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1.
Methods Mol Biol ; 2206: 179-192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32754818

RESUMO

Xenograft models allow for an in vivo approach to monitor cellular functions within the context of a host microenvironment. Here we describe a protocol to generate a xenograft model of venous malformation (VM) based on the use of human umbilical vein endothelial cells (HUVEC) expressing a constitutive active form of the endothelial tyrosine kinase receptor TEK (TIE2 p.L914F) or patient-derived EC containing TIE2 and/or PIK3CA gene mutations. Hyperactive somatic TIE2 and PIK3CA mutations are a common hallmark of VM in patient lesions. The EC are injected subcutaneously on the back of athymic nude mice to generate ectatic vascular channels and recapitulate histopathological features of VM patient tissue histology. Lesion plugs with TIE2/PIK3CA-mutant EC are visibly vascularized within 7-9 days of subcutaneous injection, making this a great tool to study venous malformation.


Assuntos
Xenoenxertos/patologia , Células Endoteliais da Veia Umbilical Humana/patologia , Malformações Vasculares/patologia , Veias/patologia , Animais , Células Cultivadas , Classe I de Fosfatidilinositol 3-Quinases/metabolismo , Modelos Animais de Doenças , Xenoenxertos/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Camundongos , Camundongos Nus , Receptor TIE-2/metabolismo , Malformações Vasculares/metabolismo , Veias/metabolismo
2.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370935

RESUMO

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.


Assuntos
Hematúria/terapia , Síndrome de Klippel-Trenaunay-Weber/complicações , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/patologia , Administração Intravenosa , Adulto , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/terapia , Lasers de Estado Sólido/uso terapêutico , Angiografia por Ressonância Magnética , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologia , Malformações Vasculares/patologia , Veias/diagnóstico por imagem , Veias/efeitos dos fármacos
3.
BMC Neurol ; 20(1): 331, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878608

RESUMO

BACKGROUND: Susceptibility weighted imaging (SWI) provides an approximate assessment of tissue perfusion and shows prominent hypointense cortical veins in the ischemic territory because of the increased concentration of deoxyhemoglobin. We aimed to evaluate whether asymmetrical prominent cortical vein sign (APCVS) on SWI can predict early neurological deterioration (END) in acute ischemic stroke patients with severe intracranial arterial stenosis or occlusion (SIASO). METHODS: One hundred and nine acute ischemic stroke patients with SIASO who underwent SWI were retrospectively recruited. END was defined as an increase in the National Institutes of Health Stroke Scale score ≧2 points despite standard treatment in the first 72 h after admission. The APCVS was defined as more and/or large vessels with greater signal loss than those in the opposite hemisphere on SWI. RESULTS: Thirty out of the 109 (27.5%) patients developed END. Sixty (55.0%) patients presented with APCVS on SWI. APCVS occurred in 24 (80%) patients with END, whereas it only occurred in 36 (45.6%) patients without END (P = 0.001). Patients with APCVS were more likely to have END (40.0%, vs. 12.2%, P = 0.001) than those without END. Multivariate logistic regression indicated that APCVS (OR = 4.349, 95% C.I. = 1.580-11.970, P = 0.004) was a significant predictor of END in acute ischemic stroke patients with SIASO, adjusted for previous stroke history and acute infarct volume. CONCLUSIONS: In acute ischemic stroke patients with SIASO, the APCVS might be a useful neuroimaging marker for predicting END, which suggests the importance of evaluation of perfusion status.


Assuntos
Isquemia Encefálica/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Idoso , Constrição Patológica/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Estudos Retrospectivos , Veias/patologia
4.
Vasc Endovascular Surg ; 54(7): 579-585, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32744174

RESUMO

Objective: To describe the types of intervention and determine patency and survival after arterial and venous reconstruction after surgical excision of sarcomas. Methods: Between November 2001 and July 2015, 42 patients with sarcomas and vascular involvement underwent surgical oncologic resection followed by arterial or venous reconstruction or preservation of the native vascular bundle. Univariate, multivariate, and Kaplan-Meier survival analyses were performed on abstracted data, which included demographics, risk factors, oncologic and vascular treatment modalities, postoperative complications, graft patency, and survival outcomes. Results: A total of 42 sarcomas required vascular assistance for oncologic removal. The majority of sarcomas were malignant fibrous histiocytoma (23.8%), and the most common anatomic location was the retroperitoneum (48%). A total of 12 revascularizations procedures were performed, including 5 arterial, 3 venous, and 2 concomitant arterial and venous. In 32 cases, a vascular surgeon was needed for vessel ligation, repair, or mobilization. The overall 2- and 5-year survival was 77.7% and 26.2%, respectively, with no significant survival difference between patients who underwent revascularization compared to those without revascularization. There was a 100% patency rate in all cases at last follow-up, regardless of the type of vascular reconstruction (median 18 months, range 1-29 months). On multivariate analysis, chronic obstructive pulmonary disease (COPD; P = .002) and positive surgical margins (P = .003) were associated with decreased survival. Most cases were performed in the last 5 years of the study (n = 27, 64.3%). Conclusions: Vascular reconstruction is feasible after surgical oncologic resection of sarcomas with good mid-term patency and limb preservation. Factors independently associated with mortality included COPD and positive surgical margins.


Assuntos
Artérias/cirurgia , Sarcoma/cirurgia , Procedimentos Cirúrgicos Vasculares , Veias/cirurgia , Adulto , Idoso , Artérias/patologia , Chicago , Feminino , Humanos , Salvamento de Membro , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica , Complicações Pós-Operatórias/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sarcoma/mortalidade , Sarcoma/patologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Veias/patologia
5.
J Vis Exp ; (160)2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32597867

RESUMO

Venous malformation (VM) is a vascular anomaly that arises from impaired development of the venous network resulting in dilated and often dysfunctional veins. The purpose of this article is to carefully describe the establishment of a murine xenograft model that mimics human VM and is able to reflect patient heterogeneity. Hyper-activating non-inherited (somatic) TEK (TIE2) and PIK3CA mutations in endothelial cells (EC) have been identified as the main drivers of pathological vessel enlargement in VM. The following protocol describes the isolation, purification and expansion of patient-derived EC expressing mutant TIE2 and/or PIK3CA. These EC are injected subcutaneously into the back of immunodeficient athymic mice to generate ectatic vascular channels. Lesions generated with TIE2 or PIK3CA-mutant EC are visibly vascularized within 7‒9 days of injection and recapitulate histopathological features of VM patient tissue. This VM xenograft model provides a reliable platform to investigate the cellular and molecular mechanisms driving VM formation and expansion. In addition, this model will be instrumental for translational studies testing the efficacy of novel drug candidates in preventing the abnormal vessel enlargement seen in human VM.


Assuntos
Xenoenxertos , Malformações Vasculares/patologia , Animais , Proliferação de Células/efeitos dos fármacos , Classe I de Fosfatidilinositol 3-Quinases/genética , Colagenases/metabolismo , Modelos Animais de Doenças , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/patologia , Fibronectinas/farmacologia , Humanos , Injeções Subcutâneas , Masculino , Camundongos Nus , Escleroterapia , Malformações Vasculares/genética , Malformações Vasculares/terapia , Veias/anormalidades , Veias/patologia
6.
Sci Rep ; 10(1): 8857, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483308

RESUMO

It is widely accepted that the internal mammary vein (IMV) is valveless. However, few anatomical studies are available on the presence or absence of IMV valves. To test the hypothesis that the IMV is valveless, we performed microscopic histological examination of the IMV. IMV samples were collected from 10 human fresh frozen cadavers. For a control, the small saphenous vein (SSV) was obtained. Histological stains were performed. Microscopic examination showed that a venous valve was found in 8 of 20 IMVs. The structure of the valve leaflet consisted of two parts. There was a "thick part" located near the wall of the vein that consisted of smooth muscle cells and fibers. There was also a "thin part" located near the center of the venous lumen that lacked smooth muscle cells. The size of the thick part of the IMV valve was smaller than the SSV valve, whereas there was no difference in the size of the thin part between the IMV and SSV. IMV valves exist. Our results that an IMV valve was present in less than half of IMVs and there was a small-sized valve leaflet suggest that the IMV valve may be rudimentary.


Assuntos
Mama/patologia , Veias/patologia , Mama/irrigação sanguínea , Cadáver , Feminino , Humanos , Veia Safena/patologia
7.
Clin Imaging ; 65: 8-14, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32353719

RESUMO

PURPOSE: Venous malformations (VMs) are low-flow vascular anomalies that are commonly treated with image-guided percutaneous sclerotherapy. Although many VMs can be safely accessed and treated using ultrasonography and fluoroscopy, some lesions may be better treated with magnetic resonance imaging (MRI)-guided sclerotherapy. The aim of this study is to evaluate the feasibility, efficiency, and outcomes of MRI-guided sclerotherapy of VMs using a 3T MRI system. METHODS: Six patients with VMs in the neck (n = 2), chest (n = 1), and extremities (n = 3) underwent sclerotherapy with 3T MRI guidance. Feasibility was assessed by calculating the technical success rate and procedural efficiency. Efficiency was evaluated by using planning, targeting, intervention, and total procedure times. Outcomes were assessed by measuring VM volumes before and after sclerotherapy, patient-reported pain scores, and occurrence of complications. RESULTS: Technical success was achieved in all 6 procedures. There was a non-significant 30% decrease in mean VM volume after the procedure (P = .350). The procedure resulted in a decrease in mean pain score (on an 11-point scale) of 2.6 points (P = .003). After the procedure, 4 patients reported complete pain resolution, 1 reported partial pain resolution, and 1 reported no change in pain. Procedural efficiency was consistent with similar sclerotherapy procedures performed at our institution. There were no major or minor complications. CONCLUSION: 3T MRI guidance is feasible for percutaneous sclerotherapy of VMs, with promising initial technical success rates, procedural efficiency, and therapeutic outcomes without complications.


Assuntos
Escleroterapia/métodos , Malformações Vasculares/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Estudos Retrospectivos , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento , Ultrassonografia , Veias/patologia
8.
Sci Rep ; 10(1): 6433, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32286495

RESUMO

PURPOSE: Aside from severe traumatic brain injury, uncontrolled bleeding and corresponding haemorrhage shock are the leading causes of traumatic deaths. No established recommendations exist about venous access placement for severely injured, bleeding children at a pre-hospital scene. This study sought to evaluate the association between pre-hospital venous access placement and mortality in a paediatric trauma population by analysing the Japan Trauma Data Bank (JTDB). METHODS: This epidemiologic study compared the outcomes of severe traumatic paediatric patients with or without venous access placement at a pre-hospital scene. Data were obtained from JTDB from 2004 to 2015. RESULTS: Of 4,109 patients who met our inclusion criteria, 144 patients received venous access placement and 3,965 patients did not. The probability of survival was lower in the venous access group than in the no access group (0.90 [0.67-0.97] vs. 0.97 [0.90-0.99], p < 0.01). After multivariable logistic analysis, venous access placement did not improve survival to hospital discharge (odds ratio = 1.40, confidence interval = 0.32-6.15, p = 0.653). CONCLUSIONS: The probability of survival was lower in the venous access group than in the no access group. Survival outcome at discharge was not affected by venous access placement at a pre-hospital scene.


Assuntos
Hospitais , Veias/patologia , Ferimentos e Lesões/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Resultado do Tratamento
9.
Hum Pathol ; 99: 36-42, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32240666

RESUMO

Intravenous leiomyomatosis (IVL) is a rare neoplasm that is characterized by smooth muscle cell proliferation within venous vessels. The aim of this study is to investigate the clinicopathological features, immunophenotypes, and MED12 gene mutations in IVL. Nine cases of IVL from the Affiliated Hospital of Qingdao University were collected, and the clinicopathological features were reviewed. The immunohistochemical expressions of p16, phosphatase and tensin homolog deleted on chromosome 10 (PTEN), alpha thalassemia/mental retardation syndrome X-linked (ATRX), retinoblastoma 1 (RB1), fumarate hydratase (FH), and p53, were evaluated. The mutation status of MED12 gene exon 2 was detected by Sanger sequencing. All the 9 patients were women ranging from 32 to 58 years, and uterine leiomyomas were identified in 5 patients. Immunohistochemical staining showed that all IVL and leiomyoma samples were positive for estrogen receptor and progesterone receptor, but negative for CD34. IVL displayed similar immunostaining patterns with their uterine counterparts with focal p16 immunostaining. FH, PTEN, ATRX, and RB1 were variably positive, and p53 and Ki-67 positive rates were less than 5% in all cases. Two novel genetic variations at MED12 exon 2, a synonymous mutation c.141C>T (p.Asn47=), and an in-frame deletion mutation c.133_147del15 (p.Phe45_Pro49del) were identified in two IVL cases. One missense mutation c.131G>A (p.Gly44Asp) was identified in one uterine leiomyoma. The remaining 11 tumor samples (7 IVL cases and 4 uterine leiomyomas) showed no mutations at MED12 exon 2. Our results showed two novel MED12 mutations in IVL. The MED12 mutations are different between IVL and uterine leiomyoma. These findings indicate that IVL is a unique entity and different from uterine leiomyoma.


Assuntos
Biomarcadores Tumorais/genética , Proliferação de Células , Éxons , Leiomiomatose/genética , Complexo Mediador/genética , Mutação , Neoplasias Uterinas/genética , Neoplasias Vasculares/genética , Veias/patologia , Adulto , Biomarcadores Tumorais/análise , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Leiomiomatose/química , Leiomiomatose/patologia , Pessoa de Meia-Idade , Fenótipo , Neoplasias Uterinas/química , Neoplasias Uterinas/patologia , Neoplasias Vasculares/química , Neoplasias Vasculares/patologia , Veias/química
10.
Biochem Biophys Res Commun ; 526(1): 141-146, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32199614

RESUMO

Smoke inhalation injury (SII) affects more than 50,000 people annually causing carbon monoxide (CO) poisoning. Although the increased blood level of carboxyhemoglobin (CO-Hb) is frequently used to confirm the diagnosis of SII, knowledge of its elimination in the acute phase is still limited. The aim of this study is to determine CO-Hb elimination rates and their differences in arterial (aCO-Hb) and mixed-venous (vCO-Hb) blood following severe SII in a clinically relevant ovine model. Forty-three chronically instrumented female sheep were subjected to SII (12 breaths, 4 sets) through tracheostomy tube under anesthesia and analgesia. After the SII, sheep were awakened and placed on a mechanical ventilator (FiO2 = 1.0, tidal volume 12 mL/kg, and PEEP = 5cmH2O) and monitored. Arterial and mixed-venous blood samples were withdrawn simultaneously for blood gas analysis at various time points to determine CO-HB half-lifetime and an elimination curve. The mean of highest aCO-Hb level during SII was 70.8 ± 13.9%. The aCO-Hb elimination curve showed an approximated exponential decay during the first 60 min. Per mixed linear regression model analysis, aCO-Hb significantly (p < 0.001) declined (4.3%/minute) with a decay constant lambda of 0.044. With this lambda, mean lifetime and half-lifetime of aCO-Hb were 22.7 and 15.7 min, respectively. The aCO-Hb was significantly lower compared to vCO-Hb at all-time points (0-180 min). To our knowledge, this is the first report describing CO-Hb elimination curve in the acute phase after severe SII in the clinically relevant ovine model. Our data shows that CO-Hb is decreasing in linear manner with supportive mechanical ventilation (0-60 min). The results may help to understand CO-Hb elimination curve in the acute phase and improvement of pre-hospital and initial clinical care in patients with CO poisoning.


Assuntos
Artérias/patologia , Intoxicação por Monóxido de Carbono/sangue , Carboxihemoglobina/metabolismo , Lesão por Inalação de Fumaça/sangue , Veias/patologia , Doença Aguda , Animais , Artérias/fisiopatologia , Intoxicação por Monóxido de Carbono/fisiopatologia , Modelos Animais de Doenças , Feminino , Meia-Vida , Hemodinâmica , Ovinos , Lesão por Inalação de Fumaça/fisiopatologia , Veias/fisiopatologia
12.
Am J Case Rep ; 21: e916575, 2020 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-32008035

RESUMO

BACKGROUND Lemierre's syndrome is a potential life-threatening disease commonly occurring in young, healthy individuals. It is often preceded by an oropharyngeal infection causing bacteremia. This may rapidly progress into thrombophlebitis of the internal jugular venous system, its branches, and septic embolization and often fulminant organ failure. CASE REPORT A previously healthy 31-year-old male with recent history of facial herpes zoster infection, presented with 1-week history of increasingly painful nasal, and periorbital swelling. Imaging confirmed superior ophthalmic vein thrombosis. Staphylococcus aureus was isolated in blood cultures and had an uncomplicated hospital course with full recovery. CONCLUSIONS Early recognition of Lemierre's syndrome contributes significantly in reducing morbidity and mortality associated with it. Staphylococcus aureus skin infection is a very rare cause of Lemierre's syndrome, and its association with superior ophthalmic vein thrombosis has not yet been reported in literature.


Assuntos
Celulite (Flegmão)/complicações , Síndrome de Lemierre/etiologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Trombose Venosa/diagnóstico por imagem , Adulto , Celulite (Flegmão)/microbiologia , Herpes Zoster , Humanos , Masculino , Veias/patologia
13.
Eur J Cancer ; 128: 1-6, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32109846

RESUMO

Rectal cancer can spread in a number of ways which have been previously recognised and validated as prognostic markers. These routes of spread are not adequately recognised in the stage grouping of the tumour-node-metastasis system, which focuses predominantly on the depth of invasion and nodal status, thus limiting its prognostic accuracy. Tumour spread involving veins occurs in 40% of patients. Venous channels have greater direct access to distant sites by means of a vascular 'anatomical highway'. This rapid spread of tumour cells to distant metastatic sites by veins cannot occur by means of lymph node pathways. Thus, lymph nodes have been overestimated in their importance. Distinction between local tumour spread (lymph node metastases, perineural and lymphatic invasion) and tumour spread mediated by a direct vascular pathway to distant dissemination (extramural venous invasion and tumour deposits) must be made as the implications for prognosis and choice of treatment are not likely to be equal. Improved precision of radiological and pathological assessment is needed to scrutinise and carefully document each route of tumour spread. Only with this accurate information will it be possible to correctly weight each feature and develop a more prognostically accurate staging method that would allow separation of true high- and low-risk groups and subsequent improvements in patient care.


Assuntos
Metástase Linfática/patologia , Células Neoplásicas Circulantes/patologia , Neoplasias Retais/patologia , Veias/patologia , Humanos , Linfonodos/irrigação sanguínea , Linfonodos/patologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/irrigação sanguínea , Neoplasias Retais/mortalidade , Neoplasias Retais/terapia , Medição de Risco
14.
Interact Cardiovasc Thorac Surg ; 30(5): 788-789, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31985793

RESUMO

Mediastinal teratomas are uncommon, fast-growing thoracic tumours, which are usually diagnosed in childhood or adolescence. Neonatal forms are the rarest and often present with life-threatening respiratory distress syndrome. In our case, respiratory failure in a neonate was aggravated by severe cardiogenic shock due to aortic and systemic venous compression, extreme heart displacement and rotation, necessitating an emergency operation on the first day of life.


Assuntos
Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Choque Cardiogênico/etiologia , Teratoma/complicações , Teratoma/cirurgia , Fatores Etários , Aorta/patologia , Feminino , Humanos , Recém-Nascido , Neoplasias do Mediastino/diagnóstico , Teratoma/diagnóstico , Veias/patologia
15.
Acta Neurochir (Wien) ; 162(1): 211-219, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31754846

RESUMO

BACKGROUND: Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm. METHODS: Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively. RESULTS: MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell's palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients. CONCLUSIONS: In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.


Assuntos
Aracnoide-Máter/patologia , Espasmo Hemifacial/etiologia , Doenças Vasculares/complicações , Veias/patologia , Adulto , Idoso , Aracnoide-Máter/cirurgia , Artérias/patologia , Artérias/cirurgia , Nervo Facial/patologia , Nervo Facial/cirurgia , Feminino , Espasmo Hemifacial/cirurgia , Humanos , Masculino , Cirurgia de Descompressão Microvascular , Pessoa de Meia-Idade , Veias/cirurgia
16.
J Vasc Access ; 21(2): 161-168, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31608758

RESUMO

BACKGROUND AND OBJECTIVES: The venous vasa vasorum is the mesh of microvessels that provide oxygen and nutrients to the walls of large veins. Whether changes to the vasa vasorum have any effects on human arteriovenous fistula outcomes remains undetermined. In this study, we challenged the hypothesis that inadequate vascularization of the arteriovenous fistula wall is associated with maturation failure. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This case-control pilot study includes pre-access veins and arteriovenous fistula venous samples (i.e. tissue pairs) from 30 patients undergoing two-stage arteriovenous fistula creation (15 matured and 15 failed to mature). Using anti-CD31 immunohistochemistry, we quantified vasa vasorum density and luminal area (vasa vasorum area) in the intima, media, and adventitia of pre-access veins and fistulas. We evaluated the association of pre-existing and postoperative arteriovenous fistula vascularization with maturation failure and with postoperative morphometry. RESULTS: Vascularization of veins and arteriovenous fistulas was predominantly observed in the outer media and adventitia. Only the size of the microvasculature (vasa vasorum area), but not the number of vessels (vasa vasorum density), increased after arteriovenous fistula creation in the adventitia (median vasa vasorum area 1366 µm2/mm2 (interquartile range 495-2582) in veins versus 3077 µm2/mm2 (1812-5323) in arteriovenous fistulas, p < 0.001), while no changes were observed in the intima and media. Postoperative intimal thickness correlated with lower vascularization of the media (r 0.53, p = 0.003 for vasa vasorum density and r 0.37, p = 0.045 for vasa vasorum area). However, there were no significant differences in pre-existing, postoperative, or longitudinal change in vascularization between arteriovenous fistulas with distinct maturation outcomes. CONCLUSION: The lack of change in intimal and medial vascularization after arteriovenous fistula creation argues against higher oxygen demand in the inner walls of the fistula during the vein to arteriovenous fistula transformation. Postoperative intimal hyperplasia in the arteriovenous fistula wall appears to thrive under hypoxic conditions. Vasa vasorum density and area by themselves are not predictive of maturation outcomes.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/patologia , Falência Renal Crônica/terapia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/patologia , Adulto , Idoso , Biomarcadores/análise , Estudos de Casos e Controles , Hipóxia Celular , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/metabolismo , Humanos , Hiperplasia , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Neointima , Projetos Piloto , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Fatores de Risco , Falha de Tratamento , Veias/química , Veias/cirurgia
18.
J Minim Invasive Gynecol ; 27(3): 748-754, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31100342

RESUMO

STUDY OBJECTIVE: To highlight the circumstances, presentation, and treatment of venous gas embolism (VGE) and provide guidance and propose potential changes in surgical practice and perioperative monitoring to minimize the adverse consequences and sequalae of this potentially serious complication. DESIGN: A case series. SETTING: A university-affiliated teaching hospital. PATIENTS: Five women developed VGE during hysteroscopic endometrial ablation. INTERVENTIONS: From 1990 through 2014, the principle author (G.A.V.) performed 5249 primary and 458 repeat hysteroscopic endometrial ablations under general anesthesia using a monopolar 26F (9-mm) resectoscope connected to a peristaltic pump-driven active inflow and outflow irrigation and distension system (1.5% glycine) and an 8-mm monopolar loop electrode at a 120-W continuous (cut) and/or a 3- to 5-mm rollerball interrupted (coagulation) waveform or a combination of them. MEASUREMENTS AND MAIN RESULTS: Among 5707 procedures, we encountered 5 (0.09%, 1/1140) incidents of VGE during primary ablations. All patients exhibited the same symptoms of ventilatory and hemodynamic decompensation, beginning with a reduction in end-tidal carbon dioxide and arterial oxygen desaturation. All patients recovered after immediate cessation of the surgery and resuscitation including ventilatory support with 100% O2 and intravenous fluids. CONCLUSIONS: Although entrainment of some air/gas bubbles is common during hysteroscopy, life-threatening/fatal VGE is rare (1/1140 cases). Situational awareness and strict adherence to certain principles including understanding the conditions, prerequisites, and pathophysiology of VGE; attention to surgical principles and operative technique; close communication with the anesthesiologist; and early therapeutic intervention are of paramount importance to avoid this rare but potentially serious complication.


Assuntos
Embolia Aérea/etiologia , Técnicas de Ablação Endometrial/efeitos adversos , Histeroscopia/efeitos adversos , Miomectomia Uterina/efeitos adversos , Adulto , Dióxido de Carbono , Embolia Aérea/diagnóstico , Técnicas de Ablação Endometrial/métodos , Feminino , Humanos , Histeroscopia/métodos , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Miomectomia Uterina/métodos , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Veias/patologia
19.
Aging (Albany NY) ; 11(23): 11073-11083, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31790365

RESUMO

The purpose of this study was to discriminate the clinical and imaging correlates of cerebral arterial stenosis (CAS), venous stenosis (CVS) and arterio-venous stenosis (CAVS) in the clinical setting. Patients were classified into three groups: CAS (n = 75), CVS (n=74) and CAVS (n=67). Focal neurological deficits were the prominent presenting symptoms in CAS group, while venous turbulence related symptoms were common in both CVS and CAVS group. Risk factor analysis showed the OR (95%CI) for diabetes, male gender and age in CAS vs. CVS group were 13.67(2.71, 68.85), 6.69(2.39, 18.67) and 1.07(1.03, 1.12) respectively. Male gender, diabetes and age in CAVS vs. CAS groups were 0.27(0.11, 0.63), 0.26(0.10, 0.67) and 1.09(1.04, 1.14) respectively, while age in CAVS vs. CVS group was 1.11(1.07, 1.15). The white matter lesions (WMLs) in CAS group varied in size, with clear boundaries asymmetrically distributed in bilateral hemispheres. CVS-induced WMLs revealed a bilaterally symmetric, cloudy-like appearance. The cerebral perfusion was asymmetrically reduced in CAS but symmetrically reduced in CVS group. The clinical characteristics and neuroimaging presentations were different among patients with CAS, CVS and CAVS. We recommended for aged patients, both arterial and venous imaging should be considered in diagnosis of cerebral stenotic vascular disorders.


Assuntos
Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/patologia , Neuroimagem/métodos , Adulto , Idoso , Artérias/diagnóstico por imagem , Artérias/patologia , Estudos de Casos e Controles , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Veias/diagnóstico por imagem , Veias/patologia
20.
Sci Rep ; 9(1): 18188, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796822

RESUMO

We aimed to evaluate the pooled incidence of central vein sign on T2*-weighted images from patients with multiple sclerosis (MS), and to determine the diagnostic performance of this central vein sign for differentiating MS from other white matter lesions and provide an optimal cut-off value. A computerized systematic search of the literature in PUBMED and EMBASE was conducted up to December 14, 2018. Original articles investigating central vein sign on T2*-weighted images of patients with MS were selected. The pooled incidence was obtained using random-effects model. The pooled sensitivity and specificity were obtained using a bivariate random-effects model. An optimal cut-off value for the proportion of lesions with a central vein sign was calculated from those studies providing individual patient data. Twenty-one eligible articles covering 501 patients with MS were included. The pooled incidence of central vein sign at the level of individual lesion in patients with MS was 74% (95% CI, 65-82%). The pooled sensitivity and pooled specificity for the diagnostic performance of the central vein sign were 98% (95% CI, 92-100%) and 97% (95% CI, 91-99%), respectively. The area under the HSROC curve was 1.00 (95% CI, 0.99-1.00). The optimal cut-off value for the proportion of lesions with a central vein sign was found to be 45%. Although various T2*-weighted images have been used across studies, the current evidence supports the use of the central vein sign on T2*-weighted images to differentiate MS from other white matter lesions.


Assuntos
Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/patologia , Veias/patologia , Animais , Humanos , Sensibilidade e Especificidade , Substância Branca/patologia
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