A Novel Marking Technique for Accurate Minimal Invasive Approaches in Spine Tumor Surgeries With Activated Carbon Marking.

BACKGROUND AND OBJECTIVES: To describe a novel, practical, reproducible, and effective preoperative marking technique for accurate localization of the spinal level in a series of patients with tumor lesions. METHODS: We retrospectively analyzed patients undergoing minimally invasive (MIS) surgery for spine tumors from 2016 to 2021, in which this marking technique was used. Twenty-one patients, with tumor lesions involving difficult radioscopic visualization (cervicothoracic junction or upper dorsal spine, C6-T8), were included. Tumor lesion level was previously determined with enhanced MRI in all cases. Twenty-four to forty-eight hours before surgery, computed tomography image-guided carbon marking was performed by administration of aqueous suspension of carbon with a 21-gauge needle placed resembling the MIS approach planned trajectory. During surgery, activated carbon marking was followed until reaching the final target on the bone. Next, sequential dilators and an MIS retractor were placed. Then, bone resection and tumor exeresis were performed according to the case. RESULTS: Average age was 60.6 years (26-76 years). Fifteen (71%) patients were women. In most cases (76%), tumor pathology involved intradural lesions (meningiomas and schwannomas). In all cases, the marking described allowed to accurately guide the MIS approach to tumor site. Neither intraoperative fluoroscopy nor approach enlargement was required in any procedure. Postoperative complications were reported in only 4 patients, none related with the marking. CONCLUSION: Computed tomography image-guided activated carbon marking allows to accurately lead MIS approaches in a practical, reproducible, and effective way in cases of tumors localized in regions of the spine of difficult radioscopic visualization.

[Retroperitoneal schwannoma mimicking colorectal cancer metastases: a false positive result report.] / Schwannoma retroperitoneal simulando metástasis de cáncer colorrectal: reporte de un resultado falso positivo.

Introduction: schwannomas are benign and common soft tissue tumors. They are usually asymptomatic and are discovered for other reasons. Materials: we present the case of an 82-year-old male patient with a recent diagnosis of moderately differentiated adenocarcinoma of the colon and a hypermetabolic periaortic nodule as an incidental finding. Results: percutaneous biopsy of the periaortic nodule confirmed the diagnosis of schwannoma. At one year of follow-up, growth of the schwannoma has been demonstrated. There are no signs of progression of his oncological disease. Conclusions: schwannomas are benign tumors, rarely found in the retroperitoneum and can be sources of false-positive positron emission tomography results.

Introducción: los schwannomas son tumores benignos y frecuentes de las partes blandas. Habitualmente son asintomáticos y son descubiertos por otros motivos. Materiales y métodos: presentamos el caso de un paciente masculino de 82 años con diagnóstico reciente de adenocarcinoma de colon moderadamente diferenciado y con un nódulo periaórtico hipermetabólico como hallazgo incidental. Resultados: la biopsia percutánea del nódulo periaórtico confirmó el diagnóstico de schwannoma. Al año de seguimiento, se ha demostrado crecimiento del schwannoma. No hay signos de progresión de su enfermedad oncológica. Conclusión: los schwannomas son tumores benignos, infrecuentes en el retroperitoneo y pueden ser fuentes de resultados falsos positivos en tomografía por emisión de positrones.

[Percutaneous radiofrequency ablation of osteoid osteoma: results from 9 years of experience in a third-level center.] / Ablación percutánea por radiofrecuencia de osteoma osteoide: resultados en 9 años de experiencia en un centro de tercer nivel.

Introduction: Osteoid osteoma is a benign bone tumor that accounts for roughly 2-3% of primary bone tumors and up to 10-12% of benigns bone neoplasms. It is most commonly seen in young adults, and shows male predominance. Over the last years, minimally invasive thermal ablation techniques such as radiofrequency ablation have gained popularity over classical surgery. In this study we evaluate results and complications of CT guided osteoid osteoma radiofrequency ablation. Materials and methods: In this retrospective cohort study all patients that were diagnosed with osteoid osteoma and treated using radiofrequency ablation between January 2014 and December 2022 were included. Pain was assessed using Visual Analog Scale (VAS) pre and post procedure. Technical success was established as positioning of the radiofrequency electrode in the nidus. Primary clinical success was defined as absence of pain after one radiofrequency session. All patients that required a second radiofrequency ablation were included in the overall clinical success group. Results: During the studied period, 61 osteoid osteoma radiofrequency ablations were performed. Fiftyseven of them were included in this study, 32 were men and 25 female. Pre procedure median pain was 9 according to VAS score. Only 23 patients were treated as outpatient, the rest stayed in hospital for 24 hours. Median follow up time was 21,7 months (SD 8,3). Biopsy was performed in 52 patients. Technical success was accomplished in 57 patients (100%). Primary clinical success was 80,7% (46 patients). Those who continued with pain or had recurrence after a symptoms free period (11 patients), were treated with a second radiofrequency ablation, achieving an overall success rate of 94,7%. Only one patient suffered a minor complication (1,7%). Conclusion: CT guided osteoid osteoma radiofrequency ablation is a safe, effective and low complication rate procedure, that can be performed on an outpatient basis. We believe it should be considered as a first line treatment option for osteoid osteoma.

Introducción: El osteoma osteoide es un tumor óseo benigno, que representa el 2-3% de las neoplasias óseas primarias y hasta el 10-12% de los tumores óseos benignos. Tiene mayor incidencia en adultos jóvenes, con predominancia masculina. En los últimos años las técnicas de termoablación mínimamente invasivas han sido utilizadas para el tratamiento del osteoma osteoide, como alternativa a la cirugía clásica. En este estudio evaluaremos los resultados y complicaciones de ablación por radiofrecuencia de osteoma osteoide. Materiales y métodos: Se analizó una cohorte de pacientes en forma retrospectiva con diagnóstico de osteoma osteoide tratados con radiofrecuencia en el Hospital Italiano de Buenos Aires desde Enero del año 2014 hasta Diciembre del año 2022. Todos los pacientes fueron evaluados con la Escala Visual Analógica del dolor (EVA) pre y post procedimiento. El éxito técnico del procedimiento fue considerado como el correcto posicionamiento del electrodo de radiofrecuencia en el nido de la lesión, y el éxito clínico primario como ausencia de dolor post procedimiento. Mientras que los pacientes que requirieron de una segunda sesión de radiofrecuencia para controlar los síntomas serán incluidos como éxito clínico secundario. Resultados: Durante el período mencionado se realizaron 61 ablaciones percutáneas de osteoma osteoide. Se incluyeron en el análisis 57 pacientes, 32 fueron hombres y 25 mujeres. La media de dolor medido por EVA pre procedimiento fue 9. Del total de los pacientes, 23 fueron tratados de manera ambulatoria, el resto permanecieron internados durante 24hs. El tiempo medio de seguimiento fue de 21,7 meses (DS8,3). Se realizó biopsia de la lesión durante el procedimiento en 52 pacientes. Se logró el éxito técnico en 57 pacientes (100%), de ellos el éxito clínico primario se logró en 46 pacientes (80,7%). Los 11 pacientes que continuaron con dolor o presentaron recurrencia de los síntomas luego de un período asintomáticos fueron tratados con una segunda sesión de radiofrecuencia, logrando un éxito clínico secundario 94,7%. Un solo paciente presentó complicaciones post procedimiento (1,7%), correspondiente a hematoma en la planta del pie. Conclusión: Podemos concluir que la ablación percutánea por radiofrecuencia de OO guiada por tomografía en manos de expertos, es un procedimiento seguro, de alta efectividad y baja tasa de complicaciones que puede realizarse de manera ambulatoria. Por lo que consideramos que debe ser tenida en cuenta como primera elección para el tratamiento de esta patología.

Eleven New Species of the Genus Tarzetta (Tarzettaceae, Pezizales) from Mexico.

The genus Tarzetta is distributed mainly in temperate forests and establishes ectomycorrhizal associations with angiosperms and gymnosperms. Studies on this genus are scarce in México. A visual, morphological, and molecular (ITS-LSU) description of T. americupularis, T. cupressicola, T. davidii, T. durangensis, T. mesophila, T. mexicana, T. miquihuanensis, T. poblana, T. pseudobronca, T. texcocana, and T. victoriana was carried out in this work, associated with Abies, Quercus, and Pinus. The results of SEM showed an ornamented ascospores formation by Mexican Taxa; furthermore, the results showed that T. catinus and T. cupularis are only distributed in Europe and are not associated with any American host.

Risk factors for COVID-19 in-hospital mortality in Argentina: A competing risk survival analysis.

COVID-19 poses dire threats for low and middle-income countries (LMICs). Yet, there remains limited rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs, and often the evidence was based on small samples and/or unicentric. The objective of this study was to examine risk factors of COVID-19 mortality in Argentina, a hard-hit middle-income Latin American country. We analyze data on 5,146 COVID-19 patients from 11 centers across 10 cities in Argentina, making this one of the largest multi-centric retrospective observational descriptive studies in the LMICs. Information on demographics and co-morbidities was extracted from medical records. Outcomes of relevance consisted of whether the patient was discharged or deceased (as established in medical records), along with date of each event. We use survival models that account for competing risks. Median age was 60 years (IQR: 48-72), there were fewer women (40.8%) hospitalized than men (59.2%), and the most prevalent comorbidities were hypertension (40.9%), diabetes (20.0%) and obesity (19.1%). Patients were hospitalized for a median duration of 8 days (IQR: 5-13), and in-hospital mortality was 18.1%, though it varied substantially across health centers (95%CI: 17.1%-19.2%). Baseline characteristics most associated with in-hospital mortality were respiratory rate (adjusted HR = 3.6, 95%CI: 2.5-5.4 for ≥ 26 breathes/min), older age (adjusted HR = 2.5, 95%CI: 2.0-3.3 for the 80+ age group), and chronic kidney disease (adjusted HR = 2.2, 95%CI: 1.8-2.8). Associations were attenuated when survival models did not account for the competing risk of being discharged. We document lower mortality rates than those in prior studies, likely due to a lower prevalence of comorbidities amongst patients in our sample. Compared with standard Cox models, we find that, when using competing risk models, risk factors have a larger role in explaining COVID-19 mortality. Overall, we provide rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs. Thus, our findings are useful to conduct a more accurate in-hospital monitoring of patient subgroups who may be at greater risk. They also provide valuable guidance for public health and policy efforts in Argentina and other developing countries.

CT-Guided Trans-osseous Biopsy: Experience in 24 Patients.

PURPOSE: The objective of this study is to assess the effectiveness of computed tomography-guided trans-osseous biopsies in deep-seated lesions and report encountered complications. MATERIALS AND METHODS: A retrospective cohort study was performed which included twenty-four patients with pathologic medical history and lesions non-accessible by common approaches. Exclusion criteria include patients who could be biopsied without trans-osseous access, as for example procedures aided with hydro- or pneumo-dissection. The population studied included 13 females (54.2%) and the overall average age was 64.5 (IIQ 43-69). The procedures were carried out through the following bones: sternum (n = 6), vertebral (n = 5), iliac (n = 5), scapula (n = 3), rib (n = 2), sacral (n = 2), and pubis (n = 1). RESULTS: The efficiency for these procedures was 87.5%, while 8.33% of them were non-diagnostic and 4.17% were inconclusive due to vital risk during the procedure. CONCLUSION: Computed tomography-guided trans-osseous biopsy resulted in a safe and effective technique for those lesions blocked by vital structures or apparently directly inaccessible.

[Ultrasound guided biopsy of lung tumors: evaluation of efficacy and complications]. / Biopsia de tumores pulmonares con guía ecográfica: evaluación de eficacia y complicaciones

Introduction: The diagnosis of lung cancer, as well as that of lung nodules, is increasing. Percutaneous biopsy has become a transcendental tool for its diagnosis. Traditionally, computed tomography is used for these procedures because of its ability to clearly demonstrate bone and aerated lung. However, in selected cases it can be performed with ultrasound. Methods: Retrospective study conducted between January 2020 and December 2021, during the SARS-CoV-2 pandemic. All patients had pleural-based lung lesions or pleural lesions, some with a known history of cancer. Results: Thirty-six procedures were performed, in 32 (88.9%) the sample obtained presented diagnostic yield and the most used additional test was Immunohistochemistry in 23 (63.9%). Complications were reported in 5 patients (13.9%): 2 with mild pneumothorax, 2 with hemothorax (1 mild and 1 moderate) and 1 patient reported pain. Conclusion: Ultrasound is a valid method to be used as a guide for biopsies of pleural and peripheral pulmonary lesions. The complications and diagnostic rate has been shown to be in line with the experience of other authors and international guidelines.

Introducción: El diagnóstico de cáncer pulmonar al igual que el de los nódulos pulmonares se encuentra en aumento. La biopsia percutánea se ha convertido en una herramienta trascendental para su diagnóstico. Tradicionalmente la tomografía computada es empleada para estos procedimientos por su capacidad para demostrar con claridad los huesos y el pulmón aireado. Sin embargo, en casos seleccionados puede efectuarse con ecografía. Métodos: Estudio retrospectivo realizado entre enero de 2020 y diciembre de 2021, durante la pandemia por SARS-CoV-2. Todos los pacientes tenían lesiones pulmonares de base pleural o lesiones pleurales, algunos con antecedentes conocidos de cáncer. Resultados: Se realizaron 36 procedimientos, en 32 (88,9%) la muestra obtenida presentó rédito diagnóstico y la prueba adicional más utilizada fue la Inmunohistoquímica en 23 (63,9%). Se reportaron complicaciones en 5 pacientes (13,9%): 2 con neumotórax leve, 2 con hemotórax (1 leve y 1 moderado) y 1 paciente refirió dolor. Conclusión: La ecografía es un método válido para ser usado como guía de biopsias de lesiones pleurales y pulmonares periféricas. La tasa de complicaciones y reedito diagnóstico ha demostrado estar en línea con la experiencia de otros autores y guías internacionales.

Primeros pasos en el intervencionismo. Lecciones de la práctica diaria / First steps in interventionism. Lessons from daily practice

Resumen Las características del paciente y la localización de la lesión diana pueden hacer más complejo un procedimiento intervencionista. Una adecuada formación basada en el conocimiento de los instrumentos, manejo de técnicas alternativas y complementos hacen que estos procedimientos sean efectivos y seguros. Destacaremos la planificación anticipada, los enfoques seguros, el papel de la integración y la discusión interdisciplinaria. Los elementos descritos aquí y la bibliografía adjunta pueden tomarse como una guía para comenzar una carrera en radiología intervencionista.

Abstract The characteristics of the patient and the location of the target lesion can make an interventional procedure more complex. An adequate training based on the knowledge of instruments, handling of alternative techniques and supplementary tools make these procedures effective and safe. We will emphasize advanced planning, safe approaches, the role of integration, and interdisciplinary discussion. The items described here and the accompanying bibliography can be taken as a guide to starting a career in interventional radiology.

Broadening the Knowledge of Mexican Boletes: Addition of a New Genus, Seven New Species, and Three New Combinations.

Boletes are one of the most common groups of fungi in temperate, subtropical, and tropical ecosystems. In Mexico, the northern region has mainly been explored in terms of bolete diversity. This study describes a new genus and seven new species based on macromorphological, micromorphological, molecular, phylogenetic, and ecological data. Garcileccinum gen. nov. is typified with G. salmonicolor based on multigene phylogenetic analysis of nrLSU, RPB2, and TEF1, and it is closely related to Leccinum and Leccinellum. Garcileccinum viscosum and G. violaceotinctum are new combinations. Boletellus minimatenebris (ITS, nrLSU, and RPB2), Cacaoporus mexicanus (RPB2 and ATP6), Leccinum oaxacanum, Leccinum juarenzense (nrLSU, RPB2, and TEF1), Tylopilus pseudoleucomycelinus (nrLSU and RPB2), and Xerocomus hygrophanus (ITS, nrLSU, and RPB2) are described as new species. Boletus neoregius is reclassified as Pulchroboletus neoregius comb. nov. based on morphological and multigene phylogenetic analysis (ITS and nrLSU), and its geographic distribution is extended to Central Mexico, since the species was only known from Costa Rica. Furthermore, T. leucomycelinus is a new record from Mexico. This study contributes to increasing our knowledge of boletes and expands the diversity found in Mexican forests.

[Presurgical hypogastric lymph node marking under CT guidance, aided by hidrodissection] / Marcación prequirúrgica de ganglio hipogástrico con tomografía computada asistido por hidrodisección.

Introduction: Pre-surgical lymph node marking is an established medical procedure of vital importance in the treatment of cancer patients. Materials: A 60-year-old man with a history of prostatic adenocarcinoma in a plan for resection of hypogastric adenopathy. Image guided pre-surgical marking was indicated. Results: Preoperative marking was performed with local anesthesia under computed tomography with transosseous access and hydrodissection. Conclusion: We present a technique that has been little studied and rarely reported in the international literature for the surgical identification of deep pelvic adenopathy.

Introducción: La marcación pre quirúrgica de ganglios es un procedimiento médico establecido y de vital importancia en el tratamiento de pacientes oncológicos. Materiales: Hombre de 60 años con antecedentes de adenocarcinoma prostático en plan de resección de adenopatía hipogástrica. Se indicó marcación prequirúrgica mediante guía imagenológica. Resultados: Se realizó marcación prequirúrgica con anestesia local bajo tomografía computada con acceso transóseo e hidrodisección. Conclusiones: presentamos una técnica poco estudiada y escasamente reportada en la bibliografía internacional para la identificación quirúrgica de una adenopatía pélvica profunda.

Biopsia percutánea de nódulos y masas pulmonares bajo ecografía: una alternativa a la tomografía computada / Ultrasound guided percutaneous biopsy of pulmonary nodules and masses: an alternative to CT

Resumen Los nódulos y masas pulmonares tradicionalmente son biopsiados mediante tomografía computada (TC). La ecografía está subestimada como guía para biopsias pulmonares. Las imágenes pulmonares factibles de biopsia con ecografía son aquellas en contacto pleural. Las contraindicaciones específicas incluyen ventilación mecánica asistida, neumonectomía contralateral, paciente no colaborador, tos incontrolable. En el monitoreo posbiopsia deberán controlarse los signos vitales, el dolor y la presencia de complicaciones. Por la localización de las lesiones abordables por este método, el neumotórax y el sangrado parenquimatoso como complicación son menos frecuentes que en las biopsias dirigidas por TC. En este artículo describimos los conceptos básicos para la correcta selección de paciente, planificación y ejecución segura de una biopsia de nódulo pulmonar bajo ecografía.

Abstract Pulmonary nodules and masses are traditionally biopsied under computed tomography (CT) guidance. Ultrasound remains underrated as lung nodule biopsy guide. Ultrasound can be employed to target pleural based lung nodules. Specific contraindications include: mechanical ventilation, contralateral pneumonectomy, non-cooperative patient and uncontrollable coughing. Post procedural care should cover vital signs check, pain assessment and complication evaluation. Due to lesion localization, complications such as pneumothorax and parenchymal bleeding are less frequent than in CT guided biopsies. In this article we provide basic concepts for patient selection, plan and safe execution of ultrasound guided pulmonary nodule biopsy.

[Retroperitoneal lymphadenopathy trans-vertebral image-guided biopsy: a case report] / Biopsia de linfadenopatía retroperitoneal guiada por imágenes con abordaje trans-vertebral: reporte de un caso

Introduction: Transosseous biopsy allows sampling of lesions that are difficult to access with conventional techniques. Its use avoids surgeries. Objective: To present a clinical case in which retroperitoneal percutaneous biopsy with trans vertebral approach was used. A brief bibliographic revision of this technique will be made. Case: 60 year old woman with endometrial adenocarcinoma, with 7 months of clinical symptoms characterized by asthenia and non-specific lumbar pain. An intercaval aortic lymphadenopathy was found. Trans vertebral biopsy of the lesion was decided, its location precluded conventional approaches access. Conclusion: This technique must be considered when studying unreacheable lesions by other means and performed by trained professionals.

Introducción: La biopsia trans ósea permite el estudio de lesiones que presentan accesos convencionales bloqueados por otras estructuras, como órganos vitales. Su uso evita procedimientos de mayor complejidad. Objetivo: Reportar un caso clínico en el cual se utilizó la técnica de biopsia percutánea con abordaje trans vertebral para toma de muestra. En forma secundaria se hará una breve revisión de la bibliografía. Caso: Caso: Mujer de 60 años, con adenocarcinoma de endometrio con cuadro clínico de 7 meses caracterizado por astenia y dolor lumbar. Presentaba una linfadenopatía intercavo-aórtica. Se decidió biopsiar de forma trans vertebral debido a que su ubicación limitaba otros abordajes. Conclusión: Este abordaje debe ser considerado para acceder a lesiones inalcanzables por otras vías y ser empleado por profesionales entrenados.  Palabras claves: biopsia guiada por imágenes; metástasis linfática; neoplasias de endometrio.

[Hypoxemia, pleural and pericardial effusion after splanchnic neurolysis. A case report.] / Hipoxemia, derrame pleural y pericárdico en neurolisis de nervios esplácnicos. Reporte de caso

Introduction: Alcohol neurolysis of splanchnic nerves is a valuable tool for treating visceral intractable pain from the upper abdomen in cancer patients. It is a safe and effective procedure, yet not risk free. It's most common adverse effects are mild and self-limited. Materials: We present a case of a 72-year old woman suffering from pancreatic cancer with intractable pain despite opioid use. Alcohol neurolysis of splanchnic nerves was indicated after hospital admission. Results: After the procedure pain was subdued, yet hypoxemia, pleural and pericardial effusion developed. Frequent causes for these events were ruled out. The patient was discharged 24 hours after with adequate pain control. Conclusions: Hypoxemia, pleural and pericardial effusion after alcohol neurolysis of splanchnic nerves is infrequent. These findings are likely to be linked to the effect of alcohol.

Introducción: La neurolisis o alcoholización de los nervios esplácnicos es una valiosa herramienta para el tratamiento del dolor visceral del abdomen superior de origen neoplásico en pacientes con mala respuesta a tratamiento por vía oral. Es un procedimiento seguro y efectivo, aunque no exento de riesgos. Sus efectos adversos más frecuentes son leves y autolimitados. Materiales: Presentamos el caso de una mujer de 72 años con cáncer de páncreas y mal manejo del dolor pese al consumo de opioides. Se le indico neurolisis de los nervios esplácnicos bajo internación. Resultados: Post procedimiento presentó buen manejo del dolor, sin embargo evolucionó con hipoxemia, derrame pleural bilateral y pericárdico. Se descartaron causas frecuentes de estos eventos. La paciente fue dada de alta a las 24 hs con buen manejo del dolor. Conclusiones: El desarrollo de hipoxemia, derrame pleural bilateral y pericárdico posterior a la neurolisis de los nervios esplácnicos es una complicación infrecuente. Estos hallazgos probablemente se encuentren vinculados al efecto del alcohol.

Biopsias pelvianas percutáneas: guía iconográfica de abordajes seguros / Percutaneous pelvic biopsies: An illustrative guideline for safe approaches

Resumen Las biopsias percutáneas a nivel de la pelvis plantean un desafío dada la compleja anatomía regional. El conocimiento de las estructuras afectadas y el tipo de lesión a intervenir son algunos de los aspectos que van a influenciar la técnica que se utilice. Se han propuesto distintas vías de abordaje, pero aún carecen de sistematización. El objetivo de este artículo es destacar accesos seguros ejemplificando con casos ilustrativos de nuestra institución. Además, agregamos comentarios basados en nuestra experiencia.

Abstract Pelvic percutaneous biopsies are challenging due to complex regional anatomy. Knowledge of affected structures and lesion type are some of the aspects that will condition the technique applied. Different approaches to pelvic percutaneous biopsies have been proposed, but still lack systematization. The aim of this article is to highlight safe approaches supported with illustrative cases. Furthermore, we provide opinion based on our experience.