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Julia C Iezzoni
Histochemistry has an important, continuing role in the current assessment of hepatic biopsies and resection specimens. The evaluation of connective tissue elements in the liver can be accomplished with such methods as the Masson trichrome, Snook reticulin, Vierhoff van Gieson, orcein, and Victoria blue stains. The results contribute to the diagnosis of acute and chronic hepatitis, submassive necrosis, venous outflow obstruction, steatohepatitis, and cirrhosis. Fat stains done on frozen sections of liver tissue are routinely performed in the evaluation of donor liver allograft biopsies...
October 16, 2018: Seminars in Diagnostic Pathology
Elizabeth Murphy, Ahmed Lababidi, Renuka Reddy, Taaha Mendha, David Lebowitz
A pulmonary embolism (PE) is an acute life-threatening respiratory event that results in upwards of 200,000 deaths per year in the United States. While anticoagulation is currently the standard of treatment for PEs, there is increasing evidence to suggest that in certain cases anticoagulation in combination with thrombolytic therapy may improve patient outcomes and reduce mortality. This article aims to compare the effects of combined intervention with thrombolytic therapy and anticoagulation to the effects of anticoagulation alone in patients with submassive PEs in terms of various outcome measures, including but not limited to: mortality, hemodynamic status, length of hospital stay, and safety...
June 15, 2018: Curēus
Charles Hennemeyer, Abdul Khan, Hugh McGregor, Cheyenne Moffett, Gregory Woodhead
BACKGROUND: Catheter directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. METHODS: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over two years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8) or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone...
October 24, 2018: American Journal of Medicine
Luis Alberto Martínez Insfran, Felipe Alconchel Gago, Pascual Parrilla Paricio
Orlistat is an intestinal lipase inhibitor drug that is recommended in obese patients along with a hypocaloric diet. Although the most frequent secondary effect is steatorrhea, fulminant liver failure has also been associated with this drug, which has required liver transplantation in 3 patients. We present the case of a 42-year-old obese male.
October 16, 2018: Revista Española de Enfermedades Digestivas
Jay N Lozier, Jason M Elinoff, Anthony F Suffredini, Douglas R Rosing, Stanislav Sidenko, Richard M Sherry, Adam R Metwalli, Vandana Sachdev, Robert L Danner, Richard Chang
: Guidelines-recommend thrombolytic therapy for pulmonary embolism in patients with severe hemodynamic compromise and low risk of bleeding. Thrombolytics in submassive pulmonary embolism have an unfavorable risk/benefit ratio and remain controversial. Based on our experience with extensive, lower extremity thrombi, nine patients with symptomatic, submassive pulmonary embolisms (five medical, four surgical) were treated with low-dose alteplase (<10 mg/day, infused over 6 h per treatment). Alteplase was delivered by pulse spray and/or directed or undirected central venous catheters depending on clot size and location...
December 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Aditya Jandial, Kundan Mishra, Susheel Kumar, Pankaj Malhotra
No abstract text is available yet for this article.
October 8, 2018: QJM: Monthly Journal of the Association of Physicians
Oscar M P Jolobe
No abstract text is available yet for this article.
October 8, 2018: QJM: Monthly Journal of the Association of Physicians
Michael R Kendall, Stuart Swadron, Leonardo C Clavijo, Anilkumar K Mehra, Antotreas Hindoyan, Ray V Matthews, David M Shavelle
BACKGROUND: Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients. OBJECTIVE: The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE...
October 2018: Journal of Invasive Cardiology
Muhammad Saad, Danial H Shaikh, Nikhitha Mantri, Ahmed Alemam, Aiyi Zhang, Muhammad Adrish
Background: Fever is considered as a presenting symptom of pulmonary embolism (PE). We aim to evaluate the association between PE and fever, its clinical characteristics, outcomes and role in prognosis. Methods: A retrospective chart review of patients who were hospitalised with the diagnosis of acute PE was conducted. Patients in whom underlying fever could also be attributable to an underlying infection were also excluded. Results: A total of 241 patients met the study criteria...
2018: BMJ Open Respiratory Research
Rachel Rosovsky, Yuchiao Chang, Kenneth Rosenfield, Richard Channick, Michael R Jaff, Ido Weinberg, Thoralf Sundt, Alison Witkin, Josanna Rodriguez-Lopez, Blair A Parry, Savannah Harshbarger, Praveen Hariharan, Christopher Kabrhel
Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006-2012) and after (2012-2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity...
September 21, 2018: Journal of Thrombosis and Thrombolysis
Daniel P Rothschild, James A Goldstein
No abstract text is available yet for this article.
August 1, 2018: Catheterization and Cardiovascular Interventions
Barbara L LeVarge, Cameron D Wright, Josanna M Rodriguez-Lopez
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima...
September 2018: Clinics in Chest Medicine
Jeffrey S Pollak
More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work...
September 2018: Clinics in Chest Medicine
Eric Secemsky, Yuchiao Chang, C Charles Jain, Joshua A Beckman, Jay Giri, Michael R Jaff, Kenneth Rosenfield, Rachel Rosovsky, Christopher Kabrhel, Ido Weinberg
BACKGROUND: Few contemporary studies have assessed the management and outcomes of patients with massive and submassive pulmonary embolism. Given advances in therapy, we report contemporary practice patterns and event rates among these patients. METHODS: We analyzed a prospective database of patients with massive and submassive pulmonary embolism. We report clinical characteristics, therapies, and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy...
August 11, 2018: American Journal of Medicine
Ewa Konik, Nandan S Anavekar, Waldemar Wysokinski, Krishnaswamy Chandrasekaran
No abstract text is available yet for this article.
April 2018: CASE: Cardiovascular Imaging Case Reports
Kelly Galanos, Cassie Jaeger, Kevin Coakley, Peter White, David Griffen
Treatment recommendations for submassive pulmonary embolus (SMPE), defined as pulmonary embolus (PE) resulting in right ventricular dysfunction and/or myocardial necrosis, vary. The objective of this study was to develop an investigative protocol at our tertiary care hospital to standardise the approach to patients with SMPE and to evaluate the effect of the protocol on process measures including consultation with cardiology and critical care physicians and time to echocardiogram and treatment. Triggered by right ventricle/left ventricle ratios >0...
2018: BMJ open quality
Akhilesh K Sista
No abstract text is available yet for this article.
July 23, 2018: JACC. Cardiovascular Interventions
Victor F Tapson, Keith Sterling, Noah Jones, Mahir Elder, Uttam Tripathy, Jayson Brower, Robert L Maholic, Charles B Ross, Kannan Natarajan, Pete Fong, Lee Greenspon, Houman Tamaddon, Amir R Piracha, Tod Engelhardt, John Katopodis, Vasco Marques, Andrew S P Sharp, Gregory Piazza, Samuel Z Goldhaber
OBJECTIVES: The aim of this study was to determine the lowest optimal tissue plasminogen activator (tPA) dose and delivery duration using ultrasound-facilitated catheter-directed thrombolysis (USCDT) for the treatment of acute intermediate-risk (submassive) pulmonary embolism. BACKGROUND: Previous trials of USCDT used tPA over 12 to 24 h at doses of 20 to 24 mg for acute pulmonary embolism. METHODS: Hemodynamically stable adults with acute intermediate-risk pulmonary embolism documented by computed tomographic angiography were randomized into this prospective multicenter, parallel-group trial...
July 23, 2018: JACC. Cardiovascular Interventions
Nematullah Sharaf, Victoria B Sharaf, Sharon E Mace, Amy S Nowacki, James K Stoller, John C Carl
BACKGROUND: D-dimer is used to aid in diagnosing adult pulmonary embolism (PE). D-dimer has not been validated in adolescents. Clinicians must balance the risk of overtesting with that of a missed PE. D-dimer may be useful in this context. This study evaluates D-dimer in PE-positive and PE-negative adolescents. METHODS: PE-positive patients < 22 years were diagnosed with PE by computed tomography (CT) or high-probability ventilation/perfusion, seen at emergency departments (EDs)/hospitals within a 16-hospital system across two states, January 1998 through December 2016...
July 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Murat Gök, Alparslan Kurtul, Murat Harman, Meryem Kara, Muhammed Süleymanoglu, Ender Ornek
In this study, the association between the right ventricular dysfunction (RVD) and CHA2DS2-VASc (C: congestive heart failure or left ventricular systolic dysfunction, H: hypertension, A: age of ≥ 75 years, D: diabetes mellitus, S: previous stroke, V: vascular disease, A: age between 65 and 74 years, Sc: female gender) scores was investigated in patients with acute pulmonary thromboembolism (PTE). The patients have been assigned to 3 subgroups as massive, submassive, and nonmassive PTE. The CHA2DS2-VASc scores were calculated for all of the patients, and the scores have been classified into 3 groups as the scores between 0 and 1, the scores of 2, and the scores of 3 and over...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
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