Life-threatening Pathology Research Articles

Neutrophil-mediated Suppression of Influenza-induced Pathology Requires CD11b/CD18 (MAC-1).

Severe influenza virus infection can lead to life-threatening pathology through immune-mediated tissue damage. In various experimental models, this damage is dependent on T cells. There is conflicting evidence regarding the role of neutrophils in influenza-mediated pathology. Neutrophils are often regarded as cells causing tissue damage, but, in recent years, it has become clear that a subset of human neutrophils is capable of suppressing T cells, which is dependent on macrophage-1 antigen (CD11b/CD18). Therefore, we tested the hypothesis that immune suppression by neutrophils can reduce T cell-mediated pathology after influenza infection. Wild-type (WT) and CD11b-/- mice were infected with A/HK/2/68 (H3N2) influenza virus. Disease severity was monitored by weight loss, leukocyte infiltration, and immunohistochemistry. We demonstrated that CD11b-/- mice suffered increased weight loss compared with WT animals upon infection with influenza virus. This was accompanied by increased pulmonary leukocyte infiltration and lung damage. The exaggerated pathology in CD11b-/- mice was dependent on T cells, as it was reduced by T cell depletion. In addition, pathology in CD11b-/- mice was accompanied by higher numbers of T cells in the lungs early during infection compared with WT mice. Importantly, these differences in pathology were not associated with an increased viral load, suggesting that pathology was immune-mediated rather than caused by virus-induced damage. In contrast to adoptive transfer of CD11b-/- neutrophils, a single adoptive transfer of WT neutrophils partly restored protection against influenza-induced pathology, demonstrating the importance of neutrophil CD11b/CD18. Our data show that neutrophil CD11b/CD18 limits pathology in influenza-induced, T cell-mediated disease.

The neural basis of homeostatic and anticipatory thirst.

Water intake is one of the most basic physiological responses and is essential to sustain life. The perception of thirst has a critical role in controlling body fluid homeostasis and if neglected or dysregulated can lead to life-threatening pathologies. Clear evidence suggests that the perception of thirst occurs in higher-order centres, such as the anterior cingulate cortex (ACC) and insular cortex (IC), which receive information from midline thalamic relay nuclei. Multiple brain regions, notably circumventricular organs such as the organum vasculosum lamina terminalis (OVLT) and subfornical organ (SFO), monitor changes in blood osmolality, solute load and hormone circulation and are thought to orchestrate appropriate responses to maintain extracellular fluid near ideal set points by engaging the medial thalamic-ACC/IC network. Thirst has long been thought of as a negative homeostatic feedback response to increases in blood solute concentration or decreases in blood volume. However, emerging evidence suggests a clear role for thirst as a feedforward adaptive anticipatory response that precedes physiological challenges. These anticipatory responses are promoted by rises in core body temperature, food intake (prandial) and signals from the circadian clock. Feedforward signals are also important mediators of satiety, inhibiting thirst well before the physiological state is restored by fluid ingestion. In this Review, we discuss the importance of thirst for body fluid balance and outline our current understanding of the neural mechanisms that underlie the various types of homeostatic and anticipatory thirst.

Dabigatran: A Novel and Rare Cause of Diffuse Alveolar Hemorrhage (DAH)

SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 10:45 AM - 12:00 PM INTRODUCTION: DAH is a rare, life-threatening pathology characterized by intra-alveolar hemorrhage with a spectrum of clinical presentations. This syndrome includes hemoptysis, anemia, pulmonary infiltrates and hypoxemic respiratory failure. This case is a rare presentation of DAH secondary to a Novel Oral Anticoagulant (NOAC) in the absence of systemic vasculitis. CASE PRESENTATION: An 86 year old male with past medical history of atrial fibrillation on dabigatran and congestive heart failure, was found at home, hypoxemic and bradycardic to the emergency room. The patient was also noted to be anemic, requiring 2 units of PRBC and in acute renal failure. The patient met criteria for ARDS, including a chest X-ray suggestive of bilateral diffuse pulmonary infiltrates. He was maintained on low tidal volume, high PEEP ventilator support. Bronchoscopic lavage demonstrated progressively more hemorrhagic effluent, pathognomic for DAH. Investigations for vasculitis were negative. The thrombin time was noted to be elevated and hence Idaricizumab was started and hemodialysis initiated. The patient was successfully extubated in 7 days duration. DISCUSSION: GI bleeds and intracranial hemorrhages are known complications with dabigatran, however DAH is rare with only four other cases reported in our literature review1,2. Most of these cases were prior to the advent of Idarucizumab. Dabigatran toxicity may have occurred in this patient due to the occurrence of acute renal failure. Reversal agent may have a role in treating pulmonary hemorrhage and subsequent respiratory failure secondary to the use of NOACs. Interestingly, this patient also had no prior history of vasculitides or lung disease that would predispose the patient to DAH. CONCLUSIONS: To our knowledge this is the only case where resolution of ARDS secondary to DAH by Dabigatran use was achieved with the use of Idarucizumab, hemodialysis and lung protective ventilator strategy. This highlights the importance of considering DAH as a cause of ARDS especially in the setting of anticoagulation. Increasing use of NOACs requires physicians to be aware of the adverse effects and indications for using reversal agents, when available. Reference #1: Yokoi K, Isoda K, Kimura T, Adachi T. Diffuse Alveolar Hemorrhage Associated with Dabigatran. Intern Med. 2012;51(18):2667-2668 Reference #2: Kudo, K, Tanimoto, Y, Hisamoto, A, Ichihara, E, Tanimoto, M, Kiura, K. Dabigatran etexilate-induced alveolar hemorrhage. AJRS, 1(3): 247-250, 2012. DISCLOSURE: The following authors have nothing to disclose: Shyam Shankar, Prarthna Chandar, Hatem Desoky, Ishan Malhotra, Anand Kumar Rai, Mangalore Amith Shenoy, Benhoor Shamian, Pavel Gozenput, Roman Bernstein, Pavan Irukulla, Yizhak Kupfer No Product/Research Disclosure Information

MRI of anal canal: common anal and perianal disorders beyond fistulas: Part 2.

A broad spectrum of disease, from benign processes to life-threatening pathologies, can cause anal pain. MR imaging (MRI) has become increasingly widely used method over the past two decades for the evaluation of individuals with anorectal symptoms. Although imaging is rarely necessary to determine the etiology of the majority of cases, MRI is particularly useful as a noninvasive method of excluding severe neoplastic conditions. In this article, MRI findings of a number of pathologies such as anal and perianal neoplasms, hemorrhoidal disease, arteriovenous malformation of the perianal region, and anal sphincter lesions (defects, scarring, atrophy) which may lead to fecal incontinence are presented.

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

Identification of Novel Clinically Relevant Variants in 70 Southern Chinese patients with Thoracic Aortic Aneurysm and Dissection by Next-generation Sequencing

Thoracic Aortic Aneurysm and Dissection (TAAD) is a life-threatening pathology and remains challenging worldwide. Up to 40% of TAAD are hereditary with complex heterogeneous genetic backgrounds. Recently, next-generation sequencing (NGS) has been successfully applied to identify genetic variants in an efficient and cost-effective manner. In our study, NGS coupled with DNA target-capture array was used to screen 11 known causative genes of TAAD in 70 patients from Southern China. All the identified variants were confirmed by Sanger sequencing. We identified forty variants in 36 patients (51.4%), including three known pathogenic (7.5%), 10 likely pathogenic variants (25%, 9 in FBN1, 1 in ACTA2), and 27 variants with uncertain significance (VUS) (67.5%). Among the 27 VUS, 14 (51.9%) were in the FBN1 gene, 3 in Col5A2, 2 in ACTA2, 2 in MYH11, 2 in MYLK, 2 in SLC2A10, 1 in MSTN and 1 in SMAD3 respectively. Based on the segregation data and independent reports, five known likely pathogenic variants and four VUS were upgraded to pathogenic variant and likely pathogenic variant respectively. Our data indicate that NGS is a highly efficient genetic method for identification of pathogenic variants in TAAD patients.

Survey of practitioners\u2019 competency for diagnosis of acute diseases manifest on chest X-ray

BackgroundChest X-ray (CXR) is a common imaging modality that could impact immediate decision-making for acute chest pathologies. We sought to examine the non-radiologists proficiency of diagnosing acute pathologies manifest on CXR.MethodsWe selected 9 clinical vignettes, each associated with a CXR, wherein only a single acute chest pathology was manifest. We also added a low-risk vignette associated with a normal CXR. We built an electronic survey with the CXR-embedded vignettes and also inquired about the participants’ confidence in the diagnosis, and prior exposure to the topics. We distributed the survey to senior medical students and general practitioners (GPs) in Tehran, Iran. We scored each correct answer per each vignette as 1 and each incorrect answer as 0; leading into a sum score from 0 to10 for the entire survey for each participant.ResultsOf the 136 candidates, 100 had legible survey results (67 medical students and 33 GPs). The overall score (mean [standard error]) was 3.57 [0.20], with no significant difference between the students and GPs (P = 0.15). The lowest rate of correct response occurred for acute respiratory distress syndrome (8%), foreign body (12%), and normal CXR (15%), while the best-answered vignettes were diaphragmatic herniation (77%) and pneumoperitoneum (67%). Self-reported confidence was associated with correct response for pneumoperitoneum, tension pneumothorax, and pulmonary edema (P < 0.05 for all).ConclusionsDiagnostic proficiency of practitioners for acute chest pathologies in our study was poor, including for distinction of a normal CXR. Such dramatic knowledge deficiencies for common or life-threatening chest pathologies should be prioritized in the educational and continuous education curricula. Secure electronic tools for transferring the CXRs to specialists in case of acute pathologies would be an interim pragmatic alternative.

Sepsis and septic shock: New definitions, new diagnostic and therapeutic approaches.

Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era.

The “Wedge Sign”: An Imaging Sign for Aggressive Lacrimal Gland Disease

Lacrimal gland carcinoma can form a triangle of tissue back to the orbital apex, intraconal spread apparently being prevented by the intermuscular septum. The "wedge sign" frequency is assessed in lacrimal carcinoma, lacrimal lymphoma, or dacryoadenitis. Retrospective masked review of images from patients with biopsy-proven lacrimal gland pathology. For each patient, the presence of a triangle of tissue between the lateral rectus and lateral orbital wall and the superior rectus and the orbital roof was assessed by masked review of computed tomography or magnetic resonance imaging. For the lateral compartment, the wedge was classified as "grade 1" if it just reached the sphenoidal trigone and "grade 2" if it was a complete triangle reaching the orbital apex. Comparison of proportions was made using the Fisher exact test, using an α risk of 0.05 as clinically significant. Imaging for 116 patients was reviewed: 39 with lacrimal gland carcinoma, 37 with lymphoma, and 40 with dacryoadenitis. The lateral wedge (grade 1 or 2) was most common in patients with carcinoma (16/39; 41%), was present in 11 of 37 patients (30%) with lymphoma, and was rarest in patients with dacryadenitis (6/40; 15%) (P= 0.033). The proportion in patients with carcinoma (41%) was similar to that in patients with lymphoma (30%) (P= 0.345); the proportion in patients with lymphoma (30%) was similar to that in patients with dacryoadenitis (15%) (P= 0.170), but carcinoma (41%) was significantly different from dacryoadenitis (15%) (P=0.013). The proportions for malignant lesions (carcinoma and lymphoma; 27/76, 36%) and benign dacryoadenitis (15%) were significantly different (P= 0.029). Likewise, a superior wedge, of any extent, was present in 10 of 39 carcinomas (26%), 2 of 40 dacryoadenitis (5%), and 6 of 37 lymphomas (16%) (P= 0.033). The "wedge sign" is most common in lacrimal gland carcinoma, but can occur in patients with severe forms of dacryoadenitis or lymphoma and generally indicates life-threatening lacrimal gland pathology that requires urgent biopsy. It is significantly more common in lacrimal gland carcinoma compared with dacryoadenitis and in malignancy (lymphoma and carcinoma) compared with inflammation.

The 1000 lumbar spine radiograph study

Magnetic resonance imaging is being increasingly used to optimize the diagnostic process for low back pain and to manage the risk of missing life-threatening pathology. The aim of the study was to examine the care pathway of low back pain with respect to the utilisation of CT and MRI service utilisation. A descriptive, retrospective, cross-sectional study was performed. A random sample of 1000 primary care patients presenting with low back pain who underwent lumbar spine radiography within a specified period was explored. 20% (n=198) of patients who underwent lumbosacral spine X-ray were referred for MRI investigation. Subsequently, 15 (7.6%) patients underwent joint infiltration whilst 6 (3%) patients underwent neurosurgical intervention during 2 years of follow-up. Such findings provide information for policy makers about the utility of MRI and CT scans.

PKCβ: Expanding role in hepatic adaptation of cholesterol homeostasis to dietary fat/cholesterol.

Cholesterol homeostasis relies on an intricate network of cellular processes whose deregulation in response to Western type high-fat/cholesterol diets can lead to several life-threatening pathologies. Significant advances have been made in resolving the molecular identity and regulatory function of transcription factors sensitive to fat, cholesterol, or bile acids, but whether body senses the presence of both fat and cholesterol simultaneously is not known. Assessing the impact of a high-fat/cholesterol load, rather than an individual component alone, on cholesterol homeostasis is more physiologically relevant because Western diets deliver both fat and cholesterol at the same time. Moreover, dietary fat and dietary cholesterol are reported to act synergistically to impair liver cholesterol homeostasis. A key insight into the role of protein kinase C-β (PKCβ) in hepatic adaptation to high-fat/cholesterol diets was gained recently through the use of knockout mice. The emerging evidence indicates that PKCβ is an important regulator of cholesterol homeostasis that ensures normal adaptation to high-fat/cholesterol intake. Consistent with this function, high-fat/cholesterol diets induce PKCβ expression and signaling in the intestine and liver, while systemic PKCβ deficiency promotes accumulation of cholesterol in the liver and bile. PKCβ disruption results in profound dysregulation of hepatic cholesterol and bile homeostasis and imparts sensitivity to cholesterol gallstone formation. The available results support involvement of a two-pronged mechanism by which intestine and liver PKCβ signaling converge on liver ERK1/2 to dictate diet-induced cholesterol and bile acid homeostasis. Collectively, PKCβ is an integrator of dietary fat/cholesterol signal and mediates changes to cholesterol homeostasis.

Successful Endovascular Repair of Mycotic Aortic Pseudoaneurysm Followed by Aortoesophageal Fistula

Mycotic aneurysm of the aorta is a rare, but life-threatening pathology. In recent years, endovascular stent graft placement has been introduced as an effective alternative for treating infected aortic aneurysms. A 64-year-old woman with a history of paraplegia due to spinal cord injury was referred to our institute with fever and blood-tinged sputum. Computed tomography (CT) scan showed an 11-cm pseudoaneurysm arising from the proximal descending aorta, which was normal 1 month ago at the previous CT scan. The patient underwent thoracic endovascular aortic repair for the pseudoaneurysm, deployed with a transiliac access approach, and received antibacterial medical therapy. On postoperative day 11, she developed signs of infection, caused by an aortoesophageal fistula. The infection was treated conservatively with parenteral nutrition and antibiotic administration. The patient had an uneventful recovery and was discharged on postoperative day 113. At 2-year follow-up, she had a normal physical examination and CT angiography showed a marked reduction of the pseudoaneurysm sac. We report a successful endovascular stent grafting and subsequent medical treatment in a patient with a mycotic thoracic aortic pseudoaneurysm followed by a postoperative aortoesophageal fistula.

Pitfalls and problems in the management of the acute abdomen

The acute abdomen is defined as the rapid onset of severe symptoms that may indicate potentially life-threatening intra-abdominal pathology which requires urgent surgical intervention. The article reviewed the pitfalls and problems in the management of the acute abdomen. The importance of simultaneous examination and resuscitation, recognizing the need for physiological support, and maintaining the rapid progress toward a diagnosis and definitive treatment are emphasized.

RENDU-OSLER-WEBER DISEASE AT 75 YEARS OLD WOMAN

The publication presents a clinical case of hereditary hemorrhagic telangiectasia in a woman of 75 years. In the first part of the article, literature data on the incidence and features of Rundu-Osler-Weber disease are presented, modern diagnostic principles based on the Curacao criteria (1999) are reviewed, which allow to define the diagnosis as “reliable”, with three criteria, “probable” — with Two criteria (most often the family nature of the disease and spontaneous nasal bleeding) and “doubtful”, with one criterion of the above. Methods of treating hereditary hemorrhagic telangiectasia are considered, the authors draw attention to the fact that the choice of the method of therapy depends on the degree of damage to the target organ. Symptomatic methods of treatment suggest slight relief for patients, but hereditary hemorrhagic telangiectasia remains a progressive, severe and potentially life-threatening pathology. The second part of the article presents a clinical observation with late verification of the patient’s P., 75 years of age. The data of medical history, including anamnesis, catamnesis, photographs of macro- and micro-preparations are given. The presented observation illustrates the severe course of hereditary hemorrhagic telangiectasia, manifested by severe hemorrhagic syndrome, due to vascular malformations, the gradual involvement of internal organs in the pathological process with the formation of arteriovenous shunts, aneurysms. The manifestation of hereditary hemorrhagic telangiectasia in the described clinical case was manifested as abundant nasal, uterine bleeding, skin telangiectasias, followed by involvement in the pathological process of the lungs, organs of the gastrointestinal tract. The authors were able to observe a variant of the course and manifestation of visceral vascular anomalies. This clinical case illustrates the need to take into account the totality of all the symptoms of the disease in hereditary hemorrhagic telangiectasia for early detection of the disease, dynamic observation of the patient and the timely administration of therapy

The Paraoxonase Gene Cluster Protects Against Abdominal Aortic Aneurysm Formation.

Abdominal aortic aneurysm (AAA) is a life-threatening vascular pathology, the pathogenesis of which is closely related to oxidative stress. However, an effective pharmaceutical treatment is lacking because the exact cause of AAA remains unknown. Here, we aimed at delineating the role of the paraoxonases (PONs) gene cluster (PC), which prevents atherosclerosis through the detoxification of oxidized substrates, in AAA formation. PC transgenic (Tg) mice were crossed to an Apoe-/- background, and an angiotensin II-induced AAA mouse model was used to analyze the effect of the PC on AAA formation. Four weeks after angiotensin II infusion, PC-Tg Apoe-/- mice had a lower AAA incidence, smaller maximal abdominal aortic external diameter, and less medial elastin degradation than Apoe-/- mice. Importantly, PC-Tg Apoe-/- mice exhibited lower aortic reactive oxidative species production and oxidative stress than did the Apoe-/- control mice. As a consequence, the PC transgene alleviated angiotensin II-induced arterial inflammation and suppressed arterial extracellular matrix degradation. Specifically, on angiotensin II stimulation, PC-Tg vascular smooth muscle cells exhibited lower levels of reactive oxidative species production and a decrease in the activities and expression levels of matrix metalloproteinase-2 and matrix metalloproteinase-9. Moreover, PC-Tg serum also enhanced vascular smooth muscle cell oxidative stress resistance and further decreased the expression levels of matrix metalloproteinase-2 and matrix metalloproteinase-9, indicating that circulatory and vascular smooth muscle cell PC members suppress oxidative stress in a synergistic manner. Our findings reveal, for the first time, a protective role of the PC in AAA formation and suggest PONs as promising targets for AAA prevention.

Arrhythmia

Arrhythmias are disturbances in normal cardiac electrical activity. They occur in structurally normal hearts, but are sometimes indications of underlying congenital or acquired abnormalities. Arrhythmia can be a mild or transient problem; however, the potential exists for severe life-threatening pathology - even death. It is important that primary care practitioners can recognise various arrhythmias and understand their management. The GP’s role in arrhythmia care ranges from primary diagnosis, through initiation of treatment or monitoring to long-term management of some conditions e.g. atrial fibrillation. Patients require advice about driving or employment, and occasionally the GP may act as a critical link in the ‘chain of survival’ when responding to a cardiac arrest. This article highlights the key findings that can be identified from history and examination, and how these can guide subsequent investigation and diagnosis. The features of common, major arrhythmias and their immediate and subsequent treatment are discussed.

Calorie restriction protects against experimental abdominal aortic aneurysms in mice.

Abdominal aortic aneurysm (AAA), characterized by a localized dilation of the abdominal aorta, is a life-threatening vascular pathology. Because of the current lack of effective treatment for AAA rupture, prevention is of prime importance for AAA management. Calorie restriction (CR) is a nonpharmacological intervention that delays the aging process and provides various health benefits. However, whether CR prevents AAA formation remains untested. In this study, we subjected Apoe-/- mice to 12 wk of CR and then examined the incidence of angiotensin II (AngII)-induced AAA formation. We found that CR markedly reduced the incidence of AAA formation and attenuated aortic elastin degradation in Apoe-/- mice. The expression and activity of Sirtuin 1 (SIRT1), a key metabolism/energy sensor, were up-regulated in vascular smooth muscle cells (VSMCs) upon CR. Importantly, the specific ablation of SIRT1 in smooth muscle cells abolished the preventive effect of CR on AAA formation in Apoe-/- mice. Mechanistically, VSMC-SIRT1-dependent deacetylation of histone H3 lysine 9 on the matrix metallopeptidase 2 (Mmp2) promoter was required for CR-mediated suppression of AngII-induced MMP2 expression. Together, our findings suggest that CR may be an effective intervention that protects against AAA formation.

A case for studying country regimes in the public health model of violence.

Many national and international institutions advocate approaching violence as a problem in public health and preventive medicine, in a manner similar to the way we address other disabling and life-threatening pathologies such as cancer, diabetes, and heart disease. Prevention by a health model requires an ecological perspective. Previous work has found evidence that economic factors, including unemployment and relative poverty, as well as political culture and values, may affect violent death rates, including homicide and suicide. Nevertheless, wider political analyses of the effects that different regimes have on these variables have been notably absent, for understandable reasons given the sheer complexity of patterns of governance throughout the world. In view of the importance and scale of the problem, and implications of the United Nations' 2030 Agenda for Sustainable Development, we feel it is nevertheless important to bring regime types into the conversation of factors that can influence violent death.

Computational approaches to substrate-based cell motility

Substrate-based crawling motility of eukaryotic cells is essential for many biological functions, both in developing and mature organisms. Motility dysfunctions are involved in several life-threatening pathologies such as cancer and metastasis. Motile cells are also a natural realisation of active, self-propelled ‘particles’, a popular research topic in nonequilibrium physics. Finally, from the materials perspective, assemblies of motile cells and evolving tissues constitute a class of adaptive self-healing materials that respond to the topography, elasticity and surface chemistry of the environment and react to external stimuli. Although a comprehensive understanding of substrate-based cell motility remains elusive, progress has been achieved recently in its modelling on the whole-cell level. Here we survey the most recent advances in computational approaches to cell movement and demonstrate how these models improve our understanding of complex self-organised systems such as living cells.

Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis.

Deep venous thrombosis (DVT) is a life-threatening and morbid pathology. This study aimed to investigate the efficacy of an early thrombolysis procedure using a rotator thrombolysis device. Sixty-seven patients with acute proximal DVT were enrolled in the study. Patients' data were recorded retrospectively. Initially, an infrarenal retrievable vena cava filter was placed through the femoral vein. Then, a rotator thrombolysis device and a thrombolytic agent injection were applied to the occluded segments of the deep veins by puncturing the popliteal vein. The identified reasons were trauma (43.3%), pregnancy (20.9%), undiagnosed (11.9%), major surgical operation (10.5%), immobilization (7.5%), and malignancy (5.9%). Immediate total recanalization was conducted in all patients, and the leg diameters returned to normal ranges in the early postoperative period. Hospital mortality or severe complications were not detected. New thrombolytic devices seem to reduce in-hospital mortality risks and may potentially decrease post-thrombotic morbidity.