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Tonino P.A.L.,Catharina Hospital | Fearon W.F.,Stanford University | De Bruyne B.,Cardiovascular Center Aalst | Oldroyd K.G.,Golden Jubilee National Hospital | And 5 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives: The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study. Background: It can be difficult to determine on the coronary angiogram which lesions cause ischemia. Revascularization of coronary stenoses that induce ischemia improves a patient's functional status and outcome. For stenoses that do not induce ischemia, however, the benefit of revascularization is less clear. Methods: In the FAME study, routine measurement of the fractional flow reserve (FFR) was compared with angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. The use of the FFR in addition to angiography significantly reduced the rate of all major adverse cardiac events at 1 year. Of the 1,414 lesions (509 patients) in the FFR-guided arm of the FAME study, 1,329 were successfully assessed by the FFR and are included in this analysis. Results: Before FFR measurement, these lesions were categorized into 50% to 70% (47% of all lesions), 71% to 90% (39% of all lesions), and 91% to 99% (15% of all lesions) diameter stenosis by visual assessment. In the category 50% to 70% stenosis, 35% were functionally significant (FFR ≤0.80) and 65% were not (FFR >0.80). In the category 71% to 90% stenosis, 80% were functionally significant and 20% were not. In the category of subtotal stenoses, 96% were functionally significant. Of all 509 patients with angiographically defined multivessel disease, only 235 (46%) had functional multivessel disease (≥2 coronary arteries with an FFR ≤0.80). Conclusions: Angiography is inaccurate in assessing the functional significance of a coronary stenosis when compared with the FFR, not only in the 50% to 70% category but also in the 70% to 90% angiographic severity category. © 2010 American College of Cardiology Foundation.


Scott N.B.,Golden Jubilee National Hospital
Anaesthesia | Year: 2010

Wound infiltration with local anaesthetics is a simple, effective and inexpensive means of providing good analgesia for a variety of surgical procedures without any major side-effects. In particular, local anaesthetic toxicity, wound infection and healing do not appear to be major considerations. The purpose of this review is to outline the existing literature on a procedure-specific basis and to encourage a more widespread acceptance of the technique, ensuring that all layers are infiltrated in a controlled and meticulous manner.


Lobo F.A.,Abel Salazar Biomedical Sciences Institute | Schraag S.,Golden Jubilee National Hospital
Current Opinion in Anaesthesiology | Year: 2011

Purpose of Review: We critically review brain function monitors based on the processed electroencephalogram with regards to signal quality, artefacts and other limitations in clinical performance. Recent Findings: Several studies have been showing that depth of anaesthesia monitors based on processed electroencephalogram has limitations that can lead to a wrong interpretation of the level of anaesthesia. Processed electroencephalogram indices can be altered by nonanaesthetic influences ranging from artefacts that affect signal quality and signal processing, adverse effects of some anaesthetic and nonanaesthetic drugs, neuromuscular blocking agents to conditions inherent to the patient such as cerebral tumours, brain ischemia and temperature. Summary: Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Deep K.,Golden Jubilee National Hospital
Clinical Orthopaedics and Related Research | Year: 2014

Background: Proper alignment and balancing of soft tissues of the knee are important goals for TKA. Despite standardized techniques, there is no consensus regarding the optimum amount of collateral ligament laxity one should leave at the end of the TKA.Questions/purposes: I asked (1) what is the collateral laxity in young healthy volunteers, and (2) is there a difference in collateral laxity between males and females.Methods: The femorotibial mechanical angle (FTMA) was measured in 314 knees in healthy volunteers aged 19 to 35 years. Subjects with a history of pain, malalignment, dysplasia, or trauma were excluded. Twenty-five knees were excluded because the hip center could not be acquired, and 22 were excluded because of a history of pain and trauma, leaving 267 knees for inclusion in the study. Of these, 155 were from men and 112 were from women. A validated method using a computer navigation system was used to obtain the measurements. A 10-Nm torque was used to stress the knee in varus and valgus at 0° extension and 15° flexion. An independent t-test and ANOVA were applied to the data to calculate any significant difference between groups (p < 0.05).Results: The mean (SD) unstressed supine FTMA was varus of 1.2° (SD, 4°) in 0° extension and varus of 1.2° (SD, 4.4°) in 15° flexion (p = 0.88). On varus torque of 10 Nm, the supine FTMA changed by a mean of 3.1° (SD, 2°) (95% CI, 2.4°–3.8°; p < 0.001) in 0° extension and 6.9° (SD, 2.6°) (95% CI, 6.2°–7.7°; p < 0.001) in 15° flexion. On valgus torque of 10 Nm, the FTMA changed by a mean of 4.6° (SD, 2.2°) (95% CI, 3.9°–5.3°; p < 0.001) in 0° extension and 7.9° (SD, 3.4°) (95% CI, 7.1°–8.7°; p < 0.001) in 15° flexion. The mean unstressed FTMA in 0° extension was varus of 1.7° (SD, 4°) in men and 0.4° (SD, 3.9°) in women (p = 0.01). Differences in collateral ligament laxity were seen between men and women (p < 0.001 for valgus torque and 0.035 for varus torque in 15° flexion). With valgus torque at 0° flexion, the supine FTMA change was valgus of 4.2° (SD, 2.0°) for men and 5.0° (SD, 2.4°) for women, while at 15° flexion the FTMA change was valgus 7.6° (SD, 3.6°) for men and 8.3° (SD, 3.2°) for women With varus torque at 0° flexion, additional varus was −3.0° (SD, 1.8°) for men and −3.3° (SD, 2.2°) for women, while at 15° flexion, varus was −7.0° SD, (2.5°) for men and −6.9° (SD, 2.8°) for women.Conclusions: The collateral laxity in young healthy volunteers was quantified in this study. The collateral ligament laxity is variable in different persons. In addition, ligaments in women are more lax than in men in valgus stress.Clinical Relevance: This study was conducted on young, healthy knees. Whether the findings are applicable to arthritic knees and replaced knees needs additional evaluation. However the findings provide a baseline from which to work in the evaluation of arthritic knees and in the case of TKA. © 2014, The Association of Bone and Joint Surgeons®.


Campbell R.T.,University of Glasgow | Jhund P.S.,University of Glasgow | Castagno D.,University of Turin | Hawkins N.M.,Liverpool Heart and Chest Hospital | And 2 more authors.
Journal of the American College of Cardiology | Year: 2012

Examination of patients with reduced and preserved ejection fraction in the DIG (Digitalis Investigation Group) trials and the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) trials provides comparisons of outcomes in each of these types of heart failure. Comparison of the patients in these trials, along with the I-PRESERVE (Irbesartan in Heart Failure with Preserved Systolic Function Trial), with patients of similar age, sex distribution, and comorbidity in trials of hypertension, diabetes mellitus, angina pectoris, and atrial fibrillation provides even more interesting insights into the relation between phenotype and rates of death and heart failure hospitalization. The poor clinical outcomes in patients with heart failure and preserved ejection fraction do not seem easily explained on the basis of age, sex, comorbidity, blood pressure, or left ventricular structural remodeling but do seem to be explained by the presence of the syndrome of heart failure. © 2012 American College of Cardiology Foundation.

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