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1.
Intern Med ; 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31956203

RESUMO

We report a case in which diffusion-weighted magnetic resonance imaging (DWI) demonstrated renal artery stenosis-related renal ischemia and the therapeutic efficacy of revascularization. The patient was a 73-year-old man, who underwent descending thoracic aortic replacement due to DeBakey IIIb chronic aortic dissection, and who showed progressive renal dysfunction due to right renal artery stenosis caused by false lumen thrombosis. DWI demonstrated a decreased apparent diffusion coefficient (ADC) in the right kidney, indicating renal ischemia. Angioplasty with stenting restored renal perfusion and improved the renal function, resulting in the normalization of the decreased ADC in the treated kidney. Thus, DWI can be used to monitor renal ischemia in cases involving advanced renal artery stenosis.

2.
Hypertension ; 73(6): 1283-1290, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31006333

RESUMO

Peripheral 18-oxocortisol (18oxoF) level could contribute to the detection of aldosterone-producing adenoma (APA) in patients with primary aldosteronism. However, peripheral 18oxoF varies among such patients, which is a big drawback concerning its clinical application. We studied 48 cases of APA, 35 harboring KCNJ5 mutation, to clarify the significance of clinical and pathological parameters about peripheral 18oxoF. Peripheral 18oxoF concentration ranged widely from 0.50 to 183.13 ng/dL and correlated positively with intratumoral areas stained positively for steroidogenic enzymes ( P<0.0001). The peripheral 18oxoF level also correlated significantly with that of circulating aldosterone ( P<0.0001) but not with that of cortisol, a precursor of 18oxoF. However, a significant correlation was detected between peripheral 18oxoF and intratumoral glucocorticoids ( P<0.05). In addition, peripheral 18oxoF correlated positively with the number of hybrid cells double positive for 11ß-hydroxylase and aldosterone synthase ( P<0.0001). Comparing between the cases with and those without KCNJ5 mutation, the KCNJ5-mutated group demonstrated a significantly higher concentration of peripheral 18oxoF (28.4±5.6 versus 3.0±0.9 ng/dL, P<0.0001) and a larger intratumoral environment including the hybrid cells ( P<0.001), possibly representing a deviation from normal aldosterone biosynthesis. After multivariate analysis, KCNJ5 mutation status turned out to be the most associated factor involved in 18oxoF synthesis in APA ( P<0.0001). Results of our present study first revealed that enhanced 18oxoF synthesis in APA could come from a functional deviation of aldosterone biosynthesis from the normal zona glomerulosa and the utility of peripheral 18oxoF measurement could be influenced by the prevalence of KCNJ5 mutation in an APA.


Assuntos
Neoplasias do Córtex Suprarrenal/genética , Adenoma Adrenocortical/genética , Aldosterona/metabolismo , DNA de Neoplasias/genética , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética , Hidrocortisona/análogos & derivados , Mutação/genética , Neoplasias do Córtex Suprarrenal/metabolismo , Adenoma Adrenocortical/metabolismo , Análise Mutacional de DNA , Feminino , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/metabolismo , Humanos , Hidrocortisona/biossíntese , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Med Biol Eng Comput ; 57(7): 1425-1436, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887302

RESUMO

This study aimed to evaluate the effect of a notch at the distal end of a microcatheter on vein deformation in segmental adrenal venous sampling. A three-dimensional fluid-structure interaction simulation was performed using commercial finite element software. A computational model of a vein with a catheter inserted into it was constructed. The outer and inner diameters of the vein were 0.9 mm and 0.6 mm, respectively, whereas those of the catheter were 0.6 mm and 0.5 mm, respectively. The velocity of the blood flow at the outlet was 85 mm/s. The pressure at the inlet was 0 Pa. The mesh consisted of approximately 660,000 elements. The effect of the number (0-4) and shape (no notch, 1/4 circular, 1/3 circular, semicircular, 2/3 circlecircular, and 3/4 circular) of the notches at the distal end of the microcatheter on the vein deformation when a suction pressure was applied was evaluated. The venous wall displacement was the smallest with the one-notch catheter, followed by the four-notch catheter, and was the smallest with the catheter having 1/4-circular notches, followed by the one with 1/3-circular notches. In conclusion, microcatheters having one notch and 1/4-circular notches reduce vein deformation and lead to successful segmental adrenal venous sampling. Graphical abstract Comparing catheters having different notch shapes.


Assuntos
Cateteres Venosos Centrais , Modelos Cardiovasculares , Flebotomia/instrumentação , Veias/lesões , Velocidade do Fluxo Sanguíneo , Desenho de Equipamento , Humanos , Hidrodinâmica
5.
J Clin Hypertens (Greenwich) ; 20(4): 798-804, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29656438

RESUMO

Myeloproliferative neoplasms (MPNs) with Janus kinase 2 (JAK2) mutation are associated with a high risk for occlusive vascular diseases. We report 2 cases of renovascular hypertension associated with JAK2 V617F mutation-positive MPNs and provide a literature review. In Case 1, a 63-year-old woman had resistant hypertension, massive proteinuria, and erythrocytosis. Evaluations revealed right renal artery stenosis causing renovascular hypertension and polycythemia vera with JAK2 V617F mutation. Renin-angiotensin system inhibitors and subsequent angioplasty controlled the blood pressure and the proteinuria resolved. In Case 2, a 74-year-old woman had resistant hypertension and thrombocytosis. Evaluations confirmed left renal artery stenosis and essential thrombocythemia with JAK2 V617F. Angioplasty cured the hypertension. A literature review of 18 cases revealed the following as the most common characteristics of MPN-associated renovascular hypertension: manifests primarily in women; is associated with untreated polycythemia vera and essential thrombocythemia, concomitant leukocytosis, and JAK2 mutation positivity; and is responsive to angioplasty. This report demonstrates that JAK2 mutation-positive MPNs are a less common but important underlying cause of adult renovascular hypertension.


Assuntos
Angioplastia/métodos , Hipertensão Renovascular/terapia , Janus Quinase 2/genética , Transtornos Mieloproliferativos/diagnóstico , Idoso , Substituição de Aminoácidos , Feminino , Humanos , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/genética , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/complicações , Transtornos Mieloproliferativos/genética , Resultado do Tratamento
6.
Eur J Radiol ; 98: 150-157, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29279155

RESUMO

OBJECTIVES: To compare image quality and radiation dose of right adrenal vein (RAV) imaging computed tomography (CT) among conventional, low kV, and low kV with reduced contrast medium protocols. METHODS: One-hundred-and-twenty patients undergoing adrenal CT were randomly assigned to one of three protocols: contrast dose of 600mgI/kg at 120-kV tube voltage setting (600-120 group), 600mgI/kg at 80kV (600-80 group), and 360mgI/kg at 80kV (360-80 group). Iterative reconstruction was used for 80-kV groups. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the RAV and size-specific dose estimates (SSDE) were measured. Three radiologists evaluated 4-point visualisation scores of RAV by consensus reading. RESULTS: The RAV detectability was 95%, 97.2%, and 97.3% for 600-120, 600-80, and 360-80 groups, respectively (p=1.000). Visualisation scores were not significantly different among the groups (p=0.152). There were no significant differences in CNR or SNR between the 600-120 and 360-80 groups. SSDE of the 360-80 group was significantly lower than that of the 600-120 group (5.86mGy±1.44 vs. 7.27mGy±1.81, p<0.001). CONCLUSIONS: 80-kV scans with 360 mgI/kg contrast media showed comparable detectability of RAV to conventional scans, while reducing 19% of SSDE.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/diagnóstico por imagem , Meios de Contraste , Hiperaldosteronismo/diagnóstico por imagem , Doses de Radiação , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Razão Sinal-Ruído , Veias/diagnóstico por imagem
7.
J Clin Hypertens (Greenwich) ; 19(10): 1028-1031, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28560752

RESUMO

We report the case of a young woman treated with selective renal embolization for renovascular hypertension caused by intrarenal artery stenosis and show follow-up imaging of the treated kidney. An 18-year-old woman had renin-dependent hypertension with intrarenal artery stenosis caused by fibromuscular dysplasia. A middle branch artery was nearly occluded, resulting in segmental renal ischemia with excessive renin secretion. Because our angioplasty attempt for revascularization failed as a result of technical difficulty, we performed selective embolization of the diseased vessel by anhydrous ethanol. The embolization promptly ameliorated hyperreninemia and resistant hypertension without deterioration of renal function. Findings from magnetic resonance imaging showed disappearance of the blood flow in the embolized area corresponding to the ischemic lesion that had been revealed by diffusion-weighted imaging. Thus, selective embolization can be effective in treating renovascular hypertension by intrarenal stenosis for which angioplasty is not feasible. Additionally, renal magnetic resonance imaging is useful for evaluating the causative ischemic lesion and embolized area.


Assuntos
Embolização Terapêutica/métodos , Hipertensão Renovascular/cirurgia , Rim/irrigação sanguínea , Obstrução da Artéria Renal/cirurgia , Artéria Renal/patologia , Adolescente , Feminino , Displasia Fibromuscular/complicações , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/etiologia , Rim/diagnóstico por imagem , Rim/patologia , Imagem por Ressonância Magnética/métodos , Artéria Renal/cirurgia , Resultado do Tratamento
8.
Jpn Clin Med ; 8: 1179066017693597, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28469525

RESUMO

We report an elderly male patient with hyperammonemia induced by intrahepatic portal-systemic shunt without cirrhosis (IPSSwoC). The occasional emergence of his erratic behaviors was misdiagnosed as a psychiatric disorder. Regardless of his uneven symptoms, IPSSwoC was suspected due to his hyperammonemia. The contrast computed tomography of the abdomen revealed a congenital type of IPSSwoC. As blood ammonia levels are inconstant, repeated blood tests are recommended when this disease is suspected in elderly patients with psychiatric symptoms.

9.
Hypertension ; 69(3): 428-434, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28137990

RESUMO

Adrenal venous sampling is the most reliable diagnostic procedure to determine surgical indications in primary aldosteronism. Because guidelines recommend multidetector computed tomography (CT) to evaluate the adrenal gland, some past reports used multidetector CT as a guide for adrenal venous sampling. However, the detailed anatomy of the right adrenal vein and its relationship with an accessory hepatic vein remains uncertain. The purpose of this study was to describe detailed anatomical variations of the right adrenal vein and to determine the concordance between CT and catheter venography in patients with primary aldosteronism. In total, 440 consecutive patients who underwent adrenal venous sampling were included. Four-phase dynamic CT was performed. Anatomical locations and variations of the right adrenal vein and its relationship with the accessory hepatic vein were compared with catheter venographic findings. Successful catheterization was achieved in 437 patients (99%). The right adrenal vein was visualized in the late arterial phase with CT in 420 patients (95%). The right adrenal vein formed a common trunk with the accessory hepatic vein in 87 patients (20%). CT identified the correct craniocaudal level of the orifice in 354 patients (84%). Anatomical variations, location, and angle of inflow of the right adrenal vein based on CT demonstrated high concordance with catheter venography. CT may provide useful information for preparation before adrenal venous sampling.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Cateterismo/métodos , Hiperaldosteronismo/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Flebografia/métodos , Veias/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
J Vasc Interv Radiol ; 28(1): 50-59.e5, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27321887

RESUMO

PURPOSE: To evaluate risk factors predicting death and complications of primary therapy for hepatic and gastric duodenal artery pseudoaneurysms following endovascular treatment (EVT) after pancreaticoduodenectomy (PD). MATERIALS AND METHODS: Between April 2004 and December 2014, 28 patients (mean age, 64.7 y) with post-PD hemorrhage underwent EVT. Prevention of hepatic artery blockage via stents or side-holed catheter grafts was stratified in cases without a replaced hepatic artery. Mortality and major hepatic complications following EVT were evaluated according to age; sex; surgery-EVT interval; presence of portal vein stenosis, shock, and coagulopathy at EVT onset; and post-EVT angiographic findings. RESULTS: All hemorrhages were successfully treated with microcoils (n = 17; 61%), covered stents (n = 1; 3%), bare stent-assisted coil embolization (n = 5; 18%), or catheter grafts with coil embolization (n = 5; 18%). Hepatic arterial flow was observed after EVT in 18 patients (64%). Mortality and major hepatic complication rates were 28.6% and 32.1%, respectively. Hemorrhagic shock and coagulopathy at EVT onset (n = 8 each; odds ratio [OR], 27; 95% confidence interval [CI], 3.1-235.7; P < .01) were significantly associated with mortality. Coagulopathy at EVT onset (adjusted OR [aOR], 48.1; 95% CI, 3.2-2,931), portal vein stenosis (n = 16; aOR, 16.9; 95% CI, 1.3-721.9), and no visualization of hepatopetal flow through the hepatic arteries (n = 10; aOR, 29.5; 95% CI, 2.1-1,477) were significantly associated with major hepatic complications. CONCLUSIONS: EVT should be performed as soon as possible before the development of shock or coagulopathy. Hepatic arterial flow visualization decreases major hepatic complications.


Assuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Artéria Hepática/lesões , Pancreaticoduodenectomia/efeitos adversos , Hemorragia Pós-Operatória/terapia , Lesões do Sistema Vascular/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/mortalidade , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Aneurisma Roto/mortalidade , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia/mortalidade , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/mortalidade
11.
Hypertension ; 67(3): 654-60, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26865201

RESUMO

The renal resistive index (RI) calculated by Doppler ultrasonography has been reported to be correlated with renal structural changes and outcomes in patients with essential hypertension or renal disease. However, little is known about this index in primary aldosteronism. In this prospective study, we examined the utility of this index to predict blood pressure (BP) outcome after adrenalectomy in patients with primary aldosteronism. We studied 94 patients with histopathologically proven aldosteronoma who underwent surgery. Parameters on renal function, including renal flow indices, were examined and followed up for 12 months postoperatively. The renal RI of the main, hilum, and interlobar arteries was significantly higher in patients with aldosteronoma compared with 100 control patients. BP, estimated glomerular filtration rate, and urinary albumin excretion significantly decreased after adrenalectomy. The resistive indices of all compartment arteries were significantly reduced 1 month after adrenalectomy and remained stable for 12 months. Patients whose interlobar RI was in the highest tertile at baseline had higher systolic BP after adrenalectomy than those whose RI was in the lowest tertile. Logistic regression analysis demonstrated that the RI of the interlobar and hilum arteries could be an independent predictive marker for intractable hypertension (systolic BP ≥140 mm Hg, increased BP, taking ≥3 antihypertensive agents, or increased number of agents) even after adrenalectomy. Therefore, in patients with aldosteronoma, the renal RI indicates partially reversible renal hemodynamics and renal structural damages that would influence postoperative BP outcome.


Assuntos
Adrenalectomia , Taxa de Filtração Glomerular/fisiologia , Hiperaldosteronismo/fisiopatologia , Hipertensão/fisiopatologia , Rim/fisiopatologia , Artéria Renal/fisiopatologia , Resistência Vascular/fisiologia , Pressão Sanguínea , Progressão da Doença , Hipertensão Essencial , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia Doppler
12.
Radiology ; 278(1): 265-74, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26147784

RESUMO

PURPOSE: To use segmental adrenal venous sampling (AVS) (S-AVS) of effluent tributaries (a version of AVS that, in addition to helping identify aldosterone hypersecretion, also enables the evaluation of intra-adrenal hormone distribution) to detect and localize intra-adrenal aldosterone secretion. MATERIALS AND METHODS: The institutional review board approved this study, and all patients provided informed consent. S-AVS was performed in 65 patients with primary aldosteronism (34 men; mean age, 50.9 years ± 11 [standard deviation]). A microcatheter was inserted in first-degree tributary veins. Unilateral aldosterone hypersecretion at the adrenal central vein was determined according to the lateralization index after cosyntropin stimulation. Excess aldosterone secretion at the adrenal tributary vein was considered to be present when the aldosterone/cortisol ratio from this vein exceeded that from the external iliac vein; suppressed secretion was indicated by the opposite pattern. Categoric variables were expressed as numbers and percentages; continuous variables were expressed as means ± standard errors of the mean. RESULTS: The AVS success rate, indicated by a selectivity index of 5 or greater, was 98% (64 of 65). The mean numbers of sampled tributaries on the left and right sides were 2.11 and 1.02, respectively. The following diagnoses were made on the basis of S-AVS results: unilateral aldosterone hypersecretion in 30 patients, bilateral hypersecretion without suppressed segments in 22 patients, and bilateral hypersecretion with at least one suppressed segment in 12 patients. None of the patients experienced severe complications. CONCLUSION: S-AVS could be used to identify heterogeneous intra-adrenal aldosterone secretion. Patients who have bilateral aldosterone-producing adenomas can be treated with adrenal-sparing surgery or other minimally invasive local therapies if any suppressed segment is identified at S-AVS.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/metabolismo , Aldosterona/sangue , Hiperaldosteronismo/sangue , Flebografia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Eur Radiol ; 26(3): 622-30, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26108640

RESUMO

OBJECTIVES: To evaluate visualization of the right adrenal vein (RAV) with multidetector CT and non-contrast-enhanced MR imaging in patients with primary aldosteronism. METHODS: A total of 125 patients (67 men) scheduled for adrenal venous sampling (AVS) were included. Dynamic 64-detector-row CT and balanced steady-state free precession-based non-contrast-enhanced 3-T MR imaging were performed. RAV visualization based on a four-point score was documented. Both anatomical location and variation on cross-sectional imaging were evaluated, and the findings were compared with catheter venography as the gold standard. RESULTS: The RAV was visualized in 93.2% by CT and 84.8% by MR imaging (p = 0.02). Positive predictive values of RAV visualization were 100% for CT and 95.2% for MR imaging. Imaging score was significantly higher in CT than MR imaging (p < 0.01). The RAV formed a common trunk with an accessory hepatic vein in 16% of patients. The RAV orifice level on cross-sectional imaging was concordant with catheter venography within the range of 1/3 vertebral height in >70% of subjects. Success rate of AVS was 99.2%. CONCLUSIONS: Dynamic CT is a reliable way to map the RAV prior to AVS. Non-contrast-enhanced MR imaging is an alternative when there is a risk of complication from contrast media or radiation exposure. KEY POINTS: Dynamic CT and non-contrast-enhanced MR imaging detect the right adrenal vein (RAV). Dynamic CT can visualize the RAV more than non-contrast-enhanced MR imaging. Mapping the RAV helps to achieve successful adrenal venous sampling. Sixteen per cent of RAVs share the common trunk with accessory hepatic veins.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Hiperaldosteronismo/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Imagem Multimodal/métodos , Flebografia/métodos , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Variação Anatômica , Anatomia Transversal/métodos , Cateterismo Periférico/métodos , Meios de Contraste , Feminino , Veias Hepáticas/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Imagem Multimodal/estatística & dados numéricos , Flebografia/instrumentação , Valor Preditivo dos Testes , Veia Cava Inferior/diagnóstico por imagem
16.
Eur J Endocrinol ; 173(4): 465-77, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26194502

RESUMO

OBJECTIVE AND DESIGN: Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. METHODS: We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens. RESULTS: S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. CONCLUSIONS: Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.


Assuntos
Neoplasias do Córtex Suprarrenal/diagnóstico , Glândulas Suprarrenais/irrigação sanguínea , Adenoma Adrenocortical/diagnóstico , Aldosterona/metabolismo , Coleta de Amostras Sanguíneas/métodos , Hiperaldosteronismo/diagnóstico , Veias , Neoplasias do Córtex Suprarrenal/metabolismo , Neoplasias do Córtex Suprarrenal/cirurgia , Adrenalectomia/métodos , Adenoma Adrenocortical/metabolismo , Adenoma Adrenocortical/cirurgia , Feminino , Humanos , Hiperaldosteronismo/classificação , Hiperaldosteronismo/cirurgia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão
18.
Hypertension ; 65(5): 1096-102, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25776074

RESUMO

Adrenal venous sampling is currently the only reliable method to distinguish unilateral from bilateral diseases in primary aldosteronism. In this study, we attempted to determine whether peripheral plasma levels of 18-oxocortisol (18oxoF) and 18-hydroxycortisol could contribute to the clinical differentiation between aldosteronoma and bilateral hyperaldosteronism in 234 patients with primary aldosteronism, including computed tomography (CT)-detectable aldosteronoma (n=113) and bilateral hyperaldosteronism (n=121), all of whom underwent CT and adrenal venous sampling. All aldosteronomas were surgically resected and the accuracy of diagnosis was clinically and histopathologically confirmed. 18oxoF and 18-hydroxycortisol were measured using liquid chromatography tandem mass spectrometry. Receiver operating characteristic analysis of 18oxoF discrimination of adenoma from hyperplasia demonstrated sensitivity/specificity of 0.83/0.99 at a cut-off value of 4.7 ng/dL, compared with that based on 18-hydroxycortisol (sensitivity/specificity: 0.62/0.96). 18oxoF levels above 6.1 ng/dL or of aldosterone >32.7 ng/dL were found in 95 of 113 patients with aldosteronoma (84%) but in none of 121 bilateral hyperaldosteronism, 30 of whom harbored CT-detectable unilateral nonfunctioning nodules in their adrenals. In addition, 18oxoF levels below 1.2 ng/dL, the lowest in aldosteronoma, were found 52 of the 121 (43%) patients with bilateral hyperaldosteronism. Further analysis of 27 patients with CT-undetectable micro aldosteronomas revealed that 8 of these 27 patients had CT-detectable contralateral adrenal nodules, the highest values of 18oxoF and aldosterone were 4.8 and 24.5 ng/dL, respectively, both below their cut-off levels indicated above. The peripheral plasma 18oxoF concentrations served not only to differentiate aldosteronoma but also could serve to avoid unnecessary surgery for nonfunctioning adrenocortical nodules concurrent with hyperplasia or microadenoma.


Assuntos
Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Hidrocortisona/análogos & derivados , Hiperaldosteronismo/diagnóstico , Adenoma/sangue , Neoplasias das Glândulas Suprarrenais/sangue , Aldosterona/sangue , Biomarcadores/sangue , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hidrocortisona/sangue , Hiperaldosteronismo/sangue , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
Ann Otol Rhinol Laryngol ; 124(2): 162-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25139135

RESUMO

OBJECTIVES: The first objective was to describe a novel case of migration of a broken dental needle into the parapharyngeal space. The second was to address the importance of simulation elucidating visualization of such a thin needle under X-ray fluoroscopy. METHODS: Clinical case records (including computed tomography [CT] and surgical approaches) were reviewed, and a simulation experiment using a head phantom was conducted using the same settings applied intraoperatively. RESULTS: A 36-year-old man was referred after failure to locate a broken 31-G dental needle. Computed tomography revealed migration of the needle into the parapharyngeal space. Intraoperative X-ray fluoroscopy failed to identify the needle, so a steel wire was applied as a reference during X-ray to locate the foreign body. The needle was successfully removed using an intraoral approach with tonsillectomy under surgical microscopy. The simulation showed that the dental needle was able to be identified only after applying an appropriate compensating filter, contrasting with the steel wire. CONCLUSION: Meticulous preoperative simulation regarding visual identification of dental needle foreign bodies is mandatory. Intraoperative radiography and an intraoral approach with tonsillectomy under surgical microscopy offer benefits for accessing the parapharyngeal space, specifically for cases medial to the great vessels.


Assuntos
Instrumentos Odontológicos , Fluoroscopia/métodos , Migração de Corpo Estranho/cirurgia , Agulhas , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Faringe , Adulto , Migração de Corpo Estranho/diagnóstico , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Faringe/diagnóstico por imagem , Faringe/cirurgia , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Hypertension ; 64(2): 438-44, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24842915

RESUMO

Aldosterone-producing adenoma is a major subtype of primary aldosteronism. The number of cases of these adenomas, which are below the detection limit of computed tomography but diagnosed by adrenal venous sampling, has recently been increasing. However, the pathophysiology of these adenomas, especially those manifesting clinically overt hyperaldosteronism despite their small size, remains unknown. Therefore, we examined the correlation between tumor size and the status of intratumoral steroidogenic enzymes involved in aldosterone biosynthesis using immunohistochemistry. Forty patients with surgically proven aldosterone-producing adenomas were retrospectively studied. Multidetector computed tomography, adrenal venous sampling, and laparoscopic adrenalectomy were performed in all of the patients studied. The tumor area at the maximum diameter of the sections was precisely measured by ImageJ software. The status of the steroidogenic enzymes was immunohistochemically analyzed, and the findings were evaluated according to the H-score system, based on both the number of immunopositive cells and relative immunointensity. Adrenal masses were not detected by computed tomography in 20 patients. Blood pressure, plasma aldosterone concentration, urinary aldosterone excretion, and the number of antihypertensive agents also decreased significantly after the surgery in these patients, as well as in the patients with adenomas detectable by computed tomography. Maximum tumor area obtained in the specimens was significantly correlated with preoperative plasma aldosterone concentration, urinary aldosterone excretion, and the H score of 11ß-hydroxylase and was inversely correlated with the H score of aldosterone synthase. These results demonstrated that small adenomas could produce sufficient aldosterone to cause clinically overt primary aldosteronism because of the significantly higher aldosterone synthase expression per tumor area.


Assuntos
Neoplasias do Córtex Suprarrenal/metabolismo , Adenoma Adrenocortical/metabolismo , Aldosterona/metabolismo , Citocromo P-450 CYP11B2/metabolismo , Esteroide 11-beta-Hidroxilase/metabolismo , Neoplasias do Córtex Suprarrenal/patologia , Adenoma Adrenocortical/patologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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