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  • ISSN: 2378-9344
    Volume 2, Issue 1
    Case Report
    Rishi Bajaj*, Rami Eltibi, Joseph Benotti, Joseph Hannan
    Abstract:
    Introduction: There is ever increasing evidence to suggest that transradial catheterization is associated with fewer access site complications, shorter length of stay, and improved patient comfort. A principle concern remains the potential for radial artery occlusion (RAO) with a reported incidence ranging from 10-30%. One of the traditional methods used to diagnose radial artery occlusion is inverse modified Allen test with pulse plethysmography which is then graded as Barbeau A-D according to increasing severity of occlusion.
    Methods: We describe a series of patients undergoing transradial catheterization in whom we performed inverse modified Allen's testing with pulse plethysmography and compared this with Doppler ultrasound in determining the presence of a radial artery occlusion.
    Results: Three patients demonstrated a Barbeau grade of D on inverse modified Allen's test following a successful diagnostic and interventional procedures; however, Doppler ultrasound demonstrated a patent radial artery with antegrade flow and no evidence of occlusion.
    Conclusions: Inverse modified Allen test with pulse plethysmography is an inaccurate method to diagnose to radial artery occlusion and may yield false positive or negative results in comparison to Doppler ultrasound. The clinical presentation and diagnostic methods are discussed.
    Anish Desai1*, Alexander Fe2, Girish B. Nair3 and Michael S. Niederman4
    Abstract:
    Case: A 68-year-old woman presented to our emergency room with subjective fevers, non-productive cough and severe pain in the right lower extremity. Of note, she had sustained a right patellar fracture 6 weeks earlier, treated with a brace. Physical examination showed right lower extremity swelling. Subsequently, she was diagnosed with extensive right deep venous thrombosis (DVT). Local thrombolysis of the DVT was achieved by injecting tissue plasminogen activator (tpa) followed by mechanical aspiration. Immediately post procedure; the patient experienced an acute deterioration in her mental status with left hemiparesis. CT angiography of the head confirmed a right middle cerebral artery (MCA) ischemic stroke. Successful reperfusion was achieved by performing an emergent embolectomy in the M1 branch of the MCA. A bubble contrast transthoracic echocardiogram showed a patent foramen ovale (PFO). The patient's neurological symptoms gradually improved and at 6 month follow up she had no focal neurological deficits.
    Discussion: We describe the first case of an embolic stroke complicating catheter directed thrombolysis (CDT) for DVT in patient with elevated pulmonary arterial pressure as a result of acute pulmonary emboli. Currently there are no guidelines mandating routine checks for PFOs prior to performing CDT. This case illustrates the need for high clinical vigilance for PFO in patients being evaluated for CDT and provides a unique insight into a rare complication.
    Clinical Image
    Mohammed Amed Hassain* Qiang Nai, Nneka Iroka, Shoaib Zafar, Ibrahim W Sidhom, Teena Mathew, Mohammed Islam, Abdalla M Yousif, Shuvendu Sen
    A 75 year old female presented with recurrent episodes of loss of consciousness. She was found on floor surrounded by urine and feces at home, without tongue biting. She has a history of epilepsy, diabetes mellitus, hyperlipidemia, multiple myocardial infarctions, atrial fibrillation, severe cardiomyopathy which needed defibrillator placement and subsequent heart transplantation 11 years ago, peptic ulcer, chronic kidney disease, urinary incontinence, gout, depression. She smoked for 45 years before quitting in 2003. The birth of the patient was a dystocia at home with assistance of midwife. She is mostly independent for activities of daily living.
    Mini Review
    Hanène Ayari*
    Abstract: The expression of adipophilin [ADFP] seems to be elevated in atherosclerotic lesions compared with healthy arterial intima, it may play a role in the pathogenesis of atherosclerosis, notably in the transformation of macrophages into foam cells. It was proposed that adipophilin may play a key role in the lipid metabolism of foam cells and hence ultimately contributes to the formation of a lipid core in human atherosclerotic lesions. Several RNA microarray analysis showed that ADFP mRNA level was increased in carotid plaque compared with nearby intact tissue. For our part, we showed that atheroma plaque formation coincided with consequent adipophilin expression. Overall, a more complete and comprehensive analysis is required. Further studies are needed to fully understand these mechanisms and the role of each specific ADFP which will hopefully reveal new molecular targets for therapeutic applications against the development of atherosclerosis.
    Research Article
    Seyhan Yilmaz1*, Salih Ozcobanoglu2 and Serdar Gunaydin3
    Abstract:
    Purpose: To determine the usefulness of pulse oximetry in patients receiving iloprost infusion for treatment of critical limb ischemia unsuitable for revascularization.
    Material and methods: A total of 42 patients [28 male, mean age 61.80±5.81 years] were included. Patients were those who considered as unsuitable for revascularization based on angiographic study and received single-dose infusion of iloprost at 2.0 ng/kg/min for 8 hours daily. The treatment was planned to last for about two weeks. Ankle brachial index values and peripheral arterial oxygen saturation values using pulse oximetry were obtained before and after the treatment.
    Results: Treatment was complete in 42 patients. A total of 23 patients [54.7%] had pain relief and 15 patients [35.7%] had improvement in walking. Percentage changes in ankle brachial index and peripheral arterial oxygen saturation values were not significantly correlated [r=0.229, p=0.15]. Both ankle brachial index and peripheral arterial oxygen saturation values showed significant improvement after completion of the treatment. Percentage change in peripheral arterial oxygen saturation showed significant correlation with pain relief [r=0.449, p=0.003] whereas showed no correlation with improvement in walking [r=0.298, p=0.053].
    Conclusion: Iloprost infusion seems promising in patients with critical limb ischemia and its use is associated with better oxygen delivery to the ischemic lower extremity tissue, which might be easily assessed using pulse oximetry.
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