RESUMEN
AIM: To report the technical success of image and endoscopy-guided retrograde trans-urostomy urinary drainage as a primary catheter placement method performed by interventional radiology (IR). MATERIALS AND METHODS: Nine patients (15 attempted drain placements) with ureteric obstruction following radical cystectomy and urostomy creation were included. The patients were referred to IR for urinary drainage. All patients underwent primary image and endoscopy-guided retrograde trans-urostomy urinary drainage. RESULTS: Primary image and endoscopy-guided retrograde trans-urostomy urinary drainage was successful in 13/15 (86.6%) attempts. The proposed technique had a limited complication rate omitting the percutaneous nephrostomy access step. CONCLUSION: Primary image and endoscopy guided retrograde trans-urostomy urinary drainage should be considered before percutaneous nephrostomy in all patients with a urostomy.
Asunto(s)
Nefrostomía Percutánea , Obstrucción Ureteral , Drenaje/métodos , Endoscopía , Humanos , Nefrostomía Percutánea/efectos adversos , Nefrostomía Percutánea/métodos , Stents/efectos adversos , Resultado del Tratamiento , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugíaRESUMEN
Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61% vs. 37%). Downstaging to UNOS T2 was achieved in 31% of TACE and 58% of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.
Asunto(s)
Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Embolización Terapéutica , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Radioisótopos de Itrio/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Locoregional therapies, such as transarterial chemoembolization, radioembolization and thermal ablation (e.g., radiofrequency ablation) are establishing their roles in the management of liver malignancies. With yYttrium-90 radioembolization therapy (90Y) radionuclide labeled microspheres are injected into the tumor feeding artery. This allows the delivery of a high radioactive dose to the tumor with minimal toxicity to normal tissues. 90Y has demonstrated to be safe and effective in the management of liver tumors. Authors present a review of the literature available for the use of TheraSphere for radioembolization in the management of liver tumors.
Asunto(s)
Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/secundario , Neoplasias Hepáticas/radioterapia , Radioisótopos/administración & dosificación , Radiofármacos/administración & dosificación , Radioisótopos de Itrio/administración & dosificación , Humanos , Dosificación RadioterapéuticaRESUMEN
PURPOSE: To identify changes in hepatic parenchymal volume, fibrosis, and induction of portal hypertension following radioembolization with glass microspheres for patients with metastatic disease to the liver. RESULTS: In our series of sequential bilobar (n = 17) treatments, a mean decrease in liver volume of 11.8% was noted. In this group, a mean splenic volume increase of 27.9% and portal vein diameter increase of 4.8% were noted. For patients receiving unilobar treatments (n = 15), mean ipsilateral lobar volume decrease of 8.9%, contralateral lobar hypertrophy of 21.2%, and a 5.4% increase in portal vein diameter were also noted. These findings were not associated with clinical toxicities. CONCLUSION: (90)Yttrium radioembolization utilizing glass microspheres in patients with liver metastases results in changes of hepatic parenchymal volume and also induced findings suggestive of fibrosis and portal hypertension. Further studies assessing the long-term effects are warranted.
Asunto(s)
Hipertensión Portal/etiología , Cirrosis Hepática/etiología , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundario , Hígado/crecimiento & desarrollo , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Progresión de la Enfermedad , Relación Dosis-Respuesta en la Radiación , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Femenino , Humanos , Hígado/patología , Hígado/efectos de la radiación , Neoplasias Hepáticas/patología , Masculino , Microesferas , Tamaño de los Órganos/efectos de la radiación , Radioterapia/métodos , Resultado del Tratamiento , Radioisótopos de Itrio/efectos adversos , Radioisótopos de Itrio/uso terapéuticoRESUMEN
The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. Standard nonenhanced head CT protocol was followed for each patient as per department protocol. A positive head CT scan is defined to include either an air-fluid level within the paranasal sinuses or fracture of the maxillary, orbital, or zygomatic osseous structures. A negative scan demonstrates none of these findings. Intracranial/parenchymal pathology was not evaluated in this study. Sixty-five of the 115 patients had a negative head CT scan as defined above. Of these 65 patients, none subsequently had a positive facial bone or orbit CT scan. The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.