ObjectivesTo evaluate the efficacy and long‐term safety of transulnar approach in complex coronary interventions.BackgroundThe success rate of transulnar approach in complex coronary interventions and its long‐term safety remains to be proven.MethodsWe conducted a retrospective chart review of patients undergoing transulnar coronary angiography and interventions at our institution from January 2004 through July 2009. Primary endpoint of the study was the success rate of the procedure. Secondary endpoints were major bleeding, local vascular and neurological complications, cerebrovascular accident (CVA)/transient ischemic attack (TIA), myocardial infarction (MI), all‐cause mortality, and major adverse cardiovascular events (MACE) rate that was a composite of MI, CVA/TIA, and all‐cause mortality.ResultsOf 81 patients undergoing transulnar approach, 41 (50.6%) patients underwent intervention on 65 lesions. Twelve percent of the interventions were performed on coronary bypass grafts and 9.2% on the left main coronary artery. Success rates for transulnar access, coronary angiography, and coronary/bypass graft interventions were 93.8%, 100%, and 92.6%, respectively. Follow‐up data was available on 71 patients at short term (30 days) and 58 patients at long term (1 year). At 30‐day follow‐up, vascular complication rate was 2.8 %. At 1‐year follow‐up, there were no residual deficits from vascular or neurological complications associated with the index procedure and the overall MACE rate was 3.4%.ConclusionIn this first study evaluating long‐term safety and feasibility of transulnar coronary angiography and complex coronary interventions, we conclude that transulnar approach appears to be safe and effective. © 2013 Wiley Periodicals, Inc.

We sought to evaluate the safety & efficacy of same day percutaneous coronary intervention (PCI) & carotid artery stenting(CAS) in patients with coronary artery disease(CAD) and extracranial cerebrovascular disease (eCVD). We analyzed patients undergoing CAS at a tertiary care center between June

Abuzetun, Jamil Y.; Satpathy, Ruby; Suker, Manar; Elder, Mahir; Mooss, Aryan Author Information

Journal of Palliative MedicineVol. 13, No. 6 Letters to the EditorPalliative Chemotherapy: An Outdated Term for Life-Prolonging Systemic Therapies for Incurable MalignanciesWilson I. Gonsalves, Jamil Abuzetun, and Peter T. SilbersteinWilson I. GonsalvesSearch for more papers by this author, Jamil AbuzetunSearch for more papers by this author, and Peter T. SilbersteinSearch for more papers by this authorPublished Online:2 Jul 2010https://doi.org/10.1089/jpm.2009.0403AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Palliative Chemotherapy: An Outdated Term for Life-Prolonging Systemic Therapies for Incurable Malignancies." , 13(6), p. 641FiguresReferencesRelatedDetails Volume 13Issue 6Jun 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Wilson I. Gonsalves, Jamil Abuzetun, and Peter T. Silberstein.Palliative Chemotherapy: An Outdated Term for Life-Prolonging Systemic Therapies for Incurable Malignancies.Journal of Palliative Medicine.Jun 2010.641-641.http://doi.org/10.1089/jpm.2009.0403Published in Volume: 13 Issue 6: July 2, 2010PDF download

Chilaiditi sign is a radiological finding which describes the interposition of a part of the bowel between the diaphragm and the liver, a finding that can be misinterpreted as pneumoperitonium. Chilaiditi syndrome refers to a clinically symptomatic patient in the presence of the classical radiographic findings. It is a very rare syndrome which usually follows a benign course. Here we report the first documented case of Chiliaditi syndrome complicated by cecal perforation.

Agrypnia excitata is an extremely rare, life-threatening syndrome characterized by autonomic activation, persistent insomnia, and generalized overactivity. Agrypnia excitata describes a triad of three separate conditions: delirium tremens, Morvan's chorea, and familial fatal insomnia (FFI). Each of the aforementioned three conditions have sleep disturbances as a unifying theme and results in distinct neurophysiological findings. The following is an overview of agrypnia excitata with a particular emphasis placed upon each of the three individual conditions that constitute the syndrome with recommendations on appropriate management.

Cutaneous changes may be the first clue that a patient has liver disease. Recognizing these signs is crucial to diagnosing liver conditions early. Here we describe the spectrum of skin manifestations that may be found in various liver diseases.

Purpose of review Cancer patients may develop ocular complications secondary to direct or metastatic involvement with cancer, radiation exposure, or chemotherapy. As many as 1.4 million new cancer cases arise in the United States annually. Recent findings Chemotherapy administration remains a critical aspect of treating many cancers and offers improved prognosis and prolonged survival in many cases; however, these therapies are known to cause a wide range of toxicities. Summary Ocular side effects such as photophobia, cataracts, glaucoma, retinopathy, and other ocular toxicities have been reported following chemotherapy administration. To effectively treat cancer patients, oncologists, primary care clinicians, and ophthalmologists should be aware of the potential ophthalmic toxicities certain widely used chemotherapeutic agents and radiation therapy may pose to their patients, particularly in the setting of preexisting ocular conditions.

Agrypnia excitata is an extremely rare, life-threatening syndrome characterized by autonomic activation, persistent insomnia, and generalized overactivity. Agrypnia excitata describes a triad of three separate conditions: delirium tremens, Morvan's chorea, and familial fatal insomnia (FFI). Each of the aforementioned three conditions have sleep disturbances as a unifying theme and results in distinct neurophysiological findings. The following is an overview of agrypnia excitata with a particular emphasis placed upon each of the three individual conditions that constitute the syndrome with recommendations on appropriate management.

Management of hereditary angioedema should include fresh frozen plasma containing C1 inhibitor (C1-INH), whenever possible; if C1-INH-containing plasma is unavailable, fresh frozen plasma can be used instead. Do not give neomycin to patients with suspected cellulitis; the drug may promote antibiotic resistance in Staphylococcus aureus, a pathogen often associated with this condition. Whenever a patient presents with erythematous skin lesions and a recent history of receiving penicillin or a cephalosporin antibiotic, a sulfa derivative, or an anticonvulsant, the suspected medication should be stopped until Stevens-Johnson syndrome is ruled out.

One-hundred and thirteen patients between the ages of 15 and 88 years with biopsy proven, untreated Hodgkin lymphoma were treated by physicians in the Nebraska Lymphoma Study Group using the Stanford V regimen (bleomycin, doxorubicin, etoposide, mechlorethamine, prednisone, vinblastine and vincristine) between January 1997 and January 2006. With a median follow-up of all surviving patients of 63 months, the 5-year overall survival (OS) was 84% and the 5-year progression-free survival (PFS) was 74%. Age > 60 years, other than nodular sclerosing histological subtype, Ann Arbor Stage III/IV, and the presence of B-symptoms significantly predicted treatment outcome. Patients with 0-2 of these factors had a 5-year PFS and OS of 80% and 89% vs. 20% and 40% for patients with 3 or 4 factors. Patients who received radiotherapy had a superior 5-year PFS (86% vs. 42%) and OS (96% vs. 53%). Patients with 0-2 adverse risk factors who received radiotherapy had an excellent treatment outcome with 5-year PFS of 88% and a 5-year OS of 97%. The Stanford V chemotherapy regimen has an excellent treatment outcome for good prognosis patients with Hodgkin lymphoma. The results are compromised when radiotherapy is not utilized.

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a chronic sleep disorder characterized by complete or partial obstruction of the airway during sleep resulting in pauses in breathing (apneas) along with loud snoring, and frequent arousals from sleep. In addition to suffering from fragmented sleep and excessive daytime drowsiness, patients with OSAHS are at risk of serious ophthalmic complications including primary open-angle glaucoma (POAG), non-arteritic anterior ischemic optic neuropathy (NA-AION), idiopathic intracranial hypertension (IIH), and floppy eyelid syndrome. Effectively treating OSAHS can minimize long-term ocular complications. The authors review the common ocular complications associated with OSAHS and emphasize the need for early screening.

Wilson's disease and hereditary hemochromatosis are two inherited diseases with life-threatening complications. Early recognition and prompt treatment may be instrumental in reducing such complications associated with these disorders. Although both Wilson's disease and hereditary hemochromatosis are genetic in nature, the two conditions have distinct, unrelated genetic etiologies. Two distinct, separate mutations are required for simultaneous existence of the two diseases. As such, the likelihood of the two conditions coexisting is exceedingly rare. Here we report a case of a 23-year-old male with hereditary hemochromatosis with coexistent Wilson's disease. Only two reported cases exist in which this dual diagnosis was present simultaneously. In our patient, laboratory evaluation demonstrated elevated ferritin, transferrin saturation >90%, and subsequent liver biopsy demonstrated diffuse fibrotic changes. Confirmatory genetic analysis revealed the patient to be a compound heterozygous for C282Y and H63D gene mutations. Given the patient's young age and the improbability of hemochromatosis-induced hepatic damage at that age, an alternative diagnosis was sought. Further analysis revealed reduced serum ceruloplasmin along with elevated urinary copper excretion. Subsequent ophthalmologic exam revealed bilateral Kaiser Fleischer rings. In conclusion, Wilson's disease and genetic hemochromatosis both involve inherent flaws in the transportation of heavy metals and their accumulation in hepatocytes. Although both diseases arise from distinctly different genetic mutations, the coincidence of the two disorders can, in rare cases, occur.

Rhabdomyolysis is a potential adverse consequence of statin therapy. Here, we report a patient with prostate cancer being treated with simvastatin who developed rhab- domyolysis after coadministration with fluconazole. The rhabdomyolysis promptly resolved after discontinuation of fluconazole, suggesting the possible role of drug interaction in the development of rhabdomyolysis with coadministration of the two medications. Both simvastatin and fluconazole were promptly discontinued, and the patient was admitted to the intensive care unit, where vigorous hydration along with urine alkalinization led to resolution of rhabdomyolysis. Since statins are commonly prescribed treatments for individuals with hyperlipidemia, caution is advised in coadministration with azoles such as fluconazole. Although supportive treatment remains the mainstay of therapy for patients with rhabdomyolysis, fatal consequences can arise from hyperkalemia, cardiac arrhythmia, renal failure and disseminated intravascular coagulation.

Background We describe a case of transient left midventricular ballooning in 68-year-old male patient presented with picture of acute coronary syndrome. Case presentation The left ventriculogram showed mid ventricular akinesis and dilatation along with hypercontractile apex and basal segments. Follow up echocardiogram after one month showed resolution of wall motions abnormalities and normalization of the left ventricular function. Conclusion This is considered as a new variant of previously reported transient left ventricular apical ballooning; the only difference in our case is the location of wall motions abnormalities.