- Understanding delays in acute stroke care: a systematic review of reviews. [Journal Article]
- EJEur J Public Health 2018 Jun 01; 28(3):426-433
- CONCLUSIONS: This review provides a wide overview of factors influencing acute stroke pathway. Since it was observed that the identified factors were interrelated, they needed to be analyzed in a systematic way. We hence created a synthetic framework that combines several categories of factors while assuming that factor weight varies from a study context to another. Better knowledge on underlying mechanisms between factors would provide crucial improvement of the interventions aiming at reducing delays in both pre-hospital and inhospital stages. For future research, we recommend adopting a systemic perspective on factors influencing acute stroke pathway.
- Transplant renal vein thrombosis in a recipient with aberrant venous anatomy. [Journal Article]
- CCCEN Case Rep 2018 May 22
- Renal vein thrombosis in a transplanted kidney is an uncommon but critical complication that can result in graft loss if management is delayed. A 31-year-old male with known atresia of the inferior v...
Renal vein thrombosis in a transplanted kidney is an uncommon but critical complication that can result in graft loss if management is delayed. A 31-year-old male with known atresia of the inferior vena cava who received a deceased donor renal transplant 7 years previously presented to hospital with severe graft site pain and a week of nausea, vomiting, and chills. Serum creatinine was markedly elevated from baseline. Sonographic examination revealed external iliac vein thrombosis with extension of the thrombus into the transplant renal vein. Urgent angiographic administration of tissue plasminogen activator and suction thrombectomy was performed, then followed by heparin and clopidogrel post procedure. Within 24 h, his serum creatinine improved, and within 2 weeks returned to his baseline. He was started on lifelong warfarin anti-coagulation to reduce the risk of rethrombosis secondary to his uncorrectable aberrant venous anatomy. Due to the turbulent and sometimes reversed flow in the major veins, lifelong anticoagulation should be strongly considered for such transplant patients with recipient aberrancy of the large veins.
- Prediction of Thrombotic and Bleeding Events After Percutaneous Coronary Intervention: CREDO-Kyoto Thrombotic and Bleeding Risk Scores. [Journal Article]
- JAJ Am Heart Assoc 2018 May 22; 7(11)
- CONCLUSIONS: CREDO-Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.
- New Mobile Stroke Unit Programs Aim to Improve Outcomes. [Journal Article]
- EMED Manag 2017; 29(1):1-6
- Now well-established throughout Europe, mobile stroke unit (MSU) programs are in the early stages of development in the United States. The concept aims to improve outcomes by bringing diagnostic capa...
Now well-established throughout Europe, mobile stroke unit (MSU) programs are in the early stages of development in the United States. The concept aims to improve outcomes by bringing diagnostic capabilities and clot-busting care to the patients experiencing stroke, thereby reducing the time to treatment. In October, New York Presbyterian/Weill Cornell Medical Center in New York became the first medical center on the East Coast to deploy an MSU, and in July, the University of Tennessee College of Medicine in Memphis deployed a first-of-its-kind MSU that is larger and more robust than other MSUs currently in use. In the first month of operation, the MSU in New York responded to 29 calls and brought 12 patients to the hospital with suspected strokes. Two of these patients received tissue plasminogen activator in the field and both made full recoveries by the next day. The MSU deployed in Memphis is larger and carries more sophisticated diagnostic equipment than other MSUs. The program also replies on doctorally prepared, vascular neurology fellowship-trained nurse practitioners, instead of relying on telemedicine connections to external experts. Now operating with the assistance of grant funding, leaders of both programs hope that strong outcomes will prove convincing to hospitals and prayers, although the U.S. healthcare model complicates the establishment of a reimbursement structure for MSUs.
- Recanalization of Chronic Occlusion of the Middle Cerebral Artery With Tissue Plasminogen Activator Treatment: A Case Report. [Journal Article]
- CNClin Neuropharmacol 2018 May 21
- CONCLUSIONS: At present, tPA is the only approved treatment for acute ischemic stroke, although it presents a limited time frame to avoid severe medication-related adverse effects. Our report suggests nonatherosclerotic chronic MCA occlusion as an alternative application of tPA therapy.
- Correlation between the expression of IL‑18 and deep venous thrombosis. [Journal Article]
- IJInt J Mol Med 2018 May 16
- The present study aimed to investigate the effect of the expression of interleukin (IL)‑18 and related markers on deep venous thrombosis (DVT) to examine their correlation. Sprague‑Dawley rats of dif...
The present study aimed to investigate the effect of the expression of interleukin (IL)‑18 and related markers on deep venous thrombosis (DVT) to examine their correlation. Sprague‑Dawley rats of different models were established and were randomly assigned into three groups. The expression of IL‑18, nuclear factor (NF)‑κB and von Willebrand factor (vWF) were detected in blood samples. The inferior vena cava (IVC) was ligated to establish the DVT model. Rat IL‑18 overexpression and inhibition vectors were constructed. The expression levels of IL‑18 and related markers in the venous wall were compared between the model group and the control group using reverse transcription‑quantitative polymerase chain reaction and western blot analyses. Following the culture of human umbilical vein endothelial cells (HUVECs), IL‑18 was added to the cells, following which the growth of the HUVECs, and changes in vWF and other endothelial functional markers were analyzed. The IVC model demonstrated complete thrombosis at 8 h and stable thrombosis at 24 h. At 24 h following model establishment, the expression levels of IL‑18, NF‑κB and vWF were high in the blood samples with the occurrence and development of thrombosis (P<0.05). The weight, length and weight/length ratio of thrombi in each model group showed significant differences from those in the control group (P<0.05) with the overexpression of IL‑18, and the expression levels of NF‑κB and vWF in venous tissues were altered with abnormal expression levels of IL‑18. IL‑18 damaged HUVECs and significantly increased viability in early‑stage apoptosis, promoted the upregulation of vWF and P‑selectin, and reduced tissue plasminogen activator. IL‑18 and the related markers were closely associated with the occurrence and development of DVT.
- Causes and Treatment of Acute Ischemic Stroke During Pregnancy. [Review]
- CTCurr Treat Options Neurol 2018 May 21; 20(6):21
- Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neu...
Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state.
- Comparable Enhanced Prothrombogenesis in Simple Central Obesity and Metabolic Syndrome. [Journal Article]
- JOJ Obes 2018; 2018:8508549
- CONCLUSIONS: Central obesity with or without MS both demonstrated enhanced prothrombogenesis. This suggests that simple obesity possibly increases the risk of coronary artery disease in part, via increased susceptibility to thrombogenesis.
- Portal Vein Thrombosis After a Right Hemicolectomy: A Case Report. [Journal Article]
- CMConn Med 2017; 81(1):23-26
- The patient, a 43-year-old male, underwent uneventful laparoscopic right-sided hemicolectomy for a benign polyp, too large to be removed by colonoscopy. His postoperative course was uneventful; howev...
The patient, a 43-year-old male, underwent uneventful laparoscopic right-sided hemicolectomy for a benign polyp, too large to be removed by colonoscopy. His postoperative course was uneventful; however, he returned 16 days after discharge with vague abdominal pain. A CT scan of his abdomen and pelvis showed extensive acute thrombus in portal, superior mesenteric, and splenic veins. After initial intravenous anticoagu- lation, follow-up imaging showed a persistent clot. The patient then underwent catheter-guided portal vein thrombolysis with tissue plasminogen activator (tPA), on postoperative day 29. He was doing well on 12-month follow-up. Portomesenteric thrombosis is a rare complication of laparoscopic surgery. It can occur even in the absence of any direct vascular trauma, as well as in delayed fashion after an initially uneventful procedure. Gold standard for treatment has not been developed and remains individualized based on the extent ofthe thrombus, the patient's clinical status, and condition of the affected bowel.
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- Central retinal artery occlusion secondary to Barlow's disease. [Journal Article]
- AJAm J Ophthalmol Case Rep 2018; 10:249-252
- CONCLUSIONS: In young patients presenting with CRAO, aggressive work-up for systemic disease or embolic source must be undertaken to avoid future sequelae.