32 research outputs found
Pleurobiliary fistula, a rare complication of hepatocellular carcinoma after locoregional chemotherapy: a case report
A rare complication of the compilation of high intrahepatic biliary pressure and the formation of a subdiaphragmatic abscess is that of pleurobiliary fistula. We present a case of 67-year-old male who presented with pleurobiliary fistula following transarterial chemoembolization in a patient with a large hepatocellular carcinoma, as well as the course of the diagnostic procedures and the therapeutics interventions which took place
Revascularization approaches in patients with radiation-induced carotid stenosis: an updated systematic review and meta-analysis
Background: Ionizing radiation remains a well-known risk factor of carotid artery stenosis. The survival rates of head and neck cancer patients undergoing radiotherapy have risen owing to medical advancements in the field. As a consequence, the incidence of carotid artery stenosis in these high-risk patients has increased.Aims: In this study we sought to compare the outcomes of carotid endarterectomy (CEA) vs carotid artery stenting (CAS) for radiation-induced carotid artery stenosis.Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 2020. A random-effects model meta-analysis was conducted, and odds ratios (ORs) were calculated. The I-square statistic was used to assess for heterogeneity.Results: Seven studies and 201 patients were included. Periprocedural stroke, myocardial infarction (MI), and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR, 7.40; 95% CI, 1.58–34.59; I2 = 0%). Analysis revealed no significant difference in terms of long-term mortality (OR, 0.41; 95% CI, 0.14–1.16; I2 = 0%) and restenosis rates (OR, 0.69; 95% CI, 0.29–1.66; I2 = 0%) between CEA and CAS after a mean follow-up of 40.5 months.Conclusions: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results
Obstructive Jaundice in Polycystic Liver Disease Related to Coexisting Cholangiocarcinoma
Although jaundice rarely complicates polycystic liver disease (PLD), secondary benign or malignant causes cannot be excluded. In a 72-year-old female who presented with increased abdominal girth, dyspnea, weight loss and jaundice, ultrasound and computed tomography confirmed the diagnosis of PLD by demonstrating large liver cysts causing extrahepatic bile duct compression. Percutaneous cyst aspiration failed to relief jaundice due to distal bile duct cholangiocarcinoma, suspected by magnetic resonance cholangiopancreatography (MRCP) and confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Coexistence of PLD with distal common bile duct cholangiocarcinoma has not been reported so far
The relationship of hyperomocysteinaimia with development of carotid restenosis following carotid endacterectomy with venons path closure technique
Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope
Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results
Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy
The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL
Baroreflex sensitivity in obesity: Relationship with cardiac autonomic nervous system activity
Objective: The aim of this study was to test the hypothesis that
baroreflex sensitivity (BRS), assessed by indirect measurement of aortic
pressure, is blunted in obesity. Additionally, the potential effect of
cardiac autonomic nervous system (ANS) activity, aortic compliance, and
metabolic parameters on BRS of obese subjects was investigated.
Research Methods and Procedures: A group of 30 women with BMI > 30
kg/m(2) and a group of 30 controls with BMI < 25 kg/m(2) were examined.
BRS was estimated by the sequence technique, cardiac ANS activity by
short-term spectral analysis of heart rate variability (HRV), and aortic
compliance by the method of applanation tonometry.
Results: BRS was lower in obese women (9.18 +/- 3.77 vs. 19.63 +/- 9.16
ms/mm Hg, p < 0.001). The median values (interquartile range) of the
power of both the high-frequency and low-frequency components of the HRV
were higher in the lean than in the obese participants [1079.2 (202.7
to 1716.9) vs. 224.1 (72.7 to 539.6) msec(2), P = 0.001 and 4118 (199.3
to 798.0) vs. 235.8 (99.4 to 424.5) msec(2), p = 0.01 respectively].
Low-to-high-frequency ratio values were higher in the obese subjects
[0.82 (0.47 to 2.1) vs. 0.57 (0.28 to 0.89), p = 0.02]. Aortic
augmentation values were not significantly different between lean and
obese subjects. Multivariate analysis demonstrated a significant and
independent association between BRS and age (p = 0.003), BMI (p <
0.001), and high-frequency power of HRV (p < 0.001). These variables
explained 72% of the variation of BRS values.
Discussion: BRS is severely reduced in obese subjects. BMI, age, and the
parasympathetic nervous system activity are the main determinants of
BRS. Baroreflex behavior is of clinical relevance because an attenuated
BRS represents a negative prognostic factor in cardiovascular diseases,
which are common in obesity
Treatment of chronic venous disorder: A comprehensive review
Chronic venous disorder (CVD) is highly prevalent vascular disorder
affecting up to 45% of the general population, with clinical
manifestations ranging from teleangiectasias to venous leg ulcers
(VLUs). We examined the currently available data in order to provide an
updated, comprehensive review on treatment options of CVD. We searched
MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey
databases for relevant articles in English published until November
2020. Compression treatment is the mainstay of conservative treatment.
Pharmacological treatment can provide significant symptomatic relief and
hence it should be considered as part of conservative treatment.
Transcutaneous Lacer treatment (TCL) is a safe and effective alternative
option to sclerotherapy for treatment of C1 stage. High ligation and
stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS),
endovenous thermal ablation (EVTA) systems and non thermal non tumescent
ablation (NTNT) systems are safe and efficacious first-line options for
treatment of saphenous insufficiency. Interventional treatment of
co-existing incompetent perforator veins (IPVs) is not supported by
contemporary evidence. Regarding deep venous insufficiency (DVI),
treatment of symptomatic femoroiliocaval occlusive venous disease
refractory to conservative treatment with percutaneous transluminal
venoplasty stenting has produced encouraging results
Proximal Aortic Neck Progression: Before and After Abdominal Aortic Aneurysm Treatment
Several risk factors including short or highly angulated proximal aortic neck have been associated with long-term outcomes after endovascular or open abdominal aortic aneurysm (AAA) repair. However, research data have emerged recently concerning the behavior of proximal aortic neck, and several authors have tried to evaluate this behavior after endovascular or open repair. Additionally, computed tomography angiography (CTA) remains the golden standard for detecting and observing the morphology of an AAA, both before and after treatment. Moreover, the question of whether the proximal neck’s progression independently affects postoperative morbidity and reintervention risks still remains. Therefore, this focused review aims to present all relevant data on the behavior of an AAAs neck, based on CTA imaging before and after repair, in order to produce useful conclusions for future clinical practice