The effects of a large arteriovenous fistula (AVF) on pulmonary perfusion remains to be elucidated. We aimed to study, for the first time, the real-time acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. Ten healthy swine under general anesthesia were studied. AVF was created by the connection of femoral artery and femoral vein using high-diameter perfusion cannulas. The AVF was closed and after 30 min of stabilization the first values were recorded. The fistula was then opened, and new data were collected after reaching stable state. Continuous hemodynamic monitoring was performed throughout the protocol. The following functional images were analyzed by electrical impedance tomography (EIT): perfusion and ventilation distributions. We found an increased cardiac output and right ventricular work, which was strongly correlated to an increased pulmonary artery mean pressure (r=0.878, P=0.001). The ventral/dorsal ratio of pulmonary perfusion decreased from 1.9+/-1.0 to 1.5+/-0.7 (P=0.025). The percentage of total pulmonary blood flow through the dorsal lung region increased from 38.6+/-11.7 to 42.2+/-10.4 (P=0.016). In conclusion, we have used EIT for the first time for studying the acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. In this new experimental model of hyperkinetic circulation caused by AVF, we documented an increased percentage of total pulmonary blood flow through the dorsal lung region and a more homogeneous perfusion distribution. Key words Arteriovenous fistula, Hyperkinetic circulation, Tissue perfusion, Animal model, Pulmonary blood flow.
- MeSH
- arteria pulmonalis diagnostické zobrazování patofyziologie MeSH
- arteriovenózní píštěl patofyziologie diagnostické zobrazování MeSH
- arteriovenózní zkrat MeSH
- plíce krevní zásobení diagnostické zobrazování MeSH
- plicní oběh * fyziologie MeSH
- prasata MeSH
- vena femoralis diagnostické zobrazování MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The authors present their contribution to the improvement of methods suitable for the detection of the freezing and thawing damage of cells of cryopreserved venous grafts used for lower limb revascularization procedures. They studied the post-thaw viability of cells of the wall of cryopreserved venous grafts (CVG) immediately after thawing and after 24 and 48 h culture at +37 °C in two groups of six CVG selected randomly for slow thawing in the refrigerator and rapid thawing in a water bath at +37 °C. The grafts were collected from multi-organ and tissue brain-dead donors, cryopreserved, and stored in a liquid nitrogen vapor phase for five years. The viability was assessed from tissue slices obtained by perpendicular and longitudinal cuts of the thawed graft samples using in situ staining with fluorescence vital dyes. The mean and median immediate post-thaw viability values above 70% were found in using both thawing protocols and both types of cutting. The statistically significant decline in viability after the 48-h culture was observed only when using the slow thawing protocol and perpendicular cutting. The possible explanation might be the "solution effect damage" during slow thawing, which caused a gentle reduction in the graft cellularity. The possible influence of this phenomenon on the immunogenicity of CVG should be the subject of further investigations.
- MeSH
- alografty diagnostické zobrazování účinky léků MeSH
- apoptóza účinky léků MeSH
- dárci tkání MeSH
- dimethylsulfoxid farmakologie MeSH
- fluorescenční barviva * MeSH
- konfokální mikroskopie metody MeSH
- kryoprezervace metody MeSH
- kryoprotektivní látky farmakologie MeSH
- lidé MeSH
- optické zobrazování metody MeSH
- transplantace cév metody MeSH
- vena femoralis diagnostické zobrazování účinky léků MeSH
- vena saphena diagnostické zobrazování účinky léků MeSH
- viabilita buněk účinky léků MeSH
- zmrazování * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Hlboká žilová trombóza (HŽT) je závažné ochorenie, pri ktorom môže byť ohrozená vitalitakončatiny. Phlegmasia coerulea dolens predstavuje najzávažnejší stav HŽT s kompletnoutrombózou hĺbkových aj povrchových žíl zasahujúcou celú končatinu, zastavuje sa žilovýodtok, v dôsledku čoho dochádza k prerušeniu tepnového toku a ischémii končatiny. V takomprípade je koža cyanotická, tepnové pulzácie nie sú hmatné, môžu vzniknúť buly na distálnychčastiach končatiny, gangréna žilového pôvodu. Práca prezentuje kazuistiku pacientky s rý-chlym rozvojom phlegmasia coerulea dolens ľavej dolnej končatiny.
Deep vein thrombosis is a serious disease in which limb vitality may be compromised. Phleg-masia coerulea dolens is the most severe stage of deep vein thrombosis with a completethrombosis of deep and superficial veins, and therefore, the whole limb is affected. Exceptthe swelling and pain, the affected limb is cyanotic and there are no peripheral pulsations dueto absent venous and therefore arterial flow and subsequent ischaemia. Also, a venous gan-grene may develop. This case report presents a female patient with rapidly developing phleg-masia coerulea dolens.
- Klíčová slova
- Phlegmasia coerulea dolens,
- MeSH
- heparin nízkomolekulární terapeutické užití MeSH
- inhibitory faktoru Xa terapeutické užití MeSH
- kavální filtry MeSH
- lidé středního věku MeSH
- lidé MeSH
- rezistence k aktivovanému proteinu C MeSH
- vena cava inferior chirurgie diagnostické zobrazování patologie MeSH
- vena femoralis chirurgie diagnostické zobrazování patologie MeSH
- vena iliaca chirurgie diagnostické zobrazování patologie MeSH
- žilní trombóza * chirurgie etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Akutní plicní embolie je akutní formou žilního tromboembolismu a jednou z hlavních příčin mortality, morbidity a hospitalizací v západní Evropě. Na tuto diagnózu je třeba myslet vždy v rámci diferenciální diagnostiky náhle vzniklé dušnosti. K správné a časné diagnostice nám může kromě vhodně zvolených laboratorních a zobrazovacích metod pomoci i stanovení klinické pravděpodobnosti dle dostupných skórovacích systémů. Níže uvedená kazuistika popisuje případ pacienta s akutní, vysoce rizikovou plicní embolií, provázenou paradoxní embolizací do centrálního nervového systému. Pacient byl úspěšně léčen trombolytickou terapií a následně terapií nízkomolekulárním heparinem. Etiologií tromboembolické příhody je nejspíše kombinace neoplazie a traumatu s imobilizací.
Acute pulmonary embolism is an acute form of venous thromboembolism and one of the major causes of mortality, morbidity and hospitalization in Western Europe. This diagnosis should always be taken into account in differential diagnosis of sudden shortness of breath. Correct and early diagnosis can be achieved, apart from suitably chosen laboratory and imaging methods, by determining clinical probability according to available scoring systems. The case report below describes the case of a patient with acute, high-risk pulmonary embolism accompanied by paradoxical embolization into the central nervous system, successfully treated with thrombolytic therapy followed by low molecular weight heparin therapy (LMWH). The etiology of a thromboembolic event probably consists of a combination of neoplasia and trauma with immobilization.
- Klíčová slova
- pohyblivost,
- MeSH
- aneurysma srdce diagnostické zobrazování MeSH
- cévní mozková příhoda etiologie MeSH
- echokardiografie transezofageální MeSH
- echokardiografie MeSH
- hematom etiologie MeSH
- heparin nízkomolekulární terapeutické užití MeSH
- ischemická choroba srdeční diagnóza farmakoterapie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- noradrenalin aplikace a dávkování MeSH
- paradoxní embolie etiologie farmakoterapie terapie MeSH
- plicní embolie * diagnóza farmakoterapie terapie MeSH
- riziko MeSH
- síňová přepážka patologie MeSH
- srdce diagnostické zobrazování patofyziologie MeSH
- tachykardie farmakoterapie MeSH
- tkáňový aktivátor plazminogenu aplikace a dávkování MeSH
- trombolytická terapie MeSH
- ultrasonografie MeSH
- úrazy pádem MeSH
- vena femoralis diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- zhmoždění MeSH
- žilní trombóza diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The study was initiated following the observation of complete recanalization of thrombus in subjects with DVT treated with rivaroxaban after 1-2 weeks. The aim of this observational retrospective study was to evaluate clinically and by means of echo color Duplex, the fibrinolytic effect of rivaroxaban in patients with recent and previous DVT. To accomplish this two populations of patients were evaluated. METHODS: Group 1 was comprised of 31 patients (ranging in age 52-73 years) with popliteal-femoral DVT (12 months ago) treated with standard anticoagulant therapy. In these patients, we found a complete superficial femoral recanalization and partial recanalization of the popliteal vein (30% of residual thrombus). The patients had normal creatinine clearance and liver function. The patients were switched from warfarin to rivaroxaban due to a lack of compliance with warfarin therapy. Group 2 was comprised of 22 patients (ranging in age 65-82 years) with previous popliteal-femoral DVT and documented complete common femoral veins recanalization who presented with a recent superficial femoral vein re-thrombosis (1 week before). The patients had normal creatinine clearance and liver function. The patients switched from warfarin to rivaroxaban due to a lack of compliance with warfarin therapy. RESULTS: In group 1, all patients exhibited the complete recanalization of the popliteal veins after 4 weeks of rivaroxaban therapy. In group 2, all patients exhibited the complete recanalization of the popliteal veins after 4 weeks, and the complete recanalization of the acute re-thrombosis of the superficial femoral veins after 2 weeks of rivaroxaban therapy. No adverse events for both groups were observed. CONCLUSIONS: Our results suggest that rivaroxaban could have a pro-fibrinolytic effect not only on recent thrombus but also on organized thrombus that results in a complete recanalization of affected veins. It is proposed that this lytic effect will preserve venous valve structure and lead to a reduction of incidence of post-thrombotic syndrome in rivaroxaban treated patients.
- MeSH
- duplexní dopplerovská ultrasonografie MeSH
- inhibitory faktoru Xa terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- posttrombotický syndrom prevence a kontrola MeSH
- rivaroxaban terapeutické užití MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombolytická terapie MeSH
- vena femoralis diagnostické zobrazování MeSH
- vena poplitea diagnostické zobrazování MeSH
- výsledek terapie MeSH
- žilní trombóza diagnostické zobrazování farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Aims: Complications of catheter ablation for atrial fibrillation (AF) are frequently related to vascular access. We hypothesized that ultrasound-guided (USG) venipuncture may facilitate the procedure and reduce complication rates. Methods and results: We conducted a multicentre, randomized trial in patients undergoing catheter ablation for AF on uninterrupted anticoagulation therapy. The study enrolled consecutive 320 patients (age: 63 ± 8 years; male: 62%) and were randomized to USG or conventional venipuncture in 1:1 fashion. It was prematurely terminated due to substantially lower-than-expected complication rates, which doubled the population size needed to maintain statistical power. While the complication rates did not differ between two study arms (0.6% vs. 1.9%, P = 0.62), intra-procedural outcome measures were in favour of the USG approach (puncture time, 288 vs. 369 s, P < 0.001; first pass success, 74% vs. 20%, P < 0.001; extra puncture attempts 0.5 vs. 2.1, P < 0.001; inadvertent arterial puncture 0.07 vs. 0.25, P < 0.001; unsuccessful cannulation 0.6% vs. 14%, P < 0.001). Though these measures varied between trainees (49% of procedures) and expert operators, between-arm differences (except for unsuccessful cannulation) were comparably significant in favour of USG approach for both subgroups. Conclusions: Ultrasound-guided puncture of femoral veins was associated with preferable intra-procedural outcomes, though the major complication rates were not reduced. Both trainees and expert operators benefited from the USG strategy. (www.clinicaltrials.gov ID: NCT02834221).
- MeSH
- časové faktory MeSH
- fibrilace síní diagnóza patofyziologie chirurgie MeSH
- intervenční ultrasonografie * MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- periferní katetrizace škodlivé účinky metody MeSH
- pooperační komplikace etiologie MeSH
- předčasné ukončení klinických zkoušek MeSH
- punkce MeSH
- rizikové faktory MeSH
- senioři MeSH
- vena femoralis diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
- Japonsko MeSH
