ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.

2018 ESC/EACTS Guidelines on myocardial revascularization.

Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chairperson) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK), Robert A. Byrne (Germany), Jean-Philippe Collet (France), Volkmar Falk (Germany), Stuart J. Head (The Netherlands), Peter Jüni (Canada), Adnan Kastrati (Germany), Akos Koller (Hungary), Steen D. Kristensen (Denmark), Josef Niebauer (Austria), Dimitrios J. Richter (Greece), Petar M. Seferovi c (Serbia), Dirk Sibbing (Germany), Giulio G. Stefanini (Italy), Stephan Windecker (Switzerland), Rashmi Yadav (UK), Michael O. Zembala (Poland) Document Reviewers: William Wijns (ESC Review Co-ordinator) (Ireland), David Glineur (EACTS Review Co-ordinator) (Canada), Victor Aboyans (France), Stephan Achenbach (Germany), Stefan Agewall (Norway), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Andreas Baumbach (UK), James Brophy (Canada), Héctor Bueno (Spain), Patrick A. Calvert (UK), Davide Capodanno (Italy), Piroze M. Davierwala

/pdf/2014-esc-eacts-guidelines-on-myocardial-revascularization-3fr5n9jz36.pdf

2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Standardized guidelines for response assessment are needed to ensure comparability among clinical trials in non-Hodgkin's lymphomas (NHL). To achieve this, two meetings were convened among United States and international lymphoma experts representing medical hematology/oncology, radiology, radiation oncology, and pathology to review currently used response definitions and to develop a uniform set of criteria for assessing response in clinical trials. The criteria that were developed include anatomic definitions of response, with normal lymph node size after treatment of 1.5 cm in the longest transverse diameter by computer-assisted tomography scan. A designation of complete response/unconfirmed was adopted to include patients with a greater than 75% reduction in tumor size after therapy but with a residual mass, to include patients-especially those with large-cell NHL-who may not have residual disease. Single-photon emission computed tomography gallium scans are encouraged as a valuable adjunct to assessment of patients with large-cell NHL, but such scans require appropriate expertise. Flow cytometric, cytogenetic, and molecular studies are not currently included in response definitions. Response rates may be the most important objective in phase II trials where the activity of a new agent is important and may provide support for approval by regulatory agencies. However, the goals of most phase III trials are to identify therapies that will prolong the progression-free survival, if not the overall survival, of the treated patients. We hope that these guidelines will serve to improve communication among investigators and comparability among clinical trials until clinically relevant laboratory and imaging studies are identified and become more widely available.

Report of an International Workshop to Standardize Response Criteria for Non-Hodgkin's Lymphomas

ContextContrast-induced nephropathy remains a common complication of radiographic
procedures. Pretreatment with sodium bicarbonate is more protective than sodium
chloride in animal models of acute ischemic renal failure. Acute renal failure
from both ischemia and contrast are postulated to occur from free-radical
injury. However, no studies in humans or animals have evaluated the efficacy
of sodium bicarbonate for prophylaxis against contrast-induced nephropathy.ObjectiveTo examine the efficacy of sodium bicarbonate compared with sodium chloride
for preventive hydration before and after radiographic contrast.Design, Setting, and PatientsA prospective, single-center, randomized trial conducted from September
16, 2002, to June 17, 2003, of 119 patients with stable serum creatinine levels
of at least 1.1 mg/dL (≥97.2 µmol/L) who were randomized to receive
a 154-mEq/L infusion of either sodium chloride (n = 59) or sodium bicarbonate
(n = 60) before and after iopamidol administration (370 mg iodine/mL). Serum
creatinine levels were measured at baseline and 1 and 2 days after contrast.InterventionsPatients received 154 mEq/L of either sodium chloride or sodium bicarbonate,
as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast, followed
by an infusion of 1 mL/kg per hour for 6 hours after the procedure.Main Outcome MeasureContrast-induced nephropathy, defined as an increase of 25% or more
in serum creatinine within 2 days of contrast.ResultsThere were no significant group differences in age, sex, incidence of
diabetes mellitus, ethnicity, or contrast volume. Baseline serum creatinine
was slightly higher but not statistically different in patients receiving
sodium bicarbonate treatment (mean [SD], 1.71 [0.42] mg/dL [151.2 {37.1} µmol/L]
for sodium chloride and 1.89 [0.69] mg/dL [167.1 {61.0} µmol/L] for
sodium bicarbonate; P = .09). The primary end point
of contrast-induced nephropathy occurred in 8 patients (13.6%) infused with
sodium chloride but in only 1 (1.7%) of those receiving sodium bicarbonate(mean
difference, 11.9%; 95% confidence interval [CI], 2.6%-21.2%; P = .02). A follow-up registry of 191 consecutive patients receiving
prophylactic sodium bicarbonate and meeting the same inclusion criteria as
the study resulted in 3 cases of contrast-induced nephropathy (1.6%; 95% CI,
0%-3.4%).ConclusionHydration with sodium bicarbonate before contrast exposure is more effective
than hydration with sodium chloride for prophylaxis of contrast-induced renal
failure.

https://jamanetwork.com/journals/jama/articlepdf/198760/JOC32654.pdf

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate: A Randomized Controlled Trial

Computed tomography potentially offers the most accurate noninvasive means of estimating in vivo volumes. Contiguous 1-cm-thick CT scans were obtained through phantoms, dog kidneys in vivo, and human spleens before splenectomy. Cross-sectional areas were calculated for each individual scan and volumes then determined with each of four mathematical integration techniques. Volume estimations were compared to volumes determined by water displacement. The simplest, most practical means of calculating volumes, using the summation-of-areas technique with scans obtained at 2 cm intervals, was similar in accuracy to more complex methods. The mean percentage error of volume calculations using the sum-of-areas technique was 4.95% for five immobile phantoms, 3.86% for eight dog kidneys, 3.59% for eight human spleens in vivo at 1 cm scan spacing, and 3.65% for the same human spleens at 2 cm scan spacings. Difficulties in visual recognition and manual tracking of object boundaries seem to be more significant sources o...

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.138.2.329

Volume determinations using computed tomography

Pulmonary angiography is sensitive and specific in the diagnosis of pulmonary thromboembolism, but it remains an invasive procedure. Experience with 1,350 pulmonary angiograms was reviewed to ascertain the incidence, etiologies, and avoidance of complications. There were three deaths, all of which were secondary to cor pulmonale in patients with pulmonary hypertension and right ventricular end diastolic pressure (RVEDP) equal to or greater than 20 mmHg. Other complications consisted of cardiac perforation in 14 patients and endocardial or myocardial injury in six without sequelae, 11 significant arrhythmias and five cardiac arrests successfully treated, minor contrast material reactions in 11 patients, and a few insignificant complications. Carefully performed pulmonary angiography is safe if one avoids injecting contrast material into a patient with an elevated RVEDP.

The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series.

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate

Therapeutic results in 102 hypertensive patients were evaluated after either renal artery percutaneous transluminal angioplasty (PTA) or surgical bypass procedures for renovascular hypertension. A minimum of 6 months of follow-up was accepted to evaluate therapeutic success or failure. Renal angioplasty had a beneficial result in each of 13 patients with fibromuscular dysplasia and in 10 (83%) of 12 patients with atherosclerotic lesions that did not involve the origin of the renal artery. Although surgery was also beneficial in each of six patients with fibromuscular dysplasia, it helped only five of 10 patients with atherosclerosis of the renal artery. Angioplasty results were similar to surgical results for atherosclerotic lesions that involved the origin of the renal artery. Angioplasty was unsuccessful in two cases of neurofibromatosis because of the firm nature of the lesions, where a bypass procedure was successful in one case. Major complications were more common in surgical cases than in angioplas...

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.144.3.447

Arl Van Moore

Papers

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate: A Randomized Controlled Trial

Volume determinations using computed tomography

The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series.

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate

Percutaneous transluminal angioplasty vs. surgery for renovascular hypertension.