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Malignant obstructive jaundice is caused by biliary obstruction due to malignant tumor,and in clinical practice percutaneous transhepatic biliary metal stent implantation has already become one of the main measures to relieve malignant obstructive jaundice.Nevertheless,postoperative complications severely affect the life quality and survival of patients,especially the stent restenosis seriously influences the patient's prognosis,therefore,after percutaneous transhepatic biliary metal stent implantation the use of active preventive measures and the correct treatment of stent restenosis are particularly important.The causes of stent restenosis include tumor growth,cholestasis and proliferation of granulation tissue,and the main measures to prevent stent restenosis at present are re-implantation of the stent,reformation of the stent structure and combination therapy.This article aims to make a comprehensive reviewabout the causes of postoperative stent restenosis and the effective preventive measures.
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<p><b>BACKGROUND</b>Morphologic imaging after radiofrequency ablation (RFA) of liver metastases is hampered by an inflammatory response in the ablation margin, making the identification of local tumor progression (LTP) difficult. The aim of this study was to evaluate the efficacy of early (18)F-FDG PET/CT scanning to monitor the effectiveness of RFA in colorectal liver metastases.</p><p><b>METHODS</b>Twelve patients with 20 metastases were treated with RFA for colorectal liver metastases. They underwent PET/CT within 2 weeks before RFA and within 24 hours after RFA (so termed "early PET/CT"). PET/CT was repeated at 1, 3, and 6 months, and then every 6 months after ablation. The standard of reference was based on available clinical and radiological follow-up data.</p><p><b>RESULTS</b>Early PET/CT revealed total photopenia in 16 RFA-treated metastases, which were found to be without residual tumor on the final PET/CT scan. Three RFA-treated metastases with focal uptake were identified as local tumor progression, which necessitated further treatment. One RFA-treated metastasis with rim-shaped uptake was regarded as inflammation. The results of the early PET/CT scanning were consistent with the findings of the final follow-up.</p><p><b>CONCLUSIONS</b>PET/CT performed within 24 hours after RFA can effectively detect whether residual tumor exists for colorectal cancer liver metastases. The results can guide further treatment, and may improve the efficacy of RFA.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Catheter Ablation , Colorectal Neoplasms , Diagnostic Imaging , Therapeutics , Fluorodeoxyglucose F18 , Therapeutic Uses , Liver Neoplasms , Diagnostic Imaging , Therapeutics , Positron-Emission Tomography , Methods , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To obtain the coronary artery and coronary sinus (CS) and its tributaries imaging with multislice computed tomography (MSCT), measure the distance between coronary artery and CS and its tributaries and analyze their spatial relationships.</p><p><b>METHODS</b>The MSCT scans of 117 patients (67 men, 50 women, age 56 +/- 10 years) were obtained, 3D image reconstructed and the vessels courses evaluated. The concomitant distances and spatial relationships of the vessels were determined.</p><p><b>RESULTS</b>Right coronary artery domination was found in 107 cases (91.4%), left coronary artery domination in 7 cases (6.0%), and co-domination in 3 cases (2.6%). Left circumflex artery (LCX) was concomitant with CS or the great cardiac vein (GCV) in 81 cases (69.2%), intersected with left posterior vein in 62 cases (53.0%) and with middle cardiac vein (MCV) in 5 cases (4.3%), respectively. The dominant coronary artery branched out into the posterior descending artery (PDA) and the left posterior artery (LPA) in 112 cases (95.7%). PDA was concomitant with MCV in 93 cases (79.5%) and intersected with MCV in 44 cases (37.6%). LPA was intersected with MCV in 106 cases (90.6%), and concomitant with CS in 50 cases (42.7%).</p><p><b>CONCLUSIONS</b>MSCT is a reliable tool to visualize the relationship between coronary artery and CS and its tributaries. Owing to the multiple possibilities inherent to this technique, MSCT has broad potential for more clinical use.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Angiography , Coronary Sinus , Diagnostic Imaging , Coronary Vessels , Tomography, Spiral ComputedABSTRACT
Objective To evaluate the clinical efficacy of multiple stents placement in the management of hilar cholangiocarcinoma,especially in the complex cases of which the hepatic ducts are invaded.Methods Forty-five consecutive patients with hilar cholangiocarcinoma were treated with percutaneous transhepatic placement of two or three self-expandable metallic endoprostheses.The cause of hilar obstructions in these patients were all cholangiocarcinoma,including Bismuth classification type Ⅱ(n 12 ),Ⅲa(n 17),Ⅲb(n 10),and Ⅳ(n 6).Two or 3 stents were placed in the configuration of T,Y or X over the strictures.Results Stent placement with 2 or 3 endoprostheses was successful in all patients.All patients showed significant decrease in serum bilirubin level.The mortality rate within 30 days of stent placement was 2.2%(1/45).The mean survival and stent patency times were 215.3 d(26— 516 d)and 181.5 d(26—473 d),respectively.Conclusion Deploying of multiple metallic stents is an effective method to treat complex hilar cholangiocarcinoma,especially for the cases of which hepatic ducts are invaded:the henatic ducts should be drained as much as nossible.
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0.05).Three coronary artery aneurysm in the distal RCA was missed by 2DE.MSCT could not detect slight or moderate mitral regurgitation in 2 patients and artery wall thickening in 5 patients.Conclusion MSCT would be an effective complementary or alternative method for CDEC to evaluate coronary artery lesions non-invasively in pediatric patients with Kawasaki disease.