scholarly journals Comparison of 4F‐PCC in obese and nonobese patients with life‐threatening bleeding or requiring emergent surgery

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Jessica Rimsans ◽  
Karen Berger ◽  
Sarah Culbreth ◽  
Christopher Hood ◽  
Katleen Chester ◽  
...  
Keyword(s):  
Life Threatening ◽  
Nonobese Patients ◽  
Emergent Surgery

scholarly journals Trying to Survive A Serious Heart Condition in Time of COVID-19

2021 ◽  
Vol 24 (2) ◽  
pp. E372-E374
Author(s):  
Josip Varvodic ◽  
Verica Mikecin ◽  
Irzal Hadzibegovic ◽  
Marko Kutlesa ◽  
Carla Coric ◽  
...  
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Aortic Root ◽  
The Past ◽  
Cardiac Decompensation ◽  
The World ◽  
Life Threatening ◽  
Emergent Surgery ◽  
Large Abscess ◽  
Heart Condition

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.

Real-Life Applications and Challenges of Andexanet Alfa for Life-Threatening Bleeding and Reversal Prior to Surgery

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Modi K ◽  
◽  
Attar D ◽  
Rimsans J ◽  
Connors JM ◽  
...  
Keyword(s):  
Real World ◽  
Real Life ◽  
The United States ◽  
High Dose ◽  
Reversal Agent ◽  
Number Of Patients ◽  
Life Threatening ◽  
Hemostatic Efficacy ◽  
Andexanet Alfa ◽  
Emergent Surgery

Andexanet alfa is a targeted reversal agent for apixaban and rivaroxaban for life-threatening or uncontrolled bleeding. There are few multicenter, real world studies that also include patients with off-label use who require emergent surgery. The objective was to describe hemostatic efficacy, thrombotic events, clinical applications, pharmaceutical challenges, and mortality associated with reversing apixaban and rivaroxaban with andexanet alfa in clinical practice. Retrospective descriptive observational cohort study of andexanet alfa use at 2 academic medical centers in the United States from July 1, 2018 to September 30, 2019. Ninety patients received 91 doses of andexanet alfa including 6 for reversal prior to surgery. Effective hemostasis was achieved in 72.9% of bleeding episodes and all patients that received andexanet alfa preoperatively were deemed to have effective hemostasis. Thrombotic events occurred in 7 of 90 patients (7.7%) and 2 of these events occurred the day after administration. Incorrect high-dose andexanet alfa was given 11 times with an estimated excess expenditure of $272,250. Thirty-two of 90 (35.5%) patients died, and most deaths occurred during the initial hospitalization. Our real-world experience with andexanet alfa in bleeding patients is similar to the non-comparative trial that led to Food and Drug Administration approval, and our findings show good hemostatic efficacy in a small number of patients requiring emergent surgery. We highlight the importance of appropriate dose based on time of ingestion and factor Xa inhibitor dose. Our 2 institutions spent over a quarter of a million dollars on excess andexanet alfa in a year and a half.

Association of Fiber Orientation and Dissection Properties of Ascending Thoracic Aortic Aneurysms With Aortic Valve Morphology

2011 ◽  
Author(s):  
Salvatore Pasta ◽  
Julie A. Phillippi ◽  
Antonio D’Amore ◽  
Michael S. Sacks ◽  
Simon C. Watkins ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Techniques ◽  
Aortic Aneurysms ◽  
Type A Aortic Dissection ◽  
Thoracic Aortic Aneurysms ◽  
International Registry ◽  
Life Threatening ◽  
Morbidity Risk ◽  
Emergent Surgery

Type A aortic dissection (AoD) of an ascending thoracic aortic aneurysm (ATAA) is a life-threatening cardiovascular emergency with a high potential for death. Despite improved surgical techniques, the morbidity risk for emergent surgery remains 24% worldwide according to data from the International Registry of Acute Aortic Dissection [1].

scholarly journals Successful Gastric Volvulus Reduction and Gastropexy Using a Dual Endoscope Technique

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Laith H. Jamil ◽  
Brian L. Huang ◽  
David C. Kunkel ◽  
Vijay Jayaraman ◽  
Edy E. Soffer
Keyword(s):  
Gastric Volvulus ◽  
Right Hemicolectomy ◽  
Whipple Procedure ◽  
Endoscopic Gastrostomy ◽  
Upper Gi Series ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Novel Strategy ◽  
Emergent Surgery

Gastric volvulus is a life threatening condition characterized by an abnormal rotation of the stomach around an axis. Although the first line treatment of this disorder is surgical, we report here a case of gastric volvulus that was endoscopically managed using a novel strategy. An 83-year-old female with a history of pancreatic cancer status postpylorus-preserving Whipple procedure presented with a cecal volvulus requiring right hemicolectomy. Postoperative imaging included a CT scan and upper GI series that showed a gastric volvulus with the antrum located above the diaphragm. An upper endoscopy was advanced through the pylorus into the duodenum and left in this position to keep the stomach under the diaphragm. A second pediatric endoscope was advanced alongside and used to complete percutaneous endoscopic gastrostomy (PEG) placement for anterior gastropexy. The patient’s volvulus resolved and there were no complications. From our review of the literature, the dual endoscopic technique employed here has not been previously described. Patients who are poor surgical candidates or those who do not require emergent surgery can possibly benefit the most from similar minimally invasive endoscopic procedures as described here.

scholarly journals Stercoral Ulcer-Associated Perforation and Chemotherapy

2017 ◽  
Vol 10 (2) ◽  
pp. 442-446 ◽  
Author(s):  
Mohamad A. Mouchli ◽  
Anne M. Meehan
Keyword(s):  
Ct Scan ◽  
Chronic Constipation ◽  
Bowel Wall ◽  
Ulcer Perforation ◽  
Life Threatening ◽  
Emergent Surgery ◽  
Surgical Condition

Stercoral ulcer perforation is a life-threatening surgical condition which is thought to result from necrosis of the bowel wall due to an ischemic pressure by stool. This condition usually afflicts patients with chronic constipation. CT scan can identify most of the cases and emergent surgery is usually indicated.

Surgical Management of Diabetic Foot and Ankle Infections

2010 ◽  
Vol 3 (5) ◽  
pp. 223-230 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Early Diagnosis ◽  
Surgical Management ◽  
Diabetic Foot ◽  
Foot And Ankle ◽  
Diabetic Foot Infection ◽  
Delayed Treatment ◽  
Anatomic Location ◽  
Life Threatening ◽  
Emergent Surgery

Delayed treatment of any diabetic foot infection can lead to a limb- or life-threatening scenario. Urgent and/or emergent surgery may be necessary in the early diagnosis of a severe diabetic foot infection that is fol- lowed by staged reconstructive proce- dures. This article provides the reader with a thorough understanding of the surgical management of severe dia- betic foot infections and describes and guides treatment based on a rational schematic approach that identifies the anatomic location of the diabetic foot infection

scholarly journals Use of Continuous Renal Replacement Therapy for Removal of Dabigatran in a Patient in Need of Emergent Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Sara E. Parli ◽  
Melissa L. Thompson Bastin ◽  
Daniel A. Lewis
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Mesenteric Ischemia ◽  
Pain Patient ◽  
Undetectable Level ◽  
Fda Approval ◽  
Life Threatening ◽  
History Of ◽  
Emergent Surgery

Purpose.To report the ability to remove serum dabigatran using continuous renal replacement therapy (CRRT) in a patient with life-threatening bleeding.Summary.A 77-year-old female with history of atrial fibrillation who takes dabigatran for stroke prevention presented with abdominal pain. Patient was found to have bleeding and possible mesenteric ischemia and was taken to the operating room and had continued bleeding postoperatively. CRRT was initiated for the removal of any remaining dabigatran, with serum dabigatran levels collected to evaluate removal of dabigatran with CRRT. This patient had an increased dabigatran level prior to intervention, which decreased to an undetectable level after use of CRRT. Greater than 80% of the drug was removed due to 4 hours of CRRT and residual kidney function. Reversal of dabigatran is an area of current research with recent FDA approval of idarucizumab for use.Conclusion.Bleeding may occur as a result of the use of dabigatran and change in patient’s clinical condition. Use of CRRT may be an option in removing serum dabigatran in the case of a life-threatening bleed.

scholarly journals Lymphangioma of the Small Intestine Case Report and Review of the Literature

2019 ◽  
Vol 20 (4) ◽  
pp. 357-360
Author(s):  
Igor Ignjatovic ◽  
Vladimir Milosavljevic ◽  
Boris Tadic ◽  
Nikola Grubor ◽  
Slavko Matic
Keyword(s):  
Small Bowel ◽  
Histopathological Examination ◽  
Secondary Infection ◽  
Cystic Lymphangioma ◽  
Small Bowel Mesentery ◽  
Resonance Imaging ◽  
Abdominal Ultrasonography ◽  
Cystic Tumour ◽  
Life Threatening ◽  
Emergent Surgery

Abstract Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangiomas are extremely rare in adults (1,2,3). Lymphangioma of the small-bowel mesentery is rare, representing less than 1% of all lymphangiomas (4). We report a case of a 62-year-old female who presented with abdominal pain, discomfort, nausea and vomiting. Pre-operative tests including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumour. Laparotomy was performed; the tumour was excised completely, and a large cystic tumour of the small bowel mesentery was found. Histopathological examination diagnosed the tumour as a cystic lymphangioma. Lymphangiomas are extremely rare, especially in the abdomen of adults, and are asymptomatic for the most part; they often present as acute abdominal conditions, causing life-threatening complications such as secondary infection, rupture with haemorrhage, and volvulus or intestinal obstruction when the tumour increases in size, requiring emergent surgery. Lymphangioma is often difficult to diagnose, and surgical resection is selected in many cases for both diagnosis and treatment.

Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

1995 ◽  
Vol 53 ◽  
pp. 840-841
Author(s):  
Z. Hong Zhou ◽  
Jing He ◽  
Joanita Jakana ◽  
J. D. Tatman ◽  
Frazer J. Rixon ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
3D Structure ◽  
Structure Study ◽  
Herpes Simplex Virus 1 ◽  
Shell Proteins ◽  
Life Threatening ◽  
Infected Cells ◽  
Simplex Virus ◽  
Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

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