RÉSUMÉ
Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, with varying presentations and management challenges. Traditional treatment approaches often differ, particularly for submassive/intermediate-risk PEs, because of the lack of clear guidelines and comparative data on treatment efficacy. The introduction of pulmonary embolism response teams (PERTs) aims to standardize and improve outcomes in acute PE management through multidisciplinary collaboration. This review examines the conception, evolution, and operational mechanisms of PERTs while providing a critical analysis of their implementation and efficacy using retrospective trials and recent randomized trials. The study also explores the integration of advanced therapeutic devices and treatment protocols facilitated by PERTs. PERT programs have significantly influenced the management of both massive and submassive PEs, with notable improvements in clinical outcomes such as decreased mortality and reduced length of hospital stay. The utilization of advanced therapies, including catheter-directed thrombolysis and mechanical thrombectomy, has increased under PERT guidance. Evidence from various studies, including those from the National PERT Consortium, underscores the benefits of these multidisciplinary teams in managing complex PE cases, despite some studies showing no significant difference in mortality. PERT programs have demonstrated potentials to reduce morbidity and mortality, streamlining the use of healthcare resources and fostering a model of sustainable practice across medical centers. PERT program implementation appears to have improved PE treatment protocols and innovated advanced therapy options, which will be further refined as they are employed in clinical practice. The continued expansion of the capabilities of PERTs and the forthcoming results from ongoing randomized trials are expected to further define and optimize management protocols for acute PEs.
RÉSUMÉ
A 69-year-old woman with a history of heart failure with reduced ejection fraction presented for device interrogation of her cardiac implantable electronic device (CIED), revealing lead and pulse generator displacement. Surprisingly, she exhibited a narrow QRS on the ECG despite an underlying right bundle branch block, suggesting unintentional conduction system pacing (CSP). Traditional cardiac resynchronization therapy has been widely used for patients with heart failure, but alternatives like CSP are emerging as viable options. Given the global rise in CIED utilization, regular follow-up, device troubleshooting, and embracing remote monitoring are essential to manage and optimize patient outcomes.
Sujet(s)
Dispositifs de resynchronisation cardiaque , Thérapie de resynchronisation cardiaque , Défaillance cardiaque , Sujet âgé , Femelle , Humains , Bloc de branche/thérapie , Bloc de branche/physiopathologie , Électrocardiographie , Panne d'appareillage , Système de conduction du coeur/physiopathologie , Défaillance cardiaque/thérapie , Défaillance cardiaque/physiopathologieRÉSUMÉ
BACKGROUND: The efficacy of bariatric surgery may be in part attributed to altered metabolism via new gut microbiome. Milkfat may promote the growth of microbes that are beneficial in long-term weight loss. Understanding the specific gut microbiome changes after surgery and their relationship to milkfat consumption may yield important strategies for managing obesity after bariatric procedures. METHODS: In this pilot study, stool samples were collected from nine patients before and at the time of surgery, and at 1, 3, and 6 months post-surgery. At each time-point, dairy consumption was determined from dietary surveys. 16 s rRNA gene sequencing was performed followed by alpha diversity analysis. Comparisons of relative abundances of microbial taxa and analyses of fatty acids changes were performed. RESULTS: Bariatric surgery led to enrichment of (i) Roseburia, associated with weight loss and (ii) Christensenellaceae, inversely related to body mass index. High milk-fat consumption correlated with enrichment of Blautia, inversely associated with visceral fat accumulation. Faecalibacterium, possibly associated with obesity, increased in patients with low milk-fat consumption. Butter was associated with decreased alpha diversity in all subjects (p-value = 0.038) and the frequency of its use was associated with decreased alpha diversity in patients (correlation = - 0.68, p-value = 0.042). Low-milk-fat consumers showed higher concentration of saturated fatty acids. CONCLUSIONS: Our results suggest that incorporating dairy products in post-bariatric-surgery dietary plans may help cultivate a gut microbiome that is effective in regulating fat storage as well as digesting beneficial metabolites. These observations will be helpful for the management of obesity in general population as well.
Sujet(s)
Chirurgie bariatrique , Microbiome gastro-intestinal , Obésité morbide , Chirurgie bariatrique/méthodes , Microbiome gastro-intestinal/physiologie , Humains , Obésité/microbiologie , Obésité/chirurgie , Obésité morbide/chirurgie , Projets pilotes , Perte de poids/physiologieRÉSUMÉ
CASE: A 24-year-old woman with chondrosarcoma of the superior pubic ramus underwent a Type III pelvic resection through an ilioinguinal approach, modified with anterior superior iliac spine (ASIS) osteotomy. The osteotomy mobilized the ASIS and sartorious distally, exposing the anterior wall and superior ramus. A custom cutting guide was placed on the anterior acetabular wall for en bloc superior ramus resection with hip-sparing osteotomy and negative margins. CONCLUSION: ASIS osteotomy for sartorius mobilization improves visualization of the anterior column of the acetabulum and heals more reliably than sartorius tenotomy, therefore should be considered during tumor resection involving the anterior column, superior ramus, or acetabular wall.
Sujet(s)
Tumeurs osseuses , Chondrosarcome , Acétabulum/chirurgie , Adulte , Femelle , Ostéosynthèse interne , Humains , Ostéotomie , Jeune adulteRÉSUMÉ
INTRODUCTION: Adjuvant therapy is recommended in duodenal adenocarcinoma (DA), but the role of neoadjuvant therapy remains undefined. We compared the effect of neoadjuvant therapy to adjuvant therapy on overall survival, 30-day, and 90-day mortality following the resection of DA. METHODS: A retrospective review of the National Cancer Database was performed on patients with DA who received either adjuvant or neoadjuvant therapy in addition to surgical resection. Propensity score matching was done for patient, socioeconomic, and tumor characteristics. Overall survival, 30-day, and 90-day mortality were compared. RESULTS: A total of 112 patients were identified; 55 received adjuvant therapy; 57 received neoadjuvant therapy. There was no difference in 30-day (0% vs. 1.75%; P = 1.00), 90-day mortality (1.82% vs. 7.02%; P = .36), nor overall survival (1 yr: 86% vs. 76; 3 yr: 49% vs. 46%; 5 yr: 42% vs. 39%; P = .28). CONCLUSIONS: There was no difference in overall survival after propensity score matched analysis.