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1.
Rev. cuba. angiol. cir. vasc ; 22(1): e310, ene.-abr. 2021. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251686

ABSTRACT

El Estreptococo Pneumoniae es un microorganismo patógeno capaz de causar en humanos diversas infecciones y procesos invasivos severos, siempre graves y potencialmente letales. El objetivo de este trabajo fue mostrar la infrecuente presencia del Estreptococo Pneumoniae en la aparición de los aneurismas micóticos aórticos y de arterias periféricas, una asociación muy particular que coloca al cirujano vascular ante una especial conducta terapéutica encaminada a erradicar la infección, evitar la ruptura y sustituir la arteria, para mantener la continuidad de la luz del vaso y prevenir situaciones graves de isquemia(AU)


Streptococcal Pneumoniae is a pathogenic microorganism capable of causing in humans various infections and severe, always serious and potentially lethal invasive processes. The objective of this work was to show the rare presence of Streptococcal Pneumoniae in the onset of aortic mycotic aneurysms and peripheral arteries, a very particular association that places the vascular surgeon in an special therapeutic behavior aimed at eradicating the infection, preventing ruptures and replacing the artery, to maintain the continuity of vessel's light and prevent serious ischemia's situations(AU)


Subject(s)
Humans , Male , Female , Arteries , Therapeutics , Aneurysm, Infected , Infections
2.
Rev. cuba. oftalmol ; 34(1): e907, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289537

ABSTRACT

El diagnóstico temprano de las lesiones compresivas del nervio óptico adquiere cada vez mayor importancia. La descompresión precoz de este o del quiasma puede resultar una mejora significativa de la función visual, mientras que el diagnóstico erróneo puede ocasionar pérdida visual irreversible, disfunción neurológica o la muerte. Las causas de la compresión de la vía visual anterior son increíblemente variadas. Los meningiomas, los tumores hipofisarios y los aneurismas son las lesiones comúnmente más identificadas como causa de neuropatía óptica compresiva sin edema del disco. Presentamos una paciente femenina de 50 años de edad, quien se sometió a la cirugía de catarata congénita del ojo izquierdo, sin mejoría de la función visual, a lo que se sumó el empeoramiento inespecífico de la calidad visual. La psicofísica visual, la campimetría automatizada y la tomografía de coherencia óptica aportaron hallazgos sugestivos de compresión de la vía visual intracraneal. Se indicó imagen por resonancia magnética de cráneo y órbitas para confirmar la sospecha diagnóstica. La angiografía cerebral demostró la presencia de un aneurisma de la arteria carótida interna, que se trató por vía endovascular con resultados satisfactorios(AU)


The importance of early diagnosis of compressive lesions of the optic nerve is on the increase. Timely decompression of the optic nerve or the optic chiasm may bring about significant visual function improvement, whereas erroneous diagnosis may result in irreversible visual loss, neurological dysfunction or death. The causes of compression of the anterior visual pathway are incredibly varied. Meningiomas, pituitary tumors and aneurysms are the lesions most commonly identified as causes of compressive optic neuropathy without disc edema. A case is presented of a female 50-year-old patient undergoing congenital cataract surgery of her left eye without visual function improvement, alongside unspecific visual quality worsening. Visual psychophysical testing, automated campimetry and optical coherence tomography contributed findings suggestive of intracranial visual pathway compression. Magnetic resonance imaging of the brain and orbits was indicated to confirm the diagnostic suspicion. Cerebral angiography revealed the presence of an internal carotid artery aneurysm which was treated by endovascular procedure with satisfactory results(AU)


Subject(s)
Humans , Female , Middle Aged , Carotid Artery, Internal/diagnostic imaging , Tomography, Optical Coherence/adverse effects , Early Diagnosis , Endovascular Procedures/methods , Visual Field Tests/methods
3.
Rev. inf. cient ; 100(1): 1-6, ene.-feb. 2021. graf
Article in Spanish | LILACS | ID: biblio-1156709

ABSTRACT

RESUMEN Los aneurismas venosos, en especial de la extremidad superior, son malformaciones vasculares de baja frecuencia. Se presentó el manejo de dos pacientes del sexo femenino atendidas en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente "Dr. Agostinho Neto" de la provincia Guantánamo, Cuba, a las que se les diagnosticaron aneurismas en diferentes segmentos del sistema venoso superficial de la extremidad superior, los que se resecaron quirúrgicamente y se les confirmó el diagnóstico mediante biopsia.


ABSTRACT Venous aneurysms, especially the ones located in the upper limbs, are vascular malformations with low incidence in the population. Two cases of venous aneurisms on female patients showed up at the Angiology and Vascular Surgery services at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo, Cuba. Aneurism diagnosis was confirmed through biopsy. They were located in different segments of the superficial venous system of the upper limbs, and were surgically resected.


RESUMO Os aneurismas venosos, principalmente de membro superior, são malformações vasculares de baixa frequência. Foi apresentada a gestão de duas pacientes do sexo feminino atendidas no Serviço de Angiologia e Cirurgia Vascular do Hospital General Docente "Dr. Agostinho Neto" da província de Guantánamo, Cuba, que foram diagnosticados com aneurismas em diferentes segmentos do sistema venoso superficial do membro superior, os quais foram ressecados cirurgicamente e o diagnóstico foi confirmado por biópsia.


Subject(s)
Humans , Female , Middle Aged , Upper Extremity/injuries , Aneurysm/surgery , Aneurysm/diagnosis
4.
J. vasc. bras ; 20: e20200173, 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1279374

ABSTRACT

Abstract In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.


Resumo Relatamos uma série de casos de quatro pacientes consecutivos, admitidos com emergências relacionadas a aneurismas aortoilíacos em um período de 3 dias e submetidos a tratamento endovascular. A primeira paciente, do sexo feminino, com 81 anos e com histórico de aneurisma da aorta, apresentou dor abdominal iniciada nos últimos 12 dias. O segundo paciente era do sexo masculino, com 63 anos e foi admitido com hematêmese 3 dias antes da admissão, com angiotomografia demonstrando fistula aortoentérica. A terceira paciente, do sexo feminino e com 77 anos, foi admitida com quadro de ruptura de aneurisma da artéria ilíaca comum direita. O quarto paciente consecutivo apresentou dor abdominal iniciada 2 semanas antes da internação e aneurisma roto da aorta. Todos os quatro pacientes apresentaram emergências aortoilíacas e receberam alta sem complicações maiores ou mortalidade cirúrgica. O relato desta série de casos demonstra que, apesar da situação pandêmica da COVID-19, uma vez que as cirurgias eletivas diminuíram, as urgências vasculares aumentaram.

5.
Article in Chinese | WPRIM | ID: wpr-878711

ABSTRACT

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.


Subject(s)
Aneurysm/surgery , Arteries , Humans , Treatment Outcome
6.
International Journal of Surgery ; (12): 700-705, 2021.
Article in Chinese | WPRIM | ID: wpr-907508

ABSTRACT

Intracranial aneurysms will lead to subarachnoid hemorrhage, which has a high mortality and morbidity risk. Screening high-risk aneurysms for preventive intervention has a positive effect, considering the widespread presence of unruptured aneurysms in the general population, this article reviews the risk factors of aneurysm rupture from the aspects of epidemiology, pathology, morphology and hemodynamics. In terms of epidemiology, smoking history, hypertension, age, gender and family inheritance are all closely related to the risk of aneurysm rupture. In terms of pathology, inflammation on the wall of intracranial aneurysm may be related to the risk of aneurysm rupture. In imaging, the size of intracranial aneurysms, location, the characteristics of the artery wall and some morphological and hemodynamic parameters can be used as evaluation index of fracture risk factors, at the same time the growth of intracranial aneurysm is one of the high risk indicators, the indicators for us in the future to establish intracranial unruptured aneurysms rupture risk factors evaluation model is of great significance.

7.
Article | IMSEAR | ID: sea-212614

ABSTRACT

Takayasu arteritis is an inflammatory pulseless disease of large arteries with unknown etiology which advances in three stages i.e. early systemic, vascular, and burnout stage. It is more prevalent in Asian women of childbearing age. Hypertension, fever, weight loss, arthralgia, limb claudication, light-headedness, and arterial pain are common manifestations. Angiography is a gold standard test to evaluate TA. There is no reliable serological marker has been identified. Control on the inflammatory process and hypertension are two imperative angles to treat the disease. Steroids are most used. Reconstructive surgeries are limited to severe and stenotic lesions. This review aims to report comprehensive evidence about Takayasu arteritis. We conducted an integrative review of theoretical and empirical publications reporting epidemiology, etiopathogenesis, classification, diagnostic evaluation, and management of TA. The authors searched PubMed, Embase, and Scopus until March 2020.  A total of 1104 records found, we included 37 papers for review after reading the articles. Remaining was excluded because of no innovative content, insufficient details, and no clear endpoints. This review of the literature presents comprehensive evidence in all fields of TA. Still, large areas need to be studied for better management of patients with TA.

8.
Rev. cuba. angiol. cir. vasc ; 21(2): e120, mayo.-ago. 2020. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126378

ABSTRACT

Introducción: Los aneurismas de aorta abdominal resultan dilataciones arteriales a dicho nivel. Su ruptura constituye uno de los principales riesgos y provoca la muerte del paciente, de ahí la importancia de tratarlos a tiempo. Las opciones actuales de tratamiento son la cirugía abierta y la reparación aneurismática endovascular; esta última representa la primera línea de tratamiento, por constituir una técnica mínimamente invasiva con bajas tasas de morbilidad y mortalidad. Objetivo: Evaluar el tratamiento endovascular del aneurisma de la aorta abdominal con endoprótesis percutáneas en pacientes cubanos. Métodos: Entre enero y abril de 2018 se realizó un estudio prospectivo, descriptivo y cualitativo en 6 pacientes del sexo masculino con aneurisma de aorta abdominal, seleccionados aleatoriamente, que cumplieron los criterios de uso de endoprótesis vasculares y estuvieron de acuerdo con realizar el proceder. Se colocaron 6 dispositivos en una sala de angiografía, y se utilizó en los pacientes anestesia general y guía fluoroscópica. Resultados: De forma satisfactoria fue posible el tratamiento endovascular por vía percutánea de los 6 pacientes seleccionados; solo 1 presentó una complicación menor y fue dado de alta a las 72 horas y el resto fue egresado en menos de 24 horas. Se logró implementar por vez primera en el país el sistema de cierre percutáneo Proglide sin complicaciones. Conclusiones: El tratamiento endovascular por vía percutánea de aneurismas de aorta abdominal con endoprótesis vasculares es una alternativa eficaz para la cirugía convencional en pacientes que cumplen los criterios de uso del dispositivo(AU)


Introduction: Abdominal aortic aneurysms are arterial dilations in that level. Their rupture is one of the main risks and it causes death in patients; that is why the importance of treating them early. Among the current treatment options are open surgery and endovascular aneurismal reparation, being the last one in the first line of treatment since it is a minimal invasive technique with low rates of morbidity and mortality. Objective: To evaluate the endovascular treatment of abdominal aortic aneurysm with percutaneous endoprosthesis in Cuban patients. Methods: It was conducted from January to April 2018 a retrospective, descriptive and qualitative study in 6 male patients with aneurysm of the abdominal aorta, selected randomly and who met the criteria of vascular endoprosthesis use and agreed with the performance of the procedure. Six devices were placed in an angiography room and it was used general anaesthetic and fluoroscopic guidance. Results: It was possible in a satisfactory way the endovascular treatment by percutaneous way in the six patients selected; just one presented a minor complication and he was discharged after 72 hours; and the rest were discharged in less than 24 hours. It was implemented for the first time in the country without complications the system of percutaneous closure called Proglide. Conclusions: Endovascular treatment by percutaneous way of abdominal aortic aneurysms with vascular endoprosthesis is an efficient alternative for conventional surgery in patients that met the criteria of use of the device(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Angiography/methods , Prospective Studies , Aortic Aneurysm, Abdominal/diagnosis , Epidemiology, Descriptive
9.
An. Fac. Cienc. Méd. (Asunción) ; 53(1): 59-70, 20200401.
Article in Spanish | LILACS | ID: biblio-1095646

ABSTRACT

Introducción: La Hemorragia Subaracnoidea es el sangrado en el espacio subaracnoideo. La causa espontánea en la mayoría de las veces se debe a ruptura de un aneurisma cerebral. Objetivo: Describir la casuística, manejo y resultados de los aneurismas cerebrales en el Hospital de Clínicas. Pacientes y método: Estudio observacional, descriptivo, transversal, incluyendo pacientes operados de aneurismas cerebrales, mayores de 17 años, en el Hospital de Clínicas del 2011 al 2019. Las variables descriptas fueron: edad, sexo, motivo de consulta, estudios radiológicos, escala de Glasgow y Hunt y Hess, localización, segmento, cantidad, fase, clipado temporario, vasoespasmo e hidrocefalia. Resultados: Se incluyó 249 pacientes; 45% masculino, 65% femenino, con edad promedio de 47,5 años. El motivo de consulta más frecuente fue cefalea. Al ingreso tuvieron predominantemente Hunt y Hess 2, y, Glasgow 15. El 43,2% eran Fisher 4. El Glasgow de egreso fue mayor o igual a 14 en 82,1%. Se diagnosticó el 51,7% con arteriografía; el 50,9% de los aneurismas en la carótida interna y, fueron múltiples en 10,84%. Se operaron en fase aguda 28,3%, 65% en fase tardía y, el 6,7% de los aneurismas fue de hallazgo casual. En 36,44% de los casos se realizó clipado temporario y, en el 70,4% se perforó la lámina terminalis. La mortalidad fue de 4,2%. Presentaron vasoespasmo radiológico en un 46% y, vasoespasmo clínico en 24,5 %. El 11% fue sometido a craniectomía descompresiva y, 5,5% desarrolló hidrocefalia dependiente de VDVP. Conclusión: El clipado de los aneurismas cerebrales es una técnica con buenos resultados y la única accesible en el sector público.


Introduction: Subarachnoid hemorrhage is bleeding in the subarachnoid space. The spontaneous is caused most of the time by rupture of a cerebral aneurysm. Objective: Describe the casuistry, management and results of cerebral aneurysms at the Hospital de Clínicas. Patients and methods: Observational, descriptive, cross-sectional study including patients operated for cerebral aneurysms, older than 17 years, at the Hospital de Clínicas from 2011 to 2019. The variables described were: age, sex, reason for consultation, radiological studies, Glasgow and Hunt and Hess scale, location, segment, quantity, phase, temporary clipping, vasospasm and hydrocephalus. Results: 249 patients were included; 45% male, 65% female, average age 47.5 years. The most frequent reason for consultation was headache. At admission they had predominantly Hunt and Hess 2, and Glasgow 15. 43.2% were Fisher 4. The Glasgow of discharge was greater than or equal to 14 in 82.1%. 51.7% were diagnosed with arteriography; 50.9% internal carotid aneurysms, multiple 10.84%. 28.3% were operated in acute phase, 65% late phase, 6.7% were a casually found. In 36.44% of cases a temporary clipping was performed and in 70.4% the lamina terminalis was perforated. Mortality was 4.2%, radiological vasospasm 46%, clinical vasospasm 24.5%, 11% underwent decompressive craniectomy and 5.5% developed VDVP-dependent hydrocephalus. Conclusion: The clipping of cerebral aneurysms is a technique with good results and the only one in the public sector.


Subject(s)
Intracranial Aneurysm/epidemiology
10.
Article | IMSEAR | ID: sea-204512

ABSTRACT

Background: Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis predominantly targeting medium-sized arteries defined as the main visceral arteries and their branches. The objective of this study was to analyze the epidemiology, clinico-pathological and point outcome of PAN in children at a tertiary care centre in Karnataka.Methods: This prospective observational study was conducted among eighteen children diagnosed with PAN from December 2015 to May 2017.' All the children fulfilling EULAR/PRES/PRINTO classification criteria for childhood PAN were included in this study. Clinico-pathological profile of these patients was studied and documented.Results: This study had shown that there are two peaks of age at onset of symptoms at 5 to 7 years and from 11 to 13 years. No sex predilection was noted. Most children present with nonspecific symptoms like myalgia (94%), fever (84%), weight loss (50%) and joint pain (50%). Skin manifestations were seen in all the children. Neurological involvement (61%) in the form of mononeuritis multiplex (38.8%), hypertensive encephalopathy (11%) and stroke (11%) was observed. Four children (22%) presented with pain abdomen while two boys had testicular pain. Only one child had renal manifestation in the form of glomerulonephritis. Most children had neutrophilic leukocytosis, elevated ESR and thrombocytosis. Skin biopsy was performed in ten children and out of these, 9 reports were suggestive of PAN. Angiography was done in four children revealing multiple aneurysms or stenosis in the systemic arteries. All the children received corticosteroids. Cyclophosphamide was used as an induction agent in about 50% of the patients. Corticosteroid treatment alone was sufficient in only one patient. Steroid sparing agent like azathioprine (38%), mycophenolate mofetil (33%) and hydroxychloroquine (5%) were used with low dose steroids as maintenance therapy. Seven children (39%) achieved remission off drugs while 8 children are still on treatment, one child relapsed and three children were lost to follow up.Conclusions: Childhood vasculitis leads to considerable delay in diagnosis the initiation of treatment. High index of suspicion and early referral is required in all cases of vasculitis to reduce morbidity and mortality.

11.
Article in Chinese | WPRIM | ID: wpr-855939

ABSTRACT

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.

12.
Article in Chinese | WPRIM | ID: wpr-880781

ABSTRACT

OBJECTIVE@#To explore genetic mutation types and their correlation with clinical phenotypes in Uighur patients with aortic disease in Kashgar (Xinjiang Uighur Autonomous Region, China).@*METHODS@#We examined 37 pathogenic genes in 19 Uighur families with aortic diseases including Marfan syndrome from Kashgar using next generation sequencing, and the results were confirmed by Sanger sequence in the first relatives.@*RESULTS@#This study included 19 families with aortic diseases, in whom a total of 23 variants were identified, and 11 (57.89%) probands had one or more variants. Among them, definite pathogenic mutation was detected in one patient (5.26%), variants of uncertain significance (VUS) were found in 8 (42.11%), and benign/likely benign variants were detected in 7 (36.84%). The 23 variants identified included one (5.26%) pathogenic variant, 14 (60.87%) VUS, and 8 (34.78%) benign/likely benign variants. The 14 VUS were analyzed by prediction with SIFT and Polyphen2 HDIV, which identified 6 (42.86%) variants as deleterious/possibly damaging; all the 8 benign/likely benign variants were predicted to be deleterious/possibly damaging.@*CONCLUSIONS@#We detected 23 genetic variants in the 19 Uighur families with aortic diseases, and 22 of these variants remain to be verified by more patient data in future studies.


Subject(s)
Aortic Diseases , China , Genetic Predisposition to Disease/genetics , High-Throughput Nucleotide Sequencing , Humans , Mutation , Phenotype
14.
Article in Chinese | WPRIM | ID: wpr-799067

ABSTRACT

Objective@#To detect the hemodynamic mechanism of the novel endovascular stent on complicated abdominal aortic aneurysms by Computational Fluid Dynamics(CFD) firstly, and then compare the effect of the novel endovascular stent and the streamliner multilayer flow modulator(SMFM) stent.@*Methods@#All medical images were obtained by computed tomography. A semiautomatic segmentation protocol within Mimics(v17.0; Materialise, Leuven, Belgium) was used to extract the threedimensional aortic aneurysms. The stents was generated numerically and fitted along the aortic aneurysms. The lumen volume represented the fluid domain that was discretised in smaller volumes, which defined a mesh within the ICEM software(Ansys ICEM CFD v15.0). Hemodynamic analysis was performed with software Fluent 16.0.@*Results@#Both kinds of stents can change the pattern of flow distribution. Compared with SMFM, the novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall.What’s more, the flow velocity of the branch artery was accelerated by the novel endovascular stent.@*Conclusion@#The novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall, and acceleratethe the flow velocity of the branch artery.

15.
Rev. chil. infectol ; 36(5): 636-641, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058090

ABSTRACT

Resumen Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda con riesgo de desarrollar aneurismas coronarios. Objetivos: Describir características clínico-epidemiológicas en niños con diagnóstico de EK en Argentina. Analizar factores de riesgo para el desarrollo de complicaciones coronarias (CC). Población y Métodos: Estudio multicéntrico, retrospectivo, transversal, observacional y analítico. Incluyó pacientes bajo 18 años de edad, con diagnóstico de EK en hospitales de Argentina, entre el 1 de enero de 2010 y el 31 de diciembre de 2013. Resultados: N = 193 sujetos. Edad: mediana: 29 meses. Tasa promedio total país 5 casos/10.000 egresos hospitalarios. Presentaron CC 15,5%. Mayor riesgo de CC: Mayor cantidad de días de fiebre al momento de colocación del tratamiento (p = 0,0033); Aumento de: frecuencia cardíaca (p = 0,0021), eritrosedimentación (VSG) (p = 0,005), proteína C reactiva (PCR) (p < 0,0001), leucocitosis (p = 0,0006), neutrofilia (p = 0,0021); Disminución de hematocrito (p = 0,0007) y hemoglobina (p < 0,0001). Asociación con CC: alteraciones cardiológicas no coronarias (ORv10.818); PCR mayor de 68 mg/L (OR = 11.596); leucocitos mayores a 20.000/mm3 (OR= 4.316); y VSG mayor de 64 mm/1° hora (OR = 4.267). Conclusión: La forma de presentación más frecuente fue EK completa, el riesgo de CC fue mayor en varones, menores de 5 años de edad, los factores de riesgo (clínicos y de laboratorio) fueron semejantes a los descritos en la bibliografía.


Background: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. Aim: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). Methods: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. Results: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). Conclusion: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Coronary Disease/etiology , Coronary Disease/epidemiology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/epidemiology , Argentina/epidemiology , Seasons , Blood Sedimentation , C-Reactive Protein/analysis , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Immunoglobulins, Intravenous/therapeutic use , Statistics, Nonparametric , Risk Assessment , Mucocutaneous Lymph Node Syndrome/therapy
16.
Arch. cardiol. Méx ; 89(3): 248-253, jul.-sep. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149074

ABSTRACT

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.


Subject(s)
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/physiopathology
17.
Rev. colomb. reumatol ; 26(2): 132-136, ene.-jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1115671

ABSTRACT

RESUMEN La enfermedad de Kawasaki forma parte de un grupo heterogéneo de afecciones de baja frecuencia que se caracterizan por la presencia de inflamación y necrosis de la pared vascular, que generan diversas manifestaciones clínicas y patológicas, las cuales comprometen medianos vasos, y que afectan principalmente a la población pediátrica. Presentamos el caso de un hombre de 36 arios de edad, sin antecedentes patológicos previos, con cuadro febril de 4 días de evolución asociado a cefalea, náuseas y odinofagia, con posterior aparición de múltiples lesiones maculopapulares generalizadas, las cuales se resolvieron con descamación en pulpejos, palmas y plantas. Se documenta conjuntivitis no supurativa bilateral, además de compromiso de la mucosa oral y los labios. La biopsia de piel reportó vasculitis linfocítica asociada a compromiso renal, hepático y cardiaco (miocardiopatía dilatada con fracción de eyección deprimida); se configuró el diagnóstico de enfermedad de Kawasaki completa del adulto con manifestaciones atípicas. Recibió tratamiento con metilprednisolona, ácido acetilsalicílico 100mg/día, una dosis única de inmunoglobulina IgG intravenosa 2 g/kg y terapia dialítica interdiaria, logrando una recuperación completa.


ABSTRACT Kawasaki disease is part of a heterogeneous group of low frequency diseases that are characterized by the presence of inflammation and necrosis of the vascular wall, generating various clinical and pathological manifestations, which compromise medium vessels, and mainly affecting the pediatric population. The case is presented of a 36-year-old man with no relevant past medical history, with a febrile episode of 4 days of onset, together with headache, nausea, and odynophagia with subsequent onset of multiple generalized maculopapular lesions. These resolved with subsequent desquamation of fingers, palms and soles of feet. Non-suppurative bilateral conjunctivitis is documented, as well as involvement of oral mucosa and lips. Skin biopsy reported lymphocytic vasculitis, associated with renal, hepatic and cardiac involvement (dilated cardiomyopathy with depressed ejection fraction). A diagnosis of complete adult Kawasaki disease with atypical manifestations was established. He was treated with methylprednisolone, acetylsalicylic acid 100 mg per day, and a single dose of intravenous IgG immunoglobulin 2 g/kg, and daily dialysis therapy to achieve complete recovery.


Subject(s)
Humans , Adult , Mucocutaneous Lymph Node Syndrome , Vasculitis , Methylprednisolone , Exanthema
18.
Gac. méd. Méx ; 155(2): 136-142, mar.-abr. 2019. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1286474

ABSTRACT

Resumen Introducción: En México no se cuentan con estadísticas adecuadas acerca de la enfermedad aórtica, que puede ser tratada mediante manejo médico o cirugía abierta o endovascular. Objetivo: Identificar la literatura en bases de datos electrónicas relativa al manejo invasivo de la patología aórtica en México. Método: Se realizó búsqueda sistemática y revisión narrativa de la literatura disponible en diferentes bases de datos electrónicas: PubMed, Imbiomed, Clinical Key, Bibliat, Scielo, Sage Journals, Sciencedirect y con el motor de búsqueda de Google Académico. Resultados: Se encontraron 90 artículos, de los cuales 50 reunían los criterios de inclusión. Fueron seleccionados estudios observacionales y reportes de casos, con énfasis en los datos demográficos de los pacientes, resultados clínicos y la supervivencia posoperatoria a 30 días. Conclusión: Se reporta elevada tasa de complicaciones de las enfermedades aórticas debido al infradiagnóstico de estas, que deriva en manejo más complejo y pronóstico desfavorable. La creación de un registro nacional de patología aórtica es crucial para la estandarización en el abordaje y la optimación de los resultados.


Abstract Introduction: In Mexico, there are no appropriate statistical data on aortic disease, which can be treated with medical management or open or endovascular surgical approach. Objective: To carry out a systematic search and review of the literature in electronic databases with regard to invasive management of aortic pathology in Mexico. Method: A systematic search and narrative review of available literature was carried out using different electronic databases: PubMed, Imbiomed, Clinical Key, Bibliat, Scielo, Sage Journals and Sciencedirect, as well as with the Google Scholar search engine. Results: Ninety articles were found, out of which only 53 met the inclusion criteria. Observational studies and case reports were selected, emphasizing on patient demographics, clinical results, and 30-day postoperative survival. Conclusion: An elevated rate of complications is reported for aortic pathologies due to underdiagnosis, which results in management being more complicated and prognosis unfavorable. The creation of a national aortic disease registry is crucial to standardization in the approach and optimization of results.

19.
Article | IMSEAR | ID: sea-208697

ABSTRACT

Aim: The aim of the study is to analyze the usefulness of lamina terminalis fenestration (LTF) in hydrocephalus secondary tosubarachnoid hemorrhage while performing surgical interventions for anterior circulation aneurysm and to know the limitationsof this procedure in patients who undergo clipping of these aneurysms.Materials and Methods: A total of 81 aneurysms in 78 patients were included in this study from the year 2001 to 2018. Patientsin the age range of 12–80 years were included. Male-female ratio was 1:1.1. Until February 2011, LTF was done for 9 patientswho had any degree of hydrocephalus as an adjuvant to clipping of the anterior circulation aneurysms. After March 2011, insteadof LTF, intraoperative ventricular tapping was done in patients with hydrocephalus.Results: Among the 9 cases who had undergone LTF, two patients developed frontoparietal subdural hygromas with masseffect. From March 2011 till date after stopping LTF, only 2 of 47 patients required ventriculoperitoneal shunt who ultimatelydeveloped chronic hydrocephalus.Conclusion: LTF can lead to potential complications such as subdural hygromas due to poor absorption in blood cloggedsubarachnoid spaces. This procedure must be adopted with caution as it has its own limitations.

20.
Article in Chinese | WPRIM | ID: wpr-856039

ABSTRACT

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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