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Shabbir F, Rashid M, Khan MI, Sarwar SUR, Khan AH, Goher M. Our Experience in the Surgical Management of Arterio-Venous Malformations of the head and neck. JPRAS Open 2024; 40:59-67. [PMID: 38434943 PMCID: PMC10907505 DOI: 10.1016/j.jpra.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/07/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Vascular anomalies comprise a diverse group of abnormalities in blood vessel morphogenesis that usually occur prenatally. Arterio-venous malformations (AVMs) are rare congenital vascular lesions accounting for 1.5% of all vascular anomalies, with 50% of them occur in the oral and maxillo-facial regions. Treatment of large, complex vascular lesions is a serious challenge for patients and surgeons because it can cause disfigurement and massive haemorrhage, which may be spontaneous or the result of surgical intervention. Our study aimed to demonstrate surgical management of massive AVMs of the head and neck. Method This retrospective study shows the treatment outcomes of 28 patients with massive maxillo-facial vascular malformations, who presented to our department for treatment from 1 January 2015 to 31 July 2022. Results Twenty-eight patients with a mean age of 17.32 ± 12.21 years (women: 15, men: 13) were enrolled in the study. Diagnosis included extra cranial AVMs of the head and neck region. Treatment modalities, in isolation or combination, included angioembolisation procedure, sclerotherapy, and surgery. Conclusion Management of AVMs is challenging owing to the replacement of normal tissue by the diseased ones and the high rate of recurrence. Hence, multi-modal approaches are needed for the effective restoration of tissues.
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Affiliation(s)
- Farwa Shabbir
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Mamoon Rashid
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - M. Ibrahim Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Saad ur Rehman Sarwar
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Adeela Hussain Khan
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
| | - Maimoona Goher
- Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H.8/4 Islamabad, Pakistan
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2
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DeCarlo B, MacPherson E, Williams A, Bale L, MacKenzie L. Unilateral identification of a rare superficial brachioulnoradial artery contributing to the superficial palmar arch and brachial artery continuing as the interosseous artery: a case report. Surg Radiol Anat 2024; 46:495-500. [PMID: 38480592 DOI: 10.1007/s00276-024-03332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024]
Abstract
The occurrence of variations in human arterial branching of the upper limb has been commonly reported in peer-reviewed literature. However, the variability of upper limb arterial patterns may be underappreciated in medical practice, which can result in clinical and surgical errors. Here we report a case of a rare, unilateral arterial variation of the left upper limb of a 76-year-old Caucasian male cadaver, discovered during a routine educational dissection. Observed characteristics of the variation include a high brachial artery bifurcation into a superficial brachioulnoradial artery and brachial artery continuing as the interosseous artery and then a bifurcation of the superficial brachioulnoradial artery into a superficial radial and a superficial ulnar artery, which eventually contribute to the formation of the superficial palmar arch. The anatomical characteristics, prevalence, embryological origin, and clinical significance of the variation are discussed.
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Affiliation(s)
- Brooke DeCarlo
- Anatomical Sciences Program, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Emily MacPherson
- Anatomical Sciences Program, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Yellowstone Pathology Institute, Billings, MT, USA
| | - Andre Williams
- Anatomical Sciences Program, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Division of Anatomy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Logan Bale
- Anatomical Sciences Program, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Leslie MacKenzie
- Anatomical Sciences Program, Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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3
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Ponganis PJ, Williams CL, Kendall-Bar JM. Blood oxygen transport and depletion in diving emperor penguins. J Exp Biol 2024; 227:jeb246832. [PMID: 38390686 PMCID: PMC11006389 DOI: 10.1242/jeb.246832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
Oxygen store management underlies dive performance and is dependent on the slow heart rate and peripheral vasoconstriction of the dive response to control tissue blood flow and oxygen uptake. Prior research has revealed two major patterns of muscle myoglobin saturation profiles during dives of emperor penguins. In Type A profiles, myoglobin desaturated rapidly, consistent with minimal muscle blood flow and low tissue oxygen uptake. Type B profiles, with fluctuating and slower declines in myoglobin saturation, were consistent with variable tissue blood flow patterns and tissue oxygen uptake during dives. We examined arterial and venous blood oxygen profiles to evaluate blood oxygen extraction and found two primary patterns of venous hemoglobin desaturation that complemented corresponding myoglobin saturation profiles. Type A venous profiles had a hemoglobin saturation that (a) increased/plateaued for most of a dive's duration, (b) only declined during the latter stages of ascent, and (c) often became arterialized [arterio-venous (a-v) shunting]. In Type B venous profiles, variable but progressive hemoglobin desaturation profiles were interrupted by inflections in the profile that were consistent with fluctuating tissue blood flow and oxygen uptake. End-of-dive saturation of arterial and Type A venous hemoglobin saturation profiles were not significantly different, but did differ from those of Type B venous profiles. These findings provide further support that the dive response of emperor penguins is a spectrum of cardiac and vascular components (including a-v shunting) that are dependent on the nature and demands of a given dive and even of a given segment of a dive.
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Affiliation(s)
- Paul J. Ponganis
- Center for Marine Biotechnology & Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92093-0204, USA
| | - Cassondra L. Williams
- National Marine Mammal Foundation, 2240 Shelter Island Drive, San Diego, CA 92106, USA
| | - Jessica M. Kendall-Bar
- Center for Marine Biotechnology & Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92093-0204, USA
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Jörg M, Öster M, Wretborn J, Wilhelms DB. Agreement of pCO 2 in venous to arterial blood gas conversion models in undifferentiated emergency patients. Intensive Care Med Exp 2023; 11:80. [PMID: 37989791 PMCID: PMC10663424 DOI: 10.1186/s40635-023-00564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Venous blood gas sampling has replaced arterial sampling in many critically ill patients, though interpretation of venous pCO2 still remains a challenge. Lemoël et al., Farkas and Zeserson et al. have proposed models to estimate arterial pCO2 based on venous pCO2. Our objective was to externally validate these models with a new dataset. This was a prospective cross-sectional study of consecutive adult patients with a clinical indication for blood gas analysis in an academic emergency department in Sweden. Agreement of pairs was reported as mean difference with limits of agreement (LoA). Vital signs and lead times were recorded. RESULTS Two hundred and fifty blood gas pairs were collected consecutively between October 2021 and April 2022, 243 valid pairs were used in the final analysis [mean age 72.8 years (SD 17.8), 47% females]. Respiratory distress was the most common clinical indication (84% of all cases). The model of Farkas showed the best metrics with a mean difference between estimated and arterial pCO2 of - 0.11 mmHg (95% LoA - 6.86, + 6.63). For Lemoël the difference was 2.57 mmHg (95% LoA - 5.65, + 10.8), Zeserson 2.55 mmHg (95% LoA - 7.43, + 12.53). All three models showed a decrease in precision in patients with ongoing supplemental oxygen therapy. CONCLUSION Arterial pCO2 may be accurately estimated in most patients based on venous blood gas samples. Additional consideration is required in patients with hypo- or hypercapnia or oxygen therapy. Thus, conversion of venous pCO2 may be considered as an alternative to arterial blood gas sampling with the model of Farkas being the most accurate.
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Affiliation(s)
- Matthias Jörg
- Department of Emergency Medicine, Sundsvall Regional Hospital, Region Västernorrland, Sundsvall, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden.
| | - Malin Öster
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
| | - Jens Wretborn
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
| | - Daniel B Wilhelms
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
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Balakrishnan S. CT angiography of non-aortic thoracic arterial trauma. Emerg Radiol 2023; 30:667-681. [PMID: 37704920 DOI: 10.1007/s10140-023-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.
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Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency and Trauma Imaging, Emory University School of Medicine, Atlanta, GA, USA.
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6
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Farzam F, Barakzai Y, Foladi N. Arterial thoracic outlet syndrome by a commonly overlooked anomaly, the cervical rib: A case report. Radiol Case Rep 2023; 18:3351-3356. [PMID: 37502135 PMCID: PMC10371763 DOI: 10.1016/j.radcr.2023.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/08/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Thoracic outlet syndrome (TOS) is a constellation of symptoms that occur due to the compression of neurovascular structures traversing the thoracic outlet. TOS manifests in 3 distinct forms: neurogenic, venous, and arterial. Among these, arterial TOS is the rarest. A 32-year-old man presenting with severe right arm pain was referred for CT angiography. The imaging revealed bilateral cervical ribs, with the right side showing more pronounced development and fusion with the first thoracic rib. At the fusion site of the right cervical rib and the first thoracic rib, a pseudoaneurysm of the right subclavian artery was detected. Additionally, there was evidence of acute thromboembolism in the right brachial artery at the mid-humerus. Arterial thoracic outlet syndrome is a rare form of TOS that can have detrimental consequences due to associated complications. Cross-sectional imaging, such as CT scans and MRI, is the preferred method for diagnosing TOS and identifying its specific form. Physicians are expected to be familiar with the various forms of TOS, the lesions mimicking TOS, and the imaging tools utilized for diagnosis.
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Affiliation(s)
- Farhad Farzam
- Radiology Department, Kabul University of Medical Sciences, Kabul, Afghanistan
- Radiology Department, Wyagal Radiology Center (WRC), Kabul, Afghanistan
| | - Yama Barakzai
- Radiology Department, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Naqibullah Foladi
- Radiology Department, Wyagal Radiology Center (WRC), Kabul, Afghanistan
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Flynn B, Vitztum M, Miller J, Houchin A, Kim J, He J, Geiger P. Feasibility and pilot study of passive heat therapy on cardiovascular performance and laboratory values in older adults. Pilot Feasibility Stud 2023; 9:86. [PMID: 37221607 DOI: 10.1186/s40814-023-01314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Chronic heat therapy may have beneficial effects on cardiovascular function. These effects may be more pronounced in older adults. We performed a pilot feasibility study of repeated heat therapy sessions in a hot tub (40.5 °C) in older adults while wearing a noninvasive hemodynamic monitor. As part of the protocol, the volunteers underwent cardiovascular performance testing pre- and post-intervention. METHODS Fifteen volunteers > 50 years old underwent 8-10 separate 45-min hot tub session over 14 days in this exploratory and mixed methods trial. The participants had maximal oxygen consumption (VO2 max) and other cardiovascular data measured via exercise treadmill testing prior to and after all hot tub sessions. The participants also wore noninvasive fingertip volume clamp monitors while immerged in hot water that calculated systemic vascular resistance, heart rate, blood pressure, and cardiac output in order to ascertain the feasibility and utility of this data. Other laboratory studies were obtained pre- and post-intervention. The protocol was determined feasible if the heat therapy and cardiovascular testing was completed by at least 90% (14/15 subjects). Feasibility of the noninvasive monitor was determined by the fidelity of the results. Secondary exploratory outcomes were analyzed for differences to identify if they are acceptable to include in an efficacy trial. RESULTS All participants completed the study protocol identifying the feasibility of the protocol. The noninvasive hemodynamic monitors successfully recorded cardiac output, systemic vascular resistance, heart rate, and blood pressure with fidelity based on the analysis of recordings. In the secondary analyses, we found no difference in the pre- to post-intervention measurement of VO2 max but did find increased exercise duration following hot tub therapy compared with prior to the therapy (571 s versus 551 s). CONCLUSIONS The current pilot study protocol is feasible for the purpose of analyzing the effects of heat therapy and cardiovascular performance in older adults while wearing a noninvasive hemodynamic monitor and undergoing treadmill stress testing. Secondary analyses found increased exercise tolerance but no differences in VO2 max following heat sessions.
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Affiliation(s)
- Brigid Flynn
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Michelle Vitztum
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Joshua Miller
- University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Abigail Houchin
- University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Jaromme Kim
- Department of Biostatistics and Data Science, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Paige Geiger
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
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Öncül Y, Akyay A, Özgen Ü. Thromboembolism in Children. Indian J Pediatr 2023:10.1007/s12098-023-04539-3. [PMID: 37142860 DOI: 10.1007/s12098-023-04539-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/23/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To study pediatric patients who were diagnosed with thrombosis between January 2009 and March 2020. METHODS Patients were evaluated with respect to thrombophilic risk factors, localization of the thrombus, response to treatment, and recurrence rates during the last 11 y. RESULTS Among 84 patients, 59 (70%) had venous thrombosis and 20 (24%) had arterial thrombosis. The number of documented thrombosis amongst hospitalized children in authors' hospital has increased over the years. It has been observed that the annual incidence of thromboembolism has increased after 2014. Thirteen patients were recorded between 2009 and 2014 and 71 patients between 2015 and 2020 (until March 2020). Exact thrombosis localization could not be detected in 5 patients. The median age of patients was 8 ± 5.95 (range 0-18). Fourteen children (16.9%) had a history of familial thrombosis. Genetic and/or acquired risk factors were detected in 81 (96.4%) of the patients. Overall, 64 patients (76.1%) had acquired risk factors such as infection (20.2%), catheterization (13.1%), liver disease (11.9%), mastoiditis (8.3%), liver transplantation (6%), hypoxic-ischemic encephalopathy (4.8%), dehydration (3.6%), trauma (3.6%) and cancer (2.4%). As genetic risk factors, the most common genetic mutations were PAI-1 4G>5G, MTHFR C677T, and MTHFR A1298C mutations. Twenty-eight (41.2%) patients had at least one genetic thrombophilic mutation. At least one homozygous mutation in 37 patients (44%) and at least one heterozygous mutation in 55 patients (65.4%) were detected. CONCLUSIONS The annual incidence of thrombosis has increased over the years. Genetic predisposition and acquired risk factors play an important role in etiology, treatment, and follow-up in children with thromboembolism. Especially, genetic predisposition is common. Thrombophilic risk factors should be investigated and optimal therapeutic and prophylactic measures should be promptly taken in children with thrombosis.
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Affiliation(s)
- Yurday Öncül
- Department of Pediatric Hematology and Oncology, Inonu University School of Medicine, Malatya, Turkey.
| | - Arzu Akyay
- Department of Pediatric Hematology and Oncology, Inonu University School of Medicine, Malatya, Turkey
| | - Ünsal Özgen
- Department of Pediatric Hematology and Oncology, Inonu University School of Medicine, Malatya, Turkey
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Nair SK, Xie ME, Ran K, Kalluri A, Kilgore C, Huang J, Lim M, Bettegowda C, Xu R. Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia. World Neurosurg 2023; 173:e542-e547. [PMID: 36889635 DOI: 10.1016/j.wneu.2023.02.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature. We sought to address the gap in understanding of pain outcomes in patients with sole arterial versus sole venous compression. METHODS We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via χ2 tests t tests, and Mann-Whitney U Tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival. RESULTS Of 1044 patients, 642 (61.5%) had either sole arterial or venous compression. Of these cases, 472 showed arterial compression and 170 showed sole venous compression. Patients in the venous compression group were significantly younger (P < 0.001). Patients with sole venous compression showed worse preoperative (P = 0.04) and final follow-up (P < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (P = 0.02) and BNI score at pain recurrence (P = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (odds ratio, 1.66; P = 0.003). Kaplan-Meier analysis showed a significant relationship between sole venous compression and increased risk of pain recurrence (P = 0.03). CONCLUSIONS Patients with TN with sole venous compression show worse pain outcomes after microvascular decompression compared with those with only arterial compression.
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Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Faber LL, Wiley AP, Geary RL, Chang KZ, Goldman MP, Freischlag J, Velazquez G. Boney abnormalities cause arterial, venous, and/or neurogenic thoracic outlet syndrome. J Vasc Surg Cases Innov Tech 2022; 9:101080. [PMID: 36747607 PMCID: PMC9898748 DOI: 10.1016/j.jvscit.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Thoracic outlet syndrome (TOS) is a rare condition caused by compression of the neurovascular structures within the thoracic outlet. Different classifications of TOS exist depending on the neurovascular structure being compressed: neurogenic, venous, or arterial. Any of these forms can present independently or coexist with one other. TOS symptoms are sometimes precipitated by the presence of boney abnormalities that often require surgical intervention for ultimate resolution. This retrospective review will examine the presentations and outcomes of patients with TOS whose cause was a boney abnormality. Methods A total of 73 patients who underwent thoracic outlet surgery between 2016 and 2021 were retrospectively reviewed via electronic medical records. Twelve (16%) patients demonstrated boney abnormalities on presentation causing their symptoms. The patients with boney abnormalities were analyzed based on venous, arterial, or neurogenic TOS diagnosis. Results Of the 12 patients with boney abnormalities, 5 were classified as venous TOS, 6 patients as neurogenic TOS, and 1 as arterial TOS. The boney abnormalities were as follows: venous TOS: three clavicular fractures, one nonfused congenital clavicle, and one residual rib; neurogenic TOS: three fractured first ribs, one fractured clavicle, and two cervical ribs; and arterial TOS: fused first and second rib with bilateral cervical ribs and arterial compression. Postoperatively, there were no artery, vein, or nerve injuries. Five patients had a pneumothorax treated over night with a chest tube, and one patient had a superficial wound infection. The median hospital stay was 1 day. All patients completed physical therapy after surgery. All patients have symptom resolution at follow-up. Conclusions Patients with boney abnormalities constitute about one-fifth of patients who can present with all three forms of TOS: neurogenic, arterial, and venous, and some will have more than one of these presentations. Results in patients undergoing surgery with boney abnormalities causing thoracic outlet syndrome are excellent with symptom resolution and without substantial complications.
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Affiliation(s)
- Lydia L. Faber
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC,Correspondence: Lydia L. Faber, BS, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aidan P. Wiley
- University of Maryland School of Medicine, Baltimore, MD
| | - Randolph L. Geary
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Kevin Z. Chang
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Matthew P. Goldman
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Julie Freischlag
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Copeland LA, Pugh MJ, Bollinger MJ, Wang CP, Amuan ME, Rivera JC, Shireman PK. The VA vascular injury study: A glimpse at quality of care in Veterans with traumatic vascular injury repair. Injury 2022; 53:1947-1953. [PMID: 35422314 DOI: 10.1016/j.injury.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The high number of limb injuries among Post-9/11 Veterans and their long-term care pose significant challenges to clinicians. Current follow-up for extremity arterial vascular injury (EVI) is based on guideline-concordant care for treatment of peripheral vascular disease (GCC-PVD), including anticoagulant/antiplatelet or statin therapy and duplex ultrasound. No best practices exist for arterial EVI. Our goal was to determine correlates of GCC-PVD and other care among Post-9/11 Veterans with combat-related arterial EVI. MATERIALS AND METHODS We identified Post-9/11 Veterans with arterial EVI who underwent initial limb salvage repair or ligation (e.g., for single-vessel injury) attempt per DoD Trauma Registry validated by chart abstraction. Veterans Health Administration (VHA) data characterized the cohort in the first five years of VHA care. Models predicted (a) GCC-PVD, (b) pain clinic use, (c) mental/behavioral health care, (d) long-term opioid use, and (e) time to complication, controlling for injury severity and type, mental health parameters, and demographics. RESULTS The 490-Veteran cohort with validated arterial injury was 77% White averaging 25.2 years at injury (range: 18-56). Mechanism of injury was primarily explosive (63%). Veterans had Injury Severity Scores classified as mild (60%), moderate (25%) and severe (15%). Approximately 25% received at least one component of VHA GCC-PVD including 8% arterial ultrasounds, 5% statins, and 11% anticoagulants/antiplatelets; 77% had mental/behavioral healthcare. GCC-PVD, as well as PTSD and substance use disorders, were associated with receipt of mental/behavioral health care. Complications affected 46% of the cohort and were more common among those prescribed 90+ days of opioids or receiving GCC-PVD. CONCLUSION Despite injury severity (40% moderate/severe), only 25% of cohort patients received VHA GCC-PVD, and nearly half had complications from their arterial injury. Receiving GCC-PVD appeared to potentiate receiving care for mental and behavioral disorders. IMPACT The treatment gap in Veterans with arterial EVI may be due to lack of appropriate guidelines, lack of vascular specialists in VHA or accessing care outside the VHA. Focused study of care options and their outcomes will help define optimal care processes for combat Veterans with arterial EVI.
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Affiliation(s)
- Laurel A Copeland
- Research Service, VA Central Western Massachusetts Healthcare System, 421N Main, Leeds, MA 01053 USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA 01655 USA.
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148 USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132 USA
| | - Mary J Bollinger
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR 72114 USA; Department of Psychiatry, University of Arkansas for Medical Sciences, 4301W Markham St, Little Rock, AR 72205 USA
| | - Chen-Pin Wang
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA; Department of Population Health Sciences, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA
| | - Megan E Amuan
- VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148 USA
| | - Jessica C Rivera
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234 USA; Louisiana State University Health Science Center - New Orleans Department of Orthopaedic Surgery, New Orleans, LA USA
| | - Paula K Shireman
- Geriatric Research, Education & Clinical Center, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA; Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA; Departments of Primary Care & Population Health and Medical Physiology, College of Medicine, Texas A&M Health, 2900 E 29th St, Bryan, TX 77802 USA
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de Godoy JMP, Marum G, Santos HA, da Silva MOM, da Silva FC. SARS-CoV-2 gamma variant and chronic arterial insufficiency due to late arterial thrombosis. Int J Health Sci (Qassim) 2022; 16:70-72. [PMID: 35949694 PMCID: PMC9288139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The current evidence suggests a state of hypercoagulability as one of the sequelae of hyperinflammation. Thus, it is an important pathogenic mechanism that contributes to increase the mortality caused by COVID-19. The aim of the present study is to report chronic arterial insufficiency after post-thrombosis in the same arteries 32 days later, as a sequel after severe acute respiratory syndrome coronavirus 2 P.1. After the 2nd day of discharge, she had a lot of pain in her left and limiting leg and was referred to the vascular service. The patient was evaluated by vascular surgery who underwent a clinical diagnosis of Rutherford II.A arterial thrombosis and underwent arteriography of the limb that revealed thrombosis of the anterior, posterior, and fibular arteries in the middle third and the plantar arch was not contrasted. She underwent emergency embolectomy with selective isolation of the tibial arteries, but with success after the procedure only for the posterior tibial artery. Anticoagulation was maintained and 100 mg aspirin was associated.
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Affiliation(s)
- Jose Maria Pereira de Godoy
- Department of Cardiovascular Surgery, Medicine School, Sao Jose do Rio Preto-FAMERP, Brazil,Address for correspondence: Jose Maria Pereira de Godoy, Rua Floriano Peixoto, 2950, São Jose do Rio Preto-SP, Brazil. Tel.: +551732326362. E-mail:
| | - Guilherme Marum
- Department General Surgery, Medicine School, Sao Jose do Rio Preto-FAMERP, Brazil
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Stock JK. Joint statement from the European Atherosclerosis Society and European Society of Vascular Medicine focuses on patients with peripheral arterial disease. Atherosclerosis 2021; 340:48-50. [PMID: 34863531 DOI: 10.1016/j.atherosclerosis.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jane K Stock
- European Atherosclerosis Society, World Trade Center Göteborg, Mässans Gata 10, SE, 412 51, Göteborg, Sweden.
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Ferenchak NN, Abadi MG. Nighttime pedestrian fatalities: A comprehensive examination of infrastructure, user, vehicle, and situational factors. J Safety Res 2021; 79:14-25. [PMID: 34847998 DOI: 10.1016/j.jsr.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/28/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Pedestrian fatalities in the United States increased 45.5% between 2009 and 2017. More than 85% of those additional pedestrian fatalities occurred at night. METHOD We examine Fatality Analysis Reporting System (FARS) data for fatal pedestrian crashes that occurred in the dark between 2002 and 2017. Within-variable and before/after examinations of crashes in terms of infrastructure, user, vehicle, and situational characteristics are performed with one-way analysis of variance (ANOVA) and two-sample t-tests. We model changes in crash characteristic proportions between 2002-2009 and 2010-2017 using linear regressions and test for autocorrelation with Breusch-Godfrey tests. RESULTS The increase in fatal nighttime pedestrian crashes is most strongly correlated with infrastructure factors: non-intersection unmarked locations (saw 80.8% of additional fatalities); 40-45 mph roads (54.6%); five-lane roads (40.7%); urban (99.7%); and arterials (81.1%). In addition, SUVs were involved in 39.7% of additional fatalities, overrepresenting their share of the fleet. Increased pedestrian alcohol and drug involvement warrant further investigation. The age of pedestrians killed increased more (18.1%) than the national average (3.2%). CONCLUSIONS By identifying factors related to the increase in nighttime pedestrian fatalities, this work constitutes a vital first step in making our streets safer for pedestrians. Practical Applications: More research is needed to understand the efficacy of different solutions, but this paper provides guidance for such future research. Engineering solutions such as road diets or traffic calming may be used to improve identified infrastructure issues by reducing vehicle speeds and road widths. Rethinking vehicle design, especially high front profiles, may improve vehicle issues. However, the problems giving rise to these pedestrian fatalities are likely a result of not only engineering issues but also interrelated social and political factors. Solutions may be correspondingly comprehensive, employing non-linear, systems-based approaches such as Safe Systems.
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Affiliation(s)
- Nicholas N Ferenchak
- Department of Civil, Construction & Environmental Engineering, University of New Mexico, MSC01 1070, 1 University of New Mexico, Albuquerque, NM 87133, United States.
| | - Masoud Ghodrat Abadi
- Department of Civil Engineering, California State University, Sacramento, CA 95819, United States
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Abdel Razek AAK, Elmokadem AH, Soliman M, Mukherji SK. MR Imaging of Vascular Malformations and Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:199-213. [PMID: 34802579 DOI: 10.1016/j.mric.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Soft tissue vascular anomalies show a wide heterogeneity of clinical manifestations and imaging features. MR imaging has an important role in the diagnosis and management of vascular lesions of the head and neck. MR angiography is mandatory in cases of arteriovenous and combined malformations to assess the high-flow nature/component of the lesions and plan therapy. Infantile hemangiomas can be differentiated from congenital hemangiomas by clinical course. Reactive vascular tumors have nonspecific features similar to infantile hemangiomas. Locally malignant and malignant vascular tumors have irregular borders, infiltration of different tissue planes, and lower apparent diffusion coefficient values than benign vascular tumors.
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Affiliation(s)
| | - Ali H Elmokadem
- Department of Diagnostic Radiology, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Mosad Soliman
- Department of Vascular Surgery, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Shastri L, Kjærgaard S, Thyrrestrup PS, Rees SE, Thomsen LP. Mathematically arterialised venous blood is a stable representation of patient acid-base status at steady state following acute transient changes in ventilation. J Clin Monit Comput 2021. [PMID: 34647198 DOI: 10.1007/s10877-021-00764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022]
Abstract
Hyper- or hypoventilation are commonly occurring stress responses to arterial puncture around the time of blood sampling and have been shown to rapidly alter arterial blood acid–base parameters. This study aimed to evaluate a physiology-based mathematical method to transform peripheral venous blood acid–base values into mathematically arterialised equivalents following acute, transient changes in ventilation. Data from thirty patients scheduled for elective surgery were analysed using the physiology-based method. These data described ventilator changes simulating ‘hyper-’ or ‘hypoventilation’ at arterial puncture and included acid–base status from simultaneously drawn blood samples from arterial and peripheral venous catheters at baseline and following ventilatory change. Venous blood was used to calculate mathematically arterialised equivalents using the physiology-based method; baseline values were analysed using Bland–Altman plots. When compared to baseline, measured arterial and calculated arterialised values at each time point within limits of pH: ± 0.03 and PCO2: ± 0.5 kPa, were considered ‘not different from baseline’. Percentage of values considered not different from baseline were calculated at each sampling timepoint following hyper- and hypoventilation. For the physiological method, bias and limits of agreement for pH and PCO2 were -0.001 (-0.022 to 0.020) and -0.02 (-0.37 to 0.33) kPa at baseline, respectively. 60 s following a change in ventilation, 100% of the mathematically arterialised values of pH and PCO2 were not different from baseline, compared to less than 40% of the measured arterial values at the same timepoint. In clinical situations where transient breath-holding or hyperventilation may compromise the accuracy of arterial blood samples, arterialised venous blood is a stable representative of steady state arterial blood.
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Callingham BA, Khan MA, Milton AS, Rainsford KD. Effects of nitro-butoxyl- and butyl-esters of non-steroidal anti-inflammatory drugs compared with parent compounds on the contractility of digital arterial smooth muscle from the fallow deer (Dama dama). Inflammopharmacology 2021; 29:1459-73. [PMID: 34532846 DOI: 10.1007/s10787-021-00858-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are a major cause of upper gastro-intestinal (GI) ulceration and bleeding as well as cardiovascular (CV) diseases (e.g., myocardial infarction and stroke). A feature common to both these adverse events is a variety of vascular reactions. One approach to overcome these side effects has been the development of nitric-oxide (NO)-donating NSAIDs. The NO is considered to overcome some of these vascular reactions caused by NSAIDs. Unfortunately, the NO-NSAIDs developed so far have not had the expected benefits compared with NSAIDs alone. OBJECTIVES Using in vitro preparations it is hoped to gain insight into the vascular and smooth muscle reactions induced by NO-NSAIDs compared with NSAIDs as a basis for improving the protective responses attributed to the NO-donating properties of these drugs. METHODS A range of NO-NSAIDs was synthesized based on the esterification of NSAIDs with the nitro-butoxylate as a prototype of an NO-donor. These compounds, as well as NO-donor agents and NSAIDS, were examined for their possible effects on isolated segments of digital arteries of fallow deer, which provide a robust model for determining the effects of vasodilator and vasoconstrictor activities, in comparison with those of standard pharmacological agents. RESULTS The NO-NSAIDs were found to antagonise the smooth muscle contractions produced by 5-hydroxytryptamine (serotonin, 5-HT). However, while almost all their parent NSAIDs had little or no effect, with the exception of the R-(-)-isomers of both ibuprofen and flurbiprofen, which caused vasodilatation, all the NO-NSAIDs tested antagonised the increase in tension produced by 5-HT. CONCLUSIONS R-(-)-ibuprofen and R-(-)-flurbiprofen, along with the nitro-butoxyl esters of the NSAIDs examined, produce relaxation of segments of deer digital artery smooth muscle in vitro. The evidence presented suggests that their mechanism involves the release of NO or its products.
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Nezami A, Heidari G, Tarhani F, Oliaee F. Frequency of Cardiac Arrhythmias in Children with Cardiological Consulting and Containing Electrocardiogram. Cardiovasc Hematol Disord Drug Targets 2021; 21:141-146. [PMID: 34521334 DOI: 10.2174/1871529x21666210914113115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart diseases are the leading causes of mortality and congenital heart disease (CHD) is the most common birth defect reported worldwide. OBJECTIVE The aim of this study was to evaluate the incidence of arrhythmias and CHD and the association between the two, among infants and children reported to our center. METHODS This cross-sectional study included infants and children who were referred to Shahid Madani Hospital, Khorramabad. Electrocardiogram (ECG) was performed in these children to determine the type of arrhythmia and records were used to obtain demographic data and the data regarding CHD. RESULTS Of 200 children enrolled in the study, 10 children had arrhythmias, 12 had tachycardia, 5 had bradycardia, and 31 had congenital disease. Among children with arrhythmias, 1 had atrial fibrillation, 4 patients had paroxysmal supraventricular tachycardia, 1 person had right bundle branch block, 1 had ventricular tachycardia, 2 had premature ventricular contractions and 1 had junctional ectopic tachycardia. Of the 31 children with CHD, 9 patients were presented with small ventricular septal defect, 4 children had patent foramen ovale, 2 had pulmonary stenosis and 1 of the children had tetralogy of fallout, arterial and ventricular septal defects and transposition of greater arteries, respectively. CONCLUSION We reported a positive correlation between the arrhythmias and CHD. A larger number of studies collecting focusing on different age groups are therefore required to verify our findings.
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Affiliation(s)
- Alireza Nezami
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Ghobad Heidari
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Fariba Tarhani
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Fatemeh Oliaee
- Student of Research Committee, Lorestan University of Medical Sciences, Khorramabad. Iran
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Beken S, Sarıyılmaz K, Albayrak E, Akçay A, Korkmaz A. Extremity Necrosis Due to Intrauterine Arterial Ischemia. Turk J Haematol 2021; 38:222-223. [PMID: 33053965 PMCID: PMC8386303 DOI: 10.4274/tjh.galenos.2020.2020.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Serdar Beken
- Acıbadem University Faculty of Medicine, Department of Pediatrics, Neonatology Subdivision, İstanbul, Turkey
| | - Kerim Sarıyılmaz
- Acıbadem University Faculty of Medicine, Department of Orthopedics, İstanbul, Turkey
| | - Eda Albayrak
- Acıbadem University Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Arzu Akçay
- Acıbadem University Faculty of Medicine, Department of Pediatrics, Pediatric Hematology Subdivision, İstanbul, Turkey
| | - Ayşe Korkmaz
- Acıbadem University Faculty of Medicine, Department of Pediatrics, Neonatology Subdivision, İstanbul, Turkey
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Abstract
Pulmonary arterial hypertension secondary to drugs and toxins is an important subgroup of group 1 pulmonary hypertension associated with significant morbidity and mortality. Many drugs and toxins have emerged as risk factors for pulmonary arterial hypertension, which include anorexigens, illicit agents, and several US Food and Drug Administration-approved therapeutic medications. Drugs and toxins are classified as possible or definite risk factors for pulmonary arterial hypertension. This article reviews agents that have been implicated in the development of pulmonary arterial hypertension, their pathologic mechanisms, and methods to prevent the next deadly outbreak of drug- and toxin-induced pulmonary arterial hypertension.
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Affiliation(s)
- Ramon L Ramirez
- Division of Pulmonary, Allergy and Critical Care, Stanford University School of Medicine, 300 Pasteur Drive, Room S102, Stanford, CA 94305, USA
| | - Shaun M Pienkos
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room S102, Stanford, CA 94305, USA
| | - Vinicio de Jesus Perez
- Division of Pulmonary, Allergy and Critical Care, Stanford University School of Medicine, 300 Pasteur Drive, Room S102, Stanford, CA 94305, USA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | - Roham T Zamanian
- Division of Pulmonary, Allergy and Critical Care, Stanford University School of Medicine, 300 Pasteur Drive, Room S102, Stanford, CA 94305, USA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA.
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Giurazza F, Ierardi AM, Contegiacomo A, Corvino F, Carrafiello G, Niola R. Embolization with MVP (Micro Vascular Plug ®): experience on 104 patients in emergent and elective scenarios. CVIR Endovasc 2021; 4:59. [PMID: 34250548 PMCID: PMC8273051 DOI: 10.1186/s42155-021-00246-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
AIM To describe a 3 years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA). MATERIALS AND METHODS The following parameters were investigated: type of vascular injury, anticoagulation therapy at time of procedure, anatomical district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success, device related clinical complications. Technical success was defined as complete embolization without deployment of additional embolics after MVP release. Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session. RESULTS 116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. 85 patients were treated in emergent settings while in 19 patients the procedure was scheduled. The overall technical success was 75%. Primary clinical success was 96.1%, secondary clinical success 3% and clinical failure 0.9%. No statistical differences in terms of effectiveness were observed among patients assuming anticoagulation (p-value = 0.6). A straight and longer landing zone were statistically associated with higher technical success compared to curved and shorter ones, (p-values < 0.001 and = 0.048 respectively). MVP-3 and MVP-5 were the most frequently adopted models in this sample, in 29.8% and 49% of the patients respectively. No clinically adverse events directly related to MVP occurred; in 3 cases device migration was registered without clinical complications. CONCLUSION MVP is a safe and effective embolic agent. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.
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Affiliation(s)
- Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, 80100, Naples, Italy.
| | - Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 10, 20100, Milan, Italy
| | - Andrea Contegiacomo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
| | - Fabio Corvino
- Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, 80100, Naples, Italy
| | - Giampaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 10, 20100, Milan, Italy
| | - Raffaella Niola
- Interventional Radiology Department, Cardarelli Hospital, Via Cardarelli 9, 80100, Naples, Italy
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Singh B, Kaur P, Patel P, Nabati C, Ayad S, Shamoon F, Maroules M. COVID-19 and arterial thrombosis: Report of 2 cases. Radiol Case Rep 2021; 16:1603-7. [PMID: 33968287 DOI: 10.1016/j.radcr.2021.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
The SARS-CoV-2 infection has been predominately associated with lung disease. However, emerging evidence has associated the COVID-19 infection with a hypercoagulable state. This hypercoagulable state can occur despite the use of anticoagulants and antiplatelets. In fact, it may even be the presenting symptom of COVID-19 in some patients. Thromboembolism associated with COVID-19 carries a worse prognosis and should be identified as early as possible. Therefore, we report 2 patients with arterial thrombosis in the form of limb ischemia in the setting of COVID-19.
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Ghouti C, Leon G, Seddik S, Ait Said K, Vaudreuil L, Tillou X. Uretero- arterial fistula: Six new cases and systematic review of the literature. Prog Urol 2021; 31:605-617. [PMID: 34158218 DOI: 10.1016/j.purol.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 10/21/2022]
Abstract
AIM Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF 3.
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Affiliation(s)
- C Ghouti
- Urology department, University Hospital Caen, Caen, France
| | - G Leon
- Urology department, University Hospital Caen, Caen, France
| | - S Seddik
- Urology department, University Hospital Caen, Caen, France
| | - K Ait Said
- Urology department, University Hospital Caen, Caen, France
| | - L Vaudreuil
- Urology department, University Hospital Caen, Caen, France
| | - X Tillou
- Urology department, University Hospital Caen, Caen, France.
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Chakravarthy M, Prabhakumar D, Shivalingappa B, Rao S, Padgaonkar S, Hosur R, Harivelam C, Jawali V. Routine preoperative doppler ultrasound examination of arterial system in patients undergoing cardiac surgery is beneficial: A retrospective study. Ann Card Anaesth 2021; 23:298-301. [PMID: 32687086 PMCID: PMC7559945 DOI: 10.4103/aca.aca_18_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Presence of peripheral vascular disease enhances surgical risk in cardiac surgical patients. Prior knowledge of peripheral arterial disease may help the physician make changes in the monitoring and cardiopulmonary bypass cannulation plans. It is claimed that the incidence of peripheral vascular disease in cardiac surgical patients ranges from 11 to 30%. Aims: This study was conducted to understand the characteristics of peripheral vascular disease and their implication on cardiac surgery. Settings and Design: This was a prospective study undertaken in a tertiary referral hospital. Materials and Methods: All adult patients who underwent cardiac surgery during the period of six months were included. A Doppler examination of the neck, upper limb, abdomen and lower limb was carried out by our inhouse radiologist. The incidence of peripheral vascular disease, the implication on invasive pressure monitoring site and cannulation for cardiopulmonary bypass or intraaortic balloon pump or extracorporeal membrane oxygenation were made note of. Results: During the said period, six hundred twenty eight patients underwent cardiac surgery, of whom five hundred and sixty-one patients who underwent CABG surgery. All these were subjected to Doppler examination. We observed peripheral arterial disease in 105 patients (20%). In general men suffered from PAD more often than women. Monitoring site of invasive arterial pressure, the choice of beating heart surgery, insertion of intraaortic balloon pump, femoral arterial route for cardiopulmonary bypass were some of the decision that were altered. Conclusions: Performing Doppler examination in cardiac surgical patients may yield important data that might prevent complications and support patient safety.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Dattatreya Prabhakumar
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Benak Shivalingappa
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sonali Rao
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Sumant Padgaonkar
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Rajathadri Hosur
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Chidananda Harivelam
- Department of Anesthesia, Critical Care, and Pain Relief, Fortis Hospital, Bengaluru, Karnataka, India
| | - Vivek Jawali
- Department of Cardiovascular Surgery, Fortis Hospital, Bengaluru, Karnataka, India
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Beyer SE, Dicks AB, Shainker SA, Feinberg L, Schermerhorn ML, Secemsky EA, Carroll BJ. Pregnancy-associated arterial dissections: a nationwide cohort study. Eur Heart J 2021; 41:4234-4242. [PMID: 32728725 DOI: 10.1093/eurheartj/ehaa497] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. METHODS AND RESULTS We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151 897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. <0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (<2.5%) dissection. CONCLUSION Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions.
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Affiliation(s)
- Sebastian E Beyer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Andrew B Dicks
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Loryn Feinberg
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Eric A Secemsky
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA.,Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
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Shastri L, Kjærgaard S, Thyrrestrup PS, Rees SE, Thomsen LP. Is venous blood a more reliable description of acid-base state following simulated hypo- and hyperventilation? Scand J Trauma Resusc Emerg Med 2021; 29:35. [PMID: 33596977 PMCID: PMC7888697 DOI: 10.1186/s13049-021-00848-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background ABGs are performed in acute conditions as the reference method for assessing the acid-base status of blood. Hyperventilation and breath-holding are common ventilatory changes that occur around the time of sampling, rapidly altering the ‘true’ status of the blood. This is particularly relevant in emergency medicine patients without permanent arterial catheters, where the pain and anxiety of arterial punctures can cause ventilatory changes. This study aimed to determine whether peripheral venous values could be a more reliable measure of blood gases following acute changes in ventilation. Methods To allow for characterisation of ventilatory changes typical of acutely ill patients, but without the confounding influence of perfusion or metabolic disturbances, 30 patients scheduled for elective surgery were studied in a prospective observational study. Following anaesthesia, and before the start of the surgery, ventilator settings were altered to achieve a + 100% or − 60% change in alveolar ventilation (‘hyper-’ or ‘hypoventilation’), changes consistent with the anticipation of a painful arterial puncture commonly encountered in the emergency room. Blood samples were drawn simultaneously from indwelling arterial and peripheral venous catheters at baseline, and at 15, 30, 45, 60, 90 and 120 s following the ventilatory change. Comparisons between the timed arterial (or venous) samples were done using repeated-measures ANOVA, with post-hoc analysis using Bonferroni’s correction. Results Arterial blood pH and PCO2 changed rapidly within the first 15–30s after both hyper- and hypoventilation, plateauing at around 60s (∆pH = ±0.036 and ∆PCO2 = ±0.64 kPa (4.7 mmHg), respectively), with peripheral venous values remaining relatively constant until 60s, and changing minimally thereafter. Mean arterial changes were significantly different at 30s (P < 0.001) when compared to baseline, in response to both hyper- and hypoventilation. Conclusion This study has shown that substantial differences in arterial and peripheral venous acid-base status can be due to acute changes in ventilation, commonly seen in the ER over the 30s necessary to sample arterial blood. If changes are transient, peripheral venous blood may provide a more reliable description of acid-base status.
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Affiliation(s)
- Lisha Shastri
- Respiratory and Critical Care (RCare) group, Aalborg University, Aalborg, Denmark.
| | - Søren Kjærgaard
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital North, Aalborg, Denmark
| | - Peter S Thyrrestrup
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital North, Aalborg, Denmark
| | - Stephen E Rees
- Respiratory and Critical Care (RCare) group, Aalborg University, Aalborg, Denmark
| | - Lars P Thomsen
- Respiratory and Critical Care (RCare) group, Aalborg University, Aalborg, Denmark
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Ramia JM, de Vicente E, Pardo F, Sabater L, Lopez-Ben S, Quijano Y, Villegas T, Blanco-Fernandez G, Diez-Valladares L, Lopez-Rojo I, Martin-Perez E, Pereira F, Gonzalez AJ, Herrera J, García-Domingo MI, Serradilla M. Spanish multicenter study of surgical resection of pancreatic tumors infiltrating the celiac axis: does the type of pancreatectomy affect results? Clin Transl Oncol 2021; 23:318-324. [PMID: 32592157 DOI: 10.1007/s12094-020-02423-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates. METHODS Observational retrospective multicenter study. INCLUSION CRITERIA patient undergoing TP, PD or DP plus CAR for a pancreatic cancer. RESULTS Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups. CONCLUSION It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.
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Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Pintor Baeza, 11, 03010, Alacant, Alacant, Spain.
| | - E de Vicente
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - F Pardo
- Department of Surgery, Clínica Universitaria de Navarra, Pamplona, Spain
| | - L Sabater
- Department of Surgery, Hospital Clínico, Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - S Lopez-Ben
- Department of Surgery, Hospital Josep Trueta, Girona, Spain
| | - Y Quijano
- Department of Surgery, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - T Villegas
- Department of Surgery, Hospital Virgen de las Nieves, Granada, Spain
| | - G Blanco-Fernandez
- Department of Surgery, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - L Diez-Valladares
- Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - I Lopez-Rojo
- Department of Surgery, Fundación Jimenez Diaz, Madrid, Spain
| | - E Martin-Perez
- Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain
| | - F Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - A J Gonzalez
- Department of Surgery, Hospital Quirón Málaga, Malaga, Spain
| | - J Herrera
- Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - M Serradilla
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Shankar A, Varadan B, Ethiraj D, Sudarsanam H, Hakeem AR, Kalyanasundaram S. Systemic arterio-venous thrombosis in COVID-19: A pictorial review. World J Radiol 2021; 13:19-28. [PMID: 33574991 PMCID: PMC7852348 DOI: 10.4329/wjr.v13.i1.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Systemic complications include cardiovascular, neurological, hepatic, renal and altered coagulation. Derangements in haemostasis with SARS-CoV-2 infection have been termed COVID-19 associated coagulopathy (CAC). CAC is postulated to be one of the significant causes for sudden deaths in this pandemic, with infection of endothelial cells and subsequent endotheliitis through angiotensin-converting enzyme-2 receptors playing a key role in the pathogenesis. In this pictorial review, we describe the imaging findings in a multitude of extrapulmonary arterial (aorta, cerebral, mesenteric, renal and peripheral arterial system) and venous thrombotic phenomena detected on contrast-enhanced computed tomography and magnetic resonance imaging of COVID-19 patients which could not be attributed to any other causes. Knowledge of incidence of these complications, lowering the threshold for diagnostic imaging in symptomatic patients and timely radiological detection can play a vital role in subsequent management of these critically ill patients.
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Affiliation(s)
- Abhinaya Shankar
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Baskaran Varadan
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Dillibabu Ethiraj
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Hemanth Sudarsanam
- Department of Radiology, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Abdul Rahman Hakeem
- HPB Surgery and Liver Transplantation, The Leeds Teaching Hospitals NHS Trust, Leeds LS97TF, West Yorkshire, United Kingdom
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Tucker T. Arterial stiffness as a vascular contribution to cognitive impairment: a fluid dynamics perspective. Biomed Phys Eng Express 2021; 7. [PMID: 33482655 DOI: 10.1088/2057-1976/abdf36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
A model of cerebral pulsatile blood through multiple arterial bifurcations is developed, based on the physics of wave propagation in compliant vessels. The model identifies the conditions for the optimum antegrade flow of blood into the arterioles as a function of the areas and stiffnesses of the arteries. The model predicts and quantifies the reduction in vessel diameter which occurs in progressing from the large central arteries into the arterioles. It also predicts and quantifies the change in vessel compliance which occurs in progressing from the large central arteries, through the small arteries, into the arterioles. Physics predicts that the clinically observed compliance changes are consistent with the efficient delivery of blood to the cerebral capillary bed. The model predicts that increasing arterial stiffening with age, reduces pulsatile cerebral blood flow substantially, potentially resulting in ischemia, hypoperfusion and hypoxia, with attendant neurological and cognition consequences. The model predicts that while central pulse pressure increases with aging, small vessel pulse pressure reduces, contrary to the concept of a pressure wave tsunami in the small vessels. The model also predicts that increased luminal diameters with increasing age, mitigate, somewhat the negative consequences of arterial stiffening, a form of adaptive arterial remodelling.
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Affiliation(s)
- Trevor Tucker
- Independent Researcher, Independent Researcher, Ottawa, Ontario, CANADA
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31
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Köse S, Özdemir S. Evaluation of functions after surgical treatment in patients with arterial thoracic outlet syndrome using QuickDASH. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:70-6. [PMID: 33768983 DOI: 10.5606/tgkdc.dergisi.2021.19810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 11/21/2022]
Abstract
Background The aim of this study was to examine the validity and reliability of the Quick Disability of the Arm, Shoulder and Hand questionnaire in patients with arterial thoracic outlet syndrome. Methods A total of 106 patients (15 males, 91 females; mean age: 30.7±10.2 years; range, 13 to 60 years) with arterial thoracic outlet syndrome were included in this prospective study between January 2015 and December 2018. The questionnaire was administered to all patients before and six months after surgery. The patients were operated using a transaxillary or supraclavicular approach under general anesthesia. Results The Cronbach"s alpha value of the questionnaire was found to be 0.85 and the scale consisted of two factors. The change in both the functional status subscale scores (p<0.001) and the physical pain subscale scores (p<0.001) were statistically significantly different before and after surgery. At the end of six months, 53% of the patients with at least one mild difficulty continued to have complaints related to hand, arm and shoulder. Conclusion Based on our study results, this questionnaire is a valid and reliable tool for measuring and monitoring disease symptoms in patients with arterial thoracic outlet syndrome.
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Scott BA, Garg K, Johnson W, Al-Ajam M, Patalano P, Rotella V, Edwards JA, Aboushi H, Lee P, Daniel M, Rancy S, Heimann D. Upper Extremity Arterial Thromboembolism in a Coronavirus Patient. A Case Report. ACTA ACUST UNITED AC 2021; 3:273-278. [PMID: 33432306 PMCID: PMC7788384 DOI: 10.1007/s42399-020-00694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
The coronavirus disease 2019 pandemic has impacted millions of people worldwide. This novel virus has a variety of presentations and complications. Notably, patients with this infection have an associated coagulopathy, presenting with symptoms such as gastrointestinal bleeds, deep vein thrombosis, ischemic cerebrovascular events, and pulmonary embolism. Although there are documented cases of venous thromboembolism in patients with coronavirus disease 2019, the authors present an interesting case of upper extremity arterial thromboembolism in a 75-year-old patient surgically treated for arterial thrombus removal. We also discuss diagnosis, medical management, and surgical approach to an upper extremity arterial thromboembolism in a patient with coronavirus disease 2019, to highlight the challenges of hypercoagulability in such patients.
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Affiliation(s)
| | | | - William Johnson
- VA New York Harbor Health System - Manhattan, New York, NY USA
| | | | - Peter Patalano
- VA New York Harbor Health System - Manhattan, New York, NY USA
| | | | | | | | - Paul Lee
- SUNY Downstate Medical Center, New York, NY USA
| | | | | | - David Heimann
- VA New York Harbor Health System - Brooklyn, New York, NY USA
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Shiwani TH, Shiwani H. Intra- arterial anaesthetics for pain control in arterial embolisation procedures: a systematic review and meta-analysis. CVIR Endovasc 2021; 4:6. [PMID: 33399961 PMCID: PMC7785604 DOI: 10.1186/s42155-020-00198-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-020-00198-z.
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Affiliation(s)
| | - Hunain Shiwani
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
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Yadava OP, Raman J. Radial Artery Patency and Clinical Outcome Study (RAPCOS) Trial. Indian J Thorac Cardiovasc Surg 2021; 37:215-216. [PMID: 33642722 DOI: 10.1007/s12055-020-01111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Dr. O.P. Yadava, CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi, India, and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery, in conversation with Dr. Jai Raman from the University of Melbourne on the Radial Artery Patency and Clinical Outcome (RAPCO) Trial. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-020-01111-y.
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Affiliation(s)
| | - Jai Raman
- University of Melbourne, Melbourne, Australia
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35
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Alexander MD, Hutcheson D, Lawton M. Neurovascular arterial anatomy: Brain, head, and neck. Handb Clin Neurol 2021; 176:1-21. [PMID: 33272390 DOI: 10.1016/b978-0-444-64034-5.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An understanding of neurovascular anatomy is essential to endovascular diagnosis and therapy. This chapter provides an overview of the arterial anatomy from the aortic arch to the vertex.
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Affiliation(s)
- Matthew D Alexander
- Departments of Radiology and Imaging Sciences, and Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - David Hutcheson
- Department of Neurobiology & Anatomy, University of Utah, Salt Lake City, UT, United States
| | - Michael Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.
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Patel JN, Robinson M, Jagosky M, Slaughter D, Arnall J, Jandrisevits E, Matusz-Fisher A, Atrash S, Paul B, Bhutani M, Voorhees P, Usmani SZ. Thromboembolism Incidence and Risk Factors in Multiple Myeloma After First Exposure to Immunomodulatory Drug-Based Regimens. Clin Lymphoma Myeloma Leuk 2021; 21:188-198.e2. [PMID: 33339769 DOI: 10.1016/j.clml.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We evaluated time to thromboembolism (TE) and risk factors in multiple myeloma (MM) patients after first exposure to immunomodulatory therapy, stratified by thromboprophylaxis. PATIENTS AND METHODS We retrospectively analyzed adult MM patients who received immunomodulatory therapy with or without dexamethasone between February 2012 and October 2017. Thromboprophylaxis included aspirin, anticoagulants (low-molecular-weight heparin, direct oral anticoagulants, or warfarin), or none. Primary endpoint was time to on-treatment TE by thromboprophylaxis type. Time to TE using death as a competing risk censored at 12 months was used in univariate and multivariable analyses to identify risk factors. RESULTS Of 485 evaluable patients, 57% were white and 36% African American; median age was 66. Most received lenalidomide (97.5%) and dexamethasone (90%). Half presented with ≥ 1 comorbidities. Sixty-nine had no documented receipt of prophylaxis, 357 aspirin, and 59 anticoagulation. More patients receiving anticoagulants had ≥ 1 comorbidities compared to aspirin or no-prophylaxis groups (P < .001). There was no difference in 12-month estimated cumulative incidence of TE (7.3%; 95% confidence interval, 5.2-9.9) between thromboprophylaxis groups (none 4.4%, aspirin 8.5%, anticoagulant 3.4%) (P = .24). In multivariable analyses, male sex (hazard ratio, 2.50; 95% confidence interval, 1.21-5.17; P = .014) and presence of any comorbidity (hazard ratio, 2.35; 95% confidence interval, 1.17-4.73; P = .016) were associated with TE incidence; thromboprophylaxis type was not (P = .12). CONCLUSION Male sex and presence of any comorbidity were associated with time to TE. There were no differences in TE incidence between thromboprophylaxis groups despite a higher proportion of those in the anticoagulant group having ≥ 1 comorbidities.
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Cheng C, Cheng GY, Denas G, Pengo V. Arterial thrombosis in antiphospholipid syndrome (APS): Clinical approach and treatment. A systematic review. Blood Rev 2020; 48:100788. [PMID: 33341301 DOI: 10.1016/j.blre.2020.100788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
Thrombotic Antiphospholipid Syndrome (APS) is a condition affecting young individuals in whom a thromboembolic event occurs in the presence of circulating antiphospholipid antibodies (aPL). An extensive body of literature has covered the most common clinical presentation of the syndrome, venous thromboembolism. Arterial thrombosis in APS, a lesser clinical expression, is less studied. This review will concentrate on the body of literature concerning pathogenesis, clinical presentation and management of arterial thrombosis in APS.
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Affiliation(s)
- Chunyan Cheng
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gang-Yi Cheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Gentian Denas
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Vittorio Pengo
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy; Arianna Foundation on Anticoagulation, Bologna, Italy.
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Dior UP, Karavani G, Bursztyn M, Paltiel O, Calderon-Margalit R, Friedlander Y, Youssim I, Manor O, Hochner H. Birth Weight and Maternal Body Size as Determinants of Blood Pressure at Age 17: Results from the Jerusalem Perinatal Study Cohort. Matern Child Health J 2020; 25:162-171. [PMID: 33247825 DOI: 10.1007/s10995-020-03096-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of birth weight (BW) and maternal pre-pregnancy BMI (mBMI) on blood pressure (BP) in adolescence. METHODS A Population-based cohort of 11,729 births in Jerusalem during 1974-1976, with archival data on maternal and birth characteristics was performed. Measurements at age 17 were assessed and linear regression models were used to evaluate the associations of birth characteristics with BP outcomes. RESULTS BW was inversely associated with both systolic (SBP) and diastolic (DBP) BP at age 17 (SBP: B = - 0.829, p = 0.002; DBP: B = - 0.397, p = 0.033). The interaction term between BW and weight at age 17 was significant for DBP (p = 0.017) and pulse pressure (p = 0.005). mBMI yielded significant positive associations with BP, independent of BW. CONCLUSIONS FOR PRACTICE Our findings indicate that there are at least two distinct pathways linking early life characteristics with subsequent BP: Intrauterine growth, as reflected by BW and other genetic or environmental factors, reflected by mBMI and maternal education, contribute to offspring adolescent BP. These results warrant replication in other birth cohorts and underline the need to explore specific mechanisms that account for these associations.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel. .,Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Michael Bursztyn
- Hypertension Unit, Department of Medicine, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yechiel Friedlander
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Abstract
Identification of the prostatic arteries (PAs) is one of the most challenging aspects of prostate artery embolization for treatment of benign prostatic hyperplasia-associated lower urinary tract symptoms. Operators require a detailed understanding of the prostate arterial anatomy to ensure technical and clinical success with minimal complications. Due to substantial variability in internal iliac artery branch patterns and specifically the origin of the PA, we focus on 3 clinically relevant classification systems used to categorize the pelvic vasculature. These include classification systems to understand the internal iliac artery branching pattern, PA origin variation, and intraprostatic branching.
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Affiliation(s)
- Srini Tummala
- University of Miami Miller School of Medicine, Department of Interventional Radiology, Miami, FL.
| | | | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL
| | - Shivank Bhatia
- University of Miami Miller School of Medicine, Department of Interventional Radiology, Miami, FL
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Tholakanahalli VN. Epicardial Ablation via Arterial and Venous Systems. Card Electrophysiol Clin 2020; 12:391-399. [PMID: 32771192 DOI: 10.1016/j.ccep.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique anatomic location of these vessels on the epicardial surface enables mapping/interventions without the need to access the pericardial space. These anatomic routes also track deep into certain intramural regions, with interventions that are not accessible from either epicardial or endocardial routes. To map smaller vessels, multipolar catheters and wires are used to record local electrograms. Endocardial/epicardial ablation at adjacent sites is sometimes required to enhance successful outcomes. This article describes tools, techniques, and site-specific mapping and interventions.
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Affiliation(s)
- Venkatakrishna N Tholakanahalli
- Advanced Interventional Cardiac Electrophysiology, LAA Closure program and EP Laboratory, Minneapolis VA Health Care System, University of Minnesota, 111C, One Veterans Dr. Minneapolis MN 55417, USA.
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Sartipy F, Lundin F, Wahlberg E, Sigvant B. Cardiovascular long-term outcome and prophylactic treatment patterns in peripheral arterial disease in a population-based cohort. Eur Heart J Qual Care Clin Outcomes 2020; 5:310-320. [PMID: 31304962 DOI: 10.1093/ehjqcco/qcz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 12/31/2022]
Abstract
AIMS This study evaluates 10-year follow-up data on associated comorbidity, mortality, and pharmacological treatment patterns for men and women with different stages of peripheral arterial disease (PAD) in a population-based setting. METHODS AND RESULTS This was a prospective observational population-based cohort study, based on physical examinations and questionnaires at baseline supplemented with national register data between 2005 and 2015. Subjects were placed in subgroups defined by ankle-brachial index levels and reported symptoms; asymptomatic PAD (APAD), intermittent claudication (IC), severe limb ischaemia (SLI), or references (Ref). Cox proportional hazards regression models were used for analysis with adjustments for sex and baseline age and comorbidity. The cohort consisted of 5080 subjects (45% males). At baseline, APAD, IC, and SLI were prevalent in 559 (11%), 320 (6.3%), and 78 (1.5%) subjects, respectively. A significant increased risk for cardiovascular (CV) death, even when adjusted for age and baseline morbidity, were noted in all PAD stages as compared with reference group with a small difference between APAD and IC, an adjusted hazard ratio 1.80 (confidence interval 1.45-2.22) and 1.95 (1.50-2.53), respectively. Only about 60% of PAD subjects received medical prophylactic treatment as recommended in guidelines. CONCLUSION Peripheral arterial disease subjects had significantly increased CV morbidity and mortality risks, especially males. Asymptomatic PAD subjects confer similar risk for CV events as symptomatic patients. Our findings motivate enhanced preventive efforts of all PAD stages, including in asymptomatic disease.
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Affiliation(s)
- Fredrik Sartipy
- Department of Clinical Science and Education, Section of Vascular Surgery, Karolinska Institutet at Södersjukhuset, Kirurgkliniken, Sjukhusbacken 10, Stockholm, Sweden
| | - Fredrik Lundin
- Centre of Clinical Research, County Council of Värmland, Älvgatan 49, Karlstad, Sweden
| | - Eric Wahlberg
- Department of Medicine and Health, Linköping University, Linkoping University Hospital, SE Linköping, Sweden
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Dag Hammarskjölds väg 38, Sweden
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Buetti N, Ruckly S, Lucet JC, Bouadma L, Schwebel C, Mimoz O, Timsit JF. Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials. Ann Intensive Care 2020; 10:89. [PMID: 32643100 DOI: 10.1186/s13613-020-00705-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results. RESULTS We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27-2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20-3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92-1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23-2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17-3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63-1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69). CONCLUSIONS Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT01189682).
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Gori E, Pierini A, Ceccherini G, Citi S, Mannucci T, Lippi I, Marchetti V. Pulmonary complications in dogs with acute presentation of pancreatitis. BMC Vet Res 2020; 16:209. [PMID: 32571307 PMCID: PMC7310026 DOI: 10.1186/s12917-020-02427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality. Results This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO2 and HCO3− levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001). Conclusions As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.
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Affiliation(s)
- Eleonora Gori
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Alessio Pierini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy.
| | - Gianila Ceccherini
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Tommaso Mannucci
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - Veronica Marchetti
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Via Livornese Lato monte, San Piero a Grado, 56122, Pisa, Italy
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Royse A, Pamment W, Pawanis Z, Clarke-Errey S, Eccleston D, Ajani A, Wilson W, Canty D, Royse C. Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts. BMC Cardiovasc Disord 2020; 20:148. [PMID: 32204693 PMCID: PMC7092416 DOI: 10.1186/s12872-020-01433-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Methods Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Results Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. Conclusions All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
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Affiliation(s)
- Alistair Royse
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia. .,Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, PO Box 2135, Melbourne, Victoria, 3050, Australia.
| | - William Pamment
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia
| | - Zulfayandi Pawanis
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, The University of Melbourne, 139 Barry St, Parkville, 3010, Australia
| | - David Eccleston
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Andrew Ajani
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - William Wilson
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - David Canty
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
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Decker G, Sprinkart AM, Wolter K, Schild HH, Thomas DK. The impact of rheolytic percutaneous mechanical thrombectomy on glomerular filtration rate levels. J Vasc Surg Venous Lymphat Disord 2020; 8:545-550. [PMID: 31928956 DOI: 10.1016/j.jvsv.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rheolytic percutaneous mechanical thrombectomy (PMT) has been established as an endovascular technique for thrombus removal. Initial studies reporting on postinterventional kidney dysfunction have surfaced. The aim of this study was to investigate glomerular filtration rate (GFR) changes after PMT. METHODS A total of 45 interventions were included; 21 were performed in the venous system and 24 in the arterial system. Renal function was evaluated through assessment of GFR value changes from baseline to a minimum of two postinterventional values, and RIFLE criteria (Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease) were applied. RESULTS The univariate analysis of variance revealed a significant association of GFR increase between time points and the type of intervention (arterious or venous; P = .002), whereas there was no significant association of intervention duration (P = .382), quantity of administered contrast medium (P = .544), or use of urokinase (P = .377). Repeated measures analysis of variance revealed a significant difference in GFR values between the four time points for venous interventions (P = .008) but not for arterial interventions (P = .908). In venous interventions, postinterventional GFR values were significantly lower compared with preinterventional values (P = .008) and the two measurements after intervention (P = .017 and P = .014, respectively). According to the RIFLE criteria, 1 of the 21 patients in the venous group had a complete loss of kidney function and 2 patients progressed to the risk group (GFR decreases >25%). CONCLUSIONS PMT in the venous system has a significant impact on GFR levels, although there is only a low risk for clinically important renal dysfunction. The occurrence of renal impairment should be taken into account in evaluating PMT treatment, especially because of the associated morbidity.
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Affiliation(s)
- Georges Decker
- Department of Radiology, University of Bonn, Bonn, Germany.
| | | | - Karsten Wolter
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
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Bonnefont-Rousselot D, Benouda L, Bittar R, Darabi-Amin M, Demondion P, Lesnik P, Leprince P, Kontush A, Charniot JC, Giral P. Antiatherogenic properties of high-density lipoproteins from arterial plasma are attenuated as compared to their counterparts of venous origin. Nutr Metab Cardiovasc Dis 2020; 30:33-39. [PMID: 31753791 DOI: 10.1016/j.numecd.2019.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS High-density lipoprotein (HDL) particles play atheroprotective roles by their ability to efflux cholesterol from foam cells and to protect low-density lipoproteins (LDLs) from oxidative damage in the arterial intima. We hypothesized that antioxidative properties of HDLs can be attenuated in the oxygen-rich prooxidative arterial environment, contributing to the development of atherosclerosis. To evaluate this hypothesis, we compared antioxidative activity of HDLs from arterial and venous plasmas. METHODS AND RESULTS Arterial and venous blood samples were simultaneously obtained from 16 patients (age 68 ± 10 years; 75% males) presenting with ischemic or valvular heart disease. Major HDL subfractions and total HDLs were isolated by density gradient ultracentrifugation and their chemical composition and the capacity to protect LDLs from in vitro oxidation were evaluated. HDL-cholesterol, triglycerides and apolipoprotein (apo) B-100 levels were slightly but significantly reduced by -4 to -8% (p < 0.01) in the arterial vs. venous samples. Total mass of HDL subpopulations was similar and HDL subpopulations did not reveal marked compositional differences between the arterial and venous circulation. Potent antioxidative activity of the small, dense HDL3c subpopulation was significantly reduced in the particles of arterial origin vs. their counterparts from venous plasma (increase of +21% in the propagation rate of LDL oxidation, p < 0.05). Interestingly, antioxidative properties of venous HDLs were enhanced in statin-treated patients relative to untreated subjects. CONCLUSION Antioxidative properties of small, dense HDLs from arterial plasma are attenuated as compared to the particles of venous origin, consistent with the development of atherosclerosis in the arterial wall.
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Affiliation(s)
- Dominique Bonnefont-Rousselot
- Department of Metabolic Biochemistry, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France; INSERM U 1022 CNRS UMR 8258, Chimie ParisTech, PSL Research University, Laboratory of Chemical and Biological Technologies for Health (UTCBS), Faculty of Pharmacy of Paris, University of Paris, France.
| | - Leila Benouda
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Randa Bittar
- Department of Metabolic Biochemistry, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France; National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Maryam Darabi-Amin
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Pierre Demondion
- Department of Cardiac Surgery, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Philippe Lesnik
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Pascal Leprince
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France; Department of Cardiac Surgery, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | - Anatol Kontush
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
| | | | - Philippe Giral
- National Institute for Health and Medical Research (INSERM), UMR ICAN 1166, Sorbonne University Paris 6, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France; Department of Endocrinology and Metabolism, Pitié-Salpêtrière - Charles Foix Hospital, AP-HP, Paris, France.
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Crouch AC, Cao AA, Scheven UM, Greve JM. In Vivo MRI Assessment of Blood Flow in Arteries and Veins from Head-to-Toe Across Age and Sex in C57BL/6 Mice. Ann Biomed Eng 2019; 48:329-341. [PMID: 31456089 DOI: 10.1007/s10439-019-02350-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
Although widely used as a preclinical model for studying cardiovascular diseases, there is a scarcity of in vivo hemodynamic measurements of the naïve murine system in multiple arterial and venous locations, from head-to-toe, and across sex and age. The purpose of this study is to quantify cardiovascular hemodynamics in mice at different locations along the vascular tree while evaluating the effects of sex and age. Male and female, adult and aged mice were anesthetized and underwent magnetic resonance imaging. Data were acquired from four co-localized vessel pairs (carotid/jugular, suprarenal and infrarenal aorta/inferior vena cava (IVC), femoral artery/vein) at normothermia (core temperature 37 ± 0.2 °C). Influences of age and sex on average velocity differ by location in arteries. Average arterial velocities, when plotted as a function of distance from the heart, decrease nearly linearly from the suprarenal aorta to the femoral artery (adult and aged males: - 0.33 ± 0.13, R2 = 0.87; - 0.43 ± 0.10, R2 = 0.95; adult and aged females: - 0.23 ± 0.07, R2 = 0.91; - 0.23 ± 0.02, R2 = 0.99). Average velocity of aged males and average volumetric flow of aged males and females tended to be larger compared to adult comparators. With cardiovascular disease as the leading cause of death and with the implications of cardiovascular hemodynamics as important biomarkers for health and disease, this work provides a foundation for sex and age comparisons in pathophysiology by collecting and analyzing hemodynamic data for the healthy murine arterial and venous system from head-to-toe, across sex and age.
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Affiliation(s)
- A Colleen Crouch
- Mechanical Engineering, University of Michigan, 1049 Bonisteel Interdisciplinary Research Building, 2360 Bonisteel Boulevard, Ann Arbor, MI, 48109-2099, USA.
| | - Amos A Cao
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ulrich M Scheven
- Mechanical Engineering, University of Michigan, 1049 Bonisteel Interdisciplinary Research Building, 2360 Bonisteel Boulevard, Ann Arbor, MI, 48109-2099, USA
| | - Joan M Greve
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Abstract
Antiphospholipid syndrome an autoimmune disease characterized by thrombosis and/or pregnancy morbidity alongside the presence of antiphospholipid antibodies (aPL). This review evaluates primary and secondary thromboprophylaxis in patients with aPL and thrombotic events. In primary thromboprophylaxis a risk-stratified approach is needed based on aPL, comorbidity with other autoimmune conditions and cardiovascular vascular risk factors. In primary thromboprophylaxis, the efficacy of low-dose aspirin is debatable and requires better-designed controlled studies. So far warfarin has not been shown to improve venous and/or arterial thrombosis incidence in aPL carriers and instead increased safety concerns. The benefit of hydroxychloroquine is inconclusive despite promising data, requiring large, controlled trials. For secondary thromboprophylaxis warfarin seems to be the best option with potential in renal transplant recipients and better efficacy at high intensity, although maintenance of target international normalized ratio needs careful monitoring. Aspirin has not shown to be beneficial, and data on rivaroxaban are limited and contradictory. Despite all data being informative, there are limitations that need to be addressed with robust clinical trials.
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Affiliation(s)
- T S Vadgama
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
| | - A Smith
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
| | - M L Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, St Thomas' Hospital, London, UK
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Hutchinson ML, Beslow LA. Hemorrhagic Transformation of Arterial Ischemic and Venous Stroke in Children. Pediatr Neurol 2019; 95:26-33. [PMID: 30904397 DOI: 10.1016/j.pediatrneurol.2019.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022]
Abstract
Hemorrhagic transformation can complicate both arterial ischemic stroke and cerebral sinus venous thrombosis. Risk factors for hemorrhagic transformation after adult arterial ischemic stroke include larger infarct volume, cardioembolic stroke, and anticoagulation in the acute period. Large hemorrhagic transformation in adults is associated with poor outcome. Therefore hemorrhagic transformation is used as a safety end point for most arterial ischemic stroke acute treatment and secondary prevention trials. Up to 30% of children with arterial ischemic stroke have hemorrhagic transformation, most of which are petechial. As in adults, large infarct size is the greatest predictor of hemorrhagic transformation, but in children, acute anticoagulation is not a clear predictor of hemorrhage. As use of acute endovascular interventions for arterial ischemic stroke has expanded in adults, these therapies have also been used in some teenagers and even younger children. More information, including safety data with end points like hemorrhagic transformation, is needed in the pediatric population. In adults with cerebral sinus venous thrombosis, including those with hemorrhagic transformation, acute anticoagulation is associated with better outcomes and is the standard of care. Some hemorrhagic transformation may be evident at baseline in over half of children and neonates with cerebral sinus venous thrombosis. Anticoagulation-associated hemorrhage in pediatric cerebral sinus venous thrombosis occurs in about 10% of children but is not clearly related to outcome, whereas lack of anticoagulation may be associated with clot propagation and worse outcomes. This review provides background on hemorrhagic transformation of ischemic stroke in adults and summarizes literature regarding hemorrhagic transformation of pediatric arterial ischemic stroke and cerebral sinus venous thrombosis, with a focus on implications for acute treatment and outcome.
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Affiliation(s)
- Melissa L Hutchinson
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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50
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Mahmoodpoor A, Shadvar K, Sanaie S, Golzari SEJ, Parthvi R, Hamishehkar H, Nader ND. Arterial vs venous lactate: Correlation and predictive value of mortality of patients with sepsis during early resuscitation phase. J Crit Care 2019; 58:118-124. [PMID: 31174974 DOI: 10.1016/j.jcrc.2019.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare the lactate concentrations obtained from venous to those obtained from arterial blood in predicting hospital mortality of patients with sepsis and septic shock. To also assess lactate clearance as predictor for mortality. METHODS 100 patients with septic shock were prospectively enrolled. Serum was sampled at baseline and after 6 h of resuscitation from arterial and venous lines. Demographic, severity indices, hemodynamic measures as well as lactate clearance levels were noted. Data were analyzed for bias and precision. RESULTS There was correlation between venous and arterial lactate concentrations at the baseline (R = 0.68) and at the 6-hour time point (R = 0.95). Venous concentrations were consistently higher than those obtained from an arterial access by 0.684 mg/dL. Further, arterial lactate level > 3.2 mmol/L and clearance of <20% were considered the cutoff for the mortality risk. While only 8% of the patients with no risk died, all 20 patients who had lactate level > 3.2 mmol/L and clearance of <20% died within the hospital. CONCLUSION Our data suggests a strong correlation between arterial and peripheral venous the lactate levels and in the initial phase of resuscitation in septic shock patients we can use venous lactate level as biomarker instead of arterial lactate level. The study also showed that combining lactate levels and its clearance is a reliable predictor of mortality in sepsis.
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Affiliation(s)
- Ata Mahmoodpoor
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Lung Disease and Tuberculosis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Samad E J Golzari
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rukma Parthvi
- Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
| | - Hadi Hamishehkar
- Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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