RESUMO
Toxicity of polyethylene microplastics (PE-MP) of size ranges similar to their natural food to zooplanktonic organisms representative of the main taxa present in marine plankton, including rotifers, copepods, bivalves, echinoderms and fish, was evaluated. Early life stages (ELS) were prioritized as testing models in order to maximize sensitivity. Treatments included particles spiked with benzophenone-3 (BP-3), a hydrophobic organic chemical used in cosmetics with direct input in coastal areas. Despite documented ingestion of both virgin and BP-3 spiked microplastics no acute toxicity was found at loads orders of magnitude above environmentally relevant concentrations on any of the invertebrate models. In fish tests some effects, including premature or reduced hatching, were observed after 12 d exposure at 10 mg L-1 of BP-3 spiked PE-MP. The results obtained do not support environmentally relevant risk of microplastics on marine zooplankton. Similar approaches testing more hydrophobic chemicals with higher acute toxicity are needed before these conclusions could be extended to other organic pollutants common in marine ecosystems. Therefore, the replacement of these polymers in consumer products must be carefully considered.
Assuntos
Polietileno/toxicidade , Poluentes Químicos da Água/toxicidade , Zooplâncton/efeitos dos fármacos , Animais , Invertebrados/efeitos dos fármacos , Tamanho da Partícula , Testes de Toxicidade AgudaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Melanoma/tratamento farmacológico , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Análise Mutacional de DNA , Humanos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Metástase Linfática/genética , Masculino , Melanoma/genética , Melanoma/patologia , Mutação , Oximas/farmacologia , Oximas/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Piridonas/farmacologia , Piridonas/uso terapêutico , Pirimidinonas/farmacologia , Pirimidinonas/uso terapêutico , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
OBJECTIVES: This report demonstrates the application and feasibility of novel 3D-MDCT real-time fusion technology with fluoroscopy, for left atrial appendage (LAA) occlusion procedures. BACKGROUND: A successful LAA occlusion procedure relies on multiple imaging modalities, including TEE or 3D-MDCT, and fluoroscopy. Effectively integrating these imaging modalities may improve implantation safety and success. To our knowledge this technique has not been previously described for LAA occlusions. METHODS: This observational study compared clinical and procedural parameters for procedures performed with or without fusion integration. All patients had a pre-procedural 3D-MDCT for LAA measurements, along with 3D analyses of LAA morphology and surrounding structures. Using the image fusion software (Valve ASSIST 2, GE Healthcare, UK), landmarks were identified on fluoroscopy, and MDCT LAA anatomy outlines were then projected onto the real-time fluoroscopy image during the procedure, to guide all steps of the intervention. RESULTS: A total of 57 patients underwent LAA occlusion, with 16 performed using fusion software. In comparison to the pre-fusion group, reductions in contrast volume (21.0 ± 11.7 vs. 95.9 ± 80.5 ml, P < 0.001), procedure time (63.0 ± 22.0 vs. 87.3 ± 43.0 min, P = 0.01), and fluoroscopy time (6.2 vs. 8.3 min, P = 0.03) were observed. Incomplete sealing (0 vs. 14.6%, P = 0.16) and device deployment success (100 vs. 92.7%, P = 0.17) were not significantly different. CONCLUSIONS: The addition of this novel fusion technology is safe and feasible. To optimize LAA procedural success, fusion integration may offer a promising addition, or alternative, to current imaging modalities. © 2017 Wiley Periodicals, Inc.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Cateterismo Cardíaco , Imageamento Tridimensional/métodos , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Intervencionista/métodos , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/instrumentação , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Masculino , Imagem Multimodal , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the frequency of uterine involvement in patients with borderline ovarian tumors (BOT) and to evaluate the recurrence risk and survival after hysterectomy. MATERIALS AND METHODS: In two French hospitals: A tertiary referral centre (University hospital centre of Tours, France) and the Alliance community hospital of Tours (France), we reviewed data of consecutive women undergoing surgery for presumed stage I BOT between January 1997 and December 2012. Patients were divided into two groups: patients treated with fertility sparing surgery (group 1) and those treated with radical surgery (group 2). RESULTS: A total of 135 patients were evaluated. 35 had fertility sparing surgery, 81 had radical surgery with hysterectomy and 19 had previous hysterectomy for other reasons. There were more recurrent borderline ovarian disease and more ovarian invasive disease developed in group 1 (p = 0.02, p = 0.04, respectively). Hysterectomy affected favorably borderline disease-free survival, OR = 0.09 95%CI (0.005-0.69), p = 0.04, but perceived benefits may be related to bilateral salpingo-oophorectomy and not hysterectomy directly.
Assuntos
Preservação da Fertilidade , Histerectomia/métodos , Recidiva Local de Neoplasia , Neoplasias Ovarianas/cirurgia , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , PrognósticoRESUMO
UNLABELLED: Amiodarone-induced pulmonary toxicity (APT) is a serious adverse event that can lead to death. The aims of our study are to determine factors associated with mortality and to describe outcome and sequelae of patients with APT. METHODS: Forty-six patients with APT were divided into two groups according to survival at day 90 for a clinical, functional, biological and radiological comparaison. We then evaluated the evolution of 15 survivors at a median of three months [1-6 months] and/or 12 months [8-36 months]. RESULTS: Mortality of APT at day 90 was 37% (17 patients) and was linked to the speed of onset of symptoms and a high HRCT alveolar score. Angiotensin system antagonist treatment was prescribed significantly more in the survival group (p = 0.042, HR 0.34 (95% CI 0.12-0.96)). In surviving patients, dyspnea, vital capacity and HRCT alveolar score improved significantly while HRCT fibrosis score deteriorated gradually during the first six months. At the end of the study, all the surviving patients presented functional and/or radiological sequelae. CONCLUSIONS: Severity of APT is linked to the extent and speed of onset of pulmonary damage. After the initial episode, the patients who survived improved slowly but with persistent sequelae.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Pneumopatias/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/diagnóstico por imagem , Pneumopatias/tratamento farmacológico , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodosRESUMO
Myoepithelial carcinoma of the breast is a rare and malignant tumor. Local recurrence and distant metastasis are common. Treatment is not consensual. Here, we report a case of a 61-year-old female who developed a myoepithelial carcinoma. Primary treatment was a local wide excision with clear pathological margins. Three years later, a local recurrence was treated by further wide excision. Neither recurrences nor distant metastasis were detected four years later. Regular following of patients with myoepithelial carcinoma is essential.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Mioepitelioma/diagnóstico , Mioepitelioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Mioepitelioma/patologia , Recidiva Local de Neoplasia/patologia , PalpaçãoRESUMO
OBJECTIVE: To report the clinical and radiological features of temporal bone metastases and their association with primary lung cancer. CASE REPORTS: Both patients complained of headache, cochlear signs or cranial nerve palsy. Computed tomography of the petrous temporal bones and magnetic resonance imaging showed an osteolytic lesion of the temporal bone. The preoperative work-up was completed by chest, abdomen and pelvis computed tomography and positron emission tomography. Bronchoscopic biopsies confirmed the diagnosis of lung cancer. DISCUSSION/CONCLUSION: The discovery of an osteolytic lesion of the temporal bone requires an aetiological work-up, including the search for a lung tumour based on the hypothesis of temporal bone metastasis. Positron emission tomography should now be performed in the context of such lesions. Management consists of palliative chemotherapy and analgesic radiotherapy.
Assuntos
Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Carcinoma de Células Escamosas/secundário , Neoplasias Pulmonares/patologia , Osso Temporal , Idoso , Evolução Fatal , Humanos , MasculinoAssuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia Doppler/normas , Ecocardiografia Transesofagiana , França , Próteses Valvulares Cardíacas , Ventrículos do Coração/diagnóstico por imagem , Humanos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Medição de Risco/métodosRESUMO
The purpose of this study is to assess the value of US guided vacuum-assisted breast biopsy compared to surgery for management of intraductal papilloma. This retrospective study included 13 patients with hypoechoic nodular lesion corresponding to small benign intraductal papillomas on biopsy and visible by US. The lesions were removed using US-guided vacuum-assisted biopsy and all tissue material was reviewed at histology. The mean size of papillomas was 9.3 mm (5-16 mm). Vacuum-assisted tumor removal was considered total for all 13 lesions. Maximum follow-up was 57 months. Two patients had tumor recurrence at 22 and 28 months respectively. In one case, atypical ductal hyperplasia was present at the periphery of the papilloma, requiring complementary surgery. US-guided vacuum-assisted excision of small benign tumors such as solitary intraductal papillomas appears to be an alternative to surgical biopsy. Because of the large volume of tissue removed, total tumor excision is possible allowing detection of incidental associated lesions.
Assuntos
Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Papiloma Intraductal/patologia , Ultrassonografia de Intervenção , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Hiperplasia , Glândulas Mamárias Humanas/patologia , Glândulas Mamárias Humanas/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Papiloma Intraductal/diagnóstico por imagem , Papiloma Intraductal/cirurgia , Estudos Retrospectivos , VácuoRESUMO
Non-coronary interventional cardiology has for about ten years been undergoing significant development, with the arrival of new percutaneous procedures in various domains. Some of them have already been well validated, notably percutaneous mitral comissurotomy, percutaneous closure of inter-atrial (IA) communications and patent foramen ovale, trans-septal catheterisation, and alcohol septal ablation of hypertrophic obstructive cardiomyopathy. Other interventional techniques are still in the validation phase, such as the techniques for percutaneous occlusion of the left atrium, percutaneous implantation of valvular prostheses, or the new approaches to percutaneous treatment of mitral valvulopathy. The rapid development of these techniques has benefited widely from the use of echocardiography in the catheter suite, providing a very precise clarification of the anatomy and continuous guidance during procedures. This echocardiographic guidance provides optimal results for the interventional procedure and reduces the incidence of complications.
Assuntos
Cateterismo Cardíaco , Ecocardiografia , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Cardíacos , HumanosRESUMO
The long-term evolution following aortic valve replacement depends on the specific clinical context for each patient, but also on the type of prosthesis used. The increased hemorrhagic risk with mechanical prosthesis has to be weighed against the long-term risk of structural failure of bioprostheses. The patient's age will be a key determinant in the choice of the best suited prosthesis. Usually, bioprostheses are preferred after 70 years of age, while mechanical prostheses are chosen in patients under 65.
Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Fatores Etários , Idoso , Bioprótese , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Hemorragia Pós-Operatória , Desenho de Prótese , Falha de Prótese , Fatores de RiscoRESUMO
A 68-year old woman was hospitalised because of isolated right heart failure. Doppler echocardiography revealed severe tricuspid regurgitation with thickened, shortened, hypomobile leaflets. Pulmonary valve was thickened with mild pulmonary regurgitation. Mitral and aortic valves were normal. The patient was finally diagnosed with carcinoid heart disease from an isolated ovarian carcinoid cancer without hepatic metastases. Ovarectomy was performed and the patient was considered cured of her cancer. Because of refractory right heart failure, she underwent tricuspid valve replacement with a bioprosthesis. Such cardiovascular manifestations are rarely the presenting symptoms of carcinoid disease. Carcinoid heart disease from ovarian primary cancer is exceptional. In this circumstance, carcinoid cardiac lesions may develop in the absence of hepatic metastases because the venous blood from the ovaries drains into the inferior vena cava without hepatic first past effect. Surgical resection of primary ovarian carcinoid tumor is often curative and the prognosis depends mainly on the cardiac condition. The diagnosis of carcinoid syndrome should be discussed in patients with organic tricuspid regurgitation without left valvular disease.
Assuntos
Doença Cardíaca Carcinoide/etiologia , Tumor Carcinoide/secundário , Neoplasias Ovarianas/patologia , Insuficiência da Valva Tricúspide/etiologia , Idoso , Doença Cardíaca Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico , Valva TricúspideRESUMO
Echography is a key investigation in the diagnosis and follow up of patients with mitral valvulopathy. Recent advances in transthoracic imaging allow precise evaluation of the entire mitral apparatus in the majority of patients, which avoids recourse to the esophageal route especially for mitral insufficiency. On the other hand, TEE remains systematic in cases of stenosis when percutaneous commissurotomy is envisaged to look for intra-cavitary thrombosis. Echographic analysis has the objectives of defining the anatomical mechanism of the leak or stenosis, addressing aetiological arguments, quantifying the valvular dysfunction, and finally appreciating its repercussions (size of the left atrium, left ventricular function, pulmonary pressures). These elements, as well as evaluation of the symptoms, influence the therapeutic indications. The feasibility of conservative action, for which the significance compared to valvular replacement is known, depends directly upon the anatomical lesion and influences the therapeutic indications, especially in asymptomatic subjects for whom recent recommendations have been published. The experience of the ultrasonographer in the evaluation of mitral valvulopathies and his knowledge of conservative techniques allows improvement of the therapeutic discussion with the patient, the surgeon and the catheteriser. Performing TEE in the operative suite prior to conservative mitral surgery is practiced in many centres, as well as checking at the end of the procedure, especially for complex plasties. Three dimensional echography can currently be performed routinely by the transesophageal route, and probably in the near future by the transthoracic route, thanks to the recent arrival of real time 3D. Exercise echography also promises an important development thanks to the commercialization of new effort tables, and will allow refinement of the therapeutic indications in patients with few symptoms or for whom there is a discordance between the objective data and the functional status, but the therapeutic implications of this investigation remain to be defined.
Assuntos
Ecocardiografia/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Cateterismo Cardíaco , Teste de Esforço , Humanos , Insuficiência da Valva Mitral/patologia , Estenose da Valva Mitral/patologiaRESUMO
OBJECTIVES: Current knowledge of the cardiac manifestations of rheumatoid arthritis (RA) stems only from clinical and transthoracic echocardiography (TTE) studies. To determine the incidence and type of heart lesions in RA, we coupled TTE with transesophageal echocardiography (TEE), which is more sensitive and more accurate. METHODS: Thirty unselected RA patients (26 women and 4 men aged 27 to 84 years, with a mean age of 57.8+/-15.1 years) free of known progressive heart disease underwent a chest radiograph, an electrocardiogram, laboratory tests, and TTE coupled with TEE. Results were compared with those in age- and sex-matched patients who were free of rheumatic disease and who underwent TEE to investigate a neurologic or cardiologic disorder. RESULTS: Mitral regurgitation (MR) was evidenced in 24 cases (80%). Among the controls, only 11 (37%) had MR (P < 0.001). Aortic regurgitation was found in 10 cases (33%), versus 7 controls (not significant-NS). Seven cases (23%) versus only 2 controls (7%) had tricuspid valve abnormalities (NS). Pericarditis was found in 4 cases (13%) and in none of the controls. Eleven cases had evidence of cardiomyopathy (37%) and 12 (40%) had atheroma of the aorta, this last being missed by TTE in 10 patients. Echo-generating nodules were seen on a mitral valve in 2 cases and on an aortic valve in 1. We found no correlations linking cardiac lesions to clinical or laboratory features of RA. CONCLUSION: Our study demonstrated that cardiac involvement, particularly of the mitral valve, is extremely common in RA patients.
Assuntos
Artrite Reumatoide/complicações , Ecocardiografia Transesofagiana/métodos , Cardiopatias/etiologia , Artrite Reumatoide/epidemiologia , Estudos de Casos e Controles , Ecocardiografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Echography can be considered as the gold standard method for quantifying a valvular dysfunction, evaluating its hemodynamic impact and assessing anatomy. Echocardiography is a major step in the diagnosis and the pretherapeutic evaluation of valvular disease.
Assuntos
Ecocardiografia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Diagnóstico Diferencial , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , PrognósticoRESUMO
AIMS: This study assessed the results of repeat percutaneous mitral commissurotomy for mitral restenosis following a first procedure. METHODS AND RESULTS: Repeat balloon commissurotomy was performed in 53 patients who had symptomatic restenosis a mean of 6+/-2 years (2-11) after a successful first procedure; seven patients had mildly calcified valves. All patients had restenosis with a fusion of both commissures as assessed by echocardiography. A double-balloon was used in one case and the Inoue technique in 52. Complications were stroke in one patient and severe mitral regurgitation (Sellers grade 3) in two. Valve area increased from 1.03+/-0.22 to 1.82+/-0.21 cm(2)(P<0.0001) as assessed by planimetry. Good immediate results, defined as valve area >/=1.5 cm(2)with no regurgitation >2/4, were obtained in 48 patients (91%). The 5-year survival rate without operation and in NYHA class I or II was 69+/-11% in the whole population, and 76+/-11% in the 48 patients who had had good immediate results. CONCLUSION: This study suggests that repeat balloon commissurotomy is a valid treatment for symptomatic restenosis after a first successful procedure. It gives good results in patients selected on the basis of favourable characteristics and the echocardiographic analysis of the mechanism of restenosis.
Assuntos
Cateterismo , Estenose da Valva Mitral/terapia , Adulto , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Recidiva , Acidente Vascular Cerebral/etiologia , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of this study was to assess late results of percutaneous mitral commissurotomy (PMC) in calcific mitral stenosis and to identify predictors to improve patient selection. We analyzed 422 patients who underwent PMC for calcific mitral stenosis. The extent of calcium was graded from 1 to 4 by fluoroscopy: 227 patients (53%) were graded 1, 125 (30%) graded 2, 55 graded 3 (13%), and 15 graded 4 (4%). The procedure failed in 15 patients, used a single balloon in 11, a double balloon in 126, and the Inoue balloon in 270. In-hospital mortality was 1.2%. Good immediate results (valve area >/=1.5 cm(2) without mitral regurgitation >2/4), were obtained in 321 patients (76%). Multivariate analysis identified 5 predictors of good immediate results: a younger age (p = 0.0004), a lesser degree of stenosis (p = 0.0005), a smaller extent of calcium (p = 0.04), the use of the Inoue balloon (p = 0.015), and a larger effective balloon dilating area (p = 0.006). Good functional results, defined as survival with no further intervention and in New York Heart Association class I or II, were 36 +/- 4% at 8 years. The predictors of good functional results after good immediate results were a younger age (p = 0.04), a lower pre-PMC New York Heart Association class (p <0.0001), sinus rhythm (p = 0.0006), a smaller extent of calcium (p = 0.02), and a lower gradient after PMC (p <0.0001). Despite a frequent deterioration on follow-up after PMC for calcific mitral stenosis, the predictive analysis suggests that PMC may be useful in deferring surgery in selected patients with mild to moderate calcific deposits, who have otherwise favorable characteristics.