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1.
J Clin Neurosci ; 64: 145-149, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929959

RESUMO

Our objective was to assess the impact of hs-cTnT elevation on functional outcome and mortality in AIS patients with large vessel occlusion (LVO) in the anterior circulation 3 months after ET and explore factors affecting hs-cTnT elevation. A total of 143 consecutive AIS patients with large vessel occlusion (LVO) in the anterior circulation following ET in a single stroke center were enrolled between January 2015 and November 2017. Hs-cTnT was quantitated on admission. Demographic characteristics, clinical data, functional outcome and all-cause mortality were compared between patients with elevated hs-cTnT levels (>14 ng/L) and those with normal hs-cTnT levels (≤14 ng/L). 58/143(40.6%) patients showed elevated hs-cTnT levels before ET. Factors independently associated with hs-cTnT elevation were admission NIHSS score (OR = 1.08, 95% CI 1.01-1.16, p = 0.032), coronary heart disease (OR = 4.89, 95% CI 1.82-13.11, p = 0.002) and congestive heart failure (OR = 4.10, 95% CI 1.07-15.68, p = 0.039). In the univariate analysis, patients with elevated hs-cTnT levels were at significantly higher risk of 3-month poor outcome (p = 0.029) and mortality (p < 0.001) than those with normal hs-cTnT levels. After multivariable analysis, hs-cTnT elevation remained an independent predictor of 3-month mortality (OR = 4.49, 95% CI 1.68-11.98, p = 0.003). In this cohort of AIS patients with LVO in the anterior circulation undergoing ET, hs-cTnT elevation is an independent predictor of 3-month mortality. Admission NIHSS score, coronary heart disease and congestive heart failure are independently associated with elevated hs-cTnT levels.


Assuntos
Biomarcadores/sangue , Acidente Vascular Cerebral/cirurgia , Troponina T/sangue , Idoso , Isquemia Encefálica/sangue , Isquemia Encefálica/mortalidade , Isquemia Encefálica/cirurgia , Estudos de Coortes , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Trombectomia/métodos , Trombectomia/mortalidade
2.
Eur Radiol ; 29(9): 4922-4929, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30762114

RESUMO

OBJECTIVES: To compare collateral status on single-phase CT angiography (sCTA) and multiphase CT angiography (mCTA) and their ability to predict a target mismatch on CT perfusion (CTP) and clinical outcome in patients with acute ischemic stroke (AIS). METHODS: Seventy-three AIS patients with stroke onset between 5 and 15 h or with unclear onset time and occlusions in the M1/M2 segment of the middle cerebral artery and/or intracranial internal carotid artery underwent head non-contrast CT and CTP. Simulated sCTA and mCTA were reconstructed from CTP data and were compared for collaterals assessment. The ability to predict target mismatch on CTP (an ischemic core < 70 ml, a mismatch ratio ≥ 1.8, and an absolute difference ≥ 15 ml) and 90-day modified Rankin Scale (mRS) score of 0-2 was compared between sCTA and mCTA by using receiver operating curve analysis. RESULTS: sCTA underestimated the collateral status when compared with mCTA (p < 0.01). The ability of mCTA to predict target mismatch (AUC = 0.902, 95% confidence interval [CI] 0.809, 0.959) and clinical outcome (AUC = 0.771; 95% CI, 0.655, 0.864) was better than that of sCTA (p < 0.05 overall). A mCTA collateral score of > 3 best identified the target mismatch (sensitivity, 78.4%; specificity, 90.9%) and predicted 90-day mRS score of 0-2 (sensitivity, 84.8%; specificity, 69.4%). CONCLUSIONS: The collaterals were better estimated by mCTA compared with sCTA. A mCTA collateral score of > 3 optimized the prediction of a target mismatch on CTP and a good clinical outcome in patients with AIS. KEY POINTS: • Collateral circulation is a key determinant of ischemic core and penumbra. Better collaterals are associated with smaller ischemic core volumes and larger mismatch ratios on CT perfusion. • The collaterals can be better estimated by multiphase CTA compared with single-phase CTA. • A collateral score of > 3 on multiphase CTA best identifies patients with target mismatch on CT perfusion and predicts 90-day mRS score of 0-2.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Circulação Colateral , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Imagem de Perfusão , Sensibilidade e Especificidade
3.
J Cell Physiol ; 234(2): 1354-1368, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30076722

RESUMO

In recent years, studies have shown that the secretome of bone marrow mesenchymal stromal cells (BMSCs) contains many growth factors, cytokines, and antioxidants, which may provide novel approaches to treat ischemic diseases. Furthermore, the secretome may be modulated by hypoxic preconditioning. We hypothesized that conditioned medium (CM) derived from BMSCs plays a crucial role in reducing tissue damage and improving neurological recovery after ischemic stroke and that hypoxic preconditioning of BMSCs robustly improves these activities. Rats were subjected to ischemic stroke by middle cerebral artery occlusion and then intravenously administered hypoxic CM, normoxic CM, or Dulbecco modified Eagle medium (DMEM, control). Cytokine antibody arrays and label-free quantitative proteomics analysis were used to compare the differences between hypoxic CM and normoxic CM. Injection of normoxic CM significantly reduced the infarct area and improved neurological recovery after stroke compared with administering DMEM. These outcomes may be associated with the attenuation of apoptosis and promotion of angiogenesis. Hypoxic preconditioning significantly enhanced these therapeutic effects. Fourteen proteins were significantly increased in hypoxic CM compared with normoxic CM as measured by cytokine arrays. The label-free quantitative proteomics analysis revealed 163 proteins that were differentially expressed between the two groups, including 107 upregulated proteins and 56 downregulated proteins. Collectively, our results demonstrate that hypoxic CM protected brain tissue from ischemic injury and promoted functional recovery after stroke in rats and that hypoxic CM may be the basis of a potential therapy for stroke patients.


Assuntos
Células da Medula Óssea/metabolismo , Encéfalo/efeitos dos fármacos , Meios de Cultivo Condicionados/farmacologia , Infarto da Artéria Cerebral Média/tratamento farmacológico , Células-Tronco Mesenquimais/metabolismo , Fármacos Neuroprotetores/farmacologia , Animais , Apoptose/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Hipóxia Celular , Células Cultivadas , Meios de Cultivo Condicionados/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/metabolismo , Infarto da Artéria Cerebral Média/patologia , Infarto da Artéria Cerebral Média/fisiopatologia , Masculino , Neovascularização Fisiológica/efeitos dos fármacos , Fármacos Neuroprotetores/metabolismo , Fosfatidilinositol 3-Quinase/metabolismo , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ratos Sprague-Dawley , Recuperação de Função Fisiológica
4.
Neurol Res ; 40(9): 717-723, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29843579

RESUMO

OBJECTIVE: The role of CD40/CD40 ligand (CD40L) in microvascular thrombosis is now widely accepted. However, the exact mechanisms linking the CD40/CD40L system and the soluble form of CD40L (sCD40L) with microvascular thrombosis are currently a topic of intensive research. The objective of this study was to assess the potential mechanisms in CD40/CD40L system-regulated microvascular thrombosis after focal ischemia/reperfusion (I/R). METHODS: Rats were subjected to 60-min transient middle cerebral artery occlusion (MCAO). The experiments were divided into three groups: sham operation, MCAO, and MCAO + CD40 antagonist. Dynamic changes of serum-free sCD40L levels for 0, 1, 3, 5, 6, and 12 h by ELISA detecting kit after focal I/R were observed, and the CD40 expression levels in both platelet surface and vascular endothelial cell surface were measured by flow cytometry and immunofluorescence, respectively. Cerebral infarct volume was analyzed 12 h after reperfusion. mTOR/S6K signaling was determined by Western blot. RESULTS: A comparison of thrombus formation between MCAO and CD40 antagonist treatment rats revealed a role for CD40 and/or CD40L in the inflammation-enhanced thrombosis responses in both of the platelet and vascular endothelial cell. MCAO rats yielded an acceleration of thrombus formation that was accompanied by increased CD40 levels in serum. The brain infarction was significantly decreased in CD40 antagonist treatment group compared to MCAO model group. The mTOR/S6K signaling was activated in MACO model than that of CD40 antagonist treatment group. CONCLUSIONS: Our findings indicate that CD40/CD40L system contributes to microvascular thrombosis and brain infarction induced by MCAO and reperfusion. The mTOR/S6K signaling pathway is involved in the regulation of cerebral microvasculature after focal I/R by CD40/CD40L. ABBREVIATIONS: AKT: protein kinase B; CD40L: CD40 ligand; CSF: cerebrospinal fluid; FITC: fluorescein isothiocyanate; I/R: ischemia/reperfusion; MCAO: middle cerebral artery occlusion; mTOR: mechanistic target of rapamycin; PE: P-phycoerythrin; sCD40L: soluble form of CD40L; TNF-a: tumor necrosis factor-alpha; WT: wild type.


Assuntos
Antígenos CD40/metabolismo , Ligante de CD40/metabolismo , Infarto da Artéria Cerebral Média/metabolismo , Microvasos/metabolismo , Traumatismo por Reperfusão/metabolismo , Serina-Treonina Quinases TOR/metabolismo , Animais , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Plaquetas/patologia , Encéfalo/irrigação sanguínea , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Encéfalo/patologia , Edema Encefálico/metabolismo , Edema Encefálico/patologia , Antígenos CD40/antagonistas & inibidores , Permeabilidade Capilar/efeitos dos fármacos , Permeabilidade Capilar/fisiologia , Modelos Animais de Doenças , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/patologia , Masculino , Microvasos/efeitos dos fármacos , Microvasos/patologia , Ratos Sprague-Dawley , Traumatismo por Reperfusão/patologia , Proteínas Quinases S6 Ribossômicas/metabolismo , Transdução de Sinais
5.
Vasc Endovascular Surg ; 52(1): 46-51, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29130853

RESUMO

OBJECTIVES: Congenital renal arteriovenous malformations (rAVMs) represent rare vascular diseases. The heterogeneous vascular architecture of each rAVM determines the endovascular treatment techniques employed. We reported our experience with the endovascular treatment of a series of rAVMs. MATERIALS: This retrospective study consisted of 12 patients with 12 rAVMs who underwent renal arterial embolization (RAE) in our hospital. Embolic materials, including particles, liquid embolic agents (n-butyl 2-cyanoacrylate, Onyx, and ethanol), and coils, were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of the feeding arteries and nidus on postprocedure renal arteriography. Clinical success was defined as the resolution of hematuria or the disappearance of rAVM-relevant symptoms. RESULTS: The median follow-up period was 13.5 months (range: 4-72). The technical success based on 12 procedures in 12 patients was 83.3% (10 of 12). In the 2 procedures that technically failed, the existence of multiple fine feeding arteries arising from the proximal portion of different segmental renal arteries explains the incomplete embolization. One of the 2 patients achieved clinical success without additional RAE. The other patient had recurrent hematuria 25 months after initial treatment, which was successfully managed conservatively with hemostatic agents. Thus, the clinical success was 91.7% (11 of 12). CONCLUSIONS: Renal artery embolization with the selective use of various embolic materials is an effective treatment for patients with rAVMs. The existence of multiple fine feeding vessels arising from the proximal portion of different segmental renal arteries is likely to affect the technical success of treatment.


Assuntos
Malformações Arteriovenosas/terapia , Dimetil Sulfóxido/administração & dosagem , Embolização Terapêutica , Embucrilato/administração & dosagem , Procedimentos Endovasculares , Etanol/administração & dosagem , Polivinil/administração & dosagem , Artéria Renal/anormalidades , Veias Renais/anormalidades , Adulto , Idoso , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , China , Circulação Colateral , Angiografia por Tomografia Computadorizada , Dimetil Sulfóxido/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Etanol/efeitos adversos , Feminino , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Polivinil/efeitos adversos , Radiografia Intervencionista , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Circulação Renal , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Neuroradiology ; 59(11): 1165-1170, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28879505

RESUMO

PURPOSE: Oculomotor nerve palsy (ONP) may result from Posterior communicating artery (Pcom) aneurysms. Endovascular treatment of ruptured Pcom aneurysms generally is a safe procedure, but the effect of this therapy on ONP is incompletely elucidated. This retrospective study evaluates outcomes of ONP after endovascular treatment for ruptured Pcom aneurysm and with the intention to clarify predictors of recovery. METHODS: From May 2010 to October 2015, 210 patients with Pcom aneurysms underwent endovascular treatment at our institution. Among them, 34 patients with ruptured aneurysms and either complete or incomplete ONP were identified. The outcomes and predictors of ONP recovery were analyzed. RESULTS: At the last available clinical follow-up, ONP resolution was complete in 21 (61.8%) patients and incomplete in 8 (23.5%) patients. The mean resolution time after embolization was 24.5 days. Five patients showed no signs of ONP recovery. In no case was an initial incomplete ONP observed to worsen. There was a statistically insignificant trend toward complete recovery among patients with initial incomplete ONP (OR = 4.17; 95% CI, 0.75-23.18; P = 0.103). CONCLUSION: Endovascular treatment appears to be an effective treatment modality for ruptured Pcom aneurysm and related ONP. The initial incomplete ONP might encourage complete ONP recovery after endovascular treatment.


Assuntos
Aneurisma Roto/complicações , Aneurisma Roto/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
Acta Otolaryngol ; 136(8): 864-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27055585

RESUMO

CONCLUSIONS: Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. OBJECTIVE: To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. MATERIALS AND METHODS: From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). RESULTS: Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).


Assuntos
Embolização Terapêutica , Epistaxe/terapia , Adolescente , Adulto , Idoso , Angiografia , Criança , Epistaxe/diagnóstico por imagem , Epistaxe/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Ren Fail ; 37(9): 1470-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26335729

RESUMO

PURPOSE: To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. MATERIALS AND METHODS: Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. RESULTS: All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n = 4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n = 1), stenting for renal vein kinking (n = 2), and percutaneous nephrostomy (PCN) for UO (n = 7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0 ± 3.6 to 2.6 ± 2.1 mg/dL (p < 0.001), as well as patients' clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p < 0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. CONCLUSION: Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.


Assuntos
Falso Aneurisma/cirurgia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Obstrução da Artéria Renal/cirurgia , Terapia de Salvação/métodos , Adolescente , Adulto , Angioplastia com Balão , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Stents , Transplante Homólogo , Resultado do Tratamento , Adulto Jovem
9.
AJR Am J Roentgenol ; 204(6): 1322-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26001244

RESUMO

OBJECTIVE: The long-term prognosis after hepatic resection for the treatment of hepatocellular carcinoma (HCC) has been disappointing because of the high recurrence rates in the remnant liver, which constitutes the major cause of death. The purpose of this study was to identify the prognostic factors for overall survival after transarterial chemoembolization (TACE) in recurrent HCC after the initial curative surgical resection. MATERIALS AND METHODS: From January 2003 through October 2012, 362 patients who developed recurrent HCC after initial surgical resection and underwent TACE as the first-line therapy were retrospectively studied at a single institution in our hospital. Patients who met our inclusion criteria were followed until December 2012. Prognostic factors for overall survival were analyzed. RESULTS: In total, 287 patients were enrolled. The median overall survival period was 747 days. The 1-, 2-, and 3-year overall survival rates after TACE were 72.9%, 51.8%, and 31.8%, respectively. Multivariate analysis indicated that the number of resected HCCs (≥ 2, p < 0.001), the number (≥ 2, p < 0.001) and size (> 5 cm, p = 0.022) of the recurrent HCCs, and the number of TACE sessions (≤ 3, p < 0.001) are independent risk factors for poor survival after TACE for recurrent HCC after HCC resection. CONCLUSION: TACE appears to be an effective treatment of patients who experienced a recurrence after curative HCC resection. An initial solitary HCC, a solitary recurrence, and recurrent tumor mass 5 cm or smaller are statistically significant independent prognostic factors for survival.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , China/epidemiologia , Feminino , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
11.
J Vasc Interv Radiol ; 26(2): 223-30, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25645411

RESUMO

PURPOSE: To evaluate the efficacy and safety of transarterial embolization with ethanol-soaked gelatin sponge (ESG) for the treatment of arterioportal shunts (APSs) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 61 patients with unresectable HCC was included in this study, conducted from June 2008 to November 2011. These patients, who were treated with APSs, had received transarterial therapy. They underwent transarterial embolization of the shunt with ESG followed by transarterial chemoembolization if available. Changes in APSs, tumor response (per modified Response Evaluation Criteria in Solid Tumors), postembolization events, patient survival, and prognostic factors were analyzed. RESULTS: The median follow-up period was 13 months (range, 3-34 mo). The immediate APS improvement rate was 97% (59 of 61), and the APS improvement rate at first-time follow-up was 54% (33 of 61). Tumor response at 2 months after first embolization was as follows: complete response in two patients (3.3%), partial response in 24 patients (39.3%), stable disease in 24 patients (39.3%), and progressive disease in 11 patients (18.1%). Survival rates were 79% at 6 months, 50% at 1 year, and 12% at 2 years; the median survival time was 382 days. Maximal tumor size and APS improvement at first-time follow-up were demonstrated to be independent prognostic factors (P < .05). CONCLUSIONS: Transarterial embolization with ESG may be safe and effective for the treatment of APSs in patients with unresectable HCC. Small maximal tumor size (< 5 cm) and an improvement in APSs favored overall survival.


Assuntos
Fístula Artério-Arterial/terapia , Carcinoma Hepatocelular/terapia , Esponja de Gelatina Absorvível/uso terapêutico , Artéria Hepática/anormalidades , Neoplasias Hepáticas/terapia , Veia Porta/anormalidades , Idoso , Idoso de 80 Anos ou mais , Fístula Artério-Arterial/etiologia , Carcinoma Hepatocelular/complicações , Embolização Terapêutica/métodos , Etanol/uso terapêutico , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
12.
World J Gastroenterol ; 21(1): 373-6, 2015 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-25574114

RESUMO

Herein, we report a new technique that consists of placing two (125)I seed strands and two stents in the right and left intrahepatic bile ducts for the treatment of hilar cholangiocarcinoma. A 75-year-old man presented with jaundice and was diagnosed with Bismuth type IV Klatskin tumor. Abdominal computed tomography (CT) showed intrahepatic and extrahepatic bile duct dilatation and a soft tissue mass in the hepatic hilum. Because curative surgical resection was not possible, we placed (125)I seed strands and stents in the right and left intrahepatic bile ducts. Three months later, abdominal CT showed less intrahepatic and extrahepatic bile duct dilatation than before the procedure. This technique was feasible and could be considered for the treatment of patients with Bismuth type IV tumors.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Ductos Biliares Intra-Hepáticos/efeitos da radiação , Braquiterapia/métodos , Colangiocarcinoma/terapia , Drenagem/instrumentação , Radioisótopos do Iodo/uso terapêutico , Tumor de Klatskin/terapia , Stents , Idoso , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/radioterapia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/patologia , Colangiocarcinoma/radioterapia , Terapia Combinada , Humanos , Tumor de Klatskin/patologia , Tumor de Klatskin/radioterapia , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Thromb Res ; 135(4): 727-32, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25618266

RESUMO

PURPOSE: To establish a canine model of acute pulmonary embolism (PE) with right ventricular (RV) dysfunction using autologous blood clots and evaluate by echocardiography and contrast-enhanced Computed Tomography (CT). MATERIALS AND METHODS: Autologous blood clots formed in vitro were introduced sequentially into the pulmonary arteries of eight healthy mixed-breed dogs while monitoring pulmonary and systemic hemodynamic function. Blood clots were injected until the mean pulmonary artery pressure (MPAP) reached two-three times the baseline pressure, which was maintained up to 1 hour. The RV function was assessed by echocardiography and ECG-gated dual-source contrast CT. RESULTS: All animals survived the imaging procedure. The post-injection pulmonary angiograms showed extensive PE, and MPAP increased from 16.50±2.45 mmHg to 43.13±4.91 mmHg (P<0.001). On echocardiography, the RV fractional area change decreased from 42.06±3.36 to 27.96±3.54 (P<0.001), and the RV myocardial performance increased from 0.20±0.05 to 0.63±0.16 (P<0.001). On CT, the RV end-systolic volume increased from 11.11±1.81 ml to 24.71±4.60 ml (P<0.001), RV end-diastolic volume from 20.73±2.83 ml to 34.63±5.76 ml (P<0.001), and the four-chamber RV/left ventricular diameter ratio from 0.38±0.07 to 0.81±0.14 (P<0.001). CONCLUSION: Acute PE with RV dysfunction was established in a large animal model through controlled injection of autologous blood clots, which may be useful for developing and evaluating new therapeutic approaches for acute PE with RV dysfunction.


Assuntos
Ecocardiografia/métodos , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Direita/complicações , Doença Aguda , Animais , Modelos Animais de Doenças , Cães , Disfunção Ventricular Direita/diagnóstico por imagem
14.
Cardiovasc Intervent Radiol ; 38(1): 177-81, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24798136

RESUMO

PURPOSE: To evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis. METHODS: From March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated. RESULTS: Technical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days. CONCLUSIONS: The newly designed stent is associated with a high degree of technical success and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.


Assuntos
Obstrução Duodenal/cirurgia , Stents , Idoso , Obstrução Duodenal/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Desenho de Equipamento , Feminino , Fluoroscopia , Humanos , Atresia Intestinal , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Resultado do Tratamento
15.
Neurology ; 82(21): 1897-904, 2014 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-24771536

RESUMO

OBJECTIVE: We investigated whether pial venous reflux (PVR) is associated with hemorrhage or edema in dural arteriovenous fistula (DAVF). METHODS: We evaluated the association of hemorrhage or edema with the occurrence of PVR or cortical venous reflux (CVR) in 222 patients with DAVF. We determined whether angiographic findings of PVR or CVR (more than Borden I or Cognard IIa) were associated with symptoms, lesion location, or brain lesion (hemorrhage or edema). We evaluated the lesion progression or the follow-up results after obliteration of the DAVF. RESULTS: Hemorrhage or edema developed in 18% (40/222) of the patients with DAVF and 55% (40/72) of the patients with PVR. There were 2 patterns of PVR associated with hemorrhage or edema: (1) PVR in any particular CVR territory (75%), and (2) direct PVR not via CVR (25%). The presence of brain lesion increased the odds of presence of PVR by 4.09 times compared to the group without brain lesion (95% confidence interval = 1.570-11.394, p = 0.004). Brain edema caused by PVR was reversible after obliteration of the fistula and may have progressed to hemorrhage without proper patient management performed within several weeks after the initial presentation. CONCLUSIONS: Our results show that PVR is more closely associated with the hemorrhage or edema than CVR in patients with DAVF. PVR can occur not only as a part of CVR but also directly in certain types of DAVF.


Assuntos
Edema Encefálico/patologia , Malformações Vasculares do Sistema Nervoso Central/patologia , Hemorragias Intracranianas/patologia , Pia-Máter/irrigação sanguínea , Pia-Máter/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
16.
Neurointervention ; 9(1): 32-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24642961

RESUMO

Problem with embolization of arteriovenous fistula (AVF) with liquid embolic agent is its over-penetration into the veins or regurgitation to the proximal feeder without reaching the shunt point. We present a technique that controls the flow of AVF during embolization. Two microcatheter technique consists of positioning one microcatheter close to the AVF for embolization, and with another microcatheter at the proximal feeding artery to control the AVF flow by coiling. Selective angiograms obtained using a distally positioned microcatheter before and after coiling, were compared how much stagnant effect was achieved. Using two microcatheter technique, AVF occlusion was achieved with good penetration of glue to the venous side of the AVF. Its advantage is the ability to push glue into the shunt without causing over-penetration of glue or its reflux along the feeder. Two microcatheter technique was safe and effective in glue embolization of AVF and also expected to be applied with other liquid embolic agent like Onyx.

17.
World J Gastroenterol ; 19(40): 6869-75, 2013 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-24187463

RESUMO

AIM: To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery. METHODS: This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography, and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization. RESULTS: Angiography showed that a discrete bleeding focus was detected in 21 (81%) of 26 patients. Positive angiographic findings included extravasations of contrast medium (n = 9), pseudoaneurysms (n = 9), and fusiform aneurysms (n = 3). Transarterial embolization was technically successful in 21 (95%) of 22 patients. Clinical success was achieved in 18 (82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding. CONCLUSION: The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Embolização Terapêutica , Hemorragia Gastrointestinal/terapia , Hemorragia Pós-Operatória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Emergências , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Radiografia , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
18.
Neuroradiology ; 55(9): 1129-34, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23811958

RESUMO

INTRODUCTION: The aetiology of dural arteriovenous fistula (DAVF) is not well known, but it has been suggested that abnormality in angiogenesis plays a pathological role. Abnormality in angiogenesis is also involved in diabetes mellitus (DM). The purpose of this study was to quantify the relation between DAVF and DM in a Korean population. METHODS: Medical records of 192 patients with DAVF between 2002 and 2011 were reviewed. Age, sex and the presence of DM, hypertension, hyperlipidaemia, stroke, coronary artery disease and cancers were compared between DAVF and control subjects. Data for control were obtained from the Korean National Health and Nutrition Examination Survey. The relationship of DM and DAVF location, presenting symptoms (benign vs. aggressive) and classification (Borden and Geibprasert) were assessed using the Pearson's chi-square test. RESULTS: Prevalence of DM was higher in DAVF patients (19.8 %) than in controls (9.5 %; p = 0.004). Univariate analysis showed that DM (odds ratio (OR), 2.356; 95 % confidence interval (CI), 1.634-3.399; p < 0.001) and age (OR, 1.022; 95 % CI, 1.012-1.032; p < 0.001) increased the odds of DAVF. This was supported by multivariate analysis (DM: OR, 2.092; 95 % CI, 1.391-3.145; p = 0.0004 and Age: OR, 1.021; 95 % CI, 1.009-1.033; p = 0.001). When these analyses were repeated after stratification by sex, there was no relation between age and DAVF in men. Borden II and III (p = 0.038) and aggressive symptoms (p = 0.023) were related to DM. CONCLUSION: There was a positive relation between DM and DAVF in a Korean population. DAVFs with aggressive symptoms and behaviour were more commonly related to DM.


Assuntos
Fístula Arteriovenosa/epidemiologia , Diabetes Mellitus/epidemiologia , Malformações Arteriovenosas Intracranianas/epidemiologia , Distribuição por Idade , Fístula Arteriovenosa/diagnóstico , Comorbidade , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo
19.
J Clin Neurol ; 9(2): 83-90, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23626645

RESUMO

BACKGROUND AND PURPOSE: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. METHODS: Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. RESULTS: All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. CONCLUSIONS: Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.

20.
Neurointervention ; 8(1): 3-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23515458

RESUMO

The interventional neuroradiology (INR, or neurointerventional surgery) became a rapidly emerging specialty since the first Working group in Interventional Neuroradiology (WIN) meeting was held in Santa Barbara in 1980 by 15 pioneers. Although the specialty has been led by neuroradiologists, other specialists of neurosurgery and neurology have become involved. Due to diverse background of the specialties with inadequate requirement of education and training, proper level of training standard and quality assurance may be achieved for outcomes of treated patients with neurovascular diseases. In East Asia, there are less inter-relationship of education and training among China, Japan and Korea when compared to the learning opportunities in western countries from the three nations. Therefore, we present the current status and difference of medical education system and compare INR training to improve understanding of INR development in the adjacent countries.

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