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https://www.readbyqxmd.com/read/29628684/thirty-day-mortality-following-total-knee-arthroplasty-over-7-years-at-a-tertiary-referral-centre-of-orthopaedic-excellence
#1
Yuen Chan, Veenesh Selvaratnam, Videsh Raut
Total Knee Arthroplasty (TKA) is one of the most successful orthopaedic procedures. Around 100,000 TKAs are performed yearly in the United Kingdom. The aim of this study was to report the mortality rate within 30 days after a TKA in an Orthopaedic Centre of Excellence. We reviewed prospectively collected data of 7067 TKAs performed between April 2009-November 2016. All mortalities within 30 days of a TKA were recorded. Data such as age, sex, ASA, comorbidities and cause of death was recorded. There were 14 (0...
January 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29619581/approach-to-undifferentiated-dyspnea-in-emergency-department-aids-in-rapid-clinical-decision-making
#2
Siva Nageswara Rao Guttikonda, Kiran Vadapalli
BACKGROUND: Diagnosis and management of patients presenting with acute dyspnea is one of the major challenges for physicians in emergency department (ED). A correct diagnosis is frequently delayed and difficult to ascertain, and clinical uncertainty is common, explaining the need for rapid diagnosis and a management plan. The primary aim of our study is to assess a diagnostic strategy using multiorgan point of care ultrasonography (USG) to differentiate patients presenting with acute dyspnea to ED into different diagnostic categories for timely management in a resource-limited setting...
April 4, 2018: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29610172/histoplasmosis-myocarditis-in-an-immunocompetent-host-after-a-recreational-mud-run
#3
Briana L Scott, Jennifer I Sherwin, Kyle J Rehder, Michael J Campbell, Caroline P Ozment
Mud runs are an increasingly popular recreational fitness activity across the United States, combining a running race through an obstacle course with submersion in mud. Recent reports estimate 4 million people have participated in these types of events over the last 5 years. We describe an atypical case of myocarditis and multiorgan failure from disseminated histoplasmosis in a previously healthy pediatric patient, likely acquired during participation in a mud run. Although cases of histoplasmosis-associated endocarditis and pericarditis have been reported in the literature, cases of histoplasmosis myocarditis are rare...
April 2018: Pediatrics
https://www.readbyqxmd.com/read/29603246/elevated-free-hemoglobin-and-decreased-haptoglobin-levels-are-associated-with-adverse-clinical-outcomes-unfavorable-physiologic-measures-and-altered-inflammatory-markers-in-pediatric-cardiac-surgery-patients
#4
Jill M Cholette, Anthony P Pietropaoli, Kelly F Henrichs, George M Alfieris, Karen S Powers, Francisco Gensini, Jeffrey S Rubenstein, Dawn Sweeney, Richard Phipps, Sherry L Spinelli, Majed A Refaai, Michael P Eaton, Neil Blumberg
BACKGROUND: There are data suggesting that free hemoglobin (Hb), heme, and iron contribute to infection, thrombosis, multiorgan failure, and death in critically ill patients. These outcomes may be mitigated by haptoglobin. STUDY DESIGN AND METHODS: 164 consecutively treated children undergoing surgery for congenital heart disease were evaluated for associations between free Hb and haptoglobin and clinical outcomes, physiologic metrics, and biomarkers of inflammation RESULTS: Higher perioperative free Hb levels (and lower haptoglobin levels) were associated with mortality, nosocomial infection, thrombosis, hours of intubation and inotropes, increased interleukin-6, peak serum lactate levels, and lower nadir mean arterial pressures...
March 30, 2018: Transfusion
https://www.readbyqxmd.com/read/29602471/early-and-midterm-outcome-of-multilayer-flow-modulator-stent-for-complex-aortic-aneurysm-treatment-in-germany
#5
Walid Ibrahim, Konstantinos Spanos, Andreas Gussmann, Christoph A Nienaber, Joerg Tessarek, Heinrich Walter, Jörg Thalwitzer, Sebastian E Debus, Nikolaos Tsilimparis, Tilo Kölbel
OBJECTIVE: The objective of this study was to assess the early and midterm outcomes of endovascular repair of complex aortic aneurysm cases using the Multilayer Flow Modulator (MFM; Cardiatis, Isnes, Belgium) endograft in Germany. METHODS: A retrospective study including patients presenting with abdominal aortic aneurysm (AAA), thoracic aortic aneurysm, or thoracoabdominal aortic aneurysm treated with the MFM was conducted in Germany. Mortality and morbidity (in terms of spinal cord ischemia, visceral ischemia, and stroke) at 30 days postoperatively were evaluated...
March 27, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29592975/fulminant-hepatic-failure-in-the-setting-of-progressive-anca-associated-vasculitis-associated-with-a-rare-alpha-1-antitrypsin-phenotype-piee
#6
Ronald Reilkoff, Laurel Stephenson
Abnormalities in alpha-1 antitrypsin (AAT) proteins are risk factors for human disease. While the most common is AAT deficiency, a genetic disorder associated with chronic obstructive pulmonary disease, additional disorders associated with AAT abnormalities are increasingly recognised. We describe a middle-aged woman who presented with fulminant hepatic and multiorgan failure. Evaluation revealed the patient to have a rare AAT phenotype PiEE. Her clinical presentation was consistent with antineutrophilic cytoplasmic antibody-associated vasculitis, and her history suggested features of panniculitis...
March 28, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29580343/incidence-and-impact-of-variant-celiacomesenteric-vascularization-and-vascular-stenosis-on-pancreatic-surgery-outcomes-personal-experience
#7
Alejandro M Sánchez, Antonio P Tortorelli, Paola Caprino, Fausto Rosa, Roberta Menghi, Giuseppe Quero, Giovanni B Doglietto, Sergio Alfieri
Ischemic complications after pancreatic surgery can raise postoperative mortality from 4 to 83 per cent. Variants in vascular anatomy play a major role in determining such complications, but they have been only occasionally reported in the literature. We retrospectively analyzed 100 records of patients consecutively treated between January 2011 and December 2013 for resectable malignant diseases who underwent pancreaticoduodenectomy (PD) or total pancreatectomy to state the statistical impact of anatomical vascular variations in surgical outcomes (mean surgical timing, mean blood loss during surgery, and postoperative major complications onset) and to state whether preoperatively undetected vascular anomalies (VA) can raise the risk of postoperative ischemic complications...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29575675/novel-oral-anticoagulant-use-in-adult-fontan-patients-a-single-center-experience
#8
Justin Georgekutty, Amir Kazerouninia, YunFei Wang, Peter R Ermis, Dhaval R Parekh, Wayne J Franklin, Wilson W Lam
OBJECTIVE: Adult Fontan patients are at increased risk for thrombosis and thromboembolic complications leading to increased morbidity and mortality. Most are prescribed antiplatelet or anticoagulant therapy for thromboprophylaxis; novel oral anticoagulants (NOACs) are uncommonly used given lack of data on their use in this population and generalized concerns regarding Fontan patients' abnormal coagulation. We report the largest single-center experience with the use of NOACs for treatment and prophylaxis of thrombosis and thromboembolism in adult Fontan patients...
March 24, 2018: Congenital Heart Disease
https://www.readbyqxmd.com/read/29558785/renin-angiotensin-aldosterone-system-in-the-pathogenesis-of-pregnancy-induced-hypertension
#9
Renata Świątkowska-Stodulska, Piotr Kmieć, Katarzyna Stefańska, Krzysztof Sworczak
Hypertension occurs in 7-10% of pregnant women. Despite the continuous development of medicine, it is still an important risk factor for perinatal mortality of both mothers and fetuses. Pregnant women with hypertension are at greater risk of complications such as: placental abruption, cerebral and cardiac incidents, multiorgan failure, and disseminated intravascular coagulation. The aim of this review was to discuss multilevel disorders of the renin-angiotensin-aldosterone system in the etiopathogenesis of pregnancy-induced hypertension...
March 20, 2018: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/29544388/complementary-role-of-hypothermia-identification-to-the-quick-sequential-organ-failure-assessment-score-in-predicting-patients-with-sepsis-at-high-risk-of-mortality-a-retrospective-analysis-from-a-multicenter-observational-study
#10
Shigeki Kushimoto, Satoshi Gando, Hiroshi Ogura, Yutaka Umemura, Daizoh Saitoh, Toshihiko Mayumi, Seitaro Fujishima, Toshikazu Abe, Atsushi Shiraishi, Hiroto Ikeda, Joji Kotani, Yasuo Miki, Shin-Ichiro Shiraishi, Koichiro Suzuki, Yasushi Suzuki, Naoshi Takeyama, Kiyotsugu Takuma, Ryosuke Tsuruta, Yoshihiro Yamaguchi, Norio Yamashita, Naoki Aikawa
BACKGROUND: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29534714/lumbar-spine-epidural-abscess-and-facet-joint-septic-arthritis-due-to-streptococcus-agalactiae-a-case-report
#11
Costansia Bureta, Hiroyuki Tominaga, Takuya Yamamoto, Takao Setoguchi, Hideki Kawamura, Satoshi Nagano, Ichiro Kawamura, Masahiko Abematsu, Hironori Kakoi, Yasuhiro Ishidou, Setsuro Komiya
BACKGROUND: Here we report a rare case of lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae, which had spread to the iliopsoas muscles, leading to urine retention. CASE PRESENTATION: A 68-year-old woman with low back pain experienced a sudden onset of bilateral lower limb weakness, it was followed 14 days later by urine retention. At consultation, magnetic resonance imaging and identification of serum β-hemolytic streptococci provided a diagnosis of Streptococcus agalactiae infection...
March 13, 2018: BMC Surgery
https://www.readbyqxmd.com/read/29532238/is-the-brain-spared-in-crimean-congo-haemorrhagic-fever-an-mr-swi-study-to-reveal-cns-involvement
#12
Bilge Öztoprak, İbrahim Öztoprak, Aynur Engin
OBJECTIVES: The aim of this prospective study is to investigate the central nervous system involvement in Crimean-Congo haemorrhagic fever (CCHF) with magnetic resonance imaging (MRI) in conjunction with clinical and laboratory findings. METHODS: Between July 2015 and August 2016, 36 patients with CCHF were undergone brain MRI including SWI. Two MRIs, one at the time of admission and the second in the convalescent period, were performed for each patient in order to see if there is any sign of central nervous system (CNS) involvement, especially in terms of intracranial haemorrhage or viral encephalitis...
March 12, 2018: European Radiology
https://www.readbyqxmd.com/read/29523423/capnocytophaga-canimorsus-an-emerging-pathogen-in-immunocompetent-patients-experience-from-an-emergency-department
#13
Nicole Bertin, Gabriele Brosolo, Fabrizio Pistola, Francesco Pelizzo, Christian Marini, Franco Pertoldi, Olga Vriz
BACKGROUND: Capnocytophaga canimorsus is a bacterium of the normal oral flora of dogs and cats. Human infection is caused by animal bite but is rarely observed, mainly in immunocompromised patients. We present 2 cases of C. canimorsus infection that occurred in immunocompetent patients and caused multiorgan failure and in both cases severe neurologic involvement. CASE REPORT: In the first case, we present a 69-year-old immunocompetent woman with septic shock derived from skin and soft tissue infection after a dog's bite...
March 6, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29518819/-intra-and-postoperative-complications-classified-according-to-the-clavien-dindo-classification-in-patients-80-years-after-transurethral-resection-of-the-urinary-bladder
#14
Bara Barakat, Yousif Dawood, Marcus Horstmann
INTRODUCTION:  Urothelial carcinoma of the urinary bladder is a tumour of advanced age. The demographic change increases the number of very old patients ( > 80 years) subjected to TUR-B. MATERIAL AND METHODS:  In a retrospective analysis, perioperative complications in 89 patients (> 80 years), who underwent a transurethral resection of the bladder between 2013 and 2016 in our department, were recorded and evaluated using the Clavien-Dindo grading system...
March 8, 2018: Aktuelle Urologie
https://www.readbyqxmd.com/read/29507026/multiorgan-failure-associated-with-severe-ovarian-hyperstimulation-syndrome-due-to-inadequate-protocol-optimisation-a-rare-but-avoidable-complication
#15
Lorraine Sheena Kasaven, Anastasia Goumenou, Kenneth Adegoke
Ovarian hyperstimulation syndrome (OHSS) is a well-recognised iatrogenic complication following controlled ovarian stimulation (COS). Mild to moderate cases are mostly managed conservatively. Severe cases of OHSS can be potentially fatal. For this reason, UK clinics providing licensed fertility treatment are obliged to follow Human Fertilisation and Embryology Authority guidelines for reporting severe incidents. We present an unusually severe complication of OHSS resulting in significant morbidity. A nulligravida woman aged 25, with a 4-year history of subfertility and multiple risk factors for the development of OHSS, underwent COS...
March 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29491755/significant-hyperbilirubinemia-and-acute-hepatocellular-jaundice-in-a-pediatric-patient-receiving-deferasirox-a-case-report
#16
Elizabeth A Feldman, Christopher D Miller, Sarabeth Wojnowicz, Robert Seabury
Despite a boxed warning, postmarketing reports of deferasirox-associated hepatic injury in patients with chronic transfusions are not well described. Hepatic impairment, including failure, has been reported to occur more frequently in patients older than 55 years and in those with significant comorbidities, including liver cirrhosis and multiorgan failure. In this case report, we describe significant hyperbilirubinemia and acute hepatocellular jaundice related to deferasirox in a 7-year-old female being treated for iron overload secondary to chronic transfusions...
January 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/29487752/thyroid-storm-triggered-by-strangulation-in-a-patient-with-undiagnosed-graves-disease
#17
Jorge I Conte, Marilyn A Arosemena, Kunal Kapoor, Naomi G Dempsey, Megan L Zaleski, Atil Y Kargi
Thyroid storm is the life-threatening end-organ manifestation of severe thyrotoxicosis. If left untreated, thyroid storm may cause acute heart failure, multiorgan dysfunction, and death. A high degree of suspicion is necessary to make the diagnosis and start antithyroid medications to decrease mortality. Thyroid storm is generally seen in patients with Graves' disease but should also be suspected in patients with fever, tachycardia, altered mental status, and risk factors including local trauma to the neck, such as strangulation...
2018: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/29487661/tension-pneumocephalus-mimicking-septic-shock-a-case-report
#18
Caroline Miranda, Ali Mahta, Lee Adam Wheeler, A John Tsiouris, Hooman Kamel
Tension pneumocephalus can lead to rapid neurologic deterioration. We report for the first time its association with aseptic systemic inflammatory response syndrome mimicking septic shock and the efficacy of prompt neurosurgical intervention and critical care support in treating this condition. A 64-year-old man underwent 2-stage olfactory groove meningioma resection. The patient developed altered mental status and gait instability on postoperative day 6. Imaging showed significant pneumocephalus. The patient subsequently developed worsening mental status, respiratory failure, and profound shock requiring multiple vasopressors...
February 2018: Radiology Case Reports
https://www.readbyqxmd.com/read/29470255/clinical-implications-of-oncogenic-mutations-in-pulmonary-langerhans-cell-histiocytosis
#19
Noah A Brown, Kojo S J Elenitoba-Johnson
PURPOSE OF REVIEW: Langerhans cell histiocytosis (LCH) is a neoplasm of dendritic cells with a wide clinical spectrum. Localized pulmonary LCH occurs in young adults with a history of smoking and can either resolve spontaneously or lead to progressive decline in pulmonary function. Young children can also present with localized disease - frequently bone or skin - or with multifocal or multisystem disease. Clinical outcomes in these patients also vary widely, ranging from spontaneous resolution to multiorgan failure and death...
February 20, 2018: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/29468592/experimental-protocol-for-cecal-ligation-and-puncture-model-of-polymicrobial-sepsis-and-assessment-of-vascular-functions-in-mice
#20
Santosh Kumar Mishra, Soumen Choudhury
Sepsis is the systemic inflammatory response syndrome that occurs during infection and is exacerbated by the inappropriate immune response encountered by the affected individual. Despite extensive research, sepsis in humans is one of the biggest challenges for clinicians. The high mortality rate in sepsis is primarily due to hypoperfusion-induced multiorgan dysfunctions , resulting from a marked decrease in peripheral resistance. Vascular dysfunctions are further aggravated by sepsis-induced impairment in myocardial contractility...
2018: Methods in Molecular Biology
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