No abstract

RIPC by serial balloon inflations and deflations during PCI was found to confer protection against AKI in patients with a non-ST-segment elevation myocardial infarction undergoing PCI. The reduction in the rate of AKI translated into a clear trend (of borderline significance) toward better 30-day clinical outcome.

Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.

Objective: The purpose of the present study was to provide evidence regarding the safety of real-time flashcontrast echocardiography combined with dobutamineatropine stress echo (DASE). Background: The combination of perfusion assessment using myocardial contrast echocardiography (MCE) with DASE has shown very promising results for the diagnosis of coronary artery disease. Concerns have, however, been expressed regarding the safety of the use of echocontrast agents in echocardiography. Design: 5250 individuals (70.8% men, aged 64.6 years (SD 10.6)) were submitted to DASE, with concurrent MCE using a low mechanical index technique with the administration of high-energy impulses in order to assess replenishment time. Results: No deaths or myocardial infarctions were observed. Sustained ventricular tachycardia (VT) or fibrillation requiring resuscitation occurred in two cases (0.04%). The incidence of other arrhythmic events was: sustained VT not requiring resuscitation, 10 (0.18%); nonsustained VT, 18 (0.34%); atrial tachycardia, 4 (0.08%); atrial fibrillation, 25 (0.48%). Other observed adverse events included: intense headache, 52 (1%); intense back pain, 26 (0.5%). Vagal reactions with marked systolic blood pressure falls were observed in 45 cases (0.9%). Hypersensitivity reactions were reported in 23 cases (0.44%), although no serious cases of hypersensitivity requiring hospitalisation were recorded. The sensitivity, specificity and overall accuracy of DASE/MCE were 92%, 61% and 85%, respectively. Conclusions: This report of safety data regarding stresscontrast echocardiography in a large series of subjects suggests that this is an exceptionally safe technique, given that in 5250 studies no study-related deaths or myocardial infarctions were encountered, whereas serious adverse events requiring hospitalisation were extremely rare (one in 2625 studies).