Lege Artis Medicinae

[A Natural History of Risk on the Apropos of Healthcare Services ]

HANTI Péter

JULY 20, 2012

Lege Artis Medicinae - 2012;22(06-07)

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[Use of a drug-eluting stent for the treatment of in-stent restenosis of the superior mesenteric artery]

P. SZABÓ Réka, PÉTER Mózes, VARGA István, VAJDA Gusztáv, HARANGI Mariann, MÁTYUS János, BALLA József

[INTRODUCTION - Diagnosis and treating intestinal ischaemia in time presents a great challenge for clinicians. CASE REPORT - In a 60-year-old woman on dialysis who presented with abdominal angina, angiography revealed stenosis of the superior mesenteric artery, which was treated by implantation of a 6×29 mm Genesis stent. After a year, her symptoms reoccurred and angiography revealed restenosis, which was treated with a 7×34 mm Wallstent, while her previous acetylsalicylic acid treatment was supplemented with clopidrogel. Nevertheless, her abdominal angina reoccurred again after a year. During the next intervention - because of the in-stent restenosis - a Taxus Liberte stent was implanted. During the dual antiplatelet therapy, her abdominal complaints did not reoccur, her body weight increased and angiography did not reveal restenosis in the affected artery even after 4 years. CONCLUSIONS - A drug-eluting stent can be a good choice in case of restenosis of the superior mesenteric artery. In a stented patient, it is crucial to use an appropriately controlled, long-term, dual antiplatelet therapy.]

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Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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