54 research outputs found
Retrograde Pedal/Tibial Artery Access for Treatment of Infragenicular Arterial Occlusive Disease
No full textOutcomes of native superficial femoral artery chronic total occlusion recanalization after failed femoropopliteal bypass
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Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery
No full textBackground: Knee arthroscopy is usually associated with a variable degree of pain ranging from moderate-to-severe pain in about 70% of patients.
Objective: This trial was designed to assess the efficacy of intra-articular administration of dexamethasone versus fentanyl as adjuncts to bupivacaine in patients undergoing arthroscopic knee surgery.
Patients and methods: Eighty-nine patients of either sex were enrolled in this study. The patients were randomly divided into three equal groups. Group F that received intra-articular (IA) injection of 1 μg/kg fentanyl (In 2 ml saline) added to 18 ml of 0.25% bupivacaine, group D, which received IA injection of 8 mg (2 ml) dexamethasone added to 18mL of 0.25% bupivacaine and group S that received IA injection of 2 ml normal saline added to 18 mL of 0.25% bupivacaine.
Results: The time required for the first request of analgesia in group F, group D, and group S was 5.7 ± 0.7 vs 4.5 ± 0.5 vs 3.3 ± 0.5 hours respectively. There were significant differences between both treatment groups and the control group (p < 0.001) and in between both treatment groups (p < 0.001) in favor of group F. There was a significantly lower median visual analogue score in group F when compared to group D and S at 6 hours (p = 0.006 & 0.01, respectively), 12 hours (p < 0.001 & < 0.001, respectively), and 18 hours (p = 0.003 & 0.007, respectively) postoperatively.
Conclusion: The addition of fentanyl or dexamethasone to IA bupivacaine in knee arthroscopic surgery provided a better quality of analgesia with less consumption of systemic analgesics without significant adverse effects
Outcomes of intervention for cephalic arch stenosis in brachiocephalic arteriovenous fistulas
No full textSingle-center retrospective review of ultrasound-accelerated versus traditional catheter-directed thrombolysis for acute lower extremity deep venous thrombosis
No full textObjective Systemic anticoagulation remains the standard for acute lower extremity (LE) deep venous thrombosis (DVT), but growing interest in catheter-directed thrombolysis (CDT) and its potential to reduce the incidence of post-thrombotic syndrome (PTS) has led to advent of ultrasound-accelerated CDT (US-CDT). Few studies to date have examined the outcomes of US-CDT against traditional CDT (T-CDT). Methods This is a retrospective, single-center review of all patients treated for acute LE DVT over a five-year period with either US- and T-CDT. Patients were stratified based on demographics, presentation, co-morbidities, risk factors, and peri-procedural data. Results Seventy-six limbs in 67 patients were treated; 51 limbs in 42 patients were treated with US-CDT, and 25 limbs in 25 patients were treated with T-CDT. Adjuncts include: pharmacomechanical thrombolysis ( n = 28 vs. 20, p = 0.04), angioplasty ( n = 22 vs. 18, p = 0.11), stenting ( n = 30 vs. 6, p ≤ 0.001), and IVC filter insertion ( n = 5 vs. 0, p = 0.07). Mean lysis times were 21 ± 1.7 and 24 ± 1.8 h for US- and T-CDT, respectively ( p = 0.26). Thirty (25 ultrasound, 5 traditional) limbs had complete lysis. Thirty-one (22 ultrasound, 9 traditional) limbs had incomplete lysis. Fifteen (4 ultrasound, 11 traditional) limbs had ineffective lysis ( p = 0.002 in favor of ultrasound). Four patients (3 US-CDT, 1 T-CDT) had recurrent ipsilateral thrombosis within 30 days ( p = 0.60). By Kaplan-Meier analysis, there were no significant difference between primary patency, primary-assisted patency, secondary patency, re-thrombosis, and recurrent symptoms at 6, 12, and 24 months. Conclusion US-CDT does not significantly improve mid-term patencies but results in greater acute clot burden reduction in patients with acute LE DVTs compared to T-CDT, which may be beneficial in reducing the long-term incidence of PTS. </jats:sec
In Situ Laser Fenestration for Zone 2 TEVAR: A 15 Year Experience Demonstrating Its Safety, Efficacy and Durability
No full textDeterminants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia
No full textBackgroundAcute mesenteric ischemia (AMI) is associated with high morbidity and mortality due in part to its diagnostic difficulty and operative challenges. The purpose of this study was to review our experience of surgical management in patients with this condition and to identify variables associated with adverse outcomes following surgical interventions.MethodsHospital records and clinical data of all patients undergoing surgical interventions for AMI were reviewed during a recent 12-year period. Clinical outcomes as well as factors influencing mortality were analyzed.ResultsA total of 72 patients (41 females, overall mean age 65 years, range 34 to 83 years) were included in the study. Thrombosis and embolism were the cause of AMI in 48 patients (67%) and 24 patients (33%), respectively. Abdominal pain was the most common presenting symptom (96%), followed by nausea (56%). Preoperative angiogram was performed in 61 patients (85%). All patients underwent operative interventions, which included thromboembolectomy (n = 22, 31%), mesenteric bypass grafting (n = 33, 46%), patch angioplasty (n = 9, 12%), reimplantation (n = 5, 7%), and endarterectomy (n = 3, 4%). Bowel resection was necessary in 22 patients (31%) during the initial operation, and second-look operation was performed in 38 patients (53%). Perioperative morbidity and 30-day mortality rates were 39% and 31%, respectively. Univariate analysis showed renal insufficiency (P < .02), age >70 (P < .001), metabolic acidosis (P < .02), and symptom duration (P < .005), and bowel resection in second-look operations (P < .01) were associated with mortality. Logistic regression analysis showed age >70 (P = .03) and prolonged symptom duration (P = .02) were independent predictors of mortality.ConclusionsElderly patients and those with a prolonged duration of symptoms had worse outcomes following surgical intervention for AMI. A high index of suspicion with prompt diagnostic evaluation may reduce time delay prior to surgical intervention, which may lead to improved patient survival. Aggressive surgical intervention should be performed as promptly as possible in patients once the diagnosis of AMI is made
Whatâs the clinical significance of adding diffusion and perfusion MRI in the differentiation of glioblastoma multiforme and solitary brain metastasis?
No full textObjective: To evaluate the additional diagnostic value of diffusion and perfusion MRI in the differentiation of glioblastoma multiforme (GBM) and solitary brain metastasis. Patients and methods: This retrospective study included 24 patients with histologically proven brain tumors who underwent conventional MRI with analysis of diffusion (DWI) and perfusion (PWI) MRI findings of each tumor. The Apparent Diffusion Coefficient (ADC) values were calculated in the minimum (ADC-MIN), mean (ADC-MEAN), and maximum (ADC-MAX) in all the tumors and the peritumoral regions. The PWI data was expressed as maximum regional cerebral blood volume (rCBV) of the tumors and peritumoral regions. Results: After adding diffusion and perfusion to conventional MRI findings, we found that the accuracy of differentiation between glioblastoma multiforme (GBM) and solitary metastasis increased from 70% to 90%.There is a significant difference in DWI signal intensity between GBM and metastatic tumors (PÂ <Â 0.05). The ADC values of GBM were lower than that of metastatic tumors. On perfusion MRI, the maximum rCBV of the peritumoral region (rCBVP) of GBM was higher than that of brain metastases (PÂ <Â 0.001). Conclusion: The addition of diffusion and perfusion to the MRI protocol increases the accuracy of differentiation between GBM and solitary brain metastasis and should be considered routinely. Keywords: Diffusion MRI, Perfusion MRI, GBM, Solitary brain metastase
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