Hilinenult pöördunud südameinfarktihaigel tehtud edukas müokardi revaskulariseeriminetrombi aspiratsiooni ja kaetud stendiga. Haigusjuhu kirjeldus

Müokardiinfarkti haige kiire pöördumise korral haiglasse kasutatakse soone avamiseks esmavalikuna angioplastikat (PTKA – perkutaanne transluminaalne koronaarangioplastika) stentimisega. Haige hilise pöördumise korral on pärgarteri oklusiooni piirkonnas kujunemas ulatuslik tromboos. Angioplastika käigus soone mehaaniline rekanaliseerimine põhjustab enamasti trombimasside distaalse embolisatsiooni ning seeläbi nii antegraadse voolu lakkamise kui ka retrograadsete avanenud kollateraalide oklusiooni. Kokkuvõttes revaskulariseerimine sageli ebaõnnestub ja halvemal juhul infarktikolle laieneb.Eesti Arst 2014; 93(6):339–34

Ööpäevase invasiivkardioloogilise valveteenistuse osa ägeda koronaarsündroomiga haigete ravi ajakohastamisel

Tartu Ülikooli Kliinikumis on loodud teenistus ägeda müokardiinfarktiga ja ebastabiilse stenokardiaga haigete ööpäevaringse invasiivkardioloogilise abi osutamiseks. Loodud üksus tagab osale Eesti patsientidest praegu maailmas kasutusel oleva parimate tulemustega infarktiravimeetodi rakendamise ning ravijuhendipõhise arstiabi ööpäevaringse kättesaadavuse. Eesti Arst 2005; 84 (11): 775–78

Koronaarinterventsioonid südame halvenenud pumbafunktsiooniga patsientidel

Südamepuudulikkus on muutumas üha suuremaks tervishoiuprobleemiks kogu arenenud maailmas, haiguse üheks sagedasemaks tekkepõhjuseks on südame isheemiatõbi ja selle tüsistused (1). Südame vähenenud kontraktsioonivõimet on peetud koronaarinterventsioonide vastunäidustuseks ning protseduuride riski suurendavaks teguriks (2, 3). Samas on aga hästi teada müokardi isheemia (hüberneeruva müokardi) osa südamepuudulikkuse tekkes ja progresseerumises (4)

Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE) : a prospective, randomised, open-label, non-inferiority trial

Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1 . 35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1 . 48 (95% CI 1 . 11-1 . 96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0 . 0066). As-treated estimates were 28% versus 19% (1 . 55, 1 . 18-2 . 04, p= 0 . 0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1 . 07, 0 . 67-1 . 72, p= 0 . 77) for all-cause mortality, 7% versus 2% (2 . 88, 1 . 40-5 . 90, p= 0 . 0040) for non-procedural myocardial infarction, 16% versus 10% (1 . 50, 1 . 04-2 . 17, p= 0 . 032) for any revascularisation, and 5% versus 2% (2 . 25, 0 . 93-5 . 48, p= 0 . 073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease.Peer reviewe

Comparison of the metabolic syndrome risk in valproate-treated patients with epilepsy and the general population in Estonia.

BackgroundNo study has explored the risk of metabolic syndrome (MS) in patients with epilepsy treated with valproate (VPA) at the population level. The aim of this study was to compare the risk of MS in VPA-treated patients in Estonia to the risk in the general population.MethodsThis study involved 118 patients with epilepsy (63 men, 55 women) who received VPA monotherapy. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).ResultsIn the multiple logistic regression analysis, after adjustment for age and sex, the risk of MS in VPA-treated patients was not increased compared to the control subjects (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.59-1.68). VPA-treated patients had higher serum insulin concentrations than control subjects, independent of body mass index (BMI). A positive association was found between MS development and BMI (OR = 1.47; 95% CI, 1.25-1.73) in VPA-treated patients, but there were no associations with the VPA dosage or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. In control subjects, BMI and HOMA-IR had similar predictive abilities for MS occurrence. In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.ConclusionsThe risk of MS is not increased among VPA-treated patients with epilepsy in Estonia compared to the general population. The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population

Proteomic dataset of wolframin-deficient mouse heart and skeletal muscles.

The data presented in this article are related to the research article entitled "Increased Mitochondrial Protein Levels and Bioenergetics in the musculus rectus femoris of Wfs1-Deficient mice" (Eimre et al., accepted for publication). This dataset reports the analysis of Wfs1-deficient mouse heart, musculus soleus, and white part of musculus rectus femoris by liquid chromatography/tandem mass spectrometry. Label-free quantitative analysis of the mass spectrometry data identified 4056 proteins, with 114, 212, and 1290 proteins differentially expressed (t-test; p m. soleus, and m. rectus femoris, respectively, between the Wfs1-deficient and wild-type groups. Eight proteins were found to be differentially expressed in all mentioned muscles, with 1 protein differently expressed in oxidative (m. soleus and heart) and 88 in skeletal muscles. This dataset supports the cited study and can be used to extend additional analyses. Data are available via ProteomeXchange with identifier PXD011019

Flowchart for the inclusion of valproate-treated patients with epilepsy.

<p>Flowchart for the inclusion of valproate-treated patients with epilepsy.</p

B2I et EPS

Connaissances et capacités exigibles pour le Brevet informatique et internet au collège (B2I). Maîtriser les compétences du B2I aide les apprentissages en EPS : illustration en handball, course de durée, tennis de table, acrospor

Clinical characteristics of patients with epilepsy who received valproate treatment.

<p>Values are expressed as means (%) ± standard deviations, except for the number of patients, seizure type, and epilepsy etiology.</p><p>No, number; G, primarily generalized seizure type; L, localization-related seizure type; U, unknown; Gen, genetic; Str/met, structural/metabolic; VPA, valproate.</p

Characteristics of subjects receiving valproate monotherapy with and without metabolic syndrome.

<p>Data presented as means ± standard deviations.</p><p>VPA, valproate; HOMA-IR, homeostasis model assessment of insulin resistance.</p