Navegando por Palavras-chave "angiografia"
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- ItemSomente MetadadadosAngiorm sem contraste na avaliação do tronco celíaco e da artéria mesentérica superior: um estudo comparativo com a angiotc(Universidade Federal de São Paulo (UNIFESP), 2014-04-09) Cardia, Patricia Prando [UNIFESP]; Ippolito, Giuseppe D Ippolito [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: to evaluate the quality and diagnostic accuracy of the images obtained with non enhanced MR angiography (NEMRA) for the evaluation of the celiac trunk (CTR) and superior mesenteric artery (SMA), using CT angiography (CTA) as a reference standard. Methods: we prospectively evaluated 41 patients submitted contemporaneously to NEMRA and CTA of the main branches of the abdominal aorta. Two independent observers analyzed the quality and the accuracy of the images in the definition of the celiac trunk (CTR), left gastric artery (LGA), common hepatic artery (CHA), splenic artery (EA) and superior mesenteric artery (SMA). Kappa test was used to evaluate the NEMRA reproducibility and the agreement between NEMRA and CTA. We also evaluated the correlation and the overall accuracy of NEMRA to identify arterial stenosis using CTA as a reference standard. Results: the NEMRA provided diagnostic quality images of the CTR and the proximal portions of, LGA, CHA, EA and SMA respectively 87.8%, 43.9%, 51.2%, 51.2% and 90.2% of cases. The interobserver agreement was high (k: 0.70 to 0.95). In the assessment of CTR and SMA stenosis, NEMRA obtained respectively sensitivity of 100% and 100%, specificity of 87.5% and 94.2%, positive predictive value of 50% and 50%, negative predictive value of 100% and 100%, and accuracy of 88.8% and 94.5%. Conclusion: NEMRA provides images with quality comparable to CTA in the evaluation of the CTR and proximal portion of SMA and is an accurate method for detecting stenosis of these arterial segments.
- ItemSomente MetadadadosAngiotomografia abdominal no paciente com sangramento gastrointestinal ativo(Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Reis, Fatima Regina Silva [UNIFESP]; Ippolito, Giuseppe D Ippolito [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates. That’s why the prompt diagnosis is essential for a better prognosis of these patients. Endoscopy is the main diagnostic tool in this context, however, when the gastrointestinal hemorrhage is massive, the bleeding site can be obscured during endoscopy; in addition, endoscopy is not always available and a trained professional might not be present. Bowel preparation is necessary for colonoscopy, which doesn’t evaluate the most part of small intestine. Scintigraphy does not allow precise anatomic localization of the bleeding and it’s unavailable in the emergency setting. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night and it has high costs. Digital angiography is invasive, has risks associated with vascular access, besides little availability in the emergency setting. On the other hand, angiotomography (angio-CT) is fast, highly available and minimally invasive. It is a promising alternative in these patients algorithm, being capable to determine the localization and the cause of bleeding with high accuracy and to guide treatment. Basing in a critical literature review and our own experience, we propose an angio- CT’s protocol for the patient with gastrointestinal bleeding.
- ItemAcesso aberto (Open Access)Teste ergométrico precoce após infarto do miocárdio: comparação com ecocardiograma, monitorização eletrocardiográfica e arteriografia coronariana(Sociedade Brasileira de Cardiologia - SBC, 2008-03-01) Leite, Wagner Aparecido [UNIFESP]; Gil, Manoel Adan [UNIFESP]; Lima, Valter Correia [UNIFESP]; Luna Filho, Bráulio [UNIFESP]; Servantes, Denise Maria [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Oliveira Filho, Japy Angelini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Predischarge exercise testing early after myocardial infarction is useful for risk stratification, exercise prescription, and assessment of prognosis and treatment. OBJECTIVE: The objective of this study was to compare the findings of exercise testing early after myocardial infarction with those of echocardiography, electrocardiographic monitoring (24-hour Holter monitoring) and coronary angiography. METHODS: We evaluated 60 cases (mean age of 51.42 ± 9.34 years), of which 46 were males (77%). The symptom-limited maximal exercise test according to the Naughton protocol12 was performed between the sixth day of hospitalization and hospital discharge, with the patients on medication. During hospitalization, the patients underwent echocardiography, electrocardiographic monitoring and coronary angiography. The significance level was set at 0.05 (a = 5%). RESULTS: Exercise testing had a poor performance in the detection of multivessel coronary artery disease (sensitivity, 42%; specificity, 69%). No significant differences were found when the presence of ischemia on exercise test was compared with multivessel coronary disease, complex ventricular arrhythmias on electrocardiographic monitoring, and the finding of an ejection fraction lower than 60% on echocardiography (p = 0.56), as well as with the presence of multivessel lesions, complex ventricular arrhythmias on electrocardiographic monitoring and abnormal ejection fraction on echocardiography (p = 0.36). CONCLUSION: The presence of ischemia during exercise testing was associated with the occurrence of ventricular arrhythmias on electrocardiographic monitoring, with reduced ejection fraction on echocardiography, as well as with the presence of multivessel coronary lesions, which constitutes an indicator of a high coronary risk.