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Kawasaki disease is an acute febrile rash disease with systemic vasculitis as the main lesion, which can lead to coronary artery lesion(CAL)in some children.Early diagnosis of Kawasaki disease can effectively prevent CAL.Previous studies on the risk factors of CAL in Kawasaki disease focused on leukocyte, neutrophil percentage, erythrocyte sedimentation rate, C-reactive protein, serum albumin, etc.In recent years, many new biomarkers have been found.This review summarized the newly studied risk factors, aiming to provide reference for timely treatment of Kawasaki disease and prevention of CAL.
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Objective:To analyze risk factors for duration of small or medium-sized coronary artery aneurysms (CAA) in children with Kawasaki disease (KD) so as to provide clinical guidance for early and full course treatment.Methods:The clinical data of 68 children diagnosed with KD in the Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University from January 2018 to January 2021 were retrospectively analyzed.According to duration of CAA, all cases were divided into 2 groups, duration of CAA ≥ 8 weeks group and duration of CAA <8 weeks group.Risk factors associated with CAA duration were screened using univariate analysis, and then independent risk factors for CAA duration in children with KD were analysed using multiple Logistic regression analysis. Results:A total of 68 cases were enrolled in this study.Among these cases, 45 cases (66.18%) were male and 23 cases (33.82%) were female.The onset age was from 3 months to 10 years old, and the median onset age was 1.59 (1.02-3.19). There were 31 cases in the group with CAA duration ≥8 weeks and 37 cases in the group with CAA duration <8 weeks.Univariate analysis showed that patients with the total fever course >10 days[45.16%(14/31 cases) vs.21.62%(8/37 cases)], time of treatment with intravenous immunoglobulin (IVIG)>10 days[54.84%(17/31 cases) vs.16.22%(6/37 cases)], platelet (PLT)>600×10 9/L[32.26%(10/31 cases) vs.10.81%(4/37 cases)], hypersensitive C-reactive protein (HsCRP) >100 mg/L[38.71%(12/31 cases) vs.13.51%(5/37 cases)] (all P<0.05 ) in the group with CAA duration ≥8 weeks were significantly more than those in the group with CAA duration <8 weeks.However, there were no significant differences in gender, age, type of KD, etiology evidence, hormone application, duration of fever before IVIG application, IVIG sensitivity, IVIG application way, urine leukocytes, white blood cells, hemoglobin, percent of neutrophilic granulocyte, erythrocyte sedimentation rate, glutamic-pyruvic transaminase between the 2 groups (all P>0.05). Multivariate Logistic regression analysis showed that the course of IVIG before application >10 days ( OR=6.589, 95% CI: 1.678-25.867, P=0.007)and HsCRP >100 mg/L ( OR=7.949, 95% CI: 1.947-32.461, P=0.004)were independent risk factors for predicting the duration of KD complicated with small and medium-sized CAA ≥8 weeks. Conclusions:The course of IVIG before application >10 days and HsCRP>100 mg/L are independent risk factors for KD complicated with small and medium-sized CAA lasting ≥8 weeks.
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The internal iliac artery originating from the common iliac artery is an important branch, and communicating with the branches of the abdominal aorta, such as lumbar artery and sacral median artery, forming rich collateral circulation and nourishing the blood supply of gluteal muscle and pelvic floor viscera. Surgical intervention is recommended when the maximum diameter of internal iliac artery aneurysms>2 cm. A variety of treatment modalities are available, particularly, endovascular technique has been successfully applied in the clinical treatment of internal iliac artery aneurysms, which can significantly improve the cure and reduce complications and deaths. This article reviews the previous literature and summarizes the progress of internal iliac artery aneurysms treatment.
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Peripheral artery aneurysms,with low incidence and complex anatomic structure,often involve important branches.This paper introduces a new surgical technique-sleeve shaping on the basis of two cases.The basic data,including characteristics,imaging,operation and follow-up data of the cases,were collected.The data were then combined with the previous literature for explaining in detail that this technique can be used as a supplementary method of reconstruction following resection or endovascular repair.
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Humans , Aneurysm/surgery , Arteries , Treatment OutcomeABSTRACT
Objective To evaluate the safety and efficiency of the treatment strategy based on three-dimensional digital subtraction angioplasty (3 D-DSA) for the side selection of pterional approach to clip anterior communicating artery aneurysm. Methods All 75 continuous patients with single anterior communicating artery aneurysm(Hunt-Hess 0-III grade) treated by microsurgical clipping via the pterional approach were analyzed retrospectively. The side selection of approach was based on 3D-DSA. All patients' gender, age, Hunt-Hess grade, aneurysm size, the side of approach, complications, the length of postoperative stay, the ratio of complete occlusion, and the Glasgow outcome scale (GOS) score at discharge were collected. The ratio of complete occlusion and clinical outcome were analyzed according to the group of left or right approach and different Al dominant approach. Results (1) Fifty-six patients (74. 7%) were left Al dominants, with 30 of those treated via the left-side approach and 26 of those treated via the right-side approach. Nineteen patients (25.3%) were right Al dominants, with 15 of those treated via the right-side approach and 4 of those treated via the left-side approach. (2) Surgical exposure of all aneurysms was satisfactory during operation, which was consistent with the 3D-DSA image simulation before the operation. The median length of postoperative stay was 9(8, 11) days. Six patients(8. 0%) suffered symptomatic cerebral infarction, and 1 patient (1.3%) had an intracranial infection. Sixty-five cases performed DSA or CT antigraphy after the operation. Sixty-two aneurysms (95.4%) were completely clipped and 3 aneurysms (4.6%) existed residual segments in the neck of the aneurysm. Sixty-nine patients (92.0%) reached 5 grade of GOS, 3 patients (4.0%) reached 4 grade of GOS, 3 patients (4.0%) reached 3 grade of GOS, and no patient was below 3 grade of GOS at discharge. (3) The surgical-related complications, clipping results, hospital-stay time after operation, and GOS at discharge were insignificantly different between left and right side approach, also insignificantly different between the dominant Al side and contralateral side approach. Conclusion The treatment strategy, based on preoperative 3D-DSA imaging simulation for the side selection of pterional approach to clip anterior communicating artery aneurysms, was safe and effective.
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Resumen Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.
Abstract Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.
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Humans , Male , Aged , Thrombosis/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/therapy , Dilatation, Pathologic/diagnostic imaging , Non-ST Elevated Myocardial Infarction/physiopathologyABSTRACT
Objective@#To investigate the high risk factors for early coronary artery aneurysms(CAA)early complicated with Kawasaki disease (KD) in inpatient children.@*Methods@#Totally 679 inpatient children with KD from January 2005 to December 2011 in Children′s Hospital of Chongqing Medical University were enrolled in this study.These data were analyzed by Chi-square test to analyze the possible risk factors for CAA.Multiple Logistic regression analysis was performed to estimate the OR and 95%CI for the risk factors.@*Results@#There were 385(56.70%) male and 294(43.30%) female cases with the onset ages of 2 months to 15 years and 7 months.There were 32 cases (4.71%) of CAA, among them, 8 cases resistant to intravenous immunoglobulin (IVIG). In total 32 cases of CAA, 25 cases were treated with 2 g/(kg·time) IVIG for 1 to 3 times, and 2 cases were also treated by methylprednisolone.The other 7 cases of CAA were treated with IVIG less than or equal to 1 g/(kg·time) for 4 to 7 times.There were 6 recu-rrent KD cases (0.88%), occurred on the 2nd-18th month after the onset of the illness, including 1 case complicated with CAA.There was no death case during the acute stage.The monofactor analysis showed that male, duration of fever ≥ 10 d, time of treatment with IVIG ≥7 d, hemoglobin < 100 g/L, erythrocyte sedimentation rate ≥100 mm/1 h, serum albumin < 30 g/L were associated with early complicated CAA(all P<0.05). However, the age, white blood cells, platelets, C-reactive protein were not associated with early complicated CAA(all P>0.05). The multiple Logistic regression analysis showed that hemoglobin <100 g/L (OR=2.99, 95%CI: 1.01-8.75, P=0.04), duration of fever ≥ 10 d (OR=6.67, 95%CI: 1.57-22.54, P=0.01), time of treatment with IVIG ≥7 d(OR=3.57, 95%CI: 1.12-11.02, P=0.02) were the independent risk factors for CAA.@*Conclusions@#The levels of hemoglobin<100 g/L, duration of fever ≥ 10 d and time of treatment of IVIG ≥7 d are the independent risk factors for CAA.
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Objectives: To investigate the morphological characteristics of pericallosal artery aneurysms (PAAs) and to analyze the morphological influence factor of PAA rupture. Methods: From January 2013 to May 2017A,40 consecutive patients with PAA admitted to the Department of Neurosurgery,Xuanwu Hospital, Capital Medical University were enrolled retrospectively. They were diagnosed by whole brain vascular DSA before treatment. Forty patients were divided into ruptured group (n = 22 with 22 aneurysms) and the unruptured group (n = 18 with 23 aneurysms). The morphological parameters of the number of aneurysms in two-dimensional or three-dimensional rotational angiography included diameter, height, width, aneurysm neck width,diameter of parent arteries, and inflow angle of aneurysms, and the aspect ratio, size ratio and length-width ratio (aneurysm diameter/aneurysm width) of each aneurysm were further calculated. The aspect ratio was calculated using aneurysm height/aneurysm neck width and aneurysm diameter/aneurysm neck width, respectively, and the size ratio was calculated using aneurysm height/parent artery diameter and aneurysm diameter/parent artery diameter, respectively. The differences of morphological parameters of PAAs were compared and multivariate logistic regression analysis was performed to preliminarily investigate the morphology of influencing factors of PAA rupture. Results: (1) There were no significant differences in age, male, multiple aneurysms, and risk factors for cardiocerebrovascular diseases between the two groups (all P>0.05). (2) The proportion of irregular aneurysms and the length-width ratio of aneurysms in the rupture group were higher than those in the unruptured group. The difference between the groups was statistically significant (90.9% [20/22] ts. 39. 1% [9/23],χ2 =8. 01); 1. 35 ±0. 36 vs. 1. 01 ±0. 22,t= -3. 85; all P 0. 05). (3) Amongthe 45 aneurysms,the proportion of A3 anterior bifurcation aneurysms was 53.3% (24 aneurysms), and the proportion of the ruptured group and unruptured group was 68. 2% (15/22) and 39. 1% (9/23) respectively. There were no significant differences between the groups (χ2 =0. 381,P = 0. 051). (4) The mean length-width ratio in 45 PAAs was 1. 18. using this as the defined value, the length-width ratio was converted into a two-category variable,and the PAA rupture was used as the dependent variable. The univariate analysis of the morphological parameters in the length-width ratio (> 1. 18) and the irregular aneurysm were included in the multivariate logistic regression analysis. The results showed that the length-width ratio was >1.18 (OR,1.84,95% CI 1.42-28. 11,P =0. 016),and irregular aneurysms (OR,2. 06,95% CI 1. 66-37. 11, P = 0. 009) were the independent risk factor for PAA rupture. Conclusions: The ratio of height-length-width of PAAs and the irregular morphology of aneurysms suggest that PAAs are prone to rupture. The evaluation of PAA morphological parameters should be emphasized in clinical practice.
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Objective To evaluate the safety and efficacy of endovascular treatment of posterior communicating artery (PCoA) aneurysms with fetal posterior cerebral artery (fPCA). Methods From January 2015 to December 2017,55 consecutive patients with PCoA aneurysm with fPCA (57 aneurysms) treated at the Department of Neurosurgery, First Hospital Affiliated to Naval Military Medical University were enrolled retrospectively. All aneurysms were treated with endovascular treatment, including 27 aneurysms treated with coils alone and 30 treated with stent-assisted embolizatioa The immediate degree of embolization after procedure was assessed according to the Raymond grade. Imaging follow-up was performed using DSA or MR angiography, and the clinical prognosis was followed up by the outpatient and/or telephone. The prognosis was assessed using the modified Rankin scale (MRS) score. Results Of the 55 patients ,41 (74. 5% ) had subarachnoid hemorrhage. Immediate post-operative angiography revealed that 21 aneurysms (36. 8% ) were Raymond grade 1,11 aneurysms (19. 3% ) were Raymond grade E ,and 25 aneurysms (43. 9% ) were Raymond grade HI. All the PCoAs were patent Three patients (5.5%) had perioperative complications, they were operation-related bleeding.no ischemic events occurred,and 3 patients died. Thirty-nine patients with 41 aneurysms were followed up with imaging, of which 26 (63. 4% ) were cured, 1 (2. 4% ) were improved,8 ( 19. 5% ) were stable, and 6 (14. 6% ) recurred ( all treated with coils alone). All PCoAs with fPCA remained patent during the follow-up. Of the 52 patients who were clinically followed up,2 died and the aneurysm of 1 ease reruptured one year after procedure. The follow-up MRS score was 0-2 in 47 cases (90.4% ) ,3 in 1 case,4 in 1 case,5 in 1 case,and 6 in 2cases. Conclusion Endovascular treatment of PCoA aneurysms with fPCA is feasible and effective.
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Objective To investigate the high risk factors for early coronary artery aneurysms (CAA)early complicated with Kawasaki disease (KD) in inpatient children.Methods Totally 679 inpatient children with KD from January 2005 to December 2011 in Children's Hospital of Chongqing Medical University were enrolled in this study.These data were analyzed by Chi-square test to analyze the possible risk factors for CAA.Multiple Logistic regression analysis was performed to estimate the OR and 95% CI for the risk factors.Results There were 385 (56.70%) male and 294(43.30%) female cases with the onset ages of 2 months to 15 years and 7 months.There were 32 cases (4.71%) of CAA,among them,8 cases resistant to intravenous immunoglobulin (IVIG).In total 32 cases of CAA,25 cases were treated with 2 g/(kg · time) IVIG for 1 to 3 times,and 2 cases were also treated by methylprednisolone.The other 7 cases of CAA were treated with IVIG less than or equal to 1 g/(kg · time) for 4 to 7 times.There were 6 recurrent KD cases (0.88%),occurred on the 2nd-18th month after the onset of the illness,including 1 case complicated with CAA.There was no death case during the acute stage.The monofactor analysis showed that male,duration of fever ≥ 10 d,time of treatment with IVIG ≥7 d,hemoglobin< 100 g/L,erythrocyte sedimentation rate ≥ 100 mm/1 h,serum albumin < 30 g/L were associated with early complicated CAA (all P < 0.05).However,the age,white blood cells,platelets,C-reactive protein were not associated with early complicated CAA (all P > 0.05).The multiple Logistic regression analysis showed that hemoglobin < 100 g/L (OR =2.99,95% CI:1.01-8.75,P =0.04),duration of fever ≥ 10 d (OR =6.67,95 % CI:1.57-22.54,P =0.01),time of treatment with IVIG ≥ 7 d (OR =3.57,95 % CI:1.12-11.02,P =0.02) were the independent risk factors for CAA.Conclusions The levels of hemoglobin <100 g/L,duration of fever ≥ 10 d and time of treatment of IVIG ≥7 d are the independent risk factors for CAA.
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Objective To compare the safety and efficacy of stent-assisted coil and non-stent-assisted coil for the treatment of ruptured posterior communicating artery aneurysms.Methods A total of 121 consecutive patients with ruptured posterior communicating artery aneurysm treated at the Department of Neurosurgery,Heze Municipal Hospital between June 2014 and June 2017 were enrolled retrospectively.They divided into either a stent group (n =63) or non-stent group (n =58) according to whether they used stent treatment or not.The two groups were compared,and their clinical data,surgical related complications,the degree of embolism immediately after aneurysm surgery,and the follow-up results of clinical and imaging were analyzed.Results Interventional embolization therapy was successfully performed in all the patients.(1) The proportion of wide-necked aneurysms of the stent group was higher than that of the non-stent group.There was significant difference (92.1% [58/63] vs.8.6% [5/58],x2 =84.249,P < 0.01).There were no significant differences in age,aneurysm size,sex,and HuntHess grade (all P > 0.05).(2) The incidences of intraoperative aneurysm rupture of the stent group and non-stent group were 4.8% (3/63) and 3.4% (2/58) respectively.There was no significant difference (x2 =0.132,P =0.717).The incidence of thromboembolie complication was 12.7% (8/63) and 5.2% (3/58)respectively.There was no significant difference (x2 =2.070,P =0.150).In the stent group,1 patient disabled and 1 died,and in the non-stent group,there were no cases with surgical related disability,and 1 died.(3) The comparison of immediate results after procedure between the stent group and non-stent group:there were no significant differences in the complete embolic rate (39.7% [25/63] vs.37.9%[22/58],x2 =0.039),aneurysm neck residual rate (25.4% [16/63] vs.39.7% [23/58],x2 =2.811],and residual rate of aneurysm (34.9% [22/63] vs.22.4% [13/58],x2 =2.298,all P > 0.05).(4) The recurrence rate of aneurysms (4.3% [2/46]) of the stent group was lower than that of the non-stent group (31.8% [14/44]).There was significant difference between the two groups (x2 =112.610,P =0.01).No rebleeding occurred in all aneurysms after procedure.Conclusion Compared with the non-stent-assisted coil embolization,the stent assisted embolization of ruptured posterior communicating artery aneurysms in acute phase may reduce the recurrence rate of aneurysms and without significantly increasing the incidence of surgery-related complications.
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Hughes-Stovin syndrome is a rare disorder of unknown etiology. Although the association between multiple pulmonary artery aneurysms and venous thrombosis of the lower limbs was reported by Beattie and Hall in 1911, it was not until 1962 that the eponym “Hughes-Stovin syndrome” was formally introduced in the medical literature. We describe 2 patients with Hughes-Stovin syndrome who presented with pulmonary artery aneurysm, thrombophlebitis, hemoptysis, and oral ulcers, review the manifestations of the disease, and compare its similarities with and differences from Behçet disease.
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Humans , Aneurysm , Behcet Syndrome , Eponyms , Hemoptysis , Lower Extremity , Oral Ulcer , Pulmonary Artery , Thrombophlebitis , Thrombosis , Venous ThrombosisABSTRACT
Objective To compare the safety and efficacy of surgical and endovascular management for popliteal artery aneurysms.Methods The clinical data of 28 patients with popliteal artery aneurysm admitted to our department from December 2009 to March 2015 was analyzed retrospectively.12 patients underwent open surgery,and 16 did endovascular repair.Results In the surgical operation group (12 cases),the mean length of hospital stay was 18 ± 3 days,with 1 case suffering from delayed wound healing,and 1 case of anastomotic pseudoaneurysm The vascular graft patency rate was 100% at 1 year (12/12),and 75% (9/12) at 2 years.In the endovascular repair treatment group(16 cases),the average time of hospitalization was (10 ± 2) days.The patency rate of vascular stent was 93.3% (14/15) at 1 year,and 86.7% (13/15) at 2 years (all P > 0.05).Surgical operation had longer hospitalization and more complications than endovascular repair.Conclusions Endovascular repair provides similar shortterm patency rate to that of surgical operation treatment,but with shorter hospitalizations and less complications in patients with popliteal artery aneurysms.Viabahn stenting helps improve the patency rate.
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Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operativemanagement of ruptured bilateral PA aneurysms is feasible and effective.
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Humans , Female , Middle Aged , Subarachnoid Hemorrhage/surgery , Aneurysm, Ruptured/surgery , Anterior Cerebral Artery/surgery , Smokers , Tomography, X-Ray Computed , Aneurysm, Ruptured/diagnostic imaging , Computed Tomography AngiographyABSTRACT
Resumen Introducción: La enfermedad multianeurismática es una entidad patológica poco conocida, la cual presenta diversas etiologías, por lo que su localización, morfología y formas de presentación varían de un caso a otro. Caso clínico: Mujer de 51 años dislipémica. Acude por epigastralgia. Se realiza TC abdominal con resultados de hematoma retroperitoneal y aneurisma en arteria pancreática duodenal. Se practica cirugía urgente para evacuación del hematoma sin encontrarse más hallazgos. Durante el ingreso presenta crisis hipertensivas y se realiza nuevo AngioTC donde se visualizan múltiples lesiones en distintas arterias viscerales con posibilidad diagnóstica de vasculitis. Se decide no intervención en el momento actual y estudio de filiación. Discusión: La enfermedad multianeurismática es una entidad poco común, cuya etiología se determina de acuerdo con su correlación clínica e histopatológica con diversas posibles causas; sin embargo, establecer un diagnóstico en donde el cuadro clínico coincida al 100%, es un desafío. Es muy frecuente la afectación de las arterias viscerales a diferencia de los aneurismas de origen ateroesclerótico. El tratamiento quirúrgico es seguro y deberá iniciarse en los segmentos que estén causando la sintomatología. El tratamiento endovascular es menos invasivo siendo la técnica de elección en pacientes con elevada comorbilidad y en los casos de cirugía complicada con rotura.
Introduction: Multiple artery aneurysms are a rare pathological condition which may be caused by different etiologies. Therefore, its location, morphology and clinical presentation may vary in a case to case basis. Case report: A 51-year-old woman, prior history of dyslipedemia presents with upper abdominal pain. Abdominal tomographic scans showed aneurysm of the pancreaticduodenal artery and retroperitoneal hematoma. Emergent surgical evacuation of the hematoma was performed, with no other findings. In the postoperative period, the patient suffers hypertensive crisis and a new tomographic scan is conducted observing multiple dilations in different visceral arteries. The patient is treated conservatively and is being studied for a possible vasculitis. Discussion: Multi-aneurysmatic artery disease is a very rare entity, its etiology is determined by clinical and histopathological correlation. Although establishing a diagnosis in which the clinical presentation completely corresponds, is a real challenge. Unlike degenerative aneurysms due to atherosclerosis, multi-aneurysmatic disease commonly involves visceral arteries. Open surgery is considered safe treatment option and should be established in the segments causing symptoms. Endovascular treatment is less invasive, being the technique of choice in patients with high comorbidity and in cases of complicated surgery with rupture.
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Humans , Female , Middle Aged , Splenic Artery/diagnostic imaging , Hepatic Artery/diagnostic imaging , Aneurysm/diagnostic imaging , Mesenteric Arteries/diagnostic imaging , Splenic Artery/pathology , Computed Tomography Angiography , Hepatic Artery/pathology , Mesenteric Arteries/pathologyABSTRACT
Resumen Objetivo: Describir las manifestaciones cardiacas en la etapa aguda de la enfermedad de Kawasaki en pacientes atendidos en un hospital de tercer nivel de la Ciudad de México, México. Métodos: Estudio retrospectivo, descriptivo en pacientes con diagnóstico de enfermedad de Kawasaki de agosto de 1995 a diciembre del 2016 en el Instituto Nacional de Pediatría, México. Se estudio la demografía de los pacientes, características clínicas, tratamiento empleado y desarrollo de complicaciones cardiacas en la etapa aguda de la enfermedad. Resultados: Se estudiaron 508 casos de enfermedad de Kawasaki. La edad media al diagnóstico fue de 37.64 ± 35.56 meses. Predominio de pacientes masculinos del 65.4%, con una relación masculino/femenino de 1.88:1. La mayoría de los casos (79.2%) tuvo una presentación completa. La gammaglobulina intravenosa fue administrada en 92.4% de los casos. Veintiocho pacientes (5.5%) desarrollaron arritmias, se presentaron cambios en el segmento ST en 29 pacientes (5.6%) y 5 pacientes desarrollaron isquemia miocárdica. En el ecocardiograma inicial, 51 pacientes (9.9%) presentaron datos de miocarditis, 72 pacien- tes (14%) datos de pericarditis y 77 casos tuvieron derrame pericárdico (15%). Se detectaron alteraciones en las arterias coronarias en 169 casos (32.9%). Cuatro pacientes fallecieron en la etapa aguda de la enfermedad por complicaciones cardiacas de la enfermedad de Kawasaki. Conclusiones: En México cada vez existen más casos de enfermedad de Kawasaki con un alto porcentaje de manifestaciones cardiacas al diagnóstico. Se requiere de un mayor conocimiento de la enfermedad en México, para poder establecer cuál es la evolución cardiológica de los pacientes en el país.
Abstract Objectives: To describe the cardiac manifestations in the acute phase of patients with Kawasaki disease treated in a third level Children's hospital in Mexico City, Mexico. Methods: A cross-sectional study was conducted in patients with a diagnosis of Kawasaki disease treated in this hospital from August 1995 to December 2016. Information included patient demographics, clinical features, treatment used, electrocardiographic findings, extra-coronary echocardiographic findings, and the development of coronary artery aneurysms in the acute phase of the disease. Results: The study included 508 cases of Kawasaki disease, with a mean age at diagnosis of 37.64 ± 35.56 months (range from 2 to 200 months). Almost two-thirds (65.4%) of the patients were male, with a male/female ratio of 1.88:1. Complete Kawasaki disease was diagnosed in 79.2% of cases. Almost all cases (92.4%) received intravenous immunoglobulin. Twenty-eight patients (5.5%) developed arrhythmias, ST changes developed in 29 patients (5.6%), and 5 patients presented with ischaemic changes. In the initial echocardiographic evaluation, 51 patients (9.9%) were diagnosed with myocar- ditis, 72 patients (14.0%) with pericarditis and 77 cases (15.0%) developed pericardial effusion. Coronary artery anomalies were detected in 169 cases (32.9%). 32 cases were diagnosed as giant coronary aneurysms. Four patients died from cardiac complications in the acute phase of the disease. Conclusions: There has been an increase in the diagnosis of Kawasaki disease in Mexico. They presented with more cardiac complications than reported in literature. An increased knowledge of Kawasaki disease is required in Mexico in order to establish the cardiac outcomes of this group of patients.
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Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Coronary Aneurysm/etiology , Coronary Artery Disease/etiology , Heart Diseases/etiology , Mucocutaneous Lymph Node Syndrome/complications , Coronary Aneurysm/epidemiology , Coronary Artery Disease/epidemiology , Echocardiography , Cross-Sectional Studies , Retrospective Studies , Immunoglobulins, Intravenous/administration & dosage , Heart Diseases/epidemiology , Hospitals, Pediatric , Mexico/epidemiology , Mucocutaneous Lymph Node Syndrome/drug therapyABSTRACT
Objective To investigate the clinical effect of external ventricular drainage on the prognosis of anterior communicating artery aneurysms.Methods Retrospectively collected and analyzed 96 patients of anterior communicating artery aneurysms who were treated in our hospital from June 2013 to October 2015,and they were divided into the observation group which was given external ventricular drainage treatment and the control group which was not given external ventricular drainage treatment.These patients were followed up for 6 months to 2 years,and the results of the 2 groups were graded according to the analysis of postoperative complications and the Glasgow prognostic score (GOS).Meanwhile,evaluated the general function of the patients according to the KPS score.Results The the incidence rate of complications after treatment in observation group was 54.17%,which was lower than 86.96% in the control group,and the difference was statistically significant(P < 0.05).The cure rate of observation group was 79.16%,which was higher than 50% in the control group,and the difference was statistically significant (P < 0.05).The postoperative KPS score in the observation group was (79.68 ± 13.24) points,which was higher than (62.57 ± 12.72) points in the control group,and the differences were statistically significant (P < 0.05).Conclusion External ventricular drainage can reduce the compression injury of the brain tissue to a minimum degree,reduce intracranial pressure,relieve cerebral edema caused by intracranial pressure,reduce complications,and improve the prognosis of patients and the cure rate.
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Objective To summarize the clinical characteristics of children with coronary artery aneurysms (CAA) and thrombosis in Kawasaki disease (KD),in order to explore the safe and effective thrombolytic therapy and its prognosis.Methods The clinic,treatment and follow-up data of 210 patients with KD between January 2006 and December 2016 were retrospectively reviewed in the Department of Pediatrics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.The clinic signs and laboratory data for CAA with thrombosis were analyzed.The characteristics of CAA were monitored by tltrasound.All KD patients with thrombus received intravenous antithrombotic therapy,including urokinase,heparin,and oral Warfarin,and anti-platelet treatment.The effectiveness of antithrombotic treatment was evaluated by measuring the ability to dissolve the thrombus.Results Fourteen cases in 210 patients with KD developed CAA,and had associated thrombosis.In these 14 patients,the largest diameter of CAA was 18.5 mm,and the average value was 12.6 mm.There was no special blood analysis in CAA with thrombus.Moreover,typical KD symptoms and acute myocardial infarction were not found in CAA with thrombosis.Thrombus occurred in giant aneurysms,and 2 patients had multiple thrombosis.After thrombolytic therapy,12 cases in the 14 patients had successful thrombolysis,2 patients had thrombus organization and coronary artery stenosis.Conclusions Neither clinical features nor laboratory data could reliably predict CAA associated thrombosis.Thrombus was easily formed in giant CAA.Frequent and periodly follow-up are important to detect thrombosis in KD patients with giant coronary artery.Therapy with adequate intravenous antithrombotic therapy and anti-platelet treatment earlier can effectively dissolve thrombus in KD patients,and avoid deterioration.
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Objective To investigate the effect of intracranial aneurysm isolation combined with extra-intracranial bypass in treatment of middle cerebral artery aneurysm.Methods From January 2013 to March 2015,there were 32 patients with complex middle cerebral artery aneurysm in our hospital,who were treated by intracranial aneurysm isolation combined with extra-intracranial bypass.The clinical symptoms and image examination after surgery were retrospectively analyzed,and the hemodynamic index of middle cerebral artery before and after treat-ment was statistically analyzed.Results The postoperative clinical symptoms of 25 patients were relieved,the mRS score was 0 point.Seven patients received surgery,1 week later,the muscle force of involved side was grade 2 to 3,the mRS score was 2 to 3 point,the blood flowing smoothly in target vessel,with no original aneurysm,no new ischemic stroke or infarct.After intervention,systolic and diastolic blood flow ve-locity were faster than those before the intervention(P <0.05),blood flow resistance were lower than those before intervention(P <0.05). Conclusion The intracranial aneurysm isolation combined with extra-intracranial bypass can effectively improve the clinical symptoms of pa-tients with complex intracranial aneurysms,with high graft patency rate and reliable effect.
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Objective To investigate the feasibility and effectiveness of endovascular treatment of posterior communicating artery aneurysm (PcoAA)in keeping the fetal posterior cerebral artery (FPCA) patency. Methods Form January 2014 to December 2015,14 patients with ruptured PcoAA enrolled retrospectively were treated with endovascular embolization. Six of them were treated with simple coil embolization,3 with stent-assisted coil embolization,3 with double catheter-assisted coil embolization,1 with stent-assisted coil embolization + double catheter technique,and 1 with Y-stent in Yijishan Hospital, Wannan Medical College. The immediate embolization rate of PcoAA (using Raymond grade),prognosis of the patients (the modified Rankin scale score at 6 months after procedure),complications,and imaging follow-up results were analyzed. Results The success rate of coil and stenting was 100% . All the stents were accurately released in place without displacement. The immediate Raymond grading of the aneurysms displayed that Raymond grade Ⅰ was in 8 cases,Raymond grade Ⅱ was in 4 cases,and Raymond grade Ⅲ was in 2 cases. All FPCA were kept patent. A coil protruded into internal carotid artery in one case during the procedure. Others did not have any complications,such as intraoperative cerebral vasospasm,in-stent thrombosis,and rupture. All 14 patients were followed up for 3 -24 months after procedure. Two had recurrence. Both were aneurysms embolized with coils only. No rebleeding and ischemic complications were observed. The modified Rankin scale scores in 13 cases were 0 -2 at 6 months after procedure,1 was 4. Conclusions Endovascular embolization for the treatment of PcoAA and keeping FPCA patency are safe and feasible. A variety of endovascular treatment modalities are necessary in order to keep FPCA patency.