Assuntos
Procedimentos Endovasculares/métodos , Malformações Vasculares/diagnóstico por imagem , Artéria Vertebral/anormalidades , Idoso , Angiografia , Diagnóstico Diferencial , Humanos , Masculino , Artéria Subclávia/anormalidades , Tomografia Computadorizada por Raios X , Malformações Vasculares/cirurgia , Artéria Vertebral/cirurgiaRESUMO
Granulosa cell tumors account for 2 to 3 per cent of all ovarian neoplasms. This case report describes a patient with splenic rupture from a bulky metastatic deposit 29 years after her initial surgery. A review of the literature regarding the patterns and timing of recurrence is also discussed.
Assuntos
Tumor de Células da Granulosa/secundário , Histerectomia , Neoplasias Ovarianas/patologia , Ovariectomia , Neoplasias Esplênicas/secundário , Ruptura Esplênica/etiologia , Antimetabólitos Antineoplásicos/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Tumor de Células da Granulosa/sangue , Tumor de Células da Granulosa/terapia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Ruptura Espontânea , Esplenectomia , Neoplasias Esplênicas/sangue , Neoplasias Esplênicas/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Angioplastia/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Falha de Prótese , Stents/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos ProspectivosRESUMO
BACKGROUND: Available information on outcome and best strategies for thoracic endovascular repair is somewhat limited and unclear. We sought to gain a better understanding of these issues through a retrospective review of our 8-year clinical experience in the treatment of thoracic aortic aneurysms and dissections. METHODS: A retrospective chart review of 186 patients undergoing stent-graft repair of thoracic aortic lesions at our institution during the 92-month period ending on December 31, 2004 was performed. Patients were divided into two groups based on the indication for treatment; group A had thoracic aortic aneurysms (TAA) and group B had type B aortic dissections (TBAD). Both groups were analyzed for outcome variables including technical success, mortality, major morbidity, endoleak rate and type, secondary endovascular interventions, and long-term survival. Mean follow-up was 40 months (range, 1 to 92 months). RESULTS: Compared to group B, group A patients were older and had a higher incidence of peripheral vascular disease and chronic obstructive pulmonary disease. Sixty percent of all patients were American Society of Anesthesiologists class III and the remainder were class IV (38.3%) and V (1.7%). The procedure was completed in 180 patients (96.7%), with all 6 failures being access-related. The average procedure time was 149 minutes (range, 72 to 405). The 30-day mortality was 4.7% (9 patients), and serious morbidity was 19.9% (37 patients). Eight patients (4.3%) developed spinal cord ischemia, 4 immediately after the procedure and 4 delayed (1 to 3 days). Total hospital length of stay averaged 6.7 days. Secondary endovascular interventions were successful in 17 patients with angiographically confirmed endoleaks (type I and III). At an average follow-up of 40 months, freedom from all-cause mortality was 62.5% in group A and 58.1% in group B. CONCLUSIONS: Stent-graft repair for TAA and TBAD can be achieved with high technical success and comparatively low rates of morbidity and mortality. Midterm survival appears to be favorable. Further refinements in device technology and procedural techniques are needed.