RESUMEN
The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.
Asunto(s)
Arteriosclerosis Obliterante/cirugía , Endarteritis/cirugía , Enfermedad de Raynaud/cirugía , Simpatectomía , Toracoscopía/métodos , Arteriosclerosis Obliterante/diagnóstico , Arteriosclerosis Obliterante/etiología , Arteriosclerosis Obliterante/fisiopatología , Endarteritis/diagnóstico , Endarteritis/etiología , Endarteritis/fisiopatología , Extremidades/irrigación sanguínea , Ganglionectomía/efectos adversos , Ganglionectomía/normas , Humanos , Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/fisiopatología , Factores de Riesgo , Prevención Secundaria , Simpatectomía/efectos adversos , Simpatectomía/métodos , Simpatectomía/normas , Nervios Torácicos/cirugía , Tiempo , Estimulación Eléctrica Transcutánea del Nervio , Resultado del TratamientoRESUMEN
Two cases of sclerosing cholangitis after oily arterial chemoembolization are reported. In one patient angiocholitis with liver abscesses, in the other patient gradual cholestasis were the main clinical features. In both cases, endoscopic retrograde cholangiogram showed a stricture of the common hepatic bile duct and, in one case, irregularities of intrahepatic biliary tree. Histologic examination of the liver in the two patients pointed out the involvement of small bile ducts and arteriolar endarteritis obliterans. Ischaemia is likely to be the main mechanism of these two cases of sclerosing cholangitis as well as in those described after FUDR intra-arterial chemotherapy. The prevalence of sclerosing cholangitis after arterial oily chemoembolization is probably underestimated because of a non specific clinical presentation and need to be precise by further study.
Asunto(s)
Colangitis Esclerosante/etiología , Embolización Terapéutica/efectos adversos , Aceite Yodado/efectos adversos , Carcinoma Hepatocelular/terapia , Colangiopancreatografia Retrógrada Endoscópica , Colangitis Esclerosante/diagnóstico por imagen , Colangitis Esclerosante/patología , Endarteritis/etiología , Endarteritis/patología , Resultado Fatal , Femenino , Conducto Hepático Común/diagnóstico por imagen , Humanos , Neoplasias del Íleon/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana EdadRESUMEN
The clinical outcome in 12 late-diagnosed patients with homocystinuria is reported. Three children died: all were mentally damaged and were never treated effectively. Eight children have been treated with pyridoxine--or with a low-methionine diet with supplemental L-cystine--for 2 to 9 years. Follow-up of these patients shows a striking improvement in behaviour and intellectual development in close correlation to the biochemical normalisation. No thromboembolic episodes occurred in adequately treated patients. However, in one child thrombosis of the retinal artery developed during dietary failure. In another patient the characteristic symptoms of an endangiitis obliterans completely disappeared. Both the reversibility and the improvement of some of the main sequelae in homocystinuria emphasize the need to treat all patients, regardless of their age at diagnosis.