Angiographic Therapies for Diabetic Foot Syndrome

Background. The study aimed to improve treatment outcomes in diabetic foot syndrome patients by use of invasive pressure monitoring during arterial radiological interventions.Materials and methods. A total of 36 patients with type 2 diabetes and purulent necrotic lesions of lower extremities have been treated at the surgery unit of Bashkir State Medical University Clinic during 2019—2020, with 12 persons forming the main cohort and receiving the measures complemented with the newly developed “X-ray endovascular intraoperative significance evaluation of lower limb arterial stenosis” technique (Patent RU 2737215 of 26.11.2020). The control cohort comprised 24 patients following pertinent standard treatment and recommendations in this pathology.Results and discussion. Immediate treatment outcomes were evaluated by person in the main and control cohorts. Longterm outcomes were observed at 6, 12 and 24 months since hospital discharge in 10 (83.3 %) patients of the main and 19 (79.2 %) — of the control cohort. In a 2-year run, the limb was kept in 8 (66.7 %) patients having the new revascularisation technique and in 10 (41.7 %) persons of the control cohort (p < 0.05).Conclusion. The use of endovascular radiology for limb revascularisation and intraoperative significance monitoring of lower limb arterial stenosis allow the volume determination of balloon angioplasty and statement of revascularisation completeness.

Development of a Critical Care Air Transport Team “Go Bag”: Slimming Down ICU Capability to Augment Pararescue or Civilian Contract Medical Evacuation Personnel

ABSTRACT Introduction Critical Care Air Transport Team (CCATT) is a three-person United States Air Force (USAF) medical asset, typically providing intercontinental medical evacuation on large military aircraft. The CCATT equipment Allowance Standard (AS) weighs approximately 272 kg (600 lbs). In austere locations, CCATT teams may augment contract medical evacuation (CME) personnel or Pararescue (PJ) in small aircraft with limited space for medical equipment. It was unknown what deployed PJ and CME carry within their packouts. We sought to design a packout or “Go Bag,” weighing less than 22.7 kg (50 lbs) and sourced from the CCATT AS, that a CCATT member could use to complement CME or PJ equipment to provide a higher level of care while limiting redundancy. Materials and Methods Equipment lists were obtained from a CME and PJs from two separate USAF squadrons. The equipment lists were combined to provide a reference for development of a CCATT Go Bag. Three members of a deployed CCATT team independently generated a list of necessary equipment from the CCATT AS. The list was peer reviewed by a separate, deployed CCATT team. Results A Go Bag was developed with the supplies and equipment necessary for video laryngoscopy, ventilation, invasive pressure monitoring, basic laboratory capability, chest tube placement, ultrasound, and advanced pharmacologic interventions. The Go Bag weighed 18.3 kg (40.4 lbs). A separate respiratory bag weighing 1.1 kg (2.4 lbs) was attached directly to a ventilator. Intravenous pumps and cardiac monitoring equipment were notable ICU equipment excluded from the Go Bag. Conclusion Major components of the CCATT AS can be reduced into a Go Bag and accompanying Ventilator Accessory Bag. This may benefit CCATT teams required to augment PJs or CME in small aircraft during prolonged field care scenarios.

ANAESTHETIC MANAGEMENT OF PHEOCHROMOCYTOMAA REVIEW OF 3 CASES

INTRODUCTION: Pheochromocytoma is pharmacologically volatile, potentially lethal catecholamine- Containing tumor of chromafn tissues 1 . Pediatric pheochromocytomas, although rare, have an increased incidence of bilateral, multifocal, and familial preponderance when compared to 2 adults. It occurs in less than 2% of pediatric patients with hypertension and is a diagnosis of exclusion . They are usually located in adrenal medulla 3 or sympathetic paraganglia but may be found anywhere chromafn tissue exists. These locations extend from the base of skull to anus . Traditionally it was thought that 90% of pheochromocytoma are found in adrenal medulla and 10% occuredelse where. Prevalence of extra adrenal 4 tumorsis now thought to be as high as 20%.theseare commonly called paragangliomas . RESULT: The child was premedicated with midazolam 30mcg/kg intravenously and was transferred to the operating room on an infusion of normal saline 60 mL/hr and hydrocortisone 10mg/hr according to the endocrinologist's advice. After instituting electrocardiogram (ECG), noninvasive blood pressure (NIBP), and pulse oximeter (SpO2) monitors, the child was pre-oxygenated and anesthesia was induced with propofol2 mg/Kg and fentanyl 2 mcg/Kg. Endotracheal intubation was facilitated with vecuronium0.1 mg/Kg. Right internal juglar vein and right radial artery were cannulated for continuous invasive pressure monitoring. A19G epidural catheter was inserted in T8-T9 interspace for analgesia. CONCLUSION: On the basis of these case reports, we want to emphasize that while dealing with surgeries of pheochromocytomahaemodynamic instability should be kept in mind. Preoperative blood pressure optimization is necessity along with intraoperative beat to beat monitoring and use of titrated doses of antihypertensive accordingly. Persistent hypertension after removal of pheochromocytoma occasionally signies that a residual tumor is present, so post operative biochemical assay and imaging studies are repeated for conrmation and further management.

Acute coronary syndrome leading to a new diagnosis of phaeochromocytoma following a profound intraprocedural hypertensive surge

Phaeochromocytomas are rare neuroendocrine tumours, which can significantly increase the risk of cardiovascular morbidity and mortality. They are also recognised as ‘the great mimic’ and can present in many ways. A 42-year-old male patient presented with a non-ST elevation acute coronary syndrome and was medically treated pending an invasive coronary angiogram. During this procedure, he suffered a profound, symptomatic hypertensive surge documented with invasive pressure monitoring. This raised concern for potential secondary causes of hypertension, particularly given his age. He was subsequently diagnosed with a phaeochromocytoma, and after surgical resection of the tumour, his blood pressure control improved and he remains on single therapy only. As clinicians, it is important to remain alert for previously undiagnosed comorbidities contributing to common pathology, including rare, but life-threatening conditions as we present in this case.