Journal of vascular and interventional radiology : JVIR
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J Vasc Interv Radiol · Aug 2006
ReviewUpdate on the management of neuroendocrine hepatic metastases.
Neuroendocrine tumors (NETs) are rare and represent a diverse collection of malignancies that occur in many organ systems throughout the body, including the gastrointestinal and respiratory tracts. Unfortunately, the majority of patients with NETs have hepatic metastases at the time of diagnosis. ⋯ Although many patients have long indolent courses, without treatment, most patients die within 5 years of diagnosis. This article reviews the care of patients with NETs and hepatic metastases, with emphasis on the increasingly important role of oncologic image-guided interventions.
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Interventional radiologists often treat patients who are at risk of becoming acutely septic while in the radiology department. Identifying those most at risk and initiating treatment plans before the acute situation are fundamental to this difficult group of patients. Treatment plans for life-threatening infection are based on controlling the source of infection and administering appropriate systemic antimicrobial therapy as well as volume and cardiopulmonary support. The purpose of this review is to provide a framework for the diagnosis and treatment of sepsis in the interventional radiology patient.
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Intravenous recombinant tissue-type plasminogen activator (rtPA, alteplase) is the only drug approved for the treatment of acute ischemic stroke. It should be administered within 3 hours of stroke. There is additional evidence, however, that administration at later times, by means of other methods, is effective. Herein, is a broad review of the knowledge gained and insights created from studies in which thrombolytic treatment was used in patients with stroke.
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J Vasc Interv Radiol · Jan 2004
ReviewCritical care assessment and management of acute ischemic stroke.
The resuscitation and treatment of patients with an acute stroke has evolved measurably during the past 2 decades. Acute ischemic stroke represents a true emergency where time is crucial and, therefore, evaluation and treatment often proceed simultaneously. Advanced imaging techniques can provide information about the state of brain perfusion, metabolism, and the cerebrovascular anatomy to help identify patients with viable brain tissue who may derive the greatest benefit from available therapies. ⋯ In addition, newer agents such as ancrod and abciximab may be effective within the acute time period. Optimal care requires a multidisciplinary approach with attention to a wide variety of therapeutic issues while maintaining adequate brain perfusion to reverse or halt the ischemic process. Herein, the author examines the important therapeutic concerns in the critical care management of ischemic stroke, including the management of elevated intracranial pressure, elevated and low blood pressure, cardiac complications, and potential metabolic disturbances.
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J Vasc Interv Radiol · Jan 2004
ReviewPhysiologic monitoring and anesthesia considerations in acute ischemic stroke.
Acute ischemic stroke is considered a neurologic emergency. The perioperative anesthesia management of acute ischemic stroke is challenging owing to the dynamic pathophysiology of the disease itself and the patients' comorbid factors and conditions. Herein, the authors review preoperative assessment, intraoperative and postoperative physiologic monitoring, and anesthesia management, with a focus on the control of the cerebrovascular and cardiovascular circulations. Issues specific to anesthesia monitoring and management in the radiology suite are emphasized.