Angio-Seal Used as a Bailout for Incomplete Hemostasis After Dual Perclose ProGlide Deployment in Transcatheter Aortic Valve Implantation

BackgroundThe failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice.MethodsThis research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared.ResultsNo significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044).ConclusionFinding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure.     

First description of the alpha lipoic acid intoxication in an adult patient worldwide following oral administration

Alpha lipoic acid (ALA), which is an anti-oxidant acting as a scavenger for reactive oxygen species, is especially used to improve glycemic control and prevent polyneuropathies associated with diabetes mellitus. ALA is considered to be a safe drug and intoxication with ALA is extremely rare. However, this paper reports a 38-year-old young woman who was admitted to the emergency department after she had ingested ten pills of 600 mg ALA belonging to her diabetic parent, which led to delirium, metabolic acidosis, thrombocytopenia, and rhabdomyolysis. To the best of our knowledge, there are only four cases of ALA intoxication reported in the literature and all were observed in children. This report aims to present the first case of ALA related intoxication worldwide in an adult patient.     

Is radiological appearance of lower respiratory tract infection due to respiratory syncytial virus a predictor of clinical outcome?

Objective: Respiratory syncytial virus (RSV) lower respiratory tract infection is the most common viral infection in childhood. RSV-infected infants demonstrate various radiographic findings. The aim of the study is to evaluate whether assessment of radiological characteristics of lower tract infection due to RSV may be a predictor of clinical outcome in newborns.

Methods: The study included 36 newborn infants hospitalized for lower tract infection. In order to detect RSV, RSV Respi-Strip (Coris Bioconcept Organization) test kits were used on admission. Chest X-rays and clinical characteristics of the study group were reviewed.

Results: Of 36 patients hospitalized for lower tract infection from October 2012 to April 2013, 18 (50%) newborns were infected with RSV. The study included 36 neonates. Patients with RSV-positive infants at admission had greater need for respiratory support, supplemental oxygen and prolonged stay in the NICU. Newborns with an atelectasis pattern on admission chest radiograph had greater at RSV-positive infants.

Conclusion: Chest radiological patterns with lower respiratory tract infection in newborn infants due to RSV are a predictor of clinical outcome.     

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions

Purpose: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions.

Materials and methods: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren’s syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test–retest reliability.

Results: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach’s α?>?0.90); concurrent validity was strong (Health Assessment Questionnaire:?r_s?=?0.60–0.92; Short-Form Health Survey v2 Physical Function:?r_s?=??0.61 to ?0.91) and test–retest reliability excellent (Intra-Class Correlation Coefficient(2,1)?=?0.77–0.96).

Conclusion: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions.

• Implications for rehabilitation

• The Evaluation of Daily Activity Questionnaire evaluates users’ ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren’s syndrome).

• Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist.

• The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility.

• The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

     

CT angiography as a confirmatory test in diagnosis of brain death: comparison between three scoring systems

PURPOSE

Computed tomography (CT) angiography emerges as a viable alternative technique for confirmation of brain death. However, evaluation criteria are not well established for demonstration of cerebral circulatory arrest. This retrospective study aimed to evaluate CT angiography scoring systems in diagnosis of brain death, review the literature, and compare interobserver agreement between different scales for the diagnosis of brain death.

METHODS

CT angiography examinations of 25 patients with a clinical diagnosis of brain death were reevaluated according to 10-, 7-, and 4-point scales. Exams were performed with a 64-slice CT scanner including unenhanced, arterial (20 s) and venous phase (60 s) scans. Subtraction images of both phases were obtained. Interobserver agreement was evaluated for the assessment of vessel opacification and diagnosis of brain death.

RESULTS

According to 10-, 7-, and 4-point scales; 13, 16, and 22 of 25 patients had full score, respectively. Using the clinical exam as the reference standard, sensitivities obtained for 10-, 7-, and 4-point scales were 52%, 64%, and 88%, respectively. Percent agreement between readers was 100% for 10- and 7-point scales and 88% for 4-point scale. Percent agreement for opacification of scale vessels was equally high for all three scales (93.6%, 93.7%, 91% for 10-, 7-, and 4-point scales, respectively).

CONCLUSION

The 4-point scale appears to be more sensitive than the 10-and 7-point scales in CT angiography evaluation for brain death. Interobserver agreement is high for all three scales when subtraction images are used.Clinical diagnosis of brain death is established by national guidelines and laws in many countries. Deep unresponsive coma, absence of brain stem functions and spontaneous ventilation are principal requisites for diagnosis (1). Guidelines are revised by New York Task Forces in 2011 for determining brain death and represent a broad consensus on clinical evaluation (2). Although clinical criteria are well established, considerable practice variations are found between countries or leading hospitals of the countries such as the number of staff responsible from diagnosis, number of required examinations, observation period between examinations, application of apnea test, and confirmatory tests (3).Confirmatory tests are required in the presence of confounding factors that could influence the exam (e.g., sedative medications, electrolyte disturbances, acid-base disorders) or make the examination severely difficult to test (e.g., severe facial or orbital trauma) (4). In neonates and children, diagnosis of brain death is more complicated and ancillary tests are usually advocated (5–7). On the other hand, a confirmatory test demonstrating lack of cerebral function or circulation is obligatory after clinical evaluation in some countries. Among the ancillary tests demonstrating absence of cerebral blood flow, multidetector computed tomography (CT) angiography emerges as a viable alternative to other tests due to its noninvasiveness, ease of access, lower operator dependence, and greater rapidity (8). However, an international consensus about application and parameters of this technique is currently not established.The CT angiography protocols for diagnosis of brain death differ between studies in the literature. Scanning time of arterial or venous phase is the major difference in applied protocols. Beside this, disparities in scoring systems, evaluation of blood flow phases, specific vessels, and number of vessels may constitute confusing points for radiologists. Also, CT angiography findings in patients with open skull or anoxia following cardiac arrest may cause false negative interpretation (9). In the context of those diversities, diagnosis of brain death by CT angiography may become quite complicated.In the present study, we aimed to retrospectively evaluate CT angiograms of patients with a clinical diagnosis of brain death according to 10-, 7- and 4-point score systems, review the literature, and emphasize the difficulties and confusing points of the diagnosis by previous methods. Interobserver agreement was evaluated for the diagnosis of brain death and opacification of scale vessels by CT angiography.     

P wave dispersion is prolonged in patients with Wilson＇s disease

AIM： To investigate the P wave dispersion as a noninvasive marker of intra-atrial conduction disturbances in patients with Wilson＇s disease.
METHODS： We compared Wilson＇s disease patients （n = 18） with age matched healthy subjects （n = 15） as controls. The diagnosis was based on clinical symptoms, laboratory tests （ceruloplasmin, urinary and hepatic copper concentrations）. P wave dispersion, a measurement of the heterogeneity of atrial depolarization, was measured as the difference between the duration of the longest and the shortest P-waves in 12 lead electrocardiography.
RESULTS： All the patients were asymptomatic on cardiological examination and have sinusal rhythm in electrocardiography. Left ventricular and left atrial diameters, left ventricular ejection fraction and left ventricular mass index were similar in both groups. The Wilson＇s disease patients had a significantly higher P wave dispersion compared with the controls （44.7 ± 5.8 vs 25.7 ± 2.5, P 〈 0.01）.
CONCLUSION： There was an increase in P wave dispersion in cardiologically asymptomatic Wilson＇s disease patients which probably represents an early stage of cardiac involvement.     

Variations of the cerebellar arteries at CT angiography

Purpose

There are few studies that investigated variations of the cerebellar arteries, and the prevalence of some variations has not been reported. We aim to identify and evaluate variations of the cerebellar arteries using CTA.

Methods

The findings in 341 patients who underwent 64-slice CTA were reviewed for anatomical variations of the cerebellar arteries. We assessed variations and classified our findings to describe the results of our analysis. We attempted to create an anatomical model for CTA that is somewhat different from previous studies and described our findings according to vascular anatomy.

Results

Only 11.7 % of the 341 patients had all the cerebellar arteries without anatomical variations. Vertebral artery continuation as posterior inferior cerebellar artery (PICA) was found in 4.4 % of the patients. Absence of the anterior inferior cerebellar artery (AICA) was observed in 36.1 %, and absence of the PICA was observed in 6.7 % of the patients. The origin of the PICA was extradural in 71 (20.8 %) patients. Double origin of the PICA, PICA duplication, and fenestration were rarely found. Duplication of the AICA (7.9 %), and superior cerebellar artery (SCA) (20.5 %), and early bifurcation of SCA (9.4 %) were frequently observed. Superior cerebellar artery and posterior cerebral artery (PCA) common trunk and SCA originating from PCA were found 9.4 and 8.2 %, respectively.

Conclusion

Variations of the cerebral arteries can be easily evaluated by CTA. Recognizing and reporting them at cerebral CT angiography may be clinically important.     

Risk Factors of Germinal Matrix Intraventricular Hemorrhage in Premature Infants

Objective

To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear.

Methods

A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher’s exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors.

Findings

Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear.

Conclusion

Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.     

The detection of sensitivity of proprioception by a new clinical test: The dual joint position test

Objectives

To date, very few studies have paid attention to the joint sense (proprioception) of toes other than the big toe. We evaluated the sensitivity of joint position sense at the joint of the great toe in comparison to other digits, and with that determined by the dual digit stimulation test, in a sample of healthy normal controls and patients with clinical diagnosis of the lemniscal system dysfunction.

Material and methods

Seventy-two patients with lemniscal system dysfunction (55 clinically definitive multiple sclerosis, 17 vasculitis) and 110 healthy volunteers participated in the study. All subjects underwent the joint position sense test of all digits of upper and lower extremities. The position sense resulting from the combined operation of the joints of the second and the fourth digits (simultaneous two digits position sense) was also measured and subsequently compared with the results of the great toe position sense.

Results

Upper extremities: no difference was found in recognition of the position sense in the single digits of the upper extremities between patients and healthy volunteers. There was a significant difference in the dual joint position test of the right upper extremity between patients and the case group (p < 0.05) but not in the left upper extremity. Lower extremities: there was no significant difference in proprioception of the great toe neither in the right and nor in the left side between patients and normal subjects. However, the joint position sense of other single digits was deteriorated in the patients, a difference that was significant compared to normal controls (p < 0.05). Additionally, patients and normal controls displayed a difference in dual digit position sense of the right and left lower extremities (p < 0.05).

Conclusions

We show in this paper that the proprioception of simultaneous dual digits is diminished in patients when compared to a single digit position sense. Moreover, the great toe proprioception is less sensitive than other digits. Taken together, these observations lend evidence for a new clinical method which we named as dual joint position test. We suggest this novel method offers clinical utility to demonstrate lemniscal system dysfunction.     

Protective effect of astaxanthin against cisplatin-induced gastrointestinal toxicity in rats

European Surgery - The aim of the present study was to demonstrate astaxanthin’s attenuating effects against cisplatin (CIS)-induced gastrointestinal toxicity in a&nbsp;rat model....