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1
Hayashino(Miyagawa), Aya. "Arteriopathy in chronic allograft rejection in liver transplantation." Kyoto University, 2005. http://hdl.handle.net/2433/144489.
2
Quesada, Sabaté Miquel. "Arteriopatia perifèrica assimptomàtica: prevalença, detecció i tractament." Doctoral thesis, Universitat de Girona, 2017. http://hdl.handle.net/10803/457149.
Анотація:
Background
There is few epidemiological data of peripheral arterial disease (PAD) in our environment. The recommendation of screening with ankle brachial index (ABI) in asymptomatic individuals is controversial. Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease (PAD).
Aims
1) To determine the prevalence of ankle-brachial index (ABI)<0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening
2) to develop and validate a pre-screening test to select candidates for ABI measurement in the Spanish population 50-79 years old, and to compare its predictive capacity to current Inter-Society Consensus (ISC) screening criteria.
3) to assess whether statin therapy was associated with a reduction in major cardiovascular events (MCE) and mortality in this populationIntroducció Existeix poca informació epidemiològica de la malaltia arterial perifèrica (MAP) al nostre medi, la recomanació de cribratge amb índex turmell-braç (ITB) en individus asimptomàtics és objecte de controvèrsia i es desconeix l'efectivitat de les intervencions de reducció de risc amb estatines en pacients amb MAP asimptomàtica. Objectius Els objectius de la present tesi són: 1) Determinar la prevalença d'ITB <0,9 i de MAP asimptomàtica, la seva associació amb factors de risc cardiovascular (FRCV) en la població de 35-79 anys i estimar l'impacte d'afegir la mesura d'ITB a la predicció de risc cardiovascular 2) Desenvolupar i validar una funció de risc per seleccionar els millors candidats pel cribratge de MAP amb ITB en la població de 50-79 anys d'edat 3) Avaluar si la teràpia amb estatines s'associa a una reducció d'esdeveniments cardiovasculars (ECV) i de mortalitat en aquesta població
3
Joseph, Emlyn Clive. "Pathogenesis of arteriopathy induced by PDE III inhibitors in the rat and dog." Thesis, Queen Mary, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307684.
4
Low, Wee Chuang Roger. "Molecular pathology of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and hereditary multi-infarct dementia." Thesis, University of Newcastle Upon Tyne, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417546.
5
Martin, Roswell James. "CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) : clinical features and approaches to genetic screening in the UK." Thesis, University of Cambridge, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.609947.
6
Cowan, Bryce John. "Elafin inhibition of fibronectin synthesis and inflammatory cell proliferation, and reduction of post-cardiac transplant coronary arteriopathy and myocardial necrosis, in vitro and in vivo mechanisms." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0003/NQ35133.pdf.
7
FELISATTI, Michele. "Compressione pneumatica intermittente negli stadi avanzati di arteriopatia periferica: studio delle modificazioni emodinamiche e della perfusione distale indotte da un dispositivo originale e confronto con uno strumento disponibile sul mercato." Doctoral thesis, Università degli studi di Ferrara, 2011. http://hdl.handle.net/11392/2389232.
Анотація:
Introduction: Intermittent pneumatic compression (IPC) is a technique based on the application of pressure at the level of various points of the inferior limb, aimed at provoking haemodynamic modifications starting from the treatment zone. IPC devices, that are mainly used in the area of venous-lymphatic pathologies to reduce edema and for the prevention of venous thromboembolism, have also been applied for treatment of peripheral arterial occlusive disease (PAOD). An IPC device, “Gradient Pump” (GP), based on new haemodynamic concept and technical solutions, has been recently developed by the Vascular Diseases Center of the University of Ferrara-Italy. Aim of the present study in PAOD patients is a) to evaluate the effects of GP on haemodynamic parameters and foot perfusion during a single operative cycle and during a therapeutic cycle and b) to compare efficacy and compliance to the treatment of GP versus a traditional device for PAOD available on the market.
Subjects and Methods: In the study were enrolled and evaluated a) 7 patients (12 diseased legs) with PAOD at III-IV Fontaine’s stage and b) 12 patients (21 diseased legs, 12 out of them affected by critical ischemia).
The GP device is composed of a single inflatable cuff to be positioned at the thigh, including a rigid element to apply a proper pressure to the femoral vein. The cuff is connected to a compressor which produces periodic sequences of pressure at 1 operative cycle/minute (20 sec of compression, 40 sec of decompression). The therapeutic cycle is composed by a 5min working period followed by a 5min resting period repeated for 3-4 times, modifiable by a manual electromechanical timer. The pressure of cuff inflation is set by a manual pressure regulator to patient’s blood systolic pressure – 20 mmHg with maximal value at 120 mmHg.
For the phase A of the study, haemodynamic measurements as Time Average Velocity (TAV) and Blood Flow (BF) were performed by Echo color doppler (ECD) at the femoral vein at different phases of the operative cycle, at rest (basal level), early compression (In1), full compression (In) and full decompression (Out).
The haemodynamic measurements during a therapeutic cycle were performed before the start of the first working cycle (basal level), at the end of the second cycle and at the end of the last working period, during the phase Out of both operative cycles. The study of tissue perfusion at the foot was performed using a Near Infrared Spectroscopy (NIRS) device, in order to detect variations in total (tHb), oxygenated (O2Hb) and deoxygenated haemoglobin by means of probes positioned on the dorsum of the foot. The changes of these parameters were recorded and quantified by the calculation of the areas under the curve (AUC). Measurements were performed continuously for a 5min period before the treatment and for the whole treatment.
For the phase B of the study, GP was compared to a device available on the market (Art Assist ACI Medical, LLC San Marcos, CA), with cuffs to be positioned at foot and calf sequentially inflating (foot cuff first and calf cuff after 3 seconds, 20 seconds of rest). The device operates for 3 cycles/min at a fixed pressure of inflation of 120 mmHg.
Outcome measures: a) Ankle-Brachial Index (ABI) measured according to the standard at rest and after treatment b) Haemodynamic measurements by ECD, including TAV e BF evaluation at femoral vein and at popliteal artery, performed before treatment, after 30 min in the decompression phase of the operative cycle and at the end of the treatment c) Evaluation of Foot perfusion by NIRS device as above described, by measurements performed continuously for a 5 min period before the treatment and for the whole treatment with both devices.4) Compliance, measured by a properly developed questionnaire proposed to the patients before and after the treatment with both devices to evaluate symptoms reduction and satisfaction. The effects of the AA instrument and GP device were measured in the same subjects in supine position in two different days with an interval of 48 ± 2 hours between the two treatments and an alternate order for each device. AA was tested for two consecutive hours of treatment and GP for 35 minutes.
Results: A): the treatment with GP was well tolerated, without reported negative symptoms. During a single operative cycle BF and TAV at the femoral vein significantly increased during In e In1 phases (p>0.01). During a therapeutic cycle (25 min) BF and TAV slightly increased during the phase “out” from the beginning to the end of the treatment (p=0,10 n.s.). The foot perfusion was improved, with a significant increase both of tHbAUC and HbO2AUC (p<0.005), correlated to the TAV variations from the basal level recorded at femoral vein during the phase “out” (p<0.05).
B): all patients completed the treatment with GP, while three out of them interrupted the treatment for painful symptoms at the foot. ABI increased from the baseline after treatment with GP (n=21, p=0.005), being unmodified after treatment with AA. After 30min of GP treatment the ECD parameters (TAV e BF) increased significantly at the femoral vein (n=21, p<0.05) as well BF at popliteal artery (p=0.011), while no variations were observed after AA treatment. Following compression with GP an improved foot perfusion was observed, with increase of tHbAUC (p<0.0001) and Hb O2AUC (p=0.001) that instead decreased after AA treatment (p=0.03). Compared to the AA treatment, the compression therapy with GP obtained a higher score for compliance, reduction of symptoms, easy use of the device and patients’ satisfaction (p<0.0001).
Conclusions: GP, a new device for IPC in PAOD, evokes favourable haemodynamic changes with increased foot perfusion. Haemodynamic changes, distal perfusion and compliance with GP are more relevant than those observed after treatment with a traditional IPC device available on the market.
8
Ait, Hmad Zouhair. "Lp(a) et arteriopathie obliterante des membres inferieurs." Strasbourg 1, 1994. http://www.theses.fr/1994STR15001.
9
Lanéelle, Damien. "Hémodynamique cérébrale et périphérique dans un contexte de variation de pression de perfusion d'origine environnementale ou pathologique." Electronic Thesis or Diss., Normandie, 2023. http://www.theses.fr/2023NORMC430.
Анотація:
L’hémodynamique occupe une place centrale dans la prise en charge des maladies vasculaires et en physiologie gravitationnelle. Les travaux présentés ici explorent l’analyse spectrale du signal doppler (ou sonogramme) dans l’artériopathie et l’effet de la microgravité sur l’hémodynamique cérébrale. La reproductibilité de l’analyse de sonogramme est faible quelle que soit la classification utilisée (κ=0.522 [0.520-0.523], p < 0.005 avec 4 catégories, κ=0.546 [0.544-0.547], p < 0.001 avec 13 catégories), indépendamment du diplôme ou de l’expérience. La classification à 13 catégories a un taux de déviance faible par rapport aux autres (5% contre 82 à 88%). Ces résultats encouragent à identifier une méthode d’analyse du sonogramme plus reproductible. Les transitions gravitationnelles sont associées à une augmentation des biomarqueurs de rupture de la barrière hémato-encéphalique ainsi que du stress oxydant et nitrosant (augmentation des protéines GFAP et S100ß, augmentation des radicaux libres et réduction du monoxyde d’azote biodisponible, p < 0,05). La microgravité entraine une augmentation sélective rapide du débit sanguin de l’artère carotide externe ( ̇��ECA, 46% ; p = 0,030, mesuré en échodoppler) alors que le débit sanguin cérébral (DSC) reste identique. Les variations de DSC liées à l’hypercapnie (+ 29% ±18) ou à l’hypovolémie simulée (- 11% ±10) ainsi que la distribution de ce DSC (entre les circulations cérébrales antérieure et postérieure, mesuré en angiographie de flux par résonance magnétique) sont indépendantes de l’anatomie artérielle intracrânienne. Ces résultats encouragent à évaluer l’effet combiné de l’hypoxie et de la microgravité sur le ̇��ECA ainsi que le lien avec les troubles neuro-oculaires associés aux vols spatiaux. La perspective commune est l’étude des résistances vasculaires périphériques afin d’une part de standardiser les conditions d’acquisition des sonogrammes dans le cadre de l’artériopathie ; et d’autre part, d’étudier les potentielles contre-mesures permettant une régulation des débits artériels dans le cadre de la physiologie gravitationnelleThe work presented here explore the spectral analysis of the sonogram and the impact of microgravity on cerebral hemodynamics. The reproducibility of sonogram analysis by classification is low (κ=0.522 [0.520-0.523], p<0.005 with 4 categories, κ=0.546 [0.544-0.547], p<0.001 with 13 categories) independently of the professional’s diploma or experience. The 13-category classification had a low deviance rate (5% compared with 82% to 88%). Gravitational transitions can promote a minor rupture of the blood-brain barrier (significant increase in specific biomarkers, p < 0.05). Microgravity causes a selective increase in external carotid artery blood flow ( ̇��ECA, 46%; p = 0.030) while cerebral blood flow (CBF) remains unchanged. The variations in CBF associated with hypercapnia (+29% ±18) or simulated hypovolemia (-11% ±10) and the distribution of this CBF were independent of intracranial arterial anatomy. These results encourage us to evaluate the combined effect of hypoxia and microgravity on the ̇��ECA as well as the link with the spaceflight associated neuro-ocular syndrome. The common perspective is to study the control of peripheral vascular resistance in order, on the one hand, to standardize the conditions for acquiring sonograms in the context of arteriopathy and, on the other hand, to study potential countermeasures for regulating the arterial flow in the context of gravitational physiology
10
Ombredane, Marie-Pierre. "L'endofibrose de l'artere iliaque externe : une arteriopathie du cycliste de competition." Angers, 1988. http://www.theses.fr/1988ANGE1080.
11
GOUIRAND, ROMAIN. "Arteriopathie obliterante de type moyamoya : cause d'infarctus cerebral chez 6 adultes." Aix-Marseille 2, 1993. http://www.theses.fr/1993AIX20851.
12
PUECH, JEAN-LUC. "Osteoporose masculine et arteriopathie des membres inferieurs : etude sur 32 cas." Toulouse 3, 1991. http://www.theses.fr/1991TOU31037.
13
Arnoni, Renato Tambellini. "Avaliação da arteriopatia distal em pacientes com embolia pulmonar: estudo anátomo-patológico." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-20022009-135725/.
Анотація:
O tromboembolismo pulmonar causado por obstrução de ramos arteriais pulmonares por trombos originados de outras partes do corpo apresenta elevada incidência. Em 5% dos casos ocorre a cronificação do processo e manutenção ou agravamento da hipertensão pulmonar Duas hipóteses explicam a cronificação nos casos de embolia pulmonar: 1. manutenção do fator oclusivo como fundamental para o desenvolvimento da resposta vascular pulmonar caracterizada por hipertrofia da camada média; 2. hipertensão pulmonar secundária a uma arteriopatia inicial, nos pacientes que evoluíram de maneira desfavorável. Este estudo tem por objetivo avaliar sob critérios histopatológicos qualitativos e quantitativos o comportamento do leito arterial pulmonar distal (pré e intra-acinar), comparativamente em pulmões de pacientes sem tromboembolismo prévio e de pacientes portadores de tromboembolismo agudo e crônico. Para tanto, estudou-se a resposta vascular através de estudo histológico de 31 casos de embolia (aguda e crônica), comparando-os com 24 pacientes do grupo controle (Infarto agudo do miocárdio) (análise de autópsias). As lâminas de tecido pulmonar foram preparadas e coradas em hematoxilina-eosina e Miller. A análise realizada foi dividida em qualitativa (vasoconstrição e proliferação intimal concêntrica) e quantitativa (hipertrofia da camada média). Foram observadas alterações histopatológicas do leito arterial pulmonar distal nos pacientes portadores de quadro tromboembólico agudo e crônico, em relação aos pacientes sem tromboembolismo prévio. Estas alterações, entre os grupos agudo e crônico, foram: diferentes quanto aos critérios qualitativos, caracterizadas por maior vasoconstrição nos quadros tromboembólicos agudos e maior proliferação intimal concêntrica nos crônicos; semelhantes quanto aos critérios quantitativos, caracterizadas por hipertrofia da camada média. A isquemia decorrente da obstrução parece exercer um importante papel nestas alterações, o que, entretanto, necessita de comprovação futuraThe pulmonary embolism, caused by pulmonary artery branches obstruction from thrombus originated on other parts of the body, has a high incidence. However, just 5% of the cases develop the cronification and pulmonary hypertension. Two hypotheses can explain the cronification of tromboembolic pulmonary events: 1. maintenance of occlusive factor with pulmonary vascular response characterized by medial hypertrophy; 2. pulmonary hypertensive response as an initial arteriopathy in patients with bad evolution. This study aims to evaluate histologic aspects of pulmonary arterial bed (quantitative and qualitative), and to compare the results from embolic cases with non embolic cases. The study evaluated 55 patients (31 with pulmonary embolic disease and 24 in the control group myocardium infarction). From the selected cases, the blades with pulmonary tissue were colored by two techniques (haematoxilin-eosin and Miller). The analysis encompassed qualitative (vasoconstriction and intimal proliferation) and quantitative (mensuration of medial thickness) observations. It has been observed histologic changes between the two groups with pulmonary embolic disease (chronic or acute), and the control group. The changes between the embolic groups were: 1. higher vasoconstriction in the acute group, 2. more intimal proliferation in the chronic group, 3. no difference in the quantitative response (medial thickness). The ischemic response to obstruction can perform an important role in these changes, but further studies are necessary. There was a similar response in chronic and acute cases
14
Forés, Raurell Rosa. "Incidència d´arteriopatia perifèrica i morbi-mortalitat cardiovascular després de 5 anys de seguiment de la cohort poblacional ARTPER." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/650852.
Анотація:
Aquesta tesi es va plantejar per a millorar el coneixement de l’ epidemiologia de l’arteriopatia perifèrica, estudiar els factors implicats en la seva aparició i la repercussió en la morbimortalitat cardiovascular en el nostre entorn. A través del seguiment durant 5 anys d’ una cohort poblacional d'edat superior a 49 anys (cohort ARTPER), es van realitzar 3 estudis relacionats. En el primer estudi es va valorar la incidència d’arteriopatia perifèrica als 5 anys de seguiment de la cohort poblacional ARTPER i els factors associats a la seva aparició. En el segon estudi es va valorar la contribució de l’índex turmell-braç en la reclassificació del risc cardiovascular segons les funcions de risc Framingham i REGICOR i en el tercer estudi es va valorar l’evolució i el grau de control dels factors de risc cardiovascular clàssics, després de 5 anys de seguiment de la cohort i la seva relació amb la incidència d’arteriopatia perifèrica. La cohort ARTPER va ser creada entre octubre de 2006 i juny de 2008 per a estudiar la prevalença d’ arteriopatia perifèrica reclutant 3.786 individus >49 anys procedents de 24 centres de salut de l’àrea metropolitana de Barcelona i del Barcelonès Nord-Maresme. Posteriorment es va realitzar seguiment telefònic i revisió de la història clínica cada 6 mesos des de la inclusió dels participants fins 2016. Entre 2011- 2012 es van reexaminar els participants en una segona visita presencial per tal d’ avaluar la incidència d’ arteriopatia perifèrica. La participació va ser del 77%. Com a resultats d’ aquesta tesi s’ han publicat els següents articles:
Alzamora MT, Forés R, Pera G, Baena-Díez JM, Heras A, Sorribes M, Valverde M, Muñoz L, Mundet X, Torán P. Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up. BMC Cardiovasc Disord. 2016; 16: 8. FI: 1,832. Q3.
Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P. Contribution of the ankle-brachial index to improve the prediction of coronary risk: the ARTPER cohort. PLoS One. 2018; 13(1): e0191283. FI: 2,806 Q1.
Forés R, Alzamora MT, Pera G, Valverde M, Angla M, Baena-Díez JM, Mundet-Tuduri X. Evolución y grado de control de los factores de riesgo cardiovascular tras 5 años de seguimiento y su relación con la incidencia de arteriopatía periférica: cohorte poblacional ARTPER. Med Clin (Barc). 2017;148(3):107–113. FI: 1,125. Q3.
Conclusions: La incidència d’ arteriopatia perifèrica en la cohort poblacional ARTPER després de 5 anys de seguiment es de 8,6 casos /1.000 persones-any. En persones < 65 anys és major en homes, igualant-se a partir dels 75 anys en ambdós sexes. Els factors associats al descens de l’índex turmell-braç i a la incidència d’arteriopatia perifèrica són: el tabaquisme, l’ edat i la limitació per realitzar exercici físic. Afegir l’índex turmell-braç al càlcul del risc cardiovascular (REGICOR) produeix una millora en la reclassificació a risc elevat del 7%. L’índex turmell-braç < 0,9 s’associa a una major incidència d’esdeveniments coronaris i cerebrovasculars en la cohort poblacional, de baix risc cardiovascular, ARTPER. La prevalença dels factors de risc clàssics i el seu tractament augmenten als 5 anys de seguiment però, només s’ obté un control òptim en el 7% dels pacients. El risc de presentar AP es multiplica per 2 en pacients amb HTA mal controlada i per 5 en persones fumadores.This thesis was designed to improve the knowledge of peripheral arterial disease epidemiology , to study the involved factors in its onset and the cardiovascular morbidity and mortality impact in our environment. After 5 years of follow - up of a population cohort aged over 49 years (ARTPER cohort), 3 related studies were conducted. The first study evaluated the incidence of peripheral arterial disease at 5 years of follow-up of the ARTPER population cohort and the factors associated with its onset. The second study evaluated the contribution of the ankle-brachial index in the reclassification of cardiovascular risk according to Framingham and REGICOR the risk scores. The third study evaluated the evolution and the degree of control of the classics cardiovascular risk factors, after 5 years of cohort monitoring and its relation to the incidence of peripheral arterial disease. The ARTPER cohort was created between October 2006 and June 2008 to study the prevalence of peripheral arterial disease recruiting 3,786 individuals > 49 years old from 24 health centers in the metropolitan area of Barcelona and the Barcelonès Nord-Maresme. Subsequently, a telephone tracking and review of the medical history was carried out every 6 months from the inclusion of the participants until 2016. Between 2011-2012 the participants were re-examined in a second face-to-face visit to evaluate the incidence of peripheral arterial disease. The participation was 77%. As a result of this thesis the following articles have been published: Alzamora MT, Forés R, Pera G, Baena-Díez JM, Heras A, Sorribes M, Valverde M, Muñoz L, Mundet X, Torán P. Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up. BMC Cardiovasc Disord. 2016; 16: 8. FI: 1,832. Q3. Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P. Contribution of the ankle-brachial index to improve the prediction of coronary risk: the ARTPER cohort. PLoS One. 2018; 13(1): e0191283. FI: 2,806 Q1. Forés R, Alzamora MT, Pera G, Valverde M, Angla M, Baena-Díez JM, Mundet-Tuduri X. Evolución y grado de control de los factores de riesgo cardiovascular tras 5 años de seguimiento y su relación con la incidencia de arteriopatía periférica: cohorte poblacional ARTPER. Med Clin (Barc). 2017;148(3):107–113. FI: 1,125. Q3. Concusions: The peripheral arterial disease incidence in the ARTPER cohort after 5 years of follow-up was 8.6 cases / 1,000 person-years. In people <65 years old, it is higher in men, equaling> 75 years in both sexes. Smoking, age and limitation for physical exercise are the associated factors with decreased ankle-brachial index and the appearance of peripheral arterial disease. Adding the ankle-brachial index to the REGICOR score improves the reclassification at high risk cardiovascular about 7%. An ankle-brachial index <0.9 is associated with a higher incidence of coronary and cerebrovascular events in the population cohort, with low cardiovascular risk, ARTPER. The classic cardiovascular risk factors prevalence and its treatment increase after 5 years of follow-up, but only optimal control is achieved in 7% of patients. Poorly controlled hypertension doubles the risk of having peripheral arterial disease and smoking fivefold.
15
Bascou-Bussac, Mylène. "Comparaison des effets hemodynamiques de l'etomidate et du thiopental a l'induction anesthesique chez le sujet age arteriopathe." Aix-Marseille 2, 1990. http://www.theses.fr/1990AIX20827.
16
LEMBERTHE, THIERRY. "Les arteriopathies tronculaires de la femme jeune." Lyon 1, 1988. http://www.theses.fr/1988LYO1M291.
17
NIQUET, LEFEVRE YASMINE. "Les complications vasculaires apres les radiotherapies." Amiens, 1990. http://www.theses.fr/1990AMIEM007.
18
Linke, Kristina. "Idiopathische Arteriopathia calcificans (iAc) bei operierten Patienten mit therapieresistenter Epilepsie unter Berücksichtigung der Literatur." [S.l.] : [s.n.], 2003. http://deposit.ddb.de/cgi-bin/dokserv?idn=968415911.
19
Junqueira, Paulo Alves. "Arteriopatia do tipo moyamoya na Sindrome de Down : estudo clinico-epdemiologico atraves de metanalise." [s.n.], 2000. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311125.
Анотація:
Orientador: Maria Valeriana Leme de Moura-RibeiroDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A coexistência de pacientes com diagnóstico de síndrome de Down e anormalidades cerebrovasculares semelhantes às detectadas na doença de moyamoya (fenômeno moyamoya) têm sido sistematicamente relatadas nos últimos 20 anos. FUKUSHIMA et a! (1986) encontraram esta associação em um entre 532 pacientes com síndrome de Down e NISHIMURA et al (1985) um entre 400. Segundo KAWAI (1985 ) estes dados são três vezes superiores a incidência da doença de moyamoya na população geral. Este trabalho tem como objetivo estudar o caso de duas crianças com diagnóstico de síndrome de Down que apresentaram quadro vascular isquêmico agudo, atendidas na disciplina de Neurologia Infantil da FCM-UNICAMP e rever a literatura pertinente a este tema. Realizou-se avaliação clínico-neuro lógica e estudo por imagem dos pacientes, bem como metanálise de todos os casos desta associação descrita na literatura no período compreendido entre 1977 a 2000. Foram encontrados 40 relatos de casos, resumidos na Tabela 1, acrescidos de dois casos pessoais. Nove casos ocorreram em lactentes (até dois anos de idade). 19 em pré-escolares (dois - seis anos), seis em escolares (sete - 12 anos) cinco em adolescentes (13-19 anos) e apenas três em adultos (acima dos 20 anos). A relação entre sexo masculino/feminino foi de 1:1,33. Foi constatado ataque isquêmico transitório [AIT] em sete pacientes (16,6%); infarto em 32 (76,2%) e episódio hemorrágico somente em três (7,2%). A idade de início dos sinais e sintomas variou de seis meses a 27 anos, com pico de incidência ocorrendo entre um e seis anos. Os pacientes catalogados na metanálise são oriundos de 12 diferentes países, sendo 13 originários do Japão. Hemiparesia foi o sintoma clínico inaugural em 33 casos (78,5%), seguidos por distúrbios da feia em 11 casos (26,2%), convulsões em seis casos (14,3%) e, numa incidência menor em ordem decrescente de freqüência, movimentos involuntários (coréia), fraqueza muscular, paralisia facial, cefaléia, atrofia óptica e cegueira cortical nos demais casos. Em 24 pacientes por ocasião do diagnóstico encontrava-se presente apenas um distúrbio neurológico, em 15 pacientes, dois distúrbios concomitantes e em três pacientes, três distúrbios concomitantes. O comprometimento vascular foi bilateral em 35 casos (83,3%) e unilateral em sete (16,7%). Cardiopatia esteve presente em 10 pacientes (23,8%) sendo a Comunicação Intraventricular [CIV] a mais freqüente (40%). Os episódios isquêmicos foram recorrentes em 26 pacientes (62%) e isolados em 16 (38%). Estes dados enfatizam a freqüente associação entre síndrome de Down e moyamoya, fazendo com que, diante de pacientes com síndrome de Down e episódios de hemiparesia aguda, se formalize a hipótese de quadro vascular isquêmico com a inclusão da síndrome de moyamoya no diagnóstico diferencial
Abstract: Patients diagnosed with Down syndrome and cerebrovascular abnormalities similar to those detected in moyamoya disease (moyamoya phenomenum) have been systematically described in the last 20 years. FUKUSHIMA et al (1986) found this association in one of 532 Down Syndrome patients, and NISHIMURA et al (1985) found one in 400. According to KAWAI(1985), these figures are three fold the incidence of moyamoya disease in the general population. This paper has the goal of studying two children diagnosed with Down syndrome who presented with an acute ischemic vascular condition, and were cared for at the Child Neurology Department of FMC - UN1CAMP, and reviewing the literature pertaining to this theme. The patients were clinically and neuro logically evaluated, imaging tests were performed and a meta-analysis was conducted including all the cases in the literature presenting the above association in the period of 1977 to 2000. Forty cases reports were found and are summarized in Table 1, plus two cases seen by the author. Nine were infants (up to two years of age ), nineteen pre-schoolers (2-6 years of age), six children in school age (7-12 years of age), five teen-agers (13-19 years of age) and only three adults (over 20 years of age). The gender ratio was 1:1.33 (male/female ratio). With regard to the disease subtype, the transient ischemic attack (TIA) type was reported in 7 patients (16,6%), the infarction type in 32 (76,2%), and the hemorrhagic type in 3 (7,2 %). The age of onset of signs and symptoms ranged from six months to 27 years of age, with a peak incidence occurring between one and six years . The patients included in the meta-analysis came from 12 different countries, and of the total 13 came from Japan. Hemiparesis was initial clinical symptom in 33 cases (78,5%), followed by speech disorders in II cases (26,2%), seizures in 6 cases (14,3%), and, with a lower incidence, from most to less frequent, involuntary movements (chorea), muscle weakness, facial paralysis, headache, optical atrophy and cortical blindness in the remaining cases. In 24 patients, at the time of diagnosis, there was only one neurological disorder present; in 15 patients, two concurrent disorders; and in 3 patients, three concurrent disorders. Vascular involvement was bilateral in 35 cases (83.3%) and unilateral in 7 cases (16.7%). Congenital heart detects were present in 10 patients (23.8%), and among those, ventricular septal defect (VSD) was the most frequent condition (40%). Ischemic episodes were recurrent in 26 patients (62%) and isolated in 16 (38%). These data highlight the frequent association between Down syndrome and moyamoya disease, so that, when faced with Down syndrome patients with acute hemiparesis episodes, the hypothesis should be raised of an ischemic vascular condition including moyamoya syndrome in the differential diagnosis
Mestrado
Neurologia
Mestre em Ciências Médicas
20
Velescu, Alina. "Arteriopatía obliterante de extremidades inferiores en una población Mediterránea: epidemiología y asociación con enfermedad cardiovascular." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/405306.
Анотація:
INTRODUCCIÓN:
La enfermedad arterial periférica (EAP) es una de las tres principales manifestaciones clínicas de la aterosclerosis. Es la primera causa de pérdida de la extremidad en los países occidentales y un factor de riesgo independiente de eventos coronarios, cerebrovasculares y mortalidad en general.
OBJETIVOS:
1. Determinar la incidencia y factores de riesgo de la EAP en nuestro medio.
2. Evaluar la asociación entre EAP y la incidencia de otras formas de enfermedad cardiovascular. Si existe asociación, evaluar si la inclusión del índice tobillo-brazo (ITB) en las funciones de riesgo cardiovascular mejora su capacidad predictiva.
3. Evaluar la asociación entre un ITB elevado y la incidencia de otras formas de enfermedad cardiovascular. Caracterizar el perfil de los individuos con el ITB elevado.
METODOLOGÍA:
Cohorte prospectiva de base poblacional, de 6352 sujetos residentes en Girona, con edades comprendidas entre 35 y 79 años, evaluada entre 2004-2006 y seguida hasta 2012, y que forma parte del estudio REGICOR (Registro de Girona del Corazón).
Se recogieron como variables basales los factores de riesgo cardiovascular clásicos, los antecedentes de enfermedad coronaria y cerebro-vascular, y el ITB. Todos los participantes fueron invitados a asistir a un segundo examen físico entre 2009-2012. En esta visita se volvieron a medir los factores de riesgo cardiovascular clásicos se realizó una segunda medición del ITB. Durante el seguimiento se registraron todos los eventos coronarios y cerebrovasculares incidentes y la mortalidad.
RESULTADOS:
Objetivo 1:
La tasa de incidencia acumulada de EAP en la población fue de 377/100.000 personas-año-1. La tasa de incidencia de la EAP asintomática fue casi tres veces mayor que la de EAP sintomática. La tasa de incidencia de EAP aumentó con la edad, con un marcado ascenso a partir de los 65 años y fue mayor en hombres que en mujeres.
La diabetes mellitus no controlada fue el factor de riesgo más potente para la aparición de EAP (OR=10,14). En los participantes de 65 años o menos, la diabetes y la presión arterial sistólica (PAS) se asociaron con la incidencia de EAP; mientras que en los mayores de 65 años, las variables con mayor asociación fueron el tabaco y la PAS.
Objetivo 2:
La EAP se asoció con mayor riesgo de enfermedad coronaria y cardiovascular en general (HR=2,08 y HR=2,24, respectivamente). La inclusión del ITB en la función de Framingham-REGICOR mejoró tanto la discriminación como su capacidad de reclasificación para eventos cardiovasculares. El incremento del estadístico C fue 0,007 y la mejora neta de la reclasificación (NRI) fue 0,029.
Objetivo 3:
Un ITB≥ 1,4 no se asoció a una mayor incidencia de eventos CV, pero sí con la mortalidad por cualquier causa (HR=1,97) y la mortalidad CV (HR=3,30). El perfil de los individuos con ITB calcificado revela los siguientes factores independientes: edad, sexo masculino, diabetes y la presión arterial diastólica elevada.
CONCLUSIONES:
La incidencia de EAP en nuestro estudio fue menor que en otros países desarrollados. La diabetes es el factor de riesgo más importante para desarrollar EAP en los individuos menores de 65 años, mientras que el tabaquismo es el más relevante en los mayores de 65 años. La diabetes mal controlada a largo plazo es el factor de riesgo que más se asocia con la incidencia de EAP.
La presencia de un EAP es indicativo de un mayor riesgo de presentar acontecimientos coronarios y cardiovasculares. La incorporación del ITB a la función Framingham-REGICOR mejora su capacidad predictiva para eventos cardiovasculares mayores.
Los sujetos con un ITB elevado no presentan una mayor tasa de eventos cardiovasculares pero sí presentan un mayor riesgo de mortalidad CV y por todas las causas.INTRODUCTION: Peripheral arterial disease (PAD) is one of the three main clinical manifestations of atherosclerosis. PAD is the leading cause of limb loss in western countries and an independent risk factor for coronary and cerebrovascular events, and all cause mortality. OBJECTIVES: 1. To determine the incidence and risk factors of PAD in the Mediterranean population. 2. Evaluate the association between PAD and the incidence of other forms of cardiovascular disease. If there is an association, evaluate whether the inclusion of ankle-brachial index (ABI) in cardiovascular risk functions improves its predictive capacity. 3. To evaluate the association between a high ABI and the incidence of other forms of cardiovascular disease. Characterize the profile of individuals with abnormally high ABI. METHODOLOGY: Prospective population-based cohort of 6352 subjects living in Girona, aged between 35 and 79 years, evaluated between 2004-2006 and followed up to 2012, which is part of the REGICOR study (Girona Registry from the heart). Baseline variables included baseline cardiovascular risk factors, history of coronary and cerebrovascular disease, and ABI measurement. All participants were invited to attend a second physical examination between 2009-2012. At this follow-up visit, classic cardiovascular risk factors and other comorbidities were measured again, and second ABI measurement was performed. During follow-up all incident coronary and cerebrovascular events and mortality were recorded. RESULTS: Objective 1: The cumulative incidence rate of PAD in the population was 377 / 100,000 person-years-1. The incidence rate of asymptomatic PAD was almost three times higher than that of symptomatic PAD. The incidence rate of PAD increased with age, with a marked increase from 65 years and was higher in men than in women. Uncontrolled diabetes mellitus was the most potent risk factor for the development of PAD (OR=10.14). In participants of 65 years or less, diabetes and systolic blood pressure (SBP) were associated with the incidence of PAD, while in those older than 65 years; the variables with the greatest association were tobacco and SBP. Objective 2: PAD was associated with an increased risk of coronary and cardiovascular disease in general (HR=2.08 and HR=2.24, respectively). The inclusion of ABI in the Framingham-REGICOR function improved both discrimination and its ability to reclassify cardiovascular events. The increment of the C statistic for cardiovascular events was 0.007 and the net improvement of the reclassification (NRI) was 0.029. Objective 3: An ITB≥1.4 was not associated with a higher incidence of CV events, but with all-cause mortality (HR=1.97) and CV mortality (HR=3.30). The profile of individuals with abnormally high ABI revealed the following independent factors: age, male sex, diabetes and high diastolic blood pressure CONCLUSIONS: The incidence of PAD in our study was lower than in other developed countries. Diabetes is the most important risk factor in individuals younger than 65 years, while smoking is the most relevant in people over 65 years. Long term uncontrolled diabetes is the main risk factor for PAD incidence. PAD is strongly associated with the incidence of coronary and cardiovascular events in general. The inclusion of ABI in the Framingham-REGICOR risk function improves its predictive capacity for cardiovascular events. Subjects with abnormally high ABI do not present a higher rate of cardiovascular events. However, they do show a clear association with cardiovascular and total mortality, so they can be considered as a high-risk population.
21
PADOVANI, MICHEL. "Les pontages jambiers pour arteriopathie chronique obliterante des membres inferieurs : a propos de 73 cas." Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20172.
22
ECKSTEIN, ULRICH JOHANNES. "L'angioscopie arterielle peripherique par voie percutanee : interet diagnostique et therapeutique ; a propos de 111 patients." Lille 2, 1990. http://www.theses.fr/1990LIL2M124.
23
CONCHONNET, PHILIPPE. "Arteriopathies de la femme : a propos d'une etude prospective comparative entre les sexes." Saint-Etienne, 1989. http://www.theses.fr/1989STET6401.
24
CATTEAU, TREHAUT NATHALIE. "Arteriopathies symptomatiques du membre superieur : a propos de 66 observations." Lille 2, 1993. http://www.theses.fr/1993LIL2M338.
25
MILLION-RANQUIN, MARTIAL. "Pontages composites sous le genou : resultats a propos de 83 cas." Lyon 1, 1989. http://www.theses.fr/1989LYO1M209.
26
Bosnardo, Carla Aparecida Faccio. "Avaliação clinica de doentes hipercolesterolemicos e arteriopatas apos tratamento medico com base na qualidade de vida." [s.n.], 2002. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310512.
Анотація:
Orientador: Ana Terezinha GuillaumonDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A ateroesclerose atinge cerca de 10% da população mundial e é uma das principais causas de morte ou incapacidade física nos países desenvolvidos; inúmeros tratamentos médicos vem sendo propostos para o seu controle e de suas complicações como a doença oc1usiva crônica dos membros inferiores. No período de maio a dezembro de 1999, foram acompanhados trinta doentes, divididos em três grupos distintos de maneira aleatória, sendo 19 homens (63.3%) e 11mulheres (36,6%) com idade média de 59.9 anos; todos arteriopatas e claudicantes. Cada grupo recebeu um tipo de tratamento distinto:grupo I dieta hipocolesterolêmica e fisioterapia programada, grupoII dieta normocolesterolêmica, fisioterapia programada e Sinvastatina na dose diária de 10mg e grupo III dieta livre, fisioterapia programada e Sinvastatina na dose diária de 10mg. A cada doente foram aplicados questionários relacionados a qualidade de vida, cuja a conclusão foi que o grupo II é o que melhor responde e é o que tem melhor qualidade de vida ao final do tratamento
Abstract: Since atheroesclerosis hits around 10% of the world population and is one of the major causes of death or physical disability in developed countries, endless treatments have been proposed for its control as well as for the treatment of its further complications, such as the chronic occlusive disease of the lower members. The present study was conducted taking this into account. In the period ofMay to December 1999, thirty patients19 men (63,3%) and 11 women (36,6%) of an average age of 59,9 years - were followed up. They were randomly divided into three groups. All patients were arteriopatas and limping. Each group received a different kind of treatment: the first one was treated with a hipocolesterolemic diet and programmed physiotherapy; the second with a normocolesterolemic diet, programmed physiotherapy and a daily dose of 10 mg of Sinvastatine and the third with a ffee diet, programmed physiotherapy and a daily dose of 10 mg of Sinvastatine. A questionnaire about the qua1ity of life was given to each patient, the conc1usion being that the second group was the one with the best response to its treatment, having the greatest improvement regarding quality of life
Mestrado
Cirurgia
Mestre em Cirurgia
27
RAILLAT, CHRISTOPHE. "Endoprotheses vasculaires auto-expansives et arteriopathie obliterante des membres inferieurs : resultats preliminaires de 50 premiers cas." Toulouse 3, 1988. http://www.theses.fr/1988TOU31146.
28
Valverde, Peris Marta. "Eventos vasculares tras 9 años de seguimiento en una cohorte poblacional mediterránea (Estudio ARTPER)." Doctoral thesis, Universitat Autònoma de Barcelona, 2019. http://hdl.handle.net/10803/669951.
Анотація:
La población española es considerada una población de bajo riesgo cardiovascular (RCV), a pesar de los eventos vasculares (EV) son una de las principales causes de muerte. Los eventos coronarios (EC) han sido la principal causa de muerte seguida de los eventos cerebrales (ECe).
Objetivo: Determinar la incidencia de EV en una población mediterránea de bajo RCV después de 9 años de seguimiento, así como la influencia de los diferentes factores de riesgo vascular (FRV), en especial la arteriopatía periférica (AP) y la aparición de recurrencia.
Material y métodos: El grupo ARTPER es un estudio poblacional prospectivo observacional iniciado en el ano 2006 y con un seguimiento hasta la actualidad, con una muestra inicial de 3.786 sujetos mayores de 49 anos, reclutados bajo muestreo simple aleatorio de diferentes centros de Atención Primaria. Se recogieron los datos socio-demográficos y las variables de RCV [Hipertensión arterial (HTA), Diabetes Mellitus (DM), Dislipemia (DSLP), tabaquismo, obesidad y AP]. Los EV y la morbi-mortalidad fueron las variables principales del estudio.
Resultados: Los sujetos con AP presentan mayor incidencia de EV. El riesgo de mortalidad vascular es hasta 7 veces superior en individuos con AP respecto a los sanos. El riesgo de EC y ECe es mayor de 4 veces y 3 veces, respectivamente, en sujetos con AP, en relación con individuos con índice tobillo brazo (ITB) normal. Los sujetos con calcificación arterial (CA) no presentan diferencias en la incidencia de EV respecto a los sanos, excepto en ECe. La recurrencia de EV, independientemente de la etiología, es mayor en el grupo de AP (42%) respecto a los sanos (31%). La odds ratio (OR) de recurrencia de ECe de AP respecto a los sanos, tras ajustar por los FRV, es de 1,77.
Conclusiones: La presencia de AP aumenta la incidencia de EV
independientemente de FRV, así como el riesgo de recurrencia, especialmente en lo que se refiere a los ECe.Spanish population is considered a low cardiovascular risk population although vascular events are the principal cause of death. Coronary events were ranked as the first in number of deaths in the general population, followed by cerebrovascular events. Objective: the aim of our study is to determine the incidence of vascular events in lowcardiovascular-risk general population after 9 years follow-up, as well as the influence of vascular risk factors, with a special interest in peripheral arterial disease patients and future events. Methods: ARTPER is an ongoing prospective observational population cohort study with 3786 subjects over 49 years old recruited (simple random sampling) from Primary Health Care Centers. We obtained demographic variables, different vascular risk scores, the presence of principal cardiovascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking habit, obesity, abdominal obesity and peripheral arterial disease). Vascular events or morbi-mortality (vascular and non-vascular cause) were classified as end points. Results: Patient with peripheral arterial disease present higher incidence of vascular events. The risk of vascular mortality is up to 7 times higher in individuals with peripheral arterial disease than healthy population. The risk of coronary events and cerebrovascular events is greater than 4 times and 3 times respectively in subjects with peripheral arterial disease in contrast with healthy population. Subjects with arterial calcification do not present differences in the incidence of vascular events compared to healthy subjects, except in cerebrovascular events. The recurrence of vascular events independently of etiology is greater in in peripheral arterial disease (42%) compared to healthy group (31%). The Odds Ratio of recurrence of cerebrovascular events for patients with peripheral arterial disease vs healthy patients after adjusting for cardiovascular risk factor is 1.77. Conclusions: The presence of peripheral arterial disease increases the incidence of vascular evens independently of other vascular risk factors, as well as the risk of recurrence, especially in cerebrovascular events.
29
CHEN, TI PHOON. "Implication des lipides dans les arteriopathies des membres inferieurs." Clermont-Ferrand 1, 1994. http://www.theses.fr/1994CLF1M038.
30
DECLEMY, SERGE. "L'arteriopathie chronique obliterante des membres inferieurs du sujet jeune de moins de 40 ans." Nice, 1990. http://www.theses.fr/1990NICE6819.
31
FAUCHEUX, JEAN-MARC. "La neuropathie liee a l'arteriopathie chronique des membres inferieurs : realite clinique et consequences." Toulouse 3, 1994. http://www.theses.fr/1994TOU31508.
32
DEBUSE, QUATANNENS ANNE-SOPHIE. "Interet de la neuro-stimulation cordonale posterieure cervicale dans le traitement des arteriopathies digitales." Lille 2, 1989. http://www.theses.fr/1989LIL2M422.
33
Descamps-Pirot, Marie-José. "Interet de l'oxymetrie transcutanee statique pour la determination du niveau d'amputation chez l'arteritique : etude preliminaire." Lille 2, 1990. http://www.theses.fr/1990LIL2M079.
34
SOUILLART, DENIS. "Amputes arteritiques : le resultat fonctionnel justifie-t-il l'appareillage ?" Lille 2, 1988. http://www.theses.fr/1988LIL2M288.
35
Desmyttere, Jacques, and CHRISTOPHE GRARD. "Interet de l'oxymetrie transcutanee dynamique etagee chez le claudicant : etude preliminaire." Lille 2, 1988. http://www.theses.fr/1988LIL2M324.
36
Fratta, Leila Xavier Sinigaglia. "Arteriopatia na atresia biliar : papel dos fatores induzidos por hipóxia e sua relação com prognóstico pós-portoenterostomia." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/116798.
Анотація:
Introdução: A atresia biliar (AB) inclui obstrução completas das vias biliares extra-hepáticas e uma colangiopatia intra-hepática progressiva, cirrogênica. A natureza da colangiopatia destes processos permanece obscura. Uma arteriopatia levando a colangiopatia isquêmica explicaria a natureza progressiva da lesão biliar. A imunolocalização do fator de crescimento endotelial vascular A (VEGFA) em ramos arteriais e ductos biliares intra-hepáticos e do porta hepatis dos pacientes com AB sugere isquemia nestas estruturas. A ocorrência de hipóxia hepatobiliar na AB necessita ser esclarecida. Objetivo: Determinar a presença de hipóxia nos fígados de pacientes com AB, analisando a expressão gênica dos fatores induzidos por hipóxia (HIF) -1α e -2α. Métodos: Estudo de amostras de biópsias em cunha coletadas na laparotomia exploradora de pacientes com AB isolada sem IgM+ para citomegalovírus (n= 32) comparando com lactentes com colestase intra-hepática (CIH, n= 09), pareados por idade. Uma amostra foi ultracongelada (análise molecular) e outra, parafinizada (análises histológica e imunoistoquímica). Por PCRq, usando sondas TaqMan®, avaliaram-se as expressões gênicas de: HIF1-α, HIF2-α, proteína quimiotática de monócitos 1 (MCP1) (marcador de fibrose biliar), citoqueratina 19 (CK19) (marcador de colangiócitos). O gene normalizador foi 18S ribossômico. Por morfometria, foram quantificadas as extensões de fibrose e reação ductular. Dados clínico-laboratoriais foram prospectivamente coletados. Resultados: O grupo AB, comparado à CIH, apresentou maior expressão de HIF1-α e HIF2-α. No grupo AB, a expressão do HIF1-α correlacionou-se positivamente com a bilirrubina total (BT) sérica. Dois subgrupos de AB foram detectados quanto à expressão dos HIFs: alta (hiHIF, expressão 3x maior que a mediana da CIH) e baixa (loHIF). Pacientes hiHIF-1α eram mais velhos e com maiores níveis de BT e bilirrubina direta (BD) que loHIF-1α. O subgrupo hiHIF-2α apresentou expressão de CK19 inferior a do loHIF-2α. As demais variáveis foram semelhantes nos subgrupos HIFs. Conclusão: Na AB ocorre hipóxia tecidual hepática. Os dados sugerem a existência de hipóxia tecidual progressiva nos fígados afetados pela AB, associada ao desaparecimento de ductos biliares e à piora do quadro obstrutivo biliar.Background: Biliary atresia (BA) includes a complete obstruction of the extrahepatic biliary tract and progressive intrahepatic cholangiopathy, and the nature of these processes remains unclear. An arteriopthy, leading to an ischemic cholangiopathy, can be involved. The immunolocalization of vascular endothelial growth factor A (VEGFA) in arterial branches and bile ducts both within the liver and at porta hepatis from patients with BA suggests ischemia in these structures. The occurrence of hypoxia in the hepatobiliary system in BA needs to be elucidated. Aim: To determinate the presence of hypoxia in the livers from patients with BA, by analyzing the gene expression of hypoxia-inducible factor (HIF) -1α and -2α. Methods: Liver biopsy specimens collected at exploratory laparotomy of age-matched patients with isolated, cytomegalovirus IgM-negative BA (n=32) and intrahepatic cholestasis (IHC, n=9) were evaluated. A sample was ultrafrozen (molecular analysis) and the other was paraffin-embedded (for histological and morphometric analyzes). Gene expression of: HIF-1α, HIF-2α, monocyte chemoattractant protein 1 (MCP1) (biliary fibrosis marker) and cytokeratin 19 (CK19) (cholangiocyte marker) were evaluated by PCRq using TaqMan® probes. The normalizing gene was 18S ribosomal. The extents of fibrosis and ductular reaction were assessed by morphometry. Clinical and laboratory data were prospectively collected. Results: There was higher HIF-1α and HIF-2α expression in BA in comparison with IHC. In BA, the HIF-1α expression was positively correlated with total serum bilirubin (TB). Two groups were observable in BA regarding HIFs: higher (hiHIF, considering as cutoff point a value higher than 3x the median of expression in IHC) and lower (loHIF). Patients with hiHIF-1α were older and presented increased levels of TB and direct-reacting serum bilirubin (DB) than loHIF-1α. Patients with hiHIF-2α presented CK19 expression lower than in loHIF-2α. The other variables were similar in subgroups HIFs. Conclusion: In BA there is hypoxia in the liver tissue, which seems to be progressive and associated with the disappearance of bile ducts and worsening biliary obstruction.
37
Pérez, Ramírez Paulina. "Influencia de la anemia y el tratamiento con cilostazol en el pronóstico de los pacientes con arteriopatía periférica." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/377766.
Анотація:
Introducción: La arteriopatía periférica es la manifestación de la arteriosclerosis en aquellos territorios que no sean en el coronario, intracraneal ni cerebral. Se trata de una enfermedad ampliamente estudiada que es considerada como un indicador de riesgo cardiovascular sobre todo para cardiopatía isquémica y enfermedad cerebrovascular. Suele ser asintomática y su primera manifestación es habitualmente la claudicación intermitente.
Objetivos: En esta tesis se presentan dos trabajos donde se analiza la influencia de la anemia en el pronóstico de los pacientes estables con enfermedad arterial periférica así como si el tratamiento con cilostazol, fármaco que aumenta la distancia de claudicación, influye negativamente en la aparición de nuevos eventos cardiovasculares ya sea en forma de infarto agudo de miocardio, hemorragia o muerte.
Pacientes y métodos: Para ello se han obtenido datos del FRENA, un registro prospectivo que incluye pacientes con arteriopatía periférica seguidos una media de 18 meses. Se recogen características clínicas de los pacientes, su tratamiento farmacológico y cada uno de los eventos cardiovasculares, hemorragia o muerte durante este periodo.
Resultados: De 1663 pacientes con arteriopatía periférica, 208 (12.5%) tenían anemia, tras 18 meses aquellos con anemia presentaban una mayor tasa de infarto agudo de miocardio (RR 2.10; 95% intervalo de confianza (CI): 1.04-3.99), amputación (RR: 2.98; 95% CI: 1.70-5.05), mortalidad (RR: 3.58; 95% CI: 2.39-5.28), con tasas de isquemia cerebrovascular y hemorragia similares. En el análisis multivariante tener anemia se asoció a un incremento del riesgo de muerte. De los 1317 pacientes con arteriopatía periférica analizados en el segundo trabajo, aquellos que tomaban cilostazol (14.5%) no presentaron diferencias estadísticamente significativas de eventos cardiovasculares, hemorragia o muerte con respecto a los que no lo tomaban.
Conclusiones: Podemos concluir que la anemia, en pacientes estables con arteriopatía periférica, se asocia a un incremento de la mortalidad. De los pacientes con claudicación intermitente, aquellos tratados con cilostazol no tanían mayor número de eventos cardiovasculares, hemorragias o muerte.Introduction: Peripheral artery disease (PAD) is one of the symptoms of arteriosclerosis out of coronary or cerebral arteries. PAD has been widely studied and it is considered as an indicator of cardiovascular risk, especially for coronariopaty and cerebrovascular disease. It is usually asymptomatic and when symptomatic it is commonly in form of intermittent claudication. Objectives: In this work we present two articles where the influence of anemia in the prognosis on outpatients with symptomatic PAD and the influence of the treatment with cilostazol, pharmacological treatment of intermittent claudication, and its risk for subsequent ischemic events, myocardial infarction, bleeding or death. Patients and Methods: We have used data from the FRENA Registry, a prospective registry of patients with PAD with mean follow up of 18 months. We collect data from clinical characteristics, pharmacological treatment, cardiovascular events, bleeding or death during this period. Results: Of 1663 patients with PAD, 208 (12.5%) had anemia. Over 18 months, patients with anemia had a higher rate of myocardial infarction (RR 2.10; 95% Confidence interval (CI): 1.04-3.99), limb amputation (RR: 2.98; 95% CI: 1.70-5.05), mortality (RR: 3.58; 95% CI: 2.39-5.28), with similar results for ischemic stroke and major bleeding. On multivariate analysis, anemia was associated with an increased risk to die. Of 1317 patients with intermittent claudication those who received cilostazol (14.5%) had no significant differences in the rate of subsequent ischemic events, major bleeding or death than those without cilostazol. Conclusions: In stable outpatients with PAD, anemia was associated with increased mortality but not with an increased rate of subsequent ischemic events or major bleeding. In stable outpatients with intermittent claudication, the use of cilostazol was not associated with increased rates of subsequent ischemic events, major bleeding or death.
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