New surgical strategy to induce liver hypertrophy: role of MDCT-volumetry to monitor and predict liver growth.

BACKGROUND/AIMS: To describe the role of MDCT-volumetry to monitor and predict liver hypertrophy in a recently introduced surgical technique in patients needing hepatectomy. METHODOLOGY: This prospective study was approved by the local research and ethics committee and patient informed consent was obtained. Twelve consecutive patients were selected for associating liver partition and portal vein ligation for staged-hepatectomy procedure. The mean absolute the future-liver-remnant (FLR) and FLR/total liver volume (TLV) ratio was calculated before and after surgery to determine the degree of hypertrophy. Six days after surgery a new CT-examination was performed to determine the FLR-volume and FLR/TLV. If the enlargement of the FLR was the expected a second-step surgery was performed. Continuous variables are expressed as mean (range). A p<0.05 was considered significant. RESULTS: The mean pre-operative FLR-volume was 402 mL and the FLR/TLV was 27%. The mean post-operative FLR-volume 6 days after the first step was 702 mL (range 521-1030 mL) being the mean difference between preoperative and postoperative FLR volume 303 mL (p<0.0001). The mean volume increase was 80% ranged from 21-139%. At day six, FLR/TLV was 46.5% (range 33.5-67.7), morbidity was 41% and mortality 0%. CONCLUSIONS: MDCT-volumetry has a key role in decision-making, monitoring and predicting liver hypertrophy pre- and postoperatively.

Huge Pulmonary Arteriovenous Malformation, Venous Thromboembolism and Anticoagulation Treatment in a Patient with Hereditary Hemorrhagic Telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) usually presents in association with pulmonary arteriovenous malformations (PAVMs). In addition, the incidence of venous thromboembolism tends to be increased in these patients. A 74-year-old female with HHT presented with cyanosis and hypoxemia. Contrast-enhanced multislice computed tomography (MSCT) revealed two left PAVMs and one in the right upper lobe. Both left PAVMs were treated with embolotherapy. Follow-up MSCT revealed an incidental pulmonary embolism in the right pulmonary branches. Deep venous thrombosis was confirmed and anticoagulation was initiated. Follow-up MSCT revealed the resolution of thromboembolism. Finally, embolotherapy was performed. This case illustrates the chronic adaptation to hypoxemia and adds further evidence to the relative safety of anticoagulation treatment in these patients.

Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature.

Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are critical in the diagnosis and characterization of this pathology. In this review, CMRs role in TC will be evaluated in light of the current available evidence in medical literature, while also revising the clinical and physiopathologic characteristics of TC.

Colonoscopia virtual: papel en el screening del cáncer colorrectal / Virtual colonoscopy: role in colorectal cancer screening

La colonoscopia virtual (CV) desempeña dos papeles en el screening del cáncer colorrectal (CCR): uno indiscutidoy otro que plantea un debate, aun entre las diferentes sociedades gastroenterológicas, radiológicasy de cáncer más representativas del mundo.El papel que no genera discusión es la clara superioridad (avalada por numerosa evidencia en la literatura) de la CV sobre el estudio colon por enema (CXE) en la detección de CCR y pólipos. Tampoco plantea debate su integración en programas de screening, como reemplazo del CXE en el caso de una colonoscopia convencional (CC) incompleta. El papel que sí es discutido es el avalado por la American Cancer Society (ACS), la US Multi-Society TaskForce on Colorectal Cancer y el American College of Radiology (ACR) que incluye la CV en el grupo deestudios (junto con la CC, la sigmoidoscopia y el CXE) como método diagnóstico en el screening del CCR enpacientes de riesgo promedio, para ser realizado cada 5 años a partir de los 50 años. Algunas sociedades, como el American College of Gastroenterology o el Asia Pacific Working Group onColorectal Cancer, consideran la CV como un método de segunda línea para aquellos pacientes reacios a realizaruna CC o con CC incompletas.Ya sea con un papel discutido u otro más cuestionado, lo cierto es que la CV se viene utilizando y se utiliza cada vez más y no podemos dejar de conocer cómo se realiza, cuáles son sus ventajas, limitaciones y eficaciadiagnóstica. Desde el año 2007 se vienen realizando en el Servicio de Diagnóstico por Imágenes del Hospital Italiano de Buenos Aires un promedio de 950 estudios por año. Y es importante recalcar que la CV no compite con laCC sino que la complementa. El objetivo del presente artículo es: explicar y dar a conocer en qué consiste el métodoy cómo se realiza e interpreta, mostrar sus ventajas, limitaciones y eficaciadiagnóstica.