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Endoscopy International Open Oct 2017Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All... (Review)
Review
BACKGROUND AND STUDY AIMS
Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay.
PATIENTS AND METHODS
A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs).
RESULTS
Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 - 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding.
CONCLUSIONS
In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.
PubMed: 28975147
DOI: 10.1055/s-0043-117958 -
VASA. Zeitschrift Fur Gefasskrankheiten Mar 2023Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We... (Review)
Review
Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We present two cases of vascular handlebar syndrome treated in our hospital and a systematic review of the literature using MEDLINE and SCOPUS databases. Literature review identified 20 similar cases. The median age of patients was 18 years, and in vast majority males in gender. In most cases, the common femoral artery injury was an intimal flap and lumen occlusion with intramural thrombosis followed by transection and intimal injury without occlusion or thrombosis. The median time between injury and diagnosis/treatment was half an hour. Clinical presentation ranged from asymptomatic to acute limb ischemia. The grade of acute ischemia was mostly Rutherford class I (n=14), while acute IIa (n=4), chronic ischemia (n=3), and no ischemia (n=1) were also noticed. The correct diagnosis was revealed by clinical examination only (n=1), or by the combination of clinical and imaging techniques including computed tomography angiography (n=7) and duplex ultrasonography (n=4) or both (n=10). Management of the handlebar trauma syndrome injuries was surgical in most cases. Outcome was favorable in all patients. Vascular handlebar syndrome is extremely rare and high suspicion is required for early diagnosis and definitive treatment, as the early management is effective and crucial for averting the devastating consequences. An individualized approach to the vascular trauma patient is to be applied with considerations taken to the age of the patient, the mechanism of the injury, the anatomy of the lesion, and symptomatology of the case.
Topics: Adolescent; Humans; Male; Femoral Artery; Ischemia; Thrombosis; Tomography, X-Ray Computed; Vascular System Injuries; Wounds, Nonpenetrating
PubMed: 36698255
DOI: 10.1024/0301-1526/a001054 -
Eye (London, England) Jul 2022To assess the association between optical coherence tomography angiography (OCTA) retinal measurements and Alzheimer's disease (AD). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To assess the association between optical coherence tomography angiography (OCTA) retinal measurements and Alzheimer's disease (AD).
METHODS
We searched MEDLINE and EMBASE from inception up to October 28th, 2020 for studies assessing the association between OCTA retinal measurements and AD. Estimates from eligible studies were meta-analysed and pooled standardized mean differences (SMDs) between AD patients and healthy participants with corresponding 95% confidence intervals (95% CI) were calculated, using the Hartung-Knapp/Sidik-Jonkman random-effects method. In addition, we quantified the minimum strength on the risk ratio scale (E value) required for an unmeasured confounder to nullify these associations.
RESULTS
Ten eligible studies for our systematic review were identified through our search strategy. The pooled SMD between the retinal vessel density of AD patients and healthy participants in the whole superficial vascular plexus (SVP), parafoveal SVP and foveal avascular zone (FAZ) was -0.41 (95% CI: -0.69 to -0.13, p value = 0.01, I = 15%, seven studies), -0.51 (95% CI: -0.84 to -0.18, p value = 0.01, I = 40%, six studies), and 0.87 (95% CI: -0.03 to 1.76, p value = 0.05, I = 91%, seven studies), respectively. An unmeasured confounder would need to be associated with a 2.26-, 2.56- and 3.82-fold increase in the risk of AD and OCTA retinal measurements, in order for the pooled SMD estimate of vessel density in whole SVP, parafoveal SVP and FAZ, respectively, to be nullified.
CONCLUSIONS
In our study, whole and parafoveal SVP vessel density were inversely associated with AD. However, prospective longitudinal studies with larger sample sizes are needed to furtherly assess these associations.
Topics: Alzheimer Disease; Fluorescein Angiography; Fovea Centralis; Humans; Prospective Studies; Retinal Vessels; Tomography, Optical Coherence
PubMed: 34193983
DOI: 10.1038/s41433-021-01648-1 -
Minerva Anestesiologica Nov 2015Post-traumatic vasospasm (PTV) remains a poorly understood entity. Using a systematic review approach, we examined the incidence, mechanisms, risk factors, impact on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-traumatic vasospasm (PTV) remains a poorly understood entity. Using a systematic review approach, we examined the incidence, mechanisms, risk factors, impact on outcome and potential therapies of PTV.
METHODS
A search on Medline database up to 2015 performed with "traumatic brain injury" and "vasospasm" key-words retrieved 429 references. This systematic review was reported and analysed following the PRISMA criteria and according to the relevance in human clinical practice.
RESULTS
The research retrieved 429 references of which 226 were excluded from analysis because of their irrelevance and 87 finally included in the review.
CONCLUSION
Mechanical stretching, inflammation, calcium dysregulation, endotelin, contractile proteins, products of cerebral metabolism and cortical spreading depolarization have been involved in PTV pathophysiology. PTV occurs in up to 30-40% of the patients after severe traumatic brain injury. Usually, PTV starts within the first 3 days following head trauma and may last 5 to 10 days. Young age, low Glasgow Coma Score at admission and subarachnoid hemorrhage have been identified as risk factors of PTV. Suspected on transcranial Doppler, PTV diagnosis is best confirmed by angiography, CT angiography or MR angiography, and perfusion and ischaemic consequences by perfusion CT or MRI. Early PTV is associated with poor outcome. No PTV prevention strategy has proved efficient up to now. Regarding PTV treatment, only nimodipine and intra-arterial papaverine have been studied up to now. Treatment with milrinone has been described in a few cases reports and may represent a new therapeutic option.
Topics: Brain Injuries, Traumatic; Humans; Vasospasm, Intracranial
PubMed: 26372114
DOI: No ID Found -
Cureus Jan 2017The pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is a rare but potentially lethal disease; its... (Review)
Review
The pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is a rare but potentially lethal disease; its incidence is unclear, as most of the literature includes case reports. It most commonly occurs as a complica-tion of malignancy, post lung surgery, or atrial fibrillation and can be idiopathic in some cases. Most patients with PVT are commonly asymptomatic or have nonspecific symptoms such as cough, hemoptysis, and dyspnea from pulmonary edema or infarction. The thrombi are typically detected using a variety of imaging modalities including transesophageal echocardiogram (TEE), computed tomography (CT) scanning, magnetic resonance imaging (MRI), or pulmonary angiog-raphy. Treatment should be determined by the obstructing pathological finding and can include antibiotic therapy, anticoagulation, thrombectomy, and/or pulmonary resection. The delay in diagnosing this medical entity can lead to complications including pulmonary infarction, pulmonary edema, right ventricular failure, allograft failure, and peripheral embolism resulting in limb ischemia, stroke, and renal infarction (RI).
PubMed: 28265529
DOI: 10.7759/cureus.993 -
Circulation Apr 2024Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)- and optical coherence tomography (OCT)-guided percutaneous... (Meta-Analysis)
Meta-Analysis
Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography for Guiding of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis.
BACKGROUND
Results from multiple randomized clinical trials comparing outcomes after intravascular ultrasound (IVUS)- and optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with invasive coronary angiography (ICA)-guided PCI as well as a pivotal trial comparing the 2 intravascular imaging (IVI) techniques have provided mixed results.
METHODS
Major electronic databases were searched to identify eligible trials evaluating at least 2 PCI guidance strategies among ICA, IVUS, and OCT. The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events. Frequentist random-effects network meta-analyses were conducted. The results were replicated by Bayesian random-effects models. Pairwise meta-analyses of the direct components, multiple sensitivity analyses, and pairwise meta-analyses IVI versus ICA were supplemented.
RESULTS
The results from 24 randomized trials (15 489 patients: IVUS versus ICA, 46.4%, 7189 patients; OCT versus ICA, 32.1%, 4976 patients; OCT versus IVUS, 21.4%, 3324 patients) were included in the network meta-analyses. IVUS was associated with reduced target lesion revascularization compared with ICA (odds ratio [OR], 0.69 [95% CI, 0.54-0.87]), whereas no significant differences were observed between OCT and ICA (OR, 0.83 [95% CI, 0.63-1.09]) and OCT and IVUS (OR, 1.21 [95% CI, 0.88-1.66]). Myocardial infarction did not significantly differ between guidance strategies (IVUS versus ICA: OR, 0.91 [95% CI, 0.70-1.19]; OCT versus ICA: OR, 0.87 [95% CI, 0.68-1.11]; OCT versus IVUS: OR, 0.96 [95% CI, 0.69-1.33]). These results were consistent with the secondary outcomes of ischemia-driven target lesion revascularization, target vessel myocardial infarction, and target vessel revascularization, and sensitivity analyses generally did not reveal inconsistency. OCT was associated with a significant reduction of stent thrombosis compared with ICA (OR, 0.49 [95% CI, 0.26-0.92]) but only in the frequentist analysis. Similarly, the results in terms of survival between IVUS or OCT and ICA were uncertain across analyses. A total of 25 randomized trials (17 128 patients) were included in the pairwise meta-analyses IVI versus ICA where IVI guidance was associated with reduced target lesion revascularization, cardiac death, and stent thrombosis.
CONCLUSIONS
IVI-guided PCI was associated with a reduction in ischemia-driven target lesion revascularization compared with ICA-guided PCI, with the difference most evident for IVUS. In contrast, no significant differences in myocardial infarction were observed between guidance strategies.
Topics: Humans; Coronary Artery Disease; Coronary Angiography; Tomography, Optical Coherence; Network Meta-Analysis; Percutaneous Coronary Intervention; Bayes Theorem; Ultrasonography, Interventional; Myocardial Infarction; Thrombosis; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38344859
DOI: 10.1161/CIRCULATIONAHA.123.067583 -
Biomedicines Oct 2023Subarachnoid hemorrhage resulting from cerebral aneurysm rupture is a significant cause of morbidity and mortality. Early identification of aneurysms on Computed... (Review)
Review
Subarachnoid hemorrhage resulting from cerebral aneurysm rupture is a significant cause of morbidity and mortality. Early identification of aneurysms on Computed Tomography Angiography (CTA), a frequently used modality for this purpose, is crucial, and artificial intelligence (AI)-based algorithms can improve the detection rate and minimize the intra- and inter-rater variability. Thus, a systematic review and meta-analysis were conducted to assess the diagnostic accuracy of deep-learning-based AI algorithms in detecting cerebral aneurysms using CTA. PubMed (MEDLINE), Embase, and the Cochrane Library were searched from January 2015 to July 2023. Eligibility criteria involved studies using fully automated and semi-automatic deep-learning algorithms for detecting cerebral aneurysms on the CTA modality. Eligible studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A diagnostic accuracy meta-analysis was conducted to estimate pooled lesion-level sensitivity, size-dependent lesion-level sensitivity, patient-level specificity, and the number of false positives per image. An enhanced FROC curve was utilized to facilitate comparisons between the studies. Fifteen eligible studies were assessed. The findings indicated that the methods exhibited high pooled sensitivity (0.87, 95% confidence interval: 0.835 to 0.91) in detecting intracranial aneurysms at the lesion level. Patient-level sensitivity was not reported due to the lack of a unified patient-level sensitivity definition. Only five studies involved a control group (healthy subjects), whereas two provided information on detection specificity. Moreover, the analysis of size-dependent sensitivity reported in eight studies revealed that the average sensitivity for small aneurysms (<3 mm) was rather low (0.56). The studies included in the analysis exhibited a high level of accuracy in detecting intracranial aneurysms larger than 3 mm in size. Nonetheless, there is a notable gap that necessitates increased attention and research focus on the detection of smaller aneurysms, the use of a common test dataset, and an evaluation of a consistent set of performance metrics.
PubMed: 38001922
DOI: 10.3390/biomedicines11112921 -
AJNR. American Journal of Neuroradiology Sep 2014MR angiography is proposed as a safer and less expensive alternative to the reference standard, DSA, in the follow-up of intracranial aneurysms treated with endovascular... (Meta-Analysis)
Meta-Analysis Review
MR angiography is proposed as a safer and less expensive alternative to the reference standard, DSA, in the follow-up of intracranial aneurysms treated with endovascular coil occlusion. We performed a systematic review and meta-analysis to evaluate the accuracy of TOF-MRA and contrast-enhanced MRA in detecting residual flow in the follow-up of coiled intracranial aneurysms. Literature was reviewed through the PubMed, Cochrane, and EMBASE data bases. In comparison with DSA, the sensitivity of TOF-MRA was 86% (95% CI: 82-89%), with a specificity of 84% (95% CI: 81-88%), for the detection of any recurrent flow. For contrast-enhanced MRA, the sensitivity and specificity were 86% (95% CI: 82-89%) and 89% (95% CI: 85-92%), respectively. Both TOF-MRA and contrast-enhanced MRA are shown to be highly accurate for detection of any recanalization in intracranial aneurysms treated with endovascular coil occlusion.
Topics: Angiography, Digital Subtraction; Embolization, Therapeutic; Endovascular Procedures; Follow-Up Studies; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography
PubMed: 24008171
DOI: 10.3174/ajnr.A3700 -
Annals of Medicine and Surgery (2012) May 2022The diagnosis and treatment of pulmonary embolism have multi-modal approach based on specificity, sensitivity, availability of the machine, and associated risks of... (Review)
Review
BACKGROUND
The diagnosis and treatment of pulmonary embolism have multi-modal approach based on specificity, sensitivity, availability of the machine, and associated risks of imaging modalities.
AIM
This review aimed to provide shreds of evidence that improve perioperative diagnosis and management of suspected pulmonary embolism.
METHODS
The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020. After a clear criteria has been established an electronic searching database was conducted using PubMed, Google Scholar, Cochrane library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), with Key search terms included:('pulmonary embolism' AND' anesthesia management ', 'anticoagulation' AND 'pulmonary embolism', 'thrombolysis 'AND 'pulmonary embolism', 'surgery' AND' pulmonary embolism'), were used to draw the evidence.The quality of literatures were categorized based on WHO 2011 level of evidence and degree of recommendation, in addition, the study is registered with research registry unique identifying number (UIN) of reviewregistry1318." and has high quality based on AMSTAR2 assessment criteria.
RESULTS
A totally of 27 articles were included [guidelines (n = 3), Cochrane (=5), systemic reviews (n = 7), meta-analyses (=2), RCT (n = 4), cohort studies (n = 3), and cross-sectional study (n = 3) and illegible articles identified from searches of the electronic databases were imported into the ENDNOTE software version X7.1 and duplicates were removed.
DISCUSSION
Currently divergent and contradictory approaches are implemented in diagnosis and management for patients suspected of pulmonary embolism.
CONCLUSION
All perioperative patients, especially trauma victims, prostate or orthopedic surgery, malignancy, immobility, and obesity; smokers; and oral contraceptive users, antipsychotic medications are at increased risk of venous thromboembolism and need special caution during surgery and anesthesia
PubMed: 35638051
DOI: 10.1016/j.amsu.2022.103684 -
Emergency Radiology Aug 2022Chest CT is valuable to detect alternative diagnoses/complications of COVID-19, while its role for prognostication requires further investigation. Non-pulmonary... (Meta-Analysis)
Meta-Analysis Review
Chest CT is valuable to detect alternative diagnoses/complications of COVID-19, while its role for prognostication requires further investigation. Non-pulmonary radiological findings such as cardiovascular calcifications could increase the predictivity of clinical outcomes of COVID-19 patients beyond pulmonary involvement. Several observational studies have reported mixed results on the role of coronary calcifications in COVID-19 patients as a predictor of hospitalization, ventilatory support, and mortality. The purpose of the study is to systematically review the available evidence on the predictive role of cardiovascular calcifications in SARS-CoV2 disease. The meta-analysis confirms the prognostic significance of coronary calcifications on hospital mortality, and coronary calcifications (CAC ≠ 0) were associated with an OR for mortality of 2.19 (95% CI 1.36-3.52). CAC was neutral on respiratory outcomes, but it was associated with an increased trend of cardiovascular events. Coronary calcium appears as a promising biomarker imaging even in short-term outcomes (MACEs, hospital mortality) in a non-cardiovascular disease such as Sars-CoV2 infection. Further large studies are needed to confirm promising results of this imaging biomarker in non-cardiovascular disease.
Topics: COVID-19; Calcinosis; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Humans; RNA, Viral; Risk Assessment; Risk Factors; SARS-CoV-2
PubMed: 35501615
DOI: 10.1007/s10140-022-02048-y