RESUMEN
BACKGROUND: There has been little effective treatment in patients with cerebral infarction at >24 hours after onset. We assessed the effects of high-dose argatroban therapy in delayed administration, and investigated the mechanism based on our clinical findings. METHODS: Argatroban 30 mg was first administered for 15 minutes intravenously, and then 90 mg for 60 minutes followed by 60 mg for 60 minutes were infused continuously. The change of vascular obstruction caused by the treatment was assessed with magnetic resonance angiography. RESULTS: In 4 patients studied, high-dose argatroban resulted in 100% recanalization of occluded vessels (5/5), even though argatroban was administrated >24 hours after onset. On the other hand, when an inadequate dose of argatroban was administered, a hemorrhage was identified. This supports our hypothesis that high-dose argatroban promotes recanalization by deactivating thrombin and exerting an anticoagulant effect on the vascular endothelium. CONCLUSIONS: High-dose argatroban is an effective treatment for cerebral infarction and offers a novel therapeutic approach for delayed hospitalized patients at >24 hours after onset. Additional studies are necessary to identify the cellular and molecular mechanisms and determine the adequate dose in order to reduce risks of complication.
Asunto(s)
Antitrombinas/administración & dosificación , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Arteria Cerebral Media/efectos de los fármacos , Ácidos Pipecólicos/administración & dosificación , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Antitrombinas/efectos adversos , Arginina/análogos & derivados , Coagulación Sanguínea/efectos de los fármacos , Constricción Patológica , Esquema de Medicación , Femenino , Humanos , Infarto de la Arteria Cerebral Media/sangre , Infarto de la Arteria Cerebral Media/diagnóstico , Infusiones Intravenosas , Angiografía por Resonancia Magnética , Masculino , Arteria Cerebral Media/patología , Ácidos Pipecólicos/efectos adversos , Sulfonamidas , Factores de Tiempo , Resultado del TratamientoRESUMEN
Severe adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre-surgery MRI. No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra-abdominal adhesions.
RESUMEN
We evaluated clinical usefulness of MD online Image Match with the clinical images of 70 intracranial lesions. Total diagnostic accuracy and image similarity between the clinical image and search results was better with enhanced-T1WI. In all sequence, localization was matched precisely in more than 90% of cases. MDOL Image Match was thought to be useful for enhancing the quality of brain MRI diagnosis.