scholarly journals Nonsurgical management of an asymptomatic popliteal venous aneurysm

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Vinay Bajaj ◽  
Francisco Benavides ◽  
Jay Fisher
Keyword(s):  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Venous Aneurysm ◽  
Chronic Obstructive ◽  
Medial Malleolus ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Vein Thrombosis ◽  
Nonsurgical Management ◽  
The Right

Abstract An 81-year-old male with a history of poorly controlled congestive heart failure, chronic obstructive pulmonary disease and atrial fibrillation among other comorbidities was admitted to the hospital for worsening bilateral leg swelling and cellulitis. The patient had an injury to his left medial malleolus 2 weeks prior, which failed outpatient care. During the physical exam, a soft mobile mass was palpated in the right popliteal fossa along with bilateral varicose veins, +1 pitting edema in bilateral lower extremities up to mid-calf. Duplex ultrasound revealed a saccular dilation in the right popliteal vein measuring 2.2 × 1.8 × 2.8 cm, without any evidence of superficial or deep vein thrombosis. After an extended conversation with the patient and his care team, a decision to continue with medical management with close monitoring was made. Follow-up ultrasounds performed at 1, 6 and 12 months show no changes.

Abstract 15082: Repolarization Vulnerability is Rarely Observed in COVID-19 Patients With Low Comorbidity Treated With a Combination of Hydroxychloroquine Azithromycin

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David E Goldgrab ◽  
Sokol Kalaveshi ◽  
Ruifang Yang ◽  
Mauricio Gomez ◽  
Jearim Craig ◽  
...  
Keyword(s):  
Torsades De Pointes ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Healthy Population ◽  
Close Monitoring ◽  
Qtc Interval ◽  
Short Term Treatment ◽  
Obstructive Pulmonary Disease ◽  
Artery Disease ◽  
The Right

Background: Global pandemic of COVID-19 has attracted a number of proposed treatment therapies. Hydroxychloroquine/Azithromycin (HA) combination has been reported to potentially affect repolarization by prolonging the QTc and causing torsades de pointes (TdP). Methods: We prospectively followed hospitalized patients with PCR confirmed COVID-19. Hydroxychloroquine was administered 400mg twice daily on day 1 and daily for the last 4 days plus daily Azithromycin 250mg. QTc interval was measured via 12 lead ECG prior to initiation of therapy, 3 hours post second dose of hydroxychloroquine, and subsequent daily QTc evaluation via telemetry. Potassium and magnesium were checked daily and replaced accordingly. QTc prolonging medications were discontinued when possible. Results: Sixteen patients were followed for 5 days, 56% were male with average age of 67. Comorbidities were 31% coronary artery disease, 31% diabetes mellitus, 13% congestive heart failure, 69% hypertension, 19% chronic obstructive pulmonary disease, 25% atrial fibrillation, and average BMI of 29. Average Tisdale score was 11/21. Mean QTc prior to HA therapy was 442 ms, 3 hours post second dose 429 ms and on day 5 was 441 ms with a change of (-)3ms compared to prior starting therapy as seen in figures below. Fifteen patients recovered and 1 patient expired. Twenty five percent of patients required ET intubation and mechanical ventilation. Zero patients required stopping of HA therapy. Only 1 patient required 2 extra days of QTc monitoring due to 5th day QTc being 504ms. Conclusion In acutely infected COVID-19 patients with limited comorbidities, repolarization/risk for TdP appears to be low in the presence of HA. With close monitoring and the right patient population, this combination therapy for short term treatment appears to be safe in regards to QTc and the risk for TdP. Although larger published studies have shown repolarization risk, we did not find that to be the case in our relatively healthy population.

Intracranial entrapment of a haemodialysis catheter guidewire

2020 ◽  
Vol 13 (8) ◽  
pp. e232535
Author(s):  
Natasha Hemicke Langer ◽  
Lars Hein ◽  
Morten Heiberg Bestle
Keyword(s):  
Vital Signs ◽  
Jugular Foramen ◽  
Seldinger Technique ◽  
Chronic Obstructive ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Haemodialysis Catheter ◽  
The Wire ◽  
Introducer Needle ◽  
The Right

A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire’s 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient’s comorbidity and medication.

scholarly journals A complete duplication of the right and a segmental duplication of the left great saphenous vein - a case report

2015 ◽  
Vol 04 (02) ◽  
pp. 93-97
Author(s):  
Mehandi V Mahajan ◽  
Durga Devi ◽  
Kalpana R.
Keyword(s):  
Case Report ◽  
Saphenous Vein ◽  
Segmental Duplication ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Medial Malleolus ◽  
Vein Thrombosis ◽  
The Right ◽  
Complete Duplication

AbstractAbnormalities of the lower limb veins lead to venous disorders such as obstructive or the ones associated with venous insufficiency. Varicose veins, deep vein thrombosis and ulcers are the common disorders. As many variations are noted in veins in comparison to arteries, the present case report expresses the need for a detailed evaluation of the veins of the lower limb. During the routine dissection of a 65 year old male cadaver, a complete duplication of the Great Saphenous vein (GSV) was noted from the medial malleolus of the tibia till the saphenofemoral junction in the right lower limb and a segmental duplication was noted in the thigh region of left lower limb. Such findings would be of great value to surgeons, orthopaedicians and interventional radiologists as iatrogenic varicosity can be prevented and for cardiovascular surgeons who can use the duplicated vein as vascular grafts in cases of Ischemia and arterial blocks.

CONDITION OF HEMODYNAMICS IN THE PULMONARY CIRCULATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) CONCURRENT WITH METABOLIC SYNDROME WITH HYPERTROPHY AND ATROPHY OF THE MYOCARDIUM

2019 ◽  
Vol 72 (8) ◽  
pp. 1491-1493
Author(s):  
Viktor P. Boriak ◽  
Svitlana V. Shut’ ◽  
Tetiana A. Trybrat ◽  
Olena V. Filatova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Metabolic Syndrome ◽  
Right Ventricular ◽  
Pulmonary Disease ◽  
Pulmonary Circulation ◽  
Contractile Function ◽  
Ventricular Myocardium ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Right

Introduction: In recent years, COPD is observed as not an isolated, but an associated pathology, in particular, concurrent with metabolic syndrome. The aim of the research is to identify the differences in changes of the rheopulmonography parameters (RPG) depending on the presence of hypertrophy or atrophy of the right ventricular myocardium in patients with COPD concurrent with metabolic syndrome.. Materials and methods: We studied changes in rheopulmonography (RPG) in 145 patients with chronic obstructive pulmonary disease (COPD) concurrent with metabolic syndrome. Results: We detected precapillary hypertension of the pulmonary circulation in patients with right ventricular myocardial hypertrophy: anacrotism serration; flattened peak of the systolic wave; decreased Vcp; high placement of incisura; horizontal course of catacrotism; decreased amplitude of the systolic wave (in this case, due to a greater increase in the resistance of the blood flow in the pulmonary vessels than the decreased impact volume of the right ventricle); prolonged Q-a (in this group of patients, it depends more on hypertension of the pulmonary circulation than on the reduction of contractile function of the myocardium). In atrophy of the right ventricular myocardium, the following changes in the RPG were revealed: decreased systolic wave at its dramatic rise; prolonged Q-a (in this case, due to the weakened heart contraction); Vmax reduction (it reflects the reduction of myocardial contractility); in hypertrophy of the myocardium, Vcp., unlike RPG, does not decrease, which is explained by the decrease in the pressure of the pulmonary circulation. Conclusions: We believe that these changes in RPG allow differentiating hypertrophy and right ventricular myocardial atrophy along with established diagnostic criteria, and can be used as markers for the diagnosis and treatment of COPD concurrent with metabolic syndrome.

A COMPARATIVE STUDY OF ABG PATTERN IN PATIENTS OF COPD WITH OR WITHOUT COR PULMONALE

2021 ◽  
pp. 64-66
Author(s):  
Md Shoeb Alam ◽  
Rahul Ranjan ◽  
V N Jha
Keyword(s):  
Hypoxic Pulmonary Vasoconstriction ◽  
Respiratory Acidosis ◽  
Public Health Problem ◽  
Cor Pulmonale ◽  
Chronic Obstructive ◽  
P Value ◽  
Major Public Health Problem ◽  
Close Monitoring ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major public health problem. COR PULMONALE describes the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or increased pulmonary artery pressure. Hypoxic pulmonary vasoconstriction, hypercapnia, respiratory acidosis and pulmonary vascular remodeling in COPD can cause an increase in right ventricular (RV) after load, which in turn, results in RVfailure leading to COR PULMONALE AIM:The purpose of the study is to compare the ABG pattern in patients of COPD with or without COR PULMONALE. MATERIALS AND METHODS: This prospective observational study was conducted in the Department of Medicine of DMCH, Laheriasarai, Bihar. The study was conducted with duration of 2 years. Atotal of 100 patients admitted as a case of COPD with or without COR PULMONALE. The patients were put into two subgroups, COPD with and without COR PULMONALE. RESULT: The mean duration was 10.17 years and 9.20 years respectively in patients with and without COR PULMONALE. There was no statistically signicant difference regarding mean duration of disease (p value =0.304). Mean CAT score was 16.59 ± 6.26 and mean mMRC was 3.19± 0.45 in COPD patients with COR PULMONALE group. Mean CAT score was 14.06 ± 4.46 and mean mMRC was 3.10 ± 0.44 in COPD patients without COR PULMONALE group. We found no signicant difference among these variables between groups. Although COR PULMONALE patients had higher CATscore and mMRC score, the difference was not signicant (p value = >0.05). CONCLUSION:ABG ANALYSIS should be recommended for all patients of COPD with or without COR PULMONALE to assess the degree of hypoxemia, hypercapnea, respiratory acidosis and also, we can identify individuals who need more close monitoring and intensive treatment.

The state of the cardiovascular system in occupational bronchitis and chronic obstructive pulmonary disease, not associated with the impact of harmful industrial factors

2021 ◽  
pp. 55-68
Author(s):  
Vyacheslav S. Lotkov ◽  
Anton Vladimirovich Glazistov ◽  
Antonina G. Baykova ◽  
Marina Yuryevna Vostroknutova ◽  
Natalia E. Lavrentieva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cardiovascular System ◽  
Pulmonary Disease ◽  
Lung Diseases ◽  
Chronic Obstructive ◽  
External Respiration ◽  
Obstructive Pulmonary Disease ◽  
Occupational Lung Diseases ◽  
The Right ◽  
The Impact

The formation and progression of chronic dust bronchitis and chronic bronchitis of toxic-chemical etiology, chronic obstructive pulmonary disease is accompanied by an increase in the degree of ventilation disorders, echocardiographic signs of hypertrophy and dilatation of the right ventricle are formed, typical for chronic pulmonary heart disease. The progression of disturbances in the function of external respiration in dusty lung diseases leads to a decrease in myocardial contractility. The detection of hemodynamic disturbances at the early stages of the development of occupational lung diseases indicates the need for individual monitoring of the functional state of the cardiovascular system in the process of contact with industrial aerosols, especially in groups of workers with long-term exposure.

Care of adults with long-term conditions

2020 ◽  
pp. 597-676
Keyword(s):  
Varicose Veins ◽  
Healthcare Providers ◽  
Motor Neurone ◽  
Chronic Obstructive ◽  
Long Term Conditions ◽  
Obstructive Pulmonary Disease ◽  
Lower Back ◽  
Respiratory Conditions

Multiple comorbidities necessitate care from a number of healthcare providers. Continuity of care is important for both patient satisfaction and quality of life. This chapter outlines primary care for adults with a variety of conditions, including osteoarthritis, rheumatoid arthritis, lower back pain, asthma and acute asthma, and stable and chronic obstructive pulmonary disease. It covers drugs commonly used in the treatment of respiratory conditions, including long-term oxygen and nebulizers. It then goes on to cover coronary heart disease, angina, hypertension, cardiac rehabilitation, heart failure, abnormal cardiac rhythms and atrial fibrillation, patients on anticoagulant therapies, and drugs used in cardiovascular diseases. The chapter also includes information on anaemia, varicose veins, diabetes, multiple sclerosis, motor neurone disease, and Parkinson’s disease.

Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 15 (2) ◽  
pp. 120-132 ◽  
Author(s):  
Cosei Valentin-Caius ◽  
Borcea Corina-Ioana ◽  
Zaharie Ana-Maria ◽  
Mihaltan Florin-Dumitru ◽  
Deleanu Oana-Claudia
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Patient Reported ◽  
The Right

The benefit of non-invasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) remains controversial. However, there is increasingly more evidence of NIV efficiency, especially high-flow NIV. This review presents the old and the new evidence of NIV effectiveness in stable COPD, considering pathophysiological arguments for NIV in COPD. Guidelines, randomized controlled trials (RCTs) and crossover studies included in review and metaanalysis based on patient-reported outcomes (PROs) have been analyzed. The role of NIV in rehabilitation and in palliative care and the role of telemedicine in relation with NIV are still up for debate. Challenges in choosing the right device and the optimal mode of ventilation still exist. There are also discussions on the criteria for patient inclusion and on how to meet them. More studies are needed to determine the ideal candidate for chronic NIV and to explain all the benefits of using NIV.

scholarly journals Endovenous Ablation of Varicose Veins Experience at Tertiary Neurological Center

2018 ◽  
Vol 1 (2) ◽  
pp. 94-96
Author(s):  
Sandeep Raj Pandey ◽  
George Bush Jung Katwal ◽  
Sharad Hari Gajuryal
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Normal Activity ◽  
Vein Thrombosis ◽  
Long Term Follow Up ◽  
Endovenous Thermal Ablation

Introduction: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein.Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction.Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3.Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required.  Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.

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