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1.
Medicine (Baltimore) ; 98(39): e17130, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574813

RESUMO

Animal studies have demonstrated that autophagy was involved in neuronal damage after intracerebral hemorrhage (ICH). Several studies showed thrombin-antithrombin (TAT) plasma levels were elevated in patients with ICH. In this study, we aimed to evaluate if autophagy occurred in patients with ICH; and the relationship between the severity of brain injury and plasma TAT levels.A novel tissue harvesting device was used during hematoma removal surgery to collect loose fragments of tissue surrounding the affected brain area in 27 ICH patients with hematoma volumes of >30 mL in the basal ganglia. Control tissues were obtained from patients who underwent surgery for arteriovenous malformation (n = 25). Transmission electron microscopy (TEM) and immunohistochemistry for autophagy-related proteins were used to evaluate the ultrastructural and morphologic cellular characteristics; and the extent of autophagy in the recovered tissue specimens. Stroke severity was assessed by using the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS). An enzyme-linked immunosorbent assay (ELISA) was used to measure plasma TAT levels.Transmission electron microscopy showed autophagosomes and autolysosomes exist in neurons surrounding the hematoma, but not in the control tissues. The number of cells containing autophagic vacuoles correlated with the severity of brain injury. Immunohistochemistry showed strong LC3, beclin 1, and cathepsin D staining in ICH tissue specimens. Plasma TAT levels correlated positively with autophagic cells and ICH severity (P < .01).Autophagy was induced in perihematomal neurons after ICH. Autophagy and plasma TAT levels correlated positively with severity of brain injury. These results suggest that autophagy and increased plasma TAT levels may contribute to the secondary damage in ICH patients.


Assuntos
Autofagia , Hemorragia Cerebral/sangue , Hematoma/sangue , Neurônios/fisiologia , Peptídeo Hidrolases/sangue , Adulto , Idoso , Antitrombina III , Gânglios da Base/metabolismo , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
2.
J Stroke Cerebrovasc Dis ; 28(8): 2311-2317, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31171459

RESUMO

BACKGROUND: Hematoma expansion after acute spontaneous intracerebral hemorrhage (ICH) is well established to result in poor prognosis. Recent studies have demonstrated that the ABO blood type system has potential implications on hemostatic properties. The purpose of this study was to explore the potential association of blood type O with hematoma expansion in patients with ICH and validate the usefulness in predicting early hematoma expansion. METHODS: We retrospectively enrolled consecutive patients with ICH who underwent baseline computed tomographic (CT) scan within 6 hours after onset of symptoms. The follow-up CT scan was available within 48 hours after the baseline CT scan. Hematoma expansion was defined as total volume increase more than 33% or more than 6 mL. We performed univariate and multivariate logistic regression analyses to investigate the relationship between the different types of blood (type O versus other types) and hematoma expansion. RESULTS: A total of 210 patients were included in the study. Among them, 72 patients (34.3%) carried blood type O. Hematoma expansion was more common in patients with blood type O (41.7%) than those with other blood types (18.1%; P < .001). Furthermore, the time to baseline CT scan, blood type O, and admission Glasgow Coma Scale score were demonstrated to be independent predictors of hematoma expansion in multivariate logistic regression analysis model. The sensitivity, specificity, positive, and negative predictive values of blood type O for predicting hematoma expansion were 54.5%, 72.9%, 41.6%, and 81.9%, respectively. CONCLUSIONS: Our findings suggest that blood type O represents an independent predictor of hematoma expansion after ICH. Hemostasis seems to be involved in expansion and may represent an important treatment target.


Assuntos
Sistema do Grupo Sanguíneo ABO , Hemorragia Cerebral/sangue , Hematoma/sangue , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
3.
J Stroke Cerebrovasc Dis ; 28(8): 2177-2186, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31133486

RESUMO

BACKGROUND: Intracerebral hemorrhage (ICH) is considered a devastating neurologic emergency and carried a higher morbidity and mortality rates. Early hematoma expansion (HE) is considered one of the poor prognostic factors after ICH. Consequently, determination of the possible risk factors for HE could be effective in early detection of high-risk patients and hence directing management course aiming to improving ICH outcome. METHODS: One-hundred and thirty-six spontaneous ICH patients were included and prospectively evaluated for the presence of HE. Demographic, laboratory, and certain radiological factors were studied and compared between those with HE and those without, the in-hospital mortality rates were assessed as well. RESULTS: HE was observed in 30% of the studied cohort, those who developed HE had more neurologic impairment (Glasgow coma scale, median 9; National Institute of Health Stroke Scale, median 34), and higher in-hospital mortality rate (53.6%) than those without HE. HE was related to the presence of higher red blood cell distribution width (RDW), reduced total cholesterol, low-density lipoprotein-C (LDL-C), and Ca levels. Among the radiological factors, hematoma density (heterogeneous), and shape (irregular) are highly related to the occurrence of HE. The computed tomography angiography (CTA) spot sign among patients with ICH was associated with HE development. CONCLUSIONS: Abnormal RDW; low cholesterol, LDL, and Ca level; heterogeneous density, irregular shape hemorrhage, and presence of CTA spot sign were associated with the development of HE in the setting of spontaneous ICH.


Assuntos
Hemorragia Cerebral/complicações , Hematoma/etiologia , Idoso , Cálcio/sangue , Angiografia Cerebral/métodos , Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Angiografia por Tomografia Computadorizada , Avaliação da Deficiência , Progressão da Doença , Índices de Eritrócitos , Feminino , Escala de Coma de Glasgow , Nível de Saúde , Hematoma/sangue , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Mortalidade Hospitalar , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
J Investig Med High Impact Case Rep ; 6: 2324709618817572, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30574513

RESUMO

Acquired hemophilia A poses a clinical and diagnostic challenge. Although rare, it is still the most common acquired factor deficiency. We present a case of acquired hemophilia A diagnosed in a 71-year-old female who presented with a right thigh hematoma of acute onset. The diagnosis was established based on the coagulation profile along with factor VIII levels, mixing studies, and inhibitor levels. The patient received multiple lines of therapy including steroids, factor VIIa, Obizur (porcine-derived recombinant factor VIII), followed by multiple cycles of chemotherapy including cyclophosphamide and rituximab.


Assuntos
Fator VIII/uso terapêutico , Fator VIIa/uso terapêutico , Hematoma/sangue , Hemofilia A/sangue , Idoso , Anticorpos Monoclonais Murinos/uso terapêutico , Ciclofosfamida , Quimioterapia Combinada , Feminino , Hematoma/complicações , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Humanos , Tempo de Tromboplastina Parcial , Rituximab
5.
J Neurosurg Pediatr ; 23(2): 159-163, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30485223

RESUMO

The authors report on the clinical course of two infants with severe hemophilia A (HA) and concomitant progressive hydrocephalus that required management with a ventriculoperitoneal shunt. The first child, with known HA, presented with a spontaneous intracranial hemorrhage and acquired hydrocephalus. He underwent cerebrospinal fluid diversion with a temporary external ventricular drain, followed by placement of a ventriculoperitoneal shunt. The second child had hydrocephalus secondary to a Dandy-Walker malformation and was diagnosed with severe HA during preoperative evaluation. He underwent placement of a ventriculoperitoneal shunt after progression of the hydrocephalus. The authors also review the treatment of hydrocephalus in patients with HA and describe the perioperative protocols used in their two cases. Treatment of hydrocephalus in infants with HA requires unique perioperative management to avoid complications.


Assuntos
Síndrome de Dandy-Walker/complicações , Fator VIII/uso terapêutico , Hematoma/tratamento farmacológico , Hemofilia A/tratamento farmacológico , Hidrocefalia/terapia , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Síndrome de Dandy-Walker/sangue , Hematoma/sangue , Hematoma/etiologia , Hemofilia A/sangue , Hemofilia A/complicações , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Derivação Peritoneovenosa , Proteínas Recombinantes/uso terapêutico
6.
World Neurosurg ; 118: e500-e504, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30257302

RESUMO

BACKGROUND AND OBJECTIVE: We tested the hypothesis that ionized calcium levels at admission are associated with early hematoma expansion and functional outcome in patients with hypertensive intracerebral hemorrhage (HICH). METHODS: Patients presenting with HICH were enrolled in the observational cohort study that prospectively collected age, sex, blood pressure, history of diabetes and smoking, time from symptom onset to initial computed tomography (CT), admission ionized calcium (iCa) and total calcium (tCa), coagulation function, Glasgow Coma Scale (GCS), and postoperative modified Rankin Scale score. Hematoma reconstruction on CT was performed to measure hematoma volumes. Hematoma expansion (HE) was defined as an increase of more than 30% or 6 mL in HICH volume. We performed univariate and multivariate analyses to assess for association of iCa level with early HE and functional outcome. RESULTS: We included 111 patients with HICH for analysis. Admission serum iCa was 1.10 mmol/L in patients with HE and 1.17 in patients without HE. Univariate analysis indicated significant difference of GCS, initial HICH volume, iCa, and tCa between the HE and non-HE groups (P < 0.05). Lower admission iCa (less than 1.12 mmol/L) was associated with HE (odds ratio [OR] 0.300, 95% confidence interval [CI] 0.095-0.951, P = 0.041) after adjustment for age, blood pressure, GCS score, time to initial CT scan, baseline HICH volume, prothrombin time, and tCa. Furthermore, predictive factors of poor outcome included iCa (OR 0.192, 95% CI 0.067-0.554, P = 0.002) and GCS score (OR 0.832, 95% CI 0.722-0.959, P = 0.011). CONCLUSIONS: These data support the hypothesis that lower ionized calcium is associated with early hematoma expansion and poor outcome in patients with hypertensive intracerebral hemorrhage.


Assuntos
Cálcio/sangue , Hematoma/sangue , Hematoma/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Clin Neurol Neurosurg ; 172: 51-58, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29975876

RESUMO

OBJECTIVE: Prognostic models for Intracerebral hemorrhage (ICH), mainly based on clinical evaluation, have remained inherently confounded by subjective scoring assessments and limited accuracy. In this study, we aimed at assessing the risk for poor outcome after ICH based on peripheral biochemical markers (TNF-α, glutamate and glucose) and radiological variables (both at admission and five days after patient's care), for modeling purposes of prognostication. PATIENTS AND METHODS: The defined initial variables of fifty non-comatose conservatively treated ICH patients without severe complications during the hospitalization process (as intraventricular bleeding, or hematoma expansion) were aligned with the evaluated parameters during re-evaluation (3 months later). A comprehensive statistical approach has been applied by using different modeling strategies for prediction of their functional status and outcome. RESULTS: Higher blood plasma glutamate, TNF-α and initial ICH volume at admission, as well as higher volumes of ICH and perihematomal edema after five days of care were significantly more likely associated with the poor outcome. Nevertheless, in all of the constructed models, TNF-α was estimated as the only significant predictive risk factor, thus outperforming the capacity of the initial ICH volume and the radiological variables after 5 days, both in terms of prognostication of the functional status and the 3-month neurological outcome. The constructed canonical variable that has fairly marked off the different outcomes was also mainly weighed by the admission TNF-α levels. For the first time, we have carefully developed probability functions for the neurological outcome as a response to the admission TNF-α levels; TNF-α levels >110.35 pg/mL were assessed as an optimal cutoff point fairly identifying patients who will fall into the group with poor outcome. CONCLUSIONS: TNF-α based models and admission TNF-α screening might be appropriate as a key component that assists more objective prognostication and management of patient's care in clinical decision making, as rapid initial diagnosis and concentrated management are crucial for secondary prevention of further devastating neurological impairments after ICH.


Assuntos
Edema Encefálico/sangue , Hemorragia Cerebral/diagnóstico , Hematoma/sangue , Fator de Necrose Tumoral alfa/sangue , Idoso , Edema Encefálico/etiologia , Hemorragia Cerebral/sangue , Hemorragia Cerebral/complicações , Tomada de Decisões/fisiologia , Feminino , Hematoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
8.
Biomed Res Int ; 2018: 4509873, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29854754

RESUMO

Background and Purpose: This study aimed to explore the relationship between blend sign and prognosis of patients with intracerebral hemorrhage (ICH). Methods: Between January 2014 and December 2016, the results of cranial computed tomography imaging within 24 h after the onset of symptoms from 275 patients with ICH were retrospectively analyzed. The patients with or without blend sign were compared to observe and analyze the difference in coagulation function abnormality, rebleeding, mortality, and bad prognosis rates in the early stages. Results: Of the 275 patients with ICH, 47 patients had Blend Sign I (17.09%) and 17 patients had Blend Sign II (6.18%). The coagulation function abnormality rate had no statistical difference among Blend Sign I, Blend Sign II, and conventional groups (P > 0.05). In the Blend Sign I group, the rebleeding rate was 4.26%, bad prognosis rate was 25.53%, and mortality rate was 6.38%, which were not statistically significantly different compared with those in the conventional group (P > 0.05). The rebleeding rate in the Blend Sign II group was 47.06%, bad prognosis rate was 82.35%, and mortality rate was 47.06%, which were statistically significantly different compared with those in the conventional and Blend Sign I groups (P < 0.05). Conclusions: For the patients associated with Blend Sign I, the prognosis was equivalent to that in the conventional group, with no statistically significant difference. The rebleeding, bad prognosis, and mortality rates were higher in the Blend Sign II group than in the conventional group and deserved more attention.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/sangue , Hemorragia Cerebral/mortalidade , Craniotomia , Feminino , Hematoma/sangue , Hematoma/diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico
9.
J Am Heart Assoc ; 7(8)2018 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-29654197

RESUMO

BACKGROUND: Magnesium (Mg) has potential hemostatic properties. We sought to investigate the potential association of serum Mg levels (at baseline and at 48 hours) with outcomes in patients with acute spontaneous intracerebral hemorrhage (ICH). METHODS AND RESULTS: We reviewed data on all patients with spontaneous ICH with available Mg levels at baseline, over a 5-year period. Clinical and radiological outcome measures included initial hematoma volume, admission National Institutes of Health Stroke Scale and ICH scores, in-hospital mortality, favorable functional outcome (modified Rankin Scale scores, 0-1), and functional independence (modified Rankin Scale scores, 0-2) at discharge. Our study population consisted of 299 patients with ICH (mean age, 61±13 years; mean admission serum Mg, 1.8±0.3 mg/dL). Increasing admission Mg levels strongly correlated with lower admission National Institutes of Health Stroke Scale score (Spearman's r, -0.141; P=0.015), lower ICH score (Spearman's r, -0.153; P=0.009), and lower initial hematoma volume (Spearman's r, -0.153; P=0.012). Higher admission Mg levels were documented in patients with favorable functional outcome (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.025) and functional independence (1.9±0.3 versus 1.8±0.3 mg/dL; P=0.022) at discharge. No association between serum Mg levels at 48 hours and any of the outcome variables was detected. In multiple linear regression analyses, a 0.1-mg/dL increase in admission serum Mg was independently and negatively associated with the cubed root of hematoma volume at admission (regression coefficient, -0.020; 95% confidence interval, -0.040 to -0.000; P=0.049) and admission ICH score (regression coefficient, -0.053; 95% confidence interval, -0.102 to -0.005; P=0.032). CONCLUSIONS: Higher admission Mg levels were independently related to lower admission hematoma volume and lower admission ICH score in patients with acute spontaneous ICH.


Assuntos
Hemorragia Cerebral/sangue , Hematoma/sangue , Hemostasia/fisiologia , Magnésio/sangue , Admissão do Paciente , Doença Aguda , Biomarcadores/sangue , Hemorragia Cerebral/mortalidade , Feminino , Seguimentos , Hematoma/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
10.
Inflammation ; 41(3): 1084-1092, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29511935

RESUMO

A controlled local inflammatory response is essential for adequate fracture healing. However, the current literature suggests that local and systemic hyper-inflammatory conditions after major trauma induce increased influx of neutrophils into the fracture hematoma (FH) and impair bone regeneration. Inhibiting neutrophil chemotaxis towards the FH without compromising the hosts' defense may therefore be a target of future therapies that prevent impairment of fracture healing after major trauma. We investigated whether chemotaxis of neutrophils towards the FH could be studied in vitro. Moreover, we determined whether chemotaxis of neutrophils towards the FH was mediated by the CXCR1, CXCR2, FPR, and C5aR receptors. Human FHs were isolated during an open reduction internal fixation (ORIF) procedure within 3 days after trauma and spun down to obtain the fracture hematoma serum. Neutrophil migration towards the FH was studied using Ibidi™ Chemotaxis3D µ-Slides and image analysis of individual neutrophil tracks was performed. Our study showed that the human FH induces significant neutrophil chemotaxis, which was not affected by blocking CXCR1 and CXCR2. In contrast, neutrophil chemotaxis towards the FH was significantly inhibited by chemotaxis inhibitory protein of Staphylococcus aureus (CHIPS), which blocks FPR and C5aR. Blocking only C5aR with CHIPSΔ1F also significantly inhibited neutrophil chemotaxis towards the FH. Our finding that neutrophil chemotaxis towards the human FH can be blocked in vitro using CHIPS may aid the development of therapies that prevent impairment of fracture healing after major trauma.


Assuntos
Quimiotaxia/efeitos dos fármacos , Fraturas Ósseas/patologia , Hematoma/sangue , Neutrófilos/patologia , Proteínas de Bactérias/farmacologia , Regeneração Óssea/efeitos dos fármacos , Consolidação da Fratura/efeitos dos fármacos , Humanos , Receptor da Anafilatoxina C5a/fisiologia
11.
J Stroke Cerebrovasc Dis ; 27(5): 1167-1173, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29310956

RESUMO

OBJECTIVE: We evaluated whether reduced platelet activity detected by point-of-care (POC) testing is a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. METHODS: Patients presenting with spontaneous ICH were enrolled in a prospective observational cohort study that collected demographic, clinical, laboratory, and radiographic data. We measured platelet activity using the PFA-100 (Siemens AG, Germany) and VerifyNow-ASA (Accumetrics, CA) systems on admission. We performed univariate and adjusted multivariate analyses to assess the strength of association between those measures and (1) hematoma growth at 24 hours and (2) functional outcomes measured by the modified Rankin Scale (mRS) at 3 months. RESULTS: We identified 278 patients for analysis (mean age 65 ± 15, median ICH score 1 [interquartile range 0-2]), among whom 164 underwent initial neuroimaging within 6 hours of symptom onset. Univariate association with hematoma growth was stronger for antiplatelet medication history than POC measures, which was confirmed in multivariable models (ß 3.64 [95% confidence interval [CI] 1.02-6.26], P = .007), with a larger effect size measured in the under 6-hour subgroup (ß 7.20 [95% CI 3.35-11.1], P < .001). Moreover, antiplatelet medication history, but not POC measures of platelet activity, was independently associated with poor outcome at 3 months (mRS 4-6) in the under 6-hour subgroup (adjusted OR 3.6 [95% CI 1.2-11], P = .023). CONCLUSION: A history of antiplatelet medication use better identifies patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.


Assuntos
Plaquetas/efeitos dos fármacos , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/diagnóstico , Hematoma/induzido quimicamente , Hematoma/diagnóstico , Ativação Plaquetária/efeitos dos fármacos , Inibidores da Agregação de Plaquetas/efeitos adversos , Testes de Função Plaquetária , Testes Imediatos , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Hemorragia Cerebral/sangue , Avaliação da Deficiência , Progressão da Doença , Feminino , Hematoma/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco
12.
J Stroke Cerebrovasc Dis ; 27(5): 1226-1236, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29310959

RESUMO

OBJECTIVE: To study the expression of T cell immunoglobulin and mucin domain 3 (Tim-3) on peripheral blood immunocytes, and the relationship between Tim-3 and the systemic inflammatory response or brain injury in patients with intracerebral hemorrhage (ICH). METHODS: According to the volume of hematoma at 12 hours after onset of ICH, 60 newly diagnosed patients with ICH were divided into the small (volume of hematoma <30 mL, 30 cases) and large (volume of hematoma ≥30 mL, 30 cases) ICH groups. The expression of Tim-3 on peripheral blood immunocytes was analyzed by flow cytometry. Real-time reverse transcriptase polymerase chain reaction was used to detect Tim-3 mRNA on peripheral blood mononuclear cells (PBMCs). Meanwhile, tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and S-100B protein were measured by enzyme-linked immunosorbent assay. Glasgow outcome scale (GOS) score at Day 30 was used to estimate prognosis of patients. RESULTS: The leukocyte count, neutrophil count, monocyte count, TNF-α, IL-1ß, and S-100B protein increased remarkably after ICH. However, all of them in the large ICH group increased more obviously, and there were significant differences when compared with those in the small ICH group (P < .01). The expression of Tim-3 mRNA on PBMCs in the large ICH group increased remarkably, peaked at Day 3, and was positively associated with the concentrations of TNF-α, IL-1ß, and S-100B protein (P < .01). Tim-3 was predominantly expressed itself on CD14+ monocytes. There was a negative correlation between GOS score and Tim-3 mRNA, TNF-α, IL-1ß, or S-100B protein. CONCLUSIONS: The expression of Tim-3 on CD14 + monocytes involves in systemic inflammatory reaction after ICH and may be a novel treatment target.


Assuntos
Lesões Encefálicas/imunologia , Hemorragia Cerebral/imunologia , Hematoma/imunologia , Receptor Celular 2 do Vírus da Hepatite A/sangue , Inflamação/imunologia , Receptores de Lipopolissacarídeos/sangue , Monócitos/imunologia , Idoso , Biomarcadores/sangue , Lesões Encefálicas/sangue , Lesões Encefálicas/diagnóstico , Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Escala de Coma de Glasgow , Hematoma/sangue , Hematoma/diagnóstico , Receptor Celular 2 do Vírus da Hepatite A/genética , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Mediadores da Inflamação/sangue , Interleucina-1beta/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangue , Regulação para Cima
13.
Lupus ; 27(5): 828-836, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29301470

RESUMO

Objective The objective of this paper is to identify the risk of complications of real-time ultrasound-guided renal biopsy in adult and pediatric patients with systemic lupus erythematosus (SLE). Materials and methods This retrospective study examined outcomes of 296 renal biopsy procedures in 275 SLE patients. Imaging-confirmed symptomatic hematoma was regarded as a major complication when intervention (blood transfusion, angiographic embolization, or surgery) was required or as a minor complication otherwise. Clinical and laboratory data were compared between groups with or without complications after initial or subsequent renal biopsy. Binary logistic regressions were used to evaluate complication risk of initial renal biopsy. Results Overall complication rate of initial renal biopsy was 8.7% (major: 2.9%, minor: 5.8%). Three patients expired from pulmonary hemorrhage, thrombotic microangiopathy, and pneumonia. Pediatric SLE patients tended to have a higher rate of major complications (12.5%) than adult patients (2.3%). According to multivariable analysis results, elevated serum creatinine (SCr) level (OR 1.45; 95% CI 1.17-1.81 per mg/dl), prolonged prothrombin time (PT) (OR 2.2; 95% CI 1.05-4.62 per second), and thrombocytopenia (OR 4.3; 95% CI 1.56-11.9) increased overall complication risk of initial renal biopsy. Age < 18 years (OR 8.43; 95% CI 1.21-58.8), thrombocytopenia (OR 16.4; 95% CI 2.44-110.5), and elevated SCr level (OR 1.97; 95% CI 1.36-2.86 per md/dl) increased risk of major complications. Thrombocytopenia, prolonged PT, and elevated SCr level were associated with complications after subsequent renal biopsy (all p = 0.01). Conclusions SLE patients, particularly patients under 18 years old or with elevated SCr level, prolonged PT, or thrombocytopenia, have an increased risk of complications after initial or subsequent renal biopsy.


Assuntos
Hematoma/epidemiologia , Biópsia Guiada por Imagem/efeitos adversos , Rim/patologia , Lúpus Eritematoso Sistêmico/patologia , Nefrite Lúpica/patologia , Ultrassonografia de Intervenção/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Coagulação Sanguínea , Creatinina/sangue , Feminino , Hematoma/sangue , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Modelos Logísticos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/epidemiologia , Nefrite Lúpica/sangue , Nefrite Lúpica/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Tempo de Protrombina , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Trombocitopenia/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Atherosclerosis ; 269: 14-20, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29253643

RESUMO

BACKGROUND AND AIMS: The relationship between lipoprotein levels, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and clinical outcome after intracerebral hemorrhage (ICH) remains controversial. We sought to evaluate the association of lipoprotein cholesterol levels and statin dosage with clinical and neuroimaging outcomes in patients with ICH. METHODS: Data on consecutive patients hospitalized with spontaneous acute ICH was prospectively collected over a 5-year period and retrospectively analyzed. Demographic characteristics, clinical severity documented by NIHSS-score and ICH-score, neuroimaging parameters, pre-hospital statin use and doses, and LDL-C and HDL-C levels were recorded. Outcome events characterized were hematoma volume, hematoma expansion, in-hospital functional outcome, and in-hospital mortality. RESULTS: A total of 672 patients with acute ICH [(mean age 61.6 ± 14.0 years, 43.6% women, median ICH score 1 (IQR: 0-2)] were evaluated. Statin pretreatment was not associated with neuroimaging or clinical outcomes. Higher LDL-C levels were associated with several markers of poor clinical outcome and in-hospital mortality. LDL-C levels were independently and negatively associated with the cubed root of hematoma volume (linear regression coefficient -0.021, 95% CI: -0.042--0.001; p = 0.049) on multiple linear regression models. Higher admission LDL-C (OR 0.88, 95% CI 0.77-0.99; p = 0.048) was also an independent predictor for decreased hematoma expansion. Higher admission LDL-C levels were independently (p < 0.001) associated with lower likelihood of in-hospital mortality (OR per 10 mg/dL increase 0.68, 95% CI: 0.57-0.80) in multivariable logistic regression models. CONCLUSIONS: Higher LDL-C levels at hospital admission were an independent predictor for lower likelihood of hematoma expansion and decreased in-hospital mortality in patients with acute spontaneous ICH. This association requires independent confirmation.


Assuntos
Hemorragia Cerebral/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Hematoma/sangue , Idoso , Biomarcadores/sangue , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , HDL-Colesterol/sangue , Dislipidemias/diagnóstico , Dislipidemias/tratamento farmacológico , Dislipidemias/mortalidade , Feminino , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Admissão do Paciente , Prognóstico , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
15.
Nephrology (Carlton) ; 23(6): 592-596, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28976051

RESUMO

Children with systemic lupus erythematosus (SLE) generally undergo a pretreatment kidney biopsy. However, some of these patients, especially those with antiphospholipid syndrome (APS), may experience serious coagulopathic complications. We report herein two cases of paediatric SLE with APS in which, despite normal blood test results, the disparate coagulopathic complications of haemorrhage and embolism developed following a kidney biopsy. Case 1 was, an 8-year-old male in whom, primary APS was initially diagnosed. Fourteen months later SLE was diagnosed. Based on a percutaneous kidney biopsy, International Society of Nephrology and the Renal Pathology Society (ISN/RPS) class III-A lupus nephritis was histologically diagnosed. On post-biopsy Day 9, a giant haematoma in the fascia of the left kidney developed and was accompanied by changes in the vital signs. Case 2, a 13-year-old male, initially received the diagnosis of SLE with APS and underwent two courses of pulse methylprednisolone therapy. His coagulation abnormalities improved, and a percutaneous needle kidney biopsy was performed, leading to the histological diagnosis of ISN/RPS class III-A lupus nephritis. Furthermore, thrombotic microangiopathy was also detected in the renal histopathology. On post biopsy Day 6, the patient experienced right leg pain. A contrast CT and lower extremity ultrasonography detected a massive deep vein thrombosis and partial left pulmonary artery thrombosis. A kidney biopsy in children with SLE and APS can cause lethal coagulopathic complications, and the risks to such patients should be weighed carefully before the procedure is performed.


Assuntos
Síndrome Antifosfolipídica/complicações , Arteriopatias Oclusivas/etiologia , Biópsia/efeitos adversos , Hematoma/etiologia , Rim/patologia , Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica/etiologia , Trombose Venosa/etiologia , Adolescente , Idade de Início , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Arteriopatias Oclusivas/sangue , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/tratamento farmacológico , Coagulação Sanguínea , Criança , Glucocorticoides/uso terapêutico , Hematoma/sangue , Hematoma/diagnóstico , Hematoma/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/patologia , Masculino , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológico
16.
J Neuroinflammation ; 14(1): 247, 2017 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-29237474

RESUMO

BACKGROUND: Asymmetric dimethylarginine (ADMA)--the most potent endogenous NO-synthase inhibitor, has been regarded as mediator of endothelial dysfunction and oxidative stress. Considering experimental data, levels of ADMA and its structural isomer symmetric dimethylarginine (SDMA) might be elevated after intracerebral hemorrhage (ICH) and associated with clinical outcome and secondary brain injury. METHODS: Blood samples from 20 patients with acute ICH were taken at ≤ 24 h and 3 and 7 days after the event. Nine patients had favorable (modified Rankin Scale (mRS) at 90 days 0-2) outcome, and 11 patients unfavorable outcome (mRS 3-6). Patients' serum ADMA, SDMA, and L-arginine levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Levels were compared to those of 30 control subjects without ICH. For further analysis, patients were grouped according to outcome, hematoma and perihematomal edema volumes, occurrence of hematoma enlargement, and cytotoxic edema as measured by computed tomography and serial magnetic resonance imaging. RESULTS: Levels of ADMA--but not SDMA and L-arginine--were elevated in ICH patients compared to controls (binary logistic regression analysis: ADMA ≤ 24 h, p = 0.003; 3 days p = 0.005; 7 days p = 0.004). If patients were grouped according to outcome, dimethylarginines were increased in patients with unfavorable outcome. The binary logistic regression analysis confirmed an association of SDMA levels ≤ 24 h (p = 0.048) and at 3 days (p = 0.028) with unfavorable outcome. ADMA ≤ 24 h was increased in patients with hematoma enlargement (p = 0.003), while SDMA ≤ 24 h was increased in patients with large hematoma (p = 0.029) and perihematomal edema volume (p = 0.023). CONCLUSIONS: Our data demonstrate an association between dimethylarginines and outcome of ICH. However, further studies are needed to confirm this relationship and elucidate the mechanisms behind.


Assuntos
Arginina/análogos & derivados , Edema Encefálico/sangue , Hemorragia Cerebral/sangue , Hemorragia Cerebral/complicações , Hematoma/sangue , Idoso , Idoso de 80 Anos ou mais , Arginina/sangue , Edema Encefálico/etiologia , Feminino , Hematoma/etiologia , Humanos , Masculino
17.
Rev. cuba. obstet. ginecol ; 43(4): 69-76, oct.-dic. 2017. ilus
Artigo em Espanhol | CUMED | ID: cum-73577

RESUMO

El hematoma retroperitoneal espontáneo durante el embarazo es una complicación infrecuente definido como el sangrado en el espacio retroperitoneal que ocurre sin historia de trauma reciente, tratamiento anticoagulante o enfermedad vascular. El objetivo del trabajo es presentar un caso grave poco usual en que el hematoma retroperitoneal coexistió en una paciente con atonía uterina. Se presenta una gestante de 21 años y 39 semanas que acudió al Cuerpo de Guardia del Hospital Ginecobstétrico de Guanabacoa en noviembre 2016 por presentar dolor abdominal. Se ingresa en Cuidados perinatales. Los exámenes complementarios, físico y la cardiotocografía fueron normales. Cuatro horas después aqueja dolor lumbar y se detectó dolor a la palpación en región intercostal posterior derecha sin otro hallazgo ni alteraciones hemodinámicas. No hay dinámica uterina y frecuencia fetal 140 latidos/minuto. Dos horas después, presentó un cuadro que el familiar informa como una "convulsión", no observada por personal médico o de enfermería. No hay toma de conciencia y los signos vitales normales, se comprueba una bradicardia fetal que motiva la indicación de cesárea de urgencia. La hemoglobina descendió a 70 g/L. Se repone volumen y se extrae un neonato con Apgar 1-3. Se produce atonía uterina que no cedió al tratamiento medicamentoso y/o masaje. Se realiza técnica de B- Lynch para la hemostasia que se logra. Se comprueba hematoma retroperitoneal no activo desde borde superior hepático hasta flanco derecho. Se estabiliza hemodinámicamente. El neonato fallece a las 72 horas. El diagnóstico y tratamiento precoz del hematoma retroperitoneal contribuye a disminuir la morbilidad y mortalidad materna(AU)


Spontaneous retroperitoneal hematoma during pregnancy is an uncommon complication defined as bleeding in the retroperitoneal space that occurs without a history of recent trauma, anticoagulant treatment or vascular disease. The objective of this study is to present an unusual case in which the retroperitoneal hematoma coexisted in a patient with uterine atony. A 21 year old pregnant woman of 39 weeks who went to the Emergency Room at Guanabacoa Gynecobstetric Hospital in November 2016, due to abdominal pain. The patient is admitted to perinatal care. Complementary studies and physical examination were normal, including cardiotocography. Four hours later, she suffered back pain, which was detected on palpation in the right posterior intercostal region without any other finding or hemodynamic changes. There were no uterine dynamics and fetal frequency was 140 beats / minute. Two hours later, this patient presented a "seizure," according to her family member that was not observed by medical or nursing staff. There was no loss of consciousness and her vital signs were normal. A fetal bradycardia is verified that motivates the indication of emergency caesarean section. Hemoglobin decreased to 70 g / L. Volume was replaced and an Apgar 1-3 neonate was extracted. There was uterine atony that did not yield to drug treatment and massage. The B-Lynch technique was performed for the hemostasis that was achieved. A non-active retroperitoneal hematoma was found from the superior border of the liver to the right flank. The patient was hemodynamically stabilized. The neonate died at 72 hours. The diagnosis and early treatment of retroperitoneal hematoma help to reduce maternal morbidity and mortality(AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Doenças Peritoneais/sangue , Hematoma/sangue , Doenças Uterinas/sangue
18.
Rev. cuba. obstet. ginecol ; 43(4): 69-76, oct.-dic. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-901333

RESUMO

El hematoma retroperitoneal espontáneo durante el embarazo es una complicación infrecuente definido como el sangrado en el espacio retroperitoneal que ocurre sin historia de trauma reciente, tratamiento anticoagulante o enfermedad vascular. El objetivo del trabajo es presentar un caso grave poco usual en que el hematoma retroperitoneal coexistió en una paciente con atonía uterina. Se presenta una gestante de 21 años y 39 semanas que acudió al Cuerpo de Guardia del Hospital Ginecobstétrico de Guanabacoa en noviembre 2016 por presentar dolor abdominal. Se ingresa en Cuidados perinatales. Los exámenes complementarios, físico y la cardiotocografía fueron normales. Cuatro horas después aqueja dolor lumbar y se detectó dolor a la palpación en región intercostal posterior derecha sin otro hallazgo ni alteraciones hemodinámicas. No hay dinámica uterina y frecuencia fetal 140 latidos/minuto. Dos horas después, presentó un cuadro que el familiar informa como una "convulsión", no observada por personal médico o de enfermería. No hay toma de conciencia y los signos vitales normales, se comprueba una bradicardia fetal que motiva la indicación de cesárea de urgencia. La hemoglobina descendió a 70 g/L. Se repone volumen y se extrae un neonato con Apgar 1-3. Se produce atonía uterina que no cedió al tratamiento medicamentoso y/o masaje. Se realiza técnica de B- Lynch para la hemostasia que se logra. Se comprueba hematoma retroperitoneal no activo desde borde superior hepático hasta flanco derecho. Se estabiliza hemodinámicamente. El neonato fallece a las 72 horas. El diagnóstico y tratamiento precoz del hematoma retroperitoneal contribuye a disminuir la morbilidad y mortalidad materna.


Spontaneous retroperitoneal hematoma during pregnancy is an uncommon complication defined as bleeding in the retroperitoneal space that occurs without a history of recent trauma, anticoagulant treatment or vascular disease. The objective of this study is to present an unusual case in which the retroperitoneal hematoma coexisted in a patient with uterine atony. A 21 year old pregnant woman of 39 weeks who went to the Emergency Room at Guanabacoa Gynecobstetric Hospital in November 2016, due to abdominal pain. The patient is admitted to perinatal care. Complementary studies and physical examination were normal, including cardiotocography. Four hours later, she suffered back pain, which was detected on palpation in the right posterior intercostal region without any other finding or hemodynamic changes. There were no uterine dynamics and fetal frequency was 140 beats / minute. Two hours later, this patient presented a "seizure," according to her family member that was not observed by medical or nursing staff. There was no loss of consciousness and her vital signs were normal. A fetal bradycardia is verified that motivates the indication of emergency caesarean section. Hemoglobin decreased to 70 g / L. Volume was replaced and an Apgar 1-3 neonate was extracted. There was uterine atony that did not yield to drug treatment and massage. The B-Lynch technique was performed for the hemostasis that was achieved. A non-active retroperitoneal hematoma was found from the superior border of the liver to the right flank. The patient was hemodynamically stabilized. The neonate died at 72 hours. The diagnosis and early treatment of retroperitoneal hematoma help to reduce maternal morbidity and mortality.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Doenças Peritoneais/sangue , Hematoma/sangue , Doenças Uterinas/sangue
19.
Hamostaseologie ; 37(2): 104-106, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29582910

RESUMO

Haemophilic arthropathy is a complex multifactorial disorder that poses significant challenges to both the treating haematologist and arthroplasty surgeon. Its pathogenesis is incompletely understood. Recent literature has concentrated on the toxic effects of iron and the characteristic inflammatory synovitis. Discussion of the role of subchondral bleeding in joint damage has been neglected. A case of haemophilic arthropathy with extensive evidence of subchondral bleeding and related osteochondral destruction is presented. RESULT: The relevance of this mechanical pathway in the future management of haemophilic arthropathy is discussed with reference to recent literature. CONCLUSION: Clinicians should consider its importance when deciding whether to manage patients expectantly or with prophylactic factor replacement.


Assuntos
Doenças Ósseas/diagnóstico , Fêmur , Hemartrose/diagnóstico , Hematoma/diagnóstico , Hemofilia A/diagnóstico , Articulação do Joelho , Idoso , Artroplastia do Joelho , Doenças Ósseas/sangue , Doenças Ósseas/cirurgia , Comorbidade , Fator VIII/análise , Fêmur/cirurgia , Hemartrose/sangue , Hemartrose/cirurgia , Hematoma/sangue , Hematoma/cirurgia , Hemofilia A/sangue , Hemofilia A/complicações , Hepatite C/sangue , Hepatite C/diagnóstico , Humanos , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino
20.
Turk Neurosurg ; 27(3): 368-373, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27593780

RESUMO

AIM: Hypertension is a primary risk factor for intracerebral hemorrhage (ICH) and is thought to be responsible for about 55% of all ICH cases. Thus, the primary goal of the study was to examine whether the status of vascular rheological factors upon admission to the hospital was associated with hypertensive ICH growth and early outcomes. MATERIAL AND METHODS: Over a 2-year period, the present study evaluated 60 ICH patients who were admitted within the first 12 hours of symptom onset. Brain computed tomography scans were performed at admission and then 24 hours later as a control. Hematoma growth was classified as an volume increase more than 6.5 ml or > 33%, and good outcome was defined using the modified Rankin Scale (mRS) score (? 2 at 3 months). RESULTS: The mean age of the study population was 65.07 ± 11.659 years, with 34 men and 26 women. The leading vascular risk factor was hypertension (86.7%). There were significant associations between the initial red blood cell distribution width (RDW) and hematoma growth (p=0.038). Therefore, hematoma growth in the first 24 hours after symptom onset was significantly related to a poor clinical outcome at 3 months (p = 0.050). CONCLUSION: The study identified significant relationships between the initial RDW and poor outcome as well as the initial RDW and hypertensive hematoma growth. Additionally, this study demonstrated that these parameters are easily obtainable and could be used to effectively evaluate outcomes in ICH patients.


Assuntos
Eritrócitos/patologia , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/patologia , Adulto , Idoso , Feminino , Hematoma/sangue , Hematoma/etiologia , Hematoma/patologia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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