Assuntos
Derivação Portossistêmica Transjugular Intra-Hepática , Contraindicações , Humanos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/normas , Complicações Pós-Operatórias/epidemiologia , Controle de Qualidade , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the safety and efficacy of a hydrodynamic thrombectomy system in a prospective, multicenter randomized comparison with pulse-spray thrombolysis in hemodialysis grafts. MATERIALS AND METHODS: Nine centers enrolled 120 adult patients with recently (=14 days) thrombosed hemodialysis grafts. Graft venography was used to confirm occlusion in 62 patients randomly assigned to thrombectomy and 58 to thrombolysis. For thrombolysis, a mixture of 5,000 U of heparin and 250,000 U of urokinase was distributed throughout the thrombus, first to the venous then to the arterial graft end. For thrombectomy, the catheter was passed in the same sequence. Technical success was removal of 80% or more of thrombus. Clinical success was technical success plus the ability to dialyze. Also assessed were total procedure time, thrombus treatment time, procedure-related blood loss, other complications, and 30- and 90-day outcomes. RESULTS: Patient demographics were comparable. Technical success rates were 95% (59 of 62) for thrombectomy and 90% (52 of 58) for thrombolysis (P: =.31). Clinical success rates were 89% (55 of 62) and 81% (47 of 58), respectively (P: =.24). At 30 days, 69% (43 of 62) and 66% (38 of 58), respectively, could be dialyzed through the graft (P: =.70); at 90 days, the rates were 40% (25 of 62) and 41% (24 of 58), respectively (P: =.91). None of these differences or those for procedure-related blood loss and early and late complications were statistically significant. Thrombus treatment times of 16.8 minutes for thrombectomy and 23.4 minutes for thrombolysis were significantly different (P: <.01). CONCLUSION: The hydrodynamic thrombectomy system is at least as efficacious and safe as pulse-spray thrombolysis but shortens thrombus treatment time.
Assuntos
Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Trombose/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/métodos , Constrição Patológica/terapia , Feminino , Fibrinolíticos/administração & dosagem , Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Diálise Renal , Trombectomia/instrumentação , Fatores de Tempo , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagemAssuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateteres de Demora/efeitos adversos , Garantia da Qualidade dos Cuidados de Saúde , Diálise Renal/instrumentação , Trombose/terapia , Angioplastia com Balão , Contraindicações , Oclusão de Enxerto Vascular/terapia , Humanos , Stents , Trombectomia , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
PURPOSE: The increased use of thrombectomy with deliberate pulmonary embolization of thrombus following initial thrombolysis for occluded hemodialysis fistulas prompted the authors to measure the prevalence of pulmonary embolism (PE) due to the procedure. PATIENTS AND METHODS: Thirty-one patients with 43 acutely thrombosed polytetrafluoroethylene hemodialysis fistulas were treated with thrombolysis/thrombectomy. Perfusion lung scans were obtained in 22 patients. Patients were also continuously monitored for clinical signs or symptoms of PE. RESULTS: Perfusion scans were interpreted as consistent with PE in 59% of those studied, but no clinical signs or symptoms were present in 41 of the 43 cases (95%). However, two patients developed both signs and symptoms of acute PE in the postprocedural period and died. One had underlying pulmonary disease and had undergone thrombectomy before. The other had chronic heart disease. CONCLUSION: Thrombolysis/thrombectomy is usually safe and effective, even though many patients develop subclinical PE. The authors urge extreme caution in patients who have underlying pulmonary or cardiac disease and/or have undergone the procedure before.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Embolia Pulmonar/etiologia , Diálise Renal , Trombectomia , Terapia Trombolítica , Trombose/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Oclusão de Enxerto Vascular/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Embolia Pulmonar/prevenção & controle , Trombose/complicaçõesRESUMO
PURPOSE: We have identified a specific sign of lumbar thecal sac compression seen in patients with symptomatic lumbar epidural lipomatosis. Recognition of this sign will aid with proper diagnosis of this unusual disorder. METHODS: Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) examinations of the lumbar spine performed in the evaluation of low back pain over a 24 mo period demonstrated nine patients with excessive fat in the epidural space. Myelography was performed on five of these patients. Detailed analysis of the shape and degree of thecal sac compression was made. RESULTS: Eight of the nine patients with epidural lipomatosis demonstrated a characteristic type of thecal sac compression not seen with other spinal disorders. On cross sectional imaging, the thecal sac has a striking stellate appearance with three rays emanating from a central core. This produces a trifid shape resembling the letter "Y". In two patients scanned following subsequent surgical removal of the epidural fat, the thecal sac had resumed its normal configuration. CONCLUSION: A seemingly specific and easily recognized type of compression of the thecal sac may occur with lumbar epidural lipomatosis. This creates a trifid appearance of the thecal sac; we have termed this the "Y" sign.
Assuntos
Lipomatose/diagnóstico por imagem , Lipomatose/diagnóstico , Imageamento por Ressonância Magnética , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Meios de Contraste , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Espaço Epidural , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Mielografia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/diagnóstico por imagemRESUMO
Twelve presurgical patients with colorectal carcinoma received a single intravenous infusion of 0.5-20.0 mg of the radiolabeled monoclonal antibody conjugate CYT-103. This product is an immunoconjugate of B72.3 labeled with Indium-111 (111In). Patients underwent preoperative gamma camera imaging and computed tomographic (CT) scanning of the abdomen and pelvis. Fifteen intraabdominal sites of tumor were found at surgery. Monoclonal antibody imaging detected 87% of these lesions, whereas CT of the abdomen and pelvis detected 47%. Monoclonal antibody imaging identified tumor in 27% of the patients in which CT did not identify any sites of tumor. The results of this study indicate that monoclonal antibody imaging using [111In]CYT-103 is useful for the preoperative evaluation of colorectal carcinoma patients and the results are complimentary to CT of the abdomen and the pelvis.