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https://www.readbyqxmd.com/read/28513500/rescue-vitrectomy-with-blocked-artery-massage-and-bloodletting-for-branch-retinal-artery-occlusion
#1
Chun-Ju Lin, Cheng-Wen Su, Huan-Sheng Chen, Wen-Lu Chen, Jane-Ming Lin, Yi-Yu Tsai
A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset...
April 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28497416/internal-medicine-point-of-care-ultrasound-curriculum-consensus-recommendations-from-the-canadian-internal-medicine-ultrasound-cimus-group
#2
Irene W Y Ma, Shane Arishenkoff, Jeffrey Wiseman, Janeve Desy, Jonathan Ailon, Leslie Martin, Mirek Otremba, Samantha Halman, Patrick Willemot, Marcus Blouw
Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs...
May 11, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28494541/-new-therapeutic-paradigm-and-concepts-for-patients-with-cirrhotic-refractory-ascites
#3
S Z Wang, H G Ding
The activation of renin-angiotensin-aldosterone-vasopressin system is a key factor in the formation of ascites due to splanchnic vasodilation in cirrhosis. In theory, aldosterone antagonists, contraction of blood vessels, vasopressin V2 receptor, and angiotensin receptor antagonists are important targets for the prevention and treatment of cirrhotic ascites. The 15%-20% of patients with cirrhotic ascites that show no response to at least one week's treatment with potent diuretics (spironolactone 160 mg/d combined with furosemide 80 mg/d) are considered to have refractory ascites...
April 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28493448/utility-of-an-immunocytochemical-assay-using-aqueous-humor-in-the-diagnosis-of-feline-infectious-peritonitis
#4
Sandra Felten, Kaspar Matiasek, Stefanie Gruendl, Laura Sangl, Katrin Hartmann
OBJECTIVE: In cats suffering from feline infectious peritonitis (FIP) without effusion, antemortem diagnosis is challenging. Uveitis is common in these cats. It was the aim of this study to evaluate sensitivity and specificity of an immunocytochemical assay (ICC) in aqueous humor of cats suspected of having FIP. ANIMALS STUDIED: The study included 26 cats with immunohistochemically confirmed FIP and 12 control cats for which FIP was suspected due to similar clinical or laboratory changes, but which suffered from other diseases confirmed via histopathology...
May 10, 2017: Veterinary Ophthalmology
https://www.readbyqxmd.com/read/28491181/tips-performed-in-a-patient-with-complete-portal-vein-thrombosis
#5
Ashwani Kumar Sharma, David Charles Kaufman
Portal vein thrombosis is common in cirrhotic patients and results in increased morbidity and mortality. Transjugular intrahepatic portosystemic shunt (TIPS) creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements have led to improved TIPS outcomes that have encouraged an expanded application. Complete portal vein thrombosis has come a long way from being a contraindication to an indication for TIPS procedure...
June 2017: Radiology case reports
https://www.readbyqxmd.com/read/28489618/core-competencies-or-a-competent-core-a-scoping-review-and-realist-synthesis-of-invasive-bedside-procedural-skills-training-in-internal-medicine
#6
Ryan Brydges, Lynfa Stroud, Brian M Wong, Eric S Holmboe, Kevin Imrie, Rose Hatala
PURPOSE: Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training...
May 9, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28473429/atraumatic-chylous-ascites-an-unusual-presentation-of-bladder-cancer
#7
Ashish Srinivasan, Ross Apostolov, Amanda Leong, Douglas Johnson
We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature...
May 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28468013/translating-our-current-understanding-of-ascites-management-into-new-therapies-for-patients-with-cirrhosis-and-fluid-retention
#8
Elisa Pose, Andres Cardenas
Ascites is the most common complication associated with cirrhosis resulting in poor quality of life, high risk of development of other complications of cirrhosis, increased morbidity and mortality associated with surgical interventions, and poor long-term outcome. Patients with cirrhosis and a first onset of ascites, have a probability of survival of 85% during the first year and 56% at 5 years without liver transplantation. Ascites is caused due to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28442933/drainage-of-malignant-ascites-patient-selection-and-perspectives
#9
REVIEW
Maciej Stukan
Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/28439354/residents-procedural-experience-does-not-ensure-competence-a-research-synthesis
#10
Jeffrey H Barsuk, Elaine R Cohen, Joe Feinglass, William C McGaghie, Diane B Wayne
BACKGROUND: Many medical certifying bodies require that a minimum number of clinical procedures be completed during residency training to obtain board eligibility. However, little is known about the relationship between the number of procedures residents perform and their clinical competence. OBJECTIVE: This study evaluated associations between residents' medical procedure skills measured in a simulation laboratory and self-reported procedure experience and year of training...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28433123/optical-coherence-tomography-angiography-of-a-central-retinal-artery-occlusion-before-and-after-anterior-chamber-paracentesis
#11
Christopher K Hwang, Anton M Kolomeyer, Alexander J Brucker
No abstract text is available yet for this article.
May 2017: Ophthalmology
https://www.readbyqxmd.com/read/28433104/wilson-disease-symptomatic-liver-therapy
#12
Jan Pfeiffenberger, Karl-Heinz Weiss, Wolfgang Stremmel
Wilson disease leads to symptomatic impairment of liver function or liver cirrhosis. Strict adherence to decoppering agents is essential in these patients. Secondary prevention of additional hepatic damage by avoidance of other toxic substances (e.g., alcohol, drugs) and sufficient calorie intake is recommended. Routine examinations in cirrhotic patients include screening for signs of portal hypertension (esophagus varices), development of ascites, and hepatic encephalopathy. Where varices are present, primary or secondary preventive interventions may include treatment with nonselective beta-blockers or variceal ligation, similar to the approach in patients with liver cirrhosis due to other etiologies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28410719/assessment-of-resident-training-and-preparedness-for-cataract-surgery
#13
Sidharth Puri, Divya Srikumaran, Christina Prescott, Jing Tian, Shameema Sikder
PURPOSE: To assess which surgical teaching methods are used for residency surgical training and which methods residents find most useful. SETTING: Wilmer Eye Institute, Baltimore, Maryland, USA. DESIGN: Retrospective observational cross-sectional study. METHODS: A survey was developed and sent to residents at accredited ophthalmology training programs in the United States. The survey asked about demographics, program characteristics, surgical training methods, perceived initial preparedness, eventual competence, and difficulty with the steps of cataract surgery...
March 2017: Journal of Cataract and Refractive Surgery
https://www.readbyqxmd.com/read/28402708/diagnosing-sarcopenia-in-male-patients-with-cirrhosis-by-dual-energy-x-ray-absorptiometry-estimates-of-appendicular-skeletal-muscle-mass
#14
Giliane Belarmino, Maria Cristina Gonzalez, Priscila Sala, Raquel Susana Torrinhas, Wellington Andraus, Luiz Augusto Carneiro D'Albuquerque, Rosa Maria R Pereira, Valéria F Caparbo, Eduardo Ferrioli, Karina Pfrimer, Lucas Damiani, Steven B Heymsfield, Dan L Waitzberg
BACKGROUND: Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual-energy x-ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid-filled abdominal compartment. OBJECTIVE: To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients...
April 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28383303/early-hospital-readmissions-and-mortality-in-patients-with-decompensated-cirrhosis-enrolled-in-a-large-national-health-insurance-administrative-database
#15
Steven J Scaglione, Leanne Metcalfe, Stephanie Kliethermes, Ivan Vasilyev, Rebecca Tsang, Allyce Caines, Shaham Mumtaz, Vik Goyal, Asra Khalid, David Shoham, Talar Markossian, Amy Luke, Howard Underwood, Scott J Cotler
BACKGROUND: Patients with decompensated cirrhosis have high rates of morbidity and mortality and frequently require hospital admission. Few studies have examined early readmission as an indicator of 90 day and overall mortality. Analysis of large databases is needed to evaluate the association between early readmission and mortality in decompensated cirrhosis. METHODS: We analyzed 5 years of private, employer-based, health insurance claims data associated with HealthCare Services Corporation on 13...
April 5, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28373923/three-cases-of-pseudo-meigs-syndrome-secondary-to-ovarian-metastases-from-colorectal-cancer
#16
Yuta Yamamoto, Yusuke Miyagawa, Takehito Ehara, Makoto Koyama, Satoshi Nakamura, Daisuke Takeuchi, Futoshi Muranaka, Masato Kitazawa, Shinichi Miyagawa
Pseudo-Meigs' syndrome is used to describe cases of ascites and/or pleural effusion associated with ovarian neoplasms other than benign tumors, which improve after removal of the ovarian lesion. We present three cases of pseudo-Meigs' syndrome secondary to ovarian metastasis from colorectal cancer. In case 1, the patient has severe dyspnea and hypoxia due to massive right pleural effusion; therefore preoperative thoracic drainage was needed. In case 2, the patient needed paracentesis every two or three days to improve abdominal distension...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28370388/quality-of-widely-available-video-instructional-materials-for-point-of-care-ultrasound-guided-procedure-training-in-internal-medicine
#17
Aditi Khandelwal, Luke A Devine, Mirek Otremba
OBJECTIVES: Many instructional materials for point-of-care ultrasound (US)-guided procedures exist; however, their quality is unknown. This study assessed widely available educational videos for point-of-care US-guided procedures relevant to internal medicine: central venous catheterization, thoracentesis, and paracentesis. METHODS: We searched Ovid MEDLINE, YouTube, and Google to identify videos for point-of-care US-guided paracentesis, thoracentesis, and central venous catheterization...
April 3, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28365696/non-malignant-cerebrospinal-fluid-ascites-in-a-patient-with-atypical-teratoid-rhabdoid-tumor
#18
Santhosh A Upadhyaya, Paul Klimo, Giles W Robinson
BACKGROUND: The development of symptomatic ascites from a ventriculoperitoneal shunt is rare in children without prior intra-abdominal pathology. Here we report a case of symptomatic ascites in a young child with a ventriculoperitoneal shunt and metastatic atypical teratoid rhabdoid tumor. CASE REPORT: This 15-month-old boy developed symptomatic ascites while undergoing chemotherapy for his malignant brain tumor. Diagnostic work up to identify the etiology of this ascites yielded a non-malignant, sterile transudate, refractory to repeated paracentesis...
2017: Oncology Research and Treatment
https://www.readbyqxmd.com/read/28350743/home-based-drainage-of-refractory-ascites-by-a-permanent-tunneled-peritoneal-catheter-can-safely-replace-large-volume-paracentesis
#19
Philipp Solbach, Christoph Höner Zu Siederdissen, Richard Taubert, Szilvia Ziegert, Kerstin Port, Andrea Schneider, Katja Hueper, Michael P Manns, Heiner Wedemeyer, Elmar Jaeckel
BACKGROUND AND AIM: Refractory ascites has a poor prognosis. Recurrent large-volume paracentesis is the current standard of care; however, it results in circulatory dysfunction and renal dysfunction, and hospitalization is commonly required. Transjugular intrahepatic portosystemic shunt placement is not an option in a substantial number of patients because of contraindications. The placement of a tunneled peritoneal drainage catheter has been shown to be effective in patients with malignant ascites...
May 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28331804/infected-ascites-distinguishing-secondary-peritonitis-from-spontaneous-bacterial-peritonitis-in-a-cirrhotic-patient-with-classic-symptoms
#20
Marvin Louis Roy Lu, Akanksha Agarwal, Josh Sloan, Aaron Kosmin
INTRODUCTION: Spontaneous bacterial peritonitis can be differentiated from secondary bacterial peritonitis by the absence of a surgically treatable intra-abdominal source of infection. However, oftentimes this is unapparent and other clinical clues need to be sought after to make the right diagnosis. CASE: A 64-year-old woman was admitted because of three days of worsening diffuse abdominal pain and distention. She was morbidly obese and had a history of non-alcoholic steatohepatitis (NASH) cirrhosis...
2017: IDCases
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