Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre.

Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.

Percutaneous Radiology Gastrostomy (PRG)-Associated Complications at a Tertiary Hospital over the Last 25 Years.

OBJECTIVES: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.

[Solitary fibrous tumor of the abdomen. A rare neoplasm of vascular origin]. / Tumor fibroso solitario abdominal. Una rara neoplasia de origen vascular.

Solitary fibrous tumor (formerly known as hemangiopericytoma) is a rare soft tissue neoplasm, most frequently arising from the retroperitoneum and lower extremities. We present two cases of retroperitoneal solitary fibrous tumors diagnosed after surgical removal. We provide a literature review showing the basic clinical, pathologic and therapeutic features of these tumors.

Multicentre prospective study of drug-eluting bead chemoembolisation safety using tightly calibrated small microspheres in non-resectable hepatocellular carcinoma.

PURPOSE: To assess the safety and tolerability of transarterial drug-eluting bead chemoembolisation (DEB-TACE) using tightly calibrated 100-µm microspheres in hepatocellular carcinoma (HCC). METHOD: This multicentre prospective study included 131 patients with a 2-year follow-up. All patients had Child-Pugh scores ≤ B7, a good performance status, and Barcelona Clinic Liver Cancer stage A or B. Beads were loaded with 50 mg of doxorubicin per millilitre. Overall, 223 nodules were treated (mean size: 27.6 mm, average number of nodules per patient: 1.7). Toxicity was assessed using Common Terminology Criteria for Adverse Events 4.03 and response according to the modified Response Evaluation Criteria in Solid Tumours. The primary endpoint was safety. Secondary endpoints included technical success, post-embolisation syndrome (PES), local tumour response, and 2-year survival. RESULTS: A total of 214 DEB-TACE procedures were performed (mean per patient: 1.64), with a technical success rate of 97.6 % and a PES rate of 9.3 %. Major complications occurred in 6.8 % of patients and 4.1 % of procedures. There were no treatment-related deaths. Doxorubicin dose was an independent predictor of complications (p = 0.01). Four patients were lost to follow-up and 18 received liver transplants. Objective response rates were 74.6 %, 45.7 %, and 44.1 % at 6, 12, and 24 months, respectively. The cumulative 24-month overall survival rate was 55.96 %. Median survival was 22 months (interquartile range = 13-24). Co-morbidities and tumour response were independent predictors of survival (p = 0.0012 and 0.0052, respectively). Complications did not affect survival (p = 0.24). CONCLUSIONS: DEB-TACE with tightly calibrated 100-µm beads is safe and not associated with increases in biliary toxicity or complications. Tumour response and survival are in the expected range for chemoembolisation therapy. (Clinical trials ID: NCT02670122).

Aortic Customized Stent-Graft Treatment of Postnephrectomy Renal Pedicle Arteriovenous Fistula.

A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.

Analysis of the Indications and Complications of Vena Cava Filter in Patients with Venous Thromboembolism / Análisis de las indicaciones y complicaciones de los pacientes con enfermedad tromboembólica venosa a los que se ha colocado filtro de vena cava inferior

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Refractory hypertension in a young woman.

A 36-year-old woman was referred for the evaluation of refractory arterial hypertension with vasculorenal profile. Abdominal multislice computed tomography angiography (MSCT-angiography) was performed for further evaluation. Bilateral renal artery involvement was demonstrated with aneurysms, stenotic segments, and a string-of-beads-appearance in the right renal artery. We discuss the occurrence of fibromuscular dysplasia as a cause of refractory hypertension in young women and the increasing importance of MSCT studies for its diagnosis.

Trombosis portal tras terapia endoscópica de varices gástricas con N-butil-2-cianocrilato: tratamiento con TIPS / Portal vein thrombosis following endoscopic treatment for gastric varices with N-butyl-2-cyanoacrylate: Management with TIPS

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Hiperplasia nodular regenerativa hepática y linfoma cutáneo de células T: una asociación no descrita / Nodular regenerative hyperplasia of the liver and cutaneous T-cell lymphoma: an unreported association

La hiperplasia nodular regenerativa hepática –una modalidad de hipertensión portal no cirrótica– es una enfermedad poco frecuente de etiopatogenia desconocida que se ha asociado a multitud de trastornos diversos, incluyendo enfermedades hematológicas de distinta índole. Presentamos el caso de una paciente de 36 años diagnosticada de linfoma cutáneo de células T, tipo micosis fungoide, estadio T2N0M0B0, en la que una biopsia por vía transyugular demostró la existencia de una hiperplasia nodular regenerativa con gradiente de presión venosa hepática de 15 mm Hg; el detonante del estudio fue la aparición radiológica de una hepatomegalia incidental con datos indirectos de hipertensión portal. No nos consta que la asociación entre hiperplasia nodular regenerativa y micosis fungoide esté descrita en la literatura médica (AU)

Nodular regenerative hyperplasia of the liver –a type of noncirrhotic portal hypertension– is a rare condition of unknown etiopathogenesis that has been associated with multiple disorders, including diverse types of hematologic disease. We report the case of a 36-year-old female patient diagnosed with cutaneous T-cell lymphoma of the mycosis fungoides variety, staged as T2N0M0B0, where a transjugular liver biopsy demonstrated the presence of nodular regenerative hyperplasia with a hepatic venous pressure gradient of 15 mm Hg. The study was triggered by the incidental radiologic finding of hepatomegaly with indirect evidence of portal hypertension. We are not aware of any previous reports on the association of nodular regenerative hyperplasia with mycosis fungoides in the medical literature (AU)

Utilidad de la resonancia magnética abdominopélvica en el diagnóstico de abscesos tuboováricos / Utility of abdominopelvic magnetic resonance imaging in the diagnosis of tubo-ovarian abscesses

Se presenta el caso clínico de una paciente de 39 años con absceso tuboovárico diagnosticado por RM pélvica. Destacamos la importancia de esta técnica de imagen para diferenciarlos de otros procesos pélvicos, principalmente neoplásicos (AU)

We present the case of a 39-year-old woman with a tubo-ovarian abscess diagnosed by pelvic magnetic resonance imaging. We highlight the importance of this imaging technique in differentiating these abscesses from other pelvic processes, especially neoplasms (AU)

Utilidad de la resonancia magnética abdominopélvica en el diagnóstico de la patología tubárica y sus causas / Utility of abdominopelvic magnetic resonance in the diagnosis of tuboovarian abscesses

Se presenta el caso clínico de una paciente de 39 años, con hidrosálpinx diagnosticado por resonancia magnética en el contexto de una enfermedad pélvica inflamatoria. Destacamos la importancia de esta técnica de imagen para diferenciarlo de otros procesos pélvicos, principalmente neoplásicos(AU)

We present the case of a 39 year old woman with hidrosálpinx diagnosed by pelvis magnetic resonance in the context of pelvic inflammatory disease. We note the importance of this imaging technique to differentiate it from other pelvic processes, especially neoplasms(AU)

Tumor fibroso solitario abdominal. Una rara neoplasia de origen vascular / Solitary fibrous tumor of the abdomen. A rare neoplasm of vascular origin

El tumor fibroso solitario (antiguo hemangiopericitoma) es una infrecuente neoplasia de partes blandas cuya localización más frecuente es el retroperitoneo y las extremidades inferiores. Presentamos dos casos de hemangiopericitomas retroperitoneales diagnosticados tras intervención quirúrgica. Realizamos una revisión bibliográfica exponiendo los aspectos clínicos, anatomopatológicos y terapéuticos de estos tumores (AU)

Solitary fibrous tumor (formerly known as hemangiopericytoma) is a rare soft tissue neoplasm, most frequently arising from the retroperitoneum and lower extremities. We present two cases of retroperitoneal solitary fibrous tumors diagnosed after surgical removal. We provide a literature review showing the basic clinical, pathologic and therapeutic features of these tumors (AU)