146 research outputs found
STEMI care in the elderly: Does under-treatment reflect appropriate clinical judgment or therapeutic nihilism?
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Performing Percutaneous Coronary Intervention Without On-Site Cardiac Surgery Is Not a License for Percutaneous Coronary Intervention Instead of Coronary Artery Bypass Grafting—Reply
No full textEnhanced External Counterpulsation Therapy: Past, Present, and Future
No full textExternal counterpulsation therapy was first developed over half a century ago as a resuscitative tool to support the failing heart and was based on hemodynamic principles of the intraaortic balloon pump. Over the course of last few decades, it has evolved into the modern enhanced external counterpulsation (EECP) therapy, which has proven to be a safe, effective, and low-cost noninvasive treatment for patients with debilitating angina and chronic heart failure who are poor candidates for revascularization procedures and have suboptimal results from other therapies. Numerous studies have shown EECP to be efficacious in patients with chronic angina, with its effects lasting for several years after completion of therapy. Besides being safe in patients with coexisting left ventricular dysfunction, there is emerging evidence that EECP therapy may result in improvement in exercise capacity and oxygen consumption in heart failure patients. Several mechanisms have been postulated to explain the therapeutic effects of EECP, including improvement in endothelial function, promotion of angiogenesis and new collaterals, reduction in atherosclerotic burden, improvement in ventricular function, and peripheral training effects analogous to that of exercise. With greater understanding of these complex mechanisms, possible applications of EECP have broadened in recent years, with its use being studied in conditions like hepatorenal syndrome, erectile dysfunction, and restless leg syndrome. This review article offers a historical perspective on the origins of EECP, an overview of our current understanding of its physiological effects, and a glimpse at its future utilization in clinical practice
Rotational Atherectomy: A Contemporary Appraisal
No full textRotational atherectomy (RA) is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. RA works on the principle of ‘differential cutting’ and preferentially ablates hard, inelastic, calcified plaque. The objective of RA use has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion. The clinical experience over the past 30 years has informed the current best practices for RA with use of smaller burr sizes, short ablation runs a ‘pecking’ motion, and avoidance of sudden decelerations. This has led to significant improvements in procedural safety and a reduced rate of associated complications. This article reviews the principles, clinical indications, contemporary evidence, technical considerations and complications associated with the use of RA
The Forgotten Disease: Bilateral Lemierre\u27s Disease With Mycotic Aneurysm of the Vertebral Artery
No full textPATIENT: Male, 25 FINAL DIAGNOSIS: Lemierre\u27s disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe
MEDICATION: - Clinical Procedure: - Specialty: Infectious Diseases.
OBJECTIVE: Rare disease.
BACKGROUND: Lemierre\u27s disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre\u27s disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli.
CASE REPORT: We report a case of Lemierre\u27s disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre\u27s disease. This is the first report of a case of Lemierre\u27s disease associated with mycotic aneurysm of the vertebral artery.
CONCLUSIONS: Lemierre\u27s disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that \u27symptoms and signs of Lemierre\u27s disease are so characteristic that it permits diagnosis before bacteriological examination\u27. The prognosis of patients with Lemierre\u27s disease is generally good, provided prompt recognition and appropriate treatment
Regional Variation in Utilization, In-hospital Mortality, and Health-care Resource Use of Transcatheter Aortic Valve Implantation in the United States
No full textWe queried the National Inpatient Sample database from 2012 to 2014 to identify all patients aged \u3e/=18 years undergoing transcatheter aortic valve implantation (TAVI) in the United States. Regional differences in TAVI utilization, in-hospital mortality, and health-care resource use were analyzed. Of 41,025 TAVI procedures in the United States between 2012 and 2014, 10,390 were performed in the Northeast, 9,090 in the Midwest, 14,095 in the South, and 7,450 in the West. Overall, the number of TAVI implants per million adults increased from 24.8 in 2012 to 63.2 in 2014. The utilization of TAVI increased during the study period in all 4 geographic regions, with the number of implants per million adults being highest in the Northeast, followed by the Midwest, South, and West, respectively. Overall in-hospital mortality was 4.2%. Compared with the Northeast, risk-adjusted in-hospital mortality was higher in the Midwest (adjusted odds ratio [aOR] 1.26 [1.07 to 1.48]) and the South (aOR 1.61 [1.40 to 1.85]) and similar in the West (aOR 1.00 [0.84 to 1.18]). Average length of stay was shorter in all other regions compared with the Northeast. Among patients surviving to discharge, disposition to a skilled nursing facility or home health care was most common in the Northeast, whereas home discharge was most common in the West. Average hospital costs were highest in the West. In conclusion, we observed significant regional differences in TAVI utilization, in-hospital mortality, and health-care resource use in the United States. The findings of our study may have important policy implications and should provide an impetus to understand the source of this regional variation
The forgotten disease: Bilateral lemierre\u27s disease with mycotic aneurysm of the vertebral artery.
No full textPATIENT: Male, 25 FINAL DIAGNOSIS: Lemierre\u27s disease Symptoms: Back pain • fever • headache • tachycardia • tachypnoe
MEDICATION: - Clinical Procedure: - Specialty: Infectious Diseases.
OBJECTIVE: Rare disease.
BACKGROUND: Lemierre\u27s disease, also known as the forgotten disease, postanginal sepsis, or necrobacillosis, was first reported in 1890 by Courmont and Cade, but it was Dr. Andre Lemierre, a professor of microbiology, who described this disease in 1936. The typical causative agent is Fusobacterium necrophorum, although other organisms may be involved. The pathogenesis of Lemierre\u27s disease is not well understood. It is characterized by a primary oropharyngeal infection associated with septicemia, internal jugular vein thrombosis, and metastatic septic emboli.
CASE REPORT: We report a case of Lemierre\u27s disease with bilateral internal jugular vein (IJV) thrombosis and metastatic septic emboli to the lungs and brain, associated with epidural abscess and mycotic aneurysm of the vertebral artery, which is quite rare in Lemierre\u27s disease. This is the first report of a case of Lemierre\u27s disease associated with mycotic aneurysm of the vertebral artery.
CONCLUSIONS: Lemierre\u27s disease is a rare and perplexing medical entity. Clinical suspicion should be high in previously healthy young adults presenting with fever and neck pain following oropharyngeal infection. Dr. Lemierre stated that \u27symptoms and signs of Lemierre\u27s disease are so characteristic that it permits diagnosis before bacteriological examination\u27. The prognosis of patients with Lemierre\u27s disease is generally good, provided prompt recognition and appropriate treatment
Temporal Trends in Transcatheter Aortic Valve Replacement for Isolated Severe Aortic Stenosis
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