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The objective of the study is to assess the efect of thrombolitic therapy on clinical prognostic markers in patients with intermediate-high risk pulmonary embolism compared to clasic therapy, and also the assessment of the bleeding risk associated with thrombolitic therapy. Material and methods. We included 82 consecutive patients with intermediate-high risk pulmonary embolism, which were divided in two groups: study group (thrombolysed) and control group (treated with unfractioned heparine alone). Patients with lower bleeding risk were included in control group. Patients were assessed regarding the right ventricle dysfunction markers (both imagistic and biochemical) on admision and on 48 h. The early (7th day) mortality rate and hemodinamic instability rate were evaluated in the two groups, also the major bleeding rate. Outcomes. We proved a statistical significant lower mortality rate in the study group, with no difference regarding the major bleedings. Meanwhile, the hemodinamic instability was lower in the study group compared to control group. Conclusions. The proper patient selection with intermediate-high pulmonary embolism for thrombolitic therapy can bring important benefits in terms of mortality and bleeding complications

Objective: To explore a 5-year comparison of disparities in intravenous t-PA (IV t-PA) use among acute ischemic stroke (AIS) patients based on race, gender, age, ethnic origin, hospital status, and geographic location.Methods: We extracted patients' demographic information and hospital characteristics for 2010 and 2014 from the New York Statewide Planning and Research Cooperative System (SPARCS). We compared disparities in IV t-PA use among AIS patients in 2010 to that in 2014 to estimate temporal trends. Multiple logistic regression was performed to compare disparities based on demographic variables, hospital designation, and geographic location.Results: Overall, there was approximately a 2% increase in IV t-PA from 2010 to 2014. Blacks were 15% less likely to receive IV t-PA compared to Whites in 2014, but in 2010, there was no difference. Patients aged 62-73 had lower odds of receiving IV t-PA than age group ≤61 in both 2010 and 2014. Designated stroke centers in the Lower New York State region were associated with reduced odds of IV t-PA use in 2010 while those located in the Upper New York State region were associated with increased odds of IV t-PA use in both 2010 and 2014, compared to their respective nondesignated counterparts. Gender, ethnic origin, and insurance status were not associated with IV t-PA utilization in both 2010 and 2014.Conclusion: Overall IV t-PA utilization among AIS patients increased between 2010 and 2014. However, there are evident disparities in IV t-PA use based on patient's race, age, hospital geography, and stroke designation status. [ABSTRACT FROM AUTHOR]

Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel’s inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

Previous studies have suggested a greater ischemic tolerance in posterior circulation as compared to anterior cerebral circulation. We aimed to investigate whether a differential response exists between anterior and posterior circulation strokes. Two hundred and four middle cerebral artery (MCA) patients and 28 basilar artery occlusion (BAO) patients treated with intravenous recombinant tissue plasminogen activator were included. Transcranial Doppler assessed recanalization at different time points. Patients were divided in three groups: total time of ischemia (TTI) <6, 6-24, or >24 hours. We calculated the percentage of recovery (admission National Institutes of Health Stroke Scale [NIHSS]– discharge NIHSS/admission NIHSS) × 100. Mean time to treatment was longer in BAO patients (P = .031). Early recanalization was more frequent among MCA occlusions (41% vs 29%; P = .039); the rate of persisting occlusion at 24 hours was similar (P = .933). Clinical recovery according to TTI was similar in each group: <6 hours: BAO 84%/MCA 69%; 6-24 hours: BAO 63%/MCA 61%; >24 hours: BAO −44%/MCA 11% (P = .23). For each hour of ischemia MCA patients worsened 1.78% (P = .035) and BAO 1.76% (P = .421). MCA occlusions compared to BAO were independently associated with hemorrhagic transformation (OR: 8.2; P = .043). Our data do not support the theory of increased ischemic tolerance in posterior circulation. Despite longer time-to-treatment, BAO were more resistant to hemorrhagic transformations. [ABSTRACT FROM AUTHOR]

recombinant plasmid carrying a modified gene of human plasminogen (mini-plasminogen), lacking four kringle domains and an amino terminal fragment, and containing an additional oligopeptide of six N-terminal histidine residues has been constructed. The plasmid was used for transformation of E. coli JM 109 cells to obtain a strain producing a recombinant modified human plasminogen. The target protein is superexpressed in a form of inclusion bodies and is composed of more than 50% insoluble protein. The renaturated and chromatographically purified protein exhibits amidolytic activity specific for plasminogen proenzyme in a fibrinolytic system. [ABSTRACT FROM AUTHOR]

Introduction: We present the case of a patient suffering from inferior vena cava hypoplasia complicated with Phlegmasia cerulean dolens. Imaging techniques allow precise diagnosis of inferior vena cava hypoplasia, providing essential structural details on the degree of damage of the vena cava and for the other branches. Case presentation: A 58 years old, obese and diabetic male patient presented with intense pain in the lower limbs, with the onset 24h before presentation. The patient presented generalized edema, cyanosis and functional impotence. Angio CT examination revealed hypoplasia of the inferior vena cava, with extensive DVT (deep vein thrombosis). In emergency conditions, with the agreement of the patient, we initiated the thrombolytic therapy (streptokinase for 72h) associated with anticoagulants (heparin). The evolution was favorable: a significant reduction in leg circumference was recorded, together with pain relief and reduction of local inflammation in the lower limbs. Conclusion: Severe cases of inferior vena cava hypoplasia complicated with deep vein thrombosis can present a good prognosis if appropriate treatment with anticoagulants and thrombolytics is initiated in time. [ABSTRACT FROM AUTHOR]