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Objective Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. Methods This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. Results The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P

OBJECTIVE: Transradial approach (TRA) for coronary angiography is a popular alternative approach to transfemoral coronary angiography due to the infrequent occurrence of access site complications such as bleeding, hematoma and pseudoaneursym formation. However, not all patients are suitable for TRA. This study aimed to determine the predictors of radial artery diameter in patients who are candidates for TRA. METHODS: The study included 222 consecutive patients who underwent TRA due to suspected stable coronary artery disease. Radial artery diameter was evaluated prior to the procedure using B-mode ultrasonography. RESULTS: Radial artery diameter was correlated with wrist circumference (r=0.539, p

Atherosclerosis is the most important cause of acute coronary syndromes. The mediators that trigger vasospasm, including endothelin and serotonin, are synthesized and secreted into circulation from atherosclerotic plaques and surrounding tissues. A 68-year-old man was hospitalized due to acute coronary syndrome four times in a one-year period. The patient presented to emergency service again with heartburn and a pressure-like pain in his upper abdomen in February 2012. He was admitted to the coronary care unit with the detection of a more than three-fold increase in troponin values and ischemic changes on electrocardiography. By decision of the cardiology council, the endothelin receptor antagonist, bosentan was added to the treatment. There were no contraindications to this medication according to his blood and hepatic indicators. After confirmation of the Social Security Institution, bosentan was started as 62.5 mg twice a day. After the first month, the dose was increased to 125 mg b.i.d. As of completion of the eighth month of treatment with bosentan, the patient had not been hospitalized due to angina attack or acute coronary syndrome.

FUNDAMENTO: A previsão de gravidade ou complexidade da doença arterial coronariana (DAC) é valiosa devido ao aumento do risco de eventos cardiovasculares. Embora a associação entre o escore do cálcio arterial coronariano (CAC), e a gravidade da DAC pelo escore Gensini não tenha sido utilizado, já foi anteriormente demonstrado. Não há informações sobre a associação entre o escore do CAC total e a complexidade da DAC. OBJETIVOS: Investigar a associação entre a gravidade ou complexidade da doença arterial coronariana (DAC), avaliada pelo escore Gensini e SYNTAX (SS), respectivamente, e o escore do cálcio arterial coronariano (CAC), um método não invasivo para avaliação de DAC em pacientes sintomáticos com DAC significativa. MÉTODOS: Duzentos e quatorze pacientes foram incluídos. A pontuação total do CAC foi obtido antes da angiografia. A severidade e complexidade da DAC foram avaliadas pelo escore Gensini e SS, respectivamente. Foram analisadas as associações entre parâmetros clínicos e angiográficos e o escore total do CAC. RESULTADOS: A mediana do escore total do CAC foi de 192 (23,0-729,8), e correlacionou-se positivamente com ambos os escores Gensini (r: 0,299, p < 0,001) e ES (r: 0,577, p < 0,001). Na análise multivariada associou-se independentemente com a idade (ß: 0,154, p: 0,027), sexo masculino (ß: 0,126, p: 0,035) e ES (ß: 0,481, p < 0,001). A análise da curva ROC (Receiver Operating Characteristics) revelou um valor de corte > 809 para ES > 32 (tercil de SS alto). CONCLUSÃO: Em pacientes sintomáticos com DAC significativa, o escore total de CAC foi independentemente associado com SS e os pacientes com SS > 32 podem ser detectados através de escore Agatston alto.

Aim. Takayasu’s arteritis (TA) is a chronic inflammatory disease that affects predominantly the aorta. Percutaneous intervention (PI) may be use the TA. In this manuscript, we studied the outcomes (in-hospital and 6 months later) and effectiveness of PI in patients with TA.Material and methods. The study was performed on 24 consecutive patients (39.3±11.8 (20–61) years; 4 men and 20 women) with TA who were treated with PI, surgical or medical therapy. Nine patients (7 females, 2 male) underwent PI. PI was performed after the erythrocyte sedimentation rate had been normalized in patients with TA.Results. Although 9 patients received PI with stent for subclavian, carotid, renal and coronary artery, 1 patient received PI with only balloon for brachial artery. One percutaneous transluminal angioplasty and 10 stentings were performed. There was not any complication during interventional procedure. The patients were followed for 6 months. After 6 month, the arteries treated were patent and showed no proliferative lesions in Doppler ultrasound at 8 patients. At a woman patient, left subclavian artery restenosis was determined in Doppler ultrasound and confirmed by angiography. During angiography the stenotic lesion has been successfully treated with balloon angioplasty.Conclusions. Takayasu’s patients with active systemic disease must receive immunosuppressive therapy before PI. PI was performed after the active period such as during normal erythrocyte sedimentation rate. In these circumstances, PI in patient with TA may be safely and much less traumatic. Also, recurrence of stenosis in patient with TA has been treated successfully by reintervention without significant complications.

Thrombotic occlusion of prosthetic valves continues to be an uncommon but serious complication. Intravenous thrombolytic treatment has been proposed as an alternative to surgical intervention. Due to the lack of a generally accepted standard regimen, various infusion protocols and thrombolytic doses were used for the management of prosthetic heart valve thrombosis. However, rapid thrombolytic infusion, especially in the presence of large thrombus, may increase the risk of embolization. Continuous transoesophageal echocardiography may provide monitoring the efficacy of thrombolysis especially in critically ill patients. [ABSTRACT FROM AUTHOR]