[Evaluation of cerebral blood perfusion in patients undergoing carotid endarterectomy using densitometric analysis of conventional cranial CT]. / Evaluación de la perfusión cerebral mediante análisis densitométrico de la tomografía craneal en pacientes sometidos a endarterectomía carotídea.

OBJECTIVE: To evaluate the efficacy of densitometric analysis of cranial CT imaging in the measurement of areas with low cerebral blood flow and lack of hemodynamic reserve in patients undergoing carotid endarterectomy. PATIENTS AND METHODS: 40 consecutive patients undergoing carotid endarterectomy have been included in the study. All of them had preoperative cranial CT, pre and postoperative basal and acetazolamide SPECT. Cranial CT imaging after digitalization and computer processing were obtained with 4 densitometric patterns: 1). normal cerebral blood perfusion; 2). ischemic or low brain blood perfusion (patron I); 3). parenchyma without cerebral hemodynamic reserve (patron nR), and 4). brain infarction. RESULTS: 32 out of 40 (80 %) patients had abnormal densitometric patterns: 19 nR patterns (47.5 %), 11 I pattern (27.5 %) and 2 established brain infarction. The correlation between densitometric cranial TC imaging and SPECT was 92% when analyzing areas with hypoperfusion (S: 96.5 %; E: 82 %). Cranial CT detected 12/13 of patients who lacked cerebral hemodynamic reserve in the SPECT analysis (S: 74 %; E: 92 %; Vpp: 95 %). CONCLUSIONS: There is a good correlation between analysis of densitometric cranial TC imaging and SPECT in determining low cerebral blood flow areas and lack of cerebral hemodynamic reserve. This method could help to improve carotid surgery indications in patients with carotid stenosis.

[Pulsatile perineal hematoma after transrectal prostatic biopsy]. / Hematoma perineal pulsátil tras biopsia prostática transrectal.

OBJECTIVE: A case of pulsatile perineal hematoma following transrectal biopsy of the prostate is presented. METHODS: A patient who had undergone transrectal biopsy of the prostate a few days earlier complained of a pulsatile sensation in the perineal region caused by a pseudoaneurysm of a left hypogastric artery. Patient evaluation included echo Doppler, pelvioabdominal CT and arteriography. Transcatheter intraarterial embolization with Gianturco-Wallace coils was performed. RESULTS: Excellent results were achieved. Filling of the aneurysm was immediately reduced and symptoms disappeared. CONCLUSION: This technique is gaining importance in the treatment of pelvic hemorrhage because it is relatively simple and carries a low morbidity and mortality.