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1.
Plast Reconstr Surg ; 145(2): 407e-411e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985656

RESUMO

The utility of nitroglycerin is well established in coronary angiography but less so in other surgical fields. In this study, the authors investigated the utility of preoperative computed tomographic angiography after sublingual nitroglycerin followed by three-dimensional visualization for selecting suitable perforators in planning the free anterolateral thigh flap. The authors performed preoperative computed tomographic angiography following sublingual nitroglycerin (after screening for contraindications) in patients for whom reconstructive surgery with the free anterolateral thigh flap was planned. Data were reconstructed three-dimensionally, mapping location and course of source arteries and perforators. Suitable perforators were selected, and flap design was planned. The characteristics of perforators were analyzed statistically. Of 14 patients for whom surgery was planned, two had contraindications to nitroglycerin and underwent computed tomographic angiography alone. Nitroglycerin allowed for the visualization of more peripheral branches. The Hounsfield units at the deep fascia of perforators selected for surgery were significantly higher than for those not selected (p = 0.003). The distance from the intermuscular septum to the selected perforators was significantly shorter than the distance to nonselected perforators (p = 0.017). There were no adverse events, and all flaps survived. Sublingual nitroglycerin before computed tomographic angiography was safe and increased the visibility of perforators, enabling preoperative planning of flap design based on the three-dimensionally-reconstructed image. The authors highly recommend this procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, IV.


Assuntos
Angiografia/instrumentação , Artérias/diagnóstico por imagem , Nitroglicerina/administração & dosagem , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Coxa da Perna/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Angiografia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino
2.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 29(2): 104459, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839548

RESUMO

A 51-year-old Japanese woman was admitted to our hospital because of speech difficulty following severe headache. Neurological examination showed dysarthria and tongue weakness on the right side, indicating right hypoglossal nerve palsy. Needle electromyography of the right side of the tongue showed fibrillation potentials. Magnetic resonance angiography and computed tomography angiography revealed a right, persistent, primitive hypoglossal artery (PPHA) that met Lie's diagnostic criteria. Digital subtraction angiography showed an extended PPHA with irregular caliber in the portion running through the right hypoglossal canal. We diagnosed compression neuropathy of the hypoglossal nerve due to PPHA enlargement based on the findings of ipsilateral hypoglossal nerve palsy, fibrillation that indicated peripheral nerve palsy, and the enlarged diameter of the portion of the PPHA running through the right hypoglossal canal. We prescribed antihypertensive therapy. At 1 year after onset, her tongue weakness was alleviated. Clinicians should consider compression neuropathy due to a PPHA as one of the possibilities in the differential diagnosis of hypoglossal nerve palsy.


Assuntos
Artérias/anormalidades , Doenças do Nervo Hipoglosso/etiologia , Nervo Hipoglosso/fisiopatologia , Síndromes de Compressão Nervosa/etiologia , Língua/irrigação sanguínea , Língua/inervação , Malformações Vasculares/complicações , Anti-Hipertensivos/uso terapêutico , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Feminino , Humanos , Doenças do Nervo Hipoglosso/diagnóstico , Doenças do Nervo Hipoglosso/fisiopatologia , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/tratamento farmacológico , Malformações Vasculares/fisiopatologia
4.
Ann Vasc Surg ; 62: 106-113, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394233

RESUMO

BACKGROUND: Current algorithms for the management of blunt lower extremity trauma recommend additional imaging in patients presenting with soft signs of vascular injury and an ankle-brachial index (ABI) less than 0.9. The aim of this study is to analyze lower extremity computed tomography angiographies (CTAs) to determine the incidence and characteristics of patients sustaining vascular injury from blunt lower extremity trauma. We hypothesized that a lower ABI threshold can avoid unnecessary imaging without missing clinically significant vascular injury. METHODS: A single-center, retrospective review of all consecutive patients who presented to a level 1 trauma center with blunt lower extremity trauma and underwent a CTA from January 2015 to December 2017 was conducted. Baseline demographics, clinical features, and outcomes were recorded. Patients without documented ABIs were excluded. A receiver operating characteristic curve was used to define the ABI threshold. RESULTS: One hundred twenty-five patients (133 injured limbs) met inclusion criteria. The mean age was 44 years (range 9-96), and 74% of the patients were male. A vascular abnormality was identified on CTA in 65 limbs (48.9%), of which only 8 (12%) required intervention. The ABIs in these 8 injured limbs were between 0 and 0.6. An ABI threshold of 0.6 maximized the balance between sensitivity (100%) and specificity (87%) and missed no injuries requiring revascularization. CONCLUSIONS: The ABI remains useful in evaluating blunt lower extremity trauma. A lower ABI threshold in patients presenting with soft signs of vascular injury after blunt trauma may avoid unnecessary imaging without missing vascular injuries requiring intervention. Further prospective studies are needed to validate the safety and effectiveness of a lower ABI threshold.


Assuntos
Índice Tornozelo-Braço , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Extremidade Inferior/irrigação sanguínea , Procedimentos Desnecessários , Lesões do Sistema Vascular/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/fisiopatologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia , Washington , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/terapia , Adulto Jovem
5.
Int. j. morphol ; 37(4): 1456-1462, Dec. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1040153

RESUMO

La colecistectomía laparoscópica es el tratamiento indicado en la colelitiasis, sin embargo el procedimiento no está exento de complicaciones o morbilidad concomitante. Es posible que, debido a lesiones ductales colaterales, ocurra sangrado con posibilidad de conversión de la cirugía e indeseables resultados. Para un correcto abordaje de la región se hace fundamental la identificación del trígono cistohepático (TCH) y sus componentes, a su vez de la ligadura y sección de la arteria cística (AC). Conociendo la elevada variabilidad de la AC, el objetivo de este trabajo consistió en identificar el número, origen, trayecto y relación de la AC con el TCH y sus variaciones, utilizando angiotomografía por medio de un tomógrafo detector de 64 cortes, en el preoperatorio de 30 pacientes de sexo femenino, entre 24 y 54 años de edad, con colelitiasis diagnosticadas clínicamente y por ecosonografía. La AC en el 76,67 % era única y se encontraba dentro del TCH, en el 16,67 % era única y se observó fuera del TCH. En el 6,67 % se observaron dos AC, una dentro y otra fuera del TCH. En el 66,67 % de los casos la AC se originaba de manera normal de la arteria hepática derecha. La trazabilidad de la AC fue en el 53,3 % medianamente visible y en el 46,7 % de trazabilidad excelente. En conclusión, la identificación de la AC y sus variaciones anatómicas se puede determinar en el preoperatorio y puede ser útil para mejorar el plan quirúrgico en pacientes con colelitiasis, brindando información al procedimiento, optimizarlo y disminuir los riesgos de eventuales complicaciones relacionados con sangrado.


Laparoscopic cholecystectomy is the treatment indicated for cholelithiasis, however the procedure is not free of complications or concomitant morbidity. It is possible that, due to collateral ductal lesions, bleeding occurs with the possibility of surgery conversion and undesirable results. For a correct approach to the region it is essential to identify the cystohepatic trigone (CHT) and its components, as well as the ligation and section of the cystic artery (AC). Knowing the high variability of CA, the aim of this work was to identify the number, origin, path and relationship of CA with the CHT and its variations using angiotomography by means of a 64-slice detector tomograph in the preoperative period of 30 female patients, between 24 and 54 years old, with clinically diagnosed cholelithiasis and by echo sonography. The AC in 76.67 % was unique and was within the CHT, in 16.67 % it was unique and was observed outside the CHT. In 6.67 %, two ACs were observed, one inside and one outside the TCH. In 66.67 % of cases, CA originated normally from the right hepatic artery. The traceability of AC was 53.3 % moderately visible and 46.7 % excellent traceability. In conclusion, the identification of AC and its anatomical variations can be determined in the preoperative period and can be useful to improve the surgical plan in patients with cholelithiasis, providing information on the procedure, optimizing it and reducing the risks of possible bleeding related complications.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Artérias/anormalidades , Artérias/diagnóstico por imagem , Colecistectomia Laparoscópica/métodos , Angiografia por Tomografia Computadorizada , Cuidados Pré-Operatórios/métodos , Colelitíase/cirurgia , Variação Anatômica , Artéria Hepática/anormalidades , Artéria Hepática/diagnóstico por imagem
6.
Georgian Med News ; (294): 7-10, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687940

RESUMO

Today, the issues of surgical tactics remain unresolved, namely, the choice of volume and area of ​​primary reconstruction with occlusion-stenotic lesions of extracranial arteries and aorto-iliac-femoral segment in conditions of high risk of reperfusion-reoxygenative syndrome. The aim of the study - To improve the results of surgical treatment of combined occlusion-stenotic lesions of extracranial arteries and the aorto-iliac-femoral segment in conditions of high risk of development of reperfusion-reoxygenative complications. The study included 58 patients with combined atherosclerotic lesions of extracranial arteries and aorto-iliac-femoral zone. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disorders, ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. The proposed set of measures to prevent the development of reperfusion-reoxygenative complications was introduced to the system of preoperative preparation. The decision of the order of restorative operations on the brachiocephalic arteries and the aorto-iliac-femoral segment was based on the analysis of the localization of the occlusive process in both arterial basins, their hemodynamic characteristics, the degree of ischemia and the tolerance of the brain to ischemia. Due to the spread occlusion-stenotic lesion of extracranial arteries in combination with the stenotic process of the contralateral ICA in the stage of relative compensation of cerebral bloodflow in 7 patients, primarily the surgical intervention on the vessels of the neck was performed. Four to six days after the first surgical intervention, the revascularization of aorta/iliac-femoral segment was performed. In 51 patients, one-time surgical intervention was performed on extracranial arteries and aorto-iliac-femoral basin. Analyzing the results of revascularization operations, it can be argued that a differentiated approach to choosing the tactics of surgical treatment of multifocal atherosclerotic lesions of arterial basins should be used. The revascularization of both arterial basins should be carried out in stages: a reconstructive operation on the extracranial arteries is performed initially, and 4 to 6 days after the first surgical intervention, the aorta/iliac-femoral arterial zone revascularization or revascularization of both arterial basins simultaneously.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Artérias/diagnóstico por imagem , Ultrassonografia Doppler Dupla/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Angiografia Digital , Aorta Abdominal/patologia , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão/prevenção & controle
7.
J Med Vasc ; 44(6): 422-425, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761308

RESUMO

Pseudoaneurysms of the gluteal arteries are rare, often secondary to blunt or penetrating pelvic trauma. These pseudoaneurysms are initially asymptomatic and manifest after a variable delay ranging from a few weeks to many years after the initial trauma. The spontaneous outcome can be fatal in case of rupture. Previously, treatment of gluteal pseudoaneurysms was exclusively surgical, but the advent of endovascular techniques revolutionized management practices by decreasing perioperative morbidity and offering results comparable to those of surgery. We report the case of a patient admitted for emergency management of a ruptured post-traumatic pseudoaneurysm of the superior gluteal artery that had occurred 20 days after penetrating buttock trauma. Selective embolization was successful.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Roto/cirurgia , Artérias/cirurgia , Nádegas/irrigação sanguínea , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adulto , Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Artérias/diagnóstico por imagem , Artérias/lesões , Emergências , Humanos , Masculino , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem
9.
Clin Nucl Med ; 44(11): 889-891, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584493

RESUMO

A 59-year-old man presented with fever and lower extremity myalgia. Laboratory studies revealed elevated C-reactive protein. F-FDG PET/CT demonstrated FDG uptake not only in the brachial arteries, femoral arteries, and their main ramifications, which were equivalent to small- to medium-sized arteries but also in the kidneys. Angiography revealed a renal aneurysm, confirming the diagnosis of polyarteritis nodosa. The increased FDG uptake in the vessels and kidneys resolved after 6 months of glucocorticoid treatment.


Assuntos
Artérias/metabolismo , Fluordesoxiglucose F18/metabolismo , Rim/metabolismo , Poliarterite Nodosa/metabolismo , Angiografia , Artérias/diagnóstico por imagem , Transporte Biológico , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
10.
Vasc Health Risk Manag ; 15: 317-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31616151

RESUMO

One of the challenges of thromboangiitis obliterans (TAO) management is in the patients whose other vascular beds are involved and it remains a challenge to know whether to pursue invasive procedures or to continue medical treatment for such TAO patients. The aim of this review was to investigate reports of the involvement of the visceral vessels in TAO and the related clinical manifestations, management approaches and outcomes. According to our systematic review, the frequency of published articles, the organs most commonly involved were the gastrointestinal tract, the heart, the central nervous system, the eye, the kidneys, the urogenital system, the mucocutaneous zones, joints, lymphohematopoietic system and the ear. Notably, reports of the involvement of almost all organs have been made in relation to TAO. There were several reports of TAO presentation in other organs before disease diagnosis, in which the involvement of the extremities presented after visceral involvement. The characteristics of the visceral arteries looked like the arteries of the extremities according to angiography or aortography. Also, in autopsies of TAO patients, the vascular involvement of multiple organs has been noted. Moreover, systemic medical treatment could lead to the recovery of the patient from the onset of visceral TAO. This study reveals that TAO may be a systemic disease and patients should be aware of the possible involvement of other organs along with the attendant warning signs. Also, early systemic medical treatment of such patients may lead to better outcomes and reduce the overall mortality rate.


Assuntos
Artérias , Tromboangiite Obliterante/terapia , Vísceras/irrigação sanguínea , Adulto , Artérias/diagnóstico por imagem , Artérias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/mortalidade , Tromboangiite Obliterante/patologia , Adulto Jovem
11.
Biomed Eng Online ; 18(1): 95, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511011

RESUMO

BACKGROUND: Improving imaging quality is a fundamental problem in ultrasound contrast agent imaging (UCAI) research. Plane wave imaging (PWI) has been deemed as a potential method for UCAI due to its' high frame rate and low mechanical index. High frame rate can improve the temporal resolution of UCAI. Meanwhile, low mechanical index is essential to UCAI since microbubbles can be easily broken under high mechanical index conditions. However, the clinical practice of ultrasound contrast agent plane wave imaging (UCPWI) is still limited by poor imaging quality for lack of transmit focus. The purpose of this study was to propose and validate a new post-processing method that combined with deep learning to improve the imaging quality of UCPWI. The proposed method consists of three stages: (1) first, a deep learning approach based on U-net was trained to differentiate the microbubble and tissue radio frequency (RF) signals; (2) then, to eliminate the remaining tissue RF signals, the bubble approximated wavelet transform (BAWT) combined with maximum eigenvalue threshold was employed. BAWT can enhance the UCA area brightness, and eigenvalue threshold can be set to eliminate the interference areas due to the large difference of maximum eigenvalue between UCA and tissue areas; (3) finally, the accurate microbubble imaging were obtained through eigenspace-based minimum variance (ESBMV). RESULTS: The proposed method was validated by both phantom and in vivo rabbit experiment results. Compared with UCPWI based on delay and sum (DAS), the imaging contrast-to-tissue ratio (CTR) and contrast-to-noise ratio (CNR) was improved by 21.3 dB and 10.4 dB in the phantom experiment, and the corresponding improvements were 22.3 dB and 42.8 dB in the rabbit experiment. CONCLUSIONS: Our method illustrates superior imaging performance and high reproducibility, and thus is promising in improving the contrast image quality and the clinical value of UCPWI.


Assuntos
Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Microbolhas , Ondas de Rádio , Abdome/irrigação sanguínea , Animais , Artérias/diagnóstico por imagem , Meios de Contraste , Coelhos , Ultrassonografia
12.
Int J Comput Assist Radiol Surg ; 14(12): 2069-2081, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493112

RESUMO

PURPOSE : The purpose of this paper is to present a fully automated abdominal artery segmentation method from a CT volume. Three-dimensional (3D) blood vessel structure information is important for diagnosis and treatment. Information about blood vessels (including arteries) can be used in patient-specific surgical planning and intra-operative navigation. Since blood vessels have large inter-patient variations in branching patterns and positions, a patient-specific blood vessel segmentation method is necessary. Even though deep learning-based segmentation methods provide good segmentation accuracy among large organs, small organs such as blood vessels are not well segmented. We propose a deep learning-based abdominal artery segmentation method from a CT volume. Because the artery is one of small organs that is difficult to segment, we introduced an original training sample generation method and a three-plane segmentation approach to improve segmentation accuracy. METHOD : Our proposed method segments abdominal arteries from an abdominal CT volume with a fully convolutional network (FCN). To segment small arteries, we employ a 2D patch-based segmentation method and an area imbalance reduced training patch generation (AIRTPG) method. AIRTPG adjusts patch number imbalances between patches with artery regions and patches without them. These methods improved the segmentation accuracies of small artery regions. Furthermore, we introduced a three-plane segmentation approach to obtain clear 3D segmentation results from 2D patch-based processes. In the three-plane approach, we performed three segmentation processes using patches generated on axial, coronal, and sagittal planes and combined the results to generate a 3D segmentation result. RESULTS : The evaluation results of the proposed method using 20 cases of abdominal CT volumes show that the averaged F-measure, precision, and recall rates were 87.1%, 85.8%, and 88.4%, respectively. This result outperformed our previous automated FCN-based segmentation method. Our method offers competitive performance compared to the previous blood vessel segmentation methods from 3D volumes. CONCLUSIONS : We developed an abdominal artery segmentation method using FCN. The 2D patch-based and AIRTPG methods effectively segmented the artery regions. In addition, the three-plane approach generated good 3D segmentation results.


Assuntos
Abdome/irrigação sanguínea , Artérias/diagnóstico por imagem , Imagem Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada de Feixe Cônico , Humanos
13.
J Med Vasc ; 44(5): 336-339, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474344

RESUMO

Jejunal pseudoaneurysm is a rare complication of pancreatitis, usually manifested by digestive bleeding when it ruptures into the digestive lumen. This complication is extremely rare and may be life-threatening. The diagnosis is based on abdominal angiographic computed tomography. Radiology allows therapeutic management through arterial embolization. This case report describes a pseudoaneurysm of jejunal artery that developed as the result of pancreatitis: A 77-year-old man seen in early September 2015 at the emergency department for acute pancreatitis had a pseudocyst infected and spontaneously fistulized into the jejunum lumen. His condition responded initially to symptomatic therapy, and he was discharged. He returned two years later, with digestive bleeding from jejunal pseudoaneurysm that had ruptured into the jejunal lumen. Angiographic embolization was performed as first-line treatment with good outcome. Bleeding more than two years after acute pancreatitis due to rupture of a jejunal pseudoaneurysm is an exceptional complication. Here we report a rare case of digestive hemorrhage caused by jejunal pseudoaneurysm, complicating acute pancreatitis.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Roto/etiologia , Artérias , Jejuno/irrigação sanguínea , Pancreatite/complicações , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Artérias/diagnóstico por imagem , Embolização Terapêutica , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pancreatite/diagnóstico , Resultado do Tratamento
14.
Biomed Eng Online ; 18(1): 93, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492145

RESUMO

BACKGROUND: As the only arterial structure of which two main arteries merged into one, the vertebro-basilar (VA-BA) system is one of the favorite sites of cerebral atherosclerotic plaques. The aim of this study was to investigate the detailed hemodynamics characteristics in the VA-BA system. METHODS: A scale-up subject-specific flow phantom of VA-BA system was fabricated based on the computed tomography angiography (CTA) scanning images of a healthy adult. Flow fields in eight axial planes and six radial planes were measured and analyzed by using particle image velocimetry (PIV) under steady flow conditions of [Formula: see text], [Formula: see text]. A water-glycerin mixture was used as the working fluid. RESULTS: The flow in the current model exhibited highly three-dimensional characteristics. The confluence of VAs flow formed bimodal velocity distribution near the confluence apex. Due to the asymmetrical structural configuration, the bimodal velocity profile skewed towards left, and sharper peaks were observed under higher Reynolds condition. Secondary flow characterized by two vortices formed in the radial planes where 10 mm downstream the confluence apex and persists along the BA under both Reynolds numbers. The strength of secondary flow under [Formula: see text] is around 8% higher than that under [Formula: see text], and decayed nonlinearly along the flow direction. In addition, a low momentum recirculation region induced by boundary layer separation was observed near the confluence apex. The wall shear stress (WSS) in the recirculation area was found to be lower than 0.4 Pa. This region coincides well with the preferential site of vascular lesions in the VA-BA system. CONCLUSIONS: This preliminary study verified that the subject-specific in-vitro experiment is capable of reflecting the detailed flow features in the VA-BA system. The findings from this study may help to expand the understanding of the hemodynamics in the VA-BA system, and further clarifying the mechanism that underlying the localization of vascular lesions.


Assuntos
Artérias/diagnóstico por imagem , Artérias/fisiologia , Angiografia por Tomografia Computadorizada , Hemodinâmica , Imagens de Fantasmas , Reologia/instrumentação , Adulto , Voluntários Saudáveis , Humanos , Cinética , Resistência ao Cisalhamento , Estresse Mecânico
15.
BMC Neurol ; 19(1): 180, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370812

RESUMO

BACKGROUND: This study examined how intracranial large artery stenosis (ILAS), symptomatic and asymptomatic ILAS, and risk factors affect unfavorable outcome events after medical treatment in routine clinical practice. METHODS: This was a 24-month prospective observational study of consecutively recruited stroke patients. All participants underwent magnetic resonance angiography, and their clinical characteristics were assessed. Outcome events were vascular outcome, recurrent stroke, and death. Cox regression analyses were performed to identify potential factors associated with an unfavorable outcome, which included demographic and clinical characteristics, the risk factors, and stenosis status. RESULTS: The analysis included 686 patients; among them, 371 were assessed as ILAS negative, 231 as symptomatic ILAS, and 84 as asymptomatic ILAS. Body mass index (p < .05), hypertension (p = .01), and old infarction (p = .047) were factors relating to vascular outcomes. Hypertension was the only factor for recurrent stroke (p = .035). Poor glomerular filtration rate (< 30 mL/min/1.73 m2) (p = .011) and baseline National Institutes of Health Stroke Scale scores (p < .001) were significant predictors of death. CONCLUSIONS: This study extended previous results from clinical trials to a community-based cohort study by concurrently looking at the presence/absence of stenosis and a symptomatic/asymptomatic stenotic artery. Substantiated risk factors rather than the stenosis status were predominant determinants of adverse outcome. Although the degree of stenosis is often an indicator for treatment, we suggest risk factors, such as hypertension and renal dysfunction, should be monitored and intensively treated.


Assuntos
Isquemia Encefálica/complicações , Doenças Arteriais Intracranianas/complicações , Acidente Vascular Cerebral/complicações , Idoso , Artérias/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Estudos de Coortes , Constrição Patológica , Feminino , Taxa de Filtração Glomerular , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Taiwan/epidemiologia
16.
Ulus Travma Acil Cerrahi Derg ; 25(4): 389-395, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297775

RESUMO

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84+-1.84 h in the TVS group and 5.95+-1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.


Assuntos
Artérias/lesões , Traumatismos da Perna/cirurgia , Extremidade Inferior/irrigação sanguínea , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Amputação/estatística & dados numéricos , Conflitos Armados , Artérias/diagnóstico por imagem , Artérias/cirurgia , Embolectomia com Balão , Angiografia por Tomografia Computadorizada , Constrição , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/etiologia , Ligadura , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síria , Trombose/cirurgia , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/complicações , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Veias/lesões , Veias/cirurgia , Adulto Jovem
17.
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
18.
Molecules ; 24(13)2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31324029

RESUMO

The present study investigated the possibilities and feasibility of drug targeting for an arterial bifurcation lesion to influence the host healing response. A micrometer sized iron particle was used only to model the magnetic carrier in the experimental investigation (not intended for clinical use), to demonstrate the feasibility of the particle targeting at the lesion site and facilitate the new experimental investigations using coated superparamagnetic iron oxide nanoparticles. Magnetic fields were generated by a single permanent external magnet (ferrite magnet). Artery bifurcation exerts severe impacts on drug distribution, both in the main vessel and the branches, practically inducing an uneven drug concentration distribution in the bifurcation lesion area. There are permanently positioned magnets in the vicinity of the bifurcation near the diseased area. The generated magnetic field induced deviation of the injected ferromagnetic particles and were captured onto the vessel wall of the test section. To increase the particle accumulation in the targeted region and consequently avoid the polypharmacology (interaction of the injected drug particles with multiple target sites), it is critical to understand flow hemodynamics and the correlation between flow structure, magnetic field gradient, and spatial position.


Assuntos
Artérias/fisiopatologia , Artérias/efeitos da radiação , Sistemas de Liberação de Medicamentos , Hemodinâmica/efeitos da radiação , Campos Magnéticos , Nanopartículas de Magnetita , Nanomedicina Teranóstica , Algoritmos , Angiografia , Artérias/anormalidades , Artérias/diagnóstico por imagem , Substitutos Sanguíneos , Hemodinâmica/efeitos dos fármacos , Modelos Biológicos , Tamanho da Partícula , Reologia
19.
Georgian Med News ; (290): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322512

RESUMO

The association of cerebral arteriovenous malformations (bAVM) and associated paranidal aneurysms, that is closely related to the AVM nidus, carry a high risk of rapture and re-rapture after initial hemorrhage. This association is consider as therapeutic challenge and supportive data about their natural history and best treatment modalities are still lacking. In this article we report our experience of their treatment. We reviewed 443 cases of patients with AVMs between 2004 and 2018, who were treated at our institution and found 73 (16,5%) cases of AVM association with paranidal aneurysms (22 (30,2%) arterial - prenidal, 20 (27,4%) intranidal, and 19 (26,0%) venous - postnidal). Twelve (16,4 %) patients had multiple aneurysm. All patients received endovascular treatment with n-butyl cyanoacrylate (NBCA), ONYX or Embolin embolization. We evaluated clinical and radiological data, treatment and outcomes at discharge. Among 73 patients (32 (43,8 %) women and 41 (56,2 %) men, mean age - 34 years, 8 - 65 years) with AVM and paranidal aneurysms who were enrolled in our study, hemorrhage was the most frequent presenting symptom (47 patients (64.4%). The timing of procedure varied between 3 - 23 days. Total occlusion of AVM was achieved in 23 (31,5%) cases, in all other cases partial or target occlusion with obligatory aneurysm embolization was done. Seven (9,6%) patients had complication (5 ischemic and 2 hemorrhagic) after procedure. Clinical improvement was seen in all groups at discharge. Mean change of mRS score between admission and discharge was 0,2-0,5 point. Excellent or good outcome (mRS - 0,1,2) was observed in 58 (79,5%) patients at discharge. Unfavorable outcome (mRS - 3-5) had 13 (17,8%) patients, mRS - 6 - 2 (2,7%) patients. Patients sustaining AVM and multiple paranidal aneurysms had higher risk of hemorrhage comparing with single one (OR-17,5 (95% CI -1,0-309,8 (p=0,010). Relationship between AVM with paranidal aneurysms and hemorrhagic presentation is obvious, however definite source of hemorrhage is difficult to evaluate. To our belief arterial prenidal and intranidal aneurysms especially multiple are the most dangerous and should be in therapeutic focus after it's finding. Endovascular embolization has the potential to be effective and safe in treatment of AVM with paranidal aneurysms.


Assuntos
Artérias/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Embolização Terapêutica , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Adolescente , Adulto , Idoso , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Criança , Feminino , Humanos , Aneurisma Intracraniano/patologia , Malformações Arteriovenosas Intracranianas/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
20.
BMC Musculoskelet Disord ; 20(1): 347, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31351455

RESUMO

BACKGROUND: Impaired lumbar artery flow has been reported in clinical and epidemiological studies to be associated with low back pain and lumbar disc degeneration. However, it has not been experimentally demonstrated that impaired lumbar artery flow directly induces intervertebral disc (IVD) degeneration by affecting IVD matrix metabolism. The purpose of this study was to evaluate whether ligation of the lumbar artery can affect degenerative changes in the rabbit IVD. METHODS: New Zealand White rabbits (n = 20) were used in this study. Under general anesthesia, the third and fourth lumbar arteries were double-ligated using vascular clips. The blood flow to the L3/L4 disc (cranial disc) was reduced by ligation of the third lumbar artery and that of the L5/L6 disc (caudal disc) by ligation of the fourth lumbar artery. The blood flow to the L4/L5 disc (bilateral disc) was decreased by ligation of both the third and fourth lumbar arteries. The L2/L3 disc was used as the control. Disc height was radiographically monitored biweekly until 12 weeks after surgery. The rabbits were sacrificed at 4, 8, and 12 weeks after surgery and magnetic resonance imaging (MRI) T2-mapping, histology and immunohistochemistry were assessed. RESULTS: Lumbar artery ligation did not induce significant changes in disc height between control and ischemic discs (cranial, bilateral and caudal discs) during the 12-week experimental period. T2-values of ischemic discs had no significant trend to be lower than those of the control L2/L3 discs. Histologically, Safranin-O staining changed following ligation of corresponding IVD lumbar arteries. Histological grading scores for disc degeneration, which correlated significantly with MRI T2-values, had significant changes after the surgery. Immunohistochemical analysis showed that the ligation of lumbar arteries significantly affected a change in the percentage of HIF-1α immunoreactive cells of ischemia discs compared to that of control discs four weeks after the surgery (p < 0.05). CONCLUSIONS: The MRI and histology results suggest that diminished flow in lumbar arteries induce mild changes in the extracellular matrix metabolism of rabbit IVDs. These matrix changes, however, were not progressive and differed from the degenerative disc changes seen in the process of human IVD degeneration.


Assuntos
Artérias/diagnóstico por imagem , Degeneração do Disco Intervertebral/etiologia , Disco Intervertebral/irrigação sanguínea , Vértebras Lombares/irrigação sanguínea , Animais , Artérias/cirurgia , Modelos Animais de Doenças , Matriz Extracelular/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Ligadura , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Coelhos , Fluxo Sanguíneo Regional
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