Search

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) describes an endovascular procedure in which a blocking balloon is introduced into the aorta to reduce bleeding situated distal to the balloon and simultaneously to improve cardiac and cerebral oxygenation. Objective: Presentation of the REBOA technique, the possible indications, the required material and possible complications of the procedure. Material and methods: Non-systematic review of the currently available literature. Results: The REBOA procedure is an adjunct to achieve hemodynamic stabilization in patients with traumatic hemorrhage and ruptured aortic aneurysms. The complication rate of the procedure is approximately 5%, whereby access complications are the most common; however, fatal complications are also possible. Conclusion: A balloon block of the aorta is well established in the treatment of ruptured aortic aneurysms. There is growing evidence that REBOA is a minimally invasive alternative to open surgical cross-clamping of the aorta by thoracotomy for the treatment of patients with polytrauma and hemorrhagic shock due to abdominal or visceral bleeding. Due to the development of new balloon catheters, which can be placed without stiff guidewires and require smaller sheath diameters, REBOA is also discussed for treatment of postoperative abdominal or gynecological bleeding or as a possible adjunct to cardiopulmonary resuscitation for nontraumatic cardiac arrest. [ABSTRACT FROM AUTHOR]

Metformin-induced lactic acidosis is a rare but severe disease for the individual patients. A case of a 64-year-old patient with diabetes mellitus type 2 suffering from this disease is presented where metformin accumulation was caused by prerenal acute kidney failure. The clinical evaluation up to the final diagnosis, the pathophysiology and the appropriate therapy are presented in detail. Additionally, the current guidelines regarding the perioperative management of metformin administration are summarized. The case described aims to direct attention to the rare but, nevertheless, severe symptoms of metformin-induced lactic acidosis. [ABSTRACT FROM AUTHOR]

Metformin-induced lactic acidosis is a rare but severe disease for the individual patients. A case of a 64-year-old patient with diabetes mellitus type 2 suffering from this disease is presented where metformin accumulation was caused by prerenal acute kidney failure. The clinical evaluation up to the final diagnosis, the pathophysiology and the appropriate therapy are presented in detail. Additionally, the current guidelines regarding the perioperative management of metformin administration are summarized. The case described aims to direct attention to the rare but, nevertheless, severe symptoms of metformin-induced lactic acidosis. [ABSTRACT FROM AUTHOR]

Congenital malformations, tumors and aortic infections are rare and mostly asymptomatic. Unspecific clinical symptoms may cause delayed verification of the underlying disease. Contrast enhanced computer tomography- and magnetic resonance angiography are important sectional imaging methods for diagnostic completion. Consistent guidelines concerning diagnosis and therapy of rare aortic diseases are non-existent. Aortic tumors must be resected by open surgery, aortic infections in general require medical treatment and anomalies, if indicated, are treated more and more by endovascular or hybrid procedures. Therefore, it is recommended to treat these entities in an interdisciplinary approach in specialized aortic centers. [ABSTRACT FROM AUTHOR]

Geomorphologists have long debated the relative importance of disturbance magnitude, duration, and frequency in shaping landscapes. For river‐channel adjustment by floods, some argue that the cumulative hydrograph, rather than magnitude or duration, matters most. However, studies of flood‐induced river‐channel change often draw upon small data sets. Here, we combine Sentinel‐2 imagery with flow data from laterally active rivers to address this question using a larger data set. We apply automated algorithms in Google Earth Engine to map rivers and detect their lateral shifting; we generate a large data set to quantify planform erosion during 175 floods at 34 selected sites. Erosion during these floods is best explained by their duration and then their cumulative hydrograph. We use a random forest regression model to predict flood‐induced erosion, with potential applications for hazard management. Ultimately, better global data on sediment supply and caliber would help us to understand flood‐driven change to river planforms. Plain Language Summary: Some rivers change their shape over time. In this paper, we explore how high‐flow events drive these river channels to reshape themselves. We use Google Earth Engine to automatically map the shapes of rivers in satellite images. We apply this method to pairs of satellite images before and after high‐flow events, to understand how the river shape is changed by the event. We compare the amount of channel widening measured to aspects of the high‐flow event, including its peak, duration, and total flow. We do so for 175 events, and find that the duration and total flow are most important for explaining how much a channel widens during the event. Finally, we build a statistical model to predict the average amount of channel widening for a given high‐flow event. This method has potential applications for hazard management in rivers that are known to change their shape. Key Points: We develop a method to quantify river planform change after flood events, using Google Earth EngineWe do so for a data set of 175 floods that exceeded the 80th percentile stage, at 34 flow gauging sites on laterally active riversPlanform erosion during these high‐flow events was most correlated with the event duration, and then the summed hydrograph [ABSTRACT FROM AUTHOR]

Purpose: Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. Method: A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. Results: Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100–4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2–330 days and 0–5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97–100% and 89–100%, respectively. The clinical success rate of CL and PLI was 73–95%. CL-associated and PLI-associated major complication rates were 0–3% and 0–5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. Conclusion: The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes. [ABSTRACT FROM AUTHOR]