[Cerebrovascular disease in children with sickle cell anaemia]. / Enfermedad cerebrovascular en niños con anemia de células falciformes.

INTRODUCTION: Cerebrovascular disease (CVD) is one of the most clinically devastating complications in children with sickle cell anaemia (SCA) and an important cause of death in this population. AIMS: To determine the incidence of CVD in children with SCA and to characterise the risk factors and other related clinical and imaging aspects. PATIENTS AND METHODS: We conducted a retrospective, cross sectional, descriptive study of paediatric patients with SCA and CVD that covered the period between January 1992 and February 2002. RESULTS: A total of 131 children with SCA were registered in the period between January 1992 and February 2002, during which five children suffered some kind of CVD event. This figure corresponds to 3.81% of the patients with SCA and 7.69% of the total number of children with CVD. The most frequent clinical presentation of the CVD is bouts of seizures and the most frequently observed type of CVD is ischemic, chiefly located in the middle cerebral artery. Of the different predictors that exist for ischemic CVD, haemoglobin count was found to be lower than in haemorrhagic CVD. CONCLUSION: CVD is a common complication in the progress of patients with SCA with a high percentage of neurological sequelae.

Enfermedad cerebrovascular en niños con anemia de células falciformes / Cerebrovascular disease in children with sickle cell anemia

Introducción. La enfermedad cerebrovascular (ECV) es una de las complicaciones más devastadoras clínicamente en los niños con anemia de células falciformes (ACF) y una causa importante de muerte en esta población. Objetivo. Determinar la incidencia de ECV en los niños con ACF y caracterizar los factores de riesgo y demás aspectos clínicos e imaginológicos relacionados. Pacientes y métodos. Estudio retrospectivo, transversal y descriptivo, durante el período comprendido entre enero de 1992 y febrero de 2002, de los pacientes pediátricos con ACF y ECV. Resultados. Se registraron 131 niños con ACF en un período comprendido entre enero de 1992 y febrero de 2002, durante el cual cinco niños tuvieron algún evento de ECV; correspondió al 3,81 por ciento de los pacientes con ACF y al 7,69 por ciento del total de niños con ECV. La presentación clínica más frecuente del ECV es la convulsión, y el tipo de ECV es el isquémico, con localización anatómica en la arteria cerebral media. Dentro de los predictores existentes para la ECV isquémica, se encontró una hemoglobina más baja que en la ECV hemorrágica. Conclusión. La ECV es una complicación frecuente en la evolución del paciente con ACF, y deja un alto porcentaje de secuelas neurológicas (AU)

Introduction. Cerebrovascular disease (CVD) is one of the most clinically devastating complications in children with sickle cell anaemia (SCA) and an important cause of death in this population. Aims. To determine the incidence of CVD in children with SCA and to characterise the risk factors and other related clinical and imaging aspects. Patients and methods. We conducted a retrospective, cross-sectional, descriptive study of paediatric patients with SCA and CVD that covered the period between January 1992 and February 2002. Results. A total of 131 children with SCA were registered in the period between January 1992 and February 2002, during which five children suffered some kind of CVD event. This figure corresponds to 3.81% of the patients with SCA and 7.69% of the total number of children with CVD. The most frequent clinical presentation of the CVD is bouts of seizures and the most frequently observed type of CVD is ischemic, chiefly located in the middle cerebral artery. Of the different predictors that exist for ischemic CVD, haemoglobin count was found to be lower than in haemorrhagic CVD. Conclusion. CVD is a common complication in the progress of patients with SCA with a high percentage of neurological sequelae (AU)

Initial experience with Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction.

PURPOSE: Initial experience with use of Song's covered duodenal stent in the treatment of malignant gastroduodenal obstruction is reported. MATERIALS AND METHODS: Sixteen consecutive patients with malignant gastroduodenal obstruction were treated with peroral placement of Song's covered duodenal stent. The mean age was 58 years (range, 28-90 y). Gastroduodenal obstruction was caused by gastric (n = 8), metastatic (n = 2), gallbladder (n = 3), pancreatic (n = 2), or ampullary (n = 1) cancer. The disease was considered inoperable in all patients. With use of a flexible 20-F introducing system, seven fully covered, three uncovered, and 10 partially covered duodenal stents were placed under fluoroscopic guidance. RESULTS: The technical success rate was 94% (15 of 16) with no major complications. Symptoms of gastroduodenal obstruction improved in 14 patients. Stent migration was observed in three of seven fully covered stents. Patients with migrated stents required endoscopic stent removal and placement of uncovered duodenal stents. Tumor ingrowth was observed in two thirds of uncovered stents. In the 10 procedures with partially covered duodenal stents, no migration or tumor ingrowth was observed. All patients died 1-48 weeks (mean, 12 weeks) after stent placement. CONCLUSION: Peroral placement of Song's covered duodenal stent is a feasible and effective method of palliation in the majority of patients with malignant gastroduodenal obstruction. Migration of fully covered stents and tumor ingrowth of uncovered stents are important limitations that can be overcome with the use of a partially covered duodenal stent.

Malignant hilar and perihilar biliary obstruction: use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions.

PURPOSE: To determine the usefulness of magnetic resonance (MR) cholangiography in defining the extent of biliary ductal involvement in patients with malignant hilar and perihilar biliary obstruction and to evaluate whether findings at MR cholangiography alone are sufficient to plan percutaneous interventions in these patients. MATERIALS AND METHODS: Twenty-nine patients with malignant hilar and perihilar biliary obstruction were examined with MR cholangiography. Two radiologists evaluated MR images and determined the extent of biliary ductal involvement. A hypothetical plan for biliary drainage was established prior to any intervention. All patients underwent percutaneous cholangiography, and 27 of 29 patients also underwent biliary drainage and/or stent placement within 7 days after MR cholangiography. By using direct cholangiography as the standard of reference, the usefulness of MR cholangiography in defining the extent of biliary ductal involvement was determined. The type of drainage performed was compared with the type that had been anticipated at MR cholangiography. RESULTS: MR cholangiography was adequate in helping predict the extent of biliary ductal involvement in 28 (96%) of 29 patients and led to underestimation of the extent of the disease in one patient. The therapeutic plan anticipated with MR cholangiography matched the one actually used in 24 (83%) of 29 patients. CONCLUSION: The high accuracy of MR cholangiography for defining extent of ductal involvement in patients with malignant hilar and perihilar obstruction allows adequate planning of percutaneous interventions in a majority of patients.

Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis.

PURPOSE: To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities. MATERIALS AND METHODS: During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up. RESULTS: Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%. CONCLUSION: Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.

Biliary obstruction: findings at MR cholangiography and cross-sectional MR imaging.

Twenty-two patients with malignant biliary obstruction and 21 patients with suspected obstruction of biliary-enteric anastomoses were evaluated over a 12-month period with magnetic resonance (MR) cholangiography and cross-sectional MR imaging. In patients with malignant obstruction, MR cholangiography helped accurately determine the status of the biliary ductal system by identifying the exact location and extent of the obstruction and the severity of duct dilatation. In so doing, MR cholangiography helped determine whether percutaneous transhepatic cholangiography with antegrade stent placement or retrograde cholangiography with stent placement constituted the more suitable treatment. Cross-sectional MR imaging was necessary to identify the organ of tumor origin, define the tumor margins, and determine the stage of disease. This information helped evaluate the appropriateness of curative surgical therapy versus palliative drainage procedures. In patients with biliary-enteric anastomoses, MR cholangiography clearly depicted the site of the anastomosis and demonstrated the status of the intrahepatic ducts, thereby helping determine which patients would benefit from undergoing antegrade duct cannulation with a drainage procedure or perhaps balloon dilation. In some of these patients, MR cholangiography was sufficient to help plan therapeutic intervention. MR cholangiography also demonstrates the presence and size of biliary stones and associated findings such as intraductal tumor growth. In addition, MR cholangiography may obviate retrograde cholangiography, which can be technically difficult to perform.

Gastrostomía percutánea radiológica / Fluoroscopic percutaneous gastrostomy

Presentamos la experiencia inicial con la realización de 14 gastrostomias percutáneas con control fluoroscópico en el Servicio de Radiologia del Hospital Universitario San Vicente de Paul de Medellin, con elementos fácilmente disponibles y economicos. Se transcribe el procedimiento y se analizan indicaciones y morbimortalidad comparadas con un grupo de gastrostomias quirurgicas realizadas en la misma institucion. Concluimos que por su bajo costo, fácil aprendizaje y realización y baja morbilidad, la gastrostomia percutanea radiológica es una excelente alternativa para los pacientes que la requieran.