RESUMO
OBJECTIVES: The aim of this work was to study physiological aortic arch three-dimensional displacement using non-rigid registration methods and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten healthy volunteers underwent thoracic MRI. Prospective cardiac gating was performed with a 3D turbo field echo sequence to obtain end-systolic and end-diastolic MR images. The rigid and elastic behavior between these two cardiac phases was detected and compared using either an affine or an elastic registration method. To assess reproducibility, a second MRI acquisition was performed 14 days later. RESULTS: Affine registration between the end-systolic and end-diastolic MR images showed significant global translations of the aortic arch and the supra-aortic vessels in the x, y, and z directions (2.02 ± 1.6, -0.71 ± 1.1, and -1.21 ± 1.4 mm, respectively). Corresponding elastic registration indicated significant local displacement with a vector magnitude of 5.1 ± 0.89 mm for the brachiocephalic artery (BCA), of 4.26 ± 0.83 mm for the left common carotid artery (LCCA), and of 4.8 ± 0.86 mm for the left subclavian artery (LSCA). There was a difference in displacement between the supra-aortic trunks of the order of 2 mm. Vector displacement was not statistically different between the repeated acquisitions. CONCLUSIONS: The present results showed important deformations in the ostia of supra-aortic vessels during the cardiac cycle. It seems that aortic arch motions should be taken into account when designing and manufacturing fenestrated endografts. The elastic registration method provides more precise results, but is more complex and time-consuming than other methods.
Assuntos
Aorta Torácica/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Adulto , Aorta Torácica/cirurgia , Fenômenos Biomecânicos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Técnicas de Imagem de Sincronização Cardíaca , Procedimentos Endovasculares/instrumentação , Voluntários Saudáveis , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Modelos Cardiovasculares , Dinâmica não Linear , Valor Preditivo dos Testes , Desenho de Prótese , Reprodutibilidade dos Testes , StentsRESUMO
OBJECTIVES/BACKGROUND: ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus) is a prospective multicentre randomized controlled trial including consecutive patients with ruptured aorto-iliac aneurysms (rAIA) eligible for treatment by either endovascular (EVAR) or open surgical repair (OSR). Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aorto-iliac rupture. METHODS: Randomization was done by week, synchronously in all centers. The primary end point was 30 day mortality. Secondary end points were post-operative morbidity, length of stay in the intensive care unit (ICU), amount of blood transfused (units) and 6 month mortality. RESULTS: From January 2008 to January 2013, 107 patients (97 men, 10 women; median age 74.4 years) were enrolled in 14 centers: 56 (52.3%) in the EVAR group and 51 (47.7%) in the OSR group. The groups were similar in terms of age, sex, consciousness, systolic blood pressure, Hardman index, IGSII score, type of rupture, use of endoclamping balloon, and levels of troponin, creatinine, and hemoglobin. Delay to treatment was higher in the EVAR group (2.9 vs. 1.3 hours; p < .005). Mortality at 30 days and 1 year were not different between the groups (18% in the EVAR group vs. 24% in the OSR group at 30 days, and 30% vs. 35%, respectively, at 1 year). Total respiratory support time was lower in the EVAR group than in the OSR group (59.3 hours vs. 180.3 hours; p = .007), as were pulmonary complications (15.4% vs. 41.5%, respectively; p = .050), total blood transfusion (6.8 vs. 10.9, respectively; p = .020), and duration of ICU stay (7 days vs. 11.9 days, respectively; p = .010). CONCLUSION: In this study, EVAR was found to be equal to OSR in terms of 30 day and 1 year mortality. However, EVAR was associated with less severe complications and less consumption of hospital resources than OSR.
Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico , Aneurisma Roto/economia , Aneurisma Roto/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/economia , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/economia , Ruptura Aórtica/mortalidade , Transfusão de Sangue , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Implante de Prótese Vascular/mortalidade , Análise Custo-Benefício , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/mortalidade , Feminino , França , Custos Hospitalares , Mortalidade Hospitalar , Humanos , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/economia , Aneurisma Ilíaco/mortalidade , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis. METHODS: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥ 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS. RESULTS: CE-MRA had a sensitivity and specificity of 96-98% and 66-83% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 94% and 76-84% respectively for carotid stenoses ≥ 70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50-69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥ 70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85-90% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 96-100% and 80-87% respectively for carotid stenoses ≥ 70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥ 70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63-72%, and the overestimations cases were recorded only for carotid stenosis ≤ 69%. CONCLUSION: Combined DUS-CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50-69%) due to the risk of overestimations.
Assuntos
Estenose das Carótidas/diagnóstico , Imageamento Tridimensional , Angiografia por Ressonância Magnética , Ultrassonografia Doppler , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To compare the PaCO(2) with the ETCO(2) obtained with the Smart Capnoline™ in the postoperative setting of cardiac surgery during ventilation and after extubation TYPE OF STUDY: Prospective, observational. PATIENTS: Twenty patients after cardiac surgery. METHODS: In the intensive care unit, arterial blood gases were measured concomitantly with ETCO(2), and difference between PaCO(2) and ETCO(2) were calculated. Three CO(2) sensors were utilized: Filterline H set for intubated patients, Smart Capnoline HO(2) (nasal version) and Smart Capnoline O(2) (bucconasal version) after extubation. Data were compared with Wilconson test and the intraclass correlation coefficient was calculated. RESULTS: The difference PaCO(2) - ETCO(2) was significantly larger in extubated patients compared to intubated patients, which is also confirmed for the bucconasal sensor (intubated patients: 6.6 ± 4.3 mmHg, nasal sensor: 9.3 ± 3.5 mmHg, bucconasal sensor: 15,4 ± 12.9 mmHg). CONCLUSION: In the postoperative setting of cardiac surgery, ETCO(2) measurements allow a reliable estimation of PaCO(2) in intubated patients in contrast to measurements in extubated patients. The bucconasal CO(2) sensor does not show more reliable measurements compared to nasal sensors in the postoperative setting of cardiac surgery.
Assuntos
Capnografia/métodos , Dióxido de Carbono/sangue , Procedimentos Cirúrgicos Cardíacos , Idoso , Testes Respiratórios , Capnografia/instrumentação , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Cuidados Pós-Operatórios , Estudos Prospectivos , Respiração ArtificialRESUMO
OBJECTIVES: To evaluate the outcomes of ischemic diabetic foot lesions for which distal arterial bypass grafting was considered as the first-line vascular procedure. PATIENTS AND METHODS: Between November 2004 and November 2006, 19 lower limbs of 17 diabetic patients with lower limb critical ischemia were operated in our department. The bypass grafts included five femoro-popliteal bypass grafts below knee and 14 distal bypass grafts. The 14 distal bypass grafts included; seven venous grafts on the dorsalis pedis artery, four femorotibial PTFE grafts and three femoroperoneal grafts. Arterio-venous fistula was applied to the distal anastomosis site in three limbs. RESULTS: At the time of discharge, the graft patency rate was 93.75%. The mean follow up period was 24 months. The primary cumulative patency rate was 63% at 2 year. The corresponding secondary patency rate was 87%. Among six ischemic ulcers, four ulcers healed within 2 to 12 months (66.6%). At 24 months, the cumulative rate of limb salvage was 76% and that of survival was 74%. CONCLUSION: Distal arterial bypass in diabetic lower limb ischemia improves blood circulation that accelerates foot ulcer healing. It can also avoid amputation or lower its level, and thus improving the patient's quality of life.
Assuntos
Implante de Prótese Vascular/métodos , Pé Diabético/complicações , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Artérias da Tíbia/cirurgia , Idoso , Angiografia , Pé Diabético/diagnóstico , Pé Diabético/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Artérias da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To demonstrate the added diagnostic value of time-resolved imaging of contrast kinetics (TRICKS) in the evaluation of lower limb arteries compared to standard 3 level MRA with stepping table method. PATIENTS AND METHODS: Forty patients (30% diabetics) with lower extremity peripheral arterial disease (87.5% with chronic ischemia) underwent standard contrast MRA including TRICKS of the distal arteries. Five arterial segments were defined per leg, and 395 arterial segments were compared (one patient with amputation). Two reviewers evaluated the quality of arterial imaging, presence of venous return and degree of stenosis per segment. The degree of interobserver agreement for arterial stenosis measurement was calculated. RESULTS: More arterial segments could be analyzed on the TRICKS sequence (good or excellent analysis in 63.03%-66.32% of arterial segments compared to 41.51%-47.08% on routine MRA). There was less venous contamination on TRICKS images (25.57% to 27.60% gain). The degree of interobserver agreement was superior with TRICKS compared to standard MRA (kappa 0.85 vs 0.69). CONCLUSION: The TRICKS sequence can be added to standard MRA for pre-therapeutic evaluation of distal arteries in patients with peripheral arterial disease, especially with chronic ischemic with rest pain and/or trophic changes.
Assuntos
Perna (Membro)/irrigação sanguínea , Angiografia por Ressonância Magnética , Doenças Vasculares Periféricas/diagnóstico , Idoso , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , MasculinoRESUMO
The authors sought to determine in a retrospective analysis whether carotid plaque soft TD on CT is associated with recent ischemic neurologic events. Among 141 patients (99 asymptomatic), 106 plaques with more than 50% stenosis were selected for density measurements. They found an odds ratio for neurologic events associated with a 10-point decrease in density of 1.54 (p = 0.002), showing an association between plaque density and neurologic events.
Assuntos
Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Estenose das Carótidas/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Isquemia Encefálica/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/fisiopatologia , Meios de Contraste , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologiaRESUMO
In order to show the value of CT angiography in the pretherapeutic assessment of lower leg ischemia, we studied 93 CT angiographies in 85 patients. Two groups were defined according to the level of revascularization: 52 angioscanner were made prior to suprainguinal revascularization and 41 prior to infrainguinal reconstruction. Two decision attitudes were chosen by two different physicians, a radiologist and vascular surgeon, members of the same team. The attitudes where then compared in order to evaluate the value of CT angiography. The first attitude was a pragmatic strategy based on the images as interpreted by the first physician and on the intraoperative information including surgical treatment and, if necessary, angiography. This indicates that the results of this attitude cover the performed revascularizations. The second attitude determined a virtual strategy and was chosen by the second physician a posteriori, based solely on the medical file with the same CT angiography images. These two strategies were compared in order to assess the agreement on the level of the lesion and the choice of revascularization. In 84 CT angiographies (90.3%), the analysis of the lesions and the choice of lesions to be treated were identical. In 9.6% of scans the strategies were not comparable because the lesions were interpreted differently or the scans were difficult to read. The sensitivity of CT angiography in detecting lesions and guiding the therapeutic strategy was 96% and its positive predictive value was 93%. Follow-up was reported according to the life-table method to assess the overall outcome and the results in both groups. The overall survival rate at 12 months for 85 patients was 90%. Secondary patency rates at 12 months in the group of patients who underwent a suprainguinal and infrainguinal revascularization were 98% and 71% respectively. Overall limb salvage at 12 months was 94%. In this setting, CT angiography allowed us to select adequate treatment in the majority of cases. These results obtained after a strategy based on CT angiography images are comparable with the results as published in the literature after the strategy based on conventional angiography.
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Tomada de Decisões , Extremidade Inferior/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Arteriopatias Oclusivas/mortalidade , Meios de Contraste , Humanos , Iohexol , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos VascularesRESUMO
The poor prognosis of vasculo Behcet's disease is often due to postoperative vascular complications (false aneurysm and graft occlusion). We report a case of an abdominal aortic aneurysm associated with an aneurysm of the left common femoral artery in a 23-year-old Portuguese man. The primary treatment was surgical (aneurysmectomy and prosthetic revascularization). The early occlusion of the left femoral revascularized artery was treated surgically with a new bypass. The occlusion of the right limb of the aortoiliac graft was asymptomatic and was not treated. Two months after admission to our hospital, the stenosis of the infrarenal aorta successfully treated by angioplasty via the occluded right limb of the graft. The patient was followed up for 18 months. He could only walk a short distance and had rest pain in the left foot. Magnetic resonance angiography showed a false aneurysm of the infrarenal aorta, and an occlusion of the remaining left limb of the aortoiliac graft. The endovascular treatment performed does not avoid the need for surgical treatment, because occlusion and false aneurysm may occur after dilatation. The endovascular approach can also be used during a sudden inflammatory surge, and makes it possible to wait for a quiescent period when surgery can be performed.
Assuntos
Falso Aneurisma/etiologia , Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Síndrome de Behçet/cirurgia , Artéria Femoral , Oclusão de Enxerto Vascular/etiologia , Complicações Pós-Operatórias/cirurgia , Adulto , Síndrome de Behçet/complicações , Humanos , MasculinoRESUMO
OBJECTIVES: to assess the prognosis of atherosclerotic popliteal aneurysms (APAs), according to whether they were occluded or patent at the time of diagnosis. DESIGN: retrospective study. PATIENTS AND METHODS: fifty-two APAs were investigated in 35 patients. Nineteen were occluded (group I) and 33 patent (group II). In group I, 11 lower limbs had critical ischaemia, and eight had severe claudication. In group II, 27 were asymptomatic, 3 were painful, and 3 presented with symptomatic distal occlusion. In group I, treatment consisted of six bypasses, five thrombectomies, four thrombolyses, but for five APAs, no revascularisation was possible due to lack of runoff. In group II, 30/33 APAs were treated by graft replacement; the other three were not operated on due to the patients>> poor general condition. RESULTS: the 4-year survival rate was 72% in group I vs. 77% in group II, and the limb salvage rate was 72% in group I vs. 100% in group II, p<0.01. CONCLUSION: prophylactic treatment of asymptomatic popliteal aneurysms may avoid amputation caused by thrombosis and embolisation of runoff.
Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular , Claudicação Intermitente/prevenção & controle , Isquemia/prevenção & controle , Perna (Membro)/irrigação sanguínea , Artéria Poplítea , Terapia de Salvação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Aneurisma/complicações , Aneurisma/diagnóstico , Angiografia , Feminino , Humanos , Claudicação Intermitente/complicações , Claudicação Intermitente/diagnóstico , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose/diagnóstico , Trombose/etiologia , Trombose/prevenção & controle , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
The causal effect of cannabis, associated or not with smoking, in juvenile thromboangiitis disorders such as Leo Buerger disease, has been suggested. We describe here a case of a 30-year-old woman who smoked cannabis and developed intermittent claudication of the lower limbs. Female sex and proximal localization of the lesions (external iliac artery) are not usually described in "cannabis arteritis". Cannabis would be involved not only in the pathogenesis of juvenile obstructive arteriopathy, but also in the development of atheromatous lesions in the young subject.
Assuntos
Artéria Ilíaca/patologia , Fumar Maconha/efeitos adversos , Fumar/efeitos adversos , Tromboangiite Obliterante/etiologia , Adulto , Sinergismo Farmacológico , Feminino , Humanos , Claudicação Intermitente/etiologia , Tromboangiite Obliterante/patologiaRESUMO
BACKGROUND: In order to find out if surgical or endoluminal treatment changes the long-term results of atherosclerotic occlusive disease in patients of under 40 years of age we reviewed 17 consecutive patients. METHODS: Their mean age was 36.5. Patients with Buerger's disease or inflammatory arteriopathy were excluded. All patients were extremely heavy smokers. The indications for surgical procedures were disabling claudication (less than 100 meters) for 11 patients, rest pain for 4 patients and grangrene of a lower limb for 2 patients. The lesions were aorto-iliac in 12 cases and femoro-popliteal in 5. Ten surgical procedures were performed (5 aorto-femoral bypasses, 1 ilio-femoral bypass associated with an aorto-renal bypass, 2 femoropopliteal bypasses, 1 aorto-iliac endarteriectomy, 1 femoral endarteriectomy). On the other hand there were 7 endoluminal procedures (1 aortic, 4 iliac, 1 femoral and 1 popliteal). RESULTS: The mean follow-up was 97.3+/-50 months (range, from 34 to 216 months). Two patients died by 57 and 132 months respectively. At 5 years the survival rate was 94%; the primary patency rate was 59%; the secondary patency rate was 81% and the limb salvage rate was 94%. At 10 years these rates were respectively 94%, 44%, 54% and 75%. A total of 21 reoperations were performed. During follow-up 11 patients were better, 2 were stable and 4 were worse with 2 limbs lost. CONCLUSIONS: These bad results suggest keeping the surgical and endoluminal indications for patients younger than 40 years with threatened limbs.
Assuntos
Arteriosclerose/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Adulto , Angioplastia com Balão , Artérias/cirurgia , Endarterectomia , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Resultado do TratamentoRESUMO
Technical aspects of 3D contrast-enhanced magnetic resonance angiography are exposed, detailing more particularly the pulse sequence used and the mode of injection of contrast agent. Then, various vascular territories are analyzed, and illustrated using various examples of main pathologies observed in routine clinical practice: abdominal aorta, renal arteries, pelvic and mesenteric vessels, and peripheral arteries.
Assuntos
Aorta Abdominal , Doenças da Aorta/diagnóstico , Angiografia por Ressonância Magnética , Aneurisma/diagnóstico , Dissecção Aórtica/diagnóstico , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aortite/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Prótese Vascular , Gadolínio , Humanos , Artéria Ilíaca/cirurgia , Perna (Membro)/irrigação sanguínea , Síndrome de Leriche/diagnóstico , Transplante de Fígado , Oclusão Vascular Mesentérica/diagnóstico , Neoplasias Pélvicas/diagnóstico , Obstrução da Artéria Renal/diagnóstico , Arterite de Takayasu/diagnósticoRESUMO
During air travel, the length of time spent in a sitting position and the absence of muscular activity in the calves severely slow the rate of blood flow in the lower limbs. The aim of this randomized, cross-over, double-blind study was to evaluate local application of Hydroxyethyl-rutosides (O-Beta-Hydroxyethylrutosides) in the treatment of symptoms of venous insufficiency including stasis-induced edema during extended air travel on flights exceeding 6 hours. Hydroxyethyl-rutosides or placebo was applied every 3 or 4 hours throughout the flight. In the 51 subjects evaluated (both males and females) the results show statistically significant differences favoring treatment with Hydroxyethyl-rutosides both with regard to objective signs of edema: change in minimum ankle circumference was less during trips in which Hydroxyethyl-rutosides was applied, whether compared with the maximum measurement (p = 0.04) or the last measurement made during the flights, and with regard to subjective signs: several symptoms occurred significantly less frequently when the subject applied Hydroxyethyl-rutosides during the flight [pain (p = 0.03), sensation of heavy and tired legs (p = 0.04) and sensation of swelling (p = 0.02)]. the patient's overall assessment of the treatment was also favorable after using Hydroxyethyl-rutosides Gel (p = 0.01). the number of subjects complaining of edema (pitting edema, marks of shoes, difficulties putting shoes back on) was significantly lower during periods of treatment with Hydroxyethyl-rutosides Gel (p = 0.001). Local application of Hydroxyethyl-rutosides, 3 to 4 times during 6 to 14 hours is thus effective in treating the main symptoms of venous insufficiency including stasis-induced edema caused by extended periods in the sitting position during long air flights.
Assuntos
Hidroxietilrutosídeo/uso terapêutico , Viagem , Insuficiência Venosa/tratamento farmacológico , Adulto , Aeronaves , Método Duplo-Cego , Edema/tratamento farmacológico , Feminino , Humanos , Hidroxietilrutosídeo/efeitos adversos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Intraarterial injection may result in acute ischemia and amputation. The authors describe the case of a 27-year-old man with an acute hand ischemia following intraarterial injection of a suspension of buprenorphine. Despite its initial severity, this case was successfully treated with iloprost, a stable prostacyclin analogue, and dextran-40, a low-molecular-weight dextran.
Assuntos
Anticoagulantes/uso terapêutico , Buprenorfina/efeitos adversos , Dextranos/uso terapêutico , Mãos/irrigação sanguínea , Iloprosta/uso terapêutico , Isquemia/etiologia , Entorpecentes/efeitos adversos , Vasodilatadores/uso terapêutico , Doença Aguda , Adulto , Anticoagulantes/administração & dosagem , Buprenorfina/administração & dosagem , Dextranos/administração & dosagem , Humanos , Iloprosta/administração & dosagem , Infusões Intravenosas , Injeções Intra-Arteriais/efeitos adversos , Injeções Intravenosas , Isquemia/tratamento farmacológico , Masculino , Entorpecentes/administração & dosagem , Vasodilatadores/administração & dosagemRESUMO
Glomus tumor is a neuro-myo-arterial benign tumor accounting for 1 to 5% of hand tumors which occurs principally in young adult females. It may be unique or multiple. Acute, focalized, pain is the main sign, the pressure of a small trigger zone induces a syncopal pain and immediate hand withdrawal. Differential diagnoses includes neurinoma, melanoma, hematoma, osteoid osteoma, fibrokeratoma, mucoid cyst, angioma, and exostosis. The diagnosis is suspected on clinical grounds, and X rays exhibits a bone erosion in one third of the cases. Magnetic resonance angiography is now the first line non invasive tool for both diagnosis and precise localization. Treatment consists in complete surgical tumor resection (J Mal Vasc 1999; 24: 364-367).
Assuntos
Tumor Glômico , Mãos , Diagnóstico Diferencial , Tumor Glômico/diagnóstico , Tumor Glômico/patologia , Tumor Glômico/cirurgia , Mãos/patologia , Mãos/cirurgia , Humanos , Imageamento por Ressonância MagnéticaRESUMO
We describe a case of digital glomus tumor diagnosed by MRI and three-dimensional contrast MR angiography (MRA). Images provided the formal definitive diagnosis and the precise localization of the tumor, guiding the necessary surgical resection. It is possible that noninvasive MRA could replace conventional arteriography for the evaluation of patients with clinical suspicion of glomus tumor.
Assuntos
Dedos , Tumor Glômico/diagnóstico , Processamento de Imagem Assistida por Computador , Angiografia por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico , Meios de Contraste/administração & dosagem , Gadolínio , Tumor Glômico/irrigação sanguínea , Humanos , Injeções Intravenosas , Imageamento por Ressonância Magnética , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Neoplasias de Tecidos Moles/irrigação sanguínea , Tomografia Computadorizada por Raios XRESUMO
Bilateral traumatic dissection of an internal carotid artery (BTDIC) after a closed injury is very rare. We report a case of bilateral thrombosis caused by internal carotid artery dissection due to a closed injury. The 22 cases documented in the literature are also reviewed. Six of the patients (26%) were asymptomatic at the initial examination, but all developed secondary symptoms, during the first 48 hours. Sixteen patients (69%) had associated traumatic lesions. Six patients died during the week after the accident, all of them had initial neurological symptoms. Magnetic resonance imaging (MRI) provided more items of information than angiography, showing a dissection on an occluded artery and a clearer picture of the length of the dissection, directly visualizing the wall hematoma and a residual signal that showed the persistence or arrest of blood flow. Treatment of BTDIC is based on early anticoagulation therapy.
Assuntos
Trombose das Artérias Carótidas/etiologia , Angiografia por Ressonância Magnética , Lesões do Pescoço/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Adulto , Lesões das Artérias Carótidas , Trombose das Artérias Carótidas/diagnóstico , Trombose das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Humanos , Masculino , RadiografiaRESUMO
OBJECTIVE: The present study was designed to measure the cutaneous postural vasoconstrictive reflex (PVR) in normal controls and patients with atherosclerotic occlusive disease of the lower extremities, and to determine its diagnostic and prognostic relevance. EXPERIMENTAL DESIGN: The postural vasoconstrictive reflex was recorded in 34 patients with atherosclerotic occlusive disease of the lower limbs and 27 normal controls, using laser-Doppler flowmetry. Patients also had ankle and toe pressure measurements and transcutaneous oximetry (TcPO2). SETTING: University hospital. RESULTS: The PVR on the pulp of the big toe was 20+/-7 arbitrary perfusion units in normal controls, 9.4+/-12 in patients with claudication, and -19 +/- 5 in patients with rest pain and/or gangrene, who differed from the claudicant and control groups (p=0.001 and 0.0001 respectively). The sensitivity of negative PVR in the big toe was 89% for the diagnosis of rest pain and/or gangrene, and its specificity, 83%. The severity of foot ischaemia and PVR values exhibited a significant inverse correlation (r=-0.56, p<0.0001). All patients with a poor outcome, ie. death and/or major amputation within 100 days of follow-up, had a negative PVR, and all patients with a positive PVR had a good 100-day prognosis without even a minor amputation. CONCLUSIONS: Laser-Doppler provides useful additional information in the assessment of foot ischaemia severity by showing that postural vasoconstriction is impaired in patients with severe atherosclerotic occlusive disease of the lower limbs, resulting in increased skin microcirculatory flow during leg dependency.
Assuntos
Arteriopatias Oclusivas/fisiopatologia , Arteriosclerose/fisiopatologia , Postura/fisiologia , Reflexo/fisiologia , Pele/irrigação sanguínea , Vasoconstrição/fisiologia , Idoso , Monitorização Transcutânea dos Gases Sanguíneos , Feminino , Pé/irrigação sanguínea , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Humanos , Fluxometria por Laser-Doppler , Perna (Membro)/irrigação sanguínea , Masculino , Microcirculação/fisiopatologia , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: During the last few years, AIDS has been the main cause of large pericardial effusions in urban settings. We have therefore had to perform surgical pericardial drainage for diagnostic and/or therapeutic purposes in AIDS patients. This study was designed to establish the diagnostic and therapeutic yield of pericardial drainage for these patients. METHODS: We retrospectively reviewed the data of the 13 AIDS patients with a pericardial effusion, referred to our surgical department between December 1989 and December 1996 for surgical drainage and pericardial biopsy. RESULTS: Cytological studies and searches for bacteria, mycobacteria and parasites were all negative. The histology of the 13 pericardial biopsies disclosed three pericardial locations of a Kaposi's sarcoma (all three patients had a pre-existent extra-cardiac location of this sarcoma) and one pericardial location of an already known immature mediastinal teratoma. In the nine other cases, the lesions were aspecific. Four patients died of multivisceral failure within 30 days of surgery. For the survivors, surgical drainage afforded relief and there were no clinical signs of recurrent effusion. CONCLUSIONS: The cause of pericardial effusion in AIDS is still often unknown, even after pericardial biopsy. Here, aspecific pericarditis was the most common diagnosis. Although the prognosis of such effusion in these patients is known to be poor, surgical drainage provided relief for those who survived the post-operative period.