Objectives: The influence of race or ethnicity on limb loss after traumatic vascular injury is unclear. We sought to determine whether there were racial differences in rates of amputation between American Indians, blacks, Asians, and Hispanics compared to white patients following arterial axillosubclavian vessel injury (ASVI), femoral artery injury (FAI), or popliteal artery injury (PAI). As black race has been identified as an independent prognostic factor for postsurgical complication in trauma-associated lower extremity amputation, we further hypothesized that black race would be associated with a higher risk for limb loss after arterial ASVI, FAI, and PAI injury in a large national database. Methods: The National Trauma Data Bank was queried for patients 16-years-old with arterial ASVI, FAI, or PAI to determine the risk of arm, above knee amputation (AKA), and below knee amputation (BKA), respectively. Covariates were included in separate multivariable logistic regression models for analysis. The reference group included white trauma patients. Results: From 5,683,057 patients, 21,843 were identified with arterial ASVI, FAI, or PAI (<0.4%). For arterial ASVI, American Indian race was associated with higher risk for upper-extremity amputation as compared to white race (OR ¼ 5.10, CI ¼ 1.62e16.06, p < 0.05). For FAI, black race was associated with (OR ¼ 0.66, CI ¼ 0.49e0.89, p < 0.05) a lower risk of AKA, compared to white race. For PAI, race was not associated with risk for BKA. Conclusion: Black race is associated with a lower risk of AKA after FAI, compared to whites. Race was not associated with a risk for limb loss after PAI. Future prospective studies examining socioeconomic factors and access to healthcare within this patient population is warranted to identify barriers and areas of improvement.
Background Pertuzumab has improved pathologic complete response rates when compared with other chemotherapeutics in the treatment of HER‐2 positive breast cancer patients. Aims We sought to determine if axillary lymph node dissections (ALNDs) yielding at least the national standard of 10 lymph nodes is lower in patients who received neoadjuvant pertuzumab. Methods and Results A retrospective database identified patients who underwent ALND for breast cancer. We compared the axillary lymph node retrieval rates in those who received or did not receive neoadjuvant pertuzumab. Of 139 breast cancer patients who underwent ALND, fewer than 10 axillary lymph nodes were found in 41.7% of patients who received neoadjuvant pertuzumab (P < 0.01) and 18.6% of patients who received neoadjuvant therapy without pertuzumab (P = 0.01). Conclusion Neoadjuvant chemotherapy was associated with a significantly lower rate of “adequate” ALNDs as defined by current guidelines. The patient subset that received neoadjuvant pertuzumab was more likely to have fewer than 10 axillary lymph nodes retrieved.
The objective of this study is to describe the contemporary management of proximal upper extremity and neck arterial injuries by comparing open and endovascular repair at a single institution. This is a retrospective study of 22 patients that sustained subclavian, axillary, and carotid artery injuries from 2011 to 2016 that were managed with open or endovascular repair. There were nine subclavian, eight axillary, and five carotid artery injuries of which 10 (45.5%) underwent endovascular repair and 12 (54.5%) underwent open repair. There was no statistically significant difference between the groups including injury severity score or preoperative hypotension. There were no deaths in the endovascular group, and three (25.0%) deaths in the open group. All patients in the endovascular group were discharged home. In the open group, seven (58.3%) patients had at least one inpatient complication with a mean of 1.1 (standard deviation 1.4) complications per patient. In the endovascular group, there were three (30.0%) patients with inpatient complications and a mean of 0.4 (standard deviation 0.7) complications per patient (P = 0.18). Endovascular management of nonaortic cervicothoracic arterial injuries was successfully performed in hypotensive patients and patients with other life threatening traumatic injuries. Further studies are warranted to look at long-term patency of these repairs and to help develop a protocol to guide decision-making in the management of cervicothoracic injuries.
were all found to be independent risk factors for postoperative embolization. These factors did not confer increased risk to patients undergoing CEA. Conclusions: Patients undergoing CAS are at higher risk for postoperative embolization. The risk for postoperative embolization is related to the length of the lesion and calcification. Identifying the preoperative risk factors may help to guide selection of patients and thereby reduce embolization-related neurocognitive impairment. Further work to understand how microembolization affects neurocognitive impairment is also under way.
Severe haemolytic anaemia is a rare complication of prosthetic valve thrombosis (PVT). Emergent surgical replacement of the affected valve is normally the treatment of choice unless contraindicated, such as in high surgical risk patients. Systemic thrombolysis is the alternative to surgical valve replacement. The purpose of this report is to highlight the unique case of an elderly man with New York Heart Association class IV heart failure, history of extensive cardiopulmonary surgeries and haemorrhagic stroke, who presented with severe haemolytic anaemia secondary to prosthetic mitral valve thrombosis. After weighing the risks and benefits, our decision was to use systemic thrombolytic therapy, even in light of the patient's previous intracranial haemorrhage. Pretreatment and post-treatment Doppler echocardiography showed markedly reduced regurgitant jetting that ultimately resolved completely, thereby eliminating the underlying cause of haemolysis and achieving symptom resolution.
Background: South Sudan became an independent state on July 9 2011, after having endured two civil wars with Republic of the Sudan lasting 51 years. Over the 51 years approximately 300,000 South Sudanese were abducted and in held in captivity in the Republic of the Sudan. The South Sudanese abductees suffered abuse and deprivation. Presently it is estimated that 35,000 are still in captivity. Assessing the health status of returning South Sudanese citizens immediately after their return is imperative. The aim of this report is to examine the effect of captivity on heart rate, (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and basic chemistry panel between men and women. Methods: In March of 2013, an American medical team performed health assessments for 48 hours in the state of Bahr el Gazal located in the northwest region of South Sudan. All returnees received health assessments within four days of their return. Health assessments defined as returnees’ demographics, along with their full history and physical examination. During physical exam height, weight, SBP, DBP, and HR, electrolytes and blood urea nitrogen (BUN) were recorded and analyzed. Results: Analysis was run on 186 participants, 50.5% (94) male, and 49.5% (92) female. Females were significantly younger at age of abduction, whereas men spent a significantly longer time in captivity (Table). SBP and DBP were significantly higher in males compared to females, even after adjusting for Age (p = 0.002, p = 0.036). HR was significantly less in males compared with females, even when adjusting for age (p < 0.001). BUN was significantly lower in females compared to males adjusting for age (p < 0.001) Conclusion: Although a majority of measurements in both men and women slaves returning to South Sudan fell within normal ranges, it is crucial to continue to monitor this group’s cardiovascular health because their deprivation while in captivity may have significantly impacted their health and risk for long term cardiovascular disease.
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