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https://www.readbyqxmd.com/read/28721349/hepatocellular-carcinoma-early-stage-management-challenges
#1
REVIEW
Derek J Erstad, Kenneth K Tanabe
Hepatocellular carcinoma (HCC) is a major cause of cancer death and is increasing in incidence. This review focuses on HCC surveillance and treatment of early-stage disease, which are essential to improving outcomes. Multiple societies have published HCC surveillance guidelines, but screening efforts have been limited by noncompliance and overall lack of testing for patients with undiagnosed chronic liver disease. Treatment of early-stage HCC has become increasingly complex due to expanding therapeutic options and better outcomes with established treatments...
2017: Journal of Hepatocellular Carcinoma
https://www.readbyqxmd.com/read/28718666/atrial-cardiopathy-a-mechanism-of-cryptogenic-stroke
#2
Shadi Yaghi, Hooman Kamel, Mitchell S V Elkind
Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes. Areas covered: This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial cardiopathy, critically review data on biomarkers of atrial cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research...
July 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28717966/association-between-aspirin-use-and-deep-venous-thrombosis-in-mechanically-ventilated-icu-patients
#3
Ena Gupta, Furqan S Siddiqi, Ryan Kunjal, Muhammad Faisal, Farah Al-Saffar, Abubakr A Bajwa, Lisa M Jones, Vandana Seeram, James D Cury, Adil Shujaat
Deep venous thrombosis (DVT) is common in intensive care unit (ICU) patients. It is often silent and may be complicated by pulmonary embolism and death. Thromboprophylaxis with heparin does not always prevent venous thromboembolism (VTE). Aspirin (ASA) reduces the risk of VTE in surgical and high-risk medical patients but it is unknown if ASA may prevent DVT in mechanically ventilated ICU patients. We performed a retrospective chart review of critically ill patients who received mechanical ventilation for >72 h and underwent venous ultrasonography for suspected DVT between Jan 2012 and Dec 2013...
July 17, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28717121/impact-of-doppler-ultrasound-on-diagnosis-and-therapy-control-of-lienalis-steal-syndrome-after-liver-transplantation
#4
Eva M Teegen, Timm Denecke, Rosa B Schmuck, Robert Öllinger, Dominik Geisel, Johann Pratschke, Sascha S Chopra
BACKGROUND Lienalis steal syndrome is a rare complication after orthotopic liver transplantation leading to severe complications. Routine duplex sonography allows early and safe detection of lienalis steal syndrome and secondarily helps to monitor the outcome by evaluating the hemodynamics. MATERIAL AND METHODS This analysis included eight patients who after orthotopic liver transplantation needed splenic artery embolization due to lienalis steal syndrome. Lienalis steal syndrome was assumed in case of elevated transaminases, bilirubinemia or persistent ascites, and the absence of further pathologies...
July 18, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28716646/pulmonary-infarction-in-the-beginning
#5
Peter B Terry, Philip Clay Buescher
BACKGROUND: Massive pulmonary emboli can cause abrupt onset of symptoms simultaneous with large pulmonary artery occlusions. In contrast the temporal relationship between pulmonary vascular occlusion by smaller emboli and the development of pulmonary infarction symptoms is unknown. We describe the time interval between embolization and the onset of clinical symptoms and signs compatible with pulmonary infarction. METHODS: We examined the records of fifty six patients with Hereditary Hemorrhagic Telangiectasia (HHT) undergoing therapeutic balloon embolization of pulmonary arteriovenous malformations (PAVM's) in a single center after noting that some developed symptoms and signs compatible with pulmonary infarction...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28710023/transient-brain-hypothermia-reduces-the-reperfusion-injury-of-delayed-tissue-plasminogen-activator-and-extends-its-therapeutic-time-window-in-a-focal-embolic-stroke-model
#6
Mohammadreza Zarisfi, Fatemeh Allahtavakoli, Mahsa Hassanipour, Mohammad Khaksari, Hosain Rezazadeh, Mohammad Allahtavakoli, Mohammad Mohsen Taghavi
It has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether short-term and mild local brain cooling can prevent hyperemia and/or adverse effects of delayed tPA in rat embolic stroke model. Male animals were subjected to embolic stroke and then randomly classified into control (saline), tPA (1mg/kg; i.v.), local hypothermia (LH), and tPA+LH. The drug was injected at 6h after ischemia...
July 11, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28709650/anticoagulation-control-in-warfarin-treated-patients-undergoing-cardioversion-of-atrial-fibrillation-from-the-edoxaban-versus-enoxaparin-warfarin-in-patients-undergoing-cardioversion-of-atrial-fibrillation-trial
#7
Gregory Y H Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M Winters, Dmitry Zamoryakhin, Andreas Goette
In the Edoxaban Versus Enoxaparin-Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban was compared with enoxaparin-warfarin in 2,199 patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). In this multicenter prospective randomized open blinded end-point trial, we analyzed patients randomized to enoxaparin-warfarin. We determined time to achieve therapeutic range (TtTR); time in therapeutic range (TiTR); their clinical determinants; relation to sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) score; and impact on primary end points (composite of stroke, systemic embolic event[SEE], myocardial infarction [MI], and cardiovascular death [CVD] and composite of major + clinically relevant nonmajor bleeding)...
June 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28704875/sonographic-and-doppler-sonographic-diagnosis-of%C3%A2-neonatal-ischemic-stroke
#8
Karl-Heinz Deeg
Children are particularly at risk for stroke in the neonatal period. 1/3 of all strokes in children occur during the perinatal period. The incidence of perinatal stroke is 1:4000. A differentiation is made between ischemic stroke and hemorrhagic stroke. Ischemic strokes are caused by arterial occlusion due to thrombosis or embolism. As a result of the nonspecific clinical symptoms in this age group, diagnosis is usually made too late. The only relatively specific symptom is focal cerebral seizure during the first week of life...
July 13, 2017: Ultraschall in der Medizin
https://www.readbyqxmd.com/read/28700711/non-vitamin-k-oral-anticoagulants-are-non-inferior-for-stroke-prevention-but-cause-fewer-major-bleedings-than-well-managed-warfarin-a-retrospective-register-study
#9
Vilhelm Sjögren, Björn Byström, Henrik Renlund, Peter J Svensson, Jonas Oldgren, Bo Norrving, Anders Själander
BACKGROUND: For patients with atrial fibrillation, non-vitamin K oral anticoagulants, or NOACs (dabigatran, rivaroxaban, edoxaban, and apixaban) have been proven non-inferior or superior to warfarin in preventing stroke and systemic embolism, and in risk of haemorrhage. In the pivotal NOAC studies, quality of warfarin treatment was poor with mean time in therapeutic range (TTR) 55-65%, compared with ≥70% in Swedish clinical practice. METHODS: We compared NOACs (as a group) to warfarin in non-valvular atrial fibrillation, studying all 12,694 patients starting NOAC treatment within the Swedish clinical register and dosing system Auricula, from July 1, 2011 to December 31, 2014, and matching them to 36,317 patients starting warfarin using propensity scoring...
2017: PloS One
https://www.readbyqxmd.com/read/28700413/venous-thromboembolism-after-major-venous-injuries-competing-priorities
#10
Brian Frank, Zoё Maher, Joshua P Hazelton, Shelby Resnick, Elizabeth Dauer, Anna Goldenberg, Andrea L Lubitz, Brian P Smith, Noelle N Saillant, Patrick M Reilly, Mark J Seamon
BACKGROUND: Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging as the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type and intraoperative anticoagulation would influence VTE formation after MVI. METHODS: A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at 3 urban, level-I centers (2005-2013)...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28679480/non-vitamin-k-antagonist-oral-anticoagulants-compared-with-warfarin-at-different-levels-of-inr-control-in-atrial-fibrillation-a-meta-analysis-of-randomized-trials
#11
João Carmo, Jorge Ferreira, Francisco Costa, Pedro Carmo, Diogo Cavaco, Salomé Carvalho, Francisco Morgado, Pedro Adragão, Miguel Mendes
BACKGROUND: The efficacy and safety of warfarin for stroke prevention in atrial fibrillation (AF) depend on the time in the therapeutic range (TTR) with an international normalised ratio (INR) of 2.0-3.0. This meta-analysis focused the relative efficacy and safety of non-VKA oral anticoagulants (NOAC) compared with warfarin at different thresholds of centre's TTR (cTTR). METHODS: We searched PubMed, Embase, CENTRAL and websites of regulatory agencies, limiting searches to randomized phase 3 trials...
June 3, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28679128/comparison-of-intracoronary-and-intravenous-ultrasound-targeted-microbubble-destruction-mediated-ang1-gene-transfection-on-left-ventricular-remodeling-in-canines-with-acute-myocardial-infarction
#12
Sheng Cao, Qing Zhou, Jin-Ling Chen, Jing-Jing Cui, Ying-Guang Shan, Bo Hu, Rui-Qiang Guo
Intravenous ultrasound-targeted microbubble destruction (IV-UTMD) has made distinct but limited progress in gene therapy. Intracoronary (IC) injection may lead to more gene transfection than IV injection. This study compared the therapeutic effects of IC-UTMD-mediated and conventional IV-UTMD-mediated gene transfection in acute myocardial infarction (MI). A canine MI model was successfully established through transcatheter coronary artery embolism, and the animals were divided into several treatment groups: IC injection with UTMD and the negative control plasmid (IC-UTMD); IC injection of the angiopoietin 1 (Ang1) plasmid (IC-Ang1); IC injection with UTMD and the Ang1 plasmid (IC-UTMD-Ang1); and IV injection with UTMD and the Ang1 plasmid (IV-UTMD-Ang1)...
July 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28675964/postoperative-blood-pressure-variability-exerts-an-influence-on-clinical-outcome-after-coil-embolization-of-ruptured-intracranial-aneurysms
#13
Bin Xu, Qiuhong Ji, Yunfeng Zhang, Lihua Shen, Maohong Cao, Kefu Cai
OBJECTIVE: The present study was conducted to evaluate the effect of postoperative blood pressure (BP) variability on functional outcome in patients after coil embolization of ruptured aneurysms. METHODS: The authors retrospectively reviewed their database of patients undergoing endovascular coiling to treat subarachnoid hemorrhage (SAH) between November 2011 and December 2014. BP values were recorded every 2 hours in the initial 24 hours after endovascular obliteration of ruptured aneurysms...
July 4, 2017: Neurological Research
https://www.readbyqxmd.com/read/28671868/stemi-and-nstemi-acs-in-a-30-year-old-patient-an-extremely-rare-complication-of-a-left-atrial-myxoma
#14
Francesco Bartolomucci, Antonio Tito, Eliano Pio Navarese, Fortunato Iacovelli, Marco Mele, Claudio Larosa, Marco Matteo Ciccone, Mauro Cassese, Martino Pepe
Primary cardiac tumors are a rare entity whose incidence in the general population ranges from 0.0017% to 0.28%. Myxomas represent nearly half of all primary benign cardiac tumors and they prevalently affect female patients. Embolic manifestation is rare with a reported incidence of 0.06%.We present the case of a 30-year-old male patient with acute anterolateral infarction caused by total occlusion of the left anterior descending artery as a consequence of a left atrial myxoma embolization. Urgent surgical resection of the mass didn't avoid early recurrence of atrial myxoma, whose second presentation was again myocardial infarction...
June 30, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28671788/-therapeutic-news-in-infective-endocarditis
#15
Stella Marchetta, Alessandra Iovino, Patrizio Lancellotti, Luc Piérard
The European recommendations for the management of infective endocarditis have been updated in 2015. The therapeutic modalities depend on both a better prevention in high-risk population, a faster diagnosis through new approaches in medical imaging, and interdisciplinary collaboration by an « endocarditis team. » Treatment involves antimicrobial therapy which can be complex, initially empirical and then targeted, depending on local infectious epidemiology, and whether the infringement affects a native or a prosthetic valve...
August 24, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28665807/new-paradigms-in-the-conservative-surgical-and-interventional-management-of-adenomyosis
#16
Farah A Alvi, Laura M Glaser, Angela Chaudhari, Susan Tsai, Magdy P Milad
PURPOSE OF REVIEW: Adenomyosis is commonly diagnosed in women of reproductive age. Interest in conservative interventions has grown as more women desire fertility preservation or avoidance of hysterectomy. This review discusses surgical and interventional methods for treatment of symptomatic adenomyosis. The technique, evidence, and utility of each method are described. RECENT FINDINGS: Hysteroscopic ablative techniques are associated with lower morbidity than with hysterectomy but may result in an unacceptable risk of treatment failure...
August 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28665071/feasibility-and-safety-of-mild-therapeutic-hypothermia-in-poor-grade-subarachnoid-hemorrhage-prospective-pilot-study
#17
Wookjin Choi, Soon Chan Kwon, Won Joo Lee, Young Cheol Weon, Byungho Choi, Hyeji Lee, Eun Suk Park, Ryeok Ahn
Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups...
August 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28659059/endovascular-treatment-of-visceral-artery-aneurysms-and-pseudoaneurysms-in-100-patients-covered-stenting-vs-transcatheter-embolization
#18
Massimo Venturini, Paolo Marra, Michele Colombo, Marco Alparone, Giulia Agostini, Luca Bertoglio, Claudio Sallemi, Marco Salvioni, Simone Gusmini, Gianpaolo Balzano, Renata Castellano, Luca Aldrighetti, Yamume Tshomba, Massimo Falconi, Germano Melissano, Francesco De Cobelli, Roberto Chiesa, Alessandro Del Maschio
PURPOSE: To retrospectively report a large single-center experience of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) treated with covered stenting (CS) as the first therapeutic option vs transcatheter embolization (TE). METHODS: One hundred patients (mean age 59±14 years; 58 men) underwent 59 elective and 41 emergent endovascular procedures to treat 51 VAAs and 49 VAPAs. Seventy patients had TE and 30 received CS (27 Viabahn and 3 coronary stent grafts)...
June 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28650949/efficacy-and-safety-of-tranexamic-acid-in-orthopedic-fracture-surgery-a-meta-analysis-and-systematic-literature-review
#19
Kamil Amer, Saqib Rehman, Christopher Haydel
BACKGROUND: Tranexamic acid (TXA) is an anti-fibrinolytic drug that has been shown to be effective in reducing blood loss and the need for transfusions after several orthopedic surgeries. However, the effectiveness of TXA use in orthopedic fracture surgeries still remains unclear. The purpose of this meta-analysis was to review existing literature with interest in the effectiveness and safety of TXA treatment in reducing total blood loss and transfusion rates for patients who underwent surgery for fracture repairs...
June 12, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28649478/cerebral-air-embolism-as-possible-cause-of-stroke-during-therapeutic-endobronchial-application-of-argon-plasma-coagulation
#20
Venkatkiran Kanchustambham, Manasa Reddy, Swetha Saladi, Setu Patolia
A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness...
May 17, 2017: Curēus
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