Ahmad Dawalibi, Muhammad Atif Mazhar, Sadia Qazi, P. Ganguly, Ayman Behiery
{"title":"Vascular Abnormalities in a Pelvic Ectopic Kidney: How a Dissection-Based Program Improves the Knowledge of Clinical Anatomy","authors":"Ahmad Dawalibi, Muhammad Atif Mazhar, Sadia Qazi, P. Ganguly, Ayman Behiery","doi":"10.1055/s-0042-1756486","DOIUrl":"https://doi.org/10.1055/s-0042-1756486","url":null,"abstract":"Anatomy is a vital basic science for safe and effective medical practice and its significance increases several folds when it is taught in a clinically relevant manner. In today's time-compressed modern medical curricula, the importance of dissection-based anatomy programs is integral to teaching–learning outcome. Sound anatomical knowledge is critical to safe clinical and surgical practice as it is fundamental to the career of future doctors. In this pictorial essay, we present a case of a left ectopic pelvic kidney during one of the faculty-guided dissection sessions at the Alfaisal University. Such an anomaly motivated students to perform further meticulous dissection and to engage in detailed discussions after identifying associated abnormal findings. It is believed that these practices at the very start of the medical journey of students will effectively enhance their clinical reasoning skills by integrating basic and clinical anatomy.","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45778646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Involvement of AGE and Its Receptors in the Pathogenesis of Hypertension in Elderly People and Its Treatment.","authors":"Kailash Prasad","doi":"10.1055/s-0042-1756175","DOIUrl":"10.1055/s-0042-1756175","url":null,"abstract":"<p><p>Both systolic and diastolic blood pressures increase with age up to 50 to 60 years of age. After 60 years of age systolic pressure rises to 84 years of age but diastolic pressure remains stable or even decreases. In the oldest age group (85-99 years), the systolic blood pressure (SBP) is high and diastolic pressure (DBP) is the lowest. Seventy percent of people older than 65 years are hypertensive. This paper deals with the role of advanced glycation end products (AGE) and its cell receptor (RAGE) and soluble receptor (sRAGE) in the development of hypertension in the elderly population. Plasma/serum levels of AGE are higher in older people as compared with younger people. Serum levels of AGE are positively correlated with age, arterial stiffness, and hypertension. Low serum levels of sRAGE are associated with arterial stiffness and hypertension. Levels of sRAGE are negatively correlated with age and blood pressure. Levels of sRAGE are lower in patients with arterial stiffness and hypertension than patients with high levels of sRAGE. AGE could induce hypertension through numerous mechanisms including, cross-linking with collagen, reduction of nitric oxide, increased expression of endothelin-1, and transforming growth factor-β (TGF-β). Interaction of AGE with RAGE could produce hypertension through the generation of reactive oxygen species, increased sympathetic activity, activation of nuclear factor-kB, and increased expression of cytokines, cell adhesion molecules, and TGF- β. In conclusion, the AGE-RAGE axis could be involved in hypertension in elderly people. Treatment for hypertension in elderly people should be targeted at reduction of AGE levels in the body, prevention of AGE formation, degradation of AGE in vivo, downregulation of RAGE expression, blockade of AGE-RAGE interaction, upregulation of sRAGE expression, and use of antioxidants.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803554/pdf/10-1055-s-0042-1756175.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Classification and Stratification of Pulmonary Embolisms.","authors":"Cody Russell, Suresh Keshavamurthy, Sibu Saha","doi":"10.1055/s-0042-1756218","DOIUrl":"https://doi.org/10.1055/s-0042-1756218","url":null,"abstract":"<p><p>Pulmonary embolism remains a leading cause of cardiovascular mortality. Presentation and outcomes are variable among patients and require rapid risk stratification for assessment and prognosis, as well as selection of appropriate treatment. Over the past several decades, several different models and parameters have become available to assess risk and classify pulmonary embolism into different risk categories. Some patients may be candidates for early discharge or complete outpatient treatment, while some may require invasive diagnostics and intensive monitoring. In this review, we summarize contemporary guidelines and methods for classification and risk stratification in an effort to provide tools for physicians to use in their management of patients with acute pulmonary embolisms.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507558/pdf/10-1055-s-0042-1756218.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10492936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnosis, Diagnostic Tools, and Risk Stratification for Contemporary Treatment of Pulmonary Embolism.","authors":"Taylor C Remillard, Arber Kodra, Michael Kim","doi":"10.1055/s-0042-1756177","DOIUrl":"https://doi.org/10.1055/s-0042-1756177","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is quite common and is associated with significant morbidity and mortality. It is estimated that it is the cause of approximately 100,000 annual deaths in the United States. With great variability in presenting symptoms of PE, poor recognition of PE can be fatal. As such, many risk scores have been created to identify the sickest patients. Choosing the appropriate imaging modality is also critical. Invasive pulmonary angiography was once the gold standard to establish the diagnosis. With the advent of nuclear imaging, V/Q scans, invasive angiography has been phased out for diagnosing acute PE. At present, the standard for diagnosis of acute PE is computed tomography pulmonary angiography. In select patient cohorts, nuclear studies remain the modality of choice. Once the diagnosis of acute PE is established, there is a broad spectrum of severity in outcome which has led to substantial focus and development of risk stratification prediction models. We will discuss making the proper diagnosis with contemporary diagnostic tools and risk stratifying patients with PE to receive the correct treatment.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507591/pdf/10-1055-s-0042-1756177.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scarlett Tohme, Joshua S Newman, Christopher Gasparis, Frank Manetta
{"title":"Massive Embolism: Knife versus PCI.","authors":"Scarlett Tohme, Joshua S Newman, Christopher Gasparis, Frank Manetta","doi":"10.1055/s-0042-1755573","DOIUrl":"https://doi.org/10.1055/s-0042-1755573","url":null,"abstract":"<p><p>Pulmonary embolism is the third most common cardiovascular syndrome with an estimated up to 25% of patients presenting with sudden death. For those who survive, a mainstay of management for patients with hemodynamic stability is anticoagulation; however, recommendations and options are rapidly changing for patients with submassive or massive pulmonary embolism with hemodynamic instability. Catheter-based and surgical approaches offer efficacious management options for unstable patients or patients with contraindications to anticoagulation; however, both approaches have inherent benefits and risk. This article seeks to offer a brief review on the recommendations and options for management of pulmonary embolism from both surgical and catheter-based perspectives.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507597/pdf/10-1055-s-0042-1755573.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10409982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James J Glazier, Skarlet Patiño-Velasquez, Carlos Oviedo
{"title":"The Pulmonary Embolism Response Team: Rationale, Operation, and Outcomes.","authors":"James J Glazier, Skarlet Patiño-Velasquez, Carlos Oviedo","doi":"10.1055/s-0042-1750328","DOIUrl":"https://doi.org/10.1055/s-0042-1750328","url":null,"abstract":"<p><p>The pulmonary embolism response team (PERT) is an institutionally based multidisciplinary team that is able to rapidly assess and provide treatment for patients with acute pulmonary embolism (PE). Intrinsic to the team's structure is a formal mechanism to execute a full range of medical, endovascular, and surgical therapies. In addition, the PERT provides appropriate multidisciplinary follow-up of patients. In the 10 years since the PERT was first introduced, it has gained acceptance in many centers in the United States and around the world. These PERTs have joined together to form an international association, called the PERT Consortium. The mission of this consortium is to advance the diagnosis, treatment, and outcomes of patients with PE. There is considerable evidence that the PERT model improves delivery and standardization of care of PE patients, particularly those patients with massive and submassive PE. However, it is not yet clear whether PERTs improve clinical outcomes. A large prospective database is currently being compiled by the PERT Consortium. Analysis of this database will likely further delineate the role of PERTs in the management of intermediate-to-high risk PE patients and, importantly, help determine in which PE patients PERT may improve clinical outcomes.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507552/pdf/10-1055-s-0042-1750328.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10445615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jimmy Kerrigan, Michael Morse, Elias Haddad, Elisabeth Willers, Chand Ramaiah
{"title":"Advances in Percutaneous Management of Pulmonary Embolism.","authors":"Jimmy Kerrigan, Michael Morse, Elias Haddad, Elisabeth Willers, Chand Ramaiah","doi":"10.1055/s-0042-1756174","DOIUrl":"https://doi.org/10.1055/s-0042-1756174","url":null,"abstract":"<p><p>Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide. Systemic anticoagulation remains the recommended treatment for low-risk PE. Systemic thrombolysis is the recommended treatment for PE with hemodynamic compromise (massive/high-risk PE). A significant number of patients are not candidates for systemic thrombolysis due to the bleeding risk associated with thrombolytics. Historically, surgical pulmonary embolectomy (SPE) was recommended for massive PE with hemodynamic compromise for these patients. In the last decade, catheter-directed thrombolysis (CDT) has largely replaced SPE in the patient population with intermediate risk PE (submassive), defined as right heart strain (as evidenced by right ventricle enlargement on echocardiogram and/or computed tomography, usually along with elevation of troponin or B-type natriuretic peptide). Use of CDT increased in the last few years due to high incidence of PE in hospitalized patients with coronavirus disease 2019 pneumonia, and the use of mechanical thrombectomy (initially reserved for those with contraindications to thrombolysis) has also grown. In this article, we discuss the value of the PE response team, our approach to management of submassive (intermediate risk) and massive (high risk) PE with systemic thrombolytics, CDT, mechanical thrombectomy, and surgical embolectomy.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507563/pdf/10-1055-s-0042-1756174.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10492935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen Moreland, Debabrata Mukherjee, Nils P Nickel
{"title":"Contemporary Treatment of Pulmonary Embolism: Medical Treatment and Management.","authors":"Stephen Moreland, Debabrata Mukherjee, Nils P Nickel","doi":"10.1055/s-0042-1750329","DOIUrl":"https://doi.org/10.1055/s-0042-1750329","url":null,"abstract":"<p><p>Pulmonary embolus (PE) is defined as obstruction of the pulmonary artery or one of its branches by material (e.g., thrombus, tumor, air, or fat) but most commonly due to thrombus originating from the lower extremity deep veins. We reviewed the current literature describing the optimal medical treatment and management of PE. Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL) were searched for relevant studies and guidelines for management of patients with PE. The initial approach to patients with suspected PE should focus upon stabilizing the patient while further workup for risk stratification is in progress. In most cases, anticoagulation should ideally be started even prior to confirming PE, if risk-benefit regarding suspicion of PE and bleeding risk is favorable. Once the diagnosis is confirmed, risk stratification will guide further therapies consisting of anticoagulation, thrombolysis, or catheter-directed interventions. Data for initial, long-term, and indefinite anticoagulation, and factors that determine whether or not a patient can be treated in the outpatient setting, are reviewed and discussed.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507607/pdf/10-1055-s-0042-1750329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9832970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly.","authors":"Kahtan Fadah, Aimee Hechanova, Debabrata Mukherjee","doi":"10.1055/s-0042-1751234","DOIUrl":"10.1055/s-0042-1751234","url":null,"abstract":"<p><p>Elderly patients over the age of ≥ 75 years are especially susceptible to coronary artery disease (CAD) as age is an important nonmodifiable risk factors for atherosclerosis and a predictor of poorer outcomes. In fact, CAD is a major cause of mortality and morbidity in this population. Due to concerns of functional frailty, comorbidities, and patient preference of conservative to no treatment have played a role in reducing the interest in pursuing prospective studies in this high-risk group. In this review, we provide an overview of the epidemiology, pathophysiology, and management of CAD in older adults.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803549/pdf/10-1055-s-0042-1751234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed Farhan, Muhammad A Latif, Anum Minhas, Clifford R Weiss
{"title":"Cardiac and Hemodynamic Manifestations of Hereditary Hemorrhagic Telangiectasia.","authors":"Ahmed Farhan, Muhammad A Latif, Anum Minhas, Clifford R Weiss","doi":"10.1055/s-0042-1745842","DOIUrl":"10.1055/s-0042-1745842","url":null,"abstract":"<p><p>The autosomal dominant trait hereditary hemorrhagic telangiectasia (HHT) causes multiorgan dysplastic lesions of the vasculature that can activate multiple physiological cascades leading to a broad array of cardiovascular diseases. Up to 78% of patients with HHT develop hepatic arteriovenous malformations (AVMs), which cause a hyperdynamic circulatory state secondary to hepatic/portal shunting. This condition can eventually progress to high-output cardiac failure (HOCF) with continued peripheral tissue hypoxemia. Treatment for HOCF is often limited to supportive measures (diuretics and treatment of anemia); however, recent studies using systemic bevacizumab have shown promise by substantially reducing the cardiac index. In the context of liver AVMs and high cardiac output, the pulmonary vasculature can also experience high flow. Without adequate dilation of pulmonary vessels, post-capillary pulmonary hypertension can develop. Another form of pulmonary hypertension observed in HHT, pulmonary arterial hypertension, is caused by HHT-related mutations in <i>ENG</i> and <i>ACVRL1</i> causing congestive arteriopathy. Post-capillary pathogenesis is addressed by reducing the high-output state, whereas the pre-capillary state is treated with supportive mechanisms (diuretics, oxygen) and agents targeting pulmonary vasoreactivity: endothelin-1 receptor antagonists and phosphodiesterase-5 inhibitors. If either form of pulmonary hypertension is left untreated or proves refractory and progresses, the common hemodynamic complication is right heart failure. Targeted right heart therapies involve similar strategies to those of pulmonary arterial hypertension, with several experimental approaches under study. In this review, we describe in detail the mechanisms of pathogenesis, diagnosis, and treatment of the hemodynamic complications and associated cardiovascular diseases that may arise in patients with HHT.</p>","PeriodicalId":13798,"journal":{"name":"International Journal of Angiology","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341259/pdf/10-1055-s-0042-1745842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9765027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}