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1.
S D Med ; 74(9): 414-416, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34461680

RESUMO

Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in patients with type 1 DM. Due to severe acidosis, ketonemia and electrolyte disturbances it can lead to various complications in the body, which can be fatal in some cases. Neurological complications related to DKA include cerebral edema, cerebral infarction, brain herniation, cortical venous thrombosis. It is very rare for DKA to cause subarachnoid hemorrhage (SAH). We present a case 19-year-old female with severe DKA, who developed SAH without any pre-existing aneurysm or other common risk factors. The patient did not have any neurologic deficits and was managed conservatively with the resolution of her symptoms. We have also summarized the existing literature regarding the association of DKA with subarachnoid hemorrhage.


Assuntos
Edema Encefálico , Cetoacidose Diabética , Hemorragia Subaracnóidea , Adulto , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Infarto Cerebral , Cetoacidose Diabética/complicações , Feminino , Humanos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto Jovem
2.
S D Med ; 72(12): 552-555, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32130799

RESUMO

Insulinomas are rare neuroendocrine tumors that produce excessive insulin and result in hypoglycemia. It can have a wide spectrum of symptoms and presentations which makes it difficult to diagnose at times. Here we present a 39-year-old woman who presented with intermittent diplopia, confusion, and staring episodes for one month. She had previously been seen by a neurologist who diagnosed her with possible absence seizures. However, evaluation showed that that patient had severe hypoglycaemia even with dextrose infusions. She was diagnosed with insulinoma based on lab work and a biopsy of a pancreatic tail mass. She underwent partial pancreatectomy, and has had a good outcome, with no recurrence of her symptoms. This case highlights the variable presentation of insulinomas, and the challenges faced with its diagnosis.


Assuntos
Insulinoma , Neoplasias Pancreáticas , Convulsões , Adulto , Feminino , Humanos , Insulinoma/complicações , Insulinoma/diagnóstico , Insulinoma/cirurgia , Recidiva Local de Neoplasia , Pancreatectomia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Convulsões/etiologia
3.
S D Med ; 72(8): 344-347, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465638

RESUMO

Herpes simplex (HS) is an opportunistic infection, primarily in immunocompromised patients, caused by herpes simplex virus. Oral and genital mucosa are the most commonly involved sites; it is rare for HSV to invade the esophagus and cause esophagitis, especially in immunocompetent patients. Here, we present a case where an immunocompetent patient presented with HS esophagitis, which had evolved into esophageal ulcers. He was successfully treated with acyclovir. Subsequently, we did a comprehensive literature search and tabulated all the possible complications and management plans of previously reported cases of HS in immunocompetent patients.


Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Esofagite , Herpes Simples , Esofagite/tratamento farmacológico , Esofagite/virologia , Humanos , Masculino
5.
BMJ Case Rep ; 16(2)2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36792142

RESUMO

Small cell cancer is an aggressive neoplasm of neuroendocrine origin that is most commonly found in the lungs. However, up to 5% of cases can be extrapulmonary. These have been reported to be located in the gastrointestinal and genitourinary systems and rarely in other locations. Only five prior cases of small cell cancer have been reported where the primary lesion is at the adrenal gland. Here we present the case of a female patient in her mid-50s who presented with right upper quadrant pain and was diagnosed with metastatic small cell carcinoma of the adrenal gland. The patient received palliative chemotherapy for her metastatic cancer and was ultimately admitted to hospice after progression of her disease. This case and the accompanying literature review highlight a rare manifestation of extrapulmonary small cell cancer.


Assuntos
Carcinoma Neuroendócrino , Carcinoma de Células Pequenas , Neoplasias Pulmonares , Humanos , Feminino , Carcinoma de Células Pequenas/patologia , Neoplasias Pulmonares/patologia , Glândulas Suprarrenais/patologia , Carcinoma Neuroendócrino/patologia
6.
Case Rep Gastrointest Med ; 2021: 8884820, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33996160

RESUMO

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the United States. It has a variable presentation with most patients having asymptomatic lymphocytosis. Many other patients present with lymphadenopathy or enlargement of other organs of the reticuloendothelial system. However, CLL can present with extramedullary involvement. Most commonly, this is in the form of skin or central nervous system involvement, though rarely it can present with gastrointestinal involvement. Here, we present the case of a 70-year-old Caucasian male who presented with chronic diarrhea for over 4 months. After failing conservative treatment, a colonoscopy was performed which showed diffuse mucosal nodularities with a biopsy revealing CLL. The patient was treated successfully with chemotherapy and his diarrhea improved. This is a differential to keep in mind in patients with chronic diarrhea, once the more common causes have been ruled out.

7.
BMJ Case Rep ; 12(7)2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31324669

RESUMO

Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.


Assuntos
Abscesso Abdominal/cirurgia , Apendicectomia , Apendicite/cirurgia , Cálculos/cirurgia , Corpos Estranhos/cirurgia , Complicações Pós-Operatórias/cirurgia , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Cálculos/complicações , Diafragma/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Recidiva , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326902

RESUMO

Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.


Assuntos
Infarto Encefálico/induzido quimicamente , Parada Cardíaca/induzido quimicamente , Mitragyna/intoxicação , Psicotrópicos/efeitos adversos , Adulto , Infarto Encefálico/terapia , Diagnóstico Diferencial , Parada Cardíaca/terapia , Humanos , Hipotermia Induzida , Masculino , Síndrome de Abstinência a Substâncias
9.
BMJ Case Rep ; 12(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31822530

RESUMO

Rheumatoid arthritis (RA) is a multisystem inflammatory disease which can involve many organ systems including the central nervous system (CNS). Though not very common, the results can be severely debilitating. The spectrum of the CNS involvement includes meningitis, encephalitis and occasionally rheumatoid nodules. Its presentation is variable, though very rarely it can present as focal neurological deficits. Imaging can be suggestive, but diagnosis usually requires tissue biopsy. Treatment consists of high-dose steroids and immunosuppressants. We describe the case of a 55-year-old male patient with a history of RA presenting with a third nerve palsy and headache who was found to have rheumatoid nodules on biopsy. CNS involvement in RA should be considered in anyone with rheumatoid arthritis who presents with focal neurological deficits, though infections and space-occupying lesions should also be ruled out.


Assuntos
Artrite Reumatoide/fisiopatologia , Hipóxia/fisiopatologia , Meningite/fisiopatologia , Nódulo Reumatoide/patologia , Sepse/fisiopatologia , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Evolução Fatal , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/fisiopatologia , Humanos , Hipóxia/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Meningite/etiologia , Meningite/microbiologia , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/microbiologia , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/fisiopatologia , Insuficiência Respiratória/microbiologia , Nódulo Reumatoide/fisiopatologia , Sepse/complicações , Sepse/tratamento farmacológico , Recusa do Paciente ao Tratamento
10.
Expert Rev Gastroenterol Hepatol ; 13(5): 507-514, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30933549

RESUMO

BACKGROUND: To review all the reported literature on acute esophageal necrosis. RESEARCH METHODS: Databases were searched using the special Medical Subject Heading (MeSH) terms. All the available reported cases of acute esophageal necrosis were analyzed. RESULTS: A total of 154 cases were identified and 130 cases were analyzed. The mean age of presentation was 61 years, and 70% of cases were males. The most common presenting symptoms were hematemesis in 66%, shock in 36%, melena in 33%, abdominal or substernal pain in 28%. The most common comorbidities reported were diabetes in 38%, hypertension in 37%, alcohol abuse in 25%, and chronic kidney disease in 16%. On upper endoscopy, 51% had a distal disease, 36% had pan esophageal, and only 2% had a proximal disease. 84% of patients were treated with IV Proton Pump Inhibitors, 22% received transfusions, 23% got antibiotics for underlying sepsis, 14% also received sucralfate, and 4% required surgery for treatment. The mortality rate was 32%, while perforation was reported in 5% and stricture formation reported in 9% of patients. CONCLUSIONS: Patients with acute esophageal necrosis can have a favorable outcome if treated appropriately.


Assuntos
Doenças do Esôfago/diagnóstico , Doenças do Esôfago/terapia , Esôfago/patologia , Doença Aguda , Comorbidade , Doenças do Esôfago/mortalidade , Doenças do Esôfago/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Fatores de Risco , Resultado do Tratamento
11.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451465

RESUMO

Human cytomegalovirus (CMV) is a double-stranded DNA virus that can cause widespread severe infection in immunocompromised individuals but is more typically a subclinical infection in immunocompetent individuals. Rarely, it can cause a serious infection in immunocompetent individuals. Here, we describe a 36-year-old otherwise healthy male who presented with fever, cough and malaise who was diagnosed with CMV pneumonia. He made a rapid recovery after initiation of ganciclovir and has been doing well on follow-up visits. We performed a comprehensive review of CMV pneumonia in immunocompetent individuals and have summarised the prior 16 reported cases of CMV pneumonia in immunocompetent patients. This article highlights the importance of considering CMV as a cause of pneumonia even in immunocompetent individuals, especially when the more common causes have been excluded. Early diagnosis allows prompt treatment and potentially complete recovery.


Assuntos
Infecções por Citomegalovirus , Citomegalovirus/isolamento & purificação , Intervenção Médica Precoce/métodos , Ganciclovir/administração & dosagem , Pneumonia , Adulto , Antivirais/administração & dosagem , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/fisiopatologia , Diagnóstico Precoce , Humanos , Imunocompetência , Masculino , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/fisiopatologia , Pneumonia/virologia , Resultado do Tratamento
12.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133549

RESUMO

A sexual headache or coital cephalgia is a headache associated with sexual activity and is a well-recognised condition. It is usually benign, primary and self-limiting. However, occasionally sexual headaches can result from more sinister causes. Intraparenchymal and subdural haemorrhages have been reported as secondary causes of sexual headaches. We present the case of a 61-year-old woman with no comorbidities who presented acutely with a sexual headache and vision loss, and was found to have an occipital and parietal intraparenchymal haemorrhage. She was normotensive and after extensive workup was found to have no predisposing condition for her haemorrhage. The patient had an uneventful recovery with physical rehabilitation and had regular follow-ups, with no residual weakness. She was in a completely normal state of health 1 year after her event, and continued to be off any medications.


Assuntos
Coito/fisiologia , Cefaleia/etiologia , Hemorragias Intracranianas/complicações , Doença Aguda , Feminino , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/reabilitação , Pessoa de Meia-Idade , Comportamento Sexual/fisiologia , Resultado do Tratamento
13.
Cardiol Res ; 10(2): 74-82, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31019636

RESUMO

BACKGROUND: American College of Cardiology (ACC) guidelines suggest clopidogrel (Plavix) suspension for 5 days before non-emergent cardiac surgery (class IIa, level B). It puts the patients with recent angioplasty and ongoing ischemia at a higher risk of stent thrombosis. We sought to determine the bleeding risk in patients who stopped clopidogrel at 3 and less than 3 days before coronary artery bypass grafting (CABG) as compared to the usual 5 days prior to CABG. METHODS: A retrospective single center study was performed; and a total of 90 patients were included. Forty patients were not on clopidogrel but underwent CABG and hence were used as a control group (group 3). Fifty remaining patients were divided into three groups. Patients in whom clopidogrel was stopped 3 days or less before CABG were included in group 1 (n = 25); group 2 included patients who followed the standard ACC guidelines and clopidogrel was suspended 5 days before the CABG (n = 17); and finally patients who had stopped clopidogrel 4 days prior to surgery were included in group 4 (n = 8). This was compared to controls. Postoperative hemoglobin drop was analyzed between subgroups using IBM SPSS version 25. RESULTS: The mean age of the included population was 69.9 years (46 - 88) with 65% of them being male and 35% female patients. The difference in the hemoglobin fall was compared amongst these groups using the one-way ANOVA. There were no outliers, as assessed by boxplot, the data were normally distributed for each group, as assessed by Shapiro-Wilk test (P > 0.05), and there was homogeneity of variances, as assessed by Levene's test of homogeneity of variances (P > 0.05). The fall in hemoglobin for the four different groups was analyzed. The fall in hemoglobin in group 1 (stopped clopidogrel 3 days or less before CABG) was (n = 25, 2.36 ± 1.24), the fall in group 2 (stopped clopidogrel 5 days prior to CABG) was (n = 17, 2.89 ± 1.22), the fall in hemoglobin in group 3 (patients not on clopidogrel) was (n = 40, 2.54 ± 1.35), and the fall in hemoglobin in group 4 (patients stopped clopidogrel 4 days prior to CABG) was (n = 8, 2.02 ± 1.31). ANOVA was subsequently performed on the patient data, which showed no statistical difference between all the four groups regarding the fall in hemoglobin during surgery (P = 0.41). CONCLUSIONS: Our study concludes that there was no significant difference in the hemoglobin drop of the patients who had clopidogrel stopped 3 days prior to the major procedure like CABG in comparison to the patients who stopped clopidogrel 5 days before surgery. We advocate, that early cessation of clopidogrel is posing a threat of thrombosis in high risk patients with no additional benefit of decreased bleeding risks. However, large population studies are needed to validate the results.

14.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383675

RESUMO

Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) are a constellation of signs and symptoms that are collectively referred to as the CRAB features. When present together, multiple myeloma (MM) should be at the top of the differential diagnosis. We present a 69-year-old man who presented with severe body aches and bone pain in his ribs and pelvis, associated with fatigue and constipation. He was found to have hypercalcaemia, acute kidney injury, anaemia and numerous lytic lesion on chest imaging. Physical examination and imaging were unremarkable for any enlarged lymph nodes. The patient was initially suspected to have multiple myeloma, however, serum and urine protein electrophoresis, and serum free light chain assays were negative. The patient was ultimately diagnosed with diffuse large B cell lymphoma based on a bone marrow biopsy. This case highlights the fact that presence of hypercalcaemia, renal dysfunction, anaemia and bone lesions are not usually specific for MM.


Assuntos
Anemia/diagnóstico , Doenças Ósseas/diagnóstico , Hipercalcemia/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Insuficiência Renal/diagnóstico , Idoso , Anemia/etiologia , Doenças Ósseas/etiologia , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiologia , Linfoma Difuso de Grandes Células B/complicações , Masculino , Mieloma Múltiplo/diagnóstico , Insuficiência Renal/etiologia
15.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320372

RESUMO

Pericardial effusions resulting in a cardiac tamponade have previously been reported with oesophageal cancers. However, most of these cases have been reported in association with radiation and chemotherapy. Rarely as oesophageal pericardial fistuls (OPF) have been reported as the culprits in causing pericardial effusions in patients with oesophageal cancers. Here we present the case of a 61-year-old woman who presented clinically with cardiac tamponade. She was found to have an OPF due to oesophageal squamous cell cancer that resulted in a purulent pericardial effusion. She underwent a median sternotomy, pericardial decompression, and mediastinal debridement. An oesophageal stent was attempted unsuccessfully. The patient refused any more aggressive treatments and was discharged to a hospice where she passed away 13 days after presentation. This case and the associated literature review highlights an unusual presentation of oesophageal cancer and an uncommon cause of cardiac tamponade.


Assuntos
Tamponamento Cardíaco/etiologia , Fístula Esofágica/etiologia , Neoplasias Esofágicas/complicações , Carcinoma de Células Escamosas do Esôfago/complicações , Pericardite/etiologia , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Eletrocardiografia , Endoscopia do Sistema Digestório , Fístula Esofágica/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Humanos , Mediastinite/complicações , Pessoa de Meia-Idade , Pericardite/diagnóstico , Pericardite/cirurgia , Supuração , Tomografia Computadorizada por Raios X
16.
Cureus ; 11(8): e5381, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31616612

RESUMO

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a condition caused by the replacement of the normal right ventricular myocardium with fibrofatty tissue. ARVC/D can present with a variety of clinical conditions including right ventricular dysfunction, ventricular tachyarrhythmias, sudden cardiac arrest, and sudden cardiac death (SCD). Since the first report of ARVC/D in 1982, many advances have been made in the diagnosis, genetic findings for pathology, and treatment. The 2010 International Task Force diagnostic criteria distinguish between major and minor criteria and focus on gross structural changes, microscopic changes, repolarization defects, conduction defects, arrhythmias, and family history. Implantable cardiac defibrillators and catheter ablation of the endocardium and epicardium with electromagnetic mapping have emerged as successful tools in the treatment and prevention of ventricular tachyarrhythmias and SCD. This review discusses the pathophysiology, genetics, diagnosis, and treatment advances in ARVC/D.

17.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653638

RESUMO

Amiodarone is an antiarrhythmic agent that is used commonly in clinical practice. It is associated with many side effects, the most common being pulmonary manifestations. Interstitial pneumonitis is one of the most common complications, however rarely amiodarone can cause diffuse alveolar haemorrhage (DAH) too. We describe the case of a 73-year-old woman who presented with shortness of breath and haemoptysis 4 days after starting amiodarone. She was diagnosed with amiodarone-induced DAH based on imaging and bronchoalveolar lavage. She was treated with intravenous and then oral steroids, and amiodarone was discontinued. The patient made a significant clinical and radiological recovery. She was discharged 10 days after her presentation. This case highlights a rare but potentially life-threatening complication of a commonly used medication.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Hemorragia/induzido quimicamente , Doenças Pulmonares Intersticiais/induzido quimicamente , Idoso , Diagnóstico Diferencial , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/tratamento farmacológico , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Radiografia , Esteroides/uso terapêutico
18.
BMJ Case Rep ; 12(11)2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31780604

RESUMO

Anastrozole is an aromatase inhibitor that has been used more frequently over the last decade especially for oestrogen receptor-positive breast cancer. It has a relatively safe side effect profile. However, occasionally it has been associated with serious adverse events. Here, we present the case of a 58-year-old woman who presented with significantly elevated liver enzymes 4 years after starting anastrozole. She was not taking any other medications and an extensive workup did not reveal any other cause for her liver injury. The patient's liver enzymes normalised after discounting the anastrozole. She scored 4 on the updated Roussel Uclaf Causality Assessment Method grading system which was possible for drug-induced liver injury. A review of the literature revealed six prior cases of anastrozole-related liver injury. Anastrozole should be considered as a possible culprit in patients who develop an unexplained acute liver injury.


Assuntos
Anastrozol/efeitos adversos , Antineoplásicos Hormonais/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
19.
Cardiol Res ; 10(3): 150-156, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31236177

RESUMO

BACKGROUND: Conflicting data exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on intervention timings. It is believed that short staffing at night hours may lead to a lapse in the delivery of effective, efficient and timely medical intervention. METHODS: A retrospective single-center study was performed, and a total of 436 patients were randomized into two groups. Group A had 279 patients who had the heart catheterization done during the daytime (between 6 am and 6 pm), while group B had 157 patients who had the same intervention performed at night (between 6 pm and 6 am). RESULTS: Door to balloon (DTB) time during the day was about 16 min shorter than the DTB time at night (81.29 ± 3.26 vs. 97.30 ± 8.54) with no statistical difference (P = 0.051). The mean troponin rise during the day was 1.94 ± 10.60 SEM (95% confidence interval (CI): -22.70 to 18.90) higher than night troponin levels (71.75 ± 7.18 vs. 69.80 ± 7.18), but P value was 0.85. The left ventricular ejection fraction (LVEF) fall for daytime was 0.93% vs. 0.90% for night time patients (P = 0.94). CONCLUSION: There is no significant difference in the mean DTB time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient's time of presentation between the two groups.

20.
Artigo em Inglês | MEDLINE | ID: mdl-32002152

RESUMO

Background: Great saphenous vein (GSV) grafts are used for coronary artery bypass surgeries, but the remaining stump of the GSV may be the nidus for superficial and deep vein thrombosis. This study aims to determine the risk of thrombosis in the GSV stump in patients who developed lower extremity swelling following coronary artery bypass graft (CABG). Methods: We conducted a single-center retrospective analysis at Abington Jefferson Hospital of 100 patients who underwent CABG with GSV. Patients were monitored via follow-up for seven days for the development of saphenous vein thrombosis without any prophylactic anticoagulation for venous thrombosis. Risk factors including age, diabetes, hypertension, smoking, familial thrombophilia's, family history of thrombosis, malignancy, and confounding factor-like early mobilization that may potentially alter the results were recorded. Results: The mean age of included patients was 70 years, and 65% of participants were men, 35% were women. Fourteen percent of the patients developed pain, swelling and edema in a leg where the graft was taken. We included patients aged >50 years with coronary artery disease who underwent CABG with SVG and developed lower extremity symptoms concerning for thrombosis. These patients underwent duplex ultrasound for possible GSV stump thrombosis. Any patients with coronary artery disease but no CABG or no lower extremity edema were excluded from the study. We found no saphenous vein thrombosis in the stump of the GSV in patients with clinical symptoms of thrombosis in their lower extremities based on duplex imaging. Conclusion: Based on our findings, the postoperative risk of developing thrombosis at the GSV stump and its extension to the deep veins is low and does not warrant prophylactic anticoagulation for venous thromboembolism. However, we recommend that further prospective studies with larger samples for an extended duration are warranted for better assessment of the risk of venous thrombosis in the GSV stump with minimal confounding factors.

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