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Department of Anesthesia
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Department of Medicine
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    ABSTRACT: Background The comparative efficacy of first versus second generation drug-eluting stents (DES) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) is unknown. Methods A retrospective analysis of consecutive patients undergoing PCI at a tertiary PCI center from 2007-2011 was performed with linkage to administrative databases for long-term outcomes. CKD was defined as creatinine clearance <60ml/min. Propensity-matching by multivariable scoring method and Kaplan-Meier analyses were performed. Results Of 6,481 patients with available creatinine clearance undergoing a first PCI during the study period, 1,658 (25%) had CKD. First and second generation DES were implanted in 320 (19.3%) and 128 (7.7%) patients with CKD. At 2 years, no significant differences were observed between first (n=126) and second generation (n=126) propensity-matched DES cohorts for the outcomes of death (19% vs. 16%, p=0.51), repeat revascularization (10% vs. 10%, p=1.00), or major adverse cardiovascular and cerebrovascular events (36% vs. 37%, p=0.90). The 2-year Kaplan–Meier survival was also similar (p=0.77). In patients with CKD, second generation DES type was not an independent predictor for death (p=0.49) or major adverse cardiovascular and cerebrovascular events (p=1.00). Conclusions Although the use of first and second generation DES was associated with similar 2-year safety and efficacy in patients with CKD, our results cannot rule out a beneficial effect of second versus first generation DES owing to small sample size. Future studies with larger numbers of patients with CKD are needed to identify optimal stent types, which may improve long-term clinical outcomes.
    The Canadian journal of cardiology 10/2014;
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    ABSTRACT: Malignant mesothelioma is becoming increasingly common, and rates of diagnosis are expected to continue to climb in the coming years due to the extensive use of asbestos in industrialized countries and the long time interval between exposure and onset of disease. Although much research has been done on the optimal treatment for this disease, the overall prognosis remains grim. The main components of therapy are surgery, chemotherapy, and radiation therapy, but there is controversy in the literature about the optimal inclusion and sequencing of these treatments, as each has unique risk profiles. We have developed a new “SMART” protocol (Surgery for Mesothelioma After Radiation Therapy) consisting of induction accelerated hemithoracic radiation followed by extrapleural pneumonectomy. The rationale behind this protocol is to maximize both the tumouricidal and immunogenic potential of the radiotherapy while minimizing the radiation toxicity to the ipsilateral lung. Our initial trial demonstrated the feasibility of this approach and has shown encouraging results in patients with epithelial histology. In this paper, we reviewed the current literature on induction chemotherapy for mesothelioma as well as described the SMART protocol and upcoming studies of novel induction therapies for mesothelioma.
    Seminars in Thoracic and Cardiovascular Surgery 08/2014;
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    ABSTRACT: Background Myocardial contrast echocardiography during angiography is critical in identifying appropriate septal perforator(s) for alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). We evaluated whether there were other angiographic and/or echocardiographic markers that might identify patients who are anatomically suitable for ASA. Methods Quantitative coronary angiographic analysis and echocardiographic assessment on 74 patients referred for ASA from January 2004 to July 2012 at the Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. Patients who proceeded to ASA were compared to those in whom ASA was aborted. Results Of the 74 patients referred for ASA, 63 proceeded to ASA whereas in 11 patients ASA was aborted due to various anatomic and technical reasons. There were no clinically significant differences observed in both quantitative angiographic and echocardiographic measurements between the 2 groups. The ratio of ostial left main (LM) to ablated septal distance on angiography versus the basal septum to the septum area where the mitral valve contacted the septum due to systolic anterior motion (SAM) was 1.53. In the whole cohort, a significant correlation was observed between the ostial LM to the target septal distance and the distance from basal septum to SAM-septal contact point on echocardiography (r=0.37, p=0.008). A stronger correlation was evident when analysis was restricted to patients undergoing ASA only (r=0.44, p=0.006). Conclusion Echocardiographic and angiographic assessments of the distance between the basal septum to SAM-septal contact point and ostial LM to the target septal distance might be useful in pre-procedural selection of the appropriate septal perforator for ASA.
    The Canadian journal of cardiology 08/2014;


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General Hospital Psychiatry 01/2000; 22(6):445-51.
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