RESUMO
BACKGROUND: The aim of our study was to evaluate and compare short- and long-term outcomes of percutaneous angioplasty and open revascularization for chronic intestinal ischemia. MATERIALS AND METHODS: Twenty-nine consecutive patients undergoing percutaneous angioplasty (n = 14) or open revascularization (n = 15) for chronic intestinal ischemia were prospectively studied from 2000 to 2006. All patients were symptomatic with at least thrombosis or 80% stenosis of superior mesenteric artery. RESULTS: No patient was lost to follow-up. Patients were older in percutaneous angioplasty than in the open revascularization group (p = 0.0009). Open revascularization allowed to revascularize more vessels (1.4 versus 1, p = 0.01). There was no difference between groups regarding major complications, mortality, hospital length of stay, and symptomatic recurrence. Primary re-stenosis was only observed in three patients (21.4%) in the percutaneous angioplasty group. Survival at 2 years estimated by the Kaplan-Meier method was 58% in the percutaneous angioplasty group and 70% in the open revascularization group (p = NS). CONCLUSION: Percutaneous angioplasty should be preferentially offered to older patients and those unable to undergo open revascularization.
Assuntos
Angioplastia com Balão , Implante de Prótese Vascular , Intestinos/irrigação sanguínea , Isquemia/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Prevenção Secundária , Aumento de Peso/fisiologiaRESUMO
Acute pancreatitis usually is a benign disease. However it can sometimes be severe with a 5% mortality. CT is the imaging technique of choice and should be performed in all cases. When clinical symptoms and laboratory findings are typical, the role of CT is to detect complications. In those cases, CT is ideally performed 72 hours after the beginning of symptoms. In other cases, CT can be performed earlier. The main usefulness of CT is to detect complications: necrosis, fluid collections and vascular involvement. Non-invasive imaging techniques, including US, are poorly sensitive for diagnosis of biliary pancreatitis.
Assuntos
Diagnóstico por Imagem , Pancreatite/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Exsudatos e Transudatos , Cálculos Biliares/diagnóstico , Humanos , Litíase/diagnóstico , Imageamento por Ressonância Magnética , Necrose , Pâncreas/irrigação sanguínea , Neoplasias Pancreáticas/diagnóstico , Pancreatite/diagnóstico por imagem , Infarto do Baço/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia , Doenças Vasculares/diagnósticoRESUMO
PURPOSE: To evaluate the specificity of spiral CT for early diagnosis of small hepato-cellular carcinoma. PATIENTS AND METHODS: One or several hepatic hypervascular nodules, with a diameter smaller than or equal to 3cm and suspected of corresponding to small hepato-cellular carcinoma, were detected during the arterial phase of spiral CT in 55 patients. The diagnosis of the main nodule could be established in 31 patients by pathologic examination, elevated alpha-foeto-protein level or follow-up examination. RESULTS: Among the 31 studied nodules, 19 were hepato-cellular carcinomas (61%) and 12 were benign (39%). Seven (78%) of the 9 nodules>20mm and 12 (54%) of the 22 nodules<=20mmm were hepato-cellular carcinomas. Three benign lesions (2 angiomas and 1 pseudo-nodule of hemodynamic origin) were showing typical radiological characteristics which retrospectively allowed their identification. On the other hand, the appearance of the 9 other benign nodules (29%) was exactly the same as the one of the hepato-cellular carcinoma. CONCLUSION: Although, in cirrhotic patients, hepato-cellular carcinoma is the most frequent cause of detected nodules during the arterial phase of the spiral CT, 29% of hypervascular lesions<=3cm were benign in this study. In some cases, only follow-up examinations are able to confirm the diagnosis.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Angiografia , Biópsia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodosRESUMO
Systemic chemotherapy is generally ineffective in patients with advanced hepatocellular carcinoma (HCC). This could be partly explained by the frequent underlying cirrhosis, which induces serious toxicity requiring dose attenuation or drug discontinuation. We present observations of three patients with HCC developed in healthy liver and treated with docetaxel (100 mg/m(2) every 3 weeks in one patient; 30 mg/m(2) weekly, three times every 4 weeks in two patients). An objective partial response with long-term survival was obtained in all cases without severe toxicity. These results suggest that chemotherapy, and especially docetaxel, could be safe and effective in patients with HCC developed in healthy liver, and should be assessed in specific trials.