scholarly journals Provocative mesenteric angiography for localizing ambiguous gastrointestinal hemorrhage

2021 ◽  
Vol 5 ◽  
pp. 18
Author(s):  
Paul A. Kohanteb ◽  
H. Gabriel Lipshutz ◽  
Benedette Okonkwo ◽  
Kimberly Oka ◽  
Eli Kasheri ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Therapeutic Embolization ◽  
Hemodynamic Stability ◽  
Recurrent Hemorrhage ◽  
Mesenteric Angiography ◽  
Institutional Review ◽  
Tissue Plasminogen ◽  
Slow Infusion ◽  
Pharmacologic Agents ◽  
Safe Approach

Objectives: Five percent of patients with recurrent gastrointestinal (GI) hemorrhage have indeterminate origin by radiological and endoscopic examinations. To improve diagnostic accuracy and therapeutic embolization, the technique of provocative mesenteric angiography (PMA) has been developed. It involves the addition of pharmacologic agents to standard angiographic protocols to induce bleeding. Material and Methods: This is an institutional review board-approved, retrospective study of 20 patients who underwent PMA between 2014 and 2019. All patients had clinical evidence of GI hemorrhage without a definite source. PMA consisted of anticoagulation with 5000 units of heparin and selective transcatheter injection of up to 600 μg of nitroglycerine, followed by slow infusion of up to 24 mg of tissue plasminogen activator into the arterial distribution of the highest suspicion mesenteric artery. Results: Among the 20 patients who underwent PMA, 11/20 (55%) resulted in angiographically visible extravasation. Of these 11 patients, nine patients underwent successful embolization with coil or glue and were discharged upon achieving hemodynamic stability. Two patients spontaneously stopped bleeding. In our series, PMA resulted in the successful treatment of 9/20 (45%) patients with recurrent hemorrhage. No procedure-associated complications were reported with these 20 patients during the procedure and their course of hospitalization. Conclusion: In our experience, PMA is an effective and safe approach in localizing and treating the source of GI bleeding in about half of patients with an otherwise unidentifiable source.

scholarly journals Retrocaruncular Approach for the Repair of Medial Orbital Wall Fractures: An Anatomical and Clinical Study

2015 ◽  
Vol 8 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Yun-Dun Shen ◽  
Daniel Paskowitz ◽  
Shannath L. Merbs ◽  
Michael P. Grant
Keyword(s):  
Oblique Muscle ◽  
Inferior Oblique Muscle ◽  
Transconjunctival Approach ◽  
Implant Placement ◽  
Institutional Review ◽  
Fresh Cadaver ◽  
Orbital Wall ◽  
Medial Orbital Wall ◽  
Safe Approach ◽  
Retrobulbar Hemorrhage

The aim of this article is to investigate a retrocaruncular approach for repairing medial orbital wall fractures. A total of 10 fresh cadaver orbits were dissected to investigate a transconjunctival approach to the orbit posterior to the caruncle. Medical records of consecutive patients with medial orbital wall fractures repaired via a retrocaruncular incision at Wilmer Eye Institute over a 10-year period were retrospectively reviewed. The study was approved by the Johns Hopkins Medical Institution's Institutional Review Board. Feasibility of this approach was clearly demonstrated on all cadavers. Horner muscle was observed to be directly attached to the caruncle and remained undisturbed throughout the retrocaruncular approach. For each of the 174 patients reviewed, this approach allowed successful access to the fracture and proper implant placement. The origin of the inferior oblique muscle was divided in only 19 patients. Sutures were not used for conjunctival incision closure in any patient. For 120 patients who underwent acute repair, the percentage with enophthalmos (≥ 2 mm) decreased from 34% preoperatively to 4% postoperatively; extraocular motility deficit decreased from 41 to 11%. Postoperative complications included recurrence of the preexisting retrobulbar hemorrhage, conjunctival granuloma, and temporary torsional diplopia, each in one patient. The retrocaruncular transconjunctival incision is an effective and safe approach for repairing medial orbital wall fractures with minimal complications. The retrocaruncular incision offers advantages over dividing the caruncle because Horner muscle is left undisturbed, and the incision heals well without suturing.

scholarly journals Thinking Outside the Field: Two Cases of RT+ICI Synergy in Melanoma

2021 ◽  
Author(s):  
Tara Davidson ◽  
Henan Zhang ◽  
Haidong Dong ◽  
Michael P. Grams ◽  
Sean S. Park ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Lower Extremity ◽  
Disease Control ◽  
Immune Checkpoint ◽  
Burden Of Disease ◽  
Clinical Evidence ◽  
Treatment Plan ◽  
Immune Checkpoint Blockade ◽  
Local Disease Control ◽  
Safe Approach

Abstract While combination radiotherapy (RT) and immunotherapy is not novel there is still much to learn about this approach. Some initial pre-clinical and clinical evidence suggests triple therapy with RT and dual immune checkpoint blockade (anti-CTLA-4 + anti-PD-1/PD-L1) is a complimentary technique. We present two cases using the same novel regime of combination RT plus nivolumab and ipilimumab to treat metastatic melanoma. In both cases the burden of disease was significant within a lower extremity. Additionally, in both cases using this treatment plan, we were able establish sustained local disease control with additional systemic benefit which allowed both patients to avoid significant debility from surgical amputation. Given the response and safety we observed, this technique could be used as a potentially safe approach for future patients who are not eligible for traditional RT palliation or clinical trials.

scholarly journals Correction to the article “Abnormal Uterine Bleeding in Adolescents: A Multidisciplinary Approach”, Published on Acta Med Port 2021 Apr;34(4):291-297.

2021 ◽  
Vol 34 (5) ◽  
pp. 405
Author(s):  
Inês Ramalho ◽  
Helena Leite ◽  
Fernanda Águas
Keyword(s):  
Haemoglobin Level ◽  
Multidisciplinary Approach ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Hemodynamic Stability ◽  
Pharmacologic Agents

On page 293, last paragraph on the left side column, where it reads:“We will discuss in detail the approved pharmacologic agents to treat acute AUB in adolescents, followed by a pharmacologicalmanagement algorithm, taking in consideration the hemodynamic stability and the haemoglobin level.8,9,15” It should read:“We will discuss in detail the approved pharmacologic agents to treat acute AUB in adolescents, followed by a pharmacologicalmanagement algorithm, taking in consideration the hemodynamic stability and the haemoglobin level [Appendix 1 (see Appendix 1: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/12829/Appendix_01.pdf)].8,9,15”Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/12829

scholarly journals Comparative study of intrathecal preservative-free midazolam versus nalbuphine as an adjuvant to intrathecal bupivacaine (0.5%) in patients undergoing elective lower-segment caesarean section

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Manisha Kapdi ◽  
Shruti Desai
Keyword(s):  
Caesarean Section ◽  
Adverse Effects ◽  
Postoperative Analgesia ◽  
Lower Segment ◽  
Hemodynamic Stability ◽  
Lower Segment Caesarean Section ◽  
Institutional Review ◽  
Group A ◽  
Group B ◽  
Preservative Free

Abstract Background Intrathecal anesthesia is common for parturients undergoing lower-segment caesarean section. Various adjuvants are added to intrathecal bupivacaine for potentiating pharmacological effects, improving quality of sensorimotor block and postoperative analgesia, and preventing adverse effects. The study period was from November 2017 to September 2018, and it was a randomized double-blinded observational study. The sample size calculation was done according to results of our pilot study (done with 5 patients in each group) and discussion with the institutional review board. Also, in this study, we aim to assess nalbuphine/midazolam as adjuvant to intrathecal bupivacaine for LSCS in terms of quality of sensorimotor block, postoperative analgesia, adverse effects, hemodynamic stability, and Apgar scores of baby at 1 and 5 min. One hundred full-term parturients between 20 and 35 years of ASA grade I/II scheduled for elective lower-segment caesarean section after approval from the institutional review board, and written informed consent were allocated into 2 groups. Randomization was done at the time of giving intrathecal anesthesia by odd and even numbers in an opaque sealed envelope. Group A (n = 50): Bupivacaine heavy (0.5%) 2.0 ml (10 mg) + 0.2 ml Preservative-free inj. midazolam 1 mg Group B (n = 50): Bupivacaine heavy (0.5 %) 2.0 ml (10 mg) + 0.2 ml (0.75 mg) Preservative-free inj. nalbuphine The primary outcome was to assess the perioperative hemodynamic stability, Apgar score, and postoperative analgesia, and the secondary outcome was to assess the complications and adverse effects during the study period. Results The onset of sensory and motor block was earlier in group A than in group B. Total duration of effective postoperative analgesia was more in the midazolam group as compared with the nalbuphine group. The incidence of complications (nausea, vomiting, and pruritus) were more in group B as compared with group A. Conclusion Nalbuphine and midazolam both are good adjuvants to hyperbaric bupivacaine for LSCS in terms of hemodynamic stability and good Apgar scores at 1 and 5 min. Intrathecal midazolam provides better postoperative analgesia and less adverse effects.

The Role of Fluoxetine and Selective Serotonin Re-uptake Inhibitors in Motor Recovery Following Acute Ischemic Stroke

US Neurology ◽  
2012 ◽  
Vol 08 (01) ◽  
pp. 37
Author(s):  
François Chollet ◽  
Jean Tardy ◽  
Jérémie Pariente ◽  
Isabelle Loubinoux ◽  
Jean-François Albucher ◽  
...  
Keyword(s):  
Spontaneous Recovery ◽  
Brain Plasticity ◽  
Direct Action ◽  
Recombinant Tissue Plasminogen Activator ◽  
Selective Serotonin ◽  
Uptake Inhibitors ◽  
Tissue Plasminogen ◽  
Pharmacologic Agents ◽  
Neuroimaging Techniques

Until now, recombinant tissue plasminogen activator thrombolysis within the first hours after a stroke has been recognised as the only validated treatment able to improve the spontaneous—and most of the time incomplete—recovery of neurologic functions after stroke. However, we have learnt from research over the last decade, in part based on the considerable improvement in neuroimaging techniques, that spontaneous recovery of neurologic functions was associated with a large intracerebral re-organization of the damaged human brain. The question of whether lesioned-brain plasticity can be modulated by external factors such as pharmacologic agents is now addressed, with the aim of improving recovery and reducing the final disability of patients. We review the preclinical and clinical arguments for a direct action of selective serotonin re-uptake inhibitors in promoting recovery after stroke in humans.

scholarly journals What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping?

2014 ◽  
Vol 14 (4) ◽  
pp. 336-339 ◽  
Author(s):  
Lindsey Spiegelman ◽  
Richa Asija ◽  
Stephanie L. Da Silva ◽  
Mark D. Krieger ◽  
J. Gordon McComb
Keyword(s):  
Clinical Evidence ◽  
Positive Culture ◽  
Clinical Information ◽  
Shunt Infection ◽  
Access Port ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Butterfly Needle ◽  
Culture Positive ◽  
Do So

Object Most CSF-diverting shunt systems have an access port that can be percutaneously tapped. Tapping the shunt can yield valuable information as to its function and whether an infection is present. The fear of causing a shunt infection by tapping may limit the physician's willingness to do so. The authors of this study investigate the risk of infecting a shunt secondary to percutaneous tapping. Methods Following institutional review board approval, CSF specimens obtained from tapping an indwelling CSF-diverting shunt during the 2011 and 2012 calendar years were identified and matched with clinical information. A culture-positive CSF sample was defined as an infection. If results were equivocal, such as a broth-only–positive culture, a repeat CSF specimen was examined. The CSF was obtained by tapping the shunt access port with a 25-gauge butterfly needle after prepping the unshaven skin with chlorhexidine. Results During the study period, 266 children underwent 542 shunt taps. With 541 taps, no clinical evidence of a subsequent shunt infection was found. One child's CSF went from sterile to infected 11 days later; however, this patient had redness along the shunt tract at the time of the initial sterile tap. Conclusions The risk of infection from tapping a shunt is remote if the procedure is done correctly.

Ultrastructural Study of Human Testicular Biopsies in Infertility

1976 ◽  
Vol 34 ◽  
pp. 156-157
Author(s):  
Shirley Siew ◽  
Philip Troen ◽  
Howard R. Nankin
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Basement Membrane ◽  
Leydig Cells ◽  
Clinical Evidence ◽  
Young Male ◽  
Germinal Epithelium ◽  
Transmission Electron ◽  
Age Range ◽  
Male Subjects

Testicular biopsies were obtained from six young male subjects (age range 24-33) who complained of infertility and who had clinical evidence of oligospermia. This was confirmed on histological examination which showed a broad spectrum from profound hypospermatogenesis to relatively normal appearing germinal epithelium. Thickening of the tubular walls was noted in half of the cases and slight peritubular fibrosis in one. The Leydig cells were reported as normal or unremarkable.Transmission electron microscopy showed that the thickening of the supporting tissue of the germinal epithelium was caused more by an increase in the thickness of the layers of the lamina propria than of the tubular wall itself. The changes in the basement membrane of the tubular wall consisted mostly of a greater degree of infolding into the tubule and some reduplication which gave rise to a multilayered appearance.

Severe Drooling and Treatment With Botulinum Toxin

2012 ◽  
Vol 21 (1) ◽  
pp. 15-21
Author(s):  
Merete Bakke ◽  
Allan Bardow ◽  
Eigild Møller
Keyword(s):  
Botulinum Toxin ◽  
Side Effects ◽  
Health Risk ◽  
Flow Rate ◽  
Clinical Evidence ◽  
Acetylcholine Release ◽  
Psychosocial Problems ◽  
Rate Reduction ◽  
Local Inhibition ◽  
Surgical Treatments

Severe drooling is associated with discomfort and psychosocial problems and may constitute a health risk. A variety of different surgical and non-surgical treatments have been used to diminish drooling, some of them with little or uncertain effect and others more effective but irreversible or with side effects. Based on clinical evidence, injection with botulinum toxin (BTX) into the parotid and submandibular glands is a useful treatment option, because it is local, reversible, and with few side effects, although it has to be repeated. The mechanism of BTX is a local inhibition of acetylcholine release, which diminishes receptor-coupled secretion and results in a flow rate reduction of 25–50% for 2–7 months.

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