RESUMEN
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon but potentially catastrophic pathology. Multiple classification schemes have been proposed for this occurrence. Although no consensus has emerged regarding which classification should be used, Li's classification scheme is more precise and complete compared to other classification systems and can be used to guide the treatment of SISMAD. Initial conservative treatment is promising, with favorable early and long-term outcomes for most patients; endovascular treatment is recommended for patients with persistent/recurrent symptoms after conservative treatment; surgical treatment should be performed without delay for patients with arterial rupture, intestinal necrosis, or failed endovascular treatment.
Asunto(s)
Humanos , Clasificación , Consenso , Arteria Mesentérica Superior , Necrosis , Patología , RoturaRESUMEN
Objective To evaluate risk factors of hepatitis B virus (HBV) reactivation after transarterial chemoembolization (TACE) in patients with HBV-related hepatocellular carcinoma (HCC) with undetectable HBV DNA levels.Methods From August 2012 to Sepemter 2015,all patients who underwent TACE for HBV-related HCC with HBV DNA level less than 103 copies/ml in the First Affiliated Hospital of Soochow University were enrolled into the study.These patients were followed-up for at least 6 months after TACE to assess HBV reactivation.Univariate and multivariate logistic regression analyses were done to evaluate the risk factors related to HBV reactivation in these patients.Results With predetermined inclusion and exclusion criteria,99 patients were enrolled into the study.Twenty-four patients (24.2％) developed HBV reactivation after TACE in the followed-up period.The level of transaminase was significantly higher in the HBV reactivation group than the non HBV reactivation group (P ＜ 0.05).HBeAg positivity and tumors more than 3 in number were independent risk factors of HBV reactivation.Conclusion HCC patients with undetectable levels of HBV DNA had a significant risk of HBV reactivation after TACE.
RESUMEN
Portal vein tumor thrombus (PVTT) is a common finding in patients with advanced hepatocellular carcinoma (HCC),and the presence of PVTT usually indicates a poor prognosis.At present,two PVTT classifications are adopted in clinical practice;they are VP classification of Japan and eastern hepatobiliary classification (Cheng's classification).There are some differences in PVTT classification between the above two typing criterion.Certain correlation exists between patient's prognosis and PVTT typing;for example,PVTT of type Ⅰ0 carries the best prognosis,while PVTT of type Ⅳ indicates the worst prognosis.The choice of treatment plan is limited by the type of PVTT for a given patient.Therefore,the optimal therapeutic regimen should be formulated based on the type of PVTT in order to control HCC and to benefit the patient.
RESUMEN
Objective To investigate the efficacy of gelatin sponge particles(GSP)or polyvinyl alcohol particles (PVA) for hemoptysis secondary to bronchiectasis or pulmonary tuberculosis. Methods The clinical data on 271 patients with bronchiectasis- or tuberculosis-induced hemoptysis were retrospectively analyzed. The efficacy and rates of recurrence and complications were analyzed. Results A total 271 patients were included in this study, 176 of whom suffered from bronchiectasis and the rest 95 had tuberculosis. One-week cure rate was signifi-cantly higher in bronchiectasis group than in tuberculosis group(73.3%vs. 46.3%,P0.05). No severe complications occurred. Conclusions In-terventional artery embolization therapy for hemoptysis secondary to bronchiectasis is better than tuberculosis-induced hemoptysis,and PVA is more effective than GSP. Recurrence of massive hemoptysis mostly occurrs within one month ,and most of the patients are complicated with blood supply and have a history of hemoptysis.
RESUMEN
Objective To investigate the therapeutic efficacy of transcatheter arterial embolization (TAE) in treating advanced bladder cancer. Methods A total of 22 patients with advanced bladder cancer were included in this study. The clinical data and the imaging materials were retrospectively analyzed. The clinical efficacy of TAE in treating advanced bladder cancer was evaluated. Results TAE was successfully accomplished in all the 22 patients. The preoperative and the postoperative abdominal pain scores were 4.73± 1.91 and 2.45±1.29 respectively, the difference was statistically significant (P<0.01); the preoperative and the postoperative ECOG scores were 3.14±0.47 and 2.68±0.56 respectively (P<0.05); the preoperative and the postoperative hemoglobin levels were (61.4±11.8) g/L and (79.3±14.5) g/L respectively (P<0.01). Of 7 patients with urinary tract obstruction, after the treatment the obstruction disappeared in 5 and was improved in 2, although the urination was still not smooth. All patients were followed up for (7.1±3.0) months. The 6-month survival rate was 54.5% (12/22). No serious complications occurred in all patients. Conclusion TAE can not only effectively improve the hematuria and urinary tract obstruction symptoms caused by bladder cancer, but also effectively control the tumor growth, improve the quality of life and prolong the survival time as well.
RESUMEN
Usually the survival period of patients with duodenal obstruction caused by inoperable advanced pancreatic cancer is rather short. For such patients, minimally invasive treatment should be employed as the first choice. This paper reported a case with advanced pancreatic cancer complicated by biliary and duodenal obstruction. After implantation of biliary stent, the obstructive jaundice was relieved. Because of the insufficient cardiac function, the patient was not able to tolerate gastrojejuostomy; besides, as both DSA-guided stent implantation and endoscopic nutrition tube placement failed to success, implantation of nutrition tube via the trans-hepatic and biliary route, as a novel tube placement technique, had to be carried out, and the result in this case was satisfactory.
RESUMEN
Isolated superior mesenteric artery dissection (ISMAD) is a clinically common disease,of which multi-slice spiral computed tomography (MSCT) is effective method for screening and follow-up.The diagnosis and treatment should be made based on pathological changes of true or and false lumen.Most patients can relieve by medical treatment,and those with treatment failure can adapt endovascular treatment.Patients with aneurysm rupture or intestinal necrosis should undergo emergent surgical treatment.
RESUMEN
Objective To investigate the efficacy and safety of using various sedative regimens during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods 156 HCC patients were randomly divided into four groups.The control group (n =30):intramuscular injection of 10 ml saline;The diazepam group (n =42):intramuscular injection of 10 mg of diazepam;The promethazine group (n =42):intramuscular injection of promethazine 25 mg;and The combined group (n =42):intramuscular injection of 10 mg of diazepam and promethazine 25 mg.Results The blood pressure and heart rate of the control group was significantly higher than the other three groups,while the combined group was significantly lower than the diazepam and the promethazine groups.The sedative rating:Grade 0 of the four groups were:30,11,18,0 patients respectively;Grade 1 of the four groups were:0,21,15,24 patients respectively;Grade 2 of the four groups were:0,10,9,18 patients respectively;No patients were in grades 3 and 4.The anxiety score of the control group was significantly higher than the other three groups.There was no significant difference in complications among the four groups.Conclusion Diazepam and/or promethazine could be used effectively and safely during TACE,and they could reduce stress response of HCC patients during TACE,and improved tolerance of TACE.
RESUMEN
Objective To study the efficacy of combining Entecavir with TACE to treat patients with primary hepatocellular carcinoma with undetectable levels of HBV-DNA.Methods From Aug 2011 to Sep 2013, patients with HBV-related hepatocellular carcinoma but with undetectable levels of HBV DNA who underwent TACE were divided into the treatment group (treated with Entecavir antiviral therapy) and the control group.The endpoints of the study were HBV reactivation rates, liver function, and survival rates.Results Using our predefined inclusion and exclusion criteria, 64 patients with primary liver cancer were divided into the treatment group (n =32) and the control group (n =32).The transaminase and bilirubin levels were raised and the albumin level was reduced at 5 days after TACE.However, there were no significant differences between the 2 groups (P ＞0.05).At 12-month follow-up after TACE, 8 (25.0％) patients developed HBV reactivation in the control group and 2 (6.3％) in the treatment group, the difference was significant (P ＜ 0.05).The level of transaminase was significantly higher in the HBV reactivation group when compared with the no HBV reactivation group (P ＜ 0.05).The overall 6-and 12-month survival rates in the treatment group and the control group were 93.8％ and 84.4％ vs 90.6％ and 59.4％ respectively.There were significant differences in the 12-month survival rates (P ＜ 0.05).Conclusion Entecavir combined with TACE to treat patients with HBV-related primary liver cancer with undetectable HBV-DNA effectively reduced HBV reactivation and improved survival at 12 months.
RESUMEN
Objective To evaluate the efficacy and safety of rabbit VX2 liver tumor model by percutaneous intratumoral injection with 188Re labeled stannic sulfur colloid.Methods The VX2 liver tumor model was established in 45 rabbits,which were randomly assigned to 3 groups (n =15) according to material used in intratumoral injections,as follows:0.1 ml normal saline (Group A,control group),absolute ethanol 1ml (Group B),37MBq (1mCi) 188Re labeled stannic sulfur colloid 0.1 ml (Group C).Five rabbits from each group were killed at intervals of 1,4 and 7d after injection and the volume of tumors were measured.Meanwhile,the histopathological changes and extent of cell apoptosis were evaluated.ALT and urea levels before the operation and at intervals of 1,4,7d post injection were also detected.Results In the first day after the injection,there was no significant statistical heterogeneity of the tumor volumes between each group.At 4th day post injection,tumor volumes of group A [(1 873.1 ± 77.3) mm3] showed significant statistical heterogeneity with group B [(905.7 ± 113.3) mm3] and C [(860.2 ± 59.6) mm3] (P ＜0.01),while there were no obvious statistical significance between group B and group C (P =0.421).At 7th day post injection,there were marked statistical significance of tumor volumes between A,B and C groups[respectively,(4093.1 ± 126.5)mm3,[(2569.5 ±64.6)mm3 and (2 169.6 ± 141.9)mm3](P＜0.01).At any time after injection,the apoptosis index (AI) of peritumoral tissue in group B and C was higher than control group with statistical significance (P ＜ 0.001).At 4th day post injection,AI of group C remained higher than group B (P ＜ 0.05).At 7th day,AI of group C progressively decreased,and there were no statistical difference between group B and group C (P ＞ 0.05).Conclusion Percutaneous intratumoral injection of 188Re labeled stannic sulfur colloid is a safety and effective approach to the treatment of VX2 liver tumor in rabbits.
RESUMEN
Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography.To study the incidence and risk factors for contrast-induced nephropathy (CIN).Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included.The 0.9 ％ sodium chloride (1 ml · kg-1 · h-1) was administered in all patients 6 hours before and 12 hours after contrast media administration.No patients suffered from obviously congestive heart failure.The levels of serum creatinine (Scr) and serum urea nitrogen (SUN) were measured 3 days before and at day 1,2,6 after the administration of contrast media respectively.Then creatinine clearance rate (Ccr) was calculated.Multivariate predictors of contrastinduced nephropathy were determined by logistic regression.Results Among the 276 patients,CIN occurred in 19 patients (6.9％),among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty (PTRA) at 1 week after undergoing angiography.The renal function in the other 15 cases with CIN were recovered to baseline 1evel 3 months after the use of contrast media.No patients underwent a maintenance hemodialysis.In the 19 patients with CIN,the levels of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure (all P ＜ 0.05),but the parameters were decreased to preoperative level at day 6 after angiography (all P＞0.05).Logistic regression analysis showed that renal dysfunction,diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy.Conclusions Low-osmoiar nonionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 ％ sodium chloride.The clinical risk factors for CIN are renal dysfunction,diabetes mellitus and severe renal artery stenosis.
RESUMEN
Tumor lysis syndrome (TLS) results from a sudden and rapid release of nuclear and cytoplasmic degradation products from malignant cells. It is a rare complication in adult patients with solid tumors who are undergoing treatment. Herein, the authors present a case with advanced hepatocellular carcinoma (HCC) who developed TLS after transarterial chemoembolization (TACE), which was successfully treated with aggressive fluid administration, oral allopurinol and urine alkalization, hemodialysis and other supportive therapies. TLS following TACE should be suspected in HCC patients who has large and rapidly-growing lesion.
RESUMEN
Objective To investigate the efficacy and safety of endovascular treatment for subclavian steal syndrome (SSS). Methods During the period from April 2004 to Feb. 2013 at authors’ hospital, a total of 12 patients with SSS, including subclavian artery stenosis (n = 7) and occlusion (n = 5), underwent endovascular treatment. Percutaneous transluminal angioplasty (PTA) was carried out in 4 cases and stent implantation in 8 cases. The clinical data were retrospectively analyzed. Results Technical success rate was 100%(12/12). The diseased side/healthy side blood pressure ratio increased from preoperative (0.46 ± 0.28) to postoperative (0.89 ± 0.32), and the difference was statistically significant (P < 0.05). After the treatment, the clinical symptoms were improved in different degrees in all patients. During the follow - up period lasting for (16.7 ± 7.9) months, restenosis occurred in one case with left SSS thirteen months after PTA, and the condition was improved after stenting angioplasty. Another patient with severe subclavian artery stenosis developed peripheral micro- vascular thrombosis of the diseased limb in 23 days after PTA, which was relieved after medication to improve microcirculation and vasodilation. No severe complications such as stroke occurred. Conclusion For subclavian artery steal syndrome, endovascular management is a minimally invasive, safe and effective treatment. It can significantly relieve the clinical symptoms due to vertebral- basilar artery insufficiency caused by subclavian steal syndrome, and improve limb weakness, low body temperature, etc. Therefore, this technique should be recommended in clinical practice.
RESUMEN
Objective To investigate the prevalence and risk factors of atherosclerotic renal artery stenosis (ARAS) in patients with ischemic stroke (IS).Methods A total of 596 consecutive patients with ischemic stroke underwent cerebrovascular and renal angiography at our hospital from January 2008 to March 2013.Renal artery stenosis was defined as at least one of renal artery narrowing ≥ 50％ of luminal diameter.Multivariate logistic regression analysis was performed to investigate the association of the clinical variables with ARAS.Results Intracranial arterial stenosis (ICAS) was identified in 203 patients (34.1％),including 108 cases (18.5％) with arteriostenosis ≥ 50％.Extracranial arterial stenosis (ECAS) was identified in 250 patients (41.9％),including 149 cases (25.0％) with arteriostenosis ≥ 50％.The prevalence of ECAS was higher than that of ICAS(x2 =7.86,P ＜ 0.05).ARAS was identified in 77 patients (12.9％),and the prevalence of ARAS in patients with ECAS ≥50％ was higher than that in with ICAS ≥50％ (30.2 ％ vs.18.5％,x2 =4.52,P ＜0.05).Multivariate analysis showed that the age≥ 60 y (OR:2.48,P ＜ 0.05) and ECAS ≥ 50％ (OR:5.37,P ＜ 0.05) were independent risk factors for prevalence of ARAS.Conclusion ARAS is a relatively common finding among patients with ischemic stroke,suggesting that renal angiography should be performed in elderly IS patients,especially for those combined with severe ECAS.
RESUMEN
Objective To study the biodistribution of 188Re-labeled stannic sulfur colloid in rabbit orthotopic VX2 liver cancer model by intratumoral injection and to evaluate its potential for endoradiotherapy.Methods 188Re-labeled stannic sulfur colloid was prepared with direct labeling method.The labeling efficiency and radiochemical purity were measured.Twelve rabbits xenografted by orthotopic VX2 liver cancer were used to determine the biodistribution of 188Re-labeled stannic sulfur colloid.Under CT guidance,37 MBq (0.1 ml) 188Relabeled stannic sulfur colloid was injected directly into the center of the tumor.Four rabbits were sacrificed after gamma imaging at 1,24,48 h post injection.The organ uptake was calculated as ％ID/g,the absorbed dose and T/NT ratio were calculated.One-way analysis of variance was used to analyze the data.Results The labeling efficiency of 188 Re-labeled stannic sulfur colloid was (98.23±0.25)％.The radiochemical purity was (94.23±0.54) ％ at 48 h.The radioactivity essentially accumulated in the tumor area and remained trapped up to 48 h.The radioactivity in other organs was at background level.The T/NT ratios were 88.22± 11.57,32.87±9.13 and 31.65± 10.11 at 1,24 and 48 h post injection respectively,with the corresponding tumor uptakes of (43.318±11.931) ％ID/g,(39.875±9.290) ％ID/g and (37.761±6.849) ％ID/g,which were much higher than those in normal tissues (F=77.350,97.577,417.072,all P＜0.01).Radiation dose to the tumor was (88.12 ± 12.21) Gy.Conclusions 188 Re-labeled stannic sulfur colloid may have a stable distribution at the site of orthotopic VX2 liver cancer after intratumoral injection.Thus it may have potential for the endoradiotherapy of liver cancer.
RESUMEN
Objective To investigate the incidence and causes of complication of stenting in the treatment of superior vena cava syndrome (SVCS) for its proper prevetions. Methods Thirty nine patients with SVCS due to various diseases were retrospectively analyzed. The location, extension and degree of the stenosis were identified on venography before stent placement. Lumen narrowing becoming less than 50% or 20% improvement after stenting was taken as effective. Complications after stenting were analyzed. Results Thirty-five(89.7%, 35/39) patients relieved after stenting. Six patients (15.4%) had complications, including stents displacement due to mass lessened after chemotherapy in 1 cases, stents displacement and thrombogenesis due to lack of anticoagulant therapy and mass lessened after chemotherapy in 1 cases, restenosis due to mass growing into the screening of Gianturco Z-type stent in 1 cases, acute pericardial effusion in 1 cases, 1 of acute pulmonary embolism(PE) in 1 cases and acute congestive right heart failure and relieved after treatment in 1 cases. Conclusions Some complications of stenting in SVCS is serious. Proper procedure, stents selection and skillful handling can reduce the frequency of the complications.