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ESTUDIOS


01 marzo 2012

JACC. Renal Sympathetic Denervation Reduces Left Ventricular Hypertrophy and Improves Cardiac Function in Patients With Resistant Hypertension

Mathias C. Brandt, MD; Felix Mahfoud, MD; Sara Reda, MD; Stephan H. Schirmer, MD, PhD; Erland Erdmann, MD; Michael Böhm, MD; Uta C. Hoppe, MD

Objectives: This study investigated the effect of catheter-based renal sympathetic denervation (RD) on left ventricular hypertrophy (LVH) and systolic and diastolic function in patients with resistant hypertension.

20 marzo 2013

JAMA. Computed Tomography Screening for Lung Cancer

Phillip M. Boiselle, MD

Objectives To discuss the evidence for use of chest x-rays and low-dose CT in screening for lung cancer; to describe potential benefits, harms, and uncertainties of CT screening; and to review current guidelines for CT screening.

27 marzo 2012

JOUNAL OF HEPATOLOGY. Hepatic encephalopathy: An approach to its multiple pathophysiological features

Juan Carlos Perazzo, Silvina Tallis, Amalia Delfante, Pablo Andrés Souto, Abraham Lemberg, Francisco Xavier Eizayaga and Salvador Romay.

Hepatic encephalopathy (HE) is a neuropsychiatric complex syndrome, ranging from subtle behavioral abnormalities to deep coma and death. Hepatic encephalopathy emerges as the major complication of acute or chronic liver failure. Multiplicity of factors are involved in its pathophysiology, such as central and neuromuscular neurotransmission disorder, alterations in sleep patterns and cognition, changes in energy metabolism leading to cell injury, an oxidative/nitrosative state and a neuroinflammatory condition.

07 marzo 2012

KOREAN JOURNAL OF RADIOLOGY. Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

Dong Gyu Na, MD, Jeong Hyun Lee, MD, So Lyung Jung, MD, Ji-hoon Kim, MD, Jin Yong Sung, MD, Jung Hee Shin, MD, Eun-Kyung Kim, MD, Joon Hyung Lee, MD, Dong Wook Kim, MD, Jeong Seon Park, MD, Kyu Sun Kim, MD, Seon Mi Baek, MD, Younghen Lee, MD, Semin Chong, MD, Jung Suk Sim, MD, Jung Yin Huh, MD, Jae-Ik Bae, MD, Kyung Tae Kim, MD, Song Yee Han, MD, Min Young Bae, MD, Yoon Suk Kim, MD, Jung Hwan Baek, MD, Korean Society of Thyroid Radiology (KSThR), and Korean Society of Radiology

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.

14 marzo 2012

BIOLOGY OF SEX DIFFERENCES. Sex differences in primary hypertension

Kathryn Sandberg and Hong Ji

Men have higher blood pressure than women through much of life regardless of race and ethnicity. This is a robust and highly conserved sex difference that it is also observed across species including dogs, rats, mice and chickens and it is found in induced, genetic and transgenic animal models of hypertension. Not only do the differences between the ovarian and testicular hormonal milieu contribute to this sexual dimorphism in blood pressure, the sex chromosomes also play a role in and of themselves. This review primarily focuses on epidemiological studies of blood pressure in men and women and experimental models of hypertension in both sexes. Gaps in current knowledge regarding what underlie male-female differences in blood pressure control are discussed. Elucidating the mechanisms underlying sex differences in hypertension may lead to the development of anti-hypertensives tailored to one s sex and ultimately to improved therapeutic strategies for treating this disease and preventing its devastating consequences.

01 abril 2013

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

Tiago Bilhim, João Pisco, Hugo Rio Tinto, Lúcia Fernandes, Luís Campos Pinheiro, Marisa Duarte, José A. Pereira, António G. Oliveira, JoAo O Neill

Purpose: This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS).

01 abril 2013

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

Nicholas Chalmers, Paul T. Walker, Anna-Maria Belli, Anthony P. Thorpe, Paul S. Sidhu, Graham Robinson, Mariella van Ransbeeck, Steven A. Fearn

Purpose: To determine whether primary stenting reduces the rate of restenosis compared with balloon angioplasty alone in the endovascular treatment of long superficial femoral artery lesions; and to assess the effect of treatment on quality of life.

01 abril 2013

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

Erwin De Cock, Marc Sapoval, Pierre Julia, Greg de Lissovoy, Sandra Lopes

Purpose: The Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent.

01 marzo 2013

DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY. Critical limb ischemia: an update for interventional radiologists

Nicholas F. Brazeau, Erique G. Pinto, Harlan B. Harvey, George R. Oliveira, Benjamin J. Pomerantz, Stephan Wicky, Rahmi Oklu

Summary: Critical limb ischemia (CLI) is a growing epidemic with bleak patient outcomes. A variety of treatment modalities have been adopted to address CLI based on comorbidities, life expectancy, and the nature of the arterial disease. With advances in technology and treatment strategies, the clinical outcomes of CLI patients have significantly improved over recent years. However, despite progress, patency rates of both surgical and endovascular interventions, limb-salvage and amputation rates are still dismal. We review the epidemiology, treatment strategies, imaging modalities, and the microcirculation aspect of CLI.

01 marzo 2013

DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY. Fogarty balloon application technique in dislodging residual thrombus on the single sheath entry point at the apex of thrombosed loop grafts

Dong Erk Goo, Seung Boo Yang, Yong Jae Kim, Chul Moon, Dan Song, Sang Chul Yoon, Woong Hee Lee

PURPOSE: e aimed to evaluate the effectiveness of the Fogarty balloon application in dislodging residual thrombus at the sheath en- try point in a graft by using single apex puncture to declot thrombosed hemodialysis loop grafts.

15 julio 2012

INTERNATIONAL JOURNAL OF HEPATOLOGY. Milan Criteria and UCSF Criteria: A Preliminary Comparative Study of Liver Transplantation Outcomes in the United States

Supriya S. Patel, Amanda K. Arrington, Shaun McKenzie, Brian Mailey, Michelle Ding, Wendy Lee, Avo Artinyan, Nicholas Nissen, Steven D. Colquhoun, and Joseph Kim

The application of orthotopic liver transplantation (OLT) for patients with hepatocellular cancer (HCC) necessitates highly selective criteria to maximize survival and to optimize allocation of a scarce resource. The objective of this study was to compare the outcomes of OLT for HCC in patients transplanted under Milan and UCSF criteria. The United Network of Organ Sharing (UNOS) database was queried for patients who had undergone OLT for HCC from 2002 to 2007, and 1,972 patients (Milan criteria, ; UCSF criteria, ) were identified. Patients were stratified by pretransplant criteria (Milan versus UCSF), and clinical and pathologic factors and overall survival were compared. There were no differences in age, gender, diabetes mellitus, body mass index, and hepatitis B, or C status between the two groups. Overall survival was similar between the Milan and UCSF cohorts (1-, 2-, 3-, and 4-year survival rates: 88%, 81%, 76%, and 72% versus 91%, 80%, 68% and 51%, respectively, ). Although the number of patients within UCSF criteria was small, our results nevertheless suggest that patients with HCC may have equivalent survival when transplanted under Milan and UCSF criteria. Long-term followup may better determine whether UCSF criteria should be widely adopted.

01 abril 2012

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

akaaki Iwaki, Hiroyuki Miyatani, Yukio Yoshida, Katsuhiko Matsuura, Yoshihisa Suminaga

An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding.

13 febrero 2012

THE SCIENTIFIC WORLD JOURNAL. Survival after Locoregional Treatments for Hepatocellular Carcinoma: A Cohort Study in Real-World Patients

Simona Signoriello, Annalisa Annunziata, Nicola Lama, Giuseppe Signoriello, Paolo Chiodini, Ilario De Sio, Bruno Daniele, Giovanni G. Di Costanzo, Fulvio Calise, Graziano Olivieri, Vincenzo Castaldo, Rosario Lanzetta, Guido Piai, Giampiero Marone, Mario Visconti, Mario Fusco,0 Massimo Di Maio, Francesco Perrone, Ciro Gallo, and Giovanni B. Gaeta

Evidence of relative effectiveness of local treatments for hepatocellular carcinoma (HCC) is scanty. We investigated, in a retrospective cohort study, whether surgical resection, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), and transarterial embolization with (TACE) or without (TAE) chemotherapy resulted in different survival in clinical practice. All patients first diagnosed with HCC and treated with any locoregional therapy from 1998 to 2002 in twelve Italian hospitals were eligible. Overall survival (OS) was the unique endpoint. Three main comparisons were planned: RFA versus PEI, surgical resection versus RFA/PEI (combined), TACE/TAE versus RFA/PEI (combined). Propensity score method was used to minimize bias related to non random treatment assignment. Overall 425 subjects were analyzed, with 385 (91%) deaths after a median followup of 7.7 years. OS did not significantly differ between RFA and PEI (HR 1.11, 95% CI 0.79–1.57), between surgery and RFA/PEI (HR 0.95, 95% CI 0.64–1.41) and between TACE/TAE and RFA/PEI (HR 0.88, 95% CI 0.66–1.17). 5-year OS probabilities were 0.14 for RFA, 0.18 for PEI, 0.27 for surgery, and 0.15 for TACE/TAE. No locoregional treatment for HCC was found to be more effective than the comparator. Adequately powered randomized clinical trials are still needed to definitely assess relative effectiveness of locoregional HCC treatment.

01 marzo 2012

HPB. Analysis of survival predictors in a prospective cohort of patients undergoing transarterial chemoembolization for hepatocellular carcinoma in a single Canadian centre

Karim M Eltawil, Robert Berry, Mohamed Abdolell, and Michele Molinari

Background: Despite advances in the treatment of hepatocellular carcinoma (HCC), a great proportion of patients are eligible only for palliative therapy for reasons of advanced-stage disease or poor hepatic reserve. The use of transarterial chemoembolization (TACE) in the palliation of non-resectable HCC has shown a survival benefit in European and Asian populations. The aim of this study was to assess the efficacy of TACE by analysing overall 5-year survival, interval changes of tumour size and serum alpha-fetoprotein (AFP) levels in a prospective North American cohort.

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