Nasal Crust-Related Morbidity and Debridement After Endoscopic Skull Base Surgery

Abstract Introduction: Nasal crust after endoscopic skull base surgery can cause nasal congestion, obstruction, and pain, which can affect quality of life. The use of debridement aims to provide symptomatic relief and improve quality of life. Generally, most adult patients tolerate office-based debridement, except in a few select patients that require further sedation in the operating room for a debridement. The study sought to determine the rate of symptomatic crust-related morbidity and the rate of debridement in both the office and the operating room. Methods: Premorbid, operative, and postoperative data of adult patients who had endoscopic skull base surgery in our institution from 2014 to 2018 were reviewed retrospectively. The characteristics of nasal symptoms in the postoperative period were determined and the numberofdebridementsin theoffice and the operatingroomwere analyzed. Results: Two hundred and thirty-four (234) patients with 244 surgeries were included in the study. The majority, 68.9%, had a sellar lesion and a free mucosa graft (FMG) was the most common skull base reconstruction at 53.5%. One hundred and twenty (49.0%) had crust-related symptoms during the postoperative period and 11 patients (4.5%) required the operating room for debridement. The use of a pedicled flap, anxiety, and preoperative radiotherapy were significantly associated with intolerance to in-office debridement (p-value=0.05). Conclusions: The use of a pedicled flap or anxiety may predispose patients to require an OR debridement. Previous radiotherapy also influenced the tolerance to the in-office debridement.

Diagnosis and evaluation of 38 cases of pelvic congestion syndrome and single center experience in intracavitary treatment / 中国医师杂志

Objective:To evaluate the diagnostic evaluation process and the effectiveness and safety of intracavitary therapy for pelvic congestion syndrome (PCS).Methods:A retrospective analysis was conducted on 38 patients admitted to Beijing Shijitan Hospital affiliated to Capital Medical University from March 2019 to February 2022. Combined with the patient′s symptoms, PCS was diagnosed by color Doppler ultrasound, computed tomography venography (CTV), and venography. The ovarian vein was embolized with controllable spring coil and polydocanol foam sclerosing agent. The patients were followed up 1, 3 and 6 months after operation.Results:The total surgical success rate of 38 patients was 100%, and the incidence of complications was 5.3%(2/38); Spring coils (2.8±0.3)per person; The dosage of hardener was (7.0±2.1)ml/person. The improvement rate of patient symptoms was 97.4%(37/38); After 1, 3, and 6 months of surgery, color Doppler ultrasound was reexamined and no recanalization was observed in the embolized ovarian veins; The diameter of the parauterine vein was (2.8±0.5)mm, which was significantly lower than the preoperative (7.5±1.9)mm ( P<0.05); The Visual Analogue Scale (VAS) score was significantly lower than the preoperative score [(2.12±1.87)points vs (7.58±0.82)points, P<0.001]. Conclusions:Process based assessment is helpful in identifying and diagnosing PCS patients who urgently need treatment; Endovascular treatment based on embolization of ovarian vein with controllable spring coil and foam sclerosing agent is minimally invasive, safe and effective.

Seguridad en urgencias sobre la referencia de pacientes no urgentes a centros de atención primaria / Safety of referral of patients with non-urgent conditions from the emergency room to primary care centers

Objetivos: determinar la seguridad al referir pacientes triage 4 y 5 desde un servicio de urgencias a centros de atención primaria, conociendo su disposición final y las posibles complicaciones por esta estrategia. Métodos: estudio observacional retrospectivo de 333 pacientes clasificados como triage 4 y 5 que fueron referidos desde el servicio de urgencias a un centro de atención primaria en febrero 2019. A través de la aseguradora se obtuvo la información sobre si asistieron o no a dicha cita programada y la conclusión final de la consulta. Resultados: 52 pacientes (15,6%) no asistieron a la cita programada sin que esto causara alguna complicación para su salud. De los 281 que sí asistieron, 1,4% fueron referidos a valoración especializada urgente sin que requirieran ingreso hospitalario y 98,6% fueron atendidos y manejados en forma ambulatoria por el médico de atención primaria. Se encontraron diferencias entre los no asistentes a la atención primaria en los subgrupos de edad entre 3 a 17 (p=0,009) y 18 a 37 años (p=0,04). Conclusiones: la estrategia de referencia de pacientes clasificados en 4 o 5 desde un servicio de urgencias a centros de atención primaria es segura, incluso si estos no asisten a la cita programada

Objectives: to determine the safety of referral of triage category 4 and 5 patients from the emergency room to primary care centers, aware of their final disposition and the potential complications of this strategy. Methods: a retrospective observational study of 333 triage category 4 and 5 patients who were referred from the emergency room to a primary care center in February 2019. Information on scheduled appointment attendance, and final consultation diagnosis was obtained from the insurer. Results: 52 patients (15.6%) failed to attend their scheduled appointment presenting no health complications. Of the 281 who attended their clinic appointment, 1.4% were referred for urgent specialist consultation without requiring hospital admission. The primary care physician provided care and management to 98.6% of studied patients on an outpatient basis. Differences were found among those failing to attend primary care in the 3 to 17 (p=0.009) and 18 to 37 years (p=0.04) age subgroups. Conclusions: triage category 4 and 5 patients referral strategy from the emergency service to primary care centers is safe, even if patients fail to attend their scheduled appointment

Congestión Vehicular y Contaminación Ambiental en Lima Metropolitana / Vehicle Congestion and Environmental Pollution in Metropolitan Lima / Congestionamento dos Veículos e Poluição Ambiental na Metrópole de Lima

Resumen Introducción: La contaminación ambiental en las áreas urbanas, se debe principalmente a las emisiones de gases de efecto invernadero emitidas por la quema del combustible del parque automotor, el cual se incrementa en situaciones de congestión vehicular, que adicionalmente como fuente de contaminación sonora, incide en la salud física y mental de los ciudadanos. Objetivo: Esta investigación pretende determinar desde la percepción de los consultores independientes de transporte urbano, las causas de la congestión vehicular y su relación con la contaminación ambiental y la salud. Materiales y métodos: La investigación tiene un corte cuantitativo de diseño no experimental, de tipo observacional y descriptivo, donde inicialmente mediante la observación se permitió la selección de las zonas con mayor congestión de la ciudad de Lima metropolitana; además de la participación de 22 consultores independientes quienes a través de una entrevista estructurada permitieron la identificación de las causas de la congestión vehicular y su relación con la contaminación ambiental y la salud. Resultados: conforme con los resultados obtenidos las principales causas del congestionamiento identificadas por los consultores son: una deficiente gestión y planificación vial, falta de educación vial por parte de conductores y peatones, paraderos informales y vehículos obsoletos. Conclusiones: persisten en la ciudad capital niveles de congestión vehicular, que inciden en altos niveles de contaminación, los cuales afectan la salud y economía del peruano. Del análisis a raíz de las encuestas de los expertos, se recomienda dirigir estrategias y políticas de solución que incluyan reformas institucionales que favorezcan mejoras de eficiencia y eficacia en la gestión del transporte urbano, faciliten la renovación del parque automotor y se implementen campañas de sensibilización para crear cultura ciudadana.

Abstract Introduction: environmental pollution in urban areas is mainly due to greenhouse gas emissions from the burning of fuel in the vehicle fleet, which increases in situations of vehicle congestion, which, in addition to being a source of noise pollution, affects the physical and mental health of citizens. Objective: to determine the perception of independent urban transport consultant experts on the causes of vehicle congestion and its relationship with environmental pollution and health. Materials and methods: an observational and descriptive study in the city of metropolitan Lima, through the identification of critical points of vehicular congestion and through structured interviews with independent consultants, on the causes of traffic, environmental pollution and health. Results: the main traffic generators observed were constructions, closed streets, ambulatory commerce, informal stops, unauthorized parking, and accidents. While the causes of congestion, identified by the consultants, were based on poor management and road planning, lack of road safety education for drivers and pedestrians, informal stops, and obsolete vehicles. Conclusions: the capital city still suffers from high levels of traffic congestion, which affects the health and economy of Peruvians. From the analysis based on the opinions of experts, it is recommended that strategies and policies be directed towards solutions that include institutional reforms that favor improvements in efficiency and effectiveness in the management of urban transportation, facilitate the renewal of the vehicle fleet and implement awareness campaigns to create a citizen culture.

Resumo Introdução: a poluição ambiental nas zonas urbanas deve-se principalmente à emissão de gases com efeito de estufa provenientes da queima de combustível pela frota automóvel, que aumenta em situações de congestionamento de veículos, o que, além de ser uma fonte de poluição sonora, afeta a saúde física e mental dos cidadãos. Objetivo: determinar a percepção de peritos independentes em matéria de transportes urbanos sobre as causas do congestionamento dos veículos e a sua relação com a poluição ambiental e a saúde. Materiais e métodos: um estudo observacional e descritivo na cidade de Lima, através da identificação de pontos críticos de congestionamento veicular e de entrevistas estruturadas com consultores independentes, sobre as causas do trânsito, da poluição ambiental e da saúde. Resultados: os principais geradores de tráfego observados foram: construções, ruas fechadas, comércio ambulatório, paragens informais, estacionamento não autorizado e acidentes. Enquanto as causas do congestionamento, identificadas pelos consultores: má gestão e planeamento das estradas, falta de educação em segurança rodoviária para condutores e peões, paragens informais e veículos obsoletos. Conclusões: a capital ainda sofre de elevados níveis de congestionamento de tráfego, que afetam a saúde e a economia dos peruanos. A partir da análise baseada nas opiniões dos peritos, recomenda-se a orientação de estratégias e políticas para soluções que incluam reformas institucionais que favoreçam melhorias na eficiência e eficácia na gestão do transporte urbano, facilitem a renovação da frota automóvel e implementem campanhas de sensibilização para criar uma cultura cidadã.

Safety & Efficacy of a Fixed Dose Combination of Paracetamol (125 mg), Phenylephrine (2.5 mg) and Chlorpheniramine Maleate (1mg) [Flucold Drops] in the Treatment of Common Cold and Flu Syndrome in Children : Postmarketing Surveillance Study

Background :The common cold and flu syndrome primarily affects the upper respiratory tract, along with a low fever and some systemic symptoms such as sore throat, cough, nasal decongestion, headache, and so on. Several clinical studies have shown that combining analgesics, antihistaminics, and decongestants provides better symptom relief in the common cold. The current post-marketing surveillance study was designed to look into the safety and efficacy of commercially available Flucold Drops in the Indian population. Methodology :A current prospective, single arm, multicenter, post-marketing clinical study included 224 subjects, 220 of whom completed the study. All patients were given Flucold Drops for three days and then monitored for the next six days. During the study, the incidence of adverse events (AE) and serious adverse events (SAE) was assessed. The efficacy of the Flucold Drops was evaluated using VAS score changes from the beginning to the end of the treatment. The product’s safety was also evaluated using blood biomarkers such as haemoglobin, platelet count, SGOT, SGPT, and creatinine level. Results : Results show the reduction in symptomatic score of common cold and flu syndrome observed after 2rd follow-up visit (0.202+0.325 to 0.139+0.231). During the study, no intervention-related adverse events were observed. Furthermore, no Serious Adverse Events (SAE) were observed in the study or follow-up period. The study found no changes in the levels of blood biomarkers (haemoglobin, platelets, SGOT, SGPT, and creatinine). Conclusions : Flucold Drops are safe and effective in the treatment of common cold and flu syndrome in Children and infants.

A Case of Obstructive Sleep Apnea Successfully Treated with Kampo Medicine and Western Medicine / 日本東洋医学雑誌

We report a case of obstructive sleep apnea improved with the treatment both of Kampo medicine and Western medicine. The patient aged 52 years old was struggling with daytime drowsiness. Through the sleep test, he was diagnosed as severe obstructive sleep apnea (OSA) and was received a continuous positive airway pressure therapy (CPAP). Generally, positive air from CPAP applies through the nose and usage reports were recorded in the device. If having nasal congestion, it may be hard to continue CPAP. In this case he had a severe nasal congestion, and he nearly became CPAP failure. It was clear from the poor usage reports. Using Eppikajutsuto for nasal congestion, he felt decrease of nasal congestion. By switching to Shoseiryuto or kakkontokasenkyusin’i from Eppikajutsuto with reference to CPAP usage and nasal CT images, CPAP was continued effectively. Eventually, his daytime sleepiness disappeared.To continue CPAP, which is one of Western medicine, Kampo medicine was useful. On the other hand, to evaluate the effectiveness of Kampo medicine, Western medicine was necessary. CPAP reports and nasal CT images, which are Western medicine, contributed to the switch to Kampo medicine. This case showed the worth of the combined therapy of Kampo medicine with Western medicine.

Ozonoterapia en pacientes con dolor pélvico crónico / Ozone therapy in patients with chronic pelvic pain

Introducción: La factibilidad y seguridad del empleo de la ozonoterapia se evidencia en los resultados expuestos por varios autores, en enfermedades cuyo síntoma fundamental es el dolor crónico. Objetivo: Determinar la evolución clínica de las pacientes con dolor pélvico crónico, tratadas con ozono asociado al tratamiento médico convencional. Métodos: Estudio descriptivo, observacional, retrospectivo, en el que se determinó la evolución clínica de las pacientes con dolor pélvico crónico tratadas con ozono, asociada al tratamiento médico convencional. La muestra fue de 54 mujeres. Las variables utilizadas fueron: edad, causa del dolor pélvico, tiempo de evolución, puntuación de la escala de dolor antes y después de la aplicación de la ozonoterapia y evaluación del tratamiento. Resultados: Prevalecieron las pacientes con edad de 26-35 años. El 57,4 por ciento tenían entre 2 y 2 años de evolución del dolor. La enfermedad inflamatoria pélvica crónica fue la causa de mayor frecuencia con 42,5 por ciento. Antes de la aplicación de la ozonoterapia la media de puntuación en la escala de dolor fue de 6,31, y disminuyó a 3 después del tratamiento, con una evaluación de bien en el 81,1 por ciento de los casos. Conclusiones: Después de la aplicación de la ozonoterapia asociada al tratamiento médico convencional, se produce mejoría clínica, por lo que puede ser una alternativa de tratamiento(AU)

Introduction: The feasibility and safety of the use of ozone therapy is evidenced in the results presented by several authors, in diseases whose main symptom is chronic pain. Objective: To determine the clinical evolution of patients with chronic pelvic pain treated with ozone associated with conventional medical treatment. Methods: Descriptive, observational, retrospective study, in which the clinical evolution of patients with chronic pelvic pain treated from January 2018 to January 2020, with ozone therapy, associated with conventional medical treatment. The sample was 54 women. The variables used were: age, cause of pelvic pain, time of evolution, score on the pain scale before and after the application of ozone therapy, and evaluation of the treatment. Results: Patients aged 26-35 years prevailed. 57,4 percent had between two and four years of pain evolution. Chronic pelvic inflammatory disease was the most frequent cause with 42,5 percent. Before the application of ozone therapy, the mean score on the pain scale was 6.31, and it decreased to 3 after treatment, with an evaluation of good in 81,1percent of the cases. Conclusions: After the application of ozone therapy associated with conventional medical treatment, there is evident clinical improvement, which is why it constitutes an alternative of treatment(AU)

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy / 器官移植

Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

Estrés y congestionamiento vial en universitarios costarricenses / Stress and Traffic Congestion in Costa Rican University Students

Introducción: Según el estado de la nación 2018, Costa Rica es el tercer país latinoamericano con mayor densidad vehicular; es solo superado por Argentina y México. Objetivo: Identificar los factores asociados al nivel de estrés por el congestionamiento en el traslado a la universidad en los estudiantes y los factores asociados a la presencia o ausencia de estrés por el congestionamiento en el traslado a la universidad. Métodos: Estudio observacional, analítico de corte transversal, donde participaron 420 estudiantes, quienes completaron las encuestas correspondientes, para evaluar el nivel de estrés que genera el congestionamiento vial en dicha población. Las variables asociadas a la presencia o ausencia de estrés fueron edad, rendimiento, traslado de casa a la universidad por la mañana, de casa a la universidad por la tarde, de casa a la universidad por la noche, carro, taxi, tren, bus y moto. Las asociadas al nivel fueron: sexo, cantón de residencia, la forma de traslado en carro, moto y tiempo de traslado. Resultados: Los estudiantes utilizaban como principal medio de transporte el bus. El rendimiento académico reportado por el 83 por ciento de la muestra estaba en el valor de 7. El 90 por ciento de los encuestados dijo presentar estrés asociado al congestionamiento vial. La presencia de estrés no estaba asociada al tiempo de traslado, el nivel de estrés sí lo estaba. Conclusión: El rendimiento académico está asociado a la presencia de estrés, no al nivel, o sea, que su existencia podría estar afectando la situación académica del estudiante(AU)

Introduction: According to the state of the nation 2018, Costa Rica is the third Latin American country with the highest traffic density; it is only surpassed by Argentina and Mexico. Objective: To identify the factors associated with level of stress in students due to congestion during their transit to the university and the factors associated with the presence or absence of stress due to the congestion in the transit to the university. Methods: An observational, analytical and cross-sectional study was carried put, with the participation of 420 students, who completed the corresponding surveys, which allowed assessing the level of stress generated by road congestion in the study population. The variables associated with the presence or absence of stress were age, academic performance, travel from home to university in the morning, from home to university in the afternoon, from home to university at night, car, taxi, train, bus and motorcycle. The variables associated with the level of stress were sex, canton of residence, the way of transportation by car, motorcycle, and travel time. Results: The students used the bus as their main means of transportation. The academic performance reported by 83 percent of the sample was in the value of 7. 90 percent of the respondents expressed that they present stress associated with road congestion. The presence of stress was not associated with travel time; the stress level was. Conclusion: Academic performance is associated with the presence of stress, not with the level of stress; that is, its existence could be affecting the student's academic situation(AU)

Congestión y su diagnóstico en la insuficiencia cardíaca crónica descompensada

La congestión en pacientes con insuficiencia cardíaca (IC) crónica descompensada no sólo refleja fracaso del músculo cardíaco, siendo sus mecanismos fisiopatológicos heterogéneos. Las presiones de llenado del ventrículo izquierdo elevadas favorecen la progresión de la IC y la muerte celular. La congestión es uno de los principales factores de predicción de la mala evolución del paciente en pacientes con IC; sin embargo, ella es difícil de evaluar, especialmente cuando los síntomas son leves. Aunque se dispone de numerosos puntajes clínicos, herramientas de diagnóstico por imágenes y pruebas biológicas para ayudar a los médicos a determinar y cuantificar la congestión, no todos son apropiados para su uso en todas las etapas del tratamiento del paciente, existiendo grandes dificultades en el diagnóstico de patrones congestivos. Parte de este fracaso se explica no sólo por lo tardío de la presentación clínica, sino por la frecuente disociación entre examen clínico y perfiles hemodinámicos. Conocer e intervenir precozmente patrones de congestión hemodinámica (etapa preclínica) tiene efectos favorables en la calidad de vida y supervivencia. En los últimos años, la evaluación multimétodo se ha convertido en una herramienta muy importante para prevenir las hospitalizaciones por IC. Las intervenciones terapéuticas destinadas a descender la presión capilar pulmonar elevada cambian el pronóstico de esta población, con un impacto mayor que la mejoría del IC. Los avances tecnológicos permitirán detectar variaciones hemodinámicas tempranas. Nuestro mayor desafío es implementar nuevas estrategias de manejo basadas en las recientes tecnologías.

Congestion in patients with decompensated chronic heart failure (HF) not only reflects heart muscle failure, but its pathophysiological mechanisms are heterogeneous. High filling pressures promote HF progression and cell death. Congestion is one of the main predictors of poor patient outcome in patients with HF; however, it is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biomarkers tests are available to help clinicians determine and quantify congestion, not all are appropriate for use at all stages of patient treatment, and there are great difficulties in diagnosis. congestive patterns. Part of this failure is explained not only by the lateness of the clinical presentation, but also by the frequent dissociation between the clinical examination and hemodynamic profiles. Knowing and intervening early hemodynamic congestion patterns (preclinical stage) has favorable effects on quality of life and survival. In recent years, multi-method evaluation has become a very important tool to prevent hospitalizations for HF. Therapeutic interventions aimed at lowering elevated pulmonary capillary pressure change the prognosis of this population, with a greater impact than the improvement in HF. Technological advances will make it possible to detect early hemodynamic variations. Our greatest challenge is to implement new management strategies based on recent technologies.

A congestão em pacientes com insuficiência cardíaca (IC) crônica descompensada não reflete apenas a falha do músculo cardíaco, mas seus mecanismos fisiopatológicos são heterogêneos. Altas pressões de enchimento promovem a progressão da IC e morte celular. A congestão é um dos principais preditores de desfecho desfavorável do paciente em pacientes com IC; no entanto, é difícil avaliar, especialmente quando os sintomas são leves. Embora vários escores clínicos, ferramentas de imagem e testes biológicos estejam disponíveis para ajudar os médicos a determinar e quantificar a congestão, nem todos são apropriados para uso em todas as fases do tratamento do paciente, com grandes dificuldades no diagnóstico. padrões congestivos. Parte dessa falha é explicada não apenas pelo atraso do quadro clínico, mas também pela frequente dissociação entre o exame clínico e o perfil hemodinâmico. Conhecer e intervir nos padrões de congestão hemodinâmica precoce (estágio pré-clínico) tem efeitos favoráveis na qualidade de vida e sobrevida. Nos últimos anos, a avaliação multi-método tornou-se uma ferramenta muito importante para prevenir hospitalizações por IC. As intervenções terapêuticas com o objetivo de diminuir a elevação da pressão capilar pulmonar alteram o prognóstico dessa população, com impacto maior do que a melhora da IC. Os avanços tecnológicos permitirão detectar precocemente as variações hemodinâmicas. Nosso maior desafio é implementar novas estratégias de gestão baseadas em tecnologias recentes

Diagnostic and Prognostic Role of Liver Elastography in Heart Failure

Abstract Background: Hepatic congestion is a frequent finding in patients with heart failure (HF). Physical examination has limitations in quantifying systemic congestion and requires correlation with echocardiographic and laboratory data (usually B-type natriuretic peptide, BNP, or N-terminal pro-B type natriuretic peptide, NT-proBNP). Hepatic elastography evaluates liver stiffness using a transducer that transmits low-frequency vibrations (50 Hz), and the speed of shear waves propagating through the tissues is measured by ultrasound. The faster the vibrations propagate in the hepatic parenchyma, the stiffer the liver, which, in case of HF, can be correlated with hepatic congestion. Objective: In this systematic review, case-controls, cohort studies, and randomized clinical trials were searched in MEDLINE, LILACS and Cochrane Database of Systematic Review, to evaluate the use of elastography in the detection of hepatic congestion in patients with HF. Methods: From the 49 articles retrieved, seven were selected for review, according to the inclusion and exclusion criteria. The most used methods for the diagnosis and evaluation of HF were echocardiography combined with BNP and NT-proBNP measurements. Results: Elastography performed at bedside was able to establish a significant correlation between increased liver stiffness and increased venous capillary pressure. In addition, liver elastography performed at hospital discharge was able to predict rehospitalization and mortality. Conclusion: Liver elastography is a non-invasive method that can be useful in predicting prognosis and mortality of individuals with HF, contributing to the clinical management of these patients.

A review of role of lung ultrasound and clinical congestion score in acute left ventricular failure

Congestive cardiac failure (CCF) is a worldwide phenomenon and affects millions of people years and is accompanied with high mortality. The present review is undertaken to evaluate the usefulness of Lung Ultrasound Scan in diagnosis and to identify its role as a marker of clinical outcome in patients with Acute LVF. A review of literature was done to find the role of lung ultrasound and clinical congestion score in acute left ventricular failure from search engines such as PubMed, google scholar. Major exclusion criteria were the studies that included patients with Right Ventricular Failure, renal insufficiency, other respiratory causes of breathlessness like pneumonia, pulmonary embolism, pneumothorax and pleural effusion. This review concluded that lung ultrasonography is as a rapid, non-invasive, bedside tool for the diagnosis and risk assessment of pulmonary congestion in Acute LVF.

Tratamento endovascular de síndrome congestiva venosa pélvica em paciente com duplicação de veia cava inferior e anatomia venosa pélvica incomum: revisão bibliográfica / Endovascular treatment of pelvic venous congestion syndrome in a patient with duplication of the inferior vena cava and unusual pelvic venous anatomy: literature review

Resumo A dor pélvica crônica afeta aproximadamente 1/3 de todas as mulheres e é responsável por cerca de 20% de todas as consultas ginecológicas. Os autores relatam um raro caso de congestão venosa pélvica sintomática na presença de duplicação de veia cava inferior e comunicação interilíaca através de veia hipogástrica direita tratado com abordagem endovascular, por embolização das veias varicosas pélvicas e revisão da literatura publicada.

Abstract Chronic pelvic pain affects approximately one-third of all women and is responsible for about 20% of all gynecological consultations. The authors report a rare case of symptomatic pelvic venous congestion in the presence of duplication of the inferior vena cava and inter-iliac communication through the right hypogastric vein that was treated via an endovascular approach with embolization of varicose pelvic veins. The published literature is reviewed.

To study the level of congestion in Pre anesthetic Check up (PAC) clinic and use of Self-answering Pre-operative questionnaire to decongest it

Background: Aim of the study was to reduce congestion in PAC clinic, which is the direct indicator of efficiency of the hospital. 1) To study overall waiting time in the PAC clinic. 2) To suggest action to improve the waiting time in PAC. Methods: Prospective, Descriptive study, 40 patients in each group. Group “R” = Patients registered for PAC clinic, who’s all vitals and clinical assessment was done after arrival to PAC clinic as routine practice. Group “Q” = Patients were provided Self-answering Pre-operative in waiting area and whose vital parameters were taken before arrival to PAC clinic by a trained staff. Data was recorded for both the groups. Results: We found in our study that average waiting time that is total time from registration to completion of PAC in OPD clinic was statistically significantly less in QT-1 (Group “Q”) in comparison to RT-1 (Group “R”). We found in our study that average Doctor – Patient time that is time of interaction with Doctor during PAC in OPD clinic was also statistically significantly less in QT-2 (Group “Q”) in comparison to RT-2 (Group “R”). Conclusion: Present study was planned to reduce congestion in OPD for pre-anesthesia checkup for elective surgery or procedure. Patient satisfaction comes automatically as a byproduct with the achievement of the goal of the study. Time is money in the present scenario and thus best utilization of time with efficient outcome is the prerequisite of any good management.

A Successful Case of Bridge-to-Surgery Therapy with IMPELLA 5.0® for Acute Mitral Regurgitation / 日本心臓血管外科学会雑誌

A 76-year-old man with a complaint of dyspnea was diagnosed with acute severe mitral regurgitation due to ruptured chordae tendineae. For improvement of pulmonary congestion, we introduced IMPELLA 5.0® and extra-corporeal membrane oxygenation before valve surgery. After two-days' IMPELLA 5.0® support, mitral valve replacement surgery with a bioprosthetic valve was performed and IMPELLA 5.0® was withdrawn. We report a successful case of a bridge to surgery using IMPELLA 5.0® with mitral valve regurgitation accompanied by acute left heart failure with severe respiratory failure.

Tratamento endovascular da síndrome de quebra-nozes: relato de caso / Endovascular treatment of Nutcracker syndrome: case report

A dor pélvica crônica é uma doença debilitante, com impacto na qualidade de vida e custos para os serviços de saúde. A síndrome de quebra-nozes é uma importante causa dessa dor, e se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta. Seu tratamento ainda permanece controverso e varia de acordo com a gravidade clínica do paciente. Contudo, a técnica endovascular com implante de stent em veia renal tem obtido excelentes resultados. Relatamos um caso de uma paciente de 59 anos submetida a correção endovascular com stent autoexpansível de nitinol. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento dessa paciente. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias. Pôde-se observar alívio dos sintomas e melhora nos exames de imagem realizados no acompanhamento de curto prazo

Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Nutcracker Syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta. Treatment remains controversial and varies depending on the patient's clinical severity. However, endovascular treatment with renal vein stenting has achieved excellent results. We report the case of a 59 year-old female treated by endovascular repair with a self-expanding nitinol stent. Clinical data, details of the procedure, and follow-up results are presented. Technical success was achieved and there patient reported no postoperative complications. Short-term, there was relief from symptoms and follow-up imaging tests showed improvement

Pulmonary Ultrasound in Patients with Heart Failure - Systematic Review / Ultrassom Pulmonar em Pacientes com Insuficiência Cardíaca - Revisão Sistemática

Abstract Pulmonary congestion is an important clinical finding in patients with heart failure (HF). Physical examination and chest X-ray have limited accuracy in detecting congestion. Pulmonary ultrasound (PU) has been incorporated into clinical practice in the evaluation of pulmonary congestion. This paper aimed to perform a systematic review of the use of PU in patients with HF, in different scenarios. A search was performed in the MEDLINE and LILACS databases in February 2017 involving articles published between 2006 and 2016. We found 26 articles in the present review, 11 of which in the emergency setting and 7 in the outpatient setting, with diagnostic and prognosis defined value and poorly studied therapeutic value. PU increased accuracy by 90% as compared to physical examination and chest X-ray for the diagnosis of congestion, being more sensitive and precocious. The skill of the PU performer did not interfere with diagnostic accuracy. The presence of B-lines ≥ 15 correlated with high BNP values (≥ 500) and E/e' ratio ≥ 15, with prognostic impact in IC patients at hospital discharge and those followed up on an outpatient basis. In conclusion, when assessing pulmonary congestion in HF, PU has an incremental value in the diagnostic and prognostic approach in all scenarios studied.

Resumo A congestão pulmonar é um achado clínico importante em paciente com insuficiência cardíaca (IC). Exame físico e radiografia do tórax têm acurácia limitada na detecção da congestão. A ultrassonografia pulmonar (UP) vem sendo incorporada à prática clínica na avaliação da congestão pulmonar. Este artigo teve como objetivo realizar revisão sistemática sobre a utilização da UP em pacientes com IC, nos diferentes cenários. Foi realizada uma pesquisa nas bases de dados MEDLINE e LILACS no mês de fevereiro de 2017 envolvendo artigos publicados entre 2006 e 2016. Foram encontrados 26 artigos na presente revisão, 11 deles no cenário da emergência e 7 em cenário ambulatorial, com valor diagnóstico e prognóstico definido e valor terapêutico pouco estudado. A UP aumentou a acurácia em 90% em relação ao exame físico e à radiografia do tórax para o diagnóstico da congestão, sendo mais sensível e precoce. A qualificação do executor da UP não interferiu na acurácia diagnóstica. O achado de linhas B ≥ 15 teve correlação com BNP elevado (≥ 500) e relação E/e' ≥ 15, com impacto prognóstico em pacientes com IC ambulatoriais e na alta hospitalar. Conclui-se que, na avaliação da congestão pulmonar na IC, a UP tem valor incremental na abordagem diagnóstica e prognóstica em todos os cenários encontrados.

Tratamiento congestivo: diuréticos, resistencia diurética y alternativas Papel de la ultrafiltración / Tratamento congestivo: diuréticos, resistência diurética e alternativas Papel da ultrafiltração / Congestive treatment: diuretic treatment, diuretic resistance and alternatives Ultrafiltration role

Los pacientes con insuficiencia cardíaca descompensada presentan un estado congestivo. La inmensa mayoría de las veces es debido a la activación de mecanismos neurohormonales que provocan la retención de sodio y agua a nivel renal. Esta activación y la congestión pueden devenir en la alteración de la función renal (síndrome cardio-renal). El tratamiento de la congestión se basa en el uso de diuréticos, pero la inmensa mayoría de estos pacientes presentan resistencia a los mismos, además de sufrir diferentes efectos secundarios por su uso, como las alteraciones hidroelectrolíticas. Terapias como la ultrafiltración o la diálisis peritoneal se han valorado en el tratamiento de la insuficiencia cardíaca congestiva. Nuestro objetivo es hacer una aproximación al lector de las alternativas al tratamiento diurético en el paciente congestivo, centrándonos, prioritariamente, en la ultrafiltración.

Patients with decompensated heart failure have a congestive state. Volume overloaded state is due to neurohormonal mechanisms activation that cause the retention of sodium and water by the kidney. This activation and congestion can lead to impaired renal function (cardio-renal syndrome). Congestive treatment is based on use of diuretics but the vast majority of these patients have diuretic resistance, as well as suffering from different side effects due to their use such as hydroelectrolytic alterations. Therapies such ultrafiltration or peritoneal dialysis have been evaluated in the treatment of congestive heart failure. Our objective is to make an approximation of other therapeutic strategies specially on ultrafiltration to resolve congestive state.

Pacientes com insuficiência cardíaca descompensada apresentam um estado congestivo. A grande maioria é devido à ativação de mecanismos neuro-hormonais que causam a retenção de sódio e água nos rins. Essa ativação e congestão podem resultar em comprometimento da função renal (síndrome cardio-renal). O tratamento da congestão baseia-se no uso de diuréticos, mas a grande maioria destes pacientes têm a mesma resistência, e sofrem de diversos efeitos colaterais por utilização, como perturbações electrolíticas. Terapias como ultrafiltração ou diálise peritoneal foram avaliadas no tratamento da insuficiência cardíaca congestiva. Nosso objetivo é aproximar o leitor das alternativas ao tratamento diurético no paciente congestivo, enfocando, principalmente, a ultrafiltração.

Hyperthermia associated with biliary obstruction during living donor liver transplantation / 대한마취과학회지

Intraoperative hypothermia occurs frequently, but hyperthermia is relatively rare during general anesthesia. We experienced a case of hyperthermia during living donor liver transplantation that appeared to be significantly associated with biliary obstruction. A 65-year-old male patient was diagnosed with intrahepatic cholangiocarcinoma, and living donor liver transplantation was planned after confirmation of no metastasis via intraoperative frozen biopsy. Following resection of a segment of common bile duct for frozen biopsy, the surgeon clamped the common bile duct, and the patient's body temperature increased gradually to 39.5°C. As the congested bile was drained, the body temperature decreased to the normal range. This case report suggests that when a patient develops unexplained hyperthermia during hepatobiliary surgery or in a chance of biliary obstruction, clinicians should consider bile congestion as a possible reason for hyperthermia.

Research progress of venous congestion after deep inferior epigastric perforator flap breast reconstruction / 中华整形外科杂志

Breast reconstruction with deep inferior epigastric perforator flap (DIEP flap) is an optimal technique for massive tissue defect after breast cancer surgeries. Venous congestion is one of the main complications and the probable reasons include thrombus, lack of ramus communicans across the midline or between deep and superficial system, improper choice of anastomotic vein, et al. Clinical examination is the main method, and other auxiliary tests can also be used. Preoperative vascular evaluation is of great importance. The venous superdrainage is current preventive measure for congestion.