A rare cause of acute pancreatitis: Hantavirus infection.

Hantaviruses cause potentially fatal two different systemic infectious diseases in humans named as hemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome. The clinical features of HFRS are hemorrhage, fever, thrombocytopenia and acute renal insufficiency frequently observed. HFRS shows distinctive clinical manifestations throughout from acute influenza-like febrile illness to shock. Although a large portion of HRFS patients present with a complaint of abdominal pain, acute pancreatitis is a rare complication of HFRS. No specific treatment protocol has been described for HRFS and supportive treatment is the basic approach. The rate of success enhanced with early diagnosis and intensive care support. Clinicians should be alert to the HFRS in patients with acute pancreatitis associated with systemic viral infection. We describe a case with HFRS who has presented with acute kidney injury, thrombocytopenia and acute pancreatitis. The patient was treated by supportive management successfully.

Procedural sedation during transradial coronary angiography to prevent spasm.

AIM: Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm. PATIENTS AND METHODS: Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method. RESULTS: In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05). CONCLUSION: Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.

Ceraflex versus Amplatzer occluder for secundum atrial septal defect closure. Multicenter clinical experience.

AIM: The Ceraflex atrial septal defect occluder is an alternative device to the Amplatzer septal occluder with some structural innovations including flexible connection, increased flexibility, and minimized amount of implant material. We evaluated the efficiency and safety of the Ceraflex septal occluder device in percutaneous closure of secundum atrial septal defects. PATIENTS AND METHODS: This was a prospective, nonrandomized, multicenter study of patients undergoing transcatheter closure for an atrial septal defect with the Ceraflex and the Amplatzer septal occluder devices. A clinical evaluation and follow-up transthoracic echocardiography were performed at 1, 6, and 12 months. RESULTS: Between 2010 and 2014, 125 patients underwent atrial septal defect closure with the Ceraflex septal occluder (n = 58) and the Amplatzer septal occluder (n = 67) under transesophageal echocardiography guidance. Patient characteristics, the stretched size of the defect, device size, and fluoroscopy time were similar between the groups. The immediate and follow-up complete occlusion rates for both groups were 100%. There was no device embolization, procedure-related stroke, or pericardial effusion. CONCLUSIONS: The Ceraflex septal occluder is a safe and efficient device for closure of secundum atrial septal defects with no procedural complications. The Ceraflex has similar outcomes when compared with the Amplatzer septal occluder device. The advantage of the Ceraflex septal occluder device is that it can be deployed without the tension of the delivery catheter.