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1.
Cardiovasc J Afr ; 26(2): 86-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25940122

RESUMO

This case presentation concerns a woman known to have fibromuscular dysplasia (FMD) who presented with an acute coronary syndrome (ACS). The coronary angiogram was considered to be normal. However, as spontaneous coronary artery dissection (SCAD) has a close association with FMD, subsequent meticulous review of the angiogram revealed a dissection within the circumflex coronary artery. SCAD causes 10% of ACS seen in women under 55 years of age. Both FMD and SCAD are underdiagnosed and SCAD may be overlooked or misdiagnosed on coronary angiography. The recommended management of SCAD differs from that of the usual presentations of ACS. For this reason, one should be alert to the possibility of SCAD when confronted by ACS in a younger woman, especially when she is known to have FMD.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Displasia Fibromuscular/diagnóstico , Infarto do Miocárdio/diagnóstico , Doenças Vasculares/congênito , Doença Aguda , Antagonistas Adrenérgicos beta/administração & dosagem , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/tratamento farmacológico , Intervalo Livre de Doença , Terapia de Reposição de Estrogênios , Feminino , Displasia Fibromuscular/complicações , Displasia Fibromuscular/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Inibidores da Agregação Plaquetária/administração & dosagem , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/tratamento farmacológico , Suspensão de Tratamento
3.
Anesth Analg ; 119(4): 766-776, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24977631

RESUMO

BACKGROUND: We present the results of a previously unpublished hemoglobin-based oxygen carrier (HBOC) study conducted in 1998-1999. METHODS: In a multicenter, randomized, single-blind, comparative study of HBOC-201 versus allogeneic red blood cell (RBC) transfusions, no-cardiac surgery patients received HBOC-201 to a maximum of 7 units (n = 83) or RBCs (n = 77). Patients could be switched to RBCs for safety or any other reason. The efficacy end points were elimination and/or reduction of allogeneic RBC transfusions for 28 days. RESULTS: The proportion of patients in the HBOC-201 group that avoided RBC transfusion was 0.427 (95% confidence interval, 0.321-0.533). Subjects in the HBOC-201 group received on average 3.2 units of RBCs versus 4.4 units in the control arm (P = 0.004). Seventy-nine (95.2%) subjects in the HBOC-201 group and 72 (93.5%) in the RBC group experienced adverse events (AEs), judged to be associated with study treatment in 59 (71.1%) and 18 (23.4%) subjects, respectively. Thirty-day mortality, 5 (6.0%) vs 4 (5.2%) patients (P = 1.00), incidence of serious AEs, 24 (28.9%) vs 20 (26.0%) (P = 0.73), or time to intensive care unit (log-rank P = 0.15) or hospital discharge (log-rank P = 0.53) were similar for the HBOC-201 and RBC groups, respectively. CONCLUSIONS: Up to 7 units of HBOC-201 infused over the course of 6 days resulted in RBC transfusion avoidance in 43% of patients. There were no notable differences in mortality and serious AEs incidence. The use of HBOC-201 was associated with a notable excess of nonserious AEs.


Assuntos
Substitutos Sanguíneos/administração & dosagem , Substitutos Sanguíneos/efeitos adversos , Transfusão de Eritrócitos/efeitos adversos , Hemoglobinas/administração & dosagem , Hemoglobinas/efeitos adversos , Assistência Perioperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação de Medicamentos/métodos , Transfusão de Eritrócitos/métodos , Feminino , Febre/induzido quimicamente , Febre/diagnóstico , Seguimentos , Humanos , Hipertensão/induzido quimicamente , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
4.
Ann Vasc Surg ; 24(8): 1135.e1-3, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20800433

RESUMO

Endovascular techniques are often applied, but they have occasionally been reported in the treatment of popliteal vascular entrapment (PVE). A case of bilateral PVE is presented with an acute occlusion of the right popliteal artery. This was twice unsuccessfully treated with arterial recanalization and stenting at another Institution. The patient required an arterial reconstruction with his reversed saphenous vein, in addition to resection of the medial gastrocnemius muscle laterally inserted on his right limb. The left limb was treated with a simple myotomy. Recanalization and stenting is not recommended for PVE treatment.


Assuntos
Angioplastia com Balão/instrumentação , Arteriopatias Oclusivas/terapia , Claudicação Intermitente/terapia , Artéria Poplítea/cirurgia , Veia Safena/transplante , Stents , Enxerto Vascular , Adulto , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Constrição Patológica , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/cirurgia , Angiografia por Ressonância Magnética , Masculino , Músculo Esquelético/cirurgia , Artéria Poplítea/diagnóstico por imagem , Radiografia , Falha de Tratamento
5.
J Vasc Surg ; 48(5): 1189-96, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18971035

RESUMO

OBJECTIVE: Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. METHODS: Provocative tests were used to identify 58 nonoccluders and 16 occluders. Ten subjects from each group underwent magnetic resonance imaging evaluation of the popliteal fossa. The medial head of the gastrocnemius muscle attachment was assessed in the supracondylar, pericondylar, and intercondylar areas. RESULTS: In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. CONCLUSION: The more extensive midline position of the medial head of the gastrocnemius in occluders is likely to be a normal embryological variation. Forceful contraction results in compression and occlusion of the adjacent popliteal artery. The clinical significance of these anatomic variations remains unclear. However, these new observations may provide insight for future analysis of the causes and natural history of functional compression and the potential progression to clinical entrapment.


Assuntos
Arteriopatias Oclusivas/patologia , Imageamento por Ressonância Magnética , Músculo Esquelético/patologia , Artéria Poplítea/patologia , Adulto , Arteriopatias Oclusivas/fisiopatologia , Feminino , Humanos , Masculino , Contração Muscular , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Síndrome
7.
Semin Vasc Surg ; 16(3): 223-31, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12975762

RESUMO

Popliteal vascular entrapment is second only to atherosclerosis as the most common surgically correctible cause of leg claudication in young adults. Affected patients are often athletic individuals who present before the age of 50. This chapter highlights the abnormal developmental anatomy that is now accepted as the cause of popliteal entrapment and serves as the basis for the modern classification system. The importance of the unique histopathological changes observed in arterial entrapment syndromes are summarized, and the natural history of chronic arterial compression is reviewed. The diagnosis, investigation, and treatment proposed are based upon the currently published literature.


Assuntos
Doenças Vasculares Periféricas , Artéria Poplítea/anormalidades , Constrição Patológica/diagnóstico , Constrição Patológica/terapia , Humanos , Doenças Vasculares Periféricas/classificação , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/embriologia , Doenças Vasculares Periféricas/terapia , Artéria Poplítea/embriologia , Síndrome
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