scholarly journals Preventive Innominate Artery Transection for a High-Risk Case of Tracheo-Innominate Artery Fistula

2021 ◽  
Vol 50 (5) ◽  
pp. 337-341
Author(s):  
Masahiro Mizumoto ◽  
Tetsuro Uchida ◽  
Yoshinori Kuroda ◽  
Atsushi Yamashita ◽  
Eiichi Oba ◽  
...  
Keyword(s):  
High Risk ◽  
Innominate Artery ◽  
High Risk Case

scholarly journals A ruptured penetrating atherosclerotic ulcer of the ascending aorta: a case report of an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Josephine Chenesseau ◽  
Pierre-Antoine Barral ◽  
Philippe Piquet ◽  
Marine Gaudry
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Endovascular Treatment ◽  
Endovascular Repair ◽  
Innominate Artery ◽  
Ascending Aorta ◽  
Stent Grafts ◽  
Penetrating Atherosclerotic Ulcer ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background An endovascular approach to the management of a ruptured plaque in the ascending aorta may be an alternative to open surgery in high-risk patients. This option may become inevitable due to the number of elderly patients unfit for open cardiac surgery. There are very few stent grafts able to fit the ascending aorta and in emergency cases, most medical teams have been limited to current thoracic aortic endografts, the shortest of which measure 10 cm. Case summary We report a case of an endovascular repair of a ruptured penetrating atherosclerotic ulcer of the ascending aorta. The patient was considered for open cardiac surgery but was evaluated at a high mortality risk based on his age, his medical history, and significant calcifications on his aorta. Our vascular surgical team decided then to perform an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery. Discussion Endovascular treatment of an acute ruptured aorta is feasible in high-risk patients with thoracic endovascular stent grafts and coverage of the innominate artery. Endovascular treatment of the ascending aorta is at its infancy and in need of further research. New stent grafts designed for the ascending aorta are in progress and should increase the numbers of interventions in the years to come.

scholarly journals Ewing's sarcoma with distant metastasis: A brief note on management and emerging therapies

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Girish Gulab Meshram ◽  
Neeraj Kaur ◽  
Kanwaljeet Singh Hura
Keyword(s):  
High Risk ◽  
Distant Metastasis ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Molecular Targets ◽  
Chemotherapeutic Agents ◽  
Young Population ◽  
Emerging Therapies ◽  
The Right ◽  
High Risk Case

Ewing’s sarcoma is an aggressive fatal malignancy of bones and soft-tissue. It predominantly affects the young population, with a worldwide incidence of three cases per million. The pelvis, extremities, and ribs are the most common sites. We present a case of massive Ewing’s sarcoma of the right femur with metastasis to bones and lungs. The patient was treated with chemotherapy. However, he succumbed to his illness before completion of therapy. In conclusion, Ewing’s sarcoma with distant metastasis is a high risk case with poor prognosis. Integrating novel molecular targets with conventional chemotherapeutic agents holds a promise for high-risk Ewing’s sarcoma patients.

scholarly journals Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding

2010 ◽  
Vol 163 (4) ◽  
pp. 645-650 ◽  
Author(s):  
Jiri Horacek ◽  
Sylvie Spitalnikova ◽  
Blanka Dlabalova ◽  
Eva Malirova ◽  
Jaroslav Vizda ◽  
...  
Keyword(s):  
High Risk ◽  
Autoimmune Thyroiditis ◽  
Universal Screening ◽  
Thyroid Autoimmunity ◽  
Case Finding ◽  
Thyroid Disorders ◽  
Risk Criteria ◽  
Risk Criterion ◽  
History Of ◽  
High Risk Case

ObjectiveScreening of thyroid disorders in pregnancy has been controversial. Recent recommendations favour targeted high-risk case finding, though this approach may miss a significant number of those affected. We aimed to assess the prevalence of accepted high-risk criteria in women with autoimmune thyroiditis and/or hypothyroidism detected from universal screening in an iodine-sufficient population.DesignIn 400 non-selected women in the 9–11th gestational week, thyroid-related tests were performed, and those with abnormalities were offered consultation.MethodsTSH was determined by IRMA, and the upper cut-off value for screening was set at 3.5 mIU/l. For free thyroxine (FT4) and thyroperoxidase antibodies (TPO-Ab), RIAs were used, with cut-offs of <10 pmol/l and >50 IU/ml respectively. Endocrinological consultation included Doppler ultrasonography and was aimed to confirm autoimmune thyroiditis and/or hypothyroidism. The prevalence of consensus high-risk criteria was assessed.ResultsAmong the 400 women, 65 (16.3%) had ≥1 abnormality: higher TSH was found in 10.3%, lower FT4 in 2% and positive TPO-Ab in 8.3%. Fifty-one women were examined and followed up. Levo-T4 treatment was initiated in 49 women for autoimmune thyroiditis (in 42), hypothyroidism (in 34) or both (in 27). Only 22 (45%) of 49 treated women fulfilled ≥1 high-risk criterion: most commonly family history (31%), history of miscarriage or preterm delivery (14%) and personal history (8%).ConclusionsOver half (55%) of pregnant women with abnormalities suggestive of autoimmune thyroiditis and/or hypothyroidism would be missed if only those with high-risk criteria were examined. A more extensive screening of thyroid autoimmunity and dysfunction seems warranted.

scholarly journals The use of integrative therapy based on Yoga and Ayurveda in the treatment of a high-risk case of COVID-19/SARS-CoV-2 with multiple comorbidities: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Alka Mishra ◽  
Sumitra A. Bentur ◽  
Sonika Thakral ◽  
Rahul Garg ◽  
Bhanu Duggal
Keyword(s):  
High Risk ◽  
Blood Sugar ◽  
Treatment Plan ◽  
Controlled Trial ◽  
Case Series ◽  
Complete Relief ◽  
Dietary Recommendations ◽  
Integrative Therapy ◽  
Sugar Levels ◽  
High Risk Case

Abstract Background We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. Recently, some evidence has been emerging on the use of Ayurveda for treatment of COVID-19. The classical texts of Ayurvedic medicine such as Charaka Samhita and Sushruta Samhita contain descriptions of pandemics of similar proportions and describe them as Janapadoddhvansa, meaning the destruction of communities, along with their causes and treatment. Case presentation The case reported herein is a 55-year-old man from Delhi, India, with confirmed (tested) COVID-19, who first took MWM for 7 days before seeking integrative therapy. The patient has comorbidities including DM, HTN, hypothyroidism and CKD and had developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient’s symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately $$75\%$$ 75 % relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient’s real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. Conclusions Integrative therapy was found to be effective in mitigating the symptoms of COVID-19 in this patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels (not under control with modern medicine) was also achieved. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients. A case series or a suitably designed randomized controlled trial is needed to assess its efficacy.

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