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Targeted High Volume Hemofiltration Could Avoid Extracorporeal Membrane Oxygenation in Some Patients with Severe Hantavirus Cardiopulmonary Syndrome
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 July 2020 doi:10.20944/preprints202007.0046.v1 Article Targeted High Volume Hemofiltration Could Avoid Extracorporeal Membrane Oxygenation in Some Patients with Severe Hantavirus Cardiopulmonary Syndrome René López1, 2, Rodrigo Pérez-Araos1, 3, Álvaro Salazar1, Mauricio Espinoza1, 2, Cecilia Vial4, Analia Cuiza 4, Pablo A. Vial2, 4, 5, and Jerónimo Graf1, 2* 1. Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile; [email protected] (R.L.); [email protected] (R.P-A.); [email protected] (Á .S.); [email protected] (M.E); [email protected] (J.G.) 2. Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile; [email protected] (P.A.V.) 3. Escuela de Kinesiología. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile 4. Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile; [email protected] (C.V.); [email protected] (A.C.) 5. Departamento de Pediatría, Clínica Alemana de Santiago, Santiago 7650567, Chile Correspondence: [email protected] Abstract Background: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. About two-thirds of the severe cases may be rescued by extracorporeal membrane oxygenation (ECMO). However, about half of the patients supported by ECMO suffer major complications. High volume hemofiltration (HVHF) is a depurative extracorporeal support that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. Methods: We implemented HVHF prior to ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. -
Peripheral Venous Malformations with a Dominant Outflow Vein: Results of Ethanol Embolization
CASE REPORT Peripheral Venous Malformations with a Dominant Outflow Vein: Results of Ethanol Embolization Hadi Rokni-Yazdi1, Mahsa Ghajarzadeh2, Amir Hossein Keyvan3, Mohammad Javad Namavar3, and Sepehr Azizi3 1 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imaging Medical Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran 2 Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran 3 Department of Infectious Diseases, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran Received: 11 Nov. 2013; Accepted: 29 Mar. 2014 Abstract- Venous malformations are the most common form of symptomatic vascular malformations. VM s could classify into low-flow lesions (VMs) and high-flow lesions (AVMs). For low-flow venous lesions, direct percutaneous puncture with injection of sclerosing agents (sclerotherapy) has been described as a successful therapy. In this article, we want to introduce a patient who treated with ethanol sclerotherapy for VM located in the right flank. The patients were a 35-year-old man with right flank mass, skin discoloration and hemorrhagic foci. Color Doppler ultrasonography showed low flow vascular malformation while Magnetic Resonance Imaging (MRI) showed that the mass contained fat tissue with branching tubular signal void structures inside. The draining vein was first coiled via tortuous venous malformation vessels access and then VM was embolized.Under ultrasonographic guide, direct puncture of one branches of venous malformation was performed, and contrast media were injected. The patient underwent the sclerotherapy every month for four consecutive months. The patient was followed up for a year, and clinical examination revealed 40-50% size reduction of the lesion while no bleeding was detected from the lesion during the follow-up period. -
Sclerotherapy Treatment for Spider Veins
Columbus, IN 47201 Columbus, 220 • Suite 2325 18th St. Inc Southern Indiana Surgery, Hours Monday through Friday, 8 a.m. – 5 p.m. For more information, please discuss your symptoms with your primary care physician or call Southern Indiana Surgery at (800) 815-7671. Fair Oaks Mall Central Ave. Central 25th St. Hawcreek Ave. Hawcreek Columbus 18th St. Regional Health ★ 17th St. Southern Indiana Surgery Sclerotherapy Treatment for Spider Veins 2325 18th St. • Suite 220 • Columbus, IN 47201 (812) 372-2245 • (800) 815-7671 www.sisurgery.com/veins Spider veins are unsightly red or blue veins that usually appear on the thighs, calves and ankles. While they may How Many Treatment SIS Vein Clinic Surgeons not pose any health risks, the damage to self-esteem is Sessions? Douglas Y. Roese, M.D. well known in those who suffer from them. That depends on your individual needs. You may have some Vascular Center Medical Director But you don’t have to continue to suffer from spider veins. or all spider veins treated in one session, or it may take as Dr. Douglas Roese brings 15 years of Southern Indiana Surgery now offers sclerotherapy to many as three sessions. Sclerotherapy is only effective on medical expertise to Southern Indiana permanently remove ugly spider veins. visible spider veins. It does not prevent future spider veins Surgery, including a vascular fellowship from appearing. from Baylor College of Medicine and eight years of general, vascular and What Is Sclerotherapy? Who Gets Spider Veins? laparoendoscopic surgery. Dr. Roese It is an elective, cosmetic procedure to treat spider veins. -
Induced Nephropathy by Hemofiltration
The new england journal of medicine original article The Prevention of Radiocontrast-Agent– Induced Nephropathy by Hemofiltration Giancarlo Marenzi, M.D., Ivana Marana, M.D., Gianfranco Lauri, M.D., Emilio Assanelli, M.D., Marco Grazi, M.D., Jeness Campodonico, M.D., Daniela Trabattoni, M.D., Franco Fabbiocchi, M.D., Piero Montorsi, M.D., and Antonio L. Bartorelli, M.D. abstract background Nephropathy induced by exposure to radiocontrast agents, a possible complication of From the Centro Cardiologico Monzino, percutaneous coronary interventions, is associated with significant in-hospital and long- Istituto di Ricovero e Cura a Carattere Sci- entifico, Institute of Cardiology, Universi- term morbidity and mortality. Patients with preexisting renal failure are at particularly ty of Milan, Milan, Italy. Address reprint high risk. We investigated the role of hemofiltration, as compared with isotonic-saline requests to Dr. Marenzi at Centro Cardio- hydration, in preventing contrast-agent–induced nephropathy in patients with renal logico Monzino, Via Parea 4, 20138 Milan, Italy, or at giancarlo.marenzi@ failure. cardiologicomonzino.it. methods N Engl J Med 2003;349:1333-40. We studied 114 consecutive patients with chronic renal failure (serum creatinine con- Copyright © 2003 Massachusetts Medical Society. centration, >2 mg per deciliter [176.8 µmol per liter]) who were undergoing coronary interventions. We randomly assigned them to either hemofiltration in an intensive care unit (ICU) (58 patients, with a mean [±SD] serum creatinine concentration of 3.0±1.0 mg per deciliter [265.2±88.4 µmol per liter]) or isotonic-saline hydration at a rate of 1 ml per kilogram of body weight per hour given in a step-down unit (56 patients, with a mean serum creatinine concentration of 3.1±1.0 mg per deciliter [274.0±88.4 µmol per liter]). -
Spider Vein Treatments About Sclerotherapy
Spider Vein Treatments Talk to any woman with spider veins on her legs, and she’ll probably tell you that they’re the bane of her existence. And if you’re one of the women who has them, you’re not alone: Close to 55 percent of women have some type of vein problem, according to the U.S. Department of Health and Human Services' Office on Women's Health. A combination treatment of sclerotherapy and laser usually does best for those small yet unsightly clusters of blue, red, or purple veins. Sclerotherapy is a simple procedure, where veins are injected with a sclerosing solution, which causes the veins to collapse and fade from view. Our vascular laser (Nd:YAG) is ideal for vessels around the ankles or capillaries that are too small to treat with sclerotherapy. *Pricing dependent upon density and quantity of vessels, with pricing typically starting around $250 per session. About Sclerotherapy What is sclerotherapy? Sclerotherapy is a minimally invasive procedure done by your healthcare provider to treat uncomplicated spider veins and uncomplicated reticular veins. The treatment involves the injection of a solution into the affected veins. What are varicose veins? Varicose veins are large blue, dark purple veins. They protrude from the skin and many times they have a cord-like appearance and may twist or bulge. Varicose veins are found most frequently on the legs. What are spider veins? Spider veins are very small and very fine red or blue veins. They are closer to the surface of the skin than varicose veins. They can look like a thin red line, tree branches or spider webs. -
Cardiovascular Update Insert "Volumes"
CARDIOVASCULAR SErvicES Cardiovascular Disease, Cardiovascular Surgery, and Pediatric Cardiology ROCHESTE R MINNESOTA 2008 Cardiovascular Surgery Cardiovascular Diseases PROCEDURES Total Operations 2,355 Electrophysiology Laboratory PROCEDURES On Cardiopulmonary Bypass 2,191 Diagnostic Electrophysiology 111 Off Cardiopulmonary Bypass 164 Head-up Tilt 324 Cardiac Valve Surgery 1,345 ICD Implants 491 Mitral Valve Repair 350 ICD Follow-up Checks 119 Mitral Valve Replacement 180 Pacemaker Implants 685 Aortic Valve Repair 66 Biventricular Pacemakers Implants 4 Aortic Valve Replacement 647 Biventricular ICD Implants 149 Other Valve Surgery 389 Loop Recorder Implants 29 Bioprosthetic Valve 676 Lead Extractions 82 Mechanical Prosthetic Valve 324 Radiofrequency Ablations Homograft 10 Atrial Flutter 36 Coronary Artery Bypass Grafting 773 Atrial Tachycardia 37 Congenital Heart Disease 409 Accessory Pathway/AVNRT 124 Thoracic Aortic Aneurysm Repair 226 AVN 122 Maze Procedure 187 Pulmonary Vein Isolation 421 Myectomy/Myotomy (HOCM) 153 Ventricular Tachycardia 93 Pericardiectomy 75 Mediastinal Tumor Resection 36 Cardiac Catheterization Laboratory PROCEDURES Cardiac Transplantation 25 Pediatric Diagnosis and Intervention 355 Pulmonary Thromboendarterectomy 15 Percutaneous Intervention (PCI) 1,543 Carcinoid Valve Surgery 13 High-Risk (LVAD-Supported) PCI 16 Left Ventricular Assist Devices 33 Non-PCI Intervention 330 Minimally Invasive Procedures Rotablator Procedures 45 (Robotic and Thorascopic) 200 Diagnostic Catheterization 6,503 Coronary Physiology -
2018 Cpt Coding Changes
2018 CPT CODING CHANGES | 17 2018 CPT coding changes by Samuel Smith, MD, FACS; Megan McNally, MD, FACS; and Jan Nagle, MS, RPh JAN 2018 BULLETIN American College of Surgeons 2018 CPT CODING CHANGES ignificant changes in Current Procedural Termi- data, it was determined that the code did not clearly nology (CPT)* coding will be implemented in define the intended use, leading to misreporting. There- S2018. Notably, considerable changes have been fore, the code descriptor was revised to remove the made to codes for reporting endovascular repair of terminology “sinus or fistula” from the parenthetical abdominal aorta and/or iliac arteries. This article pro- instructions and to clearly define the intended use of vides reporting information about the codes that are the code term “proud flesh” as follows ( = revised relevant to general surgery and its related specialties. code for 2018): 17250, Chemical cauterization of granulation tissue (i.e., Flaps proud flesh) Code 15732, Muscle, myocutaneous, or fasciocutane- ous flap; head and neck (i.e., temporalis, masseter muscle, New exclusionary parentheticals were added to this sternocleidomastoid, levator scapulae), was deleted and code that direct reporting for this service, including replaced with new code 15733 to more clearly describe an instruction regarding exclusion of reporting 17250 a muscle, myocutaneous, or fasciocutaneous flap that for chemical cauterization for wound hemostasis and involves one of six different named vascular pedicles. excluding use in conjunction with active wound care In addition, new code 15730 was established to describe management services (97597, 97598, 97602). 18 | a midface flap that does not involve a named vascular pedicle. -
Review Article FIBROSIS: Case Report and Review Article
SURGICAL MANAGEMENT OF ORAL SUBMUCOUS Review Article FIBROSIS: Case Report and Review Article Dr. Nitu Shah*, Dr. Naman Pandya**, Dr. Devanshi Vaghela***, Dr. Neha Vyas**** ABSTRACT Objective: To assess the outcome of different surgical treatment modalities of Oral Submucous Fibrosis. Background: Oral Submucous Fibrosis (OSF) is a persistent, progressive, pre-cancerous condition of the oral mucosa, which is mainly related with betel quid chewing habit. OSF is strongly connected with the risk of oral cancer. Since decades, many treatment modalities are suggested and studied like medicinal treatment, intralesional injection and physiotherapy or surgical treatments with varying degrees of benefit. But complete eradication of disease is challenging. The present article shows the outcome of various surgical treatment modalities in the management of this condition. Method: In this article a total of 4 patients who were clinically and histologically diagnosed as Oral Submucous Fibrosis, grouped according to classification system for the surgical management of OSF proposed by Khanna JN and Andrade NN. Out of 4 patients 1 patient undergone fibrectomy with collagen membrane placement, 1 patient undergone fibrectomy with buccal fat pad placement ,in 1 case fibrectomy was done with Laser , in advanced cases coronoidectomy was done. Conclusion : In oral submucous fibrosis Fibrectomy followed by grafting is a one of the suggested treatment for prevention of the recurrence of the condition but advanced procedure like coronoidectomy gives better results -
Complete Guide for Interventional Radiology
Complete Guide for Interventional Radiology 201 Contents Introduction ................................................................... 1 Percutaneous Transcatheter Retrieval of Foreign Body .... 104 CPT Codes and Descriptions ..........................................................1 Intravascular Ultrasound, Non-coronary ............................... 105 Procedure Codes ..............................................................................2 Transcatheter Vascular Stent Placement— Chapter 1: The Basics ...................................................... 5 Cervical Carotid ................................................................ 108 APC Basics–Why Is This Important? .............................................5 Transcatheter Vascular Stent Placement—Intracranial .... 112 CCI Edits–Why Is This Important? .................................................8 Transcatheter Vascular Stent Placement—Extracranial Recovery Audit Contractors (RAC) ...............................................9 Vertebral or Intrathoracic Carotid Artery .................. 114 Coding Basics ....................................................................................9 Transcatheter Biopsy .................................................................. 116 General Coding Guidelines ............................................................9 Modifiers for Outpatient Hospital Radiology and Transcatheter Endovascular Revascularization ................... 118 Cardiology Procedures .................................................... -
Providing Continuous Renal Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation
Kidney Case Conference: How I Treat Providing Continuous Renal Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation Nithin Karakala and Luis A. Juncos CJASN 15: 704–706, 2020. doi: https://doi.org/10.2215/CJN.11220919 Nephrology Section, Case Presentation vein or by using two catheters; one in the internal Central Arkansas A 34-year-old male was admitted for respiratory jugular and one in the femoral vein. VV-ECMO is used Veterans Healthcare fl System, Little Rock, failure due to H1N1 in uenza. His hypoxia worsened in refractory hypoxemia (2). Arkansas despite maximal ventilator support and thus initiated Department of on venovenous extracorporeal membrane oxygena- Medicine/ tion (VV-ECMO). Whereas this stabilized his respira- AKI and Extracorporeal Membrane Oxygenation Nephrology, tory and hemodynamic status, his creatinine increased Patients on ECMO are severely ill and frequently University of Arkansas . for Medical Sciences, (from 1.2 to 2.4 mg/dl), urine output declined (despite develop AKI; its incidence is 50% in adults, more Little Rock, Arkansas furosemide), and his weight had increased from 79 to than one-half of whom require KRT (3). The etiology 92 kg. Ultrasound assessment revealed a noncollaps- of AKI in these patients is comparable to that in Correspondence: ing vena cava and B-lines in his lungs. Nephrology critically ill patients not on ECMO, except that ECMO- Dr. Luis A. Juncos, was consulted for management of AKI and vol- related variables (e.g., hemorheological variations, Central Arkansas ume overload. systemic inflammation, hemolysis, etc.) can also pro- Veterans Healthcare System, 4300 W. 7th mote AKI (2). -
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INTERVENTIONAL CARDIOLOGY Cardiology Journal XXXX, Vol. XX, No. X, X–X DOI: 10.5603/CJ.a2020.0039 Copyright © 2020 Via Medica ORIGINAL ARTICLE ISSN 1897–5593 Filter life span in postoperative cardiovascular surgery patients requiring continuous renal replacement therapy, using a postdilution regional citrate anticoagulation continuous hemofiltration circuit Agnieszka Kośka1, Christopher J. Kirwan2, Maciej M. Kowalik3, Anna Lango-Maziarz4, Wiktor Szymanowicz1, Dariusz Jagielak5, Romuald Lango3 1Department of Cardiac Anesthesiology, University Clinical Center, Gdansk, Poland 2Department of Adult Critical Care, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom 3Department of Cardiac Anesthesiology, Medical University of Gdansk, Poland 4Department of Gastroenterology and Hepatology, Medical University of Gdansk, Poland 5Department of Cardiovascular Surgery, Medical University of Gdansk, Poland Abstract Background: Regional citrate anticoagulation (RCA) is the recommended standard for continuous renal replacement therapy (CRRT). This study assesses its efficacy in patients admitted to critical care following cardiovascular surgery and the influence of standard antithrombotic agents routinely used in this specific group. Methods: Consecutive cardiovascular surgery patients treated with postdilution hemofiltration with RCA were included in this prospective observational study. The primary outcome of the study was CRRT circuit life-span adjusted for reasons other than clotting. The secondary outcome evaluated the influence -
Sclerotherapy Treatment of Orbital Lymphatic Malformations: a Large Single-Centre Experience Alex M Barnacle,1 Maria Theodorou,2 Sarah J Maling,2 Yassir Abou-Rayyah2
Downloaded from http://bjo.bmj.com/ on February 18, 2016 - Published by group.bmj.com Clinical science Sclerotherapy treatment of orbital lymphatic malformations: a large single-centre experience Alex M Barnacle,1 Maria Theodorou,2 Sarah J Maling,2 Yassir Abou-Rayyah2 – 1Department of Radiology, ABSTRACT sclerosing agents and techniques.8 14 Results are Great Ormond Street Hospital Background Percutaneous sclerotherapy is an promising in terms of reduction in lesion size and for Children, London, UK 2 alternative to surgery for the treatment of orbital improvement in proptosis. Detailed VA outcomes Department of 14 Ophthalmology, Great Ormond lymphatic malformations (LMs). We present a large series have only been documented in one series. We Street Hospital for Children, of patients undergoing sclerotherapy for macrocystic LMs report the largest single-centre experience of sclero- London, UK with detailed visual acuity (VA) outcome data. therapy in patients with orbital LMs including Methods Data were collected prospectively in all detailed VA outcome data. Correspondence to Dr Alex M Barnacle, patients with macrocystic orbital LMs undergoing Department of Radiology, sclerotherapy. Sclerotherapy was performed under MATERIALS AND METHODS Great Ormond Street Hospital general anaesthesia, instilling sodium tetradecyl sulfate A retrospective analysis was undertaken of all for Children, London under imaging control. Procedures were repeated at WC1N 3JH, UK; patients at our institution undergoing sclerotherapy [email protected] 2-week to 6-week intervals, depending on clinical for macrocystic orbital LMs. IRB/Ethics Committee response. Patients underwent ophthalmological ruled that approval was not required for this study. Received 19 January 2015 assessment, ultrasound and/or MRI before and after All patients had a history of proptosis.