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1.
Coron Artery Dis ; 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32271241

RESUMO

OBJECTIVES: Complex coronary lesions are more prone to complications; however, the relationship between complex coronary lesions and no-reflow phenomenon in patients undergoing primary percutaneous intervention (pPCI) is still not clarified. Previous studies reported the association of total coronary artery complexity with no-reflow; however, impact of culprit lesion complexity on no-reflow is not known. In this study, we aimed to investigate the impact of culprit lesion complexity on no-reflow phenomenon. Furthermore, we aimed to investigate the factors that are related to reversibility of no-reflow. METHODS: We prospectively included 424 patients treated with pPCI. Patients' baseline characteristics and clinical variables were recorded. Reversibility of no-reflow was decided according to final angiography or ST resolution during the first hour following pPCI. There were 90 patients with a diagnosis of no-reflow constituted group 1 and patients without no-reflow constituted group 2. Complexity of coronary artery disease was assessed with SYNTAX score and culprit lesion complexity was assessed with both American College of Cardiology/Society of Cardiovascular Angiography and Interventions lesion classification and SYNTAX score. RESULTS: Complexity of culprit lesion was significantly higher in group 1 patients (type C lesion 76.6 vs. 27.8%; P < 0.001 and SYNTAX score 8.7 ± 3.0 vs. 6.2 ± 2.6; P < 0.001, respectively, group 1 vs. 2). Multivariate analyses revealed that lesion complexity is independently associated with no-reflow. Among 90 patients of group 1, 43 patients were classified as reversible no-reflow. Logistic regression analysis revealed that only ischaemia duration is independently associated with reversibility of no-reflow. CONCLUSION: Our study demonstrated that culprit lesion complexity is independently associated with no-reflow phenomenon and short ischaemic duration is significantly associated with reversibility of no-reflow.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32281070

RESUMO

Patients with non-valvular atrial fibrillation who are under chronic oral anticoagulant therapy (OAC) treatment frequently require interruption of OAC treatment. By examining the presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (SEC) with transesophageal echocardiography (TEE) we aimed to develop an individualized strategy. To test the validity of CHA2DS2VASc score based recommendations was our secondary purpose. In this prospective study patients with non-valvular atrial fibrillation on OAC therapy were included. Patients' baseline characteristics, CHA2DS2VASc and HASBLED scores, medications, type of invasive procedures and clinical events were recorded. Each patient underwent to TEE examination prior to the invasive procedure. Bridging anticoagulation was recommended only to patients with LA/LAA thrombus. We included 155 patients and mean CHA2DS2VASc score of the study population was 3.4 ± 1.4. Seventy-one of them had LA/LAA thrombi or SEC on TEE examination and bridging anticoagulation was applied. OAC treatment was not bridged in 8 of 11 patients with prior cerebrovascular accident and 17 of 31 patients with CHA2DS2VASc score of > 4. 57 of 124 patients with CHA2DS2VASc score of ≤ 4 required bridging anticoagulation. There were 14 major bleedings decided according to ISTH bleeding classification. Major bleeding was observed only in patients underwent to high-risk bleeding procedure. In conclusion CHA2DS2VASc score by itself is not enough for decision-making regarding ischemic risk. Furthermore, since major bleedings occurred only in patients underwent to high-risk bleeding surgery, TEE-based individualisation may be a feasible approach particularly for those with high thromboembolic risk undergoing high-bleeding risk procedure.

3.
Coron Artery Dis ; 31(4): 365-371, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31860556

RESUMO

OBJECTIVE: Since coronary artery disease (CAD) is a slow progressive disease, management and appropriate follow-up of patients with nonobstructive coronary artery disease (NOCAD) remains challenging, and there are no clear guidelines recommending a follow-up strategy and indications for repeat invasive coronary angiography (ICA). We investigated the predictors of the development of obstructive CAD in patients with previously diagnosed NOCAD. METHODS: We prospectively included 186 patients who previously received a diagnosis of NOCAD with invasive coronary angiogram and underwent repeat ICA. Patients' demographics, clinical characteristics, biochemical analyses were recorded. Obstructive CAD is defined as >50% luminal narrowing in any epicardial coronary artery with a diameter of >2 mm. RESULTS: A total of 186 patients (105 male) were assigned into our study. Mean age was 64.77 ± 10.31 in patients with obstructive CAD (n = 60) vs. 61.87 ± 9.94 in NOCAD patients (n = 126) (P value: 0.068). The median time interval between index and follow-up coronary angiograms was 8 (5-10) years. There was no significant difference between groups with respect to LDL and Hs-CRP levels (P value: 461 and 354, respectively). Although patients with obstructive CAD have more comorbidities, multivariate analyses revealed that there was no significant difference between groups. On the contrary, the total number of risk factors were significantly associated with the development of obstructive CAD during follow-up. Receiver operating characteristic analyses revealed with a cut-off value of 3.5 risk factors, the sensitivity of 71%, the specificity of 61% and the area under the curve was 0.71 for prediction of obstructive CAD. CONCLUSION: Our results indicate that no single risk factor alone is related with development of obstructive CAD; however, patients with high number of multiple risk factors are more prone to develop obstructive disease and require closer follow-up.

4.
Tex Heart Inst J ; 46(3): 195-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708702

RESUMO

The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Veia Femoral , Fluoroscopia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Resultado do Tratamento
5.
Cardiovasc Revasc Med ; 20(11): 1027-1030, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30503037

RESUMO

MitraClip is an effective treatment method for severe mitral regurgitation in high-risk populations in terms of reducing morbidity and frequency of hospitalizations. Efficacy and safety of MitraClip device in elderly population have been established, yet there are only 2 case reports of MitraClip implantation in the younger patients, who generally tend to have less surgical risk (Gorenflo et al.; Joffe et al., 2016). We describe a 19-year-old patient with severe mitral regurgitation with prior mitral valve annuloplasty and received MitraClip implantation due to high-surgical risk.

6.
Cardiovasc Revasc Med ; 20(5): 424-431, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30025660

RESUMO

Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.

7.
Brain Dev ; 40(8): 662-669, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29739644

RESUMO

OBJECTIVES: Diagnosis of ventriculomegaly (VM) and identification of choroid plexus (CP) can be challenging with fetal magnetic resonance imaging (MRI). Our aim is to create an adjunct method for supporting the diagnosis of VM by investigating the CP-ventricular wall separation distance in fetuses with and without VM (nV) with fetal MRI. METHODS: T2-weighted fetal MRIs of 154 fetuses were retrospectively evaluated. The CP separation was defined as the distance between the medial wall of the dependent ventricle and distal tip of the CP glomus. The measurement was performed at the same plane with the dependent ventricle measurement by two blinded readers. RESULTS: 41 fetuses with VM (mean gestational age 27 (19-35 weeks), and 44 nV fetuses (mean gestational age 28 (20-39 weeks) were included. Interobserver reliability was excellent for ventricle diameters (R = 0.99, confidence interval (CI) 95%) and the separation of CP (R = 0.98, CI 95%). Mean distance of CP separation was 10.7 mm ±â€¯4.2 mm and 3.0 ±â€¯1.6 mm in VM and nV fetuses, respectively (p < 0.001). The distance of CP separation to differentiate VM cases was 6.5 mm (sensitivity: 0.98, specificity: 0.98). Separation of CP was correlated to ventricle diameter in cases with (R = 0.674) and without VM (R = 0.805). For the cut-off value >0.65 cm for the distance between the medial wall of the dependent ventricle and the medial border of choroid plexus sensitivity is 97.56, specificity 95.45, positive predictive value (PPV) 95.20, negative predictive value (NPV) 97.70, and likelihood ratio (LR) (+) is 21.46. CONCLUSION: Fetal CP can be efficiently evaluated with MRI, and the increase of CP-ventricular wall separation distance in correlation with the ventricle diameter is a reliable sign in the diagnosis of fetal VM.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Plexo Corióideo/diagnóstico por imagem , Imagem por Ressonância Magnética , Malformações do Sistema Nervoso/diagnóstico por imagem , Diagnóstico Pré-Natal , Área Sob a Curva , Ventrículos Cerebrais/embriologia , Plexo Corióideo/embriologia , Humanos , Curva ROC , Estudos Retrospectivos
8.
Cardiovasc Revasc Med ; 19(7 Pt A): 778-784, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29550045

RESUMO

PURPOSE: To compare OCT identified white thrombus decline, neointimal hyperplasia and clinical outcomes of patients treated with ticagrelor plus aspirin with those patients treated with clopidogrel plus aspirin after peripheral interventions. BACKGROUND: Ticagrelor is a potent platelet inhibitor. In patients with coronary artery disease, ticagrelor and aspirin demonstrated reduced rates of stent thrombosis, compared to aspirin and clopidogrel. The clinical importance of potent antiplatelet inhibition after peripheral endovascular interventions is unknown. METHODS: We enrolled 18 patients with superficial femoral artery disease and the presence of OCT-detected clot post-stent placement. Patients were randomized to 75 mg clopidogrel once daily for 1 month vs. 90 mg ticagrelor twice daily for 6 months, both in addition to 81 mg aspirin for 6 months. Clot volumes, ankle-brachial index (ABI), 6-minute walk test, and Rutherford classification were measured at baseline and 6-month follow-up. Neointimal hyperplasia and neovascularization were calculated at 6-month follow-up. RESULTS: N = 11 patients were enrolled in the clopidogrel group and N = 7 in the ticagrelor group. There was a significantly greater decrease in white thrombus in the ticagrelor group (median volume/stent length (0.067 vs 0.014 mm3/mm, p = 0.05)). No differences were found in % neointima (0.412 vs 0.536 mm3/mm, p = 0.44) and neovascularization (28 vs 44, p = 0.16). ABI and Rutherford classification were improved significantly after 6 months in the clopidogrel group, with no difference between groups at 6 months in ABI or Rutherford. CONCLUSION: In symptomatic patients with PAD, ticagrelor showed significant improvement relative to clopidogrel with respect to white thrombus burden decline.


Assuntos
Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Procedimentos Endovasculares , Artéria Femoral , Doença Arterial Periférica/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Trombose/tratamento farmacológico , Ticagrelor/uso terapêutico , Tomografia de Coerência Óptica , Idoso , Índice Tornozelo-Braço , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Quimioterapia Combinada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Europa (Continente) , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neointima , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Valor Preditivo dos Testes , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Recuperação de Função Fisiológica , Stents , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Ticagrelor/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Teste de Caminhada
9.
J Prosthet Dent ; 111(4): 269-72, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24388721

RESUMO

Cleft palate is a congenital disorder characterized by maxillary growth defect and dental anomalies. Its correction requires an interdisciplinary approach, which includes surgical, orthodontic, and prosthetic treatments. This clinical report describes the prosthetic management of a 19-year-old woman with a unilateral cleft palate defect that had not been closed completely with surgical repair. The deficient maxillary residual anterior ridge was restored with a tooth-supported overdenture that improved her facial appearance, speech, and masticatory functions.


Assuntos
Fissura Palatina/reabilitação , Revestimento de Dentadura , Prótese Parcial , Doenças Maxilares/reabilitação , Anodontia/reabilitação , Dente Pré-Molar/anormalidades , Transplante Ósseo/métodos , Ligas de Cromo/química , Fissura Palatina/cirurgia , Coroas , Dente Canino/anormalidades , Materiais Dentários/química , Planejamento de Dentadura , Estética , Feminino , Ligas de Ouro , Humanos , Incisivo/anormalidades , Mastigação/fisiologia , Doenças Nasais/cirurgia , Fístula Bucal/cirurgia , Fístula do Sistema Respiratório/cirurgia , Fala/fisiologia , Adulto Jovem , Zircônio/química
10.
J Craniofac Surg ; 22(3): 967-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21558911

RESUMO

Facial-nerve paralysis is seldom seen and may occur because of a broad spectrum of causes. The most commonly seen cause of facial paralysis is the Bell palsy; iatrogenic causes and tumors are relatively rare. Facial asymmetry, drooling, garbled speech, and difficulty in feeding: all adversely affect the psychosocial conditions of the patients. Fascial and tendon sling procedures may be performed for the static treatment of the unilateral permanent facial paralysis. These techniques are used both for the correction of the asymmetry of the face, especially by providing static support for the corner of the mouth, and to prevent drooling. Microstomia after a sling procedure is not a previously observed complication in the literature. A patient is presented with the surgical management of the complication of microstomia that had risen because of a static treatment of his unilateral facial paralysis via a tendon that passes circularly through his orbicularis oris muscle. Oral rehabilitation thereafter was maintained with the support of dental implants and fixed prosthodontics. The most efficient treatment protocol was decided with an interdisciplinary consultation of the oral and maxillofacial surgeon, the plastic surgeon, and the prosthodontist.


Assuntos
Implantes Dentários , Paralisia Facial/cirurgia , Microstomia/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Paralisia Facial/etiologia , Humanos , Masculino , Microstomia/etiologia
11.
J Magn Reson Imaging ; 31(1): 94-100, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20027577

RESUMO

PURPOSE: To reveal the possible role of diffusion-weighted images (DWI) in the differential diagnosis of benign and malignant thyroid nodules by comparing the results of fine-needle aspiration cytology (FNAC). MATERIALS AND METHODS: In an 18-month period (December 2005 to May 2007), 27 cases with benign thyroid nodules with a total of 52 benign nodules, nine cases with thyroid gland malignancy, and 24 healthy control cases were included in the study. Cases that were indicated to undergo to FNAC examination and sent by a clinician for biopsy to the radiology unit were included in the study to assess the cytopathologic confirmation of the clinic, ultrasonographic, and magnetic resonance imaging (MRI) findings. RESULTS: The mean apparent diffusion coefficient (ADC) values of thyroid nodules were 2745.3 +/- 601.1 x 10(-6) mm(2)/s (1605-3899 x 10(-6)mm(2)/s) in the benign group and 695.2 +/- 312.5 x 10(-6)mm(2)/s (165-1330 x 10(-6)mm(2)/s) in the malignant group. Normal thyroid tissues had mean ADC values of 1344.1 +/- 276.4 x 10(-6) mm(2)/s (1015-1764 x 10(-6)mm(2)/s). The ADC values of three subgroups were significantly different (P = 0.0001). A reduced ADC was observed in most types of malignant tumors due to the consequent decrease of the extracellular extravascular space. CONCLUSION: Our preliminary results showed that ADC values of nodules may provide useful data about the nature of a thyroid nodule.


Assuntos
Algoritmos , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Magn Reson Imaging ; 27(10): 1447-54, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19553048

RESUMO

PURPOSE: To prospectively evaluate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiation of postobstructive consolidation from centrally located lung carcinomas by using apparent diffusion coefficients (ADCs). MATERIALS AND METHODS: An institutional review board approved this study; informed consent was obtained from patients. Forty-nine consecutive patients (3 women, 46 men; mean age, 63.6 years; age range, 42-85 years) with lung carcinoma underwent DW MR imaging. Forty patients had central and nine patients had peripheral lung carcinomas. ADC of each lung carcinoma was calculated from DW MR images obtained with two different b values (0, 1000 s/mm(2)). In the final study group including 27 patients with central lung carcinoma accompanying distal lung consolidation (mean age, 67.2 years; 3 women, 24 men), ADCs of lung carcinomas were statistically compared among cytologic/histologic types and accompanying postobstructive consolidations. Unpaired t test was used for measurable variables with normal distribution, and Kruskal-Wallis variance analysis and Mann-Whitney U tests were used for the measurable variables without normal distribution. RESULTS: There was no significant difference between mean ADC values of all types of carcinomas (P=.302) and also between mean ADC values of central (1.91 +/- 0.7x10(-3) mm(2)/s) and peripheral carcinomas (1.58 +/- 0. 6x10(-3) mm(2)/s) (P=.224). The mean ADC value for the masses of central lung carcinoma with postobstructive consolidations was 1.83 +/- 0.75x10(-3) mm(2)/s, and for consolidation was 2.50 +/- 0.76x10(-3) mm(2)/s. ADC of central carcinoma masses was significantly lower than that of postobstructive consolidations (P=.003). CONCLUSIONS: ADC values of central lung carcinoma masses appear to be lower than accompanying postobstructive consolidations. ADC values could be considered useful as a differentiating parameter among central lung carcinomas and accompanying postobstructive consolidations.


Assuntos
Carcinoma/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Pulmonares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Encéfalo/patologia , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
13.
Appl Biochem Biotechnol ; 141(1): 15-26, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17625263

RESUMO

A parametric study to increase the enantioselectivity of Candida rugosa lipase (CRL) toward S-Naproxen production by the hydrolysis of racemic Naproxen methyl ester in an aqueous-organic biphasic batch system was carried out. Effects of organic solvent type, aqueous phase/organic solvent volume ratio, agitation rate, concentrations of the substrate and the enzyme, pH of the aqueous phase, and temperature on the enantiomeric excess for the product (eep), on the enantiomeric ratio (E) and on the conversion (x) were evaluated. Employing isooctane as the solvent resulted in higher eep, E, and x than those obtained in hexane, cyclohexane, and toluene. The higher the volume ratio of aqueous phase/organic solvent employed, the higher the conversion and enantioselectivity achieved. The increase in agitation rate increased the hydrolysis rate. Higher concentration of racemic Naproxen methyl ester than 10 mg/mL decreased both the conversion and enantioselectivity. The increase in crude CRL concentration resulted in enhancement of x, but the decrease of eep and E. Acidic pH led to higher conversion and enantioselectivity than the medium and alkaline pH values. A further increase in temperature to over 45 degrees C decreased the conversion and enantioselectivity. The highest enantiomeric ratio achieved in the S-Naproxen production was E = 171.1, with x = 49.8% and eep = 95.7%.


Assuntos
Técnicas de Química Combinatória/métodos , Modelos Químicos , Compostos Orgânicos/química , Solventes/química , Simulação por Computador , Hidrólise , Transição de Fase
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