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1.
Rev. med. Risaralda ; 27(1): 92-95, ene.-jun. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1280498

ABSTRACT

Resumen Las malformaciones venosas son lesiones vasculares benignas infrecuentes que se presentan en el útero. Están conformadas por venas anormales, de diferentes tamaños y proporciones, con configuración espongiforme y disposición al azar. En la literatura, han sido previamente reportados algunos casos, usando el término "hemangioma cavernoso", pero según los cambios recientes en la terminología, aprobados por Sociedad Internacional para el Estudio de las Anormalidades Vasculares (ISSVA), se desaconseja el uso de este término y se sugiere el de "Malformación venosa", si se cumplen los hallazgos histopatológicos al momento de hacer el diagnóstico. Presentamos el caso de una mujer de 44 años, con cuadro de hemorragia vaginal anormal y diagnóstico clínico de miomatosis y mioma abortado por el orificio cervical interno, el estudio histopatológico reveló la presencia de una malformación venosa que comprometía el miometrio y endometrio, con formación subsecuente de un pólipo.


Abstract Venous malformations are benign vascular lesions that rarely appear in the uterus. They are made up of abnormal veins, of different sizes and proportions, with spongiform configuration and random disposition. In the literature, some cases have been previously reported, using the term "cavernous hemangioma", but according to recent changes in terminology, approved by the International Society for the Study of Vascular Abnormalities (ISSVA), the use of this term is discouraged, and the diagnosis of Venous malformation is suggested, if the histopathological findings are met. We present the case of a 44-year-old woman, with abnormal vaginal bleeding and a clinical diagnosis of myomatosis and myoma aborted by the internal cervical orifice, in whom the histopathological study revealed the presence of a venous malformation that compromised the myometrium and endometrium, with subsequent formation of a polyp.


Subject(s)
Humans , Female , Adult , Uterus , Vascular Malformations , Hemangioma, Cavernous , Uterus/pathology , Vascular System Injuries , Hemangioma , Morphogenesis
2.
Rev. cuba. angiol. cir. vasc ; 22(1): e281, ene.-abr. 2021. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251684

ABSTRACT

Los traumas vasculares periféricos poseen una frecuencia elevada en relación con las lesiones vasculares y conllevan a una incapacidad significativa a pacientes relativamente jóvenes. La identificación oportuna y el manejo inicial adecuado de este tipo de lesión son muy importantes para su posterior evolución. Este artículo tuvo como objetivo exponer la importancia del tratamiento oportuno del trauma vascular en dos pacientes llegados el mismo día al servicio de urgencias del Hospital Militar Central "Dr. Luis Díaz Soto". Se presenta como primer caso a un paciente masculino de 44 años de edad, con antecedentes de salud aparente. Sufrió una herida de aproximadamente 12 cm en el brazo izquierdo, que se acompañó de sangramiento e hipotensión arterial. Se le colocó injerto protésico y se le realizó anastomosis término-terminal en la arteria humeral porque presentaba sección completa de esta; su evolución fue favorable. El segundo caso se trata de un paciente masculino de 60 años de edad, con antecedentes de salud aparente. Sufrió un trauma en el antebrazo izquierdo que le provocó una herida de alrededor de 8 cm, con sangramiento, palidez y frialdad del tercio distal del antebrazo, cianosis reversible de la mano, impotencia funcional, ausencia de pulso radial e hipotensión arterial. Se le realizó anastomosis término-terminal de arteria radial porque presentaba sección completa de esta y su evolución resultó favorable. El tratamiento oportuno y acertado del trauma vascular evitó la pérdida de la vida de los pacientes, disminuyó la presencia de complicaciones, aseguró una evolución rápida y redujo incapacidades en estos(AU)


Peripheral vascular traumas have a high frequency in relation to vascular lesions, and lead to significant disability in relatively young patients. Timely identification and adequate initial management of this type of lesion are very important for its subsequent evolution. This article aimed to show the importance of timely treatment of vascular trauma in two patients who arrived on the same day at the emergency service of Dr. Luis Díaz Soto Central Military Hospital. The first case presented corresponds to a 44-year-old male patient apparently without previous heath conditions. He had a wound of approximately twelve centimeters on the left arm, which was accompanied by bleeding and arterial hypotension. The patient was placed a prosthetic graft and performed an end-to-end anastomosis in the brachial artery because it was completely sectioned. The patient's evolution was favorable. The second case corresponds to a 60-year-old male patient with an apparent health history. He suffered a trauma to his left forearm that caused a wound of about 8 cm, with bleeding, paleness and coldness of the distal third of the forearm, reversible cyanosis of the hand, functional impotence, absence of radial pulse and arterial hypotension. End-to-end anastomosis of the radial artery was performed because the patient presented complete section of the artery and his evolution was favorable. Timely and correct treatment of vascular trauma prevented the loss of life in both patients, reduced the presence of complications, ensured a rapid evolution, and reduced their disabilities(AU)


Subject(s)
Humans , Male , Female , Pulse , Brachial Artery , Radial Artery , Transplants , Emergencies , Vascular System Injuries
3.
Rev. Col. Bras. Cir ; 48: e20202783, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155358

ABSTRACT

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.


RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.


Subject(s)
Humans , Male , Adult , Tourniquets/statistics & numerical data , Vascular System Injuries/therapy , Exsanguination/prevention & control , Hemorrhage/prevention & control , Emergency Medical Services , Emergency Treatment , Extremities/injuries , Vascular System Injuries/complications , Vascular System Injuries/mortality , Exsanguination/etiology , Exsanguination/mortality , Hemorrhage/etiology , Hemorrhage/mortality
4.
Chinese Journal of Traumatology ; (6): 401-403, 2021.
Article in English | WPRIM | ID: wpr-922352

ABSTRACT

Shark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.


Subject(s)
Adult , Animals , Bites and Stings/complications , Humans , Limb Salvage , Male , Retrospective Studies , Sharks , Vascular System Injuries/surgery
5.
Rev. bras. anal. clin ; 52(4): 303-309, 20201230. ilus
Article in Portuguese | LILACS | ID: biblio-1223466

ABSTRACT

A Doença de Behçet (DB) é uma afecção entendida por ser inflamatória, multissistêmica,de causa ainda desconhecida, apresentando sintomas como úlceras orais, genitais, uveíte, lesões cutâneas e vasculites recorrentes, sendo mais frequente nos países que se estendem desde o Mediterrâneo até o extremo Oriente. Reconhecida atualmente como uma doença autoimune, a DB parece agregar elementos genéticos do portador e fatores ambientais desencadeantes. Para o estabelecimento de critérios internacionais para um diagnóstico, protocolos clínicos foram desenvolvidos para auxiliar a atividade da doença assim permitindo a padronização das pesquisas na área, ainda que não existam alterações laboratoriais ou histopatológicas definidas da doença. O diagnóstico depende de uma avaliação clínica criteriosa que, quando precoce, é determinante para o prognóstico.Neste artigo são revistos dados clínicos para o diagnóstico da Doença de Behçet.


Behçet's disease (DB) is an affection understood to be multisystemic inflammation of an as yet unknown cause, presenting symptoms such as oral ulcers, genitalia, uveitis, cutaneous lesions and recurrent vasculitis. It is more frequent in countries stretching from the Mediterranean to the Far East. Currently recognized as an autoimmune disease, DB appears to aggregate carrier genetic elements and environmental triggering factors. The establishment of international criteria for a diagnosis, clinical protocols were developed to aid the activity of the disease thus allowing the standardization of research in the area, although there are no laboratory or histopathological changes defined disease, the diagnosis dependent on a careful clinical evaluation that when are determinants for the prognosis. In this article we review clinical data for the diagnosis of Behçet's Disease.


Subject(s)
Autoimmune Diseases , Behcet Syndrome/diagnosis , Vascular System Injuries
6.
Int. braz. j. urol ; 46(6): 1021-1028, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134271

ABSTRACT

ABSTRACT Objective To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole. Materials and Methods Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes. Results Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region. Conclusion The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.


Subject(s)
Animals , Vascular System Injuries , Nephrectomy/adverse effects , Renal Artery , Swine , Sheep , Models, Animal , Kidney/surgery
7.
Rev. colomb. cardiol ; 27(2): 117-121, mar.-abr. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1138764

ABSTRACT

Resumen La ruptura de la vena cava inferior durante los procedimientos de intervencionismo percutáneo es una complicación infrecuente que se asocia con alta tasa de mortalidad aunque sea detectada a tiempo y se realice reparo quirúrgico, el cual es hoy el estándar de manejo. No existen hasta el momento casos reportados de manejo percutáneo de perforación de la vena cava durante procedimientos de electrofisiología. Se describe el caso de una paciente llevada a aislamiento eléctrico de venas pulmonares para el manejo de fibrilación auricular paroxística, en quien, durante el procedimiento, se produjo perforación accidental de la vena cava inferior con la sonda de ecocardiografía intracardiaca, la cual fue tratada exitosamente mediante el uso de un balón de alta distensibilidad con lo que se logró adecuada hemostasia sin necesidad de intervención quirúrgica. Se considera que el uso de un balón de alta distensibilidad puede ser una herramienta útil en el control del sangrado asociado a lesiones vasculares iatrogénicas, y que por consiguiente todo intervencionista debería tener presente.


Abstract Rupture of the inferior vena cava during percutaneous intervention procedures is an uncommon complication. It is associated with a high rate of mortality, even when it is detected at the time and the current standard management, surgical repair is performed. At present there are no cases reported of the percutaneous management of a vena cava perforation during electrophysiology procedures. The case is described of a patient subjected to electric ablation of pulmonary veins for the management of paroxysmal atrial fibrillation. During the procedure there was an accidental rupture of the inferior vena cava with the echocardiography cardiac catheter. She was successfully treated using a high-compliance balloon, with adequate haemostasis being achieved without surgical intervention. The use of a high-compliance balloon is considered as a useful tool in the control of bleeding associated with iatrogenic vascular injuries, and for this reason all interventionist should be aware of it.


Subject(s)
Humans , Female , Aged , Pulmonary Veins/abnormalities , Rupture , Vena Cava, Inferior , Wounds and Injuries , Venae Cavae , Echocardiography , Electrophysiology , Vascular System Injuries
8.
Med. interna (Caracas) ; 36(3): 148-153, 2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1129868

ABSTRACT

La pancreatitis aguda o crónica puede resultar en lesiones del conducto pancreático, además, la corrosión por el jugo pancreático puede provocar la ruptura de la pared vascular periférica, lo que conduce a hemosuccus pancreático (HP) definido como el sangrado del conducto pancreático a través de la ampolla de Vater. El sangrado suele ser intermitente, repetitivo y, a menudo, no lo suficientemente grave, como para causar inestabilidad hemodinámica. La mayoría de los pacientes tiene antecedentes de enfermedades pancreáticas originales y cuando esto no se cumple, debe incluirse en el diagnóstico diferencial para alcohólicos crónicos con hemorragia digestiva alta intermitente. Presentamos una forma clínica atípica en un paciente masculino de 55 años de edad, con antecedentes de HTA, alcoholismo y aneurisma de la aorta abdominal, quien consultó por dolor tipo cólico en abdomen superior, náuseas y vómitos; luego se asoció disminución del estado de conciencia, alternando con episodios de agitación psicomotriz y primo convulsión generalizada. Una vez ingresado, sucedieron varios episodios de melena. La tomografía abdominal mostró aumento de tamaño y densidad (unidades hounsfield de 58-61) en cabeza y cuerpo del páncreas, por lo que se realizó una angiografía abdominal con protocolo de páncreas y se evidenció doble lesión aneurismática de la arteria esplénica y la arteria gástrica. Falleció en el postoperatorio(AU)


Acute or chronic pancreatitis can result in lesions of the pancreatic duct; in addition, corrosion by the pancreatic juice can cause the rupture of the peripheral vascular wall, which leads to pancreatic hemosuccus defined as bleeding from the pancreatic duct through the Vater ampulla. Bleeding is often intermittent, repetitive, and often not severe enough to cause hemodynamic instability. Most of the cases have a history of strictly pancreatic original diseases, when this is not the case, the PH should be included in the differential diagnosis for chronic alcoholics with intermittent upper gastrointestinal bleeding, We report here an atypical presentation in a 55-year-old male patient with a history of hypertension, alcoholism and an abdominal aortic aneurysm. He consulted for colicky abdominal pain in the upper abdomen, nausea and vomiting; subsequently he presented decreased consciousness, alternating with episodes of psychomotor agitation and generalized seizures. Once hospitalized he had several bouts of melena. The abdominal tomography showed an increase in the size and density (hounsfield units of 58-61) of the head and body of the pancreas. An abdominal angiography with a pancreas protocol was performed, which evidenced a double aneurismal lesion of the splenic and gastric arteries. The patient died after surgery(AU)


Subject(s)
Humans , Male , Middle Aged , Pancreatic Ducts/physiopathology , Pancreatitis/pathology , Alcoholism/complications , Hemorrhage , Pancreatic Juice , Endoscopy , Vascular System Injuries , Internal Medicine
9.
Rev. colomb. cir ; 35(3): 514-519, 2020. fig
Article in Spanish | LILACS | ID: biblio-1123239

ABSTRACT

Introducción. La embolia pulmonar por herida con arma de fuego es potencialmente fatal y una complicación rara que puede presentarse en los servicios de urgencias. En los últimos años, se ha presentado una mayor inci-dencia por la violencia social civil (85 %) que por las guerras (15 %). Los principales síntomas de los pacientes son dolor torácico, disnea y hemoptisis por la erosión vascular y el infarto pulmonar asociado.Caso clínico. Se presenta el caso de un paciente de 18 años de edad que ingresó por múltiples heridas por proyec-tiles de arma de fuego, una de ellas con un proyectil alojado en la arteria pulmonar del lóbulo inferior derecho y embolia pulmonar aguda en las ramas arteriales distales al proyectil. Se optó por un tratamiento conservador y la evolución fue adecuada. Discusión. La sintomatología de esta condición depende de la localización, la trombosis asociada, los fenóme-nos de isquemia y las complicaciones hemorrágicas. Entre las complicaciones de un proyectil de fuego alojado en una arteria pulmonar, están la isquemia, la trombosis, los pseudoaneurismas, la hemorragia, el derrame pleural, la insuficiencia vascular y la endocarditis. La mayoría de los pacientes deben someterse a una intervención quirúrgica cuando el proyectil se aloja en las arterias pulmonares principales o lobares y las compromete; cuando se localiza en las arterias segmentarias y subsegmentarias, tienden a presentar fístulas con el bronquio y vasoespasmo compensatorio, lo que permitiría el manejo conservador


Introduction: Gunshot wound pulmonary embolism is potentially fatal and a rare complication that can occur in emergency departments. In recent years, there has been a higher incidence of civil social violence (85%) than for wars (15%). The main symptoms of patients are chest pain, dyspnoea and hemoptisis from vascular erosion and associated pulmonary infarction. Clinical case: We present a case of an 18-year-old patient who was admitted for multiple projectile wounds by firearm, one of them with a projectile lodged in the pulmonary artery of the right lower lobe and acute pulmonary embolism in the arterial branches distal to the projectile. Conservative management was decided, with adequate evolution.Discussion: The symptomatology of this condition depends on the location, associated thrombosis, ischemia phenomena and hemorrhagic complications. Complications of a fire projectile lodged in a pulmonary artery include ischemia, thrombosis, pseudoaneurysms, bleeding, pleural effusion, vascular insufficiency, and endocarditis. Most patients must undergo surgery when the projectile is housed in the main pulmonary arteries or lobar, when located in the segmental and subsegmental arteries tend to have fistulas with bronchi and compensatory vasospasm, which would allow conservative management


Subject(s)
Humans , Vascular System Injuries , Pulmonary Embolism , Wounds, Gunshot , Conservative Treatment
10.
Article in Chinese | WPRIM | ID: wpr-879369

ABSTRACT

OBJECTIVE@#To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures.@*METHODS@#There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury.@*RESULTS@#The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(@*CONCLUSION@#Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Lumbar Vertebrae/surgery , Lumbosacral Region , Male , Middle Aged , Pedicle Screws , Retrospective Studies , Spinal Fusion/adverse effects , Treatment Outcome , Vascular System Injuries/surgery
11.
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
12.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 108-114, dic. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1099618

ABSTRACT

En la Argentina no existen datos epidemiológicos sobre displasia fibromuscular. La realización de un registro nacional puede aportar información que conduzca a una actualización de los consensos y recomendaciones para un correcto diagnóstico, evaluación y tratamiento. El Registro Argentino de Displasia Fibromuscular (SAHARA-DF) inició su actividad de recopilación de datos en octubre de 2015. Al año 2019 se confirmaron 49 pacientes (44 mujeres, 38 hipertensos, edad 45,3 ± 17,2 años, 12 con presentación neurológica). Veintidós pacientes tuvieron lesiones vasculares en más de un sitio, a pesar del sesgo diagnóstico por falta de estudios complementarios en casi la mitad de los casos. El sitio afectado más frecuente fue el renovascular, seguido por el carotídeo y el ilíaco, y las lesiones multifocales fueron más frecuentes que las unifocales (35 versus 14, respectivamente). Se constató la presencia de aneurismas asociados en 13 casos y disección arterial en 4 casos. De las 22 angioplastias renales realizadas, 14 fueron con colocación de stent (endoprótesis). En este estudio preliminar de una población argentina se evidencia el carácter sistémico de la enfermedad y se plantea un llamado a actuar en cuanto a la necesidad de debatir el algoritmo diagnóstico y el método de tratamiento. (AU)


In Argentina there are no epidemiological data regarding fibromuscular dysplasia. Building a National Registry may provide information leading to updated consensus and recommendations for a correct diagnosis, assessment and treatment. Data gathering for the Argentine Registry of Fibromuscular Dysplasia (SAHARA-DF) was initiated in October 2015. By 2019, 49 patients were confirmed (44 women, 38 hypertensives, age 45.3 ± 17.2 years, 12 with a neurological presentation). Twenty-two patients had multi-site vascular lesions, in spite of a diagnosis bias due to lack of supporting studies in almost half of the cases. The renovascular site was the most affected, followed by the carotid and iliac sites, and multifocal lesions were more frequent than unifocal (35 versus 14, respectively). Associated aneurysms were found in 13 cases, and arterial dissection in 4. Twenty-two renal angioplasties were performed, 14 with stent placement. In this preliminary study of an Argentinian population, the systemic nature of the disease is evidenced, and a call for action arises regarding the need for discussing the diagnostic algorithm and treatment method. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Records/statistics & numerical data , Fibromuscular Dysplasia/diagnosis , Argentina/epidemiology , Algorithms , Bias , Sex Factors , Cross-Sectional Studies , Risk Factors , Age Factors , Angioplasty/methods , Anthropological Factors , Vascular System Injuries/diagnostic imaging , Fibromuscular Dysplasia/classification , Fibromuscular Dysplasia/etiology , Fibromuscular Dysplasia/therapy , Fibromuscular Dysplasia/epidemiology , Hypertension/epidemiology , Aneurysm, Dissecting/diagnostic imaging
13.
Rev. bras. enferm ; 72(6): 1512-1518, Nov.-Dec. 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1042199

ABSTRACT

ABSTRACT Objective: to create, apply and analyze in clinical practice the effectiveness of a bundle to prevent peripheral vascular trauma to approach the peripheral venous puncture process. Method: action research with 435 adult participants in an emergency service from 2011 to 2013. Creation of the bundle for prevention of vascular trauma based on scientific evidence, ease of operation, observation and measurement with implantation through an educational intervention of the team of nursing. Effectiveness analyzed by descriptive and inferential statistics using chi-square. Consecutive sample with 95% confidence interval. Results: Five stages of the bundle were related to the catheter fixation, permanence and removal process. The incidence of vascular traumas due to vein punctures reduced by 46.41% after implantation of the bundle to prevent vascular trauma associated with emergency peripheral catheterization. Conclusion: The bundle in clinical practice reduced vascular traumas by venipuncture.


RESUMEN Objetivo: crear, aplicar y analizar en la práctica clínica la efectividad de un paquete para prevenir el traumatismo vascular periférico para abordar el proceso de punción venosa periférica. Método: investigación de acción con 435 participantes adultos en un servicio de emergencia de 2011 a 2013. Creación del paquete para la prevención de traumas vasculares basado en evidencia científica, facilidad de operación, observación y medición con implantación a través de una intervención educativa del equipo de enfermería. Efectividad analizada mediante estadística descriptiva e inferencial utilizando chi-cuadrado. Muestra consecutiva con intervalo de confianza del 95%. Resultados: Cinco etapas del paquete se relacionaron con la fijación del catéter, la permanencia y el proceso de extracción. La incidencia de traumas vasculares se redujo en un 46,41% después de la implantación del haz para prevenir traumatismos vasculares asociados con cateterismo. Conclusión: el paquete en la práctica clínica redujo los traumas vasculares por venopunción.


RESUMO Objetivo: criar e aplicar um bundle na prática clínica e analisar sua efetividade para prevenção de trauma vascular periférico para abordagem do processo de punção venosa periférica. Método: pesquisa-ação com 435 participantes adultos num serviço de urgência, no período de 2011 a 2013. Criação do bundle para prevenção de trauma vascular baseada em evidências científicas, com facilidade de operacionalização, observação, mensuração e implantação por meio de uma intervenção educativa da equipe de enfermagem. Efetividade analisada por estatística descritiva e inferencial, usando o qui-quadrado. Amostra consecutiva com intervalo de confiança de 95%. Resultados: foram realizadas cinco etapas do bundle relacionadas ao processo de fixação, permanência e remoção do cateter. Houve redução de 46,41% na incidência de traumas vasculares após a implantação do bundle para prevenção de trauma vascular associado ao cateterismo periférico em urgência. Conclusão: o bundle, na prática clínica, reduziu a ocorrência de traumas vasculares decorrentes de punção venosa.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Catheterization, Peripheral/methods , Phlebotomy/adverse effects , Emergency Service, Hospital , Vascular System Injuries/prevention & control , Patient Care Bundles/methods , Nursing Assessment/methods , Catheterization, Peripheral/adverse effects , Chi-Square Distribution , Confidence Intervals , Emergencies , Middle Aged
14.
Rev. bras. anestesiol ; 69(4): 413-416, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1042008

ABSTRACT

Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.


Resumo Justificativa e objetivos A cateterização da veia jugular interna guiada por ultrassom é um procedimento comum e geralmente seguro em sala cirúrgica. No entanto, a punção inadvertida de uma artéria não compressível, como a artéria subclávia, embora rara, pode estar associada a sequelas e risco para vida, incluindo hemomediastino, hemotórax e pseudoaneurisma. Relato de caso Descrevemos um caso bem-sucedido da correção endovascular de lesão da artéria subclávia direita em uma paciente de 75 anos. A artéria subclávia foi lesionada após cateterização guiada por ultrassom da veia jugular interna direita sob anestesia geral para cirurgia ortopédica. Conclusão Sob anestesia geral, vários fatores, como a hipotensão, podem mascarar os sinais de lesão da artéria subclávia. Este relato de caso indica que os médicos devem estar cientes das complicações da cateterização venosa central e tomar medidas imediatas.


Subject(s)
Humans , Female , Aged , Subclavian Artery/injuries , Catheterization, Central Venous/adverse effects , Vascular System Injuries/etiology , Endovascular Procedures/methods , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Orthopedic Procedures/methods , Jugular Veins/diagnostic imaging
15.
Rev. cir. (Impr.) ; 71(3): 216-224, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058260

ABSTRACT

INTRODUCCIÓN: El trauma vascular es un evento de baja frecuencia, con alta morbimortalidad que afecta la población joven; requiere en general un manejo quirúrgico. Se asocia a complicaciones desde la reintervención quirúrgica hasta la amputación de la extremidad, influenciado por variables tanto asociadas al trauma como a la atención hospitalaria. OBJETIVO: Determinar los factores de riesgo relacionados con amputación, en pacientes con trauma arterial periférico (TAP), atendidos en un Hospital de III nivel Huila- Colombia entre 2014-2017. MATERIALES Y MÉTODOS: Estudio observacional, analítico de corte retrospectiva con pacientes mayores de 13 años con TAP. RESULTADOS: Se incluyeron 79 pacientes, con un 1,56% de las consultas en nuestro Servicio de Urgencia. 89% hombres, promedio de edad 28,5 años. La principal comorbilidad fue la farmacodependencia 8,8%. El MESS (mangled extremity severity) promedio fue de 5,27 puntos y un tiempo critico de isquemia de extremidad > a 6 horas en el 38%. El mayor compromiso fue de miembros superiores, secundario a heridas por arma cortopunzante. La lesión predominante fue la transección arterial. Las principales complicaciones posquirúrgicas fueron la trombosis del vaso (21,5%) y la amputación (13,9%). Factores de riesgo asociados a amputación fueron la edad > 20 años, estancia hospitalaria > 7 días, MESS > 7 puntos, que presentaran como complicación quirúrgica la trombosis arterial y que requirieran reintervención quirúrgica. CONCLUSIONES: El trauma arterial periférico es una patología con gran repercusión socioeconómica y secuelas funcionales. Es necesaria la atención oportuna con tratamiento de las variables relacionadas con mal pronóstico, con el fin de disminuir las tasas de morbimortalidad.


INTRODUCTION: Vascular trauma is a low frequency event, with high morbidity and mortality that affects the young population; In general, it requires surgical management. It is associated with complications from surgical reintervention to amputation of the limb, influenced by trauma associated variables such as hospital care. AIM: Determine risk factors related to amputation, in patients with peripheral arterial trauma (TAP), treated at a Hospital of III level Huila-Colombia between 2014-2017. MATERIALS AND METHOD: Observational, retrospective analytical study with patients older than 13 years with TAP. RESULTS: We included 79 patients with an incidence of 1.56%. 89% men, average age 28.5 years. The main comorbidity was 8.8% drug dependence. The MESS (Mangled extremity severity) average was of 5.27 points and a critical time of limb ischemia > to 6 hours in 38%. The greater commitment was of superior members, secondary to injuries by sharp weapon. The predominant lesion was arterial transection. The main postoperative complications were vessel thrombosis (21.5%) and amputation in 13.9%. Risk factors associated with amputation were determined by age > 20 years, hospital stay > 7 days, MESS > 7 points, and that they presented arterial thrombosis as a surgical complication and finally required surgical reoperation. CONCLUSIONS: Peripheral arterial trauma is a pathology with great socioeconomic impact and functional sequelae. It is necessary the timely attention with treatment of the variables related to poor prognosis, in order to decrease the morbidity and mortality rates.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Wounds, Nonpenetrating/surgery , Extremities/surgery , Vascular System Injuries/surgery , Vascular System Injuries/complications , Endovascular Procedures/statistics & numerical data , Postoperative Complications/epidemiology , Prognosis , Reoperation/statistics & numerical data , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Colombia , Limb Salvage/statistics & numerical data , Extremities/injuries , Endovascular Procedures/methods , Amputation/statistics & numerical data
16.
Int. j. morphol ; 37(2): 647-653, June 2019. graf
Article in English | LILACS | ID: biblio-1002271

ABSTRACT

Excessive consumption of carbohydrate and fat increases the risk of cardiovascular disease. We sought to determine the potential ultrastructural alterations in large blood vessels induced by a high fat and fructose diet (HFD) in a rat model of prediabetes. Rats were either fed with HFD (model group) or a standard laboratory chow (control group) for 15 weeks before being sacrificed. The harvested thoracic aorta tissues were examined using transmission electron microscopy (TEM), and blood samples were assayed for biomarkers of pre-diabetes.TEM images showed that HFD induced profound pathological changes to the aortic wall layers, tunica intima and tunica media ultrastructures in the pre-diabetic rats as shown by apoptotic endothelial cells with pyknotic nuclei, damaged basal lamina, deteriorated smooth muscle cells that have irregular plasma membranes, shrunken nucleus with clumped nuclear chromatin, damaged mitochondria and few cytoplasmic lipid droplets and vacuoles. In addition, HFD significantly (p<0.05) decreased adiponectin and increased biomarkers of lipidemia, glycaemia, inflammation, oxidative stress, vascular injury such as soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion protein 1 (sVCAM-1), endothelin-1 (ET-1), and coagulation and thrombosis such as Von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1), compared to normal levels of these parameters in the control group. Thus, we demonstrated that feeding rats with a HFDisable to develop a pre-diabetic animal model that is useful to study the aortic ultrastructural alterations.


El consumo excesivo de carbohidratos y grasas aumenta el riesgo de enfermedades cardiovasculares. Intentamos determinar las posibles alteraciones ultraestructurales en los grandes vasos sanguíneos, inducidas por una dieta alta en grasas y fructosa (HFD) en un modelo de rata de prediabetes. Las ratas se alimentaron con HFD (grupo modelo) o una comida de laboratorio estándar (grupo de control) durante 15 semanas antes de ser sacrificadas. Los tejidos de la aorta torácica recolectados se examinaron mediante microscopía electrónica de transmisión (TEM) y las muestras de sangre se analizaron para detectar biomarcadores de prediabetes. Las imágenes TEM mostraron que HFD indujo cambios patológicos profundos en las capas de la pared aórtica, túnica íntima y túnica media en la ratas pre-diabéticas como lo muestran las células endoteliales apoptóticas con núcleos picnóticos, lámina basal dañada, células musculares lisas deterioradas que tienen membranas plasmáticas irregulares, núcleo encogido con cromatina nuclear aglomerada, mitocondrias dañadas y pocas gotitas lipídicas citoplásmicas y vacuolas. Además, HFD presentó disminución significativa de adiponectina (p <0,05), y aumento de biomarcadores de lipidemia, glucemia, inflamación, estrés oxidativo, lesión vascular como la molécula de adhesión intercelular soluble 1 (sICAM-1), proteína de adhesión de células vasculares soluble 1 (sVCAM-1), endotelina 1 (ET-1), y la coagulación y la trombosis, como el factor de Von Willebrand (vWF), y el inhibidor del activador del plasminógeno-1 (PAI -1), en comparación con los niveles normales de estos parámetros en el grupo de control. Por tanto, la alimentación de ratas con HFD es capaz de desarrollar un modelo animal prediabético que es útil para estudiar las alteraciones ultraestructurales aórticas.


Subject(s)
Animals , Aorta, Thoracic/pathology , Aorta, Thoracic/ultrastructure , Prediabetic State/pathology , Aorta/pathology , Aorta/ultrastructure , Prediabetic State/metabolism , Dietary Fats/adverse effects , Rats, Sprague-Dawley , Microscopy, Electron, Transmission , Disease Models, Animal , Vascular System Injuries/etiology , Vascular System Injuries/pathology , Fructose
17.
Rev. bras. ortop ; 54(3): 343-346, May-June 2019. graf
Article in English | LILACS | ID: biblio-1013719

ABSTRACT

Abstract Vascular complications in the surgical treatment of hip fractures are rare. Depending on the arterial injury, severe intraoperative bleeding or a subacute hematoma formation with arterial pseudoaneurysm development can occur. In the literature, the more frequently described complications are large local hematomas after osteosynthesis with sliding hip screws. This report shows a case of delayed arterial injury after proximal femur osteosynthesis.


Resumo Complicações vasculares no tratamento cirúrgico da fratura do quadril são raras. A depender da lesão arterial, pode ocorrer um grave sangramento intraoperatório ou formação de hematoma subagudo comdesenvolvimento de pseudoaneurisma arterial. Na literatura, as complicações mais frequentes relatadas são a formação de grandes hematomas locais após osteossíntese com parafuso deslizante do quadril. O objetivo do presente relato foi demonstrar um caso de lesão arterial tardia após osteossíntese proximal do fêmur.


Subject(s)
Humans , Male , Aged, 80 and over , Bone Screws , Femoral Fractures , Vascular System Injuries , Hip/surgery
18.
Arch. argent. pediatr ; 117(3): 252-256, jun. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1001197

ABSTRACT

La incontinencia pigmenti es un trastorno neurocutàneo raro, con una frecuencia de 1 en 40 000 recién nacidos, de etiología genética asociada a mutaciones en el gen IKBKG, localizado en Xq28, con herencia dominante ligada al X. Tiene una presentación clínica de manifestaciones muy variables detectadas desde la etapa neonatal y puede asociar afectación cutànea, dental, ocular y neurológica, y cada una de estas con un diagnóstico diferencial distinto. Se presenta a una paciente pediàtrica con diagnóstico de incontinencia pigmenti a la semana de vida. En la evaluación oftalmológica inicial, se observaron lesiones vasculares retinianas. Se decidió el tratamiento con làser, con buenos resultados, y se consiguió estabilizar la visión.


Incontinentia pigmenti is a rare neurocutaneous disorder with a frequency of 1 in 40,000 newborn; it is associated with mutations in IKBKG gene in Xq28, inherited as an X-linked dominant trait. Clinical manifestations detected since the newborn period are highly variable, with skin, teeth, eyes, and nervous system manifestations, and each with a characteristic differential diagnosis. We present a pediatric patient diagnosed with incontinentia pigmenti at the first week of life. In the initial ophthalmologic evaluation, retinal vascular lesions were observed. The outcomes of laser treatment of the ischemic peripheral retina were good and resulted in stability of vision.


Subject(s)
Humans , Female , Infant, Newborn , Pediatrics , Incontinentia Pigmenti , Eye Manifestations , Laser Therapy , Vascular System Injuries
19.
Med. U.P.B ; 38(1): 57-66, 13 de febrero de 2019. tab, Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-980301

ABSTRACT

El trauma vascular en las extremidades es una causa importante de mortalidad y morbilidad. Por su fisiopatología se conoce que esta lesión puede tener efectos sistémicos ocasionados por el choque hemorrágico, y efectos locales debido a la isquemia tisular. El manejo se inicia desde el primer contacto con el paciente, bien sea por personal médico o de atención prehospitalaria. El escenario puede variar desde un área de conflicto armado, la vía pública hasta un hospital y la prioridad inicial será el control del sangrado. En este artículo se exponen elementos para el diagnóstico y el manejo no quirúrgico del trauma vascular incluyendo el uso temprano de torniquete, el diagnóstico clínico, la identificación y el tratamiento de pacientes con trauma vascular, lo que permitirá salvar vidas y extremidades.


Over the years, vascular injury in extremities has been an important cause of mortality and morbidity. Because of the physiopathology of these injuries, it is known that they produce systemic effects due to the hemorrhagic shock and local effects due to tissue ischemia. Treatment begins from the first contact, whether by physicians or pre-hospital attention personnel, and the setting can range anywhere from an area of armed conflict to a public area to a hospital. Regardless of these variables, the priority will always be hemorrhage control. This article exposes key elements for diagnosis and non-surgical treatment of vascular injury in extremities including early use of tourniquets, clinical diagnosis, images and damage control resuscitation. Thus, adequate identification and treatment of patients with vascular injury allows us to salvage lives and limbs.


O trauma vascular nas extremidades é uma causa importante de mortalidade e morbilidade. Por sua fisiopatologia se conhece que esta lesão pode ter efeitos sistémicos ocasionados pelo choque hemorrágico, e efeitos locais devido à isquemia tissular. O manejo se inicia desde o primeiro contato com o paciente, bem seja pelo pessoal médico ou de atenção pré-hospitalar. O cenário pode variar desde uma área de conflito armado, a via pública até um hospital e a prioridade inicial será o controle do sangrado. Neste artigo se expõe elementos para o diagnóstico e o manejo não cirúrgico do trauma vascular incluindo o uso precoce de torniquete, o diagnóstico clínico, a identificação e o tratamento de pacientes com trauma vascular, o que permitirá salvar vidas e extremidades.


Subject(s)
Humans , Wounds and Injuries , Tourniquets , Diagnosis , Emergencies , Prehospital Care , Extremities , Vascular System Injuries , Hemorrhage
20.
Int. braz. j. urol ; 45(1): 193-193, Jan.-Feb. 2019.
Article in English | LILACS | ID: biblio-1040052

ABSTRACT

ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.


Subject(s)
Humans , Kidney Transplantation/adverse effects , Laparoscopy/adverse effects , Vascular System Injuries/etiology , Nephrectomy/adverse effects , Retrospective Studies , Living Donors , Risk Reduction Behavior , Computed Tomography Angiography , Middle Aged , Nephrectomy/methods
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