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1.
Rev Med Suisse ; 16(718): 2367-2371, 2020 Dec 09.
Artigo em Francês | MEDLINE | ID: mdl-33300695

RESUMO

Digital ischemia is suspected in presence of a cold, pale or cyanotic and painful finger. It is a diagnostic and therapeutic emergency and needs urgent referral to a vascular specialist. Digital pressure measurement is needed to confirm the diagnosis. A thorough history taking and physical examination help to guide patients' management. Antithrombotic therapy - with an antiplatelet or anticoagulant drug depending on the most likely etiology - need to be introduced without delay, while awaiting the results of the individualized etiologic workup. Hospital admission is often necessary. A prompt diagnostic and therapeutic management allows satisfactory pain control and avoidance of irreversible digital lesions in the majority of cases.


Assuntos
Dedos/patologia , Isquemia/diagnóstico , Isquemia/terapia , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência , Fibrinolíticos/uso terapêutico , Humanos , Isquemia/complicações , Isquemia/etiologia , Dor/complicações
2.
Rev Med Suisse ; 16(718): 2372-2375, 2020 Dec 09.
Artigo em Francês | MEDLINE | ID: mdl-33300696

RESUMO

Arteriopathy of the lower limbs is a frequent pathology. In the face of persistent invalidating claudication or critical ischemia, surgical or endovascular revascularization treatment is necessary. The aim of this article is to review the evolution of the endovascular therapeutic arsenal of the femoropopliteal segment, to present the new endovascular devices available and to give current recommendations for post-interventional antithrombotic treatment.


Assuntos
Procedimentos Endovasculares , Extremidade Inferior/cirurgia , Doenças Vasculares/cirurgia , Artéria Femoral/cirurgia , Humanos , Claudicação Intermitente , Isquemia/complicações , Doenças Vasculares/complicações
3.
Chirurgia (Bucur) ; 115(5): 677-680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33138906

RESUMO

The spread of SARS-CoV-2 in Italy has been rapid, with over 230.000 infections and 33.000 deaths (May 31st, 2020). The full impact of COVID19 on surgery is still unknown, as its effects on healthcare strategy, hospital infrastructure, staff, regional economy and colorectal disease progression, may not be evident before several months. No systematic reports are available about a higher incidence of COVID19 infections in patients with cancer. However, available data indicate that older people are more vulnerable, particularly when there are underlying health conditions such as chemotherapy or active cancer. Herein, we present the case of a patient with rectal cancer treated with pull-through technique low anterior rectal resection and coloanal anastomosis with protective loop ileostomy, complicated with Sars-CoV-2 infection and late (31st post-operative day) colic ischemia with colo-vaginal fistula. Late intestinal ischemia is a rare complication and can be secondary to several traditional factors, but certainly small vessel thrombosis related to Coronavirus disease must be taken into consideration.


Assuntos
Colo/patologia , Infecções por Coronavirus/complicações , Isquemia/cirurgia , Pneumonia Viral/complicações , Fístula Vaginal/cirurgia , Idoso , Betacoronavirus , Colo/cirurgia , Feminino , Humanos , Isquemia/complicações , Itália , Pandemias , Resultado do Tratamento , Fístula Vaginal/complicações
4.
Medicine (Baltimore) ; 99(46): e22391, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181638

RESUMO

Although plantar thermography can evaluate the immediate perfusion result after an endovascular therapy (EVT) has been performed, a relevant wound outcome study is still lacking.This study was to investigate whether angiosome-based plantar thermography could predict wound healing and freedom from major amputation after EVT in patients with critical limb ischemia (CLI).All 124 patients with CLI (Rutherford category 5 and 6) who underwent EVT from January 2017 to February 2019 were prospectively enrolled. All patients received thermography both before and after EVT. Both wound healing and freedom from major amputation at the 6-month follow-up period were recorded. There were 61 patients in the healing group and 63 patients in the non-healing group, whereas the major amputation total was 14 patients. The mean pre- and post-EVT temperature of the foot was significantly higher in the healing group than in the non-healing group (30.78 °C vs 29.42 °C, P = .015; and 32.34 °C vs 30.96 °C, P = .004, respectively). DIFF2 was significantly lower in the non-healing group (-1.38 vs -0.90, P = .009). DIFF1 and DIFF2 were significantly lower in the amputation group (-1.85 °C vs -1.11 °C, P = .026; and -1.82 °C vs -1.08 °C, P = .004). Multivariate analysis showed that DIFF2 stood out as an independent predictor for freedom from major amputation (hazard ratio 0.51, P = .045). Receiver operating characteristic curve analysis showed a DIFF2 cut-off value of -1.30 °C, which best predicts freedom from major amputation.Plantar thermography is associated with wound healing and helps predict freedom from major amputation in CLI patients undergoing EVT.


Assuntos
Extremidades/cirurgia , Isquemia/cirurgia , Termografia/métodos , Idoso , Idoso de 80 Anos ou mais , Amputação , Procedimentos Endovasculares/métodos , Extremidades/fisiopatologia , Feminino , Humanos , Isquemia/complicações , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Termografia/estatística & dados numéricos
6.
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
7.
J Vis Exp ; (163)2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-33016936

RESUMO

One of the commonly used models for ischemic retinopathies is the oxygen-induced retinopathy (OIR) model. Here we describe detailed protocols for the OIR model induction and its readouts in both mice and rats. Retinal neovascularization is induced in OIR by exposing rodent pups either to hyperoxia (mice) or alternating levels of hyperoxia and hypoxia (rats). The primary readouts of these models are the size of neovascular (NV) and avascular (AVA) areas in the retina. This preclinical in vivo model can be used to evaluate the efficacy of potential anti-angiogenic drugs or to address the role of specific genes in the retinal angiogenesis by using genetically manipulated animals. The model has some strain and vendor specific variation in the OIR induction which should be taken into consideration when designing the experiments.


Assuntos
Modelos Animais de Doenças , Isquemia/induzido quimicamente , Oxigênio/farmacologia , Doenças Retinianas/induzido quimicamente , Animais , Isquemia/complicações , Camundongos , Camundongos Endogâmicos C57BL , Ratos , Retina/efeitos dos fármacos , Retina/metabolismo , Retina/fisiopatologia , Doenças Retinianas/complicações , Neovascularização Retiniana/complicações
8.
Hamostaseologie ; 40(5): 592-593, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32894875

RESUMO

COVID-19 coagulopathy is a hypercoagulable state which predisposes to venous, arterial and small vessel thrombosis. We describe a patient with COVID-19 who developed an acute superior mesenteric vein thrombosis with acute intestinal obstruction despite adequate anticoagulation.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Obstrução Intestinal/complicações , Isquemia/complicações , Isquemia Mesentérica/complicações , Doença Aguda , Adulto , Humanos , Masculino , /isolamento & purificação
9.
Zhen Ci Yan Jiu ; 45(8): 652-6, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32869576

RESUMO

OBJECTIVE: To observe the short-term and long-term clinical effect on posterior circulation ischemic vertigo treated with "xiao xingnao kaiqiao" acupuncture (minor regaining consciousness and opening orifice) and explore its effect mechanism. METHODS: Ninety patients with posterior circulation ischemic vertigo were randomly divided into a treatment group and a control group, 45 cases in each group. The patients of the two groups were all treated on the base of neurological medicine. In the control group, Flunarizine Hydrochloride was prescribed for oral administration (5 mg, once daily, for 21 days totally). In the treatment group, acupuncture of "xiao xingnao kaiqiao" was provided at Yintang (EX-HN3), bilateral Neiguan (PC6), bilateral Sanyinjiao (SP6), Baihui (GV20), bilateral Fengchi (GB20), bilateral Wangu (GB12) and bilateral Tianzhu (BL10). The needles were retained for 30 min, once daily for 21 days totally. The changes in vertigo score of traditional Chinese medicine (TCM) were observed, and the changes in the mean blood velocity (Vm) of the left vertebral artery (LVA), the right vertebral artery (RVA) and the basilar artery (BA) as well as the vascular pulsatility index (PI) were monitored and determined by transcranial Doppler (TCD). Additionally, the recurrence rate was followed up after 3 months to evaluate the long-term clinical effects. RESULTS: After treatment, the total effective rate of the treatment group was 91.11% (41/45) and 75.56% (34/45) in the control group. The total effective rate in the treatment group was higher than that in the control group (P<0.05). Compared with their own pre-treatment, the vertigo scores of TCM were reduced in either the treatment group or the control group after treatment (P<0.05) and the score in the treatment group was lower than that in the control group (P<0.05). Compared with their own pre-treatment, Vm and PI were all improved after treatment in either group (P < 0.05). After treatment, the improvements in Vm and PI of LVA、RVA and BA in the treatment group were better than those in the control group (P<0.05). In the follow-up after 3 months, the recurrence rate was 19.51% (8/41) in the treatment group and was 50.00% (17/34) in the control group. The recurrence rate in the treatment group was lower than that in the control group (P<0.05). CONCLUSION: "Xiao xingnao kaiqiao" acupuncture obviously relieves the clinical symptoms of posterior circulation ischemic vertigo. The mechanism of acupuncture is potentially related with its effects in improving Vm and PI of LVA,RVA and BA, as well as improving blood supply of brain tissue.


Assuntos
Terapia por Acupuntura , Vertigem/terapia , Artéria Basilar , Humanos , Isquemia/complicações , Resultado do Tratamento , Vertigem/etiologia
11.
Medicine (Baltimore) ; 99(32): e21594, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769914

RESUMO

BACKGROUND: To evaluate the effect of dl-3-N-butylphthalide (NBP) on new cerebral microbleeds (CMBs) in patients with acute ischemic stroke (AIS). METHODS: We will prospectively enroll patients with AIS admitted to the stroke center of Jingjiang People's Hospital. Qualified participants will be randomly assigned to either the NBP group (NBP injection) or the control group (NBP injection placebo) in a ratio of 1:1. Patients will complete the brain magnetic resonance imaging within 48 hours and 14 days after stroke onset to observe the CMBs through susceptibility weighted imaging, and evaluate whether the use of NBP will affect the new CMBs in AIS patients. SPSS 20.0 will be used for statistical analyses. RESULT: We will provide practical and targeted results assessing the safety of NBP for AIS patients, to provide reference for clinical use of NBP. CONCLUSION: The stronger evidence about the effect of NBP on new CMBs in AIS patients will be provided for clinicians.


Assuntos
Benzofuranos/uso terapêutico , Hemorragia Cerebral/tratamento farmacológico , Protocolos Clínicos , Acidente Vascular Cerebral/tratamento farmacológico , Benzofuranos/normas , Hemorragia Cerebral/complicações , Humanos , Isquemia/complicações , Isquemia/tratamento farmacológico , Imagem por Ressonância Magnética/métodos , Inibidores da Agregação de Plaquetas/normas , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Prospectivos
17.
Crit Care ; 24(1): 163, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32317013

RESUMO

Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.


Assuntos
Encéfalo/fisiopatologia , Coração/fisiopatologia , Isquemia/complicações , Comunicação Parácrina/fisiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia , Humanos , Isquemia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia
18.
Rev Med Suisse ; 16(688): 636-639, 2020 Apr 01.
Artigo em Francês | MEDLINE | ID: mdl-32239837

RESUMO

Martorell hypertensive ischemic ulcer is often an unrecognized cause of chronic leg ulcer and may result in a delayed management. We describe a typical case report with clinical key features for diagnosis and therapeutic management. Pathophysiology and main differential diagnosis are discussed. Skin biopsy can be used to rule out differential diagnosis. Management should be focused on pain control, evaluation and treatment of cardiovascular risks before performing a skin graft.


Assuntos
Hipertensão/complicações , Isquemia/complicações , Úlcera da Perna/etiologia , Diagnóstico Diferencial , Humanos , Isquemia/cirurgia , Úlcera da Perna/cirurgia , Manejo da Dor , Transplante de Pele
19.
Zhongguo Zhong Yao Za Zhi ; 45(1): 149-156, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-32237424

RESUMO

In this research, high-throughput sequencing was used to investigate the mechanism of Naoxintong Capsules(NXTC) in prevention of post-ischemic inflammation. First, microglia BV-2 inflammatory model was induced by 1.0 µg·mL~(-1) LPS to investigate the effect of intestinal absorption solution of NXTC(NXTCIA) at different concentrations(62.5, 31.25, 15.63, 7.81 µg·mL~(-1)) on LPS-induced BV-2 inflammatory factors in microglia. Then, an RNA-Seq high-throughput sequencing method was performed to identify the differentially expressed mRNAs in microglia BV-2 after pre-treatment with NXTC. GO and KEGG enrichment analysis was used to screen the potential biological processes and related signaling pathways of NXTC in inhibiting inflammation. The results showed that four NXTCIA concentrations could significantly inhibit the release of LPS-induced inflammatory mediators in BV-2 in a dose-dependent manner. Furthermore, high-throughput sequencing results showed that 392 mRNA transcripts were reversed following pre-treatment with NXTC. GO enrichment analysis showed that the transcripts reversed by NXTC were mainly involved in Toll-like receptor signaling pathway, chemokine signaling pathway, and TNF signaling pathway. Taken together, our findings showed that NXTC treatment could provide protective effects against inflammatory response and the mechanism might be related to the regulation of Toll-like receptor signaling pathway, chemokine signaling pathway, and TNF signaling pathway.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Inflamação/prevenção & controle , Isquemia/complicações , RNA-Seq , Animais , Cápsulas , Medicamentos de Ervas Chinesas/química , Inflamação/etiologia , Lipopolissacarídeos , Camundongos , Microglia/efeitos dos fármacos , Microglia/metabolismo , Transcriptoma
20.
Stroke ; 51(5): 1464-1469, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32178587

RESUMO

Background and Purpose- The risk of arterial ischemic events after subdural hemorrhage (SDH) is poorly understood. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction among patients with and without nontraumatic SDH. Methods- We performed a retrospective cohort study using claims data from 2008 through 2014 from a nationally representative sample of Medicare beneficiaries. The exposure was nontraumatic SDH. Our primary outcome was an arterial ischemic event, a composite of acute ischemic stroke and acute myocardial infarction. Secondary outcomes were ischemic stroke alone and myocardial infarction alone. We used validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes to identify our predictor and outcomes. Using Cox regression and corresponding survival probabilities, adjusted for demographics and vascular comorbidities, we computed the hazard ratio in 4-week intervals after SDH discharge. We performed secondary analyses stratified by strong indications for antithrombotic therapy (composite of atrial fibrillation, peripheral vascular disease, valvular heart disease, and venous thromboembolism). Results- Among 1.7 million Medicare beneficiaries, 2939 were diagnosed with SDH. In the 4 weeks after SDH, patients' risk of an arterial ischemic event was substantially increased (hazard ratio, 3.6 [95% CI, 1.9-5.5]). There was no association between SDH diagnosis and arterial ischemic events beyond 4 weeks. In secondary analysis, during the 4 weeks after SDH, patients' risk of ischemic stroke was increased (hazard ratio, 4.2 [95% CI, 2.1-7.3]) but their risk of myocardial infarction was not (hazard ratio, 0.8 [95% CI, 0.2-1.7]). Patients with strong indications for antithrombotic therapy had increased risks for arterial ischemic events similar to patients in the primary analysis, but those without such indications did not demonstrate an increased risk for arterial ischemic events. Conclusions- Among Medicare beneficiaries, we found a heightened risk of arterial ischemic events driven by an increased risk of ischemic stroke, in the 4 weeks after nontraumatic SDH. This increased risk may be due to interruption of antithrombotic therapy after SDH diagnosis.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Hematoma Subdural/tratamento farmacológico , Hemorragia/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/complicações , Feminino , Hematoma Subdural/complicações , Hematoma Subdural/mortalidade , Hemorragia/tratamento farmacológico , Humanos , Isquemia/complicações , Isquemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações
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