Embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis: un estudio monocéntrico y retrospectivo / Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: a retrospective single-center study

Objetivos Evaluar la seguridad y la eficacia de la embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis. Métodos Se han analizado un total de 55 pacientes consecutivos con hemoptisis (14 leves, 31 moderadas y 10 masivas) tratados mediante embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil- cianoacrilato entre noviembre de 2013 y enero de 2020. Las variables principales estudiadas son tasa de éxito técnico, tasa de éxito clínico, tasas de recurrencia y complicaciones. Se ha realizado un análisis estadístico descriptivo y un análisis de supervivencia mediante el método de Kaplan-Meier. Resultados En 55 (100%) pacientes se ha realizado la embolización con éxito técnico y en 54 (98,2%), con éxito clínico. Durante el seguimiento (media, 23,8 meses; rango intercuartílico, 9,7-38,2) ha recurrido en 5 de los 54 (9,3%) pacientes. La tasa de no recurrencia al año ha sido del 91,9%, y a los 2 y 4 años, del 88,7% después del procedimiento inicial. Ha habido 6 (10,9%) complicaciones menores relacionadas con el procedimiento y ninguna mayor. Conclusiones La embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato es segura y eficaz para controlar la hemoptisis con tasas de recurrencia bajas (AU)

Objectives To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. Methods We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. Result Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7 – 38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. Conclusions The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates (AU)

Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: A retrospective single-center study.

OBJECTIVES: To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. METHODS: We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. RESULTS: Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7-38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. CONCLUSIONS: The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.

Embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate in patients with hemoptysis: a retrospective single-center study. / Embolización de arterias bronquiales y arterias sistémicas no bronquiales con n-butil-cianoacrilato en pacientes con hemoptisis: un estudio monocéntrico y retrospectivo.

OBJECTIVES: To evaluate the safety and efficacy of the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate (NBCA) in patients with hemoptysis. METHODS: We analyzed a total of 55 consecutive patients with hemoptysis (14 mild, 31 moderate, and 10 massive) treated with the embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate between November 2013 and January 2020. The main variables analyzed were the rates of technical success, of clinical success, of recurrence, and of complications. Statistics included a descriptive analysis and Kaplan-Meier survival curves. RESULTS: Embolization was a technical success in 55 (100%) and a clinical success in 54 (98.2%). During follow-up (mean, 23.8 months; interquartile range, 9.7 - 38.2 months), hemoptysis recurred in 5 (9.3%) patients. The nonrecurrence rate was 91.9% one year after the initial procedure and 88.7% two years and four years after the initial procedure. Minor complications related with the procedure occurred in 6 (10.9%); no major complications occurred. CONCLUSIONS: The embolization of bronchial arteries and nonbronchial systemic arteries with n-butyl-cyanoacrylate is safe and efficacious for controlling hemoptysis, resulting in low recurrence rates.

Efficacy of Paclitaxel Balloon for Hemodialysis Stenosis Fistulae After One Year Compared to High-Pressure Balloons: A Controlled, Multicenter, Randomized Trial.

PURPOSE: A controlled, prospective, multicenter, randomized trial to compare primary patency after angioplasty with a drug-coated balloon versus plain angioplasty balloon in stenosis of dysfunctional fistulae and grafts for hemodialysis. MATERIALS AND METHODS: A total of 136 patients (148 angioplasties) at four centers were randomized to receive a drug-coated balloon or plain angioplasty balloon after satisfactory angioplasty with a high-pressure balloon. The inclusion criteria were clinical signs of vascular dysfunction confirmed by Doppler Ultrasound and/or angiography. The primary endpoint was target lesion patency defined as time elapsed between the completion of effective and the appearance of restenosis at 6 and 12 months after angioplasty. Secondary endpoints included the relationship between the location of the stenosis, previous angioplasty, demographic variables and survival. RESULTS: Primary patency after angioplasty was higher in the group treated with the drug-coated balloon than the plain angioplasty balloon (153.01 to 141.69 days at 6 months; 265.78 to 237.83 days at 12 months). Drug-coated balloon angioplasty resulted in superior patency after 6 and 12 months, but this result was not statically significant (P = 0.068 at 6 months; P = 0.369 at 12 months). There was no relation between target lesion patency and the other variables studied. Overall mortality in the plain angioplasty balloon group was higher (9% vs. 5.7%) but not statistically significant. CONCLUSIONS: Drug-coated balloon angioplasty resulted in superior survival of dysfunctional peripheral vascular access at 6 and 12 months, but this result was not statistically significant. Both arms show equivalent complications and similar mortality. LEVEL OF EVIDENCE: Level Ia, therapeutic study, RCT. EBM ratings will be based on a scale of 1-5.

Guía clínica española del acceso vascular para hemodiálisis / Spanish clinical guidelines on vascular access for haemodialysis

El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial.

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support.

Ablación por radiofrecuencia de tumores renales. Aspectos prácticos y resultados / Radiofrequency ablation of renal tumors: practical aspects and results

Objetivos. Presentar nuestra experiencia con la ablación percutánea por radiofrecuencia de tumores renales e incidir en aspectos técnicos e indicaciones y analizar nuestros resultados. Material y métodos. Se analizó retrospectivamente a 13 pacientes con 20 tumores. Diez pacientes eran monorrenos, 2 habían rechazado la cirugía y uno tenía comorbilidad grave. Todos los procedimientos se realizaron con anestesia general y guiados por tomografía computarizada mediante la utilización del sistema radiofrequency interstitial tumor ablation. El seguimiento se realizó con tomografía computarizada sin y con contraste i.v., y se consideró la ausencia de realce como signo de necrosis completa. Resultados. El tamaño medio de los tumores fue de 2,8cm. Se consiguió necrosis completa en 17 tumores (85%): en el 100% de los de localización exofítica y parenquimatosa y en el 50% de los de localización mixta, tras un seguimiento medio de 14 meses. En 15 de 16 tumores de 3,5cm o menos se consiguió ablación completa. De los 10 pacientes monorrenos (4 de ellos con más de un tumor), en 9 la función renal permaneció normal tras el procedimiento, y sólo en uno empeoró por lesión de la vía urinaria que provocó hidronefrosis de curso mortal. En esta misma paciente, al tratar otro tumor por vía transhepática, se produjo un hematoma subcapsular hepático que no requirió transfusión. Conclusión. La ablación por radiofrecuencia de tumores renales en manos experimentadas y con una selección apropiada de los tumores (tumores <=3,5cm y de localización exofítica) puede conseguir excelentes resultados oncológicos con una mínima morbimortalidad (AU)

Objectives. To report our experience in percutaneous radiofrequency ablation of renal tumors, emphasizing technical aspects and indications and analyzing our results. Material and methods. We retrospectively analyzed 20 tumors in 13 patients (10 with a single kidney, 2 who had refused surgical treatment, and 1 with severe comorbidities). All procedures were carried out using the radiofrequency interstitial tumor ablation (RITA) technique under general anesthesia and CT guidance. All patients underwent follow-up CT examination with and without intravenous contrast administration; the absence of enhancement was considered complete necrosis. Results. The mean size of the tumors was 2.8cm. Complete necrosis was achieved in 17 tumors (85%); complete necrosis was achieved in 100% of the exophytic tumors and in 50% of the tumors with mixed growth after 14 months’ follow-up. Complete ablation was achieved in 15 of the 16 tumors measuring <=3.5cm. In 9 of the 10 patients with a single kidney (four of whom had more than one tumor), renal function remained normal after the procedure; the other patient developed hydronephrosis after a urinary tract lesion and died. The patient who died also developed a subcapsular liver lesion that did not require transfusion when another tumor was treated transhepatically. Conclusion. In experienced hands and with careful selection of patients (exophytic tumors <=3.5cm), radiofrequency ablation of renal tumors can achieve excellent oncologic results with minimal morbidity and mortality (AU)

[Radiofrequency ablation of renal tumors: Practical aspects and results]. / Ablación por radiofrecuencia de tumores renales. Aspectos prácticos y resultados.

OBJECTIVES: To report our experience in percutaneous radiofrequency ablation of renal tumors, emphasizing technical aspects and indications and analyzing our results. MATERIAL AND METHODS: We retrospectively analyzed 20 tumors in 13 patients (10 with a single kidney, 2 who had refused surgical treatment, and 1 with severe comorbidities). All procedures were carried out using the radiofrequency interstitial tumor ablation (RITA) technique under general anesthesia and CT guidance. All patients underwent follow-up CT examination with and without intravenous contrast administration; the absence of enhancement was considered complete necrosis. RESULTS: The mean size of the tumors was 2.8 cm. Complete necrosis was achieved in 17 tumors (85%); complete necrosis was achieved in 100% of the exophytic tumors and in 50% of the tumors with mixed growth after 14 months' follow-up. Complete ablation was achieved in 15 of the 16 tumors measuring < or =3.5 cm. In 9 of the 10 patients with a single kidney (four of whom had more than one tumor), renal function remained normal after the procedure; the other patient developed hydronephrosis after a urinary tract lesion and died. The patient who died also developed a subcapsular liver lesion that did not require transfusion when another tumor was treated transhepatically. CONCLUSION: In experienced hands and with careful selection of patients (exophytic tumors < or =3.5 cm), radiofrequency ablation of renal tumors can achieve excellent oncologic results with minimal morbidity and mortality.

[Embolotherapy of pulmonary arteriovenous malformations: long-term clinical and radiological follow-up]. / Embolización de malformaciones arteriovenosas pulmonares: seguimiento clinicorradiológico a largo plazo.

Pulmonary arteriovenous malformations (PAVM) are abnormal communications between the pulmonary arteries and pulmonary veins. The large majority are congenital and are commonly associated with Rendu-Osler-Weber disease or hereditary haemorrhagic telangiectasia. The PAVM may remain asymptomatic or manifest with hypoxemia, hemoptysis, hemothorax and/or neurologic symptoms. Despite its low incidence, the PAVM represent a serious entity that must be taken into account since untreated patients are in risk and present a poor prognosis. Transcatheter embolization with coils or detachable balloons is currently accepted as the treatment of choice. We present 6 patients (5 women and one man) who underwent embolotherapy of PAVM showing the long-term clinical and radiological follow-up.

Embolización de malformaciones arteriovenosas pulmonares: seguimiento clinicorradiológico a largo plazo / Embolotherapy of pulmonary arteriovenous malformations: long-term clinical and radiological follow-up

Las malformaciones arteriovenosas pulmonares (MAVP) son comunicaciones directas entre arterias y venas pulmonares sin lecho capilar normal entre ellos. La mayoría son congénitas y se asocian al síndrome de Rendu-Osler-Weber o telangiectasia hemorrágica hereditaria. Clínicamente pueden ser silentes o cursar con hipoxemia, hemoptisis, hemotórax y/o síntomas neurológicos por un mecanismo de embolia paradójica. A pesar de su baja incidencia, presentan un gran interés por el riesgo que suponen para el paciente no tratado. La terapia de elección en la actualidad es el tratamiento endovascular mediante embolización con coils o balones largables. Se presentan 6 pacientes (5 mujeres y un varón) con MAVP tratados en nuestro centro mediante embolización con coils y se muestra el seguimiento clinicorradiológico a largo plazo (AU)

Pulmonary arteriovenous malformations (PAVM) are abnormal communications between the pulmonary arteries and pulmonary veins. The large majority are congenital and are commonly associated with Rendu-Osler-Weber disease or hereditary haemorrhagic telangiectasia. The PAVM may remain asymptomatic or manifest with hypoxemia, hemoptysis, hemothorax and/or neurologic symptoms. Despite its low incidence, the PAVM represent a serious entity that must be taken into account since untreated patients are in risk and present a poor prognosis. Transcatheter embolization with coils or detachable balloons is currently accepted as the treatment of choice. We present 6 patiens (5 women and one man) who underwent embolotherapy of PAVM showing the long-term clinical and radiological follow-up (AU)

[Therapeutic embolization of uterine leiomyomas: cases requiring surgery]. / Embolización terapéutica de leiomiomas uterinos; casos que requirieron cirugía.

OBJECTIVE: To retrospectively analyze the clinical, radiolgical, and histological findings in patients with uterine leiomyomas (LU) that required surgical intervention after embolization. MATERIAL AND METHODS: Between July 1999 and January 2006, we embolized 182 patients with LU. Eight of these patients subsequently required surgical resection of the tumor. We reviewed clinical data, imaging findings, embolization technique, and reasons for surgery, histological findings in the resected specimens, identification and location of the embolizing material, presence and type of necrosis in the LU, and associated pathology in adjacent organs. RESULTS: The 8 patients that required surgery represented 4.3% of all patients embolized for LU. Surgery was necessary due to technical failure in two patients (1.02%), complications in three (1.64%) and failed treatment in the remaining three 3 (1.64%). The mean maximum diameter of the LU was 9.8 cm (range: 4-17 cm). The mean volume of the LU was 491.88 ml (range: 30-1.365 ml) The mean age of the patients was 37.7 years (range: 28-48 years). Global necrosis was evident in 6 LU; necrosis was hyaline type in 3 and inflammatory in the remaining 3. The embolizing material was detected in the LU in one case, in the uterine myometrium in two cases, and in the ovary in one. CONCLUSION: Less than 5% of cases of LU required surgery after embolization; the risk of surgery after embolization was greater in large lesions. When the embolization technique was adequate, histological study confirmed global necrosis of the tumors, although this was not accompanied by clinical improvement.

Embolización terapéutica de leiomiomas uterinos; casos que requirieron cirugía / Therapeutic embolization of uterine leiomyomas: cases requiring surgery

Objetivo. Análisis retrospectivo clínico, radiológico y patológico de pacientes con leiomiomas uterinos (LU) que requirieron intervención quirúrgica tras el tratamiento con embolización. Material y métodos. Desde julio de 1999 hasta enero de 2006 se embolizaron 182 pacientes con LU. Del total de ellas, 8 precisaron intervención quirúrgica con extirpación del tumor. Revisamos retrospectivamente, en estas 8 pacientes, datos clínicos, hallazgos de pruebas por imagen, técnica de embolización y causas de la cirugía, hallazgos histológicos en las piezas extirpadas, identificación y localización del material embolizante (ME), presencia y tipo de necrosis en los LU y patología asociada en órganos adyacentes. Resultados. Las 8 pacientes intervenidas representan un 4,3% del total de pacientes embolizadas. La causa fue por fallo técnico en dos (1,02%), complicaciones en tres (1,64%) y fallo en el tratamiento en otras tres (1,64%). La media de los diámetros máximos de los LU fue de 9,8 cm (rango: 4-17 cm). El volumen medio de los LU fue de 491,88 ml (rango: 30-1,365 ml). La edad media de las pacientes fue de 37,7 años (rango: 28-48 años). Histológicamente se evidenció necrosis global en 6 de los LU, siendo de tipo hialino en 3 e inflamatorio en los otros 3. El ME se detectó en el LU (un caso), en el miometrio uterino (dos casos) y en un ovario (un caso). Conclusión. Los casos de LU que requieren cirugía posembolización son inferiores al 5%, existiendo mayor riesgo en los de gran tamaño. Cuando la técnica de embolización fue adecuada, el estudio histológico confirmó la necrosis global de los tumores, aunque este hecho no se acompañó de mejoría clínica (AU)

Objective. To retrospectively analyze the clinical, radiolgical, and histological findings in patients with uterine leiomyomas (LU) that required surgical intervention after embolization. Material and methods. Between July 1999 and January 2006, we embolized 182 patients with LU. Eight of these patients subsequently required surgical resection of the tumor. We reviewed clinical data, imaging findings, embolization technique, and reasons for surgery, histological findings in the resected specimens, identification and location of the embolizing material, presence and type of necrosis in the LU, and associated pathology in adjacent organs. Results. The 8 patients that required surgery represented 4.3% of all patients embolized for LU. Surgery was necessary due to technical failure in two patients (1.02%), complications in three (1.64%) and failed treatment in the remaining three 3 (1.64%). The mean maximum diameter of the LU was 9.8 cm (range: 4-17 cm). The mean volume of the LU was 491.88 ml (range: 30-1.365 ml) The mean age of the patients was 37.7 years (range: 28-48 years). Global necrosis was evident in 6 LU; necrosis was hyaline type in 3 and inflammatory in the remaining 3. The embolizing material was detected in the LU in one case, in the uterine myometrium in two cases, and in the ovary in one. Conclusion. Less than 5% of cases of LU required surgery after embolization; the risk of surgery after embolization was greater in large lesions. When the embolization technique was adequate, histological study confirmed global necrosis of the tumors, although this was not accompanied by clinical improvement (AU)

[Histological study of the effect of pre-transplant chemoembolization of hepatocellular carcinoma]. / Estudio histopatológico del efecto de la quimioembolización pretrasplante en el hepatocarcinoma.

OBJECTIVE: To retrospectively evaluate the degree of necrosis brought about by chemoembolization of hepatocellular carcinoma by correlating the histological study of livers explanted in liver transplantations with morphological (number, size, histological type, encapsulation, and vascular invasion) and technical (angiographic patterns, number of sessions, and level of chemoembolization) factors of the tumors. MATERIAL AND METHODS: Seventeen cirrhotic patients that underwent chemoembolization of hepatocellular carcinoma prior to liver transplantation were studied. Chemoembolization consisted of introducing adriamycin, lipiodol, and particles of polyvinyl alcohol into the hepatic artery. The explanted livers were studied macroscopically and microscopically, evaluating the degree of necrosis achieved in each of the nodules found. RESULTS: A total of 32 nodules (26 hepatocellular carcinomas and 7 type II dysplastic nodules) were detected in 16 patients; the remaining patient had multiple hepatocellular carcinomas. The mean size of the hepatocellular carcinomas was 3.2 cms (range 0.4-7.5) and the mean size of the dysplastic nodules was 1.2 cm (range 1-1.7). Greater than 90% necrosis was achieved in 17 (68%) of the 25 hepatocellular carcinomas; 6 of these lesions were encapsulated and none had vascular infiltration. In the patient with multiple hepatocellular carcinomas (all were hypervascularized and had no capsule), the degree of necrosis achieved was < 30% in each lesion. In three patients with nodular vascular infiltration, multiple nodules were present; the necrosis achieved in these lesions ranged from 0%-70%, and extrahepatic metastases after transplantation. Eighteen of the hepatocellular carcinomas had a hypervascularized angiographic pattern and seven were hypovascular or avascular. In the seven type II dysplastic nodules (none of which was encapsulated), no necrosis was achieved. These nodules were found in three patients; all but one were avascular and coincided with simultaneous hepatocellular carcinomas in two patients. CONCLUSION: The greatest degree of necrosis was achieved in single, encapsulated, hypervascularized hepatocellular carcinomas without vascular infiltration. Chemoembolization fails to achieve necrosis in dysplastic nodules.

Estudio histopatológico del efecto de la quimioembolización pretrasplante en el hepatocarcinoma / Histological study of the effect of pre-transplant chemoembolization of hepatocellular carcinoma

Objetivo. Valorar retrospectivamente el grado de necrosis en el hepatocarcinoma producido por la quimioembolización hepática correlacionando el estudio histológico de los hígados explantados en el trasplante hepático con factores morfológicos del tumor (número, tamaño, tipo histológico, encapsulación e infiltración vascular) y técnicos (patrón angiográfico, número de sesiones y nivel de la quimioembolización). Material y métodos. Se estudian 17 pacientes cirróticos trasplantados hepáticos por hepatocarcinoma y a los que previamente se les realizó quimioembolización. Este procedimiento se realizó introduciendo en ramas de la arteria hepática adriamicina, lipiodol y partículas de alcohol de polivinilo. Los hígados explantados se estudiaron macro y microscópicamente, valorando el grado de necrosis alcanzado en cada uno de los nódulos encontrados. Resultados. En el hígado explantado se detectaron 32 nódulos en 16 pacientes: 25 hepatocarcinomas y 7 nódulos displásicos tipo II; en el paciente restante fueron múltiples hepatocarcinomas. El tamaño medio de los hepatocarcinomas fue de 3,2 cm (0,4-7,5) y el de los nódulos displásicos de 1,2 cm (1-1,7). En relación con los 25 hepatocarcinomas se consiguió una necrosis mayor del 90% en 17 de ellos (68%), 6 de los cuales estaban encapsulados y ninguno presentó infiltración vascular. En los pacientes con múltiples hepatocarcinomas la necrosis fue menor del 30% en cada uno de ellos (todos sin cápsula e hipervascularizados). En tres pacientes donde apareció infiltración vascular por alguno de los nódulos coincidió con multiplicidad de los mismos, necrosis del 0-70% de éstos y aparición de metástasis extrahepáticas en el período postrasplante. Dieciocho de los hepatocarcinomas tenían un patrón angiográfico hipervascularizado y 7 eran hipo/avasculares. En relación con los 7 nódulos displásicos tipo II (todos no encapsulados) la necrosis fue nula en todos ellos; aparecieron en tres pacientes, todos (excepto uno) eran avasculares y coincidieron con hepatocarcinomas simultáneos en dos pacientes. Conclusión. Las mayores necrosis parecen obtenerse en hepatocarcinonas únicos, encapsulados, hipervascularizados y sin infiltración vascular. La necrosis por el procedimiento es nula en los nódulos displásicos (AU)

Objective. To retrospectively evaluate the degree of necrosis brought about by chemoembolization of hepatocellular carcinoma by correlating the histological study of livers explanted in liver transplantations with morphological (number, size, histological type, encapsulation, and vascular invasion) and technical (angiographic patterns, number of sessions, and level of chemoembolization) factors of the tumors. Material and methods. Seventeen cirrhotic patients that underwent chemoembolization of hepatocellular carcinoma prior to liver transplantation were studied. Chemoembolization consisted of introducing adriamycin, lipiodol, and particles of polyvinyl alcohol into the hepatic artery. The explanted livers were studied macroscopically and microscopically, evaluating the degree of necrosis achieved in each of the nodules found. Results. A total of 32 nodules (26 hepatocellular carcinomas and 7 type II dysplastic nodules) were detected in 16 patients; the remaining patient had multiple hepatocellular carcinomas. The mean size of the hepatocellular carcinomas was 3.2 cms (range 0.4-7.5) and the mean size of the dysplastic nodules was 1.2 cm (range 1-1.7). Greater than 90% necrosis was achieved in 17 (68%) of the 25 hepatocellular carcinomas; 6 of these lesions were encapsulated and none had vascular infiltration. In the patient with multiple hepatocellular carcinomas (all were hypervascularized and had no capsule), the degree of necrosis achieved was < 30% in each lesion. In three patients with nodular vascular infiltration, multiple noduleswere present; the necrosis achieved in these lesions ranged from 0%-70%, and extrahepatic metastases after transplantation. Eighteen of the hepatocellular carcinomas had a hypervascularized angiographic pattern and seven were hypovascular or avascular. In the seven type II dysplastic nodules (none of which was encapsulated), no necrosis was achieved. These nodules were found in three patients; all but one were avascular and coincided with simultaneous hepatocellular carcinomas in two patients. Conclusion. The greatest degree of necrosis was achieved in single, encapsulated, hypervascularized hepatocellular carcinomas without vascular infiltration. Chemoembolization fails to achieve necrosis in dysplastic nodules (AU)

Aspectos prácticos de la extracción percutánea de cuerpos extraños con lazo recuperador / Practical aspects in the percutaneous extraction of foreign bodies using a Goose-Neck Snare

Objetivo. Presentar nuestra experiencia clínica en la extracción de diferentes cuerpos extraños (vasculares o no) con lazo recuperador en 13 pacientes, incidiendo en aspectos técnicos prácticos empleados durante los procedimientos.Material y métodos. Se incluyen 13 cuerpos extraños siendo 9 intravasculares y 4 no vasculares. Los vasculares correspondieron a stents (2), coils (2), fragmentos rotos de catéteres venosos centrales (3)y fragmentos rotos de catéteres-balón (2). Los no vasculares fueron fragmentos rotos de catéter doble-J (2), un catéter doble-J completamente localizado en sistemas pielo-caliciales y un fragmento roto deuna guía metálica en vía biliar intrahepática. Para la extracción se utilizó el lazo Goose Neck Snare en diferentes diámetros (según la localización).En un paciente con un fragmento de catéter doble-J se utilizó un fórceps como material auxiliar, y en otro con un fragmento de catéter en vena pulmonar se utilizó también un catéter pigtail para movilizarlo y facilitar su extracción por el lazo.Resultados. Se pudieron extraer todos los cuerpos extraños excepto un TIPSS que migró a cavidades cardíacas derechas y que se reposicionó correctamente en tronco venoso braquiocefálico derecho. No huboningún tipo de complicación durante los procedimientos.Conclusiones. El lazo Goose Neck Snare es muy útil, seguro y versátil para extraer cuerpos extraños de diferente naturaleza y en distintos territorios. Sobre todo en el territorio vascular se requiere ampliaexperiencia en el manejo y conocimiento de las diferentes técnicas de cateterización

Objective. To present our clinical experience in the extraction of different foreign bodies (from vascular or other sites) using a gooseneck snare in 13 patients, with emphasis on practical and technical aspects used during the procedures.Material and methods. A total of 13 foreign bodies, including 9 intravascular objects and 4 in other locations, were included. The intravascular foreign bodies were stents (n = 2), coils (n = 2), fragments of broken central venous catheters (n = 3), and fragments of broken balloon catheters (n = 2). The nonvascular foreign bodies were fragments of broken double-J catheters (n = 2), one double-J catheter located entirely within the calyces of the kidney, and a fragment of a broken metallic guide wire in an intrahepatic bile duct. Goose-Neck Snares of different diameters (depending on the location) were used to extract the foreign bodies. Forceps were used as an auxiliary device in one patient with a fragment of double-J catheter, and in another case with a catheter fragment in a pulmonary vein, a pigtail catheter was also used to move the fragment and facilitate its extraction with the Goose-Neck Snare.Results. All of the foreign bodies were successfully extracted except a transjugular intrahepatic portosystemic shunt that migrated to the right heart cavities and was correctly repositioned in the right brachiocephalic venous trunk. No complications of any kind were seen during the procedures.Conclusions. The Goose-Neck Snare is very useful, safe, and versatile for the extraction of different types of foreign bodies in different territories. Especially in vascular territories, it is necessary to have ample knowledge about and experience in the different techniques used for catheterization

[Practical aspects in the percutaneous extraction of foreign bodies using a Goose-Neck Snare]. / Aspectos prácticos de la extracción percutánea de cuerpos extraños con lazo recuperador.

OBJECTIVE: To present our clinical experience in the extraction of different foreign bodies (from vascular or other sites) using a goose-neck snare in 13 patients, with emphasis on practical and technical aspects used during the procedures. MATERIAL AND METHODS: A total of 13 foreign bodies, including 9 intravascular objects and 4 in other locations, were included. The intravascular foreign bodies were stents (n = 2), coils (n = 2), fragments of broken central venous catheters (n = 3), and fragments of broken balloon catheters (n = 2). The nonvascular foreign bodies were fragments of broken double-J catheters (n = 2), one double-J catheter located entirely within the calyces of the kidney, and a fragment of a broken metallic guide wire in an intrahepatic bile duct. Goose-Neck Snares of different diameters (depending on the location) were used to extract the foreign bodies. Forceps were used as an auxiliary device in one patient with a fragment of double-J catheter, and in another case with a catheter fragment in a pulmonary vein, a pigtail catheter was also used to move the fragment and facilitate its extraction with the Goose-Neck Snare. RESULTS: All of the foreign bodies were successfully extracted except a transjugular intrahepatic portosystemic shunt that migrated to the right heart cavities and was correctly repositioned in the right brachiocephalic venous trunk. No complications of any kind were seen during the procedures. CONCLUSIONS: The Goose-Neck Snare is very useful, safe, and versatile for the extraction of different types of foreign bodies in different territories. Especially in vascular territories, it is necessary to have ample knowledge about and experience in the different techniques used for catheterization.

Orbital hydrocephalus: a proven cause for optic atrophy.

A 4-year-old boy with bilateral optic sheath enlargement and progressive optic atrophy and blindness is presented. Computed tomography demonstrated hydrocephalus and enlargement of the optic nerve sheath complex. The child died during an attempted repair of hypoplastic atrioventricular valves. Autopsy demonstrated a patulous perioptic subarachnoid space and optic atrophy. This condition has been described in the literature but has not had radiologic-pathologic correlation. With the availability of magnetic resonance imaging, this diagnosis may be made prospectively, thus, it is important for the radiologist to be aware of this entity because optic atrophy and blindness may be prevented by early diagnosis and surgery.

In vitro short-term effects of SMS 201-995, bromocriptine and TRH on growth hormone cell morphology from human pituitary adenomas.

This study reports, by immunocytochemistry, ultrastructure and morphometry, the in vitro effects of SMS 201-995 (10 nM), bromocriptine (1 microM) and TRH (10 microM) on the morphology of cells from two acromegalic patient adenomas containing immunoreactive growth hormone (GH). By electron microscopy, one tumor presented numerous large secretory granules (densely granulated growth hormone cell adenoma) while they were scarce and small in the other (sparsely granulated growth hormone cell adenoma); fibrous bodies could be seen in the specimen and in vitro. In the sparsely granulated growth hormone cell adenoma, TRH produced an increase in endoplasmic reticulum surface density compared to the other cultures. Bromocriptine increased the number and decreased the secretory granule diameters, while SMS 201-995 produced no significant changes in the same time. In the densely granulated growth hormone cell adenoma, the three substances increased the number of granules. TRH increased the mitochondrial volume density and endoplasmic reticulum surface density (with respect to the other cultures). SMS 201-995 decreased the mitochondrial and lysosome volume densities and endoplasmic reticulum surface density. We conclude that 1) TRH produces in cultured cells of both adenoma types an increase in cellular activity. 2) In cultured sparsely granulated growth hormone adenoma cells, bromocriptine has a stronger inhibitory effect than SMS 201-995. In cultured densely granulated growth hormone cells adenoma, bromocriptine has smaller inhibitory effect than SMS 201-995.