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Cancer Manag Res ; 10: 4719-4726, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30410405


Objectives: To explore the efficacy and influencing factors of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT). Materials and methods: The clinical data of 3,126 consecutive patients who suffered from advanced HCC and underwent TACE were retrospectively analyzed. A total of 685 patients had a combination of HCC and PVTT. Of these patients, 475 were treated with TACE (Group A) and 210 were given a supportive care (Group B). The local response and overall survival of the two groups were observed and compared, and the influencing factors were examined through Cox regression analysis. Results: The median survival time and cumulative survival rate at 6, 12, and 24 months of Group A were higher than those of Group B (P=0.002). Multiple Cox regression analysis revealed that Child-Pugh classes and PVTT grades were the independent prognostic factors affecting a patient's survival. Stratified analysis demonstrated that the survival time of patients diagnosed with grades I/II PVTT and treated with TACE was superior to that of patients provided with supportive care (P=0.001), but the survival time of patients with grades III/IV PVTT with or without TACE did not significantly differ (P=0.662). Conclusion: TACE can significantly improve local response, increase cumulative survival rate, and prolong the survival duration of patients with HCC and grades I/II PVTT, whereas the efficacy of TACE for patients with grades III/IV PVTT should be further verified, although their local responses were improved. Child-Pugh classes and PVTT grades are essential factors influencing patient prognosis.

Exp Ther Med ; 13(2): 405-412, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28352308


The aim of the present study was to compare multislice computed tomography angiography (MSCTA) and digital subtraction angiography (DSA) in the diagnosis of aortic dissection. In total, 49 patients with aortic lesions received enhanced computed tomography scanning, and three-dimensional (3D) images were reconstructed by volume rendering (VR), maximum intensity projection (MIP), multiplanar reformation (MPR) and curved planar reconstruction (CPR). The display rate of the entry tear site, intimal flap, true and false lumen from each reconstruction method was calculated. For 30 patients with DeBakey type III aortic dissection, the entry tear site and size of the first intimal flap, aortic maximum diameter at the orifice of left subclavian artery (LSCA), distance between the first entry tear site and the orifice of LSCA, and maximum diameter of aortic true and false lumens were measured prior to implantation of endovascular covered stent-grafts. Data obtained by MSCTA and DSA were then compared. For the entry tear site, MPR, CPR and VR provided a display rate of 95.92, 95.92 and 18.37%, respectively, and the display rate of the intimal flap was 100% in the three methods. MIP did not directly display the entry tear site and intimal flap. For true and false lumens, MPR, CPR, and VR showed a display rate of 100%, while MIP only provided a display rate of 67.35%. When MSCTA was compared with DSA, there was a significant difference in the display of entry site number and position (P<0.05), whereas no significant difference was shown in the measurement of aortic maximum diameter at the orifice of LSCA and the maximum diameter of true and false lumens (P>0.05). In conclusion, among the 3D post-processing reconstruction methods of MSCTA used, MPR and CPR were optimal, followed by VR, and MIP. MSCTA may be the preferable imaging method to diagnose aortic dissection and evaluate treatment of endovascular-covered stent-grafting, preoperatively.

Medicine (Baltimore) ; 96(52): e9535, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29384971


PURPOSE: The present study investigates the side effects and complications of computed tomography (CT)-guided percutaneous iodine-125 (I-125) seeds implantation for advanced pancreatic cancer. METHODS: The clinical data were retrospectively analyzed for patients treated with implantation of I-125 seeds under CT-guide in our hospital from May 2010 to April 2015. The side effects and complications were collected and their possible reasons were analyzed. RESULTS: A total of 78 patients were enrolled. The side effects were categorized as fever in 29 cases (37.18%), abdominal pain in 26 cases (33.33%), nausea and vomiting in 9 cases (11.54%), diarrhea in 5 cases (6.41%), and constipation in 4 cases (5.13%). Complications were composed of pancreatitis in 9 cases (11.54%), infection in 5 cases (6.41%), seed migration in 2 cases (2.56%), intestinal perforation in 1 case (1.28%), and intestinal obstruction in 1 case. The incidence of complication was 23.08% (18/78). The difference in incidence of complication was statistically significant between patients implanted with ≤27 seeds and those with >27 seeds (P = .032). CONCLUSION: The side effects and complications frequently occur in implantation of I-125 seeds for patients with advanced pancreatic cancer. More concern should be given to the patients treated by this technique.

Braquiterapia/efeitos adversos , Braquiterapia/métodos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Pancreáticas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
Medicine (Baltimore) ; 95(17): e3503, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27124055


To investigate the clinical features, risk factors, and bacterial spectrum of liver abscess following transarterial chemoembolization (TACE) and evaluate the therapeutic effect of percutaneous catheter drainage (PCD) on the abscesses.A retrospective review of patient charts was performed in 3613 patients who suffered from liver malignancies (2832 patients with hepatocellular carcinoma and 781 with metastatic hepatic tumor) and had undergone 11,054 TACE procedures from January 2005 to October 2013. Liver abscesses were found in 21 patients. PCD was performed in all abscess patients. The clinical features, risk factors, and bacterial spectrum of liver abscess following TACE were investigated and the therapeutic effect of PCD was evaluated.The incidence of liver abscess was 0.58% per patient and 0.19% per procedure. Approximately 57.1% of the patients had a medical history of bilioenteric anastomosis or biliary stent implantation. On computed tomography scans, the abscesses appeared as low-attenuation lesions and high-density iodinate oil scattered in the abscesses. The ultrasound showed the well defined, heterogeneously hypoechoic lesions. Positive microbiological isolates were obtained in all pus cultures and in 47.6% of blood cultures. The most common bacterium was Escherichia coli (52.4%). Twenty patients (95.2%) were cured from abscesses by using PCD, and 1 died of sepsis.Patients with predisposing factors are prone to an increased risk of liver abscess following TACE. Bacterial culture and antibiotic sensitivity tests on pus and blood help on the antibiotics selection. PCD combined with aggressive antibiotics can be recommended as the first-line therapeutic regimen.

Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/terapia , Abscesso Hepático/microbiologia , Abscesso Hepático/terapia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Paracentese , Adulto , Idoso , Bacteriemia/microbiologia , Bacteriemia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento