The American journal of the medical sciences
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End-stage heart failure patients are being supported with continuous flow left ventricular assist devices (CF-LVAD) in increasing numbers. The severe physiologic and pharmacologic derangements associated with end-stage heart failure therapies predispose these patients to delirium. During a delirious episode, a patient may inadvertently disconnect CF-LVAD equipment, which may have dangerous consequences. ⋯ The authors present a case of acute hyperactive delirium leading to pump power disconnection and cardiopulmonary arrest occurring 7 days after CF-LVAD implantation. The case highlights the need for delirium awareness in the cardiovascular intensive care unit and the unique challenges associated with resuscitation of CF-LVAD patients. The authors propose that cardiovascular intensive care unit patients undergo at least twice daily delirium monitoring and provide a novel resuscitation algorithm for patients who have CF-LVADs.
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Atrial fibrillation and atrial flutter (AF/AFL) are the most common arrhythmias encountered in clinical practice. Rate versus rhythm control remains a difficult decision, especially in the acute setting. Ibutilide is a class III antiarrhythmic indicated for pharmacological cardioversion of recent-onset AF/AFL. At the University of Texas MD Anderson Cancer Center, restoration of sinus rhythm is desirable because many patients have contraindications to anticoagulation. In addition, most are on multiple medications that prolong the QT interval; therefore, the objective of this study was to establish the safety and efficacy of ibutilide. ⋯ Overall, ibutilide is safe and effective in cancer patients when used for acute cardioversion of AF/AFL. Despite the use of multiple medications that can potentially prolong the QT interval, no patient experienced serious life-threatening rhythm disturbances or significant QT prolongation during ibutilide administration.
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To describe bone mineral density (BMD) patterns by densitometry in adult African American (AA) men with sickle cell disease (SCD) who are vitamin D deficient (Vit DD). ⋯ A large proportion of adult AA men with SCD and Vit DD showed low BMD.
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Management of primary immune thrombocytopenia, 2012: a survey of oklahoma hematologists-oncologists.
Management options for patients with primary immune thrombocytopenia (ITP) have increased, and treatment of patients with ITP has changed during the past 10 years. ⋯ In a time of changing management for patients with ITP, these data document reported current management in Oklahoma and provide a basis for serial comparisons across time and for comparisons with other regions and comparison of management with patient outcomes.