Evaluation of transjugular intrahepatic portosystemic shunt (TIPS) as a previous step to liver transplantation in pediatric patients. / Evaluación del shunt portosistémico intrahepático transyugular (TIPS) como puente terapéutico al trasplante hepático en pacientes pediátricos.

INTRODUCTION: Transjugular intrahepatic portosystemic shunt (TIPS) was designed to treat complications of portal hypertension (PH). The objective of this study was to analyze the results of the TIPS performed in pediatric patients in our institution as a previous step to liver transplantation (LT). MATERIAL AND METHODS: A retrospective, descriptive study of pediatric patients with liver cirrhosis undergoing TIPS prior to LT from 2015 to 2020 was carried out. RESULTS: TIPS was performed in 10 patients. The reason for TIPS was hard-to-control ascites in 7 patients (70%), upper gastrointestinal bleeding due to esophageal varices in 1 patient (10%), and portal hypoplasia in 2 cases (20%). No intraoperative complications were recorded. Stent patency was achieved in all cases. TIPS patency until LT was observed in 6 patients (60%). Indirect signs of patency were noted in 1 patient (10%). 2 patients (20%) required re-intervention, with patency being achieved in the second attempt. And finally, no patency was observed after 3 attempts in 1 patient (10%). A decrease in portocaval gradient (p = 0.001) and an increase in portal velocity (p = 0.006) were observed. No platelet count changes were found. A slight, non-significant increase in ammonia was noted. CONCLUSION: TIPS is a safe and effective procedure to reduce complications of hard-to-control PH in pediatric patients. It allows general condition to be optimized, deterioration to be avoided, and portal vein narrowing to be alleviated in cirrhosis patients as a previous step to LT.

INTRODUCCION: El shunt portosistémico intrahepático transyugular (TIPS) es un procedimiento para tratar las complicaciones de la hipertensión portal. El objetivo del estudio es analizar los resultados de los TIPS realizados en nuestro centro, a pacientes pediátricos como puente al trasplante hepático (TH). MATERIAL Y METODOS: Estudio retrospectivo y descriptivo de pacientes pediátricos con cirrosis hepática a los cuales se les ha realizado un TIPS previo al trasplante hepático entre los años 2015 y 2020. RESULTADOS: Se realizó el TIPS a 10 pacientes. El motivo fue en 7 por ascitis de difícil control (70%), un caso por hemorragia digestiva alta por varices esofágicas (10%) y en 2 por hipoplasia portal (20%). No hubo complicaciones intraoperatorias y en todos los casos se logró permeabilidad de la endoprótesis. En 6 pacientes (60%) se observó permeabilidad del TIPS hasta el TH, en un paciente se observaron signos indirectos de permeabilidad (10%), 2 casos requirieron reintervención, lográndose permeabilidad en el segundo intento (20%) y en otra paciente (10%) no se observó permeabilidad tras 3 intentos. Se apreció una disminución del gradiente portocava (p = 0,001) y un aumento en la velocidad portal (p = 0,006). No se evidenció cambios en la cifras de plaquetas y se produjo un ligero aumento del amonio, sin ser significativos. CONCLUSION: El TIPS es un procedimiento seguro y eficaz para paliar las complicaciones de la hipertensión portal de difícil control en pacientes pediátricos. Nos permite optimizar el estado general, evitar el deterioro y paliar el estrechamiento de la vena porta de los pacientes cirróticos como puente al TH.

Evaluación del shunt portosistémico intrahepático transyugular (TIPS) como puente terapéutico al trasplante hepático en pacientes pediátricos / Evaluation of transjugular intrahepatic portosystemic shunt (TIPS) as a previous step to liver transplantation in pediatric patients

Introducción: El shunt portosistémico intrahepático transyugular(TIPS) es un procedimiento para tratar las complicaciones de la hiper-tensión portal. El objetivo del estudio es analizar los resultados de losTIPS realizados en nuestro centro, a pacientes pediátricos como puenteal trasplante hepático (TH).Material y métodos: Estudio retrospectivo y descriptivo de pacien-tes pediátricos con cirrosis hepática a los cuales se les ha realizado unTIPS previo al trasplante hepático entre los años 2015 y 2020.Resultados: Se realizó el TIPS a 10 pacientes. El motivo fue en 7por ascitis de difícil control (70%), un caso por hemorragia digestivaalta por varices esofágicas (10%) y en 2 por hipoplasia portal (20%).No hubo complicaciones intraoperatorias y en todos los casos se logrópermeabilidad de la endoprótesis.En 6 pacientes (60%) se observó permeabilidad del TIPS hasta elTH, en un paciente se observaron signos indirectos de permeabilidad(10%), 2 casos requirieron reintervención, lográndose permeabilidaden el segundo intento (20%) y en otra paciente (10%) no se observópermeabilidad tras 3 intentos.Se apreció una disminución del gradiente portocava (p = 0,001) yun aumento en la velocidad portal (p = 0,006). No se evidenció cambiosen la cifras de plaquetas y se produjo un ligero aumento del amonio,sin ser significativos.Conclusión: El TIPS es un procedimiento seguro y eficaz parapaliar las complicaciones de la hipertensión portal de difícil control enpacientes pediátricos. Nos permite optimizar el estado general, evitarel deterioro y paliar el estrechamiento de la vena porta de los pacientescirróticos como puente al TH.

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS)was designed to treat complications of portal hypertension (PH). Theobjective of this study was to analyze the results of the TIPS performedin pediatric patients in our institution as a previous step to liver trans-plantation (LT).Materials and methods: A retrospective, descriptive study of pedi-atric patients with liver cirrhosis undergoing TIPS prior to LT from 2015to 2020 was carried out.Results: TIPS was performed in 10 patients. The reason for TIPSwas hard-to-control ascites in 7 patients (70%), upper gastrointestinalbleeding due to esophageal varices in 1 patient (10%), and portal hypo-plasia in 2 cases (20%). No intraoperative complications were recorded.Stent patency was achieved in all cases.TIPS patency until LT was observed in 6 patients (60%). Indirectsigns of patency were noted in 1 patient (10%). 2 patients (20%) requiredre-intervention, with patency being achieved in the second attempt. Andfinally, no patency was observed after 3 attempts in 1 patient (10%).A decrease in portocaval gradient (p = 0.001) and an increase inportal velocity (p = 0.006) were observed. No platelet count changeswere found. A slight, non-significant increase in ammonia was noted.Conclusion: TIPS is a safe and effective procedure to reduce com-plications of hard-to-control PH in pediatric patients. It allows generalcondition to be optimized, deterioration to be avoided, and portal veinnarrowing to be alleviated in cirrhosis patients as a previous step to LT.

Trans-arterial chemoembolization with doxorubicin-eluting particles versus conventional trans-arterial chemoembolization in unresectable hepatocellular carcinoma: A study of effectiveness, safety and costs.

OBJECTIVES: To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. MATERIAL AND METHODS: This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ(2) test, Student t-test, and Kaplan Meier method. RESULTS: Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p=0.014 and p=0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p=0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p=0.618). The median length of hospital admission were 2.6 and 5.4 days (p<0.001) for DEB(-)TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p<0.001). The cost of the treatment was 1581 € for DEB(-)TACE and 514.63 € for cTACE. The overall mean cost of intervention was 3134 € and 3694.35 €, respectively (p=0.173). CONCLUSIONS: Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure.

Transnodal lymphangiography in the diagnosis and treatment of genital lymphedema.

PURPOSE: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. METHODS AND MATERIALS: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. RESULTS: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. CONCLUSION: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.

Formación en radiología vascular intervencionista. ¿Una carrera de obstáculos? / No disponible

No disponible

[Professional competencies: from conflict to opportunity]. / Competencias profesionales: del conflicto a la oportunidad.

The tough [correction of turf] battles with other specialties that tend to take control of the radiological practice and some of our areas of interest are one of the most important problems that Radiology must face at the present time. Interventional Radiology is the last one and the more recent example of this phenomenon that spreads world-wide. Far from defeatist attitudes, we must learn from our past mistakes to turn this scenario into an opportunity to evolve towards a more competitive and updated specialty according to our time. The authors review the present situation of the tough [correction of turf] batlles of Radiology with other specialties, pointing to their possible causes and proposing the resolution strategies.

Competencias profesionales: del conflicto a la oportunidad / Professional competencies: from conflict to opportunity

El conflicto con otras especialidades que tienden a apropiarse de la práctica radiológica y de algunas de nuestras áreas de interés es uno de los problemas más importantes con los que la Radiología y los radiólogos debemos enfrentarnos actualmente. La Radiología Vascular Intervencionista es el último y más reciente ejemplo de este fenómeno extendido a nivel mundial. Lejos de actitudes derrotistas, debemos aprender de los errores pasados, transformando este escenario actual en una oportunidad para evolucionar hacia una especialidad más competitiva y acorde con lo que de la imagen médica se debe demandar. Los autores revisan la situación actual de los conflictos de la Radiología con otras especialidades, incidiendo en sus posibles causas y proponiendo estrategias de resolución (AU)

The turf battles with other specialties that tend to take control of the radiological practice and some of our areas of interest are one of the most important problems that Radiology must face at the present time. Interventional Radiology is the last one and the more recent example of this phenomenon that spreads world-wide. Far from defeatist attitudes, we must learn from our past mistakes to turn this scenario into an opportunity to evolve towards a more competitive and updated specialty according to our time. The authors review the present situation of the turf batlles of Radiology with other specialties, pointing to their possible causes and proposing the resolution strategies (AU)

Guías de certificación de la Sociedad Española de Radiología (SERAM) y la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) sobre requerimientos y equipamiento en radiología vascular intervencionista / No disponible

No disponible

[Stenting without prior dilatation in intracranial stenosis of the internal carotid artery: a case report]. / Colocación de endoprótesis vascular sin dilatacion previa en estenosis intracraneal de la carótida interna. A propósito de un caso.

INTRODUCTION: Recent reports have described the application of coronary stents for the treatment of intracranial stenosis of the internal carotid artery (ICA), above all in patients who do not respond to medical treatment and display advancing neurological symptoms. Stenting in intracranial vascular lesions of the carotid territory has been used almost exclusively in the treatment of the complications due to transluminal angioplasties with balloons. In selected cases and without prior dilatation of the stenosis it would be possible to place a stent. CASE REPORT: We describe a case of intracranial carotid stenting, without previous dilatation, in a 57 year old male patient with multiple arteriosclerotic risk factors. The patient presented neurological symptoms with no response to medical treatment, caused by a stenosis that affected over 70% of the cavernous segment of the right ICA, which was shown up by the arteriographic study. A favourable anatomy and the material used allowed the stent to pass through the stenosis without the need for dilatation. No immediate complications were observed and the carotid artery was seen to be of a normal calibre for stenosis. The brain angiogram also proved to be normal. The patient continues with the medical treatment and has remained neurologically stable throughout the 9 month clinical follow up. CONCLUSION: In certain selected cases, placing an intracranial carotid stent, without previous balloon dilatation, can give good results and prevent the complications that can accompany angioplasty (such as dissection, rupture or embolism)

Tratamiento de la trombosis de los injertos de PTFE para hemodiálisis mediante trombectomís percutanea. Estudio prospectivo / Treatment of ptfe haemodialysis graft thrombosis by percutaneous thrombectomy. A prospective study

Objetivos. Las guías actuales (DOQI) recomiendan una permeabilidad primaria a los tres meses del 40 por ciento en el tratamiento percutáneo de las trombosis de las prótesis de PTFE para hemodiálisis. El objetivo de nuestro estudio es valorar prospectivamente la eficacia de la trombectomía mecánica en el tratamiento de esta complicación de las prótesis para hemodiálisis. Pacientes y métodos. Hemos analizado prospectivamente 107 trombectomías percutáneas consecutivas de prótesis de PTFE para hemodiálisis realizadas en 75 pacientes con técnica hidrodinámica (Hydrolyserâ) en los primeros 35 casos (33 por ciento) y con técnica mecánica simple utilizando un balón de angioplastia en los últimos 72 casos (67 por ciento). Las lesiones subyacentes fueron diagnosticadas mediante fistulografía, tratándose mediante angioplastia cuando era necesario. Se analizó el éxito anatómico, el éxito clínico, las lesiones subyacentes, las trombosis precoces (72 horas), la permeabilidad y las complicaciones. Resultados. El éxito anatómico se ha conseguido en 103 casos (96,2 por ciento) y el clínico en 101 (94,4 por ciento). La tasa de trombosis precoz ha sido del 17,3 por ciento. En 68 casos (90,6 por ciento) se han detectado estenosis asociadas, que han sido tratadas con ATP. A los 3, 6 y 12 meses, la permeabilidad primaria ha sido de 50, 39 y 30 por ciento, y la secundaria de 62, 49 y 40 por ciento. Se han producido dos complicaciones mayores (1,86 por ciento). Conclusiones. La trombectomía mecánica es segura y eficaz en el tratamiento de las trombosis de las prótesis de PTFE para hemodiálisis. Las recomendaciones del DOQI se cumplen completamente con esta técnica (AU)

[Endoluminal percutaneous thrombectomy as a treatment for acute vascular access thrombosis: long-term results of 123 procedures]. / La trombectomía endoluminal percutánea como tratamiento de la trombosis aguda del acceso vascular: resultados a largo plazo de 123 procedimientos.

UNLABELLED: Percutaneous treatment of thrombosis of occluded vascular access (VA) for haemodialysis (HD) has been an alternative to surgical and pharmacological treatments, but long term results are not well defined. The aim of our study was to analyse the long term results of percutaneous thrombectomy as a treatment of occluded VA for HD. We conducted a prospective study from june 1995 to april 1999, including 123 consecutive thrombectomies in 64 VA in patients submitted to our hospital because of recent thrombosis of VA for HD. We used two different techniques, hydrodynamic catheter thrombectomy (Hydrolyser) in the 42 first procedures (34.1%), and since october 1996 we used mechanical balloon thrombolysis in the remaining 81 patients (65.9%). Underlying stenoses were evaluated by angiography, and treated by angioplasty. After the procedure, intravenous heparin was administered for 24 hours. The VA were 28 Brescia-Cimino arteriovenous fistulae (30.4%) and 64 PTFE grafts (69.6%). PATIENT CHARACTERISTICS: mean age: 63 +/- 15 years (18-84), previous VA: 3.3 +/- 2.5 (0-9). The mean follow-up was 10.5 +/- 8.6 months (3-35). Percutaneous thrombectomy was able to remove the clots in 120 instances (technical success: 97.5%). After the thrombectomy 15 patients (16.3%) were immediately referred to the surgeon to perform a new VA due to vascular lesions in which percutaneous treatment was not indicated. Thirteen cases (14.1%) showed early thrombosis (< 72 hours). During the follow-up, 27 cases developed thrombosis (30%) and 26 VA were still patent (28.3%). In 23% of perfusion lung scans and in 2 of the 5 angiographies performed after thrombectomy, subsegmentary or segmentary perfusion defects were detected, without clinical significance. There were no relevant undesirable effects related to the technique and no symptomatic pulmonary embolism. In summary, percutaneous thrombectomy, whether hydrodynamic or mechanical, has shown to be an efficacious treatment of VA thrombosis for HD, preserving the VA with satisfactory long-term results.

La trombectomía endoluminal percutánea como tratamiento de la trombosis aguda del acceso vascular: resultados a largo plazo de 123 procedimientos / Percutaneous endoluminal thrombectomy as a treatment of thrombosed haemodialysis vascular access: experience of 123 procedures and long term results

El tratamiento percutáneo de la trombosis reciente del acceso vascular (AV) para hemodiálisis (HD) constituye una alternativa a la trombectomía quirúrgica y farmacológica, no obstante son escasos los estudios que analizan resultados a largo plazo. Se presentan los resultados de la trombectomía percutánea sin uroquinasa en el tratamiento de las trombosis recientes del AV.Se ha realizado un estudio prospectivo desde junio de 1995 hasta abril de 1999 que ha analizado los resultados de 123 trombectomías percutáneas consecutivas sobre 92 AV con trombosis reciente. En los 42 primeros procedimientos (34,1 por ciento) se realizó trombectomía hidrodinámica (Hydrolyser®), y trombectomía mecánica con balón de angioplastia en los 81 casos restantes (65,9 por ciento). Las lesiones vasculares subyacentes a la trombosis del AV recibieron tratamiento con angioplastia y/o stent. En 22 casos se realizaron gammagrafías pulmonares pre y postrombectomía y en 5 casos arteriografía pulmonar. Los AV fueron 28 fístulas autógenas (30,4 por ciento) y 64 prótesis de PTFE (69,6 por ciento). Veinte casos (21,7 por ciento) requirieron múltiples procedimientos. La edad media de los pacientes fue de: 63 ñ 15 años (1484), el número de AV previos 3,3 ñ 2,5 (0-9), y el seguimiento postrombectomía fue de 10,5 ñ 8,6 meses (1-35 meses).En 120 casos (97,5 por ciento) se consiguió restablecer el flujo sanguíneo del AV, no obstante, 15 casos (16,3 por ciento) se remitieron a cirugía vascular para realización de nuevo AV debido a lesiones no subsidiarias de tratamiento percutáneo, 13 casos (14,1 por ciento) presentaron trombosis precoz y 27 AV (30 por ciento) se trombosaron durante el seguimiento. En 26 casos (28,3 por ciento) el AV permanece permeable en la fecha de finalización del estudio. No se detectaron efectos secundarios relevantes ni clínica de embolismo pulmonar.La trombectomía, ya sea hidrodinámica -Hydrolyser®- o mecánica se ha mostrado eficaz en el tratamiento de la trombosis del AV para HD, con unos resultados satisfactorios a largo plazo. El procedimiento se ha mostrado seguro y bien tolerado por los pacientes. (AU)

[Percutaneous intrahepatic portosystemic shunt: its effects on hypersplenism]. / Derivación percutánea portosistémica intrahepática: efectos sobre el hiperesplenismo.

The aim of this study was to verify the early effects that the transjugular intrahepatic portosystemic shunt (TIPS) produces on thrombocytopenia and its possible relationship to portal pressure and the size of the spleen. A TIPS was placed in 24 cirrhotic patients (11 women and 13 men) with a mean age of 57.6 +/- 12.3 years. Prior to the test the platelets count, the size of the spleen and the portocaval gradient were determined. The same parameters were evaluated one day and one month afterwards. A significant increase was observed in then number of platelets following the placement of the prosthesis (87.6 +/- 55.2 vs 97 +/- 66.8 x 10(9)/l) (p < 0.05) which was maintained in the monthly control without achieving statistical significance (99.5 +/- 60.8 x 10(9)/l). A significant decrease was also observed in the size of the spleen from 156.7 +/- 28.7 mm during the previous control to 144.5 +/- 19.9 mm in the monthly control (p < 0.05). The portocaval gradient was significantly reduced following the procedure with the values being 23.25 +/- 3.86 mmHg prior to the TIPS, 10.29 +/- 3.84 mmHg in the immediate control and 10.37 +/- 4.81 mmHg at the one month control. A statistically significant correlation was observed between the size of the spleen and the number of platelets in both the previous control (r = 0.7264; p < 0.001) and in the monthly control (r = 0.5764; p < 0.05), between the size of the spleen and the portocaval gradient prior to the test (r = 0.5285; p < 0.05) and at one month (r = 0.7185; p < 0.01) and between the portocaval gradient and the number of platelets before the prosthesis (r = 0.5060; p < 0.05). TIPS may improve the thrombocytopenia in correlation with the decrease in portal pressure.

[Intra-arterial fibrinolysis in acute thrombosis of the basilar artery]. / Fibrinólisis intrarterial en la trombosis aguda de la arteria basilar.

INTRODUCTION: Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesia-tetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. CLINICAL CASE: We present the case of a 49 year old woman with acute thrombosis of the basilar artery and a progressive course leading to coma. No bulbar lesions were seen on the CT scan done in the Emergency Department. Thrombosis of the basilar artery and permeable bilateral carotid systems were shown on arteriography. There were no contra-indications to fibrinolysis. Following local fibrinolytic treatment with urokinase the patient had full recovery from her neurological disorder and no sequelae. The basilar artery remained permeable six months later. CONCLUSIONS: Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient's life, with total or partial recovery of brain-stem function.

[Recurrent parotiditis in adults: review and new therapeutic options]. / Parotiditis recidivante en el adulto: revisión y nuevas alternatives terapéuticas.

Our experience in the management of 20 patients with recurrent parotitis (RP) as an isolated symptom is reported. The clinical manifestations in all patients were pain, infection and swelling of the parotid gland on at least three separate occasions. The presence of obvious tumor or specific inflammation were exclusion criteria. Three patients benefited from radiological interventional treatment: two stones were removed from the main duct with a Dormia basket and one parotid duct stricture was dilated with a balloon catheter. The role of conventional or digital sialography and interventional radiology procedures in the diagnosis and management of RP is discussed. We proposed this approach as a therapeutic alternative to surgery, which is more aggressive and carries a risk of facial nerve damage.

[Percutaneous nephrostomy. Review of 92 cases]. / Nefrostomías percutáneas. Revisión de 92 casos.

Presentation of 92 nephrostomies percutaneous in 70 patients. Nephrostomy was bilateral in 5 cases. Three patients had collections of renal origin (2 urinomas and 1 abscess) which were treated percutaneously. The indication for nephrostomy was in all cases obstruction of the collector system, with one exception where the indication was ureteral fistula. Origin was lithiasis in 53 cases, 15 cases vesical carcinoma, 3 post-surgical iatrogenic stenosis, 1 fistula and formation of urinoma after lithotrity, 5 prostate carcinoma infiltration, 8 infectious origin, 4 congenital and 1 due to glandular cystitis. 9 patients were monorenal. In 6 patients leucocytosis was present, 4 has fever, and in 11 coexisted fever and leucocytosis. High creatinine and urea levels were present in 55.7% and 41% patients, respectively.. Renal puncture through lower calyceal group was the preferred option. Purulent urine was obtained in 17 cases. With regard to nephrostomy complications haematuria occurred in 30 cases (only in 9 it lasted more than 1 day); and there was 1 case of pararenal haematoma. Pain was significant in 12% procedures and contrast extravasation resulted in 14% cases (in all of them proper positioning of nephrostomy catheter was possible). Spontaneous expulsion and the subsequent replacement of the catheter occurred in 12 cases. On average, residence time of catheter was 44.8 days. In all cases both the patient's signs and symptoms, and the laboratory results were improved.

[Rounded nodular atelectasis: computerized tomography and magnetic resonance appearances]. / Atelectasias redondas nodulares: apariencia en tomografía computarizada y resonancia magnética.

Rounded atelectasis is a rare form of lung collapse whose X-ray appearance can be confused with that of tumors, especially nodular forms. We studied 14 such lesions with computerized tomography, finding that all were rounded and subpleural, specifically in the thickened pleura visceralis. The radiological sign that was most useful for diagnosis was the arc of the proximal vessels in the direction of the lesion. Such an arc was present in all the cases we reviewed. Other radiological signs such as brightness of the surrounding parenchyma, loss of volume in the affected lobe and the presence of air bronchogram were found in 10, 7 and 7 patients, respectively. When the X-ray appearance clearly indicates a diagnosis of rounded nodular atelectasis, we recommend that no additional diagnostic procedure be made. Three lesions in our sample were studied by magnetic resonance, which revealed the characteristic hypointense curves in all sequences done on 2 patients. The usefulness of computerized tomography in the diagnosis of this entity relegates magnetic resonance to a second plane.

[Diagnostic effectiveness of CT and MR in local staging of renal tumors]. / Eficacia diagnóstica del TC y RM en el estadiaje local de los tumores renales.

The aim of this paper is to study the pre-operative staging of renal tumours, comparing CT and MR, and the imaging criteria used, examining the diagnostic efficacy for each of them. Thirty-four tumours were obtained from 29 patients. All cases were studied with CT and MR. To measure diagnostic efficacy, both for each technique and the criteria used in 2 different readings, a diagnostic performance curve (DPC) is calculated. Neither CT nor MR show infiltration of renal capsule. With regard to perinephritic fat, fascia and adjacent organ invasion, both techniques lead to overstaging, mainly CT. When applying more conservative reading criteria, the results are much improved, specially in relation to CT, although results with MR continue to be more favourable. MR is better to study vascular invasion, providing no false results. Of 22 tumours undergoing surgery, first option was the correct staging in 14 tumour with CT and in 16 with MR. When selecting the best imaging technique to stage renal tumours, MR allows a better and simpler radiologic reading. Nevertheless, considering the high correlation between CT and MR, CT can be used more reliably in institutions where no easy access to a MR unit is available. Both CT and MR overstage renal tumours.