Intraarterial autologous implantation of adult stem cells for patients with Parkinson disease.

PURPOSE: To evaluate the feasibility, safety, and effectiveness of intraarterial autologous implantation of adult stem cells for Parkinson disease (PD). MATERIALS AND METHODS: From June 2006 to August 2008, 36 men and 14 women (mean age, 62.5 years +/- 10.4; range, 38-81 y) with PD (mean duration, 9.3 years; range, 1-28 y) underwent autologous implantation of stem cells with superselective arterial catheterization. Patients were evaluated with clinical and neurologic examinations; internationally recognized scales for the evaluation of PD, disability, activities of daily living, depression, and quality of life (QOL); as well as videos, magnetic resonance (MR) imaging, and MR spectroscopy. Stem cells were implanted in the posterior region of the circle of Willis. Patients were evaluated according to clinical measures. Comparison was made versus data collected from all scales before treatment, as well as videos and spectroscopy in eight patients. RESULTS: In a mean follow-up of 7.4 months +/- 4.5 (range, 1-18 months), patients showed a median improvement of 51.1% and quartile deviation (QD) of 24.8% on the Unified PD Rating Scale. They showed significant improvement in disability, activities of daily living, depression, and QOL (P < .5). No complications were observed. In eight patients, follow-up MR spectroscopy revealed mean improvements in n-acetylaspartate/creatine ratio from 1.805 to 2.07 (12.8%) and from 1.25 to 1.88 (43.56%) in right and left basal ganglia, respectively, versus preprocedural values (P < .05). CONCLUSIONS: Treatment of PD with intraarterial autologous implantation of adult stem cells is feasible and safe and results in improved severity of disease and QOL.

A modified technique to minimize filter tilting during deployment of the Günther Tulip filter: in vitro study.

With an in vitro model of the inferior vena cava, it was demonstrated that slight tension on the introducer during quick release of the jugular Günther Tulip filter led to less tilting of the filter compared with the technique recommended by the manufacturer. This technique may be useful to minimize significant filter tilting that may be associated with decreased filtration efficiency, and difficulty or impossibility of future filter retrieval.

Percutaneous transcholecystic biliary interventions using gallbladder anchors: feasibility study in the swine.

The purpose of this study was to report our initial experience with a swine model for biliary interventions by using a percutaneous transcholecystic access after suture anchor of the gallbladder. Telepaque tablets were given to five pigs to opacify the gallbladder. Under fluoroscopy, the opacified gallbladder was punctured percutaneously and three suture anchors were used to fix the anterior wall of the gallbladder to the abdominal wall. Two weeks later, the gallbladder was punctured and access into the distal common bile was obtained through the cystic duct. Balloon expandable stents were deployed into the distal common bile duct. Follow-up cholangiograms were obtained at 1 and 2 weeks. Necropsy was performed after 2 weeks to evaluate the relationship between the gallbladder and abdominal wall. Suture anchor placement was successful in all five pigs. One pig with a deep and highly positioned gallbladder developed fever, anorexia, and vomiting secondary to excessive stretch of the gallbladder. Placement of the guidewire through the extremely tortuous and small cystic ducts proved to be the most challenging step of the procedure. Metallic stents were successfully deployed in all four pigs in which it was attempted. Four animals tolerated the procedures without changes in their clinical conditions and no symptoms. Successful follow-up cholangiograms were performed at 1 and 2 weeks post-stent deployment without complications. All stents remained patent during the follow-up period. Necropsy demonstrated close attachment and adherence of the gallbladders to the antero-lateral abdominal wall in all four animals. Suture anchoring of the gallbladder is feasible in most pigs with superficially located gallbladders. This technique allows a safe and repeat access into the biliary system using a transcholecystic approach.

Embolización de arterias bronquiales en hemoptisis / Embolization of bronchial arteries in hemoptisis

Los reportes de mortalidad en pacientes con hemoptisis fluctúan aproximadamente en un 50 a 85 por ciento, (según caso clínico), para ello, es importante la evaluación cuidadosa e iniciar un tratamiento para de tener la hemorragia y permitir un adecuado tratamiento de la patología de fondo con un paciente estabilizado hemodinßmicamente en un manejo multidisciplinario, entre el neumólogo, el radiólogo intervencionista, el anestesiólogo. El siguiente trabajo, muestra la experiencia del Instituto Brazzini Radiólogos Asociados, en la embolización de arterias bronquiales, en pacientes con hemoptisis; procedimiento que se realiza desde 1974. Objetivos: Determinar el éxito del manejo en pacientes con hemoptisis, mediante la embolización de las arterias bronquiales. Materiales y métodos: El trabajo de investigación es de tipo longitudinal, prospectivo de tipo descriptivo; el estudio abarcó un total de 11 pacientes con hemoptisis severa, masiva, rebelde al tratamiento médico, con una edad media de 36.6 a±os de edad (rango: 23 - 62 a±os). Se realizaron estudios angiogrßficos y embolización en todos los pacientes (2 de ellos con hemoptisis recidivante), así como la revisión de las arterias sistémicas del tórax (arterias mamaria y torßcico laterales), y una embolización de las mismas si fuera necesario. El material de embolización que se utilizó, fueron partículas de polivinil - alcohol (PVA), émbolos metßlicos espirales entretejidos con fibras de dacrón y émbolos de gelfoam. Resultados: Se consiguió selectivizar las arterias responsables del sangrado, obteniéndo un éxito técnico para la embolización del 100 por ciento. Se presentó recidiva en un 18,1 por ciento , en los que se realizó una nueva embolización. No se observaron complicaciones. Conclusión: La embolización de arterias bronquiales, constituye un tratamiento eficaz de la hemoptisis severa, masiva y recidivante.

Gastroduodenal stent placement: current status.

Gastroduodenal obstruction is a preterminal event in patients with advanced malignancies of the stomach, pancreas, and duodenum. It severely limits the quality of life in affected patients due to constant emesis and associated malnutrition. Surgical gastrojejunostomy has been the traditional palliative treatment but is associated with a high complication rate, and delayed gastric emptying is a frequent problem. Gastroduodenal stent placement is a very safe and effective palliation method in patients with unresectable malignant tumors causing gastric outlet obstruction, with adequate palliation obtained in most cases. The procedure can be performed under fluoroscopic guidance or with a combination of fluoroscopic and endoscopic techniques. Advantages of gastroduodenal stent placement over surgical palliation include suitability as an outpatient procedure, more rapid gastric emptying, greater cost effectiveness, fewer complications, and improved quality of life. Covered duodenal stents are currently being evaluated and may play an increasingly important role in preventing recurrent obstruction secondary to tumor ingrowth. Moreover, simultaneous palliation of biliary and duodenal malignant strictures is possible with the use of metallic stents. Gastroduodenal stent placement is a promising new alternative for the palliation of malignant gastroduodenal obstruction.

Treatment of superior mesenteric and portal vein thrombosis with direct thrombolytic infusion via an operatively placed mesenteric catheter.

Acute superior mesenteric vein (SMV) and portal vein (PV) thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. It can also occur as a complication of medical or surgical intervention. Management of mesenteric and portal vein thrombosis includes both operative and nonoperative approaches. Operative interventions include thrombectomy with thrombolysis; this is often employed for patients who present with signs of peritoneal irritation. Nonoperative approaches can be either noninvasive or invasive. Treatment with anticoagulation has been shown to be efficacious, though its rate of recanalization is not as high as with intravascular infusion of thrombolytics. Intravenous catheterization and thrombolytic infusion has the advantage of direct pharmacologic thrombolysis of clot, with decreased infusion required and the possibility to carry out dilation or thrombectomy concurrently. We report the use of recombinant tissue-plasminogen activator (rt-PA) infusion via an operatively placed multi side-hole catheter/5-Fr introducer sheath into the right portal and superior mesenteric vein clot, inserted through a small jejunal vein, in a patient who presented with acute gangrenous appendicitis and thrombosis of the main portal trunk and superior mesenteric vein. A temporary abdominal closure was maintained until 36 hours after the start of infusion of the rt-PA. At this time venous system had normal flow, with complete recanalization of the right portal and superior mesenteric veins.

Percutaneous transhepatic treatment of symptomatic mesenteric venous thrombosis.

Three patients were seen with acute mesenteric venous thrombosis. With a transhepatic access, percutaneous pharmacologic thrombolysis was performed in one patient with extensive thrombosis of the portal and mesenteric veins, resulting in complete thrombolysis of the portal vein and partial thrombolysis of the superior mesenteric vein. In two patients with focal thrombosis, the use of mechanical devices achieved complete thrombolysis. Percutaneous thrombolysis of portal and mesenteric veins with a transhepatic approach, followed by coil embolization, is a promising endovascular technique for treatment of symptomatic acute mesenteric venous thrombosis.

Tratamiento percutánero endovascular del Síndrome de Budd Chiari: presentación de un caso / Percutaneos endovascular treatment of the Budd Chiari Syndrome

Presenta un caso sobre un paciente de sexo femenino, de 46 años de edad que presenta como único antecedente patológico personal, la ingestión de anovulatorios durante 10 años. No ingiere drogas hepatotóxicas ni tiene antecedentes de hepatitis viral aguda, que se presento en el Departamento Central de Endoscopía del Hospital ce Clínicas de Asunción

Shunt peritoneo venoso en el tratamiento de ascitis maligna: reporte preliminar / Peritoneal venous shunt in the treatment of malignant ascitis: preliminary report

El presente reporte, menciona el uso de una válvula de drenaje de líquido ascítico, conocida como Shunt Peritoneo Venoso como tratamiento de paliación en los pacientes oncológicos terminales. Lo realizamos en cuatro pacientes portadores de carcinomatosis diseminadas, de distintas neoplasias primarias, con una calidad de vida poco favorable, ya que al momento de admitirlos en nuestro servicio presentaban un cuadro de dificultad respiratoria, saciedad precoz, aletargamiento e imposibilidad para desenvolverse adecuadamente en sus labores habituales. Es un reporte de casos, aunque poco extenso muy alentador, la evolución de los pacientes es adecuada, la calidad de vida, nuestro objetivo principal, es mejorada.

[PERITONEAL VENOUS SHUNT IN THE TREATMENT OF MALIGNANTASCITIS: PRELIMINARY REPORT] / Shunt peritoneo venoso en el tratamiento de ascitismaligna: Reporte preliminar.

The present study, mentions the use of a valve for the drainage os ascitic fluid, better known as the peritoneo venous shunt, as a paliation treatment in terminal oncologic patients. It was performed in four patients with diseminated carcinomas, of diferent primary ethiology. These patients had a bad life quality, because when admitted in our Radiology suite, the clinical examination showed shortness of breathearly saciety, lethargy, and were found handiccapped to perform their habitual skills. This is a short and preliminar series, but it is an encouraging report, because, the quality of life, our goal, is improved.

[TIPS] / TIPS: tratamiento efectivo de la descompresiónportal, en várices gastroesofágicas sangrantes.

Esophageal hemorrage due to variceal bleeding in cirrhotic patients represents a serious problem for the physician in charge, especially in this country where liver transplants are inexistent; and also, it is a drama for the patient and its familly. We propose here the Transjugular Intrahepatic Portosystemic Shunt (TIPS). Twenty one patients were part of a study where 23 TIPS were placed, observing an immediate improval in 18 of them, a rebleeding in 2, within the first 24 and 48 hours. An embolization of the coronary veins was performed in the procedure in 15 patients, and a second intervention due to rebleeding in 2 of them. In the latter patients, the embolization of the coronary veins was rutinary.The survival of the patients has been outstanding.We conclude that this interventional procedure is a worldwide reality in the treatment of esophageal hemorrage by variceal bleeding due to portal hipertension, and it does not cut down the probability of liver transplant, unfortunately inexistent in our country. This procedure results in a low morbimortality with an adequate quality of life.

TIPS: tratamiento efectivo de la descompresión portal, en várices gastroesofágicas sangrantes / TIPS: effective treatment of the portal descompression, in bleeding esophageal and gastric varices

La hemorragía digestiva alta por várices gastroesofágicas sangrantes, en pacientes cirróticos, constituye un serio problema para el médico tratante, especialmente en este país donde no existe el transplante hepático y un drama para el paciente y sus familiares. Proponemos aquí la derivación intrahepática portosistémica transyugular (TIPS). Se estudiaron 21 pacientes, en los que se colocaron 23 TIPS, observando en 18 de ellos una mejora inmediata, en 2 un resangrado entre las 24 y 48 horas. En 15 pacientes se realizó embolización de venas coronario estomáquicas en el procedimiento, y en dos en una segunda intervención por resangrado; en los últimos pacientes, la embolización de venas coronarias estomáquicas ha sido rutinaria. La sobrevida de nuestros pacientes ha sido y es buena. Concluímos que este procedimiento intervencionista, es una realidad mundial en el tratamiento de la hemorragia digestiva alta por várices gastroesofágicas debidas a hipertensión portal y no impide la probabilidad de un transplante hepático, lamentablemente ausente en nuestro medio. Tiene una baja morbimortalidad con una calidad de vida adecuada.