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PURPOSE: To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes. METHODS: Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women-scheduled for surgical treatment with alloplastic material-who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis. RESULTS: Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6-3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67-74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50-72%. CONCLUSIONS: Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.
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Imagen por Resonancia Magnética/métodos , Ultrasonografía/métodos , Uretra/patología , Vejiga Urinaria/diagnóstico por imagen , Vagina/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.
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This article elucidates the various tools used for the diagnostics and characterization of renal lesions. The advantages and limitations of ultrasound, contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) are presented and discussed. In addition, modern imaging features of CT and MRI, such as iodine quantification in CT as well as diffusion-weighted and perfusion imaging in MRI are presented. Lastly, recent developments in standardized reporting of renal tumors regarding the intraoperative surgical risk are presented.
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Aumento de la Imagen/métodos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Cuidados Preoperatorios/métodos , Cirugía Asistida por Computador/métodos , Humanos , Pronóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: There are just a few reports on Color Doppler Ultrasound-guided PTBD with and without metal stent implantation by endoscopic control. Ultrasound guidance facilitates percutaneous bile duct access and avoids severe adverse events. Internal biliary drainage rate in PTBD should be as high as possible as endoscopic ultrasound-guided cholangiodrainage (EUCD) offers internal drainage regularly. We report our prospective study analyzing success, internal drainage and adverse event rates. MATERIALS AND METHODS: Between June 2009 and November 2014 overall 63 PTBDs were performed prospectively in 37 patients (18âm, 19f; age on average: 72 years) with benign (9â%) and malignant (91â%) bile duct obstruction. Ultrasound was used in combination with fluoroscopic guidance. Whenever possible, primary or early secondary metal stent implantation via PTBD by endoscopic control was performed as a one step-procedure. RESULTS: 38 of 41 (93â%) initial PTBDs (in four patients PTBD was performed twice) were successful. 22 of 63 PTBDs were follow-up examinations with different interventions. In 34 of 38 successful (89â%) PTBDs, an internal drainage (or metal stent) was implanted. 12 metal stent implantations via PTBD were performed under endoscopic control. Just 2 (5â%) permanent external drainages were inserted. In 63 performed PTBDs 5 (7.9â%) early major adverse events (no severe intrahepatic bleeding) were documented and treated without any procedure related death. When metal stent implantation was performed via PTBD no adverse event was documented. CONCLUSION: Color Doppler guided PTBD is an effective and safe method for biliary drainage avoiding severe adverse events. Primary or early secondary metal stent implantation via PTBD reduces complication risks additionally. Endoscopic control of stent implantation via PTBD is helpful for optimal stent placement.
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Colestasis/diagnóstico por imagen , Colestasis/cirugía , Drenaje/métodos , Endoscopía del Sistema Digestivo/métodos , Cirugía Asistida por Computador/métodos , Ultrasonografía Doppler en Color/métodos , Anciano , Anciano de 80 o más Años , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Femenino , Humanos , Masculino , Metales , Persona de Mediana Edad , Estudios Prospectivos , Stents , Cirugía Asistida por Computador/instrumentación , Resultado del TratamientoRESUMEN
BACKGROUND: In simultaneous pancreas-kidney transplantation (SPKT), monitoring of the pancreas allograft is more complex than the kidney allograft due to difficulties in obtaining pancreas histology and weak clinical evidence supporting the role of donor-specific antibodies (DSA). METHODS: We performed a single-center retrospective analysis of all 17 SPKT recipients who underwent a total of 22 pancreas allograft indication biopsies from October 2009 to September 2012. Fifteen patients had at least 2 DSA measurements: pretransplantation and at the time of biopsy. RESULTS: All 7 patients (100%) with post-transplantation DSA-positivity (de novo: n = 6; persistent: n = 1) at biopsy had at least 1 rejection episode either of the pancreas (n = 4) or the kidney (n = 3), with 3 antibody-mediated rejections (AMR). In contrast, only 4 of 8 patients (50%) without post-transplantation DSA had evidence of rejection, with 1 AMR. Findings during pancreas allograft biopsy procedures led to a change of immunosuppressive therapy in 11 of 15 (73%) patients. Patient survival, graft survival, and function were not adversely affected by the presence of post-transplantation DSA. One major and 2 minor procedure-related complications occurred during the pancreas biopsies. CONCLUSIONS: In this small retrospective analysis, pancreas allograft histology provided the most therapeutically relevant information, rather than the kidney histology or DSA monitoring.
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Aloinjertos/inmunología , Antígenos HLA/inmunología , Isoanticuerpos/análisis , Trasplante de Riñón/métodos , Trasplante de Páncreas/métodos , Adulto , Biopsia , Terapia Combinada , Femenino , Supervivencia de Injerto/inmunología , Humanos , Isoanticuerpos/inmunología , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Trasplante de Páncreas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Donantes de Tejidos , Adulto JovenRESUMEN
PURPOSE: Protective occlusion of the gastroduodenal artery (GDA) is required to avoid severe adverse effects and complications in radioembolization procedures. Because of the expandable features of HydroCoils, our goal was to occlude the GDA with only one HydroCoil to provide particle reflux protection. METHODS: Twenty-three subjects with unresectable liver tumors, who were scheduled for protective occlusion of the GDA before radioembolization therapy, were included. The primary end point was to achieve a proximal occlusion of the GDA with only one detachable HydroCoil. Evaluated parameters were duration of deployment, and early (during the intervention) and late (7-21 days) occlusion rates of GDA. Secondary end points included complete duration of the intervention, amount of contrast medium used, fluoroscopy rates, and adverse effects. RESULTS: In all cases, the GDA was successfully occluded with only one HydroCoil. The selected diameter/length range was 4/10 mm in 2 patients, 4/15 mm in 6 patients, and 4/20 mm in 15 patients. HydroCoils were implanted, on average, 3.75 mm from the origin of the GDA (range 1.5-6.8 mm), with an average deployment time of 2:47 (median 2:42, range 2:30-3:07) min. In 21 (91%) of 23 patients, a complete occlusion of the GDA was achieved during the first 30 min after the coil implantation; however, in all patients, a late occlusion of the GDA was present after 6 to 29 days. No clinical or technical complications were reported. CONCLUSION: We demonstrated that occlusion of the GDA with a single HydroCoil is a safe procedure and successfully prevents extrahepatic embolization before radioembolization.
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Arteriopatías Oclusivas/prevención & control , Embolización Terapéutica/instrumentación , Arteria Ilíaca/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Radiografía Intervencional/métodos , Terapia Recuperativa/métodos , Adulto , Angiografía/métodos , Estudios de Cohortes , Duodeno/irrigación sanguínea , Embolización Terapéutica/métodos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/radioterapia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevención Primaria/métodos , Implantación de Prótesis/métodos , Radiografía Intervencional/instrumentación , Medición de Riesgo , Stents , Estómago/irrigación sanguínea , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the effect of cold ischemia time (CIT) of renal allografts on diffusion and perfusion using intravoxel incoherent motion (IVIM) derived parameters. MATERIAL AND METHODS: A total of 37 patients with renal allografts (CIT: 27 <15 h, 10 ≥15 h) and 30 individuals with healthy kidneys were examined at 1.5 T using a single-shot echo-planar diffusion-weighted pulse sequence with nine b-values ranging from 0 to 800 s/mm(2). ADC, perfusion fraction f, and the diffusion coefficient D were calculated using the IVIM model. Parameters of allografts stratified by CIT were compared with healthy kidney groups using the Mann-Whitney U test for unpaired data. We computed the Spearman correlation coefficient for correlation with creatinine values. RESULTS: ADC, D, and f of transplanted kidneys were significantly lower than in the healthy controls. The long-CIT group showed significantly lower diffusion parameters compared with the short-CIT group [mean±SD]: ADC: 1.63±0.14 µm(2)/ms, f: 11.90±5.22%, D: 1.55±0.25 µm(2)/ms versus ADC: 1.79±0.13 µm(2)/ms, f: 16.12±3.43%, D: 1.73±0.14 µm(2)/ms, P(ADC), (f), (D)<0.05. CONCLUSION: Our results suggest that diffusion parameters, especially the ADC, depend on the CIT of the kidney allograft. Potentially, this stands for functional changes in renal allografts. Diffusion-weighted imaging could be used for follow-up examinations. Thus, diffusion parameters may help guide therapy in patients with delayed graft function.
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Isquemia Fría/métodos , Trasplante de Riñón/patología , Angiografía por Resonancia Magnética/métodos , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
The number of patients with haematopoietic malignancies receiving chemotherapy and stem-cell transplantation has increased the incidence of severe opportunistic infections. Systemic fungal infections are of major concern in immunocompromised patients, as these infections are often fatal. We report a case of a patient with acute myeloid leukaemia who developed multiple cutaneous plaques and necrotizing infiltrates in the lungs during chemotherapy. Using real-time PCR on a wax-embedded tissue sample, Rhizomucor pusillus was identified. We provide an overview of the literature on cutaneous mucormycosis and its diagnosis by PCR.
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Dermatomicosis/microbiología , Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas/microbiología , Mucormicosis/microbiología , Rhizomucor/aislamiento & purificación , Sinusitis/microbiología , Enfermedad Aguda , Anciano , Humanos , Masculino , Reacción en Cadena de la PolimerasaRESUMEN
PURPOSE: Usefulness of biexponentially fitted signal attenuation at different b-values for differentiating the histological characteristics of renal tumors. MATERIALS AND METHODS: A total of 26 patients with 28 renal masses (histologically proven: 20 clear cell renal cell carcinomas [ccRCC], three transitional cell carcinomas, two oncocytomas, and one papillary RCC) and 30 volunteers with healthy kidneys were examined at 1.5 Tesla using an echo-planar DWI sequence. Using the IVIM model, we calculated the perfusion fraction f and the diffusion coefficient D. Furthermore, the ADC was obtained. These tumor parameters were compared to healthy renal tissue nonparametrically, and a receiver operating characteristic (ROC) analysis was performed. RESULTS: Healthy renal parenchyma showed higher ADC and D values (p<0.001) than ccRCC (ADC 1.95±0.10 [SD] µm2/ms, f 18.32±2.52%, and D 1.88±0.11 µm2/ms versus ADC 1.45±0.38 µm2/ms, f 18.59±6.16%, and D 1.34±0.38 µm2/ms). When detecting malignancies the area under the curve for D was higher than for ADC. The f values for ccRCC were higher (p<0.001) than for non-ccRCC (ADC 1.52±0.47 µm2/ms, f 8.44±1.24%, and D 1.30±0.18 µm2/ms). Both f and D correlated with ccRCC grading. CONCLUSION: IVIM imaging is able to provide reliable diffusion values in the human kidney and may enhance the accuracy of tumor diagnosis. The D value was the best parameter to distinguish renal tumors from healthy renal tissue. The f value is promising for determining the histological subgroups.
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Imagen de Difusión por Resonancia Magnética/métodos , Neoplasias Renales/patología , Adenoma Oxifílico/patología , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Carcinoma Papilar/patología , Carcinoma de Células Renales/patología , Carcinoma de Células Transicionales/patología , Estudios de Casos y Controles , Medios de Contraste , Femenino , Humanos , Análisis de los Mínimos Cuadrados , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
AIM: To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. PATIENTS AND METHODS: Eighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3±8.7 (40-84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed. RESULTS: Procedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3±6.1 and 3.6±2.6, respectively. Duration of the complete procedure was 87±32 min. Dose-length product and dose-area product were 1.8±1.4 Gy cm and 3.9±4.3 Gy cm2, respectively. CONCLUSIONS: Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.
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Fluoroscopía/métodos , Nefrostomía Percutánea/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación/métodos , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
PURPOSE: Biliary cast syndrome (BCS) is the presence of casts within the intrahepatic or extrahepatic biliary system after orthotopic liver transplantation. Our work compares two percutaneous methods for BCS treatment: the mechanical cast-extraction technique (MCE) versus the hydraulic cast-extraction (HCE) technique using a rheolytic system. MATERIALS AND METHODS: A total of 24 patients were included in the study. Six patients were referred for HCE, and 18 patients were treated with MCE. A statistically significant larger number of sessions was required in the MCE group (21.0, range 11 to 72 sessions) (p = 0.033). RESULTS: Median therapy duration was shorter in the HCE group at 2.4 months (range 2 to 5) compared with 6.7 months (range 3 to 39) in the MCE group (p < 0.001). Both patient acceptance was better and costs for total therapy were 40% less in the HCE group. No significant differences where found concerning clinical and biochemical improvement or graft and patient survival. CONCLUSION: The use of the hydraulic rheolytic system decreased total therapy time, thereby decreasing the induced inflammation time of the biliary tree. A significant benefit of HCE has been observed in our patients when we compare our results with those of MCE.
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Enfermedades de los Conductos Biliares/terapia , Trasplante de Hígado/efectos adversos , Anciano , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/etiología , Cateterismo , Colangiografía , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Radiografía IntervencionalRESUMEN
Because of progress in imaging, the incidence of renal tumours, especially small lesions, has been rising over the last years. Therefore, imaging must be done to decide how to proceed further. But which is the most effective modality: computed tomography (CT) or magnetic resonance imaging (MRI)? From the technical point of view, the two alternatives appear to be nearly equal. Multidetector CT remains the reference standard for staging and lesion characterisation, whereas MRI is the method of choice for determining caval extension of a tumour thrombus and infiltration of the renal vein. If an accurate diagnosis cannot be specified, the remaining modality should be used complementarily.
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Aumento de la Imagen/métodos , Neoplasias Renales/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 +/- 10.3 h (range, 0.2-34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection and localization of arterial renal hemorrhage and appropriate for guidance of the embolization procedure.
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Angiografía/métodos , Embolización Terapéutica/métodos , Hemorragia/diagnóstico por imagen , Hemorragia/terapia , Arteria Renal , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Hemorragia/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
The aim of this study is to report our interventional radiologic procedures (IRP) in liver transplant (LTX) patients. These include procedures for biliary, arterial, venous, and portal complications, as well as the treatment of infected and non-infected fluid collections. This retrospective study covered 583 patients (mean age: 44 +/- 14 yr) in whom a total of 685 LTX were performed from August 1987 to April 2005. Overall, 182 LTX patients underwent a total of 428 IRP, including digital subtraction angiography (n = 152/35.51%), percutaneous transluminal angioplasty (PTA) (n = 4/0.93%) and PTA + stent (n = 7/1.63%) of arterial anastomosis, PTA + stent of the celiac trunk (n = 2/0.46%), transjugular intrahepatic portosystemic shunt (TIPS) (n = 2/0.46%), arterial lysis (n = 4/0.93%), venous lysis (n = 2/0.46%), inferior vena cava stenting (n = 2/0.46%), percutaneous biliary drainage (n = 34/7.94%), percutaneous transluminal dilatation (PTD) of the choledocho-enteric anastomosis (n = 16/3.73%), biliary stent (n = 5/1.16%), intrahepatic biliary flushing treatment, stone and cast biliary extraction (n = 27/6.30%), other interventions (e.g., embolization in other regions, transjugular liver biopsies, lymphangiographies) (n = 9/2.10%), and ultrasound- and computer tomography-guided biopsies and percutaneous drainage (n = 153/35.74%). The overall success rate was 85.7%. Technical improvements in LTX and interventional radiology permit vascular and biliary complications to be treated successfully by interventional radiology.
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Trasplante de Hígado/efectos adversos , Trasplante de Hígado/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Intervencional , Adulto , Angioplastia de Balón , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación Portosistémica Intrahepática Transyugular , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Stents , Análisis de SupervivenciaRESUMEN
Early HAT is the most frequent and severe vascular complication following liver transplantation. It is one of the major causes of graft failure and mortality. Endovascular thrombolytic treatment in patients with thrombotic complications after liver transplantation is an attractive alternative to open surgery as lower morbidity and mortality rates are reported for it. PTA following transcatheter thrombolysis has been successfully used to treat HAT in adults. To the best of our knowledge, there have not been any reports of a successful transcatheter thrombolysis using interventional radiological techniques in a patient only four months old. The present report describes the successful endovascular emergency treatment of a HAT three days after DD split liver transplantation.
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Angioplastia de Balón/métodos , Arterias/patología , Arteria Hepática/patología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Terapia Trombolítica/métodos , Trombosis/terapia , Síndrome de Alagille/terapia , Femenino , Rechazo de Injerto , Arteria Hepática/cirugía , Humanos , Lactante , Hígado/diagnóstico por imagen , Hígado/enzimología , Cirrosis Hepática/terapia , Resultado del Tratamiento , Ultrasonografía Doppler en Color/métodosRESUMEN
Through the large numbers of ultrasound studies and computed tomography (CT) and magnetic resonance imaging (MRI) scans being done, many symptomless renal tumors are detected. The radiologist has a duty to differentiate renal lesions and diagnose malignant tumours in adults. Modern imaging modalities such as CT and MRI have the capability to further differentiate renal tumours by specific attributes. In this article, the most common renal tumours are presented, and typical findings are discussed.
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Aumento de la Imagen/métodos , Neoplasias Renales/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , HumanosRESUMEN
Modern imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) allow high-resolution imaging of the abdomen. Modern scanners made high temporal as well as high spatial resolution available. Therapeutic approaches to the treatment of renal cell carcinoma have been improved over the recent years. Besides conventional and open laparoscopic tumor nephrectomy and nephron sparing, surgical approaches such as local tumor cryotherapy and radiofrequency ablation (RF) are ablative modalities and are used increasingly. Improved anesthesiological methods and new surgical approaches also allow curative treatment in extended tumors. Prerequisites for preoperative imaging modalities include visualization of the kidney tumor as well as its staging. Tumor-related infiltration of the renal pelvis or invasion of the perinephric fat and the renal hilus has to be excluded prior to nephron sparing surgery. In cases with extended tumors with infiltration of the inferior vena cava, it is necessary to visualize the exact extension of the tumor growth towards the right atrium in the vena cava. The radiologist should be informed about the diagnostic possibilities and limitations of the imaging modalities of CT and MRI in order to support the urologist in the planning and performance of surgical therapeutical approaches.
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Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/cirugía , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Ablación por Catéter , Crioterapia , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Laparoscopía , Imagen por Resonancia Magnética/métodos , Invasividad Neoplásica , Estadificación de Neoplasias/métodos , Nefrectomía/métodos , Nefronas , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: Acute pancreatitis (AP) is a rare complication after liver embolization (LE) of primary and secondary liver tumors (approximately 1.7%), but it has a significant morbidity and mortality potential if associated with other complications. It usually develops early within 24 h after the LE procedure. STUDY PURPOSE: To calculate the frequency of AP after LE in our institution and to analyze the factors involved in this procedure (anatomical features, embolization materials, cytostatic drugs, technical factors). MATERIALS AND METHODS: 118 LE (bland embolization and transarterial chemoembolization) were performed in our institution. The study group included 59 patients who met the following inclusion criteria: one or more LE events, with complete pre- and post-interventional laboratory studies including: serum Ca(2+), creatinine, blood urea nitrogen, glucose, lactate dehydrogenase, aminotransferases, alkaline phosphatase, amylase, lipase, C-reactive protein, hematocrit and leukocytes. The diagnosis of AP was established according to the criteria of the Atlanta system of classification. For the statistical analysis the association between two response variables (e.g. AP after embolization and risk factor during the embolization, AP after embolization and volume of embolic material) was evaluated using Pearson's chi(2) test and Fisher's exact test. RESULTS: The calculated frequency of AP after LE in our series was 15.2%. Amylase and lipase were elevated up to 8.7 and 20.1 times, respectively, 24 h after LE. We observed a statistically significantly lower incidence of AP in those patients who received 2 ml or less of embospheres compared with those with an embolization volume of >2 ml (Pearson's chi(2) = 4.5000, Pr = 0.034, Fisher's exact test = 0.040). Although carboplatin was administered to 7 of 9 of the patients who developed AP after the embolization procedure, there was no statistical significance (Fisher's exact test = 0.197) for carboplatin as an AP risk factor when compared with all the patients who received this drug (n = 107). CONCLUSION: Although AP after LE seems to have a multifactorial etiology, both the toxicity of the antineoplastic drugs (carboplatin-related toxicity) as well as direct ischemic mechanisms (non-target embolization, reflux mechanisms) may be the most important causes of the inflammatory pancreatic reaction after LE. We suggest that systematic measurement of serum pancreatic enzymes should be performed in cases of abdominal pain following selective LE and transarterial chemoembolization in order to confirm acute pancreatitis after embolization, which can clinically mimic a postembolization syndrome.
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Embolización Terapéutica/efectos adversos , Neoplasias Hepáticas/terapia , Pancreatitis/etiología , Enfermedad Aguda , Anciano , Medios de Contraste/efectos adversos , Femenino , Humanos , Aceite Yodado/efectos adversos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico por imagen , Tamaño de la Partícula , Radiografía Abdominal , Factores de RiesgoRESUMEN
Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases. We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt.
Asunto(s)
Hemorragia Gastrointestinal , Íleon/irrigación sanguínea , Cirrosis Hepática/complicaciones , Derivación Portosistémica Intrahepática Transyugular , Várices/complicaciones , Enfermedad Aguda , Anastomosis Quirúrgica , Angiografía de Substracción Digital , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Íleon/cirugía , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Várices/diagnóstico por imagen , Várices/cirugíaRESUMEN
PURPOSE: To evaluate the influence of preoperative and palliative embolization of renal cell carcinomas on survival, intra- and post-operative procedures, and symptom control for palliative and preoperative indications. MATERIALS AND METHODS: 56 patients who underwent renal cell carcinoma embolization from 1981 to 1999 were included in this retrospective study. RESULTS: 24 women and 32 men were included (mean age 59.4 years). Complete follow-up data was available for 49 patients. 42 patients underwent preoperative embolization at different tumor stages (pT1: 1 patient, pT2: 6, pT3 a: 4, pT3 b: 19, pT3 c: 2, pT4: 5). 14 patients underwent palliative embolization (T1: 0 patients, T2: 5, T3: 4, T4: 4). Indications for preoperative embolization were bleeding of the renal tumor in 6 cases -- non-recurrent bleeding reported, flank pain in 4 patients -- 3 of 4 patients had no further symptoms, recurrent tumor embolization in 1 patient, and 2 patients who wanted to be treated without symptoms. The mean survival time of preoperative embolized patients was 3.1 +/- 5.11 years with a 5-year survival rate of 50 %. The mean survival time of palliative embolized patients was 0.67 +/- 0.76 years with initial metastases (n = 7) and 2.33 +/- 2.40 without metastases (n = 6). CONCLUSION: Palliative embolization of renal cell carcinomas is a safe therapeutic method to treat advanced renal cell carcinomas allowing control of symptoms such as hematuria and flank pain in more than 90 % of our cases. Preoperative embolization yields a patient survival time comparable to that of patients at earlier tumor stages and is dependent on the metastases.