Lesión de Dieulafoy, ¿y eso qué es? / Dieulafoy lesion, what is this?

El sangrado gastrointestinal es un motivo de consulta frecuente, tanto en los servicios de urgencias hospitalarios como en Atención Primaria. Existen múltiples etiologías que lo pueden motivar. La lesión de Dieulafoy es una causa rara pero potencialmente grave de hemorragia digestiva. Su localización más frecuente es el estómago. Clínicamente se expresa en forma de: melena, hematemesis o hematoquecia. Para su diagnóstico se pueden utilizar diversas exploraciones complementarias, como la angiografía, el angio-TC o la endoscopia. El tratamiento en casos recurrentes consiste en realizar embolización a través de un cateterismo intervencionista (AU)

Gastrointestinal bleeding is a common reason for consultation, both in hospital emergency services and in Primary Care. There are multiple etiologies that can motivate it. Dieulafoy's lesion is a rare but potentially serious cause of gastrointestinal bleeding. Its most common location is the stomach. Clinically it is expressed in the form of: melena, hematemesis or hematochezia. Various complementary exams can be used for its diagnosis, such as angiography, angio-CT or endoscopy. Recurrent bleeding treatment consists of embolization through interventional catheterization. (AU)

Incidence of venous thromboembolism in patients with non-hematological cancer admitted for COVID-19 at a third-level hospital in Madrid.

An increased risk of venous thromboembolism (VTE) in hospitalized patients with COVID-19 has been reported. We aimed to describe the incidence rate of VTE on patients with non-hematological cancer who required hospitalization due to COVID-19 at our center. In this prospective study, non-hematological cancer patients hospitalized for confirmed COVID-19 at our institution from 1st March to 30th April 2020, were evaluated daily for VTE complications during their hospital stay, and after discharge until 30th June 2020. Furthermore, Doppler ultrasound of lower limbs was routinely performed in asymptomatic patients based on D-dimer levels and current active cancer therapy. The primary outcome of this study was the cumulative incidence of VTE. Secondary outcomes were the cumulative incidence of bleeding and mortality. A total of 58 hospitalized non-hematological cancer patients and confirmed COVID-19 were identified. Median follow-up since initial symptoms of COVID-19 was 91 days (IQR 19-104). Pulmonary embolism was diagnosed in three (5%) patients. Symptomatic catheter-related deep vein thrombosis (DVT) was observed in one patient. Doppler ultrasound of lower limbs was done in 11 asymptomatic patients, showing distal DVT in two of them (18%). The cumulative incidence of VTE on day 14 after admission was 10%, without new VTE events after hospital discharge and up to 90 days follow-up. No bleeding complication was observed. Seventeen patients (29%) died in the first 14 days after COVID-19 diagnosis. Four patients died after discharge due to malignancy progression. The cumulative incidence of VTE in non-hematological cancer patients under active treatment was 10% at day 14 after admission, with no further new events in the following 12 weeks.

Filtro de vena cava inferior bioconvertible / Bioconvertible inferior vena cava filter

Se presenta un caso clínico donde por complicación hemorrágica y proceso de tromboembolia pulmonar, se colocó un filtro de vena cava inferior bioconvertible. Se describen las características técnicas, el mecanismo de funcionamiento, las ventajas y las limitaciones de esta novedad tecnológica.(AU)

A clinical case is presented in which due to a hemorrhagic complication and a pulmonary thromboembolism, a bioconvertible inferior vena cava filter was placed in a patient. The technical characteristics, advantages and limitations of this technological innovation are described.(AU)

Síndrome de congestión pélvica: revisión actualizada de la literatura / Pelvic congestion syndrome: updated literature review

El síndrome de congestión pélvica (SCP) es una causa frecuente, aunque poco conocida, de dolor pélvico crónico en mujeres premenopáusicas. Aunque su etiología no está del todo clara, en general se acepta la incompetencia valvular como causa del SCP primario, mientras los síndromes compresivos llevan al SCP secundario. El diagnóstico de este síndrome se realiza después de excluir otras causas de dolor pélvico crónico y se basa en una combinación de síntomas clínicos característicos (dolor crónico, continuo o sordo, dispareunia, dismenorrea...) y en la documentación de dilatación o incompetencia de las venas pélvicas mediante pruebas de imagen. La terapia endovascular (escleroterapia, embolización o stent) de las venas incompetentes con reflujo o venas estenóticas constituye el estándar de tratamiento. El objetivo del presente trabajo es realizar una revisión actualizada de la literatura con el propósito de ayudar a mejorar el conocimiento de esta patología

Pelvic congestion syndrome (PCS) is a common, but little-known, cause of chronic pelvic pain in premenopausal women. Although its etiology is not entirely clear, valvular incompetence is generally accepted as the cause of primary PCS, while compressive syndromes lead to secondary PCS. The diagnosis of this syndrome is made after excluding other causes of chronic pelvic pain, and is based on a combination of characteristic clinical symptoms (chronic pain, continuous or dull, dyspareunia, and dysmenorrhea) and documentation of dilation or incompetence of pelvic veins by imaging tests. Endovascular therapy (sclerotherapy, embolization or stenting) of incompetent and reflux veins or stenotic veins, is today the standard of treatment. The objective of this work is to carry out an updated revision of the literature with the purpose of helping to improve the knowledge of this pathology

[Radiological diagnosis: scrotal ultrasound and Doppler ultrasound in the diagnosis of male infertility]. / Diagnóstico por imagen: ecografía escrotal y eco doppler en el diagnóstico de la infertilidad masculina.

OBJECTIVES: To review the ultrasound technique, normal anatomy, bibliography, as well as the most frequent scrotal ultrasound findings in infertile patients studied in our center over the last five years, with special emphasis in the diagnosis of varicocele and its follow-up after surgical treatment or embolization. METHODS: We reviewed a total of 439 male patients with the diagnosis of infertility referred to our vascular ultrasound section between 1998 and 2004, and 101 patients referred for ultrasound control after treatment of varicocele (endovascular or surgical). RESULTS: The most frequent diagnosis associated with infertility were left varicocele (146 patients, 33.3%), right varicocele (39 patients, 8.9%) and intratesticular varicocele (1 patient, 0.2%). Only one patient had a right-side-only varicocele (0.2%), the rest of the cases of right varicocele having bilateral affectation (38 patients, 8.7%). Other relevant diagnoses found were testicular atrophy, epididymal lesions, microlithiasis, inguinal scrotal hernias, testicular tumors, and dilation of the rete testis. CONCLUSIONS: Testicular ultrasound should be performed in every patient with unexplained infertility and abnormal sperm analysis. It allows diagnosis of more pathologic conditions than physical examination. Besides a rapid varicocele screening, colour Doppler ultrasound allows us to evaluate its hemodynamic repercussion, by studying the spectral display, colour and response to Valsalva's. It also provides an exact measure of testicular volume, allows to detect the presence of dystrophic changes in the testicle, as well as anomalies of the epididymis and vas deferens, such as cystic dilations. It is also the test of choice to detect non descended testicles. Ultrasound may also detect non palpable testicular tumors which are more prevalent in this group of patients.

[Varicocele's radiological endovascular occlusion]. / Oclusión radiológica endovascular del varicocele.

OBJECTIVES: To report our experience on percutaneous treatment of male varicocele over the last 15 years. METHODS: 690 patients with left varicocele underwent percutaneous occlusion of the spermatic vein. Embolization was undertaken using various types of materials; the most frequently used association was coils and sclerosing substances. Thorough clinical control was carried out, including ultrasound and spermiogram when indicated. RESULTS: Initial success rate was 97.8% and complication rate was 6.2%. Varicocele persistence or relapse was found in 13.2% of the cases after embolization. In the group of patients with sperm tests on follow-up, sperm counts became normal in 46% of the patients, and "a + b" mobility in 35%. Post-treatment pregnancy rate was 20%. CONCLUSIONS: Percutaneous occlusion of the spermatic vein is a very extensively developed technique. Its efficacy and nearly null rate of severe complications, associated with its good results, make it the technique of choice in the treatment of male varicocele.

[The treatment of varicocele in the infertile male II: results on fertility]. / Tratamiento del varicocele en el varón infértil II: resultados sobre la fertilidad.

OBJECTIVES: To analyze the efficacy of varicocele treatment, either surgical or endovoscular radiological occlusion, on pregnancy rates of infertile couples in which the male had clinically. patent left varicocele, and to identify which factors are associated with the probability of obtaining pregnancy in such cases. METHODS: This study is part of a more ample one described in previous article: "The treatment of varicocele in the infertile male I: Results on semen quality". Overall, 183 couples were included. 157 males received treatment (131 radiological occlusion and 26 open surgery), the remaining 26 did not received the treatment indicated. Couples underwent periodic follow-up during the first year, evaluating two parameters: 1) normalization of semen analysis parameters, and 2) pregnancy during the following 12 months after indication of treatment. RESULTS: Overall, 41 couples (22.4%) achieved pregnancy during first year, 35/157 (22%) in the group of treated patients, and 6/26 (23%) in the non treatment group. In the treatment group, surgical ligature achieved higher pregnancy rates than radiological occlusion (35% vs. 20%), but the difference was not statistically significant (p = 0.255). No association was demonstrated between male age, female age, varicocele clinical grade, degree of semen quality abnormalities, or duration of infertility and pregnancy rates. The FSH value was significantly lower (p 0.0006) in patients who achieved pregnancy. CONCLUSIONS: The degree of semen quality abnormality, which so closely correlated to normalization of seminal parameters, locked of prognostic significance in terms of achievement of pregnancy. The FSH value was the only factor with certain prognostic value, although it did not reach significance in logistic regression analysis.

Embolización de arterias bronquiales en el tratamiento de la hemoptisis de origen sistémico: experiencia en 44 pacientes / Bronchial artery embolization in the treatment of systemic hemoptysis: experience in 44 patients

Objetivo: Valorar la eficacia y seguridad de la embolización bronquial en el tratamiento de la hemoptisis de origen sistémico. Material y métodos: Se revisan retrospectivamente 44 pacientes embolizados durante los años 1981-1999 por hemoptisis masiva (mayor 300 ml/24 h) y/o recurrente. Se estudian las diferentes causas de hemoptisis, la distribución de hallazgos arteriográficos y la frecuencia y tipo de complicaciones y de recurrencias. Resultados: La tuberculosis fue la causa más frecuente de hemoptisis (veinte pacientes), seguida de bronquiectasias (siete casos), biopsia/cirugía bronquial (tres casos), neoplasias (dos casos), bullas (dos casos), mucormicosis (un caso), fístula arterio-venosa pulmonar (FAV) (un caso), fibrosis quística (un caso), tromboembolismo pulmonar (TEP) (un caso) siendo indeterminada en seis. El hallazgo arteriográfico más frecuente fue la existencia de una arteria bronquial dilatada y tortuosa (18 pacientes). Otros hallazgos fueron: ramas intercostobronquiales de aspecto tumoral o inflamatorio (ocho casos), parenquimograma patológico/hipervascular (seis casos), extravasado (cinco casos), fístula a arterias (siete casos) o venas pulmonares (tres casos) y aneurismas de Rasmunsen (dos casos). Hubo complicaciones en el 18,1 por ciento de los pacientes, consistentes en fiebre (cuatro casos), fístula broncopleural (dos casos), dolor torácico (un caso) y probable isquemia medular (un caso). Hubo recurrencias en el 22,72 por ciento (10 casos), consistentes en hemoptisis masivas, recidivantes o ambas que requirieron cirugía o reembolización. Conclusiones: La EAB es un tratamiento eficaz, rápido y seguro de hemoptisis masiva y/o recurrente. Por su elevada tasa de éxitos y su baja morbimortalidad, es considerada la técnica de elección en el manejo urgente del paciente con hemoptisis, reemplazando a la cirugía. (AU)