Percutaneous drainage of a mediastinal pancreatic pseudocyst: a paraspinal, extrapleural CT-guided approach.
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Adult↗
Biomedical subjects
R Uflacker
Publications and source records attributed to R Uflacker.
Mechanical thrombectomy in acute and subacute thrombosis with use of the Amplatz device: arterial and venous applications.
PURPOSE: To perform a feasibility study of the Amplatz Thrombectomy Device (ATD) in a variety of vascular territories with acute or subacute thrombosis. MATERIALS AND METHODS: Thirteen patients (mean age, 44.6 years) with multiple risk factors who had acute/subacute thrombosis of the inferior vena cava (IVC) and iliac veins (n = 3), superior vena cava (SVC) and/or subclavian veins (n = 3), lower extremity polytetrafluoroethylene (PTFE) graft (n = 2), iliac artery (n = 2), portal vein and transjugular intrahepatic portosystemic shunt (TIPS) (n = 2), and an IVC to pulmonary artery Fontan conduit (n = 1), were treated by means of mechanical thrombectomy with use of the ATD. Thrombolysis failed to recanalize the vessels when used before thrombectomy for 12-34 hours in three patients, and was contraindicated in three other patients. Thrombolysis was used as a complement to the ATD procedure in five patients. RESULTS: Technical success was achieved in 11 patients, and procedure success was achieved in 10 patients. Failure was observed in the remaining three patients. One patient with a PTFE graft was successfully declotted but thrombosis occurred 2 weeks later, requiring surgery. The other patient with a PTFE graft did not improve and needed surgery to declot and treat the distal anastomosis and distal circulation. The two patients with an occluded iliac artery underwent successful declotting but rethrombosis occurred in one shortly after the procedure requiring thrombolytic therapy. One patient with TIPS thrombosis improved and another patient with a thrombosed portal vein did not improve after thrombectomy. CONCLUSION: The ATD is useful for recanalization of acute/subacute clotted native vessels and grafts. The application of the device is broad, and although declotting can be achieved in most cases, long-term success may be limited by anatomical and technical problems of the grafts and multifactorial clinical problems of severely sick patients, as was the case in the series. The use of additional thrombolytic therapy may be necessary in a number of patients.
Adolescent↗
Abdominal aortic aneurysm treatment: preliminary results with the Talent stent-graft system.
PURPOSE: To evaluate the treatment of abdominal aortic aneurysm (AAA) with use of the endoluminal Talent stent-graft (TSG). PATIENTS AND METHODS: In 10 men, AAA treatment was attempted with use of the TSG. All patients presented significant surgical risk, with chronic obstructive pulmonary disease and coronary arteriopathy. The mean age was 65.5 years (range, 57-82 years). The mean proximal neck diameter was 25.8 mm (range, 21.6-34 mm). Five of the TSGs were straight tubes and five were bifurcated systems. The main body of the TSG is made of a polyester graft material mounted on a self-expandable nitinol frame. The bifurcated system uses polytetrafluoroethylene (PTFE) material for the legs and extensions mounted on a self-expandable nitinol frame. The bifurcated grafts used a 22 to 27-F introducer and the extensions, a 18-F introducer through a surgical cutdown technique. RESULTS: The TSG system was successfully implanted in nine patients and failed in one because of dislodgment after deployment, which required conversion to surgery. Four leaks occurred initially. One was sealed off with balloon dilation at the end of the procedure, one leak was treated with an additional extension, another leak disappeared spontaneously in 30 days, and the other leak required embolization 4 weeks after discharge. Seven patients were discharged on the third day after the procedure, and two patients were discharged at 1 and 2 weeks, respectively. Blood transfusion was necessary in three patients because of hematoma at the incision site in two patients, which required surgical revision for hemostasis, and because of transoperative bleeding in one patient. Follow-up time ranged from 2 to 15 months. The only death occurred 5 days postoperatively as a consequence of ischemic colitis and multisystem organ failure in the only patient who required surgery. CONCLUSION: Treatment of AAA with the TSG system is effective for aneurysm exclusion. This device seems to provide a good alternative to surgery in patients who are otherwise considered to be at high risk for complications after direct surgical repair, but it is not without risk of complications.
Aged↗
Ablation of tumor and inflammatory tissue with absolute ethanol.
Absolute ethanol was used to ablate tumors, inflammatory lesions, and end-stage nephrosclerotic kidneys in 38 patients. Thirty patients had various types of renal tumors, and 3 had chronic end-stage renal failure with malignant hypertension. One patient had a fibrosarcoma of the right leg and one had a metastasis in the humerus from a renal carcinoma. A large adrenal carcinoma was treated with absolute ethanol in a patient who had liver metastases that were ablated one year after the first procedure. An additional patient had metastatic liver disease from a non-functioning adrenal carcinoma. The remaining patient had an extensive hypervascular inflammatory lesion (tuberculosis and aspergilloma) of the right upper pulmonary lobe. In addition to ethanol, coils were introduced in one patient and Gelfoam in another. The amount of ethanol used ranged from 5 to 50 ml. Twenty-two patients suffered from considerable transient pain during ethanol injection, but sedation was necessary in only 3 of them. Skin necrosis appeared in 2 patients requiring plastic reconstruction in one of them. Two patients died within 5 days of the procedure unrelated to the ablation. Two patients presented upper gastrointestinal bleeding within 2 days of the ethanol injection and one of these died in acute renal failure. One patient suffered from left colonic infarction after left renal tumor ablation, but survived for several months. Absolute ethanol was a useful and efficient sclerosing agent causing extensive tumor destruction and marked reduction of the vascularity in tumor and inflammatory lesions, but caused an 18 per cent complication rate.
Adrenal Gland Neoplasms↗
[Hepatic hemangiomas. The importance of the image].
In the authors' experience, 0.24% of the patients submitted to liver imaging (ultrasound or computerized tomography) have hemangiomas. These are shown as solid nodular lesions, mostly found by chance. Sometimes they do not appear as typical solid vascular lesions. The authors' experience and the literature are discussed. A clear and concise approach to this benign neoplasm is suggested.
Adult↗
Transcatheter embolization for treatment of acute lower gastrointestinal bleeding.
Treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam. Bleeding was adequately controlled in 11 patients with active bleeding during the examination. One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy. One patient was septic and bled from jejunal ulcers. Ischemic changes with infarction of the large bowel developed in two patients and were treated by partial semi-elective colectomy, three and four days after embolization. Four other patients developed pain and fever after embolization. Transcatheter embolization of branches of mesenteric arteries is an effective way to control acute lower gastrointestinal bleeding, but still has a significant rate of complications that must be seriously weighed against the advantages of operation.
Adult↗