen Deloose, M.D., Vascular Surgeon at AZ Sint-Blasius Hospital, Dendermonde, Belgium, presented his study, which randomized 117
patients with chronic limb ischemia and with 149 lesions to implantation of an absorbable metal stent, or AMS (60 patients, 74 lesions)
versus a stand-alone percutaneous transluminal angioplasty, or PTA (57 patients, 75 lesions).
The 30-day complication rate was 5.3%
(3/57) and 5.0 % (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively.
On an intentionto-treat basis, the 6-month angiographic patency rate at for the lesions treated with AMS (31.8 %) was significantly inferior (p=0.013) to those treated with PTA (58.0 %).
Although the present study indicates that the AMS technology can be safely applied, it did
not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.
Initial studies show AMS to be a
safe technique, bet design modifications are needed and further studies should be performed before being widely adopted..but the
future looks positive.
VEITH SYMPOSIUM - New York, November 19th to 23rd
Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.
VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.
veithsymposium
Source
Pauline T. Mayer
ptmhcm
суббота, 18 июня 2011 г.
Coronary Heart Disease: Spotting The Culprit(s) Is The Way Towards Prevention, UK
In the sumptuous main hall of the Wills Memorial Building, Bristol
University, almost 500 people - mostly laypersons with a percentage of international
scientists and researchers - attended last Sept. 18, the public lecture "Who
nearly killed Sir Ranulph Fiennes?". The lecture was organized by the Bristol Heart
Institute in collaboration with the Bristol University, and took place during the joint
meetings of the European Vascular Genomics Network (EVGN, evgn/),
and the 4th European Meeting on Vascular Biology and Medicine (EMVBM). An event
that gathered more than 400 experts, among cardiologists and diabetes researchers,
hematologists, thrombosis scientists, gene therapists and oncologists.
Placing himself in the role of the witty investigator Hercule Poirot, Professor Andrew
Newby, President of the European Vascular Biology Organization (EVBO) and British
Heart Foundation Professor of Vascular Cell Biology at Bristol University's Bristol Heart
Institute, led the audience through arteries and veins, along a fantastic journey inside
a human organism in the process of developing coronary artery disease. He
interrogated likely culprits and, eventually, got to the solution of the case.
"People underestimate the role that the environment or life-style factors play in the
development of coronary artery disease" commented Professor Newby who is also
EVGN co-Director. "The purpose of this lecture was to show them the real damage
caused by this disease. Unfortunately, once altered, some of the biochemical
pathways that keep our organism alive and healthy are hardly ever restorable. Hence
the importance of prevention and of public awareness".
Beginning his journey with the description of the early signs of coronary disease,
Professor Newby opened a number of more technical windows on the actors on the
stage. He dissected the structure of atherosclerotic plaques and highlighted the role of
monocytes and macrophages in the dramatic changes that occur inside the blood
vessels microenvironment. All the take-home messages were clear-cut and the whole
presentation hit the target.
"We really need events like this one" pointed out Professor Gianni Angelini, Chairman
of the Bristol Heart Institute, founded in 1995, that soon become an international
centre of excellence for carrying out interdisciplinary cardiovascular research able to
bridge the void between clinical and basic science. "Untile recently there were little
contacts between BHI and the public opinion. Then we realized the importance of
establishing a solid dialogue with the population, aimed at keeping people informed on
our activities and at receiving individual feedbacks on their health. Therefore, two
years ago we decided to organize public lectures on a regular basis". The contacts
between the BHI and the population are not mere words: four times a year, infact, all
the patients treated at the BHI receive a Newsletter that keeps them up to date on
the most recent progress in the field. "We also send the patients a questionnare -
explains Professor Angelini - asking them to inform us on their health status, and
their availability to be enrolled in future trials".
With 230 scientists, over 1000 peer-reviewed papers since 2000 and research
fundings of 56 million Pounds coming from 160 separate grants, the Bristol Heart
Institute has become "??¦ an umbrella that gathers the major clinical Institutions and
research groups, to strenghten the link between basic research and clinical
applications".
Why mentioning Sir Ranulph Fiennes? "Because he is a symbol of hope and personal
involvement" said Professor Andrew Newby. "Sir Ranulph Fiennes, "The world's
greatest living explorer" according to the Guinness book of records, agreed to become
patron of the Bristol Heart Institute in 2005. In 2003, he underwent emergency heart
surgery at Bristol Royal Infirmary when he suffered a heart attack just before
boarding a plane at Bristol airport. 3 months after his double-bypass operation he ran
7 marathons on 7 continents in 7 days, to raise money for the British Heart
Foundation (for which he is also an ambassador)".
The European Vascular Genomics Network (EVGN) is the first Network of excellence
on cardiovascular disease funded by the European Commission under the 6th
Framework Programme "Life sciences, genomics and biotechnology for health"
(Contract Number: LSHM-CT-2003-503254).
The Conference is supported by an unrestricted educational grant from Laboratoires
SERVIER.
evgn/
University, almost 500 people - mostly laypersons with a percentage of international
scientists and researchers - attended last Sept. 18, the public lecture "Who
nearly killed Sir Ranulph Fiennes?". The lecture was organized by the Bristol Heart
Institute in collaboration with the Bristol University, and took place during the joint
meetings of the European Vascular Genomics Network (EVGN, evgn/),
and the 4th European Meeting on Vascular Biology and Medicine (EMVBM). An event
that gathered more than 400 experts, among cardiologists and diabetes researchers,
hematologists, thrombosis scientists, gene therapists and oncologists.
Placing himself in the role of the witty investigator Hercule Poirot, Professor Andrew
Newby, President of the European Vascular Biology Organization (EVBO) and British
Heart Foundation Professor of Vascular Cell Biology at Bristol University's Bristol Heart
Institute, led the audience through arteries and veins, along a fantastic journey inside
a human organism in the process of developing coronary artery disease. He
interrogated likely culprits and, eventually, got to the solution of the case.
"People underestimate the role that the environment or life-style factors play in the
development of coronary artery disease" commented Professor Newby who is also
EVGN co-Director. "The purpose of this lecture was to show them the real damage
caused by this disease. Unfortunately, once altered, some of the biochemical
pathways that keep our organism alive and healthy are hardly ever restorable. Hence
the importance of prevention and of public awareness".
Beginning his journey with the description of the early signs of coronary disease,
Professor Newby opened a number of more technical windows on the actors on the
stage. He dissected the structure of atherosclerotic plaques and highlighted the role of
monocytes and macrophages in the dramatic changes that occur inside the blood
vessels microenvironment. All the take-home messages were clear-cut and the whole
presentation hit the target.
"We really need events like this one" pointed out Professor Gianni Angelini, Chairman
of the Bristol Heart Institute, founded in 1995, that soon become an international
centre of excellence for carrying out interdisciplinary cardiovascular research able to
bridge the void between clinical and basic science. "Untile recently there were little
contacts between BHI and the public opinion. Then we realized the importance of
establishing a solid dialogue with the population, aimed at keeping people informed on
our activities and at receiving individual feedbacks on their health. Therefore, two
years ago we decided to organize public lectures on a regular basis". The contacts
between the BHI and the population are not mere words: four times a year, infact, all
the patients treated at the BHI receive a Newsletter that keeps them up to date on
the most recent progress in the field. "We also send the patients a questionnare -
explains Professor Angelini - asking them to inform us on their health status, and
their availability to be enrolled in future trials".
With 230 scientists, over 1000 peer-reviewed papers since 2000 and research
fundings of 56 million Pounds coming from 160 separate grants, the Bristol Heart
Institute has become "??¦ an umbrella that gathers the major clinical Institutions and
research groups, to strenghten the link between basic research and clinical
applications".
Why mentioning Sir Ranulph Fiennes? "Because he is a symbol of hope and personal
involvement" said Professor Andrew Newby. "Sir Ranulph Fiennes, "The world's
greatest living explorer" according to the Guinness book of records, agreed to become
patron of the Bristol Heart Institute in 2005. In 2003, he underwent emergency heart
surgery at Bristol Royal Infirmary when he suffered a heart attack just before
boarding a plane at Bristol airport. 3 months after his double-bypass operation he ran
7 marathons on 7 continents in 7 days, to raise money for the British Heart
Foundation (for which he is also an ambassador)".
The European Vascular Genomics Network (EVGN) is the first Network of excellence
on cardiovascular disease funded by the European Commission under the 6th
Framework Programme "Life sciences, genomics and biotechnology for health"
(Contract Number: LSHM-CT-2003-503254).
The Conference is supported by an unrestricted educational grant from Laboratoires
SERVIER.
evgn/
пятница, 17 июня 2011 г.
Many Blackout Patients Misdiagnosed With Epilepsy
Anyone with unexplained blackouts can now access a new checklist to help them and their doctors reach a correct diagnosis. The Blackouts Checklist will be useful for millions, as nearly half of the UK population will suffer blackouts at some stage in life.1 Supporting the launch of this campaign is Sir Roger Moore, patron of STARS, the blackouts charity. The Blackouts Checklist, endorsed by the Department of Health, is available from STARS at stars.uk.
Sir Roger fronted an appeal on BBC Radio 4, on Sunday 18 March, on behalf of STARS. Sir Roger commented, "I was lucky, having blacked out on stage I received excellent and rapid medical attention, and I now have a pacemaker which kicks in whenever my heart rhythm requires a correction. Thousands of sufferers aren't so lucky."
Blackouts triggered by cardiovascular irregularities can appear similar to epileptic seizures and are often misdiagnosed as such.1 These blackouts happen when blood supply to the brain is interrupted,2 this is known medically as syncope [SIN-koh-pee]. Blackouts are much more likely to be due to syncope than epilepsy.3 Despite this, the condition is relatively unknown, and it is estimated that over a third of patients diagnosed with epilepsy may have been misdiagnosed.1
Many blackout patients never see a heart rhythm specialist and become diagnosed incorrectly. Sir Roger added, "This checklist is what anyone who has had a blackout should use, as it could save years of confusion, fear and the tragedy of misdiagnosis."
Blackouts can also be a first symptom of a fatal irregular heart rhythm,4 which causes over 100,000 deaths every year in the UK.5 Many of these lives could be saved with appropriate diagnosis and treatment.6 Despite these arrhythmias (heart rhythm disorders) being the leading single cause of death in the UK,7 there are fewer than 70 heart rhythm specialists in the whole country8 - not even one for every ten thousand sufferers.6
"A failure to realise that blackouts are much more likely to be due to syncope than epilepsy can frequently lead to misdiagnosis of epilepsy. Also, a "faint", (the commonest cause of syncope), can be abrupt, can be accompanied by twitching and jerking, injuries and incontinence, just like epilepsy" - explained Dr Adam Fitzpatrick, a Cardiologist and Heart Rhythm Specialist from the Manchester Heart Centre. "It is really important that patients provide as much accurate information as possible when they see their doctor, and always attend with an eye-witness wherever possible. Another valuable contribution is video. Increasingly, the use of video-phones for recording an attack is adding huge value. The Blackouts Checklist is exactly what we need patients to use as a guide when seeking an accurate diagnosis and effective treatment."
Trudie Lobban, founder of STARS, added, "When patients are empowered with important information they can help their doctor better understand the symptoms and nature of their blackouts. This can help avoid a long list of referrals, misdiagnosis and inappropriate treatment before an accurate diagnosis is secured."
Patients and parents can access a copy of the checklist from stars.uk.
A download of Sir Roger Moore's BBC Radio 4 appeal (broadcast on Sunday 18 and repeated on Thursday 22 March 2007), is accessible at bbc.co.uk/radio4.
STARS was founded by Trudie Lobban in 1993 after her daughter Francesca was diagnosed with Reflex Anoxic Syncope with the support of Prof. J Stephenson, Consultant Paediatric Neurologist - Royal Hospital for Sick Children, Glasgow.
STARS aims to alleviate the effects of, and provide support and information on, syncope to those in distress as a result of these blackouts, whether suffered by themselves or as a member of the family group.
STARS patrons include Sir Roger Moore, Twiggy and celebrity chef John Burton Race. Sir Roger and John Burton Race have both suffered from syncope and have pacemakers fitted.
References
1. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 : September/October : Conference reports
2. European Society of Cardiology, Guidelines on Management (Diagnosis and Treatment) of Syncope,
Update 2004 escardio
3. Fitzpatrick, A; Cooper P. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568
4. STARS Syncope Handout
5. Arrhythmia Alliance data on file
6. Department of Health, National Service Framework, Arrhythmias and Sudden Cardiac Death,
Chapter Eight, 4 March, 2005. Link here.
7. Heart Rhythm UK hruk.uk
8. Arrhythmia Alliance Annual UK Heart Rhythm Congress, September 2006 - retrieved from heartrhythmcharity.uk on 7 March 2007
stars.uk
Sir Roger fronted an appeal on BBC Radio 4, on Sunday 18 March, on behalf of STARS. Sir Roger commented, "I was lucky, having blacked out on stage I received excellent and rapid medical attention, and I now have a pacemaker which kicks in whenever my heart rhythm requires a correction. Thousands of sufferers aren't so lucky."
Blackouts triggered by cardiovascular irregularities can appear similar to epileptic seizures and are often misdiagnosed as such.1 These blackouts happen when blood supply to the brain is interrupted,2 this is known medically as syncope [SIN-koh-pee]. Blackouts are much more likely to be due to syncope than epilepsy.3 Despite this, the condition is relatively unknown, and it is estimated that over a third of patients diagnosed with epilepsy may have been misdiagnosed.1
Many blackout patients never see a heart rhythm specialist and become diagnosed incorrectly. Sir Roger added, "This checklist is what anyone who has had a blackout should use, as it could save years of confusion, fear and the tragedy of misdiagnosis."
Blackouts can also be a first symptom of a fatal irregular heart rhythm,4 which causes over 100,000 deaths every year in the UK.5 Many of these lives could be saved with appropriate diagnosis and treatment.6 Despite these arrhythmias (heart rhythm disorders) being the leading single cause of death in the UK,7 there are fewer than 70 heart rhythm specialists in the whole country8 - not even one for every ten thousand sufferers.6
"A failure to realise that blackouts are much more likely to be due to syncope than epilepsy can frequently lead to misdiagnosis of epilepsy. Also, a "faint", (the commonest cause of syncope), can be abrupt, can be accompanied by twitching and jerking, injuries and incontinence, just like epilepsy" - explained Dr Adam Fitzpatrick, a Cardiologist and Heart Rhythm Specialist from the Manchester Heart Centre. "It is really important that patients provide as much accurate information as possible when they see their doctor, and always attend with an eye-witness wherever possible. Another valuable contribution is video. Increasingly, the use of video-phones for recording an attack is adding huge value. The Blackouts Checklist is exactly what we need patients to use as a guide when seeking an accurate diagnosis and effective treatment."
Trudie Lobban, founder of STARS, added, "When patients are empowered with important information they can help their doctor better understand the symptoms and nature of their blackouts. This can help avoid a long list of referrals, misdiagnosis and inappropriate treatment before an accurate diagnosis is secured."
Patients and parents can access a copy of the checklist from stars.uk.
A download of Sir Roger Moore's BBC Radio 4 appeal (broadcast on Sunday 18 and repeated on Thursday 22 March 2007), is accessible at bbc.co.uk/radio4.
STARS was founded by Trudie Lobban in 1993 after her daughter Francesca was diagnosed with Reflex Anoxic Syncope with the support of Prof. J Stephenson, Consultant Paediatric Neurologist - Royal Hospital for Sick Children, Glasgow.
STARS aims to alleviate the effects of, and provide support and information on, syncope to those in distress as a result of these blackouts, whether suffered by themselves or as a member of the family group.
STARS patrons include Sir Roger Moore, Twiggy and celebrity chef John Burton Race. Sir Roger and John Burton Race have both suffered from syncope and have pacemakers fitted.
References
1. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 : September/October : Conference reports
2. European Society of Cardiology, Guidelines on Management (Diagnosis and Treatment) of Syncope,
Update 2004 escardio
3. Fitzpatrick, A; Cooper P. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568
4. STARS Syncope Handout
5. Arrhythmia Alliance data on file
6. Department of Health, National Service Framework, Arrhythmias and Sudden Cardiac Death,
Chapter Eight, 4 March, 2005. Link here.
7. Heart Rhythm UK hruk.uk
8. Arrhythmia Alliance Annual UK Heart Rhythm Congress, September 2006 - retrieved from heartrhythmcharity.uk on 7 March 2007
stars.uk
четверг, 16 июня 2011 г.
Different Treatment Options In Chronic Coronary Artery Disease
Sometimes cardiologists and cardiac surgeons can agree! There is often disagreement between the professions of cardiology and cardiac surgery about the proper therapy for coronary artery disease (CAD) and this can harm the patient. In the current edition of Deutsches Arzteblatt International, an interdisciplinary team of authors consisting of cardiologists and cardiac surgeons provides answers to the question of when a bypass operation (ACB) and when percutaneous coronary intervention (PCI) is effective (Dtsch Arztebl Int 2009; 106(15): 253-61). Martin Russ, Jochen Cremer and coauthors show that ACB and PCI are of equivalent value and can be placed in a complementary treatment plan.
The authors not only consider the results of randomized controlled studies, but extend their overview to the analyses of registries, which provide complementary data.
Thus PCI or ACB is advisable in those patients who still suffer from angina pectoris under drug treatment or for whom relevant ischemia has been demonstrated by non-invasive methods. According to the authors, the main indication for aortocoronary bypass surgery is when the proportion of ischemic myocardia is at least 10%. A bypass operation can greatly improve the symptoms in the intermediate and long term. Severe comorbidity, such as renal failure or chronic obstructive pulmonary disease, support the use of PCI rather than ACB.
In critical constellations, the decision about the procedure to be used should be shared by cardiologists and cardiac surgeons, who must consider the patient's expectations, as well as the advantages and disadvantages in the short and long term.
The authors not only consider the results of randomized controlled studies, but extend their overview to the analyses of registries, which provide complementary data.
Thus PCI or ACB is advisable in those patients who still suffer from angina pectoris under drug treatment or for whom relevant ischemia has been demonstrated by non-invasive methods. According to the authors, the main indication for aortocoronary bypass surgery is when the proportion of ischemic myocardia is at least 10%. A bypass operation can greatly improve the symptoms in the intermediate and long term. Severe comorbidity, such as renal failure or chronic obstructive pulmonary disease, support the use of PCI rather than ACB.
In critical constellations, the decision about the procedure to be used should be shared by cardiologists and cardiac surgeons, who must consider the patient's expectations, as well as the advantages and disadvantages in the short and long term.
среда, 15 июня 2011 г.
Aspirin Does Not Prevent Heart Attacks In Diabetes Patients
Taking regular aspirin and antioxidant supplements does not prevent heart attacks even in high risk groups with diabetes and asymptomatic arterial disease, and aspirin should only be given to patients with established heart disease, stroke or limb arterial disease, according to a study published today on bmj.
In light of these findings, and the evidence from six other well controlled trials, the prescribing practice of doctors and international guidelines should be reviewed so that aspirin is only prescribed to patients with established heart and stroke disease, argues the author of an accompanying editorial.
Patients with diabetes are two to five times more likely to suffer from heart disease than the general population and heart disease is a major cause of death in patients with type 1 and 2 diabetes. Although there is considerable evidence showing no protective benefit of aspirin in high risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.
But aspirin is one of the top 10 causes of adverse drug events reported to the Commission on Human Medicines. It causes gastrointestinal bleeding and the risk of bleeding increases with age and prolonged use.
Professor Jill Belch and colleagues from Scotland investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease. 1276 patients with diabetes and evidence of artery disease over 40 years of age were randomised to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant or double placebo, and followed over eight years.
Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.
The authors conclude by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.
These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin, writes Professor William Hiatt in an accompanying editorial.
Research paper:
"The prevention of progression of arterial disease and diabetes (POPADAD): a factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease
Jill Belch, Angus MacCuish, Iain Campbell, Stuart Cobbe, Roy Taylor, Robin Prescott, Robert Lee, Jean Bancroft, Shirley MacEwan, James Shepherd, Peter Macfarlane, Andrew Morris, Roland Jung, Christopher Kelly, Alan Connacher, Norman Peden, Andrew Jamieson, David Matthews, Graeme Leese , John McKnight, Iain O'Brien, Colin Semple, John Petrie, Derek Gordon, Stuart Pringle, Ron MacWalter
BMJ 2008;337:a1840 doi:10.1136/bmj.a1840
Click here to view abstract online
Editorial:
"Aspirin for prevention of cardiovascular events"
BMJ 2008;337:a1806 doi:10.1136/bmj.a1806
Click here to view first 150 words online
British Medical Journal
bmj
In light of these findings, and the evidence from six other well controlled trials, the prescribing practice of doctors and international guidelines should be reviewed so that aspirin is only prescribed to patients with established heart and stroke disease, argues the author of an accompanying editorial.
Patients with diabetes are two to five times more likely to suffer from heart disease than the general population and heart disease is a major cause of death in patients with type 1 and 2 diabetes. Although there is considerable evidence showing no protective benefit of aspirin in high risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.
But aspirin is one of the top 10 causes of adverse drug events reported to the Commission on Human Medicines. It causes gastrointestinal bleeding and the risk of bleeding increases with age and prolonged use.
Professor Jill Belch and colleagues from Scotland investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease. 1276 patients with diabetes and evidence of artery disease over 40 years of age were randomised to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant or double placebo, and followed over eight years.
Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.
The authors conclude by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.
These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin, writes Professor William Hiatt in an accompanying editorial.
Research paper:
"The prevention of progression of arterial disease and diabetes (POPADAD): a factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease
Jill Belch, Angus MacCuish, Iain Campbell, Stuart Cobbe, Roy Taylor, Robin Prescott, Robert Lee, Jean Bancroft, Shirley MacEwan, James Shepherd, Peter Macfarlane, Andrew Morris, Roland Jung, Christopher Kelly, Alan Connacher, Norman Peden, Andrew Jamieson, David Matthews, Graeme Leese , John McKnight, Iain O'Brien, Colin Semple, John Petrie, Derek Gordon, Stuart Pringle, Ron MacWalter
BMJ 2008;337:a1840 doi:10.1136/bmj.a1840
Click here to view abstract online
Editorial:
"Aspirin for prevention of cardiovascular events"
BMJ 2008;337:a1806 doi:10.1136/bmj.a1806
Click here to view first 150 words online
British Medical Journal
bmj
вторник, 14 июня 2011 г.
Coronary Disease: A New Perspective Thanks To Ultrasound
Compared to other techniques, Intravascular Ultrasound (IVUS) is much better at monitoring the increase or decrease of atherosclerosis in the coronary arteries. Can the method even be used to predict the odds of a heart attack or other cardiovascular event? Studies indicate this may be the case, states Professor Clemens von Birgelen in his inaugural address at the University of Twente. Results of IVUS measurements also raise the question of whether patients with demonstrated coronary disease should be treated with more powerful cholesterol-lowering statins to reverse atherosclerosis. Von Birgelen's inaugural address takes place on 5 June.
Narrowed coronary arteries due to atherosclerosis can be visualised using 'classic' cardiac catheterisation, but the technique only shows the space the blood flows through, the 'lumen', and not the diseased vascular wall surrounding it. By using a specialised catheter with an ultrasound 'sensor', IVUS also creates images of the calcifications, the 'plaque', and allows various components of the plaque to be identified not only calcium, but also fat and connective tissue. Von Birgelen states that this additional information is important for assessing disease progression - plaque progression. Plaque initially leaves the lumen unaffected and grows outward. The blood vessel as a whole becomes wider, leading to a significantly increased risk of heart attack. However, plaques may also decrease in volume while the lumen diameter remains the same, something that can only be determined using IVUS.
Statins
Various studies have shown a relationship between plaque growth and cardiovascular events, such as heart attacks. "Plaque progression measured using IVUS could become a valuable 'surrogate marker' for cardiovascular events", states Von Birgelen. In his address, he also highlights the relationship between plaque progression and cholesterol. Decreasing cholesterol through intensive statin therapy not only slows plaque formation, but actually reverses it. This is reason enough for the professor to question the current target value for LDL cholesterol of 2.5 for patients with coronary disease; at that value, over half of patients still have plaque growth. Von Birgelen wants to determine whether or not a large group of patients is receiving sub-optimal treatment for reducing plaque.
Drug eluting stents
IVUS also plays an important role in the treatment of narrow coronary arteries, for example during balloon dilation and the placement of a so-called 'stent'. New types of stents are being made with integrated regulated drug release to prevent the formation of scar tissue in the stent thereby decreasing the odds of recurrence. Von Birgelen is currently performing research on these new stents at the University of Twente, and will soon be launching the so-called 'TWENTE study' at the Medisch Spectrum Twente hospital, in which about 1400 patients will be treated with one of two promising drug eluting stents in order to compare the clinical results. "During some PCI procedures, IVUS is essential for properly guiding the implantation", according to Von Birgelen. He believes that good invasive imaging of the coronary arteries will remain important in future in order to safeguard the quality of care for heart patients.
Professor Clemens von Birgelen is a cardiologist on staff at the Thorax Centre of the Medisch Spectrum Twente in Enschede. His Chair at the University of Twente, made possible in part by the Heart Centre Twente Foundation and entrepreneur Ferdinand Fransen, shares the university's ambition to play a leading role in the development and application of technology in healthcare.
TWENTE UNIVERSITY
P.O. Box 217
7500 AE Enschede
utwente.nl
Narrowed coronary arteries due to atherosclerosis can be visualised using 'classic' cardiac catheterisation, but the technique only shows the space the blood flows through, the 'lumen', and not the diseased vascular wall surrounding it. By using a specialised catheter with an ultrasound 'sensor', IVUS also creates images of the calcifications, the 'plaque', and allows various components of the plaque to be identified not only calcium, but also fat and connective tissue. Von Birgelen states that this additional information is important for assessing disease progression - plaque progression. Plaque initially leaves the lumen unaffected and grows outward. The blood vessel as a whole becomes wider, leading to a significantly increased risk of heart attack. However, plaques may also decrease in volume while the lumen diameter remains the same, something that can only be determined using IVUS.
Statins
Various studies have shown a relationship between plaque growth and cardiovascular events, such as heart attacks. "Plaque progression measured using IVUS could become a valuable 'surrogate marker' for cardiovascular events", states Von Birgelen. In his address, he also highlights the relationship between plaque progression and cholesterol. Decreasing cholesterol through intensive statin therapy not only slows plaque formation, but actually reverses it. This is reason enough for the professor to question the current target value for LDL cholesterol of 2.5 for patients with coronary disease; at that value, over half of patients still have plaque growth. Von Birgelen wants to determine whether or not a large group of patients is receiving sub-optimal treatment for reducing plaque.
Drug eluting stents
IVUS also plays an important role in the treatment of narrow coronary arteries, for example during balloon dilation and the placement of a so-called 'stent'. New types of stents are being made with integrated regulated drug release to prevent the formation of scar tissue in the stent thereby decreasing the odds of recurrence. Von Birgelen is currently performing research on these new stents at the University of Twente, and will soon be launching the so-called 'TWENTE study' at the Medisch Spectrum Twente hospital, in which about 1400 patients will be treated with one of two promising drug eluting stents in order to compare the clinical results. "During some PCI procedures, IVUS is essential for properly guiding the implantation", according to Von Birgelen. He believes that good invasive imaging of the coronary arteries will remain important in future in order to safeguard the quality of care for heart patients.
Professor Clemens von Birgelen is a cardiologist on staff at the Thorax Centre of the Medisch Spectrum Twente in Enschede. His Chair at the University of Twente, made possible in part by the Heart Centre Twente Foundation and entrepreneur Ferdinand Fransen, shares the university's ambition to play a leading role in the development and application of technology in healthcare.
TWENTE UNIVERSITY
P.O. Box 217
7500 AE Enschede
utwente.nl
понедельник, 13 июня 2011 г.
AGGRASTAT(R), Lowers Incidence Of Heart Attack, In Patients Who Respond Poorly To Aspirin Or Clopidogrel, After Elective Coronary Angioplasty
Antiplatelet medicine, AGGRASTAT® (tirofiban HCL), a glycoprotein IIb/IIIa inhibitor, has been shown to significantly lower the incidence of heart attack after elective coronary angioplasty, in patients with coronary artery disease who have shown poor response to standard oral antiplatelet agents such as aspirin and clopidogrel.1 These results were announced at the Annual European Society of Cardiology Congress in Munich, Germany.
"These findings are significant in that we demonstrate a proof of concept for a new treatment strategy in a patient segment whose needs have so far remained unaddressed - managing for the increased risk of thrombotic events due to non-responsiveness of patients to standard oral antiplatelets such as aspirin or clopidogrel," said Dr Marco Valgimigli, Chair of Cardiology, University of Ferrara, Italy and principal investigator of the 3T/2R Study (Tailoring Treatment with Tirofiban in patients showing Resistance to aspirin and/or Resistance to clopidogrel).
Inhibition of platelet aggregation following an intake of aspirin or clopidogrel varies greatly among patients, and previous studies have shown that poor response to oral antiplatelet agents increases the risk of thrombotic events, especially after coronary angioplasty.1 It was previously unknown if this reflected suboptimal platelet inhibition per se which might benefit from alternative or more potent antiplatelet agents.
Enrolled in the study were 263 patients who were poor responders to aspirin and/or clopidogrel, based upon a point-of-care assay, who underwent elective coronary angioplasty at ten European sites for stable or low-risk unstable coronary artery disease. Patients were randomly assigned in a double blind manner to receive either AGGRASTAT® or placebo on top of standard aspirin and clopidogrel therapy.1 The primary end point was the occurrence of periprocedural myocardial infarction, as defined by an increase in Troponin I or T within 48 hours, and was observed in 20.4 percent of patients treated with AGGRASTAT®, compared to 35.1 percent of patient treated with placebo.1 This resulted in a significant reduction of major adverse cardiovascular events within 30 days in the AGGRASTAT® group compared to the placebo group (21.2 percent versus 36.6 percent, respectively; p=0.0065).1 The incidence of bleeding was low and did not differ between the two groups.1
"Current treatment strategies for patients with coronary artery disease ignore the individual response to antiplatelet agents, and likewise fail to identify therapeutic targets for platelet reactivity necessary to intensify treatment," said Dr Paul Gurbel, Director of Cardiovascular Research, Centre for Thrombosis Research, Sinai Hospital, Baltimore, USA. "These findings illustrate the efficacy and safety of AGGRASTAT® in treating poor responders to aspirin or clopidogrel, as compared to standard care. This study shows that by assessing response to standard antiplatelet agents by a point-of-care assay, intensity of treatment can be modulated accordingly."
Dr Gurbel further commented, "These data are in accordance with our earlier results from the CLEAR PLATELETS studies that have demonstrated the strong association between high periprocedural platelet reactivity and the risk of in-hospital myocardial infarction in patients undergoing elective stenting. The use of glycoprotein IIb/IIIa inhibitors, in patients identified as poor responders to oral antiplatelet agents by objective measurements of platelet function, makes perfect sense and deserves greater attention in future studies."
"These data findings are extremely encouraging for this patient population and we believe it reinforces the potential benefits of high-dose bolus AGGRASTAT®," said John Vavricka, President and Chief Executive Officer of Iroko Pharmaceuticals. "Iroko is committed to furthering clinical research in this area, and exploring AGGRASTAT®'s potential for patients who do not respond to oral anti-platelet therapy."
In January of 2008, Iroko Pharmaceuticals acquired all non-US commercial rights to AGGRASTAT® from Merck & Co., Inc. The 3T/2R study was initiated and conducted by the University of Ferrara, Italy with an unrestricted grant from Merck & Co., Inc. and Iroko.
About AGGRASTAT®
AGGRASTAT®, a glycoprotein IIb/IIIa inhibitor, is indicated for the prevention of early myocardial infarction in patients presenting with unstable angina or non-Q-wave myocardial infarction with the last episode of chest pain occurring within 12 hours and with ECG changes and/or elevated cardiac enzymes. Patients most likely to benefit from AGGRASTAT® treatment are those at high risk of developing myocardial infarction within the first 3-4 days after onset of acute angina symptoms including for instance those that are likely to undergo an early PTCA.
In most patients, AGGRASTAT® should be administered intravenously, at an initial rate of 0.4 mcg/kg/min for 30 minutes and then continued at 0.1 mcg/kg/min. For complete information, please refer to the product's prescribing information. AGGRASTAT® is intended for use with acetylsalicylic acid and unfractionated heparin.
AGGRASTAT® (tirofiban hydrochloride) is contraindicated in patients with known hypersensitivity to any component of the product; active internal bleeding or a history of bleeding diathesis within the previous 30 days; or a history of intracranial hemorrhage, intracranial neoplasm, arteriovenous malformation, or aneurysm. Other contraindications to AGGRASTAT® include: a history of thrombocytopenia following prior exposure to AGGRASTAT®; history of stroke within 30 days or any history of hemorrhagic stroke; major surgical procedure or severe physical trauma within the previous month; or history, symptoms, or findings suggestive of aortic dissection. AGGRASTAT® is also contraindicated in patients with: severe hypertension (systolic blood pressure >180 mmHg and/or diastolic blood pressure >110 mmHg); concomitant use of another parenteral GP IIb/IIIa inhibitor; or acute pericarditis.
Bleeding is the most common complication encountered during therapy with AGGRASTAT®. Administration of AGGRASTAT® is associated with an increase in bleeding events classified as both major and minor bleeding events, by criteria developed by the Thrombolysis in Myocardial Infarction Study group (TIMI). Most major bleeding associated with AGGRASTAT® occurs at the arterial access site for cardiac catheterization. Fatal bleedings have been reported. AGGRASTAT® should be used with caution in patients with platelet count
"These findings are significant in that we demonstrate a proof of concept for a new treatment strategy in a patient segment whose needs have so far remained unaddressed - managing for the increased risk of thrombotic events due to non-responsiveness of patients to standard oral antiplatelets such as aspirin or clopidogrel," said Dr Marco Valgimigli, Chair of Cardiology, University of Ferrara, Italy and principal investigator of the 3T/2R Study (Tailoring Treatment with Tirofiban in patients showing Resistance to aspirin and/or Resistance to clopidogrel).
Inhibition of platelet aggregation following an intake of aspirin or clopidogrel varies greatly among patients, and previous studies have shown that poor response to oral antiplatelet agents increases the risk of thrombotic events, especially after coronary angioplasty.1 It was previously unknown if this reflected suboptimal platelet inhibition per se which might benefit from alternative or more potent antiplatelet agents.
Enrolled in the study were 263 patients who were poor responders to aspirin and/or clopidogrel, based upon a point-of-care assay, who underwent elective coronary angioplasty at ten European sites for stable or low-risk unstable coronary artery disease. Patients were randomly assigned in a double blind manner to receive either AGGRASTAT® or placebo on top of standard aspirin and clopidogrel therapy.1 The primary end point was the occurrence of periprocedural myocardial infarction, as defined by an increase in Troponin I or T within 48 hours, and was observed in 20.4 percent of patients treated with AGGRASTAT®, compared to 35.1 percent of patient treated with placebo.1 This resulted in a significant reduction of major adverse cardiovascular events within 30 days in the AGGRASTAT® group compared to the placebo group (21.2 percent versus 36.6 percent, respectively; p=0.0065).1 The incidence of bleeding was low and did not differ between the two groups.1
"Current treatment strategies for patients with coronary artery disease ignore the individual response to antiplatelet agents, and likewise fail to identify therapeutic targets for platelet reactivity necessary to intensify treatment," said Dr Paul Gurbel, Director of Cardiovascular Research, Centre for Thrombosis Research, Sinai Hospital, Baltimore, USA. "These findings illustrate the efficacy and safety of AGGRASTAT® in treating poor responders to aspirin or clopidogrel, as compared to standard care. This study shows that by assessing response to standard antiplatelet agents by a point-of-care assay, intensity of treatment can be modulated accordingly."
Dr Gurbel further commented, "These data are in accordance with our earlier results from the CLEAR PLATELETS studies that have demonstrated the strong association between high periprocedural platelet reactivity and the risk of in-hospital myocardial infarction in patients undergoing elective stenting. The use of glycoprotein IIb/IIIa inhibitors, in patients identified as poor responders to oral antiplatelet agents by objective measurements of platelet function, makes perfect sense and deserves greater attention in future studies."
"These data findings are extremely encouraging for this patient population and we believe it reinforces the potential benefits of high-dose bolus AGGRASTAT®," said John Vavricka, President and Chief Executive Officer of Iroko Pharmaceuticals. "Iroko is committed to furthering clinical research in this area, and exploring AGGRASTAT®'s potential for patients who do not respond to oral anti-platelet therapy."
In January of 2008, Iroko Pharmaceuticals acquired all non-US commercial rights to AGGRASTAT® from Merck & Co., Inc. The 3T/2R study was initiated and conducted by the University of Ferrara, Italy with an unrestricted grant from Merck & Co., Inc. and Iroko.
About AGGRASTAT®
AGGRASTAT®, a glycoprotein IIb/IIIa inhibitor, is indicated for the prevention of early myocardial infarction in patients presenting with unstable angina or non-Q-wave myocardial infarction with the last episode of chest pain occurring within 12 hours and with ECG changes and/or elevated cardiac enzymes. Patients most likely to benefit from AGGRASTAT® treatment are those at high risk of developing myocardial infarction within the first 3-4 days after onset of acute angina symptoms including for instance those that are likely to undergo an early PTCA.
In most patients, AGGRASTAT® should be administered intravenously, at an initial rate of 0.4 mcg/kg/min for 30 minutes and then continued at 0.1 mcg/kg/min. For complete information, please refer to the product's prescribing information. AGGRASTAT® is intended for use with acetylsalicylic acid and unfractionated heparin.
AGGRASTAT® (tirofiban hydrochloride) is contraindicated in patients with known hypersensitivity to any component of the product; active internal bleeding or a history of bleeding diathesis within the previous 30 days; or a history of intracranial hemorrhage, intracranial neoplasm, arteriovenous malformation, or aneurysm. Other contraindications to AGGRASTAT® include: a history of thrombocytopenia following prior exposure to AGGRASTAT®; history of stroke within 30 days or any history of hemorrhagic stroke; major surgical procedure or severe physical trauma within the previous month; or history, symptoms, or findings suggestive of aortic dissection. AGGRASTAT® is also contraindicated in patients with: severe hypertension (systolic blood pressure >180 mmHg and/or diastolic blood pressure >110 mmHg); concomitant use of another parenteral GP IIb/IIIa inhibitor; or acute pericarditis.
Bleeding is the most common complication encountered during therapy with AGGRASTAT®. Administration of AGGRASTAT® is associated with an increase in bleeding events classified as both major and minor bleeding events, by criteria developed by the Thrombolysis in Myocardial Infarction Study group (TIMI). Most major bleeding associated with AGGRASTAT® occurs at the arterial access site for cardiac catheterization. Fatal bleedings have been reported. AGGRASTAT® should be used with caution in patients with platelet count
воскресенье, 12 июня 2011 г.
Study To Boost Quality Of Life And Improve Outcomes For Children Born With Half A Heart
A trial on shunts used to direct blood flow to the lungs, led by researchers at the University of Michigan's C.S. Mott Children's Hospital, will lead to better outcomes for kids worldwide born with hypoplastic left heart syndrome, the most common severe heart birth defect.
Under the leadership of the University of Michigan, the first multi-institutional randomized prospective trial ever conducted in congenital heart surgery was just completed by the Pediatric Heart Network with funding from the National Heart, Lung, Blood Institute.
Kids with the hypoplastic left heart syndrome have hearts that don't develop properly in the womb. Because the left side of the heart fails to develop, they are often referred to as being born with half a heart.
This groundbreaking study is published in the May 27, 2010 issue of the New England Journal of Medicine. Richard G. Ohye, M.D., Division Head of the Pediatric Cardiovascular Surgery at the University of Michigan's C.S. Mott Children's Hospital, is the study chair and lead author.
"Congenital heart disease is much more common than people realize," says Ohye. "Heart abnormalities are the most common birth defect, and it occurs in almost one out of every 100 live births."
Twenty years ago, doctors were unable to save these children with hypoplastic left heart syndrome. Today, because of efforts by the University of Michigan Congenital Heart Center and other centers like it around the world, most of these infants can be saved through a series of three operations that can be compared to re-plumbing their heart.
Research into this congenital defect has been rare because most centers do not see enough patients with any one diagnosis to be able to effectively study it. Hypoplastic left heart syndrome occurs in about 1,000 kids every year in the United States and it accounts for roughly about 8 percent of all different congenital heart defects.
"We can't really rebuild the heart so we have to make do with what there is -- the one pumping chamber," Ohye says. "So we re-plumb the heart so that the kids can get by with just the single ventricle or pumping chamber."
The treatment of hypoplastic left heart syndrome requires three operations and the first one is done around the time of birth, the second one at about four to six months of age and the last one at 18 to 24 months of age.
The University of Michigan has had a pioneering role in the treatment of hypoplastic left heart syndrome.
Prior to the early 1980s, there was no operation for it at all, so all the kids unfortunately died as newborns. Since that time, survivals have dramatically improved. Initially, they were quite low. During the 1990s, hospital survivals for the first operation were only about 40 percent. Now, at experienced centers, they're up above 90 percent.
In the first stage operation for hypoplastic left heart syndrome, there are two different versions. Researchers were interested in finding out which had a better survival rate.
One version gets blood directly from the heart through a tube, or shunt, to the artery to the lungs. The other allows the blood first to exit the heart through the reconstructed aorta and then bring the shunt from that reconstructed aorta over to the artery to the lungs.
"What we found was that the shunt that went directly from the heart to the artery to the lungs did better over the course of the first year," Ohye says. "We also found that they had tended to have a few more complications though, and so I think the jury's still out over the long run which is going to be better."
"We're going to continue to follow these kids," says Ohye. "We're almost up to a four-year follow-up at this point and then we'll continue to follow them and plan on looking at them again when they're about 8 or 10 years old."
This research also is significant because it is the very first randomized prospective trial ever done in congenital heart surgery. The study enrolled 555 kids and will provide a tremendous opportunity to observe them all the way into adulthood and follow them and see how they do.
"It is important to test anything we do to manage our patients in a rigorous scientific way, and it's the first time that we've ever gotten together, many centers - 15 in this case - and agreed that this was really important to do," Ohye adds. "We showed that we can do it and that we believe that it's important to do for our kids."
"Not only did the study answer an important question about how we care for them at birth, but it's going to continue to help us understand how we take care of them throughout their lives," says Ohye.
Additional authors paragraph: Richard G. Ohye, M.D., Lynn A. Sleeper, Sc.D., Lynn Mahony, M.D., Jane W. Newburger, M.D., M.P.H., Gail D. Pearson, M.D., Sc.D.,
Minmin Lu, M.S., Caren S. Goldberg, M.D., Sarah Tabbutt, M.D., Ph.D., Peter C. Frommelt, M.D., Nancy S. Ghanayem, M.D., Peter C. Laussen, M.B., B.S., John F. Rhodes, M.D., Alan B. Lewis, M.D., Seema Mital, M.D., Chitra Ravishankar, M.D., Ismee A. Williams, M.D., Carolyn Dunbar-Masterson, B.S.N., R.N., Andrew M. Atz, M.D., Steven Colan, M.D., L. LuAnn Minich, M.D., Christian Pizarro, M.D., Kirk R. Kanter, M.D., James Jaggers, M.D., Jeffrey P. Jacobs, M.D., Catherine Dent Krawczeski, M.D., Nancy Pike, R.N., Ph.D., Brian W. McCrindle, M.D., M.P.H., Lisa Virzi, R.N., M.S., M.B.A., and J. William Gaynor, M.D., for the Pediatric Heart Network Investigators
Funding source: Funded by the Pediatric Heart Network
Journal reference: N Engl J Med 2010;362:1980-92.
Source
University of Michigan Health System
Under the leadership of the University of Michigan, the first multi-institutional randomized prospective trial ever conducted in congenital heart surgery was just completed by the Pediatric Heart Network with funding from the National Heart, Lung, Blood Institute.
Kids with the hypoplastic left heart syndrome have hearts that don't develop properly in the womb. Because the left side of the heart fails to develop, they are often referred to as being born with half a heart.
This groundbreaking study is published in the May 27, 2010 issue of the New England Journal of Medicine. Richard G. Ohye, M.D., Division Head of the Pediatric Cardiovascular Surgery at the University of Michigan's C.S. Mott Children's Hospital, is the study chair and lead author.
"Congenital heart disease is much more common than people realize," says Ohye. "Heart abnormalities are the most common birth defect, and it occurs in almost one out of every 100 live births."
Twenty years ago, doctors were unable to save these children with hypoplastic left heart syndrome. Today, because of efforts by the University of Michigan Congenital Heart Center and other centers like it around the world, most of these infants can be saved through a series of three operations that can be compared to re-plumbing their heart.
Research into this congenital defect has been rare because most centers do not see enough patients with any one diagnosis to be able to effectively study it. Hypoplastic left heart syndrome occurs in about 1,000 kids every year in the United States and it accounts for roughly about 8 percent of all different congenital heart defects.
"We can't really rebuild the heart so we have to make do with what there is -- the one pumping chamber," Ohye says. "So we re-plumb the heart so that the kids can get by with just the single ventricle or pumping chamber."
The treatment of hypoplastic left heart syndrome requires three operations and the first one is done around the time of birth, the second one at about four to six months of age and the last one at 18 to 24 months of age.
The University of Michigan has had a pioneering role in the treatment of hypoplastic left heart syndrome.
Prior to the early 1980s, there was no operation for it at all, so all the kids unfortunately died as newborns. Since that time, survivals have dramatically improved. Initially, they were quite low. During the 1990s, hospital survivals for the first operation were only about 40 percent. Now, at experienced centers, they're up above 90 percent.
In the first stage operation for hypoplastic left heart syndrome, there are two different versions. Researchers were interested in finding out which had a better survival rate.
One version gets blood directly from the heart through a tube, or shunt, to the artery to the lungs. The other allows the blood first to exit the heart through the reconstructed aorta and then bring the shunt from that reconstructed aorta over to the artery to the lungs.
"What we found was that the shunt that went directly from the heart to the artery to the lungs did better over the course of the first year," Ohye says. "We also found that they had tended to have a few more complications though, and so I think the jury's still out over the long run which is going to be better."
"We're going to continue to follow these kids," says Ohye. "We're almost up to a four-year follow-up at this point and then we'll continue to follow them and plan on looking at them again when they're about 8 or 10 years old."
This research also is significant because it is the very first randomized prospective trial ever done in congenital heart surgery. The study enrolled 555 kids and will provide a tremendous opportunity to observe them all the way into adulthood and follow them and see how they do.
"It is important to test anything we do to manage our patients in a rigorous scientific way, and it's the first time that we've ever gotten together, many centers - 15 in this case - and agreed that this was really important to do," Ohye adds. "We showed that we can do it and that we believe that it's important to do for our kids."
"Not only did the study answer an important question about how we care for them at birth, but it's going to continue to help us understand how we take care of them throughout their lives," says Ohye.
Additional authors paragraph: Richard G. Ohye, M.D., Lynn A. Sleeper, Sc.D., Lynn Mahony, M.D., Jane W. Newburger, M.D., M.P.H., Gail D. Pearson, M.D., Sc.D.,
Minmin Lu, M.S., Caren S. Goldberg, M.D., Sarah Tabbutt, M.D., Ph.D., Peter C. Frommelt, M.D., Nancy S. Ghanayem, M.D., Peter C. Laussen, M.B., B.S., John F. Rhodes, M.D., Alan B. Lewis, M.D., Seema Mital, M.D., Chitra Ravishankar, M.D., Ismee A. Williams, M.D., Carolyn Dunbar-Masterson, B.S.N., R.N., Andrew M. Atz, M.D., Steven Colan, M.D., L. LuAnn Minich, M.D., Christian Pizarro, M.D., Kirk R. Kanter, M.D., James Jaggers, M.D., Jeffrey P. Jacobs, M.D., Catherine Dent Krawczeski, M.D., Nancy Pike, R.N., Ph.D., Brian W. McCrindle, M.D., M.P.H., Lisa Virzi, R.N., M.S., M.B.A., and J. William Gaynor, M.D., for the Pediatric Heart Network Investigators
Funding source: Funded by the Pediatric Heart Network
Journal reference: N Engl J Med 2010;362:1980-92.
Source
University of Michigan Health System
суббота, 11 июня 2011 г.
Open Surgery Often The Best Option In Patients With Critical Limb Ischemia?
There are certain clinical situations in which an endovascular-first approach may be pose greater risk than with an open
approach; in these situations, open surgery should be the initial procedure to maximize the short and long-term success of the
procedure for critical limb ischemia (CLI).
Peter F. Lawrence, M.D., Chief of Vascular Surgery and Director of the Gonda Vascular Center at UCLA, described anatomic situations in which open surgery should be the first choice: "Open surgery is the best initial option for patients with extensive disease in the common femoral artery that extends into the profunda femoris artery. Open surgery should be the first choice also in patients with TASC D disease of the infrapopliteal vessels and CLI".
Dr. Lawrence also specifically identified diabetics with CLI as a group of patients for which often open surgery is more favorable, as it is essential that
pulsatile blood flow is delivered to the lower leg.
He has found that endovascular procedures frequently recanalize only a segment of
the vessels of the lower extremity and do not provide pulsatile flow to the foot.
Importantly, Dr. Lawrence believes that when an
open procedure is selected as the initial therapy, the procedure should be minimally invasive to be comparable in morbidity
and mortality with an endovascular procedure.
VEITH SYMPOSIUM - New York, November 19th to 23rd
Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.
VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.
veithsymposium
Source
Pauline T. Mayer
ptmhcm
approach; in these situations, open surgery should be the initial procedure to maximize the short and long-term success of the
procedure for critical limb ischemia (CLI).
Peter F. Lawrence, M.D., Chief of Vascular Surgery and Director of the Gonda Vascular Center at UCLA, described anatomic situations in which open surgery should be the first choice: "Open surgery is the best initial option for patients with extensive disease in the common femoral artery that extends into the profunda femoris artery. Open surgery should be the first choice also in patients with TASC D disease of the infrapopliteal vessels and CLI".
Dr. Lawrence also specifically identified diabetics with CLI as a group of patients for which often open surgery is more favorable, as it is essential that
pulsatile blood flow is delivered to the lower leg.
He has found that endovascular procedures frequently recanalize only a segment of
the vessels of the lower extremity and do not provide pulsatile flow to the foot.
Importantly, Dr. Lawrence believes that when an
open procedure is selected as the initial therapy, the procedure should be minimally invasive to be comparable in morbidity
and mortality with an endovascular procedure.
VEITH SYMPOSIUM - New York, November 19th to 23rd
Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.
VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.
veithsymposium
Source
Pauline T. Mayer
ptmhcm
пятница, 10 июня 2011 г.
Physio-Control Receives Market Approval From Health Canada For LIFEPAK(R) 15 Monitor/Defibrillator
Physio-Control, Inc., a wholly owned subsidiary of Medtronic, Inc., (NYSE: MDT) announced today it received approval by Health Canada to market the LIFEPAK 15 monitor/defibrillator within Canada. Official license notification was received on Sept. 1, 2009.
Physio-Control was granted CE mark in January 2009, certifying compliance with the European Union Medical Device Directive and began its U.S. market release of the LIFEPAK 15 monitor/defibrillator in March 2009.
The LIFEPAK 15 monitor/defibrillator builds on a 54-year Physio-Control heritage of providing innovative, reliable equipment to lifesaving teams around the world. With an all-new product platform, it delivers best-in-class clinical and operational innovations and raises the bar on the legendary LIFEPAK® standard for durability.
Clinically innovative, the LIFEPAK 15 provides the widest range of energy dosing up to 360 joules, and the broadest selection of monitoring options available. It continues Physio-Control's legacy of industry firsts as the first monitor/defibrillator to integrate Masimo Rainbow SET® Pulse CO-Oximetry™ technology for the noninvasive detection of carboxyhemoglobin (carbon monoxide in the blood; the leading cause of poisoning death in industrialized countries1) and methemoglobin in the blood (which may result from exposure to certain chemicals and drugs).
The design focuses on several key operational innovations which include the largest color screen on the market, with a one-touch button that flips the screen to high-contrast SunVue™ mode for easy viewing in sunlight; along with 10 times the processing speed and three times the battery life of its predecessor. Needed for the harshest rescue environments, Physio-Control developed the LIFEPAK 15 to be tougher than any other monitor/defibrillator on the market. For current LIFEPAK customers, this model reduces transition costs, with a user interface that complements the market-leading LIFEPAK 12 defibrillator/monitor. Emergency care providers are able to work with a mixed fleet of LIFEPAK monitors, and transition their equipment when budgets allow-enabling them to save on critical operational costs and minimize their overall training resources.
"Physio-Control has been developing and refining monitoring and defibrillation technology for more than 50 years. With the latest approval for distribution by Health Canada the LIFEPAK 15 continues to build momentum in the marketplace and is setting the new standard for emergency care products," said Brian Webster, president of Physio-Control. "The '15' has already been put into use by multiple leading EMS systems around the world."
Masimo Founder and CEO, Joe E. Kiani, stated, "The LIFEPAK 15 monitor with Masimo Rainbow SET Pulse CO-Oximetry technology represents a significant advancement for emergency first responders who provide lifesaving care and treatment to combat a range of silent killers. The combination of a defibrillator with noninvasive carboxyhemoglobin (SpCO) and methemoglobin (SpMet) monitoring capabilities means that more cases of potentially life-threatening conditions may be detected and treated earlier to improve patient safety, outcomes and recoveries."
About Physio-Control
Physio-Control, a wholly-owned subsidiary of Medtronic, is located in Redmond, Wash. Physio-Control pioneered defibrillation technology more than 54 years ago. With nearly 800,000 LIFEPAK® defibrillators distributed worldwide, the company is the world's leading provider of external defibrillation and monitoring technology for the treatment of sudden cardiac arrest and other cardio-respiratory emergencies. To find out more about Physio-Control, go to physio-control or call 1-800-442-1142.
Source
Medtronic
Physio-Control was granted CE mark in January 2009, certifying compliance with the European Union Medical Device Directive and began its U.S. market release of the LIFEPAK 15 monitor/defibrillator in March 2009.
The LIFEPAK 15 monitor/defibrillator builds on a 54-year Physio-Control heritage of providing innovative, reliable equipment to lifesaving teams around the world. With an all-new product platform, it delivers best-in-class clinical and operational innovations and raises the bar on the legendary LIFEPAK® standard for durability.
Clinically innovative, the LIFEPAK 15 provides the widest range of energy dosing up to 360 joules, and the broadest selection of monitoring options available. It continues Physio-Control's legacy of industry firsts as the first monitor/defibrillator to integrate Masimo Rainbow SET® Pulse CO-Oximetry™ technology for the noninvasive detection of carboxyhemoglobin (carbon monoxide in the blood; the leading cause of poisoning death in industrialized countries1) and methemoglobin in the blood (which may result from exposure to certain chemicals and drugs).
The design focuses on several key operational innovations which include the largest color screen on the market, with a one-touch button that flips the screen to high-contrast SunVue™ mode for easy viewing in sunlight; along with 10 times the processing speed and three times the battery life of its predecessor. Needed for the harshest rescue environments, Physio-Control developed the LIFEPAK 15 to be tougher than any other monitor/defibrillator on the market. For current LIFEPAK customers, this model reduces transition costs, with a user interface that complements the market-leading LIFEPAK 12 defibrillator/monitor. Emergency care providers are able to work with a mixed fleet of LIFEPAK monitors, and transition their equipment when budgets allow-enabling them to save on critical operational costs and minimize their overall training resources.
"Physio-Control has been developing and refining monitoring and defibrillation technology for more than 50 years. With the latest approval for distribution by Health Canada the LIFEPAK 15 continues to build momentum in the marketplace and is setting the new standard for emergency care products," said Brian Webster, president of Physio-Control. "The '15' has already been put into use by multiple leading EMS systems around the world."
Masimo Founder and CEO, Joe E. Kiani, stated, "The LIFEPAK 15 monitor with Masimo Rainbow SET Pulse CO-Oximetry technology represents a significant advancement for emergency first responders who provide lifesaving care and treatment to combat a range of silent killers. The combination of a defibrillator with noninvasive carboxyhemoglobin (SpCO) and methemoglobin (SpMet) monitoring capabilities means that more cases of potentially life-threatening conditions may be detected and treated earlier to improve patient safety, outcomes and recoveries."
About Physio-Control
Physio-Control, a wholly-owned subsidiary of Medtronic, is located in Redmond, Wash. Physio-Control pioneered defibrillation technology more than 54 years ago. With nearly 800,000 LIFEPAK® defibrillators distributed worldwide, the company is the world's leading provider of external defibrillation and monitoring technology for the treatment of sudden cardiac arrest and other cardio-respiratory emergencies. To find out more about Physio-Control, go to physio-control or call 1-800-442-1142.
Source
Medtronic
четверг, 9 июня 2011 г.
How Inflammatory Cells Get From The Blood To The Site Of Injury
New insight into the way in which inflammatory cells known as macrophages leave the blood and access sites of injury has been provided by Jane Hoover-Plow and colleagues, at Cleveland Clinic Lerner Research Institute, Cleveland, who studied the process in mice. This information has particular clinical relevance to injury and inflammation of the major arterial blood vessels, one of the main causes of heart attack and stroke.
It was found that in mice lacking a protein known as plasminogen, macrophages were less able to leave the blood and access sites of injury than in normal mice. This was associated with decreased activation of a protein known as MMP-9, and addition of MMP-9 to the mice restored the ability of macrophages to access sites of injury.
As this was also true in a mouse model of abdominal aortic aneurysm (AAA), a chronic degenerative condition of the aorta that is usually fatal if it ruptures, the authors suggest that targeting the plasminogen/MMP-9 pathway might be a viable approach to controlling disease-causing inflammation, such as occurs in the development of AAA.
"Inflammatory macrophage migration requires MMP-9 activation by plasminogen in mice"
Yanqing Gong, Erika Hart, Aleksey Shchurin and Jane Hoover-Plow
J. Clin. Invest. doi:10.1172/JCI32750.
Click here to view article online
The Journal of Clinical Investigation (JCI) is the publication of the American Society for Clinical Investigation, an honor society of physician-scientists.
jci
It was found that in mice lacking a protein known as plasminogen, macrophages were less able to leave the blood and access sites of injury than in normal mice. This was associated with decreased activation of a protein known as MMP-9, and addition of MMP-9 to the mice restored the ability of macrophages to access sites of injury.
As this was also true in a mouse model of abdominal aortic aneurysm (AAA), a chronic degenerative condition of the aorta that is usually fatal if it ruptures, the authors suggest that targeting the plasminogen/MMP-9 pathway might be a viable approach to controlling disease-causing inflammation, such as occurs in the development of AAA.
"Inflammatory macrophage migration requires MMP-9 activation by plasminogen in mice"
Yanqing Gong, Erika Hart, Aleksey Shchurin and Jane Hoover-Plow
J. Clin. Invest. doi:10.1172/JCI32750.
Click here to view article online
The Journal of Clinical Investigation (JCI) is the publication of the American Society for Clinical Investigation, an honor society of physician-scientists.
jci
среда, 8 июня 2011 г.
If leg-bypass patients' lives are saved by drugs, why do so many not have them?
Contact: Kara Gavin
kegavinumich
734-764-2220
University of Michigan Health System (USA)
Statins and ACE inhibitors for peripheral arterial disease studied
ANN ARBOR, MI (USA) - The same drugs that help millions of heart patients can also aid people who have painful blockages in the blood vessels of their legs, new research from the University of Michigan Cardiovascular Center shows.
Drugs called statins and ACE inhibitors can save those patients' lives, or their limbs, if they take the medications before having a leg bypass operation, the study finds.
But the U-M researchers found that only about half of patients whose leg vessel disease has progressed far enough to require a bypass operation are actually taking the potentially beneficial drugs.
The results, published in the February issue of the Journal of Vascular Surgery, suggest that vascular surgeons should make sure their patients are receiving appropriate drugs before performing leg bypass surgery to re-route blood flow around a severely clogged leg artery.
'What we found surprised us,' says lead author and U-M vascular surgeon Peter Henke, M.D. 'Patients who were taking statins before their leg bypass operation had better patency, or openness, of their bypass graft, and a lower risk of leg amputation after surgery. Those taking ACE inhibitors had a lower risk of dying after the operation. And the effect of the medications far outweighed the effects of the patients' PAD severity, other medical problems, or the type of graft used.'
An estimated 12 million Americans have peripheral arterial disease, or PAD, in which clogged or stiffened leg arteries cause pain during walking or rest.
Left untreated, PAD can cause non-healing wounds and gangrene, and can led to amputation unless the blocked area is opened or bypassed. It's also associated with a high risk of heart attack and stroke.
The new U-M study looked at the usage rates and effects of statins and ACE inhibitors in 293 patients with advanced PAD who had open-leg bypass operations at the U-M Health System between 1997 and 2002. Average follow-up was 17 months.
The fact that the medicines had such a strong effect may not be surprising, Henke says, when you consider that they've been shown to do the same for patients with clogged heart arteries who have heart bypass surgery or angioplasty.
So, Henke and his colleagues suggest that millions more people whose legs hurt because of early-stage PAD should get a full cardiovascular checkup to look at their overall blood vessel health and determine if they could be helped by medication, or by changes in diet, exercise habits and tobacco use.
After all, he notes, the same factors that cause arteries in the heart to narrow or become blocked -- including high cholesterol, high blood pressure, tobacco use, diabetes and lack of exercise -- affect arteries in the legs and arms too.
'Many of the same strategies that help heart patients do better have also been shown to help PAD patients reduce their pain and increase their walking distance, including exercise, quitting smoking and lowering cholesterol and blood pressure,' says Henke.
'It stands to reason that the same medications could help, too -- this is a systemic, whole-body disease.'
Henke and his colleagues were dismayed to find that even though scientific evidence shows statins and ACE inhibitors can help overall cardiovascular health, about half of the PAD patients studied had gotten all the way to surgery without taking them.
'These were all patients who were having infrainguinal bypass surgery to address severe pain and non-healing wounds, or to save their legs from amputation, but many of them apparently had gone without the kind of whole-body cardiovascular care that might have led to the use of one or more of these drugs,' says Henke.
However, the vast majority (93 percent) were taking one or more blood-thinning drugs to reduce pain and prevent blood clots, mostly aspirin but also prescription drugs clopidogrel and warfarin.
The patient population studied was two-thirds male, and about one-third were smokers. Besides their severe, limb-threatening PAD, they had a high rate of other diseases, including hypertension (70 percent), diabetes (52 percent), high blood cholesterol (37 percent), coronary heart disease (51 percent) and heart failure (14 percent).
Thirty-nine percent had graft surveillance, or regular monitoring of the status of their bypass graft using ultrasound.
The bypass grafts used in their operations were mainly the patients' own veins, taken from the leg or other parts of the body. These autologous grafts, as they are called, are known to be superior to artificial grafts, which use synthetic tubes.
But 88 of the 338 grafts done on the patients in the study were artificial, and 32 were a combination -- most likely because those patients' eligible veins had already been used for other leg or heart bypass operations.
In all, the results show that the 56 percent of patients who had been on statins before their leg bypass were more than three-and-a-half times as likely as non-statin users to have good flow through their bypass grafts in the follow-up period.
They were also significantly less likely to require an amputation during the follow-up period.
Meanwhile, the 54 percent of patients who were taking ACE inhibitors before surgery were far less likely to die during the follow-up period than those who had not been taking them.
The bottom line, Henke says, is that vascular surgeons need to familiarize themselves with the best medical evidence about cardiovascular drugs, and follow guidelines for their use.
This is especially true as vascular surgeons and interventional cardiologists both increase their use of minimally invasive procedures for clogged vessels in the legs and other areas of the body.
And, he notes, it's important for people to tell their regular doctors if they feel leg pain when they walk or while they're at rest.
The symptoms of PAD often go unreported, and only if patients speak up about the pain they're feeling can they get the early intervention -- diet, exercise, lifestyle changes, medications -- which can prevent them from needing risky leg bypass surgery.
This is especially true for diabetics. A newly released recommendation from the American Diabetes Association urges all diabetics over the age of 50 to get tested for PAD by checking the blood pressure in their ankles.
In addition to Henke, the study's authors are Susan Blackburn, MBA, Mary C. Proctor, M.S., Jeri Stevens, M.S., Debabrata Mukherjee, M.D., Sanjay Rajagopalan, M.D., Gilbert Upchurch, M.D., James Stanley, M.D., and Kim Eagle, M.D., all of the U-M Cardiovascular Center.
View drug information on Warfarin Sodium tablets.
kegavinumich
734-764-2220
University of Michigan Health System (USA)
Statins and ACE inhibitors for peripheral arterial disease studied
ANN ARBOR, MI (USA) - The same drugs that help millions of heart patients can also aid people who have painful blockages in the blood vessels of their legs, new research from the University of Michigan Cardiovascular Center shows.
Drugs called statins and ACE inhibitors can save those patients' lives, or their limbs, if they take the medications before having a leg bypass operation, the study finds.
But the U-M researchers found that only about half of patients whose leg vessel disease has progressed far enough to require a bypass operation are actually taking the potentially beneficial drugs.
The results, published in the February issue of the Journal of Vascular Surgery, suggest that vascular surgeons should make sure their patients are receiving appropriate drugs before performing leg bypass surgery to re-route blood flow around a severely clogged leg artery.
'What we found surprised us,' says lead author and U-M vascular surgeon Peter Henke, M.D. 'Patients who were taking statins before their leg bypass operation had better patency, or openness, of their bypass graft, and a lower risk of leg amputation after surgery. Those taking ACE inhibitors had a lower risk of dying after the operation. And the effect of the medications far outweighed the effects of the patients' PAD severity, other medical problems, or the type of graft used.'
An estimated 12 million Americans have peripheral arterial disease, or PAD, in which clogged or stiffened leg arteries cause pain during walking or rest.
Left untreated, PAD can cause non-healing wounds and gangrene, and can led to amputation unless the blocked area is opened or bypassed. It's also associated with a high risk of heart attack and stroke.
The new U-M study looked at the usage rates and effects of statins and ACE inhibitors in 293 patients with advanced PAD who had open-leg bypass operations at the U-M Health System between 1997 and 2002. Average follow-up was 17 months.
The fact that the medicines had such a strong effect may not be surprising, Henke says, when you consider that they've been shown to do the same for patients with clogged heart arteries who have heart bypass surgery or angioplasty.
So, Henke and his colleagues suggest that millions more people whose legs hurt because of early-stage PAD should get a full cardiovascular checkup to look at their overall blood vessel health and determine if they could be helped by medication, or by changes in diet, exercise habits and tobacco use.
After all, he notes, the same factors that cause arteries in the heart to narrow or become blocked -- including high cholesterol, high blood pressure, tobacco use, diabetes and lack of exercise -- affect arteries in the legs and arms too.
'Many of the same strategies that help heart patients do better have also been shown to help PAD patients reduce their pain and increase their walking distance, including exercise, quitting smoking and lowering cholesterol and blood pressure,' says Henke.
'It stands to reason that the same medications could help, too -- this is a systemic, whole-body disease.'
Henke and his colleagues were dismayed to find that even though scientific evidence shows statins and ACE inhibitors can help overall cardiovascular health, about half of the PAD patients studied had gotten all the way to surgery without taking them.
'These were all patients who were having infrainguinal bypass surgery to address severe pain and non-healing wounds, or to save their legs from amputation, but many of them apparently had gone without the kind of whole-body cardiovascular care that might have led to the use of one or more of these drugs,' says Henke.
However, the vast majority (93 percent) were taking one or more blood-thinning drugs to reduce pain and prevent blood clots, mostly aspirin but also prescription drugs clopidogrel and warfarin.
The patient population studied was two-thirds male, and about one-third were smokers. Besides their severe, limb-threatening PAD, they had a high rate of other diseases, including hypertension (70 percent), diabetes (52 percent), high blood cholesterol (37 percent), coronary heart disease (51 percent) and heart failure (14 percent).
Thirty-nine percent had graft surveillance, or regular monitoring of the status of their bypass graft using ultrasound.
The bypass grafts used in their operations were mainly the patients' own veins, taken from the leg or other parts of the body. These autologous grafts, as they are called, are known to be superior to artificial grafts, which use synthetic tubes.
But 88 of the 338 grafts done on the patients in the study were artificial, and 32 were a combination -- most likely because those patients' eligible veins had already been used for other leg or heart bypass operations.
In all, the results show that the 56 percent of patients who had been on statins before their leg bypass were more than three-and-a-half times as likely as non-statin users to have good flow through their bypass grafts in the follow-up period.
They were also significantly less likely to require an amputation during the follow-up period.
Meanwhile, the 54 percent of patients who were taking ACE inhibitors before surgery were far less likely to die during the follow-up period than those who had not been taking them.
The bottom line, Henke says, is that vascular surgeons need to familiarize themselves with the best medical evidence about cardiovascular drugs, and follow guidelines for their use.
This is especially true as vascular surgeons and interventional cardiologists both increase their use of minimally invasive procedures for clogged vessels in the legs and other areas of the body.
And, he notes, it's important for people to tell their regular doctors if they feel leg pain when they walk or while they're at rest.
The symptoms of PAD often go unreported, and only if patients speak up about the pain they're feeling can they get the early intervention -- diet, exercise, lifestyle changes, medications -- which can prevent them from needing risky leg bypass surgery.
This is especially true for diabetics. A newly released recommendation from the American Diabetes Association urges all diabetics over the age of 50 to get tested for PAD by checking the blood pressure in their ankles.
In addition to Henke, the study's authors are Susan Blackburn, MBA, Mary C. Proctor, M.S., Jeri Stevens, M.S., Debabrata Mukherjee, M.D., Sanjay Rajagopalan, M.D., Gilbert Upchurch, M.D., James Stanley, M.D., and Kim Eagle, M.D., all of the U-M Cardiovascular Center.
View drug information on Warfarin Sodium tablets.
вторник, 7 июня 2011 г.
Study Results On The Impact Of New CPR Techniques
A new seven-city study on the impact of new CPR techniques supports the widespread use of the American Heart Association's new 2005 CPR guidelines, according to the study authors in a presentation at the AHA's Scientific Sessions in Orlando. Lead author, Tom P. Aufderheide, MD, Professor of Emergency Medicine, and Director of the Resuscitation Research Center in the Department of Emergency Medicine at the Medical College of Wisconsin in Milwaukee, presented the data showing a doubling of hospital discharge rates when the AHA's new CPR guidelines were consistently and effectively applied to 893 patients.
Resuscitation science can seem esoteric to the public until it hits home when a loved one, colleague or neighbor experiences cardiac arrest. Survival rates are only five percent for those who experience a sudden cardiac arrest outside the hospital, a shockingly low national average.
The EMS departments submitting data in the study tracked individuals who experienced cardiac arrest outside of the hospital all the way through hospital discharge. When subjects were treated with new CPR techniques including the use of the ResQPOD, an Impedance Threshold Device (ITD), the hospital discharge rates went from 7.9 percent to 15.7 percent, or double the survival rate of the control group.
Aufderheide said, "This menu of interventions for patients with cardiac arrest has resulted in one of the highest overall survival rates ever documented for this devastating medical condition.
It represents a major breakthrough in the treatment of cardiac arrest, which we hope will be disseminated in other systems throughout the United States."
The seven EMS departments participating in the study used AHA recommended new CPR including increased compressions, full chest wall recoil and use of the Impedance Threshold Device. The ResQPOD ITD is a $99 device that is the size of a small fist and manufactured by Advanced Circulatory Systems. The Impedance Threshold Device received a Class IIa rating by the AHA in its 2005 Emergency Cardiac Care Guidelines. This is the highest recommendation possible given to an intervention that improves hemodynamics and improves the rate of return of spontaneous circulation after cardiac arrest.
The study is considered important by the medical community as well as the participants because it demonstrated statistically that survival rates can improve when a combination of therapies is used together to improve emergency cardiac care.
The sites participating in the study were the Medical College of Wisconsin in Milwaukee; Madison Fire Department in Madison, WI; Allina Medical Transportation in Anoka County, MN; Wake County EMS in Raleigh, NC; Pinellas County EMS in Largo, Florida; Omaha Fire Department in Omaha, NE; and Cypress Creek EMS in Cypress Creek, TX.
The data presented included 893 individuals who experienced cardiac arrest compared with a control group of 1,424 patients. The average age of both study populations was 64 years and 65 percent of the study subjects were male.
Dr. Keith Lurie, Chief Medical Officer at Advanced Circulatory Systems, said, "There are technologies and practices that we know can move the needle to save more lives. This is especially true when we use these therapies together as recommended in the American Heart Association 2005 Guidelines. People should not have to rely on being in the right place at the right time when they experience cardiac arrest. While there remains a lot of work to further increase survival rates, the findings from this study, that survival to hospital discharge rates are doubled with this new approach, has great value for all patients who suffer from a cardiac arrest."
Further information on the AHA 2005 CPR Guidelines can be obtained at americanheart/. More information on Advanced Circulatory Systems is available at advancedcirculatory/.
The generally cleared indication for the ResQPOD is a temporary increase in blood circulation during emergency care, hospital, clinic and home use. Studies are ongoing in the United States to evaluate the long-term benefit of the ResQPOD for indications related to patients suffering from cardiac arrest, hypotension during dialysis and severe blood loss. The references in this communication are not intended to imply specific outcome-based claims not yet cleared by the US Food and Drug Administration. Clinical study references are available upon request.
Product Information Contact:
Nancy Theisen
Advanced Circulatory Systems
Medical Contacts:
* Tom P. Aufderheide, Lead Author, M.D., FACEP; Professor of Emergency Medicine, Director of the Resuscitation Research Center in the department of Emergency Medicine at the Medical College of Wisconsin in Milwaukee.
* Marvin Birnbaum, Co-author, Madison Fire Dept. Madison, WI.
* Charles Lick, M.D. Medical Director of Allina Medical Transportation, Anoka County, MN.
* Brent Myers, Wake County EMS Raleigh, NC.
* Laurie Romig, Pinellas County EMS, Largo, FL.
* Joseph Stothert, Omaha Fire Dept., Omaha NE.
* Levon Vartanian, Cypress Creek EMS; Cypress Creek, TX.
* Keith Lurie, M.D., Chief Medical Officer at Advanced Circulatory Systems, Edina, MN.
Cities using the ResQPOD ITD in the Study
Allina Medical, Anoka County, MN
Cypress Creek, TX
Madison Fire Dept., Madison, WI
Medical College of Wisconsin, Milwaukee, WI
Omaha Fire Dept., Omaha, NE
Pinellas County EMS, Largo, FL
Wake County EMS, Raleigh, NC
Resuscitation science can seem esoteric to the public until it hits home when a loved one, colleague or neighbor experiences cardiac arrest. Survival rates are only five percent for those who experience a sudden cardiac arrest outside the hospital, a shockingly low national average.
The EMS departments submitting data in the study tracked individuals who experienced cardiac arrest outside of the hospital all the way through hospital discharge. When subjects were treated with new CPR techniques including the use of the ResQPOD, an Impedance Threshold Device (ITD), the hospital discharge rates went from 7.9 percent to 15.7 percent, or double the survival rate of the control group.
Aufderheide said, "This menu of interventions for patients with cardiac arrest has resulted in one of the highest overall survival rates ever documented for this devastating medical condition.
It represents a major breakthrough in the treatment of cardiac arrest, which we hope will be disseminated in other systems throughout the United States."
The seven EMS departments participating in the study used AHA recommended new CPR including increased compressions, full chest wall recoil and use of the Impedance Threshold Device. The ResQPOD ITD is a $99 device that is the size of a small fist and manufactured by Advanced Circulatory Systems. The Impedance Threshold Device received a Class IIa rating by the AHA in its 2005 Emergency Cardiac Care Guidelines. This is the highest recommendation possible given to an intervention that improves hemodynamics and improves the rate of return of spontaneous circulation after cardiac arrest.
The study is considered important by the medical community as well as the participants because it demonstrated statistically that survival rates can improve when a combination of therapies is used together to improve emergency cardiac care.
The sites participating in the study were the Medical College of Wisconsin in Milwaukee; Madison Fire Department in Madison, WI; Allina Medical Transportation in Anoka County, MN; Wake County EMS in Raleigh, NC; Pinellas County EMS in Largo, Florida; Omaha Fire Department in Omaha, NE; and Cypress Creek EMS in Cypress Creek, TX.
The data presented included 893 individuals who experienced cardiac arrest compared with a control group of 1,424 patients. The average age of both study populations was 64 years and 65 percent of the study subjects were male.
Dr. Keith Lurie, Chief Medical Officer at Advanced Circulatory Systems, said, "There are technologies and practices that we know can move the needle to save more lives. This is especially true when we use these therapies together as recommended in the American Heart Association 2005 Guidelines. People should not have to rely on being in the right place at the right time when they experience cardiac arrest. While there remains a lot of work to further increase survival rates, the findings from this study, that survival to hospital discharge rates are doubled with this new approach, has great value for all patients who suffer from a cardiac arrest."
Further information on the AHA 2005 CPR Guidelines can be obtained at americanheart/. More information on Advanced Circulatory Systems is available at advancedcirculatory/.
The generally cleared indication for the ResQPOD is a temporary increase in blood circulation during emergency care, hospital, clinic and home use. Studies are ongoing in the United States to evaluate the long-term benefit of the ResQPOD for indications related to patients suffering from cardiac arrest, hypotension during dialysis and severe blood loss. The references in this communication are not intended to imply specific outcome-based claims not yet cleared by the US Food and Drug Administration. Clinical study references are available upon request.
Product Information Contact:
Nancy Theisen
Advanced Circulatory Systems
Medical Contacts:
* Tom P. Aufderheide, Lead Author, M.D., FACEP; Professor of Emergency Medicine, Director of the Resuscitation Research Center in the department of Emergency Medicine at the Medical College of Wisconsin in Milwaukee.
* Marvin Birnbaum, Co-author, Madison Fire Dept. Madison, WI.
* Charles Lick, M.D. Medical Director of Allina Medical Transportation, Anoka County, MN.
* Brent Myers, Wake County EMS Raleigh, NC.
* Laurie Romig, Pinellas County EMS, Largo, FL.
* Joseph Stothert, Omaha Fire Dept., Omaha NE.
* Levon Vartanian, Cypress Creek EMS; Cypress Creek, TX.
* Keith Lurie, M.D., Chief Medical Officer at Advanced Circulatory Systems, Edina, MN.
Cities using the ResQPOD ITD in the Study
Allina Medical, Anoka County, MN
Cypress Creek, TX
Madison Fire Dept., Madison, WI
Medical College of Wisconsin, Milwaukee, WI
Omaha Fire Dept., Omaha, NE
Pinellas County EMS, Largo, FL
Wake County EMS, Raleigh, NC
понедельник, 6 июня 2011 г.
Brittle Bones And Heart Disease Go Hand In Hand
Norwegian studies indicate that people with osteoporosis have a greater risk of developing cardiovascular disease, and vice versa. Now researchers believe they have found a biological system that may influence both disease processes.
Today over 400 000 Norwegians have some form of cardiovascular disease, according to figures from the Norwegian Society of Public Health. These diseases are the most frequent cause of death of both men and women in Norway.
Osteoporosis is another common, widespread disease. One-half of all Norwegian women and one-fourth of all Norwegian men will experience at least one bone fracture after they have turned 50.
Now it appears that in some cases the same mechanism is at work in both disease processes, making us more vulnerable to osteoporosis and heart attack and stroke.
Greater risk of stroke
Osteoporosis is a disease in which a reduction of the mineral content of the bones results in low bone density. In 2001, Professor Lone J??rgensen and her colleagues at the University of Troms?? published a study showing that women who had suffered a stroke had much lower bone density than other women of the same age.
"This finding piqued our interest in looking for potential connections between osteoporosis and atherosclerosis ('hardening of the arteries'). Atherosclerosis is a disease in which fatty material, calcium and connective tissue collect along the walls of arteries. It is a common cause of stroke and other cardiovascular diseases," Dr J??rgensen explains.
The researchers carried out a project to study some of the possible connections between osteoporosis and the risk of developing cardiovascular disease using data from about 6 000 men and women who participated in a special survey in 1994-1995 and 2001-2002, which was part of the comprehensive Troms?? study of cardiovascular diseases. The project ran from 2006 to 2009, and was funded by the Research Council's allocations earmarked for women's health research.
A possible connection found
"It appears there is a connection between low bone density and the type of atherosclerotic changes that are rich in connective tissue and calcium. Women who exhibit these changes also have a higher risk of bone fracture," Dr J??rgensen says.
In many cases, a person may develop osteoporosis and suffer a heart attack for completely different reasons. But there may be a causal relationship between the diseases. Data from several research groups now indicate that a biological system involving osteoprotegerin (OPG), among other things, may be a common denominator.
"We have found that bone loss is linked to a high level of OPG in post-menopausal women. In addition, we see that a high level of OPG also predicts the development of atherosclerosis in women," she continues.
Prevention
The researchers want to learn more about the role played by the system of which OPG is a part.
"Our contribution will be to find out as much as possible about the connections between these One-half of all Norwegian women and one-fourth of all Norwegian men will experience at least one bone fracture after they have turned 50.diseases in the population in general and the factors that influence them. We hope that our findings will help to develop methods of preventing these serious diseases," Dr J??rgensen concludes.
Sources: Research Council of Norway, AlphaGalileo Foundation.
Today over 400 000 Norwegians have some form of cardiovascular disease, according to figures from the Norwegian Society of Public Health. These diseases are the most frequent cause of death of both men and women in Norway.
Osteoporosis is another common, widespread disease. One-half of all Norwegian women and one-fourth of all Norwegian men will experience at least one bone fracture after they have turned 50.
Now it appears that in some cases the same mechanism is at work in both disease processes, making us more vulnerable to osteoporosis and heart attack and stroke.
Greater risk of stroke
Osteoporosis is a disease in which a reduction of the mineral content of the bones results in low bone density. In 2001, Professor Lone J??rgensen and her colleagues at the University of Troms?? published a study showing that women who had suffered a stroke had much lower bone density than other women of the same age.
"This finding piqued our interest in looking for potential connections between osteoporosis and atherosclerosis ('hardening of the arteries'). Atherosclerosis is a disease in which fatty material, calcium and connective tissue collect along the walls of arteries. It is a common cause of stroke and other cardiovascular diseases," Dr J??rgensen explains.
The researchers carried out a project to study some of the possible connections between osteoporosis and the risk of developing cardiovascular disease using data from about 6 000 men and women who participated in a special survey in 1994-1995 and 2001-2002, which was part of the comprehensive Troms?? study of cardiovascular diseases. The project ran from 2006 to 2009, and was funded by the Research Council's allocations earmarked for women's health research.
A possible connection found
"It appears there is a connection between low bone density and the type of atherosclerotic changes that are rich in connective tissue and calcium. Women who exhibit these changes also have a higher risk of bone fracture," Dr J??rgensen says.
In many cases, a person may develop osteoporosis and suffer a heart attack for completely different reasons. But there may be a causal relationship between the diseases. Data from several research groups now indicate that a biological system involving osteoprotegerin (OPG), among other things, may be a common denominator.
"We have found that bone loss is linked to a high level of OPG in post-menopausal women. In addition, we see that a high level of OPG also predicts the development of atherosclerosis in women," she continues.
Prevention
The researchers want to learn more about the role played by the system of which OPG is a part.
"Our contribution will be to find out as much as possible about the connections between these One-half of all Norwegian women and one-fourth of all Norwegian men will experience at least one bone fracture after they have turned 50.diseases in the population in general and the factors that influence them. We hope that our findings will help to develop methods of preventing these serious diseases," Dr J??rgensen concludes.
Sources: Research Council of Norway, AlphaGalileo Foundation.
воскресенье, 5 июня 2011 г.
Osteoporosis Drugs Increase Risk For Heart Problems
People who take bisphosphonates
for osteoporosis may be at risk for serious atrial fibrillation (AF), or
irregular heartbeats, according to a new study. The research, presented at
CHEST 2008, the 74th annual international scientific assembly of the
American College of Chest Physicians (ACCP), shows that people taking
alendronate or zoledronic acid, two common medications to prevent or slow
the occurrence of osteoporosis, were significantly more likely to
experience serious AF, including hospitalization or death, compared with
placebo.
"Atrial fibrillation can be serious if it is persistent or occurs in
people with preexisting heart disease or hypertension," said Jennifer
Miranda, MD, Jackson Memorial Hospital, Miami, FL. "If left untreated, it
can lead to pulmonary edema, congestive heart failure, or the formation of
a blood clot that can cause a brain embolism and stroke."
In a metaanalysis, Dr. Miranda and colleagues from the University of
Miami evaluated the relationship between the use of bisphosphonates and AF,
a condition that can produce a wide range of symptoms, including
light-headedness, palpitations, chest pain, and shortness of breath, or no
symptoms at all. Three studies met eligibility criteria and included a
total of 16,322 patients, of whom 76 to 100 percent were women using
bisphosphonates for osteoporosis with a mean age range 69 to 75 years.
Patients in the study were taking alendronate or zoledronic acid. The
analysis showed that 2.5 to 3 percent of patients taking bisphosphonates
experienced atrial fibrillation and 1 to 2 percent experienced serious AF,
including hospitalization or death. Patients taking bisphosphonates were
more likely to experience AF than patients receiving placebo and up to two
times more likely to experience serious AF than patients receiving placebo.
"In patients with increased risk factors for atrial fibrillation,
clinicians should be more cautious when choosing treatment for osteoporosis
and weigh the risks against the benefit of decreased fracture risk," said
Dr. Miranda.
"Bisphosphonates are widely used to treat millions of women and men who
suffer from osteoporosis or low bone density," said James A. L. Mathers,
Jr., MD, FCCP, President of the American College of Chest Physicians. "A
potential link between bisphosphonates and atrial fibrillation warrants
additional research in this area."
CHEST 2008 is the 74th annual international scientific assembly of the
American College of Chest Physicians, held October 25-30 in Philadelphia,
PA. ACCP represents 17,000 members who provide patient care in the areas of
pulmonary, critical care, and sleep medicine in the United States and
throughout the world. The ACCP's mission is to promote the prevention and
treatment of diseases of the chest through leadership, education, research,
and communication. For more information about the ACCP, please visit the
ACCP Web site at chestnet.
American College of Chest Physicians
chestnet
for osteoporosis may be at risk for serious atrial fibrillation (AF), or
irregular heartbeats, according to a new study. The research, presented at
CHEST 2008, the 74th annual international scientific assembly of the
American College of Chest Physicians (ACCP), shows that people taking
alendronate or zoledronic acid, two common medications to prevent or slow
the occurrence of osteoporosis, were significantly more likely to
experience serious AF, including hospitalization or death, compared with
placebo.
"Atrial fibrillation can be serious if it is persistent or occurs in
people with preexisting heart disease or hypertension," said Jennifer
Miranda, MD, Jackson Memorial Hospital, Miami, FL. "If left untreated, it
can lead to pulmonary edema, congestive heart failure, or the formation of
a blood clot that can cause a brain embolism and stroke."
In a metaanalysis, Dr. Miranda and colleagues from the University of
Miami evaluated the relationship between the use of bisphosphonates and AF,
a condition that can produce a wide range of symptoms, including
light-headedness, palpitations, chest pain, and shortness of breath, or no
symptoms at all. Three studies met eligibility criteria and included a
total of 16,322 patients, of whom 76 to 100 percent were women using
bisphosphonates for osteoporosis with a mean age range 69 to 75 years.
Patients in the study were taking alendronate or zoledronic acid. The
analysis showed that 2.5 to 3 percent of patients taking bisphosphonates
experienced atrial fibrillation and 1 to 2 percent experienced serious AF,
including hospitalization or death. Patients taking bisphosphonates were
more likely to experience AF than patients receiving placebo and up to two
times more likely to experience serious AF than patients receiving placebo.
"In patients with increased risk factors for atrial fibrillation,
clinicians should be more cautious when choosing treatment for osteoporosis
and weigh the risks against the benefit of decreased fracture risk," said
Dr. Miranda.
"Bisphosphonates are widely used to treat millions of women and men who
suffer from osteoporosis or low bone density," said James A. L. Mathers,
Jr., MD, FCCP, President of the American College of Chest Physicians. "A
potential link between bisphosphonates and atrial fibrillation warrants
additional research in this area."
CHEST 2008 is the 74th annual international scientific assembly of the
American College of Chest Physicians, held October 25-30 in Philadelphia,
PA. ACCP represents 17,000 members who provide patient care in the areas of
pulmonary, critical care, and sleep medicine in the United States and
throughout the world. The ACCP's mission is to promote the prevention and
treatment of diseases of the chest through leadership, education, research,
and communication. For more information about the ACCP, please visit the
ACCP Web site at chestnet.
American College of Chest Physicians
chestnet
суббота, 4 июня 2011 г.
VCR - First US implant
Ventracor Limited (ASX: VCR) announced today the first implant in the United States of the VentrAssistTM Left Ventricular Assist System (LVAS).
The procedure was performed by a team led by Professor Bartley P. Griffith, M.D. at the University of Maryland Medical Center in Baltimore. The first US implant of the VentrAssist is part of an FDA-approved feasibility study in 10 patients at up to five hospitals across the United States. The trial is managed in part by the International Center for Health Outcomes and Innovation Research (InCHOIR).
Dr. Griffith said: "We are very pleased to participate in the clinical trial of the VentrAssist, and hope that this new technology will be shown to provide new hope for the thousands of people suffering from end stage heart failure."
Ventracor Limited Chief Executive Officer, Colin Sutton PhD, said: "With each implant, we are adding to the body of clinical evidence and experience. The first VentrAssist implant in the United States was only possible due to the tireless work and dedication of a worldwide team of people in Australia, US and Europe." Dr Sutton noted that to date nearly 30 patients had been implanted with the VentrAssist globally.
Dr. Griffith - is Chief of the Division of Cardiac Surgery and Director of Heart and Lung Transplantation in the Department of Surgery at the University of Maryland Medical Center and is a Professor of Surgery at the University of Maryland School of Medicine. Prior to his arrival at the University of Maryland, Dr. Griffith served as Vice Chair, Department of Surgery at the University of Pittsburgh School of Medicine, where he was also Chief of Cardiothoracic Surgery and the Henry T. Bahnson Professor of Surgery.
Congestive Heart Failure - in the United States, congestive heart failure (CHF) affects about five million people, or two percent of the population. There are an estimated 550,000 new cases diagnosed each year, and around 45,000 deaths from CHF.
Ventracor - is a global medical device company that has developed a blood pump, the VentrAssistTM left ventricular assist system (LVAS) for patients in cardiac failure. The company hopes to bring the VentrAssistTM to the global market in record time, and expects to obtain a significant share of the huge potential market.
Andrew Geddes
infoventracor
61-294-063-086
Research Australia
researchaustralia.au
The procedure was performed by a team led by Professor Bartley P. Griffith, M.D. at the University of Maryland Medical Center in Baltimore. The first US implant of the VentrAssist is part of an FDA-approved feasibility study in 10 patients at up to five hospitals across the United States. The trial is managed in part by the International Center for Health Outcomes and Innovation Research (InCHOIR).
Dr. Griffith said: "We are very pleased to participate in the clinical trial of the VentrAssist, and hope that this new technology will be shown to provide new hope for the thousands of people suffering from end stage heart failure."
Ventracor Limited Chief Executive Officer, Colin Sutton PhD, said: "With each implant, we are adding to the body of clinical evidence and experience. The first VentrAssist implant in the United States was only possible due to the tireless work and dedication of a worldwide team of people in Australia, US and Europe." Dr Sutton noted that to date nearly 30 patients had been implanted with the VentrAssist globally.
Dr. Griffith - is Chief of the Division of Cardiac Surgery and Director of Heart and Lung Transplantation in the Department of Surgery at the University of Maryland Medical Center and is a Professor of Surgery at the University of Maryland School of Medicine. Prior to his arrival at the University of Maryland, Dr. Griffith served as Vice Chair, Department of Surgery at the University of Pittsburgh School of Medicine, where he was also Chief of Cardiothoracic Surgery and the Henry T. Bahnson Professor of Surgery.
Congestive Heart Failure - in the United States, congestive heart failure (CHF) affects about five million people, or two percent of the population. There are an estimated 550,000 new cases diagnosed each year, and around 45,000 deaths from CHF.
Ventracor - is a global medical device company that has developed a blood pump, the VentrAssistTM left ventricular assist system (LVAS) for patients in cardiac failure. The company hopes to bring the VentrAssistTM to the global market in record time, and expects to obtain a significant share of the huge potential market.
Andrew Geddes
infoventracor
61-294-063-086
Research Australia
researchaustralia.au
пятница, 3 июня 2011 г.
What Is A Mini-Stroke? What Is A Transient Ischemic Attack (TIA)?
A mini-stroke, or transient ischemic attack (TIA) occurs when there is a temporary drop in the blood supply to the brain, depriving it of essential oxygen. The patient experiences stroke-like symptoms, although they don't last as long. A mini-stroke only lasts a few minutes and disappears within a day.
In other words, a TIA is like a stroke, produces similar symptoms, but only lasts a few minutes and causes no permanent damage.
Health experts say a TIA may be a warning. Approximately 30% of people who have a TIA eventually go on to have a stroke. Half of that 30% have a stroke within a year of their TIA. Although some may call it a warning, it may also be seen as an opportunity to take steps to prevent a full blown stroke.
According to Medilexicon's medical dictionary, a Transient Ischemic Attack is "a sudden focal loss of neurologic function with complete recovery usually within 24 hours; caused by a brief period of inadequate perfusion in a portion of the territory of the carotid or vertebral basilar arteries."
What are the signs and symptoms of a TIA (mini-stroke)?
A symptom is something the patient experiences or reports, such as a headache, while a sign is something others detect, such as a rash. The signs and symptoms of a TIA are represented by the abbreviation FAST (Face, Arms, Speech, Time):
Face - the face may fall on one side as some of the facial muscles become paralyzed. The patient's eye or mouth may droop, and he/she may be unable to smile properly.
Arms - arm weakness or numbness might make it hard for the patient to either raise both arms, or to keep them raised.
Speech - speech may be slurred and garbled.
Time - when you see at least one of these symptoms it is Time to dial emergency services (911 in USA, 999 in UK).
If signs and symptoms last more than 24 hours or cause lasting brain damage, it's considered a stroke. Do not wait 24 hours to find out!
Being able to identify the signs and symptoms present in FAST is especially important if you live with somebody in a high risk group, such as an elderly person, or an individual with hypertension (high blood pressure) or diabetes.
Other signs and symptoms include:
Dizziness
Difficulty talking
Difficulty understand what others are talking about
Swallowing difficulties
Very bad headache
Paralysis, numbness or weakness on one side of the body
In severe cases, loss of consciousness
If you or somebody else has at least three of these signs and symptoms medical attention should be sought immediately.
TIA symptoms are temporary and should disappear within 24 hours. They may last from a couple of minutes to 15 minutes. TIA sufferers experience varying symptoms, depending on which part of the brain is affected.
In some cases a TIA may be a prelude to a full stroke, in which case permanent and possibly serious damage occurs. Prompt medical attention and treatment significantly reduces the risk of experiencing another TIA or stroke.
In other words - if think that you, or somebody else, is having a TIA, get medical attention immediately.
What are the causes of a TIA?
Disruption of blood supply to the brain
Two main blood vessels - the carotid arteries - supply blood to the brain. These arteries branch off into many smaller blood vessels which provide the whole of the brain with essential nutrients, such as blood, glucose, and oxygen. A TIA can occur if one of the smaller blood vessels becomes blocked, depriving that part of the brain of oxygen-rich blood.
In the case of a TIA, the blocked blood supply is temporary and the affected part of the brain soon returns to normal. When a full stroke occurs the oxygen-rich blood supply is disrupted for much longer, causing brain cells to die.
Blood supply to parts of the brain is usually disrupted because of a narrowing of the arteries (stenosis) or the formation of a blood clot.
Atherosclerosis
Atherosclerosis causes arteries to narrow (stenosis). Fatty deposits (plaque) develop on the inner lining of blood cells, causing them to become hardened, thickened and less flexible - resulting in more difficulties with blood flow.
Blood clots
A blood clot can disrupt the supply of oxygen-rich blood to parts of the brain. Blood clots are usually caused by:
Heart conditions - congestive heart muscle disease or atrial fibrillation are common causes of blood clots.
Blood conditions - leukemia (blood cell cancer), sickle cell anemia, hyperlipidemia (high blood fat levels), polycythemia (very thick blood), or thrombocyemia (overproduction of blood platelets) are common causes of blood clots.
Infections - phlebitis can cause blood clots.
An embolism can cause a TIA, and even a full blown stroke. A blood clot from a blood vessel in another part of the body becomes dislodged and travels into one of the arteries that supplies blood to the brain.
Hemorrhage (internal bleeding)
A minor brain hemorrhage (small amount of bleeding in the brain) can cause a TIA; however, this is rare.
What are the risk factors for TIA?
There are some risk factors we can change, and others we can't.
Risk factors we cannot change:
A family history - people with a family history of TIA or stroke, i.e. people with a close relative who has had a stroke or TIA, have a higher risk of experiencing one themselves.
Age - people aged 55 years or more have a higher risk of TIAs compared to younger people. The older you get, the higher the risk becomes.
Sex - males have a slightly higher risk of stroke and/or TIA than women.
Ethnic origin - people of black African ancestry have a higher risk of stroke and TIA than others.
Risk factors we can change:
Hypertension - people with high blood pressure have a significantly higher risk of developing a TIA, compared to people of normal blood pressure. Hypertension means the patient's systolic blood pressure is 140 mm hg or higher, and diastolic pressure is mm hg or higher.
Cardiovascular disease - people with cardiovascular diseases have a higher risk of stroke and/or TIA. This includes a heart defect, heart failure or arrhythmia (abnormal heart rhythm).
Carotid artery disease - this is when the blood vessels in the neck that lead to the brain are clogged.
PAD (peripheral artery disease) - people whose blood vessels that carry blood to their arms and legs become clogged have a higher risk of stroke and TIA.
Smoking - smoking increases the risk of various diseases and conditions, including TIA, stroke, blood clots, heart attack, cardiovascular disease, cancer, erectile dysfunction, and blindness in old age.
Sedentary lifestyle - people who are physically inactive have a significantly higher risk of stroke or TIA compared to people who do 30 minutes of moderate exercise at least 5 times per week.
Diabetes - patients with diabetes are more likely to suffer from atherosclerosis (narrowing of the arteries due to a build up of fatty deposits), raising the risk of stroke or TIA. This is especially the case if the diabetes is poorly controlled.
Bad diet - people who consume too much bad qualtiy fat and/or salt have a higher risk of stroke and TIA.
Blood cholesterol levels - if your blood cholesterol level is at least 200 mg/dL or 5.2 mmol/L you have a higher risk of TIA or stroke.
Homocysteine levels - homocysteine is an amino acid produced by the body. It is usually a byproduct of consuming meat. It is made from another amino acid, methionine, and then is concerted into other amino acids. Elevated levels of homocysteine in the blood can make the arteries thicken and scar, and more susceptible to clogs, resulting in a higher risk of stroke and TIA.
Bodyweight - obese people have a significantly higher risk of stroke or TIA than people of normal body weight.
Alcohol - people who drink large quantities of alcohol regularly are much more likely to have a stroke or TIA than people who never drink or drink within recommended limits.
Illegal drugs - some illegal drugs, such as cocaine, can raise the risk of stroke or TIA if taken often enough.
How is a TIA diagnosed?
Anybody who has signs and symptoms of a TIA should seek medical attention immediately. As TIAs do not last very long it is most likely the patient will have no symptoms by the time he/she gets to see the doctor.
The GP (general practitioner, primary care physician) or hospital doctor may need to carry out a neurological examination, even if symptoms have gone. This will include some simple tasks to check skills, such as memory and coordination. While being examined the patient will be asked questions regarding symptoms, such as how long they lasted, what they were like, and how they affected the patient. This will help the doctor discard any other conditions which may have similar symptoms.
If the GP, or non-specialized doctor or health care professional believes the patient may have had a TIA he/she will be referred to a neurologist for further testing. A neurologist is a doctor specialized in the diagnosis and treatment of disorders of the nervous system - the brain, spinal cord and the nerves. In the UK and many other countries the patient may be referred to a neurologist who specializes in strokes, or a specialist TIA clinic.
The specialist may order a number of tests designed to identify the underlying factors or conditions which may have caused the TIA.
Blood tests
Blood pressure - the patient's blood pressure will be checked for hypertension.
Blood clotting test - this is to find out how likely the patient's blood is to clot.
Blood cholesterol test - this test determines whether the patient's blood cholesterol level is high.
Electrocardiogram (ECG) - this device records the electrical activity and rhythms of the patient's heart. Electrodes are attached to the patient's skin and impulses are recorded as waves are displayed on a screen (or printed on paper). The test may also reveal any damage to the heart from a heart attack.
Echocardiogram - this is an ultrasound scan that checks the pumping action of the patient's heart. This test also helps distinguish systolic heart failure from diastolic heart failure (the heart is stiff and does not fill properly). Sound waves are used to create a video image of the patient's heart, which helps the doctor see how well the heart is pumping. The doctor measures the percentage of blood pumped out of the patient's left ventricle (the main pumping chamber) with each heartbeat - this measurement is called the ejection fraction.
Chest X-ray - this test helps the doctor rule out any other illness or health condition.
Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain. It can also reveal whether there is a tumor.
Magnetic resonance imaging (MRI) scan - a magnetic field generates a 3-D view of the brain. An MRI can often give a more detailed view of the brain than a CT scan, and can help the doctor identify any brain damage.
Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting.
What are the treatment options for TIAs?
When the doctor has identified what caused the TIA his/her aim is to treat it, thus minimizing the risk of a subsequent stroke. The doctor may prescribe medication which lowers the risk of a blood clot, or recommend surgery or an angioplasty; this will depend on the cause of the TIA.
Medications
The type of medication(s) prescribed will depend on what caused the TIA, how severe it was, and what part of the brain was affected.
Anti-platelet drugs
These make the platelets less likely to stick together. When a blood vessel has a lesion platelets start forming clots by initially sticking to each other.
Aspirin and dipyridamole - drugs, such as aspirin make the platelets less sticky and lower the risk of undesirable blood clots. Aspirin is commonly prescribed because it is cheap and has few side-effects. Some doctors may prescribe Aggrenox - this drug contains both aspirin as well as dipyridamole, another anti-platelet medication. Some doctors may recommend ticlopidine (Ticlid).
Side effects of aspirin may include:
Indigestion
Nausea
Stomach irritation
Side effects of dipyridamole may include:
Diarrhea
Dizziness
Headaches
Nausea
Clopidogrel - the doctor may prescribe clopidogrel (Plavix) if the patient experienced severe side effects from taking aspirin, had a further TIA despite taking aspirin, or has arterial disease.
Side effects of clopidogrel may include:
Abdominal pain
Bleeding
Bruising
Diarrhoea
Indigestion
Anticoagulants
Examples of anticoagulants are warfarin (Coumadin) and heparin. Warfarin can be used long-term, while heparin is used short-term. Patients on anticoagulants need to be monitored closely.
Warfarin - this is the most commonly used anticoagulant for the prevention of subsequent TIAs. The doctor has to make sure that warfarin thins the patient's blood enough, but not so much that there is a risk of internal bleeding. Patients will have to undergo regular blood tests (INR - international normalized ratio tests).
The most serious undesirable side effect of warfarin is bleeding. Any patient on warfarin who has any of the following symptoms should tell his/her doctor immediately:
-- Blood in urine
-- Blood in feces (either specs of blood, or feces are black)
-- Severe bruising
-- Nosebleeds that persist for more than ten minutes
-- Blood in vomit
-- Coughing up blood
-- Unexplained headaches
-- Bleeding from the vagina
-- Heavy or increased bleeding during menstruation
Medications for hypertension - hypertension (high blood pressure) needs to be controlled as it is an important risk factor for stroke and TIA. There are many different types of antihypertensive drugs. A doctor may prescribe one, or a combination. If the patient is unfit and overweight hypertension can often be brought down by losing weight, doing exercise, getting at least 7 hours good quality sleep every night, and eating a well balanced healthy diet.
Cholesterol medication - high blood cholesterol levels significantly increase a patient's risk of stroke and TIA. As with hypertension, losing weight, following a well balanced diet, doing regular exercise, and sleeping at least 7 hours every night can help bring cholesterol levels back to normal. Sometimes medications are necessary and the patient may be prescribed a statin, which helps reduce the production of cholesterol.
Surgery - Carotid endarterectomy - this operation involves removing part of the lining of the damaged carotid artery, as well as any blockage that has accumulated in the artery. The carotid arteries deliver blood to the brain. When plaques (fatty deposits) accumulate inside them they become narrow and hard, making it more difficult for blood to flow through them (atherosclerosis).
This operation is not suitable for patients whose arteries are nearly completely blocked. Even some patients with partial blockage may not be suitable for this procedure because of the risk of stroke during the operation.
Prevention of TIAs or mini-strokes
The measures below can help you reduce your risks of having a mini-stroke (TIA), stroke, or a recurrent TIA:
Give up smoking - the moment you stop smoking your risk of stroke, TIA and many other conditions and diseases goes down significantly, and continues dropping each month.
Diet - follow a well balanced diet, with plenty of fruit and vegetables, whole grains, fish, poultry and very lean meat. Avoid all junk foods and foods with bad fats, such as saturated and trans fats.
Salt (sodium) intake - if you have high blood pressure, or tend to have high blood pressure, avoid salty foods and do not add salt to your cooking.
Physical exercise - exercise moderately for at least 30 minutes five times a week. Check with your doctor whether you can do this.
Sensible alcohol consumption - either don't drink alcohol at all, or stay within the daily recommended limits.
Body weight - if you are overweight or obese and can bring your body weight down to normal for your height and age your risk of stroke or TIA will go down dramatically, as will your risk of developing several other diseases and conditions.
Illegal drugs - many illegal drugs, such as cocaine, significantly raise your risk of stroke and TIA. Even illegal drugs which are seen not to be particularly harmful are made without inspectors and quality control guarantees (you really don't know what is in them). Avoiding them may help reduce your risks.
Diabetes - good diabetes control, i.e. following your diabetes treatment properly, greatly reduces your risks of stroke and TIA.
Sleep - make sure you get at least 7 hours good quality, continuous sleep every day.
View drug information on Aggrenox; Plavix; Warfarin Sodium tablets.
In other words, a TIA is like a stroke, produces similar symptoms, but only lasts a few minutes and causes no permanent damage.
Health experts say a TIA may be a warning. Approximately 30% of people who have a TIA eventually go on to have a stroke. Half of that 30% have a stroke within a year of their TIA. Although some may call it a warning, it may also be seen as an opportunity to take steps to prevent a full blown stroke.
According to Medilexicon's medical dictionary, a Transient Ischemic Attack is "a sudden focal loss of neurologic function with complete recovery usually within 24 hours; caused by a brief period of inadequate perfusion in a portion of the territory of the carotid or vertebral basilar arteries."
What are the signs and symptoms of a TIA (mini-stroke)?
A symptom is something the patient experiences or reports, such as a headache, while a sign is something others detect, such as a rash. The signs and symptoms of a TIA are represented by the abbreviation FAST (Face, Arms, Speech, Time):
Face - the face may fall on one side as some of the facial muscles become paralyzed. The patient's eye or mouth may droop, and he/she may be unable to smile properly.
Arms - arm weakness or numbness might make it hard for the patient to either raise both arms, or to keep them raised.
Speech - speech may be slurred and garbled.
Time - when you see at least one of these symptoms it is Time to dial emergency services (911 in USA, 999 in UK).
If signs and symptoms last more than 24 hours or cause lasting brain damage, it's considered a stroke. Do not wait 24 hours to find out!
Being able to identify the signs and symptoms present in FAST is especially important if you live with somebody in a high risk group, such as an elderly person, or an individual with hypertension (high blood pressure) or diabetes.
Other signs and symptoms include:
Dizziness
Difficulty talking
Difficulty understand what others are talking about
Swallowing difficulties
Very bad headache
Paralysis, numbness or weakness on one side of the body
In severe cases, loss of consciousness
If you or somebody else has at least three of these signs and symptoms medical attention should be sought immediately.
TIA symptoms are temporary and should disappear within 24 hours. They may last from a couple of minutes to 15 minutes. TIA sufferers experience varying symptoms, depending on which part of the brain is affected.
In some cases a TIA may be a prelude to a full stroke, in which case permanent and possibly serious damage occurs. Prompt medical attention and treatment significantly reduces the risk of experiencing another TIA or stroke.
In other words - if think that you, or somebody else, is having a TIA, get medical attention immediately.
What are the causes of a TIA?
Disruption of blood supply to the brain
Two main blood vessels - the carotid arteries - supply blood to the brain. These arteries branch off into many smaller blood vessels which provide the whole of the brain with essential nutrients, such as blood, glucose, and oxygen. A TIA can occur if one of the smaller blood vessels becomes blocked, depriving that part of the brain of oxygen-rich blood.
In the case of a TIA, the blocked blood supply is temporary and the affected part of the brain soon returns to normal. When a full stroke occurs the oxygen-rich blood supply is disrupted for much longer, causing brain cells to die.
Blood supply to parts of the brain is usually disrupted because of a narrowing of the arteries (stenosis) or the formation of a blood clot.
Atherosclerosis
Atherosclerosis causes arteries to narrow (stenosis). Fatty deposits (plaque) develop on the inner lining of blood cells, causing them to become hardened, thickened and less flexible - resulting in more difficulties with blood flow.
Blood clots
A blood clot can disrupt the supply of oxygen-rich blood to parts of the brain. Blood clots are usually caused by:
Heart conditions - congestive heart muscle disease or atrial fibrillation are common causes of blood clots.
Blood conditions - leukemia (blood cell cancer), sickle cell anemia, hyperlipidemia (high blood fat levels), polycythemia (very thick blood), or thrombocyemia (overproduction of blood platelets) are common causes of blood clots.
Infections - phlebitis can cause blood clots.
An embolism can cause a TIA, and even a full blown stroke. A blood clot from a blood vessel in another part of the body becomes dislodged and travels into one of the arteries that supplies blood to the brain.
Hemorrhage (internal bleeding)
A minor brain hemorrhage (small amount of bleeding in the brain) can cause a TIA; however, this is rare.
What are the risk factors for TIA?
There are some risk factors we can change, and others we can't.
Risk factors we cannot change:
A family history - people with a family history of TIA or stroke, i.e. people with a close relative who has had a stroke or TIA, have a higher risk of experiencing one themselves.
Age - people aged 55 years or more have a higher risk of TIAs compared to younger people. The older you get, the higher the risk becomes.
Sex - males have a slightly higher risk of stroke and/or TIA than women.
Ethnic origin - people of black African ancestry have a higher risk of stroke and TIA than others.
Risk factors we can change:
Hypertension - people with high blood pressure have a significantly higher risk of developing a TIA, compared to people of normal blood pressure. Hypertension means the patient's systolic blood pressure is 140 mm hg or higher, and diastolic pressure is mm hg or higher.
Cardiovascular disease - people with cardiovascular diseases have a higher risk of stroke and/or TIA. This includes a heart defect, heart failure or arrhythmia (abnormal heart rhythm).
Carotid artery disease - this is when the blood vessels in the neck that lead to the brain are clogged.
PAD (peripheral artery disease) - people whose blood vessels that carry blood to their arms and legs become clogged have a higher risk of stroke and TIA.
Smoking - smoking increases the risk of various diseases and conditions, including TIA, stroke, blood clots, heart attack, cardiovascular disease, cancer, erectile dysfunction, and blindness in old age.
Sedentary lifestyle - people who are physically inactive have a significantly higher risk of stroke or TIA compared to people who do 30 minutes of moderate exercise at least 5 times per week.
Diabetes - patients with diabetes are more likely to suffer from atherosclerosis (narrowing of the arteries due to a build up of fatty deposits), raising the risk of stroke or TIA. This is especially the case if the diabetes is poorly controlled.
Bad diet - people who consume too much bad qualtiy fat and/or salt have a higher risk of stroke and TIA.
Blood cholesterol levels - if your blood cholesterol level is at least 200 mg/dL or 5.2 mmol/L you have a higher risk of TIA or stroke.
Homocysteine levels - homocysteine is an amino acid produced by the body. It is usually a byproduct of consuming meat. It is made from another amino acid, methionine, and then is concerted into other amino acids. Elevated levels of homocysteine in the blood can make the arteries thicken and scar, and more susceptible to clogs, resulting in a higher risk of stroke and TIA.
Bodyweight - obese people have a significantly higher risk of stroke or TIA than people of normal body weight.
Alcohol - people who drink large quantities of alcohol regularly are much more likely to have a stroke or TIA than people who never drink or drink within recommended limits.
Illegal drugs - some illegal drugs, such as cocaine, can raise the risk of stroke or TIA if taken often enough.
How is a TIA diagnosed?
Anybody who has signs and symptoms of a TIA should seek medical attention immediately. As TIAs do not last very long it is most likely the patient will have no symptoms by the time he/she gets to see the doctor.
The GP (general practitioner, primary care physician) or hospital doctor may need to carry out a neurological examination, even if symptoms have gone. This will include some simple tasks to check skills, such as memory and coordination. While being examined the patient will be asked questions regarding symptoms, such as how long they lasted, what they were like, and how they affected the patient. This will help the doctor discard any other conditions which may have similar symptoms.
If the GP, or non-specialized doctor or health care professional believes the patient may have had a TIA he/she will be referred to a neurologist for further testing. A neurologist is a doctor specialized in the diagnosis and treatment of disorders of the nervous system - the brain, spinal cord and the nerves. In the UK and many other countries the patient may be referred to a neurologist who specializes in strokes, or a specialist TIA clinic.
The specialist may order a number of tests designed to identify the underlying factors or conditions which may have caused the TIA.
Blood tests
Blood pressure - the patient's blood pressure will be checked for hypertension.
Blood clotting test - this is to find out how likely the patient's blood is to clot.
Blood cholesterol test - this test determines whether the patient's blood cholesterol level is high.
Electrocardiogram (ECG) - this device records the electrical activity and rhythms of the patient's heart. Electrodes are attached to the patient's skin and impulses are recorded as waves are displayed on a screen (or printed on paper). The test may also reveal any damage to the heart from a heart attack.
Echocardiogram - this is an ultrasound scan that checks the pumping action of the patient's heart. This test also helps distinguish systolic heart failure from diastolic heart failure (the heart is stiff and does not fill properly). Sound waves are used to create a video image of the patient's heart, which helps the doctor see how well the heart is pumping. The doctor measures the percentage of blood pumped out of the patient's left ventricle (the main pumping chamber) with each heartbeat - this measurement is called the ejection fraction.
Chest X-ray - this test helps the doctor rule out any other illness or health condition.
Computerized tomography (CT) scan - a scanning device that creates a 3-D image that can show aneurysms, bleeding, or abnormal vessels within the brain. It can also reveal whether there is a tumor.
Magnetic resonance imaging (MRI) scan - a magnetic field generates a 3-D view of the brain. An MRI can often give a more detailed view of the brain than a CT scan, and can help the doctor identify any brain damage.
Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting.
What are the treatment options for TIAs?
When the doctor has identified what caused the TIA his/her aim is to treat it, thus minimizing the risk of a subsequent stroke. The doctor may prescribe medication which lowers the risk of a blood clot, or recommend surgery or an angioplasty; this will depend on the cause of the TIA.
Medications
The type of medication(s) prescribed will depend on what caused the TIA, how severe it was, and what part of the brain was affected.
Anti-platelet drugs
These make the platelets less likely to stick together. When a blood vessel has a lesion platelets start forming clots by initially sticking to each other.
Aspirin and dipyridamole - drugs, such as aspirin make the platelets less sticky and lower the risk of undesirable blood clots. Aspirin is commonly prescribed because it is cheap and has few side-effects. Some doctors may prescribe Aggrenox - this drug contains both aspirin as well as dipyridamole, another anti-platelet medication. Some doctors may recommend ticlopidine (Ticlid).
Side effects of aspirin may include:
Indigestion
Nausea
Stomach irritation
Side effects of dipyridamole may include:
Diarrhea
Dizziness
Headaches
Nausea
Clopidogrel - the doctor may prescribe clopidogrel (Plavix) if the patient experienced severe side effects from taking aspirin, had a further TIA despite taking aspirin, or has arterial disease.
Side effects of clopidogrel may include:
Abdominal pain
Bleeding
Bruising
Diarrhoea
Indigestion
Anticoagulants
Examples of anticoagulants are warfarin (Coumadin) and heparin. Warfarin can be used long-term, while heparin is used short-term. Patients on anticoagulants need to be monitored closely.
Warfarin - this is the most commonly used anticoagulant for the prevention of subsequent TIAs. The doctor has to make sure that warfarin thins the patient's blood enough, but not so much that there is a risk of internal bleeding. Patients will have to undergo regular blood tests (INR - international normalized ratio tests).
The most serious undesirable side effect of warfarin is bleeding. Any patient on warfarin who has any of the following symptoms should tell his/her doctor immediately:
-- Blood in urine
-- Blood in feces (either specs of blood, or feces are black)
-- Severe bruising
-- Nosebleeds that persist for more than ten minutes
-- Blood in vomit
-- Coughing up blood
-- Unexplained headaches
-- Bleeding from the vagina
-- Heavy or increased bleeding during menstruation
Medications for hypertension - hypertension (high blood pressure) needs to be controlled as it is an important risk factor for stroke and TIA. There are many different types of antihypertensive drugs. A doctor may prescribe one, or a combination. If the patient is unfit and overweight hypertension can often be brought down by losing weight, doing exercise, getting at least 7 hours good quality sleep every night, and eating a well balanced healthy diet.
Cholesterol medication - high blood cholesterol levels significantly increase a patient's risk of stroke and TIA. As with hypertension, losing weight, following a well balanced diet, doing regular exercise, and sleeping at least 7 hours every night can help bring cholesterol levels back to normal. Sometimes medications are necessary and the patient may be prescribed a statin, which helps reduce the production of cholesterol.
Surgery - Carotid endarterectomy - this operation involves removing part of the lining of the damaged carotid artery, as well as any blockage that has accumulated in the artery. The carotid arteries deliver blood to the brain. When plaques (fatty deposits) accumulate inside them they become narrow and hard, making it more difficult for blood to flow through them (atherosclerosis).
This operation is not suitable for patients whose arteries are nearly completely blocked. Even some patients with partial blockage may not be suitable for this procedure because of the risk of stroke during the operation.
Prevention of TIAs or mini-strokes
The measures below can help you reduce your risks of having a mini-stroke (TIA), stroke, or a recurrent TIA:
Give up smoking - the moment you stop smoking your risk of stroke, TIA and many other conditions and diseases goes down significantly, and continues dropping each month.
Diet - follow a well balanced diet, with plenty of fruit and vegetables, whole grains, fish, poultry and very lean meat. Avoid all junk foods and foods with bad fats, such as saturated and trans fats.
Salt (sodium) intake - if you have high blood pressure, or tend to have high blood pressure, avoid salty foods and do not add salt to your cooking.
Physical exercise - exercise moderately for at least 30 minutes five times a week. Check with your doctor whether you can do this.
Sensible alcohol consumption - either don't drink alcohol at all, or stay within the daily recommended limits.
Body weight - if you are overweight or obese and can bring your body weight down to normal for your height and age your risk of stroke or TIA will go down dramatically, as will your risk of developing several other diseases and conditions.
Illegal drugs - many illegal drugs, such as cocaine, significantly raise your risk of stroke and TIA. Even illegal drugs which are seen not to be particularly harmful are made without inspectors and quality control guarantees (you really don't know what is in them). Avoiding them may help reduce your risks.
Diabetes - good diabetes control, i.e. following your diabetes treatment properly, greatly reduces your risks of stroke and TIA.
Sleep - make sure you get at least 7 hours good quality, continuous sleep every day.
View drug information on Aggrenox; Plavix; Warfarin Sodium tablets.
четверг, 2 июня 2011 г.
Toshiba Introduces New X-Ray System With 12" X 12" Flat Panels And Hybrid Catheterization Table At ACC 2010
When working on patients in a hybrid setting, it is critical the imaging system provides outstanding image quality, as well as the flexibility to reach ancillary equipment and the patient quickly and easily. Designed to create a best-in-class hybrid suite, Toshiba America Medical Systems, Inc. will showcase its InfinixTM VF-i biplane system with two identical 12" x 12" flat panel detectors and the CAT 880B hybrid catheterization table at this year's American College of Cardiology (ACC) annual meeting in Atlanta, March 14 - 16, 2010 (Booth # 1944).
The new mid-sized 12" x 12??? flat panel detector expands the versatility of the Infinix-i line, which features a five-axis C-arm positioner and enables unprecedented patient access and coverage. The new mid-sized flat panel detector covers more anatomical area in one view. The ability to see more anatomy in one view reduces C-arm movement or table panning and decreases overall procedure time. The flexible system easily accommodates acquiring all standard views of the heart and is also beneficial when imaging anatomy outside the heart.
Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality with side-to-side cradle and head-to-toe tilt permits clinicians to angle the table in the optimal position to quickly complete procedures. The flexibility and ergonomic design enhance the clinicians' ability to work around the patient and accommodate views that conventional angiographic tables cannot achieve.
The new hybrid catheterization table features a 550-pound table weight limit, making this table ideal for a range of patients, from pediatric to bariatric. It also allows for angulations of up to 16 degrees in all four directions and offers the lowest tabletop height of any catheterization table in the industry. The 75-cm table height is particularly important for open surgical procedures, as it provides ultimate patient access and physician comfort, regardless of the procedure being performed. With the new table, Toshiba's Infinix-i five-axis X-ray systems are designed to accommodate endovascular catheter based techniques, open surgical settings or a combined hybrid approach.
"Toshiba is dedicated to improving patient access and flexibility during procedures to enhance the quality of care," said Robert Micer, director, X-ray Vascular Business Unit. "Our Infinix VF-i vascular X-ray system with 12" x 12" flat panel detectors and CAT 880B hybrid catheterization create the ideal hybrid cath lab unmatched in the industry today."
Source
Toshiba
The new mid-sized 12" x 12??? flat panel detector expands the versatility of the Infinix-i line, which features a five-axis C-arm positioner and enables unprecedented patient access and coverage. The new mid-sized flat panel detector covers more anatomical area in one view. The ability to see more anatomy in one view reduces C-arm movement or table panning and decreases overall procedure time. The flexible system easily accommodates acquiring all standard views of the heart and is also beneficial when imaging anatomy outside the heart.
Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality with side-to-side cradle and head-to-toe tilt permits clinicians to angle the table in the optimal position to quickly complete procedures. The flexibility and ergonomic design enhance the clinicians' ability to work around the patient and accommodate views that conventional angiographic tables cannot achieve.
The new hybrid catheterization table features a 550-pound table weight limit, making this table ideal for a range of patients, from pediatric to bariatric. It also allows for angulations of up to 16 degrees in all four directions and offers the lowest tabletop height of any catheterization table in the industry. The 75-cm table height is particularly important for open surgical procedures, as it provides ultimate patient access and physician comfort, regardless of the procedure being performed. With the new table, Toshiba's Infinix-i five-axis X-ray systems are designed to accommodate endovascular catheter based techniques, open surgical settings or a combined hybrid approach.
"Toshiba is dedicated to improving patient access and flexibility during procedures to enhance the quality of care," said Robert Micer, director, X-ray Vascular Business Unit. "Our Infinix VF-i vascular X-ray system with 12" x 12" flat panel detectors and CAT 880B hybrid catheterization create the ideal hybrid cath lab unmatched in the industry today."
Source
Toshiba
среда, 1 июня 2011 г.
Siemens Highlights Cardiovascular IT Integrated Imaging And Information Solutions
Siemens Healthcare will showcase the latest advancements in cardiovascular information technology (IT) innovations that focus on providing innovative solutions to help enable sounder decisions and enhance operational efficiency in booth 1629 at the 60th Annual Scientific Session and Expo of the American College of Cardiology (ACC) in New Orleans. Highlights include syngo Dynamics and syngo.via1 on one workstation, creating an exciting experience and ease of use - anywhere2.
"At this year's ACC, we are highlighting syngo Dynamics' expanded CVIS functionalities, building upon a solid platform that is already deployed at hundreds of customer sites worldwide," said Kurt Reiff, CEO of the Americas, Center of Competence, SYNGO Business Unit, Siemens Healthcare. "Additionally, syngo Dynamics interfacing with syngo.via allows all images to be available on one workstation, helping the clinician save time and improve their workflow.
syngo.via is Siemens' imaging software for multimodality reading of clinical cases that automatically prepares images and enables timely navigation through a case - in line with disease-specific requirements. When this solution interfaces with syngo Dynamics3, routine and 3D pre-processed multi-modality images are available and integrated with structured reporting.
syngo Dynamics' new Cardiovascular Patient Jacket and Analytics functionality3 provides a holistic, patient-centric view for the clinical team that expands upon the realm of in vivo diagnostics and also includes in vitro diagnostics data. The flexible user interface allows clinical and business analyses through customizable key performance indicators (KPIs).
Additionally, the new Cardiovascular Whiteboard functionality3 brings a new level of efficiency to cardiology departments. The Web-native user interface will allow anywhere, anytime2 access to robust tools to manage the case load among care teams and corresponding resources.
1. syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights.
2. Prerequisites include: Internet connection to clinical network, DICOM compliance, meeting of minimum hardware requirements, and adherence to local data security regulations.
3. The information about this product is preliminary. The product is under development and is not commercially available in the U.S., and its future availability cannot be ensured.
"At this year's ACC, we are highlighting syngo Dynamics' expanded CVIS functionalities, building upon a solid platform that is already deployed at hundreds of customer sites worldwide," said Kurt Reiff, CEO of the Americas, Center of Competence, SYNGO Business Unit, Siemens Healthcare. "Additionally, syngo Dynamics interfacing with syngo.via allows all images to be available on one workstation, helping the clinician save time and improve their workflow.
syngo.via is Siemens' imaging software for multimodality reading of clinical cases that automatically prepares images and enables timely navigation through a case - in line with disease-specific requirements. When this solution interfaces with syngo Dynamics3, routine and 3D pre-processed multi-modality images are available and integrated with structured reporting.
syngo Dynamics' new Cardiovascular Patient Jacket and Analytics functionality3 provides a holistic, patient-centric view for the clinical team that expands upon the realm of in vivo diagnostics and also includes in vitro diagnostics data. The flexible user interface allows clinical and business analyses through customizable key performance indicators (KPIs).
Additionally, the new Cardiovascular Whiteboard functionality3 brings a new level of efficiency to cardiology departments. The Web-native user interface will allow anywhere, anytime2 access to robust tools to manage the case load among care teams and corresponding resources.
1. syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights.
2. Prerequisites include: Internet connection to clinical network, DICOM compliance, meeting of minimum hardware requirements, and adherence to local data security regulations.
3. The information about this product is preliminary. The product is under development and is not commercially available in the U.S., and its future availability cannot be ensured.
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