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Objective—In the light of the reported inconsistent anti-ischaemic and antiangi-nal effects of transdermal glyceryl trinitrate, its efficacy and influence on the effects of intracoronary glyceryl trinitrate were examined during c...
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Objective—In the light of the reported inconsistent anti-ischaemic and antiangi-nal effects of transdermal glyceryl trinitrate, its efficacy and influence on the effects of intracoronary glyceryl trinitrate were examined during coronary angioplasty, which provides a model of controlled, reversible ischaemia. Design—Double blind, randomised study of the effect of transdermal and intracoronary glyceryl trinitrate on ischaemia during coronary angioplasty. Patients—40 patients with isolated severe stenosis of the left anterior descending coronary artery. Interventions—Patients were randomised (double blind) to transdermal gylceryl trinitrate (10 mg per day) and placebo, starting four to six hours before angioplasty. After 4 one-minute balloon inflations intracoronary glyceryl trinitrate was injected (0.2 mg) and then 4 further one-minute inflations were performed. Main outcome measures—The time to angina and the time to > 0.2 mV ST shift on surface electrocardiogram (ECG) or intracoronary ECG during the individual inflations. Results—These times did not significantly differ during initial inflations between transdermal glyceryl trinitrate (27 (11), 25 (9), and 19 (9) s, respectively) and placebo (34 (11), 30 (8), and 21 (7) s. After intracoronary glyceryl trinitrate, they were significantly prolonged compared with the initial values, without differences between patients with transdermal glyceryl trinitrate (37 (10), 30 (8), and 23 (8) s, respectively) or placebo (39 (15), 36 (11), and 28 (12) s). Ischaemic preconditioning was not seen. Conclusions—Transdermal glyceryl trinitrate (10 mg per day), unlike intracoronary glyceryl trinitrate, did not alleviate the myocardial ischaemia produced by balloon inflation during coronary angioplasty.
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Abstract Background Transdermal glyceryl trinitrate (GTN) has potential beneficial properties in acute stroke including intracerebral hemorrhage (ICH) and possible clinical benefits suggested in ultra‐early stroke (≤6?h). Our me...
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Abstract Background Transdermal glyceryl trinitrate (GTN) has potential beneficial properties in acute stroke including intracerebral hemorrhage (ICH) and possible clinical benefits suggested in ultra‐early stroke (≤6?h). Our meta‐analysis updated the evidence on its safety and benefits in acute stroke. Methods We searched major electronic databases for randomized trials comparing transdermal GTN versus placebo/control in acute stroke. Primary outcomes were mortality, 90‐day modified Rankin Scale (mRS), and blood pressure (BP) effects. Secondary outcomes included early, late, resource utilization, and surrogate outcomes. Safety outcomes were adverse events. Reviewers identified studies, extracted data, and assessed risk of bias (RoB) using a modified Cochrane RoB instrument and quality of evidence (QoE) using GRADE. We also performed a priori subgroup and trial sequential analyses (TSA) on primary outcomes. These subgroup analyses were ICH versus ischemic stroke, minor (NIHSS ≤5) versus major (NIHSS >5) ischemic stroke, ischemic stroke with versus without thrombolysis, prehospital versus non prehospital settings, time from stroke to randomization ≤6?h versus >6?h, and high versus low overall RoB studies. Results Seven eligible primary trials enrolled 5363 patients. GTN reduced BP (mean difference [MD]?=?–4.74 mm?Hg, 95% confidence interval [CI]?=?–6.03 to –3.45?mm?Hg] and diastolic BP (MD?=?–2.94 mm?Hg, 95% CI?=?–3.74 to ?2.13?mm?Hg) 24?h posttreatment but did not affect 4‐ to 10‐day mortality (relative risk [RR]?=?1.11, 95% CI?=?0.82 to 1.49), 90‐day mortality (RR?=?0.96, 95% CI?= 0.77 to 1.19), and 90‐day mRS >2 (RR?=?0.98, 95% CI?=?0.93 to 1.03) compared to control/placebo. The QoE was high for primary outcomes with no subgroup effects detected. GTN did not affect secondary outcomes and increased risk of headache and hypotension. TSA generally supported our conclusions regarding primary outcomes. Conclusions Transdermal GTN reduces BP in acute stroke but does not alter clinical outcomes even in ultra‐early stroke (≤6?h).
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The ischaemic penumbra is sensitive to alterations in cerebral perfusion. A myriad of drugs are used in acute ischaemic stroke (AIS) management, yet their impact on cerebral haemodynamics is poorly understood. As part of the Cereb...
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The ischaemic penumbra is sensitive to alterations in cerebral perfusion. A myriad of drugs are used in acute ischaemic stroke (AIS) management, yet their impact on cerebral haemodynamics is poorly understood. As part of the Cerebral Autoregulation Network led INFOMATAS project (Identifying New Targets for Management and Therapy in Acute Stroke), this paper reviews some of the most common drugs a patient with AIS will come across and their potential influence on cerebral haemodynamics with a particular focus being on cerebral autoregulation (CA). We first discuss how compounds that promote clot lysis and prevent clot formation could potentially impact cerebral haemodynamics, before focusing on how the different classes of antihypertensive drugs can influence cerebral haemodynamics. We discuss the different properties of each drug and their potential impact on cerebral perfusion and CA. With emerging interest in CA status of AIS patients, either during or soon after treatment when timely reperfusion and salvageable tissue is at its most critical, the properties of these pharmacological agents may be relevant for modelling cerebral perfusion accuracy and for setting individualised treatment strategies.
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Recently, the number of patients with peripheral artery disease (PAD), including those with chronic limb-threatening ischemia (CLTI), has increased because of the increasing number of diabetic or dialysis patients worldwide. Revas...
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Recently, the number of patients with peripheral artery disease (PAD), including those with chronic limb-threatening ischemia (CLTI), has increased because of the increasing number of diabetic or dialysis patients worldwide. Revascularization is an important therapy for patients with CLTI. However, we sometimes experience refractory cases with insufficient peripheral circulation or microcirculation after revascularization. In this situation, additional therapy can be administered, such as low-density lipoprotein apheresis, high-pressure oxygen therapy, and spinal cord stimulation. However, they are not effective in some cases. Some reports have also indicated that transdermal isosorbide dinitrate patch (ISDN-P) is a useful therapy for PAD. As the efficacy of ISDN-P for patients with CLTI is not well-known, we examined it in this study. We assessed the skin perfusion pressure (SPP) after affixing an ISDN-P on the foot, because SPP measurement has proved useful in the assessment of PAD and is a good indicator of wound healing potential. The SPP (dorsal and plantar aspects) after ISDN-P application on the foot of healthy volunteers increased (n = 8; mean +/- SD, 12.6 +/- 7.9 [P= .12], and 21.2 +/- 7.7 mm Hg [P< .05], respectively), as did SPP of patients with CLTI (n = 10; mean +/- SD, 19.8 +/- 2.5 [P< .01], and 14.1 +/- 5.9 mm Hg [P< .05], respectively). All the patients who received an ISDN-P on the foot had no major complication, and no significant change in blood pressure. In conclusion, the ISDN-P is one of the effective and safe therapies for patients with CLTI.
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Nitric oxide is involved in a countless number of physiological processes and is known to have cytoprotective as well as cytotoxic effects. Increased knowledge about the multifaceted role of nitric oxide in a variety of disease st...
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Nitric oxide is involved in a countless number of physiological processes and is known to have cytoprotective as well as cytotoxic effects. Increased knowledge about the multifaceted role of nitric oxide in a variety of disease states has led to the design of multiple treatment strategies involving the nitric oxide system. The current review focuses on recent research advances in the fields of obstetrics, bone disease and erectile dysfunction that have led to current or potential future therapies involving nitric oxide. (C) 2003 Elsevier Inc. All rights reserved. [References: 188]
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