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https://www.readbyqxmd.com/read/28644688/intraosseous-administration-of-antidotes-a-systematic-review
#1
Audrée Elliott, Pierre-André Dubé, Amélie Cossette-Côté, Laura Patakfalvi, Eric Villeneuve, Martin Morris, Sophie Gosselin
CONTEXT: Intraosseous (IO) access is an established route of administration in resuscitation situations. Patients with serious poisoning presenting to the emergency department may require urgent antidote therapy. However, intravenous (IV) access is not always readily available. OBJECTIVE: This study reviews the current evidence for IO administration of antidotes that could be used in poisoning. The primary outcome was mortality as a surrogate of efficacy. Secondary outcomes included hemodynamic variables, electrocardiographic variables, neurological status, pharmacokinetics outcomes, and adverse effects as defined by each article...
June 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28644260/intravenous-alteplase-for-acute-stroke-and-pulmonary-embolism-in-a-patient-with-recent-abdominoplasty
#2
Michael E Christiansen, Gyanendra Kumar, Raman C Mahabir, Richard A Helmers, Bernard R Bendok, Cumara B O'Carroll
INTRODUCTION: Major surgery in the past 14 days is a relative contraindication to treatment of acute stroke with intravenous (IV) alteplase. The 2016 American Heart Association/American Stroke Association scientific statement discussing inclusion and exclusion criteria for alteplase in acute stroke allows for provider judgment citing a lack of evidence to support surgery as an absolute contraindication. CASE REPORT: A 59-year-old woman presented with acute left hemiparesis, dysarthria, and acute respiratory failure...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644058/air-embolism-diagnosis-and-management
#3
Neera Malik, Paul L Claus, Jeffery E Illman, Seth J Kligerman, Michael R Moynagh, David L Levin, David A Woodrum, Arvin Arani, Shivaram P Arunachalam, Philip A Araoz
Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation...
June 23, 2017: Future Cardiology
https://www.readbyqxmd.com/read/28631982/carotid-intraplaque-hemorrhage-on-vessel-wall-mri-does-not-correlate-with-tcd-emboli-monitoring-in-patients-with-recently-symptomatic-carotid-atherosclerosis
#4
Adam de Havenon, David Tirschwell, Jennifer J Majersik, Scott McNally, Gregory Stoddard, Anne Moore, Mahmud Mossa-Basha
Background Carotid intraplaque hemorrhage (IPH) seen on vessel wall MRI is associated with an increased risk of stroke or transient ischemic attack, as are microembolic signals (MES) detected by transcranial Doppler (TCD). We sought to examine the association between IPH and MES in acute stroke patients with symptomatic carotid atherosclerosis. Methods Through a retrospective chart review, we included patients from 2011 to 2013 with acute ischemic stroke due to carotid atherosclerosis of varying stenosis who had both 3D volumetric MRI of the neck and TCD emboli monitoring...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28615616/early-stage-mucinous-ovarian-adenocarcinoma-with-extensive-clotting-in-a-previously-healthy-young-female-patient-an-uncommon-presentation-of-a-relatively-uncommon-disease
#5
Suchin R Khanna, Brave Nguyen, Mahmoud Charif
BACKGROUND Mucinous ovarian adenocarcinoma is one of the less common epithelial cancers of the ovaries, and typically does not occur in younger women. Nearly all mucinous ovarian adenocarcinomas present with early-stage disease without significant sequelae of cancer, such as clotting. Anchoring bias is a common problem in medicine that has been shown to significantly affect physician decision-making. CASE REPORT We present the case of a 24-year-old healthy female Chinese immigrant with no significant past medical history, who presented with a subacute history of nonproductive cough and shortness of breath with exertion...
June 15, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28611138/cardiac-arrest-following-arteriovenous-fistula-manipulation-a-cautionary-note
#6
Miles Gandolfi, Bimbi S Fernando
Arteriovenous fistulas can lead to a number of different chronic complications. We describe a case where a patient developed a thrombosis within her brachiobasilic arteriovenous fistula, which was manually manipulated in order to restore fistula flow. This resulted in a pulseless electrical activity cardiac arrest within a few minutes. After ten minutes of chest compressions and intubation, there was return of spontaneous circulation. No epinephrine was given nor shocks administered. Patient was extubated within minutes and was alert, orientated and haemodynamically stable...
June 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28611134/toothpick-induced-aortoenteric-fistula-presenting-as-sepsis
#7
Elizabeth Liao, Martin Simons, Leonard W Tse, Graham Roche-Nagle
Aortoenteric fistulas (AEF) are a rare but life-threatening cause of gastrointestinal (GI) bleeding. We present the case of a primary AEF caused by ingestion of a toothpick by a 47-year-old male. This is the 10th known case in the literature in which a foreign body was found to be the cause of a communication between the aorta and the GI tract. Most foreign objects have been sewing needles; this is the first known case of a toothpick penetration. The patient presented to our institution with polymicrobial sepsis and bilateral pulmonary septic emboli...
June 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28609680/characterization-and-targeting-of-platelet-derived-growth-factor-receptor-alpha-pdgfra-in-inflammatory-breast-cancer-ibc
#8
Madhura Joglekar-Javadekar, Steven Van Laere, Michael Bourne, Manal Moalwi, Pascal Finetti, Peter B Vermeulen, Daniel Birnbaum, Luc Y Dirix, Naoto Ueno, Monique Carter, Justin Rains, Abhijit Ramachandran, Francois Bertucci, Kenneth L van Golen
PURPOSE: Inflammatory breast cancer (IBC) is arguably the deadliest form of breast cancer due to its rapid onset and highly invasive nature. IBC carries 5- and 10-year disease-free survival rates of ~45% and <20%, respectively. Multiple studies demonstrate that in comparison with conventional breast cancer, IBC has a unique molecular identity. Here, we have identified platelet-derived growth factor receptor alpha (PDGFRA) as being uniquely expressed and active in IBC patient tumor cells...
June 10, 2017: Neoplasia: An International Journal for Oncology Research
https://www.readbyqxmd.com/read/28607332/massive-ischemic-stroke-due-to-pulmonary-barotrauma-and-cerebral-artery-air-embolism-during-commercial-air-travel
#9
Sara Farshchi Zarabi, Matteo Parotto, Rita Katznelson, James Downar
BACKGROUND Air embolism into the systemic arterial circulation secondary to pulmonary barotrauma has rarely been reported. Herein, we report the clinical course of an extremely rare presentation of cerebral air embolism likely due to ruptured pulmonary bullae during commercial air travel. CASE REPORT A 65-year-old man suddenly became unconscious during an airplane descent. Upon landing, he was immediately transferred to the nearest emergency department where he was intubated for airway protection. His head CT angiogram showed multiple air pockets in the right parietal lobe suspicious for multiple air emboli...
June 13, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28603588/transcervical-access-reversal-of-flow-and-mesh-covered-stents-new-options-in-the-armamentarium-of-carotid-artery-stenting
#10
REVIEW
Kosmas I Paraskevas, Frank J Veith
In the last 25 years, the very existence of carotid artery stenting (CAS) has been threatened on a number of occasions. The initial disappointing results that even lead to the discontinuation of an early randomized controlled trial have improved considerably with time. Novel devices, advanced stent and equipment technology, alternative types of access and several types of filters/emboli protecting devices have been reported to reduce stroke/death rates during/after CAS and improve CAS outcomes. The present review will provide a description of the various technology advances in the field that aim to reduce stroke and death rates associated with CAS...
May 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28603431/hereditary-hemorrhagic-telangiectasia-and-pregnancy-potential-adverse-events-and-pregnancy-outcomes
#11
REVIEW
Omar Bari, Philip R Cohen
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant condition with a prevalence of ~1 in 5,000 individuals. The pathophysiology of this condition centers on the lack of capillary beds between arterioles and venules, leading to direct contact between these vessels. This results in telangiectases on characteristic locations such as the face, fingers, mouth, and nasal mucosa. Visceral arteriovenous malformations (AVMs) are also observed in many patients, and these are most commonly seen in the brain, gastrointestinal tract, and lungs...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/28602537/atrial-septal-defect-increases-the-risk-for-stroke-after-total-hip-arthroplasty
#12
Dean C Perfetti, Morad Chughtai, Matthew R Boylan, Qais Naziri, Aditya V Maheshwari, Michael A Mont
BACKGROUND: Atrial septal defect (ASD) and patent foramen ovale (PFO) are 2 of the most common congenital heart diseases in adults and pose important risks of perioperative acute ischemic stroke (AIS) from paradoxical emboli. We evaluated the following: (1) the prevalence of ASD/PFO in the total hip arthroplasty (THA) population; (2) the rate of perioperative AIS during index admissions; and (3) the risk for perioperative AIS after THA for patients with ASD/PFO vs matched controls. METHODS: We identified 393,652 patients in the Nationwide Inpatient Sample who underwent THA between January 1, 2007, and December 31, 2013...
May 11, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28597590/in-vitro-evaluation-of-pediatric-hollow-fiber-membrane-oxygenators-on-hemodynamic-performance-and-gaseous-microemboli-handling-an-international-multicenter-multidisciplinary-approach
#13
Shigang Wang, Luiz F Caneo, Marcelo B Jatene, Fábio B Jatene, Idagene A Cestari, Allen R Kunselman, Akif Ündar
The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr arterial cannula, primed with lactated Ringer's solution and packed red blood cells...
June 8, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28594333/quantification-of-carotid-artery-plaque-stability-with-multiple-region-of-interest-based-ultrasound-strain-indices-and-relationship-with-cognition
#14
Nirvedh Meshram, Tomy Varghese, Carol Mitchell, Daren Jackson, Stephanie Wilbrand, Bruce Hermann, Robert Dempsey
Vulnerability and instability in carotid artery plaque has been assessed based on strain variations using noninvasive ultrasound imaging. We previously demonstrated that carotid plaques with higher strain indices in a region of interest (ROI) correlated to patients with lower cognition, probably due to cerebrovascular emboli arising from these unstable plaques. This work attempts to characterize the strain distribution throughout the entire plaque region instead of being restricted to a single localized ROI...
June 8, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28589250/histopathological-and-bacteriological-analysis-of-thrombus-material-extracted-during-mechanical-thrombectomy-in-acute-stroke-patients
#15
Francisco Hernández-Fernández, Laura Rojas-Bartolomé, Jorge García-García, Óscar Ayo-Martín, Juan David Molina-Nuevo, Rosa Angélica Barbella-Aponte, Gemma Serrano-Heras, Enrique Juliá-Molla, María José Pedrosa-Jiménez, Tomás Segura
PURPOSE: Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. METHODS: All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining...
June 6, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28583644/improved-detection-of-melanoma-metastases-by-iodine-maps-from-dual-energy-ct
#16
Monika Uhrig, David Simons, David Bonekamp, Heinz-Peter Schlemmer
OBJECTIVE: Metastatic disease in melanoma has an unpredictable nature with deposits in rare locations such as musculature. Dual energy CT (DECT) provides high contrast-visualization of enhancement by using spectral properties of iodine. Purpose of this study was to evaluate whether iodine maps from DECT improve lesion detection in staging examinations of melanoma patients. METHODS: This retrospective study was approved by IRB and written informed consent was obtained from all patients...
May 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/28580216/septic-thrombophlebitis-of-the-internal-jugular-vein-a-case-of-lemierre-s-syndrome
#17
Adam Alperstein, Raymond M Fertig, Matthew Feldman, Daniel Watford, Susan Nystrom, Guesly Delva, Salman Muddassir
An 18-year-old gentleman with a history of recurrent tonsillitis presented to the emergency room complaining of worsening sore throat. He was found to have a peritonisillar abscess, and imaging revealed a non-occlusive left internal jugular vein thrombosis. Lemierre's syndrome is a rare, potentially fatal condition characterized by internal jugular vein thrombosis with septicemia following an acute oropharyngeal infection. While anticoagulation is the mainstay of treatment of deep venous thromboembolism (DVT) and pulmonary embolism (PE), the use of therapy is controversial in septic thrombophlebitis...
May 2017: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/28575717/recurrent-pulmonary-emboli-with-characteristic-histopathology
#18
Sadahiro Hijikata, Takamichi Miyamoto, Junji Yamaguchi, Takamasa Iwai, Keita Watanabe, Yuichiro Sagawa, Ryo Masuda, Ryoichi Miyazaki, Naoyuki Miwa, Masahiro Sekigawa, Tetsuo Yamaguchi, Nobuhiro Hara, Yasutoshi Nagata, Toshihiro Nozato, Urara Sakurai, Kenzo Hirao
We report a unique case of recurrent thromboembolism and its histological findings that were revealed in an autopsy. Although it is well known that repeating thrombosis presents organization and recanalization, we also observed rare findings of thickening of the bronchial artery and fixation of the valve of the lower extremity vein in this case.
May 11, 2017: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
https://www.readbyqxmd.com/read/28575478/the-preservation-of-cognition-1-yr-after-carotid-endarterectomy-in-patients-with-prior-cognitive-decline
#19
Robert J Dempsey, Daren C Jackson, Stephanie M Wilbrand, Carol C Mitchell, Sara E Berman, Sterling C Johnson, Nirvedh H Meshram, Tomy Varghese, Bruce P Hermann
BACKGROUND: Vascular cognitive decline is critically important in the course of atherosclerosis and stroke. OBJECTIVE: To explore the hypothesis that carotid endarterectomy (CEA) by removing an unstable plaque may slow the course of vascular cognitive decline in both symptomatic and asymptomatic patients. METHODS: Patients with clinically significant (>60%) carotid stenosis were studied preop and 1 yr post-CEA for clinical symptoms, vascular cognitive decline, instability of carotid plaque-presence of microemboli, brain white matter changes, and medical risk factors...
June 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28573932/efficacy-and-safety-of-uninterrupted-low-intensity-warfarin-for-radiofrequency-catheter-ablation-of-atrial-fibrillation-in-the-elderly-a-pilot-study
#20
Yangbo Xing, Buyun Xu, Chao Xu, Fang Peng, Biao Yang, Yufang Qiu, Yong Sun, Shengkai Wang, Hangyuan Guo
BACKGROUND: No previous studies exist investigating the optimal intensity of uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in the elderly. OBJECTIVE: Evaluate the efficacy and safety of continuous low-intensity warfarin therapy throughout the periprocedural period of RFCA for AF in the elderly. METHODS: This is a prospective randomized study. We enrolled AF patients (age ≥ 70 years) who underwent first-time RFCA for AF...
June 1, 2017: Annals of Pharmacotherapy
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