RESUMEN
BACKGROUND: In the treatment of gallstones with extracorporeal shock-wave lithotripsy, the bile acid ursodiol is administered to dissolve the gallstone fragments. We designed our study to determine the value of administering this agent. METHODS: At 10 centers, 600 symptomatic patients with three or fewer radiolucent gallstones 5 to 30 mm in diameter, as visualized by oral cholecystography, were randomly assigned to receive ursodiol or placebo for six months, starting one week before lithotripsy. RESULTS: The stones were fragmented in 97 percent of all patients, and the fragments were less than or equal to 5 mm in diameter in 46.8 percent. On the basis of an intention-to-treat analysis of all 600 patients, 21 percent receiving ursodiol and 9 percent receiving placebo (P less than 0.0001) had gallbladders that were free of stones after six months. Among those with completely radiolucent solitary stones less than 20 mm in diameter, 35 percent of the patients receiving ursodiol and 18 percent of those receiving placebo (P less than 0.001) were free of stones after six months. Biliary pain, usually mild, occurred in 73 percent of all patients but in only 13 percent of those who were free of stones after three and six months (P less than 0.01). There were few adverse events. Only diarrhea occurred with a significantly different frequency in the two groups: 32.6 percent were affected in the ursodiol group, as compared with 24.7 percent in the placebo group (P less than 0.04). Severe biliary pain occurred in 1.5 percent of all patients, acute cholecystitis in 1.0 percent, and acute pancreatitis in 1.5 percent; endoscopic sphincterotomy was performed in 0.5 percent, and cholecystectomy in 2.5 percent. CONCLUSIONS: Extracorporeal shock-wave lithotripsy with ursodiol was more effective than lithotripsy alone for the treatment of symptomatic gallstones, and equally safe. Treatment was more effective for solitary than multiple stones, radiolucent than slightly calcified stones, and smaller than larger stones.
Asunto(s)
Colelitiasis/terapia , Litotricia , Ácido Ursodesoxicólico/uso terapéutico , Presión Sanguínea , Colelitiasis/sangre , Colelitiasis/complicaciones , Colelitiasis/fisiopatología , Terapia Combinada , Femenino , Hematuria/etiología , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Use of therapeutic arterial embolization (TAE) in the traumatized patient can achieve rapid control of hemorrhage and obviate the need for immediate surgery on poor-risk patients or in high-risk areas of the body. The techniques of embolization, its risks, and complications are discussed in light of the authors' experience, and a review of recent literature is presented.
Asunto(s)
Arterias , Embolización Terapéutica , Hemorragia/terapia , Heridas y Lesiones/complicaciones , Adolescente , Adulto , Anciano , Angiografía , Arterias/lesiones , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Femenino , Arteria Femoral/diagnóstico por imagen , Hemorragia/etiología , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Riesgo , Arteria Subclavia/diagnóstico por imagen , Arterias Torácicas/diagnóstico por imagen , Arteria Vertebral/diagnóstico por imagenRESUMEN
Eight cases of esophageal lymphoma are presented. Contiguous involvement of the distal esophagus and stomach with narrowing and/or nodularity was the most common esophageal abnormality. Other appearances noted were an ulcerated mass, multiple submucosal nodules, and a pattern simulating varices. The spectrum of radiologic appearances with esophageal lymphoma is similar to lymphomatous involvement in the remainder of the gastroinestinal tract.
Asunto(s)
Neoplasias Esofágicas/diagnóstico por imagen , Enfermedad de Hodgkin/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
Xerography in combination with tomography is a useful modality in evaluating pulmonary lesions. Comparison is made between this technique and conventional film tomography. Xerotomography is felt to be preferable although it requires considerably higher radiation exposure to the patient.