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1.
Phlebology ; : 2683555231212302, 2023 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-37934910

RESUMO

The core content for a medical specialty outlines the scope of the discipline as well as the categories of knowledge considered essential to practice in the field. It provides a template for the development of curricula for medical school, graduate, and postgraduate education, as well as for creating certification standards. Venous and Lymphatic Medicine (VLM) is a specialty that has benefitted from contributions from specialists from several medical disciplines. Optimally, the societies, boards, and residency review committees representing these disciplines would uniformly recognize the scope of VLM to develop education and assessment standards to allow training and identification of qualified practitioners. In order to inform the standard setting bodies and other stakeholders of the current scope of VLM, a task force of VLM experts from cardiology, dermatology, emergency medicine, general surgery, interventional radiology, vascular medicine, and vascular surgery was formed to revise a 2014 consensus document defining the core content of the specialty of VLM.

2.
Nanoscale ; 15(5): 2223-2233, 2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36625389

RESUMO

Two-dimensional (2D) van der Waals (vdW) ferromagnetic metals FexGeTe2 with x = 3-5 have raised significant interest in the scientific community. Fe5GeTe2 shows prospects for spintronic applications since the Curie temperature Tc has been reported near or higher than 300 K. In the present work, epitaxial Fe5-δGeTe2 (FGT) heterostructures were grown by Molecular Beam Epitaxy (MBE) on insulating crystalline substrates. The FGT films were combined with Bi2Te3 topological insulator (TI) aiming to investigate the possible beneficial effect of the TI on the magnetic properties of FGT. FGT/Bi2Te3 films were compared to FGT capped only with AlOx to prevent oxidation. SQUID and MOKE measurements revealed that the growth of Bi2Te3 TI on FGT films significantly enhances the saturation magnetization of FGT as well as the Tc well above room temperature (RT) reaching record values of 570 K. First-principles calculations predict a shift of the Fermi level and an associated enhancement of the majority spin (primarily) as well as the total density of states at the Fermi level suggesting that effective doping of FGT from Bi2Te3 could explain the enhancement of ferromagnetism in FGT. It is also predicted that strain induced stabilization of a high magnetic moment phase in FGT/Bi2Te3 could be an alternative explanation of magnetization and Tc enhancement. Ferromagnetic resonance measurements evidence an enhanced broadening in the FGT/Bi2Te3 heterostructure when compared to FGT. We obtain a large spin mixing conductance of g↑↓eff = 4.4 × 1020 m-2, which demonstrates the great potential of FGT/Bi2Te3 systems for spin-charge conversion applications at room temperature.

3.
Infect Dis Ther ; 11(4): 1609-1629, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35716251

RESUMO

INTRODUCTION: 'Real-world' data for mold-active triazoles (MATs) in the treatment of invasive fungal infections (IFIs) are lacking. This study evaluated usage of MATs in a disease registry for the management of IFIs. METHODS: Data were collected for this multicenter, observational, prospective study from 55 US centers, between March 2017 and April 2020. Eligible patients received isavuconazole, posaconazole, or voriconazole as MAT monotherapy (one MAT) or multiple/sequenced MAT therapy (more than one MAT) for prophylaxis or treatment. Patients were enrolled within 60 days of MAT initiation. The primary objective was to characterize patients receiving a MAT and their patterns of therapy. The full analysis set (FAS) included eligible patients for the relevant enrollment protocol, and the safety analysis set (SAF) included patients who received ≥ 1 MAT dose. RESULTS: Overall, 2009 patients were enrolled in the SAF. The FAS comprised 1993 patients (510 isavuconazole; 540 posaconazole; 491 voriconazole; 452 multiple/sequenced MAT therapies); 816 and 1177 received treatment and prophylaxis at study index/enrollment, respectively. Around half (57.8%) of patients were male, and median age was 59 years. Among patients with IFIs during the study, the most common pathogens were Aspergillus fumigatus in the isavuconazole (18.2% [10/55]) and voriconazole (25.5% [12/47]) groups and Candida glabrata in the posaconazole group (20.9% [9/43]); the lungs were the most common infection site (58.2% [166/285]). Most patients were maintained on MAT monotherapy (77.3% [1541/1993]), and 79.4% (1520/1915) completed their MAT therapies. A complete/partial clinical response was reported in 59.1% (591/1001) of patients with a clinical response assessment. Breakthrough IFIs were reported in 7.1% (73/1030) of prophylaxis patients. Adverse drug reactions (ADRs) were reported in 14.7% (296/2009) of patients (3.9% [20/514] isavuconazole; 11.3% [62/547] posaconazole; 14.2% [70/494] voriconazole). CONCLUSIONS: In this 'real-world' study, most patients remained on their initial therapy and completed their MAT therapy. Over half of patients receiving MATs for IFIs had a successful response, and most receiving prophylaxis did not develop breakthrough IFIs. ADRs were uncommon.

4.
J Phys Condens Matter ; 34(2)2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34638109

RESUMO

The influence of an external static magnetic field (up to 480 mT) on the structural properties of EuTiO3(ETO) polycrystalline samples was examined by powder XRD at the Elettra synchrotron facilities in the temperature range 100-300 K. While the cubic to tetragonal structural phase transition temperature in this magnetic field range remains almost unaffected, significant lattice effects appear at two characteristic temperatures (∼200 K and ∼250 K), which become more pronounced at a critical threshold field. At ∼200  K a change in the sign of magnetostriction is detected attributed to a modification of the local magnetic properties from intrinsic ferromagnetism to intrinsic antiferromagnetism. These data are a clear indication that strong spin-lattice interactions govern also the high temperature phase of ETO and trigger the appearance of magnetic domain formation and phase transitions.

5.
Transpl Infect Dis ; 20(2): e12855, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29427356

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) is a common complication of lung and allogeneic hematopoietic cell (HCT) transplant, but the epidemiology and outcomes of CDI after transplant are poorly described. METHODS: We performed a prospective, multicenter study of CDI within 365 days post-allogeneic HCT or lung transplantation. Data were collected via patient interviews and medical chart review. Participants were followed weekly in the 12 weeks post-transplant and while hospitalized and contacted monthly up to 18 months post-transplantation. RESULTS: Six sites participated in the study with 614 total participants; 4 enrolled allogeneic HCT (385 participants) and 5 enrolled lung transplant recipients (229 participants). One hundred and fifty CDI cases occurred within 1 year of transplantation; the incidence among lung transplant recipients was 13.1% and among allogeneic HCTs was 31.2%. Median time to CDI was significantly shorter among allogeneic HCT than lung transplant recipients (27 days vs 90 days; P = .037). CDI was associated with significantly higher mortality from 31 to 180 days post-index date among the allogeneic HCT recipients (Hazard ratio [HR] = 1.80; P = .007). There was a trend towards increased mortality among lung transplant recipients from 120 to 180 days post-index date (HR = 4.7, P = .09). CONCLUSIONS: The epidemiology and outcomes of CDI vary by transplant population; surveillance for CDI should continue beyond the immediate post-transplant period.


Assuntos
Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Pulmão/efeitos adversos , Transplantados , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco
6.
7.
Psychol Health Med ; 21(4): 439-447, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26399373

RESUMO

The aim of the present study was to explore the differences in the psychological profiles between genders and different specialties among Greek doctors. Five-thirty nine doctors in five different specialties, namely 115 general practitioners, 168 internists, 81 surgeons, 108 microbiologists and 67 anesthesiologists, participated in the study. 253 participants were specialized doctors and 286 participants were medical residents. The sample consisted of 280 women and 259 men. The mean age of the sample was 38.75(±7.98) years. A cross sectional survey study was conducted. Symptom Check List 90-Revised (SCL-90-R) was used to collect the data. Multivariate Analysis of Variance indicated the significant effect of specialty (Wilks' Lambda = .20, p = .000), the effect of gender (Wilks' Lambda = .90, p = .000) as well as their interaction (Wilks' Lambda = .68, p = .000) on participants' scores in SCL-90-R subscales. Internists reported high scores in 8 out of 9 subscales of SCL-90-R. Surgeons scored significantly higher compared to all other specialties in hostility(HS) subscale. Women reported statistically higher scores in almost all subscales of the SCL-90-R test compared to men, apart from HS (p = .191). Gender and specialty choice play role in the psychological profile of Greek doctors. Women and internists seem to be more prone to psychopathology. These findings should be taken into account in future studies and interventions.

8.
Radiat Prot Dosimetry ; 172(4): 409-415, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26656074

RESUMO

The aim of the present study is the estimation of radiation burden during liver chemoembolisation procedures. Organ dose and effective dose conversion factors, normalised to dose-area product (DAP), were estimated for chemoembolisation procedures using a Monte Carlo transport code in conjunction with an adult mathematical phantom. Exposure data from 32 patients were used to determine the exposure projections for the simulations. Equivalent organ (HT) and effective (E) doses were estimated using individual DAP values. The organs receiving the highest amount of doses during these exams were lumbar spine, liver and kidneys. The mean effective dose conversion factor was 1.4 Sv Gy-1 m-2 Dose conversion factors can be useful for patient-specific radiation burden during chemoembolisation procedures.


Assuntos
Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Método de Monte Carlo , Imagens de Fantasmas , Planejamento da Radioterapia Assistida por Computador/métodos , Adulto , Humanos , Prognóstico , Dosagem Radioterapêutica
9.
Int J Oncol ; 47(2): 455-64, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26095084

RESUMO

Metronomic chemotherapy is the protracted, dense administration of low sub-toxic doses of chemotherapy, to inhibit tumor angiogenesis. Vinorelbine is an orally bioavailable vinca alkaloid shown to be useable for metronomic administration. In clinical trials, metronomic vinorelbine has been demonstrated to generate sustainable antitumor efficacy at low nanomolar (nM) concentrations with negligible toxicity. We sought to determine whether the clinically relevant metronomic concentration of vinorelbine is anti-angiogenic in vitro and whether hypoxia, often induced by anti-angiogenic therapy, modifies its effectiveness. We found that the metronomic concentration of 10 nM vinorelbine inhibited human umbilical vein endothelial cell (HUVEC) proliferation, migration, tube formation and sprouting. Severe hypoxia, did not affect the inhibitory effect of metronomic vinorelbine on migration, tube formation and sprouting. However, severe hypoxia reduced its anti-proliferative effect by decreasing its ability to induce G2/M block as it shifted the cell population to the G1 phase and decreased the fraction of the cells in the DNA synthesis S phase. Furthermore, the pro-apoptotic effects of 10 nM vinorelbine were also decreased. Metronomic vinorelbine decreased the Bcl-2/Bax ratio in normoxia whereas the ratio was reduced in severe hypoxia but unaltered by vinorelbine treatment. Akt signals to an anti-apoptotic pathway and we demonstrated that the Akt inhibitor V reversed the protective effect of severe hypoxia. Thus, we provide evidence for the anti-angiogenic basis of metronomic vinorelbine and we show that severe hypoxia mediates resistance to its anti-proliferative effect on endothelial cells. Akt warrants further investigation as a potential target to circumvent this hypoxic resistance.


Assuntos
Inibidores da Angiogênese/farmacologia , Antineoplásicos Fitogênicos/farmacologia , Resistencia a Medicamentos Antineoplásicos , Vimblastina/análogos & derivados , Administração Metronômica , Hipóxia Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana , Humanos , Técnicas In Vitro , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , Vimblastina/farmacologia , Vinorelbina
10.
Int J Cardiol ; 178: 117-23, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25464234

RESUMO

BACKGROUND: Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality. METHODS AND RESULTS: Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement. Patients who received bioprostheses were older (62 vs 54years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p=0.0009) and 25.3% vs 16.6% (p<.0001), respectively. In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60). Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298). CONCLUSIONS: Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction.


Assuntos
Bioprótese/microbiologia , Endocardite/mortalidade , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/mortalidade , Infecções Relacionadas à Prótese/mortalidade , Idoso , Bioprótese/tendências , Estudos de Coortes , Endocardite/diagnóstico , Feminino , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Prospectivos , Infecções Relacionadas à Prótese/diagnóstico , Resultado do Tratamento
11.
Transplant Proc ; 46(9): 3203-5, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25420859

RESUMO

BACKGROUND AND PURPOSE: Urinary lithiasis represents an unusual urologic complication in renal transplantation, with an incidence of 0.17%-1.8%.We present our experience with renal graft lithiasis in our series of renal transplantations. MATERIAL AND METHODS: We reviewed the medical records for 2045 patients who underwent kidney transplantation from January 1983 to July 2013. Among the grafts, 9 patients were found to have allograft lithiasis. In 6 cases, the calculi were localized within the renal unit, and in 3 cases in the ureter. Two of the patients had relapsed after a few years from the first treatment. In both of them the stones were localized again in the ureter. RESULTS: In our series, incidence of graft lithiasis was 0.44% (n = 9). Three of the 9 patients (33.3%) were treated via percutaneous nephrolithotripsy (PCNL), 3 (33.3%) underwent extracorporeal shockwave lithotripsy (ESWL), 2 (22.2%) passed their stones spontaneously, and 1 (11.1%) underwent PCNL after 2 failed ESWL interventions. All patients are currently stone free but still remain under close urologic surveillance. CONCLUSIONS: Urinary stone formation can lead to significant morbidity and graft loss. The treatment options should be similar to those for patients in the general population. Long-term follow-up is substantial to determine the outcome and to prevent the recurrence.


Assuntos
Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Cálculos Urinários/epidemiologia , Adulto , Aloenxertos , Feminino , Grécia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cálculos Urinários/etiologia
12.
Am J Transplant ; 14(6): 1328-33, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24726020

RESUMO

Invasive mold infections (IMIs) are a major source of morbidity and mortality among lung transplant recipients (LTRs), yet information regarding the epidemiology of IMI in this population is limited. From 2001 to 2006, multicenter prospective surveillance for IMIs among LTR was conducted by the Transplant-Associated Infection Surveillance Network. The epidemiology of IMI among all LTRs in the cohort is reported. Twelve percent (143/1173) of LTRs under surveillance at 15 US centers developed IMI infections. The 12-month cumulative incidence of IMIs was 5.5%; 3-month all-cause mortality was 21.7%. Aspergillus caused the majority (72.7%)of IMIs; non-Aspergillus infections (39, 27.3%) included Scedosporium (5, 3.5%), mucormycosis (3, 2.1%) and "unspecified" or "other" mold infections (31, 21.7%). Late-onset IMI was common: 52% occurred within 1 year posttransplant (median 11 months, range 0-162 months). IMIs are common late-onset complications with substantial mortality in LTRs. LTRs should be monitored for late-onset IMIs and prophylactic agents should be optimized based on likely pathogen.


Assuntos
Pneumopatias/epidemiologia , Transplante de Pulmão , Micoses/epidemiologia , Estudos de Coortes , Humanos , Pneumopatias/microbiologia , Micoses/microbiologia
13.
Transpl Infect Dis ; 16(2): 213-24, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24589027

RESUMO

BACKGROUND: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations. METHODS: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006. RESULTS: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died. CONCLUSIONS: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.


Assuntos
Blastomicose/epidemiologia , Coccidioidomicose/epidemiologia , Doenças Endêmicas , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Histoplasmose/epidemiologia , Transplante de Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Blastomicose/tratamento farmacológico , Criança , Coccidioidomicose/tratamento farmacológico , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Comorbidade , Feminino , Histoplasmose/tratamento farmacológico , Humanos , Incidência , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
14.
East Afr Med J ; 91(5): 145-51, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-25684784

RESUMO

BACKGROUND: Cryptococcal meningitis (CM) is an increasingly prevalent infection among HIV/AIDS patients and is becoming a leading cause of morbidity and mortality in Africa. The short-term prognosis and management of patients with CM may be improved by identifying factors leading to mortality in patients with CM. OBJECTIVE: To assess the clinical management and mortality associated with cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS) in Kenya. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital and Mbagathi District Hospital, between August 2008 and March 2009. SUBJECTS: Seventy six HIV-infected patients confirmed to be CM positive. RESULTS: Results show that 30 (40%) of 76 patients diagnosed with CM died during hospitalisation after a median hospital stay of ten days (range, 2-73 days). Significant predictors of mortality in the univariate model were Mycobacterium tuberculosis (TB) co-infection (P = 0.04), having been diagnosed with a co-morbid condition such as diabetes mellitus, oral candidiasis and hypertension (P = 0.01), and a low median CD4+ T lymphocyte count (P < 0.001). The multivariable model revealed that male sex, previous or current anti-retroviral therapy (ART) at admission and CD4+ T lymphocyte count less than 50 were significant predictors of mortality. Conversely, a minimum of two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and monitoring of creatinine and electrolyte levels (P = 0.02) were significantly associated with survival in the univariate model. CONCLUSIONS: CM-associated mortality in Kenya is high; there is an opportunity to improve the management and the short-term outcomes of hospitalised HIV positive patients with CM in Kenya.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Mortalidade Hospitalar , Meningite Criptocócica/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Comorbidade , Feminino , Humanos , Quênia , Masculino , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Phys Med ; 30(4): 432-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24374260

RESUMO

OBJECTIVES: To estimate the organ equivalent doses and the effective doses (E) in patient undergoing percutaneous transhepatic biliary drainage (PTBD) examinations, using the MCNP5 and PCXMC2 Monte Carlo-based codes. METHODS: The purpose of this study is to estimate the organ doses to patients undergoing PTBD examinations by clinical measurements and Monte Carlo simulation. Dose area products (DAP) values were assessed during examination of 43 patients undergoing PTBD examination separated into groups based on the gender and the dimensions and location of the beam. RESULTS: Monte Carlo simulation of photon transport in male and female mathematical phantoms was applied using the MCNP5 and PCXMC2 codes in order to estimate equivalent organ doses. Regarding the PTBD examination the organ receiving the maximum radiation dose was the lumbar spine. The mean calculated HT for the lumbar spine using the MCNP5 and PCXMC2 methods respectively, was 117.25 mSv and 131.7 mSv, in males. The corresponding doses were 139.45 mSv and 157.1 mSv respectively in females. The HT values for organs receiving considerable amounts of radiation during PTBD examinations were varied between 0.16% and 73.2% for the male group and between 1.10% and 77.6% for the female group. E in females and males using MCNP5 and PCXMC2.0 was 5.88 mSv and 6.77 mSv, and 4.93 mSv and 5.60 mSv. CONCLUSION: The doses remain high compared to other invasive operations in interventional radiology. There is a reasonable good coincidence between the MCNP5 and PCXMC2.0 calculation for most of the organs.


Assuntos
Angiografia/métodos , Ductos Biliares/cirurgia , Colangiografia/métodos , Drenagem/métodos , Método de Monte Carlo , Doses de Radiação , Angiografia/efeitos adversos , Colangiografia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco
17.
Int Angiol ; 32(5): 506-11, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23903310

RESUMO

AIM: Velocity criteria for diagnosis of carotid stenosis are subject to flow phenomenon such as contralateral stenosis or occlusion. Duplex tri-axial diameter and cross sectional area measurements are potentially more accurate because they are anatomic. METHODS: As part of a prospective study on triplanar ultrasound carotid stenosis measurements, 30 consecutive patients were studied by 3 independent operators to assess variability of the technique. PSV and EDV were recorded at the common and internal carotid arteries and Duplex B-mode long-axis and diameter views were obtained using color and/or power Doppler. Cross-sectional area (CSAS), minimal luminal diameter (MLD), and triaxial diameter measurements, based on the NASCET criteria were performed at the narrowest lumen. RESULTS: The CSAS, MLD and triaxial diameter measurements were not significantly different in the 3 measurements and that was true for the 3 operators (ANOVA, P=0.1 for both). There were 4 patients where the velocity measurements differed by one stenosis grade, when compared to diameter. The triaxial diameter stenosis correlated well with the percent area reduction for all three measurements. Other than having a very good linear relationship (R2=0.95, R2=0.96, R2=0.93). The MLD was reduced with increasing grades of stenosis and provided a clear separation between the 50-69% and 80-99% grades with only a small overlap in the 70-79% grade. CONCLUSION: The present analysis demonstrates that CSAS and triaxial diameter can be performed by experienced investigators with low variability and good reproducibility. Velocity and planimetric measurements are complimentary in the assessment of carotid artery stenosis.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Hemodinâmica , Ultrassonografia Doppler Dupla , Análise de Variância , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/fisiopatologia , Humanos , New Hampshire , New York , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Ultrassonografia Doppler em Cores
18.
Perfusion ; 28(2): 156-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23104581

RESUMO

Peripartum cardiomyopathy (PPCM) is defined by acute heart failure in the late stages of pregnancy to a few months postpartum. Cardiogenic shock in PPCM, though rare, can be life-threatening, often requiring support with mechanical circulatory support devices. We present a case of 37-year-old Caucasian female who developed cardiogenic shock within 24 hours of the delivery of her twins. The echocardiogram demonstrated severe biventricular failure which necessitated biventricular device placement and support with a CentriMag® centrifugal pump. This biventricular support was employed, using a single-circuit CentriMag® pump, using a 'Y' connection which made weaning from right-sided support and conversion to univentricular support easier and feasible. The patient recovered four weeks later and was explanted off the CentriMag® support and did well. This technology allows for the CentriMag® to be considered as an early option for biventricular support in the treatment and management of these patients as a bridge to recovery.


Assuntos
Cardiomiopatias , Circulação Extracorpórea , Insuficiência Cardíaca , Período Pós-Parto , Complicações Cardiovasculares na Gravidez , Choque Cardiogênico , Adulto , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Eletrocardiografia , Circulação Extracorpórea/instrumentação , Circulação Extracorpórea/métodos , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/cirurgia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/cirurgia
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