PubMed · 15332036
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Tomohiro Kato, Takafumi Naiki, Hiroshi Araki, Masahito Nagaki, Hisataka Moriwaki. 2004. Diffuse esophageal spasm.. https://doi.org/10.1016/s0016-5107(04)01706-7
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A systematic review was conducted to determine whether certain vascular access policies are better than others in terms of prevention of catheter-related infections. Publications were retrieved by a search of Medline, the Cochrane Library and Embase up to May 2005. All randomized trials and systematic reviews/meta-analyses of randomized trials evaluating the effect of vascular access policies (i.e. needleless closed systems, conventional closed systems or conventional open systems) on catheter-related infection in hospitalized patients with intravascular catheters in situ were selected. Two reviewers independently assessed trial quality and extracted data. Data from the original publications were used to calculate the relative risk or the incidence-density relative rate of catheter-related infection. Data for similar outcomes were combined in the analysis where appropriate using a random-effects model. Of the six studies reviewed, one was excluded. Five randomized controlled trials were included in the review. The quality of the trials and the way they were reported were generally unsatisfactory. Four trials compared needleless closed systems with conventional open systems. There was a trend for an advantage of the needleless closed devices in terms of less catheter-associated bloodstream infection, less catheter tip colonization and less hub inlet colonization. There were no possibilities for combining data because of clinical heterogeneity. One trial compared needleless closed systems with conventional closed systems and the evidence was inconclusive. From the point of view of infection prevention, there are no objections to use these new systems. However, there is insufficient evidence at this stage to recommend the needleless closed vascular devices.
There is a clear need for a large multicentre trial comparing the efficacy of the two available drug eluting stents, sirolimus and paclitaxel, in diabetic patients with multivessel disease.
BACKGROUND: Since its introduction in the eighties by Inoue, percutaneous balloon valvotomy has been established as treatment of choice for symptomatic degenerative mitral stenosis. Especially young patients with rheumatic fusion of the mitral commissures and no calcification of the still pliable valve leaflets are candidates for this procedure. In these patients balloon valvotomy is expected to give results comparable or even superior to operative commissurotomy. PATIENTS AND METHODS: This report presents the short and long-term results of 33 patients (24 females, 9 males; median age: 53 years) that underwent percutaneous mitral valvotomy (PMV) at the cardiac unit of the university hospital in Cologne during the last three years. RESULTS: The intervention was immediately successful in 31 patients (94%). The median mitral valve area was increased after PMV to 2.0 +/- 0.5 cm(2) an increase of mean opening area of 82% and a decrease of mean pressure gradient by about 50%. Follow-up date at 12 and 24 months were available for 21 and 12 patients, respectively. During the first 12 months after intervention four patients subsequently had to have surgical mitral valve replacement, one of them together with a coronary artery bypass graft. One patient, who had undergone PMV in cardiogenic shock died after the intervention. A 12-month follow-up demonstrated a mean mitral valve area of 1.7 +/- 0.4 cm(2) as assessed by echocardiography. After 24 months comparable mean valve area was 1.7 +/- 0.4 cm(2). One other patient required operative valve replacement, but there were no further deaths. CONCLUSION: The data collected from this very heterogeneous group of patients at the cardiac unit of the university hospital in Cologne confirms the observation that PMV is beneficial in young patients with favorable valve morphology and shows that it is indicated not only as a palliative measure but also as treatment option in older patients with more complex alterations of the mitral valve.