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1.
J Investig Allergol Clin Immunol ; 31(5): 404-416, 2021 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-32301440

RESUMEN

BACKGROUND AND OBJECTIVE: Hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) and acquired angioedema related to angiotensin-converting enzyme (ACE) inhibitors (ACEI-AAE) are types of bradykinin-mediated angioedema without wheals characterized by recurrent swelling episodes. Recent evidence suggests that a state of "vascular preconditioning" predisposes individuals to attacks, although no data are available on possible structural alterations of the vessels. Objective: This study aims to compare the features of nailfold capillaries to highlight possible structural anomalies between patients affected by C1-INH-HAE and controls and between patients with ACEI-AAE and hypertensive controls. METHODS: We used nailfold videocapillaroscopy (NVC) to assess the following: apical, internal, and external diameter; loop length; intercapillary distance; and capillary density, distribution, and morphology. Plasma levels of vascular endothelial growth factor (VEGF) A, VEGF-C, angiopoietin (Ang) 1, and Ang2 were also measured. RESULTS: Compared with healthy controls (n=28), C1-INH-HAE patients (n = 34) were characterized by significant structural alterations of the capillaries, such as greater intercapillary distance (216 vs 190 µm), increased apical, internal, and external diameter (28 vs 22 µm; 22 vs 20 µm; and 81 vs 65 µm, respectively), decreased density (4 vs 5 capillaries/mm2), more irregular capillary distribution, and more tortuous morphology. Apical diameter was enlarged in patients with ≥12 attacks per year. In ACEI-AAE patients, NVC showed no alterations with respect to hypertensive controls. NVC performed in 2 C1-INH-HAE patients during attacks showed no changes compared with the remission phase. CONCLUSIONS: We detected major structural capillary alterations in C1-INH-HAE patients, thus confirming the involvement of microcirculation in the pathogenesis of angioedema.


Asunto(s)
Angioedema , Angioedemas Hereditarios , Bradiquinina , Proteína Inhibidora del Complemento C1 , Humanos , Angioscopía Microscópica , Factor A de Crecimiento Endotelial Vascular
2.
J Investig Allergol Clin Immunol ; 30(4): 272-280, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31599724

RESUMEN

BACKGROUND AND OBJECTIVE: Angiotensin-converting enzyme inhibitor-associated angioedema (ACEI-AAE) affects 0.1%-0.7% of patients treated with ACEIs. While previous research suggests that angioedema attacks result from increased vascular permeability, the pathogenesis is not completely understood. Objective: This study aimed to describe the clinical, genetic, and laboratory parameters of ACEI-AAE patients and to investigate the role of vascular endothelial growth factors A and C (VEGF-A and VEGF-C), angiopoietins 1 and 2 (Ang1/Ang2), and secretory phospholipase A2 (sPLA2) in the pathogenesis of ACEI-AAE. METHODS: The clinical and laboratory data of ACEI-AAE patients were collected from 2 angioedema reference centers. Healthy volunteers and ACEI-treated patients without angioedema were enrolled to compare laboratory parameters. Genetic analyses to detect mutations in the genes SERPING1, ANGPT1, PLG, and F12 were performed in a subset of patients. RESULTS: A total of 51 patients (57% male) were diagnosed with ACEI-AAE. The average time to onset of symptoms from the start of ACEI therapy was 3 years (range, 30 days-20 years). The most commonly affected sites were the lips (74.5%), tongue (51.9%), and face (41.2%). Switching from ACEIs to sartans was not associated with an increased risk of angioedema in patients with a history of ACEIAAE. VEGF-A, VEGF-C, and sPLA2 plasma levels were higher in ACEI-AAE patients than in the controls. Ang1/2 concentrations remained unchanged. No mutations were detected in the genes analyzed. CONCLUSIONS: Our data suggest that sartans are a safe therapeutic alternative in ACEI-AAE patients. Increased concentrations of VEGF-A, VEGF-C, and sPLA2 in ACEI-AAE patients suggest a possible role of these mediators in the pathogenesis of ACEI-AAE.


Asunto(s)
Angioedema/inmunología , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antígenos de Plaqueta Humana/sangre , Factor A de Crecimiento Endotelial Vascular/sangre , Factor C de Crecimiento Endotelial Vascular/sangre , Adulto , Anciano , Anciano de 80 o más Años , Angiopoyetina 1/sangre , Angiopoyetina 2/sangre , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Cambio de Tratamiento , Regulación hacia Arriba
4.
J Thorac Imaging ; 16(2): 103-5, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11292200

RESUMEN

Thirty-one adult patients with a cluster of small, noncalcified, pulmonary nodules identified on chest computed tomography (CT) examinations were studied retrospectively. Pathology revealed an infectious/inflammatory etiology in all cases in which a surgical resection of the involved lung was performed. None of the patients in our study group showed evidence of malignancy in the region of a cluster of pulmonary nodules over the follow-up period. The authors conclude that an isolated cluster of small pulmonary nodules is strongly suggestive of benign disease. Although exceptions may rarely occur, most cases represent incidental infectious or inflammatory disease.


Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
5.
Abdom Imaging ; 28(6): 853-5, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-14753605

RESUMEN

The most common imaging appearance of the pancreas in cystic fibrosis is diffuse, complete fatty replacement. We present a case of complete fatty replacement of the pancreatic body and tail with total sparing of the pancreatic head. To our knowledge, this pattern of fatty sparing and its associated computed tomographic appearance have not been previously reported in cystic fibrosis.


Asunto(s)
Fibrosis Quística/diagnóstico por imagen , Páncreas/diagnóstico por imagen , Adulto , Fibrosis Quística/patología , Humanos , Masculino , Páncreas/patología , Tomografía Computarizada por Rayos X
6.
J Comput Assist Tomogr ; 23(6): 934-6, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10589569

RESUMEN

Some clear cell renal cell carcinomas contain intracellular lipid, which can be detected with chemical shift MRI. We present an example of surgically proven metastatic clear cell renal carcinoma to the pancreas, which was diagnosed using chemical shift MRI.


Asunto(s)
Adenocarcinoma de Células Claras/secundario , Carcinoma de Células Renales/secundario , Neoplasias Renales/patología , Imagen por Resonancia Magnética/métodos , Neoplasias Pancreáticas/secundario , Adenocarcinoma de Células Claras/química , Carcinoma de Células Renales/química , Medios de Contraste , Gadolinio DTPA , Humanos , Lípidos/análisis , Masculino , Persona de Mediana Edad , Pancreatectomía , Neoplasias Pancreáticas/química , Estudios Prospectivos
7.
Radiology ; 212(3): 861-5, 1999 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-10478258

RESUMEN

PURPOSE: To determine the appearance of tumorous gastric varices on double-contrast barium studies and whether these varices have characteristic radiographic features. MATERIALS AND METHODS: Review of radiology files revealed 86 patients with gastric varices diagnosed during double-contrast upper gastrointestinal tract examinations. Of these 86 patients, 12 (14%) had a conglomerate mass of varices, or tumorous varices. Five of the 12 patients had proved gastric varices and five were presumed to have varices on the basis of additional diagnostic test results, clinical follow-up findings, or both. Radiographs from these 10 patients were reviewed retrospectively to determine the size, location, and morphologic features of these lesions. RESULTS: Tumorous varices had a mean size of 6.8 cm (range, 3-11 cm). They involved the posteromedial border of the gastric fundus in eight patients, the central cardiac region in one, and the anterolateral-inferior fundal border in one. Viewed in profile, the varices appeared as smooth submucosal masses with undulating contours and discrete borders. Viewed en face, the varices manifested as a conglomerate of thickened, tortuous folds that faded peripherally into the adjacent mucosa. CONCLUSION: Tumorous gastric varices manifest as remarkably similar findings on double-contrast barium studies, usually appearing en face as a conglomerate of thickened, lobulated folds and in profile as smooth, undulating, submucosal masses on the posteromedial border of the gastric fundus. It is important to be aware of the characteristic features of tumorous gastric varices on double-contrast studies so that they are not mistaken for neoplastic lesions in the stomach.


Asunto(s)
Várices Esofágicas y Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Sulfato de Bario , Medios de Contraste , Diagnóstico Diferencial , Várices Esofágicas y Gástricas/etiología , Femenino , Mucosa Gástrica/irrigación sanguínea , Mucosa Gástrica/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen
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