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1.
Methodist Debakey Cardiovasc J ; 16(2): 155-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670476

RESUMO

A COVID-19-positive patient presented with pleuritic chest pain and cough and was found to have acute pulmonary embolisms (APEs). There has been an increase in observational reports of venous thromboembolic events in patients who are positive for COVID-19, especially in the setting of elevated inflammatory markers. The possibility of COVID-19 as an independent risk factor for APEs should be further explored in this novel pandemic.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Síndrome Respiratória Aguda Grave/complicações , Doença Aguda , Adulto , Anticoagulantes/uso terapêutico , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/diagnóstico , Tosse/diagnóstico , Tosse/etiologia , Serviço Hospitalar de Emergência , Seguimentos , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Síndrome Respiratória Aguda Grave/diagnóstico , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 76-81, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32621414

RESUMO

OBJECTIVE: To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). METHODS: Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. RESULTS: Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, P < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio (HR) in the vulnerable plaque group was 5.022 (95% CI:3.254-7.751, P < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (HR=3.149, 95% CI:1.987-4.992, P < 0.01); but the difference did not seen in stable plaque group (HR=1.721, 95% CI:0.798-3.712, P>0.05). CONCLUSIONS: This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Placa Aterosclerótica , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Lactente , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Prognóstico , Fatores de Risco
3.
Medicine (Baltimore) ; 99(28): e21108, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664133

RESUMO

RATIONALES: The natural history of fibromuscular dysplasia (FMD) is unclear. Furthermore, the correlation between radiologic findings and clinical significance has not been documented. Previously, the development of new vascular symptoms was reported in a small number of patients, but some of these symptoms were from other vascular causes. New arterial lesions were rarely observed during follow-up in the previous reports. PATIENT CONCERNS: A 40-year-old man was admitted due to dysarthria and left-sided weakness. He had developed flank pain due to bilateral renal infarction about 10 months earlier. He had no known risk factors for atherosclerosis. Initial neurological examination revealed a mild weakness and central facial palsy on the left side. DIAGNOSES: Diffusion-weighted magnetic resonance imaging revealed a small acute infarction in the right insular cortex. Magnetic resonance angiography and digital subtraction angiography showed a severe stenosis with post-dilatation in the right internal carotid artery (ICA). There was a focal ectatic lesion in the left ICA. On the previous abdominal computed tomography angiography (CTA), there were arterial lesions suggestive of dissection in the bilateral renal arteries and a rod-shaped ectasia in the left common iliac artery (CIA). The pathological diagnosis was mixed-type FMD involving the intima and media. INTERVENTIONS: The patient was prescribed antiplatelet agents for prevention of further ischemic events and followed up regularly. OUTCOMES: Seven years after the initial renal infarction, the patient developed abdominal pain radiating to the back. Abdominal CTA revealed that an aortic dissection had developed in the infrarenal aorta, which was shown as normal previously. The ectasia in the left CIA and left ICA showed no interval changes during follow-up. LESSONS: We present a patient who developed spontaneous symptomatic dissection of the bilateral renal arteries, right ICA, and abdominal aorta during 7 years of follow-up, which were caused by pathologically confirmed FMD. Besides the symptomatic multifocal dissection, the patient showed an asymptomatic multifocal ectasia on cerebral and abdominal angiographies that had not changed over 7 years.


Assuntos
Aneurisma/diagnóstico , Artéria Carótida Primitiva , Estenose das Carótidas/diagnóstico , Infarto Cerebral/diagnóstico , Displasia Fibromuscular/diagnóstico , Artéria Ilíaca , Artéria Renal , Adulto , Aneurisma/etiologia , Estenose das Carótidas/etiologia , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Displasia Fibromuscular/complicações , Seguimentos , Humanos , Angiografia por Ressonância Magnética , Masculino , Fatores de Tempo
4.
Emergencias ; 32(4): 253-257, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32692002

RESUMO

OBJECTIVES: To analyze clinical, laboratory, and radiologic findings and final health outcomes in patients with pulmonary embolism and coronavirus disease 2019 (COVID-19). To compare them to findings and outcomes in patients with pulmonary embolism without COVID-19. MATERIAL AND METHODS: Multicenter, observational, retrospective study in 4 Spanish hospital emergency departments (EDs) from January 15 to April 15, 2020. Cases were located by reviewing all ED requests for pulmonary computed tomography angiography (CTA) procedures. Clinical, laboratory, and radiologic findings; medical histories and comorbidity; risk factors; and outcomes were compared between the 2 groups of patients (with or without COVID-19). RESULTS: A total of 399 CTAs were ordered; 88 pulmonary embolisms were diagnosed, 28 of them (32%) in patients with COVID-19. This group had more men, and a history of thromboembolic disease was more common. We found no between-group differences in clinical presentation, laboratory, or radiologic findings; nor were there differences in final outcomes. In-hospital mortality was 7% (2 cases) in patients with COVID-19 and 17% (10 cases) in patients without the virus (odds ratio for death in patients with pulmonary embolism and COVID-19, 0.38; 95% CI, 0.08-1.89). CONCLUSION: We found no clinically important differences in the clinical, laboratory, or radiologic findings between patients with or without COVID-19 who were treated for pulmonary embolism in our hospital EDs. Final outcomes also did not differ.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/diagnóstico por imagem , Idoso , Comorbidade , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Tempo de Internação , Masculino , Razão de Chances , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
5.
J Comput Assist Tomogr ; 44(4): 586-590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697529

RESUMO

BACKGROUND: The clinical relevance and anatomic characteristics of intracavitary coronary arteries coursing within the right ventricle (RV) are largely unknown. OBJECTIVES: The aim of our study was to assess the clinical and computed tomographic characteristics of patients diagnosed with intracavitary coronary arteries coursing within RV (intra-RV coronaries). METHODS: Electronic records from a single high-volume cardiac center were retrospectively screened for the presence of intra-RV coronaries among consecutive patients who underwent coronary computed tomography angiography (coronary CTA) from 2008 to 2019. RESULTS: Overall, 31,748 coronary CTA reports were evaluated, and 17 subjects with intra-RV coronaries were identified. None of these patients was referred for subsequent invasive coronary angiography. One patient underwent coronary artery bypass grafting, 1 patient had a history of percutaneous coronary intervention, and 1 patient had a concomitant coronary anomaly: left circumflex coronary artery originating from the right coronary artery. All of the involved coronaries (n = 17) were the left anterior descending coronary arteries (LADs). Typical segmental coronary course within RV was along the border between free RV wall and interventricular septum (beneath interventricular groove), often within trabeculae carneae of the RV. Only the midsegment and distal segment of the LAD traversed within the RV. The mean ± SD distance from the aorta to the coronary entrance into the RV was 74.5 ± 17.1 mm, whereas the mean ± SD intra-RV coronary length was 25.1 ± 14.0 mm. CONCLUSIONS: Intra-RV course of the coronaries in an adult CTA population is an infrequent anatomical variant involving LAD. It may require additional attention during interventional and surgical interventions.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Idoso , Anomalias dos Vasos Coronários/patologia , Feminino , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Br J Hosp Med (Lond) ; 81(6): 1-12, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32589531

RESUMO

Pulmonary embolism remains an important cause of morbidity and mortality in the UK, particularly following the outbreak of the novel coronavirus 2019 (COVID-19), where those infected have an increased prevalence of venous thromboembolic events. The pathophysiology in COVID-19 patients is thought to relate to a thromboinflammatory state within the pulmonary vasculature, triggered by the infection, but other risk factors such as reduced mobility, prolonged immobilisation and dehydration are likely to contribute. Several societies have released comprehensive guidelines emphasising the importance of risk stratification in patients with acute pulmonary embolism. They advocate the use of clinically validated risk scores in conjunction with biochemical and imaging results. Patients with mild disease can now be managed in the outpatient setting and with newly developed therapies, such as catheter-directed thrombolysis, becoming available in more centres, treatment options for those with more severe disease are also expanding. This article presents four theoretical but realistic cases, each diagnosed with acute pulmonary embolism, but differing in levels of severity. These demonstrate how the guidelines can be applied in a clinical setting, with particular focus on risk stratification and management.


Assuntos
Anticoagulantes/uso terapêutico , Embolectomia , Fibrinolíticos/uso terapêutico , Embolia Pulmonar/terapia , Adulto , Idoso , Assistência Ambulatorial/métodos , Betacoronavirus , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/epidemiologia , Oxigenação por Membrana Extracorpórea , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia
7.
J Thromb Thrombolysis ; 50(1): 223-226, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32474757

RESUMO

Since December 2019, a novel Coronavirus (SARS-CoV-2) was confirmed as the etiologic agent of a worldwide outbreak of a pneumonia that can result in severe respiratory failure. This clinical entity seems to be associated with a marked hypercoagulable state that causes both arterial and venous thromboembolic complications. Therefore, an adequate anti-thrombotic prophylaxis is recommended in hospitalized COVID-19 patients. Although rapidly worsening respiratory symptoms in a patient with SARS-CoV-2 respiratory infection may correlate with worsening pneumonia itself, it may also mask a pulmonary embolism. We report the case of a 50-year-old man affected by SARS-CoV-2 pneumonia, who developed acute pulmonary embolism.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Trombofilia/virologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/diagnóstico por imagem , Trombofilia/complicações
8.
Ideggyogy Sz ; 73(05-06): 213-216, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579312

RESUMO

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo-gical examination excluded mycotic etiology of the aneu-rysm and "normal aneurysm wall" was described. The brain stem haemorrhage - Duret bleeding - was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Cefaleia , Humanos , Aneurisma Intracraniano/complicações , Pessoa de Meia-Idade , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(26): e20873, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590793

RESUMO

INTRODUCTION: Central venous catheters related thrombosis (CRT) insertion has been shown to increase the risk of venous thromboembolism, particularly pulmonary embolism (PE). Nevertheless, deaths cased due to PE have been rarely reported. PATIENT CONCERNS: A central venous catheter was introduced through the right jugular vein during the operation due to severe septic shock from a 57-year-old male patient. Two days after surgery, the hemodynamics was stable. On the 7th day, and low molecular weight heparin calcium (4100 units, once a day) was added for anticoagulation to prevent venous thromboembolism. On the 15th day, during the process of central venous catheter removal, the patient suddenly lost consciousness, suffered cardiac arrest, and received emergency cardiopulmonary resuscitation. DIAGNOSIS: Jugular venous catheter-associated thrombosis and fatal PE. An acute bedside ultrasound showed a thrombus drifting with the blood stream in the right jugular vein. The lower section of the xiphoid process by echocardiography showed decreased systolic amplitude of the right atrium and right ventricle, widened and fixed inferior vena cava, and no variation with respiration. Para-sternal left ventricular long axis section showed that the right ventricular outflow tract was significantly extended, and the contraction amplitude of the anterior and posterior walls of the left ventricle decreased. Left ventricular short axis section indicated a right ventricle enlargement and ventricular septum deviation of left ventricle, showing "D" sign. Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased. INTERVENTIONS: One and a half million units of urokinase were immediately given trough intravenous drip. OUTCOMES: Twenty minutes after thrombolysis, the patient's autonomic heart rhythm was recovered, but continued to suffer from hypotension and coma, followed by multiple organ failure, and died 50 hours later. CONCLUSION: Recent clinical practice guidelines recommend against the routine use of any anticoagulant thromboprophylaxis in patients with central venous catheters, but for patients at particularly high risk for CRT, consideration can be given to using higher doses of anticoagulant as prophylaxis, although there are virtually no data to support this approach.


Assuntos
Veias Jugulares/anormalidades , Embolia Pulmonar/complicações , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada/métodos , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Ultrassonografia/métodos , Trombose Venosa Profunda de Membros Superiores/complicações , Trombose Venosa Profunda de Membros Superiores/tratamento farmacológico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Tromboembolia Venosa/etiologia
10.
Medicine (Baltimore) ; 99(26): e20991, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590813

RESUMO

RATIONALE: Pial arteriovenous fistula (PAVF) occurs when intracranial arteries communicate directly with veins. PAVFs are very rare congenital vascular lesions that are commonly seen in infants and children. Arachnoid cysts are congenital cavitation often filled with cerebrospinal fluid. We present a very rare associated occurrence of bilateral pediatric PAVF and a giant arachnoid cyst presenting as torticollis in a child. So far, this is the first case. PATIENT CONCERNS: A 6-year-old male child was referred to our facility from a local hospital due to severe torticollis. DIAGNOSES: An enhanced computed tomography scan revealed 2 slightly high-density masses at the anterior pontine cistern, right circumferential cistern, as well as left posterior occipital region. The same computed tomography scan revealed a giant arachnoid cyst in the left occipital as well as the temporal region with a thin cerebral cortex adjacent to the cyst. INTERVENTIONS: Digital subtraction angiography confirmed that the 2 high-flow lesions were PAVFs. The patient was treated with a combination of detachable coils and Onyx Liquid Embolic System (Onyx HD-500) (Covidien/ev3 Neurovascular) via the transarterial endovascular route while the giant arachnoid cyst was managed conservatively. OUTCOMES: The torticollis resolved 2 days after the procedure. He is currently well with no neurologic deficit. LESSONS: We advocate that in cases of PAVF with accompanying cyst, the cyst should be managed conservatively if it is not associated with intracranial hemorrhage or focal neurologic deficit.


Assuntos
Fístula Arteriovenosa/diagnóstico , Veias Cerebrais/anormalidades , Cistos Aracnóideos , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Criança , Angiografia por Tomografia Computadorizada/métodos , Humanos , Masculino , Torcicolo/etiologia
12.
J Investig Med High Impact Case Rep ; 8: 2324709620931239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493073

RESUMO

On December 31, 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), which was later named coronavirus infectious disease 2019 (COVID-19). The symptoms most commonly reported by patients affected by COVID-19 include fever, dry cough, and shortness of breath. In this report, we present a case of a 57-year-old woman who presented to the clinic's infectious department with swelling, pain, warmth, and redness in the left leg who was treated with therapeutic heparin. There were no typical and distinguished symptoms of COVID-19, and she had no risk factor for deep vein thrombosis. Then chest X-ray revealed bilateral patchy ground-glass opacity, and computed tomography angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Left lower limb venous color Doppler ultrasound revealed dilatation and thrombosis in the external iliac and left iliac veins up to the level of the bifurcation of the common iliac veins, as well as thrombosis to the superficial and small saphenous veins. Because of ground-glass opacity and lymphopenia, nasal swabs were used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR). This case aims to arouse the medical staff's awareness of deep vein thrombosis as a clinical symptom of COVID-19 even if the patient has no typical symptoms of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Linfopenia/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Anticoagulantes/uso terapêutico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Combinação de Medicamentos , Feminino , Heparina/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Lopinavir/uso terapêutico , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Radiografia Torácica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ritonavir/uso terapêutico , Veia Safena/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
13.
Rev Soc Bras Med Trop ; 53: e20200267, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32491103

RESUMO

The full spectrum of COVID-19 is still emerging, although several studies have highlighted that patients infected with the novel coronavirus can potentially develop a hypercoagulable state. However, several aspects related to the incidence and pathophysiology of the association between COVID-19 and pulmonary embolism are not well established. Here, we present a case of a patient with COVID-19 who developed acute pulmonary embolism. Clinical and laboratory data and findings of non-enhanced CT indicate possibility of acute pulmonary embolism, and support the decision to proceed with computed tomography pulmonary angiography that can objectively identify filling defects in pulmonary arterial branches.


Assuntos
Betacoronavirus , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/virologia , Doença Aguda , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológico , Rivaroxabana/uso terapêutico
14.
J Endovasc Ther ; 27(3): 385-393, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32517556

RESUMO

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Desenho Assistido por Computador , Procedimentos Endovasculares/instrumentação , Impressão Tridimensional , Desenho de Prótese , Stents , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fluxo de Trabalho
15.
J Thromb Thrombolysis ; 50(1): 239-241, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32394237

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease that primarily affects the respiratory system, but it may cause cardiovascular complications such as thromboembolism. Rarely, pulmonary embolism may be encountered in patients with severe COVID-19 infection, especially in intensive care units. An asymptomatic young case of COVID-19 presenting with sudden death due to acute massive pulmonary embolism has not been previously described. We report a 41-year-old woman presented to emergency department with sudden death during physical activity. She had only history of diabetes mellitus and she was asymptomatic until sudden death. CT pulmonary angiography and chest CT scans revealed acute massive embolism and typical imaging findings of COVID-19 pneumonia, respectively. Interestingly, the patient had no symptoms or signs of infection and also had no risk factors for thromboembolism. COVID-19 infection appears to induce venous thromboembolism, especially pulmonary embolism. The case is remarkable in terms of showing how insidious and life-threatening COVID-19 infection can be.


Assuntos
Infecções por Coronavirus/complicações , Morte Súbita/etiologia , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Adulto , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Humanos , Pandemias , Embolia Pulmonar/diagnóstico por imagem
16.
Br J Radiol ; 93(1111): 20200136, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32406752

RESUMO

OBJECTIVE: The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter. METHODS: Cross-sectional CT head scans were reviewed for patients undergoing carotid endarterectomy. The masseter was manually delineated and the total masseter area (TMA) and the total masseter density (TMD) calculated. Measurements of the TMA were standardised against the cranial circumference. Observer variability in measurements were assessed using Bland-Altman plots. The relationship between TMA and TMD were evaluated using Pearson's correlation and linear regression analyses. The prognostic value of TMA and TMD were assessed using receiver operator curves and cox-regression analyses. RESULTS: In total, 149 patients who had undergone routine CT scans prior to a carotid endarterectomy were included in this study. No significant observer variations were observed in measuring the TMA, TMD and cranium circumference. There was a significant positive correlation between standardised TMA and TMD (Pearson's correlation 0.426, p < 0.001, adjusted R-squared 17.6%). The area under the curve for standardised TMA in predicting all-cause mortality at 30 days, 1 year and 4 years were higher when compared to TMD. Standardised TMA was only predictive of post-operative overall all-cause mortality (adjusted hazard ratio 0.38, 95% confidence interval 0.15-0.97, p = 0.043). CONCLUSION: We demonstrate a strong relationship between muscle size and density. However, the utilisation of muscle area is likely to be limited in routine clinical care. ADVANCES IN KNOWLEDGE: Our study supports the utilisation of muscle area in clinical sarcopaenia research. We did not observe any additional prognostic advantage in quantifying muscle density.


Assuntos
Endarterectomia das Carótidas , Músculo Masseter/anatomia & histologia , Idoso , Amaurose Fugaz/diagnóstico por imagem , Amaurose Fugaz/mortalidade , Amaurose Fugaz/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Feminino , Fragilidade/diagnóstico por imagem , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Humanos , Masculino , Músculo Masseter/diagnóstico por imagem , Músculo Masseter/fisiologia , Variações Dependentes do Observador , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios X
17.
Br J Radiol ; 93(1111): 20190995, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436788

RESUMO

OBJECTIVES: To perform CT pulmonary angiography (CTPA) using a minimal amount of iodinated contrast media. METHODS: 47 patients (25 females) with mean age 69 years (range 41-82 years) referred for contrast-enhanced chest CT were prospectively included in this Phase IV clinical drug trial. All participants underwent a study specific CTPA in addition to the chest CT. The participants received 80 mg I/kg body weight Iohexol contrast media using a preparatory saline bolus, a dual flow contrast/saline bolus and a saline flush, and a scanner protocol with 80 kVp dual source high-pitch mode. Three readers independently assessed the image quality on the 3-point scale non-diagnostic, adequate or good-excellent image quality. Additionally, the pulmonary arterial contrast opacification was measured. RESULTS: On average, the patients received 16.8 ml Iohexol 350 mg I/mL (range 12-20 ml). Mean patient weight was 71 kg (range 50-85 kg). Identically for all readers, pulmonary embolism (PE) was detected in 1/47 participants. The median number of examinations visually scored concerning pulmonary embolism as good-excellent was 47/47 (range 44-47); adequate 0/47 (0-3) and non-diagnostic 0/47 (range 0-0). The proportion adequate or better examinations was for all readers 47/47, 100% [95% confidence interval 92-100%]. The mean attenuation ± standard deviation in the pulmonary trunk was 325 ± 72 Hounsfield unit (range 165-531 Hounsfield unit). CONCLUSIONS: Diagnostic CTPA with 17 ml contrast media is possible in non-obese patients using low kVp, high pitch and carefully designed contrast media administration. ADVANCES IN KNOWLEDGE: By combining several procedures in a CTPA protocol, the contrast media dose can be minimized.


Assuntos
Meios de Contraste/administração & dosagem , Iohexol/administração & dosagem , Embolia Pulmonar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem
19.
BMC Infect Dis ; 20(1): 370, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448130

RESUMO

BACKGROUND: Brain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses. CASE PRESENTATION: The patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically. CONCLUSIONS: It is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Penicilina G/uso terapêutico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus intermedius/genética , Fístula Arteriovenosa/complicações , Abscesso Encefálico/líquido cefalorraquidiano , Abscesso Encefálico/microbiologia , Angiografia por Tomografia Computadorizada , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius/isolamento & purificação , Resultado do Tratamento
20.
Int J Cardiol ; 313: 129-131, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32471650

RESUMO

There is some evidence that Covid 19 pneumonia is associated with prothrombotic status and increased risk of venous thromboembolic events (deep venous thrombosis and pulmonary embolism). Over a two-week period we admitted in our Unit 25 patients with Covid-19 pneumonia, of these pulmonary embolism was diagnosed using computed tomography angiography in 7. We report on clinical and biochemical features of these patients. They were all males, with a mean age of 70.3 years (range 58-84); traditional risk factors for venous thromboembolism were identified in the majority of patients with pulmonary embolism, however not differently from those without pulmonary embolism. Clinical presentation of pulmonary embolism patients was usually characterized by persistence or worsening of respiratory symptoms, with increasing oxygen requirement. D-dimer levels were several fold higher than the upper threshold of normal; in patients in whom PE was recognized during hospital stay, a rapid and relevant increase of D-dimer levels was observed. Computed tomographic findings ranged from massive acute pulmonary embolism to a segmental or sub-segmental pattern; furthermore, thrombosis of sub-segmental pulmonary arteries within lung infiltrates were occasionally seen, suggesting local mechanisms. Six out of 7 patients were treated with unfractionated or low molecular weight heparin with clinical benefit within few days; one patient needed systemic thrombolysis (death from hemorrhagic complication).


Assuntos
Infecções por Coronavirus , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina/administração & dosagem , Pandemias , Pneumonia Viral , Embolia Pulmonar , Tromboembolia Venosa , Idoso , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Comorbidade , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Oxigênio/sangue , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Fatores Sexuais , Tromboembolia Venosa/complicações , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/terapia
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