RESUMEN
Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITNs). ThyroidPrint® is a ten-gene classifier aimed to rule out malignancy in ITN. Post-validation studies are necessary to determine the real-world clinical benefit of ThyroidPrint® in patients with ITN. A single-center, prospective, noninterventional clinical utility study was performed, analyzing the impact of ThyroidPrint® in the physicians' clinical decisions for ITN. Demographics, nodule characteristics, benign call rates (BCRs), and surgical outcomes were measured. Histopathological data were collected from surgical biopsies of resected nodules. Of 1272 fine-needle aspirations, 109 (8.6%) were Bethesda III and 135 (10.6%) were Bethesda IV. Molecular testing was performed in 155 of 244 ITN (63.5%), of which 104 were classified as benign (BCR of 67.1%). After a median follow-up of 15 months, 103 of 104 (99.0%) patients with a benign ThyroidPrint® remained under surveillance and one patient underwent surgery which was a follicular adenoma. Surgery was performed in all 51 patients with a suspicious for malignancy as per ThyroidPrint® result and in 56 patients who did not undergo testing, with a rate of malignancy of 70.6% and 32.1%, respectively. A higher BCR was observed in follicular lesion of undetermined significance (87%) compared to atypia of undetermined significance (58%) (P < 0.05). False-positive cases included four benign follicular nodules and six follicular and four oncocytic adenomas. Our results show that, physicians chose active surveillance instead of diagnostic surgery in all patients with a benign ThyroidPrint® result, reducing the need for diagnostic surgery in 67% of patients with preoperative diagnosis of ITN.
Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Humanos , Estudios Prospectivos , Perfilación de la Expresión Génica/métodos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/genética , Nódulo Tiroideo/cirugía , Biopsia con Aguja FinaRESUMEN
Background: Although most thyroid nodules with indeterminate cytology are benign, in most of the world, surgery remains as the most frequent diagnostic approach. We have previously reported a 10-gene thyroid genetic classifier, which accurately predicts benign thyroid nodules. The assay is a prototype diagnostic kit suitable for reference laboratory testing and could potentially avoid unnecessary diagnostic surgery in patients with indeterminate thyroid cytology. Methods: Classifier performance was tested in two independent, ethnically diverse, prospective multicenter trials (TGCT-1/Chile and TGCT-2/USA). A total of 4061 fine-needle aspirations were collected from 15 institutions, of which 897 (22%) were called indeterminate. The clinical site was blind to the classifier score and the clinical laboratory blind to the pathology report. A matched surgical pathology and valid classifier score was available for 270 samples. Results: Cohorts showed significant differences, including (i) clinical site patient source (academic, 43% and 97% for TGCT-1 and -2, respectively); (ii) ethnic diversity, with a greater proportion of the Hispanic population (40% vs. 3%) for TGCT-1 and a greater proportion of African American (11% vs. 0%) and Asian (10% vs. 1%) populations for TGCT-2; and (iii) tumor size (mean of 1.7 and 2.5 cm for TGCT-1 and -2, respectively). Overall, there were no differences in the histopathological profile between cohorts. Forty-one of 155 and 45 of 115 nodules were malignant (cancer prevalence of 26% and 39% for TGCT-1 and -2, respectively). The classifier predicted 37 of 41 and 41 of 45 malignant nodules, yielding a sensitivity of 90% [95% confidence interval; CI 77-97] and 91% [95% CI 79-98] for TGCT-1 and -2, respectively. One hundred one of 114 and 61 of 70 nodules were correctly predicted as benign, yielding a specificity of 89% [95% CI 82-94] and 87% [95% CI 77-94], respectively. The negative predictive values for TGCT-1 and TGCT-2 were 96% and 94%, respectively, whereas the positive predictive values were 74% and 82%, respectively. The overall accuracy for both cohorts was 89%. Conclusions: Clinical validation of the classifier demonstrates equivalent performance in two independent and ethnically diverse cohorts, accurately predicting benign thyroid nodules that can undergo surveillance as an alternative to diagnostic surgery.
Asunto(s)
Glándula Tiroides/patología , Neoplasias de la Tiroides/genética , Nódulo Tiroideo/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Citodiagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adulto JovenRESUMEN
Liver involvement by multiple arterio-venous shunts in hereditary hemorrhagic telangiectasia can lead to severe heart failure. Total hepatectomy with liver transplantation has emerged as a therapeutic option for severe cases where other therapies have failed. We report a 51-year-old male who underwent a liver transplant for this condition, with full cardiac recovery within the first year after receiving the allograft. Nine years after transplantation, he remains with normal functional capacity and normal liver function tests.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Telangiectasia Hemorrágica Hereditaria/complicaciones , Trasplante de Hígado/métodos , Insuficiencia Cardíaca/cirugía , Anastomosis Quirúrgica , Resultado del Tratamiento , Insuficiencia Cardíaca/etiología , Hígado/patologíaRESUMEN
BACKGROUND: In most of the world, diagnostic surgery remains the most frequent approach for indeterminate thyroid cytology. Although several molecular tests are available for testing in centralized commercial laboratories in the United States, there are no available kits for local laboratory testing. The aim of this study was to develop a prototype in vitro diagnostic (IVD) gene classifier for the further characterization of nodules with an indeterminate thyroid cytology. METHODS: In a first stage, the expression of 18 genes was determined by quantitative polymerase chain reaction (qPCR) in a broad histopathological spectrum of 114 fresh-tissue biopsies. Expression data were used to train several classifiers by supervised machine learning approaches. Classifiers were tested in an independent set of 139 samples. In a second stage, the best classifier was chosen as a model to develop a multiplexed-qPCR IVD prototype assay, which was tested in a prospective multicenter cohort of fine-needle aspiration biopsies. RESULTS: In tissue biopsies, the best classifier, using only 10 genes, reached an optimal and consistent performance in the ninefold cross-validated testing set (sensitivity 93% and specificity 81%). In the multicenter cohort of fine-needle aspiration biopsy samples, the 10-gene signature, built into a multiplexed-qPCR IVD prototype, showed an area under the curve of 0.97, a positive predictive value of 78%, and a negative predictive value of 98%. By Bayes' theorem, the IVD prototype is expected to achieve a positive predictive value of 64-82% and a negative predictive value of 97-99% in patients with a cancer prevalence range of 20-40%. CONCLUSIONS: A new multiplexed-qPCR IVD prototype is reported that accurately classifies thyroid nodules and may provide a future solution suitable for local reference laboratory testing.
Asunto(s)
Regulación Neoplásica de la Expresión Génica , Proteínas de Neoplasias/metabolismo , Glándula Tiroides/metabolismo , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Biomarcadores de Tumor/metabolismo , Biopsia con Aguja Fina , Chile/epidemiología , Estudios de Cohortes , Biología Computacional , Diagnóstico Diferencial , Sistemas Especialistas , Estudios de Seguimiento , Humanos , Aprendizaje Automático , Proteínas de Neoplasias/genética , Estadificación de Neoplasias , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Glándula Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/metabolismo , Nódulo Tiroideo/patologíaRESUMEN
Hepatopulmonary syndrome (HPS) is a complication of portal hypertension (PH) defined by the presence of liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations (IPVD) producing a right to left intrapulmonary shunt. Liver transplantation (LT) is the treatment of choice; however, severe hypoxemia may contraindicate LT. The use of transjugular intrahepatic portosystemic shunts (TIPS) could be effective in HPS, although available data is limited. AIM: To report a clinical case of severe HPS treated sequentially with TIPS and LT. CASE REPORT: A 46 year old female cirrhotic patient presented with rapidly progressive dyspnea, hypoxemia (PaO2 60 mmHg, SaO2 92%) and increased alveolar-arterial oxygen gradient (A-a) (46 mmHg). She also had orthodeoxia (SaO2 87% in sitting position, but 91% in a prone position). A CT scan and pulmonary angiography were normal. Spirometric assessment showed a mild restrictive pattern and a desaturation was observed in a six-minute walking test. Contrast-enhanced echocardiography (CEE) showed intrapulmonary shunting. A HPS was diagnosed and liver transplantation was disregarded due to severe hypoxemia. The patient underwent TIPS placement. After four weeks, a significant improvement of dyspnea and a complete remission of orthodeoxia were seen. One year later, the patient was successfully transplanted. Interestingly, six months after LT, and in the absence of dyspnea, a new CEE showed persistent passing of bubbles to the left cavities. COMMENTS/CONCLUSION: Persistent right-to-left shunt after TIPS placement and liver transplantation in spite of the improvement of pulmonary function tests suggests long-term persistence of structural changes in the pulmonary vascular tree after liver transplantation. Because of lack of data, it is not possible to recommend the routine use of TIPS as a part of the conventional management of HPS. However, in patients with severe hypoxemia TIPS placement can reasonably be used as a bridge towards transplantation.
Asunto(s)
Síndrome Hepatopulmonar/cirugía , Cirrosis Hepática/complicaciones , Trasplante de Hígado , Derivación Portosistémica Intrahepática Transyugular , Disnea/etiología , Ecocardiografía , Prueba de Esfuerzo , Femenino , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/etiología , Humanos , Hipoxia/etiología , Cirrosis Hepática/cirugía , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Espirometría , Resultado del TratamientoRESUMEN
Chemoembolization is a therapeutic alternative for those patients with hepatocarcinoma that cannot be excised surgically or that are waiting a liver allograft. We report two patients with hepatocarcinoma who were subjected to chemoembolization. A 65 years old male with a chronic liver disease and right lobe hepatocarcinoma, waiting for a liver transplantation, was subjected to two sessions, of chemoembolization four weeks apart. A magnetic resonance showed a 80% reduction of tumor volume one month later. A 72 years old diabetic male with an alcoholic liver disease with two hepatocarcinoma in the right lobe was subjected to two sessions of chemoembolization, separated by four weeks. A magnetic resonance one month later showed the absence of blood flow in both lesions, suggesting complete necrosis.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Anciano , Angioplastia , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Enfermedad Crónica , Humanos , Cirrosis Hepática/patología , Cirrosis Hepática/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Trasplante de Hígado/patología , Masculino , Estadificación de Neoplasias/métodos , Cuidados Preoperatorios , Radiografía , Resultado del TratamientoRESUMEN
Chemoembolization is a therapeutic alternative for those patients with hepatocarcinoma that cannot be excised surgically or that are waiting a liver allograft. We report two patients with hepatocarcinoma who were subjected to chemoembolization. A 65 years old male with a chronic liver disease and right lobe hepatocarcinoma, waiting for a liver transplantation, was subjected to two sessions, of chemoembolization four weeks apart. A magnetic resonance showed a 80 percent reduction of tumor volume one month later. A 72 years old diabetic male with an alcoholic liver disease with two hepatocarcinoma in the right lobe was subjected to two sessions of chemoembolization, separated by four weeks. A magnetic resonance one month later showed the absence of blood flow in both lesions, suggesting complete necrosis.
Asunto(s)
Anciano , Humanos , Masculino , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Angioplastia , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular , Enfermedad Crónica , Cirrosis Hepática/patología , Cirrosis Hepática/terapia , Neoplasias Hepáticas/patología , Neoplasias Hepáticas , Trasplante de Hígado/patología , Estadificación de Neoplasias/métodos , Cuidados Preoperatorios , Resultado del TratamientoRESUMEN
Primary hyperaldosteronism is the most prevalent cause of secondary hypertension. Approximately 10 percentof hypertensive patients may be carriers of this condition. Idiopathic bilateral adrenal hyperplasia (HSBI) and aldosterone producing adenoma (APA) are the most common causes of hyperaldosteronism. To diagnose these conditions, adrenal venous catheterization (CVS) is the test of choice to evaluate functional imagingfindings. The aim of this communication is to demonstrate the usefulness of the CVS in the etiological diagnosis of this condition. We report two patients with primary hyperaldosteronism who were subjected to CVS. A male in whom and abdominal CAT scan showed bilateral adrenal growth, that was severest atthe left side. CVS concluded hyper secretion of aldosterone on the right side, but without suppression of the contralateral gland, corresponding to a bilateral adrenal hyperplasia. A 43 years old male in whom an abdominal CAT scan showed a right adrenal tumor measuring 11 x 5 mm. CVS showed a right lateralization of aldosterone secretion, with suppression of the contralateral gland. The conclusion was the presence of an aldosteronoma, which was excised by laparoscopy with excellent clinical outcome.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Adenoma/diagnóstico , Hiperaldosteronismo/etiología , Hiperplasia/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Aldosterona , Cateterismo , Glándulas Suprarrenales/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents. BACKGROUND: Carotid dissection is an important cause of ischemic stroke in young and middle-aged patients. There are some patients in whom invasive management is recommended. METHODS: Twelve patients (eight females, four males), mean age of 50 years (range 35-80 years) with ICA dissection, were treated with the endovascular approach during a 24-month period. Patients included in this study underwent magnetic resonance (MR) and digital subtraction angiography (DSA) for diagnosis. Over this time period, 162 patients with ICA dissections were seen at our institution. Indications for endovascular treatment were: recurrent ischemic events despite adequate anticoagulant treatment in seven cases, contraindication to anticoagulation in four cases, and one case with significant mismatch between diffusion and perfusion weighted MR. Eleven dissections were spontaneous and one was traumatic. The follow-up was performed clinically with Doppler ultrasound (US) and MR at 6, 12, and 24 months. RESULTS: Stent deployment was successful in all cases. Acute symptoms were resolved in 66.7% of patients. No patients deteriorated their neurological status. There were no new clinical events, stent stenosis or occlusion on 24 months follow-up. CONCLUSION: Our results showed an excellent clinical outcome of the treated patients. This suggests promising results with the use of endovascular treatment in selected patients.
Asunto(s)
Angioplastia de Balón/instrumentación , Isquemia Encefálica/prevención & control , Disección de la Arteria Carótida Interna/terapia , Stents , Adulto , Anciano , Angiografía de Substracción Digital , Angioplastia de Balón/efectos adversos , Isquemia Encefálica/etiología , Isquemia Encefálica/patología , Disección de la Arteria Carótida Interna/complicaciones , Disección de la Arteria Carótida Interna/patología , Embolización Terapéutica , Femenino , Estudios de Seguimiento , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Selección de Paciente , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient's respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.
Asunto(s)
Ascitis/terapia , Trasplante de Corazón/efectos adversos , Cirrosis Hepática/complicaciones , Derivación Portosistémica Intrahepática Transyugular , Adulto , Displasia Ventricular Derecha Arritmogénica/diagnóstico por imagen , Displasia Ventricular Derecha Arritmogénica/cirugía , Ascitis/diagnóstico por imagen , Ascitis/etiología , Ecocardiografía , Femenino , HumanosRESUMEN
Seven patients with massive pulmonary embolism (PE) causing cardiac arrest underwent percutaneous mechanical thrombectomy (PMT) with Hydrolyser and Oasis catheters during cardiopulmonary resuscitation (CPR). Three received adjunctive recombinant tissue plasminogen activator. Thrombectomy was successful in restoring pulmonary perfusion in six patients (85.7%). One patient died of cardiac arrest. Systolic pulmonary pressure decreased after thrombectomy from a median of 73 mm Hg (range, 63-90 mm Hg) to 42 mm Hg (range, 32-81 mm Hg; P < .05). There was one groin hematoma that required blood transfusion. In conclusion, massive PE causing cardiac arrest can be treated with PMT simultaneously with CPR maneuvers to rapidly revert circulatory collapse, with restoration of pulmonary circulation. Larger series are needed to validate this method.
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Reanimación Cardiopulmonar , Paro Cardíaco/terapia , Embolia Pulmonar/terapia , Trombectomía/métodos , Adulto , Anciano , Cateterismo , Terapia Combinada , Fluoroscopía , Paro Cardíaco/etiología , Humanos , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoRESUMEN
Pulmonary Embolism (PE) has a wide clinical spectrum. It is imperative to detect patients with a high risk to develop right ventricular failure, because this is the main cause of death in patients with massive PE. In this group of patients, invasive therapies to relieve pulmonary obstruction and right ventricle overload should be used as soon as possible. We report a 85 years old male with massive PE treated with pharmacological thrombolysis and mechanical fragmentation with an angioplasty balloon. Pulmonary perfusion improved significantly. Afterwards, systemic anticoagulation was started and an inferior vena cava filter was installed percutaneously. The patient was discharged in good conditions, five days after admission.
Asunto(s)
Cateterismo , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Anciano de 80 o más Años , Terapia Combinada , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/tratamiento farmacológico , Radiografía , Filtros de Vena CavaRESUMEN
PURPOSE: A new form of angioplasty, called cryoplasty, was developed to improve the late results typically associated with percutaneous transluminal angioplasty. Cryoplasty combines the dilation force of percutaneous transluminal angioplasty with the delivery of cold thermal energy to the vessel wall. This study reports the authors' early clinical experience with cryoplasty in patients with femoropopliteal disease. MATERIALS AND METHODS: Fifteen patients with femoropopliteal arterial lesions were treated with cryoplasty (CryoVascular Systems, Los Gatos, CA). Cryoplasty was performed at 6 atm of pressure and delivered at -10 degrees C for 60 seconds. The ankle-brachial index (ABI) was measured at baseline, 24 hours after cryoplasty, and at 1 and 3 months during follow-up. Repeated angiography was performed at 6 and 18 months to determine short-term and late primary patency. RESULTS: Cryoplasty was technically successful in 93% of patients (< 30% residual stenosis and less then grade C dissection). ABIs at baseline were 0.64 +/- 0.08 and improved the day after cryoplasty to 0.95 +/- 0.09 (P < .05). ABIs were well maintained at 1 and 3 months with measurements of 0.94 +/- 0.09 and 0.92 +/- 0.10, respectively (P < .05 vs baseline). Baseline angiographic diameter stenosis improved significantly immediately following cryoplasty (86% +/- 12% to 16% +/- 3%; P < .05). Angiography at 6 months revealed 0% binary restenosis and insignificant change in residual stenosis from the acute cryoplasty results (16 +/- 3% vs 21 +/- 5%; P = NS). Late angiographic follow-up at 14 months +/- 4 demonstrated primary patency of 83.3%. CONCLUSION: Cryoplasty was able to achieve substantial dilation of femoropopliteal lesions with well-preserved late angiographic patency. Cryoplasty represents a potential advance in the field of endovascular medicine.
Asunto(s)
Angioplastia de Balón/instrumentación , Arteriopatías Oclusivas/terapia , Crioterapia/instrumentación , Arteria Femoral/diagnóstico por imagen , Arteria Poplítea/diagnóstico por imagen , Anciano , Análisis de Varianza , Angioplastia de Balón/métodos , Angioplastia de Balón/estadística & datos numéricos , Arteriopatías Oclusivas/diagnóstico por imagen , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/terapia , Estudios Transversales , Crioterapia/métodos , Diseño de Equipo/métodos , Femenino , Estudios de Seguimiento , Humanos , Pierna/irrigación sanguínea , Pierna/diagnóstico por imagen , Masculino , Radiografía , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular/fisiologíaRESUMEN
Percutaneous mechanical thrombectomy (PMT) has matured into a reliable and valuable therapeutic tool in acute vascular diseases. PMT devices are designed to achieve rapid clearance of acute occlusion in large arteries and veins. This article provides a summary of cumulated experience on pulmonary embolism (PE) treatment with PMT devices. PMT devices are a heterogeneous group of devices that uses different forms of energy. Most of the devices do not totally eliminate thrombus rather fragment in small particles. The rationale of PMT is based on the rapid relief of central pulmonary obstruction. PMT in massive PE provides efficacious and safe debulking of centrally located thrombus in PE, lowering pulmonary artery pressures and improving hemodynamics and blood oxygenation. This results in lowering mortality if compared with natural history of PE, and reduced procedure time if compared with pharmacological thrombolysis. The clinical indications for percutaneous intervention in PE are discussed in the text.
Asunto(s)
Embolia Pulmonar/cirugía , Trombectomía , Diseño de Equipo , Humanos , Complicaciones Posoperatorias , Trombectomía/instrumentación , Trombectomía/métodos , Terapia TrombolíticaRESUMEN
Objetivo: evaluar la utilidad de las endoprótesis metálicas autoexpandibles en el tratamiento de la obstrucción colorrectal secundaria a una neoplasia maligna. Material y métodos: se instalaron un total de doce endoprótesis en doce pacientes bajo fluorscopica, en dos casos asistido por endoscopía. Los pacientes presentaban signos clínicos y radiológicos de una obstrucción intestinal a nivel colorrectal. Las indicaciones de instalación fueron: tratamiento paliativo en 10 pacientes con evidencias de enfermedad tumoral a distancia (9) o pelvis congelada (1) y en 2 pacientes como método de descompresión prequirúrgica. Se utilizaron prótesis metálicas autoexpandibles (Wallstent 20 x 55 mm). Resultados: la colocación de la endoprótesis fue exitosa en 12 pacientes, que se recuperaron de su obstrucción colónica dentro de las 24 horas siguientes. Conclusión: la instalación de endoprótesis autoexpandibles en pacientes con obstrucción intestinal a nivel colorrectal es un método mínimamente invasivo, efectivo como tratamiento paliativo en aquellos pacientes de alto riesgo para una intervención quirúrgica. Por otra parte, éste procedimiento también permite la preparación preoperatoria del colon y así proceder en una sola etapa quirúrgica
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias del Colon , Neoplasias Colorrectales , Implantación de Prótesis/métodos , Obstrucción Intestinal/terapia , Neoplasias del Recto , Implantación de Prótesis/instrumentación , Obstrucción Intestinal/etiología , Resultado del TratamientoRESUMEN
Objetivo: evaluar la utilidad de las endoprótesis metálicas autoexpandibles en el tratamiento de la obstrucción colorrectal secundaria a una neoplasia maligna. Material y métodos: se instalaron un total de doce endoprótesis en doce pacientes bajo fluorscopica, en dos casos asistido por endoscopía. Los pacientes presentaban signos clínicos y radiológicos de una obstrucción intestinal a nivel colorrectal. Las indicaciones de instalación fueron: tratamiento paliativo en 10 pacientes con evidencias de enfermedad tumoral a distancia (9) o pelvis congelada (1) y en 2 pacientes como método de descompresión prequirúrgica. Se utilizaron prótesis metálicas autoexpandibles (Wallstent 20 x 55 mm). Resultados: la colocación de la endoprótesis fue exitosa en 12 pacientes, que se recuperaron de su obstrucción colónica dentro de las 24 horas siguientes. Conclusión: la instalación de endoprótesis autoexpandibles en pacientes con obstrucción intestinal a nivel colorrectal es un método mínimamente invasivo, efectivo como tratamiento paliativo en aquellos pacientes de alto riesgo para una intervención quirúrgica. Por otra parte, éste procedimiento también permite la preparación preoperatoria del colon y así proceder en una sola etapa quirúrgica (AU)