Pulmonary arteriovenous malformations (PAVM) are the direct communications between the pulmonary arteries and veins. These malformations can cause serious complications, and most of these patients ...should be treated. Herein we present our experience in the treatment of 18 cases of PAVM, treated with endovascular embolisation.
Eighteen patients with PAVMs underwent endovascular embolisation during a five-year period. Eight were male and 10 were female, with ages ranging from 16 to 65 years. Standard steel coils and vascular plug were used for embolisation.
Embolisation was successful in 17 of 18 patients. Coiling was used in 10 patients, vascular plug in five, and both materials in two patients. All symptomatic patients with successful embolisation lost all their symptoms after treatment. Control angiography after embolisation showed a closure of AV shunt without migration of embolic material in all patients. Post-embolisation syndrome developed in four patients and late onset of pleural pain in three patients. There was no connection between pleural reaction and type of PAVM and embolic material.
Endovascular PAVM treatment is a minimally invasive, highly successful method with a low rate of only transitory complications.
Aim To compare the long-term outcomes between liver transplant (LT) recipients with hepatocellular carcinoma (HCC) who were downstaged with transarterial-chemoembolization (TACE) to the Milan ...criteria (MC) and those initially meeting the MC. Methods This retrospective study enrolled 198 patients with HCC: 38 were downstaged and 160 patients initially met the MC. Post-LT survival and HCC recurrence-free survival were evaluated. We assessed the association of death and HCC recurrence with TACE, baseline (age, sex, disease etiology, Model of End-stage Liver Disease, tumor number and the sum of maximum tumor diameters, waiting time, alpha-fetoprotein level) and explant characteristics (tumor number and the sum of maximum tumor diameters, micro- and macrovascular invasion). Results The recipient survival rates one, three, and five years after LT were 88.2%, 80.1%, and 75.9%, respectively. HCC recurrence-free probabilities were 92.3%, 87.9%, and 85%, respectively. The outcomes were comparable between the groups. In multivariate analysis, the number of tumors on the explant, age, and tumor recurrence were independent risk factors for death. Only the sum of maximum tumor diameters on the explant was an independent risk factor for HCC recurrence. Conclusions Patients successfully downstaged with TACE to the MC can achieve post-LT recipient and HCC recurrence-free survival comparable with patients initially within the MC. Good response to TACE as a criterion for LT may be a method of selecting patients with favorable biological characteristics.
The KEYWORDS of this article on page 87 as listed are first-line treatment, metastatic urothelial bladder cancer,
maintenance immunotherapy. Keywords have been corrected to: transplantation, ...chemoembolization, radioembolization,
ablation.
Summary
Background
The computed tomography (CT) is the “golden standard” for the assessment of lung cancer progression due to its ability to clearly display the radiomorphologic characteristics. As ...lung cancer mortality is very high, more comprehensive approaches may be needed for its earlier diagnosis. The research hypothesis was to investigate the relation between the CT morphologic characteristics (size, stage, and edges) of pulmonary lesion and the extent of release of a soluble fragment of cytokeratin 19 being a part of the cytoskeleton of lung epithelial cells.
Methods
This is a retrospective study including 246 pulmonary lesions being diagnosed and subsequently treated at the University Hospital Centre Zagreb, Croatia. The information about the relevant clinical, radiological, and laboratory facts was collected at the time of diagnosis in 164 NSCLC patients, 52 patients with pulmonary metastases, and 30 benign cysts. CYFRA 21-1 was determined by electrochemiluminescence immunoassay. The nonparametric statistical methods were applied.
Results
There was a positive correlation between the size and CYFRA 21-1 in NSCLC unlike metastases or cysts (
p
= 0.0001). The highest values of CYFRA 21-1 were seen in advanced stages of NSCLC and lesions with spiculated edges.
Conclusions
The level of CYFRA 21-1 positively correlates with the greatest size of NSCLC measured by CT. The differences in CYFRA 21-1 according to TNM classification are significant (
p
= 0.0001): higher values were observed in advanced stages and with tumors having spiculated, lobulated, and poorly defined edges. The combination of CYFRA 21-1 and CT may help articulate the malignancy of pulmonary lesions.
Summary Objectives The genus Mycobacterium has more than 120 well-characterized species. Although the incidence of tuberculosis has decreased over the studied period, other, non-tuberculous ...mycobacteria (NTM) are isolated more often. Since, Mycobacterium xenopi is the most frequent NTM isolate in Croatia we studied its epidemiology and clinical relevance. Methods We performed a retrospective study over a 25-year period determining epidemiology, radiological findings and clinical importance of M. xenopi infection, obtaining data from archives in health care institutions from all over the country. Results We detected 40 patients with a positive isolate of M. xenopi . Twenty-four patients met American Thoracic Society criteria for pulmonary disease. Eighteen (90%) of treated patients were male, on average 61.7 years old. Nineteen (95%) patients lived in towns. Most of them had comorbid disease, 18 (90%), with chronic obstructive pulmonary disease (COPD) being the most frequent, found in 11 (55%) patients. All patients were immunocompetent. We found COPD as the most frequent comorbid disease in the group of patients with worse treatment response ( n = 8; 80%), while in patients with good treatment response COPD was less frequent ( n = 3; 30%). Differences in the proportions of patients with COPD were significant ( p = 0.037). Conclusion In patients with M. xenopi pulmonary infection, COPD is a predisposing condition, and as a comorbid disease, is an important prognostic factor for treatment response.
Cilj: Kompjutorizirana tomografska angiografija (CTA) zlatni je standard za otkrivanje endoleaka nakon endovaskularnog liječenja aorte (EVAR). Cilj je ovog rada utvrditi može li kontrastni ultrazvuk ...(CEUS) zamijeniti CTA u dijagnostici endoleaka nakon EVAR-a. Materijali i metode: Pregled literature na engleskom jeziku proveden je u bazama podataka: PubMed/MEDLINE, ScienceDirect, Google Scholar. Ključne riječi bile su: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studije koje su odgovarale kriterijima uključivanja recenzirane su u cijelosti te je odabrano 39 studija. Rezultati: Pacijenti su u analiziranim studijama najvećim dijelom bili muškarci (86 %). Medijan dobi iznosio je 74 godine. Endoleak nakon EVAR-a promatran je u infrarenalnih (79 %), jukstarenalnih (17 %) i suprarenalnih aneurizama (4 %). Stopa endoleaka kretala se između 3 i 52 %. Najčešći endoleak bio je po tipu II te se u 15 % slučajeva javljao unutar prvih šest mjeseci, odnosno u manje od 10 % slučajeva unutar dvije godine nakon EVAR-a. Za sve tipove endoleaka CEUS je pokazao uravnoteženu osjetljivost, specifičnost i područje ispod krivulje od 94 %, 88 % i 96 %. U odnosu na CTA, CEUS ima veću osjetljivost (94/83 %), ali lošiju specifičnost (94,8/99 %). Specifično za tip II endoleaka, CEUS je imao veću stopu detekcije (36,88/20,88 %). Visoka osjetljivost (97 %) i specifičnost (100 %) obilježje su CEUS-a u prikazu endoleaka tipa I i III, bez prednosti u odnosu na CTA. Zaključci: CEUS je slikovna metoda ravnopravna CTA u probiru pacijenata za endoleak nakon EVAR-a. CEUS ne može u potpunosti nadomjestiti CTA, no sigurna je i efikasna alternativa za korištenje u pacijenata bez CTA komplikacija nakon jednogodišnjeg kontrolnog intervala.
Aim: Computed tomography angiography (CTA) is the mainstay in endoleak detection after endovascular aneurysm repair (EVAR). The objective of this review is to determine if contrast enhanced ultrasound (CEUS) is able to replace CTA in monitoring endoleaks in patients after EVAR. Materials and methods: The literature search of Englishlanguage articles was conducted in PubMed/MEDLINE, ScienceDirect, Google Scholar. The used keywords included: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studies appearing to meet inclusion criteria were reviewed in full and 39 studies were included. Results: In analysed studies, patients were predominantly men (86%) and median age was 74 years. Endoleak after EVAR was followed in infrarenal (79%), juxtarenal (17%) and suprarenal aneurysms (4%). Endoleak detection rate was 3-52%. Type II endoleaks were the most frequently encountered – in 15% of cases during the first six months and in less than 10% of cases during the first two years after EVAR. In diagnosing all endoleaks, CEUS demonstrated sensitivity, specificity, and AUC of 94%, 88%, 96%, respectively. Compared to CTA, CEUS possesses higher sensitivity (94/83%), but lesser specificity (94.8/99%). Particularly in type II endoleak evaluation, CEUS provided higher detection rates (36.88/20.88%). Regarding type I and type III endoleaks, CEUS demonstrated high sensitivity (97%) and specificity (100%), but without superiority over CTA. Conclusions: CEUS is an imaging technique equivalent to CTA in screening for post-EVAR endoleaks. CTA cannot be entirely replaced by CEUS; however, it is safe and effective alternative method to use after one year of negative CTA exams.
Transplantacija jetre je metoda koja omogućuje liječenje brojnih jetrenih patoloških stanja. Intervencijska radiologija (IR) najveći značaj pruža liječenju onkoloških pacijenata, najčešće onima s ...hepatocelularnim karcinomom. Odlike interventnih radioloških tehnika ogledaju se ponajprije u prevenciji progresije trenutne jetrene bolesti te smanjenju stupnja proširenosti tumorske bolesti. U najčešće korištene IR metode u liječenju jetrenih tumora svrstavaju se transarterijska kemoembolizacija (TACE), tj. konvencionalna transarterijska kemoembolizacija (cTACE) ili TACE česticama koje sadržavaju citostatik (DEB-TACE), radioembolizacija, BLAND embolizacija, radiofrekvencijska ablacija (RFA) te mikrovalna ablacija (MWA). cTACE metoda konvencionalni je oblik TACE metode temeljen na lokalnoj aplikaciji citostatika u mikrookoliš tumora te embolizaciji krvnih žila koje opskrbljuju tumor. DEB-TACE metoda zasniva se na lokalnoj aplikaciji čestica ispunjenih citostatikom koje omogućavaju konstantno otpuštanje lijeka u tumorski mikrookoliš.
BLAND embolizacijom emboliziraju se krvne žile koje opskrbljuju tumor što rezultira tumorskom ishemijom. Transarterijska radioembolizacija metoda je kojom se radiosferama apliciraju radioaktivne supstance u tumorski mikrookoliš. RFA tehnika zasnovana je na aplikaciji toplinske energije kroz radiofrekvencijsku iglu uvedenu u jetreni tumor što rezultira koagulacijskom nekrozom tumora.
MWA je metoda zasnovana na perkutanoj aplikaciji molekula sa unutarnjim dipolom koje u kombinaciji sa vanjskim promjenjivim poljem uzrokuju produkciju topline što rezultira nekrozom tumora.
Hepatocelularni karcinom (HCC) je primarna maligna bolest jetre. Uslijed porasta broja oboljelih od kroničnog hepatitisa koji u konačnici dovodi do stadija ciroze jetre, incidencija ovog karcinoma je ...u porastu. U svom početnom stadiju bolest je najčešće asimptomatska, a postavljanje konačne dijagnoze je zahtjevno i s odgodom. Probir visoko rizične populacije zasniva se na ultrazvučnoj dijagnostici koja se, u slučaju pronalaska sumnjive lezije, nadopunjuje multifaznim CT i MR pregledom radi daljnje evaluacije bolesti. Odabir terapijske metode ovisi o veličini i lokaciji tumora, ekstraheptalnom širenju i priležećoj bolesti jetre. Prema svim dosadašnjim smjernicama, liječenje je uključivalo kiruršku resekciju i transplantaciju jetre. U pacijenata s određenim stadijem bolesti danas je metoda odabira lokoregionalna terapija. Tehnike ablacije pogodne su za pacijente u vrlo ranoj fazi bolesti. Transarterijska embolizacija (TACE) je metoda odabira kod pacijenata s multifokalnim HCC-om održane jetrene funkcije, nepodobnih za operaciju. Primjena lokoregionalne terapije s kombinacijom ostalih tehnika pridonosi boljoj rezoluciji bolesti s boljim ishodima preživljenja. U prikazanom slučaju, pratimo pacijenticu s HCCom u podlozi hepatitis C virusne (HCV) infekcije kod koje se, odlukom multidisciplinarnog tima, odlučilo na lokoregionalnu terapiju naizmjeničnom kombinacijom mikrovalne ablacije i TACE kod recidivirajućeg HCC-a.
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