Singh, Waryaam

Abstract Vascular anomalies are disorders of arteries or veins which are further sub-classified as vascular malformations or vascular tumors. Vascular malformations are attributed to disorderly vascular morphogenesis, trauma, or hormonal imbalances. We present a rare case of a patient in their 30s who presented to the outpatient department with a localized post-traumatic soft tissue swelling in the temporalis region, which was soft and non-pulsatile with occurrences in periods of acute emotional stress, followed by spontaneous resolution when the same was negated by the patient. The diagnosis was established on the basis of magnetic resonance imaging and contrast enhanced computed tomography. We add to the existing limited literature on intramuscular vascular malformations of the temporalis muscle and highlight the effect of emotional stress and anxiety on vascular anomalies.

Background: Sepsis-associated acute kidney injury (AKI) is linked to increased mortality and prolonged hospital stays. The exact relationship between central venous pressure (CVP) and AKI remains unclear. We explored the correlation between CVP and AKI in septic shock patients. Methods: This retrospective study included adult patients with septic shock admitted to Mayo Clinic Rochester between 2006 and 2018. CVP levels were measured at 6, 12, 24, and 48 h after the diagnosis of sepsis, and patients were stratified into two groups based on CVP levels (CVP < 8 or ≥8 mmHg). Results: Of 5600 patients with septic shock, 3128 patients without AKI on admission are included. One-thousand-and-ninety-eight patients (35.1%) developed AKI within a median of 4.4 days. The median CVP levels and frequency of elevated CVP at 6, 12, 24, and 48 h are significantly higher in the AKI group. Elevated CVP (≥8 mmHg) at 6, 12, 24, and 48 h is associated with AKI incidence, even after adjusting for mean arterial pressure (MAP) levels. This association, after multivariable adjustments, only remains significant at 12 h with an odds ratio (OR) of 1.60 (95% CI, 1.26–2.05), p < 0.001 and 48 h with an OR of 1.60 (95% CI, 1.29–1.99), p < 0.001. Conclusions: Our findings indicate that CVP ≥ 8 mmHg is strongly associated with an increased risk of AKI, even after adjusting for MAP at the 12 and 48 h time points. These findings underscore a critical 12 or 48h window for interventions to lower CVP.