-Background -Transjugular liver biopsy is an alternative procedure for patients who present contraindications to standard percutaneous procedure. Aim -To compare the rate of histological diagnosis obtained on transjugular liver biopsy with an automated trucut needle and with a modified Ross needle. Patients/Methods -Eighty-five patients with suspicion of chronic liver diseases and presenting contraindications for percutaneous liver biopsy (coagulopathy, massive ascites, morbid obesity, or chronic renal problems) were submitted to 89 transjugular liver biopsies between March 1994 and April 2001 at "Hospital São José, Irmandade da Santa Casa de Misercórdia", Porto Alegre, RS, Brazil. Thirty-five patients underwent 36 biopsies with an automated trucut needle, and 50 patients underwent 53 biopsies with a modified Ross needle. Results -Histological diagnosis was reached in 32/35 subjects submitted to transjugular liver biopsy with the trucut needle (91%) and in 35/50 (70%) submitted to biopsy with the modified Ross needle. Specimens obtained with the trucut needle were significantly larger and less fragmented than those obtained with the Ross needle. Conclusion -Transjugular liver biopsy with the automated trucut needle allowed a higher rate of histological diagnosis when compared to the modified Ross needle in patients with suspicion of chronic liver diseases.
Transjugular liver biopsy is useful for the histopathologic diagnosis of patients with chronic liver diseases whenever the percutaneous route is contraindicated. In this series we obtained histopathologic diagnosis for 64.1% of the subjects studied. Patients suspected of having cirrhosis had a low yield of histopathologic diagnosis (50%) when compared to subjects without clinical evidence for cirrhosis (78.9%). The technique is rather complex, and can cause serious complications. This, it should be performed in reference centers in radiology and hepatology.
ResumoO tratamento endovascular da doença aneurismática da artéria renal tem sido, cada vez mais, aceito como uma alternativa à cirurgia convencional, especialmente em casos de aneurismas complexos intra-parenquimatosos ou que comprometam a bifurcação da artéria renal. Os autores relatam a experiência do tratamento endovascular de uma paciente com aneurisma sacular da bifurcação da artéria renal direita, associado à hipertensão renovascular de difícil controle. Foi realizada a cateterização seletiva da artéria renal, com a inserção de micromolas no saco aneurismático. O aneurisma foi completamente ocluído com preservação total do fluxo sanguíneo renal. A evolução clínica foi satisfatória com redução significativa das medicações anti-hipertensivas. A angio-tomografia de controle, após o oitavo mês do procedimento, confirmou o sucesso do tratamento. Palavras-chave:Embolização terapêutica, artéria renal, aneurisma. AbstractEndovascular treatment of renal artery aneurysmal disease has been increasingly accepted as an alternative to conventional surgery, especially in cases of renal artery bifurcation or complex intrarenal aneurysms. The authors report a case of endovascular treatment of a saccular aneurysm of the right renal artery bifurcation associated with poorly controlled renovascular hypertension. Selective catheterization of the renal artery was performed and microcoils were inserted into the aneurysmal sac. The aneurysm was completely obliterated with total preservation of renal blood flow. Clinical evolution was satisfactory with significant reduction in anti-hypertensive drugs. Control tomographic angiography, after eight months, confirmed treatment success.Keywords: Therapeutic embolization, renal artery, aneurysm. IntroduçãoO tratamento cirúrgico dos aneurismas de artéria renal é, geralmente, complexo. A conduta adotada com maior freqüência é a aneurismectomia combinada com a arterioplastia ou ponte aorto-renal. A aneurismectomia pode ser realizada com sucesso em mais de 95% dos casos de aneurismas extra-parenquimatosos, enquanto o tratamento de certos tipos de aneurismas intraparenquimatosos ou que comprometem a bifurcação da artéria renal pode levar à nefrectomia parcial ou total. Recentemente, o tratamento percutâneo tem sido empregado com maior freqüência para estes casos de aneurismas complexos, evitando complicações isquêmi-cas renais e nefrectomias 1,2 .Relatamos o caso de uma paciente em que foi realizado o tratamento endovascular por embolização com micromolas de um aneurisma sacular da bifurcação da artéria renal, com preservação completa do fluxo sanguíneo renal.
Transarterial chemoembolization is an effective therapy; however, AFP levels more than or equal to 100 ng/ml are associated with poorer prognosis.
We report a case of a patient with symptomatic benign superior vena cava syndrome treated by the endovascular technique. The angiographic resonance before angioplasty showed extensive thrombosis of the left brachiocephalic trunk, left subclavian vein and superior vena cava obstruction close to the right brachiocephalic trunk. The patient underwent radical mastectomy 2 years ago with adjuvant chemotherapy and chest radiotherapy. Venous angioplasty and balloonexpandable stenting were performed. Satisfactory result was obtained with immediate relief of symptoms due to recanalization of the right brachiocephalic trunk and superior vena cava. Oral anticoagulation was initiated. The patient is still asymptomatic after 8 months of follow-up. The endovascular treatment is a therapeutic alternative with low morbidity and satisfactory mid-term results that can be offered to patients with superior vena cava syndrome.Keywords: Angioplasty, vena cava, stenosis. ResumoRelatamos o caso de uma paciente portadora de síndrome da veia cava superior sintomática de origem benigna tratada pela técnica endovascular. A angiorressonância magnética pré-angioplastia evidenciou extensa trombose do tronco braquiocefálico esquerdo, da veia subclávia esquerda e obstrução da veia cava superior junto ao tronco braquiocefálico direito. A paciente realizou mastectomia radical 2 anos antes, associada à quimioterapia e radioterapia do tórax. Foram realizados angioplastia venosa e implante de stent expansível por balão. O resultado foi satisfatório, com alívio imediato dos sintomas devido à recanalização da veia cava superior e do tronco braquiocefálico direito. Foi instituída anticoagulação oral. A paciente permanece sem recidiva dos sintomas após 8 meses de acompanhamento. O tratamento endovascular é uma alternativa terapêutica com baixa morbidade e resultado satisfatório a médio prazo que pode ser oferecida aos pacientes portadores de síndrome da veia cava superior.Palavras-chave: Angioplastia, veia cava, estenose.
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