Obstruction Of Vessels Research Articles

Elevated Serum Levels of IgG4 in Patients with Heart Failure with Reduced Ejection Fraction: A Prospective Controlled Study.

Simple SummaryImmunoglobulin is a group of proteins participating in process of inflammation. One of its subtypes is Immunoglobulin Gamma-4 (IgG4) which is related to a rare disease called IgG4-related disease and characterized by a process of fibrosis—deposition of fibers in different organs and inflammation, resulting in tissue damage and dysfunction including the heart muscle and vessels. There is a paucity of information regarding the potential link between of IgG4 and cardiovascular diseases. The purpose of this study is to assess the serum levels of IgG4 in patients with dilated cardiomyopathy (DCM), a disease characterized by cardiac muscle dysfunction of ischemic and non-ischemic origin. Ischemic heart disease is a disease in which heart muscle is damaged by inappropriate blood supply caused by blood vessel obstruction and may cause heart muscle dysfunction. Ninety-eight patients with ischemic and non-ischemic cardiomyopathy were included in this study. The serum concentrations of IgG4 were measured. Patients with DCM had significantly higher levels of IgG4 compared with the healthy control group (77.4 ± 64.0 vs. 50.3 ± 28.8 mg/dL, p < 0.01). Although there was no difference in the total IgG levels in patients with ischemic DCM, the serum concentrations of IgG4 were significantly higher than the corresponding values in the control group (89.8 ± 67.3 vs. 50.3 ± 28.8 mg/dL, p < 0.01). In conclusion, we found that patients with ischemic cardiomyopathy had increased blood levels of IgG4. Additional studies with a larger number of patients are needed to support and explain this finding.(1) Background: Immunoglobulin gamma subclass 4 (IgG4) is a serum protein belonging to the immunoglobulin superfamily. It has a central role in certain immune-mediated conditions defined as IgG4-related disease. There is a paucity of data regarding the potential association of IgG4 and cardiovascular diseases. Our aim is to study the serum levels of IgG4 in patients with ischemic and non-ischemic dilated cardiomyopathy (DCM). (2) Methods: patients with ischemic and non-ischemic DCM were included in this study. Non-ischemic DCM was defined as a left ventricular ejection fraction (LVEF) < 40% without coronary artery disease (CAD). Ischemic DCM was defined as a LVEF < 40% and proven CAD. The serum concentrations of IgG4 were measured by turbidimetry. (3) Results: Overall 98 patients with cardiomyopathy had significantly higher levels of IgG4 compared with the control group (77.4 ± 64.0 vs. 50.3 ± 28.8 mg/dL, p < 0.01). Although there was no difference in the total IgG levels in patients with ischemic DCM, the serum concentrations of IgG4 were significantly higher than the corresponding values in the control group (89.8 ± 67.3 vs. 50.3 ± 28.8 mg/dL; interquartile ranges: 40.4–126.5 vs. 31.8–66.8 mg/dL, p < 0.01). This was altered by gender and smoking. (4) Conclusions: The patients with ischemic DCM had increased serum concentrations of IgG4. Future studies are warranted to explore the potential role of an IgG4-mediated process in patients with heart failure with reduced LVEF.

Magnetic Resonance Angiography and Cisternography fused images in acute ischemic stroke may save time during endovascular procedure revealing vessel anatomy

Background and purposeEndovascular treatment (EVT) is a time-dependent procedure that aims to remove the arterial blood flow obstruction in brain vessels in acute ischemic stroke. In our center, the MRI patient selection protocol in acute ischemic stroke is performed with DWI, FLAIR, MR angiography (MRA) and MR cisternography (MRC) sequences. MRA and MRC are promptly and automatically fused in order to have a clear detection of vessel anatomy, before and during EVT.Our study aim is to evaluate if the fusion process between MRA and MRC could be considered time-safe and could influence EVT duration or outcome. Materials and methods45 patients were retrospectively selected for the study and divided into 2 groups according to the presence of MRC sequence fused with MRA (Group 1) or not (Group 2 - controls). ResultsMRA and MRC fusion was able to depict vessel anatomy in all subjects of Group 1 (22 patients, 12 females; age 75.59 years ± 10.87). Group 1 presented EVT time reduction (p < 0.05;p = 0.040) (51.59 min ± 30.94) when compared to Group 2 (23 patients, 13 females; age 75.04 years ± 12.12) (71.96 min ± 34.55) of 20.37 min average. No differences between groups were detected evaluating: NIHSS at admission (p = 0.49) and discharge (p = 0.67), pre-stroke mRS (p = 0.89), mRS at 90 days (p = 0.62), ASPECT (p = 0.98) and ASPECT-DWI scores (p = 0.93), time from symptom onset to groin puncture (p = 0.80), thromboaspiration vs combined technique (p = 0.67), EVT success (p = 0.63). ConclusionFusion of MRA and MRC is a safe and promising technique in promptly revealing vascular anatomy beyond vessel obstruction, and can play a role in EVT duration reduction.

Transverse permeability in Eucalyptus nitens wood specimens

ABSTRACT Permeability functionalities are noticeable in the wood drying and impregnation processes because it has an effect on the bulk flow of a fluid through the wood structure. The aim of this work was to measure the radial and tangential specific gas permeability of Eucalyptus nitens wood for 10 different provenances. Furthermore, the effect of the radial position (defined as inner-wood, middle-wood, and outer-wood) on the measurements was investigated. The specific gas permeability of E. nitens ranged in order of magnitude from 10−20 to 10−16 m2. The results showed that the radial position had a statistically significant effect on the specific permeability in both flow directions and, in general, the permeability values increased from inner-wood to outer-wood. Moreover, the scanning electron microscopy images showed obstruction of vessels by tyloses which explained the lower permeability values obtained in the inner-wood of E. nitens. Differences in the magnitude of the permeability values could explain the diverse drying and impregnation behavior according to the wood zones, the low permeability values in the internal wood-zone could suggest an opportunity for improving it, through chemical modification or structural changes to introduce new functionalities of this radial wood-zone in Eucalyptus nitens.

Computer tomography of uro-lymphatic fistulas associated with renal colic

This article presents two clinical observations of uro-lymphatic fistulas diagnosed by computed tomography. In both cases, the patients were admitted with symptoms of renal colic. Uro-lymphatic fistulas are a rare condition caused by the formation of a connection between the urinary and lymphatic systems, which is caused by, as a rule, lymphatic vessel obstruction due to parasitic infestation. Other causes may be radiation therapy, retroperitoneal trauma, and tumor sprouting. In the era before antibiotics, infectious processes such as xanthogranulomatous pyelonephritis and renal tuberculosis were common. Cases of uro-lymphatic fistulas formed against urolithiasis background are presented below. In the clinical cases presented, urine directly entered the lymphatic vessels through a uro-lymphatic fistula detected on contrast-enhanced computed tomography. Uro-lymphatic fistulas caused by impaired urine outflow due to blocked urinary tract are rarely detected since abdominal ultrasound is the diagnostic method of choice in renal colic. In the vast majority of cases, uro-lymphatic fistulas are treated conservatively and do not require surgical intervention. As a rule, the formed fistulas cease to exist when its root cause is successfully treated.

Antiphospholipid Syndrome in Patients with Venous Thromboembolism.

Unprovoked (or provoked by mild risk factors) venous thromboembolism (VTE) in young patients, VTE in uncommon sites, or cases of unexplained VTE recurrence may be positive for antiphospholipid antibodies (aPL) and thus may be diagnosed with antiphospholipid syndrome (APS). The evaluation of aPL is standardized using immunological tests for anticardiolipin and anti-β2-glycoprotein I. The determination of functional antibodies (lupus anticoagulant) is less standardized, especially in patients on anticoagulant treatment. Patients positive for all the three tests are at high risk of recurrence, which, in turn, might lead to chronic obstruction of pulmonary vessels (chronic thromboembolic pulmonary hypertension). Randomized clinical trials have shown that triple-positive patients should be treated with vitamin K antagonists maintaining an international normalized ratio between 2 and 3. Whether patients with VTE and incomplete aPL profile can be treated with direct oral anticoagulants should be further investigated.

Ischemic stroke: a rare complication of a large multinodular goiter

SummaryMass effect from a goiter is a serious complication with potentially life-threatening consequences. In rare instances, a goiter can compress nearby vessels, compromising cerebral blood flow, which can lead to an ischemic stroke. Ischemic strokes generally occur due to atherogenic or embolic phenomenon, albeit a rare etiology can be due to a mechanical obstruction of great vessels of the neck that provide blood supply to the brain. An unusual example of a similar obstruction is the mass effect of an expansive goiter on the carotid artery (CA) in the neck. We present a rare case of a 90-year-old female who had a historically untreated goiter for 13 years. She presented with symptoms of acute stroke, including right-sided weakness and dysarthria. CT angiogram of the neck revealed a massively enlarged thyroid gland causing compression and intermittent obstruction of the blood flow in the left common CA. Subsequently, the patient underwent a total thyroidectomy. Postoperatively, she had a remarkable recovery of her symptoms of right-sided weakness and dysarthria. Acknowledging stroke as a grave mechanical complication of a large multinodular goiter is crucial for timely and appropriate management to avoid serious consequences.Learning pointsThe natural history of euthyroid multinodular goiters include progressive, abnormal goiter which occurs when it obstructs the carotid artery (CA) and compromises cerebral blood flow.Timely diagnosis and surgical management of an enlarging goiter compressing the CA can reduce morbidity from an ischemic stroke.Ischemic stroke is a rare and dangerous complication of a giant multinodular goiter.

In vitro and ex vivo antioxidant and vasodilatory properties of Syzygium cumini, Piper sarmentosum roxB and Psidium guajava plant extracts from Reunion Island

Ischemic heart disease is the leading cause of cardiovascular death. It may originate from large vessel obstruction or from coronary microvascular dysfunction (CMD). CMD is associated with oxidative stress, which induces endothelial dysfunction and therefore alters vasodilation. The potentially beneficial cardiovascular effects of plant extracts have long been suggested by traditional medicine. We investigated the antioxidant and vasodilatory potential of 5 extracts from 3 plants from Reunion Island on in vitro and ex vivo experimental models. Aqueous extracts (AE) of Piper sarmentosum roxB (PSR) roots, PSR leaves, Psidium guajava (PG) leaves, a methanolic extract (ME) of Syzygium cumini (SC) seeds, and a hydroalcoholic extract (HE) of SC fruits were obtained. Their antioxidant capacities were assessed using DPPH (2,2DiPhenyle-1-Picryl-Hydrazyle). Concentrations of extracts ranged from 5 to 40 μg/mL in order to determine EC50 and T-EC50 values. To assess the vasodilatory potential of the extracts, phenylephrine-precontracted aortic rings from male Sprague Dawley rats with > 60% endothelium-dependent vasodilation were incubated with the extracts (50 μg/mL). Extracts displaying a vasodilatory effect were then used at 0.5, 5, and 50 μg/mL on precontracted aortic rings with (> 60%) or without (< 10%) endothelium. Finally, the pathway involved in endothelium-dependent relaxation by the extract was investigated by preincubation with the nitric oxide synthase (NOS) inhibitor L-NAME. The results are presenting in Table 1 . A high antioxidant capacity was observed for SC seed ME (EC50 = 8.0 μg/mL; T-EC50 = 10 min) and PG AE (EC50 = 9.7 μg/mL; T-EC50 = 15 min). SC seed ME and PG AE also demonstrated a vasodilatory effect (respectively: 64 ± 12% and 55 ± 17% vs. 4 ± 9% for control, P < 0.0001). No vasodilation was observed following endothelium removal. L-NAME significantly inhibited the vasodilatory effect of SC seed ME (32 ± 19% vs. 67 ± 15%, P = 0.003), but not that of PG (38 ± 19% vs. 66 ± 30%, P = 0.7). SC seed and PG demonstrated promising potential to prevent CMD due to their antioxidant properties and endothelium-dependent vasodilatory effects, with the effect of SC seed effect involving endothelial NOS. Further studies are warranted to determine the in vivo potential of these extracts.

MO266: Deficiency of Urokinase-Type Plasminogen Activator Exacerbates CBSA-Induced Membranous Nephropathy in Mice

Abstract BACKGROUND AND AIMS In nondiabetic population, primary membranous nephropathy (PMN) is the most common cause of idiopathic nephrotic syndrome in the world. Urokinase-type plasminogen activator (uPA) is one of the key members of fibrinolysis system, which functions as dissolving blood clots to prevent obstruction of blood vessels. Currently, the roles of uPA in PMN remain undefined. METHOD Six-week-old male mice with Plau wild-type and knockout in BALB/c strain were used to induce MN by cationic bovine serum albumin (cBSA). Biochemistry assays of blood and urine were measured by a Fuji Dri-Chem FDC NX 500 machine. Glomerular polyanions were determined by using Colloidal Iron Stain Kit. Reactive oxygen species (ROS) was detected by immunohistochemistry stained by 4-HNE antibody. TUNEL positivity in the kidneys of mice was determined using an ApopTag® Plus Peroxidase In Situ Apoptosis Kit. The deposition of immune complex in glomeruli was examined by a transmission electron microscope. Lymphocyte subsets were determined by flow cytometry. Serum concentrations of IgG1 and IgG2a were measured by ELISA. RESULTS It has been reported that BALB/c mice is an ideal strain for mimicking human PMN. Thus, we generated uPA deficient mice (Plau-/-) in BALB/c strain by backcrossing C.129S2-Plautm1Mlg/J mice with BALB/c wild-type mice to N10. Plau-/- mice exhibited severe urinary albumin-to-creatinine ratio significantly when compared with wild-type mice at 2 weeks post-cBSA administration. Consistently, cBSA-induced Plau-/- mice displayed higher serum creatinine, hypoalbuminemia and hypercholesterolemia than wild-type mice. Histologically, Plau-/- mice presented more severed glomerular basement thickening, IgG granular deposition, intensified podocyte effacement, irregular thickening of glomerular basement membrane and subepithelial deposits than wild-type mice. Attenuated colloidal iron stain was observed in Plau-/- mice when compared with wild-type mice. Moreover, elevated ROS and apoptosis in the kidneys of Plau-/- mice were observed. B lymphocyte subsets were enriched significantly in the Plau-/- mice with MN, suggesting that pathological aggravation of MN is associated with dominant B lymphocyte population. The enriched ratio of IgG1 to IgG2a further confirmed predominant Th2 subset in Plau-/- mice. CONCLUSION uPA deficiency enhances Th2 dominant immune response, leading to enhancement of ROS and apoptosis in the kidneys, which subsequently exacerbates the progression of MN. Maintenance of uPA homeostasis may be a promising therapeutic approach for MN management.

"No-Reflow" Phenomenon: A Contemporary Review.

Primary percutaneous angioplasty (pPCI), represents the reperfusion strategy of choice for patients with STEMI according to current international guidelines of the European Society of Cardiology. Coronary no-reflow is characterized by angiographic evidence of slow or no anterograde epicardial flow, resulting in inadequate myocardial perfusion in the absence of evidence of mechanical vessel obstruction. No reflow (NR) is related to a functional and structural alteration of the coronary microcirculation and we can list four main pathophysiological mechanisms: distal atherothrombotic embolization, ischemic damage, reperfusion injury, and individual susceptibility to microvascular damage. This review will provide a contemporary overview of the pathogenesis, diagnosis, and treatment of NR.

ACUTE SUPERIOR MESENTERIC VESSEL THROMBOSIS CAUSING BOWEL ISCHEMIA – A 5 CASE SERIES

Background: Acute mesenteric ischemia consists of the sudden, partial or complete, interruption of the blood ow in superior or inferior mesenteric vessels that result in intestinal ischemia. The incidence was exponentially increasing with age and no difference has been observed between sexes. Aim: The Aim of this case series was to highlight clinical presentation, the difculty in diagnosis and importance of early intervention and the prognosis of superior mesenteric vessel thrombosis with bowel ischemia. This article presented a case series of intestinal infarction through obstruction of superior mesenteric vessels – three cases of acute mesenteric artery thrombosis, two case of acute mesenteric vein thrombosis. Materials and methods: The materials for this case series was collected from patients diagnosed and admitted as acute superior mesenteric vessel thrombosis in various surgical units in Department of General Surgery, Govt. Kilpauk Medical College &amp; Hospital &amp; Govt Royapettah Hospital,Chennai. All 5 cases have been analyzed for this study during period of 18 months from March 2020 to Augest 2021. All Cases with superior mesenteric vessels thrombosis were included.No exclusion criteria. Results: This case series consisted of 5 cases, three cases of acute mesenteric artery thrombosis and two case of acute mesenteric vein thrombosis. In this case series, superior mesenteric artery thrombosis was more common with male preponderance. 4 out of 5 cases were male in which Superior mesenteric artery was more common when compared to vein thrombosis. Out of 5 cases, 2 cases were asymptomatic with mild abdominal discomfort. Most common complaints of 5 cases were sudden onset of abdominal pain with or without vomiting. Abdominal distension/ Constipation were not seen in all cases. Out of 5 cases, 2post- operative stay and no complications after surgery. 2 cases developed postop complications.1 case had deceased because of late presentation. Conclusion: The diagnosis of AMI is difcult and mostly delayed resulting in irreversible bowel ischemia which requires emergency intervention. Mortality and morbidity for AMI remains high, and in patients requiring extensive bowel resection the survival rate was low. As AMI mostly affects the elderly population physicians have to be aware of the possibility of this condition when facing the elderly patient even with mild sudden onset of abdominal pain complaints. An interdisciplinary collaboration is must, since patients are not initially evaluated by surgeons.

A Vegfc-Emilin2a-Cxcl8a Signaling Axis Required for Zebrafish Cardiac Regeneration.

Ischemic heart disease following the obstruction of coronary vessels leads to the death of cardiac tissue and the formation of a fibrotic scar. In contrast to adult mammals, zebrafish can regenerate their heart after injury, enabling the study of the underlying mechanisms. One of the earliest responses following cardiac injury in adult zebrafish is coronary revascularization. Defects in this process lead to impaired cardiomyocyte repopulation and scarring. Hence, identifying and investigating factors that promote coronary revascularization holds great therapeutic potential. We used wholemount imaging, immunohistochemistry and histology to assess various aspects of zebrafish cardiac regeneration. Deep transcriptomic analysis allowed us to identify targets and potential effectors of Vegfc (vascular endothelial growth factor C) signaling. We used newly generated loss- and gain-of-function genetic tools to investigate the role of Emilin2a (elastin microfibril interfacer 2a) and Cxcl8a (chemokine (C-X-C) motif ligand 8a)-Cxcr1 (chemokine (C-X-C) motif receptor 1) signaling in cardiac regeneration. We first show that regenerating coronary endothelial cells upregulate vegfc upon cardiac injury in adult zebrafish and that Vegfc signaling is required for their proliferation during regeneration. Notably, blocking Vegfc signaling also significantly reduces cardiomyocyte dedifferentiation and proliferation. Using transcriptomic analyses, we identified emilin2a as a target of Vegfc signaling and found that manipulation of emilin2a expression can modulate coronary revascularization as well as cardiomyocyte proliferation. Mechanistically, Emilin2a induces the expression of the chemokine gene cxcl8a in epicardium-derived cells, while cxcr1, the Cxcl8a receptor gene, is expressed in coronary endothelial cells. We further show that Cxcl8a-Cxcr1 signaling is also required for coronary endothelial cell proliferation during cardiac regeneration. These data show that after cardiac injury, coronary endothelial cells upregulate vegfc to promote coronary network reestablishment and cardiac regeneration. Mechanistically, Vegfc signaling upregulates epicardial emilin2a and cxcl8a expression to promote cardiac regeneration. These studies aid in understanding the mechanisms underlying coronary revascularization in zebrafish, with potential therapeutic implications to enhance revascularization and regeneration in injured human hearts.

Novel anti-inflammatory and wound healing controlled released LDH-Curcumin nanocomposite via intramuscular implantation, in-vivo study

One of the most common problems in wounds is delayed healing and complications such as infection. Therefore, the need for novel materials accelerates the healing of wounds especially abdominal wounds after surgery besides high efficiency and safety is mandatory. The rate of wound healing, anti-inflammatory and biocompatibility of Zn-Al LDH (Zn-Al layer double hydroxide) alone and loaded with Curcumin (Zn-Al LDH/Curcumin) was screened via in-vivo assays through intramuscular implantation in rat abdominal wall with intact peritoneum cavity. The implanted drugs were formed through Curcumin loaded into LDH of Zn-Al with drug release of 56.78 ± 1.51% within 24 h. The synthesized nanocomposite was characterized by (TGA/DTA) thermal analysis, (XRD) X-ray diffraction, (FESEM) Field emission scanning electron microscopy, (HRTEM) high resolution transmission electron microscope, energy dispersive X-ray (EDX) and low-temperature N 2 adsorption, pore volume and average pore size distribution. The integrity of blood circulation, inflammatory signs, wound healing rate, capacity of tissue integration, antigenicity and composite biocompatibility, auto fluorescence ability of collagen bundles and the tensile strength of the muscle were assessed histopathologically after 7 and 30 days’ post-implantation. Excellent wound healing ability was achieved with shortest length between the wound gap edges and higher tensile strength of the muscle. Besides emit florescence very well followed by good healing and tensile muscles strength in Curcumin while very low strength with scar formation in Zn-Al LDH/Curcumin in both acute and chronic wound. No signs of inflammation in Curcumin & Zn-Al LDH. No vessels obstruction or bleeding observed in both Zn-Al LDH and Curcumin more than Zn-Al LDH/Curcumin and control which examined through candling. Good healing & infiltrated immune cells in same groups through histopathological examination. This work supports the anti-inflammatory, wound healing and biocompatibility of both LDH and Curcumin with living matter, increasing their biomedical applications in this era with safety and increasing efficacy with prolonged drug release.

Sciatica and femoral head osteonecrosis complicating a gluteal hydatid cyst: A case report.

Introduction and importanceHydatid disease is an endemic echinococcal infestation in Tunisia.Only 4% of hydatid cysts are located in the muscle. The gluteal localization is a very rare entity.The present case illustrates a gluteal hydatid cyst resulting in sciatica and osteonecrosis of the femoral head, an exceptional entity.Case presentationA 49-year-old man of urban origin, with free medical history, presented to our outpatient clinic with left sciatica and mechanical hip pain, that have been ongoing for 2 years.Pelvic radiograph showed femoral head osteonecrosis and lytic lesions of the ischium.MRI scan identified an extra-articular vesicular cyst in the left gluteal region involving the gluteus maximus. It suggested the diagnosis of musculo-skeletal echinococcosis.The patient underwent surgery and intraoperative findings showed a gluteal vesicular cyst with direct compression of the sciatic nerve, it also revealed femoral head necrosis. The cyst was drained and the pericyst excised. Total hip arthroplasty was postponed and the patient received a course of anthelmintic chemotherapy.Clinical discussionMuscular involvement of hydatid cysts is rare and seen only in 4% of cases. Neurological complications from sciatic nerve compression can present as sciatica, with a principal differential diagnosis of nerve root compression. Aseptic femoral head osteonecrosis, an exceptional complication of an extra-articular gluteal hydatid cyst, can result from three mechanisms: a direct mechanical compression, an ischemic process due to vessel obstruction or a cellular process mediated by osteoclasts.Treatment is based on surgical excision combined with anthelmintic chemotherapy, the latter reduces the number of live cysts and the risk of recurrence.ConclusionAlthough gluteal cysts are extremely rare with different clinical symptoms, surgery associated with anthelmintic treatment has a good functional outcome.

Orthopedic Surgery Referral Pattern Analysis per Demographic Factors Among Patients Diagnosed With Severe Peripheral Artery Disease in Terms of Partial or Total Limb Amputation.

Introduction: Peripheral artery disease (PAD) signifies the obstruction of blood vessels in the lower extremities due to harmful buildup of fatty material. Patients may present to their primary care provider complaining of lower extremity pain, especially during exercise. Primary care providers must weigh the severity of patients’ disease process to determine if an orthopedic surgery referral is needed based on an extensive history as well as analysis of demographic factors that may influence their risk of morbidity and mortality. We aimed to objectively present these demographic factors with numeric values in terms of influence.Methods: We utilized the Cerner Health Facts database to analyze 63 million unique patient encounters from 2000 to 2018. The database is categorized as Institutional Review Board (IRB) exempt due to its de-identified presentation. In an outcome-based approach, we were able to calculate referral patterns based on entered demographic parameters.Results: A patient’s age, census region, marital status, previous history of PAD/critical limb ischemia (CLI), history of surgeries, race, facility type, and urban/rural status presented as predictors of seeing a surgeon during a patient encounter.Conclusion: Our results found numerous aforementioned demographic factors to be associated with orthopedic surgery referral patterns. This is significant as proper reconciliation of these factors may help reduce patient morbidity in terms of amputation reduction and reduce patient mortality associated with this surgery or complications.

Role of Transarterial Embolization in the Treatment of Life-Threatening Hemorrhage in Patients With Maxillofacial Injury.

Life-threatening hemorrhage following maxillofacial injury (MFI) is rare but can be fatal. Conventional measures for hemostasis including nasal packing, balloon tamponade, and surgical ligation of bleeding points may not be effective or efficient in patients at risk of hypovolemic shock. Advantages of transarterial embolization (TAE) include rapid identification of the bleeding focus and its access, direct obstruction of the culprit vessels, ability to control multiple bleeding sites, and no requirement of general anesthesia. The internal maxillary artery is the most frequently targeted vessel for embolization. Several studies have demonstrated that TAE was technically successful at rates between 79.4% and 100% and was associated with good clinical outcomes. However, major complications such as tongue necrosis or facial nerve palsy have rarely been reported (0%-7%), probably because of rich collaterals in the maxillofacial region, and failure to diagnose complications in patients who are severely disabled or died. Traditionally, Gelfoam and coils have been widely used as embolic materials. Polyvinyl alcohol particles and n-butyl-cyanoacrylate are also favored, and newer embolic materials, such as Onyx or precipitating hydrophobic injectable liquid, are available for use. Operators should be familiar with the distinctive characteristics of each embolic material. Early treatment with TAE for intractable hemorrhage may improve outcomes in patients with MFI, and further studies are necessary to develop a treatment algorithm to define when to initiate TAE in cases of severe oronasal hemorrhage following MFI.

Filariasis diagnosed by real-time ultrasound scanning as filarial dance sign - A case report.

IntroductionLymphatic filariasis (LF) is a vector-borne illness caused due to Wuchereria bancrofti. Genital abnormalities may result from chronic inflammation of the lymphatic vessels and obstruction of the afferent vessels in Bancroftian filariasis. Doxycycline, albendazole, diethylcarbamazine, and ivermectin are among the treatments available.CaseA 16-year male presented to our OPD with a complaint of left inguinal swelling for the past 6 Months. Examination of the swelling revealed a left-sided inguinal swelling of 5 × 4 cm with intact overlying skin. A provisional diagnosis of inguinal lymph varix was made, and real-time ultrasound scanning along with FNAC was performed. Swelling resolved after conservative management.DiscussionUltrasonography can easily observe adult worms due to their size and fast movements. Using pulsed-wave doppler mode, the characteristic movement profile of adult worms in pulsed-wave doppler mode can be distinguished from other movements (e.g., blood in venous vessels).ConclusionUltrasound is the imaging modality of choice to detect filarial worms/microfilaria in the lymphatic system, which produces the classic twirling of microfilaria in the lymphatic system, known as the "filarial dance sign".

Stroke in the COVID-19 pandemic era.

The aim of this article is to outline the impact of COVID-19 on the frequency of occurrence, course of stroke treatment, and to highlight the cause-effect relationship between SARS-CoV-2 infection and stroke on the basis of a literature overview. Since the end of 2019, the whole world has been struggling with the effects of the pandemic caused by the coronavirus SARS-CoV-2. The virus induces a wide spectrum of symptoms, ranging from mild or serious ones, which may lead to a severe multiorgan failure. Acute ischaemic stroke (AIS) might be associated with COVID-19 as a potentially fatal complication, while hemorrhagic stroke is less frequent. In most cases, stroke is caused by large artery occlusion. One of its reasons is hypercoagulation with a complex mechanism, which has not been fully explained. Research has shown that during COVID-19 pandemic, the number of patients admitted to hospitals due to AIS decreased. During the first pandemic wave there was no change regarding the proportion of patients with cerebral vessel obstruction who received endovascular treatment. In the COVID-19 pandemic era, rapid intravenous administration of tissue plasminogen activator remains the main treatment for acute ischaemic stroke. Patients often fail to report to hospital for the fear of SARS-CoV-2 infection. It is of the utmost importance to raise society's awareness of the necessity to report to hospital when experiencing serious symptoms, including stroke.

Kajian Efektivitas Pengobatan pada Pasien Stroke Iskemik di Instalasi Rawat Inap RSUD Nunukan

Ischemic stroke occurs due to obstruction of the blood vessels that supply the brain. Obstruction occurs due to increased fat lining the blood vessels or atherosclerosis. Atherosclerosis will cause cerebral thrombosis and cerebral embolism. This study aims to examine effectiveness of the use of drugs in ischemic stroke patients hospitalization at Nunukan Hospital. This study is a non-experimental study with a descriptive analysis design using medical record data collected retrospectively and the number of samples in this study was 70 patients. The sample selection of this research was using purposive sampling technique. The results showed tthe highest characteristics of ischemic stroke patients by gender were male (54.29%), based on age group 45-65 years (64.29%), based on diagnoses with comorbidities (64.70%), and the length of treatment the most occurred in 5-10 days (72.55%). The most used drugs single therapy for ischemic stroke are antiplatelet drugs, namely aspirin (28.57%) and the most used combination therapy is piracetam and citicoline (50%). The most frequent drug interactions were aspirin and clopidogrel (48.57%). While the accuracy of drug use includes the right indication (100%), the right drug (94.29%), the right dose (97.14%), and the right frequency (97.14%). Thus, it was concluded that the treatment of ischemic stroke at the inpatient installation the Nunukan General Hospital was effective.

Computed tomography in intestinal obstruction: a tertiary care perspective from Northern India

Background: Intestinal obstruction is a very common surgical emergency faced today in surgical ERs (emergency rooms) all around the globe. With the advent of newer technology, management of intestinal obstruction has changed significantly. Today computed tomography (CT) employs both intravenous as well as oral contrast for determining the cause and the level of obstruction. It also gives additional information regarding any malignancy causing the obstruction, its staging and status of vessels. Thus, a surgeon can go in the procedure with a plan already in mind which can be discussed in detail with experienced surgeons beforehand.Methods: This was a prospective observational study that was done in department of surgery at GMC Jammu over a period of two years. Patients of intestinal obstruction who presented to our department were enrolled in this study. They were subjected to a contrast enhanced CT after due preparation and managed accordingly. Data was recorded in a tabulated fashion and evaluated.Results: After implementing the exclusion criteria’s, a total of 163 patients were included in this study, majority being males in the age group of 20-40 years. Major cause of intestinal obstruction was attributed to post-operative adhesions followed by band obstruction due to various cause. CT findings were seen to be quite significant in evaluation and management of intestinal obstruction. About 30 % of the patients enrolled in our study were treated conservatively while 70 % required operative intervention in form of exploratory laparotomy.Conclusions: Computed tomography is widely available now a days at a cheaper cost. It greatly increases the armamentarium of the surgeon in dealing with this condition. A lot many cases today are dealt conservatively due to high utilisation of CT scan. It also helps the surgeon to preoperatively plan a proper surgical approach

Four Limb Gangrene - A Rare Presentation

We report a case of a 73-year-old male, who presented with acute gangrene of the left thumb which then progressed to symmetrical peripheral gangrene of digits of all four limbs, with no comorbid diseases. On investigation, there was high D-dimer, normal lipid profile, and two-dimensional Echo. Computed tomography and magnetic resonance angiogram of all limbs revealed atherosclerotic changes. The patient underwent disarticulation of digits under the wrist block. Symmetrical peripheral gangrene, seen in a wide variety of medical conditions presents as symmetrical gangrene of two or more extremities without large vessel obstruction or vasculitis. The fingers and toes (rarely nose, ear lobes, or genitalia) are affected. It may manifest unpredictably in conditions associated with sepsis, diabetes mellitus, low-output states, vasospastic conditions, myeloproliferative disorders, or hyperviscosity syndrome. It carries a high mortality rate with a very high frequency of multiple limb amputations in survivors.