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1.
Clin Transplant ; 23 Suppl 21: 92-101, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19930322

RESUMEN

The aim of this study is to report our interventional radiologic procedures (IRP) in liver transplant (LTX) patients. These include procedures for biliary, arterial, venous, and portal complications, as well as the treatment of infected and non-infected fluid collections. This retrospective study covered 583 patients (mean age: 44 +/- 14 yr) in whom a total of 685 LTX were performed from August 1987 to April 2005. Overall, 182 LTX patients underwent a total of 428 IRP, including digital subtraction angiography (n = 152/35.51%), percutaneous transluminal angioplasty (PTA) (n = 4/0.93%) and PTA + stent (n = 7/1.63%) of arterial anastomosis, PTA + stent of the celiac trunk (n = 2/0.46%), transjugular intrahepatic portosystemic shunt (TIPS) (n = 2/0.46%), arterial lysis (n = 4/0.93%), venous lysis (n = 2/0.46%), inferior vena cava stenting (n = 2/0.46%), percutaneous biliary drainage (n = 34/7.94%), percutaneous transluminal dilatation (PTD) of the choledocho-enteric anastomosis (n = 16/3.73%), biliary stent (n = 5/1.16%), intrahepatic biliary flushing treatment, stone and cast biliary extraction (n = 27/6.30%), other interventions (e.g., embolization in other regions, transjugular liver biopsies, lymphangiographies) (n = 9/2.10%), and ultrasound- and computer tomography-guided biopsies and percutaneous drainage (n = 153/35.74%). The overall success rate was 85.7%. Technical improvements in LTX and interventional radiology permit vascular and biliary complications to be treated successfully by interventional radiology.


Asunto(s)
Trasplante de Hígado/efectos adversos , Trasplante de Hígado/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Intervencional , Adulto , Angioplastia de Balón , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación Portosistémica Intrahepática Transyugular , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Stents , Análisis de Supervivencia
2.
J Radiol ; 88(9 Pt 2): 1255-60, 2007 Sep.
Artículo en Francés | MEDLINE | ID: mdl-17878871

RESUMEN

Over the last 10 years, there has been much development in the management of metastatic and osteoporotic vertebral compression fractures using vertebroplasty. This percutaneous image-guided interventional radiology procedure allows stabilization of a vertebral body by injection of an acrylic cement and frequently results in significant symptomatic relief. During cement polymerisation, an exothermic reaction may destroy adjacent tumor cells. Advances have been made to reduce complications from extravasation of cement in veins or surrounding soft tissues. Safety relates to experience but also to technical parameters: optimal cement radio-density, adequate digital fluoroscopy unit (single or bi-plane digital angiography unit), development of cements other than PMMA to avoid the risk of adjacent vertebral compression fractures. The rate of symptomatic relief from vertebroplasty performed for its principal indications (vertebral hemangioma, metastases, osteoporotic fractures) reaches 90-95%. The rate of complications is about 2% for metastases and less than 0.5% for osteoporotic fractures. Vertebroplasty plays a major role in the management of specific bone weakening vertebral lesions causing, obviating the need for kyphoplasty.


Asunto(s)
Radiología Intervencionista , Vertebroplastia , Angiografía , Cementos para Huesos/uso terapéutico , Extravasación de Materiales Terapéuticos y Diagnósticos/prevención & control , Fluoroscopía , Fracturas por Compresión/cirugía , Hemangioma/complicaciones , Humanos , Mieloma Múltiple/secundario , Osteoporosis/complicaciones , Radiografía Intervencional , Seguridad , Fracturas de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/secundario , Vertebroplastia/efectos adversos , Vertebroplastia/métodos , Vertebroplastia/tendencias
3.
Pancreatology ; 7(1): 53-62, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17449966

RESUMEN

INTRODUCTION: Acute pancreatitis (AP) is a rare complication after liver embolization (LE) of primary and secondary liver tumors (approximately 1.7%), but it has a significant morbidity and mortality potential if associated with other complications. It usually develops early within 24 h after the LE procedure. STUDY PURPOSE: To calculate the frequency of AP after LE in our institution and to analyze the factors involved in this procedure (anatomical features, embolization materials, cytostatic drugs, technical factors). MATERIALS AND METHODS: 118 LE (bland embolization and transarterial chemoembolization) were performed in our institution. The study group included 59 patients who met the following inclusion criteria: one or more LE events, with complete pre- and post-interventional laboratory studies including: serum Ca(2+), creatinine, blood urea nitrogen, glucose, lactate dehydrogenase, aminotransferases, alkaline phosphatase, amylase, lipase, C-reactive protein, hematocrit and leukocytes. The diagnosis of AP was established according to the criteria of the Atlanta system of classification. For the statistical analysis the association between two response variables (e.g. AP after embolization and risk factor during the embolization, AP after embolization and volume of embolic material) was evaluated using Pearson's chi(2) test and Fisher's exact test. RESULTS: The calculated frequency of AP after LE in our series was 15.2%. Amylase and lipase were elevated up to 8.7 and 20.1 times, respectively, 24 h after LE. We observed a statistically significantly lower incidence of AP in those patients who received 2 ml or less of embospheres compared with those with an embolization volume of >2 ml (Pearson's chi(2) = 4.5000, Pr = 0.034, Fisher's exact test = 0.040). Although carboplatin was administered to 7 of 9 of the patients who developed AP after the embolization procedure, there was no statistical significance (Fisher's exact test = 0.197) for carboplatin as an AP risk factor when compared with all the patients who received this drug (n = 107). CONCLUSION: Although AP after LE seems to have a multifactorial etiology, both the toxicity of the antineoplastic drugs (carboplatin-related toxicity) as well as direct ischemic mechanisms (non-target embolization, reflux mechanisms) may be the most important causes of the inflammatory pancreatic reaction after LE. We suggest that systematic measurement of serum pancreatic enzymes should be performed in cases of abdominal pain following selective LE and transarterial chemoembolization in order to confirm acute pancreatitis after embolization, which can clinically mimic a postembolization syndrome.


Asunto(s)
Embolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Pancreatitis/etiología , Enfermedad Aguda , Anciano , Medios de Contraste/efectos adversos , Femenino , Humanos , Aceite Yodado/efectos adversos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico por imagen , Tamaño de la Partícula , Radiografía Abdominal , Factores de Riesgo
4.
Neurology ; 67(12): 2217-20, 2006 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-17190947

RESUMEN

OBJECTIVE: To characterize the muscle involvement of patients with central core disease (CCD) caused by mutations in the ryanodine receptor 1 gene (RYR1) and to compare these findings with those from patients with core myopathies unlinked to the RYR1 gene. METHODS: We performed a systematic muscular imaging assessment in 11 patients with an RYR1 gene mutation and compared these findings with those of 5 patients from two unrelated families with autosomal dominant core myopathies not linked to RYR1, ACTA1, or MYH7 gene loci. RESULTS: All patients with RYR1 CCD had a characteristic pattern with predominant involvement of the gluteus maximus, adductor magnus, sartorius, vastus intermediolateralis, soleus, and lateral gastrocnemius muscles. In contrast, muscle CT in the first family not linked to RYR1 showed predominant affection of the gluteus minimus and hamstring muscles, whereas the second family presented with predominant involvement of the gluteus minimus, vastus intermediolateralis, tibialis anterior, and medial gastrocnemius muscles. In addition to muscle imaging data, we present detailed information on the clinical and pathologic findings of these novel phenotypes of core myopathies not linked to RYR1. CONCLUSIONS: Our data suggest genetic heterogeneity in autosomal dominant core myopathies and the existence of additional unidentified genes.


Asunto(s)
Trastornos de los Cromosomas/genética , Trastornos de los Cromosomas/patología , Músculo Esquelético/patología , Miopatía del Núcleo Central/genética , Miopatía del Núcleo Central/patología , Canal Liberador de Calcio Receptor de Rianodina/genética , Predisposición Genética a la Enfermedad/genética , Humanos , Estadística como Asunto
5.
Neurology ; 61(6): 839-41, 2003 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-14504335
6.
Gac Med Mex ; 136(6): 585-94, 2000.
Artículo en Español | MEDLINE | ID: mdl-11131860

RESUMEN

One of the great challenges in molecular biology is to understand the mechanisms by which a particular genetic defect gives origin to a specific disease. Mitochondrial DNA is more susceptible than nuclear DNA to mutations. Mitochondrial mutations have been associated with a wide spectrum of disorders characterized by a complex phenotype and actually named mitochondrial cytopathies or oxidative phosphorylation diseases. The objective of this paper is to review the relevant genetic, clinical, and morphologic features of cardiac involvement in this heterogeneous but exciting group of diseases. The clinical features of cardiac involvement in mitochondrial cytopathies vary in the different subgroups of these disorders and in particular, mitochondrial mutations can causes characteristic cardiac abnormalities.


Asunto(s)
ADN Mitocondrial/genética , Miopatías Mitocondriales/genética , ADN Mitocondrial/fisiología , Cardiopatías/genética , Humanos , Miopatías Mitocondriales/patología , Mutación , Oxidación-Reducción , Fosforilación Oxidativa , Fenotipo
7.
Rev Invest Clin ; 51(2): 121-34, 1999.
Artículo en Español | MEDLINE | ID: mdl-10410592

RESUMEN

The investigations of mitochondrial DNA abnormalities and its relationship with derangements of oxidative phosphorylation and electron transport system, has yielded description a myriad of syndromes called mitochondrial diseases or cytopathies. The objective of this paper is to review the clinical relevant features of this heterogeneous group of diseases, to understand the board spectrum of signs and symptoms and suggest an algorithm for the diagnosis.


Asunto(s)
ADN Mitocondrial/genética , Genoma , Miopatías Mitocondriales/genética , Fosforilación Oxidativa , Cardiomiopatías/genética , Diagnóstico Diferencial , Herencia Extracromosómica , Femenino , Humanos , Ácido Láctico/sangre , Masculino , Miopatías Mitocondriales/diagnóstico , Atrofias Ópticas Hereditarias/genética , Fenotipo , Ácido Pirúvico/sangre
8.
Arch Inst Cardiol Mex ; 69(6): 559-65, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10742853

RESUMEN

Kearns-Sayre syndrome is a mitochondrial cytopathy characterized by chronic progressive external ophthalmoplegia, retinitis pigmentosa and heart block, the last of which determines the survival of these patients. The case of a 23 year old man with Kearns-Sayre syndrome, conduction disturbances and mitral valve prolapse is presented. The characteristics of this syndrome are described and the criteria for prophylactic installation of a pacemaker discussed.


Asunto(s)
Síndrome de Kearns-Sayre/terapia , Marcapaso Artificial , Adulto , Bloqueo de Rama/prevención & control , Humanos , Masculino
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