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https://www.readbyqxmd.com/read/28645996/treatment-of-suspected-pulmonary-embolism-in-a-morbidly-obese-patient
#1
Viviene Heitlage, Mary Beth Borgstadt, Lisa Carlson
PURPOSE: A case highlighting challenges with enoxaparin dosage and monitoring in obese patients is presented. SUMMARY: A morbidly obese 22-year-old Caucasian female (height, 168 cm; weight, 322 kg; body mass index [BMI], 114 kg/m(2)) who presented to the emergency department with acute-onset dyspnea and hypoxia was empirically initiated on enoxaparin for suspected pulmonary embolism at the institution's standard maximum dosage (160 mg subcutaneously every 12 hours)...
July 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28634363/long-term-health-outcomes-in-patients-with-prader-willi-syndrome-a-nationwide-cohort-study-in-denmark
#2
E Hedgeman, S P Ulrichsen, S Carter, N C Kreher, K P Malobisky, M M Braun, J Fryzek, M S Olsen
BACKGROUND: Prader-Willi syndrome (PWS) is a rare congenital disease that affects growth, sexual development, cognitive function and behavior. Individuals exhibit food preoccupation and hyperphagia, which may lead to obesity with premature morbidity and mortality. The aim of this work was to evaluate the risk of venous thromboembolisms (VTE), myocardial infarction, pulmonary hypertension, sleep apnea, depression, anxiety and all-cause mortality among persons with PWS as compared to an age- and sex-matched general population cohort...
June 21, 2017: International Journal of Obesity: Journal of the International Association for the Study of Obesity
https://www.readbyqxmd.com/read/28621512/endovascular-redo-aortic-surgery
#3
Jacob Budtz-Lilly, Kiattisak Hongku, Björn Sonesson, Nuno Dias, Tim Resch
Endovascular redo aortic operations are a challenging undertaking. Techniques for treatment date almost as far back as the original open repair itself. Risk factors for failure following aortic repair include larger AAA necks, severe neck angulation, as well as clinical variables such as age, family history, obesity and chronic obstructive pulmonary disease. The armamentarium of endovascular treatments is vast and increasing. Aside from provisional embolization of endoleaks or deferment to open repair conversion, attention should be directed toward obtaining adequate proximal and distal sealing...
June 16, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28567574/differences-in-effectiveness-and-use-of-robotic-surgery-in-patients-undergoing-minimally-invasive-colectomy
#4
M Schootman, S Hendren, T Loux, K Ratnapradipa, J M Eberth, N O Davidson
BACKGROUND: We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients. METHODS: We used the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus...
May 31, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28560886/ultrasound-guided-thrombin-injection-is-a-safe-and-effective-treatment-for-femoral-artery-pseudoaneurysm-in-the-morbidly-obese
#5
Taehwan Yoo, Jean E Starr, Michael R Go, Patrick S Vaccaro, Bhagwan Satiani, Mounir J Haurani
INTRODUCTION: Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28556449/effects-of-metap2-inhibition-on-hyperphagia-and-body-weight-in-prader-willi-syndrome-a-randomized-double-blind-placebo-controlled-trial
#6
Shawn E McCandless, Jack A Yanovski, Jennifer Miller, Cary Fu, Lynne M Bird, Parisa Salehi, Christine L Chan, Diane Stafford, M Jennifer Abuzzahab, David Viskochil, Sarah E Barlow, Moris Angulo, Susan E Myers, Barbara Y Whitman, Dennis Styne, Elizabeth Roof, Elisabeth M Dykens, Ann O Scheimann, Jaret Malloy, Dongliang Zhuang, Kristin Taylor, Thomas E Hughes, Dennis D Kim, Merlin G Butler
AIMS: There are no treatments for the extreme hyperphagia and obesity in Prader-Willi syndrome (PWS). The bestPWS trial assessed the efficacy, safety, and tolerability of the methionine aminopeptidase 2 (MetAP2) inhibitor, beloranib. MATERIALS AND METHODS: Participants with PWS (12-65 years) were randomly assigned (1:1:1) to biweekly placebo, 1.8 mg beloranib, or 2.4 mg beloranib injection for 26 weeks at 15 US sites. Coprimary endpoints were the changes in hyperphagia (measured by Hyperphagia Questionnaire for Clinical Trials [HQ-CT]; possible score 0-36) and weight by intention-to-treat...
May 29, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28540132/more-risks-and-complications-for-elective-spine-surgery-in-morbidly-obese-patients
#7
REVIEW
Nancy E Epstein
BACKGROUND: The vast majority of studies emphasize the greater morbidity/mortality for elective spine surgery in morbidly obese patients. METHODS: This review focuses on the increased morbidity/mortality of performing elective spinal operations in morbidly obese patients. There are two definitions of morbid obesity; a body mass index (BMI) of equal to or greater than 35 plus two major comorbid factors (e.g., hypertension, diabetes, etc.) or a BMI (morbidly obese III) of =≥40 kg/m(2)...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28527240/recurrent-deep-vein-thrombosis-after-the-first-venous-thromboembolism-event-a-single-institution-experience
#8
Mohammad Asim, Hassan Al-Thani, Ayman El-Menyar
BACKGROUND We investigated the frequency, clinical presentation, risk factors, and outcome after the first deep vein thrombosis (DVT) event. MATERIAL AND METHODS A retrospective study was conducted for patients with DVT between 2008 and 2012 with a 1-year follow-up. Patients were divided into 2 groups: single vs. recurrent DVT (RDVT). RESULTS Of the 6420 patients screened for DVT, 662 (10.3%) had DVT. RDVT constituted 22% of cases. A single event was more frequent in left lower limb DVT (p=0.01), while RDVT cases had more bilateral DVT (p=0...
May 20, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28525397/an-unusual-case-of-sudden-death-is-there-a-relationship-between-thyroid-disorders-and-fatal-pulmonary-thromboembolism-a-case-report-and-review-of-literature
#9
Isabella Aquila, Silvia Boca, Fiorella Caputo, Matteo A Sacco, Santo Gratteri, Vittorio Fineschi, Pietrantonio Ricci
In adults, the most common cause of sudden death is coronary heart disease or defects in the cardiac conduction system; however, there are many cases of sudden death occurring from other causes such as fatal pulmonary thromboembolism. Several risk factors are recognized, including hospitalization, surgery, obesity, pregnancy, the use of oral contraceptives, traumatic fractures, and genetic conditions, which cause hypercoagulable states such as factor V Leiden mutations. Although many risk factors have been identified, the mortality rate is still high...
May 19, 2017: American Journal of Forensic Medicine and Pathology
https://www.readbyqxmd.com/read/28522388/trends-in-socioeconomic-costs-of-morbid-obesity-among-korean-adults-2009-2013-data-from-national-health-insurance-service
#10
Jae-Woo Lee, Young-Eun Choi, Dong-Wook Kim, Sunmi Lee, Kyung-Hee Cho
As the prevalence of morbid obesity increased in Korea, the estimation of the accurate socioeconomic costs by morbid obesity was required; we analysed national medical costs through the big data. From 2009 year to 2013 year, Direct Costs (DC) for medical costs, transit costs and nursing costs and Indirect Costs (IC) for Future Income Loss (FIL) and Productivity Loss (PL) of morbid obesity (BMI≥30) were calculated, and socioeconomic costs were estimated by applying Population Attributable Risk (PAR) proportion according to obesity related diseases...
May 15, 2017: Obesity Research & Clinical Practice
https://www.readbyqxmd.com/read/28501724/different-manifestations-of-pulmonary-embolism-in-younger-compared-to-older-patients-clinical-presentation-prediction-rules-and-long-term-outcomes
#11
Izabela E Kiluk, Agnieszka Krajewska, Urszula Kosacka, Agnieszka Tycińska, Robert Milewski, Włodzimierz Musiał, Bożena Sobkowicz
PURPOSE: Data concerning specific manifestations of pulmonary embolism (PE) among younger patients are scarce. We aimed to evaluate differences in clinical presentation, PE prediction rules, thrombolytic treatment use and PE outcomes in younger (<50 years of age) compared to older patients. MATERIAL/METHODS: We studied 238 consecutive patients with proven PE who were retrospectively categorized into three PE probability subgroups according to the revised Geneva score (RGS) and Wells score (WS)...
May 11, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28492861/vena-cava-filter-use-in-trauma-and-rates-of-pulmonary-embolism-2003-2015
#12
Alan D Cook, Brian W Gross, Turner M Osler, Katelyn J Rittenhouse, Eric H Bradburn, Steven R Shackford, Frederick B Rogers
Importance: Vena cava filter (VCF) placement for pulmonary embolism (PE) prophylaxis in trauma is controversial. Limited research exists detailing trends in VCF use and occurrence of PE over time. Objective: To analyze state and nationwide temporal trends in VCF placement and PE occurrence from 2003 to 2015 using available data sets. Design, Setting, and Participants: A retrospective trauma cohort study was conducted using data from the Pennsylvania Trauma Outcome Study (PTOS) (461 974 patients from 2003 to 2015), the National Trauma Data Bank (NTDB) (5 755 095 patients from 2003 to 2014), and the National (Nationwide) Inpatient Sample (NIS) (24 449 476 patients from 2003 to 2013) databases...
May 10, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28445793/predictors-of-30-day-pulmonary-complications-after-outpatient-surgery-relative-importance-of-body-mass-index-weight-classifications-in-risk-assessment
#13
Gildasio S De Oliveira, Robert J McCarthy, Kristopher Davignon, Herb Chen, Heather Panaro, William G Cioffi
BACKGROUND: The current literature is controversial regarding the importance of obese body mass index (BMI) classifications as a risk factor for pulmonary complications following outpatient surgery. The objective of the current investigation was to evaluate predictors of pulmonary outcomes following outpatient surgery and to assess the importance of BMI weight classifications in risk assessment. STUDY DESIGN: Patients with "outpatient" recorded as their inpatient/outpatient status in the 2012-2013 NSQIP database were included...
April 23, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28440519/-prevention-diagnosis-and-treatment-of-perioperative-complications-of-bariatric-and-metabolic-surgery
#14
Haifu Wu, Ming Zhong, Di Zhou, Chenye Shi, Heng Jiao, Wei Wu, Xinxia Chang, Jing Cang, Hua Bian
Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy...
April 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28439955/recurrent-venous-thrombosis-related-to-overweight-and-obesity-results-from-the-mega-follow-up-study
#15
B A Vučković, S C Cannegieter, A van Hylckama Vlieg, F R Rosendaal, W M Lijfering
Essentials Whether excess body weight influences recurrent venous thrombosis (VT) risk is uncertain. We included 3889 VT patients, classified into body mass index (BMI) strata to estimate recurrent VT risk. No evidence of an increased risk for excess body weight was found. Measuring BMI is not a good tool to identify patients at high risk of VT recurrence. SUMMARY: Background Studies on the risk of recurrent venous thrombosis in patients with excess body weight have yielded conflicting results...
April 25, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28390919/symptomatic-deep-femoral-artery-pseudoaneurysm-endovascular-exclusion-case-report-and-literature-review
#16
Felice Pecoraro, Ettore Dinoto, Umberto M Bracale, Giovanni Badalamenti, Arduino Farina, Guido Bajardi
Deep femoral artery pseudoaneurysms (DFAPs) are rare and generally occur after penetrating trauma or surgical procedures. A 36-year-old obese man presented with pain in correspondence of the anterior-lateral thigh after 6 months from gunshot wound. Duplex and computed tomography (CT) showed a bilobed right DFAP (maximal diameter 12.9 cm). The patient was managed urgently, under local anesthesia, by placement in the distal DFA of a Viabahn 8 × 100-mm stent graft (W L Gore & Associates, Inc). The postoperative course was uneventful, and the 24-month CT showed regular stent-graft patency and 20-mm DFAP shrinkage...
April 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28348360/an-uncommon-case-of-lower-limb-deep-vein-thrombosis-with-multiple-etiological-causes
#17
Jing Miao, Geetha Naik, Sivakumar Muddana, Xiaohuan Li, Supriya Bhimasani, Ronald Alvin Mitchell, Dariush Alaie, Richard L Petrillo
BACKGROUND Deep vein thrombosis (DVT) is a type of venous thromboembolism with diverse clinical and environmental risk factors. Very few cases of DVT with multiple high risk factors have been reported. Here, we report an uncommon DVT case with multiple etiological causes, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and heterozygous factor V Leiden mutation. CASE REPORT A 43-year-old female was brought to the emergency room because of 2-week history of pain and swelling and ultrasound revealing evidence of DVT in the right leg...
March 28, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28331932/pulmonary-embolism-and-in-situ-pulmonary-artery-thrombosis-in-paediatrics-a-systematic-review
#18
Madhvi Rajpurkar, Tina Biss, Ernest Amankwah, Denise Martinez, Suzan Williams, C Heleen Van Ommen, Neil A Goldenberg
Data on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946-2013) and Embase (1980-2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51 % of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74 % of patients)...
March 23, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28316156/-risk-factors-of-pulmonary-embolism-in-senile-and-non-senile-inpatients-and-the-predictive-value-of-caprini-risk-assessment-model-in-these-two-populations
#19
Y Chen, H X Zhou, Y H Hu, T X Cong, Y J Tang, L Wang, M Y Wang, Q Yi, Z A Liang
Objective: To investigate the risk factors of pulmonary embolism (PE) in senile and non-senile inpatients, and evaluate the predictive value of Caprini risk assessment model in these two populations. Methods: Case control study design was used in this study. All the PE patients diagnosed in West China Hospital of Sichuan University between January 2012 and December 2014 was included and divided into senile PE group (age ≥65 years old) and non-senile PE group (age <65 years old). Age matched controls (senile control group and non-senile control group) were selected from the patients admitted into the same departments during the same time period as PE patients, at a ratio of 2∶1...
March 14, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28314711/validating-the-herdoo2-rule-to-guide-treatment-duration-for-women-with-unprovoked-venous-thrombosis-multinational-prospective-cohort-management-study
#20
MULTICENTER STUDY
Marc A Rodger, Gregoire Le Gal, David R Anderson, Jeannot Schmidt, Gilles Pernod, Susan R Kahn, Marc Righini, Patrick Mismetti, Clive Kearon, Guy Meyer, Antoine Elias, Tim Ramsay, Thomas L Ortel, Menno V Huisman, Michael J Kovacs
Objective To prospectively validate the HERDOO2 rule (Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years), which states that women with none or one of the criteria can safely discontinue anticoagulants after short term treatment.Design Prospective cohort management study.Setting 44 secondary or tertiary care centres in seven countries.Participants Of 3155 consecutive eligible participants with a first unprovoked venous thromboembolism (VTE, proximal leg deep vein thrombosis or pulmonary embolism) who completed 5-12 months of short term anticoagulant treatment, 370 declined to participate, leaving 2785 enrolled participants...
March 17, 2017: BMJ: British Medical Journal
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