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https://www.readbyqxmd.com/read/29150405/cirrhosis-with-ascites-in-the-last-year-of-life-a-nationwide-analysis-of-factors-shaping-costs-health-care-use-and-place-of-death-in-england
#1
Benjamin Hudson, Jeff Round, Brendan Georgeson, Andrew Pring, Karen Forbes, Catherine Anne McCune, Julia Verne
BACKGROUND: Liver disease mortality increased by 400% in the UK between 1970 and 2010, resulting in rising pressures on acute hospital services, and an increasing need for end-of-life care. We aimed to assess the effect of demographic, clinical, and health-care factors on costs, patterns of health-care use, and place of death in a national cohort of patients with cirrhosis and ascites in their last year of life. METHODS: We did a retrospective, nationwide analysis of all patients who died from cirrhosis in England between 2013 and 2015, who required large-volume paracentesis in their last year of life...
November 14, 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29142455/large-volume-paracentesis-up-to-27-l-with-adjuvant-vaginal-cabergoline-in-the-case-of-severe-ovarian-hyperstimulation-syndrome-with-successful-pregnancy-outcome-a-case-report
#2
Nupur Agarwal, Sanghamitra Ghosh, Shikha Bathwal, Baidyanath Chakravarty
Severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproductive technology. Herein, we report the case of an infertile couple, with the husband being azoospermic, who underwent in-vitro fertilisation and intracytoplasmic sperm injection at our institute. The woman presented with late OHSS 7 days after embryo transfer. Inpatient management was performed with intensive surveillance. Oral cabergoline was started prophylactically but was replaced by the vaginal route due to intolerance...
July 2017: Journal of Human Reproductive Sciences
https://www.readbyqxmd.com/read/29138381/-a-case-of-lung-cancer-associated-with-drug-induced-immune-thrombocytopenia
#3
Mayuka Yamane, Toshihito Otani, Yojiro Onari
A Stage IV lung adenocarcinoma was diagnosed in the left upper lobe of an 81-year-old man 2.5 years ago. Following another form of chemotherapy, he then received docetaxel as fourth-line therapy. After 21 days of therapy, although his white blood cell count recovered, his platelet count decreased to 20,000/mL and continued to decrease. Subsequently, he was closely monitored without therapy, and eventually, his platelet count returned within the normal range after 112 days. Blood biochemistry and bone marrow paracentesis findings suggested the presence of paraneoplastic syndrome, idiopathic thrombocytopenic purpura, and drug-induced immune thrombocytopenia...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29132516/decompensated-cirrhosis-and-fluid-resuscitation
#4
REVIEW
Erin Maynard
The critically ill patient with decompensated cirrhosis has a unique physiology and alterations in albumin that need to be understood to properly resuscitate them and minimize morbidity and mortality. Little data exist on specific resuscitation of the patient with cirrhosis compared with those patients without liver disease. The effectiveness of albumin administration compared with saline administration in common settings, such as large-volume paracentesis, can be extrapolated to the care of the general surgical patient but further studies in this area are warranted...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29129477/transrectal-endoscopic-ultrasound-guided-paracentesis-for-diagnosis-of-malignant-ascites-in-the-pelvis
#5
Kosuke Minaga, Mamoru Takenaka, Ken Kamata, Masatoshi Kudo
No abstract text is available yet for this article.
October 27, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/29119207/anesthesia-in-a%C3%A2-child-with-suspected-peroxisomal-disorder
#6
J S Englbrecht, M Maas
We present the case of an 8‑year-old female child with suspected peroxisomal disorder requiring general anesthesia for adenotomy, paracentesis and brainstem-evoked response audiometry. Peroxisomes are small intracellular organelles that catalyse key metabolic reactions. Peroxisomal disorders are a heterogeneous group of rare genetic diseases. Anesthesia can be challenging as adrenal insufficiency, mental retardation, muscle weakness, risk of pulmonary aspiration, airway complications, seizure disorders and altered pharmacokinetics and pharmacodynamics can occur in these patients but guidelines for anesthesia do not exist due to the heterogeneity and rarity of these diseases and case reports are rare...
November 8, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29099421/effects-of-atorvastatin-on-portal-hemodynamics-and-clinical-outcomes-in-patients-with-cirrhosis-with-portal-hypertension-a-proof-of-concept-study
#7
Saptarshi Bishnu, Sk M Ahammed, Avik Sarkar, Jabaranjan Hembram, Saswata Chatterjee, Kshaunish Das, Gopal K Dhali, Abhijit Chowdhury, Kausik Das
BACKGROUND AND AIM: Statins can modulate portal microvascular dynamics in patients with cirrhosis. We present data from a proof-of-concept study aimed at comparing combination of propranolol and atorvastatin versus propranolol alone in reducing portal pressure in patients with cirrhosis. PATIENTS AND METHODS: In this open-label proof-of-concept study, 23 consecutive patients with cirrhosis were randomized into group A (incremental dose propranolol, n=12) or group B (atorvastatin 20 mg daily with propranolol in incremental dose, n=11)...
November 2, 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29098551/ascites-neutrophil-gelatinase-associated-lipocalin-identifies-spontaneous-bacterial-peritonitis-and-predicts-mortality-in-hospitalized-patients-with-cirrhosis
#8
Giuseppe Cullaro, Grace Kim, Marcus R Pereira, Robert S Brown, Elizabeth C Verna
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of both tissue injury and infection. Urine NGAL levels strongly predict acute kidney injury and mortality in patients with cirrhosis, but ascites NGAL is not well characterized. We hypothesized that ascites NGAL level is a marker of spontaneous bacterial peritonitis (SBP) and mortality risk in patients with cirrhosis. METHODS: Hospitalized patients with cirrhosis and ascites undergoing diagnostic paracentesis were prospectively enrolled and followed until death or discharge...
December 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29091351/eptfe-tips-versus-repetitive-lvp-plus-albumin-for-the-treatment-of-refractory-ascites-in-patients-with-cirrhosis
#9
Theresa Bucsics, Sophie Hoffman, Johanna Grünberger, Maria Schoder, Wolfgang Matzek, Alexander Stadlmann, Mattias Mandorfer, Philipp Schwabl, Arnulf Ferlitsch, Markus Peck-Radosavljevic, Michael Trauner, Josef Karner, Franz Karnel, Thomas Reiberger
INTRODUCTION: Reduction of portal pressure by self-expandable polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts (TIPS) is a treatment option for refractory ascites. Data on clinical outcomes after ePTFE-TIPS versus repetitive large-volume paracentesis (LVP) plus albumin (A) administration for the treatment of patients with refractory ascites are limited. METHODS: Retrospective comparison of ePTFE-TIPS versus LVP+A in terms of (i) control of ascites, (ii) occurrence of overt hepatic encephalopathy (HE) and (iii) transplant-free survival in cirrhotic patients with refractory ascites...
November 1, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29073312/vascular-ultrasonography-a-novel-method-to-reduce-paracentesis-related-major-bleeding
#10
Jeffrey H Barsuk, Bradley T Rosen, Elaine R Cohen, Joe Feinglass, Mark J Ault
Paracentesis is a core competency for hospitalists. Using ultrasound for fluid localization is standard practice and involves a low-frequency probe. Experts recommend a "2-probe technique, " which incorporates a high-frequency ultrasound probe in addition to the low-frequency probe to identify blood vessels within the intended needle path. Evidence is currently lacking to support this 2-probe technique, so we performed a pre- to postintervention study to evaluate its effect on paracentesis-related bleeding complications...
October 18, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29072497/efficacy-and-safety-of-ultrasound-guided-percutaneous-glue-embolization-in-iatrogenic-haemorrhagic-complications-of-paracentesis-and-thoracocentesis-in-cirrhotic-patients
#11
Amar Mukund, Vinay Kumar Dp, Naveen Kumar Condati, Ajeet Singh Bhadoria, Shiv Kumar Sarin
OBJECTIVE: To compare the safety and efficacy of ultrasound guided percutaneous glue (N-butyl-2-cyanoacrylate) embolization with transarterial embolization in the management of iatrogenically injured arteries while performing paracentesis or thoracocentesis in patients with chronic liver disease. METHODS: Hospital database was searched for cirrhotic patients having abdominal/thoracic wall haemorrhage following paracentesis/thoracocentesis procedure from January 2011 to June 2016...
November 8, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29064193/-paracentesis-and-cirrhotic-patients-should-we-fear-hemorrhages
#12
Marisa De Carvalho Fernandes, Emiliano Giostra, Martine Louis Simonet
Paracentesis is a frequent procedure, especially in patients with cirrhosis. In these patients, given the fears of severe bleeding associated with coagulation disorders as well as thrombocytopenia, we were interested to review the literature on this subject. Few studies are available and, for the moment, recommendations are of a low level of evidence. Paracentesis seems to be a safe procedure without severe haemorrhagic complications (< 1%), regardless of coagulation disorders and platelet count. Renal insufficiency, Child-Pugh C cirrhosis, thrombocytes < 50 G/L and cirrhosis of alcoholic origin may however increase the risk of bleeding...
October 18, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29059269/the-practice-and-implications-of-finding-fluid-during-point-of-care-ultrasonography-a-review
#13
Rachel B Liu, Joseph H Donroe, Robert L McNamara, Howard P Forman, Chris L Moore
Importance: Point-of-care ultrasonography (POCUS) is an increasingly affordable and portable technology that is an important part of 21st-century medicine. When appropriately used, POCUS has the potential to expedite diagnosis and improve procedural success and safety. POCUS is now being adopted in medical education as early as the first year of medical school. While potentially powerful and versatile, POCUS is a user-dependent technology that has not been formalized or standardized yet within internal medicine residency training programs...
October 23, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29054902/chylous-ascites-in-a-patient-with-an-overlap-syndrome-a-surprising-response-to-rituximab
#14
Alexandra Daniel, Gianluca Bagnato, Edward Vital, Francesco Del Galdo
The authors present a case of a 51-year-old woman with clinical diagnosis of mixed connective tissue disease and overlap systemic lupus erythematosus features, with a 6-month history of progressive painless abdominal distension. On examination, evident signs of ascites were present. Both the abdominal-pelvic ultrasound and CT scan confirmed a large amount of ascites. A diagnostic paracentesis was performed, which revealed typical features of chylous ascites (CA). An extensive diagnostic work-up led by a multidisciplinary team was performed, excluding malignancy, cirrhosis, infectious, as well as cardiac and primary lymphatic causes...
October 20, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29044064/utility-of-angiotensin-converting-enzyme-activity-in-aqueous-humor-in-the-diagnosis-of-ocular-sarcoidosis
#15
Violeta Mihailovic-Vucinic, Ljubica Popevic, Spasoje Popevic, Mihailo Stjepanovic, Andjelka Aleksic, Anka Stanojevic-Paovic
PURPOSE: Many studies include elevated activity of angiotensin-converting enzyme (ACE) in serum in sarcoidosis and in ocular sarcoidosis as well, but there are only a few analyzing ACE activities in aqueous humor. The aim of this study is to illuminate the diagnostic value of ACE in aqueous humor in patients with ocular sarcoidosis. METHODS: We analyzed twenty patients with ocular sarcoidosis and 18 patients with nonocular involvement. All patients have biopsy-positive sarcoidosis of the lungs and/or mediastinal lymph nodes...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29041907/detection-of-bacterial-dna-by-in-situ-hybridization-in-patients-with-decompensated-liver-cirrhosis
#16
Shingo Usui, Hirotoshi Ebinuma, Po-Sung Chu, Nobuhiro Nakamoto, Yoshiyuki Yamagishi, Hidetsugu Saito, Takanori Kanai
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is often difficult to diagnose because bacteria in ascites cannot be detected accurately by conventional culture. In situ hybridization (ISH) was previously developed for rapid detection of genes from bacteria phagocytized by neutrophils. SBP may develop after bacteria enter into the systemic circulation following bacterial translocation. Therefore, we performed ISH to identify bacteria in blood samples collected from patients with decompensated liver cirrhosis (LC)...
October 17, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/28991950/hospital-privileging-practices-for-bedside-procedures-a-survey-of-hospitalist-experts
#17
Trevor P Jensen, Nilam J Soni, David M Tierney, Brian P Lucas
Many hospitalists are routinely granted hospital privileges to perform invasive bedside procedures, but criteria for privileging are not well described. We conducted a survey of 21 hospitalist procedure experts from the Society of Hospital Medicine Point-of-Care Ultrasound Task Force to better understand current privileging practices for bedside procedures and how those practices are perceived. Only half of all experts reported their hospitals require a minimum number of procedures performed to grant initial (48%) and ongoing (52%) privileges for bedside procedures...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28989288/a-family-of-early-english-oculists-1600-1751-with-a-reappraisal-of-john-thomas-woolhouse-1664-1733-1734
#18
REVIEW
Christopher T Leffler, Stephen G Schwartz
INTRODUCTION: John Thomas Woolhouse (1666-1733/1734), who practiced in Paris, was part of a family with 5 generations of English oculists. Some historians have derided him as a "charlatan" and have criticized him for adhering to the old notion that a cataract was a membrane anterior to the lens. METHODS: We reviewed treatises and digital records related to Woolhouse and his family and the handwritten notes of his 1721 lecture series at the Royal Society of Medicine...
2017: Ophthalmology and Eye Diseases
https://www.readbyqxmd.com/read/28965794/health-care-associated-infections-in-pre-transplant-liver-intensive-care-unit-perspectives-and-challenges
#19
Elham A Hassan, Nahla M Elsherbiny, Abeer S Abd El-Rehim, Asmaa M A Soliman, Asmaa O Ahmed
BACKGROUND: Health care-associated infections (HAIs) threaten patient's safety worldwide especially in the intensive care units (ICU). In end-stage liver disease (ESLD), the condition is much more complicated. Data regarding HAIs among ESLD patients is lacking. We aimed to assess the incidence of HAIs, risk factors, causative micro-organisms, antimicrobial susceptibilities and mortality rates among patients with end-stage liver disease (ESLD) admitted to pre-transplant liver intensive care unit (LICU)...
September 28, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/28965174/lactate-determination-in-pleural-and-abdominal-effusions-a-quick-diagnostic-marker-of-exudate-a-pilot-study
#20
Giovanni Porta, Fabio G Numis, Valerio Rosato, Antonio Pagano, Mario Masarone, Giorgio Bosso, Claudia Serra, Luca Rinaldi, Maria C Fascione, Annalisa Amelia, Fiorella Paladino, Fernando Schiraldi
Pleural or abdominal effusions are frequent findings in ICU and Internal Medicine patients. Diagnostic gold standard to distinguish between transudate and exudate is represented by "Light's Criteria," but, unfortunately, the chemical-physical examination for their calculation is not a rapid test. Pursuing an acid-base assessment of the fluid by a blood-gas analyzer, an increase of lactate beyond the normal serum range is reported in the exudative effusions. The advantages of this test are that it is a very fast bed-side test, executable directly by the physician...
September 30, 2017: Internal and Emergency Medicine
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