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14. Immunosuppressive regimens based on Cyclophospamide or Calcineurin inhibitors: Comparison of their effect in the long term outcome of Primary Membranous Nephropathy

Author

Stangou, M. Marinaki, S. Papachristou, E. Kolovou, K. Sambani, E. Zerbala, S. Papadea, P. Balafa, O. Rapsomanikis, K.-P. Andrikos, A. Manolakaki, P. Papadopoulou, D. Mitsopoulos, E. Liakou, H. Andronikidi, P.-E. Choulitoudi, V. Moustakas, G. Galitsiou, D. Dafnis, E. Stylianou, K. Stefanidis, I. Golfinopoulos, S. Panagoutsos, S. Tsilivigkou, M. Papadogianakis, A. Tzanakis, I. Sioulis, A. Vlachakos, D. Grapsa, E. Spaia, S. Kaperonis, N. Paliouras, C. Dioudis, C. Papoulidou, F. Apostolou, T. Iatrou, C. Boletis, I. Goumenos, D. Papagianni, A.

Abstract

Introduction Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term followup. Aim The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN. Patients-methods Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens. Results Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14- 87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p

Published
2019

15. Histological grading in primary membranous nephropathy is essential for clinical management and predicts outcome of patients

Author

Stangou, M.J. Marinaki, S. Papachristou, E. Liapis, G. Pateinakis, P. Gakiopoulou, H. Nikolaidou, C. Kolovou, K. Lampropoulou, I.-T. Zerbala, S. Papadea, P. Dounousi, E. Balafa, O. Pavlakou, P. Andrikos, A. Balassi, E. Manolakaki, P. Moustakas, G. Galitsiou, D. Mitsopoulos, E. Vourlakou, C. Choulitoudi, V. Andronikidi, P.-E. Stefanidis, I. Golfinopoulos, S. Dafnis, E. Stylianou, K. Panagoutsos, S. Papadogianakis, A. Tzanakis, I. Sioulis, A. Vlahakos, D. Grapsa, I. Tsilivigkou, M. Kaperonis, N. Paliouras, C. Dioudis, C. Spaia, S. Apostolou, T. Iatrou, C. Boletis, J. Goumenos, D. Papagianni, A.

Abstract

Aims: Diagnosis of primary membranous nephropathy (PMN) is mainly based on immunofluorescence/immunohistochemistry findings. However, assessment of specific features on optical microscopy can help to estimate the severity of the disease, guide treatment and predict the response. The aim of this study was to identify, classify and grade the precise histological findings in PMN to predict renal function outcome and guide treatment. Methods and results: Histological parameters, including focal segmental sclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF) and vascular hyalinosis (VH), were re-evaluated in 752 patients with PMN. Their predictive value was estimated separately, and also in a combination score (FSTIV) graded from 0 to 4. Finally, the impact of histology was assessed in the response to immunosuppressive treatment. Mean age of patients was 53.3 (15–85) years and most presented with nephrotic syndrome. FSGS was present in 32% and VH in 51% of the patients, while TA and IF were graded as stage ≥1 in 52% and 51.4%, respectively. The follow-up period was 122.3 (112–376) months. FSGS, TA and IF and VH were associated with impaired renal function at diagnosis (P = 0.02, P 50% eGFR reduction, FSGS (P = 0.001) and TA (P = 0.02). Also, patients presented with FSGS, IF, VH and/or with FSTIV > 1 could benefit from immunosuppression, regardless of clinical presentation. Conclusions: The presence and degree of four histological indices, FSGS, VH, TA and IF, assessed separately or in combination, and FSTIV score not only predict renal function outcome after long-term follow-up, but can also help in the choice of appropriate treatment. Decisions concerning immunosuppressive treatment can be guided by pathology regardless of clinical findings. © 2019 The Authors. Histopathology published by John Wiley & Sons Ltd

Published
2019

18. IgA nephropathy in Greece: Data from the registry of the hellenic society of nephrology

Author

Stangou, M. Papasotiriou, M. Xydakis, D. Oikonomaki, T. Marinaki, S. Zerbala, S. Stylianou, C. Kalliakmani, P. Andrikos, A. Papadaki, A. Balafa, O. Golfinopoulos, S. Visvardis, G. Moustakas, G. Papachristou, E. Kouloukourgiotou, T. Kapsia, E. Panagiotou, A. Koulousios, C. Kavlakoudis, C. Georgopoulou, M. Panagoutsos, S. Vlahakos, D.V. Apostolou, T. Stefanidis, I. Siamopoulos, K. Tzanakis, I. Papadogiannakis, A. Daphnis, E. Iatrou, C. Boletis, J.N. Papagianni, A. Goumenos, D.S.

Subjects
urologic and male genital diseases
Abstract

Background: Natural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months. Methods: Patients with normal renal function and proteinuria 2.5 mg/dL and/or severe glomerulosclerosis received no treatment. Patients with normal or impaired renal function and proteinuria >1 g/24 h for >6 months received daily oral prednisolone or a 3-day course of intravenous (IV) methylprednisolone followed by oral prednisolone per os every other day or a combination of prednisolone and azathioprine. The clinical outcome was estimated using the primary endpoints of end-stage renal disease and/or doubling of baseline SCr. Results: The overall 10-year renal survival was 90.8%, while end-stage renal disease and doubling of baseline SCr developed in 9.2% and 14.7% of patients, respectively. Risk factors related to the primary endpoints were elevated baseline SCr, arterial hypertension, persistent proteinuria >0.5 g/24 h and severity of tubulointerstial fibrosis. There was no difference in the clinical outcome of patients treated by the two regimens of corticosteroids; nevertheless, remission of proteinuria was more frequent in patients who received IV methylprednisolone (P ¼ 0.000). The combination of prednisolone with azathioprine was not superior to IV methylprednisolone followed by oral prednisolone. Side effects related to immunossuppressive drugs were observed in 12.8% of patients. Conclusion: The clinical outcome of patients with IgAN was related to the severity of clinical and histological involvement. The addition of azathioprine to a corticosteroid-based regimen for IgAN does not improve renal outcome. © The Author 2017.

Published
2018

21. Renal outcomes in patients with AL amyloidosis: Prognostic factors, renal response and the impact of therapy

Author

Kastritis, E. Gavriatopoulou, M. Roussou, M. Migkou, M. Fotiou, D. Ziogas, D.C. Kanellias, N. Eleutherakis-Papaiakovou, E. Panagiotidis, I. Giannouli, S. Psimenou, E. Marinaki, S. Apostolou, T. Gakiopoulou, H. Tasidou, A. Papassotiriou, I. Terpos, E. Dimopoulos, M.A.

Subjects
urologic and male genital diseases
Abstract

A staging system for patients with renal AL amyloidosis, based on eGFR (100) at 3 months had a 2-year progression to dialysis of 0% vs 24% for patients who either did not reduce to or still had a ratio >100 (P =.001); similar results were obtained by applying the same criteria at 6 months; thus, the evaluation of treatment effect on renal function may be identified early. Furthermore, primary bortezomib-based therapy was more effective than lenalidomide-based therapy, in terms of renal outcomes, especially in patients at intermediate renal risk, but without affecting overall survival. © 2017 Wiley Periodicals, Inc.

Published
2017

22. Early Conversion From Calcineurin Inhibitor- to Everolimus-Based Therapy Following Kidney Transplantation: Results of the Randomized ELEVATE Trial

Author

de Fijter, J. W., Holdaas, H., Oyen, O., Sanders, J. -S., Sundar, S., Bemelman, F. J., Sommerer, C., Pascual, J., Avihingsanon, Y., Pongskul, C., Oppenheimer, F., Toselli, L., Russ, G., Wang, Z., Lopez, P., Kochuparampil, J., Cruzado, J. M., van der Giet, M., Gaite, L. E., Lopez, V. F., Maldonado, R., Massari, P., Novoa, P., Palti, G., Chadban, S., Kanellis, J., Masterson, R., Oberbauer, R., Saemann, M., Kuypers, D., Lohmus, A., Cassuto, E., Frimat, L., Lebranchu, Y., Le Meur, Y., Rostaing, L., Hauser, A., Muehlfeld, A., Nashan, B., Suwelack, B., Weithofer, P., Witzke, O., Zeier, M., Apostolou, T., Boletis, I., Gourmenos, D., Jasuja, S., Khullar, D., Ravishankar, M. S., Sharma, R. K., Garosi, G., Rigotti, P., Tisone, G., Todeschini, P., Acevedo, R., Rozentais, R., Juarez, F. J., Mier, G. M., Urrea, M., Machado, D., Nolasco, F., Sampaio, S., Dubanova, A., Lucan, M., Kolsanov, A. V., Medvedev, V. L., Moysyuk, Y. G., Nesterenko, V., Perlin, D. V., Ulyankina, I. V., Zagainov, E., Dalmau, A., Hernandez, D., Millan, S., Avhingsanon, Y., Turkmen, A., Tuncer, M., Yildiz, A., DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, Facolta' di MEDICINA e CHIRURGIA, Kuypers, Dirk, AII - Inflammatory diseases, Nephrology, AII - Amsterdam institute for Infection and Immunity, Groningen Kidney Center (GKC), and Groningen Institute for Organ Transplantation (GIOT)

Subjects
Graft Rejection, Male, HLA ANTIBODIES, immunosuppressant, kidney transplantation/nephrology, ELEVATE study, SIROLIMUS, immunosuppression/immune modulation, 030204 cardiovascular system & hematology, 030230 surgery, Pharmacology, Kidney Function Tests, Kidney Failure, 0302 clinical medicine, Postoperative Complications, cardiovascular disease, Risk Factors, Clinical endpoint, Immunology and Allergy, DONOR-SPECIFIC ANTIBODIES, Pharmacology (medical), Chronic, CARDIAC-HYPERTROPHY, Kidney transplantation, calcineurin inhibitor (CNI), clinical research/practice, clinical trial, kidney (allograft) function/dysfunction, mechanistic target of rapamycin: everolimus, Everolimus, Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Survival, Humans, Immunosuppressive Agents, Kidney Failure, Chronic, Kidney Transplantation, Middle Aged, Prognosis, Tacrolimus, RENAL-TRANSPLANTATION, Kidney transplant, ELEVATE study, Certican, Life Sciences & Biomedicine, medicine.drug, medicine.medical_specialty, Certican, Urology, Renal function, Mycophenolic acid, 03 medical and health sciences, LEFT-VENTRICULAR MASS, PRESSURE-OVERLOAD, medicine, Kidney transplant, Transplantation, Science & Technology, business.industry, medicine.disease, Settore MED/18, Calcineurin, RECIPIENTS, MAMMALIAN TARGET, Sirolimus, CYCLOSPORINE, Surgery, business
Abstract

none 24 si In a 24-month, multicenter, open-label, randomized trial, 715 de novo kidney transplant recipients were randomized at 10-14 weeks to convert to everolimus (n = 359) or remain on standard calcineurin inhibitor (CNI) therapy (n = 356; 231 tacrolimus; 125 cyclosporine), all with mycophenolic acid and steroids. The primary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, was similar for everolimus versus CNI: mean (standard error) 0.3(1.5) mL/min/1.732 versus -1.5(1.5) mL/min/1.732 (p = 0.116). Biopsy-proven acute rejection (BPAR) at month 12 was more frequent under everolimus versus CNI overall (9.7% vs. 4.8%, p = 0.014) and versus tacrolimus-treated patients (2.6%, p < 0.001) but similar to cyclosporine-treated patients (8.8%, p = 0.755). Reporting on de novo donor-specific antibodies (DSA) was limited but suggested more frequent anti-HLA Class I DSA under everolimus. Change in left ventricular mass index was similar. Discontinuation due to adverse events was more frequent with everolimus (23.6%) versus CNI (8.4%). In conclusion, conversion to everolimus at 10-14 weeks posttransplant was associated with renal function similar to that with standard therapy overall. Rates of BPAR were low in all groups, but lower with tacrolimus than everolimus open de Fijter JW, Holdaas H, Øyen O, Sanders JS, Sundar S, Bemelman FJ, Sommerer C, Pascual J, Avihingsanon Y, Pongskul C, Oppenheimer F, Toselli L, Russ G, Wang Z, Lopez P, Kochuparampil J, Cruzado JM, van der Giet M; ELEVATE Study Group: [...; Guido Garosi; Paolo Rigotti; Giuseppe Tisone; Paola Todeschini; ...] de Fijter JW, Holdaas H, Øyen O, Sanders JS, Sundar S, Bemelman FJ, Sommerer C, Pascual J, Avihingsanon Y, Pongskul C, Oppenheimer F, Toselli L, Russ G, Wang Z, Lopez P, Kochuparampil J, Cruzado JM, van der Giet M; ELEVATE Study Group: [..; Guido Garosi; Paolo Rigotti; Giuseppe Tisone; Paola Todeschini; ..]

Published
2017

25. Glomerular expression of matrix metalloproteinases in AL-amyloidosis and association with renal function at the time of kidney biopsy

Author

Charitaki, E. Kastritis, E. Petraki, C. Liapis, K. Adamidis, K. Apostolou, T. Christodoulidou, C. Nikolopoulou, N. Terpos, E. Nakopoulou, L. Dimopoulos, M.A.

Subjects
urologic and male genital diseases
Abstract

Background: Matrix metalloproteinases (MMPs) have been implicated in the pathophysiology of various renal diseases, however, there are limited data regarding their role in renal AL-amyloidosis. In the present study, we evaluated the glomerular expression of MMPs in renal-biopsy specimens containing AL-amyloid deposits. We also examined the association of MMPs with renal function at the time of diagnostic renal biopsy. Methods: We performed immunohistochemistry with monoclonal antibodies against MMP-1, MMP-2, MMP-3, MMP-9, and TIMP-1 in 19 kidney-biopsy specimens with AL-amyloidosis and 8 specimens from normal kidney tissue. We used clinical data of the patients at the time of kidney biopsy to evaluate the association between MMP expression and renal function. Results: We found increased MMP-1 and MMP-3 expression within the amyloid deposits and adjacent tissues in > 50% of the amyloid-positive biopsies, whereas MMP-1 and MMP-3 were negative in control samples. In contrast, we found no significant glomerular MMP-2 and TIMP-1 expression in amyloid-containing or normal kidneys. MMP-9 expression was found in the glomerular basement membrane equally in AL-amyloidosis and control specimens. The presence of MMP-1 and MMP-3 in the glomeruli of patients with AL-amyloidosis correlated with worse renal function at the time of kidney biopsy. Conclusion: The findings of this study show increased glomerular expression of MMP-1 and MMP-3 in patients with AL-amyloidosis which is associated with worse renal function at the time of the kidney biopsy. Our results suggest an important role for MMP-1 and MMP-3 in the pathogenesis of renal damage in AL-amyloidosis. © 2016 Dustri-Verlag Dr. K. Feistle.

Published
2016

29. PP.31.10

Author

Psounis, K., primary, Kolyvas, G., additional, Oikonomaki, T., additional, Geladari, H., additional, Evangelatou, E., additional, Kritsos, K., additional, Nikolopoulou, N., additional, Apostolou, T., additional, and Andreadis, E., additional

Published
2015
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30. Immunologic Prognostic Factors of Renal Allograft Survival

Author

Koukoulaki, M., primary, Kitsiou, V., additional, Balaska, A., additional, Pistolas, D., additional, Loukopoulos, I., additional, Drakopoulos, V., additional, Athanasiadis, T., additional, Tarassi, K., additional, Vougas, V., additional, Metaxatos, G., additional, Apostolou, T., additional, Papasteriadi, C., additional, Drakopoulos, S., additional, and Hadjiyannakis, E., additional

Published
2014
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31. Prospective monitoring of BK virus replication in renal transplant recipients

Author

Koukoulaki, M. Grispou, E. Pistolas, D. Balaska, K. Apostolou, T. Anagnostopoulou, M. Tseleni-Kotsovili, A. Hadjiconstantinou, V. Paniara, O. Saroglou, G. Legakis, N. Drakopoulos, S.

Subjects
virus diseases
Abstract

Background. BK virus-associated nephropathy (BKVAN) can be diagnosed only with renal graft biopsy. Definitive diagnosis of BKVAN requires demonstration of BK virus (BKV) replication in renal allograft tissues. Non-invasive analysis of urine and blood is considered essential in screening renal transplant recipients. Patients and methods. This study evaluated prospectively the replication of BKV in plasma and urine with qualitative and quantitative real-time polymerase chain reaction in 32 de novo (group A) and 34 chronic (group B) renal transplant recipients and the long-term impact on graft function. Results. In group A, 456 samples (228 plasma, 228 urine) were examined and BKV was detected in 31 (31/228, 14%) samples of plasma and 57 (57/228, 25%) samples of urine in 20 (20/32, 62.5%) and 23 (23/32, 72%) recipients, respectively. Incidence of viremia and viruria increased during the first 6 months presenting a peak the third postoperative month (viremia: 28% and viruria: 31%). Immune suppressive treatment with tacrolimus showed significant relation with viremia. Renal graft function in de novo renal transplant recipients remained stable throughout the follow-up period without influence of BKV replication. In group B, incidence of viremia and viruria were 3% (1/34) and 9% (3/34) correspondingly, indicating that after the first post-transplant year the risk of BKV re-activation is diminished. Conclusion. The highest incidence of BK viremia and viruria is observed the third post-transplantation month, confirming previously published studies in Europe and the United States, and long-term follow up shows that BKV replication decreases significantly after the third post-transplant month and even transient viremia or viruria does not have an impact on renal function. © 2008 Wiley Periodicals, Inc.

Published
2009

32. Percutaneous harlow wood needle biopsy of the spine: A retrospective analysis of 238 spine lesions

Author

Christodoulou, A Zidrou, C Savvidou, OD Givissis, P and Apostolou, T Mavrogenis, AF Papagelopoulos, PJ Pournaras, J

Abstract

This retrospective study assessed the diagnostic accuracy and clinical usefulness of the Harlow Wood needle biopsy for spinal lesions. The medical records of 238 patients (138 men and 100 women) who underwent closed spine biopsy from 1987 through 1997 were reviewed. Patient age ranged from 21 to 83 years. Lesions involved the thoracic vertebrae in 127 patients, the lumbar vertebrae in 99 patients, and the sacrurn in 12 patients. Cultures of the biopsy specimens were examined histopathologically and cytologically. One hundred twenty-four patients were diagnosed with a spinal infection, and 68 patients were diagnosed with a tumor. In the remaining 46 patients, the biopsy specimens were negative for infection or neoplasia in 20 patients and not diagnostic in 26 (10.9%) patients. There were no major complications. The Harlow Wood needle biopsy is a simple, repeatable procedure with satisfactory diagnostic accuracy (89.1%) and can be performed on an outpatient basis.

Published
2005

34. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction

Author

Van de Werf, F., Armstrong, P. W., Granger, C., Wallentin, L., Adgey, A. A. J., Aylward, P., Binbrek, A. S., Califf, R., Cassim, S., Diaz, R., Fanebust, R., Fioretti, P. M., Huber, K., Husted, S., Lindahl, B., Lopez-Sendon, J. L., Makijarvi, M., Meyer, J., Navarro Robles, J., Pfisterer, M., Seabra-Gomes, R., Soares-Piegas, L., Sugrue, D., Tendera, M., Theroux, P., Toutouzas, P., Vahanian, A., Verheugt, F., Sarelin, H., Goetz, G., Bluhmki, E., Daclin, V., Danays, T., Houbracken, K., Kaye, J., Reilly, P., Hacke, W., von Kummer, R., Lesaffre, E., Bogaerts, K., Peeters, C., Fox, K. A. A., Brower, R., Hirsh, J., Maggioni, A., Tijssen, J., Weaver, D., Beernaert, A., Beysen, N., Broos, K., De Prins, E., D'Hollander, K., Dupon, L., Fomyna, N., Fransen, A., Genesse, D., Goffin, L., Hendrickx, R., Jansen, B., Jorissen, F., Luys, C., Luyten, A., Marschal, C., Moreira, M., Munsters, K., Salerno, R., Schoovaerts, C., Sinnaeve, P., Schildermans, C., Vandenberghe, K., Vandeschoot, K., Van Gucht, H., Van Rompaey, P., Vlassak, S., Watzeels, M., Wittockx, H., Galan, K., Humeniuk, L., Seidel, A., Molina, M., Hafley, G., Alexander, J., Pascual, A., Bestilny, S., Temple, T., Ahuad Guerrero, R., Albisu, J. P., Bassani Arrieta, C. A., Bono, J., Caccavo, A., Cagnolatti, A., Cartasegna, L. R., Castellanos, R., Chekerdemian, S., Covelli, G., Cuello, J. L., Cuneo, C. A., Fernandez, A., Ferrara, C., Ferro-Queirel, E., Gambarte, A., Garcia-Duran, R., Hasbani, E., Hrabar, A., Keller, L., Lobo Marquez, L. L., Luciardi, H., Macin, S. M., Marinig, A., Marzetti, E., Muntaner, J., Nordaby, R., Orlandini, A. D., Piombo, A. C., Pomposiello, J. C., Quijano, R. A., Amerena, J., Aroney, G., Buckmaster, N., Carroll, P., Fitzpatrick, M., Newman, R., Rowe, M., Singh, B., Thomson, A., Winter, C., Eber, B., Gaul, G. B., Klein, W., Leisch, F., Mayr, H., Mlczoch, J., Niessner, H., Pachinger, O., Pall, H., Pichler, M., Roggla, G., Schaflinger, E., Schreiber, W., Slany, J., Traindl, O., Zenker, G., Beckers, J., Bekaert, I., Berthe, C., Bodur, G., Carlier, B., Carlier, M., Carpentier, J., Celen, H., Charlier, F., Clement, A., Coenen, A., Crochelet, L., De Keyser, F., De Man, F., de Meester, A., Dendale, P., Dhondt, E., Dhooghe, G., El Allaf, D., Elshot, S., Emmerechts, C., Foret, F., Gatera, E., Geraedts, J., Gerardy, A. C., Gysbrechts, M., Hallemans, R., Hellemans, S., Herssens, H., Huygens, L., Janssens, L., Lalmand, J., Maamar, R., Marechal, P., Mertens, D., Michel, P., Morandini, E., Nannan, M., Nguyen, D., Odeurs, W., Peerenboom, P., Pirenne, B., Quinonez, M., Raymenants, E., Renard, M., Silance, P. G., Standaert, A. M., Striekwold, H., Thiels, H., Valadi, D., van Brabandt, H., Van Dormael, M., Van Iseghem, P., Van Walleghem, U., Vanden Bosch, H., Vandenbossche, J. L., Vermylen, J., Verstraete, S., Vo Ngoc, P., Willems, P., Zenner, R., Campos de Albuquerque, D., Coutinho, M., de Camargo Carvalho, A. C., Fernandes Manenti, E. R., Ferreira Azevedo, A., Golin, V., Gun, C., Marin Neto, J. A., Marino, R. L., Miranda Abrantes, J. A., Nicolau, J. C., Porto Alegre Dancini, E. M., Rabelo, A., Ramos, R. F., Rizzi Coelho, O., Alexander, D., Bata, I. R., Bhargava, R. K., Bogaty, P., D'Amours, G., Darcel, I., Finnie, K. J. C., Fowlis, R., Gupta, M. K., Henderson, M., Howlett, M. K., Javier, J. J., Kieu, C. V., Kumar, G., Lebouthillier, P., Leduc, F., Lepage, S., Mcavinue, T., Mcgillen, J. E., Mcmeekin, J. D., Morse, J. W., Pistawka, K., Raimondo, E. F., Sandrin, F., Smith, H., Smylie, P. C., Tran, K., Turabian, M., Wagner, K. R., Winkler, L. H., Woo, K. S., Falstie-Jensen, N., Lind Rasmussen, S., Lomholt, P., Markenvard, J., Nielsen, H., Petersen, J., Romer, F., Ahonen, J., Huttunen, M., Kokkonen, L., Luukkonen, J., Mantyla, P., Melin, J., Mustonen, J., Valli, J., Voutilainen, S., Agraou, B., Allam, S., Baradat, G., Battistella, P., Bazin, P., Bouvier, J. -M., Destrac, S., Fouche, R., Fournier, P. -Y., Funck, F., Garnier, H., Grall, J. -Y., Gully, C., Lallement, P. -Y., Loiselet, P., Mycinsky, C., Page, A., Parisot, M., Range, G., Rocher, R., Tafani, C., Thisse, J. -Y., Tibi, T., Tissot, M., Wahl, P., Backenkohler, U., Bavastro, P., Beckmann-Hiss, H., Behnke, M., Bermes, M., Bernsmeier, R., Bethge, K. P., Bethge, H., Block, M., Burkhardt, W., Cieslinski, G., Claus, G., Deetjen, A., Diefenbach, A., Diehm, C., Dietz, A., Dippold, W. G., Eichner, A., Erckenbrecht, J. F., Gawlick, L., Gerber, V., Goppel, L., Gottwik, M., Grosch, B., Hammer, B., Hanheide, M., Hanrath, P., Haspel, J., Hennersdorf, F., Hermanns, M., Hoffmeister, H. M., Holzapfel, P., Hubner, H., Jansen, W., Jung, S., Kaddatz, J., Kienbock, H., Klein, H. H., Konz, K. H., Kulschbach, M., Leschke, M., Liebau, G., Linnartz, M., Lockert, G., Loesbrock, R., Lollgen, H., Ludwig, N., Mudra, H., Munzer, K., Nebel, B., Nellessen, U., Neu, C., Olbrich, H. G., Pfeffer, A., Pfeiffer, P., Plate, V., Pollock, B., Rapp, H., Rommele, U., Sauer, K., Scheffler, N., Schlotterbeck, K., Schmidt-Salzmann, A., Schnitzler, G., Schumann, H., Schuster, C. J., Schuster, P., Schweizer, P., Seitz, K., Simon, R., Spes, C., Szabo, S., Terhardt-Kasten, E., Theuerkauf, B., Tigges, R., Tinnappel, J., Topp, H., Trockel, P., Unland, N., Veth, V., Vom Dahl, J., Vossbeck, G., Weindel, K., Weib, D., Wiewel, D., Wirtz, P., Zipp, C., Apostolou, T., Chalkidis, C., Exadaktylos, N., Foussas, S., Hatseras, D., Karas, S., Karydis, K., Lambrou, S., Louridas, G., Manolis, A., Nanas, J., Novas, I., Panagiotidou, T., Papadopoulos, C., Papakonstantinou, D., Papasteriadis, E., Pavlidis, P., Pyrgakis, V., Skoufas, P., Stavrati, A., Tyrologos, A., Vardas, P., Vrouchos, G., Zacharoulis, A., Zarifis, J., Brown, A., Daly, K., Fennell, W., Horgan, J., Mccann, H., Mcdonald, K., O'Reilly, M., Sullivan, P., Altamura, G., Ambrosio, G., Auteri, A., Aveta, P., Azzarito, M., Badano, L. P., Barbiero, M., Barletta, C., Biscosi, C., Boccanelli, A., Bottero, M., Brizio, E., Brunazzi, M. C., Brunelli, C., Bugatti, U., Capozi, A., Capucci, A., Carfora, A., Caronna, A., Carrone, M., Casazza, F., Cauticci, A., Ceci, V., Ciconte, V., Circo, A., Ciricugno, S., Comito, F., Cornacchia, D., Corsini, G., D'Andrea, F., De Rosa, P., De Simone, M., Del Citerna, F., Del Pinto, M., Dell'Ali, C., Della Casa, S., Della Monica, R., Delogu, G., Di Biase, M., Di Chiara, A., Di Guardo, G., Di Marco, S., Di Mario, F., Di Napoli, T., Di Palma, F., Fadin, B. M., Fazzari, M., Ferraiuolo, G., Fiaschetti, R., Fontanelli, A., Fresco, C., Gambelli, G., Gasbarri, F., Gemelli, M., Giani, P., Gigantino, A., Giomi, A., Giorgi, G., Greco, C., Gregorio, G., Guagnozzi, G., Guiducci, U., Guzzardi, G., Izzo, A., La Rosa, A., Leone, F., Leone, G., Lo Bianco, F., Locuratolo, N., Maggiolini, S., Malinconico, M., Mancone, C., Mangiameli, S., Marchi, S. M., Maresta, A., Mauri, F., Mazzini, C. A., Michisanti, M., Miracapillo, G., Modena, M. G., Morgagni, G. L., Mossuti, E., Nascimbeni, F., Negrelli, M., Notaristefano, A., Pardi, S., Peci, P., Pettinati, G., Pietropaolo, F., Pirelli, S., Pretolani, M., Prinzi, D., Proietti, F., Raganelli, L., Rapino, S., Re, F., Ricci, R., Rinaldi, G., Rusticali, G., Severi, S., Spallarossa, P., Tartagni, F., Terrosu, P., Tortorella, G., Tota, F., Tritto, I., Tuccilo, B., Turco, V., Uscio, G., Valagussa, F., Vergoni, W., Verzuri, M. S., Vetrano, A., Villani, R., Zanini, R., Boisante, L., Niclou, R., Alcocer, L., Castro, A., Fragoso, J., Gonzalez, V., Gonzalez-Pacheco, H., Hernandez-Santamaria, I., Huerta, R., Huerta, D., Martinez, A., Mendoza, M., Moguel, R., Navarro, J., Portos, J. M., Rodriguez, I., Sierra, L., Valencia, S., Vazquez, A., Arnold, A. E. R., Boehmer, A. G., de Graaf, J. J., Funke Kupper, A. J., Gobel, E. J. A. M., Janus, C. L., Linssen, G. C. M., Sedney, M. I., Slegers, L. C., Spierenburg, H. A. M., Strikwerda, S., Tans, J. G. M., Twisk, S. P. M., van der Heijden, R., van Kalmthout, P. M., Verheugt, F. W. A., Holt, E., Skogsholm, A., Thorshaug, R., Thybo, N. K., Wang, H., Maciejewicz, J., Piotrowski, W., Pluta, W., Ruminski, W., Skura, M., Smielak-Korombel, W., Carranca, J., Carvalho, M., Catarino, C., Cunha, D., Ferreira, D., Ferreira, J., Ferreira da Costa, A. F., Lopes de Carvalho, J., Martins, L., Mourao, L., Oliveira Carrageta, M., Prazeres de Sa, E., Puig, J., Ramalho Dos Santos, M. J. J., Resende, M., Seabra Gomes, R., Baig, M. M. E., Bayat, J., Benjamin, J. D., Ranjith, N., Routier, R., Wittmer, H., Abizanda Campos, R., Alonso Garcia, M. A., Amaro Cendon, A., Arboleda Sanchez, J. A., Blanco Varela, J., Bruguera I Cortada, J., Carpintero Avellaneda, J. L., Caturla Such, J., Civeira Murillo, E., Fernandez Aviles, F., Fernandez Fernandez, R., Figueras Bellot, J., Fiol Sala, M., Froufe Sanchez, J., Garcia Calabozo, R., Garcia Palacios, J. L., Gonzalez Maqueda, I., Kallmeyer Martin, C., Lopez Sendon, J. L., Manzano Ramirez, A., Marine Rebull, J., Monton Rodriguez, A., Pique Gilart, M., Reina Toral, A., Rodriguez Llorian, A., Ruano Marco, M., Sanchez Miralles, A., Sanjose Garagarza, J. M., Santalo Bel, M., Torres Ruiz, J. M., Valentin Segura, V., Ahlstrom, P., Ahremark, U., Bandh, S., Bellinetto, A., Dahlberg, A., Hansen, O., Hurtig, U., Jonasson, L., Karlsson, J. E., Larsson, L. E., Moller, B., Ohlin, H., Persson, H., Sandstedt, L., Soderberg, S., Svennberg, L., Swahn, E., Tygesen, H., Broccard, A. F., Estlinbaum, W., Follath, F., Frutiger, A., Hess, N., Maggiorini, M., Marti, D., Muller, P., Rickenbacher, P., Schaller, M. D., Weinbacher, M., Abdulali, S., Ahmad, G., George, S., Ghazi, A., Rao, K. N., Bishop, A., Bridges, A., Canepa-Anson, R., Cave, M., Clarck, R., Cooper, I., de Belder, A., Farrer, M., Kendall, J. M., Ludman, P., Mattu, R., Mcglinchey, P., Moriarty, A. J., Muthusamy, S., Nee, P. A., Nolan, J., Papouchado, M., Rose, E. L., Shahi, M., Stephens, J., Trevelyan, J., Abdul-Karim, A., Adler, L., Arunasalam, S., Avington, D., Baron, S., Beel, T., Bellamy, B., Bennett, J., Berndt, T., Berrick, A., Bersin, R. M., Bethala, V., Bharath, S., Bouchard, A., Boulet, J. E., Bowerman, R., Boyek, T., Brar, R. S., Brodell, G., Bryant, B., Buckner, J. K., Cage, J., Cannon, J. D., Carducci, B., Carr, K., Chang, M., Chelliah, N., Chin, W. L., Chin, J., Church, D. H., Clark, R., Coulis, L., Dadkhah, S., Dearing, B., Defranco, A., Dharawat, M., Dharawat, R., Dhruva, N., Dicola, J., Dykstra, G., Eisenberg, S., El-Bialy, A., Fera, S., Ford, K., Foreman, R. D., Friedman, S., Friedman, V., Garibian, G., Gelormini, J., Geninatti, M. R., Genovese, R., Ghazi, F., Gilchrist, I., Gitler, B., Glover, R., Gonzalez, J., Goulah, R., Graham, B., Gray, R., Grodman, R., Habib, G. B., Hack, T., Hamroff, G., Hanna, G., Hart, M., Haught, H., Hawkins, J., Hempel, R., Hiremath, Y., Hiser, W., Holland, E., Jaffe, N., Jamal, N., James, K. F., Kalla, S., Kates, M., Kemper, A. J., Kennedy, J. J., Kerut, E. K., Killpack, M., King, J., T. Y., Ko, Kollar, K., Kontos, M., Kugelmassluu, A., Kumar, A., Kutscher, A. H., Lambrecht, C., Lancaster, L., Layden, J., Lazar, A., Lebow, M., Lee, C., Lee, A. B., Lehr, J., Levin, F. L., Levitt, R., Levy, R. M., Lieberman, A., Litman, G. I., Lui, H., Luu, M. Q., Macdonald, G., Madyoon, H., Mancherje, C., Marmulstein, M., Mclaurin, B. T., Mcnellis, M., Mendelson, R., Micale, P. J., Miller, M. J., Miller, M. S., Miller, J., Millman, A., Millsaps, R., Minor, S., Modica, J., Morse, H., Moskovits, N., Nester, B. A., Newton, A. S., Niazi, I., Niederman, A., Oatfield, R., Painter, J. A., Pamfilis, S. M., Pamulapati, K. M., Patel, N., Payne, R., Pearson, C., Peizner, D. S., Petrovich, L., Piriz, J., Pollack, M., Pollock, S., Popkave, A., Puma, J. A., Quesada, R., Quigley-Malcolm, D., Raby, K., Ravindran, K., Rees, A. P., Reiner, J., Rivera, E., Rogers, F., Rosenthal, A., Rowe, W. W., Ryan, P. F., Ryman, K., Salacata, A., Santolin, C., Saucedo, J., Savage, R., Savage, W., Schumacher, R., Segarra, S., Sharkey, S., Shonkoff, D., Silver, M., Silver, S. L., Singh, G., Sinyard, R. D., Sporn, D., Srivastava, N. K., Stomel, R., Suresh, D. P., Tallman, M., Togioka, T., Varma, S., Verant, R. P., Wallach, R., Weinberg, M., Weinberg, D., Weinstein, J. M., Wesley, G., Westerman, J. H., Wheeling, J., Whitaker, J., Widmer, M., Yasin, M., and Zakrzewski, M. J.

Subjects
Male, medicine.medical_specialty, Abciximab, Ischemia, Myocardial Infarction, Tenecteplase, Injections, Immunoglobulin Fab Fragments, Reperfusion therapy, Fibrinolytic Agents, Recurrence, Internal medicine, medicine, Humans, Myocardial infarction, Enoxaparin, Aged, Intention-to-treat analysis, Chi-Square Distribution, business.industry, Heparin, Antibodies, Monoclonal, General Medicine, Middle Aged, medicine.disease, Survival Analysis, Regimen, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, Cardiology, Drug Therapy, Combination, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

BACKGROUND: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. METHODS: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. FINDINGS: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p

Published
2001

35. Mineral and bone disease - CKD 5D

Author

Hecking, M., primary, Kainz, A., additional, Bielesz, B., additional, Plischke, M., additional, Beilhack, G., additional, Hoerl, W. H., additional, Sunder-Plassmann, G., additional, Bieglmayer, C., additional, Benchetrit, S., additional, Green, J., additional, Bernheim, J., additional, Golan, E., additional, Oyake, N., additional, Suzuki, K., additional, Itoh, S., additional, Tanabe, K., additional, Fujimori, A., additional, Okada, S., additional, Yamamoto, K., additional, Sakai, M., additional, Kamiura, N., additional, Solenne, P., additional, Guebre-Egziabher, F., additional, Bacchetta, J., additional, Drai, J., additional, Richard, M., additional, Chapurlat, R., additional, Fouque, D., additional, Nowak, Z., additional, Grzegorz, K., additional, Maria, K., additional, Zofia, W., additional, Zamboch, K., additional, Zahalkova, J., additional, Kosatikova, Z., additional, Skypalova, P., additional, Skarda, J., additional, Cunha, J., additional, Boim, M., additional, Ferreira, V., additional, Naves, M., additional, Kikuchi, H., additional, Shimada, H., additional, Takimoto, Y., additional, Karasawa, R., additional, Shimotori, M., additional, Ikarashi, K., additional, Saito, N., additional, Miyazaki, S., additional, Sakai, S., additional, Suzuki, M., additional, Ogata, H., additional, Takeshima, A., additional, Yamamoto, M., additional, Asakura, K., additional, Kato, T., additional, Shishido, K., additional, Koiwa, F., additional, Mizobuchi, M., additional, Kinugasa, E., additional, Akizawa, T., additional, Londrino, F., additional, Corbani, V., additional, Ardini, M., additional, Falqui, V., additional, Zattera, T., additional, Rombola', G., additional, Takeshige, Y., additional, Matsuzaka, K., additional, Ciceri, P., additional, Volpi, E., additional, Brenna, I., additional, Elli, F., additional, Borghi, E., additional, Brancaccio, D., additional, Cozzolino, M., additional, Farrand, K., additional, Copley, J. B., additional, Heise, J., additional, Fridman, M., additional, Keith, M., additional, Silverberg, A., additional, Wilson, R., additional, Poole, L., additional, Jean, G., additional, Bresson, E., additional, Chazot, C., additional, Maduell, F., additional, Arias, M., additional, Sentis, A., additional, Rodriguez, N., additional, Jimenez, S., additional, Alemany, B., additional, Perez, N., additional, Vera, M., additional, Fontsere, N., additional, Carrera, M., additional, Cases, A., additional, Sonikian, M., additional, Miha, T., additional, Skarakis, I., additional, Karatzas, I., additional, Karaitianou, A., additional, Tomanoski, V., additional, Petkovic, D., additional, Curic, I., additional, Hrvacevic, R., additional, Kaperonis, N., additional, Kourvelou, C., additional, Sgantzos, A., additional, Nastou, D., additional, Ntatsis, G., additional, Ziakka, S., additional, Karakasis, F., additional, Nikolopoulos, V., additional, Zoubaniotou, D., additional, Koutsovasili, A., additional, Zagorianakos, A., additional, Kolovos, V., additional, Papagalanis, N., additional, Forni, V., additional, Pruijm, M., additional, Tousset, E., additional, Zweiacker, C., additional, Menetrey, I., additional, Berwert, L., additional, Bullani, R., additional, Cherpillod, A., additional, Gabutti, L., additional, Gauthier, T., additional, Halabi, G., additional, Mathieu, C., additional, Meier, P., additional, Phan, O., additional, Pianca, S., additional, Schoenholzer, C., additional, Teta, D., additional, Von Albertini, B., additional, Vrijens, B., additional, Burnier, M., additional, Kurita, N., additional, Fukagawa, M., additional, Onishi, Y., additional, Yamaguchi, T., additional, Hasegawa, T., additional, Fukuma, S., additional, Kurokawa, K., additional, Fukuhara, S., additional, Urena, P., additional, Bridges, I., additional, Christiano, C., additional, Cournoyer, S., additional, Cooper, K., additional, Farouk, M., additional, Kopyt, N., additional, Rodriguez, M., additional, Zehnder, D., additional, Covic, A., additional, Tominaga, Y., additional, Hiramitsu, T., additional, Yamamoto, T., additional, Nanmoku, K., additional, Matsuda, Y., additional, Tsuzuki, T., additional, Lang, C.-L., additional, Lu, K.-C., additional, Wang, M.-H., additional, Liu, S.-Y., additional, Huang, J.-W., additional, Chiang, C.-K., additional, Hung, K.-Y., additional, Bantis, C., additional, Kouri, N.-M., additional, Tsandekidou, E., additional, Frangidis, S., additional, Tsiandoulas, A., additional, Liakou, E., additional, Bamichas, G., additional, Stangou, M., additional, Papagianni, A., additional, Efstratiadis, G., additional, Natse, T., additional, Memmos, D., additional, Messa, P., additional, Cannella, G., additional, Mazzaferro, S., additional, Yu, X., additional, Bieber, B., additional, Guidinger, M., additional, Yang, X., additional, Tentori, F., additional, Pisoni, R., additional, Qian, J., additional, Chen, N., additional, Yan, Y., additional, Wang, M., additional, Zuo, L., additional, Wang, H., additional, Albert, J., additional, Ramirez, S., additional, Caccetta, F., additional, Caroppo, M., additional, Musio, F., additional, Mudoni, A., additional, Accogli, A., additional, Zacheo, M. D., additional, Nuzzo, V., additional, Selim, G., additional, Stojceva-Taneva, O., additional, Tozija, L., additional, Gelev, S., additional, Pusevski, V., additional, Dzekova-Vidimliski, P., additional, Rambabova-Busletic, I., additional, Sikole, A., additional, Esposito, P., additional, Coppo, R., additional, Malberti, F., additional, Dal Canton, A., additional, Moriwaki, K., additional, Komaba, H., additional, Kakuta, T., additional, Cernaro, V., additional, Lupica, R., additional, Donato, V., additional, Lacquaniti, A., additional, Fazio, M. R., additional, Lucisano, S., additional, Buemi, M., additional, Okuno, S., additional, Ishimura, E., additional, Tsuboniwa, N., additional, Norimine, K., additional, Yamakawa, K., additional, Yamakawa, T., additional, Shoji, S., additional, Mori, K., additional, Nishizawa, Y., additional, Inaba, M., additional, Dahaba, M., additional, Seck, S., additional, Cisse, M., additional, Jotoku, Y., additional, Sato, Y., additional, Dimkovic, N., additional, Asicioglu, E., additional, Kahveci, A., additional, Arikan, H., additional, Koc, M., additional, Tuglular, S., additional, Ozener, C., additional, Kido, R., additional, Yamaguch, T., additional, Krasniak, A., additional, Drozdz, M., additional, Chmiel, G., additional, Podolec, P., additional, Pasowicz, M., additional, Kowalczyk-Michalek, M., additional, Sulowicz, W., additional, Perez-Suarez, G., additional, Baamonde, E., additional, Bosch, E., additional, Ramirez, J. I., additional, El Hayek, B., additional, Lago, M. D. M., additional, Garcia, C., additional, Checa, M. D., additional, Hiramatsu, R., additional, Ubara, Y., additional, Salas, K., additional, Vicent, E. S., additional, Gonzalez Oliva, J. C., additional, Fulquet, M., additional, Duarte, V., additional, Pou, M., additional, Saurina, A., additional, Macias, J., additional, Ramirez de Arellano, M., additional, Matias, P., additional, Jorge, C., additional, Mendes, M., additional, Amaral, T., additional, Ferreira, C., additional, Aires, I., additional, Gil, C., additional, Ferreira, A., additional, Arcal, C., additional, Campistol, J. M., additional, Seferi, S., additional, Rroji, M., additional, Likaj, E., additional, Petrela, E., additional, Barbullushi, M., additional, Zeneli, N., additional, Mumajesi, S., additional, Thereska, N., additional, Vulpio, C., additional, Bossola, M., additional, Stigliano, E., additional, Fadda, G., additional, Gueiros, A. P. S., additional, Borba Junior, J. O., additional, Lordsllen, A. B. d. M. D. S., additional, Gueiros, J. E. d. B., additional, Itami, N., additional, Tuneyama, K., additional, Uemura, S., additional, Hamada, H., additional, Takada, J., additional, Takahashi, K., additional, Adamidis, K., additional, Apostolou, T., additional, Pleros, C., additional, Oikonomaki, T., additional, Kyratzi, E., additional, Exarchos, D., additional, Metaxatos, G., additional, Dracopoulos, S., additional, Nikolopoulou, N., additional, Delanaye, P., additional, Dubois, B., additional, Krzesinski, J.-M., additional, Cavalier, E., additional, De la Fuente, V., additional, Gil, M. T., additional, Gutierrez, P., additional, Delgado, P., additional, Ribero, J., additional, Arenas, L., additional, Sezer, S., additional, Tutal, E., additional, Bal, Z., additional, Erkmen Uyar, M., additional, Ozdemir Acar, F. N., additional, Azevedo de Oliveira, R., additional, Carvalho Barreto, F., additional, Dos Reis, L., additional, Cunha Ferreira, J., additional, Maria Leme Britto, Z., additional, Maria Moyses, R., additional, Jorgetti, V., additional, Ozelsancak, R., additional, Gurlek Demirci, B., additional, Torun, D., additional, Veljancic, L., additional, Radojevic, M., additional, Paunic, Z., additional, Vavic, N., additional, Obrencevic, K., additional, Kovacevic, Z., additional, and Pejovic, J., additional

Published
2012
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43. PAINLESS MYOCARDIAL-ISCHEMIA IN CHRONIC HEMODIALYZED PATIENTS - A REAL EVENT

Author

KREMASTINOS, D PARASKEVAIDIS, I VOUDIKLARI, S APOSTOLOU, T and KYRIAKIDES, Z ZIROGIANNIS, P TOUTOUZAS, P

Subjects
cardiovascular diseases
Abstract

We investigated the incidence of painless (silent) myocardial ischemia, manifested as S-T segment deviation, by Holter ECG monitoring in patients with chronic renal failure undergoing regular hemodialysis. Forty-five patients underwent Holter ECG monitoring for a continuous 48-hour period covering dialysis and the intermediate period of everyday activity at home. ECG criteria for ischemia were found in 15.5% of patients mainly during and immediately after dialysis with a simultaneous increase of R, S, R + S amplitude. There was no correlation of S-T segment deviation with the existence of cardiac dysfunction and coronary artery disease proved by hemodynamic and angiographic studies. It is concluded that hemodialysis itself seems to play an important role in the genesis of the above ECG findings, possibly by means of serum K and Mg changes.

Published
1992

44. INTRAVENOUS ATENOLOL IN ELDERLY PATIENTS IN THE EARLY PHASE OF ACUTE MYOCARDIAL-INFARCTION

Author

KYRIAKIDES, ZS KREMASTINOS, D KARAVOLIAS, G PAPADOPOULOS, C and APOSTOLOU, T PARASKEVAIDIS, J TOUTOUZAS, P

Subjects
cardiovascular diseases
Abstract

The aim of this study was to assess the hemodynamic response to intravenous atenolol in elderly patients with acute myocardial infarction. We studied 14 elderly men, aged 64-85 years, and 14 younger men, aged 29-48 years, in the early postfibrinolytic phase of acute myocardial infarction. All the patients were in Killip class I. A triple-lumen Swan-Ganz thermodilution catheter was introduced into the right heart chambers. The patients received 5 mg intravenous atenolol over 5 minutes. All hemodynamic parameters were measured before and 10 minutes after atenolol. The hemodynamic characteristics and the location and extent of acute myocardial infarction were the same in both groups before atenolol. The hemodynamic changes after atenolol administration were the same in the two groups, but the stroke volume and cardiac indexes decreased to a greater extent in the elderly (p = .01 and p = .0001, respectively). These results indicate that intravenous atenolol in the early postfibrinolytic phase of acute myocardial infarction is safe in Killip class I elderly patients, although the cardiac and stroke volume indexes decrease, and the increase in the total systemic resistance is more in older than in younger patients.

Published
1992

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