Administración de medios de contraste. ¿Existe riesgo de daño renal agudo? / The administration of contrast media: is there a risk of acute kidney injury?

Objetivo: Conocer si la administración intravenosa de contraste yodado en la tomografía computarizada (TC) se asocia a un aumento en los niveles de creatinina y de daño renal agudo. Material y métodos: Estudio de cohortes retrospectivo. Incluye todos los pacientes que acudieron al servicio de urgencias del 2010 al 2015 y que presentaban una creatinina basal (C1) y otra 24-72 horas después (C2). El Comité de Ética y de Investigación aprobó el estudio. Criterios de exclusión: paciente menor de 18 años, creatinina ≤ 0,4mg/dl, ≥4,0mg/dl y administración de contraste en los últimos 6 meses. Al servicio de urgencias acudieron una media de 105.435,6 pacientes/año. Tres grupos de pacientes: 1) TC con contraste (6.642), 2) TC sin contraste (6.193,3) y 3) Sin TC (33.802). Se usaron los criterios de Acute Kidney Injury Network (AKI) y nefropatía aguda por contraste (NAC). Se realizó estudio estadístico bivariante y de regresión logística con el programa (Stata15). Resultados: Se analizaron 52.411 pacientes; depurando datos: 46.637. Edad media: 67,95 años. Valor de C1: media 1,16mg/dl (DE: 0,61) y de C2: 1,14mg/dl (DE: 0,66). Con criterios AKI y NAC: la realización de TC con contraste no se asocia a una mayor probabilidad de desarrollar nefropatía (odds ratio [OR]: 0,90, intervalo de confianza [IC]: 0,83-0,99 y OR 0,89, IC: 0,81-0,98, respectivamente). El estudio "propensity score matching", usando ambos criterios (AKI+NAC), obtuvo una OR de 0,80 y una IC de 0,77-0,84. Pacientes con filtrado glomerular inferior a 30ml/min no asociaron incremento del daño renal (OR: 0,66, IC: 0,47-0,91). Conclusión: La administración de contraste intravenoso, en el grupo de pacientes estudiados, no está asociada a un aumento del daño renal agudo

Objective: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. Material and methods: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. Results: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. Conclusion: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury

The administration of contrast media: is there a risk of acute kidney injury? / Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?

OBJECTIVE: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. MATERIAL AND METHODS: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. RESULTS: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. CONCLUSION: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.

Estudio de las enfermedades de las trompas de Falopio mediante resonancia magnética / Fallopian tube disease on magnetic resonance imaging

Conocer las enfermedades de las trompas de Falopio es esencial para valorar la pelvis ginecológica. Las alteraciones primarias y secundarias de las trompas, cursen o no con alteraciones ováricas asociadas, son muy variadas. Pese a que la ecografía, por su gran sensibilidad y disponibilidad, es la técnica inicial para estudiar las alteraciones anexiales, la RM es muy útil en el diagnóstico de las enfermedades tubáricas porque su elevada resolución tisular y el detalle anatómico que proporciona le confieren una mayor especificidad. Los hallazgos morfológicos y las características del contenido tubárico con la RM posibilitan un diagnóstico más preciso o limitan el diagnóstico diferencial y permiten orientar el tratamiento más adecuado en cada caso(AU)

Knowledge about fallopian tube disease is essential in the assessment of the pelvis in female patients. Primary and secondary changes in the tubes vary widely, regardless of whether associated changes in the ovaries are present. Ultrasonography is the initial technique in the study of adnexal disease because it is very sensitive and widely available; however, MRI is also very useful in this context because its high tissue resolution and anatomic detail make it more specific. The morphologic findings and the characteristics of the contents of the tubes on MRI enable a more accurate diagnosis or limit the differential diagnosis, helping to ensure that the most appropriate treatment is provided in each case(AU)

[Fallopian tube disease on magnetic resonance imaging]. / Estudio de las enfermedades de las trompas de Falopio mediante resonancia magnética.

Knowledge about fallopian tube disease is essential in the assessment of the pelvis in female patients. Primary and secondary changes in the tubes vary widely, regardless of whether associated changes in the ovaries are present. Ultrasonography is the initial technique in the study of adnexal disease because it is very sensitive and widely available; however, MRI is also very useful in this context because its high tissue resolution and anatomic detail make it more specific. The morphologic findings and the characteristics of the contents of the tubes on MRI enable a more accurate diagnosis or limit the differential diagnosis, helping to ensure that the most appropriate treatment is provided in each case.

Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento / Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment

Objetivo. La mastopatía diabética (MD) es una complicación infrecuente de la diabetes mellitus de larga evolución, que plantea el diagnóstico diferencial con el cáncer de mama. Se estudian la presentación clínica y evolución de la MD, los hallazgos radiológicos, la histología y el tratamiento en los pacientes diagnosticados en nuestro hospital. Material y métodos. Se incluyen 6 pacientes diabéticos insulinodependientes con MD, 5 mujeres y un varón, diagnosticados en un periodo de 11 años. El estudio radiológico se realiza con mamografía, ecografía y resonancia magnética (RM). Se obtiene en todos los casos un diagnóstico anatomopatológico definitivo con biopsia con aguja gruesa o quirúrgica. No se recurre en ningún caso a punción-aspiración con aguja fina. Se lleva a cabo un seguimiento clínico en un periodo medio de 7 años. Resultados. La presentación clínica más frecuente es el nódulo palpable (67%). Los hallazgos radiológicos son: en la mamografía, la asimetría de densidad (50%), en la ecografía un nódulo/masa sólido, hipoecoico, de 1-5cm, mal definido, con sombra acústica y sin señal Doppler (50%) y en la RM el realce tras la administración de contraste (66%). El hallazgo anatomopatológico más frecuente es la mastitis linfocítica en estadios iniciales (83%). Se realiza un tratamiento quirúrgico en todos los pacientes (100%). Conclusiones. La MD es una enfermedad poco frecuente que plantea el diagnóstico diferencial con el cáncer de mama. Su diagnóstico es complejo, pues requiere el conocimiento de los antecedentes personales del paciente, la clínica, la exploración física y los hallazgos radiológicos e histológicos. El tratamiento quirúrgico conservador es de elección, porque no se obtiene respuesta con el tratamiento médico (AU)

Objective. Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. Material and methods. In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7years. Results. The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). Conclusions. Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment (AU)

[Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment]. / Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento.

OBJECTIVE: Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. MATERIAL AND METHODS: In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7 years. RESULTS: The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). CONCLUSIONS: Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment.