Renal Ablation for Treatment of Hypertension Without Symplicity Catheter: The First Human Experience.

Renal ablation for treatment of hypertension without Symplicity catheter: The first human experience.

ARYA Atheroscler. 2013 Jan; 9(1): 82-8
Honarvar M, Amirpour A, Pourmoghaddas M

Hypertension (HTN) treatment has remained insufficient. New modalities such as “Symplicity method” for the treatment of HTN are a priority, especially in patients with resistant hypertension. In this study, we describe our first experience with a novel percutaneous treatment modality, without using Symplicity catheter.30 Patients who were resistant to at least three types of antihypertensive medical therapy were selected. Patients received percutaneous renal artery denervation, without Symplicity catheter method, and were followed up for 1 week, 1, 3, and 6 months later after treatment. Ambulatory 24-hour blood pressure (BP) Holter was performed 1 week before intervention and after 1 month. The primary outcome was change in 24-hour ambulatory BP and change in office and home-based BP measurements.The mean age of the studied patients was 52 ± 15.4 years and 43.3% (n = 13) were female. Systolic and diastolic BP at baseline was 163 ± 17.2 and 95 ± 8.2 mmHg, respectively. Patients took 3.6 ± 1.3 hypertensive medications. Systolic and diastolic BP at 1-week, 1-month, 3-month and 6-month after renal denervation significantly decreased compared to the baseline (P < 0.0001). Average BP derived from 24-hour ambulatory BP monitoring changed in parallel with office-based BP measurements. Most of patients (50%) who underwent renal denervation had reductions of 10 mmHg or greater in systolic BP and 56.7% of them had reductions of 5 mmHg or greater in diastolic BP. 33.3% of patients also achieved the target of systolic BP less than 140 mmHg and 60% achieved the target of diastolic BP less than 90 mmHg. No patients showed vascular damage at final angiography.Catheter based renal ablation was associated with a significant reduction in both systolic and diastolic BP, on top of maximal medical therapy, which persisted throughout 6 months follow-up in the first-in-man study without the Symplicity catheter. HubMed – rehab


Effects of streptokinase on reflow in rescue percutaneous coronary intervention.

ARYA Atheroscler. 2013 Jan; 9(1): 22-8
Sanatkar M, Shemirani H, Sanei H, Pourmoghaddas M, Rabiei K

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI.This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student’s t-test, chi-square test, and logistic regression analysis.A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery.According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications. HubMed – rehab


The incidence of in-hospital atrial fibrillation after coronary artery bypass grafting using ventricular and atrial pacing.

ARYA Atheroscler. 2013 Jan; 9(1): 11-5
Naghnaeian M, Samienasab M, Mirmohammadsadeghi M, Rabani M, Pourmoghaddas A, Behnemun M

Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is a common problem. In this study, we sought to evaluate the safety and tolerance of continuous atrial pacing after CABG. We hypothesized that a strategy of temporary atrial pacing after CABG would reduce the incidence of postoperative AF.During 2012, CABG candidates over 18 years of age at Sina Hospital (Isfahan, Iran) were recruited. Before surgery, the participants were randomly assigned to two groups of ventricular pacing and left atrial ventricular pacing (atrial pacing). The primary end point of the study was the initial occurrence of AF or atrial flutter with a ventricular rate greater than 100 beats per minute for 10 consecutive minutes or completion of the 48-hour monitoring period.We evaluated 64 consecutive CABG candidates with sinus rhythm. They were allocated to two groups of ventricular pacing and atrial ventricular pacing (n = 32 in each group). Three patients in the ventricular pacing group (10%) and six in the atrial ventricular pacing group (22%) had sustained AF during the first 48 hours after CABG (P = 0.18 according to Fisher’s exact test).Continuous atrial pacing in the postoperative setting is safe and well-tolerated. In this study, we found that temporary atrial pacing increased the frequency of postoperative AF. Since the difference between the two groups was not significant, larger studies are required to determine the exact relation between pacing method and AF. HubMed – rehab


Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy.

J Int Med Res. 2013 May 21;
Jianjun L, Shurong J, Weihong W, Yan Z, Fanyong Z, Nanling L

OBJECTIVE: To determine the efficacy of botulinum toxin-A (BTX-A) nerve block, with and without rehabilitation, in the treatment of spastic cerebral palsy. METHODS: Patients (aged 1-23 years) with spastic cerebral palsy underwent nerve block with BTX-A, followed by???2?h/day rehabilitation (experimental group) or <2?h/day rehabilitation (control group). Muscle tension and motor function were evaluated pre-block using the Modified Ashworth Scale (MAS) and gross motor function measure (GMFM), respectively. MAS was assessed weekly to determine duration of action of BTX-A; GMFM was assessed at 1 year post-block. RESULTS: There were no significant differences between the experimental group (n?=?120) and the control group (n?=?124) in age, body weight, pre-block MAS or GMFM, or BTX-A duration of action. MAS was significantly improved in both groups at 1 month post-block. At 1 year post-block, GMFM was significantly improved in both groups, with a significantly greater improvement seen in the experimental group compared with the control group. CONCLUSION: BTX-A block improved muscle tension and motor function. Rehabilitation training, following the block, resulted in greater improvements to motor function than block alone. HubMed – rehab


Integrative Wellness in Rehabilitation: Social and Behavioral Aspects of Health Care and Clinical Applications.

Rehabil Nurs. 2013 May 21;
Lyn Nathenson S, Nathenson P

PURPOSE: Social and clinical research has demonstrated the importance psychosocial and health behaviors contribute to both the etiology of illness conditions and the success of treatment in the rehabilitation setting. The purpose of this paper is to provide a brief review of the social and behavioral factors in illness, recovery and prevention of impairments, and to provide clinical applications of such findings. DESIGN/METHODS: The content of this paper draws on both a literature search as well as the case study of programs and strategies currently being utilized at Madonna Rehabilitation Hospital located in the American Midwest. FINDINGS: Authors present an integrative medical framework with respect to incorporating a preventive approach to rehabilitation. CONCLUSIONS: Rehabilitation clinicians and nurses may draw on this research in the formation of an integrative approach to care. CLINICAL RELEVANCE: An integrative rehabilitation nursing model, such as the personal wellness plan outlined in this article, incorporates psychosocial and health behavior change as a method of wellness promotion, adaptation to functional limitations (temporary or permanent), and illness prevention. HubMed – rehab