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Usa jobs government jobs login paget schroetter syndrome de. Adam J. Doyle, M.D.
If you search by a city, we’ll include jobs within a mile radius. FILTERS Use one or more filters to search for jobs by hiring path, pay, departments, job series and more options under More . Introduction: Paget-von Schroetter Syndrome is a rare condition, which refers to primary venous thrombosis of the subclavian-axillary bed. It is related to vigorous activities involving the upper . Enter the email address you signed up with and we’ll email you a reset link.
– Upper extremity DVT – case study | GPonline
Paget-Schroetter is a rare diagnosis in the general population; however, it is more common in younger, physically active individuals. This “effort thrombosis,” also known as Paget-Schroetter Syndrome, classically occurs in the dominant arm of young, active individuals.3 VTOS.
Paget-Schroetter Syndrome – PMC.
Over time, the body forms collaterals to bypass the venous obstruction. In the chronic phase, the vein becomes fibrotic. Surrounding inflammatory changes from the thrombosis lead to scar tissue formation.
Patients may present with upper extremity swelling and pain. The presentation of these symptoms can be acute, subacute, or chronic. For the onset of symptoms in PSS, a history of an antecedent strenuous exercise can usually be elicited from the patients.
On examination, the upper extremity will demonstrate edema with an enlarged girth of the extremity compared to the contralateral side.
The upper extremity may be tense and cyanotic. A convenient non-invasive first test is ultrasonography of the upper extremities. This will demonstrate thrombus in the deep venous system. Acute thrombus will be non-compressible on ultrasound. A vein with chronic thrombus will have an irregular and more collapsed appearance with the development of collaterals on ultrasound. Ultrasonography will not allow for complete demonstration of the central veins. Computed tomography CT venography and magnetic resonance MR venography can demonstrate thrombus in the venous system as well.
Contrast venography is a more invasive test that can demonstrate patency of the central venous system. Laboratory workup includes a thrombophilia panel protein C and S levels, antithrombin levels, prothrombin gene mutation analysis, factor V Leiden mutation testing, among others and D-dimer levels. D-dimer levels will be elevated in a patient with deep venous thrombosis; however, this elevation can also be seen in other infectious, inflammatory, and physiologic conditions.
If the patients have any symptoms concerning for a pulmonary embolism, a CT angiogram CTA thorax with pulmonary embolism protocol should be obtained. Alternatively, a ventilation-perfusion study can diagnose pulmonary embolism as well, but CTA thorax remains the study of choice. PSS is a deep venous thrombosis, and, as such, the first step in the management is to initiate anticoagulation therapy, typically, via an intravenous IV heparin drip. Patients are given an initial bolus of intravenous IV heparin and then kept on a maintenance IV heparin drip.
The dose of the bolus and maintenance heparin drip is weight-based. The affected extremity should be elevated to mitigate edema. If the patient presents within 2 weeks of the onset of symptoms, it is reasonable to consider a venogram and catheter-directed thrombolysis to reduce the clot burden.
Under fluoroscopic guidance, a lysis catheter is placed to drip a thrombolytic agent such as alteplase for 24 to 48 hours. Alternatively, a pharmacomechanical thrombectomy system can be used. When using alteplase, the fibrinogen levels should be monitored closely to direct the dosing and duration of the catheter-directed lysis.
When using pharmacomechanical thrombectomy, one should be mindful of the risk of acute kidney injury associated with hemolysis. If the presentation is more than 2 to 4 weeks from the onset of symptoms, heparinization alone may be initiated without thrombolytic therapy as the success of thrombolytic therapy is low beyond that window of time. Another option for treatment is mechanical catheter-directed thrombectomy.
This must be done early in the course of the disease. Decompression of the thoracic outlet is the definitive management of PSS. The surgical approach can either be transaxillary or supra, infra, or para-clavicular.
The timing of decompression after thrombolytic therapy is widely debated. The role of long-term anticoagulation in these patients after adequate decompression remains unclear.
Some clinicians perform a venogram, often with intravascular ultrasound, 2 weeks postoperatively and decide about the duration of anticoagulation at that time. In this setting, venoplasty can be used for any residual stenosis since decompression has been achieved surgically.
The use of stents is discouraged in this anatomic location due to the repetitive motion and risk of stent fracture and thrombosis. The duration of anticoagulation in patients with underlying hypercoagulability disorders after decompression also remains unclear.
In most patients, anticoagulation for 3 to 6 months following an episode of deep venous thrombosis such as PSS is reasonable. This can be achieved either via warfarin or direct oral anticoagulants DOAC. In the case of recurrent thrombosis after decompression surgery, thrombolysis and venography are usually attempted again with the maintenance of long-term anticoagulation therapy afterward. In some patients with PSS, chronic total occlusion of the subclavian vein may persist despite adequate decompression maneuvers.
Depending on the severity of the symptoms, venous reconstruction should be considered. This can be achieved with a bypass or jugular vein turndown procedure with or without medial claviculectomy. Upper extremity swelling may be present in patients with lymphatic disorders or systemic conditions such as end-stage renal disease and congestive heart failure.
Upper extremity deep venous thrombosis can be seen with indwelling catheters as well. Anticoagulation with decompression is less successful than thrombolysis and decompression but still yields better results than anticoagulation alone.
Patients should be encouraged to adhere to all medication recommendations and have close follow up with all of their healthcare providers. Activity and lifestyle modification may reduce the risk of recurrent thrombosis. Patients with hypercoagulable states should be made aware that they may need long-term anticoagulation.
Diagnostic work-up focuses on identifying the underlying etiology. It includes carotid artery imaging, cardiac evaluation, and hypercoagulable testing. In the case of our patient, her BRAO remains of unknown etiology as all of her inpatient work-up yielded normal results. Further testing is currently ongoing.
Chickenpox is a highly contagious viral infection due to the varicella zoster virus. Primary infection in young children typically presents as a cutaneous, self-limited disease. Prior to the introduction of the varicella vaccine in , roughly 4 million people contracted chickenpox each year. The vaccine led to a reduction in rates of infection, hospitalizations, and mortality. Today, fewer than , people contract chickenpox yearly. However, breakthrough infections in vaccinated individuals still occurs in approximately 13 per , individuals.
Below, we discuss the case of a vaccinated 9 year old female with a superimposed bacterial infection secondary to chickenpox. A fully vaccinated 9 year old female was transferred from an outside hospital for worsening cellulitis of her right upper extremity. Two weeks prior to admission she was treated with 10 days of oral clindamycin for cellulitis of her face, chest, and right arm with clinical improvement.
Four days after resolution of the cellulitis she developed a new pruritic papule on her right arm. Her sister had several similar lesions which resolved within 48 hours. Our patient developed progressive erythema of her right antecubital fossa with evolution to a large, serum crusted plaque. Pruritic vesicles developed on her face, abdomen, and legs. She was transferred to our hospital for worsening cellulitis and started on intravenous vancomycin while wound cultures were pending.
Though she experienced moderate improvement in the right arm plaque after several days of vancomycin, she developed progressive vesicles, facial swelling, eye pain, and severe pruritus. Varicella infection was confirmed by direct fluorescence antibody testing. The bacterial culture grew methicillin sensitive Staphylococcus aureus. She was discharged home with oral acyclovir and cephalexin.
Despite previous varicella vaccination, our patient developed disseminated infection consistent with chickenpox, which was complicated by a superimposed bacterial infection. Due to the high efficacy of the varicella vaccine, many clinicians lack firsthand experience with varicella infections and are unfamiliar with the natural progression of the virus.
Prompt recognition of varicella infection is necessary to prevent and manage significant complications and to ensure appropriate isolation precautions both inpatient and outpatient settings. Despite reduced rates of this infection, the varicella virus remains a significant pathogen in both the unvaccinated and the immunocompromised populations.
This case highlights the importance of familiarity with both typical and atypical presentations of varicella, as well as the importance of maintaining a high index of suspicion for varicella even in the vaccinated patient. Adenoid cystic carcinoma is a rare malignant tumor of the secretory glands, most often affecting the salivary glands. It is known for taking a prolonged course with late local recurrences, distant metastases, and poor response to systemic chemotherapy.
A case review of the presentation and the multi-disciplinary management of an adolescent female patient with adenoid cystic carcinoma of the soft palate. A year-old female presented to Otolaryngology for evaluation of chronic pharyngitis. She endorsed a year-long history of recurring sore throat and a growing lump on the roof of her mouth.
On physical exam, a 1 cm submucosal lesion on the soft palate was noted. Surgical excision revealed adenoid cystic carcinoma with perineural invasion and positive margins. Imaging revealed localized disease. Due to increased risk of recurrence with positive margins, the patient subsequently underwent a repeat excision with negative margins.
She was then treated with 60 Gy of adjuvant radiotherapy over 6 weeks with minor complications. She remains without local recurrence 6 months after presentation. Chronic pharyngitis is an uncommon pediatric complaint and should prompt concern for malignancy. Salivary gland tumors account for 0. The incidence of head and neck cancer amongst the pediatric population has risen, warranting greater awareness of these cancers amongst general pediatricians and more treatment standardization.
As a rare tumor, studies of optimal treatment for adenoid cystic carcinoma have been limited and there is no agreed upon set of prognostic factors to predict recurrence. Up-front treatment with surgery and radiotherapy has remained the standard of care for decades, as no effective systemic chemotherapy has been identified. Complete tumor excision must be balanced with the risk of functional deficits and the consequent morbidity of dysfunction in speech, swallowing or nerve injury.
In children undergoing radiation therapy, late effects may occur at a much earlier age and cause lifelong morbidity. Recurrence can be locoregional but often presents as distant metastases to the lung or liver.
The lack of effective systemic treatments during recurrence presents a dim prospect for a pediatric patient looking towards young adulthood. Further research is needed to determine optimal treatment, including targeted therapy, in pediatric patients to improve long-term event-free survival. A year-old female presented to our hospital with cough, weight loss, and a mediastinal mass. She initially developed a cough after moving from Oklahoma to Florida in In January , she sought medical care for vomiting, vaginal bleeding, and a persistent cough.
She was found to have a miscarriage, and her cough was not addressed. A month later, she sought medical evaluation due to persistent cough and new onset chest pain, and was diagnosed with an upper respiratory infection. Her symptoms failed to improve so she presented to the ER. X-rays of the chest and abdomen were negative. Her labs were significant for an elevated d-dimer and a microcytic anemia. A chest CT was done to rule out pulmonary embolism and revealed right hilar and subcarinal adenopathy, and a right middle lobe pulmonary nodule.
She underwent a VATS procedure and debulking. On further testing, her histoplasma antibody was positive. She was treated with a day course of Amphotericin B with plans for a month course of itraconazole.
Over the next month she developed worsening cough, vomiting, dysphagia, and a 10 kg weight loss. She was subsequently readmitted and repeat chest CT showed an infiltrative mediastinal and right hilar mass that had increased in size, with the pulmonary nodule in her right middle lobe now causing mass effect on the pulmonary artery and left atrium.
She was given a steroid burst with a steroid taper prior to transfer to our hospital for higher level of care. Differential diagnosis included: lymphoma, histoplasmosis, sarcoidosis. Right thoracotomy with mass biopsy was performed by pediatric cardiothoracic surgery. Pathology was consistent with fibrosing mediastinitis, likely secondary to histoplasmosis. She was continued on oral steroids and itraconazole. She was discharged home with repeat imaging and follow up arranged. At most recent follow up her mass has decreased in size, though she continues to deal with a chronic cough and has some night-time sweats.
She has minimal limitations in physical activity. Currently, her specialists are debating initiation of Rituximab as the next best step in her treatment. Fibrosing mediastinitis is a rare condition of fibrosing on the mediastinum from an abnormal immune reaction. This condition is typically seen in adult patients. Histoplasmosis, tuberculosis, sarcoidosis, other autoimmune disorders, and mediastinal radiation are all known causes of fibrosing mediastinitis, though many cases are idiopathic.
Symptomatic therapies include vascular stents, airway dilation, esophageal stenting, and surgery. Targeted therapies include antifungals, glucocorticoids, and rituximab. Our patient received both antifungals and steroids. This case is unique given her presentation, young age, and the relative rarity of this diagnosis. She will require life-long therapy though currently is stable and overall doing well.
Optic neuritis ON is typically caused by demyelination of the optic nerves. Etiologies include autoimmune, inflammatory, or infectious causes.
Epstein-Barr virus EBV is a rare cause of ON and should be included in the differential diagnosis as its presentation in children can be variable and difficult to distinguish. A 5-year-old female presented to the emergency department with a history of headache, vision changes, and fatigue with initial symptom resolution with acetaminophen seven days prior to presentation.
Over the next several days, her parents noticed symptom recurrence leading to worsening visual and ambulation impairment. History revealed no recent infectious or toxic exposures and no family history of neurological disorders.
On physical exam the patient was somnolent with bilateral vision loss, mydriasis, and sluggish pupillary light responses. Funduscopic exam performed by ophthalmology revealed bilateral mild optic disc edema. Intravenous methylprednisolone was administered which led to marked improvement with ability to track objects by day two of treatment. The patient was eventually discharged on a day oral prednisolone taper and referred for follow-up with outpatient ophthalmology.
Epstein-Barr virus is a rare etiology of optic neuritis in children and should be considered in the primary workup in addition to MRI, lumbar puncture, autoimmune studies, and other infectious panels.
A combination of visual and central nervous system changes can be observed, but these findings may be complicated in the pediatric population, due to difficulties obtaining a detailed history. It is important to inquire about symptoms such as somnolence, headache, and ataxia in combination with ocular findings such as papilledema, mydriasis, and vision loss.
The combination of a positive anti-EA and anti-EBNA confirms the diagnosis of recent infection with EBV, which further supports the etiology of ON as it typically does not present during the acute infection period. The current standard treatment includes corticosteroids, which have been shown to accelerate symptom resolution.
This case highlights the important role of EBV workup in pediatric optic neuritis and the wide variety of history and physical findings present as well as the importance of serologic studies and role of treatment in recovery.
Here we present a patient who arrived to the pediatric emergency department ED with MIS-C and suspected cardiogenic shock, though without the echocardiogram abnormalities commonly associated with MIS-C. During this time, he had no chest pain, palpitations, shortness of breath, or abnormal cardiopulmonary exam. At the first 2 ED visits, he was generally well appearing and after treating fever, had vital signs normal for his age.
Troponins, chest X-ray, and EKG were normal. He soon developed an S3 gallop and facial edema indicating fluid overload. A formal cardiology echocardiogram confirmed the bedside ultrasound findings, noting normal ventricular size and motion, trivial pericardial effusion, and normal coronary artery size.
The patient had no further episodes of hypotension, though it is unclear if steroids had resolved this by alleviating the underlying inflammation or as a secondary effect. We present a case of MIS-C that led to diastolic heart failure detected by mild hypotension, elevated proBNP, and subtle findings on formal echocardiogram.
Diastolic heart failure with preserved systolic function has been seen on echo of MIS-C patients, and is hypothesized to be the subacute period after recovery of systolic function.
It is therefore essential to recognize that a patient with MIS-C may present with diastolic heart failure without preceding symptoms or echo findings of other cardiac anomalies. Mediastinal masses can be difficult to diagnose and may be an incidental finding on imaging or present with diverse symptoms. Etiology differs based on location in the mediastinum.
Here we see three cases of mediastinal masses in children having diverse etiology and varying presentations. Case 1: A 2 yo male with history of G6PD deficiency presented with fever and cough for one week. On exam, patient was noted to have an abnormal lung exam, warranting chest x-ray which exhibited pneumonia and collapsed RUL. CT chest showed a large mediastinal and hilar mass. Given family history of death secondary to granulomatous disease, DHR was done and was low at Patient underwent bone marrow biopsy at a higher center which was negative for malignancy.
Unable to obtain a biopsy of the mass as the family was concerned about consequences of anesthesia. Patient was started on Interferon Gamma 1b injections and prophylactic Trimethoprim and Itraconazole. Follow-up CT chest done at 7 months showed significant improvement. Patient is well and continues to follow with multiple specialties. Chest x-ray revealed a focal left suprahilar opacity and CT chest reported a mediastinal lesion with multilocular fluid collection.
Patient was diagnosed with pneumonia and discharged on antibiotics. Patient returned 3 months later with similar complaints. Repeat chest x-ray revealed persistence left suprahilar opacity. CT chest showed mass and multilocular fluid collections in the anterior mediastinum.
Work-up was done to rule out malignancy, fungal etiology, and TB, all of which were unremarkable. Patient followed up with pediatric surgery and underwent robotic-assisted excision of the mediastinal mass. Pathology reported thymic hyperplasia with benign cystic changes. Currently, patient is well. Case 3 : A 12 yo female with history of asthma hospitalized for right upper back pain in the scapular region and acute worsening of chronic cough.
Chest x-ray showed right-sided hilar lesion, pleural effusion and middle lobe atelectasis. CT chest revealed middle mediastinal soft tissue conglomerate mass with mediastinal lymphadenopathy.
Leukemia, lymphoma, and TB were ruled out. Biopsy of the mass was negative for malignancy. Serology revealed histoplasmosis. She was treated with itraconazole and is currently stable. Etiology and presentation of mediastinal masses in children differ based on location, which may be anterior, middle, or posterior mediastinum.
When patients present with respiratory symptoms such as cough, we are inclined to assume the presence of a pulmonary infection. There must be a high index of suspicion if any abnormal mediastinal findings are noted in primary imaging. Further workup, including CT and biopsy, must be conducted in a timely manner and treated. Hypersensitivity pneumonitis HP is a rare cause of lung disease in children with an estimated prevalence of 4 per million cases. Inadequate or delayed treatment can result in irreversible fibrosis.
An 8-year-old Hispanic female presented to pulmonary clinic due to recurrent pneumonia, anemia, and failure to thrive FTT. For two years prior to admission, she had multiple episodes of a cough with associated pneumonia in various lung lobes that would improve with different courses of antibiotics amoxicillin-clavulanate, ceftriaxone, azithromycin, doxycycline, and ceftazidime , but would eventually recur. Cystic fibrosis, primary ciliary dyskinesia, and immune deficiency workup was reassuring.
A CT scan obtained during one of her acute illnesses revealed bilateral lower lobe consolidation, yet no ground glass opacification or nodular pattern.
Given her course, she was admitted for intravenous antibiotics and further work up. Further history revealed direct exposure to birds. She received pulse dose of methylprednisolone and was discharged home on a 2 week steroid taper with instruction to avoid avian triggers.
This patient represents a unique presentation of HP without classical imaging findings likely due to her sporadic exposure to birds. Although rare, HP should be included in the differential for chronic cough, FTT, or digital clubbing. Our case highlights that patients can have HP without classical imaging findings and the importance of discussing certain exposures such as hay, plastic, or animals.
Treatment with antigen avoidance and steroids is effective and prevents the complication of pulmonary fibrosis. Hypersensitivity pneumonitis in children. Revue Des Maladies Respiratoires ; 36 4. Hypersensitivity pneumonitis: lessons for diagnosis and treatment of a rare entity in children. Orphanet journal of rare diseases. Common symptoms are fever, cough, myalgia, fatigue, headache, dyspnea, sore throat, vomiting, and diarrhea.
Patients may present with end-organ failure, ARDS, shock, acute kidney injury, or even death. An year-old woman with COPD and diastolic heart failure presented with shortness of breath. She had hypoxemia on room air upon presentation. Lungs were clear on physical examination. Her chest radiograph demonstrated no pulmonary infiltrates.
Transthoracic echocardiography TTE demonstrated a large, irregularly shaped echogenic mass in both the right atrium and right ventricle consistent with a large thrombus. The mass in the right atrium was 3. A previous TTE study in this patient did not reveal an intra-cardiac thrombus. No deep venous thrombosis was found.
She was begun on anticoagulation and refused catheter-directed therapy. She improved and was discharged to her home. The most common are deep venous thrombosis and pulmonary embolism in critically ill patients despite the use of prophylactic anticoagulation.
Several studies have reported post-mortem biopsies with widespread microthrombi. Arterial thrombosis with stroke and limb ischemia has also been described. Our case had an unusual presentation since the cause of her shortness of breath was the intra-cardiac thrombus.
Some studies propose direct endothelial injury by the COVID virus, causing microvascular inflammation, endothelial exocytosis, and endothelitis.
Yet, no definitive mechanism has been identified. Criteria for ME include 6 months of fatigue-limited daily activities, unrefreshing sleep, and symptom exacerbation following physical or mental strain, and orthostatic intolerance. New reports indicate that ME incidence may be higher in specific patient populations. The patient population used for this study includes 19 patients that were referred to the Amarillo Heart Group in Amarillo, TX who also tested positive for Covid at least 6 months prior to September 1, The patients that fit this timeline were asked a series of standardized questions and rate the severity of their symptoms on a scale of 0 to 5, with 0 being the absence of symptoms and 5 being the most severe.
Rating more than 1 Life Spheres question as a 3 or higher or rating all 3 Symptoms Criteria questions as a 3 or higher indicated Chronic Fatigue Syndrome. Information from the survey, including time since infection, demographics, and question scores, were analyzed. Our study included 10 women and 10 men, with the average amount of time since Covid infection being Worsening of symptoms with mild exertion was the most commonly endorsed criteria 3. Women scored higher in every category except reduced activity in school when compared to men.
However, there was no significant difference in symptom scores between the two groups with the Combined Fatigue Score being 2. Nearly all symptom scores significantly positively correlated with one another, meaning if one category was high it was likely for other categories to be high as well. Ultimately, when looking at the Cumulative Pearson Correlation Scores, reduced social life, difficulty concentrating, and symptoms worsening with mild exertion were found to be most predictive of a high Combined Fatigue Score.
To our knowledge, this is the first study to examine ME in patients with both of these predisposing conditions. A high degree of clinical suspicion for ME should be used when screening and treating cardiac patients who have been infected with COVID Coronary artery aneurysms CAAs , especially multiple, are a rare cardiac pathology and an unusual cause of cardiac chest pain.
A year-old African American woman with hypertension and non-insulin dependent type II diabetes mellitus presented with one day of chest pain. She was evaluated five months prior for a similar presentation and had negative cardiac stress test and normal echocardiogram at that time.
She followed with cardiology and was compliant with a regimen that included aspirin, statin, beta blocker, calcium channel blocker, thiazide and metformin. Troponin was elevated to 0. A subsequent coronary angiogram revealed no atherosclerotic disease but multiple saccular coronary artery aneurysms: 6 mm in the left anterior descending artery segment D1 and two 6—8 mm aneurysms in the left circumflex artery OM1 lower pole and OM2 upper pole. The patient was discharged on long-term clopidogrel.
Subsequent rheumatologic workup has been unrevealing and she continues to follow with cardiology. Coronary artery aneurysms involving multiple vessels is an extremely rare finding, particularly in this patient without any other significant risk factors. CAAs should be considered as a rare differential diagnosis in a patient with cardiac chest pain who does not fit the classic ACS illness script.
CAA require close follow up, and can be managed percutaneously, surgically, or medically, depending on factors such as size, location, and if they are causing cardiac ischemia. Further reporting and study of this rare condition is crucial for better understanding and delineation of best management. Reverse takotsubo cardiomyopathy is a rare variant of takotsubo cardiomyopathy which is characterized by basal wall ballooning and apical hyperkinesis.
In this case, we present the first documented incidence of reverse takotsubo cardiomyopathy caused by profound hypokalemia. A 62 year old male was resuscitated following cardiac arrest secondary to ventricular fibrillation in the field. After resuscitation, initial lab work was notable for hypokalemia with a potassium level of 2. The patient underwent emergent left heart catheterization which demonstrated angiographically normal coronary arteries.
It should be noted that, takotsubo cardiomyopathy is a rare syndrome characterised by temporary and reversible left ventricular dysfunction that is provoked by a stressor that can be either physical or emotional. There are 4 types of takotsubo cardiomyopathy; reverse takotsubo is unique in that it causes ballooning of the left ventricular base rather than the apex.
As evidenced in this case, takotsubo cardiomyopathy is generally considered a diagnosis of exclusion and paitents must undergo detailed evaluation in order to exclude alternative causes of left ventricular dysfunction prior to diagnosis. Hyperdynamic left ventricular apex circle relative to ballooned base on transthoracic echocardiogram A-diastole, B-systole and left vetriculogram C-diastole, D-systole. Left Ventricular Non-Compaction LVNC is a rare congenital cardiomyopathy which carries a high risk of malignant arrhythmias, thromboembolic phenomenon and left ventricular dysfunction.
Prominent trabeculations were noted in the LV apical and anterolateral segments. There was no evidence of stress induced myocardial ischemia.
The patient responded to intravenous diuresis and was counselled on the diagnosis of LVNC cardiomyopathy, fitted with a LifeVest and discharged on warfarin anticoagulation.
LVNC is congenital cardiomyopathy characterized by extensive endomyocardial trabeculations and recesses within the ventricular cavity. The clinical sequelae of LVNC mainly involve congestive heart failure CHF , arrhythmogenesis, thromboembolism, and a small percentage of patients may remain asymptomatic.
The diagnosis is made through imaging, with echocardiography as the first-line method. Cardiac Magnetic Resonance Imaging has also emerged as a potentially superior method due to its 3-dimensional nature and higher image quality. After the diagnosis of LVNC is made, treatment is directed at the different elements of disease. Due to the increased thromboembolism risk of LVNC, the strategy of anticoagulation has been a subject of debate.
Due to the genetic nature of the disease, it is recommended that a thorough 3 generation family history is obtained and genetic testing be done in appropriate relatives if a specific genetic mutation was determined. Genetic cardiomyopathies should be considered in the differential diagnosis of young patients presenting with symptoms of heart failure with no known comorbidities or prior history of cardiac disease.
Gender differences in systolic heart failure HF patients for the implantation of various cardiac implantable electronic devices CIEDs using ICD have not been studied.
We aim to explore the gender differences for each type of procedure. Demographic data were obtained using the variables provided in the NIS. We identified 4,, HF hospitalizations from January to December Overall, two third of patients were male Among the CIEDs, males had a higher rates of procedure utilization compared to females : Percutaneous insertion of defibrillator in right ventricle 1.
Reword to support the conclusion. Despite minimal differences in baseline characteristics, implantation of CIEDs appear to be utilized less often in women than in men, less often in blacks than in white, and more often in urban hospitals.
Further studies are required to confirm these findings and further explore gender differences. Coronary calcium is an independent risk factor for adverse outcomes in coronary artery intervention. Modification of this calcium via intravascular lithotripsy is accomplished through acoustic pressure waves that disrupt the calcium and improve vessel compliance.
Studies have shown intravascular lithotripsy is effective in the management of heavily calcified de novo coronary lesions. Evidence for use in in-stent restenosis is limited and is still off-label. The purpose of this study is to evaluate the effectiveness and safety of intravascular lithotripsy for management of calcium-mediated in-stent restenosis.
A retrospective, single-center study was performed for four cases of in-stent restenosis with evidence of significant underlying calcium burden resulting in stent under-expansion and probable calcium intimal neoplasia.
Lesions were treated with intravascular lithotripsy Shockwave Medical. Complications were defined as vessel dissection, decrease in Thrombolysis in Myocardial Infarction flow, recurrent anginal symptoms, or death. In-stent intravascular lithotripsy followed by angioplasty with non-compliant balloon inflations at high pressures was performed.
There were no complications identified in the study group. The role of intravascular lithotripsy has been established in patients with de novo calcified lesions. This study demonstrates the effectiveness and safety of intravascular lithotripsy for calcium-mediated coronary in-stent restenosis. Given the challenges of in-stent restenosis, particularly associated with underlying calcium, additional studies are warranted.
Other risk factors include smoking half a pack-year for 45 years, hyperlipidemia, BMI 34, no family history of heart disease, carvedilol, aspirin, and statin. The BP was controlled with IV labetalol and amlodipine. He was observed for two days without any further events. Chest pain was more suggestive of costochondritis than cardiac. He was recommended to avoid weight lifting one week, smoking and drug cessation, and follow up with a cardiologist. In all three admissions, the patient was admitted and discharged with elevated troponins with no definite diagnosis.
Potential reasons a patient with clinically suspected acute MI may be misdiagnosed can be a Test-related issues, b myocardial injury not related to coronary artery atherothrombosis, and c acute myocardial injury not related to the coronary circulation. In most high-sensitivity cardiac troponin hs-cTn assays, the 99 th percentile URL values are higher in men than in women. The United States recommends sex-specific cut-off values; however, not adopted in Europe.
A subgroup of these patients have a Type 2 MI, consequent to increased oxygen demand or decreased supply, and will not have significant epicardial coronary artery disease when coronary angiography is performed.
The patients with acute ischemia and elevated troponin benefit from diagnostic coronary angiography and possible percutaneous coronary intervention. This may almost be true with hs-cTn assays, as the increased sensitivity means that more significant numbers of patients with type 2 MI will also be detected. Hence, these patients may not benefit from an invasive approach. In most studies, short- and long-term mortality rates were higher in type 2 MI than in type 1 MI patients.
In a multivariable model accounted for competing risk of death between subgroups, the adjusted 5-year risk of MACE was lower in type 2 MI versus type 1 MI with risk ratio, 0. Higher mortality but similar or lower MACE rate among type 2 MI and nonischemic myocardial injury versus type 1 MI advocates this risk of death is from comorbidities rather than by complications of ischemia or necrosis.
The patient is a year-old man with a history of dextro-transposition of the great arteries for which he underwent an atrial switch Senning operation with VSD closure at 3 years of age. As an adult, he required pacemaker and ICD implantation for complete heart block and ventricular tachycardia. He endorsed functional class II symptoms in clinic. Right and left heart catheterizations demonstrated no coronary disease, normal filling pressures, and a preserved cardiac index.
ICD interrogation revealed that the subpulmonic LV threshold was elevated and the battery was at replacement time. He was referred for generator replacement and ventricular resynchronization. A plan was made to attempt His bundle pacing, and if that failed, to implant a new pacing lead in the LV septum. The His bundle could not be located, so we proceeded with placement of a lead in the interventricular septum. We first attempted placement of a Medtronic pacing lead; however, due to the tortuosity of the baffle, we could not affix the lead.
We advanced a Medtronic pacing lead and, using a primary and secondary curved stylette, successfully positioned and affixed the lead to the LV septum. Pacing from this location demonstrated appropriate pacing and sensing parameters. Three months later, the patient reported functional class I symptoms. A 2-year-old male presented to the Emergency Department ED for the 3rd time in 2 months with staring spells and mild encephalopathy. Parents had also noted irritability, headaches, emesis, diarrhea, generalized erythematous rash, lymphadenopathy, and intermittent fevers.
Symptoms started shortly after the family moved into a new home from out of state 2 months prior to presentation but had worsened in the preceding 2 weeks. Lab results during the prior two ED visits included microcytic anemia and elevated ESR; investigation for Kawasaki disease including TTE was negative and on both occasions was diagnosed with a presumed viral infection. On this visit to the ED, he was afebrile and tachycardic. Exam showed a tired, irritable, but consolable male with tachycardia with regular rhythm, faint bibasilar crackles, occipital and inguinal lymphadenopathy, excoriations in various stages of healing over torso and legs.
He had an episode concerning for seizure while in the emergency department. He was started on oxcarbazepine and discharged home. Following discharge, patient continued to be sleepier than normal and re-presented to the ED. A detailed social history was obtained and revealed the unexpected deaths of two family cats who died shortly after moving to the area, raising concern for environmental toxins.
Patient was subsequently given chelation therapy. This case highlights several challenges with identification of a subacute pediatric environmental exposure. Acute mercury inhalation injury secondary to a solution being spilled then inhaled over at least a month presented initially as an acute upper respiratory illness.
Later, the initial morbilliform rash was recognized as acrodynia, an idiosyncratic hypersensitivity to mercuric salts. Unfortunately, each of these symptoms can be found in a spectrum of clinical pathologies. The key to diagnosis in this scenario was the identification of the unexpected death of two pets that ultimately led to the timely detection of a very dangerous environmental toxin.
The management of pain in vaso-occlusive crises VOC in patients with sickle cell disease SCD often involves opioids, putting patients at risk for adverse effects. However, the management of VOC-related pain with continuous peripheral nerve blocks CPNBs shows potential as a viable alternative to opioids.
The purpose of this study is to examine the outcome of a patient with a chronic non-healing medial malleolar ulcer related to repeated VOC which was effectively managed with a series of CPNBs.
A year-old female patient with SCD and acute-on-chronic pain due to a VOC-related chronic ulcer on her right medial malleolus was referred to the Acute Pain Service. The patient required daily oral opioids for pain control and had been hospitalized 15 times for pain control since the wound developed.
With informed consent, a CPNB of the saphenous nerve was performed midthigh with an gauge Touhy needle. VG Katana and JS Weiss had full access to all the data in the study and take responsibility for the integrity of the data, and VG Katana and JS Weiss interpreted the data and take responsibility for the accuracy of the data analysis. Drafting of the manuscript and critical revision of the manuscript for important intellectual content was performed by VG Katana and JS Weiss.
Phlebology ; 30 10 : — Google Scholar. Curr Opin Cardiol ; 25 6 : — Vasc Med ; 20 2 : — 9. Curr Treat Options Cardiovasc Med ; 4 3 : — Acute Paget-Schroetter syndrome: does the first rib routinely need to be removed after thrombolysis? Ann Vasc Surg ; 29 6 : — 7. A staged, multidisciplinary approach. Arch Surg ; 10 : — 8. J Invasive Cardiol ; 27 9 : — 8. J Vasc Surg ; 43 6 : — J Vasc Surg ; 60 4 : — 7.
Vascular thoracic outlet syndrome: successful outcomes with multimodal therapy. Cardiovasc Surg ; 9 1 : 11 — 5. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg ; 40 4 : — A decade of excellent outcomes after surgical intervention in patients with thoracic outlet syndrome. J Am Coll Surg ; 5 : — 9. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome.
Surgery ; 5 : — 7. Vasc Endovascular Surg ; 46 1 : 15 — J Vasc Surg ; 52 3 : — Arch Surg ; 1 : 54 — 7. J R Army Med Corps ; 4 : — J Orthop Sports Phys Ther ; 44 4 : Mil Med ; 12 : — 2. Ann Acad Med Singap ; 40 4 : — 6. J Am Board Fam Pract ; 18 4 : — 9.
Mil Med ; 10 : — 3. Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.
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Volume Journal Article. Oxford Academic. Jeffrey S. Cite Cite Vienna G. Select Format Select format. Permissions Icon Permissions. ABSTRACT The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important cause of primary thrombosis.
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Create Alert Alert. Share This Paper. Figures from this paper. Paget-Schroetter Syndrome Nathan A. MallGeoffrey S. Van ThielWendell Sjndrome. HeardG. Paletta pavet, C.
Bush-JosephB. Bach Medicine. Sports health. SansonV. GautierA. StansalD. SfeirC. FranceschiP. Priollet 7. BenhamouI. Government agencies not usajobs login 365 Medicine. A comprehensive review of Paget-Schroetter syndrome. IlligAdam J. Doyle Medicine. Journal of vascular surgery. Images in clinical medicine. Paget-Schroetter syndrome. SeegerB. Bewig Medicine. The New England journal of medicine. Robert-EbadiF. BeckerM. Righini Medicine.
Revue medicale suisse. View 2 excerpts, references background. Priollet Medicine. Journal des maladies vasculaires. Upper extremity deep venous thrombosis. BernardiR. PesaventoP. Prandoni Medicine. Seminars in thrombosis and hemostasis. Clinical practice. Deep-vein thrombosis of the upper extremities. Kucher Medicine. This article reviews usual strategies for treating thrombosis of the upper extremities, including anticoagulation therapy and thrombolysis.
The use of catheters and surgical interventions in … Expand. D-dimer for the diagnosis of upper extremity deep and superficial venous thrombosis. SartoriL. Cosmi Medicine. Thrombosis research. Related Usa jobs government jobs login paget schroetter syndrome de. Abstract Figures 16 References Related Papers.
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