RESUMEN
An optical diagnostic system is designed and constructed for imaging a free mercury jet interacting with a high intensity proton beam in a pulsed high-field solenoid magnet. The optical imaging system employs a backilluminated, laser shadow photography technique. Object illumination and image capture are transmitted through radiation-hard multimode optical fibers and flexible coherent imaging fibers. A retroreflected illumination design allows the entire passive imaging system to fit inside the bore of the solenoid magnet. A sequence of synchronized short laser light pulses are used to freeze the transient events, and the images are recorded by several high speed charge coupled devices. Quantitative and qualitative data analysis using image processing based on probability approach is described. The characteristics of free mercury jet as a high power target for beam-jet interaction at various levels of the magnetic induction field is reported in this paper.
RESUMEN
Folate deficiency has been associated with age-related neurodegeneration. One direct consequence of folate deficiency is a decline in the major methyl donor, S-adenosyl methionine (SAM). We demonstrate herein that pro-oxidant stress and dietary folate deficiency decreased levels of acetylcholine and impaired cognitive performance to various degrees in normal adult mice (9-12 months of age, adult mice heterozygously lacking 5',10'-methylene tetrahydrofolate reductase, homozygously lacking apolipoprotein E, or expressing human ApoE2, E3 or E4, and aged (2-2.5 year old) normal mice. Dietary supplementation with SAM in the absence of folate restored acetylcholine levels and cognitive performance to respective levels observed in the presence of folate. Increased aggressive behavior was observed among some but not all genotypes when maintained on the deficient diet, and was eliminated in all cases supplementation with SAM. Folate deficiency decreased levels of choline and N-methyl nicotinamide, while dietary supplementation with SAM increased methylation of nicotinamide to generate N-methyl nicotinamide and restored choline levels within brain tissue. Since N-methyl nicotinamide inhibits choline transport out of the central nervous system, and choline is utilized as an alternative methyl donor, these latter findings suggest that SAM may maintain acetylcholine levels in part by maintaining availability of choline. These findings suggest that dietary supplementation with SAM represents a useful therapeutic approach for age-related neurodegeneration which may augment pharmacological approaches to maintain acetylcholine levels, in particular during dietary or genetic compromise in folate usage.
Asunto(s)
Acetilcolina/metabolismo , Agresión/efectos de los fármacos , Cognición/efectos de los fármacos , Deficiencia de Ácido Fólico/fisiopatología , Ácido Fólico/metabolismo , S-Adenosilmetionina/farmacología , 5,10-Metilenotetrahidrofolato Reductasa (FADH2)/deficiencia , Envejecimiento , Animales , Apolipoproteínas E/deficiencia , Cognición/fisiología , Ácido Fólico/administración & dosificación , Ácido Fólico/farmacocinética , Deficiencia de Ácido Fólico/metabolismo , Humanos , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Oxidación-Reducción , Estrés Oxidativo/efectos de los fármacos , Estrés Oxidativo/fisiología , Distribución Aleatoria , S-Adenosilmetionina/metabolismoAsunto(s)
Transfusión de Sangre Autóloga , Transfusión Sanguínea , Transfusión de Eritrocitos , Hemólisis , Plasma/fisiología , Absceso/patología , Absceso/terapia , Lesión Renal Aguda/fisiopatología , Adulto , Negro o Afroamericano , Dopamina/uso terapéutico , Tratamiento de Urgencia , Femenino , Enfermedad de la Hemoglobina SC/fisiopatología , Humanos , Hipotensión/tratamiento farmacológico , Tiempo de Internación , Lípidos/sangre , Morfina/efectos adversos , Insuficiencia Multiorgánica/terapia , Dolor/tratamiento farmacológico , Enfermedades Pancreáticas/patología , Enfermedades Pancreáticas/terapia , Plasmaféresis , Diálisis Renal , Resultado del TratamientoRESUMEN
A potential therapeutic option for patients with Fanconi anemia is collection of peripheral blood stem cells prior to the development of severe pancytopenia. These hematopoietic cells potentially could be infused when symptomatic bone marrow failure develops, as autologous rescue after chemotherapy in the event of leukemic transformation, or as targets for gene therapy. Eight patients with Fanconi anemia were mobilized with 10 microg/kg per day of granulocyte colony-stimulating factor (median, 10 +/- 4 days) to determine the feasibility of collecting peripheral blood stem cells for future use. Six patients achieved a peripheral blood CD34+ count of > or = 6/microL and underwent apheresis. The collection goal was 2 x 10(6) CD34+ cells/kg based on a predicted weight 5 years from the date of collection. A mean of 2.6 +/- 0.9 x 10(6) CD34+ cells/kg of the weight at the time of collection were collected, which corresponded to 1.9 +/- 0.4 x 10(6) CD34+ cells/kg of the target weight. The collections required a mean of 4 +/- 3 days (range, 2-8 days) of apheresis. Six of the 8 subjects had > or = 1 x 10(6) CD34+ cells/kg cryopreserved based on both actual and target weights, and 4 subjects had > or = 2 x 10(6) CD34+ cells/kg cryopreserved based on the target weight. These results suggest that some patients with Fanconi anemia can have adequate numbers of CD34+ cells mobilized and collected from the peripheral blood prior to the onset of severe bone marrow failure, but they may require an extended mobilization and multiple days of collection.
Asunto(s)
Eliminación de Componentes Sanguíneos , Anemia de Fanconi/sangre , Factor Estimulante de Colonias de Granulocitos/farmacología , Movilización de Célula Madre Hematopoyética/métodos , Adolescente , Adulto , Antígenos CD34/análisis , Recuento de Células Sanguíneas , Conservación de la Sangre , Niño , Preescolar , Criopreservación , Anemia de Fanconi/terapia , Estudios de Factibilidad , Femenino , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Humanos , Masculino , Dolor/etiologíaRESUMEN
We describe collection and purification of peripheral blood CD34+ cells from volunteer, normal donors and allogeneic stem cell donors. A total of 98 aphereses were performed on 68 volunteer donors using peripheral venous access. The mean number of nucleated cells collected was 4.6 x 10(10) which included 1.9 x 10(8) CD34+ cells corresponding to 2.7 x 10(6) CD34+ cells/kg. The number of CD34+ cells collected did not differ between males and females but did correlate with the donor's weight and the total number of nucleated cells collected. The Nexell Isolex 300i cell separator was used to isolate CD34+ cells from 30 of the collections. A mean of 0.36% of the total cells was recovered and included 43 +/- 18% of the CD34+ cells. CD34+ cells represented 85 +/- 11% of the recovered cells. The total number of CD34+ cells recovered was not influenced by the number of nucleated cells placed on the Isolex 300i. The percentage of CD34+ cells recovered was not related to the number of CD34+ cells placed on the Isolex 300i. The purity of the final product was influenced by the number of CD34+ cells but not the total number of nucleated cells. An additional 38 CD34+ cell isolations were performed on normal allogeneic stem cell donors with similar results. These observations further support the safety and feasibility of peripheral blood CD34+ cell collection and purification.
Asunto(s)
Antígenos CD34/análisis , Donantes de Sangre , Movilización de Célula Madre Hematopoyética/normas , Adulto , Eliminación de Componentes Sanguíneos/efectos adversos , Eliminación de Componentes Sanguíneos/instrumentación , Peso Corporal , Femenino , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Factor Estimulante de Colonias de Granulocitos/farmacología , Movilización de Célula Madre Hematopoyética/efectos adversos , Movilización de Célula Madre Hematopoyética/métodos , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Factores SexualesRESUMEN
In the use of autologous PBPC transplantation in patients with multiple myeloma, contamination of PBPC with myeloma cells is commonly observed. Enrichment for CD34+ cells has been employed as a method of reducing this contamination. In this study the reduction of myeloma cells in PBPC was accomplished by the positive selection of CD34+ cells using immunomagnetic bead separation (Isolex 300 system). PBPC were mobilized from 18 patients using cyclophosphamide (4.5 g/m2) and G-CSF (10 microg/kg/day). A median of two leukaphereses and one selection was performed per patient. The median number of mononuclear cells processed was 3.50 x 10(10) with a recovery of 1.11 x 10(8) cells after selection. The median recovery of CD34+ cells was 48% (range 17-78) and purity was 90% (29-99). The median log depletion of CD19+ cells was 3.0. IgH rearrangement, assessed by PCR, was undetectable in 13 of 24 evaluable CD34+ enriched products. Patients received 200 mg/m2 of melphalan followed by the infusion of a median of 2.91 x 10(6)/kg CD34+ cells (1.00-16.30). The median time to absolute neutrophil count >0.5 x 10(9)/l was 11 days, and sustained platelet recovery of >20 x 10(9)/l was 14 days. We conclude that immunomagnetic-based enrichment of CD34+ cells results in a marked reduction in myeloma cells without affecting engraftment kinetics.
Asunto(s)
Antígenos CD34 , Movilización de Célula Madre Hematopoyética , Trasplante de Células Madre Hematopoyéticas , Mieloma Múltiple/terapia , Adulto , Anciano , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/uso terapéutico , Terapia Combinada , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Esquema de Medicación , Femenino , Humanos , Cadenas Pesadas de Inmunoglobulina/genética , Separación Inmunomagnética , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Acondicionamiento Pretrasplante/métodos , Trasplante AutólogoRESUMEN
PURPOSE: To compare the delineation of stenosis at the carotid artery bifurcation on three-dimensional (3D) magnetic resonance (MR) digital subtraction angiographic (DSA) images with that on two-dimensional (2D) and 3D time-of-flight (TOF) MR angiographic images. MATERIALS AND METHODS: Twenty-six patients with 29 carotid artery bifurcations and symptoms of cerebral ischemia underwent 3D MR DSA. A time-resolved series was generated with 3D MR DSA after the bolus injection of gadodiamide. The resolution for a carotid artery examination was 0.4 x 0.4 x 1.0 mm, with volumes reconstructed at 4.5-second intervals. The 3D MR DSA images were compared with contemporaneously acquired unenhanced 2D and 3D TOF images. Two observers ranked the 2D and 3D TOF MR angiographic and 3D MR DSA images according to the following: (a) stenosis delineation, (b) internal carotid artery delineation, (c) intravascular signal intensity, and (d) diagnostic confidence. RESULTS: The mean ranking for diagnostic confidence was 1.10 (1 = best technique, 3 = worst technique) for 3D MR DSA. Compared with the pooled 2D TOF and 3D TOF ranks, the 3D MR DSA rank was significantly better (P < .01). Similar levels of statistical significance were found for the other criteria. CONCLUSION: Three-dimensional MR DSA improves the delineation of carotid arterial stenosis by virtually eliminating saturation effects and reducing intravoxel dephasing. Surface morphology and nearly occluded vessels ("string sign") were easily identified. Confidence in identifying carotid arterial occlusions was also very high with this technique.
Asunto(s)
Angiografía de Substracción Digital , Estenosis Carotídea/diagnóstico , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Angiografía de Substracción Digital/instrumentación , Arteria Carótida Común/patología , Sistemas de Computación , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Angiografía por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/instrumentación , Sensibilidad y EspecificidadRESUMEN
Direct endovascular access to the anterior cerebral artery (ACA) with a guidewire and catheter is not always possible. A C-shaped guidewire advanced as a loop into the middle cerebral artery and then withdrawn to advance the guidewire into the ACA is a way to gain endovascular access to the ACA when the direct approach is unsuccessful.
Asunto(s)
Angioplastia/métodos , Cateterismo/métodos , Aneurisma Intracraneal/terapia , Malformaciones Arteriovenosas Intracraneales/terapia , Ataque Isquémico Transitorio/terapia , Angioplastia/instrumentación , Angiografía Cerebral , Humanos , Aneurisma Intracraneal/diagnóstico por imagenRESUMEN
PURPOSE: To determine the clinical effectiveness of parent artery occlusion of the carotid or vertebral artery by means of temporary proximal flow arrest and microcoils. METHODS: Nineteen parent artery occlusions (15 carotid, four vertebral) were performed in 19 patients who successfully passed a balloon test occlusion. In these patients, endovascular occlusion of the carotid or vertebral artery was accomplished with the use of temporary proximal flow arrest and microcoils. RESULTS: All 19 parent arteries were occluded. Eighteen patients (95%) had good outcomes and one (5%) had a poor outcome. Fourteen patients (74%) had no complications and five (26%) had complications, of whom only one was left with a permanent neurologic deficit. Three (60%) of the complications were the result of delayed ischemic events after parent artery occlusion and were not predicted by balloon test occlusion. CONCLUSION: Endovascular occlusion with temporary proximal flow arrest and microcoils can be done effectively and successfully. The predictive value of the balloon test occlusion is the major complicating factor, as it is with balloon occlusion. This technique offers an additional tool that can be used for endovascular occlusion of the carotid or vertebral artery and seems to be less difficult technically. It is our primary technique for parent artery occlusion.
Asunto(s)
Aneurisma Falso/terapia , Fístula Arteriovenosa/terapia , Arteria Carótida Interna , Seno Cavernoso , Embolización Terapéutica/instrumentación , Neoplasias de Cabeza y Cuello/terapia , Aneurisma Intracraneal/terapia , Arteria Vertebral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Encéfalo/irrigación sanguínea , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/etiología , Arteria Carótida Interna/diagnóstico por imagen , Seno Cavernoso/diagnóstico por imagen , Angiografía Cerebral , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Niño , Preescolar , Circulación Colateral/fisiología , Diseño de Equipo , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Arteria Vertebral/diagnóstico por imagenRESUMEN
PURPOSE: To develop a pig model of arterial thrombosis suitable for assessing different methods of thrombolysis and to use this model to compare the efficacy of intraarterial thrombolysis performed by continuous proximal urokinase infusion versus mechanical clot disruption combined with intrathrombic urokinase injection. METHODS: In a control group of five pigs, a thrombus was made in a short segment of femoral artery and observed for 2 hours to assess its stability. In a treatment group of six pigs, intraarterial thrombolysis was performed immediately after thrombus formation. Thrombolysis was accomplished by continuously infusing urokinase into the proximal leading edge of the thrombus in three pigs and by mechanical clot disruption combined with intrathrombic urokinase injection in the remaining three pigs. RESULTS: There was no spontaneous reestablishment of flow in the control group during the 2-hour observation period. In the first treatment group, no flow was observed after a 1-hour treatment period when urokinase was infused continuously into the proximal edge of the thrombus. In the second treatment group, with mechanical clot disruption and intrathrombic urokinase injection, some degree of flow was observed in all three pigs. Reestablishment of flow was more sustained and of a greater degree with the addition of systemic heparinization. CONCLUSION: This animal model could provide a useful way to evaluate and compare different methods of thrombolysis. Our results suggest that mechanical clot disruption combined with intrathrombic urokinase injection is more effective in achieving reestablishment of flow than is continuous infusion of urokinase into the proximal edge of the thrombus.
Asunto(s)
Activadores Plasminogénicos/uso terapéutico , Terapia Trombolítica/métodos , Trombosis/tratamiento farmacológico , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéutico , Animales , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Arteria Femoral , Activadores Plasminogénicos/administración & dosificación , Valores de Referencia , Porcinos , Trombectomía , Trombosis/cirugía , Resultado del Tratamiento , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificaciónRESUMEN
PURPOSE: To evaluate the in vivo and in vitro properties of collagen-coated acrylic microspheres and to compare them with polyvinyl alcohol (PVA) particles. METHODS: Samples of 100- to 300-microns, 300- to 500-microns, 500- to 700-microns, and 700- to 900-microns collagen-coated acrylic microspheres and 200- to 300-microns PVA particles were suspended in solutions of 50% saline and 50% contrast material. The samples were evaluated for quantitative and qualitative microscopic characteristics (shape, size, deformability); injectability via standardized microcatheters; degree of particulate penetration in the pig rete mirabile; and reaction of tissue to the particles in 48-hour- and 4-week-old specimens. RESULTS: The acrylic microspheres were spherical and deformable. The sample of 100- to 300-microns microspheres (n = 202) had a mean diameter of 210 microns (standard deviation, 43 microns). Hub accumulation, particle aggregation, and catheter occlusion were not observed with the microspheres (all sizes) but were noted with the PVA particles. The 200- to 300-microns PVA particles formed aggregates in the proximal rete. The 100- to 300-microns microspheres were found throughout the rete and beyond. Chronic transmural and perivascular inflammation was observed with the microspheres and the PVA particles. CONCLUSIONS: Particle aggregation and catheter occlusion do not complicate the transcatheter delivery of collagen-coated acrylic microspheres as they do with PVA particles. For a given particle and vessel size, acrylic microspheres penetrate to a much greater extent than the PVA particles. Tissue reaction to acrylic microspheres and PVA particles is similar.
Asunto(s)
Resinas Acrílicas , Colágeno , Embolización Terapéutica/instrumentación , Microesferas , Resinas Acrílicas/química , Animales , Materiales Biocompatibles/química , Plaquetas/patología , Arteria Carótida Externa/diagnóstico por imagen , Arteria Carótida Externa/patología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Cateterismo/instrumentación , Colágeno/química , Medios de Contraste , Diseño de Equipo , Fibrina , Células Gigantes/patología , Inflamación , Microinyecciones/instrumentación , Microscopía , Neutrófilos/patología , Tamaño de la Partícula , Alcohol Polivinílico/química , Radiografía , Cloruro de Sodio , Propiedades de Superficie , Porcinos , Trombosis/patología , Factores de TiempoRESUMEN
PURPOSE: To review our experience using MR angiography to assess the cerebral vasculature after aneurysmal treatment with Guglielmi detachable coils (GDCs). METHODS: Forty three-dimensional time-of-flight MR angiographic studies were performed in 23 patients after endovascular aneurysmal therapy with GDCs. Digital subtraction angiographic (DSA) studies were evaluated retrospectively for the following findings: parent artery patency, branch vessel patency, residual flow within the aneurysm, and residual aneurysmal neck. The MR angiographic examinations were inspected for the same findings, as well as for the degree of signal loss surrounding the coil mass. Clinical histories were reviewed to determine the impact of MR angiographic findings on therapy. RESULTS: Patency status of the parent artery was correctly identified on 25 of 26 MR angiographic examinations with DSA confirmation. Thirty-four of 37 patent branch vessels were identified by MR angiography. Residual neck was correctly identified in seven studies of six aneurysms, with no false-negative or false-positive results. Intraaneurysmal flow was correctly identified in five of eight studies of six aneurysms with residual flow shown by DSA. Artifact and hemorrhage mimicked residual flow in two of 18 MR angiographic studies of aneurysms with no residual flow shown by DSA. In eight patients, MR angiography provided clinically useful information that affected therapy. CONCLUSIONS: MR angiography can identify flow within an aneurysm after treatment with GDCs as well as in the adjacent parent and branch vessels. This technique may be a useful adjunct to DSA in some clinical situations.
Asunto(s)
Embolización Terapéutica , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/terapia , Angiografía por Resonancia Magnética , Adulto , Angiografía de Substracción Digital , Artefactos , Angiografía Cerebral , Arterias Cerebrales/patología , Embolización Terapéutica/instrumentación , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Sensibilidad y Especificidad , Grado de Desobstrucción VascularAsunto(s)
Aneurisma/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Medios de Contraste/efectos adversos , Embolización Terapéutica/métodos , Hemorragia/terapia , Orofaringe/patología , Dióxido de Torio/efectos adversos , Aneurisma/inducido químicamente , Enfermedades de las Arterias Carótidas/inducido químicamente , Arteria Carótida Común/patología , Embolización Terapéutica/instrumentación , Diseño de Equipo , Granuloma/inducido químicamente , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Cuello/patología , Enfermedades Faríngeas/inducido químicamente , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/terapia , Flujo Sanguíneo RegionalRESUMEN
PURPOSE: To determine the effect of proximal flow arrest on the frequency and timing of distal embolic events during occlusion of the common femoral artery with detachable coils. METHODS: Twenty-three complex fibered platinum coils were delivered into 10 common femoral arteries without proximal flow arrest. The arteries were continuously monitored for flow and embolic events by Doppler sonography during delivery and for at least 10 minutes after delivery of each coil. Thirty-four coils were delivered into 6 arteries after proximal flow arrest by inflation of a nondetachable balloon. After balloon deflation, each artery was monitored by Doppler sonography for 10 minutes. RESULTS: In the 10 arteries occluded without flow arrest, 87 events (8.7 per artery) occurred, of which 47 were embolic and 40 were indeterminate. In the 6 arteries with flow arrest, the number of emboli detected was 3 (0.5 per artery). Embolic events occurred only if there was residual flow. In those arteries that were occluded when the flow-arrest balloon was deflated, no emboli were detected. CONCLUSIONS: Proximal flow arrest virtually eliminates the risk of distal emboli during arterial occlusion with detachable fibered coils. The use of fibered coils, in conjunction with proximal flow arrest, allows for safe arterial occlusion when detachable balloons are not available or their use is not feasible.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Embolia/diagnóstico por imagen , Embolización Terapéutica/instrumentación , Procesamiento de Imagen Asistido por Computador , Ultrasonografía Doppler en Color , Animales , Perros , Arteria Femoral/diagnóstico por imagen , Factores de RiesgoRESUMEN
Three patients with vertebrobasilar junction aneurysms and associated fenestration were treated with Guglielmi detachable coils. The structure and hemodynamics of fenestrations may account for their frequent association with aneurysms. The complex hemodynamics of these aneurysms requires evaluation of both vertebral arteries. One treatment complication occurred but resulted in no deficit. All patients have returned to normal activity and remain healthy at 14 to 46 months.
Asunto(s)
Arteria Basilar , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Arteria Vertebral , Insuficiencia Vertebrobasilar/terapia , Anciano , Arteria Basilar/diagnóstico por imagen , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Examen Neurológico , Resultado del Tratamiento , Arteria Vertebral/diagnóstico por imagen , Insuficiencia Vertebrobasilar/diagnóstico por imagenRESUMEN
The major causes of mortality and morbidity in patients surviving the rupture of a saccular aneurysm are subsequent bleeding and vasospasm. The purpose of this study was to evaluate the influence of early treatment of ruptured aneurysms with Guglielmi detachable coils on the incidence of subsequent bleeding. Thirteen patients were treated within 72 hours of initial aneurysm rupture with Guglielmi detachable coils. Excluding three patients who died 2, 4, and 12 weeks after initial hemorrhage, all others have been followed up for intervals between 6 and 36 months (mean, 16 mo). None of these have had either clinical or radiographic evidence of subsequent bleeding. Assuming that there is a 30% incidence of subsequent bleeding in conservatively (nonsurgically) treated patients, the 0% subsequent bleed rate observed in this subgroup was significant at a P value of 0.01. Only one procedure-related complication occurred in this series, and 9 of 13 (69%) aneurysms were 100% occluded at the time of initial treatment. All aneurysms were at least 90% occluded at the end of initial treatment. In addition to reducing the risk of subsequent bleeding, early treatment facilitated the institution of an aggressive approach for management of both vasospasm and increased intracranial pressure. Patient outcome, as measured by the Glasgow Outcome Scale, was good in 9 of 13 (69%), poor in 1 of 13 (8%), and death in 3 of 13 (23%) patients. The results of this study suggest that early Guglielmi detachable coil treatment of ruptured aneurysms may be effective in reducing the incidence of subsequent bleeding and can be performed with a low incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aneurisma Roto/terapia , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Hemorragia Subaracnoidea/terapia , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/mortalidad , Angiografía Cerebral , Femenino , Estudios de Seguimiento , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/mortalidad , Presión Intracraneal/fisiología , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/terapia , Masculino , Persona de Mediana Edad , Recurrencia , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Goodpasture's syndrome rarely affects children. Therefore, we present our experience in a young boy whose pulmonary hemorrhage was dramatically resolved by three plasma exchanges. We believe the hemorrhage was caused primarily by acute capillaritis. He received cytoxan and steroids and a series of plasma exchanges which removed/suppressed his anti-glomerular basement membrane (anti-GBM) antibody production. However, after a year, his renal function did not return, and he required renal transplantation and continues to do well.
Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Inmunosupresores/uso terapéutico , Intercambio Plasmático , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico por imagen , Niño , Terapia Combinada , Humanos , Masculino , RadiografíaRESUMEN
This study compares differences in the cellularity and levels of CD34 positive cells in bone marrows from patients treated with G-/GM-CSF prior to harvest and marrows from untreated patients. The average volume of marrow aspirated was 1302mL in the untreated group containing an average of 2.6 x 10(10) nucleated cells, while an average volume of 1147mL of marrow was aspirated from patients treated with GM-/G-CSF prior to harvest which contained an average of 5.6 x 10(10) nucleated cells. Analysis of these marrows by flow cytometry revealed a higher percentage of CD34 positive cells within the lymphoid gate of marrow specimens from patients receiving GM-/G-CSF as compared with their untreated counterparts (21.4% vs. 9.1%). All patients receiving GM-/G-CSF prior to harvest were also given G-CSF subcutaneously (5 micrograms/kg/day) following the infusion of autologous marrow after high dose myelosuppressive chemotherapy and the duration of neutropenia (AGC < 500/mm3) in this group was shortened, an average of 12 days as compared to 24 days in untreated patients. This decreased duration of neutropenia is similar to that reported in patients receiving GM-/G-CSF only after transplantation (Lieschke & Burgess, 1992). Further studies are needed to determine whether the administration of GM-/G-CSF prior to bone marrow harvest is clinically beneficial.