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1.
Clin Radiol ; 76(2): 157.e11-157.e18, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33138981

RESUMO

AIM: To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS: Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS: Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION: Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Hematoma/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia por Tomografia Computadorizada , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Resultado do Tratamento
2.
Clin Radiol ; 74(7): 539-546, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30955836

RESUMO

AIM: To investigate the accuracy of ultrasonography in the assessment of hepatic steatosis using magnetic resonance imaging (MRI) as standard of reference and to explore the influence of additional hepatic iron overload. MATERIAL AND METHODS: A total of 2,783 volunteers (1,442 women, 1,341 men; mean age, 52.3±13.8 years) underwent confounder-corrected chemical-shift-encoded MRI of the liver at 1.5 T. Proton-density fat fraction (PDFF) and transverse relaxation rate (R2*) were calculated to estimate hepatic steatosis and liver iron overload, respectively. In addition, the presence of hepatic steatosis was assessed by B-mode ultrasonography. The sensitivity, specificity, and accuracy of hepatic ultrasonography were determined for different degrees of hepatic steatosis and different amounts of liver iron. RESULTS: MRI revealed hepatic steatosis in 40% of participants (n=1,112), which was mild in 68.9% (n=766), moderate in 26.7% (n=297), and severe in 4.4% (n=49) of patients. Ultrasonography detected hepatic steatosis in 37.8% (n=1,052), corresponding to 74.5% sensitivity and 86.6% specificity. The sensitivity of ultrasound increased with the amount of hepatic fat present and was 65.1%, 95%, and 96% for low, moderate, and high fat content; whereas the specificity was constantly high at 86.6%. The diagnostic accuracy of ultrasound for detection of hepatic steatosis did not vary significantly with the amount of liver iron present. CONCLUSION: Ultrasonography is an excellent tool to assess hepatic steatosis in the clinical setting with some limitations in patients with a low liver fat content. The detection of hepatic steatosis by ultrasonography is not influenced by liver iron.


Assuntos
Fígado Gorduroso/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Ultrassonografia/métodos , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Radiologe ; 59(4): 342-347, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30806733

RESUMO

CLINICAL ISSUE: Percutaneous transhepatic biliary and gall bladder interventions play an important role in the diagnosis and therapy of biliary tract diseases. PERFORMANCE: With technical success rates up to 99% as well as complications rates up to a maximum of 26% they showed good results. Indications were opacification of the biliary tree as well as treatment of biliary system pathologies, such as drainage and stents. ACHIEVEMENTS: Interventions were used if endoscopic approaches are not possible or exploited. We describe the current state of knowledge and the range for percutaneous biliary/gall bladder interventions and give an overview of technical approaches for fundamental interventional procedures, including percutaneous transhepatic biliary drainage. PRACTICAL RECOMMENDATIONS: Percutaneous transhepatic biliary and gall bladder interventions are safe and effective treatments for benign and malignant stenosis, postoperative complications and risk patients with cholecystitis.


Assuntos
Drenagem , Vesícula Biliar , Constrição Patológica , Humanos , Complicações Pós-Operatórias , Stents
6.
Radiologe ; 57(2): 90-96, 2017 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-28130578

RESUMO

Liver metastases are the most common cause of death in colorectal cancer patients. Nowadays, complete resection is considered to be the only curative treatment but only approximately 25% of patients are suitable candidates for surgery; therefore, many different interventional oncology techniques have been developed in recent years for the treatment of secondary liver metastases. The aim of interventional oncological procedures is either to provide a potentially curative treatment option for locally limited metastases with local ablative techniques, to enable nonresectable tumors to become accessible to surgical or local ablative techniques using transarterial procedures or to achieve improved survival in a palliative setting. These interventional therapies include transarterial approaches, such as chemoembolization and radioembolization as well as a multitude of different ablative techniques, such as radiofrequency and microwave ablation as well as irreversible electroporation (IRE). This article describes the indications for the various procedures and the clinical results of each of these techniques are reviewed based on the currently available literature.


Assuntos
Técnicas de Ablação/estatística & dados numéricos , Quimioembolização Terapêutica/estatística & dados numéricos , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Neoplasias Colorretais/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Técnicas de Ablação/mortalidade , Quimioembolização Terapêutica/mortalidade , Neoplasias Colorretais/terapia , Medicina Baseada em Evidências , Humanos , Neoplasias Hepáticas/mortalidade , Prevalência , Taxa de Sobrevida , Resultado do Tratamento
7.
Internist (Berl) ; 58(8): 766-774, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28721530

RESUMO

Depending on the type and acuteness, diseases of the aorta can be imaged by a variety of techniques. Modalities and quality of imaging have developed rapidly in recent years. In combination with the clinical assessment of patients, the results obtained by imaging determine the further management. They not only establish the underlying diagnosis but provide the information essential for indications, planning and reassessment of therapy, as well as for evaluation of the clinical course and surveillance. Whereas conventional catheter-guided angiography and intravascular ultrasound are only used in exceptional cases and then in conjunction with interventional therapy, cross-sectional imaging modalities, such as contrast-enhanced computed tomography (CT) angiography and magnetic resonance imaging (MRI) are nowadays the mainstay of diagnostics. Ultrasound techniques are improving steadily and are gaining increasing importance, e. g. for screening purposes and for pretherapeutic and posttherapeutic surveillance. Additional information of therapeutic relevance may be acquired by means of molecular imaging with positron emission tomography (PET) CT.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/terapia , Aortografia , Meios de Contraste , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
Oncology ; 86(1): 24-32, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24401529

RESUMO

OBJECTIVE: To analyze the clinical efficacy of (90)Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. METHODS: Data from 19 pancreatic cancer patients (9 females/10 males) who had received (90)Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. RESULTS: The median age at (90)Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after (90)Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at (90)Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. CONCLUSION: (90)Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Microesferas , Neoplasias Pancreáticas/patologia , Radioisótopos de Ítrio/administração & dosagem , Adulto , Idoso , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Radioisótopos de Ítrio/efeitos adversos
9.
Radiologe ; 54(7): 679-84, 2014 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-24981447

RESUMO

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide. Besides liver transplantation, which is only feasible in few patients and surgical resection, the scope of potential treatment options has considerably expanded in recent years. Thermoablative therapies are now well established in early HCC due to the low rate of complications and short hospital stay. The disadvantage of higher relapse rates compared to surgical resection will be further diminished through technical advances regarding radiofrequency ablation and microwave ablation, as well as growing experience of users and thorough multidisciplinary selection of potential candidates for thermoablative therapy.


Assuntos
Técnicas de Ablação/métodos , Carcinoma Hepatocelular/terapia , Hepatectomia/métodos , Hipertermia Induzida/métodos , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/prevenção & controle , Carcinoma Hepatocelular/diagnóstico , Humanos , Neoplasias Hepáticas/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Resultado do Tratamento
10.
Radiologie (Heidelb) ; 64(7): 575-581, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38761204

RESUMO

BACKGROUND: The majority of patients with neuroendocrine tumors (NET) develop liver metastases during the course of the disease, significantly impacting prognosis and quality of life. CLINICAL ISSUE: Radiologically guided interventional therapies, such as thermal ablation, transarterial embolization (TAE)/chemoembolization (TACE), and selective internal radiotherapy (TARE), can play a crucial role in the treatment of metastatic NET. DATA: Due to the rarity of the disease, the majority of evidence is based on retrospective studies. For thermal ablation, the complete response rates ranging from 31.6 to 95.3% depending on the study. No significant differences in outcomes were found between TAE, TACE, and TARE. In several studies, all intra-arterial procedures led to a reduction of tumor-related symptoms and achieved disease control. CONCLUSION: Thermal ablation can be used as a curative therapy in oligometastatic patients with nonresectable liver metastases from NETs. In cases of disseminated liver metastases, intra-arterial therapy using TAE, TACE, or TARE can be employed.


Assuntos
Neoplasias Hepáticas , Tumores Neuroendócrinos , Humanos , Técnicas de Ablação/métodos , Quimioembolização Terapêutica/métodos , Embolização Terapêutica/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/radioterapia , Tumores Neuroendócrinos/terapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/radioterapia , Tumores Neuroendócrinos/secundário , Radiografia Intervencionista/métodos
11.
Z Gastroenterol ; 51(11): 1269-326, 2013 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-24243572

RESUMO

The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Oncologia/normas , Guias de Prática Clínica como Assunto , Alemanha , Humanos
12.
Radiologe ; 53(6): 513-8, 2013 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-23681511

RESUMO

UNLABELLED: CLINICAL ISSUE OF THORACIC ANEURYSMS: Aneurysms are among the most common diseases affecting the thoracic aorta, with a continuous increase in incidence over the recent decades. The main cause of thoracic aneurysms is atherosclerosis, which, due to the frequent lack of major symptoms and the potentially lethal complications such as ruptured aortic aneurysm, remains a challenge in clinical practice. STANDARD RADIOLOGICAL METHODS: CT angiography remains the imaging method of choice for acute aortic aneurysms, with MR angiography being increasingly used for follow-up imaging. THRESHOLD FOR TREATMENT: In the ascending aorta a diameter larger than 5-5.5 cm (descending aorta 6.5 cm) is regarded as the threshold for treatment. THORACIC ENDOVASCULAR AORTIC REPAIR: The continuous evolution of aortic stent grafting (i.e., thoracic endovascular aortic repair [TEVAR]) since Parodi, Palmaz and Dake has led to a steep rise in stent grafting procedures in recent years. PRACTICAL RECOMMENDATIONS: Particularly in elderly patients with multiple comorbidities, TEVAR is a valuable, less invasive option compared to open surgical repair.


Assuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Angiografia/métodos , Humanos , Cuidados Pré-Operatórios/métodos
13.
Radiologie (Heidelb) ; 63(3): 180-186, 2023 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-36627368

RESUMO

BACKGROUND: Lesions of the paravertebral mediastinum are rare, and knowledge of possible differential diagnoses is essential for clinical practice. OBJECTIVE/METHODS: To review common lesions of the paravertebral mediastinum. RESULTS: The paravertebral mediastinum mainly includes fatty tissue and neurogenic structures. Imaging is commonly performed using computed tomography (CT) and magnetic resonance imaging (MRI). Neurogenic tumors are the most common lesions of the paravertebral mediastinum. Other pathologies include extramedullary hematopoiesis, lipomatous, lymphogenic, inflammatory, and cystic lesions. Moreover, also diaphragmatic hernias, vascular and esophageal pathologies may be found in the paravertebral mediastinum.


Assuntos
Lipoma , Neoplasias do Mediastino , Humanos , Mediastino , Neoplasias do Mediastino/diagnóstico , Tomografia Computadorizada por Raios X , Imageamento por Ressonância Magnética
14.
Digestion ; 86(4): 338-48, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23207185

RESUMO

PURPOSE: To evaluate the efficiency of a multimodality approach consisting of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) as bridging therapy for patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT) and to evaluate the histopathological response in explant specimens. MATERIALS AND METHODS: Between April 2001 and November 2011, 36 patients with 50 HCC nodules (1.4-5.0 cm, median 2.8 cm) on the waiting list for liver transplantation were treated by TACE and RFA. The drop-out rate during the follow-up period was recorded. The local efficacy was evaluated by histopathological examination of the explanted livers. RESULTS: During a median follow-up time of 29 (4.0-95.3) months the cumulative drop-out rate for the patients on the waiting list was 0, 2.8, 5.5, 11.0, 13.9 and 16.7% at 3, 6, 12, 24, 36 and 48 months, respectively. 16 patients (with 26 HCC lesions) out of 36 (44.4%) were transplanted by the end of study with a median waiting list time of 13.7 (2.5-37.8) months. The histopathological examination of the explanted specimens revealed a complete necrosis in 20 of 26 HCCs (76.9%), whereas 6 (23.1%) nodules showed viable residual tumor tissue. All transplanted patients are alive at a median time of 29.9 months. Imaging correlation showed 100% specificity and 66.7% sensitivity for the depiction of residual or recurrent tumor. CONCLUSION: We conclude that TACE combined with RFA could provide an effective treatment to decrease the drop-out rate from the OLT waiting list for HCC patients. Furthermore, this combination therapy results in high rates of complete tumor necrosis as evaluated in the histopathological analysis of the explanted livers. Further randomized trials are needed to demonstrate if there is a benefit in comparison with a single-treatment approach.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Transplante de Fígado , Recidiva Local de Neoplasia/diagnóstico , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Terapia Combinada , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Listas de Espera
15.
Radiologie (Heidelb) ; 62(7): 601-606, 2022 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-35352137

RESUMO

BACKGROUND: Aortoiliac stenosis is common cause of peripheral arterial disease (PAD), which is particularly prevalent in older age (> 60 years) with a prevalence of 20%. In early stages (TASC [Trans-Atlantic Inter-Society Consensus] II A/B), these stenoses can be successfully treated by endovascular procedures. For more complex aortoiliac stenoses (TASC II C/D), open surgical treatment was the primary treatment in the past. CLINICAL ISSUE: Because of the advanced age and multiple comorbidities of PAD patients with complex aortoiliac stenoses, open surgical treatment is usually associated with high risk, and therefore endovascular procedures are an alternative despite their poorer outcome. Covered endovascular reconstruction of the aortic bifurcation (CERAB) aims to improve the primary patency rate compared with the usual endovascular implantation of kissing stents. DATA: With regard to the primary patency rate, open surgical treatment remains superior to both endovascular procedures; however, the CERAB technique shows a better 5­year outcome than the kissing stent technique. No differences are found in the secondary patency rate for any of the three procedures. The morbidity and mortality of the CERAB and kissing stent techniques are comparably low, and both procedures are superior to open surgical treatment. CONCLUSION: Because of the better long-term outcome of the CERAB versus the kissing stent technique, it should be used in patients with complex aortoiliac stenoses with increased risk of complications expected with open surgical treatment.


Assuntos
Doenças da Aorta , Doença Arterial Periférica , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/cirurgia , Constrição Patológica , Humanos , Artéria Ilíaca/cirurgia , Doença Arterial Periférica/cirurgia , Resultado do Tratamento
16.
Sci Rep ; 12(1): 1257, 2022 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-35075169

RESUMO

To investigate the accuracy of liver diameters for estimation of liver size and to evaluate their application as tool for assessment of parenchymal liver disease. In the course of a population-based study, (SHIP) one thousand nine hundred thirty-nine volunteers underwent magnetic resonance imaging (MRI) of the liver including 3D gradient echo MRI sequences. Maximum liver diameters were measured in cranio-caudal (CC), anterior-posterior (AP), medial-lateral (ML) orientation. Diameters were compared with true liver volume assessed by liver segmentation. Additionally, age-dependent reference values for diameters were defined. Finally, accuracy of liver diameters was assessed to discriminate volunteers with healthy livers and participants with parenchymal changes, measured by MRI and laboratory. Reference values of liver diameters within the healthy population (n = 886) were defined as follows (mean ± standard deviation, confidence interval CI in cm): CC 17.2 ± 2, CI 13.6/21.2; AP 15.8 ± 1.9, CI 12.6/19.8; ML 19.7 ± 2.3, CI 15.8/24.6. There was a poor correlation using linear regression between liver diameter and true liver volume; CC 0.393, AP 0.359; ML 0.137. The AP direction shows the best correlation to discriminate between healthy and pathologic liver changes; AUC 0.78; p < 0.001, CC AUC 0.53; p < 0.001 and ML AUC 0.52; p = 0.008. Measurement of liver diameter, especially in the anterior-posterior direction is a simple option to detect chronic liver disease but less suitable for prediction of liver volume.


Assuntos
Fígado/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Hepatopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Adulto Jovem
17.
Chirurg ; 93(1): 5-15, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34757436

RESUMO

BACKGROUND: Abdominal sarcomas are a heterogeneous group of rare soft tissue tumors and can be localized intraperitoneally or retroperitoneally. A pretherapeutic differentiated subtyping is essential for planning an individual, multimodal treatment concept in an interdisciplinary team of experts. OBJECTIVE: The central aspects of histology acquisition, imaging diagnostics and (molecular) pathological subtyping of abdominal soft tissue sarcomas are described in detail. MATERIAL AND METHODS: Imaging and pathological diagnostics are depicted based on the German S3 guidelines on adult soft tissue sarcomas, a current literature search and personal experiences at the Sarcoma Center at the National Center for Tumor Diseases in Dresden (NCT/UCC). RESULTS: Preoperative imaging and (molecular) pathological subtyping of abdominal soft tissue sarcomas place high demands on surgeons, radiologists and pathologists. Genome analyses of sarcomas have the potential to identify points of attack for individualized treatment options. The limitations of resectability can only be assessed by experienced sarcoma surgeons at specialized centers. CONCLUSION: The treatment of abdominal soft tissue sarcomas at an experienced center is associated with a better prognosis. Even at the first suspicion of an abdominal sarcoma, a referral to an experienced center should be made in order to guarantee optimal expertise in diagnostics and treatment.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Adulto , Terapia Combinada , Humanos , Prognóstico , Encaminhamento e Consulta , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia
18.
Sci Rep ; 12(1): 12465, 2022 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-35864140

RESUMO

To evaluate the suitability of volume index measurement (VI) by either ultrasound (US) or computed tomography (CT) for the assessment of liver volume. Fifty-nine patients, 21 women, with a mean age of 66.8 ± 12.6 years underwent US of the liver followed immediately by abdominal CT. In US and CT imaging dorsoventral, mediolateral and craniocaudal liver diameters in their maximum extensions were assessed by two observers. VI was calculated by multiplication of the diameters divided by a constant (3.6). The liver volume determined by a manual segmentation in CT ("true liver volume") served as gold standard. True liver volume and calculated VI determined by US and CT were compared using Bland-Altman analysis. Mean differences of VI between observers were - 34.7% (- 90.1%; 20.7%) for the US-based and 1.1% (- 16.1%; 18.2%) for the CT-based technique, respectively. Liver volumes determined by semi-automated segmentation, US-based VI and CT-based VI, were as follows: 1.500 ± 347cm3; 863 ± 371cm3; 1.509 ± 432cm3. Results showed a great discrepancy between US-based VI and true liver volume with a mean bias of 58.3 ± 66.9%, and high agreement between CT-based VI and true liver volume with a low mean difference of 4.4 ± 28.3%. Volume index based on CT diameters is a reliable, fast and simple approach for estimating liver volume and can therefore be recommended for clinical practice. The usage of US-based volume index for assessment of liver volume should not be used due to its low accuracy of US in measurement of liver diameters.


Assuntos
Fígado , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Fígado/diagnóstico por imagem , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia
19.
Sci Rep ; 11(1): 11661, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083637

RESUMO

Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.


Assuntos
Cistos/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Cistos/diagnóstico por imagem , Cistos/patologia , Feminino , Seguimentos , Humanos , Incidência , Achados Incidentais , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Adulto Jovem
20.
Am J Physiol Gastrointest Liver Physiol ; 299(4): G877-86, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20671193

RESUMO

Endoplasmic reticulum (ER) stress leads to accumulation of un- or misfolded proteins inside the ER and initiates the unfolded protein response (UPR). Several UPR components are physiologically involved in pancreatic development and are pathophysiologically activated during acute pancreatitis. However, the exact role of ER stress in exocrine pancreatic acini is mainly unclear. The present study examined the effects of tauroursodeoxycholic acid (TUDCA), a known ER chaperone, on acinar function and UPR components. Isolated rat pancreatic acini were stimulated by increasing concentrations of cholecystokinin (CCK-8) with or without preincubation of TUDCA. UPR components were analyzed, including chaperone binding protein (BiP), protein kinase-like ER kinase (PERK), X-box binding protein (XBP)-1, c-Jun NH(2)-terminal kinase (JNK), CCAAT/enhancer binding protein homologues protein (CHOP), caspase 3 activation, and apoptosis. In addition, TUDCA effects were measured on amylase secretion, calcium signaling, trypsin, and cathepsin B activation. TUDCA preincubation led to a significant increase in amylase secretion after CCK-8 stimulation, a 50% reduction of intracellular trypsin activation, and reduced cathepsin B activity, although the effects for cathepsin B were not statistical significant. Furthermore, TUDCA prevented the CCK-8-induced BiP upregulation, diminished PERK and JNK phosphorylation, and prohibited the expression of CHOP, caspase 3 activation and apoptosis. XBP-1 splicing was not altered. ER stress response mechanisms are activated in pancreatic inflammation. Chemical chaperones enhance enzyme secretion of pancreatic acini, reduce ER stress responses, and attenuate ER stress-associated apoptosis. These data hint new perspectives for an employment of chemical chaperones in the therapy of acute pancreatitis.


Assuntos
Retículo Endoplasmático/efeitos dos fármacos , Pâncreas/citologia , Pâncreas/efeitos dos fármacos , Ácido Tauroquenodesoxicólico/farmacologia , Tripsina/metabolismo , Amilases/metabolismo , Animais , Apoptose/efeitos dos fármacos , Sinalização do Cálcio/efeitos dos fármacos , Catepsina B/metabolismo , Colagogos e Coleréticos/farmacologia , Relação Dose-Resposta a Droga , Retículo Endoplasmático/fisiologia , Ativação Enzimática , Pâncreas/metabolismo , Ratos , Estresse Fisiológico
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