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Septic Superficial Femoral Vein Thrombophlebitis Causing Pulmonary emboli and Respiratory Failure: Case Report and Review of the Literature

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International Journal of Clinical Medicine 2019年第8期10卷 413-420页

作者： Ziad Fayad Paul Guentert Erin Rissler Nuha Zackariya Shivani Patel Ali Sualeh Mahmoud Al-Fadhl Sufyan Zackariya Grant Wiarda Mallory Martin Joseph Lake Sarah Philbrick Mark Walsh General and Vascular Surgery X-Ray Consultants South Bend IN USA Saint Joseph Regional Medical Center Mishawaka IN USA St. Luc Family Hospital Tabarre Haiti Indiana University School of Medicine South Bend Campus South Bend IN USA

Septic pulmonary emboli rarely cause respiratory failure that requires mechanical ventilation. The most common causes of septic pulmonary emboli are related to intravenous drug abuse, indwelling intravenous catheters, endocarditis and septic pelvic thrombophlebitis. In addition, soft tissue injury-related thrombophlebitis rarely causes septic pulmonary emboli. We describe a unique case of a 43-year-old man who developed septic thrombophlebitis of the femoral vein following soft tissue injury from trauma to the shin with ensuing septic pulmonary emboli which necessitated endotracheal intubation and mechanical ventilation. The patient required mechanical ventilation for eleven days, developed empyema and grew out methicillin-resistant Staphylococcus aureus on blood cultures. A transesophageal echocardiogram was normal, and there was no indication of bacterial endocarditis. In addition to eleven days of mechanical ventilation, the patient was treated with intravenous heparin, cefepime and clindamycin. These medications were then discontinued and the patient was treated with weight-adjusted vancomycin. Following the return of cultures, the patient was treated for six weeks with ceftaroline 600 mg IV twice a day. In addition, the patient received bilateral thoracentesis followed by chest tube drainage until resolution of the pleural effusions. The patient made a complete recovery. We describe this case and the implications for differential diagnosis and treatment of these two uncommon conditions.

关键词： Septic Thrombophlebitis Pulmonary emboli Respiratory Failure Critical Care

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ABCD^(2) risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

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Stroke & Vascular Neurology 2017年第2期2卷 41-46页

作者： Mahmud Saedon Charles E Hutchinson Christopher H E Imray Donald R J Singer Warwick Medical School University of WarwickCoventryUK University Hospitals Coventry Warwickshire NHS Trust CoventryUK Fellowship of Postgraduate Medicine LondonUK Yale School of Medicine New HavenConnecticutUSA

Introduction:ABCD^(2) risk score and cerebral microemboli detected by transcranial Doppler(TCD)have been separately shown to the predict risk of recurrent acute stroke.We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methods:We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis(≥50% ).86 patients(age 70±1(SEM:years),58 men,83 Caucasian)had evidence of microemboli;72(84% )of these underwent carotid endarterectomy(CEA).120 patients(age 72±1 years,91 men,113 Caucasian)did not have microemboli detected;102(85% )of these underwent CEA.Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic(ROC)curves.Results:140/206(68% :95% CI 61.63 to 74.37)patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score≥4.There was no significant difference in the NICE red flag criterion for early assessment(ABCD^(2) risk score≥4)for patients with cerebral microemboli versus those without microemboli(59/86 vs 81/120 patients:OR 1.05 ABCD2 risk score≥4(95% CI 0.58 to 1.90,p=0.867)).The ABCD2 risk score wasembolising patients and in 39 of 120(31% :95% CI 23 to 39)without cerebral microemboli.After adjusting for pre-neurological event antiplatelet treatment(APT),area under the curve(AUC)of ROC for ABCD2 risk score showed no prediction of cerebral microemboli(no pre-event APT,n=57:AUC 0.45(95% CI 0.29 to 0.60,p=0.531);preevent APT,n=147:AUC 0.51(95% CI 0.42 to 0.60,p=0.804)).Conclusions:The ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis.On the basis of NICE guidelines(refer early if ABCD2≥4),assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

关键词： patients cerebral emboli

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On the Function of Wall Sculpturing in Xylem Conduits

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Journal of Bionic Engineering 2009年第4期6卷 324-329页

作者： Mika M.Kohonen se Helland Department of Physical Sciences University of HullCottingham RoadHU6 7RX UK

The water-conducting network of capillaries in vascular plants has evolved over hundreds of millions of years in order to be able to cope with bubble clogging,a problem which also affects modern microfluidic devices.Decades of anatomical studies have revealed that plants growing in habitats in which the formation of bubbles,or emboli,is likely to be a frequent occurrence often have various forms of geometrical sculpturing on the internal surfaces of the xylem conduits.The possible function of such wall sculpturing has long been the subject of speculation.We have investigated the hypothesis that wall sculpturing is a functional adaptation designed to increase the wettability of the walls of xylem conduits,an effect which could be described as the inverse of the well-known lotus-effect.Our results show that wall sculpturing does enhance wettability.Importantly,theoretical calculations reveal that the geometric parameters of various types of wall sculpturing are such that the resulting surfaces are sufficiently rough to enhance wettability,but not significantly rougher.The results provide an appealing answer to the long-standing debate on the function of wall sculpturing in xylem conduits,and may provide biomimetic clues for new approaches to the removal of bubbles in microfluidic channels.

关键词： xylem wettability capillary wall sculpturing bubble emboli microfluidic

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Hydrogen peroxide ingestion with injury to upper gastrointestinal tract

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World Journal of Clinical Cases 2017年第10期5卷 378-380页

作者： Jonathan V Martin Choichi Sugawa Michael and Marian Ilitch Department of Surgery 6-C University Health Center

Hydrogen peroxide is a common over-the-counter solution that has developed a growing body of literature regarding toxic ingestion. Intentional ingestion of high concentration hydrogen peroxide for health purposes has gained popularity in certain patient populations; purported benefits are due to the increased oxygen released into the blood stream. We present for evaluation one such case with associated imaging that presented to our urban medical center. A brief review of the literature was also performed noting current recommendations regarding both outcomes and indications for endoscopy as well as hyperbaric oxygen therapy following ingestion of hydrogen peroxide. Our patient was a 51-year-old white female who presented with foamy hematemesis after ingesting 10 drops of 35% hydrogen peroxide as part of a home remedy to cleanse her colon and improve blood oxygenation. In addition to hematemesis,she also reported diffuse abdominal pain with sore throat and hoarse voice. Her imaging demonstrated portal venous gas and gastric edema. She was admitted for hyperbaric oxygen therapy and underwent upper endoscopy demonstrating diffuse esophagitis and gastritis with white exudate and multiple petechiae. She was later discharged home in stable condition and was lost to follow-up.

关键词： Hydrogen peroxide Caustic injury Hyperbaric oxygen therapy Ingestion of hydrogen peroxide Arterial gas emboli

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EXPERIMENTAL EVALUATION OF BLOCKING EFFECT ON emboli IN THE AORTA ASCENDENS BY USING PHASED ARRAY ULTRASOUND

EXPERIMENTAL EVALUATION OF BLOCKING EFFECT ON EMBOLI IN THE ...

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2016年全国压电和声波理论及器件应用研讨会

作者： Zhen ZHANG Kang AN Min TANG Ya-zhu CHEN Jing-feng BAI School of Biomedical Engineering Shanghai Jiao Tong University Department of Cardiothoracic Surgery Xinhua Hospital School of Medicine Shanghai Jiao Tong University

ISBN: (纸本)9781509011902

Background, Motivation and Objective Neurologic complications, such as transient ischemic attack, stroke and cognitive decline, are common complications after cardiac surgery. They can not only disable patient or take away patient’s life but also cause heavy financial and mental burden upon the patients and their family. The reason of neurologic complications is related to gaseous and solid emboli of head blood vessel which are generated in extracorporeal circulation and surgical operation. Therefore, it is very meaningful to block gaseous and solid emboli from flowing into head from the right common carotid artery. Ultrasound field can generate ultrasonic radiation force acting on embolic and may block emboli from flowing into some blood vessels. This study is aimed to evaluate the blocking effect of the phased array ultrasound on emboli. Statement of Contribution/Methods We did experiments on eight pigs(40kg). After opening thorax, we positioned ultrasound transducer between aorta ascendens and truncus brachiocephalicus. And emboli were detected by PHILIPS CX50 on the right common carotid artery. Air embolic used every time were created by mixing 1 ml air with 9 ml normal saline and polystyrene particles(Duke Corp) dissolved in normal saline as the solid emboli. Both kinds of emboli were injected in the left auricle 8 times on each pig. 4 times with ultrasound transducer off and 4 times with ultrasound transducer on. The emboli which flowed into the right common carotid artery were detected and analyzed. At the end of the experiment, the sonicated tissue was cut for histopathology test. Results The histopathology test showed that the sonicated tissue was not injured. The use of phased array ultrasound significantly reduced the number of emboli which flowed into the right common carotid artery. The gaseous emboli reduced by 69% and the solid emboli reduced by 61%. Discussion and Conclusions The research revealed that use of phased array ultrasound is a safe way to block emboli from flowing into right common caro

关键词： Phased array ultrasound Ultrasonic radiation force emboli Experimental evaluation

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TREATMENT OF ACNE WITH EAR ACUPUNCTURE——A CLINICAL OBSERVATION OF 80 CASES

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Journal of Traditional Chinese Medicine 1989年第4期9卷 238-239页

作者：徐宜厚 Department of Dermatology Wuhan Hospital of TCMWuhan

Under the guidance of“Theory of Channelsand Collaterals and Their Relationship with theVisceral Organs”in TCM,80 cases of varioustypes of ache were treated with ear acupuncture.The clinical results are reported as f... 详细信息

关键词： acupuncture guidance totally tuberous organs rupture minutes emboli weekly glandular

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Microembolic signal detection by transcranial Doppler: Old method with a new indication

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World Journal of Methodology 2018年第3期8卷 40-43页

作者： Sombat Muengtaweepongsa Charturong Tantibundhit Department of Internal Medicine Faculty of Medicine Thammasat University

Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.