ABSTRACT
Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.
Subject(s)
Anticoagulants/therapeutic use , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass/methods , Drug Resistance/drug effects , Heparin/therapeutic use , Peptide Fragments/therapeutic use , Hirudins , Humans , Recombinant Proteins/therapeutic useSubject(s)
Chromosome Deletion , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/genetics , Peptide Hydrolases/genetics , Polymorphism, Genetic/genetics , Thalidomide/analogs & derivatives , Adaptor Proteins, Signal Transducing , Aged , Aged, 80 and over , Angiogenesis Inhibitors/therapeutic use , Biomarkers, Tumor/genetics , Humans , Lenalidomide , Middle Aged , Risk , Thalidomide/therapeutic use , Ubiquitin-Protein LigasesABSTRACT
Eosinophilic pleural effusions have multiple aetiologies. We report on the case of a 40-year-old man who experienced an eosinophilic pleural effusion with blood hypereosinophilia that occurred nine weeks after a treatment with valproic acid was introduced. Usual aetiologies of eosinophilic pleural effusion were excluded. Once valproic acid was discontinued, both pleural effusion and blood eosinophilia decreased rapidly. The persistence of a residual pleural effusion required the introduction of oral corticosteroids, which resulted in the effusion disappearing completely and rapidly. Valproic acid is a rare cause of eosinophilic pleural effusion. The effusion usually regresses when treatment is discontinued but short-term oral corticotherapy may be necessary in order to heal the patient.
Subject(s)
Eosinophilia/chemically induced , Pleural Effusion/chemically induced , Valproic Acid/adverse effects , Adult , Antimanic Agents/adverse effects , Blood Cell Count , Eosinophilia/complications , Eosinophilia/diagnostic imaging , Eosinophils/pathology , Humans , Male , Pleural Effusion/complications , Pleural Effusion/diagnostic imaging , Radiography, ThoracicSubject(s)
Bacteremia/microbiology , Endocarditis, Bacterial/microbiology , Staphylococcal Infections/etiology , Telangiectasia, Hereditary Hemorrhagic/complications , Abscess/microbiology , Acute Kidney Injury/etiology , Aged , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/therapy , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Blood Transfusion , Combined Modality Therapy , Disease Susceptibility , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Fatal Outcome , Female , Heart Valve Prosthesis Implantation , Humans , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/surgery , Pleurisy/microbiology , Recurrence , Sinus Thrombosis, Intracranial/etiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiologyABSTRACT
BACKGROUND: Comatose state is a major cause for admission to the intensive care unit. The most commonly used assessment score is the Glasgow coma scale (GCS). Although widely accepted, this score has several limitations. Recently, the full outline of unresponsiveness score (FOUR) has been validated and tested as reliable as the GCS. METHODS: We translated this score in French and tested its reliability in a neurological critical care unit. This study included eight critical care patients and eight intensive care patients. The patients were successively evaluated by two neurologists, four experienced nurses and five inexperienced nurses; a total of 176 evaluations were performed. The weighted kappa (kappa(W)) was used to determine the reliability of the evaluation for both the FOUR score and the GCS. RESULTS: The mean age of the patients was 62 years. The interobserver reliability of the French version of the FOUR score was high (kappa(W)=0.86; IC 95%: 0.83-0.89) comparable to that of the GCS (kappa(W)=0.85; IC 95%: 0.82-0.88). CONCLUSION: The French version of the FOUR score has an excellent interobserver reliability. This score is easy to perform and well accepted, only requiring simple and short training.
Subject(s)
Coma/diagnosis , Critical Care/standards , Adult , Aged , Aged, 80 and over , Female , France , Glasgow Coma Scale , Humans , Language , Male , Middle Aged , Nurses , Observer Variation , Reproducibility of Results , Young AdultSubject(s)
Consultants , Expert Testimony , Insurance, Health , Confidentiality , Decision Making , HumansABSTRACT
A new multiple risk factor intervention program, combining a comprehensive, stepwise and health education-based approach, was tested in an outpatient setting. In the first 47 patients (aged 17-55, referred by their physicians) total cardiovascular risk (estimated by Framingham index) was reduced within the first 12 months by an average of 32.5%. This improvement derived from significant reductions in all major risk factors. These findings demonstrate the feasibility and potential, yet unexploited, benefit of a more comprehensive risk factor, approach in general medical practice.
