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Le reazioni anafilattiche da Mdc: dubbi ed evidenze su premedicazione, diag...






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Le reazioni anafilattiche da Mdc: dubbi ed evidenze su premedicazione, diagnosi e trattamento\" dott. Elio Carchietti . PubMedNeuroradiology. 1988;30(3):256-7Iopamidol 300-induced epilepsy: intensive treatment and pathogenic hypothesis.Carchietti E, Baldassarre
Le reazioni anafilattiche da Mdc: dubbi ed evidenze su prem...

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1. ?Le reazioni anafilattiche da Mdc: dubbi ed evidenze su premedicazione, diagnosi e trattamento? Relatore: Dott. Elio CARCHIETTI 1

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6. Computed tomography pulmonary angiogram was performed at 22.50 hours, confirming PE. During the procedure he was given 120 mL of i.v. iopamidol 300. At 23.03 hours he became dyspnoic with rapidly ensuing cardio-respiratory arrest. Laryngeal edema was seen at tracheal intubation, but he was successfully resuscitated. ?Le reazioni anafilattiche da M d c: dubbi ed evidenze su premedicazione, diagnosi e trattamento? dott. Elio Carchietti 6

7. During the admission he developed further chest pain. Cardiac scintigraphy was positive for ischaemia and coronary angiography was planned. This necessitated clarification of the role of RCM and other drugs in his anaphylactic event. He was confirmed to be allergic to both RCM and ceftriaxone 7

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9. A second RCM challenge was performed with prednisolone 25 mg cetirizine 10 mg ranitidine 150 mg given at 24, 12, and 1 h before This regimen is adapted from a validated Protocol: Greenberger PA, Patterson R. The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J Allergy Clin Immunol 1991; 87: 867?72. 9

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15. GLUCOCORTICOID DOSES ? Low dose - <7.5 mg prednisone equivalent a day : Occupies less than 50% of the cytosolic receptors. ? Medium dose - >7.5 mg, but <30 mg prednisone equivalent a day : Occupies above 50% but below 100% of the cytosolic receptors. ? High dose - >30 mg, but <100 mg prednisone equivalent a day: almost complete cytosolic receptor saturation. ? Very high dose - >100 mg prednisone equivalent a day: there is virtually a 100% receptor saturation. ? Pulse therapy : >250 mg prednisone equivalent F Buttgereit et Al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimen . Ann Rheum Dis. 2002 August; 61(8): 718?722 15

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19. Prednisone 25mg 24, 12, 1, ora prima del M.d.c. Prime 12 ore (dalla 24a alla 12a ora) 25 mg (dose media = 50% recettori) Seconde 12 ore 50 mg (dose piena: 100% recettori) 19

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30. Grazie per l?invito e la cortese attenzione. 30


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