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British Journal of Haematology Mar 2018Paediatric venous thromboembolism (VTE) is a rare disorder but a rising incidence has been observed in recent years, due to improved VTE diagnosis and increased use of... (Review)
Review
Paediatric venous thromboembolism (VTE) is a rare disorder but a rising incidence has been observed in recent years, due to improved VTE diagnosis and increased use of central venous catheters in the treatment of severe diseases. Risk assessment strategies are well established for adult patients, however, similar guidelines for paediatric patients are largely lacking. Several risk prediction tools have been reported in recent literature, which make use of established risk factors to assess VTE risk in paediatric subgroups, such as hospitalised children, cancer-diagnosed children and paediatric trauma patients. Although these models suffer several limitations regarding their study size and heterogeneous selection of predictor variables, they offer potential for improving the thromboprophylaxis management in these children. Here, we give an overview on recently reported risk prediction models for paediatric VTE.
Topics: Blood Coagulation; Child; Child, Preschool; Forecasting; Hospitalization; Humans; Infant; Infant, Newborn; Neoplasms; Risk Assessment; Risk Factors; Thrombophilia; Venous Thromboembolism; Wounds and Injuries
PubMed: 29265336
DOI: 10.1111/bjh.15060 -
Wounds : a Compendium of Clinical... Jun 2018Recent advances in the preservation and processing of amnion/chorion tissue have dramatically increased the bioavailability of these wound healing factors as well as the... (Review)
Review
INTRODUCTION
Recent advances in the preservation and processing of amnion/chorion tissue have dramatically increased the bioavailability of these wound healing factors as well as the shelf life of their related tissue products, allowing for a surge in clinical use. Many studies, including basic science, clinical trials, and randomized controlled trials, have emerged examining the biologic properties of amnion/chorion membrane products and their efficacy in wound healing.
OBJECTIVE
A literature review was conducted regarding the safety and efficacy of amniotic membrane adjuncts.
METHODS
The PubMed and MEDLINE databases were queried and sorted based on clinical trials with publication dates ranging from 2013 to 2017. Only studies pertaining to human subjects were included for review.
RESULTS
Amnion/chorion membranes have been studied in the treatment of burns, diabetic foot ulcers, fistulas, ocular defects, and venous leg ulcers, among other wounds. Amnion/chorion allografts were found to be beneficial in the setting of difficult-to-heal fistulas and were effective in treating diabetic and venous ulcers when combined with standard therapy.
CONCLUSIONS
Overall, clinical trials have demonstrated that patients treated with amniotic membrane products have increased rates of wound healing compared with the standard of care. Additional trials are needed to examine more amnion/chorion membrane products.
Topics: Allografts; Amnion; Burns; Chorion; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Varicose Ulcer; Wound Healing; Wounds and Injuries
PubMed: 30059334
DOI: No ID Found -
Neurologia Medico-chirurgica Oct 2017The evaluation of venous drainage patterns prior to surgery for skull base meningioma is important owing to their deep location and the vulnerability of surrounding... (Review)
Review
The evaluation of venous drainage patterns prior to surgery for skull base meningioma is important owing to their deep location and the vulnerability of surrounding vascular structures. In recent years, the microsurgical skull base approach has matured as a surgical technique, making it an important option for reducing complications related to skull base meningioma surgery. In addition, knowledge of the venous anatomy can prevent venous drainage route disturbance and potentially life-threatening complications. Hence, this topic review aimed to provide an overview of normal venous anatomy as it relates to the microsurgical skull base approach, discuss known changes in venous drainage routes that are associated with the progression of skull base meningioma and the selection of an appropriate operative approach with the highest likelihood of preserving venous drainage structures.
Topics: Cerebral Angiography; Cerebral Veins; Cerebrovascular Circulation; Clinical Decision-Making; Computed Tomography Angiography; Craniotomy; Humans; Imaging, Three-Dimensional; Intraoperative Complications; Meningeal Neoplasms; Meningioma; Microsurgery; Neurosurgical Procedures; Petrous Bone; Skull Base Neoplasms
PubMed: 28579577
DOI: 10.2176/nmc.ra.2016-0336 -
Journal of Ayub Medical College,... 2022Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We...
Penetrating heart injuries are associated with higher mortality rates. Coronary lesions caused by penetrating trauma are considered even rarer and universally fatal. We present a case of a fortunate survivor who had complete transection of left anterior descending (LAD) artery with right ventricular (RV) tear after being stabbed by knife, arriving in emergency unit with massively bleeding chest wound. Complex cardiac trauma involving coronaries and cardiac chambers is a challenge to surgeons if patients miraculously reach the hospital alive. This patient had complete transection of LAD artery with penetration into RV cavity, he was successfully managed by timely and prompt surgical intervention by on call team. This case highlights the importance of team dynamics working in harmony during emergency situations, we stress upon conducting routine drills to train surgical residents, perfusionists and operation theatre staff.
Topics: Male; Humans; Wounds, Stab; Wounds, Penetrating; Thoracic Injuries; Heart Injuries; Coronary Vessels
PubMed: 36550672
DOI: 10.55519/JAMC-04-S4-10328 -
Angiogenesis May 2021Endothelial cells display an extraordinary plasticity both during development and throughout adult life. During early development, endothelial cells assume arterial,... (Review)
Review
Endothelial cells display an extraordinary plasticity both during development and throughout adult life. During early development, endothelial cells assume arterial, venous, or lymphatic identity, while selected endothelial cells undergo additional fate changes to become hematopoietic progenitor, cardiac valve, and other cell types. Adult endothelial cells are some of the longest-lived cells in the body and their participation as stable components of the vascular wall is critical for the proper function of both the circulatory and lymphatic systems, yet these cells also display a remarkable capacity to undergo changes in their differentiated identity during injury, disease, and even normal physiological changes in the vasculature. Here, we discuss how endothelial cells become specified during development as arterial, venous, or lymphatic endothelial cells or convert into hematopoietic stem and progenitor cells or cardiac valve cells. We compare findings from in vitro and in vivo studies with a focus on the zebrafish as a valuable model for exploring the signaling pathways and environmental cues that drive these transitions. We also discuss how endothelial plasticity can aid in revascularization and repair of tissue after damage- but may have detrimental consequences under disease conditions. By better understanding endothelial plasticity and the mechanisms underlying endothelial fate transitions, we can begin to explore new therapeutic avenues.
Topics: Animals; Arteries; Cell Differentiation; Endothelial Cells; Hematopoietic Stem Cells; Humans; Lymphatic Vessels; Neovascularization, Physiologic; Veins; Wounds and Injuries; Zebrafish
PubMed: 33449300
DOI: 10.1007/s10456-020-09761-7 -
Wounds : a Compendium of Clinical... Jan 2018Everyone has experienced itch. It might simply be the nuisance of a mosquito bite or a transient itch on the scalp that is relieved by a simple scratch. For wounds such...
Everyone has experienced itch. It might simply be the nuisance of a mosquito bite or a transient itch on the scalp that is relieved by a simple scratch. For wounds such as venous ulcers, itch may be present but is usually mild. For some of the 40% of people with neuropathic itch or pain that can develop and persist following mastectomy, itch can be overwhelming, intractable, not widely appreciated by the medical community, and poorly responsive to current treatment regimens. Why are some wounds in some patients itchy whereas seemingly equivalent ones in the same or other patients not? Why is the sensation of itch present in the wound itself in some cases while in the surrounding skin in others? Why are burns so frequently associated with itch? How commonly do wounds itch? Detailed answers to these questions are lacking, but this area is beginning to be explored. Herein, the author provides an overview of the current understanding of the physiology of itch. An effort is made to place that understanding in the context of wounds, and therapeutic approaches that may be outside of the conventional toolkit are made based on this background.
Topics: Humans; Peripheral Nerves; Pruritus; Signal Transduction; Wound Healing; Wounds and Injuries
PubMed: 29406291
DOI: No ID Found -
The Journal of International Medical... Feb 2021To evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers.
OBJECTIVE
To evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers.
METHODS
From December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded.
RESULTS
The mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3.
CONCLUSION
Venous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.
Topics: Finger Injuries; Humans; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome
PubMed: 33616458
DOI: 10.1177/0300060521991032 -
The Journal of Trauma and Acute Care... Jan 2021Following trauma, persistent inflammation, immunosuppression, and catabolism may characterize delayed recovery or failure to recover. Understanding the metabolic...
BACKGROUND
Following trauma, persistent inflammation, immunosuppression, and catabolism may characterize delayed recovery or failure to recover. Understanding the metabolic response associated with these adverse outcomes may facilitate earlier identification and intervention. We characterized the metabolic profiles of trauma victims who died or developed chronic critical illness (CCI) and hypothesized that differences would be evident within 1-week postinjury.
METHODS
Venous blood samples from trauma victims with shock who survived at least 7 days were analyzed using mass spectrometry. Subjects who died or developed CCI (intensive care unit length of stay of ≥14 days with persistent organ dysfunction) were compared with subjects who recovered rapidly (intensive care unit length of stay, ≤7 days) and uninjured controls. We used partial least squares discriminant analysis, t tests, linear mixed effects regression, and pathway enrichment analyses to make broad comparisons and identify differences in metabolite concentrations and pathways.
RESULTS
We identified 27 patients who died or developed CCI and 33 who recovered rapidly. Subjects were predominantly male (65%) with a median age of 53 years and Injury Severity Score of 36. Healthy controls (n = 48) had similar age and sex distributions. Overall, from the 163 metabolites detected in the samples, 56 metabolites and 21 pathways differed between injury outcome groups, and partial least squares discriminant analysis models distinguished injury outcome groups as early as 1-day postinjury. Differences were observed in tryptophan, phenylalanine, and tyrosine metabolism; metabolites associated with oxidative stress via methionine metabolism; inflammatory mediators including kynurenine, arachidonate, and glucuronic acid; and products of the gut microbiome including indole-3-propionate.
CONCLUSIONS
The metabolic profiles in subjects who ultimately die or develop CCI differ from those who have recovered. In particular, we have identified differences in markers of inflammation, oxidative stress, amino acid metabolism, and alterations in the gut microbiome. Targeted metabolomics has the potential to identify important metabolic changes postinjury to improve early diagnosis and targeted intervention.
LEVEL OF EVIDENCE
Prognostic/epidemiologic, level III.
Topics: Adult; Aged; Chronic Disease; Critical Illness; Female; Humans; Length of Stay; Male; Metabolomics; Middle Aged; Treatment Outcome; Wounds and Injuries
PubMed: 33017357
DOI: 10.1097/TA.0000000000002952 -
The Journal of Invasive Cardiology Jul 2022To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI).
OBJECTIVES
To examine the incidence, treatment and outcomes of perforation during percutaneous coronary intervention (PCI).
BACKGROUND
Coronary perforation is a potentially life-threatening PCI complication.
METHODS
We examined the clinical, angiographic, and procedural characteristics, management, and outcomes of coronary perforation at a tertiary care institution.
RESULTS
Between 2014 and 2019, perforation occurred in 70 of 10,278 PCIs (0.7%). Patient age was 71 ± 12 years, 66% were men, and 30% had prior coronary artery bypass graft surgery. Among perforation cases, the prevalence of chronic total occlusions was 33%, moderate/severe calcification was 66% and moderate/severe tortuosity was 41%. The frequency of Ellis class 1, 2, and 3 perforations was 14%, 50%, and 36%, respectively. Most (n = 51; 73%) were large vessel perforations, 16 (23%) were distal vessel perforations and 3 (4%) were collateral vessel perforations (1 septal and 2 epicardial). Hypotension occurred in 26%, pericardial effusion in 36% and tamponade in 13%; 47% of perforations did not have clinical consequences. Perforations were most often treated with prolonged balloon inflation (63%), reversal of anticoagulation (39%), and covered stent implantation (33%). Technical and procedural success were 73% and 60%, respectively, and major periprocedural adverse cardiac events occurred in 21% of the patients. Three patients (4%) required emergent CABG surgery and four (6%) died.
CONCLUSIONS
Coronary perforation is an infrequent complication of PCI. Most perforations are large vessel perforations and often require further intervention. The incidence of death or emergent cardiac surgery is low.
Topics: Aged; Aged, 80 and over; Coronary Angiography; Coronary Vessels; Female; Heart Injuries; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention; Treatment Outcome; Vascular System Injuries
PubMed: 35714223
DOI: No ID Found -
Interventional Neuroradiology : Journal... Jun 2023Coil embolization is the mainstay treatment for carotid-cavernous fistulas (CCFs). However, few studies have reported entire occlusion of engorged veins to interrupt...
BACKGROUND
Coil embolization is the mainstay treatment for carotid-cavernous fistulas (CCFs). However, few studies have reported entire occlusion of engorged veins to interrupt venous outflow. We report our experience with venous outflow-targeted coil embolization of direct CCFs.
METHODS
We retrospectively reviewed all the patients diagnosed with direct CCFs treated with venous outflow-targeted coil embolization between November 2013 and February 2020. Venous outflow-targeted coil embolization of the CCFs was performed as follows. First, transarterial stent-assisted coil embolization of CCFs was performed. If the venous outflow to the engorged veins persisted after transarterial stent-assisted coil embolization, entire occlusion of the engorged veins and additional coil packing within the cavernous sinus were performed to interrupt the venous outflow.
RESULTS
Ten patients had undergone venous outflow-targeted coil embolization, 6 women (60%) and 4 men (40%). Transfemoral cerebral angiography showed high-flow, direct CCFs in all the patients. Venous outflow occurred through the superior ophthalmic vein (SOV) in all the patients and was completely interrupted by the entire occlusion of the engorged veins with fibered coils. Three patients (30%) had undergone additional treatment in a supplementary manner because of recurrent symptoms (chemosis in 1 patient, faint tinnitus in 2 patients) in the early postprocedural period (1 to 4 weeks). All the symptoms were resolved on follow-up. No additional recurrence was found during follow-up (1-75 months). No peri-procedural complications were encountered.
CONCLUSIONS
Venous outflow-targeted coil embolization of CCFs would be a safe and effective treatment method.
Topics: Male; Humans; Female; Retrospective Studies; Carotid-Cavernous Sinus Fistula; Cavernous Sinus; Veins; Treatment Outcome; Embolization, Therapeutic
PubMed: 35238235
DOI: 10.1177/15910199221084787