Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT / Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico.(AU)

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.(AU)

Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy.

BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

COVID-19 pneumonia: Relationship between initial chest X-rays and laboratory findings.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (P<.05 for platelets, P<.01 for lymphocytes, and P<.001 for the remaining parameters), as well as with the time from the onset of symptoms (P<.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

COVID-19 pneumonia: relationship between initial chest X-rays and laboratory findings. / Neumonía COVID-19: relación entre la radiografía de tórax inicial y los datos analíticos.

OBJECTIVE: To analyze the initial findings in chest X-rays of patients with RT-PCR positive for SARS-CoV-2, and to determine whether there is a relationship between the severity of these findings and the clinical and laboratory findings. MATERIALS AND METHODS: This retrospective study analyzed the relationship between initial chest X-rays and initial laboratory tests in symptomatic adults with nasopharyngeal RT-PCR results positive for SARS-CoV-2 seen at our center between February 29 and March 23, 2020. Among other radiologic findings, we analyzed ground-glass opacities, consolidations, linear opacities, and pleural effusion. We also used a scale of radiologic severity to assess the distribution and extent of these findings. Among initial laboratory findings, we analyzed leukocytes, lymphocytes, platelets, neutrophil-to-lymphocyte ratio, and C-reactive protein. RESULTS: Of 761 symptomatic patients, 639 (84%) required hospitalization and 122 were discharged to their homes. The need for admission increased with increasing scores on the scale of radiologic severity. The extent of initial lung involvement was significantly associated with the laboratory parameters analyzed (p<0.05 for platelets, p<0.01 for lymphocytes, and p<0.001 for the remaining parameters), as well as with the time from the onset of symptoms (p<0.001). CONCLUSION: It can be useful to use a scale of radiologic severity to classify chest X-ray findings in diagnosing patients with COVID-19, because the greater the radiologic severity, the greater the need for hospitalization and the greater the alteration in laboratory parameters.

Recomendaciones para el diagnóstico radiológico y la valoración de la respuesta terapéutica en el cáncer de pulmón. Consenso nacional de la Sociedad Española de Radiología Médica y la Sociedad Española de Oncología Médica / Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology

En esta última década se han producido avances importantes en el diagnóstico y tratamiento del cáncer de pulmón que han permitido mejorar su pronóstico. Por ello, la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Oncología Médica (SEOM) han elaborado un documento de consenso nacional para hacer recomendaciones sobre el diagnóstico radiológico y la valoración de la respuesta terapéutica en pacientes con cáncer de pulmón. Este grupo de expertos recomienda la tomografía computarizada multidetector (TCMD) como la técnica de elección para estudiar esta enfermedad, y respecto al informe radiológico incluir una valoración completa siguiendo el sistema de estadificación TNM. Por último, cuando el paciente reciba inmunoterapia, además de usar los criterios para evaluar la respuesta en tumores sólidos (Response Evaluation Criteria in Solid Tumors [RECIST 1.1]) también habrá que usar los criterios de respuesta inmunológica (Immune-Related Response Criteria [irRC]) (AU)

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM) have therefore produced a national consensus statement in order to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography (MDCT) as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only Response Evaluation Criteria in Solid Tumours (RECIST 1.1) but also Immune-Related Response Criteria (irRC) (AU)

Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology have therefore produced a national consensus statement to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only response evaluation criteria in solid tumours, but also immune-related response criteria (AU)

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Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology.

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology have therefore produced a national consensus statement to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only response evaluation criteria in solid tumours, but also immune-related response criteria.

[Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology]. / Recomendaciones para el diagnóstico radiológico y la valoración de la respuesta terapéutica en el cáncer de pulmón. Consenso nacional de la Sociedad Española de Radiología Médica y la Sociedad Española de Oncología Médica.

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM) have therefore produced a national consensus statement in order to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography (MDCT) as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only Response Evaluation Criteria in Solid Tumours (RECIST 1.1) but also Immune-Related Response Criteria (irRC).

Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas / Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics

Introducción: En los últimos años se ha producido un incremento de las infecciones invasivas por este patógeno que requieren ingreso en cuidados intensivos pediátricos (UCIP). Pacientes y métodos: Estudio retrospectivo (entre enero del 2006 y junio del 2010) en el que se incluyó a todos los pacientes con infección por Staphylococcus Aureus (S. aureus) que precisaron ingreso en UCIP. Estos fueron clasificados en 2 grupos: infección comunitaria (grupo 1) e infección nosocomial (grupo 2). Se recogieron los siguientes datos: epidemiológicos, tipo de aislamiento de S. aureus (S. aureus sensible a meticilina [SASM], S. aureus resistente a metilicina [SARM]), factores de riesgo, localización de la infección, presencia de inestabilidad hemodinámica, soporte respiratorio y mortalidad. Resultados: Se estudiaron a 51 pacientes, 21 pertenecientes al grupo 1 y 30 al grupo 2. La mediana de edad fue menor en el grupo 1 (1,6 años frente 3,2 años, p = 0,009). Se aisló SASM en el 88% de los casos. Se detectaron 6/51 (12%) pacientes con infección por SARM, los cuales se aislaron en el último periodo del estudio (enero 2009-junio 2010). Los factores de riesgo fueron: inmunosupresión, catéter venoso central, institucionalización, ventilación mecánica, cirugía previa, traumatismo previo y osteomielitis crónica. Un 83% de los pacientes con infección por SARM tenían factores de riesgo. La localización de la infección por S. aureus fue variada, siendo las infecciones respiratorias las más frecuentes (75%). Un 43% de los pacientes requirieron fármacos vasoactivos. La mayoría de los pacientes (86%) requirió soporte respiratorio. Un paciente del grupo 1 falleció por neumonía necrotizante por SAMS. Conclusiones: Las infecciones por S. aureus son graves y tienen elevada morbilidad. La infección pulmonar es la más frecuente en esta serie. Aunque el aislamiento de SASM es predominante en estas infecciones se ha visto una tendencia al incremento de las infecciones por SARM en el último periodo del estudio (AU)

Introduction: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). Patients and methods: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. Results: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=0.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010).The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. Conclusions: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study(AU)

Resolución de múltiples nódulos pulmonares cavitados con el abandono del hábito tabáquico como único tratamiento / Resolution of multiple cavitated lung nodules with smoking cessation as the only treatment

El término histiocitosis hace referencia a un grupo heterogéneo de enfermedades caracterizadas por la infiltración de células de Langerhans (CL) en diferentes órganos. La histiocitosis pulmonar (HP) es una enfermedad poco frecuente que afecta típicamente a adultos jóvenes. Su patogenia no es bien conocida, aunque se ha observado una relación con el tabaquismo, por lo que la primera medida de tratamiento que se debe realizar es el abandono de éste. Presentamos un caso de histiocitosis pulmonar que evolucionó en seis meses de forma favorable, clínica, funcional y radiológicamente como consecuencia del abandono del tabaco como único tratamiento (AU)

The term histiocytosis refers to a heterogeneous group of diseases characterized by the infiltration of Langerhans cells (LC) in different organs. Pulmonary Histiocytosis (PH) is anuncommon disease that typically affects young adults. Its pathogeny is not well known, although a relationship with smoking has been observed. Thus, the first treatment measure should be smoking cessation. We present a case of pulmonary histiocytosis that showed a favorable clinical, functional and radiological course in six months as a consequence of using smoking cessation as the only treatment (AU)

[Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics]. / Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas.

INTRODUCTION: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). PATIENTS AND METHODS: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. RESULTS: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010). The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. CONCLUSIONS: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study.

[Cystic lymphangioma of the spleen in a patient with Klippel-Trenaunay-Weber syndrome: MRI findings]. / Linfangioma quístico esplénico en una paciente con síndrome de Klippel-Trenaunay-Weber. Hallazgos en la ecografía y la RM.

We present the case of a 22-year-old woman with Klippel-Trenaunay-Weber syndrome who presented with clinical signs and symptoms of gastrointestinal obstruction. Ultrasonography and magnetic resonance imaging showed massive splenomegaly with multiple cysts replacing the normal parenchyma of the spleen. Histologic study after splenectomy confirmed the diagnosis of cystic lymphangioma of the spleen, which is an exceptional manifestation of Klippel-Trenaunay-Weber syndrome.

Linfangioma quístico esplénico en una paciente con síndrome de Klippel-Trenaunay-Weber. Hallazgos en la ecografía y la RM / Cystic lymphangioma of the soleen in a patient with Klippel-Trenaunay- Weber syndrome: MRI findings

Presentamos un caso de síndrome de Klippel-Trenaunay-Weber en una mujer de 22 años con clínica obstructiva gastrointestinal. La ecografía y la resonancia magnética mostraron una esplenomegalia masiva con múltiples quistes reemplazando el parénquima esplénico normal.Se realizó esplenectomía y el estudio histológico confirmó el diagnóstico de linfangioma quístico esplénico. Esta entidad es una manifestaciónexcepcional del síndrome de Klippel-Trenaunay-Weber

We present the case of a 22-year-old woman with Klippel-Trenaunay-Weber syndrome who presented with clinical signs and symptoms of gastrointestinal obstruction. Ultrasonography and magnetic resonance imaging showed massive splenomegaly with multiple cysts replacingthe normal parenchyma of the spleen. Histologic study after splenectomy confirmed the diagnosis of cystic lymphangioma of the spleen, which is an exceptional manifestation of Klippel-Trenaunay-Weber syndrome

Neumotórax catamenial. Hallazgos radiológicos / Imaging findings in catamenial pneumothorax

Objetivo. Mostrar la forma de presentación y los hallazgos radiológicos del neumotórax catamenial.Material y método. Se revisaron las pruebas de imagen (radiografía simple, tomografía computarizada [TC] y resonancia magnética [RM]) de 6 mujeres de entre 28 y 44 años que presentaron neumotórax recurrentes asociados a la menstruación. A todas se les realizó cirugía por videotoracoscopia (VTS) y en tres de ellas fue necesaria la realización de una toracotomía debido a la recurrencia del neumotórax.Resultados. En tres casos se realizó TC, encontrando nódulos pleurales en dos casos, uno de ellos confirmado en la RM. Histológicamente se demostró endometriosis pleural en un único caso. Se identificaron agujeros diafragmáticos y bullas en 5 de las 6 pacientes.Discusión. Los síntomas más frecuentes del neumotórax catamenial son el dolor torácico, la disnea y la hemoptisis. La localización más frecuente es el lado derecho (90%). Los hallazgos radiológicos son neumotórax, hemotórax o hidroneumotórax. La TC y la RM pueden ayudar en la identificación de lesiones pleurales no visibles en la radiografía simple que suponen un hallazgo muy frecuente en la cirugía.Conclusión. El diagnóstico de neumotórax catamenial debe sospecharse en mujeres en edad fértil con historia de neumotórax recidivantes coincidentes con la menstruación. La TC y la RM pueden ayudar a identificar lesiones sospechosas de endometriosis

Objective. To show the presentation and imaging findings of catamenial pneumothorax.Material and methods. We reviewed the imaging tests (plain-film radiography, computed tomography [CT], magnetic resonance [MR]) performed in six women aged between 28 and 44 years with recurrent pneumothorax associated to menstruation. All patients underwent videothoracoscopic surgery and thoracotomy was necessary in three due to the recurrence of the pneumothorax.Results. CT was performed in three cases and found pleural nodules in two; one of these was confirmed at MR. Pleural endometriosis was only demonstrated at histological examination in one case. Diaphragmaticblebs and bullae were found in five of the six patients.Discussion. The most common symptoms of catamenial pneumothorax are chest pain, dyspnea, and hemoptysis. The right side is affected in 90% of cases. The radiological findings are pneumothorax, hemothorax,or hydropneumothorax. CT and MR can help to identify thepleural lesions that are not visible on plain-film radiographs and are a very common finding at surgery.Conclusion. The diagnosis of catamenial pneumothorax should be suspected in fertile-aged women with a history of recurrent pneumothorax coinciding with menstruation. CT and MR can help to identify lesions suspicious of endometriosis

[Imaging findings in catamenial pneumothorax]. / Neumotórax catamenial.Hallazgos radiológicos.

OBJECTIVE: To show the presentation and imaging findings of catamenial pneumothorax. MATERIAL AND METHODS: We reviewed the imaging tests (plain-film radiography, computed tomography [CT], magnetic resonance [MR]) performed in six women aged between 28 and 44 years with recurrent pneumothorax associated to menstruation. All patients underwent videothoracoscopic surgery and thoracotomy was necessary in three due to the recurrence of the pneumothorax. RESULTS: CT was performed in three cases and found pleural nodules in two; one of these was confirmed at MR. Pleural endometriosis was only demonstrated at histological examination in one case. Diaphragmatic blebs and bullae were found in five of the six patients. DISCUSSION: The most common symptoms of catamenial pneumothorax are chest pain, dyspnea, and hemoptysis. The right side is affected in 90% of cases. The radiological findings are pneumothorax, hemothorax, or hydropneumothorax. CT and MR can help to identify the pleural lesions that are not visible on plain-film radiographs and are a very common finding at surgery. CONCLUSION: The diagnosis of catamenial pneumothorax should be suspected in fertile-aged women with a history of recurrent pneumothorax coinciding with menstruation. CT and MR can help to identify lesions suspicious of endometriosis.

[Successful pregnancy in a patient with systemic lupus erythematosus on hemodialysis]. / Gestación con éxito en una paciente con lupus eritematoso sistémico en hemodiálisis.

We report a twenty-nine-year-old patient, on renal replacement treatment (including 2 kidney transplants) since she was 11 years old, because of systemic lupus erythematosus. The patient became pregnant on hemodialysis, concluding the pregnancy successfully. The evolution and management of pregnancy were described and the related literature was revised. We concluded that, although pregnancy on hemodialysis and/or systemic lupus erythematosus patients involves a high risk for the mother and the fetus that makes advisable contraception, an increase in success in pregnancies in systemic lupus erythematosus patients on remission during the previous months, has been recently observed. Moreover, the increase of frequency and duration of hemodialysis sessions, has improved the neonatal survival around the 50% in pregnancies on dialysis. We emphasize the difficulty to maintain the mother's hemoglobin at an adequate target, as well as the high frequency of fetal prematury.

[Immunity and malnutrition in alcoholic liver diseases]. / Inmunidad y malnutrición en hepatopatías alcohólicas.

Assessment of immunity was performed in 150 patients with alcoholic liver disease (15 steatosis, 30 hepatitis and 105 cirrhosis: 34 in grade A, 34 in grade B and 37 in grade C, according to Child-Pugh classification). This assessment was based on the total lymphocyte count and a delayed hypersensitivity skin multiple test. Likewise, nutritional status of patients was studied using anthropometric and biochemical parameters (triceps skinfold thickness, arm muscle circumference and serum albumin). The association between alcoholic liver disease, malnutrition and immunity was analyzed. The results show that lymphopenia and disorders in cell-mediate immunity were more common in those patients with cirrhosis, increasing the number of anergic patients while the degree of hepatocellular insufficiency worsens (8.8% in grade A, 11.8% in grade B and 32.4% in grade C). Although there where significantly more alterations of delayed cutaneous hypersensitivity in cirrhotics with malnutrition (hypoergy: 55.2% and anergy: 37.9%) than in those well nourished (hypoergy: 23.7% and anergy: 10.5%, p < 0.01), lymphopenia didn't show differences between these groups. We think that immunity mus'nt be considered a parameter in nutritional assessment.