The Experts below are selected from a list of 81 Experts worldwide ranked by ideXlab platform
David D'cruz - One of the best experts on this subject based on the ideXlab platform.
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P278 Extra-corporeal Membrane Oxygenation And Diffuse Alveolar Haemorrhage – A Single Centre Case Series And Analysis Of The Elso Database
Thorax, 2014Co-Authors: Trg Simpson, C.y. Ling, Guy Glover, Nicholas A Barrett, Nicholas Ioannou, Boris Lams, C Langrish, C. Meadows, N Agarwal, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a potentially fatal complication of the systemic vasculitides and may present directly to the intensivist as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60%. Whilst a severe respiratory failure (SRF) therapy strategy incorporating extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS, use of ECMO in DAH is often considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods We present a case series of 4 patients with DAH due to underlying ANCA-associated vasculitides managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, since 2012. We analysed the Extracorporeal Life Support Organisation (ELSO) database and report on the current international experience of DAH and ECMO. Results The case series is described in Table 1. Median Lung Injury Score was 3.5. All patients received ECMO (median duration 8 days) and all received immunosuppression. One patient received normal heparin protocol to target APTTr 1.5–2 whilst two patients had 48 h of ECMO with no heparin followed by targeted sub-therapeutic low dose heparin. ICU survival was 100% and six month survival was also 100%. There were no exacerbations of pulmonary haemorrhage, no new events of extra-pulmonary haemorrhage and no clotting complications. ELSO The ELSO database contains 78 patients (adult, 59; paediatric, 19) with pulmonary vasculitides who received ECMO. 43 had a diagnosis of Granulomatosis and PolyAngiitis (GPA), whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture’s syndrome and thrombotic microangiopathy. The median age was 23 yrs (IQR 16–47). The median duration of ECMO was 190hrs (IQR 146–282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications. Conclusion In this case series, ECMO offers an excellent survival rate in SRF due to ANCA-associated DAH. ELSO registry data supports this, suggesting that ECMO should be considered as supportive therapy in DAH with SRF not responsive to conventional therapy.
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FRI0451 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage - A Single Centre CASE Series and Analysis of the ELSO Database
Annals of the Rheumatic Diseases, 2014Co-Authors: C.y. Ling, Trg Simpson, Guy Glover, B. Nicholas, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of the systemic vasculitides 1 . DAH may present as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60% 1. Whilst extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS 2 , use of ECMO in DAH may be considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods A case series of 4 patients with DAH due to ANCA vasculitides diagnosed and or managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, between 2012-13. Analysis of the Extracorporeal Life Support Organisation (ELSO) database using ICD-9 codes 446.2,446.21,446.4,446.6 to report the current international experience of DAH and ECMO 3 . Results 4 patients with ARDS due to systemic vasculitides were referred via the SRF pathway, but only 3 patients required ECMO (range 120 – 208 hours). 1 patient received a normal protocol heparin regime to target an APTTr of 1.5-2 whilst two patients had 48 hours of ECMO with no heparin followed by low-dose heparin. ICU survival and six months survival were 100% and there were no exacerbations of pulmonary haemorrhage and no clotting complications. The ELSO database contains 78 patients (adult,59; paediatric,19) with pulmonary vasculitides who received ECMO. 43 had GPA, whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture9s syndrome and thrombotic microangiopathy. The median age was 23 years old (IQR: 16-47). The median duration of ECMO was 190 hours (IQR: 146-282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications in the context of likely conservative heparinisation. Conclusions In this case series, ECMO offers an excellent survival rate and clinical outcomes in SRF due to ANCA-associated DAH. ELSO data supports our case series and suggests that DAH related to vasculitides should not be considered a contraindication. ECMO should be considered as supportive therapy in DAH patients with SRF not responsive to conventional therapy. References Sugimoto T et al. Pulmonary-renal syndrome, diffuse pulmonary haemorrhage and glomerulonephritis, associated with Wegener9s granulomatosis effectively treated with early plasma exchange therapy. Intern Med 2007;46:49-53. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan,June (2013). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4191
Carolyn F. Moyer - One of the best experts on this subject based on the ideXlab platform.
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Autoimmune vasculitis in MRL/Mp-lpr/lpr mice: orthochromatic basophils participate in the development of delayed-type Hypersensitivity Angiitis.
Autoimmunity, 1992Co-Authors: Carolyn F. Moyer, Taylor R, Tulli HAbstract:The pathogenesis of autoimmune vasculitis is poorly understood. Understanding the immunologic mechanisms governing this disease requires precise identification of the cells which comprise the lesion. In this report, we have evaluated tissue sections from MRL/lpr mice from 16 to 45 weeks of age, representing all stages of clinical vasculitis. We demonstrate that basophil myelocytes participate in the evolution of the delayed-type Hypersensitivity (DTH) response which initiates and perpetuates autoimmune vasculitis in these mice. These findings raise questions regarding the immunologic mechanisms by which basophils develop in this lesion and the interaction of basophils, VSMCs and lymphocytes in vasculitic angiodestruction.
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autoimmune vasculitis in mrl mp lpr lpr mice orthochromatic basophils participate in the development of delayed type Hypersensitivity Angiitis
Autoimmunity, 1992Co-Authors: Carolyn F. Moyer, W G Jerome, R Taylor, H Tulli, C. L. ReinischAbstract:The pathogenesis of autoimmune vasculitis is poorly understood. Understanding the immunologic mechanisms governing this disease requires precise identification of the cells which comprise the lesion. In this report, we have evaluated tissue sections from MRL/lpr mice from 16 to 45 weeks of age, representing all stages of clinical vasculitis. We demonstrate that basophil myelocytes participate in the evolution of the delayed-type Hypersensitivity (DTH) response which initiates and perpetuates autoimmune vasculitis in these mice. These findings raise questions regarding the immunologic mechanisms by which basophils develop in this lesion and the interaction of basophils, VSMCs and lymphocytes in vasculitic angiodestruction.
C.y. Ling - One of the best experts on this subject based on the ideXlab platform.
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P278 Extra-corporeal Membrane Oxygenation And Diffuse Alveolar Haemorrhage – A Single Centre Case Series And Analysis Of The Elso Database
Thorax, 2014Co-Authors: Trg Simpson, C.y. Ling, Guy Glover, Nicholas A Barrett, Nicholas Ioannou, Boris Lams, C Langrish, C. Meadows, N Agarwal, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a potentially fatal complication of the systemic vasculitides and may present directly to the intensivist as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60%. Whilst a severe respiratory failure (SRF) therapy strategy incorporating extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS, use of ECMO in DAH is often considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods We present a case series of 4 patients with DAH due to underlying ANCA-associated vasculitides managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, since 2012. We analysed the Extracorporeal Life Support Organisation (ELSO) database and report on the current international experience of DAH and ECMO. Results The case series is described in Table 1. Median Lung Injury Score was 3.5. All patients received ECMO (median duration 8 days) and all received immunosuppression. One patient received normal heparin protocol to target APTTr 1.5–2 whilst two patients had 48 h of ECMO with no heparin followed by targeted sub-therapeutic low dose heparin. ICU survival was 100% and six month survival was also 100%. There were no exacerbations of pulmonary haemorrhage, no new events of extra-pulmonary haemorrhage and no clotting complications. ELSO The ELSO database contains 78 patients (adult, 59; paediatric, 19) with pulmonary vasculitides who received ECMO. 43 had a diagnosis of Granulomatosis and PolyAngiitis (GPA), whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture’s syndrome and thrombotic microangiopathy. The median age was 23 yrs (IQR 16–47). The median duration of ECMO was 190hrs (IQR 146–282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications. Conclusion In this case series, ECMO offers an excellent survival rate in SRF due to ANCA-associated DAH. ELSO registry data supports this, suggesting that ECMO should be considered as supportive therapy in DAH with SRF not responsive to conventional therapy.
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FRI0451 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage - A Single Centre CASE Series and Analysis of the ELSO Database
Annals of the Rheumatic Diseases, 2014Co-Authors: C.y. Ling, Trg Simpson, Guy Glover, B. Nicholas, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of the systemic vasculitides 1 . DAH may present as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60% 1. Whilst extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS 2 , use of ECMO in DAH may be considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods A case series of 4 patients with DAH due to ANCA vasculitides diagnosed and or managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, between 2012-13. Analysis of the Extracorporeal Life Support Organisation (ELSO) database using ICD-9 codes 446.2,446.21,446.4,446.6 to report the current international experience of DAH and ECMO 3 . Results 4 patients with ARDS due to systemic vasculitides were referred via the SRF pathway, but only 3 patients required ECMO (range 120 – 208 hours). 1 patient received a normal protocol heparin regime to target an APTTr of 1.5-2 whilst two patients had 48 hours of ECMO with no heparin followed by low-dose heparin. ICU survival and six months survival were 100% and there were no exacerbations of pulmonary haemorrhage and no clotting complications. The ELSO database contains 78 patients (adult,59; paediatric,19) with pulmonary vasculitides who received ECMO. 43 had GPA, whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture9s syndrome and thrombotic microangiopathy. The median age was 23 years old (IQR: 16-47). The median duration of ECMO was 190 hours (IQR: 146-282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications in the context of likely conservative heparinisation. Conclusions In this case series, ECMO offers an excellent survival rate and clinical outcomes in SRF due to ANCA-associated DAH. ELSO data supports our case series and suggests that DAH related to vasculitides should not be considered a contraindication. ECMO should be considered as supportive therapy in DAH patients with SRF not responsive to conventional therapy. References Sugimoto T et al. Pulmonary-renal syndrome, diffuse pulmonary haemorrhage and glomerulonephritis, associated with Wegener9s granulomatosis effectively treated with early plasma exchange therapy. Intern Med 2007;46:49-53. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan,June (2013). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4191
Trg Simpson - One of the best experts on this subject based on the ideXlab platform.
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P278 Extra-corporeal Membrane Oxygenation And Diffuse Alveolar Haemorrhage – A Single Centre Case Series And Analysis Of The Elso Database
Thorax, 2014Co-Authors: Trg Simpson, C.y. Ling, Guy Glover, Nicholas A Barrett, Nicholas Ioannou, Boris Lams, C Langrish, C. Meadows, N Agarwal, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a potentially fatal complication of the systemic vasculitides and may present directly to the intensivist as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60%. Whilst a severe respiratory failure (SRF) therapy strategy incorporating extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS, use of ECMO in DAH is often considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods We present a case series of 4 patients with DAH due to underlying ANCA-associated vasculitides managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, since 2012. We analysed the Extracorporeal Life Support Organisation (ELSO) database and report on the current international experience of DAH and ECMO. Results The case series is described in Table 1. Median Lung Injury Score was 3.5. All patients received ECMO (median duration 8 days) and all received immunosuppression. One patient received normal heparin protocol to target APTTr 1.5–2 whilst two patients had 48 h of ECMO with no heparin followed by targeted sub-therapeutic low dose heparin. ICU survival was 100% and six month survival was also 100%. There were no exacerbations of pulmonary haemorrhage, no new events of extra-pulmonary haemorrhage and no clotting complications. ELSO The ELSO database contains 78 patients (adult, 59; paediatric, 19) with pulmonary vasculitides who received ECMO. 43 had a diagnosis of Granulomatosis and PolyAngiitis (GPA), whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture’s syndrome and thrombotic microangiopathy. The median age was 23 yrs (IQR 16–47). The median duration of ECMO was 190hrs (IQR 146–282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications. Conclusion In this case series, ECMO offers an excellent survival rate in SRF due to ANCA-associated DAH. ELSO registry data supports this, suggesting that ECMO should be considered as supportive therapy in DAH with SRF not responsive to conventional therapy.
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FRI0451 Extra-Corporeal Membrane Oxygenation and Diffuse Alveolar Haemorrhage - A Single Centre CASE Series and Analysis of the ELSO Database
Annals of the Rheumatic Diseases, 2014Co-Authors: C.y. Ling, Trg Simpson, Guy Glover, B. Nicholas, David D'cruzAbstract:Background Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of the systemic vasculitides 1 . DAH may present as a severe acute respiratory distress syndrome (ARDS) with reported mortality of 12- 60% 1. Whilst extracorporeal membrane oxygenation (ECMO) improves outcomes in ARDS 2 , use of ECMO in DAH may be considered to be relatively contraindicated due to the requirement for systemic anticoagulation. Methods A case series of 4 patients with DAH due to ANCA vasculitides diagnosed and or managed by a standardised diagnostic pathway and ARDS treatment algorithm in a single, UK SRF centre, between 2012-13. Analysis of the Extracorporeal Life Support Organisation (ELSO) database using ICD-9 codes 446.2,446.21,446.4,446.6 to report the current international experience of DAH and ECMO 3 . Results 4 patients with ARDS due to systemic vasculitides were referred via the SRF pathway, but only 3 patients required ECMO (range 120 – 208 hours). 1 patient received a normal protocol heparin regime to target an APTTr of 1.5-2 whilst two patients had 48 hours of ECMO with no heparin followed by low-dose heparin. ICU survival and six months survival were 100% and there were no exacerbations of pulmonary haemorrhage and no clotting complications. The ELSO database contains 78 patients (adult,59; paediatric,19) with pulmonary vasculitides who received ECMO. 43 had GPA, whereas the remaining diagnoses included Hypersensitivity Angiitis, Goodpasture9s syndrome and thrombotic microangiopathy. The median age was 23 years old (IQR: 16-47). The median duration of ECMO was 190 hours (IQR: 146-282) and ICU survival was 82%. Twelve patients (15%) were reported to have thrombotic ECMO circuit complications in the context of likely conservative heparinisation. Conclusions In this case series, ECMO offers an excellent survival rate and clinical outcomes in SRF due to ANCA-associated DAH. ELSO data supports our case series and suggests that DAH related to vasculitides should not be considered a contraindication. ECMO should be considered as supportive therapy in DAH patients with SRF not responsive to conventional therapy. References Sugimoto T et al. Pulmonary-renal syndrome, diffuse pulmonary haemorrhage and glomerulonephritis, associated with Wegener9s granulomatosis effectively treated with early plasma exchange therapy. Intern Med 2007;46:49-53. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63. ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan,June (2013). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4191
Sang Don Lee - One of the best experts on this subject based on the ideXlab platform.
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Segmental Testicular Infarction: Radiologic Diagnosis and Conservative Management
Korean Journal of Urology, 2008Co-Authors: Suk Gun Jung, Sung Woo Park, Hyun Jun Park, Suk Kim, Sang Don LeeAbstract:Segmental testicular infarction is a rare cause of an acute scrotum. The etiology can be related to sickle cell anemia, Hypersensitivity Angiitis and polycythemia in some cases, but the condition is usually an idiopathic phenomenon. Because making the differential diagnosis between segmental testicular infarction and testicular tumor can be difficult, most authors have recommended surgery in the past. We report here on cases of testicular segmental infarction that were treated by conservative management and we describe the radiologic findings. (Korean J Urol 2008; 49:574-578)