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1.
Medicine (Baltimore) ; 98(39): e17286, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574847

RESUMO

BACKGROUND: This study aims to systematically investigate the impact of ultrasound angiography (UA) combined with fine needle aspiration (FNA) for the diagnosis of thyroid nodules (TNs). METHODS: The following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search them from their inceptions to the present without language limitations. We will consider all case-controlled studies on investigating the impact of diagnosis UA combined FNA for TNs. We will apply Quality Assessment of Diagnostic Accuracy Studies tool to assess methodological quality for all eligible studies. RESULTS: In this study, outcomes consist of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. All these outcomes will be analyzed to evaluate the diagnostic accuracy of UA combined with FNA for TNs. CONCLUSION: This study will provide evidence of the diagnostic accuracy of UA combined with FNA for TNs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138884.


Assuntos
Angiografia/estatística & dados numéricos , Biópsia por Agulha Fina/estatística & dados numéricos , Biópsia Guiada por Imagem/estatística & dados numéricos , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/estatística & dados numéricos , Angiografia/métodos , Biópsia por Agulha Fina/métodos , Estudos de Casos e Controles , Humanos , Biópsia Guiada por Imagem/métodos , Razão de Chances , Projetos de Pesquisa , Sensibilidade e Especificidade , Revisão Sistemática como Assunto , Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos
2.
Undersea Hyperb Med ; 46(4): 461-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509902

RESUMO

Introduction: Mastectomy skin flap necrosis represents a significant complication of breast reconstructive procedures and is reported to occur in 30%-52% of patients undergoing breast reconstruction. Early identification of ischemia and early initiation of hyperbaric oxygen (HBO2) therapy can mitigate the effects of ischemia and rescue otherwise non-viable breast flap tissue. Methods: We retrospectively examined the outcomes of HBO2 therapy in eight breasts with compromised mastectomy skin flaps between September 2015 and January 2017. Indocyanine green angiography (ICGA) was used to assess perfusion intraoperatively and post-HBO2 administration. Results: Seven patients were referred for HBO2 within 24 hours of mastectomy. One patient failed to improve despite starting hyperbaric treatment within 24 hours. All other patients manifested successful healing of their mastectomy skin flaps with acceptable cosmesis after 10 HBO2 treatments. The mean relative perfusion of the at-risk area was 13.8% (±3.7%) pre-HBO2 and 101.6% (±37.3%) post-HBO2. The average area at-risk pre-HBO2 was 17.1 cm2 and reduced to zero post-HBO2. Relative perfusion values after HBO2 were found to be 6.8 (±3.4) times greater than those measured prior to HBO2. Conclusions: A short course of HBO2 may be sufficient to successfully rescue at risk post-mastectomy breast flaps. ICGA is a useful adjunct for evaluating post-mastectomy breast flap perfusion before and after HBO2 therapy.


Assuntos
Oxigenação Hiperbárica , Isquemia/terapia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/terapia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Angiografia/métodos , Neoplasias da Mama/cirurgia , Corantes , Feminino , Humanos , Verde de Indocianina , Isquemia/etiologia , Mastectomia , Pessoa de Meia-Idade , Necrose/terapia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Terapia de Salvação/métodos , Retalhos Cirúrgicos/patologia , Cicatrização
3.
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
4.
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
5.
Int Braz J Urol ; 45(5): 925-931, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268637

RESUMO

OBJECTIVE: To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA. MATERIALS AND METHODS: We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered. RESULTS: Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identifi ed with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases. On doppler evaluation, mean blood fl ow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a signifi cant difference between between preintervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a signifi cant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%. CONCLUSIONS: Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.


Assuntos
Angioplastia/métodos , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/cirurgia , Adolescente , Adulto , Idoso , Análise de Variância , Angiografia/métodos , Pressão Sanguínea/fisiologia , Criança , Creatinina/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 291-296, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1023081

RESUMO

Avaliar a eficácia diagnóstica da angiotomografia coronariana (AC) comparada com a cineangiocoronariografia (CAT). Material e Métodos: Foram avaliados retrospectivamente 146 pacientes submetidos a AC e CAT com angiografia coronariana quantitativa (ACQ), com intervalo médio de um mês entre os exames. O estudo foi realizado no Hospital Cardiológico Costantini. Foram avaliados os fatores de risco da amostra, a localização das lesões e o grau de severidade da obstrução coronariana nos grandes vasos (TCE, DA, CX e CD). Os resultados dos métodos diagnósticos foram comparados pelo coeficiente de correlação de Pearson. A partir dos achados positivos foi realizada a avaliação de correlação entre os métodos perante a severidade das lesões. Resultados: A amostra foi composta predominantemente por homens (73,97%), sendo a hipertensão arterial (HAS) (71,91%) o fator de risco mais frequente. A artéria mais acometida foi a DA. Quanto ao grau de severidade das lesões, os resultados foram os seguintes na comparação entre AC e CAT: lesões discretas com correlação r = 0,23; moderadas com r = 0,53 e severas com r = 0,70. Na comparação entre AC e ACQ: lesões discretas com correlação r = 0,45; moderadas com r = 0,70 e severas com r = 0,67. Conclusão: A AC apresentou moderada com ACQ e CAT em lesões moderadas e severas, e forte correlação na ausência de lesões quando comparada com ACQ


To evaluate the diagnostic efficacy of multislice CT coronary angiotomography compared with coronary cineangiography. Material and Methods: We retrospectively evaluated 146 patients submitted to MSCT and CA with quantitative coronary angiography (QCA), with a mean interval of one month between the exams. The study was carried out at the Costantini Cardiology Hospital. The risk factors for the sample, the location of the lesions and the degree of severity of the coronary obstruction in the large vessels (LCT, AD, CX and RC).The results of the diagnostic methods were compared using Pearson correlation coefficient. From the positive findings, a correlation evaluation was performed between the methods for the severity of the lesions. Results: The sample consisted predominantly of men (73.97%), and hypertension (SAH) (71.91%) was the most frequent risk factor. The most affected artery was AD. Regarding the degree of severity of the lesions, the results were as follows in the comparison between MSCT and CA: mild lesions with correlation r = 0.23, moderate with r = 0.53 and severe with r = 0.70. In the comparison between MSCT and QCA: mild lesions with correlation r = 0.45, moderate with r = 0.70 and severe with r = 0.67. Conclusion: MSCT showed moderate correlation with QCA and CA in moderate and severe lesions, and a strong correlation in the absence of lesions when compared with QCA


Assuntos
Humanos , Masculino , Feminino , Doença da Artéria Coronariana/diagnóstico por imagem , Angiografia/métodos , Angiografia Digital/métodos , Angiografia Coronária/métodos , Diagnóstico por Imagem/métodos , Doenças Cardiovasculares/mortalidade , Estudos Retrospectivos , Fatores de Risco , Angiografia por Ressonância Magnética/métodos , Angiografia por Tomografia Computadorizada/métodos , Hipertensão
7.
Pediatr Cardiol ; 40(6): 1199-1207, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31218373

RESUMO

Right to left (R-L) shunts resulting in cyanosis or systemic embolization occur after the Fontan procedure. The primary modality of diagnosing these is angiography. Successful delineation of these shunts in Fontan patients using selective saline contrast transesophageal echocardiography (SCTEE) may allow for reduced radiation and contrast exposure. We hypothesized that SCTEE could accurately determine the presence, type, and semiquantitative shunt size of R-L shunts in Fontan patients. SCTEE was performed in Fontan patients undergoing angiography for clinical indications. Injections were performed in six sites: mid-Fontan, right and left pulmonary arteries, superior and inferior vena cavae, and innominate vein. R-L shunt size was subjectively graded as 0 = absent, 1 = small, and 2 = medium or large based on echo contrast density in the left atrium. SCTEE was compared to angiography. 33 patients with Fontan were studied with median age 15 years, median weight 50.1 kg, and median O2 saturation of 90% in the R-L shunt group and 95% in the no R-L shunt group. R-L shunt types included intracardiac shunts (ICS), veno-venous collaterals (VVCs), arteriovenous malformations (AVMs), and their combinations. SCTEE versus angiography results were the same for the presence, type, and size of R-L shunts in 79% (26/33). SCTEE identified shunts in 88% (29/33). Angiography identified shunts in 85% (28/33). Neither method missed any medium or large R-L shunts. SCTEE and angiography had similar accuracy. SCTEE accurately detected the presence, type, and size of R-L shunts in most Fontan patients in this study. This can be used to guide targeted angiography, reducing radiation exposure and contrast load.


Assuntos
Angiografia/métodos , Ecocardiografia Transesofagiana/métodos , Técnica de Fontan/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Cianose/etiologia , Embolização Terapêutica , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Adulto Jovem
8.
J Bras Pneumol ; 45(4): e20180137, 2019 Jun 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31241656

RESUMO

OBJECTIVE: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. METHODS: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). RESULTS: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. CONCLUSIONS: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Adulto , Idoso , Angiografia/métodos , Malformações Arteriovenosas/etiologia , Cateterismo/métodos , Angiografia por Tomografia Computadorizada , Ecocardiografia , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/métodos , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Telangiectasia Hemorrágica Hereditária/complicações , Resultado do Tratamento , Adulto Jovem
9.
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
10.
Med. clín (Ed. impr.) ; 152(12): 495-501, jun. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183321

RESUMO

Las técnicas de imagen se han convertido en una herramienta esencial en la valoración de los pacientes con arteritis de células gigantes. La detección del compromiso del territorio craneal con la ecografía Doppler tiene una utilidad diagnóstica indudable. La afectación de la aorta y sus ramas detectada mediante la tomografía por emisión de positrones, la tomografía computarizada con angiografía o la resonancia magnética con angiografía puede ayudar también en el diagnóstico y en la valoración de la actividad de la enfermedad y la respuesta al tratamiento, pero es necesaria la estandarización y validación de su uso. El desarrollo de daño vascular aórtico puede influir en la supervivencia de los pacientes con arteritis de células gigantes por lo que se recomienda su cribado periódico


Imaging has become an essential tool in the management of patients with giant cell arteritis. Cranial involvement detected by Doppler ultrasonography is an unquestionable diagnostic finding. Imaging of the aorta and its branches with positron emission tomography, computed tomography angiography or magnetic resonance imaging may also have a role in diagnosis and in the assessment of disease activity and response to treatment, but standardisation and validation are still needed before their widespread use as an outcome measure. Aortic structural damage is associated with increased mortality in giant cell arteritis; therefore, periodic screening is recommended


Assuntos
Humanos , Arterite de Células Gigantes/diagnóstico por imagem , Angiografia/métodos , Aneurisma Aórtico/diagnóstico por imagem , Angiografia/instrumentação , Inflamação/diagnóstico por imagem , Ultrassonografia Doppler em Cores/instrumentação , Ultrassonografia Doppler em Cores/métodos
11.
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
12.
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
14.
J Nippon Med Sch ; 86(2): 131-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130565

RESUMO

Obstructive colitis (OC) is a nonspecific inflammatory condition that occurs at the proximal side of a completely or partially stenotic lesion typically caused by colorectal cancer. Impaired blood flow caused by these stenotic changes in the colon or rectum results in this condition. During surgery for sigmoid colon carcinoma with OC, complete surgical removal of the OC lesions is required. However, it is difficult to anticipate the range of OC before surgery. Diagnosing the potential ischemia during surgery would decrease the need for re-operation. This is the first report of HyperEye Medical System (HEMS) angiography for surgery of colon cancer with OC. We report a case of sigmoid colon carcinoma in which HEMS angiography was used and found to be useful for real-time detection of the OC lesion.


Assuntos
Angiografia/métodos , Colite/diagnóstico por imagem , Colite/cirurgia , Colo/irrigação sanguínea , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Isquemia/diagnóstico , Margens de Excisão , Reto/irrigação sanguínea , Neoplasias do Colo Sigmoide/irrigação sanguínea , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Colite/etiologia , Colite/fisiopatologia , Humanos , Verde de Indocianina , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Período Intraoperatório , Masculino , Neoplasias do Colo Sigmoide/complicações , Neoplasias do Colo Sigmoide/diagnóstico por imagem
15.
BMC Surg ; 19(1): 50, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101073

RESUMO

BACKGROUND: A pancreaticoduodenal artery aneurysm (PDAA) occurring in close association with median arcuate ligament syndrome (MALS) is rare. A surgical procedure, such as median arcuate ligament (MAL) release, should be considered in such cases, but the operative criteria remain unknown. In this study, we reported an extremely rare case of PDAA with periarteritis nodosa (PAN) and MALS. CASE PRESENTATION: A 60-year-old man was transferred to our department with sudden onset of abdominal pain. We initially diagnosed his condition as a PDAA rupture with MALS based on enhanced computed tomography (CT). We promptly performed transcatheter arterial embolization (TAE) of PDAA, and the angiogram showed stagnant contrast agent in the celiac trunk, indicating total celiac artery occlusion. Follow-up enhanced CT three weeks after the first TAE clearly demonstrated newly formed, multiple aneurysms in the pancreaticoduodenal arcade and the hepatic artery. These findings indicated a systemic disorder, such as PAN or segmental arterial mediolysis, as the underlying cause. Therefore, we started corticosteroid therapy and performed diagnostic angiography to clarify the celiac artery's patency. Contrary to the initial angiography, the second angiography showed sustained blood flow in the celiac artery. Nevertheless, we performed both extrinsic MAL release and consecutive TAE because of the risk of multiple aneurysms rupturing due to an uncontrolled systemic disorder and consequent hepatic ischemia. The patient had no episode of recurrence until one year of follow-up. CONCLUSIONS: It is important to evaluate risk for hemodynamically unstable events to decide the best treatment strategy for MALS.


Assuntos
Dor Abdominal/etiologia , Embolização Terapêutica/métodos , Síndrome do Ligamento Arqueado Mediano/cirurgia , Pâncreas/cirurgia , Aneurisma Roto/terapia , Angiografia/métodos , Artéria Celíaca/cirurgia , Meios de Contraste/administração & dosagem , Hemodinâmica , Artéria Hepática/patologia , Humanos , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares/métodos
16.
BMC Musculoskelet Disord ; 20(1): 143, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947704

RESUMO

BACKGROUND: Microvascular problems like increased intraosseous pressure or venous congestion may influence the development of Kienböck's disease. We examined if wrist position modifies the blood flow in the nutrient vessels. METHODS: Retrospective analysis of 17 patients with Kienböck's disease who had a superselective microangiography of the radial, ulnar and interosseous artery in different wrist positions under general anaesthesia. We analysed the data with Fisher's exact and Wilcoxon-test. RESULTS: We found vessels that entered the bone, that ended at the bone edge, and that supplied a vascular plexus. The origins were the anterior interosseous artery in 10 of 17 cases, the radial artery in seven cases, and the ulnar artery in five cases. Movement of the wrist could reduce or stop the blood flow. Type of lunate configuration showed no significant influence on the blood supply in neutral position. CONCLUSION: The radial, ulnar, and anterior interosseous artery contribute to the vascular supply of the lunate bone in different combinations. Wrist movement can reduce blood flow to the lunate bone.


Assuntos
Angiografia/métodos , Osso Semilunar/irrigação sanguínea , Osteonecrose/patologia , Artéria Radial/diagnóstico por imagem , Artéria Ulnar/diagnóstico por imagem , Adulto , Meios de Contraste/administração & dosagem , Feminino , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Articulação do Punho/irrigação sanguínea , Articulação do Punho/diagnóstico por imagem , Adulto Jovem
17.
Prog Urol ; 29(5): 263-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30948187

RESUMO

INTRODUCTION: Prostatic arterial embolization (PAE) is an experimental therapy for benign prostatic hyperplasia. Its feasibility is based on the knowledge of the pelvic arterial anatomy, and more specifically the prostate. The aim of this study was to describe the prostatic arterial supply: origins, distribution and variability. MATERIAL AND METHODS: We reviewed retrospectively, with two radiologists, 40 arteriographies of patients who underwent PAE in our center. With these observations of 80 hemipelvics, we described the number of prostatic arteries, their origins, their distributions and eventually their anastomoses with other pelvic arteries. RESULTS: There was one prostatic artery in 70% of the cases. It came from a common trunk for the prostate and the bladder in 55% of the cases, from the obturator artery in 17.5% of the cases, from the pudendal artery in 25% of the cases, from the intern iliac artery in 1% of the cases, and from the superior gluteal artery in 1% of the cases. The prostatic artery splitted in two branches (medial and lateral), with no anastomoses in 37% of the cases. Anastomoses with penile and rectal arteries were observed in 29% of the cases. CONCLUSIONS: For our 40 patients, we observed many variations of arterial prostatic anatomy. We proposed a classification in order to increase security and efficacy of PAE, and it should be validated with more patients. LEVEL OF EVIDENCE: 2.


Assuntos
Artérias/anatomia & histologia , Artérias/patologia , Embolização Terapêutica/métodos , Próstata/anatomia & histologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Artérias/diagnóstico por imagem , Artérias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Estudos Retrospectivos
18.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015236

RESUMO

Intraorbital ophthalmic artery (OA) aneurysms are rare. They can be asymptomatic or present with visual disturbances, exophthalmos and headaches. We present a case of a 57-year-old man who presented with reduced vision, diplopia and exophthalmos. A carotid artery angiogram identified a right OA aneurysm. Due to the low risk of rupture and the patient's comorbidities including cardiac and renal impairment, a conservative approach was followed. A few weeks post presentation, the patient's vision and optic nerve function had improved. This case reiterates the importance of considering conservative treatment for patients with intraorbital OA aneurysms.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Aneurisma Intracraniano/complicações , Artéria Oftálmica/patologia , Órbita/patologia , Angiografia/métodos , Tratamento Conservador , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Órbita/irrigação sanguínea , Doenças Raras , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
19.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015249

RESUMO

We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.


Assuntos
Trombose do Corpo Cavernoso/microbiologia , Trombose do Corpo Cavernoso/cirurgia , Seio Cavernoso/microbiologia , Ventriculostomia/métodos , Administração Intravenosa , Assistência ao Convalescente , Idoso , Angiografia/métodos , Antibacterianos/uso terapêutico , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/tratamento farmacológico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Feminino , Gentamicinas/administração & dosagem , Gentamicinas/uso terapêutico , Humanos , Injeções Intraventriculares/métodos , Imagem por Ressonância Magnética/métodos , Meningite/diagnóstico por imagem , Meningite/tratamento farmacológico , Meningite/microbiologia , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Sinusite/complicações , Sinusite/cirurgia , Resultado do Tratamento
20.
J Cancer Res Ther ; 15(2): 305-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964102

RESUMO

Background: Hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) and right atrium (RA) is rare, which is generally associated with serial syndromes and poor prognosis. The results of earlier observations revealed that the median survival was 1-5 months after diagnosis for untreated patients. The prognosis was poor with surgery, radiotherapy, transarterial chemoembolization (TACE), and chemotherapy. Methods: A total of 1850 patients received TACE for advanced HCC at our institution from October 2011 to September 2016. Among them, 18 cases presented tumor thrombus extended from hepatic vein to IVC and RA. TACE was performed to deal with the tumor thrombus inside the RA, and angiography was performed for characterizing. The successful rate, survival, safety, and clinical adverse events were retrospectively studied. Results: A total of 56 interventional procedures were conducted for the 18 cases of tumor thrombus extending to IVC and RA. TACE were successfully performed in all patients without significant complications. One case died of pneumonia, and no severe adverse effect was observed in the other 17 cases. The 1- and 3-year overall survival rates were 50% and 16.7%, respectively. The average survival from diagnosis of right atrial tumor thrombus (RATT) was 15.2 months. The blood supply was rich for all RATT. There were seven cases with single-feeding artery and 11 cases with two or three feeding arteries that originated from intra- or extra-hepatic arteries. The extrahepatic artery played a critical role in the blood supply of RATT, including right inferior phrenic artery (8/18), left inferior phrenic artery (1/18), and the left gastric artery (2/18). Conclusion: For HCC with tumor thrombus in the IVC and RA, TACE could safely improve the prognosis of these patients. Searching for multiple feeding arteries are essential for ensuring efficacy. In addition, careful examination and appropriate embolization technique are essential for safety and efficacy. Lipiodol was a safe and ideal agent for the embolization in RATT.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Átrios do Coração/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Adulto , Idoso , Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/métodos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Tromboembolia/mortalidade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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