13 research outputs found
[Trasjugularni intrahepatalni portosistemski Ŕant (TIPS)]
Background. A clear presentation of TIPS indications and contraindications, which can be divided into absolute and relative, is given. Absolute indications are fresh and renewed bleeding of varices and inveterate ascites. Relative indications, on the other hand, are splenomegaly with hypersplenism, Budd-Chiari syndrome, liver transplantation and hepatorenal syndrome. Absolutecontraindications are severe liver dysfunction and right heart failure, while the relative ones polycystic liver degeneration, neoplasm, obstruction of the portal vein and severe local and systemic infection. Beforethe TIPS procedure, the level of dysfunction of the liver, right heart and kidneys is determined. Biochemical and blood tests, including a blood coagulation test, are made, the ammonia level in the serum is determined and possible obstructions/strictures of the portal vein are checked. A detailed description of the procedure, a care for patient and a operative monitoring are given. The success rate of the procedure is between 93% and 100% and the mortality rate within 30 days because TIPS is between 1% and 3%. The hemorrhage is stopped in 95% to 100%, the ascites is improved in 87% to 92% and the kidney function in 81%. In case of hypersplenism the thrombocytopenia is improved in 75% and leucopenia in 50% of patients. There are relatively fewcomplications during the procedure. Postoperative complications are more frequent due to stricture and obstruction of the shunt. After a two-year treatment the shunt is passable in 50% of patients. Thus, in a group of 29 patients, who were treated in the period of four years with an average monitoring period of two years, 22 patients (75,9%) are still alive and only 7died (24,1%). Six of dead patients suffered from alcoholic cirrhosis of the liver. In two cases the cause of death was not related to the TIPS and the cirrhosis of the liver. (Abstract truncated at 2000 characters).IzhodiÅ”Äa. Avtorji prikazujejo indikacije in kontraincikacije za transjugularni intrahepatalni portosistemski Å”ant, ki jih delimo na absolutne in relativne. Absolutne indikacije so sveža in ponovna krvavitev iz varic požiralnika in trdovratni ascites. Relativne indikacije so splenomegalija s hipersplenizmom, Budd-Chariev sindrom, prepreÄevanje zapletov pred presaditvijo jeter in hepatorenalni sindrom. Absolutni kontraindikaciji sta huda okvara jeter in odpoved desnega srca, relativne pa so policistiÄna degeneracija jeter, novotvorbe, zapora portalne vene in hujÅ”a lokalna ali sistemska okužba. Pred posegom doloÄimo stopnjo okvare jeter, desnega srca in ledvic, naredimo biokemiÄne in krvne preiskave s testi koagulacije ter doloÄimo koncentracijo amoniaka v serumu in preverimo prehodnost portalne vene. NatanÄno je pisana izvedba posega, skrb za bolnika in njegovo spremljanje po posegu. Poseg je uspeÅ”en v 93-100%, smrtnost znotraj 30 dni zaradi transjugularnega intrahepatalnega portosistemskega Å”anta je 1-3%. Krvavitev ustavimo v 95-100%, ascites se izboljÅ”a v 87-92% in ledviÄno delovanje v 81%, pri hipersplenizmu se trombocitopenija izboljÅ”a pri 75% in levkopenija pri 50% bolnikov. Zapletov ob posegu je relativno malo, veÄ jih jekasneje zaradi zožitev in zapor Å”anta. Po dveh letih je Å”ant prehoden pri 50% bolnikov. V naÅ”i skupini 29 bolnikov, zdravljenih v obdobju Å”tirih let, s povpreÄnim Äasom opazovanja 2 leti je Å”e živih (75,9%) bolnikov, umrlo jih je 7 (24,1%). Å est umrlih bolnikov je imelo alkoholno cirozo jeter, pri dveh bolnikih pa vzrok smrti ni povezan s transjugularnim intrahepatalnim portosistemskim Å”antom oziroma cirozo jeter. ZakljuÄki. TIPS je zlasti uÄinkovita metoda za ustavljanje svežih varikoznih krvavitev. (IzvleÄek prekinjen pri 2000 znakih)
Karotidna angioplastika s cerebralnom zaŔtitom
Carotid endarterectomy (CEA) is widely used in the management of high grade carotid stenosis. It is a surgical procedure requiring general anesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It has complications, including stroke, death, cranial nerve palsies, wound hematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in the presence of cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anesthesia and carries a lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal embolization of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure and it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. In Slovenia, we have also started with carotid angioplasty by the study Slovenian Carotid Angioplasty Study (SCAS). According to our initial experience in 17 patients, CAS could gain more importance in stroke prevention with proper selection of patients with brain ischemia and improved cerebral protection during the procedure.Karotidna endarterektomija (CEA) u Å”irokoj je uporabi pri lijeÄenju karotidne stenoze visokog stupnja. KirurÅ”ki zahvat obavlja se u opÄoj anesteziji, a primjenjuje se samo pri oÅ”teÄenjima na raÄviÅ”tu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaÄaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srÄane komplikacije. Rizik komplikacija poveÄan je u bolesnika s recidivirajuÄom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u podruÄju vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su lijeÄnike da potraže alternativne naÄine lijeÄenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za lijeÄenje recidivirajuÄih stenoza nakon prethodne CEA te za lijeÄenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opÄa anestezija, a u bolesnika s teÅ”kom kardiopulmonalnom bolesti pobol i smrtnost su manji. U komplikacije CAS pripadaju moždani udar zbog distalne embolizacije plaka ili odvajanja tromba tijekom postupka, nagla okluzija krvne žile zbog tromboze, disekcija ili vazospazam te ponovna stenoza zbog hiperplazije intime. CAS je razmjerno nov postupak, pa je nužno utvrditi njegovu djelotvornost i sigurnost prije nego Å”to se uvede u Å”iroku kliniÄku uporabu. U Sloveniji smo zapoÄeli s istraživanjem karotidne angioplastike u okviru projekta āSlovenian Carotid Angioplasty Study (SCAS)ā. Prema naÅ”im prvim iskustvima u 17 bolesnika, CAS bi se mogao pokazati važnim u prevenciji moždanog udara, uz dobar odabir bolesnika s moždanom ishemijom i uz bolju cerebralnu zaÅ”titu tijekom postupka
Karotidna angioplastika s cerebralnom zaŔtitom
Carotid endarterectomy (CEA) is widely used in the management of high grade carotid stenosis. It is a surgical procedure requiring general anesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It has complications, including stroke, death, cranial nerve palsies, wound hematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in the presence of cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anesthesia and carries a lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal embolization of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure and it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. In Slovenia, we have also started with carotid angioplasty by the study Slovenian Carotid Angioplasty Study (SCAS). According to our initial experience in 17 patients, CAS could gain more importance in stroke prevention with proper selection of patients with brain ischemia and improved cerebral protection during the procedure.Karotidna endarterektomija (CEA) u Å”irokoj je uporabi pri lijeÄenju karotidne stenoze visokog stupnja. KirurÅ”ki zahvat obavlja se u opÄoj anesteziji, a primjenjuje se samo pri oÅ”teÄenjima na raÄviÅ”tu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaÄaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srÄane komplikacije. Rizik komplikacija poveÄan je u bolesnika s recidivirajuÄom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u podruÄju vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su lijeÄnike da potraže alternativne naÄine lijeÄenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za lijeÄenje recidivirajuÄih stenoza nakon prethodne CEA te za lijeÄenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opÄa anestezija, a u bolesnika s teÅ”kom kardiopulmonalnom bolesti pobol i smrtnost su manji. U komplikacije CAS pripadaju moždani udar zbog distalne embolizacije plaka ili odvajanja tromba tijekom postupka, nagla okluzija krvne žile zbog tromboze, disekcija ili vazospazam te ponovna stenoza zbog hiperplazije intime. CAS je razmjerno nov postupak, pa je nužno utvrditi njegovu djelotvornost i sigurnost prije nego Å”to se uvede u Å”iroku kliniÄku uporabu. U Sloveniji smo zapoÄeli s istraživanjem karotidne angioplastike u okviru projekta āSlovenian Carotid Angioplasty Study (SCAS)ā. Prema naÅ”im prvim iskustvima u 17 bolesnika, CAS bi se mogao pokazati važnim u prevenciji moždanog udara, uz dobar odabir bolesnika s moždanom ishemijom i uz bolju cerebralnu zaÅ”titu tijekom postupka
OÄuvanje udova i preživljenje dijabetiÄnih bolesnika s ishemijom donjih udova
We retrospectively analyzed the results of treatment of lower limb ischemia in 63 diabetic patients (27 female and 36 male, mean age 73.5 years) who were identified in a group of 138 randomly selected patients among those who had undergone lower limb arteriography during hospitalization at the Department of Vascular Medicine, Department of Radiology, Clinical Centre Ljubljana, in the year 1998. The reason for lower limb arteriography was claudication in 18 (29%), chronic critical ischemia in 42 (66%), and acute ischemia in three (5%) patients. After arteriography, the procedure of a revascularization was performed in 32 (51%) patients, among whom three patients with acute ischemia had successful embolectomy, 24 were treated endovascularly, and five patients surgically. Thirty (47%) patients were treated conservatively, and one patient with primary amputation. The patient status was reassessed after an average of 24 months, range 19 to 33 months. Among the 18 patients with claudication, two patients died, one from stroke and the other due to worsening of chronic obstructive pulmonary disease with respiratory failure, however, all patients retained their limb during the survival or follow-up, 15 after revascularization procedure and 18 with conservative treatment. Nine (21%) patients had amputation, four below and five above the knee. One amputation was primary, 2 amputations followed endovascular treatment, and 6 were performed after conservative treatment. During the follow-up period, 13 (31%) patients with chronic critical ischemia died, five from stroke, three from acute myocardial infarction, and five due to unknown causes. Our results have confirmed that lower limb ischemia can be treated relatively successfully in diabetic patients, but that mortality remains high, especially in patients with chronic critical ischemia.Retrospektivno smo analizirali rezultate lijeÄenja ishemije donjih udova u 63 bolesnika sa Å”eÄernom boleÅ”Äu (27 žena i 36muÅ”karaca, prosjeÄne dobi 73,5 god.) izdvojenih iz skupine od 138 sluÄajno odabranih bolesnika me.u onima kojima je tijekom 1998. god. za vrijeme hospitalizacije na Odjelu vaskularne medicine Odjela za radiologiju KliniÄkog centra u Ljubljani uÄinjena arteriografija donjih udova. Razlozi za arteriografiju donjih udova bili su: klaudikacija u 18 (29%), kroniÄna kritiÄna ishemija u 42 (66%) i akutna ishemija u 3 (5%) bolesnika. Poslije arteriografije, postupak revaskularizacije proveden je u 32 (51%) bolesnika, od kojih je u troje bolesnika s akutnom ishemijom uspjeÅ”no provedena embolektomija, 24 bolesnika lijeÄeno je endovaskularno, a 5 bolesnika lijeÄeno je kirurÅ”ki. Tridesetoro (47%) bolesnika lijeÄeno je konzervativno, a u jednoga je uÄinjena primarna amputacija. Status bolesnika ponovno je ocijenjen u prosjeku nakon 24 mjeseca (raspon 19-33 mjeseca). Od 18 bolesnika s klaudikacijom dvoje je umrlo, jedan zbog moždanog udara, a drugi zbog pogorÅ”anja kroniÄne opstrukcijske pluÄne bolesti sa zatajenjem respiracije. U svih su bolesnika u razdoblju preživljenja ili tijekom praÄenja udovi bili oÄuvani, u 15 nakon postupka revaskularizacije, a u 18 uz konzervativno lijeÄenje. U 9 (21%) bolesnika uÄinjena je amputacija (u 4 bolesnika ispod koljena, a u 5 iznad koljena). Jedna je amputacija bila primarna, 2 su uslijedile poslije endovaskularnog lijeÄenja, a 6 poslije konzervativne terapije. Tijekom razdoblja praÄenja umrlo je 13 (31%) bolesnika s kroniÄnom kritiÄnom ishemijom (5 zbog moždanog udara, 3 zbog akutnog infarkta miokarda, a 5 zbog nepoznatih uzroka). NaÅ”i rezultati potvrÄuju da se ishemija donjih udova u bolesnika sa Å”eÄernom boleÅ”Äu može lijeÄiti razmjerno uspjeÅ”no, no smrtnost je i dalje visoka, poglavito meÄu bolesnicima s kroniÄnom kritiÄnom ishemijom
Preoperative intraarterial chemotherapy with cisplatin for locally advanced high grade soft tissues sarcomas of the extremities
Intervencijska radiologija mokraÄnog sustava, vrijednost perkutanog lijeÄenja simptomatske ciste bubrega : doktorska disertacija
Sažetak disertacije "Intervencijska radiologija mokraÄnog sustava, vrijednost perkutanog lijeÄenja simptomatske ciste bubrega" nije dostupan
Intervencijska radiologija mokraÄnog sustava, vrijednost perkutanog lijeÄenja simptomatske ciste bubrega : doktorska disertacija
Sažetak disertacije "Intervencijska radiologija mokraÄnog sustava, vrijednost perkutanog lijeÄenja simptomatske ciste bubrega" nije dostupan