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1.
Wien Klin Wochenschr ; 135(Suppl 3): 493-523, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37358642

RESUMEN

The Billroth IV consensus was developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on the 26th of November 2022 in Vienna.Based on international recommendations and considering recent landmark studies, the Billroth IV consensus provides guidance regarding the diagnosis and management of portal hypertension in advanced chronic liver disease.


Asunto(s)
Várices Esofágicas y Gástricas , Hipertensión Portal , Humanos , Austria , Consenso , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico , Hipertensión Portal/terapia , Hemorragia Gastrointestinal , Cirrosis Hepática
2.
Respirology ; 27(8): 581-599, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35758539

RESUMEN

Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows real-time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image-guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.


Asunto(s)
Fístula Arteriovenosa , Embolización Terapéutica , Humanos , Arteria Pulmonar , Stents , Vena Cava Superior
3.
BMC Nephrol ; 22(1): 75, 2021 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639869

RESUMEN

BACKGROUND: Anti-glomerular basement membrane disease (GBM) disease is a rare autoimmune disease causing rapidly progressive glomerulonephritis and pulmonary haemorrhage. Recently, an association between COVID-19 and anti-glomerular basement membrane (anti-GBM) disease has been proposed. We report on a patient with recurrence of anti-GBM disease after SARS-CoV-2 infection. CASE PRESENTATION: The 31-year-old woman had a past medical history of anti-GBM disease, first diagnosed 11 years ago, and a first relapse 5 years ago. She was admitted with severe dyspnoea, haemoptysis, pulmonary infiltrates and acute on chronic kidney injury. A SARS-CoV-2 PCR was positive with a high cycle threshold. Anti-GBM autoantibodies were undetectable. A kidney biopsy revealed necrotising crescentic glomerulonephritis with linear deposits of IgG, IgM and C3 along the glomerular basement membrane, confirming a recurrence of anti-GBM disease. She was treated with steroids, plasma exchange and two doses of rituximab. Pulmonary disease resolved, but the patient remained dialysis-dependent. We propose that pulmonary involvement of COVID-19 caused exposure of alveolar basement membranes leading to the production of high avidity autoantibodies by long-lived plasma cells, resulting in severe pulmonary renal syndrome. CONCLUSION: Our case supports the assumption of a possible association between COVID-19 and anti-GBM disease.


Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , COVID-19/complicaciones , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/etiología , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/fisiopatología , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Niño , Ciclofosfamida/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Riñón/patología , Riñón/fisiología , Metilprednisolona/uso terapéutico , Plasmaféresis , Prednisona/uso terapéutico , Recurrencia , SARS-CoV-2 , Vejiga Urinaria/fisiopatología , Reflujo Vesicoureteral/fisiopatología
4.
BMC Nephrol ; 20(1): 425, 2019 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752733

RESUMEN

BACKGROUND: Pregnancy is rare in women on hemodialysis. Recommendations for the treatment of secondary hyperparathyroidism (sHPT) and preservation of bone health in pregnant dialysis patients are lacking. CASE PRESENTATION: We present the case of a young woman with end-stage kidney disease (ESKD) due to lupus nephritis, who developed multiple brown tumors while on hemodialysis during her second pregnancy. During her first pregnancy sHPT was well controlled and no skeletal complications occurred. Before the second pregnancy she developed severe sHPT. During pregnancy, dialysis time was increased to 24 h per week, the patient was given oral calcitriol, and the dialysate calcium concentration was set at 1.5 mmol/l. In week 20 the patient complained about bone pain in her left hip. Magnetic resonance imaging revealed a cystic lesion compatible with a brown tumor. The baby was delivered in the 36th week by cesarean section. Further assessment identified multiple brown tumors of her skeleton, including the acetabulum, tibia, ribs, skull, thoracic spine and thumb. She required multiple orthopedic surgeries. Three months after pregnancy, etelcalcetide was started, which brought about a gradual improvement in her sHPT. CONCLUSIONS: This case demonstrates that the combination of pregnancy and severe sHPT in dialysis patients can have deleterious consequences for bone health.


Asunto(s)
Hiperparatiroidismo Secundario/complicaciones , Fallo Renal Crónico/terapia , Nefritis Lúpica/complicaciones , Osteítis Fibrosa Quística/etiología , Complicaciones del Embarazo , Diálisis Renal/efectos adversos , Adulto , Calcio/sangre , Femenino , Humanos , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/tratamiento farmacológico , Fallo Renal Crónico/sangre , Fallo Renal Crónico/etiología , Osteítis Fibrosa Quística/diagnóstico por imagen , Osteítis Fibrosa Quística/cirugía , Hormona Paratiroidea/sangre , Péptidos/uso terapéutico , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/terapia
6.
PLoS One ; 13(1): e0189414, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29315304

RESUMEN

BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunts (TIPS) are used in patients with cirrhosis for the prevention of variceal rebleeding. METHODS: We retrospectively evaluated re-bleeding rate, patency, mortality, and transplant-free survival (TFS) in cirrhotic patients receiving TIPS implantation for variceal bleeding between 1994-2014. RESULTS: 286 patients received TIPS (n = 119 bare metal stents, n = 167 polytetrafluorethylene (PTFE)-covered stents) for prevention of variceal re-bleeding. Mean age was 55.1 years, median MELD was 11.8, and the main etiology of cirrhosis was alcoholic liver disease (70%). Median follow-up was 821 days. 67 patients (23%) experienced at least one re-bleeding event. Patients with PTFE-TIPS were at significantly lower risk for variceal re-bleeding than patients with bare metal stents (14% vs. 37%, OR:0.259; p<0.001) and had less need for stent revision (21% vs. 37%; p = 0.024). Patients with PTFE stent grafts showed lower mortality than patients with bare stents after 1 year (19% vs. 31%, p = 0.020) and 2 years (29% vs. 40%; p = 0.041) after TIPS implantation. Occurrence of hepatic encephalopathy after TIPS was similar between groups (20% vs. 24%, p = 0.449). CONCLUSIONS: PTFE-TIPS were more effective at preventing variceal re-bleeding than bare metal stents due to better patency. Since this tended to translate in improved survival, only covered stents should be implemented for bleeding prophylaxis when TIPS is indicated.


Asunto(s)
Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal/prevención & control , Derivación Portosistémica Intrahepática Transyugular , Adulto , Anciano , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia
7.
Dig Liver Dis ; 49(12): 1360-1367, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28869158

RESUMEN

BACKGROUND: Early implantation (<72h) of a transjugular intrahepatic portosystemic shunt (TIPS) after acute variceal bleeding (AVB) improves survival in highly selected patients. METHODS: We retrospectively assessed bleeding control and survival of unselected cirrhotic patients undergoing early TIPS implantation within 72h. We compared the outcomes to patients meeting early TIPS criteria but receiving late TIPS within 3-28days after AVB and endoscopic/medical treatment. RESULTS: Forty-nine patients were included. Mean MELD was 14.4 (±4.4). Thirteen patients (26.5%) presented characteristics that were exclusion criteria in previous early TIPS trials (age>75, CPS>13, HCC>Milan, previous beta-blocker/band-ligation, renal insufficiency). Bare metal and PTFE-covered stents were used in n=32 (65.3%) and n=17 (34.7%) patients, respectively, and showed similar early re-bleeding rates (9.9% vs. 7.1%; p=0.6905) and bleeding-related mortality (25.0% vs. 23.5%; p=0.9906). However, overall re-bleeding rate was lower with PTFE-TIPS (7.7% vs. 64.2%; p=0.0044) over a median follow-up of 18.5 months with a tendency towards improved survival (median 70.5 vs. 13.8 months; p=0.204). Additional 68 patients meeting stringent criteria but receiving late TIPS also showed a favorable bleeding-related mortality (8.8%), which was not achieved in similar n=34 patients by a medical/endoscopic strategy with bleeding-related mortality of 35.7%. CONCLUSIONS: An early TIPS strategy using covered stents and implementation of 'stringent criteria' results in a favorable outcome in patients with acute variceal bleeding.


Asunto(s)
Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal/mortalidad , Hipertensión Portal/etiología , Cirrosis Hepática/cirugía , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Austria , Várices Esofágicas y Gástricas/etiología , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Stents , Resultado del Tratamiento
8.
Insights Imaging ; 6(1): 17-32, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25638646

RESUMEN

OBJECTIVES: To demonstrate the various presentations of acute aortic pathology and to present diagnostic and therapeutic approaches. METHODS: Diagnostic imaging is the key to the reliable diagnosis of acute aortic pathology with multi-slice computed tomography angiography (CTA) as the fastest and most robust modality. Endovascular aortic repair (EVAR) with stent grafts and open surgical repair are therapeutic approaches for aortic pathology. RESULTS: CTA is reliable in diagnosing and grading aortic trauma, measuring aortic diameter in aortic aneurysms and detecting vascular wall pathology in acute aortic syndrome and aortic inflammation. CTA enables planning the optimal therapeutic approach. Stent graft implantation and/or an open surgical approach can address vascular wall pathology and exclude aortic aneurysms. CONCLUSION: Aortic emergencies have to be detected quickly. CTA is the imaging method of choice and helps to decide whether elective, urgent or emergent treatment is necessary with EVAR and open surgical repair as the main treatment approaches. TEACHING POINTS: • To present aortic pathology caused by trauma • To present acute aortic syndrome (aortic dissection, intramural haematoma and penetrating ulcers) • To present symptomatic and ruptured aortic aneurysm • To present infection (mycotic aneurysms/aorto-duodenal fistulae) or iatrogenic injury of the aorta • To understand different presentations for treatment planning (EVAR and open surgery).

10.
Neurol Res ; 34(3): 314-7, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22449387

RESUMEN

OBJECTIVE: The sensitivity of 5-aminolevolinic acid (5-ALA) in detecting intraoperative glioblastoma (GBM) tissue compared to postoperative (18)F-fluoroethyl-L-tyrosine and T1 contrast uptake of tumor cells in positron emission tomography (PET) and magnetic resonance imaging (MRI) scans was investigated in a retrospective image correlative study. METHODS: Ten patients with histological verified GBM in eloquent brain regions underwent 11 surgeries with neuronavigation and 5-ALA assisted tumor resection. Residual 5-ALA fluorescence was labeled intraoperatively on the navigation MRI scans and images were fused with postoperative (18)F-FET PET and T1 contrast MRI. RESULTS: Intraoperatively, at the end of save resection, in all patients 2-5 faint 5-ALA positive resection planes were detected (mean 3·6), compared to 0-4 (18)F-FET positive resection planes (mean 1·4) and 0-2 positive T1 contrast MRI resection planes in postoperative scans. The difference between the number of 5-ALA and (18)F-FET positive resection planes was statistically significant (P = 0·0002). The histological investigation of 5-ALA positive resection margins demonstrated infiltrative tumor in every case. Residual 5-ALA fluorescence on resection margins and postoperative (18)F-FET uptake areas or residual contrast T1 areas were colocalized in all cases, documented by pre-/postoperative image fusion. CONCLUSION: Residual faint 5ALA uptake is documented in large areas at the end of GBM resection and corresponds to tumor infiltration. These 5-ALA positive resection plans exceeded the (18)F-FET uptake areas in postoperative PET scans. Thus, intraoperative 5-ALA residual fluorescence seems to be a more sensitive marker than (18)F-FET PET for residual tumor in malignant gliomas.


Asunto(s)
Ácido Aminolevulínico , Neoplasias Encefálicas/cirugía , Colorantes Fluorescentes , Glioblastoma/cirugía , Monitoreo Intraoperatorio/métodos , Neoplasia Residual/diagnóstico , Adulto , Anciano , Neoplasias Encefálicas/patología , Medios de Contraste , Femenino , Glioblastoma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuronavegación , Tomografía de Emisión de Positrones , Estudios Retrospectivos , Sensibilidad y Especificidad
11.
Eur J Radiol ; 81(9): 2265-9, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21703792

RESUMEN

BACKGROUND: Multidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required. METHODS: Seventy randomized patients who underwent stent implantation (n=47) or balloon angioplasty (n=23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (>50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients. RESULTS: Binary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ=0.88, 95% CI: 0.80-0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ=0.82, 95% CI: 0.66-0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ=0.92, 95% CI: 0.84-1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ=0.65; 95% CI 0.54-0.76). Significant correlations (r=0.85, p<0.001) were noted between degree of re-stenosis on CTA and peak velocity ratio on CDUS. The correlation coefficient was higher in patients after balloon angioplasty (r=0.94, p<0.001) than in patients after stent implantation (r=0.71, p<0.001). CONCLUSION: CTA and CDUS show excellent agreement for evaluation of native and in-stent re-stenosis after endovascular treatment of SFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy.


Asunto(s)
Angiografía/métodos , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/diagnóstico por imagen , Stents/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Anciano , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
12.
Wien Klin Wochenschr ; 123(13-14): 444-9, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21691757

RESUMEN

BACKGROUND: The purpose of this retrospective population-based study was to investigate the incidence of subarachnoid haemorrhage from small (5 mm and below) cerebral aneurysms and their localisation in consecutive patients surgically treated in the State of Vorarlberg/Austria. METHODS: Altogether, during the last 4 years, 82 patients after spontaneous subarachnoid haemorrhage (mean age 53.7 years, range 21-84 years, 47 females and 35 males) were referred to the Neurosurgical Department of the Academic Teaching Hospital Feldkirch, serving for all 360,000 inhabitants of the State (corresponding to a subarachnoid haemorrhage incidence of 5.7/100,000/year). In 70 patients (85.4%), a cerebral aneurysm was detected by computed tomography angiography and/or digital cerebral angiography. Out of these, 47 patients (66.2%, mean age 52.1 years, range 24-77 years) were treated with aneurysm clipping and included in the study. Preoperatively, computed tomography, computed tomography angiography and/or digital cerebral angiography were assessed for amount of blood, aneurysm size and localisation, respectively. Clinical status was graded according to the Hunt and Hess classification at admission and according to the Glasgow Outcome Scale at discharge. FINDINGS: According to Koivisto categories, 18 aneurysms were localised at the anterior cerebral artery, 17 aneurysms at the middle cerebral artery, 11 at the internal carotid artery, and 1 at the vertebrobasilar artery. The mean aneurysm diameter was 7.7 mm (range 3-30 mm). In 34% of the aneurysms the diameter was 5 mm or smaller (n = 16), in 51% between 6 and 10 mm (n = 24) and in 15% between 11 and 30 mm (n = 7). Only 1/17 ruptured middle cerebral artery aneurysms (5.9%), 4/11 internal carotid artery aneurysms (36.4%) and the vertebrobasilar artery aneurysm were small. However, in 10/18 anterior cerebral artery aneurysms (55.6%) the diameter was 5 mm or below. CONCLUSIONS: In conclusion, in our consecutive patient series with clipped cerebral aneurysms after subarachnoid haemorrhage, one third had small ruptured aneurysms, with the anterior cerebral artery complex as the main predilection site. Therefore, despite the previously reported low rupture risk, incidental small aneurysms should also be considered for therapy, depending on localisation and individual risk factors.


Asunto(s)
Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/epidemiología , Angiografía de Substracción Digital , Angiografía Cerebral , Procesamiento de Imagen Asistido por Computador , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/epidemiología , Tomografía Computarizada Multidetector , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/epidemiología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/terapia , Austria , Estudios Transversales , Femenino , Humanos , Aneurisma Intracraneal/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rotura Espontánea , Hemorragia Subaracnoidea/terapia , Adulto Joven
13.
Wien Klin Wochenschr ; 123(11-12): 364-8, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21590320

RESUMEN

INTRODUCTION: The purpose of this retrospective population based study was to investigate the effect of the extent of surgery on overall survival in young versus adult glioblastoma patients in Vorarlberg/Austria during the last 4 years. METHODS: Forty-eight patients (median age 62.5 years, ranging from 25-82 years, 19 female and 29 male) with histologically proven glioblastoma received surgery (16 biopsies, 18 partial and 14 complete resections) and postoperative chemo-irradiation with concomitant and adjuvant temozolomide. The median follow up of the patient population was 11.7 months (ranging from 3 to 36 months). Postoperative temporary morbidity was found in 5 out of 48 (10.4%) patients, and no mortality or permanent morbidity occurred. One infection led to revision surgery. FINDINGS: Altogether, the 12/24 months overall survival was 54/20.2% with a median survival of 13.7 months. In younger patients (<65 yrs, median 57.5 yrs, 28 patients), the 12/24 months overall survival was 68.4/34.3% with 16.9 months median survival, in the elderly patients (>65 yrs, median 73 yrs, 20 patients) the 12/24 months overall survival was 28.8/5.8%, with 7.7 months median survival (Log-rank, p = 0.0005). Extent of surgery influenced overall survival of the adult group nearly significantly (biopsy versus complete resection: p = 0.06), but did not affect overall survival of the elderly (p = 0.5). CONCLUSIONS: Overall survival of elderly glioblastoma patients treated with surgery and chemo-irradiation with concomitant and adjuvant temozolomide is significantly reduced compared to the younger patients. In addition, in the elderly the extent of surgery did not influence the prognosis in our population.


Asunto(s)
Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/cirugía , Glioblastoma/mortalidad , Glioblastoma/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos Alquilantes/administración & dosificación , Biopsia , Encéfalo/patología , Encéfalo/cirugía , Neoplasias Encefálicas/patología , Quimioradioterapia Adyuvante , Terapia Combinada , Dacarbazina/administración & dosificación , Dacarbazina/análogos & derivados , Femenino , Glioblastoma/patología , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Tasa de Supervivencia , Temozolomida
14.
Clin Neurol Neurosurg ; 112(5): 386-91, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20189713

RESUMEN

PURPOSE: Computed tomography angiography (CTA) is a time and cost saving investigation for postoperative evaluation of clipped cerebral aneurysm patients. A retrospective study was conducted to analyse image quality and artefact generation due to implanted aneurysm clips using a new technology. METHODS: MSCTA was performed pre- and postoperatively using a Philips Brilliance 64-detector-row CT scanner. Altogether, 32 clipping sites were analysed in 27 patients (11 female and 16 male, mean ages 52a, from 24 to 72 years). Clip number per aneurysm was 2.3 mean (from 1 to 4), 54 clips were made of titanium alloy and 5 of cobalt alloy. RESULTS: Altogether, image quality was rated 1.8 mean, using a scale from 1 (very good) to 5 (unserviceable) and clip artefacts were rated 2.4 mean, using a 5 point rating scale (1 no artefacts, 5 unserviceable due to artefacts). A significant loss of image quality and rise of artefacts was found when using cobalt alloy clips (1.4 versus 4.2 and 2.1 versus 4.0). In 72% of all investigations, an excellent image quality was found. Excluding the cobalt clip group, 85% of scans showed excellent image quality. Artefacts were absent or minimal (grade 1 or 2) in 69% of all investigations and in 81% in the pure titanium clip group. In 64-row MSCTA of good image quality with low artefacts, it was possible to detect small aneurysm remnants of 2mm size in individual patients. CONCLUSION: By using titanium alloy clips, in our study up to 85% of postoperative CTA images were of excellent quality with absent or minimal artefacts in 81% and seem adequate to detect small aneurysm remnants.


Asunto(s)
Angiografía de Substracción Digital/instrumentación , Procesamiento de Imagen Asistido por Computador , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Tecnología/instrumentación , Aleaciones , Artefactos , Angiografía Cerebral/instrumentación , Diseño de Equipo , Femenino , Humanos , Masculino , Procedimientos Neuroquirúrgicos/instrumentación , Estudios Retrospectivos , Instrumentos Quirúrgicos , Tomografía Computarizada por Rayos X/normas
15.
Cardiovasc Intervent Radiol ; 33(2): 251-9, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19669832

RESUMEN

This article reports the results of carotid artery stenting during an 11-year period. Data from 168 carotid artery stenting procedures (symptomatic, n = 55; asymptomatic, n = 101; symptoms not accessible, n = 12) were retrospectively collected. Primary technical success rate, neurological events in-hospital, access-site complications, and contrast-induced nephropathy (n = 118) were evaluated. To evaluate the influence of experience in carotid artery stenting on intraprocedural neurologic complications, patients were divided into two groups. Group 1 included the first 80 treated patients, and group 2 the remainder of the patients (n = 88). In-stent restenoses at last-follow-up examinations (n = 89) were assessed. The overall primary technical success rate was 95.8%. The in-hospital stroke-death rate was 3.0% (n = 5; symptomatic, 5.4%; asymptomatic, 2.0%; p = 0.346). Neurologic complications were markedly higher in group 1 (4.2%; three major strokes; symptomatic, 2.8%, asymptomatic, 1.4%) compared to group 2 (2.4%; one major and one minor stroke-symptomatic, 1.2%, asymptomatic 1.2%), but this was not statistically significant. Further complications were access-site complications in 12 (7.1%), with surgical revision required in 1 (0.6%) and mild contrast-induced nephropathy in 1 (0.85%). Twenty-one (23.6%) patients had >50% in-stent restenosis during a mean follow-up of 28.2 months. In conclusion, advanced experience in carotid artery stenting leads to an acceptable periprocedural stroke-death rate. In-stent restenosis could be a critical factor during the follow-up course.


Asunto(s)
Implantación de Prótesis Vascular/métodos , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Stents , Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Angiografía/métodos , Austria , Implantación de Prótesis Vascular/efectos adversos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Probabilidad , Falla de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Accidente Cerebrovascular/etiología , Tasa de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
17.
Surg Infect (Larchmt) ; 10(2): 159-62, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19388837

RESUMEN

BACKGROUND: Liver abscess is a rare complication after pancreatectomy. Clostridium perfingens is a rare cause of intrahepatic infections. CASE REPORT: A 65-year-old woman with pancreatic cancer underwent explorative laparotomy, during which encasement of the hepatic artery by the tumor was found. Neoadjuvant radiochemotherapy with capecitabine was started, which caused tumor regression, and duodenopancreatectomy was performed. The portal vein was occluded and infiltrated by cancer and therefore was resected and not reconstructed. After a slow recovery, the patient developed hemorrhage at the gastrojejunal anastomosis, which was controlled by fibrin injection. Within a few days, she presented with signs of sepsis, and blood cultures yielded Clostridium perfringens, Streptococcus oralis, Staphylococcus aureus, and Candida albicans. The source of the sepsis proved to be a 9-cm liver abscess, which was drained; cultures grew C. perfringens, Hafnia alvei, and Enterobacter cloacae. Despite antibiotic treatment, the patient died from sepsis and multiorgan failure 27 days after pancreatic surgery. CONCLUSION: Such rare infections can follow pancreatic resection with neoadjuvant radiochemotherapy. Clostridium perfringens-associated liver abscess maintains a high mortality rate.


Asunto(s)
Infecciones por Clostridium/microbiología , Absceso Hepático/microbiología , Pancreatectomía/efectos adversos , Complicaciones Posoperatorias/microbiología , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Resultado Fatal , Femenino , Humanos , Hígado/patología , Absceso Hepático/diagnóstico , Absceso Hepático/tratamiento farmacológico , Terapia Neoadyuvante , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/uso terapéutico , Piperacilina/uso terapéutico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Tazobactam
18.
Radiology ; 248(1): 297-302, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18566179

RESUMEN

PURPOSE: To prospectively determine whether cutting balloon angioplasty, when compared with conventional balloon angioplasty (CBA), improves morphologic and clinical outcome in patients with femoropopliteal in-stent restenosis. MATERIALS AND METHODS: Patients with symptomatic femoropopliteal in-stent restenosis were randomly assigned to undergo CBA or peripheral cutting balloon angioplasty (PCBA) for treatment of lesions up to 20 cm in length. Patients were followed up clinically and with duplex ultrasonography (US) at 1, 3, and 6 months for occurrence of a restenosis of 50% or higher. The Fisher exact test and Mann Whitney U test were used for statistical analyses. RESULTS: Forty patients were enrolled; one patient was lost to follow-up. In the remaining patients, CBA was performed in 22 patients; PCBA was used in 17 patients. Average lesion length was 80 mm +/- 68 (standard deviation). Restenosis rates at 6 months were 65% (11 of 17; 95% confidence interval: 42%, 88%) after PCBA versus 73% (16 of 22; 95% confidence interval: 54%, 92%) after CBA (P = .73). Ankle brachial index (0.83 vs 0.75, P = .26) and maximum walking capacity on the treadmill (117 m vs 103 m, P = .97) at 6 months were also not significantly different between the two groups. CONCLUSION: PCBA failed to prove superiority compared with CBA for treatment of femoropopliteal in-stent restenosis in this pilot study. In restenotic lesions with an average length of approximately 8 cm, both treatment modalities yielded disappointing 6-month patency rates.


Asunto(s)
Angioplastia de Balón/métodos , Prótesis Vascular/efectos adversos , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Arteria Poplítea/cirugía , Stents/efectos adversos , Anciano , Femenino , Humanos , Masculino , Proyectos Piloto , Resultado del Tratamiento
19.
Radiology ; 247(1): 267-72, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18270378

RESUMEN

PURPOSE: To prospectively determine, in a randomized controlled trial, whether cutting balloon angioplasty (CBA) yields superior morphologic and clinical outcomes at 6 months compared with the 6-month outcomes after conventional percutaneous transluminal angioplasty (PTA) in patients with short de novo superficial femoropopliteal artery (SFA) lesions. MATERIALS AND METHODS: This study was approved by the ethics committees of the two participating centers, and informed consent was obtained from all patients. The authors randomly assigned 43 patients (26 men, 17 women; median age, 69 years) who had 5 cm or shorter de novo SFA lesions in association with intermittent claudication or chronic limb ischemia to undergo CBA or PTA. The patients were followed up clinically, and restenosis was assessed with duplex ultrasonography (US) at 6 months. chi(2) and Mann-Whitney U tests were used to compare data between the two treatment groups. RESULTS: The US-determined 6-month restenosis rate was 32% (seven patients) in the PTA group versus 62% (13 patients) in the CBA group (P = .048). Sixteen (73%) PTA group patients versus eight (38%) CBA group patients were asymptomatic at follow-up (P = .059). There was no significant difference in ankle-brachial index (median, 0.83 vs 0.77 for PTA vs CBA group, respectively; P = .56) or pain-free walking distance (median, >1000 m vs 600 m for PTA vs CBA group, respectively; P = .17) between the two groups. CONCLUSION: CBA did not prove to be superior to conventional PTA for treatment of short de novo SFA lesions and yielded increased restenosis rates at 6 months.


Asunto(s)
Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Arteria Femoral , Arteria Poplítea , Anciano , Femenino , Humanos , Masculino , Recurrencia
20.
Cardiovasc Intervent Radiol ; 31(3): 563-8, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-17955287

RESUMEN

This paper reports our experience with endovascular techniques for the retrieval of lost or misplaced intravascular objects. Over 12 years, 78 patients were referred for interventional retrieval of intravascular foreign objects. In this retrospective study, radiological procedure records and patients' medical records were reviewed to determine the exact removal procedure in every case, to report success rates, and to identify significant procedure-related complications. Written, informed consent was obtained from all patients prior to the intervention; this retrospective analysis was performed according to the guidelines of the Institutional Review Board. Thirty-six of seventy-eight foreign objects (46%) were located in the venous system, 27 of 78 (35%) in the right heart, and 15 of 78 (19%) in the pulmonary arteries. For foreign object removal, in 71 of 78 (91%) cases a snare loop was used, in 6 of 78 (8%) cases a sidewinder catheter combined with a snare loop was used, and in 1 case (1%) a sidewinder catheter alone was used for foreign object removal. In 68 of 78 (87%) cases, primary success was achieved. In 3 of 78 cases (4%), foreign objects were successfully mobilized to the femoral vessels and surgically removed. In 7 of 78 cases (9%), complete removal of the foreign object was not possible. In 5 of 78 cases (6%), minor complications occurred during the removal procedure. In conclusion, endovascular retrieval of lost or misplaced intravascular objects is highly effective, with relatively few minor complications. On the basis of our findings, these techniques should be considered as the therapy of choice.


Asunto(s)
Angioplastia/métodos , Vasos Sanguíneos , Cateterismo/efectos adversos , Cuerpos Extraños/terapia , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Cateterismo/instrumentación , Catéteres de Permanencia/efectos adversos , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/epidemiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Radiografía Intervencional/métodos , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Factores de Tiempo
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