- Publikační typ
- abstrakt z konference MeSH
Cílem této práceje prezentovat první dva případy provedení vnitřně-zevní punkce centrální žíly se systémem Surfaceŕ8 v České republice. Jedná se o novou metodu, která umožňuje získat centrální žilní přístup přes uzavřenou brachiocefalickou a vnitřníjugulámí žílu vpravo. Metoda je přínosná pro pacienty, kteří potřebují dlouhodobý centrální žilní vstup. S použitím této metodyje možné zavést do horní duté žíly jakýkoliv typ centrálního žitního katétru nebo i elektrody kardiostimulátoru. Pacientje tak ušetřen žilního katétru v oblasti třísla a při včasném užití této metody je možné ušetřiti centrální žíly vlevo, a předejít ta k vzniku syndromu horní duté žíly.
The aim of this work is to present the first use of inside-out puncture of the central vein using Surfacer® system in the Czech Republic in two patients. This is a novel method that enables to access centralvenous system via occluded right brachiocephalic and intemal jugular vein. The method is beneficial for patients requiring long-term centralvenous access. This method enables to introduce any type of central venous catheter or even pacemaker electrodes into the superior vena cava. Using this method the patients can avoid venous line through inguinalvessels and spare left-sided central veins if used in a timely manner in order to avoid possible superior vena cava syndrome.
- Publikační typ
- abstrakt z konference MeSH
Background Abnormal findings at brain MRI in patients with neurologic Wilson disease (WD) are characterized by signal intensity changes and cerebral atrophy. T2 signal hypointensities and atrophy are largely irreversible with treatment; their relationship with permanent disability has not been systematically investigated. Purpose To investigate associations of regional brain atrophy and iron accumulation at MRI with clinical severity in participants with neurologic WD who are undergoing long-term anti-copper treatment. Materials and Methods Participants with WD and controls were compared in a prospective study performed from 2015 to 2019. MRI at 3.0 T included three-dimensional T1-weighted and six-echo multigradient-echo pulse sequences for morphometry and quantitative susceptibility mapping, respectively. Neurologic severity was assessed with the Unified WD Rating Scale (UWDRS). Automated multi-atlas segmentation pipeline with dual contrast (susceptibility and T1) was used for the calculation of volumes and mean susceptibilities in deep gray matter nuclei. Additionally, whole-brain analysis using deformation and surface-based morphometry was performed. Least absolute shrinkage and selection operator regression was used to assess the association of regional volumes and susceptibilities with the UWDRS score. Results Twenty-nine participants with WD (mean age, 47 years ± 9 [standard deviation]; 15 women) and 26 controls (mean age, 45 years ± 12; 14 women) were evaluated. Whole-brain analysis demonstrated atrophy of the deep gray matter nuclei, brainstem, internal capsule, motor cortex and corticospinal pathway, and visual cortex and optic radiation in participants with WD (P < .05 at voxel level, corrected for family-wise error). The UWDRS score was negatively correlated with volumes of putamen (r = -0.63, P < .001), red nucleus (r = -0.58, P = .001), globus pallidus (r = -0.53, P = .003), and substantia nigra (r = -0.50, P = .006) but not with susceptibilities. Only the putaminal volume was identified as a stable factor associated with the UWDRS score (R2 = 0.38, P < .001) using least absolute shrinkage and selection operator regression. Conclusion Individuals with Wilson disease (WD) had widespread brain atrophy most pronounced in the central structures. The putaminal volume was associated with the Unified WD Rating Scale score and can be used as a surrogate imaging marker of clinical severity. © RSNA, 2021 Supplemental material is available for this article. See also the editorial by Du and Bydder in this issue.
- MeSH
- atrofie MeSH
- hepatolentikulární degenerace diagnostické zobrazování farmakoterapie metabolismus patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- mozek diagnostické zobrazování metabolismus patologie MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- železo metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cílem této práce je seznámit čtenáře s novou metodou punkce centrální žíly. Tento nový postup umožňuje získat centrální žilní přístup přes uzavřenou jugulární a brachiocefalickou žílu vpravo. Metoda se provádí pomocí unikátního systému Surfacer® Inside-Out® Access Catheter System zaváděného pravou femorální žílou, který umožňuje provedení vnitřně-zevní punkce. Tento postup je možné použít v případě uzávěru všech centrálních žil v horní části hrudníku, ale je indikován již při izolovaném uzávěru pravé vnitřní jugulární žíly. Přínosný je pro pacienty vyžadující dlouhodobý centrální žilní vstup. Největší skupinu budou pravděpodobně tvořit pacienti závislí na dialyzačním katétru, ale s použitím této metody je možné zavést do horní duté žíly jakýkoliv typ centrálního žilního katétru nebo i elektrody kardiostimulátoru. Metoda jednoznačně přináší zlepšení kvality života této specifické skupiny pacientů, protože budou ušetřeni žilního katétru v oblasti třísla a při včasném užití této metody je možné ušetřit i centrální žíly vlevo, což pak zjednoduší eventuální založení dialyzačního zkratu na levé horní končetině, a navíc může předejít vzniku syndromu horní duté žíly.
The aim of this work is to present a novel method of central venous puncture. This new approach enables to gain central venous access through occluded right jugular and brachiocephalic vein. The method uses a unique Surfacer® Inside-Out® Access Catheter System introduced via right femoral vein which enables performance of inside-out puncture. This approach can be used in patients with closure of all central veins in upper part of the thorax but it is also indicated in an isolated closure of right internal jugular vein. The method is beneficial in patients requiring long-term central venous access. The largest group of patients will probably consist of patients dependent on dialysis catheter but any type of central venous catheter or even pacemaker electrode can be introduced to the superior vena cava using this approach. The method definitely improves quality of life of this specific group of patients as they can be spared venous line through the inguinal region. Furthermore a left-sided central venous access can be spared if this method is used in a timely manner which can make possible future dialysis shunt introduction easier to the left arm and moreover it can prevent possible superior vena cava syndrome.
- Klíčová slova
- Systém Surfacer,
- MeSH
- centrální žilní katétry MeSH
- dialýza ledvin metody MeSH
- katetrizace centrálních vén * metody trendy MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
BACKGROUND: In Wilson's disease (WD), demyelination, rarefaction, gliosis, and iron accumulation in the deep gray matter cause opposing effects on T2 -weighted MR signal. However, the degree and interplay of these changes in chronically treated WD patients has not been quantitatively studied. PURPOSE: To compare differences in brain multiparametric mapping between controls and chronically treated WD patients with neurological (neuro-WD) and hepatic (hep-WD) forms to infer the nature of residual WD neuropathology. STUDY TYPE: Cross-sectional. POPULATION/SUBJECTS: Thirty-eight WD patients (28 neuro-WD, 10 hep-WD); 26 healthy controls. FIELD STRENGTH/SEQUENCE: 3.0T: susceptibility, T2 *, T2 , T1 relaxometry; 1.5T: T2 , T1 relaxometry. ASSESSMENT: The following 3D regions of interest (ROIs) were manually segmented: globus pallidus, putamen, caudate nucleus, and thalamus. Mean bulk magnetic susceptibility, T2 *, T2 , and T1 relaxation times were calculated for each ROI. STATISTICAL TESTS: The effect of group (neuro-WD, hep-WD, controls) and age was assessed using a generalized least squares model with different variance for each ROI and quantitative parameter. A general linear hypothesis test with Tukey adjustment was used for post-hoc between-group analysis; P < 0.05 was considered significant. RESULTS: Susceptibility values were higher in all ROIs in neuro-WD compared to controls and hep-WD (P < 0.001). In basal ganglia, lower T2 and T2 * were found in neuro-WD compared to controls (P < 0.01) and hep-WD (P < 0.05) at 3.0T. Much smaller intergroup differences for T2 in basal ganglia were observed at 1.5T compared to 3.0T. In the thalamus, increased susceptibility in neuro-WD was accompanied by increased T1 at both field strengths (P < 0.001 to both groups), and an increased T2 at 1.5T only (P < 0.001 to both groups). DATA CONCLUSION: We observed significant residual brain MRI abnormalities in neuro-WD but not in hep-WD patients on chronic anticopper treatment. Patterns of changes were suggestive of iron accumulation in the basal ganglia and demyelination in the thalamus; 3.0T was more sensitive for detection of the former and 1.5T of the latter abnormality. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1829-1835.
