scholarly journals Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates

2020 ◽  
Vol 8 ◽  
Author(s):  
Rosemary Elizabeth Paine ◽  
Elizabeth Noel Turner ◽  
Daniel Kloda ◽  
Carolyne Falank ◽  
Bruce Chung ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Inclusion Criteria ◽  
Treatment Practices ◽  
Tissue Plasminogen ◽  
Promising Treatment ◽  
Considerable Morbidity ◽  
Groin Hematoma ◽  
Salvage Rate ◽  
Optimal Treatment Strategy

Abstract Background Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability. Despite the complexity of these patients, diagnostic and treatment practices lack standardization. Thrombolytic therapy has emerged as a promising treatment modality, demonstrating impressive digit salvage rates. We review our experience with thrombolytic therapy for severe upper extremity frostbite. Methods Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected. A subgroup of patients with severe frostbite treated with intra-arterial thrombolytic therapy (IATT) were analysed. Results Of the 17 frostbite patients treated at our institution, 14 (82%) were male and the median age was 31 (range: 19–73). Substance misuse was involved in a majority of the cases (58.8%). Five (29.4%) patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively. Angiography demonstrated a 74.5% improvement in perfusion after tissue plasminogen activator thrombolysis. When comparing phalanges at risk on initial angiography to phalanges undergoing amputation, the phalangeal salvage rate was 83.3% and the digit salvage rate was 80%. Complications associated with IATT included groin hematoma, pseudoaneurysm and retroperitoneal hematoma. Conclusions Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive, protocoled thrombolytic therapy. A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.

Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472094006
Author(s):  
James Drinane ◽  
Adee J. Heiman ◽  
Joseph A. Ricci ◽  
Ashit Patel
Keyword(s):  
Systematic Review ◽  
Thrombolytic Therapy ◽  
Upper Extremity ◽  
Animal Studies ◽  
English Language ◽  
Case Series ◽  
Current Data ◽  
Ischemic Tissue ◽  
Promising Treatment ◽  
Salvage Rate

Background Vascular thrombosis secondary to frostbite can lead to ischemic tissue damage in severe cases. Threatened extremities may be salvaged with thrombolytics to restore perfusion; however, current data are limited to single institution case series. The authors performed a systematic review to determine the efficacy of thrombolytic therapy in treating upper extremity frostbite. Methods PubMed, EBSCO, and Google Scholar were queried using the keywords “thrombolytics,” “frostbite,” “fibrinolytics,” and “tPA.” Exclusion criteria were failure to delineate anatomic parts injured, failure to report number of limbs salvaged, animal studies, and non-English language publications. Thrombolytic therapy was defined as intraarterial (IA) or intravenous (IV) administration of tissue plasminogen activator (tPA), alteplase, urokinase, streptokinase, or any tPA derivative. Results A total of 42 studies were identified, with 13 satisfying inclusion criteria. Eight studies reported catheter-directed IA thrombolysis, four reported systemic IV administration, and 1 reported both methods. A total of 157 patients received thrombolytics. In all, 73 upper extremity digits were treated by IA route and 136 digits were treated by IV route. Overall upper extremity digit salvage rate was 59%. There was a significantly higher salvage rate in digits treated by the IA route compared to the IV route. Conclusions Thrombolytics, particularly when administered by the intra-arterial route, are emerging as a promising treatment of severe frostbite of the upper extremity, increasing digit salvage rates.

Long-term results of low-dose tissue plasminogen activator therapy in acute pulmonary embolism

2019 ◽  
Vol 67 (8) ◽  
pp. 1142-1147
Author(s):  
Habibe Hezer ◽  
Hatice Kiliç ◽  
Osama Abuzaina ◽  
H Canan Hasanoǧlu‎ ◽  
Ayşegül Karalezli
Keyword(s):  
Thrombolytic Therapy ◽  
Low Dose ◽  
Standard Dose ◽  
Mortality Rates ◽  
Tissue Plasminogen ◽  
Long Term Follow Up ◽  
Acute Pe ◽  
Overall Mortality

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality.In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups.Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

scholarly journals Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience

2017 ◽  
Vol 4 (12) ◽  
pp. 3799
Author(s):  
Osama Abdou Ismail ◽  
Ahmed Saif Al-Islam Abdelfattah
Keyword(s):  
Limb Ischemia ◽  
Technical Success ◽  
First Line ◽  
Catheter Directed Thrombolysis ◽  
Proper Patient Selection ◽  
Tissue Plasminogen ◽  
Infusion Method ◽  
A Prospective Study ◽  
Groin Hematoma ◽  
Salvage Rate

Background: To assess the effectiveness of catheter directed thrombolysis in management of early acute thrombotic ischemia.Methods: A prospective study was carried out on 18 patients (13 males, 5 females) with a mean age of 49 years (ranged from 45 - 69 years) suffered from acute thrombotic lower limb ischemia (Rutherford II- a) and submitted to catheter directed thrombolysis (CDT) using tissue plasminogen activator (TPA) between August 2015 to March 2017. The commonest thrombosed artery was superficial femoral artery (SFA). Major risk factors were diabetes and smoking (66% and 56%) respectively. The infusion method was lacing technique followed by continuous infusion.Results: Technical success was obtained in 15 patients (83%). Complementary revascularization was performed in 5/15 patients (33.3 %) by balloon angioplasty. Limb salvage rate at 6 months was (77.7%). Failure of thrombolysis occurred in 3 limbs (16.6%); one patient treated by femoro-popliteal bypass while the other two limbs ended by amputation. Regarding complications, bleeding (local groin hematoma or minimal retroperitoneal hematoma) occurred in 3 patients (16.6 %). No major bleeding was recorded. Amputation had performed in 2 cases (11%) while mortality rate within 6 months was 16.6 %.Conclusions: With proper patient selection, CDT should be considered the first-line treatment for patients with (Rutherford II- a) acute thrombotic limb ischemia.

Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia

2021 ◽  
Vol 20 (4) ◽  
pp. 397-405
Author(s):  
Andrew R Pines ◽  
Richard J Butterfield ◽  
Evelyn L Turcotte ◽  
Jose O Garcia ◽  
Noel De Lucia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Postoperative Pain ◽  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Microvascular Decompression ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Trigeminal Nerve Root

Abstract BACKGROUND Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence. OBJECTIVE To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon. METHODS Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence. RESULTS A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23). CONCLUSION Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.

Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

2021 ◽  
pp. 112972982110150
Author(s):  
Jeremy Liu ◽  
Josiah Situmeang ◽  
Devin Takahashi ◽  
Russell Harada
Keyword(s):  
Primary Patency ◽  
The Body ◽  
Secondary Patency ◽  
Close Monitoring ◽  
Arteriovenous Graft ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Brachial Vein ◽  
Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

scholarly journals Cariogenic Biofilm: Pathology-Related Phenotypes and Targeted Therapy

2021 ◽  
Vol 9 (6) ◽  
pp. 1311
Author(s):  
Xiuqin Chen ◽  
Eric Banan-Mwine Daliri ◽  
Akanksha Tyagi ◽  
Deog-Hwan Oh
Keyword(s):  
Treatment Strategies ◽  
High Specificity ◽  
Low Ph ◽  
Oral Microbiota ◽  
Extracellular Polymers ◽  
Dental Biofilm ◽  
Health And Disease ◽  
Promising Treatment ◽  
Cariogenic Biofilm

The initiation and development of cariogenic (that is, caries-related) biofilms are the result of the disruption of homeostasis in the oral microenvironment. There is a daily accumulation of dental biofilm on the surface of teeth and its matrix of extracellular polymers supports the host in its defense against invading microbes, thus helping to achieve oral microbial homeostasis. However, the homeostasis can be broken down under certain circumstances such as during long-term exposure to a low pH environment which results in the dominance of acidogenic and acid-tolerating species in the dental biofilm and, thus, triggers the shift of harmless biofilm to an acidic one. This work aims to explore microbial diversity and the quorum sensing of dental biofilm and their important contributions to oral health and disease. The complex and multispecies ecosystems of the cariogenic biofilm pose significant challenges for the modulation of the oral microenvironment. Promising treatment strategies are those that target cariogenic niches with high specificity without disrupting the balance of the surrounding oral microbiota. Here, we summarized the recent advances in modulating cariogenic biofilm and/or controlling its pathogenic traits.

scholarly journals Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

2021 ◽  
Author(s):  
Gayathri S. Kumar ◽  
Jenna A. Beeler ◽  
Emma E. Seagle ◽  
Emily S. Jentes
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Public Health Practice ◽  
The United States ◽  
Inclusion Criteria ◽  
Physical Health Outcomes ◽  
Increased Risk ◽  
The Us ◽  
Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

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