Differences In Immediate Outcomes Research Articles

Gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting

Aim.To determine gender differences in immediate outcomes of patients with acute non-ST-elevation myocardial infarction undergoing off-pump coronary artery bypass grafting (CABG).Methods.CABG was indicated to patients with persistent myocardial ischemia (postinfarction angina) who did not meet criteria for percutaneous coronary intervention. Hybrid procedures and CABG aimed at repairing mechanical complications of AMI were not considered. Men (n = 66, 65.3%) were assigned to Group 1, whereas women (n = 35, 34.7%) were assigned to Group 2. Women were older and obese (grades 2-3), had higher GRACE scores, levels of cardiospecific troponin and higher rate of type 2 diabetes (p<0.05). Men and women commonly had three-vessel CAD (3.0; 4.0). The mean SYNTAX score for men and women was 29.0 (24.0; 33.0) and 27.0 (24.0; 28.0), p>0.05.Results.The median preoperative period was 4.0 days (3.8; 5.0) in male patients and 5.0 (4.0; 6.0) days in female patients (p>0.05). The groups did not have any significant differences in technical aspects of CABG (p>0.05). Mortality was 3.0% in men and 2.9% in women (p>0.05). No deaths were recorded from the onset of AMI till the first 72 hours after CABG. Three patients who under CABG died after 72 hours from the onset of MI (p>0.05). The total number of complications was 13 (19.7%) in men and 5 (14.3%) in women (p>0.05). There were no cases of conversion to cardiopulmonary bypass.Conclusion.The immediate outcomes of delayed of-pump CABG in both, men and women with acute non-ST-segment myocardial infarction, were comparable in mortality and complications (p>0.05). The immediate outcomes of CABG performed within 72 hours in both, men and women, were comparable in mortality as compared to surgeries performed after 72 hours from the MI onset. Obtained data demonstrated safety of early open-heart surgeries for acute non-ST-elevation myocardial infarction.

Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis.

Background/AimsTo assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology. MethodsCases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed. ResultsFrom 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years). ConclusionsER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

Comparison of sensory attributes and immediate efficacy of intranasal ciclesonide and fluticasone propionate in allergic rhinitis: A randomized controlled trial

Objectives:Intranasal corticosteroids (INCs) are the most effective modality for treating allergic rhinitis and their sensory attributes are important in patient compliance. This study aimed to compare the sensory attributes (scent, immediate taste, aftertaste, run down to throat, nose run off, soothing feel, nasal irritation, and urge to sneeze) and immediate response to the new intranasal steroid, ciclesonide (CIC), with fluticasone propionate (FLP) in allergic rhinitis.Materials and Methods:A randomized, double blind, single dose, crossover study was done with 74 patients presenting with acute allergic rhinitis. Eligible subjects were randomized in 1:1 ratio to one of the two treatment sequences – CIC followed by FLP or vice versa. Sensory attributes were assessed using a questionnaire to score each item on a seven-point Likert scale, immediately and 2 min after dosing. Total nasal symptom score (TNSS) was calculated to evaluate immediate efficacy 10 min after first drug administration. Overall preference was recorded 10 min after the second drug administration. Patients were queried about treatment emergent adverse events following study drug administration and also 24 h later over the phone.Results:Patients (58% males; pooled median age 32 years [Interquartile range, IQR, 25–41]; pooled median symptom duration 24 months [IQR 12–72]) preferred FLP over CIC nasal spray overall (55.41% vs. 25.68%, P = 0.007) and also with respect to attributes of scent, soothing feel, and nasal irritation. There was no statistically significant difference in immediate efficacy. Two patients reported mild headache following CIC first, while three felt mild headache, one dizziness, and one nasal congestion following FLP first administration. There were no delayed adverse events.Conclusions:There was no difference in immediate outcome following use of either of the two INCs. FLP was preferred over CIC with respect to scent, soothing feel and nasal irritation, and also overall. There were no significant adverse events.

Comparison of immediate and long-term results of mitral balloon valvotomy with the double-balloon versus inoue techniques

There is controversy as to whether the double-balloon or Inoue technique of percutaneous mitral balloon valvotomy (PMBV) provides superior immediate and long-term results. This study compares the immediate procedural and long-term outcomes of patients undergoing PMBV using the double-balloon versus the Inoue techniques. Seven hundred thirty-four consecutive patients who underwent PMBV using the double-balloon (n = 621) or Inoue technique (n = 113) were studied. There were no statistically significant differences in baseline clinical and morphologic characteristics between the double-balloon and Inoue patients. The double-balloon technique resulted in superior immediate outcome, as reflected in a larger post-PMBV mitral valve area (1.9 ± 0.7 vs 1.7 ± 0.6 cm 2; p = 0.005) and a lower incidence of 3+ mitral regurgitation after PMBV (5.4% vs 10.6%; p = 0.05). This superior immediate outcome of the double-balloon technique was observed only in the group of patients with echocardiographic score ≤8 (post-PMBV mitral valve areas 2.1 ± 0.7 vs 1.8 ± 0.6; p = 0.004). Despite the difference in immediate outcome, there were no significant differences in event-free survival at long-term follow-up between the 2 techniques. Our study demonstrates that compared with the Inoue technique, the double-balloon technique results in a larger mitral valve area and less degree of severe mitral regurgitation after PMBV. Despite the difference in immediate outcome between both techniques, there were no significant differences in event-free survival at long-term follow-up.

Is term breech presentation in primigravida an absolute indication for cesarean section?

Excessive perinatal loss is associated with breech presentation, this loss being accounted for by prematurity, congenital anomalies and birth trauma. In the endeavor to exert an effect on two of these problems, cesarean section has been resorted to increasingly. We have compared two management regimes of primigravida term breech presentation corresponding to two 4-yr periods. During the first period every case was evaluated carefully and, if no other pathology was found, a trial vaginal delivery was allowed. During the second period all the cases were delivered by elective cesarean section. Of the 108 cases of the first period, 46 delivered vaginally and 62 underwent cesarean section. 119 cases were scheduled for abdominal delivery during the second period. Immediate infant outcome for each group was determined by the 1 and 5 min Apgar scores. Analysis of 5 min Apgar scores demonstrated no significant differences in immediate outcome between infants delivered vaginally and by cesarean section. Fetal morbidity related to birth trauma was higher in the vaginal delivery group but there were no perinatal deaths. Maternal morbidity was observed only in the cesarean section groups. This study suggests that properly selected primigravid term breech infants could be delivered vaginally without increased perinatal mortality and with immediate outcomes comparable to those found with cesarean section.