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1.
J Surg Res ; 246: 1-5, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31541708

RESUMO

BACKGROUND: Intestinal atresia is a congenital defect resulting in intestinal discontinuity and can be associated with significant morbidity related to intestinal failure. The bowel proximal to the atresia is often significantly dilated and dysfunctional. The treatment approaches of this dilated bowel include resection with primary anastomosis versus tapering enteroplasty with preservation of bowel length. The purpose of this study was to compare these two approaches in regard to bowel function as characterized by the time to full enteral feeding. METHODS: A retrospective review was performed of intestinal atresia repair performed at a tertiary referral pediatric hospital from 2007 to 2017. Length of stay, time to full enteral feeds, and complications were assessed in patients who underwent repair with tapering enteroplasty (n = 8) and compared with those who underwent resection and anastomosis (n = 39). RESULTS: The median age at surgery, gender distribution, weeks gestational age (WGA), location of the atresia, and comorbidities were similar between the two groups. Overall, there was no statistically significant difference in length of stay and time to full enteral feeds between groups. Three of eight (38%) patients in the tapered group and five of 39 patients (13%; P = 0.12) in the nontapered group underwent further surgical exploration because of bowel dysmotility. Factors associated with longer length of hospital stay were abdominal reoperation and WGA, and factors associated with longer time to full enteral feeds were WGA, abdominal reoperation, and gastroschisis. CONCLUSIONS: Tapering enteroplasty at initial operation for intestinal atresias preserves bowel length and has statistically equivalent outcomes to resection and anastomosis in regard to the length of stay and time to full enteral feeds.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Nutrição Enteral/estatística & dados numéricos , Atresia Intestinal/cirurgia , Intestino Delgado/anormalidades , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Motilidade Gastrointestinal , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/complicações , Intestino Delgado/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(39): e17079, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574807

RESUMO

Advancements in diagnostic modalities have improved the diagnosis of meconium peritonitis (MP) both in utero and ex utero. This study aimed to determine the efficacy of prompt prenatal and postnatal diagnoses of MP on the postnatal outcomes of these patients.We conducted a retrospective chart review of neonates with MP admitted to the Mackay Memorial Hospital Systems from 2005 to 2016. The prenatal diagnoses, postnatal presentations, surgical indications, operative methods, types of MP, operative findings, associated anomalies, morbidities, patient outcomes, and survival rates were analyzed. Morbidities included postoperative adhesion ileus, bacteremia, and short bowel syndrome. We also performed subgroup analyses of the morbidity and survival rates of prenatally versus postnatally diagnosed patients, as well as inborn versus outborn neonates.Thirty-seven neonates with MP were enrolled. Of this number, 24 (64.9%) were diagnosed prenatally. Twenty-two (59.5%) were born preterm. The most common prenatal sonographic findings included fetal ascites followed by dilated bowel loops. Abdominal distention was the most frequent postnatal symptom. Thirty-four (91.9%) neonates underwent surgery, whereas 3 were managed conservatively. Volvulus of the gastrointestinal tract was the most frequent anatomic anomaly. The total morbidity and survival rates were 37.8% and 91.9%, respectively. The morbidity and survival rates did not differ significantly between prenatally and postnatally diagnosed patients (37.5% vs 33.3%, P = 1.00; 91.7% vs 92.3%, P = 1.00, respectively). Inborn and outborn patients did not differ in terms of morbidity and survival rates (27.3% vs 53.3%, P = .17; 100% vs 80.0%, P = .06, respectively).Although not statistically significant, inborn MP neonates had higher survival rates when compared with outborn MP neonates. Prompt postnatal management at tertiary centers seemed crucial.


Assuntos
Mecônio , Peritonite/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ascite/etiologia , Dilatação Patológica/etiologia , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Volvo Intestinal/etiologia , Intestinos/patologia , Avaliação de Resultados da Assistência ao Paciente , Peritonite/complicações , Peritonite/mortalidade , Peritonite/terapia , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento
3.
Khirurgiia (Mosk) ; (6): 88-93, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317946

RESUMO

Optimal surgical strategy for secondary tricuspid regurgitation is still under discussion. First of all, this is due to rare organic disease of tricuspid valve and tricuspid regurgitation is almost always classified as secondary insufficiency. Fibrous annulus enlargement of tricuspid valve is the most common cause of tricuspid regurgitation. Annular dilatation may by the result of left ventricular failure due to myocardial or valvular diseases, right ventricular enlargement, pressure or volume overload. No surgical correction of tricuspid insufficiency during cardiac surgery for other leading disease aggravates short- and long-term results. Considering the wide interest and disputes around optimal surgical strategy for tricuspid regurgitation, this review is devoted to modern methods of surgical treatment of secondary tricuspid insufficiency.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Humanos , Insuficiência da Valva Tricúspide/etiologia
4.
Cardiol Young ; 29(5): 564-569, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31111802

RESUMO

INTRODUCTION: This research investigated patients who underwent surgery for a dilated aorta associated with a connective tissue disease or inflammatory vasculitis in children and adolescents. MATERIALS AND METHODS: The medical records of 11 patients who underwent aortic surgery for dilatation resulting from a connective tissue disease or inflammatory vasculitis between 2000 and 2017 were retrospectively reviewed. RESULTS: The median age and body weight of the patients were 9.6 years (range 5.4 months-15.5 years) and 25.8 kg (range 6.8-81.5), respectively. The associated diseases were Marfan syndrome (n = 3), Loeys-Dietz syndrome (n = 3), Kawasaki disease (n = 1), Takayasu arteritis (n = 1), PHACE syndrome (n = 1), tuberous sclerosis (n = 1), and unknown (n = 1). The most common initially affected area was the ascending aorta. During the 66.4 ± 35.9 months of follow-up, two Marfan syndrome patients died, and four patients (one Marfan syndrome and three Loeys-Dietz syndrome) had repeated aortic operation. Except for one patient, the functional class was well maintained in all patients who were followed up. CONCLUSION: Cases of surgical treatment for a dilated aorta associated with a connective tissue disease and inflammatory vasculitis are rare in children and adolescents at our institution. Most of the patients in this study showed a tolerable postoperative course. However, the aorta showed progressive dilation over time even after surgical treatment, especially in patients with Loeys-Dietz syndrome. In these patients, close and more frequent regular follow-up is required.


Assuntos
Aorta Torácica/patologia , Aorta Torácica/cirurgia , Doenças do Tecido Conjuntivo/complicações , Dilatação Patológica/cirurgia , Vasculite/complicações , Adolescente , Criança , Pré-Escolar , Doenças do Tecido Conjuntivo/fisiopatologia , Dilatação Patológica/etiologia , Feminino , Humanos , Masculino , Reoperação , República da Coreia , Estudos Retrospectivos , Vasculite/fisiopatologia
5.
Pediatr Cardiol ; 40(6): 1134-1143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31087143

RESUMO

The effect of pregnancy on aortic root in women with repaired conotruncal anomalies (CTA) has not been clarified. This study examined aortic diameters during and after pregnancy in women with repaired CTA. A retrospective review of consecutive pregnant women with repaired CTA was performed for results of echocardiography from 1 year before pregnancy to 3 years after delivery and compared with findings from healthy pregnant volunteers. Participants comprised 42 subjects and 49 deliveries with repaired CTA (CTA group), and 47 healthy pregnant women (control group). Although no maternal aortic events were encountered, aortic diameters during pregnancy increased by 1.0 ± 2.2 mm (maximum, 7.0 mm) in the CTA group and 0.6 ± 1.3 mm (maximum, 3.4 mm) in the control group (p = 0.13). The CTA subgroup with increase in aortic diameter ≥ 3.5 mm during pregnancy showed no reversion to baseline diameter at follow-up > 6 months after delivery. Significant risk factors for increased aortic diameter and no reversal included pulmonary atresia, history of aortopulmonary shunt, older age at repair, and smaller left ventricular end-diastolic diameter pre-pregnancy. Women with repaired CTA tolerated pregnancy and delivery well. However, the aortic root progressively dilated during pregnancy and 1/4 of them, especially those with longstanding high aortic blood flow before repair, showed an increase of aortic root size of ≥ 3.5 mm during the peripartum period; this dilatation tended not to revert to the pre-pregnancy diameter. Therefore, serial measurement of the aortic root during pregnancy and after delivery is recommended in these women.


Assuntos
Aorta/patologia , Valva Aórtica/patologia , Seio Aórtico/patologia , Adulto , Fatores Etários , Aorta/anormalidades , Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Parto Obstétrico/efeitos adversos , Dilatação Patológica/etiologia , Ecocardiografia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Gravidez , Atresia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Fatores de Tempo
6.
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
7.
Obstet Gynecol ; 133(3): 503-505, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30741808

RESUMO

BACKGROUND: Urethral coitus can occur with vaginal and hymenal anomalies and typically presents with incontinence, dyspareunia, and recurrent urinary infections. Penetration of the urethra occurs unknowingly, and delayed diagnosis permits ongoing urethral coitus and dilation. CASE: A 23-year-old woman presented to a specialty clinic for a possible vaginal anomaly after failed intrauterine device insertion owing to difficulty locating the cervix. She reported regular menses and satisfying intercourse. Clinical examination revealed a dilated urethra from presumed urethral intercourse and a microperforate hymen with a 1-mm opening. CONCLUSION: This case highlights the importance of taking a thorough sexual history paired with careful examination of the external genitalia to correctly identify and diagnose vaginal and hymenal anomalies and to prevent long-term complications.


Assuntos
Coito , Hímen/anormalidades , Uretra/patologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/cirurgia , Diagnóstico Tardio , Dilatação Patológica/etiologia , Feminino , Humanos , Hímen/cirurgia , Adulto Jovem
8.
J Refract Surg ; 35(1): 6-14, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30633782

RESUMO

PURPOSE: To evaluate extracellular matrix regulators and inflammatory factors in a patient who developed ectasia after small incision lenticule extraction (SMILE) despite normal preoperative tomographic and biomechanical evaluation. METHODS: The SMILE lenticules from both eyes of the patient with ectasia and three control patients (5 eyes) matched for age, sex, and duration of follow-up were used for gene expression analysis of lysyl oxidase (LOX), matrix metalloproteinase 9 (MMP9), collagen types I alpha 1 (COLIA1) and IV alpha 1 chain (COLIVA1), transforming growth factor-beta (TGF-beta), bone morphogenetic protein 7 (BMP7), interleukin-6 (IL-6), cathepsin K, cluster of differentiation 68, integrin beta-1, and tissue inhibitor of metalloproteinase-1 (TIMP1). Furthermore, the functional role of LOX was assessed in vitro by studying the collagen gel contraction efficiency of LOX overexpressing in primary human corneal fibroblast cells. RESULTS: Preoperatively, manifest refraction was -9.25 diopters (D) in the right eye and -10.00 D in the left eye. Corneal thickness, Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Germany) tomography, and Corvis biomechanical indices (OCULUS Optikgeräte GmbH) were normal. The ectatic eye lenticule (left) had reduced expression of LOX and COLIA1 compared to controls without ectasia. Increased mRNA fold change expression of TGF-beta, BMP7, IL-6, cathepsin K, and integrin beta-1 was noted in the ectatic left eye compared to controls; however, MMP9 and TIMP1 levels were not altered. Ectopic LOX expression in human corneal fibroblast induced significantly more collagen gel contraction, confirming the role of LOX in strengthening the corneal stroma. CONCLUSIONS: Reduced preexisting LOX and collagen levels may predispose clinically healthy eyes undergoing refractive surgery to ectasia, presumably by corneal stromal weakening via inadequately cross-linked collagen. Preoperative molecular testing may reveal ectasia susceptibility in the absence of tomographic or biomechanical risk factors. [J Refract Surg. 2019;35(1):6-14.].


Assuntos
Biomarcadores/metabolismo , Substância Própria/metabolismo , Cirurgia da Córnea a Laser/efeitos adversos , Ceratocone/etiologia , Miopia/cirurgia , Adulto , Células Cultivadas , Ceratócitos da Córnea/metabolismo , Topografia da Córnea , Citocinas/genética , Citocinas/metabolismo , Dilatação Patológica/etiologia , Dilatação Patológica/metabolismo , Proteínas da Matriz Extracelular/genética , Proteínas da Matriz Extracelular/metabolismo , Proteínas do Olho/metabolismo , Feminino , Perfilação da Expressão Gênica , Humanos , Ceratocone/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Refração Ocular/fisiologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
11.
J Gastrointest Surg ; 23(1): 58-66, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215199

RESUMO

BACKGROUND: Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center. METHODS: From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device. Demographics, procedure details, and outcomes were recorded. RESULTS: There were 107 patients (M:F = 29:78) treated with 133 EGR procedures for weight regain (n = 81), dumping syndrome (n = 13), or both (n = 13) with mean age 47.3 years (R 22.0-72.9) and mean BMI 32.9 kg/m2 (R 22.2-49.8) at time of procedure. Mean procedure time was 17.8 min (R 12-41), with median 1 suture used (R 1-2). No intra-operative or 30-day complications were recorded. Mean follow-up time was 9.2 months (R 1-26.8). Patients lost a mean of 4.1, 5.8, and 8.0 kg at 3, 6, and 12 months, respectively, after the procedure. Weight loss outcomes were significantly better when two compared to one suture was used (p = 0.036), and for patients with higher starting BMI (p = 0.047). For patients with dumping syndrome, 90-100% had treatment response after one or two EGRs. CONCLUSION: EGR is feasible and safe for weight regain and dumping syndrome after RYGB. It can stabilize weight regain and improve dumping symptoms. Around 20% of patients will need repeat EGR within 1 year to achieve sufficient narrowing of the anastomosis.


Assuntos
Endoscopia Gastrointestinal/métodos , Derivação Gástrica/efeitos adversos , Jejuno/cirurgia , Reoperação , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Síndrome de Esvaziamento Rápido/etiologia , Síndrome de Esvaziamento Rápido/cirurgia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Duração da Cirurgia , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Suturas , Ganho de Peso , Perda de Peso , Adulto Jovem
12.
Heart ; 105(8): 603-608, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30322846

RESUMO

OBJECTIVE: Bicuspid aortic valve (BAV) is the most common congenital heart disease. This study aimed to determine the prevalence rate of BAV in first-degree relatives (FDR) and the inheritance pattern according to different morphotypes and aortic dilation. METHODS: BAV probands were consecutively studied at eight tertiary referral centres. After sequential screening, FDR were included in the study. The BAV morphotype, aortic dilation and aortic phenotype were assessed by transthoracic echocardiography. RESULTS: Seven hundred and twenty-four FDR of 256 BAV probands agreed to undergo family screening. The prevalence of BAV was 6.4% in FDR (9.2% in men, 3.5% in women, p=0.002). Aortic dilation was diagnosed in 9.6% of FRD with tricuspid aortic valves (TAV), with a root phenotype in 2.7% and tubular in 6.9% and more frequently in the presence of arterial hypertension (OR 4.48; CI 95% 2.51 to 7.99; p=0.0001) and valvular regurgitation (OR 5.87, CI 95% 1.37 to 25.16; p=0.025). The heritability (h2 ) of BAV was highly significant (0.47; p=0.002); however, no concordance was observed among valve morphotypes. Aortic dilation heritability was not significant. CONCLUSIONS: The BAV prevalence rate in FDR was low (6.4%) but aortic dilation was observed in 9.6% of FDR with TAV. The heritability of BAV was high without concordance in valve morphotypes, and aortic dilation heritability was not observed. Patients with BAV should be made aware of its familial pattern.


Assuntos
Aorta , Doenças da Aorta , Valva Aórtica/anormalidades , Família , Doenças das Valvas Cardíacas , Adulto , Aorta/anormalidades , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Doenças da Aorta/fisiopatologia , Valva Aórtica/fisiopatologia , Variação Biológica da População , Análise por Conglomerados , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia/métodos , Saúde da Família/estatística & dados numéricos , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Padrões de Herança , Masculino , Pessoa de Meia-Idade , Linhagem , Prevalência , Análise de Sequência/métodos , Espanha/epidemiologia
13.
J Robot Surg ; 13(5): 703-705, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30542788

RESUMO

Ovarian vein syndrome is a rare cause of ureteral obstruction. Most of these cases occur during pregnancy likely from the gravid uterus causing ovarian vein dilatation and valvular incompetence. Hormonal changes associated with pregnancy also affect the muscular wall of ureter, causing decrease in tone and may facilitate compression as well. There is a predilection for right side and in thin females. The traditional treatment has been the ligation of ovarian vein and ureterolysis. We report a case of ovarian vein syndrome in a young female which was managed by robot-assisted laparoscopic ovarian vein ligation, resection of stenosed ureteric segment and end-to-end ureterostomy.


Assuntos
Laparoscopia/métodos , Ovário/irrigação sanguínea , Complicações na Gravidez/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Ureterostomia/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Veias/patologia , Adulto , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Humanos , Ligadura/métodos , Gravidez , Síndrome , Resultado do Tratamento , Obstrução Ureteral/etiologia
14.
Rev Gastroenterol Peru ; 38(3): 280-284, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30540732

RESUMO

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.


Assuntos
Doenças dos Ductos Biliares/etiologia , Hemorragia Gastrointestinal/etiologia , Doença de Gaucher/complicações , Hemangioma Cavernoso/complicações , Hipertensão Portal/complicações , Veia Porta/anormalidades , Veia Porta/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Dilatação Patológica/etiologia , Terapia de Reposição de Enzimas , Vesícula Biliar/irrigação sanguínea , Doença de Gaucher/diagnóstico , Doença de Gaucher/tratamento farmacológico , Glucosilceramidase/uso terapêutico , Humanos , Hipertensão Portal/diagnóstico por imagem , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Veia Porta/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Esplenectomia , Veia Esplênica/diagnóstico por imagem , Veia Esplênica/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
BMC Ophthalmol ; 18(1): 294, 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30419866

RESUMO

BACKGROUND: To report a first case of lenticule addition and corneal cross-linking for post-LASIK ectasia with associated corneal thinning. CASE PRESENTATION: Lenticule addition followed by corneal cross-linking was performed on the left eye of a patient with post-LASIK ectasia. Postoperatively, the corneal power and elevation were stable with a remarkable improvement in corneal thickness, and the lenticule had merged with the adjacent corneal stroma at 30 months follow-up. The patient's corrected distance visual acuity gained two lines. CONCLUSIONS: This case provides a potential treatment option for patients with keratectasia and keratoconus in association with thin corneal thickness (less than 400 µm) and may provide the benefit of delaying or avoiding the need for keratoplasty, which has its own associated complications and is limited by the availability of donor corneas.


Assuntos
Substância Própria/cirurgia , Reagentes para Ligações Cruzadas , Ceratocone/terapia , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer , Fotoquimioterapia/métodos , Complicações Pós-Operatórias , Adulto , Colágeno/metabolismo , Terapia Combinada , Substância Própria/metabolismo , Topografia da Córnea , Dilatação Patológica/etiologia , Dilatação Patológica/terapia , Humanos , Ceratocone/etiologia , Ceratocone/metabolismo , Ceratocone/fisiopatologia , Masculino , Microscopia Confocal , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Tomografia de Coerência Óptica , Raios Ultravioleta , Acuidade Visual/fisiologia
16.
J Coll Physicians Surg Pak ; 28(11): 824-828, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30369372

RESUMO

OBJECTIVE: To investigate the clinical and angiographic characteristics of coronary artery ectasia (CAE) and its relation with the inflammatory marker, HsCRP. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Rawalpindi Institute of Cardiology, Rawalpindi, from April 2015 till November 2016. METHODOLOGY: Eighty-one patients with CAE and 57 age matched patients with stenotic coronary artery disease (CAD), but without CAE, were included in the study. Clinical, angiographic, and laboratory data were documented. Chi-square test was used to compare coronary risk factors between two groups. T test was used to compare means between the groups. Analysis of variance was used to analyse HsCRP levels among various types of ectasia. Correlation analysis was used to study association of ectasia with different risk factors. RESULTS: Males were predominant in both with & without CAE. Hypertension, smoking and obesity were significantly more common among CAE patients than those without (60.5% vs. 52.6%, 56.8% vs. 43.9% and 80.2% vs. 14%, respectively). Diabetes was much less in CAE group (32.1% vs. 42.1%). HsCRP was higher in patients with CAE than those without and was significantly higher in patients with more extensive ectasia. Majority (65.4%) of CAE patients had significant CAD; whereas, only 7.4% had isolated CAE. Most common artery involved was RCA (70.4% of total) and most common pattern was single ectatic vessel. CONCLUSION: Obesity and smoking predispose to CAE, along with male sex and hypertension. While diabetes is negatively associated with CAE. HsCRP levels tend to be higher in ectasia patients, especially those with severe forms. Finally, CAE has a predilection for RCA.


Assuntos
Aterosclerose/complicações , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Dilatação Patológica/etiologia , Idoso , Angiografia Coronária/métodos , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Int Urol Nephrol ; 50(12): 2173-2177, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30349963

RESUMO

INTRODUCTION: Benign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures. AIM: To determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation. MATERIALS AND METHODS: Retrospective study included 465 patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3-HoLEP; 4-ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1-HoLEP; 2-ThuFLEP). In four cases, stenting was not performed (2-HoLEP; 2-ThuFLEP). The follow-up period was 6 months. RESULTS: Postoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30 days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis-up to 1.5 cm; the calyx-up to 0.5 cm). At 1 month after surgery, no patients had dilatation of the PCS. CONCLUSIONS: Upper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.


Assuntos
Complicações Intraoperatórias/terapia , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/efeitos adversos , Stents , Ureter/lesões , Ureter/patologia , Idoso , Dilatação Patológica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Estudos Retrospectivos , Obstrução do Colo da Bexiga Urinária/etiologia
19.
J Am Coll Cardiol ; 72(14): 1613-1618, 2018 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-30261963

RESUMO

BACKGROUND: Beta-blockers are the standard treatment in Marfan syndrome (MFS). Recent clinical trials with limited follow-up yielded conflicting results on losartan's effectiveness in MFS. OBJECTIVES: The present study aimed to evaluate the benefit of losartan compared with atenolol for the prevention of aortic dilation and complications in Marfan patients over a longer observation period (>5 years). METHODS: A total of 128 patients included in the previous LOAT (LOsartan vs ATenolol) clinical trial (64 in the atenolol and 64 in the losartan group) were followed up for an open-label extension of the study, with the initial treatment maintained. RESULTS: Mean clinical follow-up was 6.7 ± 1.5 years. A total of 9 events (14.1%) occurred in the losartan group and 12 (18.8%) in the atenolol group. Survival analysis showed no differences in the combined endpoint of need for aortic surgery, aortic dissection, or death (p = 0.462). Aortic root diameter increased with no differences between groups: 0.4 mm/year (95% confidence interval: 0.2 to 0.5) in the losartan and 0.4 mm/year (95% confidence interval: 0.3 to 0.6) in the atenolol group. In the subgroup analyses, no significant differences were observed considering age, baseline aortic root diameter, or type of dominant negative versus haploinsufficient FBN1 mutation. CONCLUSIONS: Long-term outcome of Marfan syndrome patients randomly assigned to losartan or atenolol showed no differences in aortic dilation rate or presence of clinical events between treatment groups. Therefore, losartan might be a useful, low-risk alternative to beta-blockers in the long-term management of these patients.


Assuntos
Aorta/diagnóstico por imagem , Atenolol/uso terapêutico , Dilatação Patológica/etiologia , Dilatação Patológica/prevenção & controle , Losartan/uso terapêutico , Síndrome de Marfan/tratamento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Adulto , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/prevenção & controle , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Aorta/cirurgia , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/prevenção & controle , Dilatação Patológica/diagnóstico por imagem , Progressão da Doença , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Síndrome de Marfan/complicações , Síndrome de Marfan/mortalidade , Adulto Jovem
20.
J Cataract Refract Surg ; 44(8): 979-992, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30115298

RESUMO

PURPOSE: To identify risk factors for ectasia after laser in situ keratomileusis (LASIK) by comparing the accuracy of the Ectasia Risk Score System (ERSS), Screening Corneal Objective Risk of Ectasia (SCORE) Analyzer, and percentage of tissue altered (PTA) in predicting the occurrence of ectasia. SETTING: Multiple centers in 8 countries. DESIGN: Retrospective case series. METHODS: Previously unpublished post-LASIK ectasia cases were analyzed. Consecutive patients who had LASIK performed at least 5 years previously with no resultant ectasia were used as controls. Axial maps from preoperative Orbscan IIz topographies were analyzed in a masked fashion, and examination files tested with the SCORE Analyzer. The PTA values and ERSS scores were generated using available preoperative and perioperative data. Only eyes with subjectively identified normal preoperative topography were tested with the PTA. Threshold values for the SCORE, ERSS, and PTA were more than or equal to 0, 4, and 40, respectively. RESULTS: Ectasia occurred in 31 eyes (22 patients); 79 eyes (44 patients) were used as controls. In all eyes, the sensitivity and specificity for predicting ectasia, respectively, were 67.7% and 79.7% for the ERSS and 64.5% and 100% for the SCORE. In eyes with normal topography (ectasia group, 12 eyes; controls, 64 eyes), the PTA yielded sensitivity of 33.3% and specificity of 85.9%. The area under the receiver operating characteristic curve was highest for SCORE (0.911) followed by the ERSS (0.844) and PTA (0.557). CONCLUSIONS: The SCORE was most predictive of ectasia, achieving the best specificity; the ERSS had the best sensitivity. Further studies are required to validate the PTA as a screening metric for ectasia.


Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Dilatação Patológica/etiologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Adulto , Estudos de Casos e Controles , Dilatação Patológica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
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