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J Neurointerv Surg ; 11(6): 610-613, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30415222


BACKGROUND: Neo-intimal hyperplasia (NIH) is frequently observed after flow-diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular response can sometimes lead to delayed ischemic strokes. This study intended to evaluate the factors potentially influencing the rates of NIH following FDS treatment. MATERIAL AND METHODS: All aneurysm treatments performed with a Pipeline embolization device (PED) or a SILK stent from May 2011 to May 2015 were collected in a prospectively maintained database. Patient demographics, clinical, and angiographic outcomes including both digital subtraction angiography and C-arm cone-beam CT were registered. Two blind reviewers rated the presence of NIH on a binary scale (present/absent). RESULTS: From 148 patients, 63 datasets were available for analysis. Inter-reader agreement was excellent (Kappa=0.88). NIH was positively correlated with smoking, dyslipidemia, and high blood pressure, but not with aneurysm characteristics. At early follow-up (<12 months), NIH was more frequently associated with the use of the SILK stent (68%) rather than the PED (38%): P<0.02. At long-term follow-up, the NIH rate in the total population dropped from 55% to 26% with no more significant difference between the two stents. The complete occlusion rate as seen in early follow-up was higher in the SILK group with 76% vs 65% but without statistical significance (P=0.4). CONCLUSION: NIH is a dual-vessel reaction after FDS implant. When planning a treatment in locations at risk of ischemic complications if severe NIH would occur, then the stent design should be considered. However, minimal NIH might also be needed as it is involved in aneurysm healing. Before treatment patients should be recommended best medical management of their cardiovascular risks factors to prevent an excessive NIH reaction.

Cardiovascular Diseases/diagnostic imaging , Cardiovascular Diseases/epidemiology , Embolization, Therapeutic/adverse effects , Neointima/diagnostic imaging , Neointima/epidemiology , Self Expandable Metallic Stents/adverse effects , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis/trends , Cerebral Angiography/methods , Cerebral Angiography/trends , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/trends , Female , Follow-Up Studies , Humans , Hyperplasia/diagnostic imaging , Hyperplasia/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Self Expandable Metallic Stents/trends , Treatment Outcome
J Neurointerv Surg ; 9(7): 674-678, 2017 Jul.
Article in English | MEDLINE | ID: mdl-27387710


BACKGROUND: Flow-diverter stent (FDS) placement for treatment of intracranial aneurysms can cause flow changes in the covered branches. OBJECTIVE: To assess the impact of the treatment of carotid siphon aneurysms with FDS on the posterior communicating artery (PComA) flow. MATERIALS AND METHODS: Between February 2011 and January 2015, 125 carotid siphon aneurysms were treated with FDS. We retrospectively analyzed all cases with PComA ostial coverage. The circle of Willis anatomy was also studied as the flow changes in PComA postoperatively and during angiographic follow-up. Data from neurological examination were also collected. RESULTS: Eighteen aneurysms of the carotid siphon in 17 patients were treated with FDS covering the ostium of the PComA. Based on the initial angiography, patients were divided into two groups: the first with a P1/PComA size ratio >1 (10 cases) and the second with a ratio ≤1 (8 cases). Follow-up angiography (mean time of 10 months) showed 90% of PComA flow changes in group 1 but only 12.5% in group 2. There was a significant difference between the two groups (p=0.002). Nevertheless, no patient had new symptoms related to these flow changes during the follow-up period. CONCLUSIONS: In our experience, covering the PComA by FDS when treating carotid siphon aneurysms appeared safe and the P1/PComA ratio is a good predictor of flow changes in PComA.

Carotid Artery, Internal/surgery , Intracranial Aneurysm/surgery , Posterior Cerebral Artery/surgery , Stents , Adult , Aged , Angiography/methods , Carotid Artery, Internal/diagnostic imaging , Cerebrovascular Circulation/physiology , Circle of Willis/diagnostic imaging , Circle of Willis/surgery , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Male , Middle Aged , Neurologic Examination , Posterior Cerebral Artery/diagnostic imaging , Retrospective Studies , Stents/adverse effects
Acta Med Port ; 28(6): 726-34, 2015.
Article in Portuguese | MEDLINE | ID: mdl-26849757


INTRODUCTION: Although vitamin D deficiency is increasingly recognized around the world, there are few studies on the Portuguese reality. This study aims to analyse vitamin D levels in the assays performed in our hospital and their relationship with age, genre, requesting specialty and moment of sample collection. MATERIAL AND METHODS: Cross-sectional study of measurements of 25(HO)D performed in our Hospital between June 2012 and November 2014. Included variables: gender, age, requesting specialty, month of sample collection. Vitamin D status classified as: 'Deficiency' (≤ 20 ng/mL), 'Insufficiency' (21 - 29 ng/ml) and 'Sufficiency' (≥ 30 ng/mL). RESULTS: We included 5 439 assays; 55.0% from women; the median age was 64.0 years. Sixty per cent had 'Deficiency', 20.7% 'Insufficiency' and 18.9% 'Sufficiency'. We found a negative correlation between age and vitamin D level (p < 0.001). We didn't find differences in vitamin D levels between genres. Nine specialties requested 98% of the assays, namely Nephrology (56.2%). We found differences between specialties based on age and vitamin D level (p < 0.001). Vitamin D levels changed throughout the year, with higher levels in the summer, followed by autumn, spring and winter (p < 0.001). Despite this seasonal fluctuation, vitamin D sufficiency was only present in a minority of assays (27.8% in summer and 9.2% in winter). DISCUSSION: Vitamin D deficiency is prevalent in this population, affects individuals of all ages and is not offset by the seasonal variation of sunlight. CONCLUSION: Vitamin D deficiency is a real and prevalent problem in our population that needs further attention and action, given its clinical implications.

Introdução: Apesar da hipovitaminose D ser cada vez mais reconhecida em todo o mundo, existem poucos estudos sobre a realidade portuguesa. Este trabalho pretende analisar o nível de vitamina D nos doseamentos realizados no nosso hospital e sua relação com idade, sexo, especialidade requisitante e momento da colheita. Material e Métodos: Estudo observacional dos doseamentos de 25(OH)D realizados no nosso Hospital entre junho de 2012 e novembro de 2014. Variáveis estudadas: sexo, idade, especialidade requisitante, mês de colheita. O status de vitamina D foi classificado como: 'Deficiência' (≤ 20 ng/mL), 'Insuficiência' (21 ' 29 ng/mL) e 'Suficiência' (≥ 30 ng/mL). Resultados: Incluímos 5 439 doseamentos; 55,0% pertenciam a mulheres; a idade mediana foi 64,0 anos. Sessenta por cento apresentavam 'Deficiência', 20,7% 'Insuficiência' e 18,9% 'Suficiência'. Encontrámos uma correlação negativa entre idade e nível de vitamina D (p < 0,001), não havendo diferenças significativas entre sexos. Nove especialidades requisitaram 98% dos doseamentos, destacando-se a Nefrologia (56,2%). Encontrámos diferenças entre especialidades requisitantes relativamente à idade e nível de vitamina D (p < 0,001). O nível de vitamina D variou ao longo do ano, com níveis superiores no verão, seguido do outono, primavera e inverno (p < 0,001). Apesar desta variação sazonal, a suficiência de vitamina D foi sempre minoritária, sendo de 27,8% no Verão e 9,2% no Inverno. Discussão: A carência de vitamina D nesta população é elevada, transversal a todas as idades e não compensada pela variação sazonal da exposição solar.Conclusão: A hipovitaminose D é um problema real, prevalente e merecedor de atuação na nossa população, atendendo às suas implicações clínicas.

Vitamin D Deficiency/epidemiology , Aged , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Middle Aged , Sunlight , Vitamin D , Vitamins
Anal Sci ; 31(1): 29-35, 2015.
Article in English | MEDLINE | ID: mdl-25792271


This work describes the highly sensitive detection of organophosphorus pesticides employing the cobalt(II) 4,4,4,4-tetrasulfo-phthalocyanine (CoTSPc) macrocycle complex, carbon nanotubes (CNT), and 1-methyl-3-octylimidazolium tetrafluoroborate (OMIM[BF4]). The technique is based on enzyme acetylcholinesterase (AChE) inhibition. The composite was characterized by scanning electron microscopy (SEM), Fourier transform infrared (FT-IR) spectroscopy, and amperometry. The AChE was immobilized on the composite electrode surface by cross-linking with glutaraldehyde and chitosan. The synergistic action of the CoTSPc/CNT/OMIM[BF4] composite showed excellent electrocatalytic activity, with a low applied potential for the amperometric detection of thiocholine (TCh) at 0.0 V vs. Ag/AgCl. The calculated catalytic rate constant, k(cat), was 3.67 × 10(3) mol(-1) L s(-1). Under the optimum conditions, the inhibition rates of these pesticides were proportional to their concentrations in the ranges of 1.0 pmol L(-1) to 1.0 nmol L(-1) (fenitrothion), 2.0 pmol L(-1) to 8.0 nmol L(-1) (dichlorvos), and 16 pmol L(-1) to 5.0 nmol L(-1) (malathion).

Biosensing Techniques/methods , Enzymes, Immobilized/chemistry , Imidazoles/chemistry , Indoles/chemistry , Nanotubes, Carbon/chemistry , Organometallic Compounds/chemistry , Organophosphorus Compounds/chemistry , Pesticides/analysis , Acetylcholinesterase/chemistry , Acetylcholinesterase/metabolism , Electrochemistry , Electrodes , Enzymes, Immobilized/metabolism , Pesticides/chemistry