• Title/Summary/Keyword: Preconditioning method

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Effects of Remote Ischemic Pre-Conditioning to Prevent Contrast-Induced Nephropathy after Intravenous Contrast Medium Injection: A Randomized Controlled Trial

  • Dihia Belabbas;Caroline Koch;Segolene Chaudru;Mathieu Lederlin;Bruno Laviolle;Estelle Le Pabic;Dominique Boulmier;Jean-Francois Heautot;Guillaume Mahe
    • Korean Journal of Radiology
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    • v.21 no.11
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    • pp.1230-1238
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    • 2020
  • Objective: We aimed to assess the effects of remote ischemic pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy (CIN) after an intravenous (IV) or intra-arterial injection of contrast medium (CM) in patient and control groups. Materials and Methods: This prospective, randomized, single-blinded, controlled trial included 26 patients who were hospitalized for the evaluation of the feasibility of transcatheter aortic valve implantation and underwent investigations including contrast-enhanced computed tomography (CT), with Mehran risk scores greater than or equal to six. All the patients underwent four cycles of five minute-blood pressure cuff inflation followed by five minutes of total deflation. In the RIPC group (n = 13), the cuff was inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in the control group (n = 13), it was inflated to 10 mm Hg below the patient's SBP. The primary endpoint was the occurrence of CIN. Additionally, variation in the serum levels of cystatin C was assessed. Results: One case of CIN was observed in the control group, whereas no cases were detected in the RIPC group (p = 0.48, analysis of 25 patients). Mean creatinine values at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 88 ± 32 μmol/L, 91 ± 28 μmol/L and 82 ± 29 μmol/L, respectively (p = 0.73) in the RIPC group, whereas in the control group, they were 100 ± 36 μmol/L, 110 ± 36 μmol/L, and 105 ± 34 μmol/L, respectively (p = 0.78). Cystatin C values (median [Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L, and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group, whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16 [1.03, 1.31] mg/L, respectively (p = 0.93), in the control group. Conclusion: The risk of CIN after an IV injection of CM is very low in patients with Mehran risk score greater than or equal to six and even in the patients who are unable to receive preventive hyperhydration. Hence, the Mehran risk score may not be an appropriate method for the estimation of the risk of CIN after IV CM injection.

Evaluation of Clinical Availability for Shoulder Forced Traction Method to Minimize the Beam Hardening Artifact in Cervical-spine Computed Tomography (CT) (경추부 전산화단층촬영에서 선속 경화 인공물을 최소화하기 위한 견부 강제 견인법에 대한 임상적 유용성 평가)

  • Kim, Moonjeung;Cho, Wonjin;Kang, Suyeon;Lee, Wonseok;Park, Jinwoo;Yu, Yunsik;Im, Inchul;Lee, Jaeseung;Kim, Hyeonjin;Kwak, Byungjoon
    • Journal of the Korean Society of Radiology
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    • v.7 no.1
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    • pp.37-44
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    • 2013
  • In study suggested clinical availability to shoulder forced traction method in term of quality of image, the patient's convenience and stability, according to whether to use of shoulder forced traction bend using computed tomography(CT) that X-ray calibration and various mathematic calibration algorithm application can be applied by AEC. To achieve this, 79 patients is complaining of cervical pain oriented that shoulder forced traction bend use the before and after acquires lateral projection scout image and transverse image. transverse image of a fixed size in concern field of pixel and figure the average HU value compare that quantitative analysis. Artifact and pixel and resolution to qualitative clinical estimation image analysis. the patient feel inconvenience degree that self-diagnosis survey that estimate. As a result, lateral projection scout image if you used shoulder forced traction bend for the depicted has been an increase in the number of a cervical vertebrae. transverse image concern field shoulder forced traction bend use the before and after for pixel and the average HU-value changes was judged to be almost irrelevant. Artifact and resolution and contrast, in qualitative analysis of the results relating the observer to the unusual result. So, the patients of 82.27% complained discomfort that use of shoulder forced traction bend in self-diagnosis survey. No merit of medical image by using of bend from result was analyzed quality of image to quantitative and qualitative method judged. Nowadays, CT is supplied possible revision of quality of radiation by reduction of slice and automatic exposure controller, etc and application of preconditioning filter process due to various mathematic revision algorithm. So, image noise by beam hardening artifact should not be a problem. shoulder forced traction bend of use no longer judged clinically availability because have not influence of image quality and give discomfort, have extra dangerousness.

Study on the Short-Term Hemodynamic Effects of Experimental Cardiomyoplasty in Heart Failure Model (심부전 모델에서 실험적 심근성형술의 단기 혈역학적 효과에 관한 연구)

  • Jeong, Yoon-Seop;Youm, Wook;Lee, Chang-Ha;Kim, Wook-Seong;Lee, Young-Tak;Kim, Won-Gon
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.224-236
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    • 1999
  • Background: To evaluate the short-term effect of dynamic cardiomyoplasty on circulatory function and detect the related factors that can affect it, experimental cardiomyoplasties were performed under the state of normal cardiac function and heart failure. Material and Method: A total of 10 mongrel dogs weighing 20 to 30kg were divided arbitrarily into two groups. Five dogs of group A underwent cardiomyoplasty with latissimus dorsi(LD) muscle mobilization followed by a 2-week vascular delay and 6-week muscle training. Then, hemodynamic studies were conducted. In group B, doxorubicin was given to 5 dogs in an IV dose of 1 mg/kg once a week for 8 weeks to induce chronic heart failure, and simultaneous muscle training was given for preconditioning during this period. Then, cardiomyoplasties were performed and hemodynamic studies were conducted immediately after these cardiomyoplasties in group B. Result: In group A, under the state of normal cardiac function, only mean right atrial pressure significantly increased with the pacer-on(p<0.05) and the left ventricular hemodynamic parameters did not change significantly. However, with pacer-on in group B, cardiac output(CO), rate of left ventricular pressure development(dp/dt), stroke volume(SV), and left ventricular stroke work(SW) increased by 16.7${\pm}$7.2%, 9.3${\pm}$3.2%, 16.8${\pm}$8.6%, and 23.1${\pm}$9.7%, respectively, whereas left ventricular end-diastole pressure(LVEDP) and mean pulmonary capillary wedge pressure(mPCWP) decreased by 32.1${\pm}$4.6% and 17.7${\pm}$9.1%, respectively(p<0.05). In group A, imipramine was infused at the rate of 7.5mg/kg/hour for 34${\pm}$2.6 minutes to induce acute heart failure, which resulted in the reduction of cardiac output by 17.5${\pm}$2.7%, systolic left ventricular pressure by 15.8${\pm}$2.5% and the elevation of left ventricular end-diastole pressure by 54.3${\pm}$15.2%(p<0.05). With pacer-on under this state of acute heart failu e, CO, dp/dt, SV, and SW increased by 4.5${\pm}$1.8% and 3.1${\pm}$1.1%, 5.7${\pm}$3.6%, and 6.9${\pm}$4.4%, respectively, whereas LVEDP decreased by 11.7${\pm}$4.7%(p<0.05). Comparing CO, dp/dt, SV, SW and LVEDP that changed significantly with pacer-on, both under the state of acute and chronic heart failure, augmentation widths of these left ventricular hemodynamic parameters were significantly larger under the state of chronic heart failure(group B) than acute heart failure(group A)(p<0.05). On gross inspection, variable degrees of adhesion and inflammation were present in all 5 dogs of group A, including 2 dogs that showed no muscle contraction. No adhesion and inflammation were, however, present in all 5 dogs of group B, which showed vivid muscle contractions. Considering these differences in gross findings along with the following premise that the acute heart failure state was not statistically different from the chronic one in terms of left ventricular parameters(p>0.05), the larger augmentation effect seen in group B is presumed to be mainly attributed to the viability and contractility of the LD muscle. Conclusion: These results indicate that the positive circulatory augmentation effect of cardiomyoplasty is apparent only under the state of heart failure and the preservation of muscle contractility is important to maximize this effect.

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