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1.
Khirurgiia (Mosk) ; (9): 80-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030006

RESUMO

Two-stage surgical treatment of a patient with type I acute aortic dissection and lower limb malperfusion is reported in the manuscript. Frozen elephant trunk procedure was applied. A 49-year-old man was hospitalized with a diagnosis of «Debakey type I acute aortic dissection¼ in 7 hours after manifestation of the disease. At admission, paleness and numbness of both lower limbs with a violation of active movements were observed in addition to pain syndrome. Chest CT revealed false lumen thrombosis within the distal aorta followed by stenosis of aortic bifurcation up to 80% and stenosis of the right common iliac artery up to 80%. Considering critical lower limb ischemia, axillo-bifemoral bypass surgery was performed at the first stage. A day later, the patient underwent replacement of ascending aorta, aortic arch and descending thoracic aorta. E-vita Open Plus № 24 hybrid prosthesis and frozen elephant trunk procedure under hypothermia 25o C with bilateral antegrade cerebral perfusion were used. CPB time was 285 min, aortic cross-clamping time - 180 min, circulatory arrest - 135 min. Postoperative period was uneventful, ICU-stay - 5 days. The patient was discharged after 20 days. Control CT confirmed false lumen thrombosis throughout the stent-graft. Follow-up survey after 1 year revealed no complaints.


Assuntos
Aneurisma Dissecante , Implante de Prótese Vascular , Extremidade Inferior/cirurgia , Aorta Torácica , Humanos , Masculino , Pessoa de Meia-Idade , Stents
2.
Khirurgiia (Mosk) ; (9): 102-108, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030010

RESUMO

OBJECTIVE: To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. MATERIAL AND METHODS: We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. RESULTS: Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. CONCLUSION: Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.


Assuntos
Artérias/cirurgia , Necrose/cirurgia , Procedimentos Cirúrgicos Vasculares , Arteriopatias Oclusivas , Humanos , Artéria Poplítea , Stents
3.
Rozhl Chir ; 99(8): 364-367, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032442

RESUMO

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically.  EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.


Assuntos
Drenagem , Endossonografia , Constrição Patológica , Endoscopia , Humanos , Stents
4.
Kyobu Geka ; 73(9): 643-649, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879266

RESUMO

OBJECTIVES: We examined the spring back force (SBF) in the frozen elephant trunk technique between patients receiving a Matsui-Kitamura stent (M group) or a J Graft Open Stent Graft (J group). METHODS: There were 11 cases in the M group and 10 cases in the J group. For all cases, we performed computed tomography( CT) scan and measured distal arch angle( DAA) and stent graft angle (SGA). RESULTS: There was no difference between groups with regards to patient characteristics. The insertion graft length[155±19 mm (M group) versus 138±17 mm (J group)]was significantly longer in the M group( p<0.05). In the J group, the SGA at 1 and 2 years postoperatively( 105°±18.5° and 114°±19.1°, respectively) were significantly increased compared to that at 1 month postoperatively (99.9°± 18.7°). In addition, the SGA in the J group was significantly larger than that in the M group during the postoperative period. CONCLUSIONS: The SBF in the J group was thought to be significantly larger than that in the M group. SBF was thought to be associated with the stent frame characteristic.


Assuntos
Aneurisma Dissecante/cirurgia , Antivirais , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Hepatite C Crônica , Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Stents , Resultado do Tratamento
5.
Kyobu Geka ; 73(9): 695-699, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879275

RESUMO

In recent years, re-rupture due to endoleaks after thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysms has become a problem. Hemoptysis has been reported in patients after pneumocentesis. We report a patient who developed delayed hemoptysis not related to endoleak after TEVAR. An 80-year-old male underwent emergent TEVAR due to a ruptured thoracic aortic aneurysm accompanying sudden hemoptysis. Eleven days after the operation, recurrent hemoptysis was noted, but contrast-enhanced computed tomography (CT) revealed no endoleak or re-rupture. Bronchoscopy demonstrated hemorrhage from the left upper lobe. As hemostasis was difficult by conservative treatment, left upper lobectomy was performed. The aortic rupture hole exhibited thrombus, and there was no hemorrhage. On histopathological examination of the resected lung, formation accompanied by severe intra-alveolar fibrosis and cholesterin clefts, and marked foreign body reactions in the interstitium and small blood vessels of the lung were observed. Cholesterol embolism is associated with not only organ ischemia due to microembolism, but also immunological mechanisms. Thus, cholesterol embolism due to aorta-derived cholesterin may have led to the delayed pulmonary hemorrhage. Differentiation from re-rupture due to endoleaks is important.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Aortografia , Hemoptise , Humanos , Masculino , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
6.
Kyobu Geka ; 73(8): 606-609, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32879290

RESUMO

Recently, thoracic endovascular aortic repair( TEVAR) has emerged as an alternative to open repair. We reported a case of a 92-year-old woman who underwent successful TEVAR for impending rupture of aortic arch aneurysm. The patient presented with back pain. Computed tomography revealed an impending rupture site at the aortic arch and left hemothorax. First, an axilo-axilo-carotid artery bypass was performed, and then 2 thoracic stent grafts were deployed successfully. Her postoperative course was uneventful, and at day 20, she was discharged. Debranching TEVAR is an effective procedure for aortic arch aneurysms in elderly patients.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/cirurgia , Prótese Vascular , Feminino , Humanos , Estudos Retrospectivos , Stents , Resultado do Tratamento
7.
J Med Vasc ; 45(5): 254-259, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862982

RESUMO

INTRODUCTION: Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS: This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS: Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION: TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hemodinâmica , Humanos , Escala de Gravidade do Ferimento , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
8.
Vasc Health Risk Manag ; 16: 325-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982261

RESUMO

Lumivascular optical coherence tomography (OCT) is a novel adjunct in the field of medicine. It offers clear real-time imaging of artery walls before and during endovascular intervention. This study reports our initial experience on the use of lumivascular OCT-guided atherectomy in the management of two patients with recurrent restenosis in their femoropopliteal arteries associated with in-stent restenosis. Endovascular procedures were successful with a Pantheris atherectomy device (Avinger, Redwood City, CA, USA) and drug-eluting balloons. The OCT images clearly distinguished normal anatomy from plaque pathology, were of great advantage in both the accurate diagnosis and treatment of target lesions, and may reduce radiation during the endovascular procedure. However, the price of the device and its need for contrast infusion limit its routine clinical use.


Assuntos
Angioplastia com Balão/instrumentação , Aterectomia , Artéria Femoral/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Stents , Tomografia de Coerência Óptica , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Aterectomia/efeitos adversos , Aterectomia/instrumentação , Feminino , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Valor Preditivo dos Testes , Recidiva , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(33): e21729, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872056

RESUMO

To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.Mean IOP was reduced from 15.8 ±â€Š2.8 mm Hg to 14.5 ±â€Š2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ±â€Š1.2 to 0.8 ±â€Š1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799-10.454) and 3.717 (95% confidence interval: 1.516-9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ±â€Š0.10 to 0.09 ±â€Š0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Idoso , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/instrumentação , República da Coreia/epidemiologia , Estudos Retrospectivos , Stents , Acuidade Visual
10.
Int Heart J ; 61(5): 1041-1043, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879262

RESUMO

The current treatment of radiation-induced coronary artery disease (RCAD) is comparable to that of generic coronary artery disease (CAD); however, the outcomes of these treatment measures have not been fully examined in RCAD. A 33-year-old woman, without conventional cardiovascular risk factors, presented with left main coronary artery (LMCA) lesions. At the age of 26, she received mediastinal radiation therapy (RT) to treat mixed cellularity Hodgkin lymphoma. One BiodivYsio 3.5 × 18 mm stent was implanted at the LMCA site. At the age of 38, the patient was treated by balloon dilatation because of approximately 50% in-stent stenosis. At the last follow-up in February 2018, when the patient was 51 years old, she no longer complained of chest pain. Coronary angiography showed no de novo or in-stenosis lesions, although optical coherence tomography showed mild neointimal proliferation, calcific plaque, small ruptured intima, and several uncovered struts. The experience of treating this case may shed some light on coronary stenting in coronary lesions caused by RCAD.


Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/terapia , Reestenose Coronária/terapia , Doença de Hodgkin/radioterapia , Lesões por Radiação/terapia , Stents , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Mediastino , Pessoa de Meia-Idade , Neointima/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Tomografia de Coerência Óptica
11.
Int Heart J ; 61(5): 865-871, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921667

RESUMO

Bleeding complication has been considered as a serious problem in current percutaneous coronary interventions (PCI). Fortunately, several groups have already reported the effectiveness of protamine use just after PCI to immediately remove any arterial sheath. However, there is a concern that protamine reversal may increase non-occlusive thrombus and, in turn, lead to mid-term cardiovascular events such as target vessel revascularization (TVR) or stent thrombosis. Thus, the purpose of this study was to evaluate whether protamine use following elective PCI was associated with mid-term clinical outcomes. In total, 472 patients were included in this study; subsequently, they were divided into protamine group (n = 142) and non-protamine group (n = 330). The primary endpoint was the composite of ischemia-driven TVR and stent thrombosis. The median follow-up period was determined to be at 562 days. In total, 32 primary endpoints were observed during the study period, and the incidence of primary endpoints tended to be greater in the protamine group than in the non-protamine group (P = 0.056). However, the lesion length, the degree of calcification, and the prevalence of hemodialysis were significantly determined greater in the protamine group than in the non-protamine group. In the multivariate Cox proportional hazards model, the use of protamine (versus non-protamine: hazard ratio 0.542 and 95% confidence interval 0.217-1.355, P = 0.191) was deemed not to be associated with the primary endpoint after controlling legion length, calcification, and hemodialysis. In conclusion, immediate protamine use following elective PCI did not increase mid-term ischemia-driven TVR or stent thrombosis. However, immediate protamine use after PCI should be discussed further for the safety of the patient.


Assuntos
Estenose Coronária/cirurgia , Antagonistas de Heparina/uso terapêutico , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Protaminas/uso terapêutico , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Estudos de Casos e Controles , Estenose Coronária/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Heparina/efeitos adversos , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/estatística & dados numéricos , Complicações Pós-Operatórias/induzido quimicamente , Hemorragia Pós-Operatória/induzido quimicamente , Modelos de Riscos Proporcionais , Diálise Renal , Estudos Retrospectivos , Stents , Trombose/induzido quimicamente , Calcificação Vascular/epidemiologia
12.
Lancet ; 396(10252): 726-734, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891214

RESUMO

Acute pancreatitis is an unpredictable and potentially lethal disease. The prognosis mainly depends on the development of organ failure and secondary infection of pancreatic or peripancreatic necrosis. In the past 10 years, treatment of acute pancreatitis has moved towards a multidisciplinary, tailored, and minimally invasive approach. Despite improvements in treatment and critical care, severe acute pancreatitis is still associated with high mortality rates. In this Seminar, we outline the latest evidence on diagnostic and therapeutic strategies for acute pancreatitis.


Assuntos
Antibacterianos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Hidratação , Apoio Nutricional , Pancreatite/diagnóstico , Pancreatite/terapia , Amilases/sangue , Colecistectomia , Diabetes Mellitus/etiologia , Diabetes Mellitus/terapia , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Lipase/sangue , Imagem por Ressonância Magnética , Pancreatite/sangue , Pancreatite/etiologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Pancreatite Alcoólica/diagnóstico , Pancreatite Alcoólica/terapia , Prevenção Secundária , Stents , Tomografia Computadorizada por Raios X , Ultrassonografia
13.
Medicine (Baltimore) ; 99(39): e22293, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991432

RESUMO

RATIONALE: The indwelling ureteral stents is a common procedure in routine urological practice. The double-J (D-J) stent is the most common type of stents used and is indicated mainly for short-term urinary drainage and prevention of obstruction and infection. However, prolonged indwelling stents may result in disastrous complications, such as hematuria, infection, encrustation, and stone formation. In this context, the persistence of stent in situ might play a key role as a nidus in deposition of urinary sediment, then forming calculus. Although the encrustation may become more serious as time goes on, large bladder stones are relatively rare. However, the serious encrustation and giant stone may complicate or exacerbate the conditions in turn. PATIENT CONCERNS: A 45-year-old female patient who underwent right ureteral stent placement after open ureterolithotomy 6 years ago complained of dysuria, urinary frequency, and urgency over 2 months. DIAGNOSIS: The kidney ureter bladder (KUB) x-ray showed the presence of a giant stone in the bladder and an entire D-J stent. The computed tomography (CT) urography scans revealed normal left kidney, right hydronephrosis, and an encrusted D-J stent with the significant stone, diameter 4.2 cm with a CT value of 1211.0 ±â€Š221.6 HU, on the vesical coil. On the basis of these auxiliary examinations, the case was diagnosed as cystolith and prolonged-indwelling stents. INTERVENTIONS: Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent. OUTCOMES: No residual stone was detected on postoperative KUB x-ray and CT urography scans. Patient recovered well and was discharged 10 days after surgery. Semi-annual ultrasound examination was suggested to monitor the effect of therapy. LESSONS: This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.


Assuntos
Stents/efeitos adversos , Ureter/patologia , Cálculos da Bexiga Urinária/etiologia , Feminino , Humanos , Litotripsia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Cálculos da Bexiga Urinária/terapia
14.
J Urol ; 204(4): 776-777, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32898972
15.
J Urol ; 204(4): 776, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32898973
16.
Rev Col Bras Cir ; 47: e20202481, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965301

RESUMO

OBJECTIVE: Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. To evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. METHOD: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. RESULTS: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). CONCLUSION: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.


Assuntos
Procedimentos Endovasculares/métodos , Doença Arterial Periférica , Doenças Vasculares Periféricas/terapia , Artéria Poplítea , Falha de Prótese , Stents , Ultrassonografia Doppler em Cores/métodos , Humanos , Perna (Membro)/irrigação sanguínea , Doenças Vasculares Periféricas/diagnóstico por imagem , Prevalência , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Klin Monbl Augenheilkd ; 237(9): 1117-1123, 2020 Sep.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32967033

RESUMO

BACKGROUND: Glaucoma is one of the most common causes of blindness worldwide. The only evidence-based treatment to slow down the progression of glaucoma is the reduction of intraocular pressure (IOP) using local medication or through surgery. During the last years, a large number of microinvasive glaucoma surgery techniques (MIGS) has been developed, in order to reduce the IOP in glaucoma patients safely and effectively. Until now, efficacy of MIGS has been assessed mainly according to the postoperative IOP and the number of medications used. Results from long-term studies are rare or not available in the majority of the cases. In order to better evaluate the functionality of MIGS, a new examination method has been developed with the help of a new oculopressor device. In this study the efficacy of different MIGS techniques will be examined using the new oculopressor. MATERIAL/METHODS: At first, glaucoma patients that had previously received a MIGS surgery (iStent inject, XEN Stent, ELT) were examined with the new oculopression test. Their results were compared with those of non-operated patients and healthy individuals. Overall, 38 healthy subjects (group 1), 10 non-operated patients (group 2), 19 patients after iStent inject implantation (group 3), 14 patients after XEN Stent implantation (group 4) and 5 patients after ELT (group 5) were examined. The new examination measures the IOP-reduction that occurs after oculopression and can be seen as an indirect measurement of the outflow facility of the eye. RESULTS: The IOP-reduction after oculopression differed among the study groups. Non-operated patients showed a significantly lower IOP-reduction compared to healthy individuals. Patients after iStent inject and XEN stent implantation showed a larger reduction of IOP after oculopression in relation to non-operated patients and their results approximated those of healthy individuals. These patients needed fewer medications postoperatively in relation to non-operated patients. Patients after ELT showed postoperatively a smaller reduction of IOP after oculopression compared to iStent inject and XEN stent patients. CONCLUSION: MIGS can increase the outflow facility of the eye in patients with glaucoma. Though ELT had the lowest impact on the aqueous outflow among the studied procedures in this study. The new test can help in the evaluation of current and further development of new MIGS in the future.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma/cirurgia , Teste de Esforço , Humanos , Pressão Intraocular , Stents , Resultado do Tratamento
18.
Hinyokika Kiyo ; 66(9): 319-321, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988170

RESUMO

A 66-year-old male with bladder cancer underwent radical cystectomy and ileal conduit construction. The pathological diagnosis was urothelial carcinoma with squamous differentiation (pT3b). Computed tomography (CT) 18 months postoperatively revealed a right external iliac lymph node metastasis. He was treated with systemic chemotherapy after placement of bilateral ureteral stents, but CT following chemotherapy revealed an increase in the size of the metastasis, and the patient was diagnosed with progressive disease. Radiotherapy to the metastasis was selected as local therapy, but the patient was at risk of an uretero-arterial fistula because the right external iliac artery and the right ureter adjacent to the metastasis were involved in the irradiated field. The right external iliac lymph node metastasis was irradiated with a dose of 50 Gy after stent grafting for the right external iliac artery to prevent an ureteroarterial fistula. He had no adverse events, including hematuria after radiotherapy, but died of cancer cachexia 12 months after radiotherapy.


Assuntos
Ureter , Doenças Ureterais , Neoplasias da Bexiga Urinária/radioterapia , Fístula Urinária/etiologia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Idoso , Humanos , Masculino , Stents
20.
Zhongguo Gu Shang ; 33(9): 827-30, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959569

RESUMO

OBJECTIVE: To investigate the clinical efficacy of vertebral body stent (VBS) system and percutanous kyphoplasty (PKP) combined with zoledronic acid for the treatment of severely osteoporotic compression vertebral fractures (OVCFs). METHODS: The clinical data of 48 patients with osteoporotic thoracolumbar fractures treated from December 2017 to December 2018 were retrospectively analyzed, including 13 males and 35 females, aged 55 to 92 years old with an average (71.2±10.5) years. All patients were treated with VBS system PKP surgery, and zoledronic acid injection was used for anti-osteoporosis treatment after operation. The VAS scores ODI, the height of diseasedvertebral lost were compared before operation, 3 d and half a year after operation, and whether there was re-fracture of diseased or adjacent vertevrae after operation was observed. RESULTS: Before operation, 3 d and half a year after operation, VAS scores were 7.60±0.12, 3.00±0.46, 1.20±0.23, ODI were(82.00±0.32)%, (30.00±1.50) %, (18.00±0.16) %, the height of diseased vertebral lost were (12.00±0.43) mm, (3.00± 0.15) mm, (3.60±0.51) mm respectively. Postoperative VAS score, ODI, the height of diseased vertebral lost were obviously improved (P<0.05), and there was no significant difference between 3 d and half a year after operation (P>0.05). All the 48 patients were followed up with an average time of (6.6±0.5) months. All the incisions healed at grade A after operation, and no re-fracture of diseased vertebrae or adjacent vertebrae was found at the final follow-up. CONCLUSION: VBS system and PKP combined with zoledronic acid in the treatment of OVCFs not only may effectively relieve the pain in the thoracolumbar back, improve the mobility of the thoracolumbar, but also can restore the height of the vertebral body to the maximum extent, and prevent the re-fracture of the affected vertebrae and adjacent vertebrae, which is worthy to spread in clinic.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ácido Zoledrônico
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