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1.
CVIR Endovasc ; 7(1): 64, 2024 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-39225967

RESUMEN

BACKGROUND: Hepatic vein embolization in double vein embolization (DVE) can be performed with transhepatic, transjugular or transfemoral access. This study evaluates the feasibility and technical success of using a transfemoral access for the hepatic vein embolization in patients undergoing preoperative to induce hypertrophy of the future liver remnant (FLR). MATERIAL AND METHODS: Retrospective analysis of single center cohort including 17 consecutive patients. The baseline standardized FLR was 18.2% (range 14.7-24.9). Portal vein embolization was performed with vascular plugs and glue through an ipsilateral transhepatic access. Hepatic vein embolization was performed using vascular plugs. Access for the hepatic vein was either transhepatic, transjugular or transfemoral. Technical success, number of hepatic veins embolized and complications were registered. In addition, volumetric data including degree of hypertrophy (DH) and kinetic growth rate (KGR), and resection data were registered. R: Seven of the 17 patients had transfemoral hepatic vein embolization, with 100% technical success. No severe complications were registered. In the whole cohort, the median number of hepatic veins embolized was 2 (1-6). DH was 8.6% (3.0-19.4) and KGR was 3.6%/week (1.4-7.4), without significant differences between the patients having transfemoral versus transhepatic /transjugular access (p = 0.48 and 0.54 respectively). Time from DVE to surgery was median 4.8 weeks (2.6-33.9) for the whole cohort, with one patient declining surgery, two having explorative laparotomy and one patient having change of surgical strategy due to insufficient growth. CONCLUSION: Transfemoral access is a feasible option with a high degree of technical success for hepatic vein embolization in patients with small future liver remnants needing DVE.

2.
Scand Cardiovasc J ; 58(1): 2335906, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38613333

RESUMEN

Objective: The multibranched off-the-shelf Zenith® t-Branch (Cook Medical, Bloomington, IN) device is commonly chosen for endovascular repair of thoracoabdominal aortic aneurysms. The aim of this study was to report early and mid-term outcomes in all patients treated with the t-Branch in Norway; Design and Methods: A retrospective multicenter study with Norwegian centers performing complex endovascular aortic repair was undertaken. T-Branch patients from 2014 to 2020 were included. All postoperative computed tomography angiography images were reviewed, and demographic, anatomical, perioperative and follow-up data were analyzed; Results: Seventy patients were treated in a single-step (n = 55) or staged (n = 15) procedure. Symptomatic presentation was seen in 20 patients, six of which had a contained rupture. Technical success was 87% (n = 59), with failures caused by unsuccessful bridging of target vessels (n = 4), target vessel bleeding (n = 3), persisting type 1c endoleak (n = 1) and t-Branch malrotation (n = 1). 30-day mortality was 9% (n = 6) and was associated with high BMI (p = .038). The spinal cord ischemia rate was 21% (n = 15) and was associated with type II aneurysms (OR 5.4, 95% CI 1.1-26.7, p = .04), smoking (OR 6.0, 95% CI 1.3-27.6, p = .02) and intraoperative blood loss (OR 1.1, 95% CI 1.0-1.3, p = .01). Survival at one, two and three years was 84 ± 4%, 70 ± 6% and 67 ± 6%, respectively. Freedom from aortic-related reinterventions at one, two and three years was 80 ± 5%, 65 ± 7% and 50 ± 8%, respectively; Conclusion: The study showed low early mortality (9%) and satisfactory mid-term survival. Technical success was achieved in acceptable 87% of procedures. The rate of spinal cord ischemia was high, occurring in 21% of patients.


This paper provides a national experience of all TAAA patients treated with the multibranched t-Branch stent graft in Norway in a multi-center study. As we aimed at including all Norwegian patients operated with the device, the paper adds real-world data on t-Branch outcomes from four regional smaller-volume vascular centers.The paper provides technical and clinical mid-term results with several patients being followed up for >3 years.Technical success was achieved in 87% of procedures.The 30-day mortality rate was 9% and survival at one, two and three years was 85 ± 4%, 70 ± 6% and 67 ± 6%, respectively.Spinal cord ischemia was associated with Crawford type II aneurysms, smoking and intraoperative blood loss.


Asunto(s)
Aneurisma de la Aorta Toracoabdominal , Procedimientos Endovasculares , Isquemia de la Médula Espinal , Humanos , Aorta , Angiografía , Procedimientos Endovasculares/efectos adversos
3.
Eur J Vasc Endovasc Surg ; 66(6): 814-820, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37722651

RESUMEN

OBJECTIVE: To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. METHODS: This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. RESULTS: Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. CONCLUSION: Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.


Asunto(s)
Aneurisma , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Masculino , Humanos , Femenino , Persona de Mediana Edad , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/cirugía , Estudios Retrospectivos , Implantación de Prótesis Vascular/efectos adversos , Resultado del Tratamiento , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Aneurisma/cirugía , Stents , Procedimientos Endovasculares/efectos adversos
4.
Acta Radiol ; 64(6): 2205-2210, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37116869

RESUMEN

BACKGROUND: Endovascular aortic repair with fenestrated or branched endografts is technically challenging, and proper intraoperative assessment of all stent graft components with only angiography and fluoroscopy can be difficult. Intraoperative computed tomography (CT) imaging can be a valuable aid for the operators in the evaluation of stent grafting results prior to completion of surgery. PURPOSE: To examine the feasibility of performing intraoperative CT imaging during fenestrated and branched endovascular aortic repair (f-bEVAR) under sterile conditions and with patients under general anesthesia. MATERIAL AND METHODS: Intraoperative CT imaging was performed in 10 patients undergoing elective aortic repair with fenestrated or branched endografts. Adverse events, time consumption for CT set-up and image acquisition, and additional radiation dose to the patient were recorded. CT image quality was graded. Immediate corrective maneuvers performed based on the CT findings was registered. RESULTS: There were no adverse events related to intraoperative CT imaging. The median additional operating time by including intraoperative CT was 16 min (interquartile range [IQR] = 12-19), comprising 7% of the median total operating time. The median estimated additional radiation dose to the patient was 4.8 mSv (IQR = 3.8-4.9). All intraoperative CT examinations were considered to be of sufficient quality for stent graft evaluation. No immediate corrective procedures were performed on the basis of CT findings in this study cohort. CONCLUSION: CT imaging intraoperatively during f-bEVAR is feasible with an acceptable increase in operating time and radiation dose.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Prótesis Vascular , Aneurisma de la Aorta Torácica/etiología , Aneurisma de la Aorta Torácica/cirugía , Estudios de Factibilidad , Reparación Endovascular de Aneurismas , Aortografía/métodos , Resultado del Tratamiento , Procedimientos Endovasculares/métodos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Estudios Retrospectivos , Factores de Riesgo
5.
J Plast Reconstr Aesthet Surg ; 77: 46-53, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36549122

RESUMEN

PURPOSE: The aim of this observational study was to assess health-related quality of life (HRQOL) changes in patients with vascular malformations, over a period of almost eight years, and to assess clinical and demographic characteristics possibly associated with HRQOL changes. METHODS: Eighty out of 111 patients who were included in a previously published comparative HRQOL study accepted inclusion in this follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. Linear mixed models and linear regression models were applied to assess HRQOL change and possible associations with demographic and clinical variables. RESULTS: The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. Ninety-six out of 111 (86.5%) patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems (difference=13.5; 95% CI [1.6, 25.3]) and Bodily pain (difference=11.3; 95% CI [3.8, 18.8]). No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in the domains Physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change. CONCLUSIONS: Over a period of almost eight years, significant improvement of SF-36 scores was observed in the physical domains RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.


Asunto(s)
Calidad de Vida , Malformaciones Vasculares , Humanos , Femenino , Adulto , Calidad de Vida/psicología , Estudios de Seguimiento , Estudios Prospectivos , Encuestas y Cuestionarios , Dolor
7.
Int J Surg Case Rep ; 92: 106837, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35231731

RESUMEN

INTRODUCTION AND IMPORTANCE: There is lack of evidence regarding the best treatment option for metastatic melanoma. In patients with a single splenic metastasis, preoperative superselective embolization followed by partial splenectomy (PS) could be a feasible treatment strategy to preserve splenic function and hopefully reduce the risk of postoperative bleeding. To our knowledge, this two-step procedure has yet not been published in patients with splenic metastasis. CASE PRESENTATION: We present the case of a 73-year-old man with stage IV melanoma consisting of a single splenic metastasis located at the lower pole. Four days prior to surgery, the patient underwent percutaneous superselective embolization of the segmental arteries going to the lower splenic pole. Subsequent, PS was performed using an upper midline laparotomy were a clearly visible tumor was found at the devascularized lower third of the spleen. The splenic parenchyma was divided using an energy device and hemostasis was secured with diathermia and a hemostatic patch. The patient had an uncomplicated recovery and was discharged home on postoperative day 8. Histology revealed an 8 mm, partly necrotic metastasis from a melanoma. There were no signs of recurrency at his last control four months postoperative. CLINICAL DISCUSSION: There are no guidelines on how splenic metastasis from melanoma are to be removed, nor any literature on postoperative splenic function or survival after PS. CONCLUSION: Superselective embolization followed by PS for metastatic melanoma could be a feasible treatment approach in highly selective patients where there is a strong desire to preserve splenic function.

8.
Cardiovasc Intervent Radiol ; 45(4): 450-458, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34907454

RESUMEN

PURPOSE: To examine if the addition of a central vascular plug (CVP) to portal vein embolization (PVE) with N-butyl cyanoacrylate-glue (NBCA) increases future liver remnant (FLR) growth. MATERIAL AND METHODS: This is a single-center retrospective study of 115 consecutive patients with colorectal liver metastases undergoing PVE in 2013-2019. All patients were embolized with NBCA as the main embolic agent. In 2017-2019 NBCA was combined with a CVP in the central part of the right portal vein. Growth of the FLR and standardized FLR (sFLR) including degree of hypertrophy (DH) and kinetic growth rate (KGR) were analyzed, as well as procedure data such as use of cone-beam CT (CBCT), dose area product (DAP), fluoroscopy time and contrast dose. RESULTS: A total of 40 patients (35%) underwent PVE with a combination of CVP and NBCA. The DH was higher in these patients after 4 weeks, mean 13.6% (SD 7.8) vs. 10.5% (SD 6.4; p = 0.022), verified in multivariate analysis (coefficient 4.1, p = 0.015). A CVP did not significantly increase the resection rate (90% vs 82%, p = 0.4). Cone beam CT was used in 65 patients (57%). Use of CBCT did not affect FLR growth, and fluoroscopy time and contrast doses were not different in patients having a CBCT or not. Slightly lower DAP (median 3375 vs. 4499 cGy*cm2; p = 0.09) was seen in procedures where CBCT was used. CONCLUSION: A CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.


Asunto(s)
Embolización Terapéutica , Enbucrilato , Neoplasias Hepáticas , Embolización Terapéutica/métodos , Enbucrilato/uso terapéutico , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento
9.
PLoS One ; 16(3): e0247615, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33705460

RESUMEN

BACKGROUND: Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged. METHODS: To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1-2 hours. RESULTS: Nine patients with graft venous thrombosis had significant lactate and lactate-to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas. CONCLUSIONS: Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.


Asunto(s)
Rechazo de Injerto/diagnóstico , Hematoma/diagnóstico , Microdiálisis/métodos , Monitoreo Fisiológico/métodos , Trasplante de Páncreas/efectos adversos , Trombosis de la Vena/diagnóstico , Adulto , Suero Antilinfocítico/uso terapéutico , Catéteres de Permanencia , Diagnóstico Precoz , Estudios de Factibilidad , Femenino , Glucosa/metabolismo , Glicerol/metabolismo , Rechazo de Injerto/inmunología , Rechazo de Injerto/metabolismo , Hematoma/etiología , Hematoma/inmunología , Hematoma/metabolismo , Humanos , Inmunosupresores/uso terapéutico , Ácido Láctico/metabolismo , Masculino , Microdiálisis/instrumentación , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Ácido Pirúvico/metabolismo , Tacrolimus/uso terapéutico , Trombosis de la Vena/etiología , Trombosis de la Vena/inmunología , Trombosis de la Vena/metabolismo
10.
Langenbecks Arch Surg ; 405(5): 657-664, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32621087

RESUMEN

PURPOSE: To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. METHODS: Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. RESULTS: A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78-100%, a clinical success rate of 72-100%, and a long-term patency of 57-100%, whereas the procedure-related complication rate varied from 0-33.3%. CONCLUSIONS: Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Vena Porta/cirugía , Complicaciones Posoperatorias/cirugía , Stents , Adulto , Anciano , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Vena Porta/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos
11.
J Plast Reconstr Aesthet Surg ; 72(12): 1880-1886, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31636028

RESUMEN

PURPOSE: The aim of this study was to assess Health-Related Quality of Life (HRQoL) in a population of patients with vascular malformations outside the central nervous system (CNS) and to compare the results with data from a national reference population. METHODS: In total, 111 consecutive patients above 14 years of age and referred for the first time to the national vascular malformation center from September 2011 to December 2012 were included. HRQoL was assessed using the Short-Form 36-item questionnaire (SF-36), which is a validated questionnaire with eight domains, covering both physical and mental aspects of HRQoL. The results were compared with national reference values. Possible association between HRQoL and selected demographic and clinical variables was analyzed using linear regression analysis. RESULTS: The sample consisted of 47 men (42.3%) and 64 women (57.7%). The median age of patients was 27 years (range 14-63 years). Ninety-six patients (86.5%) were diagnosed with venous malformations and nine patients (8.1%) with arteriovenous malformations. Six patients had other types of malformations (9%). The patients had significantly lower SF-36 scores in all domains, except for General health, than the general population. There was a significant association between muscular involvement and lower SF-36 scores in the physical domains Bodily pain and Role limitation due to physical problems. CONCLUSIONS: Our data suggest that patients with vascular malformations outside the CNS have impaired quality of life when compared with the general population. Muscular involvement seems to be associated with worse HRQoL in the physical aspects.


Asunto(s)
Calidad de Vida , Malformaciones Vasculares/epidemiología , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Dolor Musculoesquelético/epidemiología , Dolor Musculoesquelético/psicología , Noruega/epidemiología , Malformaciones Vasculares/psicología , Adulto Joven
12.
Eur Radiol ; 29(9): 5013-5021, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30737565

RESUMEN

OBJECTIVES: Invasive treatment of tumors adjacent to large hepatic vessels is a continuous clinical challenge. The primary aim of this study was to examine the feasibility of ablating liver tissue adjacent to large hepatic and portal veins with magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU). The secondary aim was to compare sonication data for ablations performed adjacent to hepatic veins (HV) versus portal veins (PV). MATERIALS AND METHODS: MRgHIFU ablations were performed in six male land swine under general anesthesia. Ablation cells of either 4 or 8 mm diameter were planned in clusters (two/animal) adjacent either to HV (n = 6) or to PV (n = 6), with diameter ≥ 5 mm. Ablations were made using 200 W and 1.2 MHz. Post-procedure evaluation was made on contrast-enhanced MRI (T1w CE-MRI), histopathology, and ablation data from the HIFU system. RESULTS: A total of 153 ablations in 81 cells and 12 clusters were performed. There were visible lesions with non-perfused volumes in all animals on T1w CE-MRI images. Histopathology showed hemorrhage and necrosis in all 12 clusters, with a median shortest distance to vessel wall of 0.4 mm (range 0-2.7 mm). Edema and endothelial swelling were observed without vessel wall rupture. In 8-mm ablations (n = 125), heat sink was detected more often for HV (43%) than for PV (19%; p = 0.04). CONCLUSIONS: Ablations yielding coagulative necrosis of liver tissue can be performed adjacent to large hepatic vessels while keeping the vessel walls intact. This indicates that perivascular tumor ablation in the liver is feasible using MRgHIFU. KEY POINTS: • High-intensity focused ultrasound ablation is a non-invasive treatment modality that can be used for treatment of liver tumors. • This study shows that ablations of liver tissue can be performed adjacent to large hepatic vessels in an experimental setting. • Liver tumors close to large vessels can potentially be treated using this modality.


Asunto(s)
Venas Hepáticas/cirugía , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Neoplasias Hepáticas/cirugía , Imagen por Resonancia Magnética/métodos , Vena Porta/cirugía , Cirugía Asistida por Computador/métodos , Animales , Modelos Animales de Enfermedad , Venas Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/irrigación sanguínea , Masculino , Vena Porta/diagnóstico por imagen , Porcinos
13.
Acta Radiol ; 60(6): 702-709, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30205701

RESUMEN

BACKGROUND: Treatment outcome for hepatocellular carcinoma (HCC) is related to tumor burden and liver function. Grading systems assessing liver function need validation in different clinical settings. PURPOSE: To evaluate drug-eluting embolic transarterial chemoembolization (DEE-TACE) in Child-Pugh A HCC with respect to albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (P-ALBI) grade. MATERIAL AND METHODS: Forty-nine patients with Child-Pugh class A, diagnosed with HCC and allocated to DEE-TACE treatment, were retrospectively analyzed regarding tumor and treatment characteristics, radiological response (mRECIST) one month post treatment, overall survival (OS), and adverse events (AEs; CTCAE, grades ≥3) with respect to ALBI and P-ALBI grade. RESULTS: There were 21 ALBI 1 patients, 29 P-ALBI 1 patients, and 19 patients were both ALBI and P-ALBI 1. Objective response rate was 74% with no statistically significant difference for ALBI (1 vs. 2; P = 0.08), or P-ALBI (1 vs. 2; P = 0.49). OS was 14.8 months (range = 1.7-62.0; ALBI 1 vs. 2: P = 0.08; P-ALBI 1 vs. 2: P = 0.003). OS in responders with ALBI 1 and 2 was 28.9 vs.10.2 months ( P = 0.02), and P-ALBI 1 and 2 was 26.7 vs. 8.6 months ( P < 0.001). In multivariate analyses, both ALBI 2 (HR = 2.4, P = 0.02) and P-ALBI 2 (HR = 3.3, P < 0.01) were negative prognostic factors for survival. There were 15 AEs in 13 patients, with hepatic failure only occurring in ALBI 2 and P-ALBI 2 patients. CONCLUSION: P-ALBI grade 1 and 2 differentiated survival in Child-Pugh A patients treated with DEE-TACE. Both grading systems can differentiate survival in patients responding to treatment.


Asunto(s)
Bilirrubina/sangre , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Albúmina Sérica/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/sangre , Femenino , Humanos , Hígado/metabolismo , Hígado/patología , Hígado/fisiopatología , Pruebas de Función Hepática/métodos , Pruebas de Función Hepática/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Carga Tumoral
14.
Tidsskr Nor Laegeforen ; 137(4): 279-282, 2017 Feb.
Artículo en Noruego | MEDLINE | ID: mdl-28225234

RESUMEN

BACKGROUND To estimate the prevalence, symptoms, causes and treatment of renovascular disease in children, and also to assess the degree of secondary organ damage to the heart, kidneys and eyes (end organ damage).MATERIAL AND METHOD Retrospective review of data for all children (0 - 16 years) who were examined for resistant hypertension in the period 1998 - 2013 at Oslo University Hospital Rikshospitalet.RESULTS A total of 21 children/adolescents (median age 8.5 years, 11 girls) were assessed and treated for resistant hypertension in the study period. Altogether had 38 % no symptoms at the time of diagnosis and 19 % had classical symptoms of hypertension. Fifteen patients received invasive treatment in the form of percutaneous transluminal renal angioplasty (PTRA) (n = 5), nephrectomy (n = 6), coiling (n = 1), autotransplantation (n = 1) or a combination of these (n = 2). Blood pressure improved following treatment in 10 of 14 patients for whom outcomes were recorded in the medical records. End organ damage to the heart and retina was observed in 60 % and 50 % of patients, respectively.INTERPRETATION Children with severely elevated blood pressure as a result of renovascular disease often have unspecific or no symptoms. Blood pressure improved following invasive treatment in 10 of 14 children and few complications were recorded. Invasive treatment may be considered in children and adolescents when standard treatment for hypertension is insufficient.


Asunto(s)
Hipertensión Renovascular , Adolescente , Angioplastia , Niño , Preescolar , Femenino , Displasia Fibromuscular/complicaciones , Humanos , Hipertensión , Hipertensión Renovascular/diagnóstico , Hipertensión Renovascular/etiología , Hipertensión Renovascular/cirugía , Lactante , Masculino , Nefrectomía , Enfermedades Raras , Obstrucción de la Arteria Renal/complicaciones , Estudios Retrospectivos , Arteritis de Takayasu/complicaciones , Trasplante Autólogo
15.
Cardiovasc Intervent Radiol ; 38(6): 1532-41, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25832764

RESUMEN

PURPOSE: The purpose of this study was to evaluate treatment response and complications of transarterial chemoembolization using drug-eluting beads loaded with irinotecan (DEBIRI) in patients with liver metastases from uveal melanoma (UM). MATERIALS AND METHODS: Patients treated with DEBIRI (n = 14) were retrospectively analyzed regarding overall survival, compared to patients (n = 14) treated with intravenous dacarbazine (DTIC). Median overall survival was calculated from time of diagnosis of metastatic disease (OS1) and start of treatment (OS2). Radiological response for DEBIRI was assessed according to RECIST 1.1 on contrast-enhanced computed tomography (CT), obtained 1.5 months (range 1.2-3.7) post treatment. Major complications of DEBIRI were defined according to the Society of Interventional Radiology classification for complications by outcome. RESULTS: In the DEBIRI group, OS1 was 14.8 months (range 3.9-47.5), and OS2 was 9.4 months (range 1.7-39). Further, 11/13 (84.6%) of these patients had progressive disease on first follow-up CT and new lesions were seen in nine. There were 12 major complications in nine patients, possibly including one case of mortality due to disseminated intravascular coagulation (DIC). CONCLUSION: For patients with liver metastases from UM, the effect on overall survival of DEBIRI alone is questionable. Compared to previous reports, the response rate of DEBIRI was poor, with new liver lesions observed in the majority of patients. Major complications possibly included one case of DIC.


Asunto(s)
Antineoplásicos Fitogénicos/administración & dosificación , Camptotecina/análogos & derivados , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Melanoma/patología , Neoplasias de la Úvea/patología , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos Fitogénicos/efectos adversos , Camptotecina/administración & dosificación , Camptotecina/efectos adversos , Quimioembolización Terapéutica/efectos adversos , Medios de Contraste , Sistemas de Liberación de Medicamentos , Femenino , Humanos , Irinotecán , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica , Estudios Retrospectivos , Terapéutica , Tomografía Computarizada por Rayos X , Adulto Joven
18.
Minim Invasive Ther Allied Technol ; 22(2): 73-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22793778

RESUMEN

INTRODUCTION: The purpose of this study was to evaluate the feasibility and safety of the Sonalleve high-intensity focused ultrasound (HIFU; Philips Healthcare, Vantaa, Finland) system in ablating uterine fibroids in a 3T magnet. MATERIAL AND METHODS: Seven women were included in this study. Treatment was performed according to the manufacturer's recommendation. Technical data describing the HIFU procedures were collected. On MR images at baseline, immediately and 30 days after ablation, we evaluated the volumes of the uterus, the dominant fibroid and the ablation zone. The Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire was used to assess potential clinical response. RESULTS: The procedure was technically feasible in all patients. The median number of sonications performed during each procedure was 20 (range 2-27) per patient, the maximum temperature in all sonication cells was about 68°C. The median procedure time was 156 minutes (range 95-164). The non-perfused volume after treatment ranged from 1 to 27 ml and was unchanged or decreased in all but one patient at 30 days follow-up. There were no major adverse events. DISCUSSION: In our 3T magnet the system was able to heat tissue and induce areas of non-enhancement within uterine fibroids without major complications. Clinical benefit remains to be proven.


Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Leiomioma/cirugía , Imagen por Resonancia Magnética/métodos , Neoplasias Uterinas/cirugía , Adulto , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Ultrasonido Enfocado de Alta Intensidad de Ablación/efectos adversos , Ultrasonido Enfocado de Alta Intensidad de Ablación/instrumentación , Humanos , Leiomioma/patología , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios , Temperatura , Factores de Tiempo , Resultado del Tratamiento , Neoplasias Uterinas/patología
19.
Acta Radiol ; 53(1): 34-8, 2012 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-22184676

RESUMEN

BACKGROUND: In order to achieve sustained symptom control and minimize the risk of recurrence, uterine artery embolization (UAE) should aim at complete infarction of all fibroids. PURPOSE: To retrospectively evaluate the infarction rate of uterine fibroids in patients that had undergone uterine artery embolization (UAE) after the introduction of contrast-enhanced ultrasound (CEUS) during UAE procedures at our institution. MATERIAL AND METHODS: Thirty patients treated with UAE between February 2006 and August 2009 were included. MR images obtained before, at 3 months, and 12 months after the procedure were reviewed. We evaluated volume changes in dominant fibroids as well as the infarction rate of all fibroids in each patient. Clinical results were evaluated by reviewing the medical records. The study was approved by the institutional review board. RESULTS: CEUS was technically successfully performed during the UAE procedure in all patients. In five cases the endpoint of embolization was adjusted based on findings at CEUS. The mean volume shrinkage of dominant fibroids was 39.8% after 3 months and 59.8% after 12 months. There was complete infarction of all fibroid tissue in 97% of patients at 3 months and 96% at 12 months. No major complications were observed. CONCLUSION: After the introduction of CEUS during UAE procedures in our institution, high infarction rates were achieved.


Asunto(s)
Medios de Contraste , Infarto/prevención & control , Leiomioma/diagnóstico por imagen , Leiomioma/cirugía , Ultrasonografía Intervencional/métodos , Embolización de la Arteria Uterina/métodos , Adulto , Femenino , Gadolinio DTPA , Humanos , Aumento de la Imagen/métodos , Infarto/etiología , Leiomioma/irrigación sanguínea , Leiomioma/complicaciones , Persona de Mediana Edad , Estudios Retrospectivos , Prevención Secundaria , Resultado del Tratamiento
20.
Cardiovasc Intervent Radiol ; 32(5): 980-7, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19641959

RESUMEN

Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.


Asunto(s)
Anticoagulantes/administración & dosificación , Cateterismo Periférico/métodos , Terapia Trombolítica/métodos , Extremidad Superior/irrigación sanguínea , Trombosis de la Vena/tratamiento farmacológico , Adolescente , Adulto , Angioplastia de Balón , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Flebografía , Síndrome Postrombótico/prevención & control , Punciones , Radiografía Intervencional , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del Tratamiento , Ultrasonografía Intervencional , Trombosis de la Vena/diagnóstico por imagen
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