[Laparoscopic gastric bypass: computed tomography appearance of common postoperative changes and complications]. / Bypass gástrico laparoscópico: cambios postoperatorios habituales y aspecto radiológico de sus complicaciones en la tomografía computarizada.

Laparoscopic Roux-en-Y bypass is being increasingly used for weight reduction in patients with morbid obesity. Unfortunately, some complications can occur after this procedure, the most frequent being intestinal obstruction (due to stenosis of the anastomosis at the distal end of the loop, internal hernias, bands, and adhesions), anastomotic leaks, and bleeding. This article provides basic knowledge about the surgical technique and its correlation with the common postoperative changes with the aim of facilitating the interpretation of CT findings and the identification of postoperative complications in these patients.

[Impact of mammographic breast density on computer-assisted detection (CAD) in a breast imaging department]. / Impacto de la densidad mamaria mamográfica en el funcionamiento de un sistema de detección asistido por ordenador en una unidad de patología mamaria.

OBJECTIVE: To evaluate whether breast density influences the sensitivity of a computer-assisted detection (CAD) system for the detection of breast cancer. MATERIAL AND METHODS: We prospectively studied 8750 digital mammograms with an associated CAD system. We used BI-RADS criteria to classify breast density. We calculated the overall sensitivity of the radiologist and of the CAD system, as well as the sensitivity for each projection and type of finding in relation to the mammographic density of the breast. Finally, we analyzed the interval carcinomas. We used SPSS 11 for all statistical analyses. RESULTS: The overall sensitivity of the CAD system was 88.5% (95% CI: 83.2-92.7%), and the overall sensitivity of the radiologist was 93.5% (95% CI: 84.4%-95.5%). The sensitivity of the craniocaudal view was 81.6% (95% CI: 76.5-90.7%) vs 76.5% (95% CI: 69.3-89.3%) for the mediolateral oblique view. The sensitivity for microcalcifications was 98.6% (95% CI: 96.5-99.7%), and the sensitivity for masses 83.4% (95% CI: 81.2-91.7%). We detected discrepancies smaller than 20% both for microcalcifications present in the four types of densities and for masses with densities 1 and 2. In masses with density 3 the discrepancy was 20.8% and in those with density 4 it was 55%. The CAD system failed to mark only 9.1% (9/94) of the cancers presenting as masses. Half of the interval carcinomas were found in type 4 density and 75% manifested as masses, asymmetries, and distortions. The CAD system had marked 35.7% of the carcinomas. CONCLUSIONS: The craniocaudal view was more sensitive, although this difference was not statistically significant. The sensitivity of CAD was high for microcalcifications in all four density types; however, CAD's sensitivity for masses was low in density types 3 and 4. The CAD system only failed to mark 9.1% of the cancers presenting as masses but was not sensitive for the other two radiological findings included in this marking. Half of the interval carcinomas occurred in type 4 densities and 35.7% had been marked by the CAD system.

[Treatment of hepatocellular carcinoma using precision transcatheter arterial chemoembolization (TACE): results of two years' experience in a general hospital]. / Quimioembolización de hepatocarcinoma mediante TACE-precisión: resultados al 2.° año en un hospital general.

OBJECTIVES: To present our experience in the use of microspheres preloaded with adriamycin (DC Bead(®)) in the transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma, in a two-year prospective multidisciplinary study in consecutive patients to evaluate the efficacy, safety, and tolerance of this procedure. MATERIAL AND METHODS: From May 2007 to January 2010, we performed 30 TACE procedures in 17 patients (3 women and 14 men; mean age, 68 years; age range, 56-85 years). We performed a mean of 1.76 procedures per patient using the precision TACE protocol. Outcomes were evaluated using the RECIST-EASL criteria by clinical, laboratory, CT, and MRI follow-up at 1, 3, 6, and 12 months. RESULTS: The procedure was considered an initial technical success in all cases. The total dose was delivered in seven cases; in the remaining cases, the total dose was not reached (mean dose, 80mg). An objective response was observed in 64.7% of patients: a complete response was observed in 29.41% and a partial response in 35.29%. Disease was stabilized in 23.52% and progressed in 11.76%. We observed two cases of abscess/necrosis and one of ischemic cholecystitis. There were no deaths or cases of liver failure related with the procedure. CONCLUSIONS: TACE using microspheres preloaded with adriamycin (DC Beads®) is safe and effective, given the low rate of complications, good tolerance in patients, and increased tumor response.

[Neck and thorax multifocal rhabdomyoma. A case report and review of the literature]. / Rabdomioma multifocal cervical y torácico. Descripción del caso y revisión de la literarura.

We present one rare case of multifocal rabdomyoma in the cervical region and chest. We describe the presentation, clinical, special tests done for the diagnosis and localization. Therefore we present the type of the treatment and evolution post therapy. We review the literature.

Helical CT of the stomach: differentiation between benign and malignant pathologies, together with the staging of gastric carcinoma.

OBJECTIVES: To evaluate the capacity of Helical Hydro-CT to differentiate between benign and malignant gastric pathologies, and also to measure its usefulness in the staging of gastric carcinoma. PATIENTS AND DESIGN: We perform a cross-sectional study to evaluate the diagnostic efficacy of CT, including patients prospectively. We study 92 patients with a clinical suspicion of gastric pathology using helical CT with a contrast agent (HCTC), water being the oral contrast agent, and i.v. iodine contrast. According to the findings of previous works, we considered stomachs to be normal when the thickness of their wall was less than or equal to 6 mm, with a multilayered appearance that stands out homogeneously with the i.v. contrast. A malignant tumour was diagnosed if the thickness of the wall was greater, together with strong marking by the contrast agent and loss of the normal multilayered pattern. Parietal thickening was classified as gastritis if there was no excessive marking and no loss of the layered pattern. Masses with smooth borders, intraluminal growth and a rounded morphology were diagnosed as sub-mucosal tumours. The results of our 92 studies were compared in all cases with the findings of endoscopic studies, while in the 52 patients treated with surgery they were compared against surgical findings. RESULTS: In 12 of the 92 patients studied using HCTC no gastric pathology was observed by CT or endoscopy. Of the 80 pathological cases CT was used to diagnose 29 as benign pathology, 19 of which were confirmed as such by histology, and 51 cases as malignant pathology, of which 49 were confirmed by histology. We obtained a sensitivity of 81.7% in the diagnosis of malignant pathology and a specificity of 90%, with a PPV of 96% and a NPV of 62%. Regarding TNM staging (in comparison with the 1997 TNM classification), the diagnostic reliability obtained amounted to 56% for T and N, and 87% for M. CONCLUSIONS: Helical hydro CT makes it possible to diagnose advanced gastric carcinoma. Its usefulness basically lies in the evaluation of metastatic neoplastic disease. It has also been shown to be useful in the diagnosis of benign pathologies. It is not a good screening method for the diagnosis of gastric carcinoma.