Air bubbles are released by thoracic endograft deployment: An in vitro experimental study

Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft. Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe. Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and from <0.025 to 0.04 mL for Gore TAG. The largest bubbles had a diameter of approximately 3 mm and came from the proximal end of the Medtronic Valiant device. Conclusion: Air bubbles are released from thoracic endografts during deployment. Air embolism may be an alternative cause of stroke during thoracic endovascular aortic repair

Air bubbles are released by thoracic endograft deployment: An in vitro experimental study

Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft.Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe.Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and fro

Air bubbles are released by thoracic endograft deployment: An in vitro experimental study

Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft.Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe.Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and fro

Plateletkrit ve Trombosit Dağılım Genişliği Koroner Arter Ektazisinin Bağımsız Öngördürücüsüdür

Giriş: Koroner arter ektazisi (KAE), koroner arterlerin anormal genişlemesi ile karakterize edilir. Ortalama trombosit hacmi (OTH), trombosit dağılım genişliği (TDG), plateletkrit (PKT) dahil olmak üzere trombosit hacmi endeksleri ve trombosit sayısı trombosit aktivasyonunun göstergeleridir. Bu çalışmada KAE'li hastalarda trombosit hacmi endeksleri incelendi. Hastalar ve Yöntem: Çalışmaya, izole KAE'si olan 51 (38 erkek; ortalama yaş: 52 + 9.9 yıl) hasta ve koroner arterleri normal olan 50 (39 erkek; ortalama yaş: 54 + 11.3 yıl) sağlıklı birey dahil edildi. Başvuruda trombosit hacmi endeksleri otomatik tam kan sayımı parçası olarak ölçüldü. Bulgular: Trombosit sayımı, OTH, PKT ve TDG, KAE grubunda kontrol grubuna göre daha yüksekti (p<0.05). Çok değişkenli lojistik regresyon analizinde, TDG (Odds oranı: 0.22, %95 güven aralığı: 0.06-0.73,p= 0.013) ve PKT'nin (Odds oranı: 3.41, %95 güven aralığı: 1.66-6.98, p<= 0.001) KAE'nin bağımsız öngördürücüleri olduğu gösterildi. Sonuç: Bu çalışma, PKT ve TDG'nin KAE'nin bağımsız belirleyicileri olduğunu göstermektedir.Introduction: Coronary artery ectasia (CAE) is characterised by an abnormal dilatation of the coronary arteries. Platelet volume indices, including the mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) and platelet count, are indicators of platelet activation. In this study, we investigated platelet volume indices in patients with CAE. Patients and Methods: The study group included 51 patients (38 men; mean age: 52 ± 9.9 years) with isolated CAE and 50 individuals with normal coronary arteries (39 men; mean age: 54 ± 11.3 years). Admission platelet volume indices were measured as part of the automated complete blood count. Results: Platelet count, MPV, PCT and PDW were higher in CAE than in the control group (p< 0.05). Multivariate analysis revealed PDW (odds ratio: 0.22, 95% confidence interval: 0.06-0.73, p= 0.013) and PCT (odds ratio: 3.41, 95% confidence interval: 1.66-6.98, p<= 0.001) as independent predictors of CAE. Conclusion: This study demonstrates that PCT and PDW are independent predictors of CAE

Outcomes and prognostic factors in patients with HER2-positive metastatic breast cancer with brain metastasis

Background:Breast cancer is the most common malignancy in females. Brain metastasis is a poor prognostic factor in breast cancer. Brain metastasis can develop in about half of the HER2- positive metastatic breast cancer patients. The study was aimed to determine outcomes and prognostic factors in HER2 positive metastatic breast cancer patients who had brain metastasis.Methods:We evaluated the HER2-positive metastatic breast cancer patients with brain metastasis between 2008 and 2018. Data of the patients were recorded retrospectively. Kaplan Meier and Cox regression analysis were used for survival analysis and prognostic factors.Results:Eighty-three patients were included in the study. The median age was 49 (range, 25-76). Thirty-two (38.6%) patients had de-novo metastatic disease at diagnosis. The most common histopathological type was invasive ductal carcinoma (88.4%). The estrogen receptor and progesterone receptor positivity ratios were 42.2% and 28.9%, respectively. At the beginning of brain metastasis, the median number of extra-cranial metastasis was 2 (range, 0-4). The most common extra-cranial metastasis sites were bone (63.9%), liver (41%), and lung (34.9%), respectively. Twenty-eight patients (41.8%) had solitary brain metastasis. The median size of brain metastasis was 16 mm (range, 5-63) at diagnosis. All patients had treated with trastuzumab-based chemotherapy, 29 patients (34.9%) TDM-1, and 73 patients (88%) lapatinib+capesitabine combination. Seventeen patients (20.5%) had undergone craniotomy, and 82 patients (98.8%) received brain radiotherapy. The patients also received hormonotherapy (41%) and bisphosphonates (56.6%). At a median follow-up of 36 months (range 5.9-177.7) from beginning metastasis, the median overall survival was 34.9 months (95% CI, range 24.6-45.2). In multivariate analysis, age at diagnosis (p = 0.005), presence of five and over brain metastasis (p = 0.016), the number of chemotherapy used with trastuzumab (p = 0.017), and receiving three different HER2-targetted therapy (p = 0.032) were statistically significant for overall survival. However, size of brain metastasis (p = 0.091), lung metastasis (p = 0.428), liver metastasis (p = 0.338), bone metastasis (p = 0.132), and hormone positivity of tumor (p = 0.238) were not.Conclusions:Real-life outcomes of HER2-positive breast cancer patients with brain metastases were presented in this study. We showed that age at diagnosis, number of brain metastasis, number of chemotherapy received with trastuzumab, and had received three different HER2 targetted therapy was prognostic factors for overall survival

Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey

The purpose of the present study is to evaluate the prognostic factors of patients with renal cell carcinoma. The treatment results such as distant metastasis-free survival and overall survival of 59 previously untreated patients were retrospectively analysed. Median follow-up was 17.5 months (3.8-88.5 months). Overall survival was 22.4 months (3-87 months). Distant metastasis developed in 35 (59%) patients. The Eastern Cooperative Oncology Group (ECOG) performance status (P = 0.022), tumour size (P = 0.025) and lymphatic invasion (P < 0.0001) were significantly effective prognostic factors for distant metastasis-free survival on multivariate analysis. Related to overall survival, gender (P = 0.025), ECOG performance status (P = 0.027), nuclear grade (P = 0.002), tumour size (P = 0.029), T stage (P = 0.044), nodal involvement (P = 0.003), surgical margin (P = 0.046), renal sinus invasion (P < 0.0001), perineural growth (P = 0.001) and lymphatic invasion (P < 0.0001) were significant prognostic factors on univariate analysis. Gender (P = 0.008), ECOG performance status (P = 0.027), tumour size (P = 0.025) and lymphatic invasion (P < 0.0001) retained their significance on multivariate analysis. We concluded that the most important prognostic factors for patients with renal cell carcinomas are ECOG performance status, tumour size and lymphatic invasion

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

WOS: 000384041400052PubMed ID: 27583892This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients