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Background and Objectives: Primary hyperparathyroidism (pHPT) is a common endocrine disorder caused by excessive production of parathyroid hormone (PTH) leading to elevated calcium levels. Diagnosis is primarily based on biochemical evaluation, and surgery is the curative treatment. Imaging techniques like ultrasound and Tc-99m Sestamibi scintigraphy are used for localization, but selective Internal Jugular Venous (SVS) becomes valuable in cases of inconclusive or conflicting results. This study evaluated the diagnostic efficacy of SVS for localizing parathyroid adenomas in cases where non-invasive radiological diagnostic methods yielded inconclusive results or negative findings despite clinical symptoms suggestive of pHPT. Materials and Methods: In this retrospective study, a total of 28 patients diagnosed with pHPT underwent SVS at a tertiary center known for receiving referrals from 2017 to 2022. The diagnoses were confirmed through biochemical analysis. The SVS results in 22 patients were compared with non-invasive imaging methods, including ultrasound, scintigraphy, and computed tomography with/without contrast material. SVS was indicated when at least two non-invasive diagnostic procedures failed to clearly localize the parathyroid glands or provided ambiguous results. Results: SVS demonstrated higher sensitivity for localizing parathyroid adenomas compared to non-invasive imaging methods, accurately lateralizing the adenoma in 68.18% of cases. Among the SVS findings, 31.8% of patients had negative results, with 9.1% not having clinically proven parathyroid adenoma, while 22.7% had false negative SVS findings but were later confirmed to have adenoma during surgery. Ultrasound correctly identified the location in 45.45% of cases, CT in 27.27%, and scintigraphy in 40.9%. Conclusions: SVS is a valuable diagnostic tool for accurately localizing parathyroid adenomas in patients with inconclusive non-invasive imaging results. It aids in targeted surgical interventions, contributing to improved management and treatment outcomes in primary hyperparathyroidism.
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Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Humanos , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Estudos Retrospectivos , Glândulas Paratireoides , Tecnécio Tc 99m Sestamibi , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgiaRESUMO
BACKGROUND: Iterative reconstruction techniques (IRTs) are commonly used in computed tomography (CT) and help to reduce image noise. PURPOSE: To determine the minimum radiation dose while preserving image quality in head CT using IRTs. MATERIAL AND METHODS: The anthropomorphic phantom was used to scan nine head CT image series with varied radiation parameters. CT dose parameters, including volume CT dose index (CTDIvol [in mGy]) and dose length product (DLP [in mGy/cm]), were recorded for each scan series. Different noise levels (iDoseL1-6) were used in IRT reconstructions for soft and bone tissues. In total, 15 measurements were taken from five regions of interest (ROI) with an area of 10 mm2. The signal-to-noise ratio (SNR) and noise values obtained at different ROIs were compared among various reconstruction methods with repeated measures of statistical analysis. RESULTS: In the head CT scan, applying IRT iDoseL5 had the lowest noise and highest SNR for soft tissue (P < 0.05), and increased iDose can decrease CT dose by 54.6% without compromising image quality. While for bone tissue reconstruction, no clear association was found between the level of iDose and noise. However, when CTDIvol is >20 mGy, iDoseL4 is slightly superior to other reconstruction methods (P < 0.065). CONCLUSION: Using IRTs in head CTs reduces radiation dose while maintaining image quality. IDoseL5 provided optimal balance for soft tissue.
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Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Humanos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Cabeça/diagnóstico por imagem , Razão Sinal-Ruído , AlgoritmosRESUMO
For its unique role in developing and designing new bioactive materials and healthcare products, fluoro-organic compounds have attracted remarkable interest. Along with ever-increasing demand for a wider availability of fluorine-containing structural units, a large diversity of methods has been introduced to incorporate fluorine atoms specially in a stereoselective fashion. Among them, catalytic Mannich reaction can proceed with a broad variety of reactants and open clear paths for the synthesis of versatile amine synthons in the synthesis of natural product and pharmaceutical molecules. This review provides an overview of the employment of catalytic asymmetric Mannich reactions in the synthesis of fluorine-containing amine compounds and highlights the conceivable distinct mechanisms.
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Produtos Biológicos , Flúor , Aminas , Produtos Biológicos/química , Catálise , Flúor/química , EstereoisomerismoRESUMO
Isocyanides as key intermediates and magic reactants have been widely applied in organic reactions for direct access to a broad spectrum of remarkable organic compounds. Although the history of these magical compounds dates back more than 100 years, it still has been drawing widespread attention of chemists who confirmed their versatility and effectiveness. Because of their wide spectrum of pharmacological, industrial and synthetic applications, many reactions with the utilization of isocyanides are reported in the literature. In this context, Iranian scientist played a significant role in the growth of isocyanides chemistry. The present review article covers literature from the period starting from 2010 onward and encompasses new synthetic routes and organic transformation involving isocyanides by Iranian researchers. During this period, a diverse range of isocyanide-based multi-component reactions (I-MCRs) has been reported such as a new modification of Ugi, post-Ugi, Passerini and Groebke-Blackburn-Bienayme condensation reactions, isocyanide-based [1 + 4] cycloaddition reactions, isocyanide-acetylene-based MCRs, isocyanide and Meldrum's acid-based MCRs, several unexpected reactions besides green mediums and novel catalytic systems for the synthesis of diverse kinds of pharmaceutically and industrially remarkable heterocyclic and linear organic compounds. This review also emphasizes the neoteric applications of I-MCR for the synthesis of valuable peptide and pseudopeptide scaffolds, enzyme immobilization and functionalization of materials with tailorable properties that can play important roles in the plethora of applications.
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Cianetos/química , Técnicas de Química Sintética , Compostos Heterocíclicos com 2 Anéis/química , Irã (Geográfico) , Metais/química , Pirazinas/químicaRESUMO
Cerebral ischemia because of vertebrobasilar insufficiency (VBI) rarely presents as an initial sign within the systemic lupus erythematosus (SLE) population, and there are very few case reports supporting this manifestation. This report details 3 different patients with SLE who experienced VBI as an initial manifestation. Patient 1 was a 24-year-old female who developed a bilateral pontine lesion as a consequence of basilar artery stenosis. Patient 2 was a 34-year-old male with an acute ischemic lesion on the right side of his cerebellum and pons because of significant stenosis in the distal segment of the right vertebral artery. Patient 3 was a 37-year-old female, previously diagnosed with multiple sclerosis, with multiple lesions in her cerebellum and pons bilaterally. Further investigations within this case revealed severe stenosis of the left vertebral artery. The diagnosis of SLE was based on clinical presentations such as myalgia, skin rashes, ulcers, and fatigue along with relevant laboratory findings including positive anti ds-DNA antibody and depressed levels of complement C3 and C4 proteins. In young patients with multifocal ischemic lesions or infarcts in the posterior cerebral circulation system, physicians should investigate for less common etiologies such as SLE.
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Circulação Cerebrovascular , Lúpus Eritematoso Sistêmico/complicações , Ponte/irrigação sanguínea , Acidente Vascular Cerebral/etiologia , Insuficiência Vertebrobasilar/etiologia , Adulto , Angiografia Digital , Angiografia Cerebral/métodos , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Ponte/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Adulto JovemRESUMO
PURPOSE: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. MATERIALS AND METHODS: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. RESULTS: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. CONCLUSIONS: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.
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Materiais Biocompatíveis/uso terapêutico , Rim/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Cães , Fibrose , Rim/patologia , Modelos Animais , Reprodutibilidade dos Testes , Fatores de Tempo , Alicerces Teciduais , Resultado do Tratamento , Bexiga Urinária/patologia , UrodinâmicaRESUMO
INTRODUCTION: Endovascular treatment of aneurysms has been introduced as a less invasive method for decreasing the rate of aneurysm rerupture and subsequent subarachnoid hemorrhage. The outcome and complication rate for endovascular treatment of very small (≤3 mm) and very large (15-25 mm) intracranial aneurysms has been controversial. Here we report our experience with endovascular coiling of very small and very large ruptured aneurysms of the anterior cerebral circulation. METHODS: Patients were included in the study if the maximum dimension of the intracranial ruptured aneurysm was reported to be ≤3 mm or 15-25 mm and if the aneurysm was within the anterior cerebral circulation. The largest dimension was calculated using CT angiography and was confirmed by digital subtraction angiography. Endovascular coiling was performed using Guglielmi detachable coils. All patients underwent follow-up contrast MR angiography every 6 months. RESULTS: A total of 40 cases (18 females and 22 males) were included in this single-center study. Twenty-one very small and 19 very large ruptured aneurysms were analyzed. Preprocedural Hunt and Hess grades were determined. Endovascular coiling was performed successfully in most cases (97.5%), with unsuccessful coiling in 1 patient with a very small ruptured aneurysm. In the very small aneurysm group, the most common location was the anterior communicating artery and, in the large aneurysm group, the most common location was the middle cerebral artery (MCA) bifurcation. The mean follow-up time was 15.08 months (range: 6-30 months). The 6th month modified Rankin scale (mRS) values for very small aneurysm cases were 0 (no symptoms at all) in 16 cases (76.2%) and 1 (no significant disability despite symptoms) in 5 cases (23.80%). For the very large aneurysm cases, the mRS values were 1 in 2 cases (10.5%), 2 in 7 cases (36.8%), 3 in 6 cases (31.6%), 4 in 3 cases (15.8%) and 6 in 1 case (died due to vasospasm 72 h later; 5.2%). The immediate complications that were observed were MCA branch occlusion in 1 very small aneurysm patient and early vasospasms in 3 very large aneurysm patients. The late complication that was observed was recanalization in 1 very small aneurysm case (1/21, 4.76%) and in 5 very large aneurysm cases (5/18, 27.77%). CONCLUSION: Endovascular treatment of very small aneurysms is an effective method of treatment with acceptable immediate and long-term outcomes. Immediate and long-term complications were more prevalent in very large ruptured aneurysms.
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Aneurisma Roto/terapia , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Aneurisma Roto/patologia , Angiografia Cerebral/métodos , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Pregnancy after liver transplantation poses a significant challenge to both the patient and the transplant team. CASE PRESENTATION: We present the case of a 19-year-old European patient who underwent liver transplantation 5 years previously owing to autoimmune hepatitis. Poor compliance with immunosuppressive therapy and missed follow-up visits during the patient's first pregnancy likely contributed to her liver function deterioration, hospitalization, and failed pregnancy. Owing to the patient's complex medical history, combined immunosuppressive treatment, and risks to the fetus, her second pregnancy was high risk. However, close outpatient monitoring and adherence to treatment led to a successful, uneventful, full-term pregnancy and healthy delivery. CONCLUSION: Liver transplant recipients who desire to become pregnant require careful planning and management to ensure optimal outcomes for both the mother and the fetus. A personalized strategy is necessary to balance the potential benefits of childbirth with the risks involved in pregnancy after liver transplantation.
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Transplante de Fígado , Complicações na Gravidez , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem , Feto , Número de Gestações , Terapia de Imunossupressão , Imunossupressores/efeitos adversos , Transplante de Fígado/efeitos adversos , Resultado da GravidezRESUMO
This case report describes the clinical presentation, diagnostic approach, and treatment strategies for a 58-year-old male patient diagnosed with spontaneous isolated superior mesenteric artery dissection (SISMAD). The patient presented with suddenonset abdominal pain and was diagnosed with SISMAD using computed tomography angiography (CTA). SISMAD is a rare but potentially serious condition that can lead to bowel ischemia and other complications. Management options include surgery, endovascular therapy and conservative management with anticoagulation and close observation. The patient was managed conservatively with antiplatelet therapy and close follow-up. During hospitalization, he received antiplatelet therapy and was closely monitored for signs of bowel ischemia or other complications. The patients' symptoms gradually improved over time, and he was eventually discharged on oral mono- antiagreggation therapy. Clinical follow-up showed a significant symptimatic improvement. Conservative management with antiplatelet therapy was chosen due to the absence of bowel ischemia signs and overall stable clinical condition of patient. This report emphasizes the importance of prompt recognition and management of SISMAD to prevent potentially life-threatening complications. Conservative management with antiplatelet therapy can be a safe and effective treatment option for SISMAD, especially in cases without evidence of bowel ischemia or other complications.
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OBJECTIVES: Management of patients undergoing coronary artery bypass grafting (CABG) with obstructive disease of the carotid arteries is still a matter of debate. We compared the results of staged carotid artery stenting (CAS) before CABG in patients with carotid lesions. MATERIALS AND METHOD: Patients with significant carotid artery disease who were deemed to simultaneously suffer from an obstructive coronary artery disease requiring CABG from 2008 to 2018 were screened and enrolled in this study. We performed a staged CAS in cases with ≥60% stenosis and neurological symptoms or asymptomatic patients with ≥80% carotid artery stenosis. Patients with bilateral carotid lesions received sequential CAS within three weeks. Six weeks after the CAS procedure, all patients underwent CABG. RESULTS: A total of 142 patients were included. Eighty-five of these had neurological symptoms, while the remaining 40% were asymptomatic. Thirty-one patients underwent sequential CAS for bilateral lesions. The cerebrovascular event (CVE) following CAS (3 patients) and CABG (3 patients) was 4.2%. There was only a single case of mortality in this cohort. Although it was not statistically significant, CVE after CABG was more frequent in patients with bilateral carotid disease. CONCLUSIONS: Our results showed that staged CAS could be performed with minimal adverse outcomes in patients suffering from a simultaneous occlusive disease of carotids and coronary arteries before CABG. Bilateral CAS will further decrease cerebrovascular events and could be performed consequently or concomitantly.
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Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Humanos , Artérias Carótidas , Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Endarterectomia das Carótidas/efeitos adversos , Fatores de Risco , Stents , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
Wunderlich syndrome, also known as the spontaneous non-traumatic retroperitoneal hemorrhage, is an uncommon condition characterized by acute, spontaneous, non-traumatic renal hemorrhage into the subcapsular or perirenal spaces. The majority of the cases are caused by renal cell carcinoma or renal angiomyolipoma. Other causes are arteriovenous malformation, cystic renal disease, and anticoagulation medications. The classic presentation is "Lenk's triad" of acute flank pain, palpable flank mass, and hypovolemia. The diagnosis is based on clinical suspicion and confirmed by a CT scan, which is the preferred imaging modality. Due to the rarity of these cases and the wide range of clinical manifestations, the treatment is divergent ranging from conservative management to nephrectomy. Herein, we present a case of massive right renal hemorrhage caused by warfarin toxicity that was initially misdiagnosed as acute renal colic due to the patient's refusal to refer to the clinic during Corona Virus Disease- 19 era and was later managed with a right nephrectomy.
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INTRODUCTION: The most serious complications of carotid artery stenting (CAS) are related to the release of particles into the cerebral circulation. Although embolic protection devices may reduce the incidence of cerebral embolization, their use may be associated with additional complications including spasm or dissection. In this report, we present our experience with patients who underwent unprotected CAS. METHODS: We prospectively enrolled patients with symptomatic internal carotid artery stenosis from October 2008 to June 2010.Stenosis diagnosed based on carotid duplex and/or CT angiography findings and confirmed by digital subtraction angiography. All stenting procedures were done without using a protection device. Neurologist evaluated neurological situation of the patients, 24 h, 30 days, 3 and 6 months after stenting. Patients had carotid duplex scan scheduled on the third and sixth month after the procedure. RESULTS: Overall, 116patients underwent stenting; technical success rate was 100% .Mean age of patients was 68.48 ± 9.84 years, and 69% of the patients were male. One patient (1/116, 0.86%) developed transient ischemic attack during the procedure. One non-neurologic death (1/116, 0.86%) occurred 18 h after the procedure because of myocardial infarction. In 1-month follow-up, only one patient (1/115, 0.87%) presented with neurological complication as a consequence of thalamic hemorrhagic. Six months follow-up revealed two cases (2/115, 1.74%) with in-stent restenosis which one of them was severe and symptomatic and underwent angioplasty. CONCLUSION: Unprotected carotid stenting appears to accompany with low early and late complications. Cerebral embolization during CAS is not the only cause of these complications and the use of cerebral protection devices may therefore not prevent all major complications including myocardial infarction, hyperperfusion syndrome, and re-stenosis.
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Estenose das Carótidas/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
Materials functionalization through multicomponent reactions (MCRs) has recently attracted great attention due to the generation of outstanding features in materials. Herein, an efficient novel heterogeneous catalytic system was designed and synthesized via the MCRs functionalization of the most abundant biopolymer in nature, cellulose. In this regard, cellulose was oxidized using periodate as an oxidant agent, and then the resulted carbonyl functional groups participated in the three-component Betti reaction. The ICP-OES analysis was revealed that the functionalization of cellulose via this three-component reaction effectively improved the complexing ability of functionalized cellulose with Cu(II). The synthesized biocatalyst was characterized by FT-IR, 1H NMR, XRD, SEM, EDS, ICP, and TGA techniques. The efficiency of the designed biocatalyst was investigated in the CH functionalization reaction of N-acylhydrazones to synthesize 1,3,4-oxadiazoles. This biocatalyst's outstanding advantages are high yields, non-hazardous catalyst, mild reaction conditions, operational simplicity, and reusability.
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Celulose/química , Cobre/química , Hidrazonas/química , Iminas/química , Oxidiazóis/química , Catálise , Oxirredução , Ácido Periódico/química , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Difração de Raios X/métodosRESUMO
OBJECTIVES: To evaluate the efficacy of intravesically applied amikacin for the prophylaxis of urinary tract infections (UTIs) occurring in the first 3 months after kidney transplantation. METHODS: In a prospective, randomized, controlled trial, 200 consecutive renal transplant recipients were randomly divided into two equal groups. The bladders of the first group, the amikacin group, were filled with saline solution containing amikacin (1 g in adults and 30 mg/kg in pediatric patients) whereas the bladders of the patients of the second group, the control group, were filled with saline solution. Patients were followed up for 3 months after transplantation with urine cultures to evaluate the prevalence of posttransplantation UTIs in both groups. RESULTS: The overall incidence of UTIs was found to be significantly lower in the amikacin group (25 vs. 49%; p = 0.0007). In addition, male patients, patients with end-stage renal disease due to glomerulonephritis, patients receiving renal transplantation for the first time, or those from the amikacin group receiving a living-related graft had a significantly lower incidence of UTIs than their counterparts in the control group (p < 0.05). UTIs were most frequently caused by Escherichia coli (28.9%). CONCLUSIONS: Perioperative bladder irrigation with amikacin solution significantly decreases the overall incidence of UTIs in the first 3 months after kidney transplantation.
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Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Falência Renal Crônica/cirurgia , Infecções Urinárias/prevenção & controle , Administração Intravesical , Adulto , Distribuição de Qui-Quadrado , Método Duplo-Cego , Enterobacter/isolamento & purificação , Escherichia coli/isolamento & purificação , Feminino , Humanos , Imunossupressores/uso terapêutico , Incidência , Irã (Geográfico) , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Estudos Prospectivos , Pseudomonas aeruginosa/isolamento & purificação , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
Ugi four-component reactions (U-4CRs) are widely recognized as being highly efficient for the synthesis of pseudopeptides. However, the products of these reactions are not so interesting as drug candidates because they are not conformationally restricted enough for a potent interaction with biological targets. One possible way to overcome this problem is to replace amine and oxo components in the U-4CRs with cyclic imines in so-called Joullié-Ugi three-component reactions (JU-3CRs). This approach provides a robust single-step route to peptide moieties connected to N-heterocyclic motifs that are found as core skeletons in many natural products and pharmaceutical compounds. JU-3CRs also provide much better diastereoselectivity than their four-component analogues. We survey here the redesign of many synthetic routes for the efficient preparation of a wide variety of three-, five-, six-, and seven-membered heterocyclic compounds connected to the peptide backbone. Additionally, in the Ugi reactions based on the cyclic imines, α-acidic isocyanides, or azides can be replaced with normal isocyanides or acids, respectively, leading to the synthesis of N-heterocycles attached to oxazoles or tetrazoles, which are of great pharmaceutical significance. This Review includes all research articles related to Ugi reactions based on the cyclic imines to the year 2020 and will be useful to chemists in designing novel synthetic routes for the synthesis of individual and combinatorial libraries of natural products and drug-like compounds.
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Compostos Heterocíclicos/síntese química , Iminas/química , Peptídeos/síntese química , Compostos Heterocíclicos/química , Estrutura Molecular , Oxazóis/química , Peptídeos/química , Estereoisomerismo , Tetrazóis/químicaRESUMO
Introduction: Measurement of thrombolytic activity is crucial for research and development of novel thrombolytics. It is a key factor in the assessment of the effectiveness of conventionally used thrombolytic therapies in the clinic. Previous methods used for the assessment of thrombolytic activity are often associated with some drawbacks such as being costly, time-consuming, complex with low accuracy. Here, we introduce a simple, economic, relatively accurate and fast method of spectrophotometric analysis of thrombolytic activity (SATA) assay, standardized by tissue plasminogen activator (tPA), which can quantitatively measure in vitro thrombolytic activity. Methods: Blood clots were formed, uniformly, by mixing citrated whole blood with partial thromboplastin time (PTT) reagent, together with calcium chloride. Then, designated concentrations of tPA were added to the samples, and the released red blood cells from each clot were quantified using spectrophotometry (λmax=405nm) as an indicator of thrombolytic activity. The accuracy of the method was tested by assessment of dose-responsibility against R2 value obtained by linear equation and measurement of the limit of detection (LOD) and limit of quantification (LOQ). The SATA assay was validated in comparison with some currently used techniques. Results: A linear relationship was obtained between different concentrations of tPA versus the spectrophotometric absorbance of the related dilutions of lysed clots, at λmax=405nm. Calculated R2 values were greater than 0.9; with LOD of 0.90 µg/mL of tPA (436.50IU) and LOQ of 2.99 µg/mL of tPA (1450.15IU). Conclusion: Conclusively, the SATA assay is a very simple quantitative method with repeatable and reproducible results for estimating the potency of an unknown thrombolytic agent, and calculating the activity as delicate as 1 µg/mL of tPA (485 IU/mL of thrombolytic dose).
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OBJECTIVES: Octogenarians account for a third of ischemic stroke (IS) patients and applying endovascular carotid artery stenting (CAS), as a secondary prevention, in these patients is challenging. The aim of this study was to evaluate peri-procedural and long term clinical and angiographic impact of CAS on octogenarians. PATIENTS AND METHODS: In a prospective study, 102 patients aged over 80 years old with symptomatic internal carotid artery (ICA) stenosis presenting by non-disabling IS or transient ischemic attack and having undergone CAS were evaluated prospectively from January 2012 to July 2016. All patients received standard stroke care during the study follow up period. Peri-procedural complication, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded and the collected data were analyzed to evaluate safety and durability of CAS in octogenarians. RESULTS: 48 (47.06%) males and 54 (52.9%) females with the mean age of 83.39 ± 2.53 (range, 80-88) years were followed in a mean period of 24.5 ± 14.1 months (6-50 months). Success rate of CAS was 100%; whereas, the peri-procedural complication rate was 5.8% (only one patient experienced acute ischemic stroke during the procedure). Restenosis and recurrent cerebrovascular accidents were observed in 3.9% and 9.8% of the cases, respectively. Recurrent cerebrovascular accident leading to death was seen in 2.9% of the cases. The median patient event-free survival was 20 months. CONCLUSION: Endovascular CAS seems to be a safe and durable method for secondary prevention in ischemic stroke following symptomatic carotid artery stenosis in octogenarians.
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Artérias Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Ataque Isquêmico Transitório/complicações , Stents/efeitos adversos , Acidente Vascular Cerebral/prevenção & controle , Idoso de 80 Anos ou mais , Angioplastia/métodos , Isquemia Encefálica/complicações , Isquemia Encefálica/prevenção & controle , Feminino , Humanos , Masculino , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.
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Seio Cavernoso/cirurgia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Embolização Terapêutica/métodos , Embucrilato/uso terapêutico , Adesivos Teciduais/uso terapêutico , Adolescente , Adulto , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Seio Cavernoso/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Edema/etiologia , Procedimentos Endovasculares/métodos , Oftalmopatias/etiologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
PURPOSE: To evaluate the efficacy of intradetrusor Dysport (a type of botulinum toxin type A) injection in patients with idiopathic or neurogenic detrusor overactivity, who were refractory to antimuscarinic drugs, and to compare the efficacy of Dysport injection in both groups. MATERIALS AND METHODS: Twelve patients with neurogenic detrusor overactivity (NDO) and 18 patients with idiopathic detrusor overactivity (IDO) participated in this study. All the patients received intravesical injection of 500 units of Dysport. They were followed up for 3 months after injection with maximum cystometric capacity, maximum detrusor filling pressure, and number of catheterization or pad usage. RESULTS: After 3 months, the mean maximum cystometric capacity increased from 109.36 ± 24.11 mL to 266.81 ± 97.18 mL (P = .000) in the NDO group and from 192.24 ± 36.21 mL to 272.61 ± 63.37 mL (P = .000) in the IDO group. The mean maximum detrusor filling pressure decreased from 48.14 ± 26.51 cmH2O to 28.91 ± 9.01 cmH2O (P = .005) in the NDO group and from 39.22 ± 9.92 cmH2O to 29.64 ± 10.14 cmH2O (P = .003) in the IDO group. CONCLUSION: Intradetrusor Dysport injection improved urodynamic parameters and quality of life (QoL) in both groups significantly. We did not find significant difference in QoL or urodynamic parameters between both groups.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Satisfação do Paciente , Bexiga Urinária Hiperativa/tratamento farmacológico , Administração Intravesical , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Indução de Remissão , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinária Hiperativa/classificação , Bexiga Urinária Hiperativa/etiologia , Adulto JovemRESUMO
OBJECTIVES: Right Laparoscopic adrenalectomy (LA) is technically more challenging than left LA, because of the anatomical position of the right adrenal gland and vein. We modified the technique for right LA to optimize the procedure, and compared the operative outcome with standard technique. PATIENTS AND METHODS: The operative outcome of 13 cases of right adrenal mass treated with modified LA were compared retrospectively with 29 cases of standard right LA. For modified right LA, we used a 4-port transperitoneal laparoscopic approach that omitted the subxiphoid trocar (classically used for liver retraction), and instead, an assistant applied continuous, dynamic upward liver retraction in a plane perpendicular to the inferior vena cava (IVC). RESULTS: Modified Right LA was done in 13 patients (3 men, 23.1%), without difficulty and with excellent direct exposure of the upper and medial aspect of the adrenal gland and adrenal vein. Mean operative time was significantly shorter compared with standard technique (122.3 ± 20.1 vs. 165 ± 33.6 min; P < 0.0001) There were no bleeding complication and open conversion in modified technique which was promising compared with 2 bleeding complications in our experience with 29 cases of right LA using standard technique. CONCLUSION: Modified right LA with a 4-port approach and dynamic upward liver retraction in a plane perpendicular to IVC resulted in direct exposure of the upper and medial aspect of the adrenal gland and adrenal vein. This approach can be effective in challenging cases when the infrahepatic fossa is poorly exposed.