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1.
Medicine (Baltimore) ; 98(31): e16666, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374041

RESUMO

INTRODUCTION: Pulmonary sequestration (PS) is a rare congenital lung malformation. The classical treatment of the disease has been conventional surgery with resection of abnormal parenchyma. Recently, the endovascular embolization has been proposed for the treatment of this disease. Here we present 2 cases of PS successfully treated with thoracic endograft. PATIENT CONCERNS: Two patients with abnormal consolidation in the left lower lobe were admitted in our hospital. DIAGNOSIS: Chest computed tomography angiography (CTA) showed abnormal consolidation in the left lower lobe, which received systemic blood supply from the descending aorta in both patients. So the diagnosis of PS was confirmed. INTERVENTIONS: Endovascular treatment with thoracic endograft was successfully performed. OUTCOMES: The patients recovered well and were completely free of symptoms. And the CTA follow-up showed the abnormal pulmonary parenchyma shrunk significantly. CONCLUSIONS: Endovascular treatment with thoracic endograft is a promising treatment option for PS.


Assuntos
Sequestro Broncopulmonar/terapia , Embolização Terapêutica/métodos , Adulto , Angiografia , Humanos , Masculino
2.
J Pediatr Ophthalmol Strabismus ; 56: e53-e56, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31282962

RESUMO

A 53-year-old woman presented with diplopia and deviation of the left eye for the past 3 years. She had non-resolving isolated left lateral rectus palsy. She underwent a medial rectus recession and Hummelsheim (Wright's modification) procedure in her left eye. Postoperatively, the anterior segment ischemia resolved with steroids. [J Pediatr Ophthalmol Strabismus. 2019;56:e53-e56.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Segmento Anterior do Olho/irrigação sanguínea , Isquemia/etiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Visão Binocular , Doenças do Nervo Abducente/fisiopatologia , Angiografia , Segmento Anterior do Olho/diagnóstico por imagem , Movimentos Oculares/fisiologia , Feminino , Humanos , Isquemia/diagnóstico , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças Raras
3.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(3): 359-366, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31282330

RESUMO

Objective To observe the imaging features of optical coherence tomography angiography(OCTA)in eyes with wet age-related macular degeneration(wAMD)after treatment with 3+pro re nata(3+PRN)of intravitreal anti-Ranibizumab.Methods This study included 8 treatment-naive eyes with wAMD diagnosed by fluorescein fundus angiography(FFA)and indocyanine green angiography(ICGA)from September 2016 to May 2017.All the patients were treated with 3+PRN of intravitreal anti-Ranibizumab(0.5 mg/0.05 ml).We performed OCTA with 6 mm×6 mm scans at baseline and 1,3,and 6 months after treatment.We analyzed best corrected visual acuity(BCVA)(logMAR),type of choroidal neovascular(CNV),and morphological features and changes of CNV,central retinal thickness(CRT),outer retina vessel density(ORVD),and choroidal capillary vessel density(CCVD).Results A total of 8 eyes were examined in 8 patients[4 males and 4 females with a mean age of(70.9±10.6)years of age].Three eyes had type Ⅰ CNV and 5 eyes had type Ⅱ CNV.At baseline,month 1,month 3,and month 6,BCVA was 0.55(0.33,0.87),0.35(0.24,0.84),0.35(0.22,0.58),and 0.26(0.10,0.58)logMAR,respectively(all P>0.05).CRT was(271.88±91.95),(204.00±45.78),(196.00±31.14),and(219.25±71.32)µm,respectively,and there was a statistical significance between CRT at baseline and CRT at month 3(t=2.211,P=0.044).ORVD was(41.38±2.77)%,(41.73±3.60)%,(42.53±1.95)%,and(41.40±2.33)%,respectively(all P>0.05).CCVD was(64.38±2.24)%,(64.96±1.39)%,(64.16±1.39)%,and(64.63±1.86)%,respectively(all P>0.05).Correlation analysis showed BCVA was significantly correlated with both CRT(P=0.009, RR=0.457)and CCVD(P=0.001,RR=0.574),but not with ORVD(P=0.093,RR=0.302).The morphological features at baseline showed that 2 eyes were lump-like,2 eyes were line-like,2 eyes were tangles,1 eye was elliptical ring-like,and 1 eye was fragment.At month 1,the morphologies were improved in 7 eyes,including the CNV showed decreased maximum diameter,rupture/fragment,loss of peripheral capillaries,decreased numbers and density,and reduced maximum cross-sectional area;the condition became worse in 1 eye,including the CNV showed ring formation,increased density,and increased maximum diameter.At month 3,the morphologied of 7 eyes were improved,while no obvious change was seen in 1 eye.At month 6,the CNV became normalized in 5 eyes but worsened in 3 eyes.No intraocular infection or other intravitreal injection-related complication was observed during the follow-up.Conclusion Observing CNV characteristics using OCTA technology can be used to evaluate the efficacy of Ranibizumab in patients with wAMD and guide the treatment and follow-up of wAMD patients.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Angiografia , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
4.
World J Pediatr Congenit Heart Surg ; 10(4): 464-468, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307306

RESUMO

OBJECTIVES: To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight. METHODS: Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated. RESULTS: Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications. CONCLUSIONS: Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.


Assuntos
Aorta Torácica/anormalidades , Cateterismo/métodos , Circulação Cerebrovascular/fisiologia , Recém-Nascido de Baixo Peso , Perfusão/métodos , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia , Aorta Torácica/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Resultado do Tratamento , Malformações Vasculares/fisiopatologia
5.
J Assoc Physicians India ; 67(4): 76-78, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299847

RESUMO

A 21-year old female, recently diagnosed with osteosarcoma of right humerus, presented to the emergency with history of fever, productive cough, chest pain and progressive respiratory distress for six days. Initial investigations suggested pneumonia but she did not respond to parenteral antibiotics. CT pulmonary angiogram revealed bilateral pulmonary artery embolism. Thrombolysis was performed using alteplase, which failed to improve the clinical condition. In view of underlying malignancy, a possibility of tumour-embolism was considered and she was started on chemotherapy for osteosarcoma. There was dramatic improvement in her respiratory symptoms after the first chemotherapy cycle, along with radiological resolution of the embolism. This case highlights the importance of suspecting tumour embolism in a known case of malignancy with respiratory distress.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Osteossarcoma/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Angiografia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/tratamento farmacológico , Feminino , Humanos , Osteossarcoma/complicações , Osteossarcoma/tratamento farmacológico , Pneumonia , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Adulto Jovem
6.
Braz J Cardiovasc Surg ; 34(3): 344-351, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310474

RESUMO

OBJECTIVES: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). METHODS: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. RESULTS: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. CONCLUSION: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/normas , Adolescente , Adulto , Angiografia/métodos , Insuficiência da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Ecocardiografia/métodos , Desenho de Equipamento , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Rev Med Chil ; 147(4): 426-436, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344203

RESUMO

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). AIM: To report the initial experience with the "refined BPA technique" with the use of intravascular images. PATIENTS AND METHODS: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. RESULTS: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm-5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). CONCLUSIONS: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Adulto , Idoso , Angiografia/métodos , Doença Crônica , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Reprodutibilidade dos Testes , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
9.
No Shinkei Geka ; 47(7): 799-804, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358700

RESUMO

A 55-year-old man presented with progressive pain and expanding swelling in his right neck. He had no history of trauma or infectious disease. The patient had undergone chiropractic manipulations once in a month and the last manipulation was done one day before the admission to our hospital. On examination by laryngeal endoscopy, a swelling was found on the posterior wall of the pharynx on the right side. The right piriform fossa was invisible. CT revealed hematoma in the posterior wall of the right oropharynx compressing the airway tract. Aneurysm-like enhanced lesion was also seen near the right common carotid artery. Ultrasound imaging revealed a fistula of approximately 1.2 mm at the posterior wall of the external carotid artery and inflow image of blood to the aneurysm of a diameter of approximately 12 mm. No dissection or stenosis of the artery was found. Jet inflow of blood into the aneurysm was confirmed by angiography. T1-weighted MR imaging revealed presence of hematoma on the posterior wall of the pharynx and the aneurysm was recognized by gadolinium-enhancement. We performed emergency surgery to remove the aneurysm while preserving the patency of the external carotid artery. The pin-hole fistula was sutured and the wall of the aneurysm was removed. Histopathological assessment of the rissue revealed pseudoaneurysm. The patient was discharged after 12 days without deficit. Progressively growing aneurysm of the external carotid artery is caused by various factors and early intervention is recommended. Although, currently, intravascular surgery is commonly indicated, direct surgery is also feasible and has advantages with regard to pathological diagnosis and complete repair of the parent artery.


Assuntos
Falso Aneurisma , Doenças das Artérias Carótidas , Manipulação Quiroprática , Falso Aneurisma/etiologia , Angiografia , Doenças das Artérias Carótidas/etiologia , Artéria Carótida Externa , Artéria Carótida Interna , Humanos , Masculino , Manipulação Quiroprática/efeitos adversos , Pessoa de Meia-Idade
10.
Br J Radiol ; 92(1102): 20190127, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317769

RESUMO

OBJECTIVE: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. METHODS: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. RESULTS: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. CONCLUSION: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. ADVANCES IN KNOWLEDGE: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.


Assuntos
Oclusão com Balão , Cesárea/métodos , Circulação Colateral , Artéria Ilíaca , Ovário/irrigação sanguínea , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Operatória/etiologia , Adulto , Angiografia , Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Artérias/diagnóstico por imagem , Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Histerectomia , Artéria Ilíaca/diagnóstico por imagem , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Hemorragia Pós-Operatória/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores de Risco , Ligamento Redondo do Útero/irrigação sanguínea , Ultrassonografia , Útero/irrigação sanguínea
11.
Khirurgiia (Mosk) ; (5): 68-70, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169822

RESUMO

The patient 58-year-old with nodular goiter grade 2 was hospitalized to the surgical clinic. Thyroidectomy was performed. Postoperative period was complicated by hiccups and pulsation in the right half of the neck. According to angiography and CT data, there were a hematoma within thyroid bed and arteriovenous fistula between superior thyroid artery and right facial vein. Surgical repair of the fistula and false aneurysm drainage were carried out. This case report demonstrates a rare complication of thyroidectomy - arteriovenous fistula between superior thyroid artery and facial vein followed by pulsatile false aneurysm.


Assuntos
Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Bócio Nodular/cirurgia , Tireoidectomia/efeitos adversos , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Angiografia , Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/etiologia , Face/irrigação sanguínea , Humanos , Pessoa de Meia-Idade , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia
12.
No Shinkei Geka ; 47(6): 653-658, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31235668

RESUMO

Extracranial carotid artery aneurysms are relatively rare. We present a case involving a giant aneurysm arising from the extracranial carotid artery. The patient was a 79-year-old woman. She had a pulsating mass in the right side of her neck. However, she was neurologically intact. Contrast-enhanced CT scans of the neck showed an enhanced mass lesion with a thrombus in the right side of her neck. Angiography revealed a saccular aneurysm 3.4 cm in size near the bifurcation site of the right common carotid artery into the external carotid artery. She underwent an urgent resection of the aneurysm and a carotid artery reconstruction. Postoperatively, she recovered well and the total resection of the lesion was angiographically confirmed. Histopathological examination revealed that the wall of the aneurysm had undergone fibrosis and contained a few elastic fibers and microhemorrhages. The wall of the aneurysm was also infiltrated by inflammatory cells. The surgical strategy for and appropriate preoperative evaluation of this rare disease was discussed.


Assuntos
Doenças das Artérias Carótidas , Aneurisma Intracraniano , Idoso , Angiografia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Procedimentos Cirúrgicos Vasculares
14.
World J Emerg Surg ; 14: 28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210779

RESUMO

Introduction: While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. Methods: From January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival. Results: Eighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015). Conclusion: In pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.


Assuntos
Embolização Terapêutica/métodos , Fraturas Ósseas/tratamento farmacológico , Hemostasia/efeitos dos fármacos , Adulto , Idoso , Angiografia/métodos , Distribuição de Qui-Quadrado , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/mortalidade , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Taiwan
16.
Tech Vasc Interv Radiol ; 22(2): 93-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079717

RESUMO

Radioembolization with Yttrium-90 (Y90) has been proven safe and effective for the treatment of primary and secondary hepatic malignancies. Standard protocols have necessitated planning angiography with Technetium-99m macroaggregated albumin (Tc99m MAA) administration/scan typically 1-2 weeks prior to the radioembolization therapy. The intent of this practice is to ensure appropriate patient selection and treatment candidacy while also confirming best dosimetry approaches. At our center, we started performing "same-day Y90" in 2008; in a subset of international patients with travel hardship, we performed the planning and treatment procedures consecutively on the same day. In this article, we reveal our practical approach to treating patients on the same day as planning angiography. With more than 160 same-day procedures completed between 2008 and 2017, the safety and efficacy of such a paradigm has been established at our center. This approach is appealing to patients, their families, and referring physicians. Appropriate patient selection and proper preprocedure planning based on baseline imaging are key elements in successful same-day radioembolization treatments.


Assuntos
Assistência Ambulatorial/métodos , Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radioisótopos de Ítrio/uso terapêutico , Idoso , Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Imagem Tridimensional , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Microesferas , Seleção de Pacientes , Compostos Radiofarmacêuticos/administração & dosagem , Dosagem Radioterapêutica , Agregado de Albumina Marcado com Tecnécio Tc 99m/administração & dosagem , Resultado do Tratamento
18.
Int Heart J ; 60(3): 521-526, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105145

RESUMO

Prior research has revealed poorer clinical outcomes after drug-eluting stent (DES) implantation for hemodialysis patients. This study aims to investigate the long-term clinical and angiographic outcomes after new-generation DES implantation for hemodialysis patients.We retrospectively enrolled 91 consecutive patients (118 lesions) who underwent successful new-generation DES (everolimus-, zotarolimus-, and biolimus-eluting stents) implantation for the first time. We measured the serum calcium and phosphorus levels in the blood samples obtained just before hemodialysis. The follow-up period of clinical events was, at least, 1.5 years. In this study, major adverse cardiac and cerebrovascular events (MACCE) and clinically driven target lesion revascularization were reported in 36 (39.6%) and 11 (12.1%) patients, respectively. The prevalence of peripheral artery disease was significantly higher in the MACCE group (41.7% versus 14.5%, P = 0.006). The serum calcium level was significantly higher in the MACCE group (9.34 ± 0.92 mg/dL versus 8.77 ± 0.88 mg/dL; P = 0.004). The multivariate Cox proportional hazards model revealed that the serum calcium level (hazard ratio, 1.86; 95% confidence interval [CI]: 1.26-2.77; P = 0.002), suboptimal (over 55 mg2/dL2) calcium-phosphorus product (hazard ratio, 3.27; 95% CI: 1.41-7.61; P = 0.006) and the coexistence of peripheral artery disease (hazard ratio, 3.15; 95% CI: 1.49-6.65; P = 0.003) were independent predictors of MACCE.For hemodialysis patients, MACCE remains a frequent occurrence after new-generation DES implantation and is associated with calcium-phosphate metabolism and peripheral artery disease.


Assuntos
Angiografia/métodos , Cálcio/sangue , Stents Farmacológicos/efeitos adversos , Doença Arterial Periférica/epidemiologia , Fósforo/sangue , Diálise Renal/instrumentação , Idoso , Everolimo/administração & dosagem , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/etiologia , Prevalência , Estudos Retrospectivos , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados
19.
No Shinkei Geka ; 47(5): 565-572, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31105081

RESUMO

We report an extremely rare case of a fenestration in the infracallosal(A2)segment of the right anterior cerebral artery(ACA)associated with an unruptured aneurysm at the proximal end of the fenestrated portion. A 70-year-old man was referred to our hospital for further examination and treatment of unruptured aneurysms at the A1/A2 junction of the right ACA and the distal end of the right vertebral artery that were incidentally detected on MR angiography. CT angiography and 3D-rotational angiography revealed a fenestration in the proximal A2 segment of the right ACA with a small(3.6×3.8mm)aneurysm arising from the proximal end of the fenestration. The dome of the aneurysm projected to the left anterior/inferior direction. He underwent aneurysm neck clipping surgery via the right pterional approach without complications, while the vertebral artery aneurysm was managed conservatively. An extensive review of the literature revealed that only a small number of cases of A2 fenestration have been reported to date. To our knowledge, this is the first report of an A2 fenestration associated with an aneurysm at the fenestrated segment. Embryologically, the A2 fenestration may represent a remnant of plexiform arterial channels that constitute the primitive ACA system including the primitive olfactory artery, median artery of the corpus callosum and anterior communicating plexus.


Assuntos
Artéria Cerebral Anterior , Aneurisma Intracraniano , Idoso , Angiografia , Artéria Cerebral Anterior/diagnóstico por imagem , Artérias , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino
20.
Zhonghua Yan Ke Za Zhi ; 55(5): 392-396, 2019 May 11.
Artigo em Chinês | MEDLINE | ID: mdl-31137152

RESUMO

Optical coherence tomography angiography (OCTA) can reflect the vascular morphological changes of various types of uveitis, including flow void, hypoperfusion, capillary abnormalities, capillary network disorders and choroidal neovascularization. Moreover, OCTA is featured of particular quantification functions, such as measurement of the areas of foveal avascular zone, choroidal neovascularization, vascular density and flow index. Despite certain limitations, its characteristics of non-invasiveness and capabilities of depicting vascular details are helpful to the observation and follow-up of uveitis. As current interpretation of the OCTA images for uveitis is not thorough enough, hence further analysis of the images is needed to improve its application on uveitis. (Chin J Ophthalmol, 2019, 55: 392-396).


Assuntos
Angiografia , Angiofluoresceinografia , Tomografia de Coerência Óptica , Uveíte/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico por imagem , Humanos , Microvasos/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem
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