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Objective:To summarize the treatment process of rapid decrease in blood flow due to centrifugal pump dysfunction during extracorporeal membrane oxygenation (ECMO) and its related thinking.Methods:On September 25, 2021, the ECMO treatment of a 14-year-old boy with severe mycoplasma pneumonia, severe viral pneumonia and acute respiratory distress syndrome (ARDS) admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College was analyzed.Results:Oxygenation of the child was difficult to maintain under invasive mechanical ventilation, and lung consolidation progressed seriously. After evaluation, venous-venous ECMO (VV-ECMO) was implemented, then oxygenation was improved. In the 120th hour after VV-ECMO establishment, the blood flow sudden decreased, the speed was 3 822 r/min, while the flow was only 0.2 L/min, more over there was no change in the flow when the speed was increased. Before that, the ECMO speed was 3 530 r/min, and the flow was up to 3.4 L/min and stable. After rapid screening, it was determined that the centrifugal pump was dysfunction. ECMO was successfully replaced and the flow was satisfactory.Conclusions:At present, most ECMO centers do not routinely monitor the pressure before and after the pump. There is a lack of visual and quantitative techniques or indicators to judge the pump's function, and there is also a lack of corresponding clinical experience in treatment. This paper summarizes the investigation and treatment process of ECMO pump dysfunction of this case to provide reference.
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We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture (LVFWR) after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography (TTE). She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP (intra-aortic balloon pumping) management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture (PMR) due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.
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Objective@# To evaluate the clinical effects of full-arch cement-retained implant-supported combined crowns and screw-retained implant-supported bridge dentures in complete or half edentulous patients. @*Methods @#A total of 25 patients with complete or partial edentulous dentures followed up for 1, 3, and 5 years in our hospital from June 2013 to June 2018 and were treated with Straumann bone horizontal implantation, cobalt-chromium stenting and cobalt-chromium porcelain restoration with cement-retained and screw-retained implant-supported fixed dental prostheses to evaluate the accumulative implant survival rate, accumulative prosthesis survival rate, mechanical complications, and biological complications in both groups. @*Results @#There were 25 complete or half edentulous patients who received 165 Straumann implants and 28 implant-supported fixed dental prostheses in this study. There were 11 cases with 69 implants in the cement group and 17 cases with 96 implants in the screw group. The accumulative implant survival rate was 100% in the cement group and 96.9% in the screw group. The accumulative prosthesis survival rate was 100% in both groups. The cumulative peri-implant mucositis rate was 23.2% in the cement group and 29.2% in the screw group, and the peri-implantitis rate was 6.8% in the cement group and 7.3% in the screw group. There was 1 case of porcelain collapse (n=1/11) and no screw of abutment loosening in the cement group and 4 cases of porcelain collapse (n=4/17) and 1 case of screw loosening in the screw group. No fracture of abutment was observed in either group. There was no difference in bone loss between the two groups in the first year (P > 0.05), and a higher rate of bone loss was found in the screw group in the third and fifth years (P < 0.05). There was no difference in the sulcus bleeding index(mSBI) between the two groups in the first year and the third year (P > 0.05) and a higher modified mSBI value in the cement group in the fifth year (P < 0.05).@*Conclusion @#The survival rates of the implant and prosthesis for cement-retained or screw-retained implant-supported fixed dental prostheses were both high, but there were more mechanical and biological complications in the traditional cobalt-chromium alloy screw-retainer group. The removal of residual adhesives must be reasonably considered when choosing the cement retention method.
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@#The crown-root ratio (C/R) theory of natural teeth has been widely recognized in the field of stomatology,and has important clinical significance in predicting and assessing the prognosis of natural teeth as well as for abutment selection during denture restoration. In the past few decades, scholars have advocated for the implantation of implants as long in length as possible to improve the success rate according to the theory of crown-root ratio of natural teeth. However, with the application of short implants, our philosophy of implantation has changed, and the relationship between the crown-implant (C/I) ratio and complications has become one of the current research hotspots. In this paper, the concept of the crown-implant ratio, the research progress of the C/I ratio, the implant survival rate and clinical complications of implant restoration were reviewed and summarized, and the following suggestions were put forward: although most studies have shown no significant correlation between the C/I ratio and implant survival or marginal bone loss, this relationship may increase the risk of mechanical complications. A C/I < 3 and a crown length < 15 mm are recommended in implant restoration; when ultra-short implants are applied, the implant system can increase the bone-to-implant contact area, and splint prostheses such as crown or bridge are recommended.
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Background:@#Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI). However, no valid risk score model was found to predict CR after AMI in previous researches. This study aimed to establish a simple model to assess risk of CR after AMI, which could be easily used in a clinical environment.@*Methods:@#This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1, 2010 to December 31, 2017. The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio. Risk factors for CR were identified using univariate analysis and multivariate logistic regression. Risk score model was developed based on multiple regression coefficients. Performance of risk model was evaluated using receiveroperating characteristic (ROC) curves and internal validity was explored using bootstrap analysis.@*Results:@#Among all 7985 AMI patients, 53 (0.67%) had CR (free wall rupture, n=39; ventricular septal rupture, n=14). Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P < 0.001). Independent variables associated with CR included: older age, female gender, higher heart rate at admission, body mass index (BMI) <25 kg/m2, lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment. In ROC analysis, our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC]= 0.895, 95% confidence interval: 0.845–0.944, optimism-corrected AUC= 0.821, P < 0.001).@*Conclusion:@#This study developed a novel risk score model to help predict CR after AMI, which had high accuracy and was very simple to use.
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RESUMEN Introducción: La cateterización percutánea por punción de una vena de gran calibre y flujo sanguíneo conocido como catéter venoso central ―CVC― es un procedimiento que no deja de ser invasivo, por lo tanto no está exento de potenciales complicaciones que pueden generar un riesgo para la vida de los pacientes como lo es el neumotórax iatrogénico secundario. Objetivo: Establecer la incidencia de neumotórax secundario iatrogénico como complicación inmediata post inserción de catéter venoso central. Materiales y métodos: Se trata de un estudio prospectivo-descriptivo y observacional de las historias clínicas de los pacientes entre 15 y 60 años de edad, de ambos sexos, que ingresaron a los diferentes servicios de hospitalización del hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales ―IVSS― (Maracaibo, Venezuela), durante el período comprendido entre enero de 2016 y junio de 2017; los cuales ameritaron inserción de un catéter percutáneo para el abordaje venoso central como indicación para manejo terapéutico o de constantes fisiológicas. Resultados: Se incluyeron 140 pacientes, en el 15,6 % (22) se identificó la presencia de neumotórax secundario en los controles radiológicos post procedimiento cuando el abordaje era la vena subclavia. Conclusiones: Se debe tener en cuenta que el neumotórax secundario representa la complicación mecánica más común en la cateterización venosa central, la cual puede poner en riesgo la integridad del paciente. Este conocimiento es fundamental para detectar esa complicación por el médico operador y poder darle la solución más acorde y adecuada para evitar las complicaciones y lograr así una medicina de mejor calidad.
ABSTRACT Introduction: Percutaneous catheterization by puncture of a large caliber vein and blood flow known as the central venous catheter (CVC), is a non-invasive procedure and, therefore, it is not free of potential complications that may generate a risk for the life of patients, as it is the secondary iatrogenic pneumothorax. Objective: To establish the incidence of secondary iatrogenic pneumothorax as an immediate complication secondary to the insertion of a CVC. Materials and methods: This is a prospective, descriptive, observational study of the medical records of patients between 15-60 years of age of both sexes, who were admitted in the different hospitalization services at Dr. Adolfo Pons Hospital from the Social Insurance Institute of Venezuela ―IVSS for its acronym in Spanish― (Maracaibo, Venezuela) during the period between January 2016 and June 2017, patients who required the insertion of a percutaneous catheter for the central venous approach, as an indication for therapeutic management or physiological constants. Results: A total of 140 patients were included; in 15.6% (22) the presence of secondary pneumothorax was identified in radiological controls when the subclavian vein was approached. Conclusions: It should be considered that secondary pneumothorax represents the most common mechanical complication in central venous catheterization that can put the integrity of the patient at risk. This knowledge is essential to detect this complication by the attending physician and can give the most adequate and appropriate solution to avoid complications and thus achieve better quality medicine.
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La rotura subaguda de la pared libre del ventrículo izquierdo es una complicación rara del infarto de miocardio, cuya incidencia se encuentra disminuida considerablemente en los últimos años, debido a las terapias de reperfusión. Presentamos el caso de un paciente de sexo masculino de 65 años de edad que ingresó a nuestro hospital, derivado de otro centro médico, con diagnóstico presuntivo de taponamiento cardíaco en el curso de un infarto ínfero-pósterolateral sin tratamiento de reperfusión. Se discute la presentación clínica, los factores de riesgo, los métodos de diagnóstico y la conducta quirúrgica.
Subacute rupture of the free wall of the left ventricle is an infrequent complication of myocardial infarction; the incidence is considerably diminished in the last few years due to reperfusion therapies. We report the case of a male patient aged 65 years was admitted to our hospital, derived from another medical center, with presumptive diagnosis of cardiac tamponade in the course of an infero-posterolateral infarction without reperfusion therapy. Clinical presentation, risk factors, methods of diagnosis and surgical management are discussed.
A ruptura subaguda da parede livre do ventrículo esquerdo é uma complicação rara do infarto do miocárdio, a incidência é diminuída consideravelmente nos últimos anos devido às terapias de reperfusão. Nós relatamos o caso de um paciente do sexo masculino com 65 anos internado em nosso hospital, derivado de outro centro médico, com diagnóstico presuntivo de tamponamento cardíaco no curso de um infarto ínfero-póstero-lateral sem terapia de reperfusão. Discutimos a apresentação clínica, os fatores de risco, os métodos de diagnóstico e o tratamento cirúrgico.
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En los pacientes con síndrome coronario agudo, dos terceras partes de los casos fallece sin alcanzar a recibir atención hospitalaria (principalmente en las primeras dos horas) debido a la muerte súbita. Del tercio restante, el 50% lo hará en las 24 horas siguientes a su ingreso hospitalario, principalmente debido a las complicaciones mecánicas del infarto. Actualmente, la identificación y estratificación inmediata del paciente con síndrome coronario agudo, el papel de las unidades coronarias y la reperfusión temprana (farmacológica o mecánica) en los casos indicados, han demostrado disminuir la morbimortalidad por cardiopatía isquémica. Dentro de las complicaciones mecánicas del infarto, la ruptura de pared libre ventricular se presenta en el 5-10% de los pacientes hospitalizados que fallecen por infarto agudo del miocardio con elevación del segmento ST. Se presenta un caso clínico con estas características.
In patients with acute coronary ischemic syndrome, two-thirds of cases die without reaching hospital care (mainly in the first two hours) due to sudden death. Of the remaining third, 50% will do so within 24 hours of hospital admission, mainly due to mechanical complications of infarction. Currently, the identification and early stratification, the role of coronary care units and early reperfusion (pharmacologic or mechanical) where indicated, have been shown to decrease morbidity and mortality from ischemic heart disease. Within the mechanical complications of infarction, ventricular free wall rupture occurs in 5-10% of hospitalized patients dying of acute myocardial infarction with ST segment elevation. We report a case with these features.
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Antecedentes: la diabetes mellitus, además de ser un factor de riesgo para el infarto agudo del miocardio, parece conferir per se un peor pronóstico en los pacientes con esta entidad. Objetivo: evaluar el comportamiento del infarto agudo del miocardio en personas con diabetes mellitus de la provincia de Granma. Métodos: se realizó un estudio transversal y descriptivo con 159 pacientes que ingresaron en la Unidad de Cuidados Intensivos Coronarios del Hospital Carlos Manuel de Céspedes, de Bayamo, Granma, con diagnóstico de infarto agudo del miocardio, en el período comprendido entre enero de 2010 y junio de 2011. De ellos, 39 con diabetes mellitus y 120 sin ella. De las historias clínicas se extrajeron los datos de las variables demográficas, clínicas y metabólicas estudiadas. Resultados: en los casos con diabetes mellitus el porcentaje de infartos extensos y sin dolor precordial fue superior a los no diabéticos, sin llegar a ser estadísticamente significativo (p= 0,3283 y p= 0,1066). Los pacientes diabéticos presentaron 2,8 veces más posibilidad de sufrir una complicación eléctrica que aquellos sin diabetes mellitus (p= 0,0121). No hubo relación significativa entre las complicaciones mecánicas del infarto agudo del miocardio y la presencia de diabetes mellitus (p= 0,4104). El número de defunciones fue significativamente mayor en los casos con diabetes mellitus, que en los no diabéticos (p= 0,0124). Los niveles de glucemia al ingreso estuvieron significativamente más elevados en los casos complicados y fallecidos, tanto en los diabéticos como en los no diabéticos. Conclusiones: el infarto agudo del miocardio, en los pacientes diabéticos de nuestro medio, con frecuencia se presenta sin dolor precordial, extenso, con complicaciones eléctricas y asociado con una elevada mortalidad. La hiperglucemia al ingreso está relacionada con un incremento de la morbilidad y la mortalidad del infarto agudo del miocardio(AU)
Background: diabetes mellitus is a risk factor for acute myocardial infarction and additionally, it seems to grant per se a prognosis of severity for the patients suffering this disease. Objective: to evaluate the situation of the acute myocardial infarct in people with diabetes mellitus living in Granma province. Methods: a cross-sectional descriptive study of 159 patients, who were admitted to the coronary intensive care unit of Carlos Manuel de Céspedes hospital in Bayamo, Granma and diagnosed with acute myocardial infarction in the period of January 2010 to June 2011. Out of these patients, 39 had diabetes mellitus and 120 were not affected by the disease. Demographic, clinical and metabolic data were taken from the medical histories. Results: the percentage of extensive infarction without precordial pain in diabetes mellitus cases was higher than in non-diabetics, but it was not statistically significant (p= 0.3283 and p= 0,1066 respectively). The diabetic patients were 2,8 times more likely to suffer electrical complications that those non-diabetics (p= 0.0121). No significant association between mechanical complications of the acute myocardial infarction and diabetes mellitus was found. The number of deaths was significantly higher in cases with diabetes mellitus than in non-diabetic cases (p= 0.0214). The glycemic levels on admission were significantly higher in complicated and in dead cases, both diabetics and non-diabetics. Conclusions: the acute myocardial infarctions in the diabetic patients of our province are often extensive and occur without precordial pain, with electrical complications and associated with high mortality rates. Hyperglycemia on admission is related to increased mortality and morbidity from acute myocardial infarction(AU)
Subject(s)
Humans , Risk Factors , Diabetes Mellitus/epidemiology , Myocardial Infarction/diagnosis , Epidemiology, Descriptive , Cross-Sectional Studies , Glycemic Index/physiologyABSTRACT
Objetivo: identificar los principales factores de riesgo que influyen en el pronóstico, resultados, tipo y tasas de morbilidad y mortalidad de los pacientes con síndrome coronario agudo sometidos a cirugía de revascularización miocárdica. Material y métodos: se trató de un estudio retrospectivo de pacientes sometidos a cirugía por síndrome coronario agudo de enero de 2000 a diciembre de 2003. Se identificaron factores demográficos, indicación de cirugía, enfermedades intercurrentes, resultados de la intervención, morbilidad y mortalidad, y se compararon con escalas internacionales. Resultados: fueron 73 varones y 23 mujeres, la edad osciló entre 46 y 88 años. Predominó la angina inestable (42.7 %). Dos pacientes fueron operados por angioplastia coronaria percutánea fallida y 28 por complicaciones mecánicas del infarto del miocardio. La cirugía fue realizada como urgencia en 90.6 %. La mayoría de los pacientes estuvieron en clasificación Killip-Kimball y Forrester I y II. Los factores de riesgo detectados fueron falla del ventrículo izquierdo, complicaciones mecánicas, cirugía de emergencia, diabetes y falla respiratoria o renal. La mortalidad perioperatoria fue de 14.5 % y la morbilidad de 41.6 %, que comparadas con la clasificación de riesgo de nuestros pacientes fueron más bajas que las esperadas, según las escalas de Parsonnet y Tuman. Conclusiones: aunque el mayor número de factores de riesgo y valores más altos en las escalas de riesgo empeoran en forma importante el pronóstico, en nuestro centro los resultados obtenidos con el tratamiento quirúrgico en síndrome coronario agudo muestran resultados favorables.
BACKGROUND: The objective of this work was to determine the main risk factors that influence prognosis, results, morbidity and mortality rates and causes in patients with acute coronary syndrome requiring surgical myocardial revascularization. METHODS: This was a retrospective study including patients in our hospital with acute coronary syndrome requiring coronary artery bypass-graft surgery between January 2000 and December 2003. The following were identified and compared with international values: demographic factors, indications for surgery, intercurrent pathologies, results of the procedures, morbidity and mortality rates and causes. RESULTS: There were 73 males and 23 females with an age range of 46 to 88 years old. The main cause of surgery was unstable angina (42.7%). In two patients, surgery was indicated for percutaneous coronary angioplasty failure and in 28 patients due to mechanical complications of acute myocardial infarction. The procedure was urgent in 90.6%. The majority of patients were in Killip-Kimball or Forrester class I or II. Risk factors detected were left ventricular failure, mechanical complications, emergency surgery, diabetes and respiratory or renal failure. Perioperative mortality was 14.5% and morbidity was 41.6%, both compared with risk classification scales and were lower than expected according to Parsonet and Tuman evaluations. CONCLUSIONS: With a major number of risk factors and the high-risk associated with surgery, in our center surgical treatment for acute coronary syndromes showed favorable results.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Coronary Disease/surgery , Coronary Artery Bypass/statistics & numerical data , Acute Disease , Angina, Unstable , Comorbidity , Cross-Sectional Studies , Postoperative Complications/epidemiology , Coronary Disease/drug therapy , Emergencies , Hospital Mortality , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Myocardial Infarction/surgery , Heart Failure/classification , Heart Failure/epidemiology , Heart Failure/etiology , Mexico/epidemiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Syndrome , Treatment OutcomeABSTRACT
Los catéteres venosos centrales son un recurso terapéutico fundamental debido al advenimiento de unidades de pacientes críticos, donde se utilizan para control de variable hemodinámicas, administración de drogas y nutrición parenteral; a la masificación de la hemodiálisis, siendo una herramienta transitoria previo a la obtención de accesos definitivos y para pacientes oncológicos, con el objetivo de administración de quimioterapia. Sin embargo, el uso de catéteres venosos centrales no es inocuo. En la literatura se reportan diversas complicaciones. Dentro de éstas, las mecánicas son frecuentes, presentándose el 5-19 por ciento de los pacientes. Las complicaciones más prevalerte son la punción arterial, hemotórax y neumotórax. El objetivo de esta revisión es actualizar conceptos básicos relacionados a las complicaciones mecánicas asociadas a la instalación de catéteres venosos centrales y mostrar imágenes obtenidas en el servicio de imagenología de nuestro hospital, correspondientes a ocho pacientes que presentaron alguna de éstas.
Central venous catheters are important therapeutic resources nowadays, because of the development of critical care units, where these devices are aimed to monitorize hemodynamic parameters and to administrate drugs and parenteral nutrition to patients; massification of hemodyalisis, where central venous catheters are used as transitory accesses before the definitive ones are obtained and in the oncologycal setting, to administrate chemotherapeutic drugs to patients. Nevertheless, the use of such devices is not harmless. Several complications are reported in current literature. Mechanical complications are frequent and they are found in 5-19 percent of patients in whom central venous catheters are installed. According to their prevalence, the most important are arterial puncture, hemothorax and pneumothorax. This review is aimed to update basic concepts regarding to mechanical complications associated to the use of central venous catheters and to show radiological images from eight patients who presented to the imagenology department of our hospital with such complications.