Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

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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.

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

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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.

Air tamponade of the heart.

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Gołota, Janusz J; Orłowski, Tadeusz; Iwanowicz, Katarzyna; Snarska, Jadwiga

2016-06-01

Pneumopericardium is a rare disease defined as the presence of air or gas in the pericardial sac. Among the etiological factors, the following stand out: chest trauma, barotrauma, air-containing fistulas between the pericardium and the surrounding structures, secondary gas production by microorganisms growing in the pericardial sac, and iatrogenic factors. Until now, spontaneous pneumopericardium has been considered a harmless and temporary state, but a review of clinical cases indicates that the presence of air in the pericardium can lead to cardiac tamponade and life-threatening hemodynamic disturbances. We present the case of an 80-year-old patient with a chronic bronchopericardial fistula, who suffered from a cardiac arrest due to air tamponade of the heart.

Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

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Alaina Brinley

2017-01-01

Full Text Available History of present illness: A 47-year-old female with metastatic breast cancer presented to the Emergency Department with chest pain and shortness of breath. She was hypotensive and her EKG showed sinus tachycardia with low voltage. A bedside ultrasound was performed that detected a pericardial effusion and evidence of cardiac tamponade. The patient’s vitals improved with a fluid bolus and she went emergently to the cardiac catheterization lab for fluoroscopy and echocardiography guided pericardiocentesis. A total of 770 mL of fluid was removed from her pericardial space. Significant findings: The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow. This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s. Discussion: Cardiac tamponade is distinguished from pericardial effusion by right ventricular compression/collapse and hemodynamic instability. Findings can include hypotension, tachycardia, distant heart sounds, and jugular venous distension.3,4 One might also see a plethoric IVC without respiratory variation indicative of elevated right atrial pressures.1 Detection of right ventricular collapse for cardiac tamponade has sensitivities ranging from 48%-100% and specificities ranging from 33%-100%.5 A larger effusion is more likely to lead to cardiac tamponade. However

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

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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)

Pericardial effusion in patients with cancer: outcome with contemporary management strategies.

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Laham, R. J.; Cohen, D. J.; Kuntz, R. E.; Baim, D. S.; Lorell, B. H.; Simons, M.

1996-01-01

OBJECTIVE--To investigate the clinical presentation and current management strategies of pericardial effusion in patients with malignancy. DESIGN--Retrospective single centre, consecutive observational study. SETTING--University hospital. PATIENTS--93 consecutive patients with a past or present diagnosis of cancer and a pericardial effusion, including 50 with a pericardial effusion > 1 cm. RESULTS--Of the 50 patients with pericardial effusions > 1 cm, most had stage 4 cancer (64%), were symptomatic at the time of presentation (74%), and had right atrial collapse (74%). Twenty patients were treated conservatively (without pericardiocentesis) and were less symptomatic (55% v 87%, P = 0.012), had smaller pericardial effusions (1.5 (0.4) v 1.8 (0.5), P = 0.02), and less frequent clinical (10% v 40%, P = 0.02) and echocardiographic evidence of tamponade (40% v 97%, P < 0.001) than the 30 patients treated invasively with initial pericardiocentesis (n = 29) or pericardial window placement (n = 1). Pericardial tamponade requiring repeat pericardiocentesis occurred in 18 (62%) of 29 patients after a median of 7 days. In contrast, only four (20%) of 20 patients in the conservative group progressed to frank clinical tamponade and required pericardiocentesis (P = 0.005 v invasive group). The overall median survival was 2 months with a survival rate at 48 months of 26%. Survival, duration of hospital stay, and hospital charges were similar with both strategies. By multivariable analysis, the absence of symptoms was the only independent predictor of long-term survival (relative hazards ratio = 3.2, P = 0.05). Survival was similar in the 43 patients with cancer and pericardial effusions of < or = 1 cm. CONCLUSION--Asymptomatic patients with cancer and pericardial effusion can be managed conservatively with close follow up. In patients with symptoms or clinical cardiac tamponade, pericardiocentesis provides relief of symptoms but does not improve survival and has a high recurrence

[Primary Malignant Pericardial Mesothelioma;Report of a Case].

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Ichikawa, Seiji; Murakami, Fumihiko; Ogiwara, Hiroaki

2018-02-01

A 69-year-old male was referred to our hospital after being diagnosed as having pericarditis with pericardial effusion. The symptoms of tamponade disappeared after the effusion was drained;although the cause of pericarditis remained unidentified. About 4 months later, the tamponade symptoms recurred due to the thickened nodular pericardium. Partial pericardiectomy was performed, however the patient died on the 52nd day after surgery. Immunohistological examination with calretinin led to the diagnosis of primary malignant pericardial mesothelioma, which was an extremely rare pathology. Because the hyaluronic acid content of the effusion has been reported as a diagnostic aid for malignant mesothelioma, routine examination of the hyaluronic acid content for pericarditis with pericardial effusion may be necessary for early diagnosis and to improve prognosis.

Emergent radiologically guided drainage of large pericardial effusions

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Hartz, W.H.; Gatenby, R.A.; Kessler, H.B.

1987-01-01

The authors drained eight pericardial effusions on an emergency basis because of profound symptoms of pericardial tamponade. The etiology of the pericardial was metastatic disease in all eight cases. US of the subxyphoid region allowed definition of an optimal percutaneous approach. The pericardium was initially punctured with a 22-gauge needle, followed by tract dilation over a wire, which allowed ultimate placement of either an 8.4-F or 10-F nephrostomy catheter. Some 500 - 1,500 ml of bloody fluid drained from the pericardial space within minutes, and a total of 2 - 4 L over the next 4 days. No significant arrhythmias or immediate hypotensive episodes were observed. Six of the patients were successfully treated with sclerosis of the pericardium by injection of tetracyline into the pericardial catheter before it was removed. No recurrent effusions have been observed in any of these patients. Two patients died, one of unsuspected cerebral edema and uncal herniation and one of intractable congestive heart failure. At autopsy, the pericardial catheter was properly positioned with no significant remaining fluid. Echocardiograms were falsely normal in two patients, but CT findings were uniformly diagnostic. Radiologically guided drainage of large pericardial effusions appears to be a safe and effective technique for the treatment of pericardial tamponade from metastatic effusions. This technique is an alternative to the usual surgical intervention and does not require general anesthesia

Cardiac tamponade as the initial manifestation of pulmonary adenocarcinoma

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Letonja, M.; Debeljak, A.

2007-01-01

Background. Neoplastic pericarditis can be presented as acute pericarditis, pericardial effusion, effusive constrictive pericarditis or cardiac tamponade. For the majority of patients, a clinical manifestation of neoplastic pericarditis is absent or remains unrecognised during their life. Case report: A 69-year-old non-smoking woman with acute dyspnoea, tachycardia, jugular venous distension, hepatomegaly and right side pleural effusion was presented in the emergency department. The roentgen picture of the chest confirmed pleural effusion and revealed enlarged heart. An emergency echocardiogram established the diagnosis of cardiac tamponade. The patient improved immediately after the therapeutic pericardiocentesis. Cytology of pericardial fluid confirmed malignant glandular cells, consistent with metastatic adenocarcinoma. A computed chest tomography showed a right side pleural effusion and a solitary round lesion in the right lower lobe of the lung. Bronchoscopy with fundoscopic lung biopsy and brushing revealed adenocarcinoma. Cardiac tamponade as the initial manifestation of malignancy is rare and rare is also malignant pericardial effusion due the adenocarcinoma of the lung in a non-smoking woman. The presented patient had one of the longest survival reported in literature despite a limited life expectancy regardless of the treatment in the patient presented with neoplastic pericarditis. (author)

Effectiveness of computed tomography attenuation values in characterization of pericardial effusion.

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Çetin, Mehmet Serkan; Özcan Çetin, Elif Hande; Özdemir, Mustafa; Topaloğlu, Serkan; Aras, Dursun; Temizhan, Ahmet; Aydoğdu, Sinan

2017-04-01

The aim of this study was to evaluate the effectiveness of computed tomography (CT) attenuation values in the characterization of pericardial effusion. This study consisted of 96 patients with pericardial effusion who underwent pericardiocentesis. For further diagnostic evaluation of pericardial effusion, all the patients were assessed by thorax CT. CT attenuation values were measured from at least 5 different areas of pericardial fluid by specifying the largest region of interest. The average of these measurements was computed and considered as the CT attenuation value of the patient. The patients were classified into two groups: patients with transudative pericardial effusion and those with exudative pericardial effusion. CT attenuation values were significantly higher in patients with exudative pericardial effusion than in those with transudative pericardial effusion [14.85±10.7 Hounsfield unit (HU) vs. 1.13±4.3 HU, peffusion. In addition, a cut-off value of 6.5 HU had 71.4% sensitivity and 72.3% specificity for the prediction of cardiac tamponade. In patients with pericardial effusion, CT attenuation values seem to be correlated with the characterization parameters of the fluid and may distinguish exudative pericardial effusion from transudative pericardial effusion. This parameter was also found to be a predictor of cardiac tamponade. CT attenuation values can be a useful tool in the clinical evaluation of patients with pericardial effusion.

Cardiac tamponade as an initial manifestation of systemic lupus erythematosus.

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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.

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

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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

A case of anti-Jo1 myositis with pleural effusions and pericardial tamponade developing after exposure to a fermented Kombucha beverage.

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Derk, Chris T; Sandorfi, Nora; Curtis, Mark T

2004-08-01

The pathogenesis of the idiopathic inflammatory myopathies has been postulated to be an environmental trigger causing the expression of the disease in a genetically predisposed patient. We report a case of anti-Jo1 antibody-positive myositis which was associated with pleural effusions, pericardial effusion with tamponade, and 'mechanic's hands', probably related to the consumption of a fermented Kombucha beverage. Kombucha 'mushroom', a symbiosis of yeast and bacteria, is postulated to be the trigger for our patient's disease owing to the proximity of his symptoms to the consumption of the Kombucha beverage.

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

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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.

Pericardial effusion complicated by tamponade: a case report

African Journals Online (AJOL)

compress the heart (cardiac tamponade) and cause circulatory ... Pitting lower limb oedema up to the knees. ... and early diagnosis and treatment of TB pericarditis may prevent this ... suspicion. In the absence of an alternative diagnosis,.

Sub-acute Tamponade and the Value of Point-of-Care Ultrasound for Rapid Diagnosis: A Case Report

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Daniel C. Kolinsky

2017-07-01

Full Text Available Minoxidil is a strong oral vasodilator that is used to treat patients with hypertension refractory to first-line medications. We report a case of minoxidil-associated subacute cardiac tamponade diagnosed by point-of-care ultrasound (POCUS in a hypertensive patient. A 30-year-old male with a past medical history of poorly controlled hypertension (treated with minoxidil and chronic kidney disease presented with 2–3 days of chest pain and shortness of breath with markedly elevated blood pressures. A point-of-care transthoracic echocardiogram revealed a massive pericardial effusion with sonographic tamponade physiology. We review the risk factors for developing pericardial effusions that progress to cardiac tamponade, the utility of diagnosing these patients by POCUS, and the incidence of patients who present with sonographic signs of cardiac tamponade without hypotension.

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

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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.

CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery.

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Nour-Eldin, Nour-Eldin Abdelrehim; Alsubhi, Mohammed; Gruber-Rouh, Tatjana; Vogl, Thomas J; Kaltenbach, Benjamin; Soliman, Hazem Hamed; Hassan, Wael Eman; Abolyazid, Sherif Maher; Naguib, Nagy N

2017-08-01

This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery. The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF) effusion was 260 ml (range 80-900 ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40-55% (mean: 45%; SD: ±5; p effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.

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

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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. PMID:27517082

Myxedema coma with cardiac tamponade and severe cardiomyopathy

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Majid-Moosa, Abdulla; Schussler, Jeffrey M.; Mora, Adan

2015-01-01

Myxedema coma is an infrequent but potentially fatal complication of hypothyroidism. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Here, we focus on cardiovascular complications associated with the condition.

Myxedema coma with cardiac tamponade and severe cardiomyopathy.

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Majid-Moosa, Abdulla; Schussler, Jeffrey M; Mora, Adan

2015-10-01

Myxedema coma is an infrequent but potentially fatal complication of hypothyroidism. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Here, we focus on cardiovascular complications associated with the condition.

Case Roport: Pericardial tamponade and coexisting pulmonary ...

African Journals Online (AJOL)

This report describes a case of a patient, who presented with this association, due to an underlying pulmonary adenocarcinoma. When a major pericardial effusion is associated with pulmonary hypertension, some echocardiographic signs may redress the diagnosis. This case emphasizes a challenge diagnostic which may ...

An unusual case of cardiac tamponade following electrical cardioversion

NARCIS (Netherlands)

Jessurun, GAJ; Crijns, HJGM; vanWijngaarden, J

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.

Untying the Gordian knot of pericardial diseases: A pragmatic approach

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George Lazaros

2016-09-01

Full Text Available Pericardial disorders constitute a relatively common cause of heart disease. Although acute pericarditis, especially the idiopathic forms that are the most prevalent, is considered a benign disease overall, its short- and long-term complications, namely, recurrent pericarditis, cardiac tamponade and constrictive pericarditis, constitute a matter of concern in the medical community. In recent years, several clinical trials contributed to redefining our traditional approach to pericardial diseases. In this review, we provide the most recent evidence concerning diagnosis, treatment modalities and short- and long-term prognosis of the most common pericardial disorders.

Emergency room thoracotomy for acute traumatic cardiac tamponade caused by a blunt cardiac injury: A case report

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Kenichiro Ishida

2017-01-01

Conclusion: A prompt diagnosis using FAST and treatment can be lifesaving in traumatic acute cardiac tamponade. A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space.

Presumed hydrochlorothiazide-associated immunologic-hypersensitivity-induced pericardial effusion

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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.

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

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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.

Large pericardial effusion induced by minoxidil.

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Çilingiroğlu, Mehmet; Akkuş, Nuri; Sethi, Salil; Modi, Kalgi A

2012-04-01

A 53-year-old male admitted with increased shortness of breath. In the physical examination, he had dyspnea, tachycardia and tachypnea. An echocardiogram showed large pericardial effusion (PE) as well as significant pulmonary hypertension. He had been started recently on minoxidil for blood pressure control. PE was reported to occur with minoxidil treatment both in patients undergoing dialysis and those with normal renal function. Pulmonary hypertension has been reported to affect the cardiac tamponade physiology. Because of significant pulmonary hypertension in our patient, a right heart catheterization was also done, which prevented cardiac tamponade. He was treated conservatively without any intervention, and PE resolved spontaneously after discontinuation of minoxidil.

Patient with Small Cell Lung Carcinoma and Suspected Right Upper Lobe Abscess Presenting with a Purulent Pericardial Effusion.

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Goel, Khushboo; Ateeli, Huthayfa; Ampel, Neil M; L'heureux, Dena

2016-07-22

BACKGROUND Cardiac tamponade caused by pericardial effusion has a high mortality rate; thus, it is important to diagnose and treat this condition immediately. Specifically, bacterial pericarditis, although now very rare, is often fatal because of its fulminant process. CASE REPORT We present a case of a 61-year-old man with metastatic small cell lung cancer undergoing chemotherapy who presented with fatigue, poor appetite, and altered mental status. He was found to have a large-volume pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis. The pericardial effusion was nonmalignant, with cultures growing Streptococcus pneumoniae. It was only after his emergent pericardiocentesis that previous imaging from one month prior was able to be reviewed, which showed possible right upper lobe abscess. CONCLUSIONS Most pericardial effusions in cancer patients are related to their malignancy, either due to direct metastasis or secondary physiologic effects. This case is a unique example of a lung cancer patient presenting with a pneumococcal pericardial effusion, which in itself is a rare phenomenon. This case report demonstrates the importance of considering early antibiotic therapy in patients presenting with pericardial effusion, especially given the high mortality rates of infectious pericardial effusions.

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

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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).

External radiotherapy in the management of malignant pericardial effusion

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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).

A young woman with fever and a pericardial effusion

NARCIS (Netherlands)

Muntinghe, Friso; De Filippi,; Breedveld,; Halma,

2002-01-01

A 19-year-old woman is presented with high-spiking fever, pericardial tamponade and respiratory failure. A diagnosis of adult onset Still's disease was made. This is a rare inflammatory disease with an unknown aetiology. The diagnosis is made by exclusion and with the help of diagnostic criteria.

Acute pericarditis with cardiac tamponade induced by pacemaker implantation.

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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. © The Author(s) 2014.

Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

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Sylvia Biso

2017-01-01

Full Text Available 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.

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

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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.

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.

1982-01-01

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

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

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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.

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

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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.

Pericardial effusion following cardiac surgery. A single-center experience.

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Nguyen, Hien Sinh; Nguyen, Hung Doan-Thai; Vu, Thang Duc

2018-01-01

Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m 2 , preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.

Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion

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Stephen M McHugh

2015-01-01

Full Text Available Transesophageal echocardiography (TEE is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28-year-old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed.

Pericarditis and pericardial effusion: management update.

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Sparano, Dina M; Ward, R Parker

2011-12-01

Prompt recognition of the signs and symptoms of pericardial disease is critical so that appropriate treatments can be initiated. Acute pericarditis has a classical presentation, including symptoms, physical examination findings, and electrocardiography abnormalities. Early recognition of acute pericarditis will avoid unnecessary invasive testing and prompt therapies that provide rapid symptom relief. Non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line therapy for uncomplicated acute pericarditis, although colchicine can be used concomitantly with NSAIDS as the first-line approach, particularly in severely symptomatic cases. Colchicine should be used in all refractory cases and as initial therapy in all recurrences. Aspirin should replace NSAIDS in pericarditis complicating acute myocardial infarction. Systemic corticosteroids can be used in refractory cases or in those with immune-mediated etiologies, although generally should be avoided due to a higher risk of recurrence. Pericardial effusions have many etiologies and the approach to diagnosis and therapy depends on clinical presentation. Pericardial tamponade is a life-threatening clinical diagnosis made on physical examination and supported by characteristic findings on diagnostic testing. Prompt diagnosis and management is critical. Treatment consists of urgent pericardial fluid drainage with a pericardial drain left in place for several days to help prevent acute recurrence. Analysis of pericardial fluid should be performed in all cases as it may provide clues to etiology. Consultation of cardiac surgery for pericardial window should be considered in recurrent cases and may be the first-line approach to malignant effusions, although acute relief of hemodynamic compromise must not be delayed. Constrictive pericarditis is associated with symptoms that mimic many other cardiac conditions. Thus, correct diagnosis is critical and involves identification of pericardial thickening or calcification in

A case of tuberculous pericardial effusion

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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.

Thoracentesis-reverting cardiac tamponade physiology in a patient with myxedema coma and large pleural effusion.

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Werlang, Monia E; Pimentel, Mario R; Diaz-Gomez, Jose L

2017-07-01

A large pleural effusion causing cardiac tamponade physiology and severe hemodynamic compromise is an uncommon event. We report a case of a 53-year-old woman with severe hypothyroidism presenting with myxedema coma and refractory shock. Her hemodynamic status failed to respond to fluid resuscitation and vasopressors. A transthoracic echocardiogram and chest radiograph demonstrated a pericardial fluid accumulation associated with a large left-sided pleural effusion. Thoracostomy tube insertion resulted in prompt improvement of the patient's hemodynamic status. Our finding demonstrates that a large pleural effusion may play an important role in cardiac tamponade physiology.

Cardiac tamponade as a manifestation of extrapulmonary tuberculosis in β thalassemia major patient

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Harahap, S.; Pramudita, A.; Lusiani

2018-03-01

Cardiac tamponade is a medical emergency condition. Rapid diagnosis and determination of the etiology with epidemiologic consideration may lead to earlier treatment and improved survival. Occasionally, the etiology may be clearly related to a recognized underlying disease, but the possibility of unrelated etiologies should be considered. Pericarditis tuberculosis, a rare manifestation of extrapulmonary tuberculosis in a non-HIV patient, has to be deliberate as one of the etiology, especially in the endemic area. Here, we report a case of 28 years old male with β thalassemia major presented with excessive exertion breathlessness progressing to orthopnea. Sign of cardiac tamponade was identified from echocardiography which showed large pericardial effusion with swinging heart and right atrial systolic collapse. Pericardiocentesis was performed immediately, drained 870 ml of hemorrhagic fluid from inserted pigtail. The patient was treated with the anti-tuberculosis regimen and oral corticosteroid after real-time polymerase chain reaction of Mycobacterium tuberculosis positivity in pericardial fluid. MRI T2 confirmed no haemosiderosis in patient’s heart. After treatment, the patient responded well and showed clinical improvement.

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

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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.

Empress Sissi and cardiac tamponade: an historical perspective.

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Meyer, Philippe; Keller, Pierre-Frédéric; Spodick, David H

2008-11-01

On September 10, 1898, Empress Elizabeth of Austria, known as Sissi, was stabbed with a stiletto knife in her chest by an Italian anarchist in Geneva, Switzerland, and died 1 hour later. The autopsy revealed a large clot in the pericardial sac due to a perforation of the left ventricular wall, and the report concluded, "Death was undoubtedly caused by a progressive and slow blood leak, sufficient to compress the heart and to suspend its functions." Since antiquity, wounds of the heart had been considered immediately fatal, until Paré observed a delayed death after a stab to the heart in the 16th century. The physiology of cardiac tamponade was then elucidated by Richard Lower in 1669. However, it was only in the 19th century that the main clinical features of cardiac tamponade were described and the first treatments attempted. Kussmaul identified its most important clinical hallmark, pulsus paradoxus, in 1873 and the term "tamponade of the heart" was coined for the first time by Rose in 1884. Romero and Larrey pioneered the open drainage of the pericardium early in the century, and Rehn performed the first successful surgical suture of a heart wound in 1896. In conclusion, logistics aside, medical knowledge at the end of the 19th century would have been theoretically sufficient to save the empress from death.

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

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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.

Video-assisted thoracoscopic pericardial window placement for radiation pericarditis induced by definitive chemoradiotherapy in a patient with thoracic esophageal carcinoma

International Nuclear Information System (INIS)

Hisakura, Katsuji; Terashima, Hideo; Nagai, Kentaro; Nozaki, Reiji; Akashi, Yoshimasa; Tadano, Sosuke; Ohkohchi, Nobuhiro

2007-01-01

We report surgical management of radiation-induced massive pericardial effusion. A 55-year-old man undergoing definitive chemoradiotherapy (CRT) for esophageal squamous cell carcinoma in the middle thorax was treated with megavoltage equipment using anterior-posterior opposed fields up to 45 Gy, including the primary tumor and regional lymphnodes. A booster dose of 25 Gy was given to the primary tumor for a total dose of 70 Gy, using bilateral oblique fields. Three years and 6 months later, he was treated with an additional 30 Gy for mediastinal lymphnode metastasis, followed by percutaneous pericardiocentesis for cardiac tamponade with massive pericardial effusion 4 times in 5 months. Because medical intervention was inadequate, he underwent pericardial effusion via video-assisted thoracoscopic pericardial window placement 4 years and 6 months after definitive CRT. Histopathological examination of the pericardial tissue specimen showed marked fibrosis but no cancer recurrence, compatible with radiation pericarditis. The postoperative course was uneventful, and pericardial effusion completely disappeared. (author)

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.)

The bowed catheter sign: a risk for pericardial tamponade

International Nuclear Information System (INIS)

Towbin, Richard

2008-01-01

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.)

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

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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.

1984-01-01

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

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

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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)

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

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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.)

PERICARDIAL MESOTHELIOMA WITH THROMBOVASCULAR COMPLICATIONS (CASE FROM PRACTICE

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N. Yu. Karpova

2017-01-01

Full Text Available Primary mesothelioma of the pericardium is a rare heart tumor with a difficult diagnosis, revealed in vivo in less than a quarter of cases. The disease occurs at any age, more common in men and variably exhibits a broad spectrum of non-specific symptoms of congestive heart failure, constrictive pericarditis, pericardial effusion or cardiac tamponade. Patients are usually observed with peripheral edema, ascites, dyspnea, cough, chest pain and atrial fibrillation. Such symptoms, in the absence of cancer alertness, are erroneously attributed by doctors to more common cardiovascular diseases. As a result, primary mesothelioma is detected in 75-90% of cases only at necropsy. The article describes a case of detection at autopsy of primary pericardial mesothelioma sarcomatous type with invasion into the myocardium in a patient of 74 years old. The patient also suffered from concomitant coronary artery disease with a long history of chronic heart failure and recurrent pulmonary embolism, associated with deep vein thrombosis at the final stage of the disease. An objective study revealed signs of chronic heart failure. The laboratory data included mild iron deficiency anemia, insignificant leukocytosis and leukocyturia, as well as signs of moderate chronic kidney disease. Instrumental results corresponded to long-term course of hypertension, signs of congestive heart failure in the presence of atrial fibrillation, atherosclerosis of lower limbs arteries in patient with abdominal obesity. Thus, there were no clinical signs of pericardial damage in a standard examination of the patient. The article describes the complexity of the disease diagnosis, variable clinical picture, as well as the diagnostic value of various instrumental methods from the perspective of evidence-based medicine. It is noted that clinical alertness is still the most important factor in the lifetime diagnosis of pericardial mesothelioma. Disease should be considered in patients with

Contemporary management of pericardial effusion: practical aspects for clinical practice.

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Imazio, Massimo; Gaido, Luca; Battaglia, Alberto; Gaita, Fiorenzo

2017-03-01

A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.

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

International Nuclear Information System (INIS)

Gulati, G.S.; Sharma, S.

2004-01-01

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

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

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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

Cardiovascular magnetic resonance in pericardial diseases

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Francone Marco

2009-05-01

Full Text Available Abstract The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases; in developed countries a shift for instance in the epidemiology of constrictive pericarditis has been noted. Accurate decision making is crucial taking into account the significant morbidity and mortality caused by complicated pericardial diseases, and the potential benefit of therapeutic interventions. Imaging herein has an important role, and cardiovascular magnetic resonance (CMR is definitely one of the most versatile modalities to study the pericardium. It fuses excellent anatomic detail and tissue characterization with accurate evaluation of cardiac function and assessment of the haemodynamic consequences of pericardial constraint on cardiac filling. This review focuses on the current state of knowledge how CMR can be used to study the most common pericardial diseases.

Getting to the heart of hypopituitarism.

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Martin-Grace, Julie; Ahmed, Mohamed; Mulvihill, Niall; Feeney, Eoin R; Crowley, Rachel K

2017-04-01

A 53-year-old woman was diagnosed with hypopituitarism following an acute presentation with cardiac tamponade and hyponatraemia, having recently been investigated for a pericardial effusion. Secondary hypothyroidism is a rare cause of pericardial effusion and tamponade, but an important differential to consider. Management requires appropriate hormone replacement and, critically, a low threshold for commencing stress dose steroids. Clinical signs classically associated with cardiac tamponade are frequently absent in cases of tamponade due to primary and secondary hypothyroidism, and the relatively volume deplete state of secondary hypoadrenalism in hypopituitarism may further mask an evolving tamponade, as the rise in right atrial pressure is less marked even in the presence of large effusion. Our case demonstrates the importance of a high index of suspicion for cardiac tamponade in this patient cohort, even in the absence of clinical signs, and for measuring both thyroid-stimulating hormone and thyroxine levels when evaluating a pericardial effusion. © Royal College of Physicians 2017. All rights reserved.

Air Versus Sulfur Hexafluoride Gas Tamponade in Descemet Membrane Endothelial Keratoplasty: A Fellow Eye Comparison.

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von Marchtaler, Philipp V; Weller, Julia M; Kruse, Friedrich E; Tourtas, Theofilos

2018-01-01

To perform a fellow eye comparison of outcomes and complications when using air or sulfur hexafluoride (SF6) gas as a tamponade in Descemet membrane endothelial keratoplasty (DMEK). One hundred thirty-six eyes of 68 consecutive patients who underwent uneventful DMEK in both eyes for Fuchs endothelial corneal dystrophy were included in this retrospective study. Inclusion criteria were air tamponade (80% of the anterior chamber volume) in the first eye and 20% SF6 gas tamponade (80% of the anterior chamber volume) in the second eye; and same donor tissue culture condition in both eyes. All eyes received laser iridotomy on the day before DMEK. Main outcome measures included preoperative and postoperative best-corrected visual acuity, endothelial cell density, corneal volume, rebubbling rate, and rate of postoperative pupillary block caused by the air/gas bubble. Thirteen of 68 eyes (19.1%) with an air tamponade needed rebubbling compared with 4 of 68 eyes (5.9%) with an SF6 gas tamponade (P = 0.036). Postoperative pupillary block necessitating partial release of air/gas occurred in 1 eye (1.5%) with an air tamponade and 3 eyes (4.4%) with an SF6 gas tamponade (P = 0.301). There were no significant differences in preoperative and postoperative best-corrected visual acuity, endothelial cell density, and corneal volume within 3-month follow-up. Our results confirm the previously reported better graft adhesion when using an SF6 gas tamponade in DMEK without increased endothelial cell toxicity. The rate of pupillary block in eyes with an SF6 gas tamponade was comparable to that with an air tamponade. As a consequence, we recommend using SF6 gas as the tamponade in DMEK.

Prolonged pericardial drainage using a soft drain reduces pericardial effusion and need for additional pericardial drainage following orthotopic heart transplantation.

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Kim, Yun Seok; Jung, Sung-Ho; Cho, Won Chul; Yun, Sung-Cheol; Park, Jeong-Jun; Yun, Tae-Jin; Kim, Jae-Joong; Lee, Jae Won

2016-03-01

Pericardial effusion can cause haemodynamic compromise after heart transplantation. We identified the effects of soft drains on the development of pericardial effusion. We enrolled 250 patients ≥17 years of age who underwent heart transplantation between July 1999 and April 2012 and received two conventional tubes (n = 96; 32 French), or two tubes with a soft drain (n = 154; 4.8 mm wide). The development of significant pericardial effusion or the need for drainage procedure during 1 month after heart transplantation was compared with the use of the propensity score matching method to adjust for selection bias. At 1 month after transplantation, 69 patients (27.6%) developed significant pericardial effusion. Among these, 13 patients (5.2%) underwent pericardial drainage. According to multivariate analysis, history of previous cardiac surgery [odds ratio (OR) = 0.162; 95% confidence interval (CI) = 0.046-0.565; P = 0.004] and placement of a soft drain (OR = 0.186; 95% CI = 0.100-0.346; P effusion or the need for drainage during the early postoperative period. For the 82 propensity score matched pairs, patients receiving an additional soft drain were at a lower risk of the development of significant pericardial effusion or the need for a pericardial drainage procedure during 1 month (OR = 0.148; 95% CI = 0.068-0.318; P effusion and decreases the need for pericardial drainage after heart transplantation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Derrame pericárdico con inminente taponamiento cardiaco secundario a inhibidor de la tirosina quinasa: Reporte de un caso Pericardial effusion secondary to tyrosine kinase inhibitor with imminence of cardiac tamponade: case report

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Andrés F Buitrago

2011-04-01

Full Text Available La leucemia es una enfermedad maligna que se caracteriza por una proliferación no controlada de una clona iniciada en una etapa precoz de la diferenciación linfoide. Es importante determinar si hay una alteración genética conocida como cromosoma Filadelfia, para pronóstico y tratamiento. El imatinib, un inhibidor de la tirosina kinasa, tiene buena respuesta terapéutica y pocos efectos adversos. Uno de frecuente aparición es la serositis manifestada como derrame pleural, aunque es de menor incidencia asociada con derrame pericárdico. El tratamiento se debe individualizar, pero en caso de inminente taponamiento cardiaco se realiza pericardiocentesis.Leukemia is a malignant disease characterized by uncontrolled proliferation of a clone initiated at an early stage of lymphoid differentiation. It is important to determine if there is a genetic disorder known as the Philadelphia chromosome, for both prognosis and treatment. Imatinib, a tyrosine kinase inhibitor has good therapeutic response and few adverse effects. An adverse event is the frequent occurrence of serositis manifested as pleural effusion, but its association with pericardial effusion has a lower incidence. Treatment should be individualized, but in case of imminent cardiac tamponade pericardiocentesis is performed.

Pericardial Parietal Mesothelial Cells: Source of the Angiotensin-Converting-Enzyme of the Bovine Pericardial Fluid

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Ilsione Ribeiro de Sousa Filho

Full Text Available Abstract Background: Angiotensin II (Ang II, the primary effector hormone of the renin-angiotensin system (RAS, acts systemically or locally, being produced by the action of angiotensin-converting-enzyme (ACE on angiotensin I. Although several tissue RASs, such as cardiac RAS, have been described, little is known about the presence of an RAS in the pericardial fluid and its possible sources. Locally produced Ang II has paracrine and autocrine effects, inducing left ventricular hypertrophy, fibrosis, heart failure and cardiac dysfunction. Because of the difficulties inherent in human pericardial fluid collection, appropriate experimental models are useful to obtain data regarding the characteristics of the pericardial fluid and surrounding tissues. Objectives: To evidence the presence of constituents of the Ang II production paths in bovine pericardial fluid and parietal pericardium. Methods: Albumin-free crude extracts of bovine pericardial fluid, immunoprecipitated with anti-ACE antibody, were submitted to electrophoresis (SDS-PAGE and gels stained with coomassie blue. Duplicates of gels were probed with anti-ACE antibody. In the pericardial membranes, ACE was detected by use of immunofluorescence. Results: Immunodetection on nitrocellulose membranes showed a 146-KDa ACE isoform in the bovine pericardial fluid. On the pericardial membrane sections, ACE was immunolocalized in the mesothelial layer. Conclusions: The ACE isoform in the bovine pericardial fluid and parietal pericardium should account at least partially for the production of Ang II in the pericardial space, and should be considered when assessing the cardiac RAS.

Contemporary management of pericardial diseases.

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Imazio, Massimo

2012-05-01

Pericardial diseases are relatively common in clinical practice, either as isolated disease or as manifestation of a systemic disorder. The aim of the present study is to review more recent updates on their contemporary management. The cause of pericardial diseases is varied according to the epidemiologic background, patient population, and clinical setting. Most cases remain idiopathic, and empiric anti-inflammatory therapy should be considered as first-line therapy in most cases with the possible adjunct of colchicine in the setting of inflammatory pericardial diseases, especially relapsing or not responding to first-line drugs. A triage has been proposed to select high-risk cases requiring admission and specific cause search. The prognosis of pericardial diseases is essentially determined by the cause. The most feared complication is constriction, the risk of which is higher in bacterial forms, intermediate for postpericardiotomy syndromes and systemic inflammatory diseases, low for viral and idiopathic cases. Chronic constriction has a definite surgical therapy, whereas transient cases should be recognized and may be reversible with empirical anti-inflammatory therapy. Contemporary management of pericardial diseases is largely empirical, although first clinical trials and new studies on diagnostic modalities and prognosis of pericardial diseases are bringing the contemporary management of pericardial diseases along a more evidence-based road. Integrated cardiovascular imaging is required for optimal management of the patient with suspected pericardial disease.

Right ventricular hydatid cyst ruptured to pericardium

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Feridoun Sabzi

2015-01-01

Full Text Available Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

Echocardiography: pericardial thickening and constrictive pericarditis.

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Schnittger, I; Bowden, R E; Abrams, J; Popp, R L

1978-09-01

A total of 167 patients with pericardial thickening noted on M node echocardiography were studied retrospectively. After the echocardiogram, 72 patients underwent cardiac surgery, cardiac catheterization or autopsy for various heart diseases; 96 patients had none of these procedures. In 49 patients the pericardium was directly visualized at surgery or autopsy; 76 percent of these had pericardial thickening or adhesions. In another 8 percent, pericardial adhesions were absent, but no comment had been made about the appearance of the pericardium itself. In the remaining 16 percent, no comment had been made about the pericardium or percardial space. Cardiac catheterization in 64 patients revealed 24 with hemodynamic findings of constrictive pericarditis or effusive constrictive disease. Seven echocardiographic patterns consistent with pericardial adhesions or pericardial thickening are described and related when possible to the subsequent findings at heart surgery or autopsy. The clinical diagnoses of 167 patients with pericardial thickening are presented. The hemodynamic diagnosis of constrictive pericardial disease was associated with the echocardiographic finding of pericardial thickening, but there were no consistent echocardiographic patterns of pericardial thickening diagnostic of constriction. However, certain other echocardiographic abnormalities of left ventricular posterior wall motion and interventricular septal motion and a high E-Fo slope were suggestive of constriction.

MRI and intraocular tamponade media

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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.)

MRI and intraocular tamponade media

International Nuclear Information System (INIS)

Manfre, I.; Fabbri, G.; Avitabile, T.; Biondi, P.; Reibaldi, A.; Pero, G.

1993-01-01

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.)

Nasopharyngeal carcinoma with pericardial metastasis

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Shang-Wen Chen

2011-07-01

Full Text Available Nasopharyngeal carcinoma (NPC is prevalent in Taiwan and is characterized by a high frequency of nodal metastasis. The most common organs with distal metastases are the bones, lungs, and liver, with extremely rare cases to the pericardium. Herein, we report a rare case with NPC who presented with dyspnea and orthopnea. Serial studies, including pericardial biopsy, revealed NPC with pericardial metastasis and pericardial effusion. The tumor cells of both the original and metastatic tumors were positive for Epstein–Barr virus by in situ hybridization. This is the first histologically confirmed case of NPC with pericardial metastasis.

A Case of Low-Grade Primary Cardiac Lymphoma with Pericardial Effusion Diagnosed by Combined 18F-Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) Imaging and Effusion Cytology.

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Fukunaga, Hisanori; Tatewaki, Yasuko; Mutoh, Tatsushi; Shimomura, Hideo; Yamamoto, Shuzo; Terao, Chiaki; Totsune, Tomoko; Nakagawa, Manabu; Taki, Yasuyuki

2018-03-14

BACKGROUND Primary cardiac lymphoma is rare and can be an aggressive disease, depending on the grade. A case is reported of low-grade primary cardiac lymphoma associated with a pericardial effusion. 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) imaging was useful in the diagnosis and in evaluating the disease activity in this case. CASE REPORT A 72-year-old Japanese woman visited a general practitioner, complaining of dyspnea associated with cardiac tamponade. Pericardiocentesis was performed, and Group V malignant cells were identified by cytology, suspicious for malignant lymphoma. Whole-body FDG-PET/CT scans showed no pleural effusion or lymph node metastasis supporting the diagnosis of primary cardiac lymphoma diagnosed on pericardial effusion. The laboratory investigations showed that levels of serum soluble interleukin-2 (IL-2) receptor (sIL-2R), a diagnostic and prognostic marker for malignant lymphoma, were not elevated (258 U/ml). A six-month follow-up FDG-PET/CT scan showed an increased volume of the pericardial effusion and mild but abnormal uptake diffusely in the pericardial space, and the sIL-2R was slightly elevated (860 U/ml). No abnormal FDG accumulation outside the retained pericardial effusion was noted, which was compatible with a clinical picture of low-grade primary cardiac lymphoma, and in a period of watchful waiting during the first two years later, the sIL-2R had reduced to 195 U/ml. CONCLUSIONS This is a rare case of low-grade primary cardiac lymphoma detected in a pericardial effusion, and highlights the utility of the FDG-PET/CT scan as a valuable diagnostic and follow-up modality.

Pericardial effusion and pericardial compartments after open heart surgery

International Nuclear Information System (INIS)

Duvernoy, O.; Larsson, S.G.; Persson, K.; Thuren, J.; Wikstroem, G.; Akademiska Sjukhuset, Uppsala; Akademiska Sjukhuset, Uppsala

1990-01-01

Thirty-three patients with pericardial effusion after open heart surgery were investigated with computed tomography (CT). Twelve of the 33 patients also underwent echocardiography prior to pericardiocentesis. The effusions were typed according to the results of the CT investigation. Because of postoperative adhesions, typical patterns of localized pericardial effusions were found in 16 patients. The localized compartments were seen on the right and left side of the heart and around the aorta and the pulmonary artery. CT was therefore shown to be of value for selecting the approach for drainage with catheter pericardiocentesis. (orig.)

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

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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

Primary pericardial mesothelioma: a case report

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Kobayashi, Yuko; Murakami, Ryusuke; Ogura, Junko; Yamamoto, Kanae; Ichikawa, Taro [Dept. of Radiology, Tama-Nagayama Hospital, Tokyo (Japan); Nagasawa, Kouichi [Dept. of Internal Medicine, Tama-Nagayama Hospital, Tokyo (Japan); Hosone, Masaru [Dept. of Pathology, Tama-Nagayama Hospital, Tokyo (Japan); Kumazaki, Tatsuo [Dept. of Radiology, Nippon Medical School, Tokyo (Japan)

2001-11-01

The imaging features of primary pericardial mesothelioma have rarely been described. Herein we present a case report of its diagnostic-pathologic features. Chest computed tomography (CT) revealed an irregularly enhanced mass occupying the entire pericardial space and surrounding the superior vena cava. At autopsy, the tumor was found to fill the pericardial space completely, and to extend to the superior vena cava through the superior pericardial sinus. The CT features of the tumor were correlated well with those revealed at autopsy, and provided satisfactory information regarding the presence and the extension of the tumor. (orig.)

Imaging of pericardial lymphangioma

International Nuclear Information System (INIS)

Zakaria, Rania H; Barsoum, Nadine R; El-Basmy, Ayman A; El-Kaffas, Sameh H

2011-01-01

Pericardial cystic lymphangioma is a developmental malformation of the lymphatic system. We report a case of cystic pericardial lymphangioma in the anterior mediastinum in a 1-year-old male child. The lesion was diagnosed with multidetector computed tomography and magnetic resonance imaging (MRI). Histopathological examination showed features of cystic lymphangioma

Pericardial Effusion as a Presenting Symptom of Hashimoto Thyroiditis: A Case Report

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Alberto Leonardi

2017-12-01

administered dose. The treatment was successful because a complete regression of the effusion after one month was evidenced, with a substantial modification towards normality of the thyroid function tests. One year later, the substitutive therapy led to complete normalization of the thyroid function indexes. A slight reduction of weight (BMI, 17.60 for age and an increase of the velocity of height growth were evidenced. Conclusions: When fluid is identified in the pericardial space and pericarditis of unknown origin is diagnosed, the thyroid function should be immediately evaluated to prescribe substitutive hormonal therapy if necessary and thereby avoid overt hypothyroidism development and the risk of cardiac tamponade.

Pericardial Effusion as a Presenting Symptom of Hashimoto Thyroiditis: A Case Report.

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Leonardi, Alberto; Penta, Laura; Cofini, Marta; Lanciotti, Lucia; Principi, Nicola; Esposito, Susanna

2017-12-14

. The treatment was successful because a complete regression of the effusion after one month was evidenced, with a substantial modification towards normality of the thyroid function tests. One year later, the substitutive therapy led to complete normalization of the thyroid function indexes. A slight reduction of weight (BMI, 17.60 for age) and an increase of the velocity of height growth were evidenced. Conclusions : When fluid is identified in the pericardial space and pericarditis of unknown origin is diagnosed, the thyroid function should be immediately evaluated to prescribe substitutive hormonal therapy if necessary and thereby avoid overt hypothyroidism development and the risk of cardiac tamponade.

Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions.

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Horr, Samuel E; Mentias, Amgad; Houghtaling, Penny L; Toth, Andrew J; Blackstone, Eugene H; Johnston, Douglas R; Klein, Allan L

2017-09-01

Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient

Air versus gas tamponade in retinal detachment surgery

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Tan, H. Stevie; Oberstein, Sarit Y. Lesnik; Mura, Marco; Bijl, Heico M.

2013-01-01

Objective To compare the outcome of air tamponade with gas tamponade in primary vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). Methods We examined the records of 524 cases of 523 patients that underwent primary vitrectomy for RRD with air or sulphur hexafluoride 20% gas

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.

Neoplastic pericardial disease. Analysis of 26 patients

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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.

Novel "CHASER" pathway for the management of pericardial disease.

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Argulian, Edgar; Halpern, Dan G; Aziz, Emad F; Uretsky, Seth; Chaudhry, Farooq; Herzog, Eyal

2011-06-01

The diagnosis and management of pericardial disease are very challenging for clinicians. The evidence base in this field is relatively scarce compared with other disease entities in cardiology. In this article, we outline a unified, stepwise pathway-based approach for the management of pericardial disease. We used the "CHASER" acronym to define the entry points into the pathway. These include chest pain, hypotension or arrest, shortness of breath, echocardiographic or other imaging finding of pericardial effusion, and right-predominant heart failure. We propose a score for the assessment of pericardial effusion that is composed of the following 3 parameters: the etiology of the effusion, the size of the effusion, and the echocardiographic assessment of hemodynamic parameters. The score is applied to clinically stable patients with pericardial effusion to quantify the necessity of pericardial effusion drainage. A stepwise, pathway-based approach to the management of pericardial disease is intended to provide guidance for clinicians in decision-making and a patient-tailored evidence-based approach to medical and surgical therapy for pericardial disease. The pathway for the management of pericardial disease is the ninth project to be incorporated into the "Advanced Cardiac Admission Program" at Saint Luke's Roosevelt Hospital Center of Columbia University in New York. Further studies should focus on the validation of the feasibility, efficacy, and reliability of this pathway.

Pericardial effusion in pulmonary arterial hypertension

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2013-01-01

Abstract Pulmonary arterial hypertension (PAH) is a serious condition that can lead to right heart failure and death. Pericardial effusion in PAH is associated with significant morbidity and mortality, and its pathogenesis is complex and poorly understood. There are few data on the prevalence of pericardial effusion in PAH, and more importantly, the management of pericardial effusion is controversial. Current literature abounds with case reports, case series, and retrospective studies that have limited value for assessing this association. Hence, we summarize the available evidence on this ominous association and identify areas for future research. PMID:24618534

Chylous pericardial effusion after pulmonary lobectomy.

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Yang, Weixiong; Luo, Canqiao; Liu, Zhenguo; Cheng, Chao

2017-07-01

Chylous pericardial effusion is a rarely reported complication of lung cancer surgery. Here, we report a case of an elderly man who suffered chylous pericardial effusion after radical right upper lung resection for cancer. The massive chylous effusion first occurred in the pericardium, drained to the right chest after the drainage of the hydropericardium and subsequently moved back to the pericardium again. Lymphoscintigraphy examination indicated that a chylous fistula was present in the plane of the tracheal carina. After failure to control the chylous effusion with conservative medical treatment, the patient underwent video-assisted thoracic surgery through the left chest for thoracic duct ligation and pericardial fenestration. The patient was ultimately discharged without recurrence of the effusion after surgical treatment. This case report discusses the possible mechanism of chylopericardium after lung cancer surgery and suggests some strategies to prevent postoperative chylous pericardial effusion. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy.

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Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Ssemanda, Elizabeth; Ervin, Ann-Margret

2009-10-07

Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery. During surgery, a tamponade agent is needed to reduce the rate of recurrent retinal detachment. The objective of this review was to evaluate the benefits and adverse outcomes of surgery with various tamponade agents. We searched the Cochrane Controlled Register (CENTRAL), MEDLINE, EMBASE, Latin America and Carribbean Health Sciences (LILACS) and the UK Clinical Trials Gateway (UKCTG). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 9 July 2009. We included randomized clinical trials comparing patients treated with various tamponade agents. Two individuals screened the search results independently. One study with two trials was eligible for inclusion in the review. One study with two trials was included in the review. The first trial randomized 151 eyes to receive either silicone oil or sulfur hexafluoride (SF(6)) gas tamponades; the second trial randomized 271 eyes to receive either silicone oil or perfluropropane (C(3)F(8)) gas tamponades. In patients with RD associated with PVR, pars plana vitrectomy and infusion of either silicone oil or perfluropropane gas appear comparable for a broad variety of cases. Sulfur hexafluoride gas was associated with worse anatomic and visual outcomes than either silicone oil or perfluropropane gas. The use of either C(3)F(8) or silicone oil appears reasonable for most patients with RD associated with PVR. Because there do not appear to be any major differences in outcomes between the two agents, the choice of a tamponade agent should be individualized for each patient.

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...

Radiation-related pericarditis

International Nuclear Information System (INIS)

Martin, R.G.; Ruckdeschel, J.C.; Chang, P.; Byhardt, R.; Bouchard, R.J.; Wiernik, P.H.

1975-01-01

To determine the incidence of pericardial effusion in patients undergoing upper mantle radiation therapy, 81 patients with Hodgkin's disease, stages I to IIIB, were selected from a protocol series of 98 patients. Twenty-four patients (29.6 percent) met X-ray criteria for the presence of pericardial effusion. Eleven of the 24 also underwent right heart catheterization to confirm the presence of pericardial effusion and to define any hemodynamic abnormality. Fourteen patients were found to have transient effusion. Five of the 11 patients have had partial pericardiectomy for symptoms and signs of cardiac tamponade. There has been no evidence of recurrent Hodgkin's disease in these surgically treated patients. Ninety-two percent of the pericardial effusions occurred in the first 12 months after the end of radiation therapy. Therapeutic implications depend on elucidation of the natural history of this process. At present close follow-up is necessary with surgical intervention for signs or symptoms of cardiac tamponade

Computed tomography in the diagnosis of pericardial heart disease

International Nuclear Information System (INIS)

Isner, J.M.; Carter, B.L.; Bankoff, M.S.; Konstam, M.A.; Salem, D.N.

1982-01-01

To evaluate the use of computed tomography (CT) in the diagnosis of pericardial heart disease, 53 patients were prospectively studied by computed tomography of the chest and cardiac ultrasound. A diagnostic-quality CT study was done for all patients; a technically satisfactory ultrasound examination was not possible in six patients. Of 47 patients in whom both chest scans and satisfactory ultrasound studies were obtained, computed tomography showed pericardial thickening not shown by ultrasound in five patients. Estimated size of pericardial effusion was the same for both computed tomography and ultrasound. Computed tomography provided quantifiable evaluation of the composition of pericardial fluid in seven patients with either hemopericardium or purulent pericarditis. Neoplastic pericardial heart disease was detected by CT scan in four of the 53 patients. Computed tomography of the chest provides a sensitive evaluation of the pericardium and quality of pericardial effusion, and is a valuable adjunct in patients in whom cardiac ultrasound is technically unsatisfactory

Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results

International Nuclear Information System (INIS)

Taylor, Andrew M.; Dymarkowski, Steven; Bogaert, Jan; Verbeken, Eric K.

2006-01-01

To examine the value of late-enhancement cardiac magnetic resonance imaging (MRI) for detection of pericardial inflammation. Late-enhancement cardiac MRI was performed in 16 patients with clinical suspicion of pericardial disease. Pericardial effusion, pericardial thickening and pericardial enhancement were assessed. MRI findings were compared with those of definitive pericardial histology (n=14) or microbiology (n=2). A control group of 12 patients with no clinical evidence of pericardial disease were also imaged with the same MRI protocol. Sensitivity and specificity for late-enhancement MRI detection of pericardial inflammation was of 100%. There was MRI late enhancement of the pericardial layers in all five patients with histological/microbiological evidence of inflammatory pericarditis. MRI demonstrated no pericardial thickening and no MRI late enhancement with or without a pericardial effusion in any of the five patients with histological evidence of a normal pericardium. MRI detected pericardial thickening in the absence of both pericardial effusion and late enhancement in all six patients with histological evidence of chronic fibrosing pericarditis. The 12 control subjects showed no evidence of pericardial MRI late enhancement. These findings demonstrate that MRI late enhancement can be used to visualize pericardial inflammation in patients with clinical suspicion of pericardial disease. (orig.)

MRI Findings of Pericardial Fat Necrosis: Case Report

International Nuclear Information System (INIS)

Lee, Hyo Hyeok; Ryu, Dae Shick; Jung, Sang Sig; Jung, Seung Mun; Choi, Soo Jung; Shin, Dae Hee

2011-01-01

Pericardial fat necrosis is an infrequent cause of acute chest pain and this can mimic acute myocardial infarction and acute pericarditis. We describe here a patient with the magnetic resonance imaging (MRI) findings of pericardial fat necrosis and this was correlated with the computed tomography (CT) findings. The MRI findings may be helpful for distinguishing pericardial fat necrosis from other causes of acute chest pain and from the fat-containing tumors in the cardiophrenic space of the anterior mediastinum.

PERICARDIAL FEATURES OF IN-HOSPITAL RHEUMATOLOGY PATIENTS: AN OBSERVATIONAL STUDY.

Science.gov (United States)

Bakalli, Aurora; Rexhepi, Mjellma; Rexhepi, Blerta; Koçinaj, Dardan

Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. The aim of this observational study was to evaluate pericardial features in patients with different rheumatic diseases. Thirty-five patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fluid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an inflammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial effusion in a small amount was present in 57.1% of patients, with a mean pericardial fluid amount of 3.3 ± 1.9 mm. The severity of rheumatic disease had a positive and significant correlation with the presence of pericardial effusion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). The patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent finding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of effusion. The disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue.

Oral bacterial DNA findings in pericardial fluid

Directory of Open Access Journals (Sweden)

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.

Predictors of Pericardial Effusion in Patients Undergoing Pulmonary Artery Banding.

Science.gov (United States)

Noma, Mio; Matsubara, Muneaki; Tokunaga, Chiho; Nakajima, Tomomi; Mathis, Bryan James; Sakamoto, Hiroaki; Hiramatsu, Yuji

2018-03-01

Although pulmonary artery banding (PAB) is a common palliative procedure for pediatric heart malformation, there are concerns of pressure overload and concomitant immune reactions in the right ventricle causing postsurgical complications such as pericardial effusion. At this time, no clear guidelines as to potential risk factors or procedural contraindications have been widely disseminated. Therefore, a study was undertaken to examine wide-ranging factors to find potential biomarkers for postsurgical pericardial effusion formation risk. A retrospective study was conducted on all cardiac surgeries performed over an eight-year period, and the main inclusion criterion was pericardial effusion development after PAB that required surgical drainage. Nine cases were then analyzed against a control group of 45 cases with respect to body measurements, concomitant surgeries, genetic screens, laboratory tests results, and cardiac function parameters. Trisomy 21 was strongly associated with the development of severe pericardial effusion after PAB, and postoperative serum albumin levels in patients with trisomy 21 were associated with pericardial effusion development. Other parameters showed no significant correlation with pericardial effusion development. Our data indicate a strong association between trisomy 21 and pericardial effusion requiring drainage after PAB, which is in line with translational research findings. Pressure overload from PAB may play a role in the formation of severe pericardial effusion that is exacerbated by cardiac structural defects commonly associated with trisomy 21. Surgical teams should therefore use caution and plan to implement drainage in PAB cases, and postoperative serum albumin may serve as a useful biomarker for pericardial effusion formation.

Cardiac and pericardial calcifications on chest radiographs

Energy Technology Data Exchange (ETDEWEB)

Ferguson, E.C., E-mail: ecferguson@hotmail.co [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Section of Thoracic Imaging, Houston, TX 77030 (United States); Berkowitz, E.A. [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Section of Thoracic Imaging, Houston, TX 77030 (United States)

2010-09-15

Many types of cardiac and pericardial calcifications identified on chest radiographs can be recognized and distinguished based on characteristic locations and appearances. The purpose of this review is to emphasize the importance of detecting cardiac and pericardial calcifications on chest radiographs, and to illustrate and describe the various types of calcifications that may be encountered and how they may be differentiated from one another. Each type of cardiac and pericardial calcification is discussed, its location and appearance described, and its significance explained. Recognizing and understanding these calcifications is important as they are often encountered in daily practice and play an important role in patient care.

Radiation-related pericardial effusions in patients with Hodgkin's disease

International Nuclear Information System (INIS)

Ruckdeschel, J.C.; Chang, P.; Martin, R.G.; Byhardt, R.W.; O'Connell, M.J.; Sutherland, J.C.; Wiernik, P.H.

1975-01-01

Pericardial effusions following radiotherapy for Hodgkins Disease have previously been described as infrequent and related to the total dose of radiation received. Analysis of all chest x-rays on 81 patients who received upper-mantle radiotherapy for Hodgkins Disease at the Baltimore Cancer Research Center between 1968 and 1972 disclosed an incidence of pericardial effusions of 30.9% (25 of 81), with 13.6% (11 of 81) requiring limitation of activity (5) or pericardiectomy (6). Clinical presentation of radiation-related pericardial effusions was subtle, with signs and symptoms a late finding if they occurred. Radiotherapy data was reviewed and no difference in total dose (rads) or time-dose relationships (rets) was found between the groups who did or did not develop effusions. Analysis of multiple pre-treatment clinical and pathological characteristics disclosed four parameters that were felt to be related to the development of pericardial effusions; elevated ESR, normal absolute lymphocyte count, initial presence of extensive mediastinal adenopathy and the addition of adjuvant chemotherapy. The presence of increasing combinations of these pretreatment 'risk factors' led to an increasing likelihood of developing a radiation-related pericardial effusion such that six of seven patients with all four 'risk factors' developed a pericardial effusion. Nine of 13 clinically significanteffusions were associated with the addition of adjuvant chemotherapy. Possible pathogenetic mechanisms that include factors other than radiation dosage and the clinical management of radiation-related pericardial effusions are discussed

Raised international normalized ratio: an early warning for a late cardiac tamponade?

NARCIS (Netherlands)

Shah, Ammad; van den Brink, Albert; de Mol, Bas

2006-01-01

Seven consecutive cases of late cardiac tamponade after valvular surgery are reported; all were postoperatively treated with acenocoumarol and 6 had an international normalized ratio peak greater than 6.0 within 3 days preceding tamponade. It is suggested that during this excessive anticoagulation

Acute tamponade alters subendo- and subepicardial pressure-flow relations differently during vasodilation.

Science.gov (United States)

Kingma, J G; Martin, J; Rouleau, J R

1994-07-01

Instantaneous diastolic left coronary artery pressure-flow relations (PFR) shift during acute tamponade as pressure surrounding the heart increases. Coronary pressure at zero flow (Pf = 0) on the linear portion of the PFR is the weighted mean of the different myocardial waterfall pressures, the distribution of which varies across the left ventricular wall during diastole. However, instantaneous PFR measured in large epicardial coronary arteries cannot be used to estimate Pf = 0 in the different myocardial tissue layers. During coronary vasodilatation in a capacitance-free model, myocardial PFR differs from subendocardium to subepicardium. Therefore, we studied the effects of acute tamponade during maximal pharmacology induced coronary vasodilatation on myocardial PFR in in situ anesthetized dogs. Tamponade reduced cardiac output, aortic pressure, and coronary blood flow. Results demonstrate that different mechanisms influence distribution of myocardial blood flow during tamponade. Subepicardial vascular resistance is unchanged and the extrapolated Pf = 0 is increased, thereby shifting PFR to a higher intercept on the pressure axis. Subendocardial vascular resistance is increased while the extrapolated Pf = 0 remains unchanged. Results indicate that in the setting of acute tamponade with coronary vasodilatation different mechanisms regulate the distribution of myocardial blood flow: in the subepicardium only outflow pressure increases, whereas in the subendocardium only vascular resistance increases.

ebb® Complete Tamponade System: effective hemostasis for postpartum hemorrhage

Directory of Open Access Journals (Sweden)

McQuivey RW

2018-03-01

Full Text Available Ross W McQuivey,1 Jon E Block,2 Robert A Massaro3 1Clinical Innovations, Salt Lake City, UT, USA; 2Independent Clinical Consultant, San Francisco, CA, USA; 3Monmouth Medical Center, Long Branch, NJ, USA Abstract: As a leading cause of maternal death, postpartum hemorrhage (PPH remains a worldwide obstetrical problem. However, in most cases, mortality and morbidity can be averted if efforts are immediately undertaken to achieve hemostasis. Uterine balloon tamponade has been shown to provide effective control of PPH and avoid more invasive surgical procedures and even the emergency peripartum hysterectomy. Recent clinical recommendation suggests that balloon tamponade should be considered earlier in the treatment cascade in conjunction with uterotonic agents to ensure hemostasis in the most timely fashion and maximize clinical outcomes. This paper profiles the ebb® Complete Tamponade System, a unique dual-balloon single-use device that was developed specifically for hemostatic management of PPH. The ebb system combines a uterine conforming balloon that can be rapidly deployed with a vaginal balloon that eliminates the need for vaginal packing. The description, indications for use, procedural steps, and clinical characterization of this device are presented. Keywords: postpartum hemorrhage, balloon tamponade, hemostasis, maternal bleeding

A different management of saphenous vein graft failure related to cardiac tamponade following coronary surgery

Directory of Open Access Journals (Sweden)

Hamit Serdar Başbuğ

2016-03-01

Full Text Available Cardiac tamponade is a state of constriction of the heart with an excessive fluid or hematoma resulted from various conditions. Postoperative tamponade can occur after coronary bypass surgery. Despite it is uncommon, its results may have a high risk of mortality and morbidity. Acute postoperative cardiac tamponade reveals a vast spectrum of symptoms. Moreover, a compression over the saphenous vein graft is the worst complication that should be managed without delay. We report a rare case of saphenous vein graft failure due to the cardiac tamponade following a coronary surgery and its management with a practical measure.

PCR evaluation of selected vector-borne pathogens in dogs with pericardial effusion.

Science.gov (United States)

Tabar, M-D; Movilla, R; Serrano, L; Altet, L; Francino, O; Roura, X

2018-04-01

To investigate evidence for selected vector-borne pathogen infections in dogs with pericardial effusion living in a Mediterranean area in which several canine vector-borne diseases are endemic. Archived EDTA blood (n=68) and pericardial fluid samples (n=58) from dogs with pericardial effusion (n=68) were included. Dogs without pericardial effusion examined for other reasons were included as controls (n=60). Pericardial effusion was classified as neoplastic in 40 dogs, idiopathic in 23 dogs and of unknown aetiology in 5 dogs. Real-time PCR was performed for Leishmania infantum, Ehrlichia/Anaplasma species, Hepatozoon canis, Babesia species, Rickettsia species and Bartonella species, and sequencing of PCR products from positive samples was used to confirm species specificity. Vector-borne pathogens were found in 18 dogs: 16 of 68 dogs with pericardial effusion (23·5%) and two of 60 control dogs (3·3%). Positive dogs demonstrated DNA of Leishmania infantum (n=7), Anaplasma platys (n=2, one dog coinfected with Leishmania infantum), Babesia canis (n=5), Babesia gibsoni (n=3) and Hepatozoon canis (n=2). Vector-borne pathogens were more commonly detected among dogs with pericardial effusion than controls (P=0·001). There was no relationship between aetiology of the pericardial effusion and evidence of vector-borne pathogens (P=0·932). Vector-borne pathogens are often detected in dogs with pericardial effusion and require further investigation, especially in dogs with idiopathic pericardial effusion. PCR can provide additional information about the potential role of vector-borne pathogens in dogs with pericardial effusion living in endemic areas. © 2018 British Small Animal Veterinary Association.

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,

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.

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

NARCIS (Netherlands)

Harskamp, Ralf E.; Meuzelaar, Jacobus J.

2010-01-01

Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagnosis was delayed because of

Evaluation of pleural and pericardial effusions by magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Tscholakoff, D.; Sechtem, U.; De Geer, G.; Schmidt, H.; Higgins, C.B.

1987-08-01

MR examinations of 36 patients with pleural and/or pericardial effusions were retrospectively evaluated. The purpose of this study was to determine of MR imaging is capable of differentiating between pleural and pericardial effusions of different compositions using standard electrocardiogram (ECG)-gated and nongated spin echo pulse sequences. Additional data was obtained from experimental pleural effusions in 10 dogs. The results of this study indicate that old haemorhages into the pleural or pericardial space can be differentiated from other pleural or pericardial effusions. However, further differentiation between transudates, exudates and sanguinous effusions is not possible on MR images acquired with standard spin echo pulse sequences. (orig./MG)

Aortic reconstruction with bovine pericardial grafts

Directory of Open Access Journals (Sweden)

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.

How to diagnose cardiac tamponade

NARCIS (Netherlands)

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

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

Percutaneous removal of a pacing electrode

International Nuclear Information System (INIS)

Hoehne, U.; Schild, H.; Hake, U.

1989-01-01

The large number of pace-makers introduced transvenously has resulted in increasing the number of complications, amongst which infections and dislocations are prominent. It is usually necessary to remove the electrode, which can be attempted percutaneously by using a Dormia basket, a loop or forceps. Amongst the complications of this procedure are tears to the myocardium, with the risk of pericardial tamponade, or tears of the tricuspid valve leading to tricuspid insufficiency. Consequently, thoracic surgical intervention should be available if necessary. Four successful procedures are described. (orig.) [de

A randomized trial of early versus delayed mediastinal drain removal after cardiac surgery using silastic and conventional tubes

Science.gov (United States)

Moss, Emmanuel; Miller, Corey S.; Jensen, Henrik; Basmadjian, Arsène; Bouchard, Denis; Carrier, Michel; Perrault, Louis P.; Cartier, Raymond; Pellerin, Michel; Demers, Philippe

2013-01-01

OBJECTIVES Mediastinal drainage following cardiac surgery with traditional large-bore plastic tubes can be painful and cumbersome. This study was designed to determine whether prolonged drainage (5 days) with a silastic tube decreased the incidence of significant pericardial effusion and tamponade following aortic or valvular surgery. METHODS One hundred and fifty patients undergoing valvular or aortic surgery in a tertiary cardiac surgery institution were randomized to receive a conventional mediastinal tube plus a silastic Blake drain (n = 75), or two conventional tubes (n = 75). Conventional drains were removed on postoperative day (POD) 1, while Blake drains were removed on POD 5. The primary end-point was the combined incidence of significant pericardial effusion (≥15 mm) or tamponade through POD 5. Secondary end-points included total mediastinal drainage, postoperative atrial fibrillation (AF) and pain. RESULTS Analysis was performed for 67 patients in the Blake group and 73 in the conventional group. There was no difference between the two groups in the combined end-point of significant effusion or tamponade (7.4 vs 8.3%, P = 0.74), or in the incidence of AF (47 vs 46%, P = 0.89). Mean 24-h drainage was greater in the Blake group than in the conventional group (749 ± 444 ml vs 645 ± 618 ml, P tubes is safe and does not increase postoperative pain. There was no difference between the Blake and conventional drains with regard to significant pericardial effusion or tamponade in this cohort; however, this conclusion is limited by the low overall incidence of the primary outcome in this cohort. PMID:23575759

A case of diminished pericardial effusion after treatment of a giant hepatic cyst.

Science.gov (United States)

Okano, Hiroshi; Tochio, Tomomasa; Kumazawa, Hiroaki; Isono, Yoshiaki; Tanaka, Hiroki; Matsusaki, Shimpei; Sase, Tomohiro; Saito, Tomonori; Mukai, Katsumi; Nishimura, Akira; Kitamura, Tetsuya; Mori, Takuya

2017-08-01

A 75-year-old woman was discovered to have a pericardial effusion when she was admitted to our hospital because of a giant hepatic cyst. We could not detect the cause of the effusion and diagnosed idiopathic pericardial effusion. The patient underwent transcutaneous drainage of the hepatic cyst and an injection of antibiotics. There was no communication between the pericardial effusion and the hepatic cyst. Although the hepatic cyst was reduced in size, the pericardial effusion showed no remarkable change immediately after treatment; however, 5 months later, the pericardial effusion was found to be diminished. The pericardial effusion might have been caused by the physical pressure of the giant hepatic cyst and disturbance in the balance between the production and reabsorption of the pericardial fluid. When we experience a huge hepatic cyst, we should take into account its influence against the surrounding organs, including the intrapleural space.

Pericardial sinuses and recesses effusion of 16-slice helical CT imaging and anatomic correlation

International Nuclear Information System (INIS)

Lu Chunyan; Yang Zhigang; Zhou Xiangping; Yu Jianqun; Zhu Jie; Yang Kaiqing

2007-01-01

Objective: To evaluate the CT features and implications of the pericardial sinuses and recesses effusion by combining the sectional cadavers and 16 multi-slice CT (MSCT) reformation. Methods: The anatomy and communication of the pericardial sinuses and recesses on the axial, coronal and saggital sectional cadavers (respectively 1 case), and the morphologic features on MSCT reformatted images in 104 patients were observed. The detection rate of effusion was analyzed. Results: The sectional cadavers and CT images showed that the pericardial sinuses and recesses were formed by the reflections of the pericardium on the root of the great vessels. The detection rate of the sinuses and recesses was lower in small effusion than in moderate and large effusion (P<0.05). The superior aortic recess was the most common recess for pericardial effusion. Conclusion: The MSCT reformatted images can show the morphologic features of pericardial sinuses and recesses effusion and communications with the pericardial cavity, help differentiate pericardial effusion from other mediastinal or pericardial lesions. (authors)

Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis.

Science.gov (United States)

Meng, Bo; Zhao, Lu; Yin, Yi; Li, Hongyang; Wang, Xiaolei; Yang, Xiufen; You, Ran; Wang, Jialin; Zhang, Youjing; Wang, Hui; Du, Ran; Wang, Ningli; Zhan, Siyan; Wang, Yanling

2017-09-08

Myopic foveoschisis (MF) is among the leading causes of visual loss in high myopia. However, it remains controversial whether internal limiting membrane (ILM) peeling or gas tamponade is necessary treatment option for MF. PubMed, EMBASE, CBM, CNKI, WANFANG DATA and VIP databases were systematically reviewed. Outcome indicators were myopic foveoschisis resolution rate, visual acuity improvement and postoperative complications. Nine studies that included 239 eyes were selected. The proportion of resolution of foveoschisis was higher in ILM peeling group than non-ILM peeling group (OR = 2.15, 95% CI: 1.06-4.35; P = 0.03). The proportion of postoperative complications was higher in Tamponade group than non-Tamponade group (OR = 10.81, 95% CI: 1.26-93.02; P = 0.03). However, the proportion of visual acuity improvement (OR = 1.63, 95% CI: 0.56-4.80; P = 0.37) between ILM peeling group and non-ILM peeling group and the proportion of resolution of foveoschisis (OR = 1.80, 95% CI: 0.76-4.28; P = 0.18) between Tamponade group and non-Tamponade group were similar. Vitrectomy with internal limiting membrane peeling could contribute to better resolution of myopic foveoschisis than non-peeling, however it does not significantly influence the proportion of visual acuity improvement and postoperative complications. Vitrectomy with gas tamponade is associated with more complications than non-tamponade and does not significantly influence the proportion of visual acuity improvement and resolution of myopic foveoschisis.

Pericardiocentesis in massive pericardial effusions due to hypothyroidism

Science.gov (United States)

Nainggolan, F. H.; Dalimunthe, N. N.; Harahap, S.; Isnanta, R.; Realsyah, T.; Safri, Z.; Hasan, R.

2018-03-01

Pericardial effusion is the accumulation of abnormal fluid in the pericardial cavity. The symptoms are not specific and associated with the underlying disease. It was reported that a 53-year-old male patient entered the Emergency Room with a shortness of breath, and getting worse during activity and position. There was weight loss and smoking history. The history of diabetic, hypertension and malignancy were denied. On physical examination showed the enlarged right and left heart border and weakened heartbeat sheer off is found and edema pretibial and normal the other. The laboratory results;blood routine, renal and liver function within normal; lipid profile: hypercholesterolemia; viral marker is non-reactive.Rontgen thorax suggests cardiomegaly, but there was no infiltrate or nodules. Electrocardiogram (ECG) showed a low voltage. Echocardiography examination showed massive pericardial effusion. Pericardiosynthetis performed produces 750 cc of clear yellow liquid and showed transudate. Other laboratory tests such as ANA test, anti ds-DNA, cyfra were a normal impression. Thyroid function: hypothyroid, Mantoux test is negative. Finally, the patient is a massive pericardial effusion caused by hypothyroidism. The pericardiocentesis took, and the hypothyroid drug of euthirax is administered. The patient was well done and continued for recontrol.

Postmortem computed tomographic (PMCT) findings of pericardial effusion due to acute aortic dissection

International Nuclear Information System (INIS)

Shiotani, Seiji; Watanabe, Ko; Kohno, Mototsugu; Ohashi, Noriyoshi; Nakayama, Hidetsugu; Yamazaki, Kentaro

2004-01-01

The purpose of this study was to describe the appearance of pericardial effusion in deceased acute aortic dissection patients using postmortem computed tomography (PMCT). PMCT examinations were performed within 2 hours of death in 30 patients with pericardial effusion due to aortic dissection who arrived at our hospital in a state of cardiopulmonary arrest. Pericardial effusion in 18 of 30 patients (60%) showed double concentric rings on PMCT with striking differences in density, a low-density outer ring along the pericardium and a high-density inner ring on the epicardial surface (hyperdense armored heart). Pericardial effusion in two patients (7%) showed a high-density fluid level (hypostasis). Pericardial effusion in the remaining 10 patients (33%) showed no such stratification. A ''hyperdense armored heart'' is the most frequently seen PMCT finding in deceased cases of pericardial effusion due to acute aortic dissection. (author)

Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure

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Ates I

2016-01-01

Full Text Available Objective. While non-symptomatic pericardial effusion is seen in primary hypothyroidism, massive pericardial effusion is a very rare finding. In the literature, newly diagnosed primary hypothyroidism cases presenting with massive pericardial effusion or acute renal failure are present, but we did not encounter any case first presenting with combination of two signs. In this case report, primary hypothyroidism case that presenting with massive pericardial effusion and acute renal failure will be discussed.

Echocardiography in helping to determine the causes of pericardial ...

African Journals Online (AJOL)

Pericardial disease is not uncommon in Sudan and the etiology may impose a diagnostic problem. The aim of this study is to determine the etiology of isolated pericardial effusion and to assess the usefulness of the echocardiographic features of the effusion in helping to determine the etiology. Patients and Methods:This is ...

South Sudan Medical Journal - Vol 5, No 4 (2012)

African Journals Online (AJOL)

Pericardial effusion complicated by tamponade: a case report · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Michele Montandon, Rae Wake, Stephen Raimon, 89-91 ...

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

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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.

CT measurement of normal pericardial thickness in adults on computed tomography

International Nuclear Information System (INIS)

Choi, Young Woo; Park, Chan Sup; Jeon, Yong Sun; Bae, In Young; Choi, Sung Gyu; Koo, Jin Hoe; Chung, Won Kyun

1998-01-01

The purpose of this study was to establish, using computed tomography, the normal thickness of the pericardium in adults. Materials and Methods: CT scans of 50 patients, including sections through the level of the heart, were reviewed. Patients were excluded if there were any suspicions of pericardial abnormality such as infectious or neoplastic diseases. Twenty-four of the 50 were men and 26 were women; their mean age was 47.0(range,18-76) years. We measured pericardial thickness at the level of the right ventricle, interventricular septum and left ventricle, and also compared pericardial thickness in terms of age and sex. Results: In all patients, the pericardium was observed in the right ventricular region; in 41 (82%) at the interventricular septum; and in 41 (82%) along the left ventricle. The mean thickness of normal pericardium at the level of the right ventricle, interventricular septum, and left ventricle was 1.8 mm ± 0.5 mm, 1.8 mm ± 0.4 mm, and 1.7 mm ± 0.5 mm, respectively. No statistically significant correlation was apparent between pericardial thickness and age group (p > 0.63, ANOVA test). Mean pericardial thickness was 1.9 mm ± 0.6 mm in males and 1.7 mm ± 0.4 mm in females; thus, no statistically significant correlation was apparent between pericardial thickness and sex (p >0.29, Student's t-test). Conclusion: The pericardium was best visualized in sections through the right ventricle.The mean thickness of normal pericardium was 1.8 mm ± 0.5 mm and pericardial thickness did not differ according to age or sex

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

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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.

Use of Condom Tamponade to Manage Massive Obstetric Hemorrhage at a Tertiary Center in Rajasthan.

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Hasabe, Rakesh; Gupta, Kumud; Rathode, Pallavi

2016-10-01

Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al. in Cochrane Database Syst Rev 2:CD000007, (2000)]. The purpose of this study was to evaluate the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive PPH. This prospective study was done in the Obstetrics and Gynecology Department of NIMS Medical College and Hospital, Jaipur, between December 2013 and February 2015. With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 ml normal saline according to need. Vaginal bleeding was observed, and further inflation was stopped when bleeding ceased. In all but 2 (94.44 %) the cases, postpartum bleeding was stopped within 10 min of creation of tamponade. On an average, 350 ml of normal saline was required to create adequate tamponade to stop the bleeding. Use of condom tamponade can effectively help in reducing both maternal morbidity and mortality associated with PPH. Our study encourages use of condom tamponade which is efficient, cost-effective, easily available and requires lesser skills as compared to the traditional surgical procedures.

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

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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.

Discrete peritoneal and pericardial implants of non-Hodgkin lymphoma

International Nuclear Information System (INIS)

Eckel, C.G.; Davis, M.; Mettler, F.A. Jr.; Rosenberg, R.

1987-01-01

Peritoneal spread of non-Hodgkin lymphoma is rare: fewer than three percent of persons afflicted with this disease develop peritoneal spread. Pericardial involvement by non-Hodgkin lymphoma is equally rare. We report an instance of peritoneal and pericardial spread in a patient with non-Hodgkin lymphoma that was detected only by CT scan. The peritoneal lesions were not visible by ultrasound examination. A pertinent review of the literature is presented. (author)

Rigor mortis at the myocardium investigated by post-mortem magnetic resonance imaging.

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Bonzon, Jérôme; Schön, Corinna A; Schwendener, Nicole; Zech, Wolf-Dieter; Kara, Levent; Persson, Anders; Jackowski, Christian

2015-12-01

Post-mortem cardiac MR exams present with different contraction appearances of the left ventricle in cardiac short axis images. It was hypothesized that the grade of post-mortem contraction may be related to the post-mortem interval (PMI) or cause of death and a phenomenon caused by internal rigor mortis that may give further insights in the circumstances of death. The cardiac contraction grade was investigated in 71 post-mortem cardiac MR exams (mean age at death 52 y, range 12-89 y; 48 males, 23 females). In cardiac short axis images the left ventricular lumen volume as well as the left ventricular myocardial volume were assessed by manual segmentation. The quotient of both (LVQ) represents the grade of myocardial contraction. LVQ was correlated to the PMI, sex, age, cardiac weight, body mass and height, cause of death and pericardial tamponade when present. In cardiac causes of death a separate correlation was investigated for acute myocardial infarction cases and arrhythmic deaths. LVQ values ranged from 1.99 (maximum dilatation) to 42.91 (maximum contraction) with a mean of 15.13. LVQ decreased slightly with increasing PMI, however without significant correlation. Pericardial tamponade positively correlated with higher LVQ values. Variables such as sex, age, body mass and height, cardiac weight and cause of death did not correlate with LVQ values. There was no difference in LVQ values for myocardial infarction without tamponade and arrhythmic deaths. Based on the observation in our investigated cases, the phenomenon of post-mortem myocardial contraction cannot be explained by the influence of the investigated variables, except for pericardial tamponade cases. Further research addressing post-mortem myocardial contraction has to focus on other, less obvious factors, which may influence the early post-mortem phase too. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion.

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Okuda, Kenichi; Noguchi, Satoshi; Narumoto, Osamu; Ikemura, Masako; Yamauchi, Yasuhiro; Tanaka, Goh; Takai, Daiya; Fukayama, Masashi; Nagase, Takahide

2016-05-10

Meigs' syndrome is defined as the presence of a benign ovarian tumor with pleural effusion and ascites that resolve after removal of the tumor. The pathogenesis of the production of ascites and pleural effusion in this syndrome remains unknown. Aside from pleural effusion and ascites, pericardial effusion is rarely observed in Meigs' syndrome. Here, we report the first case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion. An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month. She had asymptomatic and unchanging pericardial effusion and a pelvic mass, which had been detected 3 and 11 years previously, respectively. The patient was radiologically followed-up without the need for treatment. Two months before admission, the patient underwent a right upper lobectomy for localized lung adenocarcinoma and intraoperative pericardial fenestration confirmed that the pericardial effusion was not malignant. However, she began to experience dyspnea on exertion leading to admission. A chest, abdomen, and pelvis computed tomography scan confirmed the presence of right-sided pleural and pericardial effusion and ascites with a left ovarian mass. Repeated thoracentesis produced cultures that were negative for any microorganism and no malignant cells were detected in the pleural effusions. Pleural fluid accumulation persisted despite a tube thoracostomy for pleural effusion drainage. With a suspicion of Meigs' syndrome, the patient underwent surgical resection of the ovarian mass and histopathological examination of the resected mass showed ovarian fibroma. Pleural and pericardial effusion as well as ascites resolved after tumor resection, confirming a diagnosis of Meigs' syndrome. This clinical course suggests a strong association between pericardial effusion and ovarian fibroma, as well as pleural and peritoneal

Effect of early vitrectomy combined with silicone oil tamponade for severe infectious traumatized endophthalmitis

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Xiao Zheng

2013-08-01

Full Text Available AIM: To explore the relations of clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious traumatized endophthalmitis.METHODS: Totally 59 patients(59 eyeswith severe infectious traumatized endophthalmitis accepted vitrectomy combined with silicone oil tamponade. Patients were divided into two groups by different surgical timing. Group A accepted operation in 24 hours. Group B accepted operation 24 hours after injury. Retina status during operation, clinical efficacy and best-corrected visual acuity were observed and recorded. RESULTS: The cases of early operation group got lesser retina injury and higher efficacy and better best-corrected visual acuity. CONCLUSION:Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected traumatized endophthalmitis. Early surgical treatment is the key to achieve better effect.

[Percutaneous tubing and drainage for the diagnosis and treatment of malignant pericardial effusion].

Science.gov (United States)

Li, Y; Zhou, J; Zhang, J

2000-01-01

To insert a tube into pericardial cavity as an emergent measure of diagnosis and treatment in patients with malignant pericardial effusion. Pericardial puncture was followed by insertion of drainage tube (diameter = 1.8 mm) through the puncture needle. The effusion collected was examined for cancer cells. After drainage, chemotherapeutic agents were administered. Four hours later, drainage was continued for 2 days (drained in 24 hr) and the tube was removed. In 34 cases with malignant pericardial effusion, tube draining was successful to relieve cardiac temponade within 15-60 minutes. Clots were present in 91.2% of the cases and cancer diagnosis was confirmed in all of them. The cytologic diagnosis of effusion was positive in 61.8%, and the cyto-pathologic typing of clots was 81.0%. The difference was statistically significant. When the results of the 2 examinations were put together, the positive rate increased to 94.1%. Tube drainage of malignant pericardial effusion is useful in diagnosis and emergency treatment.

Clinical Predictors and Outcomes of Patients with Pericardial Effusion in Chronic Kidney Disease.

Science.gov (United States)

Ravi, Venkatesh; Iskander, Fady; Saini, Abhimanyu; Brecklin, Carolyn; Doukky, Rami

2018-03-13

Pericardial effusion is common in hospitalized patients with chronic kidney disease (CKD). We sought to identify predictors of pericardial effusion in CKD patients and to evaluate the impact of pericardial effusion on their mortality and morbidity. In a retrospective nested case control study design, we analyzed hospitalized adult patients with CKD stage 4, 5, and end-stage renal disease (ESRD) diagnosed with pericardial effusion. Randomly selected patients with CKD stage 4, 5, and ESRD without pericardial effusion were used as controls. We analyzed 84 cases and 61 controls, of whom 44% and 34% were on dialysis, respectively. The mean blood urea nitrogen and creatinine were 70±27 mg/dL and 8.4±6.0 mg/dL among cases, 54±26 mg/dL and 6.0±3.4 mg/dL among controls, respectively. Effusion was moderate to large in 46% of cases. Predictors of any pericardial effusion were serum potassium (OR, 1.95 per 1 mEq/L increment in level; CI, 1.21-3.13; p=0.006), serum corrected calcium (OR, 1.33 per 1mg/dl decrement in level; CI, 1.11-1.67; p=0.015) and admission heart rate (OR, 1.29 per 10 beats/minute increment in heart rate; CI, 1.03-1.62; p=0.027). Corrected calcium level was an independent predictor of moderate to large pericardial effusion, (OR, 1.38 per 1 mg/dL decrement in level; CI, 1.04-1.82, p=0.023). Corrected calcium effusion. Patients with effusion had no significant difference in mortality or cardiovascular re-hospitalization (log-rank p=0.408). In hospitalized CKD patients, hypocalcemia may be useful in identifying those with moderate to large pericardial effusion. This article is protected by copyright. All rights reserved.

Effect of prednisolone on inflammatory markers in pericardial tuberculosis: A pilot study

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Justin Shenje

2018-03-01

Full Text Available Background: Pericardial disorders are a common cause of heart disease, and the most common cause of pericarditis in developing countries is tuberculous (TB pericarditis. It has been shown that prednisolone added to standard anti-TB therapy leads to a lower rate of constrictive pericarditis. We conducted a pilot study to evaluate the effect of adjunctive prednisolone treatment on the concentration of inflammatory markers in pericardial tuberculosis, in order to inform immunological mechanisms at the disease site. Methods: Pericardial fluid, plasma and saliva samples were collected from fourteen patients with pericardial tuberculosis, at multiple time points. Inflammatory markers were measured using multiplex luminex analysis and ELISA. Results: In samples from 14 patients we confirmed a strongly compartmentalized immune response at the disease site and found that prednisolone significantly reduced IL-6 concentrations in plasma by 8 hours of treatment, IL-1beta concentrations in saliva, as well as IL-8 concentrations in both pericardial fluid and saliva by 24 hours. Conclusion: Monitoring the early effect of adjunctive immunotherapy in plasma or saliva is a possibility in pericarditis. Keywords: Tuberculosis, HIV, Pericarditis, Steroids, Treatment monitoring

Primary Pericardial Mesothelioma: Report of a Patient and Literature Review

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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.

Hjertetamponade hos et praematurt barn med perkutant anlagt centralt venekateter

DEFF Research Database (Denmark)

Callesen, Michael T; Nielsen, Peter Ehlert

2008-01-01

We report a case of a premature girl born with a gestational age of 26 weeks who developed cardiac tamponade after displacement of a peripheral inserted central catheter. She recovered completely after an acutely performed pericardiocentesis. The pericardial fluid was consistent with parental...

Incremental benefit of three-dimensional transesophageal echocardiography in the assessment of a primary pericardial hemangioma.

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Arisha, Mohammed J; Hsiung, Ming C; Nanda, Navin C; ElKaryoni, Ahmed; Mohamed, Ahmed H; Wei, Jeng

2017-08-01

Hemangiomas are rarely found in the heart and pericardial involvement is even more rare. We report a case of primary pericardial hemangioma, in which three-dimensional transesophageal echocardiography (3DTEE) provided incremental benefit over standard two-dimensional images. Our case also highlights the importance of systematic cropping of the 3D datasets in making a diagnosis of pericardial hemangioma with a greater degree of certainty. In addition, we also provide a literature review of the features of cardiac/pericardial hemangiomas in a tabular form. © 2017, Wiley Periodicals, Inc.

Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery.

Science.gov (United States)

Rhatigan, Maedbh; McElnea, Elizabeth; Murtagh, Patrick; Stephenson, Kirk; Harris, Elaine; Connell, Paul; Keegan, David

2018-01-01

To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher's exact test and unpaired two-tailed t -test. One hundred and six patients (76.2%) had undergone silicone oil removal at the time of review with 96 patients (90.6%) showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity (BCVA). Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade ( P =0.0001, <0.0001 respectively). Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis.

Catheter-Malposition-Induced Cardiac Tamponade via Contrast Media Leakage During Computed Tomography Study

International Nuclear Information System (INIS)

Liang, C.-D.; Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M.

2005-01-01

We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status

Case report

African Journals Online (AJOL)

abp

2016-09-20

Sep 20, 2016 ... Abstract. With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however,.

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.

Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report.

Science.gov (United States)

Zare-Khormizi, M R; Rahmanian, M; Pourrajab, F; Akbarnia, S

2014-10-01

Hypothyroidism is an endocrine disease with various clinical manifestations. It is a rare cause for rhabdomyolysis and massive pericardial effusion. We describe a case of severe hypothyroidism secondary to autoimmune hashimoto thyroiditis with massive pericardial effusion and rhabdomyolysis. Improvement of mentioned complications after hypothyroidism treatment and rule out of other possible causes are supportive clues that hypothyroidism is the main cause of patient's rare presentation. With the best of our knowledge, it is the first report of rhabdomyolysis and massive pericardial effusion coincidence in a patient of adult population with primary uncontrolled hypothyroidism for years.

Massive pericardial effusion associated with hypothyroidism.

Science.gov (United States)

Ionescu, Simona Daniela; Tănase, Daniela Maria; Ouatu, Anca; Ambăruş, V; Dosa, Anca; Arsenescu-Georgescu, Cătălina

2014-01-01

The diagnosis of hypothyroidism is difficult because hypothyroidism in adults and especially the elderly, classic, has an insidious onset with a range of nonspecific symptoms which may delay diagnosis for months or even years. Old age seems to represent trigger factor for autoimmune diseases, including hypothyroidism. Clinical features in hypothyroidism, such as weight gain, fatigue, cold intolerance, constipation, dry skin, edema and muscle weakness, and decreased osteo-tendinous reflexes are usually subtle and can be overlooked. Thyroid dysfunction may be associated with a negative impact on the cardiovascular system. Pericardial, pleural and peritoneal effusions are common findings in hypothyroidism. This case report represents a typical primary hypothyroidism (autoimmune) and shows the clinical features of this disease. Basically we talked about a severe myxedema with the involvement of internal organs in an elderly woman and the euthyroidism restoration, under thyroid replacement therapy, was correlated with the clinical improvement and cardiovascular and neurological status, with radiographic remission and regression to extinction of pericardial effusion at repeated echocardiographic evaluations.

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.

Value of Artisanal Simulators to Train Veterinary Students in Performing Invasive Ultrasound-Guided Procedures

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Hage, Maria Cristina F. N. S.; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-01-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are…

Use of PTFE patch for pericardial closure after minimal invasive LVAD implantation.

Science.gov (United States)

Mohite, Prashant N; Sabashnikov, Anton; Popov, Aron F; Fatullayev, Javid; Simon, André R

2016-07-01

The left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. The thoracotomy approach for LVAD implantation, in which the left ventricle is approached through a pericardial rent, is becoming popular. We demonstrate closure of the pericardial rent with a polytetrafluoroethylene (PTFE) patch and its advantages. © The Author(s) 2015.

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

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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

Purulent Pericarditis after Liver Abscess: A Case Report

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María Fidalgo García

2014-01-01

Full Text Available We present the case of a 49-year-old woman, with previous clinical antecedents of recent hepatic metastasis, who was admitted to the ICU due to respiratory failure and hemodynamic instability. She was found to have purulent pericarditis complicated by pericardial tamponade and pleural effusion, as well as surgical site infection, which was the origin of the disease. Cultures of the surgical wound and the pericardial effusion were positive for Enterococcus faecalis and Escherichia coli. A pericardial tap was performed and the intra-abdominal abscess was surgically drained. Pleural effusion was also evacuated. She received antibiotic treatment and recovered successfully. The only after-effect was a well-tolerated effusive-constrictive pericarditis.

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

Comparison of Sulfur Hexafluoride (SF6) and Air Tamponade in Noniridectomized Descemet Membrane Endothelial Keratoplasty.

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Einan-Lifshitz, Adi; Sorkin, Nir; Boutin, Tanguy; Showail, Mahmood; Borovik, Armand; Jamshidi, Farzad; Chan, Clara C; Rootman, David S

2018-03-01

To compare the efficacy and safety of 20% sulfur hexafluoride gas (SF6) and air tamponade in patients who underwent noniridectomized Descemet membrane endothelial keratoplasty (DMEK). A retrospective chart review of patients who underwent DMEK with either air or SF6 tamponade: 41 eyes received air tamponade (group 1) and 41 received SF6 tamponade (group 2). Best spectacle-corrected visual acuity, endothelial cell density, and complications including graft detachment and elevated intraocular pressure were compared. The mean follow-up time was 8 ± 4 months in group 1 and 3 ± 2 months in group 2. Mean best spectacle-corrected visual acuity improved from 1.12 ± 0.88 to 0.64 ± 0.78 logarithm of the minimum angle of resolution (logMAR) in group 1 (P = 0.009) and from 1.00 ± 0.78 to 0.62 ± 0.53 logMAR in group 2 (P = 0.006). The graft detachment rate was 39% (16 eyes) in group 1 and 42% (17 eyes) in group 2 (P = 0.822). The rate of graft detachment larger than one third of the graft area was 17% in group 1 and 20% in group 2 (P = 0.775). Rebubbling was performed in 26.8% and 20% of eyes in group 1 and 2, respectively (P = 0.43). Average endothelial cell loss was 32% in group 1 and 33% in group 2 (P = 0.83). In the immediate postoperative period, elevated intraocular pressure was observed in 2 eyes (5%) in group 1 and in 4 eyes (10%) in group 2 (P = 0.4). There was 1 primary graft failure in each group. Use of air with it being readily available and short acting is a good method of Descemet membrane tamponade in noniridectomized DMEK.

Value of polymerase chain reaction in patients with presumptively diagnosed and treated as tuberculous pericardial effusion

International Nuclear Information System (INIS)

Rehman, H.; Hafizullah, M.; Shah, S.T.; Khan, S.B.; Hadi, A.; Ahmad, F.; Shah, I.; Gul, A.M.

2012-01-01

Objective: To know the sensitivity of polymerase chain reaction (PCR) in pericardial fluid and response to antituberculous treatment (ATT) in PCR positive patients who were presumptively diagnosed and treated as tuberculous pericardial effusion. Methodology: This was a descriptive cross sectional study carried out from June 1, 2009 to 31 May 2010 at Cardiology Department, Lady Reading Hospital, Peshawar. Patients with presumptive diagnosis and receiving treatment for tuberculous pericardial effusion were included. Pericardial fluid sample was aspirated under fluoroscopy for the routine work up. The specimens were subjected to PCR detection of mycobacterium tuberculous DNA. Results: During 12 month study period, a total of 54 patients with large pericardial effusion presented to Cardiology department, Lady Reading Hospital, Peshawar. Of them, 46 patients fulfilled the criteria for presumptive diagnosis of tuberculous pericardial effusion. PCR for mycobacterium tuberculous DNA in pericardial fluid was positive in 45.7%(21). Patients were followed for three months. In PCR positive group, 01 patient while in PCR negative group 3 patients were lost to follow up. Among PCR positive patients 17(85%) while in PCR negative group 11(47.82%) patient responded to ATT both clinically and echo-cardio graphically. We found that patients who were PCR positive responded better to therapy than those who were PCR negative and this finding was statistically significant (p=0.035). Conclusion: PCR, with all its limitations, is potentially a useful diagnostic test in patients with presumptively diagnosed tuberculous pericardial effusion. A PCR positive patient responds better to therapy as compared to PCR negative patient. (author)

Rare post-operative complications of large mediastinal tumor resection

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Mohsen Mirmohammadsadeghi

2015-03-01

Full Text Available Background: There are some reports in the literature, which suggest that cardiac tamponade drainage may transiently affect systolic function and also cause acute respiratory distress syndrome (ARDS. We did not find any reports of acute ventricular failure and ARDS secondary to mediastinal tumor resection without tamponade. Case Report: Here we report a 48-year-old woman presenting with massive pericardial effusion without tamponade in whom tumor was resected through median sternotomy using cardiopulmonary bypass. ARDS and acute heart failure were two rare complications that happened at the end of the operation secondary to a sudden decompression of the heart from tumor pressure. Conclusion: ARDS and acute heart failure are two rare complications, which can happen after large mediastinal tumor resection.

Case report

African Journals Online (AJOL)

abp

2015-06-15

Jun 15, 2015 ... Abstract. While pleural effusion and ascites secondary to acute pancreatitis are common, clinically relevant pericardial effusion and cardiac tamponade are observed rarely. In a study by Pezzilli et al., pleural effusion was noted in 7 of the 21 patients with acute pancreatitis whereas the authors detected.

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

Recurrent Pericardial Effusion Associated with Hypothyroidism in ...

African Journals Online (AJOL)

Background: The complex of Down Syndromehypothyroidism-pericardial effusion is largely unreported in sub-Sahara. Objective: To present and highlight an unusual manifestation of hypothyroidism. Methods: A 16-year-old girl with confirmed Down Syndrome presented with complaints of generalised body swelling of eight ...

Incidental finding of congenital pericardial and mediastinal pleural defect by pneumothorax in an adult

International Nuclear Information System (INIS)

Sugiura, Y.; Matsusaka, Y.; Nemoto, E.; Hashizume, T.; Kaseda, S.

2015-01-01

Introduction: Congenital pericardial defect (CPD) is an uncommon anomaly. If once cardiac herniation occurs, it threatens life. We report a case of left-sided pneumothorax with consequent protrusion of the heart into left thoracic cavity through not only a large CPD but also congenital pleuropericardium window. Case presentation: A 67-year-old man presenting with sudden-onset left-sided chest pain and slight dyspnea was referred to our hospital. Chest X-ray showed a left lung collapse, and also revealed a pneumopericardium along the right border of the ascending aorta. Subsequent computed tomography (CT) scan revealed that the heart was displaced into the left hemithorax. Thus, we diagnosed the patient with pneumothorax and a defect of the pericardial and mediastinal pleurae. Subsequently, a chest tube was inserted into the left thoracic cavity, and the collapsed lung was promptly inflated. The cardiac position was reinstated within mediastinum as evidenced by follow-up CT scan. The QRS axis on his electrocardiogram (ECG) was altered from 52° to 73°. Together with the cardiac relocation evidenced by the QRS axis shift on ECG and findings of CT, we determined that there was a low potential for complications and opted against surgical repair. Discussion: When the CPD is sufficiently large, surgical intervention is not necessary. The size of the CPD can be assessed not only by CT findings, but the alteration of the QRS axis on ECG also provides useful information whether cardiac herniation can be resolved by the inflated lung. - Highlights: • We reported a case of congenital pericardial defect (CPD) with pneumothorax. • We described how to manage to alleviate life-threatening complications. • The size of CPD was assessed by CT findings and the alteration of QRS axis on ECG

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

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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.

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

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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.

Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

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Xiangfei Wang

2014-01-01

Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

Pericardial and congestive heart failure diagnostic with CT-and MR-imaging

International Nuclear Information System (INIS)

Rienmueller, R.; Seiderer, M.; Doliva, R.; Kemkes, B.; Lissner, J.

1986-01-01

Angiocardiography is still considered the gold standard in the estimation of functional parameters of the heart. However because of the inferior density resolution and the draw back of superimposition of cardiac structures angiocardiography provides only limited information about non cardiac and some cardiac structures for instance: The perimyo-, endocardium, the valves, the myocardial perfusion and metabolism or coronary blood flow. The present diagnostic and prognostic validity of CT and MR in visualizing the pericardium, the left ventricular myocardium, the heart chambers and the great heart vessels in the clinical work up of patients with pericardial and congestive heart failure is demonstrated. MR is more reliable in the diagnosis of left ventricular myocardial atrophy or fibrosis than CT. Disadvantages of MR include the failure to identify endo-, myo-and pericardial calcifications. The measurable improvement in the visualization of systolic and diastolic myocardial wall thickness using MR is of marked prognostic value in the preoperative exclusion of myocardial atrophy or fibrosis in patients with pericardial constriction

A coarse-to-fine approach for pericardial effusion localization and segmentation in chest CT scans

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Liu, Jiamin; Chellamuthu, Karthik; Lu, Le; Bagheri, Mohammadhadi; Summers, Ronald M.

2018-02-01

Pericardial effusion on CT scans demonstrates very high shape and volume variability and very low contrast to adjacent structures. This inhibits traditional automated segmentation methods from achieving high accuracies. Deep neural networks have been widely used for image segmentation in CT scans. In this work, we present a two-stage method for pericardial effusion localization and segmentation. For the first step, we localize the pericardial area from the entire CT volume, providing a reliable bounding box for the more refined segmentation step. A coarse-scaled holistically-nested convolutional networks (HNN) model is trained on entire CT volume. The resulting HNN per-pixel probability maps are then threshold to produce a bounding box covering the pericardial area. For the second step, a fine-scaled HNN model is trained only on the bounding box region for effusion segmentation to reduce the background distraction. Quantitative evaluation is performed on a dataset of 25 CT scans of patient (1206 images) with pericardial effusion. The segmentation accuracy of our two-stage method, measured by Dice Similarity Coefficient (DSC), is 75.59+/-12.04%, which is significantly better than the segmentation accuracy (62.74+/-15.20%) of only using the coarse-scaled HNN model.

Non-invasive diagnosis of isolated chylopericardium using precordial pericardial imaging after oral administration of 131I-triolein

International Nuclear Information System (INIS)

Fujiseki, Yoshiki; Katsura, Tadahiko; Goto, Masakatsu; Kawanishi, Katsuyuki

1982-01-01

Chylopericardium is a rare disease and affects both sexes equally from neonate to adult. Usually, there are abnormal connections between the pericardial cavity and thoracic lymphatic systems. These connections are detected by (1) recovery of orally administered Sudan III from pericardial fluid, (2) evidence of radioactivity in the pericardial fluid by paracentesis after oral administration of 131 I-labeled triolein, and (3) lymphangiography. However, these method are technically difficult and invasive, thus sometimes dangerous for children. We employed precordial pericardial imaging after oral administration of 131 I-labeled triolein on a 9-year-old Japanese girl wth isolated chylopericardium before and after surgery. Abnormal connections and the back-ward flow to the pulmonary lymphatics were demonstrated by this method. This is an easy, non-invasive, reliable and safe method for detecting the abnormal connections of pericardial and lymphatic systems in children with chylopericardium. (author)

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

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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.

Efficacy of posterior pericardiotomy in prevention of atrial fibrillation and pericardial effusion after aortic valve replacement: a randomized controlled trial

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V. I. Kaleda

2017-07-01

Full Text Available Aim. Postoperative atrial fibrillation is one of the most frequent complications in cardiac surgery. The aim of this trial was to evaluate the effectiveness of posterior pericardiotomy in the prevention of postoperative atrial fibrillation and pericardial effusion in patients undergoing isolated primary aortic valve replacement.Methods. The trial was approved by the local ethics committee. It included adult patients under 70 y.o. who had signed the informed consent for participation in the study and who were planned to undergo isolated primary aortic valve replacement. Exclusion criteria were a history of atrial fibrillation, hyperthyroidism, amiodarone intake, severe chronic obstructive pulmonary disease, left ventricle ejection fraction less than 30%, the size of the left atrium exceeding 50 mm, active infective endocarditis, the presence of adhesions in the pericardium and/or left pleural cavity and mini-sternotomy. From October 2013 to April 2015 607 patients in our clinic underwent different aortic valve procedures. 507 patients were excluded from the study because of the inclusion and exclusion criteria. The remaining 100 patients were randomized into two groups: 49 patients underwent posterior pericardiotomy and 51 patients made up the control group. In both groups the frequency of postoperative atrial fibrillation, pericardial effusion greater than 5 mm, surgery-discharge time, as well as posterior-pericardiotomy-related complications were studied. Trial number: ISRCTN11129539.Results. There were no deaths, stroke or cardiac tamponade during the postoperative stay. Neither were there any complications associated with the performance of posterior pericardiotomy. The incidence of atrial fibrillation, pericardial effusion and average duration of the postoperative stay were similar in both groups: 16% in posterior pericardiotomy group vs 14% in the control group (p=0.71, 10% in posterior pericardiotomy group vs 12% in the control group (p=0

Cardiac tamponade in a patient with severe dengue fever

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Ana Isabel Vieira Fernandes

Full Text Available Abstract A 26-year-old postpartum female presented with symptoms characteristic of dengue fever on the 16th day of puerperium. On the third day of the illness, the patient presented a clinical picture consistent with shock. Tests determined primary infection with dengue virus serotype 2. Cardiac tamponade was confirmed by echocardiography. This rare manifestation is described in a patient without any associated comorbidity.

Optical coherence tomography can be used in evaluation of morphological and functional results after successful rhegmatogenous retinal detachment surgery with different tamponade agents

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Tat'yana Andreevna Avanesova

2015-03-01

Full Text Available Background: Optical coherence tomography (OCT findings are helpful in assessing the cause of reduced visual acuity (VA after successful rhegmatogenous retinal detachment (RRD surgery. Objective: To study anatomical and functional results after successful RRD surgery with gas-air mixture or silicone oil (SO tamponade using OCT. Materials and methods. 70 patients were divided into 2 groups: group I (n = 34 - gas-air mixture tamponade; group II (n = 36 - SO tamponade. At baseline, were no significant differences by gender, age and VA between the groups. Follow-up was 12 months after the surgery. OCT was performed with the Cirrus HD-OCT 4000, CARL ZEISS MEDITEC, USA. Results: VA increased significantly in both groups. Regression analysis showed lower VA in group II and statistically significant association between VA and IS/OS and ELM defects. Сonclusions. There is a strong association of disruption of the IS/OS and ELM with reduced vision after successful retinal detachment surgery. Gas-air mixture tamponade showed some benefits in comparison with SO tamponade.

Treatment of acute infectious endophthalmitis by vitrectomy surgery with silicon oil tamponade

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Xiao-Dong Han

2015-09-01

Full Text Available AIM: To observe theclinical effect of acute infectious endophthalmitis by vitrectomy surgery with silicon oil tamponade.METHODS:The clinical data of 23 patients(23 eyesdiagnosed with acute endophthalmitis in our hospital from January, 2008 to February, 2013 were retrospectively analyzed, excluding the patients with intraocular foreign body. All the patients were undergone routine closed three-channel vitrectomy with silicon oil, including 6 eyes(complicated with traumatic cataractwith Ⅰ lensectomy and Ⅰ intraocular lens(IOLimplantation, 3 eyes(complicated with traumatic cataractwith Ⅰ lensectomy and Ⅱ IOL implantation, 4 eyes(complicated with cataract during silicon oil tamponadewith Ⅱ lensectomy and Ⅱ IOL implantation, 5 eyes(4 eyes with traumatic endophthalmitis and 1 eye with entophthalmia caused by glaucoma filtering bleb leakingreserved lens, 1 eye(post-cataract surgery entophthalmiawith Ⅰ IOL explantation and Ⅱ IOL implantation, and 4 eyes(post-cataract surgery entophthalmiareserved lens. RESULTS:Within follow-up 6～24mo, inflammation after vitrectomy surgery with silicon oil tamponade was controlled in all the 23 patients(23 eyes. Final visual acuity was improved in 21 eyes(91%. The intraocular pressure(IOPof 2 eyes were over 30mmHg. IOP of 1 eye was controlled after silicon oil removed, and IOP of the other eye after silcon oil extraction was still high and needed to be controlled by IOP lowering drugs. CONCLUSION: The patients of acuteinfectious endophthalmitis should undergo vitrectomy with silicon oil tamponade as early as possible, which can effectively controli endophthalmitis and improve visual acuity.

Morganella morganii Pericarditis in a Patient with Multiple Myeloma

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Takafumi Nakao

2013-01-01

Full Text Available Purulent pericarditis caused by Morganella morganii is extremely rare. We report herein a case of a 61-year-old man who presented with chest pain and dyspnea fourteen days after chemotherapy for multiple myeloma. Echocardiogram and computed tomography revealed a massive pericardial effusion and associated cardiac tamponade. Pericardiocentesis was performed. Pericardial fluid was found to be purulent, and Morganella morganii was isolated from the fluid. The patient was successfully treated with antibiotic therapy and surgical drainage of the fluid. Morganella morganii should be considered a possible pathogen when immunocompromised patients develop purulent pericarditis.

Atypical presentation of multicentric Castleman disease in a pediatric patient: pleural and pericardial effusion.

Science.gov (United States)

Akman, Alkim Oden; Basaran, Ozge; Ozyoruk, Derya; Han, Unsal; Sayli, Tulin; Cakar, Nilgun

2016-06-01

Castleman disease (CD) is a rare poorly understood lymphoproliferative disorder. Pediatric onset CD has been reported before. However, most of them have benign unicentric pattern. Multicentric CD (MCD) is quite rare in children. Herein, we report a 13-year-old adolescent boy with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. MCD should be considered in the differential diagnosis of pleural and/or pericardial effusion with unexplained lymph nodes in children. What is Known •Pediatric Castleman disease (CD) most commonly occurs in the unicentric form, which typically is asymptomatic and cured by lymph node excision. •The diagnosis of MCD can be difficult owing to the heterogeneity of presentation and potential for nonspecific multisystem involvement. What is New •A 13-year-old adolescent boy was diagnosed with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. •In a pediatric patient with fever, pleural-pericardial effusion and multiple lymph nodes, MCD should be considered in differantial diagnosis.

Meta-Analysis of Risk of Stroke or Transient Ischemic Attack With Dabigatran for Atrial Fibrillation Ablation

DEFF Research Database (Denmark)

Sardar, Partha; Nairooz, Ramez; Chatterjee, Saurav

2014-01-01

(odds ratio 0.99, 95% CI 0.55 to 1.78), pericardial tamponade, and groin hematoma. A lower risk of minor bleeding was observed with dabigatran (odds ratio 0.60, 95% CI 0.41 to 0.87). In conclusion, periprocedural use of dabigatran for AF ablation was related to a higher risk of thromboembolic...

Dynamic Variables Fail to Predict Fluid Responsiveness in an Animal Model With Pericardial Effusion.

Science.gov (United States)

Broch, Ole; Renner, Jochen; Meybohm, Patrick; Albrecht, Martin; Höcker, Jan; Haneya, Assad; Steinfath, Markus; Bein, Berthold; Gruenewald, Matthias

2016-10-01

The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion. A single-center animal investigation. Twelve German domestic pigs. Pigs were studied before and during pericardial effusion. Instrumentation included a pulmonary artery catheter and a transpulmonary thermodilution catheter in the femoral artery. Hemodynamic variables like cardiac output (COPAC) and stroke volume (SVPAC) derived from pulmonary artery catheter, global end-diastolic volume (GEDV), stroke volume variation (SVV), and pulse-pressure variation (PPV) were obtained. At baseline, SVV, PPV, GEDV, COPAC, and SVPAC reliably predicted fluid responsiveness (area under the curve 0.81 [p = 0.02], 0.82 [p = 0.02], 0.74 [p = 0.07], 0.74 [p = 0.07], 0.82 [p = 0.02]). After establishment of pericardial effusion the predictive power of dynamic variables was impaired and only COPAC and SVPAC and GEDV allowed significant prediction of fluid responsiveness (area under the curve 0.77 [p = 0.04], 0.76 [p = 0.05], 0.83 [p = 0.01]) with clinically relevant changes in threshold values. In this porcine model, hemodynamic relevant pericardial effusion abolished the ability of dynamic variables to predict fluid responsiveness. COPAC, SVPAC, and GEDV enabled prediction, but their threshold values were significantly changed. Copyright © 2016 Elsevier Inc. All rights reserved.

Pericardial effusion presenting as an anterior mediastinal mass

International Nuclear Information System (INIS)

Schlesinger, A.E.; Fernbach, S.K.; Northwestern Univ., Chicago, IL

1986-01-01

The authors present a case of pericardial effusion in a patient with previous cardiac surgery. Because the pericardium is opened and not reclosed during surgery, fluid can extend superior to the normal upper reflections of the pericardium and simulate an anterior mediastinal mass. (orig.)

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

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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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Silicone oil migration along the optic nerve after intraocular tamponade.

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Gargallo Vaamonde, Á; Ibáñez Muñoz, D; Salceda Artola, J; Garatea Aznar, P; Zalazar, R; Yanguas Barea, N

2016-11-01

We present a case of silicone oil migration trough the optic nerve in a diabetic patient with retinal detachment and review the etiologic mechanism and clinical implications. Intracranial silicone oil migration is an uncommon complication associated with silicone oil tamponade. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Impact of 10% SF6 Gas Compared to 100% Air Tamponade in Descemet's Membrane Endothelial Keratoplasty.

Science.gov (United States)

Rickmann, Annekatrin; Szurman, Peter; Jung, Sacha; Boden, Karl Thomas; Wahl, Silke; Haus, Arno; Boden, Katrin; Januschowski, Kai

2018-04-01

To compare the clinical outcomes following Descemet's membrane endothelial keratoplasty (DMEK) with 100% air tamponade versus 10% sulfur hexafluoride (SF 6 ) tamponade. Retrospective analysis of 108 consecutive DMEK cases subdivided by anterior chamber tamponade with 54 eyes receiving 10% SF 6 and 54 eyes receiving 100% air injection. A post-hoc matched analysis revealed no statistically significant differences between the groups. The main outcome measurements were the complication rate, including intra- and postoperative complications and graft detachment rate requiring re-bubbling. Clinical outcome included best-corrected visual acuity (BCVA), endothelial cell count (ECC), and central corneal thickness (CCT) measured 1, 3, and 6 months after DMEK surgery. The graft detachment rate with consecutive re-bubbling was 18.5% in the air group and 22.2% in the SF 6 group (p = 0.2). Remaining small peripheral graft detachments with a clear cornea occurred more often in the 100% air group (air: 22.2%; 12/54, 6/12 inferior compared to SF 6 : 7.4%; 4/54, 2/4 inferior; p = 0.06). The primary graft failure rate was comparable between the two groups. No complete graft detachment occurred. Outcome results for BCVA, ECC, and CCT at all follow-up time points were comparable between the two groups. The clinical outcomes (including re-bubbling rate, primary graft failure rate, and endothelial cell loss) were comparable with 100% air versus 10% SF 6 tamponade, whereas other studies suggest that a higher SF 6 concentration (20%) may result in a lower re-bubbling rate.

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; Grandjean, Jan G.; Haalebos, Max M.P.; von Birgelen, 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

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.

Preliminary study of the safety and efficacy of medium-chain triglycerides for use as an intraocular tamponading agent in minipigs.

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Soler, Vincent J; Laurent, Camille; Sakr, Frédéric; Regnier, Alain; Tricoire, Cyrielle; Cases, Olivier; Kozyraki, Renata; Douet, Jean-Yves; Pagot-Mathis, Véronique

2017-08-01

To date, only silicone oils and gases have the appropriate characteristics for use in vitreo-retinal surgery as vitreous substitutes with intraocular tamponading properties. This preliminary study evaluated the safety and efficacy of medium-chain triglycerides (MCTs) for use as a tamponading agent in minipigs. In 15 minipigs, 15 right eyes underwent vitrectomies followed by injection of MCT tamponade (day 1). Two groups were defined. In Group A (ten eyes), the surgical procedure before MCT injection included induced rhegmatogenous retinal detachment (RRD), retina flattening, and retinopexy. In Group B (five eyes), MCT was injected without inducing RRD; in these eyes, MCT was removed on day 90. Pigs were sacrificed on day 45 (Group A) or 120 (Group B). Eyes were examined on days 1, 5, 15, and 45 in both groups and on days 90 and 120 in Group B. In Group B only, we performed bilateral electroretinography examinations on days 1 and 120, and histological examinations of MCTs and controlateral eyes were performed after sacrifice. In Group A eyes (n = 9; one eye was non-assessable), on day 45, the retina was flat in seven eyes and two RRD detachments were observed in insufficiently MCT-filled eyes. In Group B, electroretinography showed no significant differences between MCT eyes and controls on days 1 or 120. Histological analyses revealed no signs of retinal toxicity. This study showed that MCT tamponade seems to be effective and safe; however, additional studies are needed before it becomes commonly used as a tamponading agent in humans.

CT features of cardio-pericardial masses

International Nuclear Information System (INIS)

Vasile, N.; Nicoleau, F.; Mathieu, D.

1986-01-01

The results of dynamic computed tomography (CT) in 13 patients with intracardiac filling defects and one with a pericardial lipoma are presented. The intracardiac filling defects were due to thrombus in five cases, myxoma in three, hydatid cysts in three, haemangiopericytoma in one and sarcoma in one. These kinds of lesions are well identified by CT which seems to be superior to echocardiography in the characterisation of the components and in the evaluation of the malignant spreading masses. (orig.)

IOP measurement in silicone oil tamponade eyes by Corvis ST tonometer, Goldmann applanation tonometry and non-contact tonometry.

Science.gov (United States)

Zhang, Yang; Zheng, Lin; Bian, Ailing; Zhou, Qi

2018-04-01

To compare the postoperative intraocular pressure (IOP) of eyes following pars plana vitrectomy (PPV) combined with intravitreal silicone oil (SO) tamponade by Corneal Visualization Scheimpflug Technology (CST), Goldmann applanation tonometry (GAT) and non-contact tonometry (NCT). Thirty-eight participants who had undergone PPV combined with SO tamponade to treat vitreoretinal diseases were enrolled. Postoperative IOP measurements were obtained using CST, NCT and GAT. Inter-device agreement was assessed by Bland-Altman analysis. The correlation coefficient was used to describe the potential postoperative factors affecting the postoperative IOP differences between each device. Bland-Altman analysis revealed the bias between CST and GAT, between CST and NCT, and between GAT and NCT to be -0.2, 2.1 and 2.4 mmHg, respectively. CST and GAT correlated well with each other. NCT values were lower than those of GAT and CST (all p contact method for measuring postoperative IOP in SO tamponade eyes.

Rebubbling in Descemet Membrane Endothelial Keratoplasty: Influence of Pressure and Duration of the Intracameral Air Tamponade.

Science.gov (United States)

Pilger, Daniel; Wilkemeyer, Ina; Schroeter, Jan; Maier, Anna-Karina B; Torun, Necip

2017-06-01

To explore the impact of intracameral air tamponade pressure and duration on graft attachment and rebubbling rates. A prospective, interventional, nonrandomized study. setting: Department of Ophthalmology, Charité - Universitätsmedizin Berlin. One hundred seventeen patients who underwent Descemet membrane endothelial keratoplasty (DMEK). Intraocular pressure (IOP) at the end of the surgery, immediately after filling the anterior chamber with air, categorized into low (20 mm Hg), and the time until partial removal of the air. Rebubbling rates and endothelial cell density over a 3-month follow-up period analyzed by a multivariable Cox regression model and an analysis of covariance model. Thirty-two patients required a rebubbling (27% [95% CI 19%-35%]). Nine patients required more than 1 rebubbling (7% [95% CI 3%-12%]). Compared with normal IOP, lower (HR 8.98 [95% CI 1.07-75.41]) and higher IOP (HR 10.63 [95% CI 1.44-78.27]) increased the risk of requiring a rebubbling (P = .006). Independent of the IOP, an air tamponade duration beyond 2 hours reduced the risk of rebubbling (HR 0.36 [95% CI 0.18-0.71, P = .003]). One month after surgery, the mean endothelial cell loss was 13% (95% CI 2%-25%) and 23% (95% CI 17%-29%) in the group with air tamponade duration of below and above 2 hours, respectively (P = .126). At 3 months after surgery, it was 31% (95% CI 17%-42%) and 42% (95% CI 32%-52%) in the respective groups (P = .229). A postsurgical air tamponade of at least 2 hours with an IOP within the physiological range could help to reduce rebubbling rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C3F8 without Posturing

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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.

Vitrectomy and internal limiting membrane peeling with different vitreous tamponade for idiopathic macular epiretinal membrane

Directory of Open Access Journals (Sweden)

Jie Dong

2013-06-01

Full Text Available AIM: To compare visual outcomes, central foveal thickness(CFT, and postoperative complications after vitrectomy and internal limiting membrane(ILMpeeling, with balanced salt solution(BSSor gas tamponade, for the treatment of idiopathic macular epiretinal membrane(IMEM. METHODS: Retrospective clinical study. 44 patients with IMEM were included in this study. All patients had undergone vitrectomy and ILM peeling. Eyes were divided into two groups: 20 eyes in group A with BSS tamponade. 24 patients in group B with gas tamponade(11 eyes were injected with filtered air and 13 eyes with perfluoropropane,100mL/L C3F8. The follow-up period was 12-16(mean 13months. The following parameters were collected and compared: best-corrected visual acuity(BCVAand CFT(at baseline and 1, 3, 6 and 12 months postoperatively, intraocular pressure(IOP(at baseline and on the 1th,7th day, 1, 3 months postoperatively. RESULTS: BCVA significantly improved, and 29 of 44 eyes(65.9%achieved visual recovery≥0.2 logMAR. There were no significant differences between group A and group B in mean baseline logMAR BCVA(0.53±0.18 vs 0.52±0.14; P>0.05and final logMAR BCVA(0.31±0.14 vs 0.28±0.09; P>0.05. With respect to OCT parameters, the mean CFT at 12 months(285.25±70.07μmwas significantly decreased from that of the baseline(407.82±97.00μm,(Z=4.29, Pvs 406.46±88.76μm; P>0.05and final CFT(287.60±66.94μm vs 283.29±73.95μm; P>0.05. With respect to IOP, there were no significant differences between group A and group B at mean baseline and on the 7th day, 1, 3 months postoperatively(P>0.05. The IOP in group A was significant lower at 1th postoperative day compared with group B(Z=3.12, PCONCLUSION: Vitrectomy and ILM peeling can significantly improve the visual acuity and decrease the CFT no matter with gas or with BSS tamponade, there were no significant differences in clinical outcomes, but it is neither necessary for patients with BSS tamponade to maintain a prone

Primary Cardiac Burkitt Lymphoma Presenting with Abdominal Pain

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Dimitrios Tzachanis

2014-01-01

Full Text Available We describe the case of a 44-year-old woman with primary Burkitt lymphoma of the heart who presented with abdominal bloating and epigastric discomfort secondary to tamponade physiology caused by a large pericardial effusion. The pericardial fluid contained a large number of highly atypical lymphocytes with moderate basophilic cytoplasm, rare punched-out vacuoles, a vesicular nuclear chromatin, large nucleolus, and marginated chromatin that by FISH were positive for the 8;14 translocation. She had no other sites of disease. She was treated with four alternating cycles of modified CODOX-M and IVAC in combination with rituximab and remains in remission more than 5 years since diagnosis.

Outcomes of using a sutureless bovine pericardial patch graft for Ahmed glaucoma valve implantation.

Science.gov (United States)

Quaranta, Luciano; Riva, Ivano; Floriani, Irene C

2013-01-01

To evaluate the long-term outcomes of a surgical technique using a sutureless bovine pericardial patch graft for the implantation of an Ahmed glaucoma valve (AGV). 
 This was a pilot study on patients with primary open-angle glaucoma refractory to repeated surgical filtering procedures. All patients underwent AGV implant technique using a sutureless bovine pericardial patch graft. The pericardial membrane was cut using an ordinary corneal trephine with a diameter of 9.0 or 10.0 mm. The anterior part of the tube was covered with the graft and kept in place with fibrin glue. Subsequently, the cap was stitched all around the tube and the dissected conjunctiva was laid over it. Intraocular pressure (IOP) and complications were evaluated 1 week and 1, 3, 6, 12, and 24 months after surgery.
 The procedure was used to treat 20 eyes of 20 consecutive patients (12 men and 8 women: mean age [SD] 64.8 [7.8] years). Mean IOP was 28.1 mm Hg (SD 4.9) at baseline and decreased to 14.9 mm Hg (SD 1.5) 24 months after surgery (pendophthalmitis were recorded.
 The results suggest that the sutureless technique using a bovine pericardial graft patch is a safe and rapid procedure for AGV implantation.

[Opacification of an intraocular lens: calcification of hydrophilic intraocular lenses after gas tamponade of the anterior chamber].

Science.gov (United States)

Schmidinger, G; Pemp, B; Werner, L

2013-11-01

A patient with endothelial dystrophy was treated with Descemet stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and implantation of a hydrophilic intraocular lens (IOL, Lentis-L312, Oculentis) but visual acuity dropped from 0.15 logMAR to 0.52 logMAR 18 months later due to calcification of the IOL. With new methods of lamellar corneal transplantation being used more frequently the number of necessary anterior chamber tamponades with air/gas are increasing. In cataract cases in which a gas tamponade and transplantation might be necessary later on (cornea guttata), hydrophilic IOLs should be avoided.

Complement activation on the surface of cell-derived microparticles during cardiac surgery with cardiopulmonary bypass - is retransfusion of pericardial blood harmful?

Science.gov (United States)

Biró, E; van den Goor, J M; de Mol, B A; Schaap, M C; Ko, L-Y; Sturk, A; Hack, C E; Nieuwland, R

2011-01-01

To investigate whether cell-derived microparticles play a role in complement activation in pericardial blood of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and whether microparticles in pericardial blood contribute to systemic complement activation upon retransfusion. Pericardial blood of 13 patients was retransfused in 9 and discarded in 4 cases. Microparticles were isolated from systemic blood collected before anesthesia (T1) and at the end of CPB (T2), and from pericardial blood. The microparticles were analyzed by flow cytometry for bound complement components C1q, C4 and C3, and bound complement activator molecules C-reactive protein (CRP), serum amyloid P-component (SAP), immunoglobulin (Ig)M and IgG. Fluid-phase complement activation products (C4b/c, C3b/c) and activator molecules were determined by ELISA. Compared with systemic T1 blood, pericardial blood contained increased C4b/c and C3b/c, and increased levels of microparticles with bound complement components. In systemic T1 samples, microparticle-bound CRP, whereas in pericardial blood, microparticle-bound SAP and IgM were associated with complement activation. At the end of CPB, increased C3b/c (but not C4b/c) was present in systemic T2 blood compared with T1, while concentrations of microparticles binding complement components and of those binding complement activator molecules were similar. Concentrations of fluid-phase complement activation products and microparticles were similar in patients whether or not retransfused with pericardial blood. In pericardial blood of patients undergoing cardiac surgery with CPB, microparticles contribute to activation of the complement system via bound SAP and IgM. Retransfusion of pericardial blood, however, does not contribute to systemic complement activation.

Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study.

Science.gov (United States)

Pala, Şehmus; Atilgan, Remzi; Başpınar, Melike; Kavak, Ebru Çelik; Yavuzkır, Şeyda; Akyol, Alparslan; Kavak, Burçin

2018-02-01

The aim of this study was to compare the postoperative results of the patients who were treated with Bakri balloon tamponade or hysterectomy for placenta accreta and increta. Patients who were diagnosed with placenta accreta or increta preoperatively and intraoperatively and treated with Bakri balloon tamponade (Group 1) or caesarean hysterectomy (Group 2) were compared in regards to the postoperative results. Among the 36 patients diagnosed with placenta accreta or increta, 19 patients were treated with Bakri balloon tamponade while 17 cases were treated with hysterectomy. Intraoperative blood loss amount was 1794 ± 725 ml in G1, which was lower than that in G2 (2694 ± 893 ml). Blood transfusion amount was 2.7 ± 2.6 units in G1, lower than that in G2 (5.7 ± 2.4 units), too. Operation time was 64.5 ± 29 min and 140 ± 51 min in G1 and G2, respectively, showing significant differences between two groups. The success rate of Bakri balloon was determined as 84.21%. In conclusion, cases with placenta accreta/increta, with predicted placental detachment who are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy is encouraging with its advantages compared with the hysterectomy. Impact statement What is already known on this subject: Invasive placental anomalies are the most common indication of postpartum hysterectomy. Recently, uterine balloon tamponade was also included in the treatment modalities of postpartum haemorrhage.This study aimed to compare the postoperative results of UBT or hysterectomy for patients with placenta accreta and increta. What the results of this study add: In this study, the total amount of blood loss was higher in the caesarean hysterectomy group when compared with the Bakri balloon tamponade group. The mean transfusion requirement, mean operation time and hospitalisation period was significantly longer in the caesarean hysterectomy group. The success

Heparin-Induced Cardiac Tamponade and Life-Threatening Hyperkalemia in a Patient with Chronic Hemodialysis

Directory of Open Access Journals (Sweden)

Ho-Ming Su

2005-03-01

Full Text Available Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.

Biomaterial Characterization of Off-the-Shelf Decellularized Porcine Pericardial Tissue for use in Prosthetic Valvular Applications.

Science.gov (United States)

Choe, Joshua A; Jana, Soumen; Tefft, Brandon J; Hennessy, Ryan S; Go, Jason; Morse, David; Lerman, Amir; Young, Melissa D

2018-05-10

Fixed pericardial tissue is commonly used for commercially available xenograft valve implants, and has proven durability, but lacks the capability to remodel and grow. Decellularized porcine pericardial tissue has the promise to outperform fixed tissue and remodel, but the decellularization process has been shown to damage the collagen structure and reduce mechanical integrity of the tissue. Therefore, a comparison of uniaxial tensile properties was performed on decellularized, decellularized-sterilized, fixed, and native porcine pericardial tissue, versus native valve leaflet cusps. The results of non-parametric analysis showed statistically significant differences (ptesting of the tissues showed no statistical difference between decellularized or decell-sterilized tissue compared to native cusps (p>0.05). SEM confirmed that valvular endothelial and interstitial cells colonized the decellularized pericardial surface when seeded and grown for 30 days in static culture. Collagen assays and TEM analysis showed limited reductions in collagen with processing; yet, GAG assays showed great reductions in the processed pericardium relative to native cusps. Decellularized pericardium had comparatively lower mechanical properties amongst the groups studied; yet, the stiffness was comparatively similar to the native cusps and demonstrated a lack of cytotoxicity. Suture retention, accelerated wear, and hydrodynamic testing of prototype decellularized and decell-sterilized valves showed positive functionality. Sterilized tissue could mimic valvular mechanical environment in vitro, therefore making it a viable potential candidate for off-the-shelf tissue engineered valvular applications. KEYTERMS Decellularization, Sterilization, Pericardial Tissue, Heart Valves, Tissue Engineering, Biomechanics. This article is protected by copyright. All rights reserved.

CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

Energy Technology Data Exchange (ETDEWEB)

Eichler, Katrin, E-mail: k.eichler@em.uni-frankfurt.d [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Zangos, Stephan; Thalhammer, Axel; Jacobi, Volkmar [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Walcher, Felix; Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt (Germany); Moritz, Anton [Department of Thoracic and Cardiovascular Surgery, University of Frankfurt, Frankfurt (Germany); Vogl, Thomas J.; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany)

2010-07-15

Objective: To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods: 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results: All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

International Nuclear Information System (INIS)

Eichler, Katrin; Zangos, Stephan; Thalhammer, Axel; Jacobi, Volkmar; Walcher, Felix; Marzi, Ingo; Moritz, Anton; Vogl, Thomas J.; Mack, Martin G.

2010-01-01

Objective: To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods: 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results: All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

Pericardial Mesothelioma in a Yellow-naped Amazon Parrot (Amazona auropalliata).

Science.gov (United States)

McCleery, Brynn; Jones, Michael P; Manasse, Jorden; Johns, Sara; Gompf, Rebecca E; Newman, Shelley

2015-03-01

A 37-year-old female yellow-naped Amazon parrot (Amazona auropalliata) was presented with a history of lethargy, inappetence, and decreased vocalizations. On examination, the coelom was moderately distended and palpated fluctuant, and the heart was muffled on auscultation. Coelomic ultrasound, coelomocentesis, and radiographs were performed and revealed an enlarged cardiac silhouette and marked coelomic effusion. Pericardial effusion was confirmed by echocardiography. A well-circumscribed, hyperechoic soft tissue density was observed at the level of the right atrium on initial echocardiography; however, a cardiac mass was not identified by computed tomography scan or repeat echocardiograms. Ultrasound-guided pericardiocentesis was performed under anesthesia, and cytology results were consistent with hemorrhage; no neoplastic cells were identified. A repeat echocardiogram 4 days after pericardiocentesis revealed recurrence of the pericardial effusion. Due to the grave prognosis, the owners declined endoscopic pericardiectomy, and the patient died the following day. On postmortem examination, the pericardial surface of the heart was covered in a white to yellow, multinodular mass layer. Histologic analysis revealed a multinodular mass extending from the atria, running along the epicardium distally, and often extending into the myocardium. Neoplastic cells present in the heart mass and pericardium did not stain with a Churukian-Schenk stain, and thyroglobulin immunohistochemistry was negative. Cytokeratin and vimentin stains showed positive expression in the neoplastic cells within the mass. These results are consistent with a diagnosis of mesothelioma. This is the first report of mesothelioma in a psittacine bird.

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.

Hemodynamic and regional blood flow distribution responses to dextran, hydralazine, isoproterenol and amrinone during experimental cardiac tamponade

International Nuclear Information System (INIS)

Millard, R.W.; Fowler, N.O.; Gabel, M.

1983-01-01

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

[Gas tamponade following intraoperative pneumothorax on a single lung: A case study].

Science.gov (United States)

El Jaouhari, S D; Mamane Nassirou, O; Meziane, M; Bensghir, M; Haimeur, C

2017-04-01

Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation. Intraoperative pneumothorax can occur due to lesions of the tracheobronchial airway, of the brachial plexus, the placement of a central venous catheter or barotrauma. The diagnosis of pneumothorax during unipulmonary ventilation is posed by the sudden onset of hypoxia associated with increased airway pressures and hypercapnia. The immediate life-saving procedure involves fine needle exsufflation before the placement of a chest tube. Prevention involves reducing the risk of barotrauma by infusing patients with low flow volumes and the proper use of positive airway pressure, knowing that despite protective ventilation, barotraumas risk still exists. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Risk factors for pericardial effusion after chemoradiotherapy for thoracic esophageal cancer-comparison of four-field technique and traditional two opposed fields technique.

Science.gov (United States)

Takata, Noriko; Kataoka, Masaaki; Hamamoto, Yasushi; Tsuruoka, Shintaro; Kanzaki, Hiromitsu; Uwatsu, Kotaro; Nagasaki, Kei; Mochizuki, Teruhito

2018-04-11

Pericardial effusion is an important late toxicity after concurrent chemoradiotherapy (CCRT) for locally advanced esophageal cancer. We investigated the clinical and dosimetric factors that were related to pericardial effusion among patients with thoracic esophageal cancer who were treated with definitive CCRT using the two opposed fields technique (TFT) or the four-field technique (FFT), as well as the effectiveness of FFT. During 2007-2015, 169 patients with middle and/or lower thoracic esophageal cancer received definitive CCRT, and 94 patients were evaluable (51 FFT cases and 43 TFT cases). Pericardial effusion was observed in 74 patients (79%) and appeared at 1-18.5 months (median: 5.25 months) after CCRT. The 1-year incidences of pericardial effusions were 73.2% and 76.7% in the FFT and TFT groups, respectively (P = 0.6395). The mean doses to the pericardium were 28.6 Gy and 31.8 Gy in the FFT and TFT groups, respectively (P = 0.0259), and the V40 Gy proportions were 33.5% and 48.2% in the FFT and TFT groups, respectively (P effusion was not observed in patients with a pericardial V40 Gy of effusion after CCRT were similar in both groups. As symptomatic pericardial effusion was not observed in patients with a pericardial V40 Gy of effusion.

Post-irradiation pericardial malignant mesothelioma with deletion of p16: a case report.

Science.gov (United States)

Naeini, Yalda B; Arcega, Ramir; Hirschowitz, Sharon; Rao, Nagesh; Xu, Haodong

2018-02-01

Malignant mesotheliomas are rather uncommon neoplasms associated primarily with asbestos exposure; however, they may also arise as second primary malignancies after radiation therapy, with a latency period of 15-25 years. Numerous studies have reported an association between pleural malignant mesothelioma and chest radiation performed for other malignancies; on the other hand, post-irradiation mesotheliomas of the pericardium have been reported in only a few published cases to date, and no homozygous deletion of 9p21 has been described in such cases. We report the case of a 48-year-old man with a history of Hodgkin's lymphoma and no prior asbestos exposure who developed pericardial malignant epithelioid mesothelioma. We further discuss the cytologic, histologic, immunophenotypic, and fluorescence in situ hybridization findings in this case. To our knowledge, this is the first well-documented case of post-radiation pericardial malignant mesothelioma showing homozygous deletion of 9p21. Homozygous deletion of 9p21, the locus harboring the p16 gene, is present in post-irradiation pericardial malignant mesothelioma.

Clinical study of secondary glaucoma after silicone oil tamponade

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Xiao-Chun Chen

2013-12-01

Full Text Available AIM: To evaluate the related risk factors and treatment method of secondary glaucoma after pars plana vitrectomy and silicone oil tamponade.METHODS: The retrospective study analyzed 114 patients(118 eyeswho were treated with pars plana vitrectomy combined with silicone oil tamponade. Lenses were reserved in 78 eyes and were taken away in 40 eyes among which intraocular lens were implanted in 17 eyes. There were 39 eyes in which the filling time of silicone was no more than 6 months while 79 eyes in which the filling time was more than 6 months. The follow-up time was(16.2±4.9months. Primary and secondary glaucoma were excluded before the vitrectomy. Silicone oil glaucoma(SOGwas diagnosed when intraocular pressure(IOPwas measured higher than 21mmHg(1mmHg=0.133kPathree times in succession at least 1 month after silicone oil tamponade and inflammation and neovascular glaucoma should be excluded. Anti-glaucoma drugs were administrated once SOG was diagnosed. If the IOP was not controlled after 2 weeks, the silicone oil was taken away. If the IOP was still high, the anti-glaucoma surgery was operated. The data was analyzed by the SPSS 16.0 software using a binary logistic regression analysis. RESULTS: Among the 32 eyes of SOG, lenses were removed in 16 eyes(50%. The filling time of silicone oil was more than 6 months in 27 eyes(84.4%and silicone oil emulsion happened in 20 eyes(62.5%. IOP returned normal in 17 eyes after administrating anti-glaucoma medication within 2 weeks. Silicone oils were taken away in 15 eyes. However, 4 eyes still had high IOP after surgery; one of them was given anti-glaucoma drugs once more; two of them underwent trabeculectomy and one of them underwent cyclophotocoagulation. The lens conditions(whether it was taken away or not, P=0.024, the silicone oil filling time(whether the time was more than 6 months, P=0.014, and the status of the silicone oil(whether emulsification occurred or not, P=0.000were all found to be

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.

Hemodynamic effects of knee-joint tamponade; sup 99m Tc-diphosphonate scintimetry in growing dogs

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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).

A difficult case of esophageal and gastric double cancer with pleural and pericardial effusion following chemo-radiotherapy (CRT)

International Nuclear Information System (INIS)

Aoki, Taro; Kobayashi, Kenji; Tanida, Tsukasa; Hatano, Hisanori; Komori, Takamichi; Matsumoto, Takashi; Nishioka, Kiyonori; Uemura, Yoshio

2007-01-01

A 70-year-old man was presented with esophageal and gastric cancer pointed by his personal doctor in November 2002. Both of the esophageal and gastric cancer were diagnosed as multiples with cStage II and cStage IA, respectively. In consideration of the patient's quality of life (QOL), chemo-radiotherapy (CRT) for esophageal cancer was preceded, and then total gastrectomy was done. Although esophageal cancer was responded as being complete response (CR), 14 courses of FP therapy were added as supportive chemotherapy. Ten months following CRT, pericardial effusion was noticed, so that pericardiocentesis was performed. Also diuretic has been administered up to the present. Nineteen months following CRT, pleural effusion was noticed and thoracentesis was performed several times into both of the pleural cavities, and that was depending on the degree with OK-432 infusion. Consequently, the patient has been controlled well. As a treatment for esophageal and gastric double cancer, we chose CRT rather than esophagectomy because of the excessive invasiveness. Despite of CR, we have had a difficulty with pleural and pericardial effusions due to the late toxicity of radiotherapy. We need to pay attention to the late toxicity in the case of long-term survival following CRT. (author)

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

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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.

ebb® Complete Tamponade System: effective hemostasis for postpartum hemorrhage

OpenAIRE

McQuivey,Ross W; Block,Jon E; Massaro,Robert A

2018-01-01

Ross W McQuivey,1 Jon E Block,2 Robert A Massaro3 1Clinical Innovations, Salt Lake City, UT, USA; 2Independent Clinical Consultant, San Francisco, CA, USA; 3Monmouth Medical Center, Long Branch, NJ, USA Abstract: As a leading cause of maternal death, postpartum hemorrhage (PPH) remains a worldwide obstetrical problem. However, in most cases, mortality and morbidity can be averted if efforts are immediately undertaken to achieve hemostasis. Uterine balloon tamponade has been shown to provide e...

Hydrothorax, hydromediastinum and pericardial effusion: a complication of intravenous alimentation.

Science.gov (United States)

Damtew, B; Lewandowski, B

1984-01-01

Complications secondary to intravenous alimentation are rare but potentially lethal. Massive bilateral pleural effusions and a pericardial effusion developed in a patient receiving prolonged intravenous alimentation. Severe respiratory distress and renal failure ensued. He recovered with appropriate treatment. Images Fig. 1 Fig. 2 Fig. 3 PMID:6428731

Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy.

Science.gov (United States)

Schwartz, Stephen G; Flynn, Harry W; Lee, Wen-Hsiang; Wang, Xue

2014-02-14

Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery) but occasionally may be associated with primary RD. Either way, a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 26 June 2013. We included randomized controlled trials (RCTs) of participants undergoing surgery for RD associated with PVR that compared various tamponade agents. Two review authors screened the search results independently. We used the standard methodological procedures expected by The Cochrane Collaboration. The review included 516 participants from three RCTs. One study was conducted in the USA and consisted of two trials: the first trial randomized 151 adults to receive either silicone oil or sulfur hexafluoride (SF6) gas tamponades; and the second trial randomized 271 adults to receive either

Development of a pericardial acellular matrix biomaterial: biochemical and mechanical effects of cell extraction.

Science.gov (United States)

Courtman, D W; Pereira, C A; Kashef, V; McComb, D; Lee, J M; Wilson, G J

1994-06-01

There is evidence to suggest that the cellular components of homografts and bioprosthetic xenografts may contribute to calcification or immunogenic reactions. A four-step detergent and enzymatic extraction process has been developed to remove cellular components from bovine pericardial tissue. The process results in an acellular matrix material consisting primarily of elastin, insoluble collagen, and tightly bound glycosaminoglycans. Light and electron microscopy confirmed that nearly all cellular constituents are removed without ultrastructural evidence of damage to fibrous components. Collagen denaturation temperatures remained unaltered. Biochemical analysis confirmed the retention of collagen and elastin and some differential extraction of glycosaminoglycans. Low strain rate fracture testing and high strain rate viscoelastic characterization showed that, with the exception of slightly increased stress relaxation, the mechanical properties of the fresh tissue were preserved in the pericardial acellular matrix. Crosslinking of the material in glutaraldehyde or poly(glycidyl ether) produced mechanical changes consistent with the same treatments of fresh tissue. The pericardial acellular matrix is a promising approach to the production of biomaterials for heart valve or cardiovascular patching applications.

False negative pericardial Focused Assessment with Sonography for Trauma examination following cardiac rupture from blunt thoracic trauma: a case report.

Science.gov (United States)

Baker, Laura; Almadani, Ammar; Ball, Chad G

2015-07-15

The Focused Assessment with Sonography for Trauma examination is an invaluable tool in the initial assessment of any injured patient. Although highly sensitive and accurate for identifying hemoperitoneum, occasional false negative results do occur in select scenarios. We present a previously unreported case of survival following blunt cardiac rupture with associated negative pericardial window due to a concurrent pericardial wall laceration. A healthy 46-year-old white woman presented to our level 1 trauma center with hemodynamic instability following a motor vehicle collision. Although her abdominal Focused Assessment with Sonography for Trauma windows were positive for fluid, her pericardial window was negative. After immediate transfer to the operating room in the setting of persistent instability, a subsequent thoracotomy identified a blunt cardiac rupture that was draining into the ipsilateral pleural space via an adjacent tear in the pericardium. The cardiac injury was controlled with digital pressure, resuscitation completed, and then repaired using standard cardiorrhaphy techniques. Following repair of her injuries (left ventricle, left atrial appendage, and liver), her postoperative course was uneventful. Evaluation of the pericardial space using Focused Assessment with Sonography for Trauma is an important component in the initial assessment of the severely injured patient. Even in cases of blunt mechanisms however, clinicians must be wary of occasional false negative pericardial ultrasound evaluations secondary to a concomitant pericardial laceration and subsequent decompression of hemorrhage from the cardiac rupture into the ipsilateral pleural space.

The alterations of plasma ET-1 and NO post selective pericardial devascularization in patients with hepatic portal hypertension

International Nuclear Information System (INIS)

Wang Chunxi; Niu Lei; Xia Shaoyou; Peng Zheng

2011-01-01

Objective: To investigate the alterations of plasma endothelin-1 (ET-1) and nitric oxide (NO) post the selective pericardial devascularization in patients with hepatic portal hypertension,and to investigate the relationship between such alterations with illness and therapeutic effects. Methods: Before treatment,plasma ET-1 and NO contents were determined by radioimmunoassay (RIA) and Griss method respectively in 92 patients with hepatic portal hypertension. One day and three weeks after operation, 66 operated cases with selective pericardial devascularization in patients with hepatic protal hypertension were also determined the levels of plasma ET-1 and NO with RIA. Results: The levels of plasma ET-1 and NO were increased in 92 patients with hepatic portal hypertension, and which closely related to the stage of illness. Post effective selective pericardial devascularization the high levels of plasma ET-1 and No were improved and were closely returned to normal after 3 week's. Conclusion: Clinical detection of plasma ET-1 and NO levels were useful for assessment of the therapeutic effects of selective pericardial devascularization in patients with hepatic portal hypertension. (authors)

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

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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

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

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

Probable Hydrochlorothiazide-Induced Myopericarditis: First Case Reported

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Toufik Mahfood Haddad

2015-01-01

Full Text Available Hydrochlorothiazide has never been reported as a reason for myopericarditis. An African American female, with past history of hypertension, coronary artery disease, and sulfa allergy, presented with indolent onset and retrosternal chest pain which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications included hydrochlorothiazide (HCTZ which was started three months ago for uncontrolled hypertension. Significant laboratory parameters included erythrocyte sedimentation rate (ESR of 47 mm/hr and peak troponin of 0.26 ng/mL. Transthoracic echocardiogram (TTE revealed preserved ejection fraction with no segmental wall motion abnormalities; however, it showed moderate pericardial effusion without tamponade physiology. We hypothesize that this myopericarditis could be due to HCTZ allergic reaction after all other common etiologies have been ruled out. There is a scarcity of the literature regarding HCTZ as an etiology for pericardial disease, with only one case reported as presumed hydrochlorothiazide-induced pericardial effusion. Management involves discontinuation of HCTZ and starting anti-inflammatory therapy.

Pulse methylprednisolone therapy for impending cardiac tamponade in immunoglobulin-resistant Kawasaki disease

NARCIS (Netherlands)

Dahlem, P. G.; von Rosenstiel, I. A.; Lam, J.; Kuijpers, T. W.

1999-01-01

We describe a boy with Kawasaki disease (KD) whose clinical course was marked by a rapid improvement upon treatment with intravenous immunoglobulin (IVIG) and oral aspirin, which - within 14 days - was followed by the development of a large pericardial effusion with symptoms of impending cardiac

Gastropericardial Fistula and Candida albicans Pericarditis: A Rare Complication of Gastric Adenocarcinoma Treated with Radiation and Chemotherapy

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Chia-Pei Tang

2009-07-01

Full Text Available Gastropericardial fistula is generally associated with benign gastric diseases and is an uncommon complication of gastric adenocarcinoma. Pericarditis and cardiac tamponade are the ultimate outcome, with extremely high mortality rates. We report a 47-year-old man with gastric adenocarcinoma who had completed radiotherapy and was on scheduled chemotherapy, who presented with fever and chest pain. Gastric adenocarcinoma complicated with gastropericardial fistula and Candida albicans pericarditis were diagnosed and treated successfully with conservative management. Initial chest radiography and computed tomography (CT revealed no evident pericardial air or fluid. However, follow-up panendoscopy 2 weeks later revealed a malignant ulcer with a fistula opening over the lesser curvature of the high body of the stomach. Subsequent chest radiography and CT revealed pneumopericardium with fluid accumulation. Emergent CT-guided pericardial drainage was performed. The fluid was positive for Candida albicans. Total parenteral nutrition and antifungal therapy were administered. The patient refused surgical intervention and survived with medical management alone. This case demonstrates that first, panendoscopy may be safely performed in patients with gastropericardial fistula without significant risk of cardiac tamponade; second, although early diagnosis of gastropericardial fistula is generally important, delayed recognition may not lead to devastating outcomes even in the absence of surgical intervention.

Therapeutic effects of 5-fluorouracil sustained-release particles in 81 malignant pericardial effusion patients

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Yong-Li Ji

2015-02-01

Full Text Available This study aimed to investigate the clinical application value of the 5-fluorouracil (5-FU sustained-release particles implanted along the cardiac tangent direction into malignant pericardial effusion (MPCE. A total of 81 MPCE patients underwent pericardiocentesis, and were implanted with 5-FU sustained-release particles into the pericardial cavity under ultrasound guidance. The puncturing path was along the cardiac tangent direction. Ultrasound examinations were performed every week, and the efficacy was evaluated 4 weeks after treatment. The 45 patients who were treated with pericardial catheter drainage and simultaneous intracavitary chemotherapy were used as the control group. The success rate of pericardiocentesis was 100%. Ultrasound reviews performed 4 weeks after treatment showed that 71 cases achieved complete remission and eight cases achieved partial remission, while treatment was completely ineffective in two cases. The total remission rate was 97.53%, which was significantly higher than that of the control group (77.78%, p < 0.01. The implantation of 5-FU sustained-release particles along the cardiac tangent direction was safe, and demonstrated good efficacy and fewer adverse reactions. Thus, this method could be ideal for the treatment of MPCE.

Acute rhabdomyolysis and delayed pericardial effusion in an Italian patient with Ebola virus disease: a case report.

Science.gov (United States)

Nicastri, Emanuele; Brucato, Antonio; Petrosillo, Nicola; Biava, Gianluigi; Uyeki, Timothy M; Ippolito, Giuseppe

2017-08-30

During the 2013-2016 West Africa Ebola virus disease (EVD) epidemic, some EVD patients, mostly health care workers, were evacuated to Europe and the USA. In May 2015, a 37-year old male nurse contracted Ebola virus disease in Sierra Leone. After Ebola virus detection in plasma, he was medically-evacuated to Italy. At admission, rhabdomyolysis was clinically and laboratory-diagnosed and was treated with aggressive hydration, oral favipiravir and intravenous investigational monoclonal antibodies against Ebola virus. The recovery clinical phase was complicated by a febrile thrombocytopenic syndrome with pericardial effusion treated with corticosteroids for 10 days and indomethacin for 2 months. No evidence of recurrence is reported. A febrile thrombocytopenic syndrome with pericardial effusion during the recovery phase of EVD appears to be uncommon. Clinical improvement with corticosteroid treatment suggests that an immune-mediated mechanism contributed to the pericardial effusion.

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

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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.

A rare cause of pericardial effusion and ascites: POEMS syndrome

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Bilal Katipoglu

2017-12-01

Full Text Available POEMS syndrome is an important paraneoplastic syndrome associated with multisystem involvement. Extravascular volume overload like pericardial effusion and ascites has a broad differential diagnosis. In addition, it may be initial presentation of disease. For that reason, this case report is highlight to warn of different forms of presentation of poems syndrome.

Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

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Vivek Chowdhry

2013-01-01

Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

Ultrasonographic visualization of bleeding sites can help control postpartum hemorrhage using intrauterine balloon tamponade.

Science.gov (United States)

Kondoh, Eiji; Konishi, Mitsunaga; Kariya, Yoshitaka; Konishi, Ikuo

2015-01-01

Identification of precise bleeding sites is generally important to control hemorrhage. Nevertheless, the optimal technique to detect the bleeding sites has not yet been fully defined for patients with life-threatening post partum hemorrhage. We describe that ultrasonographic visualization of bleeding sites can help control post partum hemorrhage using intrauterine balloon tamponade. © 2014 Wiley Periodicals, Inc.

Isolated right atrial appendage rupture following blunt chest trauma.

Science.gov (United States)

Hegde, Rakesh; Lafayette, Nathan; Sywak, Michael; Ricketts, Gregory; Otero, Jorge; Kurtzman, Scott; Zhang, Zhongqiu

2018-02-01

Right sided tears or rupture are the most common injury to the heart after blunt chest trauma. The majority of these injuries are to the thin walled atrium. Reports of localized right atrial appendage rupture are rare. The classical features of Beck's triad are unreliable in the trauma bay. With the advent of EFAST (Focused assessment with sonography for trauma extended to thorax), Beck's triad should be considered but not used as the primary clinical tool for diagnosis of cardiac tamponade [1]. EFAST aids in rapid diagnosis and definitive care [3]. Our patient was a 17 year old male who presented with hypotension after a rollover motor vehicle accident. He presented with a grossly negative physical exam and positive EFAST for pericardial effusion with tamponade physiology. We performed an emergency pericardiocentesis and expedited transportation for operative exploration. A Right atrial appendage injury was identified and repaired and patient recovered uneventfully. EFAST examination aids in rapid diagnosis of cardiac tamponade in the trauma setting. Pericardiocentesis facilitates temporizing the hemodynamics in preparation for operative exploration.

A Minimally Invasive, Translational Method to Deliver Hydrogels to the Heart Through the Pericardial Space

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Jose R. Garcia, MS

2017-10-01

Full Text Available Biomaterials are a new treatment strategy for cardiovascular diseases but are difficult to deliver to the heart in a safe, precise, and translatable way. We developed a method to deliver hydrogels to the epicardium through the pericardial space. Our device creates a temporary compartment for hydrogel delivery and gelation using anatomic structures. The method minimizes risk to patients from embolization, thrombotic occlusion, and arrhythmia. In pigs there were no clinically relevant acute or subacute adverse effects from pericardial hydrogel delivery, making this a translatable strategy to deliver biomaterials to the heart.

Fisics-Incor bovine pericardial bioprostheses: 15 year results.

Science.gov (United States)

Pomerantzeff, P M; Brandao, C M; Cauduro, P; Puig, L B; Grinberg, M; Tarasoutchi, F; Cardoso, L F; Lerner, A; Stolf, N A; Verginelli, G; Jatene, A D

1998-01-01

From March 1982 to December 1995, 2,607 Fisics-Incor bovine pericardial bioprostheses were implanted in 2,259 patients. Mean age was 47.2 +/- 17.5 years, and 55% were male. Rheumatic fever was present in 1,301 (45.7%) patients. One thousand and seventy-three aortic valve replacements, 1,085 mitral replacements, 27 tricuspid replacements, 195 mitral-aortic replacements, and 16 other combined valve replacements were carried out. Combined procedures were performed in 788 (32.9%) patients, the most frequent being tricuspid valve repair (9.2%) and coronary artery bypass grafting (7.7%). Hospital mortality was 8.6% (194 patients), 8.6% for the mitral group, 4.7% for the aortic group, and 12.8% for double-valve replacements. The linear rates for calcification, thromboembolism, rupture, leak and endocarditis were, respectively, 1.1%, 0.2%, 0.9%, 0.1% and 0.5% patient-year. The actuarial survival curve was 56.7 +/- 5.4% in 15 years. Survival free from endocarditis was 91.92%, survival free from thromboembolism was 95 +/- 1.7%, survival free from rupture was 43.7 +/- 9.8%, survival free from leak was 98.9 +/- 4.5%, and survival free from calcification was 48.8 +/- 7.9% in 15 years. In the late postoperative period, 1,614 (80.6%) patients were in New York Heart Association functional Class I. We conclude that the results with the Fisics-Incor bovine pericardial prostheses were satisfactory in our group of patients.

Kidney allograft tolerance in diabetic patients after total lymphoid irradiation (TLI)

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Ang, K.K.; Vanrenterighem, Y.; Waer, M.; Michielsen, P.; Schueren, E. van der (University Hospital St. Rafael, Leuven (Belgium)); Vandeputte, M. (Louvain Univ. (Belgium). Rega Institute for Medical Research)

1985-04-01

The value of total lymphoid irradiation (TLI) combined with low dose prednisone as sole immunosuppressive regimen in renal allograft transplantation in humans has been investigated. Seventeen patients with end-stage diabetic nephropathy received TLI to a cumulative dose of 20-30 Gy in fractions of 1 Gy. Cadaver kidneys were grafted as soon as they were available after completion of TLI. Profound and long-term immunosuppression has been achieved in 17 patients. Six patients live already more than one year and 7 for less than one year with a functioning kidney graft. One patient returned to chronic hemodialysis 11 months after transplantation and died of pericardial tamponade one month later. One patient had severe acute rejection for which cyclosporine A was administered; he died of septic shock as a consequence of immune deficiency a month later. The other two patients succumbed to other causes (myocardial infarction and hyperglycemia).

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

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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.

Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment

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Jian-Di Liu

2013-06-01

Full Text Available AIM: To report the results of combined vitrectomy, lensectomy and silicone oil (SO tamponade in treating primary rhegmatogenous retinal detachment (RRD associated with choroidal detachment (CD.METHODS: A retrospective, consecutive and case series study of 21 subjects with concurrent RRD associated with CD was conducted. All subjects underwent a standard three-port 20G pars plana vitrectomy (PPV with lensectomy and silicone oil tamponade. Mean follow-up time was 8 months (rang from 4 to 19 months. The primary and final anatomic success rate, visual acuity and final intraocular pressure(IOP were recorded and analyzed.RESULTS: Of 21 subjects, 8 were women and 13 were men. Age at presentation ranged from 22 to 75 years (mean 57.4 years. The presenting vision ranged from light perception to 0.15. The initial IOP ranged from 3mmHg to 12mmHg (mean 6.2mmHg. All eyes were phakic except one pseudophakic. No intraocular lens was implanted during the primary surgical intervention. Fifteen of 21 (71.4% eyes had retina reattached after one operation. Six eyes had recurrent inferior retinal detachment due to proliferation. Five of them were successfully reattached after one or more additional operations. Mean IOP at final follow-up was 15.2mmHg (range from 8mmHg to 20mmHg. One case declined for further operation. The final reattachment rate was 95.2%. Visual acuity improved in 19 (90.5% eyes, was unchanged in 1 (4.8% eye and decreased in 1 (4.8% eye.CONCLUSION: Combination of vitrectomy, lensectomy and silicone tamponade is an effective method in treating RRD associated with CD, reducing the incidence of postoperative hypotony.

Marked pericardial inhomogeneity of specific ventilation at total lung capacity and beyond

DEFF Research Database (Denmark)

Sun, Yanping; Butler, James P; Lindholm, Peter

2009-01-01

uniform at FRC+1L, with a small non-gravitational cephalocaudal gradient of specific ventilation in the supine posture. Our observations at high lung volumes are consistent with the effect of high pleural tension in the concave pericardial region, which promotes expansion of the subjacent lung, leading...

Relation of Pericardial Fat, Intrathoracic Fat, and Abdominal Visceral Fat with Incident Atrial Fibrillation (From the Framingham Heart Study)

Science.gov (United States)

Lee, Jane J.; Yin, Xiaoyan; Hoffmann, Udo; Fox, Caroline S.; Benjamin, Emelia J.

2016-01-01

Obesity is associated with increased risk of developing atrial fibrillation (AF). Different fat depots may have differential associations with cardiac pathology. We examined the longitudinal associations between pericardial, intrathoracic, and visceral fat with incident AF. We studied Framingham Heart Study Offspring and Third Generation Cohorts who participated in the multi-detector computed tomography sub-study examination 1. We constructed multivariable-adjusted Cox proportional hazard models for risk of incident AF. Body mass index (BMI) was included in the multivariable-adjusted model as a secondary adjustment. We included 2,135 participants (53.3% women; mean age 58.8 years). During a median follow-up of 9.7 years, we identified 162 cases of incident AF. Across the increasing tertiles of pericardial fat volume, age- and sex-adjusted incident AF rate per 1000 person-years of follow-up were 8.4, 7.5, and 10.2. Based on an age- and sex-adjusted model, greater pericardial fat [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.03-1.34] and intrathoracic fat (HR 1.24, 95% CI 1.06-1.45) were associated with increased risk of incident AF. The HRs (95% CI) for incident AF were 1.13 (0.99-1.30) for pericardial fat, 1.19 (1.01-1.40) for intrathoracic fat, and 1.09 (0.93-1.28) for abdominal visceral fat after multivariable adjustment. After additional adjustment of BMI, none of the associations remained significant (all p>0.05). Our findings suggest that cardiac ectopic fat depots may share common risk factors with AF, which may have led to a lack of independence in the association between pericardial fat with incident AF. PMID:27666172

Effective salvage of acute massive uterine bleeding using intrauterine balloon tamponade in a uterine adenomyosis patient on dienogest.

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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. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

A Life-Threatening Bronchogenic Cyst

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Sung Joon Han

2018-02-01

Full Text Available A bronchogenic cyst causing cardiac tamponade is a rare condition. We report an unusual case of a bronchogenic cyst that caused cardiac tamponade. A 49-year-old female patient presented at our emergency room with complaints of palpitations and shortness of breath that had lasted for 5 days preceding the visit. Echocardiography revealed a v ery large cystic m ass compressing the left a trium posteriorly, and a l arge amount of pericardial effusion caused the diastolic collapse of the ventricles. Atrial fibrillation and aggravated dyspnea were o bserved, and t he p atient’s vital s igns w ere unstable a fter a dmission. We t herefore p erformed an emergency operation. The bronchogenic cyst was resected by thoracotomy and the patient was discharged 12 days after the operation without any complications over 5 years of follow-up.

Lambda light chain disease associated with myelomatous pericardial and pleural effusion

International Nuclear Information System (INIS)

Helbig, G.; Wieczorkiewicz, A.; Dziaczkowska-Suszek, J.; Krzemien, S.

2009-01-01

The paper presents the case of a 53-year patient with lambda light chain disease and concomitant myelomatous pleural and pericardial effusions. The symptoms of cardiac failure dominated the clinical manifestation. Only moderate plasma cell infiltration in bone marrow was present, whereas 100% of these cells infiltrated the pleura. Chemotherapy appeared to be ineffective and patient died from cardiac failure. (authors)

Predictors of Post Pericardiotomy Low Cardiac Output Syndrome in Patients With Pericardial Effusion

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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.

Purulent pericarditis in a dog administered immune-suppressing drugs

International Nuclear Information System (INIS)

Mohri, T.; Takashima, K.; Yamane, T.; Sato, H.; Yamane, Y.

2009-01-01

A 5-year-old castrated mongrel dog was brought to our hospital with anorexia and vomiting. Laboratory testing revealed immune-mediated hemolytic anemia (IMHA), and so treatment was initiated with multiple immune-suppressing drugs, achieving partial remission from IMHA. However, cardiac tamponade due to purulent pericarditis was identified as a secondary disease. Culture of pericardial fluid yielded numerous Candida albicans and multidrug-resistant Acinetobacter sp. Pericardiocentesis was performed, and the condition of the dog improved. However, the dog died the next day

Post cardiac injury syndrome

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Nielsen, S L; Nielsen, F E

1991-01-01

The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery, i...... on the coronary vessels, with cardiac tamponade and chronic pericardial exudate. In the lighter cases, PCIS may be treated with NSAID and, in the more severe cases, with systemic glucocorticoid which has a prompt effect....

Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

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Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

2016-01-01

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

OpenAIRE

Mohamed, Ahmed Abdel Alim; Abdrabbo, Mohamed

2013-01-01

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 f...

Masseter Muscle Hypertrophy and Pericardial Effusion in Kocher-Debre-Semelaigne Syndrome Child

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Taksande AM

2015-10-01

Full Text Available Muscular pseudohypertrophy associated with severe congenital hypothyroidism has been described as Kocher Debre Semelaigne syndrome, which is a rare disorder. We report a case of 9year old female child with hypothyroidism, limb muscular pseudo-hypertrophy with involvement of masseter muscle along with pericardial effusion in Kocher-Debré-Semelaigne syndrome.

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

Pericardial cyst with atypical location: densimetric evaluation of mediastinal masses by computerized tomography

International Nuclear Information System (INIS)

Franquet, T.; Jiminez, F.J.; Eguizabal, C.; Bescos, J.M.

1991-01-01

We present a case of pericardial cyst with atypical location. CT has been very usefull for densitometric evaluation of mediastinal masses. Using a combination of cross-section diagnostic methods and fine-needle aspiration (FNA), we can carry out accurate diagnoses of cystic lesions located in uncommom sites. (Author)

Unusual Thymic Hyperplasia Mimicking Lipomatous Tumor in an Eight-Year-Old Boy with Concomitant Pericardial Lipomatosis and Right Facial Hemihypertrophy

International Nuclear Information System (INIS)

Kim, Yoo Jin; Kim Woo Sun; Cheon, Jung Eun; Lim, Yun Jung; Kim, In One; Yeon, Kyung Mo; Jung, Kyeong Cheon; Byun, Sun Ju

2011-01-01

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.

Cardiac juvenile xanthogranuloma in an infant presenting with pericardial effusion.

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Kobayashi, Daisuke; Delius, Ralph E; Debelenko, Larisa V; Aggarwal, Sanjeev

2013-01-01

Juvenile xanthogranuloma is a rare histiocytic disorder of childhood mainly affecting skin and rarely deep soft tissues and viscera. We report a 2-month-old infant who presented with respiratory distress secondary to a large pericardial effusion associated with an epicardial mass. Excisional biopsy was performed and the mass was diagnosed as juvenile xanthogranuloma. The child is well without evidence of disease 8 months following the excision. The corresponding literature on juvenile xanthogranuloma with cardiac manifestations is reviewed. © 2012 Wiley Periodicals, Inc.

Acute pulmonary embolism in helical computed tomography

International Nuclear Information System (INIS)

Paslawski, M.

2005-01-01

Pulmonary embolism is a common condition in which diagnostic and therapeutic delays contribute to substantial morbidity and mortality. Clinical diagnosis is difficult because the signs and symptoms re unspecific, and a differential diagnosis is extensive, including pneumonia or bronchitis, asthma, myocardial infraction, pulmonary edema, anxiety, dissection of the aorta, pericardial tamponade, lung cancer, primary pulmonary hypertension, rib fracture, and pneumothorax. The purpose of the study was to present the use of CT in diagnosing acute pulmonary embolism. A group of 23 patients with clinically suspected pulmonary embolism underwent CT examination with a helical CT scanner (Somatom Emotion, Siemens) before and after administration of 150 ml of Ultravist. Pulmonary embolism was found in the CT examinations of 13 patients. In two of these it was a central filling defect. Amputation of the artery was found in one. Parietal filling defect in three patients formed an acute angle with the vessel walls. Saddle emboli appearing as filling defects in the contrast column that hung over vessel bifurcations was found in two patients. In five patients,emboli were found in small segmental arteries. CT provides information not only on the pulmonary arteries, but also on the lung parenchyma, hila, mediastinum, and the heart. Alternative findings may be identified by CT chest examination, stablishing alternative diagnoses, including pulmonary disorders (such as pneumonia or fibrosis), pleural abnormalities, and cardiovascular disease (such as aortic dissection or pericardial tamponade). Another advantage of the CT is its widespread availability.(author)

Effect of Temperature-Sensitive Poloxamer Solution/Gel Material on Pericardial Adhesion Prevention: Supine Rabbit Model Study Mimicking Cardiac Surgery.

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Hyun Kang

Full Text Available We investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl2 mixture (PACM in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model.A total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25 and saline as the control group (group CO; n = 25. In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery.In group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001. Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002 and fibrosis score (P = .018 than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant.In a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required.

Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss

NARCIS (Netherlands)

Manshanden, Johan S. J.; Gielen, Chantal L. I.; de Borgie, Corianne A. J. M.; Klautz, Robert J. M.; de Mol, Bas A. J. M.; Koolbergen, David R.

2015-01-01

Background: Prolonged or excessive blood loss is a common complication after cardiac surgery. Blood remnants and clots, remaining in the pericardial space in spite of chest tube drainage, induce high fibrinolytic activity that may contribute to bleeding complications. Continuous postoperative

Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

Science.gov (United States)

Aertker, Robert A; Cheong, Benjamin Y C; Lufschanowski, Roberto

2016-12-01

We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

Pericardial disease and myocarditis: management guide

International Nuclear Information System (INIS)

Marin, Jorge E; Duque, Mauricio; Uribe, William; Medina, Eduardo

2005-01-01

Pericardium is a structure that can be primarily affected by a series of different agents and in a secondary way by systemic processes. Its response is not specific and in general it corresponds to an inflammatory process that can be acute, chronic or recurrent. The recognition of these pathologies is of vital significance in the making of a right therapeutic approach. Some basic orientations for the correct classification, diagnosis and therapy of main pericardial syndromes, based on clinical and etiological aspects and para clinical available aids are presented. Likewise, some recommendations for the specific treatment of each one of the main entities usually affecting the pericardium are given. Next, a brief mention of some pathophysiological aspects of acute myocarditis, its main etiologies, and the treatment of the cardiac failure secondary to the disease with its specific differences, is made, and the controversy on its handling with immuno suppressors and the experimental therapy measures are studied in depth

Use of Intrauterine Balloon Tamponade Test to Determine the Feasibility of Dilation and Evacuation as a Treatment for Early Uterine Artery Pseudoaneurysm

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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.

CT imaging of complications of catheter ablation for atrial fibrillation

International Nuclear Information System (INIS)

Shroff, G.S.; Guirguis, M.S.; Ferguson, E.C.; Oldham, S.A.A.; Kantharia, B.K.

2014-01-01

The complication rate following radiofrequency catheter ablation for atrial fibrillation is low (<5%). Complications include pericardial effusion, cardiac tamponade, pulmonary vein stenosis, oesophageal ulceration or perforation, atrio-oesophageal fistula formation, stroke/transient ischaemic attack, phrenic nerve injury, haematoma at the puncture site, and femoral arteriovenous fistula. Among available imaging tools, computed tomography (CT) can be very useful in diagnosing complications of the procedure, particularly in the subacute and delayed stages after ablation. This review illustrates CT imaging of several of the common and uncommon complications of radiofrequency catheter ablation

Is a modified Senning with pericardial patch associated with less complications and better prognosis?

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Amir Mohamed

2016-08-01

Conclusion: The modified Senning procedure using autologous pericardial patch augmentation, showed less incidence of late PVPS, and higher incidence of restoration of sinus rhythm at the time of discharge in comparison to the published results of the standard technique in the literature. It had a low mortality and comparatively better survival.

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.

Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

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ZHANG Lei

2015-03-01

Full Text Available ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32 and non-bleeding group (n=206. Univariate analysis (t test or chi-square test and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT, activated partial thromboplastin time (APTT, and presence of diabetes (all P<0.05. The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

Oculomotor Nerve Palsy following Cardiac Tamponade with Churg-Strauss Syndrome: A Case Report

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Kazuki Suganuma

2011-10-01

Full Text Available A 57-year-old man with a history of more than 10 years of bronchial asthma and chronic sinusitis complained of double vision which developed 18 days after cardiac tamponade with eosinophil-rich fluid (eosinophils 30%. He had oculomotor nerve palsy, and a blood test revealed eosinophilia (12,700/mm3 and elevation of both C-reactive protein and rheumatoid factor. He was diagnosed as having Churg-Strauss syndrome. His symptoms were relieved by corticosteroid therapy. Our case and previous cases in the literature revealed that oculomotor nerve palsy in Churg-Strauss syndrome is associated with pupil involvement and may be relieved by corticosteroid treatment.

Distinct subsets of Eve-positive pericardial cells stabilise cardiac outflow and contribute to Hox gene-triggered heart morphogenesis in Drosophila.

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Zmojdzian, Monika; de Joussineau, Svetlana; Da Ponte, Jean Philippe; Jagla, Krzysztof

2018-01-17

The Drosophila heart, composed of discrete subsets of cardioblasts and pericardial cells, undergoes Hox-triggered anterior-posterior morphogenesis, leading to a functional subdivision into heart proper and aorta, with its most anterior part forming a funnel-shaped cardiac outflow. Cardioblasts differentiate into Tin-positive 'working myocytes' and Svp-expressing ostial cells. However, developmental fates and functions of heart-associated pericardial cells remain elusive. Here, we show that the pericardial cells that express the transcription factor Even Skipped adopt distinct fates along the anterior-posterior axis. Among them, the most anterior Antp-Ubx-AbdA - negative cells form a novel cardiac outflow component we call the outflow hanging structure, whereas the Antp-expressing cells differentiate into wing heart precursors. Interestingly, Hox gene expression in the Even Skipped-positive cells not only underlies their antero-posterior diversification, but also influences heart morphogenesis in a non-cell-autonomous way. In brief, we identify a new cardiac outflow component derived from a subset of Even Skipped-expressing cells that stabilises the anterior heart tip, and demonstrate non-cell-autonomous effects of Hox gene expression in the Even Skipped-positive cells on heart morphogenesis. © 2018. Published by The Company of Biologists Ltd.

Nontyphoidal Cardiac Salmonellosis: Two Case Reports and a Review of the Literature

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Ortiz, Daniel; Siegal, Eric M.; Kramer, Christopher; Brauer, Ernesto

2014-01-01

Nontyphoidal Salmonella, especially Salmonella enterica, is a rare cause of endocarditis and pericarditis that carries a high mortality rate. Proposed predisposing conditions include immunodeficiency states, congenital heart defects, and cardiac valve diseases. We present 2 cases of cardiovascular salmonellosis. The first case is that of a 73-year-old woman with mechanical mitral and bioprosthetic aortic valves who died from sequelae of nontyphoidal Salmonella mitral valve vegetation, aortic valve abscess, and sepsis. The second case is that of a 62-year-old man with a recent systemic lupus erythematosus exacerbation treated with oral steroids, who presented with obstructive features of tamponade and sepsis secondary to a large S. enteritidis purulent pericardial cyst. He recovered after emergent pericardial drainage and antibiotic therapy. Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment to minimize sequelae and death. We reviewed the literature to identify the predisposing risk factors of nontyphoidal Salmonella cardiac infection. PMID:25120393

Pericarditis as presenting manifestation of acute nonlymphocytic leukemia in a young child.

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Chu, J Y; Demello, D; O'Connor, D M; Chen, S C; Gale, G B

1983-07-15

A case of acute nonlymphocytic leukemia presenting as pericarditis is reported in a five-year-old boy. Initially, a clinical diagnosis of viral pericarditis was made, because the child did not demonstrate hematologic or clinical manifestations of leukemia. Acute undifferentiated or lymphocytic leukemia. Acute undifferentiated or lymphocytic leukemia was diagnosed one week after admission when his peripheral blood count became abnormal. The patient did not respond to vincristine and prednisone. When cytochemical evaluation indicated acute myelomonocytic leukemia, employment of cytosine arabinoside and 6-thioguanine was instituted and the child began to improve. Currently, he is still in good remission and has no evidence of recurrence of pericarditis, 1 1/2 years after his initial presentation. In reviewing the literature, we found 17 patients who had leukemic pericardial effusion with cardiac tamponade. There are three reported cases of young children with pericardial effusion as the initial manifestation of acute lymphocytic leukemia, but no reported cases due to nonlymphocytic leukemia, as in this child.

Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

Science.gov (United States)

Leisser, Christoph; Hirnschall, Nino; Hackl, Christoph; Döller, Birgit; Varsits, Ralph; Ullrich, Marlies; Kefer, Katharina; Karl, Rigal; Findl, Oliver

2018-02-20

Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3 months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3 months after surgery (p = 0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p = 0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p = 0.23; odds ratio: 2.6), age over 70 years (p = 0.29; odds ratio: 0.5) and air-tamponade (p = 0.59; odds ratio: 1.5) were not found to be significant. There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Acute intramural hematoma of ascending aorta. CT findings and clinical outcome

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Yamaguchi, Toshio; Sakuyama, Keiko; Hiekata, Tomizou; Yamanaka, Ikuo [St. Marianna Univ., Kanagawa (Japan). Yokohama Seibu Hospital; Kuroki, Kazunori; Ohyama, Yukio; Ishikawa, Tohru; Kawada, Tadanori; Akashi, Katsuya

1997-12-01

The purpose of this study was to describe the CT findings and clinical outcomes of nineteen patients with acute intramural hematoma (IMH) of the ascending aorta. Six patients underwent surgery on the emergency basis (3 patients) due to cardiac tamponade (n=2) and dilated aorta (n=1), and on the elective basis (3 patients) due to patent and enlarging false lumen. Among the 13 patients with medical management, four patients died from complications of IMH during the follow-up period (2 days-2.5 years). Transition to aortic dissection or enlargement of an intimal tear was noted in 5 patients (31%) in 1 to 6 weeks after onset. Three patients died of causes not related to IMH. Six patients had been alive 2 to 9 years after onset. Retrospective review revealed 10 patients (53%) as possible surgical candidates, and the other 9 patients as medically treated patients in the long-term follow-up. The surgical group showed cardiac tamponade or shock in 6 patients on admission and had pericardial effusion in all the patients on the initial CT scan. In the patients with acute IMH of the ascending aorta, surgery should be considered for severe clinical symptoms, pericardial effusion and large size of the ascending aorta (more than 4 cm) on CT scan, and for converting to a typical type A aortic dissection. CT scan had a major role in making an early diagnosis, in depicting a dangerous sign, and in monitoring its progression or resolution of IMH. (author)

Lung herniation into pericardial cavity: A case of partial congenital absence of right pericardium

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Sadashiv B Tamagond

2012-01-01

Full Text Available Congenital absence of pericardium is rarely seen, often diagnosed intraoperatively during cardiac and thoracic surgeries. Left-sided pericardial defects are more common than right-sided ones. We present a case of an incidentally detected congenital absence of right pericardium with herniation of part of the right lung during ventricular septal defect closure surgery in a male child aged 4 years.

Effects of colchicine on pericardial diseases: a review of the literature and current evidence

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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.

A Rare Case of Primary Meningococcal Myopericarditis in a 71-Year-Old Male

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Odilia I. Woudstra

2016-01-01

Full Text Available We describe a case of primary meningococcal C pericarditis with myocardial involvement in a 71-year-old male that is thus far the oldest patient with isolated meningococcal pericardial disease and only the third patient with primary meningococcal myopericarditis described in English literature. Our patient was successfully treated by full sternotomy and surgical drainage combined with intravenous ceftriaxone. Mild symptoms unresponsive to anti-inflammatory treatment and leukocytosis may guide clinicians towards the correct diagnosis. It is important to recognize this cause of pericarditis as the relatively mild clinical presentation may rapidly progress into tamponade and right-sided heart failure.

Percutaneous atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

DEFF Research Database (Denmark)

Munkholm-Larsen, Stine; Cao, Christopher; Yan, Tristan D

2012-01-01

databases. Fourteen studies were identified for evaluation. Overall, implantation was successful in 93% of all cases. Periprocedural mortality and stroke rates were 1.1% and 0.6%, respectively. The incidences of pericardial effusion/cardiac tamponade and device embolisation were 4% and 0.7%, respectively....... At the time of the latest follow-up (up to 40 months), the overall incidence of stroke among all studies was 1.4% per annum. Existing evidence suggests that PLAAO is a relatively safe treatment for patients with AF. However, there is a need for further evaluation of its efficacy in the form of large and well...

Periaortic haemangiosarcoma in an African wild dog (Lycaon pictus : clinical communication

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A. Newell-Fugate

2009-05-01

Full Text Available A 9-year-old apparently healthy male African wild dog (Lycaon pictus was found dead in its enclosure at the De Wildt Cheetah and Wildlife Centre. Necropsy revealed a pericardium distended by approximately 250mℓ of thick blood. A soft, red, lobulated mass was attached to the periaortic fat between the level of the aortic valves and the pericardial reflection. Histologically, the mass was consistent with a haemangiosarcoma. Other findings in the heart included mild to moderate ventricular hypertrophy and moderate, acute perivascular myocardial necrosis. Sudden death was attributed to acute heart failure precipitated by cardiac tamponade.

A Case of Constrictive Pericarditis Associated with Melioidosis in an Immunocompetent Patient Treated by Pericardiectomy

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Lu, Hou Tee; Ramsamy, Gunasekaran; Lee, Chuey Yan; Syed Hamid, Syed Rasul G.; Kan, Foong Kee; Nordin, Rusli Bin

2018-01-01

Patient: Male, 38 Final Diagnosis: Constrictive pericarditis Symptoms: Shortness of breath Medication: — Clinical Procedure: Pericardiocentesis • pericardiectomy Specialty: Cardiology Objective: Unusual clinical course Background: Melioidosis is a rare tropical bacterial infection caused by the Gram-negative soil saprophyte, Burkholderia pseudomallei. Melioidosis can mimic a variety of diseases due to its varied presentation, and unless it is treated rapidly, it can be fatal. A rare case of melioidosis, with pericarditis and pericardial effusion, is described, which demonstrates the value of early diagnosis with echocardiography and pericardiocentesis. Case Report: A 38-year-old native (Iban) East Malaysian man presented with shortness of breath and tachycardia. Transthoracic echocardiography (TTE) showed cardiac tamponade. Urgent pericardiocentesis drained a large amount of purulent pericardial fluid that grew Burkholderia pseudomallei. Despite appropriate dose and duration of intravenous treatment with ceftazidime followed by meropenem, the patient developed recurrent pericardial effusion and right heart failure due to constrictive pericarditis. The diagnosis of constrictive pericarditis was confirmed by computed tomography (CT) and surgical exploration. Following pericardiectomy, his symptoms resolved, but patient follow-up was recommended for possible sequelae of constrictive pericarditis. Conclusions: After the onset of melioidosis pericarditis, the authors recommend follow-up and surveillance for possible complication of constrictive pericarditis. PMID:29551765

Pacemaker lead perforation of the right ventricle associated with Moraxella phenylpyruvica infection in a dog.

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Ciavarella, A; Nimmo, J; Hambrook, L

2016-04-01

A 13-year-old neutered male Border Collie was presented with acute onset syncope, weakness and anorexia 10 months after transvenous pacemaker implantation. The patient was laterally recumbent, bradycardic (36 beats/min) and febrile (40.7°C) on presentation. An electrocardiogram (ECG) revealed recurrence of third-degree atrioventricular block with a ventricular escape rhythm. Fluoroscopy identified migration of the pacemaker tip through the apex of the right ventricle. Echocardiography failed to reveal any evidence of pericardial effusion or cardiac tamponade. Full postmortem was performed after euthanasia. The pacemaker lead had perforated the apex of the right ventricle and lodged in the right pleural space. Culture of blood (taken antemortem), pericardial sac, right ventricular wall (surrounding pacemaker lead), pacemaker lead tip and pericardial fluid revealed a pure growth of Moraxella phenylpyruvica. Bacteraemia associated with M. phenylpyruvica has never been reported in the dog, but sporadic cases are reported in humans. Infection could have resulted from either pre-existing myocarditis or opportunistic infection and bacteraemia post pacemaker implantation. Evaluation of the pacemaker function at regular intervals would allow early detection of poor pacemaker-to-myocardium contact, which would prompt further investigation of pacemaker lead abnormalities such as perforation. © 2016 Australian Veterinary Association.

A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis

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Lauro L. Abrahan IV

2017-01-01

Full Text Available A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.

CLOSING MACULAR HOLES WITH "MACULAR PLUG" WITHOUT GAS TAMPONADE AND POSTOPERATIVE POSTURING.

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Chakrabarti, Meena; Benjamin, Preethi; Chakrabarti, Keya; Chakrabarti, Arup

2017-03-01

To investigate the surgical results of macular hole surgery without gas tamponade or postoperative posturing in patients with Stage 3 and Stage 4 macular holes with ≥500 μm mean base diameter. Retrospective interventional case series. Twenty-six patients with Stage 3 and Stage 4 macular holes. Twenty-six eyes of 26 patients with Stage 3 and Stage 4 macular holes and a mean base diameter of 892.8 ± 349 μm underwent pars plana 23-gauge vitrectomy with broad internal limiting membrane peel (ILM peel), inverted ILM flap repositioning (ILMR), and use of autologous gluconated blood clumps as a macular plug to close the macular hole. No fluid-air exchange, endotamponade, or postoperative posturing was used. The subjects were followed up for 12 months. The anatomical outcome of the procedure was evaluated by fundus examination and optical coherence tomography. Spectral domain optical coherence tomography was used to study the restoration of the outer retinal layer integrity in the postoperative period. The preoperative and postoperative best-corrected visual acuities in logMAR units were compared to evaluate functional outcome. Macular hole closure and best-corrected visual acuity before and after surgery. Twenty-six patients with mean age 62.8 ± 7.3 years, preoperative median best-corrected visual acuity 6/60 (1.0 logMAR units), and a mean base diameter of 892.8 ± 349 μm underwent surgery to close macular holes without gas tamponade or postoperative posturing. Twenty patients (76.9%) were phakic. Twenty eyes (76.92%) had Stage 3 macular holes and 6 eyes (23.10%) had Stage 4 macular holes. After a single surgery, hole closure was achieved in 100% of eyes. The median best-corrected visual acuity improved from 6/60 (1.0 logMAR units) to 6/18 (0.50 logMAR units) (P hole closure with statically significant functional improvement for large Stage 3 and Stage 4 macular holes.

Short-Acting Gas Tamponade with Strict Face-Down Posturing for the Treatment of Idiopathic Macular Hole.

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Gotzaridis, Stratos; Liazos, Efstathios; Petrou, Petros; Georgalas, Ilias

2017-01-01

A retrospective consecutive case series to evaluate the safety and efficacy of 25 gauge pars plana vitrectomy, ILM peeling, 20% SF 6 gas tamponade and strict posturing for the treatment of idiopathic full-thickness macular holes. We report the results of 106 consecutive eyes that underwent standard 25-gauge pars plana vitrectomy, brilliant peel-assisted internal limiting membrane peel, fluid:gas exchange with 20% SF 6 and strict posturing for one week. All patients were followed up at one week, one month, three months, and nine months postoperatively. Biomicroscopy at day 1 and biomicroscopy and OCT at week 1, months 1, 3, and 9 were used to assess macular hole status postoperatively. Pre- and postoperative logMAR visual acuity was compared. The macular hole was closed in 102/106 eyes postoperatively (96.2%). Four eyes showed unclosed macular holes and underwent additional SF 6 intravitreal injection and strict posturing for 10 days. All macular holes were eventually closed without the need of a second surgical procedure. Mean visual acuity improved from 0.63 logMAR preoperatively to 0.39 logMAR postoperatively. One case of retinal toxicity was reported due to accidental intravitreal injection of antibiotic. 25-gauge vitrectomy, ILM peel, and short-acting gas tamponade are highly effective for the treatment of macular holes. Additional intravitreal gas injection followed by strict posturing seems to be a simple and effective treatment for unclosed holes.

Polyacrylate/nanosilica causes pleural and pericardial effusion, and pulmonary fibrosis and granuloma in rats similar to those observed in exposed workers.

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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.

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

Retinal Layers Measurements following Silicone Oil Tamponade for Retinal Detachment Surgery.

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Jurišić, Darija; Geber, Mia Zorić; Ćavar, Ivan; Utrobičić, Dobrila Karlica

2017-12-19

This study aimed to investigate the influence of silicone oil on the retinal nerve fiber layer (RNFL) thickness in patients with primary rhegmatogenous retinal detachment who underwent vitreoretinal surgery. The study included 47 patients (eyes), who underwent a pars plana vitrectomy with the silicone oil tamponade. The control group included unoperated eye of all participants. Spectral-domain optical coherence tomography (SD-OCT) was used for the measurements of peripapilar and macular RNFL thickness. The average peripapillary RNFL thickness was significantly higher in the silicone oil filled eyes during endotamponade and after its removal. The eyes with elevated IOP had less thickening of the RNFL in comparison to the eyes with normal IOP. Central macular thickness and macular volume were decreased in the silicone oil filled eyes in comparison to the control eyes. In conclusion, silicone oil caused peripapilar RNFL thickening in the vitrectomized eyes during endotamponade and after silicone oil removal.

Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein.

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Wang, Ruo-Yi; Wang, Jun-Feng; Liu, Qian; Ma, Nan; Chen, Wei-Xiu; Li, Jin-Liang

2017-09-01

To evaluate the effects of combined Rex-bypass shunt and pericardial devascularization on prehepatic portal hypertension secondary to cavernomatous transformation of portal vein (CTPV). Forty-two patients aged from 3 years to 49 years (divided into 3 groups), 26 cases male and 16 female, with prehepatic vascular hepertention were treated with Rex-bypass shunt combined with pericardial devascularization. In each patient, preoperative assessment included ultrasound and computed tomographic angiography of the portal vein and blood analysis. The procedure was Rex-bypass shunt (with or without graft), and patients with moderate or severe gastroesophageal varices required additional paraesophagogastric devascularization. Splenectomy or subtotal splenectomy was performed if combined hypersplenism co-existed. All data were analyzed retrospectively. No intraoperative death occurred, blood routine analysis improved (P portal vein (LPV) significantly increased, the esophageal and gastric varices significantly relieved in 34 patients (P portal hypertension caused by CTPV.

Occult constrictive pericardial disease emerging 40 years after chest radiation therapy: a case report.

Science.gov (United States)

Goten, Chiaki; Murai, Hisayoshi; Takashima, Shin-Ichiro; Kato, Takeshi; Usui, Soichiro; Furusho, Hiroshi; Saeki, Takahiro; Sakagami, Satoru; Takemura, Hirofumi; Kaneko, Shuichi; Takamura, Masayuki

2018-05-31

The main etiology of constrictive pericarditis (CP) has changed from tuberculosis to therapeutic mediastinal radiation and cardiac surgery. Occult constrictive pericardial disease (OCPD) is a covert disease in which CP is manifested in a condition of volume overload. A 60-year-old patient with a history of thoracic radiation therapy for non-Hodgkin's lymphoma (40 years earlier) was transferred to our hospital for treatment of repeated congestive heart failure. For a preoperative hemodynamic study, pre-hydration with intravenous normal saline (50 mL/hour) was used to manifest the pericardial disease and prevent contrast-induced nephropathy. The hemodynamic study showed a right ventricular dip-plateau pattern and discordance of right and left ventricular systolic pressures during inspiration, which was not seen in the volume-controlled state. These responses were concordant with OCPD. A pericardiectomy, aortic valve replacement, and mitral and tricuspid valve repair were performed. Postoperatively, the heart failure was controlled with standard medication. This case revealed a volume-induced change in hemodynamics in OCPD with severe combined valvular heart disease, which suggests the importance of considering OCPD in patients who had undergone radiation therapy 40 years before.

A case of Hodgkin`s disease presenting a cardiac tamponade during treatment developed a pancytopenia after cessation of chemotherapy

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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)

Bronchovascular reconstruction with a bovine pericardial conduit and surgical reintervention due to thrombosis with revascularisation.

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Peña, Emilio; Blanco, Montserrat; Otero, Teresa

2014-01-01

We present the case of a 57-year-old male with left hilar squamous cell carcinoma infiltrating the pulmonary artery and in whom a sleeve bronchoplasty and angioplasty were performed using a bovine pericardial conduit. Three days post-operatively, graft thrombosis was detected; thrombectomy and graft reconstruction were performed with revascularisation of the graft. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension

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Chuanchen Zhang

2016-01-01

Full Text Available Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.

The Effects of Nicorandil and Nifekalant, Which Were Injected into the Pericardial Space, for Transmural Dispersion of Repolarization in the Pig

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Hiroyuki Ito, MD

2007-01-01

Full Text Available Introduction: Some studies have reported that transmural dispersion of repolarization (TDR is involved in the onset of ventricular arrhythmia. We investigated the effects of nicorandil (NIC and nifekalant (NIF injected into the pericardial space, on TDR and T waves in the pig. Methods and Results: We injected NIC 4 or 8 mg and NIF 50 or 100 mg at intervals into the pericardial space for eleven pigs. The effects of these drugs were investigated on the effective refractory period (ERP between the endocardial and epicardial myocardial cells, as well as on QT time, QT peak-end (QTcpe as an index of TDR, and T waveforms, respectively. QTcpe increased from 91 ± 21 to 116 ± 19 msec, 2.8 min after injection of NIC (p < 0.01, although corrected QT (QTc interval did not changed. But 5.5 min after injection, QTc decreased while QTcpe recovered. T wave amplitude significantly increased, and epicardium ERP decreased. When NIF was injected, TDR decreased from 55 ± 10 msec to 44 ± 8 msec (p < 0.01 although QTc did not change. In a later phase, QTc increased (p < 0.01 and QTcpe recovered. T wave amplitude rapidly decreased and became negative. Conclusion: Injected into the pericardial space, NIC and NIF brought about certain changes in ERP, QT and T waveform. Furthermore, NIC increased TDR while NIF decreased TDR.

[Comparative study of the effects of sterilized air and perfluoropropane gas tamponades on recovery after idiopathic full-thickness macular hole surgery].

Science.gov (United States)

He, F; Zheng, L; Dong, F T

2017-05-11

Objective: To compare the effects of sterilized air and perfluoropropane (C(3)F(8)) tamponades on recovery after vitrectomy for the treatment of idiopathic full-thickness macular hole (IFTMH). Methods: Case control study. Seventy-three eyes of 69 consecutive cases underwent vitrectomy with air (53 eyes) or 10% C(3)F(8) gas (20 eyes) tamponade. Surgical outcomes were retrospectively analyzed between the two groups, including logarithm of the minimal angle of resolution (logMAR) and optical coherence tomography findings like the size of the macular hole and the photoreceptor layer defect. Results: Preoperatively, the mean best corrected visual acuity (BCVA) was (0.10±0.49), the mean hole diameter was (777.9±320.7) μm, and the mean diameter of the photoreceptor layer defect was (1 709.3±516.0) μm in the sterilized air group, while in the C(3)F(8) group, the mean BCVA was (0.07±0.50), the mean hole diameter was (853.9±355.0) μm, and the mean defect diameter was (1 480.5±429.9) μm. The primary closure rate was 90.6% in the sterilized air group and 95.0% in the C(3)F(8) group. One month after surgery, the mean BCVA was (0.17±0.41), and the mean diameter of the photoreceptor layer defect was (820.5±598.0) μm in the sterilized air group, while in the C(3)F(8) group, the mean BCVA was 0.12±0.49, and the mean defect diameter was (762.5±658.0) μm. There was no statistically significant difference in the closure rate (χ(2)=0.019), BCVA ( t =-1.689), hole diameter ( t =0.837) and diameter of the photoreceptor layer defect ( t =0.338) between the two groups( P >0.05). Conclusions: Vitrectomy with sterilized air tamponade is safe and effective for the treatment of IFTMH and even cases with relatively large diameters. (Chin J Ophthalmol, 2017, 53: 327 - 331) .

Biventricular heart failure secondary to a pericardial cystic mass: case report

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Nizzero, A. [Sudbury Regional Hospital, Dept. of Diagnostic Imaging, Sudbury, Ontario (Canada); Dobranowski, J. [St. Joseph' s Hospital, Dept. of Radiology, Hamilton, Ontario (Canada); Tanser, P. [St. Joseph' s Hospital, Dept. of Cardiology, Hamilton, Ontario (Canada)

2000-07-01

Cystic masses of the pericardium causing symptoms due to cardiac compression are very unusual. Such cysts may be congenital, or they may occur secondary to inflammatory processes or hemorrhage, similar to cysts seen in the pleura or peritoneum. Echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI) are useful for noninvasive investigation of the pericardium, although in the remote past, definitive diagnosis was possible only with thoracotomy. We present a case of biventricular cardiac failure secondary to a calcified pericardial cystic mass in a patient with constrictive pericarditis. Because of the extensive calcification, echocardiography was not helpful. CT and MRI allowed excellent delineation of the nature and effects of this abnormality. (author)

A large pericardial effusion and bilateral pleural effusions as the initial manifestations of Familial Mediterranean Fever

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Schembri, Emma Louise; Mifsud, Simon; Cassar Demarco, Daniela; Coleiro, Bernard; Mallia, Carmel

2015-01-01

Familial Mediterranean Fever (FMF) is a condition characterized by recurrent febrile poly-serositis. Typical presentations of the disease include episodes of fever, abdominal pain and joint pains. Chest pain is a less common presentation. We report a case of FMF which presented with a large pericardial effusion and bilateral pleural effusions in a lady who had no positive family history and negative genetic testing.

Protective Effect of Tea Polyphenol Ophthalmic Gel on Lens Epithelial Cells in Rabbits with Silicone Oil Tamponade after Vitrectomy

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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.

Use of abdominal binder as anti-shock garment; an adjunct to uterine tamponade in uterine atony

International Nuclear Information System (INIS)

Kallue, U.R.; Chughtai, F.; Chaudry, A.; Shamin, Z.

2017-01-01

Objective: Aim of the study was to control life threatening post partum haemorrhage (PPH) in women till blood and blood products were made available or the women transferred to a better equipped centre. Study Design: A prospective interventional consecutive case series. Place and Duration of Study: It was conducted in three hospitals; Heavy Industries Taxila (HIT) hospital Apr 2005 to Sep 2010, Pakistan Ordinance Factories (POF) hospital Wah cantt Oct 2011 to Dec 2014 and Combined Military Hospital (CMH) Tarbela Dec 2014 to Dec 2015. Material and Methods: Abdominal binder was used in 22 consecutive women, having moderate to severe primary PPH due to uterine atony, where despite uterotonics (i.v oxytocin, rectal misoprostol) and bimanual compression, uterine tamponade was performed but complete control of haemorrhage was not achieved. Protocols for the treatment of obstetric haemorrhage and hypotensive shock were observed, including administration of intravenous crystalloid fluids and blood transfusion. If required, surgery was performed in the form of uterine arteries ligation or B-Lynch sutures. Obstetric hysterectomy was performed to save the woman's life if conservative procedures failed. Results: Bleeding and hypotension were controlled successfully in 19 (86.4%) of these women. In 03 (14.6%) women, bleeding persisted and so hysterectomy had to be resorted to. There was no maternal mortality. At 06 weeks postnatal follow up, none of the patients were found to suffer from long term debility; physical or psychological. Conclusion: Abdominal binder was found to be very effective in controlling bleeding and hypotensive crisis due to significant PPH due to uterine atony, as an adjunct to uterine tamponade. (author)

Pericardial effusion in a diabetic patient with prostatic abscess; Derrame pericardico associado a abscesso prostatico em paciente diabetico

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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)

Treatment of hemodialysis vascular access rupture irresponsive to prolonged balloon tamponade: Retrospective evaluation of the effectiveness of N-butyl cyanoacrylate seal-off technique

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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

[Cardiac tamponade as first manifestation in Mediterranean fever with autosomal dominant form].

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Sánchez Ferrer, F; Martinez Villar, M; Fernández Bernal, A; Martín de Lara, I; Paya Elorza, I

2015-01-01

Familial Mediterranean fever (FMF) is a hereditary disease characterized by brief, recurring and self-limited episodes of fever and pain with inflammation, of one or several serous (peritoneum, pleura, pericardium, synovial or vaginal tunic of the testicle). Amyloidosis is its more important complication and the principal reason of death in the cases in which it appears. Diagnosis is based on the clinic and is confirmed by genetic tests. The treatment with Colchicine (0,02-0,03 mg/kg/day) prevents the recurrence of FMF attacks and the development of secondary (AA) amyloidosis. We report a case of a 13-year-old child in which FMF was diagnosed after several coincidental episodes with fever, pericarditis and cardiac tamponade. The genetic confirmation showed an autosomal dominant inheritance that is less frecuent than the recesive form, in this disease. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Acute Central Retinal Artery Occlusion Associated with Intraocular Silicone Oil Tamponade

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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

Pericardial mesothelioma: A case studied by CT and MR. Mesotelioma pericardico: Descripcion de un caso estudiado por TC y RM

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Barrera Portillo, M.C.; Garmendia Larraaga, G.; Villanua Bernues, J.; Barrera Bermejo, J.F. de; Ruiz Diaz, (Hospital Nuestra Seaora de Aranzazu, San Sebastian (Spain))

1994-01-01

A case is presented of pericardial mesothelioma, studied by CT and MR. The lesion was a rare meso dermal tumor, difficult to diagnose clinically because of the non specificity of the symptomatology. The clinical, radiological and pathological features of this lesion are described. (Author)

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

DEFF Research Database (Denmark)

Bloksgaard, Maria; Leurgans, Thomas; Nissen, Inger

2015-01-01

Peripheral vascular resistance is increased in essential hypertension. This involves structural changes of resistance arteries and stiffening of the arterial wall, including remodeling of the extracellular matrix. We hypothesized that biopsies of the human parietal pericardium, obtained during...... 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...... of 100 mm Hg) is fiber like, and no prominent external elastic lamina could be observed. This microarchitecture is very different from that in rat mesenteric arteries frequently used for resistance artery research. In conclusion, we add three-dimensional information on the structure of the extracellular...

Relaxing Responses to Hydrogen Peroxide and Nitric Oxide in Human Pericardial Resistance Arteries Stimulated with Endothelin-1

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Leurgans, Thomas M; Bloksgaard, Maria; Irmukhamedov, Akhmadjon

2018-01-01

In human pericardial resistance arteries, effects of the endothelium-dependent vasodilator bradykinin are mediated by NO during contraction induced by K(+) or the TxA2 analogue U46619 and by H2 O2 during contraction by endothelin-1 (ET-1), respectively. We tested the hypotheses that ET-1 reduces...... also acts as an endothelium-dependent vasodilator. This article is protected by copyright. All rights reserved....

A primary intestinal lymphangiectasia hiding the diagnosis of pleural and pericardial tuberculosis: a clinical observation.

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Hammi, Sanaa; Berrani, Hajar; Benouchen, Thami; Lamlami, Naima; Elkhiyat, Imane; Bourkadi, Jamal Eddine

2017-01-01

Primary intestinal lymphangiectasia (Waldmann's disease) is an exudative enteropathy characterized by lymph leakage into the small bowel lumen leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia (particularly T-cell). The diagnosis is based on viewing the duodenal lymphangiectasia. A 20 years old female patient, treated for a primary intestinal lymphangiectasia, has consulted for anasarca. Etiological work-up reveals pleural and pericardial tuberculosis. The clinical aggravation of an enteropathy, particularly in adulthood, requires a search for a secondary etiology. Tuberculosis should be sought systematically.

Assessment of a Low-Cost Ultrasound Pericardiocentesis Model

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Marco Campo dell'Orto

2013-01-01

Full Text Available Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient’s safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography n=67, participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS. Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.

Assessment of a Low-Cost Ultrasound Pericardiocentesis Model

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Campo dell'Orto, Marco; Hempel, Dorothea; Starzetz, Agnieszka; Seibel, Armin; Hannemann, Ulf; Walcher, Felix; Breitkreutz, Raoul

2013-01-01

Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient's safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography n = 67, participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS). Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians. PMID:24288616

IV DSA in the diagnosis and follow-up of dissection of the thoracic aorta

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Hendrickx, P.; Luska, G.; Laas, J.; Haverich, A.

1986-05-01

Intravenous DSA was performed in 53 patients with suspected dissection of the thoracic aorta and in 13 patients following surgery for aortic dissection. In 36 patients, the suspected diagnosis could be excluded definitely and, in 14 cases out of 17, a dissection was correctly diagnosed. All 11 type B dissections were correctly diagnosed. Of six type A dissections, only three were adequately demonstrated by IV DSA. In type B dissections, IV DSA is reliable, but in type A dissection with massive aortic insufficiency or pericardial tamponade the findings are not reliable. In all 13 patients who had surgery for dissection, IV DSA proved suitable for showing the anastomosis and progress of the disease.

[Basics of emergency ultrasound].

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Schellhaas, S; Breitkreutz, R

2012-09-05

Focused ultrasound is a key methodology of critical care medicine. By referencing few ultrasound differential diagnosis, it is possible to identifying in real-time the reason of the critical state of a patient. Therefore typical focused ultrasound protocols were developed. The well known Focused Assessment with Sonography for trauma (FAST) was incorporated into the Advanced Trauma Life Support (ATLS) for shock room. Focused echocardiographic evaluation in life support (FEEL) has been designed to be conformed with the universal Advanced Life Support (ALS) algorithm and to identify treatable conditions such as acute right ventricular pressure overload in pulmonary embolism, hypovolemia, or pericardial effusion/tamponade. Using lung ultrasound one can differentiate pulmonary edema, pleural effusion or pneumothorax.

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

Prostaglandins are vasoactive substances which are assumed to play a major role in bone metabolism and bone repair. The purpose of the present study was to investigate the effect of indomethacin on the control of epiphyseal bone blood-flow. By means of simultaneous intra-osseous pressure (IOP......) 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...

Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath

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Kars Neven, MD

2014-03-01

Full Text Available 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.

Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

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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.

Colchicine in Pericardial Disease: from the Underlying Biology and Clinical Benefits to the Drug-Drug Interactions in Cardiovascular Medicine.

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Schenone, Aldo L; Menon, Venu

2018-06-14

This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.

Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog

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Verbeke, Fei; Binst, Dominique; Stegen, Ludo; Waelbers, Tim; de Rooster, Hilde; Van Goethem, Bart

2012-01-01

A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence. PMID:23543933

Good visual outcome in a longstanding macular detachment associated with an optic disc pit treated with vitrectomy, laser, and gas tamponade: case report. doi: 10.20513/2447-6595.2016v56n1p68-70

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Ricardo Evangelista Marrocos de Aragao

2016-06-01

Full Text Available Optic disc pit is a congenital anomaly of the optic nerve frequently associated with macula detachment. It has a poor visual prognosis if left untreated. The treatment of the optic disc remains controversial and includes the use of laser along the edge of the optic nerve, vitrectomy with gas tamponade with or without removal of posterior hyaloid. We report a case of a 19-year-old female with a longstanding macula detachment due to optic disc pit who was treated with vitrectomy with removal of posterior hyaloid, gas tamponade, and laser. Despite longstanding macular detachment the final visual acuity was 20/25.

Cardiovascular effects of radiation therapy

International Nuclear Information System (INIS)

Alvarez, Jose A.G.; Leiva, Gustavo

2001-01-01

Therapeutic mediastinal irradiation can induce heart disease with variable degree of cardiac engagement. Heart disease manifestations depend on the grade of involvement of the different cardiac structures. During the first two years following irradiation, pericarditis with or without pericardial effusion is the most common manifestation of toxicity related to radiation therapy. Later on, after a latency period of five to ten years, a constrictive pericarditis may develop. Other type of late cardiac toxicities due to irradiation are restrictive cardiomyopathy, multiple valvular disease, coronary artery disease and different atrioventricular conduction disturbances. The therapeutic approach to this kind of heart disease has to be focused on its progressive course and in the possibility of a global involvement of all the cardiac structures. Pericardiectomy is strongly recommended for recurrent pericardial effusion with cardiac tamponade. Cardiac surgery for myocardial revascularization or valvular disease can be performed with variable results; the presence of myocardial fibrosis can significantly affect perioperative management and long-term results. Cardiac transplantation is a promissory option for those patients with end-stage cardiac failure. Immunosuppressive regimens are not associated with recurrence of malignancy. (author) [es

Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery

Science.gov (United States)

Sevuk, Utkan; Baysal, Erkan; Altindag, Rojhat; Yaylak, Baris; Adiyaman, Mehmet Sahin; Ay, Nurettin; Alp, Vahhac; Beyazit, Unal

2015-01-01

Objective Postpericardiotomy syndrome (PPS), which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery. Methods A total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray. Results PPS incidence was significantly lower in patients who received diclofenac (20% vs 43%) (Pdiclofenac had a significantly lower incidence of pericardial effusion (15% vs 30%) (P=0.01). Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07). Logistic regression analysis demonstrated that diclofenac administration (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18–0.65, P=0.001) was independently associated with PPS occurrence. Conclusion Postoperative administration of diclofenac may have a protective role against the development of PPS after cardiac surgery. PMID:26170687

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

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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

Pannus overgrowth after mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis.

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Oda, Takeshi; Kato, Seiya; Tayama, Eiki; Fukunaga, Shuji; Akashi, Hidetoshi; Aoyagi, Shigeaki

2009-01-01

A Carpentier-Edwards pericardial (CEP) bioprosthesis was explanted from an 81-year-old woman due to nonstructural dysfunction 9 years after mitral valve replacement. The nonstructural dysfunction produced severe regurgitation in the mitral position. During the surgery, excessive pannus overgrowth was seen on the left ventricular side of the CEP bioprosthesis. Pannus overgrowth was prominent on one leaflet. That leaflet was stiff and shortened due to the excessive overgrowth of pannus. In this patient, the distortion of one leaflet was the main reason for transvalvular leakage of the CEP bioprosthesis in the mitral position. A new CEP bioprosthesis was implanted in the mitral position. Pathological analysis revealed fibrotic pannus with a small amount of cellular material over the leaflets of the resected CEP valve. This change was marked on the distorted leaflet.

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.

Post-mortem diagnosis of chronic Chagas's disease comparative evaluation of three serological tests on pericardial fluid.

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Lopes, E R; Chapadeiro, E; Batista, S M; Cunha, J G; Rocha, A; Miziara, L; Ribeiro, J U; Patto, R J

1978-01-01

In an attempt to improve the post-mortem diagnosis of Chagas's disease the authors performed haemagglutination tests (HAT), fluorescent Trypanosoma cruzi antibody tests (FAT), and complement fixation tests (CFT) on the pericardial fluid obtained at autopsy of 50 individuals with Chagas's heart disease, and 93 patients in whom this disease was not thought to be present. The results demonstrate that all three tests are efficient for the post-mortem diagnosis of Chagas's disease but suggest that their combined use would detect more cases than would one isolated reaction only.

Pericardial and thoracic peri-aortic adipose tissues contribute to systemic inflammation and calcified coronary atherosclerosis independent of body fat composition, anthropometric measures and traditional cardiovascular risks

International Nuclear Information System (INIS)

Yun, Chun-Ho; Lin, Tin-Yu; Wu, Yih-Jer; Liu, Chuan-Chuan; Kuo, Jen-Yuan; Yeh, Hung-I.; Yang, Fei-Shih; Chen, Su-Chiu; Hou, Charles Jia-Yin; Bezerra, Hiram G.; Hung, Chung-Lieh; Cury, Ricardo C.

2012-01-01

Background: Coronary atherosclerosis has traditionally been proposed to be associated with several cardiovascular risk factors and anthropometric measures. However, clinical data regarding the independent value of visceral adipose tissue in addition to such traditional predictors remains obscure. Materials and methods: We subsequently studied 719 subjects (age: 48.1 ± 8.3 years, 25% females) who underwent multidetector computed tomography (MDCT) for coronary calcium score (CCS) quantification. Baseline demographic data and anthropometric measures were taken with simultaneous body fat composition estimated. Visceral adipose tissue of pericardial and thoracic peri-aortic fat was quantified by MDCT using TeraRecon Aquarius workstation (San Mateo, CA). Traditional cardiovascular risk stratification was calculated by metabolic (NCEP ATP III) and Framingham (FRS) scores and high-sensitivity CRP (Hs-CRP) was taken to represent systemic inflammation. The independent value of visceral adipose tissue to systemic inflammation and CCS was assessed by utilizing multivariable regression analysis. Results: Of all subjects enrolled in this study, the mean values for pericardial and peri-aortic adipose tissue were 74.23 ± 27.51 and 7.23 ± 3.69 ml, respectively. Higher visceral fat quartile groups were associated with graded increase of risks for cardiovascular diseases. Both adipose burdens strongly correlated with anthropometric measures including waist circumference, body weight and body mass index (all p < 0.001). In addition, both visceral amount correlates well with ATP and FRS scores, all lipid profiles and systemic inflammation marker in terms of Hs-CRP (all p < 0.001). After adjustment for baseline variables, both visceral fat were independently related to Hs-CRP levels (all p < 0.05), but only pericardial fat exerted independent role in coronary calcium deposit. Conclusion: Both visceral adipose tissues strongly correlated with systemic inflammation beyond traditional

Pericardial tissue valves and Gore-Tex conduits as an alternative for right ventricular outflow tract replacement in children.

Science.gov (United States)

Allen, Bradley S; El-Zein, Chawki; Cuneo, Betina; Cava, Joseph P; Barth, Mary Jane; Ilbawi, Michel N

2002-09-01

There is still no perfect conduit for reconstruction of the right ventricular outflow tract (RVOT) in children. Homografts are not always available in the appropriate size, and degenerate in a few years. This study evaluates the pericardial valve with Gore-Tex conduit as an alternative for RVOT construction. From January 1, 1993, to September 30, 1999, a pericardial tissue valve was inserted in all patients undergoing RVOT reconstruction or pulmonary valve replacement (PVR) who were large enough to accommodate a tissue valve. In patients without a native main pulmonary artery, a new technique was used to construct an RV-PA conduit out of a flat sheet of Gore-Tex, as Dacron frequently leads to stenosis. Data were collected by retrospective review, follow-up echocardiograms, and assessment by a single cardiologist. There were 48 patients, 22 undergoing a PVR alone and 26 a RV-PA valved Gore-Tex conduit. Diagnosis included tetralogy of Fallot (n = 25); truncus arteriosis (n = 9); ventricular septal defect with PA (n = 5); DORV (n = 4); D-TGA with PS (n = 2); and 1 each IAA with sub AS, VSD with PI, and PS s/p Ross procedure. Patient age ranged from 3 to 33 years and 98% were reoperations. The valve sizes ranged from 19 to 33 mm and the median hospital length of stay was 4 days. There were 2 (4.2%) perioperative and 1 (2.1%) late deaths, none related to the valve or Gore-Tex conduit. At a follow-up of 15 to 86 months (mean 43 +/- 16 months), all remaining 45 patients are New York Heart Association class I, all valves are functional, and no patient has required valve or conduit replacement or revision; more importantly, echocardiogram revealed no significant valve or conduit stenosis (mean gradient 16 +/- 8 mm Hg) and no evidence of regurgitation or structural degeneration. A pericardial tissue valve and Gore-Tex conduit provides a reliable alternative for RVOT reconstruction in pediatric patients. It is readily available, molds in the limited retrosternal space, and

Cardiac and pericardial tumors: A potential application of positron emission tomography-magnetic resonance imaging.

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Fathala, Ahmed; Abouzied, Mohei; AlSugair, Abdul-Aziz

2017-07-26

Cardiac and pericardial masses may be neoplastic, benign and malignant, non-neoplastic such as thrombus or simple pericardial cysts, or normal variants cardiac structure can also be a diagnostic challenge. Currently, there are several imaging modalities for diagnosis of cardiac masses; each technique has its inherent advantages and disadvantages. Echocardiography, is typically the initial test utilizes in such cases, Echocardiography is considered the test of choice for evaluation and detection of cardiac mass, it is widely available, portable, with no ionizing radiation and provides comprehensive evaluation of cardiac function and valves, however, echocardiography is not very helpful in many cases such as evaluation of extracardiac extension of mass, poor tissue characterization, and it is non diagnostic in some cases. Cross sectional imaging with cardiac computed tomography provides a three dimensional data set with excellent spatial resolution but utilizes ionizing radiation, intravenous iodinated contrast and relatively limited functional evaluation of the heart. Cardiac magnetic resonance imaging (CMR) has excellent contrast resolution that allows superior soft tissue characterization. CMR offers comprehensive evaluation of morphology, function, tissue characterization. The great benefits of CMR make CMR a highly useful tool in the assessment of cardiac masses. (Fluorine 18) fluorodeoxygluocse (FDG) positron emission tomography (PET) has become a corner stone in several oncological application such as tumor staging, restaging, treatment efficiency, FDG is a very useful imaging modality in evaluation of cardiac masses. A recent advance in the imaging technology has been the development of integrated PET-MRI system that utilizes the advantages of PET and MRI in a single examination. FDG PET-MRI provides complementary information on evaluation of cardiac masses. The purpose of this review is to provide several clinical scenarios on the incremental value of PET

Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era.

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Abdallah, R; Atar, S

2014-05-01

The etiology and laboratory characteristics of large symptomatic pericardial effusion (LSPE) in the Western world have evolved over the years, and vary between regions, community and tertiary hospitals. We reviewed data of 86 consecutive patients who underwent pericardiocentesis or pericardial window due to LSPE in a community hospital from 2001 to 2010. The characteristics of the PE including chemistry, hematology, bacteriology, serology and cytology have been analyzed. We correlated the etiologies of PE with age, gender and clinical presentation. The most frequent etiology of LSPE was idiopathic [36% (77% with a clinical diagnosis of pericarditis)], followed by malignancy (31.4%), ischemic heart disease (16.3%), renal failure (4.6%), trauma (4.6%) and autoimmune disease (4.6%). The average age of all the etiological groups excluding trauma was over 50 years. Laboratory tests did not modify the pre-procedure diagnosis in any of the patients. The most frequent presenting symptom was dyspnea (76.6%). Chest pain was mostly common in patients with idiopathic etiology (58.06%). The most frequent medical condition associated with LSPE was the use of anticoagulant or antiplatelet drugs (31.40%), especially aspirin, and in those, the PE tended to be bloody (73%, P = 0.11). Most of the effusions were exudates (70.9%). PE due to renal failure was the largest (1467 ± 1387 ml). The spectrum of etiologies of LSPE in a community hospital in the Western world in the contemporary era is continuously evolving. The most frequent etiology is now idiopathic, followed by malignancy. Routine laboratory testing still rarely modifies the pre-procedure diagnosis.

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.

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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

The use of bovine pericardial patch for vascular reconstruction in infected fields for transplant recipients

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Sandra Garcia Aroz, MD

2017-03-01

Full Text Available Infectious vascular complications affecting transplant recipients may lead to severe morbidity and graft loss. This is a retrospective review of vascular repair with bovine pericardial patch (BPP in infected fields for immunosuppressed patients. BPP was used as either a patch or an interposition graft. Five cases of arterial reconstruction in infected fields using BPP were performed. There were no complications related to bleeding, thrombosis, or recurrent infection. In our limited experience, the use of BPP as a vascular patch is successful, and it represents an alternative when vascular reconstruction is needed in the context of infected fields.

Pediatric oncologic emergencies

International Nuclear Information System (INIS)

Zietz, Hallie A.

1997-01-01

Oncologic emergencies arise in three ways: disease or therapy induced cytopenias; a space occupying lesion causing pressure on or obstruction of surrounding tissues; or leukemia or tumors creating life-threatening metabolic or hormonal problems. Knowledge of presenting signs and symptoms of these emergencies are essential in pediatric oncologic nursing. Neutropenia opens the door for all manner of infections, but the most life threatening is septicemia progressing to shock. A variety of organisms can cause septic shock in the neutropenic patient, but episodes are most often due to gram-negative organisms and the endotoxins they release. Shock, while still compensated, may present with a elevated or subnormal temperature, flushed, warm, dry skin, widening pulse pressure, tachycardia, tachypnoea and irritability, but without medical intervention will progress to hypo tension, cool, clammy extremities, decreased urinary out- put, and eventually to bradycardia and cardiogenic shock. Another emergency in the cytopenia category is bleeding as a result of thrombocytopenia. Of greatest concern is intracranial hemorrhage that may occur at platelet counts of less than 5,000/mm3. Space-occupying lesions of the chest may produce superior vena cava syndrome (SVGS), pleural and pericardial effusions, and cardiac tamponade. SVGS is most often caused by non-Hodgkin's lymphoma (NHL) and presents as cough, hoarseness, dyspnea, orthopnea and chest pain. Signs include swelling, plethora, cyanosis, edema of conjunctiva and wheezing. Pleural and pericardial effusions present with respiratory or cardiac distress as does cardiac tamponade. Abdominal emergencies arise because of inflammation, mechanical obstruction, hemorrhage (often from steroid induced ulcers), and perforation. Pain is the most common presenting symptom, although vital sign alterations, fever, blood in vomitus or stool, abdominal distension and cessation of flatus are also important components of the acute abdomen

Prevalence and significance of gallium-67 uptake in the heart after open-heart surgery

International Nuclear Information System (INIS)

Huikuri, H.V.; Ikaeheimo, M.J.A.; Airaksinen, J.; Linnaluoto, M.M.; Heikkilae, J.T.; Takkunen, J.T.

1988-01-01

Radioactive gallium-67 (Ga-67) has been shown to accumulate within areas of pericardial inflammation. The present study estimated prospectively the prevalence and clinical significance of Ga-67 uptake in the heart in 62 patients 10 to 16 days after open-heart surgery. Of 62 patients studied, markedly diffuse Ga-67 uptake was detected in 21 (34%) and focal or mild diffuse uptake in 23 (37%). Results were negative in 18 (29%). Nine patients with a negative scan result (50%) had received corticosteroid therapy before imaging, whereas only 2 patients with a positive scan result (5%) were receiving steroids. The erythrocyte sedimentation rate and C-reactive protein level were both higher in patients with Ga-67 uptake compared with those with a negative scan result (p less than 0.01 in both). No other clinical, echocardiographic or electrocardiographic indicators of postpericardiotomy syndrome were related to Ga-67 uptake. No patient developed cardiac tamponade or constrictive pericarditis during the 12-week follow-up and the Ga-67 scan results did not predict the occlusion of coronary artery bypass grafts. Thus, pericardial inflammation manifested as Ga-67 uptake is a common finding after open-heart surgery and appears to be a benign condition

Bronchoscopic hemostatic tamponade with oxidized regenerated cellulose for major hemoptysis control: two case reports

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C.C. Nogueira

2010-11-01

Full Text Available Hemoptysis is a common and alarming clinical problem. Acute massive hemoptysis is a life threatening condition. Different therapeutic strategies such as surgery, endovascular treatment and/or bronchoscopy have been applied. We report two cases of patients with severe hemoptysis who were treated by bronchoscopy guided topical hemostatic tamponade therapy with oxidized regenerated cellulose. Resumo: Hemoptises são um problema clinico comum e grave. Nalguns casos, como nas hemoptises maciças, podem causar mortalidade elevada. Para o seu controlo e/ou tratamento têm sido aplicadas diferentes estratégias como a cirurgia, embolização das artérias brônquicas e tratamentos broncoscópicos. Os autores descrevem dois casos clinicos de pacientes com hemoptises graves, cujo controlo foi efectuado por broncoscopia com aplicação de tamponamento hemostático com celulose oxidade regenerada (Surgicell®, Johnson and Johnson's, London. Keywords: Hemoptysis, Bronchoscopic hemostatic therapy, Oxidized regenerated cellulose, Palavras-chave: Hemoptises, Terapêutica broncoscópica hemostática, Celulose oxidada regenerada

E-FAST: A propos of hemopericardium in the Emergency Department

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Alejandro Cardozo

2016-05-01

Full Text Available The extended-focused assessment with sonography in trauma is still recognized as a technique approach to patients whose trauma involves the chest and the abdomen, with the aim of ruling out conditions as pneumothorax, hemothorax, pericardial effusion/cardiac tamponade, and intraperitoneal free fluid. Although CT is the gold standard test, the inconvenience of moving unstable patients and the amount of time it takes to carry it out, makes it not always possible in the Emergency Department, which positions the ultrasound as an ideal tool in the evaluation of patients with trauma in the Emergency Department. In this case report, we presented the case of a patient who complains of multiple stab wounds, and the extended-focused assessment with sonography in trauma confirmed the diagnostic impressions.

Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade: A possible mechanism of appearance

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Nikolić Slobodan

2016-01-01

Full Text Available Introduction. Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries. Case Outline. We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. Conclusion. We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage. [Projekat Ministarstva nauke Republike Srbije, br. 45005

FIRST REPORT OF ACUTE CHAGAS DISEASE BY VECTOR TRANSMISSION IN RIO DE JANEIRO STATE, BRAZIL

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Luiz Henrique Conde SANGENIS

2015-08-01

Full Text Available SUMMARY Chagas disease (CD is an endemic anthropozoonosis from Latin America of which the main means of transmission is the contact of skin lesions or mucosa with the feces of triatomine bugs infected by Trypanosoma cruzi. In this article, we describe the first acute CD case acquired by vector transmission in the Rio de Janeiro State and confirmed by parasitological, serological and PCR tests. The patient presented acute cardiomyopathy and pericardial effusion without cardiac tamponade. Together with fever and malaise, a 3 cm wide erythematous, non-pruritic, papule compatible with a "chagoma" was found on his left wrist. This case report draws attention to the possible transmission of CD by non-domiciled native vectors in non-endemic areas. Therefore, acute CD should be included in the diagnostic workout of febrile diseases and acute myopericarditis in Rio de Janeiro.

Type A dissection following endovascular repair of type B dissection

International Nuclear Information System (INIS)

Juszkat, R.; Zabicki, M.; Jemielity, M.; Buczkowski, P.; Urbanowicz, T.

2009-01-01

Background: We present a patient, who was treated with thoracic stentgraft implantation, because of acute type B aortic dissection (according to Stanford classification). The endovascular procedure was performed without any complications. Case Report: The patient was discharged in the 3 rd postprocedural day and was transferred to another hospital for further recovery. Nine days after the procedure, the patient was readmitted in cardiogenic shock to the Cardiac Surgery Department. The patient was immediately operated on, after dissection of the ascending aorta and pericardial tamponade had been diagnosed in transthoracic echocardiography. Conclusions: Total replacement of the aortic arch and its ascending part was performed successfully. The surgery was carried out in deep hypothermia with temporary circulatory arrest. The patient was discharged from the Cardiac Surgery Unit 15 days after the surgery, and transferred to another unit for further recovery. (authors)

Spontaneous aortic dissecting hematoma in two dogs.

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Boulineau, Theresa Marie; Andrews-Jones, Lydia; Van Alstine, William

2005-09-01

This report describes 2 cases of spontaneous aortic dissecting hematoma in young Border Collie and Border Collie crossbred dogs. Histology was performed in one of the cases involving an unusual splitting of the elastin present within the wall of the aorta, consistent with elastin dysplasia as described in Marfan syndrome in humans. The first case involved a young purebred Border Collie that died suddenly and the second case involved a Border Collie crossbred dog that died after a 1-month history of seizures. Gross lesions included pericardial tamponade with dissection of the ascending aorta in the former case and thoracic cavity hemorrhage, mediastinal hematoma, and aortic dissection in the latter. Histologic lesions in the case of the Border Collie crossbred dog included a dissecting hematoma of the ascending aorta with elastin dysplasia and right axillary arterial intimal proliferation.

The cervix as a natural tamponade in postpartum hemorrhage caused by placenta previa and placenta previa accreta: a prospective study.

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El Gelany, Saad A A; Abdelraheim, Ahmed R; Mohammed, Mo'men M; Gad El-Rab, Mohammed T; Yousef, Ayman M; Ibrahim, Emad M; Khalifa, Eissa M

2015-11-11

Placenta previa and placenta accreta carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The objective of this study was to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta. This prospective study was conducted on 40 pregnant women admitted to our hospital between June 2012 and November 2014. All participating women had one or more previous cesarean deliveries and were diagnosed with placenta previa and/or placenta previa accreta. Significant bleeding from the placental bed during cesarean section was managed by inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment. The technique of cervical inversion described above was successful in stopping the bleeding in 38 out of 40 patients; yielding a success rate of 95%. We resorted to hysterectomy in only two cases (5%). The mean intra-operative blood loss was 1572.5 mL, and the mean number of blood units transfused was 3.1. The mean time needed to perform the technique was 5.4 ± 0.6 min. The complications encountered were as follows: bladder injury in the two patients who underwent hysterectomy and wound infection in one patient. Postoperative fever that responded to antibiotics occurred in 1 patient. The mean duration of the postoperative hospital stay was 3.5 days This technique of using the cervix as a natural tamponade appears to be safe, simple, time-saving and potentially effective method for controlling the severe postpartum hemorrhage (PPH) caused by placenta previa/placenta previa accreta. This technique deserves to be one of the tools in the hands of obstetricians who face the life-threatening hemorrhage of placenta

An atypical presentation of cardiac tamponade and periorbital swelling in a patient with eosinophilic granulomatosis with polyangiitis: a case report.

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Keefe, Alexandra C; Hymas, Joseph C; Emerson, Lyska L; Ryan, John J

2017-09-24

Eosinophilic granulomatosis with polyangiitis is a rare, necrotizing systemic vasculitis associated with asthma and hypereosinophilia. Its cause and pathophysiology are still being elucidated. We report a case of eosinophilic granulomatosis with polyangiitis in a 50-year-old Caucasian woman who presented with chest pain, dyspnea at rest, fever, and periorbital swelling. She was found to have significant hypereosinophilia and cardiac tamponade physiology. A biopsy confirmed extensive infiltration of both lungs and pericardium by eosinophils. She did not have any anti-neutrophil cytoplasmic antibodies. Eosinophilic granulomatosis with polyangiitis diagnosis does not require the presence of anti-neutrophil cytoplasmic antibodies. Anti-neutrophil cytoplasmic antibody-positive and anti-neutrophil cytoplasmic antibody-negative eosinophilic granulomatosis with polyangiitis may present with different clinical phenotypes, perhaps suggesting two distinct disease etiologies and distinct pathophysiology.

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

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...... 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...

A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection

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Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org; Al-Natour, Mohammed, E-mail: mnatour85@msn.com; Gurajala, Ram Kishore, E-mail: gurajar@ccf.org [L10, Cleveland Clinic, Section of Vascular and Interventional Radiology, Imaging Institute (United States)

2017-04-15

This report describes a stenting technique used to anatomically reconstruct superior vena cava (SVC) bifurcation in a patient with benign SVC syndrome. After recanalizing the SVC bifurcation, we exchanged two 0.035-in. wires for two 0.018-in. wires, deployed the SVC stent over these two wires (“train-track” technique), and stented each innominate vein over one wire. However, our decisions to recanalize both innominate veins, use the “buddy-wire” technique for SVC dilation, and dilate the SVC to 16 mm before stent deployment likely contributed to SVC tear, which was managed by resuscitation, SVC stent placement, and pericardial drainage. Here, we describe the steps of the train-track technique, which can be adopted to reconstruct other bifurcations; we also discuss the controversial aspects of this case.

F6H8 as an Intraoperative Tool and F6H8/Silicone Oil as a Postoperative Tamponade in Inferior Retinal Detachment with Inferior PVR

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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.

Prosthesis-patient mismatch in bovine pericardial aortic valves: evaluation using 3 different modalities and associated medium-term outcomes.

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Chacko, Satish Jacob; Ansari, Asimul H; McCarthy, Patrick M; Malaisrie, S Chris; Andrei, Adin-Cristian; Li, Zhi; Lee, Richard; McGee, Edwin; Bonow, Robert O; Puthumana, Jyothy J

2013-09-01

The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines-suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area-indexed, effective orifice area (EOAi PPM) measurement. A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤ 0.60 cm(2)/m(2), moderate if EOAi was 0.60 to 0.85 cm(2)/m(2), and absent (none) if EOAi was ≥ 0.85 cm(2)/m(2). ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1 ± 1.8 years; median, 3.9 years; range, 0.01-8 years). There were no reoperations for PPM. In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.

North American trial results at 1 year with the Sorin Freedom SOLO pericardial aortic valve.

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Heimansohn, David; Roselli, Eric E; Thourani, Vinod H; Wang, Shaohua; Voisine, Pierre; Ye, Jian; Dabir, Reza; Moon, Michael

2016-02-01

A North American prospective, 15-centre Food and Drug Administration (FDA) valve trial was designed to assess the safety and effectiveness of the Freedom SOLO stentless pericardial aortic valve in the treatment of surgical aortic valve disease. Beginning in 2010, 251 patients (mean: 74.7 ± 7.5 years), were recruited in the Freedom SOLO aortic valve trial. One hundred eighty-nine patients have been followed for at least 1 year and are the basis for this review. Preoperatively, 54% of patients had NYHA functional class III or IV symptoms, and the majority of patients had a normal ejection fraction (EF) (median EF = 61%). Concomitant procedures were performed in 61.9% of patients, with coronary artery bypass grafting (CABG) (48.7%) being the most common followed by a MAZE procedure (13.7%). Reoperations were performed in 8.5% of patients in the study. The entire cohort of 251 patients enrolled had 7 deaths prior to 30 days, 2 of which were valve-related (aspiration pneumonia and sudden death) and 5 were not valve-related. There were 11 deaths after 30 days, 1 valve-related (unknown cardiac death) and 10 not valve-related. Five valves were explanted, 3 early (endocarditis, acute insufficiency and possible root dissection) and 2 late (endocarditis). Thirty-day adverse events include arrhythmias requiring permanent pacemaker (4.2%), thromboembolic events (3.7%) and thrombocytopenia (7.4%). One-year follow-up of all 189 patients demonstrated mean gradients for valve sizes 19, 21, 23, 25 and 27 mm of 11.7, 7.8, 6.3, 4.6 and 5.0 mmHg, respectively. Effective orifice areas for the same valve sizes were 1.2, 1.3, 1.6, 1.8 and 1.9 cm(2), respectively. Ninety-six percent of patients (181/189) were in NYHA class I or II at the 1-year follow-up. The Freedom SOLO stentless pericardial aortic valve demonstrated excellent haemodynamics and a good safety profile out to the 1 year of follow-up. © The Author 2015. Published by Oxford University Press on behalf of the European

Ultrasound for critical care physicians: hypotension after a MVA

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Schmitz E

2014-03-01

Full Text Available No abstract available. Article truncated after first page. A 25 year old woman was a restrained driver in a rollover motor vehicle accident (MVA and suffered a C5-C6 fracture-dislocation with spinal cord injury. She was lucid and able to follow commands and could move her upper extremities but not her lower extremities. She was given approximately 6 liters of fluid but required vasopressors to maintain her blood pressure. Initial ECG revealed a normal sinus rhythm without significant ST changes (Figure 1. Upon initial evaluation her blood pressure was low. Bedside ultrasound of the left anterior second intercostal space revealed a sliding lung sign and a 4 chamber view of her heart was performed (Figure 2. Which of the following is the most likely cause of her hypotension? 1. Blunt cardiac injury; 2. Intravascular volume depletion; 3. Neurogenic stunned myocardium; 4. Pericardial tamponade; 5. Pneumothorax ...

The prevention and management of complications during and immediately after percutaneous balloon mitral valvuloplasty

International Nuclear Information System (INIS)

Jiang Shiliang; Huang Lianjun; Xu Zhongying; Zhao Shihua; Zheng Hong; Ling Jian; Xie Ruolan; Dai Ruping

2002-01-01

Objective: To approach the cause and treatment of complication during and immediately after percutaneous balloon mitral valvuloplasty. Methods: One thousand three hundred and eleven patients with mitral stenosis were treated by percutaneous transseptal balloon mitral valvuloplasty. Among them, 42 patients with complications were retrospectively analyzed. Results: The overall complications rate was 3.2% (42/1311) including atrial fibrillation 0.8% (10/1311), acute pericardial tamponade 0.31% (4/1311), severe mitral insufficiency 0.46% (6/1311), femoral arterial venous fistula 0.69% (9/1311), acute pulmonary edema and iatrogenic atrial septal defect 0.23% (3/1311), respectively. Coronary air embolism, arterial thrombosis and transient cerebrovascular accident was 0.15% (2/1311) for every other one. Balloon rupture was 0.08%(1/1311). Conclusions: The complications of percutaneous balloon mitral valvuloplasty rarely occur. It is a safe and efficient nonsurgical method for treating rheumatic mitral stenosis

Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

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Mijušković Dragan

2012-01-01

Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

Cardiac mesothelial papillary hyperplasia in four dogs.

Science.gov (United States)

Kirejczyk, Shannon G; Burnum, Anne L; Brown, Corrie C; Sakamoto, Kaori; Rissi, Daniel R

2018-05-01

Mesothelial papillary hyperplasia (MPH) has been described as an incidental finding on the epicardial surface of clinically normal laboratory Beagle dogs. We describe MPH in 4 dogs diagnosed with acute cardiac tamponade (1 case) or chronic cardiac disease (3 cases). Cardiac MPH appeared as distinct, soft, irregular villous plaques on the epicardial surface of the auricles and occasionally the ventricles. Histologically, areas of MPH were composed of multiple papillary fronds arising from the epicardial surface and projecting into the pericardial space. Fronds were covered by cuboidal and occasionally vacuolated mesothelial cells and were supported by loose fibrovascular stroma with various degrees of edema and inflammation. Although these may represent incidental findings with no clinical significance, the gross appearance warrants differentiation from other conditions. Additional insight into the pathogenesis of MPH is needed to fully understand its significance in the face of concurrent cardiac disease.

Outcomes in variceal hemorrhage following the use of a balloon tamponade device

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Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J.; Sanchez, Leon D.; Wolfe, Richard E.; Chase, Maureen; Donnino, Michael W.; Cocchi, Michael N.

2017-01-01

Background Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. Methods In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. Results 34 patients with a BTD were identified. Median age was 57.5 (IQR 47–63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p < 0.01). One complication, an esophageal perforation, was identified and managed conservatively. Conclusion In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. PMID:28460805

Outcomes in variceal hemorrhage following the use of a balloon tamponade device.

Science.gov (United States)

Nadler, Jonathan; Stankovic, Nikola; Uber, Amy; Holmberg, Mathias J; Sanchez, Leon D; Wolfe, Richard E; Chase, Maureen; Donnino, Michael W; Cocchi, Michael N

2017-10-01

Variceal hemorrhage is associated with high morbidity and mortality. A balloon tamponade device (BTD), such as the Sengstaken-Blakemore or Minnesota tube, may be used in cases of variceal hemorrhage. While these devices may be effective at controlling acute bleeding, the effect on patient outcomes remains less clear. We sought to describe the number of patients with variceal hemorrhage and a BTD who survive to discharge, survive to one-year, and develop complications related to a BTD. In this retrospective study, we identified patients at a single, tertiary care center who underwent placement of a BTD for upper gastrointestinal hemorrhage between 2003 and 2014. Patient characteristics and outcomes were summarized using descriptive statistics. 34 patients with a BTD were identified. Median age was 57.5 (IQR 47-63) and 76% (26/34) were male. Approximately 59% (20/34) of patients survived to discharge, and 41% (13/32) were alive after one year. Two patients were lost to follow-up. Of those surviving to discharge, 95% (19/20) had undergone transjugular intrahepatic portosystemic shunt (TIPS), while 36% (5/14) of patients who did not survive to discharge had TIPS (p<0.01). One complication, an esophageal perforation, was identified and managed conservatively. In this cohort of patients undergoing BTD placement for variceal hemorrhage, approximately 59% of patients were alive at discharge and 41% were alive after one year. Placement of a BTD as a temporizing measure in the management of acute variceal hemorrhage may be helpful, particularly when utilized as a bridge to more definitive therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice : a position statement of the ESC working group on myocardial and pericardial diseases

NARCIS (Netherlands)

Pinto, Yigal M.; Elliott, Perry M.; Arbustini, Eloisa; Adler, Yehuda; Anastasakis, Aris; Boehm, Michael; Duboc, Denis; Gimeno, Juan; de Groote, Pascal; Imazio, Massimo; Heymans, Stephane; Klingel, Karin; Komajda, Michel; Limongelli, Giuseppe; Linhart, Ales; Mogensen, Jens; Moon, James; Pieper, Petronella G.; Seferovic, Petar M.; Schueler, Stephan; Zamorano, Jose L.; Caforio, Alida L. P.; Charron, Philippe

2016-01-01

In this paper the Working Group on Myocardial and Pericardial Disease proposes a revised definition of dilated cardiomyopathy (DCM) in an attempt to bridge the gap between our recent understanding of the disease spectrum and its clinical presentation in relatives, which is key for early diagnosis

A novel tamponade agent for management of post partum hemorrhage: adaptation of the Xstat mini-sponge applicator for obstetric use.

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Rodriguez, Maria I; Jensen, Jeffrey T; Gregory, Kenton; Bullard, Mary; Longo, Paul; Heidel, Jerry; Edelman, Alison

2017-06-13

Although uterine tamponade is an effective treatment for postpartum hemorrhage (PPH), current methods have key limitations in their use, particularly in low resource settings. The XStat™ Mini Sponge Dressing (MSD) is approved for the management of non-compressible wounds in the battlefield/trauma setting. The MSD applies highly compressed medical sponges capable of stopping high-flow arterial bleeding within seconds. The objective of our study was to adopt the MSD for use in managing PPH. We performed desktop testing using a uterine model with pressure sensors to compare key design elements of the obstetrical prototype MSD (fundal pressure achieved, reduction in fluid loss, time to deploy, and time to remove) with alternativetechniques (uterine packing, balloon tamponade). To evaluate safety, we delivered the fetus of pregnant ewes by cesarean section and used the prototype to deliver the MSD into one uterine horn, and closed the hysterotomy. We followed the clinical recovery of animals (n = 3) over 24 h, and then removed the reproductive tract for histologic evaluation. To evaluate late effects, we surgically removed the MSDs after 24 h, and followed the clinical recovery of animals (n = 6) for an additional seven days before tissue removal. The obstetrical prototype has a long tapered delivery system designed to be deployed during vaginal examination, and administers three times the volume of the approved MSD trauma bandage. The MSD are deployed within a mesh bag to facilitate removal by vaginaltraction. On desktop testing, the MSD resulted in the highest average fundal pressure (113 mmHg), followed by the MSD bag device (85.8 mmHg), gauze packing (15.5 mmHg), and the uterine balloon (8.2 mmHg). The MSD bag test group achieved the largest fluid flow reduction of -74%, followed by gauze packing (-55%), MSD (-35%), and uterine balloon (-19%). Animal testing demonstrated good uterine fill with no evidence of adverse clinical recovery, uterine trauma or

Prevalence of 'high-riding' superior pericardial recesses on thin-section 16-MDCT scans

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Basile, Antonio [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy)]. E-mail: antodoc@yahoo.com; Bisceglie, Paola [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Giulietti, Giorgio [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Calcara, Giacomo [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Figuera, Michele [Department of Radiology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Mundo, Elena [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Granata, Antonio [Department of Nephrology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Runza, Giuseppe [Department of Radiology, Policlinico Universitario, Via del Vespro 129, 90127 Palermo (Italy); Privitera, Carmelo [Department of Radiology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Privitera, Giambattista [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Patti, Maria Teresa [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy)

2006-08-15

Objective: The aim of this study was to evaluate the prevalence of 'high-riding' superior pericardial recess (HRSPR) on thin-section (1 mm) 16-multidetector computed tomography (MDCT) scans. Materials and methods: Three hundred and fourteen consecutive chest CT scans obtained with a thin-section 16 MDCT were retrospectively evaluated. The prevalence and characteristic of HRSPR were analyzed. Results: HRSPR was depicted in 21 patients (11 men and 10 women) (6.6%) who ranged in age from 28 to 72 years (mean age, 57 years). The extended recesses were rounded/oval shaped in five patients and triangular, spindle, half moon or irregular shaped in the other 16 patients. Conclusion: Our data suggest as HRSPRs are more frequently and better depicted on thinsection MDCT scans, and this improves the capability to distinguish this superior extension of the superior aortic recess from abnormal findings such as lymphadenopathy, cystic lesions, and aortic dissection.

Pseudo-aneurisma em tubo valvulado de pericárdio bovino corrugado após reconstrução da aorta ascendente: relato de caso False aneurysm of crimped bovine pericardial conduit after reconstruction of the ascending aorta: case report

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Noedir A. G. STOLF

1999-10-01

Full Text Available Os autores descrevem o caso de paciente que, 9 anos após a correção cirúrgica de um aneurisma de aorta ascendente com tubo valvulado de pericárdio bovino corrugado, evoluiu com a formação de um pseudo-aneurisma de aorta localizado, posteriormente, sobre a linha de sutura do tubo de pericárdio bovino. Foi realizada substituição do tubo de pericárdio bovino por tubo de Dacron valvulado (com prótese mecânica e reimplante dos óstios coronários utilizando-se a técnica de hemi-Cabrol. O tempo de seguimento pós-operatório do paciente é de 12 meses, permanecendo assintomático.The authors describe the case of a patient who had an aneurysm of the ascending aorta repaired with biologic valved crimped bovine pericardial conduit. Nine years after the surgery he presented a false aneurysm of the ascending aorta, located posteriorly on the suture line of the pericardial tube. The patient was reoperated and the pericardial tube was replaced by a valved Dacron composite graft using the hemi- Cabrol technique for the reimplantation of the coronary ostia. At 12 months follow-up the patient remains free of symptoms.

Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child.

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Takahashi, Kazuhiro; Fuchigami, Tai; Nabeshima, Taisuke; Sashinami, Arata; Nakayashiro, Mami

2016-03-01

The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.

Purulent pericarditis caused by Klebsiella pneumoniae in a Nigerian Child

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Igoche David Peter

2016-01-01

Full Text Available In the Western world, cases of purulent pericarditis have become almost nonexistent with progress and advent of new immunizations against many causative organisms. We report Klebsiella pneumoniae pericarditis, a rare cause of this uncommon disease, hitherto unreported in Nigeria. K. pneumoniae, which is a rod-shaped, Gram-negative, facultative anaerobe, produces extended-spectrum beta-lactamases; hence, it is usually resistant to a lot of antibiotics and is associated with a significant case fatality rate. Our 13-year-old male patient had septic arthritis of the right hip joint came with a 3 weeks complaint of difficulty with breathing. He had respiratory distress, tachypnea, and tachycardia. Although blood pressure was normal, he had pulsus paradoxus, elevated jugular venous pressure, diffuse apex beat, and heart sounds were distant. Chest radiograph revealed an increased cardiothoracic ratio (0.86 with “water bottle” appearance. Transthoracic echocardiography confirmed pericardial effusion with cardiac tamponade. Echo-guided pericardiocentesis was done, and 340 ml of foul-smelling and creamy pus with greenish tinge was aspirated and this grew K. pneumoniae sensitive to ciprofloxacin and gentamycin but resistant to other conventional antibiotics. Recovery was complete after a week of pericardial tube drainage and 3 weeks of treatment. To the best of our knowledge, this is the first case of Klebsiella - induced pyopericardium and with successful management in a Nigerian child. Pyopericardium may follow rare causes such as K. pneumoniae infection with its unique antibiogram.

Safety profile of multielectrode-phased radiofrequency pulmonary vein ablation catheter and irrigated radiofrequency catheter.

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Wasmer, K; Foraita, P; Leitz, P; Güner, F; Pott, C; Lange, P S; Eckardt, L; Mönnig, G

2016-01-01

Silent cerebral lesions with the multielectrode-phased radiofrequency (RF) pulmonary vein ablation catheter (PVAC(®)) have recently been investigated. However, comparative data on safety in relation to irrigated RF ablation are missing. One hundred and fifty consecutive patients (58 ± 12 years, 56 female) underwent first pulmonary vein isolation (PVI) for atrial fibrillation (61% paroxysmal) using PVAC(®) (PVAC). Procedure data as well as in-hospital complications were compared with 300 matched patients who underwent PVI using irrigated RF (iRF). Procedure duration (148 ± 63 vs. 208 ± 70 min; P drainage n = 0 vs. n = 6] occurred more frequently using iRF. Two patients in each group developed a TIA (1.3% vs. 0.6%). Of note, four of five thromboembolic events in the PVAC group (two TIAs and three transient ST elevations during ablation) occurred when all 10 electrodes were used for ablation. Pulmonary vein isolation using PVAC as a 'one-shot-system' has a comparable complication rate but a different risk profile. Pericardial effusion and tamponade occurred more frequently using iRF, whereas thromboembolic events were more prevalent using PVAC. Occurrence of clinically relevant thromboembolic events might be reduced by avoidance of electrode 1 and 10 interaction and uninterrupted anticoagulation, whereas contact force sensing for iRF might minimize pericardial effusion. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Severe necrotizing myocarditis caused by serratia marcescens infection in an axolotl (Ambystoma mexicanum).

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Del-Pozo, J; Girling, S; Pizzi, R; Mancinelli, E; Else, R W

2011-05-01

This report provides the first account of the pathological changes associated with infection by Serratia marcescens in an adult male axolotl. The infection resulted in septicaemia with severe multifocal necrotizing myocarditis. The latter lesion evolved to cardiac rupture, haemopericardium and death resulting from cardiac tamponade. This animal was exposed to higher than usual temperatures (24-25 °C) 2 weeks before the onset of disease and this may have resulted in immunocompromise and opportunistic bacterial infection. S. marcescens was isolated from the coelomic and pericardial cavity. Both isolates were identical and were resistant to β-lactam antibiotics, but not to aminoglycosides or fluoroquinolones. The production of red prodigiosin pigment by the bacterium suggested an environmental origin. Overall, the clinical and histopathological presentation suggests that S. marcescens should be included in the list of aetiological agents of the 'red-leg'/bacterial dermatosepticaemia syndrome of amphibians. Copyright © 2010 Elsevier Ltd. All rights reserved.

Surgical repair of right atrial wall rupture after blunt chest trauma.

Science.gov (United States)

Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

2012-01-01

Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

Successful displacement of a traumatic submacular hemorrhage in a 13-year-old boy treated by vitrectomy, subretinal injection of tissue plasminogen activator and intravitreal air tamponade: a case report.

Science.gov (United States)

Doi, Shinichiro; Kimura, Shuhei; Morizane, Yuki; Shiode, Yusuke; Hosokawa, Mio; Hirano, Masayuki; Hosogi, Mika; Fujiwara, Atsushi; Miyamoto, Kazuhisa; Shiraga, Fumio

2015-08-07

The natural course of submacular hemorrhage resulting from traumatic choroidal rupture generally has a poor outcome unless treated. The intravitreal injection of gas only or gas with recombinant tissue plasminogen activator (rt-PA) has been reported to be effective, but has also been reported to induce severe complications such as retinal detachment and vitreous hemorrhage. Recently, we reported a safe and effective procedure for treating submacular hemorrhage due to polypoidal choroidal vasculopathy (PCV) with a low dose of rt-PA. Here we report the application of this procedure to a case of traumatic submacular hemorrhage in a 13-year-old boy, which achieved a good visual outcome. A 13-year-old Japanese boy presented with a thick submacular hemorrhage in his left eye as a result of blunt trauma from being hit by a sinker. Best-corrected visual acuity (BCVA) was assessed as only able to perceive hand motions. We carried out a vitrectomy, subretinal injection of 4,000 IU rt-PA (6.9 μg) and air tamponade. The day after surgery, most of the submacular hemorrhage had moved to the inferior periphery. One month after the surgery, we observed cataract formation, thin remnants of the submacular hemorrhage and juxtafoveal choroidal rupture. We carried out cataract surgery and injected bevacizumab intravitreally to prevent the development of choroidal neovascularization. Two months after the second surgery, the submacular hemorrhage had totally disappeared and the patient had a BCVA of 20/40. Vitrectomy, subretinal injection of rt-PA, and intravitreal air tamponade may be a promising strategy for treating traumatic submacular hemorrhage in young patients.

Mitral valve annuloplasty with a bovine pericardial strip - 18-year results Anuloplastia mitral com tira de pericárdio bovino resultados de 18 anos

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Pablo Maria Alberto Pomerantzeff

2005-08-01

Full Text Available PURPOSE: Prosthetic annuloplasty rings are currently used in mitral reconstruction. Posterior annuloplasty with a bovine pericardial strip is a technique largely used in the Heart Institute of University of São Paulo Medical School. The purpose of the study was to analyze the late results of mitral valve repair with posterior annuloplasty using a bovine pericardial strip. METHODS: Between January 1984 and December 2002, 273 patients underwent mitral valve repair with posterior pericardial annuloplasty in the Heart Institute of University of São Paulo Medical School. One hundred and forty four (52.7% were women and ages ranged between 1 and 76 years (38.3 ± 21.1. Rheumatic fever was present in 52.0% of the patients. Associated techniques were employed in 26.0% of the patients, and the most frequent was chordal shortening (9.2%. RESULTS: Hospital mortality was 3.3% (9 patients, with the major cause being low cardiac output (6 patients. Actuarial survival was 55.1% ± 16.8% in 18 years. During the 18-year follow-up: patients were free from the following: reoperation (59.1% ±± 13.9%, (percent +/- Standard Error, thromboembolism (97.4% ± 2.3%, hemolysis (99.2% ± 0.2%, and endocarditis (99.6% ± 1.0%. In the late follow-up period, 83.9% were classified as New York Heart Association functional class I. CONCLUSIONS: Late results with mitral valve repair with posterior annuloplasty using a bovine pericardial strip were satisfactory. The technique is feasible, reproducible, and cost effective.OBJETIVO: Anéis protéticos para anuloplastia são usados nas plásticas da valva mitral de forma rotineira. A anuloplastia posterior com tira de pericárdio bovino é uma técnica largamente utilizada no Instituto do Coração - HC - FMUSP. O objetivo deste estudo foi analisar os resultados tardios da plástica da valva mitral com a utilização desta técnica na nossa instituição. MÉTODOS: Entre janeiro de 1984 e dezembro de 2002, 273 pacientes foram

Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

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Nicole Marijanovich

2018-01-01

Full Text Available Systemic lupus erythematosus (SLE is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25% and severe (+4 mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation.

Ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, cardiogenic shock, and death in a patient with acute ST elevation myocardial infarction during transthoracic echocardiography

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Osama A El Kady

2017-01-01

Full Text Available The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

Clinical evaluation on cardiac enlargement in patients with esophageal cancer treated by radiotherapy with or without chemotherapy

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Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine

2002-09-01

Recent literature on chemoradiotherapy for esophageal cancer report the comparable survival results as surgery, and suggest the importance of management for the late adverse effect of chemoradiotherapy. The aim of this study is to investigate the incidence and risk factors of cardiomegaly after chemoradiotherapy using low dose continuous infusion of 5FU/CDDP+5FU for esophageal cancer. Fifty-one patients with stage I-IVA esophageal cancer who were treated by radiotherapy with more than 50 Gy with or without chemotherapy and followed up for more than 6 months were analyzed. Sixteen patients were treated by radiation alone and 35 patients were treated by chemoradiotherapy. A change of CTR (cardio-thoracic ratio) was defined as the difference between CTR in the pre-treatment X-ray film and CTR in the post-treatment X-ray film with maximum cardiac silhouette. A change of CTR by more than 10% was defined as ''significant cardiomegaly''. In this study cardiac area-dose'', which is the sum of the products of cardiac area within every radiation field and its target dose, was calculated in each patient as a radiation parameter. Significant cardiomegaly was noted in 1 patient (6%) in the radiation alone group, in 8 patients (23%) in the chemoradiotherapy group and in 9 patients (18%) in the total population. In cases with more than 0.4 m{sup 2}{center_dot}Gy in cardiac area-dose, CTR elevation was significantly higher than in cases with less than 0.4m{sup 2}{center_dot}Gy. More than moderate pleural effusion was noted in 5 patients (10%). Chronic pericardial effusion and subsequent cardiac tamponade was considered to be one of the contributing factors for pleural effusion, because increases of pleural effusion coincided with CTR elevations in 3 cases. In addition, the fact that no case had right-sided unilateral pleural effusion suggested the direct effect of radiation to the pleura. Significant cardiomegaly was seen in 18% of 51 patients with

Technical note: subclavian artery misplacement of a 12F Shaldon catheter: percutaneous repair with a local closure device under temporary balloon tamponade; Technische Mitteilung: Entfernung eines fehlplatzierten 12F Shaldon Katheters aus der A. subclavia und Abdichtung mittels Verschlusssystem bei temporaerer Ballonblockade

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Wildberger, J.E.; Katoh, M.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Fussen, R. [Anaesthesiologische Klinik, Medizinisches Zentrum Kreis Aachen GmbH (Germany)

2006-06-15

A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal {sup registered}) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated. (orig.)

Topical use of tranexamic acid in open heart surgery.

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Chaudhary, Farid Ahmad; Pervaz, Zahid; Ilyas, Sana; Niaz, Muhammad Nabeel

2018-04-01

To determine the efficacy of topical pouring of tranexamic acid in reducing post-operative mediastinal bleeding, requirement for blood products and the rate of re-exploration for re-securing haemostasis or relief of pericardial tamponade after open heart surgery. The prospective, randomised, placebo-controlled, double-blind comparative study was conducted from March 2013 to September 2015 at Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social Security Institution, Lahore, and comprised patients scheduled for primary isolated elective or urgent open heart surgery. The subjects were divided into two equal groups. The hetranexamic acid group received cardiac bath with 2gm of tranexamic acid diluted in 50mlof normal saline, while the placebo group received cardiac bath without tranexamic acid. Before the closure of sternum, the solution was poured into pericardial cavity as cardiac bath while the chest tubes were temporarily clamped. Data was entered into a pre-designed proforma. Of the 100 subjects, there were 50(50%) in each of the two groups. There was no difference in surgical characteristics and perioperative complications in the groups (p>0.05). After 48 post-operative hours, total blood loss was significantly less in the tranexamic acid group compared to the placebo group (pacid group than the placebo group (pacid group was re-explored for excessive bleeding compared to 4(8%) in the placebo group. There was significant reduction in post-operative blood drainage, need of blood products and rate of re-exploration after topical use of tranexamic acid in open heart surgery.

Pulmonary artery reconstruction with a tailor-made bovine pericardial conduit following sleeve resection of a long segmental pulmonary artery for the treatment of lung cancer: technical details of the dog-ear method for adjusting diameter during vascular anastomosis.

Science.gov (United States)

Shimizu, Kimihiro; Nagashima, Toshiteru; Ohtaki, Yoichi; Takahashi, Toru; Mogi, Akira; Kuwano, Hiroyuki

2017-05-01

Sleeve resection of the pulmonary artery (PA) is always required for lung-sparing operations in which half or more of the vessel circumference is infiltrated by the primary tumor or metastatic hilar nodes. Following sleeve resection, conduit reconstruction may be indicated if there is excessive distance between the two vascular stumps, because there is a high degree of tension when repaired by direct anastomosis. We herein present a case of PA reconstruction using a tailor-made bovine pericardial conduit after sleeve resection of PA during lung cancer surgery. The length of resection was longer than 3 cm, and the difference in diameter between the conduit and peripheral PA stump was larger than 0.5 cm. We describe the surgical and oncological merits of a bovine pericardial conduit, and provide details of our reconstruction technique, focusing on adjustment of diameter between the conduit and peripheral PA (dog-ear method).

Postmortem diagnosis of Marfan syndrome in a case of sudden death due to aortic rupture: Detection of a novel FBN1 frameshift mutation.

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Wang, Yunyun; Chen, Shu; Wang, Rongshuai; Huang, Sizhe; Yang, Mingzhen; Liu, Liang; Liu, Qian

2016-04-01

To investigate the sudden death of a 36-year-old Chinese man, a medicolegal autopsy was performed, combining forensic pathological examinations and genetic sequencing analysis to diagnose the cause of death. Genomic DNA samples were extracted from blood and subjected to high-throughput sequencing. Major findings included a dilated aortic root with a ruptured and dissected aorta and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities were noted. By sequencing the fibrillin-1 gene (FBN1), five genetic variations were found, including four previously known single nucleotide polymorphisms (SNPs) and a novel frameshift mutation, leading to the diagnosis of Marfan syndrome. The frameshift mutation (c.4921delG, p.glu1641llysFsX9) detected in exon 40 led to a stop codon after the next 8 amino acids. The four SNPs included a splice site mutation (c.3464-5 G>A, rs11853943), a synonymous mutation (p.Asn625Asn, rs25458), and two missense mutations (p.Pro1148Ala, rs140598; p.Cys472Tyr, rs4775765). Genetic screening was recommended for the relatives as it was reported that the father and brother of the deceased had died at the ages of 40 and 25, respectively, from sudden cardiac failure. The son of the deceased lacked the relevant mutations. This report emphasizes the important contribution of medicolegal postmortem analysis on the molecular pathogenesis study of Marfan syndrome and early diagnosis of at-risk relatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A review of the safety aspects of radio frequency ablation

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Abhishek Bhaskaran

2015-09-01

Full Text Available In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF atrial fibrillation (AF ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5–11%, up to 3.4%, up to 1.8% and 4.1–8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.

The relationship of socioeconomic status with coronary artery calcification and pericardial fat.

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Nafakhi, Hussein; Almosawi, Abdulameer; Alnafakh, Hasan; Mousa, Widad

2017-01-01

Little data currently exist supporting the correlation of socioeconomic status (SES) to markers of subclinical coronary atherosclerosis. The main aim was to investigate the relationship of SES measured by economic status and educational level with coronary artery calcification (CAC) and pericardial fat volume (PFV) assessed by multi-detector computed tomography (MDCT). A total of 220 consecutive patients with suspected coronary artery disease, who underwent 64-slice MDCT angiography for assessment of coronary atherosclerosis, were recruited between January 2014 and March 2015. Of these, 186 patients were enrolled in this cross sectional study. Low economic status patients showed higher PFV values; median (inter-quartile range [IQR] was 94 [50-140] cm3, p = 0.00001 and r = 0.37, compared to patients with high economic status, and this association persisted even after multiple logistic regression to conventional cardiac risk factors (p = 0.004, CI 7.3-30.4), while patients with low economic status reported a higher calcium score (but statistically non significant) (p = 0.12) compared to high economic status patients. Pa-tients with no formal education showed higher PFV (median [IQR] was 93 [48-140] cm3, p = 0.01) compared to patients with bachelor's degree (median [IQR] was 56 [28-92] cm3), but this association was attenuated after further adjustment for conventional cardiac risk factors (p = 0.1, CI -9.52-10.88), while CAC showed no significant correlation with educational level (p = 0.2, r = 0.117). Socioeconomic status, particularly economic status measure, reported a significant inverse relationship with PFV independent of conventional cardiac risk factors.

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

(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......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...... auricles, EAT above the right ventricle, PAT, and SAT below the sternum from 50 patients undergoing cardiac surgery. Samples were frozen at -80°C and the content of n-3 PUFAs determined by gas chromatography with results given in relative weight%. RESULTS EPA and DHA were significantly correlated in EAT...

Application of Fourier transform infrared spectroscopy with chemometrics on postmortem interval estimation based on pericardial fluids.

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Zhang, Ji; Li, Bing; Wang, Qi; Wei, Xin; Feng, Weibo; Chen, Yijiu; Huang, Ping; Wang, Zhenyuan

2017-12-21

Postmortem interval (PMI) evaluation remains a challenge in the forensic community due to the lack of efficient methods. Studies have focused on chemical analysis of biofluids for PMI estimation; however, no reports using spectroscopic methods in pericardial fluid (PF) are available. In this study, Fourier transform infrared (FTIR) spectroscopy with attenuated total reflectance (ATR) accessory was applied to collect comprehensive biochemical information from rabbit PF at different PMIs. The PMI-dependent spectral signature was determined by two-dimensional (2D) correlation analysis. The partial least square (PLS) and nu-support vector machine (nu-SVM) models were then established based on the acquired spectral dataset. Spectral variables associated with amide I, amide II, COO - , C-H bending, and C-O or C-OH vibrations arising from proteins, polypeptides, amino acids and carbohydrates, respectively, were susceptible to PMI in 2D correlation analysis. Moreover, the nu-SVM model appeared to achieve a more satisfactory prediction than the PLS model in calibration; the reliability of both models was determined in an external validation set. The study shows the possibility of application of ATR-FTIR methods in postmortem interval estimation using PF samples.

Shock progression and survival after use of a condom uterine balloon tamponade package in women with uncontrolled postpartum hemorrhage.

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Burke, Thomas F; Danso-Bamfo, Sandra; Guha, Moytrayee; Oguttu, Monica; Tarimo, Vincent; Nelson, Brett D

2017-10-01

To examine the outcomes of women in advanced shock from uncontrolled postpartum hemorrhage (PPH) who underwent placement of an Every Second Matters for Mothers and Babies Uterine Balloon Tamponade (ESM-UBT) device. In a prospective case series, data were collected for women who received an ESM-UBT device at healthcare facilities in Kenya, Senegal, Sierra Leone, and Tanzania between September 1, 2012, and September 30, 2016. Shock class was assigned on the basis of recorded blood pressures and mental status at the time of UBT placement. Data for 306 women with uncontrolled PPH from uterine atony across 117 facilities were analyzed. Normal vital signs or class I/II shock were reported for 166 (54.2%). In this group, one death occurred and was attributed to PPH (survival rate 99.4%). There were no cases of shock progression. One hundred and eleven (36.3%) were in class III shock and 29 (9.5%) in class IV shock; the respective survival rates were 97.3% (n=108) and 86.2% (n=25). The ESM-UBT device arrests hemorrhage, prevents shock progression, and is associated with high survival rates among women with uncontrolled PPH from uterine atony. © 2017 International Federation of Gynecology and Obstetrics.

Development of ocular hypertension secondary to tamponade with light versus heavy silicone oil: A systematic review

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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.

Effect of pretreatment with epoxy compounds on the mechanical properties of bovine pericardial bioprosthetic materials.

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Xi, T; Liu, F; Xi, B

1992-07-01

Early failures of bovine pericardial heart valves are due to leaflet perforation, tearing and calcification. Since glutaraldehyde fixation has been shown to produce marked changes in leaflet mechanics and has been linked to development of calcification, bovine pericardium fixed with the four hydrophilic epoxy formulations and their mechanical properties are studied in this paper. We measured the thicknesses, shrinkage temperatures, stress relaxations and stress-strain curves of bovine pericardiums after different treatments with (1) non-treatment (fresh), (2) glutaraldehyde (GA), (3) epoxy compounds followed by the posttreatment with GA (EP 1#, EP 2#), and (4) epoxy compounds (EP 3# and EP 4#). Results of this study showed that the hydrophilic epoxy compounds are good crosslinking agents. There are no significant differences of shrinkage temperature and ultimate tensile stress among all tissue samples pretreated with GA, EP 1# and EP 2#. However, the stress relaxations of tissue-samples pretreated with epoxy compounds followed by the posttreatment with GA (EP 1# and EP 2#) are significantly slower than that pretreated with GA, and the strains at fracture of EP 1# and EP 2# are also significantly larger than that of GA or epoxy compounds. These facts show that the bovine pericardium pretreated with the epoxy compound followed by the posttreatment with GA (EP 1# and EP 2#) possesses greater tenacity and potential durability in dynamic stress.

SD OCT Features of Macula and Silicon Oil–Retinal Interface in Eyes Status Post Vitrectomy for RRD

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Manish Nagpal

2015-03-01

Full Text Available Aim: To objectively document findings at the Silicon oil-Retinal interface, macular status and tamponade effect in Silicon Oil (SO filled eyes using SD OCT. Methods: 104 eyes of 104 patients underwent SD OCT examination, horizontal and vertical macular scans, in silicone oil filled eyes which underwent silicone oil injection post vitrectomy for rhegmatogenous retinal detachment. Findings were divided into 3 Groups; Group A: Findings at silicon oil retinal interface, Group B: Macular pathology and Group C: Tamponade effect. Group C was further divided into two groups; Group 1: Complete tamponade and Group 2: Incomplete tamponade. Results: Group A: subsilicon epiretinal membranes N = 17 (16.3%, emulsified silicon oil N = 16 (15.4% Group B: foveal thickening N = 22 (21.2%, foveal thinning N = 6 (5.7%, subfoveal fluid N = 8 (7.6%, macular hole N = 2 (1.9%; Group C: Incomplete tamponade was noted in N = 12 (11.5%, complete tamponade N = 92 (88.5%.10 out of 104 eyes (9.6% had recurrent retinal detachment post silicon oil removal. 8 of these eyes had complete tamponade and 2 had incomplete tamponade. Conclusion: SD OCT is a useful tool to assess the SO–Retina interface, tamponade effect and macular pathology in SO filled eyes. There is lesser incidence of redetachment with incomplete tamponade in OCT.

INTRAOCULAR LENS POSITION IN COMBINED PHACOEMULSIFICATION AND VITREORETINAL SURGERY.

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Ozates, Serdar; Kiziltoprak, Hasan; Koc, Mustafa; Uzel, Mehmet Murat; Teke, Mehmet Yasin

2017-10-09

To assess the decentration and angle of tilt of the intraocular lens (IOL) according to the intravitreal tamponade types used in combined phacoemulsification and vitreoretinal surgery. This prospective and randomized clinical study involved 73 eyes of 69 patients who underwent combined vitreoretinal surgery. Eyes with intravitreal tamponades formed the study group and eyes without intravitreal tamponades formed the control group. The study group was further divided into silicone oil and gas tamponade subgroups. Cross-sectional IOL images were captured using a Pentacam HR (Oculus, Germany) and tilt and decentration were calculated with Adobe Photoshop software (Adobe, San Jose, CA). The mean angle of tilt and decentration at the vertical meridian were significantly higher in both tamponade groups than in the control group (P 0.05). When comparing the silicone oil and gas tamponade subgroups, no significant differences were noted on the position of IOL at both meridians (P > 0.05 for all). Intravitreal tamponades have an important effect on the position of IOL in combined vitreoretinal surgery. Silicone oil and gas tamponades may induce postoperative tilt and decentration of one-piece acrylic IOLs.

Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

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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.

ORGANIC TRICUSPID VALVE REPAIR WITH AUTOLOGOUS GLUTARALDEHYDE FIXED PERICARDIAL PATCH : A SINGLE CENTER RESULTS

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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

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial.

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Mirmohammad-Sadeghi, Mohsen; Pourazari, Pejman; Akbari, Mojtaba

2017-01-01

Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group ( P = 0.001), but the trend of pain score between groups was not significantly different ( P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group ( P drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

[Chylopericardium as a complication of cardiac surgery: report of two cases and review of the literature].

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Velinović, Milos; Vranes, Mile; Kocica, Mladen; Djukić, Petar; Mikić, Aleksandar; Vukomanović, Vladislav; Kacar, Sasa; Putnik, Svetozar; Marković, Dejan; Seferović, Petar M

2007-01-01

Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic--St. Jude No 21 and mitral valve--St. Jude No 29). Etiology of pericardial effusion was established by Sudan III staining of punctate specimen obtained by subxiphoid pericardial puncture. Probable cause of chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of pericardial effusion. The second patient was female, 21 years old, with chylopericardium after partial pericardiectomy performed because of the chronic severely symptomatic pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of cholesterol (3.2 mmol/l), triglycerides (16.6 mmol/l), and proteins (64.7 g/l), which verified chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial pericardiectomy. Diet rich in medium-chain triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml). Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of contrast media. Surgical ligation of ductus thoracicus was performed through the right thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the ligation of lymphatic vessels, guided by extravasation of intraoperatively iwected

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

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Cilloniz, Catia; Torres, Antoni [Servicio de Neumologia, Hospital Clinic de Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Instituto de Investigacion Biomedica Agusti Pi i Sunyer, Universidad de Barcelona (Spain); Rangel, Ernesto [Facultad de Medicina, Universidad Autonoma de Nayarit, Tepic (Mexico); Barlascini, Cornelius [Servizio di Igiene e Sanita Pubblica, Ospedale Generale di Sestri Levante, Sestri Levante (Italy); Piroddi, Ines Maria Grazia; Nicolini, Antonello, E-mail: antonellonicolini@gmail.com [Servizio di Pneumologia, Ospedale Generale di Sestri Levante, Sestri Levante (Italy)

2015-07-15

Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. (author)

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

International Nuclear Information System (INIS)

Cilloniz, Catia; Torres, Antoni; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Nicolini, Antonello

2015-01-01

Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. (author)

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

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial

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Mohsen Mirmohammad-Sadeghi

2017-01-01

Full Text Available Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. Materials and Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001, but the trend of pain score between groups was not significantly different (P = 0.097. The frequency of tamponade and atrial fibrillation (AF were significantly lower in Jackson-Pratt drain group (P < 0.05. Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

PREVALENCE OF FOVEOLAR LUCENCY WITH DIFFERENT GAS TAMPONADES IN SURGICALLY CLOSED MACULAR HOLES ASSESSED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY.

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Zarranz-Ventura, Javier; Ellabban, Abdallah A; Sim, Dawn A; Keane, Pearse A; Kirkpatrick, James N; Sallam, Ahmed A B

2017-07-07

To evaluate the prevalence of foveolar lucency (FL) in surgically closed macular holes by spectral domain optical coherence tomography. One hundred forty-two eyes of 132 patients underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade in a 60-month time frame. Anatomical success and FL rates assessed by spectral domain optical coherence tomography, mean preoperative, and postoperative best-measured visual acuity and surgical details were retrospectively analyzed. Spectral domain optical coherence tomography confirmed closed holes with FL in 33.7% (34/101) of eyes at 1 month, 7.3% (9/123) at 3 months, 4.6% (6/129) at 6 months, and 3% (4/133) at 12 months. Prevalence of FL in closed holes at Month 1 was lower in C3F8-treated eyes (9.5%, 2/21) compared with C2F6 (40.9%, 18/44, P = 0.03) and SF6-treated eyes (38.9%, 14/36, P = 0.05). No differences were observed at Month 3. No differences in best-measured visual acuity change were observed between closed holes with or without FL at Month 1 (-0.14 ± 0.19 vs. -0.11 ± 0.23, P = 0.48) or any of the other time points. Temporary FL is a highly prevalent feature in successfully closed macular holes. Eyes treated with C3F8 gas had lower rates of FL at Month 1 than C2F6 and SF6-treated eyes. The presence of FL in closed holes does not seem to have any effect on the visual outcomes.

Perioperative management of a patient with Dandy Walker malformation with tetralogy of Fallot undergoing total correction and fresh homologous pericardial pulmonary valve conduit implantation: Report of a rare case

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Vishnu Datt

2015-01-01

Full Text Available Perioperative management of a patient with Dandy-Walker malformation (DWM with tetralogy of Fallot (TOF, patent ductus arteriosus, and pulmonary artery stenosis is a great challenge to the anesthesiologist. Anesthetic management in such patients can trigger tet spells that might rapidly increase intracranial pressure (ICP, conning and even death. The increase in ICP can precipitate tet spells and further brain hypoxia. To avoid an increase in ICP during TOF corrective surgery ventriculo-peritoneal (VP shunt should be performed before cardiac surgery. We present the first case report of a 11-month-old male baby afflicted with DWM and TOF who underwent successful TOF total corrective surgery and fresh autologous pericardial pulmonary valve conduit implantation under cardiopulmonary bypass after 1 week of VP shunt insertion.

An examination of the consequences in high consequence operations

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Spray, S.D.; Cooper, J.A.

1996-06-01

Traditional definitions of risk partition concern into the probability of occurrence and the consequence of the event. Most safety analyses focus on probabilistic assessment of an occurrence and the amount of some measurable result of the event, but the real meaning of the ``consequence`` partition is usually afforded less attention. In particular, acceptable social consequence (consequence accepted by the public) frequently differs significantly from the metrics commonly proposed by risk analysts. This paper addresses some of the important system development issues associated with consequences, focusing on ``high consequence operations safety.``

PERICARDITIS CONSTRICTIVA EN UNA MUJER DE 36 AÑOS / Constrictive Pericarditis in a 36 year-old woman

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Tessa Negrín Valdés

2012-07-01

Full Text Available ResumenPaciente femenina, de 36 años de edad, con antecedentes de dos gestaciones, dos partos y ningún aborto, que en el año 2003 tras su segundo parto, distócico por cesárea, desarrolla una pericarditis de causa no precisada que produjo un derrame pericárdico grave con signos de taponamiento cardíaco, y requirió ingreso hospitalario y pericardiocentesis. Siete años después se identifican, en la consulta de Cardiología, síntomas clínicos de una pericarditis constrictiva, corroborada por ecocardiograma y cateterismo derecho; actualmente ingresa para pericardiectomía, evaluada como alto riesgo quirúrgico. / Abstract36 year-old female patient, with a history of two pregnancies, two births and no abortion, who in 2003 after her second delivery (cesarean for dystocia she developed pericarditis of undetermined cause that produced a severe pericardial effusion with signs of cardiac tamponade and required hospital admission and pericardiocentesis. Seven years later, in the Cardiology service, clinical symptoms of constrictive pericarditis are identified and confirmed by echocardiography and right heart catheterization. This patient has been recently admitted for pericardiectomy, and evaluated as high surgical risk.

Trastuzumab (Herceptin)-associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review.

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Tu, Chung-Ming; Chu, Kai-Ming; Yang, Shin-Ping; Cheng, Shu-Mung; Wang, Wen-Been

2009-09-01

Trastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumab is combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard. Pulmonary and abdominal examinations were unremarkable. Twelve-lead electrocardiography showed sinus tachycardia and new onset of complete left bundle-branch block. Emergent transthoracic echocardiography revealed generalized hypokinesia of left ventricle and akinesia over interventricular septum and apex. She subsequently underwent immediate coronary angiography that revealed normal coronary angiography, and left ventriculogram revealed generalized hypokinesia with severe left ventricle dysfunction with ejection fraction of 33%. During right heart catheterization and endomyocardial biopsy, cardiac tamponade developed and was successfully relieved by pericardial window. She was discharged event-free 3 weeks later with conservative treatment. Although new onset of complete left bundle-branch block in a patient with chest pain may be acute coronary syndrome, careful review of medicine history is mandatory to avoid unnecessary procedure and complications.

The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability.

Science.gov (United States)

Stanger, Olaf; Bleuel, Irina; Gisler, Fabian; Göber, Volkhard; Reineke, Sylvia; Gahl, Brigitta; Aymard, Thierry; Englberger, Lars; Carrel, Thierry; Tevaearai, Hendrik

2015-07-01

To report our institutional experience and long-term results with the Freedom Solo bovine pericardial stentless bioprosthesis (Sorin Group, Saluggia, Italy). Between January 2005 and November 2009, 149 patients (mean age, 73.6 ± 8.7 years; 68 [45.6%] female) underwent isolated (n = 75) or combined (n = 74) aortic valve replacement (AVR) using the Solo in our institution. Follow-up was 100% complete with an average follow-up time of 5.9 ± 2.6 years (maximum, 9.6 years) and a total of 885.3 patient years. Operative (30-day) mortality was 2.7% (1.3% for isolated AVR [n = 1] and 4.0% for combined procedures [n = 3]). All causes of death were not valve-related. Preoperative peak (mean) gradients of 74.2 ± 23.0 mm Hg (48.6 ± 16.3 mm Hg) decreased to 15.6 ± 5.4 mm Hg (8.8 ± 3.0 mm Hg) after AVR, and remained low for up to 9 years. The postoperative effective orifice area was 1.6 ± 0.57 cm(2), 1.90 ± 0.45 cm(2), 2.12 ± 0.48 cm(2), and 2.20 ± 0.66 cm(2) for the valve sizes 21, 23, 25, and 27, respectively, with absence of severe prosthesis-patient mismatch and 0.7% (n = 1) experienced moderate prosthesis-patient mismatch. During follow-up, 26 patients experienced structural valve deterioration (SVD) and 14 patients underwent explantation. Kaplan-Meier estimates for freedom from death, explantation, and SVD at 9 years averaged 0.57 (range, 0.47-0.66), 0.82 (range, 0.69-0.90), and 0.70 (range, 0.57-0.79), respectively. The Freedom Solo stentless aortic valve is safe to implant and shows excellent early and midterm hemodynamic performance. However, SVD was observed in a substantial number of patients after only 5-6 years and the need for explantation increased markedly, suggesting low durability. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Feasibility of pig and human-derived aortic valve interstitial cells seeding on fixative-free decellularized animal pericardium.

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Santoro, Rosaria; Consolo, Filippo; Spiccia, Marco; Piola, Marco; Kassem, Samer; Prandi, Francesca; Vinci, Maria Cristina; Forti, Elisa; Polvani, Gianluca; Fiore, Gianfranco Beniamino; Soncini, Monica; Pesce, Maurizio

2016-02-01

Glutaraldehyde-fixed pericardium of animal origin is the elective material for the fabrication of bio-prosthetic valves for surgical replacement of insufficient/stenotic cardiac valves. However, the pericardial tissue employed to this aim undergoes severe calcification due to chronic inflammation resulting from a non-complete immunological compatibility of the animal-derived pericardial tissue resulting from failure to remove animal-derived xeno-antigens. In the mid/long-term, this leads to structural deterioration, mechanical failure, and prosthesis leaflets rupture, with consequent need for re-intervention. In the search for novel procedures to maximize biological compatibility of the pericardial tissue into immunocompetent background, we have recently devised a procedure to decellularize the human pericardium as an alternative to fixation with aldehydes. In the present contribution, we used this procedure to derive sheets of decellularized pig pericardium. The decellularized tissue was first tested for the presence of 1,3 α-galactose (αGal), one of the main xenoantigens involved in prosthetic valve rejection, as well as for mechanical tensile behavior and distensibility, and finally seeded with pig- and human-derived aortic valve interstitial cells. We demonstrate that the decellularization procedure removed the αGAL antigen, maintained the mechanical characteristics of the native pig pericardium, and ensured an efficient surface colonization of the tissue by animal- and human-derived aortic valve interstitial cells. This establishes, for the first time, the feasibility of fixative-free pericardial tissue seeding with valve competent cells for derivation of tissue engineered heart valve leaflets. © 2015 Wiley Periodicals, Inc.

Dosimetric predictors of radiation-induced pericardial effusion in esophageal cancer

Energy Technology Data Exchange (ETDEWEB)

Ogino, Ichiro; Watanabe, Shigenobu [Yokohama City University Medical Center, Department of Radiation Oncology, Minami-ku, Yokohama, Kanagawa-prefecture (Japan); Sakamaki, Kentaro [Yokohama City University, Department of Biostatistics, Yokohama City University, Yokohama (Japan); Ogino, Yuka [Tokyo Institute of Technology, Department of Systems and Control Engineering, Tokyo (Japan); Kunisaki, Chikara [Yokohama City University Medical Center, Department of Surgery, Gastroenterological Center, Yokohama (Japan); Kimura, Kazuo [Yokohama City University Medical Center, Division of Cardiology, Yokohama (Japan)

2017-07-15

To evaluate the dose-volume parameters of the pericardium and heart in order to reduce the risk of radiation-induced pericardial effusion (PE) and symptomatic PE (SPE) in esophageal cancer patients treated with concurrent chemoradiotherapy. In 86 of 303 esophageal cancer patients, follow-up CT was obtained at least 24 months after concurrent chemoradiotherapy. Correlations between clinical factors, including risk factors for cardiac disease, dosimetric factors, and the incidence of PE and SPE after radiotherapy were analyzed using Cox proportional hazard regression analysis. Significant dosimetric factors with the highest hazard ratios were investigated using zones separated according to their distance from esophagus. PE developed in 49 patients. Univariate analysis showed the mean heart dose, heart V{sub 5}-V{sub 55}, mean pericardium dose, and pericardium V{sub 5}-V{sub 50} to all significantly affect the incidence of PE. Additionally, body surface area was correlated with the incidence of PE in multivariate analysis. Grade 3 and 4 SPE developed in 5 patients. The pericardium V{sub 50} and pericardium D{sub 10} significantly affected the incidence of SPE. The pericardium V{sub 50} in patients with SPE ranged from 17.1 to 21.7%. Factors affecting the incidence of SPE were the V{sub 50} of the pericardium zones within 3 cm and 4 cm of the esophagus. A wide range of radiation doses to the heart and pericardium were related to the incidence of PE. A pericardium V{sub 50} ≤ 17% is important to avoid symptomatic PE in esophageal cancer patients treated with concurrent chemoradiotherapy. (orig.) [German] Beurteilung der Dosis-Volumen-Parameter fuer Perikard und Herz zur Risikoreduzierung eines strahleninduzierten Perikardergusses (PE) und eines symptomatischen PE (SPE) bei mit kombinierter Strahlenchemotherapie behandelten Speiseroehrenkrebspatienten. Bei 86 von 303 Speiseroehrenkrebspatienten wurde mindestens 24 Monate nach der Strahlenchemotherapie ein Kontroll

Consequence Prioritization Process for Potential High Consequence Events (HCE)

Energy Technology Data Exchange (ETDEWEB)

Freeman, Sarah G. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2016-10-31

This document describes the process for Consequence Prioritization, the first phase of the Consequence-Driven Cyber-Informed Engineering (CCE) framework. The primary goal of Consequence Prioritization is to identify potential disruptive events that would significantly inhibit an organization’s ability to provide the critical services and functions deemed fundamental to their business mission. These disruptive events, defined as High Consequence Events (HCE), include both events that have occurred or could be realized through an attack of critical infrastructure owner assets. While other efforts have been initiated to identify and mitigate disruptive events at the national security level, such as Presidential Policy Directive 41 (PPD-41), this process is intended to be used by individual organizations to evaluate events that fall below the threshold for a national security. Described another way, Consequence Prioritization considers threats greater than those addressable by standard cyber-hygiene and includes the consideration of events that go beyond a traditional continuity of operations (COOP) perspective. Finally, Consequence Prioritization is most successful when organizations adopt a multi-disciplinary approach, engaging both cyber security and engineering expertise, as in-depth engineering perspectives are required to recognize and characterize and mitigate HCEs. Figure 1 provides a high-level overview of the prioritization process.

Malignant Tumors Of The Heart

International Nuclear Information System (INIS)

Dubrava, J.

2007-01-01

Autoptic prevalence of the heart tumors is 0,01 – 0,3 %. 12 – 25 % of them are malignant tumors and 75 – 88 % are benign. Malignancies are more frequently found in the right heart. Metastatic tumors occur 20 – 40-times more frequently than primary neoplasms. Even 94 % of primary malignant tumors are sarcomas. Most frequent of them are angio sarcomas. Heart metastases are only found in extensive dissemination. Highest prevalence of heart metastases is observed in melanoma, followed by malignant germ cell tumors, leukemia, lymphoma, lung cancer. The clinical presentation is due to the combination of heart failure, embolism, arrhythmias, pericardial effusion or tamponade. The symptoms depend on anatomical localization and the tumor size but not on the histological type. Prognosis of the heart malignancies is poor. Untreated patients die within several weeks to 2 years after the diagnosis was determined. Whenever possible the heart tumor should be resected, despite the surgery is usually neither definite nor sufficiently effective therapy. The patients with completely resectable sarcomas have better prognosis (median of survival 12 – 24 months) than the patients with incomplete resection (3 – 10 months). Complete excision is possible in only less than half of the patients. In some patients chemotherapy, radiotherapy, heart transplantation or combination of them prolonged the survival up to 2 years. Despite of this treatment median of the survival is only 1 year. (author)

Mesothelioma in Two Nondomestic Felids: North American Cougar (Felis concolor and Cheetah (Acinonyx jubatus

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Amanda Whiton

2013-01-01

Full Text Available A 15-year-old male North American cougar (Felis concolor presented with a 2-day history of anorexia, restlessness, and dyspnea. White blood cell count ( cells/μL and absolute segmented neutrophil count ( cells/μL were increased, and BUN (143 mg/dL, creatinine (6.3 mg/dL, and phosphorus (8.5 mg/dL concentrations indicated chronic renal disease. Thoracic radiographs showed severe pleural and pericardial effusion. During attempts to remove the fluid, cardiac tamponade developed and the cat died. At necropsy, nodular masses decorated the pericardium at the level of the base of the heart. The final microscopic diagnosis was mesothelioma of the pericardium, tunica adventitia of the main pulmonary artery, left auricle epicardium, and left ventricular epicardium. A 15-year-old female cheetah (Acinonyx jubatus was evaluated for acute respiratory distress. The white blood cell count ( cells/μL and absolute segmented neutrophil count ( cells/μL were increased. Radiographically pleural effusion and a cranial thoracic mass were seen. The cheetah was euthanized, and a gross diagnosis of disseminated pleural mesothelioma with thoracic effusion was made. Histologically, pleural mesothelioma was confirmed with local invasion of the lung and pulmonary arterial emboli and infarction. In both cases, a diagnosis of mesothelioma was made based on cellular morphology, microscopic architecture, and neoplastic cell coexpression of cytokeratin and vimentin.

Cardiac tamponade

Science.gov (United States)

... test may be done at the bedside in emergency cases. A physical exam may show: Blood pressure that ... Pericardiocentesis. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2014: ...

Derrame pericárdico grave en un paciente con hipotiroidismo Severe pericardial effusion in a patient with hypothyroidism

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María Norbelis Viamonte Tapia

2012-12-01

Full Text Available Se expone el caso clínico de un paciente de 40 años de edad, con aparente buena salud, atendido en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba por presentar, desde hacía varios meses, dolor abdominal en epigastrio, no irradiado, asociado a molestia en la región anterior del tórax, dificultad para respirar, hinchazón en las piernas, decaimiento, somnolencia y dolores articulares, así como andar lento y disminución de la memoria, entre otros síntomas. Los resultados de los exámenes complementarios confirmaron que se trataba de un derrame pericárdico de causa hipotiroidea. Se indicó tratamiento sustitutivo con hormonas tiroideas (levotiroxina sódica. Evolucionó favorablemente y egresó de la institución hospitalaria, pero fue reevaluado a los 3 meses, observándose una mejoría significativa.The case of an apparently healthy 40 year-old patient is reported, who was attended in "Dr. Joaquín Castillo Duany" Clinical Surgical Hospital of Santiago de Cuba to present with epigastric abdominal pain for several months, no irradiated and associated with discomfort in anterior chest, breathing difficulty, swelling of the legs, weakness, drowsiness and joint pains, as well as slow gait, impaired memory, and other symptoms. The results of additional tests confirmed a pericardial effusion of hypothyroid cause. A replacement therapy was administered with thyroid hormones (sodium levothyroxine. He made good progress and was discharged from the hospital, but he was reevaluated at 3 months and a significant improvement was observed.

The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model

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A. Maciver

2011-01-01

Full Text Available We investigate the effectiveness of buttressing the surgical stapler to reduce postoperative pancreatic fistulae in a porcine model. As a pilot study, pigs (n=6 underwent laparoscopic distal pancreatectomy using a standard stapler. Daily drain output and lipase were measured postoperative day 5 and 14. In a second study, pancreatic transection was performed to occlude the proximal and distal duct at the pancreatic neck using a standard stapler (n=6, or stapler with bovine pericardial strip buttress (n=6. Results. In pilot study, 3/6 animals had drain lipase greater than 3x serum on day 14. In the second series, drain volumes were not significantly different between buttressed and control groups on day 5 (55.3 ± 31.6 and 29.3 ± 14.2 cc, resp., nor on day 14 (9.5 ± 4.2 cc and 2.5 ± 0.8 cc, resp., P=0.13. Drain lipase was not statistically significant on day 5 (3,166 ± 1,433 and 6,063 ± 1,872 U/L, resp., P=0.25 or day 14 (924 ± 541 and 360 ± 250 U/L. By definition, 3/6 developed pancreatic fistula; only one (control demonstrating a contained collection arising from the staple line. Conclusion. Buttressed stapler failed to protect against pancreatic fistula in this rigorous surgical model.

Electrolyte composition of retro-oil fluid and silicone oil-related visual loss

NARCIS (Netherlands)

Scheerlinck, Laura M E; Kuiper, Jonas J W; Liem, Albert T A; Schellekens, Peter A W J F; van Leeuwen, Redmer

2016-01-01

PURPOSE: Up to one-third of patients with intra-ocular silicone oil (SO) tamponade for complex macula-on retinal detachment may experience an unexplained visual loss during or after SO tamponade. Although the underlying mechanism is unknown, previous studies suggested that accumulation of retinal

Heavy Silicone Oil and Intraocular Inflammation

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Francesco Morescalchi

2014-01-01

Full Text Available In the past two decades, many advances have been made in vitrectomy instrumentation, surgical techniques, and the use of different tamponade agents. These agents serve close retinal breaks, confine eventual retinal redetachment, and prevent proliferative vitreoretinopathy (PVR. Long-acting gases and silicone oil are effective internal tamponade agents; however, because their specific gravity is lower than that of the vitreous fluid, they may provide adequate support for the superior retina but lack efficacy for the inferior retina, especially when the fill is subtotal. Thus, a specific role may exist for an internal tamponade agent with a higher specific gravity, such as heavy silicone oils (HSOs, Densiron 68, Oxane HD, HWS 45-300, HWS 46-3000, and HeavySil. Some clinical evidence seems to presume that heavy tamponades are more prone to intraocular inflammation than standard silicone if they remain in the eye for several months. In this review, we discuss the fundamental clinical and biochemical/molecular mechanisms involved in the inflammatory response after the use of heavy tamponade: toxicity due to impurities or instability of the agent, direct toxicity and immunogenicity, oil emulsification, and mechanical injury due to gravity. The physical and chemical properties of various HSOs and their efficacy and safety profiles are also described.

Intravitreal gas injection without vitrectomy for macular detachment associated with an optic disk pit.

Science.gov (United States)

Akiyama, Hideo; Shimoda, Yukitoshi; Fukuchi, Mariko; Kashima, Tomoyuki; Mayuzumi, Hideyasu; Shinohara, Yoichiro; Kishi, Shoji

2014-02-01

To evaluate the clinical outcomes after gas tamponade without vitrectomy for retinal detachment associated with an optic disk pit using optical coherence tomography. Intravitreal gas injection was performed on 8 consecutive patients (mean age, 35.0 years; range, 15-74 years) with unilateral macular detachment associated with an optic disk pit. A 0.3-mL injection of 100% sulfur hexafluoride 6 gas was carried out without an anterior chamber tap. Patients treated with gas injection were instructed to remain facedown for 5 days. Complete retinal reattachment after only gas tamponade was achieved in four out of eight eyes. The mean number of gas injections was 1.8. The mean best-corrected visual acuity before and after the treatment with gas tamponade was approximately 30/100 and 20/20, respectively. The period required for reattachment after final gas treatment was 12 months. There were no incidences of recurrence after complete reattachment by gas tamponade in any of the cases during the 94-month average follow-up period (range, 64-132 months). Gas tamponade appears to be an effective alternative method for macular detachment associated with an optic disk pit, even though the mechanisms of optic disk pit maculopathy are still unknown.

Disseminated infection with Strongyloides stercoralis in a diabetic patient

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Murali A

2010-01-01

Full Text Available A 58-year-old male diabetic who was operated for carcinoma larynx 4 years back was admitted with exertional dyspnoea and bilateral leg swelling for the past 2 years. Over the last 2 months, there was a progressive worsening of symptoms. Echocardiography done 2 years back showed pericardial effusion. Echo done during the current admission also showed pericardial effusion with preserved left ventricular function; cytological examination of the pericardial fluid showed larvae of Strongyloides stercoralis. He was treated with antinematodal drugs. A follow-up echo done at discharge showed no pericardial effusion and the patient was completely asymptomatic. To our knowledge, this is the first reported case of Strongyloides pericardial effusion in a diabetic patient.

Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker

Science.gov (United States)

Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

2017-01-01

Abstract Introduction: The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. Case Presentation: In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and

Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker: The phantom injury of the ventricular lead.

Science.gov (United States)

Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

2017-06-01

The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and disabled. So, we can speculate that

Evaluation of supine and sitting cardiac blood pool scans with sup(99m)Tc-HSA

International Nuclear Information System (INIS)

Bunko, Hisashi; Kuwajima, Akira; Hisada, Kinichi

1977-01-01

In the differential diagnosis of enlarged cardiac silhouette on plain chest x-ray film, cardiac blood pool scan was usually performed at first. However, small amount of pericardial effusion was difficult to detect on cardiac blood pool scan and differentiation of pericardial effusion from myocardial thickening was sometimes difficult. We evaluated cardiac blood pool scan with sup(99m)Tc-HSA(human serum albumin) and gamma camera imaged on both supine and sitting position, and evaluated diagnostic efficiency of criteria for pericardial effusion of these scans. Fifty-seven patients suspected of having pericardial effusion were included in the study. Sixteen of these patients had pericardial effusion and 2 of these 16 patients had free pleural effusion. Three patients had pleural effusion alone and excluded from the study. Of the five criteria for pericardial effusion, separation between heart and right lung activities was most frequent in both effusion (true positive, TP=100% on both supine and sitting) and no effusion (false positive, FP=18.4% on supine and 23.7% on sitting) groups. However, increased heart and right lung separation on sitting position was rather frequent in effusion group, and this finding was also thought to be typical for effusion but not for myocardial thickening. Decreased cardiohepatic separation on sitting position was frequent in no effusion group, and FP rate was decreased from 18.4% (supine) to 10.5% (sitting). Two patients with both pericardial effusion and free pleural effusion were easily diagnosed on sitting cardiac blood pool scan. With ROC(receiver operating characteristic) curve, three criteria should be agreed on either supine or sitting scan for diagnosis of pericardial effusion, and six criteria should be agreed when both supine and sitting scans were employed for diagnosis of pericardial effusion. (auth.)

An Unusual Presentation of Plasma Cells – Castleman Disease: A Case Report

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Mihăilă Mariana

2016-06-01

Full Text Available We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the right hemi-abdomen and hip with posterior extension, and a peripheral indurated erythematous plaque. The patient presented nodular masses of 3 cm in the right latero-cervical and bilateral axillary regions, non-adherent to the superficial structures, as well as adenopathic blocks in both inguinal regions. CT scan of the thorax and abdomen showed moderate bilateral pleuresia, minimal pericardial effusion (15 mm and multiple adenopathies on both sides of the diaphragm. Skin biopsy was performed, as well as bone marrow aspirate and excision of a right axillary lymph node. Pathological exams and immunohistochemistry tests confirmed the diagnosis of Plasma Cells Castleman disease.

An Unusual Presentation of Plasma Cells - Castleman Disease: A Case Report.

Science.gov (United States)

Mihăilă, Mariana; Herlea, V; Dobrea, Camelia; Lupescu, Ioana; Munteanu, Gina Rusu; Chiriac, Grethi; Micu, L; Serescu, R; Copaci, I

2016-01-01

We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the right hemi-abdomen and hip with posterior extension, and a peripheral indurated erythematous plaque. The patient presented nodular masses of 3 cm in the right latero-cervical and bilateral axillary regions, non-adherent to the superficial structures, as well as adenopathic blocks in both inguinal regions. CT scan of the thorax and abdomen showed moderate bilateral pleuresia, minimal pericardial effusion (15 mm) and multiple adenopathies on both sides of the diaphragm. Skin biopsy was performed, as well as bone marrow aspirate and excision of a right axillary lymph node. Pathological exams and immunohistochemistry tests confirmed the diagnosis of Plasma Cells Castleman disease.

Atypical Presentation of Constrictive Pericarditis in a Holstein Heifer

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Mohamed M. Elhanafy

2012-01-01

Full Text Available The field diagnosis of constrictive pericardial effusion is often established on the pertinent pathognomonic physical examination findings, but the condition cannot be ruled out based on absence of these cardinal signs. Constrictive pericardial effusion is not always manifested by bilateral jugular venous distention and pulsation, brisket edema, and muffled heart sounds, all of which are considered the key points in the field diagnosis of pericardial effusion and hardware disease. This case will also document that the outcomes of hematology, serum biochemistry panels, and blood gas analysis can be totally inconsistent with passive venous congestion and constrictive pericardial effusion in cattle. Chest radiographic findings revealed radio dense, wire-like objects; the findings were suggestive but not conclusive for pericardial or pleural effusions, due to indistinguishable diaphragmatic outline and cardiopulmonary silhouette. Cardiac ultrasonography was found to be an excellent paraclinical diagnostic procedure for cases that potentially have traumatic pericarditis and constrictive pericardial effusion. Ultrasound-guided pericardiocentesis was also a valuable diagnostic aid in establishing a definitive diagnosis.

Pericardial Effusion

Science.gov (United States)

... heart was within the field of radiation Chemotherapy treatment for cancer, such as doxorubicin (Doxil) and cyclophosphamide Waste products in the blood due to kidney failure (uremia) Underactive thyroid (hypothyroidism) Viral, bacterial, fungal or parasitic infections Trauma or ...

Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up.

Science.gov (United States)

Taylor, Frederick L; Levine, Laurence A

2008-09-01

Limited publications exist regarding long-term outcomes of surgical correction for Peyronie's Disease (PD). To report on long-term postoperative parameters including rigidity, curvature, length, sensation, function, and patient satisfaction in men with PD treated surgically via Tunica Albuginea Plication (TAP) or Partial Plaque Excision with Tutoplast Human Pericardial Grafting (PEG). Objective and subjective data regarding patients who underwent either TAP or PEG. We report on 142 patients (61 TAP and 81 PEG) with both objective data and subjective patient reports on their postoperative experience. Patients underwent either TAP or PEG following our previously published algorithm. Data was collected via chart review and an internally generated survey, in which patients were asked about their rigidity, straightness, penile length, sensation, sexual function and satisfaction. Average follow up for TAP patients was 72 months (range 8-147) and 58 months (range 6-185) for PEG patients. At survey time, 93% of TAP and 91% of PEG patients reported curvatures of less than 30o. Rigidity was reportedly as good as or better than preoperative in 81% of TAP and 68% of PEG patients, and was adequate for coitus in 90% of TAP and 79% of PEG patients with or without the use of PDE5i. Objective flaccid stretched penile length measurements obtained pre and postoperatively show an average overall length gain of 0.6 cm (range -3.5-3.5) for TAP and 0.2 cm (range -1.5-2.0) for PEG patients. Sensation was reportedly as good as or better than preoperative in 69% of both TAP and PEG patients; 98% of TAP patients and 90% of PEG are able to achieve orgasm. 82% of TAP patients and 75% of PEG patients were either very satisfied or satisfied. Our long-term results support both TAP and PEG as durable surgical therapy for men with clinically significant PD.

[Cardiac invasion of ATLL cells and therapeutic effects of local along with systemic treatments].

Science.gov (United States)

Imoto, S; Nakagawa, T; Ito, M

1989-07-01

We report a rare case of adult T cell leukemia/lymphoma (ATLL) in which cardiac invasion was clinically demonstrated and treated effectively. A 45-year-old female was admitted because of exertional dyspnea and cervical tumors. The leukocyte count was 19,100/microliters with 20% of flower cells. HTLV-I antibody was positive. She was diagnosed as ATLL and treated with VEPA. She got remission for a short duration which was followed by relapse. OPEC was started as salvage therapy. In the course, extensive pericardial effusion was found in chest X-P. Pericardial puncture demonstrated ATLL cells and high titer of free IL-2 receptor (57,400U/ml) in the effusion. It was diagnosed as pericardial invasion of ATLL cells. Chemotherapy was started with new combination of drugs (cisplatin, mitoxantrone, ifosfamide, and prednisolone). Concomitantly pericardial drainage was performed and the drugs were administered directly into the pericardial cavity. The clinical improvement was obtained and pericardial effusion did not appear thereafter. She died 4 months after the diagnosis of cardiac invasion. On autopsy myocardial invasion was identified. The pericardium widely adhered and effusion measured 42 ml.

Childhood Obesity Causes & Consequences

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... and Local Programs Related Topics Diabetes Nutrition Childhood Obesity Causes & Consequences Recommend on Facebook Tweet Share Compartir ... determine how a community is designed. Consequences of Obesity More Immediate Health Risks Obesity during childhood can ...

Visusminderung unter Silikon

DEFF Research Database (Denmark)

Dornonville de la Cour, Morten; Lux, Anja; Heegaard, Steffen

2010-01-01

Silicone oil is used as intravitreal tamponading agent in surgery for rhegmatogenous retinal detachment (RRD) cases complicated with proliferative vitreoretinopathy (PVR). Recently, a number of case series have appeared where profound central visual loss has been found in eyes after uncomplicated...... vitrectomy with silicone tamponade for RRD in eyes with seemingly good visual potential. Several reports have demonstrated the migration of silicone oil droplets into the retina and the optic nerve, others the widespread loss of myelinated optic nerve fibres. These reports are reviewed, and it is concluded...... that caution is warranted when silicone oil is used in eyes with good visual potential. Finally the additional danger of central visual loss should be taken into consideration when deciding to use silicone oil or gas as intravitreal tamponade....

Rapidly progressive effusive constrictive pericarditis caused by methicillin sensitive Staphylococcus aureus (MSSA). samraakhtar@hotmail.com.

Science.gov (United States)

Akhtar, Naveed; Khalid, Ayesha; Ahmed, Waqas; Rasheed, Khalid

2010-04-01

Effusive-constrictive pericarditis is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, where constrictive hemodynamics are persistent after effusion is drained. It may present at any point along the clinical course, from the occurrence of an effusion to the development of chronic pericardial constriction. We refer an unusual case of effusive constrictive pericarditis developing rapidly within days, following purulent pericarditis secondary to chest trauma.

Subxyphoid access of the normal pericardium: a novel drug delivery technique.

Science.gov (United States)

Laham, R J; Simons, M; Hung, D

1999-05-01

The pericardial space may potentially serve as a drug delivery reservoir that might be used to deliver therapeutic substances to the heart. This study describes a novel delivery technique that enables safe and rapid percutaneous subxyphoid access of the normal pericardium in a large animal model (49 Yorkshire pigs). An epidural introducer needle (Tuohy-17) is advanced gently under fluoroscopic guidance with a continuous positive pressure of 20-30 mm Hg (achieved by saline infusion using an intraflow system). The positive pressure is intended to push the right ventricle (with a lower pressure) away from the needle's path. Entry of the pericardial space is suspected after an increase in the saline flow through the intraflow system. Access to the pericardial space is confirmed by the injection of 1 ml of diluted contrast under fluoroscopy. A soft floppy-tip 0.025" guidewire is then advanced to the pericardial space and the needle is exchanged for an infusion catheter. Access of the pericardial space was achieved in all animals without any adverse events and without any hemodynamic compromise even with the delivery of fluid volumes as large as 50 ml. Histologic examination in 15 animals 4 weeks after pericardial access did not reveal any delivery-related myocardial damage. The safety, ease, and absence of hemodynamic compromise make this technique a potentially useful method for intrapericardial drug delivery and a good alternative to standard pericardiocentesis in patients with small pericardial effusions at higher risk for complications.

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

Dynamic gadolinium-enhanced MRI evaluation of porcine femoral head ischemia and reperfusion

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Schneider, T. [Clinic for Orthopaedics and Sports Traumatology, Dreifaltigkeits-Krankenhaus GmbH, Aachener Str. 445-449, 50933 Koeln (Germany); Drescher, W. [Department of Orthopaedics, Christian Albrechts University, Kiel (Germany); Becker, C. [Department of Orthopaedics, Heinrich Heine University, Duesseldorf (Germany); Sangill, R.; Stoedkilde-Joergensen, H. [Institute for Magnetic Resonance Imaging Tomography, University of Aarhus, Skejby Hospital, Aarhus (Denmark); Heydthausen, M. [Computing Center, Heinrich Heine University, Duesseldorf (Germany); Hansen, E.S.; Buenger, C. [Spine Section, Department of Orthopaedics, University of Aarhus (Denmark)

2003-02-01

To examine the potential of gadolinium (Gd)-enhanced dynamic MRI in the detection of early femoral head ischemia. Furthermore, to apply a three-compartment model to achieve a clinically applicable MR index for femoral head perfusion during the steady state and arterial hip joint tamponade.Design and materials In a porcine model femoral head perfusion was measured by radioactive tracer microspheres and by using a dynamic Gd-enhanced MRI protocol. Femoral head perfusion measurements and MRI tests were performed unilaterally before, during and after the experimentally induced ischemia of one of the hip joints. Ischemia was induced by increasing intra-articular pressure to 250 mmHg. All pigs showed ischemia of the femoral head epiphysis under hip joint tamponade followed by reperfusion to the same level as before joint tamponade. In two cases perfusion after removal of tamponade continued to be low. In dynamic MRI measurements increases in signal intensity were seen after intravenous infusion of Gd-DTPA, followed by a slow decrease in signal intensity. The signal-intensity curve during femoral head ischemia had a minor increase. Also the coefficient determined was a helpful indicator of femoral head ischemia. Femoral head blood flow as measured by microspheres fell significantly under joint tamponade. Early detection of this disturbed regional blood flow was possible using a dynamic MRI procedure. A biomathematical model resulted from the evaluation of the intervals of signal intensity over time which allows detection of bone blood flow changes at a very early stage. Using this new method earlier detection of femoral head necrosis may be possible. (orig.)

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.

Consequence Management - Ready or Not?

Science.gov (United States)

2003-04-07

Defense will have sufficient capability and be ready to respond to a Weapons of Mass Destruction/ Effects attack. An effective consequence management...Defense adopts the National Military Strategy and its consequence management approach, it must identify Weapons of Mass Destruction/ Effects threats...that the Department of Defense: develop Weapons of Mass Destruction/ Effects performance standards for response assets; implement a consequence

Retrospective Study to Compare Selective Decongestive Devascularization and Gastrosplenic Shunt versus Splenectomy with Pericardial Devascularization for the Treatment of Patients with Esophagogastric Varices Due to Cirrhotic Portal Hypertension.

Science.gov (United States)

Bao, Haili; He, Qikuan; Dai, Ninggao; Ye, Ruifan; Zhang, Qiyu

2017-06-08

BACKGROUND For patients with esophagogastric varices secondary to portal hypertension due to liver cirrhosis, portosystemic shunts and devascularization have become the most commonly used treatment methods. We have developed a novel surgical approach for the treatment of patients with cirrhotic portal hypertension, selective decongestive devascularization, and shunt of the gastrosplenic region (SDDS-GSR). This aim of this study was to compare the efficacy and safety of SDDS-GSR with splenectomy with pericardial devascularization (SPD). MATERIAL AND METHODS A retrospective study was undertaken between 2006 and 2013 and included 110 patients with cirrhotic portal hypertension, 34 of whom underwent SDDS-GSR; 76 patients underwent SPD. Kaplan-Meier analysis was used to evaluate clinical outcomes, mortality, the incidence of re-bleeding, encephalopathy, and portal venous system thrombosis (PVST). RESULTS Postoperatively portal venous pressure decreased by 20% in both groups. The long-term incidence of re-bleeding and PVST was significantly lower in the SDDS-GSR group compared with the SPD group (P=0.018 and P=0.039, respectively). CONCLUSIONS This preliminary retrospective study has shown that SDDS-GSR was an effective treatment for patients with esophagogastric varices secondary to portal hypertension that may be used as a first-line treatment to prevent variceal bleeding and lower the incidence of PVST.

Spontaneous Right Coronary Artery Rupture and Acute Cardiac Tamponade in Behçet's Disease.

Science.gov (United States)

Keskin, Muhammed; Bozbay, Mehmet; Kayacıoğlu, İlyas; Koçoğulları, Cevdet; Bozbay, Ayfer Yıldız; Hayıroğlu, Mert İlker; Gürkan, Ufuk; Eren, Mehmet

2016-11-01

Coronary involvement in Behçet's disease is extremely rare and it can bring devastating consequences when it occurs. In this report, we present a 29-year-old male patient with Behçet's disease who developed rapidly changing and progressive coronary artery involvements under medical treatment. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Subjective Evaluations of Alcohol-Related Consequences among College Students: Experience with Consequences Matters

Science.gov (United States)

Leavens, Eleanor L.; Leffingwell, Thad R.; Miller, Mary Beth; Brett, Emma I.; Lombardi, Nathaniel

2017-01-01

Objective: Research suggests college students rate some alcohol-related consequences less negatively than others, yet it is unclear how or when these differences in perception develop. The current study compared college students' subjective evaluations of alcohol-related consequences that they had and had not experienced in order to test the…

Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

Science.gov (United States)

Zengin, Suat; Yavuz, Erdal; Al, Behçet; Cindoruk, Şener; Altunbaş, Gökhan; Gümüşboğa, Hasan; Yıldırım, Cuma

2016-05-01

The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Reversible Causes in Cardiovascular Collapse at the Emergency Department Using Ultrasonography (REVIVE-US).

Science.gov (United States)

Chua, Mui Teng; Chan, Gene Wh; Kuan, Win Sen

2017-08-01

Ultrasonographic evaluation of patients in cardiac arrest is currently not protocolised in the advanced cardiac life support (ACLS) algorithm. Potentially reversible causes may be identified using bedside ultrasonography that is ubiquitous in most emergency departments (EDs). This study aimed to evaluate the incidence of sonographically detectable reversible causes of cardiac arrest by incorporating an ultrasonography protocol into the ACLS algorithm. Secondary objectives include rates of survival to hospital admission, hospital discharge, and 30-day mortality. We conducted a prospective study using bedside ultrasonography to evaluate for potentially reversible causes in patients with cardiac arrest at the ED of National University Hospital, Singapore, regardless of the initial electrocardiogram rhythm. A standardised ultrasonography protocol was performed during the 10-second pulse check window. Between June 2015 and April 2016, 104 patients were recruited, corresponding to 65% of all out-of-hospital cardiac arrest patients conveyed to the ED. Median age was 71 years (interquartile range, 55 to 80) and 71 (68.3%) patients were male. The most common rhythm on arrival was asystole (45.2%). Four (3.8%) patients had ultrasonographic findings suggestive of massive pulmonary embolism while 1 received intravenous thrombolysis and survived until discharge. Pericardial effusion without tamponade was detected in 4 (3.8%) patients and 6 (5.8%) patients had intra-abdominal free fluid. Twenty (19.2%) patients survived until admission, 2 of whom (1.9%) survived to discharge and beyond 30 days. Bedside ultrasonography can be safely incorporated into the ACLS protocol. Detection of any reversible causes may alter management and improve survival in selected patients.

Becoming an Officer of Consequence

Science.gov (United States)

2007-01-01

ndupress .ndu.edu   issue 44, 1st quarter 2007  /  JFQ        6 Becoming an officer of Consequence m uch of the literature about military history...commander become officers of consequence because their commanders value their judgment and seek their counsel when making difficult choices...COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE Becoming an Officer of Consequence 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM

Right pleural versus mediastinal drainage following elective off-pump coronary artery bypass

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Forouzan nia SKh

2011-03-01

Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Proper drainage of the mediastinal and pleural spaces following Off-Pump Coronary Artery Bypass (OPCAB surgery is essential for the prevention of pleural and pericardial effusions, cardiac tamponade and late complications such as constrictive pericarditis. Drainage tubes themselves may induce some complications which can negatively affect the result of the surgery. In this study we assessed a new technique for chest drainage following OPCAB."n"nMethods: In this clinical trial, 171 patients were allocated to two groups. In the control group, the drainage technique included one drain in the left pleural cavity and another in the mediastinum, while in the case group; the drainage technique included one drain in the left plural and one in the right pleural cavity."n"nResults: The amount of drainage in the case group was more than the control group (p=0.001. We found significant reductions in the incidence of arrhythmias in the case group (p=0.005. While one patient (1.2% needed reoperation for bleeding control in the control group, no patients needed reexploration in the case group (p=0.497. The duration of hospital (p=0.022 and ICU (p=0.002 stays was shorter in the case group."n"nConclusions: Based on the

Cardiovascular effects of radiation therapy; Efectos cardiovasculares de la radioterapia

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Alvarez, Jose A.G.; Leiva, Gustavo [Hospital Britanico, Buenos Aires (Argentina).Servicio de Cardiologia; Schwartz, Laura; D' Angiola, Marisa [Hospital de Ninos ' Dr. Ricardo Gutierrez' , Buenos Aires (Argentina)

2001-03-15

Therapeutic mediastinal irradiation can induce heart disease with variable degree of cardiac engagement. Heart disease manifestations depend on the grade of involvement of the different cardiac structures. During the first two years following irradiation, pericarditis with or without pericardial effusion is the most common manifestation of toxicity related to radiation therapy. Later on, after a latency period of five to ten years, a constrictive pericarditis may develop. Other type of late cardiac toxicities due to irradiation are restrictive cardiomyopathy, multiple valvular disease, coronary artery disease and different atrioventricular conduction disturbances. The therapeutic approach to this kind of heart disease has to be focused on its progressive course and in the possibility of a global involvement of all the cardiac structures. Pericardiectomy is strongly recommended for recurrent pericardial effusion with cardiac tamponade. Cardiac surgery for myocardial revascularization or valvular disease can be performed with variable results; the presence of myocardial fibrosis can significantly affect perioperative management and long-term results. Cardiac transplantation is a promissory option for those patients with end-stage cardiac failure. Immunosuppressive regimens are not associated with recurrence of malignancy. (author) [Spanish] La radioterapia aplicada sobre el mediastino puede afectar las diferentes estructuras cardiacas. De la magnitud de ese compromiso dependera la aparicion de diversas manifestaciones clinicas. La pericarditis, con derrame o sin el, es lo mas habitual en los dos primeros anios; algunas evolucionan hacia la cronicidad para desarrollar, cinco a diez anios mas tarde, una pericarditis constrictiva. Otras manifestaciones tardias inducidas por la radioterapia pueden ser miocardiopatia restrictiva por fibrosis intersticial, disfunciones valvulares multiples, enfermedad obstructiva coronaria y trastornos en el sistema de conduccion

First clinical use of a bioprosthetic total artificial heart: report of two cases.

Science.gov (United States)

Carpentier, Alain; Latrémouille, Christian; Cholley, Bernard; Smadja, David M; Roussel, Jean-Christian; Boissier, Elodie; Trochu, Jean-Noël; Gueffet, Jean-Pierre; Treillot, Michèle; Bizouarn, Philippe; Méléard, Denis; Boughenou, Marie-Fazia; Ponzio, Olivier; Grimmé, Marc; Capel, Antoine; Jansen, Piet; Hagège, Albert; Desnos, Michel; Fabiani, Jean-Noël; Duveau, Daniel

2015-10-17

The development of artificial hearts in patients with end-stage heart disease have been confronted with the major issues of thromboembolism or haemorrhage. Since valvular bioprostheses are associated with a low incidence of these complications, we decided to use bioprosthetic materials in the construction of a novel artificial heart (C-TAH). We report here the device characteristics and its first clinical applications in two patients with end-stage dilated cardiomyopathy. The aim of the study was to evaluate safety and feasibility of the CARMAT TAH for patients at imminent risk of death from biventricular heart failure and not eligible for transplant. The C-TAH is an implantable electro-hydraulically actuated pulsatile biventricular pump. All components, batteries excepted, are embodied in a single device positioned in the pericardial sac after excision of the native ventricles. We selected patients admitted to hospital who were at imminent risk of death, having irreversible biventricular failure, and not eligible for heart transplantation, from three cardiac surgery centres in France. The C-TAH was implanted in two male patients. Patient 1, aged 76 years, had the C-TAH implantation on Dec 18, 2013; patient 2, aged 68 years, had the implantation on Aug 5, 2014. The cardiopulmonary bypass times for C-TAH implantation were 170 min for patient 1 and 157 min for patient 2. Both patients were extubated within the first 12 postoperative hours and had a rapid recovery of their respiratory and circulatory functions as well as a normal mental status. Patient 1 presented with a tamponade on day 23 requiring re-intervention. Postoperative bleeding disorders prompted anticoagulant discontinuation. The C-TAH functioned well with a cardiac output of 4·8-5·8 L/min. On day 74, the patient died due to a device failure. Autopsy did not detect any relevant thrombus formation within the bioprosthesis nor the different organs, despite a 50-day anticoagulant-free period. Patient 2

Transmural coil embolization—alternative technique for management of arterial perforation during subintimal angioplasty

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Karthikeyan Damodharan

2016-01-01

Full Text Available Subintimal angioplasty of lower limb arterial occlusion carries a relatively higher risk of vessel perforation compared to transluminal angioplasty. Vessel perforation is a potentially life threatening complication which requires prompt recognition and management. They are usually managed by endovascular techniques such as low-pressure balloon tamponade, covered stents, and coil embolization of the ruptured artery. We describe a technique of treating vessel perforation following balloon angioplasty. Patient developed a large perforation of the proximal superficial femoral artery (SFA after balloon inflation during subintimal angioplasty of complete SFA occlusion. Following failure of balloon tamponade in sealing the perforation, we successfully treated it by deploying an embolization coil at the site of perforation through the vessel wall followed by balloon tamponade. Our technique could be a useful relatively inexpensive alternative treatment option in the management of vessel perforation compared to covered stents.

Pericardial adipose tissue and the metabolic syndrome is increased in patients with chronic major depressive disorder compared to acute depression and controls.

Science.gov (United States)

Kahl, K G; Herrmann, J; Stubbs, B; Krüger, T H C; Cordes, J; Deuschle, M; Schweiger, U; Hüper, K; Helm, S; Birkenstock, A; Hartung, D

2017-01-04

Major depressive disorder (MDD) is associated with an estimated fourfold risk for premature death, largely attributed to cardiovascular disorders. Pericardial adipose tissue (PAT), a fat compartment surrounding the heart, has been implicated in the development of coronary artery disease. An unanswered question is whether people with chronic MDD are more likely to have elevated PAT volumes versus acute MDD and controls (CTRL). The study group consists of sixteen patients with chronic MDD, thirty-four patients with acute MDD, and twenty-five CTRL. PAT and adrenal gland volume were measured by magnetic resonance tomography. Additional measures comprised factors of the metabolic syndrome, cortisol, relative insulin resistance, and pro-inflammatory cytokines (interleukin-6; IL-6 and tumor necrosis factor-α, TNF-α). PAT volumes were significantly increased in patients with chronic MDD>patients with acute MDD>CTRL. Adrenal gland volume was slightly enlarged in patients with chronic MDD>acute MDD>CTRL, although this difference failed to reach significance. The PAT volume was correlated with adrenal gland volume, and cortisol concentrations were correlated with depression severity, measured by BDI-2 and MADRS. Group differences were found concerning the rate of the metabolic syndrome, being most frequent in chronic MDD>acute MDD>CTRL. Further findings comprised increased fasting cortisol, increased TNF-α concentration, and decreased physical activity level in MDD compared to CTRL. Our results extend the existing literature in demonstrating that patients with chronic MDD have the highest risk for developing cardiovascular disorders, indicated by the highest PAT volume and prevalence of metabolic syndrome. The correlation of PAT with adrenal gland volume underscores the role of the hypothalamus-pituitary-adrenal system as mediator for body-composition changes. Metabolic monitoring, health advices and motivation for the improvement of physical fitness may be recommended in

Possible consequences of nuclear war

International Nuclear Information System (INIS)

Anon.

1986-01-01

Speeches of Soviet and foreign scientists at the Second Section of 2d All-UNION conference of scientists on problems of peace and prevention of nuclear war related to possible consequences of nuclear war have been considered. It is noted that production of a large amount of aerosol particles, dust, smoke and combustion products due to forest-fires, fires in cities, which change considerably atmosphere properties, will be the greatest effect of nuclear strike from the point of view of global consequencies. ''Nuclear winter'', photosynthesis suppression, plant bioproductivity weakening, long-term climate changes, ozone layer disturbance, mass and irreversible degeneration of all biosphere on the whole are great consequencies of nuclear conflict. Attention is paid to medical service, industrial accidents, radioactive fallouts consequence of radiation and other harmful factors for people in nuclear war

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

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Com. Phone No. +2348023574042 & +2348038231667. Abbreviations: DS, Down symdrome; ECG, Electrocardiogram; PE, Pericardial effusion; TFT, Thyroid function test; TSH, Thyroid stimulating hormone; UCTH, University of Calabar Teaching Hospital;. Recurrent Pericardial Effusion Associated with Hypothyroidism in.

Consequence analysis

International Nuclear Information System (INIS)

Woodard, K.

1985-01-01

The objectives of this paper are to: Provide a realistic assessment of consequences; Account for plant and site-specific characteristics; Adjust accident release characteristics to account for results of plant-containment analysis; Produce conditional risk curves for each of five health effects; and Estimate uncertainties

Criminological problems of studying crime consequences

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Sabitov R.A.

2014-12-01

Full Text Available The phenomenon of crime consequences is studied as a total social and not social, direct and indirect damage caused by crime. The quantitative and qualitative indicators of these consequences are shown. It is determined that concept of crime does not embrace its consequences and victims. The qualitative indicators of crime consequences imply the consequences’ character and structure; the quantitative indicators imply cumulative consequences of certain kinds of crime, the dynamics of certain kinds of consequences and coefficient of certain crime consequences. It is proved that not only physical and juridical persons, but also the public, authorities and associations (groups of people having no indication of juridical person must be recognized as crime sufferers. It is argued that crimes can cause property and moral damage (goodwill damage, ecological damage, considerable damage of interests protected by the law, information, managerial damage and other kinds of damage. Theoretically according to criminal law a crime sufferer is a physical, juridical person, an authority, the public, group of people who suffered from physical, property, moral or other kind of damage caused by a completed or uncompleted crime. The author proves the necessity to fix the concept of crime sufferer in criminal law. The concept of victim should include Russian criminal actualities, foreign experience and embrace not only physical but also juridical persons and groups of people suffered from crimes.

Consequences of Diffusion of Innovations.

Science.gov (United States)

Goss, Kevin F.

1979-01-01

The article traces evolution of diffusion theory; illustrates undesirable consequences in a cross-cultural setting, reviews criticisms of several scholars; considers distributional effects and unanticipated consequences for potential ameliorative impact on diffusion theory; and codifies these factors into a framework for research into consequences…

Magnetic Resonance Imaging in the evaluation of the pericardium. A pictorial essay

International Nuclear Information System (INIS)

Francone, Mario; Dymarkowski, Steven; Kalantzi, Maria; Bogaert, Jan

2005-01-01

Magnetic resonance (MR) is an ideal technique for the evaluation of the pericardium since it enables the combination of high resolution anatomical images of the pericardial layers with functional information concerning the impact of pathology on diastolic heart function and cardiac filling in particular. In comparison with echocardiography, which remains the first choice techniques for the study of the pericardium, MR provides larger fields of view allowing the visualization of the entire chest, higher spatial and contrast resolution and greater reproducibility. The technique becomes particularly useful when ultrasound imaging does not provide adequate diagnostic information or requires further characterisation; non echoic patients, loculated pericardial effusions, focal thickening of the layers and pericardial effusions, focal thickening of the layers and pericardial masses are usually better assessed with MR. The method also provides valuable diagnostic information for establishing the diagnosis of constrictive pericarditis and to differentiate this condition from restrictive cardiomyopathy. The aim of this paper is to present the role of MR imaging in the assessment of a patient with suspected pericardial disease, and discuss the MR technique, anatomy and the main pathological conditions [it

CT findings of intrathoracic mesothelioma

International Nuclear Information System (INIS)

Kim, Yeong Hwa; Choi, Kyu Ok; Lee, Jong Doo

1989-01-01

8 patients with pathologically proven pleural mesothelioma (5 localized type, 3 diffuse type), and 1 patient with malignant pericardial mesothelioma, were examined by computed tomography (CT), and obtained some results as follows: 1. Pleural Mesothelioma a. Localized pleural mesothelioma 4 cases were benign and 1 case was malignant in microscopic examination. CT showed invariably sharply marginated pleura-based soft tissue mass and the density of the mass was variable, homogenous in small tumor but inhomogenous with low density area in larger ones, and even calcification was seen in one of them. The angle of pleura-mass interface was obtuse in only one small tumor and acute with smooth taping end in four lager tumor. b. Diffuse pleural mesothelioma (DPM) Multiple nodular pleural masses encompassing nearly entire lung were seen with associated multiple subpleural parenchymal nodule and localized axial interstitial thickening in two case. Protruding chest wall mass with destruction of rib was seen in previous pneumonectomized thorax. Minimal pleural effusion/thickening was also seen in all. 2. Pericardial mesothelioma Pericardial fluid and multiple nodular masses, which occupied pericardial sac up to superior sinus were well delineated on CT. It had been misinterpreted as pericardial effusion for years on echocardiogram

The Consequences of School Desegregation.

Science.gov (United States)

Rossell, Christine H., Ed.; Hawley, Willis D., Ed.

Materials on a variety of subjects related to school desegregation are collected in this book. Chapter 1 discusses assumptions about the overall consequences of desegregation. Chapters 2 to 5 synthesize the findings of existing research on the consequences of school desegregation for children and communities. Finally, Chapter 6 describes…

Pericardial Fluid Analysis

Science.gov (United States)

... of Conditions Not Listed? Not Listed? Acidosis and Alkalosis Adrenal Insufficiency and Addison Disease Alcoholism Allergies Alzheimer ... the body. For example, pericarditis may follow a respiratory infection or a chest cold. Bleeding – bleeding disorders ...

Closed Pericardial Biopsy

African Journals Online (AJOL)

1974-09-28

Sep 28, 1974 ... The instrument used is a hook biopsy needle (Fig. I). manufactured by Becton, Dickinson and Co., Rutherford,. New Jersey, USA. The instrument' and technique' will be reviewed. The instrument consists of an ll-gauge needle with a sharp cutting edge into which fits, interchangeably, a 13-gauge needle or a ...

Institutional Consequences of Quality Assessment

Science.gov (United States)

Joao Rosa, Maria; Tavares, Diana; Amaral, Alberto

2006-01-01

This paper analyses the opinions of Portuguese university rectors and academics on the quality assessment system and its consequences at the institutional level. The results obtained show that university staff (rectors and academics, with more of the former than the latter) held optimistic views of the positive consequences of quality assessment…

The consequences of "Culture's consequences"

DEFF Research Database (Denmark)

Knudsen, Fabienne; Froholdt, Lisa Loloma

2009-01-01

  In this article, it is claimed that research on cross-cultural crews is dominated by one specific understanding of the concept of culture, which is static, evenly distributed and context-independent. Such a conception of culture may bring some basic order while facing an unknown culture...... review of the theory of Geert Hofstede, the most renowned representative of this theoretical approach. The practical consequences of using such a concept of culture is then analysed by means of a critical review of an article applying Hofstede to cross-cultural crews in seafaring. Finally, alternative...... views on culture are presented. The aim of the article is, rather than to promote any specific theory, to reflect about diverse perspectives of cultural sense-making in cross-cultural encounters. Udgivelsesdato: Oktober...

Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

Energy Technology Data Exchange (ETDEWEB)

Lee, Sae Ah; Kim, Do Hyeong [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of); Jen, Gyeong Sik [Bundang CHA General Hospital, CHA University, Seongnam (Korea, Republic of)

2012-07-15

Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

Current surgery of retinal detachment recurrence. Review

Directory of Open Access Journals (Sweden)

V. D. Zakharov

2012-01-01

Full Text Available this review presents a detailed analysis and an experience of surgical treatment of retinal detachment recurrence associated with light silicone oil tamponade of vitreous cavity. Approaches and variants of treatment were described in the historical aspect and till now. there are considered general and particular issues in case of retinal detachment recurrence appearance, expediency and volume of intraoperative manipulations, time of operation and choice of temporary substitute of vitreous body for a purpose of postoperative tamponade of vitreous cavity.

[67 year old man with abdominal pain, anorexia and low-grade fever].

Science.gov (United States)

Picardi, A; Manfrini, S; Navajas, F; Zardi, E; Amicarelli, E; De Iorio, F; Galluzzo, S; Valiani, A; Spoto, S; Scarlata, S; Ves pasiani Gentilucci, U; De Galasso, L; Meloni, M C; Costantino, S

2000-01-01

A case of pericardial effusion presenting clinically with pretamponade is shown. TBC is not a rare cause of Pericardial effusion and at present Tuberculosis is a more and more frequent infection also in occidental countries. Guide lines for diagnosis and treatment are revised.

Abnormal 67Ga uptake in a fibrosarcoma of the pericardium with malignant transformation

International Nuclear Information System (INIS)

Hayashida, Kohei; Nishimura, Tsunehiko; Kumita, Shin-ichirou; Uehara, Toshiisa; Imakita, Masami

1990-01-01

A 31-year-old woman presented with general malaise, back pain, and edema of the lower extremities. A chest X-ray film showed an enlarged cardiac shadow and clear lung fields. A pericardial lesion with decreased activity on blood pool imaging and increased uptake on gallium citrate Ga67 imaging displaced the heart upwards and to the left. The pericardial mass showed an inhomogeneous signal intensity on MRI and was large enough to obstruct the venous return by compressing the heart. At operation, the mass was found to originate from the pericardium and was histologically identified as a malignant fibrosarcoma. Twelve years before, the patient had undergone an operation for the removal of a pericardial tumor which was histologically identified as a benign hemangioma. In view of the rarity of pericardial tumors, the present tumor is suspected to have undergone a transformation from benign hemangioma to malignant fibrosarcoma. (orig.)

Factors having implications on re-retinal detachments after silicone oil removal

Directory of Open Access Journals (Sweden)

Manish P Nagpal

2012-01-01

Full Text Available Aim: To investigate factors having implications on re-retinal detachments (reRD after silicone oil removal (SOR. Materials and Methods: A retroprospective study of 412 eyes (with attached retina after vitrectomy with silicone oil for rhegmatogenous RD which underwent SOR was conducted and were followed up for six months after SOR. They were studied for various factors like encirclage, 360° retinopexy, oil emulsification at the time of SOR, duration of oil tamponade and previous retinal surgeries prior to SOR with their implications on reRD after SOR. Results: Encirclage, 360 laser barrage, both, emulsification of oil (P=0.021, P=0.001, P=0.001, P=0.001, respectively were associated with lower risks of reRD after SOR whereas duration of tamponade (P=0.980 was not. Conclusion: Factors like encirclage, 360 retinopexy, their combination, oil emulsification reduced the incidence of re RD after SOR whereas duration of tamponade does not have statistical significant correlation with re RD after SOR.

Accident consequence assessment code development

International Nuclear Information System (INIS)

Homma, T.; Togawa, O.

1991-01-01

This paper describes the new computer code system, OSCAAR developed for off-site consequence assessment of a potential nuclear accident. OSCAAR consists of several modules which have modeling capabilities in atmospheric transport, foodchain transport, dosimetry, emergency response and radiological health effects. The major modules of the consequence assessment code are described, highlighting the validation and verification of the models. (author)

Phenomenological consequences of supersymmetry

International Nuclear Information System (INIS)

Hinchliffe, I.; Littenberg, L.

1982-01-01

This report deals with the phenomenological consequences of supersymmetric theories, and with the implications of such theories for future high energy machines. It is concerned only with high energy predictions of supersymmetry; low energy consequences (for example in the K/sub o/anti K/sub o/ system) are discussed in the context of future experiments by another group, and will be mentioned briefly only in the context of constraining existing models. However a brief section is included on the implication for proton decay, although detailed experimental questions are not discussed. The report is organized as follows. Section I consists of a brief review of supersymmetry and the salient features of existing supersymmetric models; this section can be ignored by those familiar with such models since it contains nothing new. Section 2 deals with the consequences for nucleon decay of SUSY. The remaining sections then discuss the physics possibilities of various machines; e anti e in Section 3, ep in Section 4, pp (or anti pp) colliders in Section 5 and fixed target hadron machines in Section 6

Supraclassical consequence relations: Tolerating rare counterexamples

CSIR Research Space (South Africa)

Labuschagne, W

2013-12-01

Full Text Available We explore a family of supraclassical consequence relations obtained by varying the criteria according to which counterexamples to classical entailment may be deemed tolerable. This provides a different perspective on the rational consequence...

Adolescent childbearing: consequences and interventions.

Science.gov (United States)

Ruedinger, Emily; Cox, Joanne E

2012-08-01

Adolescent childbearing in the United States continues to occur at high rates compared with other industrialized nations, despite a recent decline. Adolescent mothers and their offspring are at risk for negative outcomes. Recent literature exploring the consequences of teenage childbearing and interventions to ameliorate these consequences are presented. Negative consequences of adolescent childbearing can impact mothers and their offspring throughout the lifespan. These consequences are likely attributable to social and environmental factors rather than solely to maternal age. Increasing educational attainment, preventing repeat pregnancy and improving mother-child interactions can improve outcomes for mothers and their children. Home, community, school and clinic-based programs are all viable models of service delivery to this population. Connecting teen mothers with comprehensive services to meet their social, economic, health and educational needs can potentially improve long-term outcomes for both mothers and their offspring. Programs that deliver care to this population in culturally sensitive, developmentally appropriate ways have demonstrated success. Future investigation of parenting interventions with larger sample sizes and that assess multiple outcomes will allow comparison among programs. Explorations of the role of the father and coparenting are also directions for future research.

Phenomenological consequences of supersymmetry

International Nuclear Information System (INIS)

Hinchliffe, I.; Littenberg, L.

1982-01-01

This paper deals with the phenomenological consequences of supersymmetric theories, and with the implications of such theories for future high energy machines. The paper represents the work of a subgroup at the meeting. The authors are concerned only with high energy predictions of supersymmetry; low energy consequences (for example in the K/sub o/K-bar/sub o/ system) are discussed in the context of future experiments by another group, and will be mentioned briefly only in the context of constraining existing models. However a brief section is included on the implication for proton decay, although detailed experimental questions are not discussed

Assessing economic consequences of radiation accidents

International Nuclear Information System (INIS)

Rowe, M.D.; Lee, J.C.; Grimshaw, C.A.; Kalb, P.D.

1987-01-01

A recent review of existing models and methods for assessing potential consequences of accidents in the high-level radioactive waste (HLW) disposal system identifies economic consequence assessment methods as a weak point. Existing methods have mostly been designed to assess economic consequences of reactor accidents, the possible scale of which can be several orders of magnitude greater than anything possible in the HLW disposal system. There is therefore some question about the applicability of these methods, their assumptions, and their level of detail to assessments of smaller accidents. The US Dept. of Energy funded this study to determine needs for code modifications or model development for assessing economic costs of accidents in the HLW disposal system. The objectives of the study were as follows: (1) review the literature on economic consequences of accidents to determine the availability of assessment methods and data and their applicability to the HLW disposal system before closure. (2) Determine needs for expansion, revision, or adaptation of methods and data for modeling economic consequences of accidents of the scale projected for the disposal system. (3) Gather data that might be useful for the needed revisions for modeling economic impacts on this scale

Consequence Reasoning in Multilevel Flow Modelling

DEFF Research Database (Denmark)

Zhang, Xinxin; Lind, Morten; Ravn, Ole

2013-01-01

Consequence reasoning is a major element for operation support system to assess the plant situations. The purpose of this paper is to elaborate how Multilevel Flow Models can be used to reason about consequences of disturbances in complex engineering systems. MFM is a modelling methodology...... for representing process knowledge for complex systems. It represents the system by using means-end and part-whole decompositions, and describes not only the purposes and functions of the system but also the causal relations between them. Thus MFM is a tool for causal reasoning. The paper introduces MFM modelling...... syntax and gives detailed reasoning formulas for consequence reasoning. The reasoning formulas offers basis for developing rule-based system to perform consequence reasoning based on MFM, which can be used for alarm design, risk monitoring, and supervision and operation support system design....

Drinking Water Consequences Tools. A Literature Review

Energy Technology Data Exchange (ETDEWEB)

Pasqualini, Donatella [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2016-05-12

In support of the goals of Department of Homeland Security’s (DHS) National Protection and Programs Directorate and the Federal Emergency Management Agency, the DHS Office of Science and Technology is seeking to develop and/or modify consequence assessment tools to enable drinking water systems owner/operators to estimate the societal and economic consequences of drinking water disruption due to the threats and hazards. This work will expand the breadth of consequence estimation methods and tools using the best-available data describing water distribution infrastructure, owner/assetlevel economic losses, regional-scale economic activity, and health. In addition, this project will deploy the consequence methodology and capability within a Web-based platform. This report is intended to support DHS effort providing a review literature review of existing assessment tools of water and wastewater systems consequences to disruptions. The review includes tools that assess water systems resilience, vulnerability, and risk. This will help to understand gaps and limitations of these tools in order to plan for the development of the next-generation consequences tool for water and waste water systems disruption.

Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation.

Science.gov (United States)

Webster, Mark; Pasupati, Sanjeevan; Lever, Nigel; Stiles, Martin

2018-05-01

This first-in-human study evaluated the safety and technical feasibility of the Tempo temporary cardiac pacing lead (BioTrace Medical), which includes a novel fixation mechanism and soft tip. Complications of temporary pacing leads include dislodgment, arrhythmias, and ventricular perforation. Temporary pacing applications have increased with transcatheter aortic valve replacement (TAVR) growth, for rapid pacing during balloon valvuloplasty (BAV) and valve deployment, and for periprocedural bradyarrhythmia support. Eligible patients required temporary pacing for TAVR, BAV, or electrophysiology (EP) procedures. Transthoracic echocardiograms were obtained at baseline and 24 hours after lead removal. Safety was defined as freedom from pericardial effusion requiring intervention or evidence of tamponade. Technical feasibility involved successful intracardiac delivery and pace capture. Additional evaluations included pacing threshold (PCT), rapid pacing, dislodgment, or sustained ventricular arrhythmias. Follow-up was to 30 days. Twenty-five patients (60% female; mean age, 64 ± 19 years) underwent 13 TAVRs (7 Sapien 3 valves [Edwards Lifesciences], 4 CoreValves [Medtronic], and 2 Lotus valves [Boston Scientific]), 11 EP procedures, and 1 BAV at two New Zealand centers from January 2016 to June 2016. Safety was met in all patients, with no device-related adverse events. Technical feasibility was achieved in 23 cases (92%); 2 patients had unsuitable anatomy. No patient had lead dislodgment or sustained ventricular arrhythmias, and the final procedural PCT was 0.7 ± 0.5 mA. Rapid pacing was successful in all cases. Five patients had successful postprocedural use up to 5 days. This first-in-human study demonstrates the safety and technical feasibility of the Tempo lead, providing stable periprocedural temporary pacing support.

Myocardial uptake in HIV Lymphoma - A case study

International Nuclear Information System (INIS)

Watson, T.N.; Hain, S.F.; Freund, J.

1997-01-01

Full text: A 25-year-old male presented to the HIV unit with acute abdominal pain, diarrhoea, malnutrition, dehydration, abdominal distension and haematokzia. CT followed by colonscopic cultures indicated large cell Iymphoma located in the sigmoid. Bone marrow biopsy showed no evidence of Iymphoma. There were no cardiac symptoms. The patient was then referred for a radionuclide gallium scan. The patient was injected with 370 MBq of 67 Ga-citrate. At 72 hours post injection, anterior and posterior sweeps, right and left lateral skull views and a SPECT of the chest were performed. The following day, an anterior abdomen view was collected and a SPECT of the abdomen was performed. Diffuse 67 Ga-citrate accumulation was seen in the myocardium and in the bowel. Radionuclide photopeaks were found to be consistent with gallium. Uptake in the liver was notably decreased, presumably due to concurrent massive blood transfusion for pancytopaenia. Further investigation of the heart was suggested. Owing to the tumour load of the bowel, the patient was immediately treated with chemotherapy without further investigation of the heart. The patient returned for a follow-up 67 Ga-citrate scan three months later. Gallium-67-citrate uptake remained present in the myocardium and the bowel, with both being less intense than in the previous scan. The liver now appears normal. The patient re-presented to the Emergency Department two days post completion of chemotherapy with cardiac tamponade secondary to pericardial effusion, which was drained and cytology showed Iymphoma cells. Lymphoma of the myocardium is not unusual in HIV patients and should not be overlooked or left un investigated as a simple HIV infection

Myocardial uptake in HIV Lymphoma - A case study

Energy Technology Data Exchange (ETDEWEB)

Watson, T.N.; Hain, S.F.; Freund, J. [St Vincents Hospital, Sydney, NSW (Australia). Department of Nuclear Medicine

1997-12-01

Full text: A 25-year-old male presented to the HIV unit with acute abdominal pain, diarrhoea, malnutrition, dehydration, abdominal distension and haematokzia. CT followed by colonscopic cultures indicated large cell Iymphoma located in the sigmoid. Bone marrow biopsy showed no evidence of Iymphoma. There were no cardiac symptoms. The patient was then referred for a radionuclide gallium scan. The patient was injected with 370 MBq of {sup 67}Ga-citrate. At 72 hours post injection, anterior and posterior sweeps, right and left lateral skull views and a SPECT of the chest were performed. The following day, an anterior abdomen view was collected and a SPECT of the abdomen was performed. Diffuse {sup 67}Ga-citrate accumulation was seen in the myocardium and in the bowel. Radionuclide photopeaks were found to be consistent with gallium. Uptake in the liver was notably decreased, presumably due to concurrent massive blood transfusion for pancytopaenia. Further investigation of the heart was suggested. Owing to the tumour load of the bowel, the patient was immediately treated with chemotherapy without further investigation of the heart. The patient returned for a follow-up {sup 67}Ga-citrate scan three months later. Gallium-67-citrate uptake remained present in the myocardium and the bowel, with both being less intense than in the previous scan. The liver now appears normal. The patient re-presented to the Emergency Department two days post completion of chemotherapy with cardiac tamponade secondary to pericardial effusion, which was drained and cytology showed Iymphoma cells. Lymphoma of the myocardium is not unusual in HIV patients and should not be overlooked or left un investigated as a simple HIV infection

Choices and Consequences.

Science.gov (United States)

Thorp, Carmany

1995-01-01

Describes student use of Hyperstudio computer software to create history adventure games. History came alive while students learned efficient writing skills; learned to understand and manipulate cause, effect choice and consequence; and learned to incorporate succinct locational, climatic, and historical detail. (ET)

Somatostatin analogues for acute bleeding oesophageal varices

DEFF Research Database (Denmark)

Gøtzsche, Peter C.; Hrobjartsson, A.

2008-01-01

or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

Demographic Consequences of Defeating Aging

OpenAIRE

Gavrilov, Leonid A.; Gavrilova, Natalia S.

2010-01-01

A common objection against starting a large-scale biomedical war on aging is the fear of catastrophic population consequences (overpopulation). This fear is only exacerbated by the fact that no detailed demographic projections for radical life extension scenario have been conducted so far. This study explores different demographic scenarios and population projections, in order to clarify what could be the demographic consequences of a successful biomedical war on aging. A general conclusion o...

[Treatment of macular hematoma complicating AMD by vitrectomy, subretinal r-TPA injection, intravitreal injection of bevacizumab combined with gas tamponade: Report of 4 cases].

Science.gov (United States)

Abboud, M; Benzerroug, M; Milazzo, S

2017-02-01

The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas. Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients. We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively. Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar. The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of

Trauma sternotomy for presumed haemopericardium with incidental coccidioidal pericarditis

Directory of Open Access Journals (Sweden)

Seth I. Felder

2015-02-01

Full Text Available Background: Disseminated cocciodiomycosis with extrapulmonary disease occurs in less than 1% of infected patients, with few cases involving the pericardium reported in the literature. A subxiphoid window in a focussed assessment with sonography for trauma is a fast and reliable study for detecting haemopericardium in the haemodynamically unstable injured patient. Methods: Case report and literature review. Case report: A 50-year old man presented in extremis following a stab wound to the right thoracoabdominal region with a positive pericardial ultrasound. At the time of emergent sternotomy, the pericardial effusion appeared non-traumatic and not the cause of haemodynamic instability. Lung, diaphragm, liver and transverse colon lacerations were controlled by laparotomy. He was discovered to have extensive adenopathy within the mediastinum, porta hepatis, and lesser sac, which after histopathologic examination, demonstrated granulomatous lymphadenitis consistent with disseminated cocciodiomycosis. Conclusions: This case report describes the first reported “incidental” pericardial effusion in a haemodynamically unstable patient sustaining a thoracoabdominal stab wound discovered on a positive ultrasound study. Emergent operative exploration and subsequent workup determined the pericardial fluid to be of infectious origin, rather than traumatic. With the incidence of cocciodiomycosis within endemic geographic regions significantly rising, coccidioidal pericarditis may become an increasingly relevant cause of fluid detected on noninvasive pericardial examination. Keywords: Trauma, Infection, Focussed assessment with sonography for trauma (FAST

40 CFR 68.22 - Offsite consequence analysis parameters.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Offsite consequence analysis... PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Hazard Assessment § 68.22 Offsite consequence analysis parameters. (a) Endpoints. For analyses of offsite consequences, the following endpoints shall be...

General Logic-Systems and Consequence Operators

OpenAIRE

Herrmann, Robert A.

2005-01-01

In this paper, general logic-systems are investigated. It is shown that there are infinitely many finite consequence operators defined on a fixed language L that cannot be generated from a finite logic-system. It is shown that a set map is a finite consequence operator iff it is defined by a general logic-system.

Psychological consequences caused by nuclear terrorism

International Nuclear Information System (INIS)

Peyankov, I.

2009-01-01

The psychological consequences caused by eventual nuclear terrorist act are believed to be some of the most: serious. in this article are presented the issues concerning psychological effects as psychological suffering, alteration of risk estimation, changes of individual and social behavior, etc. The most common psychological consequences as a result of the most popular large-scale nuclear accidents in Chernobyl, TMI (USA), Goiania (Brazil) are described. Some of the main factors, such as sex, age, health status, social status and etc, are analyzed. These factors determine the expression of psychological reactions provoked by nuclear accidents or eventual act of nuclear terrorism. In addition, the main precautions to cope with psychological consequences caused by nuclear terrorism are listed

Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases.

Science.gov (United States)

Alexander, P; Prasad, R; Ang, A; Poulson, A V; Scott, J D; Snead, M P

2008-06-01

For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.

Different drinking motives, different adverse consequences?

DEFF Research Database (Denmark)

Wicki, Matthias; Kuntsche, Emmanuel; Eichenberger, Yvonne

2017-01-01

INTRODUCTION AND AIM: This study, which builds on previous research demonstrating that drinking motives are associated with adverse consequences, investigates the associations between drinking motives and non-alcohol-attributed adverse consequences and disentangles alcohol-related and direct......, differences across countries were tested in a multigroup analysis. RESULTS: The indirect effect (via alcohol use) was greater for injuries and academic problems than for more general outcomes such as life dissatisfaction and negative body image. For social, enhancement and coping motives, we found positive...... indirect effects (via alcohol use) on injuries and academic problems; the association was negative for conformity motives. The direct effect, that is, the effect above and beyond alcohol use, indicated more negative consequences among those who tended to drink more frequently for coping motives. More...

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

Directory of Open Access Journals (Sweden)

Frederico José Neves Mancuso

2014-12-01

Full Text Available Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

Energy Technology Data Exchange (ETDEWEB)

Mancuso, Frederico José Neves, E-mail: frederico.mancuso@grupofleury.com.br [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Gois, Aécio Flavio Teixeira [Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

2014-12-15

Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

International Nuclear Information System (INIS)

Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

2014-01-01

Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy

Modeling atmospheric dispersion for reactor accident consequence evaluation

International Nuclear Information System (INIS)

Alpert, D.J.; Gudiksen, P.H.; Woodard, K.

1982-01-01

Atmospheric dispersion models are a central part of computer codes for the evaluation of potential reactor accident consequences. A variety of ways of treating to varying degrees the many physical processes that can have an impact on the predicted consequences exists. The currently available models are reviewed and their capabilities and limitations, as applied to reactor accident consequence analyses, are discussed

Constrained consequence

CSIR Research Space (South Africa)

Britz, K

2011-09-01

Full Text Available their basic properties and relationship. In Section 3 we present a modal instance of these constructions which also illustrates with an example how to reason abductively with constrained entailment in a causal or action oriented context. In Section 4 we... of models with the former approach, whereas in Section 3.3 we give an example illustrating ways in which C can be de ned with both. Here we employ the following versions of local consequence: De nition 3.4. Given a model M = hW;R;Vi and formulas...

40 CFR 68.165 - Offsite consequence analysis.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...

An Examination of the Relationship between Consequence-Specific Normative Belief Patterns and Alcohol-Related Consequences among College Students

Science.gov (United States)

Reavy, Racheal; Cleveland, Michael J.; Mallett, Kimberly A.; Scaglione, Nichole M.; Sell, Nichole M.; Turrisi, Rob

2016-01-01

Background Research has previously identified a high-risk subgroup of college students who experience high levels of multiple and repeated alcohol-related consequences (MRC group). The purpose of this study was to examine the association between consequence-specific normative influences and experiencing multiple and repeated drinking-related consequences using a person-centered approach. Normative subgroups were identified using latent profile analysis (LPA), which were then used to predict MRC group status at 6-month follow-up. Methods First-year college student drinkers (N=2024) at a large northeastern university completed online surveys during the fall and spring semesters of their freshman year. Retention was high with 92% of invited participants completing T2, of which the MRC group accounted for 27%. Results Three student profiles were identified from LPA on T1 data: Non Permissive Parents (77%), Positive Peer and Parent Norms (20%), and Permissive Parents (3%). Logistic regression revealed that both the Positive Peer and Parent Norms and Permissive Parents profiles had significantly higher odds of MRC group membership at follow-up (1.81 and 2.78 times greater, respectively). Conclusions The results suggest value in prevention efforts that include normative beliefs about alcohol-related consequences. Further, parental norms in particular have the potential to enhance interventions, especially through direct communication of disapproval for experiencing consequences. PMID:27805274

Domestic policy consequences of new implementation models. Consequences for industrial niches; Industripolitiske konsekvenser av nye gjennomfoeringsmodeller. Konsekvenser for nisjebedriftene

Energy Technology Data Exchange (ETDEWEB)

Johannessen, T.

1995-12-31

The paper relates to the consequences of domestic policy with the focus on new implementation models used for cost reduction of offshore development projects in Norway. The paper puts the attention to the consequences from implementation models on industrial niches (subcontractors)

Subjective and Objective Work-Based Identity Consequences

NARCIS (Netherlands)

Botha, F.C.; Roodt, G.; van de Bunt-Kokhuis, S.G.M.; Jansen, P.G.W.; Roodt, G.

2015-01-01

The aim of this chapter is to provide a systematic literature review on the selected consequences of work-based identity (WI). The first section of the chapter includes the following subjective consequences: self-report measures on personal alienation, helping behaviour (H-OCB), burnout (consisting

Pericarditis mediated by respiratory syncytial virus in a hematopoietic stem cell transplant patient.

Science.gov (United States)

Rubach, M P; Pavlisko, E N; Perfect, J R

2013-08-01

We describe a case of pericarditis and large pericardial effusion in a 63-year-old African-American man undergoing autologous hematopoietic stem cell transplant for multiple myeloma. Pericardial tissue biopsy demonstrated fibrinous pericarditis, and immunohistochemistry stains were positive for respiratory syncytial virus. The patient improved with oral ribavirin and intravenous immune globulin infusions. © 2013 John Wiley & Sons A/S.

Reversible tricuspid valve stenosis due to a metastatic dissemination of a noncardiac sarcoma.

Science.gov (United States)

Uribe-Etxebarria, Naia; Voces, Roberto; Rodriguez, Miguel Angel; Llorente, Alberto; Perez, Pedro; Aramendi, Jose I

2005-07-01

Malignant disease is present in the pericardium of 1.5% to 20.6% of patients dying of malignant diseases as was examined postmortem. We present a case of a 57-year-old man with a history of Hodgkin's disease and a sarcoma of gluteus who presented with tachypnea, generalized weakness, and anasarca for 7 days. The echocardiogram revealed the presence of a significant pericardial thickening and localized pericardial effusion resulting from a tricuspid stenosis. A right anterior thoracotomy was performed, and a pericardiectomy (4 x 4 cm) was done. The histologic examination of the pericardium revealed the presence of a metastatic dissemination from a sarcoma. The cause for the clinical presentation and the treatment of malignant pericardial disease are discussed.

Assessing economic consequences of radiation accidents

International Nuclear Information System (INIS)

Rowe, M.D.; Lee, J.C.; Grimshaw, C.A.; Kalb, P.D.

1987-01-01

This project reviewed the literature on the economic consequences of accidents to determine the availability of assessment methods and data and their applicability to the high-level radioactive waste (HLW) disposal system before closure; determined needs for expansion, revision, or adaptation of methods and data for modeling economic consequences of accidents of the scale projected for the disposal system; and gathered data that might be useful for the needed revisions. 8 refs., 1 tab

College Alcohol Beliefs and Drinking Consequences: A Multiple Mediation Analysis of Norms, Expectancies, and Willingness to Experience Drinking Consequences

Science.gov (United States)

Osberg, Timothy M.; Boyer, Amber

2018-01-01

Objective: We explored the potential mediating role of willingness to experience drinking consequences and other traditional alcohol outcome predictors (descriptive norms, injunctive norms, positive alcohol expectancies) in explaining the association between college alcohol beliefs1 (CABs) and the actual experience of drinking consequences among…

29 CFR 2570.114 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.114 Section 2570.114 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR... ERISA Section 502(c)(6) § 2570.114 Consequences of default. For 502(c)(6) civil penalty proceedings...

29 CFR 2570.134 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.134 Section 2570.134 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR... ERISA Section 502(c)(7) § 2570.134 Consequences of default. For 502(c)(7) civil penalty proceedings...

29 CFR 2570.164 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.164 Section 2570.164 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR... ERISA Section 502(c)(8) § 2570.164 Consequences of default. For 502(c)(8) civil penalty proceedings...

Greenhouse effect: analysis, incertitudes, consequences

International Nuclear Information System (INIS)

Perrier, A.

1991-01-01

A general presentation of climatic changes due to greenhouse effect with their consequences is analysed. After a schematic description of this effect a simplified atmospheric model (box model) is proposed. This model integrates the main feedback effects and quantifies them. The effects of astronomic and atmospheric factors on climatic changes are analyzed and compared with classical paleoclimatic results. This study shows the need of good global modelization to evaluate long term quantification of climatic greenhouse effects according to the main time lag of the several biospheric boxes. An overview of biologic and agronomic consequences is given to promote new research subjects and to orientate protecting and conservative biospheric actions [fr

Hepatic steatosis : metabolic consequences

NARCIS (Netherlands)

Boer, Adriana Maria den

2006-01-01

In this thesis we focused on the causes and consequences of hepatic steatosis. Epidemiological studies in humans, as well as experimental studies in animal models, have shown an association between visceral obesity and dyslipidemia, insulin resistance and type 2 diabetes mellitus. The mechanism

Intended and unintended consequences of mandatory IFRS adoption

OpenAIRE

Brüggemann, Ulf; Hitz, Jörg-Markus; Sellhorn, Thorsten

2012-01-01

This paper discusses empirical evidence on the economic consequences of mandatory adoption of International Financial Reporting Standards (IFRS) in the European Union (EU) and provides suggestions on how future research can add to our understanding of these effects. Based on the explicitly stated objectives of the EU‟s so-called „IAS Regulation‟, we distinguish between intended and unintended consequences of mandatory IFRS adoption. Empirical research on the intended consequences generally fa...

Employment protection and the consequences for displaced workers

DEFF Research Database (Denmark)

Albæk, Karsten; van Audenrode, Marc; Browning, Martin

We compare the wage and employment consequences of a job displacement in Belgium and Denmark. These two countries both have generous unemployment insurance schemes but job protection laws vary dramatically between the two. Using comparable data we find that the incidence of displacement and the c...... and the consequences for wages are similar in the two countries. The consequences for employment are very different with Danish workers experiencing much less unemployment after a displacement...

29 CFR 2570.94 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.94 Section 2570.94 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR... ERISA Section 502(c)(5) § 2570.94 Consequences of default. For 502(c)(5) civil penalty proceedings, this...

29 CFR 2570.64 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.64 Section 2570.64 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR... ERISA Section 502(c)(2) § 2570.64 Consequences of default. For 502(c)(2) civil penalty proceedings, this...

Probabilistic Criticality Consequence Evaluation

International Nuclear Information System (INIS)

P. Gottlieb; J.W. Davis; J.R. Massari

1996-01-01

This analysis is prepared by the Mined Geologic Disposal System (MGDS) Waste Package Development (WPD) department with the objective of providing a comprehensive, conservative estimate of the consequences of the criticality which could possibly occur as the result of commercial spent nuclear fuel emplaced in the underground repository at Yucca Mountain. The consequences of criticality are measured principally in terms of the resulting changes in radionuclide inventory as a function of the power level and duration of the criticality. The purpose of this analysis is to extend the prior estimates of increased radionuclide inventory (Refs. 5.52 and 5.54), for both internal and external criticality. This analysis, and similar estimates and refinements to be completed before the end of fiscal year 1997, will be provided as input to Total System Performance Assessment-Viability Assessment (TSPA-VA) to demonstrate compliance with the repository performance objectives

International climate policy : consequences for shipping

OpenAIRE

Mæstad, Ottar; Evensen, Annika Jaersen; Mathiesen, Lars; Olsen, Kristian

2000-01-01

This report summarises the main results from the project Norwegian and international climate policy consequences for shipping. The aim of the project has been to shed light on how climate policies might affect shipping, both from the cost side and from the demand side. The project has been divided into three sub-projects, investigating the consequences of climate policies for 1. Optimal shipping operations and management 2. The competitiveness of shipping relative to land transport 3. The tra...

Resource consequences of reenrichment versus blending

International Nuclear Information System (INIS)

Owen, P.S.

1981-01-01

Many recent studies, including INFCE and NASAP, have concluded that recycling thermal reactor fuel reduces natural uranium requirements. These studies are based on a common set of assumptions concerning the method of recycling uranium, and consequently have produced quite similar results. It was assumed, however, that the residual uranium would be reenriched rather than blended with higher enriched uranium. This paper will examine several possible alternatives to reenriching residual uranium and discuss the consequences of each

Socioeconomic consequences of nuclear reactor accidents

International Nuclear Information System (INIS)

Tawil, J.J.; Callaway, J.W.; Coles, B.L.; Cronin, F.J.; Currie, J.W.; Imhoff, K.L.; Lewis, P.M.; Nesse, R.J.; Strenge, D.L.

1984-06-01

This report identifies and characterizes the off-site socioeconomic consequences that would likely result from a severe radiological accident at a nuclear power plant. The types of impacts that are addressed include economic impacts, health impacts, social/psychological impacts and institutional impacts. These impacts are identified for each of several phases of a reactor accident - from the warning phase through the post-resettlement phase. The relative importance of the impact during each accident phase and the degree to which the impact can be predicted are indicated. The report also examines the methods that are currently used for assessing nuclear reactor accidents, including development of accident scenarios and the estimating of socioeconomic accident consequences with various models. Finally, a critical evaluation is made regarding the use of impact analyses in estimating the contribution of socioeconomic consequences to nuclear accident reactor accident risk. 116 references, 7 figures, 15 tables

A methodology for overall consequence modeling in chemical industry

International Nuclear Information System (INIS)

Arunraj, N.S.; Maiti, J.

2009-01-01

Risk assessment in chemical process industry is a very important issue for safeguarding human and the ecosystem from damages caused to them. Consequence assessment is an integral part of risk assessment. However, the commonly used consequence estimation methods involve time-consuming complex mathematical models and simple assimilation of losses without considering all the consequence factors. This lead to the deterioration of quality of estimated risk value. So, the consequence modeling has to be performed in detail considering all major losses with optimal time to improve the decisive value of risk. The losses can be broadly categorized into production loss, assets loss, human health and safety loss, and environment loss. In this paper, a conceptual framework is developed to assess the overall consequence considering all the important components of major losses. Secondly, a methodology is developed for the calculation of all the major losses, which are normalized to yield the overall consequence. Finally, as an illustration, the proposed methodology is applied to a case study plant involving benzene extraction. The case study result using the proposed consequence assessment scheme is compared with that from the existing methodologies.

Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine

Science.gov (United States)

2012-01-01

Background Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis. Methods rtCMR-guided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components. Results rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology. Conclusions Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media. PMID:22453050

Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine.

Science.gov (United States)

Kahlert, Philipp; Parohl, Nina; Albert, Juliane; Schäfer, Lena; Reinhardt, Renate; Kaiser, Gernot M; McDougall, Ian; Decker, Brad; Plicht, Björn; Erbel, Raimund; Eggebrecht, Holger; Ladd, Mark E; Quick, Harald H

2012-03-27

Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis. rtCMR-guided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components. rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology. Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media.

Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine

Directory of Open Access Journals (Sweden)

Kahlert Philipp

2012-03-01

Full Text Available Abstract Background Real-time cardiovascular magnetic resonance (rtCMR is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI using the nitinol-based Medtronic CoreValve bioprosthesis. Methods rtCMR-guided transfemoral (n = 2 and transsubclavian (n = 6 TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components. Results rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology. Conclusions Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media.

Normative perceptions of alcohol-related consequences among college students.

Science.gov (United States)

Brett, Emma I; Leavens, Eleanor L; Miller, Mary Beth; Lombardi, Nathaniel; Leffingwell, Thad R

2016-07-01

College students in the U.S. continue to drink in hazardous ways and experience a range of alcohol-related consequences. Personalized feedback interventions (PFIs), which often include normative components comparing personal drinking to that of similar peers, have been effective in reducing alcohol outcomes among college students. Though normative perceptions of the quantity and frequency of alcohol use have been examined in many studies, norms for alcohol-related consequences have received less attention. The current study examined self-other discrepancies (SODs) for alcohol-related consequences among college students. Participants overestimated how often alcohol-related consequences are experienced by other same-sex students on campus and rated consequences as more acceptable for others to experience than themselves. No differences in SODs were found between those who did and did not report alcohol use. Future studies should examine the efficacy of PFIs that incorporate normative feedback on alcohol-related consequences. Copyright © 2016 Elsevier Ltd. All rights reserved.

29 CFR 2570.5 - Consequences of default.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Consequences of default. 2570.5 Section 2570.5 Labor... ERISA Section 502(i) § 2570.5 Consequences of default. For prohibited transaction penalty proceedings... administrative law judge may set aside a default entered under this provision where there is proof of defective...

Class differences in the social consequences of illness?

DEFF Research Database (Denmark)

Lindholm, C; Burström, B; Diderichsen, F

2002-01-01

with eight years interval 1979-89 and 1986-97. Sociodemographic characteristics, self reported longstanding illness, employment situation and financial conditions were measured at baseline. Social consequences (economic inactivity, unemployment, financial difficulties) of limiting longstanding illness were......STUDY OBJECTIVE: To investigate adverse social consequences of limiting longstanding illness and the modifying effect of socioeconomic position on these consequences. DESIGN: Cohort study on the panel within the annual Swedish Survey of Living Conditions where participants were interviewed twice...

Temporal Consequences, Message Framing, and Consideration of Future Consequences: Persuasion Effects on Adult Fruit Intake Intention and Resolve.

Science.gov (United States)

de Bruijn, Gert-Jan; Budding, Jeen

2016-08-01

Message framing is a persuasive strategy that has seen mixed evidence for promoting fruit intake intentions, potentially because framed messages for fruit intake have not (a) explicitly compared short-term consequences versus long-term consequences, (b) considered individual-level differences in time perspective, and (c) used alternative measures of fruit intake intentions. In the present online study, the effects of persuasive messages created from temporal context (short term vs. long term) and message frame (gain framed vs. loss framed) were investigated on fruit intake intentions and resolve among a sample of Dutch adults who were categorized as either present oriented or future oriented. For intention and resolve, results showed a significant Type of Frame × Type of Temporal Context interaction, such that gain-framed messages were more persuasive when combined with long-term consequences and loss-framed messages were more persuasive when combined with short-term consequences. The effect sizes for these differences were similar for resolve and intention, but only differences for intentions were significant. No other effects were found. These results demonstrate that message framing theory may usefully consider the inclusion of temporal context of outcomes and alternative motivation measures to maximize their persuasive effects.

Echocardiography-guided or "sided" pericardiocentesis.

Science.gov (United States)

Degirmencioglu, Aleks; Karakus, Gultekin; Güvenc, Tolga Sinan; Pinhan, Osman; Sipahi, Ilke; Akyol, Ahmet

2013-10-01

Echocardiography-guided pericardiocentesis is the first choice method for relieving cardiac tamponade, but the exact role of the echocardiography at the moment of the puncture is still controversial. In this report, detailed echocardiographic evaluation was performed in 21 consecutive patients with cardiac tamponade just before the pericardiocentesis. Appropriate needle position was determined according to the probe position using imaginary x, y, and z axes. Pericardiocentesis was performed successfully using this technique without simultaneous echocardiography and no complications were observed. We concluded that bedside echocardiography with detailed evaluation of the puncture site and angle is enough for pericardiocentesis instead of real time guiding. © 2013, Wiley Periodicals, Inc.

Validation of a new bedside echoscopic heart examination resulting in an improvement in echo-lab workflow.

Science.gov (United States)

Réant, Patricia; Dijos, Marina; Arsac, Florence; Mignot, Aude; Cadenaule, Fabienne; Aumiaux, Annette; Jimenez, Christine; Dufau, Marilyne; Prévost, Alain; Pillois, Xavier; Fort, Patrick; Roudaut, Raymond; Lafitte, Stéphane

2011-03-01

In daily cardiology practice, porters are usually required to transfer inpatients who need an echocardiogram to the echocardiographic department (echo-lab). To assess echo-lab personnel workflow and patient transfer delay by comparing the use of a new, ultraportable, echoscopic, pocket-sized device at the bedside with patient transfer to the echo-lab for conventional transthoracic echocardiography, in patients needing pericardial control after cardiac invasive procedures. After validation of echoscopic capabilities for pericardial effusion, left ventricular function and mitral regurgitation grade compared with conventional echocardiography, we evaluated echo-lab personnel workflow and time to perform bedside echoscopy for pericardial control evaluation after invasive cardiac procedures. This strategy was compared with conventional evaluation at the echo-lab, in terms of personnel workflow, and patients' transfer, waiting and examination times. Concordance between echoscopy and conventional echocardiography for evaluation of pericardial effusion was good (0.97; kappa value 0.86). For left ventricular systolic function and mitral regurgitation evaluations, concordances were 0.96 (kappa value 0.90) and 0.96 (kappa value 0.86), respectively. In the second part of the study, the mean total time required in the bedside echoscopy group was 20.3±5.4 mins vs. 66.0±16.4 mins in the conventional echo-lab group (pporters in 100% of cases; 69% of patients needed a wheelchair. The use of miniaturized echoscopic tools for pericardial control after invasive cardiac procedures was feasible and accurate, allowing improvement in echo-lab workflow and avoiding patient waiting time and transfer. Copyright © 2011 Elsevier Masson SAS. All rights reserved.