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1.
J Cardiothorac Vasc Anesth ; 29(3): 576-81, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25622973

RESUMO

OBJECTIVE: To investigate the impact of a sequence of educational interventions in a one-day course on focused transthoracic echocardiography (FOTE) by anesthesia and critical care practitioners. DESIGN: A prospective analysis of the educational data. SETTING: Educational setting in two academic medical centers and a medical meeting workshop organized by one of these institutions. PARTICIPANTS: Fifty-six anesthesia and critical care providers, divided into three groups, participated separately in a FOTE training course. INTERVENTIONS: All participants received a sequence of educational intervention as follows: A standardized, multiple-choice pretest; a lecture on cardiac and lung ultrasound; and a FOTE "hands-on" training session. The same standardized test was administered and graded as a posttest. MEASUREMENTS AND MAIN RESULTS: Fifty-six professionals attended the course in three separate groups: The first were cardiothoracic anesthesia fellows (n = 16) (group 1), the second included critical care practitioners (n = 21) (group 2), and the third were general anesthesiologists (n = 19) (group 3). Parasternal views were most difficult to obtain for all groups (58.1, 63.8, and 58%, respectively). The mean written test scores increased from 14.9±2 to 21.0±2.3 in group 1; from 12.3±3.8 to 19.2±3.7 in group 2; 12±3.5 to 21±2.4 in group 3, (p = 0.0003, 0.00005, 0.0001, respectively). CONCLUSIONS: A FOTE training course improves image acquisition skills and knowledge to the same level independently of professional background and level of experience in critical care ultrasound.


Assuntos
Anestesiologia/educação , Cuidados Críticos/métodos , Ecocardiografia , Cirurgia Torácica/educação , Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Competência Clínica , Avaliação Educacional , Humanos , Internato e Residência , Modelos Anatômicos , Estudos Prospectivos , Cirurgiões , Ultrassonografia de Intervenção
2.
Arterioscler Thromb Vasc Biol ; 27(2): 387-93, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17138936

RESUMO

OBJECTIVE: To determine the accuracy of detection of different tissue types of intravascular ultrasound-virtual histology (IVUS-VH) in a porcine model of complex coronary lesions. METHODS AND RESULTS: Coronary lesions were induced by injecting liposomes containing human oxidized low-density lipoprotein into the adventitia of the arteries. IVUS-VH imaging was performed in vivo at 8.2+/-1.6 weeks after injection. A total of 60 vascular lesions were analyzed and compared with their correspondent IVUS-VH images. Correlation analysis was performed using linear regression models. Compared with histology, IVUS-VH correctly identified the presence of fibrous, fibro-fatty, and necrotic tissue in 58.33%, 38.33%, and 38.33% of lesions, respectively. The sensitivity of IVUS-VH for the detection of fibrous, fibro-fatty, and necrotic core tissue was 76.1%, 46%, and 41.1% respectively. A linear regression analysis performed for each individual plaque component did not show strong correlation that would allow significant prediction of individual values. CONCLUSIONS: In a porcine model of complex coronary lesions, IVUS-VH was not accurate in detecting the relative amount of specific plaque components within each individual corresponding histological specimen.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Ultrassonografia de Intervenção/métodos , Interface Usuário-Computador , Animais , Estenose das Carótidas/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Modelos Animais de Doenças , Técnicas Histológicas/métodos , Imuno-Histoquímica , Modelos Lineares , Lipossomos , Variações Dependentes do Observador , Sensibilidade e Especificidade , Suínos
3.
Heart Lung ; 47(6): 622-625, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29903639

RESUMO

OBJECTIVE: To describe a focused transthoracic echocardiography (FoTE) curriculum for advanced practice providers (APPs) for echocardiography-driven diagnosis of shock in critically ill patients. METHODS: Twelve APPs in 4 intensive care units at an academic medical center received didactic sessions on FoTE, including 1-on-1 proctorship with a registered cardiac sonographer. For a period of 6 months the trainees performed individual studies, then they performed FoTE examinations on critically ill patients; their diagnoses were compared with those of experienced intensivists for the same patients. RESULTS: After 6 months of multiple steps of training, APPs could acquire good echocardiographic views, achieving a good inter-rater agreement (Cohen's κ of 0.745 [95% CI, 0.385-1.0; P < .01]) in the diagnosis of shock when compared to experienced intensivists. CONCLUSIONS: Structured FoTE curriculum enables APPs to have reasonably good diagnostic concordance with intensivists in an echocardiography-driven diagnosis of shock in critically ill patients.


Assuntos
Ecocardiografia/normas , Educação Médica Continuada , Estado Terminal , Currículo , Humanos , Unidades de Terapia Intensiva , Estudos Longitudinais , Estudos Prospectivos
4.
Am Heart J ; 154(4): 694.e1-7, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17892993

RESUMO

BACKGROUND: Clopidogrel inhibits the platelet P2Y12 receptor, leading to increased intracellular cyclic AMP (cAMP) levels. Caffeine also causes a rise in platelet cAMP. We aimed to test the effect of acute caffeine administration on platelet inhibition by clopidogrel, in healthy volunteers and patients with coronary artery disease. METHODS: Cohort 1: 12 healthy subjects were enrolled in a 2-week crossover study. Blood samples were drawn at baseline, 2, 4, and 24 hours after 300 mg clopidogrel intake. At the first week, 6 subjects received caffeine (300 mg pill, equivalent to a medium sized coffee drink) 30 minutes after clopidogrel. At week 2, the other 6 subjects received caffeine. One month later the effect of caffeine alone was tested. Platelet function was evaluated by aggregation in response to 5, 10, and 20 micromol/L adenosine diphosphate, 1 microg/mL collagen, and flow cytometric determination of P-selectin expression, PAC-1 binding, and vasodilator-stimulated phosphoprotein phosphorylation. Cohort 2: 40 patients with coronary artery disease receiving aspirin and clopidogrel (75 mg daily) for > or = 1 week were tested at baseline and 2.5 hours after caffeine (300 mg). RESULTS: In cohort 1 (crossover study), caffeine was associated with lower adenosine diphosphate-induced aggregation at 4 hours, lower activation markers at 2 hours, and lower vasodilator-stimulated phosphoprotein phosphorylation at 4 hours after clopidogrel. Caffeine alone had no effect on the assessed platelet surface biomarkers. In cohort 2, caffeine administration was associated with lower platelet activation markers (P-selectin, PAC-1 binding), without significant effect on aggregation. CONCLUSIONS: Acute caffeine administration after clopidogrel loading appears to be associated with enhanced platelet inhibition 2 to 4 hours after clopidogrel intake. The mechanism probably involves synergistic increase in cAMP levels.


Assuntos
Cafeína/farmacologia , Inibidores de Fosfodiesterase/farmacologia , Inibidores da Agregação Plaquetária/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Ticlopidina/análogos & derivados , Adulto , Idoso , Clopidogrel , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estudos Cross-Over , Sinergismo Farmacológico , Feminino , Humanos , Hidrazonas/sangue , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Piperazinas/sangue , Testes de Função Plaquetária , Receptor A2A de Adenosina/efeitos dos fármacos , Ticlopidina/farmacologia
5.
EuroIntervention ; 5(8): 981-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20542785

RESUMO

AIMS: There is little in vivo data in regards to the impact of adventitial neovascularisation on vascular remodelling and plaque composition. Using a porcine model of coronary atherosclerosis, we aimed to determine the impact of adventitial neovascularisation on plaque composition and vascular remodelling evaluated by IVUS. METHODS AND RESULTS: Coronary atherosclerosis was induced by adventitial delivery of lipids and a high cholesterol diet. At termination all vessels were analysed using IVUS to determine the degree of remodelling of each individual segment containing atherosclerotic lesions. Then, each segment was correlated with its correspondent histological frame for plaque composition and neovessel density. A total of 57 atherosclerotic lesions at different stages of development were analysed. The total neovessel count (TNC) correlated to the degree of plaque burden (15.6+/-7.2 TNC in <40% stenosis versus 35.7+/-14.0 TNC in >60% stenosis, p<0.01) and to the amount of intra-plaque collagen (32.4+/-14.1%, lower TNC tertile versus 47.5+/-8.9% upper TNC tertile, p< 0.01). The amount of intra-plaque SMC content inversely correlated with the TNC (49.7+/-18.9% versus 36.4+/-14.4%, lower versus upper tertiles, p<0.05). Plaques with the highest TNC showed higher remodelling indexes by IVUS (0.89+/-0.32 in lower TNC tertile versus 1.36+/-0.73 in upper TNC tertile, p<0.05) and higher macrophage cell content (161.42+/-157.6 in lower TNC tertile versus 340.6+/-127.2 in upper TNC tertile, p<0.05) compared to non-remodelled segments. CONCLUSIONS: Adventitial neovascularisation is more prominent in positively remodelled segments and appears to be associated to SMC loss, increase collagen deposition and localised macrophage infiltration.


Assuntos
Tecido Conjuntivo/irrigação sanguínea , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Neovascularização Patológica/fisiopatologia , Animais , Colágeno/metabolismo , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/metabolismo , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/metabolismo , Modelos Animais de Doenças , Progressão da Doença , Imuno-Histoquímica , Macrófagos/patologia , Miócitos de Músculo Liso/patologia , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/metabolismo , Índice de Gravidade de Doença , Suínos , Ultrassonografia de Intervenção
6.
J Thromb Thrombolysis ; 24(1): 15-21, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17277998

RESUMO

BACKGROUND: Recent data indicate that among patients undergoing percutaneous coronary intervention low platelet response to aspirin is associated with clopidogrel low response. It is unclear whether these findings extend to other patient populations. We, therefore, aimed to evaluate the relation between response to aspirin and clopidogrel among patients scheduled to undergo cardiac or vascular surgery. METHODS: Patients who were scheduled for cardiac or vascular surgery and had taken aspirin 81-325 mg daily for at least a week and clopidogrel 75 mg daily for at least 3 days underwent blood testing for platelet function. One hundred patients were included in the current analysis. Platelet function was evaluated by the modified TEG platelet mapping assay with addition of ADP or arachidonic acid (AA), and by the PFA-100 assay with collagen-epinephrine (CEPI) or collagen-ADP (CADP) cartridges. Low response to aspirin or clopidogrel was defined as inhibition < or =20% for TEG-AA or TEG-ADP, respectively. RESULTS: Thirteen patients (13%) were low responders to aspirin and 34 (34%) were low responders to clopidogrel. Eight patients were low responders to both drugs. There were no differences in clinical characteristics between drug low responders versus sensitive patients. Aspirin low responders had lower TEG-ADP inhibition (19.5 +/- 6 vs. 35.8 +/- 3%, P = 0.03) and tended to have lower PFA-CADP time (84.7 +/- 7 vs. 105.6 +/- 5 s, P = 0.1) than aspirin sensitive patients. Clopidogrel low responders had lower TEG-AA inhibition (58 +/- 6 vs. 75.1 +/- 4%, P = 0.01) and PFA-CEPI time (168 +/- 13 vs. 200.4 +/- 10 s, P = 0.07) than clopidogrel sensitive patients. CONCLUSIONS: In patients scheduled to undergo cardiovascular surgery low response to aspirin is associated with low response to clopidogrel.


Assuntos
Aspirina/uso terapêutico , Doenças Cardiovasculares/cirurgia , Inibidores da Agregação Plaquetária/uso terapêutico , Ticlopidina/análogos & derivados , Idoso , Aspirina/sangue , Clopidogrel , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/sangue , Contagem de Plaquetas , Cuidados Pré-Operatórios , Ticlopidina/sangue , Ticlopidina/uso terapêutico , Resultado do Tratamento
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