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1.
Radiología (Madr., Ed. impr.) ; 62(2): 112-121, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194208

RESUMO

OBJETIVO: El trasplante hepático es uno de los tratamientos de la hepatopatía crónica en estadios avanzados y pacientes seleccionados con tumores hepáticos. La ecografía es la técnica de imagen de elección para su evaluación. En este trabajo se revisan la técnica quirúrgica, la anatomía del trasplante hepático y los hallazgos ecográficos normales en el postoperatorio inmediato, que servirán de referencia para evaluaciones posteriores. CONCLUSIÓN: Las complicaciones vasculares tempranas (arteriales y portales) pueden suponer una amenaza para el injerto o el paciente. Tras el trasplante hepático existe un periodo de adaptación del injerto al nuevo medio y de recuperación posquirúrgica en el que podemos observar alteraciones parenquimatosas o hallazgos en el estudio Doppler que difieren de los habituales y se pueden considerar como normales en esta situación; generalmente son transitorios. Su conocimiento e interpretación es clave para detectar o excluir complicaciones


OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transplante de Fígado/métodos , Cuidados Pós-Operatórios/instrumentação , Ultrassonografia Doppler/métodos , Artéria Hepática/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem
2.
Radiología (Madr., Ed. impr.) ; 62(2): 131-138, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194210

RESUMO

OBJETIVO: Identificar la incidencia de reacciones adversas inmunomediadas (irAE, immune related adverse events), con y sin manifestaciones radiológicas, y correlacionarla con la respuesta al tratamiento inmunoterápico. MATERIAL Y MÉTODOS: Se reclutaron retrospectivamente 79 pacientes con carcinomas de pulmón (n=24), renal (n=11) y melanoma (n=44) en estadio IV que fueron tratados con fármacos inmunoterápicos. Se valoró la aparición de irAE, sus manifestaciones radiológicas y el tipo de patrón de respuesta de acuerdo con los criterios de respuesta a la inmunoterapia (irRC). Se relacionó la presencia de irAE con el patrón de respuesta al tratamiento. RESULTADOS: El 27,8% de los pacientes sufrieron irAE. Estas reacciones fueron más frecuentes en pacientes con melanoma (40,9% de los pacientes). Más de la mitad de las reacciones (59,1%) presentaron manifestaciones radiológicas a modo de neumonitis, colitis, hipofisitis, tiroiditis y miocarditis. La neumonitis fue la irAE con expresión radiológica más frecuente, incluso en pacientes asintomáticos. En la población estudiada, la tasa de respuesta a la inmunoterapia fue significativamente mejor en pacientes que desarrollaron irAE (68,2% frente a 38,6%, χ2=5,58; p = 0,018). La tasa de respuesta favorable en los pacientes con y sin manifestaciones radiológicas de las irAE fue de 84,6% y 44,4%, respectivamente (p = 0,023). CONCLUSIONES: La presencia de reacciones adversas inmunomediadas se asocia, de forma significativa, con una mejor respuesta a la inmunoterapia. La asociación con respuesta favorable es incluso mayor en pacientes con manifestaciones radiológicas de las irAE


OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p = 0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p = 0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Imunoterapia/efeitos adversos , Neoplasias Pulmonares/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Imunoterapia/métodos , Estudos Retrospectivos , Neoplasias Pulmonares/terapia , Nivolumabe/uso terapêutico , Ipilimumab/uso terapêutico , Tomografia Computadorizada por Raios X , Neoplasias/diagnóstico por imagem
3.
Radiologia (Engl Ed) ; 62(2): 131-138, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31405549

RESUMO

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Neoplasias Renais/terapia , Neoplasias Pulmonares/terapia , Melanoma/terapia , Anticorpos Monoclonais Humanizados/efeitos adversos , Carcinoma de Células Renais/imunologia , Carcinoma de Células Renais/terapia , Colite/diagnóstico por imagem , Colite/imunologia , Feminino , Humanos , Hipofisite/diagnóstico por imagem , Hipofisite/imunologia , Ipilimumab/efeitos adversos , Neoplasias Renais/imunologia , Neoplasias Pulmonares/imunologia , Masculino , Melanoma/imunologia , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/imunologia , Nivolumabe/efeitos adversos , Pneumonia/diagnóstico por imagem , Pneumonia/imunologia , Estudos Retrospectivos , Tireoidite/diagnóstico por imagem , Tireoidite/imunologia , Tomografia Computadorizada por Raios X
4.
Radiologia (Engl Ed) ; 62(2): 112-121, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31866060

RESUMO

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications.


Assuntos
Transplante de Fígado/métodos , Fígado/diagnóstico por imagem , Ultrassonografia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Criança , Colecistectomia , Feminino , Artéria Hepática/cirurgia , Veias Hepáticas/cirurgia , Humanos , Fígado/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pós-Operatório , Coleta de Tecidos e Órgãos/métodos , Veia Cava Inferior/diagnóstico por imagem
5.
Radiologia ; 48(5): 317-20, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-17168244

RESUMO

Erdheim-Chester disease is a rare disorder, belonging to the group of histiocytoses, in which diffuse infiltration of histiocytes affects various organs and systems. Bone involvement in Erdheim-Chester disease manifests as generalized sclerosis of the bone marrow and cortex of the long bones, and this peculiar radiologic characteristic differentiates it from other histiocytoses. Diagnostic suspicion of the disease derives from the pulmonary and bone radiologic findings as well as from the clinical findings. Histological study reveals histiocyte infiltration affecting the soft tissues, musculoskeletal system, and central nervous system. The definitive diagnosis is reached by immunohistochemistry. Like other histiocytoses, such as Langerhans cell histiocytosis, immunohistochemical techniques reveal lipid-laden histiocytes; however, unlike the other types, Erdheim-Chester histiocytes stain negatively for S 100 protein and do not contain Birbeck granules.


Assuntos
Doença de Erdheim-Chester/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Radiología (Madr., Ed. impr.) ; 48(5): 317-321, sept. 2006. ilus
Artigo em Es | IBECS | ID: ibc-049417

RESUMO

La enfermedad de Erdheim-Chester es una patología poco frecuente que pertenece al grupo de las histiocitosis. Se produce por una infiltración difusa de histiocitos que afecta a varios órganos y sistemas. La afectación ósea muestra una característica radiológica peculiar que la diferencia de otras histiocitosis, y es una esclerosis córtico-medular de huesos largos. La sospecha diagnóstica de la enfermedad se realiza tanto por los hallazgos clínicos como por los radiológicos pulmonares y óseos. En el estudio anatomopatológico se observa la infiltración por células histiocitarias que afecta tanto a tejidos blandos, sistema musculoesquelético, como al sistema nervioso central. El diagnóstico definitivo es inmunohistoquímico, donde se demuestran histiocitos cargados de lípidos, negativos a la proteína S 100 y sin gránulos de Birbeck, rasgo que la diferencia de otras histiocitosis como la de células de Langerhans


Erdheim-Chester disease is a rare disorder, belonging to the group of histiocytoses, in which diffuse infiltration of histiocytes affects various organs and systems. Bone involvement in Erdheim-Chester disease manifests as generalized sclerosis of the bone marrow and cortex of the long bones, and this peculiar radiologic characteristic differentiates it from other histiocytoses. Diagnostic suspicion of the disease derives from the pulmonary and bone radiologic findings as well as from the clinical findings. Histological study reveals histiocyte infiltration affecting the soft tissues, musculoskeletal system, and central nervous system. The definitive diagnosis is reached by immunohistochemistry. Like other histiocytoses, such as Langerhans cell histiocytosis, immunohistochemical techniques reveal lipid-laden histiocytes; however, unlike the other types, Erdheim-Chester histiocytes stain negatively for S 100 protein and do not contain Birbeck granules


Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Doença de Erdheim-Chester/diagnóstico , Histiocitose/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Fêmur/patologia , Tíbia/patologia
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