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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526520

RESUMO

A 10-year-old child had painful periorbital swelling in the left eye. It was diagnosed as preseptal cellulitis and treated with oral antibiotics. Three days later, the ocular condition worsened so the child was referred for further management. On examination, the child had a temperature of 102 °F. Ocular examination revealed proptosis, restricted ocular movements and a relative afferent pupillary defect in the left eye. Ocular examination of the right eye was normal. There was a history of recurrent episodes of cold in the past. CT scan orbit and sinuses revealed signs of orbital cellulitis with sinusitis on the left side. The child was treated with parenteral antibiotics and endoscopic sinus surgery. A child presenting with unilateral periorbital swelling needs to be thoroughly evaluated. It is important to differentiate orbital cellulitis from preseptal cellulitis. Orbital cellulitis is an emergency and delay in diagnosis can lead to vision and life-threatening intracranial complications.


Assuntos
Antibacterianos/uso terapêutico , Endoscopia , Celulite Orbitária/diagnóstico , Sinusite/diagnóstico , Celulite (Flegmão)/diagnóstico , Criança , Diagnóstico Tardio , Edema/diagnóstico por imagem , Edema/fisiopatologia , Exoftalmia/diagnóstico por imagem , Exoftalmia/fisiopatologia , Humanos , Masculino , Oftalmoplegia/fisiopatologia , Celulite Orbitária/diagnóstico por imagem , Celulite Orbitária/fisiopatologia , Celulite Orbitária/terapia , Distúrbios Pupilares/fisiopatologia , Sinusite/diagnóstico por imagem , Sinusite/terapia , Tomografia Computadorizada por Raios X
2.
Medicina (Kaunas) ; 57(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33430046

RESUMO

Background and Objectives: Hyperbaric oxygenation (HBO) denotes breathing of 100% oxygen under elevated ambient pressure. Since the initiation of HBO for burns in 1965, abundant experimental and clinical work has been done. Despite many undisputedly positive and only a few controversial results on the efficacy of adjunctive HBO for burn injury, the method has not yet been established in clinical routine. Materials and Methods: We did a retrospective analysis of the literature according to PRISMA-guidelines, from the very beginning of HBO for burns up to present, trying to elucidate the question why HBO is still sidelined in the treatment of burn injury. Results: Forty-seven publications (32 animal experiments, four trials in human volunteers and 11 clinical studies) fulfilled the inclusion criteria. Except four investigators who found little or no beneficial action, all were able to demonstrate positive effects of HBO, most of them describing less edema, improved healing, less infection or bacterial growth and most recently, reduction of post-burn pain. Secondary enlargement of burn was prevented, as microvascular perfusion could be preserved, and cells were kept viable. The application of HBO, however, concerning pressure, duration, frequency and number of treatment sessions, varied considerably. Authors of large clinical studies underscored the intricate measures required when administering HBO in severe burns. Conclusions: HBO unquestionably has a positive impact on the pathophysiological mechanisms, and hence on the healing and course of burns. The few negative results are most likely due to peculiarities in the administration of HBO and possibly also to interactions when delivering the treatment to severely ill patients. Well-designed studies are needed to definitively assess its clinical value as an adjunctive treatment focusing on relevant outcome criteria such as wound healing time, complications, length of hospital stay, mortality and scar quality, while also defining optimal HBO dosage and timing.


Assuntos
Queimaduras/terapia , Oxigenação Hiperbárica/métodos , Animais , Queimaduras/fisiopatologia , Sobrevivência Celular , Edema/fisiopatologia , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Oxigenação Hiperbárica/história , Microcirculação , Dor/fisiopatologia , Cicatrização , Infecção dos Ferimentos/prevenção & controle
3.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169595

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Assuntos
Cardiomegalia/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Betacoronavirus , Cardiomegalia/fisiopatologia , Angiografia Coronária , Infecções por Coronavirus/fisiopatologia , Ecocardiografia , Edema/diagnóstico por imagem , Edema/fisiopatologia , Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Isquemia Miocárdica/fisiopatologia , Miocardite/fisiopatologia , Pandemias , Derrame Pericárdico/fisiopatologia , Pneumonia Viral/fisiopatologia , Radiografia Torácica , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia
4.
Med J Aust ; 213(8): 352-353.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32946596

Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Herpes Zoster/diagnóstico , Mononeuropatias/diagnóstico , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/tratamento farmacológico , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/virologia , Idoso , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/fisiopatologia , Doenças dos Nervos Cranianos/virologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Dor de Orelha/fisiopatologia , Edema/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/fisiopatologia , Doenças do Nervo Facial/virologia , Paralisia Facial/fisiopatologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/tratamento farmacológico , Doenças do Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/virologia , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/virologia , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/virologia , Osteomielite/diagnóstico , Otite Externa/diagnóstico , Prednisolona/uso terapêutico , Base do Crânio , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/tratamento farmacológico , Doenças do Nervo Vago/fisiopatologia , Doenças do Nervo Vago/virologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/tratamento farmacológico , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/virologia , Ativação Viral
5.
PLoS One ; 15(8): e0232302, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822373

RESUMO

Sepsis is a life-threatening condition due to a dysregulated immunological response to infection. Apart from source control and broad-spectrum antibiotics, management is based on fluid resuscitation and vasoactive drugs. Fluid resuscitation implicates the risk of volume overload, which in turn is associated with longer stay in intensive care, prolonged use of mechanical ventilation and increased mortality. Antisecretory factor (AF), an endogenous protein, is detectable in most tissues and in plasma. The biologically active site of the protein is located in an 8-peptide sequence, contained in a synthetic 16-peptide fragment, named AF-16. The protein as well as the peptide AF-16 has multiple modulatory effects on abnormal fluid transport and edema formation/resolution as well as in a variety of inflammatory conditions. Apart from its' anti-secretory and anti-inflammatory characteristics, AF is an inhibitor of capillary leakage in intestine. It is not known whether the protein AF or the peptide AF-16 can ameliorate symptoms in sepsis. We hypothesized that AF-16 decreases the degree of hemodynamic instability, the need of fluid resuscitation, vasopressor dose and tissue edema in fecal peritonitis. To test the hypothesis, we induced peritonitis and sepsis by injecting autologous fecal solution into abdominal cavity of anesthetized pigs, and randomized (in a blind manner) the animals to intervention (AF-16, n = 8) or control (saline, n = 8) group. After the onset of hemodynamic instability (defined as mean arterial pressure < 60 mmHg maintained for > 5 minutes), intervention with AF-16 (20 mg/kg (50 mg/ml) in 0.9% saline) intravenously (only the vehicle in the control group) and a protocolized resuscitation was started. We recorded respiratory and hemodynamic parameters hourly for twenty hours or until the animal died and collected post mortem tissue samples at the end of the experiment. No differences between the groups were observed regarding hemodynamics, overall fluid balance, lung mechanics, gas exchange or histology. However, liver wet-to-dry ratio remained lower in AF-16 treated animals as compared to controls, 3.1 ± 0.4, (2.7-3.5, 95% CI, n = 8) vs 4.0 ± 0.6 (3.4-4.5, 95% CI, n = 8), p = 0.006, respectively. Bearing in mind the limited sample size, this experimental pilot study suggests that AF-16 may inhibit sepsis induced liver edema in peritonitis-sepsis.


Assuntos
Edema/tratamento farmacológico , Peptídeos/farmacologia , Peritonite/complicações , Sepse/complicações , Animais , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Edema/complicações , Edema/patologia , Edema/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Hemoglobinas/metabolismo , Interleucina-6/sangue , Lactatos/metabolismo , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Peptídeos/uso terapêutico , Projetos Piloto , Troca Gasosa Pulmonar/efeitos dos fármacos , Suínos , Fator de Necrose Tumoral alfa/sangue , Resistência Vascular/efeitos dos fármacos
6.
AJR Am J Roentgenol ; 215(3): 545-558, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32507017

RESUMO

OBJECTIVE. The purpose of this study is to clarify which imaging parameters of patellofemoral maltracking are associated with superolateral Hoffa fat pad (SHFP) edema. MATERIALS AND METHODS. A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify studies evaluating the relationship between SHFP edema and patellofemoral maltracking. Parameters for assessing patellofemoral maltracking on MRI were reviewed for each study. Two reviewers performed study selection, methodologic quality assessment, and data extraction. RESULTS. Nine studies were eligible for inclusion in the present study. From the included studies, nine parameters assessing patellofemoral maltracking were analyzed: lateral patellofemoral angle, patellar tilt, patellar lateralization, trochlear depth, sulcus depth, sulcus angle, lateral trochlear inclination, distance between the tibial tuberosity and trochlear groove, and the Insall-Salvati ratio. Patients with SHFP edema had greater patellar tilt (standardized mean difference, 0.89°; 95% CI, 0.38-1.40°; p = 0.0006), greater patellar lateralization (standardized mean difference, 0.78 mm; 95% CI, 0.21-1.36 mm; p = 0.008), greater distance between the tibial tuberosity and trochlear groove (standardized mean difference, 0.96 mm; 95% CI, 0.48-1.44 mm; p < 0.0001), and higher Insall-Salvati ratio (standardized mean difference, 1.94; 95% CI, 1.29-2.60; p < 0.00001) than patients without SHFP edema. CONCLUSION. Patellofemoral maltracking imaging parameters, such as a more laterally displaced patella, greater TTTG distance, and patella alta, are correlated with SHFP edema.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Edema/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/fisiopatologia , Tecido Adiposo/fisiopatologia , Doenças do Tecido Conjuntivo/fisiopatologia , Edema/fisiopatologia , Humanos , Artropatias/fisiopatologia
7.
Ann Otol Rhinol Laryngol ; 129(10): 969-976, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456442

RESUMO

OBJECTIVE: Previous investigations suggest the use of extract from the root of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated acute upper airway inflammations, due to its strong antimicrobial and immunomodulatory effect. We aimed to compare clinical efficacy, safety and bactericidal effect of EPs 7630 and amoxicillin monotherapy in treatment of patients with mild to moderate acute bacterial rhinosinusitis (ABRS). METHODS: Fifty ABRS patients were divided into two groups by randomization. Group 1 (n = 25) received EPs 7630 tablets, 3 × 20 mg/day per os for 10 days. Group 2 (n = 25) received amoxicillin tablets 3 × 500 mg/day per os, for 10 days. We assessed total symptom score (TSS), individual symptom scores for each symptom (nasal obstruction, rhinorrhea, postnasal drip, facial pain/pressure, loss of the sense of smell), endoscopic findings, including total endoscopic score (TES) and individual endoscopic signs (mucosal edema, mucopurulent secretion), before and after treatment. Samples of discharge taken from the middle meatus of all patients were cultivated for bacteria before and after therapy. RESULTS: Higher absolute improvement after treatment was found for TSS, nasal obstruction, facial pain/pressure, impaired sense of smell, TES, mucosal edema and mucopurulent secretion in EPs 7630 group compared to amoxicillin group (P < .001 for all parameters). However, there were no differences in absolute improvement of rhinorrhea score and postnasal drip score between groups (P = .248; P = .679, respectively). Fewer types of bacteria grew on culture from middle meatal samples in EPs 7630 group compared to amoxicillin group. There were no reported adverse events from patients from either group. CONCLUSION: Our results demonstrated better clinical and antimicrobial efficacy of EPs 7630 than amoxicillin. EPs 7630 was shown as a potent agent and good alternative to antibiotic treatment of uncomplicated ABRS.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Fitoterapia , Extratos Vegetais/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Infecções Bacterianas/fisiopatologia , Edema/fisiopatologia , Dor Facial/fisiopatologia , Feminino , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae , Humanos , Masculino , Pessoa de Meia-Idade , Moraxella catarrhalis , Infecções por Moraxellaceae/tratamento farmacológico , Mucosa Nasal , Obstrução Nasal/fisiopatologia , Transtornos do Olfato/fisiopatologia , Infecções Pneumocócicas/tratamento farmacológico , Rinite/fisiopatologia , Sinusite/fisiopatologia , Streptococcus pneumoniae , Adulto Jovem
8.
Int J Rehabil Res ; 43(3): 240-246, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32459670

RESUMO

Total knee replacement (TKR) is continuously increasing with significantly faster recovery times. Soft tissue pain and edema of operated limbs play an important role in early functional recovery. The present study aims to evaluate the effectiveness of the combination of Kinesiotaping and Lymphatic drainage for the containment of pain and edema as well as the improvement of the range of motion of the knee as integration with standard postoperative rehabilitation. Ninety-nine TKR patients were included in the randomized clinical trial and divided into three groups: Kinesiotaping and Lymphatic drainage Group, Lymphatic drainage Group, and Kinesiotaping Group. The assessment was carried out on days 2-4-6 postoperation. All the patients had also standard reeducation sessions. It was observed that both Kinesiotaping and Lymphatic drainage was useful in reducing pain and edema. A significantly higher improvement was observed in the group in which Lymphatic drainage was associated with Kinesiotaping with respect to the individual treatments, for pain and leg circumference over and under the knee, and at the ankle. Range of motion of the knee did not show any difference since the flexion degree was similar in all the three groups. No difference was found between Kinesiotaping and Lymphatic drainage. In conclusion, the treatment with a combination Kinesiotaping and Lymphatic drainage provided better results on pain and edema observed as early as the first days after the intervention, thus may be considered a valid support for standard rehabilitation and pharmacological intervention.


Assuntos
Edema/terapia , Drenagem Linfática Manual , Manejo da Dor , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho , Fita Atlética , Edema/fisiopatologia , Edema/cirurgia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Período Pós-Operatório , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento
10.
Ergonomics ; 63(5): 579-592, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32009579

RESUMO

Occupational standing is associated with musculoskeletal and venous disorders. The aim was to investigate whether lower leg oedema and muscle fatigue development differ between standing and walking and whether age, gender and standing work habituation are factors to consider. Sixty participants (15 young females, 15 young males, 15 older males, and 15 young males habituated to standing work) were included and required to stand/walk for 4.5 hours in three periods with two seated breaks. Waterplethysmography/bioelectrical impedance, muscle twitch force and surface electromyography were used to assess lower leg swelling (LLS) and muscle fatigue as well as gastrocnemius muscle activity, respectively. While standing led to LLS and muscle fatigue, walking did not. Low-level medial gastrocnemius activity was not continuous during standing. No significant influence of age, gender and standing habituation was observed. Walking can be an effective prevention measure to counteract the detrimental effects of quasi-static standing.Practitioner summary: Prolonged standing leads to lower leg oedema and muscle fatigue while walking does not. The primary cause of fatigue may be in other muscles than the medial gastrocnemius. Walking may be an effective prevention measure for health risks of occupational standing when included intermittently.Abbreviation: BI: bioelectrical impedance; LLS: lower leg swelling; SEMG: surface electromyography; MTF: muscle twitch force; WP: waterplethysmography; Bsl: Baseline; L: Lunch; E: Evening; MTM: method times measurement; EA: electrical activity; IQR: interquartile range; p: percentile; M: mean; SE: standard error; Adj: adjusted.


Assuntos
Edema/fisiopatologia , Fadiga Muscular , Doenças Profissionais , Posição Ortostática , Caminhada , Adolescente , Adulto , Fatores Etários , Idoso , Impedância Elétrica , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Fatores Sexuais , Adulto Jovem
11.
Eur J Obstet Gynecol Reprod Biol ; 243: 83-86, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31675634

RESUMO

OBJECTIVE: The study was aimed at assessing the influence of pelvic congestion syndrome (PCS) on the clinical manifestations of chronic venous disease (CVD) of the lower extremities in patients with concomitant varicose veins of the pelvis and lower extremities. STUDY DESIGN: We examined clinically and with duplex ultrasound 30 women with varicose veins of the lower extremity only (VVLE) and another 45 women with VVLE and concomitant varicose veins of the pelvis (VVP) causing symptoms of the pelvic congestion syndrome (PCS). All patients had chronic venous disease (CVD) of class C2 (n = 47) or C3 (n = 28) according to the CEAP classification. All patients underwent duplex ultrasound (DUS) of the lower extremities and pelvis. Based on the clinical examination and DUS findings, the patients were allocated into two groups: group 1 (n = 30 patients with isolated VVLE without the signs of PCS and pelvic veins lesions) and group 2 (n = 45 patients with concomitant PCS, VVP and VVLE). The rates and severity of varicose, pain, and edema syndromes, and leg heaviness were assessed. RESULTS: The patients of the group 2 had significantly more severe clinical manifestations of CVD, 4 times higher risk of leg pain (odds ratio [OR] 4.23; 95% CI 1.57-11.39), 7 times higher risk of leg edema (OR 7.42; 95% CI 2.23-24.78), 5 times higher risk of leg heaviness (OR 5.3; 95% CI 1.85-15.07), and in general 2 times more severe varicose veins, compared with the group 1. CONCLUSION: The PCS is associated with an increase in the incidence and severity of the CVD symptoms.


Assuntos
Hiperemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Dor Pélvica/fisiopatologia , Pelve/irrigação sanguínea , Varizes/fisiopatologia , Adulto , Estudos de Casos e Controles , Edema/etiologia , Edema/fisiopatologia , Feminino , Humanos , Hiperemia/complicações , Dor/etiologia , Dor/fisiopatologia , Dor Pélvica/etiologia , Períneo/irrigação sanguínea , Veia Safena , Ultrassonografia , Varizes/complicações , Vulva/irrigação sanguínea
12.
Heart ; 105(23): 1777-1784, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31585946

RESUMO

The lymphatic vasculature has traditionally been considered important for removal of excessive fluid from the interstitial space, absorption of fat from the intestine and the immune system. Advances in molecular medicine and imaging have provided us with new tools to study the lymphatics. This has revealed that the vessels are actively involved in regulation of immune cell trafficking and inflammation. We now know much about how new lymphatic vessels are created (lymphangiogenesis) and that this is important in, for example, wound healing and tissue repair. The best characterised pathway for lymphangiogenesis is the vascular endothelial growth factor C (VEGF-C)/VEGFR3 pathway. Over recent years, there has been an increasing interest in the role of the lymphatics in cardiovascular medicine. Preclinical studies have shown that lymphangiogenesis and immune cell trafficking play a role in cardiovascular conditions such as atherosclerosis, recovery after myocardial infarction and rejection of cardiac allografts. Targeting the VEGF-C/VEGFR3 pathway can be beneficial in these conditions. The clinical spectrum of lymphatic abnormalities and lymphoedema is wide and overlaps with congenital heart disease. Important long-term complications to the Fontan circulation involves the lymphatics. New and improved imaging modalities has improved our understanding and management of these patients. Lymphatic leaks and flow abnormalities can be successfully treated, minimally invasively, with percutaneous embolisation. Future research will prove if the preclinical findings that point to a role of the lymphatics in several cardiovascular conditions will result in new treatment options.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Linfangiogênese/fisiologia , Vasos Linfáticos/fisiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Edema/fisiopatologia , Humanos , Inflamação/fisiopatologia , Doenças Linfáticas/complicações , Doenças Linfáticas/fisiopatologia , Vasos Linfáticos/anatomia & histologia , Vasos Linfáticos/diagnóstico por imagem , Linfedema/fisiopatologia
13.
J Med Case Rep ; 13(1): 293, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522686

RESUMO

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


Assuntos
Acetábulo/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Edema/fisiopatologia , Veia Femoral/fisiopatologia , Cistos Glanglionares/fisiopatologia , Veia Ilíaca/fisiopatologia , Idoso de 80 Anos ou mais , Constrição Patológica/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
14.
Neurology ; 93(15): e1463-e1473, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31492719

RESUMO

OBJECTIVES: To explore the relationship between insufficient ipsilateral cerebral venous drainage and the development of perihematomal edema (PHE) and functional outcome in patients with acute intracerebral hemorrhage (ICH). METHODS: We retrospectively reviewed our prospectively collected database for patients with acute spontaneous supratentorial ICH and analyzed patients who underwent baseline CT perfusion (CTP) within 6 hours of onset and noncontrast CT at 24 hours. Absence of filling of 1 or more of the ipsilateral superficial middle cerebral vein, vein of Trolard, vein of Labbé, basal vein of Rosenthal, and internal cerebral vein, evaluated on venous maps generated from baseline CTP, was identified as absent ipsilateral venous filling (AIVF). Relative PHE (rPHE) was calculated as the ratio of PHE volume to hematoma volume on follow-up CT. RESULTS: A total of 138 patients were included. Median absolute PHE volume on follow-up CT was 3.5 (1.0-9.3) mL and rPHE was 24.3% (9.0%-49.4%). One absent ipsilateral vein was observed in 38 (27.5%) patients, and 2 absent veins were observed in 5 (3.6%) patients. Multivariate analysis showed that AIVF was independently associated with large rPHE at 24 hours (odds ratio [OR] 4.032, 95% confidence interval [CI] 1.739-9.347, p < 0.001). Large PHE volume was independently associated with poor outcome (OR 1.109, 95% CI 1.009-1.218, p = 0.031). CONCLUSION: AIVF was observed in about one-third of patients with acute ICH, which might be attributed to hypoperfusion after ICH and was strongly related to the development of PHE. Identification of cerebral venous filling status might be a promising imaging marker for PHE and a potential therapeutic target in ICH.


Assuntos
Edema Encefálico/complicações , Hemorragia Cerebral/complicações , Veias Cerebrais/fisiopatologia , Hematoma/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/fisiopatologia , Hemorragia Cerebral/fisiopatologia , Drenagem/métodos , Edema/complicações , Edema/fisiopatologia , Feminino , Hematoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada
15.
Med Hypotheses ; 131: 109312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443775

RESUMO

On evaluating patients with lymphedema, the authors found that obesity is associated with generalized edema of all extremities and the trunk with increased intracellular and extracellular fluids, thus suggesting a new concept of lymphedema that the authors have termed systemic subclinical lymphedema. Animal studies show that obesity and its progression lead to changes in the lymphatic system and microcirculation with alterations in lymphatic motility, inflammatory processes, capillary permeability and immune response. Systemic subclinical lymphedema is diagnosed when above normal fluid levels are detected in all the extremities and the trunk with the progression of obesity; this can lead to the appearance of clinical lymphedema of the extremities.


Assuntos
Edema/etiologia , Linfedema/etiologia , Obesidade/complicações , Animais , Cirurgia Bariátrica , Compartimentos de Líquidos Corporais , Progressão da Doença , Edema/fisiopatologia , Extremidades/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/fisiopatologia , Modelos Biológicos , Obesidade/fisiopatologia , Obesidade/cirurgia , Especificidade de Órgãos , Tronco/fisiopatologia , Perda de Peso
16.
J Am Heart Assoc ; 8(14): e010309, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31296084

RESUMO

Background Our aim was to calibrate and externally revalidate the ELAN-HF (European Collaboration on Acute Decompensated Heart Failure) score, to confirm and improve on a previous external validation of the risk score. Methods and Results The ELAN-HF score predicts 6-month all-cause mortality in patients hospitalized for acute decompensated heart failure using absolute and percentage change of NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels in addition to clinical variables. For the external validation, we used the PRIMA II (Can NT-proBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) trial. For both data sets, observed versus predicted mortality was compared for the 4 risk categories; and the mean predicted mortality was plotted against the observed mortality with calculation of a correlation coefficient and SEE. The model discriminant ability was determined by comparing the C-statistics for both data sets. The predicted versus actual 6-month mortality values in the derivation cohort were 3.7% versus 3.6% for the low-risk category, 9.4% versus 9.2% for the intermediate-risk category, 24.2% versus 23.5% for the high-risk category, and 54.2% versus 51.1% for the very-high-risk category. The correlation between predicted and observed mortality by deciles was 0.92, with an SEE of ±4%. In the validation cohort, predicted versus actual 6-month mortality values were 3.0% versus 2.2% for the low-risk category, 9.4% versus 8.2% for the intermediate-risk category, 25.0% versus 22.9% for the high-risk category, and 56.8% versus 53.6% for the very-high-risk category. The correlation between predicted and actual mortality by quintiles was 0.99, with an SEE of ±2%. There was no significant difference in C-statistic between the derivation cohort (0.78; 95% CI, 0.74-0.82) and the validation cohort (0.77; 95% CI, 0.69-0.84; P=0.693). Conclusions Our study confirms that the ELAN-HF score predicts accurately 6-month mortality in patients hospitalized for acute decompensated heart failure with the use of easily obtained characteristics.


Assuntos
Edema/fisiopatologia , Insuficiência Cardíaca/terapia , Hiponatremia/sangue , Mortalidade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Ureia/sangue , Doença Aguda , Fatores Etários , Idoso , Pressão Sanguínea , Causas de Morte , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença
17.
Hypertension ; 74(3): 509-517, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352823

RESUMO

We have previously shown that podocyte injury increases the glomerular filtration of liver-derived Agt (angiotensinogen) and the generation of intrarenal Ang II (angiotensin II) and that the filtered Agt is reabsorbed by proximal tubules in a manner dependent on megalin. In the present study, we aimed to study the role of megalin in the generation of renal Ang II and sodium handling during nephrotic syndrome. We generated proximal tubule-specific megalin KO (knockout) mice and crossed these animals with NEP25 mice, in which podocyte-specific injury can be induced by injection of the immunotoxin LMB2. Without podocyte injury, renal Agt staining was markedly diminished and urinary Agt increased in KO mice. However, renal Ang II was similar between KO and control mice on average: 117 (95% CI, 101-134) versus 101 (95% CI, 68-133) fmol/g tissue. We next tested the effect of megalin KO on intrarenal Ang II generation with podocyte injury. Control NEP25 mice showed markedly increased renal Agt staining and renal Ang II levels: 450 (336-565) fmol/g tissue. Megalin KO/NEP25 mice showed markedly diminished Agt reabsorption and attenuated renal Ang II: 199 (156-242) fmol/g tissue (P<0.001). Compared with control NEP25 mice, megalin KO/NEP25 mice excreted 5-fold more sodium in the urine. Western blot analysis showed that megalin KO decreased NHE3 and the cleaved α and γ forms of Epithelial Na Channel. These data indicate that Agt reabsorbed by proximal tubules via megalin in nephrotic syndrome is converted to Ang II, which may contribute to sodium retention and edema formation by activating NHE3 and Epithelial Na Channel.


Assuntos
Angiotensina II/metabolismo , Hipernatremia/fisiopatologia , Túbulos Renais Proximais/metabolismo , Proteína-2 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Síndrome Nefrótica/metabolismo , Síndrome Nefrótica/patologia , Animais , Biópsia por Agulha , Edema/etiologia , Edema/fisiopatologia , Hipernatremia/metabolismo , Imuno-Histoquímica , Túbulos Renais Proximais/patologia , Masculino , Camundongos , Camundongos Knockout , Podócitos/citologia , Podócitos/metabolismo , Receptor Tipo 1 de Angiotensina/metabolismo , Sistema Renina-Angiotensina , Fatores de Risco , Sensibilidade e Especificidade , Sódio/metabolismo , Urinálise
18.
Int Rev Neurobiol ; 146: 103-152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31349925

RESUMO

Bradykinin is a mediator of vasogenic brain edema formation. Recent reports suggest that bradykinin interacts with nitric oxide synthase (NOS) system in the central nervous system (CNS). However, role of bradykinin in spinal cord injury (SCI) induced alterations in the blood-spinal cord barrier (BSCB), spinal cord blood flow (SCBF), edema formation and cell changes are still not well known. Our previous reports showed that SCI induces marked upregulation of neuronal NOS (nNOS) in the cord associated with BSCB disruption, edema formation and cell injury. Thus, a possibility exists that bradykinin participates in SCI induced nNOS upregulation and cord pathology. To explore this idea a potent bradykinin B2 receptor antagonist HOE-140 was used in our rat model of SCI and cord pathology. SCI was inflicted in Equithesin anesthetized rats by making a longitudinal incision (2mm deep and 5mm long) into the right dorsal horn of the T10-11 segment. The animals were allowed to survive 5h after injury. A focal SCI significantly disrupted BSCB to Evans blue and [131]I-sodium in the traumatized and adjacent segments. Interestingly, far remote spinal cord segments C4 and T5 segments also affected within 5h. These spinal cord segments also exhibited pronounced reductions in the SCBF (mean-30%), increased edematous swelling and profound neuronal damages. Upregulation of nNOS expression is seen in both the dorsal and ventral horns of the spinal cord exhibiting cord pathology. At the ultrastructural level, exudation of lanthanum is seen within the endothelial cell cytoplasm and occasionally in the basal lamina. Pretreatment with low doses of HOE-140 (0. 1mg to 1mg/kg, i.v.) 30min prior to SCI significantly enhanced the SCBF and reduced the BSCB disruption, edema formation, nNOS upregulation and cell injury. However, HOE-140 in doses ranging from 2mg to 5mg/kg, i.v. did not induce significant neuroprotection. These observations are the first to suggest that bradykinin B2 receptors play an important role in BSCB permeability, SCBF, edema formation, nNOS upregulation and cell injury following acute SCI, not reported earlier.


Assuntos
Bradicinina/análogos & derivados , Permeabilidade Capilar/efeitos dos fármacos , Edema/fisiopatologia , Neurônios/patologia , Fármacos Neuroprotetores/farmacologia , Óxido Nítrico Sintase Tipo I/metabolismo , Traumatismos da Medula Espinal/prevenção & controle , Animais , Bradicinina/farmacologia , Relação Dose-Resposta a Droga , Azul Evans/metabolismo , Masculino , Ratos , Iodeto de Sódio/metabolismo , Medula Espinal/irrigação sanguínea , Medula Espinal/efeitos dos fármacos , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologia , Regulação para Cima/efeitos dos fármacos
19.
Int Rev Neurobiol ; 146: 153-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31349926

RESUMO

Spinal cord injury (SCI) is a devastating disease inflicting lifetime disability to the victims. Military personnel are quite often victims of SCI for which no suitable therapeutic strategies have been developed so far. The main reason for SCI induced disability is loss of neural connections below and above the lesion site causing motor paralysis and somatosensory disturbances Loss of neuronal connections thwart spinal cord conduction resulting in motor function disability. To enhance spinal cord conduction grafting of peripheral nerves, implant of hydrogels filled with neuroprotective drugs is used but so far, no satisfactory results re achieved. In this regards implants of microelectrode for enhancing tissue connectivity is suggested that is still under experimental state. We have used titanium implant with or without TiO2 nanowires in a focal spinal cord injury and studies spinal cord pathology and motor function. In addition, we also combined with nanowired delivery of a potential neuroprotective drug DL-3-n-butylphthalide (DL-NBP) to the spinal cord in a rat model. Our observations show that a combination of titanium implant with nanowired delivery of DL-NBP induces superior neuroprotection and enhance motor functions after SCI. This treatment also restored blood-spinal cord barrier (BSCB) function and reduces edema formation and cell injury after SCI, not reports earlier.


Assuntos
Benzofuranos/farmacologia , Permeabilidade Capilar/fisiologia , Edema/fisiopatologia , Locomoção/fisiologia , Fármacos Neuroprotetores/farmacologia , Traumatismos da Medula Espinal/prevenção & controle , Titânio/farmacologia , Animais , Permeabilidade Capilar/efeitos dos fármacos , Sistemas de Liberação de Medicamentos/métodos , Implantes de Medicamento/farmacologia , Potenciais Evocados/efeitos dos fármacos , Potenciais Evocados/fisiologia , Masculino , Nanoestruturas/química , Nanofios/química , Ratos , Traumatismos da Medula Espinal/fisiopatologia , Titânio/química
20.
Transplant Proc ; 51(6): 1838-1844, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256870

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effects of using thromboembolic deterrent (TED) stockings and intermittent pneumatic compression (IPC) vs a muscle pump activator (MPA) device on limb edema and patient satisfaction after transplant. METHODS: In this single-center randomized controlled trial, 118 patients were randomly assigned to wear TED + IPC (n = 64) or the MPA device (n = 54) from postoperative days 1 to 6. We measured patients' weight and lower leg and thigh circumferences daily. Ultrasonography of the allograft and lower limbs was carried out on postoperative days 1 and 5 to assess resistive index in the transplanted kidney and flow in the femoral vein. We monitored urine output and serum creatinine level. RESULTS: We observed a significant increase in calf and thigh circumference from baseline in the TED + IPC group but not in the MPA group (2.3 [SD, 1] cm vs 0.25 [SD, 0.8] cm, respectively, P < .002). Ultrasonography showed higher femoral vein velocities in the MPA group than the TED + IPC group (0.5 [SD, 0.2] cm, P < .001). The mean total urine output in 6 days was higher in the MPA group than the TED + IPC group (P = .05), which corresponded to large change in TED + IPC weight of 6.2 kg vs 2.1 kg in the MPA group (P = .04). Patients were more satisfied with the use of the MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS: This is the first study to show that the use of an MPA device in the immediate postoperative period following kidney transplant leads to decreased lower limb edema and increased total urine output. Patients were more satisfied with the use of the MPA device than TED + IPC.


Assuntos
Circulação Assistida/instrumentação , Edema/terapia , Terapia por Estimulação Elétrica/instrumentação , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Circulação Assistida/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Edema/etiologia , Edema/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Feminino , Veia Femoral , Hemodinâmica/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Meias de Compressão , Resultado do Tratamento
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