Piedmont Henry Hospital

Patients with Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Intolerance (OI) commonly present with symptoms suggestive of Pelvic Venous Disorders (PeVD). The presence of PeVD may contribute to orthostatic symptoms in these patients due to venous obstruction with stasis and pooling. Iliac vein compression, a PeVD, has historically been treated with iliac venous stenting. The authors hypothesize that patients with POTS frequently have findings of PeVD, that venous outflow obstruction from iliac vein compression exacerbates POTS/OI symptomatology, and that treating PeVD improves POTS/OI symptoms. This paper reports results from two studies at two different institutions with a partially overlapping patient population. The first was a retrospective cross-sectional observational study of patients with POTS/OI who presented to Emory University Cardiology (Atlanta, GA, USA) from October 2019 to June 2023. We aimed to evaluate the prevalence of concurrent POTS/OI and PeVD using screening pelvic venous ultrasound, MR and/or CT, compared to venogram with intravascular ultrasound (IVUS). We secondarily evaluated the efficacy of each imaging modality in screening accuracy for PeVD. The second study was a retrospective review of medical records for 271 female patients with POTS/OI who received treatment of PeVD with iliac vein stenting from June 2019 to November 2024 at Minimally Invasive Procedure Specialists (Highlands Ranch, CO). The primary objective of this study was to explore quality of life (QoL) outcomes in female patients with POTS/OI before and after treatment. The secondary objective was to record the prevalence of associated pelvic pain, systemic symptoms, and response to therapy in this population. In the first cohort, 129 patients (84% cis female) with a diagnosis of POTS/OI and symptoms of PeVD were assessed by standard imaging for venous pathology. 107 patients (83%) had confirmed pelvic venous compression (iliac vein, renal vein, or both) or pelvic venous congestion on imaging with at least one screening modality. All screening modalities were relatively insensitive in detecting iliac venous compression compared with venography and IVUS. In the second cohort, following iliac vein stenting, significant improvements were seen in Orthostatic Hypotension Questionnaire (OHQ) composite scores at three months (p < 0·001) and at 12 months (p < 0·001). The OHQ Symptom Assessment (OHSA) and Daily Activities Scale (OHDAS) subscores, International Pelvic Pain Society (IPPS) score, Pelvic Congestion Syndrome (PCS) score, Pelvic Pain and Urgency/Frequency Symptom Scale (PUF) score, and Ancillary symptom score all demonstrated statistically significant decreases at three months that persisted at 12 months (all p < 0·001) as well. The high prevalence of PeVD in POTS/OI patients suggests an association between the two diagnoses. In the absence of expert clinical review, screening with US, CT, and MR may not be sufficient to rule out PeVD. Significant improvements were seen in QoL in patients with POTS/OI and PeVD who underwent iliac vein stenting. These results call for additional trials to examine the clinical and hemodynamic effects of venous stenting on POTS/OI symptomatology and associated systemic symptoms, including pelvic pain. These studies received no funding.

Over a year ago, we published a paper on the lessons that we as a healthcare system in Georgia learned from the first wave of the COVID-19 pandemic. These lessons included the following: (1) Take a deep breath; this is a marathon, not a sprint. (2) There is no ‘right’ way to do things. (3) Be kind to yourself and to others. (4) Teamwork. (5) Be flexible. At the time the paper was published, there was hope that with the rapid development and approval of vaccines, we would soon be looking at the end of the pandemic with a return to life as we knew it before its onset. Sadly, the slow adoption of vaccines has led to the emergence of variants like Delta and Omicron, and almost two years into the pandemic, the light at the end of the tunnel seems much dimmer than it had been a year ago. At the time of this writing, we are beginning our fifth surge. This paper describes the journey that we have been on for the past year and a half and shows that the five lessons previously learned remained relevant as we continue in the second year of the COVID-19 pandemic. Our focus as we managed the impact of the pandemic remained consistent with the values of Piedmont Healthcare: (1) Focus on patient-centred care; (2) Exemplify teamwork and connections; (3) Be an owner; (4) Embrace the future. We maintained our pursuit of the Piedmont Promise as we made a positive difference to the lives we touched.

Background and PurposeFast macromolecular proton fraction (MPF) mapping is a recent quantitative MRI method for myelin assessment. The objectives of this study were to evaluate MPF as a measure demyelination in subcortical gray matter (GM) structures in multiple sclerosis (MS) and asses a potential relationship between demyelination and excess iron deposition using MPF and T2* mapping.Materials and MethodsMPF and T2* maps were obtained from 12 healthy controls, 18 relapsing-remitting MS (RRMS), and 12 secondary-progressive MS (SPMS) patients using 3T MRI. Parameter values in the caudate nucleus, globus pallidus, putamen, substantia nigra, and thalamus were compared between groups and correlated to clinical data. RESULTS: MPF in all subcortical structures and T2* in the globus pallidus, putamen, and caudate nucleus demonstrated a significant monotonic decrease from controls to RRMS and from RRMS to SPMS. MPF in all subcortical structures significantly correlated with Expanded Disability Status Scale and MS Functional Composite scores with absolute Pearson correlation coefficient (r) values in a range 0.4-0.6. Significant correlations (r=-0.4--0.6) were also identified between MPF and the 9-hole peg test indicating a potential relationship with nigrostriatal pathway damage. Among T2* values, weak significant correlations with clinical variables were found only in the putamen. MPF did not correlate with T2* in any of the studied anatomic structures.ConclusionsMPF provides an iron-insensitive measure of demyelination. Myelin loss in subcortical GM structures in MS is unrelated to excess iron deposition. Subcortical GM demyelination is more closely associated with the disease phenotype and disability than iron overload.

Medical Journal of AustraliaVolume 2, Issue 4 p. 180-182 Report of Case IDIOPATHIC THROMBOCYTHÆMIA PRESENTING WITH ISCHÆMIA OF THE TOES: REPORT OF THREE CASES D. L. Annetts F.R.C.S., D. L. Annetts F.R.C.S. Department of Surgery, Prince Henry Hospital and University of New South WalesCurrently Research Fellow, Harbor General Hospital, Torrance, California.Search for more papers by this authorG. D. Tracy F.R.C.S., F.R.A.C.S., F.A.C.S., G. D. Tracy F.R.C.S., F.R.A.C.S., F.A.C.S. Department of Surgery, Prince Henry Hospital and University of New South WalesAssociate Professor of Surgery, University of New South Wales.Search for more papers by this author D. L. Annetts F.R.C.S., D. L. Annetts F.R.C.S. Department of Surgery, Prince Henry Hospital and University of New South WalesCurrently Research Fellow, Harbor General Hospital, Torrance, California.Search for more papers by this authorG. D. Tracy F.R.C.S., F.R.A.C.S., F.A.C.S., G. D. Tracy F.R.C.S., F.R.A.C.S., F.A.C.S. Department of Surgery, Prince Henry Hospital and University of New South WalesAssociate Professor of Surgery, University of New South Wales.Search for more papers by this author First published: 01 July 1966 https://doi.org/10.5694/j.1326-5377.1966.tb73496.xCitations: 10 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume2, Issue4July 1966Pages 180-182 RelatedInformation

Medical Journal of AustraliaVolume 1, Issue 4 p. 132-139 Special Articles on War Medicine and Surgery II. ANÆSTHESIA IN RELATION TO WAR CONDITIONS W. I. T. Hotten M.B., Ch.M. (Sydney), D.A. (England), W. I. T. Hotten M.B., Ch.M. (Sydney), D.A. (England) Major, Lecturer in Anæsthetics, Senior Honorary A.A.M.C. Reserve University of Sydney Post-Graduate Surgical Unit, Prince Henry Hospital Department of Anæsthesia, Royal Prince Alfred HospitalSearch for more papers by this author W. I. T. Hotten M.B., Ch.M. (Sydney), D.A. (England), W. I. T. Hotten M.B., Ch.M. (Sydney), D.A. (England) Major, Lecturer in Anæsthetics, Senior Honorary A.A.M.C. Reserve University of Sydney Post-Graduate Surgical Unit, Prince Henry Hospital Department of Anæsthesia, Royal Prince Alfred HospitalSearch for more papers by this author First published: 01 January 1940 https://doi.org/10.5694/j.1326-5377.1940.tb53718.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume1, Issue4January 1940Pages 132-139 RelatedInformation