scholarly journals Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jacek Kurzawski ◽  
Lukasz Zandecki ◽  
Agnieszka Janion-Sadowska ◽  
Lukasz Piatek ◽  
Anna Jaroszynska ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Symptoms ◽  
Treatment Method ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
First Line ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Psa Recurrence ◽  
First Line Treatment

AbstractUltrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

A new approach to the treatment of post-catheterization pseudoaneurysms by ultrasound-guided tissue glue injection or ultrasound-guided thrombin injection depending on a late to early velocity index

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Zandecki ◽  
J Kurzawski ◽  
A Jaroszynska ◽  
L Piatek
Keyword(s):  
Treatment Method ◽  
Line Treatment ◽  
Thrombin Injection ◽  
Ultrasound Guided ◽  
First Line ◽  
Tissue Glue ◽  
Increased Risk ◽  
Psa Recurrence ◽  
Glue Injection ◽  
First Line Treatment

Abstract Background Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are reports of the use of biologically-derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. TG are more potent procoagulants and may increase the procedure success rates at the cost of higher risk of complications in case too much substance escape into the patient's circulation during the procedure. TG are also more expensive than thrombin so they are often reserved for selected patients. We have previously identified a late to early velocity index (LEVI) &lt;0.2 as a predictor of an increased risk of psA recurrence after standard UGTI. In the current paper we report our first experiences when the choice of the first-line treatment method was based on LEVI. Methods From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI &lt;0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) and 26 had LEVI &gt;0.2 and underwent UGTI. The injection set (containing human thrombin and fibrinogen) was used for UGTGI. Bovine thrombin was used for UGTI. Results The success rate was 100% and no psA recurrence was detected during 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 15 years of experience (0% vs. 13%, p=0.02). All complications were mild and transient and included clinical symptoms of paraesthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. Conclusion The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. Two examples of LEVI calculations Funding Acknowledgement Type of funding source: None

Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax

Thorax ◽  
2019 ◽  
Vol 74 (8) ◽  
pp. 780-786 ◽  
Author(s):  
Constance Vuillard ◽  
Fadia Dib ◽  
Jallal Achamlal ◽  
Stéphane Gaudry ◽  
Damien Roux ◽  
...  
Keyword(s):  
Success Rate ◽  
Symptom Onset ◽  
Spontaneous Pneumothorax ◽  
Needle Aspiration ◽  
Primary Spontaneous Pneumothorax ◽  
Line Treatment ◽  
First Line ◽  
Discovery Phase ◽  
Registration Number ◽  
First Line Treatment

BackgroundNeedle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.MethodsA discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.ResultsIn the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.ConclusionWhen managing PSP with NA, a longer symptom onset to NA time was associated with NA success.Trial registration numberNCT02528734.

Stent-over-sponge (SOS): a novel technique complementing endosponge therapy for foregut leaks and perforations

Endoscopy ◽  
2017 ◽  
Vol 50 (02) ◽  
pp. 148-153 ◽  
Author(s):  
Piero Valli ◽  
Joachim Mertens ◽  
Arne Kröger ◽  
Christoph Gubler ◽  
Christian Gutschow ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Vacuum Therapy ◽  
Line Treatment ◽  
Second Line ◽  
Metal Stent ◽  
First Line ◽  
Novel Technique ◽  
Upper Gastrointestinal ◽  
First Line Treatment

Abstract Background and study aims Endoluminal vacuum therapy (EVT) has evolved as a promising option for endoscopic treatment of foregut wall injuries in addition to the classic closure techniques using clips or stents. To improve vacuum force and maintain esophageal passage, we combined endosponge treatment with a partially covered self-expandable metal stent (stent-over-sponge; SOS). Patients and methods Twelve patients with infected upper gastrointestinal wall defects were treated with the SOS technique. Results Indications for SOS were anastomotic leakage after surgery (n = 11) and chronic foregut fistula (n = 1). SOS treatment was used as a first-line treatment in seven patients with a success rate of 71.4 % (5/7) and as a second-line treatment after failed previous EVT treatment in five patients (success rate 80 %; 4/5). Overall, SOS treatment was successful in 75 % of patients (9/12). No severe adverse events occurred. Conclusion SOS is an effective method to treat severely infected foregut wall defects in patients where EVT has failed, and also as a first-line treatment. Comparative prospective studies are needed to confirm our preliminary results.

Discordance of clinical symptoms and electrophysiologic findings in taxane plus platinum-induced neuropathy

2007 ◽  
Vol 17 (2) ◽  
pp. 394-397 ◽  
Author(s):  
Y. Pan ◽  
M.-S. Kao
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Carcinoma ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Sensory Neuropathy ◽  
Line Treatment ◽  
First Line ◽  
Recurrent Cancer ◽  
First Line Treatment

Paclitaxel combined with carboplatin is currently accepted as the first-line treatment for ovarian carcinoma, frequently associated with neuropathy. Due to its frequent association with neuropathy, combination of docetaxel and carboplatin has been suggested as an alternative. A 47-year-old woman developed paresthesia after the first cycle of paclitaxel/carboplatin for ovarian cancer. Her nerve conduction study (NCS) showed only sural neuropathy after completion of six cycles, which returned to normal in 6 months. She had fewer neuropathy symptoms when treatment was changed to docetaxel/carboplatin for recurrent cancer. NCS revealed generalized sensory neuropathy following docetaxel/carboplatin treatment, which normalized after 12 months. Our observation indicated that there is a disparity between clinical symptoms and electrophysiologic examination in taxane-induced neuropathy. Although docetaxel was tolerated well by the patient, evidence of generalized sensory neuropathy was present in NCS

scholarly journals Adjusting the role of hydroxychloroquine with or without azithromycin in patients with COVID-19

2020 ◽  
pp. 53-59
Author(s):  
V. A. Otdelenov ◽  
Yu. Yu. Kiselev ◽  
K. B. Mirzaev ◽  
A. V. Matveev ◽  
D. A. Sychev
Keyword(s):  
Potential Benefit ◽  
Safety Monitoring ◽  
Qt Prolongation ◽  
Laboratory Monitoring ◽  
Line Treatment ◽  
First Line ◽  
Increased Risk ◽  
Outpatient Settings ◽  
First Line Treatment

Taking recent publications into account, one should consider avoiding routine use of hydroxychloroquine, especially if combined with azithromycin, for COVID-19. Such treatment may be associated with the increased risk for hospital mortality and QT prolongation, while there is no documented effectiveness regarding SARS-CoV-2 clearance and outcomes. This treatment may be considered in individual cases, provided potential benefit and risks are carefully weighted, and safety monitoring is enhanced. Hydroxychloroquine safety in outpatients with COVID-19 is poorly studied and risks are increased by challenges in monitoring QT and electrolytes, hence hydroxychloroquine cannot be considered as first line treatment in outpatient settings. Such use of hydroxychloroquine is not recommended if clinical, instrumental, and laboratory monitoring are not in place.

scholarly journals A Nine Case Series of Ultrasound-Guided Hydrostatic Reduction of Intussusception by Saline Enema

2013 ◽  
Vol 19 (1) ◽  
pp. 61-71
Author(s):  
Sornsupha Limchareon ◽  
Adisorn Boonyarit
Keyword(s):  
Case Series ◽  
Teaching Hospitals ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
First Line ◽  
Hydrostatic Reduction ◽  
Pneumatic Reduction ◽  
Reduction Techniques ◽  
Enema Reduction ◽  
First Line Treatment

Non-surgical reduction of the intussusception is the first line treatment in children with intussusception. Among various radiological reduction techniques, barium enema reduction of the intussusception under fluoroscopy has been widely used in Thailand while pneumatic reduction under fluoroscopy has become popular in teaching hospitals. To our knowledge, ultrasound-guided hydrostatic reduction of the intussusception by saline enema (UGHSE) has never been used in Thailand. We reported 9 cases using UGHSE with 100% success rate without complication.

scholarly journals The Benefits and Respective Side-Effects of PE Therapy for Intractable Kawasaki Disease

2021 ◽  
Vol 10 (5) ◽  
pp. 1062
Author(s):  
Masaaki Mori ◽  
Susumu Yamazaki ◽  
Takuya Naruto
Keyword(s):  
Kawasaki Disease ◽  
Effective Means ◽  
Ivig Therapy ◽  
Treatment Method ◽  
Treatment Result ◽  
High Dose ◽  
Line Treatment ◽  
Coronary Artery Lesions ◽  
First Line ◽  
First Line Treatment

Kawasaki disease (KD) is a vasculitis syndrome that frequently develops coronary artery lesions (CALs). In the treatment of KD, the utility of high-dose intravenous immuno-globulin (IVIG) therapy has already been clarified, and it has been established as the first-line treatment method. However, since approximately 10% of patients are refractory to this IVIG therapy and 2.6% of all patients have coronary sequelae, 500 children with KD still remain every year in Japan. In this disease, it is necessary to calm inflammation within 10 days of onset in order to suppress CALs caused by a large amount of persistent inflammatory cytokines. Indeed, the early suppression of inflammation is an effective means of suppressing the onset of CALs. Here, we describe the pathophysiology of Kawasaki disease and plasma exchange (PE), which is a therapeutic method that can calm the hyper-cytokine state of this disease. The treatment result of PE for IVIG-refractory Kawasaki disease is outstanding, and an extremely large effect can be expected if it can be started before the appearance of CALs. It seems that it should always be considered as one of the powerful additional treatments in the future.

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