Recanalization of portal vein thrombosis after pediatric liver transplantation: Efficacy and safety of the transsplenic access.

BACKGROUND: Endovascular management of portal vein thrombosis (PVT) is challenging. Transsplenic access (TSA) is growing as an access option to the portal system but with higher rates of bleeding complications. The aim of this article is to evaluate the efficacy and safety of transsplenic portal vein recanalization (PVR) using a metallic stent after pediatric liver transplantation. MATERIALS AND METHODS: This is a retrospective review of 15 patients with chronic PVT who underwent PVR via TSA between February 2016 and December 2020. Two children who had undergone catheterization of a mesenteric vein tributary by minilaparotomy were excluded from the patency analysis but included in the splenic access analysis. The technical and clinical success of PVR and complications related to the procedure via TSA were evaluated. RESULTS: Thirteen children with PVT were treated primarily using the TSA. The mean age was 4.1 years (range, 1.5-13.7 years), and the most common clinical presentation was hypersplenism (60%). Technically successful PVR was performed in 11/13 (84.6%) children, and clinical success was achieved in 9/11 (81.8%) children. No major complications were observed, and one child presented moderate pain in the TSA (from a total of 17 TSA). The median follow-up was 48.2 months. The median primary patency was 9.9 months. Primary patency in the first 4 years was 75%, and primary assisted patency was 100% in the follow-up period. CONCLUSIONS: Transsplenic PVR is a safe and effective method for the treatment of PVT after pediatric liver transplantation.

Safety and efficacy of HepaSphere 50-100 µm in the treatment of hepatocellular carcinoma.

AIM: To evaluate the effects of HepaSphere 50-100 µm (Merit Medical) as a doxorubicin carrier and embolization agent for the treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A prospective analysis of 18 patients recruited from a national cancer center was conducted. This analysis evaluated the efficacy and safety of HepaSphere, as expressed by the treatment response rate (measured by the modified Response Evaluation Criteria in Solid Tumors, mRECIST) and by the prevalence of treatment-related adverse events, respectively. RESULTS: The cohort was predominantly male, with a mean age of 69 years. The objective response rate (complete + partial response) was 53.3%. The variable most likely to be associated with objective response was Barcelona Clinic Liver Cancer (BCLC) staging. The most prevalent adverse events were nausea, vomiting and abdominal pain. CONCLUSION: HepaSphere chemoembolization yielded a substantial objective response rate with an acceptable toxicity profile and should be considered an option for HCC treatment.

Biópsia percutânea de lesões ósseas guiada por tomografia computadorizada: taxas de definição diagnóstica e complicações / Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

Objetivo: Determinar taxas de definição diagnóstica e complicações da biópsia percutânea guiada por tomografia computadorizada (TC) de lesões ósseas suspeitas de malignidade. Materiais e Métodos: Estudo retrospectivo que incluiu 186 casos de biópsia percutânea guiada por TC de lesões ósseas no período de janeiro de 2010 a dezembro de 2012. Todas as amostras foram obtidas usando agulhas de 8 a 10 gauge. Foram coletados dados demográficos, história de neoplasia maligna prévia, dados relacionados à lesão, ao procedimento e ao resultado histológico. Resultados: A maioria dos pacientes era do sexo feminino (57%) e a idade média foi 53,0 ± 16,4 anos. Em 139 casos (74,6%) a suspeita diagnóstica era metástase e os tumores primários mais comuns foram de mama (32,1%) e próstata (11,8%). Os ossos mais envolvidos foram coluna vertebral (36,0%), bacia (32,8%) e ossos longos (18,3%). Houve complicações em apenas três pacientes (1,6%), incluindo uma fratura, um caso de parestesia com comprometimento funcional e uma quebra da agulha necessitando remoção cirúrgica. Amostras de 183 lesões (98,4%) foram consideradas adequadas para diagnóstico. Resultados malignos foram mais frequentes nos pacientes com suspeita de lesão secundária e história de neoplasia maligna conhecida (p < 0,001) e nos procedimentos orientados pela PET/CT (p = 0,011). Conclusão: A biópsia percutânea guiada por TC é segura e eficaz no diagnóstico de lesões ósseas suspeitas. .

Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. .

Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications.

OBJECTIVE: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. MATERIALS AND METHODS: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. RESULTS: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). CONCLUSION: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.

OBJETIVO: Determinar taxas de definição diagnóstica e complicações da biópsia percutânea guiada por tomografia computadorizada (TC) de lesões ósseas suspeitas de malignidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que incluiu 186 casos de biópsia percutânea guiada por TC de lesões ósseas no período de janeiro de 2010 a dezembro de 2012. Todas as amostras foram obtidas usando agulhas de 8 a 10 gauge. Foram coletados dados demográficos, história de neoplasia maligna prévia, dados relacionados à lesão, ao procedimento e ao resultado histológico. RESULTADOS: A maioria dos pacientes era do sexo feminino (57%) e a idade média foi 53,0 ± 16,4 anos. Em 139 casos (74,6%) a suspeita diagnóstica era metástase e os tumores primários mais comuns foram de mama (32,1%) e próstata (11,8%). Os ossos mais envolvidos foram coluna vertebral (36,0%), bacia (32,8%) e ossos longos (18,3%). Houve complicações em apenas três pacientes (1,6%), incluindo uma fratura, um caso de parestesia com comprometimento funcional e uma quebra da agulha necessitando remoção cirúrgica. Amostras de 183 lesões (98,4%) foram consideradas adequadas para diagnóstico. Resultados malignos foram mais frequentes nos pacientes com suspeita de lesão secundária e história de neoplasia maligna conhecida (p < 0,001) e nos procedimentos orientados pela PET/CT (p = 0,011). CONCLUSÃO: A biópsia percutânea guiada por TC é segura e eficaz no diagnóstico de lesões ósseas suspeitas.

Hipertensão portal idiopática e suas alterações ultrassonográficas / Idiopathic portal hypertension and related ultrasound findings

Objetivo: caracterizar clínica e pela ultrassonografia (US) a hipertensão portal idiopática. Pacientes e métodos: foram avaliados, retrospectivamente, por US com doppler colorido, 60 pacientes com diagnóstico clínico de hepatopatia crônica e hipertensão portal, de janeiro de 1996 a janeiro de 2006, em clínica privada, encontrando dois casosde hipertensão portal idiopática. Comentários: em jovens com esplenomegalia, hematêmese recorrente, anemia, ascite, funções hepáticas normais e hipertensão portal sem evidência de cirrose, foram observados à US fígado de tamanho usual, textura heterogênea e superfície lisa, ausência de deformidades das ramificações das veias portais intra-hepáticas, espessamento da parede da veia porta maior ou igual a 3 mm e estreitamento abrupto das veias portais secundárias intra-hepáticas acompanhado de esplenomegalia.

Objective: to characterize idiopathic portal hypertension clinically and by ultrasound (US). Patients and methods: 60 patients with clinical diagnosis of chronic liver disease and portal hypertension were retrospectively assessed by color Doppler US, from January 1996 to January 2006, in a privately owned clinic. Two cases of idiopathic portal hypertension were found. Comments: in young patients with splenomegaly, recurring hematemesis, anemia, ascites, normal liver function and portal hypertension without evidence of cirrhosis, US revealed livers of usual size, heterogeneous texture and flat surface, without deformities in the branches of the intra-hepatic portal veins. The portal vein walls were also thickened starting at 3 mm and marked by an abrupt narrowing of the secondary intra-hepatic portal veins, accompanied by splenomegaly.

Giant cell tumor of the frontal sinus: case report / Tumor de células gigantes do seio frontal: relato de caso

The authors report the case of a giant cell tumor of the frontal sinus in a 54-year-old male patient. This tumor location is rare, and this is the third case reported in the literature with radiographic documentation and histopathological confirmation. The patient underwent surgery, with curettage of frontal sinus and placement of a prosthesis. He died because a voluntary abrupt discontinuation of corticosteroids.

Apresentamos um caso de tumor de células gigantes do seio frontal, num paciente do sexo masculino de 54 anos de idade. é tumor de localização rara, sendo o terceiro caso relatado na literatura mundial, com documentação radiográfica e confirmação histopatológica. O paciente foi submetido a intervenção cirúrgica, com curetagem dos seios frontais e colocação de uma prótese, falecendo por supressão abrupta voluntária de corticosteroides.

Síndrome de Cruveilhier-Baumgarten: aspectos ultrassonográficos / Cruveilhier-Baugarten syndrome: sonographic aspects

Objetivo: este trabalho analisa as alterações ultrassonográficas que caracterizam a síndrome de Cruveilhier-Baumgarten (SCB), com suas alterações clínicas. A SCB caracteriza-se pela veia paraumbilical proeminente, com dilatação das veias superficiais da parede abdominal de aspecto radiado provenientes do umbigo dos pacientes com hepatopatia crônica e hipertensão portal. Casuística e métodos: em avaliação ultrassonográfica de 60 pacientes com diagnóstico de hepatopatia crônica com hipertensão portal foram encontrados quatro casos com a SCB em que foi realizado o estudo por meio do doppler colorido. Resultados: todos os pacientes avaliados eram do gênero masculino, estavam na terceira década de vida, tinham história de esplenomegalia, varizes na parede abdominal e eram portadores de esquistossomose e aspecto histopatológico de cirrose micronodular. Foram analisados também dois pacientes com varizes do esôfago sem clinica de hematêmese. Ultrassonograficamente, todos os pacientes tinham sinais de hepatopatia crônica com esplenomegalia, com fluxo hepatopetal em todos os segmentos da veia porta e fluxo hepatofugal nas veias que deixam o fígado (veia paraumbilical no ligamento falciforme e nas veias superficiais da parede abdominal anterior). Conclusão: a SCB caracteriza-se pela associação de sinais de hepatopatia crônica com esplenomegalia, veias paraumbilicais com aumento de calibre (hipertensão porta) e com fluxo para as veias superficiais da parede abdominal, que se acham dilatadas na região umbilical e com sopro à ausculta pelo ultrassom e ao exame físico.

Objective: The purpose of this paper is to analyze the sonographic changes that characterize the Cruveilhier-Baumgarten syndrome and its clinical charactheristics. Cruveilhier- Baumgartem syndrome is characterized by a prominent paraumbilical vein, with dilatated superficial veins of the abdominal wall radiating from the umbilicus of patients with chronic liver disease and portal hypertension. Patients and methods: In a sonographic evaluation of 60 patients diagnosed with chronic liver disease with portal hypertension we found 4 cases of Cruveilhier-Baumgarten syndrome, which we studied with color doppler sonography.Results: All patients were male, in their third decade of life, with a clinical history of splenomegaly and varicose abdominal wall veins. Patients had schistosomiasis and micronodular cirrhosis on hystopathological examination. We also evaluated two patients with esophageal varices without hemathemesis. All patients had ultrasound signs of splenomegaly and chronic liver disease, with hepatopetal flow in all segments of the portal vein and hepatofugal flow in the efferent veins of the liver (paraumbilical vein in the falciform ligament and the anterior abdominal wall surface veins). Conclusion: CBS is charactherized by the associationof signs of chronic liver damage with splenomegaly, distention of paraumbilical veins (portal hypertension) and blood flow towards the superficial abdominal wall veins, which are dilated in the umbilical region, associated with an audible bruit in both clinical and sonographic examination.

Pulmão em ferradura: relato de caso / Horseshoe lung: a case report

Os autores relatam um caso de um recém-nascido a termo, com pulmão em ferradura associado a drenagem anômala total de veias pulmonares supracardíacas, cuja associação não encontramos em nenhum relato na literatura ocidental.

The authors report a case of a newborn term infant with horseshoe lung associated with supracardiac total anomalous pulmonary venous drainage; such association remains unreported in the Western literature.