Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.069
Filtrar
1.
Medicine (Baltimore) ; 99(2): e18719, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914086

RESUMO

BACKGROUND: Hematoma expansion (HE) is related to clinical deterioration and unfavorable prognosis in intracerebral hemorrhage (ICH). Some studies have revealed that low serum magnesium level is associated with larger hematoma volume at admission, HE, and unfavorable outcomes. However, the conclusions remain unsettled. The purpose of this study is to evaluate the association between low serum magnesium level and HE by meta-analysis. METHODS: We will search the following electronic bibliographic databases: PubMed, Medline, Embase, Web of Science, and The Cochrane Library. Studies will be included if they reported a relationship of low serum magnesium level and HE, mortality or poor outcome. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This will be the first systematic review and meta-analysis to evaluate the association of HE following ICH with Hypomagnesemia. We look forward to the results will offer scientific proof to predict HE for ICH patients with low serum magnesium level. PROSPERO REGISTRATION NUMBER: This protocol has been registered in the PROSPERO network with number: CRD42019135995.


Assuntos
Hemorragia Cerebral/patologia , Hematoma/patologia , Magnésio/sangue , Biomarcadores , Deterioração Clínica , Humanos , Prognóstico
2.
World Neurosurg ; 135: e610-e615, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870816

RESUMO

BACKGROUND: Noncontrast computed tomography hypodensities (HD) and ultraearly hematoma growth (uHG) are reliable markers for outcome prediction in patients with spontaneous intracerebral hemorrhage (sICH). The present study aimed to assess whether the combination of these 2 markers could improve the prognostic value for sICH. METHODS: We recruited 242 patients with sICH who had been admitted within 6 hours from the onset of symptoms. HD was assessed by 2 independent blinded readers, and uHG was calculated as baseline ICH volume/onset-to-imaging time. We divided the study population into 4 groups: uHG(L) HD(-) (uHG <6.16 mL/hour and HD negative), uHG(L) HD(+) (uHG<6.16 mL/hour and HD positive), uHG(H) HD(-) (uHG ≥6.16 mL/hour and HD negative), and uHG(H) HD(+) (uHG ≥6.16 mL/h and HD positive). The outcome at 90 days was evaluated by the modified Rankin Scale (mRS) score and was dichotomized as good (mRS score 0-3) and poor (mRS score 4-6). The association between the combined indicators and unfavorable outcome was investigated using multivariable logistic regression models. RESULTS: Patients with poor outcomes were more likely to have HD and higher uHG in univariate analysis. In multivariate logistic regression analysis, uHG(H) HD(+) had a higher risk of unfavorable outcomes compared with uHG(L) HD(-) (odds ratio [OR], 5.710; P < 0.001). In addition, the risk of unfavorable outcomes was increased in uHG(H) HD(-) (OR, 2.957, P = 0.044) and uHG(L) HD(+) (OR, 1.924; P = 0.232). The proportions of unfavorable prognoses were 32.6% in uHG(L) HD(-), 48.3% in uHG(L) HD(+), 72.2% in uHG(H) HD(-), and 87.5% in uHG(H) HD(+) (P < 0.001). CONCLUSIONS: The combination of uHG and HD improves the stratification of unfavorable prognoses in patients with sICH.


Assuntos
Hemorragia Cerebral/patologia , Hematoma/patologia , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Hematoma/diagnóstico por imagem , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Prognóstico , Estudos Retrospectivos , Tempo de Trombina , Fatores de Tempo , Tomografia Computadorizada por Raios X
3.
Eur Radiol ; 30(1): 87-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385050

RESUMO

OBJECTIVES: To develop a radiomics model for predicting hematoma expansion in patients with intracerebral hemorrhage (ICH) and to compare its predictive performance with a conventional radiological feature-based model. METHODS: We retrospectively analyzed 251 consecutive patients with acute ICH. Two radiologists independently assessed baseline noncontrast computed tomography (NCCT) images. For each radiologist, a radiological model was constructed from radiological variables; a radiomics score model was constructed from high-dimensional quantitative features extracted from NCCT images; and a combined model was constructed using both radiological variables and radiomics score. Development of models was constructed in a primary cohort (n = 177). We then validated the results in an independent validation cohort (n = 74). The primary outcome was hematoma expansion. We compared the three models for predicting hematoma expansion. Predictive performance was assessed with the receiver operating characteristic (ROC) curve analysis. RESULTS: In the primary cohort, combined model and radiomics model showed greater AUCs than radiological model for both readers (all p < .05). In the validation cohort, combined model and radiomics model showed greater AUCs, sensitivities, and accuracies than radiological model for reader 2 (all p < .05). Combined model showed greater AUC than radiomics model for reader 1 only in the primary cohort (p = .03). Performance of three models was comparable between reader 1 and reader 2 in both cohorts (all p > .05). CONCLUSIONS: NCCT-based radiomics model showed high predictive performance and outperformed radiological model in the prediction of early hematoma expansion in ICH patients. KEY POINTS: • Radiomics model showed better performance for prediction of hematoma expansion in patients with intracerebral hemorrhage than radiological feature-based model. • Hematomas which expanded in follow-up NCCT tended to be larger in baseline volume, more irregular in shape, more heterogeneous in composition, and coarser in texture. • A radiomics model provides a convenient and objective tool for prediction of hematoma expansion that helps to define subsets of patients who would benefit from anti-expansion therapy.


Assuntos
Hemorragia Cerebral/patologia , Hematoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Métodos Epidemiológicos , Feminino , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
4.
Pan Afr Med J ; 33: 314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692848

RESUMO

Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.


Assuntos
Drenagem/métodos , Hematoma/terapia , Doenças da Vulva/terapia , Adolescente , Feminino , Hematoma/patologia , Humanos , Doenças da Vulva/patologia , Adulto Jovem
5.
J Biol Regul Homeost Agents ; 33(5): 1359-1367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31659887

RESUMO

To study the expression changes of inflammatory factors heme oxygenase-1 (HO-1), tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß) in intracerebral hemorrhage (ICH), brain tissues surrounding hematoma were collected from ICH patients. The expressions of HO-1, TNF-α, IL- 1ß, and other genes were examined at different time points of ICH. Changes in HO-1, TNF-α, and IL-1ß positive cell numbers after ICH were detected by immunohistochemical staining. The results showed that the expressions of HO-1, TNF-α, and IL-1ß had no significant changes in brain tissues surrounding hematoma within 6 hours after ICH (P > 0.05). Their expressions during 6-24 hours and 24-72 hours after ICH increased constantly. After reaching the peak, they remained steady or slightly decreased after 72 hours. The dynamic expression changes of HO-1, TNF-α, and IL-1ß were observed and their development trends were interfered timely to alleviate the secondary neurological impairment after ICH, which was significant to prevent ICH.


Assuntos
Encéfalo/metabolismo , Hemorragia Cerebral/patologia , Hematoma/metabolismo , Heme Oxigenase-1/metabolismo , Interleucina-1beta/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Encéfalo/patologia , Hematoma/patologia , Humanos
7.
Medicine (Baltimore) ; 98(41): e17553, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593138

RESUMO

RATIONALE: Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. PATIENT CONCERNS: Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. DIAGNOSES: Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. INTERVENTIONS: Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). OUTCOMES: Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. LESSONS: By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.


Assuntos
Anestesia/efeitos adversos , Hematoma/etiologia , Punções/efeitos adversos , Adulto , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/patologia , Hematoma/cirurgia , Humanos , Doença Iatrogênica/epidemiologia , Injeções Espinhais , Laminectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Doenças da Medula Espinal/patologia , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
9.
World Neurosurg ; 131: 177-179, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31421300

RESUMO

This report portrays an unusual presentation of a dysembryoplastic neuroepithelial tumor characterized by a chronic, enlarging, heterogeneously enhancing organizing hematoma. Differential diagnoses included the malignant transformation of a low-grade glioma, radiation necrosis, and radiation-induced cavernoma. A dysembryoplastic neuroepithelial tumor may have atypical characteristics and behavior, so continued follow-up with serial imaging is recommended.


Assuntos
Encefalopatias/diagnóstico por imagem , Hematoma/complicações , Hematoma/diagnóstico por imagem , Neoplasias Neuroepiteliomatosas/complicações , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Adulto , Encefalopatias/complicações , Encefalopatias/patologia , Encefalopatias/cirurgia , Diagnóstico Diferencial , Hematoma/patologia , Hematoma/cirurgia , Humanos , Masculino , Neoplasias Neuroepiteliomatosas/patologia , Neoplasias Neuroepiteliomatosas/cirurgia
12.
World Neurosurg ; 129: 170-171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181364

RESUMO

Intraneural hematomas are an uncommon cause of a focal mononeuropathy. When they do occur, it is usually in the setting of inherited or iatrogenic coagulopathies or as a consequence of injections targeting nerves. We report a man aged 68 years on warfarin therapy for a prior pulmonary embolism who presented with a 6-month history of progressive weakness of knee flexion and ankle movement, excruciating pain, and dense numbness in his posterior left thigh and below the knee, consistent with a severe high sciatic palsy. Imaging depicted a contiguous cystic mass of mixed T1 and T2 intensities involving the left sciatic nerve in the thigh, which was radiologically interpreted as a hip arthroplasty-associated pseudotumor. The patient underwent surgical exploration, which revealed a thick hemorrhagic pseudocompartment within the sciatic nerve. The histopathologic diagnosis was consistent with chronic hemorrhage. These impressive lesions should be included in the differential diagnosis of nerve masses.


Assuntos
Hematoma/patologia , Neuropatia Ciática/patologia , Idoso , Anticoagulantes/efeitos adversos , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Embolia Pulmonar/tratamento farmacológico , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia , Varfarina/efeitos adversos
13.
J Craniofac Surg ; 30(4): e306-e308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166274

RESUMO

Basal ganglionic germinoma (BGG) with syncytiotrophoblastic giant cells (STGC) is a rare type of ectopic germ cell tumors with mild elevation of human chorionic gonadotropin level. Intratumoral hemorrhage is not uncommon for BGG, but presenting with repeated hemorrhage is very rare. Herein, we described an extremely rare case of BGG with STGC mimicking a growing hematoma. Furthermore, the characteristics, treatment, and prognosis of BGG with STGC were investigated and reviewed.


Assuntos
Hemorragia dos Gânglios da Base/patologia , Gânglios da Base/patologia , Neoplasias Encefálicas/patologia , Germinoma/patologia , Hematoma/patologia , Diagnóstico Diferencial , Feminino , Células Gigantes/patologia , Humanos , Masculino , Paresia/etiologia , Prognóstico , Recidiva , Trofoblastos/patologia
14.
Forensic Sci Int ; 302: 109856, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247451

RESUMO

The assessment and interpretation of the timing of skeletal trauma can be of extreme difficulty in post-mortem specimens, especially because of post-mortem processes and taphonomic events. The chronological diagnosis of bone trauma, consisting usually in the gross distinction between antemortem, perimortem and post-mortem, is based almost uniquely on macroscopic and morphologic parameters in the anthropological field. However, both the interference of taphonomy and the scarce persistence of specific features indicating vitality (meaning etymologically "produced in life") and/or some very early bone healing reactions, make it extremely difficult. In this perspective, it is important not only to distinguish between peri and post-mortem lesions, but also to interpret perimortem lesions with respect to vitality and time elapsed since the trauma which may change the course of the investigations. And techniques of forensic pathology applied to forensic anthropology can come in extremely handy. If any traces of vital blood extravasation, haemorrhage, hematoma, inflammation, and biomarkers of early healing reaction are found in the bone tissue of a skeletal lesion (regardless the state of preservation of the body), then can they be used as a diagnostic tool or marker of vitality for that lesion? In these terms, vital reactions like bleeding or any early sign of bone healing can be the only evidence for demonstrating that a traumatic event was prior the death. Nevertheless, very little information, or research for that matter, is available in literature concerning persistence and detectability of vitality markers during the bone decomposition process. A fundamental point for properly determining the vitality of a fracture and estimating the post-traumatic time interval in skeletal lesions is the physio-pathological picture of the very initial healing process. This article attempts to provide a review of the physiopathological current knowledge available and applicable to osteology.


Assuntos
Remodelação Óssea/fisiologia , Fraturas Ósseas/patologia , Osteogênese/fisiologia , Biomarcadores/metabolismo , Coagulação Sanguínea/fisiologia , Citocinas/fisiologia , Hematoma/patologia , Hemorragia/patologia , Humanos , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Neovascularização Fisiológica/fisiologia , Osteoblastos/fisiologia , Osteoclastos/fisiologia
15.
BMJ Case Rep ; 12(5)2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31079041

RESUMO

A healthy youngwoman presented 3 days after a jet ski accident with a large left vulvar haematoma measuring 12 cm. Immediately postinjury, she was managed conservatively in the emergency room of another hospital. However, the haematoma continued to slowly expand. She presented to our clinic with difficulty walking and severe discomfort. Decision was made to drain the haematoma surgically. The patient was sceptical to have scarring on her vulva. Thus, the haematoma was evacuated by a vertical incision on the left vaginal sidewall. After evacuation and achieving haemostasis, the was closed with two interrupted sutures. Edges of the incision were secured similar to marsupialisation with five interrupted sutures to allow continual drainage. Her discomfort resolved immediately postsurgery and she had an uncomplicated postoperative course. The intravaginal approach yielded superior aesthetic result with no scarring on the external vulva.


Assuntos
Drenagem/métodos , Hematoma/cirurgia , Doenças da Vulva/cirurgia , Adulto , Feminino , Hematoma/patologia , Humanos , Vagina/cirurgia , Vulva/lesões , Doenças da Vulva/patologia
16.
Pan Afr Med J ; 32: 16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143321

RESUMO

Spontaneous subcapsular hematoma of the liver is an extremely rare but potentially life-threatening condition. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy or trauma. A CT scan of the abdomen demonstrated a huge subcapsular hematoma around the liver. The patient was treated conservatively and was discharged home after one week. Up to our knowledge, this is one of the very few reported cases of a spontaneous subcapsular hepatic hematoma.


Assuntos
Hematoma/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Tratamento Conservador/métodos , Hematoma/patologia , Hematoma/terapia , Humanos , Hepatopatias/patologia , Hepatopatias/terapia , Masculino
17.
EBioMedicine ; 43: 454-459, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31060901

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is a devastating disease with high mortality rate. This study aimed to predict hematoma expansion in spontaneous ICH from routinely available variables by using support vector machine (SVM) method. METHODS: We retrospectively reviewed 1157 patients with spontaneous ICH who underwent initial computed tomography (CT) scan within 6 h and follow-up CT scan within 72 h from symptom onset in our hospital between September 2013 and August 2018. Hematoma region was manually segmented at each slice to guarantee the measurement accuracy of hematoma volume. Hematoma expansion was defined as a proportional increase of hematoma volume > 33% or an absolute growth of hematoma volume > 6 mL from initial CT scan to follow-up CT scan. Univariate and multivariate analyses were performed to assess the association between clinical variables and hematoma expansion. SVM machine learning model was developed to predict hematoma expansion. FINDINGS: 246 of 1157 (21.3%) patients experienced hematoma expansion. Multivariate analyses revealed the following 6 independent factors associated with hematoma expansion: male patient (odds ratio [OR] = 1.82), time to initial CT scan (OR = 0.73), Glasgow Coma Scale (OR = 0.86), fibrinogen level (OR = 0.72), black hole sign (OR = 2.52), and blend sign (OR = 4.03). The SVM model achieved a mean sensitivity of 81.3%, specificity of 84.8%, overall accuracy of 83.3%, and area under receiver operating characteristic curve (AUC) of 0.89 in prediction of hematoma expansion. INTERPRETATION: The designed SVM model presented good performance in predicting hematoma expansion from routinely available variables. FUND: This work was supported by Health Foundation for Creative Talents in Zhejiang Province, China, Natural Science Foundation of Zhejiang Province, China (LQ15H180002), the Science and Technology Planning Projects of Wenzhou, China (Y20180112), Scientific Research Staring Foundation for the Returned Overseas Chinese Scholars of Ministry of Education of China, and Project Foundation for the College Young and Middle-aged Academic Leader of Zhejiang Province, China. The funders had no role in study design, data collection, data analysis, interpretation, writing of the report.


Assuntos
Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Hematoma/complicações , Hematoma/patologia , Máquina de Vetores de Suporte , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Hemorragia Cerebral/metabolismo , Feminino , Escala de Coma de Glasgow , Hematoma/metabolismo , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Razão de Chances , Prognóstico , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948400

RESUMO

Intramural small bowel haematoma is a rare cause of intestinal obstruction in children. Coagulation disorders or anticoagulant therapy are the most common cause followed by blunt trauma. A one and half-year-old boy, with known case of gastro-oesophageal reflux disease had undergone upper gastrointestinal endoscopy and biopsy. Four days later, he presented to us with clinical features of small bowel obstruction. CT of the abdomen showed features suggestive of haemorrhagic duplication cyst. Explorative laparotomy revealed 15-20 cm of bowel from the third part of the duodenum to proximal jejunum filled with clotted blood and thinned out serosa. There was no evidence of intraluminal blood in the distal bowel loops. Resection of the involved bowel with primary anastomoses was done. Histopathological examination of bowel revealed intramural haematoma associated with prolapse of the mucosa. There was no evidence of duplication cyst or vascular malformations. Postoperative period was uneventful.


Assuntos
Duodenopatias/complicações , Hemorragia Gastrointestinal/complicações , Hematoma/complicações , Mucosa Intestinal/patologia , Obstrução Intestinal/etiologia , Duodenopatias/patologia , Duodeno/patologia , Hemorragia Gastrointestinal/patologia , Hematoma/patologia , Humanos , Lactente , Masculino , Prolapso
19.
PLoS One ; 14(4): e0214276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947253

RESUMO

Fractures in horses-whether simple fractures with just one clean break, or incomplete greenstick with stress fractures, or complications such as shattered bones can all be either minimal or even catastrophic. Thus, improvement in fracture healing is a hallmark in equine orthopedics. The fracture healing process implements a complex sequence of events including the initial inflammatory phase removing damaged tissue, re-establishment of vessels and mesenchymal stromal cells, a soft and hard callus phase closing the fracture gap as well as the remodeling phase shaping the bone to a scar-free tissue. Detailed knowledge on processes in equine fracture healing in general and on the initial phase in particular is apparently very limited. Therefore, we generated equine in vitro fracture hematoma models (FH models) to study time-dependent changes in cell composition and RNA-expression for the most prominent cells in the FH model (immune cells, mesenchymal stromal cells) under conditions most closely adapted to the in vivo situation (hypoxia) by using flow cytometry and qPCR. In order to analyze the impact of mesenchymal stromal cells in greater detail, we also incubated blood clots without the addition of mesenchymal stromal cells under the same conditions as a control. We observed a superior survival capacity of mesenchymal stromal cells over immune cells within our FH model maintained under hypoxia. Furthermore, we demonstrate an upregulation of relevant angiogenic, osteogenic and hypoxia-induced markers within 48 h, a time well-known to be crucial for proper fracture healing.


Assuntos
Consolidação da Fratura , Fraturas Ósseas/patologia , Fraturas Ósseas/terapia , Hematoma/terapia , Hipóxia/patologia , Células-Tronco Mesenquimais/citologia , Modelos Biológicos , Animais , Biomarcadores/metabolismo , Biópsia , Sobrevivência Celular/efeitos dos fármacos , Consolidação da Fratura/efeitos dos fármacos , Hematoma/patologia , Cavalos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Neovascularização Fisiológica/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Oxigênio/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Fatores de Tempo , Regulação para Cima/efeitos dos fármacos
20.
J Card Surg ; 34(5): 337-347, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30932260

RESUMO

OBJECTIVES: It is difficult to predict the evolution of uncomplicated type B intramural hematoma (IMHB) with a focal intimal disruption (FID) in the acute phase. The aims of this study were to investigate the predictors of FIDs and summarize the risk factors for the evolution of uncomplicated IMHB in the acute phase. METHODS: Eighty-six patients with uncomplicated IMHB were included and were divided according to the development of an FID during the acute phase: the FID group (n = 32) and the no-FID group (n = 54). Geometric measurements and computed fluid dynamic calculations were based on a computed tomography scan performed on admission. Multivariate logistic regression analysis was used to estimate the predictors of FID development. RESULTS: Thirty-two (37%) patients developed an FID. Patients with an FID had higher C-reactive protein levels (18.6 ± 2.3 vs 8.1 ± 0.2 mg/dL, P < 0.001) and white blood cell counts (10.3 ± 2.1 vs 7.5 ± 1.7 109 /L, P < 0.001). The no-FID group had lower occurrences of disease progression (15% vs 64%, P < 0.001) and aorta-related mortality (6% vs 25%, P = 0.016). Multivariate logistic regression analysis indicated a significant risk for the occurrence of an FID with a larger maximum aortic diameter (OR, 1.35; 95% CI, 1.05-1.73, P = 0.020), thicker hematoma (OR, 2.20; 95% CI, 1.40-3.48, P = 0.001), and higher oscillatory shear index (per 0.01 unit, OR, 1.74; 95% CI, 1.21-2.49, P = 0.003). The aorta-related mortality during the acute phase was 25% (n = 8). CONCLUSIONS: Certain aortic conditions, including ta larger aortic diameter, thicker hematoma and higher oscillatory shear stress, are associated with the FID development and result in worse clinical outcomes.


Assuntos
Reação de Fase Aguda , Aorta/patologia , Aorta/fisiopatologia , Hematoma/patologia , Hematoma/fisiopatologia , Hemodinâmica , Idoso , Aorta Torácica , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA