RESUMO
PURPOSE: To evaluate the effectiveness of small size trisacryl gelatin microsphere embolization as a minimally invasive treatment option for patients with symptomatic focal nodular hyperplasia (FNH). MATERIALS AND METHODS: A retrospective review was performed of experience with transarterial bland embolization of FNH during the period 2006-2011 in 12 patients (10 women and 2 men; age range, 18-61 y) with a total of 17 lesions presenting with symptoms of pain. FNH was pathologically proven in 11 lesions from 10 patients; the remaining lesions exhibited the classic imaging appearance for FNH. All patients underwent superselective embolization with 100-300 µm trisacryl gelatin microspheres. Lesion size and contrast enhancement before and after treatment were compared to determine success of the procedure. Clinical response was determined by review of the electronic medical record. RESULTS: After embolization, seven patients showed complete resolution and five patients showed partial resolution of symptoms. Compared with imaging performed before the procedure, mean decrease in lesion size after embolization was 61% (range, 26%-90%) on cross-sectional imaging obtained 4-10 weeks after embolization and 87% (range, 54%-98%) on subsequent imaging. Diminished contrast enhancement was universally noted, with 5 of 17 lesions showing complete lack of residual enhancement. CONCLUSIONS: Transarterial bland embolization of FNH with trisacryl gelatin microspheres in symptomatic patients is a suitable treatment alternative to surgical resection.
Assuntos
Resinas Acrílicas/administração & dosagem , Embolização Terapêutica , Hiperplasia Nodular Focal do Fígado/terapia , Gelatina/administração & dosagem , Artéria Hepática , Adolescente , Adulto , Feminino , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemAssuntos
Fibrinolíticos/administração & dosagem , Transplante de Fígado/efeitos adversos , Trombólise Mecânica , Veia Porta , Esplenectomia/efeitos adversos , Terapia Trombolítica , Trombose Venosa/terapia , Anticoagulantes/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Veia Porta/diagnóstico por imagem , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
PURPOSE: The purpose of the study is to evaluate the indications, techniques, and outcomes for percutaneous gastrostomy placement in the gastric remnant following Roux-en-Y gastric bypass (RYGB) in bariatric patients. MATERIALS AND METHODS: Retrospective chart review and summary statistical analysis was performed on all RYGB patients that underwent attempted percutaneous remnant gastrostomy placement at our institution between April 2003 and November 2016. RESULTS: A total of 38 patients post-RYGB who underwent gastric remnant gastrostomy placement were identified, 32 women and 6 men, in which a total of 41 procedures were attempted. Technical success was achieved in 39 of the 41 cases (95%). Indications for the procedure were delayed gastric remnant emptying/biliopancreatic limb obstruction (n = 8), malnutrition related to RYGB (n = 17), nutritional support for conditions unrelated to RYGB (n = 15), and access for endoscopic retrograde cholangiopancreatography (ERCP, n = 1). Insufflation of the gastric remnant was performed via a clear window (n = 35), transhepatic (n = 5), and transjejunal (n = 1) routes. Five complications were encountered. The four major complications (9.8%) included early tube dislodgement with peritonitis, early tube dislodgement requiring repeat intervention, intractable pain, and upper gastrointestinal bleeding. A single minor complication occurred (2.4%), cellulitis. CONCLUSION: Patients with a history of RYGB present a technical challenge for excluded gastric remnant gastrostomy placement. As the RYGB population increases and ages, obtaining and maintaining access to the gastric remnant is likely to become an important part of interventional radiology's role in the management of the bariatric patient.
Assuntos
Derivação Gástrica/métodos , Coto Gástrico/cirurgia , Gastrostomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do TratamentoAssuntos
Coartação Aórtica/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/tratamento farmacológico , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/tratamento farmacológico , Circulação Colateral , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors describe various patterns of F-18 fluorodeoxyglucose (FDG) accumulation in the diaphragm and crura. They present 6 patients in whom incidental diaphragmatic and crural uptake of FDG was observed during positron emission tomography (PET). Hyperventilation is thought to be the potential underlying mechanism of this condition.
Assuntos
Diafragma/diagnóstico por imagem , Fluordesoxiglucose F18 , Hiperventilação/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos RadiofarmacêuticosRESUMO
Retroperitoneal malignant peripheral nerve sheath tumor (MPNST), a rare type of neurogenic tumor, was diagnosed in a 14-year-old girl with a history of neurofibromatosis type 1 (NF1). Immunochemistry demonstrated spindle cells positive for S-100 protein. The patient had multiple tumor recurrences and she was evaluated with serial F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). A tumor in the right iliac wing showed increased FDG uptake on PET. FDG-PET played an important role in therapy planning and subsequent follow up. This case emphasizes the important role FDG-PET could play in the staging, restaging, and posttherapy follow up of MPNST.
Assuntos
Fluordesoxiglucose F18 , Neoplasias de Bainha Neural/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Compostos Radiofarmacêuticos , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada de Emissão/métodos , Adolescente , Neoplasias Ósseas/secundário , Feminino , Seguimentos , Humanos , Recidiva Local de Neoplasia/patologia , Neoplasias de Bainha Neural/secundário , Neurofibromatose 1/patologia , Proteínas S100/análiseAssuntos
Fluordesoxiglucose F18 , Linfonodos/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Idoso , Feminino , Fluordesoxiglucose F18/farmacocinética , Humanos , Linfonodos/metabolismo , Metástase Linfática , Linfoma Difuso de Grandes Células B/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Neoplasias da Glândula Tireoide/metabolismoRESUMO
Endobronchial brachytherapy serves as an excellent adjunct to standard external beam radiation therapy. The high dose of local radiation is still used to manage airway obstructions at some institutions, despite the well-known risks of airway fistulae to the esophagus or cardiovascular structures. A less reported complication is the development of a pulmonary artery pseudoaneurysm into the mainstem bronchi. The formation of an arterial pseudoaneurysm can lead to massive hemoptysis, which often is fatal. We present a case of massive hemoptysis due to this complication of brachytherapy managed entirely through bronchoscopic and endovascular techniques.
Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Braquiterapia/efeitos adversos , Embolização Terapêutica , Hemoptise/etiologia , Hemoptise/terapia , Artéria Pulmonar , Falso Aneurisma/complicações , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostáticos/administração & dosagem , Humanos , Instilação de Medicamentos , Intubação Intratraqueal , Laringoscopia , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Radiografia , Radiologia Intervencionista , StentsRESUMO
Deep venous thrombosis and thromboembolism are significant health risks, with high rates of morbidity and mortality. Chronically ill and hospitalized patients, particularly those with cancer, have a high risk for developing these conditions. Mechanical inferior vena cava (IVC) filtration has been standard care for patients with these conditions in whom anticoagulation therapy is contraindicated or has failed. This article reviews caval filters and the current indications for using mechanical IVC filters, including retrievable versus permanent filters, focusing on their use in treating venous thromboembolism in cancer patients.