Curēus
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Pulmonary embolism continues as a very common and also presumably life-threatening disorder. For affected individuals with intermediate- as well as high-risk pulmonary embolism, catheter-based revascularization procedures have developed a possible substitute for systemic thrombolysis or for surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is an innovative catheter-based approach; which is the main purpose of the present review article. ⋯ However, a direct comparison of ultrasound-assisted thrombolysis with systemic thrombolysis or surgical thrombectomy is not available. Ultrasound-assisted thrombolysis with early intrapulmonary thrombolytic bolus could also be successful in high-risk patients, but unfortunately, data from randomized trials is limited. This review article recapitulates existing information on ultrasound-assisted thrombolysis for acute pulmonary embolism.
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Introduction Brain death (BD) is the irreversible termination of the functioning of the brain. The diagnosis should be first made by clinical criteria and confirmed by using paraclinical confirmatory techniques (ancillary tests). While conventional brain angiography remains the standard method of choice, computed tomography angiography (CTA) has emerged as an alternative method. ⋯ Moreover, no opacification was observed in the internal cerebral veins (ICVs) or great cerebral vein (GCV). Conclusion The accuracy rate of CTA in the detection of intracranial circulatory arrest was 100%. CTA examinations confirmed BD diagnoses in all patients who had clinical and EEG BD diagnoses, and no confliction between CTA findings and clinical diagnoses was observed.
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Baastrup's disease or "kissing spines syndrome" was first described as a cause of lumbar pain before computerized tomography (CT) and magnetic resonance imaging (MRI) scanning existed. The diagnosis was based on x-ray studies, which showed that the spinous processes, especially in the lower lumbar spine, became approximated to each other and this was a generator of positional back pain. ⋯ Ligamentous stenosis and anterolisthesis would be the expected pathology with deterioration of these ligaments and were initially described on CT and MRI in patients with symptoms similar to Baastrup's disease as isolated individual case reports. This review will highlight the relationship between the various clinical presentations, biomechanics, and overlap of Baastrup's disease with interspinous bursitis, segmental stenosis, and instability, presenting them as a disease continuum rather than as separate disease processes.
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Cytomegalovirus (CMV) is a double-stranded DNA virus that is associated with clinically significant disease in patients with advanced immunosuppression, particularly those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). End-organ disease with CMV is classically associated with a CD4 cell count less than 50 cells/microliter. CMV colitis is the second most common manifestation of end-organ disease in this patient population. ⋯ These cases describe gastrocolic, enterocutaneous, enterocolic, rectovaginal, and colocutaneous fistulae. However, colovesical fistula has not been described previously. Here, we report the first case of CMV-associated colovesical fistula in a patient with HIV infection and AIDS.
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Review
Endovascular Management of Stroke Patients with Large Vessel Occlusion and Minor Stroke Symptoms.
Endovascular mechanical thrombectomy for stroke patients with large vessel occlusion (LVO) in the anterior circulation has become the standard of care based on several major randomized clinical trials. The successful result reported by these trials constitutes what may be the largest achievement in the history of neurological sciences. ⋯ To date, the evidence is lacking to support the mechanical thrombectomy in patients with acute stroke and LVO with minor to mild severity on NIHSS score. The purpose of this review was to assess the current data, safety and clinical outcomes in stroke patients with minor to mild symptoms who were treated with endovascular thrombectomy.