Can we use long PTFE graft for tibial bypass and limb salvage?

 

Generally, it is accepted that autogenous veins (GSVs) work better as Tibial artery bypass grafts. It could be due to the better compliance of the autogenous grafts with less intimal hyperplasia at the anastomotic junctions. Graft patency rate comes down as anastomosis goes down from the thigh to the ankle level. The photograph is showing the PTFE graft in the subcutaneous tissue and looks healthy. The surgeon feels happy to see such a result, but it is difficult to predict the future patency of the graft. Thrrombogenisity is high in such grafts, progressive vascular disease ( atherogenicity, intimal hyperplasia) make it difficult to predict patency.

Should IVC filters be retrieved or left behind?

 IVC filters are used to prevent pulmonary thromboembolism when the adequate anticoagulation is not effective, or contra indicated. There has been a tremendous growth in placement of retrievable IVC filters in the past decade, yet most of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include cava wall penetration, filter fracture or migration, cava thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter and should be individualized. The removal of IVC filters requires specific skills and expertise.

• Daye D, Walker TG. Novel and Advanced Techniques for Complex IVC Filter Retrieval. Curr Treat Options Cardiovasc Med. 2017 Apr;19(4):28. doi: 10.1007/s11936-017-0529-3.

Are we threatened by Monkeypox?

 

 

    Figure: Monkeypox

What is monkeypox?

We are all petrified by the emergence of another new virus and we are curious to know its potential to cause another havoc and pandemic.

Monkeypox is caused by the monkeypox virus, which belongs to a subset of the Poxviridae family of viruses called Orthopoxvirus. This subset includes smallpox, vaccinia, and cowpox viruses. While an animal reservoir for the monkeypox virus is unknown, African rodents are suspected to play a part in transmission. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name 'monkeypox.' The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox.

What does it cause?

It produces flu-like symptoms and also triggers enlargement of lymph nodes. Eventually, it produces distinctive fluid-filled lesions on the face, hands, and feet. Most people recover from monkeypox in a few weeks without treatment ( 4-5 weeks).

Monkeypox is related to smallpox or chickenpox?  It is more related to smallpox and the smallpox vaccine can provide protection to an extent of 85% from monkeypox.

Xenotransplantation

 Human organ donations such as kidney, liver, heart are saving the lives of the people with damaged organs. But there are not enough donors to meet the demand for organs.  The waiting lists are too long and many people are dying waiting for transplantation. How to over this hurdle? One of the way is to consider xeno-transplantation. Genetically modified pig is preferred for this organ transplantation. Kidneys from genetically modified pigs are transplanted in to the brain dead human beings and studied for 54 hours for acute rejection reaction, renal function improvement.  Dr . Richard Pierson, the scientific director for Transplantation science and a Professor of surgery at Harvard Medical School  gave an interview to Stephen Morrissey, Executive Managing Editor of NEJM.

The good side of it is, that we will be able to help needy patients. The negative side of it is that we are afraid of unknown viral injections jumping the species, like the AIDS virus. It was the reason for the initial refusal to consider the xeno-transplantations for some time. This can give rise to pandemics and we have to struggle to bring it down.

In this photo provided by the University of Maryland  School of Medicine, David Bennett Jr., right, stands next to his father’s hospital bed in Baltimore, Maryland on January 12, 2022, five days after doctors transplanted a pig heart into Bennett Sr., in a last-ditch effort to save his life. Bennett Sr., the first person to receive a heart transplant from a pig died on March 8, 2022, at the University of Maryland Medical Center, two months after the groundbreaking experiment. His death was announced on March 9, 2022. (University of Maryland School of Medicine via AP)

The Food and Drug Administration had allowed the dramatic Maryland experiment under “compassionate use” rules for emergency situations. Bennett’s doctors said he had heart failure and an irregular heartbeat, plus a history of not complying with medical instructions. He was deemed ineligible for a human heart transplant that requires strict use of immune-suppressing medicines, or the remaining alternative, an implanted heart pump.

 

Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study

 Indian J Med Res. 2018 May;147(5):471-476. doi: 10.4103/ijmr.IJMR_1844_16.Sandeep Mahapatra 1, Pinjala Ramakrishna 1, Bhumika Gupta 1, Arumalla Anusha 1, Muneer Ahmad Para 1

PMID: 30082571

 

PMCID: PMC6094506

DOI: 10.4103/ijmr.IJMR_1844_16

Free PMC article

Abstract

Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. 

Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. 

Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

Stockings and venous disease

 Stockings and venous disease

Stocking as a part of compression therapy is the common prescription given to the patients attending the vascular (venous) clinics. Stockings are usually pressure graded. The maximum pressure is at the bottom level (ankle) and as we go up, the pressures decrease. These pressure graded compression garments are expected to improve venous flows and reduce venous stasis and ambulatory venous pressures. The venous symptoms are linked with ambulatory venous pressures (AVP). The higher (>80mmHg) AVPs are associated with non-healing venous ulcers.

Modern compression socks were invented by Conrad Jobst, a dashing German engineer who lived in Toledo, Ohio.  He suffered from varicose veins. The compression socks, which he invented around 1950, were his flagship achievement. They are tightest near the ankle, but still pretty tight up top. They work by countering hydrostatic pressure in the wearer’s legs. After Conrad's death in 1957, his wife, Carolyn Jobst, successfully grew the business. Under her leadership, JOBST^® expanded its product lines to include Ready-to-Wear vascular garments, consumer support stockings, plastic and reconstructive surgery garments, and anti-embolism stockings. Sales extended to virtually every continent as the JOBST reputation for quality grew.