RESUMEN
RATIONALE: Pulled-in-two syndrome is one of the significant complications of strabismus surgery. This study aimed to report a case of pulled-in-two syndrome of the contractured medial rectus muscle (MR) that occurred during strabismus surgery for strabismus fixus due to high myopia, and to describe a rescue of this complication. PATIENT CONCERNS: A woman in her 60s presented to our Ophthalmology Department with the main complaint of unilateral high myopia and severe myopic strabismus fixus. Esotropia exceeded 45° and hypotropia exceeded 15° in her right eye in the Hirschberg test. Right eye duction was markedly limited in every gaze direction. Orbital magnetic resonance images showed rupture of the superior rectus to lateral rectus band ligament and lengthening of the distance between the SR and LR muscles in the right eye. DIAGNOSIS: Due to the patient's ophthalmic examination and imaging results, she was diagnosed with high myopic strabismus fixus. INTERVENTIONS: We performed MR recession and Yokoyama surgery to correct right eye hypoesotropia. In the MR recession procedure, pulled-in-two syndrome (MR muscle tear) occurred. Thus, no additional procedure was performed on the MR. After the surgery, she presented 45 prism diopter exotropia and 18 prism diopter residual right hypotropia in a Krimsky test. We performed a second surgery, combining MR muscle advancement and inferior rectus (IR) muscle recession, 3 months after the first surgery. OUTCOMES: One and a half years after the second surgery, she presented exotropia of 14 prism diopters without hypotropia in the Krimsky test and was satisfied with her ocular position and improved motility. LESSONS: We experienced pulled-in-two syndrome in a case with severe myopic strabismus fixus and achieved a good outcome by performing additional surgery 3 months later, in which the lost MR muscle was advanced. This case underscores that, if the lost muscle cannot be found during surgery, one should maintain composure and perform a reoperation a few months after the initial surgery, if necessary. This case report can aid in making rescue treatment decisions when pulled-in-two syndrome occurs.
Asunto(s)
Esotropía , Exotropía , Miopía , Estrabismo , Humanos , Femenino , Exotropía/cirugía , Exotropía/complicaciones , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Procedimientos Quirúrgicos Oftalmológicos/métodos , Estrabismo/cirugía , Músculos Oculomotores/cirugía , Esotropía/etiología , Esotropía/cirugía , Miopía/cirugía , Estudios RetrospectivosRESUMEN
Anomalous origin of the coronary artery from the aortic arch associated with hypoplastic left heart syndrome is an extremely rare anomaly. Coronary anomalies can significantly deteriorate the clinical outcomes of hypoplastic left heart syndrome. We describe the case of a newborn with concomitant hypoplastic left heart syndrome and abnormal origin of the left coronary artery arising from the distal aortic arch.
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Anomalías de los Vasos Coronarios/cirugía , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Aorta/anomalías , Aorta/cirugía , Anomalías de los Vasos Coronarios/patología , Resultado Fatal , Femenino , Paro Cardíaco/etiología , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/patología , Recién Nacido , Complicaciones Intraoperatorias/etiología , Ligadura , Procedimientos de Norwood , Cuidados Paliativos , Arteria Pulmonar/cirugíaRESUMEN
BACKGROUND: The long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown. CASE PRESENTATION: The present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed a second total arch replacement, aortic root replacement, and coronary artery bypass, using a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery, and femoral vein prior to re-sternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation; however, he was discharged in good condition on the fiftieth postoperative day. CONCLUSIONS: This case suggests that island reconstruction has the potential to cause arch anastomotic pseudoaneurysms, particularly after a long postoperative period.
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Aneurisma Falso/diagnóstico , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Disección Aórtica/cirugía , Anciano , Anastomosis Quirúrgica , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos VascularesRESUMEN
Catheter ablation provides effective results for sustained monomorphic ventricular tachycardia (VT), but the presence of mural thrombus including dense calcification occasionally causes unfavorable outcomes. The case of a 67-year-old man in whom sustained monomorphic VT, which was resistant to endocardial radiofrequency ablation, in the presence of mural thrombus including dense calcification after coronary artery bypass grafting was successfully treated by left ventricular reconstruction with cryoablation is reported.
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Calcinosis/cirugía , Cardiomiopatías/cirugía , Ablación por Catéter/métodos , Ventrículos Cardíacos/cirugía , Taquicardia Ventricular/cirugía , Trombosis/cirugía , Anciano , Ablación por Catéter/instrumentación , Electrocardiografía , Endocardio/cirugía , Humanos , Masculino , Taquicardia Ventricular/fisiopatología , Trombosis/fisiopatologíaRESUMEN
PURPOSE: The selection of optimal grafts for the right coronary artery remains controversial. This study aims to evaluate the short- and long-term results of radial artery (RA) grafts and saphenous vein grafts (SVGs) to the right coronary artery. METHODS: We reviewed, retrospectively, isolated coronary artery bypass grafts, placed between 1997 and 2007, and compared the long-term results of patients who received RA (n = 110) grafts with those of patients who received SVGs (n = 264) using propensity-score matching for risk. The preoperative predictors of graft occlusion were investigated on a per case basis. RESULTS: Superior survival was noted in the unmatched RA group, but late outcomes after propensity-score matching yielded 91 patient pairs that were similar in the two groups. Graft failure was not correlated with mortality, but showed strong correlation with cardiac events in all patients. The predictors of graft occlusion in the RA group were mild proximal stenosis and low indexing glomerular filtration rates for body surface area, whereas those in the SVG were female gender and off-pump coronary artery bypass grafting. CONCLUSIONS: There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.
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Puente de Arteria Coronaria , Vasos Coronarios/cirugía , Oclusión de Injerto Vascular , Complicaciones Posoperatorias , Puntaje de Propensión , Arteria Radial/trasplante , Vena Safena/trasplante , Anciano , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Puente de Arteria Coronaria/métodos , Estenosis Coronaria/cirugía , Arterias Mamarias/trasplante , Esternotomía/métodos , Traqueostomía , Anciano , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Estenosis Coronaria/diagnóstico , Humanos , Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/cirugía , Laringectomía , Masculino , Resultado del TratamientoRESUMEN
Congenital absence of a single pulmonary valve cusp is extremely rare. We report a case of a 38-year-old woman with a confirmed congenital absence of a single pulmonary valve cusp associated with dextrocardia. The other 2 leaflets were moderately hypoplastic, and transthoracic echocardiography showed severe pulmonary regurgitation. This combination of lesions has not been reported previously. Pulmonary valve replacement using a composite biologic valved conduit was performed with an excellent outcome.
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Válvula Pulmonar/anomalías , Anomalías Múltiples/cirugía , Adulto , Dextrocardia/complicaciones , Femenino , Humanos , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Pulmonar/complicacionesRESUMEN
We report the case of a patient who developed paraplegia after mitral valve repair and maze procedure. The first day after surgery, marked weakness of both lower extremities was noted. Neurologic examination showed almost complete loss of sensory and motor function below the level of the first thoracic vertebrae. Magnetic resonance imaging showed intramedullary hemorrhage ranging from the C7 to Th2 segments. Preoperative anticoagulation therapy and general heparinization during heart surgery may cause this rare complication.
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Hemorragia/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Paraplejía/etiología , Complicaciones Posoperatorias/etiología , Enfermedades de la Médula Espinal/complicaciones , Anciano , Humanos , MasculinoRESUMEN
We report a case of a Marfan syndrome patient who developed a complicated clinical course after total aortic repair using a hybrid technique. After hybrid total aortic repair, this patient was required to undergo open thoracic and thoracoabdominal aortic repair due to impending rupture of the aorta. Moreover, the abdominal aortic graft was rereplaced due to debranching graft occlusion of the coeliac artery and the left renal artery.
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Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Síndrome de Marfan/complicaciones , Adolescente , Aneurisma de la Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Resultado Fatal , Humanos , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND AIM OF THE STUDY: Mitral valve regurgitation (MR) is known to deteriorate following adult atrial septal defect (ASD) repair in the mid to long-term. The study aim was to identify the risk factors for this deterioration. METHODS: Between 1995 and 2011, a total of 93 consecutive patients (aged > or = 18 years) underwent ASD repair at the authors' institution. Patients who underwent concomitant procedures, other than tricuspid annuloplasty or maze procedure, were excluded; hence, 74 patients were enrolled in the study. MR was evaluated by transthoracic echocardiography shortly after surgery and subsequently on a regular basis in the outpatient clinic. Risk factors for the deterioration of MR were estimated using Cox proportional hazards regression. RESULTS: The mean patient age at surgery was 48.0 +/- 17.1 years, and 20 patients (27%) had atrial fibrillation (AF) preoperatively. The mean follow up was 6.9 +/- 5.5 years. The degree of MR was not unchanged or not improved in 54 patients (73.0%) (group 1), but was increased by one grade in 12 patients (16.2%) (group 2), and by two or more grades in eight patients (10.8%) (group 3). At surgery, all patients in group 3 were aged > 50 years. In group 3, on echocardiography, the average end-diastolic left ventricular dimension was increased from 41.8 mm to 51.8 mm (p = 0.027), and enlargement of the mitral annulus was noted in seven patients. Four of the group 3 patients required reoperation for MR after ASD repair. The Cox proportional hazards model revealed preoperative AF (p = 0.045, hazard ratio (HR): 11.68, 95% confidence interval (95% CI): 1.05-129.48) and Qp/Qs > or = 2.8 (p = 0.015, HR: 9.19, 95% CI :1.53-55.04) to be independent risk factors of new-onset or aggravated MR (by two or more grades) after ASD repair. CONCLUSION: An earlier repair of ASD would be preferable in terms of MR aggravated after ASD repair. For elderly patients with a preoperative high Qp/Qs and AF, mitral valve annuloplasty with ASD repair should considered.
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Defectos del Tabique Interatrial/cirugía , Insuficiencia de la Válvula Mitral/complicaciones , Adulto , Fibrilación Atrial/complicaciones , Femenino , Defectos del Tabique Interatrial/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Periodo Posoperatorio , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: The Trifecta valve is a recent, newly designed high performance valve, with few studies on the clinical and hemodynamic data. The purpose of this study was to evaluate the early clinical and echocardiographic results of the Trifecta valve. METHODS: Between April 2012 and December 2012, 23 consecutive patients underwent aortic valve replacement with the Trifecta valve in our institution. Clinical and hemodynamic data were prospectively recorded and hemodynamic performance was assessed by transthoracic echocardiography. RESULTS: Nine patients were male and the overall mean age was 75 ± 9 years. Twenty patients suffered aortic stenosis, and 3 suffered aortic insufficiency. Prosthesis sizes implanted were: 19 mm (n = 4), 21 mm (n = 12), and 23 mm (n = 7). There were no 30-day deaths and no valve-related events during follow-up, except for 1 postoperative stroke. The mean postoperative transprosthetic pressure gradient was 10.0 ± 1.4, 9.6 ± 3.6, and 7.1 ± 3.6 mmHg, and the effective orifice area was 1.45 ± 0.13, 1.68 ± 0.16, and 1.90 ± 0.28 cm(2), for valve sizes 19, 21, and 23 mm, respectively. One patient had moderate prosthesis-patient mismatch. No moderate to severe aortic regurgitation was observed. The mean pressure gradient in aortic stenosis patients decreased significantly from 49.9 ± 20.7 to 8.9 ± 3.6 mmHg (p < 0.001). Left ventricular mass index in all patients decreased significantly from 142.0 ± 33.6 to 115.4 ± 26.4 g/m(2) (p < 0.001). CONCLUSIONS: The Trifecta aortic bioprosthesis provided satisfactory early outcomes and hemodynamic function.
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Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Bioprótesis , Prótesis Valvulares Cardíacas , Hemodinámica , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/fisiopatología , Ecocardiografía , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Diseño de Prótesis , Accidente Cerebrovascular/etiología , Resultado del TratamientoRESUMEN
Insulin-like growth factor-I receptor (IGF-IR) signaling is required for carcinogenicity and tumor development, and this pathway has not been well studied in human esophageal carcinomas. Esophageal cancer is one of the human cancers with the worst prognosis and has two main histologies: squamous cell carcinomas (ESCC) and adenocarcinoma (EAC). Previously, we have reported that detection of the IGF axis may be useful for the prediction of recurrence and poor prognosis of ESCC. We have also shown the successful therapy for several gastrointestinal cancers using recombinant adenoviruses expressing dominant negative IGF-IR (ad-IGF-IR/dn). The aim of this study is to develop potential targeted therapeutics to IGF-IR and to assess the effect of IGF-IR blockade in both of these types of esophageal cancer. We determined immunohistochemical expression of IGF-IR in a tissue microarray. We then assessed the effect of IGF-IR blockade on signal transduction, proliferation, apoptosis, and motility. Ad-IGF-IR/dn, a tyrosine kinase inhibitor, BMS-536924, and adenovirus expressing shRNA for IGF-IR were used. IGF-IR expression was common in both tumor types but not in normal tissues. IGF-IR was detected in metastatic sites at similar levels compared to the primary site. IGF-IR inhibition suppressed proliferation and colony formation in both cancers. IGF-IR blockades up-regulated both stress- and chemotherapy-induced apoptosis and reduced migration. Although IGF-IR/dn blocked ligand-induced activation of Akt-1 mainly, BMS-536924 effectively blocked both activation of Akt and MAPK. The IGF axis might play a key role in tumor progression of esophageal carcinomas. The IGF-IR targeting strategies might thus be useful anticancer therapeutics for human esophageal malignancies.
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Adenocarcinoma/genética , Carcinoma de Células Escamosas/genética , Neoplasias Esofágicas/genética , Factor I del Crecimiento Similar a la Insulina/genética , Terapia Molecular Dirigida , Receptor IGF Tipo 1/genética , Adenocarcinoma/patología , Adenocarcinoma/terapia , Adenoviridae , Carcinogénesis , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Línea Celular Tumoral , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas de Esófago , Regulación Neoplásica de la Expresión Génica , Humanos , Factor I del Crecimiento Similar a la Insulina/antagonistas & inhibidores , Factor I del Crecimiento Similar a la Insulina/biosíntesis , Pronóstico , Receptor IGF Tipo 1/biosíntesis , Transducción de Señal/genéticaRESUMEN
We report the case of a patient who developed severe cardiogenic shock during the open repair of a ruptured abdominal aortic aneurysm. After controlling the bleeding from the ruptured aneurysm, the electrocardiogram exhibited ST-T elevation and bradycardia. A median sternotomy was performed, and cardiopulmonary bypass was established. Under cardiopulmonary bypass support, the patient successfully underwent a Y-shaped graft replacement. The venous and arterial cannulae were recannulated through the femoral artery and vein. The chest and abdomen were closed in the usual fashion. Five hours after admission to the intensive care unit, cardiopulmonary bypass was weaned successfully, and the patient was extubated 1 day after surgery. Postoperative coronary angiography showed severe vasospastic angina of the right coronary artery, which might have caused cardiogenic shock during the aneurysm repair. The patient had an uneventful recovery period and was discharged on the 14th postoperative day without neurological complications.
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Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Puente Cardiopulmonar , Choque Cardiogénico/cirugía , Esternotomía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/fisiopatología , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/fisiopatología , Aortografía/métodos , Angiografía Coronaria , Vasoespasmo Coronario/diagnóstico por imagen , Vasoespasmo Coronario/etiología , Electrocardiografía , Urgencias Médicas , Hemodinámica , Humanos , Masculino , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/etiología , Choque Cardiogénico/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas/diagnóstico , Hemangioma Cavernoso/diagnóstico , Procedimientos Quirúrgicos Cardíacos/métodos , Diagnóstico Diferencial , Ecocardiografía , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos , Hemangioma Cavernoso/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada MultidetectorRESUMEN
BACKGROUND AND AIM OF THE STUDY: The purpose of this study is to evaluate mid-long-term results of aortic arch replacement. METHODS: Between 1992 and 2012, 263 consecutive patients underwent aortic arch repair in our institution. Follow-up rate was 92%, and 243 patients were enrolled in this study. Two hundred twelve patients (87%) underwent total arch replacement using a four-branched graft with antegrade selective cerebral perfusion. Ninety-nine patients (41%) were operated on for acute aortic dissection. RESULTS: Hospital mortality was 13.2%. The mean follow-up duration was 3.6 ± 3.7 (0-19) years. Late mortality occurred in 38 patients, 4.3 ± 3.2 (0.3-14.1) years after surgery. The survival rates were 85%, 70%, and 50% at one, five, and 10 years. In the acute type A aortic dissection group, survival rate at one and five years was 86% and 79%. In the nonacute type A dissection group, one- and five-year survivals were 85% and 62% (log-rank test: p=0.0027). The causes of late mortality were respiratory failure in five, aortic aneurysm rupture in six, cancer in four, stroke in eight, others in seven, and unknown in eight. Twenty-six patients had another aortic intervention 3.6 ± 6.0 (0.04-19.6) years after arch repair. Seven patients had stroke after discharge 6.5 ± 3.9 (1.9-13.0) years after repair. CONCLUSIONS: Mid-long-term results after aortic arch repair with antegrade selective cerebral perfusion were satisfactory. Acute type A aortic dissection did not negatively influence the mid-long-term survival.
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Aorta Torácica/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/cirugía , Disección Aórtica/mortalidad , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/mortalidad , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Circulación Cerebrovascular/fisiología , Perfusión/métodos , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Rotura de la Aorta , Puente Cardiopulmonar/métodos , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria , Accidente Cerebrovascular , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: To evaluate the utility of measuring epigenetic alterations in pancreatic and biliary fluids in determining molecular markers for pancreatobiliary cancers. METHODS: DNA was extracted from undiluted pancreatic and biliary fluids. As a surrogate for a genome-wide hypomethylation assay, levels of long interspersed nuclear element-1 (LINE-1) methylation were analyzed using bisulfite pyrosequencing. CpG island hypermethylation of 10 tumor-associated genes, aryl-hydrocarbon receptor repressor, adenomatous polyposis coli, calcium channel, voltage dependent, T type α1G subunit, insulin-like growth factor 2, O-6-methyl-guanine-DNA methyltransferase, neurogenin 1, CDKN2A, runt-related transcription factor 3 (RUNX3), secreted frizzled-related protein 1, and ubiquitin carboxyl-terminal esterase L1 (UCHL1), was analyzed using MethyLight. To examine the role of CpG methylation and histone deacetylation in the silencing of UCHL1, human gallbladder carcinoma cell lines and pancreatic carcinoma cell lines were treated with 2 or 5 µmol/L 5-AZA-dC for 72 h or 100 nmol/L Trichostatin A for 24 h. After the treatment, UCHL1 expression was analyzed by real-time reverse transcription-polymerase chain reaction. RESULTS: Pancreatobiliary cancers exhibited significantly lower LINE-1 methylation levels in pancreatic and biliary fluids than did noncancerous pancreatobiliary disease (58.7% ± 4.3% vs 61.7% ± 2.2%, P = 0.027; 53.8% ± 6.6% vs 57.5% ± 1.7%, P = 0.007); however, LINE-1 hypomethylation was more evident in pancreatic cancer tissues than in pancreatic fluids (45.4% ± 5.5% vs 58.7% ± 4.3%, P < 0.001). CpG island hypermethylation of tumor-associated genes was detected at various frequencies, but it was not correlated with LINE-1 hypomethylation. Hypermethylation of the UCHL1 gene was cancer-specific and most frequently detected in pancreatic (67%) or biliary (70%) fluids from patients with pancreatobiliary cancer. As a single marker, hypermethylation of the UCHL1 gene in pancreatic and biliary fluids was most useful for the detection of pancreatic and pancreatobiliary cancers, respectively (100% specificity). Hypermethylation of the UCHL1 and RUNX3 genes in pancreatic and biliary fluids was the most useful combined marker for pancreatic (87% sensitivity and 100% specificity) and pancreatobiliary (97% sensitivity and 100% specificity) cancers. Treatment with a demethylating agent, 5-AZA-2'-deoxycytidine, restored UCHL1 expression in pancreatobiliary cancer cell lines. CONCLUSION: Our results suggest that hypermethylation of UCHL1 and RUNX3 in pancreatobiliary fluid might be useful for the diagnosis of pancreatobiliary cancers.
Asunto(s)
Neoplasias del Sistema Biliar/enzimología , Biomarcadores de Tumor/metabolismo , Metilación de ADN , Elementos de Nucleótido Esparcido Largo , Neoplasias Pancreáticas/enzimología , Ubiquitina Tiolesterasa/metabolismo , Acetilación , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Animales , Bilis/enzimología , Neoplasias del Sistema Biliar/genética , Biomarcadores de Tumor/genética , Gatos , Línea Celular Tumoral , Distribución de Chi-Cuadrado , Subunidad alfa 3 del Factor de Unión al Sitio Principal/genética , Subunidad alfa 3 del Factor de Unión al Sitio Principal/metabolismo , Islas de CpG , Metilasas de Modificación del ADN/antagonistas & inhibidores , Metilasas de Modificación del ADN/metabolismo , Femenino , Inhibidores de Histona Desacetilasas/farmacología , Histonas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Jugo Pancreático/enzimología , Neoplasias Pancreáticas/genética , Ubiquitina Tiolesterasa/genéticaRESUMEN
BACKGROUND AND AIM OF THE STUDY: Echocardiography or cinefluoroscopy are standard modalities for evaluating implanted mechanical valve prostheses. The aim of the present study was to evaluate the validity of multidetector computed tomography (MDCT) with three-dimensional image reconstruction in a cine mode (four-dimensional (4D)-CT) for evaluating the functional and morphological findings of implanted mechanical valves. METHODS: A total of 37 patients who had received 45 implanted mechanical valves was studied using electrocardiogram-gated (16- or 256-row) MDCT. The mean age of patients at the MDCT examination was 65.1 +/- 10.1 years (range: 0.5-85 years). The series included 18 aortic and 27 mitral mechanical valves, in addition to 36 bileaflet valves and nine monoleaflet valves. Fifteen patients had atrial fibrillation, and seven had permanent pacemaker implantation. Volume-rendering 3D and multiplanar reformations were obtained, and valve leaflet movement was evaluated using reformatted images in a cine mode (4D images). The quality of mechanical valve leaflet visualization was scored on a four-grade scale (Leaflet index), and the level of artifact was also scored (Artifact index). RESULTS: There were two stuck-valve patients who required emergency surgery. Stuck mechanical leaflets could be visualized using 4D-CT. In all of the bileaflet mechanical valves the valve leaflet motions were visualized with 4D images. In contrast, in four of nine valves with monoleaflet valves the opening and closing angles could not be visualized because of radio-opacity of the leaflet. The median Leaflet index was 3.7 +/- 0.8, and the median Artifact index 3.0 + 0.8. The Leaflet and Artifact indices were significantly lower in monoleaflet valves (p < 0.0001, p = 0.0037, respectively). When using 256-row MDCT the Artifact index was superior to that achieved with 16-row MCDT, but was without statistical difference (p = 0.0654). CONCLUSION: Functional and morphological evaluations of mechanical valves with 4D-MDCT is promising in patients with bileaflet mechanical valves. However, the evaluation of monoleaflet valves is limited.