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  • Lynn Welch posted an update 4 days, 19 hours ago

    Therefore, this metalloporphyrin derived from biomass represents an interesting alternative as a potential therapeutic drug for the treatment of CL through PDT, especially for patients with intolerance to the chemotherapeutic drugs currently available.Cutaneous angiosarcoma is a rare neoplasm. One important predictor of recurrence is the resection margin; however, identifying the tissue area containing malignant cells is difficult. Indocyanine green fluorescence angiography (ICG-FA) has been used to identify superficial malignancies, including malignant tumors in the liver and sentinel lymph node metastasis of breast cancer. ICG-FA is also used to identify and define the resection margin of cutaneous angiosarcomas. However, there are currently only a few reports on the application of ICG-FA for detecting cutaneous angiosarcomas. We report a case of cutaneous angiosarcoma in the scalp in which one lesion, located in the parietal scalp, showed high fluorescence intensity corresponding exactly with the lesion was defined by physical examination, whereas the malignant area of the second lesion, located in the occipital scalp, was revealed more accurately by ICG-FA than by physical examination. Further, the second lesion was the first case diagnosed as angiosarcoma by the limited-area biopsy for a high-intensity area of ICG-FA. By determining where ICG is located within cutaneous angiosarcomas and quantitating the ICG intensity level corresponding to the malignant area, ICG-FA could be a promising tool for identifying cutaneous angiosarcomas.

    Extracorporeal membrane oxygenation (ECMO) has become an accepted treatment modality in the management of select patients with cardiopulmonary failure. As a result, its use has increased significantly over the past decade. However, the effect of complications on mortality is not clearly established. We performed a comprehensive, up-to-date meta-analysis of peer-reviewed literature focusing on the effect of vascular complications (VCs) on the survival of patients receiving venoarterial ECMO (VA-ECMO) with femoral cannulation.

    A systematic search of 4 different databases (PubMed, Embase, Scopus, and Web of Science) was conducted from their inception to mid-September of 2019. To keep the pooled analysis current, only studies published within the past 5 years were included. Mortality was analyzed based on presence or absence of VCs. Studies with less then 10 patients, with incomplete mortality data, and not accessible in the English language were excluded.

    Ten studies were included in the analysis encompassssive attempts should be made to minimize VCs in patients with femoral VA-ECMO cannulation.

    To compare aortic sac changes after endovascular aneurysm repair (EVAR) assessed by three-dimensional ultrasound (3D-US), two-dimensional ultrasound (2D-US), and traditional computed tomographic angiography (CTA).

    Using volume assessment with three-dimensional CTA (3D-CTA-volume) as the gold standard, this study investigated aortic sac changes at three and 12months after EVAR with three different ultrasound methods (2D-US anterior-posterior (AP) diameter, 3D-US AP centerline diameter, and 3D-US partial volume), and traditional CT multiplanar outer-to-outer diameter (CT-MPR OTO diameter). PMA activator solubility dmso From august 1st, 2011 to January 2014, consecutive EVAR patients (n=113) were available for analysis in two time intervals; 1) between preoperative and three-month follow-up and 2) between three and 12month follow-up.

    The risk of missing true aortic sac growth (false negative finding) at three-month postoperative visit using 3D-US partial volume, 3D-US AP centerline diameter, 2D-US AP diameter, and CT-MPR OTO diameter was 19%, 21%, 22%, and 18%, respectively. Corresponding low sensitivities (0% to 21%) and kappa-values (<0.50) in detecting aortic sac changes were found. The risk of missing true growth between three and 12 months were lower (6%, 5%, 6%, and 6%, respectively), and matching sensitivities 33%, 33%, 17%, and 17%, respectively.

    All tested methods for aortic sac changes were as good as traditional CT-MPR OTO diameter and corresponded poorly with 3D-CTA-volume at three months postoperative visit but substantially better after 12months where the residual sac change was more profound.

    All tested methods for aortic sac changes were as good as traditional CT-MPR OTO diameter and corresponded poorly with 3D-CTA-volume at three months postoperative visit but substantially better after 12 months where the residual sac change was more profound.

    Current guidelines indicate iliac-branched endografts (IBDs) as the ideal means to preserve pelvic perfusion during endovascular aortic repair. Because patient vascular anatomy represents the main limitation to extensive use of these devices, off-label application may be considered to expand the number of patients being treated. The aim of this study is to evaluate long-term outcomes obtained using the Cook ZBIS endograft in the treatment of aortoiliac aneurysms as per or outside manufacturer’s instruction for use (IFU).

    Data from all patients who underwent IBD implant in a single center were reviewed. Study population was divided into two subgroups Group I treated as per manufacturer’s IFU and group II treated outside IFU.

    During the study period (2008-2018), 119 patients were treated with 130 IBDs. Eighty-six patients were treated as per IFU (group I) and 44 outside IFU (group II). Overall technical success was 99.2%. Mean follow-up was of 63.5±38.3months for group I and 58.3±35.9months for group II (g patients with hypogastric aneurysms.

    Opioid overprescription for acute postoperative pain is an inadvertent contributor to the opioid epidemic via pill diversion and misuse. In response, the surgical community advocates for evidence-based postoperative opioid prescribing guidelines. The objective of this study is to evaluate patient-reported opioid consumption after lower extremity bypass surgery.

    We conducted a retrospective review of a prospectively maintained database of infrainguinal bypass operations from 2016 to 2019. For patients receiving an opioid prescription at discharge, a telephone survey was administered questioning the percentage of pills used. Exclusion criteria included chronic opioid use and reoperations or amputations within 30days. The primary outcome was the difference in opioids prescribed versus opioids consumed.

    Forty-nine patients met inclusion criteria. Forty-one (84%) were prescribed opioids at discharge, and 27 (65.9%) completed the survey. The average age was 65.8±7.7years; 29.6% were women. Oxycodone immediate-release was most commonly prescribed (78%).