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1.
Rev Clin Esp ; 199(7): 431-6, 1999 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-10481558

RESUMO

OBJECTIVE: To evaluate the efficiency of self-expanding metal stents (SES) for the palliative treatment of malignant oesophageal strictures and fistulas. MATERIAL AND METHODS: Fifty non-operable patients with malignant oesophageal strictures and/or fistulas were treated with SES placement. All patients had dysphagia, the mean degree for the studied group being 3.36. Ten patients presented associated tumoral fistula. Uncoated SES were placed for simple stenosis cases and coated SES for cancers with associated fistulas. RESULTS: A improvement in dysphagia was obtained in 47 patients (94%). The mean degree of dysphagia after the procedure was 1.12. In nine patients (90%) the fistula closed with resolution of the associated clinical picture. Complication were observed in six patients (12%), the perioperative mortality rate being 2%. During follow-up, twelve patients (25%) had malfunction of the stent, which was successfully treated in eight patients. CONCLUSION: SES are efficient for the palliative treatment of malignant oesophageal strictures and/or fistulas, but not commonly re-interventions are necessary to maintain a long-term functionality.


Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Fístula Esofágica/terapia , Neoplasias Esofágicas/terapia , Estenose Esofágica/terapia , Cuidados Paliativos/métodos , Stents , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico por imagem , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico por imagem , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Esofagoscopia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Stents/efeitos adversos
2.
Br J Surg ; 85(2): 232-5, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9580077

RESUMO

BACKGROUND: Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. METHODS: Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. RESULTS: The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patients, three of whom underwent emergency colostomy. CONCLUSION: Transanal SEMS placement is an appealing method for the relief of obstruction in selected patients, obviating the need for palliative colostomy.


Assuntos
Neoplasias do Colo/cirurgia , Obstrução Intestinal/cirurgia , Cuidados Paliativos/métodos , Stents , Idoso , Idoso de 80 Anos ou mais , Colectomia/métodos , Neoplasias do Colo/complicações , Colostomia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Falha de Tratamento
5.
Arch Esp Urol ; 46(8): 711-8, 1993 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-8311522

RESUMO

Until early in the eighties, the initial treatment of choice for pyonephrosis was by emergency surgical excision, which carried a high intraoperative and early postoperative morbidity and mortality. The introduction of percutaneous nephrostomy, a technique with a low complication rate that permits easy access in dilated excretory tracts and is highly effective, as shown by the clinical and analytical course of the patients with pyonephrotic kidney and by the number of nephrectomies performed, represented a substantial change in the initial therapeutic approach. The present article reports our experience of 123 percutaneous nephrostomies performed in 118 pyonephrotic kidneys over a period of 10 years, which constitutes one of the largest series reported in the literature. The clinical features and the findings disclosed by imaging techniques that permit making the diagnosis are presented. We describe the PCN procedure and its advantages, with special reference to the reduced morbidity and mortality, particularly in those cases complicated by septic shock. The procedure also permits evaluation of the underlying obstructive uropathy and function of the compromised kidney, therefore more renal units can be preserved, nephrectomy can be avoided and morbidity is minimal. For all the foregoing reasons, PCN guided by an imaging technique is currently the most effective initial treatment of pyonephrosis.


Assuntos
Nefropatias/cirurgia , Nefrostomia Percutânea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Nefropatias/etiologia , Nefropatias/microbiologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/estatística & dados numéricos , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/estatística & dados numéricos , Choque Séptico/etiologia , Supuração/etiologia , Supuração/cirurgia
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