Journal of Trauma-injury Infection and Critical Care, Sep 1, 1998
Blunt chest trauma can result in a tear of the thoracic aortic wall with development of a contain... more Blunt chest trauma can result in a tear of the thoracic aortic wall with development of a contained false aneurysm. Previous case reports and series [1-8] have described a few patients with extensive aortic dissections complicating a traumatic rupture of the thoracic ...
The prevalence of chronic kidney disease (CKD) is increasing in North America, with an attendant ... more The prevalence of chronic kidney disease (CKD) is increasing in North America, with an attendant increase in cardiovascular complications. The bulk of the mortality and morbidity in CKD patients can be attributed to coronary artery disease (CAD), especially in the presence of diabetes mellitus. Thus, screening and diagnosis of CAD is particularly important in the management of these patients, especially during evaluation for renal transplantation. However, numerous limitations exist with noninvasive tests that cloud the ideal strategy for diagnosis. In addition, the optimal revascularization strategy (surgery versus percutaneous intervention) for CAD is controversial for these patients. Randomized trials are clearly needed; unfortunately, major cardiovascular trials usually exclude patients with significant renal dysfunction. The current diagnostic and revascularization strategy for CAD in CKD patients is discussed, highlighting current controversies that warrant further investigation.
Objective: To review comparative studies evaluating oral propafenone for restoring sinus rhythm i... more Objective: To review comparative studies evaluating oral propafenone for restoring sinus rhythm in recent onset atrial fibrillation. Data sources: A MEDLINE search of the English-language literature (1966 to 1996) along with any referenced articles not identified by MEDLINE. Study selection: Because intravenous propafenone is not marketed in Canada, only studies evaluating oral propafenone were included. Studies were selected if they compared oral propafenone with placebo or other antiarrhythmic agents for converting recent onset atrial fibrillation to normal sinus rhythm. Data synthesis: Propafenone is often used as a first-line agent for pharmacological cardioversion of atrial fibrillation. In earlier studies, the efficacy of propafenone in restoring sinus rhythm was reported to be low with conversion rates of 6% to 62%. Many of these studies were noncomparative and often included patients with refractory, chronic atrial fibrillation or employed suboptimal doses of propafenone. More recently propafenone has been evaluated in the treatment of recent onset atrial fibrillation by using a single 600 mg oral loading dose. Success rates of 76% at 8 h and 83% at 12 h following the loading dose are reported. The incidence of atrial flutter during active treatment was similar to that with placebo, with the majority exhibiting 2:1 or greater atrioventricular conduction ratios and heart rates 150 beats/min or less. Conclusions: A single 600 mg oral dose of propafenone is highly effective at restoring sinus rhythm in patients with acute onset atrial fibrillation with few adverse effects. The small studies reviewed cannot lead to definitive conclusions about the safety of propafenone without prior administration of agents for rate control.
Background: There is evidence that the addition of nonstandard electrocardiographic (ECG) leads r... more Background: There is evidence that the addition of nonstandard electrocardiographic (ECG) leads results in significant increases in sensitivity for the diagnosis of acute myocardial infarction compared with the standard 12-lead ECG. Objective: To examine how cardiologists and emergency physicians in British Columbia use nonstandard ECG leads (V4R to V6R and V7 to V9) in the diagnosis and treatment of acute myocardial infarction. Design: A list of fax numbers of all cardiologists and emergency physicians in British Columbia was obtained and questionnaires were then transmitted. Main results: More than 75% of cardiologists and emergency physicians correctly identified the diagnostic criteria for acute right ventricular and posterior myocardial infarction. More than 70% of surveyed physicians reported that they would use the 18-lead ECG regularly if they could gain an increased sensitivity for the diagnosis of acute myocardial infarction. However, fewer than 20% of all surveyed physicians reported regular use of the 18-lead ECG. Furthermore, the survey determined that the majority of physicians would alter their choice of thrombolytic if they could diagnose right ventricular infarction complicating an inferior infarction. Finally, most physicians reported that they would treat an isolated posterior wall myocardial infarction with a thrombolytic. Conclusions: This study suggests most cardiologists and emergency physicians in British Columbia are aware of 18-lead ECG diagnostic criteria for acute right ventricular and posterior wall myocardial infarction. Furthermore, these physicians would be willing to use this tool if it were to increase diagnostic sensitivity for acute myocardial infarction. Despite these findings, only the minority of surveyed physicians use this tool regularly.
... We used Stata intercooled version 10.1, in particular the metan command,26 the midas command2... more ... We used Stata intercooled version 10.1, in particular the metan command,26 the midas command27 and the metandi command28 for all statistical analyses. ... Forrest plot of the summary correlation coefficient and I 2 statistic for heterogeneity for the included studies (n=27). ...
Journal of Trauma-injury Infection and Critical Care, Sep 1, 1998
Blunt chest trauma can result in a tear of the thoracic aortic wall with development of a contain... more Blunt chest trauma can result in a tear of the thoracic aortic wall with development of a contained false aneurysm. Previous case reports and series [1-8] have described a few patients with extensive aortic dissections complicating a traumatic rupture of the thoracic ...
The prevalence of chronic kidney disease (CKD) is increasing in North America, with an attendant ... more The prevalence of chronic kidney disease (CKD) is increasing in North America, with an attendant increase in cardiovascular complications. The bulk of the mortality and morbidity in CKD patients can be attributed to coronary artery disease (CAD), especially in the presence of diabetes mellitus. Thus, screening and diagnosis of CAD is particularly important in the management of these patients, especially during evaluation for renal transplantation. However, numerous limitations exist with noninvasive tests that cloud the ideal strategy for diagnosis. In addition, the optimal revascularization strategy (surgery versus percutaneous intervention) for CAD is controversial for these patients. Randomized trials are clearly needed; unfortunately, major cardiovascular trials usually exclude patients with significant renal dysfunction. The current diagnostic and revascularization strategy for CAD in CKD patients is discussed, highlighting current controversies that warrant further investigation.
Objective: To review comparative studies evaluating oral propafenone for restoring sinus rhythm i... more Objective: To review comparative studies evaluating oral propafenone for restoring sinus rhythm in recent onset atrial fibrillation. Data sources: A MEDLINE search of the English-language literature (1966 to 1996) along with any referenced articles not identified by MEDLINE. Study selection: Because intravenous propafenone is not marketed in Canada, only studies evaluating oral propafenone were included. Studies were selected if they compared oral propafenone with placebo or other antiarrhythmic agents for converting recent onset atrial fibrillation to normal sinus rhythm. Data synthesis: Propafenone is often used as a first-line agent for pharmacological cardioversion of atrial fibrillation. In earlier studies, the efficacy of propafenone in restoring sinus rhythm was reported to be low with conversion rates of 6% to 62%. Many of these studies were noncomparative and often included patients with refractory, chronic atrial fibrillation or employed suboptimal doses of propafenone. More recently propafenone has been evaluated in the treatment of recent onset atrial fibrillation by using a single 600 mg oral loading dose. Success rates of 76% at 8 h and 83% at 12 h following the loading dose are reported. The incidence of atrial flutter during active treatment was similar to that with placebo, with the majority exhibiting 2:1 or greater atrioventricular conduction ratios and heart rates 150 beats/min or less. Conclusions: A single 600 mg oral dose of propafenone is highly effective at restoring sinus rhythm in patients with acute onset atrial fibrillation with few adverse effects. The small studies reviewed cannot lead to definitive conclusions about the safety of propafenone without prior administration of agents for rate control.
Background: There is evidence that the addition of nonstandard electrocardiographic (ECG) leads r... more Background: There is evidence that the addition of nonstandard electrocardiographic (ECG) leads results in significant increases in sensitivity for the diagnosis of acute myocardial infarction compared with the standard 12-lead ECG. Objective: To examine how cardiologists and emergency physicians in British Columbia use nonstandard ECG leads (V4R to V6R and V7 to V9) in the diagnosis and treatment of acute myocardial infarction. Design: A list of fax numbers of all cardiologists and emergency physicians in British Columbia was obtained and questionnaires were then transmitted. Main results: More than 75% of cardiologists and emergency physicians correctly identified the diagnostic criteria for acute right ventricular and posterior myocardial infarction. More than 70% of surveyed physicians reported that they would use the 18-lead ECG regularly if they could gain an increased sensitivity for the diagnosis of acute myocardial infarction. However, fewer than 20% of all surveyed physicians reported regular use of the 18-lead ECG. Furthermore, the survey determined that the majority of physicians would alter their choice of thrombolytic if they could diagnose right ventricular infarction complicating an inferior infarction. Finally, most physicians reported that they would treat an isolated posterior wall myocardial infarction with a thrombolytic. Conclusions: This study suggests most cardiologists and emergency physicians in British Columbia are aware of 18-lead ECG diagnostic criteria for acute right ventricular and posterior wall myocardial infarction. Furthermore, these physicians would be willing to use this tool if it were to increase diagnostic sensitivity for acute myocardial infarction. Despite these findings, only the minority of surveyed physicians use this tool regularly.
... We used Stata intercooled version 10.1, in particular the metan command,26 the midas command2... more ... We used Stata intercooled version 10.1, in particular the metan command,26 the midas command27 and the metandi command28 for all statistical analyses. ... Forrest plot of the summary correlation coefficient and I 2 statistic for heterogeneity for the included studies (n=27). ...
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Papers by Kenneth Gin