RESUMO
BACKGROUND AND STUDY AIMS: Covered self-expanding metal stents (SEMSs) have proven effective for managing malignant bile duct strictures and may reduce risk of tumor ingrowth. A new nitinol partially covered biliary SEMS was prospectively evaluated. PATIENTS AND METHODS: 70 patients with inoperable extrahepatic biliary obstructions were enrolled in a prospective multicenter trial, and followed up to 6 months or death, whichever came first. Primary endpoint was adequate palliation defined as absence of recurrent biliary obstruction from partly covered SEMS placement to end of follow-up. RESULTS: Mean age of the patients was 69 years and 52 % were men. Pancreatic carcinoma was present in 68 %. One stent was placed in 67 patients, two patients received two, and in one patient a guide wire could not traverse the stricture. In 55 % of patients the SEMS was inserted de novo and in 45 % for exchange with a plastic stent. Technical success was 97 %. At 6 months, 62 % of patients were free of obstructive symptoms; compared with baseline the mean number of symptoms per patient was significantly reduced (3.1 at baseline, 0.6 at 6 months; P < 0.0001) and total bilirubin levels dropped by 73 %. There were four cases of recurrent biliary obstruction, due to stent migration (2), tumor overgrowth (1), and sludge formation (1). Device-related complications included cholecystitis (3), right upper quadrant pain (1), and moderate pancreatitis (1). No tumor ingrowth was reported. CONCLUSIONS: This new partially covered nitinol SEMS is easily inserted, and safe and effective in the palliation of biliary obstruction secondary to malignant bile duct strictures.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase Extra-Hepática/cirurgia , Materiais Revestidos Biocompatíveis , Cuidados Paliativos , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Neoplasias dos Ductos Biliares/secundário , Colestase Extra-Hepática/etiologia , Doenças do Ducto Colédoco/etiologia , Doenças do Ducto Colédoco/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversosAssuntos
Anemia/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemangioma/diagnóstico , Neoplasias Intestinais/diagnóstico , Idoso , Anemia/terapia , Transfusão de Sangue , Colonoscopia , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Feminino , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/etiologia , Hemangioma/complicações , Humanos , Neoplasias Intestinais/complicações , Intestino Delgado/patologia , SíndromeRESUMO
Little sequence information is available for human immunodeficiency virus type 1 (HIV-1) vif genes of African origin. Here we describe 37 new complete vif genes of 18 AIDS patients from Uganda and show that vif has a high in vivo genetic variability. vif proviral DNA sequences of peripheral blood cells were determined by direct sequencing of PCR products. Only 52% of the deduced Vif amino acids were absolutely conserved; when Vif sequences previously analysed were considered, only 32% of the Vif consensus sequence comprised conserved and as such possibly functionally important motifs. The high inter-individual vif variability was in contrast to a very low intra-individual variability. One patient carried a vif gene with a stable C-terminal deletion, but N-terminal truncations were not found in patients' predominant vif sequences. The vif genes analysed comprised subtypes A, D and an A/D mosaic. Phylogenetic analyses additionally showed that HIV- 1 in Uganda has spread across the boundaries of ethnic groups.