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1.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33777432

RESUMO

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Assuntos
/diagnóstico , Emergências , Encaminhamento e Consulta , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/métodos , Aneurisma Dissecante/terapia , Angioplastia/métodos , Aneurisma Aórtico/terapia , Derivação Arteriovenosa Cirúrgica , Estenose das Carótidas/terapia , Gerenciamento Clínico , Embolectomia/métodos , Feminino , Oclusão de Enxerto Vascular/complicações , Oclusão de Enxerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Omã , Centros de Atenção Terciária , Extremidade Superior
2.
Molecules ; 26(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652665

RESUMO

The aim of the study was to investigate combined effects of flavonoids (apigenin, baicalein, chrysin, quercetin, and scutellarin) and methyldopa on the expression of selected proinflammatory and vascular factors in vitro for prediction of their action in pregnancy-induced hypertension. The research was conducted on a trophoblast-derived human choriocarcinoma cell line and a primary human umbilical vein endothelial cell line. Cytotoxicity of compounds in selected concentrations (20, 40, and 100 µmol) was measured using the MTT test and the concentration of 40 µmol was selected for further analysis. Subsequently, their effects with methyldopa on the expression of selected markers responsible for inflammation (TNF-α; IL-1ß; IL-6) and vascular effects (hypoxia-inducible factor 1α-HIF-1α; placental growth factor-PIGF; transforming growth factor ß-TGF-ß; vascular endothelial growth factor-VEGF) at the mRNA and protein levels were assessed. It was found that every combined administration of a flavonoid and methyldopa in these cells induced a down-regulating effect on all tested factors, except PIGF, especially at the mRNA expression level. As hypertension generally raises TNF-α, IL-1ß, IL-6, HIF-1α, TGF-ß, and VEGF mRNA expression and/or protein levels, the results obtained in the studied model may provide a positive prognostic factor for such activity in vivo.


Assuntos
Flavonoides/farmacologia , Inflamação/tratamento farmacológico , Metildopa/farmacologia , Doenças Vasculares/tratamento farmacológico , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Técnicas In Vitro , Inflamação/genética , Inflamação/patologia , Placenta/efeitos dos fármacos , Placenta/patologia , Fator de Crescimento Placentário/genética , Gravidez , Trofoblastos/efeitos dos fármacos , Doenças Vasculares/genética , Doenças Vasculares/patologia
7.
Viruses ; 13(2)2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567734

RESUMO

Human cytomegalovirus (HCMV) is a ubiquitous double-stranded DNA virus belonging to the ß-subgroup of the herpesvirus family. After the initial infection, the virus establishes latency in poorly differentiated myeloid precursors from where it can reactivate at later times to cause recurrences. In immunocompetent subjects, primary HCMV infection is usually asymptomatic, while in immunocompromised patients, HCMV infection can lead to severe, life-threatening diseases, whose clinical severity parallels the degree of immunosuppression. The existence of a strict interplay between HCMV and the immune system has led many to hypothesize that HCMV could also be involved in autoimmune diseases (ADs). Indeed, signs of active viral infection were later found in a variety of different ADs, such as rheumatological, neurological, enteric disorders, and metabolic diseases. In addition, HCMV infection has been frequently linked to increased production of autoantibodies, which play a driving role in AD progression, as observed in systemic lupus erythematosus (SLE) patients. Documented mechanisms of HCMV-associated autoimmunity include molecular mimicry, inflammation, and nonspecific B-cell activation. In this review, we summarize the available literature on the various ADs arising from or exacerbating upon HCMV infection, focusing on the potential role of HCMV-mediated immune activation at disease onset.


Assuntos
Doenças Autoimunes/imunologia , Infecções por Citomegalovirus/imunologia , Citomegalovirus/imunologia , Autoanticorpos/imunologia , Doenças Autoimunes/patologia , Doenças Autoimunes/virologia , Autoimunidade , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/patologia , Infecções por Citomegalovirus/virologia , Humanos , Hospedeiro Imunocomprometido , Inflamação , Doenças Vasculares/patologia
8.
Medicine (Baltimore) ; 100(6): e24570, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578554

RESUMO

RATIONALE: Intravenous pyogenic granuloma (IVPG) is a special type of pyogenic granuloma, and its preoperative diagnosis is difficult. We report a rare case of IVPG that develops in the lumen of the internal jugular vein (IJV). Here, we analyze the imaging characteristics of present case and summarize the imaging characteristics of previous reported cases. PATIENT CONCERNS: A 44-year-old man who presented with a growth in the IJV without any symptoms. DIAGNOSES: A diagnosis of IVPG was made, based on the pathological examination after surgery. INTERVENTIONS: The patient underwent surgery to excise the vein segment containing the neoplasm. OUTCOMES: The patient did not present with any complications in the postoperative follow-up period. LESSONS: For clinician, IVPG's preoperative diagnosis is difficult. Although histopathology remains the gold standard for diagnosis, the combination of multiple types of imaging examinations is necessary to rule out the differential diagnoses of IVPG.


Assuntos
Granuloma Piogênico/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adulto , Granuloma Piogênico/patologia , Granuloma Piogênico/cirurgia , Humanos , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Doenças Vasculares/patologia , Doenças Vasculares/cirurgia
10.
Ther Umsch ; 78(1): 41-47, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33538629

RESUMO

Spontaneous coronary artery dissection Abstract. Spontaneous coronary artery dissection (SCAD) is an increasingly recognized etiology of acute coronary syndrome (ACS) and an important cause of myocardial infarction in women. First described in 1931, SCAD is defined as a spontaneous tear in a coronary artery that is not associated with atherosclerosis, trauma or medical intervention. SCAD predominantly affects younger women, who often lack atherosclerotic risk factors. Some risk factors that have been identified include female sex, pregnancy, severe emotional or physical stress, underlying blood vessel diseases such as fibromuscular dysplasia, and connective tissue diseases such as Ehlers-Danlos syndrome or Marfan syndrome. Previously believed to be rare, a chiefly fatal condition, recent epidemiological data suggests SCAD is accountable for up to 4 % of all ACS cases and up to 35 % of ACS cases in women < 50 years of age. There is a lack of awareness of SCAD among physicians, which probably results in underreporting and underdiagnosing of this disorder. The clinical presentation of SCAD is often similar to that of ACS making differentiation at first presentation difficult. Cardiac enzymes are elevated like in ACS and there are no biomarkers that are specific for the diagnosis of SCAD. Coronary angiography is the gold standard method to distinguish both entities, however correct diagnosis by cath is challenging and SCAD can be truly missed and misdiagnosed as classic ACS. Still there are no randomized controlled trials about the optimal treatment of these patients. But it is suggested that management should be different to atherosclerotic myocardial infarction. Conservative medical treatment is favored in the majority of cases, with percutaneous coronary intervention (PCI) being reserved for high risk patients due to poor interventional outcomes and higher failure rates. However, there is still a lack of data on this poorly understood condition and the optimal management has yet to be determined.


Assuntos
Anomalias dos Vasos Coronários , Intervenção Coronária Percutânea , Doenças Vasculares , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/terapia , Dissecação , Feminino , Humanos , Gravidez , Fatores de Risco , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia
11.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547102

RESUMO

A 32-year-old doctor, who has a medical history of primary Raynaud's disease and previous scotomas, presented to eye clinic with sudden onset blurring of vision (infero-nasally) with no other associated symptoms. The patient had good visual acuity bilaterally (6/6) and no anterior chamber activity or conjunctival hyperaemia. Findings consistent with a nerve fibre layer infarct were noted in the right eye, with unremarkable examination of the left eye. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were obtained, which showed an area of capillary shut down in keeping with a nerve fibre layer lesion. Previous literature pertaining to similar symptoms is sparse with symptoms such as migraines, epilepsy and visual loss being stated. This case provides further evidence of Raynaud's associated retinal artery spasm, with complete resolution at 4 weeks. We also demonstrate the accessibility of OCT and more importantly OCTA for investigation of sudden onset visual deficit.


Assuntos
Doença de Raynaud/complicações , Artéria Retiniana , Doenças Retinianas/etiologia , Espasmo/etiologia , Doenças Vasculares/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos
12.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563672

RESUMO

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline-an ergot derivative and dopamine agonist that may induce vasospasm-has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.


Assuntos
Cabergolina/efeitos adversos , Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/complicações , Anomalias dos Vasos Coronários/etiologia , Agonistas de Dopamina/efeitos adversos , Doenças Vasculares/congênito , Adulto , Feminino , Humanos , Neoplasia Endócrina Múltipla/tratamento farmacológico , Doenças Vasculares/etiologia
14.
Rev Med Suisse ; 17(727): 394-398, 2021 Feb 24.
Artigo em Francês | MEDLINE | ID: mdl-33625805

RESUMO

Calciphylaxis is a rare but devastating condition characterized by a calcifying thrombosing microangiopathy resulting in painful necrotic skin lesions. Risk factors are multiple, the most important being obesity, disorders of phosphocalcic metabolism and acenocoumarol. Largely unknown by the medical community, its pathogenesis is still incompletely elucidated; its diagnosis by skin biopsy remains difficult and increasingly debated because potentially associated with an aggravation of lesions. Its treatment must be as premature as possible andmultimodal. However, the results are up to now unsatisfactory, as specific treatment of calciphylaxis does not yet exist.


Assuntos
Calciofilaxia , Doenças Vasculares , Biópsia , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Feminino , Humanos , Rim , Necrose , Gravidez
15.
Arterioscler Thromb Vasc Biol ; 41(3): 999-1011, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33441027

RESUMO

Platelets rapidly undergo responsive transitions in form and function to repair vascular endothelium and mediate hemostasis. In contrast, heterogeneous platelet subpopulations with a range of primed or refractory phenotypes gradually arise in chronic inflammatory and other conditions in a manner that may indicate or support disease. Qualitatively distinguishable platelet phenotypes are increasingly associated with a variety of physiological and pathological circumstances; however, the origins and significance of platelet phenotypic variation remain unclear and conceptually vague. As changes in platelet function in disease exhibit many similarities to platelets following the activation of platelet agonist receptors, the intracellular responses of platelets common to hemostasis and inflammation may provide insights to the molecular basis of platelet phenotype. Here, we review concepts around how protein-level relations-from platelet receptors through intracellular signaling events-may help to define platelet phenotypes in inflammation, immune responses, aging, and other conditions. We further discuss how representing systems-wide platelet proteomics data profiles as circuit-like networks of causally related intracellular events, or, pathway maps, may inform molecular definitions of platelet phenotype. In addition to offering insights into platelets as druggable targets, maps of causally arranged intracellular relations underlying platelet function can also advance precision and interceptive medicine efforts by leveraging platelets as accessible, dynamic, endogenous, circulating biomarkers of vascular wellness and disease. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Plaquetas/fisiologia , Proteoma/fisiologia , Doenças Vasculares/sangue , Animais , Biomarcadores/sangue , Endotélio Vascular/fisiologia , Hemostasia/fisiologia , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/sangue , Peptídeos e Proteínas de Sinalização Intracelular/fisiologia , Modelos Cardiovasculares , Fenótipo , Proteômica , Transdução de Sinais , Doenças Vasculares/fisiopatologia
16.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431452

RESUMO

Lobular capillary haemangioma, also known as pyogenic granuloma, is a benign vascular tumour that usually originates in the skin and mucosal membrane. It sometimes derives from the lumen of a vein and the clinical presentations are various and non-specific. A 72-year-old woman complained of a sensation of pressure in her left neck for 1 month when cooking. Her left cephalic vein was enlarged with no signs of oedema, and cervical ultrasound revealed a space-occupying lesion in the left subclavian vein. Contrast-enhanced CT and MRI revealed an intravascular tumour. This tumour was removed with operation, and histopathological examination revealed intravascular capillary haemangioma. Intravascular lobular capillary haemangioma is a rare condition that occurs in the veins of the neck and upper extremities. Intravascular tumours could cause a unique symptom, such as neck discomfort associated with neck anteflexion.


Assuntos
Granuloma Piogênico/diagnóstico , Pescoço/irrigação sanguínea , Veia Subclávia/patologia , Doenças Vasculares/diagnóstico , Idoso , Implante de Prótese Vascular , Diagnóstico Diferencial , Feminino , Granuloma Piogênico/complicações , Granuloma Piogênico/patologia , Granuloma Piogênico/cirurgia , Humanos , Leiomiossarcoma/diagnóstico , Imagem por Ressonância Magnética , Pescoço/diagnóstico por imagem , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Doenças Vasculares/complicações , Doenças Vasculares/patologia , Doenças Vasculares/cirurgia , Neoplasias Vasculares/diagnóstico
17.
Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1147874

RESUMO

El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)


Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Vitamina K/antagonistas & inibidores , Varfarina/uso terapêutico , Trombose Venosa/tratamento farmacológico , Anticoagulantes , Fibrilação Atrial/tratamento farmacológico , Tromboembolia , Doenças Vasculares , Isquemia Miocárdica/tratamento farmacológico
18.
Khirurgiia (Mosk) ; (1): 83-89, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395517

RESUMO

Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4th and 5th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.


Assuntos
Cistos , Artéria Poplítea , Doenças Vasculares , Túnica Adventícia/patologia , Cistos/diagnóstico , Humanos , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Doenças Vasculares/diagnóstico
19.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395518

RESUMO

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Doenças Vasculares/cirurgia , Veias/cirurgia , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Artéria Braquial/diagnóstico por imagem , Humanos , Resultado do Tratamento , Doenças Vasculares/etiologia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
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