50 results on '"Ricardo Wang"'
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2. Efeitos Anti-inflamatórios e Cardioprotetores do HDL-C: Associação com Autoanticorpos contra LDL Oxidada?
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Estêvão Lanna Figueiredo and Ricardo Wang
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Aterosclerose ,HDL-Colesterol ,Lipoproteínas-HDL ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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Catalog
3. Troponina – Use com Sabedoria. E como mais um Instrumento na Clínica
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Ricardo Wang and Estevāo Lanna Figueiredo
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Infarto do Miocárdio ,Biomarcadores ,Troponina ,Mortalidade ,Epidemiologia ,Isquemia Miocárdica ,Revascularização Miocárdica ,Síndrome Coronariana Aguda ,Prognóstico ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2022
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4. Dor Precordial em Idoso e Infarto. Não é Tão Elementar, Meu Caro Watson!
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Ricardo Wang, José Carlos da Costa Zanon, and Fernando Carvalho Neuschwander
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Dor no Peito ,Angina Pectoris ,Idoso ,Envelhecimento ,Infarto do Miocárdio/diagnóstico ,Síndrome Coronariana Aguda/diagnóstico ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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5. Uma Nova Via para Oclusão Coronariana com Elabela?
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Ricardo Wang, Estevão Lanna Figueiredo, and Fernando Carvalho Neuschwander
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Oclusão Coronária ,Angina Microvascular ,Miócitos Cardíacos ,Circulação Colateral ,Biomarcadores (Elabela) ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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6. Inflamação pós-Infarto Agudo do Miocárdio: 'Médico ou Monstro'
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Ricardo Wang, Fernando Carvalho Neuenschwander, and Bruno Ramos Nascimento
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Infarto do Miocárdio ,Inflamação/complicações ,Linfócitos Tipo B ,Citocinas ,Vasoplegia ,Choque Cardiogênico ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2021
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7. Uso de Intervenções Baseadas em Evidências na Síndrome Coronária Aguda – Subanálise do Registro ACCEPT
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Ricardo Wang, Fernando Carvalho Neuenschwander, Augusto Lima Filho, Celsa Maria Moreira, Elizabete Silva dos Santos, Helder Jose Lima Reis, Edson Renato Romano, Luiz Alberto Piva e Mattos, Otávio Berwanger, and Jadelson Pinheiro de Andrade more...
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Prática clínica baseada em evidências ,Síndrome coronariana aguda ,Registros de doenças ,Epidemiologia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Fundamento: As diretrizes baseiam-se em evidências para pautar suas recomendações; apesar disso, há uma lacuna entre o recomendado e a prática clínica. Objetivo: Descrever a prática de prescrição de tratamentos com indicação baseada em diretrizes para pacientes com síndrome coronariana aguda no Brasil. Métodos: Foi realizada uma subanálise do registro ACCEPT, na qual foram avaliados os dados epidemiológicos e a taxa de prescrição de ácido acetilsalicílico, inibidores P2Y12, antitrombóticos, betabloqueadores, inibidores da enzima conversora de angiotensina/bloqueadores AT1 e estatinas. Além disso, avaliou-se a qualidade da reperfusão coronariana no infarto com supradesnivelamento do segmento ST. Resultados: Foram avaliados 2.453 pacientes. As taxas de prescrição de ácido acetilsalicílico, inibidores de P2Y12, antitrombóticos, betabloqueadores, inibidores da enzima conversora de angiotensina/bloqueadores AT1 e estatinas foram, respectivamente, de 97,6%, 89,5%, 89,1, 80,2%, 67,9%, 90,6%, em 24 horas, e, respectivamente, de 89,3%, 53,6, 0%, 74,4%, 57,6%, 85,4%, em 6 meses. Com relação ao infarto com supradesnivelamento do segmento ST, somente 35,9% e 25,3% dos pacientes foram submetidos a angioplastia primária e trombólise, respectivamente, nos tempos recomendados. Conclusão: Este registro mostrou altas taxas de prescrição inicial de antiplaquetários, antitrombóticos e estatina, bem como taxas mais baixas de betabloqueadores e de inibidores da enzima conversora de angiotensina/bloqueadores AT1. Independentemente da classe, todos apresentaram queda do uso aos 6 meses. A maioria dos pacientes com infarto com supradesnivelamento do segmento ST não foi submetida a reperfusão coronariana no tempo recomendado. more...
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- 2014
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8. Avaliação da doença vascular do enxerto no transplante cardíaco: experiência de um centro brasileiro
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Elide Sbardellotto Mariano da Costa, Ricardo Wang, Michelle F. Susin, Sergio Lopes Veiga, Francisco Costa Diniz, Paulo Roberto Slud Brofman, and Lidia Ana Zytynski Moura
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Doenças vasculares ,doenças vasculares ,avaliação ,transplante de coração ,ultrasonografia ,Brasil ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
FUNDAMENTO: O transplante cardíaco continua sendo o tratamento de escolha para a insuficiência cardíaca refratária ao tratamento otimizado. Dois métodos diagnósticos apresentam elevada sensibilidade no diagnóstico de episódios de rejeição ao enxerto e Doença Vascular do Enxerto (DVE), causas importantes de mortalidade no pós-transplante. OBJETIVO: Avaliar a relação entre os resultados do ultrassom intracoronariano (USIV) e os laudos das biópsias endomiocárdicas (BX) no seguimento de pacientes submetidos a transplante cardíaco em um serviço de referência brasileiro. MÉTODOS: Foi realizado um ensaio epidemiológico retrospectivo observacional, com pacientes submetidos a transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os prontuários desses pacientes e os resultados dos USIV e BX realizados rotineiramente no seguimento clínico pós-transplante e terapêutica em uso. RESULTADOS: Dos 77 pacientes analisados, 63,63% são do sexo masculino, nas faixas etárias de 22 a 69 anos. Quanto aos resultados dos USIV, 33,96% foram classificados em Stanford classe I, e 32,08%, como Stanford IV. Dos 143 laudos das biópsias, 51,08% tiveram resultado 1R, 3R em 0,69% dos laudos, e 14,48% apresentaram a descrição de efeito Quilty. Todos usaram antiproliferativos, 80,51% usaram inibidores da calcineurina e 19,48% usaram inibidores do sinal de proliferação (ISP). CONCLUSÃO: A avaliação dos pacientes pós-transplante cardíaco por meio do USIV incorpora informações detalhadas para o diagnóstico precoce e sensível da DVE, que são complementadas pelas informações histológicas fornecidas pelas BX, estabelecendo uma possível relação causal entre a DVE e os episódios de rejeição humoral. more...
- Published
- 2012
9. Tronco de coronária esquerda ocluso secundário a Lues terciária Tronco de coronaria izquierda ocluido secundario a Lúes terciaria Occlusion of the left coronary trunk secondary to tertiary syphilis
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Ricardo Wang, Gustavo Blume, Newton Fernando Stadler Souza Filho, and Lidia Zytynski Moura
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Tronco arterial ,sífilis cardiovascular ,Truncus Arteriosus ,Syphilis, Cardiovascular ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Paciente de 27 anos, portador de sífilis terciária, manifestando isquemia miocárdica, com angina instável, secundária à oclusão do tronco da coronária esquerda. O diagnóstico foi confirmado pelos achados da sorologia e da patologia do fragmento da aorta.Paciente de 27 años, portador de sífilis terciaria, manifestando isquemia miocárdica, con angina inestable, secundaria a la oclusión del tronco de la coronaria izquierda. El diagnóstico fue confirmado por los resultados de la serología y de la patología del fragmento de la aorta.A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment. more...
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- 2009
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10. Angioplastia coronariana via transeptal em paciente com doença vascular periférica grave
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Ricardo Wang, Newton Stadler Souza Filho, Augusto Lima Filho, and Marcos Vinícius de Freitas Moreira
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2013
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11. Síndrome do balonamento apical secundário ao uso abusivo de descongestionante nasal Síndrome del abombamiento apical secundario al uso abusivo de descongestionante nasal Apical ballooning syndrome secondary to nasal decongestant abuse
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Ricardo Wang, Newton F. Stadler Souza, Jose Augusto Ribas Fortes, Gilmar Jorge dos Santos, Jose Rocha Faria Neto, and Lidia Zytinski
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Infarto do Miocárdio ,Síndrome Coronariana Aguda ,Agonistas Adrenérgicos ,Miocárdio Atordoado ,Myocardial infarction ,acute coronary syndrome ,adrenergic agonists ,myocardial stunning ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Descrevemos um caso típico de síndrome do balonamento apical em uma paciente octogenária com alteração eletrocardiográfica, de contratilidade do ventrículo esquerdo, e que apresentou recuperação da função ventricular. A paciente é portadora de rinite alérgica e fez uso excessivo de descongestionante nasal horas antes do episódio da dor.Describimos un caso típico de síndrome de abombamiento apical en una paciente octogenaria con alteración electrocardiográfica, de contractilidad del ventrículo izquierdo, y que presentó recuperación de la función ventricular. La paciente es portadora de rinitis alérgica y hace uso excesivo de descongestionante nasal horas antes del episodio del dolor.We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain. more...
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- 2009
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12. Reduced Progression of Cardiac Allograft Vasculopathy with Routine Use of Induction Therapy with Basiliximab
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Ricardo Wang, Lidia Ana Zytynski Moura,, Sergio Veiga Lopes, Francisco Diniz Affonso da Costa, Newton Fernando Stadler Souza Filho, Tiago Luiz Fernandes, Natália Boing Salvatti, and José Rocha Faria-Neto more...
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Doenças Vasculares / fisiopatologia ,Transplante Cardíaco ,Anticorpos Monoclonais Murinos / administração & dosagem ,Imunossupressores ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Introduction: Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV. Objectives: The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group. Methods: Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel. Results: Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3 [∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001). Conclusion: Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT. more...
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- 2015
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13. Aterosclerose e Inflamação: Ainda Muito Caminho a Percorrer
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Ricardo Wang, Bruno Ramos Nascimento, and Fernando Carvalho Neuenschwander
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atherosclerosis/physiopathology ,inflammation ,interleukin-18 ,thrombosis ,coronary artery disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Full Text
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14. Antiinflammatory and Cardioprotective Effects of HDL-C: Association With Autoantibodies Against Oxidized LDL?
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Estêvão Lanna, Figueiredo and Ricardo, Wang
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Lipoproteins, LDL ,Humans ,Autoantibodies - Published
- 2022
15. Antiinflammatory and Cardioprotective Effects of HDL-C: Association With Autoantibodies Against Oxidized LDL?
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Estêvão Lanna Figueiredo and Ricardo Wang
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Lipoproteínas-HDL ,Aterosclerose ,Cholesterol, HDL ,Cardiology and Cardiovascular Medicine ,Atherosclerosis ,Lipoproteins, HDL ,HDL-Colesterol - Published
- 2022
16. Troponin - Use it wisely. And as Another Instrument in the Clinic
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Ricardo, Wang and Estevāo Lanna, Figueiredo
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Humans ,Troponin - Published
- 2022
17. Troponin – Use it wisely. And as Another Instrument in the Clinic
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Ricardo Wang and Estevāo Lanna Figueiredo
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Epidemiology ,Troponina ,Prognóstico ,Myocardial Infarction ,Myocardial Ischemia ,Prognosis ,Troponin ,Isquemia Miocárdica ,Síndrome Coronariana Aguda ,Biomarcadores ,Mortalidade ,Myocardial Revascularization ,Infarto do Miocárdio ,Mortality ,Acute Coronary Syndrome ,Cardiology and Cardiovascular Medicine ,Epidemiologia ,Revascularização Miocárdica ,Biomarkers - Published
- 2022
18. A New Pathway to Coronary Occlusion with Elabela?
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Ricardo, Wang, Estevão Lanna, Figueiredo, and Fernando Carvalho, Neuschwander
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Male ,Minieditorial ,Collateral Circulation ,Chronic Total Occlusion ,Coronary Angiography ,Angina Pectoris ,Pre-Eclampsia ,Colateral Circulation ,Pregnancy ,Angiografia Coronária ,Biomarkers (Elabela) ,Circulação Colateral ,Humans ,Myocytes, Cardiac ,Angina, Stable ,Apelina ,Oclusão Coronária ,Microvascular Angina ,Aged ,Biomarcadores (Elabela) ,Peptídeos ,Angina Microvascular ,Artigo Original ,Middle Aged ,Coronary Vessels ,Oclusão Total Crônica ,Coronary Occlusion ,Chronic Disease ,Multivariate Analysis ,Apelin ,Miócitos Cardíacos ,Female ,Original Article ,Elabela ,Short Editorial ,Peptides - Abstract
The beneficial effects of Elabela on the cardiovascular system have been shown in studies.To compare serum Elabela levels of chronic total occlusion (CTO) patients with control patients with normal coronary arteries, and to investigate whether there is a correlation with collateral development.The study was planned cross-sectionally and prospectively. Fifty patients (28.0% female, mean age 61.6±7.3years) with CTO in at least one coronary vessel and 50 patients (38% female, mean age 60,7±6.38 years) with normal coronary arteries were included in the study. Patients in the CTO group were divided into two groups as Rentrop 0-1, those with weak collateral development, and Rentrop 2-3 with good collateral development. In addition to the age, sex, demographic characteristics and routine laboratory tests of the patients, Elabela levels were measured.Demographic characteristics and laboratory values were similar in both groups. While the mean NT-proBNP and troponin were higher in the CTO group, the Elabela mean was lower (p0.05 for all). In the multivariate regression analysis, NT-proBNP and Elabela levels were found to be independent predictors for CTO. Also, Elabela level was found to be statistically higher in Rentrop class 2-3 patients compared to Rentrop class 0-1 patients (p0.05).In our study, we showed that the average Elabela level was low in CTO patients compared to normal patients. In addition, we found the level of Elabela to be lower in patients with weak collateral development compared to patients with good collateral development. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).Os efeitos benéficos do elabela no sistema cardiovascular foram demonstrados em estudos.Comparar os níveis séricos de elabela de pacientes com oclusão total crônica (OTC) com pacientes controle com artérias coronárias normais e investigar se há correlação com o desenvolvimento colateral.Estudo transversal e prospectivo. O estudo incluiu cinquenta pacientes (28,0% mulheres, idade média 61,6±7,3 anos) com OTC em pelo menos um vaso coronário e 50 pacientes (38% mulheres, idade média 60,7±6,38 anos) com artérias coronárias normais. Os pacientes do grupo OTC foram divididos em dois grupos: Rentrop 0–1, composto por pacientes com fraco desenvolvimento colateral e Rentrop 2–3, composto por pacientes com bom desenvolvimento colateral. Além da idade, sexo, características demográficas e exames laboratoriais de rotina dos pacientes, foram medidos os níveis de elabela.As características demográficas e os valores laboratoriais mostraram-se semelhantes em ambos os grupos. Ao passo que o nível médio de NT-proBNP e troponina estava maior no grupo OTC, o nível médio de elabela estava menor (p0,05 para todos). Na análise de regressão multivariada, os níveis de NT-proBNP e elabela foram considerados preditores independentes para OTC. Além disso, o nível de elabela apresentou-se estatisticamente maior em pacientes do grupo Rentrop 2–3 em comparação com os pacientes do grupo Rentrop 0–1 (p0,05).Em nosso estudo, mostramos que o nível médio de elabela estava baixo em pacientes com OTC em comparação com pacientes normais. Além disso, constatamos que o nível de elabela é inferior em pacientes com desenvolvimento colateral fraco em comparação com pacientes com bom desenvolvimento colateral. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0). more...
- Published
- 2021
19. A New Pathway to Coronary Occlusion with Elabela?
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Ricardo Wang, Estevão Lanna Figueiredo, and Fernando Carvalho Neuschwander
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Biomarcadores (Elabela) ,Coronary Occlusion ,RC666-701 ,Angina Microvascular ,Circulação Colateral ,Biomarkers (Elabela) ,Diseases of the circulatory (Cardiovascular) system ,Collateral Circulation ,Miócitos Cardíacos ,Myocytes, Cardiac ,Oclusão Coronária ,Microvascular Angina - Published
- 2021
20. Precordial Pain and Infarction in the Elderly. It´S no so Elementary, My Dear Watson!
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Ricardo, Wang, José Carlos da Costa, Zanon, and Fernando Carvalho, Neuschwander
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Síndrome Coronariana Aguda ,Chest Pain ,Elderly ,Infarction ,Idoso ,Prognóstico ,Artigo Original ,Dor no Peito ,Humans ,Original Article ,Acute Coronary Syndrome ,Prognosis ,Aged - Abstract
Resumo Fundamento De acordo com o pensamento diagnóstico tradicional, indivíduos muito idosos estão mais predispostos a desenvolver sintomas atípicos em síndromes coronarianas agudas. Objetivo Testar a hipótese de que indivíduos muito idosos estão mais predispostos a manifestações de dor torácica atípica devido à doença arterial coronariana obstrutiva (DAC). Métodos O Registro de dor torácica inclui pacientes internados com dor torácica aguda. Primeiramente, foi construído o índice de tipicidade dessa manifestação clínica: a soma de 12 características de sintomas (8 sintomas típicos e 4 sintomas atípicos). No subgrupo de pacientes com etiologia coronariana, o índice de tipicidade foi comparado entre octogenários e não octogenários. A significância estatística foi definida por p more...
- Published
- 2021
21. Dor Precordial em Idoso e Infarto. Não é Tão Elementar, Meu Caro Watson!
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José Carlos da Costa Zanon, Fernando Carvalho Neuschwander, and Ricardo Wang
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Chest Pain ,Aging ,Infarto do Miocárdio/diagnóstico ,business.industry ,Envelhecimento ,Idoso ,Dor no Peito ,Acute Coronary Syndrome/diagnosis ,Angina Pectoris ,RC666-701 ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Síndrome Coronariana Aguda/diagnóstico ,Myocardial Infarction/diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Humanities ,Aged - Published
- 2021
22. Inflammation Post-Acute Myocardial Infarction: 'Doctor or Monster'
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Ricardo, Wang, Fernando Carvalho, Neuenschwander, and Bruno Ramos, Nascimento
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Inflammation ,B-Lymphocytes ,Myocardial Infarction ,Shock, Cardiogenic ,Minieditorial ,Citocinas ,Choque Cardiogênico ,Inflammation/complications ,Linfócitos Tipo B ,Vasoplegia ,Humans ,Inflamação/complicações ,Cytokines ,Infarto do Miocárdio ,Short Editorial - Published
- 2021
23. Manual thromboaspiration during primary percutaneous intervention in the Brazilian practice
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Leonardo Greco Machado, Marcelo José de Carvalho Cantarelli, Ricardo Wang, Adriana Costa Diamantino, Roberto Botelho, Gustavo Monteiro Soares, Saulo Augusto de Lima, Daniel Ramos, Viviana de Mello Guzzo Lemke, and Freddy Garcia Montecinos more...
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Gynecology ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine ,business - Abstract
RESUMO Introducao A aspiracao manual de trombos durante a intervencao coronaria percutânea primaria foi muito utilizada no fim da decada passada, mas, a partir de resultados de publicacoes recentes, houve queda em seu grau de recomendacao. O objetivo deste trabalho foi avaliar o uso desta tecnica no Brasil. Metodos Utilizando dados da Central Nacional de Intervencoes Cardiovasculares (CENIC) do periodo de 2008 a 2016, avaliamos pacientes submetidos a intervencao coronaria percutânea primaria que realizaram tromboaspiracao manual. Dividimos a analise em [...] more...
- Published
- 2018
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24. Cangrelor With and Without Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention
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Muthiah Vaduganathan, Robert A. Harrington, Gregg W. Stone, Efthymios N. Deliargyris, Ph. Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Matthew J. Price, Alberto Menozzi, Jayne Prats, Steven Elkin, Kenneth W. Mahaffey, Harvey D. White, Deepak L. Bhatt, Fernando Cura, Miguel Ballarino, Anibal Agustín Damonte, Diego Grinfeld, Carlos Alejandro Álvarez, Alberto Fernandez, Ahmad Farshid, Brendan Gunalingam, Craig Jeurgens, Harry Lowe, Hisham Hallani, Greg Nelson, Gishel New, Ronald Dick, Jeffrey Lefkovits, Stephen Duffy, Nick Bett, Raibhan Yadav, Paul Garrahy, Ron Lehman, Philip Aylward, John Horowitz, Matthew Worthley, David Cross, Jaime Rankin, Peter Thompson, Phil Roberts-Thomson, Rohan Jayasinghe, Con Aroney, Kurt Huber, Franz Leisch, Johann Altenberger, Georg Gaul, Thomas Neunteufl, Franz Weidinger, Herwig Schuchlenz, Heinrich Weber, Werner Benzer, Paulo Rossi, Breno Almeida, Antonio Godinho, Fabio Vilas-Boas, Luciano Vacanti, Renato Serpa, José Antonio Jatene, Gilmar Reis, Jamil Saad, Marcos Marino, Roberto Botelho, Constantino Costantini, Ricardo Wang, Dalton Precoma, Miguel Rati, Luis Bodanese, Euler Manenti, João Paulo Zouvi, Rogerio Tumelero, Arthur Herdy, Eulogio Martinez Filho, Antônio Carvalho, Roberto Franken, Lawrence Title, Charles Lazzam, Francois Reeves, Tamaz Shaburishvili, Gulnara Chapidze, Merab Mamatsashvili, Irakli Khintibidze, Hubertus Heuer, Hans-Georg Olbrich, Sabine Genth-Zotz, Sven Moebius-Winkler, Michael Buerke, Stefan Hoffmann, Peter Radke, Helge Moellmann, Hugo Katus, Hans-Friedrich Voehringer, Christian Hengstenberg, Volker Klauss, Johannes Brachmann, Aftab Khan, Sampath Kumar, Padinhare Mohanan, Praveen Chandra, Maddury Rao, S.S. Ramesh, Keyur Parikh, Arun Srinivas, Nakul Sinha, V.S. Prakash, Shirish Hiremath, Anil Mishra, Sanjeeb Roy, Kamal Sethi, Ashwani Mehta, Tejas Patel, Suman Bhandari, Milind Gadkari, Stefano De Servi, Giuseppe Musumeci, Bernardo Cortese, Giancarlo Marenzi, Raffaele De Caterina, Ralph Stewart, Gerard Devlin, Scott Harding, John Elliott, Gerard Wilkins, Douglas Scott, Slawomir Dobrzycki, Waldemar Dorniak, Dariusz Dudek, Zbigniew Gasior, Jaroslaw Hiczkiewicz, Zdzislawa Kornacewicz-Jach, Leszek Kubik, Krzysztof Kuc, Jerzy Kuzniar, Walentyna Mazurek, Jakub Ostrowski, Michal Tendera, Andrzej Wisniewski, Elzbieta Zinka, Krzysztof Zmudka, Jana Pawła, Maciej Kosmider, null Seweryna, Andres Iñiguez, Rafael Melgares, Francisco Goicolea, Jose Hernandez, Javier Zueco, Igor Kraiz, Mykola Vatutin, Anatoliy Polyakov, Yury Sokolov, Kenneth House, Charles Campbell, Timothy Trageser, Kenneth Baran, Neal Kleiman, Roberto Medina, Roger Hill, M. Zubair Jafar, David Drenning, Herbert Ladley, Ahed Nahhas, Alan Niederman, Amit Goyal, William Abernethy, Naseem Jaffrani, Richard Zelman, Brian Negus, Jose Marquez, Ehtisham Mahmud, William French, John Paulowski, Charles Pollack, Mark Mines, Robert Federici, Marc Schweiger, Kalim Habet, Ofsman Quintana, Thomas Nygaard, Steve Orlow, Douglas Spriggs, Ivan Chavez, Mark Warner, Richard Paulus, David Cochran, Cary Hirsch, Ajay Virmani, Peter Soukas, Nalin Srivastava, L. Norman Ferrier, Annapoorna Kini, Mark Greenberg, Howard Herrmann, Valerian Fernandes, Barry Bertolet, Ron Waksman, Joseph Henderson, Harinder Gogia, Maged Amine, Kourosh Mastali, Thomas Stuckey, Peter Hui, Luigi Pacifico, Todd Caulfield, Wilson Ginete, William Ballard, Robert Iwaoka, Joseph Stella, Vijay Misra, Costa Andreou, Michele Voeltz, Wayne Batchelor, Cezar Staniloae, Sanford Gips, Jeffrey Kramer, Paul Mahoney, John Wang, Prospero Gogo, David Rizik, Rex Winters, Garry MacKenzie, Stephen Jenkins, Paul Teirstein, Pierre Leimgruber, J. Christopher Scott, Seth Krauss, Steven Rohrbeck, Robert Martin, Gustavo Grieco, Louis Cannon, Don Westerhausen, F. David Fortuin, Steven Schulman, Joel Cohn, Brent McLaurin, Jorge Saucedo, Robert Wozniak, Jack Hall, Kevin Marzo, Merrill Krolick, Lawrence Gimple, Eric Hockstad, Arsenio Rodriguez, John Kao, Adhir Shroff, Michael Attubato, Ramon Quesada, Ernesto Rivera, Dean Kereiakes, Russell Raymond, Thomas Amidon, David Lee, Spencer King, John Douglas, Abnash Jain, J. Patrick Kleaveland, Mitchell Driesman, Krishna Kumar, Glen Kowalchuk, Behzad Taghizadeh, Lawrence Barr, Keith Benzuly, Tarek Helmy, Duane Pinto, Joseph Aragon, Reginald Low, Phillip Horwitz, Thomas LeGalley, Dominick Angiolillo, Rajesh Sachdeva, Kenneth Kent, Luis Gruberg, Richard Bach, Thomas Pow, Charles O'Shaughnessy, Shing Wong, Saeed R. Shaikh, Arthur Reitman, Mark Lawrence, Alejandro Garcia Escudero, Carlos Poy, Miguel Miceli, Antonio Pocovi, Hugo Londero, Jorge Baccaro, Leonid Polonetsky, Aliaksey Karotkin, Leanid Shubau, Eduardo Maffini, Bruno Machado, José Airton, Valter Lima, Jose Jatene, Marco Perin, Paulo Caramori, Iran Castro, Ivan Manukov, Mladen Grigorov, Plamen Milkov, Julia Jorgova, Svetoslav Georgiev, Nizar Rifai, Alexander Doganov, Ivo Petrov, William Hui, Jean-Francois Tanguay, Marek Richter, Frantisek Tousek, Zdenek Klimsa, Michal Padour, Jan Mrozek, Marian Branny, Zdenek Coufal, Stanislav Simek, Vladimir Rozsival, Leos Pleva, Josef Stasek, Petr Kala, Ladislav Groch, Viktor Kocka, Rajesh Jain, Darshan Banker, Lanka Krishna, Hasit Joshi, Jaspal Arneja, Virgilijus Grinius, Sigute Norkiene, Birute Petrauskiene, Rolf Michels, Melvin Tjon, Hans de Swart, Robbert de Winter, Harvey White, Malcolm Abernethey, Alexander Osiev, Kirill Linev, Svetlana Kalinina, Svetlana Baum, Elena Kosmachova, Zaur Shogenov, Valentin Markov, Svetlana Boldueva, Olga Barbarash, Victor Kostenko, Elena Vasilieva, Aleksey Gruzdev, Victor Lusov, Pavel Dovgalevsky, Oleg Azarin, Sergey Chernov, Olga Smolenskaya, Alexey Duda, Viliam Fridrich, Marian Hranai, Martin Studenčan, Peter Kurray, John Bennett, Pieter Blomerus, Laurence Disler, Johannes Engelbrecht, Eric Klug, Robert Routier, Tjaart Venter, Nico Van Der Merwe, Anthony Becker, Kwang-Soo Cha, Seung-Hwan Lee, Sang-Jin Han, Tae Jin Youn, Seung-Ho Hur, Hong Seog Seo, Hun-Sik Park, Chong-Yun Rhim, Wook-Bum Pyun, Hyunmin Choe, Myung-Ho Jeong, Jong-Seon Park, Eak-Kyun Shin, Felipe Hernández, Jaume Figueras, Rosana Hernández, José Ramón López-Minguez, José Ramón González Juanatey, Ramón López Palop, Guillermo Galeote, Noppadol Chamnarnphol, Wacin Buddhari, Nakarin Sansanayudh, Srun Kuanprasert, William Penny, Charles Lui, Garfield Grimmett, Venkatraman Srinivasan, Kevin Ariani, Waqor Khan, James Blankenship, Steven Eisenberg, Jerry Greenberg, Jeffrey Breall, Harish Chandna, Paul Tolerico, Georges Nseir, Adam Greenbaum, Pierre Istfan, Joel Sklar, Robert Smith, Nicholaos Xenopoulos, Mahesh Mulumudi, James Hoback, Gregory Eaton, John Griffin, Ramin Ebrahimi, Robert Lundstrom, Dogan Temizer, Kenneth Tam, Jose Suarez, Amish Raval, Jay Kaufman, Emmanouil Brilakis, Michael Stillabower, Kathleen Quealy, Boris Nunez, Bruce Samuels, Agustin Argenal, Vankeepuram Srinivas, Andrew Rosenthal, Pradyumna Tummala, Paul Myers, Nelson LaMarche, Michael Chan, Daniel Simon, Richard Kettelkamp, Gary Schaer, Edward Kosinski, Maurice Buchbinder, Mukesh Sharma, Mark Goodwin, J. Tift Mann, David Holmes, Sunil Rao, Michael Azrin, Roger Gammon, Kreton Mavromatis, Abdel Ahmed, Marcel Zughaib, R. Jeffrey Westcott, Ash Jain, Georg Delle-Karth, Jamil Abdalla Saad, Alexandre Abizaid, Carlos Augusto Formiga Areas, Expedito E. Ribeiro, Fabio Rossi Dos Santos, Rogerio Tadeu Tumelero, Roberto Vieira Botelho, Borislav Atzev, Boicho Boichev, Georgi Grigorov, Nikolay Penkov, Boris Zehirov, Pavel Cervinka, Petr Hajek, David Horak, Petr Kmonicek, Jan Sitar, Nodar Emukhvari, George Khabeishvili, Steffen Behrens, Harald Darius, Martin Dissmann, Stephan Fichtlscherer, Wolfgang Franz, Tobias Geisler, Britta Goldmann, Andreas Mugge, Tudor Poerner, Gert Richardt, Christoph Stellbrink, Nikos Werner, Ezio Bramucci, Gennaro Galasso, Andrea Picchi, Patrizia Presbitero, Alexander Sasse, Szyszka Andrzej, Witold Dubaniewicz, Jaroslaw Kasprzak, Andrzej Kleinrok, Andrzej Rynkiewicz, Cezary Sosnowski, Radoslaw Targonski, Jaroslaw Trebacz, Adam Witkowski, Yakov Dovgalevsky, Ivan Gordeev, Prokhor Pavlov, Sergey Shalaev, Irina Sukmanova, Alexey Yakovlev, Sarana Boonbaichaiyapruck, Pinij Kaewsuwanna, Dilok Piyayotai, Imran Arif, Joseph Cinderella, Brent Davis, Chandanreddy Devireddy, Mark Dorogy, Norman Ferrier, Daniel Fisher, Robert Foster, John Galla, Raghava Gollapudi, James Hermiller, Richard Heuser, Zubair Jafar, Carey Kimmelstiel, Scott Kinlay, James Leggett, Dustin Letts, Michael Lipsitt, Joaquin Martinez-Arraras, Marc Mayhew, Paul McWhirter, Ayoub Mirza, William O'Riordan, John Petersen, Hector Picon, Mark Picone, Matthew Price, Virender Sethi, Craig Siegel, Daniel Steinberg, Jeffrey Tauth, Mladen Vidovich, Jonathan Waltman, and Michael Wilensky more...
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Male ,medicine.medical_specialty ,Ticlopidine ,medicine.medical_treatment ,Myocardial Ischemia ,Hemorrhage ,Platelet Glycoprotein GPIIb-IIIa Complex ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Cangrelor ,P2Y12 ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Infusions, Intravenous ,Aged ,Aspirin ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,Clopidogrel ,Adenosine Monophosphate ,Surgery ,Treatment Outcome ,chemistry ,Glycoprotein IIb/IIIa inhibitors ,Conventional PCI ,Eptifibatide ,Cardiology ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background Cangrelor, an intravenous, reversible P2Y12 antagonist, is approved for use in patients undergoing percutaneous coronary intervention (PCI). Objectives This study sought to evaluate the efficacy and safety of cangrelor compared with clopidogrel in subgroups that did and did not receive glycoprotein IIb/IIIa inhibitors (GPIs). Methods This pooled, patient-level analysis of the 3 CHAMPION (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials analyzed all randomized patients who underwent PCI and received the study drug (n = 24,902). Only bailout/rescue GPI use was permitted, except in CHAMPION PCI, in which routine or bailout/rescue GPI use was at the site investigator’s discretion. The primary efficacy endpoint was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h after randomization. Results Overall, 3,173 patients (12.7%) received a GPI, most commonly eptifibatide (69.4%). Despite variation in indications for GPIs, baseline characteristics were well balanced between the cangrelor and clopidogrel arms in subsets receiving and not receiving GPIs. Rates of the primary composite endpoint were lower with cangrelor compared with clopidogrel in patients who did (4.9% vs. 6.5%; odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55 to 1.01) or did not receive a GPI (3.6% vs. 4.4%; OR: 0.82; 95% CI: 0.72 to 0.94; Pint = 0.55). Cangrelor did not increase the primary safety endpoint, GUSTO-defined severe/life-threatening bleeding, in patients who did (0.4% vs. 0.5%; OR: 0.71; 95% CI: 0.25 to 1.99) or did not receive GPIs (0.2% vs. 0.1%; OR: 1.56; 95% CI: 0.80 to 3.04; Pint = 0.21). GPI use was associated with increased risk of bleeding in both treatment arms. Conclusions Cangrelor’s efficacy in reducing ischemic complications in patients undergoing PCI was maintained irrespective of GPI administration. GPI use was associated with substantially higher bleeding rates, regardless of the randomization to cangrelor or clopidogrel. (A Clinical Trial to Demonstrate the Efficacy of Cangrelor [PCI]: NCT00305162 ; Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [PLATFORM]: NCT00385138 ; A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]: NCT01156571 ) more...
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- 2017
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25. The Use of Aspirin to Reduce the Risk of Thrombotic Events in Patients With End-Stage Renal Disease: Protocol for a Randomized Controlled Trial
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Clara Krystal Pérez Fermin, Walid Ezzeldin Omer, Tiago Lemos Cerqueira, Daniele Argentina Silva, Janis L. Breeze, Nathalie Monique Vandevelde, Evelin Elfriede Balbino, Armando Fartolino Guerrero, Ricardo Wang, and Paola Gonzalez Mego more...
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medicine.medical_specialty ,drug safety ,aspirin ,030204 cardiovascular system & hematology ,End stage renal disease ,law.invention ,03 medical and health sciences ,kidney failure, chronic ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Protocol ,platelet activation ,Medicine ,030212 general & internal medicine ,Platelet activation ,end stage renal disease ,thrombosis ,Aspirin ,business.industry ,Type 2 Diabetes Mellitus ,General Medicine ,medicine.disease ,bleeding ,Clinical trial ,diabetes mellitus, type 2 ,randomized controlled trial ,prophylaxis ,business ,TIMI ,Kidney disease ,medicine.drug - Abstract
Background End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin's efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Objective The overall objective of this protocol is to (1) evaluate aspirin's safety and efficacy in reducing the risk of thrombotic events in patients with ESRD on hemodialysis and (2) examine whether aspirin's efficacy is modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Specifically, the primary objective is to compare the 12-month rate of any thrombotic event (cardiac death, nonfatal myocardial infarction, nonfatal stroke, arteriovenous fistula thrombosis) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding in patients treated with aspirin compared to those on placebo. Secondary objectives are to test for effect modification of treatment by the presence of type 2 diabetes mellitus or platelet hyperreactivity and compare the rate of TIMI minor bleeding between treatment groups. Methods We developed a protocol for a phase 2 randomized, single-center, placebo-controlled, triple-blind, superiority clinical trial to assess the prophylactic efficacy and safety of aspirin in patients with ESRD and on hemodialysis. It follows the ethical principles of the Declaration of Helsinki of the World Medical Association. A total of 342 participants would be enrolled over 12 months at a large dialysis center. Patients will be randomized in a 1:1 ratio and stratified by presence of type 2 diabetes mellitus and platelet hyperreactivity to receive either oral aspirin (100 mg/d) or placebo for a treatment period of 12 months. An intention-to-treat statistical analysis will be performed. Results The randomized clinical trial will be performed after approval by the ethical committee of the participating center and registration at ClinicalTrials.gov. Conclusions We provide a protocol for a randomized controlled trial to evaluate the safety and efficacy of treatment with aspirin to reduce the risk of thrombotic events. In addition, such a study would further our understanding of the mechanism of aspirin-related bleeding and help identify subgroups of best-responders and patients with a higher risk of adverse events. Registered report identifier RR1-10.2196/10516. more...
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- 2018
26. Aspirin to Reduce the Risk of Thrombotic Events in Patients With End-Stage Renal Disease: Protocol for a Randomized Controlled Trial (Preprint)
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Tiago Lemos Cerqueira, Armando Fartolino Guerrero, Clara Krystal Pérez Fermin, Ricardo Wang, Evelin Elfriede Balbino, Janis L Breeze, Paola Gonzalez Mego, Danielle Argentina Silva, Walid Ezzeldin Omer, and Nathalie Monique Vandevelde more...
- Abstract
BACKGROUND End-stage renal disease (ESRD) is the last stage of chronic kidney disease, mainly caused by type 2 diabetes mellitus and characterized by an increased mortality risk related to cardiovascular disease. Low-dose aspirin (acetylsalicylic acid or ASA) seems to effectively prevent cardiovascular events in patients with ESRD. However, the number of interventional studies in this population remains limited and the mechanisms of aspirin-related bleeding remain poorly understood. Aspirin’s efficacy and safety may be modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. OBJECTIVE The overall objective of this protocol is to (1) evaluate aspirin’s safety and efficacy in reducing the risk of thrombotic events in patients with ESRD on hemodialysis and (2) examine whether aspirin’s efficacy is modified by the presence of type 2 diabetes mellitus or platelet hyperreactivity. Specifically, the primary objective is to compare the 12-month rate of any thrombotic event (cardiac death, nonfatal myocardial infarction, nonfatal stroke, arteriovenous fistula thrombosis) and Thrombolysis in Myocardial Infarction (TIMI) major bleeding in patients treated with aspirin compared to those on placebo. Secondary objectives are to test for effect modification of treatment by the presence of type 2 diabetes mellitus or platelet hyperreactivity and compare the rate of TIMI minor bleeding between treatment groups. METHODS We developed a protocol for a phase 2 randomized, single-center, placebo-controlled, triple-blind, superiority clinical trial to assess the prophylactic efficacy and safety of aspirin in patients with ESRD and on hemodialysis. It follows the ethical principles of the Declaration of Helsinki of the World Medical Association. A total of 342 participants would be enrolled over 12 months at a large dialysis center. Patients will be randomized in a 1:1 ratio and stratified by presence of type 2 diabetes mellitus and platelet hyperreactivity to receive either oral aspirin (100 mg/d) or placebo for a treatment period of 12 months. An intention-to-treat statistical analysis will be performed. RESULTS PLEASE WRITE RESULTS. CONCLUSIONS We provide a protocol for a randomized controlled trial to evaluate the safety and efficacy of treatment with aspirin to reduce the risk of thrombotic events. In addition, such a study would further our understanding of the mechanism of aspirin-related bleeding and help identify subgroups of best-responders and patients with a higher risk of adverse events. more...
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- 2018
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27. Is there an association between hospital costs and door-to-balloon time?
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Marcus Vinicius de Freitas Moreira, Renato Rocha Rabelo, Luciana Alves Ribeiro, Ubirajara Lima Filho, Fernando Carvalho Neuenschwander, Edson Elviro Alves, Ricardo Wang, Augusto Lima Filho, Raimundo Antônio de Melo, and Manoel Augusto Batista Esteves more...
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Intervenção coronária percutânea ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Infarto do miocárdio ,Left circumflex artery ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Culprit ,Surgery ,Myocardial infarction ,medicine.anatomical_structure ,Right coronary artery ,medicine.artery ,medicine ,Door-to-balloon ,Circumflex ,Hospital costs ,business ,Custos hospitalares ,Artery - Abstract
BackgroundDoor-to-balloon time (DBT) has become a measure of performance and is the focus in quality of care improvement initiatives. This study aimed to evaluate the association between DBT and its impact on hospital costs.MethodsPatients treated with primary percutaneous coronary intervention between 2008 and 2013 were divided according to the DBT < or ≥ 90minutes. All costs recorded at hospital discharge were adjusted by the Medical-Hospital Cost Variation Index.ResultsA total of 141 patients were included, grouped as DBT < 90minutes (n = 77) and DBT ≥ 90minutes (n = 64). DBT was 64.0 ± 14.1minutes and 133.8 ± 35.2minutes, respectively. There were no differences in clinical outcomes between the groups. The costs were R$ 34,883.24 ± 27,749.46, with the mean cost for DBT < 90minutes being R$ 33,194.24 ± 27,387.61 and the cost for DBT ≥ 90minutes R$ 36,947.58 ± 28,267.80 (p = 0.43). The costs, according to the culprit artery, were R$ 29,588.53 ± 16,358.85 for the right coronary artery; R$ 48,494.62 ± 44,015.04 for the left circumflex artery; and R$ 34,016.96 ± 26,503.94 for the left anterior descending artery. There was a difference between the costs of procedures related to the left circumflex artery when compared to the right coronary or left anterior descending arteries (p = 0.01), but there was no difference between the costs related to the right coronary, when compared to the left anterior descending artery (p = 0.68).ConclusionsThere was no difference in hospital costs regarding the private health insurance, when the groups were divided according to the DBT. Clinical outcomes were similar and a difference in costs was found for patients with the circumflex artery as the culprit vessel. more...
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- 2015
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28. Há relação entre custos hospitalares e tempo porta‐balão?
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Ubirajara Lima Filho, Ricardo Wang, Edson Elviro Alves, Raimundo Antônio de Melo, Renato Rocha Rabelo, Luciana Alves Ribeiro, Augusto Lima Filho, Fernando Carvalho Neuenschwander, Marcus Vinicius de Freitas Moreira, and Manoel Augusto Batista Esteves more...
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Gynecology ,medicine.medical_specialty ,Intervenção coronária percutânea ,Myocardial infarction ,business.industry ,Infarto do miocárdio ,Medicine ,business ,Hospital costs ,Cardiology and Cardiovascular Medicine ,Custos hospitalares ,Percutaneous coronary intervention - Abstract
RESUMOIntroduçãoO tempo porta‐balão (TPB) tornou‐se uma medida de desempenho e é foco de iniciativas de melhoria da qualidade assistencial. Este estudo teve como objetivo avaliar a relação entre o TPB e seu impacto nos custos de internação hospitalar.MétodosPacientes tratados com intervenção coronária percutânea primária, entre 2008 e 2013, foram divididos de acordo com o TPB < ou ≥ 90 minutos. Todos os custos registrados na alta hospitalar foram ajustados por meio do Índice de Variação de Custos Médico‐Hospitalares.ResultadosForam incluídos 141 pacientes, agrupados em TPB < 90 minutos (n=77) e TPB ≥ 90 minutos (n=64). Os TPB foram 64,0 ± 14,1 minutos e 133,8 ± 35,2 minutos, respectivamente. Não foram observadas diferenças nos desfechos clínicos entre os grupos. Os custos foram de R$ 34.883,24 ± 27.749,46, sendo o custo médio para TPB < 90 minutos de R$ 33.194,24 ± 27.387,61, e para TPB ≥ 90 minutos, de R$ 36.947,58 ± 28.267,80 (p=0,43). Os custos, segundo a artéria culpada, foram de R$ 29.588,53 ± 16.358,85 para a coronária direita; R$ 48.494,62 ± 44.015,04 para a circunflexa; e de R$ 34.016,96 ± 26.503,94 para a descendente anterior. Houve diferença entre os custos dos procedimentos relativos à artéria circunflexa comparados aos da coronária direita ou da descendente anterior (p=0,01), mas não houve diferença entre os custos relativos à coronária direita, comparados à descendente anterior (p=0,68).ConclusõesNão houve diferença nos custos hospitalares, no âmbito da saúde suplementar, quando os grupos foram divididos de acordo com o TPB. Os desfechos clínicos foram semelhantes, e foi encontrada uma diferença de custos em pacientes com a artéria circunflexa culpada.ABSTRACTBackgroundDoor‐to‐balloon time (DBT) has become a measure of performance and is the focus in quality of care improvement initiatives. This study aimed to evaluate the association between DBT and its impact on hospital costs.MethodsPatients treated with primary percutaneous coronary intervention between 2008 and 2013 were divided according to the DBT < or ≥ 90minutes. All costs recorded at hospital discharge were adjusted by the Medical‐Hospital Cost Variation Index.ResultsA total of 141 patients were included, grouped as DBT < 90minutes (n=77) and DBT ≥ 90minutes (n=64). DBT was 64.0 ± 14.1minutes and 133.8 ± 35.2minutes, respectively. There were no differences in clinical outcomes between the groups. The costs were R$ 34,883.24 ± 27,749.46, with the mean cost for DBT < 90minutes being R$ 33,194.24 ± 27,387.61 and the cost for DBT ≥ 90minutes R$ 36,947.58 ± 28,267.80 (p=0.43). The costs, according to the culprit artery, were R$ 29,588.53 ± 16,358.85 for the right coronary artery; R$ 48,494.62 ± 44,015.04 for the left circumflex artery; and R$ 34,016.96 ± 26,503.94 for the left anterior descending artery. There was a difference between the costs of procedures related to the left circumflex artery when compared to the right coronary or left anterior descending arteries (p=0.01), but there was no difference between the costs related to the right coronary, when compared to the left anterior descending artery (p=0.68).ConclusionsThere was no difference in hospital costs regarding the private health insurance, when the groups were divided according to the DBT. Clinical outcomes were similar and a difference in costs was found for patients with the circumflex artery as the culprit vessel. more...
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- 2015
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29. Impact of the implementation of hospital work processes on reduced door-to-balloon time
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Edson Elviro Alves, Ubirajara Lima Filho, Fernando Carvalho Neuenschwander, Antônio Carlos Mansur Bedeti, Raimundo Antônio de Melo, Ricardo Wang, Henrique Augusto Becho de Campos, Marcus Vinicius de Freitas Moreira, Augusto Lima Filho, Manoel Augusto Baptista Esteves, and Renato Rocha Rabello more...
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,Conventional PCI ,medicine ,Door-to-balloon ,Cardiology ,Myocardial infarction ,Symptom onset ,business ,Artery - Abstract
Introduction: The time interval between symptom onset and coronary artery reperfusion for ST-elevation myocardial infarction is directly related to patient morbidity and mortality. The guidelines stipulate that door-to-balloon time, i.e., the time spent between hospital arrival and percutaneous coronary intervention (PCI), must not exceed 90 minutes. Few hospitals achieve this goal. Thus, the objective of the present study was to assess the efficacy of the implementation of hospital work processes with respect to reducing the door-to-balloon time. Methods: Two [...] more...
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- 2017
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30. Observation Versus Adjuvant Radiation or Chemotherapy in the Management of Stage I Seminoma
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Margaret S. Soper, H. Cosmatos, K. Lodin, Ricardo Wang, Jeffrey M. Slezak, and Joseph R. Hastings
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Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,endocrine system diseases ,medicine.medical_treatment ,Chorionic Gonadotropin ,California ,Cohort Studies ,Testicular Neoplasms ,Internal medicine ,medicine ,Humans ,Orchiectomy ,Retrospective Studies ,Chemotherapy ,business.industry ,Retrospective cohort study ,Seminoma ,Prognosis ,medicine.disease ,Radiation therapy ,Treatment Outcome ,Chemotherapy, Adjuvant ,Cohort ,Radiotherapy, Adjuvant ,Neoplasm Recurrence, Local ,business ,Adjuvant ,Follow-Up Studies ,Cohort study - Abstract
The management of stage I seminoma has evolved over the past 20 years. Contemporary management options after orchiectomy include adjuvant radiation, adjuvant chemotherapy, and observation. This analysis defines the experience at Kaiser Permanente Southern California from 1990 to 2010. We examined outcomes for stage I seminoma patients and reviewed prognostic factors for recurrence in those managed with observation.This is a retrospective study of 502 stage I seminoma patients who underwent orchiectomy from 1990 to 2010. Outcomes examined were relapse-free survival (RFS), overall survival (OS), and cause-specific survival (CSS). Risk factors for recurrence evaluated were age, preoperative hCG elevation, preoperative LDH elevation, tumor size, lymphovascular invasion, rete testis invasion, epididymis invasion, and invasion through the tunica albuginea.Among radiation patients, 5-year RFS was 97.2%, OS was 98.0%, and CSS was 99.3%. Among chemotherapy patients, 2-year RFS was 98.3% and OS and CSS were 100%. Among observation patients, 5-year RFS was 89.2%, OS was 98.8%, and CSS was 100%. There was no difference in OS or CSS among the groups. RFS was significantly lower for observation patients. Among observation patients, univariate analysis identified tumor size, lymphovascular invasion, and rete testis invasion as risk factors for relapse. No factors were significant on multivariate analysis.Our data show that adjuvant radiation and chemotherapy yield similar outcomes in the management of stage I seminoma. Observation results in a lower RFS, but patients who relapse can be salvaged; OS and CSS are not affected. more...
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- 2014
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31. Avaliação da doença vascular do enxerto no transplante cardíaco: experiência de um centro brasileiro
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Sergio Lopes Veiga, Paulo Roberto Slud Brofman, Michelle F. Susin, Lidia Zytynski Moura, Ricardo Wang, Francisco Costa Diniz, and Elide Sbardellotto Mariano da Costa
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Doenças vasculares/complicações ,heart transplantation ,Cardiac allograft vasculopathy ,transplante de coração ,medicine ,avaliação ,Gynecology ,evaluation ,business.industry ,Brasil ,ultrasonografia ,ultrasonography ,Doenças vasculares ,Surgery ,Transplantation ,transplante de coração/estatística e dados numéricos ,lcsh:RC666-701 ,vascular diseases ,doenças vasculares/mortalidade ,Age distribution ,Ultrasonography ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
FUNDAMENTO: O transplante cardíaco continua sendo o tratamento de escolha para a insuficiência cardíaca refratária ao tratamento otimizado. Dois métodos diagnósticos apresentam elevada sensibilidade no diagnóstico de episódios de rejeição ao enxerto e Doença Vascular do Enxerto (DVE), causas importantes de mortalidade no pós-transplante. OBJETIVO: Avaliar a relação entre os resultados do ultrassom intracoronariano (USIV) e os laudos das biópsias endomiocárdicas (BX) no seguimento de pacientes submetidos a transplante cardíaco em um serviço de referência brasileiro. MÉTODOS: Foi realizado um ensaio epidemiológico retrospectivo observacional, com pacientes submetidos a transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os prontuários desses pacientes e os resultados dos USIV e BX realizados rotineiramente no seguimento clínico pós-transplante e terapêutica em uso. RESULTADOS: Dos 77 pacientes analisados, 63,63% são do sexo masculino, nas faixas etárias de 22 a 69 anos. Quanto aos resultados dos USIV, 33,96% foram classificados em Stanford classe I, e 32,08%, como Stanford IV. Dos 143 laudos das biópsias, 51,08% tiveram resultado 1R, 3R em 0,69% dos laudos, e 14,48% apresentaram a descrição de efeito Quilty. Todos usaram antiproliferativos, 80,51% usaram inibidores da calcineurina e 19,48% usaram inibidores do sinal de proliferação (ISP). CONCLUSÃO: A avaliação dos pacientes pós-transplante cardíaco por meio do USIV incorpora informações detalhadas para o diagnóstico precoce e sensível da DVE, que são complementadas pelas informações histológicas fornecidas pelas BX, estabelecendo uma possível relação causal entre a DVE e os episódios de rejeição humoral. BACKGROUND: Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation. OBJECTIVE: To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service. METHODS: A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used. RESULTS: Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors. CONCLUSION: The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes. more...
- Published
- 2012
32. Limitation of coronary angiography in the evaluation of a coronary aneurysm
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Saulo Lima Filho, Freddy Garcia Montecinos, Carlos Augusto Bueno Silva, Ricardo Wang, and Leonardo Greco Machado
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Coronary angiography ,Aneurysm ,business.industry ,Medicine ,business ,Nuclear medicine ,medicine.disease - Abstract
Paciente do sexo masculino, 43 anos, assintomatico, portador de hipertensao arterial sistemica, diabetes melito e insuficiencia renal cronica dialitica. Submetido a ecodopplercardiograma transtoracico para avaliacao da funcao ventricular esquerda, sendo visualizada massa proxima ao ventriculo direito, em sua face diafragmatica. Ressonância magnetica mostrou tratar-se de aneurisma da arteria coronaria direita, localizado em terco distal, com 3,9 x 3,5 cm de diâmetro em seus maiores eixos, revestido por trombo mural circunferencial excentrico (). Foi indicada coronariografia, que evidenciou dilatacao difusa de [...] more...
- Published
- 2017
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33. Redução da Progressão da Doença Vascular do Enxerto Cardíaco com o Uso Rotineiro da Terapia de Indução com Basiliximab
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Ricardo Wang, Francisco Diniz Affonso da Costa, Tiago Luiz Fernandes, José Rocha Faria-Neto, Natália Boing Salvatti, Lidia Moura, Newton Fernando Stadler de Souza Filho, and Sergio Veiga Lopes
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Graft Rejection ,Male ,Anticorpos Monoclonais Murinos / administração & dosagem ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Pathology ,Time Factors ,Transplante Cardíaco ,Basiliximab ,Biopsy ,medicine.medical_treatment ,Coronary Artery Disease ,Vascular Diseases / physiopathology ,Coronary artery disease ,Risk Factors ,Induction therapy ,Ultrasonography ,Heart transplantation ,medicine.diagnostic_test ,Antibodies, Monoclonal ,Antibodies, Monoclonal, Murine-Derived / admininstration & dosage ,Middle Aged ,Allografts ,Tunica intima ,Plaque, Atherosclerotic ,Treatment Outcome ,medicine.anatomical_structure ,Disease Progression ,cardiovascular system ,Cardiology ,Original Article ,Female ,Cardiology and Cardiovascular Medicine ,Doenças Vasculares / fisiopatologia ,Immunosuppressive Agents ,medicine.drug ,Adult ,medicine.medical_specialty ,Recombinant Fusion Proteins ,Statistics, Nonparametric ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Imunossupressores ,business.industry ,Case-control study ,Retrospective cohort study ,medicine.disease ,lcsh:RC666-701 ,Case-Control Studies ,Interleukin-2 ,Heart Transplantation ,Tunica Intima ,business - Abstract
Introduction: Cardiac allograft vasculopathy (CAV) is a major limitation for long-term survival of patients undergoing heart transplantation (HT). Some immunosuppressants can reduce the risk of CAV. Objectives: The primary objective was to evaluate the variation in the volumetric growth of the intimal layer measured by intracoronary ultrasound (IVUS) after 1 year in patients who received basiliximab compared with that in a control group. Methods: Thirteen patients treated at a single center between 2007 and 2009 were analyzed retrospectively. Evaluations were performed with IVUS, measuring the volume of a coronary segment within the first 30 days and 1 year after HT. Vasculopathy was characterized by the volume of the intima of the vessel. Results: Thirteen patients included (7 in the basiliximab group and 6 in the control group). On IVUS assessment, the control group was found to have greater vessel volume (120–185.43 mm3 vs. 127.77–131.32 mm3; p = 0.051). Intimal layer growth (i.e., CAV) was also higher in the control group (27.30–49.15 mm3 [∆80%] vs. 20.23–26.69 mm3 [∆33%]; p = 0.015). Univariate regression analysis revealed that plaque volume and prior atherosclerosis of the donor were not related to intima growth (r = 0.15, p = 0.96), whereas positive remodeling was directly proportional to the volumetric growth of the intima (r = 0.85, p < 0.001). Conclusion: Routine induction therapy with basiliximab was associated with reduced growth of the intima of the vessel during the first year after HT. Resumo Fundamento: A doença vascular do enxerto (DVE) constitui uma grande limitação de sobrevida a longo prazo de pacientes submetidos a transplante cardíaco (TxC). Alguns imunossupressores diminuem o aparecimento da DVE. Objetivos: O principal objetivo foi avaliar, através de ultrassonografia intracoronária (USIC), a variação do crescimento volumétrico da camada íntima e comparar, após um ano, o grupo que recebeu basiliximab com um grupo de controle. Métodos: Treze pacientes de um único centro foram analisados retrospectivamente de 2007 a 2009. As análises foram feitas através de USIC, medindo-se o volume de um segmento coronariano nos primeiros 30 dias e um ano após o TxC. A vasculopatia foi caracterizada pelo volume da camada íntima do vaso. Resultados: O estudo incluiu 13 pacientes (7 no grupo com o basiliximab e 6 no grupo de controle). A análise por USIC revelou que o grupo de controle apresentou maior crescimento volumétrico do vaso (131,32 a 127,77 mm3 x 120 a 185,43 mm3 p = 0,051). O crescimento da camada íntima (CCI) também foi maior no grupo de controle [Basiliximab: 20,23 a 26,69 mm3 (∆ 33%); Controle: 27,30 a 49,15 mm3 (∆ 80% p = 0,015)]. De acordo com a regressão univariada, o volume da placa aterosclerótica prévia do doador não teve relação com o crescimento da íntima (r = 0,15, p = 0,96), enquanto que o remodelamento positivo do vaso foi diretamente proporcional ao crescimento da íntima (r = 0,85, p < 0,001). Conclusão: A terapia de indução de rotina com basiliximab está associada à redução do crescimento da camada íntima do vaso no primeiro ano após o transplante cardíaco. more...
- Published
- 2015
34. Use of Evidence-Based Interventions in Acute Coronary Syndrome - Subanalysis of the ACCEPT Registry
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Elizabete Silva dos Santos, Otavio Berwanger, Helder Jose Lima Reis, Celsa Maria Moreira, Jadelson Pinheiro de Andrade, Fernando Carvalho Neuenschwander, Edson Romano, Ricardo Wang, Augusto Lima Filho, and Luiz Alberto Mattos more...
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,Time Factors ,Epidemiology ,medicine.medical_treatment ,Adrenergic beta-Antagonists ,Myocardial Infarction ,Disease registries ,Angiotensin-Converting Enzyme Inhibitors ,Myocardial Reperfusion ,Drug Prescriptions ,Evidence based practice ,Fibrinolytic Agents ,Internal medicine ,Antithrombotic ,medicine ,Humans ,Myocardial infarction ,Acute Coronary Syndrome ,Medical prescription ,Aged ,Analysis of Variance ,Aspirin ,Evidence-Based Medicine ,business.industry ,Original Articles ,Thrombolysis ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Practice Guidelines as Topic ,Purinergic P2Y Receptor Antagonists ,Platelet aggregation inhibitor ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Platelet Aggregation Inhibitors ,Fibrinolytic agent ,medicine.drug - Abstract
Background: The recommendations in guidelines are based on evidence; however, there is a gap between recommendations and clinical practice. Objective: To describe the practice of prescribing evidence-based treatments for patients with acute coronary syndrome in Brazil. Methods: This study carried out a subanalysis of the ACCEPT registry, assessing epidemiological data and the prescription rate of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (IAT1RB), and statins. In addition, the quality of myocardial reperfusion in ST-segment elevation myocardial infarction was evaluated. Results: This study assessed 2,453 patients. The prescription rates of acetylsalicylic acid, p2y12 inhibitors, antithrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors/IAT1RB, and statins were as follows: in 24 hours - 97.6%, 89.5%, 89.1%, 80.2%, 67.9% and 90.6%; and at six months - 89.3%, 53.6%, 0%, 74.4%, 57.6% and 85.4%, respectively. Regarding ST-segment elevation myocardial infarction, only 35.9% and 25.3% of the patients underwent primary angioplasty and thrombolysis, respectively, within the recommended times. Conclusion: This registry showed high initial prescription rates of antiplatelet drugs, antithrombotic drugs, and statins, and lower prescription rates of beta-blockers and angiotensin-converting enzyme inhibitors/IAT1RB. Independently of the class, the use of all drugs decreased by six months. Most patients with ST-segment elevation myocardial infarction did not undergo myocardial reperfusion within the time recommended. more...
- Published
- 2014
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35. Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center
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Elide Sbardellotto Mariano da, Costa, Ricardo, Wang, Michelle F, Susin, Sergio Lopes, Veiga, Francisco Costa, Diniz, Paulo Roberto Slud, Brofman, and Lidia Ana Zytynski, Moura
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Adult ,Graft Rejection ,Male ,Biopsy ,Coronary Artery Disease ,Middle Aged ,Young Adult ,Age Distribution ,Risk Factors ,Heart Transplantation ,Humans ,Transplantation, Homologous ,Female ,Sex Distribution ,Brazil ,Aged ,Retrospective Studies ,Ultrasonography - Abstract
Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation.To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service.A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used.Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors.The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes. more...
- Published
- 2012
36. Síndrome do balonamento apical secundário ao uso abusivo de descongestionante nasal
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Newton F. Stadler Souza, José Rocha Faria Neto, Ricardo Wang, Lidia Zytinski, José Augusto Ribas Fortes, and Gilmar Jorge dos Santos
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medicine.medical_specialty ,medicine.diagnostic_test ,Ventricular function ,business.industry ,Apical Ballooning Syndrome ,Surgery ,Nasal decongestant ,Internal medicine ,Female patient ,medicine ,Cardiology ,Left ventricular wall motion abnormality ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain. more...
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- 2009
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37. Apical ballooning syndrome secondary to nasal decongestant abuse
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Ricardo, Wang, Newton F Stadler, Souza, Jose Augusto Ribas, Fortes, Gilmar Jorge Dos, Santos, Jose Rocha, Faria Neto, and Lidia, Zytinski
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Aged, 80 and over ,Nasal Decongestants ,Takotsubo Cardiomyopathy ,Oxymetazoline ,Humans ,Female ,Drug Overdose - Abstract
We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain. more...
- Published
- 2008
38. Occlusion of the left coronary trunk secondary to tertiary syphilis
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Ricardo, Wang, Gustavo, Blume, Newton Fernando Stadler, Souza Filho, and Lidia Zytynski, Moura
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Adult ,Male ,Humans ,Aorta, Thoracic ,Coronary Artery Disease ,Syphilis, Cardiovascular - Abstract
A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment. more...
- Published
- 2008
39. Treatment of T3 and T4 anal carcinoma with combined chemoradiation and interstitial 192Ir implantation: a 10-year experience
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Ricardo Wang, Aroor R. Rao, H. Cosmatos, Julie M. Hwang, Jim Y. Hsiang, Michael Tome, John S. Kaptein, and Robert Kagan
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Adult ,Male ,medicine.medical_specialty ,Radiation proctitis ,Anal Carcinoma ,medicine.medical_treatment ,Mitomycin ,Brachytherapy ,medicine ,Anal cancer ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Aged, 80 and over ,Chemotherapy ,Antibiotics, Antineoplastic ,business.industry ,Combination chemotherapy ,Middle Aged ,medicine.disease ,Anus Neoplasms ,Iridium Radioisotopes ,Surgery ,Oncology ,Fluorouracil ,Female ,Implant ,business ,medicine.drug - Abstract
Purpose To report our experience in treating T3 and T4 anal carcinoma with combined external beam (EBRT) and chemotherapy, followed by interstitial 192Ir implant boost. Methods and Materials From 1990 to 2000, 31 patients with T3 and T4 anal carcinoma were treated with: 30 Gy EBRT (2 Gy fractions, 5 days/week) + 5-fluorouracil + mitomycin-C. Median implant dose was 31.3 Gy at 0.5 cm, delivered at a mean rate of 0.52 Gy/h. Results Six patients had local persistence and 4 eventually developed local-regional recurrence. Eight underwent abdomino-perineal resection (APR). With the addition of APR in selected cases, the ultimate local-regional control after initial treatment was 84%. Distant metastases occurred in 10. Of the initial cohort, 55% is still alive and NED. Eight had radiation proctitis and 7 developed postimplant ulceration. Only 1 required surgical intervention. Conclusions Treatment of T3 and T4 anal cancer with combined chemotherapy and EBRT, followed by interstitial implant results in an ultimate local-regional control of 84%, after the inclusion of selected APR. It is well tolerated, with acceptable toxicity. more...
- Published
- 2004
40. Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse
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P.J. Anderson, Shahrokh Iganej, Michael Tome, Morteza Dowlatshahi, Robert Kagan, Ricardo Wang, Thomas L. Morgan, Aroor R. Rao, and H. Cosmatos
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Salvage therapy ,Disease-Free Survival ,Carcinoma ,Medicine ,Combined Modality Therapy ,Humans ,Survival rate ,Retrospective Studies ,Salvage Therapy ,business.industry ,Head and neck cancer ,Neck dissection ,Radiotherapy Dosage ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,Survival Rate ,Otorhinolaryngology ,Epidermoid carcinoma ,Head and Neck Neoplasms ,Carcinoma, Squamous Cell ,Neck Dissection ,Neoplasms, Unknown Primary ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Purpose Management of squamous cell carcinoma of undetermined primary tumors in the head and neck region is controversial. Here we report the Southern California Kaiser Permanente experience with these patients. Methods and Materials From January 1969 through December 1994, 106 patients were eligible for this retrospective analysis. Distribution of nodal staging was as follows: 14 N1, 27 N2A, 39 N2B, 2 N2C, and 24 N3. Initial treatment included excisional biopsy alone in 12, radical neck dissection alone in 29, radiotherapy alone in 24, excisional biopsy followed by radiotherapy in 15, and radical neck dissection plus postoperative radiation in 26 patients. Results Except for two patients, all patients have had a minimum follow-up of 5 years. Overall, 57 patients (54%) have had recurrences. Only two patients (3%) who had received radiotherapy as part of their initial treatment had an appearance of a potential primary site inside the irradiated field vs 13 patients (32%) who had not received radiotherapy (p = .006). Combined modality therapy resulted in fewer neck relapses, particularly in patients with advanced neck disease. Including salvage, surgery alone as the initial treatment resulted in 81% ultimate tumor control above the clavicle for patients with N1 and N2a disease without extracapsular extension. The 5-year survival for the entire population was 53%. Radiotherapy alone resulted in poor survival in patients with advanced/unresectable neck disease. No significant difference in survival based on the initial treatment was found. The statistically significant adverse factors in determining survival included advanced nodal stage and the presence of extracapsular extension. Conclusions Radiotherapy is very effective in reducing the rate of appearance of a potential primary site. However, in the absence of advanced neck disease (N1 and N2A without extracapsular extension), radiotherapy can be reserved for salvage. Radiotherapy alone results in poor outcomes in patients with advanced/unresectable neck disease, and incorporation of concurrent chemotherapy and cytoprotective agents should be investigated. © 2002 Wiley Periodicals, Inc. Head Neck 24: 236–246, 2002; DOI 10.1002/hed.10017 more...
- Published
- 2002
41. Comparison of Whole-Brain Integral Dose Between Whole-Brain Radiation Therapy and Stereotactic Radiosurgery of Multiple Brain Metastases
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E.C. White, J. Rahimian, and Ricardo Wang
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Cancer Research ,medicine.medical_specialty ,Radiation ,Oncology ,Integral dose ,business.industry ,medicine.medical_treatment ,Medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Whole brain radiation therapy ,Radiosurgery - Published
- 2014
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42. Terapia trombolítica no tratamento da embolia pulmonar maciça
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Evandro Antonio Sardeto, Guiseppe Facin, Alexandre Varela, Marcelo Pandolfo, Gustavo Deteschi dos Santos, Ricardo Wang, Arlete Pereira de Matos, Newton Fernando Stadler de Souza Filho, Claudia Burigo Zanuzzi, and Paulo Batista Queiroz Júnior more...
- Subjects
General Medicine - Abstract
aciente de 44 anos, sexo feminino, admitida naUnidade de Dor Toracica da Santa Casa de Mise-ricordia de Curitiba, com quadro de dispneia deinicio subito, com piora progressiva nos ultimos 5 dias,associada a dor ventilatoria-dependente. Relatode empastamento do membro inferior esquerdo e usode contraceptivo oral, nega outros fatores de risco paraembolia pulmonar. A admissao, encontrava-se taquip-neica, hipoxemica (Sat O more...
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- 2007
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43. Primary Adenocarcinoma of the Anal Canal: A Single Institutional Report on a Rare Malignancy
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Ricardo Wang, Aroor R. Rao, Jekwon Yeh, E.C. White, and M.A. Abbas
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Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,General surgery ,Anal canal ,Malignancy ,medicine.disease ,Primary adenocarcinoma ,medicine.anatomical_structure ,Oncology ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2013
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44. The effects of cigarette smoking on aggressiveness of prostate adenocarcinoma: a retrospective study
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Oscar E. Streeter, Eila C. Skinner, S.D. Lieskovsky, Stuart D. Boyd, D.E. Skinner, S.M. Aval, T.V. Aguirre, J.A. Sullivan-Halley, M. Katz, and Ricardo Wang
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Prostate adenocarcinoma ,Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Cigarette smoking ,business.industry ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Retrospective cohort study ,business - Published
- 2001
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45. The economical impact of subcutaneous amifostine in the Kaiser Permanente health care system
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Ricardo Wang, J. Hastings, and Michael Tome
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Radiation therapy ,Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,medicine.medical_treatment ,Health care ,medicine ,Amifostine ,business ,medicine.drug ,Surgery - Abstract
18526 Background: We have previously shown that Subcutaneous amifostine (SQ A) was safe and effective in decreasing the early and late complications of patients (PTS) treated with radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck cancer (HNC). We have further observed that the QOL is better for many PTS treated with SQ A compared with historical controls (HC). Although we believe we cannot put a price on QOL, we hypothesized that the use of SQ A could result in cost savings to our institution because of the observed decrease in treatment-related complications. Methods: From May 2001 to October 2004, we treated 52 consecutive HNC PTS with RT or CRT and daily SQ A. PTS treated in our SQ A protocol received 500 mg of SQ A at least 30 minutes prior to daily RT. In order to be included in our present study, SQ A PTS had to have completed at least 80% of the prescribed SQ A dose. These PTS were then matched with HC based on age, sex, stage, primary site, smoking status, co-morbidiites, and treatment (RT or CRT). Fourteen PTS treated with SQ A (SQ A Group) were successfully matched with HC (Control Group). The entire costs of these 28 PTS to our institution (including the cost of SQ A) was obtained using our Management Accounting and Analysis database. Cost data was obtained at 6 months and 12 months after the completion of treatment. The median follow-up is 18 months (range 12–31). The economical impact of SQ A on xerostomia and dental care were not addressed in this study. Results: Ten PTS received RT and 18 received CRT. At 6 months of follow-up, the total cost for the Control Group was $196,789 versus $211,711 for the SQ A Group (p= 0.59). At 12 months, the total cost in the Control Group and SQ A Group were $287,594 and $275,654 respectively (p = 0.51). Within the SQ A Group, the cost was lowest in PTS who had never smoked or had a remote (>5 years) smoking history (p < 0.01). Conclusions: This study primarily addresses one of SQ A’s cytoprotective properties, mucositis. Our analysis suggests that we were able to offset the cost of SQ A in most PTS because of fewer complications observed in this group. The cost benefit of SQ A appears to be greater at 12 months vs. 6 months after treatment, suggesting continued cytoprotection. QOL is better in the SQ A Group. We plan to continue to follow these PTS and accrue new ones in a prospective fashion. [Table: see text] more...
- Published
- 2006
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46. Combined modality treatment for stage IV squamous cell carcinoma of the oropharynx
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Ricardo Wang, H. Jim, H. Cosmatos, Aroor R. Rao, J. M. Hwang, Michael Tome, V. Chiu, and R. Kagan
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Oncology ,Cancer Research ,medicine.medical_specialty ,Oncologic resection ,business.industry ,medicine.medical_treatment ,Locally advanced ,Combined modality treatment ,stomatognathic diseases ,Internal medicine ,Medicine ,Basal cell ,business ,Stage iv ,Adjuvant - Abstract
5609 Background: Traditional tx for locally advanced squamous cell carcinoma [SCC] of oropharynx [OPX] has been oncologic resection + adjuvant RT. In recent years, organ preserving therapy with che... more...
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- 2005
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47. Subcutaneous (SQ) amifostine (A) during radiation or chemoradiation for the treatment of head and neck cancers
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M. Tome, Ricardo Wang, and R. Kagan
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Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,medicine ,Amifostine ,Radiology ,business ,Head and neck ,medicine.drug - Abstract
8154 BACKGROUND: We have previously reported that SQ A. was safe and effective in 24 patients (pts) receiving chemoradiation (CR) for SCCA of the H & N (SCCHN). Our expanded experience includes 19 ... more...
- Published
- 2004
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48. Concurrent Weekly Paclitaxel, Radiotherapy and SQ Amifostine in Patients with Advanced Stage Squamous Cell Carcinoma of the Head and Neck (SCCHN)
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Frank Latino, Ricardo Wang, and A. Robert Kagan
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Oncology ,Larynx ,Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Urology ,Amifostine ,medicine.disease ,Primary tumor ,Radiation therapy ,stomatognathic diseases ,chemistry.chemical_compound ,medicine.anatomical_structure ,Paclitaxel ,chemistry ,Internal medicine ,medicine ,Mucositis ,Stage (cooking) ,business ,Progressive disease ,medicine.drug - Abstract
Objectives: 1) To determine feasibility and outcome of treating patients with advanced SCCHN using concurrent low- dose weekly Paclitaxel and radiation therapy; 2) To study the role of SQ Amifostine as a radiation protectant. Methods: Previously untreated patients with stage III and IV SCCHN were eligible. From Oct 1998 to June 2001, 38 patients were treated with 30 mg/m2 of Paclitaxel given weekly over 1 hour with concurrent once a day radiation (2Gy/day;total dose 70 Gy), with no planned breaks. There were 32 patients with stage IV disease. Primary tumor sites included oropharynx (23), larynx (7), hypopharynx (7) and parotid (1). SQ Amifostine was added to the protocol in early 2001; 7 patients have received this drug. Results: At the end of the planned treatment the Response Rate (CR + PR) was 100%; 25 pts(66%) achieved a CR at both neck and primary. Nine pts(24%) had residual lymphadenopathy, underwent neck dissections and are now NED. The ultimate locoregional control rate is 89%; 3 pts died of progressive disease, one died of intercurrent disease. With a median followup of 24 months, 34 pts(89%) are alive and NED. Organ preservation was achieved in 100%. Thirty(79%) finished the radiotherapy dose as planned, 64% received all 7 cycles of Paclitaxel. Grade 3 mucositis was observed in 36% pts and these were the only pts who required a treatment break. Eight pts(21%) required a PEG tube for feeding; median weight loss was 10%. There were no complications durng the administration of SQ Amifostine. Conclusion: This treatment is feasible and highly active in the treatment of locally advanced SCCHN. Although the followup for patients treated with Amifostine is short, it appears that the addition of this drug in our protocol resulted in reduced early and late toxicity. more...
- Published
- 2002
- Full Text
- View/download PDF
49. Metastatic squamoms cell carcinema of the neck from an unknewn primary: Management optiens and patterns of relanse
- Author
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Aroor R. Rao, P.J. Anderson, Robert Kagad, Ricardo Wang, Morteza Dowlatshahi, H. Cosmatos, and S. Iganej
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Primary (chemistry) ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cell ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 1998
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- View/download PDF
50. Aterosclerose e Inflamação: Ainda Muito Caminho a Percorrer
- Author
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Fernando Carvalho Neuenschwander, Bruno Ramos Nascimento, and Ricardo Wang
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Aterosclerose ,Atherosclerosis/physiopathology ,MEDLINE ,Coronary Artery Disease ,atherosclerosis/physiopathology ,Gastroenterology ,interleukin-18 ,Doença da Artéria Coronária ,Coronary artery disease ,Internal medicine ,Trombose ,medicine ,thrombosis ,Inflammation ,Interleucina-18 ,business.industry ,Interleukin-18 ,Thrombosis ,medicine.disease ,Inflamação ,inflammation ,lcsh:RC666-701 ,Interleukin 18 ,Cardiology and Cardiovascular Medicine ,business ,coronary artery disease
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