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1.
Toxicol Lett ; 319: 250-255, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778774

RESUMO

The effect of thalidomide on mandibular development is unclear. In this study, thalidomide was delivered to pregnant rabbits from the 8th to 14th day of gestation. Then, embryos were harvested for examination on the 16th day (GD16), 20th day (GD20) and 24th day (GD24) of gestation. The results showed obvious hemorrhage and hematoma on one side of the craniofacial region in 50 % of the thalidomide-treated embryos and obvious hemorrhage and hematoma on both sides of the craniofacial region in 50 % of the thalidomide-treated embryos at GD16. Histological examination showed soft tissues and mandible defects on the affected side of the maxillofacial region. The expression of Vegf-α, Ki67 and Sox9 on the affected side was significantly down-regulated in comparison to their expression on the unaffected side at GD20. There was also an obvious defect in the affected mandible, and the density of the skull and mandible was decreased compared to the unaffected side or the control group at GD24. These findings demonstrated that thalidomide may lead to hemorrhage and hematoma in the craniofacial region by inhibiting angiogenesis, resulting in the abnormal development of cranial neural crest cells that are involved in the normal development of the mandible in rabbits.


Assuntos
Anormalidades Craniofaciais/induzido quimicamente , Anormalidades Craniofaciais/patologia , Hemorragia/induzido quimicamente , Hemorragia/patologia , Mandíbula/patologia , Neovascularização Fisiológica/efeitos dos fármacos , Teratogênios/toxicidade , Talidomida/toxicidade , Animais , Regulação para Baixo/efeitos dos fármacos , Feminino , Mandíbula/anormalidades , Anormalidades Maxilofaciais/induzido quimicamente , Anormalidades Maxilofaciais/patologia , Crista Neural/patologia , Gravidez , Coelhos , Crânio/anormalidades
2.
J Forensic Sci ; 65(1): 274-275, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31469426

RESUMO

A 29-year-old man died at the scene of an altercation from a stab wound to the left side of the neck. At autopsy, careful in situ examination of the common carotid artery did not reveal any evidence of hemorrhage or apparent vascular injury. However, applying pressure to the chest wall and underlying thoracic viscera (lungs and heart) resulted in filling of the collapsed vessel with blood causing hemorrhage from a small incision on the medial aspect of the common carotid artery. Release of pressure and drying of the dissection field enabled the artery to be opened and the small defect to be identified. This technique may be used to temporarily restore blood to a vessel to help identify a small bleeding point that may otherwise be difficult to detect.


Assuntos
Lesões das Artérias Carótidas/patologia , Hemorragia/patologia , Pressão , Tórax , Ferimentos Perfurantes/patologia , Adulto , Autopsia/métodos , Artéria Carótida Primitiva/patologia , Exsanguinação/etiologia , Humanos , Masculino
3.
Orv Hetil ; 160(52): 2073-2078, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31868009

RESUMO

The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073-2078.


Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Doenças Fetais/diagnóstico , Hemorragia/patologia , Ultrassonografia Pré-Natal/métodos , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Gravidez
4.
Presse Med ; 48(12): 1416-1421, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679898

RESUMO

Antiplatelet therapy is the cornerstone of coronary artery disease treatment and prevention. Combination of aspirin and P2Y12 inhibitor is recommended after acute coronary syndrome and after elective percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy depends on the individual ischemic and bleeding risk of the patient. Bleeding on dual anti platelet therapy remains the most frequent complication of antiplatelet therapy even is mostly minimal or moderate. Beyond individualized evaluation of patients' bleeding risk, management of patients with severe bleeding complications is a challenging situation and requires general and specific recommendations with interruption of the dual antiplatelet therapy in the vast majority of the cases.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/terapia , Inibidores da Agregação de Plaquetas/efeitos adversos , Anticoagulantes/administração & dosagem , Quimioterapia Combinada , Hemorragia/epidemiologia , Hemorragia/patologia , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem , Índice de Gravidade de Doença , Stents/efeitos adversos , Trombose/tratamento farmacológico , Trombose/epidemiologia , Trombose/etiologia
5.
Forensic Sci Int ; 305: 110029, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31726327

RESUMO

The question whether an injury was sustained during life or not is one of the most important subjects in forensic medicine. Therefore, vital reactions have been a main research topic in forensic medicine for a long period and many renowned forensic pathologists have devoted important papers to this field. The research area ranges from macroscopically visible organ reactions, over tissue alterations (enzyme histochemistry, later on immunohistochemistry with a wide range of enzymes and other analytes, molecular pathology) to biochemical responses to injury. Especially in the field of immunohistochemistry and molecular pathology much progress has been achieved in the last years (e.g. heat-shock-proteins or positive aquaporine3-staining in mechanical skin trauma). Furthermore, 20 years after its implementation postmortem imaging also contributes to the detection and visualization of vital signs. The aim of the present review is to provide an update on forensically relevant vital signs/vital reactions. Systemic vital reactions especially of the circulatory and respiratory system as well as local vital reactions will be addressed. Vital reactions of different organ systems will be discussed in detail regarding pathogenesis and possible postmortem evolution. Current research on immunohistochemically detectable vital reactions (heat-shock-protein expression, aquaporine3-staining in mechanical trauma of the skin) will be addressed as well as biochemical vital reactions (agonochemical stress reaction, myoglobine in electrocution death, hypoxanthine as marker of hypoxia).


Assuntos
Medicina Legal/métodos , Ferimentos e Lesões/patologia , Catecolaminas/sangue , Tosse , Deglutição , Embolia/patologia , Exsanguinação/patologia , Hemorragia/patologia , Humanos , Imuno-Histoquímica , Insulina/sangue , Absorção Intestinal , Isquemia/patologia , Pneumotórax/patologia , Proteínas/metabolismo , Enfisema Pulmonar/patologia , Ventilação Pulmonar , Púrpura/patologia , Aspiração Respiratória/patologia , Salivação
6.
World Neurosurg ; 132: 326-328, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31449995

RESUMO

BACKGROUND: Hemorrhage is a rare presentation of spinal synovial cysts, which are usually located in the lumbar spine. They may cause an epidural hematoma and compression of the cauda equina. Infrequently, they may be located in the thoracic spine. CASE DESCRIPTION: We present a case of sudden onset paraparesis caused by hemorrhage in a synovial cyst at a midthoracic level. Clinical, radiologic, and histologic findings are described. CONCLUSIONS: This report describes a unique case of hemorrhagic synovial cyst at the mid-thoracic spine. These lesions are rarely located in the cervico-thoracic spine but should be included in the differential diagnosis of myelopathy.


Assuntos
Hematoma Epidural Espinal/complicações , Hemorragia/complicações , Paraparesia/etiologia , Cisto Sinovial/complicações , Idoso de 80 Anos ou mais , Feminino , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/patologia , Hemorragia/diagnóstico por imagem , Hemorragia/patologia , Humanos , Cisto Sinovial/diagnóstico por imagem , Cisto Sinovial/patologia , Cisto Sinovial/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
8.
Life Sci ; 233: 116711, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374233

RESUMO

AIMS: Insulin is a central peptide hormone required for carbohydrate metabolism; however, its role in diabetes-associated pulmonary disease is unknown. Here, we investigated the preventative effect of insulin against hyperglycemia-induced pulmonary vascular leakage and its molecular mechanism of action in the lungs of diabetic mice. MAIN METHODS: Vascular endothelial growth factor (VEGF) activated transglutaminase 2 (TGase2) by sequentially elevating intracellular Ca2+ and reactive oxygen species (ROS) levels in primary human pulmonary microvascular endothelial cells (HPMVECs). KEY FINDINGS: Insulin inhibited VEGF-induced TGase2 activation, but did not affect intracellular Ca2+ elevation and ROS generation. Insulin prevented VEGF-induced vascular leakage by inhibiting TGase2-mediated c-Src phosphorylation, disassembly of VE-cadherin and ß-catenin, and stress fiber formation. Insulin replacement therapy prevented hyperglycemia-induced TGase2 activation, but not ROS generation, in the lungs of diabetic mice. Insulin also prevented vascular leakage and cancer metastasis in the diabetic lung. Notably, vascular leakage was not detectable in the lungs of TGase2-null (Tgm2-/-) diabetic mice. SIGNIFICANCE: These findings demonstrate that insulin prevents hyperglycemia-induced pulmonary vascular leakage in diabetic mice by inhibiting VEGF-induced TGase2 activation rather than ROS generation.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Proteínas de Ligação ao GTP/antagonistas & inibidores , Hemorragia/prevenção & controle , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Pneumopatias/prevenção & controle , Transglutaminases/antagonistas & inibidores , Animais , Proteínas de Ligação ao GTP/fisiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Pneumopatias/etiologia , Pneumopatias/patologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Masculino , Melanoma Experimental/metabolismo , Melanoma Experimental/patologia , Melanoma Experimental/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transglutaminases/fisiologia , Células Tumorais Cultivadas
9.
Clin Appl Thromb Hemost ; 25: 1076029619866916, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31359769

RESUMO

Correlations between bleeding symptoms and von Willebrand factor (VWF) levels may help to predict hemorrhagic severity in the Westerners with von Willebrand disease (VWD), but data in Asians are lacking. In this study, Thai patients with VWF levels <50 IU/dL without any secondary causes were enrolled from 1988 to 2018 to determine the relationship between VWF levels and hemorrhagic manifestations. According to the current concept, we reclassified VWD and low VWF by VWF levels ≤30 and 30 to 50 IU/dL, respectively. Type 2 VWD was diagnosed if VWF activity to antigen ratio was ≤0.6. Bleeding severity was determined by the condensed MCMDM-1VWD bleeding score (BS). Among 83 patients, VWF activities showed negative correlations with BS (P = .001), which were higher in type 2 (median: 7, interquartile range [IQR]: 5-11) compared with type 1 VWD (median: 3, IQR: 2-4) and low VWF (median: 4, IQR: 2-8). Bleeding symptoms were indistinguishable between type 1 VWD and low VWF using the 30 IU/dL cutoff point. However, VWF ristocetin cofactor activity or gain-of-function mutant glycoprotein Ib binding activity <36.5 IU/dL and VWF collagen binding activity <34.5 IU/dL could predict increased bleeding risk (BS ≥3) by 92.3% specificity and 70.0% sensitivity (P < .0001).


Assuntos
Hemorragia/patologia , Fator de von Willebrand/metabolismo , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Criança , Hemorragia/etnologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Adulto Jovem , Doença de von Willebrand Tipo 1/sangue , Doença de von Willebrand Tipo 1/etnologia , Doença de von Willebrand Tipo 2/sangue , Doença de von Willebrand Tipo 2/etnologia
11.
J Forensic Leg Med ; 66: 79-85, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229802

RESUMO

Although the diagnosis of drowning may appear straightforward the reality is that it is sometimes one of the most difficult in forensic pathology. To begin with, there is no universal agreement on what constitutes drowning with some definitions using the term in the absence of a lethal outcome. Next are the significant problems that arise in finding immersed bodies and in assessing the death scene. Prolonged post mortem intervals are associated with artefactual modifications of the body from putrefaction and post mortem animal predation. Both of these may create and disguise injuries. The absence of pathognomonic pathological features at autopsy and the presence of potentially life threatening underlying organic illnesses complicate determination of both the cause and manner of death. There may even be no autopsy findings to indicate that immersion had occurred. Finally, the unreliability of laboratory tests with significant overlap with control cases where death had no association with immersion presents further problems. Thus lethal drowning remains a complex event that requires the use of a wide variety of information sources, not just data gleaned from the dissection table.


Assuntos
Afogamento/diagnóstico , Patologia Legal/métodos , Animais , Aorta/patologia , Comorbidade , Consenso , Diatomáceas/isolamento & purificação , Afogamento/patologia , Eletrólitos/análise , Hemorragia/patologia , Humanos , Pulmão/patologia , Tamanho do Órgão , Seios Paranasais/patologia , Mudanças Depois da Morte , Sistema Respiratório/patologia , Pele/patologia , Baço/patologia , Terminologia como Assunto , Tomografia Computadorizada por Raios X , Túnica Íntima/patologia
12.
Forensic Sci Int ; 302: 109856, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31247451

RESUMO

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


Assuntos
Remodelação Óssea/fisiologia , Fraturas Ósseas/patologia , Osteogênese/fisiologia , Biomarcadores/metabolismo , Coagulação Sanguínea/fisiologia , Citocinas/fisiologia , Hematoma/patologia , Hemorragia/patologia , Humanos , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Neovascularização Fisiológica/fisiologia , Osteoblastos/fisiologia , Osteoclastos/fisiologia
13.
Am J Forensic Med Pathol ; 40(3): 289-292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31205056

RESUMO

The bone marrow biopsy is usually a safe procedure; however, it can occasionally present important complications. These complications are not always immediately evident or quickly diagnosed and may include pain at the biopsy site, trauma to neighboring structures, vascular injuries, infection, transient pressure neuropathies, pneumoretroperitoneum, and hemorrhage. Several risk factors are recognized, including thrombocytopenia, concurrent use of anticoagulants, and the presence of an underlying myeloproliferative disorder. While several reports of adverse events have been published, only 2 deaths attributable to this procedure have been reported. We present 2 cases of fatal hemorrhage after bone marrow biopsy.


Assuntos
Biópsia/efeitos adversos , Medula Óssea/patologia , Hemorragia/patologia , Espaço Retroperitoneal/patologia , Choque Hemorrágico/etiologia , Idoso , Evolução Fatal , Feminino , Humanos , Artéria Ilíaca/lesões , Artéria Ilíaca/patologia , Masculino , Pessoa de Meia-Idade
14.
J Forensic Leg Med ; 66: 95-99, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31252196

RESUMO

Intense blunt compression trauma to the neck can result in subcutaneous, intramuscular or laryngeal mucosa bleedings of different intensity. While these findings can easily be detected through a layer-wise dissection of the neck muscles and soft tissue during autopsy, it can be difficult to distinguish between peri-/post- and ante mortem hemorrhages solely based on macroscopic findings. Especially when an initial preliminary diagnosis is required, possible artifacts have to be excluded. The study at hand examines possible peri- and post mortem hemorrhages in the anterior neck after NorMors™ chin-collar application. In routine clinical and forensic autopsy cases, where such a chin-collar has been placed around the neck of the deceased in close proximity after death, focus was directed to the soft tissue and muscles of the neck. The results of our analysis could prove that the use of chin-collar shortly within the first 1 ½ hours after death applies just enough pressure to the neck to be able to cause superficial hemorrhages within the surface of the sternocleidomastoid muscles, which can mimic vital compression trauma injuries. Based on location, morphological outlines and intensity of the injuries, it is possible to correlate them with the position of the applied collar. Together with histological analyses, asphyxia by a second party involvement can be excluded. However, the application of chin-collars should be prohibited in any case, where an autopsy might be performed.


Assuntos
Hemorragia/patologia , Práticas Mortuárias/instrumentação , Músculos do Pescoço/patologia , Adulto , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mudanças Depois da Morte , Pressão
15.
Nat Commun ; 10(1): 1932, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036816

RESUMO

Achieving rapid definitive hemostasis is essential to ensure survival of patients with massive bleeding in pre-hospital care. It is however challenging to develop hemostatic agents or dressings that simultaneously deliver a fast, long-lasting and safe treatment of hemorrhage. Here, we integrate meso-/micro-porosity, blood coagulation and stability into a flexible zeolite-cotton hybrid hemostat. We employ an on-site template-free growth route that tightly binds mesoporous single-crystal chabazite zeolite onto the surface of cotton fibers. This hemostatic material maintains high procoagulant activity after water flow treatment. Chabazite particles are firmly anchored onto the cotton surface with < 1% leaching after 10 min of sonication. The as-synthesized hemostatic device has superior hemostatic performance over most other clay or zeolite-based inorganic hemostats, in terms of higher procoagulant activity, minimized loss of active components and better scalability for practical applications (a hemostatic T-shirt is hereby demonstrated as an example).


Assuntos
Bandagens , Fibra de Algodão/análise , Hemorragia/terapia , Hemostáticos/farmacologia , Ferida Cirúrgica/terapia , Zeolitas/farmacologia , Animais , Cristalização , Artéria Femoral/lesões , Hemorragia/patologia , Hemostasia/efeitos dos fármacos , Hemostáticos/química , Humanos , Camundongos , Porosidade , Coelhos , Pele/lesões , Ferida Cirúrgica/patologia , Cicatrização/efeitos dos fármacos , Zeolitas/química
16.
Medicine (Baltimore) ; 98(19): e15477, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083181

RESUMO

RATIONALE: Recurrent massive hemorrhagic ascites secondary to endometriosis is extremely rare in the medical literature. PATIENT CONCERNS: We report the case of a 24-year-old nulliparous woman presenting with severe abdominal distention, massive ascites, moderate anemia, menstrual pain, and an elevated CA-125 level. DIAGNOSIS: We found a thickened peritoneum in the left lower abdomen by ultrasound during the follow-up period, and endometriosis was subsequently diagnosed by performing core needle biopsy (CNB). INTERVENTIONS AND OUTCOMES: The patient received medical treatment for endometriosis and had a good response to the treatment. LESSONS: This is the first case in which endometriosis ectopic to peritoneum was diagnosed by CNB. Endometriosis should be considered a differential diagnosis when recurrent massive hemorrhagic ascites occur. CNB should be valued as a method for diagnosing endometriosis.


Assuntos
Ascite/diagnóstico , Endometriose/diagnóstico , Hemorragia/diagnóstico , Ascite/complicações , Ascite/tratamento farmacológico , Ascite/patologia , Biópsia com Agulha de Grande Calibre , Tratamento Conservador , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/tratamento farmacológico , Endometriose/patologia , Feminino , Hemorragia/complicações , Hemorragia/tratamento farmacológico , Hemorragia/patologia , Humanos , Peritônio/diagnóstico por imagem , Peritônio/patologia , Recidiva , Adulto Jovem
17.
Biomed Res Int ; 2019: 2674758, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073523

RESUMO

Aims: To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods: Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results: PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion: Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.


Assuntos
Oclusão com Balão/métodos , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/terapia , Cirrose Hepática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/efeitos adversos , Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Fístula/fisiopatologia , Fístula/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Estimativa de Kaplan-Meier , Fígado/fisiopatologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veias Renais/efeitos dos fármacos , Veias Renais/cirurgia , Adesivos Teciduais/administração & dosagem , Resultado do Tratamento
18.
Anticancer Res ; 39(5): 2615-2625, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092460

RESUMO

BACKGROUND/AIM: This study aimed to assess whether low-molecular-weight heparin (LMWH) is effective and safe in preventing postoperative venous thromboembolism (VTE) in patients undergoing esophageal cancer surgery. PATIENTS AND METHODS: In this single-institution, prospective, randomized trial, 73 patients with esophageal cancer undergoing esophagectomy were randomly divided into the enoxaparin group (E group) and intermittent pneumatic compression group (I group). The primary endpoint was efficacy of enoxaparin, and secondary endpoints were evidence of bleeding and serum anti-Xa activity in the E group. RESULTS: The E group comprised 42 patients and the I group comprised 31 patients. Deep vein thrombosis was observed in 0 (0%) patients in the E group and 7 (22.6%) patients in the I group (p=0.002). Soluble fibrin monomer complex was significantly lower in the E versus I group on day 8 (p<0.001). D-dimer was significantly lower in the E versus I group on days 2, 8, and 15 (p=0.008, p<0.001, p<0.001, respectively). CONCLUSION: VTE was significantly reduced by using enoxaparin.


Assuntos
Enoxaparina/administração & dosagem , Neoplasias Esofágicas/complicações , Esofagectomia/efeitos adversos , Tromboembolia Venosa/tratamento farmacológico , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/patologia , Heparina de Baixo Peso Molecular , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Tromboembolia Venosa/etiologia , Trombose Venosa/diagnóstico , Trombose Venosa/patologia , Trombose Venosa/prevenção & controle
19.
Forensic Sci Int ; 300: 82-84, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079011

RESUMO

Muscular hemorrhages around the scapula are frequently found in fatal drowning cases without injuries in the upper back at time of autopsy. The present study investigated the frequency of muscular hemorrhages around the scapula and determined the mechanism responsible for this phenomenon. Muscular hemorrhages around the scapula were found in 104 of 164 (63.4%) bodies assessed. Hemorrhage in the infraspinatus muscle was most common, followed by the supraspinatus muscle. These muscular hemorrhages were not associated with upper extremity injuries and were most frequently found in accidental drowning cases (78.7%), followed by cases of suicide (56.0%), and in natural disease prior to drowning (19.0%). We examined muscular hemorrhage around the scapula and cervical injuries that restricted the active motion of upper extremities in drowning cases. The vertebral level of cervical injuries were related to muscular hemorrhages around the scapula. These results suggested that muscular hemorrhages around the scapula were not a result of agonal convulsions but were caused by consciously active excessive motion of the upper extremities while drowning. Investigations of the muscular hemorrhages around the scapula can provide insights towards the manner of fatal drowning.


Assuntos
Afogamento/diagnóstico , Hemorragia/patologia , Músculo Esquelético/patologia , Manguito Rotador/patologia , Escápula , Acidentes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/lesões , Criança , Pré-Escolar , Patologia Legal , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio , Adulto Jovem
20.
Forensic Sci Med Pathol ; 15(3): 485-487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31028574

RESUMO

A 79-year-old man with a history of arterial hypertension, insulin-dependent diabetes mellitus, renal insufficiency and thoracic endovascular aortic repair (TEVAR) was brought to the emergency department, following an episode of oliguria and urine retention. During chest X-ray he suddenly collapsed and died. Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm whose right lateral wall firmly adhered to the right lung. There was more than 2.5 l of blood with fibrin deposits in the right part of the thoracic cavity. The right bronchus contained a cast of blood; blood was also present in the trachea and the distal airways of the right lung. Further dissection revealed that the aneurysm had eroded the tissue surrounding it and made a fistulous canal into the lower lobe of the right lung, causing the lung to fill with fluid blood. The cause of death was hemorrhage from the aortopulmonary fistula caused by pressure necrosis from the thoracic aortic aneurysm.


Assuntos
Aneurisma da Aorta Torácica/patologia , Fístula Artério-Arterial/patologia , Artéria Pulmonar/anormalidades , Idoso , Aneurisma da Aorta Torácica/cirurgia , Fístula Artério-Arterial/etiologia , Procedimentos Endovasculares/efeitos adversos , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Pulmão/patologia , Masculino , Artéria Pulmonar/patologia
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