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Early identification of culprit drugs is crucial for the treatment and prevention of severe drug eruptions.At present,no accurate and effective methods are available for identifying the culprit drugs in severe drug eruptions.Commonly used tests include patch test,lymphocyte transformation test and so on.However,low sensitivity and specificity limit their clinical application.Enzyme-linked immunospot assay,an in vitro technique,can identify culprit drugs in cutaneous adverse drug reactions by detecting cytokines secreted by drug-specific T lymphocytes.It has high sensitivity and specificity in patients with severe drug eruptions,and can be carried out during the acute stage of disease or among immunocompromised patients.Therefore,enzyme-linked immunospot assay may be an effective method for identifying culprit drugs in severe drug eruptions.
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Morbidity and mortality rates associated with acute myocardial infarction accompanying chronic total occlusion are comparatively high. European guidelines recommend primary intervention for the causative lesion in patient with acute myocardial infarction. Therefore, it is important to identify the culprit lesion. We report two cases of myocardial infarction with concurrent chronic total occlusion in an emergency setting.
Subject(s)
Humans , Emergencies , Mortality , Myocardial Infarction , Percutaneous Coronary InterventionABSTRACT
Food allergy (FA) has become more common in recent decades, and it is a serious health problem in children. FA is divided into immunoglobulin E (IgE)-mediated and non-IgE-mediated FA based on its mechanism. FA most often develops early in life, affecting up to 10% of children, and increasing concerns have been raised regarding severe FA including food-induced anaphylaxis, especially in young children. The 2 most common food allergens worldwide are milk and eggs, while the third most common allergen varies among countries. In addition to a detailed and convincing history of diverse symptoms (involving the skin, gastrointestinal, respiratory, cardiovascular, and neurologic systems) after exposure to culprit foods, the following tools can be useful in the diagnosis of FA: the skin prick test, measurement of serum food-specific IgE antibodies, and the elimination or provocation test with suspected foods. The current recommended management of FA relies on the strict avoidance of causative foods; the immediate treatment of allergic reactions, including epinephrine use for food-induced anaphylaxis; and education to prevent further reactions. Emerging approaches for tolerance induction to FA, such as food immunotherapy, have been investigated, but concrete evidence for clinical application is lacking. This review presents a detailed overview of the pathogenesis of FA, its prevalence, common culprit foods, and its diagnosis and management, and additionally shares recent data on common causative foods in Korean infants and children.
Subject(s)
Child , Humans , Infant , Allergens , Anaphylaxis , Antibodies , Diagnosis , Education , Eggs , Epinephrine , Food Hypersensitivity , Hypersensitivity , Immunoglobulin E , Immunoglobulins , Immunotherapy , Milk , Ovum , Prevalence , SkinABSTRACT
OBJECTIVE: This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). MATERIALS AND METHODS: In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. RESULTS: Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391–24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103–22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242–43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000–1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). CONCLUSION: Noninvasive assessment of NCLs by CCTA has potential prognostic value.
Subject(s)
Humans , Adipose Tissue , Angiography , Cholesterol , Constriction, Pathologic , Coronary Vessels , Follow-Up Studies , Lipoproteins , Logistic Models , Myocardial Infarction , Percutaneous Coronary InterventionABSTRACT
Objective To investigate the differences and significance of blood levels of T helper 17 (Th17) cell and interleukin17 (IL-17) between peripheral and culprit vessels in patients with acute coronary syndrome.Methods A total of 76 patients recruited in 2012 were divided into three groups according to the coronary angiography and clinical manifestations:acute coronary syndrome,stable angina and control groups.The blood samples were taken from cubital vein and culprit coronary artery after coronary angiography.The percentage of Th17s among CD4+ T cells was detected by flow cytometric analysis and the IL-t7 levels were measured by enzyme-linked immunosorbent assay.Results There was no significant difference in the percentages of Th17 cells between peripheral blood and culprit artery blood [(3.18 ± 0.29) ％ vs.(3.17 ±0.30)％,(P =0.919)];but the perecentages of Th17 in peripheral blood were found to be significantly higher in patients with acute coronary syndrome (3.18 ± 0.29)％ than those with stable angina (1.32 ± 0.31) ％ and those without coronary heart disease (1.28 ± 0.33) ％,(P ＜ 0.01).There was no significant difference in the level of IL-17 between peripheral blood and culprit artery blood [(81.23 ± 18.63) vs.(82.37 ±20.51) pg/mL,P =0.573];but the level of IL-17 in peripheral blood was also significantly higher in patients with acute coronary syndrome than those with stable angina and those without coronary heart disease [(81.23 ± 18.63) vs.(25.96 ± 14.58) pg/mL or (23.75 ± 13.64) pg/mL,P ＜0.01].Conclution There were no significant differences in percentage of Th17 cell among CD4 + T cells and levels of IL-17 in blood between peripheral and culprit vessels in patients with acute coronary syndrome.The percentage of Th17 among CD4 + T cells and the levels of IL-17 in blood increase in patients with acute coronary syndrome suggesting a potential role of Th17 and IL-17 in the development and instability of the atheroma.
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Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction (STEMI) pa-tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention (PPCI) were analyzed. We used propensity score matching (PSM) to control differences of baseline characteristics between culprit only intervention (CP) and multivessel percutaneous coronary interventions (MP), and between double vessel disease (DVD) and triple vessel disease (TVD). The major adverse cardiac event (MACE) was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE (14.2%vs. 8.6%, P=0.01), any cause of revascularization (10.6%vs. 5.9%, P=0.01), and repeated PCI (9.5%vs. 5.7%, P=0.02), as compared to DVD patients during one year after discharge. MP reduced MACE effectively (7.3%vs. 13.8%, P=0.03), as compared to CP for one year, but all cause of death (1.6%vs. 3.2%, P=0.38), MI (0.4%vs. 0.8%, P=1.00), and any cause of revascularization (5.3%vs. 9.7%, P=0.09) were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD. MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.
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Objective To study the feasibility of using fractional flow reserve (FFR) to guide whether to perform coronary revascularization of non-culprit moderate stenosis in patients with unstable angina and estimate their clinical prognosis. Methods This study enrolled unstable angina patients with multivessel disease. First successful stenting of the culprit artery, then the other non-culprit moderate coronary stenosis were randomized into PCI guided by angiography or guided by FFR measurements. Death from any cause, nonfatal myocardial infarction, unplanned hospitalization leading to urgent revascularization and clinical manifestations with angina were followed during the first year. Results 71 patients were included, among them 35 patiens were randomly assigned to angiography-guided PCI and 36 patients to FFR-guided PCI. In FFR-guided PCI group, FFR was successfully measured in all of non-culprit moderate coronary stenosis. In 23 stenosis, the FFR was greater than 0.80, and stents were not placed in these stenosis. In 13 stenosis with FFR<0.8, stent were inplant and FFR was raised≥0.95 after stenting. The percentage of patients who had a primary end-point event was higher in the angiography-guided PCI group than the FFR-guided PCI group (P<0.05). Neither the rate of mortelity from any cause nor the rate of non-fatal myocardial infarction had significant difference between the 2 groups. Related to the target vessels rates of nonfatal myocardial infarction (5.6%vs. 28.6%) and target lesion revascularization (5.6%vs. 31.4%) were statistically different (P<0.01 and P<0.05, respectively). Conclusions In patients with unstable angina, it is safe to use FFR values to guide decisions on the revascularization of angiographically moderate non-culprit stenosis. Routine measurement of FFR in addition to angiographic guidance, as compared with PCI guided by angiography alone, results in a significant reduction in major adverse events at 1 year, particularly in urgent revascularization, and clinical manifestations with angina get better.
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Introduction: Various electrocardiogram (ECG) patterns can determine the site of occlusion in culprit coronary artery in ST-elevation myocardial infarction (STEMI) and the size of the myocardium that is jeopardized. Objectives: The aim of this study was to assess diagnostic accuracy of the ECG localization of culprit vessel occlusion site as compared to coronary angiographic findings. Material and methods: ECG criteria for localization of culprit vessel occlusion site were specified and patients with STEMI (n = 21) were divided into three groups: Groups I, II and III, according to the localization of culprit vessel occlusion site in left anterior descending (LAD), right coronary artery (RCA) and left circumflex (LCx) coronary arteries, respectively. Group I was further divided into four subgroups: Ia, Ib, Ic and Ib+c according to whether occlusion in LAD was proximal to both first septal (S1) and first diagonal (D1) branches, distal to S1 but proximal to D1 branches, distal to both S1 and D1 branches or distal to S1 branch, respectively. Group II was further divided into two subgroups: IIa and IIb according to whether occlusion in RCA was proximal or distal to RV branch, respectively. The results of coronary angiograms were compared with those predicted by ECG. Results: The positive predictive accuracy (PPA) and negative predictive accuracy (NPA) of ECG criteria for LAD, RCA and LCx coronary arteries were 90.91% and 100%, 90% and 100%, and undetermined and 90.48%, respectively. Among subgroups, the sensitivity of ECG criteria was maximum for groups Ib+c and IIb (100%) followed by Group IIa (71.43%), Group Ic (50%), Group Ia (42.86%) and least for Group Ib (0%). The specificity was maximum for Groups Ia and IIa (92.86%) followed by Group Ib (90%), Group IIb (89.47%), Group Ic (78.95%) and Group Ib+c (77.78%) in that order. The PPA and NPA for Groups Ia, Ib, Ic, Ib+c, IIa and IIb were 75% and 76.47%, 0% and 94.74%, 20% and 93.75%, 42.86% and 100%, 83.33% and 86.67% and 50% and 100%, respectively. Conclusion: The present study demonstrates that ECG is an easily and widely available inexpensive tool to localize site of occlusion in culprit vessel in acute STEMI.
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Objective To evaluate the value of mean platelet volume (MPV) in identifying the location of infarct at left circumflex artery (LCX) in patients with non-ST-elevation myocardial infarction (NSTEMI).Methods In this retrospective study,184 consecutive patients with NSTEMI were eligible to be enrolled from January 1,2009 to June 30,2011 and laboratory examinations including platelet count,B-type natriuretic peptide (BNP),troponins test (TnI),C-reactive protein and serum creatinine (SCr) were done.The demographics and detailed history of patients were documented.In addition,left ventricular ejection fraction (LVEF) test and coronary angiography to determine the culprit vessel implicating in infarction were carried out in all enrolled patients.The patients were categorized into LCX group and N-LCX group according to culprit vessel.Results Of 184 patients,68 patients were in LCX group and 116 patients had left anterior descending artery (LAD) lesion or right coronary artery (RCA) lesion.High percent of LCX infarction were found in patients with high MPV level and low BNP level,and in smokers.And lower proportion of those patients had previous percutaneous coronary artery intervention.The results showed that MPV was larger in patients with LCX infarction than that in patients with LAD or RCA.Receiver operating characteristic curve showed the area under curve was 0.75 (95％ CI:0.675-0.826).An optimized cut off point at 9.15 fL of MPV showed 83.8％ sensitivity and 63.8％ specificity for prediction of LCX infarction.Multivariate analysis also showed that MPV was the only independent predictor of a LCX infarction in patients with NSTEMI [OR=1.32,(95％ CI:1.031-1.688),P＜0.05].Conclusions MPV was the only independent factor associated with LCX infarction in patients with NSTEMI.
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Objective To study ST-segment deviation on predicting culprit artery or culprit lesion in acute myocardial infarction(AM/).Methods The study population included patients with AMI who subsequently underwent coronary angiography during hospitalization.Culprit artery and culprit parts were evaluated,and ST-segment characteristics were analyzed.Results A higher ST-segment elevation in leadⅢthan in leadⅡand ST-segment depression＞1 mm in lead aVL or lead I were highly sensitive(75%)and specific(100%)markers for right coronary artery-related AMI.ST-segment depression＞1 mm in leadⅡ,Ⅲand aVF was lowly sensitive(39%)and highly specific (93%)marker for the left anterior descending artery-related AMI.Conclusion The culprit artery or culprit lesion coutd be predicted by using electrocardiogram at admission.
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The corresponding electrocardiographic manifestat of the different culprit vessels in patients with acute myocardial infarct is elaborated and its diagnostic value is discussed.