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Mediterranean Journal of Hematology and... 2024
Pneumatosis Cystoides Intestinalis with Fatal Air Embolism after Minor Blunt Abdominal Trauma in a 6-Year-Old Girl Undergoing Hematopoietic Stem Cell Trasplant: Case Report and Review of Literature.
PubMed: 38468831
DOI: 10.4084/MJHID.2024.028 -
Annals of Surgery Apr 2024To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR).
BACKGROUND
LLR has an increased risk of gas embolism. Although animal studies have shown that low PP reduces the occurrence of gas embolism, clinical evidence is lacking.
METHODS
This parallel, dual-arm, double-blind, randomized controlled trial included 141 patients undergoing elective LLR. Patients were randomized into standard ("S," 15 mm Hg; n = 70) or low ("L," 10 mm Hg; n = 71) PP groups. Severe gas embolism (≥ grade 3, based on the Schmandra microbubble method) was detected using transesophageal echocardiography and recorded as the primary outcome. Intraoperative vital signs and postoperative recovery profiles were also evaluated.
RESULTS
Fewer severe gas embolism cases (n = 29, 40.8% vs n = 47, 67.1%, P = 0.003), fewer abrupt decreases in end-tidal carbon dioxide partial pressure, shorter severe gas embolism duration, less peripheral oxygen saturation reduction, and fewer increases in heart rate and lactate during gas embolization episodes was found in group L than in group S. Moreover, a higher arterial partial pressure of oxygen and peripheral oxygen saturation were observed, and fewer fluids and vasoactive drugs were administered in group L than in group S. In both groups, the distensibility index of the inferior vena cava negatively correlated with central venous pressure throughout LLR, and a comparable quality of recovery was observed.
CONCLUSIONS
Low PP reduced the incidence and duration of severe gas embolism and achieved steadier hemodynamics and vital signs during LLR. Therefore, a low PP strategy can be considered a valuable choice for the future LLR.
Topics: Animals; Humans; Carbon Dioxide; Embolism, Air; Laparoscopy; Liver; Pneumoperitoneum, Artificial
PubMed: 38456278
DOI: 10.1097/SLA.0000000000006130 -
Cureus Mar 2024Lung needle biopsy can cause air to enter the vessels due to the traffic between the vessels and the trachea. Hyperbaric oxygen therapy (HBOT) according to the U.S. Navy...
Lung needle biopsy can cause air to enter the vessels due to the traffic between the vessels and the trachea. Hyperbaric oxygen therapy (HBOT) according to the U.S. Navy Treatment Table (USNTT) 6 or 6A protocol is used for arterial gas embolism (AGE). However, no treatment or HBOT protocol for asymptomatic intra-arterial air has been established. Here we report two cases of asymptomatic intra-arterial air during lung needle biopsy that were preventively treated with HBOT according to the USNTT 5 protocol. In case 1, a 72-year-old man with malignant lymphoma in remission underwent computed tomography (CT)-guided lung needle biopsy of a nodule in his right lung. During the biopsy, the patient developed a cough, followed by chest pain and dyspnea. Chest CT revealed a right pneumothorax and air in the left ventricle and aorta. The patient did not present with symptoms suggestive of AGE. After thoracic drainage, 4.5 hours after onset, the patient underwent HBOT according to the USNTT 5 protocol. After one session in the hyperbaric chamber, follow-up whole-body CT showed disappearance of intravascular air. In case 2, a 69-year-old man with chronic obstructive pulmonary disease underwent CT-guided lung needle biopsy of a nodule in his right lung. Post-examination CT showed intravascular air in the aorta, pulmonary artery and vein, and left ventricle. However, the patient had no symptoms. One hour after onset, the patient underwent HBOT according to the USNTT 5 protocol. A whole-body CT the next day confirmed the disappearance of intravascular air. Both patients were discharged without sequelae. HBOT is an effective treatment to flush out intra-arterial air and inhibit the expression of adhesion molecules. Asymptomatic intra-arterial air may be adequately treated with HBOT according to a short protocol such as USNTT 5.
PubMed: 38449913
DOI: 10.7759/cureus.55665 -
Frontiers in Physiology 2024Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers....
Intrapulmonary air-filled cavities, e.g., bullae, blebs, and cysts, are believed to contribute topulmonary barotrauma (PBT) and arterial gas embolism (AGE) in divers. However, literature is unclear about the prevalence of bullae in healthy adults, ranging from 2.3-33.8%. While this could in part be explained due to increasing quality of radiologic imaging, such as computed tomography (CT) scans, other methodological factors may also affect these findings. This study aims to ascertain the prevalence of bullae in young and healthy adults. This single-center cross-sectional observational study re-assessed the CT scans of adults (aged 18-40) performed for a clinical suspicion for pulmonary embolism, from 1 January 2016 to 1 March 2020. Presence of bullae was recorded in an electronic database. Chi-square and Fisher exact tests were used for statistical analyses. Additionally, a multivariate logistic regression analysis was performed to study the independent predictive value of identified risk factors. A total of 1,014 cases were identified, of which 836 could be included. Distribution amongst age groups (18-25, 26-30, 31-35, and 36-40) was almost equally, however, 75% of the population was female. Of the male proportion, 41% smoked, compared to 27% in females. In 7.2% (95% CI 5.6-9.1) bullae were identified. The prevalence increased with increasing age ( < 0.001), with odd ratios up to 5.347 (95% CI 2.164-13.213, < 0.001) in the oldest age group. Males and smokers had higher odds ratios for bullae of 2.460 (95% CI 1.144-4.208; = 0.001) and 3.406 (95% CI 1.878-6.157, < 0.001), respectively. Similar results were seen in the multivariate logistic regression analysis, where age, male sex and smoking were all statistically significant independent risk factors for bullae. Bullae were seen in 7.2% of a healthy population up to 40 years old. Increasing age, smoking, and being male were identified as statistically significant risk factors, both in independent and in multivariate logistic regression analyses. Our observations may warrant a re-evaluation of the contribution of bullae to PBT and AGE, as the latter two occur very rarely and bullae appear to be more frequently present than earlier assumed.
PubMed: 38420621
DOI: 10.3389/fphys.2024.1349229 -
The Journal of Invasive Cardiology Apr 2024A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI...
A 52-year-old man with a history of percutaneous coronary intervention (PCI) in the left anterior descending (LAD) coronary artery was admitted for a facilitated PCI following an anterior ST-elevation myocardial infarction treated with thrombolysis at a nearby clinic.
Topics: Male; Humans; Middle Aged; Percutaneous Coronary Intervention; Embolism, Air; Embolism; Thrombectomy; Coronary Artery Disease; Catheters; Coronary Angiography; Treatment Outcome
PubMed: 38412441
DOI: 10.25270/jic/23.00259 -
The Journal of Invasive Cardiology Apr 2024Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in...
OBJECTIVES
Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in randomized controlled trials. However, it remains uncertain if differences in the structure and design of the occluder devices impact the outcomes. The aim of this study was to compare results of percutaneous PFO closure using 2 widely used double-disc occluders.
METHODS
Consecutive patients who underwent percutaneous PFO closure with the Abbott Amplatzer occluder (APO) or the Occlutech Figulla-Flex-II occluder (OPO) at the Heart Center Lucerne between February 2017 and December 2022 were included in a registry. The primary endpoint was effective closure of the PFO, defined as a residual shunt grade 0 or 1, assessed by contrast echocardiogram at 6-month follow-up. Secondary endpoints included procedural efficacy/safety and major adverse cardiovascular events during the hospital stay and at 6-month follow-up.
RESULTS
One hundred ninety-three consecutive patients (mean age 51.7 ± 12.5 years; 39% women; Risk of Paradoxical Embolism (RoPE) score = 7, IQR = 6-8) underwent percutaneous PFO closure with the APO (120 patients, 62.2%) or the OPO (73 patients, 37.8%). Main indications for closure were crypotogenic stroke in 168 patients (87.1%) and peripheral embolism in 13 patients (6.7%). At baseline, right-to-left shunt (RLS) greater than or equal to grade 2 was present in 189 patients (97.9%). Immediate procedural success was 99.5%. In 1 patient, an air embolism occurred during positioning of the APO occluder with transient chest pain and electrocardiogram changes, but without further sequelae to the patient. At 6-month follow-up, effective closure was achieved in 185 patients (95.8%; APO: 96.6% vs OPO: 94.5%, P = .30). Rates of atrial fibrillation and recurrent thromboembolic events were 4.2 and 0.5%, respectively.
CONCLUSIONS
PFO closure is safe and effective when performed with either the self-expanding Abbott Amplatzer or Occlutech Figulla Flex II PFO occluder.
Topics: Humans; Female; Adult; Middle Aged; Male; Foramen Ovale, Patent; Treatment Outcome; Echocardiography; Stroke; Septal Occluder Device; Thromboembolism; Cardiac Catheterization
PubMed: 38412438
DOI: 10.25270/jic/23.00291 -
Frontiers in Immunology 2024[This corrects the article DOI: 10.3389/fimmu.2023.1230049.].
[This corrects the article DOI: 10.3389/fimmu.2023.1230049.].
PubMed: 38380313
DOI: 10.3389/fimmu.2024.1378003 -
Journal of Medical Case Reports Feb 2024Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for...
BACKGROUND
Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting.
CASE PRESENTATION
This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week.
CONCLUSIONS
This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
Topics: Humans; Female; Middle Aged; Embolism, Air; Liver Transplantation; Thrombosis; Heart Diseases; Echocardiography, Transesophageal; Intraoperative Complications; Liver Neoplasms; Pulmonary Embolism
PubMed: 38368412
DOI: 10.1186/s13256-024-04376-8