Acute Embolism Research Articles

Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case-control study.

ObjectiveAcute organ embolism in children with Mycoplasma pneumoniae pneumonia (MPP) has been reported, but changes in coagulation are unclear. This study aimed to investigate changes in coagulation in children with MPP.MethodsA total of 185 children with MMP (cases) and 117 healthy children (controls) were recruited. We measured prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and plasma fibrinogen (FIB) and D-dimer levels.ResultsPlasma FIB (3.39 ± 0.96 g/L vs 2.93 ± 0.6 6g/L, t = 4.50) and D-dimer (326.45 ± 95.62mg/L vs 263.93 ± 103.32mg/L, t=5.36) in MPP children were higher than controls and PT (9.54 ± 4.97S vs 11.48 ± 5.96S, t=3.05) and APTT (31.41 ± 12.01S vs 38.38 ± 11.72S, t=4.95) were shorter than controls. FIB, D-dimer, PT, and APTT were not different between the high IgM-titre and low-titre groups. The areas under the receiver operating characteristic curves in cases and controls for plasma FIB and D-dimer levels were 0.654 (95% confidence interval [CI], 0.593–0.716, P = 0.031) and 0.682 (95% CI, 0.619–0.744, P = 0.032), respectively.ConclusionsChildren with MPP have a higher risk of blood coagulation and thrombosis. Controlling these problems should be considered as soon as possible.

Severe pulmonary embolism: surgical aspects

Severe pulmonary embolism is a life-threatening disease requiring a well-balanced therapeutic approach. It is of upmost importance to differentiate between acute pulmonary embolism and chronic pulmonary embolism in this setting. The management of acute embolism is predominantly carried out by the internal specialist, whereas the therapy of chronic pulmonary embolism is in the domain of the surgical community.

Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Vascular Surgery

The National Inpatient Sample (NIS) from years 2010 through 2012 was utilized to determine the incidence, predictive risk factors, and outcomes of heparin-induced thrombocytopenia (HIT) in patients undergoing vascular surgery. Retrospective population-based study. Data from the National Inpatient Sample (NIS) (2011 through 2013) using specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes corresponding with vascular surgery. 425,379 hospital admissions in patients which underwent vascular surgery. Among these, 1,290 (0.31%) were diagnosed with HIT, and 17,765 (4.18%) were diagnosed with secondary thrombocytopenia. The incidence of HIT is 0.3% in the vascular surgery population. The highest incidence is observed in thoraco-subclavian and vein reconstruction procedures. This study indicated that liver disease, endocarditis, chronic renal failure, congestive heart failure, atrial fibrillation, obesity, and female sex are associated with a higher incidence of HIT in this population. In vascular surgery patients, HIT can increase mortality by 3-fold and lead to severe complications such as acute renal failure, venous embolism, pulmonary embolism, and respiratory failure. The incidence of HIT in the vascular surgery population is similar to previously reported incidence in cardiac surgery patients. In the vascular surgery population, mortality increases 3-fold in patients with HIT versus those without any thrombocytopenia. Understanding the associated risk factors and complications will allow clinicians to make informed decisions and anticipate HIT and associated complications in certain high-risk populations.

Assessment of Endovascular Management of Extracranial Internal Carotid Artery Stenosis

Background: carotid artery stenting (CAS) had become widely used as an alternative to carotid endarterectomy (CEA) in revascularization therapy of carotid artery stenosis, especially in some high risk patients for surgical intervention. Objective: the purpose of this study was to evaluate the outcome and follow up of cases that undergo extracranial CAS at the Neuroendovascular Unit of Ain Shams University Hospital. Methods: during a 30 month period, 50 cases were enrolled and underwent carotid artery stenting with open cell (Protege® - EV3) or closed cell (Wall stent® - Boston scientific) stents. A filter device for embolic protection (Spider filter® - EV3) was used. Clinical assessment with the National Institute of Health Stroke Scale (NIHSS) together with post procedural diffusion-weighted magnetic resonance imaging (DW-MRI) was used to determine cerebral embolization. Results: CAS was performed in 50 cases; 40 (80%) symptomatic and 10 (20%) asymptomatic . A similar number of open-cell and closed-cell stents were used. New acute cerebral emboli were detected with DW-MRI in 12% (6/50) of cases after the procedure. Three (3/50) cases (6%) showed corresponding clinical deterioration in NIHSS; two cases developed minor stroke and the third case developed a major stroke. Conclusion: CAS at Ain Shams Neuroendovascular Unit showed a high technical success rate and good short term clinical outcome.

TCTAP C-218 Successful Percutaneous Revascularization in a Patient with Acute Renal Artery Embolism

TCTAP C-218 Successful Percutaneous Revascularization in a Patient with Acute Renal Artery Embolism

Nursing research progress of lower limb ischemic pain

Lower limb ischemic pain is the disease of lower extremity arteriosclerosis occlusion, buerger's disease, acute lower limb artery embolization common pain and other regular symptoms of vascular surgical disease. The pain is unbearabl, and no special treatment, seriously affect the quality of life. In this paper will review the related research at home and abroad, from the pain of the characteristics of the relevant assessment tools, the characteristics of the pain, the pain of the related nursing measures this three aspects, in order to provide evidence for reducing the patient's physical and mental pain, and promoting the recovery of patients effectively for the patients with lower limb ischemic pain. Key words: Review; Pain; Ischemia; Nursing care; Assessment

The effects of oral acetylsalicylic acid onblood fluidity and infusion speed inthecancer patients with PICC.

This study aimed to examine the influence of oral acetylsalicylic acid on blood fluidity and infusion speed in the cancer patients with Peripherally Inserted Central Catheter (PICC). PICC is placed for prolonged chemotherapy of cancer patients. The fibrin sheaths, which consist of cellular substance and non-cellular substance, generate at the place of insertion and grow down all over the catheter. Finally they cover the vent of the catheter and lead to catheter dysfunctions such as the decrease of infusion speed. In addition, the high viscosity status of cancer patients could lead to acute embolization, which adds to the high risk of death. Randomized controlled trial. This research was carried out between April 2013 and January 2014 in the second hospital of Xiangya, Central South University in Changsha, China. Initially 96 cancer participants with PICC were chosen and randomly allocated to experimental and control group. The participants of the experimental group were conducted route PICC maintain technique and took acetylsalicylic acid 100 mg per day after dinner, while the control group received route PICC maintain technique only. The infusion speed and hemorheology indexes of the two groups were tested before our study and at the end of the 2nd and 4th months with several instruments. Repeated measures analysis of variance indicated that taking acetylsalicylic acid orally had significant main effect on high shear blood viscosity and red blood cell deformability index (P < 0.05), and it also had significant main effect as well as time effect on plasma viscosity (P < 0.05); and time had significant main effect as well as interaction effect with oral acetylsalicylic acid on low shear blood viscosity and red blood cell aggregation index (P < 0.05). Repeated measures ANOVA also showed that taking acetylsalicylic acid orally had significant main effect, time effect and interaction effect on infusion speed (P < 0.01). Oral acetylsalicylic acid could improve hemorheology condition and the infusion speed related to fibrin sheath in the cancer patients.

A general description for Chinese medicine in treating premature ovarian failure.

Premature ovarian failure (POF) is a kind of gynecological disease that causes amenorrhea, infertility, menopause and urogenital symptoms. Currently hormone replacement therapy (HRT) is the most popular choice for women with POF to get rid of menopausal syndrome. However, as the popularization of Chinese herbs made Chinese medicine (CM) shine new lights, physicians are able to treat POF with both meno-herbs and integrated therapy. HRT has its own indications and contraindications. For example, unexplained vaginal bleeding, acute liver damage, liver dysfunction, vascular embolization, and breast cancer are all contraindications of HRT, and CM is taken by more physicians as an adjuvant therapy. This review, including a range of common Chinese herbs and formulations according to the existing literature, provides a general description of CM treating POF from the aspects of mechanisms and clinical application. It also highlights acupuncture as a unique physiotherapy for POF. Although the validity of CM has been supported by the evidence of many preclinical trials, clinical trials and meta-analysis, the adverse events with CM therapy still exist and no guarantee has been made for its safety. This review concludes the updated information for CM treating POF contributing to further studies.

Machine Learning Algorithms Dramatically Improve the Accuracy and Time to Diagnosis of Pulmonary Embolisms

Acute pulmonary embolism is a common diagnostic challenge across the all hospitals in the US. Diagnosis can be delayed due to a number of variables including, but not limited to, the diagnostic time in medical imaging. The presented algorithm offers a solution to such delays by allowing treating physicians an accurate preliminary report. This gained time advantage should translate into a faster treatment response by the ED team. Moreover, the algorithm is designed to accurately depict pulmonary artery and veins and accounts for respiratory artifact during scan acquisition. As second and third pass search is initiated, the algorithm continues to “learn” upon the subsequent pass. Hence, each application is produces greater diagnostic accuracy. We hope this abstract clearly outlines how the latest developments in machine learning algorithms can aid in diagnostic fidelity of acute embolic events.

A Multidisciplinary Approach to a Complicated Acute Paradoxical Embolism via a Patent Foramen Ovale

A Multidisciplinary Approach to a Complicated Acute Paradoxical Embolism via a Patent Foramen Ovale

Acute embolisation of Watchman plug onto aortic bioprosthesis followed by successful percutaneous removal.

Acute embolisation of Watchman plug onto aortic bioprosthesis followed by successful percutaneous removal.

Akut üst ekstremite arteryel embolileri: 2 yıllık klinik deneyimimiz

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment.

Rosuvastatin prevents aortic arch plaque progression and improves prognosis in ischemic stroke patients

Objectives: Complicated aortic arch plaques (CAP) and their progression are important for recurrent ischemic stroke (IS) and its prognosis. We investigated the effects and clinical benefits of rosuvastatin therapy on this pathophysiology. The purpose of this study was to investigate whether rosuvastatin prevention of aortic arch plaque progression improved the prognosis of IS patients.Methods: Ninety-seven consecutive acute cerebral embolism patients were retrospectively surveyed. All had transesophageal echocardiography (TEE) to assess the presence or absence of CAP, defined as aortic wall thickness ≥4 mm or plaque ulceration. Patients received conventional antithrombotic therapy as clinically indicated. All patients with CAP were recommended to receive 5 mg rosuvastatin/day, administered by their attending physicians; not all physicians followed this recommendation. Six-month follow-up TEEs were performed in patients with CAP who received rosuvastatin. Major adverse cerebrovascular events (MACEs) comprised recurrent IS and death.Results: CAP was detected in 39 patients (40%), and MACEs in 15. Multivariate regression analysis showed that patients with CAP not taking rosuvastatin was an independent risk factor for MACEs (odds ratio = 18.044; 95% confidential interval = 2.089–155.846, p < 0.01). When patients were divided into three groups: those with CAP taking rosuvastatin, those with CAP not taking rosuvastatin, and those without CAP, Kaplan–Meier analysis demonstrated that patients with CAP not taking rosuvastatin had significantly more MACEs than those in the other two groups (long-rank test; χ2 = 6.553, p < 0.05). Six-month TEE follow-ups in the 26 patients with CAP taking rosuvastatin showed significant improvement in CAP diameter with improved lipid profiles; 88% (23/26 patients) showed no morphological CAP progression; 15 of these showed CAP regression.Discussion: Rosuvastatin therapy prevented aortic arch plaque progression in IS patients with CAP, and may also have long-term clinical benefits.

Venetoclax Combined with Bortezomib and Dexamethasone for Patients with Relapsed/Refractory Multiple Myeloma

Venetoclax Combined with Bortezomib and Dexamethasone for Patients with Relapsed/Refractory Multiple Myeloma

Acute pulmoner embolism mimicking acute coronary syndrome can misdirect the diagnostic approach

Acute pulmoner embolism mimicking acute coronary syndrome can misdirect the diagnostic approach

Diagnosis and treatment of acute superior artery embolism: analysis of 10 cases

Objective To explore the early diagnosis, surgical treatment and clinical effect of acute superior mesenteric artery embolism. Methods Base on the retrospectively study of the clinical data of 10 patients with acute superior mesenteric artery embolism, all the patients were treated with routine blood test, D-dimer, abdominal ultrasound, abdominal CT examination.At the same time, partial selective superior mesenteric artery angiography was performed.Patients with definite or highly suspected of mesenteric artery embolism, such as no absolute surgical procedure, were treated by immediate surgical fixation.Superior mesenteric artery embolism was confirmed in the surgery.Then Operation was decided according to intestinal necrosis.Fogaty catheter removal was applied to the main trunk of the superior mesenteric artery.At the same time, such as the discovery of branches of vascular embolism, the therapy using direct injection of urokinase in local embolism was performed because of difficulty in embolectomy for narrow vessels.Then anticoagulation therapy was performed after surgery. Results Among them, 1 case gave up treatment from the hospital, 2 cases died of multiple organ failure after operation, and 7 cases recovered well after operation. Conclusion Early diagnosis of acute superior mesenteric artery embolization combined with early surgical treatment is the key to the treatment of acute superior mesenteric artery embolism.The cure rate can be significantly improved and the mortality rate can be reduced.Fogaty catheter was applied to treat acute superior mesenteric artery embolism with the therapy using direct injection of urokinase in local embolism has the characteristics of quick effect and curative effect. Key words: Embolism; Mesenteric artery, Superior; Thrombolytic therapy

Acute brachial artery thrombosis with diabetic ketoacidosis

Background: Diabetes Mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis. Diabetic ketoacidosis is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. There is one report where diabetic ketoacidosis was reported to be associated with acute arterial embolism. Acute arterial thrombosis is a rare disease that requires immediate treatment. Methods: We present a diabetic patient who presented with acute arterial embolism and developed diabetic ketoacidosis. This is the first case in our hospital in which we have reported with acute brachial artery thrombosis and DKA. Results: We present a 68 years old male chronic smoker with a 25 year history of type 2 Diabetes (non-compliant to medications), Peripheral vascular disease, dyslipidemia and transient ischemic attack. He experienced severe pain and numbness in his right arm and forearm with no wound, puncture lesion or ecchymosis. Forearm was cold, pale with delayed capillary refill on right hand. Right brachial, right radial and right ulnar arteries were not palpable. Strong pulsations of the right subclavicular and right carotid arteries were palpated. This led to a strong suspicion of an acute thrombosis of the right brachial artery. Emergency thrombectomy with +/ − fasciotomy was planned. Patient was anticoagulated with intravenous heparin. Patient's blood sugar was persistently elevated and blood gases showed mild acidosis. Urinary examination confirmed presence of diabetic ketoacidosis. Conclusions: A high index of suspicion of diabetic ketoacidosis in patients with acute arterial thrombosis may lead to early recognition and treatment, avoiding any adverse outcome.

Corrigendum: Interventional Therapy for Bilateral Acute Renal Artery Embolism Caused by Paroxysmal Atrial Fibrillation.

[This corrects the article DOI: 10.4103/0366-6999.181956.].

Are inflammatory parameters predictors of amputation in acute arterial occlusions?

Background The aim of the present study was to investigate the role of inflammatory markers to predict amputation following embolectomy in acute arterial occlusion. Methods A total of 123 patients operated for arterial thromboembolectomy due to acute embolism were included in the study. The patients without an extremity amputation following thromboembolectomy were classified as Group 1 ( n = 91) and the rest were classified as Group 2 ( n = 32). These groups were compared in terms of clinical and demographic characteristics, C-reactive protein, complete blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red cell distribution width. Results The average age was 68.0 ± 11.7 years. The most common thromboembolism localization was femoral artery. When preoperative mean C-reactive protein ( p = 0.0001), mean platelet volume ( p = 0.0001), platelet-lymphocyte ratio ( p = 0.0001), neutrophil-lymphocyte ratio ( p = 0.0001) and red cell distribution width ( p = 0.0001) were compared, a statistically significant difference was observed between groups. In univariate and multivariate regression analysis, higher levels of preoperative C-reactive protein ( p = 0.009) and mean platelet volume ( p = 0.04) were detected as independent risk factors of early extremity amputation. Conclusion We observed that preoperative mean platelet volume and C-reactive protein were predictors of amputation after thromboembolectomy in acute arterial occlusion.

Acute Renal Artery Embolism Secondary to Atrial Fibrillation - An Uncommon Manifestation of a Common Disease

Abstract Atrial fibrillation is a commonly encountered clinical condition, especially in predisposing conditions like rheumatic heart disease. The typical manifestations are palpitations and breathlessness. However, infrequently, it manifests in the form of certain complications. We present a case of a patient with rheumatic heart disease with valvular lesions with atrial fibrillation who presented with acute abdomen and on investigation was found to have renal artery embolism.