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1.
Adv Exp Med Biol ; 1161: 125-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562627

RESUMO

Ischemic strokes are caused by one or more blood clots that typically obstruct one of the major arteries in the brain, but frequently also result in leakage of the blood-brain barrier and subsequent hemorrhage. While it has long been known that the enzyme 12/15-lipoxygenase (12/15-LOX) is up-regulated following ischemic strokes and contributes to neuronal cell death, recent research has shown an additional major role for 12/15-LOX in causing this hemorrhagic transformation. These findings have important implications for the use of 12/15-LOX inhibitors in the treatment of stroke.


Assuntos
Araquidonato 15-Lipoxigenase , Isquemia Encefálica , Hemorragia , Acidente Vascular Cerebral , Barreira Hematoencefálica/patologia , Encéfalo/patologia , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
3.
Emerg Med Pract ; 21(8): CD3-CD4, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31386321

RESUMO

The HAS-BLED score estimates the risk of major bleeding for patients on anticoagulation, in order to assess risks and benefits in the care of patients with atrial fibrillation.


Assuntos
Hemorragia/classificação , Projetos de Pesquisa , Medição de Risco/normas , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/psicologia , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Medição de Risco/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
4.
Biomed Res Int ; 2019: 8919230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317041

RESUMO

Several previous studies demonstrated the risk of stroke in asthma patients. The aim of this study was to evaluate the risk of hemorrhagic and ischemic stroke in asthma patients, independent of age, sex, income, region of residence, and past medical histories. The Korean Health Insurance Review and Assessment Service-National Sample Cohort from 2002 through 2013 was used. Overall, 111,364 asthma patients ≥ 20 years old were matched to 111,364 control participants for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia. Asthma was classified using ICD-10 codes (J45 and J46) and medication history. The admission histories were investigated for hemorrhagic stroke (I60-I62) and ischemic stroke (I63) using ICD-10 codes. The crude and adjusted (age, sex, income, region of residence, hypertension, diabetes, dyslipidemia, ischemic heart disease, and depression) hazard ratios (HRs) for hemorrhagic and ischemic stroke in asthma patients were analyzed using a Cox proportional hazards model. Subgroup analyses were conducted according to age and sex. Hemorrhagic and ischemic stroke were found in 0.7% (795/117,364) and 2.4% (922/117,364) of the asthma group and in 0.8% (922/117,364) and 2.6% (93,079/117,364) of the control group, respectively. The asthma group demonstrated adjusted HRs of 0.86 (95% confidence interval [CI] = 0.78-0.94, p = 0.002) for hemorrhagic stroke and 0.91 (95% CI = 0.86-0.95, p = 0.002) for ischemic stroke. None of the subgroups of asthma patients showed higher HRs for stroke. Asthma did not elevate the risk of either hemorrhagic or ischemic stroke.


Assuntos
Asma/epidemiologia , Hemorragia/epidemiologia , Isquemia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Asma/complicações , Asma/fisiopatologia , Feminino , Seguimentos , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
5.
Khirurgiia (Mosk) ; (5): 25-30, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169815

RESUMO

AIM: To justify the concept of systemic membrane-destabilizing distress syndrome in surgery via analysis of phospholipid bilayer of cell membranes of various organs in urgent surgical abdominal diseases. MATERIAL AND METHODS: Experimental research on dogs (n=90) included modeling of peritonitis, pancreatitis, intestinal obstruction, obstructive jaundice, and post-hemorrhagic anemia. Clinical and laboratory studies were performed in patients (n=119) with acute peritonitis, severe pancreatitis, intestinal obstruction, post-hemorrhagic anemia, acute cholecystitis, gastrointestinal bleeding, benign mechanical jaundice. Lipid profile in tissues and blood cells was determined by extraction, fractionation and densitometry. Moreover, we assessed intensity of lipid peroxidation and phospholipase activity, endogenous intoxication, functional state of organs and blood cells. RESULTS: It was revealed that all above-mentioned acute abdominal diseases are followed by significant changes of lipid bilayer and dysfunction of tissues in target organs, blood cells and other organs (liver, kidney, colon and small intestine, heart, lungs, spleen, brain). Changes of phospholipid bilayer are correlated with severity and course of the disease. These data were used to determine a new complex in surgery - systemic membrane-destabilizing distress syndrome. Its concept, pathogenesis, and diagnosis are presented. It was analyzed its role in development and progression of dysregulation pathology and thanatogenesis. Evidence of its importance in the pathogenesis of surgical aggression was obtained.


Assuntos
Anemia/fisiopatologia , Membrana Celular/fisiologia , Doenças do Sistema Digestório/fisiopatologia , Hemorragia/fisiopatologia , Icterícia Obstrutiva/fisiopatologia , Estresse Fisiológico/fisiologia , Anemia/complicações , Animais , Doenças do Sistema Digestório/complicações , Modelos Animais de Doenças , Cães , Hemorragia/complicações , Humanos , Icterícia Obstrutiva/complicações , Lipídeos de Membrana/fisiologia , Fosfolipídeos/fisiologia , Síndrome
6.
J Clin Neurosci ; 66: 220-225, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31176592

RESUMO

The relationship between carotid blood flow and carotid intraplaque haemorrhage (IPH) is not fully understood. This study was to investigate the relationship between local haemodynamics and carotid plaques with IPH associated with severe artery stenosis. Fifty-nine patients with carotid atherosclerosis were enrolled in this study and underwent magnetic resonance imaging (MRI) measurement. IPH and non-IPH compositions were differentiated based on plaque sequences. Haemodynamic simulations were performed by using computational fluid dynamics (CFD). All the carotids were categorised into IPH and non-IPH groups. In each group, the artery stenosis was divided into mild (<50%), moderate (50-70%) and severe (>70%) subgroups. Maximum wall shear stress (mWSS) was calculated and comparisons made between IPH and non-IPH groups using independent t-test. Furthermore, the relationship between mWSS and IPH volume was examined using Pearson's correlation. The mWSS result calculated from the IPH group was significantly higher than that of the non-IPH group; at mild stenosis (P = 0.001) and moderate stenosis (P = 0.002) respectively. However, there was no significant difference in cases of severe stenosis (P = 0.42). Furthermore, the results showed a positive correlation between mWSS and IPH volume (r = 0.763, P < 0.001) in the cases of stenosis of less than 70%. mWSS was found to be significantly associated with IPH for carotids with stenosis of less than 70%. This highlights that mWSS is a potential quantitative parameter for the risk diagnosis of the carotid atherosclerosis.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Hemodinâmica/fisiologia , Hemorragia/diagnóstico por imagem , Hidrodinâmica , Imagem por Ressonância Magnética/métodos , Índice de Gravidade de Doença , Idoso , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/fisiopatologia , Feminino , Hemorragia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Mecânico
7.
Curr Med Sci ; 39(3): 415-418, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209812

RESUMO

The colon is an alternative graft organ for esophageal reconstruction. The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion, to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range: 270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20, 16.8%), the larynx (n=3, 2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon). One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.


Assuntos
Colo/cirurgia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante Autólogo/métodos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Colo/fisiologia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/fisiopatologia , Estenose Esofágica/fisiopatologia , Esôfago/fisiopatologia , Feminino , Seguimentos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Nervos Laríngeos/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento
9.
Biomed Res Int ; 2019: 3170957, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31016189

RESUMO

Background: Percutaneous treatment of coronary bifurcation lesions can potentially lead to higher risk of ischemic events than the nonbifurcation ones, thus calling for further optimization of dual antiplatelet therapy (DAPT). This study aimed to compare the clinical outcomes from ticagrelor and clopidogrel in bifurcation lesions patients undergoing percutaneous coronary intervention (PCI). Methods: We performed a retrospective cohort study in patients with coronary bifurcation lesions. A total of 553 patients discharged on ticagrelor or clopidogrel combined with aspirin were recruited for 1-year follow-up. The incidences of primary endpoint (major adverse cardiovascular event [MACE]: a composite of cardiac death, myocardial infarction [MI] or stroke), secondary endpoints (the individual component of the primary endpoint or definite/probable stent thrombosis), and major bleeding (Bleeding Academic Research Consortium [BARC]≥3 bleeding events) were evaluated. To minimize the selection bias, a propensity score-matched population analysis was also conducted. Results: The risks of both primary endpoint (8.15% and 12.01% for the ticagrelor and clopidogrel groups, respectively; adjusted hazards ratio [HR]: 0.488, 95% confidence interval [CI]: 0.277-0.861, P=0.013) and MI (4.44% and 8.48% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.341, 95% CI: 0.162-0.719, P=0.005) were significantly reduced in the ticagrelor group as compared with those of the clopidogrel counterpart, whereas the risk of major bleeding was comparable (2.96% and 2.47% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.972, 95% CI: 0.321-2.941, P=0.960). Propensity score-matched analysis confirmed such findings. Conclusions: For patients with bifurcation lesions after PCI, ticagrelor treatment shows lower MACE and MI rates than the clopidogrel one, along with comparable major bleeding.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Clopidogrel/uso terapêutico , Intervenção Coronária Percutânea/efeitos adversos , Ticagrelor/uso terapêutico , Síndrome Coronariana Aguda/cirurgia , Aspirina/uso terapêutico , Feminino , Hemorragia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia
10.
BMJ Case Rep ; 12(4)2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31028048

RESUMO

Vasculitis presents several diagnostic challenges. Herein, we present a clinical case of a 71- year old woman, observed in our emergency department due to asthenia, vomiting and persistent cough. The patient had a history of progressive renal failure and anaemia over the last years. On physical examinations, fine pulmonary crackles were detected and laboratory test showed haemoglobin 69 g/L, creatinine 4 mg/dL, potassium 6.3 mmol/L, positive antineutrophil cytoplasm antibody (ANCA), with proteins and dimorphic erythrocytes in the urinary sediment. CT analysis of the thorax revealed patchy ground glass haziness, likely due to diffuse alveolar haemorrhage. Pulmonary-renal syndrome was assumed, and induction therapy was initiated. She was discharged after 33 days of hospitalisation. On the following months, ANCA titres remained undetectable, but minor recovery of renal function was observed, requiring haemodialysis. Indeed, the use of aggressive induction therapy at early stage dramatically improve prognosis, maintenance of disease remission may be difficult, as relapse is frequent.


Assuntos
Ciclofosfamida/uso terapêutico , Glomerulonefrite/diagnóstico , Hemorragia/diagnóstico , Imunossupressores/uso terapêutico , Pneumopatias/diagnóstico , Plasmaferese/métodos , Idoso , Progressão da Doença , Feminino , Glomerulonefrite/fisiopatologia , Glomerulonefrite/terapia , Hemorragia/fisiopatologia , Hemorragia/terapia , Humanos , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Radiografia Torácica , Resultado do Tratamento
11.
Biomater Sci ; 7(5): 1833-1841, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-30907899

RESUMO

Uncontrollable hemorrhage is the main cause of death in military and civilian accidents. It is therefore necessary and an urgent requirement to develop a safe and efficient hemostatic material. In this study, the hemostatic performance of frustules of three centric diatom species (Thalassiosira weissflogii, Thalassiosira sp., and Cyclotella cryptica) with similar shapes and different sizes was investigated. The complicated structure of T. weissflogii, leading to its highest BET surface area (169.5 m2 g-1) and liquid absorption (51.4 ± 1.6 times the weight of liquid), exhibited the shortest hemostasis time (158 ± 8.19 s) in in vitro blood coagulation. Thalassiosira sp. had a shorter hemostasis time (167.33 ± 14.74 s) than that of QuikClot® and C. cryptica, indicating that diatom size also played an important role in hemostasis due to the interface reaction between the material and plasma protein. The in vivo hemostasis results further confirmed this conclusion. Diatom frustules also exhibited favorable blood compatibility (<5%), and no significant cell toxicity could be observed from the three frustules. Our results suggest that the coagulation effect of frustules is strengthened upon a decrease in the size and increase in the liquid absorbability. This report provides valuable information for the medical application of diatom frustules in the field of hemorrhage control.


Assuntos
Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Fenômenos Químicos , Diatomáceas/citologia , Hemorragia/tratamento farmacológico , Animais , Materiais Biocompatíveis/uso terapêutico , Materiais Biocompatíveis/toxicidade , Coagulação Sanguínea/efeitos dos fármacos , Parede Celular/química , Hemólise/efeitos dos fármacos , Hemorragia/fisiopatologia , Teste de Materiais , Camundongos , Porosidade , Coelhos , Ratos
12.
Mil Med ; 184(Suppl 1): 318-321, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901407

RESUMO

Vital signs are included in the determination of shock secondary to hemorrhage; however, more granular predictors are needed. We hypothesized that fast Fourier transformation (FFT) would have a greater percent change after hemorrhage than heart rate (HR) or systolic blood pressure (SBP). Using a porcine model, nine 17 kg pigs were hemorrhaged 10% of their calculated blood volume. Peripheral venous pressure waveforms, HR and SBP were collected at baseline and after 10% blood loss. FFT was performed on the peripheral venous pressure waveforms and the peak between 1 and 3 hertz (f1) corresponded to HR. To normalize values for comparison, percent change was calculated for f1, SBP, and HR. The mean percent change for f1 was an 18.8% decrease; SBP was a 3.31% decrease; and HR was a 0.95% increase. Using analysis of variance, FFT at f1 demonstrates a statistically significant greater change than HR or SBP after loss of 10% of circulating blood volume (p = 0.0023). Further work is needed to determine if this could be used in field triage to guide resuscitation.


Assuntos
Hemorragia/fisiopatologia , Pressão Venosa/fisiologia , Sinais Vitais/fisiologia , Animais , Pressão Sanguínea/fisiologia , Modelos Animais de Doenças , Frequência Cardíaca/fisiologia , Hemodinâmica , Hemorragia/diagnóstico , Curva ROC , Suínos
13.
Ear Nose Throat J ; 98(5): E13-E20, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30909739

RESUMO

To investigate the application of inner ear 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL) accompanied by inner ear hemorrhage. A total of 1252 SSNHL patients who were admitted from January 2010 to April 2018 were included in the study. The patients' clinical features, complete blood counts, coagulation profiles, audiometry data, and MRI scans were retrospectively reviewed. Twenty-four patients had high labyrinth signals on inner ear 3D-FLAIR MRI (24/1252, 1.9%) that were diagnosed as inner ear hemorrhage. One patient had endolymphatic hydrops on the contralesional side. In the 24 patients, pure tone audiometry curves revealed profound deafness (19/24) and flat moderate hearing loss (5/24); most patients had associated vertigo (23/24) and tinnitus (19/24). Patients with SSNHL (N = 24) were treated. Sixteen patients had invalid improvement, 3 patients were markedly improved, 4 patients had effective treatment, and only 1 patient was cured, for a therapeutic efficacy of 33.3% (8/24). Follow-up 3D-FLAIR MRI in patients showed absorbance of labyrinthine hemorrhage and disappearance of the high signal intensity in the inner ear within 2 weeks to 4 months. Inner ear 3D-FLAIR MRI indicate that most cases of inner ear hemorrhage are spontaneous and that high labyrinth signals are absorbed within 4 months. The site of labyrinth hemorrhage is irregular and independent of hearing loss. Conventional treatment is not very effective, and an appropriate therapy for SSNHL requires further investigation.


Assuntos
Otopatias/complicações , Orelha Interna/diagnóstico por imagem , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Hemorragia , Adulto , Audiometria de Tons Puros/métodos , China/epidemiologia , Otopatias/diagnóstico , Otopatias/fisiopatologia , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/epidemiologia , Perda Auditiva Súbita/etiologia , Hemorragia/complicações , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Humanos , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Zumbido/diagnóstico , Vertigem/diagnóstico
14.
Biomed Res Int ; 2019: 8619460, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30834279

RESUMO

Objective: This study investigated the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy, so as to prevent the occurrence of bleeding and improve the surgical effect. Patients and Methods: The data of 396 patients who underwent percutaneous nephrolithotomy by an experienced surgeon between May 2014 and December 2017 were retrospectively analyzed. To identify the risk factors for bleeding during percutaneous nephrolithotomy, each group was stratified according to the decrease in median hemoglobin. Age, gender, body mass index, stone size, operation time, stone type, degree of hydronephrosis, number of accesses, puncture guidance, underlying disease (diabetes; hypertension), and previous surgical history were evaluated. Univariate analysis was performed to calculate the potential factors. In order to determine the independence of each factor, we finally selected stone size, staghorn stone, degree of hydronephrosis, and operation time. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Results: A total of 396 patients were successfully treated with percutaneous nephrolithotomy. The univariate analysis demonstrated that the potential risk factors for bleeding during percutaneous nephrolithotomy included stone size, type of stone, operative time, and degree of hydronephrosis. According to the previous studies, stone size, staghorn stone, degree of hydronephrosis, and operation time were ultimately selected. Multivariate logistic regression analysis was used to identify the risk factors for bleeding during percutaneous nephrolithotomy. According to the outcome of logistic regression analysis, stone size, staghorn stone, operation time, and degree of hydronephrosis were the risk factors for bleeding during minimally invasive percutaneous nephrolithotomy. Conclusions: Percutaneous nephrolithotomy is an effective method for the treatment of upper urinary calculi with few complications. According to the results achieved by an experienced surgeon, the size of stone, staghorn stone, operation time, and degree of hydronephrosis were associated with the bleeding during minimally invasive percutaneous nephrolithotomy.


Assuntos
Hemorragia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Cálculos Urinários/patologia , Cálculos Urinários/cirurgia , Sistema Urinário/patologia , Sistema Urinário/cirurgia , Adulto Jovem
15.
Biomed Res Int ; 2019: 3428123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30719442

RESUMO

Purpose: To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). Methods: We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. Results: The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. Conclusions: AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.


Assuntos
Dilatação/métodos , Rim/cirurgia , Nefrolitotomia Percutânea/métodos , Ultrassonografia/métodos , Transfusão de Sangue/métodos , Feminino , Hemorragia/fisiopatologia , Hospitalização , Humanos , Testes de Função Renal/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pós-Operatórios/métodos
16.
In Vivo ; 33(2): 621-626, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804150

RESUMO

AIM: To present the experience of the upper Gastrointestinal Unit of the Surgical Department of National and Kapodistrian University of Athens in order to inform surgeons of the exact harms and benefits associated with their decisions concerning management of antiplatelet therapy. MATERIALS AND METHODS: This was a single-center study of patients who underwent surgery for esophageal cancer and had concomitant coronary artery disease from 1/1/2005 to 31/7/2017. Patients were divided into two cohorts based on when their antiplatelet therapy was stopped (<7 vs. ≥7 days). Esophageal cancer was classified as esophageal only or as Siewert type I, II, or III based on tumor location at the gastroesophageal junction. A univariate logistic regression model was developed to assess the relationship between baseline variables and myocardial infraction, mortality, bleeding and stroke after the operation. For all tests, differences with a value of p<0.05 were considered significant. RESULTS: During the study period, 135 esophagectomies were performed for esophageal cancer. Almost 17% of them had concomitant coronary artery disease medically managed with antiplatelet therapy. No difference was found in terms of myocardial infarction, stroke or severe bleeding events between patients that stopped antiplatelet therapy for more or less than 7 days before esophagectomy. CONCLUSION: It is a reasonable approach to discontinue antiplatelet therapy for more than 7 days before surgery, especially in such a population of patients with esophageal cancer that require complex operations with high bleeding risk.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Inibidores da Agregação de Plaquetas/administração & dosagem , Idoso , Clopidogrel/administração & dosagem , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/fisiopatologia , Feminino , Hemorragia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Inibidores da Agregação de Plaquetas/efeitos adversos , Medição de Risco , Fatores de Risco , Stents/efeitos adversos , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversos
17.
Int J Cardiol ; 282: 47-52, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777405

RESUMO

BACKGROUND: Chronic kidney disease (CKD), commonly described by estimated glomerular filtration rate (eGFR), is a frequent comorbidity in patients with atrial fibrillation (AF) and associated with thromboembolic and bleeding complications. Instead of single eGFR measurements, kidney function decline over time may better predict clinical outcomes but this has not been studied so far. METHODS: Patients with AF and stage 3/4 CKD were prospectively followed within a primary care electronic database from the United Kingdom (IMS-THIN). The associations between the longitudinal eGFR trajectory of these patients and stroke/systemic embolism, major bleeding, first hospitalization-for-any-cause, and death-from-any-cause were estimated with joint models of longitudinal and time-to-event data. RESULTS: 18,240 patients were included (median age 80.4 years, median CHA2DS2-VASc score 4). In 133,676 eGFR measurements (mean: 6 per patient) median "baseline" eGFR was 49 ml/min/1.73m2 [41-55] and mean eGFR decline was 0.54 ml/min/1.73m2/year (95%CI: 0.47-0.62). During follow-up (median 3.2 years; 50,841 patient-years at risk), 5-year cumulative incidence estimates were 9%, 3%, 32% and 76% for stroke/systemic embolism, major bleeding, hospitalization and death, respectively. In joint modeling, an accelerated decline in kidney function strongly predicted for a higher risk of major bleeding (hazard ratio [HR] 1.09 per ml/min/1.73m2/year increase in eGFR decline), hospitalization (HR 1.06), and death-from-any-cause (HR 1.11; all p < 0.05), but not for stroke/systemic embolism (HR 0.97; p = 0.239). CONCLUSIONS: Declining kidney function is a critical determinant of unfavourable outcomes in patients with AF and CKD. Longitudinal kidney function trajectories may enable a much more individualized prediction of adverse outcomes in this vulnerable patient population.


Assuntos
Fibrilação Atrial/mortalidade , Hemorragia/mortalidade , Hospitalização/tendências , Rim/fisiologia , Insuficiência Renal Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Feminino , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Mortalidade/tendências , Valor Preditivo dos Testes , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia
18.
Anesthesiol Clin ; 37(1): 171-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30711230

RESUMO

Hemorrhage is the leading cause of preventable death after trauma. Junctional and extremity hemorrhage can be temporized with direct pressure and tourniquet application, but noncompressible torso hemorrhage has traditionally required operative or angiographic intervention. Retrograde endovascular balloon occlusion of the aorta (REBOA) can temporize patients with hemorrhage below the diaphragm long enough to enable definitive surgery. REBOA is increasingly available in US trauma centers but prospective, randomized demonstration of efficacy is not yet available. Emergency perfusion and resuscitation is an investigational therapy, limited to use in patients with cardiac arrest due to hemorrhage.


Assuntos
Aorta/fisiopatologia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Hemorragia/terapia , Ressuscitação/métodos , Hemorragia/fisiopatologia , Humanos
19.
Orphanet J Rare Dis ; 14(1): 28, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717761

RESUMO

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular dysplasia that leads to nosebleeds and visceral arteriovenous malformations (AVMs). Anti-angiogenic drugs thalidomide and bevacizumab have been increasingly used off-label with variable results. The HHT working group within the ERN for Rare Multisystemic Vascular Diseases (VASCERN), developed a questionnaire-based retrospective capture of adverse events (AEs) classified using the Common Terminology Criteria for Adverse Events. RESULTS: Sixty-nine HHT patients received bevacizumab, 37 (50.6%) for high output cardiac failure/hepatic AVMs, and 32 (49.4%) for bleeding; the 69 patients received bevacizumab for a mean of 11 months for a total of 63.8 person/years treatment. 67 received thalidomide, all for epistaxis and/or gastrointestinal bleeding; they received thalidomide for a mean of 13.4 months/patient for a total of 75 person/years treatment. AEs were reported in 58 patients, 33 with bevacizumab, 37 with thalidomide. 32 grade 1-3 AEs related to bevacizumab were reported with an average incidence rate of 50 per 100 person-years. 34 grade 1-3 AEs related to thalidomide were reported with an average incidence rate of 45.3 per 100 person-years. Bevacizumab AEs were more common in females (27 AEs in 46 women) than males (6 in 23, p < 0.001). Thalidomide AEs occurred at more similar rates in males (25 AEs in 41 men, 60.9%) and females (12 in 26 (46.2%), but were more common in ENG patients (17 in 17) than in ACVRL1 (14 in 34, p < 0.0001). For bevacizumab, the most common reports were of joint pains (7/69, 10%), headache (3/69, 4.4%) and proteinuria (2/69, 3%), and for thalidomide, peripheral neuropathy (12/67, 18%); drowsiness (8/67, 12%); and dizziness (6/67, 9%). Fatal adverse events were more common in males (p = 0.009), and in patients with ENG pathogenic variants (p = 0.012). One fatal AE was possibly related to bevacizumab (average incidence rate: 1.5 per 100 person-years); 3 fatal AEs were possibly related to thalidomide (average incidence rate: 4 per 100 person-years). CONCLUSIONS: With potential increase in use of Bevacizumab and Thalidomide in HHT patients, data presented support appropriate weighing of the toxicities which can arise in HHT settings and the practice recommendations for their prevention and management.


Assuntos
Bevacizumab/efeitos adversos , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Talidomida/efeitos adversos , Adolescente , Adulto , Bevacizumab/uso terapêutico , Epistaxe/tratamento farmacológico , Epistaxe/metabolismo , Epistaxe/fisiopatologia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/metabolismo , Hemorragia/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Telangiectasia Hemorrágica Hereditária/metabolismo , Talidomida/uso terapêutico , Adulto Jovem
20.
Br Poult Sci ; 60(3): 265-271, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30657354

RESUMO

1. The objective of the study was to investigate the susceptibility of young and older laying hens to fatty liver-haemorrhagic syndrome (FLHS) and to evaluate the reliability of different blood lipid fractions for predicting or diagnosing FLHS. 2. Forty young hens and 40 older hens were caged individually. Each group of hens was randomly allotted to four treatments for 21 days: either a control, an oestradiol group, a high energy-low protein diet (HELPD) group or a HELPD + oestradiol group. Blood levels of oestradiol, triglyceride (TG), cholesterol (CHOL), high density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C), liver total lipids, hepatic haemorrhagic scores and productive performance were assessed. 3. In older hens, ß-oestradiol increased (P < 0.05) liver total lipids, hepatic haemorrhagic scores and the incidence of FLHS but reduced (P < 0.05) productive performance; however, such changes were not observed in young hens. 4. In two groups of hens, serum TG, CHOL and HDL-C levels were increased (P < 0.001) by ß-oestradiol. Hens with FLHS had higher serum TG, CHOL and HDL-C (P < 0.001) than non-FLHS birds in the older layer group of hens. 5. An interaction (ß-oestradiol × HELPD) (P < 0.05) for LDL-C levels was observed in both groups of hens. In young hens, ß-oestradiol induced a decrease (P = 0.004) in serum LDL-C levels but the effect was attenuated by HELPD. In older hens, HELPD caused an increase (P = 0.02) in serum LDL-C although the effect depended on the presence of ß-oestradiol. 6. In conclusion, older layers were more susceptible to FLHS than young layers after oestradiol treatment. Blood TG, CHOL and HDL-C rather than LDL-C levels can be used as a prediction tool for the overall susceptibility to FLHS in older rather than young layers. There were interactions between oestradiol and HELPD on blood LDL-C levels in laying hens.


Assuntos
Galinhas , LDL-Colesterol/análise , Dieta com Restrição de Proteínas/veterinária , Estradiol/análise , Fígado Gorduroso/veterinária , Hemorragia/veterinária , Doenças das Aves Domésticas , Fatores Etários , Ração Animal/análise , Animais , Colesterol/análise , HDL-Colesterol/análise , Suscetibilidade a Doenças/diagnóstico , Suscetibilidade a Doenças/fisiopatologia , Suscetibilidade a Doenças/veterinária , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/fisiopatologia , Feminino , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Doenças das Aves Domésticas/diagnóstico , Doenças das Aves Domésticas/fisiopatologia , Triglicerídeos/análise
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