Assuntos
Injúria Renal Aguda/etiologia , Comportamento Alimentar/psicologia , Obstrução da Saída Gástrica/etiologia , Hiperfagia/complicações , Pancreatite/etiologia , Dor Abdominal/sangue , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Acidose/sangue , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico por imagem , Injúria Renal Aguda/terapia , Adulto , Comportamento Competitivo , Duodeno/diagnóstico por imagem , Lavagem Gástrica , Obstrução da Saída Gástrica/sangue , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/terapia , Humanos , Hiperfagia/sangue , Hiperfagia/diagnóstico por imagem , Pancreatite/sangue , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Estômago/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vômito/sangue , Vômito/diagnóstico por imagem , Vômito/etiologiaRESUMO
AIM: To investigate the predictive factors of self-expandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction. METHODS: A total of 116 patients underwent stent placements for inoperable malignant gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization's scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency. RESULTS: Self-expandable metallic stent placement was technically successful in all patients (100%), and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model, carcinoembryonic antigen (CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio (aHR) = 2.92, 95%CI: 1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency (P = 0.009; aHR = 0.27, 95%CI: 0.10-0.72). CONCLUSION: CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.
Assuntos
Obstrução Duodenal/terapia , Endoscopia Gastrointestinal/instrumentação , Obstrução da Saída Gástrica/terapia , Metais , Neoplasias/complicações , Stents , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Antígeno Carcinoembrionário/sangue , Obstrução Duodenal/sangue , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Obstrução da Saída Gástrica/sangue , Obstrução da Saída Gástrica/diagnóstico , Obstrução da Saída Gástrica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/sangue , Neoplasias/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Desenho de Prótese , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
BACKGROUND: In some neonates suffering from ductus arteriosus dependent congenital heart defect, a Prostaglandin E(1) (PGE1) therapy longer than 2 weeks may be needed. However, PGE1 analogue compounds may produce several adverse effects. METHODS: The authors retrospectively analyzed the data of nine patients who underwent a PGE1 treatment lasting longer than 14 days. RESULTS: The leukocyte count of the patients remained high throughout the treatment period, and the proportion of neutrophils was over 50%. Transient feeding difficulty and abdominal distension, and possible signs of gastric-outlet obstruction, were observed in two cases. In the case of three patients, cortical hyperostosis developed after different cumulative doses (1584, 3384 and 4320 microg). Significant correlations were found between the doses of PGE1 and serum K(+) levels (r=-0.770, P < 0.05) and between the blood standard bicarbonate levels and PGE1 doses (r= 0.889, P < 0.01). Bartter syndrome-like condition developed in those three patients who received the largest cumulative doses. CONCLUSIONS: Fluid-electrolyte parameters must be controlled frequently in the case of each patient treated with PGE1 for longer than 2 weeks. Although the dose, the length of the therapy and individual susceptibility may be equally important, fluid-electrolyte disturbances and the development of pseudo-Bartter syndrome seem to be more dose-dependent than cortical hyperostosis.
