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  • ISSN: 2378-9344
    Volume 4, Issue 4
    Research Article
    Toccafondi A*, Bonacchi A, Miccinesi G, Baroncelli TA, Franchi G, Ben Amor C, Pasqualini M, and Muraca MG
    Aim: The aim of this observational study was to investigate the use of a night-time compression sleeve (NTCS) as a routine maintenance therapy for breast cancer-related lymphedema (BCRL).
    Methods: We performed a retrospective analysis of 145 breast cancer patients who over a five-year period used the Made-to-Measure Mobiderm® NTCS as adjuvant treatment for BCRL. The total sum of the percent differences between the two arms (%) after 6 months of NTCS use was the principal criterion. The circumferences of each patient’s arm at the beginning of the NTCS use (baseline measurement=T0), and data from 6 months before (T-1) and 6 months after (T1) the use of the NTCS were considered.
    Results: All patients were previously treated for breast cancer. At baseline (T0) the sum of the percent differences between the two arms in the sample of the study (n=145) was 53.1% ± 24.2. Data showed a significant decrease by 6.6% of the sum of the percent differences between baseline (T0) and 6 months after NTCS use (T1) (p=0.010). Among the 145 patients, 74 patients (51.0%) were already treated for lymphedema and had received a medical examination 6 months before the NTCS use (defined as treated lymphedema patients), while 46 patients (31.7%) were receiving their first medical examination for lymphedema at baseline (defined as newly diagnosed patients). In the newly diagnosed patients subgroup, a greater significant reduction of the sum of the percent differences of -13.4% at T1 compared to baseline was observed (p=.013). Among the 74 treated lymphedema patients, the sum of the percent differences after NTCS use (T1) was well maintained with a slight tend to decrease (-2.6%), while between before the NTCS use (T-1) and base line, this percentage significantly increased by 16.9% (p<.001).
    Conclusion: The reduction of lymphedema observed in this study during the NTCS use period suggests that MOBIDERM® NTCS seems to be associated to a control of lymphedema volume in BCRL patients during the maintenance phase. This night garment might be an adjuvant effective component of the therapy to achieve the volume maintenance goal but its efficacy should be confirmed with a randomized clinical trial.
    Heather Balch*, Heath Crawford, Jamie McDonald, Ryan O'Hara, and Kevin Whitehead
    Objective: To review the long-term outcomes of transcatheter embolotherapy for pulmonary arteriovenous malformations (PAVMs) in children with Hereditary Hemorrhagic Telangiectasia (HHT) at a single HHT Center of Excellence.
    Study Design: A retrospective review of medical records and imaging was performed on all pediatric patients (age = 18 years) with known diagnosis of HHT who underwent transcatheter embolotherapy for PAVM from 1998 to 2016. 15 patients underwent embolization treatments. A total of 36 embolization treatments for 22 PAVMs were performed. Mean age at time of first treatment was 11.79 years.
    Results: The 15 patients who had embolotherapy, 10 required at least 1 additional procedure (60%), 6 patients required at least 3 procedures (40%), and 2 required greater than 3 procedures. There were 9 AVMs requiring >1 treatment. Of the 12 patients in whom we have follow up imaging, 8 patients (67%) still have residual flow through their treated PAVMs. Of the 18 PAVMs for which we have follow up imaging, 9 treated PAVMs (50%) have been shown to have no residual flow on follow up imaging, and 9 treated PAVMs (50%) had definite residual flow. 4 AVMs have not had follow up CT imaging.
    Conclusion: In our case series of pediatric patients with HHT, who underwent embolotherapy of PAVMs, there was a high rate of recurrence of PAVMs after embolotherapy. Given the high rate of recurrence and the low rate of complications in asymptomatic HHT pediatric patients, this should factor into risk-benefit analysis when deciding which patients to screen and treat, particularly in the asymptomatic patient.
    Case Report
    Haydar Yasa* and Furuzan Aktug
    The incidence of multiple fistulas within all coronary arteriovenous fistulas varies between 10.7% and 16%. Double coronary-arteriovenous fistulas originating from a coronary artery are much less common. In this study, we present a double fistula originating from left anterior descending coronary artery and communicating with main pulmonary artery.
    A 72-year-old female patient was admitted to our clinic with complaints of chest pain and shortness of breath with progressive exertion. Coronary angiography revealed the presence of a double fistula originating from the LAD and a major pulmonary arterial drainage. Median sternotomy was performed. From the LAD proximal segment, two A-V fistulas with fragile tissue at the origin and connecting to the mid portion of the main pulmonary artery were identified. LAD exit site - pulmonary arterial entry site identified. Exit locations and access sites were ligated with 5.0 prolene. No electrocardiographic and hemodynamic changes were detected. Several other vascular structures on the pulmonary artery were separately sutured.
    Clinical Image
    Pasquale Zamboli* and Massimo Punzi
    A 81-year-old man with type 2 diabetes mellitus from 20 years complicated by heart failure (pacemaker implantation via left subclavian vein in 2013) and chronic kidney disease, started hemodialysis [1] as a late referral patient in July 2014 via two single-lumen tunneled cuffed venous catheters (Tesio catheter) implanted in the right internal jugular vein with the tips allocated in the right atrium.
    Review Article
    Rachel Nicoll*, John McLaren Howard and Michael Y. Henein
    Several studies show the co-existence of cardiovascular calcification and osteoporosis and we have sought to determine whether dietary factors may be associated. In this review of B vitamins (principally B6, B12 and folate) and homocysteine, elevated homocysteine, a known risk factor for Alzheimer’s disease and stroke, proved also to be a significant risk factor for the presence and extent of arterial, but not valvular, calcification, with a plasma concentration threshold of 12 µmol/l. The MTHFR reductase C677T genotype, although associated with homocysteine concentrations, was not an independent predictor of arterial calcification. Homocysteine is also associated with osteoporosis and bone fracture but the lack of association with BMD may be because homocysteine interferes with collagen cross-linking, causing fragility, which increases fracture risk but does not affect BMD. Although trials of B vitamins consistently demonstrate an ability to lower homocysteine, there is only one arterial calcification observational study, which showed a lower carotid calcification score with plasma folate concentrations >39.4nmol/l. There are more studies of supplementation of B vitamins and bone, where they have proved beneficial, particularly with elevated homocysteine in osteoporosis. Homocysteine appears to act principally through its pro-oxidant properties and many of its effects may be inhibited by supplementing antioxidants rather than B vitamins. This suggests that although B vitamins can prevent homocysteine concentrations from rising or rising further, once its pro-oxidant effects have been initiated, then dietary antioxidants should be increased as well. We recommend that trials of B vitamins and antioxidants should be carried out in patients with arterial calcification and osteoporosis.
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