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1.
Ann R Coll Surg Engl ; 103(3): e101-e105, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645269

RESUMO

Suprarenal or adrenal gland haemorrhage is an uncommon but potentially lethal condition if unrecognised. Adrenal masses rarely present with haemorrhage, but they remain an important differential aetiology for adrenal bleeding. We present a novel case of primary adrenal lymphoma with adrenal haemorrhage in a middle-aged woman who presented with right-sided abdominal pain and class 1 haemorrhagic shock. She was found to have spontaneous unilateral adrenal gland haemorrhage in the absence of any underlying previous pathology. Presenting features, diagnosis and subsequent oncological management are reported.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Choque Hemorrágico/diagnóstico , Dor Abdominal/etiologia , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/etiologia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/patologia , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Choque Hemorrágico/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Vincristina/uso terapêutico
2.
Ann R Coll Surg Engl ; 103(3): e91-e93, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645276
4.
Niger J Clin Pract ; 24(3): 443-445, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33723121

RESUMO

During and after cardiac resynchronization therapy (CRT) implantation, many adverse events may occur. We present an interesting and important patient with hemoptysis and massive focal alveolar hemorrhage in a patient after a successful CRT implantation. CRT implantation was completed without any problems. In the follow-up, complaints of cough and hemoptysis began 1 h after the procedure. On the PA chest X-ray, a ground glass image was found in the left upper zone. Thorax CT revealed focal alveolar hemorrhage in the left upper lobe anterior segmental lung parenchyma. The patient was followed up with medical treatment and discharged in good health.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Dispositivos de Terapia de Ressincronização Cardíaca , Hemoptise/etiologia , Hemoptise/terapia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Resultado do Tratamento
5.
Br J Radiol ; 94(1120): 20200879, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529044

RESUMO

Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.


Assuntos
Cateterismo/efeitos adversos , Colestase/terapia , Drenagem/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Radiologia Intervencionista/educação , Angiografia , Ductos Biliares/diagnóstico por imagem , Cateterismo/métodos , Colangiografia , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Drenagem/métodos , Fluoroscopia , Hemorragia/etiologia , Humanos , Internato e Residência , Punções , Radiologia Intervencionista/métodos , Ultrassonografia
6.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504529

RESUMO

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.


Assuntos
Hemorragia/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Neoplasias Renais/secundário , Melanoma Amelanótico/secundário , Melanoma/secundário , Neoplasias Ovarianas/secundário , Neoplasias Cutâneas/patologia , Transfusão de Sangue , Feminino , Hemorragia/etiologia , Humanos , Nefropatias/etiologia , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Melanoma/complicações , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Melanoma Amelanótico/complicações , Melanoma Amelanótico/diagnóstico por imagem , Melanoma Amelanótico/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Espaço Retroperitoneal , Choque/etiologia , Tomografia Computadorizada por Raios X
7.
Clin Imaging ; 73: 119-123, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33387916

RESUMO

OBJECTIVE: To evaluate the efficacy of empiric embolization for postpancreatectomy hemorrhage (PPH) with negative angiographic signs of active bleeding. MATERIALS AND METHODS: A total of 100 patients (76 men, 24 women) who were diagnosed with PPH with angiographic findings revealing no signs of active bleeding from December 2013 to December 2019 were included in the study. The patients were divided into two groups according to whether the procedures were performed with or without empiric embolization in angiography (group of empiric embolization, N=47; group of no embolization, N=53). Data reflecting patients' characteristics, hemorrhagic details, classification of PPH grade, and postoperative complications were acquired. The rates of clinical success in hemostasis and mortality were compared between the group of empiric embolization and the group of no embolization. RESULTS: In the group of empiric embolization, the rate of clinical success in hemostasis and mortality were 61.7% and 27.7%, respectively. In the group of no embolization, the rates of clinical success in hemostasis and mortality were 39.6% and 13.2%, respectively. The rate of clinical success in hemostasis in the group of empiric embolization was significantly higher than that in the group of no embolization (p = 0.028). There was no statistically significant difference in mortality between the different groups (p = 0.071). CONCLUSION: The clinical success rate of hemostasis in patients with empiric embolization is higher than that in patients with no embolization. Empiric embolization may be an efficacious hemostatic treatment for PPH with angiographic findings revealing no signs of active bleeding.


Assuntos
Tratamento Conservador , Embolização Terapêutica , Angiografia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/terapia , Estudos Retrospectivos , Resultado do Tratamento
8.
Rev Esp Anestesiol Reanim ; 67(9): 516-520, 2020 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33012537

RESUMO

Coronavirus associated severe acute respiratory syndrome (SARS-CoV-2) causes a worldwide syndrome called Covid-19 that has caused 5,940,441 infections and 362,813 deaths until May 2020. In moderate and severe stages of the infection a generalized swelling, cytokine storm and an increment of the heart damage biomarkers occur. In addition, a relation between Covid-19 and neurological symptoms have been suggested. The results of autopsies suggest thrombotic microangiopathy in multiple organs. We present 2 cases of patients infected with severe Covid-19 that were hospitalized in the Reanimation Unit that presented cerebrovascular symptoms and died afterwards. A high dose prophylaxis with antithrombotic medication is recommended in patients affected by moderate to severe Covid-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hemorragia/complicações , Isquemia/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Evolução Fatal , Hemorragia/diagnóstico por imagem , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Acidente Vascular Cerebral/diagnóstico por imagem , Microangiopatias Trombóticas/complicações , Microangiopatias Trombóticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 99(44): e23025, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126388

RESUMO

RATIONALE: Pulmonary hemorrhage is a rare but fatal complication of Henoch-Schönlein purpura (HSP), and more easily ignored in children than in adults due to the absence of clinically evident hemoptysis. Moreover, despite being sporadically reported, given that pulmonary hemorrhage may develop after regression and even disappearance of skin rash, the asynchronous progression of skin and lung lesions poses escalating challenges in the timely diagnosis. We herein presented a delayed diagnosis of late-onset pulmonary hemorrhage in a child with HSP after regression of purpuric rash. PATIENT CONCERNS: A 6-year and 3-month child with a history of self-resolved purpuric rash three weeks ago, presented acutely with cough and dyspnea but without fever. DIAGNOSES: The decreased hemoglobin and diffuse ground-glass opacities of both lungs on CT scan weren't comprehensively evaluated. The child was initially misdiagnosed as pneumonia. INTERVENTIONS: Antibiotic treatment was initiated. However, no improvement of respiratory status was found following aggressive combination therapy. Bronchoscopy was subsequently performed. OUTCOMES: An diffuse alveolar hemorrhage with low inflammatory profile was noted after a bronchoscopy. Considering the history of HSP, the diagnosis of HSP-associated pulmonary hemorrhage was ultimately confirmed and the patient received corticosteroids with satisfactory results. LESSONS: Pulmonary hemorrhage could occur in children with HSP at late onset of disease after regression of skin rash. New-onset respiratory symptoms in patients with a history of HSP should heighten suspicion for pulmonary hemorrhage, particularly if presenting with lack of fever, sudden drop of hemoglobin, new pulmonary infiltrates and unresponsiveness to antibiotics therapy. Bronchoscopy should be performed early to confirm the diagnosis, specifically for children.


Assuntos
Exantema , Hemorragia/diagnóstico , Pneumopatias/diagnóstico , Púrpura de Schoenlein-Henoch , Criança , Tosse/etiologia , Diagnóstico Tardio , Hemorragia/complicações , Hemorragia/diagnóstico por imagem , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
11.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(4): 405-408, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32935518

RESUMO

OBJECTIVE: To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. METHODS: The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. RESULTS: The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. CONCLUSIONS: SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.


Assuntos
Técnicas de Imagem por Elasticidade , Varizes Esofágicas e Gástricas , Hemorragia , Esquistossomose , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem por Elasticidade/normas , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esquistossomose/complicações , Esquistossomose/diagnóstico por imagem , Baço/diagnóstico por imagem
12.
J Stroke Cerebrovasc Dis ; 29(9): 105063, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807468

RESUMO

BACKGROUND AND OBJECTIVE: After cerebral hemorrhage, cognitive functions and activities of daily living (ADL) are affected by various factors, including hematoma volume and patient age. In the present study, we investigated the effect of age and hematoma volume on cognitive functions and on ADL. METHODS: The sample comprised 274 patients (183 men and 91 women; mean age 58.2 ± 12.5 years) with putaminal hemorrhage who were hospitalized in a convalescent rehabilitation ward. Hematoma volume was estimated from computed tomography imaging at stroke onset. Cognitive functions were evaluated using Raven's Colored Progressive Matrices test (RCPM) and the Mini-Mental State Examination (MMSE) at hospital admission, while ADL score was assessed at discharge using the Functional Independence Measure motor subscale (FIM-M). In the present study, we classified the patients into six groups according to whether they were non-elderly or elderly (cutoff age, 60 years) and whether their hematoma was small, medium, or large (cutoff volumes, 20 and 40 mL, respectively). Subsequently, the scores on the RCPM, MMSE, and FIM-M were compared among the groups. RESULTS: In both age groups, patients with a larger hematoma volume had lower RCPM and MMSE scores. Patients <60 years old exhibited different trends in their RCPM and MMSE scores, such that the RCPM score showed a step-wise decrease according to hematoma volume, while a difference in the MMSE score was only observed at the 20 mL boundary. Most of the younger patients (<60 years of age) attained high FIM-M scores at discharge, as long as their hematoma volume was either medium or small (<40 mL). This age group had higher RCPM scores on admission, which may have contributed to their higher FIM-M scores on discharge. CONCLUSIONS: In the present study, we demonstrated that advancing age increases the effect of hematoma volume on RCPM and MMSE scores and identified differences in the effects observed on these two scores. Thus, it may be important to use the RCPM alongside the MMSE for patient assessment.


Assuntos
Atividades Cotidianas , Transtornos Cognitivos/etiologia , Cognição , Envelhecimento Cognitivo , Hemorragia/diagnóstico por imagem , Hemorragia Putaminal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Feminino , Hemorragia/complicações , Hemorragia/fisiopatologia , Hemorragia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Prognóstico , Hemorragia Putaminal/complicações , Hemorragia Putaminal/fisiopatologia , Hemorragia Putaminal/psicologia , Fatores de Risco
14.
Arch. argent. pediatr ; 118(4): e414-e417, agosto 2020. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1118595

RESUMO

La hemorragia de las glándulas suprarrenales en el período neonatal se produce secundariamente a traumatismos del parto y a modificaciones de la presión venosa. La ictericia neonatal tiene como causa infrecuente la presencia de un hematoma suprarrenal. Los casos sintomáticos son poco frecuentes y, si se manifiestan, suele ser como ictericia prolongada.Se presenta el caso de un neonato que ingresó a las 20 horas de vida por ictericia isoinmune anti-A. Por aumento de bilirrubina directa, se solicitó una ecografía abdominal a los 10 días de vida, que mostró una masa suprarrenal derecha no vascularizada, de 50 x 21 mm, con imágenes quísticas en su interior, compatible con hemorragia de glándula suprarrenal derecha. La ecografía seriada mostró una resolución progresiva hasta desaparecer, y el paciente se mantuvo asintomático y sin ictericia. Cuando persiste una ictericia en el período neonatal, hay que evaluar la posibilidad de una hemorragia suprarrenal significativ


Hemorrhage of the adrenal glands in the neonatal period happens secondarily to birth trauma and to changes in venous pressure. Neonatal jaundice has as an infrequent etiology the presence of an adrenal gland hematoma. Symptomatic cases are rare, and if they manifest, it is usually as prolonged jaundice.We present the case of a neonate who was admitted at 20 hours of life due to isoimmune jaundice. Due to an increase in conjugated bilirubin, an abdominal ultrasound was requested at 10 days of life, which showed a non-vascularized right adrenal mass, 50 x 21 mm, with cystic images inside, compatible with bleeding of the right adrenal gland. Serial ultrasound showed a progressive resolution until its disappearance, keeping the baby asymptomatic and without jaundice. In cases of prolonged jaundice in the neonatal period, the possibility of significant adrenal hemorrhage must be assessed.


Assuntos
Humanos , Masculino , Recém-Nascido , Glândulas Suprarrenais , Hemorragia/diagnóstico por imagem , Icterícia Neonatal , Bilirrubina
15.
Radiología (Madr., Ed. impr.) ; 62(4): 320-326, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194250

RESUMO

OBJETIVO: Analizar el impacto clínico de adquirir la secuencia de susceptibilidad magnética (SWI) de forma rutinaria en los estudios de resonancia magnética (RM) cerebral. MATERIAL Y MÉTODOS: Se lleva a cabo un estudio prospectivo observacional unicéntrico durante 6 meses a pacientes a los que se le realizó una RM cerebral. Los grupos de estudio se establecieron basándose en la información clínica remitida: el grupo 1 de estudio está formado por aquellos pacientes a los que el radiólogo protocolizó la adquisición de la secuencia SWI, y el grupo 2, por aquellos a los que se les realizó la secuencia SWI sin haber sido protocolizada. Se recogen la edad, sexo y factores de riesgo (hipertensión arterial, historia de traumatismo craneal o de malformaciones vasculares intracraneales). Se analizaron los hallazgos en la secuencia de SWI, si estos eran visibles en el resto de las secuencias y si su identificación suponía cambios sustanciales en el informe radiológico del paciente. RESULTADOS: El grupo 1 estaba formado por 62 pacientes y el grupo 2, por 79. No hubo diferencias al comparar la edad y los factores de riesgo entre los dos grupos. En el grupo 1, los hallazgos de la SWI supusieron un cambio en el informe radiológico en el 34% de los pacientes, y en el grupo 2, en un 14%: las diferencias fueron estadísticamente significativas. CONCLUSIÓN: La secuencia SWI puede ayudar al radiólogo a detectar hallazgos adicionales a las secuencias convencionales en la RM cerebral, que en algunos casos suponen un cambio en el informe radiológico


OBJECTIVE: To analyze the clinical impact of routine acquisition of susceptibility-weighted imaging (SWI) in magnetic resonance imaging (MRI) studies of the brain. MATERIAL AND METHODS: This prospective observational study included all patients undergoing brain MRI including SWI during a 6-month period. Patients were divided into two groups based on the clinical information provided: Group 1 comprised patients in whom SWI acquisition formed part of the brain MRI protocol, and Group comprised patients who underwent SWI without these sequences being included in the protocol. We recorded patients' age, sex, and risk factors (hypertension, history of brain trauma or intracranial vascular malformations). We analyzed the SWI findings, whether these findings were visible on the other sequences, and whether identifying these findings resulted in substantial changes to the radiological report. RESULTS: There were 62 patients in Group 1 and 79 in Group 2. The groups were similar in age and risk factors. SWI findings resulted in substantial changes to the radiological report in 34% of the patients in Group 1 and in 14% of those in Group 2; this difference was statistically significant. CONCLUSION: SWI can help radiologists detect findings not seen on conventional brain MRI that sometimes result in substantial changes to the radiological report


Assuntos
Humanos , Imagem por Ressonância Magnética/métodos , Protocolos Clínicos , Hemorragia/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco
16.
Medicine (Baltimore) ; 99(29): e19800, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702807

RESUMO

RATIONALE: Cerebral cavernous malformation (CCM) of the familial type is caused by abnormalities in the CCM1, CCM2, and CCM3 genes. These 3 proteins forming a complex associate with the maintenance of vascular endothelial cell-cell junctions. Dysfunction of these proteins results in the development of hemangiomas and abnormal intercellular junctions. PATIENT CONCERNS: We report a 68-year-old man with familial cerebral cavernous malformation with initial presentation as convulsions at an advanced age. Brain magnetic resonance imaging revealed multiple cavernous hemangiomas in the right occipital lobe. The convulsions were considered to be induced by hemorrhage from cavernous hemangioma in the right occipital lobe. DIAGNOSES: Genetic screening of the CCM1, CCM2, and CCM3 genes revealed a novel mutation in the CCM2 gene (exon4 c: 359 T>A, p: V120D). No abnormalities were found in CCM1 or CCM3. Therefore, we diagnosed the patient with familial CCM caused by a CCM2 mutation. INTERVENTIONS: This patient was treated with the administration of levetiracetam at a dosage of 1000 mg/day. OUTCOMES: No seizures have been observed since the antiepileptic drug was administered. We performed brain magnetic resonance imaging (MRI) regularly to follow-up on appearance of new cerebral hemorrhages and cavernous hemangiomas. LESSONS: This report reviews cases of familial cerebral cavernous malformations caused by abnormalities in the CCM2 gene. This mutation site mediates interactions with CCM1 and CCM3. The mutation occurs in the phosphotyrosine binding (PTB) site, which is considered functionally important to CCM2.


Assuntos
Proteínas de Transporte/genética , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Idoso , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Testes Genéticos , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/genética , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/tratamento farmacológico , Hemangioma Cavernoso do Sistema Nervoso Central/genética , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Hemorragia/etiologia , Humanos , Levetiracetam/administração & dosagem , Levetiracetam/uso terapêutico , Imagem por Ressonância Magnética/métodos , Masculino , Mutação , Convulsões/diagnóstico , Convulsões/etiologia , Resultado do Tratamento
17.
Cerebrovasc Dis ; 49(4): 355-360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32674096

RESUMO

INTRODUCTION: Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. METHODS: A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. RESULTS: Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipidemia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p <0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009). CONCLUSIONS: IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.


Assuntos
Estenose das Carótidas/complicações , Transtornos Cerebrovasculares/etiologia , Hemorragia/complicações , Placa Aterosclerótica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico , Comorbidade , Feminino , Hemorragia/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Fatores Sexuais , Fatores de Tempo
19.
J Vasc Interv Radiol ; 31(7): 1103-1109, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32457013

RESUMO

PURPOSE: To explore the safety and effectiveness of bronchial artery (BA) embolization (BAE) in children with pulmonary hemorrhage. MATERIALS AND METHODS: Between February 2016 and February 2019, 41 patients (median age, 4 y; interquartile range, 2.3-8 y; median weight, 17.6 kg; interquartile range, 12.3-23.6 kg) underwent BAE. The indication of BAE included massive hemoptysis in 10 patients (24.4%), recurrent hemoptysis in 18 patients (43.9%), and refractory anemia in 13 patients (31.7%). The main etiology of pulmonary hemorrhage included pulmonary hemosiderosis (58.5%), congenital heart disease (17.1%), and infection (14.6%). A retrospective review was conducted of clinical outcomes of BAE. RESULTS: There were 44 embolization sessions, with a total of 137 embolized vessels. Pulmonary hemorrhage was caused by BAs in 30 cases, nonbronchial systemic arteries plus BAs in 10, and nonbronchial systemic arteries in 1. Embolic particles were used in 30 cases (24 polyvinyl alcohol [PVA] and 6 microsphere), coils in 9 cases, and particles plus coils in 5 cases (4 PVA and 1 microsphere). Technical success (ability to embolize abnormal vessel) was achieved in 97.6% of patients (40 of 41), and clinical success (complete or partial resolution of hemoptysis within 30 days of embolization) was achieved in 90.2% (37 of 41). There was 1 procedure-related complication (2.4%) of cerebral infarction and 1 death from multiple-organ dysfunction (2.4%). Bleeding-free survival rates at 6, 12, 24, and 36 months were 92.5%, 83.9%, 83.9%, and 70.8%, respectively. CONCLUSIONS: BAE is a safe and effective procedure in children with pulmonary hemorrhage.


Assuntos
Artérias Brônquicas , Embolização Terapêutica , Hemoptise/terapia , Hemorragia/terapia , Fatores Etários , Artérias Brônquicas/diagnóstico por imagem , Criança , Pré-Escolar , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Hemoptise/diagnóstico por imagem , Hemoptise/etiologia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Vascular ; 28(6): 756-759, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32437239

RESUMO

INTRODUCTION: Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. OBJECTIVES: Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation. METHODS: Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA). RESULTS: All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described. CONCLUSIONS: Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.


Assuntos
Lesões das Artérias Carótidas/terapia , Cateterismo Venoso Central/efeitos adversos , Hemorragia/terapia , Técnicas Hemostáticas/instrumentação , Doença Iatrogênica , Artéria Subclávia/lesões , Dispositivos de Oclusão Vascular , Lesões do Sistema Vascular/terapia , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
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