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2.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 151-154, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352979

ABSTRACT

El caso expuesto a continuación demuestra que, a pesar del diagnóstico precoz de la endocarditis infecciosa, el buen pronóstico del paciente se da cuando el tratamiento es oportuno. Por lo tanto, es de suma importancia tener presente cuales son las posibles complicaciones para tratarlas a tiempo. Paciente de sexo masculino, de 72 años de edad, consultó por fiebre de ocho días de evolución. Al examen físico se constató soplo diastólico en foco aórtico. Retornaron hemocultivos positivos para streptococcus gallolyticus, se inició tratamiento con antibióticos según antibiograma; en la segunda semana de tratamiento presentó deterioro del sensorio, primero estuvo confuso y luego somnoliento. Se realizó una tomografía de cráneo simple en primera instancia y luego resonancia magnética encefálica donde se observaron lesiones compatibles con posibles complicaciones de la endocarditis infecciosa como el émbolo séptico. Se continuó con el mismo esquema de antibióticos por seis semanas con mejoría del sensorio. El germen aislado en el caso clínico se relaciona en un porcentaje no infrecuente en pacientes con patologías gastrointestinales, el dato positivo que se obtuvo dentro de sus hábitos fisiológicos era la constipación crónica como dato importante ya que se relaciona frecuentemente con pólipos intestinales o neoplasias que se descartaba con estudios complementarios. Además, que los patógenos frecuentemente implicados en complicaciones neurológicas fueron por S. aureus y Streptococcus gallolyticus, coincidiendo el último con el germen aislado en este caso clínico, además que presentaba dos de las muchas complicaciones como ictus isquémico y émbolos sépticos en un mismo paciente


The case presented below goes beyond the early diagnosis of infective endocarditis and the association of the patient's prognosis with timely treatment; It is also important to keep in mind about possible complications despite adequate clinical management. A male patient consulted for a fever of eight days of evolution, the positive finding on physical examination was the auscultation of a diastolic murmur in the aortic focus. Positive blood cultures returned for streptococcus gallolyticus, antibiotic treatment had been started according to the antibiogram, and in the second week of treatment there was deterioration of the sensorium. A simple skull tomography had been performed in the first instance and then brain magnetic resonance imaging showing lesions compatible with possible complications of infective endocarditis. The same antibiotic scheme was continued for six weeks with improvement of the sensorium. The isolated germ in the clinical case is related in a not infrequent percentage in patients with gastrointestinal pathologies, the positive data that was obtained within their physiological habits was chronic constipation as important data since it is frequently related to intestinal polyps or neoplasms that are ruled out with complementary studies. In addition, the pathogens frequently involved in neurological complications were S. aureus and Streptococcus gallolyticus, the latter coinciding with the isolated germ in this clinical case, in addition to presenting two of the many complications such as ischemic stroke and septic embolism in the same patient


Subject(s)
Embolism , Endocarditis , Ischemic Stroke
5.
Pesqui. vet. bras ; 40(10): 758-775, Oct. 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1143410

ABSTRACT

The aim of this study was to investigate the main causes of death in growing-finishing pigs in southern Brazil. During a one-year period (from 2018 to 2019), two industrial pig herds (18 and 20 thousand pigs each farm) in southern Brazil were monitored along the four seasons of the year (12 days per season on each farm), in order to perform necropsies of all pigs that died in that period. The two farms had an average monthly mortality rate ranging from 0.94 to 3.93% in the evaluated months. At necropsy, tissues were collected, fixed in 10% formalin solution and processed routinely for histopathological examination. When necessary, samples were sent for bacterial culture and PCR to identify etiologic agents. A total of 601 necropsies were performed, with 94.9% of conclusive diagnoses. Infectious diseases corresponded to 64.4% of conclusive diagnosis and non-infectious diseases to 35.6%. The most prevalent causes of death were: pneumonia (33%), gastric ulcers (15.4%), circovirosis (9.9%), systemic bacterial embolism (5.4%), polyserositis (4.4%), dilated cardiomyopathy and torsion of abdominal organs (4.3% each), and bacterial pericarditis (3.4%). Regarding pneumonias (199/601), the main agents identified in these cases were Pasteurella multocida, Influenza A virus and Mycoplasma hyopneumoniae, mainly in associations.(AU)


O objetivo do presente trabalho foi investigar as principais causas de morte de suínos em fase de crescimento e terminação no Sul do Brasil. Durante o período de um ano (entre 2018 e 2019), duas granjas tecnificadas de suínos no Sul do Brasil foram acompanhadas nas quatro estações (12 dias por estação em cada granja), para realização de necropsias dos suínos que morreram nesse período. As duas propriedades apresentavam mortalidade mensal média entre 0,94 e 3,93% nos meses avaliados. Na necropsia, amostras de órgãos foram colhidas, fixadas em formol 10% e processadas rotineiramente para o exame histopatológico. Quando necessário, amostras foram enviadas para o cultivo bacteriano e PCR para identificação de agentes etiológicos. Foram realizadas um total de 601 necropsias, com 94,9% de diagnósticos conclusivos. As doenças infecciosas corresponderam a 64,4% dos diagnósticos conclusivos e as não infecciosas a 35,6%. As principais causas de morte foram: pneumonias (33%), úlcera gástrica (15,4%), circovirose (9,9%), embolia bacteriana sistêmica (5,4%), polisserosite (4,4%), cardiomiopatia dilatada e torção de órgãos abdominais (4,3% cada) e pericardite bacteriana (3,4%). Com relação às pneumonias (199/601), os principais agentes associadas as lesões foram Pasteurella multocida, vírus da Influenza A e Mycoplasma hyopneumoniae, principalmente associados entre si.(AU)


Subject(s)
Animals , Pneumonia/mortality , Stomach Ulcer/mortality , Swine Diseases/mortality , Circoviridae Infections/mortality , Sus scrofa , Pasteurella multocida , Mycoplasma hyopneumoniae , Embolism/mortality
6.
Article in Chinese | WPRIM | ID: wpr-826344

ABSTRACT

Infective endocarditis is a microbial infection of the endocardium and can easily affect heart valve.Its characteristic lesion is vegetation formation,and the shedding of vegetation results in arterial embolism and ischemic necrosis of corresponding tissues and organs.A case of infective endocarditis with multiple extracardiac complications was described in this article.The characteristic ultrasound finding was the vegetation formation in anterior mitral valve.CT and MRI scans revealed involvements in multiple organs and blood vessels,which were manifested as splenic infarction,renal infarction,cerebral infarction,splenic aneurysm,superior mesenteric artery aneurysms,renal artery aneurysms,and distal segment stenosis and occlusion of right middle cerebral artery.


Subject(s)
Embolism , Endocarditis , Endocarditis, Bacterial , Humans , Infarction , Mitral Valve
7.
Article in English | WPRIM | ID: wpr-886668

ABSTRACT

@#INTRODUCTION: Persistent carotid-basilar anastomoses are potentially clinically relevant anomalies of the intracranial vasculature. The trigeminal artery is the largest and persists for the longest embryonic period among the anastomoses. The increasing use of arteriographic procedures has augmented its incidence to 0.1-1%. This is a case of a 39-yearold male who presented with acute occipital lobe infarct after sustaining a traumatic right carotid dissection. CASE PRESENTATION: A 39-year-old male was brought in to the emergency room after a 200-kilogram sack fell on his upper back. He landed on his chest with his head rotated to the right and sustained multiple lacerations on his face and chest. There were noted acute bilateral loss of vision, lethargy and unsteady gait. Computed tomography (CT) scan of the brain showed neither infarct nor hemorrhage. However, magnetic resonance imaging (MRI) of the brain revealed an acute occipital lobe infarct. The patient was started on antiplatelet. Further workup revealed a totally occluded right common carotid artery upon carotid duplex. His vision improved to be able to perceive light and hand movement. Further workup was done as an outpatient. A week after hospital discharge, patient’s vision improved to left bilateral hemianopsia. His gait has improved and was able to walk with balance. A cerebral angiogram later revealed a large bilateral persistent primitive trigeminal artery (PPTA). The right PPTA provided collateral flow to the right cerebral hemisphere. This primitive collateral vessel is believed to have served as a route for emboli to be thrown to the posterior circulation in the occipital lobe. CONSLUSION: The consideration of a persistent primitive carotid-basilar anastomoses may elucidate the physician when a gap between patient’s manifestation and imaging studies exist. The presence of persistent carotid-basilar anastomoses may herald other vascular anomalies, it may offer as alternative endovascular access, or may serve as access for emboli passage.


Subject(s)
Carotid Artery Diseases , Stroke , Aneurysm, Dissecting , Embolism , Arteries , Dissection
8.
Rev. Eugenio Espejo ; 13(2): 71-78, 20191202.
Article in Spanish | LILACS | ID: biblio-1048532

ABSTRACT

Las malformaciones arteriovenosas representan un grupo extenso y heterogéneo de lesiones. Dichas anomalías se caracterizan por ser congénitas y por representar un verdadero desafío diagnóstico y terapéutico. El presente caso trata de una paciente femenina de 7 años, sin antecedentes de importancia que presentó un cuadro evolutivo de 2 meses, caracterizado por cefalea a nivel fronto-parietal derecha y debilidad de miembro superior izquierdo. Mediante exámenes complementarios de imagen se identifica una malformación arteriovenosa-cerebelosa que compromete diencéfalo y tálamo derecho. Durante su estadía hospitalaria es sometida a embolización, lo que mejoró notablemente el cuadro patológico establecido.


Arteriovenous malformations represent a large and heterogeneous group of lesions. These anomalies are characterized by being congenital and representing a true diagnostic and therapeutic challenge. The present case deals with a 7-year-old female patient without health history of importance. She presented a 2-month evolutionary picture, specified by right frontal-parietal headache and left upper limb weakness. Complementary imaging tests identify an arteriovenous-cerebellar malformation that compromises the diencephalon and right thalamus. An embolization was applied during hospitalization, which markedly improved the established pathological picture


Subject(s)
Humans , Female , Child , Congenital Abnormalities , Cerebellum , Vascular System Injuries , Paresis , Stroke , Embolism
10.
Rev. colomb. cardiol ; 26(5): 286-291, sep.-oct. 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1092939

ABSTRACT

Resumen La aorta shaggy se define como una degeneración ateromatosa agresiva y extensa de la aorta, cuya friabilidad predispone a ulceración y complicaciones embólicas, cursa con alto riesgo de embolia sistémica y no se conocen prevalencia ni incidencia en poblaciones de riesgo. La mayoría de casos publicados hacen referencia a complicaciones en procedimientos quirúrgicos. En la literatura no se hallaron reportes que asocien ateroembolia aórtica con obstrucción de la arteria de Adamkiewicz, cuyo diagnóstico no siempre es posible visualizando su oclusión por angiotomografía o por angiorresonancia, pues el defecto puede ser evanescente o puede existir compromiso distal con obstrucción microvascular, difícilmente aparente con arteriografía selectiva. Se presenta un caso de mielopatía isquémica embólica asociada a aorta shaggy con probable oclusión de la arteria de Adamkiewicz como responsable del deterioro neurológico agudo de la paciente, confirmado por resonancia magnética nuclear. Para caracterizar mejor esta enfermedad y para tener las estrategias diagnósticas y terapéuticas apropiadas en su abordaje oportuno, consideramos importante el reporte de casos similares aumentando así su sospecha diagnóstica.


Abstract A shaggy aorta is defined as an aggressive and extensive atheromatous degeneration of the aorta. Its friability predisposes to ulceration and embolic complications. It carries a high risk of systemic embolisms, and its prevalence and incidence in risk populations is unknown. The majority of published cases mention complications in surgical procedures. No reports have been found in the literature that associate aortic atheroembolism with obstruction of the artery of Adamkiewicz. Its diagnosis is not always possible by visualising its occlusion by computed tomography angiography or by magnetic resonance angiography, since the defects may be evanescent, or there may be a distal compromise with a microvascular obstruction, hardly apparent with selected angiography. A case is presented of embolic ischaemic myelitis associated with a shaggy aorta, with probable occlusion of the artery of Adamkiewicz being responsible form the acute neurological deterioration of the patient, confirmed by a nuclear magnetic resonance scan. In order to better describe the features of this disease and to have the appropriate diagnostic and therapeutic strategies for its timely approach, it is considered important to report all similar cases, thus increasing its diagnostic suspicion.


Subject(s)
Humans , Female , Aged , Aorta , Atherosclerosis , Myelitis , Surgical Procedures, Operative , Magnetic Resonance Spectroscopy , Magnetic Resonance Angiography , Embolism
11.
Rev. méd. Hosp. José Carrasco Arteaga ; 11(1): 75-78, Marzo 2019. Ilustraciones
Article in Spanish | LILACS | ID: biblio-1016298

ABSTRACT

INTRODUCCIÓN:La embolización de cuerpos extraños intravasculares es una complicación poco frecuente; sin embargo, está asociada a alteraciones cardíacas y pulmonares en más del 50% de los casos. Actualmente se prefiere realizar el manejo utilizando técnicas de extracción por cateterismo cardíaco, esto debido a la naturaleza menos invasiva del procedimiento y a las menores tasas de mortalidad y complicaciones asociadas. A continuación se presenta un reporte de caso donde se realizó la extracción un catéter intracardiaco mediante vía percutánea. CASO CLÍNICO: Lactante de sexo masculino, de 51 días de vida, con antecedentes de prematuridad extrema y peso adecuado para edad gestacional, ingresado en el servicio de neonatología; a quien como acceso vascular central se le colocó un catéter percutáneo femoral. Tras el retiro del mismo se apreció rotura y embolización de los dos tercios distales; la evaluación radiológica evidenció catéter a nivel de cavidades cardíacas derechas. EVOLUCIÓN: Se inició antibioticoterapia por el riesgo de infección asociado. De forma exitosa se realizó la extracción del cuerpo extraño por intervencionismo percutáneo; el paciente evolucionó favorablemente, no presentó ninguna complicación. CONCLUSIÓN: La rotura y embolización del catéter es un evento poco frecuente que incrementa la morbimortalidad de los pacientes ingresados en neonatología. La extracción percutánea debe ser la primera opción por la eficacia y seguridad del procedimiento.(au)


BACKGROUND: The embolization of foreign intravascular bodies is a rare complication; however, it is associated with cardiac and pulmonary dysfunction in more than 50% of cases. Currently, it is preferred to perform the management using extraction techniques by cardiac catheterization; this is explained by the less invasive nature of the procedure and the lower mortality and complications rates. The following is a case report where an intracardiac catheter was extracted by a percutaneous procedure. CASE REPORT: Male, 52-day-old infant, with history of extreme prematurity and adequate weight for gestational age; hospitalized in the neonatology service; as central vascular access a percutaneous femoral catheter was placed. After removal, rupture and embolization of the distal two thirds were observed; the radiological evaluation showed a catheter at the level of right heart cavities. EVOLUTION: By the associated infection risk, antibiotic therapy was initiated. The foreign body was extracted successfully by percutaneous intervention; the patient presented a favorable evolution without any complications. CONCLUSIONS: The catheter rupture and embolization is a rare event that increases morbidity and mortality rates of patients admitted to neonatology. Percutaneous extraction should be the first option by the procedure efficacy and safety.(au)


Subject(s)
Humans , Male , Infant , Catheterization , Embolism , Femoral Vein , Catheters , Foreign Bodies
12.
Rev. colomb. cardiol ; 26(1): 3-9, ene.-feb. 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1058373

ABSTRACT

Resumen Introducción: Las masas cardiacas son una entidad heterogénea, que incluye lesiones neoplásicas y no neoplásicas y se clasifican en primarias y secundarias o metastásicas. Métodos: Estudio observacional analítico de tipo cohorte retrospectivo. Resultados: Se incluyeron un total de 73 individuos de los cuales se analizaron los datos de 66. Las masas cardiacas se diagnosticaron con mayor frecuencia en mujeres (53%). El síntoma más frecuente fue disnea (35%), seguido por dolor torácico (28%); otras manifestaciones comunes fueron fiebre (22%), pérdida de peso (22%) y focalización neurológica (22%). 44 pacientes fueron llevados a intervención quirúrgica o toma de biopsia de lesiones primarias encontrando como principal diagnóstico mixoma en 18 de ellos (27%); el resto de neoplasias primarias cardiacas fueron raras, fibroelastoma 2 casos (3%), al igual que rabdomioma y rabdomiosarcoma con solo un caso; el compromiso secundario fue frecuente con 18 casos (27%) representados principalmente por linfomas con 5 casos (8%), tumores primarios renales con 4 casos (6%) y cáncer de pulmón con 3 casos (5%). Dentro del seguimiento, el 77% estaban vivos en los siguientes seis meses del diagnóstico; la principal causa de muerte fue la progresión de la enfermedad oncológica (8 pacientes), seguida por ataque cerebrovascular (3 pacientes) y choque postoperatorio (2 pacientes). Conclusiones: Los pacientes con masas cardíacas con frecuencia tienen síntomas inespecíficos incluidos en tres ejes principales: insuficiencia cardíaca, síntomas generales y embolia sistémica. La frecuencia de mixoma auricular y las neoplasias secundarias fue similar.


Abstract Introduction: Cardiac masses are a heterogeneous condition, and include neoplastic and non-neoplastic lesions that can be classified as primary, secondary, or metastatic. Methods: An analytical observational study of a retrospective cohort. Results: A total of 74 subjects were included, of which the data of 66 of them were analysed. Cardiac masses were diagnosed more often in women (53%). The most frequent symptom was dyspnoea (35%), followed by chest pain (28%). Other common signs were fever (22%), weight loss (22%), and a neurological focus (22%). A total of 44 patients had surgery or a biopsy taken of the primary lesions found. The primary diagnosis was a myxoma in 18 (27%). The rest of the primary cardiac tumours were rare, with a fibroelastoma in 2 cases (3%), rhabdomyoma 2 cases (3%), and only one case of rhabdomyosarcoma. There was secondary involvement in 18 cases (27%), mainly as lymphomas in 5 cases (8%), primary renal tumours in 4 cases (6%), and lung cancer in 3 cases. During follow-up, 77% were alive in the six months following the diagnosis. The main cause of death was progression of the oncological disease (8 patients), followed a cerebrovascular attack (3 patients), and post-surgical shock (2 patients). Conclusions: Patients with cardiac masses of have non-specific symptoms included in three main groups: heart failure, general symptoms, and systemic embolisms. The frequency of atrial myxoma and secondary tumours was similar.


Subject(s)
Humans , Female , Adult , Heart Neoplasms , Myxoma , Neoplasms , Embolism , Heart Failure
14.
J. vasc. bras ; 18: e20180040, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-990123

ABSTRACT

O tromboembolismo venoso (TEV) é uma doença silenciosa e potencialmente letal que acomete parcela importante dos pacientes hospitalizados. Com alta morbimortalidade e elevado custo financeiro para o sistema de saúde, o TEV pode ser prevenido com uso da profilaxia, já estabelecida pela literatura. No mundo real, a profilaxia para TEV possui média de adequação inferior a 50%. Objetivos Definir o perfil epidemiológico do doente com TEV em um hospital universitário e a taxa de adequação da profilaxia para TEV no referido serviço, além de determinar meios para melhorá-la. Métodos Estudo transversal observacional realizado pela coleta de dados no prontuário médico dos pacientes que preencheram critérios de inclusão. Comparou-se a taxa de adequação da profilaxia para TEV prescrita para pacientes clínicos e cirúrgicos, segundo diretrizes da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV), de acordo com sua classificação de risco para TEV. Resultados A taxa global de adequação das prescrições de profilaxia para TEV foi de 42,1% versus 57,9% de inadequação. Pacientes clínicos obtiveram taxa de adequação de 52,9%, enquanto pacientes cirúrgicos obtiveram taxa de adequação de 37,5%. Conclusões As taxas de prescrição adequada para profilaxia para TEV ainda se encontram aquém do esperado. Educação continuada, estímulo à aplicação da estratificação de risco à beira do leito e adequações no sistema de prescrição eletrônica podem aumentar as taxas de prescrição adequada para profilaxia de TEV


Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates


Subject(s)
Humans , Male , Female , Adult , Disease Prevention , Venous Thromboembolism/diagnosis , Hospitals, University , Thrombosis , Health Profile , Chronic Disease , Cross-Sectional Studies , Risk Factors , Venous Thrombosis , Embolism , Myocardial Infarction
15.
Chonnam Medical Journal ; : 54-61, 2019.
Article in English | WPRIM | ID: wpr-719475

ABSTRACT

Rivaroxaban has emerged as a potential alternative to warfarin for the prevention of thromboembolism in patients with atrial fibrillation (AF). However, there has been concern for the risk of major bleeding, especially in Asian patients. We investigated the efficacy and safety of rivaroxaban compared to warfarin in Korean real world practice. A total of 2,208 consecutive non-valvular AF patients were divided into the Warfarin group (n=990) and the Rivaroxaban group (n=1218). Propensity matched 1-year clinical outcomes were compared (Warfarin, n=804; Rivaroxaban, n=804). The efficacy outcome was defined as stroke/systemic embolism (SE). The safety outcome was major bleeding. The primary net clinical benefit (NCB) was defined as the composite of stroke/SE, major bleeding, and all-cause mortality. Secondary, NCB was defined as the composite of stroke, SE, and major bleeding. Rivaroxaban had the similar efficacy in terms of thromboembolic event prevention [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.37–1.32, p=0.266] compared to warfarin. Rivaroxaban significantly lowered the risk of major bleeding [HR 0.41, 95% CI 0.22–0.76, p=0.004]. Primary NCB was significantly low in the rivaroxaban group [HR 0.54, 95% CI 0.36–0.81, p=0.003]. Secondary NCB was also low in the rivaroxaban group [HR 0.62, 95% CI 0.40–0.99, p=0.041]. Both rivaroxaban 15 mg and 20 mg groups had similar efficacy and significantly lower risks of major bleeding as well as primary and secondary NCB compared to the warfarin group. In patients with non-valvular AF, rivaroxaban had a similar efficacy to warfarin in Korean real world practice. However, rivaroxaban had better safety and net clinical outcomes compared to warfarin.


Subject(s)
Asian Continental Ancestry Group , Atrial Fibrillation , Cohort Studies , Embolism , Hemorrhage , Humans , Mortality , Rivaroxaban , Stroke , Thromboembolism , Warfarin
16.
Korean Circulation Journal ; : 829-837, 2019.
Article in English | WPRIM | ID: wpr-759475

ABSTRACT

BACKGROUND AND OBJECTIVES: Left ventricular (LV) apical thrombi are usually present with LV dilatation, and oral anticoagulants reduce embolic risk in these patients. However, echocardiographic data regarding thrombus resolution remain limited. We studied its echocardiographic features that were associated with early resolution (within 1 month). METHODS: We performed a retrospective observational study by reviewing baseline and follow-up echocardiographic images and medical records in patients with LV apical thrombi. RESULTS: Between January 2005 and December 2017, 77 patients (59 males, mean 61±12 years old) were enrolled. Patients were classified into 2 groups based on duration of thrombus resolution: group 1 showing resolution within 1 month (n=23) and group 2 with persistence after 1 month (n=54). Thrombus size was significantly smaller in group 1 (10.7±4.2 vs. 12.1±5.5 mm, p=0.046). Grade 1 mobility (partially mobile; odds ratio [OR], 7.800; p=0.012) and grade 2 mobility (highly mobile; OR, 14.625; p=0.002) were significantly associated with the early resolution. Round thrombi were associated with early resolution than mural form (OR, 3.187; p=0.026). Multivariate analysis showed that the mobility was the most important parameter, and a highly mobile (grade 2 mobility) LV apical thrombi showed earlier resolution (OR, 12.525; p=0.013). During the follow-up over 62±44 months, 25 patients (32.5%) had ≥1 adverse clinical events. The late resolution of thrombi was associated with poor long-term clinical outcomes (hazard ratio, 5.727; p=0.020). CONCLUSIONS: Mobility of LV apical thrombi was the most important parameter associated with early thrombus resolution. Late resolution of LV apical thrombi was associated with poor long-term clinical outcomes.


Subject(s)
Anticoagulants , Dilatation , Echocardiography , Embolism , Follow-Up Studies , Heart Ventricles , Humans , Male , Medical Records , Multivariate Analysis , Observational Study , Odds Ratio , Retrospective Studies , Thrombosis
18.
Article in Korean | WPRIM | ID: wpr-766741

ABSTRACT

Endoscopic obliteration with N-butyl-2-cyanoacrylate is the first-line treatment for gastric variceal bleeding. Although N-butyl-2-cyanoacrylate has higher success rate, there is some fatal complications such as systemic embolization. We report a case of 54-year-old male who developed myocardial and multiple cerebral infarction after endoscopic obliteration of gastric variceal bleeding with N-butyl-2-cyanoacrylate.


Subject(s)
Cerebral Infarction , Embolism , Enbucrilate , Esophageal and Gastric Varices , Humans , Male , Middle Aged
19.
Journal of Stroke ; : 184-189, 2019.
Article in English | WPRIM | ID: wpr-766248

ABSTRACT

BACKGROUND AND PURPOSE: To analyze long-term stroke recurrence (SR) characteristics after transient ischemic attack (TIA) according to initial etiological classification. METHODS: A prospective cohort of 706 TIA patients was followed up in a single tertiary stroke center. Endpoint was SR. Etiologic subgroup was determined according to the evidence-based causative classification system. Location of TIA and SR was recorded as right, left, or posterior territory. Disability stroke recurrence (DSR) was defined as modified Rankin Scale (mRS) score >1 or a one-point increase in those with previous mRS >1 at 3-month follow-up. RESULTS: During a follow-up of 3,493 patient-years (mean follow-up of 58.9±35.9 months), total SR was 125 (17.7%), corresponding to 3.6 recurrences per 100 patient-years. The etiology subgroups with a higher risk of SR were the unclassified (more than one cause) and large-artery atherosclerosis (LAA) categories. Of the SR cases, 88 (70.4%) had the same etiology as the index TIA; again, LAA etiology was the most frequent (83.9%). Notably, cardioaortic embolism was the most frequent cause (62.5%) of SR in the subgroup of 24 patients with undetermined TIA. Overall, SR occurred in the same territory in 74 of 125 patients (59.2%), with significant differences between etiological TIA subgroups (P=0.015). Eighty-two of 125 (65.6%) with SR had DSR, without differences between etiologies (P=0.453). CONCLUSIONS: SR occurred mainly with the same etiology and location as initial TIA, although undetermined TIA was associated with a high proportion of cardioaortic embolism SR. More than half of the recurrences caused some disability, regardless of etiology.


Subject(s)
Atherosclerosis , Classification , Cohort Studies , Embolism , Follow-Up Studies , Humans , Ischemic Attack, Transient , Prospective Studies , Recurrence , Stroke
20.
Journal of Stroke ; : 195-206, 2019.
Article in English | WPRIM | ID: wpr-766246

ABSTRACT

BACKGROUND AND PURPOSE: Patients with nonvalvular atrial fibrillation (NVAF) who survive an intracranial hemorrhage (ICH) have an increased risk of ischemic stroke and systemic embolism (IS/SE). We investigated whether starting oral anticoagulants (OACs) among older NVAF patients after an ICH was associated with a lower risk of IS/SE and mortality but offset by an increase in major bleeding. METHODS: We assembled a patient cohort from the Quebec Régie de l'Assurance Maladie du Québec (RAMQ) and Med-Echo administrative databases. We identified older adults with NVAF from 1995 to 2015. All patients with incident ICH and discharged in community were included. Patients were categorized according to OAC exposure. Outcomes included IS/SE, all-cause mortality, recurrent ICH and major bleeding after a quarantine period of 6 weeks. Crude event rates were calculated at 1-year of follow-up, and Cox proportional hazard models with a time-dependent binary exposure were used to assess adjusted hazard ratios (AHRs). RESULTS: The cohort of 683 NVAF patients with ICH aged 83 years on average. The rates (per 100 person-years) for IS/SE, death, ICH and major bleeding were 3.3, 40.6, 11.4, and 2.7 for the no OAC group; and 2.6, 16.3, 5.2, and 5.2 for OAC group, respectively. The AHR for IS/SE and death was 0.10 (95% confidence interval [CI], 0.05 to 0.21), 0.43 (95% CI, 0.19 to 0.97) for recurrent ICH and 1.73 (95% CI, 0.71 to 4.20) for major extracranial bleeding comparing OAC exposure to non-exposed. CONCLUSIONS: Initiating OAC after ICH in older individuals with NVAF is associated with a reduction of IS/SE and mortality and a trend in recurrent ICH supporting its use after ICH.


Subject(s)
Adult , Anticoagulants , Atrial Fibrillation , Cohort Studies , Embolism , Follow-Up Studies , Hemorrhage , Humans , Intracranial Hemorrhages , Mortality , Proportional Hazards Models , Quarantine , Quebec , Stroke
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