scholarly journals Femoral Pseudoaneurysm in IV Drug Abusers: Single-center Study Experience

2020 ◽  
Vol 18 (3) ◽  
pp. 478-482
Author(s):  
Kajan Raj Shrestha ◽  
Dinesh Gurung ◽  
Nischal Khanal ◽  
Uttam Krishna Shrestha
Keyword(s):  
Purulent Discharge ◽  
Drug Abusers ◽  
Eptfe Graft ◽  
Pulsatile Mass ◽  
Patent Graft ◽  
Single Center Study ◽  
Immunodeficiency Virus ◽  
Study Experience ◽  
Infected Pseudoaneurysm

Background: Pseudoaneurysm of the femoral artery is the most common complication among IV drug abusers who inject drugs in groin. These are usually infective and potentially fatal so it requires astute clinical recognition and prompt treatment, possessing a significant challenge to vascular surgeons. Methods: We present a retrospective descriptive study and the prevalent practice of their management covering the period from 2013 July- December 2019 at our center. Data regarding demography, presentation, surgical management, and the outcome was analyzed. Results: Among 368 femoral pseudoaneurysm operated during the period, groin swelling with pulsatile mass was the most frequent presentation accounting 304 (82.61%) patients. About 67.12% (247 patients) of the pseudoaneurysm has purulent discharge and 60.07% (221 patients) had bleeding at presentation out of which 211patients had hepatitis C (HCV), hepatitis B (HBsAg) and/or Human Immunodeficiency virus (HIV) status positive.  Thirty six patients (9.78%) presented with femoral pseudoaneurysm in both groins. Ligation and excision of the pseudoaneurysm were done in all cases while delayed revascularization was done in eight patients with expanded Polytetrafluoroethylene (ePTFE) graft in one patient and venous bypass grafts in other 7 cases. All patients after bypass had no major limb loss and two patients had a patent graft at five years follow up. There were nine mortalities and thirty two patients underwent amputation.  Conclusions: Infected femoral pseudoaneurysm can be managed by ligation of the involved artery with delayed revascularization if required without major limb and life loss. Keywords: Delayed revascularization; drug abuser; infected pseudoaneurysm; ligation

Endovascular management of infected iliofemoral pseudoaneurysms – a systematic review

VASA ◽  
2017 ◽  
Vol 46 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Konstantinos G. Moulakakis ◽  
Vangelis G. Alexiou ◽  
George S. Sfyroeras ◽  
John Kakisis ◽  
Andreas Lazaris ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stent Graft ◽  
Purulent Discharge ◽  
Covered Stents ◽  
Graft Thrombosis ◽  
Stent Grafting ◽  
Vascular Bypass ◽  
Infected Pseudoaneurysm ◽  
Risk Patients

Abstract. We conducted a systematic review regarding the efficacy and outcome of endovascular treatment of infected iliofemoral arterial pseudoaneurysms with covered stents. 35 cases were identified, including 5 own. 22 pseudoaneurysms were located in the femoral area and 13 in the iliac vessels. The most commonly reported complaints were pulsatile groin mass (40 %), sepsis (37.1 %), active bleeding (31.4 %), and groin infection with purulent discharge (17.1 %). S. aureus (65.7 %) and Streptococcus species (22.9 %) were the most common microbes isolated. Factors for the development of infected pseudoaneurysms were intravenous drug use (20 %), infection of anastomosis in bypass surgery (22.9 %), cancer (14.3 %), history of multiple hip operations (14.3 %), renal transplantation (2.9 %), and obesity (5.7 %). The most commonly used covered stents were Viabahn (22.9 %),Jostent (17.1 %), Fluency (14.3 %), and Wallgraft (14.3 %). In 15 cases, surgical debridement and/or drainage was also performed.The mean follow-up was 15.8 months. There were only 2 cases of stent graft thrombosis (5.7 %). 2 patients required an open vascular bypass procedure at a later stage. One death was attributed to procedure-related complications (2.9 %). The infection rate of the deployed stent graft in follow-up was 3.4 %. Endovascular exclusion of an infected pseudoaneurysm with primary stent grafting and drainage may be an option in high-risk patients.


scholarly journals ECMO in COVID-19—prolonged therapy needed? A retrospective analysis of outcome and prognostic factors

Perfusion ◽  
2021 ◽  
pp. 026765912199599
Author(s):  
Esther Dreier ◽  
Maximilian Valentin Malfertheiner ◽  
Thomas Dienemann ◽  
Christoph Fisser ◽  
Maik Foltan ◽  
...  
Keyword(s):  
Lung Compliance ◽  
Ecmo Support ◽  
Short Term ◽  
Single Center Study ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Baseline Characteristics ◽  
Ecmo Therapy ◽  
Vv Ecmo

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.

scholarly journals Proteinuria in COVID-19: prevalence, characterization and prognostic role

2021 ◽  
Author(s):  
Justine Huart ◽  
Antoine Bouquegneau ◽  
Laurence Lutteri ◽  
Pauline Erpicum ◽  
Stéphanie Grosch ◽  
...  
Keyword(s):  
Urinary Catheter ◽  
Single Center ◽  
Tubular Injury ◽  
Tubular Proteinuria ◽  
Prognostic Role ◽  
Urine Creatinine ◽  
Single Center Study ◽  
Center Study

Abstract Background Proteinuria has been commonly reported in patients with COVID-19. However, only dipstick tests have been frequently used thus far. Here, the quantification and characterization of proteinuria were investigated and their association with mortality was assessed. Methods This retrospective, observational, single center study included 153 patients, hospitalized with COVID-19 between March 28th and April 30th, 2020, in whom total proteinuria and urinary α1-microglobulin (a marker of tubular injury) were measured. Association with mortality was evaluated, with a follow-up until May 7th, 2020. Results According to the Kidney Disease Improving Global Outcomes staging, 14% (n = 21) of the patients had category 1 proteinuria (< 150 mg/g of urine creatinine), 42% (n = 64) had category 2 (between 150 and 500 mg/g) and 44% (n = 68) had category 3 proteinuria (over 500 mg/g). Urine α1-microglobulin concentration was higher than 15 mg/g in 89% of patients. After a median follow-up of 27 [14;30] days, the mortality rate reached 18%. Total proteinuria and urinary α1-microglobulin were associated with mortality in unadjusted and adjusted models. This association was stronger in subgroups of patients with normal renal function and without a urinary catheter. Conclusions Proteinuria is frequent in patients with COVID-19. Its characterization suggests a tubular origin, with increased urinary α1-microglobulin. Tubular proteinuria was associated with mortality in COVID-19 in our restropective, observational study.

WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation

2021 ◽  
pp. 1-7
Author(s):  
Orit Kliuk-Ben Bassat ◽  
Doron Schwartz ◽  
Alexander Zubkov ◽  
Amir Gal-Oz ◽  
Alexander Gorevoy ◽  
...  
Keyword(s):  
Bleeding Time ◽  
Control Group ◽  
Dialysis Adequacy ◽  
Cotton Gauze ◽  
Single Center Study ◽  
Time Required ◽  
Venous Fistula ◽  
Thrombosis Rate

<b><i>Introduction:</i></b> Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation. <b><i>Methods:</i></b> This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events. <b><i>Results:</i></b> WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (<i>p</i> &#x3c; 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, <i>p</i> = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups. <b><i>Conclusions:</i></b> WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min.

scholarly journals Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seiichiro Hirono ◽  
Ko Ozaki ◽  
Masayoshi Kobayashi ◽  
Ayaka Hara ◽  
Tomohiro Yamaki ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Awake Craniotomy ◽  
Rank Test ◽  
Wild Type ◽  
Log Rank Test ◽  
Positron Emission ◽  
Single Center Study ◽  
Supratotal Resection ◽  
Subcortical Mapping

AbstractThe oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS). Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI] 14.2–35.1) and not reached (95% CI 30.5-not estimable), respectively; this difference was statistically significant (p = 0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.

scholarly journals Mortality in Patients with Brainstem Cavernous Malformations

2021 ◽  
pp. 1-7
Author(s):  
Julia Velz ◽  
Marian Christoph Neidert ◽  
Yang Yang ◽  
Kevin Akeret ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Cavernous Malformations ◽  
Patient Cohort ◽  
Actual Risk ◽  
Single Center Study

<b><i>Objective:</i></b> Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. <b><i>Methods:</i></b> Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. <b><i>Results:</i></b> Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. <b><i>Conclusion:</i></b> The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.

scholarly journals Prevalence of Feline Immunodeficiency Virus and Toxoplasma gondii in Feral Cats on St. Kitts, West Indies

2021 ◽  
Vol 8 (2) ◽  
pp. 16
Author(s):  
Xinyu Chi ◽  
Kexin Fang ◽  
Liza Koster ◽  
Jevan Christie ◽  
Chaoqun Yao
Keyword(s):  
Toxoplasma Gondii ◽  
Feline Immunodeficiency Virus ◽  
Odds Ratio ◽  
Protozoan Parasite ◽  
Domestic Cat ◽  
Feral Cats ◽  
Immunodeficiency Virus ◽  
Polymerase Chain ◽  
One Year

Toxoplasma gondii (T. gondii) is a cosmopolitan protozoan parasite that infects all warm-blooded species including humans. The definitive hosts of T. gondii are felid vertebrates including the domestic cat. Domestic cats shed oocysts for approximately two weeks in their feces after the primary infection. It has been shown that feline immunodeficiency virus (FIV) positive cats have a higher prevalence of and a higher titer of antibodies to T. gondii than those of FIV-negative cats. The main purposes of this study were to determine FIV prevalence and to investigate the oocysts shedding in FIV-positive and FIV-negative feral cats on St. Kitts. Fecal samples were collected from feral cats while their FIV statues were determined using a commercial SNAP kit. Total fecal DNA of each cat was tested for the presence of T. gondii DNA using a polymerase chain reaction (PCR) consistently detecting one genome equivalent. A FIV-positive status was detected in 18 of 105 (17.1%, 95% confidence interval (CI): 9.9%−24.3%) feral cats sampled. Furthermore, males were three times more likely to be FIV positive than females (p = 0.017) with an odds ratio of 3.93 (95% CI: 1.20–12.89). Adults were found to have at least twice the prevalence of FIV compared to cats younger than one year of age (p = 0.056) with an odds ratio of 3.07 (95% CI: 0.94–10.00). Toxoplasma gondii DNA was not detected in the feces of any of the 18 FIV-positive (95% CI: 0%−0.18%) and 87 FIV-negative cats (95% CI: 0%−0.04%). A follow-up study with a much bigger sample size is needed to prove or disprove the hypothesis that FIV-positive cats have a higher prevalence of shedding T. gondii oocysts than FIV-negative cats.

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