[Trasjugularni intrahepatalni portosistemski šant (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).Izhodišča. Avtorji prikazujejo indikacije in kontraincikacije za transjugularni intrahepatalni portosistemski šant, 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, preprečevanje zapletov pred presaditvijo jeter in hepatorenalni sindrom. Absolutni kontraindikaciji sta huda okvara jeter in odpoved desnega srca, relativne pa so policistična degeneracija jeter, novotvorbe, zapora portalne vene in hujša lokalna ali sistemska okužba. Pred posegom določimo stopnjo okvare jeter, desnega srca in ledvic, naredimo biokemične in krvne preiskave s testi koagulacije ter določimo koncentracijo amoniaka v serumu in preverimo prehodnost portalne vene. Natančno je pisana izvedba posega, skrb za bolnika in njegovo spremljanje po posegu. Poseg je uspešen v 93-100%, smrtnost znotraj 30 dni zaradi transjugularnega intrahepatalnega portosistemskega šanta je 1-3%. Krvavitev ustavimo v 95-100%, ascites se izboljša v 87-92% in ledvično delovanje v 81%, pri hipersplenizmu se trombocitopenija izboljša pri 75% in levkopenija pri 50% bolnikov. Zapletov ob posegu je relativno malo, več jih jekasneje zaradi zožitev in zapor šanta. Po dveh letih je šant prehoden pri 50% bolnikov. V naši skupini 29 bolnikov, zdravljenih v obdobju štirih let, s povprečnim časom opazovanja 2 leti je še živih (75,9%) bolnikov, umrlo jih je 7 (24,1%). Šest umrlih bolnikov je imelo alkoholno cirozo jeter, pri dveh bolnikih pa vzrok smrti ni povezan s transjugularnim intrahepatalnim portosistemskim šantom oziroma cirozo jeter. Zaključki. TIPS je zlasti učinkovita metoda za ustavljanje svežih varikoznih krvavitev. (Izvleček prekinjen pri 2000 znakih)

Karotidna angioplastika s cerebralnom zaštitom

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 širokoj je uporabi pri liječenju karotidne stenoze visokog stupnja. Kirurški zahvat obavlja se u općoj anesteziji, a primjenjuje se samo pri oštećenjima na račvištu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaćaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srčane komplikacije. Rizik komplikacija povećan je u bolesnika s recidivirajućom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u području vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su liječnike da potraže alternativne načine liječenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za liječenje recidivirajućih stenoza nakon prethodne CEA te za liječenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opća anestezija, a u bolesnika s teškom 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 što se uvede u široku kliničku uporabu. U Sloveniji smo započeli s istraživanjem karotidne angioplastike u okviru projekta “Slovenian Carotid Angioplasty Study (SCAS)”. Prema našim 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 zaštitu tijekom postupka

Karotidna angioplastika s cerebralnom zaštitom

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 širokoj je uporabi pri liječenju karotidne stenoze visokog stupnja. Kirurški zahvat obavlja se u općoj anesteziji, a primjenjuje se samo pri oštećenjima na račvištu karotide ili u njegovoj neposrednoj blizini. Komplikacije koje se mogu pojaviti obuhvaćaju moždani udar, smrt, paralizu kranijskih živaca, hematom na mjestu rane i srčane komplikacije. Rizik komplikacija povećan je u bolesnika s recidivirajućom stenozom karotidne arterije nakon CEA, u bolesnika u kojih je primijenjena radioterapija u području vrata te u bolesnika s kardiopulmonalnom bolesti. Nedostatci CEA potaknuli su liječnike da potraže alternativne načine liječenja. Karotidna angioplastika uz postavljanje stenta (CAS) manje je invazivna metoda od CEA. Ona je poglavito prikladna za liječenje recidivirajućih stenoza nakon prethodne CEA te za liječenje stenoze distalnog dijela unutarnje karotidne arterije koja je nedostupna za CEA. CAS ne uzrokuje paralizu kranijskih živaca. Usto, nije nužna opća anestezija, a u bolesnika s teškom 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 što se uvede u široku kliničku uporabu. U Sloveniji smo započeli s istraživanjem karotidne angioplastike u okviru projekta “Slovenian Carotid Angioplasty Study (SCAS)”. Prema našim 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 zaštitu tijekom postupka

Očuvanje udova i preživljenje dijabetičnih 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 liječenja ishemije donjih udova u 63 bolesnika sa šećernom bolešću (27 žena i 36muškaraca, prosječne dobi 73,5 god.) izdvojenih iz skupine od 138 slučajno odabranih bolesnika me.u onima kojima je tijekom 1998. god. za vrijeme hospitalizacije na Odjelu vaskularne medicine Odjela za radiologiju Kliničkog centra u Ljubljani učinjena arteriografija donjih udova. Razlozi za arteriografiju donjih udova bili su: klaudikacija u 18 (29%), kronična kritična 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 uspješno provedena embolektomija, 24 bolesnika liječeno je endovaskularno, a 5 bolesnika liječeno je kirurški. Tridesetoro (47%) bolesnika liječeno je konzervativno, a u jednoga je učinjena 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 pogoršanja kronične opstrukcijske plućne bolesti sa zatajenjem respiracije. U svih su bolesnika u razdoblju preživljenja ili tijekom praćenja udovi bili očuvani, u 15 nakon postupka revaskularizacije, a u 18 uz konzervativno liječenje. U 9 (21%) bolesnika učinjena je amputacija (u 4 bolesnika ispod koljena, a u 5 iznad koljena). Jedna je amputacija bila primarna, 2 su uslijedile poslije endovaskularnog liječenja, a 6 poslije konzervativne terapije. Tijekom razdoblja praćenja umrlo je 13 (31%) bolesnika s kroničnom kritičnom ishemijom (5 zbog moždanog udara, 3 zbog akutnog infarkta miokarda, a 5 zbog nepoznatih uzroka). Naši rezultati potvrđuju da se ishemija donjih udova u bolesnika sa šećernom bolešću može liječiti razmjerno uspješno, no smrtnost je i dalje visoka, poglavito među bolesnicima s kroničnom kritičnom ishemijom

Intervencijska radiologija mokraćnog sustava, vrijednost perkutanog liječenja simptomatske ciste bubrega : doktorska disertacija

Sažetak disertacije "Intervencijska radiologija mokraćnog sustava, vrijednost perkutanog liječenja simptomatske ciste bubrega" nije dostupan

Intervencijska radiologija mokraćnog sustava, vrijednost perkutanog liječenja simptomatske ciste bubrega : doktorska disertacija

Sažetak disertacije "Intervencijska radiologija mokraćnog sustava, vrijednost perkutanog liječenja simptomatske ciste bubrega" nije dostupan