As lesões no pé diabético é uma das complicações mais devastadoras do Diabetes Mellitus, devido a altas taxas de morbi-mortalidade e que provocam seqüelas de incapacidade causando amputações de membros inferiores. O objetivo deste estudo foi identificar os fatores de risco em trabalhadores portadores dessa doença, quanto aos aspectos sócio-demográficos, clínicos e o grau de risco para o desenvolvimento de lesões. Os dados foram coletados com 117 trabalhadores, de um ambulatório que pertence a uma Instituição Pública de Londrina-PR, por meio de um roteiro semiestruturado. Os resultados demonstraram predomínio de que 53% dos trabalhadores com idade de 51 a 60 anos, do sexo masculino (52,1%), casados (71,8%), os quais, em grande parte, trabalham em serviços gerais (36,8%) e com mais de 21 anos de tempo de serviço (32,5%). Quanto aos dados clínicos, o tempo de diagnóstico de 2 a 5 anos (45,3%), a maioria dos trabalhadores são diabéticos tipo 2 (98,3%) e fazem uso de antidiabéticos oral (57,3%), 55,6% são hipertensos. Entre as complicações, 40.8% tiveram acuidade visual diminuída, a grande maioria não fumam (79,5%) e não bebem (85,5%). Quanto ao índice de massa corporal (52,1%) tinham sobrepeso. No exame clínico dos pés os trabalhadores apresentaram boas condições de higiene (80,3%), faziam uso de calçados adequados (75,2%). A maioria dos trabalhadores não apresentaram comprometimentos graves relacionados a doença vascular periférica com presença de pulsação pedioso (88,5%), tibial posterior (74,1%) e apresentaram boa perfusão periférica (88,9%). Quanto à neuropatia diabética, a maioria apresentou reflexos positivos para aquileu (93,2%) e patelar (93,2%), e para sensibilidade vibratória (93,2%), protetora (100%), térmica (87,2%), dolorosa (87,2%) e tátil positiva (98,9%). A presença de úlcera se fizeram presentes em 4,27% dos trabalhadores sendo que 3,41% sofreram amputações a nível falangiano. Quanto ao grau de risco encontram-se 71,8% em grau 0. Evidenciou-se a necessidade de implementar ações educativas para orientar e sistematizar medidas de prevenção, controle das condições de saúde dos trabalhadores portadores de diabetes mellitus. / The diabetic foot is one of Diabetes Mellitus's complications (DM), due to high morbimortality taxes and that you/they provoke sequels of incapacity causing amputations of inferior members. He/she has for objective to identify the risk factors in workers bearers of DM, as for the aspects partner-demographic, clinical and the risk degree for the development of lesions. The data were collected 117 workers close to, of a Public Institution of the city of Londrina-PR, through a pré-established itinerary. They reveal senior workers' prevalence (53%), male (52,1%), married (71,8%), the ones which, largely, they work in general services (36,8%) and he/she has more than 21 years of time of service (32,5%). As for the clinical data, his/her time of diagnosis has from 2 to 5 years (45,3%), most is diabetic type 2 (98,3%) and they make use of antidiabetic oral (57,3%), 55,6% are hipertensos. Among the current complications of the referred diabetes, 40.8% were affected in the visual sharpness, the great majority doesn't smoke (79,5%) and they don't drink (85,5%). As for the index of corporal mass (52,1%) they are overweight. In the clinical exam of the feet the workers are in good hygiene conditions (80,3%), they make use of appropriate shoes (75,2%). They still don't present related serious compromisings the outlying vascular disease with presence of pulsation pedioso (88,5%), subsequent tibial (74,1%) and good outlying perfusion (88,9%). As for the diabetic neuropatia, most presents positive reflexes for aquileu (93,2%) and patelar (93,2%), and for vibratory sensibility (93,2%), protecting (100%), thermal (87,2%), painful (87,2%) and tactile positive (98,9%). The ulcer presence was made presents in 4,27% of the workers and they already submitted 3,41% to amputations in phalangeal level. As for the risk degree they are 71,8% in degree 0.Estes results confirmed the present need to implement educational actions to guide and to systematize prevention measures, control and the diabetic workers' vinculação and for a favorable condition in the working environment.

Background: Diabetes mellitus and vascular diseases have a significant impact on the eye. / Aim: To determine the prevalence, risk factors, and racial/ethnic differences of major eye conditions, particularly retinal conditions, associated with diabetes and vascular diseases. / Scope: To date, the majority of studies have examined the association of retinal vascular calibre and diabetes in predominantly white Caucasian populations. Further elucidation of ethnic differences in effects of hyperglycaemia on early microvascular disease is relevant, particularly amongst Asians where diabetes is likely to see the largest increase in prevalence over the next decade. We therefore examined these findings from three Asian population-based studies, the Singapore Malay Eye Study (n=3280), Singapore Prospective Cohort Study and Singapore Cardiovascular Cohort Study 2 (n=3748). / Results: The prevalence of diabetic retinopathy in the Singapore Malay Eye Study was 35%, and associated with longer duration of diabetes, poorer glycemic and blood pressure control. More importantly, 9.0% had vision-threatening retinopathy, and retinopathy was found in 6.0% of people without diabetes. Retinal vascular calibre changes were incriminated in diseases such as diabetes and hypertension, independent of traditional cardiovascular risk factors. Wider venular calibre was independently associated with early age-related macular degeneration. We also found a novel association between peripheral artery disease and glaucoma, stronger in persons with diabetes, independent of vascular risk factors, supporting the vascular theory of glaucoma. / Implications: Subtle changes in retina, including retinal vascular calibre may be early markers of widespread microvascular changes in diabetes, resulting from chronic hyperglycaemia and other pathogenic processes. These results will have broad implications for understanding the impact of both microvascular and macrovascular complications of diabetes in the Asia Pacific region and targeting relevant therapeutic interventions.

No description available.

As lesões no pé diabético é uma das complicações mais devastadoras do Diabetes Mellitus, devido a altas taxas de morbi-mortalidade e que provocam seqüelas de incapacidade causando amputações de membros inferiores. O objetivo deste estudo foi identificar os fatores de risco em trabalhadores portadores dessa doença, quanto aos aspectos sócio-demográficos, clínicos e o grau de risco para o desenvolvimento de lesões. Os dados foram coletados com 117 trabalhadores, de um ambulatório que pertence a uma Instituição Pública de Londrina-PR, por meio de um roteiro semiestruturado. Os resultados demonstraram predomínio de que 53% dos trabalhadores com idade de 51 a 60 anos, do sexo masculino (52,1%), casados (71,8%), os quais, em grande parte, trabalham em serviços gerais (36,8%) e com mais de 21 anos de tempo de serviço (32,5%). Quanto aos dados clínicos, o tempo de diagnóstico de 2 a 5 anos (45,3%), a maioria dos trabalhadores são diabéticos tipo 2 (98,3%) e fazem uso de antidiabéticos oral (57,3%), 55,6% são hipertensos. Entre as complicações, 40.8% tiveram acuidade visual diminuída, a grande maioria não fumam (79,5%) e não bebem (85,5%). Quanto ao índice de massa corporal (52,1%) tinham sobrepeso. No exame clínico dos pés os trabalhadores apresentaram boas condições de higiene (80,3%), faziam uso de calçados adequados (75,2%). A maioria dos trabalhadores não apresentaram comprometimentos graves relacionados a doença vascular periférica com presença de pulsação pedioso (88,5%), tibial posterior (74,1%) e apresentaram boa perfusão periférica (88,9%). Quanto à neuropatia diabética, a maioria apresentou reflexos positivos para aquileu (93,2%) e patelar (93,2%), e para sensibilidade vibratória (93,2%), protetora (100%), térmica (87,2%), dolorosa (87,2%) e tátil positiva (98,9%). A presença de úlcera se fizeram presentes em 4,27% dos trabalhadores sendo que 3,41% sofreram amputações a nível falangiano. Quanto ao grau de risco encontram-se 71,8% em grau 0. Evidenciou-se a necessidade de implementar ações educativas para orientar e sistematizar medidas de prevenção, controle das condições de saúde dos trabalhadores portadores de diabetes mellitus. / The diabetic foot is one of Diabetes Mellitus's complications (DM), due to high morbimortality taxes and that you/they provoke sequels of incapacity causing amputations of inferior members. He/she has for objective to identify the risk factors in workers bearers of DM, as for the aspects partner-demographic, clinical and the risk degree for the development of lesions. The data were collected 117 workers close to, of a Public Institution of the city of Londrina-PR, through a pré-established itinerary. They reveal senior workers' prevalence (53%), male (52,1%), married (71,8%), the ones which, largely, they work in general services (36,8%) and he/she has more than 21 years of time of service (32,5%). As for the clinical data, his/her time of diagnosis has from 2 to 5 years (45,3%), most is diabetic type 2 (98,3%) and they make use of antidiabetic oral (57,3%), 55,6% are hipertensos. Among the current complications of the referred diabetes, 40.8% were affected in the visual sharpness, the great majority doesn't smoke (79,5%) and they don't drink (85,5%). As for the index of corporal mass (52,1%) they are overweight. In the clinical exam of the feet the workers are in good hygiene conditions (80,3%), they make use of appropriate shoes (75,2%). They still don't present related serious compromisings the outlying vascular disease with presence of pulsation pedioso (88,5%), subsequent tibial (74,1%) and good outlying perfusion (88,9%). As for the diabetic neuropatia, most presents positive reflexes for aquileu (93,2%) and patelar (93,2%), and for vibratory sensibility (93,2%), protecting (100%), thermal (87,2%), painful (87,2%) and tactile positive (98,9%). The ulcer presence was made presents in 4,27% of the workers and they already submitted 3,41% to amputations in phalangeal level. As for the risk degree they are 71,8% in degree 0.Estes results confirmed the present need to implement educational actions to guide and to systematize prevention measures, control and the diabetic workers' vinculação and for a favorable condition in the working environment.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-18T12:31:58Z No. of bitstreams: 1 wanderbarrosdocarmo.pdf: 2180793 bytes, checksum: 01a70125998e9e171b91382cc7f06995 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-25T12:07:58Z (GMT) No. of bitstreams: 1 wanderbarrosdocarmo.pdf: 2180793 bytes, checksum: 01a70125998e9e171b91382cc7f06995 (MD5) / Made available in DSpace on 2016-10-25T12:07:58Z (GMT). No. of bitstreams: 1 wanderbarrosdocarmo.pdf: 2180793 bytes, checksum: 01a70125998e9e171b91382cc7f06995 (MD5) Previous issue date: 2007-10-01 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A prevalência das doenças cardiovasculares em pacientes com doença renal crônica (DRC) é elevada, e a taxa de mortalidade por estas patologias pode ser até 10 vezes maior neste grupo quando comparada à população geral, fato este mais evidente quando a FG atinge níveis inferiores a 60 ml/min. Esta alta prevalência pode ser justificada pela associação dos fatores de risco ditos tradicionais (comuns em toda a população) com os fatores não-tradicionais (comuns em pacientes com DRC). A doença arterial obstrutiva de membros inferiores (DAOMI), está relacionada ao mau prognóstico tanto em pacientes em terapia dialítica, transplantados ou em tratamento conservador. Além disso, o seu diagnóstico precoce encontra-se associado ao acometimento de outros leitos vasculares, como coronariano e carotídeo. Em função destas observações, optamos por estudar a prevalência da DAOMI em uma população de pacientes com DRC não dialisados, utilizando o índice tornozelo braquial (ITB) e a claudicação intermitente (CI) como métodos diagnósticos, e também, avaliar a relação de alguns fatores de risco entre os grupos com e sem a DAOMI. Foram estudados 72 pacientes. Todos os pacientes foram submetidos ao ITB, sendo considerado diagnóstico de DAOMI quando ITB <0,9. A prevalência da DAOMI foi de 37,5%, e 10 apenas 48% destes pacientes apresentaram sintoma clínico compatível com CI. Os pacientes com DAOMI eram mais idosos (65,8 ± 13 vs 53,9 ± 13,7 anos), tinham maior prevalência de doença coronariana (40% vs 10,6%) e utilizavam mais estatinas (40% vs 17%). Não houve diferença quanto à dosagem da proteína C reativa entre os grupos com e sem DAOMI. A análise de regressão logística mostrou relação entre a presença de DAOMI e idade, baixo LDLc e a CI. A alta prevalência da DAOMI em pacientes com DRC não dialítica, foi semelhante à descrita por outros autores e traz consigo um dado importante, de que a maioria dos pacientes não apresentava sintomas clínicos. A possibilidade de diagnóstico precoce da DAOMI ainda na fase assintomática, utilizando o ITB, nos faz sugerir a utilização deste procedimento na rotina ambulatorial de pacientes com DRC não dialisados. / The occurrence of cardiovascular diseases in patients with chronic kidney disease (CKD) is high, and the mortality rate from these pathologies can be up to 10 times greater in this group than in the general population, a fact that is even clearer when the GF rate reaches levels of less than 60 ml/min. This high occurrence may be put down to the association of the so-called traditional risk factors (common to the entire population) with non-traditional factors (common in patients with CKD). Lower limb obstructive arterial disease (LLOAD) is related to poor prognosis not only in patients undergoing dialysis therapy, but also those receiving transplants or conservative treatment. Besides, its early diagnosis is associated with suffering in other vascular beds such as the coronary and the carotid. In view of these observations, we decided to study the occurrence of LLOAD in a population of patients with CKD not in dialysis, using the ankle braquial index (ABI) and intermittent claudication (IC) as diagnostic methods, as well as assessing the relationship of certain risk factors among the groups with or without LLOAD. 72 patients were studied. All the patients were submitted to the ABI, LLOAD being diagnosed when the ABI < 0.9. The occurrence of LLOAD was 37.5% and only 48.1% of these patients had clinical symptoms compatible with IC. The patients with LLOAD were older (65.9 ± 13.0 vs. 54.6 ± 13.1 years of age), were more prone to coronary disease (37% vs. 11.1%) and used more 12 statins (40.7% vs. 15.5%). There was no difference as regards the dosage of reactive protein C among the groups with and without LLOAD. Analysis of logistic regression showed a relationship between the presence of LLOAD and age, low LDLc and IC. The high occurrence of LLOAD in patients with CKD not in dialysis was similar to that described by other authors and brings with it an important fact – that the majority of patients had no clinical symptoms. The possibility of early diagnosis of LLOAD in the asymptomatic phase, using ABI, leads us to suggest the use of this procedure in the routine attendance of outpatients with CKD not in dialysis.

Introdução: A Doença Vascular do Enxerto (DVE), um processo envolvendo fatores de natureza inflamatória e proliferativa, é a principal causa de morte após o Transplante Cardíaco (TxC), com incidência acima de 50 % ao fim do quinto ano. É possível que a intervenção farmacológica nesses fatores possa resultar na inibição da proliferação de células musculares lisas vasculares e melhora da DVE. Neste sentido, em trabalho anterior desta Instituição, o paclitaxel, agente antiproliferativo usado no tratamento do câncer, foi capaz de regredir as lesões ateromatosas em coelhos com aterosclerose induzida por dieta rica em colesterol. Naquele trabalho, o paclitaxel foi concentrado nas lesões utilizando-se uma nanopartícula lipídica, parecida com a lipoproteína de baixa densidade (LDL), mas sem a parte protéica, denominada LDE. Tendo em vista as dificuldades do tratamento da DVE em pacientes e da grande importância dessa doença para o êxito do procedimento, novas alternativas terapêuticas devem ser procuradas, e o uso do paclitaxel associado à LDE pode ser uma rota interessante, tendo em vista que as bases inflamatórias e proliferativas da DVE são semelhantes às da doença cardiovascular aterosclerótica, onde a LDE-paclitaxel mostrou-se eficiente. Objetivos: Verificar se o tratamento com LDE-Paclitaxel reduz a incidência e o grau de DVE de coelhos submetidos a transplante cardíaco heterotópico. Analisar a biodistribuição da LDE em coelhos submetidos a transplante cardíaco heterotópico. Método: TxC heterotópico em posição cervical foi realizado utilizando-se 21 coelhos da raça New Zealand vermelhos como doadores e 21 coelhos brancos como receptores (peso ± 3 kg). Os coelhos receptores receberam dieta com acréscimo de 0,5 % de colesterol e ciclosporina A na dose de 10 mg/kg/dia via oral como imunossupressor. Foram divididos em 2 grupos: um grupo, constituído de 11 animais, foi tratado com LDE-Paclitaxel na dose de 4 mg/kg/semana, durante 6 semanas, por via endovenosa. O outro grupo (controle) compôs-se de 10 animais tratados com 3 mL de solução fisiológica por via endovenosa, semanalmente, durante 6 semanas. A biodistribuição da LDE foi determinada em 4 animais do grupo controle, injetando-se a LDE marcada com éter de colesterol radioativo 24 h antes do sacrifício, seguindose a contagem de radioatividade nos corações e outros tecidos após extração lipídica. Após o sacrifício dos animais, retiraram-se os corações nativo e transplantado para análise histológica com coloração H/E e Verhoeff-van Gieson. A área transversal das artérias coronárias foi estimada pela medida da lamina elástica interna e da área do lúmen. A porcentagem de estenose foi calculada da diferença entre área do lúmen do vaso e a área da lamina elástica interna. Análise estatística com ANOVA e o teste T, com valor p <= 0,05 considerado significante. Resultados: A captação da LDE pelo coração transplantado foi quase 4 vezes maior do que no coração nativo (p<=0,0001). Nos animais tratados com LDE-paclitaxel, houve uma dramática melhora no status das artérias coronárias dos corações transplantados, ocorrendo um acentuado aumento de 3 vezes na área da luz dos vasos (p<=0,031) e de redução da estenose em 45% (p<=0,0008). Conclusões: A LDE é capaz de concentrar-se no coração transplantado, o que possibilita o direcionamento do paclitaxel para o enxerto. O tratamento com LDE-paclitaxel reduziu acentuadamente a DVE, o que pode abrir uma nova perspectiva para o controle da doença vascular do enxerto. / Introduction: Cardiac Allograft Vasculopathy (CAV), a process involving factors of inflammatory and proliferative nature, is the leading cause of death after heart transplantation (HT), with incidence above 50% after the fifth year. It is possible that pharmacological intervention on these factors may result in inhibiting the proliferation of vascular smooth muscle cells and improves the CAV. Thus, in previous studies of this institution, paclitaxel, an antiproliferative agent used in cancer treatment, was able to recede the atheromatous lesions in rabbits with atherosclerosis induced by high cholesterol diet. In that study, paclitaxel was concentrated in the lesions using a lipid nanoparticle, similar to low density lipoprotein (LDL) but without the protein part, called LDE. Given the difficulties of the treatment of CAV in HT patients and the great importance of this disease to the success of the procedure, new therapeutic alternatives must be sought, and the use of paclitaxel associated to LDE can be an interesting route, given that the bases inflammatory and proliferation of CAV are similar to those of atherosclerotic cardiovascular disease, where the LDE-paclitaxel was efficient. Objectives: To determine whether treatment with LDE-paclitaxel reduces the incidence and degree of CAV in rabbits undergoing heterotopic heart transplantation. To analyze the biodistribution of LDE in rabbits undergoing heterotopic heart transplantation. Methods: Heterotopic HT in cervical position was performed using 21 New Zealand red rabbits as donors and 21 white rabbits as recipients (weight ± 3 kg). The receptors rabbits were fed regular chow with added 0.5% cholesterol and with cyclosporine A, 10 mg / kg / day orally as immunosuppressants. They were divided into two groups: one consisting of 11 animals was treated with LDE-paclitaxel at a dose of 4 mg / kg / week for 6 weeks intravenously. The other group (control) was composed of 10 animals treated with 3 ml of saline intravenously weekly for six weeks. The biodistribution of LDE was determined in four control animals, by injecting the LDE labeled with radioactive cholesteryl ether 24 h before sacrifice, followed by radioactivity count in the hearts and other tissues after lipid extraction. After sacrificing the animals, we excised the native and transplanted hearts for histological staining with H / E and Verhoeff-van Gieson. The cross-sectional area of the coronary arteries was estimated by measuring the internal elastic lamina and the lumen area. The percentage of stenosis was calculated from the difference between the area of the vessel lumen and the area of internal elastic lamina. Statistical analysis with ANOVA and T test with p value <= 0.05 was considered significant. Results: The uptake of LDE for the transplanted heart was almost fourfold higher than in the native heart (p<=0.0001). In animals treated with LDE-paclitaxel, there was a dramatic improvement in the status of the coronary arteries of the transplanted hearts, indicating by a marked increase of three times of the vascular lumen area (p<=0.031) and reduction of stenosis in 45% (p<=0.0008). Conclusions: The LDE is able to concentrate on the transplanted heart, which enables the targeting of paclitaxel to the graft. Treatment with LDE-paclitaxel markedly reduced CAV in the transplanted heart, which may open a new perspective for control of Cardiac Allograft Vasculopathy.

L’optimisation du guidage en radiologie interventionnelle implique de simplifier les gestes, d’améliorer la qualité d’images et leur précision tout en réduisant l’exposition aux rayons X du personnel soignants et des patients et l’usage du produit de contraste iodé, néphrotoxique. Elle implique un travail sur chacune des quatre étapes fondamentales de chaque intervention que sont : « voir », « atteindre », « intervenir » et « contrôler » le succès de l’intervention et l’absence de complication.L’étape « voir » la cible a fait l’objet de 3 études : la première, animale, portait sur l’amélioration de la qualité d’images de cone-beam computed tomography (CBCT) et la seconde, clinique, sur la précision de la segmentation des tumeurs hépatiques mise en évidence sur les images de CBCT lors de chimioembolisations (CHE). Et enfin, la troisième, clinique, sur le repérage des artères épigastriques inférieures profondes en réalité augmentée avant lambeau.L’étape « atteindre » la cible a fait l’objet de 5 études. Deux études ont validé la précision du ciblage des tumeurs hépatiques lors des CHE utilisant des logiciels de détection automatique des artères nourricières et de perfusion virtuelle du territoire tumoral à traiter sur les images de CBCT lors de CHE. Trois autres études portaient sur les cartographies 3D par la technique de fusion d’images 3D projetées sur la fluoroscopie 2D. Les deux premières premières ont montré que l’usage de la fusion d’images lors des traitements endovasculaires des anévrismes complexes de l’aorte abdominale utilisant les images d’angioscanner ou d’angioIRM préopératoires permettant de réduire voire de s’affranchir de l’usage de produit de contraste iodé dans la prise en charge de ces pathologies. Le développement de la fusion d’images notamment lors du placement de shunt porto-systémique trans-hépatique par voie trans-jugulaire a permis de faciliter ces interventions tout en limitant l’usage des rayons X dans une troisième étude.La troisième étape « interventir » a fait l’objet de trois études. Une étude, fantôme, a montré la possibilité d’obternir une imagerie sélective et quantitative des structures iodées par l’imagerie spectrale des microsphères chargées d’huile iodée. Une seconde étude préclinique animale a attesté la radioopacité de ces mêmes microsphères chargées lorsqu’elles s’accumulent dans les capillaires ou néovaisseaux et sont le reflet de la nécessité de combiner une recherche commune sur le couple imagerie/matériel. Et enfin l’étude sur la rentabilité des biospies des tumeurs guidées par l’image qui a permis de mettre fin à des dogmes.La quatrième étape « contrôler » le succès des traitements comprend deux études. La première, est une revue de la littérature et a permis de proposer une standardisation de l’usage du CBCT lors des CHE et la seconde a évalué différents facteurs prédicteurs de réponse tumorale en IRM après CHE avec un intérêt particulier porté sur l’usage de nouveaux critères d’analyse 3D (vRECIST et qEASL).Le guidage en radiologie et notamment par le CBCT est encore confronté à la limitation majeure qu’est d’utiliser des rayons X et des produits de contraste iodé mais également à un champ de vue limité et à une qualité d’images sensibles aux artéfacts. D’ou le développement d’autre moyen de guidage comme l’IRM, éléctromagnétisme, fibroptique ou encore la réalité augmentée. Ces derniers éléments font partis de projets de recherche en cours ou à venir. / Optimizing image guidance in interventional radiology involves simplifying procedures, improving image quality and accuracy while reducing X-rays exposure, and the use of iodinated contrast media, which is nephrotoxic. It involves to improve each of the four fundamental steps of each intervention: "see", "reach", "intervene" and "control" the success of the intervention and the absence of complication.To "see" the target was the subject of 3 studies: the first study, was an animal study focused on improving the quality of images of cone-beam computed tomography (CBCT). The second study was a clinical study about the precision of the tumor segmentation of on CBCT images during chemoembolization (TACE). And finally, the third study was a clinical study and described the identification of the lower deep epigastric arteries in augmented reality before flap.To "reach" the target was the subject of 5 studies. Two studies investigated the accuracy of hepatic tumor targeting in TACE using automatic feeding detection and virtual tumor perfusion software on CBCT images. Three other studies were focused on 3D roadmap using the image fusion technique overlaid onto 2D fluoroscopy. The two first studies were about endovascular treatments of complex abdominal aortic aneurysms using images fusion based on angiography of computed tomography or IRM to reduce or even eliminate the use of iodinated contrast agent in the management of such disease. The development of image fusion, particularly during trans-hepatic porto-systemic shunt placement, was shown to facilitate these interventions while limiting the use of X-rays published in to a thrid study.To "intervene" step included three studies. A phantom study showed that spectral imaging displayed selective and quantitative images of iodine content of iodine-loaded microspheres. A preclinical study demonstrated their visibility on x-ray based imaging when they accumulated in capillaries or neovessels and reflected the need to combine a common search for the couple imaging / biomaterials. And finally the study on the rentability of the image guided biospies of tumors which allowed to end dogmas.To "control" the success of treatments included two studies. The first study is a review of the literature and allowed a standardization of the use of the CBCT during the TACE and the second evaluated the factors predictors of tumor response on MRI images after TACE by the use of new 3D criteria. Image guidance with the use of CBCT, is still confronted with the major limitation of the use of X-rays and iodinated contrast media, but also to a limited field of view and a sentitive images quality to artefacts. Hence the development of other image guidance types such as MRI, electromagnetism, fibroptic or augmented reality are on its way. These last elements are part of a research projects in progress or to come.

Background: Despite the fact that peripheral arterial disease (PAD) significantly increases the risk of cardiovascular mortality, it is significantly underdiagnosed and underrated. The purpose of this study was to evaluate the practice at a northeast Tennessee university primary care clinic regarding the diagnosis and treatment of PAD. Methods: A retrospective medical record survey was conducted to evaluate practice patterns in diagnosing and treating PAD in a university primary care clinic. A clinic population of 711 patients was selected using International Classification of Diseases-9 codes for coronary artery disease (CAD), cerebovascular disease (CVD), and/ or PAD. A sample of 180 patients (25.3%) was randomly selected using a systematic statistical method. Of these, 125 patients met the diagnostic criteria for CAD, CVD, and/or PAD. The study covered a 3-year period, from July 2001 until June 2004. Demographic and other data, including the use of antiplatelet therapy, were collected. Results: One hundred ten patients met all of the inclusion and exclusion criteria. Thirty-nine percent were males, and 61% were females. Overall, 79% had CAD, 53% had CVD, and 25% had PAD. Almost half of the patients had some combination of these. Only about 2% had PAD only compared with 36% with CAD only and 17% with CVD only. Although the prevalence of CAD and CVD (among other atherosclerotic vascular diseases) in our clinic was comparable to national figures, the prevalence of PAD was significantly lower (p = .004). The overall use of any antiplatelet agent was 84.2% for patients with only CAD and 80% for only CVD. There was not an adequate number of patients with only PAD to evaluate the use of antiplatelet therapy in this group. Conclusion: The low prevalence of PAD only (most PAD patients had coexisting CAD and CVD) indicates that PAD is underdiagnosed at our clinic. There was suboptimal use of aspirin and other antiplatelet drugs among patients with atherosclerotic vascular disease.

No description available.

No description available.