Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.689
Filtrar
1.
Radiol Clin North Am ; 57(6): 1093-1108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582037

RESUMO

Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Humanos , Fatores de Risco , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem
2.
Medicine (Baltimore) ; 98(35): e16612, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464896

RESUMO

RATIONALE: Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force. PATIENT CONCERNS: In this paper we report a 48-year-old man with chest pain for 2 years. DIAGNOSES: Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM). INTERVENTIONS: He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS). OUTCOMES: Then SF was revealed 9 months later. LESSONS: This is the first case report of SF after coronary intervention therapy in SCAD patients.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Stents/efeitos adversos , Doenças Vasculares/congênito , Dor no Peito/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
3.
Medicine (Baltimore) ; 98(26): e16073, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261518

RESUMO

The present study aims to measure the retinal thickness of the macular region of AIDS patients with normal ocular fundus, HIV-related microvascular retinopathy patients and cytomegalovirus retinitis (CMVR) patients by optical coherence tomography, and generalize the characteristics of retinal thickness of these 3 groups of patients.In this retrospective case series, the study object comprised of 111 AIDS patients who received diagnosis and treatment in the Ophthalmology Department of Beijing Youan Hospital. There are 33 patients in the AIDS normal ocular fundus group, 47 patients in the HIV-related microvascular retinopathy group, and 31 patients in the CMVR group. The retinal thickness of the macular region of these above patients was measured. The main indicators were retinal thickness of 9 macular partitions, best corrected visual acuity, CD4+ T lymphocyte count, and the start of highly active antiretroviral therapy.In the CMVR group, except for the nasal-outer and temporal-outer sectors, the thickness of the affected eye of the rest of the regions was greater than that of healthy eye (P < .05). Furthermore, there was a difference in thickness of the superior-outer and inferior-outer sectors between the AIDS normal ocular fundus group and HIV-related microvascular retinopathy group. The difference in thickness of the superior-inner sector between patients in the AIDS normal ocular fundus group and CMVR group was not statistically significant, while the difference in thickness of the rest of the regions was statistically significant. The difference in thickness of various regions between patients in the HIV-related microvascular retinopathy group and CMVR group was statistically significant.The retinal thickness of patients in the CMVR group generally increased, the retinal thickness of superior-outer and inferior-outer sections of patients in the HIV-related microvascular retinopathy group increased, when compared to the AIDS normal ocular fundus group. These optical coherence tomography (OCT) examination results present its own characteristics in different eye diseases in AIDS patients, and different stages of eye disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Síndrome de Imunodeficiência Adquirida/diagnóstico por imagem , Macula Lutea/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/patologia , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , Fundo de Olho , Humanos , Macula Lutea/patologia , Masculino , Microvasos , Pessoa de Meia-Idade , Tamanho do Órgão , Doenças Retinianas/complicações , Doenças Retinianas/patologia , Vasos Retinianos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Doenças Vasculares/complicações , Doenças Vasculares/patologia , Acuidade Visual , Adulto Jovem
4.
Expert Rev Cardiovasc Ther ; 17(7): 497-510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232618

RESUMO

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Doenças Vasculares/congênito , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Recidiva , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
5.
Expert Rev Cardiovasc Ther ; 17(4): 275-291, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30957570

RESUMO

INTRODUCTION: Spontaneous coronary artery dissection (SCAD) accounts for up to 4% of acute coronary syndromes (ACS) on coronary angiography and predominantly affects women (>90%). SCAD most often occurs in patients with few or no conventional cardiovascular risk factors. This condition remains underdiagnosed due to a lack of awareness among health-care providers and misdiagnosis on coronary angiography. Areas covered: In this review, authors aim to summarize contemporary data on the etiology, morbidity and mortality risks, as well as management strategies in order to raise awareness. Expert opinion: The last decade of extensive research revealed that SCAD is not as rare as previously thought and needs to be in the differential diagnosis of all MI patients, especially in young to middle-aged women. Predisposing factors, such as fibromuscular dysplasia, and potential triggers like physical or emotional stresses, are frequently linked. Coronary angiography is the first-line diagnostic tool and should be performed meticulously because of more fragile vessel architecture to avoid iatrogenic dissections. If angiographic findings are uncertain, the use of intravascular imaging may be required. Conservative therapy is favored over revascularization unless patients have high-risk features. Recurrent cardiovascular events post-SCAD are frequent, and patients should be closely monitored after a SCAD event.


Assuntos
Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/terapia , Doenças Vasculares/congênito , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologia , Diagnóstico Diferencial , Displasia Fibromuscular/complicações , Humanos , Fatores de Risco , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/epidemiologia , Doenças Vasculares/terapia
6.
BMJ Case Rep ; 12(3)2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30872339

RESUMO

A 52-year-old man presented to our cardiology service for an elective diagnostic coronary angiogram for risk stratification in the context of stable angina. He was diagnosed with antiphospholipid syndrome 2 years prior and had three known thrombotic episodes in the form of a stroke, retinal artery occlusion and deep vein thrombosis. Our initial differential was atherosclerotic coronary artery disease, however, coronary angiography demonstrated a dominant right coronary artery with a long segment of chronic spontaneous dissection distally but with thrombolysis in myocardial infarction III flow. He was treated medically with antianginals which rendered him asymptomatic and is currently on regular follow-up in the cardiology outpatient department.


Assuntos
Angina Estável/diagnóstico , Síndrome Antifosfolipídica/complicações , Anomalias dos Vasos Coronários/complicações , Doenças Vasculares/congênito , Angina Estável/etiologia , Angiografia/métodos , Antibióticos Antineoplásicos/uso terapêutico , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/uso terapêutico , Infarto do Miocárdio/complicações , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem
7.
Acta Cir Bras ; 34(3): e201900303, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30892389

RESUMO

PURPOSE: To evaluate whether there is a relationship between renal artery vasospasm related low glomerular density or degeneration and neurogenic lung edema (NLE) following subarachnoid hemorrhage. METHODS: This study was conducted on 26 rabbits. A control group was formed of five animals, a SHAM group of 5 to which saline and a study group (n=16) injected with homologous blood into the sylvian cisterna. Numbers of degenerated axons of renal branches of vagal nerves, atrophic glomerulus numbers and NLE scores were recorded. RESULTS: Important vagal degeneration, severe renal artery vasospasm, intrarenal hemorrhage and glomerular atrophy observed in high score NLE detected animals. The mean degenerated axon density of vagal nerves (n/mm2), atrophic glomerulus density (n/mm3) and NLE scores of control, SHAM and study groups were estimated as 2.40±1.82, 2.20±1.30, 1.80±1.10, 8.00±2.24, 8.80±2.39, 4.40±1.14 and 154.38±13.61, 34.69±2.68 and 12.19±1.97 consecutively. Degenerated vagal axon, atrophic glomerulus and NLE scores are higher in study group than other groups and the differences are statistically meaningful (p<0.001). CONCLUSION: Vagal complex degeneration based glomerular atrophy have important roles on NLE following SAH which has not been extensively mentioned in the literature.


Assuntos
Isquemia/complicações , Rim/irrigação sanguínea , Degeneração Neural/complicações , Edema Pulmonar/etiologia , Artéria Renal , Hemorragia Subaracnóidea/complicações , Nervo Vago/patologia , Doenças Vasculares/complicações , Animais , Modelos Animais de Doenças , Coelhos
8.
Dtsch Med Wochenschr ; 144(6): 398-410, 2019 03.
Artigo em Alemão | MEDLINE | ID: mdl-30870871

RESUMO

In case of an acute leg swelling a deep leg vein thrombosis needs to be excluded. In order to do this, compression sonography and the D-dimer-test are applied in the framework of an established diagnostic algorithm. The ensuing therapy consists in anticoagulation and compression.In case of a chronic leg swelling anamnesis and a clinical check-up often lead to a differential diagnosis. Chronic venous insufficiency is a generic term for a disturbed venous backflow. It is caused by an obstruction or an antegrade or retrograde flow insufficiency. Most common diseases in this context are varicosis or a post-thrombotic syndrome. Sonography and special function tests provide a diagnosis. The basic therapy consists in regular exercise, normalization of weight and compression therapy. In case of a hemodynamically relevant varicose vein surgery or endovascular treatment is advisable. The post-thrombotic syndrome must be treated consistently with the basic therapy.A lymphedema may be hereditary or acquired. In a first step diseases like neoplasia need to be excluded. The initial therapy consists in manual lymph drainage in combination with special compression bandages. Flat knit stockings should be prescribed. Surgical treatment is reserved for special circumstances.A lipedema is clinically diagnosed. It is characterized by lipohypertrophia, pressure sensitivity of the tissue and susceptibility to hematomas. Treatment options include weight reduction, regular exercise, lymph drainage and compression therapy, in some cases liposuction.


Assuntos
Edema , Perna (Membro) , Linfedema , Doenças Vasculares , Diagnóstico Diferencial , Edema/diagnóstico , Edema/etiologia , Edema/patologia , Edema/fisiopatologia , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/patologia , Perna (Membro)/fisiopatologia , Linfedema/complicações , Linfedema/diagnóstico , Linfedema/patologia , Linfedema/fisiopatologia , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/patologia , Doenças Vasculares/fisiopatologia
9.
Hell J Nucl Med ; 22 Suppl: 187-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30877737

RESUMO

Subcortical small-vessel disease (SSVD) is a disorder that has been fully described in clinical, neuropathological and imaging aspects. It is considered as the most prevalent ischemic CNS disorder and has been associated to arterial hypertension, diabetes mellitus, dyslipidemia and obstructive sleep apnea. The hallmark of SSVD is the ischemic white matter lesions which can be presented as lacunar infracts and global brain hypoperfusion in a common and homogeneous subtype of vascular cognitive impairment (VCI) which is often unrecognized. The special nature and course of SSVD offers the opportunity of collecting knowledge at all stages of its pathogenicity. Arteriosclerosis, hypoxic hypo-perfusion and inflammation act synergistically, causing myelin degeneration and blood brain barrier alteration. Clinical diagnosis of SSVD includes early executive dysfunction manifested by impaired capacity to use complex information, to formulate strategies, and to exercise self-control. Brain imaging has advanced substantially the diagnostic tools for SSVD. Diagnostic biomarkers for Alzheimer Disease include reduction of cerebrospinal fluid amyloid-ß (Aß)42 and of the ratio Aß42/Aß40 sometimes with increased total tau levels. However, biomarkers specific for the diagnosis at all stages of SSVD are needed, especially because of the unsatisfactory treatment options at its late stages to date.


Assuntos
Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Doenças Vasculares/complicações , Biomarcadores/metabolismo , Disfunção Cognitiva/metabolismo , Humanos
10.
Medicine (Baltimore) ; 98(7): e14471, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762767

RESUMO

RATIONALE: Dieulafoy's lesions are characterized by the presence of a dysplastic artery in the submucosa, most frequently associated with gastrointestinal hemorrhage. They are rarely identified in the bronchial submucosa and can cause massive or fatal hemoptysis PATIENT CONCERNS:: The patient was a 62-year-old male farmer with intermittent hemoptysis of approximately 2 years duration and a definite diagnosis could not be established. DIAGNOSIS: A thorax-computed tomography at our hospital revealed that the bronchus of left lower lobe was narrowed with associated local atelectasis, and lung cancer was suspected. A bronchoscopy showed a slit-like stenosis of the left lower lobe, swollen and smooth mucosa, and a significantly wider subsection carina. INTERVENTIONS: A fatal hemorrhage occurred during biopsy and, rescue and resuscitation measures were immediately taken. A double-lumen endotracheal intubation was implanted and single-lung ventilation was started to maintain oxygenation. Hemoptysis completely stopped after bronchial artery embolization. OUTCOMES: The patient eventually died of disseminative intravascular coagulation and multiple organ failure. Bronchial arteriography and subsequent autopsy confirmed Dieulafoy's disease of the bronchus. LESSONS: In cases with recurrent unexplained hemoptysis, where CT chest or thoracic radiography show no abnormalities, pulmonologist should suspect a bronchial Dieulafoy's disease and avoid blindly performing bronchoscopy guided biopsy, which may result in fatal hemoptysis.


Assuntos
Brônquios/patologia , Broncopatias/patologia , Doenças Vasculares/patologia , Broncopatias/complicações , Broncopatias/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico
11.
Braz J Cardiovasc Surg ; 34(1): 41-47, 2019 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30810673

RESUMO

OBJECTIVE: To evaluate the predictive value of epicardial fat thickness (EFT) in CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) score risk groups. METHODS: A total of 158 consecutive patients (75 females, 83 males, mean age 70.8±6.3 years) admitted routinely for cardiologic control were divided into two groups according to their CHA2DS2-VASc scores (scores 0 and 1 were regarded as low risk, and score ≥2 as high risk). One hundred twenty-five of 158 patients had a high-risk score. RESULTS: Mean EFT was significantly higher in the high-risk group than in the low-risk group (4.34±0.62 vs. 5.37±1.0; P<0.001). EFT was positively correlated with CHA2DS2-VASc score (r=0.577, P<0.001). According to receiver operating characteristics (ROC) analysis, EFT value of 4.4 mm was found to be predictive of high risk in CHA2DS2-VASc score with 80% of sensitivity and 79% of specificity (C-statistic = 0.875, P<0.001, 95% confidence interval [CI] = 0.76-0.90). And according to multivariate logistic regression analysis, EFT was an independent predictor of high thromboembolic risk in terms of CHA2DS2-VASc score. CONCLUSION: Our findings suggest that echocardiographic EFT measurement could provide additional information on assessing cardiovascular risks, such as thromboembolic events, and individuals with increased EFT should receive more attention to reduce unfavorable cardiovascular risk factors and the development of future cardiovascular events.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Doenças Cardiovasculares/etiologia , Ecocardiografia/métodos , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Medição de Risco/métodos , Fatores Etários , Idoso , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Complicações do Diabetes/diagnóstico , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Estatísticas não Paramétricas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico
12.
Restor Neurol Neurosci ; 37(1): 31-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741709

RESUMO

BACKGROUND: It is still debatable whether visual field defects in glaucoma have a reversible component and to what extent a temporary loss can be provoked. OBJECTIVE: To investigate the response of the visual function to a cold provocation in glaucoma patients, particularly to test whether subjects with Flammer syndrome (FS) behaved differently from subjects without FS. METHODS: Ten (10) primary open-angle glaucoma (POAG) patients with FS, 7 POAG patients without FS, and 11 healthy controls were tested with program G2 on the Octopus 101 perimeter before and after putting one hand in cold water (4°C) for 2 min. The mean sensitivity (MS) of each visual field was included in the statistical analysis. RESULTS: In glaucoma patients with FS, the mean MS significantly decreased after cold provocation (delta MS = -0.91 dB, CI = -1.43 to -0.39, p = 0.0014). In contrast, the mean MS in glaucoma patients without FS did not change significantly (delta MS = 0.17 dB, CI = -0.43 to 0.78, p = 0.56). Likewise, the mean MS did not change significantly in the healthy controls (delta MS = 0.23 dB, CI = -0.27 to 0.72, p = 0.36). CONCLUSIONS: Cold provocation induced a transient visual field deterioration in the glaucoma patients with FS but not in the glaucoma patients without FS or in the healthy controls. We assume this effect to be the result of a transient reduction of ocular blood flow.


Assuntos
Temperatura Baixa , Glaucoma de Ângulo Aberto/fisiopatologia , Doenças Vasculares/fisiopatologia , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Adulto , Olho/irrigação sanguínea , Olho/fisiopatologia , Feminino , Glaucoma de Ângulo Aberto/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Doenças Vasculares/complicações , Testes de Campo Visual , Campos Visuais , Adulto Jovem
13.
Rev. nefrol. diál. traspl ; 39(1): 26-37, ene. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1007060

RESUMO

INTRODUCTION: Cardiovascular disease is the main cause of mortality and morbidity in chronic renal failure. It's known that vascular calcification (VC) and carotid intima media thickness (CIMT) are strongly associated with cardiovascular diseases. Growth arrest specific protein 6 (Gas6) is a vitamin K-dependent protein and regulates various processes such as proliferation, cell survival, migration and inflammation. Gas6 is known to protect endothelial cells and vascular smooth muscle cells against apoptosis by inhibiting Bcl-2 induced Caspase 3 activation. The relationship between Gas6 and cardiovascular diseases has been demonstrated in many mouse models and cell cultures. However, there are conflicting reports whether Gas6 levels are increasing or decreasing in human studies of diabetic and/or chronic renal failure. In present study the aim was to examine plasma Gas6 levels and its relation with CIMT and coronary artery calcification score (CACS) in chronic kidney disease (CKD) patients. METHODS: Total of 137 patients of which 32 chronic hemodialysis and 105 predialysis patients as well as 73 healthy controls were enrolled in the study. Human Gas6 levels in serum samples were studied by ELISA method. CIMT was measured by ultrasonography. CACS was measured by multislice computed tomography. RESULTS: The mean age was 54.37±16.61 years in dialysis group, 55.20±14.80 years in predialysis group and 53.26±9.04 years in control group. Serum creatinine was 0.78±0.16 mg/dl in the control group and 1.96±1.64 mg/dl in the predialysis group and 5.94±1.55 mg/dl in the dialysis group. 24 hours urine protein levels were significally higher in the dialysis group than the predialysis and the control group. CIMT values were similar in predialysis and dialysis groups. These values were significantly higher than the control group. Although CACS was higher in dialysis group than predialysis and control group, the results were not statistically significant since the distribution range was very wide. Gas6 was 98.84±53.32 ng/mL in the control group and statistically higher than the dialysis (63.85±38.92 ng/mL) and the predialysis groups (54.96±38.49 ng/mL) (p=0.001). Gas6 levels were lower in diabetic patients than non-diabetics (53.69±35.26 ng/mL, 69.26±47.50 ng/mL, p=0.023, respectively). Negative correlation was detected between Gas6 and age, BMI, CACS, carotid IMT and proteinuria. In the logistic regression analysis, Gas6 remained significantly associated with BMI, CIMT and proteinuria. CONCLUSION: In our study, a negative correlation of Gas6 with BMI, CACS, CIMT and proteinuria and lower Gas6 levels in diabetic patients support that decreased Gas6 levels in chronic renal failure may have a role in vascular calcification through altered glucose tolerance, chronic inflammation, endothelial dysfunction and increased apoptosis. Our study has an importance because it is the first study showing a relation between Gas6 and proteinuria, CACS and carotid IMT in patients with chronic renal failure


INTRODUCCIÓN: La enfermedad cardiovascular es la principal causa de mortalidad y morbilidad en la insuficiencia renal crónica. Se sabe que la calcificación vascular (CV) y el grosor de la íntima-media de la carótida (CIMT, por sus siglas en inglés) están vinculados de forma muy estrecha con enfermedades cardiovasculares. La proteína específica del gen 6 de la detención de crecimiento (Gas6) es una proteína dependiente de la vitamina K y regula diversos procesos, como la proliferación, la supervivencia celular, la migración y la inflamación. La proteína Gas6 es conocida por proteger las células endoteliales y las células musculares lisas vasculares contra la apoptosis mediante la inhibición de la activación de la caspasa-3 inducida por la proteína Bcl-2. Se ha demostrado la relación entre la Gas6 y las enfermedades cardiovasculares en muchos modelos de ratones y cultivos celulares. Sin embargo, existen informes contradictorios acerca de si los niveles de Gas6 aumentan o disminuyen en estudios de humanos con insuficiencia renal crónica y/o diabética. En este estudio, el objetivo fue examinar los niveles plasmáticos de Gas6 y su relación con el CIMT y la puntuación de calcificación de las arterias coronarias (CACS, por sus siglas en inglés) en pacientes con enfermedad renal crónica (ERC). MATERIAL Y MÉTODOS: Un total de 137 pacientes fueron incluidos en el estudio, de los cuales 32 estaban en hemodiálisis crónica, 105 en prediálisis, y 73 pacientes representaban controles sanos. Se esudiaron los niveles de Gas6 en muestras de suero mediante el método ELISA. El CIMT se midió por medio de ecografía. La CACS se midió mediante tomografía computarizada multicorte. RESULTADOS: La edad media fue de 54,37 ± 16,61 años en el grupo de diálisis; 55,20 ± 14,80 años en el grupo de prediálisis, y 53,26 ± 9,04 años en el grupo de control. La creatinina sérica fue de 0,78 ± 0,16 mg/dl en el grupo de control; 1,96 ± 1,64 mg/dl en el de prediálisis, y 5,94 ± 1,55 mg/dl en el de diálisis. Las concentraciones de proteína en orina de 24 horas fueron significativamente más altas en el grupo de diálisis que en los de prediálisis y control. Los valores del CIMT fueron similares en los grupos de prediálisis y de diálisis. Estos valores fueron considerablemnete más altos que en el grupo de control. Aunque la CACS fue más alta en el grupo de diálisis que en los otros dos, los resultados no fueron estadísticamente significativos, ya que el rango de distribución fue muy amplio. La proteína Gas6 fue de 98,84 ± 53,32 ng/ml en el grupo de control y estadísticamente más alta que en los grupos de diálisis (63,85 ± 38,92 ng/ml) y de prediálisis (54,96 ± 38,49 ng/ml) (p = 0,001). Los niveles de Gas6 fueron más bajos en los pacientes diabéticos que en los no diabéticos (53,69 ± 35,26 ng/ml; 69,26 ± 47,50 ng/ml, [p = 0,023], respectivamente). Se detectó una correlación negativa entre la proteína Gas6 y la edad, el IMC, la CACS, el CIMT y la proteinuria. En el análisis de regresión logística, la Gas6 se mantuvo estrechamente relacionada con el IMC, el CIMT y la proteinuria. CONCLUSIÓN: En nuestro estudio, la correlación negativa de Gas6 con IMC, CACS, CIMT y proteinuria, y los niveles más bajos de Gas6 en pacientes diabéticos sustentan la idea de que la disminución de los niveles de Gas6 en la insuficiencia renal crónica puede jugar un papel en la calcificación vascular a través de la tolerancia alterada a la glucosa, la inflamación crónica, la disfunción endotelial y el aumento de la apoptosis. La importancia de nuestro estudio radica en que es el primero que muestra una relación entre la Gas6 y la proteinuria, la CACS y el CIMT en pacientes con insuficiencia renal crónica


Assuntos
Humanos , Doenças Vasculares/complicações , Calcinose , Túnica Íntima/anormalidades , Anomalias dos Vasos Coronários , Fator 6 de Crescimento de Fibroblastos/sangue
14.
Medicine (Baltimore) ; 98(2): e14112, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30633224

RESUMO

RATIONALE: Acute myocardial infarction (AMI) secondary to spontaneous coronary artery dissection (SCAD) is a rare condition. SCAD can be underdiagnosed on a coronary angiography (CAG). Therefore, the application of intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is crucial for ensuring an accurate diagnosis and treatment. PATIENTS CONCERNS: A 72-year-old woman had an evolving AMI with ST elevation in the inferior leads (II, III, and aVF). DIAGNOSES: An emergent CAG showed that a double lumen had developed in the middle portion of the left circumflex artery. An IVUS examination revealed a coronary artery dissection and intramural hematoma. INTERVENTIONS: First, the patient was treated with conservative management. We later placed a stent in response to the progression of the intramural hematoma observed during the IVUS follow-up. OUTCOMES: The patient remained symptom free after discharge. CAG with OCT at the 1-year follow-up after stent implantation showed in-stent restenosis with dissection flap with residual false lumen at the proximal site of stent. We treated this lesion with another stent. LESSONS: From this case, we learned that in patients with AMI, SCAD should be considered as a possible diagnosis and that intravascular imaging tool can successfully guide clinical decision making and the treatment strategies.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Doenças Vasculares/congênito , Idoso , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/terapia , Feminino , Humanos , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/terapia
15.
Graefes Arch Clin Exp Ophthalmol ; 257(4): 665-673, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30643967

RESUMO

Primary open-angle glaucoma is currently characterized by a pattern of progressive retinal ganglion cell loss that stems from a complex underlying pathophysiology that remains poorly elucidated. The roles of blood flow and intraocular pressure (IOP) in glaucoma pathogenesis have been extensively studied. Further, it has been established that lowering IOP can slow the progression of glaucoma. In addition, a number of influential factors have emerged and gained momentum over the years. Increasing evidence implicates the contributions of low cerebrospinal fluid pressure, autoimmunity, neurodegeneration, and impaired autoregulation towards glaucoma pathophysiology. We aggregate and explore these different camps of thought that have garnered attention over the last few decades, and, in doing so, aim to challenge the long-standing view of glaucoma as a primary disease of the eye. A shift in our perspective towards understanding glaucoma as an ocular manifestation of systemic dysregulation may lead ultimately to better clinical management of the disease.


Assuntos
Doenças Autoimunes/complicações , Glaucoma de Ângulo Aberto/etiologia , Doenças Neurodegenerativas/complicações , Doenças Vasculares/complicações , Glaucoma de Ângulo Aberto/patologia , Humanos , Pressão Intraocular , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia
16.
Sci Rep ; 8(1): 17840, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552340

RESUMO

Onychomycosis (OM) is a common nail disease. Although controversial, vascular diseases are considered independent predictors of OM and vice versa. Sequential pattern mining (SPM) has not been previously used for statistical analysis in dermatology, but it is an efficient method for identifying frequent association rules in multiple sequential data sets. The aim of our study was to identify the relationship between OM and vascular diseases in the real world through a population-based study using SPM. We obtained population-based data recorded from 2002 to 2013 by the Health Insurance Research and Assessment Agency. Cases of vascular-related disease and OM were identified using the diagnostic codes of the International Classification of Diseases 10th Revision, version 2010. SPM measures were based on comorbidity and duration values. We estimated 3-year risk for progression from OM to vascular disease and vice versa using logistic regression. Patients with varicose veins and peripheral vascular disease had higher OM comorbidity (comorbidity: 1.26% and 0.69%, respectively) than did those with other vascular diseases. Patients diagnosed with varicose veins and peripheral vascular disease were diagnosed with OM after 25.50 and 55.10 days, respectively, which was a shorter duration than that observed for other diseases. Patients with OM were at higher risk for peripheral vascular disease (adjusted odds ratio (aOR) 1.199 [95% confidence interval (CI) 1.151-1.249]) and varicose veins (aOR 1.150 [95% CI 1.063-1.245]). Patients with peripheral vascular disease (aOR 1.128 [95% CI 1.081-1.177]) were at higher risk for OM, while patients with varicose veins had no significant risk for OM. Careful consideration of varicose veins or peripheral vascular disease is required for proper management of comorbidities in patients with OM.


Assuntos
Onicomicose/complicações , Onicomicose/epidemiologia , Doenças Vasculares/complicações , Doenças Vasculares/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bioestatística , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Coreia (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
Arthritis Res Ther ; 20(1): 281, 2018 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-30567570

RESUMO

BACKGROUND: To determine whether lung involvement is related to microvascular perturbations, nailfold videocapillaroscopy (NVC) was performed in patients with systemic sclerosis (SSc). METHODS: A cross-sectional study was consecutively accomplished in 152 SSc patients. NVC, a pulmonary function test and echocardiography were undergone within a 3-month period. Finally, 134 patients with at least eight NVC (200× magnification) images were selected for quantitative and qualitative examinations. RESULTS: Patients with interstitial lung disease presented lower median capillary density (4.86/mm vs 5.88/mm, p = 0.005) and higher median of neoangiogenesis (0.56/mm vs 0.31/mm, p = 0.005). A higher quantity of neoangiogenesis capillaries was found in patients with pulmonary arterial hypertension (0.70/mm vs 0.33/mm, p = 0.008). Multivariate linear regression analysis established a correlation between neoangiogenesis and decreased forced vital capacity (FVC) (p < 0.001): for each capillary with neoangiogenesis visualized on average per 1 mm, FVC was 7.3% reduced. In qualitative NVC, a late pattern as defined by Cutolo was also associated with lower FVC (p = 0.018). The number of giant capillaries was associated with reduced diffusion capacity of the lung for carbon monoxide (DLCO) (p = 0.016); for each giant capillary per 1 mm, DLCO was 11.8% diminished. CONCLUSIONS: A good correlation was observed between distinctive quantitative and qualitative NVC features with lung functional parameters such as FVC and DLCO. It is suggested that vasculopathy could play a role in SSc lung involvement.


Assuntos
Lesão Pulmonar/fisiopatologia , Angioscopia Microscópica/métodos , Sistema Respiratório/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Doenças Vasculares/fisiopatologia , Adulto , Idoso , Capilares/fisiopatologia , Estudos de Coortes , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Pulmão/irrigação sanguínea , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Lesão Pulmonar/complicações , Lesão Pulmonar/diagnóstico , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória/métodos , Escleroderma Sistêmico/complicações , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico
19.
Rev. argent. radiol ; 82(3): 107-113, set. 2018. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: biblio-977271

RESUMO

Objetivo Determinar la frecuencia de las complicaciones observadas durante la trombectomía en el ictus isquémico agudo. Materiales y Métodos Se revisó de forma retrospectiva las trombectomías realizadas en nuestra institución cuando los ictus isquémicos tuvieron una indicación de tratamiento endovascular. Se registraron los diferentes dispositivos utilizados en ese periodo de tiempo y si presentaron relación con el desarrollo de las complicaciones inmediatas mediante arteriografía. Resultados De un total de 228 casos, se registraron complicaciones en el 16,6% de los casos. Se identificaron embolias (n » 31), hemorragias subaracnoideas (n » 2), hemorragia gangliobasal (n » 1), vasoespasmo (n » 1), disección (n » 1) y peusoaneurismas (n » 2). La embolia a nuevos territorios se presentó solo en 5 casos. Discusión El tratamiento endovascular ha demostrado ser efectivo para la recanalización en oclusión de gran vaso. El uso de dispositivos presume un riesgo por la manipulación de los vasos. Conclusión La embolia fue la complicación más frecuente. El tratamiento endovascular en el ictus genera un desenlace clínico favorable de los pacientes, al mismo tiempo, el bajo porcentaje de complicaciones que encontramos no suponen una afectación negativa en el desenlace final.


Purpose To determine the complications we observed during thrombectomy in acute ischemic stroke. Materials and Methods We reviewed retrospectively thrombectomies performed in our institution when endovascular treatment for stroke was done. The different devices used in this period of time were recorded and we determined if these were related to the development of immediate complications duringthe procedure visualized in arteriography. Results We had 228 cases, complications were found in 16.6% of the cases. Embolisms (n » 31), subarachnoid hemorrhages (n » 2), gangliobasal hemorrhage (n » 1), vasospasm (n » 1), dissection (n » 1) and peusoaneurysms (n » 2) were identified. 5 embolisms happened to new territories during thrombectomy. Discussion Endovascular treatment has been shown to be effective for recanalization in large vessel occlusion. The use of devices presumes a risk for the manipulation of the vessels. Conclusion Embolism was the most frequent complication. The endovascular treatment in the acute stroke produces a favorable clinical outcome of the patients and we found a low percentage of complications that would not suppose a negative affectation in the final outcome.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Trombectomia/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Crânio/diagnóstico por imagem , Espanha , Doenças Vasculares/complicações , Cateterismo/métodos , Cateterismo/estatística & dados numéricos , Artéria Carótida Interna/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Stents/estatística & dados numéricos , Estudos Retrospectivos , Estudo Multicêntrico , Trombectomia/estatística & dados numéricos , Embolia , Hemorragia
20.
Medicine (Baltimore) ; 97(31): e11504, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075514

RESUMO

RATIONALE: Spontaneous coronary artery dissection is a highly unusual cause of acute coronary disease. It is a result of a hematoma formation within the outer third of the tunica media,with subsequent expansion leading to compression of the true lumen and resultant myocardial ischemia. PATIENT CONCERNS: We present a case of a middle-aged woman presenting with chest pain with acute anterior myocardial infarction, who did not reveal any of the cardiovascular risk factors. Finally,when pressed further about her past history, the patient revealed she had been taking oral contraceptives for the past 2 years. DIAGNOSES: The diagnosis is usually confirmed by coronary angiography, but it has some limitations. If necessary, intravascular ultrasound (IVUS) may help in further examinations to reduce the incidence of erroneous diagnosis or missed diagnosis. INTERVENTIONS: There is no guiding suggestion for the treatment of SCAD. The main treatment methods are 3 aspects: conservative internal medical treatment, stent implantation, coronary artery bypass grafting. The treatment strategy depends mainly on the patienst' clinical symptoms, the hemodynamic state, and the position and quantity of the dissection. In this case,we used stent implantation treatment originally and then we resorted to medical treatment. OUTCOMES: After careful review and analysis, coronary arteriography results was able to prove the existence of the spiral shaped dissection. We then resorted to medical treatment and her symptoms were gradually relieved. LESSONS: SCAD should be suspected in young to middle-aged women with chest pain symptoms, particularly during the perinatal period or for subjects who use oral contraceptives. Doctors should be able to obtain a detailed past history and analyze coronary angiography results carefully.


Assuntos
Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Infarto do Miocárdio/etiologia , Doenças Vasculares/congênito , Anticoncepcionais Orais/efeitos adversos , Anomalias dos Vasos Coronários/etiologia , Anomalias dos Vasos Coronários/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA