- |||||||||| Essential Thrombocythemia Presenting as Decompensated Cirrhosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4481;
Case Description/ A 40-year-old female with past medical history of essential thrombocythemia complicated by chronic splenic and portal vein thrombosis on warfarin and hydroxyurea presented with abdominal distention and dark stools...She was transfused 3 units of packed red blood cells and started on a PPI, octreotide, and ceftriaxone...She was started on furosemide and spironolactone for her ascites and nadolol for her varices...B - EGD with non-bleeding, grade III esophageal varices. C - EGD with portal hypertensive gastropathy.
- |||||||||| lactulose / Generic mfg., ceftriaxone / Generic mfg., furosemide / Generic mfg.
Aeromonas Bacteremia in a Patient With Decompensated EtOH Cirrhosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4455;
Although Aeramonas is a rare cause of bacteremia, the increased mortality risk associated for patients with cirrhosis and this infection should be considered during treatment and management. With wound exposure to brackish water and concern for cellulitis, empiric treatment for Vibrio is reasonable.
- |||||||||| Necrotizing Sarcoid Granulomatosis With Hepatic Involvement and Non-Cirrhotic Portal Hypertension (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_4363;
She had mild improvement and was discharged on hospital day 7 with 40mg prednisone...Methotrexate (MTX) was added 5 weeks after discharge...Lasix 40mg and spironolactone 100mg were started...Cases of NSG with hepatic involvement are exceedingly rare, a 2015 study identified 92 cases of NSG since being first described in 1973 with only 1 case of hepatic involvement. Treatment consists of steroids, ursodiol, or immunosuppressive agents such as azathioprine, MTX, or TNF-a inhibitors.
- |||||||||| Lamprene (clofazimine) / Novartis
Unexpected Finding: Pseudomelanosis Duodeni on Surveillance Endoscopy in a Patient With Hemosiderosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3894;
The patient's pertinent outpatient medications include iron carbonyl hydralazine, furosemide, and lisinopril...Differentiating between PD, iron pill-induced mucositis, clofazimine related pigmentation, diffuse malignant melanoma, brown bowel syndrome and eosinophilic enteritis is crucial, as the management and prognosis vary significantly...(B) Histopathology showed brown-black pigment deposition in lamina propria macrophages of duodenum on H&E 40x stain. (C)The tissue stained positive for Iron on Iron Stain 20x.
- |||||||||| Opsumit (macitentan) / Nippon Shinyaku, J&J
Iron Pill Associated Gastritis With Positional Emesis and Unique Endoscopic Findings (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3312;
Beyond the commonly discussed side effects of constipation and change in stool color, gastritis and related symptoms such be discussed with patients as a rare but known potential side effect of oral iron therapy. Figure: Figure 1: (A) endoscopic image of distal posterior gastric antral wall with discrete erosions on the posterior wall of the gastric body; (B) endoscopic image of posterior gastric body wall with similar erosions
- |||||||||| furosemide / Generic mfg., warfarin / Generic mfg.
Malnutrition Due to a Rare Condition: A Case of M (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3303;
Treatment has yet to be standardized but typically involves proton pump inhibitor therapy, high-protein diet, and surgery in severe refractory cases. Though rare, M
- |||||||||| Carafate (sucralfate) / AbbVie
A Case Report of Gastroduodenal Fistula in a Patient With Longstanding Peptic Ulcer Disease (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_3275;
The patient was later discharged on extended course of Pantoprazole/Carafate, instructed to have close follow up for repeat endoscopy and to avoid nonsteroidal anti-inflammatory drugs...Timely endoscopic evaluation and prompt intervention are essential in preventing these complications and improving patient outcomes. Figure: A - Pre-pyloric Stomach B - 2nd Portion of the Duodenum C - Gastric Body D - Gastric Antrum
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Financial Burden of Drugs Prescribed for CirrhosisAssociated Symptoms (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_2884;
However, when LDP is taken into consideration, the costs were similar (i.e., $17.5 in urban county and $16.49 in rural). Rifaximin carried the most out-of-pocket expense with ARP of $3713 vs.
- |||||||||| Duodenal Pseudomelanosis in a Patient With Chronic Renal Disease (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1786;
Certain medications such as ferrous sulfate, thiazides, vitamins, furosemide, digoxin and methyldopa have been linked to DP and some chronic medical conditions such as end stage renal disease, chronic hypertension, congestive heart failure, anemia have been reported to be associated with DP...She is on Hydralazine, clonidine, Carvedilol for hypertension...Hence, any specific therapy or change of medications and endoscopic surveillance have not been determined. Figure: Endoscopic picture showing multiple dark pigmented spots in the duodenum
- |||||||||| ceftriaxone / Generic mfg., furosemide / Generic mfg., spironolactone / Generic mfg.
Flood Syndrome: A Case Report With Discussion on Optimal Treatments (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1611;
C: Computerized tomography (CT) abdomen with ascites and a ventral hernia with inflammatory changes in the subcutaneous tissue within and surrounding the hernia. D: Post-surgical abdominal incision after hernia repair.
- |||||||||| furosemide / Generic mfg., fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
A Curious Case of Happy Hypoxia in NASH Cirrhosis (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1543;
This alludes to underlying diagnosis of HPS, a management conundrum in the acute setting, associated with dismal outcomes and is an indication independent of MELD for LT. 4
- |||||||||| hydrochlorothiazide / Generic mfg., furosemide / Generic mfg.
A Case of Pseudomelanosis Duodeni: Incidental Finding or Related to GI Bleed? (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_1058;
Histopathological biopsies would rule out other causes but no guidelines regarding management or the need for follow up have been established. Figure: Endoscopic imaging showing speckled pigmentation pattern in duodenum
- |||||||||| A Case of Esophagitis Dissecans Superficialis in a Patient Without Any Known Risk Factors (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_920;
Her medications included spironolactone, furosemide, and propranolol...The patient was discharged on Pantoprazole 40mg daily...Our patient showed complete resolution of EDS after successful treatment with PPI therapy. Figure: (A), (B), (C) Visualized Appearance of Lower Third of Esophagus on Initial EGD; (D), (E), (F) Visualized Appearance of Lower Third of Esophagus on Follow-Up EGD
- |||||||||| Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Norgine, ASKA Pharma
Novel Hemostatic Agent as a Modality for Postsphincterotomy Bleeding (Exhibit Hall) - Jul 29, 2023 - Abstract #ACG2023ACG_857;
His medications included furosemide, lactulose, rifaximin, and spironolactone...Significant post-sphincterotomy bleeding was noted, and complete hemostasis was achieved using a 10 mm x 60 mm fully covered metal biliary stent, bicap gold probe cautery, 4 mL of epinephrine 1/10000 dilution injection, and hemospray with bone wax...The application of PuraStat as a hemostatic agent could potentially provide a valuable alternative or adjunct treatment option for addressing post-sphincterotomy bleeding. However, additional prospective studies are necessary to confirm the generalizability and efficacy of PuraStat gel in treating these patients
- |||||||||| prednisone / Generic mfg., furosemide / Generic mfg.
Review, Journal: Clinical Toxicology of Vitamin D in Pediatrics: A Review and Case Reports. (Pubmed Central) - Jul 28, 2023
VDT in pediatrics can be managed by discontinuing vitamin D intake; using activated charcoal, furosemide, prednisone, and calcitonin; rehydration using intravenous sodium chloride 0.9%; and dextrose fluid therapy. It is important for parents to be more careful when providing vitamin D to their children.
- |||||||||| furosemide / Generic mfg.
Journal: Evaluation Of Renal Function And Stent Durability Following Resonance Stent Placement For Benign Disease. (Pubmed Central) - Jul 26, 2023
The impact of chronic RS placement on renal function was evaluated by estimated serum creatinine-based glomerular filtration rate (eGFR), furosemide renal scan, and CT-based renal parenchymal volume measurement...Placing a RS resulted in a 52%, 37% and 5.6% cost reduction compared to a regular polymeric stent placement, were it exchanged every six, four or three months, respectively. CONCLUSION RS deployment in the patient with a BUO result in cost effective maintenance of renal function and of renal parenchymal volume at a mean follow-up of 2 years; however, only 28% of patients fulfilled the one-year criterion for RS indwell time.
- |||||||||| Ameile (aumolertinib) / Jiangsu Hansoh Pharma, EQRx
A Case of Brain Metastases from Lung Cancer with Epilepsy and ECOG Score of 4 Successfully Treated with Aumolertinib (Exhibit Hall) - Jul 25, 2023 - Abstract #IASLCWCLC2023IASLC_WCLC_1707;
In this case, we reported a right lung adenocarcinoma cT3N3M1 patient with brain metastasis, malignant pleural effusion, and a positive EGFR 19del mutation who obtained a remarkable curative effect and good tolerance,after treatment with aumolertinib. This was the first report successfully applied aumolertinib to an EGFR sensitive lung patient with brain metastases with epilepsy as the initial symptom and in poor physical condition, and suggested the fast and good therapeutic potential of aumolertinib in this population.
- |||||||||| Jardiance (empagliflozin) / Eli Lilly, Boehringer Ingelheim
Anesthetic Considerations In The Perioperative Period For Guideline-directed Medical Therapy In Heart Failure With Reduced Ejection Fraction (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2904;
This was the first report successfully applied aumolertinib to an EGFR sensitive lung patient with brain metastases with epilepsy as the initial symptom and in poor physical condition, and suggested the fast and good therapeutic potential of aumolertinib in this population. His prior to admission medications include carvedilol, lisinopril, furosemide, and empagliflozin.Key Question 1:Are there any contraindications to proceeding with this case today?Key Question 2:Would you measure a B-type natriuretic peptide (BNP) or N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) preoperatively?...Toward the end of the case, the central venous pressure is 20 mm Hg from a baseline of 14 mm Hg, the patient is on a low-dose epinephrine infusion, and oxygenation on the arterial blood gas is acceptable, but has declined throughout surgery.Key Question 9:What effect does this patient
- |||||||||| aspirin / Generic mfg., furosemide / Generic mfg., allopurinol / Generic mfg.
Anesthesiologist-Guided Shared Medical Decision-Making (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2792;
Is the desire for a genetically-similar child sufficient to overcome the substantial risks of the anesthetic to the patient? What obligation do anesthesiologists have to patient
- |||||||||| Lantus (insulin glargine) / Sanofi
Lvad Patient Presenting For Urgent Laparoscopic Surgery (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2778;
If the patient's mental status is normal after awakening, would you extubate? If the patient does not awaken, how would you proceed?
- |||||||||| Optimal Perioperative Management Of Carotid Endarterectomy (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2620;
What target pressures are reassuring of adequate cerebral perfusion? 15.What are the advantages and disadvantages of Transcranial Doppler (TCD) as a monitoring modality for patients under carotid endarterectomy?16.Is there a role for near-infrared spectroscopy (NIRS) in carotid endarterectomy in perioperative stroke prevention?17.Is there a role for a
- |||||||||| Entresto (sacubitril/valsartan) / Novartis, ROVI Pharmaceuticals Laboratories, Jardiance (empagliflozin) / Eli Lilly, Boehringer Ingelheim
Impella Aided Mitral Clip Procedure In An Unstable Cardiac Patient. (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2497;
Preoperative medications included: Sacubitril-valsartan (Entresto), Metoprolol, Empagliflozin, Furosemide, Protonix, Sertraline and Digoxin...He then received 150 mg of IV amiodarone load followed by continuous infusion and was taken to the hybrid Cath Lab to undergo a TEE followed by cardioversion and mitral clip application...Anesthesia was induced with etomidate, fentanyl, rocuronium and esmolol...Inotropic support was provided pharmacologically with milrinone and norepinephrine infusions...How can the Impella flow adjustments facilitate mitral clipping. How would you manage new onset hypotension in PACU after extubation.
- |||||||||| Jardiance (empagliflozin) / Eli Lilly, Boehringer Ingelheim
Anesthetic Considerations In The Perioperative Period For Guideline-directed Medical Therapy In Heart Failure With Reduced Ejection Fraction (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_2495;
How would you manage new onset hypotension in PACU after extubation. His prior to admission medications include carvedilol, lisinopril, furosemide, and empagliflozin.Key Question 1:Are there any contraindications to proceeding with this case today?Key Question 2:Would you measure a B-type natriuretic peptide (BNP) or N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) preoperatively?...Toward the end of the case, the central venous pressure is 20 mm Hg from a baseline of 14 mm Hg, the patient is on a low-dose epinephrine infusion, and oxygenation on the arterial blood gas is acceptable, but has declined throughout surgery.Key Question 9:What effect does this patient
- |||||||||| irbesartan / Generic mfg., furosemide / Generic mfg.
The Patient Affected By Morbid Obesity Who Presents For Non-bariatric Surgery (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_1836;
A recent Bruce protocol stress electrocardiogram has been deemed negative.Medications include irbesartan 300mg daily, rosuvastatin 10mg daily and furosemide 40 mg daily (for lower limb edema with no other clinical signs of heart failure.)1.How do we classify Obesity? Are there any clear benefits demonstrated in this group of patients for Total Intravenous Anesthesia compared to inhalational anesthesia?10.What conundrums face the anesthesiologist keen to use a total intravenous technique in patient with morbid obesity?11.Describe the dose adjustments, handling and disposition of: intravenous anaestheticsopioidsneuromuscular blocking agentsnon-opioid analgesicshypnotic agents andcentral alpha-2 agonists in this group of patients.12.What do you understand by
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Hocus Pocus - Evaluating Shock Through The Magic Of Ultrasound. (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_1346;
She also has HTN for which she takes furosemide 20 mg and lisinopril 10 mg daily, DM type I (HgbA1c 8.6) on glargine 29 U every morning as well as aspartate 6 mg before meals, hypothyroidism on 0.025 mcg levothyroxine, hyperlipidemia on simvastatin 20 mg daily, history of Charcot arthropathy and recent hardware removal...100 mg hydrocortisone bolus is given, and a cortisol level is sent...Why is dobutamine added?...Alteplase (TPA) 100 mg is infused over 2 hours...She becomes net neg of 1.5 liters for the day over the next 4 hours and bumetanide is further decreased to 0.05 mg/hr...She is given fluids of 300 cc over the next 4 hours. After 15 days in the ICU, she is transferred to the floor and after 1 month she has her left BKA and by the 7th week she is transferred to rehab.
- |||||||||| irbesartan / Generic mfg., furosemide / Generic mfg.
The Patient Affected By Morbid Obesity Who Presents For Non-bariatric Surgery (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_600;
A recent Bruce protocol stress electrocardiogram has been deemed negative.Medications include irbesartan 300mg daily, rosuvastatin 10mg daily and furosemide 40 mg daily (for lower limb edema with no other clinical signs of heart failure.)1.How do we classify Obesity? Are there any clear benefits demonstrated in this group of patients for Total Intravenous Anesthesia compared to inhalational anesthesia?10.What conundrums face the anesthesiologist keen to use a total intravenous technique in patient with morbid obesity?11.Describe the dose adjustments, handling and disposition of: intravenous anaestheticsopioidsneuromuscular blocking agentsnon-opioid analgesicshypnotic agents andcentral alpha-2 agonists in this group of patients.12.What do you understand by
- |||||||||| Entresto (sacubitril/valsartan) / Novartis, ROVI Pharmaceuticals Laboratories, Jardiance (empagliflozin) / Eli Lilly, Boehringer Ingelheim
Impella Aided Mitral Clip Procedure In An Unstable Cardiac Patient. (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_596;
Preoperative medications included: Sacubitril-valsartan (Entresto), Metoprolol, Empagliflozin, Furosemide, Protonix, Sertraline and Digoxin...He then received 150 mg of IV amiodarone load followed by continuous infusion and was taken to the hybrid Cath Lab to undergo a TEE followed by cardioversion and mitral clip application...Anesthesia was induced with etomidate, fentanyl, rocuronium and esmolol...Inotropic support was provided pharmacologically with milrinone and norepinephrine infusions...How can the Impella flow adjustments facilitate mitral clipping. How would you manage new onset hypotension in PACU after extubation.
- |||||||||| aspirin / Generic mfg., furosemide / Generic mfg., allopurinol / Generic mfg.
Anesthesiologist-Guided Shared Medical Decision-Making (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_366;
Is the desire for a genetically-similar child sufficient to overcome the substantial risks of the anesthetic to the patient? What obligation do anesthesiologists have to patient
- |||||||||| Optimal Perioperative Management Of Carotid Endarterectomy (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_358;
What target pressures are reassuring of adequate cerebral perfusion? 15.What are the advantages and disadvantages of Transcranial Doppler (TCD) as a monitoring modality for patients under carotid endarterectomy?16.Is there a role for near-infrared spectroscopy (NIRS) in carotid endarterectomy in perioperative stroke prevention?17.Is there a role for a
- |||||||||| Clotinab (abciximab) / ISU Abxis, Integrilin (eptifibatide) / Takeda, NovoLog (insulin aspart) / Novo Nordisk
Keeping Coronary Stents Patent In Patients (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_356;
His past medical history was significant for coronary artery disease, myocardial infarction 10 years ago followed by a coronary artery bypass surgery, ESRD on dialysis three times a week via an arterio-venous fistula, diabetes mellitus, obstructive sleep apnea and a history of deep vein thrombosis (was on warfarin until 2 years ago).Medications: Novolog, glipizide, metoprolol, carvedilol, lisinopril, lasix, aspirin (ASA), nitroglycerin (NTG) patch.Dialyzed: 1 day agoECG- inferolateral ischemiaMeds taken: metoprolol, carvedilol, NTG patch.Recent stress test at outside hospital (copy requested)Cardiac catheterization...What is the implication of Dabigatran (Pradaxa) as compared to clopidogrel (Plavix) or ASA?10...(ASA, Clopidogrel (Plavix), Eptifibatide (Integrelin), Abciximab (Reopro)Intra operatively, the patient develops hypotension, ST elevation and T wave inversion on EKG.16. What are the therapeutic options available in this scenario?
- |||||||||| Lantus (insulin glargine) / Sanofi
Lvad Patient Presenting For Urgent Laparoscopic Surgery (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_352;
If the patient's mental status is normal after awakening, would you extubate? If the patient does not awaken, how would you proceed?
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Hocus Pocus - Evaluating Shock Through The Magic Of Ultrasound. (South: Hall D-7) - Jul 20, 2023 - Abstract #ASA2023ASA_50;
She also has HTN for which she takes furosemide 20 mg and lisinopril 10 mg daily, DM type I (HgbA1c 8.6) on glargine 29 U every morning as well as aspartate 6 mg before meals, hypothyroidism on 0.025 mcg levothyroxine, hyperlipidemia on simvastatin 20 mg daily, history of Charcot arthropathy and recent hardware removal...100 mg hydrocortisone bolus is given, and a cortisol level is sent...Why is dobutamine added?...Alteplase (TPA) 100 mg is infused over 2 hours...She becomes net neg of 1.5 liters for the day over the next 4 hours and bumetanide is further decreased to 0.05 mg/hr...She is given fluids of 300 cc over the next 4 hours. After 15 days in the ICU, she is transferred to the floor and after 1 month she has her left BKA and by the 7th week she is transferred to rehab.
- |||||||||| furosemide / Generic mfg.
Preclinical, Journal: IL-6 mediates the hepatic acute phase response after prerenal azotemia in a clinically-defined murine model. (Pubmed Central) - Jul 20, 2023
4 mg of furosemide intraperitoneally (IP) or vehicle (Veh) was administered at time 0 hr and 3 hr to induce PRA from volume loss...Significantly upregulated genes and their proteins were also investigated and included: serum amyloid A2, serum amyloid A1, CXCL1, and haptoglobin; hepatic gene expression and plasma protein levels were all increased in WT PRA and were all reduced in IL-6 PRA. This work demonstrates previously unknown systemic effects of prerenal azotemia that includes IL-6-mediated upregulation of the hepatic acute phase response.
- |||||||||| furosemide / Generic mfg., bumetanide / Generic mfg.
Journal: Response to Comment on "Inhibition mechanism of NKCC1 involves the carboxyl terminus and long-range conformational coupling". (Pubmed Central) - Jul 16, 2023
On the basis of the structural information, the authors proposed a scissor-like inhibition mechanism that involves a coupled movement between the cytosolic and transmembrane domains of hNKCC1. This work has provided important insights into the mechanism of inhibition and substantiated the concept of a long-distance coupling involving movements of both the transmembrane and carboxyl-terminal cytoplasmic domains for inhibition.
- |||||||||| Journal: MANAGEMENT OF ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA, LEFT VENTRICULAR DYSFUNCTION, AND SUBSEQUENT CARDIOPATHOLOGIC EVALUATION IN AN ORANGUTAN (PONGO PYGMAEUS (Pubmed Central) - Jul 14, 2023
Treatment was initiated with carvedilol...Additional treatment included amiodarone, furosemide, spironolactone, clopidogrel, and aspirin...The orangutan died 27 mon after initial diagnosis of heart disease, and a complete necropsy was performed. This article describes successful diagnosis and management of structural and arrhythmic heart disease in an orangutan, emphasizing the role of cardiac disease screening and behavioral training in apes, as well as the value of matching thorough antemortem and postmortem cardiac evaluation.
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