Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.705
Filtrar
2.
J Cardiothorac Surg ; 15(1): 24, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31952521

RESUMO

BACKGROUND: Evaluate the safety and efficacy of our modified technique of the extravascular procedure for treating mild to moderately dilated ascending aorta in patients with bicuspid aortic valve (BAV) aortopathy. METHODS: From January 2015 to December 2018,119 consecutive patients with BAV and ascending aorta dilatation (dimension 40 mm~ 45 mm) were diagnosed in our institution. Among these,49 patients received aggressive aortic valve replace (AVR) + ascending aorta wrapped (wrapped group) while the other 70 patients received AVR + ascending aorta replacement (wheat group). All patients clinical and follow up data were collected for 12 months. RESULTS: Aortic clamping and cardio-pulmonary bypass times were significantly longer in wheat group than wrap group (P < 0.001and 0.021,respectively). The first 24 h drainage in wheat group were much more than wrap group(P = 0.04). Ascending aorta diameter、left ventricular end diameter and ejection fraction were statistically different between pre- and post-operation (p < 0.001) in both groups, but the heart function and complication were no difference during follow up. CONCLUSIONS: External wrapping of the ascending aorta and wheat procedure have good short-term and long-term results in BAV patients with a mild to moderately dilated ascending aorta. The perioperative period results of external wrapping of the ascending aorta for BAV patients were encouraging.


Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Doenças das Valvas Cardíacas/cirurgia , Idoso , Aorta/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
World Neurosurg ; 133: e259-e266, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31513955

RESUMO

OBJECTIVE: How Chiari malformation type I (CM-I) affects posterior fossa brain structures and produces various symptoms remains unclear. The fourth ventricle is surrounded by critical structures required for normal function. The foramen of Magendie can be obstructed in CM-I; therefore, fourth ventricle changes may occur. To test this hypothesis, we assessed fourth ventricle volume in CM-I compared with healthy controls. METHODS: Using our database from 2007-2016, we studied 72 patients with CM-I and 30 age-matched healthy control subjects. Fourth and lateral ventricle volumes and posterior fossa volumes (PFV) were assessed and correlated with clinical signs and symptoms. Statistical analysis was performed. RESULTS: Patients with CM-I had larger fourth ventricle volumes compared with control subjects (1.31 vs. 0.95 mL; P = 0.012). There were no differences in lateral ventricle volume or PFV. CM-I fourth ventricle volume was associated with tonsillar descent (P = 0.030). CM-I fourth ventricle volume variance was larger than healthy controls (F71,29 = 8.33; P < 0.0001). Patients with CM-I with severe signs and symptoms had a significantly larger fourth ventricle than patients with CM-I with mild signs and symptoms (1.565 vs. 1.015 mL; P = 0.0002). CONCLUSIONS: The fourth ventricle can be enlarged in CM-I independent of lateral ventricle size and is associated with greater tonsillar descent. Most importantly, fourth ventricle enlargement was associated with a worse clinical and radiographic presentation independent of PFV. Fourth ventricle enlargement can affect critical structures and may be a mechanism contributing to symptoms unexplained by tonsil descent. Fourth ventricle enlargement is a useful adjunct in assessing CM-I.


Assuntos
Malformação de Arnold-Chiari/patologia , Fossa Craniana Posterior/patologia , Quarto Ventrículo/patologia , Adolescente , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Criança , Pré-Escolar , Fossa Craniana Posterior/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/patologia , Encefalocele/diagnóstico por imagem , Encefalocele/etiologia , Feminino , Quarto Ventrículo/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Tamanho do Órgão , Estudos Prospectivos , Adulto Jovem
6.
Clin Exp Hypertens ; 42(1): 75-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30701983

RESUMO

Objectives: Recently, serum uric acid (UA) has emerged as an important independent risk factor for adverse outcomes in hypertension. The aim of the study was to evaluate the relationship between UA levels and ascending aortic dilatation (AAD) in newly diagnosed nondiabetic hypertensive subjects.Methods: A total of 818 patients with a new diagnosis of hypertension for which they had never received treatment were enrolled in this cross-sectional study. All patients underwent comprehensive transthoracic echocardiography measurement. AAD was defined as a diameter of ascending aorta equal to or more than 35 mm.Results: There were 302 patients with AAD (mean age 69 ± 11 years; 157 male) and 516 subjects with normal ascending aorta diameters (mean age 64 ± 12 years; 158 male). The correlation analysis pointed out positive correlations between ascending aorta size and serum UA levels (r = 0.30, P<0.001). In multiple logistic regression analysis, the OR of a 1 mg/dL increase in serum UA was 1.29(95% CI, 1.18 to 1.43; P < 0.001) for AAD. In reference to the first quartile, the prevalence of AAD increased such that the OR for the fourth quartile was 4.03 (95% CI, 2.38 to 6.82; P for trend < 0.001) of the serum UA concentration. The optimal UA cutoff value for detecting AAD was 6.45 mg/dL, based on receiver operating characteristic curve analysis with a sensitivity of 68.0% and a specificity of 70.0%.Conclusion: Serum UA concentration was significantly associated with AAD prevalence in newly diagnosed nondiabetic hypertensive patients.


Assuntos
Aorta/patologia , Hipertensão/sangue , Ácido Úrico/sangue , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Estudos Transversais , Dilatação Patológica/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco
8.
BMJ Case Rep ; 12(8)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31444255

RESUMO

Idiopathic localised dilatation of the intestine (ILDI) presenting in adults is rare and difficult to diagnose. Only 18 cases have been reported in the literature. We report a case of a 32-year-old woman presenting with abdominal pain and intermittent small bowel obstruction. After detailed radiological studies, the patient, known for Crohn's disease, was scheduled for laparoscopy in the suspicion of small bowel stricture. A localised dilatation of the ileum was found intraoperatively and subsequently resected. A systematic review of this rare pathology in adults is carried out. ILDI should be part of the differential diagnosis in patients with unexplained abdominal pain or gastrointestinal bleeding in the presence of segmental dilatation of the intestine. Surgical resection is the treatment of choice.


Assuntos
Doença de Crohn/diagnóstico , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Dor Abdominal/etiologia , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Feminino , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Tomografia Computadorizada por Raios X
10.
Cir Cir ; 87(4): 466-469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264980

RESUMO

Background: Anterior spinal artery syndrome, usually resulting in flaccid paraplegia, is a rare but disastrous complication that can occur after surgery of aortic aneurysms and aortic dissections. Spinal cord infarct as the initial clinical presentation of aortic dissection is a very rare finding. Case report: A 42-year-old male patient who comes to the emergency department due to severe chest pain associated with presyncope and paraplegia of the lower limbs in the context of type A aortic dissection. Conclusions: Recognizing this atypical clinical presentation of aortic dissection and knowing how to approach it is critical for an early diagnosis and to minimize the risk of spinal cord ischemia during surgery.


Assuntos
Aneurisma Dissecante/complicações , Síndrome da Artéria Espinal Anterior/etiologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Torácica/complicações , Paraplegia/etiologia , Adulto , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dor no Peito/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Am J Cardiol ; 124(4): 594-598, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208699

RESUMO

Tricuspid annular (TA) dilation is a key process in functional tricuspid regurgitation, but normal TA dimensions using cardiovascular magnetic resonance have not been established. We measured TA diameters in 66 healthy volunteers, aged 38 ± 11 years, during 3 different phases of the cardiac cycle (end-systole, early diastole, and end-diastole) and in 2 routinely acquired cardiovascular magnetic resonance imaging planes (4-chamber [4C] and right ventricular inflow-outflow [RVIO]). Three readers independently measured each value and 1 reader repeated measurements 1 month apart. The upper limit of normal (ULN) was calculated as 1.96 standard deviations above the mean. We assessed inter- and intraobserver reliability using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. We found the TA diameter largest during early diastole in the 4C view with an ULN of 43 mm (22 mm/m2). Men had larger absolute TA diameters (36 mm, 95% CI 27 to 44 mm) than women (30 mm, 95% CI 23 to 37 mm) but not after indexing for body surface area (both 18 mm/m2). In the RVIO view, the largest TA diameter occurred during early diastole with a ULN value of 46 mm (27 mm/m2). In this view, females had a larger indexed TA than men (21 mm/m2 vs 17 mm/m2). Reproducibility of measurements was excellent in all cardiac phases with an inter-rater ICC between 0.90 to 0.96 and an intrarater ICC 0.89 to 0.96. In conclusion, we have provided normative data regarding TA dimensions in routinely acquired 4C and RVIO views, and these values are larger than the current thresholds of annular dilation measured by echocardiography. Gender differences with the TA diameter in the RVIO view may be an important finding with consideration of future tricuspid devices.


Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Valva Tricúspide/diagnóstico por imagem , Adulto , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Reprodutibilidade dos Testes , Valva Tricúspide/anatomia & histologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem
14.
Gastrointest Endosc Clin N Am ; 29(2): 161-171, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30846146

RESUMO

Isolated biliary dilation, as an incidental diagnosis, is increasing owing to an increase in the use of noninvasive abdominal imaging and poses a diagnostic challenge to physicians especially when further noninvasive diagnostic testing fails to reveal an etiology. This article reviews available data describing the natural history of this clinical scenario and the impact of endoscopic ultrasound examination in the evaluation of unexplained dilation of the common bile duct.


Assuntos
Ductos Biliares/diagnóstico por imagem , Endossonografia , Ductos Biliares/patologia , Dilatação Patológica/sangue , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Humanos , Testes de Função Hepática , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
16.
J Coll Physicians Surg Pak ; 29(2): 178-180, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30700361

RESUMO

Ogilvie syndrome (acute colonic pseudo-obstruction) represents a clinical condition with symptoms of colonic obstruction without a distinct mechanical factor. The damage to the neural ganglia in the intestinal wall is the most likely etiology. A 62-year man was admitted to the Emergency Department due to acute dyspnea and vomiting. The patient had not defecated for 10 days prior to admission. An angio-CT revealed dilated colon, especially its left part, up to 85 mm with gas inside its lumen. During laparotomy, extremely dilated colon was confirmed with signs of the intestinal wall necrosis. A left sided hemicolectomy was performed. Despite the intensive treatment in the intensive care unit (ICU), the patient died on 3rd day after the surgery. In this case, the acute pseudo-obstruction of the large intestine was recognised late. This is due to overcrowding in this type of institution, overworked staff, and their inability to give individual attention to each patient.


Assuntos
Colectomia/métodos , Pseudo-Obstrução do Colo/diagnóstico por imagem , Pseudo-Obstrução do Colo/cirurgia , Dilatação Patológica/cirurgia , Doença Aguda , Pseudo-Obstrução do Colo/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico por imagem , Progressão da Doença , Serviço Hospitalar de Emergência , Evolução Fatal , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Vômito/diagnóstico , Vômito/etiologia
17.
BMC Pulm Med ; 19(1): 49, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795758

RESUMO

BACKGROUND: The term hepatopulmonary syndrome typically applies to cyanosis that results from "intrapulmonary vascular dilatation" due to advanced liver disease. Similar findings may result from a congenital portosystemic shunt without liver disease. An adverse consequence of such shunts is intrapulmonary vascular dilatation, which affects the microvascular gas exchange units for oxygen. CASE PRESENTATION: Here, we describe a toddler with chronic cyanosis, exercise intolerance, and finger clubbing due to a malformation shunt between the portal vein and the inferior vena cava. A transcatheter embolization of the shunt resulted in resolution of his findings. CONCLUSIONS: Congenital portosystemic shunts need to be considered in the differential diagnosis of cyanosis.


Assuntos
Cianose/etiologia , Osteoartropatia Hipertrófica Secundária/etiologia , Veia Porta/anormalidades , Malformações Vasculares/complicações , Veia Cava Inferior/anormalidades , Angiografia , Pré-Escolar , Dilatação Patológica/diagnóstico por imagem , Ecocardiografia , Embolização Terapêutica , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia , Veia Cava Inferior/diagnóstico por imagem
20.
Arq Bras Cir Dig ; 32(1): e1416, 2019 Jan 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30624525

RESUMO

BACKGROUND: Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. AIM: To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. METHODS: This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. RESULTS: It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. CONCLUSIONS: The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.


Assuntos
Colangiografia/métodos , Colangiopancreatografia por Ressonância Magnética/métodos , Coledocolitíase/diagnóstico por imagem , Adulto , Idoso , Sistema Biliar/diagnóstico por imagem , Colecistectomia/métodos , Coledocolitíase/cirurgia , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagem , Período Perioperatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Ultrassonografia/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA