Dilated cardiomyopathy is characterised by left ventricular dilation that is associated with systolic dysfunction. Diastolic dysfunction and impaired right ventricular function can develop.
2010 Feb 27 - Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial
Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage.
2010 Mar - Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data
Dexamethasone improves outcome for some patients with bacterial meningitis, but not others. We aimed to identify which patients are most likely to benefit from dexamethasone treatment.
For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings.
The major function of the kidneys is to remove metabolic waste products. Patients with acute kidney injury, especially in the context of multiple-organ failure, are often highly catabolic, and hence have increased production of such waste products. This fact led to the idea that survival of such patients might be improved by increased removal of these toxins by renal replacement therapy. Two multicentre randomised trials that were designed to investigate the effect of dose of renal replacement t ...
2010 Feb 13 - Lancet Correspondence: Ventilatory support versus ECMO for severe adult respiratory failure
Thilo Busch, Sven Laudi, Udo Kaisers: Giles Peek and colleagues (Oct 17, p 1351)1 report an improved outcome in patients with severe acute respiratory failure who were treated in one centre according to a management protocol based on extracorporeal membrane oxygenation (ECMO) when compared with conventional therapy in less specialised hospitals. .....
Jayant S Jainandunsing, Farouq Ismael: Giles Peek and colleagues1 describe the beneficial effects of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome. ....
Thomas Bein, Bernhard Graf, Steffen Weber-Carstens: We congratulate Giles Peek and co-workers1 for successfully doing a study of the effect on survival of extracorporeal membrane oxygenation (ECMO) in patients with severe lung failure. .....
Andrew Jones, Nicholas Barrett, Damon Scales, Richard Beale: We congratulate the authors of the CESAR study1 on their considerable achievement. ....
Pulmonary embolism (PE) is the leading cause of maternal mortality in the developed world. Mortality from PE in pregnancy might be related to challenges in targeting the right population for prevention, ensuring that diagnosis is suspected and adequately investigated, and initiating timely and best possible treatment of this disease.
Acute coronary syndromes are a leading cause of morbidity and mortality worldwide. The mechanisms underlying the triggering of these events are diverse and include increased coronary and systemic inflammatory activity, dominant prothrombotic conditions, increased biomechanical stress on coronary arteries, variations in the coronary arterial tone, disturbed haemodynamic homoeostasis, and altered myocardial metabolic balance.
2010 Jan 29 - A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial
Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation.
The Lancet today, Lila Bouadma and colleagues 1 report the results of the PRORATA trial. These investigators assessed the effect of a procalcitonin-guided algorithm on the duration of antimicrobial therapy in critically ill patients. The main findings were that patients in the procalcitonin group had significantly more antibiotic-free days than did those in the control group, who were managed according to present practices. Mortality, relapsing infection, and days free of mechanical ventilation d ...
2010 Jan 23 - Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial
Reduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units. We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting.
Although case reports of trauma describe single events only, they can contain very useful scientific information for applied surgery. The portrait of Gregor Baci from the collection of Archduke Ferdinand II of Austria (figure A) provokes the question: is the legend that Baci survived a piercing injury with a lance only a myth, or does medical fact indicate that such severe impalement of the head and neck can be survived?
2010 Jan 16 - Lancet Viewpoint: Adjustment of dosing of antimicrobial agents for bodyweight in adults
Advances in molecular biology have given rise to the disciplines of pharmacogenomics and pharmacoproteomics and have created the appealing possibility of individual patient-tailored drug therapy. 1
Tremendous progress has been achieved over the past decade in the treatment of acute coronary syndromes (ST-segment elevation myocardial infarction [STEMI ] , non-STEMI [NSTEMI ] , and unstable angina).
2010 Jan 14 - Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study
Figure. Structure of Ticagrelor
Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients.
Clinicians have for a long time witnessed the tragedy of injury, disability, and death from snake bite that is a daily occurrence in many parts of Africa, Asia, and Latin America. To many people living in these regions, including some of the world's poorest communities, snake bite is an ever present occupational risk and environmental hazard, an additional penalty of poverty. Like malaria, dengue, tuberculosis, and parasitic diseases, the risk of snake bite is always present. Unlike many of thes ...
Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Its public health importance has been largely ignored by medical science. Snake venoms are rich in protein and peptide toxins that have specificity for a wide range of tissue receptors, making them clinically challenging and scientifically fascinating, especially for drug design.
2010 Jan - Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum β-lactamase producing, Enterobacteriaceae infections: a systematic review
Rising rates of resistance to antimicrobial drugs among Enterobacteriaceae limit the choice of reliably active forms of these drugs. We evaluated the evidence on fosfomycin as a treatment option for infections caused by members of the family Enterobacteriaceae with advanced resistance to antimicrobial drugs, including producers of extended-spectrum β-lactamase (ESBL).
In view of the global shortage of transplantable organs, 1 does an individual's willingness to accept an organ transplant create a responsibility to agree to organ donation? In The Lancet today, Jacob Lavee and colleagues 2 describe an Israeli initiative which aims to increase rates of organ donation, which are presently low, 3 and address the challenge of free riders (ie, people who are willing to take but not to give) by bestowing privileges on individuals who are willing to donate in preference to th ...
Paolo Bruzzone aIn The Lancet today, Jacob Lavee and colleagues 1 describe a new law recently approved by Israel's Parliament. The law will become effective in January, 2010, and will grant donor-card holders priority in organ allocation, with the aim of increasing the number of organ donations and reducing the length of transplantation waiting lists.