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  • ISSN: 2378-9344
    Volume 3, Issue 1
    Case Report
    Alisa Y Chen*, Eric J Heyer and Robert A Solomon
    Abstract:
    The patient was a 71 year old male with asymptomatic left internal carotid artery stenosis > 95% who underwent carotid endarterectomy with transcranial Doppler ultrasonography and electroencephalography for neuro monitoring. The surgical course was complicated by postoperative carotid occlusion caused by a carotid plaque located distal to the operative site that acted as a one way ball valve. This allowed for retrograde flow through the internal carotid artery as demonstrated in the surgical field with back bleeding. The plaque did not allow for anterograde flow from the internal carotid artery to Circle of Willis, but this could not be evaluated prior to surgical closure. Upon initially unclamping the internal carotid artery, transcranial Doppler ultrasonography velocities remained low and did not return to baseline values. The patient emerged with postoperative right-sided hemiplegia and aphasia requiring immediate repeat carotid surgery. The plaque located distal to the operative site was removed and transcranial Doppler ultrasonography velocities exceeded baseline values, demonstrating restoration of anterograde blood flow in the internal carotid artery. The patient emerged this time neurologically intact at his baseline. This case demonstrates the role of transcranial Doppler ultrasonography in carotid endarterectomy for monitoring and eventual diagnostic and treatment decision.
    Fabrizio D’Abate*, Cristiana Vitale and Robert J Hinchliffe
    Abstract:
    Case: A 19 year old elite male cyclist presented with exercise induced thigh pain. He had been cycling competitively for 5 years with an average of 23 hours of training per week with a history of thigh pain over the past year. The patient was healthy and fit with no significant medical history. General vascular examination was normal with no femoral bruits on extension or flexion of the hips. A Colour Doppler ultrasound (CDU) of the iliac and femoral arteries at rest and after cycle ergometer test was performed. A pre and post exercise ankle brachial pressure index (ABPI) was measured and resulted within the normal range. At rest, a 50% stenosis of the profunda femoris artery (PFA) caused by a subtle dissection with intimal flap was diagnosed with CDU. A diagnostic digital subtraction angiogram confirmed the ultrasound findings. The patient underwent successful endarterectomy of the PFA with a great saphenous vein patch.
    Discussion: Profunda femoris artery dissection is an unusual complication of endofibrosis in young cyclists, however the diagnosis should be considered in those with exertional related pain confined to the thigh. This case report shows the importance of using CDU in addition to ABPI in the assessment of athletes with exertion related thigh pain.
    Howard MacLennan, Amy McCoart*, Cristobal S. Berry-Caban, Jason Burris and Robert Diem
    Abstract:
    Inferior vena cava agenesis (IVCA) has 5% prevalence in individuals, less than 30 years of age with unprovoked lower extremity deep vein thrombosis (DVT). One study revealed that eight out of ten patients with IVCA-associated DVT developed abdominal and/or back pain after major, intense physical activity. This case is the first identifiable report of a patient with bilateral extremity DVT through the pelvis into the distal IVC. A 22 year old male U.S. soldier presented to the clinic describing excruciating lower back pain and swelling that progressed to bilateral leg pain and swelling over a five day period. Ultrasound revealed diffuse bilateral DVTs. On admission tissue plasminogen activator (t-PA) was given through the femoral artery and a heparin regime was initiated. The patient decompensated with worsening back, abdominal and scrotal pain combined with breathing difficulties and was transferred to another facility. Imaging results revealed diffuse thrombotic disease with IVCA. The soldier was diagnosed with DVT secondary to congenital agenesis/ atresia of the IVC that caused spontaneous development of bilateral venous thrombi from the posterior calf through the iliac veins as a result of repeated insults from strenuous exertional exercise.
    Research Article
    Guglielmo Saitto*, Marco Russo, Paolo Nardi, Valentina Gislao, Antonio Scafuri, Antonio Pellegrino and Giovanni Ruvolo
    Abstract:
    The association of Tricuspid Regurgitation (TR) to left side heart valve diseases is common but surgical indications during left side heart surgery is still controversial and tricuspid valve annuloplasty (TVA) ranging from more than 60% to 6% depending on each single institution strategy. This study aims to evaluate clinical and instrumental results of adjunctive TVA during left side heart valve surgery also in case of non-severe TR but only annular dilation. We retrospectively analyzed 20 consecutive patients (mean age 71±7 yo, 70% females) who underwent during 2015 to adjunctive TVA by means of De Vega (12 patients) or Kay (8 patients) techniques during left side heart operation for mitral valve regurgitation or steno insufficiency: 14 patients underwent mitral valve replacement (6 combined operation: 2 CABG, 2 AVR and 2 PFO) and 6 to repair (one combined for PFO). Mean CBP and cross clamp time was 126±34 and 101±27minutes respectively. Mean Euroscore II was 4.9±4.4%. In-hospital mortality was 5%. No postoperative MI or strokes were noticed. Three patients had a new atrial fibrillation (15%), but no onset of BAV was noticed and no PPMK was necessary. At discharge, 18 patients (90%) had no TR more than 1+, and only 1 patient had mild (2+). Mean postoperative in hospital stay was 13±18 days. At short term follow up (8.7±3.8 months) no patients had a TR >2+. In conclusion additional TVA takes short operative time and seems to be a low-risk procedure with stable good results at short term follow up.
    Koji Takeuchi*, Kohei Yamasaki, Chitose Izuhara, and Hikaru Nishio
    Abstract:
    Background/Aim: Recent studies suggested a risk of gastric adverse reaction on the concomitant use of antiplatelet drugs with NSAIDs. The present study was performed to examine the adverse effects of anti-platelet drug clopidogrel, a P2Y12 receptor antagonist, on gastric antral lesions induced by conventional NSAIDs in refed rats.
    Methods: Rats fasted for 24 h were refed for 1 h, and subsequently administered NSAIDs such as indomethacin (30 mg/kg), loxoprofen (100 mg/kg), or flurbiprofen (30 mg/kg) s.c. 1 h after refeeding. The animals were killed 6 h after NSAID treatment, and the stomachs were examined for non-hemorrhagic and hemorrhagic lesions, separately. Clopidogrel (30 mg/kg) was administered p.o. 48, 24, and 0.5 h before NSAID treatment. Antisecretory drugs (atropine, omeprazole or famotidine) and mucosal protective drugs (rebamipide or teprenone) were given p.o. 1 h before indomethacin.
    Results: NSAIDs used alone produced non-hemorrhagic lesions in the antrum of refed rats. Clopidogrel, despite causing no damage by itself, aggravated the severity of antral lesions in response to NSAIDs, with an increase of MPO activity; the lesions induced by NSAIDs alone were mostly non-hemorrhagic, while they became hemorrhagic by the co-administration with clopidogrel. The aggravation by clopidogrel of indomethacin-induced antral lesions was significantly prevented by antisecretory drugs or mucosal protective drugs, with the concomitant suppression of MPO activity.
    Conclusion: Clopidogrel, an antiplatelet drug, aggravates the severity of NSAID-induced antral lesions in refed rats, especially converting from non- hemorrhagic damages into hemorrhagic ones. Both antisecretory and mucosal protective drugs are useful for preventing the development of antral lesions induced by NSAIDs plus clopidogrel.
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