RESUMEN
BACKGROUND: Intravenous drug abuse is a global social and health care problem. Vascular complications following intravascular inguinal self-injection of addictive drugs are rarely seen. An efficient therapeutic concept is needed because, besides the risk of vascular injuries, infections ranging up to systemic inflammatory response syndrome or sepsis might occur. METHODS: This was a single center retrospective analysis of vascular complications in drug addicts from 1994 to 2002 in an university hospital. A systematic literature review in MEDLINE was performed with the following key words: 1 vascular, 2 complications, 3 drugs, 4 addicts, 5 mycotic aneurysms. RESULTS: 10 patients with a long lasting history of i. v. drug abuse (median: 16.1 years, range: 10-28 years) and vascular complications were included in this study. The mean age was 40.2 years (range 32-50 years). 5 patients showed pain and tumescence of the inguinal region at the time of admission. 7/10 patients had a poor general health and nutritional status. 2 patients had a hepatitis-B- and C-infection, 7 patients were hepatitis C Ag positive. All patients were HIV negative. 1 patient had an older deep venous leg thrombosis that was treated conservatively. In six cases, we saw an intraoperative arterial bleeding; in five cases pseudoaneurysms. The patients were treated with 5 venous interpositions, 4 venous patch plastics, 1 end-to-end anastomosis and 2 prosthetic grafts. 3 thrombectomies were performed. One time we performed a ligation of the pseudoaneurysm without reconstruction. Six reconstructions were covered with a biological seal. One thigh amputation was necessary; no patient died. In 2 patients with severe problems, we performed 11 operative revisions. The systematic literature review in MEDLINE showed no evidenced based therapy regimen. CONCLUSION: We favour the resection of the aneurysm including a radical debridement of the wound with secondary wound healing. In the case of an isolated aneurysm of the arteria femoralis superficialis or the arteria profunda femoris, a ligation or excision without reconstruction is possible with a low risk of postoperative complications. A reconstruction with autologous material is necessary in the case of aneurysms of the common femoral artery or its bifurcation. The reconstructed vessel should be covered with a biological seal, e. g. omentum majus. If there is no autologous material available for the reconstruction, we recommend the ligation without reconstruction, because the results after implantation of artificial vascular prostheses are not satisfying.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Trastornos Relacionados con Cocaína/complicaciones , Arteria Femoral/lesiones , Dependencia de Heroína/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Amputación Quirúrgica , Anastomosis Quirúrgica , Aneurisma Falso/diagnóstico , Aneurisma Infectado/diagnóstico , Implantación de Prótesis Vascular , Trastornos Relacionados con Cocaína/cirugía , Arteria Femoral/cirugía , Hemorragia/diagnóstico , Hemorragia/cirugía , Dependencia de Heroína/cirugía , Humanos , Conducto Inguinal/irrigación sanguínea , Isquemia/diagnóstico , Isquemia/cirugía , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación , Abuso de Sustancias por Vía Intravenosa/cirugía , Trombectomía , Trombosis/diagnóstico , Trombosis/cirugía , Venas/trasplanteRESUMEN
Primary vascular leiomyosarcomas are very rare tumors, with the venous variety most often arising from the inferior caval vein and the arterial variety from the pulmonary artery. The tumors show either an exclusive intra- or extravascular pattern or a mixed growth pattern. The clinical symptoms depend on tumor location, with intraluminal tumors of the inferior caval vein causing edema or a Budd-Chiari syndrome. Leiomyosarcomas of the pulmonary artery can mimic chronic central or recurrent peripheral pulmonary embolism. Contrast enhanced spiral CT with multiplanar reconstruction is the diagnostic method of choice when a vascular leiomyosarcoma is suspected. MRI with MR-angiography can be added. If a tumor of undetermined origin shows a broad contact with a vessel and/or an intraluminal component, possible primary vascular leiomyosarcoma should be included in the differential diagnosis.
Asunto(s)
Leiomiosarcoma/diagnóstico , Imagen por Resonancia Magnética , Arteria Pulmonar , Tomografía Computarizada Espiral , Neoplasias Vasculares/diagnóstico , Vena Cava Inferior , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/etiología , Diagnóstico Diferencial , Edema/diagnóstico , Edema/etiología , Femenino , Humanos , Leiomiosarcoma/complicaciones , Leiomiosarcoma/diagnóstico por imagen , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico , Neoplasias Vasculares/complicaciones , Neoplasias Vasculares/diagnóstico por imagenRESUMEN
OBJECTIVE: to evaluate local surgical trauma induced by endovascular (TPEG) and conventional infrarenal aortic aneurysm repair (AAA-C), the inflammatory response and changes in cell-mediated and antibody-mediated immunity as illustrated by the type-1/type-2 T-helper (TH1/TH2) cell balance were investigated. DESIGN: prospective study. PATIENTS AND METHODS: sixteen patients were included, eight patients underwent AAA-C and eight TPEG. Venous peripheral blood samples were collected 24h preoperatively and 24, 48, 72h, 5 and 7 days postoperatively. Besides the WBC, intracellular TH1/TH2 cytokines (IFN-gamma/IL-4) and the cell surface markers HLA-DR on monocytes and CD23 on B cells were measured by four colour flow cytometry. RESULTS: statistically significant higher values in the AAA-C group were demonstrated for neutrophiles. The TH1/TH2 immunobalance (expressed by forming the ratio of IFN-(gamma/IL-4 producing T cells as well as by the ratio of HLA-DR(pos) monocytes/CD23(pos) B-cells) showed a significant shift towards TH2 immunity in the AAA-C group whereas TPEG led to a significant lesser shift 24-72h after surgery (p < 0.05). CONCLUSIONS: TPEG leads to a minor distortion of the TH1/TH2 immunobalance. This implies that TPEG is a less stressing procedure, that is especially beneficial in patients whose conditions are considered less suitable for AAA-C due to age and serious comorbidity.
Asunto(s)
Aneurisma de la Aorta Abdominal/inmunología , Aneurisma de la Aorta Abdominal/cirugía , Células TH1/inmunología , Células Th2/inmunología , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Citometría de Flujo , Antígenos HLA-DR/análisis , Humanos , Inmunidad Celular/fisiología , Interferón gamma/sangre , Interleucina-4/sangre , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos/fisiología , Estudios Prospectivos , Receptores de IgE/análisisRESUMEN
The purpose of this article is to review the etiology, clinical presentation and treatment options of visceral artery aneurysms (VAA) on the basis of our experiences. Visceral artery aneurysms are uncommon lesions with a frequency of 0,1-0,2 % in autopsy statistics. In fact many visceral artery aneurysms still present first with a rupture (22 %) and despite emergency laparotomies the mortality rate is about 8,5 %. The course of disease often is disastrous due to rupture of the aneurysms or thromboembolic complications, emphasizing the importance to be aware of this differential diagnosis of abdominal pain. This article covers 9 patients with VAA. 3 patients each revealed an a. lienalis aneurysm and a. gastrica aneurysm, resp. In the other 3 patients an aneurysm of the a. gastroepiploica, the a. pancreatico-duodenalis and the a. mesenterica superior resp. was proven. In 8 of 9 patients a surgical therapy of the VAA took place. Only 2 patients (22 %) were interventionally treated. 1 patient deceased due to postoperative hemorrhage. Both the surgical and the radiological intervention therapy are available for treatment of the VAA. The decision on the choice of the therapeutic procedure should be made on an individual basis.
Asunto(s)
Abdomen Agudo/cirugía , Aneurisma Roto/cirugía , Aneurisma/cirugía , Vísceras/irrigación sanguínea , Abdomen Agudo/etiología , Abdomen Agudo/mortalidad , Anciano , Aneurisma/diagnóstico , Aneurisma/mortalidad , Aneurisma Roto/diagnóstico , Aneurisma Roto/mortalidad , Angiografía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tasa de SupervivenciaRESUMEN
Abdominal infections are an important cause of morbidity and mortality in neutropenic patients. We present a retrospective series of 16 patients, mostly with acute leukemia, who developed severe abdominal infections during chemotherapy-induced neutropenia between 1991 and 1997. The frequency among patients with acute leukemia was 2.35% (13 of 553). Thirteen patients presented with enterocolitis and 3 patients presented with cholecystitis. Eight patients died. Bacteremia was present in 6 patients, 4 patients suffered from proven or strongly suspected fungal infections, and 1 patient suffered from cytomegalovirus infection. Early surgical management was required in a patient with intestinal obstruction, whereas other patients could be managed conservatively. Two patients with acute cholecystitis were treated with antibiotics until the end of neutropenia and then were resected. Severe abdominal injections in neutropenic patients, which are often fatal, were caused by nonbacterial microorganisms in one-fourth of the cases and could be managed conservatively in most instances.
Asunto(s)
Bacteriemia/etiología , Colecistitis/etiología , Infecciones por Citomegalovirus/etiología , Fungemia/etiología , Neutropenia/complicaciones , Abdomen/microbiología , Abdomen/patología , Adulto , Anciano , Bacteriemia/patología , Colecistitis/patología , Infecciones por Citomegalovirus/patología , Resultado Fatal , Femenino , Fungemia/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Estudios RetrospectivosAsunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Conductos Biliares Intrahepáticos , Conductos Biliares/irrigación sanguínea , Colangiocarcinoma/diagnóstico por imagen , Radiografía Abdominal , Tomografía Computarizada por Rayos X , Várices/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Arteria Mesentérica Superior/diagnóstico por imagen , Venas Mesentéricas/diagnóstico por imagen , Persona de Mediana Edad , Factores de TiempoAsunto(s)
Isquemia Encefálica/diagnóstico , Embolia Paradójica/diagnóstico , Defectos del Tabique Interatrial/diagnóstico , Aneurisma Intracraneal/diagnóstico , Vena Poplítea/patología , Adolescente , Afasia/etiología , Isquemia Encefálica/etiología , Isquemia Encefálica/terapia , Embolia Paradójica/etiología , Embolia Paradójica/terapia , Femenino , Defectos del Tabique Interatrial/complicaciones , Hemiplejía/etiología , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/cirugía , Imagen por Resonancia Magnética , Vena Poplítea/diagnóstico por imagen , Vena Poplítea/cirugía , Recuperación de la Función , Ultrasonografía Doppler DúplexRESUMEN
We report the case of a patient with portal hypertension and portal vein thrombosis who was admitted to hospital for evaluation prior to a scheduled portosystemic shunt operation. Ultrasound examination revealed dilatation of intrahepatic bile ducts and echogenic thickening of the walls of both right and left main bile ducts as well as the common bile duct, highly suspicious of a carcinoma. Further evaluation, however, showed a varicosis of the bile duct walls to be the cause of the thickening of the walls, the varicosis resulting from the long-standing cavernous transformation of the portal vein and the portal hypertension. This tumour-like thickening of the walls, caused by numerous tiny varicose veins, is also known as "Pseudo-cholangiocarcinoma sign" in the Anglo-American world.
Asunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Conductos Biliares Intrahepáticos/irrigación sanguínea , Colangiocarcinoma/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Várices/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , UltrasonografíaRESUMEN
PURPOSE: Detection of hepatic artery variants is of great clinical importance, for instance, pre liver transplantation, pre intraarterial chemotherapy or for measurement of the Doppler perfusion index. We therefore investigated how accurate variants of the hepatic artery can be detected using color-coded sonography pre and post Levovist injection. MATERIALS AND METHODS: 52 patients (21-78 years) were examined using color-coded sonography pre and post Levovist injection. After the sonographic examination, intraarterial digital subtraction angiography was performed and the results were compared. RESULTS: Using angiography 14 variants of the hepatic artery were detected in 13 patients. The most common variant in 10 patients were hepatic arteries originating from the superior mesenteric artery. This could be detected with unenhanced color-coded sonography in 8 and with enhanced sonography in 9 patients. In one patient in addition, a hepatogastric trunk was noted by angiography, this was not recognized by sonography. In 2 patients with a hepatogastric trunk, this variant was sonographically seen after Levovist injection in both but with unenhanced sonography in only 1 patient. CONCLUSION: Most variants of the arterial hepatic blood supply can be diagnosed using conventional color-coded sonography. In some cases enhanced sonography provides additional information, but even with these techniques all variations cannot be detected.
Asunto(s)
Medios de Contraste/metabolismo , Arteria Hepática/diagnóstico por imagen , Polisacáridos/metabolismo , Adulto , Anciano , Angiografía , Efecto Doppler , Arteria Hepática/anatomía & histología , Humanos , Inyecciones , Hígado/irrigación sanguínea , Persona de Mediana Edad , Ultrasonografía/métodosRESUMEN
PURPOSE: To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist. MATERIALS AND METHODS: 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof. RESULTS: On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection. CONCLUSION: Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Hígado/diagnóstico por imagen , Hígado/patología , Ultrasonografía Doppler/métodos , Medios de Contraste , Diagnóstico Diferencial , Equinococosis Hepática/diagnóstico por imagen , Hígado Graso/diagnóstico por imagen , Humanos , Hiperplasia , Neoplasias Hepáticas/secundario , Polisacáridos , Cintigrafía , Radiofármacos , Reproducibilidad de los Resultados , Lidofenina de Tecnecio Tc 99mRESUMEN
Atrioventricular septal defects were repaired in 87 patients from 1981 to 1988. Interventricular communications were present in 73 patients, and major associated anomalies were present in 17 (tetralogy of Fallot in four, double-outlet right ventricle in two, multiple ventricular septal defects in 11). Five deaths occurred in the hospital (5.7%; 70% confidence limits, 3.2% to 9.7%). A preoperative New York Heart Association class V functional condition was the only incremental risk factor (p = 0.02) for death in the hospital. No patient (0%; 70% confidence limits, 0% to 2.15%) had complete heart block. Actuarial survival rate at 80 months was 81.4%. The only incremental risk factor (p = 0.005) leading to reoperation was a preoperative valve incompetence. Actuarial rate at 80 months for freedom from reoperation was 84.2% in the overall group of patients after repair of atrioventricular septal defect. We conclude that an improvement in survival and success rates should be found when a policy of earlier repair is followed.
Asunto(s)
Defectos de los Tabiques Cardíacos/cirugía , Análisis Actuarial , Factores de Edad , Niño , Preescolar , Femenino , Cardiopatías Congénitas/complicaciones , Defectos de los Tabiques Cardíacos/complicaciones , Defectos de los Tabiques Cardíacos/mortalidad , Humanos , Lactante , Masculino , Reoperación , Factores de Riesgo , Tasa de Supervivencia , Factores de TiempoRESUMEN
In 1982, an epidemic of acute trichinosis occurred in Bitburg with 402 cases. The acute stage was observed and documented in 193 patients. The first signs of the disease appeared on average 17 days after eating trichina-containing meat. Muscle pain was reported by 85% of patients, lid and/or facial edema by 83%, gastrointestinal complaints by 62%, fever by 60%, flu-like symptoms by 56%, headache by 26%, eye complaints by 19%. Eosinophils were present in the blood of 92%. Trichinella antibodies were demonstrated in 98% of patients examined for them. Interstitial myositis was found in 90% of muscle biopsies (from 162 patients). Serious complications--thrombosis, myocarditis, pneumonia, hepatitis or meningism--occurred in 26 (13.5%) of the 193 patients. Even six months after onset of the disease 43% of patients were still not free of symptoms.