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https://www.readbyqxmd.com/read/28092206/impact-of-uk-nice-clinical-guidelines-168-on-referrals-to-a-specialist-academic-leg-ulcer-service
#1
Huw Ob Davies, Matthew Popplewell, Gareth Bate, Lisa Kelly, Katy Darvall, Andrew W Bradbury
Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service...
January 1, 2017: Phlebology
https://www.readbyqxmd.com/read/28090513/an-update-and-review-of-cell-based-wound-dressings-and-their-integration-into-clinical-practice
#2
REVIEW
Austin Pourmoussa, Daniel J Gardner, Maxwell B Johnson, Alex K Wong
Chronic wounds affect over 4 million individuals and pose a significant burden to the US healthcare system. Diabetes, venous stasis, radiation or paralysis are common risk factors for chronic wounds. Unfortunately, the current standard of care (SOC) has a high relapse rate and these wounds continue to adversely affect patients' quality of life. Fortunately, advances in tissue engineering have allowed for the development of cell-based wound dressings that promote wound healing by improving cell migration and differentiation...
December 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28088662/metabolic-profiles-of-exudates-from-chronic-leg-ulcerations
#3
Adam Junka, Wojciech Wojtowicz, Adam Ząbek, Grzegorz Krasowski, Danuta Smutnicka, Barbara Bakalorz, Agnieszka Boruta, Mariusz Dziadas, Piotr Młynarz, Parish Paymon Sedghizadeh, Marzenna Bartoszewicz
Chronic leg ulceration is a disease usually associated with other comorbidities, and significantly reduces patient quality of life. Infected leg ulcers can lead to limb-threatening sequelae or mortality. Leg ulcerations are colonized by a number of microbes that are able to cause life-threating infections in susceptible patients. Wound exudate is a body fluid that collects metabolites from patient eukaryotic cells and from prokaryotic bacterial communities inhabiting the wound. This study aimed at identification of metabolites in exudates collected from chronic leg ulcers, and correlation of this metabolome with patient comorbidities and microbiological status of the wound...
January 10, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28088580/grand-round-anticoagulation-in-chronic-liver-disease
#4
REVIEW
Ameet Dhar, Benjamin H Mullish, Mark R Thursz
In this Grand Round, we first present a case of a man with decompensated liver disease who subsequently developed a fatal pulmonary embolism, having not been prescribed prophylactic anticoagulation to prevent venous thromboembolic disease. We go on to discuss the burden of thrombotic disease in those with chronic liver disease, before a more detailed discussion regarding the current evidence, safety data, and clinical dilemmas regarding the use of anticoagulation in patients with chronic liver disease, as well as discussing potential future directions within this field...
January 11, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28077026/a-case-control-study-of-risk-factors-of-chronic-venous-ulceration-in-patients-with-varicose-veins
#5
Gohar Abelyan, Lusine Abrahamyan, Gayane Yenokyan
Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013-2014 years. Cases were patients with varicose veins and venous leg ulcers...
January 1, 2017: Phlebology
https://www.readbyqxmd.com/read/28076514/evaluation-of-embolization-for-periuterine-varices-involving-chronic-pelvic-pain-secondary-to-pelvic-congestion-syndrome
#6
Flavio Meirelles Siqueira, Lucas Moretti Monsignore, Julio Cesar Rosa-E-Silva, Omero Benedicto Poli-Neto, Luis Henrique de Castro-Afonso, Guilherme Seizem Nakiri, Valdair Francisco Muglia, Daniel Giansante Abud
OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale...
December 1, 2016: Clinics
https://www.readbyqxmd.com/read/28068437/association-between-early-lactate-levels-and-30-day-mortality-in-clinically-suspected-sepsis-in-children
#7
Halden F Scott, Lina Brou, Sara J Deakyne, Allison Kempe, Diane L Fairclough, Lalit Bajaj
Importance: Improving emergency care of pediatric sepsis is a public health priority, but optimal early diagnostic approaches are unclear. Measurement of lactate levels is associated with improved outcomes in adult septic shock, but pediatric guidelines do not endorse its use, in part because the association between early lactate levels and mortality is unknown in pediatric sepsis. Objective: To determine whether the initial serum lactate level is associated with 30-day mortality in children with suspected sepsis...
January 9, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28065464/lipid-metabolism-in-patients-with-chronic-hyperglycemia-after-an-episode-of-acute-pancreatitis
#8
Nicola A Gillies, Sayali A Pendharkar, Ruma G Singh, Varsha M Asrani, Maxim S Petrov
BACKGROUND: The importance of dyslipidemia is well recognized in the context of both risk factor for acute pancreatitis and prognostic factor for its in-hospital outcomes. With a growing appreciation of post-pancreatitis diabetes mellitus, there is a need to catalogue changes in lipid metabolism after hospitalization due to an acute pancreatitis attack and their associations with glucose metabolism. OBJECTIVE: To investigate lipid metabolism in patients with impaired glucose homeostasis following acute pancreatitis...
December 23, 2016: Diabetes & Metabolic Syndrome
https://www.readbyqxmd.com/read/28063094/stasis-dermatitis-pathophysiology-evaluation-and-management
#9
REVIEW
Swaminathan Sundaresan, Michael R Migden, Sirunya Silapunt
Stasis dermatitis commonly occurs in older age. It is caused by venous hypertension resulting from retrograde flow due to incompetent venous valves, valve destruction, or obstruction of the venous system. Further tissue changes arise from an inflammatory process mediated by metalloproteinases, which are up-regulated by ferric ion from extravasated red blood cells. Stasis dermatitis presents initially as poorly demarcated erythematous plaques of the lower legs bilaterally, classically involving the medial malleolus...
January 6, 2017: American Journal of Clinical Dermatology
https://www.readbyqxmd.com/read/28062630/soluble-cd146-is-a-novel-marker-of-systemic-congestion-in-heart-failure-patients-an-experimental-mechanistic-and-transcardiac-clinical-study
#10
Mattia Arrigo, Quynh A Truong, Duygu Onat, Jackie Szymonifka, Etienne Gayat, Heli Tolppanen, Malha Sadoune, Ryan T Demmer, Ka Y Wong, Jean Marie Launay, Jane-Lise Samuel, Alain Cohen-Solal, James L Januzzi, Jagmeet P Singh, Paolo C Colombo, Alexandre Mebazaa
BACKGROUND: Soluble CD146 (sCD146), is an endothelial marker with similar diagnostic power as natriuretic peptides in decompensated heart failure (HF). While natriuretic peptides are released by the failing heart, sCD146 may be released by veins in response to stretch induced by systemic congestion in HF. This study investigated the source, effects of vascular stress on release and prognostic properties of sCD146 in HF. METHODS: In a peripheral venous stress study, plasma concentrations of sCD146 and N-terminal probrain natriuretic-peptide (NT-proBNP) were measured in 44 HF patients at baseline and after 90 min of unilateral forearm venous congestion...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28059916/does-hospital-transfer-impact-outcomes-after-colorectal-surgery
#11
Christopher J Chow, Wolfgang B Gaertner, Christine C Jensen, Bradford Sklow, Robert D Madoff, Mary R Kwaan
BACKGROUND: With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion. OBJECTIVE: We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables. DESIGN: We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009-2013 American College of Surgeons National Surgical Quality Improvement Program database...
February 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28056699/functional-chronic-venous-disease-a-systematic-review
#12
Raffaele Serra, Michele Andreucci, Giovanni De Caridi, Mafalda Massara, Pasquale Mastroroberto, Stefano de Franciscis
Objectives Functional chronic venous disease is an underestimated syndrome quite present in the general population. It affects up to 20% of the general population and is based on the presence of venous symptoms without instrumental evidence of anatomic and morphologic damage. The aim of this review article is to provide the reader with the most updated information on this phenomenon. Methods Medline and Scopus databases were searched without time limit using the key-word: 'Functional chronic venous disease of legs', C0s patients...
January 1, 2017: Phlebology
https://www.readbyqxmd.com/read/28056580/utility-of-adjunctive-digital-subtraction-venography-for-the-treatment-of-saphenous-vein-insufficiency
#13
Ramon L Varcoe, Shannon D Thomas, Victor Bourke, Nicole M K Rübesamen, Andrew F Lennox
PURPOSE: To report the use of adjunctive venography for the treatment of superficial venous reflux. METHODS: Two hundred consecutive patients (mean age 60.9 years, range 33-86; 128 women) with chronic venous disease underwent saphenous or perforator vein ablation in 268 limbs (305 venous trunks) guided by adjunctive venography and fluoroscopy in addition to ultrasound between October 2010 and May 2016. Intraprocedural venograms were independently evaluated by 2 vascular specialists to identify the presence of venous anomalies and the need for fluoroscopy-guided maneuvers to successfully complete venous ablation...
January 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28055065/effect-of-fish-oil-supplementation-and-aspirin-use-on-arteriovenous-fistula-failure-in-patients-requiring-hemodialysis-a-randomized-clinical-trial
#14
Ashley B Irish, Andrea K Viecelli, Carmel M Hawley, Lai-Seong Hooi, Elaine M Pascoe, Peta-Anne Paul-Brent, Sunil V Badve, Trevor A Mori, Alan Cass, Peter G Kerr, David Voss, Loke-Meng Ong, Kevan R Polkinghorne
Importance: Vascular access dysfunction is a leading cause of morbidity and mortality in patients requiring hemodialysis. Arteriovenous fistulae are preferred over synthetic grafts and central venous catheters due to superior long-term outcomes and lower health care costs, but increasing their use is limited by early thrombosis and maturation failure. ω-3 Polyunsaturated fatty acids (fish oils) have pleiotropic effects on vascular biology and inflammation and aspirin impairs platelet aggregation, which may reduce access failure...
January 3, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28053158/a-bioengineered-living-cell-construct-activates-an-acute-wound-healing-response-in-venous-leg-ulcers
#15
Rivka C Stone, Olivera Stojadinovic, Ashley M Rosa, Horacio A Ramirez, Evangelos Badiavas, Miroslav Blumenberg, Marjana Tomic-Canic
Chronic nonhealing venous leg ulcers (VLUs) are widespread and debilitating, with high morbidity and associated costs; about $15 billion is spent annually on the care of VLUs in the United States. Despite this, there is a paucity of treatments for VLUs because of the lack of pathophysiologic insight into ulcer development as well as the lack of knowledge regarding biologic actions of existing VLU-targeted therapies. The bioengineered bilayered living cellular construct (BLCC) skin substitute is a U.S. Food and Drug Administration-approved biologic treatment for healing VLUs...
January 4, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28052946/dabigatran-related-leukocytoclastic-vasculitis
#16
Josiah An, Rohan Garje, Karolyn A Wanat, José Pablo Leone
Dabigatran is a non-vitamin K antagonist oral anticoagulant that has been approved for atrial fibrillation and prevention of venous thromboembolism. Its use has been increasing in the USA since serum drug levels do not need monitoring. To date, no significant skin side effects have been reported other than 4 cases of non-specific skin lesion and 2 cases of leukocytoclastic vasculitis (LCV), which is a small vessel inflammatory disease that presents as palpable purpura in lower extremities. We present a man aged 57 years with chronic deep vein thrombosis who developed palpable purpura, petechiae, swelling in lower extremities, torso and distal upper extremities on the third day after dabigatran initiation...
January 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28050545/intraosseous-anomalous-drainage-a-rare-case-of-pretibial-varicose-vein
#17
Frederico Barra de Moraes, Carolina Parreira Ribeiro Camelo, Marcelo Luiz Brandão, Pedro Ivo Fávaro, Tercília Almeida Barbosa, Raul Carlos Barbosa
Valve failure with reflux and post-thrombotic syndrome are the factors most commonly correlated with varicose disease. Other rare etiologies can be put forward when these two main causes are ruled out. We report a case in which a young man presented chronic pain in the left tibia, varicose veins in the lower limbs and frequent occurrences of erysipelas. During investigation of the etiology of the varicose veins, radiographs and magnetic resonance imaging of the left leg were requested. These showed images suggestive of an osteolytic lesion in the tibia, but led us to the diagnosis of an intraosseous vein with anomalous drainage...
November 2016: Revista Brasileira de Ortopedia
https://www.readbyqxmd.com/read/28045725/utilization-of-stand-by-extracorporeal-membrane-oxygenation-in-a-high-risk-parturient-with-methamphetamine-associated-cardiomyopathy-undergoing-dilation-and-evacuation-a-case-report
#18
Cesar Padilla, Antonio Hernandez Conte, Danny Ramzy, Lorraine Lubin, Troy LaBounty, Judith H Chung, Ying Zeng
Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of "stand-by" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery...
December 30, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/28043678/associations-between-blood-coagulation-markers-nt-probnp-and-risk-of-incident-heart-failure-in-older-men-the-british-regional-heart-study
#19
S Goya Wannamethee, Peter H Whincup, Olia Papacosta, Lucy Lennon, Gordon D Lowe
AIMS: Chronic heart failure (HF) is associated with activation of blood coagulation but there is a lack of prospective studies on the association between coagulation markers and incident HF in general populations. We have examined the association between the coagulation markers fibrinogen, von Willebrand Factor (VWF), Factors VII, VIII and IX, D-dimer, activated protein C (APC) and activated partial thromboplastin time (aPPT) with NT-proBNP and incident HF. METHODS AND RESULTS: Prospective study of 3366 men aged 60-79years with no prevalent HF, myocardial infarction or venous thrombosis and who were not on warfarin, followed up for a mean period of 13years, in whom there were 203 incident HF cases...
December 20, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28034701/the-prevalence-of-chronic-cerebrospinal-venous-insufficiency-in-meniere-disease-24-month-follow-up-after-angioplasty
#20
Aldo Bruno, Marisanta Napolitano, Luigi Califano, Giuseppe Attanasio, Vincenzo Giugliano, Pier Paolo Cavazzuti, Marika Viccaro, Eleonora Masci, Diego Mastrangelo, Francesca Salafia, Salvatore Mazzone, Benedetto Bernardo, Laura Cagnoni, Roberto Filipo, Marco De Vincentis, Antonio Greco
PURPOSE: To evaluate relationship between Meniere disease (MD) and chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound, magnetic resonance (MR) imaging, and venography and to evaluate the effectiveness of angioplasty of the internal jugular vein (IJV) and azygos vein (AV) in reducing symptoms of MD. MATERIALS AND METHODS: Patients with a confirmed diagnosis of MD unresponsive to standard treatment underwent duplex ultrasound and MR imaging to diagnose CCSVI...
December 26, 2016: Journal of Vascular and Interventional Radiology: JVIR
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