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Cureus May 2024Takayasu arteritis (TA) is an autoimmune entity of unknown aetiology causing granulomatous thickening of large and medium-sized arteries. Common symptoms include...
Takayasu arteritis (TA) is an autoimmune entity of unknown aetiology causing granulomatous thickening of large and medium-sized arteries. Common symptoms include claudication, headaches, dizziness, syncope, visual changes, and palpitations. Diverse cardiac manifestations, such as ischemic heart disease, significant aortic regurgitation, and pulmonary hypertension, are associated with TA, although they rarely manifest as congestive heart failure. Radio-imaging, including CT angiography and MR angiography, along with more invasive procedures such as conventional angiography, are often used for diagnosis. Treatment is done with corticosteroids, steroid-sparing agents, biologics, and revascularization procedures. Here, we have a case of a 17-year-old Indian female who presented to us with a complaint of abdominal pain. She was diagnosed with Hashimoto's thyroiditis a few years ago, along with a history of congestive heart failure. On general examination, blood pressure was asymmetrical in the upper limbs with the presence of bilateral carotid bruit. There was also the presence of extensive scaly lesions on the extensor surface of all four limbs, suggestive of psoriasis. Radio-imaging confirmed the diagnosis of TA. CT angiography also showed total occlusion of the celiac trunk and proximal left gastric artery, which was likely the cause of her symptoms. The patient received treatment with corticosteroids in conjunction with methotrexate, along with other supportive drugs. TA with congestive heart failure has been occasionally described in the literature, while the association of TA with psoriasis is much rarer. The simultaneous occurrence of various autoimmune diseases is common, but the triad of Hashimoto thyroiditis, psoriasis, and TA with an initial presentation of heart failure is unique. Due to the common co-occurrence of autoimmune conditions, early and thorough patient evaluation with comprehensive studies is imperative for optimal health outcomes.
PubMed: 38933629
DOI: 10.7759/cureus.61153 -
Journal of Inflammation Research 2024Significant gastrointestinal hemorrhages, resulting from long-term compression of the duodenum by a hepatic pseudoaneurysm (HAPA), is an extremely rare condition. In...
AIM
Significant gastrointestinal hemorrhages, resulting from long-term compression of the duodenum by a hepatic pseudoaneurysm (HAPA), is an extremely rare condition. In fact, when the pseudoaneurysm is small in diameter, diagnosis can be particularly challenging. Timely and effective diagnosis and treatment is therefore of great significance, and in this case, endoscopy, combined with intravascular therapy, can provide an effective approach, especially since it removes the need for surgery while yielding favorable outcomes.
CASE SUMMARY
A 75-year-old old man presented to the hospital's emergency department with hematemesis and black stool. Despite conservative treatments such as "acid suppression, fluid resupply, hemostasis and blood transfusion", no significant improvement was noted. Emergency gastroscopy subsequently revealed an ulcer in the duodenal bulb (Figure 1), with an exposed thrombotic head and active bleeding on the surface. In addition, abdominal computed tomography (Figure 2) showed no obvious HAPA manifestations. After unsuccessful endoscopic hemostasis, angiography was performed (Figure 3) and a pseudotumor-like dilatation measuring 5.56 mm in diameter was found at the distal end of the proximal branch vessel of the common hepatic artery. Following spring coil embolization (Figure 4), the patient's condition improved and he was discharged from the hospital, with a follow-up after six months showing no signs of recurrence or complications.
CONCLUSION
Duodenal ulcer hemorrhages due to small hepatic pseudoaneurysms are very rare, with endoscopic intervention being effective for such cases.
PubMed: 38933359
DOI: 10.2147/JIR.S467969 -
Acta Ortopedica Brasileira 2024Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern....
INTRODUCTION
Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook.
MATERIALS AND METHODS
A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs.
RESULTS
There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2.
CONCLUSIONS
The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons' equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique.
PubMed: 38933356
DOI: 10.1590/1413-785220243202e274533 -
Acta Ortopedica Brasileira 2024Radial head fractures are consistently part of a terrible triad of the elbow and can occur in association with Monteggia fracture-dislocations, transolecranon fractures,...
INTRODUCTION
Radial head fractures are consistently part of a terrible triad of the elbow and can occur in association with Monteggia fracture-dislocations, transolecranon fractures, and their variations. Understanding the degree of comminution of the radial head fracture and the location of fragments determines the course of action to be taken.
OBJECTIVES
To correlate fracture-dislocations with the pattern of radial head fracture (number of fragments) and involvement in the proximal radioulnar region.
MATERIALS AND METHODS
A retrospective study (level II) of patients undergoing surgery for radial head fractures associated with fracture-dislocations. Patients had radiographs in anteroposterior and lateral views, as well as tomography. The number of radial head fracture fragments and the presence of fractures in the proximal radioulnar region were correlated with the type of fracture-dislocation and demographic variables.
CONCLUSION
Elbow fracture-dislocation types could not predict the number of fragments and the location of radial head fractures. However, most injuries presented three or more fragments in the radial head, and many had involvement of the proximal radioulnar region, suggesting high-energy trauma.
PubMed: 38933351
DOI: 10.1590/1413-785220243202e278639 -
Annals of Pediatric Cardiology 2024Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review...
BACKGROUND
Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review identified 59 patients.
METHODS
Patients with ARAT from two centers were analyzed for their demographics, symptoms, morphology, management, and follow-up thromboprophylaxis.
RESULTS
Among 21 patients including 8 males with a median age of 3 years (18 days-72 years) diagnosed as ARAT, 12 (57%) had posterior tunnels and 9 had anterior tunnels. Four patients had multiple exits. Eighteen tunnels were closed after arteriovenous circuit formation. Six patients (29%) weighing <10 kg presented early with heart failure. Transcatheter closure normalized the hemodynamics including in one infant after failed surgery. Two elderly patients (10%) above 60 years presented with angina and atrial fibrillation. The rest were asymptomatic. Occluders were positioned in the narrow proximal aortic end of the tunnel in all except two patients, where the distal atrial end was closed. All procedures were successful without complications. There was one late death after 1 year from subarachnoid hemorrhage. At a median follow-up of 96 months, all survivors were asymptomatic. Thromboprophylaxis with dual antiplatelets for 1-2 years followed earlier was recently changed to aspirin with Coumadin. Complete remodeling occurred when the proximal aortic end was closed, but partial persistence of the track was noted after distal closure.
CONCLUSIONS
This largest cohort of ARAT showed the safety and efficacy of transcatheter closure even in neonates. The narrow proximal aortic end should be the target for closure rather than the distal atrial end to achieve complete remodeling.
PubMed: 38933058
DOI: 10.4103/apc.apc_1_24 -
Orthopedic Research and Reviews 2024Despite a sufficient number of papers on the technique of transtibial amputations, the technique of Ertl-type reamputation in short tibial stump remains unreported.
BACKGROUND
Despite a sufficient number of papers on the technique of transtibial amputations, the technique of Ertl-type reamputation in short tibial stump remains unreported.
AIM
To propose a modification of the Ertl operation in the proximal tibia.
CASE PRESENTATION
The technique of bone bridge creation in a patient with a malformed stump in the upper third of the tibia at the expense of the regenerate formed after corticotomy of the tibial remnant and dosed distraction of the graft by the Ilizarov apparatus is described. Radiological, ultrasound and MRI methods were used to control the regenerate. The follow-up period was 36 months. At 3.5 months, a synostosis was formed, which allowed primary and then permanent prosthesis with a full-contact prosthesis. At 36 months, the organotypic remodelling of the regenerate was completed. The patient works, uses the prosthesis for 15-16 hours a day, and walks on average 8-10 km.
CONCLUSION
The use of the proposed method makes it possible to obtain tibial synostosis without their shortening with elimination of valgus deviation of the fibula stump and the possibility of early functional loading. Synostosis formation occurs within 3.5 months after surgery. Organotypic bone remodelling occurs during primary and then permanent prosthetics. The formed bone bridge has a large support area, which is maintained during the whole follow-up period of 36 months and allows to perform full-contact prosthetics with maximum load on the residual limb end.
PubMed: 38933018
DOI: 10.2147/ORR.S459421 -
BMJ Neurology Open 2024Accurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and...
BACKGROUND
Accurate outcome predictions for patients who had ischaemic stroke with successful reperfusion after endovascular thrombectomy (EVT) may improve patient treatment and care. Our study developed prediction models for key clinical outcomes in patients with successful reperfusion following EVT in an Australian population.
METHODS
The study included all patients who had ischaemic stroke with occlusion in the proximal anterior cerebral circulation and successful reperfusion post-EVT over a 7-year period. Multivariable logistic regression and Cox regression models, incorporating bootstrap and multiple imputation techniques, were used to identify predictors and develop models for key clinical outcomes: 3-month poor functional status; 30-day, 1-year and 3-year mortality; survival time.
RESULTS
A total of 978 patients were included in the analyses. Predictors associated with one or more poor outcomes include: older age (ORs for every 5-year increase: 1.22-1.40), higher premorbid functional modified Rankin Scale (ORs: 1.31-1.75), higher baseline National Institutes of Health Stroke Scale (ORs: 1.05-1.07) score, higher blood glucose (ORs: 1.08-1.19), larger core volume (ORs for every 10 mL increase: 1.10-1.22), pre-EVT thrombolytic therapy (ORs: 0.44-0.56), history of heart failure (outcome: 30-day mortality, OR=1.87), interhospital transfer (ORs: 1.42 to 1.53), non-rural/regional stroke onset (outcome: functional dependency, OR=0.64), longer onset-to-groin puncture time (outcome: 3-year mortality, OR=1.08) and atherosclerosis-caused stroke (outcome: functional dependency, OR=1.68). The models using these predictors demonstrated moderate predictive abilities (area under the receiver operating characteristic curve range: 0.752-0.796).
CONCLUSION
Our models using real-world predictors assessed at hospital admission showed satisfactory performance in predicting poor functional outcomes and short-term and long-term mortality for patients with successful reperfusion following EVT. These can be used to inform EVT treatment provision and consent.
PubMed: 38932996
DOI: 10.1136/bmjno-2024-000707 -
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi =... Jun 2024Accurately evaluating the local biomechanics of arterial wall is crucial for diagnosing and treating arterial diseases. Indentation measurement can be used to evaluate...
Accurately evaluating the local biomechanics of arterial wall is crucial for diagnosing and treating arterial diseases. Indentation measurement can be used to evaluate the local mechanical properties of the artery. However, the effects of the indenter's geometric structure and the analysis theory on measurement results remain uncertain. In this paper, four kinds of indenters were used to measure the pulmonary aorta, the proximal thoracic aorta and the distal thoracic aorta in pigs, and the arterial elastic modulus was calculated by Sneddon and Sirghi theory to explore the influence of the indenter geometry and analysis theory on the measured elastic modulus. The results showed that the arterial elastic modulus measured by cylindrical indenter was lower than that measured by spherical indenter. In addition, compared with the calculated results of Sirghi theory, the Sneddon theory, which does not take adhesion forces in account, resulted in slightly larger elastic modulus values. In conclusion, this study provides parametric support for effective measurement of arterial local mechanical properties by millimeter indentation technique.
Topics: Animals; Swine; Elastic Modulus; Biomechanical Phenomena; Aorta, Thoracic; Pulmonary Artery; Stress, Mechanical; Arteries
PubMed: 38932532
DOI: 10.7507/1001-5515.202310062 -
Pharmaceuticals (Basel, Switzerland) Jun 2024Adhesion between calcium oxalate crystals and renal tubular epithelial cells is a vital cause of renal stone formation; however, the drugs that inhibit crystal adhesion...
Adhesion between calcium oxalate crystals and renal tubular epithelial cells is a vital cause of renal stone formation; however, the drugs that inhibit crystal adhesion and the mechanism of inhibition have yet to be explored. The cell injury model was constructed using nano-COM crystals, and changes in oxidative stress levels, endoplasmic reticulum (ER) stress levels, downstream p38 MAPK protein expression, apoptosis, adhesion protein osteopontin expression, and cell-crystal adhesion were examined in the presence of polysaccharide (DLP) and sulfated DLP (SDLP) under protected and unprotected conditions. Both DLP and SDLP inhibited nano-COM damage to human kidney proximal tubular epithelial cell (HK-2), increased cell viability, decreased ROS levels, reduced the opening of mitochondrial membrane permeability transition pore, markedly reduced ER Ca ion concentration and adhesion molecule OPN expression, down-regulated the expression of ER stress signature proteins including CHOP, Caspase 12, and p38 MAPK, and decreased the apoptosis rate of cells. SDLP has a better protective effect on cells than DLP. SDLP protects HK-2 cells from nano-COM crystal-induced apoptosis by reducing oxidative and ER stress levels and their downstream factors, thereby reducing crystal-cell adhesion interactions and the risks of kidney stone formation.
PubMed: 38931471
DOI: 10.3390/ph17060805 -
Pharmaceuticals (Basel, Switzerland) Jun 2024The extensive use of rodenticides poses a severe threat to non-target species, particularly birds of prey and scavengers. In this study, a GC-MS/MS-based method was used...
The extensive use of rodenticides poses a severe threat to non-target species, particularly birds of prey and scavengers. In this study, a GC-MS/MS-based method was used to unlock the cause of bird deaths in Poland. Organs (liver, heart, kidney, and lungs) collected during autopsies of two rooks () and one carrion crow (), as well as fecal samples, were analyzed for the presence of anticoagulant coumarin derivatives, i.e., warfarin and bromadiolone. As for warfarin, the highest concentration was found in crow samples overall, with concentrations in the feces and lungs at 5.812 ± 0.368 µg/g and 4.840 ± 0.256 µg/g, respectively. The heart showed the lowest concentration of this compound (0.128 ± 0.01 µg/g). In the case of bromadiolone, the highest concentration was recorded in the liver of a rook (16.659 ± 1.499 µg/g) and this concentration significantly exceeded the levels in the other samples. By revealing the reality of the threat, these discoveries emphasize the need to regulate and monitor the trade in rodenticides.
PubMed: 38931431
DOI: 10.3390/ph17060764