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1.
J Urol ; 205(1): 68-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856981

RESUMO

PURPOSE: Encrustation is a common phenomenon that can occur following placement of a ureteral stent into the urinary tract, and it can lead to serious complications. The following review addresses the mechanism of encrustation, the management of these stents and the newest technology developed to mitigate this issue. MATERIALS AND METHODS: We performed a comprehensive literature search on stent encrustation including peer-reviewed publications, public product listings, and material on current and future stent technology. RESULTS: The mechanism of encrustation is complex and multifaceted, including dwell time, patient specific risk factors, conditioning film formation, biofilm formation and mineral deposition. Several technological developments in stent materials and coatings may have a role in reducing the risk of stent encrustation. It is important to identify the extent of stent encrustation and plan treatment strategies accordingly. We propose a novel treatment algorithm for the management encrusted ureteral stents. CONCLUSIONS: The ubiquity of ureteral stents in urology practice mandates updated knowledge about the prevention of stent encrustation, identification of high risk patients and preparedness for removal using multimodal techniques.


Assuntos
Calcinose/cirurgia , Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/cirurgia , Stents/efeitos adversos , Ureter/cirurgia , Calcinose/epidemiologia , Calcinose/etiologia , Calcinose/prevenção & controle , Cistoscopia , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Litotripsia , Masculino , Nefrostomia Percutânea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Fatores de Risco , Tecnologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureter/diagnóstico por imagem , Ureter/microbiologia , Ureter/patologia , Obstrução Ureteral/cirurgia , Ureterolitíase/etiologia , Ureterolitíase/prevenção & controle
2.
Medicine (Baltimore) ; 99(46): e23299, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181720

RESUMO

Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08-2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02-1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30-2.92) in women and 0.82 (95% CI, 0.48-1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53-1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29-3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.


Assuntos
Calcinose/etiologia , Hiperlipidemias/complicações , Artropatias/etiologia , Fatores Sexuais , Ombro/anormalidades , Tendinopatia/etiologia , Doenças Vasculares/etiologia , Adulto , Idoso , Calcinose/epidemiologia , Calcinose/fisiopatologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/fisiopatologia , Artropatias/epidemiologia , Artropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Ombro/fisiopatologia , Taiwan/epidemiologia , Tendinopatia/epidemiologia , Tendinopatia/fisiopatologia , Doenças Vasculares/epidemiologia , Doenças Vasculares/fisiopatologia
3.
Am J Cardiol ; 134: 99-107, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32917344

RESUMO

Heart failure (HF) is a leading cause of morbidity. Strategies for preventing HF are paramount. Prevalent extracoronary calcification is associated with HF risk but less is known about progression of mitral annular (MAC) and aortic valve calcification (AVC) and HF risk. Progression of valvular calcification (VC) [interval change of >0 units/yr] was assessed by 2 cardiac computed tomography scans over a median of 2.4 years. We used Cox regression to determine the risk of adjudicated HF and linear mixed effects models to determine 10-year change in left ventricular (LV) parameters measured by cardiac magnetic resonance imaging associated with VC progression. We studied 5,591 MESA participants free of baseline cardiovascular disease. Mean ± SD age was 62 ± 10 years; 53% women; 83% had no VC progression, 15% progressed at 1 site (AVC or MAC) and 3% at both sites. There were 251 incident HF over 15 years. After adjusting for cardiovascular risk factors, the hazard ratios (95% confidence interval) of HF associated with VC progression at 1 and 2 sites were 1.62 (1.21 to 2.17) and 1.88 (1.14 to 3.09), respectively, compared with no progression (p-for-trend <0.001). Hazard ratios were higher for HFpEF (2.52 [1.63 to 3.90] and 2.49 [1.19 to 5.25]) but nonsignificant for HFrEF. Both AVC (1.61 [1.19 to 2.19]) and MAC (1.50 [1.09 to 2.07]) progression were associated with HF. VC was associated with worsening of some LV parameters over 10 years. In conclusion, VC progression was associated with increased risk of HF and change in LV function. Interventions targeted at reducing VC progression may also impact HF risk, particularly HFpEF.


Assuntos
Valva Aórtica/diagnóstico por imagem , Calcinose/epidemiologia , Insuficiência Cardíaca/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Calcinose/diagnóstico por imagem , Técnicas de Imagem de Sincronização Cardíaca , Progressão da Doença , Feminino , Insuficiência Cardíaca/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Volume Sistólico , Tomografia Computadorizada por Raios X
4.
Am J Cardiol ; 128: 60-66, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650925

RESUMO

Left atrial calcium (LAC) is often observed in patients who have undergone mitral valve (MV) surgery, but little is known about its characteristics and clinical implications. Therefore, we sought to investigate the structural and hemodynamic significance of LAC and its association with clinical outcomes. We investigated 327 patients with repaired or prosthetic MV who underwent cardiac CT from 2010 to 2017. The degree of LAC was analyzed and classified into three groups: group 1 (no LAC), group 2 (mild-to-moderate LAC), and group 3 (severe LAC). Clinical and echocardiographic characteristics and clinical outcomes were compared in three groups. LAC was seen in 79 (24.2%) patients. Groups 2 and 3 showed more prevalent atrial fibrillation, a rheumatic etiology, a higher number of previous surgeries, a larger LA volume index, and higher pulmonary artery systolic pressure than group 1. Paravalvular leakage of the MV increased progressively according to severity of LAC (15.4% in group 1, 39.3% in group 2, and 66.7% in group 3, p <0.001). Event-free survival rate for major adverse cardiovascular adverse events (log rank p = 0.033) and all-cause mortality (log rank p <0.001) were significantly different according to LAC group. In Cox regression analyses, presence of severe LAC was an independent predictor of all-cause mortality (hazard ratio: 4.44, 95% confidence interval: 1.71 to 11.58, p = 0.002). LAC on cardiac CT is not uncommon and reflects more advanced LA remodeling and a stiff LA. The presence and severity of LAC are associated with a worse clinical outcome after MV surgery.


Assuntos
Calcinose/epidemiologia , Cardiomiopatias/epidemiologia , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Fibrilação Atrial/epidemiologia , Calcinose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Complicações Pós-Operatórias/diagnóstico por imagem , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Cardiopatia Reumática/cirurgia , Tomografia Computadorizada por Raios X
5.
PLoS One ; 15(7): e0235135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628733

RESUMO

BACKGROUND: In patients on hemodialysis (HD), the various chemical elements in the dialysate may influence survival rates. In particular, calcium modifies mineral and bone metabolism and the vascular calcification rate. We studied the influence of the dialysate calcium concentration and the treatments prescribed for mineral bone disease (MBD) on survival. METHODS: All patients in REIN having initiated HD from 2010 to 2013 were classified according to their exposure to the different dialysate calcium concentrations in their dialysis unit. Data on the individual patients' treatments for MBD were extracted from the French national health database. Cox proportional hazard models were used to estimate mortality hazard ratios (HR) associated with time-dependent exposure to dialysate calcium concentrations and MBD therapies, adjusted for comorbidities, laboratory and technical data. RESULTS: Dialysate calcium concentration of 1.5 mmol/L was used by 81% of the dialysis centers in 2010 and in 83% in 2014. Most centers were using several formulas in up to 78% for 3 formulas in 2010 to 86% in 2014. In full adjusted Cox survival analyses, the percentage of calcium >1.5 mmol/L and <1.5 mmol/l by center and the number of formula used per center were not associated with survival. Depending on the daily dose used, the MBD therapies were associated with survival improvement for calcium, native vitamin D, active vitamin D, sevelamer, lanthanum and cinacalcet in the second and third tertiles of dose. CONCLUSION: No influence of the dialysate calcium concentration was evidenced on survival whereas all MBD therapies were associated with a survival improvement depending on the daily dose used.


Assuntos
Osso e Ossos/efeitos dos fármacos , Cálcio/análise , Soluções para Hemodiálise/análise , Sistema de Registros , Diálise Renal , Insuficiência Renal Crônica/terapia , Idoso , Vasos Sanguíneos/efeitos dos fármacos , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/fisiopatologia , Osso e Ossos/metabolismo , Osso e Ossos/fisiopatologia , Calcinose/epidemiologia , Calcinose/metabolismo , Calcinose/fisiopatologia , Cálcio/administração & dosagem , Cálcio/metabolismo , Cinacalcete/análise , Feminino , França/epidemiologia , Soluções para Hemodiálise/administração & dosagem , Soluções para Hemodiálise/química , Humanos , Lantânio/análise , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/fisiopatologia , Sevelamer/análise , Vitamina D/análise , Vitamina D/metabolismo
6.
Niger J Clin Pract ; 23(6): 759-763, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525108

RESUMO

Objective: The aim of this study was to detect the prevalence of soft tissue calcifications in the head and neck using cone beam computed tomography (CBCT) and to determine their clinical importance. Subjects and Methods: Soft tissue calcifications in the head and neck region were retrospectively evaluated in 1557 CBCT images obtained between 2013 and 2015. The findings were categorized as follows: tonsillolith (calcified tonsil), carotid artery calcification (CAC), sialolith (salivary stone), calcified triticeous cartilage (CTC), calcified lymph node (CLN), rhinolith, antrolith, calcification of the superior cornu of the thyroid cartilage (CSCTC), calcified stylohyoid ligaments (CSL), myositis ossifican, osteoma cutis, and intracranial calcification. A Chi-square test was performed for categorical variables. In the 1557 CBCT images, 520 (33.4%) contained had at least one soft tissue calcification in the head and neck region. Results: Tonsilloliths (18.8%) were the most prevalent soft tissue calcification, followed by CTC (5.8%), CAC (4.3%), intracranial calcifications (3.9%), CSL (3.7%), CSCTC (2.1%), osteoma cutis (1%), sialoliths (0.7%), antroliths (0.5%), myositis ossificans (0.4%), rhinoliths, and CLN (0.2%). Conclusion: There was a high prevalence of soft tissue calcifications in the head and neck region on CBCT images. Tonsilloliths were the most common type of calcification. CBCT imaging may aid the diagnosis and assessment of these calcifications.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Cabeça/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Tonsila Palatina/diagnóstico por imagem , Adulto , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/epidemiologia , Feminino , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/epidemiologia , Prevalência , Estudos Retrospectivos
7.
Prog Cardiovasc Dis ; 63(4): 496-502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526213

RESUMO

Calcific aortic valve stenosis (AS) is the most common form of acquired valvular heart disease needing intervention and our understanding of this disease has evolved from one of degenerative calcification to that of an active process driven by the interplay of genetic factors and chronic inflammation modulated by risk factors such as smoking, hypertension and elevated cholesterol. Lipoprotein(a) [Lp (a)] is a cholesterol rich particle secreted by the liver which functions as the major lipoprotein carrier of phosphocholine-containing oxidized phospholipids. Lp(a) levels are largely genetically determined by polymorphisms in the LPA gene. While there is an extensive body of evidence linking Lp(a) to atherosclerotic cardiovascular disease, emerging evidence now suggests a similar association of Lp(a) to calcific AS. In this article, we performed a systematic review of all published literature to assess the association between Lp(a) and calcific aortic valve (AV) disease. In addition, we review the potential mechanisms by which Lp(a) influences the progression of valve disease. Our review identified a total of 21 studies, varying from case-control studies, prospective or retrospective observational cohort studies to Mendelian randomized studies that assessed the association between Lp(a) and calcific AS. All but one of the above studies demonstrated significant association between elevated Lp(a) and calcific AS. We conclude that there is convincing evidence supporting a causal association between elevated Lp(a) and calcific AS. In addition, elevated Lp(a) predicts a faster hemodynamic progression of AS, and increased risk of AV replacement, especially in younger patients. Further research into the clinical utility of Lp(a) as a marker for predicting the incidence, progression, and outcomes of sclerodegenerative AV disease is needed.


Assuntos
Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/patologia , Calcinose/sangue , Calcinose/epidemiologia , Lipoproteína(a)/sangue , Estenose da Valva Aórtica/patologia , Calcinose/patologia , Humanos
8.
J Ayub Med Coll Abbottabad ; 32(2): 179-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583990

RESUMO

BACKGROUND: Mitral Annular Calcification (MAC) is a degenerative process involving the mitral valve and is a marker of advanced cardiovascular disease. Prevalence in the general population is upto 10% and increases in advanced age, diabetes mellitus, chronic kidney disease (CKD), end stage renal disease (upto 40%) and mitral valve prolapse.The aims of this study were to assess the prevalence of MAC in CKD5D patients and correlate with patients' characteristics. METHODS: Echocardiograms were obtained in 84 hemodialysis patients. Association of MAC with various patient characteristics was studied. Data was analysed using SPSS-22. RESULTS: The mean age of the patients was 63.38±12.3 years and 48 (57%) were males. Sixty-eight patients (81%) had DM and 79 (94%) had hypertension. MAC was present in 37 out of 84 (44%) patients. Sixty-four (72%) had IHD. The presence of MAC correlated significantly with IHD (Odds Ratio 6.42, p=0.006). Mean follow up of the patients was 30.30±29.22 months and 37 (44%) suffered mortality during this period. Patients on dialysis for longer than 36 months had an elevated risk of developing MAC (OR=3.32, p=0.019). Patients with the following risk factors: serum PO4 greater than 5.5 (OR=2.03), DM (OR=1.95), HTN (OR=3.35), Age >60 (OR=1.83), AFIB (OR=1.28); had an observable increase in incidence of MAC with time but they weren't statistically significant. CONCLUSIONS: Mitral Annular Calcification is common in hemodialysis patients and correlates significantly with IHD. Our findings support the recommendation by KDIGO 2017 guidelines on Mineral and Bone Disease on the use of echocardiography for the detection of valvular calcification.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Valva Mitral/fisiopatologia , Diálise Renal , Insuficiência Renal Crônica , Idoso , Calcinose/complicações , Calcinose/epidemiologia , Calcinose/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia
9.
Prog Cardiovasc Dis ; 63(3): 219-227, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32277995

RESUMO

Elevated circulating concentrations of lipoprotein(a) [Lp(a)] is strongly associated with increased risk of atherosclerotic cardiovascular disease (CVD) and degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies. Everybody should have their Lp(a) concentration measured once in their lifetime. CVD risk is elevated when Lp(a) concentrations are high i.e. > 50 mg/dL (≥100 mmol/L). Extremely high Lp(a) levels >180 mg/dL (≥430 mmol/L) are associated with CVD risk similar to that conferred by familial hypercholesterolemia. Elevated Lp(a) level was previously treated with niacin, which exerts a potent Lp(a)-lowering effect. However, niacin is currently not recommended because, despite the improvement in lipid profile, no improvements on clinical outcomes have been observed. Furthermore, niacin use has been associated with severe adverse effects. Post hoc analyses of clinical trials with proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have shown that these drugs exert clinical benefits by lowering Lp(a), independent of their potent reduction of low-density lipoprotein cholesterol (LDL-C). It is not yet known whether PCSK9 inhibitors will be of clinical use in patients with elevated Lp(a). Apheresis is a very effective approach to Lp(a) reduction, which reduces CVD risk but is invasive and time-consuming and is thus reserved for patients with very high Lp(a) levels and progressive CVD. Studies are ongoing on the practical application of genetic approaches to therapy, including antisense oligonucleotides against apolipoprotein(a) and small interfering RNA (siRNA) technology, to reduce the synthesis of Lp(a).


Assuntos
Estenose da Valva Aórtica/sangue , Valva Aórtica/patologia , Artérias/metabolismo , Aterosclerose/sangue , Calcinose/sangue , Lipoproteína(a)/sangue , Placa Aterosclerótica , Animais , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/terapia , Artérias/patologia , Aterosclerose/epidemiologia , Aterosclerose/patologia , Aterosclerose/terapia , Biomarcadores/sangue , Calcinose/epidemiologia , Calcinose/patologia , Calcinose/terapia , Humanos , Lipoproteína(a)/química , Prognóstico , Fatores de Risco , Regulação para Cima
10.
Lancet Child Adolesc Health ; 4(5): 378-387, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32199080

RESUMO

BACKGROUND: Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS: This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS: All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION: We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING: Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.


Assuntos
Discinesias/fisiopatologia , Doenças Neuromusculares/fisiopatologia , Infecção por Zika virus/fisiopatologia , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Encefalopatias/epidemiologia , Brasil/epidemiologia , Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Pré-Escolar , Comorbidade , Transtornos de Deglutição/epidemiologia , Discinesias/epidemiologia , Epilepsia/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Malformações do Desenvolvimento Cortical/epidemiologia , Malformações do Desenvolvimento Cortical/fisiopatologia , Microcefalia/epidemiologia , Microcefalia/fisiopatologia , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Exame Neurológico , Doenças Neuromusculares/epidemiologia , Pneumonia/epidemiologia , Tratos Piramidais/fisiopatologia , Transtornos do Sono-Vigília/epidemiologia , Tomografia Computadorizada por Raios X , Infecções Urinárias/epidemiologia , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico por imagem , Infecção por Zika virus/epidemiologia
11.
Plast Reconstr Surg ; 145(3): 530e-537e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097306

RESUMO

BACKGROUND: Breast augmentation with fat grafting is used as an alternative to breast implants. However, a systematic evaluation of the complication rates after fat grafting using only studies with consecutive patients has not previously been performed. In this study, the authors compiled studies reporting complication rates and radiologic changes in consecutive patients undergoing cosmetic breast augmentation with fat grafting. METHODS: Studies reporting on consecutive patients undergoing breast augmentation with fat grafting were included. Complication rates, radiologic changes, Breast Imaging Reporting and Data System assessments, and the number of patients undergoing revision surgery were extracted. Mean complication rates and radiologic changes were calculated with meta-analytical methods. RESULTS: Twenty-two studies with 2073 patients were included. The rates of major complications were low (hematoma, 0.5 percent; infection, 0.6 percent; and seroma, 0.1 percent). None of these patients needed revision surgery. The most frequent minor complication was palpable cysts in 2.0 percent of the patients; 67 percent of these were treated with aspiration. The radiologic changes in the patients after fat grafting were as follows: oil cysts, 6.5 percent; calcifications, 4.5 percent; and fat necrosis, 1.2 percent. The risk of being referred for additional radiologic imaging (e.g., to exclude malignant changes) was 16.4 percent, and the risk of being referred for biopsy was 3.2 percent. CONCLUSIONS: The complication rates after breast augmentation with fat grafting are low and support fat grafting as an alternative to breast augmentation with implants. The rates of radiologic changes are high after fat grafting, but the changes do not seem to have any therapeutic consequences for the patients.


Assuntos
Tecido Adiposo/transplante , Cisto Mamário/epidemiologia , Calcinose/epidemiologia , Necrose Gordurosa/epidemiologia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Mama/diagnóstico por imagem , Mama/cirurgia , Cisto Mamário/diagnóstico , Cisto Mamário/etiologia , Calcinose/diagnóstico , Calcinose/etiologia , Necrose Gordurosa/diagnóstico , Necrose Gordurosa/etiologia , Feminino , Humanos , Mamoplastia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
12.
Trends Cardiovasc Med ; 30(5): 289-295, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31402089

RESUMO

The mitral annulus is a fibrous structure that surrounds the mitral valve leaflets and is prone to calcification. Despite its common occurrence, association with cardiovascular morbidity and mortality and relationship with dysfunction of the mitral valve, the pathobiology of mitral annular calcification is incompletely understood. Mitral annular calcification is no longer regarded as a local, chronic and degenerative process resulting in precipitation of calcium and phosphate, but as an active and regulated molecular process that is related to lipid metabolism, hemodynamic stress, chronic kidney disease, bone and mineral metabolism and inflammation. This review summarizes the current evidence examining the pathophysiologic determinants of mitral annular calcification.


Assuntos
Calcinose/metabolismo , Doenças das Valvas Cardíacas/metabolismo , Valva Mitral/metabolismo , Osteogênese , Fatores Etários , Animais , Calcinose/epidemiologia , Calcinose/patologia , Calcinose/cirurgia , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Mediadores da Inflamação/metabolismo , Metabolismo dos Lipídeos , Valva Mitral/patologia , Valva Mitral/cirurgia , Prevalência , Prognóstico , Fatores de Risco , Transdução de Sinais
13.
World Neurosurg ; 134: 240-263, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31682989

RESUMO

OBJECTIVE: Calcified or ossified chronic subdural hematoma (CSDH), characterized by slowly progressing neurologic symptoms, is a rarely seen entity that may remain asymptomatic for many years. Management of CSDH has improved dramatically in recent years as a result of advances in diagnostic tools, but there is still some controversy regarding the optimal treatment strategy. METHODS: In this systematic review, PRISMA guidelines were followed to query existing online databases between January 1930 and December 2018. We found a total of 88 articles containing 114 cases of calcified or ossified CSDH, comprising 83 patients operated on and 31 not operated on. RESULTS: In this study, there were 78 males and 29 females (7 with unreported gender) from 25 countries, ages ranging from 4 months to 86 years (mean, 33.7 years), with CSDH caused by head trauma in 33.3%, shunting for hydrocephalus in 27.2%, or after cranial surgery in 4.4%. The duration of symptoms ranged from acute onset to 20 years, with a mean of 24.1 months. Imaging techniques such as radiography, computed tomography, and magnetic resonance imaging were used, with pathologic confirmation of CSDH and complete recovery in 56.4% of patients. CONCLUSIONS: Incidence of calcified or ossified CSDH is high in certain countries, including the United States, Japan, and Turkey, with a steady increase in recent years. The therapy of choice is surgery in these patients and it should be considered in the differential diagnosis at presentation because of its infrequency and variable clinical manifestation, after shunting in children or head trauma in adults.


Assuntos
Calcinose/epidemiologia , Hematoma Subdural Crônico/epidemiologia , Ossificação Heterotópica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Derivações do Líquido Cefalorraquidiano , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Craniotomia , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Hidrocefalia/cirurgia , Incidência , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Radiografia , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
J Pediatr ; 217: 158-164.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761429

RESUMO

OBJECTIVE: To collect all published cases up to January 2019 of pulmonary alveolar microlithiasis (PAM) in patients age 5 years and under and to compare their characteristics with those of the 1022 cases in the most recent all-age cohort published in 2015. STUDY DESIGN: We identified 28 cases of PAM worldwide in children age 5 years and under, accounting for only 2%-3% of all cases. RESULTS: Children seem more frequently symptomatic, notably with more cough and severe acute respiratory failure, but had no reported extrapulmonary manifestation. Children with PAM evidenced less typical radiologic findings, with frequent ground glass opacities not reported in adult cases and milder calcifications as less frequent, smaller, and mainly restricted to the lower lobes. CONCLUSIONS: PAM remains an uncommon diagnosis in young children, as symptoms and radiologic findings are less specific. Physicians should be aware to look for calcifications in chest computed tomography at mediastinal window and avoid elution of the bronchoalveolar lavage to find microliths. Collecting longitudinal data through an international registry would help in characterizing PAM to predict disease progression and plan lung transplantation.


Assuntos
Calcinose/epidemiologia , Doenças Genéticas Inatas/epidemiologia , Pneumopatias/epidemiologia , Alvéolos Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Lavagem Broncoalveolar , Calcinose/diagnóstico , Pré-Escolar , Seguimentos , Doenças Genéticas Inatas/diagnóstico , Humanos , Lactente , Pneumopatias/diagnóstico , Masculino , Radiografia Torácica
16.
J Clin Neurosci ; 72: 202-205, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31836383

RESUMO

Pineal gland calcification (PGC) has been associated with low melatonin production, a hormone with anti-oxidant, anti-inflammatory, and neuro-protective effects. Therefore, melatonin deficiency may play a role in the development of cerebral small vessel disease (cSVD), a condition that is partly related to upregulation of oxidative and inflammatory mechanisms leading to endothelial dysfunction, breakdown of the blood-brain barrier, and impaired interstitial fluid drainage. In this study, the association between PGC (a surrogate for melatonin deficiency) and white matter hyperintensities (WMHs) of presumed vascular origin (a biomarker of cSVD) was assessed in Atahualpa cohort individuals aged ≥60 years undergoing head CT and brain MRI. PGC was rated as none-to-mild and moderate-to-severe. WMHs were classified according to the modified Fazekas scale. A logistic regression model was fitted to assess the independent association between moderate-to-severe PGC and WMHs. Inverse probability of exposure weighting was used to estimate the effect of PGC on WMH. Of 373 individuals, 96 (26%) had moderate-to-severe PGC and 86 (23%) had moderate-to-severe WMHs. Moderate-to-severe PGC and WMH were independently associated in a fully-adjusted logistic regression model (OR: 2.21; 95% C.I.: 1.19-4.11; p = 0.012). Inverse probability of exposure weighting showed an estimate for the proportion of moderate-to-severe WMH among those with none-to-mild PGC of 20.5%, and the exposure-effect was 13.2% higher among those with moderate-to-severe PGC (ß: 0.132; 95% C.I: 0.036-0.229; p = 0.007). The association found in this study provides grounds for further evaluation of the role of melatonin deficiency in cSVD development.


Assuntos
Calcinose/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Glândula Pineal/diagnóstico por imagem , Vigilância da População , Substância Branca/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Calcinose/epidemiologia , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Estudos de Coortes , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Prospectivos
17.
Circ Cardiovasc Imaging ; 12(12): e009570, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31813271

RESUMO

BACKGROUND: By virtue of its proximity to structures vital to cardiac conduction, aortomitral continuity calcification (AMCC) may help identify patients at highest risk for developing atrioventricular conduction disease requiring permanent pacemaker implantation (PPMI). We aim to determine the association of AMCC and need for PPMI after transcatheter aortic valve replacement. METHODS: Of 614 patients who underwent transcatheter aortic valve replacement (11.8% PPMI rate), we included 136 patients (age 85±8 years, 47% male) without a preexisting intracardiac device or prior valve surgery who underwent preprocedural computed tomography. We analyzed for the presence of AMCC, aortic valve calcification, and mitral annular calcification as well as quantified AMCC and aortic valve calcification score using the Agatston method. We further stratified AMCC score into 3 categories: 0, 1 to 300, and >300. End point was PPMI at 1 month after transcatheter aortic valve replacement. RESULTS: There were 51 (38%) new PPMIs (median time to PPMI, 5 days). Patients who underwent PPMI had a higher prevalence of AMCC than patients without PPMI (69% versus 32%; P<0.0001), as well as higher median AMCC score (263 versus 0; P<0.0001). There was no difference in aortic valve calcification and mitral annular calcification between patients with and without PPMI (all P≥0.09). Patients with AMCC had a 4-fold increase in odds for PPMI compared with those without (adjusted odds ratio, 4.0; P=0.0026). Compared with patients with an AMCC score of 0, patients with an AMCC score >300 had greater than a 5-fold increased odds for PPMI (adjusted odds ratio, 5.7; P=0.0016). CONCLUSIONS: Presence of AMCC, particularly with AMCC score >300, is associated with the need for PPMI after transcatheter aortic valve replacement.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Arritmias Cardíacas/terapia , Calcinose/cirurgia , Estimulação Cardíaca Artificial , Valva Mitral/cirurgia , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Calcinose/fisiopatologia , Feminino , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Cidade de Nova Iorque/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(44): e17548, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689756

RESUMO

BACKGROUND: The incidence of atrial fibrillation (AF) varies from 5.4% to 47.1% in patients with mitral annulus calcification (MAC). We conducted a systematic review and meta-analysis on the association between MAC and AF, as well as the relation between MAC and major cardiac adverse events (MACEs) in AF patients. METHODS: We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between MAC and AF, as well as the rates of MACEs in AF patients with or without MAC. RESULTS: Thirteen studies met our eligibility criteria on associations between MAC and AF, including 6232 patients with MAC and 15,199 patients without MAC. Moreover, 5 studies met our eligibility criteria on the rates of MACEs in AF patients with or without MAC. The pooled analysis demonstrated a statistically significant increased risk of development of incident AF in patients with MAC than those without MAC (random effects OR: 2.34; 95% CI: 1.91, 2.85; P = .000). And the pooled analysis demonstrated a statistically significant increased risk of development of MACEs in AF patients with MAC (random effects OR: 2.34; 95% CI: 1.24, 4.41; P = .009). CONCLUSION: MAC was independently associated with AF and AF patients with MAC were at greater risk for cardiovascular and cerebrovascular events.


Assuntos
Fibrilação Atrial/epidemiologia , Calcinose/epidemiologia , Cardiomiopatias/epidemiologia , Valva Mitral/patologia , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Humanos , Razão de Chances , Fatores de Risco , Fatores Sexuais
19.
PLoS One ; 14(10): e0224138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31648281

RESUMO

Thyroid calcification is frequent in thyroid nodules. The aim of our study was to evaluate the prevalence of calcifications in thyroid tissue samples of patients with various thyroid diseases, and to identify their composition according to their localization. Among 50 thyroid samples included, 56% were malignant (papillary carcinoma) and 44% were benign (adenoma, multinodular goiter, Graves' disease, sarcoidosis). Calcifications were found in 95% of samples using polarised light microscopy, whereas only 12% were described in initial pathological reports. Three types were individualised and analyzed by infrared spectrometry (µFTIR): colloid calcifications composed of calcium oxalate, capsular calcifications and psammoma bodies, both composed of calcium phosphate. Of notice, psammoma bodies characterized by FE-SEM were composed of concentric structure suggesting a slow process for crystal deposition. Calcium phosphates were found only in malignant samples whereas calcium oxalate was not associated with a define pathology. Proliferation assessed by KI67 staining was high (33% of positive follicles), and RUNX2, OPN, and CD44 positive staining were detected in thyrocytes with a broad variation between samples. However, thyrocyte proliferation and differentiation markers were not associated with the number of crystals. TRPV5 and CaSR expression was also detected in thyrocytes. mRNA transcripts expression was confirmed in a subgroup of 10 patients, altogether with other calcium transporters such as PMCA1 or Cav1.3. Interestingly, TRPV5 mRNA expression was significantly associated with number of colloid calcifications (rho = -0.72; p = 0.02). The high prevalence of calcium oxalate crystals within colloid gel raises intriguing issues upon follicle physiology for calcium and oxalate transport.


Assuntos
Calcinose/epidemiologia , Calcinose/patologia , Carcinoma Papilar/fisiopatologia , Neoplasias da Glândula Tireoide/fisiopatologia , Nódulo da Glândula Tireoide/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
20.
Presse Med ; 48(10): e284-e291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31653544

RESUMO

OBJECTIVE: The Prevalence of systemic sclerosis (SSc) and different clinical subsets varies across the world. Few data have been published on SSc patients in North Africa. Our objective was to describe a SSc cohort in south of Tunisia and to compare clinical findings, disease subsets and antibodies with other international SSc populations. METHODS: In this retrospective observational study, Folders of patients with SSc seen in the internal medicine section of the Hedi Chaker Hospital between 2000 and 2013 were retrospectively analyzed. The diagnosis of SSc was retained according to ACR/EULAR 2013 criteria. Patients were classified into diffuse cutaneous SSc and limited cutaneous SSc subsets. Comparison with other cohorts was made based on published information. RESULTS: A higher female: male ratio (8:1) and a higher diffuse subset prevalence (82%) was found in this Tunisian cohort comparing with others. We also found a lower prevalence of calcinosis and anticentromere antibodies. Within each subset, diffuse cutaneous and limited cutaneous scleroderma clinical findings were similar with other systemic sclerosis populations except for a very low prevalence in renal crisis and pulmonary hypertension. Our results indicate overlap syndrome defined as scleroderma associated with others connective tissue disorder's is a relatively common condition. CONCLUSION: With slight variations, perhaps due to genetic, environmental or referral factors, SSc in this cohort appears to be similar to that described in other part of the world.


Assuntos
Esclerodermia Limitada , Escleroderma Sistêmico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/epidemiologia , Centrômero/imunologia , Estudos Transversais , DNA Topoisomerases Tipo I/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Esclerodermia Limitada/complicações , Esclerodermia Limitada/diagnóstico , Esclerodermia Limitada/imunologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/imunologia , Tunísia , Adulto Jovem
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