RESUMO
INTRODUCTION: Thrombolysis has been suggested as a feasible method to treat arterial renal transplant thrombosis under conditions of short duration of ischemia. Data on maximal duration of ischemia that are still feasible to treat are scarce. METHODS: We retrospectively analysed our experience involving three attempts to utilize thrombolysis to treat transplant renal artery thrombosis. We searched through literature on PubMed and compared the data we found with our own experience. RESULTS: In case number 1 of our cohort, thrombolysis was initiated 12 hours after the onset of thrombosis and had to be ceased after five hours due to the formation of a haematoma. Perfusion of the graft was restored but it did not regain function, most likely due to long ischemia time. In case number 2, an attempt to use thrombolysis was unsuccessful due to failure to cross the graft artery occlusion with a guidewire. Thrombosis was most likely caused by chronic rejection of the graft. In case number 3, thrombolysis restored arterial patency but, due to an onset of ischemia, which lasted 2 to 3 days, did not lead to restoration of graft function. The prolonged ischemia period in case three occurred, at least in part, due to failure to perform an ultrasound scan when the patient was first admitted. CONCLUSION: We can confirm that thrombolysis for transplant renal artery thrombosis seems to be feasible only when the condition has a short duration. In the event of sudden deterioration of graft function, the absence of perfusion must always be ruled out by ultrasound scan.
Assuntos
Artéria Renal , Trombose , Humanos , Estudos Retrospectivos , Terapia Trombolítica , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/etiologia , Resultado do TratamentoRESUMO
PURPOSE: Presentation of our own experience with percutaneous treatment of symptomatic bile-duct stones like late complication in patients with biliodigestive anastomosis. METHOD: Three symptomatic female patients with biliodigestive anastomosis and acutely symptomatic with proven bile-duct stones above anastomosis were treated with initial percutaneous transhepatic drainage and later via percutaneous route using of endoscopic lithotryptor with special technique. RESULTS: All procedures were successful without complication, the patients are free of biliary symptoms in the long term. CONCLUSION: Percutaneous removal of bile-duct stones in patients with biliodigestive anastomosis is safe and effective method which can be used as an alternative to surgery.
Assuntos
Cálculos Biliares/terapia , Litotripsia , Adulto , Idoso , Anastomose Cirúrgica , Procedimentos Cirúrgicos do Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Feminino , Humanos , Intestinos/cirurgia , Pessoa de Meia-IdadeRESUMO
The authors present a case report of long- term follow up of 66-year old male with the abdominal aortic aneurysm treated with aortouniiliac stent-graft implantation in combination with the cross-over femoro-femoral bypass 14 years ago. Various leaks type Ia, IIb and III developed during follow-up. In spite of endovascular treatment of these complications the size of the aneurysmal sac enlarged and the patient was successfully treated by the aortobifemoral bypass.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares , Idoso , Fístula Anastomótica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular , Artéria Femoral/cirurgia , Seguimentos , Humanos , Masculino , Radiografia , StentsRESUMO
The authors demonstrate relatively rare case of evolution and spontaneous thrombosis of the postpancreatitic pseudoaneurysm of the splenic artery, which developed from a pancreatic pseudocyst. The miniinvasive therapeutic approach to the pancreatic pseudoaneurysms is discussed.
Assuntos
Falso Aneurisma/diagnóstico , Artéria Esplênica , Trombose/diagnóstico , Falso Aneurisma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/complicações , Trombose/complicaçõesRESUMO
Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.
Assuntos
Aneurisma/complicações , Isquemia/etiologia , Perna (Membro)/irrigação sanguínea , Artéria Poplítea , Terapia Trombolítica , Trombose/complicações , Doença Aguda , Idoso , Aneurisma/cirurgia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Trombose/tratamento farmacológico , Trombose/cirurgiaRESUMO
There is discussed case of malignant paraganglioma with cervical lymph node metastasis that was complicated by mistake during peroperative histology. Peroperative histological examination revealed metastasis of medular carcinoma of thyroid gland. Total thyroidectomy was performed. Postoperative histological assessment revealed metastasis of carotic paraganglioma. Tumour was resected together with carotic arteries. Their reconstruction was performed during second procedure.
Assuntos
Tumor do Corpo Carotídeo/patologia , Tumor do Corpo Carotídeo/diagnóstico , Tumor do Corpo Carotídeo/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/secundárioRESUMO
Mesenteric artery embolisation is serious complication of heart diseases. Its mortality is almost 95%. Diagnostics of mesenteric artery embolisation is based not only on clinical examination, but also on CT scan. Presence of the gas in portal and mesenteric venous basin is very suspected from vascular ileus. This sign can be very helpful in diagnostics and consequently in treatment of this disease. Late diagnostics and treatment of vascular ileus has fatal prognosis.
Assuntos
Gases , Íleus/etiologia , Intestinos/irrigação sanguínea , Isquemia/complicações , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Idoso , Feminino , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
To determine whether PHEMA [poly(2-hydroxyethylmethacrylate)] is suitable for portal vein embolization in patients scheduled to right hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).
Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Fígado/efeitos dos fármacos , Poli-Hidroxietil Metacrilato/uso terapêutico , Veia Porta/efeitos dos fármacos , Idoso , Embucrilato/farmacologia , Embucrilato/uso terapêutico , Óleo Etiodado/farmacologia , Óleo Etiodado/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poli-Hidroxietil Metacrilato/farmacologiaRESUMO
The aim of this article is to evaluate the occurrence of complications following diagnostic and therapeutic ERCP's and their treatment. It is based on data collected between January 1, 1998 and December 31, 2002, during which time period the Surgical Clinic in Pardubice completed 18 surgical procedures on patients experiencing post-ERCP complications. The article also provides an analysis of the individual types of complications, their specific surgical procedures, and the results. The discussion passage deals with the theoretical possibility of applying conservative treatment that is applicable in certain types of perforation occurrences, with special concern focused on the occurrence of fatal retroperitoneal phlegmona.