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Catheter directed

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 10, 2018: American Journal of Medicine
Masahide Harada, Masayuki Koshikawa, Yuji Motoike, Tomohide Ichikawa, Kunihiko Sugimoto, Eiichi Watanabe, Yukio Ozaki
BACKGROUND: In atrial fibrillation (AF) patients, the effect of direct oral anticoagulant (DOACs) therapy on the incidence of left atrial appendage thrombus (LAT) remains poorly investigated. This study examined the prevalence and risk factors of LAT in AF patients on DOACs undergoing catheter ablation, and sought an anticoagulation strategy for LAT.Methods and Results:In 407 AF patients on DOACs, transesophageal echocardiography (TEE) was performed 1 day before ablation. If patients had LAT, initial DOACs were switched to dabigatran (300 mg) or warfarin based on their renal function; TEE was repeated after treatment for ≥4 weeks...
August 11, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
Jamie Sy Ho, Edwin R Chilvers, Muhunthan Thillai
Sarcoidosis is a multisystem granulomatous disease predominantly affecting the lungs, with increased risk of cardiovascular disease, pulmonary hypertension and cardiac sarcoidosis (CS), the latter due to direct granuloma infiltration. Sarcoidosis is often managed by chest physicians who need to understand the diagnostic pathways and initial management plans for patients with cardiac involvement. Areas covered: The most serious consequence of CS is sudden cardiac death due to ventricular tachyarrhythmias or complete atrioventricular block...
August 13, 2018: Expert Review of Respiratory Medicine
Patricia A Crock, Dieter K Lüdecke, Ulrich J Knappe, Wolfgang Saeger
Background Transnasal surgery (TNS) is the first choice in the treatment of pediatric Cushing's disease. The question is how can high remission rates be achieved with minimally invasive investigations and TNS whilst avoiding radiotherapy or bilateral adrenalectomy in children. Methods Data from a published series 1 (n=55) of surgeon DKL will be compared with his recent series 2 (n=45) until 2009. All patients were operated by direct transnasal microsurgery. Over time, inferior petrosal sinus sampling (IPSS) was replaced by cavernous sinus sampling (CSS), restricted to unclear cases without increase of salivary cortisol in corticotropin-releasing hormone-test, difficult sellar anatomy or negative magnetic resonance imaging (MRI)...
August 11, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
David Welch, Manuela Buonanno, Igor Shuryak, Gerhard Randers-Pehrson, Henry M Spotnitz, David J Brenner
Drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) are a target for new antimicrobial technologies. Far-UVC technology is an emerging disinfection method that directly kills microorganisms using light. In contrast with conventional UV sterilization, far-UVC light has antimicrobial capabilities without apparent harm to mammalian cells. This study examines the application of 224 nm far-UVC light delivered from a laser using an optical diffuser towards the goal of protecting against bacterial invasion around skin penetrating devices...
2018: PloS One
Anne Marie Sowerbutts, Simon Lal, Jana Sremanakova, Andrew Clamp, Chris Todd, Gordon C Jayson, Antje Teubner, Anne-Marie Raftery, Eileen J Sutton, Lisa Hardy, Sorrel Burden
BACKGROUND: People with advanced ovarian or gastrointestinal cancer may develop malignant bowel obstruction (MBO). They are able to tolerate limited, if any, oral or enteral (via a tube directly into the gut) nutrition. Parenteral nutrition (PN) is the provision of macronutrients, micronutrients, electrolytes and fluid infused as an intravenous solution and provides a method for these people to receive nutrients. There are clinical and ethical arguments for and against the administration of PN to people receiving palliative care...
August 10, 2018: Cochrane Database of Systematic Reviews
Juliana M Bernstein, Peter Graven, Kathleen Drago, Konrad Dobbertin, Elizabeth Eckstrom
OBJECTIVES: To design a value-driven, interprofessional inpatient geriatric consultation program coordinated with systems-level changes and studied outcomes and costs. DESIGN: Propensity-matched case-control study of older adults hospitalized at an academic medical center (AMC) who did or did not receive geriatric consultation. SETTING: Single tertiary-care AMC in Portland, Oregon. PARTICIPANTS: Adults aged 70 and older who received an inpatient geriatric consultation (n=464) and propensity-matched controls admitted before development of the consultation program (n=2,381)...
August 10, 2018: Journal of the American Geriatrics Society
Hyun Yong Lee, Young Nam Roh, Hyoung Tae Kim, Ui Jun Park
Flush ostial occlusion of the superficial femoral artery (SFA) is challenging for endovascular treatment. Neither ipsilateral nor contralateral access is easy. The drawback of ipsilateral common femoral artery (CFA) access is that the CFA is too short for catheter manipulation and sheath engagement. Contralateral retrograde CFA access could have merit, but it has the drawback of poor pushability and torquability in the manipulation of devices. The most challenging part of flush ostial occlusion is the difficulty of wire engagement into the SFA orifice...
August 6, 2018: Annals of Vascular Surgery
Ashraf Odeh Alshabatat, Mohammad Esmaeil Barbati, Omran Alzoubi, Houman Jalaie, Cees Ha Wittens
BACKGROUND: May-Thurner syndrome (MTS) leads to an increased incidence of deep vein thrombosis (DVT). Early thrombus removal decreases the post-thrombotic morbidities. Our aim was to better elucidate the relationship between MTS and venous patency after Catheter-directed thrombolysis CTD. METHOD: The medical records of all patients who underwent CTD from January 2005 to December 2011 due to acute DVT were reviewed retrospectively. Patient characteristics and clinical variables were evaluated to determine association with vein patency...
August 6, 2018: Annals of Vascular Surgery
Tammy R Dugas, Gabrielle Brewer, Madison Longwell, Taylor Fradella, Jacob Braun, Carlos E Astete, Merilyn H Jennings, Cristina M Sabliov
Peripheral artery disease is a cardiovascular disease characterized by a narrowing of arteries that supply blood to the extremities, particularly, the legs. When surgical intervention is warranted, the primary approach is balloon angioplasty. Drug coated balloons (DCB) designed to release antimitogenic agents to the site of the blockage are a relatively new product aimed at reducing artery re-narrowing, or restenosis, after intervention. However, first generation DCB utilize mainly direct application of the chemotherapy drug paclitaxel, along with hydrophilic excipients to facilitate uptake into the tissue, and the majority of drug is released from the DCB systemically...
August 9, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Muhammad U Butt, John C Gurley, Alison L Bailey, Claude S Elayi
BACKGROUND The persistence of a vein of Marshall (VoM) from the left subclavian vein to the coronary sinus is a rare cardiac anomaly known as a persistent left superior vena cava (PLVC). This anatomical variant is usually asymptomatic but can lead to serious complications during catheterization via the left subclavian or internal jugular vein, as described here. In our case, the patent vein of Marshall directly connected the coronary sinus with the left subclavian vein discovered in a cardiac arrest patient because of pericardial effusion during the insertion of a central venous catheter (CVC)...
August 9, 2018: American Journal of Case Reports
Stephen M Seedial, Samdeep K Mouli, Kush R Desai
Acute portal vein thrombosis (PVT) is a relatively rare diagnosis with a nonspecific clinical presentation. Imaging plays an important role in establishing the diagnosis as well as the etiology and complications of acute PVT. Prompt diagnosis is essential to prevent catastrophic short-term complications including bowel infarction, sepsis, and possible death; missed diagnosis can also result in the long-term sequelae of portal hypertension. Differentiation of acute from chronic PVT is crucial as management strategies differ...
August 2018: Seminars in Interventional Radiology
Hae Keum Kil
In infants and small children, ultrasound (US) provides ample anatomical information in combination with neuraxial block. We can measure the distance from the skin to the epidural space in the US image and can refer to it in the needle puncture. And we may detect the needle or a catheter during real-time US-guided epidural catheterization. In cases where direct needle or catheter visualization is difficult, US allows predicting successful puncture and catheterization using surrogate markers, such as dura mater displacement, epidural space widening due to drug injection, or mass movement of the drug within the caudal space...
August 8, 2018: Korean Journal of Anesthesiology
Mamoru Takenaka, Kentaro Yamao, Masatoshi Kudo
The efficacy of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered gastrointestinal anatomy has been previously reported. However, although this method allows the endoscope to reach the papilla, successful biliary cannulation is difficult. Unlike normal ERCP, directions in these patients are reversed, and it is difficult to adjust the catheter in the direction of the bile duct. Intubating the cannula to the papilla is therefore time-consuming...
August 7, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Ronald S Winokur, Akhilesh K Sista
PURPOSE OF REVIEW: Patients suffering from acute lower extremity deep vein thrombosis (DVT) are at risk for developing chronic limb pain, heaviness, and fatigue, known as the post-thrombotic syndrome (PTS). RECENT FINDINGS: Although several studies have shown that catheter-directed therapy reduces clot burden and may improve clinical outcomes, the multicenter randomized controlled ATTRACT trial showed no difference in PTS or quality of life at 2 years between patients treated with pharmacomechanical catheter-directed thrombolysis (PCDT) and those treated with anticoagulation alone, and a higher major bleeding rate in the PCDT group...
August 6, 2018: Current Treatment Options in Cardiovascular Medicine
Irina Debnath, Anne M Stringer, Sara N Smith, Emily Bae, Harry L T Mobley, Joseph T Wade, Melanie M Pearson
Proteus mirabilis is a leading cause of catheter-associated urinary tract infections (CAUTIs) and urolithiasis. The transcriptional regulator MrpJ inversely modulates two critical aspects of P. mirabilis UTI progression: fimbria-mediated attachment, and flagella-mediated motility. Transcriptome data indicated a network of virulence-associated genes under MrpJ's control. Here we identify the direct gene regulon of MrpJ and its contribution to P. mirabilis pathogenesis, leading to the discovery of novel virulence targets...
August 6, 2018: Infection and Immunity
Cihangir Kaymaz, Ozgur Yasar Akbal, Aykun Hakgor, H Ceren Tokgoz, Ali Karagoz, Ibrahim Halil Tanboga, Seda Tanyeri, Berhan Keskin, Sevim Turkday, Durmus Demir, Cem Dogan, Zubeyde Bayram, Rezzan Deniz Acar, Busra Guvendi, Nihal Ozdemir, Victor F Tapson, Stavros Konstantinides
AIMS: In this single-centre study, we evaluated short- and long-term efficacy and safety outcomes of ultrasound-assisted thrombolysis (USAT) performed in patients with acute pulmonary embolism (PE) at intermediate-high- and high-risk (IHR,HR). METHODS AND RESULTS: Study group comprised retrospectively evaluated 141 patients with PE who underwent USAT. Tissue-type plasminogen activator (t-PA) dosage was 36.1±15.3 mg, and infusion duration was 24.5±8.1 hours. The USAT was associated with improvements in echocardiographic measures of right-ventricle systolic function, pulmonary-arterial (PA) obstruction score, right to left ventricle diameter ratio (RV/LV), right to left atrial diameter ratio and PA pressures, irrespective of the risk (p<0...
August 7, 2018: EuroIntervention
Martin Rabellino, Pedro Moltini, Vanesa Di Caro, Ricardo García-Mónaco
INTRODUCTION: Proximal (iliocaval and iliofemoral) deep vein thrombosis (DVT) and pulmonary thromboembolism are the second cause of death in patients with cancer. MATERIAL AND METHODS: A retrospective analysis was performed in 35 patients with cancer treated with endovascular therapy for proximal DVT. The primary objective was to evaluate the technical success of the procedure and the 30-day and long-term symptom improvement. RESULTS: Thirty-five patients with a mean age of 57...
August 5, 2018: Vascular and Endovascular Surgery
Michael S Wu, James Gabriels, Mohammad Khan, Nada Shaban, Salvatore A D'Amato, Christopher F Liu, Steven M Markowitz, James E Ip, George Thomas, Parmanand Singh, Bruce B Lerman, Apoor Patel, Jim W Cheung
PURPOSE: Left atrial thrombus (LAT) may be detected by transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF) or flutter (AFL) despite continuous anticoagulation therapy. We sought to examine the rates and timing of LAT resolution in response to changes in anticoagulation regimen. METHODS: A retrospective study of 1517 consecutive patients on ≥ 4 weeks continuous oral anticoagulation (OAC) undergoing TEE prior to either direct current cardioversion or catheter ablation for AF or AFL was performed...
August 4, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Nadine Taleb, Virginie Messier, Sylvie Ott-Braschi, Jean-Luc Ardilouze, Rémi Rabasa-Lhoret
AIMS: To assess perceptions of patients using subcutaneous insulin infusion (CSII) about metabolic control, pump malfunctions, technical and insertion site adverse events (AEs) related to infusion sets/catheters as well as patients' practices. METHODS: Online survey (from June 2016 to January 2017) using an actualized 39-item questionnaire directed to adults with type 1 diabetes (T1D) using CSII therapy and living in the province of Quebec, Canada. RESULTS: Participants with T1D (n=115, 72% females, 39...
August 2, 2018: Diabetes Research and Clinical Practice
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