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1.
J Med Case Rep ; 13(1): 293, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522686

RESUMO

BACKGROUND: A hip joint ganglion is a rare cause of lower-extremity swelling. CASE PRESENTATION: We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. CONCLUSIONS: Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.


Assuntos
Acetábulo/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Edema/fisiopatologia , Veia Femoral/fisiopatologia , Cistos Glanglionares/fisiopatologia , Veia Ilíaca/fisiopatologia , Idoso de 80 Anos ou mais , Constrição Patológica/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
2.
Eur J Radiol ; 118: 264-270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439253

RESUMO

PURPOSE: A multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn's disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence. METHODS: This was a retrospective study of 59 patients (mean age 40.8 ±â€¯16.1) with Crohn's disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data. RESULTS: On univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility. CONCLUSIONS: As previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.


Assuntos
Doença de Crohn/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Intestino Delgado , Adulto , Idoso , Constrição Patológica/patologia , Constrição Patológica/fisiopatologia , Doença de Crohn/patologia , Fístula Cutânea/etiologia , Fístula Cutânea/patologia , Fístula Cutânea/fisiopatologia , Feminino , Humanos , Inflamação/patologia , Fístula Intestinal/etiologia , Fístula Intestinal/patologia , Fístula Intestinal/fisiopatologia , Obstrução Intestinal/patologia , Intestinos/patologia , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Proc Inst Mech Eng H ; 233(10): 979-988, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31291847

RESUMO

A localized stenosis or aneurysm is a discontinuity that presents the pulse wave produced by the contracting heart with a reflection site. However, neither wave speed (c) in these discontinuities nor the size of reflection in relation to the size of the discontinuity has been adequately studied before. Therefore, the aim of this work is to study the propagation of waves traversing flexible tubes in the presence of aneurysm and stenosis in vitro. We manufactured different sized four stenosis and four aneurysm silicone sections, connected one at a time to a flexible 'mother' tube, at the inlet of which a single semi-sinusoidal wave was generated. Pressure and velocity were measured simultaneously 25 cm downstream the inlet of the respective mother tube. The wave speed was measured using the PU-loop method in the mother tube and within each discontinuity using the foot-to-foot technique. The stenosis and aneurysm dimensions and c were used to determine the reflection coefficient (R) at each discontinuity. Wave intensity analysis was used to determine the size of the reflected wave. The reflection coefficient increased with the increase and decrease in the size of the aneurysm and stenosis, respectively. c increased and decreased within stenosis and aneurysms, respectively, compared to that of the mother tube. Stenosis and aneurysm induced backward compression and expansion waves, respectively; the size of which was related to the size of the reflection coefficient at each discontinuity, increases with smaller stenosis and larger aneurysms. Wave speed is inversely proportional to the size of the discontinuity, exponentially increases with smaller stenosis and aneurysms and always higher in the stenosis. The size of the compression and expansion reflected wave depends on the size of R, increases with larger aneurysms and smaller stenosis.


Assuntos
Aneurisma/fisiopatologia , Constrição Patológica/fisiopatologia , Hemodinâmica , Fenômenos Mecânicos , Elasticidade , Cinética , Pressão
4.
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
5.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350227

RESUMO

A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.


Assuntos
Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Constrição Patológica/complicações , Veias Jugulares/patologia , Ligadura , Zumbido/etiologia , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Zumbido/fisiopatologia , Zumbido/cirurgia , Resultado do Tratamento
6.
Neurosci Lett ; 708: 134336, 2019 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-31220523

RESUMO

The ability to detect noxious stimuli is essential to survival. However, pathological pain is maladaptive and severely debilitating. Endogenous and exogenous opioids modulate pain responses via opioid receptors, reducing pain sensibility. Due to the high genetic and physiological similarities to rodents and humans, the zebrafish is a valuable tool to assess pain responses and the underlying mechanisms involved in nociception. Although morphine attenuates pain-like responses of zebrafish, there are no data showing if the antagonism of opioid receptors prolongs pain duration in the absence of an exogenous opioid. Here, we investigated whether a common opioid antagonist naloxone affects the abdominal constriction writhing-like response, recently characterized as a zebrafish-based pain behavior. Animals were injected intraperitoneally with acetic acid (5.0%), naloxone (1.25 mg/kg; 2.5 mg/kg; 5.0 mg/kg) or acetic acid with naloxone to investigate the changes in their body curvature for 1 h. Acetic acid elicited a robust pain-like response in zebrafish, as assessed by aberrant abdominal body curvature, while no effects were observed following PBS injection. Although naloxone alone did not alter the frequency and duration of this behavior, it dose-dependently prolonged acetic acid-induced abdominal curvature response. Besides reinforcing the use of the abdominal writhing-like phenotype as a behavioral endpoint to measure acute pain responses in zebrafish models, our novel data suggest a putative role of endogenous opioids in modulating the recovery from pain stimulation in zebrafish.


Assuntos
Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Dor/fisiopatologia , Dor Visceral/fisiopatologia , Abdome , Ácido Acético , Animais , Comportamento Animal , Constrição Patológica/induzido quimicamente , Constrição Patológica/fisiopatologia , Constrição Patológica/psicologia , Modelos Animais de Doenças , Dor/psicologia , Dor Visceral/induzido quimicamente , Dor Visceral/psicologia , Peixe-Zebra
7.
Med Sci Monit ; 25: 4051-4058, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31148547

RESUMO

BACKGROUND The aim of this study was to determine whether poor collaterals contribute to the occurrence of certain types of cognitive disorders in asymptomatic middle cerebral artery stenosis (MCAS). MATERIAL AND METHODS Patients aged ≥45 years with asymptomatic MCAS confirmed by computed tomography angiography were included in a single-center retrospective study. They did not have prior stroke or dementia. Within 7 days of admission, MRI and comprehensive neuropsychological assessment were performed. Cognitive assessment was conducted after 2 years. Two independent neuroradiologists evaluated intracranial collaterals by using the Miteff scale. Demographic date and Fazekas scores were collected. RESULTS A total of 173 patients with asymptomatic MCAS (66% men, mean age 59.4 years) and 42 controls (45% men, mean age 61.4 years) were enrolled. Executive function, attention, and information-processing speed in poor collateral circulation patients were more frequently and more often impaired than those in good collateral circulation patients. Throughout the study period, patients with poor collateral circulation had worse executive function, attention, and information-processing speed than those with moderate collateral circulation. Over time, MCAS patients with good collateral circulation did not show an association with cognitive function. CONCLUSIONS MCAS patients with moderate and poor collateral circulation have impairment of ≥1 cognitive domain over time. The affected domains are consistent with the profile of vascular cognitive impairment. Good collateral circulation is more important in patients with MCAS, and is associated with less risk of cognitive disorders.


Assuntos
Disfunção Cognitiva/fisiopatologia , Circulação Colateral/fisiologia , Infarto da Artéria Cerebral Média/fisiopatologia , Adulto , Idoso , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/complicações , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Transtornos Cerebrovasculares , Cognição/fisiologia , Disfunção Cognitiva/complicações , Angiografia por Tomografia Computadorizada/métodos , Constrição Patológica/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia
8.
Am J Otolaryngol ; 40(5): 645-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130270

RESUMO

PURPOSE: To assess the effectiveness of Buteyko breathing technique in patients with obstructive Eustachian tube dysfunction (ETD). MATERIALS AND METHODS: Fifty-one patients (77 ears) aged between 21 and 62 years were randomized to Buteyko breathing in conjunction with medical management (nasal steroid) group or medical management alone group. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up. RESULTS: Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05). CONCLUSIONS: Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery.


Assuntos
Exercícios Respiratórios/métodos , Constrição Patológica/fisiopatologia , Otopatias/terapia , Tuba Auditiva/fisiopatologia , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Otopatias/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Medição de Risco , Fatores Sexuais , Resultado do Tratamento , Manobra de Valsalva , Adulto Jovem
10.
Medicine (Baltimore) ; 98(15): e15081, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985660

RESUMO

This study aims to investigate the value of the ABCD score combined with the position of the offending vessel stenosis in predicting the risk of transient ischemic attack (TIA) to develop into cerebral infarction.The ABCD score and head magnetic resonance imaging + magnetic resonance angiography (MRA) results of 192 patients with TIA were retrospectively analyzed. With the 7th day as the endpoint time, these patients were divided into 3 groups, according to ABCD scores: low-risk group (n = 105), moderate-risk group (n = 60), and high-risk group (n = 27). Blood vessels were screened using head MRA results, and patients were accordingly divided into 2 groups: proximal vascular stenosis group (n = 71) and nonproximal vascular stenosis group (n = 171). Then, the association of the position of the intracranial vascular stenosis and ABCD score with short-term prognosis was analyzed.Based on the ABCD score, the incidence of cerebral infarction after 1 week was significantly higher in the high-risk group (85.7%) than in the moderate-risk group (16.7%) and low-risk group (1.9%), and the differences were statistically significant (P < .05). When the ABCD score was ≥4 points, the incidence of cerebral infarction after 1 week was significantly higher in the proximal vascular stenosis group (59.1%) than in the nonproximal vascular stenosis group (30.8%), and the difference was statistically significant (P < .05). When the ABCD score was <4 points, the incidence of cerebral infarction after 1 week in the proximal stenosis group (2%) was not significantly different from that in the nonproximal stenosis group (1.9%, P > .05).The ABCD score combined with proximal offending vessel stenosis can improve the short-term prediction of cerebral infarction in patients with TIA.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Infarto Cerebral/epidemiologia , Infarto Cerebral/fisiopatologia , Constrição Patológica/complicações , Constrição Patológica/diagnóstico , Constrição Patológica/epidemiologia , Constrição Patológica/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Feminino , Humanos , Incidência , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco
11.
Neurol Sci ; 40(Suppl 1): 59-70, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30838545

RESUMO

Available evidences suggest that a number of known assumption on idiopathic intracranial hypertension (IIH) with or without papilledema might be discussed. These include (1) the primary pathogenetic role of an excessive dural sinus collapsibility in IIH, allowing a new relatively stable intracranial fluids pressure balance at higher values; (2) the non-mandatory role of papilledema for a definite diagnosis; (3) the possibly much higher prevalence of IIH without papilledema than currently considered; (4) the crucial role of the cerebral compliance exhaustion that precede the raise in intracranial pressure and that may already be pathologic in cases showing a moderately elevated opening pressure; (5) the role as "intracranial pressure sensor" played by the trigeminovascular innervation of dural sinuses and cortical bridge veins, which could represent a major source of CGRP and may explain the high comorbidity and the emerging causative link between IIHWOP and chronic migraine (CM). Accordingly, the control of intracranial pressure is to be considered a promising new therapeutic target in CM.


Assuntos
Cavidades Cranianas/patologia , Hipertensão Intracraniana/fisiopatologia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/patologia , Constrição Patológica/fisiopatologia , Cavidades Cranianas/fisiopatologia , Humanos , Hipertensão Intracraniana/epidemiologia , Pressão Intracraniana/fisiologia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/fisiopatologia , Pseudotumor Cerebral/fisiopatologia
12.
Fluids Barriers CNS ; 16(1): 7, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30909935

RESUMO

BACKGROUND: Fluid homeostasis in the central nervous system (CNS) is essential for normal neurological function. Cerebrospinal fluid (CSF) in the subarachnoid space and interstitial fluid circulation in the CNS parenchyma clears metabolites and neurotransmitters and removes pathogens and excess proteins. A thorough understanding of the normal physiology is required in order to understand CNS fluid disorders, including post-traumatic syringomyelia. The aim of this project was to compare fluid transport, using quantitative imaging of tracers, in the spinal cord from animals with normal and obstructed spinal subarachnoid spaces. METHODS: A modified extradural constriction model was used to obstruct CSF flow in the subarachnoid space at the cervicothoracic junction (C7-T1) in Sprague-Dawley rats. Alexa-Fluor 647 Ovalbumin conjugate was injected into the cisterna magna at either 1 or 6 weeks post-surgery. Macroscopic and microscopic fluorescent imaging were performed in animals sacrificed at 10 or 20 min post-injection. Tracer fluorescence intensity was compared at cervical and thoracic spinal cord levels between control and constriction animals at each post-surgery and post-injection time point. The distribution of tracer around arterioles, venules and capillaries was also compared. RESULTS: Macroscopically, the fluorescence intensity of CSF tracer was significantly greater in spinal cords from animals with a constricted subarachnoid space compared to controls, except at 1 week post-surgery and 10 min post-injection. CSF tracer fluorescence intensity from microscopic images was significantly higher in the white matter of constriction animals 1 week post surgery and 10 min post-injection. At 6 weeks post-constriction surgery, fluorescence intensity in both gray and white matter was significantly increased in animals sacrificed 10 min post-injection. At 20 min post-injection this difference was significant only in the white matter and was less prominent. CSF tracer was found predominantly in the perivascular spaces of arterioles and venules, as well as the basement membrane of capillaries, highlighting the importance of perivascular pathways in the transport of fluid and solutes in the spinal cord. CONCLUSIONS: The presence of a subarachnoid space obstruction may lead to an increase in fluid flow within the spinal cord tissue, presenting as increased flow in the perivascular spaces of arterioles and venules, and the basement membranes of capillaries. Increased fluid retention in the spinal cord in the presence of an obstructed subarachnoid space may be a critical step in the development of post-traumatic syringomyelia.


Assuntos
Líquido Cefalorraquidiano , Constrição Patológica/fisiopatologia , Hidrodinâmica , Espaço Subaracnóideo/fisiopatologia , Siringomielia/fisiopatologia , Animais , Constrição Patológica/diagnóstico por imagem , Modelos Animais de Doenças , Corantes Fluorescentes , Masculino , Microscopia de Fluorescência , Imagem Óptica , Ratos Sprague-Dawley , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Medula Espinal/fisiopatologia , Espaço Subaracnóideo/diagnóstico por imagem , Siringomielia/diagnóstico por imagem
13.
J Atheroscler Thromb ; 26(10): 847-855, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30842350

RESUMO

AIM: Although the InnovaTM self-expanding nitinol stent (Boston Scientific, Marlborough, MA) exhibits acceptable performance in long-term safety and efficacy when used for the treatment of femoropopliteal (FP) lesions, clinical outcomes following its implantation have not been systematically studied in real-world settings. We investigated the one-year clinical outcomes after implantation of InnovaTM self-expanding nitinol stents for the treatment of FP lesions in real-world settings. METHODS: In this multicenter study, 481 lesions in 453 consecutive patients with peripheral artery disease (PAD) (74±9 years; male, 70%; diabetes mellitus, 61%; dialysis, 27%; critical limb ischemia, 37%) who underwent endovascular therapy with the implantation of InnovaTM self-expanding nitinol stents for FP lesions were analyzed from February 2016 to April 2017. The primary endpoint was one-year restenosis, whereas the secondary endpoints included one-year major adverse limb events and predictors for one-year restenosis. RESULTS: The mean lesion length was 18±10 cm. One-year restenosis and major adverse limb event rates were 36% and 18%, respectively. Multivariate analysis revealed that the presence of diabetes mellitus (odds ratio [OR]: 1.83; 95% confidence interval [CI]: 1.07-3.13), distal reference vessel diameter (OR: 1.86; 95% CI: 1.09-3.16), spot stenting (OR: 2.27; 95% CI: 1.27-4.06), and lack of one-year cilostazol treatment (OR: 0.58; 95% CI: 0.33-1.00) were independent risk factors for one-year restenosis. CONCLUSION: The current study demonstrated one-year clinical outcomes after InnovaTM self-expanding nitinol stent placement for the treatment of FP lesions, including challenging cases in real-world settings.


Assuntos
Ligas/química , Constrição Patológica/fisiopatologia , Artéria Femoral/fisiopatologia , Doença Arterial Periférica/terapia , Artéria Poplítea/fisiopatologia , Stents , Idoso , Feminino , Seguimentos , Humanos , Masculino , Doença Arterial Periférica/patologia , Resultado do Tratamento
14.
Facial Plast Surg ; 35(1): 14-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30759457

RESUMO

A clinical study was conducted to determine the effect of nasal valve lift treatment using absorbable, polylactic acid, self-retaining cone threads (Silhouette Soft) in patients with nasal valve stenosis. Sixty patients (n = 60) were included in this prospective study which was performed from January 2015 until December 2018, 19 patients dropped out due to noncompliance. Initially, participants were divided into two equal groups. One was treated by nasal valve lift only, the other additionally received turbinoplasty. A visual analog scale (VAS) was used to rate the sense of nasal ventilation. Patients' satisfaction was examined by a categorical scale, preoperatively, after 1 week, and after 1, 6, 12, 18, and 24 months. For statistical analysis, an univariant variance analysis was conducted to test the significance of differences in nasal breathing within one group at different points of postoperative controls, with the statistical significance set at p < 0.05. Moreover, the two groups were compared with each other regarding results of the categorical scale. After surgical treatment, an improvement is reported by all participants. Average VAS scores were significantly lower between preoperative and every postoperative rating. Although a decline in the effect of breathing improvement is recognizable as threads are dissolved, patients' satisfaction in improvement of nasal breathing is persistent in most cases, even at long-term observation. Overall, these results demonstrate that valve lift is an effective method to treat patients with nasal valve stenosis.


Assuntos
Cavidade Nasal/patologia , Obstrução Nasal/cirurgia , Rinoplastia/métodos , Suturas , Implantes Absorvíveis , Adulto , Idoso , Resistência das Vias Respiratórias , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/fisiopatologia , Satisfação do Paciente , Poliésteres , Estudos Prospectivos , Rinoplastia/instrumentação , Conchas Nasais/cirurgia , Escala Visual Analógica , Adulto Jovem
15.
Med Eng Phys ; 65: 8-23, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30745099

RESUMO

The development of atherosclerosis at the carotid bifurcation is impacted by local variations in wall shear stress (WSS) magnitude and direction, as well as flow complexity within the vessel. In this study, stereoscopic particle image velocimetry (PIV) was used to investigate multidirectional WSS and disturbed flow for idealized models of the carotid bifurcation with varying eccentric stenosis of the internal carotid artery (ICA) and both Newtonian (N-fluid) and non-Newtonian (nN-fluid) blood analogues. Turbulence intensity (TI) was reduced with the nN-fluid compared to N-fluid for mild to moderate stenosis, and comparable for more severely stenosed (70%) models. Differences in maximum TI due to viscosity model ranged from 0.02 m/s to 0.06 m/s compared to much larger differences due to geometry of up to 0.29 m/s between mild and severe stenosis. The level of time-averaged WSS (TAWSS) increased with stenosis severity from 5 Pa to 32 Pa, and nN-fluid led to higher WSS on average than N-fluid counterparts. Regions of elevated oscillatory shear index (OSI) demarcated recirculation regions, and mean OSI in the ICA branch was reduced for nN-fluid models by 9-19% compared to N-fluid. Transverse WSS (transWSS) increased with WSS magnitude and again was higher in nN-fluid models. Surface area exposure to shear metrics indicated that a Newtonian viscosity assumption predicted larger regions of low and oscillatory WSS, while predicting reduced regions of high transWSS, in comparison to the more physiological shear thinning fluid.


Assuntos
Artérias Carótidas/fisiopatologia , Constrição Patológica/fisiopatologia , Reologia , Resistência ao Cisalhamento , Estresse Mecânico , Fenômenos Biomecânicos , Modelos Biológicos , Viscosidade
16.
BMJ Case Rep ; 12(2)2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30755426
17.
Thromb Haemost ; 119(2): 308-318, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30605919

RESUMO

Recently, internal jugular vein stenosis (IJVS) is gaining increasing attention from clinical researchers due to a series of confounding symptoms that impair the quality of life in affected individuals but cannot be explained by other well-established causes. In this study, we aimed to elucidate the clinical features, neuroimaging characteristics and pathogenesis of IJVS, and explore their possible correlations, in attempt to provide useful clues for clinical diagnosis and treatment. Forty-three eligible patients with unilateral or bilateral IJVS confirmed by contrast-enhanced magnetic resonance venography of the brain and neck were enrolled in this study. Magnetic resonance imaging along with magnetic resonance angiography or computed tomography angiography was applied to identify the radiological pattern of parenchymal or arterial lesions. Cerebral perfusion and metabolism were evaluated by single-photon emission computed tomography (SPECT). Of the 43 patients (46.0 ± 16.0 years old; 30 female), 14 (32.6%) had bilateral and 29 had unilateral IJVS. The common clinical symptoms at admission were tinnitus (60.5%), tinnitus cerebri (67.6%), headache (48.8%), dizziness (32.6%), visual disorders (39.5%), hearing impairment (39.5%), neck discomfort (39.5%), sleep disturbance (60.5%), anxiety or depression (37.5%) and subjective memory decline (30.2%). The presence of bilateral demyelination changes with cloudy-like appearance in the periventricular area and/or centrum semiovale was found in 95.3% (41/43) patients. SPECT findings showed that 92.3% (24/26) patients displayed cerebral perfusion and metabolism mismatch, depicted by bilaterally and symmetrically reduced cerebral perfusion and increased cerebral glucose consumption. IJVS may contribute to alterations in cerebral blood flow and metabolism, as well as white matter lesion formation, all of which may account for its clinical manifestations.


Assuntos
Veias Jugulares/fisiopatologia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Neuroimagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Ansiedade/complicações , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Estudos de Coortes , Constrição Patológica/fisiopatologia , Depressão/complicações , Feminino , Cefaleia/complicações , Perda Auditiva/complicações , Humanos , Masculino , Transtornos da Memória/complicações , Pessoa de Meia-Idade , Flebografia/métodos , Projetos Piloto , Qualidade de Vida , Fatores de Risco , Zumbido/complicações , Transtornos da Visão/complicações
18.
J Thromb Thrombolysis ; 48(1): 61-67, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30689154

RESUMO

Internal jugular vein (IJV) stenosis and cerebral venous sinus (CVS) stenosis belong to cerebral venous outflow insufficiency. This study aimed to analyze the similarities and differences between IJV stenosis and CVS stenosis. Patients with either IJV stenosis or CVS stenosis confirmed by contrast-enhanced magnetic resonance venography between October 2017 and July 2018 were enrolled in this retrospective study. The similarities and differences between IJV stenosis and CVS stenosis on the aspects of clinical and imaging features were compared. A total of 82 eligible patients entered into the final analysis. The similarities of the two subsets of cerebral venous outflow insufficiency mainly included headache, head noises or tinnitus, visual disorders, and sleeping disorders, as well as cloud-like white matter hyperintensity in T2WI and FLAIR sequences of MRI. However, there were differences in between, the ratio of patients with higher intracranial pressure (ICP) was common in CVS stenosis (p < 0.001). Namely, higher ratios of papilledema (p = 0.001) and visual damage (p = 0.029), as well as poor Frisen papilledema grade scores were more commonly observed in CVS stenosis (p = 0.004), while abnormal collateral-vessels appeared more frequently in IJV stenosis (100.00%) than CVS stenosis (28.57%). Continuous head noises, tinnitus and cloud-like white matter hyperintensity in MRI are the features of both IJV stenosis and CVS stenosis. Whereas, severe headache, visual damage, papilledema, and intracranial hypertension (IH) were more common in CVS stenosis, and the appearance of collateral-vessels is a key feature of IJV stenosis.


Assuntos
Veias Cerebrais/patologia , Constrição Patológica/patologia , Veias Jugulares/patologia , Insuficiência Venosa/patologia , Adulto , Constrição Patológica/fisiopatologia , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Papiledema/etiologia , Estudos Retrospectivos , Zumbido/etiologia , Transtornos da Visão/etiologia
19.
Med Hypotheses ; 123: 86-88, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30696602

RESUMO

Cerebral arteriovenous malformations (AVMs) are an uncommon vascular anomaly that carry the risk of rupture and hemorrhage. Several factors have been implicated in the propensity of an AVM to bleed. One such factor is stenosis of AVM draining veins, as impairment of the AVM venous drainage system is associated with increased risk of intracranial hemorrhage. Currently, our understanding of the pathogenesis of AVM venous outflow stenosis is limited, as there is insufficient data on the blood flow patterns and local hemodynamic parameters of these draining veins. The angioarchitecture of AVMs features a nidus lacking a high resistance capillary network. Accordingly, our previous studies on AVM arterial feeders have demonstrated an abnormally high flow volume rate along with low pulsatility and resistance indices on quantitative magnetic resonance angiography. As such, AVM vessels endure high, non-physiologic levels of flow that may partially contribute to ectasia or stenosis depending on whether wall shear stress (WSS) is high or low, respectively. We hypothesize that AVM venous outflow stenosis occurs most commonly near the junction of the draining vein and the dural venous sinus. Increased flow volume rate through the AVM circuit coupled with the variation in compliance and rigidity between the walls of the draining vein and the dural venous sinus likely create turbulence of blood flow. The resulting flow separation, low WSS, and departure from axially aligned, unidirectional flow may create atherogenic conditions that can be implicated in venous intimal hyperplasia and outflow stenosis. We have previously found there to be a significant association between intimal hyperplasia risk factors and venous outflow stenosis. Additionally, we have found a significant association between age and likelihood as well as degree of stenosis, suggesting a progressive disease process. Similar conditions have been demonstrated in the pathophysiology of stenosis of the carotid artery and dialysis arteriovenous fistulas. In both of these conditions, the use of computational fluid dynamics (CFD) has been employed to characterize the local hemodynamic features that contribute to the pathogenesis of intimal hyperplasia and stenosis. We recommend the utilization of CFD to characterize the anatomic and hemodynamic features of AVM venous outflow stenosis. An improved understanding of the possible causative features of venous outflow stenosis may impact how clinicians choose to manage the treatment of patients with AVMs.


Assuntos
Fístula Arteriovenosa/fisiopatologia , Circulação Cerebrovascular , Constrição Patológica/fisiopatologia , Hemodinâmica , Malformações Arteriovenosas Intracranianas/fisiopatologia , Idoso , Veias Cerebrais , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
20.
Clin Neuroradiol ; 29(2): 321-329, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29464268

RESUMO

PURPOSE: To investigate the cerebral macrovascular changes as well as the relationship of large vessels and cerebral blood flow (CBF) in mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) using magnetic resonance angiography (MRA) and arterial spin labeling (ASL) perfusion MR imaging (MRI). METHODS: A total of 20 patients diagnosed with MELAS (12 males, 8 females; mean age, 23.3 years) underwent conventional MRI, time-of-flight (TOF) MRA and three dimensional ASL. Follow-up scans were performed in 10 patients. The changes of cerebral arteries and branches on MRA images from both acute and recovery patients were independently evaluated by two radiologists. Lesion distribution and CBF were observed on the integrated maps of MRA and ASL. RESULTS: In 14 patients with clinical onsets, increased CBF was observed in all stroke-like lesions. Dilations of a single artery (four middle cerebral arteries, two posterior cerebral arteries) were found in six patients. Dilations of multiple arteries (two anterior cerebral arteries, seven middle cerebral arteries, six posterior cerebral arteries) were found in seven patients. Normal angiography was shown in one acute patient. Cortical terminal branches feeding the lesion areas were more obviously dilated than the main trunks. The dilated vessels returned to normal on follow-up scans concurrently with decreased CBF in nine patients who were resuscitated from episode attacks. Vasodilation was even seen in one preclinical patient who suffered a recurrent episode 50 days later. CONCLUSION: Reversible dilation of cerebral macrovascular changes could be a new feature of MELAS and a presumed reason for fluctuant CBF. It would shed new light on the mitochondrial angiopathy.


Assuntos
Doenças Arteriais Cerebrais/patologia , Síndrome MELAS/patologia , Doença Aguda , Doenças Arteriais Cerebrais/fisiopatologia , Circulação Cerebrovascular/fisiologia , Constrição Patológica/patologia , Constrição Patológica/fisiopatologia , Feminino , Humanos , Síndrome MELAS/fisiopatologia , Angiografia por Ressonância Magnética/métodos , Masculino , Artéria Cerebral Média/patologia , Artéria Cerebral Média/fisiologia , Artéria Cerebral Posterior/patologia , Artéria Cerebral Posterior/fisiologia , Estudos Prospectivos , Vasodilatação/fisiologia , Adulto Jovem
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