Asunto(s)
Factores Inmunológicos/efectos adversos , Leucoencefalopatía Multifocal Progresiva/inducido químicamente , Natalizumab/efectos adversos , Adulto , Antígenos CD20/metabolismo , Evaluación de la Discapacidad , Femenino , Humanos , Leucoencefalopatía Multifocal Progresiva/diagnóstico por imagen , Imagen por Resonancia Magnética , Esclerosis Múltiple/tratamiento farmacológicoRESUMEN
Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI. The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients. Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study. A structured questionnaire was used to collect detailed clinical data before and after the ET. Data from 462 patients were collected in 33 centers. ET consisted of balloon dilatation (93 % of cases) or stent application. The mean follow-up duration after ET was 31 weeks. Mean EDSS remained unchanged after ET (5.2 vs. 4.9), 144 relapses occurred in 98/462 cases (21 %), mainly in RR-MS patients. Fifteen severe adverse events were recorded in 3.2 % of cases. Given the risk of severe adverse events and the lack of objective beneficial effects, our findings confirm that at present ET should not be recommended to patients with MS.
Asunto(s)
Encéfalo/irrigación sanguínea , Procedimientos Endovasculares/efectos adversos , Esclerosis Múltiple/cirugía , Médula Espinal/irrigación sanguínea , Insuficiencia Venosa/cirugía , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Encuestas y Cuestionarios , Resultado del Tratamiento , Insuficiencia Venosa/complicacionesRESUMEN
The introduction of the contrastographic medium (PG) eventually combined with CT scan (PCT) has been used in the study of non-infectious abdominal complications of patients on CAPD. In 27 patients on CAPD from 0 to 98 months we infused, through the peritoneal catheter, 100-200 ml of iopamidol and 500-2000 ml of peritoneal dialysis solution, effecting radiograms in different projections (27 cases), with contiguous axial scannings of 10 mm (8 cases). The information obtained was useful with regard to the therapeutic choices; it clarified the extent, the width, and the anatomical relations of hernias (7/7); the leakage site at the introduction point of the catheter (2/5), and site of surgical treatment (2/5); an inguinal hernia (1/4) and the previousness of the peritoneovaginal duct (3/4) in cases of the genital oedema; a displaced non-opaque catheter (1/4); obstruction of the terminal hole (2/4); wrapping of the omentum in a catheter malfunction (1/4); the presence of scar tissue and pathological recesses in the reduction of ultrafiltration (2/3); and the extension of secondary scar tissue after surgery and before CAPD was started. There were no infective complications or allergic reactions during the research. In conclusion, after reparative surgical intervention, PG and PCT are simple, convenient investigations, with significant diagnostic usefulness, before the introduction of the catheter and/or in cases of complications during CAPD.