Ultrasound-guided cyanoacrylate injection for the treatment of incompetent perforator veins.

OBJECTIVE: The use of cyanoacrylate products (CA) in incompetent perforator vein (IPV) treatment has not been thoroughly examined. The primary objective of this study is to describe the technique of ultra sound guided direct injection of IPV with CA, and secondarily to determine early closure rates and safety of this technique. METHODS: A retrospective analysis of patients undergoing IPV injection at two centres between 2015-2018 was conducted. Demographics, CEAP classification and IPV location were collected. Outcomes were assessed at two follow-up appointments. RESULTS: A total of 83 perforator vein injections were completed. CEAP classifications include C2 - C6 classes. Location of perforators were posteromedial (6%), femoral canal (9%), paratibial (14%), and posterior-tibial (71%). IPV closure rates were 96.3% at initial follow-up (16 ± 2 days). Closure rates decreased to 86.5% at second follow-up (72 ± 9 days). There were no deep vein thromboses during follow-up. One patient developed septic thrombophlebitis that was successfully managed with antibiotics. CONCLUSION: Ultrasound-guided CA glue injection is a simple and low risk procedure that effectively closes incompetent perforator veins.

Massive transfusion in upper gastrointestinal bleeding: a new scoring system.

Background: Massive transfusion in patients with upper gastrointestinal bleeding (UGIB) was not investigated. We developed a new scoring system to predict massive transfusion and to enhance care and early resource mobilization. Methods: Massive transfusion was defined as transfusion with ≥10 units of red blood cells within the first 24 h. Data were extracted from a 10-year, six-hospital database. Logistic regression was applied to derive a risk score for massive transfusion using data from 2006 to 2010, in 24,736 patients (developmental cohort). The score was then validated using data from 2011 to 2015 in 27,449 patients (validation cohort). Area under the receiver operating characteristic (AUROC) curve was performed to assess prediction accuracy. Results: Five characteristics were independently associated (p < .001) with massive transfusion: presence of band-form cells among white blood cells (band form >0), international normalized ratio (INR) >1.5, pulse >100 beats per minute or systolic blood pressure <100 mmHg (shock), haemoglobin <8.0 g/dL and endoscopic therapy. The new scoring system successfully discriminated well between UGIB patients requiring massive transfusion and those who did not in both cohorts (AUROC: 0.831, 95%CI: 0.827-0.836; AUROC: 0.822, 95% CI: 0.817-0.826, respectively). Conclusions: The new scoring system predicts massive transfusion requirement in patients with UGIB well. Key messages Massive transfusion is a life-saving management in massive upper gastrointestinal bleeding. How to identify patients requiring massive transfusion in upper gastrointestinal bleeding is poorly documented. Approximately 3.9% of upper gastrointestinal bleeding patients require massive transfusion. A new scoring system is developed to identify patients requiring massive transfusion with high accuracy.

Organic carbon and elemental carbon associated with PM(10) in Beijing during spring time.

A continuous observation of organic carbon (OC) and elemental carbon (EC), and PM(10) was conducted at an urban site of Beijing to investigate the characterization of carbonaceous aerosols during spring time. The mean value and standard deviations of OC, EC, PM(10) concentration, and OC/EC ratio were 13.5+/-7.0 microg m(-3), 7.1+/-4.1 microg m(-3), 187.8+/-136.9 microg m(-3), and 2.0+/-0.4, respectively. OC, EC, and total carbonaceous aerosols (TCA) in PM(10) account for 9.3+/-5.7%, 4.7+/-2.7%, and 19.6+/-11.6%, respectively. Good correlations (R(2)=0.7) between OC and EC were observed in spring season. Average OC concentrations are 13.5 microg m(-3) in both daytime and nighttime. Average EC concentrations in daytime (7.4 microg m(-3)) are slightly higher than those in nighttime (6.8 microg m(-3)). Both OC and EC concentrations reach maximum value in morning time (07:30-10:30) due to motor vehicles during the traffic rush hour. PM(10), OC, and EC concentration increase while PM(2.5) concentration, OC/EC ratio, PM(2.5)/PM(10), and TCA/PM(10) ratio decrease in dust period in Beijing. During the observation period, the carbonaceous aerosols from motor vehicle and coal combustion accounted for 76% and 24%, respectively. It shows that the motor vehicle represents the dominant emitter of carbonaceous aerosols associated with PM(10) in Beijing during spring time.

Laparoscopic aortic reconstruction: early experience.

BACKGROUND: Laparoscopic reconstruction of the abdominal aorta has been described as early as 1993. The techniques used have varied but all have been labor intensive. With advances in laparoscopic technique and the available tools, the role in aortic reconstruction is expanding. The high cost of endovascular techniques as well as the morbidity of traditional open surgery has resulted in an increased focus on the laparoscopic approach. Our goal was to determine the feasibility of this technique. METHODS: Retrospective review of the charts of patients undergoing laparoscopic aortobifemoral bypass grafting for chronic lower-limb occlusive disease. RESULTS: Thirteen patients were selected for the procedure. Ten were completed successfully and form the basis of the report. The average length of stay was 6.7 days compared with a historic cohort of 12 days. The average operative time was 6.5 hours, more than twice as long as the open technique. There was a tendency to lower blood replacement and less abdominal pain. One patient suffered a stroke postoperatively; no deaths occurred. CONCLUSION: This procedure is technically challenging but can be performed safely and successfully with adherence to several key anatomic principles. More widespread adoption of this technique may lead to improvements in the instruments and other technologies. Our very early experience is encouraging. There appear to be benefits of reduced length of stay, but improved operative times will be required to make this technique truly valuable.

Endovascular repair of a ruptured renal artery aneurysm.

PURPOSE: To describe the percutaneous treatment of a ruptured renal artery aneurysm (RAA) using a stent-graft. CASE REPORT: An 86-year-old woman had sudden onset of right-sided back pain and a swollen left leg. Computed tomography disclosed a right retroperitoneal mass involving the kidney; the inferior vena cava was compressed, with thrombus in the left common iliac artery. There was a suggestion of RAA associated with contrast extravasation. Angiography confirmed a saccular aneurysm of the distal right main renal artery immediately proximal to the first segmental branch. A Jostent peripheral stent-graft was implanted with complete exclusion of the lesion. At 6-month follow-up, the patient remained asymptomatic, but there was a suggestion of in-stent restenosis, which is being followed closely. CONCLUSIONS: In elderly patients who are hemodynamically stable and have aneurysm anatomy that is suitable for stent-graft placement, the endovascular approach may allow rapid and definitive treatment of the hemorrhage.