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https://www.readbyqxmd.com/read/28099379/systemic-intraoperative-anticoagulation-during-arterial-injury-repair-implications-for-patency-and-bleeding
#1
Zoё Maher, Brian Frank, Noelle Saillant, Anna Goldenberg, Elizabeth Dauer, Joshua P Hazelton, Andrea Lubitz, Huaqing Zhao, Jeremy W Cannon, Mark J Seamon
BACKGROUND: The role of systemic intraoperative anticoagulation (SIAC) during surgical repair of major arterial injuries is controversial. Any potential improvement in arterial patency must be weighed against the risk of hemorrhage in these critically injured patients. We hypothesized that SIAC would increase arterial patency without increasing bleeding complications. METHODS: We conducted a multi-institution, retrospective cohort study of trauma patients with major vascular injury from 2005-2013 in 3 level I centers...
January 17, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28097621/practice-patterns-of-venous-thromboembolism-prophylaxis-in-underweight-critically-ill-patients-with-neurologic-injury
#2
Kevin Betthauser, Hannah Pope, Mollie Gowan, Theresa Human
PURPOSE: Venous thromboembolism (VTE) prophylaxis in underweight patients with neurologic injury remains unaddressed by guidelines and primary literature. This study aimed to describe VTE prophylaxis strategies employed in this population and compare the impact of underweight and non-obese patients on thrombotic and bleeding events. METHODS: A retrospective review of adults admitted with a diagnosis of neurologic injury to a neurology/neurosurgery intensive care unit (ICU) over 6 years...
January 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28092265/the-fibronectin-synergy-site-re-enforces-cell-adhesion-and-mediates-a-crosstalk-between-integrin-classes
#3
Maria Benito-Jardón, Sarah Klapproth, Irene Gimeno-LLuch, Tobias Petzold, Mitasha Bharadwaj, Daniel J Müller, Gabriele Zuchtriegel, Christoph A Reichel, Mercedes Costell
Fibronectin (FN), a major extracellular matrix component, enables integrin-mediated cell adhesion via binding of α5β1, αIIbβ3 and αv-class integrins to an RGD-motif. An additional linkage for α5 and αIIb is the synergy site located in close proximity to the RGD motif. We report that mice with a dysfunctional FN-synergy motif (FNsyn/syn) suffer from surprisingly mild platelet adhesion and bleeding defects due to delayed thrombus formation after vessel injury. Additional loss of β3 integrins dramatically aggravates the bleedings and severely compromises smooth muscle cell coverage of the vasculature leading to embryonic lethality...
January 16, 2017: ELife
https://www.readbyqxmd.com/read/28089863/prevention-of-thrombosis-in-hypercoagulable-patients-undergoing-microsurgery-a-novel-anticoagulation-protocol
#4
Jonas A Nelson, Cyndi U Chung, Andrew R Bauder, Liza C Wu
BACKGROUND: Hypercoagulable conditions are often considered relative contraindications to free flap reconstruction. This paper presents and critically examines a novel anticoagulation regimen developed to address this disease state. METHODS: Hypercoagulable patients who underwent free tissue transfer between 2007 and 2015 were identified. From 2011, all such patients were subjected to a novel anticoagulation protocol involving an intravenous bolus of 2000 U of unfractionated heparin prior to microvascular pedicle anastomosis, followed by a heparin infusion at 500 U/h, which was postoperatively increased to therapeutic levels...
December 18, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28089084/predicting-the-need-for-intra-operative-large-volume-blood-transfusions-during-thoraco-abdominal-aortic-aneurysm-repair
#5
M Pieri, P Nardelli, M De Luca, G Landoni, S Frassoni, G Melissano, A Zangrillo, R Chiesa, F Monaco
OBJECTIVE: Thoraco-abdominal aortic aneurysm (TAAA) repair is a complex procedure performed in patients at high cardiovascular risk. High volume intra-operative bleeding is often recorded, and the amount of intra-operative blood product transfusion is associated with relevant morbidity and mortality. The aim of the study was to identify pre-operative predictors of intra-operative large volume blood transfusions (LVBT) to stratify patients pre-operatively. METHODS: This was a retrospective analysis of prospectively collected data of all patients who underwent open TAAA surgery at San Raffaele Scientific Institute from January 2009 to December 2015...
January 6, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28081589/preemptive-antiviral-therapy-with-entecavir-can-reduce-acute-deterioration-of-hepatic-function-following-transarterial-chemoembolization
#6
Sun Hong Yoo, Jeong Won Jang, Jung Hyun Kwon, Seung Min Jung, Bohyun Jang, Jong Young Choi
BACKGROUND/AIMS: Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. METHODS: This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013...
December 2016: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/28049359/iranian-low-dose-escalating-prophylaxis-regimen-in-children-with-severe-hemophilia-a-and-b
#7
Peyman Eshghi, Elham Sadeghi, S Zahra Tara, Behnaz Habibpanah, Razieh Hantooshzadeh
Establishing an appropriate prophylaxis regimen for children with hemophilia is a critical challenge in developing countries. Barriers including availability and affordability, catheter-related complications, and inhibitor development risks have led to the introduction of new tailored prophylaxis regimens in different countries. This study emphasizes on the benefits of the Iranian low-dose escalating prophylaxis regimen in a Hemophilia Comprehensive Care Center in Iran. Referred patients with hemophilia less than 15 years of age, who were subject to prophylaxis regimen, are studied retrospectively...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28049258/the-impact-of-implementation-of-an-enteral-feeding-protocol-on-the-improvement-of-enteral-nutrition-in-critically-ill-adults
#8
Seoung-Hyun Kim, Chi-Min Park, Jeong-Meen Seo, Mingew Choi, Dae-Sang Lee, Dong Kyung Chang, Miyong Rha, Soyoung Yu, Seonhye Lee, Eunmee Kim, Young Yun Cho
BACKGROUND AND OBJECTIVES: The optimal delivery of enteral nutrition (EN) may improve clinical outcomes in critically ill patients; thus, optimal EN protocols should be developed. The purpose of this study was to evaluate the impact of implementing an EN protocol on the improvement of EN practices and on the clinical outcomes of critically ill patients. METHODS AND STUDY DESIGN: This was a retrospective study with prospectively collected data. Multidisciplinary working group developed an evidence-based EN protocol based on an extensive review of literature and existing guidelines...
January 2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28045757/left-colonic-bleeding-secondary-to-inferior-mesenteric-vein-stenosis
#9
Thang Q Le, Donald Romanelli
Lower gastrointestinal bleeding is most commonly associated with diverticulosis, ischemic colitis, vascular ectasia, and anorectal disease and less commonly associated with colonic malignancy. Infrequently, it is associated with mesenteric varices, a rare etiology that is not well documented in the radiology literature. We present a case of a 50-year-old man diagnosed as having intermittent left colonic bleeding from mesenteric varices due to a critical stenosis at the portal vein-inferior mesenteric vein confluence...
December 29, 2016: Journal of Computer Assisted Tomography
https://www.readbyqxmd.com/read/28035007/inhibition-of-factor-xia-reduces-the-frequency-of-cerebral-microembolic-signals-derived-from-carotid-arterial-thrombosis-in-rabbits
#10
Xinkang Wang, Stan Kurowsk, Weizhen Wu, Gino A Castriota, Xueping Zhou, Lin Chu, Kenneth P Ellsworth, Scott Edmondson, Donald Chu, Amjad Ali, Patrick Andre, Dietmar Seiffert, Mark Erion, David E Gutstein, Zhu Chen
Factor XI (FXI) is an integral component of the intrinsic pathway of the coagulation cascade and plays a critical role in thrombus formation. Since its role in the pathogenesis of cerebral microembolic signals (MES) is unclear, this study utilized a potent and selective small molecule inhibitor of FXIa, Compound 1, to assess the effect of FXI blockade in our recently established preclinical model of cerebral MES induced by FeCl3 injury of the carotid artery in male New Zealand White rabbits. Ascending doses of Compound 1 were evaluated simultaneously for both carotid arterial thrombosis by a Doppler flowmeter and MES in the middle cerebral artery by a transcranial Doppler...
December 29, 2016: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/28034871/how-i-evaluate-and-treat-thrombocytopenia-in-the-intensive-care-unit-patient
#11
REVIEW
Andreas Greinacher, Sixten Selleng
Multiple causes (pseudothrombocytopenia, hemodilution, increased consumption, decreased production, increased sequestration, and immune-mediated destruction of platelets) alone or in combination make thrombocytopenia very common in intensive care unit (ICU) patients. Persisting thrombocytopenia in critically ill patients is associated with, but not causative of, increased mortality. Identification of the underlying cause is key for management decisions in individual patients. While platelet transfusion might be indicated in patients with impaired platelet production or increased platelet destruction, it could be deleterious in patients with increased intravascular platelet activation...
December 29, 2016: Blood
https://www.readbyqxmd.com/read/28034464/noninvasive-hemoglobin-monitoring-in-critically-ill-pediatric-patients-at-risk-of-bleeding
#12
P García-Soler, J M Camacho Alonso, J M González-Gómez, G Milano-Manso
OBJECTIVE: To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN: An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING: Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS: Patients weighing >3kg at risk of bleeding...
December 26, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/28034287/the-ignored-role-of-intraoperative-hypotension-in-producing-postoperative-acute-kidney-injury-an-obligatory-appeal-for-more-preventative-nephrology
#13
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi
Intraoperative hypotension (IOH) invariably follows the induction of general anesthesia. There is this general consensus that IOH is beneficial - less bleeding, less blood transfusions, shorter surgery times - and absent adverse consequences on renal, hepatic and neurological functions. Nevertheless, a critical review of the literature revealed that past research studied younger patients with normal kidney function, short surgery times while excluding patients with advanced CKD and uncontrolled hypertension...
December 29, 2016: Current Hypertension Reviews
https://www.readbyqxmd.com/read/28032562/a-novel-secure-transfixing-blood-vessel-occluder-comparison-with-the-hemoclip-in-the-porcine-model
#14
Arnold Miller, Nir Lilach, Ana-Maria Botero-Anug, Udi Willenz, Raanan Miller
BACKGROUND: Secure vessel occlusion is critical to the success of all surgical and interventional procedures. The purpose of this study was to compare in vivo the use of the Amsel Vessel Occluder (AVO), a novel occlusion clip device for secure blood vessel closure, with one of the many commercially available hemoclips, the Ligaclip, in the porcine model. METHODS: Vessel closure of arteries and veins was performed on 10 swine to compare the ease of use, safety, and efficacy of the AVO with the Ligaclip as well as the tissue response at 7 and 30 d...
October 5, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/28011279/association-of-prophylactic-endotracheal-intubation-in-critically-ill-patients-with-upper-gi-bleeding-and-cardiopulmonary-unplanned-events
#15
Umar Hayat, Peter J Lee, Hamid Ullah, Shashank Sarvepalli, Rocio Lopez, John J Vargo
BACKGROUND: Prophylactic endotracheal intubation (PEI) is often advocated to mitigate the risk of cardiopulmonary adverse events in patients presenting with brisk upper gastrointestinal bleed (UGIB). However, the benefit of such a measure remains controversial. Our study aimed to compare the incidence of cardiopulmonary unplanned events (CUE) between patients who underwent endotracheal intubation versus those who didn't, in critically ill patients with brisk UGIB. METHODS: Patients aged 18 years or older who had presented at Cleveland Clinic between 2011 and 2014 with hematemesis and/or patients with melena with consequential hypovolemic shock were included...
December 20, 2016: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28011050/could-the-addition-of-cetuximab-to-conventional-radiation-therapy-improve-organ-preservation-in-those-patients-with-locally-advanced-larynx-cancer-who-respond-to-induction-chemotherapy-an-organ-preservation-spanish-head-and-neck-cancer-cooperative-group-phase
#16
Ricard Mesía, Jose A Garcia-Saenz, Alicia Lozano, Miguel Pastor, Juan J Grau, Javier Martínez-Trufero, Julio Lambeaz, Joaquina Martínez-Galán, Jose R Mel, Belen González, Silvia Vázquez, Manel Mañós, Miren Taberna, Beatriz Cirauqui, Elvira Del Barco, Esther Casado, Jordi Rubió-Casadevall, Angles Rodríguez-Jaráiz, Juan J Cruz
PURPOSE: To evaluate the efficacy and safety of induction chemotherapy (IC) followed by bioradiotherapy (BRT) to achieve functional larynx preservation in the setting of locally advanced head and neck tumors. METHODS AND MATERIALS: This was a phase 2, open-label, multicenter study of patients with stage III and IVA laryngeal carcinoma who were candidates for total laryngectomy. The primary endpoint was the rate of survival with functional larynx (SFL) at 3 years, with a critical value to consider the study positive of SFL >59%...
November 17, 2016: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28009388/acute-gastrointestinal-haemorrhage-on-board-a-cruise-ship-in-the-antarctic-peninsula
#17
Mathieu Carron, Peter Globokar, Bruno A Sicard
Antarctic tourism on board cruise ships has expanded since the 1990s, essentially in the Antarctic Peninsula. Due to remoteness, medical cases may evolve into life threatening conditions as emergency medical evacuations are challenging. We discuss the case of a young crew member who suddenly fainted with an epigastric pain and abundant rectal bleeding while on board a cruise ship heading to the Deception Island (62°57.6 South, 60°29.5 West), 44 h away from Ushuaia by sea. A medical evacuation was necessary to save the patient whose haemoglobin level rapidly decreased from 11 g/dL to 8...
2016: International Maritime Health
https://www.readbyqxmd.com/read/28000267/reliability-of-periodontal-diagnostic-tools-for-monitoring-peri-implant-health-and-disease
#18
REVIEW
Pierluigi Coli, Véronique Christiaens, Lars Sennerby, Hugo De Bruyn
The prevalence, causes and consequences of crestal bone loss at dental implants are a matter of debate. In recent years, a high prevalence of peri-implant soft-tissue inflammation, associated with peri-implant bone loss, has been reported and the need for treatments similar to those offered for natural teeth affected by periodontitis has been proposed. This suggestion is based on the assumption that periodontal indices, such as probing pocket depth and bleeding on probing, are reliable indicators of the peri-implant tissue conditions and good predictors of future bone loss...
February 2017: Periodontology 2000
https://www.readbyqxmd.com/read/27993959/optimizing-tubal-ligation-service-delivery-a-prospective-cohort-study-to-measure-the-task-sharing-experience-of-marie-stopes-international-ethiopia
#19
Olivia Nuccio, Birhanu Sendek, Min Hae Park, Tesfaye Mesele, Francis Ogojo Okello, Cristin Gordon-Maclean
The Ethiopian government implements a progressive task-sharing policy for health services as a strategy to address shortages of highly skilled providers and increase access to critical services, such as family planning. Since 2009, Marie Stopes International Ethiopia has trained health officers to provide tubal ligations, a permanent method of family planning, as part of its task-sharing strategy. The objectives of this research were to evaluate task-sharing tubal ligations to health officers at Marie Stopes International Ethiopia, specifically: (a) to investigate safety, as measured by the proportion of major adverse events; (b) to evaluate the feasibility, as measured by adherence to the standard tubal ligation procedure protocol and (c) to investigate acceptability to clients of the tubal ligation procedure provided by health officers...
December 19, 2016: Health Policy and Planning
https://www.readbyqxmd.com/read/27990197/transcatheter-aortic-valve-implantation-for-treatment-of-aortic-valve-stenosis-a-health-technology-assessment
#20
(no author information available yet)
BACKGROUND: Surgical aortic valve replacement (SAVR) is the gold standard for treating aortic valve stenosis. It is a major operation that requires sternotomy and the use of a heart-lung bypass machine, but in appropriately selected patients with symptomatic, severe aortic valve stenosis, the benefits of SAVR usually outweigh the harms. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure that allows an artificial valve to be implanted over the poorly functioning valve...
2016: Ontario Health Technology Assessment Series
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