| 1. |
- Järemo, Petter, et al.
(författare)
-
Individual variations of platelet inhibition after loading doses of clopidogrel
- 2002
-
Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 252:3, s. 233-238
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate individual variations of platelet inhibition after clopidogrel-loading doses.Setting. Department of Cardiology, Linköping University Hospital, Linköping, Sweden.Subjects. Individuals with stable angina pectoris (n = 18) subject to percutaneous coronary interventions (PCI) and subsequent stenting were investigated.Methods and experimental protocol. A 300-mg clopidogrel loading dose was administrated immediately after stenting (day 1) followed by an additional 75 mg clopidogrel after 24 h (day 2). The ADP-evoked platelet fibrinogen binding was analysed to estimate platelet reactivity immediately before angiography and on day 2. A flow cytometry technique was used with two ADP solutions (final concentrations 0.6 and 1.7 μmol L−1) employed as platelet activating agents. Soluble P-selectin was used as a marker of platelet activity.Results. When using 1.7 μmol L−1 ADP to activate platelets four individuals had a strong inhibition (i.e. platelet reactivity <10% of the day 1-value day 2). In contrast, five patients demonstrated a weak inhibition (i.e. platelet reactivity >60% of the day 1-value day 2). Similar results were obtained when using 0.6 μmol L−1 ADP as a platelet-activating agent. Clopidogrel, however, fails to suppress platelet activity as estimated from soluble P-selectin.Conclusions. Clopidogrel evoked platelet inhibition exhibits a considerable individual heterogeneity. Some individuals only had weak responses whereas others displayed strong platelet inhibition. The present flow cytometry technique appears suitable for identifying patients with abnormal reactions after clopidogrel exposure.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Aspelin, P, et al.
(författare)
-
Nephrotoxic effects in high-risk patients undergoing angiography
- 2003
-
Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 348:6, s. 491-499
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of iodinated contrast medium can result in nephropathy. Whether iso-osmolar contrast medium is less nephrotoxic than low-osmolar contrast medium in high-risk patients is uncertain. METHODS: We conducted a randomized, double-blind, prospective, multicenter study comparing the nephrotoxic effects of an iso-osmolar, dimeric, nonionic contrast medium, iodixanol, with those of a low-osmolar, nonionic, monomeric contrast medium, iohexol. The study involved 129 patients with diabetes with serum creatinine concentrations of 1.5 to 3.5 mg per deciliter who underwent coronary or aortofemoral angiography. The primary end point was the peak increase from base line in the creatinine concentration during the three days after angiography. Other end points were an increase in the creatinine concentration of 0.5 mg per deciliter or more, an increase of 1.0 mg per deciliter or more, and a change in the creatinine concentration from day 0 to day 7. RESULTS: The creatinine concentration increased significantly less in patients who received iodixanol. From day 0 to day 3, the mean peak increase in creatinine was 0.13 mg per deciliter in the iodixanol group and 0.55 mg per deciliter in the iohexol group (P=0.001, the increase with iodixanol minus the increase with iohexol, -0.42 mg per deciliter [95 percent confidence interval, -0.73 to -0.22]). Two of the 64 patients in the iodixanol group (3 percent) had an increase in the creatinine concentration of 0.5 mg per deciliter or more, as compared with 17 of the 65 patients in the iohexol group (26 percent) (P=0.002, odds ratio for such an increase in the iodixanol group, 0.09 [95 percent confidence interval, 0.02 to 0.41]). No patient receiving iodixanol had an increase of 1.0 mg per deciliter or more, but 10 patients in the iohexol group (15 percent) did. The mean change in the creatinine concentration from day 0 to day 7 was 0.07 mg per deciliter in the iodixanol group and 0.24 mg per deciliter in the iohexol group (P=0.003, value in the iodixanol group minus the value in the iohexol group, -0.17 mg per deciliter [95 percent confidence interval, -0.34 to -0.07]). CONCLUSIONS: Nephropathy induced by contrast medium may be less likely to develop in high-risk patients when iodixanol is used rather than a low-osmolar, nonionic contrast medium.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Fransson, Sven Göran, 1949-, et al.
(författare)
-
Antonio Maria Valsalva
- 2003
-
Ingår i: Clinical Cardiology. - 0160-9289 .- 1932-8737. ; 26, s. 102-103
-
Tidskriftsartikel (refereegranskat)
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
- Fransson, Sven Göran, 1949-, et al.
(författare)
-
Patient radiation exposure during coronary angiography and intervention
- 2000
-
Ingår i: Acta Radiologica. - 0284-1851 .- 1600-0455. ; 41:2, s. 142-144
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To prospectively register fluoroscopic and cine times in a random fashion, and to measure patient radiation exposure from routine coronary angiography and coronary balloon angioplasty. We also evaluated an optional dose reduction system used during interventions. Material and Methods: The incident radiation to the patient was measured as kerma area product (KAP) in Gycm2, obtained from an ionisation chamber mounted on the undercouch tube during 65 coronary angiography procedures and another 53 percutaneous transluminal coronary angioplasties (including 29 stent procedures), mostly directly following complete coronary angiography. Results and Conclusion: The values from coronary angiography were comparable to other reports with a mean fluoroscopic time of 4.4 min and a mean KAP value of 62.6 Gycm2. The corresponding figures from coronary balloon angioplasty without stenting were lower than otherwise reported, with 8.2 min and 47.9 Gycm2, respectively. The use of coronary stents did prolong the mean fluoroscopic time (10.5 min) but did not significantly enhance the patient mean radiation dose (51.4 Gycm2). The dose reduction technique resulted in a significant KAP value reduction of 57%. In conclusion, with regard to radiation exposure, coronary angiography and balloon angioplasty are considered safe procedures.
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Håkansson, E, et al.
(författare)
-
Management of life-threatening haemoptysis
- 2002
-
Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 88, s. 291-295
-
Tidskriftsartikel (refereegranskat)abstract
- Massive haemoptysis represents a major medical emergency that is associated with a high mortality. Here we present two cases of life-threatening haemoptysis, the first caused by rupture of an aortic aneurysm into the lung in a 37-yr-old woman with polyarteritis nodosa and the second caused by massive bleeding from an angiectatic vascular malformation in the right main bronchus in a 21-yr-old woman. Fibreoptic bronchoscopy played an essential role in the diagnostic process and management of the respiratory tract. Diagnosis in the first case was obtained by CT scan and the aneurysm was treated surgically. In the second case, bronchial arteriography contributed to both definitive diagnosis and treatment. Initial cardiorespiratory management, diagnostic procedures and definitive therapy are described and reviewed. Adequate early management of the cardiorespiratory system is essential to the outcome. Aggressive measures to elucidate the cause of haemoptysis and prompt therapy are warranted because of the high risk of recurrence.
|
|
| 18. |
- Sandborg, Michael, 1961-, et al.
(författare)
-
Evaluation of patient-absorbed doses during coronary angiography and intervention by femoral and radial artery access
- 2004
-
Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 14:4, s. 653-658
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the radiation dose to patients during coronary angiography (CA) and coronary intervention (percutaneous transluminal coronary angioplasty, PTCA) by the femoral or radial artery access routes. A plane-parallel ionisation chamber, mounted on an under-couch X-ray tube (Siemens Coroskop TOP with an optional dose reduction system), recorded the dose-area product (DAP) to the patient from 40 coronary angiographies and 42 coronary interventions by the femoral route. The corresponding numbers for radial access were 36 and 24, respectively. Using a human-shaped phantom, conversion factors between maximum entrance surface dose and DAP were derived for CA and CA plus PTCA, respectively. The dose to the staff was measured with TL dosimeters for 22 examinations. Fluoroscopy time and DAP were significantly (p=0.003) larger using the radial access route for coronary angiography (7.5 min, 51 Gy cm2) than the corresponding values obtained from femoral access route (4.6 min, 38 Gy cm2. For CA plus PTCA the fluoroscopy time and DAP were larger for radial access (18.4 min, 75 Gy cm2) than for femoral access (12.5 min, 47 Gy cm2, p=0.013). In our experience, radial access did significantly prolong the fluoroscopy time and increase the patient doses.
|
|
| 19. |
|
|
| 20. |
|
|
