RESUMO
Polymorphisms of receptors involved in platelet adhesion and aggregation modulate platelet thrombogenicity and were found to predispose to premature arterial thromboses in individuals at risk. In our current study, we assessed the potential relevance of prothrombotic platelet receptor polymorphisms for the pathogenesis of acute coronary stent thrombosis. Comparing the genotype prevalences of respective polymorphisms in patients with acute coronary stent thrombosis and healthy control subjects, our data do not indicate an increased risk of carriers of prothrombotic variants of platelet receptors for this complication. Other factors such as the remodelling process and antiplatelet medication appear to be more relevant in this clinical setting. Along with our findings, screening for respective polymorphisms for risk assessment prior to coronary stenting is not indicated.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Trombose Coronária/genética , Predisposição Genética para Doença , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/genética , Polimorfismo Genético , Stents/efeitos adversos , Doença Aguda , Idoso , Angioplastia Coronária com Balão/métodos , Estudos de Coortes , Reestenose Coronária/epidemiologia , Reestenose Coronária/genética , Estenose Coronária/terapia , Trombose Coronária/epidemiologia , Feminino , Seguimentos , Genótipo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Whereas Health Care Ethics Committees (HECs) are well established in the USA, they are still an exception in Germany. In this study, the authors report of the implementation of an HEC at the SLK Hospital Heilbronn, Germany, and discuss the further development within the first 2 years. IMPLEMENTATION AND PROJECTS: After a 1-year preparatory period the official establishment of the HEC followed in March 2004. The hospital management was implicated in the implementation from the beginning. 17 HEC members were recruited proportionally to the own four hospital locations. An ethics forum existing besides the HEC represents an institution open to all clinic employees. After training of moderators with a specially developed training concept, an individual case consultation was established. In a next step, working groups were founded for the projects "advance directive", "dying in hospital", "limitation of treatment" and "patient advocate" in order to develop guidelines. Education in ethics is offered in the ethics forum. CONCLUSION: This report elucidates that a great readiness of committee members and a tight integration of the clinic management are essential for a successful establishment of an HEC. The structure converted within the authors' HEC permits a discussion of ethical problems beyond existing hierarchies and occupational groups. In this new institution the authors see a great potential for improvement in dealing with ethical problems within the hospital.
Assuntos
Comitês de Ética Clínica/organização & administração , Diretivas Antecipadas/ética , Comitês de Ética Clínica/tendências , Alemanha , Humanos , Capacitação em Serviço/organização & administração , Cuidados Paliativos/ética , Defesa do Paciente/ética , Encaminhamento e Consulta/organização & administração , Assistência Terminal/éticaRESUMO
CASE REPORT: A 39-year-old man was admitted to our intensive care unit after successful resuscitation because of ventricular fibrillation with clinical and electrographic signs of acute myocardial infarction. Coronary angiography showed normal coronary arteries. MINC syndrome (myocardial infarction with angiographically normal coronary arteries) was due to a severe proximal spontaneous spasm of the left anterior descending artery (LAD). Intracoronary ultrasound imaging demonstrated an eccentric fibrous plaque in the proximal segment of LAD and a fibrofatty plaque distal to the spastic segment. At the time of electrophysiologic study, the patient was noninducible. After starting therapy with calcium antagonist, nitrate and molsidomine, the patient was stable and symptom-free. CONCLUSION: Coronary spasm without significant organic stenosis is an important cause of sudden cardiac arrest and MINC syndrome. Because of the good prognosis under adequate treatment, exact diagnosis is important in the prevention of sudden death.