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Results: 1 to 10 of 19

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Combined Angiotensin Receptor Antagonism and Neprilysin Inhibition.
Hubers SA, Brown NJ
(2016) Circulation 133: 1115-24
MeSH Terms: Abnormalities, Drug-Induced, Aminobutyrates, Angioedema, Angiotensin Receptor Antagonists, Biphenyl Compounds, Bradykinin, Contraindications, Drug Combinations, Drug Costs, Drug Synergism, Enalapril, Enzyme Inhibitors, Female, Follow-Up Studies, Heart Failure, Humans, Hyperkalemia, Hypertension, Kidney, Multicenter Studies as Topic, Natriuretic Peptides, Neprilysin, Pregnancy, Prodrugs, Prospective Studies, Pyridines, Randomized Controlled Trials as Topic, Stroke Volume, Tetrazoles, Thiazepines, Valsartan
Show Abstract · Added April 6, 2017
Heart failure affects ≈5.7 million people in the United States alone. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone antagonists have improved mortality in patients with heart failure and reduced ejection fraction, but mortality remains high. In July 2015, the US Food and Drug Administration approved the first of a new class of drugs for the treatment of heart failure: Valsartan/sacubitril (formerly known as LCZ696 and currently marketed by Novartis as Entresto) combines the angiotensin receptor blocker valsartan and the neprilysin inhibitor prodrug sacubitril in a 1:1 ratio in a sodium supramolecular complex. Sacubitril is converted by esterases to LBQ657, which inhibits neprilysin, the enzyme responsible for the degradation of the natriuretic peptides and many other vasoactive peptides. Thus, this combined angiotensin receptor antagonist and neprilysin inhibitor addresses 2 of the pathophysiological mechanisms of heart failure: activation of the renin-angiotensin-aldosterone system and decreased sensitivity to natriuretic peptides. In the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, valsartan/sacubitril significantly reduced mortality and hospitalization for heart failure, as well as blood pressure, compared with enalapril in patients with heart failure, reduced ejection fraction, and an elevated circulating level of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide. Ongoing clinical trials are evaluating the role of valsartan/sacubitril in the treatment of heart failure with preserved ejection fraction and hypertension. We review here the mechanisms of action of valsartan/sacubitril, the pharmacological properties of the drug, and its efficacy and safety in the treatment of heart failure and hypertension.
© 2016 American Heart Association, Inc.
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31 MeSH Terms
Image-Guided Percutaneous Abdominal Mass Biopsy: Technical and Clinical Considerations.
Lipnik AJ, Brown DB
(2015) Radiol Clin North Am 53: 1049-59
MeSH Terms: Biopsy, Needle, Blood Coagulation Tests, Conscious Sedation, Contraindications, Humans, Image-Guided Biopsy, Kidney Diseases, Liver Diseases, Magnetic Resonance Imaging, Interventional, Neoplasm Seeding, Patient Positioning, Radiography, Interventional, Specimen Handling, Ultrasonography, Interventional
Show Abstract · Added September 18, 2015
Image-guided percutaneous biopsy of abdominal masses is a safe, minimally invasive procedure with a high diagnostic yield for a variety of pathologic processes. This article describes the basic technique of percutaneous biopsy, including the different modalities available for imaging guidance. Patient selection and preparation for safe performance of the procedure is emphasized, and the periprocedural management of coagulation status as well as basic indications and contraindications of the procedure are briefly discussed. In particular, the role of biopsy in the diagnosis of liver and renal masses is highlighted.
Copyright © 2015 Elsevier Inc. All rights reserved.
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14 MeSH Terms
Making the case for selective use of statins in the primary prevention setting.
Minder CM, Blaha MJ, Tam LM, Muñoz D, Michos ED, Kaul S, Blumenthal RS
(2011) Arch Intern Med 171: 1593-4
MeSH Terms: Contraindications, Diagnostic Techniques, Cardiovascular, Humans
Added March 7, 2014
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3 MeSH Terms
Responding to the clopidogrel warning by the US food and drug administration: real life is complicated.
Roden DM, Shuldiner AR
(2010) Circulation 122: 445-8
MeSH Terms: Aryl Hydrocarbon Hydroxylases, Clopidogrel, Contraindications, Cytochrome P-450 CYP2C19, Drug Approval, Genotype, Humans, Platelet Aggregation Inhibitors, Practice Guidelines as Topic, Precision Medicine, Ticlopidine, United States
Added June 26, 2014
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12 MeSH Terms
Sporadic primary hyperparathyroidism in young individuals: different disease and treatment?
Sneider MS, Solorzano CC, Montano RE, Anello C, Irvin GL, Lew JI
(2009) J Surg Res 155: 100-3
MeSH Terms: Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Contraindications, Female, Humans, Hyperparathyroidism, Primary, Male, Middle Aged, Parathyroidectomy, Retrospective Studies, United States, Young Adult
Show Abstract · Added March 5, 2014
BACKGROUND - Younger individuals with hyperparathyroidism may experience severe disease with a higher incidence of multigland disease (MGD) and operative failure, thereby requiring subtotal parathyroidectomy. This study examines the characteristics and surgical outcome of younger compared with older patients with sporadic primary hyperparathyroidism (SPHPT).
METHODS - Prospectively collected data of 1101 patients with SPHPT who underwent parathyroidectomy at a single institution were retrospectively reviewed. Patients with multiple endocrine neoplasia (MEN), familial, secondary, or tertiary hyperparathyroidism, parathyroid carcinoma, rickets, or lithium induced disease were excluded. Patients were subdivided into two groups: (1) younger individuals < or = 40 y of age (n = 110) and (2) older individuals > 40 y of age (n = 991). Both age groups were compared for gender, clinical manifestations, pre- and postoperative laboratory values, MGD, operative success, and recurrent disease.
RESULTS - There was greater male predominance in younger compared with older patients treated for SPHPT (41% versus 25%, P = 0.0004). Of the clinical manifestations of SPHPT, kidney stones were more common in younger compared with older individuals (45% versus 29%, P = 0.0006). Conversely, bone pain was more common in older compared with younger patients (32% versus 14%, P = 0.0002). There was no statistical difference in biochemical values, MGD, and outcome between both groups.
CONCLUSIONS - Despite male predominance and few differences in symptoms, SPHPT is a similar disease entity in both younger and older individuals. Patients from both age groups can be similarly treated for SPHPT with a high rate of operative success. Routine BNE and subtotal parathyroidectomy is not necessary in younger individuals.
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16 MeSH Terms
Caveat arthroplasty.
Adelani MA, Stover DG, Halpern JL, Schwartz HS, Holt GE
(2009) J Arthroplasty 24: 728-34
MeSH Terms: Aged, Arthralgia, Arthroplasty, Replacement, Bone Neoplasms, Contraindications, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Joint Diseases, Male, Middle Aged, Retrospective Studies
Show Abstract · Added March 5, 2014
Caveat arthroplasty is arthroplasty undertaken to treat a presumed nonneoplastic disorder, which is later determined to be secondary to an extraarticular tumor. We identified 6 patients who had caveat arthroplasty before referral to our orthopedic oncology center. Three patients had completed arthroplasties at an average of 29 weeks before discovery of a neoplasm. Three arthroplasties were aborted after a neoplasm was discovered intraoperatively. Prearthroplasty radiographs of 4 patients were reviewed, all demonstrating evidence of malignancy. Caveat arthroplasty may be avoided if malignancy is considered preoperatively, particularly in patients with atypical symptoms, histories of cancer, and rapid periarticular bone loss. If a neoplasm is discovered intraoperatively, the arthroplasty should be aborted. Patients in whom malignancy is suspected should be referred to a musculoskeletal oncologist.
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13 MeSH Terms
Postthoracotomy paravertebral analgesia: will it replace epidural analgesia?
Conlon NP, Shaw AD, Grichnik KP
(2008) Anesthesiol Clin 26: 369-80, viii
MeSH Terms: Analgesia, Analgesia, Epidural, Analgesics, Chronic Disease, Contraindications, Humans, Pain, Postoperative, Spine, Thoracotomy
Show Abstract · Added October 20, 2015
Thoracotomy is associated with significant acute postoperative pain and a high incidence of development of chronic pain. Thoracic epidural analgesia has long been standard treatment for postthoracotomy pain, but recently there has been increased interest in alternative regional techniques, particularly paravertebral analgesia. This article compares the analgesic efficacy, side effects, complications of, and contraindications for thoracic epidural and paravertebral analgesia techniques and discusses their effects on the development of chronic postthoracotomy pain. This information will allow a more considered choice of analgesic technique after thoracotomy.
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9 MeSH Terms
Evaluating living kidney donors: relationship types, psychosocial criteria, and consent processes at US transplant programs.
Rodrigue JR, Pavlakis M, Danovitch GM, Johnson SR, Karp SJ, Khwaja K, Hanto DW, Mandelbrot DA
(2007) Am J Transplant 7: 2326-32
MeSH Terms: Contraindications, Family, Female, Histocompatibility Testing, Humans, Informed Consent, Kidney, Kidney Transplantation, Living Donors, Male, Medical History Taking, Patient Selection, Socioeconomic Factors, Tissue and Organ Harvesting, United States
Show Abstract · Added May 22, 2014
We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.
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15 MeSH Terms
Drug evaluation: tagatose in the treatment of type 2 diabetes and obesity.
Moore MC
(2006) Curr Opin Investig Drugs 7: 924-35
MeSH Terms: Animals, Anti-Obesity Agents, Clinical Trials, Phase I as Topic, Clinical Trials, Phase II as Topic, Contraindications, Diabetes Mellitus, Type 2, Hexoses, Humans, Hypoglycemic Agents, Obesity, Structure-Activity Relationship
Show Abstract · Added December 10, 2013
Spherix Inc (formerly Biospherics) is developing tagatose, an orally active lactose derivative for the potential treatment of obesity and type 2 diabetes. The compound is also under investigation for the potential treatment of anemia, hemophilia and medical problems related to infertility, birth weight and excessive maternal food intake. Phase I and II clinical trials have been completed.
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11 MeSH Terms
Methodological issues in the investigation of ginseng as an intervention for fatigue.
Elam JL, Carpenter JS, Shu XO, Boyapati S, Friedmann-Gilchrist J
(2006) Clin Nurse Spec 20: 183-9
MeSH Terms: Breast Neoplasms, Contraindications, Cross-Over Studies, Double-Blind Method, Drug Administration Schedule, Drug Monitoring, Equipment Failure, Fatigue, Feasibility Studies, Female, Health Services Needs and Demand, Humans, Killer Cells, Natural, Middle Aged, Panax, Patient Selection, Phytotherapy, Pilot Projects, Plant Preparations, Research Design, Sleep Wake Disorders, Southeastern United States, Treatment Outcome
Show Abstract · Added December 10, 2013
BACKGROUND - Although literature suggests that fatigue is commonly reported by women during and after breast cancer treatment, treatment options are limited. Although ginseng is widely used in Asian countries as a tonic to increase energy, its efficacy for treating cancer-related fatigue has not been carefully studied. We conducted a pilot study to evaluate the feasibility of a larger clinical trial to investigate the efficacy of ginseng for treating breast cancer-related fatigue.
PARTICIPANTS/METHODS - Breast cancer survivors seeking treatment for fatigue were recruited to participate in an 8-week randomized, double-blind, placebo-controlled trial.
RESULTS - A variety of practical problems were encountered in the study, including large numbers of survivors with conditions that were possible contraindications to ginseng use, inability to achieve blinding for the intervention because of strong odor from the ginseng, and measurement device failure.
DISCUSSION - Evaluating ginseng for breast cancer treatment-related fatigue is a great challenge, particularly if a blinded randomized design is desired. This article provides insight into issues related to investigating complementary therapies and the importance of pilot studies for identifying methodological problems.
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23 MeSH Terms