Initial experience with the use of intravenous eptifibatide bolus during endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE: Despite systemic heparinization, thromboembolic complications remain a major concern related to endovascular treatment of intracranial aneurysms. We assessed the safety of intravenous eptifibatide administered during aneurysm coiling procedures to prevent such complications. METHODS: From August 2001 to November 2004, 298 coil embolization procedures were performed to treat intracranial aneurysms; eptifibatide was used in 84 endovascular coil embolization procedures to treat 79 aneurysms in 74 patients. We retrospectively reviewed medical charts, radiographic images, and procedure notes to evaluate periprocedural complications related to eptifibatide. RESULTS: The mean age of the 74 patients in our cohort was 55 +/- 9 years (range, 31-84) harboring 79 aneurysms (32 ruptured/47 unruptured). Eptifibatide was given prophylactically in 77 procedures, whereas in 7 procedures, it was given for treatment of a thromboembolic event (visualization of an arterial branch occlusion). A total of 5 (5.9% [total cohort]) bleeding complications related to eptifibatide occurred during 84 procedures. Two patients (2.4% [total cohort]/6.3% [ruptured group]) developed intracerebral hemorrhagic complications exacerbated by eptifibatide. The other 3 (3.6% [total cohort]) patients had groin hematomas requiring blood transfusions but had no surgical intervention. One thromboembolic event occurred in the 77 patients receiving eptifibatide prophylactically. CONCLUSIONS: Intravenous infusion of eptifibatide seems to be safe to administer in patients undergoing endovascular repair of an unruptured cerebral aneurysm. Caution must be used in patients harboring ruptured aneurysms as intracranial bleeding complications may occur. Further study is required to delineate the group of patients most likely to benefit from this therapy.     

Single Nucleotide Polymorphism-Based Noninvasive Prenatal Testing: Experience in India

Introduction

Noninvasive prenatal testing (NIPT) has revolutionized prenatal screening for chromosomal aneuploidies in some countries. Its implementation has been sporadic in developing countries. Given the genetic variation of the people in different countries, we evaluated the performance of the SNP-based NIPT in India .

Materials and Methods

The Panorama? NIPT was performed in 516 pregnancies, which had tested intermediate-to-high risk on conventional first and second trimester screening. Results were confirmed either by invasive diagnostic testing or by clinical evaluation after birth.

Results

Of 511 samples analyzed, results were obtained in 499 (97.7%). Of these, 480 (98.2%) were low risk and 19 were high risk. A sensitivity of 100% was obtained for detection of trisomies 21, 18, 13 and sex chromosomal abnormalities. The specificity ranged from 99.3 to 100% for abnormalities tested. Taken together, the positive predictive value for trisomies 21, 18, 13 and monosomy X was 85.7%. The average fetal fraction was 8.2%, which is lower than the average observed elsewhere.

Conclusion

This is the first report of detailed experience with NIPT in India and demonstrates comparable performance in all aspects of testing to the results elsewhere.

     

Cytokines and anti-cytokines as therapeutics--an update

Cytokines which comprise of a family of proteins--interleukins, lymphokines, monokines, interferons, and chemokines, are important components of the immune system. They act in concert with specific cytokine inhibitors and soluble cytokine receptors to regulate the human immune response. Their physiologic role in inflammation and pathologic role in systemic inflammatory states are now well recognized. An imbalance in cytokine production or cytokine receptor expression and/or dysregulation of a cytokine process contributes to various pathological disorders. Research is progressing rapidly in the area of cytokines and their therapeutic targets, the two major therapeutic modalities being the administration of purified recombinant cytokines and the use of their antagonists in various inflammatory disorders. However, given the large number of cytokines, it is disappointing that only relatively few can be used clinically. In the present article, we have made an attempt to review and present a glimpse of the history as well as up to date information that is pertinent to cytokines and anti-cytokine therapies in the treatment of cancer, autoimmune disorders and various other related diseases.     

Sonographic intraperitoneal fluid in patients with pelvic fracture: two cases of traumatic intraperitoneal bladder rupture

Two patients who presented to the Emergency Department (ED) in shock with severe pelvic fractures were evaluated for intra-abdominal injury with a focused assessment with sonography in trauma (FAST) examination. Free intraperitoneal fluid was identified in the hepato-renal recess of both patients. At laparotomy both patients were found to have extensive uroperitoneum resulting from intraperitoneal bladder rupture and no other intra-abdominal injuries. The source of shock in both cases was ultimately determined to be arterial hemorrhage from pelvic vessels. The utility of FAST examinations in the setting of major pelvic injury is relatively unstudied. Coincident injuries make the evaluation for source of hemorrhage in this subset of patients challenging. This is a report of sonographic intraperitoneal fluid in the setting of major pelvic injury and hemodynamic instability found to be uroperitoneum and not hemoperitoneum.