RESUMEN
Soluble P-selectin (marker of activation of platelets) and von Willebrand factor (marker of activation of endothelium) were measured in 44 patients with non ST-Elevation acute coronary syndrome (NSTEACS) 21 of whom received glycoprotein IIb/IIIa antagonist eptifibatide (two 180 mg/kg boluses with 10 min interval followed by infusion of 2 mcg/kg/min during first 24 hours and 1.3 mcg/kg/min during subsequent 48 hours). Measurements were made within first 2 hours, in 2--3 and 10--14 days after development of NSTEACS. During first 2 hours P-selectin content was 1.6 times higher than in healthy donors, but in 2--3 and 10--14 days after onset of NSTEACS it did not differ from normal values. Contrary to P-selectin value of von Willebrand factor was elevated both during first 2 hours (1.3 times) and in 2--3 days (2 times) compared with healthy donors. Some elevation of von Willebrand factor (1.2 times) persisted after 10--14 days after development of NSTEACS. The results obtained have shownd that elevated activity of endothelium persists at least for 2--3 days after onset of NSTEACS, while activity of platelets during this period decreases. In none of temporal points there have been revealed differences in contents of P-selectin and von Willebrand factor between groups of patients receiving and not receiving glycoprotein IIb/IIIa antagonists. No differences were also found between these parameters in groups of patients favorable and unfavorable outcomes (myocardial infarction, angina recurrence) of the disease during 30 days of follow-up.
Asunto(s)
Síndrome Coronario Agudo/sangre , Electrocardiografía , Selectina-P/sangre , Péptidos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Factor de von Willebrand/metabolismo , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/fisiopatología , Relación Dosis-Respuesta a Droga , Endotelio Vascular/metabolismo , Eptifibatida , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Infusiones Intravenosas , Péptidos/administración & dosificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Resultado del TratamientoRESUMEN
Clinical effects of glycoprotein (GP) IIb-IIIa antagonist eptifibatide (Integrilin) and its inhibitory effects on platelet aggregation were studied upon administration of eptifibatide for the treatment of acute coronary syndrome (ACS) without ST segment elevation. Eptifibatide was introduced to 25 patients with unstable angina and non-Q-wave myocardial infarction (MI) according to the following scheme: two boluses with 10 min interval at the dose of 180 mg/kg followed by supporting infusion of 2 mg/kg per min for the first 24 hours and of 1.3 mg/kg for the next 48 hours. Comparative group in which GP IIb-IIIa antagonists were not used upon therapeutic treatment also included 25 patients. All patients received standard basic therapy. 11 patients from the control group and 13 patients from the group with administration of eptifibatide underwent coronary angioplasty during in hospital period. Eptifibatide completely inhibited ADP-induced platelet aggregation within the whole infusion period but after that platelet aggregating activity was quickly recovered--for more than 50% within 6 hours, and completely within 12 hours after the end of infusion. Eptifibatide administration in none of patients was accompanied with the development of dangerous side effects. Thrombocytopenia (50,000 platelets per mm3) was registered in one, and minor bleeding events--in 3 patients. The rate of unfavourable outcomes (MI, refractory or recurrent angina) within first 30 days was almost the same in eptifibatide and control group--32% (8 out of 25) and 36% (9 out of 25) respectively. Thus, despite the complete inhibition of platelet aggregation for 72 hours, eptifibatide administration failed to decrease the amount of adverse events upon treatment of patients with ACS without ST segment elevation.
Asunto(s)
Angina Inestable/tratamiento farmacológico , Péptidos/farmacología , Péptidos/uso terapéutico , Inhibidores de Agregación Plaquetaria/farmacología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Bloqueo Sinoatrial , Enfermedad Aguda , Eptifibatida , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Dynamic MR prostatovesiculography (DMRP) is a new method of prostatic cancer diagnosis based on the ability of cancer tissue to accumulate contrast substance (omniscan) than benign tissue. Urologists from the I.M. Sechenov Moscow Medical Academy have examined 23 patients (5 patients with prostatic cancer and 18 suspects) who have undergone standard investigations (test for PSA, finger rectal examination, transrectal ultrasound investigation) and DMRP. DMRP detected prostatic areas suspected of malignancy. Taking biopsy from such areas verified diagnosis of prostatic cancer in 2 patients.