RESUMEN
OBJECTIVE: To evaluate the efficacy and safety of percutaneous gastrostomy (PG), using small catheters without gastropexy, to deliver enteral nutrition. METHODS: We reviewed the records of 176 consecutive patients in whom PG was attempted for enteral nutrition. Of these cases, 172 catheters were inserted by the Seldinger technique under fluoroscopic guidance alone, 2 were inserted under computed tomographic guidance, and 2 procedures failed. In primary procedures, 8.5- or 10.2-French catheters were used. RESULTS: The technical success rate was 98.9%. Of the 176 procedures, 2 failed because of the high position of the stomach. Seven-day follow-up was obtained in all patients; 30-day follow-up in 145 patients (83%), and long-term follow-up (30 to 1512 days) in 123 patients (70%). The 30-day mortality rate was 13.2%. One death (0.5%) was directly related to the procedure. Major complications occurred in 4 patients (2.2%), and minor complications in 12 patients (6.9%). No patient required surgery for complications attributable to the gastrostomy procedure. CONCLUSION: PG without gastropexy using small catheters is a simple, safe and effective technique for delivering enteral nutrition.
Asunto(s)
Nutrición Enteral/métodos , Gastrostomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Nutrición Enteral/efectos adversos , Nutrición Enteral/instrumentación , Femenino , Estudios de Seguimiento , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
Ischemic spinal cord injury is the major risk of bronchial artery embolization. The spinal artery may be overlooked on initial intercostobronchial trunk arteriography, as a result of reverse flow within the intercostal branch. Its identification, conversely, is easier on postembolization angiography. An illustrative case is presented, with angiographic correlation. The pathophysiology of the reverse flow is discussed. Technical recommendations are proposed for its detection.
Asunto(s)
Angiografía , Arterias Bronquiales , Embolización Terapéutica , Isquemia/prevención & control , Médula Espinal/irrigación sanguínea , Adulto , Embolización Terapéutica/efectos adversos , Hemoptisis/terapia , Humanos , Masculino , Médula Espinal/diagnóstico por imagenRESUMEN
STUDY OBJECTIVE: To assess abnormalities in thoracoabdominal pattern of breathing (TAPB) in neuromuscular disorders during spontaneous breathing, intermittent positive pressure ventilation (IPPV) with and without abdominal (AB) binder, and immediately after IPPV. DESIGN: Repeated measures design: Pre-IPPV spontaneous breathing, IPPV, IPPV with AB binder, and post-IPPV spontaneous breathing. In protocol 1, ventilator pressure was held constant at the individual value habitually adopted in sessions of IPPV. In protocol 2, it was increased stepwise from 5 to 30 cm H2O. SETTING: University hospital, Department of Pediatrics, Intensive Care, and Neuro-Ventilatory Rehabilitation. PATIENTS: Thirty-one patients with spinal muscular atrophy (SMA) and 19 patients with myopathy, mean age (+/- SD) 9.7 +/- 3 years. MEASUREMENTS: Tidal volume (VT), percent thoracic contribution to VT (%RC), the phase angle between the thoracic and the AB volume changes and the labored breathing index, which is an index of asynchrony taking into account both the phase relationships and relative volumes of rib cage and AB compartments. RESULTS: We observed marked abnormalities in TAPB during spontaneous breathing, especially in the SMA group. %RC, labored breathing index, and phase angle displayed nearly normal values during IPPV. IPPV pressures of 25 to 30 cm H2O were necessary to increase %RC above 80%. AB binding decreased VT, but led to larger thoracic volumes, especially in patients with SMA. Thoracic contribution to VT and thoracic volume after IPPV were higher than baseline levels. CONCLUSIONS: The quantitative assessment of TAPB enhances the ability to estimate pulmonary function in neuromuscular disorders, and the efficiency of mechanical ventilation.
Asunto(s)
Enfermedades Musculares/fisiopatología , Respiración/fisiología , Atrofias Musculares Espinales de la Infancia/fisiopatología , Abdomen/fisiología , Niño , Femenino , Humanos , Ventilación con Presión Positiva Intermitente , Masculino , Tórax/fisiología , Volumen de Ventilación Pulmonar , Capacidad VitalRESUMEN
Bronchial artery embolization (BAE) is well accepted and widely used for management of massive and recurrent hemoptysis. Recurrent hemoptysis occurs in 20% of cases. It may be due to partial embolization, recruitment of other systemic collaterals, recanalization of an embolized artery, or progression of primary disease. Severe complications of BAE are limited to spinal cord injury, oesophageal necrosis, and bronchial ischemia. The proper application of bronchial arteriography and embolization techniques depends on a thorough knowledge of the arterial anatomy, a meticulous catheterization technique, the use of nonionic or lowosmolarity contrast materials, and adequate positioning of the catheter. In these optical conditions of safety, BAE is the treatment of choice for severe and recurrent hemoptysis.
Asunto(s)
Arterias Bronquiales , Embolización Terapéutica , Hemoptisis/terapia , Bronquios/irrigación sanguínea , Arterias Bronquiales/diagnóstico por imagen , Cateterismo Periférico , Circulación Colateral , Medios de Contraste , Progresión de la Enfermedad , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Esófago/patología , Humanos , Isquemia/etiología , Necrosis , Radiografía , Recurrencia , Seguridad , Médula Espinal/irrigación sanguínea , Insuficiencia del TratamientoAsunto(s)
Encéfalo/patología , Cateterismo , Embolia y Trombosis Intracraneal/diagnóstico , Estenosis de la Válvula Mitral/terapia , Fibrilación Atrial/complicaciones , Cateterismo/efectos adversos , Cateterismo/instrumentación , Femenino , Humanos , Embolia y Trombosis Intracraneal/etiología , Embolia y Trombosis Intracraneal/prevención & control , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/diagnóstico por imagen , UltrasonografíaRESUMEN
Few cases of transcatheter coronary fistula closure have been reported. High flow coronary fistulae are usually treated by surgery. This case report presents a 5.4 liters/min flow coronary fistula percutaneously closed by steel coils. This large flow needed the packing of 25 coils, 10-15 cm long, for its total occlusion.
Asunto(s)
Fístula Arteriovenosa/congénito , Anomalías de los Vasos Coronarios/terapia , Embolización Terapéutica , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Cateterismo Cardíaco , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Atrios Cardíacos , Humanos , Persona de Mediana Edad , RadiografíaRESUMEN
Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.