ABSTRACT
Background: There is limited data available about the effectiveness of thrombolysis in prosthetic valve thrombosis (PVT). Therefore, this study aimed to evaluate the efficacy and safety of thrombolytic treatment in PVT patients.Methods: This was an observational study conducted at a tertiary-care centre in India between March 2013 and April 2014. Total of 56 patients with either recurrent PVT or with confirmed left-sided PVT was included in the study. Thrombolytic therapy was administered as an intravenous infusion of streptokinase or urokinase, initially at a loading dose of 2.5L IU/hour over 30 minutes, followed by 1L IU/hour for 48–78 hours depending upon the clinical and 2D-Echo observation. Primary endpoint was considered as the occurrence of a complete clinical response. Secondary endpoint was considered as a composite of death, major bleeding or embolic stroke.Results: Mean age of the patients was 37±13 years. Most of the patients presented with NYHA-II (51.7%), III (39.2%), and IV (8.9%) symptoms. Mitral and aortic valve thrombosis were observed in 40(71.4%) and 11(28.6%) patients. Forty-nine (73.3%) patients were treated with streptokinase. Whereas, rethrombosis patients were treated with urokinase [6(16%)] and tenecteplase [1(1.3%)]. Two (3.6%) patients died, 1(1.8%), 1(1.8%), 2(3.6%), and 1(1.8%) patient had peripheral embolism, central nervous system bleeding, stroke, and embolic complications.Conclusions: Thrombolytic therapy can be used as the first-line treatment for thrombolysis in PVT patients. All PVT patients can be treated with streptokinase unless specific contraindications exist. Urokinase or tenecteplase is an alternative thrombolytic agent in rethrombosis patients.
ABSTRACT
Angiokeratoma is a benign cutaneous lesion of capillaries. It is characterized by large dilated blood vessels in the superficial dermis and hyperkeratosis of extremities. It is mostly seen in generalized form affecting the extremity of the body, but we report this case of solitary angiokeratoma of the tongue which is a very rare type.
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Recent trends in maxillofacial surgery are to reduce the trauma to the adjacent soft tissue. The distoangular impaction presents a challenge to the maxillofacial surgeon and also results in more surgical morbidity. Here, we present a minimally invasive extraction technique for the distoangular mandibular third molar impaction.
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Intracranial dural arteriovenous fistulae (DAVF) are acquired fistulous communications between dural arterial branches and dural venous sinuses or cortical veins with the nidus located within the leaflets of the duramater. Dementia and Parkinsonism are amongst the rarest of clinical presentations in DAVFs and are important to diagnose early, being treatable with timely intervention. We present an interesting case of a patient who presented with rapidly progressive dementia and features of parkinsonism who was diagnosed to have extensive DAVF and made remarkable recovery after embolization of the fistulae.
Subject(s)
Humans , Central Nervous System Vascular Malformations , Dementia , Fistula , Parkinsonian Disorders , VeinsABSTRACT
Background: Klippel-Trenaunay syndrome is a non-heritable venous malformation with bone and soft tissue hypertrophy and cutaneous nevi. Case characteristics: Neonate with Klippel Trenaunay syndrome born to a mother with past history of Gestational trophoblastic neoplasm. Observation: Antenatally, a fetal vascular malformation was identified ultrasonologically at 29 weeks gestation. Acute myeloid leukemia was diagnosed in mother at 33 weeks gestation. Message: A rare association of Klippel Trenaunay syndrome and gestational trophoblastic neoplasm with the possible role of either hyperglycosylated Human Chorionic Gonadotropin or chemotherapy as a link is highlighted.
ABSTRACT
In acute decompensated heart failure [ADHF], diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia [serum sodium concentration, <135 mEq/L] is a predictor of death among patients with heart failure. We prospectively observed the short term efficacy and safety of low dose [15 mg] tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. A total of 40 patients with ADHF along with hyponatremia [<125 mEq/L] on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline [P < 0.02]. There was a significant improvement in symptoms and New York Heart Association [NYHA] class after starting tolvaptan [P