Lopezingram0826

The association of autoimmune disease (AI) with transplant-free survival in the setting of severe Group 3 pulmonary hypertension and extensive pulmonary fibrosis remains unclear. We report cases of severe pulmonary hypertension (mean pulmonary artery pressure ≥35 mmHg and right ventricular dysfunction) and extensive pulmonary fibrosis after pulmonary arterial hypertension-specific therapy. We used multivariate regression to determine the clinical variables associated with transplant-free survival. Of 286 screened patients, 55 demonstrated severe pulmonary hypertension and extensive pulmonary fibrosis and were treated with parenteral prostacyclin therapy. The (+)AI subgroup (n = 34), when compared to the (-)AI subgroup (n = 21), was more likely to be female (77% versus 19%) and younger (58.7 ± 12.1 versus 66.0 ± 10.7 years), and revealed lower forced vital capacity (absolute) (1.9 ± 0.7 versus 2.9 ± 1.1 L), higher DLCO (% predicted) (31.1 ± 15.2 versus 23.2 ± 8.0), and increased unadjusted transplant-free survion-specific therapy in Group 3 pulmonary hypertension.Recent studies have shown low high-density lipoprotein cholesterol (HDL-C) and dysregulated lipid metabolism in chronic thromboembolic pulmonary hypertension (CTEPH). Apolipoprotein A-I (ApoA-I) is the major protein component of HDL-C and mediates most of its functions. We hypothesize that ApoA-1 and its oxidative state might be more sensitive biomarkers in CTEPH. Plasma levels of HDL-C, ApoA-I, paraoxonase-1 enzyme activity (PON1), and the oxidized dysfunctional ApoA-I (oxTrp72-ApoA-I) were measured in patients with CTEPH and compared to those in healthy controls. AZD1480 price Association with markers of disease severity in CTEPH was assessed. We included a total of 61 patients with CTEPH (age 61.2 ± 15 years; male 52.5%) and 28 control subjects (age 60.1 ± 8 years; male 59.3%). When adjusting for age, sex, body mass index, and statin use, ApoA-I was lower in CTEPH compared to controls (CTEPH125.2 ± 27 mg/dl; control158.3 ± 29.4 mg/dl; p  less then  0.001), but HDL-C levels were not statistically different. There were no significant differences in PON and oxTrp72-ApoA-I/ApoA-I ratio. In exploratory analyses, ApoA-I was associated with mean right atrial pressure (rs = -0.32, p = 0.013) and N-terminal pro B-type natriuretic peptide (rs = -0.31, p = 0.038). There were no significant associations between HDL-C, PON1, or oxTrp72-ApoA-I/ApoA-I ratio and markers of disease severity. We conclude that ApoA-I is a more sensitive biomarker than HDL-C in CTEPH, and may be associated with right heart dysfunction.Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments, and in-hospital outcomes for all chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy in the German nationwide inpatient sample between 2006 and 2016. Overall, 1398 inpatients were included. Annual number of pulmonary endarterectomy increased from 67 in 2006 to 194 in 2016 (P  less then  0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P  less then  0.001). Patients' characteristics shifted slightly toward older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 (95%CI 1.01-1.05); P = 0.001), right heart failure (2.55 (1.37-4.76); P = 0.003), in-hospital complications such as ischemic stroke (6.87 (1.06-44.70); P = 0.044) and bleeding events like hemopneumothorax (24.93 (6.18-100.57); P  less then  0.001). Annual pulmonary endarterectomy volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of pulmonary endarterectomy, institutional experience, and patient selection is crucial and has improved over time.Totally implantable catheters tend to be the most popular choice because once installed they allow permanent access to a deep vein, which is gained by puncturing the port rather than a vein. In this article, we explain four cases of chemotherapy port complications superior vena cava (SVC) syndrome in a metastatic colorectal cancer patient who presented with bilateral mastitis, snare technique for removal of migrated catheter line, carotid artery placement of a port in a 5-year-old child that was referred to our hospital from a pediatric center and adhesive port tip in the heart that finally we left the port in situ. In SVC syndrome, treatment should be guided by the severity of symptoms, etiology of the obstruction, prognosis of the patient and treatment goals. We propose timely removal of port-a-cath following completion of intended chemotherapeutic regimen.Walled-off pancreatic necrosis is a challenging problem and pancreatic necrosectomy is associated with significant morbidity and mortality. Following necrosectomy, postoperative bile leak is a rare complication. We present such a case of delayed bile leak from the distal common bile duct in an 81-year-old lady following pancreatic necrosectomy, which was successfully managed by endoscopic stenting.A primiparous female developed acute large bowel obstruction Day 1 post lower segment Caesarean section. Initially presumed to be post-operative ileus, increasing abdominal pain and distension over the next 24 h prompted a surgical consult. Computed tomography imaging demonstrated an abrupt transition point of the large bowel behind a polymyomatous uterus. Although this case resolved with vigorous patient mobilization, literature review reveals previous cases resolving only after intraoperative mobilization of the uterus. It is distinct from ileus as bowel sounds are present, onset is abrupt, progression is rapid and mobilization of the uterus causes immediate resolution. This condition is likely to be more common than the literature would suggest, its scarcity partially due to the reluctance to image young females especially during pregnancy.