Peripheral Vasodilation Research Articles

Bradyarrhythmia in acute massive pulmonary embolism

Pulmonary embolism (PE) can present with a variety of electrocardiographic findings. Bradycardia is a rare finding in acute PE, which typically manifests with sinus tachycardia. Bradycardia in acute PE might arise from the physiologic Bezold–Jarisch reflex, which describes the constellation of bradycardia, peripheral vasodilation, and hypotension. We report the case of a woman in her 60s who was admitted initially for submassive PE and found to have sinus bradycardia. She had progressed to massive PE with acute worsening of atrioventricular conduction block in the setting of atrial flutter. Her bradyarrhythmia resolved and hemodynamics improved after catheter directed thrombolysis. This case revisits the pathophysiology of Bezold–Jarisch reflex, and the importance of recognizing that it signifies an underlying pathologic insult, especially a life-threatening one like PE.

Endothelial function measured by peripheral arterial tonometry in patients with chronic myeloid leukemia on tyrosine kinase inhibitor therapy: a pilot study

BackgroundArterial occlusive events are an emerging problem in patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitor (TKI) therapy. Endothelial cell damage is thought to play an important role in the development of vascular events. Measurement of the peripheral vasodilator response by peripheral arterial tonometry (PAT) has reportedly been useful in the non-invasive assessment of endothelial dysfunction. To date, no studies have assessed endothelial function using PAT in patients with CML receiving TKIs.MethodWe measured the reactive hyperemia index (RHI) using PAT in young patients with CML (men aged ≤ 55 years and women aged ≤ 65 years) receiving TKIs.ResultsThirty patients with CML were examined (mean age, 43.5 ± 9.8 years; men, 57%). The median RHI was 1.81. Among these patients, 16.7% and 83.3% were taking imatinib and second- or third-generation TKIs, respectively. There were no differences in the baseline characteristics between the low RHI (< 1.67, n = 10), borderline RHI (≥ 1.67 and < 2.10, n = 14), and normal RHI (≥ 2.10, n = 6) groups. Serum uric acid (UA) levels and the RHI were significantly negatively correlated (r = -0.40, p = 0.029).ConclusionOne-third of young patients with CML receiving TKI therapy were classified as having a low RHI. The RHI was negatively correlated with serum UA level. Larger prospective studies are necessary to examine whether the RHI predicts cardiovascular events in such patients.

Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease

Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Discussion: Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.

EFFECTIVENESS COMBINATION OF HEGU AND TAIXI POINT ACUPRESSURE WITH RED GINGER HYDROTHERAPY ON PAIN SCALE IN GOUT ARTHRITIS CLIENTS

Arthritis gout is a disease caused by a purine metabolism disorder characterized by hyperuricemia and recurrent attacks of acute synovitis causing severe pain in the joint area. One of the treatments for gout arthritis with non-pharmacological therapy is acupressure and warm red ginger hydrotherapy which is able to relax muscles, increase blood circulation, and can stimulate the effector system causing peripheral vasodilation so that blood flow to tissues is smooth, especially tissues that are inflamed so that it can reduce inflammation joint pain. This study aims to determine the effectiveness of the combination of acupressure on the hegu and taixi with red ginger hydrotherapy as a complementary nursing intervention in reducing pain in gouty arthritis sufferers. Quantitative research with true experiment approach pre and post-test control group design involving 30 respondents divided into intervention group (n=10) given acupressure and red ginger hydrotherapy, while control group 1 (n=10) was given acupressure and control group 2 (n =10) was given red ginger hydrotherapy. The sampling technique used probability sampling with simple random sampling based on inclusion and exclusion criteria. Then the research results were analyzed using parametric tests, namely Paired t test, ANOVA test and Post Hoc Bonferroni test. The ANOVA test showed a significant value of p = 0.000 (&lt;0.05), while the Post Hoc Bonferroni test showed that between the intervention group and control 1 there was a difference with a significant value of p = 0.001, between the intervention group and control 2 there was a difference in the value significant p=0.005 and between control group 1 and control 2 there was no difference with a significant value of p=1,000. There was a difference between the intervention group, control group 1 and control group 2, which means that the administration of acupressure at the hegu and taixi with red ginger hydrotherapy was more effective in reducing pain in gouty arthritis patients than acupressure and red ginger hydrotherapy alone.

Cardiovascular Function during First 24 Hours after Off-Pump and On-Pump CABG—A Prospective Observational Comparative Study

Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.

Raynaud's Phenomenon: A Brush Up!

Raynaud's Phenomenon: A Brush Up!

Comparison of Antera 3D® and TcPO2 for Evaluation of Blood Flow in Skin.

There is a need for quick skin blood flow tests that can be performed in the wound healing field. Antera 3D® is a compact scanner using multispectral imaging. It can perform quick assessment of skin conditions. The purpose of the present study was to investigate the ability of the Antera 3D® to assess skin blood flow in comparison with transcutaneous partial pressure of oxygen (TcPO2) measurements. This study was conducted on 13 patients with a history of lower extremity ulcers. Measurements of hemoglobin average level (hereafter, Hb score) measured by Antera 3D® and TcPO2 measured by a transcutaneous blood gas monitor were obtained at the same sites on the dorsal foot and lower leg. Differences in Hb score and TcPO2 were analyzed by t-test for each measurement site and for the presence of peripheral arterial disease (PAD). The correlation between TcPO2 and Hb score was analyzed by Pearson's correlation coefficient. Twenty-four limbs were tested. Hb score was higher (P < 0.001) and TcPO2 was lower (P = 0.056) in the dorsal foot compared to the lower leg. In the dorsal foot, Hb score was higher (P = 0.023) and TcPO2 was lower (P = 0.046) in patients with PAD compared to those without PAD. A significant negative correlation (r = -0.68; 95% confidence interval -0.85 to -0.38, P < 0.001) between TcPO2 and Hb score was observed in the dorsal foot. The negative correlation between TcPO2 and Hb score may reflect compensatory peripheral vasodilation due to occlusion or stenosis of central arteries. This study showed that Hb score measured by Antera 3D® may be related to skin blood flow.

Humans at the dawn of the in-body electrical nerve stimulation era.

The neuroprosthesis laparoscopic implantation technique for electric pelvic nerve stimulation was introduced to gynaecology over 15 years ago to treat intractable pelvic neuropathic pain. Following this first indication, other applications were developed, particularly in parapleology. The LION procedure developed to assist patients with paraplegia and common problems associated with inertia when confined to a wheelchair could find revolutionary applications in aging medicine and prevention. Spinal cord injured patients who have undergone the Possover's LION procedure. PubMed was systematically searched to identify peer-reviewed articles published in English that reported on LION procedure. Three independent studies published recently (100 patients worldwide) have shown revolutionary recovery of supra-spinal control in patients with chronic spinal cord injury following pelvic nerves stimulation, with 70% of them establishing a walker/crutches-assisted gait. The same studies have also shown significant whole-body muscle-mass building, peripheral vasodilatation, and an unexpected improvement in bone mineral density. These ground-breaking findings could find revolutionary applications in aging medicine and the prevention of osteoporosis, with a huge impact on global public health. Humanity is on the cusp of an exciting new era following the introduction of the in-body electrical nerve stimulation technique. In-body electrical nerve stimulation for recovery and/or control of human peripheral somatic and autonomic nervous systems.

Interaction between alcohol consumption and use of peripheral arterial tone home sleep apnea tests for sleep apnea evaluation

Objective/BackgroundHome sleep apnea tests utilizing peripheral arterial tone (PAT HSAT) detect sleep disordered breathing by measuring various physiologic measures including changes in arterial volume in the finger. Validation tests comparing PAT HSAT to simultaneous polysomnography (PSG) have demonstrated a high correlation. Alcohol increases peripheral vasodilation, which may alter arterial tone in the finger. Validation studies have not evaluated for an interaction between alcohol consumption and PAT HSAT measures. Patients/Methods: We describe an in-depth evaluation of a 53-year-old man who consumes alcohol on nightly basis. He underwent a series of 5 diagnostic studies under different conditions: three PAT HSATs (two nights with and another without alcohol) and two polysomnograms (one night with and another without alcohol). ResultsObstructive sleep apnea (OSA) was found on both polysomnograms but only on the PAT HSAT without alcohol, raising the possibility of two false negative PAT HSAT results after alcohol consumption. ConclusionsThis report demonstrates the need for further investigations into the performance of PAT HSATs with and without alcohol. In the meantime we recommend that testing be done without alcohol and over the course of multiple nights.

Acute limb ischemia in an adolescent with COVID-19 and systemic scleroderma: a case report

BackgroundJuvenile Scleroderma is a rare autoimmune disease of the connective tissue. Its concurrence with COVID-19 can lead to limb ischemia as both disease entities are pro-inflammatory and pro-thrombotic. To date, there is no case report describing the symptomatology and course of disease in patients with juvenile Scleroderma and COVID-19.Case presentationAn adolescent with acute limb ischemia presented with a history of generalized hypo-and-hyperpigmented skin lesions and mild, non-productive cough. She tested positive for SARS-CoV-2 on nasopharyngeal swab RT-PCR. Further work-up revealed elevated anti-phospholipid antibodies, anti-nuclear antibody, and D-dimer; low Protein S activity; and evidence of peripheral arterial disease on imaging studies. She was started on peripheral vasodilators, Methotrexate, and anticoagulation. Close monitoring of the affected limbs and other organs involved was done. Control of limb ischemia was achieved after 4 months of regular Cyclophosphamide infusion. Continued multi-disciplinary care was ensured for this patient.ConclusionThere is evolving knowledge about the interplay of COVID-19 hyperinflammatory state and rheumatologic disorders. COVID-19 is thought to exacerbate cutaneous manifestations of autoimmune disorders via antigen protein mimicry and cytokine imbalance. Moreover, COVID-19 is characterized by complex hematopathologic processes that put a patient in a hypercoagulable state. Elevated D-dimer can be seen in both COVID-19 and systemic sclerosis owing to their pro-thrombotic sequela. There is scarcity of data on the association of Protein S activity with COVID-19 and systemic sclerosis. More studies need to be carried out to ultimately arrive at a consensus on thrombosis prophylaxis for patients with Scleroderma and COVID-19.

Palmitic acid methyl ester induces cardiac hypertrophy through activating the GPR receptor-mediated changes of intracellular calcium concentrations and mitochondrial functions.

Myocardial hypertrophy is associated with a significant increase in intracellular Ca2+ , which can be induced by long-chain fatty acid. Palmitic acid methyl ester (PAME), a fatty acid ester released from adipose tissue, superior cervical ganglion, and retina, has been found to have anti-inflammation, antifibrosis, and peripheral vasodilation effects. However, the effects of PAME on cardiomyocytes are still unclear. The aim of this study was to determine whether PAME could disrupt the intracellular Ca2+ balance, leading to cardiomyocyte hypertrophy. Neonatal rat cardiomyocytes were treated with various concentrations (10-100 μM) of PAME for 1-4 days. Cytosolic Ca2+ and mitochondrial Ca2+ concentrations were examined using Fura-2 AM and Rhod-2, respectively. After treatment with PAME for 4 days, mitochondrial Ca2+ , an indicator of the state of mitochondrial permeability transition pore (MPTP), and cell death were monitored by flow cytometric analysis. ATP levels were detected using the ATP assay kit. Cardiomyocyte hypertrophy was analyzed by measuring the cardiac hypertrophy biomarker and cell areausing quantitative real time-polymerase chain reaction, Western Blot analysis and immunofluorescence analysis. Our results show that PAME concentration- and time-dependently increased cytosolic and mitochondria Ca2+ through the mitochondrial calcium uniporter. Moreover, treatment with PAME for 4 days caused MPTP opening, thereby reducing ATP production and enhancing reactive oxygen species (ROS) generation, and finally led to cardiomyocyte hypertrophy. These effects caused by PAME treatment were attenuated by the G-protein coupled receptor 40 (GPR40) inhibitor. In conclusion, PAME impaired mitochondrial function, which in turn led to cardiomyocyte hypertrophy through increasing the mitochondrial Ca2+ levels mediated by activating the GPR40 signaling pathway.

Myocardial perfusion recovery induced by an α-calcitonin gene-related peptide analogue

BackgroundEndogenous calcitonin gene-related peptide (CGRP) induces cardioprotective effects through coronary vasodilation. However, the systemic administration of CGRP induces peripheral vasodilation and positive chronotropic and inotropic effects. This study aims to examine the net effect on coronary perfusion of the systemically administered α-calcitonin gene-related peptide analogue, SAX, in rats during myocardial infarction. MethodsForty Sprague-Dawley rats underwent myocardial infarction. Following left anterior descending artery occlusion, [99mTc]Tc-sestamibi was administered to determine the myocardial perfusion before treatment. Twenty minutes, 24 and 48 h after [99mTc]Tc-sestamibi injection, the rats were treated with either SAX or placebo. Final infarct size was determined three weeks later by [99mTc]Tc-sestamibi SPECT/CT scan. ResultsThirty-one rats survived the surgery and 20 completed the follow-up SPECT/CT scan (SAX n = 12; Placebo n = 8). At baseline, there was no difference in size of perfusion defect between the groups (P = .88), but at follow-up the SAX group had improved myocardial recovery compared to the placebo group (P = .04), corresponding to a relative perfusion recovery of 55% in SAX-treated rats. ConclusionThe CGRP analogue, SAX, has a cardioprotective effect in this rat model of myocardial infarction, improving myocardial perfusion recovery after chronic occlusion of the coronary artery.

Albumin administration in patients with cirrhosis: Current role and novel perspectives.

Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.

Physiological And Thermoregulatory Responses Of Body Cooling During Cycling In A Hot Environment

Rapid cooling techniques are essential for populations that are active in the heat. In attempt to reduce overheating, the vasomotor reflex increases blood flow to the skin for radiative heat loss, causing peripheral vasodilation. Cooling of the extremities can be a strategy to reduce core temperature (Tc) due to their large surface area and the increased blood flow during elevations of Tc. PURPOSE: To examine the effects of four hand-cooling methods on physiological strain following two interval blocks of cycling in the heat. METHODS: Twelve participants [mean ± SD; age, 24 ± 4 years; maximal oxygen consumption; 44.5 ± 6.4 ml/kg/min; body mass, 75.7 ± 8.2 kg; height, 177.3 ± 8.4 cm] performed two 40-min blocks of cycling at 6 Watts per kilogram of body mass (W/kg) to 15 W/kg in the heat (36 °C, 30 °C relative humidity). Metabolic heat production (Hprod) was used to prescribe this exercise intensity. Each 40-min exercise block was followed by 20-min of cooling. Participants completed four trials on four separate days that included four different cooling modalities during the rest block: 1) hand mist-fan cooling (FAN), 2) forearm ice-water immersion (IMM), 3) forearm ice-towel cooling (TOW), and 4) passive cooling (PAS). Heart rate (HR) and rectal temperature (Tc) were measured throughout each trial. Repeated measures analysis of variance (ANOVA) tests were used to identify differences between experimental groups. Statistical significance was set at p ≤ 0.05. RESULTS: There were no differences between the three cooling modalities compared to passive cooling for Tc and HR. There were no significant differences between HR and Tc at any time points from block 1 and 2 of exercise. CONCLUSION: The cooling modalities FAN, IMM, and TOW provided no additional cooling benefits on Tc and HR compared to PAS. Populations that are exposed to environmental heat-stress should consider alternative cooling strategies or mixed methods cooling modalities that will improve heat loss and attenuate Tc.

Cardiorespiratory Fitness Level Alters Blood Pressure Responses Induced By Histamine H1- And H2-receptor Blockade During Dynamic Exercise

INTRODUCTION: Epidemiological studies have reported that greater cardiorespiratory fitness (CRF) is associated with lower blood pressure (BP). Histamine receptor-mediated peripheral vasodilation contributes to post-exercise hypotension and lowing exercising BP responses. Previously, our laboratory found that overactive BP responses to exercise were induced by the inability of histamine receptors in individuals with prehypertension. However, it is still unknown that CRF can impact BP responses elicited by the inability of the receptors. PURPOSE: This study was to assess whether aerobic fitness is effective in lowering excessive BP responses induced by the blockade of histamine receptors METHODS: In twelve male and female subjects (6 high CRF and 6 low CRF), we examined the effects of histamine H1- and H2- receptor blockades on heart rate (HR), stroke volume (SV), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and total peripheral resistance (TPR) at workloads corresponding to 40% and 60% workloads of VO2peak during cycling exercise. RESULTS: Our study indicated that compared to the high CRF group, changes in MAP from the baselines were higher in the low CRF group before the blockade at each workload (40%: D14±2 vs. 8±1 mmHg; 60%: D21±3 vs. 15±2 mmHg). The changes in MAP in response to the blockade during exercise were substantially lower in the high CRF group (40%: D18±2 vs. 11±1 mmHg; 60%: D29±3 vs. 19±2 mmHg). CONCLUSIONS: Our study suggests that an improvement in CRF likely reduces exaggerated BP responses elicited due to the inability of histamine receptors in pathological conditions such as prehypertension and hypertension.

Splanchnic oxygenation during phototherapy in preterm infants with hyperbilirubinemia

BackgroundIt has been reported that preterm infants can develop feeding intolerance during phototherapy (PT) and that PT can affect mesenteric perfusion in these patients. AimsOur aim was to assess if PT can decrease regional splanchnic oxygenation (rSO2S) measured by near infrared spectroscopy (NIRS). Study designWe prospectively studied infants with gestational age of 25–34 weeks with hyperbilirubinemia requiring PT. Splanchnic regional oxygenation (rSO2S), oxygen extraction fraction (FOES), and cerebrosplanchnic oxygenation ratio (CSOR) were recorded before, during, and after PT discontinuation. ResultsDuring PT rSO2S and CSOR significantly decreased and this effect lasted for some hours after its interruption. FOES contemporary increased, although this effect was not statistically significant. ConclusionsPT treatment decreases splanchnic oxygenation in preterm infants likely due to peripheral vasodilation which triggers a redistribution of blood flow. These results can help explain the association between PT and the development of feeding intolerance in preterm infants.

Advances in Pediatric Acute Kidney Injury Prevention and Early Diagnosis

Acute kidney injury (AKI) is frequent in critically ill neonates, children, and adolescents, but it is still underdiagnosed and referral to followup at the Pediatric Nephrology Clinic is scant. Nowadays, most pediatric studies use Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI diagnosis. These criteria are based on the elevation of serum creatinine levels and on the decrease in urine output and they correlate with a higher need for kidney replacement therapy and a higher risk of death. Nonetheless, the KDIGO definition of AKI has several limitations, which may be overcome by the simultaneous use of novel biomarkers, particularly urinary neutrophil gelatinase-associated lipocalin (NGAL). The latter is already available in clinical practice and it is a useful tool to identify AKI earlier and to establish the prognosis. The most common AKI etiologies in the pediatric population are the prerenal causes, namely kidney hypoperfusion due to hypovolemia and peripheral vasodilation in the context of sepsis. Exposure to nephrotoxic drugs has been rising as a primary cause of AKI. Decreasing the use of nephrotoxic drugs whenever clinically possible, monitoring the serum levels of these medications, and adjusting its doses can significantly reduce AKI incidence. Finally, it is important to recognize that AKI is not a completely reversible phenomenon and long-term sequelae are seen in up to 70% of affected children. These sequelae include progression to chronic kidney disease, which accentuates the need for follow-up after an AKI episode. In conclusion, it is essential to improve awareness in the Pediatric community for AKI in order to prevent it, rapidly identify it and establish reno-protective measures, which will improve its long-term prognosis. This review will focus on current definitions, epidemiology and most common etiologies, and it will also discuss strategies to improve pediatric AKI prevention, early diagnosis and follow-up.

Invasive hemodynamic parameters in patients with hepatorenal syndrome.

BackgroundHepatorenal syndrome (HRS), a form of kidney dysfunction frequent in cirrhotic patients, is characterized by low filling pressures and impaired kidney perfusion due to peripheral vasodilation and reduced effective circulatory volume. Cardiorenal syndrome (CRS), driven by renal venous hypertension and elevated filling pressures, is a separate cause of kidney dysfunction in cirrhotic patients. The two entities, however, have similar clinical phenotypes. To date, limited invasive hemodynamic data are available to help distinguish the primary forces behind worsened kidney function in cirrhotic patients.ObjectiveOur aim was to analyze invasive hemodynamic profiles and kidney outcomes in patients with cirrhosis who met criteria for HRS.MethodsWe conducted a single center retrospective study among cirrhotic patients with worsening kidney function admitted for liver transplant evaluation between 2010 and 2020. All met accepted criteria for HRS and underwent concurrent right heart catheterization (RHC).Results127 subjects were included. 79 had right atrial pressure >10 mmHg, 79 had wedge pressure >15 mmHg, and 68 had both. All patients with elevated wedge pressure were switched from volume loading to diuretics resulting in significant reductions between admission and post diuresis creatinine values (2.0 [IQR 1.5–2.8] vs 1.5 [IQR 1.2–2.2]; p = 0.003).Conclusion62% of patients diagnosed with HRS by clinical criteria have elevated filling pressures. Improvement of renal function after diuresis suggests the presence of CRS physiology in these patients. Invasive hemodynamic data profiling can lead to meaningful change in management of cirrhotic patients with worsened kidney function, guiding appropriate therapies based on filling pressures.

Malignant arterial hypertension in a 2-month-old girl: Etiological diagnosis and treatment

A 2-month-old girl presented with malignant arterial hypertension revealing bilateral renal artery stenosis secondary to neurofibromatosis type 1 (NF1). Life-supporting care was initiated immediately. High-dose peripheral vasodilator therapy induced life-threatening toxicity; vascular surgery was therefore performed. Technical difficulties due to the young age and low body weight of the patient resulted in fatal bleeding. Renovascular disease is an important cause of pediatric hypertension. NF1-associated renovascular hypertension in young pediatric patients is rare, and its highly specialized management is best delivered via a multidisciplinary approach. The long-term prognosis remains poor.

Tension-free inguinal hernia repair with transversus abdominis plane (TAP) block in elderly high-risk patients.

Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post-spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension-free - Lichtenstein - inguinal hernia repair operation with only TAP block application. This retrospective case-control study received ethics committee approval (decision number 21-5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia-related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients.