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Journal of Vascular Surgery Jul 2014Cystic adventitial disease (CAD) is a rare condition that affects arteries and veins. The etiology remains controversial and several treatment methods have been... (Review)
Review
BACKGROUND
Cystic adventitial disease (CAD) is a rare condition that affects arteries and veins. The etiology remains controversial and several treatment methods have been described. By understanding the pathogenesis of CAD, we can improve the surgical treatment, reduce recurrence rates, and improve patient outcomes. The objective of this study was to perform a systematic review of the world's literature.
METHODS
We searched across multiple scientific databases and cross-referenced each article to collect the world's literature on CAD. Studies included were those that reported a case or case series of CAD. Each article was analyzed for site of CAD, patient demographic data, type of imaging, surgical management, presence of a joint connection on imaging or at surgery, and recurrences. A regression analysis was used to identify risk factors for cyst recurrence.
RESULTS
We identified 503 reports (724 patients), which were included in our analysis. The most common vessel affected was the popliteal artery with 587 cysts. The mean age was 46 (range, 5-80) years with a male-to-female ratio of approximately 4:1. Magnetic resonance imaging (MRI) or angiography was performed for 182 cysts and conventional angiography was the most advanced imaging modality used in 355 patients who did not receive a MRI or computed tomography scan as part of their assessment. Multiple types of surgical interventions were reported with the most common being cyst resection and saphenous vein graft reconstruction (204 cases). There were 122 joint connections (17%) identified. Sixty-five patients (9%) developed at least one cyst recurrence or persistence. Percutaneous surgery (aspiration or angioplasty) was found to be a risk factor for cyst recurrence (odds ratio, 13.7; 95% confidence interval, 6.5-29.0; P < .0001). Because of the rarity of this condition, publications were limited to level IV evidence consisting of case series and case reports. Several reports had short or no follow-up and few patients had postoperative MRI. These limitations likely underestimate the true rate of cyst recurrence or persistence.
CONCLUSIONS
This article provides a comprehensive review of the world's literature on CAD, which can serve as a baseline for future studies. When analyzed in the context of the literature, this systematic review supplies further evidence that CAD adheres to the articular (synovial) theory. We believe that knowledge of these joint connections can simplify treatment, reduce recurrence rates, and improve patient outcomes.
Topics: Adolescent; Adult; Adventitia; Aged; Aged, 80 and over; Angiography; Child; Child, Preschool; Cysts; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Peripheral Vascular Diseases; Popliteal Artery; Recurrence; Young Adult
PubMed: 24970659
DOI: 10.1016/j.jvs.2014.04.014 -
Biomedicines Oct 2021The aim of this systematic review was to pool evidence from studies testing if pentagalloyl glucose (PGG) limited aortic expansion in animal models of abdominal aortic...
BACKGROUND
The aim of this systematic review was to pool evidence from studies testing if pentagalloyl glucose (PGG) limited aortic expansion in animal models of abdominal aortic aneurysm (AAA).
METHODS
The review was conducted according to the PRISMA guidelines and registered with PROSPERO. The primary outcome was aortic expansion assessed by direct measurement. Secondary outcomes included aortic expansion measured by ultrasound and aortic diameter at study completion. Sub analyses examined the effect of PGG delivery in specific forms (nanoparticles, periadventitial or intraluminal), and at different times (from the start of AAA induction or when AAA was established), and tested in different animals (pigs, rats and mice) and AAA models (calcium chloride, periadventitial, intraluminal elastase or angiotensin II). Meta-analyses were performed using Mantel-Haenszel's methods with random effect models and reported as mean difference (MD) and 95% confidence intervals (CIs). Risk of bias was assessed with a customized tool.
RESULTS
Eleven studies reported in eight publications involving 214 animals were included. PGG significantly reduced aortic expansion measured by direct observation (MD: -66.35%; 95% CI: -108.44, -24.27; = 0.002) but not ultrasound (MD: -32.91%; 95% CI: -75.16, 9.33; = 0.127). PGG delivered intravenously within nanoparticles significantly reduced aortic expansion, measured by both direct observation (MD: -116.41%; 95% CI: -132.20, -100.62; < 0.001) and ultrasound (MD: -98.40%; 95% CI: -113.99, -82.81; < 0.001). In studies measuring aortic expansion by direct observation, PGG administered topically to the adventitia of the aorta (MD: -28.41%; 95% CI -46.57, -10.25; = 0.002), studied in rats (MD: -56.61%; 95% CI: -101.76, -11.46; = 0.014), within the calcium chloride model (MD: -56.61%; 95% CI: -101.76, -11.46; = 0.014) and tested in established AAAs (MD: -90.36; 95% CI: -135.82, -44.89; < 0.001), significantly reduced aortic expansion. The findings of other analyses were not significant. The risk of bias of all studies was high.
CONCLUSION
There is inconsistent low-quality evidence that PGG inhibits aortic expansion in animal models.
PubMed: 34680560
DOI: 10.3390/biomedicines9101442 -
Respiratory Care May 2014There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be... (Review)
Review
INTRODUCTION
There is a need to develop simple, noninvasive, and sensitive outcome measures for respiratory therapy. Adventitious respiratory sounds (ie, crackles and wheezes) can be objectively characterized with computerized respiratory sound analysis (CORSA) and have been shown to contribute for diagnosis purposes; however, their potential for use as outcome measures is unknown. Thus, this systematic review synthesizes the evidence on the use of computerized adventitious respiratory sounds as outcome measures.
METHODS
The Web of Knowledge, MEDLINE, EMBASE, and SCOPUS databases were searched. Reviewers independently selected studies according to the eligibility criteria. Effect sizes and 95% CIs were computed.
RESULTS
Twelve studies with different designs (observational, n = 3; quasi-experimental n = 7; and randomized controlled trial, n = 2) were included. Eight studies were conducted with adults, and 4 studies with children. Most studies explored only one type of adventitious respiratory sound. For wheezes, the occupation rate seemed to be the most promising parameter to be used as an outcome measure, with high/medium effect sizes (0.62-1.82). For crackles, the largest deflection width showed high effect sizes (1.31 and 1.04); however, this was explored in only one study. Crackle number and 2-cycle duration presented conflicting information, with high/poor effect sizes depending on the study.
CONCLUSIONS
Specific variables of each adventitious respiratory sound detected and characterized by CORSA showed high effect sizes and, thus, the potential to be used as outcome measures. Further research with robust study designs and larger samples (both of children and adult populations), and following CORSA guidelines is needed to build evidence-based knowledge on this topic.
Topics: Adventitia; Humans; Observational Studies as Topic; Randomized Controlled Trials as Topic; Respiratory Sounds; Respiratory Therapy; Respiratory Tract Diseases; Signal Processing, Computer-Assisted; Sound Spectrography; Treatment Outcome
PubMed: 24046460
DOI: 10.4187/respcare.02765 -
Journal of Vascular Surgery Jun 2021Restenosis after carotid endarterectomy (CEA) limits its long-term efficacy for stroke prevention. Thus, it is of utmost importance to identify the factors that...
OBJECTIVE
Restenosis after carotid endarterectomy (CEA) limits its long-term efficacy for stroke prevention. Thus, it is of utmost importance to identify the factors that predispose a patient to restenosis after CEA. This systemic review aims to survey the current literature regarding restenosis after CEA and discuss the predictive value of carotid plaque features.
METHODS
A systemic review of studies on the predictive value of carotid plaque features for restenosis after CEA was conducted according to the PRISMA guidelines. PubMed/MEDLINE and Embase databases were searched up to March 20, 2020. Two authors independently extracted the data and assessed the risk of bias with the Quality in Prognosis Studies tool. Given the heterogeneity in the measurement of prognostic factors, types of CEA, and clinical outcomes, a qualitative synthesis was performed.
RESULTS
Twenty-one articles with a sample size that ranged from 11 to 1203 were included in this systematic review. Based on the presence of calcification in original carotid plaques, two progression patterns of restenosis were hypothesized: patients with calcified plaques may experience a temporary increase in the intima-media thickness (IMT) followed by a decrease in IMT after CEA, whereas patients with noncalcified plaques may experience a gradual increase in IMT after CEA. Accordingly, patients with a high calcium score may have a high restenosis rate within 6 months after CEA and a low restenosis rate thereafter. Thus, the late restenosis rate in patients with uniformly echogenic plaques was lower than that in patients with uniformly echolucent plaques. Pathologically, a lipid-rich, inflammatory carotid plaque is associated with a decreased risk of restenosis within 1 year after CEA, mainly owing to the relatively mild reactive intimal hyperplasia at the surgical site and active inflammation in the remaining media and adventitia. Molecular predictors for restenosis included a Mannose-binding lectin 2 genotype, preoperative C-reactive protein, serum homocysteine, apolipoprotein J, vitamin C, and telomere length of carotid plaques.
CONCLUSIONS
This review demonstrated that carotid plaque features, including imaging features, cellular composition, and molecular features, are correlated with the risk of restenosis after CEA. A comprehensive evaluation of plaque characteristics may help to stratify the risk of restenosis after CEA.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Neointima; Plaque, Atherosclerotic; Recurrence; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Calcification
PubMed: 33253876
DOI: 10.1016/j.jvs.2020.10.084 -
Frontiers in Cardiovascular Medicine 2021Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in...
Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5-3.9‰. Hazard Ratio for aortic insufficiency was 1.8-2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22-1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic "subaortic bump." Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.
PubMed: 34631824
DOI: 10.3389/fcvm.2021.719523 -
Romanian Journal of Morphology and... 2019Primary ovarian hydatid disease (HD) is a rare entity, produced by the larval stage of Echinococcus granulosus. HD commonly involves liver, lung, abdomen cavity, spleen...
Primary ovarian hydatid disease (HD) is a rare entity, produced by the larval stage of Echinococcus granulosus. HD commonly involves liver, lung, abdomen cavity, spleen and is unusually identified in pelvic organs. Based on our knowledge, the paper reviews 27 literature reports of ovarian HD, diagnosed during the last 20 years, providing a valuable database. Patients' ages ranged between 12-76 years, the gross appearance was that of 40-330 mm diameter hydatid cysts (HCs), 66.66% of them being primary. According to these reports, ovarian HD has non-specific clinical manifestations, such as abdominal or pelvic pain, nausea, dysmenorrhea or amenorrhea. The diagnosis may be achieved by abdominal ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), serological exams, such as eosinophilia (in 10-30% of patients) or indirect hemagglutination and immunoglobulin (IgG) antibodies detection. Ovarian HC microscopic pattern is characterized by three layers: pericyst or adventitia (host origin), germinal layer (endocyst), and laminated membrane (ectocyst). The immunoreaction triggered by parasites is initially rich in macrophages and neutrophils, followed by eosinophils and lymphocytes, with numerous cluster of differentiation 8 (CD8)-positive T-cells in active lesions and progressive forms. Concomitant ovarian diseases are relatively rare, being represented by borderline tumors (n=2 cases), mucinous cystadenoma (n=1 case), hemorrhagic cyst (n=1 case), and serous adenocarcinoma (n=1 case). In conclusion, the ovarian location of HD should be considered in any differential diagnosis of a cystic lesion, while it does not exclude synchronous ovarian tumors. These cases reinforce the necessity of better measures of prophylaxis and screening of HD in endemic areas.
Topics: Adolescent; Adult; Aged; Child; Echinococcosis; Female; Humans; Immunohistochemistry; Middle Aged; Ovarian Cysts; Young Adult
PubMed: 31912083
DOI: No ID Found