ABSTRACT
We describe a 28-year-old female who presented with metastatic spread of a suspected occult tumor. The diagnosis of alveolar echinococcosis was established by needle biopsy of the liver and ELISA. The patient's clinical symptoms initially decreased after treatment with mebendazole, but the lesions progressed during the following 6 months. Albendazole was not available in Austria. Because the synthesis of interferon gamma (IFN-gamma) and IFN-alpha is markedly decreased in patients with echinococcosis, we treated our patient with IFN-gamma while continuing mebendazole therapy. This combination halted progression of the disease during the 12 months of follow-up.
Subject(s)
Echinococcosis, Hepatic/drug therapy , Echinococcus , Interferon-gamma/therapeutic use , Mebendazole/therapeutic use , Adult , Animals , Brain/pathology , Drug Therapy, Combination , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Hepatic/pathology , Echinococcus/isolation & purification , Female , Humans , Liver/pathology , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To determine the effectiveness of a prototype nitinol stent in the iliac arteries. MATERIALS AND METHODS: Fourteen patients with arteriosclerotic lesions of the iliac arteries (nine stenoses, five occlusions) were treated percutaneously with a prototype nitinol vascular stent (Cragg stent) after unsuccessful percutaneous transluminal angioplasty. RESULTS: In 13 patients available for follow-up, the mean ankle-brachial index (ABI) increased from 0.4 +/- 0.32 (standard deviation) before the procedure to 0.81 +/- 0.27 after the procedure (P < .01). After 6, 12, and 24 months, the mean ABI was 0.97 +/- 0.2, 0.87 +/- 0.15, and 0.89 +/- 0.1, respectively. In two patients, radial stiffness of the stent was too low to completely eliminate a high-grade, calcified stenosis; long-term patency of the vessel, however, was preserved. In all other patients, stent placement achieved good vascular reconstitution. No stent occlusion or restenosis was observed. CONCLUSION: The results with the Cragg stent were similar to those with other commercially available stents. These preliminary results require confirmation with a larger series.
Subject(s)
Alloys , Iliac Artery , Stents , Aged , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/therapy , Female , Humans , Iliac Artery/diagnostic imaging , Male , Middle Aged , Radiography, Interventional , Recurrence , Vascular PatencyABSTRACT
Twenty-five patients with liver cirrhosis and portal hypertension were admitted for creation of a transjugular intrahepatic portosystemic shunt (TIPS). The procedure was successful in 22 patients (technical success 88%). The mean portal pressure gradient was lowered from 24.5 mmHg before to 11.4 mmHg after TIPS. Two early and three late occlusions were observed (primary patency rate 78%). The rate of secondary interventions was 41%. Five times a hepatic vein stenosis was dilated and stented, two times an occluded shunt was recanalized, two times a new shunt was created parallel to an occluded (secondary patency rate within a maximum of 16 months 95%). In two patients sepsis occurred which was effectively treated with antibiotics, two patients died shortly after TIPS due to hepatorenal syndrome and hepatic failure, respectively. There was no recurrent bleeding. Two patients developed hepatic encephalopathy; both improved after protein restriction. The authors conclude that TIPS is an alternative procedure to shunt surgery, especially for patients who cannot benefit from sclerotherapy.