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1.
J Vasc Surg ; 55(1): 223-5, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21958562

RESUMO

We report the use of a remotely steerable catheter to treat kinked renal bridging stents 8 months after branched endovascular repair of a type III thoracoabdominal aortic aneurysm. Conventional techniques using single, coaxial, and manually steerable sheaths proved too unstable to provide the support required to pass a wire against resistance through the kinked stent. A remotely steerable "robotic" catheter provided sufficient precision and stability to cross the kink and reline it with an additional stent, restoring renal perfusion. This technology can help achieve precise and stable introducer sheath position. Further evaluation is necessary to understand the wider applications.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Catéteres , Procedimentos Endovasculares/efeitos adversos , Obstrução da Artéria Renal/terapia , Robótica/instrumentação , Terapia Assistida por Computador/instrumentação , Angiografia Digital , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Reoperação , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Artigo em Inglês | MEDLINE | ID: mdl-18550349

RESUMO

Five SNPs in the CD36 gene, 25444G>A, 27645del>ins, 30294G>C, -31118G>A and -33137A>G in haplotypic combinations, link to fasting plasma NEFA concentrations. Fish oil lowers TAG concentrations. The influence of CD36 SNPs on hypotriglyceridemic effects is unknown. The study examines how four of the SNPs modify the effects of fish oil on fasting plasma TAG, NEFA, glucose LDL and HDL cholesterol concentrations in 111 healthy, middle-aged, Caucasian men. Subjects consumed habitual diets while taking 6g MaxEPA daily for 12 weeks. TAG decreased from 1.48 mol/l to 0.11 mmol/l, and glucose and HDL rose from 5.92 to 0.15 mmol/l and from 1.27 to 0.04 mmol/l, respectively, irrespective of genotype. NEFA was unaffected. Significant falls in TAG only occurred in individuals with the GG variant of the 25444, 30294, -31118 or -33137 SNPs. The TAG-lowering effects may be via stimulation of CD36 activity in extrahepatic tissue in individuals with the GG variants of these SNPs.


Assuntos
Antígenos CD36/genética , HDL-Colesterol/sangue , Óleos de Peixe/farmacologia , Polimorfismo de Nucleotídeo Único , Triglicerídeos/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Glicemia/análise , LDL-Colesterol/sangue , Suplementos Nutricionais , Jejum/sangue , Ácidos Graxos/análise , Ácidos Graxos/sangue , Ácidos Graxos não Esterificados/sangue , Ácidos Graxos Ômega-3/análise , Ácidos Graxos Ômega-3/sangue , Óleos de Peixe/administração & dosagem , Genótipo , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Fosfatidilcolinas/sangue , Fosfatidilcolinas/química , População Branca/genética
3.
J Nutr ; 137(12): 2769-74, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18029497

RESUMO

Monocytes/macrophages are key orchestrators of inflammation and are involved in the pathogenesis of chronic inflammatory disorders, including atherosclerosis. (n-3) Fatty acids, found in fish oil, have been shown to have protective effects in such disorders. To investigate possible modes of action, we used a monocyte:endothelial cell (EC) coculture model to investigate the pro-inflammatory potential of monocytes. Monocytes were isolated from the blood of donors with peripheral arterial disease (PAD) or control donors, before and after a 12-wk supplementation of their diet with fish oil. The monocytes were cultured with human umbilical vein EC (HUVEC) for 24 h, after which the ability of the HUVEC to recruit flowing neutrophils was tested. Monocytes from either group of donors stimulated the EC to support the adhesion and migration of neutrophils. Fish oil supplementation reduced the potency of monocytes from normal subjects, but not those from patients with PAD, to induce recruitment. Concurrent medication may have acted as a complicating factor. On subgroup analysis, only those free of medication showed a significant effect of fish oil. Responses before or after supplementation were not closely linked to patterns of secretion of cytokines by cultured monocytes, tested in parallel monocultures. These results suggest that fish oil can modulate the ability of monocytes to stimulate EC and that this might contribute to their protective effects against chronic inflammatory disorders. Benefits, however, may depend on existing medical status and on other treatments being received.


Assuntos
Óleos de Peixe/farmacologia , Inflamação/metabolismo , Monócitos/efeitos dos fármacos , Proteínas Aviárias/metabolismo , Estudos de Casos e Controles , Adesão Celular , Células Cultivadas , Citocinas/metabolismo , Suplementos Nutricionais , Células Endoteliais/fisiologia , Humanos , Masculino , Monócitos/fisiologia , Neutrófilos/fisiologia , Doenças Vasculares Periféricas/metabolismo , Doenças Vasculares Periféricas/patologia , Fosfolipídeos/sangue
4.
Artigo em Inglês | MEDLINE | ID: mdl-17600695

RESUMO

Peripheral arterial disease (PAD) is an atherosclerotic disease. Evidence suggests that atherosclerosis is an inflammatory condition and long chain n-3 fatty acids, found in oily fish and fish oils, have been shown to reduce inflammation. Genetic and lifestyle factors such as body mass index (BMI) also influence inflammation. In this study we have examined the effect of fish oil in patients with claudication secondary to PAD. Fish oil supplementation, providing 1g EPA and 0.7 g DHA per day for 12 weeks, increased walking distance on a treadmill set at 3.2 km/h with a 7% incline. Walking distance to first pain increased from 76.2+/-8.5 m before fish oil to 140.6+/-25.5 m after fish oil (mean+/-SEM, p=0.004) and total distance walked increased from 160.0+/-21.5 m before fish oil to 242.1+/-34.5 m after fish oil (p=0.002). Fish oil supplementation also improved ankle brachial pressure index (ABPI) from 0.599+/-0.017 before fish oil to 0.776+/-0.030 after fish oil (p<0.001). The increase in walking distance was dependent on both BMI and genotype for single nucleotide polymorphisms in the genes encoding the pro-inflammatory cytokines tumour necrosis factor-alpha and interleukin (IL)-1beta and the anti-inflammatory cytokine IL-10 (detected using amplification refractory mutation system polymerase chain reaction). Neither BMI nor any of the genotypes examined affected the ability of fish oil to increase ABPI. The mechanisms by which fish oil affects walking distance and ABPI do not appear to be the same.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Óleos de Peixe/uso terapêutico , Inflamação/genética , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/genética , Idoso , Idoso de 80 Anos ou mais , Tornozelo/irrigação sanguínea , Citocinas/genética , Gorduras Insaturadas na Dieta/uso terapêutico , Suplementos Nutricionais , Genótipo , Humanos , Claudicação Intermitente/complicações , Claudicação Intermitente/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/complicações , Fosfolipídeos/sangue , Polimorfismo Genético , Relação Cintura-Quadril , Caminhada
5.
Arch Surg ; 147(12): 1093-100, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22911324

RESUMO

OBJECTIVE To assess the outcomes of transanal endoscopic microsurgery in small (<3 cm), large (3-5 cm), and giant (>5 cm) lesions and compare these with reports of alternative techniques. DESIGN Data from January 1998 to February 2010 were prospectively collected. Lesions were divided into 3 groups according to the maximum diameter (group A, <3 cm; group B, 3-5 cm; and group C, >5 cm) and outcomes were analyzed separately. SETTING Colorectal unit in a single-district general hospital. PATIENTS Patients diagnosed as having benign rectal adenomas. INTERVENTION Transanal endoscopic microsurgery excision. MAIN OUTCOME MEASURES Completion of excision (R0), en bloc and full-thickness excisions, complication and local recurrence rates, and disease-free survival. RESULTS A total of 320 lesions were analyzed. Overall en bloc and full-thickness excision rates were 99% and 80.7%, respectively. In the 279 benign lesions, the R0 rate was 90.3%. Outcomes for groups A, B, and C were, respectively: 9.3%, 12.8%, and 14.4% incidence of unexpected malignancy (P = .64); 95.9%, 92.2%, and 85.1% R0 resection for benign lesions (P = .19); and 7.4%, 14.9%, and 24.6% complication rates (P < .05). Overall operative mortality was 1 of 320 (0.3%). In group C, there was a higher estimated recurrence rate, therefore a lower disease-free survival than groups A and B; this difference was significant 40 months after surgery. Recurrences were associated with closeness to dentate line and advanced age (univariate analysis) and R1 resection (Cox regression). CONCLUSIONS Outcomes of transanal endoscopic microsurgery on large rectal lesions compared favorably with literature reports of alternative techniques. Postoperative complications and recurrences increased significantly with lesions larger than 5 cm.

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