Quimioembolización del hepatocarcinoma: partículas cargadas frente a quimioembolización convencional / Comparison of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma

Objetivo. Comparar la quimioembolización transarterial (TACE) convencional con la quimioembolización con partículas cargadas (DEB-TACE) para el tratamiento del hepatocarcinoma, valorando la respuesta tumoral, las complicaciones tras el tratamiento y la supervivencia. Material y métodos. Presentamos 72 pacientes diagnosticados de hepatocarcinoma. El estudio incluye 25 pacientes tratados con TACE (Grupo A) y 47 pacientes tratados con DED-TACE (Grupo B), empleando en ambos grupos adriamicina. Todos los pacientes se tratan consecutivamente desde enero de 2000 hasta diciembre de 2009. Todos presentaban una cirrosis en estadio Child-Pugh compensada. Los resultados se estudiaron conforme al criterio RECIST. El estudio estadístico consistió en ANOVA, Chi2, T-Test y estudio de Kaplan-Meier (test de Log-Rank). Resultados. La edad, el tamaño, el número de tumores y la reserva hepática en los dos grupos de pacientes fueron estadísticamente similares. El número de sesiones por paciente fue: Grupo A media 1,32±0,67 veces, Grupo B media 2,13±0,95 veces. La media de dosis de adriamicina por paciente fue: 50,60±29,95mg en grupo A y 231,91±110,2mg en grupo B. Se observó una respuesta completa del tumor en 5,6% en el grupo A y 13,9% en el grupo B. Conforme al sistema RECIST no se encontraron diferencias estadísticamente significativas. La DEB-TACE fue mejor tolerada con menos complicaciones inmediatas (p=0.001). No se encontraron diferencias significativas en la supervivencia entre los dos grupos. grupo A: media 686,24, mediana 709 días, y grupo B: media 765,32, mediana 672 días. Conclusión. En los pacientes con hepatocarcinoma irresecable, la quimioembolización con partículas cargadas de adriamicina es segura y mejor tolerada que la quimioembolización convencional y parece producir una mayor necrosis tumoral (AU)

Objective. To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. Material and methods We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. Results. Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32±0.67 in Group A versus 2.13±0.95 in Group B. The mean dose of adriamycin per patient was 50.60±29.95mg in Group A and 231.91±110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. Conclusion. In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors (AU)

[Comparison of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma]. / Quimioembolización del hepatocarcinoma: partículas cargadas frente a quimioembolización convencional.

OBJECTIVE: To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. MATERIAL AND METHODS: We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. RESULTS: Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32 ± 0.67 in Group A versus 2.13 ± 0.95 in Group B. The mean dose of adriamycin per patient was 50.60 ± 29.95 mg in Group A and 231.91 ± 110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. CONCLUSION: In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors.

Cuantificación de la calcificación coronaria en tomografía computarizada torácica de baja dosis de radiación sin sincronización cardiaca / Coronary artery calcium quantification with non-ECG-gated low-radiation dose CT of the chest

Objetivo: Evaluar la posibilidad de cuantificar la calcificación coronaria en las tomografías computarizadas (TC) de baja dosis de radiación (TCBD) torácicas realizadas en un programa de detección precoz de cáncer de pulmón con respecto al protocolo cardíaco específico realizado con sincronización electrocardiográfica (ECG) retrospectiva. Material y métodos: Tras obtener el consentimiento informado se analizaron las exploraciones de 48 fumadores asintomáticos consecutivos (44 varones, 4 mujeres; edad media 59,7 años) incluidos en un programa de detección precoz de cáncer de pulmón a los que se realizó TCBD torácica y un estudio cardíaco específicamente dirigido a cuantificar la calcificación coronaria con sincronización ECG retrospectiva en un equipo TC multicorte (Volume Zoom, Siemens). La exploración TC de baja dosis de radiación se reconstruyó para reproducir los parámetros del estudio cardíaco. Los valores de calcio coronario se compararon con el test de Wilcoxon. Se calculó el coeficiente de correlación de concordancia (CCC) para determinar la concordancia entre ambos métodos. Resultados: Los valores del calcio coronario oscilaron entre 0 y 1.908,4 (mediana: 89,6; amplitud intercuartil [AIC]: 3,2; 227,4) en TCBD y entre 0 y 1.486,6 (mediana: 81,3; AIC: 2,5; 316,4) en los estudios cardíacos. No se observaron diferencias estadísticamente significativas en la estimación total de calcio coronario (p=0,28). La concordancia entre ambas técnicas fue buena (CCC≥0,81). Conclusión: Los estudios de TC de baja dosis de radiación realizados en programas de detección precoz de cáncer de pulmón permiten cuantificar la calcificación coronaria con la misma exactitud que el protocolo cardíaco específico realizado con sincronización ECG retrospectiva (AU)

Objective: To evaluate the feasibility of quantifying coronary artery calcification in low-radiation dose chest CT (LDCT) studies performed in an early lung cancer detection program by comparing the results of this technique with those of dedicated retrospectively ECG-gated cardiac CT. Material and methods: After obtaining informed consent, we evaluated the CT studies of 48 consecutive asymptomatic smokers (44 male, 4 female; mean age 59.7 years) included in an early lung cancer detection trial who underwent multislice LDCT (Volume Zoom, Siemens) of the chest and a retrospectively ECG-gated cardiac CT specifically dedicated to quantifying coronary artery calcification. LDCT examinations were reconstructed to reproduce cardiac CT parameters. Coronary calcium values were compared using the Wilcoxon signed-rank test. The concordance correlation coefficient (CCC) was calculated to determine the agreement between the two methods. Results: Coronary calcium values ranged from 0 to 1,908.4 (median: 89.6; IQR: 3.2; 227.4) in LDCT exams and from 0 to 1,486.6 (median: 81.3; IQR: 2.5; 316.4) in cardiac CT studies. No statistically significant difference was observed in the estimation of total coronary calcium score (p=0.28). The concordance between the two techniques was excellent (CCC≥0.81). Conclusion: The LDCT study performed in lung cancer early detection trials enables coronary artery calcification to be quantified with the same accuracy as the dedicated retrospectively ECG-gated cardiac CT examination (AU)

El conejo como modelo de experimentación. Inducción de lesión vascular: técnica e incidencias / The rabbit as an experimental model: technique for the induction of vascular lesions and incidents

Objetivo: Describir el proceso para conseguir la lesión aterogénica en el conejo, mostrar el daño vascular producido por 2 catéteres de balón de diferente calibre y el valor de la ecografía para su cuantificación. Material y métodos: Se emplearon 36 conejos. Se estudiaron los valores de triglicéridos y colesterol, y se realizó una ecografía de aorta e ilíacas. Se realizó una arteriografía y se indujo la lesión vascular denudando la arteria ilíaca izquierda con catéter de balón: grupo A, catéter-balón 2,5mm, y grupo B catéter-balón 3mm de diámetro. Tras 8 semanas con dieta hiperlipídica se realizaron nuevas mediciones bioquímicas y ecográficas. Resultados Colesterol antes de la dieta 37,96±19,3mg/dl, y tras la dieta 1.761±296,91mg/dl. Los hallazgos ecográficos mostraron un diámetro de la aorta de 4,1±0,7mm, de la arteria ilíaca derecha de 3±0,3mm, de la arteria ilíaca izquierda de 3±0,4mm. Tras el daño vascular y 8 semanas de dieta, en el grupo A la luz de la aorta era de 2,78±1,21mm, la arteria ilíaca derecha medía 2,18±0,81mm y la arteria ilíaca izquierda 1,16±0,63mm; en el grupo B la luz de la aorta fue de 3,07±1,06mm, la arteria ilíaca derecha 2,53 ± 0,9mm y la arteria ilíaca izquierda 1,39±1,1mm. Resultados: Murieron 4 conejos y de los 32 restantes hubo más morbimortalidad con el catéter de balón de 3 mm. Conclusión Tras la denudación con catéter de balón y dieta los conejos desarrollan estenosis de la arteria. El daño con catéter de 2,5 mm de diámetro disminuye las complicaciones (AU)

Objective: To describe the process for inducing atherogenic lesions in rabbits, to show the damage to vessels caused by two different caliber balloon catheters, and to show the usefulness of ultrasonography in the quantification of vascular damage. Material and methods: We used 36 rabbits. We studied the levels of triglycerides and cholesterol and examined the aorta and iliac arteries by ultrasonography. We performed arteriography and induced a vascular lesion by denuding the left iliac artery with a balloon catheter: group A 2.5mm diameter balloon catheter, group B 3mm diameter balloon catheter. After 8 weeks on a hyperlipidic diet, biochemical and ultrasonographic measurements were repeated. Results: Cholesterol before the diet: 37.96±19.3mg/dL and after the diet: 1761±296.91mg/dL. The baseline ultrasonographic measurements of vessel diameter were: aorta 4.1±0.7mm, right iliac artery 3±0.3mm, left iliac artery 3±0.4mm. After vascular damage and 8 weeks hyperlipidic diet, in group A the ultrasonographic measurements of vessel diameter were: aortic lumen 2.78±1.21mm, right iliac artery 2.18±0.81mm, and the left iliac artery 1.16±0.63mm; in group B, the aortic lumen measured 3.07±1.06mm, the right iliac artery 2.53±0.9mm, and the left iliac artery 1.39±1.1mm. Results: Four rabbits died; in the 32 remaining rabbits, morbidity was higher with a 3mm balloon catheter. Conclusion: After denudation with a balloon catheter and a hyperlipidic diet, the rabbits developed arterial stenosis. The damage with a 2.5mm diameter catheter reduces complications (AU)

[The rabbit as an experimental model: technique for the induction of vascular lesions and incidents]. / El conejo como modelo de experimentación. Inducción de lesión vascular: técnica e incidencias.

OBJECTIVE: To describe the process for inducing atherogenic lesions in rabbits, to show the damage to vessels caused by two different caliber balloon catheters, and to show the usefulness of ultrasonography in the quantification of vascular damage. MATERIAL AND METHODS: We used 36 rabbits. We studied the levels of triglycerides and cholesterol and examined the aorta and iliac arteries by ultrasonography. We performed arteriography and induced a vascular lesion by denuding the left iliac artery with a balloon catheter: group A 2.5mm diameter balloon catheter, group B 3mm diameter balloon catheter. After 8 weeks on a hyperlipidic diet, biochemical and ultrasonographic measurements were repeated. RESULTS: Cholesterol before the diet: 37.96 + or - 19.3mg/dL and after the diet: 1761 + or - 296.91 mg/dL. The baseline ultrasonographic measurements of vessel diameter were: aorta 4.1 + or - 0.7 mm, right iliac artery 3 + or - 0.3mm, left iliac artery 3 + or - 0.4mm. After vascular damage and 8 weeks hyperlipidic diet, in group A the ultrasonographic measurements of vessel diameter were: aortic lumen 2.78 + or - 1.21 mm, right iliac artery 2.18 + or - 0.81 mm, and the left iliac artery 1.16 + or - 0.63 mm; in group B, the aortic lumen measured 3.07 + or - 1.06 mm, the right iliac artery 2.53 + or - 0.9 mm, and the left iliac artery 1.39 + or - 1.1 mm. Four rabbits died; in the 32 remaining rabbits, morbidity was higher with a 3 mm balloon catheter. CONCLUSION: After denudation with a balloon catheter and a hyperlipidic diet, the rabbits developed arterial stenosis. The damage with a 2.5 mm diameter catheter reduces complications.

[Coronary artery calcium quantification with non-ECG-gated low-radiation dose CT of the chest]. / Cuantificación de la calcificación coronaria en tomografía computarizada torácica de baja dosis de radiación sin sincronización cardiaca.

OBJECTIVE: To evaluate the feasibility of quantifying coronary artery calcification in low-radiation dose chest CT (LDCT) studies performed in an early lung cancer detection program by comparing the results of this technique with those of dedicated retrospectively ECG-gated cardiac CT. MATERIAL AND METHODS: After obtaining informed consent, we evaluated the CT studies of 48 consecutive asymptomatic smokers (44 male, 4 female; mean age 59.7 years) included in an early lung cancer detection trial who underwent multislice LDCT (Volume Zoom, Siemens) of the chest and a retrospectively ECG-gated cardiac CT specifically dedicated to quantifying coronary artery calcification. LDCT examinations were reconstructed to reproduce cardiac CT parameters. Coronary calcium values were compared using the Wilcoxon signed-rank test. The concordance correlation coefficient (CCC) was calculated to determine the agreement between the two methods. RESULTS: Coronary calcium values ranged from 0 to 1,908.4 (median: 89.6; IQR: 3.2; 227.4) in LDCT exams and from 0 to 1,486.6 (median: 81.3; IQR: 2.5; 316.4) in cardiac CT studies. No statistically significant difference was observed in the estimation of total coronary calcium score (p=0.28). The concordance between the two techniques was excellent (CCC > or = 0.81). CONCLUSION: The LDCT study performed in lung cancer early detection trials enables coronary artery calcification to be quantified with the same accuracy as the dedicated retrospectively ECG-gated cardiac CT examination.

[Treatment of lacrimal duct obstruction with a Tear-Leader stent]. / Tratamiento de la obstrucción del conducto lacrimal con el stent Tear-Leader.

PURPOSE: To compare the effectiveness and patency of the TearLeader stent (PBN) for treatment of lacrimal system obstruction. METHODS: A prospective study of 68 patients referred from the ophthalmology department with suspicion of lacrimal system obstruction. We placed 74 TearLeader PBN stents. Inclusion criteria were: complete obstruction of lacrimal duct with canalicula and lacrimal puncta patency, and absence of acute infection. We studied the clinical improvement by means of an opinion survey, and the patency of stents was evaluated with Kaplan-Meier survival curves. RESULTS: Follow-up of patients was two years. A painful procedure was reported in 10% of cases. Minor dacryocystitis appeared in 18.9% of cases, while complete resolution of epiphora was confirmed in 77% of cases (23% of cases showed grade I epiphora). Patency of stents: median patency 490 days (15 months), range 11 to 730 days; 1 year after stent placement patency was 0.51 and long term patency rate for 2 years was 0.31. Opinion survey of the 68 patients: satisfaction with the technique, the procedure and prosthesis placement was 41%; satisfaction whilst the stent remained patent was 60.8%. CONCLUSION: Tearleader stent placement is easy to perform and comfortable for patients. TearLeader placement gave a patency outcome similar to other stents (Arch Soc Esp Oftalmol 2009; 84: 515-522).

Tratamiento de la obstrucción del conducto lacrimal con el stent Tear-Leader / Treatment of lacrimal duct obstruction with a Tear-Leader stent

Objetivo: Describir los resultados clínicos y estudiarla permeabilidad del stent de Tear-Leader(PBN) en el tratamiento de la obstrucción del conductolacrimal.Método: Estudio prospectivo de 68 pacientes, remitidosdesde el Servicio de Oftalmología para estudiode epífora por sospecha de obstrucción del conductolacrimal. Hemos colocado un total de 74 stentsTear-Leader. Los criterios de inclusión fueron: obstruccióncompleta del conducto lacrimal con permeabilidadde canalículos y de puntos lacrimales asícomo ausencia de infección aguda. Hemos realizadoen todos los pacientes el control clínico y unaencuesta de satisfacción. Se realizó un estudio estadísticodescriptivo y se evaluó la permeabilidad de laprótesis usando las curvas de Kaplan Meier.Resultados: El seguimiento de los pacientes se realizódurante dos años. Se confirmó la resolucióntotal de la epífora en el 77%, (en el 23% persistióuna epífora grado I). Permeabilidad del stent: lamediana fue de 490 días (15 meses) con rango de11-730 días, al año la permeabilidad fue de 0,51 y a2 años de 0,31. Refieren implantación dolorosa el10% de los casos implantados. Aparecieron episodiosde dacriocistitis leve en el 18% de los casos.Encuesta de satisfacción a los 68 pacientes: con respectoa la técnica, procedimiento y prótesis estabansatisfechos un 41%. Mientras la prótesis se mantuvopermeable se encontraban satisfechos un 60,8%.Conclusión: La prótesis Tear-Leader es de fácilcolocación, con escasas molestias para el paciente.Presenta una permeabilidad similar al resto destents del mercado (AU)

Purpose: To compare the effectiveness and patencyof the TearLeader stent (PBN) for treatment oflacrimal system obstruction.Methods: A prospective study of 68 patients referredfrom the ophthalmology department with suspicionof lacrimal system obstruction. We placed 74TearLeader PBN stents. Inclusion criteria were:complete obstruction of lacrimal duct with canaliculaand lacrimal puncta patency, and absence ofacute infection. We studied the clinical improvementby means of an opinion survey, and thepatency of stents was evaluated with Kaplan-Meiersurvival curves.Results: Follow-up of patients was two years. Apainful procedure was reported in 10% of cases.Minor dacryocystitis appeared in 18.9% of cases,while complete resolution of epiphora was confirmedin 77% of cases (23% of cases showed grade Iepiphora). Patency of stents: median patency 490days (15 months), range 11 to 730 days; 1 year afterstent placement patency was 0.51 and long termpatency rate for 2 years was 0.31. Opinion survey ofthe 68 patients: satisfaction with the technique, theprocedure and prosthesis placement was 41%; satisfactionwhilst the stent remained patent was 60.8%. Conclusion: Tearleader stent placement is easy toperform and comfortable for patients. TearLeaderplacement gave a patency outcome similar to otherstents(AU)

[Intestinal pneumatosis and portomesenteric gas: a case review]. / Neumatosis intestinal y gas portomesentérico: a propósito de un caso.

Intestinal pneumatosis (presence of gas in the intestinal wall and in the portomeseteric veins) is an infrequent clinical situation that has been associated with extended bowel necrosis and fatal outcome. However, there are other reasons that can justify these findings without such an outcome. Recent advances in diagnostic imaging techniques, especially multislice computerized tomography (MSCT), have allowed precise and quick diagnosis of these entities. In this article, we review the MSCT radiological manifestations of intestinal pneumatosis, as well as the different diagnoses related with the findings observed in a patient diagnosed with esophageal carcinoma under chemotherapy treatment.

Neumatosis intestinal y gas portomesentérico: a propósito de un caso / No disponible

La neumatosis intestinal (presencia de gas en el interior de la pared intestinal y en el complejo venoso portomesentérico) es una situación clínica poco frecuente que ha sido característicamente relacionada con la isquemia intestinal y con un desenlace fatal. Existen otras causas que pueden justifi car estos hallazgos y cuya repercusión para el paciente no es inevitablemente trágica. Los avances recientes en técnicas de imagen, sobre todo en tomografía computarizada multicorte (TCMC), permiten un diagnóstico preciso fi able y precoz de estos hallazgos. En este artículo, repasamos las manifestaciones radiológicas de la neumatosis intestinal en TC así como las distintas causas relacionadas con esta entidad, en relación con los hallazgos presentes en un paciente diagnosticado de carcinoma de esófago y en tratamiento quimioterápico

Intestinal pneumatosis (presence of gas in the intestinal wall and in the portomeseteric veins) is an infrequent clinical situation that has been associated with extended bowel necrosis and fatal outcome. However, there are other reasons that can justify these fi ndings without such an outcome. Recent advances in diagnostic imaging techniques, especially multislice computerized tomography (MSCT), have allowed precise and quick diagnosis of these entities. In this article, we review the MSCT radiological manifestations of intestinal pneumatosis, as well as the different diagnoses related with the fi ndings observed in a patient diagnosed with esophageal carcinoma under chemotherapy treatment

Endovascular treatment of thoracic dissection.

Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.

[Endovascular therapeutic techniques]. / Técnicas terapéuticas endovasculares.

Percutaneous and endovascular techniques have shown their efficacy in the treatment of a great variety of pathologies. The advances in diagnostic imaging as well as the development of new materials have made it possible to carry out new procedures that were unthinkable not many years ago. The irruption of this new form of treating patients has had, is having, and will have a clear impact on the multidisciplinary approach to numerous diseases.

Técnicas terapéuticas endovasculares / Endovascular therapeutic techniques

Las técnicas percutáneas y endovasculares han demostrado su eficacia en el tratamiento de una gran variedad de patologías. Los avances en la imagen diagnóstica así como en el desarrollo de nuevos materiales han posibilitado la realización de nuevos procedimientos, impensables hace no mucho años. La irrupción de esta nueva forma de tratar a los pacientes ha tenido, tiene y tendrá, aún más, un claro impacto en el enfoque multidisciplinar de múltiples enfermedades

Percutaneous and endovascular techniques have shown their efficacy in the treatment of a great variety of pathologies. The advances in diagnostic imaging as well as the development of new materials have made it possible to carry out new procedures that were unthinkable not many years ago. The irruption of this new form of treating patients has had, is having, and will have a clear impact on the multidisciplinary approach to numerous diseases