RESUMO
Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.
RESUMO
OBJECTIVES: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.
Assuntos
Gastrostomia , Radiologia , Humanos , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Estudos Retrospectivos , Centros de Atenção Terciária , Radiografia Intervencionista/métodosRESUMO
PURPOSE: To assess the safety and tolerability of transarterial drug-eluting bead chemoembolisation (DEB-TACE) using tightly calibrated 100-µm microspheres in hepatocellular carcinoma (HCC). METHOD: This multicentre prospective study included 131 patients with a 2-year follow-up. All patients had Child-Pugh scoresâ¯≤â¯B7, a good performance status, and Barcelona Clinic Liver Cancer stage A or B. Beads were loaded with 50â¯mg of doxorubicin per millilitre. Overall, 223 nodules were treated (mean size: 27.6â¯mm, average number of nodules per patient: 1.7). Toxicity was assessed using Common Terminology Criteria for Adverse Events 4.03 and response according to the modified Response Evaluation Criteria in Solid Tumours. The primary endpoint was safety. Secondary endpoints included technical success, post-embolisation syndrome (PES), local tumour response, and 2-year survival. RESULTS: A total of 214 DEB-TACE procedures were performed (mean per patient: 1.64), with a technical success rate of 97.6 % and a PES rate of 9.3 %. Major complications occurred in 6.8 % of patients and 4.1 % of procedures. There were no treatment-related deaths. Doxorubicin dose was an independent predictor of complications (pâ¯=â¯0.01). Four patients were lost to follow-up and 18 received liver transplants. Objective response rates were 74.6 %, 45.7 %, and 44.1 % at 6, 12, and 24â¯months, respectively. The cumulative 24-month overall survival rate was 55.96 %. Median survival was 22 months (interquartile rangeâ¯=â¯13-24). Co-morbidities and tumour response were independent predictors of survival (pâ¯=â¯0.0012 and 0.0052, respectively). Complications did not affect survival (pâ¯=â¯0.24). CONCLUSIONS: DEB-TACE with tightly calibrated 100-µm beads is safe and not associated with increases in biliary toxicity or complications. Tumour response and survival are in the expected range for chemoembolisation therapy. (Clinical trials ID: NCT02670122).
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Doxorrubicina/administração & dosagem , Neoplasias Hepáticas/terapia , Microesferas , Idoso , Calibragem , Feminino , Humanos , Masculino , Estudos Prospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.
Assuntos
Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Nefrectomia/efeitos adversos , Artéria Renal/cirurgia , Veias Renais/cirurgia , Stents , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Resultado do TratamentoAssuntos
Embucrilato/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/efeitos adversos , Veia Porta , Soluções Esclerosantes/efeitos adversos , Trombose Venosa/etiologia , Idoso , Embucrilato/uso terapêutico , Feminino , Hemostase Endoscópica/métodos , Humanos , Derivação Portossistêmica Transjugular Intra-Hepática , Soluções Esclerosantes/uso terapêutico , Trombose Venosa/terapiaRESUMO
A 36-year-old woman was referred for the evaluation of refractory arterial hypertension with vasculorenal profile. Abdominal multislice computed tomography angiography (MSCT-angiography) was performed for further evaluation. Bilateral renal artery involvement was demonstrated with aneurysms, stenotic segments, and a string-of-beads-appearance in the right renal artery. We discuss the occurrence of fibromuscular dysplasia as a cause of refractory hypertension in young women and the increasing importance of MSCT studies for its diagnosis.
Assuntos
Displasia Fibromuscular/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Adulto , Angiografia/métodos , Pressão Sanguínea , Constrição Patológica , Feminino , Humanos , Imageamento Tridimensional , Artéria Renal/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
Solitary fibrous tumor (formerly known as hemangiopericytoma) is a rare soft tissue neoplasm, most frequently arising from the retroperitoneum and lower extremities. We present two cases of retroperitoneal solitary fibrous tumors diagnosed after surgical removal. We provide a literature review showing the basic clinical, pathologic and therapeutic features of these tumors.