RESUMEN
Biopsies of metastatic tissue are increasingly being performed. Bone is the most frequent site of metastasis in breast cancer patients, but bone remains technically challenging to biopsy. Difficulties with both tissue acquisition and techniques for analysis of hormone receptor status are well described. Bone biopsies can be carried out by either by standard posterior iliac crest bone marrow trephine/aspiration or CT-guided biopsy of a radiologically evident bone metastasis. The differential yield of these techniques is unknown. Results from three prospective studies of similar methodology were pooled. Patients underwent both an outpatient posterior iliac crest bone marrow trephine/aspiration and a CT-guided biopsy of a radiologically evident bone metastasis. Samples were assessed for the presence of malignant cells and where possible also for estrogen (ER) and progesterone receptor (PgR) expression. 40 patients were enrolled. Bone marrow aspiration/trephine biopsy was completed in 39/40 (97.5%) and CT-guided biopsy was completed in 34/40 (85%) of patients. Sufficient tumor cells for hormone receptor analysis were available in 19/39 (48.8%) and 16/34 (47%) of and bone marrow aspiration/trephine and CT-guided biopsies, respectively. Significant discordance in ER and PgR between the primary and the bone metastasis was also seen. Nine patients had tissue available from both bone marrow and CT-guided bone biopsies. ER and PgR concordance between these sites was 100 and 78%, respectively. Performing studies on human bone metastases is technically challenging, with relatively low yields regardless of technique. Given resource issues and similar success rates when comparing both techniques, bone marrow examination may be utilized first and if inadequate tissue is obtained, CT-guided biopsies can then be used.
Asunto(s)
Biopsia con Aguja/métodos , Neoplasias Óseas/patología , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Adulto , Anciano , Examen de la Médula Ósea , Neoplasias Óseas/metabolismo , Neoplasias de la Mama/metabolismo , Femenino , Humanos , Persona de Mediana Edad , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management. MATERIALS AND METHODS: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan. RESULTS: Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002). CONCLUSIONS: This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Metástasis de la Neoplasia/diagnóstico , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Biomarcadores de Tumor/análisis , Biopsia , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/terapia , Femenino , Humanos , Estadificación de NeoplasiasRESUMEN
The assessment of the effectiveness of MRI-guided focused ultrasound surgery (MRIgFUS) of breast carcinomas can be performed by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters which monitor the presence of residual tumour. The aim of this study was to evaluate the effect of the post-treatment delay on this assessment. DCE-MRI data were acquired immediately and 3-14 days after MRIgFUS treatment of 26 tumours (<7 days, n = 6; = or > ge;7 days, n = 20). The percentage of residual tumour was determined histologically on the resected mass and correlated with two DCE-MRI parameters: increase in signal intensity (ISI) and positive enhancement integral (PEI). No correlation could be found between DCE-MRI data acquired immediately after treatment and the percentage of residual tumour. Good correlation coefficients were found for data acquired several days after treatment (ISI, r = 0.749; PEI, r = 0.778). However, they were higher when the post-treatment time interval was 7 days or more (ISI, r = 0.962; PEI, r = 0.934). These results suggest that a post-treatment delay of 7 days is necessary for the accurate assessment of the presence of residual tumour by DCE-MRI parameters.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Aumento de la Imagen , Imagen por Resonancia Magnética/métodos , Neoplasia Residual/diagnóstico , Terapia por Ultrasonido/métodos , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/terapia , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Persona de Mediana Edad , Neoplasia Residual/patología , Neoplasia Residual/terapia , Curva ROC , Sensibilidad y Especificidad , Factores de Tiempo , Ultrasonografía MamariaRESUMEN
This article provides an overview of recently developed, noninvasive imaging modalities for the evaluation of gastrointestinal disease processes. The advent of spiral computed tomography, magnetic resonance cholangiopancreatography and conventional magnetic resonance imaging has facilitated the noninvasive assessment of pancreaticobiliary disease. Magnetic resonance cholangiopancreatography provides projectional images of the biliary tree and pancreatic duct, similar to those achieved by direct cholangiography, without the need to administer contrast medium. Spiral computed tomographic colonography provides virtual colonoscopic images of the colonic mucosa, allowing the detection of polyps without the risk associated with colonoscopy.
Asunto(s)
Diagnóstico por Imagen , Enfermedades Gastrointestinales/diagnóstico , Enfermedad de Caroli/diagnóstico , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Colangitis Esclerosante/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X/métodosRESUMEN
111 patients aged two days to 20 years with neck masses were examined by ultrasound. Results were compared to subsequent histo-pathological or clinical diagnosis. Sonography allowed us to divide neck masses into two groups, a sonospecific group in which an accurate presurgical diagnosis was made in 92%, and a non-sonospecific group. The sonospecific group contained 48 patients and included thyroid masses, cystic hygromas, certain cases of adenopathy and a cervical myelomeningocele. The non-sonospecific group contained 63 patients and included a variety of neck masses such as dermoid cysts, branchial cleft cysts, the majority of cases of adenopathy, hemangiomas, lymphangiomas and various other neoplastic masses. Sonography serves to delineate the extent of neck masses, define the relationship of the mass to the thyroid and major neck vessels and guide fine needle aspiration biopsy.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Enfermedades Linfáticas/diagnóstico , Ultrasonografía , Adolescente , Adulto , Niño , Preescolar , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades de la Tiroides/diagnósticoRESUMEN
The management of intrahepatic and common bile duct stones has been modified by the advent of endoscopic sphincterotomy and percutaneous extraction through a T-tube tract or transhepatic access. Occasionally, nonoperative extraction is incomplete. The use of extracorporeal lithotripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years) were treated by extracorporeal shockwave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had previously undergone a cholecystectomy and 44% exploration of the common duct. Patients were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the lithotripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patient were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobiliary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalities contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessary in order to obtain those results.
Asunto(s)
Conductos Biliares Intrahepáticos/cirugía , Colelitiasis/terapia , Cálculos Biliares/terapia , Litotricia/métodos , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esfinterotomía EndoscópicaRESUMEN
Abnormal decision-making (DM) performance has been reported in several neurobehavioral disorders such as schizophrenia, addiction, and obsessive compulsive disorders. The exploration of DM correlates in terms of symptom formation may add more knowledge about the meanings of DM performance in schizophrenia. We examined the Iowa Gambling Task (IGT) and its relationship with clinical symptoms, evaluated by Positive and Negative Symptom Scale (PANSS), in 40 schizophrenic patients and 20 controls. Schizophrenic patients did worse on IGT performance with a significant difference between the two groups in Net Score. PANSS positive symptoms were negatively correlated with Net Score and advantageous choices and directly with disadvantageous choices. Results suggest that persons with schizophrenia display a pattern of compromised DM related to positive symptoms.
Asunto(s)
Trastornos del Conocimiento/fisiopatología , Toma de Decisiones/fisiología , Deluciones/fisiopatología , Juego de Azar/fisiopatología , Esquizofrenia/fisiopatología , Adulto , Trastornos del Conocimiento/etiología , Deluciones/etiología , Función Ejecutiva/fisiología , Femenino , Juego de Azar/etiología , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pruebas Psicológicas , Esquizofrenia/complicacionesRESUMEN
The molecular mechanisms underlying the development of bone metastases in breast cancer remain unclear. Disseminated tumour cells (DTCs) in the bone marrow of breast cancer patients are commonly identified, even in early stage disease, but their potential to initiate metastases is not known. The mechanism whereby DTCs become overt metastatic tumour cells (MTCs) is therefore, an area of considerable interest. This study explored the analysable yield of genetic material from human biopsy samples in order to describe differences in gene expression between DTCs and bone MTCs. Thirteen breast cancer patients with bone metastases underwent a CT-guided bone metastasis biopsy and a bone marrow biopsy. Tumour cells were enriched and gene expression profiling was conducted to identify differentially expressed genes. The analysable yield of sufficient RNA for microarray analysis was 60% from bone metastasis biopsies and 80% from bone marrow biopsies. A signature of 133 candidate genes differentially expressed between DTCs and MTCs was identified. Several genes relevant to breast cancer metastasis to bone (osteopontin, CTGF, parathyroid hormone receptor, EGFR) were significantly overexpressed in MTCs as compared to DTCs. Biopsies of bone metastases and bone marrow rarely yield enough tissue for robust molecular biology studies using clinical samples. The findings obtained however are interesting and seem to overlap with the bone metastasis gene expression signature described in murine xenograft models. Larger biopsy specimens or improved RNA extraction techniques may improve analysable yield and feasibility of these techniques.
Asunto(s)
Neoplasias Óseas/genética , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Perfilación de la Expresión Génica , Células Neoplásicas Circulantes , Adulto , Biomarcadores de Tumor/metabolismo , Biopsia , Médula Ósea/patología , Neoplasias de la Mama/genética , Estudios de Factibilidad , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Persona de Mediana Edad , Neoplasia Residual/patología , Estudios Prospectivos , ARN Neoplásico/análisisRESUMEN
Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.
Asunto(s)
Neoplasias de la Mama/terapia , Imagen por Resonancia Magnética Intervencional , Terapia por Ultrasonido , Ultrasonografía Intervencional , Femenino , Humanos , Terapia por Ultrasonido/tendenciasRESUMEN
OBJECTIVE: To evaluate the role of computed tomographic abscessograms (CTABs, consisting of injection of contrast medium through a drainage catheter followed by computed tomographic examination) in the management of patients referred for percutaneous abscess drainage (PAD). PATIENTS AND METHODS: Over 50 months, 169 patients with 203 abscesses underwent PAD, and 432 CTABs were performed. CTAB was assessed for its ability to influence treatment decisions, detect fistulae and visualize the septic process. RESULTS: CTABs allowed the detection of fistulous communications in 32% (65/203) of abscesses. In 60 of the 65 patients with fistulae (92%), the specific etiology of the abscess cavity was established through analysis of CTABs. The presence of a pathologic fistula prolonged the catheter drainage time (20.5 v. 11.9 days, p < 0.0001), and the success rate was lower if the drainage catheter was removed before the fistula was closed (90% v. 72%). CTAB images influenced catheter-manipulation decisions for 23 of the 169 patients (14%). CONCLUSION: CTABs provide important information about the underlying pathologic process while allowing detection of fistulae and ultimately influencing interventional treatment for PAD.
Asunto(s)
Absceso Abdominal/diagnóstico por imagen , Drenaje , Tomografía Computarizada por Rayos X , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Catéteres de Permanencia , Medios de Contraste , Drenaje/instrumentación , Femenino , Fístula/diagnóstico por imagen , Fístula/etiología , Fístula/cirugía , Humanos , Yotalamato de Meglumina , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine whether percutaneous drainage of Crohn's abscesses obviates the need for early surgical drainage. METHODS: All cases of percutaneous drainage of Crohn's abscesses between 1990 and 1995 were reviewed and classified as a success or failure on the basis of the need for surgery within < 30 days of catheter removal. RESULTS: Twenty-seven drainage procedures were performed in 24 patients; 15 (56%) were classified as successes, and 12 (44%) were classified as failures. Successes and failures did not significantly differ with respect to patient demographics and Crohn's disease characteristics. Patients whose abscesses were successfully drained had significantly fewer associated fistulae (46.6 vs 92.0%, p = 0.037), and their abscesses tended more often to be first (vs recurrent), spontaneous (vs postoperative), located in the right lower quadrant, and smaller. Patients whose abscesses were successfully drained also tended to spend more time with the catheter in place and to require more imaging procedures. Complications were noted in four cases (15%), enterocutaneous fistula at the site of catheter insertion in three cases and postprocedure fever in one case. Hospital stay was significantly shorter after successful drainage (16.3 +/- 6.9 vs 31.7 +/- 22.1 days, p = 0.017). After a total of 543.5 patient-months of follow-up, subsequent intra-abdominal Crohn's-related surgery was required in only two of the successes and one failure. CONCLUSIONS: 1) Percutaneous drainage of Crohn's abscess successfully obviates the need for early surgery in approximately 50% of cases, and this benefit is maintained on long term follow-up. 2) Percutaneous drainage shortens hospital stay. 3) Crohn's abscesses in various locations, single or multiple, with or without an associated fistula may be successfully drained percutaneously. 4) Presence of an associated fistula may be a risk factor for failure.
Asunto(s)
Absceso Abdominal/cirugía , Enfermedad de Crohn/cirugía , Drenaje/métodos , Absceso Abdominal/etiología , Terapia Combinada , Enfermedad de Crohn/complicaciones , Drenaje/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Seventeen venous angiomas in 16 patients were evaluated radiologically at the Montreal Neurological Hospital. Radiologic investigations included contrast-enhanced computed tomograms (CECT) in 15 patients, cerebral angiograms with a long venous phase study in 15, and magnetic resonance (MR) imaging with a spin-echo pulse sequence technique in six. CECT revealed abnormalities including six nodular nonspecific enhancing lesions and nine enhanced draining veins, whereas plain CT revealed intracerebral hemorrhages in four patients and calcification in one. All the angiograms showed the characteristic pattern of venous angiomas consisting of medullary veins converging to a large draining vein during the late venous phase. All six patients examined by MR showed abnormal vascular structures; parenchymal hemorrhages were present in two patients. In five patients with venous angiomas, medullary veins converging to a large draining vein were demonstrated as echo-void curvilinear structures. In two patients, the increased signal from medullary veins in long echo delay sequences was suggestive of a slow venous flow rate. Demonstration of the venous nature of the malformation may, in the future, obviate the need for angiography.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Venas Cerebrales/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico , Angiografía Cerebral , Venas Cerebrales/anomalías , Femenino , Hemangioma/diagnóstico , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To assess the clinical impact of computed tomographic (CT) fluoroscopy (CTF) with regard to procedure time and success rate for CT image-guided biopsy procedures. MATERIALS AND METHODS: One hundred ninety consecutive patients referred to the same radiologist underwent biopsy procedures performed with use of a CT scanner equipped with fluoroscopic capabilities during a 15-month period. CTF procedures were performed predominantly by means of a continuous fluoroscopic technique, with typical exposure factors of 50 mA at 120 kV and a slice thickness of 10 mm. The total procedure time, fluoroscopy time, and complication and procedure success rates were documented prospectively in this group. A control group consisted of retrospective analysis of 93 consecutive patients who had undergone a classic CT-guided procedure performed by the same radiologist. RESULTS: Procedure success rate was increased in the CTF group (93.7 versus 88.2%), although the difference was not statistically significant (P > .05: Fisher exact test). A statistically significant difference was noted when comparing mean procedure times (CTF, 27.56 minutes; range, 20-60 minutes versus control, 43.17 minutes; range, 35-80 minutes; P < .0001; Welch unpaired t test). CONCLUSION: CT fluoroscopy facilitates CT-guided biopsy procedures by allowing visualization of the needle trajectory from skin entry to the target point, allowing procedures to be performed more rapidly and efficiently.
Asunto(s)
Biopsia con Aguja/métodos , Fluoroscopía/métodos , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Hepatopatías/patología , Enfermedades Pulmonares/patología , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/patología , Estudios Prospectivos , Dosis de Radiación , Estudios Retrospectivos , Estadística como Asunto , Factores de TiempoRESUMEN
PURPOSE: To assess if the learning process associated with computed tomography fluoroscopy (CTF) technology influences procedure and fluoroscopy times for percutaneous biopsy procedures. MATERIALS AND METHODS: Prospective analysis of the initial 250 consecutive patients who underwent percutaneous biopsy with use of a CT scanner equipped with rapid image reconstruction and fluoroscopic capabilities in a 24-month period. All procedures were performed with both continuous and spot fluoroscopic technique, with typical radiation parameters of 50 mA, 120 kV, and a 10-mm-slice thickness. The procedures were all performed by a single experienced interventional radiologist to limit the variables of physician expertise, interventional materials used, and biopsy approach. The subject group was divided into five equal consecutive groups of 50 patients. In each subgroup, the authors recorded mean lesion size, success, and complication rates, as well as mean procedure and fluoroscopy times. RESULTS: The five subgroups were similar patient populations as documented by the absence of statistically significant differences when comparing mean lesion size, procedure success, and complication rates (P > .05; ANOVA test). A statistically significant decrease in mean fluoroscopy (groups 1-5: 50.26 vs 45.24 vs 33.86 vs 32.68 vs 25.8 sec/patient) and mean procedure times (groups 1-5: 30.08 vs 27.9 vs 26.34 vs 25.6 vs 21.6 min/patient) was recorded between the patient subgroups (P < .0001; ANOVA test). CONCLUSION: The learning process associated with CTF technology impacts procedure parameters by decreasing both mean procedure and fluoroscopy times, thereby increasing patient turnover and decreasing radiation exposure to the patient and the operator.
Asunto(s)
Biopsia/métodos , Fluoroscopía/métodos , Aprendizaje , Radiología Intervencionista/educación , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Competencia Clínica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional , Estudios Prospectivos , Radiología Intervencionista/instrumentación , Radiometría , Factores de TiempoRESUMEN
Whipple's operation consists of resection of the pancreatic head and duodenum, followed by pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy or duodenojejunostomy. Indications include neoplasms of the periampullary region, symptomatic chronic pancreatitis, and, occasionally, trauma CT is useful in diagnosing postoperative complications and in detecting disease recurrence during long-term follow-up. This complex surgical procedure causes alterations of the normal anatomy, which may lead to difficulty interpreting images. Familiarity with the appearance of postoperative changes and common complications and with patterns of disease recurrence is a prerequisite to accurate interpretation of CT scans in these patients.
Asunto(s)
Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Pancreatitis/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Coledocostomía , Estudios de Seguimiento , Humanos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/epidemiología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/epidemiología , Pancreatoyeyunostomía , Pancreatitis/diagnóstico por imagen , Pancreatitis/epidemiología , Complicaciones Posoperatorias/epidemiología , Recurrencia , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To assess the frequency of splenic vein thrombosis (SVT) after splenectomy and its consequences on patient treatment. MATERIALS AND METHODS: A group of 183 consecutive patients who underwent splenectomy were evaluated. Of these patients, 119 underwent postoperative ultrasound (US) or computed tomography. RESULTS: SVT was diagnosed in 13 of 119 patients in the first 2 weeks after surgery. In these 13 patients, splenectomy had been performed for hematologic disorders (n = 12) or trauma (n = 1). Seven of the 13 patients were asymptomatic. After anticoagulant therapy, follow-up US of 12 patients showed resolution of thrombosis with no complications in 10 patients; two patients developed cavernous transformation of the portal vein. CONCLUSION: Since only 65% of patients underwent imaging, the true frequency of SVT could not be determined; however, it occurred in at least 7% of patients who underwent splenectomy. Routine Doppler US should be performed after splenectomy to allow early anticoagulant therapy in patients with SVT.
Asunto(s)
Esplenectomía/efectos adversos , Vena Esplénica , Trombosis/etiología , Humanos , Vena Esplénica/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: The goal of this study was to compare patients with aortic graft infection treated by primary percutaneous drainage with patients who initially underwent surgery. MATERIALS AND METHODS: A retrospective review of 23 consecutive patients treated for aortic graft infection was performed. Eleven patients were initially treated with percutaneous drainage and 12 were treated with surgery. The morbidity, mortality, and postprocedural reintervention rates and clinical outcome were analyzed for each group. RESULTS: The septic process resolved in nine (82%) of 11 patients treated with percutaneous drainage. Of these nine patients, four were treated with percutaneous drainage alone. Drainage was followed by removal of the infected prosthetic graft in the remaining five patients. In the surgical group, sepsis resolved in only four patients (33%) (p = .036). No periprocedural deaths occurred in the percutaneous drainage group, whereas six patients in the surgical group died in the perioperative period (p = .014). CONCLUSION: Percutaneous drainage can be used as an initial form of treatment in the management of aortic graft infections. Surgery after percutaneous drainage appears to be safer than surgery alone.
Asunto(s)
Prótesis Vascular/efectos adversos , Drenaje/métodos , Infecciones Relacionadas con Prótesis/terapia , Anciano , Antibacterianos , Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Estudios de Casos y Controles , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Masculino , Tereftalatos Polietilenos , Infecciones Relacionadas con Prótesis/mortalidad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.
Asunto(s)
Aire , Vena Porta/diagnóstico por imagen , Adulto , Animales , Perros , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
Thirty healthy volunteers and 12 liver allograft recipients (two with cirrhotic changes seen at microscopy) were given a standard meal. Doppler sonography of the right and left hepatic arteries, the superior mesenteric artery, and the portal vein was performed. The change in hepatic arterial resistance was evaluated with the resistive index (RI). After the standard meal, portal venous flow increased in both the healthy volunteers and allograft recipients (more so in the latter group). Superior mesenteric arterial RI decreased in all subjects. A postprandial increase in hepatic arterial RI, likely reflecting constriction of the hepatic artery, was seen in both groups. It was absent in the two patients with recurrent transplant cirrhosis. These results show the importance of examining hepatic arterial flow in the fasting subject, since high resistance after a meal may be falsely interpreted as a sign of disease. Absence of a postprandial change in resistance of the hepatic artery could signal abnormal liver function.
Asunto(s)
Ingestión de Alimentos , Arteria Hepática/fisiopatología , Trasplante de Hígado , Resistencia Vascular , Adulto , Femenino , Arteria Hepática/diagnóstico por imagen , Humanos , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/fisiopatología , Cirrosis Hepática/cirugía , Masculino , Arterias Mesentéricas/diagnóstico por imagen , Arterias Mesentéricas/fisiopatología , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Recurrencia , UltrasonografíaRESUMEN
OBJECTIVE: In the present study we evaluated the predictive value of pretransjugular intrahepatic portosystemic shunt (TIPS) portal perfusion as assessed by Doppler ultrasonography for the onset of chronic encephalopathy after TIPS. METHODS: A total of 231 cirrhotic patients were followed-up prospectively after TIPS placement. The pattern of intrahepatic portal flow was assessed before TIPS. Patients were divided into two groups according to Doppler findings. Group 1 comprised patients with prograde portal flow (n = 200), whereas group 2 comprised those with loss of portal perfusion (hepatofugal or back-and-forth flow or portal vein thrombosis; n = 31). The presence of chronic encephalopathy during a median follow-up of 32 months was prospectively recorded. The prognostic value of the following parameters for the onset of chronic recurrent encephalopathy after TIPS was evaluated: age, presence of encephalopathy before TIPS, alcoholism, Pugh score, and loss of portal perfusion before TIPS. The independent prognostic value of each variable was tested with a multiple logistic regression analysis. RESULTS: The two groups were comparable in terms of age, incidence of prior episodes of hepatic encephalopathy, and portacaval gradient before and after the procedure; however, liver failure was more severe in patients in group 2 (Pugh score: 9.2 +/- 1.9 vs 10.3 +/- 1.7). The 3-yr survival was identical for both groups; 25% of the 200 patients in group 1 developed chronic encephalopathy as compared to 6% of the 31 patients in group 2 (p = 0.03). Multiple logistic regression analysis demonstrated that loss of portal perfusion and age >65 yr were the only independent predictors of the onset of post-TIPS chronic encephalopathy (odds ratios 0.24 and 1.98, respectively). CONCLUSIONS: Cirrhotic patients with loss of portal perfusion before TIPS were protected against post-TIPS chronic hepatic encephalopathy despite a more severe liver dysfunction at baseline. The only other independent predictive factor for the onset of this complication was age.