RESUMO
To determine whether total lung capacity (TLC) can be measured from plain chest radiographs in patients with pneumonectomy, we examined 20 such patients (17 male, 3 female) who had pneumonectomy for lung carcinoma. In 16 patients the right lung was preserved, and in 4 the left. The TLC was measured with the helium dilution method and by planimetry of the anterior and lateral projections of the lung on chest radiographs, summing the anterior and lateral projected areas of the lung to a single value, S. The correlation between S and TLC by helium gas dilution was r = 0.95. Linear fit of TLC to S explained 99.5% of the variance in TLC, with the equation. The side resected did not influence the predictive value (p < 0.001). The interquartile range of the residual error was +/-130 ml, and standard error was 64 ml. Therefore in patients with pneumonectomy, TLC of the preserved lung may be estimated within +/-130 ml by planimetry of the anterior and lateral chest radiographs.
Assuntos
Pulmão/fisiopatologia , Pneumonectomia , Radiografia Torácica/métodos , Capacidade Pulmonar Total/fisiologia , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
BACKGROUND/AIMS: Up to now, all reports about metallic stents concerned mostly patients with obstructive jaundice due to primary cancer although some of these series included a small number of patients with metastatic disease as a cause of occlusion of the bile ducts. The question of whether they should be used in patients with biliary obstruction due to metastatic disease, and consequently have a limited life expectancy, is investigated. PATIENTS AND METHODS: Between January 1994 and April 1995, we inserted percutaneously 20 metallic self-expandable endoprostheses in 14 patients with obstructive jaundice due to metastatic disease. RESULTS: Twelve patients died with a mean survival of 144.6 (range 25-338) days without any evidence of biliary reobstruction. For 2 patients, we have followup no longer than 30 days. Thirty day mortality was 7.2% (1/14). Jaundice reoccurred in one patient but wasn't related to stent obstruction, and he died during the first 30 days. We had 2 cases with moderate hemobilia. CONCLUSION: We believe that the use of metal stents in patients with obstructive jaundice due to metastatic disease is justified. Their high initial cost is offset by their prolong patency, decreased complication rate and shorter hospitalization.
Assuntos
Colestase/etiologia , Colestase/terapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/secundário , Cuidados Paliativos , Stents , Idoso , Colestase/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , RadiografiaRESUMO
A case of polyarteritis nodosa with bilateral ureteral changes in IVU is reported, because of the rarity of ureteric involvement in this entity. The urographic findings were unilateral ureteral stricture with hydronephrosis and irregular ureter outlines bilaterally. All lesions subsided after treatment.
Assuntos
Poliarterite Nodosa , Doenças Ureterais , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Quimioterapia Combinada , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico por imagem , Poliarterite Nodosa/tratamento farmacológico , Poliarterite Nodosa/fisiopatologia , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Radiografia , Ureter/diagnóstico por imagem , Ureter/patologia , Doenças Ureterais/complicações , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/tratamento farmacológico , Doenças Ureterais/fisiopatologiaRESUMO
Non-invasive modalities (ultrasound, computerized tomography, MRI and somatostatin receptor scintigraphy) often fail to localize insulinomas smaller than 1.5 cm in diameter. Recently, regionalization of such occult insulinomas was facilitated by the arterial stimulation and venous sampling (ASVS) technique, using calcium as the insulin secretagogue. However, so far experience with this technique has been limited to a few tertiary referrals centres worldwide. In these case studies we report our experience in three consecutive patients with occult insulinomas. Three consecutive patients (all men 34, 51 and 56 years of age) with insulin-mediated hypoglycaemia were studied. Diagnosis of insulin hypersection was established by the finding of a high amended insulin: blood sugar ratio during fasting. Localization of a pancreatic mass lesion was unsuccessful by ultrasound, CT and/or MRI in all patients. Two patients had negative octreotide scans. In all patients after the infusion of calcium sequentially into the gastroduodenal, splenic and the superior mesenteric arteries, insulin levels rose significantly in right hepatic vein samples giving rise to diagnostic gradients from the splenic artery (in 2 patients) and gastroduodenal artery (in 1 patient), regionalizing insulinomas in the tail and head or neck of the pancreas respectively. The simultaneously obtained angiogram was positive in only 1 patient, in whom it corresponded to the insulin gradient. Regionalization of these occult tumours was subsequently confirmed at laparoscopy in the 2 patients operated. It is concluded, that the arterial stimulation venous sampling technique is an effective method in regionalizing occult insulinomas and should complement invasive angiography whenever the latter procedure is performed.