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2.
Article in Spanish | LILACS | ID: biblio-1292488

ABSTRACT

INTRODUCCIÓN: En 6 meses se notificaron más de 400 mil fallecidos por COVID-19. Han surgido múltiples investigaciones para comprender su etiopatogenia, siendo la autopsia médica uno de los mejores procedimientos para obtener información. Presentamos una revisión respecto a hallazgos post mortem publicados hasta mayo, 2020. RESULTADOS: Se recolectaron 12 estudios, de un total de 109 pacientes cuyo deceso fue por complicación respiratoria, predominó el sexo masculino, edad avanzada y con múltiples comorbilidades. El estudio PCR se realizó principalmente para diagnóstico. Se demostró ARN viral en riñón, hígado, corazón, cerebro y otros órganos. Los autores relataron presencia de micro y/o macro trombosis, en 50 de 109 casos, sobre todo a nivel pulmonar y renal, de tipo microscópica y relacionados a signos de shock. Desde la perspectiva anatomopatológica, se centra en alteraciones pulmonares y renales: daño alveolar difuso, injuria tubular aguda, microtrombos y otros signos de alteración microcirculatoria. Los estudios inmunohistoquímicos, de inmunofluoresencia y microscopía electrónica sugieren tropismo del virus por células epiteliales y estromales a nivel pulmonar y renal. En otros órganos se encuentran elementos morfológicos inespecíficos, atribuibles a patologías de base o shock. CONCLUSIÓN: El patrón histopatológico de daño alveolar difuso es frecuente, principalmente en fase exudativa o temprana. En el tejido renal destaca la injuria tubular aguda y daño microcirculatorio. El número y la descripción de muestras en otros órganos es reducida, siendo necesaria mayor casuística. La trombosis, es un trastorno prevalente en pulmones y riñones de pacientes con signos de shock. El tipo de trombo con más frecuencia descrito, es el microtrombo. Si bien se puede explicar como gatillante del fenómeno trombótico la interacción entre agente y huésped, otros factores deben ser estudiados para dilucidar la patogenia.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Thrombosis/pathology , COVID-19/pathology , Autopsy , Thrombosis/diagnosis , RNA, Viral/analysis , Polymerase Chain Reaction , COVID-19/diagnosis , COVID-19/mortality , Kidney/pathology , Kidney/virology , Liver/pathology , Liver/virology , Lung/pathology , Lung/virology
4.
J. vasc. bras ; 16(2): f:140-l:149, abr.-jun. 2017. ilus, tab
Article in Portuguese | LILACS | ID: biblio-859619

ABSTRACT

A síndrome antifosfolipíde (SAF) é uma doença autoimune sistêmica caracterizada por trombose arterial ou venosa recorrente e/ou morbidade gestacional e pela presença dos anticorpos antifosfolipídeos, podendo apresentar outras manifestações vasculares, como microangiopatia, arteriopatia crônica e SAF catastrófica. Determinados testes laboratoriais para a síndrome (por exemplo, o anticoagulante lúpico) podem sofrer interferência do uso de medicações anticoagulantes, dificultando o diagnóstico. A fisiopatologia da SAF é complexa, sendo enumerados no texto diversos mecanismos patogênicos relacionados à coagulação, ao endotélio e às plaquetas. Por fim, discutimos o tratamento da SAF de acordo com a presença e o tipo de manifestações clínicas, o uso dos anticoagulantes orais diretos e o manejo perioperatório de pacientes com SAF


Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent arterial or venous thrombosis and/or gestational morbidity and by the presence of antiphospholipid antibodies. It can also cause other vascular manifestations such as microangiopathy, chronic arteriopathy and catastrophic APS (CAPS). Certain laboratory tests for the syndrome (for example, the lupus anticoagulant test) can be affected by the use of anticoagulant agents, making diagnosis more difficult. The pathophysiology of APS is complex, and several mechanisms of pathogenesis related to coagulation, endothelium, and platelets are discussed in this article. We conclude by discussing treatment of APS according to the presence and type of clinical manifestations, use of direct oral anticoagulants (DOAs), and perioperative management of patients with APS


Subject(s)
Humans , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/physiopathology , Autoimmunity/immunology , Thrombosis/diagnosis , Thrombosis/therapy , Antibodies, Anticardiolipin , Anticoagulants/therapeutic use , Autoimmune Diseases/diagnosis , Autoimmune Diseases/physiopathology , Hemorrhage/complications , Heparin/therapeutic use , Lupus Coagulation Inhibitor , Risk Factors
5.
J. vasc. bras ; 16(2): 168-173, abr.-jun. 2017. ilus
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-859630

ABSTRACT

As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava


Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula


Subject(s)
Humans , Male , Aged , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Endovascular Procedures/methods , Fistula/complications , Vascular Closure Devices , Prostheses and Implants , Thrombosis/diagnosis , Thrombosis/therapy , Echocardiography/methods , Ultrasonography, Doppler/methods , Lower Extremity , Femoral Artery , Catheters
6.
J. bras. nefrol ; 38(4): 462-465, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-829061

ABSTRACT

Abstract We present the case report of a 19-year-old patient with chronic kidney disease due to chronic glomerulonephritis, in hemodialysis (HD) by central catheter, with the incidental finding of a mass of 28x16 mm in right atrium (RA). The diagnosis of thrombus, infective endocarditis or myxoma were considered. Given the context of immunosuppression and difficult access vascular therapeutic practice has proved complex. Although Doppler echocardiography suggested thrombus in RA, nuclear magnetic resonance imaging (MRI) indicated for the diagnosis of myxoma in RA. In both conditions, the proposed surgical approach was limited by intense immunosuppression history and the risk of infectious complications. Throughout the treatment, the general state of K.M.F. remained satisfactory and revealed no signs or symptoms related to atrial dysfunction. The absence of fever and negative blood cultures excluded infective endocarditis. Prior echocardiogram report without masses in the RA decreased the chance of cardiac myxoma. The therapeutic response to anticoagulation confirmed the diagnosis of thrombosis. After 180 days of anticoagulation, there was significant reduction in mass. The patient developed asymptomatic. The diagnosis of mass in RA can be a challenge and only the evolution of the case was able to guide the appropriate conduit. While MRI has high sensitivity and specificity for the diagnosis of cardiac myxoma, the interpretation of images can be subjective. Controversial point is the removal of the catheter in such cases, which is subject discussed throughout the report.


Resumo Apresentamos o relato de caso de uma paciente de 19 anos com doença renal crônica devido à glomerulonefrite crônica e em hemodiálise (HD) por cateter central, com o achado incidental de uma massa de 28x16 mm em átrio direito (AD). Foram considerados os diagnósticos de trombo, endocardite infecciosa ou mixoma. Devido ao contexto de imunossupressão e dificuldade de acesso vascular, a condução terapêutica revelou-se complexa. Apesar de Ecodopplercardiograma sugerir trombo em AD, imagens de ressonância nuclear magnética (RNM) apontaram para o diagnóstico de mixoma em AD. Nas duas condições a proposta de abordagem cirúrgica esteve limitada pelo histórico de imunossupressão intensa e o risco de complicações infecciosas. Ao longo do tratamento, o estado geral de K.M.F. manteve-se satisfatório e não foram observados sinais ou sintomas relacionados a disfunção atrial. A ausência de febre e hemoculturas negativas excluíram endocardite infecciosa. O relato de ecocardiograma prévio sem massas em AD tornou menor a possibilidade de mixoma cardíaco. A resposta terapêutica à anticoagulação confirmou o diagnóstico de trombo. Após 180 dias de anticoagulação, houve redução significativa da massa. A paciente evoluiu assintomática. O diagnóstico de massa em AD pode ser um desafio e somente a evolução foi capaz de guiar a conduta apropriada. Apesar da RNM ter elevada sensibilidade e especificidade para o diagnóstico de mixoma cardíaco, a interpretação de imagens pode ser subjetiva. Ponto controverso é a retirada de cateter nesses casos, que é assunto discutido ao longo do relato.


Subject(s)
Humans , Female , Young Adult , Endocarditis/diagnosis , Heart Atria , Heart Diseases/diagnosis , Heart Neoplasms/diagnosis , Mycoses/diagnosis , Myxoma/diagnosis , Thrombosis/diagnosis , Renal Dialysis , Diagnosis, Differential
7.
Rev. Assoc. Med. Bras. (1992) ; 62(7): 647-651, Oct. 2016. tab
Article in English | LILACS | ID: biblio-829517

ABSTRACT

Summary Introduction: In patients with essential thrombocythemia (ET), the vascular complications contribute to morbidity and mortality. To better predict the occurrence of thrombotic events, an International Prognostic Score for Thrombosis in Essential Thrombocythemia (IPSET-thrombosis) has recently been proposed. We present the application of this score and compare its results with the usual classification system. Method: We retrospectively evaluated the characteristics and risk factors for thrombosis of 46 patients with a diagnosis of ET seen in the last 6 years at Faculdade de Medicina do ABC (FMABC). Results: Thrombosis in the arterial territory was more prevalent than in venous sites. We observed that cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and smoking) were also risk factors for thrombosis (p<0.001). Age over 60 years and presence of JAK2 V617F mutation were not associated with the occurrence of thrombotic events. No patient classified by IPSET-thrombosis as low risk had a thrombotic event. Furthermore, using the IPSET-thrombosis scale, we identified two patients who had thrombotic events during follow-up and were otherwise classified in the low-risk group of the traditional classification. Leukocytosis at diagnosis was significantly associated with arterial thrombosis (p=0.02), while splenomegaly was associated with venous thrombotic events (p=0.01). Conclusion: Cardiovascular risk factors and leukocytosis were directly associated with arterial thrombosis. IPSET-thrombosis appears to be better than the traditional classification at identifying lower risk patients who do not need specific therapy.


Resumo Introdução: em pacientes com trombocitemia essencial (TE), complicações vasculares contribuem para morbidade e mortalidade. Para melhor predizer a ocorrência de eventos trombóticos, um escore prognóstico internacional de trombose para TE (IPSET-trombose) foi recentemente desenvolvido. Apresentamos aqui a aplicação desse escore e comparamos seus resultados com o sistema de classificação usual. Método: avaliamos retrospectivamente as características e os fatores de risco para trombose em 46 pacientes com diagnóstico de TE que foram atendidos nos últimos 6 anos na Faculdade de Medicina do ABC. Resultados: trombose em território arterial é mais prevalente que em sítio venoso. Observamos que fatores de risco cardiovascular (hipertensão, hipercolesterolemia, diabetes mellitus e tabagismo) foram considerados fatores de risco para trombose (p<0,001). Idade > 60 anos e presença de mutação JAK2 V617F não se associaram à ocorrência de eventos trombóticos. Nenhum paciente classificado como baixo risco pelo IPSET-trombose apresentou evento trombótico. Quando comparado à classificação de risco tradicional, IPSET-trombose foi capaz de identificar dois pacientes que evoluíram com trombose no seguimento e estavam categorizados no grupo de baixo risco. Leucocitose ao diagnóstico foi mais prevalente em pacientes que apresentaram trombose arterial (p=0,02), e esplenomegalia, entre aqueles com evento trombótico venoso (p=0,01). Conclusão: fatores de risco cardiovascular e leucocitose se associaram de forma direta com trombose arterial. IPSET-trombose parece ser melhor que a classificação tradicional na identificação de pacientes de baixo risco que não precisam de terapia específica.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Thrombosis/etiology , Risk Assessment/methods , Thrombocythemia, Essential/complications , Prognosis , Reference Values , Thrombosis/diagnosis , Brazil , Smoking/adverse effects , Retrospective Studies , Risk Factors , Diabetes Complications , Janus Kinase 2/genetics , Hospitals, Public/statistics & numerical data , Hypertension/complications , Middle Aged
8.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(2): 128-133, abr.-jun.2016. tab
Article in Portuguese | LILACS | ID: lil-796517

ABSTRACT

Aproximadamente 30% dos pacientes que se apresentam com quadro de síndrome coronariana aguda têm revascularização prévia do miocárdio. Os eventos coronarianos subsequentes à revascularização do miocárdio podem ocorrer por progressão da doença aterosclerótica no leito coronário nativo, evento relacionado ao stent (reestenose, trombose ou neoaterosclerose) ou evento relacionado à cirurgia de revascularização domiocárdio (degeneração ou oclusão de enxertos cirúrgicos). Esses pacientes que necessitamde um novo procedimento de revascularização têm perfil de alto risco, geralmente associado a doença renal crônica, diabetes mellitus, doença arterial periférica, além deelevada carga aterosclerótica no leito coronariano nativo, degeneração de enxertos de veia safena e reestenose de stents. Este cenário faz com que o segundo procedimento de revascularização tenha maior risco e maior complexidade. Neste artigo discutiremos as características clínicas e as possibilidades terapêuticas de pacientes com SCA e revascularização percutânea ou cirúrgica prévias.


Around 30% of patients who present acute coronary syndrome have undergone previous myocardial revascularization. Coronary events following myocardial revascularization can occur due to progression of atherosclerotic disease in the native coronary bed, an event related to the stent (restenosis, thrombosis or neoatherosclerosis) or to the myocardial revascularization surgery (degeneration or occlusion of surgical grafts). These patients who need a new revascularization procedure have a high-risk profile, generally associated with chronic kidney disease, diabetes mellitus, and peripheral arterial disease, as well as a high atherosclerotic burden in the native coronary bed, degeneration of grafts of the saphenous vein, and restenosis of stents. This scenario confers a higher risk and greater complexity on the second revascularization procedure. In this article, we discuss the clinical characteristics and therapeutic possibilities of patients with ACS and previous percutaneous or surgical revascularization.


Subject(s)
Humans , Percutaneous Coronary Intervention/methods , Coronary Restenosis/diagnosis , Coronary Restenosis/therapy , Myocardial Revascularization/adverse effects , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Angioplasty/methods , Acute Disease , Risk Factors , Stents , Thrombosis/diagnosis , Thrombosis/therapy , Coronary Vessels/surgery , Saphenous Vein , Heart Ventricles
9.
Dental press j. orthod. (Impr.) ; 20(4): 63-67, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-757421

ABSTRACT

OBJECTIVE: To assess facial morphology (Pattern) and sagittal relationship between dental arches (Class), and establish a potential association between them and the variables sex, age and ethnicity, among schoolchildren aged between 4 and 9 years old (mean age of 6.7 years) in primary and mixed dentitions.METHODS: The sample comprised 875 children (457 males and 418 females) attending schools in Descalvado, São Paulo, Brazil. An attempt was made with a view to establish a potential association between children's morphological features with sex, age and ethnicity.RESULTS: Descriptive analysis revealed a predominance of facial Pattern I (69.9 %) and Class I (67.4 %). Statistical tests (p < 0.001) showed that Class I was more frequent among Pattern I children, whereas Class II prevailed among Pattern II, and Class III was frequent among Pattern I and III children. Ethnicity was the only variable associated with facial pattern.CONCLUSIONS: Results suggest that facial pattern and sagittal relationship between dental arches tend to be correlated. Ethnicity was associated with facial pattern, with Pattern I being the most recurrent among Caucasians and facial Pattern II being recurrent among Afro-descendant subjects.


OBJETIVO: avaliar a morfologia facial (Padrão) e a relação sagital entre as arcadas dentárias (Classe) e determinar a associação entre sexo, idade e etnia, em escolares com 4 a 9 anos de idade (média de 6,7 anos), nas fases de dentadura decídua e mista.MÉTODOS: a amostra constou de 875 crianças (457 do sexo masculino e 418 do sexo feminino) de escolas do município de Descalvado/SP, que tiveram suas características morfológicas relacionadas ao sexo, idade e etnia.RESULTADOS: com base na análise descritiva dos dados, constatou-se que há predominância do Padrão I (69,9%) e da Classe I (67,4%). Nos testes estatísticos (p < 0,001), ficou evidente que a Classe I foi mais frequente no Padrão I; a Classe II, no Padrão II; e a Classe III, igualmente frequente nos Padrões I e III; apenas a raça teve associação com o padrão facial.CONCLUSÃO: o padrão facial e a relação sagital entre as arcadas dentárias tendem a estar relacionados, e a etnia tem associação com o padrão facial, sendo mais recorrente o Padrão I nos leucodermas e o Padrão II nos melanodermas.


Subject(s)
Animals , Dogs , Male , Dog Diseases/diagnosis , Heart Diseases/veterinary , Thrombosis/veterinary , Dog Diseases/pathology , Heart Atria/pathology , Heart Diseases/diagnosis , Heart Diseases/drug therapy , Heart Diseases/pathology , Thrombosis/diagnosis , Thrombosis/drug therapy , Thrombosis/pathology
10.
Rev. bras. cardiol. invasiva ; 23(1): 22-27, abr.-jun.2015. tab
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-782171

ABSTRACT

O stent liberador de everolimus XIENCE V® é um stent farmacológico de nova geração que incorpora uma plataforma de cromo-cobalto de baixo perfil (81 m) e um polímero de elevada biocompatibilidade (fluoropolímero), o qual carreia e controla a liberação do fármaco everolimus. Estudos recentes demonstram segurança e eficácia sustentadas do dispositivo XIENCE V® no tratamento de populações da prática clínica. Nosso objetivo foi reportar resultados clínicos de 12 meses do protocolo brasileiro BRAVO. Métodos: O registro BRAVO foi um estudo prospectivo, não randomizado, de braço único, multicêntrico (25centros), que avaliou os resultados clínicos tardios de 535 pacientes minimamente selecionados, tratados com o stent farmacológico XIENCE V®.Resultados: Cerca de 40% dos pacientes tinham diabetes, 25% infarto agudo do miocárdio prévio e 42% apresentaram-se com síndrome coronária aguda. A maioria das lesões (69%) era de elevada complexidade(ACC/AHA tipo B2/C). As médias da extensão e do diâmetro nominais dos stents foram, respectivamente, 19,9 ± 5,3 mm e 3,0 ± 0,4 mm. Os sucessos angiográfico e de procedimento foram de 99,7 e 98%, respectivamente. Aos 12 meses, a taxa cumulativa de eventos cardíacos adversos maiores, disponível em 100% dos pacientes, foi de 5,6% (morte cardíaca: 1,3%; infarto agudo do miocárdio: 3,0%; revascularização da lesão-alvo: 2,2%). Já a trombose de stent ocorreu em cinco pacientes (0,9%), sendo reportada apenas uma ocorrência entre 6 e 12 meses. Conclusões: O stent farmacológico XIENCE V® demonstrou segurança e eficácia sustentadas ao final de 12meses no tratamento de lesões coronárias complexas em pacientes da prática diária...


The Xience VTM everolimus-eluting stents is a new generation drug-eluting stent (DES)that incorporates a low profile cobalt-chromium platform (81 m) and a highly biocompatible polymer(fluoropolymer), which carries and controls the release of everolimus. Recent studies have demonstrated sustained safety and efficacy of the Xience VTM in the treatment of real-world populations. Our aim was to report the clinical results of 12 months of the BRAVO Brazilian protocol. Methods: The BRAVO Registry was a prospective, non-randomized, single-arm, multicenter (25 centers) study that evaluated the late clinical results of 535 minimally selected patients treated with the drug eluting stent Xience VTM in Brazilian daily practice. Results: Overall, 40% of patients had diabetes, 25% prior myocardial infarction, and 42% presented with acute coronary artery syndrome. The majority of lesions (69%) was highly complex (ACC/AHA type B2 or C).The mean length and the nominal stent diameter were 19.9 ± 5.3 mm and 3.0 ± 0.4 mm, respectively.The angiographic and procedural successes were 99.7 and 98%, respectively. At 12 months, the cumulative rate of major adverse cardiac events, available in 100% of patients, was 5.6% (cardiac death: 1.3%; acute myocardial infarction: 3.0%; revascularization of the target lesion: 2.2%). Stent thrombosis occurred in 5 patients (0,9%), and only 1 case was reported between 6 and 12 months. Conclusions: The drug-eluting stent Xience V™ demonstrated sustained safety and efficacy up to 12 months in the treatment of complex coronary lesions in patients from daily practice...


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Disease , Percutaneous Coronary Intervention/methods , Patients , Drug-Eluting Stents , Thrombosis/complications , Thrombosis/diagnosis , Statistical Analysis , Prospective Studies , Risk Factors , Prostheses and Implants/methods , Treatment Outcome
11.
Rev. bras. cardiol. invasiva ; 23(1): 28-37, abr.-jun.2015. ilus, tab
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-782172

ABSTRACT

No estudo BIOACTIVE, avaliamos as respostas vasculares após implante do stent eluidor de biolimus A9 (SEB; BioMatrix®) e o stent eluidor de everolimus (SEE; XIENCE V®). Apresentamos a análise detomografia de coerência óptica (OCT) 6 meses pós-intervenção. Métodos: Os pacientes foram randomizados para tratamento com SEB (n = 22) ou SEE (n = 18). O desfecho primário foi a frequência de hastes não cobertas e mal apostas pela OCT. Resultados: A OCT foi realizada em 26 pacientes (SEB: n = 15; SEE: n = 11) e foram analisadas 749 imagens tomográficas e 7.725 hastes de stent. SEB e SEE apresentaram áreas luminais e dos stents semelhantes.A área de hiperplasia neointimal, a espessura neointimal e o porcentual de obstrução intra-stent (8,44 ± 5,10% vs. 9,21 ± 6,36%; p = 0,74) foram similares. As taxas de hastes não cobertas (SEB: 2,10 ± 3,60% vs. SEE: 2,46 ± 2,15%; p = 0,77) e mal apostas (SEB: 0,48 ± 1,48% vs. SEE 0,44 ± 1,05%; p = 0,94) foram baixas e semelhantes. A frequência de frames com sinais compatíveis com infiltrado inflamatório peri-haste foi baixa e similar entre SEB (15,53 ± 20,77%) e SEE (11,70 ± 27,51%; p = 0,68).Conclusões: Stents farmacológicos de segunda geração SEB e SEE se mostraram igualmente eficientes emsuprimir a formação neointimal aos 6 meses, com respostas vasculares favoráveis. A frequência de framescom sinais de infiltrado peri-haste por paciente foi baixa, e menor do que a historicamente observada comos stents farmacológicos de primeira geração...


In BIOACTIVE study, we evaluated vascular responses after the implant of biolimus A9-eluting stent (BES; BioMatrixTM) and the everolimus-eluting stent (EES; XIENCE VTM). In this study, we present the optical coherence tomography analysis (OCT) 6 months post-intervention. Methods: Patients were randomized to treatment with BES (n = 22) or EES (n = 18). The primary outcome was the frequency of non-covered, poorly positioned struts by OCT.Results: OCT was performed in 26 patients (BES: n = 15; EES: n = 11) and 749 tomographic images and 7,725stent struts were analyzed. BES and EES showed similar luminal and stent areas. Neointimal hyperplasia area, neointimal thickness and the percentage of in-stent obstruction (8.44 ± 5.10% vs. 9.21 ± 6.36%; p = 0.74) were similar. The rates of not covered struts (BES: 2.10 ± 3.60% vs. ESS: 2.46 ± 2.15%, p = 0.77) and poorly positioned struts (BES: 0.48 ± 1.48% vs. EES 0.44 ± 1.05%, p = 0.94) were similarly low. The frequency of frames with signs consistent with peri-strut inflammatory infiltrate was low and similar between BES (15.53 ± 20.77%) and EES (11.70 ± 27.51%; p = 0.68). Conclusions: The second-generation drug-eluting stents BES and EES were equally effective at suppressing the neointimal formation after 6 months, with favorable vascular responses. The frequency of frameswith peri-strut infiltrate signals per patient was low, and lower than that observed historically with firstgenerationdrug-eluting stents...


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Disease/physiopathology , Coronary Disease/therapy , Drug-Eluting Stents , Tomography, Optical Coherence/methods , Statistical Analysis , Prospective Studies , Percutaneous Coronary Intervention/methods , Polymers/therapeutic use , Treatment Outcome , Thrombosis/complications , Thrombosis/diagnosis
12.
Article in English | IMSEAR | ID: sea-158467

ABSTRACT

Nanotechnology has been integrated into healthcare system in terms of diagnosis as well as therapy. The massive impact of imaging nanotechnology has a deeper intervention in cardiology i.e. as contrast agents , to target vulnerable plaques with site specificity and in a theranostic approach to treat these plaques, stem cell delivery in necrotic myocardium, etc. Thus cardiovascular nanoimaging is not limited to simple diagnosis but also can help real time tracking during therapy as well as surgery. The present review provides a comprehensive description of the molecular imaging techniques for cardiovascular diseases with the help of nanotechnology and the potential clinical implications of nanotechnology for future applications.


Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/diagnostic imaging , Humans , Nanomedicine/methods , Nanostructures/toxicity , Nanotechnology/methods , Theranostic Nanomedicine/methods , Thrombosis/diagnosis , Thrombosis/diagnostic imaging
15.
Article in Korean | WPRIM | ID: wpr-153827

ABSTRACT

A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.


Subject(s)
Amyloidosis/complications , Endoscopy, Digestive System , Female , Heart Atria/diagnostic imaging , Heart Failure/complications , Humans , Immunoglobulin kappa-Chains/blood , Immunoglobulin lambda-Chains/blood , Immunohistochemistry , Magnetic Resonance Imaging , Middle Aged , Stomach Diseases/complications , Thrombosis/diagnosis , Tomography, X-Ray Computed , Ultrasonography
16.
Full dent. sci ; 6(21): 45-52, dez. 2014.
Article in Portuguese | LILACS, BBO | ID: lil-750181

ABSTRACT

Os anticoagulantes orais (AOC) e antiagregantes plaquet rios sÆo drogas utilizadas para a preven‡Æo de fen“menos tromboemb¢licos, como tromboembolismo pulmonar em pacientes com fibrila‡Æo atrial e/ou v lvulas card¡acas, trombose e embolismo pulmonar. Para pacientes submetidos a procedimentos cir£rgico-odontol¢gico eram solicitados a interromperem o uso dos anticoagulantes at‚ que o valor do INR se mantivesse ≤que 2.0, de modo a evitar hemorragias no trans e p¢s-operat¢rio. No entanto, a interrup‡Æo do AOC pode causar a forma‡Æo de um co gulo, levando a obstru‡Æo das vias sangu¡neas. Sendo assim, tornava-se duvidosa a interrup‡Æo do medicamento para a realiza‡Æo de cirurgias odontol¢gicas, em que medidas hemost ticas locais seriam suficientes para promover hemostasia. Deste modo, o objetivo da revisÆo foi avaliar o risco de hemorragia em pacientes usu rios de AOC que sÆo submetidos a procedimentos cir£rgicos, por meio de um levantamento bibliogr fico realizado em estudos cl¡nicos relevantes publicados entre 1990 e 2012, pela base Medline/PubMed. Nesta revisÆo de literatura concluiu- se que o benef¡cio da preven‡Æo de tromboembolismo supera o risco de hemorragia, assim sendo, recomenda-se manter a dose da terapia com anticoagulantes inalterada para pacientes submetidos … cirurgia oral menor e Implantodontia, utilizando n¡veis de INR adequado, com aux¡lio de hemost tico locais. Al‚m disto, uma t‚cnica cir£rgica apurada deve ser realizada nestes pacientes. Com rela‡Æo … cirurgia oral mais invasiva com risco de hemorragia, pode ser necess rio o tratamento em conjunto com a equipe m‚dica.


The oral anticoagulants (AOC) and platelet antiagregants are drugs used for the prevention of thromboembolic phenomena, such as pulmonary embolism in patients with atrial fribrilation heart valves, thrombosis and pulmonary embolism. For patients who are undergoing surgical procedures-dentistry were asked to discontinue the use of anticoagulants until the value of the INR remained≤2.0, that in order to avoid trans and hemorrhages in the postoperative period. However, the AOC can cause the formation of a clot, leading to obstruction of blood pathways. Thus, it became doubtful the medicine for surgery, in which local hemostatic measures would be sufficient to promote hemostasis. Thus, the objective of the review was to evaluate the risk of bleeding in patients AOC users that are subjected to surgical procedures, through a bibliographical survey carried out in relevant clinical studies published between 1990 and 2012, by the MedlinePubMed data. In this review of literature was concluded that the benefit of thromboembolism prevention overcomes the risk hemorrhage, therefore, it is recommended to keep the dose of anticoagulant therapy unchanged for patients undergoing oral surgery and implant dentistry, using appropriate INR levels with the assistance of local hemostatic. In addition, a refined surgical technique should be performed in these patients. With respect to the most invasive oral surgery, with a risk of bleeding, treatment may be necessary in conjunction with the medical staff.


Subject(s)
Anticoagulants/administration & dosage , Hemostasis , Surgery, Oral , Thrombosis/diagnosis , Protocols
17.
Arch. cardiol. Méx ; 84(4): 273-275, oct.-dic. 2014. ilus
Article in English | LILACS | ID: lil-744061

ABSTRACT

Intracardiac thrombosis is a rare manifestation of cardiac involvement in Behçet's disease, and it may be mistaken for a heart tumor. In this letter we present the case of a patient diagnosed with Behçet's disease who was incidentally found to have a mass in the right atrium suspicious of a cardiac tumor. Nevertheless, cardiac magnetic resonance showed a cardiac thrombus. Immunosuppressive therapy and anticoagulation were effective for thrombus resolution.


La trombosis intracardiaca es una manifestación muy rara del compromiso cardiaco en la enfermedad de Behçet, la cual puede confundirse con una masa tumoral. Se presenta el caso de una paciente con esta enfermedad a quien de manera incidental se le detectó una masa intraauricular derecha sugestiva de tumor intracardiaco. Sin embargo los hallazgos de la resonancia magnética cardiaca fueron los de un trombo intracavitario que se resolvió con tratamiento inmunosupresor y terapia anticoagulante.


Subject(s)
Female , Humans , Middle Aged , Heart Diseases/diagnosis , Heart Neoplasms/diagnosis , Thrombosis/diagnosis , Behcet Syndrome/complications , Diagnosis, Differential , Heart Diseases/etiology , Heart Neoplasms/etiology , Thrombosis/etiology
18.
Article in English | WPRIM | ID: wpr-95300

ABSTRACT

Massive thoracoabdominal aortic thrombosis is a rare finding in patients with iatrogenic Cushing syndrome in the absence of any coagulation abnormality. It frequently represents an urgent surgical situation. We report the case of an 82-year-old woman with massive aortic thrombosis secondary to iatrogenic Cushing syndrome. A follow-up computed tomography scan showed a decreased amount of thrombus in the aorta after anticoagulation therapy alone.


Subject(s)
Aged, 80 and over , Anticoagulants/therapeutic use , Aorta, Abdominal/diagnostic imaging , Cushing Syndrome/complications , Electrocardiography , Female , Humans , Iatrogenic Disease , Thrombosis/diagnosis , Tomography, X-Ray Computed , Treatment Outcome
19.
ABC., imagem cardiovasc ; 26(4): 335-340, out.-dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-705131

ABSTRACT

Os principais objetivos para o relato deste caso foram: Enfatizar a importância do diagnóstico ultrassonográfico de um trombo móvel na carótida interna, responsável pelo acidente vascular de um paciente atendido no setor de emergência e descrever uma nova técnica de imagem futurística, denominada Caracterização Tecidual Ultrassonográfica (CATUS). A CATUS tem a finalidade de avaliar e estimar a composição do trombo, a sua aderência na parede arterial e o risco de embolização relacionado em potencial com a gravidade de sintomas cerebrovasculares. A demonstração ultrassonográfica do trombo móvel foi o fator determinante para o planejamento cirúrgico e a endarterectomia confirmou a presença do material trombótico.


The objectives of this case report were: to emphasize the importance of the ultrasonographic diagnosis of a floating thrombus in the internal carotid artery, linked to a stroke on a pacient seen in the emergency room, and to describe a new visionary imaging technique, ultrasonographic tissue characterization (USTC), designed toevaluate and estimate the thrombus composition, it’s adherence to the vascular walland embolization risk. Ultrasonographic demonstration of a embolus was determinant factor for surgical planning. Presence of the thombus was confirmed during carotidendarterectomy.


Subject(s)
Humans , Male , Middle Aged , Carotid Arteries/surgery , Endarterectomy, Carotid/methods , Endarterectomy, Carotid , Thrombosis/complications , Thrombosis/diagnosis , Ultrasonography/methods , Ultrasonography , Stroke/complications , Echocardiography/methods , Echocardiography
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