Subject(s)
Mohs Surgery , Skin Neoplasms , Humans , Patient Satisfaction , Quality of Life , Skin Neoplasms/surgeryABSTRACT
BACKGROUND: Among many other factors, restrictions on sleeping positions decrease quality of life after durable left ventricular assist device implantation. Specifically, device manufacturers and clinicians typically advise against sleeping in the prone position owing to concerns for driveline disruption, exit site infection, and hemodynamic compromise. Yet, no data exist to inform these recommendations and to the best of our knowledge no studies have examined sleep position in people with left ventricular assist devices. We report the first case of a person with a left ventricular assist device who slept prone, every night, for over one year. CASE: This is a 38-year-old man with a HeartWare™ left ventricular assist device who had previously not disclosed that he was sleeping in the prone position for the 16 months following device implantation. The patient did not suffer any episodes of device-related malfunction, infection, neurologic insult, or hemodynamic compromise. We performed a non-invasive assessment in both supine and prone positions to better understand the hemodynamic effects of the prone position. CONCLUSION: In select recipients of left ventricular assist devices, sleeping in the prone position may be safely tolerated.
Subject(s)
Heart Failure , Heart-Assist Devices , Male , Humans , Adult , Quality of Life , Heart Failure/therapy , Hemodynamics , SleepABSTRACT
A woman in her late 30s recently diagnosed with viral myopericarditis presented with 1 month of worsening fatigue, diffuse myalgias and chest pain radiating to her back. While undergoing work-up for chest wall myositis, she rapidly decompensated, developing heart failure and acute hypoxaemic respiratory failure. Her clinical course was complicated by cardiac arrest and severe cardiogenic shock requiring intra-aortic balloon pump support.
Subject(s)
Heart Arrest , Myocarditis , Myositis , Female , Heart Arrest/complications , Heart Arrest/therapy , Humans , Intra-Aortic Balloon Pumping/adverse effects , Myocarditis/complications , Myocarditis/diagnosis , Myositis/complications , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapyABSTRACT
A 67-year-old African-American woman with remote history of complete heart block (s/p pacemaker 3 years ago) and recent onset of ventricular tachycardia (VT) (s/p VT ablation and cardiac resynchronisation therapy defibrillator upgrade 3 months ago) presented to the hospital with VT storm. Workup showed newly reduced left ventricular ejection fraction with global hypokinesis (20%) and restrictive physiology. Positive technetium pyrophosphate scan was suspicious for TTR amyloid while serological workup revealed a monoclonal gammopathy. Cardiac MRI was contraindicated given remote brain aneurysm clip. Given clinical suspicion for cardiac sarcoidosis and divergent non-invasive workup, endomyocardial biopsy was performed which showed non-necrotising granulomas consistent with cardiac sarcoidosis. She was started on steroids with clinical improvement. Cardiac sarcoidosis is a challenging clinical diagnosis, particularly in patients without extracardiac manifestations. This case highlights the importance of a detailed and thorough workup of non-ischaemic cardiomyopathy and being cognizant of infiltrative disease as it can change patient management and outcomes.
Subject(s)
Cardiomyopathies/diagnosis , Sarcoidosis/diagnosis , Tachycardia, Ventricular/diagnosis , Aged , Biopsy , Cardiomyopathies/drug therapy , Cardiomyopathies/pathology , Diagnosis, Differential , Electrocardiography , Female , Humans , Sarcoidosis/drug therapy , Sarcoidosis/pathology , Steroids/therapeutic useABSTRACT
OBJECTIVE: To examine sociodemographic and audiometric factors associated with hearing aid (HA) uptake in adults with hearing loss (HL), and to investigate the role of self-perceived hearing status on pursuit of hearing treatment. The relationship between self-perceived hearing status and HA adoption has not been reported in a nationally representative sample of United States (US) adults. STUDY DESIGN: Cross-sectional analysis of nationwide household health survey. METHODS: Audiometric and questionnaire data from the 2005 to 2012 National Health and Nutrition Examination Survey cycles were used to examine trends in untreated HL and HA adoption in US adults. Adjusted odds ratios for HA adoption were calculated for individuals with measured HL. RESULTS: Of 5230 respondents, 26.1% had measurable HL, of which only 16.0% correctly self-identified their hearing status, and only 17.7% used an HA. Age, higher education, severe hearing impairments, and recent hearing evaluations, were positively associated with HA adoption. CONCLUSION: Hearing loss is a global public health concern placing significant economic burden on both the individual and society. Self-reported hearing status is not a reliable indicator for HL, and measured HL is not correlated with increased rates of treatment. Recent hearing evaluation is positively associated with increased rates of treatment. Routine hearing assessment will help to better identify those with HL and improve access to hearing treatment. LEVEL OF EVIDENCE: III Laryngoscope, 131:E289-E295, 2021.
Subject(s)
Hearing Aids/statistics & numerical data , Hearing Loss/therapy , Patient Acceptance of Health Care/statistics & numerical data , Self Report , Adult , Aged , Aged, 80 and over , Audiometry, Pure-Tone , Cross-Sectional Studies , Female , Hearing Loss/epidemiology , Humans , Male , Middle Aged , Nutrition Surveys , United States/epidemiologyABSTRACT
INTRODUCTION: Dermoscopy is a noninvasive, in vivo imaging technique that allows for the visualization of subsurface skin structures. In recent years, several education interventions have incorporated dermoscopy in the primary care setting to improve skin cancer detection. We aim to describe the perspectives, attitudes, and interest of primary care physicians (PCPs) regarding dermoscopy. METHODS: PCPs associated with academic institutions completed an anonymous survey emailed to faculty and resident listservs. The survey consisted of 23 questions related to dermoscopy. RESULTS: A total of 156 PCPs completed the questionnaire. Few PCPs reported having access to a dermatoscope (16%), using it regularly (9%), or having received training (15%). The most common reasons for not using a dermatoscope were the lack of access to the device (85%), followed by the lack of training (76%). However, the majority view dermoscopy as a valuable tool in primary care and are interested in receiving training (87%), particularly with a hands-on approach. CONCLUSION: Our sample of PCPs in the United States showed that although few use dermoscopy, most perceive it as a useful tool, particularly family medicine physicians. The main reported barriers preventing its use included the lack of training and poor access to dermatoscopes. The vast majority of PCPs in our sample want to be trained in dermoscopy, thereby providing an opportunity for educational initiatives that take into account the barriers and preferred learning strategies.
Subject(s)
General Practitioners , Physicians, Primary Care , Skin Neoplasms , Dermoscopy , Humans , Primary Health Care , Surveys and Questionnaires , United StatesABSTRACT
OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
Subject(s)
Anxiety/epidemiology , Craniocerebral Trauma/epidemiology , Depression/epidemiology , Headache/epidemiology , Refugees/statistics & numerical data , Stress Disorders, Post-Traumatic/epidemiology , Violence/statistics & numerical data , Adolescent , Adult , Anxiety/psychology , Brain Concussion/epidemiology , Brain Concussion/psychology , Craniocerebral Trauma/psychology , Cross-Sectional Studies , Depression/psychology , El Salvador/ethnology , Female , Guatemala/ethnology , Haiti/ethnology , Headache/psychology , Honduras/ethnology , Humans , Male , Memory Disorders/epidemiology , Memory Disorders/psychology , Mexico/ethnology , Nicaragua/ethnology , Odds Ratio , Patient Health Questionnaire , Prevalence , Psychological Trauma/epidemiology , Psychological Trauma/psychology , Refugees/psychology , Retrospective Studies , Sex Distribution , Sex Offenses/psychology , Sex Offenses/statistics & numerical data , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/psychology , Stress Disorders, Post-Traumatic/psychology , Unconsciousness/epidemiology , Unconsciousness/psychology , United States/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/psychology , Young AdultSubject(s)
Health Knowledge, Attitudes, Practice , Hispanic or Latino/psychology , Skin Neoplasms/ethnology , White People/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Florida/epidemiology , Humans , Male , Middle Aged , Quality of Life , Risk Factors , Skin Neoplasms/prevention & control , Skin Neoplasms/psychology , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes. METHODS: Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement. RESULTS: Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (P=0.75, P=0.41), clinical success rate (P=0.26), and in-hospital mortality (P=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis. CONCLUSIONS: In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.
Subject(s)
Device Removal/methods , Endovascular Procedures/methods , Sternotomy , Aged , Defibrillators, Implantable/adverse effects , Equipment Failure , Female , Follow-Up Studies , Humans , Jugular Veins , Male , Prospective StudiesABSTRACT
Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.
Subject(s)
Aortic Valve/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Aged , Computed Tomography Angiography/methods , Female , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/surgery , HumansABSTRACT
BACKGROUND: Superior vena cava (SVC) tears are one of the most lethal complications in transvenous lead extraction. An endovascular balloon can occlude the SVC in the event of a laceration, preventing blood loss and offering a more controlled surgical field for repair. An early study demonstrated that proper use of this device is associated with reduced mortality. Thereafter, high-volume extractors at the Eleventh Annual Lead Management Symposium developed a best practice protocol for the endovascular balloon. METHODS: We collected data on adverse events in lead extraction from July 1, 2016, to July 31, 2018. Data were prospectively collected from both a US Food and Drug Administration-maintained database and physician reports of adverse events as they occurred. We gathered case details directly from extracting physicians. Confirmed SVC tears were analyzed for patient demographics, case details, and index hospitalization mortality. RESULTS: From July 1, 2016, to July 31, 2018, 116 confirmed SVC events were identified, of which 44.0% involved proper balloon use and 56.0% involved no use or improper use. When an endovascular balloon was properly used, 45 of 51 patients (88.2%) survived in comparison to 37 of 65 patients (56.9%) when a balloon was not used or improperly used (P=0.0002). Furthermore, multivariate regression modeling found that proper balloon deployment was an independent, negative predictor of in-hospital mortality for patients who experienced an SVC laceration (odds ratio, 0.13; 95% CI, 0.04-0.40; P<0.001). CONCLUSIONS: From July 1, 2016, through July 31, 2018, patients undergoing lead extraction were more likely to survive SVC tears when treatment included an endovascular balloon.
Subject(s)
Balloon Occlusion/methods , Device Removal/adverse effects , Electrodes, Implanted/adverse effects , Endovascular Procedures/methods , Intraoperative Complications , Vascular System Injuries/surgery , Vena Cava, Superior/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Phlebography , Retrospective Studies , Treatment Outcome , Vascular System Injuries/diagnosis , Vascular System Injuries/etiology , Vena Cava, Superior/diagnostic imaging , Vena Cava, Superior/injuriesABSTRACT
Abstract Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.
Subject(s)
Humans , Female , Aged , Aortic Valve/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Computed Tomography Angiography/methods , Heart Neoplasms/surgery , Heart Neoplasms/pathology , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imagingABSTRACT
INTRODUCTION: Patch testing is the gold standard for evaluating allergic contact dermatitis (ACD), yet current interpretation methods are limited by their subjectivity and possible variability between observers. Optical coherence tomography (OCT) imaging enables noninvasive in vivo skin visualization and holds promise as an objective method of patch test interpretation. OBJECTIVE: To evaluate the micromorphological changes of patch test reactions and identify objective, quantitative OCT markers that correlate with clinically graded patch test reactions. RESULTS: A total of 25 patch test reactions (7 grade-0, 4 grade-1+, 14 grade-2+) from 7 patients underwent OCT evaluation. Increased epidermal thickness and density was qualitatively observed in grade 1+ and grade 2+ allergic reactions while well-demarcated, signal-free cavities were observed in all grade 2+ reactions. Attenuation coefficients significantly increased across the three reaction grades (2.58 ± 0.092, 2.96 ± 0.121, 3.05 ± 0.065; P < 0.01). Cutaneous blood flow at 0.35 mm monotonically increased with reaction grade severity and blood measurements significantly differed across the three reaction grades (0.053 ± 0.011 mm/s, 0.078 ± 0.015 mm/s, and 0.121 ± 0.008 mm/s; P < 0.01). CONCLUSIONS AND RELEVANCE: Attenuation coefficient and cutaneous blood flow at 0.35 mm correlate with clinically graded patch test reactions and hold promise as objective, quantitative markers. OCT may help dermatologists differentiate clinical scoring of allergic reactions in patch test and thereby improve their diagnostic accuracy and interpretation of patch test reactions.
Subject(s)
Dermatitis, Allergic Contact/diagnosis , Patch Tests/methods , Analysis of Variance , Blood Flow Velocity/physiology , Dermatitis, Allergic Contact/physiopathology , Female , Humans , Male , Middle Aged , Pilot Projects , Tomography, Optical CoherenceABSTRACT
The use of cardiac implantable electronic devices (CIEDs) has continued to rise along with indications for their removal. When confronted with challenging clinical scenarios such as device infection, malfunction or vessel occlusion, patients often require the prompt removal of CIED hardware, including associated leads. Recent advancements in percutaneous methods have enabled physicians to face a myriad of complex lead extractions with efficiency and safety. Looking ahead, emerging technologies hold great promise in making extractions safer and more accessible for patients worldwide. This review will provide the most up-to-date indications and procedural approaches for lead extractions and insight on the future trends in this novel field.
ABSTRACT
BACKGROUND: Many clinicians use the strategy of prophylactically placing an endovascular balloon before transvenous lead extraction, yet there are no data regarding this practice. OBJECTIVE: This study assesses long-term outcomes of prophylactic placement of an endovascular balloon in the venae cavae of patients during transvenous lead extraction. METHODS: From April 1, 2016 to March 31, 2017 data were prospectively collected at 2 international cardiovascular centers on patients who had the balloon prophylactically placed in the venae cavae. Patients were monitored for a minimum of 3 months to capture any associated adverse events. RESULTS: Twenty-one patients had the balloon prophylactically placed in the venae cavae during lead extraction. Sixteen patients were male (76%); the mean age was 57.6 ± 18.7 years; and the mean body mass index was 26.1 ± 4.4 kg/m2. The mean lead dwell time was 11.2 ± 8.3 years, with an average of 2.2 ± 1.1 leads per case, and most indications for extraction were noninfectious (62%). Two minor complications (10%, pocket hematomas) and 1 major complication (5%, cardiac tamponade) occurred during the procedure. All cases (100%) were procedural successes, and all patients (100%) were discharged alive. On follow-up (6.8 ± 3.7 months), all patients were alive and reported no adverse events related to prophylactic balloon placement, such as pulmonary emboli or deep venous thrombi. CONCLUSION: During the study period, we observed no acute or long-term adverse outcomes associated with prophylactic placement of an endovascular balloon in the venae cavae of patients undergoing transvenous lead extraction.
Subject(s)
Catheterization, Peripheral/adverse effects , Defibrillators, Implantable/adverse effects , Device Removal/adverse effects , Endovascular Procedures/methods , Postoperative Complications/prevention & control , Pulmonary Embolism/prevention & control , Surgery, Computer-Assisted/methods , Equipment Design , Female , Fluoroscopy , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Retrospective Studies , Risk Factors , Time Factors , United States/epidemiology , Venae CavaeABSTRACT
BACKGROUND: Superior vena cava (SVC) lacerations have been identified as the most lethal complication encountered during cardiac implantable electronic device lead extraction. The case fatality rate of these events approximates 50% due to rapid exsanguination. A novel, compliant balloon specifically designed for use in the SVC may provide hemostasis in the event of endovascular perforation. By temporarily occluding the compromised vessel, the endovascular balloon should delay hemodynamic collapse, provide a more controlled surgical field for repair, and thereby reduce the mortality of SVC tears complicating transvenous lead extraction. OBJECTIVE: To assess the early impact of the compliant endovascular balloon on the management of SVC tears and survival outcomes. METHODS: We searched a publicly available, United States Food and Drug Administration-maintained database for adverse events from 1 manufacturer of lead extraction tools. Reports from July 1, 2016, to December 31, 2016 were reviewed by 2 physicians to identify instances of SVC tears. Extracting physicians were contacted for further case details. Confirmed SVC tears were analyzed for patient demographics, repair strategies, and index hospitalization mortality. RESULTS: Of the complications reported, 35 cases of surgically confirmed SVC tears were identified. One hundred percent of patients (9/9) were discharged alive when the endovascular balloon was properly utilized, compared to 50% of patients (13/26) when the device was not used (P = .0131). Differences between all other variables analyzed were statistically insignificant. CONCLUSION: During the study period, we observed a reduction in mortality in patients who suffered SVC tears while undergoing lead extraction when treatment included an endovascular balloon.