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Arch. cardiol. Méx ; 90(4): 442-451, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1152819


Abstract Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; −3.831 mL [−6.165 mL to −1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], −72.471 s [−99.694 s to −45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.

Resumen Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.

Humans , Cardiac Catheterization/methods , Coronary Angiography/methods , Cardiac Catheters , Fluoroscopy , Cardiac Catheterization/instrumentation , Randomized Controlled Trials as Topic , Coronary Angiography/instrumentation , Radial Artery , Contrast Media/administration & dosage , Coronary Vessels/diagnostic imaging
Int. braz. j. urol ; 45(5): 1022-1032, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040074


ABSTRACT Purpose This hybrid retrospective and prospective study performed on 200 consecutive patients undergoing renal CTA, investigates the opacification of renal vasculature, radiation dose, and reader confidence. Materials and Methods 100 patients were assigned retrospectively to protocol A and the other 100 were allocated prospectively to protocol B. Both protocols implemented a contrast material and saline flow rate of 4.5 mL/sec. Protocol A utilized a 100 mL of low-osmolar nonionic IV contrast material (Ioversol 350 mg I/mL) while protocol B employed a patient-tailored contrast media formula using iso-osmolar non-ionic (Iodixanol 320 mg I/mL). Results Arterial opacification in the abdominal aorta and in the bilateral main proximal renal arteries demonstrated no statistical significance (p>0.05). Only the main distal renal artery of the left kidney in protocol B was statistically significant (p<0.046). In the venous circulation, the IVC demonstrated a significant reduction in opacification in protocol B (59.39 HU ± 19.39) compared to A (87.74 HU ± 34.06) (p<0.001). Mean CNR for protocol A (22.68 HU ± 13.72) was significantly higher than that of protocol B (14.75 HU ± 5.76 p< 0.0001). Effective dose was significantly reduced in protocol B (2.46 ± 0.74 mSv) compared to A (3.07 ± 0.68 mSv) (p<0.001). Mean contrast media volume was reduced in protocol B (44.56 ± 14.32 mL) with lower iodine concentration. ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (p< 0.0001), with inter-reader agreement increasing from moderate to excellent in renal arterial visualization. Conclusion Employing a patient-tailored contrast media injection protocol shows a significant refinement in the visualization of renal vasculature and reader confidence during renal CTA.

Humans , Male , Female , Adult , Aged , Renal Artery/diagnostic imaging , Contrast Media/administration & dosage , Computed Tomography Angiography/methods , Kidney/blood supply , Kidney/diagnostic imaging , Radiation Dosage , Reference Values , Renal Veins/diagnostic imaging , Triiodobenzoic Acids/administration & dosage , Logistic Models , Prospective Studies , Reproducibility of Results , Retrospective Studies , ROC Curve , Computed Tomography Angiography/standards , Middle Aged
Arq. neuropsiquiatr ; 77(7): 485-492, July 2019. tab, graf
Article in English | LILACS | ID: biblio-1011371


ABSTRACT Because of the need for a standardized and accurate method for detecting multiple sclerosis (MS) inflammatory activity, different magnetic resonance (MR) acquisitions should be compared in order to choose the most sensitive sequence for clinical routine. Objective To compare the sensitivity of a T1-weighted image to a single dose of gadolinium (Gd) administration both with and without magnetization transfer to detect contrast enhancement in active demyelinating focal lesions. Methods A sample of relapsing-remitting MS patients were prospectively examined separately by two neuroradiologists using a 1.5 Tesla scanner. The outcome parameters were focused on Gd-enhancement detection attributed to acute demyelination. All MR examinations with at least one Gd-enhancing lesion were considered positive (MR+) and each lesion was analyzed according to its size and contrast ratio. Results Thirty-six MR examinations were analyzed with a high inter-observer agreement for MR+ detection (k coefficient > 0.8), which was excellent for the number of Gd-enhancing lesions (0.91 T1 spin-echo (SE), 0.88 T1 magnetization transfer contrast (MTC) sequence and 0.99 magnetization-prepared rapid acquisition with gradient-echo (MPRAGE). Significantly more MR+ were reported on the T1 MTC scans, followed by the T1 SE, and MPRAGE scans. Confidently, the T1 MTC sequence demonstrated higher accuracy in the detection of Gd-enhancing lesions, followed by the T1 SE and MPRAGE sequences. Further comparisons showed that there was a statistically significant increase in the contrast ratio and area of Gd-enhancement on the T1 MTC images when compared with both the SE and MPRAGE images. Conclusion Single-dose Gd T1 MTC sequence was confirmed to be the most sensitive acquisition for predicting inflammatory active lesions using a 1.5 T magnet in this sample of MS patients.

RESUMO No que se refere à necessidade de um método preciso e padronizado para a detecção de atividade inflamatória em esclerose múltipla (EM), diferentes aquisições de RM devem ser comparadas com objetivo de escolher a sequência mais sensível para a rotina clínica. Objetivo Comparar a sensibilidade das sequências ponderadas em T1 após a administração endovenosa de uma única dose de gadolínio, com e sem a adição da transferência de magnetização, para detectar a impregnação das lesões desmielinizantes focais agudas. Métodos Uma amostra de pacientes com EM-RR foi prospectivamente avaliada separadamente por dois neurorradiologistas em um equipamento de RM de 1,5 Tesla. Os parâmetros de desfecho foram direcionados para a avaliação da detecção de impregnação pelo Gd atribuída à desmielinização aguda. Todos os exames de RM que demonstraram ao menos uma lesão com impregnação pelo Gd foram considerados positivos (RM+) e cada lesão foi analisada de acordo com suas dimensões e contraste. Resultados Trinta e seis exames de RM foram analisados. Os avaliadores demonstraram elevada concordância para a detecção de RM+ (coeficiente> 0,8), sendo excelente quanto ao número de lesões com impregnação pelo Gd (0,91 SE, 0,88 T1 MTC e 0,99 MPRAGE). A sequência T1 MTC apresentou número significativamente maior de RM+, seguida pelas sequências T1 SE e MPRAGE. De forma análoga, a sequência T1 MTC demonstrou maior acurácia na detecção de lesões com impregnação pelo Gd, seguida pelas sequências T1 SE e MPRAGE. As demais comparações demonstraram aumento estatisticamente significativo na relação de contraste e na área de impregnação pelo Gd nas imagens T1 MTC quando comparadas às imagens SE e MPRAGE. Conclusão A sequência T1 MTC com uma única dose de Gd confirmou ser a sequência mais sensível em demonstrar lesões inflamatórias agudas em equipamento de 1,5 T nessa coorte de pacientes com EM.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Brain/pathology , Magnetic Resonance Imaging/methods , Demyelinating Diseases/diagnostic imaging , Contrast Media/administration & dosage , Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging , Gadolinium/administration & dosage , Prospective Studies , Sensitivity and Specificity , Demyelinating Diseases/etiology , Multiple Sclerosis, Relapsing-Remitting/complications , Multiple Sclerosis
Arch. cardiol. Méx ; 88(4): 277-286, oct.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1124149


Resumen Antecedentes: Los procedimientos coronarios invasivos conllevan la administración de contraste y la exposición a radiaciones ionizantes, comportando un incremento de la morbimortalidad. La angiografía coronaria rotacional (ACR) permite adquirir múltiples proyecciones con una inyección de contraste. Hasta la fecha, no hay metaanálisis específicos comparando la ACR y la angiografía coronaria convencional (ACC) en pacientes en los que se realizan procedimientos coronarios invasivos, tanto diagnósticos como diagnósticos y terapéuticos. El objetivo de este metaanálisis es evaluar el impacto de la ACR en la cantidad de contraste, y la radiación ionizante en procedimientos coronarios invasivos. Métodos: Se realizó una búsqueda en las bases de datos PubMed y Ovid para identificar estudios tanto diagnósticos como diagnósticos y terapéuticos que comparasen ACR y ACC. Los estudios fueron evaluados sobre la calidad y los sesgos, y fueron incluidos si contemplaban alguna de las siguientes variables de valoración: volumen de contraste, radiación ionizante medida como producto dosis-área, Kerma-aire o tiempo de fluoroscopia. Resultados: Dieciséis estudios, totalizando 2,327 pacientes, fueron incluidos en el análisis final (1,146 pacientes recibieron ACR y 1,181, ACC), objetivándose diferencias significativas en volumen de contraste (diferencia estándar de medias (intervalo de confianza al 95%) −1.887 (−2.472 a −1.302); p < 0.001), producto dosis-área (−0.726 (−1.034 a −0.418); p < 0.001), Kerma-aire (−0.842 (−1.104 a −0.581); p < 0.001) y tiempo de fluoroscopia (0.263 (−0.496 a −0.030); p = 0.027). Conclusiones: La ACR permite reducir el volumen de contraste y la radiación, evaluada como producto dosis-área, Kerma-aire y tiempo de fluoroscopia en pacientes a los que se les realizan procedimientos coronarios invasivos.

Abstract Background: Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures. Methods: A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time. Results: Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means (95% confidence interval) −1.887 (−2.472 to −1.302); P < .001), dose-area product (−0.726 (−1.034 to −0.418); P < .001), Kerma-air (−0.842 (−1.104 to −0.581); P < .001), and fluoroscopy time (0.263 (−0.496 to −0.030); P = .027). Conclusions: RCA reduces the volume of contrast and the exposure to radiation, evaluated as dose-area product, Kerma-air, and fluoroscopy time, in patients undergoing invasive coronary procedures.

Humans , Coronary Artery Disease/diagnostic imaging , Coronary Angiography/methods , Contrast Media/administration & dosage , Radiation, Ionizing , Fluoroscopy , Iodine Compounds/administration & dosage
Rev. chil. radiol ; 24(4): 129-133, dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978168


El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.

The purpose of this study is describing a novel and minimally invasive technique of CT-guided marking of small pulmonary nodules with lipiodol prior to resection by videothoracoscopic surgery with radioscopic support. This is a retrospective study that includes 51 consecutive patients between June 2012 and September 2017, with the final diagnosis confirmed by pathology. Malignant nodules represented 81% of the cases with the remaining 19% being benign nodules. Through this technique, 100% of the marked nodules were successfully identified and extracted with few procedure related complications and no adverse clinical outcome, demonstrating the effectiveness and safety of the procedure.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Solitary Pulmonary Nodule/surgery , Solitary Pulmonary Nodule/diagnostic imaging , Ethiodized Oil/administration & dosage , Thoracic Surgery, Video-Assisted/methods , Lung Neoplasms/surgery , Lung Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Solitary Pulmonary Nodule/pathology , Contrast Media/administration & dosage , Lung Neoplasms/pathology
Int. braz. j. urol ; 44(6): 1129-1138, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975650


ABSTRACT Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion. Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.

Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Contrast Media/administration & dosage , Predictive Value of Tests , Sensitivity and Specificity , Middle Aged
Yonsei Medical Journal ; : 158-161, 2018.
Article in English | WPRIM | ID: wpr-742489


Radiocontrast media-induced acute severe thrombocytopenia is a very rare complication and potentially life-threatening. Here, we report the case of a 63-year-old male patient with severe acute thrombocytopenia following first exposure to intravenous non-ionic contrast media without immediate allergic reactions. His platelet count dropped from 107000/µL to 2000/µL after six hours of radiocontrast infusion. After administration of corticosteroid and transfusion of platelet concentrates, the platelet count returned gradually to normal within 5 days. To the best of our knowledge, non-ionic contrast media-induced isolated acute severe thrombocytopenia following no signs or symptoms of immediate allergic reaction has never been described.

Acute Disease , Administration, Intravenous , Contrast Media/administration & dosage , Contrast Media/adverse effects , Humans , Infusions, Intravenous , Male , Middle Aged , Platelet Count , Thrombocytopenia/etiology
Clinics ; 73: e182, 2018. tab
Article in English | LILACS | ID: biblio-952799


OBJECTIVES: To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS: Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS: After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS: During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.

Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Aspiration/chemically induced , Barium Sulfate/adverse effects , Fluoroscopy/methods , Deglutition Disorders/diagnostic imaging , Contrast Media/adverse effects , Pneumonia, Aspiration/diagnosis , Barium Sulfate/administration & dosage , Video Recording/methods , Iohexol/administration & dosage , Iohexol/adverse effects , Deglutition Disorders/complications , Contrast Media/administration & dosage , Deglutition/drug effects , Stroke Rehabilitation/methods
Rev. bras. ter. intensiva ; 29(3): 303-309, jul.-set. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-899517


RESUMO Objetivo: Estabelecer se há superioridade entre os critérios para predizer desfecho clínico desfavorável na lesão renal aguda e nefropatia induzidas por contraste. Métodos: Estudo retrospectivo conduzido em hospital terciário com 157 pacientes submetidos à infusão de contraste radiológico para fins propedêuticos. Resultados: Cumpriram os critérios para inclusão 147 pacientes. Aqueles que cumpriram os critérios de lesão renal aguda induzida por contraste (59) também cumpriram os critérios para nefropatia induzida por contraste (76); 44,3% dos pacientes cumpriram os critérios para o estadiamento pelo sistema KDIGO; 6,4% dos pacientes necessitaram utilizar terapia de substituição renal, e 10,7% dos pacientes morreram. Conclusão: O diagnóstico de nefropatia induzida por contraste foi o critério mais sensível para determinar a necessidade de terapia de substituição renal e óbito, enquanto o KDIGO demonstrou a maior especificidade; na população avaliada, não houve correlação entre o volume de contraste e a progressão para lesão renal induzida por contraste, nefropatia induzida por contraste, diálise de suporte ou óbito.

ABSTRACT Objective: To establish whether there is superiority between contrast-induced acute kidney injury and contrast-induced nephropathy criteria as predictors of unfavorable clinical outcomes. Methods: Retrospective study carried out in a tertiary hospital with 157 patients undergoing radiocontrast infusion for propaedeutic purposes. Results: One hundred forty patients fulfilled the inclusion criteria: patients who met the criteria for contrast-induced acute kidney injury (59) also met the criteria for contrast-induced nephropathy (76), 44.3% met the criteria for KDIGO staging, 6.4% of the patients required renal replacement therapy, and 10.7% died. Conclusion: The diagnosis of contrast-induced nephropathy was the most sensitive criterion for renal replacement therapy and death, whereas KDIGO showed the highest specificity; there was no correlation between contrast volume and progression to contrast-induced acute kidney injury, contrast-induced nephropathy, support dialysis or death in the assessed population.

Humans , Adult , Aged , Aged, 80 and over , Renal Replacement Therapy/statistics & numerical data , Contrast Media/adverse effects , Acute Kidney Injury/diagnosis , Intensive Care Units , Prognosis , Severity of Illness Index , Prevalence , Retrospective Studies , Sensitivity and Specificity , Disease Progression , Contrast Media/administration & dosage , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Kidney Diseases/diagnosis , Kidney Diseases/chemically induced , Kidney Diseases/epidemiology , Middle Aged
Yonsei Medical Journal ; : 51-58, 2017.
Article in English | WPRIM | ID: wpr-65063


PURPOSE: We aimed to investigate the effectiveness of ferritin as a contrast agent and a potential reporter gene for tracking tumor cells or macrophages in mouse cancer models. MATERIALS AND METHODS: Adenoviral human ferritin heavy chain (Ad-hFTH) was administrated to orthotopic glioma models and subcutaneous colon cancer mouse models using U87MG and HCT116 cells, respectively. Brain MR images were acquired before and daily for up to 6 days after the intracranial injection of Ad-hFTH. In the HCT116 tumor model, MR examinations were performed before and at 6, 24, and 48 h after intratumoral injection of Ad-hFTH, as well as before and every two days after intravenous injection of ferritin-labeled macrophages. The contrast effect of ferritin in vitro was measured by MR imaging of cell pellets. MRI examinations using a 7T MR scanner comprised a T1-weighted (T1w) spin-echo sequence, T2-weighted (T2w) relaxation enhancement sequence, and T2*-weighted (T2*w) fast low angle shot sequence. RESULTS: Cell pellet imaging of Ad-hFTH in vitro showed a strong negatively enhanced contrast in T2w and T2*w images, presenting with darker signal intensity in high concentrations of Fe. T2w images of glioma and subcutaneous HCT116 tumor models showed a dark signal intensity around or within the Ad-hFTH tumor, which was distinct with time and apparent in T2*w images. After injection of ferritin-labeled macrophages, negative contrast enhancement was identified within the tumor. CONCLUSION: Ferritin could be a good candidate as an endogenous MR contrast agent and a potential reporter gene that is capable of maintaining cell labeling stability and cellular safety.

Animals , Brain Neoplasms/diagnostic imaging , Cell Line, Tumor , Cell Tracking/methods , Colonic Neoplasms/diagnostic imaging , Contrast Media/administration & dosage , Disease Models, Animal , Female , Ferritins/administration & dosage , Genes, Reporter , Glioma/diagnostic imaging , Humans , Injections, Intravenous , Macrophages , Magnetic Resonance Imaging/methods , Male , Mice , Neoplasm Transplantation , Skin Neoplasms/diagnostic imaging , Time Factors
Rev. chil. radiol ; 23(2): 59-65, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900107


Magnetic resonance imaging has been shown to be very useful in the diagnosis and monitoring of multiple diseases affecting the central nervous system. Gadolinium has been used extensively worldwide. It has been estimated that since its introduction more than two hundred million doses of GBCA have been administered globally. Gadolinium-based contrast agents (GBCAs) were long considered medicines with a high safety profile, the literature reports incidences of immediate adverse effects such as headache, dizziness, and altered sense of taste. Studies performed a few years after the introduction of GBCA showed that there were gadolinium deposits in the tissues but their clinical significance was not known. It wasn’t until 2006 when the first reports were published that associated the gadolinium ion tissue deposits from GBCA with a systemic inflammatory entity of the connective tissue similar to scleroderma known as Nephrogenic Systemic Fibrosis (NSF), in patients with chronic renal failure. In 2013, the association between the use of GBCAs and the progressive increase in the signal intensity of the dentate nucleus and the globus pallidus in T1-weighted MRI images without contrast medium, was described for the first time. This review describes the most relevant aspects of the pathophysiology of these findings taking into account their differential diagnosis.

Las imágenes por resonancia magnética han mostrado ser de gran utilidad en el diagnóstico y seguimiento de múltiples enfermedades que afectan el sistema nervioso central. El gadolinio se ha utilizado ampliamente a nivel mundial. Se estima que desde su introducción se han administrado más de doscientos millones de dosis de MCBG en el mundo. Los medios de contraste basados en Gadolinio (MCBG) fueron considerados por mucho tiempo medicamentos con un alto perfil de seguridad, la literatura reporta incidencia de efectos adversos inmediatos como cefalea, mareo y alteración del sentido del gusto. Estudios realizados pocos años después de la introducción de los MCBG mostraron que había depósitos de gadolinio en los tejidos, pero no se conocía su significancia clínica Fue hasta 2006 cuando se publicaron los primeros reportes que asociaban el depósito tisular del ion gadolinio proveniente de los MCBG con una entidad inflamatoria sistémica del tejido conectivo similar a la escleroderma conocida como Fibrosis Sistémica Nefrogénica (FSN) en pacientes con falla renal crónica. En 2013 se describió por primera vez la asociación entre el uso de los MCBG y el aumento progresivo de la intensidad de señal del núcleo dentado y los globos pálidos en las imágenes de RM ponderadas en T1 sin medio de contraste. En esta revisión se describen los aspectos más relevantes de la fisiopatología de estos hallazgos considerando su diagnóstico diferencial.

Humans , Nephrogenic Fibrosing Dermopathy/diagnostic imaging , Gadolinium/administration & dosage , Magnetic Resonance Spectroscopy , Contrast Media/administration & dosage
Rev. chil. radiol ; 23(1): 2-6, 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-844629


Introduction: Recently, some studies have reported accumulation of gadolinium in the brain of patients with multiple administrations of gadolinium-based contrast. Patients with multiple sclerosis are subjected to multiple contrasting resonances and could become a population at risk. Objective: To determine whether repeated intravenous exposure to gadolinium is associated with more intensity in the thalamus, dentate nucleus, pons and the globus pallidus. Methods: A retrospective study of 60 patients with MS who had undergone two or more contrasted MRs between 2007 and 2015, was performed. The ratios calculated were: dentate nuclei-to-pons (DNP), thalamus-to-pons (TP), caudate nuclei-to-pons (CNP), globus pallidus-to-thalamus (GPT), globus pallidus-to-pons (GPP), by reviewing simple T1 axial sequences. Relative changes were calculated and compared with the number of contrasted MRs. The concordance between observers and the intraclass correlation coefficient was evaluated. Results: There was no evidence of increased signal intensity in T1 sequences (DNP 0.524, GPT 0.466, GPP 0.684, TP 0.771, CNP 0.352). As there were no differences, the Spearman coefficient showed no correlation between relative changes and the number of resonances performed. Inter-observer agreement was almost perfect (0.982) for all structures. Conclusion: Our study did not find a statistically significant increase in the T1 signal intensity in patients with multiple sclerosis. However, there are factors to consider, such as the type of gadolinium and the time lapse between administrations.

Introducción: Recientemente, algunos estudios han informado acumulación de gadolinio en el cerebro de los pacientes con múltiples administraciones de contraste basado en gadolinio. Los pacientes con esclerosis múltiple son sometidos a múltiples resonancias contrastadas y podrían convertirse en una población de riesgo. Objetivo: Determinar si la exposición repetida por vía intravenosa a gadolino se asocia con mayor intensidad en el tálamo, el dentado, el puente y el globo pálido. Métodos: Se realizó un estudio retrospectivo núcleo de 60 pacientes con EM que habían sido sometidos a dos o más RM contrastadas entre 2007 - 2015. Se calcularon las razones núcleo dentado - puente (DNP), tálamo-puente (TP), núcleo caudado- puente (CNP), globus pallidus - tálamo (GPT), globus pallidos - puente (GPP), revisando secuencias T1 axiales simples. Se calcularon los cambios relativos y se compararon con el número de RM contrastadas. Se evaluó la concordancia entre observadores con el coeficiente de correlación intraclase. Resultados: No hubo evidencia de aumento de la intensidad de la señal en secuencias T1 (DNP 0,524, 0,446 GPT, GPP 0,684, 0,771 PT, CNP 0.352). Al no existir diferencias, el coeficiente de Spearman no mostró correlación entre los cambios relativos y el número de resonancias realizadas. La concordancia interobservador fue casi perfecta (0.982) para todas las estructuras. Conclusión: Nuestro estudio no encontró un aumento estadísticamente significativo en la intensidad de la señal T1 en pacientes con esclerosis múltiple. Sin embargo, hay factores a considerar, tales como el tipo de gadolinio y el lapso de tiempo entre las administraciones.

Humans , Male , Female , Adult , Middle Aged , Contrast Media/administration & dosage , Gadolinium DTPA/administration & dosage , Multiple Sclerosis/diagnosis , Cerebellar Nuclei/pathology , Globus Pallidus/pathology , Magnetic Resonance Imaging , Multiple Sclerosis/pathology , Retrospective Studies , Thalamus/pathology
Rev. bras. anestesiol ; 66(2): 208-211, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-777413


ABSTRACT BACKGROUND AND OBJECTIVES: Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. CASE REPORT: A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. CONCLUSION: It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cateterização venosa inadvertida ocorre em aproximadamente 9% das anestesias peridurais lombares com introdução de cateter e caso não seja prontamente reconhecida pode trazer consequências fatais. O objetivo deste relato é descrever um caso de cateterização acidental do plexo venoso peridural e o seu registro por tomografia computadorizada com injeção de contraste pelo cateter. RELATO DE CASO: Paciente feminina, sexagenária, estado físico II (ASA), submetida à colecistectomia convencional sob anestesia geral balanceada e peridural com cateter para analgesia pós-operatória. Durante cirurgia houve suspeição clínica de cateterização acidental do plexo venoso peridural, por refluxo de sangue pelo cateter, fato confirmado pela administração de dose-teste pelo cateter. Feita tomografia computadorizada com injeção de contraste pelo cateter, após o termino da cirurgia. Observado todo o trajeto do contraste desde a pele até a veia ázigo, passando pelo plexo venoso peridural anterior, posterior e veia intervertebral. CONCLUSÃO: É possível a identificação do real posicionamento do cateter peridural, bem como o registro da cateterização acidental do plexo venoso peridural, por meio de tomografia computadorizada com injeção de contraste pelo cateter peridural.

Humans , Female , Tomography, X-Ray Computed/methods , Epidural Space/diagnostic imaging , Anesthesia, General/adverse effects , Pain, Postoperative/drug therapy , Catheterization/methods , Cholecystectomy/methods , Contrast Media/administration & dosage , Anesthesia, Epidural/methods , Anesthesia, General/methods , Middle Aged
Int. j. cardiovasc. sci. (Impr.) ; 29(1): 1-5, jan.-fev.2016. tab, graf
Article in Portuguese | LILACS | ID: lil-797105


A utilização de agentes iodados em exames radiológicos pode causar nefropatia induzida porcontraste (NIC) na presença de fatores de risco clássicos, como doença renal prévia e diabetes. Recentemente,níveis séricos elevados de proteína C-reativa ultrassensível (PCR-us) têm sido descritos como indicadores de maior risco de NIC. Independente da ocorrência de NIC, a PCR-us pode elevar-se após exames contrastados.Objetivo: Investigar o comportamento da PCR-us em pacientes submetidos à administração parenteral de agentede contraste iodado. Métodos: Estudo observacional, transversal, prospectivo, realizado no Hospital Universitário Antônio Pedro, de 2007 a 2014, envolvendo 51 pacientes, 30 homens e 21 mulheres, média de idade 60,19±20,0 anos, submetidos aexames com contraste de baixa osmolalidade (Iopamidol 612 mg/mL).Resultados: NIC ocorreu em 15 pacientes (29,4%). Não houve correlação entre a PCR-us aumentada e a ocorrência de NIC. O aumento percentual da PCR-us foi significativamente maior entre os pacientes submetidos ao cateterismocardíaco (p=0,0044). O aumento médio da PCR-us nos pacientes submetidos ao cateterismo cardíaco e naquelessubmetidos à administração do contraste iodado por veia periférica foi 100,3% e 13,8%, respectivamente.Conclusão: Os achados sugerem que o aumento da PCR-us após cateterismo cardíaco não pode ser atribuído aoagente de contraste iodado...

Background: The use of iodinated agents in radiological studies can cause contrast-induced nephropathy (CIN) in the presence of classic risk factors such as previous renal disease and diabetes. High serum levels of high-sensitivity C-reactive protein (CRP) have been described as indicators of increased risk of CIN. Regardless of the occurrence of CIN, hs-CRP may rise after contrast studies. Objective: To investigate the behavior of hs-CRP in patients undergoing parenteral administration of iodinated contrast agent. Methods: Observational cross-sectional prospective study held at Hospital Universitário Antônio Pedro from 2007 to 2014 involving 51 patients, 30 men and 21 women, mean age 60.19±20.0, undergoing tests with low-osmolality contrast (Iopamidol 612mg/ml).Results: CIN occurred in 15 patients (29.4%). There was no correlation between increased hs-CRP and occurrence of CIN. The percentage increase in hs-CRP was significantly higher among patients undergoing cardiac catheterization (p=0.0044). The mean increase in hs-CRP in patients undergoing cardiac catheterization and in those submitted to administration of iodinated contrast by peripheral vein was 100.3% and 13.8%, respectively.Conclusion: The findings suggest that increased hs-CRP after cardiac catheterization cannot be attributed to iodinated contrast agente...

Humans , Male , Female , Middle Aged , Cardiac Catheterization/methods , Inflammation/complications , Contrast Media/administration & dosage , Patients , C-Reactive Protein/analysis , C-Reactive Protein/adverse effects , Acute Disease , Percutaneous Coronary Intervention/methods , Acute Kidney Injury/complications , Acute Kidney Injury , Kidney Diseases/chemically induced , Observational Study , Risk Factors , Data Interpretation, Statistical , Multidetector Computed Tomography/methods
Rev. chil. cardiol ; 35(3): 209-215, 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-844292


Introducción: El acceso radial izquierdo (ARI) puede ser una alternativa para la realización de cateterismos coronarios, especialmente en pacientes añosos, donde modificaciones anatómicas pueden dificultar el procedimiento por acceso radial derecho (ARD). Objetivo: Determinar si el uso del ARI en pacientes mayores de 70 años disminuye el tiempo de fluoroscopía y la dosis de radiación durante una coronariografía realizada por operadores entrenados. Métodos: De forma prospectiva se evaluaron pacientes mayores de 70 años sometidos a cateterismo coronario por vía radial por operadores experimentados (>200 procedimiento por vía radial/año), utilizando la misma técnica. El acceso derecho o izquierdo fue asignado de forma aleatoria y se registraron los tiempos de procedimiento, la exposición a radiación, insumos utilizados y apreciación de dificultad del operador. Resultados: Se incluyeron 102 pacientes (ARD 52 / ARI 50). Ambos accesos fueron comparables en los tiempos utilizado para realizar el procedimiento (ARD 782 vs ARI 695 segundos, p= 0,06), aunque hubo un significativo menor tiempo utilizado para canular la arteria coronaria derecha en aquellos pacientes que se accedieron por ARI (206 vs 169 segundos; p= 0,01). No hubo diferencias en la radiación producida por el examen entre ambos grupos (PDA ARD 56,7 vs ARI 59,3 Gy/ cm2, p= 0,09), ni en la cantidad de medio de contraste utilizado (ARD 106,33 (31,04) vs ARI 108,13 (30,23), p=0,24). Se encontró una mayor frecuencia de tortuosidad (25% vs 6%, p <0,01) y de dificultad del procedimiento (58% vs 28%, p <0,01) en el grupo de ARD, principalmente debido al uso de una guía adicional (33% vs 4%, p< 0,01). Conclusión: Tanto el acceso radial derecho como el izquierdo son alternativas factibles para la realización de una coronariografía en pacientes de edad avanzada, no existiendo diferencias entre éstos en el tiempo total del procedimiento. Sin embargo, el ARD en pacientes añosos se asocia más frecuentemente con dificultades a nivel braquiocefálico y mayor uso de guías adicionales para sortear estos desafíos.

Background: Left radial access (LRA) for coronary angiography is an alternative to right radial access (RRA), especially in elderly patients in whom anatomic features may complicate the latter approach. Aim: To determine whether LRA in patients 70 years or older involves a decreased fluoroscopy time and radiation doses in coronary angiography performed by experienced operators. Method: Patients 70 years or older were randomly assigned to undergo coronary angiography through de RRA (n=52) or LRA (n=50). The procedure was performed by experienced operators (>200 radial access coronary angiographies, yearly). Duration of the procedure, exposure to radiation, materials used and subjective evaluation of the difficulty in performing the angiography were assessed. Results: Mean procedure duration was similar between accesses (RRA = 782 vs LRA = 695 seconds (p=0.06). The time to access the right coronary artery was significantly greater for de RRA compared to the LRA (206 vs 169 seconds, respectively, p=0.01). There was no difference in radiation dose (PDA) between groups (RRA = 106.3 ± 31.4 vs LRA = 108.1 ± 30.2 Gy/cm2, p=0.24), nor in the amount of contrast (ARD 106,33 (31,04) vs ARI 108,13 (30,23), p=0,24). Tortuosity (25% vs 6%, p <0,01) and subjective evaluation of procedure difficulties (58% vs 28%, p <0,01) were higher in RRA compared to LRA. An additional guide was needed with RRA compared to LRA (33% were higher in RRA compared to LRA, an additional guide was used in RRA 33% than in LRA (33% vs 4%, p< 0,01). Conclusion: RRA may be used in elderly patients within the same procedure duration compared to LRA. However, RRA is more frequently associated to the presence of tortuosity at the brachio-cephalic site, leading to greater use of additional wire.

Humans , Male , Female , Aged , Cardiac Catheterization/methods , Coronary Angiography/methods , Radial Artery , Catheterization, Peripheral , Contrast Media/administration & dosage , Prospective Studies , Radiation Dosage , Time Factors
Rev. bras. cir. cardiovasc ; 30(6): 650-656, Nov.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-774548


ABSTRACT INTRODUCTION: Despite the patient and medical staff exposure to radiation in endovascular aneurysm repair, the benefits of this abdominal aortic aneurysm type of surgical management are justfied by minor recovery time and hospitalization, as well as an option for patients not elected to conventional open repair. In this minimally invasive surgical aproach, time of procedure and radiation doses can be substantial - and the increasing frequency of these procedures and it's complexity have impelled vascular surgeons to face additional and successive risk to occupational radiation exposure. Meticulous study of the computed tomography angiography during the endovascular aneurysm repair preparation allows reduction of unnecessary radiation exposure, as also reduces consecutive image acquisition and contrast use (that may be related to renal overload in susceptible patients). Some studies have proposed strategies to optimize endovascular intervention to reduce contrast use and X-ray exposure. Although they might prove to be effective, they rely on use of additional specific and advanced equipment, available only in major centers. As an alternative to this expensive and restrict technology, it is presented a simpler technique through image manipulation on software OsiriX, aiming to reduce both exposures. OBJECTIVE: To analyze the efficacy of the adoption of a study protocol and a script-based guide in preparation for endovascular aneurysm repair through verifying it's impact over the surgical procedure - as referred to intravascular contrast infuse, effects over renal function, blood loss and operatory time. METHODS: A longitudinal prospective study from March 2014 through March 2015, where 30 performed endovascular aneurysm repair were compared to a historic control group. The planning for endovascular aneurysm repair through the patient's tomographic image manipulation in the prospective group was performed with OsiriX MD software. A script-based guide upon gathering detailed computed tomography angiography images was elaborated by the author and distributed to the performing surgical team for appreciation, instruction and pre operatory judgment. Based upon the script, the C-arm gantry angle was specifically corrected in each case of endovascular aneurysm repair, for image optimization and aneurysm's neck visualization. Arteriography was performed under digital subtraction angiography after catheters were positioned according to predicted level description in the referred guide. Statistical analysis were performed with a significance level of 5% (P value<0.05). RESULTS: There was a statistically significant relationship between the two studied periods and the variables: contrast volume (284.5 vs. 31.8 mL), operative time (207.5 vs. 140.4 min.) and blood loss (798.1 vs. 204.4 mL), revealing that they are considerably larger in the historical control group than in the script guided current group. There was no difference related to the volume of contrast used in the two groups and the occurrence of renal impairment. CONCLUSION: In the present paper it was possible to demonstrate the impact of the ability to manipulate digital formats of medical images without the need of sophisticated equipment, in adoption of a guide based on the compilation of informations collected with assistance of an accessible software performed on a personal computer. Although we could not prove relation to occurrence of renal impairment, there were direct results on reduction of intravascular contrast use, even as surgical time and blood loss, compared to a previous historical period.

Humans , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Radiation Exposure/prevention & control , Angiography, Digital Subtraction/methods , Aortic Aneurysm, Abdominal , Blood Loss, Surgical/prevention & control , Contrast Media/administration & dosage , Contrast Media/adverse effects , Image Processing, Computer-Assisted/methods , Longitudinal Studies , Operative Time , Prospective Studies , Treatment Outcome
Rev. bras. cardiol. invasiva ; 23(4)out.-dez. 2015. tab
Article in Portuguese | LILACS | ID: biblio-846599


Introdução:Recentemente, o estudo MOZART demonstrou que a utilização do ultrassom intracoronário (USIC) para guiar a intervenção coronariana percutânea (ICP) diminui o volume de contraste utilizado no procedimento. Avaliamos a incidência de eventos adversos cardiovasculares tardios desses pacientes. Métodos: Pacientes com risco para nefropatia induzida por contraste (NIC) ou para sobrecarga de volume, e com indicação de ICP, foram randomizados para procedimento guiado pela angiografia ou USIC, e acompanhados por um período de 1 ano. Resultados: Incluídos 83 pacientes nos grupos ICP guiado por angiografia (n = 42) ou USIC (n = 41), sendo que 77,1% eram diabéticos e 44,6% tinham clearance de creatinina < 60mL/min/1,73m2. As características clínicas e angiográficas não mostraram diferenças entre os grupos. A maioria tinha lesões tipo B2/C (89,8%) e uma mediana de dois stents foram usados (intervalo interquartil: 1,0­2,0 stents). O tempo de procedimento da ICP guiada por USIC foi 14 minutos maior do que no grupo guiado por angiografia (p = 0,006). No entanto, os grupos não diferiram em relação ao tempo de fluoroscopia ou à média de aquisições de imagem por procedimento. A NIC ocorreu em 19,0% vs. 7,3% (p = 0,26). No período de seguimento de 1 ano, 12% dos pacientes apresentaram algum evento cardiovascular maior, sendo dois óbitos (um para cada grupo), e não houve diferenças entre os grupos. Conclusões: A estratégia de redução de contraste com a ICP guiada pelo ultrassom intravascular, em pacientes com risco para NIC ou sobrecarga de volume, mostrou­se segura a curto e longo prazos.

Background: Recently, the MOZART study demonstrated that using intravascular ultrasound (IVUS) for guiding percutaneous coronary intervention (PCI) reduces the volume of contrast used in the procedure. The authors assessed the incidence of late adverse cardiovascular events in these patients. Methods: Patients at risk for contrast­induced nephropathy (CIN) or volume overload were randomized to angiography­guided versus IVUS­guided PCI, and followed­up for a 1­year period. Results: Eighty­three patients were included in the angiography­guided (n = 42) or IVUS­guided (n = 41) groups, of whom 77.1% were diabetics and 44.6% had creatinine clearance < 60mL/min/1.73m2. Clinical and angiographic characteristics did not differ between the groups. Most had type B2/C lesions (89.8%) and a median of two stents were used (interquartile range: 1.0­2.0 stents). The duration of IVUS­guided PCI was 14minutes longer than the angiography­guided PCI group (p = 0.006). However, the groups did not differ regarding fluoroscopy time or mean image acquisitions per procedure. CIN occurred in 19.0% vs. 7.3% (p = 0.26). During the 1­year follow­up, 12% of patients had a major cardiovascular event, with two deaths (one in each group), and no differences were found between groups. Conclusions: The contrast reduction strategy with IVUS­guided PCI in patients at risk for CIN or volume overload was shown to be safe in the short and long term

Humans , Male , Female , Contrast Media/administration & dosage , Percutaneous Coronary Intervention/methods , Treatment Outcome , Ultrasonography/methods , Angiography/methods , Cardiovascular Diseases/physiopathology , Creatinine , Diagnostic Imaging/methods , Prospective Studies , Data Interpretation, Statistical , Stents
Colomb. med ; 46(3): 90-103, July-Sept. 2015. ilus
Article in English | LILACS | ID: lil-765508


Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. Methods: A systematic review of studies registered in the COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO and EMBASE databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I²= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I²= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I²= 0%; p= 0.51). Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

Introducción: La nefropatía inducida por medio de contraste es una de las causas principales de lesión renal aguda, lo cual incrementa la morbilidad y mortalidad intrahospitalaria. La nefroprotección con bicarbonato de sodio ha surgido como una estrategia preventiva, sin embargo su eficacia es controversial cuando se compara con estrategias como la hidratación con solución salina al 0.9%. Objetivo: Comparar la efectividad del bicarbonato de sodio versus la hidratación con solución salina al 0.9% en la prevención de la lesión renal aguda inducida por contraste. Métodos: Se realizó una revisión sistemática de los estudios registrados en COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO y EMBASE. Se incluyeron estudios aleatorizados, controlados donde se evaluó el uso de solución salina al 0.9% versus bicarbonato de sodio para prevenir la nefropatía por medio de contraste. Resultados: Se incluyeron 22 estudios (5,686 pacientes). El bicarbonato de sodio no disminuyó el riesgo de nefropatía inducida por contraste (DR= 0.00 IC 95%= -0.02-0.03; p= 0.83, I2=0%). Tampoco se encontró diferencia significativa en la necesidad de terapia de reemplazo renal (DR= 0.00 IC 95%= -0.01-0-01, I2= 0%, p= 0.99); ni en la mortalidad (DR= -0.00, IC 95%= -0.001-0.001, I2= 0%, p= 0.51). Conclusiones: La administración de bicarbonato de sodio no es superior al suministro de solución salina al 0.9% en la prevención de nefropatía inducida por medio de contraste en pacientes con factores de riesgo. Su uso tampoco es superior en la reducción de mortalidad y el requerimiento de terapia de reemplazo renal.

Humans , Acute Kidney Injury/prevention & control , Contrast Media/adverse effects , Sodium Bicarbonate/administration & dosage , Sodium Chloride/administration & dosage , Acute Kidney Injury/chemically induced , Contrast Media/administration & dosage , Randomized Controlled Trials as Topic , Risk Factors , Renal Replacement Therapy/statistics & numerical data
Rev. bras. enferm ; 68(3): 438-444, maio-jun. 2015. tab
Article in Portuguese | LILACS, BDENF | ID: lil-756533


RESUMOObjetivo:compreender as potencialidades e fragilidades da rede de cuidado da pessoa com HIV/Aids em um serviço de referência do Estado de Santa Catarina-SC.Método:participaram oito sujeitos e sua rede de cuidado, totalizando 18 participantes. Os dados foram coletados através de entrevistas e examinados por análise de conteúdo, sustentados teoricamente pelo interacionismo simbólico.Resultado:a análise resultou nas categorias: A rede ofertando o cuidado à pessoa com síndrome da imunodeficiência adquirida e Enfrentando Barreiras no cuidar, que refletem as potencialidades e fragilidades, na rede de cuidado. A primeira retrata a oferta de cuidado afetivo e humanizado e a segunda, uma rede pouco ampliada, constituída por profissionais de saúde e algum membro familiar.Conclusão:a rede de cuidado profissional é importante, mesmo diante do aumento dos atendimentos numa estrutura física e número de profissionais que já não comportam a crescente demanda.

RESUMENObjetivo:comprender las fortalezas y debilidades de la red de atención de la persona con VIH/SIDA en un centro de referencia en el estado de Santa Catarina-SC.Metodo:ocho participantes sujetos y su red de atención, por un total de 18 participantes. Los datos fueron recolectados a través de entrevistas y se examinaron mediante análisis de contenido, en teoría, con el apoyo de la interacción simbólica.Resultados:el análisis resultó en las siguientes categorías: La red de ofrecer atención a las personas con síndrome de inmunodefi ciencia adquirida y tropezando con obstáculos a la atención, que refl ejan las fortalezas y debilidades en la red de atención. El primero representa la prestación de atención emocional y humano y la segunda un poco más amplia, incluyendo la red de profesionales de la salud y un miembro de la familia.Conclusión:la red de atención profesional es importante, a pesar del aumento de las llamadas en una estructura física y el número de profesionales que ya no se comportan de la creciente demanda.

ABSTRACTObjective:to understand the strengths and weaknesses in the care network of people with HIV/AIDS in a referral center in the state of Santa Catarina-SC.Method:participants were eight subjects and their care network, totaling 18 participants. Data were collected through interviews and examined by content analysis, theoretically supported by symbolic interaction.Results:the analysis resulted in the following categories: The network offering care to people with acquired immunodefi ciency syndrome, and Facing Barriers in care, which refl ect the strengths and weaknesses in the care network. The fi rst depicts the provision of emotional and humanized care, and the second a restricted network formed by health professionals and a family member.Conclusion:the professional care network is important, despite the increased number of assistances in a physical structure and amount of professionals who no longer meet the growing demand.

Humans , Male , Female , Adult , Contrast Media/administration & dosage , Contrast Media/adverse effects , Erythromycin/administration & dosage , Erythromycin/adverse effects , Gastric Emptying/drug effects , Intestine, Small/drug effects , Magnetic Resonance Imaging , Healthy Volunteers , Intestine, Small/physiology , Magnetic Resonance Imaging/methods , Prospective Studies