[Epidemiology of patients with hepatocellular carcinoma in a University hospital]. / Epidemiología de pacientes con hepatocarcinoma en un Hospital Universitario.

Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who underwent a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.

El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumores de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

Epidemiología de pacientes con hepatocarcinoma en un hospital Universitario / Epidemiology of patients with hepatocellular carcinoma in a University hospital

Resumen El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumo res de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

Abstract Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who under went a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.

Summary of key guidelines for locoregional treatment of HCC in Asia, Europe, South and North America.

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide accounting for over 800,000 new cases in 2018, with the highest incidence in Asia and Africa where hepatitis B is the most common risk factor. In Europe, Japan, and the United States, hepatitis C chronic alcohol abuse and non-alcoholic fatty liver disease are more common risk factors. Five-year survival is low, less than 20% worldwide. HCC is a particularly challenging disease to treat because therapeutic options and prognosis must also consider hepatitis or cirrhosis independent of the malignancy. Locoregional therapies (LRT) including ablation, arterially directed therapy and external beam radiation are the preferred treatments for patients with good performance status, unresectable disease limited to the liver and preserved liver function. In practice, patients with portal vein tumor thrombus and limited extrahepatic disease may also be considered candidates for LRT. There are several guidelines developed by expert panels provide recommendations on treating this challenging disease including the Barcelona Clinic Liver Cancer, European Association for the Study of the Liver, European Society for Medical Oncology, American Association for the Study of the Liver Diseases, and the National Comprehensive Cancer Network. The purpose of this paper is to review the guidelines as they are applied clinically in regions with high incidence of HCC.

[Percutaneous cryoablation for renal tumors cT1 as an alternative treatment for surgery]. / Crioablación percutánea de tumores renales cT1 como alternativa al tratamiento quirúrgico.

Renal cancer represents 3-4% of all malignancies. Its incidental detection is becoming more frequent. Surgery is the gold standard treatment for T1 renal cancer. Still, surgery is not suitable for every patient due to comorbidities or previous kidney surgery. Guidelines provided by The American Urological Association recommend thermoablation therapies as an alternative to surgery in tumors under 3 cm. Experience regarding percutaneous cryoablation in renal tumors is scarce in Latin America and there are only a handful of publications in this region regarding this subject. The objective of this study was to assess the effectiveness and security of percutaneous cryoablation in a cohort of adult patients with cT1 renal cancer (smaller than 5 cm) as an alternative to surgery. The procedures were performed with CT or Cone Beam CT guidance and under general anesthesia in sterile conditions. Cryoablation was carried out on an outpatient basis. Follow up was done with imaging studies, blood test and clinical consultation. All patients had complete response in imaging studies. There were no complications in 61% of all of them, the remaining patients suffered grade-1 complications such as hematuria, urinary retention and perirenal hematoma. In conclusion, percutaneous cryoablation for renal tumors is a safe and effective alternative to surgery.

El cáncer renal representa el 3 al 4% de todas las lesiones malignas y su detección incidental es cada vez más frecuente. Para los tumores renales cT1a la cirugía es el tratamiento de elección. No todos los pacientes son candidatos a este tipo de tratamiento por elevado riesgo quirúrgico debido a comorbilidades asociadas o antecedentes de cirugía en dicho órgano. Las guías de la Asociación Americana de Urología recomiendan la termoablación como alternativa a la cirugía en tumores menores a 3 cm. La experiencia con crioablación percutánea en tumores renales es escasa en Latinoamérica y hay pocas publicaciones al respecto en esta región. El objetivo de este trabajo fue describir la efectividad y seguridad de la crioablación percutánea en una cohorte de pacientes adultos con cáncer renal cT1 (menores a 5 cm) como alternativa al tratamiento quirúrgico. Los procedimientos fueron realizados con guía de tomografía computarizada o con un angiógrafo, en condiciones estériles y bajo anestesia general. Los pacientes fueron tratados en condiciones ambulatorias. El seguimiento se realizó con estudios por imágenes, análisis de laboratorio y consulta clínica. Todos tuvieron una respuesta completa constatada por imágenes en los controles evolutivos. El 61% no tuvo complicaciones y en el resto se observaron complicaciones grado 1 como hematuria, retención urinaria y hematoma perirrenal. Se concluyó que la crioablación percutánea es segura y efectiva como alternativa a la cirugía en pacientes con tumores renales.

Crioablación percutánea de tumores renales cT1 como alternativa al tratamiento quirúrgico / Percutaneous cryoablation of cT1 kidney tumors as alternative to surgical treatment

Resumen El cáncer renal representa el 3 al 4% de todas las lesiones malignas y su detección incidental es cada vez más frecuente. Para los tumores renales cT1a la cirugía es el tratamiento de elección. No todos los pacientes son candidatos a este tipo de tratamiento por elevado riesgo quirúrgico debido a comorbi lidades asociadas o antecedentes de cirugía en dicho órgano. Las guías de la Asociación Americana de Urología recomiendan la termoablación como alternativa a la cirugía en tumores menores a 3 cm. La experiencia con crioablación percutánea en tumores renales es escasa en Latinoamérica y hay pocas publicaciones al respecto en esta región. El objetivo de este trabajo fue describir la efectividad y seguridad de la crioablación percutánea en una cohorte de pacientes adultos con cáncer renal cT1 (menores a 5 cm) como alternativa al tratamiento quirúrgico. Los procedimientos fueron realizados con guía de tomografía computarizada o con un angiógrafo, en condiciones estériles y bajo anestesia general. Los pacientes fueron tratados en condiciones ambulatorias. El seguimiento se realizó con estudios por imágenes, análisis de laboratorio y consulta clínica. Todos tuvieron una respuesta completa constatada por imágenes en los controles evolutivos. El 61% no tuvo complicaciones y en el resto se observaron complicaciones grado 1 como hematuria, retención urinaria y hematoma perirrenal. Se concluyó que la crioablación percutánea es segura y efectiva como alternativa a la cirugía en pacientes con tumores renales.

Abstract Renal cancer represents 3-4% of all malignancies. Its incidental detection is becoming more frequent. Surgery is the gold standard treatment for T1 renal cancer. Still, surgery is not suitable for every patient due to comorbidities or previous kidney surgery. Guidelines provided by The American Urological Association recommend thermoablation therapies as an alternative to surgery in tumors under 3 cm. Experience regarding percutaneous cryoablation in renal tumors is scarce in Latin America and there are only a handful of publications in this region regarding this subject. The objective of this study was to assess the effectiveness and security of percutaneous cryoablation in a cohort of adult patients with cT1 renal cancer (smaller than 5 cm) as an alternative to surgery. The procedures were performed with CT or Cone Beam CT guidance and under general anesthesia in sterile conditions. Cryoablation was carried out on an outpatient basis. Follow up was done with imaging studies, blood test and clinical consultation. All patients had complete response in imaging studies. There were no complications in 61% of all of them, the remaining patients suffered grade-1 complications such as hematuria, urinary reten tion and perirenal hematoma. In conclusion, percutaneous cryoablation for renal tumors is a safe and effective alternative to surgery.

Performance of Ultrasonography Compared to Conventional Radiography for the Diagnosis of Osteoarthritis in Patients With Knee Pain.

Purpose: To investigate the performance of ultrasonography (US) for the detection of knee osteoarthritis (OA) in patients suffering from knee pain, compared to conventional radiographs. Methods: Cross-sectional study performed at a university teaching hospital. Consecutive patients complaining of unilateral or bilateral mechanical knee pain who signed an informed consent were included. All patients underwent simultaneously an ultrasonographic and a radiographic evaluation of the knee. Exclusion criteria were age under 18 years, prior diagnosis of knee OA, diagnosis of inflammatory arthritis, history of knee surgery or trauma, severe knee deformities, and corticosteroid injection within the last 2 months. The diagnostic properties of US for the detection of knee OA were evaluated using radiological data as the reference method. Evaluated test properties were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the positive and negative likelihood ratio (LR+ and LR-). Results: Three-hundred twenty-two knees (281 patients) were included. Radiographic degenerative changes were present in 56.8% (183) of the evaluated knees. Regarding the diagnostic properties of the US, the presence of either osteophytes or the compromise of the femoral hyaline cartilage had the best sensitivity to detect OA (95%), with a NPV of 92% and a LR- of 0,07, while the combined identification of osteophytes and compromise of the femoral hyaline cartilage had the best specificity (94%), with 94% PPV and a LR+ of 13. Conclusion: US demonstrated an excellent sensitivity with an adequate specificity for the detection of radiographic knee OA.

Arteriovenous Fistula after Endovenous Laser Ablation of Great Saphenous Vein Treated with Covered Stent: Case Report and Literature Review.

Endovenous ablation techniques (radiofrequency or laser) have become the less invasive choice of treatment for superficial venous insufficiency due to saphenous vein incompetence showing high effectiveness and few complications. We present a case of symptomatic arteriovenous fistula between the external iliac artery and vein after endovenous laser ablation repaired with covered stent. We also review the literature and discuss the possible causes and management of this unusual and potentially severe complication, and the feasibility of endovascular treatment.

Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors.

Transarterial radioembolization (TARE), also called radioembolization or selective internal radiation therapy, is an interventional radiology technique used to treat primary liver tumors and liver metastases. The aim of this therapy is to deliver tumoricidal doses of radiation to liver tumors while selecting a safe radiation dose limit for nontumoral liver and lung tissue. Hence, correct treatment planning is essential to obtaining good results. However, this treatment invariably results in some degree of irradiation of normal liver parenchyma, inducing different radiologic findings that may affect follow-up image interpretation. When evaluating treatment response, the treated area size, tumor necrosis, devascularization, and changes seen at functional MRI must be taken into account. Unlike with other interventional procedures, with TARE, it can take several months for the tumor response to become evident. Ideally, responding lesions will show reduced size and decreased enhancement 3-6 months after treatment. In addition, during follow-up, there are many imaging findings related to the procedure itself (eg, peritumoral edema, inflammation, ring enhancement, hepatic fibrosis, and capsular retraction) that can make image interpretation and response evaluation difficult. Possible complications, either hepatic or extrahepatic, also can occur and include biliary injuries, hepatic abscess, radioembolization-induced liver disease, and radiation pneumonitis or dermatitis. A complete understanding of these possible posttreatment changes is essential for correct radiologic interpretations during the follow-up of patients who have undergone TARE. ©RSNA, 2019.

Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance.

PURPOSE: To evaluate if parabulbar triamcinolone reduces orbital swelling in patients with Graves ophthalmopathy. METHODS: This is a prospective study of a series of patients with active and moderate Graves ophthalmopathy. Short tau inversion recovery magnetic resonance was used to evaluate the intensity of the extraocular rectus muscles and orbital fat, before and after the treatment with parabulbar triamcinolone. RESULTS: The signal intensity ratio of the sum of the OD rectus muscles was 3.67 before treatment (95% CI, 3.26-4.09) and 2.83 after treatment (95% CI, 2.63-3.03) (p < 0.001), and of the muscles of the left orbit, 3.94 before treatment (95% CI, 3.50-4.38) and 2.85 after treatment (95% CI, 2.56-3.14) (p < 0.001). The signal intensity ratio of the fat decreased from 2.95 (95% CI, 2.69-3.21) to 2.33 (95% CI, 2.07-2.58) (p < 0.001). After treatment, there were no local or systemic complications. CONCLUSION: The use of parabulbar triamcinolone reduces orbital inflammation of patients with active and moderate Graves ophthalmopathy.

Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study.

INTRODUCTION: Hysterectomy is the standard of care in placenta accreta spectrum (PAS). To reduce the risks of obstetric hemorrhage during surgery, endovascular interventions have been proposed. Our aim is to evaluate the feasibility and safety of the overall non-conservative management of PAS in the hybrid operating room (OR) to replace the classic two-step procedure (catheterization in the interventional radiology suite and transfer to conventional OR). MATERIALS AND METHODS: This is a retrospective study of series of patients with histopathologic confirmation of PAS treated in the hybrid OR at the same university hospital. We used for comparison our historical cohort managed with the standard two-step procedure. RESULTS: We included 110 patients, 80 in the conventional OR and 30 in the hybrid OR. There were no cases of major complications attributable to the endovascular procedures. In the two-step procedure, there were 10 (12.5%) intra-arterial catheter displacements that required repositioning in the conventional OR under mobile C-arm fluoroscopy and no cases in the hybrid OR (p = 0.04). The mean operative time was 380 + 42 min in the conventional OR and 296 + 66 min in the hybrid OR (p = .00001). There were no differences in the gestational age at delivery, postoperative length of stay, or large-volume blood transfusion. There were no maternal deaths. CONCLUSIONS: The overall non-conservative management of PAS in the hybrid OR has shown to be feasible and safe in our series, offering potential advantages to replace the classic two-step procedure. More studies are needed to evaluate whether this strategy is cost-effective and whether it may improve maternal and perinatal outcomes.

Intraoperative stent placement for the treatment of acute portal vein complications in pediatric living donor liver transplantation.

PURPOSE: Pediatric living donor liver transplantation (LDLT) in low weight recipients remains one of the most complex surgical procedures, with portal vein (PV) complications occurring in up to 19% of cases. When decreased PV flow is diagnosed intra- or perioperatively, intraoperative stent placement is a good substitute for surgical adjustment. Still, at the present moment, little is known about the technical feasibility, safety, efficacy, and long-term outcome of intraoperative stenting in LDLT. METHODS: Between 2006 and 2017, seven pediatric recipients underwent PV stent placement during the transplant or in the immediate post-operative setting. Preoperative, operative, and post-operative parameters were documented retrospectively. RESULTS: In total, nine stents were placed in seven patients. Procedures were technically successful in all patients. During the mean imaging follow-up period of 1313 days, none of the patients showed PV abnormality and PV stent remained patent throughout the post-transplant course. There were no deaths or graft loses during the follow-up period. CONCLUSIONS: Intraoperative stenting through the inferior mesenteric vein approach offers both a high feasibility and satisfactory results, with the potential for excellent long-term primary patency despite continued growth in children.

Symptomatic Iliofemoral and Iliocaval Venous Thrombosis in Patients With Cancer: Endovascular Treatment.

INTRODUCTION:: Proximal (iliocaval and iliofemoral) deep vein thrombosis (DVT) and pulmonary thromboembolism are the second cause of death in patients with cancer. MATERIAL AND METHODS:: A retrospective analysis was performed in 35 patients with cancer treated with endovascular therapy for proximal DVT. The primary objective was to evaluate the technical success of the procedure and the 30-day and long-term symptom improvement. RESULTS:: Thirty-five patients with a mean age of 57.7 years were treated. In 27 patients, DVT was due to tumor compression and/or invasion of the iliocaval venous axis, and in the remaining 8, it was secondary to their hypercoagulability state. The revascularization techniques used were manual catheter-directed aspiration of the thrombus plus angioplasty and stenting. Technical success was achieved in 33 patients. No complications occurred. Twenty-seven patients were followed up at 30 days posttreatment: 21 were free of postthrombotic syndrome, 4 (14.8%) had mild symptoms, and 2 (7.4%) had moderate symptoms. The mean long-term follow-up was 27.3 months, with a primary patency of 68.8% and assisted and secondary patency rates of 100%. CONCLUSION:: Endovascular revascularization in patients with cancer with extensive and symptomatic proximal DVT is safe and efficient, with a low rate of complications. We consider that this therapy should be offered to patients with cancer with an average or long life expectancy.

Resultado clínico del tratamiento endovascular con balón liberador de fármaco en el paciente claudicante con enfermedad femoropoplítea / Clinical Outcome of Drug-Eluting Balloon Endovascular Treatment for Femoropopliteal Lesions in Patients with Intermittent Claudication

RESUMEN Introducción: La restenosis continúa siendo el gran desafío de la terapia endovascular, por esa razón, se han desarrollado balones liberadores de fármaco (BLF) con la finalidad de reducir la restenosis. El objetivo de este trabajo es analizar los resultados de esta terapia. Material y métodos: Se realizó un análisis retrospectivo de 40 extremidades de pacientes claudicantes con lesiones femoro-poplíteas tratados con BLF. Resultados: Se obtuvo el éxito técnico en las 40 (100%) extremidades tratadas con una media de seguimiento de 11,1 mes sin evidencia de complicaciones graves relacionadas con el tratamiento con un 92,5% de las extremidades asintomáticas durante el seguimiento. En tres extremidades se realizó una nueva angioplastia por recidiva sintomática. Conclusiones: El BLF ha probado ser una herramienta útil, segura y eficaz para el tratamiento de lesiones de novo y restenosis intrastent; no obstante, en las lesiones TASC C-D se requiere la utilización de un mayor número de stents.

ABSTRACT Background: Restenosis continues to be the great challenge of endovascular therapy, and drug-eluting balloons (DEB) have been developed to reduce it. The aim of this study was to analyze the results of this therapy. Methods: A retrospective analysis of 40 limbs with femoropopliteal lesions treated with DEB was conducted in patients with intermittent claudication. Results: Technical success was obtained in the 40 (100%) limbs treated, without evidence of serious complications related with treatment, and with 92.5% of asymptomatic limbs during the follow-up period of 11.1 months. In three limbs, a new angioplasty was performed due to symptomatic recurrence. Conclusions: The drug-eluting balloon has proven to be a useful, safe and effective tool for the treatment of de novo and in-stent restenosis lesions; however, TASC C-D lesions require the use of greater number of stents.

Endovascular treatment of paravisceral mycotic aneurysm: Chimmeny endovascular sealing the end of de road.

Open surgery is the elective treatment for mycotic aneurysms of the aorta. This surgery consists of resection of the aneurysm, debridement and revascularization with an in situ or extra-anatomic bypass. Even when surgery has been successful, the morbi-mortality is raised and the endovascular treatment has become an alternative for specific patients. When mycotic aneurysms involved the visceral arteries, more complex techniques are necessary such as fenestrated endovascular aortic repair or chimmeny endovascular aortic repair and the most frequent complications of this are endoleaks and oclussion the visceral arteries. We present a case of a pacient with a paravisceral abdominal mycotic aneurysms that was result with 2 chimney technique (in the right renal and superior mesenteric arteries) and a single Nellix EVAS (Endologix, Irvine, Calif) of 12 cm long without evidence of endoleaks in the follow-up.

Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory.

OBJECTIVE: It has been shown that nail involvement in psoriasis is associated with systemic enthesopathy. Our objective was to evaluate the association of nail involvement and enthesopathy at distal interphalangeal joint (DIP) level in psoriasis (PsO) and psoriatic arthritis (PsA) patients. METHODS: Consecutive patients (54 PsO and 56 PsA) seen at the outpatients clinic in this cross-sectional study were included. All patients underwent both clinical and ultrasound (US) assessment on the same day. RESULTS: US revealed enthesopathy in at least 1 DIP joint in 9 patients with PsO (17%, 95% CI: 8-29%) and in 18 patients with PsA (32%, 95% CI: 20-46%). US extensor tendon enthesopathy was detected in a higher proportion of fingers with clinical nail involvement compared with fingers without clinical nail involvement, both in PsO and PsA patients (61.2% vs 16.8%, p < 0.0001 and 60.1% vs 22%, p < 0.0001, respectively). Among patients with PsO, 20% (95% CI: 7-41%) and 14% (95% CI: 4-32%) of those with and without clinical nail involvement showed enthesopathy on US examination, respectively (p = 0.54). Among PsA patients, the prevalence of enthesopathy was 30% (95% CI: 15-49%) for patients with clinical nail involvement and 35% (95% CI: 17-56%) for those without nail involvement (p = 0.71). CONCLUSION: Nail disease was associated with DIP US enthesopathy. There was a significant increased prevalence of extensor tendon enthesopathy in fingers with involved nails both in PsO and PsA, although no association was found between nail involvement and extensor tendon enthesopathy at patients' level. These features might support the nail-entheseal pathogenesis theory at DIP level.