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Reconstruction 3D des artères par imagerie intravasculaire ultrasonore (IVUS) et angiographie monoplanJourdain, Mélissa January 2009 (has links)
Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.
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Intravaskuläre Ultraschalluntersuchung bei Diagnostik und interventioneller Therapie von Herzkranzgefäßerkrankungen am Beispiel der TransplantatvaskulopathieBocksch, Wolfgang 23 April 2002 (has links)
Es wurde die Bedeutung der intravaskulären Ultraschalluntersuchung (IVUS) bei Diagnostik (1) und interventioneller Therapie (2) der koronaren Herzerkrankung am Beispiel der Transplantatvaskulopathie (TVP) untersucht. 1. Bei 321 Patienten post-HTx-Patienten ohne relevante Stenosen im Koronarangiogramm wurde eine dreidimensionale Rekonstruktion des Ramus interventricularis anterior (LAD) und des linkskoronaren Hauptstammes aus den mittles manueller Katheterrückzugstechnik aquirierten IVUS-Bildern durchgeführt und die intrakoronare Plaqueverteilung und die mittlere Plaquelast der einzelnen Koronarsegmente analysiert. Bei 296 Patienten (92%) fanden angiographisch nicht sichtbare frühe Plaquebildung. 48% dieser Patienten zeigten ein fokal,polyfokale, 52% ein diffuses Plaqueverteilungsmuster. Unabhängige Prädiktoren für das Auftreten einer diffusen TVP waren männliches Geschlecht des Empfängers, das Zeitintervall zwischen HTx und IVUS-Untersuchung (Transplantationszeit) und das Spenderalter. In beiden morphologischen Untergruppen war ein häufigere und stärkere Plaquebildung in den proximalen Koronarsegmenten nachweisbar. Ein distaler Gefäßbefall war bei diffuser Plaquebildung signifikant häufiger und zeigte eine steigende Inzidenz mit zunehmender Transplantationszeit. Somit stellt das longitudinale Plaqueverteilungsmuster und der distale Gefäßbefall einen zusätzlichen morphologischen Marker für den Schweregrad einer beginnenden Transplantatvaskulopathie dar. 2. Bei 36 post-HTx Patienten wurden 62 Stenosen prospektiv mit einer IVUS-gesteuerten, gefäßgrößen-adaptierten Stentimplantation erfolgreich versorgt. Die Stentgröße wurde dem Mittelwert aus Lumen- und Gefäßdurchmessers im proximalen Referenzsegment angepaßt. Nach Vordilatation fand sich ein Lumengewinn von 1.26± 0.16 auf 1.95 ± 0.27mm, nach abschließender Stentimplantation auf 2.94 ± 0.37mm. Nach 6 Monaten betrug die binäre In-Stent-Restenosierungsrate 21.8%, eine Re-PTCA wurde bei 10.9 % durchgeführt. / The role of intravascular ultrasound imaging in diagnosis of coronary disease (1) and guiding percutaneous coronary intervention (2) was evaluated in patients with transplant vasculopathy. 1. In 321 post-HTx-patients without angiographic evidence of coronary disease, three-dimensional intravascular ultrasound imaging of the left anterior descending coronary artery (LAD) and the left main coronary artery was performed. Intracoronary plaque distribution and plaque burden was evaluated for each coronary segment. In 296 patients (92%) angiographically silent plaque was detected by IVUS. 48% of these patients showed a focal,polyfocal and 52% a diffuse plaque distribution pattern. Independent predictors of diffuse plaque formation were male gender of the recipient, transplantation time and donor age. In both morphological subgroups of plaque distribution the incidence and magnitude of plaque formation was highest in the proximal LAD segment. Plaque formation in the distal LAD was more frequent in diffuse plaque formation and increased significantly with time after transplantation. Therefore longitudinal plaque distribution pattern and distal vessel involvment are useful additional morphological markers for staging of beginning transplant vasculopathy. 2. In 36 post-HTx-patients 62 coronary stenosis were successfully treated by vessel-size adapted stenting by use of intravascular ultrasound guidance. The stent size was adapted to the proximal reference segment´s mean of lumen/vessel diameter. After pre-dilatataion the minimal lumen diameter increased from 1.26± 0.16 to 1.95 ± 0.27mm and to 2.94 ± 0.37mm after final stent implantation. After 6 months, binary in-stent-restenosis rate was 21.8% and target vessel revascularization rate 10.9%, respectively.
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Reconstruction 3D des artères par imagerie intravasculaire ultrasonore (IVUS) et angiographie monoplanJourdain, Mélissa January 2009 (has links)
Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal
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Microparticules membranaires au cours des états septiques graves : aspects cellulaires, physiopathologiques et cliniques / Menbrane microparticles during severe septic challenge : cellular, pathophysiological and clinical aspectsDelabranche, Xavier 12 July 2013 (has links)
Ce travail porte sur le rôle des microparticules procoagulantes (MPs) générées par les cellules vasculaires en réponse à un état septique. Après une introduction rappelant la structure et les propriétés des microparticules et la réponse del’hôte à un agent pathogène, en particulier en terme d’activation de la coagulation, nous rapportons nos travauxexpérimentaux et cliniques. Le premier travail a été réalisé sur un modèle cellulaire de vésiculation induite par le LPS. Il nous a permis de caractériser le transfert du complexe CD14/TLR4 à différents types cellulaires in-vitro dépourvus du récepteur au LPS. Ainsi, les MPs monocytaires pourraient avoir un rôle d’amplification de la réponse inflammatoire mais aussi dans la réponse anti-inflammatoire secondaire en participant à l’apoptose lymphocytaire. Le second travail aété réalisé chez l’animal. Après induction d’un choc septique, nous avons observé une amélioration hémodynamique enréponse à la perfusion de protéine C activée associée à une modulation du phénotype des MPs. Réinjectées à des ratsnaïfs, les MPs issues des rats septiques traités par protéine C activée développaient une moindre vasoplégie. Enfin, nous avons réalisé une étude prospective sur 100 patients en choc septique. Nous avons ainsi pu caractériser la présence d’une concentration élevée de microparticules procoagulantes, avec une variation phénotypique en présence de coagulation intravasculaire disséminée (CIVD) : réduction du contingent plaquettaire au profit des MPs d’origine leucocytaires qui deviennent prépondérantes et témoignent d’une activation leucocytaire accrue, et surtout une activation des cellules endothéliales avec génération de MPs porteuses d’endogline (CD105). En analyse multivariée,CD105+-MPs étaient fortement associée à la CIVD et pourraient constituer un marqueur précoce de l’atteinte endothéliale au cours du choc septique. / This work focused on procoagulant microparticles shed after vascular cells stress during sepsis. The first part gives an overview on MPs and host response during pathogen challenge. The first lab experimental work confirms direct and functional transfer of CD14/TLR4 LPS sensor by MPs shed to target cells after monocytic THP-1 challenge by LPS.CD14-MPs amplify LPS-induced apoptosis in monocytes but also prompted lymphocyte apoptosis and could play a role in secondary anti-inflammatory response. Then, septic shock was induced in rats after caecal ligature and puncture.Activated protein C (APC) infusion improved haemodynamic parameters and alter septic microparticular content. Infused in naïve rats, APC-treated MPs were associated with reduced hypotension and inflammatory response, confirming cytoprotective effect of both APC and APC-induced MPs. Finally, we performed a clinical prospective study in 3 medical ICU in France. Patients referred for septic shock had an increased level of circulating procoagulant MPs regardless disseminated intravascular coagulopathy (DIC) diagnosis. Nevertheless, DIC patients evidenced a specific pattern with lower platelet-MPs, increased leucocyte-MPs and specific endothelial cells activation with endoglin (CD105) shedding. In multiple logistic regression analysis, CD105-MPs were strongly associated with DIC and were evidenced before DIC diagnosis according to routine laboratory assays.
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Les microparticules dans le choc septique, marqueurs pathogènes et cibles thérapeutiques potentielles / Microparticles in septic shock, pathogenic biomarkers and potential therapeutic targetsHelms, Julie 30 June 2014 (has links)
Le choc septique est caractérisé par une intense activation cellulaire marquée par une génération excessive de microparticules (MPs), libérées dans l’espace extracellulaire suite à un remaniement de la membrane plasmique. Les MPs participeraient à la dysfonction cardiovasculaire et à la coagulopathie du choc septique. Nous avons exploré l’intérêt des MPs circulantes comme marqueurs pathogènes, en étudiant l’effet d’acides gras exogènes sur le remodelage de la membrane plasmique et la genèse des MPs, in-vitro dans un modèle de cellules en culture stimulées par une endotoxine et in vivo chez le rat septique. Nous avons ensuite caractérisé l’activation cellulaire du choc septique chez l’homme, en utilisant les MPs circulantes comme témoins de la dysfonction du compartiment vasculaire, puis montré la place des MPs comme cibles thérapeutiques potentielles au cours du choc septique, par leur modulation pharmacologique dans un modèle de choc septique chez le rat.Nous montrons ainsi l’intérêt des MPs comme un nouvel outil dans l’exploration de nouvelles pistes physiopathologiques du choc septique et comme cibles pharmacologiquement modulables à des fins éventuellement thérapeutiques. / Septic shock is characterized by an intense cell activation marked by an excessive generation of microparticles (MPs), released into the extracellular space after plasma membrane remodeling. MPs take part in cardiovascular dysfunction and coagulopathy of septic shock. We investigated the role of circulating MPs as pathogenic markers, by studying the effects of exogenous fatty acids on plasma membrane remodeling and MP generation, in vitro with cultured cells stimulated by an endotoxin and and in vivo in septic rats. We have then characterized the cellular activation of septic shock in humans, using circulating MPs as evidence of vascular dysfunction and shown the place of MPs as potential therapeutic targets, through their pharmacological modulation in a rat model of septic shock.We have therefore shown the interest of MPs as a new tool to explore septic shock pathophysiology and as therapeutic targets than can be pharmacologically modulated.
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Ošetřovatelská péče o cévní vstupy se zaměřením na prevenci katetrových sepsí / Nursing care of vascular access focused to prevention of catheter sepsisProšková, Michaela January 2021 (has links)
Ensuring the bloodstream is one of the most frequently indicated invasive procedures, especially in the pre-hospital emergency and intensive care. All invasive inputs are nowadays an integral part of intensive care. Despite careful daily care, vascular accesses are at risk of complications, which annually effects many patients institutionalized at intensive care units. Catheter sepsis is undoubtedly one of the most serious. Although a significant proportion of these infections are considered highly preventable, they still contribute to high morbidity and mortality among these patients. The aim of this diploma thesis is to analyse nursing care for vascular inputs. One of the partial goals is to evaluate and compare the relevance of the nursing standard of a medical facility with scientific knowledge and current recommendations of professional societies. The research method is a quantitative questionnaire survey focused on nursing staff working in the Department of Anesthesiology and Reanimation. The analysis of the vascular inputs re-dressings was performed in patients hospitalized in the same ward, where the research itself took place. The results of the research survey show a discrepancy between the given procedure in the nursing standard and common practice in the ward. In view of the...
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Case Report: ANXA2 Associated Life-Threatening Coagulopathy With Hyperfibrinolysis in a Patient With Non-APL Acute Myeloid LeukemiaRuhnke, Leo, Stölzel, Friedrich, Wagenführ, Lisa, Altmann, Heidi, Platzbecker, Uwe, Herold, Sylvia, Rump, Andreas, Schröck, Evelin, Bornhäuser, Martin, Schetelig, Johannes, von Bonin, Malte 28 March 2023 (has links)
Patients with acute promyelocytic leukemia (APL) often present with potentially lifethreatening
hemorrhagic diathesis. The underlying pathomechanisms of APLassociated
coagulopathy are complex. However, two pathways considered to be APLspecific
had been identified: 1) annexin A2 (ANXA2)-associated hyperfibrinolysis and 2)
podoplanin (PDPN)-mediated platelet activation and aggregation. In contrast, since
disseminated intravascular coagulation (DIC) is far less frequent in patients with non-
APL acute myeloid leukemia (AML), the pathophysiology of AML-associated hemorrhagic
disorders is not well understood. Furthermore, the potential threat of coagulopathy in non-
APL AML patients may be underestimated. Herein, we report a patient with non-APL AML
presenting with severe coagulopathy with hyperfibrinolysis. Since his clinical course
resembled a prototypical APL-associated hemorrhagic disorder, we hypothesized
pathophysiological similarities. Performing multiparametric flow cytometry (MFC) and
immunofluorescence imaging (IF) studies, we found the patient’s bone-marrow
mononuclear cells (BM-MNC) to express ANXA2 - a biomarker previously thought to be
APL-specific. In addition, whole-exome sequencing (WES) on sorted BM-MNC (leukemiaassociated
immunophenotype (LAIP)1: ANXAlo, LAIP2: ANXAhi) demonstrated high intratumor
heterogeneity. Since ANXA2 regulation is not well understood, further research to
determine the coagulopathy-initiating events in AML and APL is indicated. Moreover,
ANXA2 and PDPN MFC assessment as a tool to determine the risk of life-threatening DIC
in AML and APL patients should be evaluated.
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AUTOMATED MACHINE LEARNING BASED ANALYSIS OF INTRAVASCULAR OPTICAL COHERENCE TOMOGRAPHY IMAGESShalev, Ronny Y. 31 May 2016 (has links)
No description available.
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Análises morfológica e dinâmica da coronária baseadas no processamento tridimensional de exames de ultrassonografia intravascular / Morphological and dynamic analysis of the coronary based on tridimensional image processing of intravascular ultrasound examinationMatsumoto, Monica Mitiko Soares 05 November 2010 (has links)
Na prática intervencionista, a ultrassonografia intravascular (USIV) é usada para se obter informações quantitativas e qualitativas do acometimento aterosclerótico, de forma complementar à angiografia. Esta tese teve como objetivos explorar a característica tomográfica do exame de USIV, bem como sua dinâmica dentro do ciclo cardíaco. Para isso, desenvolvemos técnicas de processamento de imagens médicas. Primeiramente, investigamos a reconstrução tridimensional da coronária baseando-nos apenas nas imagens de USIV, ou seja, sem a angiografia, como é feita a reconstrução atualmente. Na análise da dinâmica, fizemos um estudo para dispor volumes da coronária em diferentes fases do ciclo cardíaco de forma que estivessem alinhados espacialmente. Como consequência dos tratamentos propostos anteriormente, realizamos estudos sobre a quantificação de propriedades mecânicas dentro das condições oferecidas no intervalo de um ciclo cardíaco. As metodologias propostas foram aplicadas em simulações numéricas desenvolvidas neste trabalho e em exames reais. Obtivemos resultados compatíveis com os objetivos iniciais para reconstrução tridimensional da USIV em simulações numéricas. Na análise da dinâmica, a reconstrução de volumes em diferentes fases do ciclo e o alinhamento espacial possibilitaram a quantificação da variação setorial de volume da luz do vaso durante o ciclo cardíaco / In percutaneous coronary interventions, intravascular ultrasound (IVUS) examination is used to retrieve quantitative and qualitative information about the atherosclerotic plaque progression, complementary to angiography examination. This thesis has as objectives to explore the tomographic characteristic of the IVUS examination, as well as its dynamics within a cardiac cycle. For that purpose, medical image processing techniques were developed. Firstly, we have investigated how to reconstruct the tridimensional coronary based only on IVUS images, that is, without angiography, as it is done nowadays. Regarding dynamic analysis, we have studied models to build volumes of the coronary in distinct phases of the cardiac cycle in a spatial aligned way. Conversantly, as a consequence of the previous image processing methods, we have studied the quantification of mechanical properties of the vessel wall within a cardiac cycle. The methodologies proposed were applied in numeric phantoms developed in this work and also in real IVUS examinations. As result, tridimensional reconstruction was successful in the numeric phantom approach. In dynamics analysis, the reconstruction in distinct cardiac phases and volumes spatial alignment enabled the quantification of lumen volume variation during the cardiac cycle
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Validação de índices angiográficos e da angiotomografia computadorizada utilizando o ultrasson intravascular como padrão-ouro para quantificar a extensão da doença aterosclerótica coronariana / Validation of scoring systems derived from coronary conventional invasive and computed tomography angiography, using intravascular ultrasound as gold-standard, to estimate atherosclerotic disease extensionSilva, Rafael Cavalcante e 19 March 2015 (has links)
Introdução: A extensão da doença arterial coronariana (DAC) é um dos mais fortes preditores de eventos cardiovasculares adversos. Estratégias capazes de quantificar acuradamente a gravidade da doença coronária podem implicar em melhora na avalição prognóstica, na orientação terapêutica e na avaliação da progressão da doença. O ultrassom intracoronário (USIC) tornou-se o método padrão-ouro para quantificação da aterosclerose devido à sua habilidade em avaliar diretamente as placas ateroscleróticas. A angiotomografia coronária tem surgido como uma útil alternativa não invasiva ao USIC para avaliação de pacientes com DAC. Entretanto, pouco se sabe a respeito da sua habilidade em estimar, de modo acurado, a carga aterosclerótica coronariana global. Objetivo: Comparar diversos escores angiotomográficos que avaliam a extensão da DAC utilizando o USIC multivascular como padrão-ouro. Métodos: Pacientes com doença coronariana diagnosticada, em programação para intervenção percutânea foram incluídos prospectivamente. Pelo menos uma de três características de alto risco era necessária para inclusão: doença multiarterial, diabetes melitus e/ou síndrome coronária aguda à admissão. Todos os pacientes foram submetidos a ultrassom intracoronário multivascular e angiotomografia coronária. Escore de cálcio e cinco outros escores previamente descritos foram calculados com base na imagem da angiotomografia coronária e comparados com o volume percentual de ateroma (VPA) médio derivado do USIC. Um novo escore angiotomográfico foi criado e também comparado ao USIC. Resultados: Um total de 62 pacientes foram incluídos. Todos com exceção de um escore apresentaram baixa a moderada correlação, estatisticamente significante, com o VPA derivado do USIC. O novo escore angiotomográfico criado demonstrou a mais forte correlação com o VPA ao USIC (ρ=0,73, p < 0,001) e a maior área sob a curva ROC (estatística-C = 0,90) para predizer um VPA médio dicotomizado alto. Conclusões: Enquanto escores angiotomográficos foram capazes de estimar a carga aterosclerótica coronária global, um recém criado escore pode ser uma ferramenta útil para a quantificação da extensão da DAC em pacientes de alto risco. / Background: The extent of coronary artery disease (CAD) is one the most powerful predictors of cardiovascular outcomes. Strategies that accurately quantify coronary artery disease severity are expected to improve prognosis assessment, treatment guidance and evaluation of disease progression. Intravascular ultrasound (IVUS) has become the gold-standard method to quantify atherosclerosis due to its ability to directly analyze atherosclerotic plaques. Coronary computed tomography angiography (CTA) has emerged as a useful non-invasive alternative to IVUS for assessing patients with CAD. Nevertheless, little is known about its ability to accurately estimate global atherosclerotic burden. Objective: To compare several coronary CTA scoring systems assessing CAD extent with gold-standard multivessel intravascular ultrasound. Methods: Patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 5 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). A novel coronary CTA score was constructed and also compared to IVUS. Results: A total of 62 patients were included. All but one previously described scoring system showed a significant low-to-moderate association with IVUS-derived PAV. The newly developed \"soft plaque\" coronary CTA score demonstrated the strongest correlation with IVUS-PAV (ρ=0.73, p<0.001) and the greatest area under the ROC curve (C-statistic = 0.90) to predict a high dichotomized PAV. Conclusions: While coronary CTA scores were able to assess total atherosclerotic burden in patients with coronary disease, a newly described CTA scoring system may be a promising non-invasive tool to quantify disease extent in high-risk patients with known CAD.
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