Estadificación mediante tomografía computarizada del carcinoma de páncreas / Staging pancreatic carcinoma by computed tomography

El carcinoma de páncreas es una neoplasia cada vez más frecuente en nuestro medio, y su elevada tasa de mortalidad apenas ha variado en las dos últimas décadas. Un diagnóstico inicial precoz y una estadificación precisa son primordiales para desarrollar una correcta actitud terapéutica, con el fin de mejorar la supervivencia en aquellos pacientes en los que la resección completa es posible y minimizar la morbimortalidad quirúrgica en pacientes con alto riesgo de enfermedad residual tras la intervención. Existen diversas técnicas de imagen implicadas en la estadificación tumoral: la tomografía computarizada multidetector, la resonancia magnética, la PET-TC, la ecoendoscopia y la laparoscopia diagnóstica. Actualmente, la tomografía computarizada multidetector es la técnica de elección para el estudio de este tipo de neoplasias. Por ello, el propósito de este artículo es revisar el estado actual de la estadificación del adenocarcinoma de páncreas, basándose principalmente en las aplicaciones y limitaciones de esta técnica (AU)

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique (AU)

Staging pancreatic carcinoma by computed tomography. / Estadificación mediante tomografía computarizada del carcinoma de páncreas.

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.

Cistoscopia virtual, urografía por tomografía computarizada y uretrocistoscopia óptica en el diagnóstico y el seguimiento del cáncer de vejiga / Virtual cystoscopy, computed tomography urography and optical cystoscopy for the detection and follow-up for bladder cancer

Objetivos. Evaluar la utilidad de la cistoscopia virtual (CV) realizada junto con la urografía por tomografía computarizada (URO-TC) en pacientes en estudio por hematuria macroscópica o en seguimiento por antecedente de cáncer de vejiga tratado, y comparar los resultados con los obtenidos con la técnica de referencia (uretrocistoscopia óptica [UCO]). Material y métodos. Estudio retrospectivo de 117 pacientes derivados para realización de CV y URO-TC desde el Departamento de Urología entre mayo de 2014 y mayo de 2015. Dichos pacientes presentaban hematuria macroscópica o habían sido tratados previamente por cáncer de vejiga y estaban bajo seguimiento periódico. Fueron sometidos a CV tras la distensión de la vejiga con aire. Los resultados obtenidos fueron comparados con los de la UCO realizada no más de una semana después. Resultados. La sensibilidad y la especificidad global de la CV fueron del 81,8% y el 92,1%, respectivamente. La tasa de hallazgos críticos (que comprometían la vida del paciente) detectados en la URO-TC realizada junto a la CV fue del 12%, similar a la de otros estudios. Conclusión. La CV es una técnica útil en el diagnóstico y el seguimiento del cáncer de vejiga, con buena correlación con la UCO. Sus principales limitaciones son la imposibilidad de toma de biopsia y la capacidad para detectar lesiones eritematosas de mucosa. El empleo concomitante de la URO-TC aporta hallazgos incidentales críticos, pero el incremento en la dosis de radiación no justifica el empleo combinado de ambas (AU)

Objectives. To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy). Methods. Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after. Results. The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis. Conclusion. VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use (AU)

Virtual cystoscopy, computed tomography urography and optical cystoscopy for the detection and follow-up for bladder cancer. / Cistoscopia virtual, urografía por tomografía computarizada y uretrocistoscopia óptica en el diagnóstico y el seguimiento del cáncer de vejiga.

OBJECTIVES: To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy). METHODS: Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after. RESULTS: The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis. CONCLUSION: VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use.

[Morphologic evaluation of fecal incontinence by magnetic resonance imaging in patients with corrected anal atresia]. / Valoración morfológica mediante resonancia magnética de la incontinencia fecal en pacientes con atresia anal corregida.

PURPOSE: To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence. SUBJECT AND METHODS: Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated. RESULTS: Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients. CONCLUSIONS: MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated muscle complex hypoplasia are causes of postoperative incontinence in these patients.

Realización de TAC flebografía indirecta en pacientes con sospecha clínica de tromboembolismo pulmonar: nuestra experiencia y posibles indicaciones de esta prueba / Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test

Objetivo. Nuestro objetivo es valorar la sensibilidad de la tomografía axial computarizada (TAC) flebografía indirecta para la valoración de trombosis venosa profunda, y establecer posibles indicaciones generales de esta técnica en los casos de sospecha de enfermedad tromboembólica. Material y métodos. Se estudian 76 casos con sospecha clínica de tromboembolismo pulmonar a los que se realizó angio-TAC de arterias pulmonares y TAC flebografía indirecta. Se correlacionan los hallazgos con ecografía de extremidades en 63 casos para determinar la sensibilidad de la prueba. Se analizan los casos en los que los hallazgos de la TAC flebografía indirecta variaron el manejo de los pacientes. Resultados. La concordancia con la ecografía fue del 92%. Se hizo el diagnóstico de enfermedad tromboembólica en el 40% de los casos. De ellos, la angio-TAC de arterias pulmonares fue positivo en el 80% de los casos y en el 20% restante sólo fue positiva la TAC flebografía. En 2 casos se objetivó en el estudio abdominal patología que varió el manejo clínico de los pacientes. Conclusiones. La TAC flebografía indirecta es una técnica sensible para la detección de trombosis venosa profunda en los casos de pacientes con sospecha clínica de tromboembolismo pulmonar. Puede acortar el tiempo diagnóstico, aumentar la exactitud diagnóstica y aportar otros datos clínicos que pueden ser importantes para el manejo de los pacientes. Su uso generalizado se ve limitado porque implica el uso de radiaciones ionizantes

Objective. Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease. Material and methods. We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient. Results. The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found. Conclusions. Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation

Valoración morfológica mediante resonancia magnética de la incontinencia fecal en pacientes con atresia anal corregida / Morphologic evaluation of fecal incontinence by magnetic resonance imaging in patients with corrected anal atresia

Objetivo: Describir los hallazgos obtenidos mediante resonancia magnética (RM) en pacientes con incontinencia fecal previamente intervenidos de anorrectoplastia sagital posterior (ARPSP) por atresia de ano y definir su utilidad en la valoración de su causa. Material y métodos: Se examinaron con RM 0,5T a 12 pacientes, 9 varones y 3 mujeres, a los que previamente se les realizó ARPSP por atresia de ano. El estudio incluía secuencias potenciadas en T1, T2 y DP con planos axiales, sagitales y coronales. Se valoraba el posicionamiento del neorrecto descendido entre los músculos elevadores del ano y complejo esfinteriano y el grado desarrollo de la musculatura pelviana. Resultados: Seis pacientes presentaban un desarrollo adecuado de los músculos elevadores del ano y complejo esfinteriano, con correcto posicionamiento del neorrecto en 5 de ellos y situación excéntrica en 1. En los otros 6 casos se observaron diversos grados de subdesarrollo del complejo muscular estriado, 4 de ellos en grado moderado y en 2, grave. En el último grupo se observaron anomalías congénitas, disráficas espinales y del sistema urogenital. Los planos sagital y coronal potenciados en T1 fueron los más útiles para evaluar la interrelación entre músculos elevadores del ano y complejo esfinteriano, mientras que los planos axiales fueron útiles en la valoración del grado de desarrollo del complejo muscular estriado. Conclusiones: La RM es útil en la evaluación de pacientes con incontinencia fecal tras ARPSP por malformación anorrectal. Una inadecuada posición del neorrecto o hipoplasia del complejo muscular estriado son causas de incontinencia postoperatoria en estos pacientes (AU)

Purpose: To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence. Subject and methods: Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated. Results: Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients. Conclusions: MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated musce complex hypoplasia are causes of postoperative incontinence in these patients (AU)

[Wandering spleen associated to inflammatory pseudotumor]. / Pseudotumor inflamatorio en bazo errante.

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.

Pseudotumor inflamatorio en bazo errante / Wandering spleen associated to inflammatory pseudotumor

El bazo errante es una entidad clínica inusual, con una incidencia inferior al 0,5% de todas las esplenectomías realizadas. Su hallazgo puede ser casual en pacientes asintomáticos o consecuencia de un cuadro clínico agudo o crónico secundario a factores mecánicos provocados por compresión (retención urinaria, estreñimiento, etc.), alteraciones de la función (trombocitopenia o hiperesplenismo) o torsión del pedículo vascular. Su diagnóstico se realiza mediante técnicas de imagen, habitualmente ecografía, tomografía axial computarizada o resonancia magnética. La gammagrafía o la arteriografía pueden ser también útiles en casos no concluyentes. Se han descrito en la literatura casos de bazo errante asociados a tumoraciones diversas (quistes epidermoides, quistes simples, linfangiomas quísticos o limfomas). No hemos encontrado casos asociados a pseudotumor inflamatorio. Presentamos el caso de una paciente con bazo errante asociado a pseudotumor inflamatorio

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

[Injury to the prostatic urethra caused by firearm]. / Lesión de uretra prostática por arma de fuego.

Report of a 32-year old male patient with an injury of the posterior urethra caused by firearm. Initial examination only revealed fracture of the femoral vein. Absence of spontaneous micturition during the immediate post-operative made necessary to undertake retrograde urethrography, in which a fracture of the posterior urethra with extraperitoneal pelvian extravasation was found. The lack of references on urethral injuries by firearm and the good evolution obtained in this case with a conservative approach, suprapubic cystotomy, had encouraged us to report this case.

[Involvement of cranial pairs as manifestation of prostatic cancer]. / Afectación de pares craneales como manifestación de cáncer de próstata.

Two cases of prostate cancer (PC) which presented clinically with affectation of the cranial pairs due to skull base metastasis. In both cases, existence of intraparenchimatous brain metastasis was excluded. Initial improvement with hormonal therapy was followed by clinical, analytical and radiological relapse due to spread of process until death, at 11 and 36 months from diagnosis. Although PC's bone metastasis are frequent, their location at the skull base is uncommon. Even more rare are the cases which present with changes in the cranial pairs in the absence of signs and symptoms of prostatism.

[Value of ultrasonography in deep venous thrombosis of the legs]. / Valor de la ecografía en las trombosis venosas profundas de miembros inferiores.

A variety of non-invasive diagnostic procedures for assessing deep vein thrombosis (DVT) have appeared over the last 10 years. One is conventional ultrasound imaging, called B-mode at first and now called the Doppler-duplex mode. Several authors speak of the high level of reliability of this method for diagnosing DVT in the iliofemoral and popliteal regions. We found an initial sensitivity of 84% in a total of 162 ultrasound studies of lower extremities. Specificity was 100% in the 41 cases in which phlebograms were also used.

[Neck-tongue syndrome secondary to abrupt head movements. Clinical study and conservative treatment]. / Síndrome cuello-lengua secundario a giros bruscos de la cabeza. Estudio clínico y tratamiento conservador.

The neck-tongue syndrome is an extremely rare entity consisting of the compression of the second cervical root in the atloaxoid space in relation to certain brusque movements of the neck. Given the infrequency of this syndrome, the authors present a diagnosed and controlled case of the same in the Reina Sofia Hospital in Tudela. A 25 year old patient was consulted who, for some time, had presented paresthesia in the right half of the tongue and contraction of the cervical musculature related to certain neck postures made during sports activities. Clinical examination was completely normal. Radiography only demonstrated a defect in the segmentation between the posterior C2, C3 arches. Herewith, the authors have revised the literature concerning the topic, discuss the physiopathological theories made in other studies and analyze the therapeutic possibilities of the disease inclinning towards conservative treatment.

[Ultrasonic diagnosis of neuroblastoma]. / Diagnóstico ultrasonográfico en el neuroblastoma.

Neuroblastoma is one of the most frequent tumors in childhood. Suprarenal area is its main abdominal location, appearing in lesser proportion in paravertebral ganglionar chains. Its prediction depends principally on the age of the patient and the pathological stage. US are the best method for its diagnosis. Its most frequent appearance is as an hyperechogenic heterogeneous mass with calcifications inside. In evaluation tumoral extension, other complementary methods such as CT and MRI should be used.

[Post-traumatic arteriovenous fistula: apropos of 4 cases]. / Fístulas arteriovenosas postraumáticas: a propósito de cuatro casos.

Postraumatic arteriovenous fistulas (AVF) usually occur after traumatisms or surgical procedures. A clinic hemodynamic repercussion, or even a cardiac failure, can be caused by them. AVF diagnosis is mainly made angiographic study. In the present works we study different "Diagnosis by Images" methods (i.e.: CT, echography, MNR, angiography, gammagraphy, etc.) used in AVF diagnosis. Also, a Bibliographic Review of such disease was made. We present four cases reports with postraumatic arteriovenous fistulas; two were located in extremities (right upper limb and left lower limb, respectively) and the other two were abdominal (left reno-renal and right renocava).