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2.
Medicine (Baltimore) ; 98(45): e17877, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702657

RESUMO

RATIONALE: Budd-Chiari syndrome (BCS), which causes congestive hepatopathy and aggravates cirrhosis, is typically treated by interventional angioplasty to ameliorate blood flow. X-ray venography is useful for the evaluation of inferior vena cava (IVC) stenosis and determination of treatment timing, but it is invasive and thus unsuitable for repeated examinations. The development of a simple method for the prediction of IVC stenosis would reduce the burden on patients with BCS. PATIENT CONCERNS: We report here our experience of 2 patients with BCS who underwent percutaneous transluminal angioplasty (PTA). The first patient was a 39-year-old male who underwent PTA to expand his stenotic IVC. The second patient was a 19-year-old male who underwent PTA 3 times due to restenosis of his IVC. DIAGNOSES: Both patients were diagnosed with BCS with severe obstruction of the IVC. INTERVENTIONS: We evaluated the hepatic vein (HV) waveform by Doppler ultrasonography and measured liver stiffness (LS) using transient elastography (TE) before and after PTA. OUTCOMES: In case 1, the phasic oscillation of the HV waveform recovered and the LS value decreased after PTA. Both improvements were maintained for ∼3 years, reflecting the long-term patency of the IVC. In case 2, the HV waveform and the LS value improved temporarily after PTA, but then deteriorated gradually. Monitoring of the HV waveform and LS value allowed retreatment prior to total occlusion of the IVC and abrogated the risk of intravascular needle puncture. LESSONS: Monitoring of the HV waveform and the LS value enables safe management of patients with BCS who may require PTA.


Assuntos
Síndrome de Budd-Chiari/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Veias Hepáticas/diagnóstico por imagem , Adulto , Angioplastia com Balão , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Veias Hepáticas/cirurgia , Humanos , Masculino , Ultrassonografia Doppler , Adulto Jovem
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 243-249, sept.-oct. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183879

RESUMO

Depressed fractures that occur on the superior sagittal sinus (SSS) cause stenosis or thrombosis of the sinus in 11.5% of cases. Despite this, the appearance of signs and symptoms derived from high intracranial pressure is an infrequent event. So far, only 17 cases of venous sinus injury causing intracranial hypertension have been documented. It is necessary to establish treatment immediately before clinical suspicion. Surgical treatment by craniectomy is a fast, effective and safe alternative according to the series. However, it is necessary to anticipate the possibility of haemorrhage in the operating room. The case of a 7-year-old girl admitted for traumatic brain injury (TBI) with the diagnosis of a left parasagittal occipital sinus fracture that stenosed the posterior third of the superior sagittal sinus is presented. Upon arrival, she was asymptomatic, and conservative management was selected. Subsequently, the patient began to present with headache, nausea, vomiting and diplopia associated with bradycardia and apnoea pauses of central origin. She underwent surgery with a craniectomy with satisfactory clinical and radiological evolution and normalization of the intracranial pressure (ICP) registry


Las fracturas por hundimiento que acontecen sobre el seno sagital superior (SSS) ocasionan estenosis o trombosis del seno en el 11,5% de los casos. Sin embargo, en raras ocasiones ocasionan hipertensión intracraneal. La revisión de la literatura aporta únicamente 17 casos de fractura sobre senos venosos provocando cuadro de hipertensión intracraneal, aunque posiblemente se trata de una entidad más frecuente de lo que cabría esperar sobre lo publicado. Es necesario establecer un tratamiento de forma inmediata ante la sospecha clínica. El tratamiento quirúrgico mediante craniectomía es una alternativa rápida, eficaz y segura según las series. Sin embargo, es necesario estar anticipado en el quirófano ante la posibilidad de sufrir hemorragia. Se presenta el caso de una niña de 7 años que ingresa por traumatismo craneoencefálico con el diagnóstico de fractura por hundimiento occipital parasagital izquierda que estenosa el tercio posterior del SSS. A su llegada se encuentra asintomática y se decide manejo conservador. Posteriormente comienza con cefalea, náuseas, vómitos y diplopía asociado a bradicardia y pausas de apnea de origen central. Es intervenida mediante craniectomía con posterior evolución clínica y radiológica satisfactoria, y normalización de la presión intracraneal


Assuntos
Humanos , Feminino , Criança , Hipertensão Intracraniana/complicações , Seio Sagital Superior/lesões , Seio Sagital Superior/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia
4.
World Neurosurg ; 131: 137-140, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382069

RESUMO

BACKGROUND: The endoscopic endonasal approach for the craniovertebral junction (CVJ), instead of the microscopic transoral approach, has been widely adopted and accepted, especially in resection of the odontoid process for basilar invagination. However, there is concern regarding insufficient resection of odontoid and surgical complications, including vessel injuries, because this is a historically immature procedure. Here, we report a surgical case of endoscopic endonasal odontoidectomy (EEO) in the hybrid operating room (hOR) for improvement of its safety and reliability. CASE DESCRIPTION: A 70-year-old man presented with a 2-month history of myelopathic gait disturbance and swallowing disturbance. Neuroimaging analysis indicated medulla oblongata compression associated with basilar invagination. The patient underwent EEO in the hOR after posterior instrumented fixation. With the hOR, the extent of bone resection and anatomic orientation were confirmed intraoperatively. Postoperative course was uneventful, and symptoms were improved after surgery. CONCLUSIONS: The application of the hOR may make the EEO safe and precise for anterior decompression of the CVJ. To our knowledge, this is the first case report describing clinical experience of EEO in the hOR.


Assuntos
Cirurgia Endoscópica por Orifício Natural , Processo Odontoide/cirurgia , Cirurgia Assistida por Computador , Idoso , Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Encefalopatias/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Masculino , Salas Cirúrgicas , Cirurgia Assistida por Computador/métodos
5.
J Cardiothorac Surg ; 14(1): 141, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337418

RESUMO

BACKGROUND: Severe carotid and intracranial artery stenosis disease (CIAD) is major risk for perioperative stroke in coronary artery bypass grafting. Then, preoperative risk assessment is quite important. CASE PRESENTATION: A 58-years old Japanese woman with bilateral carotid stenosis and bilateral middle cerebral artery occlusion was suffered from worsening effort angina due to severe three coronary vessel disease. Magnetic resonance imaging angiography demonstrated severe carotid and intracranial vessel stenosis. Selective carotid/cerebral angiography also showed severe stenosis and delayed filling of the right internal carotid artery and moderate stenosis of the left internal carotid artery, with occlusion of the bilateral middle cerebral arteries. However, quantitative evaluation with brain perfusion, single-photon emission computed tomography (SPECT) with acetazolamide showed depleted cerebral perfusion volume and vascular responses, particularly in the left middle cerebral artery area. However, both sides of MCA reserve cerebral blood flow was maintained at > 34 ml/100 g/min. So, we finally considered that her cerebral perfusion reserve was maintained a certain level and could tolerate open heart surgery. Then, she underwent off-pump coronary artery grafting. Before sternotomy, prophylactic intra-aortic balloon pump support was used to minimize possible perioperative stroke. As a result, hemodynamic status and brain regional oxygen saturation were stable throughout the operation, and recovered uneventfully. CONCLUSIONS: Preoperative quantitative evaluation using brain perfusion SPECT with acetazolamide is useful in assessing hemodynamic cerebrovascular risk in patients with severe obstructive CIAD. Off pump coronary artery bypass grafting with intra aortic balloon pump assist is a good option for prevention of cerebrovascular morbidity in ischemic heart disease with severe CIAD.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Acetazolamida/administração & dosagem , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/cirurgia , Artérias Cerebrais/fisiopatologia , Artérias Cerebrais/cirurgia , Circulação Cerebrovascular , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Ponte de Artéria Coronária , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Medição de Risco , Acidente Vascular Cerebral/prevenção & controle , Tomografia Computadorizada de Emissão de Fóton Único
6.
World Neurosurg ; 130: e1111-e1115, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323417

RESUMO

BACKGROUND: The development of venous outflow stenosis in cerebral arteriovenous malformation (AVM) is poorly understood. The location of stenosis within the AVM draining vein in relation to the adjacent venous sinus and the hypothesis that the ratio of draining vein to adjacent sinus diameter might predict the development of venous stenosis were explored. METHODS: Patients with supratentorial AVMs (1997-2018) were reviewed (N = 290). AVM draining vein and adjacent venous sinus diameters, degree of draining vein stenosis, and distance from the maximal stenotic point to the junction of the adjacent draining sinus were recorded. Correlation between percentage of AVM draining vein stenosis and the ratio of AVM draining vein to venous sinus diameters was analyzed. RESULTS: A total of 360 draining veins in 243 AVMs with complete angiographic data were measured. Venous stenosis (in 131 draining veins) was observed within 20 mm of the junction to the adjacent draining sinus in 85% of our sample. The ratio of draining vein to adjacent sinus diameter correlated positively with the percentage of venous stenosis (P < 0.01, r = 0.21). The ratio between 0.51-1.0 and >1.0 showed significant tighter stenosis compared with the ratio ≤0.5 (25.9% and 28.9% vs. 10.0%, respectively; P < 0.01). CONCLUSIONS: AVM venous outflow stenosis is observed close to the adjacent venous sinus junction. The degree of venous stenosis is greater when the ratio of AVM draining vein/adjacent venous sinus diameter is >0.5. This may be related to more turbulent flow at the junction of the draining vein and venous sinus, especially in larger draining veins, which causes venous stenosis to develop over time.


Assuntos
Veias Cerebrais/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular/fisiologia , Criança , Pré-Escolar , Estudos de Coortes , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
7.
BMC Pulm Med ; 19(1): 119, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266473

RESUMO

BACKGROUND: There are few cases of multiple bronchial stenoses reported in the literature and none of the severity described here. The case is relevant due to its rareness, the pathophysiological insights derived, the successful interventional pulmonology strategies demonstrated, and as an example of a rare indication for high-risk lung transplantation. CASE PRESENTATION: A 47-year-old man developed multiple recurrent bronchial web-like stenoses five weeks after an episode of severe tracheo-bronchitis presumed secondary to a chemical inhalation injury which initially caused complete bilateral lung collapse necessitating veno-venous extracorporeal membrane oxygenation. The stenoses completely effaced bronchi in many locations causing severe type II respiratory failure requiring mechanical ventilation and bronchoscopic puncture / dilatation then ultimately bilateral lung transplantation. CONCLUSION: This very rare case highlights the morbid sequelae that can arise after catastrophic tracheobronchitis which now, in the era of extracorporeal membrane oxygenation, may be survivable in the short-term.


Assuntos
Broncopatias/diagnóstico , Constrição Patológica/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Traqueia/patologia , Broncopatias/induzido quimicamente , Broncoscopia , Queimaduras Químicas/complicações , Queimaduras por Inalação/complicações , Oxigenação por Membrana Extracorpórea , Humanos , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Respiração Artificial , Tomografia Computadorizada por Raios X
10.
BMC Neurol ; 19(1): 112, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164090

RESUMO

BACKGROUND: Internal jugular vein stenosis (IJVS), characterized by a series of clinical manifestations, such as head and neck symptoms, visual and ear symptoms, as well as sleep disorder, has been receiving attention in recent years. However, its' etiologies are not fully understood. CASE PRESENTATION: We report a cases series of IJVS induced by styloid oppression. We define it as the stylo-jugular type of Eagle syndrome (ES). CONCLUSIONS: Our study reveals that external oppression, especially by styloid process, is an important etiology of IJVS. The stylo-jugular ES diagnosis can be identified by Computed tomography venography. Whether stylo-jugular ES can be corrected by styloidectomy requires further investigation.


Assuntos
Veias Jugulares/patologia , Ossificação Heterotópica/complicações , Osso Temporal/anormalidades , Idoso , Angiografia por Tomografia Computadorizada , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Flebografia
11.
Int J Pediatr Otorhinolaryngol ; 125: 56-58, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254914

RESUMO

INTRODUCTION: Pediatric deep neck space infections (DNSI) may cause internal jugular vein and/or carotid artery narrowing. Radiologists and otolaryngologists are often queried by emergency room providers and pediatricians with regards to the clinical significance when this radiographic finding is noted. There are often questions raised about need for further imaging, anticoagulation and overall management strategy. There is limited data to support our answers to these questions. This study investigated the clinical significance of vessel narrowing of the internal jugular vein and carotid artery in the setting of DNSI in children. METHODS: 208 patients over a 10 year period were reviewed in retrospective fashion. CT scans reports were evaluated for vessel narrowing, and clinical outcomes were analyzed. RESULTS: This study found that nearly half (44.7%, 93 of 208) of pediatric DNSIs reviewed showed evidence of either carotid and/or internal jugular vein narrowing. There was no significant difference in vascular complications in those with vessel narrowing and those without (p = 0.09). There were no observed neurologic complications in either group. CONCLUSIONS: Vessel narrowing is a very common finding in pediatric DNSI. Vascular complications are very rare, and importantly no patients had neurologic complications in either group (vessel narrowing or not). We found no evidence to support more aggressive surgical management, getting further imaging, starting anticoagulation, nor changing overall management strategy for patients based solely to the finding of vessel narrowing in DNSI.


Assuntos
Abscesso/complicações , Estenose das Carótidas/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Abscesso Retrofaríngeo/complicações , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
Magn Reson Imaging ; 62: 87-93, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31247251

RESUMO

PURPOSE: Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) was developed for improved imaging of intraplaque hemorrhage (IPH). Its signal polarity also allows for non-contrast time-of-flight MR angiography (TOF). This study sought to compare SNAP and TOF in delineating carotid lumen using contrast-enhanced MRA (CE-MRA) as the reference standard. MATERIALS AND METHODS: Two hundred and eighty-nine matched slices from 15 arteries among 11 subjects (9 males and 2 females, mean age of 72.1 ±â€¯8.6 years) with luminal stenosis on CE-MRA were studied. Cross-sectional slices centered around the carotid bifurcation were matched between the three MRA techniques (SNAP, TOF, and CE-MRA) and classified as slices with or without plaque (focal wall thickness ≥ 1.5 mm) by additional black-blood vessel wall MRI. Lumen area was measured using a Sobel gradient map for TOF and CE-MRA (magnitude images) and a polarity map for SNAP. Agreement between techniques for measuring lumen area and percent stenosis was evaluated using intraclass correlation coefficient (ICC) and paired t-test. RESULTS: Among the 289 matched slices, SNAP showed a higher agreement with CE-MRA than TOF for measuring lumen area (ICC: 0.93 vs. 0.83; p = 0.03). Agreement with CE-MRA was high for both SNAP and TOF in slices without plaque (ICC: 0.91 vs. 0.89; p > 0.05) but favored SNAP over TOF in slices with plaque (ICC: 0.93 vs. 0.80; p = 0.02). CONCLUSION: SNAP, assisted by signal polarity information, demonstrated a higher agreement with CE-MRA in delineating carotid lumen compared to TOF, particularly in slices with plaque where flow conditions may be more complex.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Meios de Contraste/farmacologia , Angiografia por Ressonância Magnética , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/diagnóstico por imagem , Estudos Transversais , Feminino , Hemorragia , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Placa Amiloide/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
Vet Radiol Ultrasound ; 60(4): 423-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050093

RESUMO

Benign stricture is an uncommon cause of chronic small intestinal obstruction in the cat. The purpose of this retrospective case series was to describe the ultrasonographic features, histopathological findings, and clinical presentation in a group of cats with benign small intestinal stricture. Inclusion criteria were cats presenting during the period 2010-2017, and that had ultrasonography and small intestinal stricture confirmed at surgery. For each cat, clinical data and ultrasonographic findings were retrieved from the medical record, and histopathology, where available, was reviewed. Eight cats met the inclusion criteria. The location of strictures was duodenum (1/8), mid- to distal jejunum (4/8), and ileum (3/8). Ultrasonographic findings included gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction. Ingesta did not propagate beyond the strictured segment. Wall thickening was mild to moderate (3-6 mm). Normal wall layering was disrupted in all cats. Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8). Annular strictures (5/8) were less than 15 mm in length whereas long-segment strictures (3/8) were greater than 15 mm in length. Histopathology showed transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. The mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation. Clinical presentation reflected delayed diagnosis of chronic bowel obstruction with debilitation (8/8), marked weight loss (8/8), and prerenal azotemia (5/8). Benign fibrostenotic stricture should be considered a differential diagnosis in debilitated young cats presenting with chronic bowel disease and ultrasonographic features of intestinal obstruction.


Assuntos
Doenças do Gato/diagnóstico por imagem , Doenças do Gato/patologia , Fibrose/veterinária , Obstrução Intestinal/veterinária , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Ultrassonografia/veterinária , Animais , Gatos , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Constrição Patológica/veterinária , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Masculino , Estudos Retrospectivos
15.
World Neurosurg ; 128: 14-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054339

RESUMO

BACKGROUND: An epidermoid cyst arising from diploic space in the skull can cause an intracranial mass effect with compression of the underlying venous sinuses. CASE DESCRIPTION: A 66-year-old woman came to us with a persistent headache and unsteadiness. Computed tomography demonstrated an occipital bone cystic lesion with an intracranial mass effect overlying the torcular herophili, with high-intensity findings in diffusion-weighted magnetic resonance imaging. Cerebral angiogram demonstrated obstruction of the torcular herophili with development of diploic venous drainage. The patient underwent removal of the lesion and a cranioplasty procedure. The diagnosis was torcular epidermoid cyst. The postoperative course was uneventful, and the symptoms were resolved. CONCLUSIONS: Development of diploic venous drainage contributed to avoidance of critical intracranial hypertension during slow growth of a torcular epidermoid cyst.


Assuntos
Doenças Ósseas/complicações , Transtornos Cerebrovasculares/etiologia , Cavidades Cranianas , Cisto Epidérmico/complicações , Idoso , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cavidades Cranianas/patologia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Osso Occipital
16.
Cir Pediatr ; 32(2): 63-68, 2019 Apr 22.
Artigo em Espanhol | MEDLINE | ID: mdl-31056865

RESUMO

INTRODUCTION: In severe cases of pectus excavatum (PE) the sternal depression may cause distortion of the cardiac chambers and great vessels. The aim of our study was to determine if the sternal impingement causes significant inferior vena cava (IVC) compression. METHODS: Retrospective study of patients with severe PE assessed between 2015-2017. The antero-posterior (AP) and transverse diameters of the suprahepatic IVC were measured on a cardiac-MRI at the level of the diaphragmatic hiatus. Results were compared with patients that had a thoracic image study performed for other causes, adjusting for age and sex. RESULTS: Among the 81 patients, 28 cases and 53 controls, 63% were males and had a mean age of 12.9±0.5 yrs. Significant differences were found between groups in both AP and transverse diameter of the IVC: 13.3±0.75 mm vs. 15.8±0.76 mm (p=0.001) and 28.8±1.34 mm vs. 27.1±0.89mm (p=0.045) respectively. After adjusting for age and sex, these differences were only statistically significant for AP IVC diameter in males 12.7±0.5 mm (95% CI 11.66-13.79 mm) vs. 16.6±0.5 mm (95% CI 15.69-17.56 mm) (p=0.000). The Pearson correlation coefficient for the Haller index was r=0.471 (p=0.01). CONCLUSION: Male patients with severe sternal depression show changes in the IVC diameter that may correspond to compression. These changes are correlated with the severity of the deformity and can justify certain clinical symptoms and cardiac function abnormalities in patients with severe PE.


Assuntos
Tórax em Funil/complicações , Veia Cava Inferior/patologia , Adolescente , Estudos de Casos e Controles , Criança , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Feminino , Tórax em Funil/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem
17.
Diagn Interv Radiol ; 25(3): 231-237, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063137

RESUMO

PURPOSE: It is not easy to determine whether balloon angioplasty or stenting should be performed in patients with portal vein stenosis after liver transplantation. We aimed to propose appropriate indication by evaluating long-term outcomes of balloon angioplasty and stent insertion in adult liver transplant patients. METHODS: We retrospectively reviewed 31 patients with portal vein stenosis among 1369 patients who underwent adult liver transplantation from January 2001 to December 2015. When stenosis was confirmed by venography, angioplasty was performed first. When there was no flow improvement or pressure gradient was not decreased after angioplasty, stent insertion was performed. We also performed primary stent insertion without angioplasty for diffuse stenosis, kinking, external compression, and near occlusion of portal vein in venography. We assessed patency in patients who underwent percutaneous transluminal angioplasty and stent insertion through regular outpatient follow-up and evaluated technical and clinical success and long-term results. RESULTS: Technical success was 85% and 100% in balloon angioplasty and stent insertion, respectively. Clinical success was achieved in 78% of balloon angioplasties and in 100% of stent insertions. At 1, 5, and 10 years after balloon angioplasty, patency rates were 87%, 82%, and 68% respectively, and the rates of stent patency were all 100%. Portal vein size measured during the operation of patients with and without recurrence were 19±4.2 mm and 19±3.0 mm (P = 0.956), respectively. The balloon size of patients with and without recurrence were 11±1.95 mm and 14±1.66 mm, respectively (P = 0.013), when balloon angioplasty was performed after stenosis diagnosis. CONCLUSION: Stent insertion can be considered when fibrotic changes are expected due to repeated inflammation and when the balloon size to be used is small. Balloon angioplasty seems less risky for anastomotic ruptures in portal vein stenosis in the early post liver transplantation period.


Assuntos
Angioplastia com Balão/métodos , Constrição Patológica/terapia , Cirrose Hepática/terapia , Transplante de Fígado/estatística & dados numéricos , Veia Porta/patologia , Adulto , Angioplastia com Balão/efeitos adversos , Constrição Patológica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Cirrose Hepática/prevenção & controle , Masculino , Pessoa de Meia-Idade , Flebografia , Veia Porta/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Stents/normas , Resultado do Tratamento
18.
World Neurosurg ; 128: e1102-e1108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31103756

RESUMO

BACKGROUND: Concomitant atherosclerotic stenoses are commonly encountered in emergent large vessel occlusion. This study attempted to prove whether or not the pattern of atherosclerotic stenosis other than symptomatic occlusion is associated with pretreatment collateral status among patients with emergent large vessel occlusion. METHODS: The study included 115 patients with middle cerebral artery territory infarct within 6 hours of stroke onset who were considered for endovascular revascularization therapy. All patients underwent pretreatment conventional computed tomography angiography using a 128-detector high-definition computed tomography scanner. Based on maximum intensity projection images, ≤50% filling of the occluded territory was considered to indicate poor collaterals, whereas >50% filling was considered to indicate good collaterals. Finding of >50% stenosis on computed tomography angiography was considered significant, and the stenosis patterns were classified into intracranial atherosclerotic stenosis and extracranial atherosclerotic stenosis according to the location of the stenosis. RESULTS: All patients had symptomatic M1 (47.8%), M2 (20.0%), or internal carotid artery (32.2%) occlusion. There were 44 patients with poor collaterals (38.3%) and 71 patients with good collaterals (61.7%). Univariate analysis revealed that poor collateral status was associated with advanced age (≥65 years), hypertension, high National Institutes of Health Stroke Scale score, symptomatic internal carotid artery occlusion, and concomitant atherosclerotic stenosis. Multivariate analysis showed that poor collateral circulation was associated with concomitant intracranial atherosclerotic stenosis and symptomatic internal carotid artery occlusion (vs. a more distal occlusion). CONCLUSIONS: Concomitant intracranial atherosclerotic stenosis other than symptomatic occlusion might be a crucial factor associated with pretreatment collateral status among patients with emergent large vessel occlusion.


Assuntos
Aterosclerose/complicações , Transtornos Cerebrovasculares/complicações , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/terapia , Angiografia Cerebral , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , Angiografia por Tomografia Computadorizada , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos
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