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Durch Chemotherapie und moderne zielgerichtete Therapien entstehen bei Patienten mit malignen Tumoren Konditionen, die den postoperativen Verlauf negativ beeinflussen können. Bei Adenokarzinomen des Magens und des ösophagogastralen Überganges spielen kombinierte neoadjuvante Radiochemotherapien eine zunehmende Rolle. Aufgrund zunehmender Metastasenchirurgie beim kolorektalen Karzinom sollten die Spezifika...
Residents of impoverished areas have historically had poor access to medical care. We linked data from the Cooperative Cardiovascular Project (CCP), a sample of Medicare beneficiaries, and 1990 census to evaluate access to medical treatment for AMI by residents of impoverished areas. Patients age 65 or older with confirmed AMI with valid zip code information (N = 156,959) were evaluated for access...
The early and late mortality in elderly patients (pts) who present with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) is not established. We sought to identify baseline predictors of one-year mortality in this population who survived through discharge. We evaluated 163,223 patients 65 years of age or older with AMI in the Cooperative Cardiovascular Project database. Of these,...
We hypothesize that hospital size and location are important factors in determining treatment of AMI. Using data from the Cooperative Cardiovascular Project, we evaluated administration of four arrival therapies: ASA on arrival, heparin, IV nitroglycerin, thrombolytics; and three discharge therapies: beta blockers, ACE inhibitors and ASA on discharge. Patients 65 years or older with confirmed AMI...
Background: Patients with renal insufficiency are at increased risk for acute myocardial infarction (AMI). However, its short and long term effect upon prognosis are not well understood. We sought to determine whether the admission serum creatinine (Cr) is an independent predictor of mortality in elderly patients with AMI.Methods: We evaluated Medicare beneficiaries age 65 years or older with a...
Despite advancement in the management of acute myocardial infarction (AMI), early and late mortality in elderly patients remains high. The occurrence of a cardiac arrest with AMI contributes substantially to the high early mortality. We sought to identify baseline characteristics of elderly patients presenting with AMI at risk for an early CA. Utilizing the Cooperative Cardiovascular Project (CCP)...
Beta blockers have been shown to decrease the incidence of atrial fibrillation (AF) following cardiac surgery. However, the use of magnesium is more controversial. It was our hypothesis that adjunctive magnesium sulfate (M) would improve the efficacy of beta blockers in the prevention of postoperative AF.Methods: We prospectively randomized 150 coronary artery bypass patients (mean age 61 +/- 10...
Background: Diabetic patients have a higher short and long-term mortality from acute myocardial infarction (AMI). The absence of typical ischemic symptoms, which may delay patient presentation and diagnosis, has been cited as a factor contributing to their increased mortality.Methods: We utilized the Cooperative Cardiovascular Project database, a retrospective analysis patients with a confirmed AMI,...
Dobutamine stress echocardiography (DSE) commonly uses 3 minute (min) stages despite requiring up to 10 min to reach steady state. Prior studies have demonstrated the utility of prolonged stage duration, but DSE is already a time consuming test. We developed a novel accelerated DSE (ADSE) protocol in which a single, high dose (40 mcg/kg/min) infusion of dobutamine is administered for up to 10 minutes,...
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