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https://www.readbyqxmd.com/read/28072930/left-ventricular-outflow-tract-obstruction-be-prepared
#1
J S Evans, S J Huang, A S McLean, M Nalos
The current trend to treat hypotension in critically ill patients is to place a greater emphasis on inotropic support and less on fluid resuscitation in order to limit the potential harm from fluid overload. This combination may trigger left ventricular outflow tract obstruction (LVOTO) in susceptible patients. Although LVOTO is classically described in patients with hypertrophic cardiomyopathy it has been reported in other conditions including septic shock, apical ballooning syndrome, myocardial infarction, respiratory failure, and post valvular surgery...
January 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28054280/successful-bypass-operation-for-esophageal-obstruction-after-acute-esophageal-necrosis-a-case-report
#2
Yayoi Sakatoku, Masahide Fukaya, Kazushi Miyata, Masato Nagino
BACKGROUND: Acute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation. CASE PRESENTATION: A 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus...
December 2017: Surgical Case Reports
https://www.readbyqxmd.com/read/28034568/efficacy-and-safety-of-balloon-pulmonary-angioplasty-for-chronic-thromboembolic-pulmonary-hypertension-guided-by-cone-beam-computed-tomography-and-electrocardiogram-gated-area-detector-computed-tomography
#3
Takeshi Ogo, Tetsuya Fukuda, Akihiro Tsuji, Shigefumi Fukui, Jin Ueda, Yoshihiro Sanda, Yoshiaki Morita, Ryotaro Asano, Nao Konagai, Satoshi Yasuda
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. METHODS: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment...
December 21, 2016: European Journal of Radiology
https://www.readbyqxmd.com/read/28011405/platelet-to-lymphocyte-ratio-as-a-novel-marker-of-in-hospital-and-long-term-adverse-outcomes-among-patients-with-acute-pulmonary-embolism-a-single-center-large-scale-study
#4
Elif Hande Ozcan Cetin, Mehmet Serkan Cetin, Ugur Canpolat, Ahmet Akdi, Dursun Aras, Ahmet Temizhan, Sinan Aydogdu
BACKGROUND: The interaction of platelets with leukocytes is a well-known process both in progression and prognosis of acute pulmonary embolism (PE). Recently, platelet to lymphocyte ratio (PLR) is emerged as an indirect inflammatory indicator which was shown to be associated with adverse cardiovascular events in various clinical conditions, including acute PE. However, the long-term prognostic value of PLR in acute PE has not been investigated thoroughly. Therefore, we aimed to assess the impact of PLR on both in-hospital and long-term adverse outcomes in acute PE...
December 10, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27988252/airway-and-circulatory-collapse-due-to-retropharyngeal-hematoma-after-blunt-vertebral-artery-injury
#5
Shunsuke Kudo, Kazuyuki Fukushima, Motonori Hashimoto, Masayuki Furutake, Keiji Tanaka, Kunihiko Okada
Retropharyngeal hematoma following blunt cervical spine injury is a known cause of airway obstruction, but it is not known to cause hemorrhagic shock. We report the case of a massive retropharyngeal hematoma caused by a blunt vertebral artery transection leading simultaneously to airway obstruction and hemorrhagic shock. An 83-year-old woman was injured in a motorcycle accident. In the field, the patient exhibited paradoxical breathing with no breath sounds, and her blood pressure could not be measured. Therefore, emergency intubation and fluid resuscitation were initiated and the patient was transferred to the emergency department...
December 9, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27984523/etiology-of-shock-in-the-emergency-department-a-12-year-population-based-cohort-study
#6
Jon Gitz Holler, Helene Kildegaard Jensen, Daniel Pilsgaard Henriksen, Lars Melholt Rasmussen, Søren Mikkelsen, Court Pedersen, Annmarie Touborg Lassen
INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED. METHODS: Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first time ED presentation with shock (n = 1,646) defined as hypotension (systolic blood pressure ≤100 mmHg)) and ≥1 organ failures were included...
December 14, 2016: Shock
https://www.readbyqxmd.com/read/27983541/effect-of-increasing-mean-arterial-blood-pressure-on-microcirculation-in-patients-with-cardiogenic-shock-supported-by-extracorporeal-membrane-oxygenation
#7
Zhongtao Du, Zaishen Jia, Jinhong Wang, Zhichen Xing, Chunjing Jiang, Bo Xu, Xiaofang Yang, Feng Yang, Na Miao, Jialin Xing, Hong Wang, Ming Jia, Xiaotong Hou
BACKGROUND: Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support. METHODS: A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out...
December 14, 2016: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/27928224/clinical-outcomes-of-elderly-south-east-asian-patients-in-primary-percutaneous-coronary-intervention-for-st-elevation-myocardial-infarction
#8
Jieli Tong, Wen Wei Xiang, An Shing Ang, Wen Jun Sim, Kien Hong Quah, David Foo, Paul Jau Lueng Ong, Hee Hwa Ho
OBJECTIVE: To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary percutaneous coronary intervention (PPCI). METHODS: From January 2009 to December 2012, 1268 patients (86.4% male, mean age of 58.4 ± 12.2 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: elderly group defined as age ≥ 70 years and non-elderly group defined as age < 70 years...
October 2016: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/27904102/manifestation-of-latent-left-ventricular-outflow-tract-obstruction-in-the-acute-phase-of-takotsubo-cardiomyopathy
#9
Kazuyuki Ozaki, Takeshi Okubo, Komei Tanaka, Yukio Hosaka, Keiichi Tsuchida, Kazuyoshi Takahashi, Hirotaka Oda, Tohru Minamino
Objective Left ventricular outflow tract (LVOT) obstruction is a complication in 15-25% of patients with Takotsubo cardiomyopathy and sometimes leads to catastrophic outcomes, such as cardiogenic shock or cardiac rupture. However, the underlying mechanisms have not been clarified. Methods and Results We experienced 22 cases of Takotsubo cardiomyopathy during 3 years, and 4 of these 22 cases were complicated with LVOT obstruction in the acute phase (mean age 79±5 years, 1 man, 21 women). The LVOT pressure gradient in the acute phase was 100±17 mmHg...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27887016/inferior-vena-caval-filter-strut-perforation-causing-intramural-duodenal-haematoma
#10
Zoheb Berry Williams, Nicole M Organ, Stephen Deane
We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means...
November 24, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27884304/a-remedy-for-kidney-disease-successfully-alters-the-cold-shock-protein-response-during%C3%A2-inflammation
#11
Sabine Brandt, Peter R Mertens
Kidneys undergoing acute inflammatory responses are characterized by cell infiltration and a cytokinergic milieu. The hazard resides in the perpetuation of inflammation and ensuing fibrosis. In this issue of Kidney International, Wang et al.(4) identify the cold shock Y-box binding protein-1 as the key orchestrator of cell infiltration in experimental tubulointerstitial nephritis following ureteral obstruction. Intriguingly, a small molecule previously designed to interfere with Y-box binding protein-1 interactions mediates an anti-inflammatory response and halts fibrogenesis...
December 2016: Kidney International
https://www.readbyqxmd.com/read/27863213/tubular-cytoplasmic-expression-of-zinc-finger-protein-snai1-in-renal-transplant-biopsies-a-sign-of-diseased-epithelial-phenotype
#12
Marco Prunotto, Lyubov Chaykovska, Massimo Bongiovanni, Milo Frattini, Thomas Cagarelli, Franziska Weibel, Maurizio Bruschi, Antonio Garcia de Herreros, Solange Moll
The aim of the present study was to analyze in vivo the role of zinc finger protein SNAI1 (SNAI1) on renal fibrosis. Unilateral ureteral obstruction injury was induced in Snai1 knockout mice. Snai1 gene deletion was, however, only partial and could therefore not be correlated to reduced fibrosis. Expression of SNAI1 protein and epithelial-mesenchymal transformation markers was then assessed in human chronic allograft nephropathy biopsy specimens. Significant up-regulation of SNAI1 protein was detected within cytoplasm of proximal tubules localized, for some of them, near foci of fibrosis and tubular atrophy...
January 2017: American Journal of Pathology
https://www.readbyqxmd.com/read/27860272/endovascular-repair-of-ventricular-assist-device-outflow-cannula-stenosis
#13
Faraz S Ahmad, Andrew J Sauer, Mark J Ricciardi
This report describes a case of endovascular repair of an outflow cannula obstruction in a heart failure patient with biventricular assist devices. The patient presented with cardiogenic shock and was diagnosed via multimodality imaging with outflow cannula obstruction of the left ventricular assist device, likely from a hematoma. A transesophageal echocardiogram-guided endovascular approach was undertaken. A 10.0 mm × 38 mm covered stent was successfully deployed and post-dilated. Normal flow in the outflow cannula was restored...
November 17, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27854510/variation-in-post-sepsis-readmission-patterns-a-cohort-study-of-veterans-affairs-beneficiaries
#14
Hallie C Prescott
RATIONALE: Re-hospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. OBJECTIVES: To examine the variation in post-sepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. METHODS: Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 versus ≥ 65 years), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital...
November 17, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27851838/trends-and-outcomes-of-pulmonary-arterial-hypertension-related-hospitalizations-in-the-united-states-analysis-of-the-nationwide-inpatient-sample-database-from-2001-through-2012
#15
Vidhu Anand, Samit S Roy, Stephen L Archer, E Kenneth Weir, Sushil Kumar Garg, Sue Duval, Thenappan Thenappan
Importance: Recent trends and outcomes of pulmonary arterial hypertension (PAH)-related hospitalization in adults in the United States are unknown. Objective: To examine the characteristics of PAH-related hospitalizations. Design, Setting, and Participants: We analyzed the National Inpatient Sample database for all adult patients (≥18 years old) with PAH as the principal discharge diagnosis from January 1, 2001, through December 31, 2012...
December 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27851261/1626-mixed-obstructive-and-distributive-shock-from-empyema
#16
Avraham Cooper, Daniel Adams, Adam Mahoney, Maria Lucarelli
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27846034/an-update-on-classification-and-management-of-urosepsis
#17
Florian M E Wagenlehner, Zafer Tandogdu, Truls E Bjerklund Johansen
PURPOSE OF REVIEW: The urinary tract is the infection site in severe sepsis/septic shock in 10-30%. RECENT FINDINGS: There is a new Sepsis definition focusing on severe sepsis. Urosepsis is mainly due to obstructed uropathy of the upper urinary tract. The pathogenesis of sepsis is complex and is driven by the innate immune system. In the further course immunosuppression is developing.Management of urosepsis includes early diagnosis, early initiation of treatment such as identification and control of the complicating factor in the urinary tract and the specific sepsis therapy...
November 14, 2016: Current Opinion in Urology
https://www.readbyqxmd.com/read/27804243/low-cardiac-output-thyroid-storm-in-a-girl-with-graves-disease
#18
Marut Chantra, Alisa Limsuwan, Pat Mahachoklertwattana
A 15-year-old girl with Graves' disease presented with hypotension after methimazole and propranolol were re-started for hyperthyroidism. She was found to have pulmonary artery hypertension resulting in obstructive shock. Thyroid storm was diagnosed according to Burch and Wartofsky score. She was promptly treated with anti-thyroid drugs, inorganic iodide, corticosteroid, and respiratory support. Pulmonary hypertension was treated with inhaled nitric oxide until the clinical status improved. Propranolol was withdrawn due to poor cardiac function...
October 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/27793875/adult-necrotising-enterocolitis-pig-bel-disease-a-pacific-disease-in-london
#19
Justin Conrad Rosen Wormald, Sanjay Dindyal, Francesca Mellor, Nebil Behar
Adult necrotising enterocolitis secondary Clostridium perfringens type C-pig-bel disease-is rarely seen outside of Pacific populations, with the highest incidence being in Papau New Guinea. We present the first reported case of pig-bel disease in a previously well patient without diabetes following food poisoning since 1996. In this case, the enterotoxin-induced disease necessitated emergency laparotomy and bowel resection following the failure of medical treatment and worsening septic shock. We hypothesise that obstruction secondary to a sigmoid diverticular stricture complicated by infection-related oedema led to colonic stasis and rapid progression of disease and bowel loss...
October 28, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27789323/-results-of-conservative-management-of-emphysematous-pyelonephritis
#20
Ahmed Saadi, Haroun Ayed, Abderrazak Bouzouita, Mohamed Cherif, Walid Kerkeni, Selim Selmi, Riadh Ben Slama, Amine Derouiche, Mohamed Chebil
INTRODUCTION: Emphysematous pyelonephritis (EPN) is a rare and severe, necrotizing infection of the kidney. Diagnosis should be precocious based on computed tomography (CT). Its management remains controversial and its treatment is currently increasingly conservative. The aim of this paper is to discuss the conservative treatment of this disease through our experience in 21 patients. MATERIAL AND METHODS: A retrospective analysis including 21 patients managed conservatively for an emphysematous pyelonephritis in our department from January 2010 to April 2015...
December 2016: Néphrologie & Thérapeutique
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