ABSTRACT
Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepato-logy (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.
Subject(s)
Biliary Tract Diseases/surgery , Liver Diseases/surgery , Brazil , Disease Management , Guidelines as Topic , Humans , Societies, MedicalABSTRACT
Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.
Subject(s)
Liver Transplantation/adverse effects , Paracoccidioidomycosis/diagnosis , Antifungal Agents/therapeutic use , Biopsy , Child, Preschool , Female , Humans , Paracoccidioidomycosis/drug therapy , Tomography, X-Ray ComputedABSTRACT
ABSTRACT Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.
Subject(s)
Humans , Female , Child, Preschool , Paracoccidioidomycosis/diagnosis , Liver Transplantation/adverse effects , Paracoccidioidomycosis/drug therapy , Biopsy , Tomography, X-Ray Computed , Antifungal Agents/therapeutic useSubject(s)
Adenocarcinoma/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Pancreatic Neoplasms/pathology , Adenocarcinoma/diagnostic imaging , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Reproducibility of Results , Retrospective StudiesABSTRACT
OBJECTIVES:: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD:: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS:: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION:: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.
Subject(s)
Ablation Techniques/methods , Adrenocortical Hyperfunction/surgery , Ethanol/therapeutic use , Tomography, X-Ray Computed/methods , Adrenal Cortex Neoplasms/surgery , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Adrenocortical Adenoma/surgery , Adult , Aged , Aldosterone/biosynthesis , Cushing Syndrome/surgery , Female , Humans , Hyperplasia/surgery , Male , Middle Aged , Pheochromocytoma/surgery , Reproducibility of Results , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ablation Techniques/methods , Adrenocortical Hyperfunction/surgery , Ethanol/therapeutic use , Tomography, X-Ray Computed/methods , Adrenal Cortex Neoplasms/surgery , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Adrenocortical Adenoma/surgery , Aldosterone/biosynthesis , Cushing Syndrome/surgery , Hyperplasia/surgery , Pheochromocytoma/surgery , Reproducibility of Results , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. MATERIALS AND METHODS: From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. RESULTS: All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33-83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10-40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. CONCLUSIONS: Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.
Subject(s)
Catheter Ablation/methods , Kidney Diseases, Cystic/pathology , Kidney Diseases, Cystic/surgery , Adult , Aged , Aged, 80 and over , Biopsy , Feasibility Studies , Female , Humans , Kidney Diseases, Cystic/diagnostic imaging , Kidney Neoplasms/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative Complications , Reproducibility of Results , Retrospective Studies , Risk Factors , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
ABSTRACT Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Catheter Ablation/methods , Kidney Diseases, Cystic/surgery , Kidney Diseases, Cystic/pathology , Postoperative Complications , Biopsy , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Feasibility Studies , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Surgery, Computer-Assisted/methods , Kidney Diseases, Cystic/diagnostic imaging , Kidney Neoplasms/surgery , Middle AgedABSTRACT
AbstractMagnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.
ResumoA ressonância magnética é um método com alta resolução de contraste e por isso muito utilizada na avaliação de doenças ginecológicas pélvicas. No entanto, seu potencial para diagnóstico de lesões vaginais ainda é subestimado, provavelmente em razão da escassa literatura referente ao tema, da pouca familiaridade dos radiologistas com doenças vaginais, algumas delas relativamente raras, e das muitas peculiaridades em um exame para avaliação desta víscera oca. Desta forma, ilustraremos neste estudo o papel da ressonância magnética na avaliação das doenças vaginais e os principais achados relevantes para a conduta clínica.
ABSTRACT
Descrevemos um relato de caso de um paciente jovem do sexo masculino com tumoração abdominal de crescimento rápido, para cuja elucidação diagnóstica foi fundamental a união dos achadosdos métodos de imagem (tomografia computadorizada e ultra-sonografia) com o raciocínio clínico-radiológico, a fim de aventar a hipótese diagnóstica correta e orientar a terapêutica adequada. Apresentamos a correlação radiológico-patológica, assim como uma breve revisão da literatura relativa a esta entidade nosológica extremamente rara: seminoma metastático oriundode criptosseminoma em testículo pélvico.
We describe a case of a young male with a rapid-growing abdominal mass whose diagnosis required the correct interpretation of imaging findings (computerized tomography and sonography) along with clinical-radiologic reasoning, in order to arrive at the correct diagnostic hypothesis, and, hence, recommend optimal therapy.We hereby present a brief review of the literature and a radiologicpathologiccorrelation of this extremely rare entity: large metastatic cryptoseminoma originated from a small seminoma in a cryptorchid left pelvic testis.
Subject(s)
Humans , Male , Adult , Abdomen , Scrotum , Abdominal Neoplasms/pathology , Seminoma/secondary , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Adolescent , Cystic Fibrosis/diagnosis , Cystic Fibrosis/physiopathology , IleusSubject(s)
Humans , Female , Middle Aged , Infarction , Omentum , Omentum/blood supply , Omentum , Infarction , Tomography, X-Ray ComputedABSTRACT
O propósito do estudo foi avaliar a utilização do ultra-som intra-operatório na cirurgia por neoplasia de fígado, vias biliares e pâncreas comparando achados da avaliação pré-operatória de rotina por meio de métodos de imagem (TC e RMN) utilizando protocolos estado da arte e os achados obtidos por meio da exploração cirúrgica (inspeção e palpação) com os achados do UIO.O UIO modifica positivamente o planejamento cirúrgico em um número significativo de pacientes devendo fazer parte./The purpose of this study was to analyze the use o IOU in the setting of surgery for liver, biliary and pancreatic malignancies. To achieve that, the findings of routine preoperative state-of the-art imaging modalities (CT and MRI) and the findings of surgical exploration (inspection and palpation) were compared to those of IOU. The impact of IOU on preoperative plans based on CT and MRI and on management after surgical exploration were studied as well...
