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1.
Journal of Medical Biomechanics ; (6): E192-E196, 2022.
Article in Chinese | WPRIM | ID: wpr-920690

ABSTRACT

Thrombosis is the process of platelet adhesion and aggregation or blood coagulation after the body is subjected to certain physical and chemical stimuli. At present, the use of basic experimental research and computational simulation to understand thrombosis has become a research hotspot. The complex process of thrombosis makes computational modeling very difficult, but the development of calculation models has still made great progress. At present, a variety of calculation models for thrombosis have been developed, including coagulation models based on ordinary differential equations, mathematical models based on finite element analysis, Lattice-Boltzmann method models, smooth particle dynamics method models, etc. Each model has its advantages and disadvantages.In this review, the physiological mechanism of thrombosis was explained, the models for simulating thrombosis were also systematically sorted out and evaluated, and the limitations of computational simulation and future application prospects were summarized as well.

2.
Acta méd. colomb ; 46(1): 45-48, ene.-mar. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1278156

ABSTRACT

Resumen Se presenta un caso clínico de difícil abordaje terapéutico. Paciente masculino joven con obesidad tipo II, quien ingresa por síndrome coronario agudo con elevación del segmento ST, se realiza coronariografía que pone en evidencia un aneurisma ubicado en el tronco coronario con imagen sugestiva de trombo en su interior que se trató con inhibidor de glicoproteína IIb/IIIa. En la evolución presenta falla cardiaca aguda manejada con inotrópicos y vasopresores. En segunda coronariografía se observó desaparición completa del componente trombótico. Como prevención secundaria se deja tratamiento antiagregante plaquetario y antitrombótico. El manejo de estos pacientes a la fecha es un reto ante la posibilidad de presentar un nuevo evento trombótico por la alteración en el flujo laminar intracoronario.


Abstract We present a clinical case with difficult treatment. A young male patient with type II obesity was admitted due to acute coronary syndrome with ST elevation. Coronariography showed an aneurysm on the coronary trunk suggestive of having a thrombus inside. It was treated with a glycoprotein IIb/IIIa antagonist. The patient progressed to acute heart failure managed with inotropes and vasopressors. A second coronariography showed complete disappearance of the thrombotic component. He was prescribed antiplatelet and antithrombotic treatment as secondary prevention. To date, the management of these patients has been a challenge, given the possibility of experiencing a new thrombotic event due to altered intracoronary laminar flow.


Subject(s)
Humans , Male , Young Adult , Thrombosis , Coronary Aneurysm , Patients , Laminar Flow , Myocardial Infarction
3.
Article in Chinese | WPRIM | ID: wpr-922045

ABSTRACT

Atherosclerosis is a chronic inflammatory disease commonly seen in clinical practice. It can lead to thickening of vascular intima, occlusion of lumen stenosis and thrombosis, leading to angina pectoris, hypertension, myocardial infarction and other diseases, posing a serious threat to human life and health. This study provides a method for removing shield needles from graphene oxide thrombus and its preparation. The graphene oxide shield needle mainly includes flexible rotating shaft, radial flexible rod, rotating needle, adsorption main pipe and dosing main pipe, laser measuring device, high definition camera and other structures, which has the following advantages:firstly, it achieves multi-angle rotation grinding thrombosis, precise rotation grinding, avoids vascular damage and infection; secondly, thrombolytic drugs can be applied in the process of rotary grinding and small thrombus can be adsorbed to effectively avoid secondary embolization of blood vessels; thirdly, it a coating of graphene oxide on a rotating needle, which protects against bacteria and infection. This study has practical reference value for the development of thrombotherapy and the application of graphene in the medical field.


Subject(s)
Adsorption , Graphite , Humans , Needles , Thrombosis/prevention & control
4.
Article in Chinese | WPRIM | ID: wpr-912540

ABSTRACT

Bleeding and thrombotic diseases are closely related to various clinical departments. Laboratory-related tests play an important role in disease diagnosis and differential diagnosis, risk assessment, cause finding, and efficacy monitoring. Clot waveform analysis (CWA), as an automated coagulation detection technology, can provide more valuable information about the entire coagulation process of a plasma sample. A large number of studies have showed that CWA has certain value in the evaluation of coagulation status of COVID-19 patients, the judgment of clinical phenotype of hemophilia A (HA) patients, and the monitoring of direct oral anticoagulant drugs (DOAC). In-depth interpretation and application of CWA in different clinical settings can provide more laboratory information for diagnosis and treatment of bleeding and thrombotic diseases.

5.
Article in Chinese | WPRIM | ID: wpr-912535

ABSTRACT

Objective:To seek indicators or models for predicting the risk of deep vein thrombosis (DVT) after traumatic lower extremity fractures.Methods:A nested case-control study was conducted on 424 patients with traumatic lower extremity fractures in Beijing Jishuitan Hospital from May 2019 to December 2019. Patients with traumatic lower extremity fractures of the hip, femoral shaft, distal femoral, patella, tibial plateau, tibiofibular shaft, ankle or foot were 18 or older. Trauma patients were examined by venogram before surgery. 56 of 424 patients with traumatic lower limb fractures were diagnosed with preoperative DVT. Then, those with no evidence of DVT were paired by age, gender and fracture sites to those with DVT. Laboratory parameters included conventional coagulation tests and thrombotic biomarkers, such as D-dimer, plasmin-ɑ2-plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (tPAIC), and Caprini score was calculated. Univariate analysis was used to distinguish statistically significant variables between trauma patients with and without DVT. Then logistic regression analysis was applied to identify independent risk factors for post-traumatic DVT. The receiver-operating characteristic (ROC) curve analysis was employed to assess the efficacy of indicators in predicting the risk of DVT after traumatic lower extremity fractures.Results:The levels of tPAIC and Caprini score in patients with DVT after traumatic lower limb fractures were significantly higher than those in non-DVT patients ( P values of 0.036 and 0.016, respectively). D-dimer, PIC, and Caprini score were independent risk factors for preoperative DVT after traumatic lower limb fractures. Thus, we defined the Predicting Index as 0.098×D-dimer (mg/L FEU)+(-0.564) ×PIC (μg/ml)+0.233×Caprini score, and found that the area under the ROC curve for the Predicting Index was 0.721. Conclusions:Predicting Index, calculated by D-dimer, PIC and Caprini score, can comprehensively encompass the changes of risk factors between patients with and without DVT after traumatic lower limb fractures, and can well predict the risk of DVT after traumatic lower extremity fractures.

6.
Article in Chinese | WPRIM | ID: wpr-911591

ABSTRACT

Objective:To compare the clinical results of different endovascular thrombus reduction techniques in the treatment of acute lower extremity arterial thrombosis.Methods:The clinical data of 96 consecutive patients with acute femoral popliteal arterial thrombosis who were treated with catheter directed thrombolysis (CDT) and mechanical thrombus aspiration system (PMT) between Jan 2016 and Dec 2018 at Cangzhou People's Hospital and Peking University People's Hospital were retrospectively analyzed.Results:Ninty-six patients underwent thrombolytic surgery,including 36 with CDT thrombolysis, 28 with AngioJet aspiration alone and 32 with Rotarex aspiration alone. Angiojet thrombus aspiration reduced thrombus rate by 89.3% (25/28) and clinical success rate by 92.8% (26/28).The thrombus reduction rate of Rotarex group was 87.5% (28/32), and the clinical success rate was 96.8% (31/32). In the CDT thrombolytic group, the thrombolytic reduction rate was 61.1% (22/36), including 8 patients who underwent thrombectomy and 6 patients with PMT, with a clinical success rate of 86.1% (31/36). The rate of distal arterial embolization, puncture point and local subcutaneous hematoma and vascular rupture was 21.4%, 10.7% and 2.1%, respectively. There were no amputation cases reported during a mean 13 months follow-up.The survival rate was 97.9%. The first-stage patency rate of 67.8%, while the second-stage artery patency rate of 85.7% during the follow-up.Conclusion:Compared with CDT, PMT has higher efficiency and lower complication rate in the treatment of acute lower extremity arterial thrombosis.

7.
Chinese Journal of Urology ; (12): 730-734, 2021.
Article in Chinese | WPRIM | ID: wpr-911105

ABSTRACT

Objective:To explore the advantages of the modified right renal artery dissection in the laparoscopic resection of right renal carcinoma combined with venous tumor thrombus.Methods:From January 2016 to June 2016, a retrospective analysis of the three-dimensional CT images of renal blood vessels in 70 patients with full abdominal CT plain scan plus enhanced scan from Shandong Provincial Hospital Affiliated to Shandong First Medical University was performed. On the sagittal plane of the right margin of the aorta, the right renal artery was detected to locate above the left renal vein in 14 cases (20.0%), posterior in 33 cases(47.1%), and below in 23 cases(32.9%). In addition, on the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 1 case (1.4%), posterior in 26 cases(37.1%), and below in 43 cases (61.4%). Based on this finding, 11 patients with right kidney cancer combined with venous tumor thrombus, admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2016 to December 2019, were retrospectively analyzed. The average age of the patients was(58.7±6.8)(45-68) years old. The CT three-dimensional reconstruction of the renal blood vessels was shown on the sagittal plane of the right margin of the aorta before the operation, and the right renal artery was detected to locate above the left renal vein in 0 cases, posterior in 7 cases, and lower in 4 cases. On the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 0 case, behind in 3 cases, and below in 8 cases. Renal tumors are located in the upper middle in 5 cases and in the lower middle in 6 cases. The maximum diameter of the tumor to be resected was 8.5-12.0 cm, with an average of (10.0±1.4) cm. Among them, 4 cases had Mayo grade 0 tumor thrombus, 4 cases were grade Ⅰ tumor thrombus, and 3 cases were grade Ⅱ tumor thrombus. All 11 cases underwent transperitoneal laparoscopic surgery. During the operation, it was found that the relationship between the right renal artery and the left renal vein was consistent with the preoperative three-dimensional reconstruction of renal blood vessels. The modified right renal artery dissection method was used, that is, the right renal artery was detected and ligated between the inferior vena cava and the aorta, using the left renal vein as a mark, and then the right kidneys and vein tumor thrombi were removed.Results:All of the 11 operations in this group were completed successfully. The operation time was (110.5±29.8)(70-150) min, the average time of right renal artery dissection was(28.5±5.8)(16- 33) min, and the amount of intraoperative bleeding was(112.7±83.5)(20-300) ml. No serious complications occurred during the operation in 11 cases. Postoperative pathological examination showed 10 cases of clear cell carcinoma and 1 case of papillary cell carcinoma. The postoperative hospital stay was 4.2 (4.18±0.75) days. There were no complications such as secondary bleeding, infection, lower extremity venous thrombosis or pulmonary embolism. All 11 patients were followed up for 3 to 42 months, with an average of(19.5±12.1) months. One patient died 23 months after the operation, and no tumor recurrence or metastasis occurred in the remaining patients.Conclusions:When the right renal artery runs to the left edge of the inferior vena cava, it is mostly behind the left renal vein. In the laparoscopic resection of right renal cancer with venous tumor thrombus, the modified right renal artery dissection method can quickly find and dissociate the right renal artery. The operation time is short, the intraoperative bleeding is less, and no postoperative complications occur.

8.
Chinese Journal of Urology ; (12): 502-506, 2021.
Article in Chinese | WPRIM | ID: wpr-911058

ABSTRACT

Objective:To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.

9.
Article in Chinese | WPRIM | ID: wpr-910328

ABSTRACT

Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT). PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments, and the optimal treatment strategy remains controversial. With recent advances in techniques, the efficacy and safety of radiation therapy for PVTT has been improved. The optimization of individualized radiotherapy and multimodality treatment is the future direction of research. In this review, we will investigate the current state and future opportunities of radiation therapy and multimodality treatment for HCC with PVTT.

10.
Article in Chinese | WPRIM | ID: wpr-907945

ABSTRACT

Objective:To explore the case characteristics, treatment and prevention measures of cardiac thrombus in children caused by Mycoplasma pneumoniae infection, so as to improve the clinicians′ understanding of the disease.Methods:The clinical data of 10 children with cardiac thrombus caused by Mycoplasma pneumoniae infection treated in Department of Respiratory Intervention, Jinan Children′s Hospital from November 2015 to January 2020 were retrospectively analyzed, including datum of cases, laboratory results, imaging data and follow-up results.Results:A total of 10 children (7 males and 3 females) were included with the median age of 6.5 years old, and all had fever for more than 1 week.The plasma D-dimer (D-D) of 9 children was significantly increased, and the C-reactive protein (CRP) of 6 children was increased.After anti-infection treatment, the absorption of pneumonia with atelectasis was better than before.The embolus disappeared after operation in 1 case, and the remaining 9 cases received anticoagulant therapy, among which 7 cases received Heparin anticoagulant therapy alone: cardiac embolus disappeared during hospitalization in 2 cases, disappeared after 2 weeks of oral administration of Dipyridamole outside the hospital in 1 case, and the other 4 cases received Heparin anticoagulant therapy alone during hospitalization with poor effect, embolus disappeared in 2 cases 4 and 5 months after discharge respectively, and 2 cases were not reexamined due to personal reasons; the embolus disappeared 2 months after discharge in 2 cases who were changed to low-molecular weight Heparin + Warfarin anticoagulant therapy after failing to respond to Heparin anticoagulant therapy.All the 10 cases showed no symptoms of tachypnea or chest pain during telephone follow-up.Conclusions:Children with long fever time and significantly elevated CRP and D-D are more likely to form thrombus.Anticoagulant therapy is effective after thrombosis, and surgical thrombectomy can be performed in children who have failed to respond to anticoagulant therapy or worry about complications caused by dropped embolus.

11.
Article in Chinese | WPRIM | ID: wpr-907922

ABSTRACT

Objective:To investigate the feasibility and efficacy of combined general and cardiac surgery in the treatment of pediatric tumors with supradiaphragmatic inferior vena cava (IVC) and right atrium (RA) tumor thrombus.Methods:Retrospective analysis was performed on the clinical treatment of 8 pediatric tumor patients with supradiaphragmatic IVC and RA tumor thrombus treated by combined general and cardiac surgery in Children′s Hospital, Capital Institute of Pediatrics from June 2015 to May 2019.The operation was performed through a combined thoracoabdominal median incision.Cardiac surgeon opened the pericardium for cardiopulmonary bypass (CPB). Subsequently, general surgeon resected the primary abdominal tumor, cut open the subphrenic IVC, removed the subphrenic tumor thrombus, and made an attempt to remove the supradiaphragmatic tumor thrombus through the same incision of IVC.If the tumor thrombus cannot be completely removed through this incision, cardiac surgeon shall tighten the prefabricated pulmonary artery blocking band, establish CPB, and remove the supradiaphragmatic tumor thrombus in IVC or open RA to remove the atrial tumor thrombus.Results:In the 8 cases, there was hepatoblastoma in 4 cases, nephroblastoma in 3 cases, and adrenocortical carcinoma in 1 case.Among them, there was RA tumor thrombus in 4 cases, which was removed by right atrial thrombectomy under CPB; tumor thrombus in supradiaphragmatic IVC in 1 case, which was removed under CPB; subphrenic IVC in 3 cases, which was completely removed without the adoption of CPB.Among those 8 cases, 7 cases had complete resection of the tumor thrombus and 1 case had residual iliac vein tumor thrombus, and none of them developed pulmonary embolism.All the 8 cases underwent regular postoperative chemotherapy, and median follow-up time was 22.5 months (10-57 months), with 6 survived cases, 1 case died, and 1 case losing follow-up.Conclusions:Combined general and cardiac surgery can allow complete resection of the primary tumor and supradiaphragmatic and right a trial tumor thrombus in a single operation with reduced pain in patients, which could not only improve the rate of complete tumor resection but also reduce the risk of pulmonary embolism, thereby making the previously painful and risky surgery safer, more effective and more humane.

12.
Article in Chinese | WPRIM | ID: wpr-905866

ABSTRACT

Objective:To investigate the synergistic effect of Xiangdan injection (XDI) and Qingkailing injection (QKLI) in the treatment of inflammation and thrombosis animal model based on changes of thrombus, inflammatory indexes, organ function, and pathological changes. Method:A total of 100 male SD rats were randomly divided into a normal control group, a model group, XDI groups (2.5, 5 mL·kg<sup>-1</sup>), QKLI groups (5, 10 mL·kg<sup>-1</sup>), and XDI + QKLI groups [(2.5+5) mL·kg<sup>-1</sup>,(2.5+10) mL·kg<sup>-1</sup>,(5+5) mL·kg<sup>-1</sup>,and (5+10) mL·kg<sup>-1</sup>] according to the body weight, with 10 rats in each group. Rats were treated correspondingly by intraperitoneal injection once a day for 4 days. The normal control group and the model group received normal saline. On the second day of administration, the model was induced in rats except those in the normal control group. Specifically, 25 mg·kg<sup>-1 </sup>carrageenan was injected intraperitoneally into the rats, followed by an injection of 50 μg·kg<sup>-1</sup> lipopolysaccharide (LPS) through the tail vein 16 hours later. Twenty-four hours after LPS injection, the rats were detected for liver index, kidney index, the number of platelets (PLT), thrombus length, and biochemical indicators such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatinine, and blood urea nitrogen (BUN). Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-<italic>α</italic> (TNF-<italic>α</italic>). Hematoxylin-eosin (HE) staining was used to observe the histopathological changes of heart, liver, lung, and kidney, as well as the grading of organ injury. Result:Compared with the normal group, the model group showed decreased PLT, lengthened thrombus in the tail, increased liver index, elevated content of ALT, ALP, BUN, IL-6, and TNF-<italic>α</italic> (<italic>P</italic><0.05, <italic>P</italic><0.01), and damaged liver, lung, and kidney tissues (<italic>P</italic><0.05, <italic>P</italic><0.01). Compared with the conditions in the model group, XDI at 5 mL·kg<sup>-1</sup> reduced serum ALT and ALP in rats (<italic>P</italic><0.05, <italic>P</italic><0.01), QKLI at 5 and 10 mL·kg<sup>-1 </sup>reduced serum levels ALT and ALP, and TNF-<italic>α </italic>content<italic> </italic>(<italic>P</italic><0.05, <italic>P</italic><0.01). XDI at 5 mL·kg<sup>-1</sup> or QKLI at 10 mL·kg<sup>-1</sup> relieved the LPS-induced lung injury (<italic>P</italic><0.05), the combination of XDI and QKLI decreased the levels of ALT, AST, ALP, and TNF-<italic>α, </italic>and the effect was predominant in the combination of XDI and QKLI at 5 and 10 mL·kg<sup>-1 </sup>(<italic>P</italic><0.05, <italic>P</italic><0.01). Additionally, the length of the tail thrombus was significantly shortened (<italic>P</italic><0.05), and the degree of lung injury was also reduced (<italic>P</italic><0.05). The serum levels of ALT and BUN, TNF-<italic>α</italic> content, and liver index of rats were reduced after the combination of XDI and QKLI as compared with those in the single drug groups at the same dose (<italic>P</italic><0.05, <italic>P</italic><0.01). Conclusion:XDI or QKLI can improve or inhibit organ function, organ injury, and inflammatory response in the rat model of inflammation and thrombosis. The combination of the two drugs shows a synergistic effect in reducing the length of venous thrombus, improving liver and kidney function, inhibiting inflammatory factors, and protecting lung, liver, kidney, and other organs.

13.
Journal of Medical Biomechanics ; (6): E589-E595, 2021.
Article in Chinese | WPRIM | ID: wpr-904442

ABSTRACT

Objective To simulate the process of thrombus removal from the open-type stent retrievers, so as to provide theoretical references for the design and clinical application of the open-type stent retrievers. Methods Finite element models of the open-type stent retrievers with 3,4,5 supporting units (K3,K4,K5), the crimping tools, simulated vessels and simulated thrombus (three types) were established. Radial displacement load was applied on the crimping tool until the stent was crimped to 0.5 mm, and the maximum principal strain (MPS) peak and radial force (RF)of the stent were analyzed. When displacement of the crimping tool was restored, the stent self-expanded and contacted with blood vessels, and MPS of the stent and von Mises stress (VMS) of blood vessels were analyzed. Axial displacement was applied to proximal end of the stents to allow the stent to drive the clots to migrate, and the blood vessel VMS and withdrawal force of the stents (the ability to capture thrombus) were analyzed. ResultsThe MPS peaks for 3 types of stent retrievers during crimping process were 6.94%, 8.30% and 5.48%, which were all smaller than the 12% fracture limit. When the outer diameter of the stent was 3 mm (equal to the inner diameter of blood vessels), the K4 stent had the largest RF. The results of self-expanding release process showed that the larger the number of support units, the greater the VMS of blood vessels. At the stage of thrombus migration and removal,the VMS of blood vessels was generally small and concentrated on the thrombus. The withdrawal force of the stent reached the maximum at the initial stage of thrombus migration and removal, then gradually decreased. The peak withdrawal force of the K4 stent was larger than that of the K5 and K3 stent. Conclusions Although the MPS and VMS for 3 types of open-type stent retrievers were within the safe range, the K4 stent showed better performance in RF and withdrawal force with the three types of thrombus. The research findings can provide the analysis methods and ideas for optimizing the open-type stent retrievers, to avoid clinical complications such as vascular injury and improve safety and effectiveness of the stent retrievers.

14.
Article in Japanese | WPRIM | ID: wpr-873937

ABSTRACT

A 51-year-old man was referred to our hospital with pain and coldness of the upper left extremity. Contrasted computed tomography revealed a silhouette protruding into the aortic arch. Peripheral embolism in upper left extremity by tumor or thrombosis was suspected. Magnetic resonance imaging revealed a mobile mass in the aortic arch. To prevent recurrent embolization, the mass and the aortic arch to which the mass was attached were excised and partial arch replacement was performed under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus with no malignancy. The aortic wall showed only mild atherosclerosis of the intima. No thrombotic predisposition such as protein S or C deficiency or antiphospholipid antibody syndrome was observed. Anticoagulant therapy was started and the patient was discharged on postoperative day 10 without recurrent thromboembolism. Three years have passed since the operation and there is no recurrence of thromboembolism.

15.
Rev. invest. clín ; 72(6): 353-362, Nov.-Dec. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1289730

ABSTRACT

Abstract Background: Left ventricular (LV) thrombus formation is a common complication of anterior myocardial infarction (ANT-MI). The aim of this study was to investigate the relationship between apical longitudinal strain (ALS) and LV apical thrombus after ANT-MI. Methods: The cross-sectional study included a total of 235 patients who were followed up after primary percutaneous coronary intervention performed for ANT-MI and had a reduced LV ejection fraction (LVEF) (≤40%). Of these patients, 24 were excluded from the study, and the remaining 211 patients were included in the analysis. Patients were divided into two groups based on the presence (n = 42) or absence (n = 169) of LV thrombus detected by echocardiography. ALS was measured using speckle-tracking echocardiography. Results: Thrombus was detected in 42 of 211 patients. There was no significant difference between the groups regarding age or gender. Apical strain (AS), global longitudinal strain (GLS), apical wall thickness (AWT), and EF were significantly lower in patients with LV apical thrombus when compared to those without LV apical thrombus (AS, –5.00 ± 2.30% vs. −8.54 ± 2.48%, p < 0.001; GLS, −10.6 ± 3.54% vs. −12.1 ± 2.84%, p = 0.013; AWT, 4.71 ± 1.11 vs. 6.33 ± 1.78 mm, p < 0.001; EF, 31.40 ± 4.10% vs. 37.75 ± 3.17%, p < 0.001). On univariate and multivariate analyses, aneurysm (AA), AS, and AWT were found to be independent predictors of LV apical thrombus (AA, odds ratio [OR] 4.649, p = 0.010; AS, OR 1.749, p < 0.001; AWT, OR 0.729, p = 0.042). Conclusion: ALS is highly sensitive and specific for predicting LV thrombus after ANT-MI. An early and accurate evaluation of LV thrombus may prevent embolic complications, particularly cerebrovascular events.

16.
Rev. ADM ; 77(6): 312-315, nov.-dic. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1151256

ABSTRACT

La respuesta a la infección viral produce un estado de trombosis o hipercoagulabilidad que, unido a la inflamación de las células endoteliales, puede generar disfunción plaquetaria y predisposición a la formación de trombos que, aunque con frecuencia son más venosos, también pueden aparecer en el sistema arterial y producir infartos a cualquier nivel así como tromboembolia e hipertensión pulmonar. Estas manifestaciones han sido captadas hospitalariamente y al egreso de los pacientes detectados por SARS-CoV-2 habiendo ya cumplido el tiempo establecido de virulencia. Los criterios diagnósticos de respuesta inmunológica trombótica asociada a COVID-19 (RITAC) ayudan a seleccionar al paciente que está predispuesto a esta condición; a esto se añade que el paciente ya tiene un diagnóstico de infección por SARS-CoV-2 (AU)


The response to viral infection produces a prothrombotic state of hypercoagulability , united with an inflammation of endothelial cells, It can generate platelet dysfunction and predisposition to the formation of thrombus, that, although, are more frequently venous, Also, it can appear in the arterial system and cause heart attacks at any level; thromboembolism and pulmonary hypertension, as well. These manifestations have been captured hospitably and with the egress of patients detected by SARS-CoV-2. The diagnostic criteria of RITAC (abbreviation in Spanish of Thrombotic Immune Response Associated to COVID-19), help to select the patient who is predisposed to this condition; adding that the patient already has a diagnosis of SARS-CoV-2 infection (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pneumonia, Viral , Thrombosis , Coronavirus Infections , Betacoronavirus , Panama , Pulmonary Embolism , Dental Service, Hospital/statistics & numerical data
18.
J Cancer Res Ther ; 2020 Sep; 16(5): 1186-1190
Article | IMSEAR | ID: sea-213779

ABSTRACT

This study was designed to propose a classification of inferior vena cava tumor thrombus (IVCTT) and retrospectively evaluate the safety and efficacy of the combination therapy of transcatheter arterial chemoembolization (TACE) and sequential percutaneous ablation for hepatocellular carcinoma (HCC) with IVCTT. All HCC patients with IVCTT who underwent the combination therapies of TACE and sequential percutaneous ablation therapy between January 2015 and December 2017 in Beijing Youan Hospital were included in the study. The demographic, clinical, and pathological data were recorded. The response rate and overall survival (OS) rate were statistically analyzed. A classification system of IVCTT types was proposed based on the anatomical structure and ablation technique, which contained five types of IVCTT. Different types of IVCTT require different ablation strategies. For the response rate of IVCTT, complete response was achieved in all six patients. The 1- and 2-year OS rates were 88.3% and 55.6%, respectively. The new classification system and corresponding ablation strategies proposed in this study provided guidance for the use of ablation therapy for IVCTT. The combination therapy of TACE and ablation is effective and safe for treating HCC with IVCTT.

19.
Clinics ; 75: e1339, 2020. graf
Article in English | LILACS | ID: biblio-1089602

ABSTRACT

OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.


Subject(s)
Humans , Animals , Male , Cerebral Infarction/diagnostic imaging , Brain Ischemia/diagnostic imaging , Angiography, Digital Subtraction , China , Macaca mulatta , Models, Biological , Models, Cardiovascular
20.
Article in Chinese | WPRIM | ID: wpr-861990

ABSTRACT

Objective: To observe the safety and efficacy of large-lumen catheter aspiration combined with catheter-directed thrombolyses (CDT) and angioplasty for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) thromboses. Methods: A total of 74 patients with BCS combined with IVC fresh or mixed mainly fresh thromboses were selected, 32 cases were enrolled into thrombi aspiration group and 42 cases into simple thrombolytic group. Patients in thrombi aspiration group underwent CDT and endovascular angioplasty combined with large-lumen catheter aspiration, while those in simple thrombolytic group underwent only CDT and endovascular angioplasty. The thrombolytic effect, thrombolytic time, the amount of thrombolytic medicine and complications were compared between the two groups. Results: The technical success rate of the two groups were both 100%. The average thrombolytic time and the average dosage of urokinase in the thrombi aspiration group were all less than those in simple thrombolytic group (both P<0.05). In thrombi aspiration group, grade III, grade Ⅱ and grade thrombectomy were observed in 12, 19 and 1 cases, while in simple thrombolytic group were found in 17, 20 and 5 cases, respectively, and there was no significant difference between the two groups (P=0.33). Complications occurred in 2 patients (2/32, 6.25%) in thrombi aspiration group and 3 patients (3/42, 7.14%) in simple thrombolytic group, and no significant difference was found between 2 groups (P=1.00). Conclusion: Large-lumen catheter aspiration combined with catheter-directed thrombolysis can shorten the thrombolytic time, reduce the amount of thrombolytic drugs, therefore being safety for treating BCS with IVC thromboses.

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