Assessment of healthcare professionals' knowledge of managing emergency complications in patients with a tracheostomy

Background: Ear, nose, and throat (ENT) surgeons perform the majority ofsurgical tracheostomies. Intensive care anaesthetists are increasinglyperforming bedside percutaneous tracheostomy. The objectivesof this study were to characterize emergency complications oftracheostomy and to ascertain healthcare professionals’knowledge of life-saving strategies for the patient with a tracheostomy. Methods: Seventy staff members in two large teaching hospitals completedan interview questionnaire, comprising a simple clinical scenarioand unambiguous questions regarding the emergency managementof patients with a tracheostomy. Results: There were significant gaps in knowledge among healthcare professionalsregarding the management of specific tracheostomy-related emergencies. Conclusions: Knowledge of tracheostomy-related emergencies appears to beinsufficient among non-ENT healthcare professionals. This needsto be addressed in order to maximize patient safety.     

Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction VSD device: a case series.

The initial therapy for postmyocardial infarction ventricular septal defects is surgical repair of the defect. Unfortunately, a significant number of patients develop recurrent ventricular septal defects (VSDs) following operative repair. Transcatheter closure offers an alternative to reoperation in these critically ill patients. We present a series of four patients in whom recurrent ventricular septal defects were closed using an Amplatzer VSD device.     

Critical limb ischemia: endovascular strategies for limb salvage

Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease, defined as the presence of chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. The dominant pathology underlying CLI is atherosclerosis, distributed at multiple levels along the length of the lower extremity and with a propensity for involvement of the tibial vessels in the leg and the small vessels of the foot. To achieve limb salvage in patients with CLI, revascularization of the affected limb is generally required. In contemporary practice, endovascular techniques are rapidly replacing surgical bypass as the first option for revascularization for CLI based on high technical success rates and low rates of procedure-related morbidity and mortality. This review will describe the clinical strategy of the authors who have adopted an endovascular-first approach to revascularization in treating patients with CLI and summarize the clinical outcomes of endovascular therapy in this population.     

Safety and efficacy of dual‐axis rotational coronary angiography vs. standard coronary angiography

Objective: To determine the safety and efficacy of dual‐axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA). Background: Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well‐documented limitations. Dual‐axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement. This technological advancement obtains numerous unique images of the left or right coronary tree with a single coronary injection. We sought to assess the safety and efficacy of DARCA as well as determine DARCA's adequacy for CAD screening and assessment. Methods: Thirty patients underwent SA following by DARCA. Contrast volume, radiation dose (DAP) and procedural time were recorded for each method to assess safety. For DARCA acquisitions, blood pressure (BP), heart rate (HR), symptoms and any arrhythmias were recorded. All angiograms were reviewed for CAD screening adequacy by two independent invasive cardiologists. Results: Compared to SA, use of DARCA was associated with a 51% reduction in contrast, 35% less radiation exposure, and 18% shorter procedural time. Both independent reviewers noted DARCA to be at least equivalent to SA with respect to the ability to screen for CAD. Conclusion: DARCA represents a new angiographic technique which is equivalent in terms of image quality and is associated with less contrast use, radiation exposure, and procedural time than SA. © 2011 Wiley‐Liss, Inc.     

Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis--correlation with clinical findings, pulmonary function testing and plain radiography

Previous studies on the association of ankylosing spondylitis and abnormalities of the lung parenchyma have been based largely on plain radiography and pulmonary function testing. This study, although uncontrolled, is the first to use high-resolution computed tomography to examine the entire lung parenchyma in ankylosing spondylitis patients, and to correlate the findings with clinical assessment, plain radiography and pulmonary function testing. The study population comprised 26 patients meeting the New York criteria for idiopathic ankylosing spondylitis who attended the out-patient department at our institution. High-resolution computed tomography examination revealed abnormalities in 19 patients (70%): these included interstitial lung disease (n = 4), bronchiectasis (n = 6), emphysema (n = 4), apical fibrosis (n = 2), mycetoma (n = 1) and non-specific interstitial lung disease (n = 12). Plain radiography was abnormal in only four patients and failed to identify any patient with interstitial lung disease. All patients with interstitial lung disease on high-resolution computed tomography had respiratory symptoms and three of the four had evidence of a restrictive process on pulmonary function testing. This study raises, for the first time, the possible association between interstitial lung disease and ankylosing spondylitis, and highlights the use of high-resolution computed tomography in detecting such disease in ankylosing spondylitis patients.      

Embolization of radiopaque tip component of clip delivery system of MitraClip device: A rare complication with successful percutaneous retrieval

This case report describes a rare complication that occurred during the performance of a MitraClip procedure. Following deployment of the clip, the portion of the device that attaches the clip to the clip delivery system (CDS), referred to as the radiopaque tip, embolized to the left atrium during removal of the CDS through the guide catheter. The percutaneous strategy that was used to successfully retrieve the radiopaque tip is described and discussed.© 2012 Wiley Periodicals, Inc.     

Acute monoblastic leukemia in infancy and early childhood: successful treatment with an epipodophyllotoxin

Four of five infants and young children with acute monoblastic leukemia, a disease that heretofore has been highly refractory to therapy, were successfully treated with sequential infusions of a podophyllin derivative employed as a single agent over a protracted period of time. In three of the five children, monocytic leukemia cutis was present at birth. Treatment was begun in two of them when the disease had progressed to systemic involvement at a few months of age, and in the third when disease was still localized. The other two children were 11 and 18 months of age at initial presentation with widespread disease. Four children are off therapy 11 months, 26 months, 5 years, and 6 years, respectively.