Unlike lymphodepletion, a decrease in platelet count following induction immunosuppressive therapy with polyclonal rabbit antithymocyte globulin (rATG) is deemed as an adverse event. However, this ...phenomenon may represent a particular rATG antirejection mechanism.
This retrospective single-center study included 156 patients who received a heart transplant (HTx) between 2010 and 2018. All patients received rATG induction therapy for 5 days. Absolute lymphocyte count (ALC) and platelet counts were assessed on days 0, 7, and 14 following HTx. The primary outcome of the study was the first occurrence of acute cellular rejection (ACR) defined as grade ≥ 1B within 24 months after HTx.
Both ALC and platelet counts decreased rapidly after induction. During the 24-month follow-up period, 17% of patients had ACR. Patients with ACR had significantly higher platelet count on day 7 (145 vs 104, P < .001) and higher ALC on day 14 (162 vs 130, P = .035) than those without rejection. Patients in the highest platelet count quartile showed more ACR (50% in quartile 4 vs 0% in quartile 1, P = .006) as well as a higher cumulative total rejection score. Univariate analysis showed that ACR was associated with platelet count on day 7, recipient age, and pretransplant cytomegalovirus IgG serology. In multivariable regression analysis, platelet count on day 7 was the most accurate predictor of ACR.
Lower platelet count after induction with rATG is associated with less ACR. This suggests platelet involvement in antirejection mechanisms of rATG and a possible rationale for targeting platelets in future immunosuppressive strategies.
•Platelet count after rabbit antithymocyte globulin induction is associated with heart transplant rejection.•Lower platelet count on day 7 but not day 14 is related to less allograft rejection.•This indicates platelet involvement in alloimmunity early after transplant.
Umjerenost u svemu – sportsko srce Reschner, Ana; Jakuš, Nina; Fabijanović, Dora ...
Medicus (Zagreb, Croatia : 1992),
10/2019, Letnik:
28, Številka:
2 Tjelesna aktivnost
Journal Article
Recenzirano
Odprti dostop
Brojna klinička istraživanja dokazala su jasne koristi tjelesne aktivnosti za kardiovaskularno, ali i opće zdravlje svakoga čovjeka. Tjelesna aktivnost izaziva fiziološki odgovor organizma koji ...dovodi do različitih prilagodba pojedinih organskih sustava, a primjer jedne od njih jest i sportsko srce – benigni i reverzibilni odgovor kardiovaskularnog sustava na ponavljanu i intenzivnu tjelesnu aktivnost. Neke bolesti miokarda mogu dijeliti slične elektrokardiografske, ehokardiografske i druge karakteristike sa sportskim srcem. Pravodobno prepoznavanje takvih bolesti ključno je za zaštitu zdravlja svih koji se bave intenzivnijom tjelesnom aktivnosti rekreativno ili profesionalno.
Background: Medicor was established as the third cardiovascular center in Slovenia and started with percutaneous cardiovascular interventions in 2005. The purpose of our study was to describe the ...features and results of percutaneous coronary intervention (PCI) performed between 2005 and 2015.Methods: Our retrospective descriptive study included consecutive patients undergoing PCI, who were enrolled in the PCI Registry. Patient characteristics, coronary anatomy, PCI features, use of coronary stents, procedural success and complications were investigated. Special emphasis was put on patients undergoing unprotected left main PCI.Results: During the study period, 1981 PCI procedures were performed. PCI patients were mainly men (73 %), their average age was 65+10 years and a majority (94 %) had stable coronary disease with mutivessel involvement (62 %). PCI was performed on 2978 lesions (1.50 lesion/patient) with an average diameter stenosis of 85+10 %. Target lesion was located either in the left anterior descending artery (42.9 %), right coronary artery (32.4 %), left circumflex artery (18.4 %), left main (3 %), surgical grafs (2.3 %) or in the intermediate artery (1 %). Balloon angioplasty alone was used in 9.6 % while other patients received 1 to 7 stents (1.44+0.86 per patient). Until 2009, drug eluting stents (DES) penetration ranged between 20 % and 30 %. It then increased to 80 % in 2012 and 100 % in 2015. PCI was angiographically successful in 95.2 %. Because of PCI complications, 4 patients (0.2 %) required immediate open-heart surgery and 4 patients (0.2 %) a surgical intervention at the femoral access site. Hospital mortality was 0 %. Stent thrombosis within 30 days was documented in 6 patients (0.3 %). In a subgroup of 58 patients undergoing unprotected lef main PCI, provisional stenting was used in 88 %. DES penetration was 94 %. PCI was angiografcally successful in all patients. Hospital and 30-day mortality rates were 0 %, 1-year mortality 1.7 % (95 % confidence interval 0–11 %) and 5-year mortality 13.8 % (95 % confidence interval 7–33 %). Target vessel revascularization at 5 years was 3.5 % (95 % confidence interval 0–23 %).Conclusion: PCI in patients with predominantly stable coronary artery disease in the Medicor Cardiovascular Center appears to be an effective and safe method of revascularization, which is also true for an intervention in unprotected left main.
Background: Medicor was established as the third cardiovascular center in Slovenia and started with percutaneous cardiovascular interventions in 2005. The purpose of our study was to describe the ...features and results of percutaneous coronary intervention (PCI) performed between 2005 and 2015.Methods: Our retrospective descriptive study included consecutive patients undergoing PCI, who were enrolled in the PCI Registry. Patient characteristics, coronary anatomy, PCI features, use of coronary stents, procedural success and complications were investigated. Special emphasis was put on patients undergoing unprotected left main PCI.Results: During the study period, 1981 PCI procedures were performed. PCI patients were mainly men (73 %), their average age was 65+10 years and a majority (94 %) had stable coronary disease with mutivessel involvement (62 %). PCI was performed on 2978 lesions (1.50 lesion/patient) with an average diameter stenosis of 85+10 %. Target lesion was located either in the left anterior descending artery (42.9 %), right coronary artery (32.4 %), left circumflex artery (18.4 %), left main (3 %), surgical grafs (2.3 %) or in the intermediate artery (1 %). Balloon angioplasty alone was used in 9.6 % while other patients received 1 to 7 stents (1.44+0.86 per patient). Until 2009, drug eluting stents (DES) penetration ranged between 20 % and 30 %. It then increased to 80 % in 2012 and 100 % in 2015. PCI was angiographically successful in 95.2 %. Because of PCI complications, 4 patients (0.2 %) required immediate open-heart surgery and 4 patients (0.2 %) a surgical intervention at the femoral access site. Hospital mortality was 0 %. Stent thrombosis within 30 days was documented in 6 patients (0.3 %). In a subgroup of 58 patients undergoing unprotected lef main PCI, provisional stenting was used in 88 %. DES penetration was 94 %. PCI was angiografcally successful in all patients. Hospital and 30-day mortality rates were 0 %, 1-year mortality 1.7 % (95 % confidence interval 0–11 %) and 5-year mortality 13.8 % (95 % confidence interval 7–33 %). Target vessel revascularization at 5 years was 3.5 % (95 % confidence interval 0–23 %).Conclusion: PCI in patients with predominantly stable coronary artery disease in the Medicor Cardiovascular Center appears to be an effective and safe method of revascularization, which is also true for an intervention in unprotected left main.
Uvod: Medicor je kot tretji kardiovaskularni center v Sloveniji pričel izvajati interventno kardiovaskularno dejavnost v letu 2005. Namen prispevka je prikazati izkušnje s perkutano koronarno ...intervencijo (PCI) med letoma 2005 in 2015. Metode: Opravili smo retrospektivno raziskavo na zaporednih bolnikih, ki smo jih uvrstili v register PCI. Poleg splošnih značilnosti bolnikov in koronarne anatomije so nas zanimale značilnosti PCI, uporaba žilnih opornic, uspeh PCI in zapleti. Posebej smo obdelali bolnike s PCI na nezaščitenem deblu leve koronarne arterije, ki smo ga opredelili kot pomembno stenozo ob odsotnosti vsaj enega prehodnega kirurškega obvoda. Izsledki: V opazovanem obdobju smo opravili 1.981 PCI. Med bolniki so prevladovali moški (73 %), povprečna starost je bila 65+10 let, večina bolnikov (94 %) pa je imela stabilno koronarno bolezen z večžilno prizadetostjo (62 %). PCI smo opravili na 2.978 stenozah (1,50 stenoze/bolnika) s povprečno zožitvijo 85+10 %. Tarčna sprememba je bila bodisi na levi descendentni koronarni arteriji (42,9 %), desni koronarni arteriji (32,4 %), levi cirkumfleksni arteriji (18,4 %), deblu leve koronarne arterije (3 %), na kirurških obvodih (2,3 %) ali na intermediarni arteriji (1 %). Samo balonsko dilatacijo smo uporabili v 9,6 %, pri ostalih bolnikih pa smo vstavili 1–7 kovinskih žilnih opornic (1,44+0,86/ bolnika). Do leta 2009 je delež žilnih opornic, prevlečenih s citostatikom (DES), znašal 20–30 %, v letu 2012 je porastel na 80 %, v letu 2015 pa na 100 %. PCI je angiografsko uspela v 95,2 %. Zaradi zapleta so 4 bolniki (0,2 %) potrebovali urgentno srčno operacijo, 4 bolniki (0,2 %) pa operacijo na vbodnem mestu. Bolnišnična umrljivost je znašala 0 %. Trombozo žilne opornice v prvih 30 dneh smo ugotovili pri 6 bolnikih (0,3 %). V podskupini 58 bolnikov s PCI nezaščitene stenoze debla leve koronarne arterije smo v 88 % uporabili tehniko s samo eno žilno opornico. Delež DES je bil 94 %. PCI je uspela pri vseh bolnikih. Bolnišnična in 30-dnevna umrljivost sta bili 0 %, enoletna 1,7 % (95-odstotni interval zaupanja 0–11 %), 5-letna pa 13,8 % (95-odstotni interval zaupanja 7–33 %). Potreba po ponovni revaskularizaciji v 5-letnem obdobju je znašala 3,5 % (95-odstotni interval zaupanja 0–23 %). Sklep: PCI pri bolnikih s pretežno stabilno koronarno boleznijo je v Medicorju učinkovita in varna metoda revaskularizacije, kar velja tudi za poseg na nezaščitenem deblu leve koronarne arterije.
U bolesnika s kroničnom limfoproliferativnom bolesti (LPB) veća je učestalost nastanka sekundarnih neoplazma. Istodobna pojava limfoproliferativne neoplazme (LPN) i mijelodisplastičnog sindroma (MDS) ...vrlo je rijetka. Druga hematološka neoplazma dijagnosticira se slučajno tijekom kontrola ili pri dodatnim analizama zbog
nesukladnih kliničkih ili laboratorijskih nalaza. Prikazujemo dijagnostički postupak, tijek bolesti i liječenje 65-godišnje bolesnice s kroničnom limfoproliferativnom neoplazmom i MDS-om sa suviškom blasta tipa 2
(MDS-EB2). Vodeći nalaz bila je neutropenija, a tek su citološkim analizama koštane srži i periferne krvi dijagnosticirane navedene neoplazme. Liječenje jedne i druge hematološke neoplazme nije dalo zadovoljavajuće rezultate i MDS je progredirao u akutnu mijeloičnu leukemiju. U bolesnika s limfoproliferativnom neoplazmom i citopenijom
valja tragati za mogućim drugim uzrocima takvih aberantnih nalaza. Pri liječenju tih bolesnika razumno je liječiti dominantnu bolest.
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