scholarly journals Ascendobifemoral Bypass for the Treatment of a Thoracic Endograft Infection

2017 ◽  
Vol 06 (01) ◽  
pp. e32-e34
Author(s):  
Sebastian Pleger ◽  
Nadine Nink ◽  
Andreas Böning ◽  
Ahmed Koshty
Keyword(s):  
Endovascular Procedures ◽  
Clinical Symptoms ◽  
Celiac Trunk ◽  
Thoracic Endovascular Aortic Repair ◽  
Oral Antibiotic ◽  
Case Description ◽  
Oral Antibiotic Therapy ◽  
Thoracic And Abdominal ◽  
Endograft Infection

Background Endograft infections (EIs) are rare complications after endovascular procedures in the thoracic and abdominal aortas. The challenging treatment encloses antibiotic and surgical therapies. Case Description A 74-year-old male patient developed an EI after an endovascular procedure (thoracic endovascular aortic repair [TEVAR]). Despite a long-term oral antibiotic therapy, the clinical symptoms showed no falling trend. Because of the expanded infection from above the celiac trunk up to the aortic arch, we decided to remove the infected endograft and to implant an extra-anatomic ascendobifemoral bypass. Conclusion The implantation of an ascendobifemoral bypass was a successful treatment option for EIs after TEVAR.

Brucella aortitis managed with debridement, extra-anatomical bypass, and long-term antimicrobial therapy

Vascular ◽  
2021 ◽  
pp. 170853812110585
Author(s):  
John Perry ◽  
Hossam Alslaim ◽  
Gautam Agarwal
Keyword(s):  
Aortic Aneurysm ◽  
Retrospective Chart Review ◽  
Aortic Aneurysms ◽  
Type I ◽  
Oral Antibiotic ◽  
Oral Antibiotic Therapy ◽  
Type I Endoleak ◽  
Operative Debridement ◽  
History Of

Objectives This report aims to review the management and outcomes of Brucella-associated mycotic aortic aneurysms. Methods This is a retrospective chart review at a tertiary-level healthcare system. IRB approval was waived per policy. Results We describe a case of Brucella aortitis acquired from habitual contact with wild hogs. Clinical presentation included lower back pain and elevated white blood cell count. Diagnosis was confirmed with imaging showing an infrarenal abdominal aortic aneurysm and serology revealing elevated Brucella antibodies titers. The patient was initially managed with endovascular aortic repair and combined oral and intravenous antibiotics therapy. He then underwent explanation and extra-anatomical bypass due to symptomatic periaortic infection and interval development of type I endoleak. The patient was asymptomatic after his final operation at 24 months of follow-up and remained on suppressive oral antibiotic therapy. Conclusions An aortic aneurysm secondary to Brucella is a rare entity. A detailed history of long-term exposure to animals may be a clue to obtain serologic testing. Operative debridement and re-establishing of reliable blood flow combined with long-term antibiotic suppression are the mainstay of treatment.

A review of follow-up outcomes after elective endovascular repair of degenerative thoracic aortic aneurysms

Vascular ◽  
2015 ◽  
Vol 24 (2) ◽  
pp. 208-216 ◽  
Author(s):  
Arnoud V Kamman ◽  
Frederik HW Jonker ◽  
Foeke JH Nauta ◽  
Santi Trimarchi ◽  
Frans L. Moll ◽  
...  
Keyword(s):  
Endovascular Procedures ◽  
Survival Rates ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Review Of The Literature ◽  
Long Term Outcomes ◽  
Related Complication ◽  
Thoracic Aortic Aneurysms

Long-term outcomes of elective thoracic endovascular aortic repair (TEVAR) for degenerative thoracic aortic aneurysms (TAA) are not well defined. A review of the literature on the follow-up outcomes of elective TEVAR for degenerative TAA resulted in 22 relevant articles. Two- and five-year freedom from aneurysm-related death varied between 93.0% and 100.0%, and 82.4% to 92.7%, respectively. Two-year and five-year all-cause survival ranged between 68.0% and 97.2% and 47.0% to 78.0%, respectively. Follow-up ranged between 17.3 and 66.0 months. Most common endograft-related complication was endoleak, with reported rate between 1.4% and 14.8% during six months up to five years of follow-up. Endovascular reinterventions were reported in 0.0–32.3%, secondary open surgery was needed in 0.0% to 4.7% during follow-up. Aneurysm-related survival rates after elective TEVAR for degenerative TAA are acceptable. However, reported incidences of endograft-related complications vary considerably in the literature, but the majority can be managed with conservative treatment or additional endovascular procedures.

Thoracic Endovascular Aortic Repair With Additional Distal Bare Stents in Type B Aortic Dissection Does Not Prevent Long-Term Aneurysmal Degeneration

2021 ◽  
pp. 152660282110074
Author(s):  
Daniele Mascia ◽  
Enrico Rinaldi ◽  
Simone Salvati ◽  
Andrea Melloni ◽  
Andrea Kahlberg ◽  
...  
Keyword(s):  
Adverse Event ◽  
Aortic Dissection ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Thoracic Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Thoracic And Abdominal

Purpose: TEVAR (thoracic endovascular aortic repair) + PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique has been selectively employed since 2005 at our institution during endovascular treatment of type B aortic dissection (TBD). The aim of this study is to evaluate the long-term (>5 years) clinical results and the evolution of aortic volume. Materials and Methods: All the patients receiving an endovascular treatment for TBD with the PETTICOAT technique were collected in a prospectively maintained database and follow-up computed tomography scan were retrospectively analyzed. Study endpoints included short- and long-term clinical success (absence of need for reintervention) and any major adverse event. The volumes of thoracic and abdominal aorta at long-term follow-up were also analyzed. Results: Twenty-eight patients received a TEVAR + PETTICOAT and were followed up (median follow-up 85 months). Primary 30-day clinical success rate was 82% with an adverse event rate of 31%; 4 type I endoleak and 1 retrograde dissection were recorded. Secondary mid-term clinical success was 96% while the long-term clinical success rate was 79%. Six cases (21%) received either an open repair or an endovascular repair for a significant distal aortic enlargement at follow-up. With regards to volumetric analysis, an increase of overall (thoracic and abdominal) aortic volume was observed in 8 cases mainly related to an increase (mean: +31%) of the abdominal volume that was observed in 11 cases. Conclusions: PETTICOAT technique does not protect from long-term significant aneurysmal degeneration that may require aortic open or endovascular reinterventions. Aortic growth occurs mainly in the bare-stented aorta and thus, life-long surveillance is advisable in these patients.

scholarly journals Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Xiaorong Yan ◽  
Huiqing Wang ◽  
Cai Li ◽  
Yuanxiang Lin ◽  
Lin Lin ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Spinal Deformity ◽  
Tumor Recurrence ◽  
Clinical Symptoms ◽  
Short Term ◽  
Before And After ◽  
Intradural Extramedullary ◽  
Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

scholarly journals COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report

2021 ◽  
Author(s):  
Harsha Adnani ◽  
Akshay Khatri ◽  
Nirav Agrawal ◽  
Ernesto Molmenti ◽  
Madhu Bhaskaran
Keyword(s):  
Health Care ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Clinical Symptoms ◽  
Severe Disease ◽  
Care Facility ◽  
Health Care Facility ◽  
Asymptomatic Patients

AbstractDuring the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).

scholarly journals Clinical characteristics and outcomes of COVID-19 long-term nucleic acid positive patients

2021 ◽  
pp. 1-10
Author(s):  
Xuan Zhu ◽  
Xinxin Zhu ◽  
Min Wang ◽  
Fang Yang ◽  
Zhibing Sun ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Control Group ◽  
Viral Shedding ◽  
Imaging Characteristics ◽  
And Gender ◽  
Acid Test ◽  
Pulmonary Ct

OBJECTIVE: This study aimed to investigate the clinical characteristics and outcomes of coronavirus disease-19 (COVID-19) long-term nucleic acid positive patients (hereinafter referred to as CLTAPs). METHODS: Patients were recruited from the Xiaogan Central Hospital between 16 January 2020 and 28 March 2020. Among the 562 cases of patients with laboratory-identified COVID-19 infection by real-time polymerase chain reaction (qtPCR), 19 cases of COVID-19 patients with more than 41 days from the first to the last time of nucleic acid test were selected as the study group, and 76 cases of age- and gender-matched COVID-19 patients were selected as the control group (hereinafter referred to as C-CLTAPs). Demographic characteristics, clinical symptoms, laboratory examination and computed tomography (CT) imaging characteristics were retrospectively analyzed. RESULTS: On admission, among the 562 cases of patients with COVID-19, there were 398 cases of ordinary COVID-19 patients, 99 cases of severe COVID-19 patients and 99 cases of critical COVID-19 patients. CLTAPs had milder clinical symptoms and longer viral shedding time in comparison to C-CLTAPs. Compared to C-CLTAPs, CLTAPs had a lower infection index at admission. CLTAPs used less oxygen therapy and a higher proportion of hydroxychloroquine treatment in comparison to C-CLTAPs. In comparison to C-CLTAPs, CLTAPs showed slower pulmonary CT progression and faster pulmonary CT absorption. CONCLUSION: In this study, out of the 562 cases, we found 19 CLTAPs. The clinical differences between CLTAPs and C-CLTAPs were compared and analyzed. We hope that these finding can provide a theoretical basis for the treatment of CLTAPs.

LRF and TRF test during long-term danazol treatment: increase of the LH and FSH responses but decrease of the prolactin and TSH responses

1983 ◽  
Vol 104 (1) ◽  
pp. 1-5 ◽  
Author(s):  
J. Leppäluoto ◽  
L. Rönnberg ◽  
P. Ylöstalo
Keyword(s):  
Clinical Symptoms ◽  
Follicular Phase ◽  
Blood Samples ◽  
Hormone Levels ◽  
Coefficients Of Variation ◽  
The Mean ◽  
Thyroid Hormone Levels ◽  
Low Serum

Abstract. Seven patients suffering from severe endometriosis were treated with danazol 200 mg × 3 daily for 6 months. Clinical symptoms were alleviated and menses disappeared in response to the treatment. After cessation of the treatment the menstrual bleedings returned in 1–3 months. Blood samples for determination of gonadotrophins, prolactin (Prl), oestradiol (E2), progesterone, thyroid hormones and thyrotrophin in radioimmunoassays were taken and a combined TRF and LRF test carried out in the follicular phase before treatment, at the 6th month of treatment and after reappearance of the first menses. There were no statistically significant changes in the basal levels of serum FSH, LH or TSH during the danazol treatment. Neither was there any change in episodic secretions of FSH, LH or Prl, as determined by the mean coefficients of variation of the hormone levels in seven consecutive samples taken at 20 min intervals. On the other hand, serum E2, Prl and thyroid hormone levels were significantly decreased in the 6th month of treatment. In the TRF-LRF test the responses of serum FSH and LH were significantly higher and those of serum Prl and TSH significantly lower during danazol treatment than before. Prl responses remained lowered after the treatment. It appears that low serum oestrogen levels, induced by the danazol treatment, sensitize the pituitary gonadotrophs to exogenous LRF, but make the sensitivity of thyrotrophs and lactotrophs lower to exogenous TRF. These results thus indicate that danazol does not make the pituitary gonadotrophs insensitive to LRF, but danazol may rather inhibit the secretion of hypothalamic LRF.

scholarly journals Risk Factors Predicting for Perioperative and Long-Term Mortality in Acute and Subacute Thoracic Endovascular Aortic Repair Patients

2021 ◽  
Vol 74 (3) ◽  
pp. e125
Author(s):  
Abhishek Rao ◽  
Ambar Mehta ◽  
Richard Schutzer ◽  
Danielle Bajakian ◽  
Nicholas Morrissey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Long Term Mortality

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

2009 ◽  
Vol 24 (5) ◽  
pp. 287-296 ◽  
Author(s):  
J.M. Olivares ◽  
A. Rodriguez-Morales ◽  
J. Diels ◽  
M. Povey ◽  
A. Jacobs ◽  
...  
Keyword(s):  
Observational Study ◽  
Treatment Adherence ◽  
Prospective Observational Study ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Treatment Retention ◽  
Severity Scores ◽  
Long Term Treatment ◽  
Long Acting

AbstractBackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (−1.14 for RLAI versus −0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

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