Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 138
Filtrar
1.
BJOG ; 127(9): 1102-1107, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32146729

RESUMO

OBJECTIVE: To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. DESIGN: A retrospective national population-based study. SETTING: UK 1995-2015. POPULATION: A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. METHODS: Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. MAIN OUTCOMES: Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. RESULTS: Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. CONCLUSIONS: Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. TWEETABLE ABSTRACT: National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.


Assuntos
Coriocarcinoma/epidemiologia , Neoplasias Uterinas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Coriocarcinoma/complicações , Coriocarcinoma/secundário , Coriocarcinoma/terapia , Feminino , Número de Gestações , Humanos , Incidência , Nascido Vivo/epidemiologia , Idade Materna , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez/epidemiologia , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/terapia , Prognóstico , Fatores de Risco , Resultado do Tratamento , Reino Unido/epidemiologia , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia , Adulto Jovem
2.
J Mol Endocrinol ; 52(3): R257-65, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24740738

RESUMO

Breast cancer (BC) is traditionally viewed as an oestrogen-dependent disease in which the androgen receptor (AR) is inhibitory, counteracting the oncogenic activity of oestrogen receptor α (ERα (ESR1)). Most probably as a result of this crosstalk, the AR has prognostic value in ER-positive disease, with AR positivity reported to correlate with a better prognosis. Activation of the AR pathway has been previously used as a therapeutic strategy to treat BC, but its usage declined following the introduction of the anti-oestrogen tamoxifen. More recently, it has been demonstrated that a subset of triple-negative BCs (molecular apocrine) are dependent upon androgen signalling for growth and therapies that inhibit androgen signalling, currently used for the treatment of prostate cancer, e.g. the antiandrogen bicalutamide and the CYP17 inhibitor abiraterone acetate are undergoing clinical trials to investigate their efficacy in this BC subtype. This review summarises the current knowledge of AR activity in BC.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Antagonistas de Estrogênios/uso terapêutico , Receptores Androgênicos/metabolismo , Receptores de Estrogênio/antagonistas & inibidores , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Acetato de Abiraterona , Androgênios/metabolismo , Androstadienos/uso terapêutico , Anilidas/uso terapêutico , Antagonistas de Estrogênios/farmacologia , Feminino , Humanos , Nitrilas/uso terapêutico , Transdução de Sinais , Esteroide 17-alfa-Hidroxilase/antagonistas & inibidores , Tamoxifeno/farmacologia , Tamoxifeno/uso terapêutico , Compostos de Tosil/uso terapêutico , Neoplasias de Mama Triplo Negativas/patologia
3.
BJOG ; 120(8): 1012-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23759086

RESUMO

OBJECTIVE: The Uterine Artery Pulsatility Index (UAPI) is an ultrasound measure of tumour vascularity. In this study, we hypothesised that a UAPI ≤ 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R). DESIGN: Single-centre cohort study. SETTING: Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease. POPULATION: All women with a GTN FIGO score 5-6 treated with methotrexate (n = 92), between 1999 and 2011, at Charing Cross Hospital. METHODS: UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX-R. MAIN OUTCOME MEASURES: Frequency of MTX-R in women with UAPI ≤ 1 compared with UAPI >1. RESULTS: UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI ≤ 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI ≤ 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036). CONCLUSION: Our results suggest UAPI is an independent predictor of MTX-R in women with FIGO 5-6 GTN.


Assuntos
Resistencia a Medicamentos Antineoplásicos/fisiologia , Doença Trofoblástica Gestacional/tratamento farmacológico , Metotrexato/uso terapêutico , Artéria Uterina/fisiopatologia , Neoplasias Uterinas/tratamento farmacológico , Estudos de Coortes , Feminino , Doença Trofoblástica Gestacional/fisiopatologia , Humanos , Metotrexato/efeitos adversos , Gravidez , Medição de Risco , Reino Unido , Neoplasias Uterinas/fisiopatologia
4.
Br J Cancer ; 108(10): 1925-30, 2013 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-23632485

RESUMO

Since they were first described in the 1990s, circulating microRNAs (miRNAs) have provided an active and rapidly evolving area of current research that has the potential to transform cancer diagnostics and therapeutics. In particular, miRNAs could provide potential new biomarkers for prostate cancer, the most common cause of cancer in UK men. Current diagnostic tests for prostate cancer have low specificity and poor sensitivity. Further, although many prostate cancers are so slow growing as not to pose a major risk to health, there is currently no test to distinguish between these and cancers that will become aggressive and life threatening. Circulating miRNAs are highly stable and are both detectable and quantifiable in a range of accessible bio fluids, thus have the potential to be useful diagnostic, prognostic and predictive biomarkers. This review aims to summarise the current understanding of circulating miRNAs in prostate cancer patients and their potential role as biomarkers.


Assuntos
Biomarcadores Tumorais/sangue , MicroRNAs/sangue , Neoplasias da Próstata/diagnóstico , Transporte Biológico/fisiologia , Humanos , Masculino , Terapia de Alvo Molecular , Prognóstico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/genética , Neoplasias da Próstata/terapia
5.
J Obstet Gynaecol ; 33(4): 406-11, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23654327

RESUMO

The national registration and treatment service for molar pregnancies in the UK allows for the collection of accurate data on this relatively rare diagnosis. In England and Wales, between 2000 and 2009, 5,793 patients with complete moles and 7,790 with partial moles were registered, compared with a total of 8,242,511 conceptions. The overall molar pregnancy incidence was 1 for every 607 conceptions (complete mole 1:1,423; partial mole 1:1,058), but with major variations with age. For complete moles, the risk varied from < 1:1,000 for ages 18-40, to 1:156 for women aged 45 and 1:8 for those aged 50 and above. The overall risk of requiring chemotherapy after a complete mole was 13.6% and 1.1% for partial mole, while the risk of a further molar pregnancy in the next conception was 1:68 but each of these figures have considerable variations with age. These modern statistics on molar pregnancy risks and outcomes should be of value to clinicians and their patients, while discussing this rare diagnosis.


Assuntos
Mola Hidatiforme/epidemiologia , Idade Materna , Sistema de Registros , Neoplasias Uterinas/epidemiologia , Feminino , Humanos , Mola Hidatiforme/tratamento farmacológico , Incidência , Gravidez , Resultado da Gravidez , Medição de Risco , Reino Unido/epidemiologia , Neoplasias Uterinas/tratamento farmacológico
6.
Br J Cancer ; 107(11): 1810-4, 2012 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-23059744

RESUMO

BACKGROUND: Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. METHODS: We have reviewed the demographics, prognostic variables, treatment course and clinical outcomes for the post-mole GTT patients treated at Charing Cross Hospital between 2000 and 2009. RESULTS: Of the 618 women studied, 547 had a diagnosis of complete mole, 13 complete mole with a twin conception and 58 partial moles. At the commencement of treatment, 94% of patients were in the FIGO low-risk group (score 0-6). For patients treated with single-agent methotrexate, the primary cure rate ranged from 75% for a FIGO score of 0-1 through to 31% for those with a FIGO score of 6. CONCLUSION: In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. Prompt treatment and diagnosis should limit the exposure of most patients to combination chemotherapy. Because of the post-treatment relapse rate of 3% post-chemotherapy, hCG monitoring should be performed routinely.


Assuntos
Doença Trofoblástica Gestacional/tratamento farmacológico , Mola Hidatiforme/complicações , Adulto , Gonadotropina Coriônica/sangue , Feminino , Humanos , Leucovorina/uso terapêutico , Metotrexato/uso terapêutico , Gravidez , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
7.
QJM ; 105(9): 819-22, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22383691

RESUMO

Pancreatic neuroendocrine tumours (pNETs) are relatively rare and generally felt to follow an indolent course. But poorly differentiated tumours can behave aggressively with 5-year survival ranging from 31% to 48%. Recent data suggest that patients with pNETs may derive benefit from treatment targeting the molecular changes expressed in this tumour group. This article describes advances in the treatment of unresectable pNETs that have led to a doubling of progression free survival.


Assuntos
Antineoplásicos/uso terapêutico , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Antineoplásicos/farmacologia , Intervalo Livre de Doença , Everolimo , Humanos , Indóis/farmacologia , Indóis/uso terapêutico , Pirróis/farmacologia , Pirróis/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sirolimo/análogos & derivados , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Sunitinibe
8.
Oncogene ; 31(43): 4588-98, 2012 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-22179832

RESUMO

Prostate cancers (PCs), initially responsive to anti-androgen therapies, often advance to a hormone-refractory 'castrate-resistant' PC (CRPC) stage. However, the androgen receptor (AR) pathway remains active and key for cell growth and gene expression within tumours, even in the apparent absence of hormone. Proposed mechanisms to explain progression, including AR amplification/mutation, are insufficient to completely explain CRPC and possible roles of AR cofactors such as prohibitin (PHB) are poorly understood. We investigated whether PHB loss could sensitise PC cells and tumours to adrenal gland-derived androgens, which persist even after androgen ablation, hence contribute to development of CRPC. Using a pair of PC cell lines, inducibly expressing ectopic cDNA or RNAi for PHB, responses to different androgens and hormone concentrations were studied both in vitro and in vivo. PHB was found at the promoters of several genes, both AR and non-AR-regulated, and knockdown increased histone acetylation at these promoters. Further, PHB knockdown increased the rate of AR ligand-induced chromatin binding, and binding rate and occupancy of AR upon the PSA promoter. This resulted in increased cell growth and AR activity in response to all androgens, including promoting a response to the weaker adrenal androgens previously absent at physiological concentrations. In vivo this had functional consequences such that PHB knockdown resulted in androstenedione being sufficient to promote tumour growth, under conditions mimicking those in patients undergoing androgen ablation therapy. We conclude that reduction in PHB levels is sufficient to lower the threshold of AR activity in vitro and in vivo; this may be via a general increase in histone acetylation that could potentially affect signalling by other transcription factors. PHB loss may provide a mechanism for progression to CRPC by sensitising PC cells to 'castrate' conditions-that is, low levels of testicular androgens in the continued presence of weak adrenal and dietary androgens.


Assuntos
Glândulas Suprarrenais/metabolismo , Androgênios/metabolismo , Histonas/metabolismo , Neoplasias da Próstata/metabolismo , Receptores Androgênicos/metabolismo , Proteínas Repressoras/metabolismo , Acetilação , Feminino , Técnicas de Silenciamento de Genes , Humanos , Masculino , Proibitinas , Regiões Promotoras Genéticas , Neoplasias da Próstata/patologia , Ligação Proteica , Proteínas Repressoras/genética
9.
Eur J Vasc Endovasc Surg ; 42(2): 172-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21549622

RESUMO

OBJECTIVES: Outcome prediction in DeBakey Type III aortic dissections (ADs) remains challenging. Large variations in AD morphology, physiology and treatment exist. Here, we investigate if computational fluid dynamics (CFD) can provide an initial understanding of pressure changes in an AD computational model when covering entry and exit tears and removing the intra-arterial septum (IS). DESIGN: A computational mesh was constructed from magnetic resonance images from one patient (one entrance and one exit tear) and CFD simulations performed (scenario #1). Additional meshes were derived by virtually (1) covering the exit tear (false lumen (FL) thrombus progression) (scenario #2), (2) covering the entrance tear (thoracic endovascular treatment, TEVAR) (scenario #3) and (3) completely removing the IS (fenestration) (scenario #4). Changes in flow patterns and pressures were quantified relative to the initial mesh. RESULTS: Systolic pressures increased for #2 (300 Pa increase) with largest inter-luminal differences distally (2500 Pa). In #3, false lumen pressure decreased essentially to zero. In #4, systolic pressure in combined lumen reduced from 2400 to 800 Pa. CONCLUSIONS: CFD results from computational models of a DeBakey type III AD representing separate coverage of entrance and exit tears correlated with clinical experience. The reported results present a preliminary look at a complex clinical problem.


Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Simulação por Computador , Procedimentos Endovasculares , Hemodinâmica , Hidrodinâmica , Modelos Cardiovasculares , Dissecção Aórtica/fisiopatologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/fisiopatologia , Pressão Sanguínea , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Telas Cirúrgicas , Resultado do Tratamento
10.
Clin Immunol ; 131(3): 367-73, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19250873

RESUMO

We report a case of regression of pulmonary and bony metastases in a patient with malignant melanoma following palliative treatment with systemic zoledronate and localised radiotherapy to the bone. Zoledronate is a potent new bisphosphonate used for the treatment of metabolic bone diseases including bone metastases due to its inhibitory effect on osteoclasts. In the context of metastatic cancer zoledronate is routinely used to improve bone pain and reduce the frequency of skeletal events. There is also an increasing body of evidence suggesting that bisphosphonates exhibit anti-tumour properties. Bisphosphonates are able to activate Vgamma9Vdelta2 gamma-delta T cells which can be key players in the immune defence against malignant cells. Furthermore bisphosphonates have direct anti-proliferative, anti-metastatic and pro-apoptotic effects on tumour cells. These actions, together with their low side effect profile, may prove to be useful therapeutic tools in the treatment of cancer even in the absence of bone metastases. On the basis of this case report we here review the current literature on present preclinical and clinical studies using bisphosphonates for the treatment of cancer.


Assuntos
Neoplasias Ósseas/tratamento farmacológico , Difosfonatos/uso terapêutico , Imidazóis/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Melanoma/tratamento farmacológico , Apoptose , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Melanoma/patologia , Melanoma/radioterapia , Pessoa de Meia-Idade , Linfócitos T/imunologia , Linfócitos T/metabolismo , Ligante Indutor de Apoptose Relacionado a TNF/imunologia , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Ácido Zoledrônico
11.
J Vasc Surg ; 40(3): 571-3, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15337893

RESUMO

We present 2 cases in which a surgical adhesive embolized to the extremities. In the first case an adhesive was successfully used in the repair of a DeBakey type I aortic dissection. The patient was seen 2 months postoperatively with acute lower extremity ischemia, and a large piece of adhesive was extracted from the iliac and femoral arteries at embolectomy. In the second case the adhesive was used to seal a pericardial patch during repair of a ventricular septal defect. This patient was seen 1 day postoperatively with acute arm ischemia, and the adhesive particle was extracted from the brachial artery during embolectomy.


Assuntos
Braço/irrigação sanguínea , Embolia/etiologia , Isquemia/etiologia , Perna (Membro)/irrigação sanguínea , Adesivos Teciduais/efeitos adversos , Doença Aguda , Embolectomia , Embolia/diagnóstico , Embolia/cirurgia , Humanos , Isquemia/diagnóstico , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade
12.
J Cardiovasc Surg (Torino) ; 44(4): 527-34, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-14627225

RESUMO

An estimated 1.5 million people in the United States have abdominal aortic aneurysms (AAAs) with more than 200000 American diagnosed each year. The natural history of AAAs is to expand and rupture, accounting for an estimated 15000 deaths per year. Thus, the major impetus for AAA repair is for prophylaxis against aneurysm-related death. The standard open surgical repair of AAAs is a well-established and durable procedure. However, as with all other major abdominal surgical operations, associated significant morbidity and mortality exist, along with prolonged recovery and various late complications. Furthermore, both mortality and morbidity increase significantly with advanced patient age and associated co-morbid disease states. Endovascular AAA repair using covered stent-grafts offers a significantly less invasive alternative to conventional open-surgical repair. A considerable reduction in hospital stay has been demonstrated, with early return to preoperative levels of activity. Patients previously considered unsuitable for open repair can often receive treatment for aneurysms with endovascular techniques. Current estimates are that more than 1/2 all infrarenal AAAs will be repaired using endovascular approach in the future. Despite the minimally-invasiveness of this new treatment, there are unanswered questions as to the durability and efficacy of devices, which results in concerns about their ability to successfully protect the patient from subsequent rupture. Three devices are commercially available and have been extensively used for implantation in the United States with a 4th device recently receiving approval from the Food and Drug Administration (FDA). In this review article, endovascular management of AAAs with these devices is described, as are the design and deployment techniques of the currently available endografts.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Implante de Prótese Vascular , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Desenho de Prótese , Stents
13.
Cardiovasc Surg ; 11(3): 179-84, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12704325

RESUMO

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop pulmonary morbidity following major abdominal surgery. The purpose of this study was to examine the utility of epidural analgesia in patients with COPD who underwent elective transperitoneal abdominal aortic aneurysm (AAA) repair. METHODS: During a 7-year period, all patients diagnosed with COPD undergoing elective AAA repair (n=425) from three hospitals were reviewed. Inclusion criteria were an FEV(1)/FVC ratio <75% and/or a PaCO(2)>45 mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those who did not (control group). Primary endpoints measured were duration of intubation, ICU stay, hospital days, and pulmonary complications. RESULTS: Strict inclusion criteria were met by 131 patients, which included 86 patients in the epidural group and 45 patients in the control group. When comparing the epidural vs. control group, the mean AAA size was 6.3+/-0.9 cm vs. 6.0+/-1.5 cm (NS), FEV(1) was 57.2+/-24.7% vs. 49.0+/-10.3% (NS), and the mean FEV(1)/FVC ratio was 52.0+/-11.4% vs. 50.6+/-6.7% (NS), respectively. The epidural group had a significantly lower incidence of post-operative ventilator dependency and ICU stay (p<0.05), as well as a decreased trend in pulmonary complications when compared to the control group. The overall hospital stay remained similar between the two groups. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3. CONCLUSIONS: Perioperative epidural analgesia is beneficial in patients with COPD undergoing AAA repair by reducing both the post-operative ventilator duration and ICU stay. Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair.


Assuntos
Analgesia Epidural , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Doença Pulmonar Obstrutiva Crônica/cirurgia , Idoso , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/fisiopatologia , Estudos de Casos e Controles , Cuidados Críticos , Volume Expiratório Forçado , Humanos , Tempo de Internação , Pulmão/fisiopatologia , Seleção de Pacientes , Pneumonia/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/complicações , Estudos Retrospectivos , Resultado do Tratamento , Capacidade Vital
14.
J Vasc Surg ; 34(6): 1071-8, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11743563

RESUMO

PURPOSE: This study evaluated the risk factors and surgical management of complications caused by femoral artery catheterization in pediatric patients. METHODS: From January 1986 to March 2001, the hospital records of all children who underwent operative repairs for complications caused by femoral artery catheterization were reviewed. A prospective cardiac data bank containing 1674 catheterization procedures during the study period was used as a means of determining risk factors associated with iatrogenic femoral artery injury. RESULTS: Thirty-six operations were performed in 34 patients (age range, 1 week-17.4 years) in whom iatrogenic complications developed after either diagnostic or therapeutic femoral artery catheterizations during the study period. Non-ischemic complications included femoral artery pseudoaneurysms (n = 4), arteriovenous fistulae (n = 5), uncontrollable bleeding, and expanding hematoma (n = 4). Operative repairs were performed successfully in all patients with non-ischemic iatrogenic femoral artery injuries. In contrast, ischemic complications occurred in 21 patients. Among them, 14 patients had acute femoral ischemia and underwent surgical interventions including femoral artery thrombectomy with primary closure (n = 6), saphenous vein patch angioplasty (n = 6), and resection with primary anastomosis (n = 2). Chronic femoral artery occlusion (> 30 days) occurred in seven patients, with symptoms including either severe claudication (n = 4) or gait disturbance or limb growth impairment (n = 3). Operative treatments in these patients included ileofemoral bypass grafting (n = 5), femorofemoral bypass grafting (n = 1), and femoral artery patch angioplasty (n = 1). During a mean follow-up period of 38 months, no instances of limb loss occurred, and 84% of children with ischemic complications eventually gained normal circulation. Factors that correlated with an increased risk of iatrogenic groin complications that necessitated surgical intervention included age younger than 3 years, therapeutic intervention, number of catheterizations (>or= 3), and use of 6F or larger guiding catheter. CONCLUSION: Although excellent operative results can be achieved in cases of non-ischemic complications, acute femoral occlusion in children younger than 2 years often leads to less satisfactory outcomes. Operative intervention can provide successful outcome in children with claudication caused by chronic limb ischemia. Variables that correlated with significant iatrogenic groin complications included a young age, therapeutic intervention, earlier catheterization, and the use of a large guiding catheter.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Angioplastia/métodos , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Periférico/efeitos adversos , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Hemorragia/etiologia , Hemorragia/cirurgia , Doença Iatrogênica , Isquemia/etiologia , Isquemia/cirurgia , Trombectomia/métodos , Doença Aguda , Adolescente , Fatores Etários , Falso Aneurisma/diagnóstico , Angioplastia/instrumentação , Fístula Arteriovenosa/diagnóstico , Implante de Prótese Vascular/instrumentação , Criança , Pré-Escolar , Doença Crônica , Hematoma/diagnóstico , Hemorragia/diagnóstico , Humanos , Lactente , Recém-Nascido , Isquemia/diagnóstico , Estudos Prospectivos , Fatores de Risco , Trombectomia/instrumentação , Resultado do Tratamento
15.
J Vasc Surg ; 34(6): 1119-22, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11743570

RESUMO

The optimal management of endoleaks after endovascular repair of abdominal aortic aneurysms remains to be established. In this report, we describe a persistent side-branch, or type II, endoleak 1 year after endograft implantation treated with catheter-directed embolization of the aneurysm sac and the inferior mesenteric artery via the superior mesenteric artery, with embolization agents including thrombin, lipiodol, and gelfoam powder. Shortly after the embolization procedure, colonic necrosis developed in the patient, manifested by peritonitis, which necessitated a partial colectomy. This case underscores the devastating complication of colonic ischemia as a result of catheter-directed embolization of the inferior mesenteric artery in the management of an endoleak.


Assuntos
Angioplastia/efeitos adversos , Aneurisma da Aorta Abdominal/terapia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/métodos , Implante de Prótese Vascular/efeitos adversos , Circulação Colateral , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Esponja de Gelatina Absorvível/efeitos adversos , Hemostáticos/efeitos adversos , Artéria Mesentérica Inferior , Artéria Mesentérica Superior , Peritonite/induzido quimicamente , Doenças do Colo Sigmoide/induzido quimicamente , Trombina/efeitos adversos , Idoso , Angioplastia/instrumentação , Angioplastia/métodos , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Colectomia , Quimioterapia Combinada , Humanos , Masculino , Necrose , Peritonite/diagnóstico , Peritonite/cirurgia , Recidiva , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Stents , Fatores de Tempo , Tomografia Computadorizada por Raios X
16.
J Vasc Surg ; 34(5): 939-42, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11700498

RESUMO

Thrombin injection as a means of inducing thrombus formation has recently received wide attention as an alternative treatment for pseudoaneurysm. We present a case of a 67-year-old man in whom a large mycotic pseudoaneurysm developed in the ascending aorta because of sternal osteomyelitis and mediastinitis after coronary artery bypass grafting. Transcatheter intra-arterial thrombin injection was performed, and it successfully induced pseudoaneurysm thrombosis. However, the procedure was complicated by a sudden transient ischemic attack caused by thrombus propagation into the cerebral circulation. Complete thrombus dissolution in the cerebral circulation with the resolution of neurologic symptoms was achieved by means of intravenous abciximab.


Assuntos
Falso Aneurisma/tratamento farmacológico , Aneurisma Infectado/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Aneurisma da Aorta Torácica/tratamento farmacológico , Hemostáticos/administração & dosagem , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/etiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Trombina/administração & dosagem , Abciximab , Idoso , Hemostáticos/uso terapêutico , Humanos , Injeções Intra-Arteriais , Masculino , Trombina/uso terapêutico
17.
J Vasc Surg ; 34(4): 748-50, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11668334

RESUMO

Sloughing of the scrotal skin is an extremely rare event due to pelvic ischemia. We report herein one case of scrotal skin sloughing and impotence after bilateral hypogastric artery embolization for endoluminal aortoiliac aneurysm repair. Postoperative penile plethysmography demonstrated a 75% reduction in the penile brachial index, suggesting that pelvic ischemia is the main culprit for this complication. The devastating morbidity in our patient underscores the importance of maintaining pelvic collateral circulation when planning for endovascular aortoiliac aneurysm repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Embolização Terapêutica/efeitos adversos , Disfunção Erétil/etiologia , Aneurisma Ilíaco/cirurgia , Isquemia/etiologia , Pelve/irrigação sanguínea , Escroto/irrigação sanguínea , Pele/irrigação sanguínea , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia , Artérias , Implante de Prótese Vascular , Circulação Colateral , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Isquemia/patologia , Masculino , Necrose , Pletismografia , Stents
19.
J Vasc Surg ; 34(3): 497-502, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11533603

RESUMO

PURPOSE: This report describes our initial experience with the modular, bifurcated Excluder endoprosthesis and its safety and efficacy in the primary endovascular repair of infrarenal abdominal aortic aneurysms (AAAs). METHODS: AAAs (mean diameter, 58.2 +/- 14.3 mm) were repaired in 19 patients with this device between March 1999 and January 2000. The mean age of patients was 71.8 +/- 8.4 years (range, 57-86 years). This modular device was inserted through an 18F introducer sheath placed in one femoral artery, and the contralateral artery was cannulated with a 12F introducer sheath. All procedures were performed in a standard operating room with angiographic capabilities. RESULTS: Endograft deployment was successful in all patients. The average surgical time was 135 +/- 37 minutes, with a mean blood loss of 229 +/- 138 mL. In eight patients, the use of either aortic or iliac extenders was required for enhanced sealing or additional length. An external iliac artery dissection occurring at the time of endograft insertion was successfully treated with a Wallstent. Type II leaks initially found to be present by means of intraoperative completion angiography had spontaneously thrombosed by the 1-month follow-up computed tomography scan. There was one perioperative death (5.3%). Complications included superficial wound infections (n = 3) and a nonfatal myocardial infarction (n = 1). The mean length of hospital stay was 2.9 +/- 1.2 days, and only six patients required intensive care. Endoleaks were seen in four patients (21%) by means of the 30-day computed tomography scan; three of these endoleaks had spontaneously sealed at the time of the 6-month follow-up examination (5.5% 6-month endoleak rate). Aneurysm size did not increase in the patients with leaks. CONCLUSION: The Excluder endoprosthesis was an effective means of excluding an infrarenal AAA from the systemic circulation in this selected group of patients. The smaller sheath sizes may increase the pool of potential candidates. Further study of this device is warranted, and continued assessment of the long-term durability of the device will be necessary.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
20.
J Vasc Surg ; 34(2): 353-6, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11496291

RESUMO

Two cases of delayed (36-month) Ancure hook fracture are reported in patients who experienced a decrease in aneurysm size and no evidence of endoleak. Both devices used redesigned hooks and are otherwise identical to those devices currently used in clinical practice. Notably, hook fractures were not visualized on all abdominal radiographic views, nor were they noted on the final "institutional" report by the reviewing radiologist. Careful clinical follow-up with multiple-view abdominal radiographs remains essential for all patients treated with an endovascular graft, with particular attention directed to the integrity of the metal components. The broader clinical significance of this observation with respect to the Ancure endograft remains to be defined.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Falha de Prótese , Idoso , Humanos , Masculino , Desenho de Prótese , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA