Lipomas are extremely common benign soft tissue tumors that are usually subcutaneous and asymptomatic. However, an intramuscular lipoma, occurring adjacent to the proximal radius, may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. In this report, we describe an unusual case of a 48-year-old-woman with a posterior interosseous nerve syndrome due to an intramuscular lipoma. The patient had good recovery after surgery and rehabilitation physiotherapy.
In cardiac surgery patients, ARF often occurs on the secondto-third postoperative day, 4 when most patients have been discharged from the ICU. Therefore, the treatment of postoperative hypoxemia is part of the surgical ward handling, and studies demonstrating safety and effectiveness of the use of NIV to treat postoperative ARF outside the ICU are warranted. A few years ago, we performed an observational study on the safety of NIV application in the cardiac surgical ward to treat postoperative ARF, 5 whereas in the present study we have undertaken a randomized study of the efficacy of CPAP to treat postoperative hypoxemia. 1 Our results appear likely to carry external validity because we used pragmatic inclusion criteria and few exclusion criteria. CPAP is an inexpensive technique and is easy to apply. These features make it suitable to the main ward where there are no ventilators and where the staff-patient ratio is low. During our study, no CPAP-related complications were noted. However, we do not encourage a generalization of our protocol for all the cardiac surgery wards because the efficacyand safety of NIV outside of the ICU depend strongly on ward training, experience, monitoring capabilities, and organization. Preliminary and periodic training for all the staff, protocols, monitored beds, the possibility of prompt intubation when indicated, data collection and analysis of outcomes, and continuous quality improvement are all elements that are essential to make a ward fit for NIV.
Background.
Heart transplantation in cardiac amyloidosis (CA) patients is possible and generally considered for transplantation if other organs are not affected. In this study, we aimed to describe and assess outcome in patients following heart transplantations at our CA referral center.
Methods.
We assessed all CA patients that had heart transplantations at our center between 2005 and 2018. Patients with New York Heart Association status 3 out of 4, with poor short-term prognosis due to heart failure, despite treatment, and without multiple myeloma, systemic disease, severe neuropathic/digestive comorbidities, cancer, or worsening infections were eligible for transplantation. Hearts were transplanted by bicaval technique. Standard induction and immunosuppressive therapies were used. Survival outcome of CA patients after transplantation was compared with recipients with nonamyloid pathologies in France.
Results.
Between 2005 and 2018, 23 CA patients had heart transplants: 17 (74%) had light chain (light chain amyloidosis [AL]) and 6 (26%) had hereditary transthyretin (hereditary transthyretin amyloidosis [ATTRv]) CA. Also, 13 (57%) were male, and the mean age at diagnosis was 56.5 y (range, 47.7–62.8). Among AL patients, 13 had heart-only and 5 had heart-kidney transplantations. Among ATTRv patients, 1 had heart-only and 5 had heart-liver transplantations. The 1-y survival rate after transplantation was 78%, 70% with AL, and 100% with ATTRv. At 2 y, 74% were alive: 65% with AL and 100% with ATTRv.
Conclusion.
After heart transplantation, French CA and nonamyloid patients have similar survival outcomes. Among CA patients, ATTRv patients have better prognosis than those with AL, possibly due to the combined heart-liver transplantation. Selected CA patients should be considered for heart transplantations.
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