RESUMO
INTRODUCTION: Chronic subdural haematoma (CSDH) represents a clinical challenge due to its high recurrence rate. Endovascular middle meningeal artery embolisation (eMMAE) has emerged as an alternative for those patients presenting health problems or multiple recurrences of CSDH. Despite several encouraging reports, the safety profile, indications, and limitations of the technique are not clearly established. DEVELOPMENT: This study aimed to evaluate the current evidence on eMMAE in patients with CSDH. We performed a systematic review of the literature, following the PRISMA guidelines. Our search yielded a total of 6 studies, in which a total of 164 patients with CSDH underwent eMMAE. The recurrence rate across all studies was 6.7%, and complications occurred in up to 6% of patients. CONCLUSIONS: eMMAE is a feasible technique for treating CSDH, with a relatively low recurrence rate and an acceptable rate of complications. Further prospective and randomised studies are needed to formally establish a clear profile of the safety and effectiveness of the technique.
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Embolização Terapêutica , Hematoma Subdural Crônico , Humanos , Hematoma Subdural Crônico/terapia , Artérias MeníngeasRESUMO
Introducción: Dadas las altas tasas de recurrencia, el hematoma subdural crónico (HSDC) es una condición que supone un reto para el clínico. La embolización endovascular de la arteria meníngea media (EeAMM) ha surgido como una alternativa para aquellos pacientes con problemas de salud o con varias recurrencias de su HSDC. A pesar de la publicación de algunos artículos prometedores referentes a esta técnica, el perfil de seguridad, las indicaciones y las limitaciones no están claramente establecidas.DesarrolloNuestro objetivo es evaluar la evidencia actual sobre la EeAMM en el HSDC. Se realizó una revisión sistemática de la literatura según las guías PRISMA. Nuestra búsqueda arrojó un total de 6 estudios, en los que 164 pacientes con HSDC se sometieron a EeAMM. La tasa de recurrencia entre todos los estudios fue del 6,7% y se produjeron complicaciones en hasta el 6% de los pacientes.ConclusiónLa EeAMM es una técnica factible en el tratamiento del HSDC con una tasa de recurrencia relativamente baja y tasas aceptables de complicaciones. Se necesitan más estudios prospectivos y aleatorizados para establecer formalmente un perfil de seguridad claro y su efectividad. (AU)
Introduction: Chronic subdural haematoma (CSDH) represents a clinical challenge due to its high recurrence rate. Endovascular middle meningeal artery embolisation (eMMAE) has emerged as an alternative for those patients presenting health problems or multiple recurrences of CSDH. Despite several encouraging reports, the safety profile, indications, and limitations of the technique are not clearly established.DevelopmentThis study aimed to evaluate the current evidence on eMMAE in patients with CSDH. We performed a systematic review of the literature, following the PRISMA guidelines. Our search yielded a total of 6 studies, in which a total of 164 patients with CSDH underwent eMMAE. The recurrence rate across all studies was 6.7%, and complications occurred in up to 6% of patients.ConclusionseMMAE is a feasible technique for treating CSDH, with a relatively low recurrence rate and an acceptable rate of complications. Further prospective and randomised studies are needed to formally establish a clear profile of the safety and effectiveness of the technique. (AU)
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Humanos , Hematoma Subdural , Recidiva , Neurocirurgia , TerapêuticaRESUMO
No disponible
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Humanos , Feminino , Pessoa de Meia-Idade , Meningioma/cirurgia , Seio Sagital Superior , Neoplasias Encefálicas/cirurgia , Afasia/etiologia , Paresia/etiologia , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias , Recidiva , SíndromeRESUMO
INTRODUCTION: Chronic subdural haematoma (CSDH) represents a clinical challenge due to its high recurrence rate. Endovascular middle meningeal artery embolisation (eMMAE) has emerged as an alternative for those patients presenting health problems or multiple recurrences of CSDH. Despite several encouraging reports, the safety profile, indications, and limitations of the technique are not clearly established. DEVELOPMENT: This study aimed to evaluate the current evidence on eMMAE in patients with CSDH. We performed a systematic review of the literature, following the PRISMA guidelines. Our search yielded a total of 6 studies, in which a total of 164 patients with CSDH underwent eMMAE. The recurrence rate across all studies was 6.7%, and complications occurred in up to 6% of patients. CONCLUSIONS: eMMAE is a feasible technique for treating CSDH, with a relatively low recurrence rate and an acceptable rate of complications. Further prospective and randomised studies are needed to formally establish a clear profile of the safety and effectiveness of the technique.
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Neoplasias Meníngeas , Meningioma , Córtex Motor , Cavidades Cranianas , Humanos , SíndromeRESUMO
BACKGROUND: The antiphospholipid antibody syndrome (AAS), which is characterized by thromboembolic events and/or fetal loss and/or low platelet count associated with antiphospholipid antibodies, may evolve with acute myocardial infarction (AMI). The presence of AAS among young patients with AMI ranges from 14% to 21%, and this condition implies specific therapeutic attitudes as new thrombotic events may occur, according to some authors. MATERIALS AND METHODS: A prospective study was undertaken with 25 patients aged > or = 65 years with AMI that were admitted to our institution during one year who were compared with control patients with similar risk factors. IgG and IgM anticardiolipin antibodies (ACA) were measured in the first 24 hours since the onset of AMI symptoms and three months later. RESULTS: The follow-up ranged from three months to one year. Among patients, ACA positivity in the two measurements was higher (12%) than that observed in the control group (5%) (p = 0.36). ACA positivity on two occasions was not a risk factor for new thrombotic events. CONCLUSION: ACA positivity is higher among AMI patients (measured early and at three months) than among the general population although the presence of such antibodies does not increase the risk for new post-infarction thrombotic events.
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Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/epidemiologia , Infarto do Miocárdio/etiologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos ProspectivosRESUMO
Introducción. El síndrome antifosfolípido (SAFL), caracterizado por fenómenos trombóticos y/o pérdidas fetales y/o plaquetopenia asociados a anticuerpos antifosfolípidos, puede cursar con infarto agudo de miocardio (IAM). La presencia de SAFL en pacientes jóvenes con IAM oscila entre el 14 por ciento y el 21 por ciento, patología que conlleva actitudes terapéuticas específicas al presentar en su evolución nuevos eventos trombóticos según algunos autores. Material y métodos. Se realiza un estudio prospectivo en 25 pacientes con IAM y edad inferior o igual a 65 años que ingresaron en nuestro centro a lo largo de un año, comparándolos con controles con factores de riesgo similares. Se determinan anticuerpos anticardiolipina (ACA) IgG e IgM en las primeras 24 horas desde el inicio de la clínica de IAM y a los tres meses. Resultados. El seguimiento osciló entre tres meses y un año. En el grupo de pacientes, la positividad de ACA en las dos determinaciones fue superior (12 por ciento) a la del grupo control (5 por ciento) (p = 0,36). La positividad de ACA en dos ocasiones no fue un factor de riesgo para nuevos eventos trombóticos. Conclusión. La positividad de ACA es superior en el grupo de pacientes con IAM (determinados precozmente y a los tres meses) que en la población general, si bien la presencia de dichos anticuerpos no incrementa el riesgo de nuevos eventos trombóticos postinfarto (AU)
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Pessoa de Meia-Idade , Adulto , Idoso , Masculino , Feminino , Humanos , Síndrome Antifosfolipídica , Prevalência , Infarto do Miocárdio , Estudos Prospectivos , Fatores EtáriosRESUMO
OBJECTIVE: The purpose of this study was to investigate the effect of HIV-1 protease inhibitors on the frequency of oropharyngeal candidiasis in HIV-infected patients. STUDY DESIGN: A clinical and analytic follow-up was carried out to determine the number of episodes of oropharyngeal candidiasis during HIV-1 protease inhibitor therapy and the relation of this incidence to the CD4 lymphocyte count and circulating neutrophils level. Seventy-five HIV-positive patients were selected, and HIV-1 protease inhibitor therapy was administered to each patient over a minimum of 6 months. These patients did not receive long-term preventive antifungal therapy for oral candidiasis, even as secondary prophylaxis against cryptococcosis. Results were compared with those obtained during the previous 6 months, during which patients had been treated only with reverse transcriptase inhibitors. RESULTS: At least one episode of oropharyngeal candidiasis was seen in 56% (42/75) of patients during reverse transcriptase inhibitor therapy and in only 9.3% (7/75) of patients after the initiation of protease inhibitor therapy. The number of relapses decreased significantly when the 2 follow-up periods were compared (P<.0001). The CD4 and CD8 lymphocyte counts increased significantly with protease inhibitor therapy (P<.001 and P<.05, respectively). During reverse transcriptase inhibitor treatment, the probability of the presentation of oropharyngeal candidiasis correlated with falling CD4 counts (P<.0001). The HIV-1 protease inhibitor therapy was associated with a significant increase in the neutrophil count (P<.01). The probability of the occurrence of some episode of candidiasis correlated inversely with the circulating neutrophil level (P<.05). CONCLUSIONS: Protease inhibitor therapy decreases the frequency of HIV-related oropharyngeal candidiasis. The mechanism involved is unknown, but it can be speculated that a reduction of the viral load increases the number of intact T helper cells, which in turn enhances the number of circulating polymorphonuclear neutrophils and regulates their function by means of colony-stimulating factors.