Ipsilateral lower extremity ischemia is a common and morbid complication during veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The cannula can impede ipsilateral distal arterial flow leading to critical limb ischemia. Cannula size, placement, and utilization of distal perfusion catheters are strategies that have been used to prevent this complication. We report the novel case of a 19-year-old female on VA-ECMO complicated by contralateral lower extremity ischemia. Diagnosis was made by computed tomography, and with repositioning of the femoral arterial cannula, she had a complete resolution of symptoms.
Background To determine if the extent of high‐dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16‐positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT). Methods We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre‐treatment PET–CT and restaging PET–CT within 4 months following completion of IMPT were analyzed. Results Sixty patients were included for analysis with a median follow‐up of 17 months. The median GTV to CTV expansion was 5 mm (IQR: 2 mm). Thirty‐three percent of patients (20 of 60) did not have a GTV to CTV expansion. There was one local failure within the expansion group (3%). Conclusion Excellent local control was achieved using IMPT for p16+ OPC independent of GTV expansion. IMPT with minimal target expansions represent a potential harm‐minimization technique for p16‐positive oropharynx cancer.
Introduction: Hyperlipidemia is a modifiable risk factor for stroke, with the magnitude of LDL-C reduction correlating to risk of recurrent ischemic stroke. A high-intensity statin is considered standard of care in addition to dietary modification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are used if the LDL-C target is not achieved despite maximally tolerated statins with ezetimibe. We investigated the role for PCSK9 inhibitors in our ischemic stroke population. Methods: An IRB approved retrospective review of patients admitted for acute ischemic stroke between 2019 – 2020 was performed. We estimated the probability of benefit from PCSK9 treatment with the following criteria: LDL > 190 regardless of treatment, LDL 161-190 on any dose statin therapy, and LDL 131-160 on high intensity statin therapy. Results: 774 patients with ischemic stroke were admitted during this time frame. Mean age 62.8 +/- 13.2 with 57% male (52% Black, 42% White). 584 (75%) of these patients had LDL above goal. One patient was on PCSK9 therapy on admission. Although the majority of our patients had uncontrolled cholesterol, only one additional patient would meet the strict prescription criteria for PCSK9 therapy of being adherent to maximal tolerated statin dose and ezetimibe with LDL above goal. Other potential patients with estimated benefit include LDL >190 (20 patients), LDL 161-190 (16 patients), LDL 131-160 (13 patients). In total this amounts to 6.7% of stroke patients who we would expect to need PCSK9 inhibitors in the future. Conclusion: Using conservative projections, we estimate that about 1 in 14 patients with ischemic stroke could benefit from PCSK9 therapy. Achieving LDL targets more consistently is a promising approach to decreasing the recurrent stroke rate. Further prospective data evaluating outcomes after initiating PCSK9 inhibitor treatment are needed to validate these findings.
To the Editor: Incorporating clinical experience into the preclinical years of medical school is vital to prepare students for clinical rotations. We present our experience leading and staffing the Cardiac Coaches program, a student-run pilot program that provides lifestyle-based counseling for recovering acute coronary syndrome (ACS) inpatients, including a telehealth counseling model we implemented during the COVID-19 pandemic.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.