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Opinion statement |
相似文献
– | To date, there are no evidence-based data to support specific drug therapy for a patient with atheroembolism. It makes sense to use HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) in any patient with atherosclerosis, as these drugs have been shown to reduce the risk of myocardial infarction and stroke, and have a theoretical benefit on plaque stabilization. Surgical treatment should be considered for patients with abdominal aortic or popliteal artery aneurysms and downstream atheroembolism. There are case reports of atheroemboli in patients worsening after given warfarin or heparin. For this reason, some institutions are reluctant to prescribe these drugs for patients with atheroemboli or thromboemboli from aortic plaque. However, the incidence of this complication is quite low. Anticoagulation probably should be stopped if a patient develops atheroembolism. |
– | Similarly, the current state of knowledge does not allow for selecting specific pharmacologic intervention in patients with thromboemboli from aortic plaque. Statin therapy does make sense, as these drugs theoretically stabilize plaques and prevent plaque hemorrhage, thrombosis, and subsequent embolization. Unstable aortic plaques may develop superimposed thrombi (red thrombi on pathologic examination), easily seen as mobile elements on transesophageal echocardio-graphy. Therefore, it is possible that anticoagulation with warfarin might prevent embolic events in these patients. For this reason, we are often in the position of recommending warfarin therapy for patients with emboli and severe atheromas seen on transesophageal echocardiography, especially when superimposed mobile thrombi are seen. There are small series in the literature that indicate the potential benefit of warfarin. However, until a large multicenter randomized clinical trial is done, the use of warfarin can not be definitively recommended. Antiplatelet agents, although safer than warfarin (less risk of hemorrhage), have not been proven beneficial in patients with thromboembolism from the aorta. Surgery (endarterectomy) of the aortic arch is a very risky procedure that should not be performed routinely, but may be used in highly selected patients. |
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Maharshak N Arbel Y Gal-Oz A Rogowski O Shapira I Berliner S Vered Y Canaani J Dotan I 《Journal of digestive diseases》2008,9(3):140-143
OBJECTIVE: The recently introduced Bayer wide‐range C‐reactive protein (wr‐CRP) assay might be relevant for the real‐time low‐cost and online determination of inflammatory bowel disease (IBD) activity. Our aim was to examine whether wr‐CRP can substitute for the Dade Behring high sensitivity C‐reactive protein (hs‐CRP) assay in IBD patients. METHODS: A total of 71 patients with IBD, of whom 48 had Crohn's disease CD and 23 had ulcerative colitis (UC) with various intensities of disease activity participated in the study. The CRP of patients who were under treatment at the Department of Gastroenterology and Liver Diseases were measured using both wr‐CRP and the hs‐CRP. RESULTS: A significant (r = 0.995; P < 0.001) correlation was noted between the hs‐CRP and wr‐CRP measurements for the whole sample as well as for the two diseases, CD (r = 0.994; P < 0.001) and UC (r = 0.997; P < 0.001), which were analyzed separately. CONCLUSION: The Bayer wr‐CRP assay might be a useful low‐cost and real‐time inflammation‐sensitive biomarker in patients with IBD. 相似文献
15.
Itzhak Brook Hannah M. Wexler Ellie J. C. Goldstein 《Clinical microbiology reviews》2013,26(3):526-546
SUMMARY
Susceptibility testing of anaerobic bacteria recovered from selected cases can influence the choice of antimicrobial therapy. The Clinical and Laboratory Standards Institute (CLSI) has standardized many laboratory procedures, including anaerobic susceptibility testing (AST), and has published documents for AST. The standardization of testing methods by the CLSI allows comparisons of resistance trends among various laboratories. Susceptibility testing should be performed on organisms recovered from sterile body sites, those that are isolated in pure culture, or those that are clinically important and have variable or unique susceptibility patterns. Organisms that should be considered for individual isolate testing include highly virulent pathogens for which susceptibility cannot be predicted, such as Bacteroides, Prevotella, Fusobacterium, and Clostridium spp.; Bilophila wadsworthia; and Sutterella wadsworthensis. This review describes the current methods for AST in research and reference laboratories. These methods include the use of agar dilution, broth microdilution, Etest, and the spiral gradient endpoint system. The antimicrobials potentially effective against anaerobic bacteria include beta-lactams, combinations of beta-lactams and beta-lactamase inhibitors, metronidazole, chloramphenicol, clindamycin, macrolides, tetracyclines, and fluoroquinolones. The spectrum of efficacy, antimicrobial resistance mechanisms, and resistance patterns against these agents are described. 相似文献16.
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192Ir sources have been widely used in clinical brachytherapy. An important challenge is to perform dosimetric measurements close to the source despite the steep dose gradient. The common, inexpensive silver halide film is a classic two-dimensional integrator dosimeter and would be an attractive solution for these dose measurements. The main disadvantage of film dosimetry is the film response to the low-energy photon. Since the photon energy spectrum is known to vary with depth, the sensitometric curves are expected to be dependent on depth. The purpose of this study is to suggest a correction method for silver halide film dosimetry that overcomes the response changes at different depths. Sensitometric curves have been obtained at different depths with verification film near a 1 Ci 192Ir pulsed-dose-rate source. The depth dependence of the film response was observed and a correction function was established. The suitability of the method was tested through measurement of the radial dose profile and radial dose function. The results were compared to Monte Carlo-simulated values according to the TG43 formalism. Monte Carlo simulations were performed separately for the beta and gamma source emissions, using the EGS4 code system, including the low-energy photon and electron transport optimization procedures. The beta source emission simulation showed that the beta dose contribution could be neglected and therefore the film-depth dependence could not be attributed to this part of the source radioactivity. The gamma source emission simulations included photon-spectra collection at several depths. The results showed a depth-dependent softening of the photon spectrum that can explain the film-energy dependence. 相似文献
19.
Itzhak Shapira MD ; Amos Pines MD ; Rephael Mohr MD 《The American journal of geriatric cardiology》2001,10(4):199-206
This review of the literature is presented in an attempt to keep pace with the constantly changing statistics in postsurgical outcomes, which reflect the considerable strides in technology and technical skills that have been made during the past decade in cardiovascular surgery. Although there is still much to be done in terms of improving surgical techniques and managing emergency cases, the reported results of coronary artery bypass grafting in octogenarians are similar to or even better than those obtained with medical or angioplastic approaches, and the life expectancy and quality of life are similar to or better than those of age-matched controls. 相似文献
20.
Yaron Arbel Amir Sternfeld Adiel Barak Zvia Burgansky-Eliash Amir Halkin Shlomo Berliner Itzhak Herz Gad Keren Ardon Rubinstein Shmuel Banai Ariel Finkelstein 《Atherosclerosis》2014