RESUMO
Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.
Assuntos
Falso Aneurisma/cirurgia , Artéria Hepática , Melena/etiologia , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Stents , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia , Seguimentos , Artéria Hepática/diagnóstico por imagem , Humanos , Abscesso Hepático/complicações , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Here, we report evidence for the production of ozone in human disease. Signature products unique to cholesterol ozonolysis are present within atherosclerotic tissue at the time of carotid endarterectomy, suggesting that ozone production occurred during lesion development. Furthermore, advanced atherosclerotic plaques generate ozone when the leukocytes within the diseased arteries are activated in vitro. The steroids produced by cholesterol ozonolysis cause effects that are thought to be critical to the pathogenesis of atherosclerosis, including cytotoxicity, lipid-loading in macrophages, and deformation of the apolipoprotein B-100 secondary structure. We propose the trivial designation "atheronals" for this previously unrecognized class of steroids.
Assuntos
Arteriosclerose/metabolismo , Artérias Carótidas/metabolismo , Colestanos/metabolismo , Colesterol/metabolismo , Noresteroides/metabolismo , Ozônio/metabolismo , Esteróis/metabolismo , Colestanos/sangue , Colestanos/farmacologia , Dimetil Sulfóxido/farmacologia , Endarterectomia das Carótidas , Células Espumosas/efeitos dos fármacos , Células Espumosas/fisiologia , Humanos , Hidrazonas/metabolismo , Índigo Carmim/metabolismo , Inflamação , Leucócitos/metabolismo , Lipoproteínas LDL/metabolismo , Lipoproteínas LDL/farmacologia , Noresteroides/sangue , Noresteroides/farmacologia , Oxirredução , Oxigênio Singlete/metabolismo , Esteróis/sangue , Esteróis/farmacologia , Acetato de Tetradecanoilforbol/farmacologiaRESUMO
This phase I open label, dose-escalating study shows that gene transfer of vascular endothelial growth factor-2 naked deoxyribonucleic acid by direct myocardial injection by way of thoracotomy in patients with Canadian Cardiovascular Society class 3 or 4 angina is feasible and safe. The procedure is well tolerated, with few major adverse cardiac events at 1 year, and without complications directly related to gene expression. In this prospective, nonblinded study, the procedure is associated with clinical improvement; however, there was no angiographic evidence of angiogenesis and there is a great potential for a sham or placebo effect in the study patients. A randomized phase III trial is underway that will help determine the efficacy of vascular endothelial growth factor-2 gene transfer in "no-option" patients.