ABSTRACT
Endovascular procedures may play a role in renal artery stenosis (RAS) treatment in attempt to preserve renal function and improve hypertension control. We determined renal outcome and the incidence of restenosis in patients with RAS treated with renal percutaneous transluminal angioplasty and stenting (RPTAs) and medical therapy versus patients with RAS treated only with medical therapy. We performed an observational study based on 93 patients with RAS. In all, 53 patients underwent RPTAs in association with medical therapy and 40 patients were only treated pharmacologically. In patients receiving RPTAs, a better renal outcome, a decrease of restenosis rate, and systolic-diastolic blood pressure were associated with angiotensin receptor blockers (ARBs) + angiotensin-converting enzyme inhibitors (ACE-is) therapy. In patients treated with medical therapy alone, renal improvement was related to ARBs in association with BBs (ß-blockers; P < .0001). This study suggests that medical therapy may exert beneficial effects in patients with RAS.
Subject(s)
Angioplasty , Antihypertensive Agents/therapeutic use , Renal Artery Obstruction/therapy , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Recurrence , Renal Artery Obstruction/drug therapy , Treatment Outcome , Young AdultABSTRACT
Nephroangiosclerosis (NAS) is a major cause of progressive renal insufficiency. Hypertension is very important in the causation of NAS but other factors such as race, age, metabolic variables, and genetics play a pathogenic and prognostic role. A multifactorial treatment strategy, including antihypertensive, lipid-lowering and anti-platelet agents, could improve cardiovascular and renal outcomes in patients with vascular nephropathy.
Subject(s)
Arteriosclerosis/drug therapy , Kidney Diseases/drug therapy , Animals , Antihypertensive Agents/therapeutic use , Arteriosclerosis/etiology , Arteriosclerosis/genetics , Arteriosclerosis/physiopathology , Atherosclerosis/physiopathology , Dyslipidemias/physiopathology , Humans , Hypertension/physiopathology , Hypolipidemic Agents/therapeutic use , Kidney Diseases/etiology , Kidney Diseases/genetics , Kidney Diseases/physiopathology , Nephrosclerosis/etiology , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
After Heald's revolution in 1982, who introduced the total mesorectal excision, for improve the results in terms of recurrance and survival rate, there is a need to explore new therapeutic options in treatment of sub-peritoneal rectal cancer. In particular, local excision represent more often a valid technique for non advanced rectal cancer treatment in comparison with the more invasive procedure, especially in elderly and/or in poor health patients. The introduction of TEM by Buess (transanal endoscopy microsurgery), has extended the local treatment also to classes of patients who would normally have been candidates for TME. The author gives literature's details and his experience in the use of TEM for early rectal cancer sub-peritoneal. The aim of the study is to analyze short and long term results in terms of local recurrence and survival rate comparing TEM technique with the other transanal surgery in rectal cancer treatment. Preoperative Chemio-Radio therapy and rigorous Imaging Staging are the first steps to planning surgery. It's time, for local rectal cancer, has come to make the devolution a few decades ago has been accomplished in the treatment of breast cancer
