Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n=7), pancreatic adenocarcinoma (n=4), or another cancer (n=3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n=9), ascites (n=7), and/or thrombocytopenia (n=2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean±standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2mmHg±4.6 to 1.1mmHg±1.0 (P<0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean±SD follow-up of 134.4±123.3days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97±71.2days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7±153.5days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single sessio

Frailty degree and illness trajectories in older people towards the end-of-life:a prospective observational study

Objectives To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.Methods Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.Results Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p&lt;0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p&lt;0.01 for all the coefficients).Conclusions All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory

Valeur de l'IRM pelvienne pour le diagnostic d'oblitération du cul-de-sac de douglas dans les endométrioses pelviennes profondes

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Drainage biliaire precutané dans les tumeurs hilaires hépatiques bismuth II, III et IV (technique, faisabilité et résultats)

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Apport de l'opacification vaginale et rectale en IRM dans la détection des lésions d'endométriose pelvienne profonde

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Automatic Segmentation of Bladder and Prostate Using Coupled 3D Deformable Models

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Monitoring Slowly Evolving Tumors

International audienceno abstrac