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https://www.readbyqxmd.com/read/28790011/management-of-septic-shock-in-an-intermediate-care-unit
#1
Eric Meaudre, Cédric Nguyen, Claire Contargyris, Ambroise Montcriol, Erwan d'Aranda, Pierre Esnault, Mourad Bensalah, Bertrand Prunet, Julien Bordes, Philippe Goutorbe
BACKGROUND: While guidelines advocate goal-directed resuscitation based on timed bundles, the management of SS outside an ICU setting has been poorly studied in intermediate care units (IMCU). PATIENTS AND METHOD: We reviewed all cases of septic shock patients admitted to our IMCU between January 2013 and June 2014. The characteristics of sepsis, compliance of bundles, and outcomes were collected. The IMCU population was compared with the SS patients admitted to the ICU during the same period...
August 5, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28770255/massive-accumulation-of-myofibroblasts-in%C3%A2-the-critical-isthmus-is-associated-with%C3%A2-ventricular-tachycardia-inducibility-in%C3%A2-post-infarct-swine-heart
#2
Tarvinder S Dhanjal, Nicolas Lellouche, Christopher J von Ruhland, Guillaume Abehsira, David H Edwards, Jean-Luc Dubois-Randé, Konstantinos Moschonas, Emmanuel Teiger, Alan J Williams, Christopher H George
OBJECTIVES: In this study the authors determined the extent of cellular infiltration and dispersion, and regional vascularization in electrophysiologically (EP) defined zones in post-myocardial infarction (MI) swine ventricle. BACKGROUND: The critical isthmus (CI) in post-MI re-entrant ventricular tachycardia (VT) is a target for catheter ablation. In vitro evidence suggests that myofibroblasts (MFB) within the scar border zone (BZ) may increase the susceptibility to slow conduction and VT, but whether this occurs in vivo remains unproven...
July 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/28768818/sofia-intermediate-catheter-and-the-snake-technique-safety-and-efficacy-of-the-sofia-catheter-without-guidewire-or-microcatheter-construct
#3
Jeremy J Heit, Johnny Hy Wong, Adrienne M Mofaff, Nicholas A Telischak, Robert L Dodd, Michael P Marks, Huy M Do
BACKGROUND: Neurointerventional surgeries (NIS) benefit from supportive endovascular constructs. Sofia is a soft-tipped, flexible, braided single lumen intermediate catheter designed for NIS. Sofia advancement from the cervical to the intracranial circulation without a luminal guidewire or microcatheter construct has not been described. OBJECTIVE: To evaluate the efficacy and safety of the new Sofia Non-wire Advancement techniKE (SNAKE) for advancement of the Sofia into the cerebral circulation...
August 2, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28765996/non-central-peripherally-inserted-central-catheters-in-neonatal-intensive-care-complication-rates-and-longevity-of-catheters-relative-to-tip-position
#4
Bernard Goldwasser, Catalina Baia, Mimi Kim, Benjamin H Taragin, Robert M Angert
BACKGROUND: Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied...
August 1, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28731777/induction-and-maintenance-adjuvant-mitomycin-c-topical-therapy-for-upper-tract-urothelial-carcinoma-tolerability-and-intermediate-term-outcomes
#5
Michael Metcalfe, Gavin Wagenheim, Lianchun Xiao, John Papadopoulos, Neema Navai, John W Davis, Jose A Karam, Ashish M Kamat, Christopher G Wood, Colin P Dinney, Surena F Matin
PURPOSE: Endoscopic management of upper tract urothelial carcinoma (UTUC) is associated with higher recurrences, which could be reduced by application of topical therapy. Adjuvant induction Bacillus Calmette-Guerin has shown inferior outcomes for UTUC compared to bladder cancer, and maintenance regimens for UTUC are unexplored. We report on the efficacy, safety, and tolerability of Mitomycin C (MMC) induction and maintenance adjuvant topical therapy for UTUC. MATERIALS AND METHODS: Patients with UTUC who received adjuvant topical therapy after complete endoscopic control of Ta/T1 tumors were retrospectively reviewed...
July 21, 2017: Journal of Endourology
https://www.readbyqxmd.com/read/28717737/rivaroxaban-an-affordable-and-effective-alternative-in-cancer-related-thrombosis
#6
Flávia Dias Xavier, Paulo Marcelo Gehm Hoff, Maria Ignez Braghiroli, Ana Carolina Carvalho Rocha Paterlini, Karla Teixeira Souza, Luiza Dib Batista Bugiato Faria, Fernando Sergio Blumm Ferreira, Karime Kalil Machado, Gustavo Dos Santos Fernandes
BACKGROUND: Venous thromboembolic events (VTEs) are common and potentially fatal complications in cancer patients, and they are responsible for the second most common cause of death. Low molecular weight heparin (LMWH) is the gold-standard treatment, but the costs involved limit its use, especially in developing countries. Recently, the oral anticoagulant rivaroxaban, which directly inhibits factor Xa, was approved for VTE treatment. METHODS: We conducted a retrospective analysis from January 2009 to February 2014 with patients who had cancer and VTE who were receiving rivaroxaban...
February 2017: Journal of Global Oncology
https://www.readbyqxmd.com/read/28666552/single-dose-high-dose-rate-brachytherapy-compared-to-two-and-three-fractions-for-locally-advanced-prostate-cancer
#7
Peter Hoskin, Ana Rojas, Peter Ostler, Robert Hughes, Roberto Alonzi, Gerry Lowe
BACKGROUND: Single-dose high-dose-rate brachytherapy (HDR-BT), in a Phase-II study, was compared to two or three fractions in intermediate and high-risk localized prostate cancer. PATIENTS AND METHODS: 293 patients received 1×19Gy or 1×20Gy (A=49), 2×13Gy (B=138), or 3×10.5Gy (C=106) and assessed with prospective measures of serum PSA, late genitourinary (GU) and gastrointestinal (GI) morbidity using RTOG scales and the International Prostate Symptom Score (IPSS)...
June 27, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#8
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28595772/prevention-of-early-complications-and-late-consequences-after-acute-pulmonary-embolism-focus-on-reperfusion-techniques
#9
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of acute cardiovascular mortality and long-term morbidity. Right ventricular (RV) dysfunction is the key determinant of prognosis in the acute phase of PE, and residual RV dysfunction is associated with the development of post-PE functional impairment, chronic thromboembolic disease, and higher costs of treatment over the long term. Patients with clinically overt RV failure, i.e. hemodynamic collapse at presentation (high-risk PE), necessitate immediate thrombolytic treatment to relieve the obstruction in the pulmonary circulation; surgical or catheter-directed removal of the thrombus can be an alternative option...
June 1, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28579360/complications-of-long-and-intermediate-term-venous-catheters-in-cystic-fibrosis-patients-a-multicenter-study
#10
Teresa L May, Alex H Gifford, Thomas Lahiri, Adam Black, Janet Trang, Alexandra G Cornell, Karyll Gonzalez, Scott Morin, Mark Napier, Christine W Duarte, Jonathan B Zuckerman
BACKGROUND: Totally implantable venous access devices (TIVADs) or peripherally inserted central venous catheters (PICCs) are commonly used in the care of patients with cystic fibrosis (CF), but they are associated with various complications, including thrombosis, infection, and insertion site symptoms. METHODS: We conducted a retrospective review of PICC and TIVAD use in adults and children with CF over an 8-year period at 3 accredited care centers. Patient attributes included CFTR genotype, comorbidities, lung function, body mass index, use of anticoagulation, and respiratory tract microbiology...
June 1, 2017: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
https://www.readbyqxmd.com/read/28573334/retrieval-of-migrated-volume-coils-using-different-clot-retrievers-in-a%C3%A2-porcine-model
#11
Andreas Simgen, Toshiki Tomori, Ruben Mühl-Benninghaus, Hagen Bomberg, Umut Yilmaz, Heiko Körner, Matthias W Laschke, Michael D Menger, Wolfgang Reith
PURPOSE: During endovascular treatment of intracranial aneurysms using coils, migration is a serious complication that increases neurological morbidity. The aim of this experimental study was to assess the effectiveness and complications of retrieving volume coils with different, currently available clot retrievers in a porcine model. METHODS: Volume coils of three-dimensional (3D) shape and different sizes were placed in the axillary artery of pigs. By means of 4 different clot retrievers (Trevo ProVue; Solitaire FR; 3D-Separator; ERIC) a total of 40 retrieval maneuvers (10 per retriever) were performed by deploying the retrievers within the migrated coils and trying to trap parts of the coils by advancing the microcatheter...
June 1, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28550032/a-predictive-score-for-thrombosis-associated-with-breast-colorectal-lung-or-ovarian-cancer-the-prospective-compass-cancer-associated-thrombosis-study
#12
Grigoris T Gerotziafas, Ali Taher, Hikmat Abdel-Razeq, Essam AboElnazar, Alex C Spyropoulos, Salem El Shemmari, Annette K Larsen, Ismail Elalamy
BACKGROUND: The stratification of outpatients on chemotherapy for breast, colorectal, lung, and ovarian cancers at risk of venous thromboembolism (VTE) remains an unmet clinical need. The derivation of a risk assessment model (RAM) for VTE in these patients was the aim of the study "Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients-Cancer Associated Thrombosis" (COMPASS-CAT). PATIENTS AND METHODS: The derivation cohort consisted of 1,023 outpatients...
May 26, 2017: Oncologist
https://www.readbyqxmd.com/read/28483330/a-pragmatic-randomized-controlled-trial-examining-the-impact-of-the-retzius-sparing-approach-on-early-urinary-continence-recovery-after-robot-assisted-radical-prostatectomy
#13
Deepansh Dalela, Wooju Jeong, Madhu-Ashni Prasad, Akshay Sood, Firas Abdollah, Mireya Diaz, Patrick Karabon, Jesse Sammon, Marcus Jamil, Brad Baize, Andrea Simone, Mani Menon
BACKGROUND: Retzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite postoperative urinary continence recovery. OBJECTIVE: To compare the short-term (≤3 mo) urinary continence (UC), urinary function (UF), and UF-related bother outcomes of posterior RARP compared with standard anterior approach RARP. DESIGN, SETTING, AND PARTICIPANTS: A total of 120 patients aged 40-75 yr with low-intermediate-risk prostate cancer (per the National Comprehensive Cancer Network guidelines) underwent primary RARP at a tertiary care institution...
May 6, 2017: European Urology
https://www.readbyqxmd.com/read/28480062/locoregional-and-systemic-therapy-for-hepatocellular-carcinoma
#14
REVIEW
Olumide B Gbolahan, Michael A Schacht, Eric W Beckley, Thomas P LaRoche, Bert H O'Neil, Maximilian Pyko
The management of hepatocellular carcinoma (HCC) remains challenging due to late presentation and the presence of accompanying liver dysfunction. As such, most patients are not eligible for curative resection and liver transplant. Management in this scenario depends on a number of factors including hepatic function, tumor burden, patency of hepatic vasculature and patients' functional status. Based on these, patients can be offered catheter based intra-arterial therapy for intermediate stage disease and in more advanced disease, sorafenib...
April 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28474654/pulmonary-artery-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism
#15
Abhijeet Singh, Ayush Gupta, Jagdish Chander Suri
A case of 60-year-old male with acute pulmonary embolism without hypotension but signs of right ventricular dysfunction and elevated cardiac biomarkers is reported in this study. The patient comes under intermediate high-risk category and was successfully thrombolysed with alteplase infused through pulmonary artery catheter. Catheter-directed thrombolysis (CDT) can be considered as much safer and effective alternative to systemic thrombolysis in such patients with lower risk of bleeding. This novel bedside method of pulmonary artery CDT with the advantage of no radiation exposure and real time monitoring of pulmonary artery pressures as an end-point of thrombolysis can be utilized in the near future...
May 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28455631/real-time-three-dimensional-ct-and-mri-to-guide-interventions-for-congenital-heart-disease-and-acquired-pulmonary-vein-stenosis
#16
Patcharapong Suntharos, Randolph M Setser, Sharon Bradley-Skelton, Lourdes R Prieto
To validate the feasibility and spatial accuracy of pre-procedural 3D images to 3D rotational fluoroscopy registration to guide interventional procedures in patients with congenital heart disease and acquired pulmonary vein stenosis. Cardiac interventions in patients with congenital and structural heart disease require complex catheter manipulation. Current technology allows registration of the anatomy obtained from 3D CT and/or MRI to be overlaid onto fluoroscopy. Thirty patients scheduled for interventional procedures from 12/2012 to 8/2015 were prospectively recruited...
April 28, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28449604/retriever-first-embolectomy-refire-an-alternative-approach-for-challenging-cervical-access
#17
Daniel Behme, Michael Knauth, Marios-Nikos Psychogios
After endovascular treatment became the standard of care procedure for acute ischaemic stroke with large artery occlusion in 2015 the number of performed interventions has increased dramatically. Especially because age is no exclusion criterion for endovascular treatment, a relevant number of patients with difficult to access carotid arteries has to be treated. In these patients a direct puncture of the carotid is a valuable tool but is associated with severe complications and an initial learning curve. We therefore developed the so called retriever first embolectomy (ReFirE) technique in which a stentretriever is deployed over a 5F diagnostic catheter and a microcatheter to establish a stable anchor prior to accessing the internal carotid artery/intracranial vasculature with an 8F guide catheter and a 5F/6F intermediate catheter...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28441641/low-volume-contrast-ct-angiography-via-pulmonary-artery-injection-for-measurement-of-aortic-annulus-in-patients-undergoing-transcatheter-aortic-valve-replacement
#18
Vien T Truong, Joseph Choo, Luke McCoy, Adam Mussman, Stephanie Ambach, Dean Kereiakes, Ian Sarembock, Wojciech Mazur
OBJECTIVES: To investigate the feasibility and image quality of low-dose contrast computed tomography (CT) angiography with pulmonary artery (PA) protocol. BACKGROUND: Aortic stenosis is the most common valvular heart disease and transcatheter aortic valve replacement (TAVR) has evolved as an alternative method for surgical valve replacement in intermediate-risk and high-risk surgical patients. CT is essential for measurement of aortic annulus prior to TAVR. METHODS: Twenty patients underwent a low-dose contrast study with PA protocol and 20 patients underwent a traditional-dose study (traditional protocol)...
May 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28433432/ascende-rt-an-analysis-of-treatment-related-morbidity-for-a-randomized-trial-comparing-a-low-dose-rate-brachytherapy-boost-with-a-dose-escalated-external-beam-boost-for-high-and-intermediate-risk-prostate-cancer
#19
RANDOMIZED CONTROLLED TRIAL
Sree Rodda, Scott Tyldesley, W James Morris, Mira Keyes, Ross Halperin, Howard Pai, Michael McKenzie, Graeme Duncan, Gerard Morton, Jeremy Hamm, Nevin Murray
PURPOSE: To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer. METHODS AND MATERIALS: ASCENDE-RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost...
June 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28431023/safety-and-efficacy-of-the-sofia-6f-plus-distal-access-reperfusion-catheter-in-the-endovascular-treatment-of-acute-ischemic-stroke
#20
Hussain Shallwani, Hakeem J Shakir, Leonardo Rangel-Castilla, Jason M Davies, Ashish Sonig, Mithun G Sattur, Bernard R Bendok, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neuroendovascular intervention has become a key treatment option for acute ischemic stroke. The Sofia (6F) PLUS catheter was designed for neurovascular access for diagnostic or therapeutic interventions. OBJECTIVE: To report the first series describing use of the Sofia PLUS intermediate/distal access reperfusion catheter in the treatment of acute ischemic stroke. METHODS: In this retrospective study, 41 stroke cases were identified in which the catheter was utilized for thrombolysis/thrombectomy...
April 19, 2017: Neurosurgery
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