• Title/Summary/Keyword: Cardiac dose reduction

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Comparison of Clopidogrel versus Cilostazol in Coronary Artery Stenting (관상동맥 스텐트 삽입술 후 Clopidogrel과 Cilostazol의 비교)

  • Song, In-Sook;Choi, Seung-Ki;Oh, Jung-Mi
    • Korean Journal of Clinical Pharmacy
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    • v.15 no.2
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    • pp.105-117
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    • 2005
  • Following intracoronary stenting, antiplatelet therapy lead to greater protection from thrombotic complication. A few data are available about the effect of clopidogrel versus cilostazol, an antiplatelet commonly used after intracoronary stenting. To evaluate the efficacy and safety of clopidogrel plus aspirin compared with those of cilostazol plus aspirin in coronary stenting and to evaluate the efficacy of clopidogrel loading dose prior to coronary stealing in clopidogrel group. Data were retrospectively collected from medical charts of patients who had undergone coronary stenting and received either clopidogrel with or without loading 300 mg followed by 75 mg/d (n=58), or 200 mg/d cilostazol(n=72) for 1 year, between January 2000 and May 2002. All patients in both groups received aspirin 200 mg/d throughout the study. The primary endpoints at 7, 30, 180 and 365 days after stealing were the composite of death, Myocardial Infarction, stroke, angina, and revascularization in the intent to treat population and restenosis at follow up angiography. The secondary endpoints were the incidence of bleeding complications at 7, 30, and 365 days, and durg adverse effects at 365 days after stenting. At 180 and 365 days after stenting, the combined primary endpoints were significantly reduced in clopidogrel plus aspirin group (relative risk 0.39; 95% CI 0.17 to 0.92; p=0.021, RR 0.43; 95% CI 0.22 to 0.84; p=0.0085, respectively). However, the combined primary endpoints were not significantly different between the two groups at 7 and 30 days (p:1.00, p=0.79, respectively). Angiographic restenosis rate was 14.3% in clopidogrel plus aspirin uoup and 32.1% in cilostazol plus aspirin group (p=0.19). 300mg of clopidogrel loading dose did not significantly reduce the combined primary endpoints at 30 days after stenting (RR 0.14; 95% CI 0.01 to 2.65; p=0.23). The rate of bleeding complications and drug adverse effects were not different between the two groups. In patients undergoing intracoronary stenting, clopidogrel plus aspirin therapy is more beneficial than cilostazol plus aspirin in reducing major adverse cardiac events with similar rate of bleeding complication. A loading dose of clopidogrel did not lead to a statistically significant reduction in major adverse cardiac events.

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Evaluation of Radiation Dose and Image Quality Between Manual and Automatic Exposure Control Mode According to Body Mass Index in Cardiac CT (체질량지수에 따른 심장 CT검사의 수동노출조절 방법과 자동노출조절 방법의 방사선량 및 화질 평가)

  • Kim, Hyeong-Jin;Moon, Il-Bong;Han, Jae-Bok;Choi, Nam-Gil;Jang, Seong-Ju
    • The Journal of the Korea Contents Association
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    • v.13 no.4
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    • pp.290-299
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    • 2013
  • This study included 198 patients who underwent prospectively electrocardiogram-triggered high-pitch spiral mode(FLASH mode) in cardiac CT for health check: 123 patients who underwent manual exposure control(Group A) and 75 patients who underwent automatic exposure control(Group B). Patients were classified according to BMI grades: Grade 1, Grade 2, Grade 3, Grade 4. Radiation dose, objective and subjective image quality between two groups were compared. In Group B, tube voltage were significantly decreased in all BMI grades. Both $CTDI_{vol}$ and effective dose were significantly reduced in the BMI Grade 1, 3, and 4 whereas they were slightly reduced in the Grade 2(p>0.05), SNR was significantly decreased in the Grade 1 and increased in the Grade 3(p<0.05), but there was no significant difference in the Grade 2, 4 between the two groups(p>0.05). CNR was significantly decreased in the Grade 1(p<0.05), and there was no significant difference in the Grade 2, 3, 4 between the two groups(p>0.05). The subjective image quality showed no significant difference in all BMI Grades between the two groups(p>0.05). Automatic exposure control can lead to a significant reduction of radiation exposure dose without degradation of subjective image quality.

A Study on Radiation Dose and Image Quality using Dual Energy Computed Tomography ECG Gating High Pitch Chest Pain Protocol Mode (이중 에너지 전산화 단층촬영 ECG Gating High Pitch Chest Pain Protocol 모드를 이용한 방사선량과 영상 품질에 관한 연구)

  • Kim, Gyeong-Rip;Sung, Soon-Ki;Kim, Chang-Hyeun;Kwak, Jong-Hyeok
    • Journal of the Korean Society of Radiology
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    • v.16 no.1
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    • pp.7-13
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    • 2022
  • This study compared the aortic root image by using the ECG gating and non-ECG gating methods. We observed the presence or absence of progression of the aortic root image in the images examined by the high pitch (flash) chest pain protocol method and in the patients tested without ECG gating by the conventional method. The AAPM phantom was scanned by using high pitch (flash) chest pain protocol and general chest pain protocol. CTDI values were compared. By ECG gating, the blurring of ascending aorta was significantly reduced compared to the existing non-ECG gating test method, and the image quality of the aortic root was improved. Within the parametar range that did not show differences in noise, uniformity, and high contrast resolution, CTDI values were lower when tested with the high-pitch chest pain protocol. It was found that there is an advantage in dose reduction, and if it is applied and applied to diagnostic fields such as dissection using the dose reduction mode in the cardiac field, it is a very important test for patients who need rapid diagnosis and prompt treatment as well as a dramatic reduction in exposure dose. It is presumed to be a method.

Morphological Factors and Cardiac Doses in Whole Breast Radiation for Left-sided Breast Cancer

  • Guan, Hui;Dong, Yuan-Li;Ding, Li-Jie;Zhang, Zi-Cheng;Huang, Wei;Liu, Cheng-Xin;Fu, Cheng-Rui;Zhu, Jian;Li, Hong-Sheng;Li, Miao-Miao;Li, Bao-Sheng
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.7
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    • pp.2889-2894
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    • 2015
  • Background: To investigate the impact of the breast size, shape, maximum heart depth (MDH), and chest wall hypotenuse (the distance connecting middle point of the sternum and the length of lung draw on the selected transverse CT slice) on the volumetric dose to heart with whole breast irradiation (WBI) of left-sided breast cancer patients. Materials and Methods: Fifty-three patients with left-sided breast cancer undergoing adjuvant intensity-modulated radiotherapy (IMRT) were enrolled in the study. The primary breast size and shape, MHD and DCWH (chest wall hypotenuse) were contoured on radiotherapy (RT) planning CT slices. The dose data of hearts were obtained from the dose-volume histograms (DVHs). Data were analyzed by one-way analysis of variance (ANOVA), Student's t-test and linear regression analysis. Results: Breast size was independent of heart dose, whereas breast shape, MHD and DCWH were correlated with heart dose. The shapes of breasts were divided into four types, as the flap type, hemisphere type, cone type and pendulous type with heart mean dose being $491.8{\pm}234.6cGy$, $752.7{\pm}219.0cGy$, $620.2{\pm}275.7cGy$, and $666.1{\pm}238.0cGy$, respectively. The flap type of breasts shows a strong statistically reduction in heart dose, compared to others (p=0.008 for V30 of heart). DCWH and MHD were found to be the most important parameters correlating with heart dose in WBI. Conclusions: More attention should be paid to the heart dose of non-flap type patients. The MHD was found to be the most important parameter to correlate with heart dose in tangential WBI, closely followed by the DCWH, which could help radiation oncologists and physicsts evaluate heart dose and design RT plan in advance.

Effect of Na, K, Ca and Mg ions on the Action Potential of the Sinoatrial Node in the Rabbit (토끼 동방결절 활동전압에 대한 Na, K, Ca 및 Mg 이온의 영향)

  • Lee, Jeong-Ryeol;Eom, Yung-Ui
    • Journal of Chest Surgery
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    • v.18 no.1
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    • pp.1-6
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    • 1985
  • Isolated sinus node cells of the rabbit were used to assess the effects of extracellular Na, K, Ca and Mg concentrations on cardiac pacemaker activity. With intracellular glass micro-electrodes spontaneous action potentials of SA node were recorded and the effects of various ions and their blockers were analyzed in terms of the cycle length, the amplitude and the duration of action potentials, the results obtained were as follows. 1. Sodium reduction [up to 30%] decreased the amplitude of action potential and lengthened the cycle length. TTX, specific blocker of Na channel slightly lengthened the cycle length. 2. Increasing potassium ion concentration, the duration of action potential decreased and the frequency increased in 6mM, however, spontaneous action potential was stopped in 24 mM. Barium ion known to be decreasing K conductance increased the duration of action potential but no significant change in the cycle length was noticed. 3. Calcium ion has shortening effect on the duration and the cycle length of action potential but not with dose-dependent manner. Cadmium ion .[0.02mM] lengthened cycle length and the duration of action potential. 4. Increasing the concentration of magnesium ion the cycle length was lengthened, significantly.

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Effect of Ethanol Administration on the Induction of Hypertension by Excessive Salt Ingestion in Rats (Ethanol이 식염성고혈압(食鹽性高血壓) 유발과정(誘發過程)에 미치는 영향(影響))

  • Kim, Kee-Soon;Lee, Pyung-Hee;Shin, Hong-Kee
    • The Korean Journal of Physiology
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    • v.7 no.2
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    • pp.25-30
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    • 1973
  • In 30 rats divided into salt, ethanol and salt plus ethanol groups, the effect of ethanol on the course of hypertension induction with the salt ingestion was studied. The results obtained from the present study are as follows. 1) In salt group mean arterial blood pressure elevated to plateau (about 140 mmHg) in two weeks and the increased blood pressure was well maintained throughout entire experimental period. 2) By four weeks after ethanol ingestion, mean arterial blood pressure of ethanol group was slightly decreased followed thereafter by slow restoration to control value. And it was believed that decline of blood pressure observed in this case probably was not resulted from cardiac depression. 3) As mean arterial pressure in salt plus ethanol group remained rather low compared with that of salt group, it was suggested that ethanol may have a dose reduction effect in the course of hypertension induction by excessive salt ingestion. It was, however, not possible from the result of present study to decide that low blood Pressure in this group was resulted whether from enhanced sodium excretion activity of ethanol or from effect on blood pressure of ethanol itself.

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Impact of High-Dose Statin Pretreatment in Patients with Stable Angina during Off-Pump Coronary Artery Bypass

  • Youn, Young-Nam;Park, Seong-Yong;Hwang, Yoo-Hwa;Joo, Huyn-Chul;Yoo, Kyung-Jong
    • Journal of Chest Surgery
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    • v.44 no.3
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    • pp.208-214
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    • 2011
  • Background: Periprocedural treatment with high-dose statins is known to have cardioprotective and pleiotropic effects, such as anti-thrombotic and anti-inflammatory actions. We aimed to assess the efficacy of high-dose rosuvastatin loading in patients with stable angina undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: A total of 142 patients with stable angina who were scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60-mg rosuvastatin (rosuvastatin group, n=71) or no pre-treatment (control group, n=71) before OPCAB. The primary endpoint was the 30-day incidence of major adverse cardiac events (MACEs). The secondary endpoint was the change in the degree of myocardial ischemia as evaluated with creatine kinase-myocardial band (CK-MB) and troponin T (TnT). Results: There were no significant intergroup differences in preoperative risk factors or operative strategy. MACEs within 30 days after OPCAB occurred in one patient (1.4%) in the rosuvastatin group and four patients (5.6%) in the control group, respectively (p=0.37). Preoperative CK-MB and TnT were not different between the groups. After OPCAB, the mean maximum CK-MB was significantly higher in the control group (rosuvastatin group $10.7{\pm}9.75$ ng/mL, control group $14.6{\pm}12.9$ ng/mL, p=0.04). Furthermore, the mean levels of maximum TnT were significantly higher in the control group (rosuvastatin group $0.18{\pm}0.16$ ng/mL, control group $0.39{\pm}0.70$ ng/mL, p=0.02). Conclusion: Our findings suggest that high-dose rosuvastatin loading before OPCAB surgery did not result in a significant reduction of 30-day MACEs. However, high-dose rosuvastatin reduced myocardial ischemia after OPCAB.

Effect of low-dose Aprotinin on Postoperative Bleeding and Renal Function after Cardiopulmonary Bypass (체외순환후 출혈감소와 신기능에 미치는 저용량 aprotinin효과)

  • 박철현;현성열;이현재;박국양;김주이;임창영
    • Journal of Chest Surgery
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    • v.31 no.1
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    • pp.32-39
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    • 1998
  • High-dose aprotinin(Hammersmith regimen) has been widely used for years to control postoperative bleeding and reduce blood consumption in cardiac surgery but had known to cause some side-effects and had disadvantage in cost-effectiveness. The prospective controlled study of 33 patients undergoing cardiopulmonary bypass was performed to evaluate the efficacy for reducing postoperative bleeding and unfavorable effects of low-dose aprotinin. The level of hemoglobin and platelet in the blood and the amount of postoperative bleeding were assessed preoperatively, and postoperatively for the study of hemostatic function. The level of BUN and serum creatinine in the blood, levels of urine creatinine, total protein, albumin, alpha-1-microglobulin and creatinine clearance were assessed before and after the operation for the study of renal function. The aprotinin group had a significant reduction in chest tube drainage; 243$\pm$ 123 ml versus 406$\pm$303 ml(P=0.037) during 6 hours immediate-postoperatively, 494$\pm$358 ml versus 869$\pm$570 ml(P=0.045) during 24 hours postoperatively. The ratio of alpha-1-microglobulin/creatinine and microalbumin/creatinine in the urine were slightly increased in the aprotinin group postoperatively in comparison with the control group but there were no statistically significant difference(55$\pm$23 versus 24$\pm$10 in the alpha-1-microglobulin/creatinine, 56$\pm$19 versus 38$\pm$25 in the microalbumin/creatinine at post- operative 3rd day). There were no significant difference between two groups in other parameters of renal function, too. This study showed that low-dose aprotinin is an effective means of reducing postoperative bleeding without inducing significant renal dysfunction.

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A Study of the Metal Artifact Reduction using Dual Energy CT : Clinical Applications of Dual Energy and MAR Algorithm (Dual Energy CT를 이용한 금속물질 인공물 감소방법 : Dual Energy와 MAR알고리즘의 임상적 응용)

  • Park, Ki Seok;Choi, Woo Jeon;Kim, Dong Hyun
    • Journal of the Korean Society of Radiology
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    • v.15 no.3
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    • pp.273-279
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    • 2021
  • Metal material inserted into the body have a large difference in density from human tissues or bones around the Metal during CT scans.. Therefore, the Metal material inserted into the body produces Artifact. Metal Artifact, which occurs around Metals, can degrade the quality of CT images, causing confusion when medical team diagnose lesions. Through this experiment, we confirm that the occurrence of Artifacts decrease by using Dual energy CT and MAR algorithm in Single source Dual energy CT. We also want to present basic data on clinical application methods by comparing and analyzing the characteristics of images obtained by each method. Using GE 750HD CT, artificial implants were scanned using general method and Dual energy. Then we apply the MAR algorithm to each image obtained. And all previously acquired images were compared and analyzed the characteristics of the examination, such as image quality evaluation and dose evaluation. Images with MAR algorithm and Dual Energy confirmed a decrease in Metal Artifact. Images with MAR algorithm have reduced Metal Artifact, but have the disadvantage of distorting the details of artificial joint implants. On the other hand images teseted with Dual Energy have the advantage of being able to implement details than those applied with MAR algorithms, it takes longer to reconstruct the image and the exposure dose was about four times higher than those applied with MAR algorithm. In order to locate Metals, such as the post-operative follow-up period, it is useful to apply MAR algorithm to obtain images. And it is more useful to examine with Dual Energy when micro lesion identification, such as cardiac examination, and surgical planning or when tests are performed in diagnostic way.

Aristolochia ringens extract ameliorates oxidative stress and dyslipidaemia associated with streptozotocin-induced hyperglycaemia in rats

  • Sulyman, Abdulhakeem Olarewaju;Akolade, Jubril Olayinka;Aladodo, Raliat Abimbola;Ibrahim, Rasheed Bolaji;Na'Allah, Asiat;Abdulazeez, Azeemat Titilola
    • CELLMED
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    • v.8 no.3
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    • pp.12.1-12.7
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    • 2018
  • The study was designed to assess antioxidant and antidyslipidaemic effects of terpenoid-rich extract from the root of Aristolochia ringens V. Hyperglycemia-induced oxidative stress and dyslipidemia were established in rats by single intraperitoneal administration of 65 mg/kg bw streptozotocin. Based on therapeutic dose determined in previous study, streptozotocin-induced rats were orally administered with 75 and 150 mg/Kg bw of A. ringens extract for 14 days. Total protein, serum lipid profiles and biomarkers of oxidative stress in liver and kidney of the experimental rats were determined. Atherogenic and cardiovascular disease risk indices were computed. Streptozotocin-induced hyperglycaemia significantly (p < 0.05) decreased activities of superoxide dismutase, catalase and glutathione transferase as well as the amount of reduced glutathione in both tissues indicating oxidative stress induced kidney and liver injury due to glucotoxicity. In comparison to non-treated hyperglycaemic rats, activities of the antioxidant enzymes and concentration of glutathione-H were significantly (p < 0.0001) increased, whereas malondialdehyde was reduced in the tissues of rats treated with both 75 and 150 mg/Kg bw of the extract. The extract also caused significant (p < 0.001) reduction in elevated levels of total cholesterol, triglycerides and low density lipoprotein-cholesterol levels, whereas concentration of the attenuated high density lipoprotein-cholesterol was increased in serum of the treated rats. Reduced atherogenic and cardiac risk indices were projected for the A. ringens extract-treated groups. Results from this study showed that extract from A. ringens root was rich in terpenoids and may reduce risks of complications associated with hyperglycemia-induced oxidative stress and dyslipidemia.