RESUMO
The transplantation of the abdominal organs has a major role in the treatment of several diseases. All subspecialities affected with the transplantation showed a rapid development in the last decades. The cooperation of the specialists of different segments of medicine provides the success of organ transplantation. Teamwork is necessary throughout the whole process starting from securing the technical background and proper human workforce, followed by the lifelong management of organs and recipients as well. One of the key players of organ transplantation is radiology and interventional radiology - the role of the latter one is discussed in this review, including the minimally invasive treatment of pre- and post-transplantation situations and diseases. Besides vascular and non-vascular interventions, the options of interventional oncology will be mentioned based on international literature and Hungarian experience. Orv Hetil. 2018; 159(46): 1940-1947.
Assuntos
Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia Intervencionista/estatística & dados numéricos , Humanos , Transplante de Rim/estatística & dados numéricos , Transplante de Fígado/estatística & dados numéricos , Transplante de Pâncreas/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Radiologia Intervencionista/tendênciasRESUMO
Invasive radiological procedures provide more and more therapeutic options for patients with liver cancer. The treatment options previously used as a 2nd/3rd line treatment are making their way to 1st line treatment in selected cases. In this review, the authors take an overview of the interventional radiological procedures used in the most frequent liver neoplasms. There is a rapid development in ablational therapy, especially in the volumetric planning and stereotactic navigation. Using those new devices, the reliability of the ablation can improve a lot. At the field of embolization, new randomized studies were published recently, which can help to choose the right patient group who gains the most from the treatment. Interventional radiology has now an established place in the team of specialists treating malignant liver diseases.
Assuntos
Neoplasias Hepáticas/radioterapia , Radiologia Intervencionista/métodos , Embolização Terapêutica , Humanos , Imageamento Tridimensional , Radiocirurgia , Reprodutibilidade dos TestesRESUMO
PURPOSE: Donor site pain affects 32-43 % of patients after anterior cruciate ligament surgery when the autograft is freshly harvested bone-patellar tendon-bone tissue. Our aim was to compare functional and morphological differences between donor sites with and without serum albumin-coated bone allograft filling. METHODS: After harvesting and implanting the graft, the tibia site was filled with either fresh autologous cancellous bone enhanced with albumin-coated allograft or autologous bone alone. The patella site was filled either with albumin-coated allograft or with blood clot. Knee function was evaluated by the VISA, Lysholm and IKDC scores and a visual analog scale of pain during standing, kneeling and crouching after six weeks and six months. Computed tomography was performed at six months for morphological evaluation. RESULTS: At six weeks, both groups were still recovering from surgery and the overall knee function was still impaired but the functional scores were significantly higher in the Bone-Albumin group. The pain with crouching and kneeling was also lower as compared to controls. At six months, the knee function scores were close to normal, with a slight decrease in the controls. Pain at kneeling was still prominent in the controls, but significantly lower in the Bone-Albumin group. Computed tomography showed significantly smaller bone defects and higher bone density in the Bone-Albumin group. CONCLUSIONS: Results from the present study indicate that donor site pain, a disturbing long-term side effect of bone-patellar tendon-bone surgery, is significantly reduced if bone buildup in the patella and the tibia is augmented by serum albumin-coated bone allografts.
Assuntos
Albuminas/administração & dosagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Transplante Ósseo , Enxerto Osso-Tendão Patelar-Osso/métodos , Tíbia/cirurgia , Adulto , Autoenxertos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteogênese/fisiologia , Tíbia/fisiopatologia , Sítio Doador de Transplante/fisiopatologia , Sítio Doador de Transplante/cirurgia , Transplante Autólogo , Transplante HomólogoRESUMO
INTRODUCTION: Depending on their size and location, some benign tumors can cause prolonged discomfort and even rupture and fatal bleeding in severe cases. Hitherto the therapeutic strategies for such lesions were observation, surgery and in selected cases transarterial embolization. AIM: Our aim was to present the possibilities of thermoablation for treating lesions. METHOD: Here we present interventions of four patients in Semmelweis University Department of Transplantation and Surgery. A thyroid adenoma and a kidney angiomyolipoma were treated with radiofrequency ablation. Two patients with a liver haemangioma were treated with microwave thermoablation technique. RESULTS: Complications were not observed in any of the cases. In most cases, the size of the treated lesions decreased. The mean decrease in volume was 32.7%. The contrast enhancement of the lesions also decreased, the mean reduction in contrast enhancing volume was 75.3%. CONCLUSIONS: Thermoablational procedures for the benign tumors presented above are safe. The therapy shows excellent cosmetic results, a shorter hospital stay and quicker recovery. Orv. Hetil., 2016, 157(51), 2040-2047.
Assuntos
Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Neoplasias Hepáticas/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Neoplasias Renais/patologia , Neoplasias Hepáticas/patologia , Masculino , Temperatura , Nódulo da Glândula Tireoide/patologiaRESUMO
Interventional radiology provides fast, straightforward and tolerable solutions for many medical problems including acute and subacute situations. Aspiration and drainage of fluid collections, biliary and endourologic interventions and gastrointestinal interventions are parts of non-vascular interventions. In addition, the authors discuss in detail interventional radiological treatment options in patients with hemoptysis. In acute cases interventions must be performed within 12-24 hours. For background, an everyday 24 hours service should be provided with well-trained personnel, high quality equipment and devices, and a reasonable financial reimbursement should be included, too. Multidisciplinary teamwork, consultations, consensus in indications and structured education should make these centers function most effectively.
Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Sistema Biliar/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Embolização Terapêutica/métodos , Trato Gastrointestinal/diagnóstico por imagem , Hemoptise/terapia , Radiografia Intervencionista , Radiologia Intervencionista , Sistema Urinário/cirurgia , Doença Aguda , Embolização Terapêutica/efeitos adversos , Trato Gastrointestinal/patologia , Trato Gastrointestinal/cirurgia , Hemoptise/diagnóstico por imagem , Humanos , Radiografia Intervencionista/métodos , Radiografia Intervencionista/tendências , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Retratamento , Sistema Urogenital/cirurgia , UrografiaRESUMO
Revascularisation aims to create a patent lumen in an acutely or chronically occluded or stenosed vessel. Interventional radiology has developed and used minimally invasive methods for decades concurring surgical methods and medical therapy. Innovative fields in healthcare may be handicapped since revolutionary solutions usually gain wide acceptance slowly and the results of randomized controlled trials are reported late. At present endovascular recanalization, dilatation and stent placement have achieved a well-established role in the treatment of stenosis or occlusion of the aorta, and renal and peripheral arteries.
Assuntos
Aorta/cirurgia , Estenose da Valva Aórtica/cirurgia , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Radiografia Intervencionista/métodos , Radiologia Intervencionista/métodos , Obstrução da Artéria Renal/cirurgia , Aorta/patologia , Estenose da Valva Aórtica/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/patologia , Artéria Ilíaca/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Obstrução da Artéria Renal/diagnóstico por imagemRESUMO
INTRODUCTION: The authors reviewed the prevalence of postoperative infections, the results of bacterium cultures, and the incidence of multidrug resistance in their liver transplanted patients during a period between 2003 and 2012. AIM: The aim of this study was to analyse risk factors and colonisations of bacterial infections. METHOD: The files of 408 patients (281 bacterium cultures) were reviewed. RESULTS: Of the 408 patients 70 had a postoperative infection (17%); 58 patients (14.2%) had positive and 12 patients (2.9%) negative bacterial culture results. Cholangitis was found in 7 cases (12.1%), abdominal infection in 17 cases (29.3%), and pulmonary infection in 28 cases (48.3%). Postoperative infection was more frequent in patients with initial poor graft function, acute renal insufficiency, biliary complication, and in those with intraabdominal bleeding. The 1-, 3- and 5-year cumulative survival of patients who had infection was 70%, 56% and 56%, respectively, whereas the cumulative survival data of patients without infection was 94%, 87% and 85%, respectively (p<0.001). Multidrug resistance was found in 56% of the positive cultures, however, the one-year survival was not different in patients who had multidrug resistance positive and negative bacterial infection (both 70.2%). CONCLUSIONS: Infection control must target the management of multidrug resistance microbes through encouraging prevention, hygienic, and isolation rules, improving the operative, transfusion, and antimicrobial policy in a teamwork setting.
Assuntos
Infecções Bacterianas/epidemiologia , Farmacorresistência Bacteriana Múltipla , Controle de Infecções/métodos , Transplante de Fígado , Adulto , Idoso , Infecções Bacterianas/etiologia , Infecções Bacterianas/mortalidade , Transfusão de Sangue/normas , Colangite/complicações , Colangite/epidemiologia , Feminino , Trato Gastrointestinal/microbiologia , Sobrevivência de Enxerto , Humanos , Hungria/epidemiologia , Incidência , Transplante de Fígado/efeitos adversos , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/microbiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de SobrevidaRESUMO
BACKGROUND AND AIM: Management of hepatitis C virus (HCV) recurrence is a major challenge after liver transplantation. Significant dysregulated expression of HCV receptors (i.e. claudin-1, occludin, tetraspanin CD81, scavenger receptor type B1) has been shown recently during HCV infection. This might facilitate hepatocytic entry and reinfection of HCV. MicroRNAs (miRs) play role in the regulation of gene expression. We aimed to characterize miR expression profiles related to HCV infection and antiviral therapy in adult liver transplant recipients, with special emphasis on miRs predicted to target HCV receptors. METHODS: Twenty-eight adult liver transplant recipients were enrolled in the study. Paired biopsies were obtained at the time of HCV recurrence and at the end of antiviral treatment. MiRs for HCV receptors were selected using target prediction software. Expression levels of miR-21, miR-23a miR-34a, miR-96, miR-99a*, miR-122, miR-125b, miR-181a-2*, miR-194, miR-195, miR-217, miR-221, and miR-224 were determined by reverse transcription-quantitative polymerase chain reaction. RESULTS: miR-99a* and miR-224 expressions were increased in HCV recurrence samples, while miR-21 and miR-194 were decreased in comparison to normal liver tissue. Increased expressions of miR-221, miR-224, and miR-217 were observed in samples taken after antiviral therapy when compared with HCV recurrence samples. High HCV titer at recurrence was associated with higher level of miR-122. CONCLUSIONS: Samples at recurrence of HCV and after antiviral therapy revealed distinct HCV-related miR expression profiles, with significant dysregulation of those miRNAs potentially targeting mRNAs of HCV receptors. In particular, miR-194 and miR-21 might be involved in the regulation of HCV receptor proteins' expression during HCV infection and antiviral therapy.
Assuntos
Antivirais/uso terapêutico , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Hepatite C/genética , Transplante de Fígado , MicroRNAs/genética , MicroRNAs/fisiologia , RNA Viral/genética , Receptores Virais/genética , Adulto , Feminino , Expressão Gênica , Regulação Viral da Expressão Gênica , Hepacivirus/patogenicidade , Hepatite C/cirurgia , Hepatite C/virologia , Humanos , Fígado/metabolismo , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Masculino , MicroRNAs/metabolismo , Pessoa de Meia-Idade , RNA Viral/fisiologia , RecidivaRESUMO
The history of organ transplantation in Hungary dates back to 50 years, and the first succesful liver transplantation was performed in the United States in that time as well. The number of patients with end stage liver disease increased worldwide, and over 7000 patients die in each year due to liver disease in Hungary. The most effective treatment of end-stage liver disease is liver transplantation. The indications of liver transplantation represent a wide spectrum including viral, alcoholic or other parenchymal liver cirrhosis, but cholestatic liver disease and acute fulminant cases are also present in the daily routine. In pediatric patients biliary atresia and different forms of metabolic liver disorders represent the main indication for liver transplantation. The results of liver transplantation in Hungary are optimal with over 80% long-term survival. For better survival individual drug therapy and monitoring are introduced in liver transplant candidates.
Assuntos
Imunossupressores/administração & dosagem , Transplante de Fígado , Obtenção de Tecidos e Órgãos , Listas de Espera , História do Século XX , Humanos , Hungria , Terapia de Imunossupressão/métodos , Transplante de Fígado/história , Transplante de Fígado/métodos , Transplante de Fígado/tendências , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Obtenção de Tecidos e Órgãos/tendênciasRESUMO
INTRODUCTION: Management of hepatitis C virus recurrence is a challenge after liver transplantation. AIM: The aim of the authors was to analyse the outcome of liver transplantation performed in hepatitis C virus positive patients during the past ten years and to compare recent data with a previous report of the authors. METHOD: The authors retrospectively evaluated the data (donors, recipients, perioperative characteristics, patient and graft survival, serum titer of hepatitis C virus RNA, histology) of 409 patients who underwent liver transplantation between 2003 and 2012. RESULTS: 156 patients were transplanted due to hepatitis C virus associated liver cirrhosis (38%). Worse outcome was observed in these patients in comparison to hepatitis C virus negative recipients. The cumulative patient survival rates at 1, 5, and 10 year were 80%, 61%, 51% in the hepatitis C virus positive group and 92%, 85%, 79% in the hepatitis C virus negative group, respectively (p<0.001). The cumulative graft survival rates at 1, 5 and 10 year were 79%, 59% and 50% in hepatitis C virus positive and 89%, 80% and 70% in hepatitis C virus negative patients (p<0.001). Hepatitis C virus recurrence was observed in the majority of the patients (132 patients, 85%), mainly within the first year (83%). The authors observed recurrence within 6 months in 71 patients (56%), and within 3 months in 26 patients (20%). The mean hepatitis C virus recurrence free survival was 243 days. Higher rate of de novo diabetes was detected in case of early recurrence. The cumulative patient survival rates at 1, 3, 5, 10 years were 98%, 89.5%, 81% and 65% when hepatitis C virus recurrence exceeded 3 months and 64%, 53%, 30.5% and 30.5% in patients with early recurrence (p<0.001). CONCLUSIONS: Poor outcome of liver transplantation in hepatitis C virus positive patients is still a challenge. Hepatitis C virus recurrence is observed earlier after liver transplantation in comparison with a previous report of the authors. De novo diabetes occurs more frequently in case of early recurrence. Despite an immediate start of antiviral treatment, early recurrence has a significant negative impact on the outcome of transplantation.
Assuntos
Diabetes Mellitus/epidemiologia , Hepatite C/epidemiologia , Hepatite C/etiologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Doença Aguda , Adulto , Diabetes Mellitus/etiologia , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Hepacivirus/isolamento & purificação , Humanos , Hungria/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too. AIM: The aim of this study was to analyse the changes in kidney function during the first postoperative year after liver transplantation. METHOD: Retrospective data analysis was performed after primary liver transplantations (n = 319). RESULTS: impaired preoperative renal function increased the devepolment of postoperative complications and the first year cumulative patient survival was significantly worse (91,7% vs 69,9%; p<0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m2 after the first year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the first postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023). CONCLUSIONS: Selection of personalized immunosuppressive medication has a positive effect on renal function.
Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Imunossupressores/efeitos adversos , Rim/fisiopatologia , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Injúria Renal Aguda/mortalidade , Adulto , Idoso , Constrição , Diabetes Mellitus/etiologia , Diabetes Mellitus/fisiopatologia , Feminino , Síndrome Hepatorrenal/complicações , Humanos , Imunossupressores/administração & dosagem , Rim/irrigação sanguínea , Cirrose Hepática/mortalidade , Cirrose Hepática/fisiopatologia , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Medicina de Precisão , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Veia Cava InferiorRESUMO
Összefoglaló. Bevezetés: A májtranszplantációs program részeként 1995 óta létezik folyamatosan vezetett várólista Magyarországon. Célkituzés: A legfontosabb várólista-paraméterek megállapítása és nemzetközi összehasonlítása. Módszer: A szerzok az 1995. január 1. és 2019. december 31. között elso májátültetés céljából várólistára helyezett betegek adatait elemezték. Eredmények: Összesen 1722 beteget helyeztek várólistára, 1608 felnottet, 114 gyermeket. A férfiak aránya 51,2%, az átlagéletkor 45,6 év. Az évente regisztrált új jelöltek száma 25 év során közel az ötszörösére emelkedett. A listára helyezés leggyakoribb indikációja a víruseredetu cirrhosis volt (n = 451). Ezt követte a cholestaticus (n = 314) és az alkoholos májbetegség (n = 264). Rosszindulatú daganat, 82%-ban hepatocellularis carcinoma miatt 215 beteget regisztráltak. Krónikus betegségekben az átlagos Model for End-Stage Liver Disease pontszám a regisztráláskor 13,5 volt. A 2018. december 31-ig listára helyezettek (n = 1618) 61%-a részesült májátültetésben, 24%-a várakozás közben meghalt, 7%-a a mutétre alkalmatlanná vált. A mutét elotti medián várakozási ido 248 nap volt a krónikus és 2 nap az akut betegek listáján. A transzplantált tumoros betegek (n = 132) szignifikánsan rövidebb ideig vártak mutétre (medián 115,5 nap), mint a többi krónikus beteg (n = 803, medián 282 nap). Az Eurotransplanthoz való csatlakozás utáni idoszakban (2013. július 1. és 2018. december 31. között) a transzplantációs arány növekedett (67%), a várólista-halálozás (meghaltak + mutétre alkalmatlanná váltak) 24%-ra csökkent. Megbeszélés: A várólista folyamatos bovülése hozzájárult a hazai májátültetési program fejlodéséhez. A hazai várólista diagnózis szerinti összetétele a mások által közöltekkel nagyrészt egyezik. A transzplantáltak aránya a nemzetközi átlagnak megfelelo. A várólista-halálozás és a mutét elotti várakozási ido a magyarországinál alacsonyabb donációs aktivitású vagy jelentosen nagyobb várólistával rendelkezo országokéhoz hasonló. Következtetés: Várólista-paramétereink javításához a transzplantációk számának további növelése szükséges. Orv Hetil. 2022; 163(8): 301-311. INTRODUCTION: The Hungarian liver transplant program including waiting list started in 1995. OBJECTIVE: Evaluation of the wait-list parameters and comparing them with those in the literature. METHOD: Data of patients listed for primary liver transplantation between 1995 and 2019 were analyzed. RESULTS: A total of 1722 recipient candidates were registered on the liver transplant waiting list: 1608 adults (51.2% men) with mean age of 45.6 year and 114 patients aged <18 year. Virus-induced cirrhosis was the leading indication of listing (n = 451) and cholestatic liver diseases (n = 314) and alcoholic cirrhosis (n = 264) thereafter. The mean Model for End-Stage Liver Disease score was 13.5 for those with chronic disease. 61% of 1618 patients listed before December 31, 2018 underwent liver transplantation and 31% were removed from the wait-list for death or clinical deterioration. After joining Eurotransplant (period of 01. 07. 2013-31. 12. 2018), the transplant rate was 67%, the waiting list removal due to death/too sick for operation decreased to 24%. The median waiting time till transplantation was 248 days for those on elective and 2 days on acute list. Patients grafted with malignancy (n = 132) waited significantly shorter time than those with chronic non-malignant liver disease (median 115.5 versus 282 days). DISCUSSION: The composition of our waiting list by primary liver disease was similar to that of countries with large burden of hepatitis C. Transplant rate was average, wait-list mortality and waiting time were in line with those observed in low-donation countries or in the case of large volume waiting list. CONCLUSION: Listing of increasing the number of patients contributed to evolution of our liver transplant program. To improve our parameters, increasing transplant activity is warranted. Orv Hetil. 2022; 163(8): 301-311.
Assuntos
Doença Hepática Terminal , Transplante de Fígado , Adulto , Idoso , Feminino , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Listas de EsperaRESUMO
Pancreatic necrosis is a consistent prognostic factor in acute pancreatitis (AP). However, the clinical scores currently in use are either too complicated or require data that are unavailable on admission or lack sufficient predictive value. We therefore aimed to develop a tool to aid in necrosis prediction. The XGBoost machine learning algorithm processed data from 2387 patients with AP. The confidence of the model was estimated by a bootstrapping method and interpreted via the 10th and the 90th percentiles of the prediction scores. Shapley Additive exPlanations (SHAP) values were calculated to quantify the contribution of each variable provided. Finally, the model was implemented as an online application using the Streamlit Python-based framework. The XGBoost classifier provided an AUC value of 0.757. Glucose, C-reactive protein, alkaline phosphatase, gender and total white blood cell count have the most impact on prediction based on the SHAP values. The relationship between the size of the training dataset and model performance shows that prediction performance can be improved. This study combines necrosis prediction and artificial intelligence. The predictive potential of this model is comparable to the current clinical scoring systems and has several advantages over them.
Assuntos
Inteligência Artificial , Pancreatite Necrosante Aguda , Doença Aguda , Humanos , Necrose , Pancreatite Necrosante Aguda/diagnóstico , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Authors present the history of a 56-year-old man who was evaluated for recurrent epigastric pain. Clinical investigation revealed a 4-cm tumor in the head of the pancreas and a solitary liver metastasis. Pathological examination of the surgically excised pancreatic tumor indicated a moderately differentiated neuroendocrine carcinoma and Ki-67 labeling index revealed moderate proliferative activity. Despite short-term chemotherapy combined with interferon and somatostatin analogue administration, the metastatic disease rapidly progressed. Octreotide scintigraphy disclosed abundant expression of somatostatin receptors both on primary tumor and hepatic metastases. 9°Yttrium-DOTATOC treatment was performed in three sessions within 9 months (3 x 200 mCi) with a mixed therapeutic response. Endocrine symptoms were not observed during the first 33 months of the disease. 34 months after the initial diagnosis of the neoplastic disease, imaging studies and chromogranin A measurement revealed rapidly progressing disease and the patient developed frequent episodes of hypoglycemic attacks. Serum insulin and C-peptide measurements confirmed insulin oversecretion. Continuous administration of somatostatin analogue was supplemented with diazoxide, but the latter therapy was not tolerated because of severe water retention. The high dose oral carbohydrate intake was supplemented with continuous glucose infusion. As a rescue procedure, repeated liver chemoembolization was performed, which resulted only in a short-term effect. The autopsy and the immunohistochemical investigations confirmed the diagnosis of insulin-producing, metastatic neuroendocrine carcinoma.
Assuntos
Insulina/sangue , Insulinoma/diagnóstico , Insulinoma/terapia , Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/terapia , Autopsia , Progressão da Doença , Humanos , Hipoglicemia/sangue , Hipoglicemia/etiologia , Hipoglicemia/terapia , Imuno-Histoquímica , Insulina/metabolismo , Secreção de Insulina , Insulinoma/complicações , Insulinoma/metabolismo , Insulinoma/secundário , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , Somatostatina/análogos & derivados , Somatostatina/uso terapêuticoRESUMO
There is very limited experience regarding the interventional radiological treatment of adrenocortical cancer (ACC). We present the case of a 57-year-old female patient with a large, potentially unresectable left-sided ACC and two hepatic metastases. Both liver tumors were effectively treated by trans-arterial embolization (TAE), followed by TAE of the bulky primary tumor as a life-saving intervention necessitated by severe intratumoral bleeding. Surgical removal of the primary tumor revealed complete necrosis. The patient is considered tumor free after 3.5 years. To the best of our knowledge, this is the first report to show that even a primary ACC may be completely ablated by selective embolization, and the fourth to prove the curative potential of liver TAE for ACC metastases. This case highlights the potential of selective embolization in ACC treatment.
Assuntos
Neoplasias do Córtex Suprarrenal/terapia , Carcinoma Adrenocortical/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Neoplasias do Córtex Suprarrenal/irrigação sanguínea , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/irrigação sanguínea , Carcinoma Adrenocortical/secundário , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Necrose , Resultado do TratamentoRESUMO
During the last years, interventional radiological treatment of hepatocellular cancer has changed dramatically. The percutaneous ethanol infiltration is partly replaced by thermoablative methods, mainly by radiofrequency ablation. Cooled-tip electrodes and volumetric therapy planning increased the treatment success. Embolisation beads made vessel occlusion more precise and predictable, while the development of the drug eluting beads led to the most effective way of chemoembolisation. The so called radioembolisation with Yttrium 90 isotopes filled into glass microbeads is slowly gaining acceptance worldwide. Thermoablation and embolisation or chemoembolisation are the main tools for downstaging tumors, or avoiding disease progression in liver transplant recipients on the waiting list. All of these therapeutic options have their well established places in well known and worldwide accepted protocols, such as the algorithm of the Barcelona group (BCLC). In the near future, further results can be expected from the combination of available treatments, including sorafenib medication.
Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Radiologia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Progressão da Doença , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Radiografia Intervencionista , Radiologia Intervencionista , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/radioterapia , Tomada de Decisões , História do Século XX , História do Século XXI , Humanos , Hungria , Cooperação Internacional , Radiografia Intervencionista/história , Radiografia Intervencionista/métodos , Radiografia Intervencionista/tendências , Radiologia Intervencionista/história , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendênciasRESUMO
The authors report on their experiences related to the first adult live donor liver transplantation performed in Hungary. The transplantation was done between brother and sister on 19th of November, 2007. The right lobe of the 33-year-old healthy male's donor liver (segments 5-8) was removed and implanted into the 23-year-old female suffering from cirrhosis on the ground of autoimmune hepatitis. The implantation of the right liver lobe was done after own hepatectomy in orthotopic position. Liver function has improved rapidly following the transplantation. The donor was discharged on the 10th post-operative day with stable liver function. He had full rehabilitation, got back to work, and control check-ups showed a significant liver regeneration. Two years after transplantation, the recipient also lives an active life with compensated liver function and she is under regular medical check-up. With the case report, authors overview the indications and techniques of living donor right-lobe liver transplantation.
Assuntos
Hepatite Autoimune/cirurgia , Transplante de Fígado/métodos , Fígado/fisiopatologia , Fígado/cirurgia , Doadores Vivos , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Hepatectomia/métodos , Hepatectomia/reabilitação , Humanos , Hungria , Fígado/diagnóstico por imagem , Fígado/patologia , Testes de Função Hepática , Regeneração Hepática , Masculino , Irmãos , Coleta de Tecidos e Órgãos/reabilitação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
UNLABELLED: New-onset diabetes is a common complication after liver transplantation. AIM: We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome. METHODS: We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation. RESULTS: New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24+/-3 vs. 22.4+/-3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6+/-7.2 vs. 38.3+/-14.6 year, p<0.001), body mass index (26.7+/-3.8 vs. 23.3+/-5.6 kg/m 2 , p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05+/-1.53 vs. 1.00+/-1.08, p = 0.039). CONCLUSIONS: Risk factors for new-onset diabetes after transplantation are older age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients.
Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etiologia , Hepatite C/complicações , Cirrose Hepática/virologia , Transplante de Fígado/efeitos adversos , Doença Aguda , Adulto , Fatores Etários , Feminino , Sobrevivência de Enxerto , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Incidência , Cirrose Hepática/complicações , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Recidiva , Fatores de Risco , Fatores Sexuais , Análise de SobrevidaRESUMO
INTRODUCTION: Benign thyroid nodules are frequent findings in imaging studies, most of the time not requiring any intervention. Treatment is usually started when nodules increase in size, the patient becomes symptomatic or clinically relevant hyperthyroidism develops. Thermoablation is an effective alternative modality. In Hungary, our team has pioneered these interventions using radiofrequency ablation for decreasing the size of the nodules. AIM: We are presenting our results showing the effectiveness of this treatment after introducing the role, importance and technique of thermoablation in benign thyroid nodules. METHOD: Between June of 2016 and September of 2019, 186 nodules of 140 patients were treated with radiofrequency ablation and had at least 6 months of follow up. The volume and diameter of all the ablated nodules were measured and calculated, then the decreases of these parameters were followed using ultrasonography. The mean follow-up time was 12.5 ± 5.9 months. RESULTS: The size measurements at the follow-up ultrasonography examinations showed a decrease in size and vascularity. The mean volume reduction was 44.7 ± 17.6% at one-month post-treatment and 72.9 ± 17.9% at 6 months. There were 3 minor complications. CONCLUSIONS: Radiofrequency ablation represents a feasible, effective, well tolerated method for outpatient treatment of benign thyroid nodules. This method is a valuable alternative to surgical treatments in selected cases. Orv Hetil. 2020; 161(27): 1131-1136.