Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 724
Filtrar
1.
Int Heart J ; 62(1): 65-71, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455982

RESUMO

Left atrial (LA) fibrosis is associated with a poor outcome after atrial fibrillation (AF) ablation. This study examined the extent of low-voltage areas in patients with recurrence of atrial tachyarrhythmia (ATA) after CB-based pulmonary vein isolation (PVI).Sixty patients (mean age 67 ± 10 years, n = 32 female; n = 34 paroxysmal AF) who received radiofrequency redo-procedure due to recurrence of ATA within 6 months after CB-based PVI were included. A point-by point 3D-map was performed, and low-voltage sites were delineated based on bipolar voltage < 0.5 mV. The extent of fibrosis was categorized as stage A (0-10% of the LA wall), stage B (10-30%), stage C (30-50%), and stage D (> 50%).The median area of LA low-voltage sites was 28.9 (9; 50.3) cm2, corresponding to 17.4 (6; 30.6) % of the LA wall surface. 17/60 (28.3%) patients were categorized as fibrosis stage A, 21/60 (35%) as stage B, 18/60 (30%) as stage C, and 4/60 (6.7%) as stage D. Patient age and LA diameter were associated with more pronounced LA fibrosis; the extent of LA fibrosis was significantly higher in patients with LA tachycardia (LAT) during redo-procedures (P < 0.01), and ablation of linear lesions was more often performed (P < 0.01).In patients after CB2-based PVI, expanded LA tissue fibrosis was associated with the occurrence of LAT and more extensive LA ablation during redo-procedures.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fibrose/complicações , Átrios do Coração/patologia , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Feminino , Fibrose/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia Supraventricular/epidemiologia , Taquicardia Supraventricular/etiologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(1): e24081, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429772

RESUMO

BACKGROUND: Liver cirrhosis is a common clinical chronic progressive disease. Due to the obstruction of blood flow after cirrhosis, it leads to long-term congestion of splenic sinus, hyperplasia of fibrous tissue and proliferation of splenic myeloid cells, resulting in hepatocirrhosis and splenomegaly. At present, western medicine still uses splenectomy and interventional therapy are the main treatment, but the adverse reactions are more and the curative effect is not good. Many clinical trials have proved that Traditional Chinese medicine has a great therapeutic effect on Hepatocirrhosis with splenomegaly, which can effectively delay the development of the disease and improve the survival rate of patients. This systematic review aims to evaluate the efficacy and safety of Traditional Chinese medicine in the treatment of hepatocirrhosis with splenomegaly. METHODS: The databases of Pubmed, CENTRAL (The Cochrane Central Register of Controlled Trials), China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (WANFANG Data), Weipu Information Chinese Periodical Service Platform (VIP), and China Biomedical Literature Service System (SinoMed) will be searched online to collect randomized controlled trials related to the treatment of hepatocirrhosis with splenomegaly with Traditional Chinese medicine The time is limited from the construction of the library to November 2020. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata 13.0 software so as to systematically review the effectiveness of Traditional Chinese medicine for hepatocirrhosis with splenomegaly. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for hepatocirrhosis with splenomegaly. Because all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. In addition, all data will be analyzed anonymously during the review process. RESULTS: In this study, we will evaluate the efficacy of Traditional Chinese medicine in the treatment of cirrhosis with splenomegaly. CONCLUSION: The conclusion of this study will be evidence to ensure the efficacy of Traditional Chinese medicine© in the treatment of cirrhosis with splenomegaly and provide guidance for its treatment. TRIAL REGISTRATION NUMBER: INPLASY2020110121.


Assuntos
Protocolos Clínicos , Hipertensão Portal/tratamento farmacológico , Medicina Tradicional Chinesa/normas , Esplenomegalia/tratamento farmacológico , Fibrose/complicações , Humanos , Hipertensão Portal/etiologia , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Esplenomegalia/etiologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Kardiologiia ; 60(6): 994, 2020 Jul 07.
Artigo em Russo | MEDLINE | ID: mdl-32720621

RESUMO

Aim      To study possible correlations between echocardiography (EchoCG) indexes and markers of myocardial fibrosis, procollagen I C-terminal propeptide (PICP) and procollagen III N-terminal propeptide (PIIINP) during one year following ST-segment elevation myocardial infarction (STEMI).Material and methods  120 patients with STEMI were evaluated. EchoCG was used to assess dimensions and volumes of heart chambers, left ventricular (LV) systolic function, mean pulmonary arterial pressure (mPAP), and indexes of LV diastolic function (Em, early diastolic lateral mitral annular velocity; e', peak early diastolic septal mitral annular velocity; E / e', ratio of peak early diastolic transmitral inflow velocity and mitral annular velocity  -, Е / А, ratio of peak early and late transmitral inflow velocities; DT, deceleration time of LV early diastolic filling). EchoCG indexes and serum concentrations of PICP and PIIINP were determined at 1 (point 1) and 12 (point 2) days of disease and one year after STEMI (point 3). The sample was divided into two groups: group 1 (n=86; 71.7 %) included patients with a LV ejection fraction (EF) ≥50 % and group 2 (n=34; 28.3 %) consisted of patients with LV EF ≤49 %.Results At one year, the number of patients with signs of diastolic dysfunction increased by 10% in group 1 whereas myocardial systolic dysfunction worsened in both groups. LV EF decreased in 15 (17.4%) patients of group 1 and in 4 (11.8%) patients of group 2. Concentrations of PIIINP were correlated with Em, E / e', mPAP, PICP, e', and LV EF.Conclusion      Direct correlations between PIIINP concentrations and Em, E / e', and mPAP were found in the group with LV EF ≥50 %. In the group with LV EF <50 %, correlations were observed between PICP concentrations, LV EF, and e'. Also, in this group, the increase in PIIINP was statistically more significant. These results indicate continuing formation of myocardial fibrosis in a year following MI, which may underlie progression of chronic heart failure.


Assuntos
Infarto do Miocárdio , Disfunção Ventricular Esquerda , Diástole , Fibrose/complicações , Humanos , Infarto do Miocárdio/etiologia , Volume Sistólico , Função Ventricular Esquerda
5.
Life Sci ; 254: 117797, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32417371

RESUMO

AIMS: Atrial remodeling, including structural and electrical remodeling, is considered as the substrate in the development of atrial fibrillation (AF). Structural remodeling mainly involves atrial fibrosis, and electrical remodeling is closely related to the changes of ion channels in atrial myocytes. In this study, we aimed to investigate the changes of ion channels in atrial remodeling induced by CIH in rats, which provide the explication for the mechanisms of AF. MATERIALS AND METHODS: 80 male Sprague-Dawley rats were randomized into two groups: Control and CIH group (n = 40). CIH rats were subjected to CIH 8 h/d for 30 days. Atrial epicardial conduction velocity, conduction inhomogeneity and AF inducibility were examined. Masson's trichrome staining was used to evaluate the extent of atrial fibrosis, and the expression levels of ion channel subunits were measured by RT-qPCR, Western blot, and IHC, respectively. The remaining 40 rats were used for whole-cell patch clamp experiments. Action potential, INa, ICa-L, Ito were recorded and compared between two groups. KEY FINDINGS: CIH rats showed increased AF inducibility, atrial interstitial collagen deposition, APD, expression levels of RyR2, p-RyR2, CaMKII, p-CaMKII, and decreased atrial epicardial conduction velocity, expression levels of Nav1.5, Cav1.2, Kv1.5, Kv4.2, Kv4.3 compared to the Control rats, and the current density of INa, ICa-L, Ito were significantly decreased in CIH group. SIGNIFICANCE: We observed significant atrial remodeling induced by CIH in our rat model, which was characterized by changes in ion channels. These changes may be the mechanisms of CIH promoting AF.


Assuntos
Remodelamento Atrial/fisiologia , Hipóxia/fisiopatologia , Canais Iônicos/fisiologia , Potenciais de Ação/fisiologia , Animais , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/biossíntese , Doença Crônica , Fibrose/complicações , Fibrose/patologia , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Hipóxia/complicações , Hipóxia/metabolismo , Canais Iônicos/biossíntese , Masculino , Potenciais da Membrana/fisiologia , Ratos , Canal de Liberação de Cálcio do Receptor de Rianodina/biossíntese
6.
Aliment Pharmacol Ther ; 51(12): 1233-1246, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406116

RESUMO

BACKGROUND: Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD). AIM: To perform a systematic review summarising evidence for efficacy of systemic and endoscopic intralesional medical therapy in established small bowel strictures in adult CD patients. METHODS: A systematic search of MEDLINE, EMBASE, CENTRAL and Scopus was conducted. Primary outcomes were rates of surgical resection and repeat endoscopic dilation. Pooled event rates from random effects models across studies with 95% confidence intervals were reported. RESULTS: Ten studies describing systemic medical therapy and eight studies of intralesional injection were included. One randomised controlled trial each for systemic therapy and intrastricture injection were identified. Only observational studies were found for systemic biologic therapies, which exclusively included tumour necrosis factor (TNF) antagonists, while intralesional therapies all involved corticosteroids except for one study that evaluated infliximab. Pooled event rates for surgical resection after systemic and intralesional therapy were 28.3% (95% CI: 18.2%-41.3%) and 18.5% (95% CI: 8.3%-36.2%), respectively over a median follow-up of 23 months (range 5.5-105.8), and 21.8 months (range 5-47). Risk of repeat endoscopic balloon dilation in those with intralesional therapy was 58.3% (95% CI: 36.6%-77.3%) over a median follow-up of 21.8 months (range 5-47). CONCLUSIONS: There are no favoured therapies for patients with stricturing small bowel CD. Data are lacking for ustekinumab and vedolizumab. No endoscopic intralesional medications provided a clear benefit for prevention of repeat EBD or surgery.


Assuntos
Doença de Crohn/tratamento farmacológico , Obstrução Intestinal/tratamento farmacológico , Corticosteroides/administração & dosagem , Terapia Combinada/estatística & dados numéricos , Constrição Patológica/complicações , Constrição Patológica/tratamento farmacológico , Constrição Patológica/epidemiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Dilatação/métodos , Dilatação/estatística & dados numéricos , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/estatística & dados numéricos , Fibrose/complicações , Fibrose/tratamento farmacológico , Fibrose/epidemiologia , Fibrose/cirurgia , Humanos , Infusões Intralesionais , Obstrução Intestinal/complicações , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/cirurgia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia
8.
Ars pharm ; 61(1): 45-47, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188574

RESUMO

OBJETIVOS: Determinar la efectividad del tratamiento de la hepatitis C crónica definida como la respuesta viral sostenida a las 12 semanas (RVS12) tras la finalización del tratamiento con fármacos antivirales de acción directa (AAD) (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir y grazoprevir/elbasvir) en pacientes atendidos en la consulta de farmacia ambulatoria. MÉTODOS: estudio retrospectivo que incluye los pacientes atendidos por farmacia que iniciaron tratamiento con AAD entre el 1 de diciembre de 2017 y el 31 de mayo de 2018. Se registraron datos demográficos, de la enfermedad, grado de adherencia y consultas sobre el tratamiento (interacciones, efectos adversos y otras). RESULTADOS: Se incluyeron 205 pacientes con diferentes genotipos de hepatitis C, estados de fibrosis y grados de morbilidad. La efectividad fue del 99,5%, similar a la reportada en los ensayos clínicos. CONCLUSIONES: Estos resultados se asemejan a los obtenidos en las consultas de farmacia en Estados Unidos, funcionando desde hace más de diez años


OBJECTIVE: To determine the effectiveness of the treatment of chronic hepatitis C determined as the sustained viral response at 12 weeks (SVR12) after the end of treatment with direct-acting antiviral drugs (DAA) (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir and grazoprevir/elbasvir) in attended patients from the outpatient pharmacy consultation. METHOD: a retrospective study that includes patients attended by pharmacists who started treatment between December 1, 2017 and May 31, 2018. Demographic data, disease, adherence and treatment consultations were recorded (interactions, adverse effects and others). RESULTS: Two hundred and five patients were included, with different hepatitis C genotypes, fibrosis states and morbidity levels. Effectiveness was 99.5%, similar to that of clinical trials. CONCLUSIONS: These results resemble those obtained in pharmacy consultations in the United States, operating for more than ten years


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hepatite C/tratamento farmacológico , Resultado do Tratamento , Assistência Farmacêutica , Antivirais/uso terapêutico , Estudos Retrospectivos , Fibrose/complicações , Fibrose/tratamento farmacológico , Cooperação e Adesão ao Tratamento
9.
PLoS One ; 15(2): e0229497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101574

RESUMO

BACKGROUND: Previous studies have demonstrated that opioids are often prescribed and associated with complications in outpatients with cirrhosis. Less is known about opioids among hospitalized patients with cirrhosis. We aimed to describe the patterns and complications of opioid use among inpatients with cirrhosis. METHODS: This retrospective cohort study included adult patients with cirrhosis admitted to a single hospital system from 4/4/2014 to 9/30/2015. We excluded hospitalizations with a surgery, invasive procedure, or palliative care/hospice consult in order to understand opioid use that may be avoidable. We determined the frequency, dosage, and type of opioids given during hospitalization. Using bivariable and multivariable analyses, we assessed length of stay, intensive care unit transfer, and in-hospital mortality by opioid use. RESULTS: Of 217 inpatients with cirrhosis, 118 (54.4%) received opioids during hospitalization, including 41.7% of patients without prior outpatient opioid prescriptions. Benzodiazepines or hypnotic sleep aids were given to 28.8% of opioid recipients. In the multivariable model, younger age and outpatient opioid prescription were associated with inpatient opioids. Hospitalization was longer among opioid recipients (median 3.9 vs 3.0 days, p = 0.002) and this difference remained after adjusting for age, cirrhosis severity, and medical comorbidities. There was no difference in intensive care unit transfers and no deaths occurred. At discharge, 22 patients were newly started on opioids of whom 10 (45.5%) had opioid prescriptions at 90 days post-discharge. CONCLUSION: In non-surgical inpatients with cirrhosis, opioid prescribing was common and associated with prolonged length of stay. A high proportion of patients newly discharged with opioid prescriptions had ongoing prescriptions at 90 days post-discharge.


Assuntos
Analgésicos Opioides/uso terapêutico , Fibrose/complicações , Fibrose/tratamento farmacológico , Adulto , Feminino , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Dor Pós-Operatória/tratamento farmacológico , Alta do Paciente , Padrões de Prática Médica/tendências , Prescrições , Estudos Retrospectivos , Estados Unidos
10.
Ann Thorac Surg ; 110(1): e31-e33, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31926159

RESUMO

Characterized by pleural and subpleural fibrosis with alveolar septal elastosis, pleuroparenchymal fibroelastosis is a rare restrictive lung disease. Symptoms are often subtle, including dyspnea, cough, and weight loss; while acute presentations of spontaneous pneumothorax have been recorded. We report a patient who developed a spontaneous hemothorax, who upon evacuation of the chest was found to have a hemorrhagic lower lobe mass consistent with pleuroparenchymal fibroelastosis. Various conditions are associated with pleuroparenchymal fibroelastosis, suggesting chronic lung injury as a factor in pathogenesis. Hemothorax of this magnitude with relatively no known inciting risk factors, represents an exceptionally rare case presentation.


Assuntos
Hemotórax/etiologia , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Doenças Pleurais/complicações , Fibrose Pulmonar/complicações , Adulto , Biópsia , Fibrose/complicações , Fibrose/diagnóstico , Hemotórax/diagnóstico , Hemotórax/cirurgia , Humanos , Masculino , Doenças Pleurais/diagnóstico , Fibrose Pulmonar/diagnóstico , Toracoscopia , Tomografia Computadorizada por Raios X
11.
Eur J Pharmacol ; 870: 172913, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-31926994

RESUMO

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are considered major global medical burdens with high prevalence and steeply rising incidence. Despite the characterization of numerous pathophysiologic pathways leading to metabolic disorder, lipid accumulation, inflammation, fibrosis, and ultimately end-stage liver disease or liver cancer formation, so far no causal pharmacological therapy is available. Drug development for NAFLD and NASH is limited by long disease duration and slow progression and the need for sequential biopsies to monitor the disease stage. Additional non-invasive biomarkers could therefore improve design and feasibility of such. Here, the current concepts on preclinical models, biomarkers and clinical endpoints and trial designs are briefly reviewed.


Assuntos
Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/metabolismo , Animais , Biomarcadores , Progressão da Doença , Desenvolvimento de Medicamentos , Fibrose/complicações , Fibrose/tratamento farmacológico , Humanos , Incidência , Inflamação/complicações , Inflamação/tratamento farmacológico , Fígado/metabolismo , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Doenças Metabólicas/complicações , Doenças Metabólicas/tratamento farmacológico , Prevalência , Índice de Gravidade de Doença , Resultado do Tratamento
12.
BJU Int ; 125(1): 168-172, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31265201

RESUMO

OBJECTIVES: To compare the rates of intra- and postoperative complications between early (<4 months) or delayed (>4 months) inflatable penile prosthesis (IPP) re-implantation performed after a fibrosis-inducing event. PATIENTS AND METHODS: Cases of IPP re-implantation were performed by a single, high-volume prosthetic surgeon in hospitals domestically and abroad over a 15-year period (2001-2016). The time interval from the precipitating event to operation, intra-operative complications and postoperative complications for up to 1 year after implantation, were recorded. RESULTS: A total of 72 cases of IPP re-implantation were recorded. There were 16 (53%) intraoperative complications in patients who had surgery at <4 months (Group 1) and 23 (55%) in patients operated at >4 months (Group 2). There were four (13%) postoperative complications in Group 1 and 14 (33%) in Group 2. CONCLUSION: Re-implantation of an IPP into fibrotic corporal bodies is associated with less serious postoperative complications when performed within 4 months of the fibrosis-inducing event.


Assuntos
Cicatriz/complicações , Disfunção Erétil/complicações , Disfunção Erétil/cirurgia , Complicações Intraoperatórias/epidemiologia , Doenças do Pênis/complicações , Implante Peniano/métodos , Prótese de Pênis , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Fibrose/complicações , Humanos , Masculino , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Tempo
13.
Int J Med Sci ; 16(12): 1614-1620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31839749

RESUMO

Background: To examine the incidence of cirrhosis patients with high-risk esophageal varices (EV) who show hepatic venous pressure gradient (HVPG) < 10 mmHg and to identify their hemodynamic features. Methods: This prospective study consisted of 110 cirrhosis patients with EV, all with the candidate for primary or secondary prophylaxis. Sixty-one patients had red sign, and 49 patients were bleeders. All patients underwent both Doppler ultrasound and HVPG measurement. Results: There were 18 patients (16.4%) with HVPG < 10 mmHg. The presence of venous-venous communication (VVC) was more frequent in patients with HVPG < 10 mmHg (10/18) than in those with HVPG ≥ 10 mmHg (19/92; p = 0.0021). The flow volume in the left gastric vein (LGV) and the incidence of red sign were higher in the former (251.9 ± 150.6 mL/min; 16/18) than in the latter (181 ± 100.5 mL/min, p = 0.02; 45/92; p = 0.0018). The patients with red sign had lower HVPG (13.3 ± 4.5) but advanced LGV hemodynamics (velocity 13.2 ± 3.8 cm/s; flow volume 217.5 ± 126.6 mL/min), whereas those without red sign had higher HVPG (16.2 ± 4.6, p = 0.001) but poorer LGV hemodynamics (10.9 ± 2.3, p = 0.002; 160.1 ± 83.1, p = 0.02). Conclusion: Patients with high-risk EV with HVPG < 10 mmHg showed 16.4% incidence. Although low HVPG may be underestimated by the presence of VVC, the increased LGV hemodynamics compensates for the severity of portal hypertension, which may contribute to the development of red sign.


Assuntos
Varizes Esofágicas e Gástricas/fisiopatologia , Fibrose/fisiopatologia , Veias Hepáticas/fisiopatologia , Fígado/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Endoscopia/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Fibrose/complicações , Fibrose/diagnóstico por imagem , Hemodinâmica , Veias Hepáticas/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta/fisiologia , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Ultrassonografia , Pressão Venosa
14.
Drug Discov Ther ; 13(5): 297-298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723102

RESUMO

Myocardial injury with systemic sclerosis (SSc) causes pericarditis and arrhythmia, and polymyositis-induced muscle inflammation causes myocarditis. We report a rare case of overlap syndrome (SSc and polymyositis) who presented with sudden chest pain secondary to myocardial fibrosis. Although the etiology of chest symptoms in collagen disease was difficult to identify, cardiac magnetic resonance imaging (MRI) revealed not myocarditis but myocardial fibrosis in our case. Synthetic judgement of serum brain natriuretic peptide/ troponin T levels and cardiac MRI is useful in the search for the cause of chest symptoms even in patients with collagen diseases.


Assuntos
Dor no Peito/diagnóstico , Fibrose/diagnóstico por imagem , Fibrose/patologia , Coração/diagnóstico por imagem , Miocárdio/patologia , Polimiosite/complicações , Esclerodermia Difusa/complicações , Dor no Peito/complicações , Fibrose/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Peptídeo Natriurético Encefálico/sangue , Polimiosite/sangue , Polimiosite/diagnóstico , Esclerodermia Difusa/sangue , Esclerodermia Difusa/diagnóstico , Síndrome , Troponina T/sangue , Adulto Jovem
15.
Medicine (Baltimore) ; 98(41): e17551, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593137

RESUMO

RATIONALE: Refractory edema is characterized by persistent swelling which does not react to diuretic use and sodium restriction. Traditional herbal medicine, Gwack Rhyung Tang and Chunggan extract effectively treated refractory lower limb edema caused by cirrhosis and improved liver function. PATIENT CONCERNS: A 64-year-old male patient with a history of hypertension, diabetes mellitus, hepatic encephalopathy, and cellulitis presented lower limb edema which did not react to diuretics for more than 7 months. DIAGNOSES: Refractory edema caused by cirrhosis. INTERVENTIONS: The patient was treated for 25 days using Gwack Rhyung Tang and Chunggan extract. OUTCOMES: Loss of body weight, decrease in circumferences of both lower limb and improvement of liver function biochemistry results are checked. There was no recurrence or aggravation of the condition up to 3 weeks of follow-up periods. LESSONS: Traditional herbal medicine can be an effective alternative for refractory edema due to cirrhosis with improving liver function.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Edema/tratamento farmacológico , Medicina Tradicional/métodos , Diuréticos/uso terapêutico , Resistência a Medicamentos , Medicamentos de Ervas Chinesas/administração & dosagem , Fibrose/complicações , Medicina Herbária , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Medicina (Kaunas) ; 55(10)2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31652546

RESUMO

Background and Objectives: The influence of cardiac magnetic resonance (CMR) derived left ventricular (LV) parameters on the prognosis of patients with aortic stenosis (AS) was analyzed in several studies. However, the data on the relations between the LV parameters and the development of pulmonary hypertension (PH) in severe AS is lacking. Our objectives were to evaluate the CMR-derived changes of the LV size, morphology, and function in patients with isolated severe AS and PH, and to investigate the prognostic impact of these parameters on elevated systolic pulmonary artery pressure (sPAP). Materials and Methods: Thirty patients with isolated severe AS (aortic valve area ≤1 cm2) underwent a 2D-echocardiography (2D echo) and CMR before aortic valve replacement. Indices of the LV mass and volumes and ejection fraction were analyzed by CMR. The LV global longitudinal (LV LGS) and circumferential strain (LV CS) were calculated using CMR feature tracking (CMR-FT) software (Medis Suite QStrain 2.0, Medis Medical Imaging Systems B.V., Leiden, The Netherlands). The LV fibrosis expansion was assessed using a late gadolinium enhancement sequence. PH was defined as having an estimated sPAP of ≥45 mm Hg. The statistical analysis as performed using SPSS version 23.0 (SPSS, Chicago, IL, USA) Results: 30 patients with severe AS were included in the study, 23% with severe isolated AS had PH (mean sPAP 55 ± 6.6 mm Hg). More severe LV anatomical and functional abnormalities were observed in patients with PH when compared with patients without PH-a higher LV end-diastolic volume index (EDVi) (140 [120.0-160.0] vs. 90.0 mL/m² [82.5-103.0], p = 0.04), larger LV fibrosis area (7.8 [5.6-8.0] vs. 1.3% [1.2-1.5], p = 0.005), as well as lower LV global longitudinal strain (GLS; -14.0 [-14.9-(-8.9)] vs. -21.1% [-23.4-(-17.8)], p = 0.004). By receiver-operating characteristic (ROC) curve analysis, LV EDVi > 107.7 mL/m² (Area Under the Curve (AUC) 95.7%), LV GLS < -15.5% (AUC 86.3%), and LV fibrosis area >5% (AUC 89.3) were found to be robust predictors of PH in severe AS patients. Conclusions: In patients with severe aortic stenosis, a larger end-diastolic LV volume, impaired LV global longitudinal strain, and larger LV fibrosis extent can predict the development of pulmonary hypertension.


Assuntos
Estenose da Valva Aórtica/complicações , Ventrículos do Coração/patologia , Hipertensão Pulmonar/etiologia , Função Ventricular Esquerda , Idoso , Valva Aórtica/patologia , Estenose da Valva Aórtica/fisiopatologia , Ecocardiografia , Feminino , Fibrose/complicações , Fibrose/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Disfunção Ventricular Esquerda/fisiopatologia
17.
Endocrinol Metab (Seoul) ; 34(3): 226-233, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31565874

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is thought to stem from the body's inability to store excess energy in adipocytes; as such, it is commonly viewed as the hepatic manifestation of metabolic syndrome. The pathogenesis of NAFLD involves ectopic fat accumulation, which also takes place in the liver, muscle and visceral fat. NAFLD is rapidly becoming more widespread in Korea, with an estimated prevalence of 30% in adults. Type 2 diabetes mellitus (T2DM) and NAFLD share insulin resistance as a common pathophysiological mechanism, and each of these two diseases affects the development of the other. Recent studies have suggested that NAFLD is often present as a comorbidity in T2DM patients. The mutual interrelationship between these conditions is shown by findings suggesting that T2DM can exacerbate NAFLD by promoting progression to nonalcoholic hepatosteatosis or fibrosis, while NAFLD causes the natural course of diabetic complications to worsen in T2DM patients. It remains unknown whether one disease is the cause of the other or vice versa. In this review, I would like to discuss current epidemiological data on the associations between NAFLD and T2DM, and how each disease affects the course of the other.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Fibrose/complicações , Fibrose/epidemiologia , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , República da Coreia/epidemiologia , Fatores de Risco
18.
Am J Case Rep ; 20: 1526-1529, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31619662

RESUMO

BACKGROUND Spontaneous fungal peritonitis (SFP) is a life-threatening infection which occurs more commonly in patients with liver failure. SFP is not as common as spontaneous bacterial peritonitis (SBP) and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. Spontaneous fungal peritonitis is extremely uncommon in patients with cardiac ascites due to a high protein content, which predisposes to a low risk of infections. CASE REPORT This report presents a rare case of spontaneous fungal peritonitis in a patient with cardiogenic ascites. To the best of our knowledge, this is the second known case of SFP occurring in a patient with cardiac cirrhosis. The patient did not respond to initiation of SBP treatment and after ascitic fluid grew Candida glabrata, the diagnosis of SFP was made. The patient's clinical status improved after initiation of intravenous caspofungin. CONCLUSIONS SFP should be a differential diagnosis in patients who have cardiac or liver cirrhosis, who are not improving with empirical antibiotic therapy for spontaneous bacterial peritonitis.


Assuntos
Ascite/complicações , Fibrose/complicações , Micoses/diagnóstico , Micoses/etiologia , Miocárdio/patologia , Peritonite/diagnóstico , Peritonite/etiologia , Antifúngicos/uso terapêutico , Candida glabrata/efeitos dos fármacos , Caspofungina/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/tratamento farmacológico , Fatores de Tempo
19.
Am J Physiol Gastrointest Liver Physiol ; 317(5): G661-G669, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31460790

RESUMO

Posttraumatic stress disorder (PTSD) is associated with cirrhosis in veterans, and therapeutic results are suboptimal. An altered gut-liver-brain axis exists in cirrhosis due to hepatic encephalopathy (HE), but the added impact of PTSD is unclear. The aim of this study was to define linkages between gut microbiota and cognition in cirrhosis with/without PTSD. Cirrhotic veterans (with/without prior HE) underwent cognitive testing [PHES, inhibitory control test (ICT), and block design test (BDT)], serum lipopolysaccharide-binding protein (LBP) and stool collection for 16S rRNA microbiota composition, and predicted function analysis (PiCRUST). PTSD was diagnosed using DSM-V criteria. Correlation networks between microbiota and cognition were created. Patients with/without PTSD and with/without HE were compared. Ninety-three combat-exposed male veterans [ (58 yr, MELD 11, 34% HE, 31% combat-PTSD (42 no-HE/PTSD, 19 PTSD-only, 22 HE-only, 10 PTSD+HE)] were included. PTSD patients had similar demographics, alcohol history, MELD, but worse ICT/BDT, and higher antidepressant use and LBP levels. Microbial diversity was lower in PTSD (2.1 ± 0.5 vs. 2.5 ± 0.5, P = 0.03) but unaffected by alcohol/antidepressant use. PTSD (P = 0.02) and MELD (P < 0.001) predicted diversity on regression. PTSD patients showed higher pathobionts (Enterococcus and Escherichia/Shigella) and lower autochthonous genera belonging to Lachnospiraceaeae and Ruminococcaceae regardless of HE. Enterococcus was correlated with poor cognition, while the opposite was true for autochthonous taxa regardless of PTSD/HE. Escherichia/Shigella was only linked with poor cognition in PTSD patients. Gut-brain axis-associated microbiota functionality was altered in PTSD. In male cirrhotic veterans, combat-related PTSD is associated with cognitive impairment, lower microbial diversity, higher pathobionts, and lower autochthonous taxa composition and altered gut-brain axis functionality compared with non-PTSD combat-exposed patients. Cognition was differentially linked to gut microbiota, which could represent a new therapeutic target.NEW & NOTEWORTHY Posttraumatic stress disorder (PTSD) in veterans with cirrhosis was associated with poor cognitive performance. This was associated with lower gut microbial diversity in PTSD with higher pathobionts belonging to Enterococcus and Escherichia/Shigella and lower beneficial taxa belonging to Lachnospiraceaeae and Ruminococcaceae, with functional alterations despite accounting for prior hepatic encephalopathy, psychoactive drug use, or model for end-stage liver disease score. Given the suboptimal response to current therapies for PTSD, targeting the gut microbiota could benefit the altered gut-brain axis in these patients.


Assuntos
Cognição , Fibrose/microbiologia , Microbioma Gastrointestinal , Transtornos de Estresse Pós-Traumáticos/microbiologia , Idoso , Enterococcus/patogenicidade , Escherichia/patogenicidade , Fibrose/complicações , Fibrose/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Shigella/patogenicidade , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Veteranos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA