Embolisation of Posttraumatic Superior Mesenteric Artery Pseudoaneurysm in a Patient with Short Bowel Syndrome Preceding Bowel Transplantation

Penetrating abdominal trauma often causes bowel injuries which may lead to “short bowel syndrome” which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA) branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation

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.Kirurški napravljene fistule se koriste više od 50 godina za stvaranje pristupa za dijalizu kod pacijenata s kroničnim bubrežnim zatajenjem. Međutim, zbog problema kao što su dugotrajna maturacija te visok rizik tromboze ili stenose rezultati ostaju suboptimalni s učestalim reintervencijama i operacijama kako bi se održala prohodnost fistule. Kako bi se premostilo ove nedostatke od nedavno su stvorene endovaskularne metode za kreiranje fistula, što pacijentima na dijalizi daje dodatnu nekiruršku opciju, s dva različita trenutno dostupna sustava.Endovaskularno kreiranje A-V fistule je povezano s minimalnom traumom krvnih žila što može biti razlog za ohrabrujuće rane rezultate, koji pokazuju visoku stopu tehničke uspješnosti, nisku stopu reintervencija uz dobro prihvaćanje od strane pacijenata. U ovom radu opisujemo tehničke aspekte ovih zahvata, pravilan izbor pacijenata kao i rezultate istraživanja te trenutni status endovaskularnog zahvata stvaranja arteriovenske dijalizne fistule

Dissecting lesions of common carotid artery after carotid surgery: a case report

This case report represents rare complication of carotid surgery, iatrogenic dissection of the common carotid artery and its successful endovascular treatment. We herein report a case of 55 year-old female patient in whom carotid surgery was performed due to constant tinnitus caused by kinking of right internal carotid artery. On day 7th carotid control ultrasound was performed, according to hospital’s protocol. The carotid ultrasound showed dissecting lesion of right common carotid artery in a length of three centimeters that was confirmed with computed tomography angiography of neck vessels, and dual antithrombotic therapy was initiated. One month later percutaneous angioplasty was performed with stent implantation

COMPARISON OF PERCUTANEOUS MICROWAVE ABLATION GUIDED BY COMPUTER TOMOGRAPHY AND PARTIAL NEPHRECTOMY IN THE TREATMENT OF T1A STAGE OF RENAL CANCER

Svrha istraživanja: Zahvaljujući većoj dostupnosti radioloških metoda, raste incidencija malih karcinoma bubrega (KCB), što dovodi do sve veće potrebe za razvojem minimalno invazivne terapije uz očuvanje bubrežne funkcije. U pacijenata sa znatnim komorbiditetima, uz parcijalnu nefrektomiju (PN), koja je zlatni standard terapije, došlo je do primjene perkutanih ablativnih metoda. Mikrovalna ablacija (MVA) bubrega, unatoč dokazanim prednostima pred drugim ablativnim metodama, još uvijek nije uvrštena u terapijske smjernice te se smatra eksperimentalnom. Ciljevi istraživanja bili su usporediti stopu lokalnog recidiva, ukupno preživljenje, preživljenje bez metastaza i preživljenje specifi čno za karcinom nakon perkutanog visokoenergetskog MVA pod kontrolom kompjutorizirane tomografi je (CT) i PN-a u terapiji KCB-a stadija T1a. Postupci:U retrospektivnu studiju bilo je uključeno osamdeset pacijenata, kojima je u razdoblju od siječnja 2015. do lipnja 2018. dijagnosticiran i histološki potvrđen KCB stadija T1a. Svi su pacijenti odlukom uro-onkološkog konzilija Kliničkog bolničkog centra Sestre milosrdnice bili indicirani za perkutanu termalnu mikrovalnu ablaciju tumora bubrega ili otvoreni PN. Od pacijenata indiciranih za kiruršku resekciju izabralo se pacijente koji prema veličini tumora i kompleksnosti tumora prema klasifi kaciji mRENAL odgovaraju skupini pacijenata liječenih MVA-om, kako bi se ovim usklađivanjem metodom uparivanja po skoru sklonosti došlo do što kvalitetnijih spoznaja o onkološkim ishodima. U studiju su bili uključeni pacijenti koji su radiološki i klinički praćeni najmanje 12 mjeseci nakon zahvata. Zahvat MVA izvodio se u svih pacijenata perkutanim pristupom, pod kontrolom CT-a. Rezultati: Onkološki ishodi nisu dokazali postojanje statistički značajne razlike između ovih dviju terapijskih metoda. Ukupno preživljenje nakon jedne godine iznosilo je 100 % nakon MVA i PN-a. Jednogodišnje preživljenje bez lokalnog recidiva iznosilo je 92,5 % nakon MVA i 90 % nakon PN-a. Tri su pacijenta razvila lokalni recidiv na mjestu zahvata u skupini pacijenata liječenih MVA-om i pet pacijenata nakon PN-a. U sva tri slučaja MVA recidiv je bio tretiran dodatnim zahvatom MVA unutar dva do četiri tjedna s posljedičnom sekundarnom učinkovitošću MVA od 100 %. Unatoč nešto većem ukupnom broju pacijenata s lokalnim recidivom i metastazama KCB-a u skupini pacijenata liječenih PN-om, nije zabilježena statistički značajna razlika u onkološkom ishodu. Preživljenje bez metastaza nakon godinu dana iznosilo je 97,5 % nakon MVA i 95 % nakon PN-a. Iako se prosječne vrijednosti glomerulske fi ltracije nisu znatno razlikovale između skupina MVA i PN prije i nakon zahvata, kada se izračunao prosječni postotak gubitka bubrežne funkcije, iznosio je –8,9 ± 6 % za skupinu MVA i –21,7 ±8,2 % za skupinu PN, što predstavlja statistički značajnu razliku (P < 0,001). U skupini pacijenata liječenih ablacijom zabilježen je znatno manji procijenjeni operacijski gubitak krvi nego u skupini pacijenata koji su liječeni kirurškom resekcijom (54 ±19 mL vs 225,1 ±45,7 mL, P < 0,001). Zaključak: Perkutana terapija KCB-a metodom MVA može biti jednako vrijedna alternativa zlatnom standardu kirurškog PN-a u pacijenata sa znatnim komorbiditetima, ali i u ostalih s malim tumorima bubrega zbog dokazanih prednosti očuvanja bubrežne funkcije.Purpose: Better availability of radiologic imaging leads to an increase in the incidence of small renal cell carcinoma (RCC), which in turn gives rise to the need for developing minimally invasive and nephron sparing therapy. Along with partial nephrectomy (PN), as the gold standard therapy, percutaneous ablative methods have been introduced in patients with severe comorbidities. Despite its advantages when compared to other ablative methods, microwave ablation (MWA) has not been introduced into therapy guidelines and is still considered to be an experimental method. The aim of the study was to compare local recurrence rates, overall survival, metastasis-free survival and cancer specifi c survival after percutaneous computer tomography (CT) guided MWA and PN in the therapy of T1a stage of RCC. Methods: The retrospective study involved 80 patients, who were diagnosed and histologically confi rmed with T1a stage RCC from January 2015 to June 2018. All patients were candidates for MWA or open PN, depending on the decision of the multidisciplinary team at the University Hospital Center Sestre milosrdnice. Surgical patients were chosen, according to their tumour size and complexity, to match the patients treated with MWA in size and complexity of the tumour using propensity score matching. All included patients were under radiological and clinical follow-up for a period of at least 12 months. MWA procedures were performed via percutaneous approach under CT guidance. Results: Oncological outcomes did not show any statistically signifi cant difference between MWA and PN. Overall survival was 100% after one year in both groups. One-year recurrence-free survival was 92,5% after MWA and 90% after PN, with 3 patients showing evidence of local recurrence after MWA and 5 patients after PN. All patients with local recurrence were retreated with MWA after 2-4 weeks with a secondary-effi cacy of MWA being 100%. Despite a higher number of patients showing local recurrence or metastasis in the PN group, there was no signifi cant difference found in our study. Metastasis-free survival was 97,5% after MWA and 95% after PN. Even though average glomerular fi ltration rates were not signifi cantly different between the MWA and PN group before and after the procedure, the percentage decrease in the glomerular fi ltration rate was signifi cantly lower after MWA, -8.9 ± 6 % vs -21.7 ± 8.2 % (P<0,001). The ablation group was associated with signifi cantly lower estimated blood loss (54,0 ± 19,0 mL vs 225,1 ± 45,7 mL, P<0,001). Conclusion: It can be concluded that percutaneous MWA can be used as an equally successful therapeutic tool in small RCC, when compared to the golden standard of PN, in patients with severe comorbidities, but also in other patients due to its nephron sparing qualities

Učinkovitost zaštite dojke omatanjem prsišta u slikovnoj dijagnostici abdomena kompjutoriziranom tomografijom

The dose absorbed by sensitive breast glandular tissue in abdominal computed tomography examinations, even when the breasts are outside the primary imaging beam, is still significant. Several studies have explored using breast shielding with a protective lead sheet or a bra. Since the source of radiation in computed tomography rotates by 360° around the patient, we made a custom-tailored shielding device that wraps around the entire thorax. The hypothesis is that such a custom-tailored breast shielding device provides significantly better dose reduction. Study participants were female patients with no anatomic anomalies. Entrance surface doses were measured using thermoluminescence dosimeters placed on the skin of the breast in the control group without shielding and on the surface and below the shielding device in the group with anterior shielding and the group with the new device. As expected, according to literature data, doses measured at breast level were above the threshold that epidemiological studies determine as an increased risk of breast cancer development although they were not in the primary imaging plane. Preliminary results of our study showed that average dose reduction was 42% with conventional anterior shielding and 57% with wrapped shielding compared to the doses measured with no shielding.Doza koju apsorbira osjetljivo žljezdano tkivo dojke prilikom pregleda abdomena kompjutoriziranom tomografijom značajna je čak i kad su dojke izvan primarnog polja snimanja. Brojne studije istraživale su primjenu olovne plahte ili „grudnjaka“ za zaštitu dojki. S obzirom na to da se izvor zračenja prilikom kompjutorizirane tomografije rotira 360° oko bolesnika izradili smo vlastitu zaštitnu pregaču koja se omata oko cijelog opsega prsišta. Naša hipoteza je da tako skrojena pregača pruža značajno bolju zaštitu. U istraživanje su bile uključene bolesnice bez anatomskih anomalija. Ulazne doze na površini kože mjerene su putem termoluminiscentnih dozimetara koji su postavljeni na kožu dojke u kontrolnoj skupini bez zaštite, na površinu i ispod površine pregače u skupini s prednjom zaštitom i u skupini s novom pregačom. Prema očekivanjima i u skladu s literaturnim podacima, izmjerene doze na razini dojke su bile iznad granice koju epidemiološke studije označuju kao povišeni rizik za razvoj karcinoma dojke, iako su bile izvan primarnog snopa snimanja. Preliminarni rezultati naše studije pokazuju prosječno smanjenje doze uz konvencionalnu prednju zaštitu za 42% te uz obuhvatnu novu pregaču za 57% u usporedbi s dozama izmjerenima bez zaštite

COMPARISON OF PERCUTANEOUS MICROWAVE ABLATION GUIDED BY COMPUTER TOMOGRAPHY AND PARTIAL NEPHRECTOMY IN THE TREATMENT OF T1A STAGE OF RENAL CANCER

Svrha istraživanja: Zahvaljujući većoj dostupnosti radioloških metoda, raste incidencija malih karcinoma bubrega (KCB), što dovodi do sve veće potrebe za razvojem minimalno invazivne terapije uz očuvanje bubrežne funkcije. U pacijenata sa znatnim komorbiditetima, uz parcijalnu nefrektomiju (PN), koja je zlatni standard terapije, došlo je do primjene perkutanih ablativnih metoda. Mikrovalna ablacija (MVA) bubrega, unatoč dokazanim prednostima pred drugim ablativnim metodama, još uvijek nije uvrštena u terapijske smjernice te se smatra eksperimentalnom. Ciljevi istraživanja bili su usporediti stopu lokalnog recidiva, ukupno preživljenje, preživljenje bez metastaza i preživljenje specifi čno za karcinom nakon perkutanog visokoenergetskog MVA pod kontrolom kompjutorizirane tomografi je (CT) i PN-a u terapiji KCB-a stadija T1a. Postupci:U retrospektivnu studiju bilo je uključeno osamdeset pacijenata, kojima je u razdoblju od siječnja 2015. do lipnja 2018. dijagnosticiran i histološki potvrđen KCB stadija T1a. Svi su pacijenti odlukom uro-onkološkog konzilija Kliničkog bolničkog centra Sestre milosrdnice bili indicirani za perkutanu termalnu mikrovalnu ablaciju tumora bubrega ili otvoreni PN. Od pacijenata indiciranih za kiruršku resekciju izabralo se pacijente koji prema veličini tumora i kompleksnosti tumora prema klasifi kaciji mRENAL odgovaraju skupini pacijenata liječenih MVA-om, kako bi se ovim usklađivanjem metodom uparivanja po skoru sklonosti došlo do što kvalitetnijih spoznaja o onkološkim ishodima. U studiju su bili uključeni pacijenti koji su radiološki i klinički praćeni najmanje 12 mjeseci nakon zahvata. Zahvat MVA izvodio se u svih pacijenata perkutanim pristupom, pod kontrolom CT-a. Rezultati: Onkološki ishodi nisu dokazali postojanje statistički značajne razlike između ovih dviju terapijskih metoda. Ukupno preživljenje nakon jedne godine iznosilo je 100 % nakon MVA i PN-a. Jednogodišnje preživljenje bez lokalnog recidiva iznosilo je 92,5 % nakon MVA i 90 % nakon PN-a. Tri su pacijenta razvila lokalni recidiv na mjestu zahvata u skupini pacijenata liječenih MVA-om i pet pacijenata nakon PN-a. U sva tri slučaja MVA recidiv je bio tretiran dodatnim zahvatom MVA unutar dva do četiri tjedna s posljedičnom sekundarnom učinkovitošću MVA od 100 %. Unatoč nešto većem ukupnom broju pacijenata s lokalnim recidivom i metastazama KCB-a u skupini pacijenata liječenih PN-om, nije zabilježena statistički značajna razlika u onkološkom ishodu. Preživljenje bez metastaza nakon godinu dana iznosilo je 97,5 % nakon MVA i 95 % nakon PN-a. Iako se prosječne vrijednosti glomerulske fi ltracije nisu znatno razlikovale između skupina MVA i PN prije i nakon zahvata, kada se izračunao prosječni postotak gubitka bubrežne funkcije, iznosio je –8,9 ± 6 % za skupinu MVA i –21,7 ±8,2 % za skupinu PN, što predstavlja statistički značajnu razliku (P < 0,001). U skupini pacijenata liječenih ablacijom zabilježen je znatno manji procijenjeni operacijski gubitak krvi nego u skupini pacijenata koji su liječeni kirurškom resekcijom (54 ±19 mL vs 225,1 ±45,7 mL, P < 0,001). Zaključak: Perkutana terapija KCB-a metodom MVA može biti jednako vrijedna alternativa zlatnom standardu kirurškog PN-a u pacijenata sa znatnim komorbiditetima, ali i u ostalih s malim tumorima bubrega zbog dokazanih prednosti očuvanja bubrežne funkcije.Purpose: Better availability of radiologic imaging leads to an increase in the incidence of small renal cell carcinoma (RCC), which in turn gives rise to the need for developing minimally invasive and nephron sparing therapy. Along with partial nephrectomy (PN), as the gold standard therapy, percutaneous ablative methods have been introduced in patients with severe comorbidities. Despite its advantages when compared to other ablative methods, microwave ablation (MWA) has not been introduced into therapy guidelines and is still considered to be an experimental method. The aim of the study was to compare local recurrence rates, overall survival, metastasis-free survival and cancer specifi c survival after percutaneous computer tomography (CT) guided MWA and PN in the therapy of T1a stage of RCC. Methods: The retrospective study involved 80 patients, who were diagnosed and histologically confi rmed with T1a stage RCC from January 2015 to June 2018. All patients were candidates for MWA or open PN, depending on the decision of the multidisciplinary team at the University Hospital Center Sestre milosrdnice. Surgical patients were chosen, according to their tumour size and complexity, to match the patients treated with MWA in size and complexity of the tumour using propensity score matching. All included patients were under radiological and clinical follow-up for a period of at least 12 months. MWA procedures were performed via percutaneous approach under CT guidance. Results: Oncological outcomes did not show any statistically signifi cant difference between MWA and PN. Overall survival was 100% after one year in both groups. One-year recurrence-free survival was 92,5% after MWA and 90% after PN, with 3 patients showing evidence of local recurrence after MWA and 5 patients after PN. All patients with local recurrence were retreated with MWA after 2-4 weeks with a secondary-effi cacy of MWA being 100%. Despite a higher number of patients showing local recurrence or metastasis in the PN group, there was no signifi cant difference found in our study. Metastasis-free survival was 97,5% after MWA and 95% after PN. Even though average glomerular fi ltration rates were not signifi cantly different between the MWA and PN group before and after the procedure, the percentage decrease in the glomerular fi ltration rate was signifi cantly lower after MWA, -8.9 ± 6 % vs -21.7 ± 8.2 % (P<0,001). The ablation group was associated with signifi cantly lower estimated blood loss (54,0 ± 19,0 mL vs 225,1 ± 45,7 mL, P<0,001). Conclusion: It can be concluded that percutaneous MWA can be used as an equally successful therapeutic tool in small RCC, when compared to the golden standard of PN, in patients with severe comorbidities, but also in other patients due to its nephron sparing qualities

ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY

Svrha: Procijeniti primarni (tehnički) uspjeh i sigurnost procedure perkutane skleroterapije jednostavnih cista bubrega vođene ultrazvučno 96%-tnim etanolom. Bolesnici: 17 bolesnika sa simptomatskim jednostavnim cistama bubrega upućenih od nefrologa ili urologa. Metode: Perkutana punkcija ciste vođena UZ-om s 18 G (gauge) iglom i »pigtail« kateterom debljine 5 F (French), drenaža i inspekcija sadržaja ciste te instilacija etanola. Rezultati: Kod 2 upućena bolesnika punkcija nije učinjena zbog ciste Bosniak II i blizine hilusa bubrega. U 15 bolesnika učinjene su punkcija i drenaža sadržaja ciste. U 4 bolesnika etanol nije instiliran zbog gustog ili krvavog sadržaja ciste, blizine hilusa bubrega i jake boli pri pokušaju instilacije etanola. U 11 bolesnika uspješno je učinjena sklerozacija ciste. Prosječna veličina sklerozirane ciste bila je 8 cm (raspon 6 – 12 cm). Nije bilo znatnijih komplikacija. Zaključak: Perkutana sklerozacija jednostavnih cista bubrega vođena UZ-om lako je izvediva i za bolesnika sigurna metoda, uz prethodnu dobru selekciju cista pogodnih za sklerozaciju.Objective: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percu­taneous sclerotherapy of simple renal cysts, using 96% ethanol. Patients: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. Methods: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a »pigtail« 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. Results: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6–12 cm). There were no significant complications. Conclusion: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy

DENERVACIJA BUBREŽNIH ARTERIJA I REZISTENTNA HIPERTENZIJA

Renal sympathetic denervation (RDN) with radiofrequency (RF) is being used to treat resistant hypertension in seven non-responder patients (62±6 years for age, 5F/2M) despite treatment with >4 different antihypertensive drugs in optimal doses. Prior to diagnosing a patient as having resistant hypertension, we document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure and secondary causes. Office blood pressure (BP) measurements at 1, 3, 6, 12 and 18 months follow-up visits were compared to baseline. We used STATISTICA 10, 2011 software (Stat Soft Inc., Tulsa, OK, USA). Values are mean SD and considered statistically significant if P <0.001. At baseline, values were 184±21 and 106±26 mmHg for systolic (SBP) and diastolic (DBP), 6.7±1 for number of antihypertensive drug classes. One, 3, 6, 12 and 18 months after RDN, office SBP values were significantly lower (144±13 mmHg, 140±17, 141±15, 139±12 and 135±11 mmHg; P <0.001), with no significant reduction in DBP values at 1, 3, 6, 12 and 18 months after RDN (81±6, 82±9, 79±9, 78±6, and 76±7 mmHg). The number of antihypertensive drug classes before and 6, 12, 18 months after RDN were evaluated. Six months after RDN the number of antihypertensive drug classes required was 6.5±1, after 12 and 18 months was 5.5±1 and 4.5±1. During RDA no complications occurred (the pain during the procedure was well tolerated) and the renal function remained stabile. Renal sympathetic denervation is being a concomitant treatment of drug-resistant hypertension (rHT). The sustained reduction of SBP was observed after the RDN. Patients have benefit the most from procedure after 6-12 months. Further meta-analysis will evaluate the importance of new devices for less pain treatment of RDN.Denervacija bubrežnih arterija (DBA) radiofrekvencijom jedna je od obećavajućih novih metoda liječenja rezistentne hipertenzije refraktorne (RH) na optimalno liječenje kombiniranom antihipertenzivnom terapijom koja uključuje 3 i više lijekova iz različitih antihipertenzivnih skupina od kojih jedan mora biti diuretik. Nakon isključenja sekundarnih uzroka, neadekvatnog mjerenja tlaka te nesuradljivosti prikazujemo učinak DBA u 7 bolesnika (62±6 years for age, 5F/2M) tijekom razdoblja od 18 mjeseci praćenja. Za statističku analizu korišten je program STATISTICA 10, 2011 softwer (Stat Soft Inc., Tulsa, OK, USA), uz razinu značajnosti P <0,001. Bolesnici su praćeni na redovitim ambulantnim kontrolama 1, 3, 6, 12 i 18 mjeseci nakon DBA uz mjerenje krvnog tlaka i praćenje laboratorijskih parametara. Od početnih izmjerenih vrijednosti tlaka u ambulanti 184±21 za sistolički i 106±26 mm Hg za dijastolički tlak, uz prosječni broj antihipertenzivnih lijekova od 6,7±1 nakon DBA 1, 3, 6, 12 i 18 mjeseci prati se značajno smanjenje sistoličkih vrijednosti tlaka (144±13, 140±17, 141±15, 139±12, 135±11 mm Hg; P <0,001), bez značajnog smanjenja dijastoličkih vrijednosti (81±6, 82±9, 79±9, 78±6, 76±7 mmHg). Nakon 6 mjeseci prosječan broj antihipertenzivnih lijekova ostao je nepromijenjen (važno da se objektivizira učinak DBA) i iznosio je 6.5±1, dok je nakon 12 i 18 mjeseci došlo do smanjenja broja antihipertenzivnih lijekova (5.5±1 i 4.5±1). Tijekom DBA bolest je bila podnošljiva, nije zabilježeno neposrednih ni kasnijih komplikacija DBA, bubrežna funkcija je bila stabilna tijekom praćenja. Dokazana je dugoročna sigurnost DBA i učinkovitost na smanjenje sistoličkog krvnog tlaka u bolesnika s refraktornom RH

ULTRASOUND GUIDED PERCUTANEOUS SCLEROTHERAPY OF SIMPLE RENAL CYSTS: PRIMARY SUCCESS AND PROCEDURE SAFETY

Svrha: Procijeniti primarni (tehnički) uspjeh i sigurnost procedure perkutane skleroterapije jednostavnih cista bubrega vođene ultrazvučno 96%-tnim etanolom. Bolesnici: 17 bolesnika sa simptomatskim jednostavnim cistama bubrega upućenih od nefrologa ili urologa. Metode: Perkutana punkcija ciste vođena UZ-om s 18 G (gauge) iglom i »pigtail« kateterom debljine 5 F (French), drenaža i inspekcija sadržaja ciste te instilacija etanola. Rezultati: Kod 2 upućena bolesnika punkcija nije učinjena zbog ciste Bosniak II i blizine hilusa bubrega. U 15 bolesnika učinjene su punkcija i drenaža sadržaja ciste. U 4 bolesnika etanol nije instiliran zbog gustog ili krvavog sadržaja ciste, blizine hilusa bubrega i jake boli pri pokušaju instilacije etanola. U 11 bolesnika uspješno je učinjena sklerozacija ciste. Prosječna veličina sklerozirane ciste bila je 8 cm (raspon 6 – 12 cm). Nije bilo znatnijih komplikacija. Zaključak: Perkutana sklerozacija jednostavnih cista bubrega vođena UZ-om lako je izvediva i za bolesnika sigurna metoda, uz prethodnu dobru selekciju cista pogodnih za sklerozaciju.Objective: To evaluate primary (technical) success and procedure safety in ultrasound (US)-guided percu­taneous sclerotherapy of simple renal cysts, using 96% ethanol. Patients: 17 patients with symptomatic simple renal cysts referred by nephrologists or urologists. Methods: US-guided percutaneous puncture of the cyst with an 18G (gauge) needle and a »pigtail« 5F (French) catheter, drainage and inspection of the cyst content, and injection of ethanol. Results: Puncture was rejected in two referred patients because of Bosniak II cyst and renal hilum proximity. 15 patients underwent puncture and drainage of the cyst content. In 4 patients ethanol was not injected because: thick or bloody cyst, proximity of renal hilum and severe pain during injection of ethanol. 11 patients underwent sclerotherapy of the cyst. The average size of sclerosed cyst was 8 cm (range 6–12 cm). There were no significant complications. Conclusion: US-guided percutaneous sclerotherapy of simple renal cysts is easy to perform and safe procedure, with the previous good selection of cysts that are suitable for the sclerotherapy