Background: Antiplatelet therapy with clopidogrel decreases ischemic complication especially in patients with acute coronary syndromes or after percutaneous coronary interventions. Our study was designed to test the e...Background: Antiplatelet therapy with clopidogrel decreases ischemic complication especially in patients with acute coronary syndromes or after percutaneous coronary interventions. Our study was designed to test the effects of clopidogrel on soluble CD40 ligand(sCD40l) and on high- sensitivity C- reactive protein(hs- CRP) in patients with stable coronary artery disease(CAD). Methods: This is a randomized, double- blind, placebo- controlled study. A total of 73 patients with stable CAD for >6 months were randomized to receive either clopidogrel(loading dose 300 mg followed by 75 mg/d) for 8 weeks or placebo. Soluble CD40 ligand and hs- CRP were measured at baseline and at completion of the study. Results: All patients were on aspirin therapy, and 74% were on statins. Median and interquartile ranges(IQR) of sCD40l decreased from 64 pg/mL(43- 99) at baseline to 53 pg/mL(35- 77) at 8 weeks(P=.03) in the clopidogrel group and remained unchanged in the placebo group(59 pg/mL, IQR 35- 77 vs 55 pg/mL, IQR 35- 78)(P=non significant). Levels of hs- CRP were not affected by therapy and remained unchanged in both groups. Conclusions: In patients with stable CAD, clopidogrel inhibits the release of sCD40l by platelets, which may contribute to the clinical benefit provided by this drug. This, however, does not translate in a reduction of subclinical inflammation, as measured by hs- CRP.展开更多
Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a g...Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance.Design:Retrospective chart review.Setting:Academic medical center.Patients:Consecutive subjects from December 1,2002,to January 10,2005,with symptomatic pseudocysts in whom EUS-guided drainage was attempted.Interventions:By using a therapeutic linear echoendoscope,a 19-gauge aspiration needle was inserted into the pseudocyst.A guidewire was placed through the needle,and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa.The needle knife was then advanced by using electrocautery into the pseudocyst.The cystenterostomy was dilated by using a balloon over the guidewire.One to 4 stents were placed through the tract.Main Outcome Measurements:Successful pseudocyst drainage.Results:A total of 21 of 23 patients underwent technically successful pseudocyst drainage.One patient had self-limited hypotension during the procedure.Another patient had free intraperitoneal air after the procedure but correct stent placement.Limitations:Retrospective analysis,small sample size.Conclusions:In this preliminary experience,wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.展开更多
文摘Background: Antiplatelet therapy with clopidogrel decreases ischemic complication especially in patients with acute coronary syndromes or after percutaneous coronary interventions. Our study was designed to test the effects of clopidogrel on soluble CD40 ligand(sCD40l) and on high- sensitivity C- reactive protein(hs- CRP) in patients with stable coronary artery disease(CAD). Methods: This is a randomized, double- blind, placebo- controlled study. A total of 73 patients with stable CAD for >6 months were randomized to receive either clopidogrel(loading dose 300 mg followed by 75 mg/d) for 8 weeks or placebo. Soluble CD40 ligand and hs- CRP were measured at baseline and at completion of the study. Results: All patients were on aspirin therapy, and 74% were on statins. Median and interquartile ranges(IQR) of sCD40l decreased from 64 pg/mL(43- 99) at baseline to 53 pg/mL(35- 77) at 8 weeks(P=.03) in the clopidogrel group and remained unchanged in the placebo group(59 pg/mL, IQR 35- 77 vs 55 pg/mL, IQR 35- 78)(P=non significant). Levels of hs- CRP were not affected by therapy and remained unchanged in both groups. Conclusions: In patients with stable CAD, clopidogrel inhibits the release of sCD40l by platelets, which may contribute to the clinical benefit provided by this drug. This, however, does not translate in a reduction of subclinical inflammation, as measured by hs- CRP.
文摘Background:Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.Objective:A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance.Design:Retrospective chart review.Setting:Academic medical center.Patients:Consecutive subjects from December 1,2002,to January 10,2005,with symptomatic pseudocysts in whom EUS-guided drainage was attempted.Interventions:By using a therapeutic linear echoendoscope,a 19-gauge aspiration needle was inserted into the pseudocyst.A guidewire was placed through the needle,and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa.The needle knife was then advanced by using electrocautery into the pseudocyst.The cystenterostomy was dilated by using a balloon over the guidewire.One to 4 stents were placed through the tract.Main Outcome Measurements:Successful pseudocyst drainage.Results:A total of 21 of 23 patients underwent technically successful pseudocyst drainage.One patient had self-limited hypotension during the procedure.Another patient had free intraperitoneal air after the procedure but correct stent placement.Limitations:Retrospective analysis,small sample size.Conclusions:In this preliminary experience,wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.
