Life-threatening Clinical Entity Research Articles

MYCOTIC PULMONARY ARTERY ANEURYSM SECONDARY TO SEPTIC EMBOLI: A POTENTIALLY LIFE-THREATENING COMPLICATION OF INFECTIVE ENDOCARDITIS

MYCOTIC PULMONARY ARTERY ANEURYSM SECONDARY TO SEPTIC EMBOLI: A POTENTIALLY LIFE-THREATENING COMPLICATION OF INFECTIVE ENDOCARDITIS

Bilateral Central Retinal Vein Occlusion as a First Presentation of Multiple Myeloma: A Case Report

Introduction: Acute presentation of multiple myeloma in the emergency department (ED) is an uncommon yet life-threatening clinical entity. Case Report: A 42-year-old male presented to the ED with severe generalized fatigue and vision changes most notable in his left eye. Bilateral central retinal vein occlusion (CRVO) was diagnosed on dilated fundus exam in the ED. Conclusion: The most common cause of CRVO in adults over age 50 is vascular disease, but in younger adults, conditions of systemic inflammation or hyperviscosity must be considered. Diagnosis of CRVO requires emergent ophthalmology consultation and further treatment with phototherapy, steroids, and potentially anti-vascular endothelial growth factor. Ultimately, patients require hematology/oncology and ongoing management of acute hyperviscosity syndrome. We present this case to increase awareness surrounding this diagnosis among emergency physicians. Multiple myeloma should be considered in young patients who present to the ED with bilateral CRVO, acute renal failure, and symptomatic anemia.

Clinical features and outcomes of four atypical hemolytic uremic syndrome cases at a single institution in Miyazaki Prefecture from 2015 to 2019

BackgroundAlthough atypical hemolytic uremic syndrome (aHUS) is a life-threatening clinical entity that was characterized by thrombotic microangiopathy (TMA) with the activation of the complement system and the efficient treatment of eculizumab, the clinical features of aHUS have been unclear because of the rare incidence.Case presentationWe retrospectively analyzed 4 aHUS cases at a single institution during 2015–2019. Here, we presented 4 aHUS cases with renal transplantation (one case), influenza/acute interstitial pneumonia/disseminated intravascular coagulation (two cases), and severe fever with thrombocytopenia syndrome (one case), respectively. Initial clinical symptoms were microangiopathic hemolytic anemia (four cases), renal dysfunction (four cases), thrombocytopenia (four cases), and pulmonary hemorrhage (three cases) consisted with TMA features. Subsequent further examinations ruled out thrombotic thrombocytopenic purpura, Shiga toxin-producing E.coli-induced hemolytic uremic syndrome, and secondary TMA. Taken these findings together, we made the clinical diagnosis of aHUS. Furthermore, all cases also presented the high levels of plasma soluble C5b-9 (871.1 ng/ml, 1144.3 ng/ml, 929.2 ng/ml, and 337.5 ng/ml), suggesting persistent activation of complementary system. Regarding the treatment, plasma exchange (PE) (four cases) and eculizumab (two cases) therapy were administered for aHUS cases. Consequently, case 2 and case 4 were still alive with 768 days and 235 days, respectively. The other two cases were dead at 34 days and 13 days, respectively. Finally, although the previous reported genetic pathogenetic mutations were not detected in our cases, multiple genetic variants of complement factors were detected as CFH (H402Y, E936D), and THBD (A473V) in case 1, CFH (V62I, H402Y, V837I) in case 2, and CFH (H402Y, E 936D) and THBD (A473V) in case 3, CFH (V62I, H402Y, E936D) and THBD (473V) in case 4, respectively.ConclusionsBecause of still high mortality in our study, an urgent diagnosis of aHUS and subsequent immediate treatment including PE and eculizumab should be essential in clinical practice. Furthermore, the multiple genetic variants and the triggers may be related to one of the pathogenesis of aHUS. Thus, we assume that such a case-oriented study would be highly useful to the physicians who directly care for aHUS cases in clinical practice.

Clinical characteristics and outcome of patients with acute mesenteric ischemia: a retrospective cohort analysis

BackgroundAcute mesenteric ischemia (AMI) is an uncommon, but life-threatening clinical entity due to late diagnosis resulting in irreversible ischemic bowel necrosis. The most common causes of AMI are the embolic occlusion and the acute thrombosis of the mesenteric circulation. Typical treatment is composed of an early revascularization of the mesenteric circulation followed by abdominal surgery for resection of nonviable intestine and restoration of the intestinal continuity, but the mortality rates remain high.MethodsA retrospective cohort analysis was conducted, aiming to evaluate clinical characteristics, performed surgical procedures and outcomes of patients with acute mesenteric ischemia who underwent emergency abdominal surgery at a high volume surgical center in Germany.ResultsOverall, 53 patients were identified with the intraoperatively proven diagnosis of AMI. Overall hospital mortality was with 62% comparable to the literature. Nineteen patients presented with an intraoperatively verified complete and non-reversible intestinal infarction without any angiographic or surgical option for a revascularization of the mesenteric circulation or an option for intestinal resection. From the rest of the patients, 14 underwent intestinal resection of the ischemic area without restoration of intestinal continuity; the other 20 underwent resection with a primary anastomosis to restore intestinal continuity. The mortality rate of these patients with curative-intended surgery remained high (41% of patients died). Pre- and postoperative hyperlactatemia were associated with lower survival of these patients.ConclusionAMI remains a life-threatening abdominal emergency. Therapeutic approaches are highly depended on acting surgeon’s decision, being affected by subjectively rated bowel viability and physical condition of the affected patient. Only selected patients with good bowel viability appear to be suitable for receiving primary anastomosis. The results clearly indicate the need for further research to develop therapeutic approaches for a better management of AMI and to improve outcome of affected patients.

Deep Neck Abscess

Background: Deep neck abscess is a life-threatening clinical entity. It can result in significant morbidity for the patients. Deep neck abscess continues to be commonly found in developing countries like India. Methods: A retrospective study was conducted at tertiary care teaching hospital in eastern India from September 2016 to October 2021. The medical records of patients diagnosed with deep neck abscesses with an age range between 18 years and 65 years were reviewed. This study analyzes the etiology, clinical manifestations, diagnosis, and treatment of the deep neck abscess. Results: There was a predominance of male patients with deep neck abscesses (62.12%) and a mean age of 32.4 years. The most common clinical manifestation was fever (26.51%), followed by odynophagia (23.48%), neck swelling (20.45%), restricted neck movement (13.63%), otalgia (12.12%), trismus (11.36%), neck pain (10.60%), and stridor (2.27%). The peritonsillar abscess (28.78%) was the most commonly affected space of the deep neck abscess of this study. The important life-threatening complication in this study was stridor (2.27%). Conclusion: Early diagnosis, aggressive surgical intervention, and proper airway management are important factors for reducing the morbidity and mortality associated with deep neck abscesses.

Spondylodiscitis Caused by Aspergillus Species.

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is an uncommon life-threatening clinical entity with a reported incidence rate of 0.09 to 0.2% per patient-year at tertiary referral centers. Diagnosis is challenging: the initial presentation of abdominal pain is vague, varied, and similar to other, more common, pathologic abdominal conditions. This review covers clinical evaluation, investigative studies, management, intraoperative consultation, determination of bowel viability, mesenteric ischemia and reperfusion, and outcome after surgical treatment of AMI. Figures show computed tomographic (CT) scan of mesenteric vessels, CT scan of a partially occluding thrombus in the superior mesenteric vein, contrast-enhanced three-dimensional magnetic resonance angiography images of aorta and mesenteric vessels, a schematic drawing demonstrating the usual site for superior mesenteric artery (SMA) thrombosis versus that for SMA embolus, selective angiogram of the SMA in anterior projection demonstrating embolus within the vessel at the typical location, lateral contrast angiogram demonstrating near-occlusion of the celiac artery and total occlusion of the SMA, contrast angiograms of the aorta and mesenteric arteries in a patient with nonocclusive mesenteric ischemia, selective angiogram of the SMA demonstrating a partially occluding embolus in the distal vessel, selective angiogram showing a clot beyond the orifice of the SMA, lodged in the SMA of smaller caliber, algorithm illustrating intraoperative determination of bowel salvageability, evaluation of SMA pulses, and assessment of bowel viability after revascularization, and an intraoperative photograph of diffuse bowel ischemia with classic sparing of the proximal jejunum and transverse colon due to embolus of the SMA. This review contains 11 highly rendered figures and 65 references

Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is an uncommon life-threatening clinical entity with a reported incidence rate of 0.09 to 0.2% per patient-year at tertiary referral centers. Diagnosis is challenging: the initial presentation of abdominal pain is vague, varied, and similar to other, more common, pathologic abdominal conditions. This review covers clinical evaluation, investigative studies, management, intraoperative consultation, determination of bowel viability, mesenteric ischemia and reperfusion, and outcome after surgical treatment of AMI. Figures show computed tomographic (CT) scan of mesenteric vessels, CT scan of a partially occluding thrombus in the superior mesenteric vein, contrast-enhanced three-dimensional magnetic resonance angiography images of aorta and mesenteric vessels, a schematic drawing demonstrating the usual site for superior mesenteric artery (SMA) thrombosis versus that for SMA embolus, selective angiogram of the SMA in anterior projection demonstrating embolus within the vessel at the typical location, lateral contrast angiogram demonstrating near-occlusion of the celiac artery and total occlusion of the SMA, contrast angiograms of the aorta and mesenteric arteries in a patient with nonocclusive mesenteric ischemia, selective angiogram of the SMA demonstrating a partially occluding embolus in the distal vessel, selective angiogram showing a clot beyond the orifice of the SMA, lodged in the SMA of smaller caliber, algorithm illustrating intraoperative determination of bowel salvageability, evaluation of SMA pulses, and assessment of bowel viability after revascularization, and an intraoperative photograph of diffuse bowel ischemia with classic sparing of the proximal jejunum and transverse colon due to embolus of the SMA. This review contains 11 highly rendered figures and 65 references

Clinico-Laboratory Features and Associated Factors of Lupus Mesenteric Vasculitis.

IntroductionLupus mesenteric vasculitis (LMV) is a rare but potentially life-threatening clinical entity in systemic lupus erythematosus (SLE) patients.ObjectiveThe present study was initiated to explore the clinical features and associated factors of LMV in SLE patients.MethodsWe conducted a retrospective study on 50 cases of SLE patients with lupus mesenteric vasculitis (LMV) from January 2010 to December 2019 and 89 cases of non-LMV-SLE patients with similar demographic and comorbidities were included as control. All the data regarding clinical features, laboratory findings, and treatment were reviewed independently by two experts in the field. Both univariate and multivariate logistic regression analyses were employed to identify the associated factors of LMV.ResultsThe incidence of LMV was 2.9% among hospitalized SLE patients in the current study. The most frequent symptom and physical sign of LMV were respectively abdominal pain (48, 96%) and abdominal tenderness (45, 90%). Through univariate and subsequent multivariate analysis, oral ulcer (OR, 4.25; P = 0.024), urinary tract involvement (OR, 5.23; P = 0.021), and elevated D-dimer (OR, 1.121; P = 0.008) were demonstrated to be positively associated with LMV, while percentage of lymphocytes (OR, 0.928; P = 0.004) and complement 3 (OR, 0.048; P = 0.008) were negatively correlated with LMV.ConclusionsOral ulcer, urinary tract involvement, reduced percentage of lymphocytes and complement 3, elevated D-dimer could be associated factors for LMV in SLE patients.

Case Report: A patient with extreme hyperkalemia beats all the odds

Hyperkalemia is a common finding in patients in hemodialysis and is typically classified as mild, moderate or severe. Severe hyperkalemia is a complex and life-threatening clinical entity, closely associated with increased mortality rates. It generally presents with ascending muscle weakness and paralysis, cardiac arrhythmias and specific ECG changes. Herein, we present the case of a 30-year-old patient with end-stage renal disease, on hemodialysis. He presents to his hemodialysis session with complaints of progressive weakness and paralysis of his lower extremities, palpitations and dyspnea. His last session was 5 days prior to his ER presentation, after having missed 2 sessions. Laboratory studies revealed a serum potassium level of 10.9 mg/ dL. Intravenous calcium infusion was administered urgently and subsequently underwent urgent hemodialysis. The next day he underwent another session due to the post-hemodialysis rebound effect, but on physical examination the lower limb paralysis had improved and normal, sinus rhythm was present. Considering its silent development and ambiguous clinical presentation, hyperkalemia should invariably be considered in patients with CKD presenting with cardiac and neurological symptoms. Reported cases of severe hyperkalemia with potassium concentrations higher than 10 mg/dL, as in the case of our patient, are sparse and represent rapidly deteriorating, life-threatening conditions, requiring emergent medical interventions to prevent fatal cardiac arrhythmias.

Anaesthetic management of a parturient patient with peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare life-threatening clinical entity of unknown aetiology. The hallmark of the disease is the onset of decreased left ventricular ejection fraction either in late pregnancy or puerperium. The clinical presentation and the basic and intensive interventional strategies of the disease are more or less similar to that of dilated cardiomyopathy due to any other cause. Apart from intensive care management, these patients also require anaesthetic intervention for the management of painless labour for either vaginal or operative delivery. Favourable maternal and foetal outcomes require haemodynamic goals to be always kept in mind while choosing the technique and drugs to provide anaesthesia to the patients with PPCM. We report the case of a patient with PPCM requiring emergency lower segment caesarean section who was managed with titrated epidural anaesthesia.

Clinical risk factors for the development of late-onset circulatory collapse in premature infants.

Very low birth weight (VLBW) infants may be at risk for late-onset circulatory collapse (LCC) where otherwise stable infants develop hypotension resistant to vasoactive agents. The risk factors for LCC development are poorly defined, and it has been theorized that it may be in part due to withdrawal from exogenous prenatal steroids. The goal of this study was to define the clinical characteristics of LCC and investigate its association with antenatal steroid administration. This is a retrospective cohort study of infants born ≤1500 g. LCC was retrospectively diagnosed in infants requiring glucocorticoids for circulatory instability at >1 week of life. Demographic and clinical characteristics were compared between groups using Mann-Whitney test. Three hundred and ten infants were included; 19 (6.1%) developed LCC. Infants with LCC were born at a median 4.6 weeks' lower gestation, 509 g lower birth weight than those without LCC. There was no difference in antenatal steroid delivery between the groups. LCC occurs in a distinct subset of VLBW infants, suggesting the need for monitoring in this high-risk population. Antenatal steroids did not significantly increase the risk of LCC development in this study. Late-onset circulatory collapse (LCC) is a life-threatening clinical entity occurring in around 6% in VLBW infants and is likely underdiagnosed in the United States. Targeting specific demographic characteristics such as birth weight (<1000 g) and gestational age at birth (<26 weeks) may allow for early identification of high-risk infants, allowing close monitoring and prompt treatment of LCC. No significant association was found between antenatal steroid administration and LCC development, suggesting that the theoretical risks of antenatal steroids on the fetal HPA axis does not outweigh the benefits of antenatal steroids in fetal lung maturity. To date, no studies characterizing LCC have originated outside of Asia. Therefore, providing a description of LCC in a U.S.-based cohort will provide insight into both its prevalence and presentation to inform clinicians about this potentially devastating disorder and foster early diagnosis and treatment. This study validates LCC characteristics and prevalence previously outlined by Asian studies in a single-center U.S.-based cohort while also identifying potential risk factors for LCC development. This manuscript will provide education for U.S. physicians about the risk factors and clinical presentation of LCC to facilitate early diagnosis and treatment, potentially decreasing neonatal mortality. With prompt recognition and treatment of LCC, infants may have decreased exposure to vasoactive medications that have significant systemic effects.

Deep neck space infection of the pediatric patients: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Deep neck space infections are uncommon life-threatening clinical entity. It can cause significant morbidity in the pediatric age group. Objective: This study analyzes the clinical presentations, diagnosis, and management of the deep neck space infection of the pediatric patients. Materials and Methods: A retrospective study was conducted at a tertiary care teaching hospital during May 2015–June 2020. The medical records pediatric patients diagnosed with deep neck space infections with age

3100 Acute Esophageal Necrosis (Gurvits Syndrome) in a 78-Year-Old Male Filipino Patient

INTRODUCTION: Acute Esophageal Necrosis (AEN), also known as Gurvits Syndrome and commonly referred to as Black Esophagus, is a rare life-threatening clinical entity with an estimated prevalence of 1 to 200 in 100,000 and a mortality rate of approximately 30%. Only 88 patients over a span of 40 years have been reported. It is associated with geriatric males, diabetes mellitus, GERD, CKD, hypertension, vascular disease, alcohol abuse, malnourishment, ingestion of caustic agents and some medications. These factors predispose a patient to AEN through hemodynamic compromise, low-flow states, tissue hypoperfusion, corrosive injury and diminished mucosal defenses. Upper GI bleeding is the presenting complaint in around 90% of cases. It is diagnosed on endoscopy where characteristically, a diffuse, circumferential, necrotic esophageal mucosa is seen. The treatment for AEN aims to address the underlying medical illness, maintain and restore hemodynamic stability with intravenous fluid resuscitation and blood transfusions, attain complete esophageal rest, gastric acid suppression and antimicrobials. CASE DESCRIPTION/METHODS: A 78-year-old Filipino man developed hematemesis on a background of T2DM, hypertension, NSAID use and excessive alcohol use. He had no GI signs or symptoms prior to this episode. Four hours later he became drowsy and confused and was noted to be in hyperosmolar hyperglycemic state. An endoscopy revealed a distinctly diffuse circumferential necrosis of the esophagus with abrupt demarcation at the gastroesophageal junction. The gastric mucosa and biopsies were unremarkable. CT showed a distended aperistaltic esophagus with circumferential thickening with no evidence of perforation. Post endoscopy he was treated in ICU where he was maintained on parenteral nutrition, meropenem, nystatin, pantoprazole and insulin. Repeat endoscopy 7 days later showed pink mucosa after appropriate glycemic control, bowel rest and hemodynamic stabilization. He was discharged 3 days later. DISCUSSION: This is the first known report of a Filipino diagnosed with AEN. He presented with hematemesis, many of the risk factors associated with AEN, and his endoscopic findings were classic for AEN. However, he was only diagnosed sometime after endoscopy. This case highlights that AEN may be underdiagnosed and that clinicians should be mindful of it as populations develop more co-morbidities and risk factors that predispose them to developing it. This case also highlights the reversibility of this life-threatening condition.

2687 A Rare Case of Organoaxial Volvulus of the Stomach

INTRODUCTION: Gastric volvulus is an uncommon and potentially life-threatening clinical entity characterized by rotation of the stomach along its long or short axis provoking variable degrees of gastric outlet obstruction. Clinical presentation varies between acute and chronic volvulus. Here we present a rare case of chronic organoaxial volvulus presenting with dysphagia. CASE DESCRIPTION/METHODS: The patient is an 87 year old male with a medical history of hypertension, obstructive sleep apena, multi-nodular goiter (with thyroid resection resulting in vocal cord paralysis) who was referred to the gastroenterology clinic for dysphagia. The patient states he had dysphagia to solids for one year. The patient denied associated nausea, vomiting, hematemesis, hematochezia, constipation or unintended weight loss. Complete blood count and comprehensive metabolic panel at that time were unremarkable. Physical exam was also unremarkable. Given his symptoms a barium swallow was ordered to further evaluate his gastrointestinal tract. This was done and showed no evidence of esophageal obstruction or esophageal mass, but did incidentally find organoaxial rotation of the stomach. The patient was scheduled to undergo upper esophagogastroduodenoscopy, but was non-compliant with the appointment and lost to follow up. DISCUSSION: Acute gastric volvulus usually presents with sudden onset abdominal or chest pain, severe retching with occasional vomiting, and epigastric distention. Chronic gastric volvulus on the in contrast can present with a complete absence of symptoms to non- specific symptoms, such as abdominal pain, dyspepsia, dysphagia, acid reflux, nocturnal cough, hiccups, non-bilious vomiting, weight loss, and anemia. Diagnosis of gastric volvulus is conventionally achieved with chest radiograph, upper barium studies or CT- scan. Regardging treatment of acute symptomatic gastric volvulus, nasogastric decompression is usually the first step, followed by surgery. Some patients at high risk for surgery, mainly elderly, can also be treated endoscopically with adequate decompression and reduction of the stomach and placement of a gastrostomy tube to gastropexy the stomach to the abdominal wall.

Toxic megacolon

Toxic Megacolon (TM) is a rare life-threatening clinical entity characterized by total or segmental colonic distension in the setting of acute colitis and signs of systemic toxicity. It arises in a setting of almost any colitis, however ulcerative colitis (UC) and clostridium difficile-associated disease (CDAD) are the most common causes. The mainstays of diagnosis are clinical and laboratory assessment of systemic toxicity and underlying colitis as well as abdominal imaging demonstrating colonic distension. Medical therapy including resuscitation, electrolyte repletion, antibiotics, discontinuation of antimotility agents, and treatment of the underlying colitis is warranted in the absence of severe toxicity, perforation, or severe hemorrhage. However, 25–50% of patients with TM ultimately require colectomy, typically in the form of total abdominal colectomy with end ileostomy.

Acute Retroperitoneal Hemorrhage Induced by Giant Adrenal Myelolipoma Mimicking Renal Colic Pain: A Case Report

Retroperitoneal hemorrhage is a life-threatening clinical entity which is difficult to diagnose due to numerous etiology and unspecific symptoms. Spontaneous severe retroperitoneal hemorrhage, known as Wunderlich’s syndrome presented with Lenk’s triad, includes acute flank pain, flank mass, and hypovolemic shock. Giant adrenal myelolipoma causing Wunderlich’s syndrome is rare. Here, we presented a 59-year-old woman with spontaneous acute onset persistent left flank pain. The kidney, ureter, and bladder (KUB) study revealed left renal stones. The abnormal D-dimer level and progressive symptoms alerted emergency physicians to intervene timely. The computed tomography (CT) scan revealed a giant adrenal mass with retroperitoneal hemorrhage. After hemodynamically controlled and surgical intervention, she recovered and was followed up at the outpatient department (OPD). In this article, we highlight that myelolipoma-induced spontaneous retroperitoneal hemorrhage may cause Wunderlich’s syndrome and lead to hypovolemic shock. It is important for emergency physicians to intervene timely. Early diagnosis and management lead to a better outcome.

Surgical management of cardiac tamponade: Is left anterior minithoracotomy really safe and effective?

Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based techniques to surgical pericardiotomy. The Authors report their experience in surgical management of cardiac tamponade and an exhaustive review of literature. Methods: This study involved 61 patients (37 males and 24 females) with an average age of 61.80 ± 16.32 years. All patients underwent emergency surgery due to the presence of cardiac tamponade. Results: Cardiac tamponade was caused by a benign disease in 57.40% of patients. In cancer patients group, lung cancer, breast cancer and malignant pleural mesothelioma were the most common neoplasms (17-27, 87%). The average preoperative size of pericardial effusion at M-2D echocardiography was 30.15 ± 5.87 mm. Postoperative complications were observed in 11 patients (18%). The reoperation rate was 3.3% (2 patients) due to relapsed cardiac tamponade. 30-day mortality rate was 3.3%. Overall cumulative survival was 29.9 ± 20.1 months. Twenty-nine patients (47.5%) died during the follow up period. By dividing the population into two groups, group B (benign) and group M (malignant), there was a statistically significant difference (P < 0.001) in terms of survival. Conclusion: In conclusions, anterior minithoracotomy for surgical treatment of cardiac tamponade has to be held into account in patients both with benign diseases and malignancies.

Effect of different doses of 2‑aminoethoxydiphenyl borate on intestinal ischemia-reperfusion injury

Acute mesenteric ischemia is a life-threatening clinical entity. 2‑Aminoethoxydiphenyl borate (2-APB) is a membrane-permeable modulator of intracellular inositol triphosphate-induced calcium release. We investigated the effects of different 2‑APB doses on intestinal ischemia-reperfusion injury in an experimental rat model. We divided 24 Wistar albino rats into four groups: sham, control, ischemia-reperfusion +2 mg/kg 2‑APB, and ischemia-reperfusion +4 mg/kg 2‑APB. The sham group only underwent laparotomy for 1 h 30 min. A 30-min period of mesenteric ischemia was induced in the control and two treatment groups, followed by 1 h of reperfusion. Before the laparotomy, 2 mg/kg and 4 mg/kg 2‑APB was administered i.v. in the treatments groups, and blood samples were collected after reperfusion. Serum levels of malondialdehyde, superoxide dismutase, glutathione, total antioxidant capacity, tumor necrosis factor (TNF)-α, and interleukin-6 were analyzed. Intestinal tissues were taken for histopathological, DNA fragmentation, and terminal deoxynucleotidyl transferase dUTP nick end labeling analyses to determine the proportion of apoptotic cells. 2-APB reduced serum malondialdehyde, TNF-α, and interleukin-6 levels. However, superoxide dismutase and total antioxidant capacity levels increased significantly in the 4‑mg/kg 2‑APB group (p < 0.05). The intestinal histopathological injury scores were significantly higher in the control group; these injuries were prevented in the 4‑mg/kg 2‑APB dose group. DNA damage after ischemia-perfusion decreased significantly in the 4‑mg/kg 2‑APB group compared with the control group. 2-APB decreases oxidative stress and cell injury. Administering 4 mg/kg 2‑APB prevented ischemia-perfusion injury by diminishing histological damage.

Abstract No. 629 - Endovascular management of gonadal artery hemorrhage

1) Discuss the epidemiology and mechanism of gonadal artery hemorrhage. 2) Review pertinent anatomical and imaging considerations. 3) Highlight techniques and principles for endovascular management of gonadal artery hemorrhage. 4) Discuss follow up care, postembolization imaging, and potential complications. Gonadal artery injury is rarely encountered in clinical practice. Gonadal artery hemorrhage is most frequently seen in the setting of iatrogenic injury, blunt or penetrating trauma. In addition, ovarian artery hemorrhage has been reported due to spontaneous rupture of aneurysms during the puerperal period. Historically, these patients were managed surgically; however recent case reports have demonstrated the feasibility of endovascular treatment. Endovascular management of the gonadal artery hemorrhage is technically challenging due to anatomical considerations, particularly in postoperative patients. This exhibit includes four cases of gonadal artery hemorrhage of differing etiologies. The discussion includes evaluation of the preprocedure imaging as well as a discussion of the technique involved in each case. In particular, we will discuss different strategies for successful and stable access to tortuous gonadal arteries. We will also discuss various embolic materials (including cyanoacrylate, coils, and particles) along with considerations for choice of embolic agent. We also demonstrate management of gonadal arteriovenous fistulae as well as tumor related hemorrhage. Gonadal artery hemorrhage is a rare but potentially life-threatening clinical entity. Proper evaluation by preprocedure imaging, technical considerations, and embolic agent choice are key for successful and safe endovascular management of gonadal artery hemorrhage.