559 resultados para Ecografia intravascular


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Nos países em desenvolvimento, particularmente nas zonas remotas, os exames médicos imagiológicos são quase inexistentes devido ao elevado custo de aquisição e manutenção. A Organização Mundial de Saúde (OMS) considera essencial a difusão da ecografia por ser um exame imagiológico de baixo custo, rápido e de grande fiabilidade, se realizada por um técnico formado. O advento da ecografia portátil diminuiu os custos, aumentando a flexibilidade da ecografia. Assim como o estetoscópio revolucionou a semiologia, é de prever que os ecógrafos de bolso se introduzam como complemento ao exame físico, permitindo a validação do diagnóstico semiológico. Durante um período de 4 meses utilizou-se um ecógrafo de bolso na prática clínica de uma missão humanitária em zona remota no distrito de Angolares em São Tomé e Príncipe. O clínico, através de um formulário de relato de caso (FRC), registou o diagnóstico, confiança no diagnostico (escala de Likert) e gestão terapêutica, baseado na semiologia, sendo esta informação reavaliada após a ecografia de bolso. Foram realizados 84 exames em 76 pacientes (12,8% dos pacientes observados). Os FRC foram revistos por pares, determinando a contribuição com informação relevante em 79,8% dos casos, alteração do diagnóstico em 52,4% e gestão terapêutica em 59,5%. Foi descrito um aumento na confiança do clínico no diagnóstico (p<0,01) e diminuição nos custos globais da gestão terapêutica (p<0,05). Do primeiro período de dois meses para o segundo verificou-se um aumento do risco relativo da ecografia não contribuir com informação relevante [4,31; 95% CI 1,5-12; χ2=9,87, p<0,01] e em simultâneo um decréscimo de exames por paciente observado. Neste contexto, a ecografia de bolso aumentou a qualidade do diagnostico clínico e diminuiu os custos com a gestão terapêutica, reduzindo o tempo até ao diagnostico definitivo e os riscos inerentes a terapêuticas desnecessárias. Esta tecnologia, como complemento do exame físico, embora dependente do observador, aparenta ser benéfica para os pacientes em zonas remotas. O aumento da exactidão de diagnostico semiológico durante o estudo sugere a necessidade de investigação sobre a aprendizagem informal e ecografia de bolso.

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Com o objectivo de avaliar o impacto da ecografia do 1º trimestre de gravidez na ansiedade e vinculação pré-natal, 22 mães e 22 pais foram recrutados numa Unidade de Medicina Fetal e Diagnóstico Pré-Natal. Foram administrados a Bonding Scale (Taylor, Atkins, Kumar, Adams, & Glover, 2005; versão portuguesa de Figueiredo, Marques, Costa, Pacheco, & Pais, 2005b) e o State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983; versão portuguesa de Silva, 2003), antes e depois da ecografia, a ambos os membros do casal. Os resultados revelaram que a vinculação pré-natal aumenta significativamente enquanto a sintomatologia ansiosa diminui, depois da realização da ecografia. Conclui-se que a ecografia pode ter um papel tranquilizador e potenciador da ligação dos pais ao seu bebé por nascer.

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Purpose: The purpose of this study was to compare the plaque morphology between coronary and peripheral arteries using intravascular ultrasound (IVUS). Methods: IVUS was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Results: Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P=NS) and VH-TCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; P=0.02) was observed in all arteries. Compared to coronary arteries, VH-FA was less frequently observed in renal (P<0.001) and iliac arteries (P<0.006), while VH-PIT and VH-FC were prevalent in both of these peripheral arteries. Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary, carotid, and renal arteries compared to those with intermediate/negative remodeling (all P<0.01). There was positive relationship between RI and percent necrotic core area in all four arteries. Conclusions: Atherosclerotic plaque phenotypes were heterogeneous among four different arteries. In contrast, the associations of remodeling mode with plaque phenotype and composition were similar among the various arterial beds.

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PURPOSE: To determine the diagnostic value of the intravascular contrast agent gadocoletic acid (B-22956) in three-dimensional, free breathing coronary magnetic resonance angiography (MRA) for stenosis detection in patients with suspected or known coronary artery disease. METHODS: Eighteen patients underwent three-dimensional, free breathing coronary MRA of the left and right coronary system before and after intravenous application of a single dose of gadocoletic acid (B-22956) using three different dose regimens (group A 0.050 mmol/kg; group B 0.075 mmol/kg; group C 0.100 mmol/kg). Precontrast scanning followed a coronary MRA standard non-contrast T2 preparation/turbo-gradient echo sequence (T2Prep); for postcontrast scanning an inversion-recovery gradient echo sequence was used (real-time navigator correction for both scans). In pre- and postcontrast scans quantitative analysis of coronary MRA data was performed to determine the number of visible side branches, vessel length and vessel sharpness of each of the three coronary arteries (LAD, LCX, RCA). The number of assessable coronary artery segments was determined to calculate sensitivity and specificity for detection of stenosis > or = 50% on a segment-to-segment basis (16-segment-model) in pre- and postcontrast scans with x-ray coronary angiography as the standard of reference. RESULTS: Dose group B (0.075 mmol/kg) was preferable with regard to improvement of MR angiographic parameters: in postcontrast scans all MR angiographic parameters increased significantly except for the number of visible side branches of the left circumflex artery. In addition, assessability of coronary artery segments significantly improved postcontrast in this dose group (67 versus 88%, p < 0.01). Diagnostic performance (sensitivity, specificity, accuracy) was 83, 77 and 78% for precontrast and 86, 95 and 94% for postcontrast scans. CONCLUSIONS: The use of gadocoletic acid (B-22956) results in an improvement of MR angiographic parameters, asssessability of coronary segments and detection of coronary stenoses > or = 50%.

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L’ artrosi de genoll es una de les malalties reumatològiques mes freqüents a l’Atenció Primària Objectiu. Prevalença de sinovitis Material i mètodes. Estudi transversal descriptiu. Resultats. 19 pacients, promig d’edat de 59,8 anys . L’estudi ecogràfic es va trobar vessament articular en 17 pacients (89.4%) i hipertrofia sinovial en 10 (52,6%) . Entre pacients amb i sense vessament existeixen diferencies significatives en el temps d’evolució i el qüestionari Lequesne. Conclusions. L’ecografia articular és una eina eficaç. La malaltia artròsica no es un procés purament degeneratiu, sinó que existeixen signes inflamatoris.

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The information gathered with intravascular ultrasound (IVUS) are of great value in endovascular techniques. The aim of this study was to evaluate the reliability of IVUS when measuring vessel dimensions by comparison with an established reference method. The left carotid artery was exposed in 4 pigs (45-55 kg) and two piezoelectric crystals were sutured on the adventitia in the same cross-sectional plane. The distance between them was measured either by IVUS and by sonomicrometers. The mean distance between the two crystals calculated by the sonomicrometer was 4.7+/-0.4 mm (mean systolic distance was 4.9+/-0.2 mm, mean diastolic distance was 4.6+/-0.1 mm). The mean distance between the two targets calculated by IVUS was 4. 5+/-0.2 mm (mean systolic distance was 4.6+/-0.2 mm and mean diastolic 4.4+/-0.2 mm). Regression analysis of the two series of data shows a R(2)=0.9984. IVUS measurements are an average 5% smaller than sonomicrometer measurements (3.6% up to 8.3%) and the difference is statistically significant ( p <0.05). The underestimation of IVUS measurements will affect the accuracy, and probably the long-term outcome, of endovascular procedures.

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Les infections liées aux accès vasculaires sont à l'origine d'une proportion importante des infections nosocomiales. Elles comprennent leur colonisation par des micro-organismes, les infections du site d'insertion et les bactériémies et fongémies qui leur sont associées ou attribuées. Une bactériémie complique l'insertion de 3 à 5 % des voies veineuses, correspondant à une incidence de 2 à 14 épisodes pour 1000 jourcathéters. Cette proportion ne représente toutefois que la partie visible de l'iceberg puisque la plupart des épisodes de sepsis clinique sans foyer infectieux associé sont également considérés comme liés aux accès vasculaires. Après un rappel de leur physiopathologie, cet article passe en revue les éléments importants pour leur prévention, y compris ceux concernant l'utilisation de cathéters imprégnés de désinfectants ou d'antibiotiques. Pour terminer, nous discutons en détail les stratégies préventives globales. Fondées sur la prise en compte d'un ensemble d'éléments spécifiques, ces approches sont centrées sur l'éducation du personnel au respect des règles d'hygiène de base et sur l'introduction de recommandations précises pour l'insertion et l'utilisation des accès vasculaires.

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Patients with stenosed biologic pulmonary conduits require redo cardiac surgery to prevent severe right ventricular dysfunction. Following the latest trends, the trans-catheter pulmonary stent-valve implantation represents a new fascinating alternative carrying a lower operative risk, compared with the standard open-heart re-intervention. Traditionally, the pulmonary stent valve is positioned off pump, under fluoroscopic control, and requires angiographies. However, alternative tools not requiring contrast injections for the intra-operative cardiac imaging have to be also considered strongly. The usefulness of intravascular ultrasound for the positioning of aortic endoprosthesis has already been proven in previous reports and, following the same principle, we have started to routinely implant balloon-expandable stent valves (Edwards Sapien? THV) in stenosed pulmonary valve conduits using intravascular ultrasound for the stent-valve positioning without angiography. We describe the intra-operative intravascular imaging technique with technical details.

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In three-dimensional (3D) coronary magnetic resonance angiography (MRA), the in-flow contrast between the coronary blood and the surrounding myocardium is attenuated as compared to thin-slab two-dimensional (2D) techniques. The application of a gadolinium (Gd)-based intravascular contrast agent may provide an additional source of signal and contrast by reducing T(1blood) and supporting the visualization of more distal or branching segments of the coronary arterial tree. In six healthy adults, the left coronary artery (LCA) system was imaged pre- and postcontrast with a 0.075-mmol/kg bodyweight dose of the intravascular contrast agent B-22956. For imaging, an optimized free-breathing, navigator-gated and -corrected 3D inversion recovery (IR) sequence was used. For comparison, state-of-the-art baseline 3D coronary MRA with T(2) preparation for non-exogenous contrast enhancement was acquired. The combination of IR 3D coronary MRA, sophisticated navigator technology, and B-22956 allowed for an extensive visualization of the LCA system. Postcontrast, a significant increase in both the signal-to-noise ratio (SNR; 46%, P < 0.05) and contrast-to-noise ratio (CNR; 160%, P < 0.01) was observed, while vessel sharpness of the left anterior descending (LAD) artery and the left coronary circumflex (LCX) were improved by 20% (P < 0.05) and 18% (P < 0.05), respectively.

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Five years of experience with endovascular infrarenal aneurysm repair at our institution is reviewed. Implantation of endoprostheses in 88 patients has been performed by surgeons using exclusively intravascular ultrasound (IVUS) and fluoroscopy. IVUS identified the target site of deployment in all cases. In-hospital morbidity was 22% (19/88). Two percent mortality (2/88) and 5% early conversion (4/88) as a consequence of type I endoleaks were noted only in the first 53 patients with early devices (NS). Early endoleaks were present in 36% (32/88) including twenty-two type I, five type II and five type III endoleaks. Proximal endoleaks were associated with early devices (P<0.001), and technical difficulties with deployment. Tube grafts used in the beginning, performed poorly with 54% (7/13) type I endoleaks. Endoleaks diminished to 10% (9/88) by spontaneous closure and secondary endovascular procedures that were necessary in 24% (21/88) and consisted of coil embolization/cuff extension (9), late conversion (6), and limb recanalization or femoral cross-over bypass (6). Endovascular aneurysm repair using IVUS is a valid alternative technique. Improved devices and systematic use of bifurcated endoprostheses for infrarenal aneurysms reduce the occurrence of type I endoleaks.

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INTRODUCTION: to assess the outcome of endovascular aortic aneurysm repair (EVAR) using intravascular ultrasound (IVUS) without angiography. MATERIALS/METHODS: eighty consecutive patients (median age 69 years (range 25-90): male 72 (90%), female 8 (10%)) underwent endovascular aneurysm repair (AAA 68 (85%), TAA 12 (15%)) using either angiography in 31/80 patients (39%) or IVUS in 49/80 patients (61%) in accordance to the surgeons preference. RESULTS: hospital mortality was 2/80 (3%), 1/68 for AAA (2%), 1/12 for TAA (8%), 2/31 for angiography (7%), and 0/49 for IVUS (0.0%: NS). Median quantity of contrast medium was 190 ml (range: 20-350) for angiography versus 0 ml for IVUS (p<0.01). Median X-ray exposure time 24 min (range 9-65 min) versus 8 min (range 0-60 min) for IVUS (p<0.05). No coverage of renal or suprarenal artery orifices occurred in either group. Conversion to open surgery was necessary in 4/80 patients (5%), 1/31 for angiography (3%) and 3/49 patients for IVUS (6%: NS). Early endoleaks were observed in 13/80 patients (16%): 8/31 patients for angiography (26%) versus 5/49 for IVUS (10%: p<0.05): 5/13 endoleaks resolved spontaneously (39%) whereas 8/13 (61%) required additional procedures. CONCLUSIONS: IVUS is a reliable tool for EVAR. In most cases, perprocedural angiography is not necessary.