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Sample records for catheter-associated pericardial tamponade

  1. Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

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    Swati O. Arya

    2009-01-01

    Full Text Available Introduction. Pericardial effusion (PCE and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.

  2. Pericardial drainage for pericardial tamponade: surgical management criteria.

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    Ballore, L; Nicolini, F; Borrello, B; Beghi, C; De Cicco, G; Contini, G A; Gherli, T

    2001-01-01

    Aim of this study is the review of our experience in 82 patients treated by pericardial drainage for cardiac tamponade, to assess the efficacy and safety of different techniques and the related indications. The causes of pericardial effusion were: malignancy in 8 patients (9.7%), post-cardiac surgery in 12 (14.6%), while the others patients were admitted at our Institution with no identified preoperative diagnosis. Thirty-eight patients (46%) underwent subxiphoid pericardial drainage and 44 (54%) were operated on by catheter pericardiocentesis. There were no perioperative deaths. Two patients, who initially underwent pericardiocentesis, needed urgent sternotomy: the first patient developed a severe hypotension and bradicardia related to a vagal reaction and the other one because of accidental right ventricle puncture. Our experience indicates that subxiphoid pericardiocentesis provides expeditious, effective and durable treatment, with low morbidity, in case of pericardial effusions related to all causes. We believe that echocardiography is a powerful tool in the diagnosis and management of pericardial effusion. We conclude that pericardiocentesis seems to be the procedure of choice for patients with pericardial tamponade requiring an emergency treatment.

  3. Pericardial Tamponade in an Adult Suffering from Acute Mumps Infection

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    Sascha Kahlfuss

    2016-01-01

    Full Text Available Here, we report a case of a 51-year-old man with acute pericardial tamponade requiring emergency pericardiocentesis after he suffered from sore throat, headache, malaise, and sweats for two weeks. Serological analyses revealed increased mumps IgM and IgG indicating an acute mumps infection whereas other bacterial and viral infections were excluded. In addition, MRI revealed atypical swelling of the left submandibular gland. Whereas mumps has become a rare entity in children due to comprehensive vaccination regimens in western civilizations, our case highlights mumps as an important differential diagnosis also in adults, where the virus can induce life-threatening complications such as pericardial tamponade.

  4. Pericardial Tamponade in an Adult Suffering from Acute Mumps Infection

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    Flieger, Robert Rainer; Mankertz, Annette; Yilmaz, Kadir; Roepke, Torsten Kai

    2016-01-01

    Here, we report a case of a 51-year-old man with acute pericardial tamponade requiring emergency pericardiocentesis after he suffered from sore throat, headache, malaise, and sweats for two weeks. Serological analyses revealed increased mumps IgM and IgG indicating an acute mumps infection whereas other bacterial and viral infections were excluded. In addition, MRI revealed atypical swelling of the left submandibular gland. Whereas mumps has become a rare entity in children due to comprehensive vaccination regimens in western civilizations, our case highlights mumps as an important differential diagnosis also in adults, where the virus can induce life-threatening complications such as pericardial tamponade.

  5. Pericardial effusion and cardiac tamponade in a dog with hypothyroidism

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    J Ojeda

    2015-01-01

    Full Text Available The relationship between hypothyroidism and cardiovascular diseases in dogs is frequently associated with clinical signs like sinusal bradicardia, myocardial alterations and ECG findings such as low voltage QRS and inverted T wave. Echocardiographic studies in hypothyroid dogs have not identified pericardial effusion. Hypothyroidism in human patients is a well-known cause of pericardial effusion, but cardiac tamponade is not a frequent clinical sign. A Golden Retriever was presented with a clinical history of progressive lethargy, exercise intolerance, cold intolerance and increased respiratory effort for 3 weeks. At the clinical examination the dog presented dyspnea, muffled heart sound and hypertension. Echocardiography showed fluid in the pericardial sac and cardiac tamponade and pericardiocentesis was performed. Analyses of the fluid showed a non-neoplastic etiology. The information given by the owners, the alopecia zones detected in tail and abdomen and the clinical response, led to analise the thyroid hormones, and hypothyroidism was confirmed. Following two pericardiocentesis and levothyroxine supplementation, the effusion resolved. Although the etiology of pericardial effusion was not clear, it is possible that the pericardial effusion had been caused by hypothyroidism or the dog had idiophatic pericardial effusion and coincidental hypothyroidism. However, according to the clinical signs and the evolution of the dog, an evaluation of thyroid hormones in dogs with pericardial effusion must be considered even though pericardial effusion is a non-described sign in canine hypothyroidism.

  6. Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism

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    Acir Rachid

    2002-06-01

    Full Text Available The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window, and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

  7. Management of malignant pericardial effusion and tamponade

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    Press, O.W.; Livingston, R.

    1987-02-27

    The optimal management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis (with or without sclerotherapy), surgical decompression, and radiation therapy as primary therapeutic modalities. In the eight years since this oncologic emergency was last reviewed in this journal, several informative therapeutic trials have been reported that warrant a reappraisal of the recommended interventions for this condition.

  8. Pericardial Tamponade in an Adult Suffering from Acute Mumps Infection

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    Sascha Kahlfuss; Robert Rainer Flieger; Annette Mankertz; Kadir Yilmaz; Torsten Kai Roepke

    2016-01-01

    Here, we report a case of a 51-year-old man with acute pericardial tamponade requiring emergency pericardiocentesis after he suffered from sore throat, headache, malaise, and sweats for two weeks. Serological analyses revealed increased mumps IgM and IgG indicating an acute mumps infection whereas other bacterial and viral infections were excluded. In addition, MRI revealed atypical swelling of the left submandibular gland. Whereas mumps has become a rare entity in children due to comprehensi...

  9. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade

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    Adam Goodman

    2012-01-01

    Full Text Available This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.

  10. Recurrent hemorrhagic pericardial effusion and tamponade due to filariasis successfully treated with ivermectin and albendazole

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    Santosh Kumar Sinha

    2015-01-01

    Full Text Available Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

  11. Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole.

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    Sinha, Santosh Kumar; Goel, Amit; Sachan, Mohit; Saraf, Sameer; Verma, Chandra Mohan

    2015-01-01

    Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

  12. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients

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    Celik Sezai

    2012-06-01

    Full Text Available Abstract Background Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results Forty-eight patients (64.7% male, with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P P Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.

  13. Recurrent pericardial effusion and tamponade in a patient with Erdheim-Chester disease (ECD).

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    Mishra, Ajay Kumar; Mani, Sunithi; George, Anu Anna; Sudarsanam, Thambu David

    2015-11-24

    Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disorder characterised by the proliferation of lipid laden histiocytes along with infiltration of various organs of the body. Although commonly presenting with bone pains secondary to bony infiltration, cardiac involvement in the form of periaortic fibrosis and pericardial involvement may be seen in a subgroup of patients. We report a case of ECD presenting as recurrent pericardial effusion along with pericardial tamponade.

  14. Case report and literature review: cardiac tamponade as a complication of pericardial extramedullary hematopoiesis.

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    Mahadevan, Navin R; Morgan, Elizabeth A; Mitchell, Richard N

    2016-01-01

    Pericardial effusion can cause cardiac tamponade physiology with resultant cardiogenic shock and death. Myelofibrosis, the replacement of marrow cavity by fibrous connective tissue, is a secondary complication of a group of disorders known as myeloproliferative neoplasms, which are clonal processes characterized by abnormal proliferative growth of one or more hematopoietic lineages. One consequence of myelofibrosis is the development of hematopoiesis at other anatomic sites, most commonly the spleen and liver, a phenomenon known as extramedullary hematopoiesis (EMH). Herein we report a case of a man who died from pericardial tamponade due to a subacute pericardial effusion secondary to EMH in the pericardium in the setting of myelofibrosis. This case highlights an unusual etiology for pericardial effusion and tamponade that should be considered in cases of myelofibrosis and stimulates a discussion regarding the mechanisms and anatomic distribution of EMH.

  15. Protective effect of pulmonary hypertension against right-sided tamponade in pericardial effusion.

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    Khan, M Usman; Khouzam, Rami N

    2015-01-01

    Patients with pericardial effusion are susceptible to cardiac tamponade. A compressing circumferential pericardial effusion typically results in an equalization of intracardiac and pericardial pressure during diastole and a progressive collapse of the right atrium and ventricle. Pulmonary hypertension that increases the afterload of the right ventricle may result in elevated pressures initially in the right ventricle and subsequently in the right atrium. This may lead to right ventricular hypertrophy and a pathologic structural and functional remodeling of both right heart chambers. Conversely, elevated pressures within the right heart chambers caused by longstanding pulmonary hypertension may resist and protect against tamponade of these chambers in the setting of a coexisting pericardial effusion. In such cases, a sudden reduction in pulmonary arterial pressures may result in tamponade of the right heart chambers.

  16. Pericardial effusion and cardiac tamponade after ventriculoperitoneal shunt placement: a case report.

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    Wiwattanadittakul, Natrujee; Katanyuwong, Kamornwan; Jetjumnong, Chumpon; Sittiwangkul, Rekwan; Makonkawkeyoon, Krit

    2016-10-01

    Insertion of a ventriculoperitoneal shunt is a common neurosurgical procedure in both adult and paediatric patients. It is one of the most important treatments in cases of hydrocephalus; however, there is a wide range of complications: the most common complication being a shunt infection, and examples of rare complications are shunt migrations and cardiac tamponade. Several reports of distal ventriculoperitoneal shunt migration in different sites, including chest, right ventricle, pulmonary artery, bowel and scrotum were published. But pericardial effusion with cardiac tamponade and its relationship to distal ventriculoperitoneal shunt migration into the pericardial sac has never been reported.

  17. Pericardiocentesis with cisplatin for malignant pericardial effusion and tamponade

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    Takatsugu; Oida; Kenji; Mimatsu; Hiso; Kano; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial f...

  18. Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade

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    Saisho, Chika; Ishii, Hidenobu; Edakuni, Nobutaka; Imamura, Yohei; Tokito, Takaaki; Kinoshita, Takashi; Azuma, Koichi; Yamada, Kazuhiko; Hoshino, Tomoaki

    2016-01-01

    Primary pericardial malignant mesothelioma is a very rare clinical entity and its prognosis is very poor. We herein report a 67-year-old man who presented with pericardial mesothelioma that was diagnosed 21 months after the onset of cardiac tamponade as the initial manifestation. Despite undergoing pericardiocentesis and surgical pericardial fenestration at the onset of cardiac tamponade, we were unable to make a conclusive diagnosis of mesothelioma based on the cytological and histological f...

  19. Case report: cardiac tamponade resembling an acute myocardial infarction as the initial manifestation of metastatic pericardial adenocarcinoma.

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    Scheinin, Scott A; Sosa-Herrera, Jose

    2014-01-01

    Pericardial malignancies are uncommon, usually metastatic, linked to terminal oncology patients, and rarely diagnosed premortem. A very small number of patients will develop signs and symptoms of malignant pericardial effusion as initial clinical manifestation of neoplastic disease. Among these patients, a minority will progress to a life-threatening cardiac tamponade. It is exceedingly rare for a cardiac tamponade to be the unveiling clinical manifestation of an unknown malignancy, either primary or metastatic to pericardium. We present the case of a 50-year-old male who was admitted to the emergency department with an acute myocardial infarction diagnosis that turned out to be a cardiac tamponade of unknown etiology. Further studies revealed a metastatic pericardial adenocarcinoma with secondary cardiac tamponade. We encourage considering malignancies metastatic to pericardium as probable etiology for large pericardial effusions and cardiac tamponade of unknown etiology.

  20. Pericardial Metastasis Induced Tamponade from Urothelial Carcinoma: A Rare Entity

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    Rafay Khan; Waqas Jehangir; Sunil Tulpule; Mohamed Osman; Shilpi Singh; Shuvendu Sen

    2016-01-01

    Urothelial carcinoma in a few cases may result in cardiac metastasis. A rare presentation of this condition is its diagnosis as a result of cardiac tamponade. Tamponade is an unusual entity as a result of urothelial carcinoma and has only been reported in four cases. There have also been only a total of fifteen cases of cardiac metastasis from this form of malignancy. It is through this discussion that we emphasize the importance of early detection and monitoring of cardiac symptoms with the ...

  1. The bowed catheter sign: a risk for pericardial tamponade

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    Towbin, Richard [Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

    2008-03-15

    The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade. (orig.)

  2. Pericardial tamponade and death from Hickman catheter perforation.

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    Murray, B H; Cohle, S D; Davison, P

    1996-12-01

    In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed. Shortly after extubation and arrival in the postoperative recovery unit, the patient had respiratory and cardiac arrest. Resuscitative efforts, including chest tube placement and pericardiocentesis, were unsuccessful. Autopsy findings included perforation of the superior vena cava, with extension of the catheter in the pericardial sac and associated effusion. Despite the low reported incidence of perforation during placement of central venous catheters, we recommend confirmation of placement by fluoroscopy and instillation of radiopaque dye because of the high mortality associated with this complication.

  3. Pericardial tamponade and pancytopenia as the first manifestation of mixed connective tissue disorder and its complete reversal with corticosteroids

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    Ankur Jain

    2014-09-01

    Full Text Available We report a case of a 25-year-old lady who presented to our department with complaints of easy fatigability and shortness of breath since one week. She had a history of Raynaud’s phenomenon. Examination revealed scleroderma like skin changes and pericardial friction rub. Investigations revealed high titer of anti-U1 RNP antibodies along with co-existing pancytopenia. Chest x-ray and echocardiography confirmed pericardial tamponade. Patient was diagnosed as having mixed connective tissue disorder (MCTD and she was started on high dose prednisolone, which led to complete reversal of pancytopenia and pericardial tamponade after 1 month of treatment. There are only 6 reported cases of pericardial tamponade in a patient with MCTD, and none of them had pancytopenia. Present case highlights the need to investigate the patient of pericardial tamponade for MCTD, especially in the presence of pancytopenia and relevant clinical history, as prompt treatment with corticosteroids can avoid invasive procedures like pericardiocentesis.

  4. Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion.

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    Numico, Gianmauro; Cristofano, Antonella; Occelli, Marcella; Sicuro, Marco; Mozzicafreddo, Alessandro; Fea, Elena; Colantonio, Ida; Merlano, Marco; Piovano, Pierluigi; Silvestris, Nicola

    2016-04-01

    Malignant pericardial effusion (MPE) is a serious complication of several cancers. The most commonly involved solid tumors are lung and breast cancer. MPE can give rise to the clinical picture of cardiac tamponade, a life threatening condition that needs immediate drainage. While simple pericardiocentesis allows resolution of the symptoms, MPE frequently relapses unless further procedures are performed. Prolonged drainage, talcage with antineoplastic agents, or surgical creation of a pleuro-pericardial window are the most commonly suggested ones. They all result in MPE resolution and high rates of long-term control. Patients suitable for further systemic treatments can have a good prognosis irrespective of the pericardial site of disease. We prospectively enrolled patients with cardiac tamponade treated with prolonged drainage associated with Bleomycin administration. Twenty-two consecutive patients with MPE and associated signs of hemodynamical compromise underwent prolonged drainage and subsequent Bleomycin administration. After injection of 100 mg lidocaine hydrochloride, 10 mg Bleomycin was injected into the pericardial space. The catheter was clumped for 48 h and then reopened. Removal was performed when the drainage volume was <25 mL daily. Twelve patients (54%) achieved complete response and 9 (41%) a partial response. Only 1 (5%) had a treatment failure and underwent a successful surgical procedure. Acute toxicity was of a low degree and occurred in 7 patients (32%). It consisted mainly in thoracic pain and supraventricular arrhythmia. The 1-year pericardial effusion progression-free survival rate was 74.0% (95% confidence interval [CI]: 51.0-97.3). At a median follow-up of 75 months, a pericardial progression was detected in 4 patients (18%). One- and two-year overall survival rates were 33.9% (95% CI: 13.6-54.2) and 14.5% (95% CI: 0.0-29.5), respectively, with lung cancer patients having a shorter survival than breast cancer patients. The worst

  5. Pericardial effusion and cardiac tamponade: clinical manifestation of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.

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    Ferreira, David Cavalcanti; de Oliveira, José Salvador Rodrigues; Parísio, Katya; Ramalho, Fernanda Maria Morselli

    2014-03-01

    The authors report a case with pericardial effusion and cardiac tamponade as a rare clinical manifestation of chronic graft-versus-host disease in a young man with acute myelogenous leukemia submitted to an allogeneic hematopoietic stem cell transplantation from a related donor.

  6. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

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    Beishuizen Albertus

    2011-05-01

    Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

  7. Diagnostic accuracy retrospectively of electrocardiographic findings and cancer history for tamponade in patients determined to have pericardial effusion by transthoracic echocardiogram.

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    Mathur, Atish Pratap; Saini, Abhimanyu; Lucas, Brian P; AlYousef, Tareq; Margeta, Bosko; Mba, Benjamin

    2013-04-01

    Unexpected pericardial effusions are often found by frontline providers who perform computed tomography. To study the hypothesis that electrocardiographic findings and whether cancer is known or suspected importantly change the likelihood of tamponade for such providers, all unique patients with moderate or large pericardial effusions determined by transthoracic echocardiography during a 6-year period were retrospectively identified. Electrocardiograms were evaluated by blinded investigators for electrical alternans (total and QRS), low voltage (limb leads only, precordial leads only, and both), and tachycardia (>100 QRS complexes/min). Medical records were reviewed to determine whether cancer was known or suspected and whether tamponade was diagnosed. Tamponade was present in 66 patients (27% of 241) with moderate or large pericardial effusions. No tachycardia lowered the odds of tamponade the most (likelihood ratio 0.4, 95% confidence interval 0.3 to 0.6) but by a degree less than any single diagnostic element increased it when present. The combined presence of all 3 electrocardiographic findings and cancer increased the odds of tamponade 63-fold (likelihood ratio 63, 95% confidence interval 33 to 150), whereas their combined absence decreased the odds only fivefold (likelihood ratio 0.2, 95% confidence interval 0.2 to 0.3). In conclusion, electrocardiography findings and cancer rule in tamponade better than they rule it out. Combining these diagnostic elements improves their discriminatory power but not sufficiently enough to rule out tamponade in patients with moderate or large pericardial effusions.

  8. Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion.

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    Mars, Tomaz; Mikolavcic, Helena; Salobir, Barbara; Podbregar, Matej

    2010-07-14

    Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

  9. [Pericardial Fenestration in a Patient with Myocardial Metastasis and Cardiac Tamponade after Surgery for Esophageal Cancer;Report of a Case].

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    Kobayashi, Kensuke; Suto, Yukio; Akashi, Okihiko; Sakata, Yoshihito; Hayama, Yasufumi; Kon, Junichi; Chino, Osamu

    2016-09-01

    We report a case of pericardial fenestration in a patient with myocardial metastasis and cardiac tamponade after surgery for esophageal cancer. A 66-year-old man had been suffering from orthopnea, hypotension and general malaise due to cardiac tamponade and heart failure. Esophagectomy was performed with substernal gastric tube reconstruction for advanced esophageal carcinoma. Nine months after the operation, heart failure developed, and myocardial and pericardial metastasis was subsequently detected. Subxiphoidal pericardiocentesis was abandoned due to the substernal gastric tube, and pericardial fenestration was performed through a small left anterior thoracotomy at the 5th intercostal space. His symptoms were ameliorated immediately and the procedure contributed greatly to maintain his quality of life. Preoperative computed tomography was useful for revealing the anatomical positions of the gastric tube and important vessels.

  10. Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture

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    Bryan G Maxwell

    2013-01-01

    Full Text Available A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

  11. Echocardiography of isolated subacute left heart tamponade in a patient with cor pulmonale and circumferential pericardial effusion

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    Salobir Barbara

    2010-07-01

    Full Text Available Abstract Patients with advanced idiopathic pulmonary artery hypertension have often a chronic pericardial effusion. It is the result of increased transudation and impaired re-absorption due to elevated venous pressure. These patients have pre-existent symptoms and signs of chronic right heart failure. High degree of suspicion is required to detect of development of an atypical form of tamponade with isolated compression of left heart chambers as shown in present case report. Transthoracic echocardiography provides a rapid access to the correct diagnosis, a prompt relief of symptoms following the ultrasound guided pericardiocentesis and important diagnostic tool for regular follow up of patients thereafter as shown in our case report.

  12. [A case of cardiac tamponade due to malignant pericarditis with lung adenocarcinoma, effectively treated with pericardial drainage and pemetrexed plus cisplatin chemotherapy].

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    Yoshida, Kazufumi; Teramoto, Shinji

    2015-01-01

    A 68-year-old man was diagnosed with non small cell lung cancer in May 2013. Although the patient was negative for EGFR mutation, he wished to undergo treatment with gefitinib and erlotinib as first-line therapy. However, one year later, he was admitted to our hospital because of cardiac tamponade due to malignant pericarditis. He received pericardial drainage, after which his condition was stabilized. He was diagnosed with lung adenocarcinoma by cytology of pericardial effusion and treated with pemetrexed plus cisplatin as second-line therapy. Thereafter, the malignant effusion was decreased and the primary lesion was regressed. He received six courses of chemotherapy, however, brain metastases and bone metastases appeared. The brain metastases were controlled with gamma knife radiosurgery and he received carboptatin-paclitaxel plus bevacizumab as third-line therapy. The patient is currently receiving chemotherapy without any recurrence of malignant pericarditis or cardiac tamponade.

  13. Delayed recurrent pericarditis complicated by pericardial effusion and cardiac tamponade in a blunt trauma patient

    Directory of Open Access Journals (Sweden)

    Hazar H Khidir

    2015-01-01

    Full Text Available A 19-year-old male suffered orthopedic fractures, blunt solid organ injury and pneumopericardium after a fall from 40 feet. With the exception of an external fixation device, he was managed non-operatively and discharged to a rehabilitation unit after 8 days. He was readmitted 4 days later with chest pain and clinical evidence of pericardititis that resolved with the initiation of non-steroidal anti-inflammatory drugs and colchicine. He returned to the rehabilitation hospital, but was readmitted once again for chest pain and hypotension. Echocardiogram revealed cardiac tamponade that required emergent drainage. He tolerated the procedure well and was discharged home from the hospital to continue treatment for his pericarditis. He is doing well at 3 months of follow-up.

  14. Clinicopathological study of cardiac tamponade due to pericardial metastasis originating from gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Michiya Kobayashi; Takehiro Okabayashi; Ken Okamoto; Tsutomu Namikawa; Keijiro Araki

    2005-01-01

    AIM: To review the cases reported in the literature,examined their clinicopathological features, and evaluated the efficacy of different therapeutic modalities for this rare condition.METHODS: A search of the MEDLINE database revealed 16 cases of pericarditis carcinomatosa (PC)originating from GC reported in the literature between1982 and 2005. Additional detailed data were obtained from the authors of these studies for subsequent clinicopathological investigation. We have also described about a case study from our own clinic.RESULTS: The mean age of cases with pericarditis carcinomatosa originating from GC was 54 years.Females were diagnosed at a younger age (46.3 years)compared to males (58 years). The mean survival period after diagnosis was 4.5 mo. No statistical differences in the length of survival time were found between different therapeutic modalities, such as drainage, and local and/or systemic chemotherapy after drainage. However,three cases who underwent systemic chemotherapy survived for more than 10 mo. Cases that developed metachronous cardiac tamponade for more than 2years after the diagnosis of GC generally survived for a longer period of time, although this was not statistically significant. Multivariate analysis revealed that low levels of carcinoembryonic antigen (CEA), and CEA and/or cancer antigen 19-9 (CA 19-9) were associated with longer survival.CONCLUSION: Cases with low levels of CEA, and CEA and/or CA 19-9 should undergo systemic chemotherapy with or without local chemotherapy after drainage.

  15. Pericardial Effusion and Cardiac Tamponade Following Percutaneously Inserted Central Line Insertion in an Extremely Low-birth-weight Baby: Case Report and Successful Management

    Science.gov (United States)

    Desai, Avinash V.; Kumar, Abnish; Shanbhag, Praful; Shah, Forum

    2017-01-01

    Pericardial effusion and cardiac tamponade are rare complications of percutaneously inserted central lines (PICLs), in extremely low-birth-weight babies. This particular complication carries a high degree of mortality, if not suspected and diagnosed. Bedside echocardiography proves not only diagnostic but also can be lifesaving in these conditions. Here, we wish to report such a baby who suddenly deteriorated and showed cardiovascular instability 2 days after the insertion of PICL. Immediate bedside echocardiography helped pick up the effusion which was drained using a subxiphoid percutaneous approach. PMID:28197055

  16. Paradoxical hypertension with cardiac tamponade.

    Science.gov (United States)

    Argulian, Edgar; Herzog, Eyal; Halpern, Dan G; Messerli, Franz H

    2012-10-01

    Subacute (medical) tamponade develops over a period of days or even weeks. Previous studies have shown that subacute tamponade is uncommonly associated with hypotension. On the contrary, many of those patients are indeed hypertensive at initial presentation. We sought to determine the prevalence and predictors of hypertensive cardiac tamponade and hemodynamic response to pericardial effusion drainage. We conducted a retrospective study of patients who underwent pericardial effusion drainage for subacute pericardial tamponade. Diagnosis of pericardial tamponade was established by the treating physician based on clinical data and supportive echocardiographic findings. Patients were defined as hypertensive if initial systolic blood pressure (BP) was ≥140 mm Hg. Thirty patients with subacute tamponade who underwent pericardial effusion drainage were included in the analysis. Eight patients (27%) were hypertensive with a mean systolic BP of 167 compared to 116 mm Hg in 22 nonhypertensive patients. Hypertensive patients with tamponade were more likely to have advanced renal disease (63% vs 14%, p tamponade after pericardial effusion drainage. Those results are consistent with previous studies with an estimated prevalence of hypertensive tamponade from 27% to 43%. In conclusion, a hypertensive response was observed in approximately 1/3 of patients with subacute pericardial tamponade. Relief of cardiac tamponade commonly resulted in a decrease in BP.

  17. 介入术后急性心脏压塞的护理策略%Nursing strategy of acute pericardial tamponade after interventional therapy

    Institute of Scientific and Technical Information of China (English)

    穆希娟; 刘新

    2014-01-01

    Objective To explore the early signs,treatment process and the nursing strategies of pericardial tamponade after transradial coronary angiography interventional therapy, and improve the prognosis and decrease the mortality. Methods Retrospective analysis of clinical data of 5 595 patients by transradial coronary angiography interventional treatment in Beijing Anzhen Hospital emergency center from January 2011 to October 2013. Results The patients with pericardial tamponade show chest pain, extreme irritability, pale, sweating, difficulty in breathing, blood pressure decreased, especially systolic blood pressure decreased, increased heart rate. Early diagnosis method is ultrasonic cardiogram; nurse should carefully observe the vital signs of patients, timely report and maintenance of pericardial puncture, in order to avoid the occurrence of pericardial puncture complications. The results showed that 8 patients with cardiac tamponade in the 5 595 cases which interventional therapy , the incidence rate was 0.14%.The success rate of treatment was 100% after early detection and treatment timely. Conclusion Early detection of pericardial tamponade, the correct diagnosis and active nursing can improve the prognosis and decrease the mortality.%目的 探讨经桡动脉行冠状动脉造影介入治疗患者并发心脏压塞的早期征象,诊治流程及护理策略,从而改善预后、降低病死率.方法 回顾性分析2011年1月至2013年10月年北京安贞医院抢救中心采用经桡动脉行冠状动脉造影介入治疗5 595例患者临床资料.结果 心脏压塞的早期征象为胸痛、极度烦躁、面色苍白、大汗,呼吸困难、血压下降,特别是收缩压下降、心率增快,早期诊断手段为超声心动图;护理工作应认真观察患者生命体征,及时上报,做好心包穿刺护理工作,避免心包穿刺并发症发生.本研究结果显示在5 595例介入检查患者中8例发生心脏压塞,发病率为0.14%,经及时发

  18. Clinical Study of Interventional Cardiovascular Complication of Pericardial Tamponade%心血管介入术并发心包填塞的临床研究

    Institute of Scientific and Technical Information of China (English)

    廖德祥

    2015-01-01

    Objective To study and analyze the effective clinical cardiovascular interventional operation complicated with pericardial tamponade rescue mode. Methods Collected in our hospital from 2003 June to 2014 June cardiovascular interventional operation complicated with pericardial tamponade in patients with a total of 40 cases, the clinical data of the patients were retrospectively analyzed. Results Patients with pain, shortness of breath, chest tightness, lower blood pressure, liquid dark area and beating heart shadow disappear or abate symptom such as compared with before treatment improved obviously, and the P<0.05 indicates the differences are statistically significant, all patients were cured, and no obvious sequelae. Conclusion The most serious complication of cardiovascular intervention is pericardial tamponade, timely recognition of disease and effective treatment is the key to the success of the treatment.%目的:研究和分析心血管介入术并发心包填塞的有效临床抢救方式。方法收集该院于2003年6月—2014年6月收治的心血管介入术并发心包填塞的患者共40例,对患者的临床资料进行回顾性分析。结果患者的呼吸急促、疼痛、胸闷、血压降低、液性暗区以及心影搏动消失或减弱等症状都较治疗前有了明显改善,且P均<0.05表示差异有统计学意义,所有患者均痊愈出院,且没有明显的后遗症。结论心血管介入术中最严重的并发症就是心包填塞,对病症的及时识别和有效治疗是临床抢救成功的关键。

  19. A Case of Blunt Traumatic Cardiac Tamponade Successfully Treated by Out-of-hospital Pericardial Drainage in a "Doctor-helicopter" Ambulance Staffed by Skilled Emergency Physicians.

    Science.gov (United States)

    Otsuka, Hiroyuki; Sato, Toshiki; Morita, Seiji; Nakagawa, Yoshihide; Inokuchi, Sadaki

    2016-03-20

    We report a 55-year-old man who relapsed into a state of shock in an ambulance before arriving at our critical care center after a fall injury. The diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis and drainage were performed at the heliport. He was then transported immediately to our hospital with continuous drainage and surgery was performed. After surgery, the patient was transferred to the intensive care unit in stable condition. After undergoing rehabilitation, he made a full recovery and was discharged. This case illustrates that such patients can be treated reliably by pericardial drainage performed by skilled emergency physicians in the field by making use of the "doctor-helicopter" ambulance transportation system, followed by emergency surgery in a critical care center.

  20. 体外循环心内直视术后并发急性心包填塞的观察与护理%Observation and nursing strategies of acute pericardial tamponade after cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    熊素华; 李艳星

    2012-01-01

    Objective To investigate the observation and nursing strategies of acute pericardial tamponade after cardiopulmonary bypass. Method The clinical records of 15 patients of acute pericardial tamponade after cardiopulmonary bypass from July 2006 to July 2011 were retrospectively reviewed to summarize the experience of and nursing strategies. Result Through timely and symptomatic treatment, hemodynamics restored to stability in all the 15 patients and all of them were recovered. Conclusions A major cause of acute pericardial tamponade after cardiac operation is mediastinal bleeding combined with the blockage or no blockage of drainage tube. The hemodynamic observation and nursing care for drainage tube are the key points to the prevention and treatment of acute pericardial tamponade.%目的 探讨体外循环心内直视术后并发急性心包填塞的观察与护理要点.方法 回顾性分析本院2006年7月~2011年7月实施体外循环心内直视术后出现心包填塞15例患者的临床资料,并总结术后观察和护理要点.结果 15例患者经过及时对症治疗和护理后,血流动力学恢复稳定,无1例死亡.结论 心内直视术后心包填塞的主要原因是术后纵膈出血过多,可伴有心包液引流不畅,而积极的观察和及时正确做好纵膈引流管护理是防治急性心包填塞的关键.

  1. Rescue and nursing of complicated acute pericardial tamponade with cardiac interventional therapy%心脏介入治疗并发急性心包填塞的抢救与护理

    Institute of Scientific and Technical Information of China (English)

    李晓彤

    2012-01-01

    目的 总结心脏介入治疗并发12例急性心包填塞的护理经验.方法 回顾分析心脏介入治疗并发12例急性心包填塞患者的临床资料,总结护理要点.结果 急性心包填塞发生在冠状动脉介入治疗3例,射频消融术6例,永久起搏术1例,临时起搏术2例,无1例死亡.结论 严密观察病情,积极护理施救,加强心理护理,提高风险意识,各项护理环环相扣,从而保障患者的生命安全.%Objective To summarize the nursing experience of 12 cases of complicated acute pericardial tamponade with cardiac interventional therapy. Methods The clinical data of 12 complicated acute pericardial tamponade patients treated with cardiac interventional therapy were analyzed retrospectively,and nursing strategies were summarized as well. Results There were 3 cases of a-cute pericardial tamponade in coronary interventional therapy,6 cases of radiofrequency ablation,1 case of permanent pacing,and 2 cases of temporary pacing with no case of death. Conclusion The close observation of the disease,active care and rescue,enhancement of psychological nursing and risk awareness are interrelated. They can ensure the safety of patients.

  2. Cardiovascular collapse with attempted pericardial drain withdrawal

    Directory of Open Access Journals (Sweden)

    Molly B Kraus

    2016-01-01

    Full Text Available Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.

  3. Cardiovascular collapse with attempted pericardial drain withdrawal

    OpenAIRE

    Molly B Kraus; Spitznagel, Rachel A; Kugler, Jane A

    2016-01-01

    Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.

  4. Pericardial tamponade complicated by interventional management for Budd-Chiari syndrome: clinical analysis and treatment%Budd-Chiari综合征介入治疗并发心脏压塞的分析和处理

    Institute of Scientific and Technical Information of China (English)

    张璐西; 祖茂衡; 吴金平; 徐浩; 焦旭东; 陈正侃

    2011-01-01

    目的 探讨Budd-Chiari综合征(BCS)介入治疗并发心脏压塞的原因和处理方法.方法 回顾性分析1990 - 2006年812例行BCS介入治疗中并发心脏压塞的9例患者的造影结果、临床症状、发生原因、处理方法和转归.结果 9例发生心脏压塞患者中,8例成功救治,1例死亡.其中下腔静脉阻塞型7例,肝静脉阻塞型1例,混合型1例.单纯误穿心包5例,误穿加球囊撕裂心包3例,支架移位进入右心房损伤心包1例.行传统心包穿刺抽液1例,外科手术处理3例,行剑突下Seldinger技术置管引流2例,观察、保守处理1例,经误入导管抽液1例,经误入导管抽液加剑突下Seldinger技术置管引流1例.结论 心脏压塞是BCS介入治疗中少见且严重的并发症,术前预防、及时发现、合理处理是避免严重后果的关键.%Objective To discuss the causes and treatment of pericardial lamponade (PT) occurredin me interventional management for Budd-Chiari syndrome (. BCS I Methods [luring the period from 1990 to 2006. Intervention] treatment was performed in 812 patients with ISCS. Pericardia] tamponade occurred in nine patients during the period of interventional treatment. The clinical daia, including angiographic findings, clinical symptoms. Management and outcomes, of the nine patients were retrospectively analyzed. The possible causes of pericardial tamponade were discussed. Results Of the nine patients occurring pericardial tamponade, successful treatment was obtained in eight and death occurred in one. The lesions of BCS in the nine cases included inferior vena cava obstruction type ( n= 7), hepatic venous obstruction type (n=1 ) and mixed type (n=1). Pericardial tamponade was caused by mistakenly puncturing into pericardium (n =5 ), mistakenly puncturing together with laceration of pericardium by balloon (n=3), and breaking of pericardium by displaced stent (n= 1 ), Conventional pericardioceutesis was employed in one case, surgery was carried

  5. Cardiac tamponade as a presenting manifestation of severe hypothyroidism.

    Science.gov (United States)

    Butala, Ashvin; Chaudhari, Shilpa; Sacerdote, Alan

    2013-02-05

    We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.

  6. 九例急性心包填塞患者CT成像特点及预后分析%CT Imaging and Prognosis of 9 Patients with Acute Pericardial Tamponade

    Institute of Scientific and Technical Information of China (English)

    吴秀明; 丁长青; 刘杰; 孙慧芳

    2015-01-01

    目的:分析9例急性心包填塞( TMP)患者CT成像特点及预后。方法回顾性分析2013年10月—2015年1月丰县人民医院收治的9例TMP患者的临床资料,总结其CT成像特点及预后。结果 CT成像特点:9例患者均见心包积液(心包腔最厚处1.8~5.4 cm,平均3.7 cm;CT值26~32 HU,平均28.4 HU)。8例Stanford A型主动脉夹层破裂患者升主动脉增宽(直径6.9~8.5 cm,平均7.3 cm),呈管腔内线样征、双腔征;伴肺内渗出3例、胸腔积液3例、纵隔积液3例、肺部马赛克灌注2例、慢性支气管炎肺气肿2例。1例胸部创伤患者未见其他异常表现。预后:1例创伤患者转上级医院手术治疗后痊愈,余8例患者CT检查后1~72 h内死亡。结论9例TMP患者CT检查均见心包积液,多见升主动脉增宽,管腔内线样征、双腔征,预后多不良。%Objective To analyze the CT imaging and prognosis of 9 patients with acute pericardial tamponade. Methods A total of 9 patients with acute pericardial tamponade were selected in People's Hospital of Fengxian from October 2013 to January 2015,and their clinical data was retrospectively analyzed to summarize the CT imaging and prognosis. Results All of the 9 patients showed hydropericardium,the thickest pericardial cavity ranging at 1. 8 to 5. 4 cm,average at 3. 7 cm;the CT attenuation value was 26 to 32 HU,average at 28. 4 HU. Of the 9 patients,8 patients with Stanford type A aortic dissection rupture showed widened ascending aorta,the diameter was 6. 9 to 8. 5 cm,average at 7. 3 cm,with intra-lumen string sign or double-lumen sign;3 patients occurred intra-pulmonary exudation,3 patients occurred pleural effusion,3 patients occurred mediastinal effusion, 2 patients occurred lung mosaic perfusion, 2 patients occurred chronic bronchitis complicated with pneumonectasis. Of the 9 patients,1 patient with chest trauma did not show other obvious abnormal CT imaging, and was transferred to

  7. Use of real time ultrasound guided pericardial catheter drainage in acute pericardial tamponade during cardiac intervention%实时超声引导下心包置管引流在心脏介入术中并发急性心包填塞的应用

    Institute of Scientific and Technical Information of China (English)

    张玉静

    2015-01-01

    Objective:to explore the use of real-time ultrasound-guided pericardial drainage in acute pericardial tamponade during cardiac intervention.Methods:A total of 120 patients who developed acute cardiac tamponade during cardiac intervention in our hospital between January 2009 and January 2014 were included in this study. The patients were divided into the control group(n = 60)and study group( n = 60)by using the random digit table. During the procedure,the study group received real-time ultrasound-guided pericardial drainage,while the control group received conventional pericardial drainage.Results:After the procedure,the total effective rate in the study group(90%)was significantly higher than that in the control group(65%),with statistically significant difference between the two groups(P﹤0.05). The rate of adverse events was significantly lower in the study group( 23. 33%) compared with the control group( 50%)( P ﹤ 0. 05). Conclusion:Ultrasound-guided pericardial drainage may yield better clinical outcomes and rate of adverse events for patients who developed acute cardiac tamponade during cardiac intervention,and is therefore justified for widespread use in clinical treatment.%目的:探讨实时超声引导下心包置管引流在心脏介入术中并发急性心包填塞的应用。方法:选取2009年1月~2014年1月在我院进行心脏介入术中并发急性心包填塞的患者120例作为研究对象,将患者按照随机数字表法分为对照组60例和观察组60例,观察组在治疗时采用实时超声引导下心包置管引流,对照组在治疗时采用常规的心包置管引流。结果:观察组治疗后的总有效率(90.00%)明显好于对照组治疗后的总有效率(65.00%)(P﹤0.05);观察组治疗后的不良反应等发生率(23.33%)明显低于对照组治疗后的不良反应的发生率(50.00%,P﹤0.05)。结论:在对行心脏介入术中并发急性心包填塞的患者采用超

  8. Spontaneous chylous cardiac tamponade: a case report

    Directory of Open Access Journals (Sweden)

    Tsilikas Christodoulos

    2010-03-01

    Full Text Available Abstract Background Chylous cardiac tamponade is a rare condition with little known cause. Case presentation A case of an otherwise healthy woman who admitted with dyspnea and palpitations is presented. She had a history of a painful flexion-hyperextension of the spine. Diagnostic evaluation proved a chylous pericardial effusion with a disruption of the anterior longitudinal spinal ligament. Video-assisted thoracic surgery with mass supradiaphragmatic ligation of the thoracic duct and pericardial window formation was carried out successfully and resulted in the complete cure of the patient's condition. Conclusion Chylous pericardial effusion and subsequent tamponade is a rare entity. Endoscopic surgery is offering a safe and effective treatment.

  9. Thoracoscopic pericardial fenestration for persistent pericardial effusion after radiotherapy for esophageal cancer. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Sakamoto, Kazuhiro; Tsuchida, Kazuhito; Ariga, Takamitsu [Yokohama Rosai Hospital (Japan)

    2002-11-01

    We performed thoracoscopic pericardial fenestration for persistent pericardial effusion after radiotherapy for esophageal cancer. An 85-year-old man who had radiation therapy (70.2 Gy) for esophageal cancer was admitted for shortness of breath. Chest computed tomography showed a pericardial effusion. During the 6 months prior to this admission, the patient had undergone percutaneous pericardial drainage 3 times for cardiac tamponade. We performed thoracoscopic partial pericardiectomy with creation of a pleuropericardial window via one access port. Histopathologically, no malignant cells were found in either the resected pericardium or the pericardial effusion. Therefore, we believe the persistent pericardial effusion was secondary to radiotherapy. There was no recurrence of the pericardial effusion for 7 months postoperatively. In summary, thoracoscopic pericardial fenestration is useful in both the diagnosis and treatment of persistent pericardial effusion. (author)

  10. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

    Directory of Open Access Journals (Sweden)

    Fahad Almehmadi

    2016-01-01

    Full Text Available Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  11. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression.

    Science.gov (United States)

    Almehmadi, Fahad; Chandy, Mark; Connelly, Kim A; Edwards, Jeremy

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  12. Percutaneous treatment in patients presenting with malignant cardiac tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Marcy, P.Y. [Antoine Lacassagne Center, Interventional Radiology Department, Nice (France); Bondiau, P.Y. [Antoine Lacassagne Center, Radiation Therapy Department, Nice (France); Brunner, P. [Centre Hospitalier Princesse, Grace (Monaco). Interventional Radiology Department

    2005-09-01

    The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment. (orig.)

  13. Acute cardiac tamponade: an unusual cause of acute renal failure in a renal transplant recipient.

    Science.gov (United States)

    Nampoory, Naryanan; Gheith, Osama; Al-Otaibi, Torki; Halim, Medhat; Nair, Prasad; Said, Tarek; Mosaad, Ahmed; Al-Sayed, Zakareya; Alsayed, Ayman; Yagan, Jude

    2015-04-01

    We report a case of slow graft function in a renal transplant recipient caused by uremic acute pericardial effusion with tamponade. Urgent pericardiocentesis was done with an improvement in blood pressure, immediate diuresis, and quick recovery of renal function back to baseline. Pericardial tamponade should be included in consideration of causes of type 1 cardiorenal syndrome in renal transplant recipients.

  14. An unusual case of cardiac tamponade: ruptured subaortic diverticulum.

    Science.gov (United States)

    Salemi, Arash; Lee, Ben; Ivascu, Natalia; Webber, Geoffrey; Paul, Subroto

    2010-05-01

    Cardiac diverticula are rare congenital anomalies found as outpouchings from various chambers of the heart. We present a case of a diverticulum arising from the membranous septum with free rupture into the pericardial space and tamponade.

  15. Role of echocardiography in the treatment of cardiac tamponade.

    Science.gov (United States)

    Chandraratna, P A N; Mohar, Dilbahar S; Sidarous, Peter F

    2014-08-01

    Accumulation of fluid within the pericardial sac results in elevation of intrapericardial pressure with consequent cardiac compression or tamponade. Cardiac tamponade is a life-threatening condition which requires urgent evacuation of pericardial effusion (PE). Current pericardial evacuation techniques and approaches are varied. Echocardiography provides valuable insights into identifying patients who are suitable candidates and further facilitates pericardiocentesis by improving guidance techniques. Several previous publications have provided excellent reviews of the pathophysiology of cardiac tamponade. We review the clinical presentation and role of echocardiography for diagnosis of tamponade. We focus on medical and surgical approaches for the removal of PE. Moreover, as the clinical and hemodynamic consequences of PE depend on the volume and the rate of accumulation of PE, we review the various scenarios of "small" PE resulting in cardiac tamponade.

  16. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

    OpenAIRE

    Fahad Almehmadi; Mark Chandy; Connelly, Kim A.; Jeremy Edwards

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade...

  17. Cardiac tamponade as an initial manifestation of systemic lupus erythematosus.

    Science.gov (United States)

    Carrion, Diego M; Carrion, Andres F

    2012-06-12

    Clinical manifestations of pericardial disease may precede other signs and symptoms associated with systemic lupus erythematosus. Although pericardial effusion is one of the most common cardiac problems in patients with systemic lupus erythematosus, haemodynamically significant effusions manifesting as cardiac tamponade are rare and require prompt diagnosis and treatment.

  18. Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    ... Submit Button Frequently Asked Questions about Catheter-associated Urinary Tract Infections Recommend on Facebook Tweet Share Compartir What is ... an incision above the pubis. What is a urinary tract infection? A urinary tract infection (UTI) is an infection ...

  19. Chylopericardium presenting as cardiac tamponade secondary to mediastinal lymphangioma.

    Science.gov (United States)

    Alsmady, M M; Aladaileh, M A; Al-Zaben, K; Saleem, M M; Alimoglu, O

    2016-11-01

    Mediastinal lymphangioma is a rare entity and chylopericardium is a rare form of pericardial effusion. We report a case of acute chylous cardiac tamponade due to a cervicomediastinal lymphangioma in a one-year-old boy. A chest x-ray revealed marked cardiac enlargement and echocardiography showed massive pericardial effusion. Emergency surgery was performed whereby a pericardial window was created, followed by excision of the lymphangioma.

  20. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    OpenAIRE

    Sankalp Dwivedi; Fayez Siddiqui; Milan Patel; Shaun Cardozo

    2016-01-01

    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside ...

  1. The efficacy and safety of complete pericardial drainage by means of intrapericardial fibrinolysis for the prevention of complications of pericardial effusion: a systematic review protocol

    OpenAIRE

    Kakia, Aloysious; Wiysonge, Charles S.; Ochodo, Eleanor A.; Awotedu, Abolade A; Ristic, Arsen D; Mayosi, Bongani M

    2016-01-01

    Introduction Intrapericardial fibrinolysis has been proposed as a means of preventing complications of pericardial effusion such as cardiac tamponade, persistent and recurrent pericardial effusion, and pericardial constriction. There is a need to understand the efficacy and safety of this procedure because it shows promise. Methods and analysis We aim to assess the effects of intrapericardial fibrinolysis in the treatment of pericardial effusion. We will search PubMed, the Cochrane Library, A...

  2. [Cardiac tamponade as the first symptom of lung cancer].

    Science.gov (United States)

    Gromadziński, Leszek; Przelaskowski, Piotr; Januszko-Giergielewicz, Beata; Górny, Jerzy; Stankiewicz, Aleksander; Każarnowicz, Andrzej; Pruszczyk, Piotr

    2013-01-01

    Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.

  3. Giant epicardial cyst presenting as acute cardiac tamponade in a 2-year-old boy.

    Science.gov (United States)

    Masuoka, Ayumu; Sakurai, Hayato; Shiraishi, Masahisa; Yoshiba, Shigeki; Katogi, Toshiyuki; Suzuki, Takaaki

    2015-09-01

    Cystic structures within the pericardial cavity are rare. They are divided into epicardial and pericardial variants. Pericardial and epicardial cysts rarely cause symptoms. This report describes a case of epicardial cyst with acute cardiac tamponade in a 2-year-old boy with no previous cardiac history who was transferred to our hospital because of hemodynamic instability. Emergency drainage of the pericardial effusion and complete excision of the cyst were performed through a median full sternotomy.

  4. Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

    Directory of Open Access Journals (Sweden)

    Adrija Hajra

    2015-01-01

    Full Text Available Cardiac involvement in malignant lymphoma is one of the least investigated subjects. Pericardial effusion is rarely symptomatic in patients of Hodgkin lymphoma (HL. Few case reports are available in the literature. There are case reports of diagnosed HL patients presenting with pericardial effusion. HL patients who present with recurrent episodes of pericardial effusion have also been reported. Pericardial effusion has also been reported in cases of non HL. However, pericardial effusion leading to cardiac tamponade as an initial presentation of HL is extremely rare. Very few such cases are there in the literature. Here, we present a case of a 26-year-old male patient who presented with cardiac tamponade and in due course was found to be a case of classical type of HL. This case is interesting because of its presentation.

  5. Cardiac tamponade preceding skin involvement in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    L. Bozzola

    2011-09-01

    Full Text Available The frequency of pericardial involvement in Systemic Sclerosis (SSc is high on autoptic or echocardiographic studies, but the clinical recognition of pericarditis with or without effusion is rare. We describe a case of a 71-year-old female with no previous history of heart disease, who presented with a large pericardial effusion and tamponade that required pericardial drain. She had suffered from Raynaud’s phenomenon since 25 years. Six weeks after hospital discharge she complained of skin hardening on left leg. Pericardial tamponade is a very rare manifestation of SSc and occurs both early or late in the course of the disease, but in our case it preceded the recognition of scleroderma. We have only identified two other cases of pericardial effusion preceding cutaneous involvement in scleroderma.

  6. Cardiac tamponade - unusual clinical manifestation of undiagnosed malignant neoplasm.

    Science.gov (United States)

    Perek, B; Tomaszewska, I; Stefaniak, S; Katynska, I; Jemielity, M

    2016-01-01

    Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.

  7. Hypothyroidism in a five-year-old boy with rhabdomyolysis and recent history of cardiac tamponade: a case report

    Directory of Open Access Journals (Sweden)

    Lorenzana Claudia

    2011-10-01

    Full Text Available Abstract Introduction Cardiac tamponade is a rare manifestation of hypothyroidism, and a less rare cause of pericardial effusion. The accumulation of the pericardial fluid is gradual, and often does not compromise cardiac hemodynamic function. There is a relationship between the severity and chronicity of the disease with the presence of pericardial effusion. There are few cases describing associated pericardial tamponade published in the literature. When a tamponade occurs, a concomitant provocative factor such as a viral pericarditis may be related. Our patient's case appears to be the youngest patient described so far. Case presentation We report the case of a previously healthy five-year-old Hispanic (non-indigenous boy who developed rhabdomyolysis with a history of a recent pericardial effusion and tamponade two months before that required the placement of a percutaneous pericardial drainage. Pericardial effusion was considered to be viral. Later on readmission, clinical primary hypothyroidism was diagnosed and thought to be associated with the previous cardiac tamponade. He developed rhabdomyolysis, which was considered to be autoimmune and was treated with steroids. The level of creatine phosphate kinase and creatine kinase MB fraction returned to within the reference rangeone week after our patient was started on steroids and three weeks after he was started on thyroid hormones. Conclusions Physicians should consider hypothyroidism as a differential diagnosis in patients with pericardial effusion. Pericardial effusion may progress and cause a cardiac tamponade with hemodynamic instability. The fact that our patient did not have any manifestations of hypothyroidism might have delayed diagnosis.

  8. Clinical diagnosis of tamponade in Malawi.

    Science.gov (United States)

    Round, A; Hamilton, W

    1990-07-01

    A consecutive series of 25 Malawian patients with tamponade secondary to tuberculosis were compared to 25 patients with congestive cardiac failure, without pericardial effusion in a retrospective study. More patients with tamponade had an impalpable apex beat (21/1), pulsus paradoxus (13/0), soft heart sounds (13/2), paradoxical rise in jugular venous pressure (6/0), and fewer had a murmur (1/14). All these results are significant (p less than 0.05) by the chi 2 test with Yates' correction. The presence of two or more of these discriminating physical signs has a positive predictive value of 75 per cent, and a negative predictive value of 99.5 per cent for the diagnosis of tamponade. Clinical diagnosis of tamponade by primary health care personnel in Malawi should be possible, and lead to earlier treatment.

  9. Hiatal hernia causing extrapericardial tamponade after coronary bypass surgery.

    Science.gov (United States)

    Papoulidis, Pavlos; Beatty, Jasmine Winter; Dandekar, Uday

    2014-10-01

    Cardiac tamponade is defined as compression of the heart due to accumulation of fluid in the pericardial sac, leading to raised pericardial pressures with haemodynamic compromise. We describe the case of a 76-year old female patient who underwent a routine off-pump coronary artery bypass graft operation and within 48 h developed classic signs of cardiac tamponade. The perioperative echocardiogram and operative findings at re-exploration revealed no clots or fluid collection. A giant hiatus hernia was found to be responsible for the tamponade through extrinsic compression. After insertion of a nasogastric tube and decompression of the stomach, there was a rapid improvement of the clinical picture. The remaining postoperative course was uneventful and the patient was discharged 5 days later, with referral to the general surgeon for further management. We conclude that, in cases of tamponade post-cardiac surgery, extrapericardial pathologies should be considered.

  10. Pneumopericardium Leading to Cardiac Tamponade in a Patient with Lung Cancer.

    Science.gov (United States)

    Al-Taweel, Ahmad; Ayub, Adil; Huang, Chyun-Yin; Rehmani, Sadiq; Al-Ayoubi, Adnan; Bhora, Faiz Y

    2016-12-01

    Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

  11. Pneumopericardium Leading to Cardiac Tamponade in a Patient with Lung Cancer

    OpenAIRE

    Al-Taweel, Ahmad; Ayub, Adil; Huang, Chyun-yin; Rehmani, Sadiq; Al-Ayoubi, Adnan; Bhora, Faiz Y.

    2016-01-01

    Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

  12. Clinical and historical features of emergency department patients with pericardial effusions

    Science.gov (United States)

    Stolz, Lori; Valenzuela, Josephine; Situ-LaCasse, Elaine; Stolz, Uwe; Hawbaker, Nicolas; Thompson, Matthew; Adhikari, Srikar

    2017-01-01

    BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram. METHODS: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination findings associated with pericardial effusion and tamponade were determined. RESULTS: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck’s triad. The sensitivity of Beck’s triad was found to be 0 (0%–19.4%). The sensitivity for one finding of Beck’s triad to diagnose pericardial tamponade was 50% (28.0%–72.0%). CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography. PMID:28123617

  13. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    Science.gov (United States)

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all ptamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, ptamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  14. A severe penetrating cardiac injury in the absence of cardiac tamponade.

    Science.gov (United States)

    Connelly, Tara M; Kolcow, Walenty; Veerasingam, Dave; DaCosta, Mark

    2016-10-26

    Penetrating cardiac injury is rare and frequently not survivable. Significant haemorrhage resulting in cardiac tamponade commonly ensues. Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of significant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging. In this case of a 26-year old sailor stabbed at sea, a significant pericardial effusion and cardiac tamponade did not occur despite an injury transversing the pericardium. Instead, the pericardial haemorrhage drained into the left pleural cavity resulting in a haemothorax. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion, a concomitant cerebrovascular event and a long delay from injury to appropriate medical treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate a primary chordae of the anterior mitral leaflet.

  15. External radiotherapy in the management of malignant pericardial effusion

    Energy Technology Data Exchange (ETDEWEB)

    Fairlamb, D.J. (The Royal Hospital, Wolverhampton (UK))

    1989-05-01

    Malignant pericardial effusions that are not causing tamponade can be effectively treated by external beam irradiation - a readily available non-invasive treatment. In a consecutive series six out of eight patients achieved good palliation of their effusions as a result of this treatment. (author).

  16. Eccentric pericardial effusion after radiation therapy of left breast carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Green, B.; Zornoza, J.; Ricks, J.P.

    1977-01-01

    Pericardial damage is one of the consequences of cardiac radiation and may lead to chronic pericarditis and/or tamponade. In three patients treated with radiation for carcinoma of the left breast, the effusions were loculated on the right side of the pericardium resulting in a peculiar cardiac silhouette. The importance of recognizing this entity and possible treatment is stressed.

  17. Dying from cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Powari Manish

    2007-09-01

    Full Text Available Abstract Background To determine the causes of cardiac tamponade (CT, focussing especially on haemopericardium (HP, as a terminal mode of death, within a 430,000 rural English population. Methods Our hospital mortuary register and, all postmortem reports between 1995 and 2004 inclusive, were interrogated for patients dying of CT or HP. The causes of CT/HP and selected morphological characteristics were then determined. Results 14,368 postmortems were performed in this period: of these, 461 patients died of CT. Three cases were due to non-haemorrhagic pericardial effusion. HP accounted for the remaining 458 cases of which, five were post-traumatic, 311 followed rupture of an acute myocardial infarction (RAMI, 138 after intra-pericardial rupture of dissecting ascending aortic aneurysms (RD3A and four were due to miscellaneous causes. HP was more commonly due to RAMI. Men tended to die from RAMI or RD3A earlier than women. RAMI or RD3A were commoner in men Two thirds of RAMI were associated with coronary artery thrombosis. Anterior free wall rupture was commonest overall, and in women, but posterior free wall rupture was commoner in men. The volume of intrapericardial blood in RAMI (mean = 440 ml and RD3A (mean = 498 ml varied between 150 and 1000 ml: intrapericardial blood volume was greater in men than in women dying from either RAMI or RD3A. Conclusion At postmortem, CT is most often related to HP, attributable to either RAMI or intrapericardial RD3A. Post-traumatic and other causes of CT are infrequent.

  18. An unusual case of cardiac tamponade following electrical cardioversion

    NARCIS (Netherlands)

    Jessurun, GAJ; Crijns, HJGM; vanWijngaarden, J

    1996-01-01

    The clinical presentation of cardiac tamponade may uncover underlying pericardial disease. We describe a patient who was being treated for lone atrial fibrillation, In this case, direct current cardioversion for recurrence of atrial fibrillation was complicated by a life-threatening hemopericardium.

  19. Cardiac tamponade as initial presentation in systemic lupus erythematosus.

    Science.gov (United States)

    Jawaid, Ambreen; Almas, Aysha

    2014-05-01

    Systemic Lupus Erythematosus (SLE) is one of the many diseases known as 'the great imitators' because it can have diverse presentations and so is misunderstood for other illnesses. This case illustrates a 19 years old girl with SLE who presented as cardiac tamponade which is a rare feature of lupus pericarditis requiring medical and surgical treatment. Even after pericardiocentesis and steroid therapy there was a re-accumulation of the pericardial fluid resulting in cardiac tamponade which led to pericardial window formation. This case draws attention to the need to consider the diagnosis of tamponade in patients with connective tissue disease and dyspnea or hemodynamic compromise. It also outlines the treatment options available so that surgical referral, if needed, can be done timely for this rare but life threatening manifestation of SLE.

  20. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    Directory of Open Access Journals (Sweden)

    Sankalp Dwivedi

    2016-01-01

    Full Text Available Central venous catheter (CVC insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ central venous catheter (CVC insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  1. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign.

    Science.gov (United States)

    Dwivedi, Sankalp; Siddiqui, Fayez; Patel, Milan; Cardozo, Shaun

    2016-01-01

    Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  2. SLE or hypothyroidism: who can triumph in cardiac tamponade?

    Science.gov (United States)

    Chaudhari, Sameer Sadashiv; Wankhedkar, Kashmira Pramod; Mushiyev, Savi

    2015-01-01

    A 36-year-old Hispanic woman with a history of systemic lupus erythaematosus (SLE) in remission presented with progressive dyspnoea, bilateral leg swelling and increasing fatigue with rapid weight gain over the past few months. Her physical examination showed mildly tender thyromegaly and pericardial rub. Investigations showed new onset marked hypothyroidism as well as an active lupus serology with echocardiogram confirming severe pericardial effusion and a tamponade phenomenon. Urgent pericardiocentesis relieved her acute symptoms, and prompt treatment with thyroxine replacement and immunosuppression for lupus disease was initiated. Pericardial fluid analysis remained negative for any malignancy and/or infection/s. The patient had a gradual and consistent improvement with this treatment. She was discharged and appeared to be clinically stable at subsequent follow-up visits. However, the case remained a diagnostic dilemma over whether the tamponade was being driven by hypothyroidism versus lupus, leaving us with an opportunity to explore further. PMID:25750217

  3. SLE or hypothyroidism: who can triumph in cardiac tamponade?

    Science.gov (United States)

    Chaudhari, Sameer Sadashiv; Wankhedkar, Kashmira Pramod; Mushiyev, Savi

    2015-03-06

    A 36-year-old Hispanic woman with a history of systemic lupus erythaematosus (SLE) in remission presented with progressive dyspnoea, bilateral leg swelling and increasing fatigue with rapid weight gain over the past few months. Her physical examination showed mildly tender thyromegaly and pericardial rub. Investigations showed new onset marked hypothyroidism as well as an active lupus serology with echocardiogram confirming severe pericardial effusion and a tamponade phenomenon. Urgent pericardiocentesis relieved her acute symptoms, and prompt treatment with thyroxine replacement and immunosuppression for lupus disease was initiated. Pericardial fluid analysis remained negative for any malignancy and/or infection/s. The patient had a gradual and consistent improvement with this treatment. She was discharged and appeared to be clinically stable at subsequent follow-up visits. However, the case remained a diagnostic dilemma over whether the tamponade was being driven by hypothyroidism versus lupus, leaving us with an opportunity to explore further.

  4. Presumed hydrochlorothiazide-associated immunologic-hypersensitivity-induced pericardial effusion

    Directory of Open Access Journals (Sweden)

    Michael J Chaskes

    2013-08-01

    Full Text Available A 50-year-old Caucasian female presented for a second opinion regarding a newly diagnosed pericardial effusion. Seven months previously, hydrochlorothiazide was introduced into her pharmacologic regimen to aid in the management of her hypertension. A routine echocardiogram indicated a large pericardial effusion with signs of early cardiac tamponade. The patient subsequently underwent successful pericardiocentesis with complete drainage of the pericardial effusion. The effusion was empirically attributed to a viral etiology. Repeat echocardiograms showed recurrence of the pericardial effusion. Prior to undergoing a second pericardiocentesis with pericardial biopsy, as her physicians recommended, the patient sought a second opinion. While obtaining the patient’s history, an allergy to sulfa was elicited. The possibility that the pericardial effusion may be secondary to an immunologic-hypersensitivity reaction was considered. It was recommended the patient discontinue the use of hydrochlorothiazide. Nine days following discontinuation of hydrochlorothiazide and without any other intervention, an echocardiogram was reported to show the size of the pericardial effusion had subsided substantially. Nine weeks following discontinuation, almost complete resolution of the pericardial effusion was reported. It is hypothesized that when treated with hydrochlorothiazide, the patient had an immune response leading to the pericardial effusion.

  5. Porridge-like tuberculous cardiac tamponade: treatment difficulties in the Horn of Africa.

    Science.gov (United States)

    Massoure, Pierre-Laurent; Boddaert, Guillaume; Caumes, Jean-Luc; Gaillard, Pierre-Emmanuel; Lions, Christophe; Grassin, Frédéric

    2010-06-01

    A 16-year-old boy was hospitalized for fever, chest pain, and cardiovascular collapse. Transthoracic echocardiography revealed a 30-mm circumferential echogenic "porridge-like" pericardial effusion with signs of cardiac tamponade. Tuberculosis (TB) was suspected because of its prevalence in Djibouti. Emergency pericardiocentesis was attempted, but only 10 ml of pericardial fluid was obtained. Subxiphoid pericardiotomy and drainage were then performed, and pericardial fibrinous pockets were surgically collapsed. Antituberculosis chemotherapy was given, and the pericardial effusion progressively disappeared without corticosteroids. The diagnosis of TB was subsequently confirmed by cultures of the pericardial fluid. A pericardial biopsy was normal. After 3 months of follow-up, there was no sign of constrictive pericarditis. Pericardiocentesis may fail in cases of advanced-stage fibrinous TB pericardial effusion. Thus, pericardiotomy with complete open draining is the only lifesaving procedure.

  6. Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause

    Directory of Open Access Journals (Sweden)

    Valery Istomin

    2016-01-01

    Full Text Available This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.

  7. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

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    Praneet Iyer

    2017-01-01

    Full Text Available Drug induced lupus erythematosus (DIL or DILE is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemipericardiectomy. After hydralazine was stopped, she never had any further episodes of pericardial effusion or tamponade.

  8. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

    Science.gov (United States)

    Iyer, Praneet; Zijoo, Ritika

    2017-01-01

    Drug induced lupus erythematosus (DIL or DILE) is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS) with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemipericardiectomy. After hydralazine was stopped, she never had any further episodes of pericardial effusion or tamponade. PMID:28194293

  9. Cardiac tamponade (image)

    Science.gov (United States)

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space ... they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

  10. A case of tuberculous pericardial effusion

    Directory of Open Access Journals (Sweden)

    Wanjari K

    2009-01-01

    Full Text Available Tuberculosis accounts for up to 4% of acute pericarditis and 7% cases of cardiac tamponade. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 30-year-old male who presented with fever, chills, and dry nonproductive cough since one month. The case was diagnosed by radiological findings, which were suggestive of pulmonary tuberculosis, followed by acid fast staining and culture of the aspirated pericardial fluid. The patient was responding to antitubercular treatment at the last follow up.

  11. Pericardial effusion associated with metastatic disease from an unknown primary tumor in a dog.

    Science.gov (United States)

    Kirsch, J A; Dhupa, S; Cornell, K K

    2000-01-01

    A 6.5-year-old, spayed female Siberian husky presented with signs of cardiac tamponade and weakness. Pleural, pericardial, and abdominal effusion were identified with radiographs and ultrasound. Pericardiocentesis relieved signs of tamponade, and the dog was clinically improved. Pericardial effusion recurred, and pericardiectomy was performed. Histopathological examination of excised tissues failed to reveal evidence of infectious or neoplastic disease. After pericardiectomy, clinically apparent thoracic effusion persisted. The dog was euthanized, and postmortem histopathological examination revealed emboli of metastatic carcinoma cells in the epicardium. The location of intrathoracic disease in this dog made antemortem diagnosis difficult, if not impossible.

  12. Adult-onset Still's disease and cardiac tamponade: a rare association.

    Science.gov (United States)

    Carrilho-Ferreira, Pedro; Silva, Doroteia; de Jesus Silva, Maria; André, Rui; Varela, Manuel Gato; Diogo, António Nunes

    2015-06-01

    Adult-onset Still's disease is a rare disorder with potentially severe clinical features, including cardiac involvement. This systemic inflammatory disease of unknown origin should be considered in the differential diagnosis of pericarditis, with or without pericardial effusion. Cardiac tamponade is a very rare sequela that requires an invasive approach, such as percutaneous or surgical pericardial drainage, in addition to the usual conservative therapy. The authors describe a case of adult-onset Still's disease rendered more difficult by pericarditis and cardiac tamponade, and they briefly review the literature on this entity.

  13. Rapid progression to cardiac tamponade in Erdheim-Chester disease despite treatment with interferon alpha.

    Science.gov (United States)

    Nakhleh, Afif; Slobodin, Gleb; Elias, Nizar; Bejar, Jacob; Odeh, Majed

    2016-07-01

    Erdheim-Chester disease (ECD) is a rare form of non-Langerhans histiocytosis with heterogeneous clinical manifestations. The most common presentation is bone pains typically involving the long bones. Approximately 75% of the patients develop extraskeletal involvement. Cardiac involvement is seen in up to 45% of the patients, and although, pericardial involvement is the most common cardiac pathology of this rare disease, cardiac tamponade due to ECD has been very rarely reported. We describe a case of a patient found to have ECD with multi-organ involvement and small pericardial effusion, which progressed to cardiac tamponade despite treatment with interferon alpha.

  14. Pericardial Fluid Analysis

    Science.gov (United States)

    ... Home Visit Global Sites Search Help? Pericardial Fluid Analysis Share this page: Was this page helpful? Formal name: Pericardial Fluid Analysis Related tests: Pleural Fluid Analysis , Peritoneal Fluid Analysis , ...

  15. Acute pericarditis with cardiac tamponade induced by pacemaker implantation.

    Science.gov (United States)

    Shingaki, Masami; Kobayashi, Yutaka; Suzuki, Haruo

    2015-11-01

    An 87-year-old woman was diagnosed with third-degree atrioventricular block and underwent pacemaker implantation. On postoperative day 12, she experienced cardiac tamponade that was suspected on computed tomography to be caused by lead perforation; therefore, we performed open-heart surgery. However, we could not identify a perforation site on the heart, and drained a 400-mL exudative pericardial effusion. Subsequently, we diagnosed the pericardial effusion as due to pericarditis induced by pacemaker implantation. It is sometimes difficult to distinguish pericarditis from pacemaker lead perforation, so both should be included in the differential diagnosis.

  16. A new scoring system for the triage of cardiac tamponade.

    Science.gov (United States)

    Imazio, Massimo; Adler, Yehuda; Ristić, Arsen D; Charron, Philippe

    2015-03-01

    Prompt recognition of cardiac tamponade is critical since the underlying hemodynamic disorder can lead to death if not resolved by percutaneous or surgical drainage of the pericardium. Nevertheless, the management of cardiac tamponade can be challenging because of the lack of the validated criteria for the risk stratification that should guide clinicians in the decision-making process. The Working Group on Myocardial and Pericardial Diseases issued this position statement in order to reply to specific questions: Which patients need immediate drainage of the pericardial effusion?; Is echocardiography sufficient for guidance of pericardiocentesis or should patient be taken to the cardiac catheterization laboratory?; Who should be transferred to specialized/tertiary institution or surgical service?; What type of medical support is necessary during transportation? Current European guidelines published in 2004 do not cover these issues and no additional guidelines are available from major medical and cardiology societies.

  17. Cardiac tamponade as initial presenting feature of primary hypothyroidism in the ED.

    Science.gov (United States)

    Ekka, Meera; Ali, Imran; Aggarwal, Praveen; Jamshed, Nayer

    2014-06-01

    Pericardial effusion is commonly detected in patients with severe hypothyroidism and is typically mild; rarely, it may lead to cardiac tamponade. Cardiac tamponade with myxedema coma as initial presenting feature of previously unrecognized hypothyroidism is rare. This case highlights that previously undiagnosed hypothyroidism can manifest as myxedema coma with shock due to pericardial tamponade particularly in winters because a cold environment can precipitate myxedema.We report an undiagnosed case of primary hypothyroidism who presented to the emergency department for the first time with both cardiac tamponade and myxedema coma. This combination of cardiac tamponade and myxedema coma as the presenting features of primary hypothyroidism has rarely been reported in the literature. The patient was effectively managed with echocardiography-guided pericardiocentesis, levothyroxine, and external rewarming. Cardiac tamponade and myxedema coma as presenting features of previously unrecognized primary hypothyroidism are extremely rare. Urgent bedside echocardiography with pericardiocentesis along with thyroxine therapy is the treatment of choice. It is important to include hypothyroidism as the differential diagnosis in patients with cardiac tamponade and altered level of consciousness especially in winter months.

  18. Diagnostic difficulties in a 32-year-old patient with recurrent cardiac tamponade; Trudnosci diagnostyczne u 32-letniego chorego z tamponada serca

    Energy Technology Data Exchange (ETDEWEB)

    Piwowarska, W.; Nessler, B.; Pietrzak, I.; Gajos, G.; Pfitzner, R.; Sadowski, J. [Inst. Kardiologii, Akademia Medyczna, Cracow (Poland); Krzemieniecki, K. [Instytut Onkologii, Cracow (Poland)

    1993-12-31

    At present the most frequent cause of cardiac tamponade is neoplasma. A case of a 32-year-old male with recurrent cardiac tamponade caused by pericardium mesothelioma is described. Despite advanced neoplastic process in the pericardium, pleura and mediastinum, neither radiological examinations of the chest, echocardiography, nor repeated cytological examination of the pericardial exudate, could establish the etiology of the tamponade. Only after a pericardial window had been performed was it possible to: 1) establish the diagnosis and introduce causal treatment; 2) prevent recurrence of the tamponade; 3) perform cytoreduction of the tumor. It seems that in cases of chronic exudative pericarditis of unknown cause it is proper to perform an early pericardial window as a diagnostic and therapeutic procedure. (author) 24 refs, 1 tab

  19. Cardiac tamponade mimicking tuberculous pericarditis as the initial presentation of chronic lymphocytic leukemia in a 58-year-old woman: a case report

    Directory of Open Access Journals (Sweden)

    Nathan Sandeep

    2010-08-01

    Full Text Available Abstract Introduction Chronic lymphocytic leukemia is an indolent disease that often presents with complaints of lymphadenopathy or is detected as an incidental laboratory finding. It is rarely considered in the differential diagnosis of patients presenting with tamponade or a large, bloody pericardial effusion. In patients without known cancer, a large, bloody pericardial effusion raises the possibility of tuberculosis, particularly in patients from endemic areas. However, the signs, symptoms and laboratory findings of pericarditis related to chronic lymphocytic leukemia can mimic tuberculosis. Case Presentation We report the case of a 58-year-old African American-Nigerian woman with a history of travel to Nigeria and a positive tuberculin skin test who presented with cardiac tamponade. She had a mild fever, lymphocytosis and a bloody pericardial effusion, but cultures and stains were negative for acid-fast bacteria. Assessment of blood by flow cytometry and pericardial biopsy by immunohistochemistry revealed CD5 (+ and CD20 (+ lymphocytes in both tissues, demonstrating this to be an unusual manifestation of early stage chronic lymphocytic leukemia. Conclusion Although most malignancies that involve the pericardium clinically manifest elsewhere before presenting with tamponade, this case illustrates the potential for early stage chronic lymphocytic leukemia to present as a large pericardial effusion with tamponade. Moreover, the presentation mimicked tuberculosis. This case also demonstrates that it is possible to treat chronic lymphocytic leukemia-related pericardial tamponade by removal of the fluid without chemotherapy.

  20. Acute Purulent Tuberculosis Pericarditis with Cardiac Tamponade: a Case Report.

    Directory of Open Access Journals (Sweden)

    F. Z. Benaich

    2015-12-01

    Full Text Available Tuberculosis is a disease caused by Mycobacterium tuberculosis. Pulmonary localization is the most frequent. However, pericardial including extra- pulmonary disease, can cause fatal complications. A 37 years old man , without pathological history , who consults for emergency mid-thoracic pain associated with dyspnea, preceded by 10 days before a febrile syndrome with night sweats. Clinical examination showed patient in poor general condition, dyspneic and tachycardia. Cardiovascular examination showed spontaneous jugular veins and painful hepatomegaly, auscultation showed muted heart sounds without pericardial friction and breathless. Chest radiography showed cardiomegaly with symmetric edge straightness, electrocardiogram showed sinus tachycardia at 125bpm, microvoltage and electric alternating QRS complexes. A diffuse ST elevation ascending .Diagnosis of tamponade is suspected, transthoracic echocardiography showed abundance circumferential pericardial effusion measuring 40mm, with prolonged collapse of the right atrium and right ventricle , paradoxical septum , and significant changes in the flow inspiration. Pericardiocentesis ultrasound-guided has allowed a gradual evacuation of 2 liters of a cloudy yellow pericardial fluid, slightly viscous. Direct examination revealed the presence of 14 400 white cells, 99 % are neutrophils with gram-negative bacilli. Research bacillus by PCR and culture in the middle of LOWENSTEIN, later returned negative. Biologically, it is an important infectious syndrome. Taking into account the epidemiological profile of the country, diagnosis tuberculous primary infection tamponade was certain. quadruple anti- tuberculous treatment associated to corticosteroid therapy is instituted, The outcome was good, the patient was asymptomatic, with complete remission, echocardiography control finds no signs suggesting chronic constrictive pericarditis.

  1. Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

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    Emeka B. Kesieme

    2016-01-01

    Full Text Available Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4% were between 31 and 40 years. Fourteen patients (43.8% presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4% presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p=0.004. Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

  2. Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting.

    Science.gov (United States)

    Kesieme, Emeka B; Okokhere, Peter O; Iruolagbe, Christopher Ojemiega; Odike, Angela; Owobu, Clifford; Akhigbe, Theophilus

    2016-01-01

    Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

  3. Fatal cardiac tamponade as the first manifestation of acute myeloid leukemia.

    Science.gov (United States)

    Leptidis, John; Aloizos, Stavros; Chlorokostas, Panagiotis; Gourgiotis, Stavros

    2014-10-01

    Acute myeloid leukemia is a hemopoietic myeloid stem cell neoplasm. It is the most common acute leukemia affecting adults,and its incidence increases with age. Acute myeloid leukemia is characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells. As the leukemic cells keep filling the bone marrow, symptoms of the disease started to appear: fatigue, bleeding, increased frequency of infections, and shortness of breath. Cardiac tamponade or pericardial tamponade is an acute medical condition in which the accumulation of pericardial fluid prevents the function of the heart. Signs and symptoms include Beck triad (hypotension, distended neck veins, and muffled heart sounds), paradoxus pulses, tachycardia, tachypnea, and breathlessness. Pericardial effusion and cardiac tamponade are rare and severe complications of leukemia; they often develop during the radiation therapy, chemotherapy, or infections in the course of leukemia. This study sought to assess the fatal cardiac tamponade as the first manifestation of acute myeloid leukemia (AML). We found no reports in the literature linking these 2 clinical entities. Although the patient had no signs or diagnosis of AML previously, this case was remarkable for the rapidly progressive symptoms and the fatal outcome. The pericardial effusion reaccumulated rapidly after its initial drainage; it is a possible explanation that the leukemic cells interfered with cardiac activity or that they decreased their contractility myocytes secreting a toxic essence.

  4. The curious case of a cardiac tamponade in the hypertensive patient presenting as abdominal fullness.

    Science.gov (United States)

    Li, William; Subedi, Rogin; Madhira, Bhaskara

    2017-01-19

    Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%). Initial vital signs revealed mild tachycardia, mild tachypnea and blood pressure elevated to 162/84mm Hg along with a temperature of 38.7°C and oxygen saturation of 96% on 2l by nasal cannula. She received the standard of care for a community acquired pneumonia and was started on treatment with decitabine as further work-up was unremarkable. An abdominal CT performed for abdominal fullness later displayed a large pericardial effusion. Repeat echocardiography exhibited right atrial diastolic collapse, inferior vena cava dilatation (IVC) without inspiratory collapse >50% and the large pericardial effusion consistent with tamponade. The blood pressure remained hypertensive until she suddenly went into cardiac arrest after being intubated for a pericardial window and expired. Our case highlights the need to keep cardiac tamponade as a differential in the hypertensive individual with abdominal complaints as atypical presentations can obscure diagnosis, delay treatment and increase mortality.

  5. Autotransfusion in the management of cardiac tamponade occurring during catheter ablation of atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    GAO Ling-yun; ZHANG Xin-yong; NING Man; MA Chang-sheng; TANG Ri-bo; DONG Jian-zeng; LIU Xing-peng; LONG De-yong; YU Rong-hui; JIANG Chen-xi; CHEN Gang; SANG Cai-hua

    2010-01-01

    @@ Acute cardiac tamponade occurs in 0.1%-2% of patients undergoing catheter ablation of atrial fibrillation (AF) in experienced centers. Once it is diagnosed, emergency pericardiocentesis is required.~5 With the intervention, sternotomy and open surgical repair can be avoided in the most patients.~6 Generally, pericardial blood is reinjected directly back into the patient through the femoral venous sheath in order to invert hemodynamic instability promptly. But direct retransfusion of pericardial blood carries the risks of air embolism, hemolysis or thromboembolism, etc. Autotransfusion has been widely used during major surgical procedures. As for autotransfusion in the management of acute cardiac tamponade, there has not been yet an agreement in clinical practice. Based on the treatment of four cases, this study demonstrates the advantages and indications of autotransfusion in the management of acute cardiac tamponade.

  6. Microvascular permeability changes might explain cardiac tamponade after alcohol septal ablation for hypertrophic cardiomyopathy.

    Science.gov (United States)

    Hsu, Jen-Te; Hsiao, Ju-Feng; Chang, Jung-Jung; Chung, Chang-Min; Chang, Shih-Tai; Pan, Kuo-Li

    2014-04-01

    Various sequelae of alcohol septal ablation for hypertrophic obstructive cardiomyopathy have been reported. Of note, some cases of cardiac tamponade after alcohol septal ablation cannot be well explained. We describe the case of a 78-year-old woman with hypertrophic obstructive cardiomyopathy in whom cardiac tamponade developed one hour after alcohol septal ablation, probably unrelated to mechanical trauma. At that time, we noted a substantial difference in the red blood cell-to-white blood cell ratio between the pericardial effusion (1,957.4) and the peripheral blood (728.3). In addition to presenting the patient's case, we speculate that a possible mechanism for acute tamponade--alcohol-induced changes in microvascular permeability--is a reasonable explanation for cases of alcohol septal ablation that are complicated by otherwise-unexplainable massive pericardial effusions.

  7. Cardiac tamponade as the first clinical sign of gastric adenocarcinoma: a rare condition.

    Science.gov (United States)

    Arısoy, Arif; Memiç, Kadriye; Karavelioğlu, Yusuf; Sen, Fatma

    2014-06-01

    Cardiac tamponade originating from a primary gastric cancer (GC) is a rare condition. Patients are generally asymptomatic until the disease is advanced. We report a rare patient with cardiac tamponade as the first manifestation of primary GC. A 46-year-old male was admitted with progressive dyspnea. Cardiac tamponade was diagnosed on two-dimensional ultrasonographic echocardiography. Pericardiocentesis yielded 1500 ml of bloody fluid. Pericardial cytologic examination was positive for malignant cells. The patient underwent abdominal computed tomography scan, which showed thickening of the gastric wall and several mesenteric lymph nodes. Endoscopic examination of the stomach disclosed malignant ulcer along the lesser curvature, and the biopsy showed diffuse type adenocarcinoma. Chemotherapy was initiated by the Oncology Department, and he had no pericardial effusion after six courses of systemic chemotherapy. In conclusion, this is a rare condition and difficult to diagnosis early. Thus, physicians should be aware of malignancy of the stomach when patients present with unexplained cardiac manifestations.

  8. Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography; Tamponamento cardiaco durante infusao de contraste em acesso venoso central para realizacao de tomografia computadorizada do torax em lactente

    Energy Technology Data Exchange (ETDEWEB)

    Daud, Danilo Felix; Campos, Marcos Menezes Freitas de; Fleury Neto, Augusto de Padua [Hospital Geral de Palmas, TO (Brazil)

    2013-11-15

    Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein. (author)

  9. Cardiac tamponade due to low-volume effusive constrictive pericarditis in a patient with uncontrolled type II autoimmune polyglandular syndrome.

    Science.gov (United States)

    Palmer, William C; Kurklinsky, Andrew; Lane, Gary; Ussavarungsi, Kamonpun; Blackshear, Joseph L

    2014-03-01

    Type II autoimmune polyglandular syndrome (APS), a relatively common endocrine disorder, includes primary adrenal insufficiency coupled with type 1 diabetes mellitus and/or autoimmune primary hypothyroidism. Autoimmune serositis, an associated disease, may present as symptomatic pericardial effusion. We present a case of a 54-year old male with APS who developed pericarditis leading to cardiac tamponade with a subacute loculated effusion. After urgent pericardiocentesis intrapericardial pressure dropped to 0, while central venous pressures remain elevated, consistent with acute effusive constrictive pericarditis. Contrast computerized tomography confirmed increased pericardial contrast enhancement. The patient recovered after prolonged inotropic support and glucocorticoid administration. He re-accumulated the effusion 16 days later, requiring repeat pericardiocentesis. Effusive-constrictive pericarditis, an uncommon pericardial syndrome, is characterized by simultaneous pericardial inflammation and tamponade. Prior cases of APS associated with cardiac tamponade despite low volumes of effusion have been reported, albeit without good demonstration of hemodynamic findings. We report a case of APS with recurrent pericardial effusion due to pericarditis and marked hypotension with comprehensive clinical and hemodynamic assessment. These patients may require aggressive support with pericardiocentesis, inotropes, and hormone replacement therapy. They should be followed closely for recurrent tamponade.

  10. Catheter-associated urinary tract infection: antimicrobial sensitivity profile

    Directory of Open Access Journals (Sweden)

    Silvana Kelie Souza de Almeida Barros

    2013-11-01

    Full Text Available This descriptive quantitative study aimed to analyze the prevalence of microorganisms and the antimicrobial sensitivity profile from urine cultures of patients with catheter-associated urinary tract infection. We reviewed 394 medical records of adults hospitalized in the Intensive Care Units of the University Hospital of Londrina, Paraná, Brazil, from April to December 2011. The prevalence of catheter-associated urinary tract infection was of 34.0% (134 and 2.2% (3 of these patients developed sepsis. The most common microorganisms found in the urine cultures were Candida sp (44.4%, Acinetobacter baumannii (9.7% and Pseudomonas aeruginosa (9.2%. This last one showed resistance of 86.7% to third-generation cephalosporins and the Acinetobacter baumannii showed resistance of 83.3% to carbapenems. Klebsiella pneumonia had 87.5% of resistance to third and fourth generation cephalosporins and 75.0% to carbapenems. We concluded that bacterial resistance is frequent in catheter-associated urinary tract infection and that we should emphasize the control measures.

  11. Fatal pericardial tamponade after superior vena cava stenting.

    NARCIS (Netherlands)

    Ploegmakers, M.J.M.; Rutten, M.J.C.M.

    2009-01-01

    We discuss a fatal complication of percutaneous superior vena cava (SVC) self-expandable stent placement in a patient with superior vena cava syndrome (SVCS). The SVCS was caused by a malignant mediastinal mass with total occlusion of the SVC. Twenty-four hours after the procedure, the patient died

  12. Right atrial tamponade complicating cardiac operation: clinical, hemodynamic, and scintigraphic correlates

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    Bateman, T.; Gray, R.; Chaux, A.; Lee, M.; De Robertis, M.; Berman, D.; Matloff, J.

    1982-09-01

    Persistent bleeding into the pericardial space in the early hours after cardiac operation not uncommonly results in cardiac tamponade. Single chamber tamponade also might be expected, since in this setting the pericardium frequently contains firm blood clots localized to the area of active bleeding. However, this complication has received very little attention in the surgical literature. We are therefore providing documentation that isolated right atrial tamponade can occur as a complication of cardiac operation and that there exists a potential for misdiagnosis and hence incorrect treatment of this condition. Right atrial tamponade may be recognized by a combination of low cardiac output, low blood pressure, prominent neck veins, right atrial pressure in excess of pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, and a poor response to plasma volume expansion. Findings on chest roentgenogram and gated wall motion scintigraphy may be highly suggestive. This review should serve to increase awareness of this complication and to provide some helpful diagnostic clues.

  13. Effect of pericardiocentesis on right and left ventricular function and volumes in pericardial effusion.

    Science.gov (United States)

    Manyari, D E; Kostuk, W J; Purves, P

    1983-07-01

    To assess the effects of pericardial effusion on ventricular performance and volumes, electrocardiographically gated blood pool cardiac scintigraphy was performed immediately before and after 14 pericardiocenteses in 10 patients, 7 men and 3 women, aged 28 to 73 years (mean 50). Cardiac tamponade was present in 5 patients. After removal of 140 to 1,100 ml of pericardial fluid (527 +/- 305 ml [mean +/- standard deviation]), left ventricular (LV) ejection fraction increased from 63 +/- 5 to 64 +/- 4% (p greater than 0.05) and right ventricular (RV) ejection fraction decreased from 47 +/- 4 to 46 +/- 2% (p greater than 0.05). LV end-diastolic and end-systolic volumes increased (p less than 0.01) by 28 and 33%, and RV volumes by 40 and 43%, respectively. There were 8 patients with normal LV function (ejection fraction greater than 60%) and 6 patients with subnormal LV function. Changes in ejection fraction were nonsignificant in the 4 subgroups. LV end-diastolic volume changes were more marked (p less than 0.01) in patients with cardiac tamponade (+ 56%) than in those without tamponade (+ 17%), and in those with normal LV function (+ 36%) than in those with subnormal LV function (+ 21%). RV end-diastolic volume increased more markedly (p less than 0.05) in patients with tamponade (+ 72%) than in those without tamponade (+ 23%), but were similar in patients with normal (+ 38%) and abnormal (+ 43%) LV function. After pericardiocentesis, RV volume increased more markedly than did LV volume. Thus, hemodynamic and clinical improvement after pericardiocentesis may be related only to an increase in stroke volume. RV and LV ejection fraction, a measure of myocardial contractility, was not affected significantly by the presence of pericardial effusion, even in those patients who had cardiac tamponade.

  14. Cardiac tamponade, an unusual complication of acute pancreatitis.

    Science.gov (United States)

    Veron Esquivel, Daniel; Aello, Gerardo; Batiz, Fernando; Fernandez Barrera, Alejandro

    2016-03-11

    A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

  15. Autopsy imaging for cardiac tamponade in a Thoroughbred foal

    Science.gov (United States)

    YAMADA, Kazutaka; SATO, Fumio; HORIUCHI, Noriyuki; HIGUCHI, Tohru; KOBAYASHI, Yoshiyasu; SASAKI, Naoki; NAMBO, Yasuo

    2016-01-01

    ABSTRACT Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death. PMID:27703406

  16. Survival after blunt left ventricular rupture with cardiac tamponade

    Institute of Scientific and Technical Information of China (English)

    Yu-Jang Su; Chang-Chih Chen

    2013-01-01

    A34-year-old man was drunk and drove to hit a traffic island.Cold sweating and unconscious status were found on arrival.Vital signs revealedBP42/25, and heart rate121/min.There was massive pericardial effusion with cardiac tamponade found byCT.Immediate surgical intervention and rupture of left ventricular(LV) free wall was found.He was discharged after2 d intensive care unit(ICU) observation and5-day regular ward care.There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around20%-36% in recent3 years.

  17. Autopsy imaging for cardiac tamponade in a Thoroughbred foal.

    Science.gov (United States)

    Yamada, Kazutaka; Sato, Fumio; Horiuchi, Noriyuki; Higuchi, Tohru; Kobayashi, Yoshiyasu; Sasaki, Naoki; Nambo, Yasuo

    2016-01-01

    Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conventional necropsy are considered to complement each other. The cause of death was determined to be traumatic cardiac tamponade. In conclusion, Ai is an additional option for determining cause of death.

  18. Survival after blunt left ventricular rupture with cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2013-01-01

    Full Text Available A 34-year-old man was drunk and drove to hit a traffic island. Cold sweating and unconscious status were found on arrival. Vital signs revealed BP 42/25, and heart rate 121/min. There was massive pericardial effusion with cardiac tamponade found by CT. Immediate surgical intervention and rupture of left ventricular (LV free wall was found. He was discharged after 2 d intensive care unit (ICU observation and 5-day regular ward care. There is high mortality rate in traumatic heart rupture although timely repair, over all mortality is around 20%-36% in recent 3 years.

  19. Cardiac tamponade as a presenting manifestation of Sheehan syndrome.

    Science.gov (United States)

    Alexander, Varkey; Chattopadhyay, Arijit; Yasin, Khalid; Kurian, Thomas T

    2008-01-01

    We report a 38-year-old Syrian woman who presented with progressive breathlessness, hypotension and circulatory collapse. Echocardiogram revealed a large pericardial effusion with evidence of cardiac tamponade. There was a history of secondary amenorrhoea, loss of axillary and pubic hair following childbirth at 28 years of age. Investigations revealed low levels of gonadotrophins, oestrogen, prolactin and thyrotrophin but normal levels of basal and post-synacthen (ACTH) cortisol. An MRI of the sella showed atrophic changes of the pituitary. She was treated with intravenous fluids, dopamine infusion, intravenous hydrocortisone and thyroxine replacement. The clinical suspicion of Sheehan syndrome facilitated early administration of corticosteroids, adequate thyroxine replacement and rapid resolution of pericardial effusion.

  20. Etiology, diagnosis and management of severe pericardial effusion: A single center experience

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    Mehmet Aytürk

    2014-12-01

    Full Text Available Objective: To show etiology, diagnostic methods, and treatment options of patients with severe pericardial effusion determined after echocardiography. Methods: In this study, we retrospectively analyzed etiology, diagnosis and treatment options of 43 patients with severe pericardial effusions (i.e. effusions more than 20 mm either in front of the right ventricle or posterior to left ventricle as assessed by transthoracic echocardiography. The pericardiocentesis procedures were performed via subxiphoid approach. Glucose, protein, lactate dehydrogenase levels, polymerase chain reaction for tuberculosis, cytological, microbiological examinations and cultures were obtained from pericardial fluid. Results: Cardiac tamponade was diagnosed in 23 patients (54% and pericardiocentesis was immediately performed in these cases. Twenty patients who were unresponsive to empirical treatment, underwent pericardiocentesis to evaluate etiology and treatment.. Pericardial fluid was found to be exudate in 36 patients (83.7% and transudate in 7 patients (16.2%. The most common causes were malignancy (26%, and uremia (16% while idiopathic cases constituted 23% of the patient group. While malignant pericardial effusion was more common in males, idiopathic etiology and uremia were more common in female patients. Conclusion: Pericardiocentesis is the gold standard for clarifying the etiology and is also a lifesaving measure for cardiac tamponade. Delineating the specific etiology is particularly important for cases that do not respond to empirical treatment. A thorough history and physical examination, together with pericardiocentesis in selected cases will enable the accurate diagnosis of specific etiology and starting the treatment for this etiology.

  1. Cardiac tamponade leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): a case report and review of the literature.

    Science.gov (United States)

    Yano, Toshiyuki; Ishimura, Shutaro; Furukawa, Tetsuaki; Koyama, Masayuki; Tanaka, Marenao; Shimoshige, Shinya; Hashimoto, Akiyoshi; Miura, Tetsuji

    2015-11-01

    Eosinophilic granulomatosis with polyangiitis (EGPA), which was previously called Churg-Strauss syndrome, is a necrotizing systemic vasculitis of unknown cause accompanied by prominent eosinophilia. Cardiovascular complications, including eosinophilic myocarditis, are a major cause of mortality in this disorder. Acute pericarditis with slight pericardial effusion is a typical manifestation in EGPA, though hemodynamically significant pericardial effusion has been reported in a few cases. We report a case that initially presented with isolated cardiac tamponade, which was followed by systemic manifestations of EGPA over 3 weeks. Including the present case, previous EGPA cases with cardiac tamponade are reviewed to delineate its clinical characteristics.

  2. Cardiac tamponade following liver transplantation after intrapericardial control of the suprahepatic vena cava.

    Science.gov (United States)

    Xu, Junming; Hong, Johnny C; Busuttil, Ronald W

    2015-03-01

    Transabdominal intrapericardial control of the suprahepatic inferior vena cava (SIVC) is a rather uncommon procedure occasionally required in conjunction with complicated liver transplantation (LT) and hepatobiliary surgery. Experience with this technique is limited. Here we report 6 cases of LT in which transabdominal intrapericardial control of the SIVC was necessary. After institutional review board approval was obtained, a single-center, retrospective review was conducted from January 1991 to December 2013 to identify adult cases (age > 18 years) of LT in which transabdominal intrapericardial isolation of the SIVC was necessary. Among 4102 adult LT cases in the study period, 6 such cases were identified. To gain access to the pericardial space, a 6- to 9-cm vertical incision was made above the SIVC. After reperfusion, the diaphragmatic incision was partially closed and selectively drained. Pericardial tamponade developed in 1 patient, and it necessitated emergent reoperation and widespread drainage. In conclusion, transabdominal intrapericardial isolation of the SIVC is easily achieved without the need for a separate thoracic incision. However, to be effective, the pericardial incision should be only partially closed, and the pericardial sac should be drained liberally. Such patients should be carefully monitored for signs and symptoms of pericardial tamponade, the development of which should prompt an immediate return to the operating room for emergent decompression and widespread drainage.

  3. Benign giant mediastinal schwannoma presenting as cardiac tamponade in a woman: a case report

    Directory of Open Access Journals (Sweden)

    Sekiya Mitsuaki

    2011-02-01

    Full Text Available Abstract Introduction Mediastinal schwannomas are typically benign and asymptomatic, and generally present no immediate risks. We encountered a rare case of a giant benign posterior mediastinal schwannoma, complicated by life-threatening cardiac tamponade. Case presentation We report the case of a 72-year-old Japanese woman, who presented with cardiogenic shock. Computed tomography of the chest revealed a posterior mediastinal mass 150 cm in diameter, with pericardial effusion. The cardiac tamponade was treated with prompt pericardial fluid drainage. A biopsy was taken from the mass, and after histological examination, it was diagnosed as a benign schwannoma, a well-encapsulated non-infiltrating tumor, originating from the intrathoracic vagus nerve. It was successfully excised, restoring normal cardiac function. Conclusion Our case suggests that giant mediastinal schwannomas, although generally benign and asymptomatic, should be excised upon discovery to prevent the development of life-threatening cardiopulmonary complications.

  4. [Transoperative tamponade due to perforation with a catheter for central blood pressure: report and case analysis].

    Science.gov (United States)

    González-Arrieta, María Leonor; Grajales-y Marín, Nicolás; Martínez-Huerta, Mónica Alejandra; Rendón-Arroyo, María Elena; Rodríguez-Coria, Darío Francisco

    2006-01-01

    Pericardial tamponade due to myocardial perforation from central venous catheter is rather unusual, especially if it happens during a trans-operative period. When it comes up, it has a high mortality risk if the pericardial fluid is not drained at the proper time. At the Oncology Hospital of the National Medical Center, IMSS, Mexico City (Hospital de Oncología del Centro Médico Nacional, Siglo XXI), at the Anesthesia Service, a case of tamponade in transoperative period came up, after a surgical procedure that lasted more than 6 hours, and that manifested itself with signs of cardiogenic shock that did not improve with treatment. The etiology was not diagnosed until a postmortem study. If it had been diagnosed on time, its clinical evolution would have been different with an opportune and correct treatment.

  5. [Late tamponade after heart surgery: a dreadful diagnostic pitfall].

    Science.gov (United States)

    Glock, Y F; Herreros, J; Tejeira, F J

    1983-05-01

    In a series of 250 consecutive open-heart operations, three cases of late cardiac tamponade were noted following the operation. This led the authors to review the literature pertaining to this complication. Ninety-nine cases were collected. The frequency of late tamponade associated with cardiac surgery was 0.62% and was fatal in 16.2% of those cases. The delay before the tamponade appeared varied from 3 days to 3 months (mean 14.5 +/- 7.8 days). The initial clinical picture is insidious and vague, and this constitutes the danger of late cardiac tamponade. The clinical signs are of the respiratory (dyspnea, chest pain), gastrointestinal (anorexia, vomiting) and central nervous (mental confusion, even coma) systems. Pallor with a drop in hematocrit in patients on anticoagulant therapy suggests occult bleeding. A definitive diagnosis depends on catheterization of the right side and on mono- and bidimensional echocardiography. The authors believe that computerized axial tomography represents an interesting noninvasive and reliable examination technique when it can be used during emergency treatment. Pericardial puncture, which is both a diagnostic and therapeutic technique, was useful in one third of the cases; it produced a false-negative result in 12%. The resulting differential diagnoses are pulmonary embolism, myocardial insufficiency and septic shock. Late cardiac tamponade may be produced by one of two mechanisms: hemopericardium due to overdosage of anticoagulants or an exacerbated form of the post-pericardiotomy syndrome. Emergency treatment is always necessary. Pericardiocentesis is a useful diagnostic aid and provides temporary stabilization preoperatively. A wide surgical approach is always indicated. The mortality in untreated patients is 100%. The frequency of immediate relapse or, occasionally, of delayed relapse is estimated to be 11%; relapse may be lethal.

  6. Chylopericardium with symptoms of tamponade on the grounds of extensive neck vein thrombosis

    Science.gov (United States)

    Nardini, Marco; Katsogridakis, Emmanuel; Migliore, Marcello; Dunning, Joel

    2017-01-01

    Chylopericardium is a recognized complication of thoracic trauma, surgery or malignancy. Idiopathic or primary presentations, however, are rarely encountered in clinical practice. The severity of its presentation varies from the complete absence of symptoms to cardiac tamponade. We present the case of a 23-year-old woman with chylopericardium and extensive neck vein thrombosis that was managed surgically with a pericardial window. PMID:28122899

  7. Large pericardial effusion as a complication in adults undergoing SCT.

    Science.gov (United States)

    Norkin, M; Ratanatharathorn, V; Ayash, L; Abidi, M H; Al-Kadhimi, Z; Lum, L G; Uberti, J P

    2011-10-01

    Large pericardial effusion (LPE) leading to cardiac tamponade is a rare complication described in patients undergoing SCT. This complication is considered to be a manifestation of chronic GVHD; however its pathophysiology is poorly understood. Currently, there are no published data systematically describing the incidence, clinical characteristics and outcomes of LPEs in adult stem cell transplant recipients. We retrospectively evaluated 858 adult patients (512 autologous, 148 related and 198 unrelated donor) who underwent hematopoietic stem cell and BM transplants at our institution from 2005 to 2008 for the development of post transplant LPE. Seven patients (0.8%) were found to have LPEs and all these patients had undergone unrelated allografts. The median day of diagnosis post transplant was 229 (range 42-525). None of these patients had active manifestations of GVHD other than serositis at the time of LPE detection. Pericardial window (PW) was successfully placed in all patients who developed cardiac tamponade and most patients with LPE were effectively treated by increasing immunosuppression. We conclude that LPE is a rare late complication after allogeneic transplant in adults and in our study developed only after unrelated transplant. PW can be safely performed in these patients and LPEs can be successfully treated with intensification of systemic immunosupression.

  8. Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

    Science.gov (United States)

    Lekkham, Rapeepat; Climaco, Antoinette

    2017-01-01

    Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired. PMID:28316844

  9. Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis

    Energy Technology Data Exchange (ETDEWEB)

    Posner, M.R.; Cohen, G.I.; Skarin, A.T.

    1981-09-01

    Pericardial disease developed in 31 patients with a variety of malignancies. Half of the patients (58 percent) were found to have malignant pericardial involvement, 32 percent idiopathic pericarditis and 10 percent radiation-related pericarditis. Facial swelling, cardiac arrhythmias and pericardial tamponade occurred frequently in the patients with malignant pericardial disease. Fever, pericardial friction rub and improvement with nonsteroidal anti-inflammatory drugs characterized the patients with idiopathic pericarditis. Effusive-constrictive pericarditis requiring pericardiectomy was noted in patients with radiation-induced disease. Pericardiocentesis documented malignant pericardial disease in 85 percent of patients studied, while 15 percent required open biopsy for diagnosis. Specific therapy directed at malignant pericardial disease may contribute to survival up to one year in 25 percent of patients. In 40 percent of patients with idiopathic pericarditis and in the majority of patients with radiation-induced pericarditis, survival was one year with specific therapy. A systematic evaluation of pericardial disease will benefit a subset of cancer patients with idiopathic pericarditis and radiation-induced pericarditis who can be managed conservatively.

  10. The pericardial reflection and the tip of the central venous catheter - topographical analysis in stillborn babies

    Energy Technology Data Exchange (ETDEWEB)

    Eifinger, Frank; Vierzig, Anne; Roth, Bernhard [University Children' s Hospital, Department of Pediatric Critical Care Medicine and Neonatology, Cologne (Germany); Scaal, Martin [University of Cologne, Institute of Anatomy II, Cologne (Germany); Koerber, Friederike [University of Cologne, Department of Radiology, Cologne (Germany)

    2016-10-15

    Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium. To investigate the level of the superior pericardial reflection in stillborn babies. We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium. Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5). The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space. (orig.)

  11. Cardiac tamponade arising from a venous source following anterograde dissection re-entry coronary angioplasty to a chronic total occlusion.

    Science.gov (United States)

    Danson, E; Arena, F; Sapontis, J; Ward, M; Bhindi, R

    2016-10-01

    Cardiac tamponade is a rare complication of coronary intervention to chronic total occlusions (CTO PCI). We report a case of persistent bleeding from a venous source following successful anterograde dissection-reentry (ADR) CTO PCI. Pericardiocentesis was performed 1 h post-procedure for tamponade. Persistent bleeding was investigated with contrast transesophageal echocardiography, pericardial manometry and blood analysis. Coronary venography revealed subtle extravasation from a cardiac vein adjacent to the site of luminal re-entry. Coronary venous perforation using ADR CTO PCI has not previously been described; however, the volume of blood loss may be significant and surgical exploration may be appropriate.

  12. Resistance of catheter-associated urinary tract infections to antibacterials

    Directory of Open Access Journals (Sweden)

    Verhaz Antonija

    2005-01-01

    Full Text Available Introduction. Catheter-associated urinary tract infections (CAUTI are the most common nosocomial infections. The worldwide data show the increasing resistance to conventional antibiotics among urinary tract pathogens. Aim. To evaluate the adequacy of initial antimicrobial therapy in relation to the antimicrobial resistance of pathogens responsible for CAUTI in Clinical Center of Banja Luka. Methods. A retrospective study on major causes of CAUTI, antibiotic resistance and treatment principles was conducted at four departments of the Clinical Center of Banja Luka from January 1st, 2000 to April 1st, 2003. Results. The results showed that 265 patients had developed CAUTI. The seven most commonly isolated microorganisms were, in descending order: E. coli (31.0%, Pseudomonas aeruginosa (13.8%, Proteus mirabilis (12.9%, Gr. Klebsiella-Enterobacter (12.3%, Enterococcus spp. (5.2%, Pseudomonas spp. (4.3%, Serratia spp. (4.0%. The most common pathogens were highly resistant to ampicillin (64−100%, gentamycin (63−100%, and trimethoprim-sulfamethoxazole (68−100%, while some bacterias, like Pseudomonas aeruginosa and Serratia spp. showed rates of ciprofloxacin resistance as high as 42.8% and 72.7%, respectively. In 55.5% of the cases, the initial antibiotic therapy was inadequate, and was corrected latter on. There were no standard therapeutic protocols for this type of nosocomial infections. Conclusion. The results of this study emphasized an urgency of the prevention and introduction of clinical protocols for better management of CAUTI. Treatment principles should better correspond to the antibiotic sensitivity of uropathogens.

  13. Cardiac Tamponade as a Presenting Manifestation of Infliximab-Induced Lupus in Patient Treated for Crohn’s Disease

    Science.gov (United States)

    Kulairi, Zain; Kam, Michael

    2017-01-01

    Crohn’s disease is characterized by inflammation of the mucosal lining of the gastrointestinal tract. Infliximab is a tumor necrosis factor-α inhibitor that has been associated with increased remission and decreased disease flare-ups. Biological agents such as infliximab have been associated with adverse events. We present a rare case of cardiac tamponade caused by infliximab treatment for Crohn’s disease in a 30-year-old female. She was treated with emergent pericardial window and drainage of pericardial fluid. Infliximab was discontinued, and serositis was treated with steroids. The patient was later successfully rechallenged with vedolizumab. PMID:28138445

  14. MRI and intraocular tamponade media

    Energy Technology Data Exchange (ETDEWEB)

    Manfre, I. (Dept. of Neuroradiology, Inst. of Neurosurgery, Univ. of Catania (Italy)); Fabbri, G. (Dept. of Neuroradiology, Inst. of Neurosurgery, Univ. of Catania (Italy)); Avitabile, T. (Inst. of Ophthalmology, Univ. of Catania (Italy)); Biondi, P. (Inst. of Ophthalmology, Univ. of Catania (Italy)); Reibaldi, A. (Inst. of Ophthalmology, Univ. of Catania (Italy)); Pero, G. (Dept. of Neuroradiology, Inst. of Neurosurgery, Univ. of Catania (Italy))

    1993-05-01

    Thirteen patients who underwent surgery for retinal detachment and injection of intraocular tamponade media (silicone oil, flurosilicone oil, or perfluoro-carbon liquid) underwent magnetic resonance imaging (MRI), using spin-echo T1- and T2-weighted images. The ophthalmic tamponade media showed different signal intensity, according to their chemical structure. Unlike ophthalmoscopy or ultrasonography, MRI showed no oil-related artefact, making possible recognition of recurrent retinal detachment. (orig.)

  15. 超声心动图介入心包置管在延迟性心脏压迫中的应用(附64例报告)%Clinical Analysis of Pericardial Sac Drainage in Guidance with Echocardiography for Late Cardiac Tamponade(64 Cases Report)

    Institute of Scientific and Technical Information of China (English)

    徐新华

    2005-01-01

    目的探讨超声心动图介入心包腔直接置管引流对延迟性心脏压迫(late cardiac tamponade, LCT)患者的治疗效果. 方法 LCT患者64例,行二维超声引导下心包腔直接置管引流.结果穿刺成功率为100%,心包内置管引流15 h~4个月,治疗效果满意. 结论二维超声引导下施行心包穿刺置管引流能有效缓解症状,成功率高,可替代传统穿刺方法.

  16. An unusual case of non-small-cell lung cancer presenting as spontaneous cardiac tamponade.

    Science.gov (United States)

    Joseph, Sarah; Al-Khalisy, Hassan; Randhawa, Umair; Lazar, John; Peroutka, Kathryn

    2016-04-01

    Hemorrhagic pericardial effusion with associated cardiac tamponade as a de novo sign of malignancy is seen in about 2% of patients.1 Consequently, cardiac tamponade is an oncologic emergency and considered a unique presentation of a malignancy.2 Cancer emergency is defined as an acute condition that is caused directly by the cancer itself or its treatment and requires intervention to avoid death or significant morbidity.3 The mechanism by which cardiac tamponade is classified as a life-threatening emergency stems from its impairment of right ventricular filling, resulting in ventricular diastolic collapse and decreased cardiac output, which can ultimately lead to death.4 We describe the case of a previously healthy woman in her late 40s who was a nonsmoker with no previous risk factors and who presented with a large pericardial effusion and bilateral pulmonary emboli. She was diagnosed with metastatic epidermal growth factor receptor-positive (EGFR-positive) adenocarcinoma of the lung. This case highlights an oncologic emergency as a de novo presentation of malignancy.

  17. A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis.

    Science.gov (United States)

    Yousuf, Tariq; Kramer, Jason; Kopiec, Adam; Bulwa, Zachary; Sanyal, Shuvani; Ziffra, Jeffrey

    2015-09-01

    Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain. Echocardiography revealed borderline normal left ventricular function and a large pericardial effusion with the finding of elevated intrapericardial pressure suspicious for cardiac tamponade. Infectious workup was all found to be negative. The presence and elevation of anti-cyclic citrullinated peptide antibody, rheumatoid factor and C-reactive protein (CRP) confirmed the patient was having an active flare-up of RA. It was determined that this flare-up was the cause of the cardiac tamponade. A pericardiocentesis was performed and 850 mL of bloody fluid was drained. The patient remained stable following the pericardiocentesis. At his follow-up visit, repeat echocardiogram showed no signs for pericardial effusion. Although there has been extensive study of RA, there are only a few documented cases noting the occurrence of cardiac tamponade in these patients. Therefore, it is important for the clinician to be aware of and recognize this potentially serious cardiac outcome associated with a common rheumatologic condition.

  18. Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy

    Directory of Open Access Journals (Sweden)

    Bob T. Li

    2014-12-01

    Full Text Available Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients.

  19. [Pericardial effusion and pleural serositis in patients with severe preeclampsia and HELLP syndrome].

    Science.gov (United States)

    Quiroz, María Nayeli Salas; Rodríguez, Héctor Xavier Alfaro; Lara, Daniel S Zúñiga

    2009-11-01

    The syndrome pre-eclampsia/eclampsia is a frequent entity in the obstetrical pathology and acquires interest to take to the patients to a critical state. It has repercussion in all the organism by his complications. The definitive treatment of pre-eclampsia/eclampsia is the interruption of the pregnancy. The pericardial effussion as severe complication of pre-eclampsia and Sx de HELLP is a little frequent entity. Few cases reported in Literature exists. In the Hospital Angeles Pedregal, two cases of patients embarrassed without antecedents of previous picture hypertensive, complicated are reported with severe pre-eclampsia and HELLP syndrome class II of Martin which developed pericardial effussion without presence of tamponade. The knowledge of the behavior of this cardiovascular complication as well as the multidisciplinary and integral handling, are without a doubt the best form to modify the evolution and to avoid the appearance of tamponade. The acute pericardial effussion can get to mean a medical urgency that puts in danger the life. Mainly when the intrapericardic pressure so is lifted that the heart is compressed and the diastolic pressures ventricular lefts and right are increased and in the absence of preexisting cardiac pathology, these pressures get to equal itself. This complication little frequents must be had in mind like more of the haemodynamic complications.

  20. Cardiac tamponade 7 years after radiotherapy in a child with Hodgkin's disease

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Minoru; Horibe, Keizo; Miyajima, Yuji; Matsumoto, Kimikazu; Goto, Masahiko; Nishibata, Kenji; Nagashima, Masami (Nagoya Univ. (Japan). Faculty of Medicine); Tauchi, Akira

    1994-11-01

    A 12-year-old boy with massive pericardial effusion which developed 7 years after radiotherapy was reported. In May 1986, he had stage I Hodgkin's disease of the right axillary lymph nodes. He received 40 Gy mantle field radiotherapy without chemotherapy following complete resection of the tumor. Seven years later, he was admitted with symptoms of dyspnea and facial edema. Chest X-ray films showed pleural effusion and echocardiography showed cardiac tamponade. Cytologic examinations of the pleural and pericardial effusion, computed tomography of chest, and gallium scintigraphy showed no signs of malignancy. He was diagnosed as suffering from acute pericarditis and cardiac tamponade, most likely due to radiotherapy. Following initial improvement by pericardiocentesis, dyspnea reappeared with an increase in pericardial effusion. The effusion subsided in response to prednisolone following the second pericadiocentesis. Although pericarditis following radiotherapy is rarely reported in Japan, partly because of the low incidence of Hodgkin's disease, it should be emphasized as a major sequela of radiotherapy. (author).

  1. Pericardial effusion in celiac disease

    Directory of Open Access Journals (Sweden)

    Farzaneh Ashrafi

    2014-01-01

    Full Text Available Celiac disease is an autoimmune disorder that affected 1% of all population in United State. Classic manifestations of disease consist of early childhood diarrhea, malabsorption, steatorrhea and growth retardation but disease can affects adult at any age. In adult anemia is a more frequent finding. This patient was a 40-year-old lady with progressive fatigue and lower extremities pitting edema. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging. After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease.

  2. How to diagnose cardiac tamponade

    NARCIS (Netherlands)

    van Steijn, JHM; Sleijfer, DT; van der Graaf, WTA; van der Sluis, A; Nieboer, P

    2002-01-01

    Malignant pericardial effusion is a potentially fatal complication of malignancy unless recognised and treated promptly. Patients with this condition are often difficult to diagnose. Physical examination, chest radiography and electrocardiography have poor diagnostic values in identification of pati

  3. Tuberculous pericarditis presenting as multiple free floating masses in pericardial effusion.

    Science.gov (United States)

    Yoon, Shin-Ae; Hahn, Youn-Soo; Hong, Jong Myeon; Lee, Ok-Jun; Han, Heon-Seok

    2012-03-01

    Pericarditis is a rare manifestation of tuberculosis (Tb) in children. A 14-yr-old Korean boy presented with cardiac tamponade during treatment of pulmonary tuberculosis. He developed worsening anemia and persistent fever in spite of anti-tuberculosis medications. Echocardiography found free floating multiple discoid masses in the pericardial effusion. The masses and exudates were removed by pericardiostomy. The masses were composed of pink, amorphous meshwork of threads admixed with degenerated red blood cells and leukocytes with numerous acid-fast bacilli, which were confirmed as Mycobacterium species by polymerase chain reaction. The persistent fever and anemia were controlled after pericardiostomy. This is the report of a unique manifestation of Tb pericarditis as free floating masses in the effusion with impending tamponade.

  4. Hemorrhagic cardiac tamponade after percutaneous laser ablation of a liver metastasis in segment II

    Institute of Scientific and Technical Information of China (English)

    Paola Tombesi; Francesca Di Vece; Silvia Rinaldi; Matteo Bertini; Sergio Sartori

    2016-01-01

    Despite percutaneous laser thermal ablation (LTA) of liver tumors being regarded as a safe technique, major complications can occur. We report the ifrst case of hemorrhagic cardiac tamponade after LTA of a colorectal metastasis in segment II of the liver. Unpredictable heat diffusion causing indirect thermal injury to the pericardium with resultant hemorrhagic reaction was hypothesized as the most likely cause of tamponade. A pericardial drain was emergently placed, 200 mL of bright red blood were drained, and the patient showed rapid hemodynamic improvement. For lesions located in segment II of the liver and strictly close to the pericardium, a careful risk/beneift analysis should be made by the multidisciplinary team to identify the best treatment option, taking into account both effectiveness and complications of each available technique.

  5. Hashimoto thyroiditis with an unusual presentation of cardiac tamponade in Noonan syndrome.

    Science.gov (United States)

    Lee, Mi Ji; Kim, Byung Young; Ma, Jae Sook; Choi, Young Earl; Kim, Young Ok; Cho, Hwa Jin; Kim, Chan Jong

    2016-11-01

    Noonan syndrome is an autosomal dominant, multisystem disorder. Autoimmune thyroiditis with hypothyroidism is an infrequent feature in patients with Noonan syndrome. A 16-year-old boy was admitted because of chest discomfort and dyspnea; an echocardiogram revealed pericardial effusion. Additional investigations led to a diagnosis of severe hypothyroidism due to Hashimoto thyroiditis. The patient was treated with L-thyroxine at 0.15 mg daily. However, during admission, he developed symptoms of cardiac tamponade. Closed pericardiostomy was performed, after which the patient's chest discomfort improved, and his vital signs stabilized. Herein, we report a case of an adolescent with Noonan syndrome, who was diagnosed with Hashimoto thyroiditis with an unusual presentation of cardiac tamponade.

  6. Cardiac tamponade secondary to perforation of innominate vein following central line insertion in a neonate

    Directory of Open Access Journals (Sweden)

    Ramkumar Dhanasekaran

    2014-01-01

    Full Text Available Cardiac tamponade following central line in a neonate is rare and an uncommon situation; however, it is potentially reversible when it is diagnosed in time. We report a case of cardiac tamponade following central line insertion. A 10-day-old 2.2 kg girl operated for obstructed total anomalous pulmonary venous connections had neckline slipped out during extubation. Attempted cannulations of right femoral vein were unsuccessful. At the end of the left internal jugular vein cannulaton, there was a sudden cardiorespiratory arrest. Immediate transthoracic echocardiogram showed left pleural and pericardial collection. Chest was opened and the catheter tip was seen in the thoracic cavity after puncturing the innominate vein. The catheter was removed and the vent was repaired.

  7. Reducing catheter-associated urinary tract infections in a neuro-spine intensive care unit.

    Science.gov (United States)

    Schelling, Kimberly; Palamone, Janet; Thomas, Kathryn; Naidech, Andrew; Silkaitis, Christina; Henry, Jennifer; Bolon, Maureen; Zembower, Teresa R

    2015-08-01

    A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.18 to 0.93 per 1,000 catheter-days and standardized infection ratio decreased from 2.16 to 0.37.

  8. Primary Right Atrial Sarcoma Presenting with Cardiac Tamponade and Massive Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Shahram Momtahen

    2016-07-01

    Full Text Available Primary cardiac sarcomas are very rare and there is no consensus on management. Clinical presentation is usually late. Despite newer diagnostic technology, prognosis remains dismal. We report a case of right atrial sarcoma in a 28-year-old man who presented with acute cardiac tamponade. Emergency subxiphoid pericardial drainage stabilized the patient's critical condition. The lesion was advanced. Therefore, we only performed a suboptimal surgical resection. Despite planning for radiation, the patient's status deteriorated. Only palliative measures continued during the next four months before his death due to disseminated metastasis and progressive cardiopulmonary failure.

  9. Bacterial Pericarditis Accompanied by Sudden Cardiac Tamponade After Transbronchial Needle Aspiration Cytology.

    Science.gov (United States)

    Matsumoto, Takeshi; Otsuka, Kojiro; Imai, Yukihiro; Tomii, Keisuke

    2016-04-01

    A 48-year-old man was referred for an abnormal shadow in his chest x-ray. Transbronchial needle aspiration cytology was performed at the mediastinal necrotic lymph node #7, and he was diagnosed as having small cell carcinoma. Fifteen days after bronchoscopy, sudden cardiac tamponade occurred and pericardial drainage suggested a diagnosis of bacterial pericarditis. He was successfully treated by drainage and administration of antibiotics. Complication of bacterial pericarditis associated with bronchoscopy is rare. However, physicians should watch for the appearance of this condition for up to 3 weeks after bronchoscopy, especially in cases with necrotic lymph nodes.

  10. Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

    Science.gov (United States)

    Rimpau, C.; Nickel, C. H.; Baier, P.

    2017-01-01

    The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient's survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes. PMID:28255471

  11. Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

    Directory of Open Access Journals (Sweden)

    M. Kirsch

    2017-01-01

    Full Text Available The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.

  12. PERICARDIAL DIVERTICULUM WITH UNUSUAL SYMPTOMATOLOGY

    NARCIS (Netherlands)

    WATERBOLK, TW; HENKENS, CAM; REMMERT, DG; VANDERJAGT, EJ; POSTMUS, PE

    1991-01-01

    A healthy 37 yr old female presented with recurrent right-sided chest pain which spontaneously disappeared. On a chest roentgenogram a lesion in the right cardiophrenic angle was found. Magnetic resonance imaging suggested a cystic structure. During thoracotomy a pericardial diverticulum was found.

  13. Açık Kalp Cerrahisi Sonrası Kanama Ve/Veya Tamponad Nedeniyle Erken Dönemde Acil Yapılan Revizyonlar.

    OpenAIRE

    Fansa, İyad; Acıpayam, Mehmet; Lale, Cem

    2015-01-01

    Aim: After open heart surgery in patients with hemodynamic instability due to bleeding and / or pericardial tamponade interventions must be done without losing time. Although urgent revision rate vary according to clinical to clinical. More than 80 % of cases is due to the bleeding. Here we want to offer patients where we take urgent revision. Materials and Methods: Between January 2013 and June 2014, 123 open heart surgery is performed by two surgeons. 9 patients (7.3 %) (one female, eight m...

  14. [The clinical practice guidelines of the Sociedad Española de Cardiología on pericardial pathology].

    Science.gov (United States)

    Sagristá Sauleda, J; Almenar Bonet, L; Angel Ferrer, J; Bardají Ruiz, A; Bosch Genover, X; Guindo Soldevila, J; Mercé Klein, J; Permanyer Miralda, C; Tello de Meneses Becerra, R

    2000-03-01

    The pericardium is a serous membrane consisting of two layers (parietal and visceral), which may be involved by different infectious, physical, traumatic, or inflammatory agents as well as in metabolic or systemic diseases. The reactions of the pericardium to these insults result in rather nonspecific clinical features, such as the characteristic inflammatory findings in acute pericarditis, the development of pericardial effusion with the possible complication of cardiac tamponade, and a fibrous retractile reaction that may lead to constrictive pericarditis. These phenomena are not mutually exclusive and can be simultaneous or consecutive in the same patient; however, for the sake of clarity they are independently discussed. The aim of the present guidelines is to provide orientation about the management of patients with pericardial disease. Such management should basically rest on the knowledge of the clinical and epidemiological features (such as disease frequency) of the different types of pericardial disease that determine the diagnostic and therapeutic yield of the different invasive pericardial procedures (pericardiocentesis, pericardial biopsy and pericardiectomy), and, therefore, their respective indications. In addition, the indication of the different types of medical therapy are discussed. On the other hand, emphasis is made on the possible limitation of the validity of these guidelines for patients belonging to geographical areas or socioeconomic contexts with different etiologic spectra.

  15. Rare Purulent Cardiac Tamponade Caused by Streptococcus Constellatus in a Young Immunocompetent Patient: Case Report and Review of the Literature.

    Science.gov (United States)

    Hindi, Zakaria

    2016-11-16

    BACKGROUND Purulent pericardial tamponade is a very rare occurrence in the current era of widespread antibiotic use. It is even rarer when caused by Streptococcus constellatus: a microorganism usually classified among the normal flora of the human body. It is occasionally diagnosed with certain predisposing factors. CASE REPORT We present the third case of Streptococcus constellatus cardiac tamponade reported in the current medical literature, occurring in a previously healthy young man who was initially admitted and treated for possible community-acquired pneumonia. The patient required immediate subxyphoid pericardiocentesis. He was also treated successfully with a lengthy course of both intravenous and oral antibiotics. Two months post-hospitalization, he was confirmed clinically stable with complete resolution of his purulent effusion. We also conducted a review of the literature for all Streptococcus milleri group purulent pericardial infections between 1984 and 2015. CONCLUSIONS Purulent cardiac tamponade caused by Streptococcus constellatus is extremely rare. It can be life threatening, however. Early appropriate diagnosis and therapeutic intervention are critical for a good outcome.

  16. Over-diuresis or cardiac tamponade? An unusual case of acute kidney injury and early closure

    Directory of Open Access Journals (Sweden)

    Gurkeerat Singh

    2016-04-01

    Full Text Available An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressures but was otherwise normal. He improved with diuretic therapy but after a few days was found to be hypotensive with a concomitant rise in creatinine with decreased urine output. This was felt to be secondary to over-diuresis but he did not respond to small boluses of intravenous fluids as his kidney function continued to worsen and hypotension persisted. He was transferred to the intermediate care unit where a rapid, bedside ultrasound revealed a new, moderate-sized pericardial effusion with tamponade physiology. Pericardiocentesis, with removal of 750 cc of frank blood, led to dramatic improvement in blood pressure, kidney function, and urine output. Here, we demonstrate the utility of point-of-care ultrasound in a community hospital setting where urgent echocardiogram is not routinely available. We also report acute kidney injury due to pericardial tamponade reversed with therapeutic pericardiocentesis.

  17. Generation of a central nervous system catheter-associated infection in mice with Staphylococcus epidermidis.

    Science.gov (United States)

    Snowden, Jessica N

    2014-01-01

    Animal models are valuable tools for investigating the in vivo pathogenesis of Staphylococcus epidermidis infections. Here, we present the procedure for generating a central nervous system catheter-associated infection in a mouse, to model the central nervous system shunt infections that frequently complicate the treatment of hydrocephalus in humans. This model uses stereotactic guidance to place silicone catheters, pre-coated with S. epidermidis, into the lateral ventricles of mice. This results in a catheter-associated infection in the brain, with concomitant illness and inflammation. This animal model is a valuable tool for evaluating the pathogenesis of bacterial infection in the central nervous system, the immune response to these infections and potential treatment options.

  18. Enterobacter cloacae multidrug-resistant: a case report of nosocomial urinary catheter-associated infection

    Directory of Open Access Journals (Sweden)

    Dino De Conno

    2008-12-01

    Full Text Available Enterobacter species, particularly E. cloacae and E. aerogenes, are important nosocomial pathogenes responsible for various infections.We report a 70-y-old patient with catheter-associated urinary tract infection (UTI caused by a nosocomial Enterobacter cloacae with multidrug-resistance.The identification of isolates from clinical culture and the study of pattern antimicrobial susceptibility were performed to the clinical risolution of the patient’s disease.The initial empirical antimicrobial therapy resulted ineffective.

  19. Video-Assisted Thoracoscopic Pericardial Window in the Treatment of Pericardial Effusion: Report of Two Cases

    OpenAIRE

    2013-01-01

    A 54-year-old man had a history of subxiphoid pericardial window due to suspected tuberculous effusions. Seventeen years later, following chronic heart failure and implantation of a pacemaker, he again developed pericardial and pleural effusion, requiring repeated percutaneous pericardiocentesis, pleurocentesis and chest tube drainage. A 5×5-cm section of pericardium was successfully resected with video-assisted thoracic pericardial window. No recurrence of pericardial effusion has since been...

  20. Coexistent transient pulmonary edema and pericardial effusion

    Energy Technology Data Exchange (ETDEWEB)

    Newman, B.; Oh, K.S.; Park, S.C.

    1988-09-01

    Eight (23%) of 35 children with acute pericardial effusions due to infection or juvenile rheumatoid arthritis (JRA) had associated transient pulmonary edema demonstrated on plain chest radiographs. The presence or absence of radiographic pulmonary edema correlated well with clinical and hemodynamic parameters in patients with JRA but not in those with infectious pericarditis. There was no definite relationship between radiographic edema and amount of pericardial fluid as estimated echocardiographically or removed at pericardiocentesis. Rapidity of pericardial fluid accumulation could not be assessed in this study. Children of young age with underlying JRA were the most likely subjects to have radiographic pulmonary edema in conjunction with an acute pericardial effusion.

  1. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Bateman, T.M.; Czer, L.S.; Gray, R.J.; Kass, R.M.; Raymond, M.J.; Garcia, E.V.; Chaux, A.; Matloff, J.M.; Berman, D.S.

    1984-11-01

    Pericardial or mediastinal hemorrhage requiring reoperation occurs in 2% to 5% of patients, usually early (0 to 48 hours), after open-heart surgery. This hemorrhage may be occult, and resulting cardiac tamponade may easily be misinterpreted as ventricular dysfunction, common early postoperatively. In such cases, appropriate and timely intervention may not occur. Of 50 patients evaluated by technetium-99m red blood cell gated equilibrium radionuclide ventriculography (RNV) because of early postoperative cardiogenic shock of uncertain etiology, 17 had unique scintigraphic images suggestive of intrathoracic hemorrhage. Of these 17, 5 had a generalized halo of abnormal radioactivity surrounding small hyperdynamic right and left ventricles, 11 had localized regions of intense blood pool activity outside the cardiac chambers (two with compression of single chambers), and one demonstrated marked radionuclide activity in the right hemithorax (2000 ml of blood at reoperation). Twelve patients had exploratory reoperation for control of hemorrhage as a direct result of the scintigraphic findings, three were successfully treated with fresh frozen plasma and platelet infusions along with medical interventions to optimize cardiac performance, and two patients died in cardiogenic shock (presumed tamponade) without reoperation. In the 12 reoperated patients, all were confirmed to have active pericardial bleeding. Scintigraphic localization of abnormal blood pools within the pericardium corresponded to the sites at which active bleeding was witnessed at reoperation. The abnormal bleeding was etiologically related to the tamponade state, with marked improvement in hemodynamics after reoperation. Nine additional patients were reoperated for presumed tamponade after RNV revealed an exaggerated halo of photon deficiency surrounding the cardiac chambers.

  2. [Morgagni hernia causing cardiac tamponade].

    Science.gov (United States)

    S Breinig; Paranon, S; Le Mandat, A; Galinier, P; Dulac, Y; Acar, P

    2010-10-01

    Morgagni hernia is a rare malformation (3% of diaphragmatic hernias). This hernia is usually asymptomatic in children. We report on a case revealed by an unusual complication. Severe cyanosis was due to right-to-left atrial shunt through the foramen ovale assessed by 2D echocardiography. Diagnosis of the Morgagni hernia was made with CT scan. The intrathoracic liver compressed the right chambers of the heart causing tamponade. Cardiac compression was reversed after surgery and replacement of the liver in the abdomen. Six months after the surgery, the infant was symptom-free with normal size right chambers of the heart.

  3. Haemostasis with fibrin glue injection into the pericardial space for right ventricular perforation caused by an iatrogenic procedural complication.

    Science.gov (United States)

    Arai, Hirofumi; Miyamoto, Takamichi; Hara, Nobuhiro; Obayashi, Tohru

    2016-05-17

    An 89-year-old woman with severe aortic valve stenosis and bradycardia presented with circulatory shock due to cardiac tamponade. We performed pericardiocentesis, and then diagnosed right ventricular perforation by echocardiography with microcavitation contrast medium just before inserting a drainage tube. We then inserted the drainage tube in the appropriate position and withdrew blood-filled fluid. The patient was haemodynamically stabilised, but haemorrhage from the perforation site continued for a few days. We injected fibrin glue into the pericardial space through the drainage tube and achieved haemostasis. Thus, we avoided surgery to close the perforation in this high-risk patient. There was no recurrence of haemorrhage. She subsequently had elective aortic valve replacement at another hospital. No adhesions in the pericardial space were seen during surgery.

  4. Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function.

    Science.gov (United States)

    Minai, Kosuke; Komukai, Kimiaki; Arase, Satoshi; Nagoshi, Tomohisa; Matsuo, Seiichiro; Ogawa, Kazuo; Kayama, Yosuke; Inada, Keiichi; Tanigawa, Shin-Ichi; Takemoto, Tomoyuki; Sekiyama, Hiroshi; Date, Taro; Ogawa, Takayuki; Taniguchi, Ikuo; Yoshimura, Michihiro

    2013-07-01

    Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.

  5. 第2例:慢性持续性大量心包积液%Chronic continuous massive pericardial effusion

    Institute of Scientific and Technical Information of China (English)

    黄樱硕; 孙颖; 邢云利; 肖瑶; 王宇朋; 唐梅; 李敏; 王翠英

    2012-01-01

    A 77-year-old man was admitted to our hospital at July 5th,2010 with an unexplained massive pericardial effusion for 10 years.With dyspnea for one month and normal vital signs without pulsus paradoxus,other physical examination included a small amount of moist rale,normal heart sounds,jugular vein engorgement,positive hepatojugular reflux,hepatosplenomegaly and pitting edema of the extremities.The patient had a complex past history with lymph node tuberculosis,primary artertial hypertension,polycythernia vera,chronic renal insufficiency and hypothyroidism (Hashimoto's thyroiditis),and moreover,received a high dose radiation of 31p in 1967. Family history is negative.The patient had no cardiac tamponade or pericardial constriction during 10 years,he received pericardiocentesis twice,and pericardial effusion was exudative with a high proportion of monocyte.There was no evidences of tuberculosis infection,hypothyroidism,malignant tumor,severe heart failure,uremia,trauma,severe bacterial or fungus infection,chronic myeloid leukemia or bone marrow fibrosis during the admission. The patient refused anti tuberculosis,indwelling catheter drainage or surgical therapy.In this rare case,the aetiology of chronic massive pericardial effusion is most probably chronic idiopathic recurrent pericarditis.

  6. Neoplastic pericardial disease. Analysis of 26 patients

    Directory of Open Access Journals (Sweden)

    Helena Nogueira Soufen

    1999-01-01

    Full Text Available PURPOSE: To characterize patients with neoplastic pericardial disease diagnosed by clinical presentation, complementary test findings, and the histological type of tumor. METHODS: Twenty-six patients with neoplastic pericardial disease were retrospectively analyzed. RESULTS: Clinical manifestations and abnormalities in chest roentgenograms and electrocardiograms were frequent, but were not specific. Most patients underwent surgery. There was a high positivity of the pericardial biopsy when associated with the cytological analysis of the pericardial liquid used to determine the histological type of the tumor, particularly when the procedure was performed with the aid of pericardioscopy. CONCLUSION: The correct diagnosis of neoplastic pericardial disease involves suspicious but nonspecific findings during clinical examination and in screen tests. The suspicious findings must be confirmed through more invasive diagnostic approaches, in particular pericardioscopy with biopsy and cytological study.

  7. Delayed recurrent pericarditis complicated by pericardial effusion and cardiac tamponade in a blunt trauma patient

    OpenAIRE

    Khidir, Hazar H.; Bloom, Jordan P; Hawkins, Alexander T.

    2015-01-01

    A 19-year-old male suffered orthopedic fractures, blunt solid organ injury and pneumopericardium after a fall from 40 feet. With the exception of an external fixation device, he was managed non-operatively and discharged to a rehabilitation unit after 8 days. He was readmitted 4 days later with chest pain and clinical evidence of pericardititis that resolved with the initiation of non-steroidal anti-inflammatory drugs and colchicine. He returned to the rehabilitation hospital, but was readmit...

  8. Medical image of the week: malignant pericardial effusion and cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Yun S

    2014-06-01

    Full Text Available No abstract available. Article truncated after 150 words. A 53 year old woman with history of metastatic breast cancer presented to the emergency department (ED with worsening shortness of breath for 2 weeks. She was initially diagnosed with grade III breast intraductal carcinoma was estrogen receptor, progesterone receptor, and HER2 negative 5 years earlier. A lumpectomy was performed followed by 4 cycles of chemotherapy with cyclophosphamide and taxol as well as radiation therapy. However, follow-up CT and MRI and subsequent biopsy demonstrated metastatic disease in the left adrenal gland, right ovary, and mediastinal lymph nodes, for which additional chemotherapy was started a month prior to presentation. In the ED, the patient was tachycardic and tachypneic. Vital signs showed BP 112/94 mmHg, HR 118 /min, RR 28 /min, temperature 97.5 °F, and SpO2 97 % with room air. EKG showed sinus tachycardia, low QRS voltage with electric alternans (Figure 1, and chest x-ray demonstrated cardiomegaly with a water bottle ...

  9. Pericardial abscess occurring after tuberculous pericarditis: image morphology on computed tomography and magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gulati, G.S.; Sharma, S. E-mail: meetisv@vsnl.commeetisv@yahoo.com

    2004-06-01

    AIM: To study the image morphology on computed tomography (CT) and magnetic resonance imaging (MRI) of pericardial abscess, an uncommon complication of tuberculous pericarditis. MATERIAL AND METHODS: In a 9-year period, 120 patients with clinical and imaging features of constrictive pericarditis were retrospectively reviewed. Of them, 13 patients (age range, 1-51 years; seven females, six males), who had a pericardial mass on echocardiography, and were subjected to CT (11 patients) and MRI (7 patients), were included as subjects of the present study. Five patients underwent both the investigations. The intra-lesional morphology, location, extent, mass effect on adjacent cardiac chambers, secondary effects on the atria and venae cavae, and pericardial thickness were studied. Histopathological confirmation of tubercular infection was available in nine patients. In the remaining four patients, the diagnosis was based on typical extra-cardiac manifestations of tuberculosis. RESULTS: A total of 15 abscesses were detected. CT showed a lesion with a hypodense core and an enhancing rim in all patients. On spin-echo T1-weighted MRI, 57% of the paients had a lesion with a hyperintense core, suggesting an exudative process. Seventy-one percent of patients showed a lesion with a hyperintense core on T2-weighted MRI, while one lesion was hypointense. Post-gadolinium MRI was performed in two patients and showed an enhancing rim in both, with enhancing septa in one. The predominant site of involvement was in the right atrioventricular (AV) groove (77%). Localized tamponade, suggested by the presence of mass effect on an adjacent cardiac chamber, was noted in nine (69%) cases, with proximal atrial dilatation in 78% of them. Four other patients (31%) had atrial dilatation without a localized mass effect. CONCLUSION: Pericardial abscess is an uncommon complication of constrictive pericarditis. Tuberculosis was responsible for abscess formation in all cases in this study. The

  10. Large pericardial effusion :a clinical dilemma!

    Science.gov (United States)

    Ramalingam, Rangaraj; Kadako, Nitinkumar S; Pati, Shivanand; Manjunath, C N

    2013-07-01

    A 55yr old gentleman known diabetic and hypertensive presented with breathlessness and tingling sensation of both upper and lower limbs with strong family history of similar neurological problems. On extensive evaluation he was found to have amyloidic peripheral neuropathy with large pericardial effusion. Tubercular etiology was confirmed by pericardial fluid PCR and culture. Here the diagnostic dilemma was whether Amloidosis is primary, secondary to Tubercular pericardial effusion or Hereditary Amyloidosis. In the end, how we have arrived at the diagnosis of Hereditary Amyloidosis based upon the strong family history and nerve biopsy is interestingly presented in the following case report.

  11. Etiological diagnosis of pericardial effusion.

    Science.gov (United States)

    Levy, Pierre-Yves; Habib, Gilbert; Collart, Fréderic; Lepidi, Hubert; Raoult, Didier

    2006-08-01

    Detection and treatment of pericarditis remains a challenging problem and the etiology is unknown in 40-85% of cases. As a result, a large proportion of cases are labeled idiopathic pericarditis. The advent of echocardiography, an accurate noninvasive method for the detection of effusion, has clarified the definition from pericarditis to pericardial effusion, which is a standardized and clear entity. A systematic approach to diagnostic testing based on standardized practice guidelines has been proposed. This strategy has led to a decrease in the number of cases classified as idiopathic and to the identification of treatable conditions. Percutaneous pericardiocentesis, guided by fluoroscopy or echocardiography, can now be carried out safely and rapidly and has also allowed the intrapericardial instillation of drugs, representing a new treatment strategy. The inclusion of flexible pericardioscopy, immunohistochemistry and contemporary molecular biology tools has improved the diagnostic value of the biopsy.

  12. Myopericarditis with predominantly right ventricular involvement with normal B-type natriuretic peptide and cardiac tamponade as the initial manifestation of systemic lupus erythematosus.

    Science.gov (United States)

    Manautou, Luis; Jerjes-Sanchez, Carlos; Meraz, Manuel; Perez-Garcia, Luis F; Diaz-Cid, Antonio; de la Peña-Almaguer, Erasmo; Avila, Cesar; Sanchez, Luis

    2014-08-01

    A previously healthy young man presented with a 12-hour history of sudden dyspnea and severe chest pain at rest. Initial findings of physical examination, electrocardiogram and chest radiography showed typical pericarditis and clinical instability. Echocardiogram revealed small pericardial effusion with right ventricle dilatation. The patient was admitted in the ICU; a new echocardiogram revealed moderate pericardial effusion and diagnosis of pericarditis complicated with acute cardiac tamponade was established. The patient transiently improved after pericardial window. In the following hours, the diagnosis of myocarditis with predominantly right ventricular involvement (MPRVI) with severe right heart failure was supported by clinical, chest radiography and echocardiogram data, despite normal B-type natriuretic peptide. On day 2, cardiac troponin I detection was observed. By day 3, B-type natriuretic peptide in the range of ventricular dysfunction was identified. Cardiovascular magnetic resonance findings supported the diagnosis of MPRVI. A systematic MEDLINE/PubMed from 1993 to 2013 does not identify any cases of MPRVI related to systemic lupus erythematosus. Simultaneous acute MPRVI with normal B-type natriuretic peptide and acute cardiac tamponade heralding the diagnosis of systemic lupus erythematosus, to the best of our knowledge, has not been previously described.

  13. The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

    Directory of Open Access Journals (Sweden)

    Sezai Çelik

    2014-03-01

    Full Text Available Objective: Pericardial effusion potentially cause significant morbidity and mortality. Pericardial window by video-assisted thoracic surgery (VATS, subxiphoid and minithoracotomy is available surgical treatment options. The aim of this study is to determine the efficacy and outcome of the three different methods for surgical management of symptomatic pericardial effusions. Methods: A retrospective study of patients operated for pericardial effusion between October 2007 to December 2011 at Dr. Siyami Ersek Hospital were divided into three groups according to surgical treatment d: Group 1 (VATS, n=24, Group 2 (Subxiphoid, n=28 Group 3 (Minithoracotomy, n=36. The groups were analyzed and compared using demographic information, operative and postoperative details and course, recurrence, follow-up data, morbidity, mortality and survival. Results: A total of 88 patients (37 women, 51 men, with mean age 54.47±16.81 underwent pericardial window were included in the study. The groups had similar perioperative characteristics except sex distribution and etiology. VATS, Subxiphoid and minithoracotomy pericardial window were well tolerated by patients, resulted in similar rates of mortality, 30-day mortality, overall postoperative complications, recurrence rates and survival. Operative time was significantly shorter in group 3 (p0.05. Group 2 had a significantly higher lenght of hospital stay (p<0.05. Conclusion: Minithoracotomy pericardial window provides rapid and definitive diagnosis and treatment for pericardial effusions of all causes acceptable morbidity rates. On the other hand, VATS and subxiphoid pericardial window should be performed in selected cases.

  14. Pericardial synovial sarcoma: challenges in diagnosis and management [v2; ref status: indexed, http://f1000r.es/329

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    Prajakta Phatak

    2014-03-01

    Full Text Available Introduction: Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. Case: A 27-year-old man presented with dyspnea and cough of three weeks duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the tumor to be a monophasic synovial sarcoma. Fluorescent in-situ hybridization (FISH was positive for SS18 (SYT gene rearrangement on chromosome 18q11, substantiating the diagnosis. Work-up for metastases was negative. Neo-adjuvant chemotherapy with high dose ifosfamide led to substantial reduction in the size of the tumor. The patient underwent surgical resection and external beam radiation therapy (EBRT post surgery. He had symptom-free survival for 8 months prior to local recurrence. This was managed with left lung upper lobectomy and follow-up chemotherapy with docetaxel. The patient is currently stable with an acceptable functional status. Conclusion: In patients with pericardial effusions of unknown etiology, multiple modalities of cardiac imaging must be employed if there is suspicion of a pericardial mass. CT and magnetic resonance imaging (MRI are useful to evaluate for pericardial thickening or masses in addition to TTE. Treatment of synovial

  15. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade.

    OpenAIRE

    Purwosunu, Y; Sarkoen, W; Arulkumaran, S; Segnitz, J

    2016-01-01

    BACKGROUND: Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Vacuum-induced uterine tamponade is a possible alternative approach to balloon tamponade systems for the treatment of postpartum hemorrhage resulting from atony. METHOD: In a prospective proof-of-concept investigation of 10 women with vaginal deliveries in a hospital setting who failed first-line therapies for postpartum hemorrhage, tamponade was used. Vacuum-induced uterine tamponade was created through a...

  16. A case of tuberculous pericardial effusion.

    Science.gov (United States)

    Suman, Appukuttan; Sarin, Jawahar L; Grant, Simon C; Bazaraa, Talal A

    2003-07-01

    We report a case of an 80-year-old caucasian female in the UK who presented with weight loss and was found to have a pericardial effusion. There was neither previous exposure to tuberculosis nor any suggestion of immunosuppression. Repeated analysis of pericardial fluid established a tuberculous origin. Search of medical literature did not reveal any similar cases in the elderly in the UK.

  17. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade.

    Science.gov (United States)

    Nakagawa, Eiichiro; Abe, Yukio; Komatsu, Ryushi; Naruko, Takahiko; Itoh, Akira

    2015-10-01

    Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.

  18. Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation.

    Science.gov (United States)

    Yetter, Elizabeth; Brazg, Jared; Del Valle, Diane; Mulvey, Laura; Dickman, Eitan

    2016-11-17

    Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT. Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain. Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2]. Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].

  19. Long-term heavy silicone oil intraocular tamponade.

    Science.gov (United States)

    Dooley, Ian J; Duignan, Emma S; Kilmartin, Dara J

    2016-02-01

    Heavy silicone oil tamponade is intended to be temporary, but may occasionally be indefinite in patients who refuse, or are deemed unsuitable for, further surgery. The aim of this study is to compare the outcomes of patients with temporary versus indefinite heavy silicone oil intraocular tamponade. This retrospective, comparative case series identified 75 patients who underwent heavy silicone oil instillation (Oxane HD) over a 6 year period (2006-2012) in one institution. Thirty-nine patients had temporary heavy oil tamponade and 36 patients had indefinite tamponade. The majority (68 %) of patients had a history of previous vitreoretinal surgery prior to oil instillation and 66.7 % had pre-existing proliferative vitreoretinopathy (PVR). The mean final logMAR best corrected visual acuity (BCVA) was significantly better in the temporary tamponade group (1.34 ± 0.66) than the indefinite tamponade group 1.82 ± 0.64 (p = 0.003). Ambulatory BCVA (≥ 4/200) was retained in 76.3 % of temporary tamponade patients versus 54.3 % of indefinite tamponade patients (p = 0.093). Successful retinal reattachment was significantly more likely in temporary tamponade patients (92.3 %) than indefinite tamponade patients (75 %; p = 0.04). Complications in the patients with indefinite heavy silicone oil tamponade included redetachment (38.9 %), corneal pathology (13.8 %), secondary glaucoma (11.1 %) and anterior segment emulsification (8.3 %).While temporary tamponade patients had better outcomes than those with indefinite tamponade, the majority of indefinite tamponade patients still retained ambulatory vision in the affected eye. Indefinite heavy silicone oil tamponade remains a viable option for those who cannot undergo removal of oil surgery.

  20. Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

    Science.gov (United States)

    Greene, M Todd; Ratz, David; Meddings, Jennifer; Fakih, Mohamad G; Saint, Sanjay

    2016-04-01

    The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections.

  1. Cardiac Tamponade Associated with the Presentation of Anaplastic Large Cell Lymphoma in a 2-Year-Old Child

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    Gema Mira-Perceval Juan

    2015-01-01

    Full Text Available The anaplastic large cell lymphoma is a rare entity in pediatric patients. We present an unusual case of pericardial involvement, quite uncommon as extranodal presentation of this type of disorder, that provoked a life-risk situation requiring an urgent pericardiocentesis. To our knowledge, this is the first report on a child with pericardial involvement without an associated cardiac mass secondary to anaplastic large cell lymphoma in pediatric age. We report the case of a 21-month-old Caucasian male infant with cardiac tamponade associated with the presentation of anaplastic large cell lymphoma. Initially, the child presented with 24-day prolonged fever syndrome, cutaneous lesions associated with hepatomegaly, inguinal adenopathies, and pneumonia. After a 21-day asymptomatic period, polypnea and tachycardia were detected in a clinical check-up. Chest X-ray revealed a remarkable increase of the cardiothoracic index. The anaplastic large cell lymphoma has a high incidence of extranodal involvement but myocardial or pericardial involvements are rare. For this reason, we recommend a close monitoring of patients with a differential diagnosis of anaplastic large cell lymphoma.

  2. Unusual cause of pyopericardium with tamponade

    OpenAIRE

    Gowrinath K; Phani Krishna B; Raghavendra C; Sai Ravi Shankar A

    2015-01-01

    Acute pyopericardium due to tuberculosis is uncommon even in high prevalence countries. We report an unusual case of acute pyopericardium with cardiac tamponade complicating tuberculosis pneumonia of lingula in an adult. Prompt catheter drainage of pyopericardium under echocardiographic guidance and six month course of anti-tuberculosis treatment resulted in complete recovery without any sequelae during the follow-up period of ten months.

  3. Virulence factors in Proteus bacteria from biofilm communities of catheter-associated urinary tract infections.

    Science.gov (United States)

    Hola, Veronika; Peroutkova, Tereza; Ruzicka, Filip

    2012-07-01

    More than 40% of nosocomial infections are those of the urinary tract, most of these occurring in catheterized patients. Bacterial colonization of the urinary tract and catheters results not only in infection, but also various complications, such as blockage of catheters with crystalline deposits of bacterial origin, generation of gravels and pyelonephritis. The diversity of the biofilm microbial community increases with duration of catheter emplacement. One of the most important pathogens in this regard is Proteus mirabilis. The aims of this study were to identify and assess particular virulence factors present in catheter-associated urinary tract infection (CAUTI) isolates, their correlation and linkages: three types of motility (swarming, swimming and twitching), the ability to swarm over urinary catheters, biofilm production in two types of media, urease production and adherence of bacterial cells to various types of urinary tract catheters. We examined 102 CAUTI isolates and 50 isolates taken from stool samples of healthy people. Among the microorganisms isolated from urinary catheters, significant differences were found in biofilm-forming ability and the swarming motility. In comparison with the control group, the microorganisms isolated from urinary catheters showed a wider spectrum of virulence factors. The virulence factors (twitching motility, swimming motility, swarming over various types of catheters and biofilm formation) were also more intensively expressed.

  4. Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    Flores-Mireles, Ana L.; Walker, Jennifer N.; Potretzke, Aaron; Schreiber, Henry L.; Pinkner, Jerome S.; Bauman, Tyler M.; Park, Alyssa M.; Desai, Alana

    2016-01-01

    ABSTRACT Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI), a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD), the Ebp pilus’s adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE), revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro. Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI. PMID:27795399

  5. Impact of polymicrobial biofilms in catheter-associated urinary tract infections.

    Science.gov (United States)

    Azevedo, Andreia S; Almeida, Carina; Melo, Luís F; Azevedo, Nuno F

    2016-12-30

    Recent reports have demonstrated that most biofilms involved in catheter-associated urinary tract infections are polymicrobial communities, with pathogenic microorganisms (e.g. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and uncommon microorganisms (e.g. Delftia tsuruhatensis, Achromobacter xylosoxidans) frequently co-inhabiting the same urinary catheter. However, little is known about the interactions that occur between different microorganisms and how they impact biofilm formation and infection outcome. This lack of knowledge affects CAUTIs management as uncommon bacteria action can, for instance, influence the rate at which pathogens adhere and grow, as well as affect the overall biofilm resistance to antibiotics. Another relevant aspect is the understanding of factors that drive a single pathogenic bacterium to become prevalent in a polymicrobial community and subsequently cause infection. In this review, a general overview about the IMDs-associated biofilm infections is provided, with an emphasis on the pathophysiology and the microbiome composition of CAUTIs. Based on the available literature, it is clear that more research about the microbiome interaction, mechanisms of biofilm formation and of antimicrobial tolerance of the polymicrobial consortium are required to better understand and treat these infections.

  6. Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Ana L. Flores-Mireles

    2016-10-01

    Full Text Available Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI, a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD, the Ebp pilus’s adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE, revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro. Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI.

  7. Development of a Phage Cocktail to Control Proteus mirabilis Catheter-associated Urinary Tract Infections

    Science.gov (United States)

    Melo, Luís D. R.; Veiga, Patrícia; Cerca, Nuno; Kropinski, Andrew M.; Almeida, Carina; Azeredo, Joana; Sillankorva, Sanna

    2016-01-01

    Proteus mirabilis is an enterobacterium that causes catheter-associated urinary tract infections (CAUTIs) due to its ability to colonize and form crystalline biofilms on the catheters surface. CAUTIs are very difficult to treat, since biofilm structures are highly tolerant to antibiotics. Phages have been used widely to control a diversity of bacterial species, however, a limited number of phages for P. mirabilis have been isolated and studied. Here we report the isolation of two novel virulent phages, the podovirus vB_PmiP_5460 and the myovirus vB_PmiM_5461, which are able to target, respectively, 16 of the 26 and all the Proteus strains tested in this study. Both phages have been characterized thoroughly and sequencing data revealed no traces of genes associated with lysogeny. To further evaluate the phages’ ability to prevent catheter’s colonization by Proteus, the phages adherence to silicone surfaces was assessed. Further tests in phage-coated catheters using a dynamic biofilm model simulating CAUTIs, have shown a significant reduction of P. mirabilis biofilm formation up to 168 h of catheterization. These results highlight the potential usefulness of the two isolated phages for the prevention of surface colonization by this bacterium. PMID:27446059

  8. Oral bacterial DNA findings in pericardial fluid

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    Anne-Mari Louhelainen

    2014-11-01

    Full Text Available Background: We recently reported that large amounts of oral bacterial DNA can be found in thrombus aspirates of myocardial infarction patients. Some case reports describe bacterial findings in pericardial fluid, mostly done with conventional culturing and a few with PCR; in purulent pericarditis, nevertheless, bacterial PCR has not been used as a diagnostic method before. Objective: To find out whether bacterial DNA can be measured in the pericardial fluid and if it correlates with pathologic–anatomic findings linked to cardiovascular diseases. Methods: Twenty-two pericardial aspirates were collected aseptically prior to forensic autopsy at Tampere University Hospital during 2009–2010. Of the autopsies, 10 (45.5% were free of coronary artery disease (CAD, 7 (31.8% had mild and 5 (22.7% had severe CAD. Bacterial DNA amounts were determined using real-time quantitative PCR with specific primers and probes for all bacterial strains associated with endodontic disease (Streptococcus mitis group, Streptococcus anginosus group, Staphylococcus aureus/Staphylococcus epidermidis, Prevotella intermedia, Parvimonas micra and periodontal disease (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Fusobacterium nucleatus, and Dialister pneumosintes. Results: Of 22 cases, 14 (63.6% were positive for endodontic and 8 (36.4% for periodontal-disease-associated bacteria. Only one case was positive for bacterial culturing. There was a statistically significant association between the relative amount of bacterial DNA in the pericardial fluid and the severity of CAD (p=0.035. Conclusions: Oral bacterial DNA was detectable in pericardial fluid and an association between the severity of CAD and the total amount of bacterial DNA in pericardial fluid was found, suggesting that this kind of measurement might be useful for clinical purposes.

  9. Giant pericardial cyst mimicking dextrocardia on chest X-ray.

    Science.gov (United States)

    Hamad, Hamad M; Galrinho, Ana; Abreu, João; Valente, Bruno; Bakero, Luis; Ferreira, Rui C

    2013-01-01

    Pericardial cysts are rare benign congenital malformations, usually small, asymptomatic and detected incidentally on chest X-ray as a mass located in the right costophrenic angle. Giant pericardial cysts are very uncommon and produce symptoms by compressing adjacent structures. In this report, the authors present a case of a symptomatic giant pericardial cyst incorrectly diagnosed as dextrocardia on chest X-ray.

  10. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    Science.gov (United States)

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  11. MICROBIAL FLORA AND RISK FACTORS ASSOCIATED WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS

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    Ravi Prakash

    2015-05-01

    Full Text Available INTRODUCTION: Catheter associated Urinary Tract Infection (UTI represent the most common type of nosocomial infection and is a major health concern due to its complications and frequent recurrence. Among the nosocomial infections UTI contributes a major part. About 80% of nosocomial UTI are associated with using indwelling urinary catheters and most of them are asymptomatic. Only 5% of them develop s symptomatic UTI which leads to development of complications like bacteremia & pyelonephritis. MATERIALS AND METHODS: In th e present study a random collection of 100 urine samples from different clinical “groups ˮ like surgery, urology, AMCU, Ob stetrics & Gynecology patients with indwelling urinary catheter of different durations of catheter stay. Organisms isolated in culture, biochemical c haracterization, and antibiotic susceptibility was done. RESULTS: Among the samples tested 41/100 (41% showed culture positivity. within them surgery patients were 40.90% (18/41 , Urology accounted for, 71.42 % (20/28, in AMCU patients 20% (2/10, with more than 3 days of duration of catheter stay and in Obs & Gyn department showed 0 culture positivity. The predominant organism isolated is pseudomonas aeruginosa (34.2%, followed by Escherichia coli (22%, enterococci (12.19%, Klebsiella (12.19% and Ca ndida 19.5%. Among GNB 90% showed ESBL production, 10% ß - lactam inhibitors resistance, 90% quinolones resistant, 50% resistant to amikacin, 100% to gentamycin was o bserved. CONCLUSION: Incidence of bacteriuria in patients with indwelling urinary catheters is 41 %. Onset of bacteriuria is as early as on 3 rd day of catheterization, and gradually increases with duration of stay, technique of insertion and daily catheter care done. Pseudomonas aeruginosa and Escherichia coli are common organisms isolated. Use o f prophylactic antibiotics without doing culture, and antibiotic susceptibility testing leads to development of drug resistant organisms. So, active

  12. Occurrence of catheter-associated urinary tract infection in critical care units

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    Chanda R Vyawahare

    2015-01-01

    Full Text Available Background: Catheter-associated urinary tract infection (CAUTI is the most common nosocomial infection. The etiological agents of which may be varied. Advancing age, debilitation, diabetes mellitus, duration of catheterization are the risk factors. Complications include prostatitis, epididymitis, cystitis, pyelonephritis and septicemia in high-risk patients, adding to hospitalization and morbidity. With this background the present study was undertaken Objectives: (1 To identify microbial pathogens associated with urinary tract infection (UTI in catheterized patients from Intensive Care Units (ICU (2 to determine the susceptibility pattern of these isolates to antimicrobial agents (3 to determine the effect of days of catheterization and UTI. Materials and Methods: Consecutive urine samples of 345 catheterized patients admitted in ICUs were included in the study. They were processed by standard microbiological procedures. Isolated organisms were speciated, and antibiotic susceptibility performed as per standard guidelines. Results: From the 345 urine samples of catheterized patients, 205 showed no growth and were found to be sterile. Bacterial growth was seen in 69 patients and fungal growth in 50 patients. Among the bacterial isolates, Escherichia coli were isolated in 39, followed by Klebsiella spp. 14. The other isolates included Pseudomonas spp., Group D streptococci and methicillin-resistant Staphylococcus aureus. In the fungal isolates, Candida glabrata was the most common isolate. High resistance was seen among Klebsiella isolates (nalidixic acid-86% and cefotaxime-86%. Conclusion: Development of CAUTI is common in critically ill patients. Emphasis should be placed on good catheter management and reducing the duration of catheterization rather than prophylaxis in order to reduce the incidence of catheter-related UTI. Culture and susceptibility testing play a vital role in the management if UTI occurs.

  13. Cardiac tamponade as a complication of parenteral nutrition

    OpenAIRE

    Diego Paim Carvalho Garcia; Clarissa Santos Neto; Pablo Nelson Valle Hubner; Thiago de Almeida Furtado; Andy Petroianu; Luiz Ronaldo Alberti

    2015-01-01

    Introduction: Complications arising from the use of central venous catheters are numerous, but cardiac tamponade is a complication well defined, very rare and often fatal. The mortality rate is 47–77% in the literature. Presentation of case: We report a case of successful diagnosis and treatment of cardiac tamponade by parenteral nutrition in a 31-year-old female. Discussion: There are only few cases of cardiac tamponade reported in the world literature since 1958. The true incidence is...

  14. Cytology of Pericardial Effusion due to Malignancy

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    Kalogeraki Alexandra

    2016-09-01

    Full Text Available Background. Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare.

  15. Nonpenetrating right atrial and pericardial trauma.

    Science.gov (United States)

    Grande, Antonino M; Rinaldi, Mauro; Pasquino, Stefano; Dore, Roberto; Viganò, Mario

    2003-09-01

    Nonpenetrating chest trauma can cause cardiac rupture. Ventricles are affected more frequently than atria. Survival is rare and depends upon prompt diagnosis and immediate surgical intervention. We report the case of a 42-year-old man involved in a car accident with consequent right atrial rupture and pericardial tearing.

  16. Aortic reconstruction with bovine pericardial grafts

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    Silveira Lindemberg Mota

    2003-01-01

    Full Text Available INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8% were operated on an urgent basis (mostly acute Stanford A dissection and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6. Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits.

  17. Pericardial effusion in a mixed breed dog.

    OpenAIRE

    2001-01-01

    A 7-year-old, spayed female mixed breed dog was evaluated for labored breathing, lethargy, and a distended abdomen. Pericardial effusion was diagnosed after radiographic and echocardiographic interpretation. Treatment consisted of thoracocentesis and a single pericardiocentesis. Follow-up examinations indicate that the dog's condition has remained stable.

  18. Echocardiographic approach to cardiac tamponade in critically ill patients.

    Science.gov (United States)

    McCanny, Peter; Colreavy, Frances

    2016-12-24

    Cardiac tamponade should be considered in a critically ill patient in whom the cause of haemodynamic shock is unclear. When considering tamponade, transthoracic echocardiography plays an essential role and is the initial investigation of choice. Diagnostic sensitivity of transthoracic echocardiography is dependent on image quality, and in some cases a transoesophageal approach may be required to confirm the diagnosis. Knowledge of the pathophysiology and echocardiographic features of cardiac tamponade are essential for the practicing Intensivist. This review presents an approach to the recognition, diagnosis, and treatment of cardiac tamponade in critically ill patients.

  19. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    Science.gov (United States)

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  20. Attention! Cardiac tamponade may be caused by underlying Castleman's disease.

    Science.gov (United States)

    Atay, Hilmi; Kelkitli, Engin; Okuyucu, Muhammed; Yildiz, Levent; Turgut, Mehmet

    2015-05-01

    Castleman's disease is a rarely observed lymphoproliferative disease. In the literature, various signs and symptoms of the disease have been reported; one of these is secondary cardiac tamponade. We describe the case of a 41-year-old man who developed cardiac tamponade during examination, and who was later diagnosed with Castleman's disease, based on his lymph node biopsies.

  1. Cardiac tamponade – presentation of type A aortic dissection

    Directory of Open Access Journals (Sweden)

    Opeyemi Fadahunsi

    2014-11-01

    Full Text Available Acute aortic dissection usually presents with severe chest and/or back pain but may have a varied presentation ranging from syncope, stroke, and heart failure to shock or tamponade. We present classic chest computed tomography images of a case of type A aortic dissection presenting with cardiac tamponade.

  2. Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

    Directory of Open Access Journals (Sweden)

    Hasan Ali Gumrukcuoglu

    2011-01-01

    Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis. CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38% patients (Group A, primary surgical treatment was preformed in 36 (36% patients (Group B, and surgical treatment following pericardiocentesis was performed in 26 (26% patients (Group C. Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp., followed by tuberculosis (14%. Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates.

  3. Ureteral Stents and Foley Catheters-Associated Urinary Tract Infections: The Role of Coatings and Materials in Infection Prevention

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    Joey Lo

    2014-03-01

    Full Text Available Urinary tract infections affect many patients, especially those who are admitted to hospital and receive a bladder catheter for drainage. Catheter associated urinary tract infections are some of the most common hospital infections and cost the health care system billions of dollars. Early removal is one of the mainstays of prevention as 100% of catheters become colonized. Patients with ureteral stents are also affected by infection and antibiotic therapy alone may not be the answer. We will review the current evidence on how to prevent infections of urinary biomaterials by using different coatings, new materials, and drug eluting technologies to decrease infection rates of ureteral stents and catheters.

  4. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.

  5. Anticardiac Antibodies in Patients with Chronic Pericardial Effusion

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    Konstantinos Karatolios

    2016-01-01

    Full Text Available Objectives. Chronic pericardial effusion may be challenging in terms of diagnosis and treatment. Specific laboratory parameters predicting the frequency and severity of recurrences after initial drainage of pericardial effusion are lacking. Materials and Methods. Pericardial fluid (PF and serum (SE samples from 30 patients with chronic pericardial effusion (PE who underwent pericardiocentesis and pericardioscopically guided pericardial biopsy were compared with SE and PF samples from 26 control patients. The levels of antimyolemmal (AMLA and antifibrillary antibodies (AFA in PE and SE from patients with pericardial effusion as well as PF and SE from controls were determined and compared. Results. AMLAs and AFAs in PF and SE were significantly higher in patients with chronic pericardial effusion than in the control group (AMLAs: p = 0,01 for PF and p = 0,004 for serum; AFAs: p < 0,001 for PF and p = 0,003 for serum. Patients with recurrence of PE within 3 months after pericardiocentesis had significantly higher levels of AMLAs in SE (p = 0,029 than patients without recurrence of PE. Conclusions. The identification of elevated anticardiac antibodies in PE and SE indicates increased immunological reactivity in chronic pericardial effusion. High titer serum levels of AMLAs also correlate with recurrence of pericardial effusion.

  6. Percutaneous drainage of fluid collection in the pleural and pericardial spaces. Perkutan pleura- og perikarddrenasje

    Energy Technology Data Exchange (ETDEWEB)

    Drolsum, A.; Skjennald, A. (Ullevaal sykehus, Oslo (Norway))

    1994-11-01

    Both MRI, CT and sonography will give a good presentation of fluid collection in pleura and pericardium. Sonography is the ideal imaging method for monitoring interventional procedures. Its ability to visualize superficial fluid collection and its real-time capability allows precise control of needle and catheter insertions. If the abnormality is poorly seen with ultrasound, often because of air in the collection, CT can be used as a guidance system. Diagnostic thoracocentesis and pericardiocentesis are performed mainly to exclude malignancy and infections, and the punctions are made with small needles. Therapeutic thoracocentesis is usually performed to relieve dyspnoe and small catheters are used. Drainage of empyema is performed with larger catheters because of the high viscosity of the infected fluid. Patients with threatening cardiac tamponade will often respond immediately to drainage of the pericardial space by catheter. These procedures can be done with local anesthesia only. If complications occur, it is mainly the pneumothorax that has to be treated. This can be managed directly under the procedure as the drainage catheter is attached to continuous pleural suction, or a catheter can be inserted in the pleural space after diagnostic punction. Patients with coagulation abnormalities must be evaluated especially before any intervention, otherwise there are no contraindications for these image-guided percutaneous procedures. 14 refs., 6 figs.

  7. CT features of a pericardial gossypiboma

    Energy Technology Data Exchange (ETDEWEB)

    Coskun, M.; Boyvat, F.; Muhtesem Agildere, A. [Dept. of Radiology, Baskent Univ. Hospital, Ankara (Turkey)

    1999-05-01

    We report a case of surgically retained pericardial sponge as a cause of paracardiac mass in a woman who had thoracotomy 3 weeks prior for replacement of mitral valve prosthesis. Computed tomography examination showed a thin-walled mass containing relatively high-density material in the central part with low-density rim at the periphery suggesting a haematoma with clot formation at first. Surgically removed mass was a retained sponge between right atrium and pericardium. Gossypiboma should be included in the differential diagnosis of an intrathoracic mass besides haematoma and abscess formation in any patient who has had previous thoracotomy. (orig.) With 1 fig., 14 refs.

  8. Pericardial breast cancer metastasis 25 years after mastectomy.

    Science.gov (United States)

    Rovere, Rodrigo Kraft; de Araujo, Daniel Brito; Ribeiro, Daniel Rios Pinto; Marques, Rogério Torres

    2012-01-01

    Pericardial effusion in a patient with a history of cancer should always prompt a hypothesis of malignant involvement. We report the case of a 66-year-old white woman presenting with pericardial effusion 25 years after a mastectomy for ductal breast carcinoma. This is one of the cases with the latest recurrence ever reported.

  9. Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers' perspective at a community safety net hospital.

    Science.gov (United States)

    Gray, Dorinne; Nussle, Richard; Cruz, Abner; Kane, Gail; Toomey, Michael; Bay, Curtis; Ostovar, Gholamabbas Amin

    2016-01-01

    Preventing catheter-associated urinary tract infections is in the forefront of health care quality. However, nurse and physician engagement is a common barrier in infection prevention efforts. After implementation of a multidisciplinary catheter-associated urinary tract infection (CAUTI) prevention campaign, we studied the impact of our campaign and showed its association with reducing the CAUTI rate and catheter utilization and the positive effect on health care workers' engagement and perspectives. CAUTI prevention campaigns can lead to lower infection rates and change health care workers' perspective.

  10. Huge Pericardial Cyst Misleading Symptoms of COPD

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    Göktürk Fındık

    2012-04-01

    Full Text Available Pericardial cysts are rare benign congenital mediastinal lesions. It accounts 30% of all mediastinal cysts. They are usually asemptomatic. They can produce the compression of the mediastinal structures typically caused the symptoms of dyspnea, thoracic pain, tachicardia and cough due to the unusual large size of the cyst. It can performed symptoms of lung atelectasia. The case was a sixty-five years old woman followed with a diagnosis of COPD for seven years. The patient was admitted to our center with the diagnosis of elevation of the right hemidiaphragm on chest radiography. The computed tomography revealed a cystic lesion adjacent to the right hemidiaphragm and cyst excision was performed via right thoracotomy. Patient%u2019s postoperative clinical findings indicated that the symptoms of COPD regressed completely and the patient did not require any further bronchodilator therapy. The aim of this case report is to demonstrate that the pericardial cysts can be missed in chest radiographs and impression of cysts may cause COPD like symptoms in these patients.

  11. Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review.

    Science.gov (United States)

    Galiczewski, Janet M

    2016-02-01

    Catheter associated urinary tract infections (CAUTIs) put an unnecessary burden on patients and health care systems. The purpose of this integrative review was to examine existing evidence on preventative interventions and protocols currently implemented in intensive care units (ICUs) and the impact they have on CAUTI rates and patient outcomes. This review analysed 14 research articles obtained from electronic databases and included adult patients with urinary catheters in an ICU setting. Evidence demonstrated interventions that included criteria for catheter use, daily review of catheter necessity and discontinuation of catheter prior to day seven were successful in decreasing CAUTI rates. This review provides a scientific basis for the effectiveness of these interventions and protocols. Identification and use of interventions with the greatest positive impact on CAUTI rates are an asset to healthcare professional caring for patients with indwelling catheters and nurse clinicians developing policies.

  12. Late onset seroma post-thymectomy presenting as cardiac tamponade

    OpenAIRE

    Poudel, Dilli Ram; Giri, Smith; Pathak, Ranjan; Morsey, Mohamed; Alsafwah, Shadwan

    2015-01-01

    Late onset seroma is a rare post-operative complication occurring after various surgeries including thymectomy. Most cases are asymptomatic; however, seromas occurring in the mediastinal cavity may cause compression symptoms including airway compression or cardiac tamponade. We present a 62-year-old male with a history of thymectomy for myasthenia gravis who presented with cardiac tamponade several years ago. Further evaluation revealed a late onset seroma anteriorly compressing the cardiac c...

  13. Intrauterine tamponade balloon use in the treatment of uterine inversion

    OpenAIRE

    Haeri, Sina; Rais, Sheliza; Monks, Brian

    2015-01-01

    Uterine inversion is a rare but life-threatening obstetrical emergency that occurs when the fundus of the uterus prolapses through the cervix, hence turning the uterus inside out. In this case report, we present our experience using an intrauterine tamponade balloon for management of uterine inversion, and a review of the literature. The utility of an intrauterine tamponade balloon in cases of uterine inversion, especially when maternal medical conditions preclude the use of uterotonics, or r...

  14. 导尿管相关尿路感染的监测%Monitoring Catheter-associated Urinary Tract Infection

    Institute of Scientific and Technical Information of China (English)

    蔡玉琴

    2013-01-01

    Objective: To search the condition and reasons of indwelling catheter patients with urinary tract infection in medical ward, and to provide a scientific basis for the effective prevention and control of infection. Methods: The catheter-related urinary tract infection of all patients with indwelling catheters who hospitalized in medical ward from January 2011 to June 2012 were investigated by proactive monitoring. Results : 335 cases of patients with indwelling catheter were monitored, and there were 15 cases with urinary tract infection, so the infection rate was 4.48%. The rate of catheter-associated urinary tract infection was 2.5/ 1000 catheters per day. Conclusion: Understanding the occurrence of catheter associated urinary tract infection in a medical ward by targeted monitoring, it provides guidance for the effective control of urinary tract infections.%目的:了解内科病房留置尿管患者尿路感染发生状况及原因,为有效预防和控制感染提供科学依据.方法:采取主动监测方法,对2011年1月-2012年6月内科病房所有住院留置尿管患者发生导尿管相关尿路感染情况进行调查.结果:335例留置尿管患者,发生尿路感染15例,感染率为4.48%,导尿管相关尿路感染发生率为2.5/千导管日.结论:通过目标性监测,了解了内科病房导尿管相关尿路感染的发生状况,为有效控制尿路感染提供了指导.

  15. Recurrent late cardiac tamponade following cardiac surgery : a deceiving and potentially lethal complication

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Meuzelaar, Jacobus J.

    2010-01-01

    Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagno

  16. Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Greene, M Todd; Safdar, Nasia; Krein, Sarah L; Olmsted, Russell N; Watson, Sam R; Edson, Barbara; Albert Lesher, Mariana; Saint, Sanjay

    2017-01-01

    Background The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety. Objective Examine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates. Methods We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics. Results 1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time. Conclusions We found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS. PMID:27222593

  17. Giant Pericardial Cyst: A Case Report and Review of Literature

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    Hekmat

    2016-01-01

    Full Text Available Pericardial cysts are rare lesions. These benign anomalies are located in the middle mediastinum. In this article, we present a 24-year-old man who was referred to the emergency department with dyspnea and persistent cough. In physical exam, no abnormality was found. His past medical history was normal. His trans-thoracic echocardiogram showed an echo-lucent space next to the right atrium at the right cardiophrenic angle. No pericardial effusion was found. The patient underwent surgery. After midsternotomy, a huge cyst measuring approximately 13 × 8 × 5 cm in diameters was found on the right side and outside the pericardium that was totally excised. After 5 days, the patient was discharged and pathologic report confirmed preoperative diagnosis of pericardial cyst. Giant pericardial cysts are not common and in this report, we will review published case reports.

  18. Pericardial Window Formation Complicated by Intrapericardial Diaphragmatic Hernia

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    Jeremy Docekal

    2014-01-01

    Full Text Available In rare circumstances, a diaphragmatic defect may allow for herniation of intra-abdominal contents into the pericardial space. These occurrences are exceedingly rare and may be due to trauma or congenital defects of the septum transversum or as the result of surgical procedures. We describe a 73-year-old female who presented with cardiac and abdominal symptoms one month after undergoing a subxiphoid pericardioperitoneal window for treatment and evaluation of a symptomatic pericardial effusion.

  19. Cause and Long-Term Outcome of Cardiac Tamponade.

    Science.gov (United States)

    Sánchez-Enrique, Cristina; Nuñez-Gil, Iván J; Viana-Tejedor, Ana; De Agustín, Alberto; Vivas, David; Palacios-Rubio, Julián; Vilchez, Jean Paul; Cecconi, Alberto; Macaya, Carlos; Fernández-Ortiz, Antonio

    2016-02-15

    Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.

  20. Viral communities associated with human pericardial fluids in idiopathic pericarditis.

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    Laura Fancello

    Full Text Available Pericarditis is a common human disease defined by inflammation of the pericardium. Currently, 40% to 85% of pericarditis cases have no identified etiology. Most of these cases are thought to be caused by an infection of undetected, unsuspected or unknown viruses. In this work, we used a culture- and sequence-independent approach to investigate the viral DNA communities present in human pericardial fluids. Seven viral metagenomes were generated from the pericardial fluid of patients affected by pericarditis of unknown etiology and one metagenome was generated from the pericardial fluid of a sudden infant death case. As a positive control we generated one metagenome from the pericardial fluid of a patient affected by pericarditis caused by herpesvirus type 3. Furthermore, we used as negative controls a total of 6 pericardial fluids from 6 different individuals affected by pericarditis of non-infectious origin: 5 of them were sequenced as a unique pool and the remaining one was sequenced separately. The results showed a significant presence of torque teno viruses especially in one patient, while herpesviruses and papillomaviruses were present in the positive control. Co-infections by different genotypes of the same viral type (torque teno viruses or different viruses (herpesviruses and papillomaviruses were observed. Sequences related to bacteriophages infecting Staphylococcus, Enterobacteria, Streptococcus, Burkholderia and Pseudomonas were also detected in three patients. This study detected torque teno viruses and papillomaviruses, for the first time, in human pericardial fluids.

  1. Tamponamento cardíaco em dois recém-nascidos causado por cateter umbilical Cardiac tamponade caused by central venous catheter in two newborns

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    Andrey José Monteiro

    2008-09-01

    Full Text Available Tamponamento cardíaco secundário ao uso de cateter venoso central é uma complicação rara, porém potencialmente tratável, quando identificada a tempo. Nós relatamos dois casos de tamponamento cardíaco, diagnosticados por ecocardiograma transtorácico, seguido de pericardiocentese de urgência e drenagem pericárdica cirúrgica como complicação de cateterização venosa umbilical. Em um caso, a ponta do cateter estava adequadamente localizada e, no outro caso, não. Em ambos os casos, solução hiperosmolar estava sendo infundida. Apesar de situação incomum, esta deve ser sempre considerada em neonato, evoluindo com choque cardiogênico sem causa aparente.Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  2. Bacterial Biofilms and Catheters: A Key to Understanding Bacterial Strategies in Catheter-Associated Urinary Tract Infection

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    J Curtis Nickel

    1992-01-01

    Full Text Available Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder’s mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter-associated infection.

  3. An in vitro urinary tract catheter system to investigate biofilm development in catheter-associated urinary tract infections.

    Science.gov (United States)

    Dohnt, Katrin; Sauer, Marie; Müller, Maren; Atallah, Karin; Weidemann, Marina; Gronemeyer, Petra; Rasch, Detlev; Tielen, Petra; Krull, Rainer

    2011-12-01

    Biofilm development in urinary tract catheters is an often underestimated problem. However, this form of infection leads to high mortality rates and causes significant costs in health care. Therefore, it is important to analyze these biofilms and establish avoiding strategies. In this study a continuous flow-through system for the cultivation of biofilms under catheter-associated urinary tract infection conditions was established and validated. The in vitro urinary tract catheter system implies the composition of urine (artificial urine medium), the mean volume of urine of adults (1 mL min(-1)), the frequently used silicone catheter (foley silicon catheter) as well as the infection with uropathogenic microorganisms like Pseudomonas aeruginosa. Three clinical isolates from urine of catheterized patients were chosen due to their ability to form biofilms, their mobility and their cell surface hydrophobicity. As reference strain P. aeruginosa PA14 has been used. Characteristic parameters as biofilm thickness, specific biofilm growth rate and substrate consumption were observed. Biofilm thicknesses varied from 105±16 μm up to 246±67 μm for the different isolates. The specific biofilm growth rate could be determined with a non invasive optical biomass sensor. This sensor allows online monitoring of the biofilm growth in the progress of the cultivation.

  4. Suprachoroidal collection of internal tamponading agents through a choroidal hole

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    Gopal Lingam

    2008-01-01

    Full Text Available We report two cases of significantly large choroidal holes following penetrating trauma that led to suprachoroidal migration of internal tamponading agents during repair of retinal detachments with proliferative vitreoretinopathy secondary to penetrating trauma. In the first case, choroidal hole was a direct result of the injury and was identified immediately after vitreoretinal surgery which was done for traumatic retinal detachment with hemorrhagic choroidal detachment. In the second case, the hole occurred over a period of several months after the repair of traumatic retinal detachment with silicone oil tamponade. This was attributed to progressive fibrosis exerting traction on the bare choroid/retinal pigment epithelium. Choroidal hole significant enough to cause suprachoroidal migration of internal tamponading agents is a very rare complication seen in eyes with posttraumatic retinal detachment with proliferative vitreoretinopathy.

  5. Tamponade in the surgical management of retinal detachment

    Directory of Open Access Journals (Sweden)

    Vaziri K

    2016-03-01

    Full Text Available Kamyar Vaziri, Stephen G Schwartz, Krishna S Kishor, Harry W Flynn Jr Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Despite treatment advances, rhegmatogenous retinal detachment (RD can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors. Keywords: tamponade, retinal detachment, silicone oil, gas, air, perfluorocarbon liquids

  6. Traumatic Mitral Valve and Pericardial Injury

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    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  7. Intrauterine tamponade balloon use in the treatment of uterine inversion.

    Science.gov (United States)

    Haeri, Sina; Rais, Sheliza; Monks, Brian

    2015-01-06

    Uterine inversion is a rare but life-threatening obstetrical emergency that occurs when the fundus of the uterus prolapses through the cervix, hence turning the uterus inside out. In this case report, we present our experience using an intrauterine tamponade balloon for management of uterine inversion, and a review of the literature. The utility of an intrauterine tamponade balloon in cases of uterine inversion, especially when maternal medical conditions preclude the use of uterotonics, or reinversion is observed should be kept in mind.

  8. Tamponade in the surgical management of retinal detachment.

    Science.gov (United States)

    Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W

    2016-01-01

    Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors.

  9. Cardiac perforation and tamponade in percutaneous cardiac intervention%心导管术所致心脏压塞

    Institute of Scientific and Technical Information of China (English)

    沈向前; 方臻飞; 胡信群; 刘启明; 周滔; 唐建军; 周胜华; 吕晓玲

    2011-01-01

    Objective To explore the cause of cardiac perforation and tamponade during cardiac catheterization and intervention and to evaluate the effectiveness of the emergency treatment for tamponade in our hospital.Methods The clinical data from 23 319 patients who received diagnostic catheterization or therapeutic procedures were analyzed retrospectively.Results Cardiac perforation and cardiac tamponade were observed in 22 of the 23 319 patients during catheter procedures.It includes 1 in coronary artery angiography, 9 in percutaneous balloon mitral valvuloplasty, 3 in diagnosis, 2 in congenital heart disease intervention, 2 in pacemaker implantation, 2 in atrial fibrillation ablation and the other 3 in coronary revascularization.The occurrence of cardiac perforation in 11 patients was related to puncture of the interatrial septum and/or the procedure in the left atrial procedure and 2 were related to high pressure injection.Seventeen patients were found cardiac tamponade in the process of catheterization, and 5 were found at 2 - 14 h after operation.Pericardiocentesis and pericardial catheter drainage were performed in 20 patients and 11 of them succeeded.Among the other 11 patients, 7 were successfully saved by thoracotomy and 4 died.Conclusion Cardiac tamponade is a severe and fatal complication that may occur in different catheter procedures.Early prevention and diagnosis and pefformingperi cardiocentesis and drainage timely are critical to reduce the mortality.%目的:探讨心导管检查术及心脏介入术中发生心脏穿孔、心脏压塞的原因及紧急处理的方式和效果.方法:回顾性分析1986年1月至2009年12月在中南大学湘雅二医院心导管室接受诊断性心导管检查术或各种心脏介入术共23 319例患者的资料.结果:在23 319例各种心导管术中,共有22例(0.094%)发生急性心脏压塞.其分布情况为:冠状动脉造影术1例,二尖瓣球囊扩张术9例,心导管检查术3例,

  10. Tamponamento cardíaco tardio traumático: análise de cinco casos Traumatic late cardiac tamponade: analysis of five cases

    Directory of Open Access Journals (Sweden)

    FERNANDO LUIZ WESTPHAL

    2000-09-01

    Full Text Available São analisados cinco casos de tamponamento cardíaco tardio traumático. Os pacientes eram masculinos, idade média de 26,2 anos, vítimas de ferimento por arma branca em região precordial, área de Ziedler, sendo admitidos em centro de referência para trauma. Foram classificados pelo índice fisiológico de Ivatury para trauma cardíaco e inicialmente tratados por pleurotomia intercostal e reposição volêmica, com estabilização do quadro hemodinâmico e respiratório. Os pacientes foram readmitidos após intervalo de oito a 24 dias (mediana de 20 dias, agora no serviço de cirurgia torácica de um hospital de referência terciária, com sinais de tamponamento cardíaco. Os exames diagnósticos confirmaram derrame pericárdico com espessamento pericárdico associado a encarceramento de base pulmonar esquerdo em quatro casos, os quais foram abordados por toracotomia póstero-lateral, com realização de pericardiectomia parcial e descorticação pulmonar. Um paciente evoluiu com pericardite purulenta, comprovada por exames complementares, e foi submetido à drenagem pericárdica subxifóidea. Ocorreu arritmia pós-operatória em um paciente; os demais evoluíram sem complicações pós-operatórias ou recidiva do tamponamento.Five traumatic late cardiac tamponade cases were analyzed. All patients were male, mean age was 26.2, victims of thoracic penetrating stabbing wound in the precordial region, Ziedler area, admitted to a trauma reference center. They were classified by the Ivatury physiological index for cardiac trauma. The first treatment approach was intercostal pleurectomy and volemic resuscitation followed by hemodynamic and respiratory recovery. Patients with cardiac tamponade symptoms were re-admitted within an interval from eight to twenty four days (mean 20 days in a thoracic surgery service of a tertiary reference hospital. Diagnostic exams confirmed thickening and pericardial effusion associated with a left pulmonary base

  11. "Lose the Tube": A Choosing Wisely initiative to reduce catheter-associated urinary tract infections in hospitalist-led inpatient units.

    Science.gov (United States)

    Cho, Hyung J; Khalil, Steve; Poeran, Jashvant; Mazumdar, Madhu; Bravo, Nathaniel; Wallach, Fran; Markoff, Brian; Lee, Nathan; Dunn, Andrew S

    2017-03-01

    We developed a multidisciplinary initiative, "Lose the Tube," focused on a Choosing Wisely recommendation to decrease catheter-associated urinary tract infection (CAUTI) rates and catheter days. Through an electronic health record catheter identification tool, daily interdisciplinary query, and clinician education, our multifaceted intervention reduced mean per-person catheter days from 3.3 to 2.9, decreased CAUTI rates from 2.85 to 0.32 per 1,000 catheter days, and reduced cost by $32,245.

  12. [Long-term survival of a breast cancer patient with carcinomatous pleuritis and carcinomatous cardiac tamponade successfully treated by multimodality therapy].

    Science.gov (United States)

    Tanaka, Yosuke; Tsuboi, Kaori; Yamamoto, Akira; Tsuda, Shoichi; Tsujii, Shigehiro; Yagi, Ken; Kitamura, Tatsuhiko

    2015-04-01

    A 69-year old woman was admitted to our hospital because of dyspnea and pain in her left breast. Computed tomography revealed a massive quantity of left pleural effusion, a tumor in the left breast(5 cm in diameter), left cervical and supraclavicular lymph node metastasis, and a large left axillary metastatic mass. Based on a core needle biopsy, her breast tumor was diagnosed pathologically as scirrhous carcinoma, which was positive for estrogen receptor/progesterone receptor and negative for HER2 using the FISH assay, and left pleural metastasis was diagnosed cytologically. The carcinomatous pleural effusion was successfully controlled using pleural instillations of pirarubicin HCl and OK-432 after pleural drainage. A near clinical complete response was achieved by EC systemic chemotherapy(6 months)followed by endocrine therapy(letrozole), but 3 months later she was diagnosed cytologically with carcinomatous cardiac tamponade. After operative pericardial drainage, intrapericardial instillations of cisplatin and OK-432 successfully prevented re-accumulation of pericardial effusion. Systemic chemotherapy(weekly paclitaxel)for 11 months and endocrine therapy(letrozole)resulted in a clinical complete response. One year and 10 months after pericardial drainage, she underwent surgery(mastectomy and axillary lymph node dissection level II)because of two small tumors in the left breast which were found to be malignant using PET-CT. One tumor(diameter 1.6 cm)was found pathologically to consist of degenerated cancer cells, and another tumor(diameter 2 cm)was diagnosed as recurrent cancer. There was no lymph node metastasis in the axilla except for a single mass(1.4×0.7×0.3 cm), which was composed of extremely degenerative and necrotic non-lymphoid cancerous tissue. Since having the surgery, she has not experienced recurrence on hormone therapy with fulvestrant, and to date she is still alive, 3 years and 5 months since the left pleural metastasis episode.

  13. Bed Seldinger technique bedside pericardiocentesis and drainage of pericardial fluid in clinical application%床边seldinger技术经心包穿刺置管引流心包积液在临床中的应用

    Institute of Scientific and Technical Information of China (English)

    杨海慧; 高飞; 张航

    2015-01-01

    目的:研究seldinger技术经心包穿刺置管在心包积液诊治中的应用。方法:100例患者于心尖部或剑突下经心包穿刺置入中心静脉导管引流,反复抽液或注入相应治疗药物,观察患者液体的引流变化及临床情况。结果:100例心包积液患者全部安全、有效置管成功。心包积液有心脏填塞的患者引流后症状迅速缓解,有明确病因需治疗的患者因中心静脉导管可长期保留(2~16天,个别患者30天),置管方便,反复抽液和药物注入利于治疗。患者能获得有效救治操作,且并发症少。结论:床边seldinger技术经心包置管引流心包积液法简单、安全、有效、经济,便于临床应用。%ObjectiveSeldinger technique research of pericardial puncture intubation in pericardial effusion in diagnosis and treatment of applications.Methods100 patients with apical or below the xiphoid process of pericardial puncture inserted central venous catheter,Again pumping fluids or inject medication accordingly, changes and clinical observation of draining liquid in patients with conditions.ResultsAl 100 cases of pericardial effusion in patients with safe, effective and successful successful. Drainage of pericardial effusion in patients with cardiac tamponade after symptom relief, there is a clear etiology, treatment of patients with central venous catheter for long-term retention (2-16 days, 30 days), Catheter, drainage and drug injection to treat again. Patients can receive effective treatment operation, and fewer complications.ConclusionsBedside seldinger technique by pericardial catheter drainage for pericardial effusion method is simple, safe, effective, economical, convenient for clinical application.

  14. Primary Pericardial Mesothelioma: Report of a Patient and Literature Review

    Directory of Open Access Journals (Sweden)

    Åse Nilsson

    2009-07-01

    Full Text Available Primary mesothelioma of the pericardium is a rare tumor and carries a dismal prognosis. This case report presents a 38-year-old man who suffered from recurrent pericardial fluid. Initial symptoms were unspecific, with dry cough and progressing fatigue. Pericardiocentesis was performed, but analyses for malignant cells and tuberculosis were negative. After recurrence a pericardiectomy was planned. At operation, partial resection of tumor tissue surrounding the heart was performed. Histopathologic examination including immunohistochemical staining for calretinin showed a biphasic mesothelioma. During the postoperative period the patient’s condition ameliorated, but symptoms recurred and the patient died 3 months after diagnosis and 15 months after the first symptoms. At autopsy, the pericardium was transformed by the tumor that also expanded into the mediastinum and had set metastases to the liver. A review of 29 cases presented in the recent literature indicates a higher incidence of malignant pericardial mesothelioma among men than women. Median age was 46 (range, 19–76 years. In pleural mesotheliomas, exposure to asbestos is a known risk factor. However, in primary pericardial mesotheliomas the evidence for asbestos as an etiologic factor seems to be less convincing (3 exposed among 14 cases. Symptoms are often unspecific and cytologic examination of pericardial fluid is seldom conclusive (malignant cells demonstrated in 4/17 cases. Partial resection of the tumor can give a period of symptom reduction. Only a few patients have been treated with chemotherapy. Median survival of patients with pericardial mesotheliomas is approximately 6 months.

  15. 心脏外科术后心包积液的危险因素与治疗%The management and risk factors of pericardial effusion after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    穆军升; 尤斌; 董然; 张健群; 周帆; 顾承雄; 黄方炯; 孟旭; 孙立忠; 张宏家; 伯平

    2011-01-01

    Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3%) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P > 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P < 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4%) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1% ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3% ) or surgical drainage ( n =15,5.7% ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9% ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3% of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.%目的 探讨心脏外科手术后心包积液的危险因素和治疗方法.方法 回顾分析22 462例患者临床资料,定义心包积

  16. Pericardial Effusion in Langerhans Cell Histiocytosis: A Case Report

    Science.gov (United States)

    Gholami, Narges

    2016-01-01

    Introduction Langerhans cell histiocytosis (LCH) is a proliferative disorder of histiocytes in multiple organs. Langerhans cell histiocytosis involves bones, skin, lung and other organs. Case Presentation This study describes a seven-month-old Iranian girl who presented with skin rash and cervical lymphadenopathy. Langerhans cell histiocytosis was suspected when it was associated with anemia, splenomegaly and lytic bone lesions. A skin biopsy confirmed the diagnosis of Langerhans cell histiocytosis. During hospitalization, the patient looked ill with respiratory distress. A chest X-ray showed a ground glass view, and echocardiography showed moderate pericardial effusion. Conclusions Pericardial effusion was a rare finding in this case of Langerhans cell histiocytosis. Pericardial effusion in Langerhans cell histiocytosis, which is an unusual presentation, should be considered when the patient experiences respiratory distress. PMID:27621925

  17. A combination of cis-2-decenoic acid and antibiotics eradicates pre-established catheter-associated biofilms.

    Science.gov (United States)

    Rahmani-Badi, Azadeh; Sepehr, Shayesteh; Mohammadi, Parisa; Soudi, Mohammad Reza; Babaie-Naiej, Hamta; Fallahi, Hossein

    2014-11-01

    The catheterized urinary tract provides ideal conditions for the development of biofilm populations. Catheter-associated urinary tract infections (CAUTIs) are recalcitrant to existing antimicrobial treatments; therefore, established biofilms are not eradicated completely after treatment and surviving biofilm cells will carry on the infection. Cis-2-decenoic acid (CDA), an unsaturated fatty acid, is capable of inhibiting biofilm formation by Pseudomonas aeruginosa and of inducing the dispersion of established biofilms by multiple types of micro-organisms. Here, the ability of CDA to induce dispersal in pre-established single- and dual-species biofilms formed by Escherichia coli and Klebsiella pneumoniae was measured by using both semi-batch and continuous cultures bioassays. Removal of the biofilms by combined CDA and antibiotics (ciprofloxacin or ampicillin) was evaluated using microtitre plate assays (crystal violet staining). The c.f.u. counts were determined to assess the potential of combined CDA treatments to kill and eradicate pre-established biofilms formed on catheters. The effects of combined CDA treatments on biofilm surface area and bacteria viability were evaluated using fluorescence microscopy, digital image analysis and live/dead staining. To investigate the ability of CDA to prevent biofilm formation, single and mixed cultures were grown in the presence and absence of CDA. Treatment of pre-established biofilms with only 310 nM CDA resulted in at least threefold increase in the number of planktonic cells in all cultures tested. Whilst none of the antibiotics alone exerted a significant effect on c.f.u. counts and percentage of surface area covered by the biofilms, combined CDA treatments led to at least a 78% reduction in biofilm biomass in all cases. Moreover, most of the biofilm cells remaining on the surface were killed by antibiotics. The addition of 310 nM CDA significantly prevented biofilm formation by the tested micro-organisms, even within

  18. Incidence, risk factors, microbiology of venous catheter associated bloodstream infections - A prospective study from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    M Kaur

    2015-01-01

    Full Text Available Purpose : Central venous catheters (CVCs though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI in the intensive care unit (ICU patients and studied the formation of biofilm in CVCs. Materials and Methods: The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO and Gram staining methods. Biofilm production in catheters was detected by ′tissue culture plate′ (TCP method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS. Results : In 25/115 patients, definite diagnosis of CVC-BSI was made. The mean age was 48.44 ± 17.34 years (cases vs 40.10 ± 18.24 years (controls and the mean duration of catheterisation was 25.72 ± 8.73 days (cases vs 11.89 ± 6.38 days (controls. Local signs of infection (erythema, tenderness and oozing were found more significantly in CVC-BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non-albicans Candida were common CVC-BSI pathogens. Multidrug-resistant (MDR strains were isolated in bacterial agents of CVC-BSI. Non-albicans Candida and Enterococcus faecalis showed strong biofilm production. Conclusion : The incidence of CVC-BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC-BSI cases. The menace of multidrug resistance and

  19. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma.

    Science.gov (United States)

    Liang, Huai-min; Chen, Qiu-lin; Zhang, Er-yong; Hu, Jia

    2016-04-01

    Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

  20. Giant bronchogenic cyst with pericardial defect: a case report & literature review in Japan

    Science.gov (United States)

    Kamata, Toshiko; Iwata, Takekazu; Nakatani, Yukio; Yoshino, Ichiro

    2016-01-01

    Congenital pericardial defects are a rare anomaly, found during autopsy and cardiothoracic surgery. We describe a case of a 69-year-old female, with a right-sided congenital pericardial defect associated with a giant bronchogenic cyst (BC) found during surgery. The cyst was resected and the patient developed arrhythmia following surgery. A review of the literature in Japan was performed, focusing on congenital anomalies associated with pericardial defects and its pathogenesis. We paid particular attention to complications following thoracic surgery in patients with pericardial defects and indications of pericardial reconstruction in such patients. PMID:27621900

  1. Evaluation of an intervention program to prevent hospital-acquired catheter-associated urinary tract infections in an ICU in a rural Egypt hospital

    Directory of Open Access Journals (Sweden)

    Amine, Amira Ezzat Khamis

    2014-08-01

    Full Text Available [english] Aim: Catheter associated urinary tract infections (CAUTI are the most common hospital-acquired infection in ICUs. The aim of this study was to estimate the effectiveness of an intervention program by implementing urinary catheter bundle elements to reduce the CAUTI frequency in an ICU. Methods: The intervention study was conducted over a period of onths. During a pre-intervention phase, the base line catheter associated CAUTI incidence rates were determined and compared with the incidence rates during the post-intervention phase. The compliance of health care staff with urinary catheter bundle elements was also measured. The implemented CAUTI prevention bundle consisted of hand hygiene, wearing personal protective equipment, use of disposable gloves, cleansing of urethral meatus prior to catheter insertion using sterile saline, assessment of catheter need, aseptic urine sampling technique, and correct draining bag positioning.Results: During the study period, 55 out of 77 patients were diagnosed with a CAUTI. The mean CAUTI incidence rate for the pre-intervention period was 90.12/1,000 catheter days and for the post intervention phase 65.69/1,000 catheter days. The CAUTIs rate was inversely proportional to insertion bundle elements and maintenance bundle elements compliance rate. This negative relationship was statistically significant only with maintenance bundle elements (p=0.042 (r=–0.828. The compliance rate of the ICU nurses to the bundle elements was raised to 100% during the last 2 months of the post intervention phase.Conclusion: Increased compliance to recommended catheter associated urinary tract infections preventive practices reduced the incidence of CAUTI in an ICU unit. It is simple and effective and is recommended as a part of patient safety culture.

  2. The classification of pericardial disease in the age of modern medicine.

    Science.gov (United States)

    Maisch, Bernhard; Ristić, Arsen D

    2002-01-01

    The spectrum of pericardial diseases comprises pericarditis, pericardial neoplasms, cysts, and congenital defects. Due to the insufficient diagnostic value of standard, noninvasive diagnostic techniques, many cases remained etiologically unclear, and were therefore classified as idiopathic. A major improvement in the classification of pericardial disease is its clear distinction between the two most frequent forms of idiopathic pericarditis: viral infection and autoreactive pericarditis. This classification has major therapeutic consequences. In autoreactive forms, systemic and intrapericardial corticosteroid treatment has a favorable effect; its application in viral forms is contraindicated. The new classification of pericardial diseases synthesizes the achievements of modern imaging with molecular biology and immunology. Systematic implementation of new techniques of pericardial fluid analyses, pericardioscopy and pericardial biopsy, and the application of molecular biology and immunology techniques have opened new windows to the pericardial diseases, permitting early specific diagnosis, and creating foundations for etiologic treatment in many cases.

  3. Temporal trends and risk factors for extended-spectrum beta-lactamase-producing Escherichia coli in adults with catheter-associated urinary tract infections

    OpenAIRE

    Spadafino, Joseph T; Cohen, Bevin; Liu, JianFang; Larson, Elaine

    2014-01-01

    Background Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli cause up to 10% of catheter-associated urinary tract infections (CAUTI). We report changes in ESBL prevalence among CAUTIs in an adult acute care hospital from 2006-2012 and describe factors associated ESBL-production among E. coli CAUTI. Findings Data on patients ≥18 years discharged from a 647-bed tertiary/quaternary care hospital (2006-2012), a 221-bed community hospital (2007-2012), and a 914-bed tertiary/quater...

  4. Silicone Oil Tamponade Combined with Lensectomy Preserving Anterior Lens Capsule

    Institute of Scientific and Technical Information of China (English)

    LuL; YangJ

    1999-01-01

    Purpose:To investigate the therapeutic effect and indicatio n of silicone oil tamponade combined with lensectomy preserving anterior lens capsule.Methods:Silicone oil tamponade combined with lensectomy preserving anterior lens capsule was performed in 33 cases (33 eyes)of high myopia ,proliferative vitroretinopathy(PVR)D grade and giant retinal tear(GRT).10 cases were onlyeye and 11 cases had harder nucleus of lens.The surgical methods included:1.smashing lens nucleus and lensectomy preserving complete anterior capsule;2,vitrectomy and membrane peeling;3,usage of liquid perfluorocarbin or retinotomy or drainage;4.silicone oil tamponade;5.postoperative Nd;YAG laser for anterior capsulectomy. Results:Follow-up time was 6 months or more in 29 cases.Total retinal reattachment was achieved in 22 cases,macular retinal reattachment in 5 cases.The visual acuity was 20/800 to 20/200 in 13 cases,20/100 to 20/50 in 12 cases.Visual acuity was significantly improved in GRT group(P<0.05).Complications included unexpected anterior capsule break intraoperatively,anterior capsule opacity,silicone oil emulsification and liquid perfluorocarbin remainig postoperatively.Conclusions:Silicone oil tamponade combined with lensectomy preserving anterior capsule was safe and can reduce the operative complications.The indications included:1.GRT complicated with high myopia;2,advanced PVR cases complicated with high myopia in which silicone oil must be used;3.severe lens opacity cases in which silicone oil must be used;4.complex retinal detachment of only ye.

  5. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation.

    Science.gov (United States)

    Mahesh, Balakrishnan; Ong, Ping; Kutty, Ramesh; Abu-Omar, Yasir

    2015-10-01

    Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.

  6. Treatment of idiopathic macular hole with silicone oil tamponade

    Directory of Open Access Journals (Sweden)

    Ivanovska-Adjievska B

    2012-09-01

    Full Text Available Biljana Ivanovska-Adjievska,1 Salih Boskurt,1 Faruk Semiz,1 Hakan Yuzer,1 Vesna Dimovska-Jordanova21European Eye Hospital, Skopje, Macedonia, 2Clinic for Eye Diseases, University "St Cyril and Methodius", Skopje, MacedoniaPurpose: We analyzed the anatomical and visual outcomes after surgical treatment of idiopathic macular holes with pars plana vitrectomy, internal limiting membrane (ILM peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing.Methods: This was a retrospective interventional study of 10 eyes in eight patients who underwent surgical treatment of idiopathic macular holes using pars plana vitrectomy, ILM peeling using Brilliant Blue dye, and silicone oil tamponade without postoperative posturing. The preoperative staging of macular holes and postoperative anatomic outcomes were assessed using spectral-domain optical coherence tomography.Results: All patients were women with a mean age of 66.86 ± 4.8 years. In two patients, bilateral macular holes were present and both eyes were operated on. Stage 2 macular hole was diagnosed in three eyes, three eyes had stage 3, and four eyes had stage 4 macular holes. Anatomical success and closure of the macular hole was achieved in nine eyes (90% after one operation. In one eye, the macular hole was closed after reoperation. The preoperative mean best-corrected visual acuity (BCVA was 0.15 decimal units (0.8 logMAR units. Until the end of the follow-up period, BCVA was 0.25 decimal units (0.6 logMAR units. Visual acuity was improved in seven patients (70%. In two patients (20%, visual acuity remained at the same level, and in one eye (10%, visual acuity decreased. Postoperatively, all patients reported a significant reduction of metamorphopsia.Conclusion: Initial results after 20G pars plana vitrectomy with peeling of the ILM, use of dye (Brilliant Blue, and tamponade with silicone oil without postoperative posturing gave good anatomical and functional

  7. Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters.

    Science.gov (United States)

    Kayashima, Kenji

    2015-12-01

    Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95% CI 29.3-9,877, p tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.

  8. Eosinophilic Endomyocarditis Combined With Pericardial and Pleural Effusion

    OpenAIRE

    You, Sung-Hye; Hong, Soon Jun; Ahn, Chul Min; Lim, Do-Sun

    2009-01-01

    Eosinophilic endomyocarditis is a manifestation of hypereosinophilic syndrome, characterized by prolonged (>6 months), unexplained peripheral blood eosinophilia (>1,500 cells/mm3) with end-organ damage in unknown causes. We report a case of a 42-year-old patient who developed eosinophilic endomyocarditis following upper respiratory tract symptoms for 2 months. Additionally, endomyocarditis was combined with massive pleural effusion and pericardial effusion, which have not been reported in Korea.

  9. Atypical presentation of Boerhaave's syndrome as Enterococcal bacterial pericardial effusion.

    Science.gov (United States)

    Saha, Arin; Jarvis, Martin; Thorpe, James A C; O'Regan, David J

    2007-02-01

    Boerhaave's perforation is a serious condition describing spontaneous transmural perforation of the oesophagus. The classical presentation of this condition is vomiting, lower thoracic pain and subcutaneous emphysema. However, the condition often presents atypically and it is important to reach the correct diagnosis quickly. We present the case of a 54-year-old woman with a Boerhaave's perforation that presented as Enterococcal bacterial pericardial effusion.

  10. Autopsy imaging for cardiac tamponade in a Thoroughbred foal

    OpenAIRE

    YAMADA, Kazutaka; Sato, Fumio; HORIUCHI, Noriyuki; HIGUCHI, Tohru; KOBAYASHI, Yoshiyasu; SASAKI, Naoki; NAMBO, Yasuo

    2016-01-01

    ABSTRACT Autopsy imaging (Ai), postmortem imaging before necropsy, is used in human forensic medicine. Ai was performed using computed tomography (CT) for a 1-month-old Thoroughbred foal cadaver found in a pasture. CT revealed pericardial effusion, collapse of the aorta, bleeding in the lung lobe, gas in the ventricles and liver parenchyma, and distension of the digestive tract. Rupture in the left auricle was confirmed by necropsy; however, it was not depicted on CT. Therefore, Ai and conven...

  11. Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

    OpenAIRE

    Praneet Iyer; Ahmed Dirweesh; Ritika Zijoo

    2017-01-01

    Drug induced lupus erythematosus (DIL or DILE) is an autoimmune disorder caused by chronic use of certain drugs. We report a unique case of hydralazine induced lupus syndrome (HILS) with a negative antinuclear antibody in a female patient who was on hydralazine for a period of 1.5–2 years and developed recurrent pericardial effusion as a result of it. Initially her condition was managed with a pericardial window. The recurrence of a massive pericardial effusion necessitated a right hemiperica...

  12. 心脏介入手术并发心脏压塞的术中配合%COOPERATION OF CARDIAC TAMPONADE COMPLI CATING CARDIAC INTERVENTION OPERATION

    Institute of Scientific and Technical Information of China (English)

    陶红; 王艳

    2011-01-01

    [Objective] To sum up 8 cases of cardiac tamponade complicating cardiac interventional operation, analyze the probable causes, and observe the clinical manifestation and the result of treatment. [Methods] 3 228 patients underwent cardiac interventional operations, 8 had cardiac tamponade. There were S men and 3 women with mean age of (52±21) years. 3 of the 8 patients were caused by percutaneous transluminal coronary angioplasty, 3 by percutaneous balloon mitral valvulo-plasty and 2 by catheter mapping and radiofrequency catheter ablation. [Results] The hemodynamics was stable in 6 cases after emergency pericardial puncture with 150-500ml drainage. 2 cases were performed surgical repair because of the massive bleeding and one patient was dead because of cardiac perforation. [Conclusion] Cardiac tamponade is one of the most serious complications during cardiac interventional operations. Early detection, timely diagnosis and immediately proper managements are very important%[目的]总结8例心脏介入性手术并发心脏压塞的病例,分析其可能的原因、临床表现以及其治疗结果.[方法]3 228例心脏介入性手术发生8例心脏压塞,男性5例,女性3例,平均年龄(52±21)岁,其中3例与经皮冠状动脉内成形术有关,3例与经皮二尖瓣球囊成形术有关,2例与导管标测和射频消融术有关. [结果]6例经立即心包穿刺抽液150~500 ml病情稳定,2例因为出血量大进行了外科手术,其中1例因为心脏穿孔无法缝合裂口死亡.[结论]心脏压塞是心脏介入性手术的严重并发症,早期发现、及时诊断和果断处理十分重要.

  13. Thoracoscopic pericardial drainage for gastric tube ulcer penetrated into the pericardium.

    Science.gov (United States)

    Watanabe, Masayuki; Matsuura, Koki; Baba, Hideo; Yoshizumi, Tomoharu; Ikegami, Toru; Soejima, Yuji; Ikeda, Tetsuo; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo-ichi; Morita, Masaru; Oki, Eiji; Mimori, Koshi; Sugimachi, Keishi; Saeki, Hiroshi; Maehara, Yoshihiko

    2013-10-01

    Peptic ulcer occurring in the gastric conduit for esophageal reconstruction sometimes penetrates into the mediastinal structures. We herein reported a case of pericardial penetration of gastric tube ulcer successfully treated with thoracoscopic pericardial drainage. A 66-year-old Japanese man, who had undergone esophagectomy for esophageal cancer 20 months before, visited our emergency room complaining severe back pain. Computed tomography revealed gastric tube ulcer penetrated into the pericardial space. Thoracoscopic pericardiotomy and drainage was performed and the patient made an uneventful recovery. Thoracoscopic pericardial drainage is useful to manage acute pyogenic pericarditis due to penetration of peptic ulcer which occurred in the gastric tube.

  14. Giant pericardial cyst in a 5-year-old child: A rare anomaly

    Directory of Open Access Journals (Sweden)

    Kumar Sanjay

    2011-01-01

    Full Text Available Pericardial cysts are uncommon congenital abnormalities that occur in the middle mediastinum. Most of these are found incidentally on chest x-rays. The occurrence of pericardial cyst in children is quite rare. It needs to be differentiated from other cystic mediastinal masses. A rare case of pericardial cyst in a 5 year old male child is reported. The child presented with chest pain, cough and fever. The preoperative diagnosis of pericardial cyst was suggestive on echocardiography and CT scan. It was confirmed on histopathology after successful surgical excision. The rarity of this benign mediastinal lesion in children prompted us to report this case.

  15. Luminescent Lanthanide Cyclen-Based Enzymatic Assay Capable of Diagnosing the Onset of Catheter-Associated Urinary Tract Infections Both in Solution and within Polymeric Hydrogels.

    Science.gov (United States)

    Surender, Esther M; Bradberry, Samuel J; Bright, Sandra A; McCoy, Colin P; Williams, D Clive; Gunnlaugsson, Thorfinnur

    2017-01-11

    Herein we present a supramolecular (delayed luminescent) Eu(III)-based pH-responsive probe/sensor with the ability to detect the urease-mediated hydrolysis of urea in aqueous solution. A series of photophysical titrations show this Eu(III) chelate behaves as an "on-off" luminescent switching probe, with its luminescence being quenched upon urea being enzymatically converted into ammonia and carbon dioxide. Calculation of the rate constant (k) and activation energy (Ea) for this hydrolysis reaction are detailed; the results demonstrate a direct observation of enzymatic activity in solution by the sensor. The potential application of this probe in detecting the onset of catheter-associated urinary tract infections (CAUTIs) is also demonstrated by incorporating 1.Eu into water-permeable hydrogels that can be utilized as an alternative coating for catheters.

  16. Efficacy of Vitrectomy Combined with Subretinal rtPA Injection with Gas or Air Tamponade.

    Science.gov (United States)

    Waizel, M; Todorova, M G; Rickmann, A; Blanke, B R; Szurman, P

    2017-01-31

    Background Functional and anatomical outcome after vitrectomy with rtPA combined with gas or air tamponade. Patients and methods Retrospective analysis of pseudophakic patients treated with subretinal rtPA and gas or air tamponade. The primary endpoint was displacement of haemorrhage six months after surgery. The secondary endpoints were visual acuity (BCVA), haemorrhage diameter (MHD) and central macular thickness (CMT), as measured by SD-OCT. Results 53 of 85 eyes were pseudophakic. 27 of these eyes were treated with air tamponade and 26 with gas tamponade. For patients with air tamponade, the mean BCVA improved from 20/530 to 20/355 (p = 0.01). MHD and CMT decreased from 6386 ± 2281 µm to 3805 ± 2397 µm (p tamponade, the mean BCVA improved only slightly, from 20/471 to 20/394 (p = 0.17). MHD and CMT exhibited statistically significant decreases from 6759 ± 1773 µm to 3525 ± 1548 µm (p tamponade.

  17. Calculating the respiratory flow velocity fluctuations in pericardial diseases.

    Science.gov (United States)

    Siniorakis, Eftychios; Arvanitakis, Spyridon; Zarreas, Elias; Barlagiannis, Dimitris; Skandalakis, Nikos; Karidis, Constantinos

    2010-11-01

    An excessive respiratory fluctuation (RTFV) in transmitral early diastolic velocity E is a pivotal Doppler echocardiographic sign of haemodynamic compromise, in constrictive pericardial diseases. RTFV is expressed as a percentage and 25% is considered a threshold value. Unfortunately there is no unanimity in calculating RTFV. Sometimes it is expressed as a percentage of expiratory E velocity, while others of inspiratory E velocity. This disparity has led to gross misinterpretations in medical literature. Here we emphasize the importance of a rational procedure calculating RTFV and we propose the appropriate mathematical model.

  18. Myopericarditis and Pericardial Effusion as the Initial Presentation of Systemic Lupus Erythematosus

    Science.gov (United States)

    Quadri, Ahmed; Shaikh, Atif; Ayala-Rodriguez, Ceasar; Green, Stuart

    2017-01-01

    Myopericarditis with a pericardial effusion as the initial presenting feature of SLE is uncommon. We report an unusual case of myopericarditis and pericardial effusion with subsequent heart failure, as the initial manifestation of SLE. The timely recognition and early steroid administration are imperative in SLE-related myopericarditis with cardiomyopathy to prevent the mortality associated with this condition. PMID:28261271

  19. Thoracoscopic monitoring for pericardial application of local drug or gene therapy

    NARCIS (Netherlands)

    Tio, RA; Grandjean, JG; Suurmeijer, AJH; van Gilst, WH; van Veldhuisen, DJ; van Boven, AJ

    2002-01-01

    Cardiovascular gene therapy is a promising new approach for a variety of diseases. As far as gene therapy aimed at the myocardium is concerned a new transcutaneous delivery method may be into the pericardial sac. Objective: To evaluate the safety and applicability of the percutaneous pericardial del

  20. A Rare Case of Situs Inversus with Dextrocardia, Lutembacher Syndrome, and Pericardial Effusion

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    Vishakha V Jain

    2011-01-01

    Full Text Available Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is low as compared to congenital cardiac anomalies in isolated dextrocardia. We describe the first ever case of situs inversus with dextrocardia, Lutembacher′s syndrome, and pericardial effusion. The pericardial effusion in our case was acquired and was tubercular in etiology.

  1. Acute fatal pericardial effusion induced by accidental ingestion of cigarette butts in a dog.

    Science.gov (United States)

    Kim, Jung-Hyun; Lim, Jae-Hyun

    2016-02-01

    A dog was referred for collapse and tachypnea after ingesting cigarette butts. Thoracic radiography and echocardiography indicated pericardial effusion, and an electrocardiogram showed tachycardia, variable QRS complexes, and ventricular premature complexes. This is the first description of fatal pericardial effusion associated with cigarette butt ingestion in a veterinary patient.

  2. European Guidelines on Pericardial Diseases: a Focused Review of Novel Aspects.

    Science.gov (United States)

    Fardman, Alexander; Charron, Philippe; Imazio, Massimo; Adler, Yehuda

    2016-05-01

    Pericardial diseases are not uncommon in daily clinical practice. The spectrum of these syndromes includes acute and chronic pericarditis, pericardial effusion, constrictive pericarditis, congenital defects, and neoplasms. The extent of the high-quality evidence on pericardial diseases has expanded significantly since the first international guidelines on pericardial disease management were published by the European Society of Cardiology in 2004. The clinical practice guidelines provide a useful reference for physicians in selecting the best management strategy for an individual patient by summarizing the current state of knowledge in a particular field. The new clinical guidelines on the diagnosis and management of pericardial diseases that have been published by the European Society of Cardiology in 2015 represent such a tool and focus on assisting the physicians in their daily clinical practice. The aim of this review is to outline and emphasize the most clinically relevant new aspects of the current guidelines as compared with its previous version published in 2004.

  3. Condom Tamponade in the Management of Primary Postpartum Haemorrhage: A Report of three cases in Ghana.

    Science.gov (United States)

    Maya, Ernest T; Buntugu, Kennedy A; Aki, Lovelace; Srofenyoh, Emmanuel K

    2015-09-01

    Postpartum haemorrhage is one of the major causes of maternal mortality worldwide. The leading cause of primary postpartum haemorrhage is uterine atony and active management of the third stage of labour with oxytocin is recommended for preventing primary postpartum haemorrhage. Parenteral oxytocin is also the drug of choice for medical management of postpartum haemorrhage secondary to uterine atony. Condom uterine balloon tamponade is .a low cost technique that can be used as a second-line option for treatment. We report retrospectively three cases of primary PPH secondary to uterine atony which were managed successfully with condom tamponade. Condom tamponade is effective in managing post partum haemorrhage secondary to uterine atony and we advocate for the training of all skilled attendants on how to insert the condom tamponade.

  4. Bilateral hydrothorax and cardiac tamponade after right subclavian vein catheterization -A case report-

    OpenAIRE

    Kim, Myoung Hwa; Lee, Dong-Jun; Kim, Mun Chul

    2010-01-01

    Central venous catheterization is typically used for the anesthetic management of patients undergoing a major surgery or care of patients in Intensive Care Unit (ICU). The occurrence of complications associated with central venous catheterization such as pneumothorax or vascular injury have decreased, while delayed complications such as hydrothorax, hydromediastinum, or cardiac tamponade have risen recently. We report a case of complications of bilateral hydrothorax with cardiac tamponade by ...

  5. Tamponade or Filling Effect: Changes of Forces in Myopic Eyes

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    Francesco Semeraro

    2014-01-01

    Full Text Available Myopia is the most common ocular abnormality. Its high and growing prevalence has contributed to a recent surge in surgical interest in the disorder, since retinal detachment in eyes with high myopia differs from that in emmetropic eyes or eyes with low myopia. The myopic eye, because of its specific anatomy, poses special challenges that need to be overcome to ensure the appropriate use of vitreous substitutes. However, intraocular tamponades have shown great potential for revolutionizing retinal detachment surgery and vitreomacular surgery in general in myopic eyes. We provide an updated review of the clinical use of vitreous substitutes in the myopic eye, paying particular attention to analyzing the ideal function of endotamponade agents and comparing the effects of these agents on the physical and biological properties of the eye.

  6. Pattern specification and immune response transcriptional signatures of pericardial and subcutaneous adipose tissue.

    Directory of Open Access Journals (Sweden)

    Frank H Lau

    Full Text Available Cardiovascular disease (CVD remains the leading cause of morbidity and mortality in the United States. Recent studies suggest that pericardial adipose tissue (PCAT secretes inflammatory factors that contribute to the development of CVD. To better characterize the role of PCAT in the pathogenesis of disease, we performed a large-scale unbiased analysis of the transcriptional differences between PCAT and subcutaneous adipose tissue, analysing 53 microarrays across 19 individuals. As it was unknown whether PCAT-secreted factors are produced by adipocytes or cells in the supporting stromal fraction, we also sought to identify differentially expressed genes in isolated pericardial adipocytes vs. isolated subcutaneous adipocytes. Using microarray analysis, we found that: 1 pericardial adipose tissue and isolated pericardial adipocytes both overexpress atherosclerosis-promoting chemokines and 2 pericardial and subcutaneous fat depots, as well as isolated pericardial adipocytes and subcutaneous adipocytes, express specific patterns of homeobox genes. In contrast, a core set of lipid processing genes showed no significant overlap with differentially expressed transcripts. These depot-specific homeobox signatures and transcriptional profiles strongly suggest different functional roles for the pericardial and subcutaneous adipose depots. Further characterization of these inter-depot differences should be a research priority.

  7. Pattern specification and immune response transcriptional signatures of pericardial and subcutaneous adipose tissue.

    Science.gov (United States)

    Lau, Frank H; Deo, Rahul C; Mowrer, Gregory; Caplin, Joshua; Ahfeldt, Tim; Kaplan, Adam; Ptaszek, Leon; Walker, Jennifer D; Rosengard, Bruce R; Cowan, Chad A

    2011-01-01

    Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Recent studies suggest that pericardial adipose tissue (PCAT) secretes inflammatory factors that contribute to the development of CVD. To better characterize the role of PCAT in the pathogenesis of disease, we performed a large-scale unbiased analysis of the transcriptional differences between PCAT and subcutaneous adipose tissue, analysing 53 microarrays across 19 individuals. As it was unknown whether PCAT-secreted factors are produced by adipocytes or cells in the supporting stromal fraction, we also sought to identify differentially expressed genes in isolated pericardial adipocytes vs. isolated subcutaneous adipocytes. Using microarray analysis, we found that: 1) pericardial adipose tissue and isolated pericardial adipocytes both overexpress atherosclerosis-promoting chemokines and 2) pericardial and subcutaneous fat depots, as well as isolated pericardial adipocytes and subcutaneous adipocytes, express specific patterns of homeobox genes. In contrast, a core set of lipid processing genes showed no significant overlap with differentially expressed transcripts. These depot-specific homeobox signatures and transcriptional profiles strongly suggest different functional roles for the pericardial and subcutaneous adipose depots. Further characterization of these inter-depot differences should be a research priority.

  8. Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

    Directory of Open Access Journals (Sweden)

    Daiane Silva Resende

    2011-12-01

    Full Text Available INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7% CA-BSIs were observed. There were 46 (32% episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]. Neonates in the group after implementation of the intervention had 21 (19.6% episodes of CA-BSI (14.9 per 1,000 CVC days. The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04. In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

  9. 导尿管相关性泌尿系感染的研究%Clinical Analysis of Guide Catheter Associated Urinary System Infection

    Institute of Scientific and Technical Information of China (English)

    韩静

    2015-01-01

    Urethral catheterization and catheterization technique of diagnosis and nursing measures are the most common, due to dif iculty in urination and other reasons need retention catheterization, subject to the asepsis operating rules, as far as possible to shorten the catheter retention time, strengthening of routine maintenance of urinary catheter, improve the monitoring measures, the sterile principle runs through the whole process of indwel ing catheter prevention is an important measure guided catheter associated urinary tract infection.%导尿术及留置导尿是最常见的诊疗技术和护理措施,因排尿困难及其他原因需要保留导尿时,在遵循无菌操作规程前提下,尽可能缩短尿管保留时间,加强导尿管的日常维护,完善各项监测措施,将无菌原则贯穿保留尿管的全过程是预防发生导尿管相关性泌尿系感染的重要措施。

  10. Risk factors for central venous catheter-associated infections and prevention countermeasures%中心静脉导管感染因素及预防对策

    Institute of Scientific and Technical Information of China (English)

    夏雷; 郭小文; 叶素凤; 王美美; 洪钘钘

    2014-01-01

    OBJECTIVE To explore the risk factors for central venous catheter-associated infections and put forward prevention countermeasures in response to the risk factors so as to provide guidance for prevention of the central venous catheter-associated infections .METHODS A total of 85 patients who underwent central venous catheter indwelling from Jan 2012 to Apr 2013 were recruited in the study ,then all the patients were treated with ultra-sound-guided central venous catheter indwelling ,the bacterial culture was performed for ends of catheters of the patients with suspected infections after the treatment ,the relevant data were analyzed ,the related factors for cen-tral venous catheter-associated infections were explored ,and the statistical analysis was performed with the use of SPSS 17 .0 software .RESULTS The bacteriological examination was positive in 12 of 85 patients who underwent the central venous catheter indwelling ,with the infection rate of 14 .12% .The infections occurred in 6 of 69 patients who got the successful puncture catheterization for one time ,with the infection rate of 8 .70% ;the infec-tions occurred in 6 of 16 patients who got the successful puncture catheterization for many times ,with the infection rate of 37 .50% ;the infection rate was significantly lower in the patients who got the successful puncture catheter-ization for one time than in those who got the successful puncture catheterization for many times .There was sig-nificant difference in the infection rate between the patients with different catheterization sites ,catheter indwelling time ,or types of catheter (P<0 .05) .CONCLUSION The incidence of central venous catheter-associated infec-tions is closely related to the frequency of puncture ,catheterization sites ,catheter indwelling time ,and types of catheter .It is necessary to pay attention to the proficiency of operation procedures ,choose appropriate probes and types of catheter as well as puncture sites ,and implement aseptic

  11. Long term result of silicone oil versus gas tamponade in the treatment of traumatic macular holes

    Directory of Open Access Journals (Sweden)

    Ghoraba HH

    2012-01-01

    Full Text Available Hammouda H Ghoraba1, Amin F Ellakwa2, Ali A Ghali31Tanta University, Magrabi Eye Hospital, Tanta, Egypt; 2Menoufiya University, Shebin Elkom, Menoufiya, Egypt; 3Alazhar University, Damitta, EgyptPurpose: To compare the effectiveness of pars plana vitrectomy (PPV with either silicone oil or gas tamponade for the treatment of traumatic macular holes.Methods: A retrospective comparative study included 22 patients who were operated on by PPV for repair of traumatic macular holes with either silicone oil tamponade (nine patients or perfluoropropane (C3F8 gas tamponade (13 patients.Results: Twenty-two cases were reviewed to assess the anatomical and visual outcomes of surgery with silicone oil tamponade in nine cases (40.9% vs 14% C3F8 gas tamponade in 13 cases (59.1%. The age of the silicone oil-treated patients ranged from 10 to 40 years (mean 27.4 ± 11.3 years, while that of the gas-treated patients ranged from 19 to 35 years (mean 26.54 ± 5.68 years. Female patients accounted for 33.3% of the silicone oil group and 30.77% of the gas-treated group. The minimal follow-up time for the silicone oil-treated group was 13 months, with a maximum of 18 months after silicone oil removal. The minimal follow-up time for the gas-treated group was 12 months and the maximum was 24 months. The rate of hole closure after the primary operation with oil tamponade was significantly lower than that with gas tamponade (66.67% vs 92.3%; P = 0.022. With re-operations, the final rate of hole closure was higher in the gas group (100% than in the silicone oil group (77.8%. The final postoperative decimal visual acuity for the gas group was significantly better than for the oil group (0.433 vs 0.245; P = 0.047.Conclusions: C3F8 gas was a more effective tamponade than silicone oil in achieving initial closure of traumatic macular holes. Eyes receiving an oil tamponade required significantly more re-operations to achieve hole closure than did eyes undergoing a gas tamponade

  12. Recurrent hemorrhagic pericardial effusion in a child due to diffuse lymphangiohemangiomatosis: a case report

    Directory of Open Access Journals (Sweden)

    Bakhshi Sameer

    2010-02-01

    Full Text Available Abstract Introduction Recurrent hemorrhagic pericardial effusion in children with no identifiable cause is a rare presentation. Case presentation We report the case of a 4-year-old Indian girl who presented with recurrent hemorrhagic pericardial effusion. Diffuse lymphangiomatosis was suspected when associated pulmonary involvement, soft tissue mediastinal mass, and lytic bone lesions were found. Pericardiectomy and lung biopsy confirmed the diagnosis of diffuse lymphangiohemangiomatosis. Partial clinical improvement occurred with thalidomide and low-dose radiotherapy, but our patient died from progressive respiratory failure. Conclusion Diffuse lymphangiohemangiomatosis should be considered in the differential diagnosis of hemorrhagic pericardial effusion of unclear cause.

  13. Resolution of isolated large fetal pericardial effusion after delivery

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    Amar M Taksande

    2016-01-01

    Full Text Available Pericardial effusion (PE is detectable during routine obstetric ultrasonography. PE is the result of the same mechanism that produces fetal hydrops. Structural cardiac malformations and fetal cardiac arrhythmias are the most common cause of nonimmune hydrops. A male infant weighing 2300 g was born by through elective cesarean section. Isolated large PE was detected in a fetus at 34 weeks of gestation. The women delivered a male neonate at 37 weeks period of gestation through elective cesarean section. Baby cried immediately after birth with APGAR score 7, 9, 10 at 1, 5, and 10 min, respectively. Though the mother condition was stable. The baby was shifted to special care neonatal unit in view of for respiratory distress and severe grunt. Neonatal echocardiography showed trivial tricuspid regurgitation with no PE. Most fetal PEs resolve and fetuses with isolated PEs have a good prognosis.

  14. Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction.

    Science.gov (United States)

    Tigen, Elif T; Sari, Ibrahim; Ak, Koray; Sert, Sena; Tigen, Kursat; Korten, Volkan

    2015-08-01

    Purulent pericardial effusion, although rare, is a life-threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune-suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

  15. Prevention and control of catheter-associated urinary tract infections – implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in nursing homes for the elderly in Frankfurt am Main, Germany

    OpenAIRE

    Heudorf, U; Gasteyer, S.; Müller, M.; Samoiski, Y; Serra, N.; Westphal, T

    2016-01-01

    Introduction: Urinary tract infections range among the most frequent infections not only in hospital patients but also in residents of long-term care facilities for the elderly. Urinary catheters are the greatest risk factor for urinary tract infections. In the guidance paper on the "prevention of infections in nursing homes" (2005) as well as in the updated recommendations for the "prevention and control of catheter-associated urinary tract infections" (2015), the Commission for Hospital Hy...

  16. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO) recommendations “Prevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany

    OpenAIRE

    Heudorf, Ursel; Grünewald, Miriam; Otto, Ulla

    2016-01-01

    Aim: The Commission for Hospital Hygiene and Infection Prevention (KRINKO) updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt's hospitals in autumn, 2015.Material and methods : In two non-ICU wards of each of Frankfurt's 17 hospitals, inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of 5 wa...

  17. STUDY OF AGE, SEX AND ETIOLOGIC SPECTRUM OF PERICARDIAL EFFUSION IN TERTIARY CARE HOSPITAL

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    Ravikaladhar Reddy

    2015-10-01

    Full Text Available Pericardial effusion is perhaps one of the most commonly overlooked clinical conditions and definite establishment of etiological agent is not always easy, successful or satisfactory. In this study, 50 cases of pericardial effusion admitted in Medical wards were analysed with emphasis on pattern of age and gender distribution, clinical presentation and et iology. The incidence of pericardial effusion common in age group between 21 - 40 years. The incidence of pericardial effusion is more in males. In the present study, the youngest patient is 15 year old and the oldest is 62 year old. Breathlessness being com monest symptom and raised JVP Is commonest sign. 60% of cases are of tuberculosis etiology, 15% are due to uremia and malignancy each, and 5% due to collagen vascular disease

  18. [Loculated pericardial effusion leading to functional tricuspid stenosis in a case of rheumatoid arthritis].

    Science.gov (United States)

    Galli, C A; Alimento, M; Pepi, M

    1995-09-01

    We describe a case of loculated pericardial effusion, occurring in a women affected by rheumatoid arthritis. Because of its peculiar location, close to the atrioventricular plane, the effusion caused a haemodynamic pattern resembling tricuspid valve stenosis.

  19. Pericardial fat and myocardial perfusion in asymptomatic adults from the Multi-Ethnic Study of Atherosclerosis.

    Directory of Open Access Journals (Sweden)

    Tina E Brinkley

    Full Text Available BACKGROUND: Pericardial fat has adverse effects on the surrounding vasculature. Previous studies suggest that pericardial fat may contribute to myocardial ischemia in symptomatic individuals. However, it is unknown if pericardial fat has similar effects in asymptomatic individuals. METHODS: We determined the association between pericardial fat and myocardial blood flow (MBF in 214 adults with no prior history of cardiovascular disease from the Minnesota field center of the Multi-Ethnic Study of Atherosclerosis (43% female, 56% Caucasian, 44% Hispanic. Pericardial fat volume was measured by computed tomography. MBF was measured by MRI at rest and during adenosine-induced hyperemia. Myocardial perfusion reserve (PR was calculated as the ratio of hyperemic to resting MBF. RESULTS: Gender-stratified analyses revealed significant differences between men and women including less pericardial fat (71.9±31.3 vs. 105.2±57.5 cm(3, p<0.0001 and higher resting MBF (1.12±0.23 vs. 0.93±0.19 ml/min/g, p<0.0001, hyperemic MBF (3.49±0.76 vs. 2.65±0.72 ml/min/g, p<0.0001, and PR (3.19±0.78 vs. 2.93±0.89, p = 0.03 in women. Correlations between pericardial fat and clinical and hemodynamic variables were stronger in women. In women only (p = 0.01 for gender interaction higher pericardial fat was associated with higher resting MBF (p = 0.008. However, this association was attenuated after accounting for body mass index or rate-pressure product. There were no significant associations between pericardial fat and hyperemic MBF or PR after multivariate adjustment in either gender. In logistic regression analyses there was also no association between impaired coronary vasoreactivity, defined as having a PR <2.5, and pericardial fat in men (OR, 1.18; 95% CI, 0.82-1.70 or women (OR, 1.11; 95% CI, 0.68-1.82. CONCLUSIONS: Our data fail to support an independent association between pericardial fat and myocardial perfusion in adults without symptomatic

  20. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference?

    Science.gov (United States)

    Haifler, Miki; Mor, Yoram; Dotan, Zohar; Ramon, Jacob; Zilberman, Dorit E

    2016-12-16

    We sought to evaluate the effectiveness of the American Urological Association (AUA) antibiotic prophylaxis guidelines in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). Our prospective registry database was reviewed for all RALP cases. The following variables were evaluated: age, associated comorbidities, body mass index (BMI), total operative time, length of stay (LOS), prostate weight, pathological grade and stage. Until 11/2011, RALP patients were treated with antibiotics administered in the operating room and continued until urethral catheter removal. Since 11/2011, all patients were treated with a single intravenous dose of Cephalosporin and Aminoglycoside given within 30 min of surgical incision. The rate of catheter-associated urinary tract infection (CAUTI) was evaluated in both groups. 229 RALP patients were identified. The first 60 patients (26.2%) were treated according to the old protocol (Group 1) while the remaining 169 (73.8%) were treated according to the new protocol (Group 2). Group match was identified in all categories but LOS. Moreover, LOS was found to be longer in Group 1 compared with Group 2 (5.8 vs. 4.5 days, p < 0.001). CAUTI rate was similar in both groups (8.3 vs. 8.9%, respectively, p = 0.89). Logistic regression analysis did not demonstrate any association between treatment protocol and potential risk for CAUTI. Therefore, a single preoperative dose of antibiotics does not increase the rate of CAUTI following RALP compared with prolonged antibiotic treatment. Moreover, it was found to be associated with shorter LOS. Complying with the AUA guidelines may reduce morbidity and medical costs.

  1. A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing".

    Science.gov (United States)

    Mullin, Katherine M; Kovacs, Christopher S; Fatica, Cynthia; Einloth, Colette; Neuner, Elizabeth A; Guzman, Jorge A; Kaiser, Eric; Menon, Venu; Castillo, Leticia; Popovich, Marc J; Manno, Edward M; Gordon, Steven M; Fraser, Thomas G

    2017-02-01

    BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2017;38:186-188.

  2. Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

    OpenAIRE

    Mousavi Negareh; Czarnecki Andrew; Zeglinski Matthew; Du Joe; Sud Maneesh; Walker Jonathon R; Raja Asam; Jassal Davinder S; Kirkpatrick Iain DC

    2011-01-01

    Abstract Introduction Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts...

  3. Symptomatic pericardial schwannoma treated with video-assisted thoracic surgery: a case report

    Science.gov (United States)

    Yun, Po-Jen; Huang, Tsai-Wang; Li, Yao-Feng; Chang, Hung; Lee, Shih-Chun

    2016-01-01

    Intrathoracic schwannomas are neurogenic tumors derived from the Schwann cells of the nerve sheath, most often seen in the posterior mediastinum with anatomical correlations to nerves. Although they are typically benign, a malignant transformation can occur, and thoracotomy instead of video-assisted thoracoscopic surgery (VATS) is required to achieve a complete resection. Only a few cases of pericardial schwannoma have been reported so far. We present a rare case of pericardial schwannoma confirmed by video-assisted thoracoscopic resection. PMID:27162698

  4. 23-gauge vitrectomy and silicone oil tamponade with and without phacoemulsification in rhegmatogenous retinal detachment.

    Science.gov (United States)

    Ozkan, Seyhan Sonar; Citirik, Mehmet; Beyazyildiz, Emrullah; Beyazyildiz, Ozlem

    2015-01-01

    The aim of this study is to assess clinical outcomes of 23-gauge vitrectomy and silicone oil (SO) tamponade combined with and without phacoemulsification (PE) in rhegmatogenous retinal detachment (RRD). The study included forty eyes of 40 patients that underwent 23-gauge vitrectomy and SO tamponade combined with and without PE. Twenty eyes of 20 cases, of whom underwent 23-gauge vitrectomy and SO tamponade combined with PE were allocated to the group 1. Likewise, 20 eyes of 20 cases that underwent 23-gauge vitrectomy and SO tamponade alone were allocated to the group 2. Best corrected visual acuity (BCVA) between two groups was compared. There was no significant difference in BCVA between the two groups during the 6 months (P = 0.3). Recurrent retinal detachments were observed in 2 cases (10%) in both groups. There was no statistically significant difference between two groups as a point of recurrent retinal detachments (P = 1). We have found higher rates of post-vitrectomy cataract progression (45%) in the eyes with RRD who underwent 23-gauge vitrectomy and SO tamponade. Combined vitrectomy and PE is safe and effective for the patients with RRD.

  5. A Rare And Life Threatening Complication Of Percutaneously Inserted Central Venous Catheters: Cardiac Tamponade.

    Directory of Open Access Journals (Sweden)

    seyma Kayali

    2016-09-01

    Full Text Available Percutaneously inserted central venous catheters are commonly used to provide parenteral nutrition for premature neonates. This study presents report of two preterm neonates who developed pericardial effusion resulting from osmotic damage of parenteral nutrition. When a neonate with percutaneously inserted central venous catheter clinical status worsens a high index of clinical suspicion for diagnosing pericardial effusion and immediate treatment might be life saving. [J Contemp Med 2016; 6(3.000: 226-230

  6. Prevalence, hemodynamics, and cytokine profile of effusive-constrictive pericarditis in patients with tuberculous pericardial effusion.

    Directory of Open Access Journals (Sweden)

    Mpiko Ntsekhe

    Full Text Available BACKGROUND: Effusive constrictive pericarditis (ECP is visceral constriction in conjunction with compressive pericardial effusion. The prevalence of proven tuberculous ECP is unknown. Whilst ECP is distinguished from effusive disease on hemodynamic grounds, it is unknown whether effusive-constrictive physiology has a distinct cytokine profile. We conducted a prospective study of prevalence and cytokine profile of effusive-constrictive disease in patients with tuberculous pericardial effusion. METHODS: From July 2006 through July 2009, the prevalence of ECP and serum and pericardial levels of inflammatory cytokines were determined in adults with tuberculous pericardial effusion. The diagnosis of ECP was made by combined pericardiocentesis and cardiac catheterization. RESULTS: Of 91 patients evaluated, 68 had tuberculous pericarditis. The 36/68 patients (52.9%; 95% confidence interval [CI]: 41.2-65.4 with ECP were younger (29 versus 37 years, P=0.02, had a higher pre-pericardiocentesis right atrial pressure (17.0 versus 10.0 mmHg, P 15 mmHg (odds ratio [OR] = 48, 95%CI: 8.7-265; P 200 pg/ml (OR=10, 95%CI: 1.1, 93; P=0.04 were independently associated with ECP. CONCLUSION: Effusive-constrictive disease occurs in half of cases of tuberculous pericardial effusion, and is characterized by greater elevation in the pre-pericardiocentesis right atrial pressure and pericardial and serum IL-10 levels compared to patients with effusive non-constrictive tuberculous pericarditis.

  7. Pericardial and pericardioperitoneal canal relationships to cardiac function in the white sturgeon (Acipenser transmontanus).

    Science.gov (United States)

    Gregory, Joshua A; Graham, Jeffrey B; Cech, Joseph J; Dalton, Nancy; Michaels, Jim; Chin Lai, N

    2004-06-01

    Sturgeons are primitive bony fishes and their hearts have structural features found in other primitive fishes. Sturgeons have a pericardioperitoneal canal (PPC), a one-way conduit into the peritoneum. A PPC also occurs in elasmobranchs (sharks and rays) and studies with that group demonstrate that pericardial pressure and pericardial fluid loss via the PPC affect stroke volume. A study of white sturgeon (Acipenser transmontanus) heart function was conducted to test for a comparable PPC and pericardial effects. White sturgeon-elasmobranch heart-function similarities include biphasic ventricular filling, a comparable operational pericardial pressure (-0.03 kPa), and a strongly negative pressure (-0.2 to -0.6 kPa) with complete pericardial fluid withdrawal. Differences include the white sturgeon's relatively smaller atrium and ventricle but a larger conus arteriosus. Although white sturgeon heart size is also smaller, its pericardial volume is disproportionately less (2.4 to 2.7 vs. 3.5 to 5.4 ml kg(-1) in elasmobranchs), meaning it has less scope for increasing stroke volume upon PPC fluid release. These differences may reflect the phylogenetic progression from the less complex operation of the elasmobranch heart, which lacks sympathetic innervation and has a mechanically mediated (PPC) stroke volume, to the condition in the more derived bony fishes which have sympathetic and parasympathetic regulation of both stroke volume and heart rate.

  8. Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

    Directory of Open Access Journals (Sweden)

    Mousavi Negareh

    2011-09-01

    Full Text Available Abstract Introduction Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described. Case presentation We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water. Conclusion This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive.

  9. Life-Threatening Cardiac Tamponade Secondary to Chylopericardium Following Orthotopic Heart Transplantation-A Case Report.

    Science.gov (United States)

    Wierzbicki, Karol; Mazur, Piotr; Węgrzyn, Piotr; Kapelak, Bogusław

    2016-08-23

    Chylopericardium is a rare complication in cardiac surgery, and an extremely rare occurrence in patients following orthotopic heart transplantation (OHT), which, however, can lead to cardiac tamponade. Here we present a case of a 59-year-old man who underwent OHT and suffered from chylopericardium resulting in cardiac tamponade late in the postoperative course, despite the initially uneventful early postoperative period (decreasing blood drainage was observed directly after the procedure, and the drains were safely removed). After the diagnosis of chylopericardium was made, the conservative treatment was initiated, which turned out to be insufficient, and eventually invasive approach for the recurrence of tamponade secondary to chylopericardium was required. We discuss the available therapeutic options for chylopericardium and demonstrate the successful invasive therapeutic approach with use of the absorbable fibrin sealant patch.

  10. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  11. Elastic stability of silicone ferrofluid internal tamponade (SFIT) in retinal detachment surgery

    Energy Technology Data Exchange (ETDEWEB)

    Voltairas, P.A. E-mail: pvolter@cs.uoi.gr; Fotiadis, D.I.; Massalas, C.V

    2001-07-01

    It has been argued that silicone ferrofluid internal tamponade (SFIT) can provide (360 deg.) tamponade of the retina in retinal detachment surgery. Provided that the produced SFIT is biocompatible, exact knowledge is needed of its elastic stability in the magnetic field produced by the semi-solid magnetic silicon band (MSB) used as a scleral buckle. We propose a quantitative, phenomenological model to estimate the critical magnetic field produced by the MSB that 'closes' retinal tears and results in the reattachment of the retina. The magnetic 'deformation' of SFIT is modeled in accordance with the deformation of a ferrofluid droplet in an external magnetic field.

  12. Elastic stability of silicone ferrofluid internal tamponade (SFIT) in retinal detachment surgery

    Science.gov (United States)

    Voltairas, P. A.; Fotiadis, D. I.; Massalas, C. V.

    2001-01-01

    It has been argued that silicone ferrofluid internal tamponade (SFIT) can provide (360°) tamponade of the retina in retinal detachment surgery. Provided that the produced SFIT is biocompatible, exact knowledge is needed of its elastic stability in the magnetic field produced by the semi-solid magnetic silicon band (MSB) used as a scleral buckle. We propose a quantitative, phenomenological model to estimate the critical magnetic field produced by the MSB that 'closes' retinal tears and results in the reattachment of the retina. The magnetic 'deformation' of SFIT is modeled in accordance with the deformation of a ferrofluid droplet in an external magnetic field.

  13. 超声引导锥形套管针穿刺在心脏压塞救治中的应用%Application of Ultrasound-guided Cone-shaped Trocar Puncture for Cardiac Tamponade

    Institute of Scientific and Technical Information of China (English)

    王树松; 臧乃凉; 张广存; 王莉伟; 刘艳

    2016-01-01

    Objective To discuss the value of cone-shaped trocar puncture under ultrasound guidance in the treatment of cardiac tamponade. Methods From March 1998 to October 2015, 28 patients with pericardial tamponade caused by massive pericardium effusion ( the effusion width was more than 17 mm) underwent pericardiocentesis by using cone-shaped trocar ( Patent No:ZL 2006 2 0132265.8 ) puncture under ultrasound guidance and insertion of a drainage tube.Another 28 patients with cardiac tamponade receiving drainage placement by the Seldinger technique were selected as the control group.The time of catheterization was compared between the two groups. Results The puncture and drainage placement was successfully performed in one time in all the patients.The average time of catheterization in the trocar puncture group was significantly shorter than that in the control group [(6.2 ±1.1) min vs.(15.0 ±1.1) min, t=-27.844, P=0.000].The symptoms of cardiac tamponade disappeared after catheter drainage. Conclusions For patients with cardiac tamponade with a large amount of pericardium effusion, use of cone-shaped trocar puncture under ultrasound-guidance is simple, minimally invasive, quick, safe, and effective.It also provides the guarantee for subsequent treatments.%目的 探讨超声引导下锥形套管针穿刺在心脏压塞救治过程中的应用价值. 方法 1998年3月~2015年10月,在超声引导下使用锥形套管针(专利号:ZL 2006 2 0132265.8)对28例大量心包积液(心包积液宽度≥17 mm)引起的心脏压塞进行心包穿刺,置入引流管引流. 选择Seldinger法心包置管治疗心脏压塞患者28例作为对照组,比较2组的置管时间. 结果 所有心脏压塞患者均一次穿刺成功并置入引流管,锥形套管针组置管时间( 6.2 ±1.1 ) min,比Seldinger组(15.0 ±1.1)min明显缩短(t=-27.844,P=0.000),引流后患者心脏压塞症状均消失. 结论 在大量积液引起的心脏压塞患者的救治过程中,超声引导下锥

  14. Impact of pericardial adhesions on diastolic function as assessed by vortex formation time, a parameter of transmitral flow efficiency

    Directory of Open Access Journals (Sweden)

    Heys Jeffrey J

    2010-09-01

    Full Text Available Abstract Background Pericardial adhesions are a pathophysiological marker of constrictive pericarditis (CP, which impairs cardiac filling by limiting the total cardiac volume compliance and diastolic filling function. We studied diastolic transmitral flow efficiency as a new parameter of filling function in a pericardial adhesion animal model. We hypothesized that vortex formation time (VFT, an index of optimal efficient diastolic transmitral flow, is altered by patchy pericardial-epicardial adhesions. Methods In 8 open-chest pigs, the heart was exposed while preserving the pericardium. We experimentally simulated early pericardial constriction and patchy adhesions by instilling instant glue into the pericardial space and using pericardial-epicardial stitches. We studied left ventricular (LV function and characterized intraventricular blood flow with conventional and Doppler echocardiography at baseline and following the experimental intervention. Results Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. The mean VFT value decreased from 3.61 ± 0.47 to 2.26 ± 0.45 (P = 0.0002. Hemodynamic variables indicated the inhibiting effect of pericardial adhesion on both contraction (decrease in systolic blood pressure and +dP/dt decreased and relaxation (decrease in the magnitude of -dP/dt and prolongation of Tau function. Conclusion Patchy pericardial adhesions not only negatively impact LV mechanical functioning but the decrease of VFT from normal to suboptimal value suggests impairment of transmitral flow efficiency.

  15. Video-assisted pericardioscopy. How to improve diagnostic efficacy in pericardial effusions

    Directory of Open Access Journals (Sweden)

    Paulo M. Pêgo-Fernandes

    2001-11-01

    Full Text Available OBJECTIVE: To assess, in a prospective way, the experience with video-assisted pericardioscopy obtained in patients with pericardial effusion of unclear etiology in the preoperative period. METHODS: From January 1998 to June 2000, 20 patients were operated upon with the aid of video-assisted pericardioscopy. On echocardiography, 17 of these patients had significant pericardial effusion, and 3 had moderate pericardial effusion. Video-assisted pericardioscopy was performed through a small incision of the Marfan type. RESULTS: The diagnosis of pericardial effusion was established as follows: idiopathic in 9 (45% patients, neoplastic in 4 (20%, resulting from hypothyroidism in 3 (15%, tuberculous in 2 (10%, due to cholesterol in 1 (5%, and chylopericardial in 1 (5%. The biopsy was positive in 30% of the patients, and the etiology could not be defined in 45% of the patients. CONCLUSION: Video-assisted pericardioscopy proved to be a method with low morbidity and a high index of diagnostic positivity. A high percentage of pericardial effusions are caused by viral infections, which are not diagnosed through current methods, being, therefore, classified as idiopathic.

  16. Failure of Sengstaken balloon tamponade for rebleeding after tissue adhesive injection in a fundic varix

    NARCIS (Netherlands)

    Nieuwenhuis, JA; Peters, FTM; Sanders, J; Van der Werf, TS; Zijlstra, JG

    1998-01-01

    A 61-year-old man developed a huge fundic varix due to portal hypertension in alcoholic liver cirrhosis. After a third injection therapy session with tissue adhesive (Histoacryl(R)) massive hemorrhage developed. Sengstaken (gastric) balloon tamponade failed. Autopsy showed a huge, solid varix with a

  17. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma

    NARCIS (Netherlands)

    Hermens, Jeannine A.J.M.; Wajon, Elly M.C.J.; Grandjean, Jan G.; Haalebos, Max M.P.; Birgelen, von Clemens

    2009-01-01

    Hemopericardium with cardiac tamponade after non-penetrating chest trauma is a very rare but life-threatening condition. If this complication develops after an interval of several weeks following the non-penetrating chest trauma, the causal relation with the traumatic event is less evident, which ma

  18. The Changes of Retinal Saturation after Long-Term Tamponade with Silicone Oil

    Directory of Open Access Journals (Sweden)

    Bingsheng Lou

    2015-01-01

    Full Text Available Purpose. To evaluate the effects of long-term tamponade with silicone oil on retinal saturation. Methods. A total of 49 eyes that received tamponade with silicone oil were included. The patients were divided into 3 groups (3–6 months, 6–9 months, and >9 months according to the duration of silicone oil tamponade. Retinal oximetry was performed using the Oxymap system before and 2 months after silicone oil removal. Results. The mean retinal oxygen saturation before silicone oil removal was 107% ± 12% in the arterioles and 60% ± 10% in the venules, with an overall arteriovenous difference (AVD of 47% ± 14%. The AVD in the >9-month group was significantly higher than that in the 3–6-month group (54% ± 16% versus 44% ± 11%, P=0.042. After silicone oil removal, the AVD in the >9-month group was significantly decreased (45% ± 9% versus 54% ± 16%, P=0.009; additionally, the arterioles were significantly wider than before surgery (10.8 ± 0.7 pixels versus 10.4 ± 0.9 pixels, P=0.015. Conclusions. The tamponade with silicone oil for more than 9 months will cause the alterations of retinal saturation and the narrowing of retinal arterioles, which may further interfere with the oxygen metabolism in the retina.

  19. Direct transatrial pericardiocentesis for tamponade caused by left atrial perforation after trans-septal puncture.

    Science.gov (United States)

    Picard, Fabien; Millán, Xavier; de Hemptinne, Quentin; L L'allier, Philippe

    2016-07-07

    Trans-septal puncture is associated with risks of serious complications. We report a case of an obese 52-year-old man with hypertrophic cardiomyopathy who underwent preoperative coronary angiography and cardiac catheterisation complicated by left atrial perforation. We describe a direct transatrial pericardiocentesis approach to treating cardiac tamponade.

  20. A Therapeutic Wireless Capsule for Treatment of Gastrointestinal Haemorrhage by Balloon Tamponade Effect.

    Science.gov (United States)

    Leung, Billy H K; Poon, Carmen C Y; Zhang, Ruikai; Zheng, Y L; Chan, C K W; Chiu, Philip W Y; Lau, James Y W; Sung, Joseph J Y

    2016-07-13

    Wireless capsule endoscope (WCE) is a revolutionary approach to diagnose small bowel pathologies. Currently available WCEs are mostly passive devices with image capturing function only, while on-going efforts have been placed on robotizing WCEs or to enhance them with therapeutic functions. In this paper, the authors present a novel inflatable WCE for haemostasis in the gastrointestinal tracts by balloon tamponade effect.

  1. Taponamiento cardíaco secundario a carcinoma papilar esclerosante difuso de tiroides Metastatic cardiac tamponade as initial manifestation of papillary thyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Verónica Riva

    2011-12-01

    gland. At the time of diagnosis, patients present lymph node and lung metastasis. It affects mainly young women. This case report describes a cardiac tamponade as the initial manifestation of an unusual variant of papillary thyroid carcinoma. A 32 year-old woman was attended at the emergency room with epigastric pain and dry cough. Physical examination revealed hypotension, tachycardia and decreased heart sounds. An echocardiogram confirmed severe pericardial effusion. Pericardial fluid cytology was positive for malignancy. The patient evolved with recurrent pericardial effusion and a pleuropericardial window was performed. At this procedure, a subpleural nodular lesion was found, which histology corresponded to metastases of papillary carcinoma, probably from thyroid origin. Total thyroidectomy was performed. The final diagnosis was papillary carcinoma, diffuse sclerosing variant. This variant infiltrates the connective tissue of the interfollicular spaces, mimicking thyroiditis and it is associated with early vascular permeation. This tumor, compared to the classic variants of thyroid carcinoma, is more aggressive and it has higher risk of recurrence. Papillary thyroid carcinoma should be considered as differential diagnosis in our population, in all metastatic papillary lesions, and even more in young female patients.

  2. Analysis of integrated ICU catheter associated nosocomial infection and related factors%综合性ICU导管相关性医院感染及相关因素分析

    Institute of Scientific and Technical Information of China (English)

    范红莉

    2016-01-01

    Objective:To explore the integrated ICU catheter associated nosocomial infection and related factors.Methods:320 patients with integrated ICU catheter associated nosocomial infection were selected.The clinical data were retrospectively analyzed.Results:The positive rate of blood flow infection,pulmonary infection and urinary tract infection was 22.81%,51.56% and 25.63% respectively,and the positive rate of pulmonary infection was the highest(P0.05).Conclusion:Pulmonary infection was the most in integrated ICU catheter associated nosocomial infection,and gram negative bacteria were the main pathogens.Catheter associated nosocomial infection may not be an independent risk factor for mortality.%目的:探讨综合性ICU导管相关医院感染和相关因素。方法:收治综合性ICU导管相关性医院感染患者320例,回顾性分析临床资料。结果:血流感染、肺部感染及尿路感染阳性检出率分别为22.81%、51.56%及25.63%,其中,肺部感染阳性率最高(P<0.01)。革兰阴性菌、革兰阳性菌及假丝酵母菌构成比分别为67.81%、16.88%及15.31%,其中,革兰阴性菌构成比最高(P<0.01)。血流感染、肺部感染及尿路感染患者中死亡率分别为16.44%、15.76%及13.41%(P>0.05)。结论:ICU导管相关性医院感染以肺部感染为主,革兰阴性菌为主要病原菌。导管相关性医院感染可能并非影响死亡率的独立危险因素。

  3. Unusual region for pericardial malignant mesothelioma: cutaneous manifestation in a Turkish woman

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    Murat Günday

    2013-09-01

    Full Text Available Malignant mesothelioma is a disease that originates from mesenchymal cells. It is related to the occupational or environmental exposure to asbestos. The treatment remains controversial because it is commonly diagnosed at a very late stage, and the prognosis is very poor. In this report, we present a 37-year-old female patient who was admitted with shortness of breath, palpitation and inability to sleep on her back for the previous 10 days. A large pericardial effusion was detected on echocardiography. Pericardiocentesis was performed and the patient’s symptoms were alleviated. However, approximately 7 months later, she was readmitted to the clinic with complaints of a mass at the incision site. Pathological examination of the mass yielded a diagnosis of pericardial malignant mesothelioma. Malignant mesothelioma is a rare occurrence, and to our knowledge, there are no reports in the English literature of pericardial malignant mesothelioma local invasion to an incision site.

  4. Clinical Usefulness of Bakri Balloon Tamponade in the Treatment of Massive Postpartum Uterine Hemorrhage.

    Science.gov (United States)

    Nagai, Sayori; Kobayashi, Hiroaki; Nagata, Tomomi; Hiwatashi, Sayuri; Kawamura, Toshihiko; Yokomine, Daisaku; Orita, Yuji; Oki, Toshimichi; Yoshinaga, Mitsuhiro; Douchi, Tsutomu

    2016-01-01

    Intrauterine globe-shaped metreurynter tamponade has been used for some time to treat massive postpartum hemorrhage (PPH). More recently, the Bakri balloon has come into use to treat PPH. It is made of silicon, possesses a drainage lumen, and has a sausage-like spindle shape. The aim of the present study was to investigate the clinical usefulness of Bakri balloon tamponade for massive PPH. Subjects in the present study comprised 5 patients with uterine atony, 3 with placenta previa, and 2 with low-lying placenta. All patients exhibited massive PPH and resistance to conventional hemostatic managements. Bakri balloon tamponade was appliedto these 10 patients. The mean amounts of uterine bleeding (average ± SD) before and after Bakri insertion were2,732 ± 1,397 mL and 380 ± 376 mL, respectively. The median (third-first quartile ranges) volume of salineinflating the balloon was 200 mL (300-150 mL). The median (third-first quartile ranges) indwelling duration of Bakri balloon was 24 hours (24-11 hrs). The overall success rate of Bakri balloon tamponade was 90% (9/10).There were no cases of slipping out or complications regarding balloon placement. Our findings suggest that Bakri balloon tamponade may be applied to the treatment of massive PPH in uterine atony and placenta previa.The Bakri balloon appears to have the following merits: (1) easy insertion into the uterine cavity and low rate of slipping out, (2) proper conformability to the hemorrhagic area due to its spindle shape, (3) ability to monitor blood loss through the drainage lumen even after insertion.

  5. The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation

    Directory of Open Access Journals (Sweden)

    Kimura Takehiro

    2012-11-01

    Full Text Available Abstract Background The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed. Methods Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated. Results The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation. Conclusions Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.

  6. Mediastinoscope-controlled parasternal fenestration of the pericardium: definitive surgical palliation of malignant pericardial effusion

    Directory of Open Access Journals (Sweden)

    Toth Imre

    2012-06-01

    Full Text Available Abstract Background The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with the otherwise desirable oncological treatment. The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in the symptomatic relief of malignant pericardial effusion (MPE. The recurrence rate ranges between 43 and 69% after pericardiocentesis and 9 to 16% after pericardial drainage. The desire to overcome relative limitations of the existing methods led us to explore an alternative approach. Methods The standard armamentarium of the Carlens collar mediastinoscopy procedure was utilized in a Chamberlain parasternal approach of the pericardial sac. The laterality of approach was decided based upon the pleural involvement, as tumor-free pericardiopleural reflection is required. A pericardio-pleural window at least 3 cm in diameter was created. From January 2000 to December 2009, 22 cases were operated on with mediastinoscope-controlled parasternal fenestration (MCPF. Considering the type of the primary tumor, there were 11 lung cancer, 6 breast cancers, 2 haematologic malignancies and in 3 patients the origin of malignancy could not be verified. Results There were no operative deaths. We lost one patient (4.5% in the postoperative hospital period. All of the surviving patients had a minimum of 2 months of symptom-free survival. We detected transient recurrence of MPE in one patient (4.5% 14 days after the MCPF, which disappeared spontaneously after 24 hours. Conclusion The MCPF offers a real alternative in certain cases of pericardial effusion. We recommend this method especially for the definitive surgical palliation of MPE.

  7. 经皮心包穿刺术进行室性心律失常心外膜标测和消融的应用体会%Application of pericardial puncture for mapping and ablation of ventricular arrhythmias

    Institute of Scientific and Technical Information of China (English)

    薛玉梅; 詹贤章; 廖洪涛; 方咸宏; 魏薇; 刘洋; 廖自立; 邓海; 吴书林

    2015-01-01

    with VA who ac-cepted the subxyphoid pericardial puncture ( Sosa ’ s method ) for epicardial mappings. There were 28 men, 12 women,aged(46±13)years. Sixteen patients suffered from non-ischemic cardiomyopathies(NICM),11 arrhythmo-genic right ventricular cardiomyopathies( ARVC) ,3 ischemic cardiomyopathies( ICM) ,10 idiopathic VA. We ana-lyzed how to minimize the occurrence of complications associated with this technique,and how to rapidly recognize and treat the complications that they encountered. Results The pericardial punctures were done successfully at the first attempt in 25 patients,while in 15 patients the pericardial puncture were done successfully at the second attempt or more. Fifteen pericardial punctures were directed to the anterior wall of the right ventricle,while 25 were directed to the inferior wall. Totally in 35 cases(87. 5%) the ablations were successful,including targets on the epicardium in 15 patients,targets on both the endocardium and the epicardium in 14 patients,targets on the endocardium in 6 patients demonstrated by the combined endocardial and epicardial mappings. The combined en-docardial and epicardial ablation failed in two patients with ventricular tachycardias due to NICM. The ablations in 2 cases with idiopathic premature ventricular contractions were abandoned due to vicinity of coronary arteries. In one patient,the ablation was given up due to coronary artery injured by puncture. Totally 13 patients(32. 5%)suf-fered from complications including a severe one(2. 5%). There were 6 cases(15%)of right ventricular injuries without adverse results. There were 2 cases(5%)of bleeding in pericardial cavities,cured by drainage. The guide-wires entered the pleural cavities in 2 cases(5%),without adverse results. There was one case(2. 5%) of late pericardial tamponade,cured by drainage of 80 ml effusion. There was one case of acute pericardial tamponade due to injury of coronary artery,cured by emergent surgery. Thirty-five(87. 5%) patients

  8. Elastin organization in pig and cardiovascular disease patients' pericardial resistance arteries

    DEFF Research Database (Denmark)

    Bloksgaard, Maria; Leurgans, Thomas; Nissen, Inger;

    2015-01-01

    coronary artery bypass grafting or cardiac valve replacement surgeries, can serve as a source of resistance arteries for structural research in cardiovascular disease patients. We applied two-photon excitation fluorescence microscopy to study the parietal pericardium and isolated pericardial resistance...... arteries with a focus on the collagen and elastin components of the extracellular matrix. Initial findings in pig tissue were confirmed in patient biopsies. The microarchitecture of the internal elastic lamina in both the pig and patient pericardial resistance arteries (studied at a transmural pressure...

  9. 心脏介入手术并发急性心包填塞十例临床诊治分析%Acute Pericardial Temponade Caused by Cardiac Intervention:Report of 10 Cases

    Institute of Scientific and Technical Information of China (English)

    何益平; 余卓文; 郭航远; 陈日新; 彭放; 邢杨波

    2013-01-01

    目的 探讨心脏介入手术并发急性心包填塞的原因、临床特征、诊断及处理方法.方法 回顾性分析2009-2012年住院行介入手术并发急性心包填塞的患者的临床资料,包括临床特征、原因、治疗及转归.结果 共有10例患者(其中男7例,平均年龄67岁)出现急性心包填塞,其中行冠状动脉支架植入术7例,三腔起搏器植入术1例,室性心动过速心外膜消融术1例,经皮主动脉瓣膜置换术1例.患者表现为胸痛、气促、大汗等症状;均出现血压下降,其中5例心率减慢,3例出现意识不清;10例患者均经超声或X线检查确诊为心包积液,紧急实施经皮Seldinger法剑突下行心包穿刺及置管引流,引流出不凝血性液体250~2 000 ml,猪尾导管留置时间24~72 h,必要时给予输血、多巴胺维持血压等治疗.全部抢救成功.结论 急性心包填塞是心脏介入手术的严重并发症,早期识别非常重要,紧急超声指导下心包穿刺、引流及其他正确处理是抢救成功的关键.%Objective To analyze the causes, differential diagnosis and management of acute cardiac tamponade caused by cardiac intervention. Methods Data of patients with acute pericardial temponade caused by cardiac intervention admitted from 2009 to 2012 were analyzed retrospectively to find its clinical features, reasons, treatment and outcomes. Results A total of 10 patients ( including 7 males, at an average age of 67 ) presented with acute pericardial temponade, thereinto 7 had coronary stent implantation, 1 had 3 - chamber pacemaker implantation, 1 had ventricular tachycardia epicardial ablation, 1 had percutaneous aortic valve replacement. The patients had chest pain, shortness of breath, sweating and other symptoms with low blood pressure, 5 of them had decreased heart rate, 3 were unconscious. Ten were diagnosed as pericardial effusion by ultrasound or X -ray and successfully rescued after percutaneous Seldinger's pericardiopuncture

  10. Surgical removal of retained subfoveal perfluorocarbon liquid through a therapeutic macular hole with intravitreal PFCL injection and gas tamponade.

    Science.gov (United States)

    Kim, Jae Min; Woo, Se Joon; Park, Kyu Hyung; Chung, Hum

    2013-10-01

    We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.

  11. Shear and Extensional Rheometry of PDMS Tamponade Agents Used in Vitroretinal Surgery

    Science.gov (United States)

    Day, Michael; Blanchard, Rowan-Louise; English, Rob; Dobbie, Tom; Williams, Rachel; Garvey, Michael; Wong, David

    2008-07-01

    The emulsification of low molar mass silicone oil (PDMS)-based tamponade agents used in the treatment of complex retinal detachments is a significant clinical problem leading to the patient suffering impairment of vision whilst the tamponade is in place. This is particularly the case in temporal postoperative applications where the tamponade can remain in the ocular cavity for several months. The majority of clinicians prefer to use a PDMS fluid of kinematic viscosity 1000 cS, which offers ease of manual injection. Work is progressing towards the development of tamponades with a reduced tendency to emulsify, through specific tailoring of rheology and interfacial properties. Greater knowledge of the mechanism of intraocular emulsification is being elucidated and has led to the development of `polymer modified' tamponades with enhanced performance. Such materials are formulated by the addition of a high molecular weight PDMS to the base PDMS fluid. Measurement of the shear viscosity at moderate shear rates is useful in predicting performance during manual injection into the eye. However, the determination of the behaviour in both shear and extension at high strain rates is useful in predicting resistance to intraocular emulsification and in informing future modeling studies. Initial experiments focused on rotational rheometry (shear) and capillary breakup rheometry (CaBER—extension). A range of polymer modified tamponades were characterised—based on PDMS base oils from 100-5000 cS and containing up to 30% by weight PDMS of molecular weight varying in the range 100-800 kDa. Even though the volume occupancy of the polymeric additive ranged from dilute to significantly interpenetrated, a linear response was observed in each case. However, subsequent experiments using capillary rheometry lead to the observation of non-linear behaviour and significant differences in the type of response. Systems with enhanced high strain rate tensile viscosities gave improved

  12. Adrenal gland volume, intra-abdominal and pericardial adipose tissue in major depressive disorder.

    Science.gov (United States)

    Kahl, Kai G; Schweiger, Ulrich; Pars, Kaweh; Kunikowska, Alicja; Deuschle, Michael; Gutberlet, Marcel; Lichtinghagen, Ralf; Bleich, Stefan; Hüper, Katja; Hartung, Dagmar

    2015-08-01

    Major depressive disorder (MDD) is associated with an increased risk for the development of cardio-metabolic diseases. Increased intra-abdominal (IAT) and pericardial adipose tissue (PAT) have been found in depression, and are discussed as potential mediating factors. IAT and PAT are thought to be the result of a dysregulation of the hypothalamus-pituitary-adrenal axis (HPAA) with subsequent hypercortisolism. Therefore we examined adrenal gland volume as proxy marker for HPAA activation, and IAT and PAT in depressed patients. Twenty-seven depressed patients and 19 comparison subjects were included in this case-control study. Adrenal gland volume, pericardial, intraabdominal and subcutaneous adipose tissue were measured by magnetic resonance imaging. Further parameters included factors of the metabolic syndrome, fasting cortisol, fasting insulin, and proinflammatory cytokines. Adrenal gland and pericardial adipose tissue volumes, serum concentrations of cortisol and insulin, and serum concentrations tumor-necrosis factor-α were increased in depressed patients. Adrenal gland volume was positively correlated with intra-abdominal and pericardial adipose tissue, but not with subcutaneous adipose tissue. Our findings point to the role of HPAA dysregulation and hypercortisolism as potential mediators of IAT and PAT enlargement. Further studies are warranted to examine whether certain subtypes of depression are more prone to cardio-metabolic diseases.

  13. Silent Ischemic Heart Disease and Pericardial Fat Volume in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Kristoffersen, Ulrik S; Lebech, Anne-Mette; Wiinberg, Niels;

    2013-01-01

    to determine the prevalence of asymptomatic ischemic heart disease (IHD) in HIV patients by myocardial perfusion scintigraphy (MPS) and to determine the value of coronary artery calcium score (CACS), carotid intima-media thickness (cIMT) and pericardial fat volume as screening tools for detection...

  14. Experience of Clinical Diagnosis and Treatment of Acute Cardiac Tamponade During Cardiac Interventional Therapy%心脏介入术中并发急性心脏压塞的临床诊疗体会

    Institute of Scientific and Technical Information of China (English)

    牛少辉; 张丽华; 简立国

    2013-01-01

    [目的]探讨分析心脏介入性治疗手术过程中急性心脏压塞的临床诊断与治疗的经验。[方法]回顾性分析2002年1月至2011年9月间在本院行心脏介入性治疗手术过程中6例发生急性心脏压塞患者的临床资料。[结果]6例在心脏介入性诊治操作过程中发生急性心脏压塞的患者中,2例患者与心脏射频消融术有关、2例患者与经皮腔内冠状动脉成形术(PTCA)有关、1例患者与房间隔缺损(ASD)修补术有关、1例患者与临时起搏器安装术有关。经积极治疗,5例患者治愈出院,1例患者死亡。[结论]急性心脏压塞是心脏介入性治疗过程中严重的并发症,多与操作不当有关。及时诊断与处理是抢救中的关键所在,心包穿刺引流是治疗的首要方法,必要时行开胸手术治疗。%[Objective]To explore the experiences of clinical diagnosis and treatment of cardiac tamponade during cardiac interventional therapy .[Methods]Clinical data of 6 patients with cardiac tamponade during car-diac interventional therapy in our hospital from Jan .2002 to Sept .2011 were analyzed retrospectively .[Re-sults]Among 6 patients with cardiac tamponade undergoing interventional therapy ,2 patients were caused by radiofrequency catheter ablation ,and 2 patients were caused by percutaneous transluminal coronary angioplasty (PTCA) ,and 1 patient was caused by transcatheter atrial septal defect (ASD) closure ,and 1 patient was caused by temporary pacemaker procedure .After active treatment ,5 patients were cured and discharged from the hospital ,but 1 patient died .[Conclusion]Cardiac tamponade is a severe complication during cardiac inter-ventional therapy ,and associated with misoperation .Prompt diagnosis and treatment is the key to rescue .Per-icardial puncture and drainage are the first treatment .If necessary ,thoracotomy should be performed .

  15. Pericardial patch angioplasty heals via an Ephrin-B2 and CD34 positive cell mediated mechanism.

    Directory of Open Access Journals (Sweden)

    Xin Li

    Full Text Available OBJECTIVE: Pericardial patches are commonly used in vascular surgery to close arteriotomies. The mechanism of early healing after patch implantation is still not well defined. We used a rat aortic patch model to assess pericardial patch healing and examined Ephrin-B2, a marker of arterial identity, expression within the post-implantation patch. We also determined whether endothelial progenitor cells (EPC are associated with early patch healing in the arterial environment. METHODS: Wistar rats (200-250 grams underwent infrarenal aortic arteriotomy and then closure via bovine or porcine pericardial patch angioplasty. Control groups included subcutaneously implanted patches. Patches were harvested at 0-30 days and analyzed by histology, immunohistochemistry, immunofluorescence and Western blot as well as quantitative PCR. RESULTS: Prior to implantation, pericardial patches are largely composed of collagen and are acellular. Following arterial implantation, increasing numbers of CD68-positive cells as well as Ephrin-B2 and CD34 dual-positive cells are found within both bovine and porcine pericardial patches, whereas the infiltrating cells are negative for vWF and α-actin. Porcine patches have a luminal monolayer of cells at day 7, compared to bovine patches that have fewer luminal cells. Subcutaneously implanted patches do not attract Ephrin-B2/CD34-positive cells. By day 30, both bovine and porcine pericardial patches develop a neointima that contains Ephrin-B2, CD34, and VEGFR2-positive cells. CONCLUSION: Both CD68-positive and Ephrin-B2 and CD34 dual-positive cells infiltrate the pericardial patch early after implantation. Arteriotomy closure via pericardial patch angioplasty shows patch adaptation to the arterial environment that may involve a foreign body response as well as localization of EPC. Arterial remodeling of pericardial patches support endothelialization and may represent a paradigm of healing of scaffolds used for tissue engineering.

  16. Unsuccessful vitrectomy without gas tamponade for macular retinal detachment and retinoschisis without optic disc pit.

    Science.gov (United States)

    Hotta, Kazuki

    2004-01-01

    The mechanism of subretinal fluid accumulation in optic disc pit maculopathy is unknown. A 67-year-old Japanese woman complaining of blurred vision in her right eye presented with a best-corrected visual acuity of 20/200. Slit-lamp biomicroscopy and optical coherence tomography examination showed maculopathy typically associated with optic disc pits, except that the patient had no optic disc pit. Long-acting gas tamponade was required to achieve reattachment of the retina and retinoschisis after initial failure of surgery using surgically induced vitreous detachment without either fluid-air exchange or gas injection. Vitreous traction may not have played a major role in introducing fluid into the submacular space in this case. Gas tamponade may be indispensable to achieve surgical success. This may also pertain to some cases of optic nerve pits.

  17. Late erosion of Amplatzer septal occluder device resulting in cardiac tamponade.

    Science.gov (United States)

    Tchantchaleishvili, Vakhtang; Melvin, Amber L; Ling, Frederick S; Knight, Peter A

    2014-12-01

    Transcatheter device closure of atrial septal defects (ASDs) is a minimally invasive technique that offers an alternative to conventional surgical repair. There are risks imposed by this technique; however, they compare favourably with risks of surgical closure. Here, we present a case of a 59-year old male with late erosion of an Amplatzer septal occluder device resulting in cardiac tamponade 5 years after device placement. To the best of our knowledge, cardiac tamponade this late after device placement has not yet been reported. Septal occlusion device erosion remains a major issue among the risks imposed by device closure of an ASD. More data are needed to better understand its true causes and possible solutions.

  18. Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Faruk Ertaş

    2013-06-01

    Full Text Available Acute cardiac tamponade requires urgent diagnosis andtreatment. We report a case of a 43-year-old man whowas receiving warfarin treatment for 8 months followingmitral valve replacement. The patient had complaint ofdyspnea and fatigue for a few days. Cardiac tamponadewas diagnosed, and the INR at that time was 10.4. Urgentpericardiocentesis were undertaken and 1400 ml of pericardialblood was drained. Following surgery the patient’srecovery was uneventful. An intravenous vitamin K injectionand fresh frozen plasma transfusion were administeredto reverse the patient’s over-anticoagulated state.The final pathology revealed chronic inflammation andthere was no malignancy, and no bacteria or mycobacteriumwere seen. Emergency physicians should rememberthat over-anticoagulation with warfarin may contribute tocertain complications, including hemopericardium, andthat strict control of target INR should be the goal for patientswho require continuous warfarin treatment. J ClinExp Invest 2013; 4 (2: 229-233Key words: Hemopericardium, tamponade, oral anticoagulation,warfarin, echocardiography

  19. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

    Directory of Open Access Journals (Sweden)

    Hee Young Cho

    Full Text Available The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation.We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL.Sixty-four patients (46.7% required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1% had placenta previa totalis. The overall success rate was 75% (48/64 for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05. The drainage amount over 1 hour was 500 mL (20-1200 mL in the balloon failure group and 60 mL (5-500 mL in the balloon success group (p<0.01.Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

  20. Hemorrhagic Cardiac Tamponade: Rare Complication of Radiofrequency Ablation of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Loh, Kok Beng; Bux, Shaik Ismail; Abdullah, Basri Johan Jeet; Mokhtar, Raja Amin Raja; Mohamed, Rosmawati [Faculty of Medicine, University of Malaya, Kuala Lumpur (Malaysia)

    2012-09-15

    Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

  1. Evaluating condom catheter balloon tamponade in non-traumatic postpartum haemorrhage resistant to medical management

    OpenAIRE

    Syed Nawaz Ahmad; Sunita Seth; Shefali Agarwal; Swati Choudhary

    2016-01-01

    Background: Obstetric haemorrhage remains the most important cause of maternal mortality worldwide accounting for 25% of maternal deaths annually. The aim of the study was to evaluate efficacy of a condom catheter assembly for uterine tamponade in the management of non-traumatic postpartum haemorrhage (PPH). Methods: It was a prospective interventional study done in a tertiary care hospital in New Delhi, India. Thirty three women with intractable PPH unresponsive to medical management were...

  2. Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK

    Directory of Open Access Journals (Sweden)

    Benjamin Botsford

    Full Text Available ABSTRACT Purpose: To compare the effect of 20% sulfur hexafluoride (SF6 with that of air on graft detachment rates for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK. Methods: Forty-two eyes of patients who underwent DMEK by a single surgeon (A.S.J. at Wilmer Eye Institute between January 2012 and 2014 were identified; 21 received air for intraocular tamponade and the next consecutive 21 received SF6. The main outcome measure was the graft detachment rate; univariate and multivariate analyses were performed. Results: The graft detachment rate was 67% in the air group and 19% in the SF6 group (p<0.05. No complete graft detachments occurred, and all partial detachments underwent intervention with injection of intraocular air. The percentages of eyes with 20/25 or better vision were not different between the groups (67% vs. 71%. Univariate analysis showed significantly higher detachment rates with air tamponade (OR, 8.50; p<0.005 and larger donor graft size (OR, 14.96; p<0.05. Multivariate analysis with gas but not graft size included showed that gas was an independent statistically significant predictor of outcome (OR, 6.65; p<0.05. When graft size was included as a covariate, gas was no longer a statistically significant predictor of detachment but maintained OR of 7.81 (p=0.063 similar to the results of univariate and multivariate analyses without graft size. Conclusion: In comparison with air, graft detachment rates for intraocular tamponade in DMEK were significantly reduced by 20% SF6.

  3. Spontaneous Hemopericardium Leading to Cardiac Tamponade in a Patient with Essential Thrombocythemia

    Directory of Open Access Journals (Sweden)

    Anand Deshmukh

    2011-01-01

    thrombocythemia (ET has never been reported in the literature. We report a case of a 72-year-old Caucasian female who presented with spontaneous hemopericardium and tamponade requiring emergent pericardiocentesis. The patient was subsequently diagnosed to have ET. ET is characterized by elevated platelet counts that can lead to thrombosis but paradoxically it can also lead to a bleeding diathesis. Physicians should be aware of this complication so that timely life-saving measures can be taken if this complication arises.

  4. Densiron® 68 as an intraocular tamponade for complex inferior retinal detachments

    Directory of Open Access Journals (Sweden)

    Hussain RN

    2011-05-01

    Full Text Available Rumana N Hussain, Somnath BanerjeeLeicester Royal Infirmary, Leicester, UKIntroduction: Densiron® 68 is a high-density liquid used to tamponade inferior retinal detachments. We present a case series of 12 patients treated with Densiron as an intraocular tamponade agent.Methods: A retrospective analysis of 12 eyes in 12 patients was carried out. The primary endpoint was anatomic reattachment of the retina following removal of Densiron oil.Results: All patients had inferior detachments; 33% had associated proliferative vitreoretinopathy (PVR. Densiron was utilized as a primary agent in five patients (42%; the remaining patients had prior unsuccessful surgery for retinal reattachment, including pars plana vitrectomy, cryotherapy, laser, encirclement, gas (C3F8 or C2F6, or silicone oil. Eleven patients (91% had successful reattachment of the retina at 3 months following removal of Densiron; one patient had extensive PVR, total retinal detachment, preretinal macula fibrosis, and chronic hypotony, and surgical intervention was unsuccessful. Six patients (50% had raised intraocular pressure (IOP, resolving in the majority of cases following Densiron removal; two patients had long-term raised IOP requiring topical or surgical therapy. Of the six phakic patients, 50% developed significant cataract in the operated eye. Of those with successful retinal reattachment, visual outcome was variable, with 36% patients gaining two to four lines on Snellen, 27% remaining objectively the same, and 36% losing one to two lines.Conclusion: The anatomic success rate is high (91% in patients requiring Densiron tamponade for inferior retinal detachments with or without evidence of PVR either as a primary or secondary intervention. A common complication is raised IOP; however, this most often resolves following removal of the oil.Keywords: intraocular tamponade, silicone oil, retinal detachment, retinal reattachments

  5. Effectiveness of reminder system in decreasing catheter-associated urinary tract infections: A Meta-analysis%拔管提示系统对降低导尿管相关尿路感染效果的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张悦; 夏玲; 陈艳; 皋文君; 徐大才

    2014-01-01

    目的 系统评价拔管提示系统对降低导尿管相关尿路感染效果的影响.方法 计算机全面检索国内外主要的医学数据库中有关拔管提示系统的干预试验.按照纳入及排除标准筛选文献,提取资料并评价纳入研究的方法学质量后,采用RevMan 5.0分析软件对拔管提示系统对降低导尿管相关尿路感染的效果进行Meta分析.结果 共纳入10篇文献,合计5 662例患者.Meta分析结果显示:拔管提示系统组在降低导尿管相关尿路感染的发生率、留置尿管的天数及导尿管的使用率方面明显优于对照组,差异均有统计学意义.结论 拔管提示系统可缩短留置尿管的天数,有效降低导尿管相关尿路感染的发生.%Objective To objectively evaluate the effectiveness of reminder system in reducing catheter-associated urinary tract infections.Methods Databases were electronically searched to collect the trials.According to the inclusion and exclusion criteria,the literatures were screened,the data were extracted and the methodological quality of the included studies was assessed.Then Meta-analysis was performed by using RevMan 5.0 software.Results A total of 10 literatures involving 5 662 participants were included.The results of Meta-analysis showed that the reminder system group was superior to the control group in decreasing the incidence rate of catheter-associated urinary tract infections,shortening the days of indwelling catheter,and there were statistical differences.Conclusions Reminder system can shorten the days of indwelling catheter,decrease catheter-associated urinary tract infections,

  6. DFPE, PARTIALLY FLUORINATED ETHER: A Novel Approach for Experimental Intravitreal Tamponade.

    LENUS (Irish Health Repository)

    Santos, Rodrigo A V

    2012-07-16

    PURPOSE:: To evaluate decafluoro-di-n-pentyl ether (DFPE) as a vitreous tamponade by examining ocular tolerance in rabbits\\' eyes. METHODS:: Thirteen rabbits were divided into 4 groups after mechanical vitrectomy and were followed up to 12 months. The tamponade remained in the eye for 6 months in Group 1 (DFPE) and Group 3 (DFPE and silicone oil) and for 12 months in Group 2 (DFPE). Group 4 served as control. RESULTS:: In Groups 1, 2, and 3, dispersion of the fluid appeared 2 weeks postoperatively. Posterior subcapsular cataracts appeared in rabbits\\' eyes with large fills of DFPE (>50%). Histologic findings in Groups 1 and 2 showed no detectable change in outer nuclear layer thickness. Except for some vacuolations, the inner retina was well preserved in all injected rabbits\\' eyes. On the electroretinography of injected rabbits\\' eyes, there was no effect on the a wave amplitude and b wave implicit time, but the b wave amplitude was elevated with statistical significance (P < 0.001) at 1, 3, and 6 months postoperatively but with no statistical significance (P > 0.05) after that period when compared with Group 4 and unoperated fellow rabbits\\' eyes of each group. CONCLUSION:: Decafluoro-di-n-pentyl ether demonstrated minimum adverse effects in retinal rabbits; further studies are needed before clinical use as short-term tamponade.

  7. Visual and anatomical success with short-term macular tamponade and autologous platelet concentrate.

    LENUS (Irish Health Repository)

    Mulhern, M G

    2012-02-03

    BACKGROUND: This study aimed to determine whether, in eyes treated for macular hole by vitrectomy and autologous platelet injection, short-term tamponade with SF6 gas was as effective as longer tamponade with C3F8 gas. METHODS: Patients in group 1 (n=31) had vitrectomy, injection of platelet concentrate, and 16% C3F8 gas\\/air exchange. Patients in group 2 (n=31) were similarly treated, except that 23% SF6 gas was used. Group 1 patients were required to posture prone for 2-4 weeks, group 2 for 6 days. RESULTS: All patients had 3 months\\' follow-up. Postoperatively, visual acuity improved faster in group 2. However, the final mean improvement in logMAR acuity was similar in both groups. Intraocular pressure (IOP) spikes occurred in 12 patients in group 2 and in 17 patients in group 1. Posterior subcapsular cataract (PSCC) occurred in 55% of cases in group 1 and in just 37% in group 2. The rate of anatomical success in group 1 was 96.7%, and in group 2, 93.5% (P=1.0). CONCLUSIONS: The combination of SF6 gas, platelet concentrate, and short-term prone posturing gave a degree of anatomical and visual success comparable to that of the group which had longer tamponade. Although no differences were statistically significant, several trends did emerge; in group 2, patients recovered visual acuity faster, had fewer IOP spikes, and there were fewer cases of PSCC formation.

  8. Genomic analysis of a pathogenicity island in uropathogenic Escherichia coli CFT073: distribution of homologous sequences among isolates from patients with pyelonephritis, cystitis, and Catheter-associated bacteriuria and from fecal samples.

    Science.gov (United States)

    Guyer, D M; Kao, J S; Mobley, H L

    1998-09-01

    Urinary tract infection is the most frequently diagnosed kidney and urologic disease and Escherichia coli is by far the most common etiologic agent. Uropathogenic strains have been shown to contain blocks of DNA termed pathogenicity islands (PAIs) which contribute to their virulence. We have defined one of these regions of DNA within the chromosome of a highly virulent E. coli strain, CFT073, isolated from the blood and urine of a woman with acute pyelonephritis. The 57,988-bp stretch of DNA has characteristics which define PAIs, including a size greater than 30 kb, the presence of insertion sequences, distinct segmentation of K-12 and J96 origin, GC content (42.9%) different from that of total genomic DNA (50.8%), and the presence of virulence genes (hly and pap). Within this region, we have identified 44 open reading frames; of these 44, 10 are homologous to entries in the complete K-12 genome sequence, 4 are nearly identical to the sequences of E. coli J96 encoding the HlyA hemolysin, 11 encode P fimbriae, and 19 show no homology to J96 or K-12 entries. To determine whether sequences found within the junctions of the PAI of CFT073 were common to other uropathogenic strains of E. coli, 11 probes were isolated along the length of the PAI and were hybridized to dot blots of genomic DNA isolated from clinical isolates (67 from patients with acute pyelonephritis, 38 from patients with cystitis, 49 from patients with catheter-associated bacteriuria, and 27 from fecal samples). These sequences were found significantly more often in strains associated with the clinical syndromes of acute pyelonephritis (79%) and cystitis (82%) than in those associated with catheter-associated bacteriuria (58%) and in fecal strains (22%) (P < 0.001). From these regions, we have identified a putative iron transport system and genes other than hly and pap that may contribute to the virulent phenotype of uropathogenic E. coli strains.

  9. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO recommendations “Prevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Aim: The Commission for Hospital Hygiene and Infection Prevention (KRINKO updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt’s hospitals in autumn, 2015.Material and methods: In two non-ICU wards of each of Frankfurt’s , inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model.Results: Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%. In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change.Conclusion: Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two

  10. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Cholestasis and Pericardial Effusion Due to Brucellosis Infection: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmet Cumhur Dülger

    2010-01-01

    Full Text Available Syndrome of inappropriate secretion of antidiuretic hormone (SIADH is an extremely rare complication of infectious diseases. A rare case of brucellosis complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH cholestasis and pericardial involvement is reported. A 27-year-old woman was admitted for fever, abdominal pain, and scleral icterus. Her medical history revealed no recent use of diuretic agents. In addition to cholestasis and elevated liver enzymes, euvolemic hyponatremia, hypouricemia, low plasma osmolality, and high urinary osmolality were also detected. Surrenal and thyroid tests were also within normal range. Echocardiography revealed minimal pericardial effusion with normal cardiac functions. The final diagnosis was SIADH due to Brucellosis. Hyponatremia, cholestasis, and pericardial disease were resolved with effective antibrucellar treatment with streptomycine and doxycycline. After completing treatment of brucellosis, there was not any more evidence of cholestasis and pericardial fluid.

  11. Post-operative pericardial effusion following treatment of small hepatocellular carcinoma with radiofrequency ablation: A case report.

    Science.gov (United States)

    Zhang, Zhebo; Zhuang, Zhuonan; Xu, Zhenjie; Mei, Qiang; Ma, Kuansheng; Li, Xiaowu; Bie, Ping

    2014-02-01

    Radiofrequency ablation (RFA) is a minimally invasive technique used to treat liver tumors. The current study presents the case of a patient with hepatocellular carcinoma who suffered from post-operative pericardial effusion following RFA treatment. We hypothesize that RFA thermal conduction may damage the diaphragm and pericardium, leading to local edema in the pericardium. RFA is a minimally invasive technique, however, adequate preparatory work must be performed prior to surgery, including a comprehensive assessment of the patient. During surgery, the location and extent of the region to receive RFA must be determined precisely in order to reduce the range of damage and to avoid post-operative complications. This study describes a case of pericardial effusion caused by RFA of liver cancer. We analyzed the causes and preventive measures for pericardial effusion in order to contribute to the prevention pericardial effusion that is complicated by RFA of liver cancer.

  12. Characterization of pericardial and plasma ghrelin levels in patients with ischemic and non-ischemic heart disease.

    Science.gov (United States)

    Sax, Balazs; Merkely, Béla; Túri, Katalin; Nagy, Andrea; Ahres, Abdelkrim; Hartyánszky, István; Hüttl, Tivadar; Szabolcs, Zoltán; Cseh, Károly; Kékesi, Violetta

    2013-09-10

    Ghrelin is an endocrine regulatory peptide with multiple functions including cardioprotective effects. It is produced in various tissues among others in the myocardium. Pericardial fluid has been proven to be a biologically active compartment of the heart that communicates with the myocardial interstitium. Thus, pericardial level of certain agents may reflect their concentration in the myocardium well. In our study we measured acylated (active) and total (acylated and non-acylated) pericardial and plasma ghrelin levels of patients with ischemic and non-ischemic heart disease. Pericardial fluid and plasma samples were obtained from patients with coronary artery disease (ISCH, n=54) or valvular heart disease (VHD, n=41) undergoing cardiac surgery. Acylated pericardial ghrelin concentrations were found to be significantly higher in patients with ischemic heart disease (ISCH vs. VHD, 32±3 vs. 16±2pg/ml, pheart disease as compared to non-ischemic patients suggesting an increased ghrelin production of the chronically ischemic myocardium. According to our results, pericardial ghrelin content is negatively influenced by left ventricular hypertrophy and insulin resistance.

  13. Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion.

    Science.gov (United States)

    Antiñolo, Guillermo; De Agustin, Juan Carlos; Losada, Antonio; Marenco, Maria Luisa; Garcia-Diaz, Lutgardo; Morcillo, Juan

    2010-02-01

    Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia (congenital diaphragmatic hernia of Morgagni). We report an early antenatal diagnosis of congenital diaphragmatic hernia of Morgagni with pericardium effussion at 21 weeks' gestation. Two pericardiocentesis were performed at 21 and 22 4/7 weeks' gestation because of recurrence of pericardial effussion. Regular ultrasound assessments showed progressive herniation of the liver to practically fill the right hemithorax. An ex utero intrapartum treatment procedure was performed at 37 weeks' gestation to rescue maximum intrathoracic space for ventilation of the remaining functional lung tissue and to establish an airway for postnatal support. After birth, the patient successfully underwent early correction of the hernia. Postoperative course was uneventful, and the newborn girl was discharged 18 days later without complications and is currently doing well.

  14. Pitfalls in post-mortem CT-angiography--intravascular contrast induces post-mortem pericardial effusion.

    Science.gov (United States)

    Berger, Nicole; Martinez, Rosita; Winklhofer, Sebastian; Flach, Patricia M; Ross, Steffen; Ampanozi, Garyfalia; Gascho, Dominic; Thali, Michael J; Ruder, Thomas D

    2013-11-01

    We present a case where multi-phase post-mortem computed tomography angiography (PMCTA) induced a hemorrhagic pericardial effusion during the venous phase of angiography. Post-mortem non-contrast CT (PMCT) suggested the presence of a ruptured aortic dissection. This diagnosis was confirmed by PMCTA after pressure controlled arterial injection of contrast. During the second phase of multi-phase PMCTA the presence of contrast leakage from the inferior cava vein into the pericardial sac was noted. Autopsy confirmed the post-mortem nature of this vascular tear. This case teaches us an important lesson: it underlines the necessity to critically analyze PMCT and PMCTA images in order to distinguish between artifacts, true pathologies and iatrogenic findings. In cases with ambiguous findings such as the case reported here, correlation of imaging findings with autopsy is elementary.

  15. [Suggesting the Significance of Pericardial Fat Pad in Bronchial Stump Fistula].

    Science.gov (United States)

    Fukuoka, Tomoki; Sano, Masaaki; Tominaga, Nasa; Sanada, Shotaro; Uno, Yasuo; Oya, Hisaharu; Nishi, Tetsuo; Koshikawa, Katsumi

    2016-05-01

    Bronchial stump fistula is a post-operative complication with poor outcome after pulmonary lobectomy. In order to prevent this complication, the bronchial stump is covered with pericardial fat tissue in our hospital. The case was 58 year old male who received adjuvant chemotherapy after sigmoidectomy for sigmoid colon cancer. As he developed multiple pulmonary metastases, 48 courses of chemotherapy were performed. The lesions had been localized at the right lower lobe, and neither increase in the size of these lesions nor development of other lesions were observed. Hence, an operation was performed. After right lower lobectomy, the bronchial stump was covered with the pericardial fat tissue. Three months after the operation, he developed pneumothorax, and bubbles were detected inside the fat. The pneumothorax was cured conservatively, and the bubbles disappeared spontaneously after 10 months. It is rare that the patient with bubbles in the covering tissue observed for a long time is cured conservatively, suggesting the significance of the stump pad.

  16. Fibrinous Pericardial Effusion and Valvulitis Secondary to Previous Acute Rheumatic Fever: An Unusual Clinical Presentation

    Directory of Open Access Journals (Sweden)

    Osman Yılmaz

    2014-12-01

    Full Text Available Rheumatic heart disease, a sequela to acute rheumatic fever (ARF, is a major cause of acquired heart disease in children and young adults in developing countries. Valvular disease of variable severity, heart failure, and pericarditis has been observed in patients with rheumatic heart disease. A 12-year-old female patient presented with fever presented for 3 days, continuing for fatigue, exhaustion, and chest pain. Echocardiography revealed a pericardial effusion with a 24-mm-thick fibrin accumulation in the neighborhood of the left ventricle. Review of the patient’s medical history revealed that about 3 months earlier the patient had experienced migrating swelling, erythema, and pain of the ankles and knees that lasted for 1 week. Here, we present an ARF patient with an unusual clinical presentation who thought to have an attack of acute rheumatic fever 3 months earlier and was presented with fibrinous pericardial effusion.

  17. Morgagni hernia with massive pericardial effusion diagnosed in the second trimester: prenatal diagnosis and perinatal management.

    Science.gov (United States)

    Haino, Kazufumi; Serikawa, Takehiro; Itsukaichi, Mina; Numata, Masahiro; Kikuchi, Akira; Takakuwa, Koichi; Sakakibara, Seiichi; Hirayama, Yutaka; Tanaka, Kenichi

    2011-01-01

    Morgagni hernia is an extremely rare form of congenital diaphragmatic hernia. Only 6 cases of this condition have been reported in the English literature, as diagnosed prenatally. The prognosis of the disease is determined by the severity of the pulmonary hypoplasia and associated anomalies. Here we report a case of Morgagni hernia with massive pericardial effusion diagnosed by ultrasonography and MRI during the second trimester, enabling planning of appropriate treatment in the pre- and perinatal periods.

  18. Pericardial sac perforation: a rare complication of neonatal nasogastric tube feeding

    Energy Technology Data Exchange (ETDEWEB)

    El-Din Mahmoud Hanafy, Emad; Al Naqeeb, Niran [Al-Adan Hospital, Neonatal ICU, Department of Paediatrics, Hawally (Kuwait); Ashebu, Samuel D.; Bopaya Nanda, Harini [Al-Adan Hospital, Department of Diagnostic Radiology and Imaging, P.O. Box 43721, Hawally (Kuwait)

    2006-10-15

    The insertion of a nasogastric tube for feeding and gastric aspiration is a common practice in the care of newborns, especially if they are preterm and unwell. Esophageal perforation is a rare but serious complication of this procedure. Associated perforation of the pericardial sac is an unusual, severe, and previously unreported complication of nasogastric tube feeding in a neonate. We present an illustrative case. (orig.)

  19. Atherosclerosis associated with pericardial effusion in a central bearded dragon (Pogona vitticeps).

    Science.gov (United States)

    Schilliger, Lionel; Lemberger, Karin; Chai, Norin; Bourgeois, Aude; Charpentier, Maud

    2010-09-01

    Atherosclerosis is a common disease in pet birds, particularly in psittacines, and is frequently found when performing postmortem examinations on adult and old dogs, in which it is mainly associated with endocrine diseases, such as hypothyroidism and diabetes mellitus. However, atherosclerosis is poorly documented in reptiles and consequently poorly understood. In the current case report, atherosclerosis and pericardial effusion were diagnosed in a 2-year-old male central bearded dragon (Pogona vitticeps) based on ultrasound visualization, necropsy, and histologic examination.

  20. Comparison of intuitive versus systematic strategies for aetiological diagnosis of pericardial effusion.

    Science.gov (United States)

    Levy, Pierre-Yves; Moatti, Jean-Paul; Gauduchon, Valerie; Vandenesch, Francois; Habib, Gilbert; Raoult, Didier

    2005-01-01

    In an attempt to elucidate better the various aetiologies of pericardial effusion, we developed a diagnostic protocol that incorporated a battery of systematic tests including blood cultures, throat swab cultures and serological tests for various infectious agents and estimation of serum antinuclear antibodies and serum thyroid-stimulating hormone. Over a 2-y period ending May 2000, we evaluated prospectively and diagnostic usefulness of our strategy in a cohort (n = 136) of patients with pericardial effusion treated at Hospital Timone (HT), Marseille. We compared our findings with those observed in a retrospectively (May 1998-May 2000) drawn cohort (n = 127) of patients treated at Hospital Louis Pradel (HLP), Lyon and in which the laboratory investigation towards establishing an aetiological diagnosis was undertaken intuitively. Overall, the aetiologies were obvious clinically in 18% of cases. In other cases, specific aetiologies (27.3% vs 3.9%; p < 0.001), including treatable conditions (11.1% vs 2.4%; p < 0.001) were identified significantly more frequently in the HT cohort compared to the HLP cohort. The diagnosis strategy we propose may be helpful in elucidating the aetiological diagnosis of pericardial effusion when a cause is not obvious clinically.

  1. A rare combination of hepatic and pericardial hydatid cyst and review of literature

    Directory of Open Access Journals (Sweden)

    Kallol Dasbaksi

    2015-01-01

    Full Text Available Hydatid disease in human beings, as in all intermediate hosts, manifest as hydatid cyst (HC. It is an important cyclozoonotic disease, endemic in various sheep and cattle raising areas of the world, including India. The tapeworm commonly involved is Echinococcus granulosus. HC can occur almost anywhere in the body, most common organs being liver and lungs, and are usually solitary. In 25% of cases combination of liver HC with HC in other extra pulmonary locations are found. Cardiac HCs comprise of 0.5–2% of all HC cases. Within the heart, HCs are usually situated in the left or right ventricle and rarely found in the peri-cardium. Pericardial HC does not produce symptoms and is often painless and silent, until the cysts grow to a large size over the years, when the usual complications develop, such as cyst rupture, cardiac compression, atrial fibrillation, and even sudden death. We describe the case of a 39 year old house wife, of rural origin, with proximity to livestock, who had an asymptomatic pericardial HC along with a symptomatic hepatic HC. She clinically presented with an abdominal lump for one year with recent onset of abdominal pain for 1 month, when radiological imaging confirmed the diagnosis of an unruptured hepatic HC and a pericardial HC. The patient recovered after pericardiectomy along with excision of the HC over the left ventricle and enucleation of hepatic HC, by thoracoabdominal approach. She is doing well after 5 years of followup without recurrence.

  2. Assessment of laser treated silicone (LTS membrane as a pericardial substitute: an InVivo Study

    Directory of Open Access Journals (Sweden)

    H. Ahmadi

    2005-01-01

    Full Text Available Baekgrouund & purpose: Retrosterenal and pericardial adhesions formation after cardiac surgery makes a repeat Sternotomy is time consuming and dangerous, with high risk of iatrogenic trauma to heart, aorta, innominate vessels and grafts. Therefore we decided to find another substitute for pericard other than the ordinary ones in use, withthe advantage of lower cost but good results.Materials and Methods: Thirty sheep,35-45 kg were used in this study and categorized test group and control groups. In group one (n=18 pericardium was excised and the LTS ( Laser-Treated Sil- icone membrane implanted as a pericardial . In control group( n=12 the pericardium was excised without LTS membrane implantation. During followup ranging from 3-24 months, sheep were observed for any clinical– sign of post operation problems. Reoperation was done in all animals of test and control groups to evaluate-adhesions formation .Results:In the control group dense adhesions were observed, while in the study group adhesions- formation was reduced at all sites covered by LTS membrane and no infection or other complications were- observed .Conclusions: The LTS membrane is safe and efficient in reducing pericardial adhesions formation whom might be used in patients undergoing cardiac surgery whom may need reoperation, and due to Lower costs it may replace other substitutes such as PTFF.

  3. REGULATING EFFECTS OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND ANGⅡ ON FROG'S PERICARDIAL STOMATA, MESOTHELIUM AND ANGIOGENESIS

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective. To observe the regulating effects of vascular endothelial growth factor (VEGF) and angiotensinⅡ (ANG II) on the frog's pericardium, lymphatic stomata and angiogenesis so as to reveal their effects and mechanism on the mesothelial permeability, lymphatic stoma regulation and myocardial hypertrophy. Methods. VEGF and ANGⅡ were injected into the frog's peritoneal cavity so as to examine the changes of the pericardial stromata by using transmission electron microscopy, scanning electron microscopy and computerized imaging analysis. Results. Scattered distributed pericardial stomata were found on the parietal pericardium of the frog with a few sinusoid mesothelial cells, whose blood supply was directly from the cardiac chambers flowing into the trabecular spaces of the myocardium (because there are no blood vessels in the myocardium of the frog). The average diameters of the pericardial stomata in VEGF and ANGⅡ groups were 1.50 μ m and 1.79 μ m respectively, which were much larger than those in the control group (0.72 μ m, P< 0.01); the average distribution densities of the stomata were 8.25/0.1 mm2 and 12.80/0.1 mm2 in VEGF and ANGⅡ groups, which were also much higher than those in the control group (3.57/0.1 mm2, P< 0.01); the sinusoid areas in VEGF and ANGⅡ groups were 2442.95 μ m2/0.1 mm2 and 2121.79 μ m2/0.1 mm2, which were larger than that in the control group (995.08 μ m2 /0.1 mm2 , P< 0.01); no angiogenesis was found in the frogs of the experimental groups. Conclusions. VEGF and ANGⅡ could strongly regulate the pericardial stomata by increasing their numbers and openings with larger diameters and higher distribution density. They could also increase the sinusoid areas with the result of the higher permeability of the pericardium, which clearly indicated that VEGF and ANGⅡ could speed up the material transfer of the pericardial cavity and play an important role in preventing myocardial interstitial edema. Yet there was no strong

  4. Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C3F8 without Posturing

    OpenAIRE

    Tina Xirou; Vasiliki Xirou; George Mangouritsas; Elias Feretis; Kabanarou, Stamatina A.

    2011-01-01

    Purpose: To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C3F8 14%. Method: A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient’s chronic illness (respiratory problems), a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silic...

  5. Two cases of delayed cardiac tamponade due to pericarditis after pulmonary vein (PV) isolation for atrial fibrillation.

    Science.gov (United States)

    Torihashi, Sadayoshi; Shiraishi, Hirokazu; Hamaoka, Tetsuro; Imai, Mikimasa; Kuroyanagi, Akira; Nakanishi, Naohiko; Nakamura, Takeshi; Yamano, Tetsuhiro; Matsumuro, Akiyoshi; Shirayama, Takeshi

    2015-01-01

    Catheter ablation is an established treatment for atrial fibrillation (AF). The incidence of major complications related to the procedure is reported to be 4.5%, and delayed cardiac tamponade (DCT) is a rare, although recently recognized, complication. However, the mechanisms underlying the development of DCT remain unclear. We herein report the cases of two men, both 49 years of age, who developed cardiac tamponade requiring pericardiocentesis a few weeks after undergoing pulmonary vein isolation for persistent AF. Physicians should explain to the patient the potential for DCT as a complication prior to performing catheter ablation and provide careful follow-up for at least a few weeks after the session.

  6. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    Science.gov (United States)

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  7. Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat.

    Science.gov (United States)

    Gualis, Javier; Castaño, Mario; Rodríguez, Miguel Angel; García, Cristina

    2015-12-01

    Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.

  8. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

    Directory of Open Access Journals (Sweden)

    Mohamed AA

    2013-02-01

    Full Text Available Ahmed Abdel Alim Mohamed,1 Mohamed Abdrabbo21Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo; 2Faculty of Medicine, Ophthalmology Department, Benha University, Benha, EgyptBackground: The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies.Methods: A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade, with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score.Results: Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05. The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent, with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7% in group A which required suturing and one case (3.3% in group B, but the difference was not statistically significant (P > 0.05. There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted.Conclusion: Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase

  9. Distribution and Resistance Analysis of Pathogenic Bacteria Causing Catheter Associated Urinary Tract Infection in ICU%ICU导尿管相关性尿路感染的病原菌分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    邵俊; 郑瑞强; 林华; 卢年芳; 於江泉

    2013-01-01

    Objective :To explore the distribution and resistance of pathogenic bacteria causing catheter associated uri-nary tract infection in ICU so as to guide the clinical rational use of antibiotics .Methods :Urine culture and its drug sus-ceptibility results of patients who were diagnosed catheter associated urinary tract infection were analyzed retrospective-ly from July 2009 to June 2013 in ICU of Subei People’s Hospital of Jiangsu Province .Results:226 strains of pathogenic bacteria was detected from 4558 urine specimens ,of which 138 strains of gram-negative bacteria (61 .06% ) ,57 strains of gram-positive bacteria(25 .22% ) ,31 fungi strains(13 .72% ) .Top five of pathogenic bacteria was followed by acine-tobacter baumannii ,pneumonia klebsiella ,Escherichia coli ,Enterococcus faecalis ,candida albicans .Resistance of acine-tobacter baumannii in most drug was >50% .Under 50% of the resistance was just cefoperazone/sulbactam ,meropen-em ,imipenem/Cilastatin ,SMZ/TMP .Conclusion:Gram-negative bacteria is still the main pathogenic bacteria of catheter associated urinary tract infections in ICU .Acinetobacter baumannii has risen to the first pathogenic bacteria ,and drug resistance is very severe .Rational use of antibiotics and good hand hygiene is very important according to the results of drug susceptibility .%目的:探讨IC U导尿管相关性尿路感染的病原学分布及耐药性,为临床合理使用抗菌药物提供依据。方法:回顾性对2009年7月-2013年6月入住我院IC U确诊导尿管相关性尿路感染的患者送检的尿液标本培养及药敏结果进行统计分析。结果:4558份尿标本共检出226株致病菌,其中革兰氏阴性菌138株,占61.06%,革兰氏阳性菌株57株,占25.22%,真菌株31株,占13.72%。排名前五位的病原菌依次是鲍曼不动杆菌、肺炎克雷伯氏菌、大肠埃希菌、粪肠球菌、白色念珠菌。鲍曼不动杆菌对大部分药物耐药性均>50

  10. Calcium-phosphate deposits on a hydrophilic acrylic intraocular lens after silicon oil tamponade

    Directory of Open Access Journals (Sweden)

    Rashid Alsaeidi

    2008-01-01

    Full Text Available We report a 52-year-old man who underwent uncomplicated cataract operation and posterior chamber lens implantation (hydrophilic acrylic lens in his left eye 5 years prior to presentation. Two years after surgery he developed pseudophakic retinal detachment which was successfully treated with pars plana vitrectomy and silicon oil tamponade. The silicon oil was removed one year after surgery. A year later he complained of increasing blurred vision in the left eye. Clinical examination revealed vesicular alterations located superficially on the intraocular lens (IOL, which could not be removed by perflourocarbon-perflourohexloctane lavage. As the patient complained about increasing visual impairment, the IOL was removed. The IOL was investigated by electronmicroscopy and biochemical analysis. During electron microscopy and following biochemical analysis the observed alterations were identified as calcium-phosphate particles located on the superficial aspect of the IOL. The occurrence of calcium-phosphate deposits on a posterior chamber IOL after silicon oil tamponade is a rare complication and has not been described so far. As these deposits interfere with visual acuity, removal of the lens has to be considered.

  11. Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

    Directory of Open Access Journals (Sweden)

    Masato Kinugasa

    2015-01-01

    Full Text Available While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.

  12. Balloon Tamponade Treatment of a Stent-graft Related Rupture with a Splenic Artery Pseudoaneurysm: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2009-09-15

    An arterial rupture resulting from stent-graft placement of a splenic artery pseudoaneurysm is a life-threatening complication and immediate endovascular or surgical treatment is indicated. We report a case of a stentgraft related splenic artery rupture treated solely with a prolonged balloon catheter tamponade, which resulted in preservation of vessel patency

  13. Reduction of Catheter-Associated Urinary Tract Infections Through the Use of an Evidence-Based Nursing Algorithm and the Implementation of Shift Nursing Rounds: A Quality Improvement Project.

    Science.gov (United States)

    Thomas, Kamishia L

    2016-01-01

    Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infections. The purpose of this quality improvement (QI) project was to successfully implement a nurse-led evidence-based practice change designed to reduce CAUTIs in a cardiac intensive care and step-down unit. The QI project was implemented using a convenience sample of patients admitted to the cardiac intensive care and step-down unit.Evaluation data were collected 3 months preimplementation and 9 months postimplementation. We used Wick's Check-Plan-Do-Check-Act model of continuous QI to guide the project. A statistically significant change in the number of CAUTIs (P = .009) and CAUTI occurrences (P = .005) was observed following the intervention. The number of indwelling catheter days and indwelling catheter utilization did not significantly differ following implementation of the intervention. Nurse compliance with the intervention was computed for each month; the average compliance rate was 91%. Findings from this project indicate that a nurse-led evidence-based practice project exerted a positive influence on CAUTI occurrences.

  14. Predictors of Post Pericardiotomy Low Cardiac Output Syndrome in Patients With Pericardial Effusion

    Directory of Open Access Journals (Sweden)

    Sabzi Feridoun

    2015-03-01

    Full Text Available Introduction: Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failure.Methods: During periods of five years, 423 patients in our hospital underwent pericardiotomy for decompression of effusion. The clinical characteristics of those patient with postoperative low cardiac output (B group (14 cases recorded and compared with other patients without this postoperative complication (A group by test and X2. Significant variables in invariables (P≤0.1 entered in logistic regression analysis and odd ratio of these significant variables obtained. Results: Idiopathic pericardial effusion, malignancy, renal failure, connective tissue disease, viral pericarditis was found in 125 patients (27%, 105 patients (25.4%, 65 patients (15.6%, 50 (17.1% and 10 (2.4% of patients subsequently. The factors that predict post-operative death in logistic regression analysis were malignancy, radiotherapy, constrictive pericarditis inotropic drug using IABP using, pre-operative EF and pericardial calcification.Conclusion: Certain preoperative variables such as malignancy, radiotherapy, low EF, calcified pericardium and connective tissue disease are associated with POLCOS and post-operative risk of death. This paradoxical response to pericardial decompression may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion or thicken pericardium resulting in ventricular dilatation and failure or intra operative myocardial injury due to pericardiectomy of calcified pericardium, radiation and cardiomyopathy.

  15. Correlation of different imaging modalities in pre-surgical evaluation of pericardial metastasis of liposarcoma

    Institute of Scientific and Technical Information of China (English)

    Zeljko Z Markovic; Ana Mladenovic; Marko Banovic; Branislava Ivanovic

    2012-01-01

    A patient presented with a large pericardial tumor of uncertain etiology.Five years earlier,she had been treated for myxoid liposarcoma of the thigh.For pre-surgical evaluation,conventional radiography,positron emission tomography/computed tomography (PET/CT),magnetic resonance imaging (MRI),CT of the heart,transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed.The final histopathologic diagnosis was metastatic liposarcoma.Each of the imaging modalities used had advantages and disadvantages,and their coordination was necessary for optimal evaluation.

  16. Clinical analysis of emergency pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion%塞尔丁格法心包穿刺置管引流术治疗急诊大量心包积液临床分析

    Institute of Scientific and Technical Information of China (English)

    吴海东; 陈雪梅; 黄勇; 吴满辉; 林小鸿; 黄子通

    2014-01-01

    Objective To investigative the effectiveness and safety of emergency pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion. Methods 23 emergency patients with large amount of pericardi-al effusion and tamponade symptom were included.In Seldinger's group,1 3 patients were performed with emergency pericardio-centesis with Seldinger puncture and tube drainage technique.In traditional pericardiocentesis (traditional)group,1 0 patients were performed with traditional pericardiocentesis drainage technique.The symptoms of patients,variation in thickness of pericar-dial effusion by ultrasound and complication were compared between the two groups. Results In Seldinger's group,patients were performed with puncture only one time,the gross drainage liquid were about 800 ~1 500ml.In the traditional group,pa-tients were performed with puncture 2 ~3 times,the gross infusion were about 700 ~1 200ml.The tamponed symptom were allevi-ated in the two groups.The changes of physiological parameter (heart rate,pulse pressure difference,respiratory rate,oxyhemo-globin saturation)after operations between the two groups had no statistical difference (P >0.05).The residual liquid checked by ultrasound in the Seldinger's group were less than the traditional group (P <0.05).The Seldinger's group had less complica-tion too. Conclusion Pericardiocentesis with Seldinger puncture and tube drainage technique for pericardial effusion can thor-ough drain liquid,it is worthy of clinical popularization and application for the effect and safety.%目的:探讨急诊塞尔丁格(Seldinger)法心包穿刺置管术的疗效及安全性。方法急诊大量心包积液合并有填塞症状的患者23例,按急诊来诊顺序分为常规穿刺组10例、塞尔丁格法组13例,塞尔丁格法组采用塞尔丁格法心包穿刺置管引流术,常规穿刺组采用传统的心包穿刺抽液术治疗,比较两组患者治疗前后症状变化,治疗后

  17. Idiopathic pericardial effusion in 2 year old labrador managed with ultrasound-guided pericardiocentesis: Case report

    Directory of Open Access Journals (Sweden)

    JB Adeyanju

    2012-06-01

    Full Text Available A two-year old, 38kg-wt male Labrador was presented for management because of progressive exercise intolerance. At presentation, rectal temperature was 38.5oC, pulse rate was135 beats per minute (but weak. There was ascites along with oedema of the extremities. The heart sound was muffled and pulsus paradoxus was very mild. The patient was well hydrated. Thoracic radiography revealed a globoid shaped heart occupying most of the equatorial thoracic volume; there was loss of details of cardiac silhouette and there was dorsal deviation of trachea at carina. Ultrasonography revealed a distinct epicardium, pericardium and a very wide anechoic space in between. Blood picture was within normal findings. Idiopathic chronic pericardial effusion was diagnosed. Ultrasound-guided pericardiocentesis was carried out using a 16 gauge over the needle catheter attached to a 3-way stopcock and a 20mls syringe; about 65mls of clear effusate was aspirated. Laboratory analysis of the effusate revealed that it was a transudate. The patient was placed on 3mg/kg furosemide, twice daily for 5 days and the patient returned to gradual exercise during hospitalization. Oedema of the extremities and ascities decreased, the appetite improved and the dog became more active. Thoracic radiography fourth week post pericardiocentesis revealed a normal cardiac silhouette. The cause of pericardial effusion was not known.

  18. Pericardial effusion as the only manifestation of infection with Francisella tularensis: a case report

    Directory of Open Access Journals (Sweden)

    Landais Cécile

    2008-06-01

    Full Text Available Abstract Introduction Francisella tularensis, a facultative intracellular Gram-negative bacterium, has rarely been reported as an agent of pericarditis, generally described as a complication of tularemia sepsis. F. tularensis is a fastidious organism that grows poorly on standard culture media and diagnosis is usually based on serological tests. However, cross-reactions may occur. Western blotting allows the correct diagnosis. Case presentation A non-smoking 53-year-old woman was admitted to hospital with a large posterior pericardial effusion. Serological tests showed a seroconversion in antibody titers to F. tularensis (IgG titer = 400 and Legionella pneumophila (IgG titer = 512. F. tularensis was identified by Western immunoblotting following cross-adsorption. The patient reported close contact with rabbits 2 weeks prior to the beginning of symptoms of pericarditis. Conclusion We report a rare case of pericardial effusion as the only manifestation of infection by F. tularensis. The etiological diagnosis is based on serology. Western blotting and cross-adsorption allow differential diagnosis.

  19. Effects of colchicine on pericardial diseases: a review of the literature and current evidence

    Science.gov (United States)

    Shah, Syed Raza; Alweis, Richard; Shah, Syed Arbab; Arshad, Mohammad Hussham; Manji, Adil Al-Karim; Arfeen, Arham Amir; Javed, Maheen; Shujauddin, Syed Muhammad; Irfan, Rida; Shabbir, Sakina; Shaikh, Shehryar

    2016-01-01

    Colchicine, extracted from the colchicum autumnale plant, used by the ancient Greeks more than 20 centuries ago, is one of the most ancient drugs still prescribed even today. The major mechanism of action is binding to microtubules thereby interfering with mitosis and subsequent modulation of polymorphonuclear leukocyte function. Colchicine has long been of interest in the treatment of cardiovascular disease; however, its efficacy and safety profile for specific conditions have been variably established in the literature. In the subset of pericardial diseases, colchicine has been shown to be effective in recurrent pericarditis and post-pericardiotomy syndrome (PPS). The future course of treatment and management will therefore highly depend on the results of the ongoing large randomized placebo-controlled clinical trial to evaluate the efficacy and safety of colchicine for the primary prevention of several postoperative complications and in the perioperative period. Also, given the positive preliminary outcomes of colchicine usage in pericardial effusions, the future therapeutical use of colchicine looks promising. Further study is needed to clarify its role in these disease states, as well as explore other its role in other cardiovascular conditions. PMID:27406462

  20. Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

    Science.gov (United States)

    Bai, Hualong; Lee, Jung Seok; Chen, Elizabeth; Wang, Mo; Xing, Ying; Fahmy, Tarek M.; Dardik, Alan

    2017-01-01

    Prosthetic grafts and patches are commonly used in cardiovascular surgery, however neointimal hyperplasia remains a significant concern, especially under low flow conditions. We hypothesized that delivery of rapamycin from nanoparticles (NP) covalently attached to patches allows sustained site-specific delivery of therapeutic agents targeted to inhibit localized neointimal hyperplasia. NP were covalently linked to pericardial patches using EDC/NHS chemistry and could deliver at least 360 ng rapamycin per patch without detectable rapamycin in serum; nanoparticles were detectable in the liver, kidney and spleen but no other sites within 24 hours. In a rat venous patch angioplasty model, control patches developed robust neointimal hyperplasia on the patch luminal surface characterized by Eph-B4-positive endothelium and underlying SMC and infiltrating cells such as macrophages and leukocytes. Patches delivering rapamycin developed less neointimal hyperplasia, less smooth muscle cell proliferation, and had fewer infiltrating cells but retained endothelialization. NP covalently linked to pericardial patches are a novel composite delivery system that allows sustained site-specific delivery of therapeutics; NP delivering rapamycin inhibit patch neointimal hyperplasia. NP linked to patches may represent a next generation of tissue engineered cardiovascular implants.

  1. Effects of colchicine on pericardial diseases: a review of the literature and current evidence

    Directory of Open Access Journals (Sweden)

    Syed Raza Shah

    2016-07-01

    Full Text Available Colchicine, extracted from the colchicum autumnale plant, used by the ancient Greeks more than 20 centuries ago, is one of the most ancient drugs still prescribed even today. The major mechanism of action is binding to microtubules thereby interfering with mitosis and subsequent modulation of polymorphonuclear leukocyte function. Colchicine has long been of interest in the treatment of cardiovascular disease; however, its efficacy and safety profile for specific conditions have been variably established in the literature. In the subset of pericardial diseases, colchicine has been shown to be effective in recurrent pericarditis and post-pericardiotomy syndrome (PPS. The future course of treatment and management will therefore highly depend on the results of the ongoing large randomized placebo-controlled clinical trial to evaluate the efficacy and safety of colchicine for the primary prevention of several postoperative complications and in the perioperative period. Also, given the positive preliminary outcomes of colchicine usage in pericardial effusions, the future therapeutical use of colchicine looks promising. Further study is needed to clarify its role in these disease states, as well as explore other its role in other cardiovascular conditions.

  2. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America%成人导管相关尿路感染的诊断、预防和治疗——2009年美国感染病学会国际临床实践指南

    Institute of Scientific and Technical Information of China (English)

    邹鹤娟; 李光辉

    2010-01-01

    @@ 导(尿)管相关(catheter-associated, CA)菌尿症,在全球范围内为最常见卫生保健相关感染,系医院和长期护理院(long-term care facilities,LTCF) 广泛使用导尿管所致,其中多数为不合理使用.

  3. Assessment of Anterior Segment Changes in Pseudophakic Eyes, Using Ultrasonic Biomicroscopic Imaging, after Pars Plana Vitrectomy with Silicone Oil or Gas Tamponade

    OpenAIRE

    Erkan Ünsal; Kadir Eltutar; Belma Karini; Osman Kızılay

    2016-01-01

    Objective. To evaluate the morphological changes of the anterior segment using ultrasonic biomicroscopy (UBM) imaging in pseudophakic patients who underwent pars plana vitrectomy (PPV) with silicone oil or gas (C3F8) internal tamponade agent injection. Method. This prospective study included pseudophakic patients with planned PPV, divided into two groups according to internal tamponade agent: those in which silicone oil was used (n = 27, Group 1) and those in which gas (C3F8) was used (n = 24...

  4. Plasma Cell Type of Castleman's Disease Involving Renal Parenchyma and Sinus with Cardiac Tamponade: Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Un; Kim, Suk; Lee, Jun Woo; Lee, Nam Kyung; Jeon, Ung Bae; Ha, Hong Gu; Shin, Dong Hoon [Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2012-09-15

    Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.

  5. Late Onset Ipilimumab-Induced Pericarditis and Pericardial Effusion: A Rare but Life Threatening Complication

    Directory of Open Access Journals (Sweden)

    Seongseok Yun

    2015-01-01

    Full Text Available Metastatic cutaneous melanoma has poor prognosis with 2-year survival rate of 10–20%. Melanoma cells express various antigens including gp100, melanoma antigen recognized by T cells 1 (MART-1, and tyrosinase, which can induce immune-mediated anticancer response via T cell activation. Cytotoxic T-lymphocyte associated antigen-4 (CTLA-4 is an immune check point molecule that negatively regulates T cell activation and proliferation. Accordingly, recent phase III clinical trials demonstrated significant survival benefit with ipilimumab, a human monoclonal antibody (IgG1 that blocks the interaction of CTLA-4 with its ligands. Since the efficacy of ipilimumab depends on T cell activation, it is associated with substantial risk of immune mediated adverse reactions such as colitis, hepatitis, thyroiditis, and hypophysitis. We report the first case of late onset pericarditis and cardiac tamponade associated with ipilimumab treatment in patient with metastatic cutaneous melanoma.

  6. 聚维酮碘消毒减少导尿管相关性尿路感染的临床观察%Efficacy of povidone-iodine intervention to reduce catheter-associated urinary tract infections

    Institute of Scientific and Technical Information of China (English)

    曾娟琴; 韩斌德; 胡欣春; 邬海; 边泽源

    2012-01-01

    目的 探讨导尿时尿道注入聚维酮碘消毒,对减少导尿管相关性尿路感染的作用.方法 196例术前需留置导尿的患者随机分为对照组及试验组各98例,对照组行常规尿道外口及其周围器官皮肤消毒,按常规无菌操作技术行导尿,试验组在常规消毒的基础上,加用注射器从尿道外口注入0.5%聚维酮碘行全尿道消毒,余操作同对照组;两组均定期留取尿液标本做细菌培养及尿常规检查.结果 第5、7、10天试验组尿路感染发生率分别为2.27%、7.69%及22.73%,明显低于对照组的10.11%、25.49及66.67%,差异有统计学意义(P<0.05);而留置导尿管第2、13、>16天的尿路感染发生率两组差异无统计学意义.结论 尿道注入聚维酮碘消毒对减少早期导尿管相关性尿路感染是一种简便有效的方法.%OBJECTIVE To explore the efficacy of povidone-iodine as is injected to the urinary tract and its effect on reducing the catheter-associated urinary tract infections, METHODS A total of 196 patients who intended to the indwelling urethral catheter before the surgery were randomly divided into the control group and the study group with 98 cases in each, the urinary catheters were inserted in the control group who received the disinfection of external orifice of urethra and its surrounding skin according to routine aseptic technique protocol, while the test group received the extra-disinfection of the whole urethral using povidone-iodine besides routine aseptic technique protocol before the urinary catheters were inserted, and then the urinary specimens were taken out regularly from two groups respectively for urine routine examination and microbial culture. RESULTS The incidence rates of UTI were 2.27%, 7. 69% and 22. 73%, respectively in the study group on the 5th, 7th and 10th day, which were significantly lower than 10. 11%, 25. 49% and 66. 67% respectively of the control group, the differences were

  7. The Effect of Viscosity of PDMS Based Silicone-Oil Tamponade Agents on the Movement Relative to the Eye Wall during Eye Movements

    Directory of Open Access Journals (Sweden)

    Chan Yau Kei

    2011-05-01

    Full Text Available Silicone oil tamponade is used as vitreous substitute to treat complicated retinal diseases. It provides support to the retina and acts against contraction of the retina and as such plays a vital role in preventing eyes from certain blindness. Silicone oil however has a tendency to emulsify and is accountable to inflammation and glaucoma. In in-vitro study, it was found that using silicone-oil with higher viscosity reduce the occurrences of emulsifications. In this study, an eye model chamber was used to capture the movement of silicone oil bubbles inside the model eye chamber by rapid serial photography. A few tamponades derived from the same material but with different shear viscosities were used. Our objective of this experiment is to investigate the effect of viscosity of tamponade to the movement of tamponade relative to retinal phase in model eye chambers mimicking saccadic eye movements. Our experiment confirms that shear viscosity determines the relative movement between the silicone bubble and the chamber wall. The higher the viscosity, the smaller the movement of tamponade relative to the chamber wall. We suggested that using much viscous tamponade may reduce the onset of emulsification due to the reduction of relative movement.

  8. A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients – the HEALTHY-CATH trial

    Directory of Open Access Journals (Sweden)

    Broom Jennifer K

    2012-11-01

    Full Text Available Abstract Background Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI. Methods Patients undergoing haemodialysis (HD via a tunnelled catheter were randomised 1:1 to once per week ethanol locks (with two heparin locks between other dialysis sessions vs thrice per week heparin locks. Results Observed catheter days in the heparin (n=24 and ethanol (n=25 groups were 1814 and 3614 respectively. CRBSI occurred at a rate of 0.85 vs. 0.28 per 1000 catheter days in the heparin vs ethanol group by intention to treat analysis (incident rate ratio (IRR for ethanol vs. heparin 0.17; 95%CI 0.02-1.63; p=0.12. Flow issues requiring catheter removal occurred at a rate of 1.6 vs 1.4 per 1000 catheter days in the heparin and ethanol groups respectively (IRR 0.85; 95% CI 0.20-3.5 p =0.82 (for ethanol vs heparin. Conclusions Catheter survival and catheter-related blood stream infection were not significantly different but there was a trend towards a reduced rate of infection in the ethanol group. This study establishes proof of concept and will inform an adequately powered multicentre trial to definitively examine the efficacy and safety of ethanol locks as an alternative to current therapies used in the prevention of catheter-associated blood stream infections in patients dialysing with tunnelled catheters. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12609000493246

  9. Pericardial effusion in a diabetic patient with prostatic abscess; Derrame pericardico associado a abscesso prostatico em paciente diabetico

    Energy Technology Data Exchange (ETDEWEB)

    Omais, Ali Kassen; Oliveira, Julio Cesar; Tenuta, Marcos de Thadeu; Marchese, Miriam; Ricca, Rene A. Mattos; Tenuta, Maria Carolina Antunes de Oliveira, E-mail: aliomais@yahoo.com [Hospital Geral Universitario (HGU/UNIC), Cuiaba, MT (Brazil); Chauchar, Fause; Cardoso Junior, Valdiro Jose; Carvalho, Valdinei Vieira de [Centro de Cardiologia, Cuiaba, MT (Brazil)

    2009-04-15

    Purulent pericarditis is a rare and potentially fatal disease. Its diagnosis and treatment is difficult. An aggressive antibiotic treatment and pericardial drainage are essentials for the treatment of purulent pericarditis. We report an unusual case of a diabetic patient with purulent pericarditis and prostatic abscess with good evolution after appropriate treatment. (author)

  10. Histology and ultrastructure of pericardial cells of Scaptotrigona postica Latreille (Hymenoptera, Apidae) in workers and queens of different ages.

    Science.gov (United States)

    Poiani, Silvana Beani; da Cruz-Landim, Carminda

    2007-01-01

    The paper presents a study of the pericardial cells of Scaptotrigona postica an eusocial Brazilian stingless bee. Light and electron microscopy was used in a comparative study on workers and queens of different ages, exerting different functions in the colony. The pericardial cells are found only in the pericardial sinus, mainly in groups around the dorsal vessel. Each cell is enclosed by the basal membrane and its peripheral region is characterized by folds of the plasma membrane, which form canals and loops. The points where the plasma membrane folds is frequently closed by diaphragms, that along with the basal lamina form a barrier to substances from hemolymph. Along the membrane limiting the canals and loops, an intense endocytic activity through coated vesicles takes place indicating a selective absorption of hemolymph components. In older individuals, workers or queens, the cells exhibit larger quantities of cytoplasm inclusions, heterogeneous vacuoles containing the final products of intracellular digestion, and autophagic vacuoles with concentric membranous structures. The pericardial cells general morphology is in accordance with the role in processing metabolites captured from hemolymph and storage of indigested residues.

  11. Epicardial ablation: prevention of phrenic nerve damage by pericardial injection of saline and the use of a steerable sheath.

    Science.gov (United States)

    Neven, Kars; Fernandez-Armenta, Juan; Andreu, David; Berruezo, Antonio

    2014-03-01

    Because of the close proximity of the phrenic nerve to the pericardium, phrenic nerve damage caused by epicardial ablation can easily occur. We report two cases of epicardial VT ablation where pericardial injection of saline, combined with the use of a steerable sheath, successfully prevents the phrenic nerve from being damaged.

  12. Interaction of the tracheal tubules of Scutigera coleoptrata (Chilopoda, Notostigmophora with glandular structures of the pericardial septum

    Directory of Open Access Journals (Sweden)

    Gero Hilken

    2015-06-01

    Full Text Available Notostigmophora (Scutigeromorpha exhibit a special tracheal system compared to other Chilopoda. The unpaired spiracles are localized medially on the long tergites and open into a wide atrium from which hundreds of tracheal tubules originate and extend into the pericardial sinus. Previous investigators reported that the tracheal tubules float freely in the hemolymph. However, here we show for the first time that the tracheal tubules are anchored to a part of the pericardial septum. Another novel finding is this part of the pericardial septum is structured as an aggregated gland on the basis of its specialized epithelium being formed by hundreds of oligocellular glands. It remains unclear whether the pericardial septum has a differently structure in areas that lack a connection with tracheal tubules. The tracheal tubules come into direct contact with the canal cells of the glands that presumably secrete mucous substances covering the entire luminal cuticle of the tracheal tubules. Connections between tracheae and glands have not been observed in any other arthropods.

  13. Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest.

    Science.gov (United States)

    Nishino, Kimihiro; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu

    2013-03-01

    We present the case of a 37-year-old nulliparous woman in whom acute massive uterine bleeding during dienogest therapy was successfully treated using intrauterine balloon tamponade. Abnormal uterine bleeding and several cases of profuse bleeding causing severe anemia in association with dienogest therapy have been reported, but this is the first reported case involving hypovolemic shock. While successful control of postpartum hemorrhage with intrauterine balloon tamponade has been well described, applications for non-obstetric bleeding, particularly in the presence of underlying diseases, such as adenomyosis, have only rarely been reported. This procedure can be easily, promptly, and safely implemented without analgesia, anesthesia, or laparotomy; it can be used with a minimally dilated external cervical os or narrow uterine cavity; and it can preserve fertility.

  14. Hemodynamic effects of knee-joint tamponade; sup 99m Tc-diphosphonate scintimetry in growing dogs

    Energy Technology Data Exchange (ETDEWEB)

    Stender Hansen, E.; Buenger, C. (Aarhus Orthopedic Hospital, Aarhus (Denmark)); Brink Henriksen, T. (University of Aarhus, Institute of Experimental Clinical Research, Aarhus (Denmark)); Noer, I. (Department of Clinical Physiology, County Hospital, Randers (Denmark))

    1989-01-01

    We studied the influence of joint effusion on juxtaarticular vascularity and bone metabolism of the immature knee in puppies by dynamic and static {sup 99m}Tc-diphosphonate scintimetry. Unilateral joint tamponade of 10 KPa (75 mmHg), introduced by intraarticular dextran-70 infusion, resulted in quantitatively similar scintimetric changes in an angiographic Phase I (0-20 sec), a blood pool Phase II (20-256 sec), and a bone-uptake Phase III (2h). The uptake was reduced by 20 percent in the distal femoral epiphysis, by 15 percent in the distal femoral growth plate in Phase II-III, and by 8 percent in the proximal tibial growth plate in Phase III. The main part of scintimetric changes during joint tamponade could be ascribed to altered epiphyseal and metaphyseal intraosseous hemodynamics. (author).

  15. Hemodynamic and regional blood flow distribution responses to dextran, hydralazine, isoproterenol and amrinone during experimental cardiac tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Millard, R.W.; Fowler, N.O.; Gabel, M.

    1983-06-01

    Four different interventions were examined in dogs with cardiac tamponade. Infusion of 216 to 288 ml saline solution into the pericardium reduced cardiac output from 3.5 +/- 0.3 to 1.7 +/- 0.2 liters/min as systemic vascular resistance increased from 4,110 +/- 281 to 6,370 +/- 424 dynes . s . cm-5. Left ventricular epicardial and endocardial blood flows were 178 +/- 13 and 220 +/- 12 ml/min per 100 g, respectively, and decreased to 72 +/- 14 and 78 +/- 11 ml/min per 100 g with tamponade. Reductions of 25 to 65% occurred in visceral and brain blood flows and in a composite brain sample. Cardiac output during tamponade was significantly increased by isoproterenol, 0.5 microgram/kg per min intravenously; hydralazine, 40 mg intravenously; dextran infusion or combined hydralazine and dextran, but not by amrinone. Total systemic vascular resistance was reduced by all interventions. Left ventricular epicardial flow was increased by isoproterenol, hydralazine and the hydralazine-dextran combination. Endocardial flow was increased by amrinone and the combination of hydralazine and dextran. Right ventricular myocardial blood flow increased with all interventions except dextran. Kidney cortical and composite brain blood flows were increased by both dextran alone and by the hydralazine-dextran combinations. Blood flow to small intestine was increased by all interventions as was that to large intestine by all except amrinone and hydralazine. Liver blood flow response was variable. The most pronounced hemodynamic and tissue perfusion improvements during cardiac tamponade were effected by combined vasodilation-blood volume expansion with a hydralazine-dextran combination. Isoproterenol had as dramatic an effect but it was short-lived. Amrinone was the least effective intervention.

  16. Pericardial pathology 900 years ago. A study and translations from an Arabic medical textbook.

    Science.gov (United States)

    Abdel-Halim, Rabie E; Elfaqih, Salah R

    2007-03-01

    This is a study and translation of the section on pericarditis in Al Taisir book written by the Muslim physician Ibn Zuhr Avenzoar who lived and practiced in Eshbeelia nowadays Seville, Andalusia, Spain between 1091-1162 AD. Ibn Zuhr described the serous type of pericarditis as well as the pathological findings in fibrinous pericarditis. His description of the latter may also fit with the picture of chronic fibrous pericarditis. He also described acute purulent pericarditis and involvement of the pericardium in cases of acute carditis with hectic fever. Ibn Zuhr's description of the pericardial effusion in serous pericarditis as looking like urine indicates that he must have seen a sample of the fluid obtained either by pericardiocentesis or during a post-mortem examination. However, his description of solid substances accumulating on the inside of the hearts covering looking like layers upon layers of membranes could not have been made possible without post-mortem dissection.

  17. Left ventricular aneurysm repair with use of a bovine pericardial patch.

    Science.gov (United States)

    Henry, Matthew J; Preventza, Ourania; Cooley, Denton A; de la Cruz, Kim I; Coselli, Joseph S

    2014-08-01

    Left ventricular aneurysm, which can impair systolic function, has a reported incidence of 10% to 35% in patients after myocardial infarction. In a 58-year-old woman who had a history of myocardial infarction, we excised a large left ventricular aneurysm and restored left ventricular geometry with use of a bovine pericardial patch. The aneurysm's characteristics and the patient's preoperative left ventricular ejection fraction of 0.25 had indicated surgical intervention. The patient had an uneventful postoperative course, and her left ventricular ejection fraction was 0.50 to 0.55 on the 4th postoperative day. This case illustrates the value of surgical treatment for patients who have a debilitating left ventricular aneurysm.

  18. Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C3F8 without Posturing

    Science.gov (United States)

    Xirou, Tina; Xirou, Vasiliki; Mangouritsas, George; Feretis, Elias; Kabanarou, Stamatina A.

    2011-01-01

    Purpose To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C3F8 14%. Method A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient's chronic illness (respiratory problems), a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silicone oil with gas C3F8 14%. No face-down position was advised postoperatively due to her health problems. Results Macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas. Conclusions Macular hole surgery using a silicone-oil tamponade has been proposed as treatment of choice for patients unable to posture. In our case, the use of a long-acting gas (C3F8 14%), even without posturing, proved to be more effective. PMID:21677885

  19. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature.

    Science.gov (United States)

    Maharaj, Satish S; Chang, Simone M

    2015-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.

  20. Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C3F8 without Posturing

    Directory of Open Access Journals (Sweden)

    Tina Xirou

    2011-05-01

    Full Text Available Purpose: To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C3F8 14%. Method: A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient’s chronic illness (respiratory problems, a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silicone oil with gas C3F8 14%. No face-down position was advised postoperatively due to her health problems. Results: Macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas. Conclusions: Macular hole surgery using a silicone-oil tamponade has been proposed as treatment of choice for patients unable to posture. In our case, the use of a long-acting gas (C3F8 14%, even without posturing, proved to be more effective.

  1. Adipokine Imbalance in the Pericardial Cavity of Cardiac and Vascular Disease Patients.

    Directory of Open Access Journals (Sweden)

    Atlanta G I M Elie

    Full Text Available Obesity and especially hypertrophy of epicardial adipose tissue accelerate coronary atherogenesis. We aimed at comparing levels of inflammatory and atherogenic hormones from adipose tissue in the pericardial fluid and circulation of cardiovascular disease patients.Venous plasma (P and pericardial fluid (PF were obtained from elective cardiothoracic surgery patients (n = 37. Concentrations of leptin, adipocyte fatty acid-binding protein (A-FABP and adiponectin (APN were determined by enzyme-linked immunosorbent assays (ELISA. The median concentration of leptin in PF (4.3 (interquartile range: 2.8-9.1 μg/L was comparable to that in P (5.9 (2.2-11 μg/L and these were significantly correlated to most of the same patient characteristics. The concentration of A-FABP was markedly higher (73 (28-124 versus 8.4 (5.2-14 μg/L and that of APN was markedly lower (2.8 (1.7-4.2 versus 13 (7.2-19 mg/L in PF compared to P. APN in PF was unlike in P not significantly related to age, body mass index, plasma triglycerides or coronary artery disease. PF levels of APN, but not A-FABP, were related to the size of paracardial adipocytes. PF levels of APN and A-FABP were not related to the immunoreactivity of paracardial adipocytes for these proteins.In cardiac and vascular disease patients, PF is enriched in A-FABP and poor in APN. This adipokine microenvironment is more likely determined by the heart than by the circulation or paracardial adipose tissue.

  2. Prevention and control of catheter-associated urinary tract infections – implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO in nursing homes for the elderly in Frankfurt am Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Introduction: Urinary tract infections range among the most frequent infections not only in hospital patients but also in residents of long-term care facilities for the elderly. Urinary catheters are the greatest risk factor for urinary tract infections. In the guidance paper on the “prevention of infections in nursing homes” (2005 as well as in the updated recommendations for the “prevention and control of catheter-associated urinary tract infections” (2015, the Commission for Hospital Hygiene and Infection Prevention (KRINKO has recommended adequate preventive measures. In 2015, the implementation of these KRINKO recommendations was investigated.Method: All of Frankfurt’s 40 nursing homes were evaluated using a checklist based on the KRINKO recommendations. The evaluation included assessing the availability of operating instructions, appropriate indications for the placement of catheters etc. Age, sex and duration of catheterization, as well as current and previous infections within the past 6 months were documented for every resident with a catheter.Results: In 35 (87.5% of the nursing homes, operating instructions for the handling of urinary tract catheters were available. The decision as to whether a catheter is indicated is made by physicians, while its placement is often delegated to the nursing service. Typically, silicon catheters are used. In three-quarters of the nursing homes, regular intervals of 4–6 weeks for changing catheters were reported. On the respective survey day, 7.3% of the residents were catheterized. On the survey day, 3.6% (4.2% and in the previous 6 months a total of 28% (28.9% of the residents had a urinary tract infection (prevalence of antibiotic therapy in parentheses. Ciprofloxacin was used most often followed by cefuroxime and cotrimoxazole.Discussion: In the current evaluation, fewer nursing home residents were catheterized than in previous years and the rate of urinary tract infections was low

  3. Causes of central venous catheter associated infections and prevention countermeasures%中心静脉导管相关性感染原因分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    桂煜

    2011-01-01

    OBJECTIVE To understand the central venous catheter related infections and to propose preventive measures. METHODS From Apr 2008 to Mar 2010, the causes of 54 patients with deep catheter related infections were analyzed, and the definite preventive measures were taken in accordance with the causes. RESULTS Among 54 patients received the central venous catheterization, the infection of catheter export was found in 5 cases,accounting for 9.3%, 3 cases of catheter-related bloodstream infection, accounting for 5.6%, both of which were recovery after the corresponding disposals. CONCLUSIONS The risk factors of catheter related infections are the inserted time of the catheter,the sites, tle catheter types, the dressing and the nursing care of medical staff. To improve the training of the medical personnel, establish the preventive barrier to a maximum and strictly execute the aseptic manifestation is better propitious to prevent the occurrence of central venous catheter associated infection.%目的 了解中心静脉导管相关性感染的原因及应采取的预防措施.方法 分析医院2008年4月-2010年3月住院的54例深静脉留置管患者发生的导管相关性感染原因,并针对原因采取一定的预防措施.结果 54例行中心静脉置管术的患者中,置管出口部位感染5例,占9.3%;导管相关血流感染3例,占5.6%;经相应处理后均好转.结论 导管相关性感染的危险因素中重要是导管留置时间、插管部位、导管类型、敷料及医务人员操作护理;加强人员教育培训、最大限度的建立防护屏障、严格执行无菌操作等有利于更好的预防中心静脉导管相关性感染的发生.

  4. Clinic and echocardiographic characteristics of pericardial effusions in a university hospital, Medellín, Colombia Características clínicas y ecocardiográficas de los derrames pericárdicos en pacientes del Hospital Universitario San Vicente de Paúl

    Directory of Open Access Journals (Sweden)

    Carlos José Jaramillo G.

    2002-03-01

    Full Text Available Purpose: To determine the clinical and echocardiographic characteristics of pericardial effusions. Methods: Retrospective information was obtained from medical records of all patients who were diagnosed with echocardiographic pericardial effusions. Results: We studied 62 medical records of patients with echocardiographic pericardial effusions. We obtained medical records of 28 (45.2% patients with mild effusion, 19 (30.6% with moderate effusion and 15 (24.2% with severe effusion. Fourteen patients (22.6% showed inflammatory signs of pericarditis. Inflammatory signs had an Odds Ratio of 5.1. (CI 95% 1.28 to 23 wich was significant (p = 0.006. Uremia was the most common diagnosis in all patients (22.6% followed by metastatic tumors (14.5%, pyogenic pericarditis (11.3%, acute idiopathic pericarditis (11.3% and others. Conclusions: In almost all patients, etiology of pericardial effusion is the same of the underlying condition, but if the cause is unknown, the size of effusion, inflammatory signs and the presence of cardiac tamponade may help suggest etiology. Objetivos: determinar las características clínicas y ecocardiográficas de los derrames pericárdicos. Metodología: revisar retrospectivamente las historias clínicas de los pacientes con diagnóstico de derrame pericárdico hecho por ecocardiografía transtorácica entre febrero de 2000 y agosto de 2001. Resultados: se evaluaron las historias clínicas de 62 pacientes con diagnóstico de derrame pericárdico; 28 (45.2% presentaron derrames leves, 19 (30.6% derrames moderados y 15 (24.2% derrames severos; 21 (33.9% pacientes presentaron taponamiento cardíaco y el 50% de éstos tenían derrame severo. Se buscó la presencia de signos inflamatorios y se encontró que 14 (22.6% de los pacientes los presentaban. Además, estos pacientes tuvieron 5 veces más probabilidad de presentar taponamiento cardíaco (OR = 5.40. La principal causa de derrames pericárdicos fue la uremia (22.6%, seguida

  5. Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2.

    LENUS (Irish Health Repository)

    Minihan, M

    2012-02-03

    BACKGROUND: Vitrectomy and gas tamponade has become a recognised technique for the treatment of macular holes. In an attempt to improve the anatomic and visual success of the procedure, various adjunctive therapies--cytokines, serum, and platelets--have been employed. A consecutive series of 85 eyes which underwent macular hole surgery using gas tamponade alone, or gas tamponade with either the cytokine transforming growth factor beta 2 (TGF-beta 2) or autologous platelet concentrate is reported. METHODS: Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6 gas, and TGF-beta 2; 50 had vitrectomy, 16% C3F8 gas tamponade, and 0.1 ml of autologous platelet concentrate prepared during the procedure. RESULTS: Anatomic success occurred in 86% of eyes, with 96% of the platelet treated group achieving closure of the macular hole. Visual acuity improved by two lines or more in 65% of the SF6 only group, 33% of those treated with TGF-beta 2 and in 74% of the platelet treated group. In the platelet treated group 40% achieved 6\\/12 or better and 62% achieved 6\\/18 or better. The best visual results were obtained in stage 2 holes. CONCLUSION: Vitrectomy for macular holes is often of benefit and patients may recover good visual acuity, especially early in the disease process. The procedure has a number of serious complications, and the postoperative posturing requirement is difficult. Patients need to be informed of such concerns before surgery.

  6. Unusual Thymic Hyperplasia Mimicking Lipomatous Tumor in an Eight-Year-Old Boy with Concomitant Pericardial Lipomatosis and Right Facial Hemihypertrophy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo Jin; Kim Woo Sun; Cheon, Jung Eun; Lim, Yun Jung; Kim, In One; Yeon, Kyung Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Kyeong Cheon; Byun, Sun Ju [Seoul National University Hospital, Seoul (Korea, Republic of)

    2011-06-15

    We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.

  7. A rare case of isolate pericardial effusion detected by SPECT/CT on a post-therapeutic radioiodine whole-body scan

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Teik Hin [Dept. of Nuclear Medicine, National Cancer Institute, Putrajaya (Malaysia); Hassan, Siti Zarina Amir [Dept. of Nuclear Medicine, Kuala Lumpur Hospital, Kuala Lumpur (Malaysia)

    2015-09-15

    We reported a rare finding of isolated pericardial uptake detected by SPECT/CT on posttherapeutic radioiodine whole body scan. This case highlights the usefulness of hybrid SPECT/CT, with subsequent correlation with biochemical results, in ruling out metastatic pericardial effusion in the postsurgical radioiodine remnant ablation setting. The effusion was resolved after reinstituted thyroid replacement therapy. Recombinant thyrotropin is recommended to avoid such rare but life-threatening complication.

  8. Etiology of pericardial hemorrhagic effusion%血性心包积液病因分析

    Institute of Scientific and Technical Information of China (English)

    张天龙; 訾杰; 申芳芳; 张蕾; 孙艳明

    2015-01-01

    Objective To discuss the etiological distribution features of pericardial hemorrhagic effusion. Methods The patients (n=68, male 28, female 40 and aged from 19 to 87) were chosen from Apr. 2013 to Apr. 2014. All patients were divided into elderly group (≥60) and middle-aged and young group (18-59) according to age, and divided also male group (n=28) and female group (n=40) according to sex. The clinical materials were collected from all patients and etiological distribution of pericardial hemorrhagic effusion was analyzed. Results The common causes were malignant tumor (55.9%), tuberculosis (26.4%) and non-specific pericardial effusion (7.4%), and other causes included heart failure, aortic dissection and congenital heart disease. The difference in etiological distribution had no statistical significance between elderly group and middle-aged and young group (all P>0.05). The common causes were tumor and tuberculosis respectively in male group and female group and difference had no statistical significance (all P>0.05). The pathogenic tumors included lung tumor (60.5%), gynecologic tumor (13.2%), gastrointestinal tumor (10.5%), pericardium mesothelioma (5.3%), kidney and adrenal gland tumor (5.3%) and skin tumor and cervical lymphangioma (2.6%). Conclusion Tumors and tuberculosis are major pathogenic causes of pericardial hemorrhagic effusion, and age and sex are not significantly correlated to pericardial hemorrhagic effusion.%目的:探讨血性心包积液的病因分布特点。方法选自2002年1月至2012年7月北京军区总医院东区64例和2013年4月至2014年4月北京朝阳急诊抢救中心4例,行心包穿刺明确诊断为血性心包积液患者68例。其中男性28例,女性40例,年龄范围19~87岁。按年龄将患者分为2组,老年组33例(≥60岁)和中青年组35例(18~59岁)。按性别分男性组(28例)和女性组(40例)。收集所有患者临床资料,分析血性心包积液病因分布。结果患

  9. Acute Central Retinal Artery Occlusion Associated with Intraocular Silicone Oil Tamponade

    Directory of Open Access Journals (Sweden)

    Mehmet Yasin Teke

    2012-05-01

    Full Text Available Many systemic and ocular factors may cause acute central retinal artery occlusion (CRAO. Herein, we aimed to describe a case of CRAO due to intraocular silicone oil (SO tamponade. To the best of our knowledge, a case like our has not been reported previously. A 58-yearold male patient had undergone combined pars plana vitrectomy-lensectomy and intraocular SO for lens luxation and vitreus hemorrhage associated with a blunt ocular trauma in his right eye. Two weeks after the surgery, he presented with acute vision loss in the same eye. He was diagnosed with acute CRAO and it should be related with mechanical press or raised intraocular pressure (IOP associated with SO. He was treated by partial removal of SO immediately. In spite of the regression of retina edema, his visual acuity did not improve due to optic atrophy. SO may cause CRAO due to raised IOP and/or its mechanical pressure and this complication must be kept in mind. (Turk J Oph thal mol 2012; 42: 238-40

  10. Measurements of pericardial adipose tissue using contrast enhanced cardiac multidetector computed tomography—comparison with cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Elming, Marie Bayer; Lønborg, Jacob; Rasmussen, Thomas;

    2013-01-01

    Recent studies have suggested that pericardial adipose tissue (PAT) located in close vicinity to the epicardial coronary arteries may play a role in the development of coronary artery disease. PAT has primarily been measured with cardiac magnetic resonance imaging (CMRI) or with non...... tested, and the smallest difference in PAT was noted when -30 to -190 HU were used in MDCT measures. The median difference between MDCT and CMRI for the assessment of PAT was 9 ml (SD 50) suggesting a reasonable robust method for the assessment of PAT in a large-scale study. Pericardial adipose tissue...... and CMRI scans were performed. The optimal fit for measuring PAT using contrast MDCT was developed and validated by the corresponding measures on CMRI. The median for PAT volume in patients was 175 ml (SD 68) and 153 ml (SD 60) measured by MDCT and CMRI respectively. Four different attenuation values were...

  11. Reinfusion of aspirated pericardial blood during CPB. Part I. Hypothesis: laparotomy sponges are a significant part of the CPB circuit?

    Science.gov (United States)

    Bull, Brian S; Hay, Karen

    2005-01-01

    Blood accumulating in the pericardial sac is routinely reinfused during cardiopulmonary bypass (CPB) surgery. Such reinfusion has been associated with an increased incidence of serious complications such as coagulopathy, systemic inflammation, and neurologic sequelae. We hypothesize that some of these complications occur because the reinfused blood has been exposed to and activated by laparotomy sponges used to elevate the heart during vein graft emplacement. Such laparotomy sponges expose accumulating pericardial blood to a large, raw, cotton surface with an area approximately five times that of the CPB circuit (excluding the biocompatible oxygenator membrane). Because the reinfused blood has been exposed to this surface, the sponge becomes, in essence, a significant-though inapparent-part of the CPB circuit. Steps should be taken to either eliminate the sponge or to reduce the area of this foreign surface and make it more biocompatible.

  12. 临床操作路径应用于降低内科导尿管相关性尿路感染的临床观察%Clinical observation of clinical operation path to be applied to reduce medical catheter associated urinary tract infection

    Institute of Scientific and Technical Information of China (English)

    梁维红

    2015-01-01

    目的:观察临床操作路径应用于降低内科导尿管相关性尿路感染临床效果。方法:在2013年目标性监测有效预防措施基础上制定导尿管相关性尿路感染的临床操作路径干预措施,以2014年应用者310例为观察组,2013未应用者322例为对照组。结果:观察组发生泌尿系感染19例,感染率6.13%,对照组发生泌尿系感染37例,感染率11.49%。结论:临床操作路径应用于内科导尿管相关性尿路感染,有效降低泌尿道感染的发生,值得临床推广。%objective: to observe clinical path used to reduce catheter-associated urinary tract infection internal medicine clinical effects. Method:in the 2013 target monitoring effective prevention of catheter-associated urinary tract infections based on clinical path of interventions by 2014 in 310 cases of application for observer group, 2013 322 cases is not applied as a control group. Results:observation of urinary infection in 19 cases, the rate of infection 6.13%, 37 cases occurred in the control group urinary tract infections, infection rate was 11.49%. Conclusions:clinical path applied to medical catheter-associated urinary tract infections, effectively reducing the occurrence of urinary tract infections, isworthy of promotion.

  13. Curative Effects of Dendritic Cells Combined with Cytokine-Induced Killer Cells in Patients with Malignant Pericardial Effusion

    Science.gov (United States)

    Wang, Hongmin; Cui, Yuzhong; Wang, Sheng; Zhao, Rusen; Sun, Ming

    2016-01-01

    Background To determine the effects of dendritic cells (DCs) and cytokine-induced killer (CIK) cells in patients with malignant pericardial effusion. Material/Methods All patients underwent pericardial puncture and indwelling catheter insertion. After pericardial drainage, the 16 patients in the treatment group received an infusion of 20 mL DCs and CIK cells (>1.0×1010 cells) and 500,000 U interleukin (IL)-2 for 3 successive days. The 15 control-group patients received 30 mg/m2 cisplatin and 500,000 U IL-2 for 3 successive days. The treatment effects were assessed using imaging data. Results The total efficiency and complete remission rates were higher in the treatment group than in the control group at 4 weeks (total efficiency: 87.50% vs. 73.33%; complete remission: 62.50% vs. 46.67%) and 3 months after the treatment (total efficiency: 81.25% vs. 66.67%; complete remission: 50.00% vs. 40.00%; P<0.05 for all). In both groups, the Karnofsky scores for quality of life improved after treatment. However, the curative effects were better in the treatment group than in the control group (P<0.05). The following adverse reactions occurred: fever, 6 treatment-group patients and 3 control-group patients; chest pain, 2 treatment-group patients and 7 control-group patients; gastrointestinal reactions, 1 treatment-group patient and 6 control-group patients; and bone marrow suppression, 1 treatment-group patient and 5 control-group patients. The between-group differences in adverse reactions were significant (P<0.05). Conclusions The combination of DCs and CIK cells effectively treated malignant pericardial effusion, produced few side effects, and improved the patients’ quality of life. PMID:27806024

  14. Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices

    Institute of Scientific and Technical Information of China (English)

    Bo Liu; Mei-Hai Deng; Nan Lin; Wei-Dong Pan; Yun-Biao Ling; Rui-Yun Xu

    2006-01-01

    AIM:To detect the hemodynamic alterations in collateral circulation before and after combined endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization by ultrasonography,and to evaluate their effect using hemodynamic parameters.METHODS: Forty-three patients with esophageal varices received combined EVL and splenectomy with pericardial devascularization for variceal eradication. The esophageal vein structures and azygos blood flow (AZBF) were detected by endoscopic ultrasonography and color Doppler ultrasound. The recurrence and rebleeding of esophageal varices were followed up.RESULTS:Patients with moderate or severe varices in the esophageal wall and those with severe periesophageal collateral vein varices had improvements after treatment, while the percentage of patients with severe para-esophageal collateral vein varices decreased from 54.49% to 2.33%, and the percentage of patients with detectable perforating veins decreased from 79.07% to 4.65% (P < 0.01). Color Doppler flowmetry showed a significant decrease both in AZBF (43.00%,P < 0.05) and in diameter of the azygos vein (28.85%, P < 0.05), while the blood flow rate was unchanged. The recurrence rate of esophageal varices was 2.5% (1/40,mild), while no re-bleeding cases were recorded.CONCLUSION:EVL in combination with splenectomy with pericardial devascularization can block the collateral veins both inside and outside of the esophageal wall, and is more advantagious over splenectomy in combination with pericardial devascularization or EVL in preventing recurrence and re-bleeding of varices.

  15. ICU 导管相关感染患者干预前后的费用分析%Medical cost of intensive care unit patients with catheter-associated infec-tion before and after intervention

    Institute of Scientific and Technical Information of China (English)

    潘颖颖; 朱熠; 庄建文; 唐娜; 李辉; 邹建文; 张淑敏

    2015-01-01

    Objective To compare whether there is a difference in medical cost of intensive care unit(ICU)pa-tients with catheter-associated infection (CAI)between before and after targeted intervention.Methods CAI in ICU patients in 2010(pre-intervention group)and 2013 (post-intervention group)were investigated by retrospective survey,hospitalization cost of two groups of patients before and after intervention was compared.Results The morbidity and mortality in patients with CAI both decreased significantly after intervention,morbidity of healthcare-associated infection(HAI)decreased from 13.47% in 2010 to 4.41 % in 2013,mortality decreased from 10.36% in 2010 to 2.2% in 2103.Total hospitalization cost,blood transfusion cost,and cost of special material before and af-ter the implementation of targeted intervention all significantly different (all P <0.05),the difference of procalcito-nin and antimicrobial agents cost were also significant(all P <0.05).Conclusion Medical cost in ICU patients with CAI decreased after intervention.%目的:比较目标性干预前后重症监护室(ICU)导管相关感染患者医疗费用有无差异。方法采用回顾性调查方法,调查2010年(干预前组)、2013年(干预后组)某院 ICU 患者导管相关感染情况,比较两组患者的住院费用在干预前后的差异。结果干预后 ICU 导管相关感染患者发病率和病死率均明显下降,医院感染发病率由2010年的13.47%下降至2013年4.41%;病死率由2010年的10.36%下降至2013年的2.2%。实施目标性干预前后患者住院总费用、血费以及特殊材料费用比较,差异均有统计学意义(均 P <0.05);各感染指标相关费用比较中降钙素原检测和抗菌药物使用费用经统计学分析,差异均有统计学意义(均 P <0.05)。结论干预后 ICU 患者发生导管相关医院感染医疗费用有下降。

  16. Analysis of risk factors of indwell ing catheter associated urinary tract infection and nursing prevention%留置尿管相关性尿路感染的危险因素分析及护理预防

    Institute of Scientific and Technical Information of China (English)

    王竹君; 付林; 王玉; 陈汉霞

    2014-01-01

    Objective:To probe into the risk factors of indwelling cathe-ter associated urinary tract infection,so as to improve the clinical medi-cal security.Methods:A total of 255 patients with indwelled urinary and data integrity were included.According to whether catheter relat-ed urinary infection occurred or not,all patients were divided into infec-tion group (73 cases)and not infection group (182 cases).Single fac-tor analysis was used to investigate the differences of risk factors of catheter related urinary infection between both groups,and further Logistic regression analysis was used to analyze independent risk fac-tors of influencing catheter related urinary infection.Results:Univa-riate analysis of two groups of data showed that the age,indwelling uri-nary tube time ≥ 7 d,application of hormone,operation ≥ 2 or more times,bladder irrigation <7 times every week,urethral opening clean-ing<7 times every week in infection group were higher than those in non infection group,all differences were statistically significant (all P <0.05).Multi factor analysis of two groups data showed that in infec-tion groups,the age,indwelling urinary tube time≥7d,operation≥2 or more times and urethral opening cleaning<7 times every week were high-er than those in non infection group,the difference was statistically significant (P < 0.05).Conclusion:Old age,long indwelling time,the operation of more than 2 times and urethral mouth cleaning <7 times per week are the independent risk factors of catheter related urinary tract infection.%[目的]探讨留置尿管相关性尿路感染的危险因素,以提高临床医疗安全性。[方法]纳入资料完整的留置尿管病人255例,以是否发生导管相关性尿路感染为判断标准分为感染组(73例)和非感染组(182例)。采用单因素分析两组导管相关性尿路感染的危险因素的差异,并进一步通过 Logistic 回归分析影响导管相关性尿路感染发生的独立危险因素。[结果]两组资料单因素分析表明,感染组年龄、留置尿管时间≥7 d、应用激素、操作次数≥2次、膀胱冲洗<7次/周及尿道口清洗<7次/周均高于非感染组,差异均有统计学意义(均 P <0.05)。两组资料多因素分析表明,感染组年龄、留置尿管时间≥7 d、操作次数≥2次及尿道口清洗<7次/周均高于非感染组,差异均有统计学意义(均 P <0.05)。[结论]年龄大、留置尿管时间长、操作次数≥2次及尿道口清洗<7次/周是发生导管相关性尿路感染的独立危险因素。

  17. 基层医院ICU中心静脉导管相关性血流感染的危险因素分析%Risk Factors of Catheter-Associated Bloodstream Infections in Intensive Care Unit of Primary Hospital

    Institute of Scientific and Technical Information of China (English)

    张细江

    2012-01-01

    Objective To explore the risk factors of catheter-associated bloodstream infections (CRBSI) in intensive care unit (ICU) of primary hospital. Methods A total of 623 patients with central venous catheters were recruited in the study. 60 of them suffered from CRBSI served as an observation group and other 563 cases without CRBSI served as control. Univariate analysis was used to scan possible risk factors. Then logistic regression analysis was used to exclude the confounding factors. Results The overall incidence rate of CRBSI was 9. 63% (60/623). There were significant differences in APACHE score, type of catheter,location of catheter,duration of central venous catheter,intravenous nutrition, use of steroid,times of intubation, urgent intubations, nutritional status, diabetes, and MODS between the two groups. Logistic regression analysis revealed that higher APACHE score, double-lumen catheter, femoral vein catheter, catheter indwelling more than two weeks, intravenous nutrition, intubation more than 2 times, and emergency intubation were risk factors of CRBSI. Conclusions Higher APACHE score,double-lumen catheter,femoral vein catheter,catheter indwelling more than two weeks,intravenous nutrition,intubation more than 2 times, and emergency intubation were major risk factors of CRBSI in ICU of primary hospital.%目的 探讨基层医院ICU中心静脉导管相关血流感染(CRBSI)的危险因素.方法 以台州市立医院ICU就诊的中心静脉导管留置患者为研究对象,根据是否发生CRBSI分成感染组(60例)和非感染组(563例),首先单因素分析初步筛查CRBSI的危险因素,然后以是否发生CRBSI(1=是,0=否)为因变量,以单因素分析有差别的危险因素为自变量,进行Logistic多因素回归分析,寻找CRBSI的危险因素.结果 CRBSI的发生率为9.63% (60/623);感染组与非感染组APACHE评分、导管类型、导管留置部位、留置时间、静脉营养、激素使用、插管次数、紧急插管、营

  18. Efficacy of Radiofrequency Hyperthermia Combined with Chemotherapy 
in Treatment of Malignant Pericardial Effusion Caused by Lung Cancer

    Directory of Open Access Journals (Sweden)

    Pengfei LUO

    2011-07-01

    Full Text Available Background and objective Malignant pericardial effusion is one of the serious complications of lung cancer and lack effective treatment methods. The aim of this study is to evaluate the efficacy and safety of radiofrequency hyperthermia combined with chemotherapy for patients with malignant pericardial effusion caused by lung cancer. Methods Fifty-five patients with malignant pericardial effusion caused by lung cancer were divided into hyperthermia combined with chemotherapy group (combined therapy group and chemotherapy group. The combined therapy group was treated with radiofrequency hyperthermia after the pericardiocentesis and intracavitary injection (cisplatin 20 mg and dexamethasone 5 mg, when patients’ general state of health improved, systemic chemotherapy was performed. The chemotherapy group was treated only with intracavitary injection and systemic chemotherapy. Intracavitary chemotherapy was performed for 1-6 times (average 3 times. Hyperthermia was performed twice per week with an average of 6 times following intracavitary and systemic chemotherapy. The temperature of intracavitary was 40.5 oC-41.5 oC for 60 min during the hyperthermia periods. Systemic chemotherapy consists of cisplatin (75 mg/m2 and vinorelbine (50 mg/m2. Results The complete remission rate (CR of malignant pericardial effusion was 54.3% and the response rate (RR was 91.4% in the combined therapy group, while the rates of CR and RR of chemotherapy group were 25.0% and 70.0%, and the differences of CR and RR between the two groups were significant (P<0.05. After treatment, the quality of life improved significantly in both groups, but the combined therapy group had a higher KPS score than in the chemotherapy group (P<0.05. The adverse events associated with the chemotherapy included gastrointestinal toxicity and myelosup-pression, and there were no significant differences between the two groups. The main side effects associated with radiofrequency hyperthermia

  19. Effect of indomethacin on regulation of juxta-articular bone blood-flow during joint tamponade. An experimental study in puppies

    DEFF Research Database (Denmark)

    Ewald, Henrik Lykke; Holm, I E; Bülow, J;

    1989-01-01

    ) and regional blood flow (RBF) measurements in the distal femoral epiphysis (DFE), aspects of vascular control mechanisms in the distal femoral epiphysis were investigated during knee joint tamponade (50% of mean arterial pressure) before and after administration of indomethacin 7.5 mg/kg. Six dogs aged 3......-4 months were investigated in fentanyl anaesthesia. Knee joint tamponade resulted in a significant increase in IOP and calculated venous resistance in the DFE, while no significant changes in regional blood-flow or arterial resistance were encountered. Administration of indomethacin did not affect...

  20. Successful use of a Bakri Tamponade Balloon in the treatment of puerperal uterine inversion during caesarean section.

    Science.gov (United States)

    Vivanti, A J; Furet, E; Nizard, J

    2016-04-23

    Acute puerperal inversion of the uterus is a rare life-threatening obstetric emergency, especially during caesarean section. We present the case of a 30-year-old patient with acute puerperal inversion of the uterus that occurred during placental removal. After a quick reversion of the uterus, an immediate postpartum haemorrhage (PPH) due to massive uterine atony was observed. This atony impacted the whole uterus, with a very thin uterine myometrium. The use of a Bakri Tamponade Balloon use allowed treating extreme uterine atony, immediately stop haemorrhage, and prevent a possible risk of immediate recurrence.

  1. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Hirose Hitoshi

    2012-04-01

    Full Text Available Abstract Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

  2. Development of ocular hypertension secondary to tamponade with light versus heavy silicone oil: A systematic review

    Directory of Open Access Journals (Sweden)

    Vito Romano

    2015-01-01

    Full Text Available Aim: The intraocular silicone oil (SO tamponades used in the treatment of retinal detachment (RD have been associated with a difference ocular hypertension (OH rate. To clarify, if this complication was associated to use of standard SO (SSO versus heavy SO (HSO, we performed a systematic review and meta-analysis of comparative study between two kind of SO (standard or light vs. heavy for the treatment of RD and macular hole, without restriction to study design. Materials and Methods: The methodological quality of two randomized clinical trials (RCTs were evaluated using the criteria given in the Cochrane Handbook for Systematic Reviews of Intervention, while three non-RCTs were assessed with the Newcastle-Ottawa Scale and Strengthening the Reporting of Observational Studies in Epidemiology checklists. We calculated Mantel-Haenszel risk ratio (RR with 95% confidence intervals (95% CIs. The primary outcome was the rate of patients with OH treated with SSO compared to HSO. Results: There were a higher number of rates of OH in HSO compared to SSO. This difference was statistically significant with the fixed effect model (Mantel-Haenszel RR; 1.55; 95% CI, 1.06-2.28; P = 0.02 while there was not significative difference with the random effect model (Mantel-Haenszel RR; 1.51; 95% CI, 0.98-2.33; P = 0.06. Conclusion: We noted a trend that points out a higher OH rate in HSO group compared to SSO, but this finding, due to the small size and variable design of studies, needs to be confirmed in well-designed and large size RCTs.

  3. A case of Hodgkin`s disease presenting a cardiac tamponade during treatment developed a pancytopenia after cessation of chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Shigeru; Iwami, Mika; Narita, Tsutomu; Higashino, Katsumi; Suzuki, Atsushi; Taga, Takashi; Shimada, Morimi [Shiga Univ. of Medical Science, Otsu (Japan)

    1998-10-01

    There had been many reports about cardiac complications of patients with Hodgkin`s disease (HD) after cessation of treatment in Europe and the United States. However, cases of HD accompanied with these complications were extremely rare in Japan. We report a case with HD that developed a cardiac tamponade during the clinical course of chemotherapy and showed a pancytopenia after cessation of chemotherapy. The case was a 14 year-old boy with HD (nodular sclerosis) of anterior upper mediastinum origin. He received modified MOPP therapy and irradiation to the semimantle field and to the mediastinum. The total dose of radiation was 36.3 Gy. He suddenly developed a chest pain, chest discomfort, and dyspnea during the sixth course of chemotherapy. He was diagnosed to have a cardiac tamponade by thoracentesis. The symptoms were improved by continuous transcutaneous drainage. The invasion of HD into the effusion was not detected by cytology, and the chemotherapy was completed after one course. However, he gradually developed a macrocytic anemia and finally developed a pancytopenia. The bone marrow specimen revealed a hypoplasia without evidence of pathological cells. The karyotype of marrow derived cells was normal. With oxymetholone administration, the pancytopenia has improved in four months. He has now been doing well for five years after the cessation of therapy. (author)

  4. Iatrogenic acute cardiac tamponade during percutaneous removal of a fractured peripherally inserted central catheter in a premature neonate.

    Science.gov (United States)

    Minghui, Zou; Hujun, Cui; Li, Ma; Weidan, Chen; Yanqin, Cui; Xinxin, Chen

    2015-01-01

    Acute cardiac tamponade (ACT) is a life-threatening complication associated with a peripherally inserted central catheter (PICC) in premature neonates. We present a case of ACT in a 4-day-old male infant. On the second admission day, a PICC was inserted. After 2.5 months, chest radiography showed PICC fracture, and its distal portion had migrated into the right pulmonary artery. Percutaneous removal through cardiac catheterization was attempted. However, right ventriculography demonstrated intrapericardial spillage of contrast agents, and iatrogenic ACT was confirmed. Cardiopulmonary resuscitation (CPR) was immediately started with open-chest cardiac massage. Further surgical exploration revealed right atrial appendage perforation. After 25-min CPR, the patient restored spontaneous circulation, and removal of the foreign bodies was performed. The post-operative course was uneventful. PICC fracture is an uncommon complication, but may be life-threatening. Precaution should be taken to avoid ACT during removal of a broken PICC. Once the tamponade is diagnosed, immediate interventions are mandatory.

  5. Protective Effect of Tea Polyphenol Ophthalmic Gel on Lens Epithelial Cells in Rabbits with Silicone Oil Tamponade after Vitrectomy

    Directory of Open Access Journals (Sweden)

    Xianzhen Ma

    2014-01-01

    Full Text Available Purpose. The aim of this study was to investigate the effect of tea polyphenols (TP ophthalmic gel on lens epithelial cells (LECs in rabbits with silicone oil tamponade after vitrectomy. Methods. In this study, unilateral vitrectomy with silicone oil tamponade was performed using 2-month-old New Zealand white rabbits (n = 72; meanwhile, age-matched nonoperated rabbits (n = 18 were used as controls. The TP ophthalmic gel was administered topically in the surgical eyes till they were sacrificed. On days 45 and 90 after operation, the levels of reactive oxygen species (ROS, mitochondrial membrane potential (ΔΨm, and apoptosis of LECs were analyzed, respectively. Meanwhile, caspase-3 mRNA and protein levels were also determined. Results. The results indicate that the levels of ROS and apoptosis were elevated for LECs in rabbits after operation, whereas ΔΨm was decreased. Caspase-3 was apparently increased at both mRNA and protein levels. Treatment of TP ophthalmic gel could reduce the generation of ROS, maintain ΔΨm, inhibit the overexpression of caspase-3, and thus decrease the apoptosis of LECs of rabbits after operation. Conclusions. TP ophthalmic gel can efficiently inhibit caspase-3 overexpression, reduce the apoptosis of LECs, and prevent LECs from damage. Our result provides a new approach to prevent the development of complicated cataract after vitrectomy.

  6. ORGANIC TRICUSPID VALVE REPAIR WITH AUTOLOGOUS GLUTARALDEHYDE FIXED PERICARDIAL PATCH : A SINGLE CENTER RESULTS

    Directory of Open Access Journals (Sweden)

    Murtaza A

    2015-10-01

    Full Text Available AIM AND OBJECTIVE: The aim of this study was to determine the effectiveness and results of repair of Organic Tricuspid Valve disease. INTRODUCTION : since tricuspid valve disease most often found in association with other valve disease. Isolated tricuspid valve disease is ra re. Pattern of involvement of tricuspid valve disease shows functional (75% and primary (organic in (25%. Surgical repair of organic tricuspid valve disease often fails because of abnormal valve. This usually leads to limited options. This study examine s our experience of tricuspid valve repair with autologous pericardium for organic tricuspid valve disease. MATERIAL AND METHODS : From Jan 2014 to May 2015, 22 patients underwent repairs for organic tricuspid valve disease. The patient aged 15 to 65 years and all were in New York Heart Association (NYHA class of III or IV. All patients presented with severe tricuspid disease coexisting with other cardiac pathology, usually left - sided heart valve disease. Repair techniques included Commisurotomy, division o f secondary chordae, Glutaraldehyde treated autologous pericardial patch augmentation of tricuspid valve leaflets, anterior papillary muscle advancement etc with or without ring/suture annuloplasty. Follow - up duration was 3 to 18 months. RESULTS : No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients except one. CONCLUSIONS : Large majorit y of organic tricuspid valve regurgitation is repairable with acceptable early results. Tricuspid stenosis and mixed tricuspid valve disease are more challenging. In the latter group, it is a judgment call whether to accept a suboptimal result or replace t he valve

  7. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

    Directory of Open Access Journals (Sweden)

    Galloway Robert

    2009-12-01

    Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

  8. Assosiation of Epicardial and Pericardial Fat Thickness with Coronary Artery Disease

    Science.gov (United States)

    Ghaderi, Fereshteh; Eshraghi, Ali; Shamloo, Alireza Sepehri; Mousavi, Sareh

    2016-01-01

    Introduction Visceral adipose tissue is a known important risk factor for coronary artery disease (CAD). While some studies have suggested relationship between epicardial fat thickness (EFT) and CAD, there are no adequate studies for pericardial fat thickness (PFT). The aim of this study was to determine the association of EFT and PFT with CAD. Methods This cross-sectional study was conducted on patients who were candidates for elective coronary artery angiography, referred to Emam Reza Hospital, Mashhad, Iran during Jan 2014–2016. Demographic and laboratory data were collected. Transthoracic echocardiography was performed to determine average EFT and PFT at the standard parasternal long-axis view at end-systole for 3 cardiac cycles. SCA was performed on the same day. The patients were divided into two groups: CAD (n=59) and non-CAD (n=41) based on presence or absence of epicardial coronary artery stenosis of > 50%. Chi-square, independent T-test, and receiver operating characteristic (ROC) curve were used by SPSS Version 16 for data analysis. Results One hundred patients (44 women and 56 men) with an average age of 56.4 ± 9.9 years were studied. The two groups were not significantly different in demographic profile and cronary risk factors. While PFT was not significantly different between the two groups, EFT was significantly higher in CAD group (3.0 ± 3.69 vs. 1.2 ± 3.6, p coronary arteries, EFT increased (p <0.0001). Gensini score had a strong correlation with amount of EFT (r = 0.765, p <0.0001). EFT with a cutoff value of 4.25 mm (sensitivity=79%, specificity=68%) was specified in predicting CAD. Conclusion EFT measured by echocardiography can be used as an independent marker to predict CAD. More studies are needed to determine the predictive role of PFT for CAD.

  9. 外科重症监护室导管相关性医院感染5年监测资料分析%Catheter-associated nosocomial infection in surgical intensive care unit: a 5 year data analysis

    Institute of Scientific and Technical Information of China (English)

    糜琛蓉; 张祎博; 杨莉; 李文慧; 顾秋莹; 赵煜瑾; 孙芳艳; 李贤华

    2011-01-01

    Objective To realize the status and causes of catheter-associated nosocomial infection (CANI) in surgical intensive care unit (SICU) , so as to decrease the incidence by taking proper measures. Methods Six hundred and fifteen patients with catheters in SICU between 2005 and 2009 were monitored prospectively, including the occurrence of CANI, patients' age, length of hospital stay, invasive procedures, and pathogens. Results One hundred and ninety-seven of 615 patients (32. 03%) developed CANI, and CANI rate was 2. 60%, 12. 85% and 56. 40% in patients with 1 kind, 2 or 3 kinds of catheters simultaneously respectively, there were significant difference among three groups (x2 = 151.55, P<0. 001). The rate of ventilator-associated pneumonia (VAP), catheterassociated urinary tract infection (CA-UTI) , and central venous catheter (CVC)-associated bloodstream infection (CVC-BSI) per 1 000 catheter days was 15. 51, 13. 70 and 5. 79 respectively. The average catheter utilization days before the occurrence of CANI were as follows: ventilator (12. 22 ± 11.29) days, urinary catheter (13. 09 ± 13. 29)days , CVC (20. 64 ± 18. 39) days respectively. The major pathogen in VAP , CA-UTI and CVC-BSI was Acinetobacter spp. ( 18. 80 %), Candida albicans (36. 46 %) and Acinetobacter spp. ( 18. 75 %) respectively. Conclusion Patients with more catheters , long hospital stay and long duration of catheters are prone to develop nosocomial infection. The key to the prevention of emerging of drug-resistant strain and decrease in NI are strengthening of disinfection and isolation, shortening the time of catheter retaining, implementing hand hygiene, and using antimicrobial drug rationally.%目的 了解外科重症监护室(SICU)导管相关性医院感染发生状况及其原因,以采取相应措施降低其发病率.方法 采用前瞻性监测方法,对SICU 2005-2009年间615例留置导管患者的相关医院感染发生状况、年龄、住院天数、侵人性操作

  10. Comparison of fatty acid composition of subcutaneous, pericardial and epicardial adipose tissue and atrial tissue in patients with heart disease

    DEFF Research Database (Denmark)

    Eschen, Rikke Bülow; Gu, Jiwei; Andreasen, Jan Jesper;

    OBJECTIVES The content in adipose tissue of marine n-3 polyunsaturated fatty acids (PUFAs) is a marker of long-term fish consumption and data suggest an antiarrhythmic effect of n-3 PUFAs. We investigated the correlation between adipose tissue content of the major n-3 PUFAs, eicosapentaenoic acid...... (EPA) and docosahexaenoic acid (DHA), from three different adipose tissue compartments [epicardial (EAT), pericardial (PAT) and subcutaneous (SAT)]. Furthermore, we studied the correlation between the content of EPA and DHA in these compartments and in atrial tissue (AT). METHODS We obtained AT from...

  11. Comparison of fatty acid composition of subcutaneous, pericardial and epicardial adipose tissue and atrial tissue in patients with heart disease

    DEFF Research Database (Denmark)

    Eschen, Rikke Bülow; Gu, Jiwei; Andreasen, Jan Jesper;

    2016-01-01

    OBJECTIVES The content in adipose tissue of marine n-3 polyunsaturated fatty acids (PUFAs) is a marker of long-term fish consumption and data suggest an antiarrhythmic effect of n-3 PUFAs. We investigated the correlation between adipose tissue content of the major n-3 PUFAs, eicosapentaenoic acid...... (EPA) and docosahexaenoic acid (DHA), from three different adipose tissue compartments [epicardial (EAT), pericardial (PAT) and subcutaneous (SAT)]. Furthermore, we studied the correlation between the content of EPA and DHA in these compartments and in atrial tissue (AT). METHODS We obtained AT from...

  12. Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ghods K

    2016-10-01

    Full Text Available Kamran Ghods,1 Mohammad Reza Razavi,2 Mohammad Forozeshfard3 1Clinical Research Development Unit (CRDU, Department of Cardiovascular Surgery, Kowsar Hospital, 2Nursing Care Research Center, 3Cancer Research Center, Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran Abstract: Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012–2015 were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery. Keywords: coronary artery bypass graft, pericardial effusion, central venous catheter

  13. Characteristics of the Pathogens Causing Catheter-associated Urinary Tract Infection in Critically Ill Patients%危重患者导管相关性尿路感染病原菌特征分析

    Institute of Scientific and Technical Information of China (English)

    何超; 刘钰琪; 李纪文; 戴仲秋; 朱丽娜; 谢轶; 陈知行; 康梅

    2015-01-01

    目的 了解危重患者导管相关性尿路感染(catheter-associated urinary tract infection,CAUTI)的病原菌菌种分布及耐药表型,为其临床治疗和院感控制提供依据.方法 回顾性分析2012年1月至2014年12月在我院重症监护病房发生CAUTI的患者临床资料和实验室检查结果.对CAUTI患者尿标本分离的病原菌及其耐药表型进行统计分析.结果 共纳入CAUTI患者370例,从其尿标本共分离出病原菌517株,其中:真菌222株,占42.9%;革兰阴性菌181株,占35.0%;革兰阳性菌114株,占22.0%.从菌种分布看,真菌主要有白色念珠菌(105株,20.3%)、热带念珠菌(78株,15.1%)和光滑念珠菌(30株,5.8%);革兰阴性菌主要有大肠埃希菌(81株,15.7%)、肺炎克雷伯菌(37株,7.2%)和鲍曼/醋酸钙不动杆菌复合体(23株,4.4%);革兰阳性菌主要有屎肠球菌(79株,15.3%)和粪肠球菌(13株,2.5%).耐药表型分析结果显示:念珠菌对伊曲康唑、伏立康唑和氟康唑的耐药率均在10.0%以上;大肠埃希菌和肺炎克雷伯菌对大多数常规药物耐药率均大于30%;鲍曼/醋酸钙不动杆菌复合体对大多数常规药物耐药率均大于60%,对亚胺培南耐药率为60.8%;屎肠球菌和粪肠球菌对大多数常规药物耐药率均大于60%,对万古霉素耐药率分别为16.5%和31.0%.结论 引起我院危重患者CAUTI的主要病原菌是念珠菌,并对唑类药物表现出一定耐药性;革兰阴性菌和革兰阳性菌的耐药性值得关注.应合理使用抗生素,并采取有效措施,减少CAUTI的发生.%Objective To investigate the species and resistance phenotypes of the pathogens causing catheterassociated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University,and to provide the basis for the prevention and treatment of this kind of infection.Methods The clinical data and findings of the laboratory examination of the patients,who were

  14. Structural valve deterioration of a mitral Carpentier-Edwards pericardial bioprosthesis in an 87-year-old woman 16 years after its implantation

    Directory of Open Access Journals (Sweden)

    Haruki Takashi

    2011-07-01

    Full Text Available Abstract The second-generation pericardial valve, the Carpentier-Edwards perimount bioprosthetic (CEP valve, shows dramatically improved durability as compared to the first-generation pericardial valve, and excellent performance has been obtained, in both the aortic and mitral positions. Especially in elderly patients with an implanted CEP valve, reoperation due to structural valve deterioration (SVD is rarely required. Here, we report the case of an 87-year-old woman with an explanted CEP valve in the mitral position due to SVD, 16 years after its implantation.

  15. Lymphangiopathy in neurofibromatosis 1 manifesting with chylothorax, pericardial effusion, and leg edema

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    Finsterer J

    2013-09-01

    Full Text Available Josef Finsterer,1 Claudia Stollberger,2 Elisabeth Stubenberger,3 Sasan Tschakoschian4 1Krankenanstalt Rudolfstiftung, Vienna, Austria; 2Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria; 3Thoracic Surgery Department, Vienna, Austria; 4Interne Lungenabt, Vienna, Austria Background: This case report documents the affliction of the lymph vessels as a phenotypic feature of neurofibromatosis-1 (NF-1. Methodology: Routine transthoracic echocardiography, computed tomography scan of the thorax, magnetic resonance angiography of the renal arteries, and conventional digital subtraction angiography were applied. Comprehensive NF-1 mutation analysis was carried out by fluorescence in situ hybridization analysis, long-range reverse transcriptase polymerase chain reaction, and multiple-ligation probe assay. All other investigations were performed using routine, well-established techniques. Results: The subject is a 34-year-old, half-Chinese male; NF-1 was suspected at age 15 years for the first time. His medical history included preterm birth, mild facial dysmorphism, "café au lait" spots, subcutaneous and paravertebral fibromas, multifocal tachycardia, atrial fibrillation, and heart failure in early infancy. Noncalcified bone fibromas in the femur and tibia were detected at age 8 years. Surgical right leg lengthening was carried out at age 11 years. Bilateral renal artery stenosis, stenosis and aneurysm of the superior mesenteric artery, and an infrarenal aortic stenosis were detected at age 15 years. Leg edema and ectasia of the basilar artery were diagnosed at age 18 years. After an episode with an erysipela at age 34 years, he developed pericardial and pleural effusion during a 4-month period. Stenosis of the left subclavian vein at the level of thoracic duct insertion was detected. After repeated pleural punctures, pleural effusion was interpreted as chylothorax. Reduction of lymph fluid production by diet and injection of talcum into

  16. Development and the reliability and validity test of observation table with influencing factors for catheter-associated urinary tract infections in critical patients%重症患者导管相关性尿路感染影响因素观察表的编制及信效度检验

    Institute of Scientific and Technical Information of China (English)

    杨青兰; 曾登芬; 刘蕾; 何海燕; 杨文群; 伍亚舟

    2016-01-01

    目的:设计重症患者导管相关性尿路感染影响因素观察表,并检验其信度及效度,为评估重症患者导管相关性尿路感染的影响因素提供有效的工具。方法通过文献回顾和头脑风暴法形成初始调查条目,结合专家访谈及专题小组讨论确定重症患者导管相关性尿路感染影响因素观察表最终条目。2014年6月,采用方便抽样方法,对第三军医大学大坪医院的130例留置尿管的重症患者进行观察,采用项目分析、探索性因子分析及信效度检验对观察表进行评价。结果重症患者导管相关性尿路感染影响因素观察表包括5个维度和26个条目;累积方差贡献率为73.752%, Cronbachα系数为0.869,分半信度Spearman-Brown折半系数为0.828,观察表各因子与总分之间的相关系数为0.652~0.873(P<0.01),观察表各因子间相关系数为0.311~0.823(P<0.01)。结论观察表具有良好的信度和效度,可作为评估重症患者导管相关性尿路感染影响因素的工具。%Objective To develop a observation table with influencing factors for catheter-associated urinary tract infections in critical patients and verify its reliability and validity. Methods Literature review, brainstorming method, expert interview and group discussion were performed to identify items of the form. By convenience sampling method, totally 130 severe patients with urinary catheter were investigated by this scale. This form was evaluated by item analysis, exploratory factor analysis and reliability and validity test. Results The observation table with influencing factors for Catheter-associated Urinary Tract Infections in critical patients consisted of five dimensions and 26 items. The cumulative contribution of variance was 73.752%, the Cronbach′s alpha coefficient was 0.869 and the Spearman-Brown split-half coefficient was 0.828. Regarding to the construct validity, the correlation coefficient

  17. Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Koletsis Efstratios N

    2011-03-01

    Full Text Available Abstract Background Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases. Case presentation We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion. Conclusions Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.

  18. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.

    Science.gov (United States)

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu

    2015-01-01

    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  19. Silent ischemic heart disease and pericardial fat volume in HIV-infected patients: a case-control myocardial perfusion scintigraphy study.

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    Ulrik S Kristoffersen

    Full Text Available OBJECTIVES: to determine the prevalence of asymptomatic ischemic heart disease (IHD in HIV patients by myocardial perfusion scintigraphy (MPS and to determine the value of coronary artery calcium score (CACS, carotid intima-media thickness (cIMT and pericardial fat volume as screening tools for detection of IHD in subjects with HIV. BACKGROUND: Patients with HIV seem prone to early development of IHD. METHODS: 105 consecutive HIV patients (mean age 47.4 years; mean duration of HIV 12.3 years; mean CD4+ cell count 636×10⁶/L; all receiving antiretroviral therapy and 105 controls matched for age, gender and smoking status, without history of IHD were recruited. MPS, CACS, cIMT, pericardial fat volume, and cardiovascular risk scores were measured. RESULTS: HIV patients demonstrated higher prevalence of perfusion defects than controls (18% vs. 0%; p<0.001 despite similar risk scores. Of HIV patients with perfusion defects, 42% had a CACS = 0. CACS and cIMT were similar in HIV patients and controls. HIV patients on average had 35% increased pericardial fat volume and increased concentration of biomarkers of atherosclerosis in the blood. HIV patients with myocardial perfusion defects had increased pericardial fat volume compared with HIV patients without perfusion defects (314±43 vs. 189±12 mL; p<0.001. CONCLUSIONS: HIV patients had an increased prevalence of silent IHD compared to controls as demonstrated by MPS. The finding was strongly associated with pericardial fat volume, whereas cardiovascular risk scores, cIMT and CACS seem less useful as screening tools for detection of myocardial perfusion defects in HIV patients.

  20. 硅油注入后高眼压的治疗策略%Therapy for elevated intraocular pressure after silicone oil tamponade

    Institute of Scientific and Technical Information of China (English)

    张歆; 梁四妥; 杨艳; 赵华; 徐深

    2012-01-01

    Objective To analyze intraocular pressure (IOP) after silicone oil tamponade for one month.Methods This is a retrospective study.There were 46 cases (46 eyes) from 2004 to 2011 registered in our hospital who accepted vitrectomy and silicone oil tamponade,after one month later,who had elevated IOP.We compared the rate of elevated IOP between two types of silicon oil tamponade for one month,as well as the treatment for elevated IOP.x2 test was used to analyze the results.Result The time for light silicon oil removal was three months ( the rate is 68.8% ) after the operation,and after the second surgery the IOP could be normal.And the time for heavy silicon oil removal was two months (the rate is 64.3% ),then the IOP could be normal.The two results had no statistical differences.But the rate of glaucoma surgery after heavy silicone oil tamponade was higher than that of light silicone oil tamponade.And this result had statistical difference.Conclusion The rate of elevated IOP after light or heavy silicone oil tamponade after one month was the same.The rate of glaucoma surgery after heavy silicone oil tamponade was higher than that of light silicone oil tamponade.%目的 回顾性分析轻重硅油注入术后1个月高眼压的发生及其治疗策略.方法 玻切+轻/重硅油注入术后1个月发生高眼压共46例(46眼).对两种硅油注入术后1个月高眼压的发生率进行分析对比,且对高眼压的处理方式进行对比.结果用x2检验进行分析.结果 轻硅油注入术后取油的时机一般在3个月(68.8%)左右,取出后高眼压可以降至正常范围;重硅油在2个月左右取油(64.3%),取出后高眼压可以降至正常范围.二者没有统计学差异.但重硅油注入术后因高眼压行抗青光眼手术的比例较轻硅油者高,差异有统计学意义.结论 轻重硅油注入术后1个月高眼压的发生率没有统计学差异,但重硅油引起的高眼压最终行抗青光眼手术的比例较轻硅油者高.

  1. Use of Intrauterine Balloon Tamponade Test to Determine the Feasibility of Dilation and Evacuation as a Treatment for Early Uterine Artery Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Liangcheng Wang

    2016-12-01

    Full Text Available Uterine artery embolization is the most common treatment for uterine vascular abnormalities. Herein, we report the successful use of dilation and evacuation as a treatment for uterine artery pseudoaneurysm. A 36-year-old woman complained of vaginal bleeding after an uncomplicated vaginal delivery. Ultrasonography showed a 12.8-mm anechoic area inside the uterus. Color Doppler revealed a to-and-fro sign, indicating an arteriovenous malformation. A blood test showed a low level of human chorionic gonadotropin. Therefore, a diagnosis of early uterine artery pseudoaneurysm following spontaneous delivery was suspected. Under monitoring with transabdominal color Doppler sonography, intrauterine balloon tamponade induced complete disappearance of abnormal blood flow. With bleeding determined to be under control with balloon tamponade, dilation and evacuation was performed. The patient had a favorable postoperative course.

  2. Valvoplastia mitral percutânea complicada com tamponamento cardíaco em paciente gestante Percutaneous mitral valvuloplasty complicated by cardiac tamponade in a pregnant patient

    Directory of Open Access Journals (Sweden)

    Luís Seca

    2008-11-01

    Full Text Available A ocorrência de Hemopericárdio com Tamponamento Cardíaco é uma complicação da Valvoplastia Mitral Percutânea por balão (VMB, que apesar de pouco freqüente, pode ter graves conseqüências materno-fetais. Este artigo descreve o caso de um tamponamento cardíaco após VMB em uma mulher de 28 anos, com estenose mitral reumática severa na 20ª semana de gravidez.The occurrence of hemopericardium with cardiac tamponade is a complication of percutaneous balloon mitral valvuloplasty (BMV which, although uncommon, may have severe maternal and fetal consequences. This article describes a case of cardiac tamponade following BMV in a 28-year-old woman with severe rheumatic mitral stenosis in the 20th week of gestation.

  3. Acute tamponade of the left paracorporeal pump house due to membrane defect in a patient with a Berlin Heart EXCOR biventricular assist device.

    Science.gov (United States)

    Völz, Sebastian; Holmberg, Michael; Redfors, Bengt; Dellgren, Göran

    2014-10-01

    We report a case of acute tamponade of the left paracorporeal pump house in a patient supported by a Berlin Heart EXCOR biventricular assist device (BiVAD) caused by mechanical defect in the membrane of the arterial chamber. A 36-year old male was admitted for composite graft surgery due to a large aortic regurgitation and consecutive heart failure, decompensated postoperatively and was rescued by with an extracorporeal membrane oxygenation (ECMO) device. He was accepted for heart transplantation, and a BiVAD (Berlin Heart EXCOR) was implanted as bridge-to-transplantation. Two months after discharge, he experienced dyspnoea and received error signals from his BiVAD. Relatives released him from his BiVAD companion driver, connected him to the hand pump and transported him to our institution. On arrival, he was in cardiogenic shock and was stabilized by ECMO. Inspection of the arterial chamber revealed a wear hole and delamination of the diaphragm, which had led to a tamponade by air insufflation into the three-layer membrane. New BiVAD paracorporeal pumps were connected, and the patient was subsequently successfully transplanted. The case depicts the difficulty of diagnosis in this specific patient setting. Despite transparent design of the BiVAD chambers, the development of a chamber tamponade remained undetected until explantation of the system.

  4. Gia/Mthl5 is an aorta specific GPCR required for Drosophila heart tube morphology and normal pericardial cell positioning.

    Science.gov (United States)

    Patel, Meghna V; Zhu, Jun-Yi; Jiang, Zhiping; Richman, Adam; VanBerkum, Mark F A; Han, Zhe

    2016-06-01

    G-protein signaling is known to be required for cell-cell contacts during the development of the Drosophila dorsal vessel. However, the identity of the G protein-coupled receptor (GPCR) that regulates this signaling pathway activity is unknown. Here we describe the identification of a novel cardiac specific GPCR, called Gia, for "GPCR in aorta". Gia is the only heart-specific GPCR identified in Drosophila to date and it is specifically expressed in cardioblasts that fuse at the dorsal midline to become the aorta. Gia is the only Drosophila gene so far identified for which expression is entirely restricted to cells of the aorta. Deletion of Gia led to a broken-hearted phenotype, characterized by pericardial cells dissociated from cardioblasts and abnormal distribution of cell junction proteins. Both phenotypes were similar to those observed in mutants of the heterotrimeric cardiac G proteins. Lack of Gia also led to defects in the alignment and fusion of cardioblasts in the aorta. Gia forms a protein complex with G-αo47A, the alpha subunit of the heterotrimeric cardiac G proteins and interacts genetically with G-αo47A during cardiac morphogenesis. Our study identified Gia as an essential aorta-specific GPCR that functions upstream of cardiac heterotrimeric G proteins and is required for morphological integrity of the aorta during heart tube formation. These studies lead to a redefinition of the bro phenotype, to encompass morphological integrity of the heart tube as well as cardioblast-pericardial cell spatial interactions.

  5. Carpentier-Edwards aortic pericardial bioprosthetic valve as a valid control in preclinical in vivo ovine studies.

    Science.gov (United States)

    Harvey, Laura; Bianco, Richard; Lahti, Matthew; Carney, John; Zhang, Lindsey; Robinson, Nicholas

    2015-07-15

    To progress into clinical practice, a bioprosthetic heart valve must first pass through the preclinical evaluation phase. The International Standards Organization (ISO) recommends implantation of concurrent controls in any evaluation of a new or modified heart valve. A total of 8 adult sheep underwent aortic valve replacement, receiving either the CE Perimount Magna 3000 aortic pericardial bioprosthetic valve or the CE Perimount RSR aortic pericardial bioprosthetic valve, Model 2800. We performed serial blood sampling, echocardiography, angiography and necropsy after euthanasia. All 8 sheep survived until the end of their study term. Our 2-dimensional echocardiographic analysis showed a mean pressure gradient of 37.4±6.0mmHg at 14 days and 37.0±5.9mmHg at 90 days; mean cardiac output was 10.0±2.8l/min at 14 days and 9.6±1.6l/min at 90 days. Angiography before euthanasia showed a mean aortic transvalvular gradient of 32.3±15.3mmHg. At euthanasia, we saw no evidence of calcification in any of the valves. In our study, we found that both models of the CE bioprosthetic heart valve we tested proved to be valid controls, in the aortic position, in sheep-with no evidence of calcification. Most important, the valves we tested had a few model-related problems, allowing a clear determination of their suitability for introduction into a clinical trial. Investigators now have additional insight into the safety of these 2 models of valves and perhaps will be able to reduce the number of controls implanted.

  6. Targeted monitoring and analysis of catheter associated urinary tract infection in patients with severe brain injury%重症脑损伤患者留置尿管相关尿路感染的目标性监测与分析

    Institute of Scientific and Technical Information of China (English)

    曹闻亚; 刘芳; 王冉

    2016-01-01

    Objective To monitor the catheter associated urinary tract infection in patients with severe brain injury and analyze the incidence and risk factors of urinary tract infection in hospital, so as to take preventive measures and reduce the incidence of urinary tract infection. Methods Based on the monitoring program of indwelling urinary catheter in patients with severe brain injury and combining the method of microbial monitoring and retrospective study of patients in hospital, a total of 204 catheterized patients with severe brain injury were selected and analyzed the catheter associated urinary tract infection. Results There were 12 patients with urinary tract infections, and a higher incidence of urinary tract infection in elderly, serious condition, long-term bed ridden patients and longer catheter indwelling time with severe brain injury. The incidence of urinary tract infection in patients with more invasive operations was 3. 8‰. Fungus was the most common pathogenic bacteria. Conclusions Following indwelling catheter indications strictly, strengthening the aseptic management of catheter, shortening time of detaining urethral catheterization, and proper using of antibiotics are recommended as effective measures to lower the incidence of catheter associated urinary tract infection in patients with severe brain injury.%目的:通过对重症脑损伤患者留置尿管的目标性监测,总结出院内尿路感染的发生率和危险因素,便于积极采取预防措施,降低尿路感染的发生。方法通过制定出重症脑损伤患者留置尿管的监测方案,采取住院期间对患者的微生物监测和回顾性调查相结合的方法,收集了204例重症脑损伤同时伴有留置导尿管患者,并针对患者留置导尿管情况进行了分析。结果发生尿路感染的病例12例,重症脑损伤患者高龄、病情严重、长期卧床、导尿管留置时间长患者的尿路感染发生率高;有创性操作较多

  7. Treatment and prevention of acute cardiac tamponade during cardiac interventional therapy%心脏介入术中急性心包填塞的救治

    Institute of Scientific and Technical Information of China (English)

    邢适颖; 王红雷; 董平栓

    2011-01-01

    Objective To provide clinical experience in the treatment and prevention of complicated acute cardiac tamponade in the course of heart interventional therapy. Methods To analyse the clinical features of patients with acute cardiac tamponade and to investigate the possible underlying mechanism. Results Twenty-one cases experienced acute cardiac tamponade when undergoing heart interventional therapy. Among all the 21 patients with acute cardiac tamponade, 11 occurred from percutaneous coronary interention(PCI) ,6 from the radiofrequency catheter ablation , 1 from the closure of atrial rspetal with amplaty closure service, 1 from the percutaeous balloon mitral valvuloplasty ( PBMV), 2 from temporary pacemaker implantation. Eighteen patients were successfully rescued left no serious sequelae. Three cased died, including two PCI-related death and one temporary-pacemaker-installation-related death. Conclusion Any heart interventional operation is at the risk to cause acute cardiac tamponade. Early identification and appropriate treatment is the key to successful rescue.%目的 探讨心脏介入治疗过程中急性心包填塞的临床救治.方法 对21例心脏介入性操作相关的急性心包填塞患者临床资料进行回顾性分析.结果 21例急性心包填塞患者,其中行经皮冠状动脉介入治疗(PCI)11例;射频消融术6例;房间隔缺损封堵术1例;二尖瓣球囊扩张术(PBMV)1例;临时起搏器安装术2例.抢救成功18例,未遗留严重后遗症.死亡3例,2例为PCI相关的急性心包填塞,l例为临时起搏器安装导致.结论 任何心脏介入性操作都可能引起急性心包填塞,早期识别和果断处理是成功救治的关键.

  8. 基于失效模式与效应分析管理模式构建导尿管相关尿路感染干预策略的研究%The research of building catheter-associated urinary tract infections intervention stratagem based on failure mode and effects analysis

    Institute of Scientific and Technical Information of China (English)

    张悦; 夏玲; 谭思源; 陈艳; 胡清; 金勤; 王卉洁; 韦佳佳

    2014-01-01

    Objective To build catheter-associated urinary tract infections intervention stratagem based on failure mode and effects analysis.Methods Based on failure mode and effects analysis,forming teams,drawing the flowchart,listing the failure mode,analyzing the causes and effects of failure mode,and the experts giving RPN score,and the score>125 should be given intervention stratagem.Results The value>125 included:operator preparation,insertion of catheters,fixing the collection bags,changing the urine collection bag,target monitoring and extubation.The eight improvement program was built.Conclusions To build catheter-associated urinary tract infections intervention stratagem based on failure mode and effects analysis is feasible and scientific,there are certain clinical application prospect.%目的 基于失效模式与效应分析(failure mode and effects analysis,FMEA)管理模式构建导尿管相关尿路感染干预策略.方法 基于FMEA管理模式,组建团队、绘制流程图、识别流程中潜在失效模式、分析失效原因及影响因素、进行风险优先指数(RPT)评分,对评分>125分的失效模式构建干预策略.结果 RPN评分>125分的失效模式有8个,即操作者准备、插入导尿管、固定集尿袋、会阴护理、集尿袋放尿、更换集尿袋、目标监测及拔管.对8个失效模式构建干预策略.结论 基于FMEA管理模式构建导尿管相关尿路感染干预策略是可行的、科学的,具有一定的临床应用价值及前景.

  9. 119例导尿管相关性尿路感染的病原体分布及耐药性分析%Analysis on the distribution and the antimicrobial resistance of pathogens from 119 cases of catheter associ-ated urinary tract infection

    Institute of Scientific and Technical Information of China (English)

    王效雷; 罗婕; 丁兆霞; 曹地芹; 娄瑞

    2015-01-01

    Objective To obtain the pathogens distribution and drug resistance characteristics of catheter associated urinary tract infection (CAUTI), so as to provide the evidence of controlling urinary tract infection .Methods 119 cases of CAUTI microbial culture and drug sensitive were collected and analyzed from January 2012 to June 2014.Results Isolated 97 pathogens from 119 urine specimens.Top 6 pathogens were:Escherichia coli (26.80%), Enterococcus faecalis (15.46%), Candida albicans (11.34%), Feces Enterococcus (10.31%), Pseudomonas aeruginosa (5.15%), Coagulase negative staphylococcus (5.15%), and the multi-drug-resistance was found.Some bacterial resistance rate was higher than the results of chinet 2013 surveillance.Conclusion The surveillance of bacterial resistance and the supervision of clinical rational drug use should be enhanced , and the further heavy interven-tions should be necessary to prevent the contact transmission of the multidrug -resistant organisms and CAUTI also .%目的:掌握导尿管相关性尿路感染( catheter associated urinary tract infection ,CAUTI)的病原体分布以及耐药性特征,为控制尿路感染提供依据。方法通过统计2012年1月-2014年6月解放军81医院119例CAUTI尿液微生物培养及药敏结果,分析CAUTI病原体分布及耐药性特征。结果119例CAUTI尿液标本中检出病原菌97株,前6位病原体依次为大肠埃希菌(26.80%)、粪肠球菌(15.46%)、白色念珠菌(11.34%)、屎肠球菌(10.31%)、铜绿假单胞菌(5.15%)和凝固酶阴性葡萄球菌(5.15%),并呈现出多耐药性,部分耐药率超过2013年Chinet的相关监测结果。结论应加强CAUTI病原体耐药性监测和临床合理用药监管,重视对多重耐药菌的隔离预防和对CAUTI的预防干预。

  10. A young man with intractable ascites and effort dyspnoea without echocardiographic signs of pericardial thickening: the importance of clinical investigation, CT scan and MRI in the diagnosis of constrictive pericarditis.

    Science.gov (United States)

    Dato, Ilaria; Coluzzi, Giulio; Al-Mohanni, Ghalia; Della Bona, Roberta; Piro, Maddalena; Natale, Luigi; Luciani, Nicola; Biasucci, Luigi M; Crea, Filippo

    2008-08-18

    A 35-year-old male patient suffering from dyspnoea on effort for 8 months, with abdominal and jugular venous distension, was previously studied in another hospital and discharged with a diagnosis of restrictive cardiomyopathy. Physical examination revealed a blood pressure of 110/60 mm Hg and absence of pericardial knock and also of paradoxical pulse. Chest X-ray showed no cardio-pulmonary alterations. Transthoracic echocardiography showed mild LV dysfunction (LVEF 46%) and lack of pericardial effusion and thickening. Doppler interrogation of transmitral flow showed a restrictive pattern. Computed tomography showed diffusely thickened pericardium, with the absence of calcification and of pericardial effusion. Cardiac magnetic resonance confirmed pericardial thickening and showed lack of myocardial alterations. Mild LV dysfunction was noted with dyskinesia of interventricular septum. The patient underwent cardiac catheterization, demonstrating an equalisation of RV and LV diastolic pressures with "square root" sign. The patient underwent pericardiectomy with consequent resolution of his symptoms and improvement of LV function.

  11. Iatrogenic catheter-related cardiac tamponade: a case report of fatal hydropericardium following subcutaneous implantation of a chemotherapeutic injection port.

    Science.gov (United States)

    Shields, Lisa B E; Hunsaker, Donna M; Hunsaker, John C

    2003-03-01

    The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization. As with the introduction of any foreign object into the body, each of these devices has complications which may be life threatening and occasionally fatal. We present an unusual case of iatrogenic acute hydropericardium and cardiac tamponade caused by the percutaneous infusion of chemotherapeutic fluid via a right subclavian central venous implant system (Port-a-Cath). Failure to implant and monitor the device with a radiograph following placement according to manufacturer's guidelines and accepted standards of medical practice were causally related to an unusual complication, namely, perforation of the right cardiac ventricle by the catheter tip, resulting in sudden and unexpected cardiac death.

  12. Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers.

    Science.gov (United States)

    Zhu, Xiaoli; Cao, Wen; Chang, Bing; Zhang, Linyuan; Qiao, Peihuan; Li, Xue; Si, Lifang; Niu, Yingmei; Song, Yuguo

    2016-01-01

    Nanomaterials offer great benefit as well as potential damage to humans. Workers exposed to polyacrylate coatings have pleural effusion, pericardial effusion, and pulmonary fibrosis and granuloma, which are thought to be related to the high exposure to nanomaterials in the coatings. The study aimed to determine whether polyacrylate/silica nanoparticles cause similar toxicity in rats, as observed in exposed workers. Ninety male Wistar rats were randomly divided into five groups with 18 rats in each group. The groups included the saline control group, another control group of polyacrylate only, and low-, intermediate-, and high-dose groups of polyacrylate/nanosilica with concentrations of 3.125, 6.25, and 12.5 mg/kg. Seventy-five rats for the 1-week study were terminated for scheduled necropsy at 24 hours, 3 days, and 7 days postintratracheal instillation. The remaining 15 rats (three males/group) had repeated ultrasound and chest computed tomography examinations in a 2-week study to observe the pleural and pericardial effusion and pulmonary toxicity. We found that polyacrylate/nanosilica resulted in pleural and pericardial effusions, where nanosilica was isolated and detected. Effusion occurred on day 3 and day 5 post-administration of nanocomposites in the 6.25 and 12.5 mg/kg groups, it gradually rose to a maximum on days 7-10 and then slowly decreased and disappeared on day 14. With an increase in polyacrylate/nanosilica concentrations, pleural effusion increased, as shown by ultrasonographic qualitative observations. Pulmonary fibrosis and granuloma were also observed in the high-dose polyacrylate/nanosilica group. Our study shows that polyacrylate/nanosilica results in specific toxicity presenting as pleural and pericardial effusion, as well as pulmonary fibrosis and granuloma, which are almost identical to results in reported patients. These results indicate the urgent need and importance of nanosafety and awareness of toxicity of polyacrylate/nanosilica.

  13. Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.

    Science.gov (United States)

    Ohira, Suguru; Yaku, Hitoshi; Nakajima, Shunsuke; Takahashi, Akihiko

    2014-08-01

    We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.

  14. Implications of Pericardial, Visceral and Subcutaneous Adipose Tissue on Vascular Inflammation Measured Using 18FDG-PET/CT.

    Directory of Open Access Journals (Sweden)

    Ho Cheol Hong

    Full Text Available Pericardial adipose tissue (PAT is associated with adverse cardiometabolic risk factors and cardiovascular disease (CVD. However, the relative implications of PAT, abdominal visceral and subcutaneous adipose tissue on vascular inflammation have not been explored.We compared the association of PAT, abdominal visceral fat area (VFA, and subcutaneous fat area (SFA with vascular inflammation, represented as the target-to-background ratio (TBR, the blood-normalized standardized uptake value measured using 18F-Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET in 93 men and women without diabetes or CVD. Age- and sex-adjusted correlation analysis showed that PAT, VFA, and SFA were positively associated with most cardiometabolic risk factors, including systolic blood pressure, LDL-cholesterol, triglycerides, glucose, insulin resistance and high sensitive C-reactive proteins (hsCRP, whereas they were negatively associated with HDL-cholesterol. In particular, the maximum TBR (maxTBR values were positively correlated with PAT and VFA (r = 0.48 and r = 0.45, respectively; both P <0.001, whereas SFA showed a relatively weak positive relationship with maxTBR level (r = 0.31, P = 0.003.This study demonstrated that both PAT and VFA are significantly and similarly associated with vascular inflammation and various cardiometabolic risk profiles.

  15. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients.

    Science.gov (United States)

    Kramer, Philip A; Chacko, Balu K; George, David J; Zhi, Degui; Wei, Chih-Cheng; Dell'Italia, Louis J; Melby, Spencer J; George, James F; Darley-Usmar, Victor M

    2015-07-01

    Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients' PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.

  16. Manglende kollaps af hjertets kamre ved ekkokardiografi udelukker ikke hjertetamponade

    DEFF Research Database (Denmark)

    Juhl-Olsen, Peter; Frederiksen, Christina Alcaraz; Sloth, Erik

    2014-01-01

    The clinical presentation of cardiac tamponade is difficult to distinguish from other causes of shock. Pericardial fluid is easy to visualize with cardiac ultrasound and a key sign of overt cardiac tamponade is the compression of right side cavities. We present two cases in which cardiac tamponade...... was present, but where compression of cardiac cavities could not be demon-strated with transthoracic cardiac ultrasound. This emphasizes that cardiac tamponade is still a clinical diagnosis....

  17. Effectiveness of transurethral sustained controlled release infusion of low concentration iodophor in prevention of catheter-associated urinary tract infections%经尿道持续输注低浓度聚维酮碘预防导尿管相关性尿路感染效果评价

    Institute of Scientific and Technical Information of China (English)

    顾小红; 张玲芳; 孙建良

    2013-01-01

    OBJECTIVE To explore the effectiveness of transurethral sustained controlled release infusion of 0. 3% iodophor in the prevention of the catheter-associated urinary tract infections and propose the nursing measures so as to reduce the incidence of the urinary tract infections. METHODS A total of 140 critical patients with indwelling catheter were randomly divided into the observation group and the control group. The observation group was treated with new type of catheter transurethral sustained controlled release infusion of 0. 3% iodophor, while the control group was treated with traditional bag catheter, the positive rates of urine culture on the third, seventh, and the tenth day after the indwelling catheterization were compared between the two groups, and the adverse reactios were observed. RESULTS Of the positive rates of the urine culture on the third, seventh, and the tenth day after the indwelling bladder catheterization, the observation group were 2. 86%, 8. 57% and 11. 43%, respectively, while the control group were 18. 57%, 35. 71 % and 51. 43% , respectively, the positive rate of urine culture of the observation group was significantly lower than that of the control group (P<0. 01), there were no adverse reactions. CONCLUSION To adopt the new disposable transurethral sustained controlled release infusion of low concentration iodophor combined with the corresponding nursing measures can reduce the incidence of the catheter-associated urinary tract infections, it is worthy of the clinical promotion.%目的 探讨经尿道持续控释输注0.3%聚维酮碘预防导尿管相关性尿路感染的有效性,以降低尿路感染的发生率.方法 将140例留置导尿的危重患者随机分为观察组和对照组,观察组采用新型导尿管经尿道持续控释输注0.3%聚维酮碘;对照组采用普通气囊导尿管,比较两组患者留置导尿后第3、7、10天的菌尿阳性率,观察不良反应.结果 导尿后第3、7、10天的菌尿

  18. The Effect of Altitude on Intraocular Pressure in Vitrectomized Eyes with Sulfur Hexafluoride Tamponade by the Friedenwald Method: Rabbit Animal Model

    Science.gov (United States)

    Fromow-Guerra, Jans; Solís-Vivanco, Adriana; Perez-Reguera, Adriana; Quiroz-Mercado, Hugo; Meza-de Regil, Armando; Papa-Oliva, Gabriela; Morales-Cantón, Virgilio

    2016-01-01

    The aim of this study is to assess the change in intraocular pressure after a road trip, in eyes with different levels of filling with gas tamponade. Five rabbit eyes were subject to pars plana vitrectomy and gas tamponade (filling percentage: 25%, 50%, and 100% of nonexpansile SF6, 100% saline solution, and 100% room air). A sixth eye was injected with 0.35 cc of undiluted SF6 without vitrectomy. Guided by global positioning system, they were driven to the highest point of the highway connecting Mexico City with Puebla city and back, stopping every 300 m to assess intraocular pressure. The rabbit's scleral rigidity and estimation for human eyes were done by using the Friedenwald nomogram. Maximum altitude was 3209 m (Δ949 m). There were significant differences in intraocular pressure on the rabbit eyes filled with SF6 at 100%, 50%, 25%, and 100% room air. Per every 100 m of altitude rise, the intraocular pressure increased by 1.53, 1.0046, 0.971, and 0.97 mmHg, respectively. Using the human Friedenwald rigidity coefficient, the human eye estimate for intraocular pressure change was 2.1, 1.8, 1.4, and 1.1 mmHg per every 100 m of attitude rise. Altitude changes have a significant impact on intraocular pressure. The final effect depends on the percentage of vitreous cavity fill and scleral rigidity. PMID:27957500

  19. Application of balloon tamponade hemostasis in abdominal surgery%气囊压迫止血法在腹部外科中的应用

    Institute of Scientific and Technical Information of China (English)

    周杰; 罗丁

    2013-01-01

    临床应用气囊压迫止血法已有50余年历史,运用得当时可取得确切的疗效,不良反应少.近年来,随着外科治疗水平的不断提高,气囊压迫技术用于各类出血的治疗已积累了许多成功的经验.本文拟对气囊压迫止血技术近年来的一些进展作一回顾.%Balloon tamponade hemostasis has been applicated for 50 years,and its appropriate usage can obtain exact curative effect with less adverse reactions.In recent years,with the continuous improvement in surgical therapy,balloon tamponade technique in treating various types of bleeding has accumulated many successful experiences.This paper intends to review the advances in balloon compression technology for recent years.

  20. Assessment of Anterior Segment Changes in Pseudophakic Eyes, Using Ultrasonic Biomicroscopic Imaging, after Pars Plana Vitrectomy with Silicone Oil or Gas Tamponade.

    Science.gov (United States)

    Ünsal, Erkan; Eltutar, Kadir; Karini, Belma; Kızılay, Osman

    2016-01-01

    Objective. To evaluate the morphological changes of the anterior segment using ultrasonic biomicroscopy (UBM) imaging in pseudophakic patients who underwent pars plana vitrectomy (PPV) with silicone oil or gas (C3F8) internal tamponade agent injection. Method. This prospective study included pseudophakic patients with planned PPV, divided into two groups according to internal tamponade agent: those in which silicone oil was used (n = 27, Group 1) and those in which gas (C3F8) was used (n = 24, Group 2). UBM measurements were performed in the supine position before and one week after surgery. Results. In patients of Group 1, postoperative trabecular meshwork-ciliary process distance (T-CPD) and iris-ciliary process distance (I-CPD), according to preoperative values, were found to be statistically significantly reduced, and postoperative mean value of scleral thickness (ST) and intraocular pressure (IOP), according to preoperative value, was found to be statistically significantly increased. In patients of Group 2, postoperative mean values of anterior chamber depth (ACD), ciliary body thickness (CBT), T-CPD, I-CPD, and IOP, according to preoperative values, were found to be statistically significantly reduced. Preoperatively, in Group 2 patients, according to Group 1 patients, TIA and IOP were found to be statistically significantly increased. Preoperative and postoperative IOP between the measured parameters with UBM showed no statistically significant correlation. Conclusions. Gases cause more morphological changes in the anterior segment structures. It is thought that complications such as increased intraocular pressure can be seen more frequently for this reason.

  1. Catheter associated mycobacteremia: Opening new fronts in infection control

    Directory of Open Access Journals (Sweden)

    Neha Rathor

    2015-01-01

    Full Text Available Mycobacterium fortuitum is a rapidly growing Mycobacterium ubiquitous in nature, known to form biofilms. This property increases its propensity to colonize the in situ central line and makes it a prospective threat for nosocomial infection. We report a case of 48-year-old female with carcinoma cecum who reported to us with clinical illness and neutropenia while on chemotherapy via totally implanted central venous device, postlaparoscopic-assisted right hemicolectomy.

  2. Pericardial- Rather than Intramyocardial Fat Is Independently Associated with Left Ventricular Systolic Heart Function in Metabolically Healthy Humans.

    Directory of Open Access Journals (Sweden)

    Peter Wolf

    Full Text Available Obesity is a major risk factor to develop heart failure, in part due to possible lipotoxic effects of increased intramyocardial (MYCL and/or local or paracrine effects of pericardial (PERI lipid accumulation. Recent evidence suggests that MYCL is highly dynamic and might rather be a surrogate marker for disturbed energy metabolism than the underlying cause of cardiac dysfunction. On the other hand, PERI might contribute directly by mechanic and paracrine effects. Therefore, we hypothesized that PERI rather than MYCL is associated with myocardial function.To avoid potential confounding of metabolic disease 31 metabolically healthy subjects (age: 29±10yrs; BMI: 23±3kg/m2 were investigated using 1H-magnetic resonance spectroscopy and imaging. MYCL and PERI, as well as systolic and diastolic left ventricular heart function were assessed. Additionally, anthropometric data and parameters of glucose and lipid metabolism were analyzed. Correlation analysis was performed using Pearson's correlation coefficient. Linear regression model was used to show individual effects of PERI and MYCL on myocardial functional parameters.Correlation analysis with parameters of systolic heart function revealed significant associations for PERI (Stroke Volume (SV: R = -0.513 p = 0.001; CardiacIndex (CI: R = -0.442 p = 0.014, but not for MYCL (SV: R = -0.233; p = 0.207; CI: R = -0.130; p = 0.484. No significant correlations were found for E/A ratio as a parameter of diastolic heart function. In multiple regression analysis CI was negatively predicted by PERI, whereas no impact of MYCL was observed in direct comparison.Cardiac fat depots impact left ventricular heart function in a metabolically healthy population. Direct comparison of different lipid stores revealed that PERI is a more important predictor than MYCL for altered myocardial function.

  3. Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Nan Lin; Bo Liu; Rui-Yun Xu; He-Ping Fang; Mei-Hai Deng

    2006-01-01

    AIM: To investigate the therapeutic efficacy and complications of splenectomy with endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization (i.e. Hassab's operation) in patients with portal hypertension.METHODS: A total of 103 patients with liver cirrhosis and portal hypertension were randomly selected to receive either splenectomy with EVL (n = 53, group A) or Hassab's operation (n = 50, group B).RESULTS: The portal blood flow volume, the presence of portal vein thrombosis, gastric emptying time and free portal venous pressure (FPP) before and after the operation were determined. Patients were followed up for up to 64 mo with an average of 45 mo, and the Dagradi classification of variceal veins and the grading of portal hypertension gastropathy (PHG) were evaluated.It was found that all esophageal varices were occluded or decreased to grade Ⅱ or less in both groups. There was little difference in the recurrence rate of esophageal varices (11.9% vs13.2%) and the re-bleeding rate (7.1% vs 5.3%) between groups A and B. The incidence of complications and the percentage of patients with severe PHG after the operation were significantly higher in group B (60.0% and 52.0%) than in group A (32.1%and 20.8%, P < 0.05). No patients died of operationrelated complications. There was no significant difference in gastric emptying time, FPP and portal blood flow volume between the two groups.CONCLUSION: The results suggest that splenectomy with EVL achieves similar therapeutic efficacy to that of Hassab's operation interms of the recurrence rate of esophageal varices and the re-bleeding rate, but the former results in fewer and milder complications.

  4. Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes.

    Science.gov (United States)

    Song, Meong Gun; Yang, Hyun Suk; Choi, Jong Bum; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

    2014-12-01

    In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.

  5. 玻璃体切除联合硅油填充术后高眼压的病因%Cause analysis of intraocular pressure elevation after vitrectomy and silicone oil retinal tamponade

    Institute of Scientific and Technical Information of China (English)

    普建萍; 马嘉; 袁援生

    2013-01-01

    继发性高眼压是硅油填充术后较常见的并发症,其主要原因有:(1)硅油填充过多;(2)硅油乳化;(3)硅油进入前房;(4)硅油的慢性毒性作用;(5)联合其他手术;(6)眼外伤;(7)患者术前眼基础状况;(8)术后用药及术后体位等.本综述对玻璃体切除联合硅油填充术后继发高眼压的病因、治疗、预后等进行回顾性分析.%Secondary high intraocular pressure(IOL) is one of the most common complications after silicone oil tamponade.The mechanisms of elevated IOP secondary to silicone oil tamponade remains complex.Several factors could be involved such as:(1) excessive silicone oil tamponade ; (2) silicone oil emulsification ; (3) diffusion of silicone oil into the anterior chamber; (4) chronic toxic effects of silicone oil; (5) association with an other surgery ; (6) ocular traumatism ; (7) preoperative predisposing factors ;(8) postoperative medication and postoperative body position.This manuscript will review the different causes of IOP elevcotion after vitrectomy and silicone oil retinal tamponade.

  6. Successful early diagnosis and treatment in a case of Toxocara canis-induced eosinophilic myocarditis with eosinophil-rich pericardial effusion.

    Science.gov (United States)

    Sangen, Hideto; Tanabe, Jun; Takano, Hitoshi; Shimizu, Wataru

    2015-09-03

    Fulminant myocarditis can become fatal if left untreated. Treatments for most types of myocarditis, including mechanical support, are limited. However, immediate systemic corticosteroids are known to be effective against eosinophilic myocarditis; therefore, prompt diagnosis of this disease is crucial. Unfortunately, the standard diagnostic tool for myocarditis, endomyocardial biopsy, does not provide immediate histopathological findings. Thus, a rapid diagnostic tool for identifying types of myocarditis is urgently required. We report here the first case of Toxocara canis-induced eosinophilic fulminant myocarditis which was diagnosed based on eosinophil-rich pericardial effusion where the patient recovered with early corticosteroid therapy.

  7. Analysis of the Efficacy of Intraocular Gas Tamponade vs Silicone Oil Tamponade for the Treat-ment of Proliferative Diabetic Retinopathy%眼内气体填充和硅油填充治疗增殖型糖尿病视网膜病变

    Institute of Scientific and Technical Information of China (English)

    李云环

    2013-01-01

    [Objective] To explore the efficacy of intraocular gas tamponade vs silicone oil tamponade for the treatment of proliferative diabetic retinopathy (PDR) .[Methods]Clinical data of 84 patients with PDR un-dergoing vitrectomy were analyzed retrospectively .Gas group included 36 patients with gas tamponade ,while silicone oil group included 48 patients with silicone oil tamponade .The postoperative recovery was compared between two groups .[Results]In gas group ,visual acuity was improved in 29 patients(80 .6% ) ,and cataract occurred in 4 patients(11 .1% ) ,and vitreous hemorrhage occurred in 4 patients(11 .1% ) after treatment a-gain ,and the average occurrence time of iris neovascularization was (6 .1 ± 2 .6) months ,and 34 patients (94 .4% ) obtained retina reattachment successfully .In silicone group ,visual acuity was improved in 29 pa-tients(60 .4% ) ,and cataract occurred in 14 patients(29 .2% ) ,and vitreous hemorrhage occurred in 15 patients (31 .3% ) after treatment again ,and the average occurrence time of iris neovascularizationtime was (5 .8 ± 2 .5) months ,and 37 patients(77 .1% ) obtained retina reattachment successfully .Visual acuity ,cataract formation , vitreous hemorrhage and retinal reattachment in gas group were better than silicone oil group ( P < 0 .05) .[Conclusion] Intraocular gas tamponade for the treatment of PDR has satisfactory efficacy ,and it is safe and reliable .Therefore ,intraocular gas tamponade is worthy of clinical promotion .%[目的]探讨眼内气体填充和硅油填充治疗增殖型糖尿病视网膜病变(PDR)的疗效。[方法]回顾性分析玻璃体切割手术的PDR患者84例临床资料,气体填充患者36例(气体组),硅油填充患者48例(硅油组),比较两组术后恢复情况。[结果]气体组治疗后视力提高29例(80.6%)、治疗后发生白内障4例(11.1%)、玻璃体再出血4例(11.1%)、平均虹膜新生血管出现时间(6.1±2.6)个月、

  8. 硅油长期眼内填充的可行性分析%Analysis of the possibility for long-term intraocular silicone oil tamponade

    Institute of Scientific and Technical Information of China (English)

    马利波; 王颖; 赵健; 李垚

    2014-01-01

    目的 探讨硅油眼内长期填充的可行性及其转归.方法 收集2004年9月至2014年6月在沈阳爱尔眼视光医院随访资料完整的硅油眼内填充达3年以上的病例23例23只眼,男16例,女7例,硅油填充时间3年至15年,对其进行分析.其中严重孔源视网膜脱离16只眼、急性视网膜坏死2只眼、增殖性糖尿病视网膜病变Ⅵ期2只眼、眼球破裂伤3只眼,均行玻璃体切除、硅油填充.其中视网膜切开6只眼,联合晶状体一期切除17只眼.结果 末次手术后依然硅油填充17只眼,其中视网膜复位良好7只眼,视网膜部分复位7只眼;全视网膜脱离2只眼,眼底不清1只眼;6只眼硅油取出,其中5只眼硅油取出后视网膜复位保持良好,1只眼视网膜脱离复发.视力0.01~0.06者6只眼,光感~指数者10只眼,无光感者3只眼.随访期间并发症有角膜带状变性、角膜大泡病变、继发青光眼、硅油乳化、晶状体混浊、视乳头颜色变淡、低眼压、虹膜红变和硅油进入视网膜下等.结论 硅油长期填充会导致眼组织结构和功能的异常,但对于一些视网膜复位不佳的严重玻璃体视网膜病变病例,硅油的长期填充可以获得维持视网膜复位,延长有用的视功能,保持眼球外观的机会.%Objective To study the etiology,symptoms and prognosis of long-term intraocular silicone tamponade.Methods This study collected 23 patients (23 eyes) with intraocular silicone oil tamponade for more than 3 years during 8 years follow-up.Male was 16; female was 7; the time of silicone oil tamponade was from 3 to 15 years,including 16 eyes of rhegmatogenous retinal detachment; 2 eyes of acute retinal necrosis; 2 eyes of proliferative diabeticretinopathy; 3 eyes of traumatic ocular rupture.All patients had been performed vitrectomy and silicone oil tamponade,including 6 eyes with retinal incision and 17 eyes with lesectomy.Results Of 17 eyes with long-term silicone oil tamponade

  9. 循证护理预防长期留置导尿老年男性患者尿路感染的价值%Values of Evidence-based Nursing in Preventing Catheter-associated Urinary Tract Infection of Senile Male Patients

    Institute of Scientific and Technical Information of China (English)

    王建平; 赵敏; 成敏洁; 陈丽琴

    2014-01-01

    Objective:To discuss the value of evidence-based nursing in preventing catheter-associated urinary tract infection (CAUTI) of senile man. Methods:Sixty-seven patients were intervened by evidence-based nursing, and compared with 46 cases who received routine care in 2011. Satisfaction degree and CAUTI incidence of both groups were observed. Results:CAUTI incidence of evidence-based nursing group was 8.96%, lower than 23.91%of routine care group, χ2=4.774, P=0.029; satisfaction degree of evidence-based nursing group was 91.8%, higher than 79.7%of routine care group, χ2=4.949, P=0.026. Conclusion:Evidence-based nursing could effectively lower CAUTI incidence of senile male patients with long-term retention catheterization.%目的:探讨循证护理预防长期留置导尿老年男性患者尿路感染的价值。方法:对住院并长期留置尿管的老年男性患者67例进行循证护理干预,并与2011年常规护理下长期留置尿管的老年男性患者46例进行比较,观察2组患者尿路感染的发生率及护理满意度。结果:循证护理组尿路感染(CAUTI)的发生率为8.96%,常规护理组为23.91%,χ2=4.774,P=0.029;满意度循证护理组为91.8%,常规护理组为79.7%,χ2=4.949, P=0.026。结论:循证护理能有效降低老年男性患者长期留置导尿CAUTI的发生率。

  10. Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers

    Directory of Open Access Journals (Sweden)

    Zhu X

    2016-04-01

    Full Text Available Xiaoli Zhu,1 Wen Cao,2 Bing Chang,3 Linyuan Zhang,3 Peihuan Qiao,3 Xue Li,4 Lifang Si,5 Yingmei Niu,1 Yuguo Song1 1Department of Occupational Medicine and Clinical Toxicology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Toxicology, National Institute for Occupational Health and Poison Control, China CDC, Beijing, People’s Republic of China; 4Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China Abstract: Nanomaterials offer great benefit as well as potential damage to humans. Workers exposed to polyacrylate coatings have pleural effusion, pericardial effusion, and pulmonary fibrosis and granuloma, which are thought to be related to the high exposure to nanomaterials in the coatings. The study aimed to determine whether polyacrylate/silica nanoparticles cause similar toxicity in rats, as observed in exposed workers. Ninety male Wistar rats were randomly divided into five groups with 18 rats in each group. The groups included the saline control group, another control group of polyacrylate only, and low-, intermediate-, and high-dose groups of polyacrylate/nanosilica with concentrations of 3.125, 6.25, and 12.5 mg/kg. Seventy-five rats for the 1-week study were terminated for scheduled necropsy at 24 hours, 3 days, and 7 days postintratracheal instillation. The remaining 15 rats (three males/group had repeated ultrasound and chest computed tomography examinations in a 2-week study to observe the pleural and pericardial effusion and pulmonary toxicity. We found that polyacrylate/nanosilica resulted in pleural and pericardial effusions, where nanosilica was isolated and detected

  11. Undetected Aorto-RV Fistula With Aortic Valve Injury and Delayed Cardiac Tamponade following a Chest Stab Wound: A Case Report

    Directory of Open Access Journals (Sweden)

    Jamil Esfahanizadeh

    2013-06-01

    Full Text Available Introduction: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries. The combination of aorto-right ventricular fistula with aortic valve injury is rare.Case Presentation: A 19 year-old man referred with an aorto-right ventricular fistula accompanied with aortic regurgitation and delayed tamponade following a stab in the chest. The patient was scheduled for fistula repair, aortic valve replacement and pericardectomy two months after trauma.Conclusions: To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed. In addition, cardiac injuries should be repaired during the same hospital stay.

  12. 玻璃体切割硅油填塞术后眼压变化分析%Changes of intraocular pressure following silicone oil tamponade for vitrectomy

    Institute of Scientific and Technical Information of China (English)

    徐建敏; 张士胜; 张琼; 周颖明; 朱彩红; 葛健; 王玲

    2011-01-01

    目的 观察玻璃体切割硅油填塞术后的眼压变化,并探讨其可能原因.方法 对45例(45眼)玻璃体切割硅油填塞术后患者的临床资料进行回顾性分析,高眼压标准为术后眼压≥24 mmHg(1 mmHg=0.133 kPa).结果 22例(48.9%)患者出现高眼压,以术后早期(术后2周内)为多(17/22,77.3%).所有患者经降眼压药物治疗及调整激素用量或停用激素处理后,眼压均控制在正常范围.高眼压组与非高眼压组性别、年龄、病程、屈光度及硅油填充量比较差异均无统计学意义(P>0.∞).结论 高眼压是玻璃体切割硅油填充术后常见的并发症,术后眼内组织水肿、葡萄膜炎反应和频繁使用激素类滴眼液等可能是引起高眼压的主要原因.%Objective To observe the changes of intraocular pressure (IOP) following silicone oil tamponade for vitrectomy, and explore the possible causes. Methods The clinical data of 45 patients (45 eyes) undergoing silicone oil tamponade for vitrectomy were retrospectively analysed, and I0P elevation was defined as I0P of 24 mmHg ( 1 mmHg =0. 133 kPa) or higher. Results Postoperative IOP elevation occurred in 22 patients ( 48.9% ), especially in the early period after operation (2 weeks after operation) ( 17/22, 77.3% ). After using lOP-lowering drugs and adjusting or cessation of glucocorticoid eyedrops, the elevated lOP in all patients was controlled within normal limits. There was no significant difference in gender, age, course of disease, refractive diopters and volume of silicone oil tamponade between patients with and without elevated lOP ( P > 0.05 for all). Conclusion IOP elevation is a common complication following silicone oil tamponade for vitrectomy, and postoperative intraocular tissue edema, uveitis reaction and frequent use of glucocorticoid eyedrops may be the main causes.

  13. Treatment of hemodialysis vascular access rupture irresponsive to prolonged balloon tamponade: Retrospective evaluation of the effectiveness of N-butyl cyanoacrylate seal-off technique

    Energy Technology Data Exchange (ETDEWEB)

    Weng, Mei Jul; Liang, Huei Lung; Pan, Huay Ben [Dept. of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung (China); Chen, Matt Chiung Yu [Dept. of Radiology, Yuan' s General Hospital, Kaohsiung (China)

    2013-01-15

    The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post

  14. Vitrectomy combined with intraocular tamponade postoperative intraocular pressure changes%玻璃体切除联合眼内填充术后眼压变化

    Institute of Scientific and Technical Information of China (English)

    吴娜; 张红

    2013-01-01

    Objective To observe the posterior vitrectomy combined with intraocular tamponade in early postoperative intraocular pressure changes and to explore the pathogenesis of early high intraocular pressure. Methods On 119 eyes of 132 patients in Ophthalmological Center of Tianjin Medical University line vitrectomy in patients with clinical data analysis of high intraocular pressure, the diagnostic criteria for non contact tonometer is greater than or equal to 24 mm Hg, analysis of vitrectomy combined with different intraocular tamponade postoperative intraocular high incidence and trend. Resuis In 50 eyes in the occurrence of postoperative early elevated intraocular pressure, incidence rates for37. 88%. The sili-cone oil tamponade group, C2F6group, C3F8Group filling filling and simple phaco group, its early postoperative intraocular high morbidity rates were48% ,41.18% ,57.14% ,11.76% , the group compare (χ2 = 14.395, r =3, P =0.002) .with statistical significance. Conclusion Early postoperative intraocular pressure elevation is posterior vitrectomy postoperative common complications, posterior vitrectomy combined with intraocular inert gas or silicone oil tamponade are increased intraocular hypertension risk factors.%目的 观察后部玻璃体切除(PPV)联合眼内填充物术后早期眼压变化规律并探讨早期高眼压的发病机制.方法 对119例(132只眼)在天津医科大学眼科中心行后部PPV患者的临床资料进行分析,高眼压的诊断标准为非接触式眼压计测量眼压≥24 mm Hg,分析了玻璃体切除联合不同眼内填充物术后高眼压的发病率及变化趋势.结果 有50只眼术后发生早期眼压升高,发病率为37.88%.其中硅油填充组、C2F6填充组、C3F8填充组及单纯玻切组,其术后早期高眼压的发病率分别为48%、41.18%、57.14%、11.76%,各组间比较(x2=14.395,r=3,P=0.002),有统计学意义.结论 术后早期高眼压是后部PPV术后常见的并发症,后部PPV联

  15. Assessment of Anterior Segment Changes in Pseudophakic Eyes, Using Ultrasonic Biomicroscopic Imaging, after Pars Plana Vitrectomy with Silicone Oil or Gas Tamponade

    Directory of Open Access Journals (Sweden)

    Erkan Ünsal

    2016-01-01

    Full Text Available Objective. To evaluate the morphological changes of the anterior segment using ultrasonic biomicroscopy (UBM imaging in pseudophakic patients who underwent pars plana vitrectomy (PPV with silicone oil or gas (C3F8 internal tamponade agent injection. Method. This prospective study included pseudophakic patients with planned PPV, divided into two groups according to internal tamponade agent: those in which silicone oil was used (n=27, Group 1 and those in which gas (C3F8 was used (n=24, Group 2. UBM measurements were performed in the supine position before and one week after surgery. Results. In patients of Group 1, postoperative trabecular meshwork-ciliary process distance (T-CPD and iris-ciliary process distance (I-CPD, according to preoperative values, were found to be statistically significantly reduced, and postoperative mean value of scleral thickness (ST and intraocular pressure (IOP, according to preoperative value, was found to be statistically significantly increased. In patients of Group 2, postoperative mean values of anterior chamber depth (ACD, ciliary body thickness (CBT, T-CPD, I-CPD, and IOP, according to preoperative values, were found to be statistically significantly reduced. Preoperatively, in Group 2 patients, according to Group 1 patients, TIA and IOP were found to be statistically significantly increased. Preoperative and postoperative IOP between the measured parameters with UBM showed no statistically significant correlation. Conclusions. Gases cause more morphological changes in the anterior segment structures. It is thought that complications such as increased intraocular pressure can be seen more frequently for this reason.

  16. The Effect of Altitude on Intraocular Pressure in Vitrectomized Eyes with Sulfur Hexafluoride Tamponade by the Friedenwald Method: Rabbit Animal Model

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    Jans Fromow-Guerra

    2016-01-01

    Full Text Available The aim of this study is to assess the change in intraocular pressure after a road trip, in eyes with different levels of filling with gas tamponade. Five rabbit eyes were subject to pars plana vitrectomy and gas tamponade (filling percentage: 25%, 50%, and 100% of nonexpansile SF6, 100% saline solution, and 100% room air. A sixth eye was injected with 0.35 cc of undiluted SF6 without vitrectomy. Guided by global positioning system, they were driven to the highest point of the highway connecting Mexico City with Puebla city and back, stopping every 300 m to assess intraocular pressure. The rabbit’s scleral rigidity and estimation for human eyes were done by using the Friedenwald nomogram. Maximum altitude was 3209 m (Δ949 m. There were significant differences in intraocular pressure on the rabbit eyes filled with SF6 at 100%, 50%, 25%, and 100% room air. Per every 100 m of altitude rise, the intraocular pressure increased by 1.53, 1.0046, 0.971, and 0.97 mmHg, respectively. Using the human Friedenwald rigidity coefficient, the human eye estimate for intraocular pressure change was 2.1, 1.8, 1.4, and 1.1 mmHg per every 100 m of attitude rise. Altitude changes have a significant impact on intraocular pressure. The final effect depends on the percentage of vitreous cavity fill and scleral rigidity.

  17. F6H8 as an Intraoperative Tool and F6H8/Silicone Oil as a Postoperative Tamponade in Inferior Retinal Detachment with Inferior PVR

    Directory of Open Access Journals (Sweden)

    Gian Marco Tosi

    2014-01-01

    Full Text Available Purpose. To evaluate the effectiveness and safety of perfluorohexyloctane (F6H8 for intraoperative flattening of the retina and of F6H8/silicone oil (SO 1000 cSt as a postoperative tamponade for inferior retinal detachment with inferior proliferative vitreoretinopathy. Methods. This is a retrospective review of 22 patients who underwent pars plana vitrectomy using F6H8 as an intraoperative tool to flatten the retina. At the end of the surgery a direct partial exchange between F6H8 and SO 1000 cSt was performed, tamponing the eye with different ratios of F6H8/SO (70/30, 60/40, 50/50, 40/30, and 30/70. Anatomical and functional results and complications were evaluated over the follow-up period (mean 22.63 months. Results. F6H8 was efficacious for intraoperative flattening of the retina. Twenty-one of the 22 patients achieved a complete retinal reattachment. Postoperative visual acuity (VA ranged from light perception to 20/70, with 72% of patients obtaining VA better than 20/400. No emulsification/inflammation was observed whatever the ratio of F6H8/SO used. With higher ratios of F6H8/SO (70/30 and 60/40 cloudiness of the tamponade was observed. A transparent mixture was present with all the other ratios. Conclusions. The surgical technique adopted is very simple and safe. The optimal F6H8/SO ratio seems to be between 50/50 and 30/70.

  18. Endocardial and pericardial disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920664 Serious complications and potentialdanger of endomyocardial biopsy.QUNailu (曲乃路), et al. Cardiovascular Dept,Dalian Centr Hosp, Dalian. Chin Cir J1992; 7(3): 257-258. Endomyocardial biopsy(EMB)of 86 patients,aged 15-57 yrs; has been prerformed in this

  19. Endocardial and pericardial disease

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970308 Study on the mechanism of effect ofangiotensin converting enzyme inhibitor on renin-angiotensin system while undergoing bicycle exercisetest. WU Shendi(吴顺娣), et al. Shanghai Hyperten-sive Instit, Ruijin Hosp, 2nd Med Univ, Shanghai,200025. Acta Univ Med 2nd Shanghai 1997; 17(2); 81

  20. 超声下Seldinger技术心包穿刺置管引流治疗急性心包填塞的临床观察%Clinical observation of pericardiocentesis with Seldinger technique guided by echocardiography in treatment of patients with acute pericardial tamponade

    Institute of Scientific and Technical Information of China (English)

    任晖; 张军康; 鲁海; 袁建国; 巩洁; 韦文博

    2003-01-01

    目的评价超声下Seldinger技术心包穿刺置管引流治疗急性心包填塞的疗效及安全性.方法16例中到大量心包积液发生急性心包填塞患者,在超声心动图引导下,采用Seldinger技术,经皮穿刺心包腔内置中心静脉导管进行间断抽液.结果16例患者均一次穿刺成功,穿刺成功时间2~5min.无1例出现心肌或其它脏器损伤,4例出现抽吸时导管堵塞,用生理盐水冲洗后通畅,1例出现局限性皮下渗液,1例穿刺处皮肤轻度红肿,经处理后消失.留置导管时间一般2~14d,最长2月余.结论超声下Seldinger技术心包穿刺置入中心静脉导管引流治疗急性心包填塞,方法简单,能安全有效缓解心包填塞症状,成功率高,可替代传统穿刺方法.

  1. Pericardial cyst with atypical location: densimetric evaluation of mediastinal masses by computerized tomography. Quiste pericardico de localizacion atipica: valor diagnostico de la TC y de la puncion aspiracion con aguja fina

    Energy Technology Data Exchange (ETDEWEB)

    Franquet, T.; Jimenez, F.J.; Eguizabal, C.; Bescos, J.M.

    1991-01-01

    We present a case of pericardial cyst with atypical location. CT has been very useful for densitometric evaluation of mediastinal masses. Using a combination of cross-section diagnostic methods and fine-needle aspiration, carried out accurate diagnoses of cystic lesions located in uncommom sites. (Author)

  2. 香丹注射液心包灌洗预防心脏术后心包粘连的研究%Preventive Effect of Xiangdan Injection on Pericardial Adhesions after Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    胡光柱; 张军; 左顺庆; 罗湘玉; 郭家龙

    2011-01-01

    目的 探讨香丹注射液通过心包引流管灌洗预防心包粘连形成的作用及作用机制.方法 20只大耳白兔随机分为对照组及实验组(每组10只),按作者自行改良的左侧开胸手术法建立心包粘连动物模型.对照组灌洗用药为生理盐水;实验组灌洗用药为香丹注射液(4%浓度),干预药物均通过心包引流管注入心包腔灌洗治疗.对纤维粘连蛋白指标检测并统计分析,同时观察心包病理形态的变化.结果 实验组在给药3天后各纤维粘连指标与对照组相比有统计学差异;病理组织学观察两组粘连程度有显著区别,实验组心包粘连程度较轻.结论 香丹注射液具有降低心包腔内纤维粘连蛋白浓度的作用,中药治法对预防术后心包粘连形成具有重要意义.%Objective To study the preventive effect and mechanism of Xiangdan injection on pericardial adhesions. Methods Twenty Japanese flap-eared white rabbits were randomly divided into control group and experiment group (n = 10 each). The rabbit models with pericardial adhesions were established by the improved left-sided surgical approach presented by the authors. Experiment group received Xiangdan injection of 4% concentration by pericardial cavity perfu-sion. Control group received normal saline injection. The levels of fibronectin (FN) in the pericardial cavity were meas-ured and statistically analyzed. The pathological and morphological changes of the pericardium were observed. Results After three days of drug administration, the FN levels were significantly different between the two groups. The patholog-ical and morphological observation indicated significant difference in the pericardial adhesion degrees, which was lighter in experiment group. Conclusion Xiangdan injection can decrease the FN concentration in the pericardial cavity. The tradi-tional Chinese drug is important to prevent the pericardial adhesions after surgery.

  3. 心包积液381例病因及误诊分析%Analysis of causes of pericardial effusion and misdiagnosis in 381 Cases

    Institute of Scientific and Technical Information of China (English)

    庞伦祥

    2011-01-01

    目的 分析心包积液病因变化及误诊原因.方法 对1990~2009年收治的381例心包积液患者的临床资料进行回顾性分析.结果 心包积液病因依次为肿瘤性占21.5%、结核性占17.3%、心力衰竭性占13.6%、尿毒症性占8.9%、非特异性占8.1 %、甲状腺功能减退性占7.8%,其他各种原因合计占22.6%.结核性心包积液由10年前22.5%下降为13.0%,而肿瘤性心包积液则由10年前13.3%上升为28.4%(P<0.05).误诊32例.结论 不同时期心包积液病因构成不同,肿瘤成为当前心包积液的首位病因.%Objective To summarize the causes of pericardial effusion and to analyse the misdiagnosis during 20 years. Methods The clinical data of 381 patients with cardial effusion were analyzed in our hospilal from 1990 to 2009. Results The percentages of tumorous, tuberculous, heart failure, uremigenic, nonspecific, hypothyroidism pericardial effusion were 21.5 %, 17.3 %, 13.6%,8.9% ,8.l% ,7.8% respectively. The percentage of other causes was 22.6%. The percentage of tuberculous pericardial effusion was 22.5% in pre-10-year and downed to 13.0%(P<0.05),while that of the tumorous one rised from 13.3% to 28.4%(P<0.05). 32 patiens were misdiagnosised. Conclusion The causes of percicardial effusion in differential period. Tumor is the leading cause of percicardial effusion.

  4. Role of svp in Drosophila Pericardial Cell Growth%svp基因在果蝇副心肌细胞生长中的作用

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    袁婺洲; Rolf Bodmer; 张月娟; 唐文岘; 王俊; 李永青; 王跃群; 朱传炳; 杨鸿; 吴秀山

    2006-01-01

    果蝇心脏位于身体背部,是一个体节性重复的线性管状结构.在hedgehog(hh)基因的信号诱导下,seven-up(svp)基因调控果蝇的心脏发育,在每个体节的两个心肌细胞和两个副心肌细胞中表达.结果表明,在svp纯合突变体中,报告基因lacZ在心肌细胞中的表达图式正常,但在副心肌细胞中的表达图型明显异常,而且部分EPC细胞生长尺寸增加.某些体节的DA1肌肉祖细胞缺失,晚期突变体胚胎体壁肌肉细胞也呈现异常,表明基因svp的活性对果蝇副心肌细胞、DA1肌肉祖细胞和体壁肌肉细胞的分化是必须的,并且可能与EPC副心肌细胞的尺寸生长有关.%The Drosophila dorsal vessel is a segmentally repeated linear organ, in which seven-up (svp) is expressed in two pairs of cardioblasts and two pairs of pericardial cells in each segment. Under the control of hedgehog (hh) signaling from the dorsal ectoderm, svp participates in diversifying cardioblast identities within each segment. In this experiment, the homozygous embryos of svp mutants exhibited an increase in cell size of Eve positive pericardial cells (EPCs) and a disarranged expression pattern, while the cardioblasts pattern of svp-lacZ expression was normal. In the meantime, the DA1 muscle founders were absent in some segments in svp mutant embryos, and the dorsal somatic muscle patterning was also severely damaged in the late stage mutant embryos,suggesting that svp is required for the differentiation of Eve-positive pericardial cells and DA1 muscle founders and may have a role in EPC cell growth.

  5. Elevated Levels of Asymmetric Dimethylarginine (ADMA in the Pericardial Fluid of Cardiac Patients Correlate with Cardiac Hypertrophy.

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    Zoltan Nemeth

    Full Text Available Pericardial fluid (PF contains several biologically active substances, which may provide information regarding the cardiac conditions. Nitric oxide (NO has been implicated in cardiac remodeling. We hypothesized that L-arginine (L-Arg precursor of NO-synthase (NOS and asymmetric dimethylarginine (ADMA, an inhibitor of NOS, are present in PF of cardiac patients and their altered levels may contribute to altered cardiac morphology.L-Arg and ADMA concentrations in plasma and PF, and echocardiographic parameters of patients undergoing coronary artery bypass graft (CABG, n = 28 or valve replacement (VR, n = 25 were determined.We have found LV hypertrophy in 35.7% of CABG, and 80% of VR patients. In all groups, plasma and PF L-Arg levels were higher than that of ADMA. Plasma L-Arg level was higher in CABG than VR (75.7 ± 4.6 μmol/L vs. 58.1 ± 4.9 μmol/L, p = 0.011, whereas PF ADMA level was higher in VR than CABG (0.9 ± 0.0 μmol/L vs. 0.7 ± 0.0 μmol/L, p = 0.009. L-Arg/ADMA ratio was lower in the VR than CABG (VRplasma: 76.1 ± 6.6 vs. CABGplasma: 125.4 ± 10.7, p = 0.004; VRPF: 81.7 ± 4.8 vs. CABGPF: 110.4 ± 7.2, p = 0.009. There was a positive correlation between plasma L-Arg and ADMA in CABG (r = 0.539, p = 0.015; and plasma and PF L-Arg in CABG (r = 0.357, p = 0.031; and plasma and PF ADMA in VR (r = 0.529, p = 0.003; and PF L-Arg and ADMA in both CABG and VR (CABG: r = 0.468, p = 0.006; VR: r = 0.371, p = 0.034. The following echocardiographic parameters were higher in VR compared to CABG: interventricular septum (14.7 ± 0.5 mm vs. 11.9 ± 0.4 mm, p = 0.000; posterior wall thickness (12.6 ± 0.3 mm vs. 11.5 ± 0.2 mm, p = 0.000; left ventricular (LV mass (318.6 ± 23.5 g vs. 234.6 ± 12.3 g, p = 0.007; right ventricular (RV (33.9 ± 0.9 cm2 vs. 29.7 ± 0.7 cm2, p = 0.004; right atrial (18.6 ± 1.0 cm2 vs. 15.4 ± 0.6 cm2, p = 0.020; left atrial (19.8 ± 1.0 cm2 vs. 16.9 ± 0.6 cm2, p = 0.033 areas. There was a positive correlation

  6. Disfunção sistólica aguda de ventrículo esquerdo após drenagem de derrame pericárdico Transient left ventricular systolic dysfunction after pericardial effusion drainage

    Directory of Open Access Journals (Sweden)

    Fábio Branco de Araújo Brauner

    1997-12-01

    Full Text Available Paciente com timoma e função sistólica normal do ventrículo esquerdo desenvolveu tamponamento cardíaco, revertido por pericardiocentese. Após quatro dias, foi submetida à exérese do tumor e, em aproximadamente uma semana da drenagem, apresentou disfunção sistólica aguda e grave do ventrículo esquerdo, que melhorou com terapia venosa, normalizando o quadro em três dias.A patient with a thymoma and initially normal ventricular systolic function developed cardiac tamponade, which was relieved by pericardiocentesis. After four days, the tumor was removed and, one week after the relief of tamponade, she developed severe left ventricular systolic dysfunction, that recovered in three days with venous therapy.

  7. 重硅油填充术后眼屈光状态的初步研究%A preliminary study on the refractive state of heavy silicone oil tamponade eyes

    Institute of Scientific and Technical Information of China (English)

    胡旭颋; 孙长文; 周业辉; 吴荣瀚

    2012-01-01

    Objective To study the refractive changes induced by intraocular heavy silicone oil.Methods The theoretical refractive state of eyes with heavy silicone oil was calculated with the parameter of Gullstrand-Emsley model eye.Three shape models of posterior capsule in aphakic eyes were taken to evaluate their influence on ocular refraction.Retinoscopy was performed on 21 heavy silicone oil tamponade eyes and theoretical and experimental differences were study.Results Theoretically phakic Gullstrand-Emsley model eye showed+6.33D increase in spectacle refraction induced by intraocular heavy silicone oil.There was a+11.30D alteration in spectacle refraction with a convex forward posterior capsule,a+14.70D alteration with a flat posterior capsule and a+19.10D alteration with a convex backward posterior capsule in aphakic heavy silicone oil tamponade eyes.There was a+7.28D alteration in heavy silicone oil tamponade eyes with IOL.Experimental postoperative diopter in phakic heavy silicone oil tamponade eyes increased(+6.25±3.27)D,in aphakic heavy silicone oil tamponade eyes increased(+7.94±3.83)D and in heavy silicone oil tamponade eyes with IOL increased(+4.40±1.34)D.Conclusions Hyperopic changes are found in heavy silicone oil tamponade eyes,and the clinical measured values are lower than the theoretical ones.Refractive state of aphakic heavy silicone oil tamponade eyes is closely related with the shape of posterior capsule.%目的 研究重硅油填充对眼屈光状态的影响.方法 采用Gullstrand-Emsley模型眼计算重硅油填充眼的屈光状态,在无晶状体眼模型上设计3种后囊膜状态,计算不同状态对屈光的影响.对21例重硅油填充眼视网膜复位患者进行检影,研究重硅油填充眼屈光状态理论和实际差异.结果 重硅油填充可导致有晶状体眼屈光度增加+6.33 D.对于无晶状体眼,后囊膜前凸时镜片屈光度增加+11.30 D,后囊膜为平面时镜片屈光度增加+14.70 D,后囊膜

  8. 心房颤动射频导管消融术并发急性心脏压塞九例临床分析%Atrial Fibrillation Complicated by Acute Cardiac Tamponade in Radiofrequency Catheter Ablation

    Institute of Scientific and Technical Information of China (English)

    宁尚秋; 刘文娴; 陈立颖; 康铁朵; 李江; 董建增; 任学军; 马长生; 吕树铮

    2011-01-01

    Objective To summarize the manifestations and results of atrial fibrillation ( AF ) complicated by acute cardiac tamponade in radiofrequency catheter ablation. Methods A total of 2 094 AF patients received radiofrequency catheter ablation in our hospital from January 2006 to June 2010, 9 of whom were complicated by acute cardiac tamponade. The clinical manifestations and treatment outcomes of 9 patients were analyzed retrospectively. Results The incidence of acute cardiac tamponade was 0. 43% ( 9/2 094 ). The patients presented with chest distress and hypotension in early stage and remitted completely after drainage by pericardiocentesis without bleeding. Conclusion Cardiac tamponade is a severe complication of atrial fibrillation during radiofrequency catheter ablation. Timely detection and effective treatment are very important.%目的 探讨心房颤动射频消融术发生急性心脏压塞的临床特点和治疗结果.方法 2006年1月-2010年6月我院2 094例心房颤动患者接受射频消融治疗,其中9例并发急性心脏压塞,回顾性分析9例患者的临床表现和治疗结果.结果 急性心脏压塞发生率为0.43%(9/2 094).9例患者早期均表现为胸闷、血压下降.9例患者经心包穿刺引流后症状均完全缓解,无继续出血.结论 急性心脏压塞是心房颤动射频消融术的严重并发症,及时发现和有效救治是十分重要的.

  9. 玻璃体切割硅油填充术后眼压变化的分析及护理%Analysis of changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique

    Institute of Scientific and Technical Information of China (English)

    古丽鲜·英克尤瓦

    2015-01-01

    目的 探讨玻璃体切割联合硅油填充术后患者眼压变化及护理措施.方法 对52例(52眼)玻璃体切割硅油填塞术后患者的临床资料进行回顾性分析,总结护理措施.结果 24例(46.2%)患者出现高眼压,其中19例发生在术后2周内(79.2%).高眼压组与眼压正常组性别、年龄,病程、屈光度及硅油填充量比较早发现,早处理差异均无统计学意义(P>0.05).结论 玻璃体切割联合硅油填充术后早期高眼压临床较常见,应加强患者的病情观察,防止术后并发症.%Objective To explore the changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique.Methods Clinical data of 52 patients (52 eyes) with silicone oil tamponade after vitrectomy were retrospectively analyzed and made a summary of nursing care.Results There were 24 patients (46.2%) with high intraocular pressure,and there were 19 patients high intraocular pressure occurrence within 2 weeks.There were no significant differences in sex,age,duration,the amount of refraction and silicone oil tamponade between high and normal intraocular pressure groups (P > 0.05).Conclusion The early high intraocular pressure is common after vitrectomy with silicone oil tamponade technique.Patient 's condition observation should be strengthened and prevent from post-operation complications.

  10. Surveillance and analysis of central venous catheter-associated bloodstream infections in children with congenital heart disease after cardiac surgery%小儿先天性心脏病手术后中心静脉导管相关性血流感染调查分析

    Institute of Scientific and Technical Information of China (English)

    胡梅英; 陈修文; 乐萍

    2013-01-01

    OBJECTIVE To investigate the incidence of the central venous catheter-associated bloodstream infections in the children with congenital heart disease (CHD) after cardiac surgery and observe the distribution of pathogens. METHODS The targeted surveillance was performed for 928 children with CHD who were treated in the cardiac ICU from Jan to Dec 2012, and the children with the indwelling catheter duration over 48 hours and the children with the extubation time less than 48 hours were selected as the study objects, then the incidence of the central venous catheter-related bloodstream infections and the isolation of pathogens were analyzed. RESULTS Totally 15 cases were diagnosed as the central venous catheter-related bloodstream infections with the incidence of 1. 62% and 3. 79/1. 000 catheter days; totally 23 strains of pathogens were isolated from peripheral vein blood and/or catheter tips, which were mainly the gram-egative bacteria, and the Acinetobacter baumannii, Pseudo-monas aeruginosa and Serratia marcescens were the top three species. CONCLUSION The children with CHD are at high risk of the central-venous catheter-related bloodstream infections, it is necessary to strengthen the surveillance of the central venous catheter-related bloodstream infections in the children after cardiac surgery and take interventions so as to reduce the incidence of nosocomial infections.%目的 探讨小儿先天性心脏病(先心病)患儿术后,中心静脉导管相关血流感染(CLA-BSI)发生水平及病原菌分布特点.方法 对2012年1-12月心脏病治疗中心手术治疗的928例先心病患儿进行CLA-BSI目标性监测,将中心静脉导管留置时间>48 h或拔除导管<48 h内的先心病术后患儿作为研究对象,对CLA-BSI发生水平和病原菌检出进行分析.结果 共诊断CLA-BSI病例15例,感染率为1.62%,每千个导管日感染为3.79%;经外周静脉血或(和)中心静脉导管尖端标本共检出病原菌23株,病原菌以革

  11. 巩膜扣带术联合氩激光治疗硅油眼视网膜再脱离%The scleral buckling combined with argon laser photocoagulation treating retinal redetachment in eyes with silicone oil tamponade

    Institute of Scientific and Technical Information of China (English)

    陈建丽; 韩英军; 张荷珍; 张满红; 路馥萍

    2011-01-01

    目的 探讨巩膜扣带术联合氩激光光凝对硅油眼视网膜再脱离的治疗作用.方法 对硅油眼视网膜再脱离患者行巩膜扣带术联合氩激光治疗的45例(45眼)进行回顾性分析.结果 术后39眼视网膜复位,成功率86.67%,23眼(51.11%)视力提高.结论 矾膜扣带术联合氩激光光凝是治疗硅油眼视网膜再脱离的有效手术方法之一,此手术方法经济、省时.%Objective To evaluate the effects of scleral buckling combined with argon laser photocoagulation applying to retinal redetachment in eyes with silicone oil tamponade. Methods A retrospective study was done with 45 silicone oil tamponade eyes with retinal redetachment which were treated by scleral buckling combined with argon laser photocoagulation. Results Thirty nine eyes achieved completely retinal reattachment (86.67%), and the visual acuity improved in 23 eyes (51.11% ). Conclusions Scleral buckling combined with argon laser photocoagulation is an effective management for retinal redetachment of eyes with silicone oil tamponade. The advantages of this methode are economical and time-saving.

  12. Cardiac looping may be driven by compressive loads resulting from unequal growth of the heart and pericardial cavity. Observations on a physical simulation model

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    Jörg eMänner

    2014-04-01

    Full Text Available The transformation of the straight embryonic heart tube into a helically wound loop is named cardiac looping. Such looping is regarded as an essential process in cardiac morphogenesis since it brings the building blocks of the developing heart into an approximation of their definitive topographical relationships. During the past two decades, a large number of genes have been identified which play important roles in cardiac looping. However, how genetic information is physically translated into the dynamic form changes of the looping heart is still poorly understood. The oldest hypothesis of cardiac looping mechanics attributes the form changes of the heart loop (ventral bending → simple helical coiling → complex helical coiling to compressive loads resulting from growth differences between the heart and the pericardial cavity. In the present study, we have tested the physical plausibility of this hypothesis, which we call the growth-induced buckling hypothesis, for the first time. Using a physical simulation model, we show that growth-induced buckling of a straight elastic rod within the confined space of a hemispherical cavity can generate the same sequence of form changes as observed in the looping embryonic heart. Our simulation experiments have furthermore shown that, under bilaterally symmetric conditions, growth-induced buckling generates left- and right-handed helices (D-/L-loops in a 1:1 ratio, while even subtle left- or rightward displacements of the caudal end of the elastic rod at the pre-buckling state are sufficient to direct the buckling process towards the generation of only D-loops or L-loops, respectively. Our data are discussed with respect to observations made in biological ‘models’. We conclude that compressive loads resulting from unequal growth of the heart and pericardial cavity play important roles in cardiac looping. Asymmetric positioning of the venous heart pole may direct these forces towards a biased

  13. Tamponamento das lesões renais transfixantes com colágeno tipo I Type I collagen used to tamponade transfixing lesion of the kidney

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    Mario Mantovani

    1999-10-01

    Full Text Available Nos últimos anos temos atendido vítimas de trauma com ferimento transfixante dos rins direito e esquerdo. Em trabalho anterior utilizamos colágeno tipo I em ferimentos transfixantes do fígado, com bons resultados. Assim, extendemos a utilização do método para o rim aplicando o colágeno tipo I produzido na UNICAMP, o qual pode ser injetado e moldado ocupando toda a área lesada e o trajeto anfractuoso ou irregular. Desta forma pode-se conseguir um tamponamento completo, coibindo a hemorragia e sustando a perda de urina. O colágeno será posteriormente reabsorvido não funcionando como corpo estranho. Trinta e seis cães foram submetidos a lesão transfixante na região inferior do rim esquerdo, procurando simular uma lesão produzida por um projétil de arma de fogo. Seis destes animais não receberam tratamento e foram a óbito por choque hemorrágico. Em todos os outros 30 animais, aplicou-se o colágeno tipo I em toda a extensão do túnel formado pela lesão, através da injeção do material. Foram realizadas avaliações clínicas no pós-operatório, sendo os cães sacrificados, em grupos de seis, aos 4, 7,15, 30 e 60 dias de pós-operatório O estudo macroscópico e microscópico, revelou uma formação cicatricial homogênea, com regeneração renal intensa, precoce e organizada, a partir do 7º dia de pós-operatório. Conclui-se que a aplicação do colágeno tipo I, nestes tipos de ferimentos são de aplicação simples e segura.Over the past years we have used of the type I collagen to tamponade transfixing hepatic lesions in dogs, manufactured at University of Campinas. We have considered the use of this collagen to tamponed transfixing renal lesions, wich can be molded to the entire wounded area thus tamponading all surface irregularities. In this way, a complete tamponade way be achieved, and urinary loss is prevented. Thirty six mongrel dogs received a perforating transfixing lesion in the distal region of the kidney

  14. Clinical analysis of patients with acute cardiac tamponade complicating percutaneous coronary intervention%经皮冠状动脉介入治疗并发急性心脏压塞的临床分析

    Institute of Scientific and Technical Information of China (English)

    宁尚秋; 刘文娴; 陈立颖; 康铁朵; 李江; 杨鲲; 马长生; 吕树铮

    2011-01-01

    Objective: To report eight cases of acute cardiac tamponade complicationg percutaneous coronary intervention( PCI) , and summarize the causes, manifestation and results of management Methods:From Jan 2005 to Dec. 2008, a total of 5 241 patients with coronary artery disease were treated with PCI in cardiology department of Beijing Anzhen hospital. Among them, 8 patients were complicated with cardiac tamponade. Pencardiocentesis was managed, and surgical procedure was done when pericardiocentesis failed.Results :Total incidence of acute cardiac tamponade was 0. 15% . The early clinical presentation of 8 patients was chest distress and hypotension. Pericardiocentesis was carried out in 7 patients. In 2 of them, surgical management was needed because of active bleeding. 1 patient was dead due to not doing pericardiocentesis.Conclusion:Cardiac tamponade is a severe complication of PCI. It is very important to recognize and treat the cardiac tamponade as soon as possible.%目的:分析8例经皮冠状动脉介入治疗(PCI)并发的急性心脏压塞原因、临床表现和治疗结果.方法:2005年1月至2008年12月对5 241例冠心病患者进行了PCI术,8例患者并发急性心脏压塞.采用心包穿刺引流术处理,无效时采用外科手术.结果:急性心脏压塞的发生率为0.15%.8例患者早期均表现为胸闷、血压下降.7例患者行紧急心包穿刺引流,其中2例因引流后仍继续出血而行外科修补手术.1例患者未行心包穿刺引流死亡.结论:急性心脏压塞是PCI术的严重并发症,及时发现和有效救治是十分重要的.

  15. Longterm Outcomes after Combat Casualty Emergency Department Thoracotomy

    Science.gov (United States)

    2009-08-01

    pericardial tamponade or tension pneumo- thorax, to directly control and repair intrathoracic hemor- rhage, to allow open cardiac massage, and to cross...the effectiveness of prelaparotomy EDT. When blood fills the abdomen and causes distention, the abdom- inal wall may provide a tamponade effect in

  16. Estudo comparativo in vitro entre biopróteses de pericárdio bovino e porcinas In vitro comparative study between bovine pericardial and porcine bioprosthesis

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    Domingo M Braile

    1996-12-01

    Full Text Available A maioria dos implantes valvulares cardíacos realizados no Brasil é representada pelas válvulas de pericárdio bovino, seguidas por próteses porcinas. Na avaliação de válvulas biológicas, deve-se considerar: desempenho hidrodinámico, resistência à fadiga e processo de calcificação. No presente estudo, foi avaliado o desempenho hidrodinámico de biopróteses de pericárdio bovino (Biopro-PB-Braile Biomédica comparativamente às válvulas porcinas (Biopro-PP-Braile Biomédica através do gradiente médio transvalvular. Os testes hidrodinámicos foram realizados em próteses de diâmetros variando de 19 a 35 mm, submetidas ao Sistema Duplicador de Pulsos Shelhigh (Shelhigh Inc.. O volume de ejeção foi mantido constante em 90 ml, com freqüência de pulso de 60, 70,80, 90 e 100 ciclos por minuto, possibilitando fluxos entre 5 e 9 litros por minuto, equivalentes a fluxos contínuos aproximados de 8 a 18 litros por minuto. Houve tendência à diminuição dos gradientes pressóricos à medida em que aumenta o diâmetro externo das próteses. O gradiente pressórico médio encontrado em próteses de pericárdio bovino foi significativamente menor que o de próteses porcinas (pMost of the cardiac valve implantations in Brazil are represented by bovine pericardial valves, followed by the porcine prostheses. In the evaluation of biological valves, the following should be taken into consideration: hydrodynamic performance resistance to fatigue and calcification process. In this study, the hydrodynamic performance of bovine pericardial bioprostheses (Biopro-BP-Braile Biomedica was evaluated comparatively to porcine valves (Biopro-PP-Braile Biomedica, through the transvalvular medium gradient. The hydrodynamic tests were made on prostheses varying from 19 to 35 mm in diameter, which underwent the pulse duplicator system Shelhigh (Shelligh Inc.. The ejection volume was constantly kept at 90 ml. The pulse frequencies varied between 60 and 100

  17. AMP-Activated Kinase (AMPK Activation by AICAR in Human White Adipocytes Derived from Pericardial White Adipose Tissue Stem Cells Induces a Partial Beige-Like Phenotype.

    Directory of Open Access Journals (Sweden)

    Omar Abdul-Rahman

    Full Text Available Beige adipocytes are special cells situated in the white adipose tissue. Beige adipocytes, lacking thermogenic cues, morphologically look quite similar to regular white adipocytes, but with a markedly different response to adrenalin. White adipocytes respond to adrenergic stimuli by enhancing lipolysis, while in beige adipocytes adrenalin induces mitochondrial biogenesis too. A key step in the differentiation and function of beige adipocytes is the deacetylation of peroxisome proliferator-activated receptor (PPARγ by SIRT1 and the consequent mitochondrial biogenesis. AMP-activated protein kinase (AMPK is an upstream activator of SIRT1, therefore we set out to investigate the role of AMPK in beige adipocyte differentiation using human adipose-derived mesenchymal stem cells (hADMSCs from pericardial adipose tissue. hADMSCs were differentiated to white and beige adipocytes and the differentiation medium of the white adipocytes was supplemented with 100 μM [(2R,3S,4R,5R-5-(4-Carbamoyl-5-aminoimidazol-1-yl-3,4-dihydroxyoxolan-2-yl]methyl dihydrogen phosphate (AICAR, a known activator of AMPK. The activation of AMPK with AICAR led to the appearance of beige-like morphological properties in differentiated white adipocytes. Namely, smaller lipid droplets appeared in AICAR-treated white adipocytes in a similar fashion as in beige cells. Moreover, in AICAR-treated white adipocytes the mitochondrial network was more fused than in white adipocytes; a fused mitochondrial system was characteristic to beige adipocytes. Despite the morphological similarities between AICAR-treated white adipocytes and beige cells, functionally AICAR-treated white adipocytes were similar to white adipocytes. We were unable to detect increases in basal or cAMP-induced oxygen consumption rate (a marker of mitochondrial biogenesis when comparing control and AICAR-treated white adipocytes. Similarly, markers of beige adipocytes such as TBX1, UCP1, CIDEA, PRDM16 and TMEM26 remained

  18. Application of uterine tamponade with balloon catheter for treatment of postpartum hemorrhage%应用子宫填塞球囊导管治疗产后出血的初步经验

    Institute of Scientific and Technical Information of China (English)

    阮颖清

    2012-01-01

    Objective To investigate the efficacy and safety of uterine tamponade with balloon catheter for the treatment of postpartum hemorrhage.Methods The data on 24 patients with postpartum hemorrhage who had received uterine tamponade with balloon catheter during the period of January 2010 to February 2012 were retrospectively analyzed.The average age of the patients was 27.5 years old ( 22-34 ).Of the 24 patients,12 had uterine inertia,4 had placenta previa,and 8 had placenta accrete.Results All the patients were cured by uterine tamponade with balloon catheter,and no one needed to undergo hysterectomy.The primary effectiveness rate of hemostasis was 91.6%.Two patients had rebleeding,and the tamponade balloon was inflated again to stop bleeding.The tamponade balloon was removed after 24 hours.None had rebleeding,nor hysterectomy needed.The total effectiveness rate of hemostasis was 100%.No patients required hysterectomy or were dead.All the patients were followed up for 1 to 24 months postoperatively and had a normal uterine involution and menstrual restoration within 1 to 3 months.No puerperal infection or symptoms of premature ovarian failure occurred.Conclusions Application of uterine tamponade with balloon catheter in the treatment of postpartum hemorrhage is safe,effective,and worth popularizing clinically.%目的 探讨应用子宫填塞球囊导管治疗产后出血的疗效及安全性.方法 对我院2010年1月-2012年2月,24例使用子宫填塞球囊导管治疗产后出血患者进行回顾性分析.患者年龄22~34岁,平均27.5岁,其中产后出血病因宫缩乏力12例、前置胎盘4例,胎盘粘连8例.结果 全部病例均能应用子宫填塞球囊导管达到止血目的,无一例行子宫切除术.一次止血有效率达91.6%.2例患者出现再发出血,再次充盈气囊止血后,两例患者于24小时再尝试取出水囊,未再发大出血,总止血有效率达100%.无一例需行子宫切除术或死亡,术后随访1~24

  19. PKRP 术后早期出血致膀胱填塞原因分析与防治策略%Causes Analysis of 35 Patients with Bladder Tamponade Induced by Early Bleeding after Transurethral Plasmakinetic Resection of Prostate

    Institute of Scientific and Technical Information of China (English)

    何运胜; 刘晓波

    2014-01-01

    目的:探讨经尿道等离子体双极前列腺电切术(transurethral plasmakinetic resection of prostate,PKRP)后早期出血致膀胱填塞的原因。方法回顾分析我院2005年1月—2012年1月35例 PKRP 术后24 h 内出血致膀胱填塞患者的临床资料。结果本组常规行 PKRP,术中均顺利,膀胱填塞发生于术后6 h 内28例,6~12 h 内7例。19例表现为下腹部剧痛,冲洗液鲜红或伴随冲洗液反流;16例无主诉,仅表现为冲洗液反流或停止或波动样流动。35例经 B 超检查明确膀胱填塞,重返手术室酌情采取镜下冲洗血凝块、电凝止血,或电切血凝块,或电切残留小腺体并电凝止血等处理,5 d 后出院。随访2~7年,排尿正常,无再次出血。结论膀胱痉挛是 PKRP 术后24 h 内出血致膀胱填塞的高危因素,尤其对下腹部无明显疼痛的膀胱痉挛患者,要善于观察,并及早行 B 超检查,避免延误诊断与处理。%Objective To explore the causes of bladder tamponade induced by early bleeding after transurethral plas-makinetic resection of prostate (PKRP). Methods Clinical data of 35 patients with bladder tamponade induced by early bleeding within 24 h after PKRP during January 2005 and January 2012 was retrospectively analyzed. Results All the pa-tients underwent routine PKRP of successful operation process, 28 patients had bladder tamponade within 6 h after the opera-tion, and 7 patients had bladder tamponade within 6 - 12 h after the operation, 19 patients suffered severe pain in lower abdo-men, bright red washing fluid or contraflow with washing fluid; 16 patients did not complain with contraflow, stopping or wave-like movement of washing fluid. All the 35 patients were confirmed with having the bladder tamponade by B ultrasound exami-nation, and underwent washing the blood clot under the microscope, electric coagulation hemostasis, transurethral clot or tran-surethral residual small glands electric coagulation treatment

  20. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

    DEFF Research Database (Denmark)

    Bonser, Robert S; Ranasinghe, Aaron M; Loubani, Mahmoud;

    2011-01-01

    for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection...

  1. A case involving an Ahmed™ glaucoma valve transferred from the vitreous into the anterior chamber of the eye with a silicone oil tamponade for the treatment of neovascular glaucoma

    Directory of Open Access Journals (Sweden)

    Miki M

    2013-02-01

    Full Text Available Michiko Miki, Mari Ueki, Tetsuya Sugiyama, Shota Kojima, Tsunehiko IkedaDepartment of Ophthalmology, Osaka Medical College, Takatsuki, JapanPurpose: To report the short-term efficacy and safety of the transfer of an Ahmed™ glaucoma valve (AGV™ tube from the vitreous into the anterior chamber, in a patient with neovascular glaucoma who had undergone pars plana AGV™ implantation and ultimately needed a silicone oil tamponade.Case: A 41-year-old male with proliferative diabetic retinopathy in both eyes was referred to us for treatment in December 2009. Although the patient previously underwent several surgeries, he ultimately lost vision in his right eye. His left eye suffered from neovascular glaucoma after undergoing a pars plana vitrectomy for tractional retinal detachment. After several vitreous and glaucoma surgeries, the patient underwent implantation of a pars plana AGV™. Postoperatively, although his intraocular pressure was stabilized at approximately 10 mmHg, he had repeated vitreous hemorrhage and hyphema without improvement. He ultimately underwent PPV with a silicone oil tamponade and at the same time, the AGV™ tube was pulled out from the vitreous and inserted into the anterior chamber in order to avoid complications caused by the silicone oil.Results: At 19 months postoperative, the patient’s intraocular pressure had stabilized at 10 mmHg with no recurrence of vitreous hemorrhage and hyphema. Eventually, he lost vision in his left eye because of cerebral hemorrhage.Conclusion: The findings show that insertion of a pars plana AGV™ tube into the anterior chamber in a patient undergoing a silicone oil tamponade is both effective and safe in the short-term.Keyword: tube implantation, glaucoma surgery, tube transfer, pars plana, proliferative diabetic retinopathy, intraocular pressure

  2. Study on the Effect of Uterine Tamponade Balloon Catheter in the Treatment of Postpartum Hemorrhage%子宫填塞球囊导管治疗产后出血的效果研究

    Institute of Scientific and Technical Information of China (English)

    朱丽秋

    2015-01-01

    目的:研究产后出血应用子宫填塞球囊导管治疗的临床疗效。方法选取我院2013年6月~2014年6月间收治的产后出血患者49例,研究组采取子宫填塞球囊导管治疗,对照组采取子宫腔纱布填塞法治疗,对比两组治疗效果。结果研究组治疗时间与操作时间相对较短,预后良好,两组治疗效果差异显著,有统计学意义(P<0.05)。结论产后出血应用子宫填塞球囊导管治疗操作简便、出血量少、效果良好。%Objective Clinical effect of uterine tamponade balloon catheter in treatment of postpartum hemorrhage is to be studied.MethodsChoose 49 patients of postpartum hemorrhage who are treated in hospital from June 2013 to June 2014 and separate them into two groups, patients in study group are given uterine tamponade balloon catheter treatment and patients in control group are given intrauterine gauze packing treatment and then compare treatment effects between two groups.Results Compared to control group, patients’ treatment time and treatment operation time in study group are relatively shorter with much more favorable prognosis, there is a treatment differential between two groups and such a differential has statistic value (P<0.05). Conclusion Uterine tamponade balloon catheter is easy to operate in treatment of postpartum hemorrhage and it is conducive to reducing hemorrhage with favorable effect.

  3. 凝血酶盐水纱带宫腔填塞治疗产后出血%Intrauterine Tamponade with Thrombin Brine Cotton Tape for the Treatment of Postpartum Hemorrhage

    Institute of Scientific and Technical Information of China (English)

    张安美

    2013-01-01

      目的观察凝血酶盐水纱带宫腔填塞治疗产后出血(PPH)的疗效。方法选择我院2010年6月~2012年11月收治的12例剖宫产术中出血的产妇,施行凝血酶盐水纱带宫腔填塞止血,观测宫底高度和阴道出血情况。结果经宫腔填塞纱布治疗后,子宫收缩良好,术后按压子宫,经阴道观察均有少量出血,无隐性出血发生。结论凝血酶盐水纱带宫腔填塞是治疗产后出血的有效方法。%Objective To observe the effect of intrauterine tamponade with thrombin brine cotton tape for the treatment of postpartum hemorrhage(PPH).Methods Twelve cases of PPH who underwent cesarean section in our hospital from June 2010 to November 2012 were selected,intrauterine tamponade with thrombin brine cotton tape was used,the height of fundus and vaginal bleeding were observated .Results After treatment with filling gauze into uterine cavity,uterine contractions was good .After postoperative compressions,there was a small amount of bleeding by uterine transvaginal observation and recessive hemorrhage did not occurred .Conclusion Intrauterine tamponade with thrombin brine cotton tape is an effective method for the treatment of postpartum hemorrhage .

  4. 心脏介入术中并发急性心脏压塞的抢救与护理%Rescue and Nursing Care of Acute Cardiac Tamponade During Cardiovascular Interventional Operation

    Institute of Scientific and Technical Information of China (English)

    唐丽春; 景颖颖

    2013-01-01

    Objective Explore intraoperative cardiac interventional treatment of emergency treatment of acute cardiac tamponade, illness observation and nursing measures. Methods Back in January 2010-December 2012 in our hospital cardiac interventional therapy in 5 cases were complicated with acute cardiac tamponade emergency treatment, observation and nursing of patients. Results This case due to the timely discovery, correct treatment and careful nursing, were recovered from hospital. Conclusion The emergency nurses preoperative interventional treatment on heart ready for work;patients with intraoperative, postoperative close observation of vital signs, consciousness and condition change, early detection of disease premonitory symptoms, the treatment success has played an important role in patients with acute cardiac tamponade.%目的:探讨心脏介入治疗术中并发急性心脏压塞的急救治疗、病情观察及护理措施。方法回顾2010年1月至2012年12月在我院心脏介入治疗术中5例并发急性心脏压塞患者的急救、观察与护理。结果本组病例由于及时发现、正确救治和精心护理,均痊愈出院。结论护士在心脏介入治疗术前做好各项急救准备工作;术中、术后严密观察患者的生命体征、神志及病情变化,及早发现疾病的先兆症状,在成功救治急性心脏压塞患者中发挥了重要的作用。

  5. Dispnéia por compressão de estruturas mediastinais por cisto pericárdico Dyspnea through compression of mediastinal structures due to pericardial cyst

    Directory of Open Access Journals (Sweden)

    Jeanine Eggers Caramori

    2005-06-01

    Full Text Available Caso de uma paciente com 65 anos, apresentando dispnéia aos esforços e dor torácica lateral direita como principais sintomas de um cisto no pericárdio, de aproximadamente 8 cm. Os exames físico, bioquímico e eletrocardiográfico não evidenciaram alterações. O resultado dos exames de radiografia de tórax, tomografia computadorizada e ecocardiograma foi sugestivo de cisto pericádico. Com base nessas evidências clínicas a paciente foi submetida à toracotomia em região torácica lateral direita e realizada excisão completa da massa mediastinal com remissão total dos sintomas.A case of a 65-year-old patient, showing dyspnea to strains and right side pain as main symptoms of an approximately 8 cm cyst in the pericardium. The physical, biochemical and electrocardiographic examinations did not evince any changes. The results from the thoracic radiography, CT scan and echocardiogram suggested pericardial cyst. Based on those clinical evidences, the patient was submitted to a thoracotomy in the right side thoracic region and a complete excision of the mediastinal mass was performed, with complete remission of the symptoms.

  6. Report on the 2nd Florence International Symposium on Advances in Cardiomyopathies: 9th meeting of the European Myocardial and Pericardial Diseases WG of the ESC

    Directory of Open Access Journals (Sweden)

    Franco Cecchi

    2012-12-01

    Full Text Available A bridge between clinical and basic science aiming at cross fertilization, with leading experts presenting alongside junior investigators, is the key feature of the “2nd Florence International Symposium on Advances in Cardiomyopathies” , 9th Meeting of the Myocardial and Pericardial Diseases Working Group of the European Society of Cardiology, which was held in Florence, Italy on 26-­-28th September 2012. Patients with cardiomyopathies, with an estimated 3 per thousand prevalence in the general population, constitute an increasingly large proportion of patients seen by most cardiologists. This class of diseases, which are mostly genetically determined with different transmission modalities, can cause important and often unsolved management problems, despite rapid advances in the field. On the other hand, few other areas of cardiology have seen such an impressive contribution from basic science and translational research to the understanding of their pathophysiology and clinical management. The course was designed to constantly promote close interaction between basic science and clinical practice and highlight the top scientific and translational discoveries in this field in 10 scientific sessions. It was preceded by two mini-­-courses, which included the basic concepts of cardiomyocyte mechanical and electrophysiological properties and mechanisms, how-­-to sessions for clinical diagnosis and management and illustrative case study presentations of different cardiomyopathies.

  7. Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis

    Directory of Open Access Journals (Sweden)

    Nina P. Hofmann

    2016-01-01

    Full Text Available Left ventricular (LV hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM, cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG, echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2, severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%, accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE by cardiac magnetic resonance (CMR. Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease.

  8. 冠脉介入治疗并发急性心脏压塞的急救及护理%Coronary Intervention of Acute Cardiac Tamponade and Emergency Care

    Institute of Scientific and Technical Information of China (English)

    涂雪梅

    2015-01-01

    Objective To study and analyze the coronary artery intervention treatment technique of complicated with cardiac tamponade first aid method and nursing measures. Methods From April 2010 to September 2014 during coronary interventional therapy in 5 patients complicated with cardiac tamponade, to study the treatment result and analysis, summarizes the rescue methods and nursing measures. Results 5 patients through positive and ef ective rescue and care, hospital were recovered. Conclusion Preoperative suf icient emergency preparedness and emergency plans is the precondition of successful rescue; In postoperative close observation, timely and accurate scientific judgment is critical to the success of the rescue; Large amounts of quickly added blood volume and pressure, resist heparin therapy, timely pericardium puncture decompression is cardiac tamponade and ef ective emergency measures; Skil ed first aid skil and implement of first aid measures are the important guarantee of promoting good outcome in patients with cardiac tamponade.%目的:探讨并分析冠状动脉介入治疗术并发心脏压塞的急救方法及护理措施。方法选取我院2010年4月~2014年9月期间接受冠脉介入治疗并发心脏压塞的5例患者,对其治疗结果进行研究和分析,总结抢救方法及护理措施。结果5例患者经过积极有效抢救及护理,均痊愈出院。结论术前充分的应急准备及急救预案是抢救成功的前提;中术术后密切病情观察,及时准确的科学判断是抢救成功的关键;大量快速的补充血容量及升压、抗肝素治疗,及时的心包穿刺减压是心脏压塞有效的急救方法;娴熟的急救技能和各项急救护理措施的落实是促进心脏压塞患者良好转归的重要保证。

  9. Clinical Analysis of Cardiac Tamponade Caused by Interventional Treatment of Cardiovascular%心血管介入性治疗导致心脏压塞的临床分析

    Institute of Scientific and Technical Information of China (English)

    吴孝芳

    2015-01-01

    Objective To investigate the analysis of cardiovascular interventional treatment induced cardiac tamponade, find out the prevention measures.Methods Caused by interventional therapy in 8 patients with cardiovascular methods according to our hospital from 2004 to 2014 cardiac tamponade patients to carry on the research analysis.Results The patients received interventional therapy for cardiovascular patients appeared after the cardiac tamponade in 2 cases is due to cardiac radiofrequency ablation, 2 patients with atrial septal defect, 3 cases by PTCA, 1 cases by the installation of temporary pacemaker, a total of 1 patients died, the other patients were successfully cured. Conclusion Easily lead to cardiac tamponade complications in interventional treatment of cardiovascular, the complication arises because of the unreasonable operation result, needs to carry on the prevention, early discovery and treatment can improve the patient's condition to play. For the treatment of the complications to pericardiocentesis, sometimes also need surgical thoracotomy, on the doctor's experience relatively high requirements.%目的:探讨分析心血管介入性治疗引起的心脏压塞情况,寻找预防措施。方法根据2004至2014年我院的8例心血管介入性治疗引起的心脏压塞患者来进行研究分析。结果患者接受心血管介入性治疗后出现心脏压塞的患者中有2例是因心脏射频消融,2例因房间隔缺损修补术,3例因PTCA,1例因安装临时起搏器,共有1例患者死亡,其余患者均顺利的治愈出院。结论心血管介入性治疗容易引起心脏压塞这种并发症,该并发症的产生是因为操作不合理导致的,需要对其进行预防,尽早的发现和治疗能够对患者的病情起到改善。对该并发症的治疗需采取心包穿刺引流,有时还需要进行开胸手术,对医生的经验要求比较高。

  10. 心周脂肪组织与冠心病及代谢综合征的关系%The relationship of pericardial adipose tissue volume with coronary artery disease and metabolic syndrome

    Institute of Scientific and Technical Information of China (English)

    刘瑛琪; 费军; 刘莉; 刘军华; 王晓非; 郑冬; 张朝利

    2011-01-01

    摘要:目的 探讨心周脂肪组织(pericardial adipose tissue,PAT)容量与冠心病及代谢综合征(metabolic syndrome,MS)的关系.方法 回顾性分析1102例患者的双源CT冠状动脉造影资料,采用平扫图像测定PAT容量.根据代谢危险因素的数量和冠状动脉狭窄程度,将患者分为MS组338例和无MS组764例及≥50%狭窄组492例和<50%狭窄组610例.结果 MS组PAT容量较无MS组明显增多,≥50%狭窄组PAT容量较<50%狭窄组明显增多(P<0.01).随着代谢危险因素数目的增加,PAT容量呈上升趋势,差异有统计学意义(P<0.01).多元回归分析显示,PAT容量与≥50%狭窄(回归系数=17.78,P<0.01)、体重指数(回归系数=7.32,P<0.01)、腹围(回归系数=2.51,P<0.01)和LDL-C(回归系数=16.94,P< 0.05)相关.结论 多层螺旋CT测定PAT容量是提示患者冠心痛和代谢风险的方法 之一.%Objective To study the relationship of volume of pericardial adipose tissue(PAT) with coronary artery disease and metabolic syndrome(MS). Methods The computed tomography angi-ography data of 1102 consecutive patients were analyzed retrospectively. Pericardial adipose tissue volume was measured using non-enhanced image. According to the number of metabolic risk factors and the extent of coronary stenosis,the patients were divided into MS group (n = 338)and non-MS group (w = 764),and ≥50% stenosis group (n = 492)or <50% stenosis group( n = 610). Results Pericardial adipose tissue volume increased significantly in MS group compared with non-MS group. It also increased significantly in ≥50% stenosis group compared with <50% stenosis group. As the number of metabolic risk factors increased, the volume of pericardial adipose tissue increased correspondingly. Multiple regression analysis showed that 2≥50% stenosis (coefficient=17. 78, P < 0. 01) ,BMI(coefficient = 7. 32, P < 0. 01) ,waist circumference(coeffi-cient = 2. 51, P < 0. 01) and LDL-C level(coefficient = 16. 94

  11. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    Directory of Open Access Journals (Sweden)

    Hans A. Reyes

    2016-01-01

    Full Text Available Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

  12. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    Science.gov (United States)

    Islam, Julie; Talebi, Soheila; Cativo, Eder; Mushiyev, Savi; Pekler, Gerald; Visco, Ferdinand

    2016-01-01

    Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

  13. Clinical outcomes of double membrane peeling with or without simultaneous phacoemulsification/gas tamponade for vitreoretinal-interface-associated (VRI) disorders.

    Science.gov (United States)

    Kumar, Kshitiz; Chandnani, Nisha; Raj, Pallavi; Agarwal, Amar

    2016-08-01

    The purpose of this study is to evaluate the clinical outcomes of double membrane (ERM & ILM) peeling and the effect of combined cataract surgery and SF6 gas injection in vitreoretinal interface (VRI) disorders. This is a retrospective interventional study. Seventy-two eyes with idiopathic vitreoretinal interface abnormalities that underwent 23 gauge pars plana vitrectomy with "double stain and double peel" technique were reviewed. SD-OCT was used to classify VRI disorders into following 4 groups: 44 in ERM type, 17 in VMTS type, 7 in macular pseudohole (MPH) type, and 4 in lamellar macular hole (LMH) type. ERM was a common association in all types. Mean preoperative BCVA improved from 0.58 ± 0.14 logMAR to 0.27 ± 0.16 logMAR units (p = 0.001). Mean CFT reduced from 409.17 ± 122.31 µm preoperatively to 277.28 ± 0.16 µm postoperatively (p  0.05). Use of intraocular SF6 gas tamponade did not show any added benefits among the groups (p > 0.05). Improvement in foveal contour was seen in all groups. Simultaneous removal of ILM along with ERM during surgery for VRI disorders helps in restoring normal foveal contour with a favorable visual outcome. Combined cataract extraction or use of intraocular SF6 gas injection does not affect the surgical results.

  14. 心房颤动射频消融术后心包积液的处理及危险因素分析%Incidence,risk factors and management of pericardial effusion post radiofrequency catheter ablation in patients With atrial fibrillations

    Institute of Scientific and Technical Information of China (English)

    陈松文; 刘少稳; 林佳雄; 聂振宁; 齐保振; 陶惠伟; 吴鸿谊; 程宽; 葛均波

    2008-01-01

    目的 探讨心房颤动(房颤)患者导管射频消融术后发生心包积液的处理并分析其相关危险因素.方法 156例房颤患者[男108例,女48例,阵发性房颤114例,平均年龄(57.6±11.3)岁]在三维标测系统及环状标测电极导管指导下行射频消融治疗[包括环肺静脉电隔离、线性消融及(或)碎裂电位消融],记录消融过程、部位、时间等因素,对术后证实出现心包积液的患者根据不同情况(心脏压塞或单纯心包积液)进行不同处理,并门诊随访心脏超声等.对可能影响术后出现单纯心包积液的因素进行分析.结果 所有156例患者均完成肺静脉电隔离,共有16例(10.3%)出现心包积液,其中1例(0.6%)术后即刻出现心脏压塞,予心包穿刺后开胸探查抢救好转,随访18个月无特殊;另15例(9.6%)术后出现少量心包积液但无心脏压塞表现(单纯心包积液组),经保守治疗后好转,其中6例患者的心包积液在术后3个月消失,而另外9例则在术后6个月消失.单因素分析发现,单纯心包积液组与无心包积液组在性别组成(P<0.01)、有无行冠状静脉窦消融(P=0.026)、有无行碎裂电位消融(P=0.037)、有无行上腔静脉消融(P=0.041)等方面差异有统计学意义.Logistic多因素回归分析发现,女性[B=3.594,exp(b)=36.4,95%CI:4.2-312.1,P=0.001]、行冠状静脉窦消融[B=2.419,exp(b)=11.2,95%CI:1.0~124.6,P=0.049]是术后出现单纯心包积液的独立危险因素.结论 房颤射频消融术后心包积液的发生率较高,但绝大部分并不出现心脏压塞,可经保守治疗得到改善,而不需要进一步有创治疗.女性及行冠状静脉窦消融是术后出现单纯心包积液的独立危险因素,房颤射频消融时应谨慎对待该部位的消融,以减少术后心包积液的发生.%Objective Pericardial effusion (PE) is a major complieation of atrial fibriuation ablation(AFB).We analyzed the incidence,risk factors and managements of PE

  15. 子宫填塞球囊导管治疗产后出血10例临床分析%Clinical treatment analysis of uterine tamponade balloon catheter on 10 cases of postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    韩静; 秦永丽

    2014-01-01

    目的:评价子宫填塞球囊导管对治疗产后出血,挽救产妇生命,保留子宫的影响。方法:2013年3-8月收治产后出血患者10例,并完善随访的临床资料及产后康复追踪。结果:10例产后出血治疗成功率100%,无一例子宫切除。结论:子宫球囊填塞是宫缩乏力继发重度产后出血的有效辅助治疗措施,尤其当药物治疗失败时更显其价值。%Objective:To explore the effect of uterine tamponade balloon catheter in the treatment of postpartum hemorrhage, rescuing maternal life,retaining uterine.Methods:10 cases with postpartum hemorrhage were selected from March to August 2013. Follow-up clinical data were completed and postpartum rehabilitation was traced.Results:The treatment success rate of 10 cases of postpartum hemorrhage was 100%.No case was hysterectomy. Conclusion: Uterine tamponade balloon catheter is secondary effective auxiliary treatment for severe postpartum hemorrhage caused by uterine inertia, especially show its value when drug treatment is failure.

  16. Clinical observation on pericardial effusion in patients with lung cancer treated by intrapericardial catheterization and infusion of highly agglutinative staphylococcin and cisplatin%高聚生联合顺铂心包腔内灌注治疗肺癌致心包液的临床观察

    Institute of Scientific and Technical Information of China (English)

    江启安; 周毅得; 程桂娥

    2006-01-01

    Objective: To evaluate the therapeutic efficacy of injecting highly agglutinative staphylococcin (HASL) and cisplatin into pericardial cavity of lung cancer patients with pericardial effusion.Methods: 81 patients were randomized into two groups:45 in the experimental group (HASL and Cisplatin) and 36 in the control group (Cisplatin).At first pericardial effusion was drained out from a intrapericardial catheter and then different drugs were infused,respectively.24 h after perfusion the draining continued again until drainage quantity was less than 30 mL every day.The draining lasted 10-15 days.Results: The response rate was 91.1% for the experimental group and 80.6% for the control group.There was no significant difference between the two groups(P>0.05).The complete remission was 77.8% for the experimental group and 52.8% for the control group,which was statistically significant difference (P<0.05).The adverse effects were myelosuppression and nausea and vomiting,which were 35.6% and 40.0% in the experimental group and 72.2% and 66.7% in the control group,respectively (P<0.01,P<0.05).Conclusion: Injecting HASL and cisplatin into pericardial cavity may be a better way to control pericardial effusion of lung cancer.

  17. Reconstrução arterial com tubo de pericárdio bovino corrugado Arterial reconstruction with crimped bovine pericardial conduit

    Directory of Open Access Journals (Sweden)

    Cláudio A Salles

    1992-06-01

    Full Text Available No período de agosto de 1989 a fevereiro de 1992, 32 pacientes foram submetidos a reconstruções vasculares utilizando-se condutos de pericárdio bovino corrugado preservado em glutaraldeído. A incorporação do principio crimping utilizado nas próteses vasculares sintéticas proporcionou tubos que mantêm sua forma cilíndrica, mesmo quando submetidos a curvaturas. Vinte e nove pacientes (Grupo I eram portadores de doenças da aorta torácica e/ou abdominal, incluindo aneurismas, dissecções agudas, coarctação da aorta e lesão oclusiva aorto-ilíaca. A reconstrução da aorta torácica foi realizada em 25 pacientes (incluindo a substituição da valva aórtica em 10, da aorta abdominal em 2 e aorto-ilíaca em 2. Três pacientes (Grupo II, portadores de cardiopatias congênitas complexas, foram submetidos a reconstrução da via de saída do ventrículo direito em 2 e a operação de Fontan em 1. A mortalidade hospitalar no Grupo I foi 24% (7 pacientes, causada por baixo débito cardíaco em 4, recidiva precoce da dissecção em dois e infecção respiratória em 1. Seis destes óbitos ocorreram em pacientes operados na fase aguda de dissecção aórtica. Não houve nenhum óbito no Grupo II. Houve um óbito tardio no Grupo I devido a complicações metabólicas relacionadas a diabetes e insuficiência renal crônica. Esta experiência clínica inicial registrou um seguimento médico de 16 meses por paciente, com um máximo de 32 meses e não se verificou nenhuma complicação tardia relacionada ao conduto de pericárdio bovino corrugado.From August 1989 to February 1992, 32 patients underwent vascular reconstructions using crimped bovine pericardial conduits processed in glutaraldehyde. The introduction of the crimping process used for synthetic vascular prosthesis provided circular tubes, which retain their shape with bending and avoid kinking. Twenty-nine patients (Group I presented vascular lesions involving the thoracic and

  18. Fatores de risco hospitalar para implante de bioprótese valvar de pericárdio bovino Hospital risk factors for bovine pericardial bioprosthesis valve implantation

    Directory of Open Access Journals (Sweden)

    Mateus W. De Bacco

    2007-08-01

    Full Text Available FUNDAMENTO: Identificação de fatores de risco pré-operatórios na cirurgia cardíaca valvar visa melhor resultado cirúrgico pela possível neutralização de condições relacionadas com morbi-mortalidade aumentada. OBJETIVO: Este estudo objetiva identificar fatores de risco hospitalar em pacientes submetidos a implante de bioprótese de pericárdio bovino. MÉTODOS: Estudo retrospectivo incluindo 703 pacientes consecutivos submetidos a implante de pelo menos uma bioprótese de pericárdio bovino St. Jude Medical-Biocor® de setembro de 1991 a dezembro de 2005 no Instituto de Cardiologia do RS, sendo 392 aórticos, 250 mitrais e 61 mitro-aórticos. Analisadas as características sexo, idade, índice de massa corporal, classe funcional (New York Heart Association - NYHA, fração de ejeção, lesão valvar, hipertensão arterial sistêmica, diabete melito, função renal, arritmias cardíacas, cirurgia cardíaca prévia, revascularização miocárdica, plastia tricúspide e caráter eletivo, de urgência ou de emergência da cirurgia. Desfecho primordial foi mortalidade hospitalar. Utilizou-se regressão logística para examinar relação entre fatores de risco e mortalidade hospitalar. RESULTADOS: Ocorreram 101 (14,3% óbitos hospitalares. Características significativamente relacionadas à mortalidade aumentada foram sexo feminino (p 2,4mg/dl (p=0,004, classe funcional IV (pBACKGROUND: Identification of preoperative heart valve surgery risk factors aim to improve surgical outcomes with the possibility to offset conditions related to increased morbidity and mortality. OBJECTIVE: Intent of this study is to identify hospital risk factors in patients undergoing bovine pericardial bioprosthesis implantation. METHODS: Retrospective study including 703 consecutive patients who underwent implantation of at least one St. Jude Medical-Biocor™ bovine pericardial bioprosthesis between September 1991 and December 2005 at the Rio Grande do Sul

  19. Development of quality of life scale for compulsive position patients after intraocular tamponade%眼内填充术后强迫体位患者生活质量量表的研制

    Institute of Scientific and Technical Information of China (English)

    章莉莉; 王惠琴; 董佩芳; 孙静

    2013-01-01

    Objective To develop a quantifiable scale to assess quality of life for compulsive position patients after intraocular tamponade. Method Study a initial quality of life scale for compulsive position patients after intraocular tamponade after review relevant documents and consulting a professional group. Assess compulsive position patients after intraocular tamponade and 37 cases of non-intraocular tamponade by initial scale on quality of life. Analyze and screen on items of information. Then analyze on exploratory factor. Confirm the beta version of scale has 6 dimensions of social communication, activity of daily living, self-management, emotion, diet quality and social support, including 37 items. Test the reliability and validity of beta version. Result Cronbach's a coefficient of the scale is 0. 929. Split half reliability is 0. 856. Correlation coefficient between all items and factors is 0. 391 - 0. 886. Correlation coefficient between all factors is 0. 068 ~ 0. 642. Correlation coefficient between all factors and the scale is 0. 342 ~0. 842. Related validity with SF -36 is 0. 806. Conclusion Quality of life scale for compulsive position patients after intraocular tamponade has high reliability and validity, which can indicate patients' quality of life sensitively.%目的 制定眼内填充术后强迫体位患者生活质量评定量表.方法 查阅国内外文献,建立专家组,拟定眼内填充术后强迫体位患者生活质量初始量表.应用初始量表对138例眼内填充术后强迫体位患者和37例非眼内填充术后患者进行生活质量测评.对资料进行条目分析和筛选,再进行探索性因子分析,确定量表测试版为社会交往、日常生活能力、自我管理、情绪活动、进食质量和社会支持6个维度,含37条目.检验测试版量表的信度和效度.结果 量表的Cronbach's α系数为0.929,分半信度为0.856;各条目与因子间的相关系数为0.391~0.886,

  20. Application of the three kinds of balloon tamponade methods in emergency of postpartum hemorrhage%三种球囊填塞方法在产后出血急救中的应用比较

    Institute of Scientific and Technical Information of China (English)

    田冬梅; 杨洋; 李华丽

    2012-01-01

    Objective To compare the hemostatic effects of the three balloon tamponade methods(condom balloon,Foley catheter uterine tamponade,Sengstaken-Blakemore tube) in the postpartum hemorrhage. Methods Ninety-two patients were randomly divided into three groups: condoms group (intrauterine tamponade condom, n = 30) , catheter group (intrauterine tamponade Foley catheter balloon, n = 31) , three-chamber two-balloon catheter group ( intrauterine tamponade Sengstaken-Blakemore tube, n = 31 ). The efficacy of the three methods in stopping bleeding was compared. Results The postoperative bleeding volume and operation time were not significantly different among three groups. The time of retention in catheter group and three-cavity two-balloon catheter group was shorter than that in condoms group (P < 0. 05 ). The three-chamber two-balloon catheter was superior to catheter and condoms in monitoring the bleeding. Conclusion Foley catheter and Sengstaken-Blakemore tube have a good first-aid effect in postpartum hemorrhage with simple operation and shorter retention time. The condom balloon could be widely used in the basic hospitals due to the lower cost. The Sengstaken-Blakemore tube in the controllability of hemostasis is superior to condom balloon and Foley catheter.%目的 比较三种球囊填塞(避孕套水囊、Foley导尿管宫腔填塞、Sengstaken-Blakemore管)应用于产后出血中的止血效果. 方法 我们将92例患者随机分为三组:避孕套组(宫腔内填塞避孕套水囊,n =30),导尿管组(宫腔内填塞Foley导尿管气囊,n=31),三腔两囊管组(宫腔内填塞Sengstaken-Blakemore管,n=31).比较三种止血方法的疗效. 结果 三组间出血量、手术时间均无明显差异,但导尿管组和三腔两囊管组在宫腔填塞留置时间方面均短于避孕套组(P<0.05);三腔两囊管组在监测止血效果方面要优于导尿管组及避孕套组. 结论 Foley导尿管与Sengstaken-Blakemore管用于产后吕血急救效果