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1.
EBioMedicine ; 99: 104929, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38128412

RESUMO

BACKGROUND: Iron overload due to the excessive use of parenteral iron in haemodialysis is now an increasingly recognised clinical issue. Before erythropoiesis-stimulating agents (ESA) were introduced, a specific feature of patients treated by dialysis and having iron overload was that iron levels in the bone marrow were paradoxically low in most of them, despite severe hepatosplenic siderosis. Whether or not this paradox persists in the actual ESA era was unknown until recently, when an autopsy study in 21 patients treated by haemodialysis revealed similarities between liver and bone marrow iron content. The aim of this study was to further explore these recent findings in a cohort of alive patients on dialysis and to analyse the determinants of iron bone marrow. METHODS: Liver iron concentration (LIC) and vertebral T2∗ (a surrogate marker of bone marrow iron) were analysed retrospectively in 152 alive patients on dialysis (38.8% female) of whom 47.4% had iron overload by quantitative magnetic resonance imaging (MRI). FINDINGS: Vertebral T2∗ differed significantly between patients classified according to liver iron content at MRI: those with mild or moderate and severe liver iron overload had increased vertebral iron content at R2∗ relaxometry MRI (mild: vertebral T2∗ = 9.9 ms (4-24.8); moderate and severe: vertebral T2∗ = 8.5 ms (4.9-22.8)) when compared to patients with normal LIC (vertebral T2∗ = 13.2 ms (6.6-30.5) (p < 0.0001 Kruskal-Wallis test)). INTERPRETATION: The paradoxical discrepancy between bone marrow and liver iron-storage compartments observed in the pre-ESA era has disappeared today, as shown by a recent autopsy study and the present study in a cohort of alive patients treated by dialysis. FUNDING: None.


Assuntos
Hemossiderose , Sobrecarga de Ferro , Humanos , Feminino , Masculino , Estudos Retrospectivos , Medula Óssea/química , Diálise Renal/efeitos adversos , Hemossiderose/etiologia , Hemossiderose/patologia , Ferro , Sobrecarga de Ferro/patologia , Fígado/patologia , Imageamento por Ressonância Magnética/métodos
2.
J Med Case Rep ; 17(1): 105, 2023 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-36899396

RESUMO

BACKGROUND: Patients with Down syndrome are at a higher risk of developing autoimmune disorders such as thyroiditis, diabetes, and celiac disease compared with the general population. Although some diseases are well known to be associated with Down syndrome, others such as idiopathic pulmonary hemosiderosis and ischemic stroke due to protein C deficiency remain rare. CASE PRESENTATION: We report a case of a 2.5-year-old Tunisian girl with Down syndrome and hypothyroiditis admitted with dyspnea, anemia, and hemiplegia. Chest X-ray showed diffuse alveolar infiltrates. Laboratory tests showed severe anemia with hemoglobin of 4.2 g/dl without hemolysis. A diagnosis of idiopathic pulmonary hemosiderosis was confirmed by bronchoalveolar lavage showing numerous hemosiderin-laden macrophages, with a Golde score of 285 confirming the diagnosis of pulmonary hemosiderosis. Concerning hemiplegia, computed tomography showed multiple cerebral hypodensities suggestive of cerebral stroke. The etiology of these lesions was related to protein C deficiency. CONCLUSION: Idiopathic pulmonary hemosiderosis remains a severe disease, which is rarely associated with Down syndrome. The management of this disease in Down syndrome patients is difficult, especially when associated with an ischemic stroke secondary to protein C deficiency.


Assuntos
Síndrome de Down , Hemossiderose , AVC Isquêmico , Pneumopatias , Deficiência de Proteína C , Acidente Vascular Cerebral , Feminino , Humanos , Criança , Pré-Escolar , Síndrome de Down/complicações , Hemiplegia , Deficiência de Proteína C/complicações , Pneumopatias/diagnóstico , Acidente Vascular Cerebral/complicações , Hemossiderose/complicações , Hemossiderose/diagnóstico , Hemossiderose/patologia
3.
Am J Dermatopathol ; 45(3): 192-195, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36728283

RESUMO

ABSTRACT: Adenodermatofibromas are an extremely rare subtype of dermatofibroma (DF) characterized by a dermal proliferation of spindle-shaped fibroblasts and histocytes, dilated glandular structures with apocrine secretion, and prominent vascular proliferation, with or without hemosiderotic features. We describe a recent extraordinary case of a hemosiderotic adenodermatofibroma in a 25-year-old female. We review histologic findings and theories behind etiology, as well as review the spectrum of clinical presentations for this lesion. We also discuss imaging findings that may make identification of these entities challenging.


Assuntos
Hemossiderose , Histiocitoma Fibroso Benigno , Neoplasias Cutâneas , Feminino , Humanos , Adulto , Neoplasias Cutâneas/patologia , Histiocitoma Fibroso Benigno/patologia , Hemossiderose/patologia , Fibroblastos/patologia , Histiócitos/patologia
4.
Environ Sci Pollut Res Int ; 29(54): 81923-81937, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35739448

RESUMO

Copper nanoparticles are widely utilized in a variety of applications, including metal catalysts, semiconductors, heat transfer fluids in machine tools, and even in antibacterial medications. Forty mature healthy Westar rats were utilized in the current investigation and grouped randomly into four groups (n = 10 rats/group). Group I (G1) was kept as a control group, but G2, G3, and G4 were intraperitoneally injected with CuO NPs with a dose (5 mg, 10 mg, 25 mg/kg body weight/day) respectively for 9 days. Rats were sacrificed; then, the livers and kidneys were dissected and subjected to histopathological and immunohistochemical examination. Our findings of G2 and G3 revealed mild to moderate degenerative changes within the hepatic parenchyma, moderate blood vessel congestions, glycogen depletion, hemosiderosis, and microvesicular steatosis (fatty changes within the hepatocytes). In addition, at the level of kidney, our examination clarified moderate degenerations of the renal corpuscles and renal tubules with moderate swelling and congestions of the glomerulus with moderate vacuolations in the renal tubules lining epithelium. On the other hand, increasing the dose of CuO NPs, the toxicity became more obvious, where the liver of G4 revealed severe necrosis of hepatocytes with completely disorganizations of the hepatic rays, loss of the hepatic architectures, severe steatosis, severe hemosiderosis, sinusoidal dilatations with congestions, as well as severe fibrous tissue proliferation with anti-inflammatory cell infiltrations specially around portal triad with hyperplasia of bile duct. Meanwhile in kidney, G4 clarified severe necrosis and atrophy of the renal corpuscles with severe damage of Bowman's capsule leading to completely disorganization and loss of normal renal cortex architectures, severe congestion of the glomerulus, severe necrosis of the renal tubules with damage and sloughing for its lining epithelium, and severe hemorrhage between renal tubules. In addition, severe and diffuse caspase 3 immunoreactivity were observed within the hepatic and renal tissues of G4. The present investigation was concluded that the CuO NPs have a potential toxicological effect on the hepatic and renal tissues that may affect their functions.-->.


Assuntos
Hemossiderose , Nanopartículas Metálicas , Nanopartículas , Ratos , Masculino , Animais , Cobre/toxicidade , Caspase 3 , Hemossiderose/patologia , Fígado , Nanopartículas/toxicidade , Necrose/induzido quimicamente , Glicogênio , Antibacterianos/farmacologia , Anti-Inflamatórios/farmacologia , Óxidos/farmacologia , Nanopartículas Metálicas/toxicidade
5.
BMC Nephrol ; 22(1): 132, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858363

RESUMO

BACKGROUND: Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. CASE PRESENTATION: A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls' Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. CONCLUSIONS: IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls' Prussian blue iron staining should be more widely used in patients presenting with hematuria.


Assuntos
Glomerulonefrite por IGA/complicações , Hematúria/etiologia , Hemossiderose/etiologia , Necrose Tubular Aguda/etiologia , Idoso , Eritrócitos/patologia , Feminino , Glomerulonefrite por IGA/patologia , Hematúria/complicações , Hemossiderose/complicações , Hemossiderose/patologia , Humanos , Necrose Tubular Aguda/patologia
6.
J Cardiovasc Magn Reson ; 23(1): 27, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33691716

RESUMO

BACKGROUND: Non-invasive estimation of the cardiac iron concentration (CIC) by T2* cardiovascular magnetic resonance (CMR) has been validated repeatedly and is in widespread clinical use. However, calibration data are limited, and mostly from post-mortem studies. In the present study, we performed an in vivo calibration in a dextran-iron loaded minipig model. METHODS: R2* (= 1/T2*) was assessed in vivo by 1.5 T CMR in the cardiac septum. Chemical CIC was assessed by inductively coupled plasma-optical emission spectroscopy in endomyocardial catheter biopsies (EMBs) from cardiac septum taken during follow up of 11 minipigs on dextran-iron loading, and also in full-wall biopsies from cardiac septum, taken post-mortem in another 16  minipigs, after completed iron loading. RESULTS: A strong correlation could be demonstrated between chemical CIC in 55 EMBs and parallel cardiac T2* (Spearman rank correlation coefficient 0.72, P < 0.001). Regression analysis led to [CIC] = (R2* - 17.16)/41.12 for the calibration equation with CIC in mg/g dry weight and R2* in Hz. An even stronger correlation was found, when chemical CIC was measured by full-wall biopsies from cardiac septum, taken immediately after euthanasia, in connection with the last CMR session after finished iron loading (Spearman rank correlation coefficient 0.95 (P < 0.001). Regression analysis led to the calibration equation [CIC] = (R2* - 17.2)/31.8. CONCLUSIONS: Calibration of cardiac T2* by EMBs is possible in the minipig model but is less accurate than by full-wall biopsies. Likely explanations are sampling error, variable content of non-iron containing tissue and smaller biopsies, when using catheter biopsies. The results further validate the CMR T2* technique for estimation of cardiac iron in conditions with iron overload and add to the limited calibration data published earlier.


Assuntos
Transfusão de Sangue , Cardiomiopatias/diagnóstico por imagem , Hemossiderose/diagnóstico por imagem , Ferro/metabolismo , Imageamento por Ressonância Magnética , Miocárdio/metabolismo , Animais , Biópsia , Calibragem , Cardiomiopatias/etiologia , Cardiomiopatias/metabolismo , Cardiomiopatias/patologia , Modelos Animais de Doenças , Feminino , Hemossiderose/etiologia , Hemossiderose/metabolismo , Hemossiderose/patologia , Imageamento por Ressonância Magnética/normas , Miocárdio/patologia , Valor Preditivo dos Testes , Espectrofotometria Atômica , Suínos , Porco Miniatura
7.
Placenta ; 105: 1-6, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33497930

RESUMO

INTRODUCTION: Chronic abruption oligohydramnios sequence (CAOS) is histologically characterized by diffuse chorioamniotic hemosiderosis (DCH). However, the criteria for the histological evaluation of the extent of CAOS-related hemosiderin deposition (HD) of the membranes and the difference in HD between the chorionic plate (CP) and fetal membrane (FM) are not well studied. This case control study compared the degree and distribution pattern of HD on CP and FM to present the histological features of DCH and the criteria for histological evaluation. METHODS: From the medical records of Kyoto University Hospital (2010-2019), we selected 20 CAOS cases that were clinically diagnosed by Elliot's criteria. Twenty non-CAOS cases matched to the CAOS group by gestational age were selected as controls. We compared the clinical data and pathological features in the two groups. We performed iron staining in all the cases and analyzed HD in CP and FM according to the histological score (H-Score: 0-12), which was determined as the density (0-3) multiplied by the extent of staining (0-4). RESULTS: HD was found in 100% (20/20) of CAOS and 15% (3/20) of control cases. In both the FM and CP, CAOS cases showed a significantly higher HS than control cases (CAOS, HS = 4-12; Control, HS = 0-1, p < 0.0001). Three CAOS patients presented HD alone in the CP. The HS of the CP was significantly higher than that of the FM (p = 0.0003). DISCUSSION: CAOS presented DCH with HS ≥ 4. This study showed that the CP might be more suitable for evaluating DCH than the FM.


Assuntos
Descolamento Prematuro da Placenta/metabolismo , Córion/metabolismo , Hemossiderina/metabolismo , Hemossiderose/metabolismo , Oligo-Hidrâmnio/metabolismo , Descolamento Prematuro da Placenta/patologia , Adulto , Estudos de Casos e Controles , Córion/patologia , Membranas Extraembrionárias/metabolismo , Membranas Extraembrionárias/patologia , Feminino , Hemossiderose/patologia , Humanos , Oligo-Hidrâmnio/patologia , Gravidez , Estudos Retrospectivos
8.
Jpn J Radiol ; 39(1): 76-83, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32860160

RESUMO

PURPOSE: To evaluate the differences in MR findings between nonhemophilic hemosiderotic synovitis (HS) and diffuse-type tenosynovial giant cell tumor (D-TGCT) of the knee. METHODS: This study included 13 patients with histopathologically confirmed intra-articular hemosiderin deposition of the knee (eight with nonhemophilic HS and five with D-TGCT) who underwent preoperative MR imaging including T2*-weighted images (T2*WI). We retrospectively reviewed the MR images and compared MR findings between the two pathologies. RESULTS: Lateral meniscus tear and lateral articular cartilage injury (88% vs. 20%, p < 0.05) and distribution in the suprapatellar bursa of the maximum thickness of T2* hypointense synovium (75% vs. 0%, p < 0.05) were significantly more frequent in nonhemophilic HS than in D-TGCT, respectively. Among patients who underwent contrast-enhanced imaging, all five patients with nonhemophilic HS showed minimal to mild enhancement of the thickened synovium with superficial linear enhancement, whereas all four patients with D-TGCT showed moderate to severe enhancement (p < 0.01). CONCLUSION: As compared with D-TGCT, lateral meniscus tear, lateral articular cartilage injury, lesser degree of contrast enhancement of the thickened synovium, and distribution in the suprapatellar bursa of the maximum thickness of T2* hypointense synovium were characteristic features of nonhemophilic HS.


Assuntos
Hemossiderose/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Sinovite Pigmentada Vilonodular/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Hemossiderose/patologia , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/patologia , Sinovite/diagnóstico por imagem , Sinovite/patologia , Sinovite Pigmentada Vilonodular/patologia
9.
Respir Med ; 176: 106234, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33246295

RESUMO

Idiopathic pulmonary hemosiderosis (IPH) is an uncommon cause of diffuse alveolar hemorrhage (DAH). Patients with IPH usually present with hemoptysis, and the diagnosis is often delayed by years. Patients often present with intermittent episodes of hemoptysis interspersed between periods of relative normalcy. However, massive hemorrhage resulting in acute respiratory failure and non-remitting hemoptysis have also been described. The classic triad includes hemoptysis, radiologic lung infiltrate, and iron deficiency anemia. Several hypotheses regarding the pathogenesis of IPH have been proposed. These risk factors include an autoimmune, allergic or genetic predisposition, and possible environmental exposure. Since IPH appears to be responsive to corticosteroids, the autoimmune hypothesis is considered to play a crucial role. A diagnosis of IPH requires exclusion of other etiologies of DAH, including infection, medications, toxic inhalation, vasculitis, and anti-glomerular basement membrane disease, among others. Histologically, IPH is characterized by the presence of hemosiderin-laden macrophages in the alveolar space without any evidence of vasculitis or immunocomplex deposition. Corticosteroid therapy represents the primary modality of treatment. Other immunosuppressive medications have also been used with varying success, especially in the setting of steroid-refractory disease. The prognosis of IPH in adults is somewhat better compared to the pediatric population. The severity of the initial presentation does not predict future outcomes. Which risk factors and patient characteristics are associated with a poor outcome are also unknown. More research is necessary to elucidate the pathophysiology and appropriate treatment.


Assuntos
Hemossiderose , Pneumopatias , Corticosteroides/uso terapêutico , Anemia Ferropriva/etiologia , Autoimunidade , Criança , Diagnóstico Tardio/prevenção & controle , Feminino , Predisposição Genética para Doença , Hemoptise/etiologia , Hemossiderose/diagnóstico , Hemossiderose/tratamento farmacológico , Hemossiderose/etiologia , Hemossiderose/patologia , Humanos , Imunossupressores/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Pneumopatias/etiologia , Pneumopatias/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia Torácica , Fatores de Risco , Índice de Gravidade de Doença
10.
Acta Neuropathol Commun ; 8(1): 188, 2020 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-33168084

RESUMO

Spinal muscular atrophy (SMA) is largely linked to deletion or mutation of the Survival motor neuron 1 (SMN1) gene located on chromosome 5q13. Type III (Kugelberg-Welander disease) is the mildest childhood form and patients may become ambulatory and have a normal life expectancy. We report the clinical history and morphological findings of a 55-year-old woman who began to experience motor problems at the age of two. She was never fully ambulatory, and her severe scoliosis required the insertion of surgical rod at age 19. Unexpectedly, around 35 years of age, she began to experience sensory symptoms best characterized as a myelo-radiculo-neuropathy with pain as the dominant symptom. Investigations never clarified the etiology of these symptoms. Molecular confirmation of SMA type III was done post-mortem. Neuropathological examination showed classic changes of lower motor neuron neurodegeneration, in line with those reported in the single molecularly confirmed case published so far, and with findings in rare cases reported prior to the discovery of the gene defect. A key autopsy finding was the presence of a severe superficial siderosis of the lower half of the spinal cord. In recent years, the concept of duropathy was put forward, associating superficial siderosis of the spinal cord with various spinal abnormalities, some of which were present in our patient. The presence of significant hemosiderin deposits in the spinal cord and sensory nerve roots with associated tissue and axonal damage provide a plausible explanation for the unexpected sensory symptomatology in this mild lower motor neurodegeneration.


Assuntos
Hemossiderina/metabolismo , Hemossiderose/patologia , Neuralgia/fisiopatologia , Radiculopatia/fisiopatologia , Doenças da Medula Espinal/patologia , Atrofias Musculares Espinais da Infância/patologia , Feminino , Hemossiderose/metabolismo , Hemossiderose/fisiopatologia , Humanos , Hiperalgesia/fisiopatologia , Pessoa de Meia-Idade , Parestesia/fisiopatologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/metabolismo , Doenças da Medula Espinal/fisiopatologia , Atrofias Musculares Espinais da Infância/complicações , Atrofias Musculares Espinais da Infância/genética , Proteína 1 de Sobrevivência do Neurônio Motor/genética , Proteína 2 de Sobrevivência do Neurônio Motor/genética
12.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32512987

RESUMO

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease marked by alveolar bleeding and accumulation of hemosiderin in the lungs. Here we present three cases of IPH. The first case is of a 26-year-old male with anemia, hemoptysis and dyspnea. Bronchoscopy confirmed diffuse alveolar hemorrhage (DAH). A diagnosis of IPH was made after ruling out other causes of DAH and observing good response to steroids. The patient's condition improved with prednisolone and azathioprine. The second case is of 26-year-old female with severe anemia. Imaging suggested IPH and lung biopsy confirmed it. She died shortly afterwards. The third case is of a 7-year-old male with chronic anemia. CT was suggestive of IPH and lung biopsy confirmed the diagnosis. Later, patient developed posterior reversible encephalopathy syndrome (PRES). This patient is stable on azathioprine and prednisolone. We aim to emphasize the importance of considering IPH as a differential in patients with DAH or chronic anemia.


Assuntos
Anemia/etiologia , Hemossiderose/complicações , Pneumopatias/complicações , Pulmão/patologia , Adulto , Anemia/tratamento farmacológico , Azatioprina/uso terapêutico , Biópsia , Broncoscopia/métodos , Criança , Doença Crônica , Quimioterapia Combinada , Dispneia/etiologia , Feminino , Glucocorticoides/uso terapêutico , Hemoptise/etiologia , Hemossiderose/diagnóstico , Hemossiderose/patologia , Humanos , Imunossupressores/uso terapêutico , Pneumopatias/diagnóstico , Pneumopatias/patologia , Masculino , Síndrome da Leucoencefalopatia Posterior/etiologia , Prednisolona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
Neurology ; 94(17): e1853-e1865, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32284360

RESUMO

OBJECTIVE: To investigate the prevalence, predictors, and clinical relevance of cortical superficial siderosis (cSS) progression in cerebral amyloid angiopathy (CAA). METHODS: Consecutive patients with symptomatic CAA meeting Boston criteria in a prospective cohort underwent baseline and follow-up MRI within 1 year. cSS progression was evaluated on an ordinal scale and categorized into mild (score 1-2 = cSS extension within an already present cSS focus or appearance of 1 new cSS focus) and severe progression (score 3-4 = appearance of ≥2 new cSS foci). Binominal and ordinal multivariable logistic regression were used to determine cSS progression predictors. We investigated future lobar intracerebral hemorrhage (ICH) risk in survival analysis models. RESULTS: We included 79 patients with CAA (mean age, 69.2 years), 56 (71%) with lobar ICH at baseline. cSS progression was detected in 23 (29%) patients: 15 (19%) patients had mild and 8 (10%) severe progression. In binominal multivariable logistic regression, ICH presence (odds ratio [OR], 7.54; 95% confidence interval [CI], 1.75-53.52; p = 0.016) and baseline cSS (OR, 10.41; 95% CI, 2.84-52.83; p = 0.001) were independent predictors of cSS progression. In similar models, presence of disseminated (but not focal) cSS at baseline (OR, 5.58; 95% CI, 1.81-19.41; p = 0.004) was an independent predictor of cSS progression. Results were similar in ordinal multivariable logistic regression models. In multivariable Cox regression analysis, severe cSS progression was independently associated with increased future ICH risk (HR, 5.90; 95% CI, 1.30-26.68; p = 0.021). CONCLUSIONS: cSS evolution on MRI is common in patients with symptomatic CAA and might be a potential biomarker for assessing disease severity and future ICH risk. External validation of these findings is warranted.


Assuntos
Angiopatia Amiloide Cerebral/diagnóstico por imagem , Angiopatia Amiloide Cerebral/patologia , Hemossiderose/diagnóstico por imagem , Hemossiderose/patologia , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Hemossiderose/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
14.
World Neurosurg ; 138: 541-544.e1, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32229301

RESUMO

BACKGROUND: Superficial siderosis is an irreversible disease in the central nervous system caused by the deposition of hemosiderin in the subpial tissue due to persistent bleeding in the subarachnoid space. The main symptoms include sensorineural hearing loss, cerebellar ataxia, and pyramidal tract disorder. Superficial siderosis is mainly idiopathic, but bleeding factors such as tumors or history of surgery often play an important role in its pathogenesis. CASE DESCRIPTION: A 66-year-old man with a history of surgery for a cerebellar tumor 37 years ago complained of hearing loss. Magnetic resonance imaging showed recurrence of the tumor on T2-weighted images and hypointense areas along the cerebellar sulci on T2∗-weighted images. During the operation, microscopic bleeding was observed on the surface of the tumor. The pathologic diagnosis was pilocytic astrocytoma. A biopsy obtained during the first surgery revealed almost the same pathologic findings as those from a biopsy obtained during the second surgery, but the first specimen showed no hemosiderin deposition or active bleeding, which the second specimen did show. CONCLUSIONS: Recurrent pilocytic astrocytoma with intratumoral hemorrhage was the suspected cause for superficial siderosis. The source of chronic bleeding was identified with intraoperative and pathologic findings. We describe the first report of superficial siderosis associated with a pilocytic astrocytoma that recurred 37 years after an initial tumor was excised.


Assuntos
Astrocitoma/complicações , Neoplasias Cerebelares/complicações , Hemossiderose/etiologia , Recidiva Local de Neoplasia/complicações , Idoso , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Hemossiderina/metabolismo , Hemossiderose/diagnóstico por imagem , Hemossiderose/patologia , Hemossiderose/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Espaço Subaracnóideo/patologia
15.
Medicine (Baltimore) ; 99(3): e18798, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011483

RESUMO

RATIONALE: Renal hemosiderosis is a disease in which hemosiderin deposits in the renal cortex as a form of iron overload. However, cases of renal hemosiderosis due to intravascular hemolysis following mitral valve repair have been rarely reported. PATIENT CONCERNS: We present the case of a 62-year-old woman who developed asymptomatic urinary abnormalities including microscopic hematuria and proteinuria due to renal hemosiderosis following a mitral valve repair surgery performed two years earlier. DIAGNOSES: A percutaneous renal biopsy showed no specific glomerular abnormality, tubular atrophy, or interstitial fibrosis but extensive deposition of hemosiderin in the proximal tubule. The patient was diagnosed with renal hemosiderosis and chronic intravascular hemolysis following mitral valve repair. INTERVENTIONS: Our patient refused a mitral valve repeat surgery and hence was treated with oral iron preparations, N-acetylcysteine, and a ß-receptor blocker. OUTCOMES: Moderate mitral regurgitation with the regurgitant blood striking against the annuloplasty ring was confirmed on follow-up echocardiography. After the 24-month follow-up period, hemolytic anemia persisted, but there was no significant decline of renal function. LESSONS: For cases of chronic intravascular hemolysis accompanied with asymptomatic urinary abnormalities, a renal biopsy is required to exclude underlying kidney pathology and predict potential renal insufficiency.


Assuntos
Implante de Prótese de Valva Cardíaca , Hemólise , Hemossiderose/diagnóstico , Nefropatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Feminino , Hemossiderose/etiologia , Hemossiderose/patologia , Humanos , Nefropatias/etiologia , Nefropatias/patologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/patologia
16.
AJNR Am J Neuroradiol ; 41(2): 331-337, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31919140

RESUMO

BACKGROUND AND PURPOSE: Germinal matrix intraventricular hemorrhage is a common complication of prematurity. An underrecognized complication of germinal matrix intraventricular hemorrhage is superficial siderosis, and the clinical consequences of superficial siderosis are not well-known. We aimed to investigate the prevalence, anatomic distribution, and severity of superficial siderosis and ependymal siderosis in premature infants with germinal matrix intraventricular hemorrhage using SWI. MATERIALS AND METHODS: In this retrospective study, we included 88 patients across all grades of germinal matrix intraventricular hemorrhage who underwent MR imaging at term-equivalent age. Images were evaluated for the presence, distribution, and severity of superficial siderosis and ependymal siderosis. Univariate and multivariate logistic regression analyses were performed to determine factors associated with superficial siderosis and ependymal siderosis. The agreement among T1, T2, and SWI sequences was examined. RESULTS: Seventy-two patients had brain stem superficial siderosis, and 79 patients had ependymal siderosis. The presence, extent, and severity of superficial siderosis and ependymal siderosis were closely related to the grade of germinal matrix intraventricular hemorrhage and intraventricular hematoma volume. Brain stem superficial siderosis had a stronger correlation with intraventricular hemorrhage than with cerebellar hemorrhage. Compared with SWI, T1 and T2 sequences detected only small proportions of patients with superficial siderosis (12.5% and 6.9%, respectively). CONCLUSIONS: The incidence of superficial siderosis and ependymal siderosis is very high in preterm infants with germinal matrix intraventricular hemorrhage when assessed by SWI at term-equivalent age. The presence and extent of superficial siderosis and ependymal siderosis are closely related to germinal matrix intraventricular hemorrhage grade and intraventricular hematoma volume. Additional prospective studies using SWI are needed to clearly determine the clinical consequences of germinal matrix intraventricular hemorrhage with superficial siderosis and ependymal siderosis.


Assuntos
Hemorragia Cerebral/complicações , Hemossiderose/epidemiologia , Hemossiderose/etiologia , Doenças do Prematuro/patologia , Feminino , Hemossiderose/patologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Prevalência , Estudos Retrospectivos
17.
J Pediatr Hematol Oncol ; 42(4): e240-e243, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31107369

RESUMO

Idiopathic pulmonary hemosiderosis is characterized by a triad of iron-deficiency anemia, hemoptysis, and radiographic diffuse lung infiltrates. However, the inconsistent initial presentation in children may cause a significant delay in diagnosis. Autoimmune reactivity seems to be the most acceptable theory of pathogenesis. We reported an 8-year-old boy presenting with a cough, fever, and difficulty breathing with a history of iron-deficiency anemia and an abnormal autoimmune response in the last 3 years. Perinuclear antineutrophil cytoplasmic antibodies were positive and chest computed tomography revealed patchy ground glass haziness. Bronchoalveolar lavage fluid showed hemosiderin-laden macrophages. The respiratory symptoms improved with oral corticosteroids.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Doenças Autoimunes , Autoimunidade , Diagnóstico Tardio , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Doenças Autoimunes/patologia , Criança , Hemossiderose/diagnóstico , Hemossiderose/imunologia , Hemossiderose/patologia , Humanos , Pneumopatias/diagnóstico , Pneumopatias/imunologia , Pneumopatias/patologia , Macrófagos/imunologia , Macrófagos/patologia , Masculino
20.
PLoS One ; 14(11): e0224988, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31730658

RESUMO

OBJECTIVES: To evaluate proton density fat fraction (PDFF) and T2* measurements of the liver with combined parallel imaging (sensitivity encoding, SENSE) and compressed sensing (CS) accelerated chemical shift encoding-based water-fat separation. METHODS: Six-echo Dixon imaging was performed in the liver of 89 subjects. The first acquisition variant used acceleration based on SENSE with a total acceleration factor equal to 2.64 (acquisition labeled as SENSE). The second acquisition variant used acceleration based on a combination of CS with SENSE with a total acceleration factor equal to 4 (acquisition labeled as CS+SENSE). Acquisition times were compared between acquisitions and proton density fat fraction (PDFF) and T2*-values were measured and compared separately for each liver segment. RESULTS: Total scan duration was 14.5 sec for the SENSE accelerated image acquisition and 9.3 sec for the CS+SENSE accelerated image acquisition. PDFF and T2* values did not differ significantly between the two acquisitions (paired Mann-Whitney and paired t-test P>0.05 in all cases). CS+SENSE accelerated acquisition showed reduced motion artifacts (1.1%) compared to SENSE acquisition (12.3%). CONCLUSION: CS+SENSE accelerates liver PDFF and T2*mapping while retaining the same quantitative values as an acquisition using only SENSE and reduces motion artifacts.


Assuntos
Aceleração , Adiposidade , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Prótons , Adulto , Idoso , Idoso de 80 Anos ou mais , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/patologia , Feminino , Hemossiderose/diagnóstico por imagem , Hemossiderose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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