Cardiology

2018 ◽  
pp. 258-261
Author(s):  
Janey Phelps
Keyword(s):  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pediatric Anesthesia ◽  
Invasive Procedure ◽  
Patient Characteristics ◽  
The United States ◽  
Good Choice ◽  
Risk Patients ◽  
History Of ◽  
Intranasal Midazolam

Congenital heart disease is the most common type of birth defect and is estimated to affect nearly 1% of all births per year in the United States. Echocardiograms are necessary to fully evaluate these defects, and depending on the age of the child, sedation may be required to ensure optimal imaging. This chapter discusses the sedation/anesthesia options for transthoracic echocardiography, transesophageal echocardiography, and cardioversion. For all of these procedures high-risk patients should be triaged to a pediatric anesthesia provider and in some cases, a pediatric cardiac anesthesiologist. Transthoracic echocardiograms can be completed with distraction and/or minimal sedation with oral or intranasal midazolam. If moderate sedation is required due to patient characteristics or previous history of failure with minimal sedation, intranasal dexmedetomidine is a good option. Transesophageal echocardiography is an invasive procedure; patients <2 years of age should be intubated and those >2 years of age can maintain a native airway with deep sedation with propofol. The need for cardioversion is infrequent in pediatrics but when needed, propofol is a good choice.

Pleuroscopy early experience in the exudative pleural effusion of unknown etiology

2021 ◽  
Vol 17 ◽  
Author(s):  
Atefeh Fakharian ◽  
Hamidreza Jabbardarjani ◽  
Mohamad Reza Masjedi ◽  
Masoud Shamaei
Keyword(s):  
Pleural Effusion ◽  
Previous History ◽  
Invasive Procedure ◽  
Therapeutic Interventions ◽  
Unknown Etiology ◽  
Safe Procedure ◽  
Pathologic Diagnosis ◽  
Medical Thoracoscopy ◽  
History Of ◽  
Exudative Pleural Effusion

Background: Pleuroscopy (medical thoracoscopy) is a minimally invasive procedure to inspect and perform a biopsy of the pleural space as well as to perform therapeutic interventions; pleural fluid drainage and pleurodesis. Material and Methods: In a retrospective study in Kasra Hospital, Tehran-Iran, the patients with exudative pleural effusion of unknown etiology who underwent pleuroscopy, were evaluated. These patients had negative smear and culture for infective agents. Also, the cytological review was negative for malignancy. Results: 62 patients had undergone pleuroscopy, of which 29 (46.7) were men. After the final evaluation, 47 patients (75.8%) had a definite pathologic diagnosis, of which 39 (82.9%) were cancer. Through these 39 cases, 18 cases (46.1%) had a history of the previously confirmed cancer, in which pleural pathology was consistent with the initial diagnosis. In 21 cases (53.9%), metastatic cancers were detected without a previous history. From a total of 47 cases with definite pathologic diagnosis, 8 cases (17%) had histopathologic evidence of granulomatous lesions consistent with tuberculosis and 15 patients (24%) showed non-specific inflammatory lesions. There was no morbidity and mortality among these patients. Discussion: Considering that pleuroscopy is a safe procedure with high diagnostic accuracy, malignancy is the most finding in the exudative pleural effusion of unknown etiology. This increases the importance of this procedure in these cases to prevent wasting the time and smear-negative anti-TB treatment.

Federation and the History of the Administration of Indigenous Affairs in Canada, the United States, and Australia: New Insights through a Transnational Approach

2019 ◽  
Vol 28 (2) ◽  
pp. 1-53
Author(s):  
Ted Binnema
Keyword(s):  
United States ◽  
North America ◽  
Federal Government ◽  
Previous History ◽  
The United States ◽  
Federal States ◽  
British North America ◽  
Exclusive Jurisdiction ◽  
History Of ◽  
State Relations

The importance of decisions regarding the allocation of jurisdiction over Indigenous affairs in federal states can only be understood well when studied transnationally and comparatively. Historians of Canada appear never to have considered the significance of the fact that the British North America Act (1867) gave the Canadian federal government exclusive jurisdiction over Indian affairs, even though that stipulation is unique among the constitutional documents of comparable federal states (the United States and Australia). This article explains that the constitutional provisions in Canada, the United States, and Australia are a product of the previous history of indigenous-state relations in each location, but also profoundly affected subsequent developments in each of those countries. Despite stark differences, the similar and parallel developments also hint at trends that influenced all three countries.

scholarly journals Quantifying infective endocarditis risk in patients with predisposing cardiac conditions

2017 ◽  
Vol 39 (7) ◽  
pp. 586-595 ◽  
Author(s):  
Martin H Thornhill ◽  
Simon Jones ◽  
Bernard Prendergast ◽  
Larry M Baddour ◽  
John B Chambers ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
High Risk ◽  
Hospital Admissions ◽  
Previous History ◽  
Prosthetic Material ◽  
Moderate Risk ◽  
Prosthetic Valves ◽  
English Population ◽  
Risk Patients ◽  
History Of

Abstract Aims There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions. Methods and results English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions—even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices. Conclusion These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

The Silk Road Wends its Way to Washington

2003 ◽  
Vol 36 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Mark Slobin
Keyword(s):  
United States ◽  
Central Asia ◽  
Previous History ◽  
The United States ◽  
The Sun ◽  
Rock Band ◽  
Small Stock ◽  
History Of ◽  
Bactrian Camels ◽  
The Silk Road

In the summer of 2002, more Americans – 1.3 million – heard the music of Central Asia in just a few days than in the entire previous history of the United States. Some 370,000 of them picked up the extensive, well-documented guidebook to the 36th annual Smithsonian Folklife Festival, which broke all attendance records. As they traipsed through the humid haze of the Washington Mall, staggering into the sun baked tents to see crafts and hear music, this crowd was in a good mood. Kids asked to see the Bactrian camels, who, like their handlers, were Texans. People crowded the sprawling crafts exhibits to watch artisans, then jammed the sales pavilions to scoop up gifts and albums, also at unprecedented levels. The surging spectators jammed the tents for most of the shows on the two days I was there. The reception was rousing. The organizers had brought not just “classic” performers, but contemporary musicians, like the Kazakh rock band Roksonaki. The small stock of their CDs sold out on the first day, and their performances regularly received standing ovations.

scholarly journals Recommendations for Pathologic Evaluation of Reduction Mammoplasty Specimens: A Prospective Study With Systematic Tissue Sampling

2017 ◽  
Vol 141 (11) ◽  
pp. 1523-1528 ◽  
Author(s):  
Abiy B. Ambaye ◽  
Andrew J. Goodwin ◽  
Susan E. MacLennan ◽  
Shelly Naud ◽  
Donald L. Weaver
Keyword(s):  
Reduction Mammaplasty ◽  
Previous History ◽  
The United States ◽  
Reduction Mammoplasty ◽  
Atypical Hyperplasia ◽  
Pathologic Evaluation ◽  
Microscopic Evaluation ◽  
Pathologic Findings ◽  
History Of ◽  
A Prospective Study

Context.— Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. Objectives.— To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. Design.— All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. Results.— A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. Conclusions.— In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.

Gallbladder Cryoablation: Clinical and Technical Considerations

2022 ◽  
Author(s):  
Hugh McGregor
Keyword(s):  
Clinical Success ◽  
Gallbladder Disease ◽  
Invasive Procedure ◽  
Gallbladder Wall ◽  
The United States ◽  
Definitive Treatment ◽  
Tube Removal ◽  
Risk Patients ◽  
The Impact

AbstractAs many as 500,000 cholecystectomies are performed per year in the United States. Frail patients are at higher risk from cholecystectomy, with reported postoperative complication and mortality rates as high as 31 and 5% in patients older than 75 years. Percutaneous cholecystostomy drainage is commonly employed in high-risk patients with cholecystitis, with over 12,000 cases performed annually. Cholecystostomy, however, is not a definitive treatment, with up to 30% of patients having a recurrent episode of cholecystitis within 4 months after tube removal. Gallbladder cryoablation has emerged as a minimally invasive procedure that achieves transmural gallbladder wall necrosis in a single session resulting in gallbladder fibrosis and involution. Early clinical data have been promising, with reported technical success of 86% and clinical success of 100% at up to 500 days of follow-up. Several challenges and unknowns remain, however, including optimal patient selection and procedural technique, the potential need for adjunct procedures to occlude the cystic duct, the implications of the immunostimulatory effects of cryoablation, and the impact of the presence of gallstones on outcomes. This article reviews the rationale behind gallbladder cryoablation, updates early clinical outcomes, and discusses the challenges that remain for the adoption of the technique for the treatment of benign gallbladder disease.

scholarly journals Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 168 ◽  
Author(s):  
Carlos E Arias-Morales ◽  
Nicoleta Stoicea ◽  
Alicia A Gonzalez-Zacarias ◽  
Diana Slawski ◽  
Sujatha P. Bhandary ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Clinical Outcomes ◽  
Transfusion Requirement ◽  
Artery Bypass ◽  
The United States ◽  
Blood Products ◽  
Predictors Of Outcome ◽  
Risk Patients ◽  
History Of

In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.

scholarly journals NEURAL TUBE DEFECTS (NTDS);

2017 ◽  
Vol 24 (12) ◽  
pp. 1878-1883
Author(s):  
Nadeem Shahzad ◽  
Afshan Riaz ◽  
Uzma Ameer ◽  
Daniyal Nadeem
Keyword(s):  
United States ◽  
Risk Factors ◽  
Family History ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Previous History ◽  
The United States ◽  
Control Group ◽  
Positive History ◽  
History Of

Background: The most common congenital malformations are Neural tubedefects (NTDs) occurring in 0.6 per 1,000 live births in the United States, and almost 4000pregnancies are recorded of babies with neural tube defects, among them anencephalyand Spina bifida are the most common and their annual incidence is 2,500 to 3,000 births inthe United States. The etiology of NTDs is still an enigma, however, in the past few decadesvaluable advances has been made in understanding the causation and measures to preventNTDs and many risk factors are indentified which are associated with it. Objectives: This studywas designed to determine the risk factors and their association with neural tube defects. StudyDesign: Case control study. Place and Duration of Study: This study was conducted at unit111 Lady Willingdon Hospital Lahore and duration was one year from 1.1.2016 to 31.12.2016.Methodology: A total of 120 mothers were included in the study, of which 30 were having ofbabies delivered with NTDs, matched with 90 mothers delivered babies without NTDs (Threecontrols for each NTD case). Informations were collected on special Performa, data was analyzedon SPSS version 20. Results: Majority of the patients in both groups were found between 31-40 years of age, 43.33 %( n13) in patients with NTD group and 56.67 %( n51) in controls whileonly 16.67% (n5) in NTD and 17.78 % (n16) were found between 21-30 years. The mean agewas recorded as 33.06+1.21 and 32.12+ 0.89 respectively. Regarding parity, 23.33% (n7) werefound between P1-2, 26.67% (n11) were P2-3 while 40% (n12) with Parity >4 in the NTD group,while 21.11% (n19) were p1-2, 37.77% (n 34) with P 3-4 and 41.12% (n37) were P >4 in controlgroup. 86.67% (n 26) were found with poor economic status and 13.33% (n4) were found withrich status in NTDs, while 18.89% (n17) were found with poor and 81.11% (n73) with rich statusin control group. Distribution of fetuses according to their gender revealed that 20% (n6) weremales, and 80% (n24) were females in NTDs while 47.77 %( n43) were found males and 52.23%(n47) were females in controls. Regarding family history 80% (n24) with positive history of NTDsin patients of NTD group and 20% (n6) with no history while 4.44% (n4) had positive history and95.56% (n86) had no familial history of NTD in control cases. About previous history of NTDs,93.33% (n28) were found with positive previous history of NTDs and only 6.67% (n2)with noprevious history of NTDs in NTD group, while only 5.56% (n5) were found with positive previoushistory of NTDs and 94.44%(n85) with no previous history in controls. Conclusions: Poor socioeconomic status, family history and previous history of a baby with Neural tube defects are themajor risk factors.

scholarly journals THE RELATIONSHIP BETWEEN GENDER, HISTORY OF ANKLE SPRAIN, AND ANKLE STABILITY WITH ANKLE SPRAIN STATUS

2020 ◽  
Vol 15 (3) ◽  
pp. 276
Author(s):  
Zhafira Faruhasa
Keyword(s):  
Ankle Sprain ◽  
Previous History ◽  
The United States ◽  
Observational Research ◽  
Injury Incidence ◽  
Gender History ◽  
Cross Sectional ◽  
Ankle Stability ◽  
History Of ◽  
The Relationship

Injuries can occur as a result of various activities, which of them is a sport. In 2017, basketball was a sport that produced the highest prevalence of injury incidence in the United States at 15.77%. Athletes who have ankle sprain are 20-40% more likely to experience chronic ankle instability. This study analyzed the relationship between gender, history of ankle sprain, and ankle stability with ankle sprain status in basketball athletes of Universitas Airlangga Surabaya. This study was analytical-observational research using a cross-sectional design. The research population was basketball athletes who were members of the basketball club of Universitas Airlangga, and finally there were 23 respondents selected as the research samples. The sample selection used the accidental sampling technique. The results of chi-square test (α = 0.05) indicate that there was a relationship between the previous history of ankle sprain (p = 0.002; RR = 9.1) and ankle stability with ankle sprain status (p = 0.013; RR = 6.), but gender had no relationship with ankle sprain status (p = 0.435; RR = 1.6). It concludes that the history of ankle sprain injury and ankle stability were related to ankle sprain status, but gender was not related to it. Keywords: gender, history of ankle sprain, ankle stability, ankle sprain

scholarly journals 1027. Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs): Is It Safe?

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S306-S306
Author(s):  
Hira Rizvi ◽  
Nathalie Baratz ◽  
Hind Hadid ◽  
Ana C Bardossy ◽  
Erica Herc ◽  
...  
Keyword(s):  
Injection Drug Users ◽  
Drug Users ◽  
Illicit Drugs ◽  
Patient Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Improved Outcomes ◽  
History Of

Abstract Background OPAT is widely implemented in the United States. However, there are concerns surrounding discharge of IDU with a peripherally inserted central catheter (PICC). The objective of this study was to evaluate the characteristics and treatment outcomes of IDUs discharged on OPAT. Methods This is a retrospective observational study conducted on patients discharged from an Infectious Diseases unit at a quaternary academic healthcare center in Detroit. Charts of all IDUs discharged on OPAT between 2011 and 2017 were reviewed. Current or former IDU were discharged on OPAT if they met the following criteria: self-reported history of IDU, stable living conditions, controlled psychiatric illness (if present), and willingness to sign a discharge agreement to refrain from using the PICC as a route for illicit drugs. Patients were categorized based on clinic follow-up vs. no clinic follow-up. Outcomes evaluated were: cured (completed treatment and symptom free for 1 month after completion), improved (symptoms were improved but there was no confirmation of treatment completion); and relapsed (readmitted within 30 days for the same infection or sequela). Outcomes of patients with no clinic follow-up were based on chart review of subsequent emergency department visits or admissions. Results Patient characteristics are shown in Table 1. Of the 61 patients evaluated, 33 (54.1%) attended clinic follow-up and 28 (45.9%) did not. Outcomes based on clinic follow-up are shown in Table 2. Of the 18 patients who were cured, 16 attended clinic follow-up vs. two who did not. Conclusion This study demonstrates that some IDUs can be discharged safely on OPAT. Patients with clinic follow-up had improved outcomes compared with those who did not. Further studies are needed to look at other predictors of outcome in this patient population. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document