ABSTRACT
OBJECTIVES: To reduce the spread of the infection, especially during aerosol generating procedures, we invented "The Cupola", a shield that creates a mechanical barrier around the patient's head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region. RESULTS: The mean number of 0.3 µm particles with no Cupola was 3777 (SD: ± 556), with The Cupola was 2068 (SD: ± 1468) and with the Cupola and Drape was 2031 (SD: ± 1108) (p < 0.015). The mean number of 0.5 µm airborne particles with no Cupola was 65 (SD: ± 7), with The Cupola was 29 (SD: ± 28) and with the Cupola and Drape was 28 (SD: ± 23) (p < 0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.
Subject(s)
COVID-19/prevention & control , Dental Care , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Respiratory Protective Devices , Aerosols , COVID-19/transmission , Health Personnel , Humans , Pilot ProjectsSubject(s)
Career Choice , Cultural Diversity , Education, Medical, Graduate , Internship and Residency , Surgeons/statistics & numerical data , Vascular Surgical Procedures/education , Education, Medical, Graduate/statistics & numerical data , Female , Humans , Internship and Residency/statistics & numerical data , Male , Physicians, Women/statistics & numerical data , Racial Groups , Sex Factors , United States , Vascular Surgical Procedures/statistics & numerical dataABSTRACT
BACKGROUND: Renal toxicity from conventional, iodinated, intravenous contrast agents is a common complication in patients with peripheral artery disease (PAD). Similarly, the potential for serious side effects prevents the use of gadolinium-based agents in many patients with depressed renal function. Ferumoxytol-enhanced magnetic resonance angiography (Fe-MRA) is a novel technique that uses an intravenous, ultrasmall, superparamagnetic, iron oxide preparation, currently approved by the Food and Drug Administration for the treatment of iron deficiency anemia in adults with chronic kidney disease. Our objective was to determine the feasibility of Fe-MRA for clinical decision making in PAD patients. METHODS: This was a prospective pilot study assessing 10 patients with suspected arterial occlusive disease with contrast-enhanced MRA of the aorta and lower extremities. Of those, 5 had renal insufficiency and were imaged with Fe-MRA, whereas the remainder underwent gadolinium-enhanced MRA. Qualitative and quantitative evaluations of deidentified images at each arterial station were independently performed by 4 blinded vascular surgeons. RESULTS: All patients were men, with an average age of 68 ± 4 years. The 2 groups had similar incidences of diabetes, hypertension, hyperlipidemia, and coronary artery disease. Patients undergoing Fe-MRA had significantly decreased renal function (estimated glomerular filtration rate, 35.4 vs. 77.6; P = 0.02). There were no adverse events during contrast administration in either group. No difference was found in the overall quality of the ferumoxytol versus the gadolinium studies (7.1 ± 2.0 vs. 7.4 ± 2.4, P = 0.67). Similarly, reviewers felt comfortable basing clinical decisions on the images 89% of the time with both the ferumoxytol and gadolinium groups (P = 1.00). CONCLUSIONS: This is the first report of an important alternative to conventional computed tomography angiography and MRA in PAD patients, particularly in the setting of renal insufficiency. Fe-MRA provides a useful tool in patients with suspected lower extremity PAD without the potential risks of gadolinium.
Subject(s)
Contrast Media , Ferrosoferric Oxide , Gadolinium DTPA , Lower Extremity/blood supply , Magnetic Resonance Angiography/methods , Peripheral Arterial Disease/diagnosis , Aged , Contrast Media/adverse effects , Feasibility Studies , Gadolinium DTPA/adverse effects , Glomerular Filtration Rate , Humans , Kidney/physiopathology , Male , Middle Aged , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/pathology , Pilot Projects , Predictive Value of Tests , Prospective Studies , Renal Insufficiency/complications , Renal Insufficiency/diagnosis , Renal Insufficiency/physiopathology , Risk Factors , San FranciscoABSTRACT
Despite its initial description more than 20 years ago, combined orthotopic heart and liver transplantation is still performed infrequently. We report a 53-year-old man with familial hypertrophic restrictive cardiomyopathy who presented with right heart failure and end-stage liver failure and required combined orthotopic heart and liver transplantation. Rather then using a staged approach, the surgery was performed using a technique of simultaneous implantation supported by cardiopulmonary bypass. The relative merits of using a simultaneous approach are discussed. The patient had an uneventful postoperative course and went home on postoperative day 14.
Subject(s)
Cardiopulmonary Bypass , Heart Failure/surgery , Heart Transplantation/methods , Liver Failure/surgery , Liver Transplantation/methods , Follow-Up Studies , Graft Survival , Heart Failure/diagnosis , Humans , Liver Failure/diagnosis , Male , Middle Aged , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Stingray envenomations usually result in minor injuries with localized symptoms. In some cases the injury incurred is more serious, resulting in significant morbidity if not adequately treated. We report a case of pseudoaneurysm of the superficial femoral artery resulting from a stingray envenomation in a young female. Stingray venom is known to have necrosing properties in human tissues and in this case this led to graft failure requiring surgical repair. This case emphasizes the insidious nature of stingray venom and the necessity of extensive surgical debridement for more significant envenomations.
