Hypogastric preservation using a retrograde endovascular bypass in a patient with ruptured AAA and concomitant bilateral common iliac aneurysms: a feasible option in the acute setting

The catchment area of River das Antas (Irati, Paraná, Brazil) is of high importance both for human consumption and irrigation. Within Irati, this river passes through a rural area and through the city of Irati, crossing both poor and rich neighbourhoods. We selected three study areas downstream (a rural area, poor community, and rich neighbourhood) in which we measured turbidity, the concentration of sediments and pH during rainy days. Our results showed downstream trends of increasing turbidity and concentrations of sediments with decreasing pH. The values of turbidity and of concentration of sediments were significantly different in the rural area, while the pH values were significantly different between the three study areas. These findings highlight the effect of agricultural activities in the generation of sediments and turbidity. The—presumably expected—effects of organic urban waste from the poor neighbourhood were also detected in the pH values. We conclude that efforts should be made to ensure that land planning and training/education programmes on sustainable farming practices are undertaken by the authorities to reduce water pollution and its effects on water bodies during rainfall events, since paving streets is not a feasible option in the short term due to the high costs associated with this measure.

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Cardiac surgery simulation: A low‐cost feasible option in an Australasian setting

ANZ Journal of Surgery ◽

10.1111/ans.17077 ◽

2021 ◽

Author(s):

Varun J Sharma ◽

Calum Barton ◽

Sarah Page ◽

Jegatheesan Saravana Ganesh ◽

Nishith Patel ◽

...

Keyword(s):

Cardiac Surgery ◽

Low Cost ◽

Surgery Simulation ◽

Feasible Option

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Prospective study to assess the tissue response to HPC-coated p48 flow diverter stents compared to uncoated devices in the rabbit carotid artery model

European Radiology Experimental ◽

10.1186/s41747-019-0128-z ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 8

Author(s):

Tim Lenz-Habijan ◽

Pervinder Bhogal ◽

Catrin Bannewitz ◽

Ralf Hannes ◽

Hermann Monstadt ◽

...

Keyword(s):

Foreign Body ◽

Flow Diverter ◽

Foreign Body Response ◽

Tissue Response ◽

Acute Setting ◽

Significant Difference ◽

And Performance ◽

Surface Modified ◽

Common Carotid Arteries

Abstract Background Flow diverters (FDs) are widely used in the treatment of intracranial aneurysms, but the required medication increases the risk of haemorrhagic complications and limits their use in the acute setting. Surface modified FDs may limit the need for dual antiplatelet therapy (DAPT). Hydrophilic polymer coating (HPC) may reduce the need of medication. Methods This explorative study, approved by the local authorities and the local welfare committee, compared stent behaviour and overall tissue response between HPC-coated FDs and uncoated FDs, both implanted into the common carotid arteries of eight New Zealand white rabbits. Endothelialisation, inflammatory response, and performance during implantation were assessed. Angiographic follow-up was performed to observe the patency of the devices after implantation and after 30 days. Histological examinations were performed at 30 days to assess foreign body reaction and endothelialisation. Kruskal-Wallis and Wilcoxon tests were used to compare non-parametric variables. Results Angiography showed that both coated and uncoated FDs performed well during implantation. All devices remained patent during immediate follow-up and after 30 days. Histopathology showed no significant difference in inflammation within the vessel wall between the two cohorts (2.12 ± 0.75 vs. 1.96 ± 0.79, p = 0.7072). Complete endothelialisation of the stent struts was seen with very similar (0.04 ± 0.02 mm vs. 0.04 ± 0.03 mm, p = 0.892) neoendothelial thickness between the two cohorts after 30 days. Conclusion Taking into account the limitation in sample size, non-significant differences between the HPC-coated and uncoated FDs regarding implantation, foreign body response, and endothelialisation were found.

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Implications for the Physical Design of the Postnatal Care Unit from a Targeted Analysis of Issues With Accessing the Bathroom at Night in the Acute Setting: A Secondary Analysis

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101223 ◽

2021 ◽

Vol 10 (1) ◽

pp. 309-312

Author(s):

Varshita Chirumamilla ◽

Joseph M. Gerard ◽

Alison E. Sweeney ◽

Kristin P. Tully ◽

Alison M. Stuebe ◽

...

Keyword(s):

Healthcare Providers ◽

Secondary Analysis ◽

Hospital Environment ◽

Patient Room ◽

Hospital Visit ◽

Acute Setting ◽

Targeted Analysis ◽

Standard Patient ◽

Clinical Environments ◽

Visual Privacy

Assessing hospital environment conditions is necessary for healthcare providers and patients to coordinate safe care. The aims of this research included: a) identifying patterns in hospital visit feedback transcripts regarding bathroom doors and lights in the hospital room and b) interpreting the results to make recommendations for more enabling clinical environments. The methods used by the research team included organizing transcript data, assigning codes, and conducting an interrater reliability test to assess codebook efficacy. Finally, working with maternal and infant mortality experts, recommendations for the hospital were developed. We identified four possible interventions to address barriers: a) implement low-height, dimmable lighting along the base of the patient room, b) provide personal lights, such as penlights, to staff for nighttime assessments, c) install and improve on existing grab bars in patient room bathrooms and d) replace the standard patient room bathroom door with a different kind of auditory/visual privacy barrier.

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Validation of monocyte distribution width decisional cutoff for sepsis detection in the acute setting

International Journal of Laboratory Hematology ◽

10.1111/ijlh.13496 ◽

2021 ◽

Author(s):

Luisa Agnello ◽

Bruna Lo Sasso ◽

Matteo Vidali ◽

Concetta Scazzone ◽

Caterina Maria Gambino ◽

...

Keyword(s):

Distribution Width ◽

Acute Setting ◽

Sepsis Detection

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Lung autotransplantation for bronchial necrosis after radiotherapy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01164-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuya Nobori ◽

Masaaki Sato ◽

Mizuki Morota ◽

Yoshikazu Shinohara ◽

Daisuke Yoshida ◽

...

Keyword(s):

Radiation Therapy ◽

Pulmonary Function ◽

Treatment Success ◽

Locally Advanced ◽

Fistula Formation ◽

Bronchial Anastomosis ◽

Silicone Stent ◽

Feasible Option ◽

Malignant Germ Cell Tumor ◽

The Right

Abstract Background Bronchial necrosis is a rare but fatal complication after radiation therapy. Because of the anatomical complexity and rarity of this condition, determining the most appropriate management for individual patients is extremely challenging. Lung autotransplantation is a surgical technique that has been applied to hilar neoplastic lesions to preserve pulmonary function and avoid pneumonectomy. We herein report a case of bronchial necrosis secondary to radiotherapy that was treated with lung autotransplantation. Case presentation A 46-year-old man developed broad necrosis and infection of the right bronchus secondary to previous stereotactic body-radiation therapy. This treatment was supplied close to a right hilar metastatic pulmonary tumor derived from a mediastinal malignant germ cell tumor that had been surgically resected with the left phrenic nerve. The bronchial necrosis accompanied by infection with Aspergillus fumigatus was progressive despite antibiotics and repetitive bronchoscopic debridement. Because of the patient’s critical condition and limited pulmonary function, right lung autotransplantation with preservation of the right basal segment was selected. An omental flap was placed around the bronchial anastomosis to prevent later complications. The postoperative course involved multiple complications including contralateral pneumonia and delayed wound healing at the bronchial anastomosis with resultant stenosis, the latter of which was overcome by placement of a silicone stent. The patient was discharged 5 months postoperatively. Three months after discharge, however, the patient developed hemoptysis and died of bronchopulmonary arterial fistula formation. Conclusions We experienced an extremely challenging case of bronchial necrosis secondary to radiotherapy. The condition was managed with lung autotransplantation and omental wrapping; however, the treatment success was temporary and the patient eventually died of bronchopulmonary arterial fistula formation. This technique seems to be a feasible option for locally advanced refractory bronchial necrosis, although later complications can still be fatal.

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Territorial governance of managed retreat in Sweden: addressing challenges

Journal of Environmental Studies and Sciences ◽

10.1007/s13412-021-00696-z ◽

2021 ◽

Author(s):

Gunnel Göransson ◽

Lisa Van Well ◽

David Bendz ◽

Per Danielsson ◽

Jim Hedfors

Keyword(s):

Climate Adaptation ◽

Governance Framework ◽

Case Study Site ◽

Feasible Option ◽

Flexible Planning ◽

Barriers And Opportunities ◽

Study Sites ◽

Inland Flooding

AbstractMany climate adaptation options currently being discussed in Sweden to meet the challenge of surging seas and inland flooding advocate holding the line through various hard and soft measures to stabilize the shoreline, while managed retreat is neither considered as feasible option nor has it been explicitly researched in Sweden. However, failure to consider future flooding from climate change in municipal planning may have dangerous and costly consequences when the water does come. We suggest that managed retreat practices are challenging in Sweden, not only due to public opinions but also because of a deficit of uptake of territorial knowledge by decision-makers and difficulties in realizing flexible planning options of the shoreline. A territorial governance framework was used as a heuristic to explore the challenges to managed retreat in four urban case studies (three municipalities and one county) representing different territorial, hydrological and oceanographic environments. This was done through a series of participatory stakeholder workshops. The analysis using a territorial governance framework based on dimensions of coordination, integration, mobilization, adaptation and realization presents variations in how managed retreat barriers and opportunities are perceived among case study sites, mainly due to the differing territorial or place-based challenges. The results also indicate common challenges regardless of the case study site, including coordination challenges and unclear responsibility, the need for integrated means of addressing goal conflicts and being able to adapt flexibly to existing regulations and plans. Yet rethinking how managed retreat could boost community resilience and help to implement long-term visions was seen as a way to deal with some of the territorial challenges.

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Term gravid uterus in a congenital umbilical hernia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02760-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Friday Saidi ◽

Bakari Rajab ◽

Lameck Chinula ◽

Nomsa Kafumba ◽

Maganizo Chagomerana ◽

...

Keyword(s):

Caesarean Section ◽

Umbilical Hernia ◽

Primary Repair ◽

Recurrent Hernia ◽

Gravid Uterus ◽

Patient Centered ◽

Medical Practitioners ◽

Vaginal Deliveries ◽

Feasible Option ◽

Associated Risk Factors

Abstract Background Umbilical hernias are a frequent and well-known pathology in children or adults. Congenital umbilical hernias are commonly diagnosed in childhood, and in adulthood such a hernia is usually acquired. Umbilical hernia in pregnancy may result in serious obstetric complications including antepartum hemorrhage, intrauterine fetal demise, and preterm labor, particularly if incarcerated. Case presentation We present a rare case of a congenital umbilical hernia in a term pregnancy. The patient was a 34-year-old African (Malawian) woman, living with human immunodeficiency virus (HIV) and on antiretroviral treatment, gravida 4, with three previous vaginal deliveries, and with two babies weighing 4 kg at birth. We performed herniorrhaphy at caesarean section, and at 3 months of follow-up she had no evidence of a recurrent hernia. Conclusion Congenital umbilical hernias are commonly diagnosed in childhood but might first be seen by medical practitioners in adulthood. A patient-centered approach addressing patient complaints, associated risk factors, and possible complications is recommended. Primary repair at caesarean section is a feasible option.

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