Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding.

BACKGROUND: The transjugular intrahepatic portosystemic shunt (TIPS) is effective for treating complications of portal hypertension in cirrhotic adults but the experience in children is limited. OBJECTIVE: To retrospectively review the safety and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS in children with acute or recurrent gastrointestinal bleeding. MATERIALS AND METHODS: We reviewed the medical records of children who received implants of 10-mm-diameter PTFE-covered endoprostheses for acute or recurring upper gastrointestinal bleeding caused by medically or endoscopically uncontrollable varices. The recurrence of upper gastrointestinal bleeding, associated complications and permeability were assessed with Doppler sonography sequentially or up to transplantation. RESULTS: In all children (n = 12; mean age 9 years; mean weight 30 kg) a single endoprosthesis was implanted with no associated mortality. The mean initial transhepatic gradient was 15 mmHg (range 3-21 mmHg), dropping to 7 mmHg (range 1-12 mmHg) after TIPS. Immediate complications were mild encephalopathy (n = 1) and acute occlusion of the TIPS (n = 1). Stenosis of the TIPS was observed in two children, at 9 months and 54 months follow-up, and thrombosis was observed in two children, at 7 months and 12 months follow-up. All four stenoses/occlusions were resolved with coaxial endoprostheses. CONCLUSION: The safety profile and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS were satisfactory in this small series of children with acute or recurrent gastrointestinal bleeding.

Percutaneous radiofrequency ablation of renal tumors in solitary kidney patients.

OBJECTIVES: In solitary kidney patients with renal cell carcinoma (RCC), radiofrequency ablation (RFA) could be effective in achieving complete tumor necrosis without increasing the risk of complications or renal failure. To analyze the outcomes of a group of solitary kidney patients treated for RCC by RFA considering tumor size and location, renal function involvement and complications. METHODS: A transversal retrospective study was performed, in which we selected 11 solitary kidney patients with 19 tumors in total treated by RFA for one or more renal tumors. A CT protocol was used for follow up. It included unenhanced series and contrast enhanced series at 1 month, 3-6 months, 12 months and yearly after RFA. Serum creatinine levels of each patient, pre RFA and within the first 48 hours after RFA, were collected. RESULTS: Complete ablation was achieved in 17 tumors (89.4%) after one or two RFA sessions. 100% of exophytic and parenchymal tumors, and 3 cm size or smaller, were completely ablated. Renal failure, immediate complications or more than 24 hours hospitalization were not observed in 10 (90.1%) of our patients. CONCLUSIONS: RFA treatment for RCC in solitary kidney patients has a high success rate; it does not affect renal function and achieves complete initial tumor necrosis, especially in exophytic, parenchymal and 3 cm or smaller lesions.

Bronchial artery aneurysm treated with aortic stent graft and fibrin sealant.

Bronchial artery aneurysm occurs rarely but can cause a life-threatening hemorrhage when it ruptures. The traditional therapy has been aneurysm resection or transcatheter arterial embolization. We report a case of mediastinal bronchial artery aneurysm which could not be occluded with transcatheter arterial embolization and instead was treated with a thoracic aortic stent graft and embolization with fibrin sealant.

[Utility of arteriography with selective arterial calcium injection for the diagnosis of insulinoma]. / Utilidad de la arteriografía con inyección intraarterial selectiva de calcio en el diagnóstico del insulinoma.

BACKGROUND: Common preoperative imaging techniques for the diagnosis of insulinomas do not lead to an effective localization in 40% cases. We present here our experience with arteriography followed by selective arterial calcium injection (AACI). METHOD: Retrospective review of AACIs and other techniques performed in patients with endogenous hyperinsulinism. RESULTS: AACI either localized the tumor or at least conditional its surgical resection in nine out of 11 cases. In 2 out of 11 patients, the test yielded a negative result (factitious hypoglycemia). Only 4 tumors were identified by other techniques. CONCLUSIONS: AACI is a first-choice technique for the preoperative localization of insulinomas. It may also help rule out other causes of hypoglycemia.