Curēus
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Case Reports Retracted Publication
Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism.
Traditionally, massive, life-threatening pulmonary embolism (PE) has been treated with systemic thrombolytic therapy while submassive and smaller acute PEs have been treated with systemic anticoagulation therapy. Given that thrombolytic therapy is associated with the risk of life-threatening complications including intracranial hemorrhage, it has not been routinely used or recommended for submassive PEs. In 2017, the Food and Drug administration (FDA) approved ultrasound-facilitated catheter-directed thrombolysis (USCDT) for acute massive and sub-massive pulmonary embolism. ⋯ We present a case of USCDT in a submassive PE patient with dual right upper extremity venous access where both sheaths were advanced into the basilic vein (due to anatomic variation). Based on recent clinical trial data suggesting that shorted duration USCDT is as effective as longer duration, tissue plasminogen activator (tPA) was infused in this case for 6 hours. This strategy for intervention can enhance patient comfort with USCDT therapy and can be particularly helpful in patients at high risk for access site complications and those unable to lie supine for the long duration of infusion therapy.
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Introduction The severe acute respiratory syndrome coronavirus 2 (SARS2-CoV-2) induced pandemic (COVID-19 pandemic) has affected healthcare in all aspects, including stroke care. We sought to investigate this effect with analysis of our hospital's stroke treatment protocols as well as stroke volume on state, regional, and national levels. Methods This was a retrospective review of prospectively collected data from our stroke registry to assess the impact of the SARS2-CoV-2 induced pandemic on the volume of stroke patients presenting to our facility. ⋯ We identified a delay in LKWT to door as well as time from door to CT in March 2020 compared to March 2019 at our institution. There was a statistically significant decrease in final diagnosis of TIA at our hospital, all California hospitals, and all West Regional hospitals during the March-April 2020 window, suggesting that some patients with minor stroke symptoms may not be presenting to the hospital in the midst of the pandemic. Strategies to minimize delays in care and maximize functional recovery must continue to evolve as new challenges are met during the COVID-19 pandemic.
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Case Reports Retracted Publication
A Challenging Case of Electrical Storm in an Implantable Cardioverter Defibrillator Patient.
Implantable cardioverter defibrillators (ICD) have become indispensable in managing life-threatening ventricular arrhythmias. On average, 50%-70% of the patients receive a device-based therapy within the first two years post implantation. A few patients experience the electrical storm (ES). ⋯ We present the case of a patient with severe cardiomyopathy who presented with resistant ES after failing to respond initially to conventional medications like amiodarone and lidocaine. Propofol infusion was not an option due to his severe cardiomyopathy and hypotensive shock state. Aggressive treatment with intravenous medications stabilized his ES and he was eventually transferred to an outside facility for ventricular tachycardia ablation.
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Retracted Publication
Radiological and Functional Outcome of Medial Epicondyle Fracture Treated Surgically in Children and Adolescents: A Retrospective Study.
Fractures of the medial humeral epicondyle represent approximately 10% of all pediatric elbow fractures. Surgically treated pediatric fractures of the medial humeral epicondyle were analyzed retrospectively for their epidemiological, clinical, radiological and surgical parameters. The evaluation includes the Mayo elbow performance score (MEPS). ⋯ Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in the operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries.