Use of Embolectomy With Local Anesthesia for Anticoagulation Failure in Radial Artery Thrombosis.

OBJECTIVE: Although prevention of radial artery thrombosis and cardiac complications after interventions using radial access is well investigated, there is yet no clinical study that completely evaluated access-related complications. However, there is still no consensus on what exact treatment should be used in these patients. In clinical practice, analgesic, anticoagulant, and antiplatelet treatments usually improve symptoms in patients with pain; however, in some patients, complaints may persist and may not respond to these treatments. In these patients, low-risk embolectomy with a small skin incision may be beneficial. METHODS: A total of 102 patients with radial artery thrombosis after cardiac catheterization were included in the study between 2016 March and 2018 December. After the patients' initial evaluation, anticoagulation with enoxaparin or tinzaparin and antiplatelet therapy with acetylsalicylic acid and oral/local analgesic/anti-inflammatory and local anesthetic therapy were administered for 1 month. Patients whose symptoms resolved after medical treatment were followed up as outpatients. Embolectomy was performed in consenting patients who did not respond to the medical treatment. RESULTS: Of 102 patients included in the study, 33 underwent embolectomy, whereas 69 received only medical treatment. None of the patients experienced any complications, morbidity, or mortality in the peroperative period and during the medical treatment. The pretreatment symptom scores of patients who actively use their hands in daily life and profession were significantly higher than the scores of patients who are relatively less active (P = .013). Pretreatment symptom scores were negatively correlated with age (r = -0.584); symptom scores increased significantly with the decrease of patient age. No benefit from medical treatment and need for surgery was significantly greater in patients who are younger and use their hands actively in daily life and profession (P = .028). The decrease in symptom scores after treatment was significantly greater in the surgical group than in the medical group (P = .003). CONCLUSION: Radial access should be exercised with care in patients who may develop significant thrombosis-related complaints and it is necessary to decide whether radial access is essential. If patients have ongoing symptoms despite medical treatment, embolectomy can be considered as a treatment option.

Left atrial leiomyosarcoma extending into the posterior mediastinum and mimicking a left atrial myxoma.

BACKGROUND: Intracardiac malignancies are extremely rare and hard to detect or differentiate preoperatively. CASE REPORT: We present a 48-year-old female patient who was diagnosed primarily with left atrial myxoma and taken into emergency surgery. The tumor extended into the pulmonary veins and infiltrated the atrial endocardium, and the histopathologic diagnosis was leiomyosarcoma. The left atrial endocardium was successfully peeled off with the tumor and complete resection was achieved. CONCLUSION: The possible malignant nature of intracardiac masses should be kept in mind, especially in middle-aged patients. The extent of the tumor must be determined in elective cases to establish the proper strategy for complete resection, which is the only chance of successful treatment for this lethal disease entity. Endocardial peeling is warranted for successful removal of the tumor mass in leiomyosarcoma.

Bilateral spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema: rare and fatal complications of asthma.

Simultaneous bilateral spontaneous pneumothorax (SBSP) and pneumomediastinum are complications rarely observed synchronously during an acute asthma attack. It is a clinical condition that manifests itself with serious respiratory distress and must be rapidly diagnosed and treated. Although bilateral spontaneous pneumothorax has already been reported in asthma patients in the literature, its concurrence with subcutaneous emphysema and pneumomediastinum is extremely rare except for iatrogenic conditions. By sharing this case about a 39-year-old patient who presented to the emergency room with severe respiratory distress and developed cardiopulmonary arrest during his physical examination, our aim is to emphasize that a rapid diagnosis and treatment by the emergency physicians is the only way for survival in these patients.