Stenózy biliární anastomózy patří mezi nejčastější biliární komplikace u pacientů po transplantaci jater. Biliární komplikace jsou spojeny s vyšší letalitou, morbiditou, rizikem selhání funkce štěpu a k léčbě vyžadují zpravidla opakované endoskopické intervence s pravidelnou výměnou stentů. Biodegradabilní stenty jsou novými typy stentů z bio degradabilních polymerů, jejichž hlavní výhodou může být snížení počtu endoskopických intervencí a s nimi spojených komplikací. Cílem našeho článku byl popis případů dvou pacientů po transplantaci jater s časně zjištěnou stenózou biliární anastomózy, která byla řešena endoskopickým zavedením bio degradabilních stentů. V obou případech bylo endoskopické zavedení stentu technicky dobře proveditelné a nevyskytly se žádné periprocedurální ani postprocedurální komplikace. Klinický průběh a kontrolní zobrazení po 8 měsících svědčily pro regresi stenózy u obou pacientů.
Biliary anastomotic strictures are one of the most common biliary complications in patients after liver transplantation. Biliary complications are associated with higher mortality, morbidity, risk of graft failure and usually require repeated endoscopic interventions with regular stent replacement for treatment. Biodegradable stents are new types of stents made of bio degradable polymers, which may have the main advantage of reducing the number of endoscopic interventions and associated complications. The aim of our article was to describe the cases of two patients after liver transplantation with early biliary anastomotic strictures, which were resolved by endoscopic placement of bio degradable stents. In both cases, endoscopic stent placement was technically feasible and there were no periprocedural or postprocedural complications. The clinical course and fol low-up imaging at 8 months showed regression of the strictures in both patients.
- Klíčová slova
- benigní biliární stenózy,
- MeSH
- anastomóza chirurgická * metody MeSH
- cholangiopankreatografie endoskopická retrográdní metody MeSH
- cholestáza * etiologie MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- pooperační komplikace MeSH
- senioři MeSH
- stenty * normy MeSH
- transplantace jater škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Changes in both the vascular system and brain tissues can occur after a prior episode of coronavirus disease 2019 (COVID-19), detectable through modifications in diffusion parameters using magnetic resonance imaging (MRI) techniques. These changes in diffusion parameters may be particularly prominent in highly organized structures such as the corpus callosum (CC), including its major components, which have not been adequately studied following COVID-19 infection. Therefore, the study aimed to evaluate microstructural changes in whole-brain (WB) diffusion, with a specific focus on the CC. METHODS: A total of 101 probands (age range from 18 to 69 years) participated in this retrospective study, consisting of 55 volunteers and 46 post-COVID-19 patients experiencing neurological symptoms. The participants were recruited from April 2022 to September 2023 at the Institute for Clinical and Experimental Medicine in Prague, Czech Republic. All participants underwent MRI examinations on a 3T MR scanner with a diffusion protocol, complemented by additional MRI techniques. Two volunteers and five patients were excluded from the study due to motion artefacts, severe hypoperfusion or the presence of lesions. Participants were selected by a neurologist based on clinical examination and a serological test for COVID-19 antibodies. They were then divided into three groups: a control group of healthy volunteers (n=28), an asymptomatic group (n=25) with a history of infection but no symptoms, and a symptomatic group (n=41) with a history of COVID-19 and neurological symptoms. Symptomatic patients did not exhibit neurological symptoms before contracting COVID-19. Diffusion data underwent eddy current and susceptibility distortion corrections, and fiber tracking was performed using default parameters in DSI studio. Subsequently, various diffusion metrics, were computed within the reconstructed tracts of the WB and CC. To assess the impact of COVID-19 and its associated symptoms on diffusion indices within the white matter of the WB and CC regions, while considering age, we employed a statistical analysis using a linear mixed-effects model within the R framework. RESULTS: Statistical analysis revealed a significant difference in mean diffusivity (MD) between the symptomatic and control groups in the forceps minor (P=0.001) and CC body (P=0.003). In addition to changes in diffusion, alterations in brain perfusion were observed in two post-COVID-19 patients who experienced a severe course. Furthermore, hyperintense lesions were identified in subcortical and deep white matter areas in the vast majority of symptomatic patients. CONCLUSIONS: The main finding of our study was that post-COVID-19 patients exhibit increased MD in the forceps minor and body of the CC. This finding suggests a potential association between microstructural brain changes in post-COVID-19 patients and reported neurological symptoms, with significant implications for research and clinical applications.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Autologous vein grafts are widely used for bypass procedures in cardiovascular surgery. However, these grafts are susceptible to failure due to vein graft disease. Our study aimed to evaluate the impact of the latest-generation FRAME external support on vein graft remodeling in a preclinical model. METHODS: We performed autologous internal jugular vein interposition grafting in porcine carotid arteries for one month. Four grafts were supported with a FRAME mesh, while seven unsupported grafts served as controls. The conduits were examined through flowmetry, angiography, macroscopy, and microscopy. RESULTS: The one-month patency rate of FRAME-supported grafts was 100% (4/4), whereas that of unsupported controls was 43% (3/7, Log-rank p = 0.071). On explant angiography, FRAME grafts exhibited significantly more areas with no or mild stenosis (9/12) compared to control grafts (3/21, p = 0.0009). Blood flow at explantation was higher in the FRAME grafts (145 ± 51 mL/min) than in the controls (46 ± 85 mL/min, p = 0.066). Area and thickness of neo-intimal hyperplasia (NIH) at proximal anastomoses were similar for the FRAME and the control groups: 5.79 ± 1.38 versus 6.94 ± 1.10 mm2, respectively (p = 0.558) and 480 ± 95 vs. 587 ± 52 μm2/μm, respectively (p = 0.401). However, in the midgraft portions, the NIH area and thickness were significantly lower in the FRAME group than in the control group: 3.73 ± 0.64 vs. 6.27 ± 0.64 mm2, respectively (p = 0.022) and 258 ± 49 vs. 518 ± 36 μm2/μm, respectively (p = 0.0002). CONCLUSIONS: In our porcine model, the external mesh FRAME improved the patency of vein-to-carotid artery grafts and protected them from stenosis, particularly in the mid regions. The midgraft neo-intimal hyperplasia was two-fold thinner in the meshed grafts than in the controls.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The inferior phrenic artery is a paired artery with a variable origin and course, primarily supplying the diaphragm, but also the suprarenal glands, inferior vena cava, stomach, and oesophagus. The aim of this study is to investigate the origin and course of the inferior phrenic arteries on multidetector computed tomography and angiography. MATERIALS AND METHODS: The anatomy of the inferior phrenic artery was analysed on 2449 multidetector computed tomography scans. Three-dimensional reconstructions were made of the main variations. Additionally, the course and branching pattern of the inferior phrenic artery were descriptively analysed in a cohort of 28 angiograms. RESULTS: In 565 (23.1%) cases the inferior phrenic arteries arose as a common trunk and in 1884 (76.9%) cases as individual vessels. The most common origins of a common trunk were the coeliac trunk (n=303; 53.6%) and abdominal aorta (n=255; 45.1%). The most common origins of the right inferior phrenic artery were the coeliac trunk (n=965; 51.2%), abdominal aorta (n=562; 29.8%) and renal arteries (n=214; 11.4%). The most common origins of the left inferior phrenic artery were the coeliac trunk (n=1293; 68.6%) and abdominal aorta (n=403; 21.4%). CONCLUSION: The inferior phrenic artery has a very variable anatomy. The most common origins of the inferior phrenic artery are the coeliac trunk and its branches, the abdominal aorta, and the renal arteries.
- MeSH
- angiografie metody MeSH
- aorta abdominalis anatomie a histologie diagnostické zobrazování MeSH
- arteria coeliaca * anatomie a histologie diagnostické zobrazování MeSH
- arterie anatomie a histologie diagnostické zobrazování MeSH
- bránice krevní zásobení diagnostické zobrazování anatomie a histologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- multidetektorová počítačová tomografie * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- diagnostické techniky kardiovaskulární MeSH
- echokardiografie metody MeSH
- fibróza diagnostické zobrazování MeSH
- kardiologické zobrazovací techniky * MeSH
- kardiomyopatie diagnostické zobrazování MeSH
- koronární angiografie metody MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- myokarditida diagnostické zobrazování MeSH
- nemoci srdečních chlopní diagnostické zobrazování MeSH
- počítačová rentgenová tomografie metody MeSH
- SPECT/CT metody MeSH
- srdeční selhání * diagnostické zobrazování MeSH
- zátěžová echokardiografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Mitral regurgitation is the second most frequent valve disease in the adult population. Until recently, surgical repair or replacement were the only therapeutic options, leaving many patients untreated and even underdiagnosed, most frequently due to a presumably high surgical risk, particularly in those with secondary mitral regurgitation. Over the last few years, there has been exponential growth in the number of catheter-based procedures, with most of them using the transcatheter edge-to-edge repair (TEER) technique. Furthermore, the evolution of other systems is under way that preferentially use the transseptal approach, are more comprehensive, and are aimed at transcatheter mitral valve replacement. The purpose of this article is to review the current transcatheter repair systems and the evidence base for their use.
Mitrální regurgitace představuje druhou nejčastější chlopenní vadu v dospělé populaci. Až do nedávné doby byla jedinou terapeutickou možností chirurgická plastika nebo náhrada mitrální chlopně, přičemž mnoho nemocných nebylo léčeno ani diagnostikováno, nejčastěji z důvodů předpokládaného vysokého rizika operace, zejména u nemocných se sekundární mitrální regurgitací. V průběhu několika posledních let došlo k výraznému nárůstu počtu transkatétrových výkonů, většina z nich využívala principu sblížení obou cípů mitrální chlopně (tzv. transkatétrová edge‐to‐edge korekce - TEER). V současnosti jsme svědky vývoje dalších systémů, které využívají prefe
- Klíčová slova
- "edge‐to‐edge" intervence mitrální chlopně,
- MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- mitrální insuficience * chirurgie MeSH
- srdeční katetrizace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
