RESUMEN
We report a patient with life-threatening hematemesis caused by the rupture of a ductus aneurysm into the esophagus, which was successfully treated by coil embolism for the esophageal fistula through the aorta and subsequent thoracic endovascular aortic replacement. Second-stage therapy was performed surgically after proactive antibiotic treatment and in consideration of the patient's improved general condition. This included debridement with drainage, aortic encasement with remnant aneurysmal wall, omentopexy, and jejunostomy. The esophagus was preserved, and satisfactory healing and natural closure of the fistula were achieved. Although repeated aspirations were later required for pleural fluid, such inflammatory complications finally subsided.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Fístula Esofágica/cirugía , Hematemesis/etiología , Fístula Vascular/cirugía , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/complicaciones , Rotura de la Aorta/complicaciones , Fístula Esofágica/complicaciones , Femenino , Humanos , Fístula Vascular/complicacionesRESUMEN
OBJECTIVE: To date, numerous studies have been conducted on the diagnostic capabilities of positron emission tomography using [(18)F]-fluorodeoxyglucose (FDG-PET). However, no studies designed to evaluate the influence of FDG-PET on the selection of patient management strategies within the Japanese healthcare system have been reported to date. The aim of the present study was to investigate prospectively the proportion of patients whose management strategies were modified based on FDG-PET findings (strategy modification rate). METHODS: The strategy modification rate was calculated by comparing the patient management strategy (test and treatment plans) after FDG-PET with the strategy before FDG-PET for 560 cancer patients with nine types of cancer (lung cancer, breast cancer, colorectal cancer, head/neck cancer, brain tumor, pancreas cancer, malignant lymphoma, cancer of unknown origin, and melanoma). In addition, the details of the modifications to the patient management strategies were analyzed. RESULTS: The strategy modification rate for patients with lung cancer was 71.6% (149 of 208 patients, 95% confidence interval 65.0-77.7%), which was higher than previously reported strategy modification rates for lung cancer before and after FDG-PET (25.6%). The strategy modification rates for patients with cancers other than lung cancer were as follows: breast, 44.4% (56/126); colorectal, 75.6% (62/82); head and neck, 65.2% (15/23); malignant lymphoma, 70.0% (35/50); pancreas, 85.0% (17/20); and cancer of unknown origin, 78.0% (32/41). The mean modification rate (major and minor modifications) of the treatment plans after FDG-PET, relative to the plans before FDG-PET, was 55.4% (range 44.0-69.2%), with major modifications pertaining to the treatment plan made in 43.3-68.2% of the patients based on the objectives of the FDG-PET examination. CONCLUSIONS: The results from this study indicate that FDG-PET can contribute to the modification of management strategies (particularly treatment plans), especially for lung cancer patients but also for patients with other types of cancer.
Asunto(s)
Fluorodesoxiglucosa F18 , Interpretación de Imagen Asistida por Computador , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Tomografía de Emisión de Positrones , Radiofármacos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/terapia , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Femenino , Fluorodesoxiglucosa F18/efectos adversos , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Linfoma/diagnóstico , Linfoma/diagnóstico por imagen , Linfoma/patología , Linfoma/terapia , Masculino , Melanoma/diagnóstico , Melanoma/diagnóstico por imagen , Melanoma/patología , Melanoma/terapia , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Tomografía de Emisión de Positrones/efectos adversos , Tomografía de Emisión de Positrones/métodos , Radiofármacos/efectos adversos , Adulto JovenRESUMEN
The current treatment of type II endoleaks includes either transarterial or sac puncture techniques. Sac puncture can be further divided into translumbar, transabdominal, and transcaval approaches.1 However, transabdominal techniques for the treatment of type II leak are not well established. Herein, we report a case of a type II endoleak repaired in a 76-year-old woman using a computed tomography-guided percutaneous transabdominal approach. This type of transabdominal repair is easy and safe because punctures to the aneurysm sac are visualized in real time by computed tomography. It is possible to selectively embolize persistent blood flow in arteries in either the sac or main artery.