Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? – Analysis of 568 Patients

Background

Advantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention.

Objective

To compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedure

Methods

The dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated.

Results

A total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm², while the staged group, to 139.2 ± 75.3 Gycm² (p < 0.001).

Conclusion

Ad hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.     

Radiation Exposure from Abdominal Imaging Studies in Patients with Intestinal Beh?et Disease

Background/Aims

Recently, several studies have revealed that diagnostic imaging can result in exposure to harmful levels of ionizing radiation in inflammatory bowel disease patients. However, the extent of radiation exposure in intestinal Behcet disease (BD) patients has not been documented. The aim of this study was to estimate the radiation exposure from abdominal imaging studies in intestinal BD patients.

Methods

Patients with a diagnosis of intestinal BD established between January 1990 and March 2012 were investigated at a single tertiary academic medical center. The cumulative effective dose (CED) was calculated retrospectively from standard tables and by counting the number of abdominal imaging studies performed. High exposure was defined as CED >50 mSv.

Results

In total, 270 patients were included in the study. The mean CED was 41.3 mSv, and 28.1% of patients were exposed to high levels of radiation. Computed tomography (CT) accounted for 81.7% of the total effective dose. In multivariate analyses, predictors of high radiation exposure were azathioprine/6-mercaptopurine use, surgery, and hospitalization.

Conclusions

Approximately a quarter of intestinal BD patients were exposed to harmful levels of diagnostic radiation, mainly from CT examination. Clinicians should reduce the number of unnecessary CT examinations and consider low-dose CT profiles or alternative modalities such as magnetic resonance enterography.     

Economic and Health Consequences of COPD Patients and Their Spouses in Denmark—1998–2010

Objective: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality worldwide, but longitudinal studies of the economic consequences of COPD are scarce. This study evaluated the economic consequences of COPD patients in Denmark and their spouses at a national level before and after initial diagnosis. Methods: Using records from the Danish National Patient Registry (1998–2010), 171,557 patients with COPD and 86,260 spouses were identified; patients were compared with 664,821, and the spouses with 346,524, all controls were randomly selected and matched for age, gender and residence. Direct and indirect costs, including frequency of primary and secondary sector contacts and procedures, medication, unemployment benefits and social transfer payments were extracted from national databases for patients, spouses and controls. Results: COPD patients are earning approximately half of that of controls before diagnosis. After diagnosis this effect diminishes due to people getting older and retiring from work (65 years). Total health expenses are more than twice as high in the COPD group regardless of age and gender compared to controls. Spouses of COPD patients had significantly higher rates of health-related contacts, medication use and higher socioeconomic costs compared to controls. The employment and income rates of employed spouses of COPD patients were significantly lower compared to controls. Conclusion: This study provides unique data on the economic consequences of COPD patients in Denmark and their spouses as well as displaying the serious health consequences for the individual spouse and society. Second, data shows substantial impact of COPD on income level and health expenses regardless of age and gender. It could be speculated that early identification and intervention might contribute to more health and economic equality between patients and controls     

The Impact of Endoscopic Retrograde Cholangiopancreatography Education on Radiation Exposure to Experienced Endoscopist: “Trainee Effect”

Background  

Endoscopic retrograde cholangiopancreatography (ERCP), as with other fluoroscopic procedures, carries the risk of exposure of staff to radiation. However, over the last two decades, only a few studies have investigated this risk.     

Serotonin Supersensitivity: The Pathophysiologic Basis of Non-Ulcer Dyspepsia?: A Preliminary Report of Buspirone/Prolactin Responses: Preliminary Report

Buspirone stimulates central 5-hydroxytryptamine (5HT) receptors and brings about the release of prolactin, and there is evidence to suggest that the extent of prolactin release after a challenge with buspirone is an indicator of the sensitivity of central 5HT receptors. Seventeen patients with a diagnosis of non-ulcer dyspepsia, eight normal healthy volunteers, and six patients with peptic ulcer disease were each given a challenge test of 60 mg buspirone orally, and prolactin release over a 3-h period was monitored. The mean prolactin response was significantly greater in patients with non-ulcer dyspepsia than in healthy controls and peptic ulcer disease patients. The results suggest that central 5HT receptors may be supersensitive in non-ulcer dyspepsia.     

Do Brief Measures of Readiness to Change Predict Alcohol Consumption and Consequences in Primary Care Patients With Unhealthy Alcohol Use?

BACKGROUND: Assessing readiness to change is recommended as part of brief interventions for patients with unhealthy alcohol use. However, the utility and predictive validity of readiness measures have not been well established. METHODS: In a prospective cohort study, we assessed primary care patients with unhealthy alcohol use (past-month drinking of risky amounts, or any amount and an affirmative response to CAGE alcohol screening questionnaire) and reassessed them 6 months later. At study entry, we assessed readiness to change using 1 multi-item measure of stage of change, and 5 single-item measures (readiness per se, importance of changing, confidence in ability to change, intention to cut down, intention to abstain). Outcomes included alcohol consumption and alcohol-related consequences. Multivariable regression models were fit for each measure of readiness and each outcome. RESULTS: Of 312 patients with unhealthy alcohol use, 228 (73%) were assessed at study entry and 6 months later and had complete data. Among readiness measures, only confidence and intention to abstain (1 point changes on single-item measures) were associated with consumption 6 months later: less heavy episodic drinking [adjusted odds ratio (AOR) 0.88, 95% CI 0.80-0.98 and AOR 0.79, 0.64-0.98, respectively], and less drinking of risky amounts (AOR 0.89, 0.79-1.00 and AOR 0.78, 0.62-0.98, respectively). Intention to abstain was also associated with more abstinence (AOR 1.43, 1.09-1.88). Single-item measures of readiness, importance, and intention to cut down were significantly associated with higher odds of alcohol consequences. Greater confidence (single item) was associated with a lower odds of any consequences (AOR 0.88, 0.79-0.98). CONCLUSIONS: Greater readiness, as measured by several brief assessments, was associated with more consequences and was not predictive of consumption. However, assessing confidence in the ability to change one's alcohol use may have a role in predicting subsequent decreases in both consumption and consequences in primary care patients.     

Self‐ and Informant Report of Financial Abilities in Patients with Alzheimer's Disease: Reliable and Valid?

OBJECTIVES: To evaluate the consistency, stability, and accuracy of reports by patients with Alzheimer's disease (AD) and their caregivers regarding the patients' premorbid and current financial abilities. DESIGN: Consistency of reports was assessed within patient/caregiver dyads and within control/control informant dyads. Stability of reports over a 1-month interval was assessed for each group: patients with AD, caregivers, controls, and control informants. Accuracy of each group's reports was evaluated in reference to patients' and controls' performance on a direct psychometric measure of financial capacity. SETTING: University medical center. PARTICIPANTS: Twenty patients with AD and 20 family caregivers; 23 controls and 23 family informants. MEASUREMENTS: The Prior Financial Capacity Form (PFCF) and the Current Financial Capacity Form (CFCF) were used. Parallel versions assessed self-report (patients, controls) and informant report (caregivers, control informants) at two visits 1 month apart. Patients with AD and controls were also administered the Financial Capacity Instrument (FCI), a direct assessment of the same abilities reported on the PFCF and CFCF. RESULTS: Patients with AD reported that they had more-intact current abilities than their caregivers reported. Patients with AD and their caregivers showed lower levels of stability over time on the PFCF and CFCF than did controls and their informants. Half of the patients with AD overestimated their current abilities relative to their FCI performance, whereas caregivers demonstrated both underestimation and overestimation errors. Controls and informants evidenced high levels of consistency, stability, and accuracy in PFCF and CFCF ratings. CONCLUSION: Patients with AD overestimate their financial abilities in comparison with the reports of their family caregivers. Both patients and caregivers' reports of patients' financial abilities showed limited stability and validity. The reliability and accuracy of self- and informant reports of financial abilities may be compromised in the context of dementia and caregiving, underscoring the need for direct assessment methods to augment self- and informant report in assessing functional decline in dementia.     

The Effect of Blood Transfusion on Growth of Patients with Hb E/β-Thalassemia

Abstract

A retrospective evaluation of growth in 112 patients (68 males, 44 females) with Hb E (HBB: c.79G>A)/β-thalassemia (β-thal), classified as 88 transfusion-dependent thalassemia (TDT) and 24 non transfusion-dependent thalassemia (NTDT), is reported. Patients with TDT have received regular transfusions of red blood cells (RBCs) 15?mL/kg every 4?weeks to maintain pre transfusion hemoglobin (Hb) levels of at least 9.0?g/dL and were categorized according to age at initiation of regular RBC transfusion as subgroup 1, <4?years; subgroup 2, 4–10?years, and subgroup 3, >10?years. Iron chelation was initiated at the mean age of 7?years. The results revealed that patients in subgroups 1 and 2, receiving RBC transfusions at a young age (2.9 and 6.9?years, respectively), had normal prepubertal growth at enrollment and last follow-up. Patients in subgroup 3, with the lowest initial height Z-score of ?2.10, were able to achieve comparable final adult height as those in subgroups 1 and 2. The mean final height of 21 males and 13 females with TDT at the ages of 18.9 and 18.7?years was 168.1 and 157.7?cm, respectively, which did not significantly differ from their midparental height and those with NTDT. Early initiation of optimal transfusion and iron chelation promoted normal prepubertal growth. However, delayed initiation of transfusion at age 12?years impaired prepubertal growth but they could achieve normal final adult height.     

Causes of creatine kinase levels greater than 1000 IU/L in patients referred to rheumatology

Patients with severely elevated creatine kinase (CK) concentrations are commonly referred to rheumatologists to evaluate for the presence of an idiopathic inflammatory myopathy (IIM). However, no studies have evaluated the frequency with which IIMs are encountered in this clinical scenario. The Vanderbilt Synthetic Derivative, a de-identified copy of over 2 million patient records, was searched to identify adult patients with a CK greater than 1000 IU/L who had been evaluated by a rheumatologist. Each patient was assigned a diagnosis using a pre-determined algorithm. The records were then reviewed for pertinent demographic data and clinical characteristics. A total of 192 patients were included for analysis. Of these patients, 105 (55 %) were diagnosed with an IIM. The non-IIM causes were drug/toxin exposure (n?=?16, 8 %), infection (n?=?12, 6 %), trauma (n?=?10, 5 %), myocardial injury (n?=?5, 3 %), hypothyroidism (n?=?4, 2 %), muscular dystrophy (n?=?4, 2 %), neuropsychiatric disorder (n?=?3, 2 %), metabolic myopathy (n?=?2, 1 %), idiopathic CK elevation (n?=?11, 6 %), and other diagnoses (n?=?20, 10 %). Several characteristics were found to be significantly different between IIM and non-IIM cases. In particular, patients with an IIM were more likely to be female, have a positive ANA, have interstitial lung disease, and have proximal, symmetric weakness. This study found that approximately half of patients referred to our division of rheumatology with a CK greater than 1000 IU/L were diagnosed with an IIM. Given the importance of prompt diagnosis and treatment of these disorders, rapid assessment by the consulting rheumatologist for these patients is recommended.     

Hepatosplenic Candidiasis,its Treatment and Effect on Remission Status in Patients with Acute Leukaemia—a Report of Five Cases

Hepatosplenic candidiasis is an increasingly encountered complication of treatment of patients with acute leukaemia [[1] Clin. Infect. Dis. 24 (1997) 375]. Management is difficult as delay in further chemotherapy may allow relapse of the leukaemia while the infection may progress if chemotherapy is continued [[2] Anticancer Res. 19 (1999) 757]. We report five cases of suspected hepatosplenic candidiasis in a single haematology unit over a 30-month period. All patients were treated with oral fluconazole following intravenous amphotericin or liposomal amphotericin B lipid complex. Chemotherapy was withheld during treatment of infection. Two patients remain in haematological remission despite suboptimal therapy for their leukaemia. One patient died from progressive fungal infection, 1 patient of cardiac disease and 1 patient has had recent relapse of their leukaemia. We demonstrate that hepatosplenic candidiasis may be treated with oral fluconazole while chemotherapy is discontinued and also suggest that this infection or its treatment may have had a beneficial immunomodulatory affect on the leukaemic process in the surviving patients.