77 research outputs found
Endovaskularno kreiranje dijalizne arteriovenske fistule
Surgical fistulas have been used to create dialysis access for over 50 years in chronic
kidney disease patients. However, due to problems like slow maturation and a high risk of thrombosis
or stenosis, results remain sub-optimal with high intervention and surgery rates to maintain
patency.
Endovascular methods for fistula creation were invented recently to resolve these issues, allowing
haemodialysis patients to have an alternative non-surgical option, with two different devices currently
available. Endovascular creation of A-V fistulas is involved with minimal vessel trauma, which could
be the reason for encouraging initial results demonstrating high technical success rates, low intervention
rates, and good patient satisfaction. This article describes the technical aspects of these procedures,
patient selection as well as trial results, and the status of endovascular arteriovenous fistula
creation.KirurÅ”ki napravljene fistule se koriste viÅ”e od 50 godina za stvaranje pristupa za dijalizu kod pacijenata s kroniÄnim
bubrežnim
zatajenjem. MeÄutim, zbog problema kao Å”to su dugotrajna maturacija te visok rizik tromboze ili stenose rezultati
ostaju suboptimalni s uÄestalim reintervencijama i operacijama kako bi se održala prohodnost fistule. Kako bi se premostilo
ove nedostatke od nedavno su stvorene endovaskularne metode za kreiranje fistula, Ŕto pacijentima na dijalizi daje
dodatnu
nekirurÅ”ku opciju, s dva razliÄita trenutno dostupna sustava.Endovaskularno kreiranje A-V fistule je povezano s
minimalnom traumom krvnih žila Å”to može biti razlog za ohrabrujuÄe rane rezultate, koji pokazuju visoku stopu tehniÄke
uspjeÅ”nosti, nisku stopu reintervencija uz dobro prihvaÄanje od strane pacijenata.
U ovom radu opisujemo tehniÄke aspekte ovih zahvata, pravilan izbor pacijenata kao i rezultate istraživanja te trenutni
status endovaskularnog zahvata stvaranja arteriovenske dijalizne fistule
PoÄetna iskustva u usporedbi CT-voÄene radiofrekventne i mikrovalne ablacije u terapiji karcinoma bubrega
Percutaneous ablative techniques under imaging guidance have become a frequently used treatment method in the therapy of primary T1a or secondary renal tumours, especially in patients who were burdened with comorbidities and are not surgical candidates. Radiofrequency ablation with single or multiple electrodes has been the primary ablative technique used and the mainstay of percutaneous therapy for a long time but with the evolution of technologies, microwave ablation and cryoablation have emerged as possibly more effective methods of treatment. After the initial experience with CT-guided radiofrequency ablation for renal carcinoma treatment in 6 patients, we started using microwave ablation with the following 6 patients. Our results showed microwave ablation to have bett er results in achieving complete tumour ablation, while requiring shorter hospitalization time and better patient satisfaction. There have not been any major complications, while minor complications were more frequent with microwave ablation. Due to shorter procedure time patients treated with microwave ablation, we no longer used general anaesthesia but only local anaesthetic with conscious sedation.Perkutane ablativne tehnike pod kontrolom slikovnih metoda su postale Äesto koriÅ”tena metoda u terapiji primarnih tumora bubrega T1a stadija ili sekundarnih bubrežnih tumora, ponajprije kod pacijenata koji zbog komorbiditeta nisu primarno kirurÅ”ki kandidati. Radiofrekventna ablacija s jednom ili viÅ”e elektroda je bila prva koriÅ”tena ablativna metoda i dugo vremena glavna okosnica perkutane terapije, no s razvojem novih tehnologija, mikrovalna ablacija i krioablacija su se pojavile kao potencijalno uÄinkovitije opcije lijeÄenja. Nakon poÄetnih iskustava s CT-voÄenom radiofrekventnom ablacijom karcinoma bubrega kod Å”est pacijenata, zapoÄeli smo koristiti mikrovalnu ablaciju kod iduÄih Å”est pacijenata. NaÅ”i rezultati su pokazali da s mikrovalnom ablacijom postižemo bolje rezultate u smislu potpune ablacije tumora uz kraÄe potrebno vrijeme hospitalizacije i veÄu razinu zadovoljstva pacijenata nakon zahvata. Nisu zabilježene veÄe komplikacije, dok su manje komplikacije bile uÄestalije nakon mikrovalne ablacije. Pacijenti tretirani mikrovalnom ablacijom nisu zahtijevali opÄu anesteziju zbog kraÄeg vremena ablacije
Uloga perkutane slikovno voÄene ablacije malignih tumora jetre: svjetski trendovi i hrvatska perspektiva
Percutaneous minimally invasive methods are gaining space in oncologic treatment algorithms. Interventional radiology has a leading role in the last twenty years in developing percutaneous curative therapy for tumors of the parenchymal organs of the abdomen due to the precision of image-guided procedures. Ablative technology uses thermal energy for tumor tissue destruction. Compared to radiofrequency technology, microwave technology shows advantages in size of the liver tumors that can be ablated and the length of the procedure. Compared to surgery, both ablative techniques, enable shorter postprocedural time to chemotherapy, hospital stay and recovery time, reduced complication rate, and easier secondary ablation in case of new or residual tumors. Comparative advantages make these minimally invasive procedures,
often the first choice in the treatment of hepatocellular carcinoma and liver metastases. Even though image-guided ablation is accepted in most European countries as a valid alternative to surgery in patients with unresectable hepatic tumors, currently, there is no algorithm for the use of this minimally invasive therapy in Croatia. Lack of clinical validation of thermal ablation in Croatia is mostly due to a limited number of the interventional radiologist with such focus along with limited patient referrals despite the published data about the potential advantages, efficacy, and safety of this technology.Perkutane minimalno invazivne metode u dobivaju sve veÄu ulogu u algoritmu lijeÄenja onkoloÅ”kih pacijenata. Intervencijska radiologija kontinuirano razvija perkutane kurativne terapije parenhimskih organa abdomena zadnjih 20 godina, prije svega zbog napretka u preciznosti terapije voÄene slikovnim metodama. Ablativna tehnologija koristi toplinsku energiju za destrukciju tumora. U usporedbi s radiofrekventnom tehnologijom, mikrovalna tehnologija je indicrana i za veÄe tumore jetre uz kraÄe vrijeme zahvata. U usporedbi s kirurÅ”kim zahvatima, ablativne tehnike omoguÄavaju kraÄe vrijeme hospitalizacije i oporavka, manju stopu komplikacija i moguÄnost lakÅ”eg ponavljanja zahvata u sluÄaju recidiva kao i brži nastavak lijeÄenja drugim modalitetima primjerice kemoterapijom. Stoga su ove minimalno invazivne procedure sve ÄeÅ”Äe metoda izbora u lijeÄenju hepatocelularnog karcinoma i jetrenih metastaza. Iako je perkutana slikovno voÄena ablacija prihvaÄena u veÄini europskih zemalja kao vrijedna alternativa kirurgiji za lijeÄenje pacijenata s resektabilnim tumorom jetre, trenutno u Hrvatskoj ne postoji prihvaÄeni algoritam za koriÅ”tenje ove minimalno invazivne terapije. Slabo kliniÄko vrednovanje
termalne ablacije u Hrvatskoj je ponajprije posljedica postupnog poveÄanja broja intervencijskih radiologa u tom polju i relativno slabog upuÄivanja pacijenata unatoÄ dostupnosti publiciranih podataka o prednostima, uÄinkovitosti i sigurnosti ove tehnologije
Korelacija arterijskih kalcifikacija dojke na mamogramu s Äimbenicima rizika povezanim s naÄinom žiovta
The aim of the study was to investigate the association between some lifestyle-attributable risk factors of atherosclerosis, such as body mass index (BMI), oral contraceptives, hormone replacement therapy, smoking and alcohol consumption with breast arterial calcification (BAC) and its intensity on mammograms, and to assess the impact of these lifestyle risk factors on mammography findings of BAC. This prospective study included 300 women aged 47-69, i.e. a group of 149 women with BAC on mammograms and control group of 151 women without BAC. Self-reported BMI, use of oral contraceptives, hormone replacement therapy, smoking and alcohol consumption were recorded by medical interview. The presence of BAC and its intensity on mammography was compared according to the presence of high BMI and use of hormone therapy, smoking and alcohol consumption. The results showed the highest proportion of smokers (28.9%) in the group with mild BAC as compared with the groups without calcification (14.6%) and with intense calcification (12.1%). Women taking oral contraceptives had a higher level of calcified breast arteries but no significant between-group difference was found for high BMI, hormone therapy and alcohol consumption. Thus, study results showed the mammographic finding of BAC to be inadequate to identify women with some lifestyle-attributable risk factors such as BMI, hormone replacement therapy, smoking and alcohol consumption.Istraživala se povezanost odreÄenih Äimbenika rizika ateroskleroze povezanih s naÄinom života poput indeksa tjelesne mase (ITM), uzimanja oralnih kontraceptiva, hormonske nadomjesne terapije, puÅ”enja i konzumiranja alkohola s arterijskim kalcifikacijama dojke i njihovim stupnjem intenziteta na mamografiji. Ova prospektivna studija je ukljuÄila 300 žena u dobi od 47 do 69 godina, od kojih je skupina od 149 žena imala arterijske kalcifikacije dojki na mamografiji, a druga kontrolna skupina od 151 žene je bila bez arterijskih kalcifikacija. Medicinskim intervjuom dobiveni su podaci o tjelesnoj težini i visini ispitanica, prema kojima se izraÄunao ITM te anamnestiÄki podaci o prethodnoj uporabi oralnih kontraceptiva, hormonske nadomjesne terapije, puÅ”enju i konzumiranju alkohola. UsporeÄen je nalaz arterijskih kalcifikacija dojki i njihovog stupnja na mamografiji s ITM-om i uporabom hormonske terapije te puÅ”enjem i konzumiranjem alkohola. U skupini žena s blažim kalcifikacijama dojki bio je najveÄi udio puÅ”aÄa (28,9%) u odnosu na skupinu bez kalcifikacija (14,6%) ili skupinu s intenzivnim kalcifikacijama (12,1%). Rezultati su pokazali statistiÄki znaÄajnu povezanost arterijskih kalcifikacija dojki s oralnom kontracepcijom, dok nije naÄena statistiÄki znaÄajna povezanost izmeÄu arterijskih kalcifikacija dojki na mamogramu i uporabe hormonske nadomjesne terapije, ITM-a, puÅ”enja i konzumiranja alkohola. Dakle, mamografski nalaz arterijskih kalcifikacija dojki nije dostatan za identificiranje žena s nekim Äimbenicima rizika ateroskleroze povezanim s naÄinom života, odnosno nalaz istih na mamogramu ne upuÄuje na Äimbenike rizika na koje se može utjecati, kao Å”to su visok ITM, uporaba hormonske terapije, puÅ”enje i konzumiranje alkohola
Severova bolest komplicirana osteomijelitisom
Severās disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Severās disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Severās disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patientās condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Severās disease. MRI should be done in all atypical cases of Severās disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najÄeÅ”Äe u mladih sportaÅ”a, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostiÄka obrada ukljuÄuje rendgenske snimke i ultrazvuÄni pregled. Bolest se lijeÄi konzervativno, buduÄi da prolazi sama od sebe. Prikazali smo devetogodiÅ”njaka sa Severovom bolesti kod kojega standardna terapija nije poluÄila kliniÄki uÄinak. UÄinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo uÄiniti u svim atipiÄnim sluÄajevima Severove bolesti kako bi se iskljuÄila druga patoloÅ”ka stanja ukljuÄujuÄi osteomijelitis
Severova bolest komplicirana osteomijelitisom
Severās disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Severās disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Severās disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patientās condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Severās disease. MRI should be done in all atypical cases of Severās disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najÄeÅ”Äe u mladih sportaÅ”a, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostiÄka obrada ukljuÄuje rendgenske snimke i ultrazvuÄni pregled. Bolest se lijeÄi konzervativno, buduÄi da prolazi sama od sebe. Prikazali smo devetogodiÅ”njaka sa Severovom bolesti kod kojega standardna terapija nije poluÄila kliniÄki uÄinak. UÄinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo uÄiniti u svim atipiÄnim sluÄajevima Severove bolesti kako bi se iskljuÄila druga patoloÅ”ka stanja ukljuÄujuÄi osteomijelitis
Embolizacija prostate ā nova terapijska moguÄnost lijeÄenja simptoma donjeg urinarnog trakta kod muÅ”karaca s benignom hiperplazijom prostate
Prostatic artery embolization is a minimally invasive endovascular treatment that improves lower urinary tract symptoms in men with benign prostatic hyperplasia. Although further randomized studies and long-term evidence is still needed for this method to be fully incorporated into treatment guidelines for benign prostatic hyperplasia, current studies show that this method can be an effective and safe alternative in patients with a significantly enlarged prostate gland who are not good surgical candidates. Therefore, we present the theory, technical details and potential benefits of this method as we review the current evidence on prostatic artery embolization.Embolizacija prostate je minimalno invazivna endovaskularna metoda lijeÄenja koja se koristi za lijeÄenja simptoma donjeg urinarnog trakta kod muÅ”karaca s benignom hiperplazijom prostate. Iako su potrebne dodatne randomizirane studije s dugoroÄnim praÄenjem i rezultatima kako bi ova metoda bila ukljuÄena u smjernice lijeÄenja benigne hiperplazije prostate, dosadaÅ”nje studije ukazuju da ova metoda može predstavljati uÄinkovitu i sigurnu alternativu kod pacijenata s uveÄanom prostatom koji nisu dobri kirurÅ”ki kandidati. Stoga prikazujemo teoriju, tehniÄke detalje i moguÄe prednosti ovog zahvata kroz analizu dosadaÅ”njih studija o embolizaciji prostate
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