Heyland D.,Angada 4 |
Muscedere J.,Angada 4 |
Wischmeyer P.E.,Aurora University |
Cook D.,St. Josephs Healthcare |
And 5 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: Critically ill patients have considerable oxidative stress. Glutamine and antioxidant supplementation may offer therapeutic benefit, although current data are conflicting. METHODS: In this blinded 2-by-2 factorial trial, we randomly assigned 1223 critically ill adults in 40 intensive care units (ICUs) in Canada, the United States, and Europe who had multiorgan failure and were receiving mechanical ventilation to receive supplements of glutamine, antioxidants, both, or placebo. Supplements were started within 24 hours after admission to the ICU and were provided both intravenously and enterally. The primary outcome was 28-day mortality. Because of the interim-analysis plan, a P value of less than 0.044 at the final analysis was considered to indicate statistical significance. RESULTS: There was a trend toward increased mortality at 28 days among patients who received glutamine as compared with those who did not receive glutamine (32.4% vs. 27.2%; adjusted odds ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.64; P = 0.05). In-hospital mortality and mortality at 6 months were significantly higher among those who received glutamine than among those who did not. Glutamine had no effect on rates of organ failure or infectious complications. Antioxidants had no effect on 28-day mortality (30.8%, vs. 28.8% with no antioxidants; adjusted odds ratio, 1.09; 95% CI, 0.86 to 1.40; P = 0.48) or any other secondary end point. There were no differences among the groups with respect to serious adverse events (P = 0.83). CONCLUSIONS: Early provision of glutamine or antioxidants did not improve clinical outcomes, and glutamine was associated with an increase in mortality among critically ill patients with multiorgan failure. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00133978.) Copyright © 2013 Massachusetts Medical Society.
Nery P.B.,University of Ottawa |
Leung E.,Ottawa Hospital |
Birnie D.H.,University of Ottawa
Current Opinion in Cardiology | Year: 2012
PURPOSE OF REVIEW: Sarcoidosis is a granulomatous disease of unclear cause and variable presentation. Cardiac involvement can result in life-threatening conditions including heart block, ventricular tachycardia, sudden cardiac death, and heart failure. There is no consensus on the diagnosis and management of cardiac sarcoidosis and a practical update is needed to provide clinicians with guidance. RECENT FINDINGS: Three recent studies have described cardiac manifestations as the first presentation of sarcoidosis. In one study, cardiac sarcoidosis was found to be the underlying cause in 19% of adults aged less than 55 years presenting with new onset unexplained atrioventricular block. Also, there are increasing reports of patients with isolated cardiac sarcoidosis (i.e., without sarcoid in other organs). Finally, advances in imaging have enhanced our ability to detect myocardial involvement and perhaps follow response to treatment. SUMMARY: Cardiac sarcoidosis should be considered in patients aged less than 55 years presenting with unexplained atrioventricular block and in patients with idiopathic cardiomyopathy and sustained ventricular tachycardia. Much remains to be learned about the condition, including the role of steroids and devices in treatment, and the place of advanced imaging in following the response to treatment. Collaborative multicenter studies are required to answer these important clinical questions. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Kilty S.J.,Ottawa Hospital
Journal of Laryngology and Otology | Year: 2014
Abstract Introduction: Maxillary sinus atelectasis is a form of chronic rhinosinusitis of uncertain aetiology. Previously, the conventional treatment for this condition has been standard endoscopic surgery. There are no reports in the literature of successful treatment using balloon sinuplasty. Methods: A case of a patient with right maxillary sinus atelectasis is presented, who was treated using the balloon sinuplasty technique. Results: The patient's right maxillary sinus atelectasis was successfully treated using balloon sinuplasty. Three-month follow-up evaluation documented retention of the remodelled form of the uncinate process, and of maxillary sinus os patency. Conclusion: This is the first report of successful use of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis. Follow up demonstrated resolution of the underlying pathophysiology. Further study of the balloon sinuplasty technique for the treatment of maxillary sinus atelectasis is required to determine whether it has widespread applicability, given the current standard treatment. © JLO (1984) Limited 2014.
Carrier M.,Ottawa Health Research Institute |
Le Gal G.,Brest University Hospital Center |
Wells P.S.,Ottawa Hospital |
Rodger M.A.,Ottawa Health Research Institute
Annals of Internal Medicine | Year: 2010
Background: Case-fatality rates are important for assessing the risks and benefits of anticoagulation in patients with venous thromboembolism (VTE). Purpose: To summarize case-fatality rates of recurrent VTE and major bleeding events during anticoagulation and recurrent VTE after anticoagulation. Data Sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and all evidence-based medicine reviews in the Ovid interface through the second quarter of 2008. Study Selection: 69 articles (13 prospective cohort studies and 56 randomized, controlled trials) that reported on patients with symptomatic VTE who received anticoagulation therapy for at least 3 months and on the rate of fatal recurrent VTE and fatal major bleeding. Data Extraction: Two reviewers independently extracted data onto standardized forms. Data Synthesis: During the initial 3 months of anticoagulation, the rate of recurrent fatal VTE was 0.4% (95% CI, 0.3% to 0.6%), with a case-fatality rate of 11.3% (CI, 8.0% to 15.2%). The rate of fatal major bleeding events was 0.2% (CI, 0.1% to 0.3%), with a case-fatality rate of 11.3% (CI, 7.5% to 15.9%). After anticoagulation, the rate of fatal recurrent VTE was 0.3 per 100 patient-years (CI, 0.1% to 0.4%), with a case-fatality rate of 3.6% (CI, 1.9% to 5.7%). Limitations: Estimates come from heterogeneous trial and cohort populations and are not derived from patient-level longitudinal data. Differences in case-fatality rates during and after anticoagulation may be attributable to unmeasured patient characteristics. Conclusion: The case-fatality rates of recurrent VTE and major bleeding events are similar during the initial period of VTE treatment. The case-fatality rate of recurrent VTE decreases after completion of the initial period of anticoagulation. When combined with absolute rates of recurrent VTE and major bleeding events, case-fatality rates provide clinicians with a surrogate measure of mortality to balance the risks and benefits of anticoagulant therapy in patients with VTE. © 2010 American College of Physicians.
Duigenan S.,Ottawa Hospital |
Gee M.S.,Harvard University
American Journal of Roentgenology | Year: 2012
OBJECTIVE. The goal of this review is to examine the current imaging literature and develop basic imaging guidelines for evaluation of children with inflammatory bowel disease (IBD). The three following typical clinical scenarios in the imaging evaluation of IBD are considered: patient with an initial diagnosis of suspected IBD, the goals being to determine disease extent and severity and to differentiate Crohn disease from ulcerative colitis; patient with known IBD presenting with new acute symptoms (fever, peritonitis, leukocytosis) requiring urgent evaluation; and patient with known IBD presenting with nonacute symptomatic recurrence (abdominal pain, diarrhea), the goals being to assess the efficacy of the current treatment and to evaluate the possible need for additional medical or surgical intervention. CONCLUSION. Imaging of pediatric patients with IBD must balance considerations of diagnostic accuracy against concerns about patient exposure to ionizing radiation and tolerance of the imaging technique. The imaging modality chosen depends on the clinical presentation and expected pathologic finding. © American Roentgen Ray Society.