News Article | February 27, 2017
Lower stroke, mortality, renal failure, bleeding, atrial fibrillation, and length of intensive care unit stay with newer no-touch technique A landmark study led by Prof. Michael P. Vallely, MBBS, PhD, FRACS, of Sydney Heart and Lung Surgeons and the University of Sydney will be published in the February 28, 2017 issue of the Journal of the American College of Cardiology. According to the study, which involved 37,720 patients, a newer "no-touch" beating heart bypass surgery technique (anOPCABG) reduced postoperative stroke by 78% compared to traditional coronary artery bypass grafting (CABG). In addition, compared to traditional CABG, the newer "no-touch" technique also reduced postoperative mortality by 50%, renal failure by 53%, bleeding complications by 48%, atrial fibrillation by 34%, and length of intensive care unit stay by 13.3 hours. The co-authors of this study included world-renowned cardiothoracic surgeons from Australia, the United States, Canada, and the United Kingdom. Coronary artery bypass grafting (CABG) is a surgical procedure for ischemic heart disease, which is the most common cause of death in Western countries. In this disease, the gradual build-up of fat and calcium within the arteries of the heart causes narrowing, which reduces blood flow to the heart’s muscle. When the narrowing becomes very severe or completely blocked it causes a heart attack. CABG involves bypassing these blockages using a graft. The graft goes around the blocked artery to create new pathway for oxygen-rich blood to flow to the heart again. The aim of this is to relieve symptoms (including angina), help the patient resume a normal lifestyle, and to prevent the risk of heart attacks or other heart problems. However, traditional CABG involves stopping the heart during surgery and placing a clamp on the large vessel of the heart (aorta). Sewing the grafts to the heart is traditionally performed on a still, non-beating heart while the patient is on a heart-lung machine (“on-pump surgery”). In contrast, the newer no-touch, off-pump technique is performed on a beating heart without the heart-lung machine, using a small stabilizer. Since the heart-lung machine is not needed, the large vessels of the heart do not need to be manipulated (an “anaortic” or "no-touch" technique). This technique particularly benefits elderly and high-risk patients, and was shown in this new study to reduce the risk of stroke, death, and kidney injury following the operation. The no-touch beating heart technique performed "without aortic manipulation, whilst performed only by a minority of surgeons, has an important place in the higher risk patient undergoing CABG," commented Prof. Michael P. Vallely, corresponding author of the study and cardiothoracic surgeon at Sydney Heart and Lung Surgeons, "this powerful analysis demonstrates the potential benefit, not only in the reduction of stroke, but also in mortality... [and] provides the most comprehensive and highest-quality evidence currently available [to] help inform decisions regarding the management of these patients." "Interestingly, the risk of stroke seemed to be directly related to the extent of aortic manipulation," said John G. Byrne, MD, of Hospital Corporation of America and Marzia Leacche, MD, of Spectrum Health in an editorial for the Journal of the American College of Cardiology, "a no-touch technique is probably a superior approach compared to conventional on-pump CABG with aortic clamping... in patients with increased cerebrovascular disease or atherosclerotic disease in the aorta." For the first time, an advanced Bayesian network model has been utilized to directly compare the clinical outcomes of all the major coronary artery bypass grafting techniques, including a totally anaortic or “no touch” off-pump technique, off-pump with a partial-clamp, off-pump with the clampless Heartstring device (St. Jude Medical, Saint Paul, Minnesota), and traditional on-pump with cross-clamp technique. This study will be published in the February 28, 2017 issue of the Journal of the American College of Cardiology. Sydney Heart and Lung Surgeons has decades of combined experience in all aspects of adult cardiothoracic surgery. We offer comprehensive patient care, including pre-surgery meetings with the surgeon and daily hospital visits by our surgical team post-operation. Our group treats both private and public patients across Sydney’s major hospitals, including Strathfield Private Hospital, Macquarie University Hospital, Concord Repatriation General Hospital, and the Southern Highlands Private Hospital (Bowral), and are based at Royal Prince Alfred Hospital.
De Blasio F.,Private Hospital |
Dicpinigaitis P.V.,Yeshiva University |
Rubin B.K.,Virginia Commonwealth University |
De Danieli G.,Dompe spa |
And 2 more authors.
Cough | Year: 2012
Background: Cough is one of the most frequent symptoms in children and is the most common symptom for which children visit a health care provider.Methods: This is an observational study on acute cough associated with upper respiratory tract infection (URTI) in children. The study evaluates the epidemiology and impact of cough on quality of sleep and children's activities, and the outcome of cough with antitussive treatments in pediatric routine clinical practice. Study assessments were performed through a pediatric cough questionnaire (PCQ), developed by the Italian Society of Cough Study. A total of 433 children visited by family care pediatricians for acute cough due to a URTI were enrolled in this study, with mean age of 6.1 years (SD 3.6). Cough type, duration, severity and frequency, cough impact on sleep disturbances of children and parents and on school and sport activities were assessed at baseline. In a subset of 241 children who were either treated with antitussive drugs (levodropropizine n = 101, central antitussives n = 60) or received no treatment (n = 80), the outcome of cough after 6 days was analyzed in terms of resolution, improvement, no change, or worsening. Descriptive analysis, χ 2test, and multivariate analysis with stepwise logistic regression were performed.Results: Cough disturbed sleep in 88% of children and 72% of parents. In children treated with cough suppressants, the duration, type, intensity, and frequency cough were similar at baseline in the two groups respectively treated with levodropropizine and central antitussives (cloperastine and codeine). Both levodropropizine and central drugs reduced cough intensity and frequency. However, percentage of cough resolution was higher with levodropropizine than with central antitussives (47% vs. 28% respectively, p = 0.0012).Conclusions: Acute cough disturbs sleep in most children and their parents. Both levodropropizine and central antitussives reduced cough intensity, with levodropropizine producing a higher cough resolution rate. © 2012 De Blasio et al; licensee BioMed Central Ltd.
De Blasio F.,Private Hospital |
Dicpinigaitis P.V.,Yeshiva University |
De Danieli G.,Dompe SPA |
Lanata L.,Dompe SPA |
Zanasi A.,University of Bologna
Pulmonary Pharmacology and Therapeutics | Year: 2012
Cough in children is among the most common problems managed by pediatricians, and occurs more frequently in preschool than in older children. Most acute episodes of cough are due to viral upper respiratory tract infections. The morbidity associated with acute cough in a child extends also to parents, teachers, and other family members and caregivers. Unfortunately, therapeutic options for acute cough in children are severely limited due to the absence of drugs shown to be effective antitussives with an acceptable safety profile. Agents used in the management of adult cough, such as narcotics (codeine, hydrocodone), the non-narcotic opioid dextromethorphan, first-generation, potentially sedating antihistamines, and decongestants such as pseudoephedrine, have all been deemed inadequate for treatment of acute pediatric cough on a risk/benefit basis. A growing body of evidence suggests that the peripherally acting antitussive, levodropropizine, may be an attractive alternative for the treatment of bothersome acute cough in children. © 2012 Elsevier Ltd.
PubMed | Aristotle University of Thessaloniki, Private Hospital, University General Hospital of Alexandroupolis, Microdiagnostics Ltd. and 2 more.
Type: Journal Article | Journal: Annals of translational medicine | Year: 2016
We present a case of a 56-year-old female, with a familial history of breast, lung and brain cancer, which revealed a breast tumor, located in the upper outer quadrant of the left breast. During the routinely staging examinations, a 15 cm intrathoracic tumor was found in the upper left mediastinum, penetrating the pericardium and a smaller tumor, in the left side of parietal pleura. Core biopsies from both lesions, revealed a lobular carcinoma of the breast classic type, grade II (e-cadherin-, ER+, PR+, Her-2-, Ki-67 10%) and a B3 thymoma (CK19+, CD5+) penetrating the pericardium and the left lung. A synchronous removal of both tumors was scheduled, including median sternotomy and left intrapericardial pneumonectomy, followed by a modified radical left mastectomy and a sentinel lymph node biopsy. The postoperative course was uneventful. This case advocates that thymoma patients appear to have a predisposition towards developing additional neoplasms, as breast carcinoma. Clinicians should be aware of the increased incidence of extrathymic cancers, occurring in thymoma patients.
Orphanos G.,Private Hospital |
Kountourakis P.,Oncology Center
Hematology/ Oncology and Stem Cell Therapy | Year: 2013
The advent of targeted therapies has revolutionized the treatment of certain types of cancer. Identification of molecular targets on cancer cells has led to the design of novel drugs, which either used as single agents or in combination with chemotherapy, has prolonged survival in metastatic disease, or contributed to curative treatment in the adjuvant setting. A literature review was conducted to identify and present current knowledge on the molecular function of the HER2 receptor, its role in the pathogenesis of breast cancer and anti-HER2 targeted drugs in use or under development. Many molecular targets have been identified in breast cancer, with the HER family of receptors being the ones most extensively studied. Trastuzumab and lapatinib target the HER2 receptor and are approved drugs for the treatment of metastatic breast cancer. Several other targeted agents, including T-DM1, pertuzumab, neratinib, afatinib and ertumaxomab, are currently being tested in vivo as well as in clinical studies. The use of targeted therapies in metastatic breast cancer has improved prognosis, increased survival and dramatically changed the way we treat breast cancer patients today.
Blaganje M.,Private Hospital |
Lutfallah F.,Private Hospital |
Deval B.,Private Hospital
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2016
Aim of the video: Mini-laparoscopic surgery is the future for most laparoscopic procedures. Although already applied in some gynaecological surgical interventions, this video is to our knowledge the first publication on the use of the mini-laparoscopic approach to sacrocolpopexy for apical and posterior pelvic organ prolapse following total hysterectomy. Methods: The concept of mini-laparoscopic sacrocolpopexy presented in this video article was performed on 12 women with post-hysterectomy apical and posterior pelvic organ prolapse using mini-laparoscopic instruments and ports of 3 mm in diameter combined with a 12-mm umbilical port. Surgery was performed with the same principles as for the conventional laparoscopic procedure. Results: The mean operating time was 70 min (SD ± 12). The tensile strength of the mini-laparoscopic instruments allowed appropriate manipulation of tissue consistent with that of conventional instruments. No difficulties or complications were experienced in comparison to a conventional technique. All patients were discharged from hospital on day 1 postoperatively. Conclusions: The effectiveness, safety and feasibility of the mini-laparoscopic surgical technique was applied to sacrocolpopexy. Because of the initial favourable experience, the mini-laparoscopic sacrocolpopexy could become more widely used in the future. © 2016, The International Urogynecological Association.
Epinette J.-A.,Private Hospital |
Brunschweiler B.,Amiens Academic Regional Hospital Center |
Mertl P.,Amiens Academic Regional Hospital Center |
Mole D.,Orthopaedics and Traumatology private Hospital Center |
Cazenave A.,Helio Marin Hospital Center
Orthopaedics and Traumatology: Surgery and Research | Year: 2012
Background: This study originated from a symposium held by the French Hip and Knee Society (Société française de la hanche et du genou [SFHG]) and was carried out to better assess the distribution of causes of unicompartmental knee arthroplasty (UKA) failures, as well as cause-specific delay to onset. Hypothesis: Our working hypothesis was that most failures were traceable to wear occurring over a period of many years. Materials and methods: A multicentre retrospective study (25 centres) was conducted in 418 failed UKAs performed between 1978 and 2009. We determined the prevalence and time to onset of the main reasons for revision surgery based upon available preoperative findings. Additional intraoperative findings were analysed. The results were compared to those of nation wide registries to evaluate the representativeness of our study population. Results: Times to revision surgery were short: 19% of revisions occurred within the first year and 48.5% within the first 5. years. Loosening was the main reason for failure (45%), followed by osteoarthritis progression (15%) and, finally, by wear (12%). Other reasons were technical problems in 11.5% of cases, unexplained pain in 5.5%, and failure of the supporting bone in 3.6%. The infection rate was 1.9%. Our results were consistent with those of Swedish and Australian registries. Discussion: Our hypothesis was not confirmed. The short time to failure in most cases suggests a major role for surgical technique issues. Morbidity related to the implant per se may be seen as moderate and not greater than with total knee prostheses. The good agreement between our data and those of nationwide registries indicates that our population was representative. A finer analysis is needed, indicating that the establishment of a French registry would be of interest. Level of evidence: Level IV, retrospective study. © 2012.
Dantoft T.M.,Copenhagen University |
Elberling J.,Copenhagen University |
Brix S.,Technical University of Denmark |
Szecsi P.B.,Copenhagen University |
And 2 more authors.
Psychoneuroendocrinology | Year: 2014
Background: Multiple chemical sensitivity (MCS) is a medically unexplained condition characterized by reports of recurrent unspecific symptoms attributed to exposure to low levels of common volatile chemicals. The etiology of MCS is poorly understood, but dysregulation of the immune system has been proposed as part of the pathophysiology. Objective: To compare plasma levels of cytokines in Danish MCS individuals with a healthy, sex- and age-matched control group. Method: Blood samples were obtained from 150 un-exposed MCS individuals and from 148 age- and sex-matched healthy controls. Plasma concentrations of 14 cytokines, chemokines and growth and allergen-specific IgE were measured. All participants completed a questionnaire including questions on MCS, psychological distress, morbidities and medication use at the time of the study. Results: Plasma levels of interleukin-1β, -2, -4, and -6 were significantly (P<0.001) increased in the MCS group compared with controls, tumor necrosis factor-α was borderline significantly (P=0.05) increased and interleukin-13 was significantly decreased (P<0.001). Conclusion: MCS individuals displayed a distinct systemic immune mediator profile with increased levels of pro-inflammatory cytokines and interleukin-2 and inverse regulation of Th2 associated cytokines interleukin-4 and interleukin-13 suggestive of low-grade systemic inflammation, along with a deviating Th2-associated cytokine response not involving IgE-mediated mechanisms. © 2013 Elsevier Ltd.
News Article | November 16, 2016
St. Vincent’s private hospital has invested significantly in the hospital’s radiation therapy treatment center with the installation of C-RAD Catalyst HD™ and Sentinel 4DCT™ systems. The hospital and its patients are the first in Ireland to benefit from C-RAD’s advanced surface tracking systems. The order has a total value of more than 2.5 MSEK. The Catalyst HD™ will be delivered with the complete software configuration containing modules for Respiratory Gating, Patient Setup and Positioning, and Motion Monitoring. The systems have full integration with the linear accelerator. Through dedicated interfaces the C-RAD system can control the treatment beam in dependency of respiratory motion. The customer also selected C-RAD’s unique audio-visual couching functionality, which supports an interactive gating mode. Delivery and installation of the order is scheduled for December 2016. The installation is expected to go clinical early in 2017. St. Vincent’s Private Hospital is a registered charity and a not-for-profit organization. The hospital is a member of St. Vincent’s Healthcare Group, based in Dublin. In the UK and Ireland C-RAD is represented by the company Vertec Scientific Ltd. The Catalyst HD™ and Sentinel™ systems enable the high-end treatment techniques within radiation therapy that are increasingly common. With this dual solution C-RAD supports the whole 4D treatment chain from imaging to treatment delivery. Respiratory gated treatments are frequently used when the target volume is close to cardiac tissue, or for special treatments in which the tumor position depends on the respiratory cycle. “St Vincent’s Private Hospital is at the forefront in delivering comprehensive multidisciplinary oncology services to patients from across Ireland. We are committed to delivering the best quality of care to our patients. This new investment in our Radiotherapy Department will ensure we continue to improve patient care in our hospital”. “Patients will benefit for the advanced treatment techniques supported by the cutting edge C-RAD systems.” says Tim Thurn, CEO of C-RAD. “We welcome the team at St. Vincent’s Private Hospital to the growing group of C-RAD users. I am very pleased that C-RAD can contribute to improved patient care in Dublin and in the world.” C-RAD develops innovative solutions for use in advanced radiation therapy. The C-RAD group offers products and solutions for patient positioning, tumor localization and radiation treatment systems. All product development is conducted in three fully owned subsidiaries: C-RAD Positioning AB, C-RAD Imaging AB and C-RAD Innovation AB, all of which are located in Uppsala, Sweden. C-RAD has established three companies for direct sales: C-RAD Inc. in the US, C-RAD GmbH in Germany and C-RAD WOFE in China. Cyrpa International SPRL, a Franco-Belgian laser company, is a wholly owned subsidiary whose operations are integrated. C-RAD AB is listed on NASDAQ Stockholm. For more information on C-RAD, please visit www.c-rad.com This information is information that C-RAD AB (publ) is obliged to make public pursuant to the EU Market Abuse Regulation. The information was submitted for publication at 08:30 CET on November 16, 2016.
News Article | November 14, 2016
With an upcoming publication in the Worldwide Leaders in Healthcare, Joanne D. Pymble, RN, joins the prestigious ranks of the International Nurses Association. Joanne D. Pymble is a Licensed Practical Nurse with 33 years of experience in her field and an extensive expertise in all facets of nursing, especially medical-surgical nursing, palliative care, and wound care. Joanne is currently serving patients at Hunter Valley Private Hospital in Shortland, New South Wales. Joanne graduated in 1986 with her Nursing Diploma, which she completed at Concord Hospital. Joanne attributes her success to her dedication to her patients and their families. When she is not assisting patients at Hunter Valley Private Hospital, Joanne enjoys reading. Learn more about Joanne D. Pymble here: http://inanurse.org/network/index.php?do=/4133393/info/ and be sure to read her upcoming publication in the Worldwide Leaders in Healthcare.