Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line. / Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea.

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea / Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line

La pandemia de COVID-19 y la consecuente declaración del estado de alarma crearon una obligada modificación dentro del ámbito de la sanidad en su totalidad y los servicios de radiodiagnóstico no quedaron exentos. En nuestro servicio conllevó una reestructuración inmediata de la dinámica de trabajo del colectivo de técnicos superiores en imagen para el diagnóstico (TSID), que tuvo un papel destacado en la primera línea de batalla. Para lograr satisfacer las nuevas necesidades, se tuvo que formar al personal, distribuirlo en diferentes áreas y grupos de trabajo y adoptar nuevas medidas de protección y cuidado en el ámbito laboral. También se adecuaron los diferentes circuitos de atención asistencial (COVID-19 vs. no COVID-19), incorporando tecnología, adaptando los recursos existentes al nuevo escenario y creando un circuito rápido de diagnóstico COVID-19. Así mismo, se detallan las recomendaciones que se han de tener en cuenta sobre la estrategia organizativa dentro del servicio de radiología ante un posible rebrote de la pandemia

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19

Historia natural del carcinoma hepatocelular en una cohorte de pacientes de un hospital comarcal / No disponible

Introducción: el carcinoma hepatocelular (CHC) es una neoplasiacon una elevada incidencia y una alta mortalidad.Objetivo: nuestro objetivo es la descripción de la historia naturalde una cohorte de pacientes con CHC e identificar variablesasociadas a supervivencia.Material y métodos: estudio retrospectivo y descriptivo depacientes diagnosticados de CHC entre 1995-2002. Las variablescualitativas se expresaron mediante frecuencias y porcentajes y lascuantitativas con mediana y desviación típica. La supervivencia seestimó mediante el método de Kaplan Meyer y la prueba de LogRank.Resultados: se analizaron un total de 154 pacientes con CHC.La ratio hombre-mujer fue de 2,9/1. La edad media de 68 ± 9 años.El 82% de los pacientes fueron exitus en un tiempo medio de seguimientode 28 meses. La mediana de supervivencia fue de 21,5 meses(IC 95%: 16,98-26,04). Se realizó tratamiento con intención curativaen un 40,3% y el resto tratamiento paliativo. Las variablesasociadas a la supervivencia fueron: presencia o no de ascitis, el númerode lesiones en el momento del diagnóstico y si el tratamientorealizado fue con intención curativa o no. No hubieron diferenciasestadísticamente significativas respecto a: sexo, edad, etiología de lacirrosis y estadio de Child en el momento del diagnóstico.Conclusiones: los factores asociados a una menor supervivenciaen los pacientes con carcinoma hepatocelular fueron lapresencia de ascitis y el número de lesiones en el momento deldiagnóstico. La realización de tratamiento con intención curativase asocia a una mayor supervivencia

Background: hepatocellular carcinoma (HCC) is a cancerwith high incidence and mortality.Objective: our aim was to describe the natural history of a patientcohort with HCC, and to identify the factors associated withsurvival.Patients and methods: a retrospective and descriptive studyof patients diagnosed with HCC between 1995 and 2002. Qualitativevariables were expressed as frequencies and percentages.Quantitative variables were expressed as medians and standarddeviations. Survival was calculated using the Kaplan-Meier methodand log rank.Results: a total of 154 patients were analyzed. The men-towomenratio was 2.9/1. Mean age was 68 ± 9 years. 82% of patientsdied during a median follow-up of 28 months. Median survivalwas 21.5 months (95% CI: 16.98-26.04). Curativetreatment was done in 40.3% of diagnosed patients, and 59.7%of patients received palliative treatment. Factors associated withsurvival were: ascites, number of lesions at diagnosis, and curativetreatment. No statistical differences were found for the next factors:age, sex, etiology of cirrhosis, and Child-Pugh stage at diagnosis.Conclusions: factors associated with low survival in patientswith HCC were ascites and number of lesions. Curative treatmentis associated with a higher survival when compared to palliative treatment

[Natural history of hepatocellular carcinoma in a cohort of pacients from a county hospital]. / Historia natural del carcinoma hepatocelular en una cohorte de pacientes de un hospital comarcal.

BACKGROUND: hepatocellular carcinoma (HCC) is a cancer with high incidence and mortality. OBJECTIVE: our aim was to describe the natural history of a patient cohort with HCC, and to identify the factors associated with survival. PATIENTS AND METHODS: a retrospective and descriptive study of patients diagnosed with HCC between 1995 and 2002. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as medians and standard deviations. Survival was calculated using the Kaplan-Meier method and log rank. RESULTS: a total of 154 patients were analyzed. The men-to-women ratio was 2.9/1. Mean age was 68 +/- 9 years. 82% of patients died during a median follow-up of 28 months. Median survival was 21.5 months (95% CI: 16.98-26.04). Curative treatment was done in 40.3% of diagnosed patients, and 59.7% of patients received palliative treatment. Factors associated with survival were: ascites, number of lesions at diagnosis, and curative treatment. No statistical differences were found for the next factors: age, sex, etiology of cirrhosis, and Child-Pugh stage at diagnosis. CONCLUSIONS: factors associated with low survival in patients with HCC were ascites and number of lesions. Curative treatment is associated with a higher survival when compared to palliative treatment.

Extravasación de contraste tras stent carotídeo con clínica de infarto cerebral / Extravasation of contrast medium after carotid stent with brain infarction symptoms

La angioplastia con o sin colocación de stent como técnica de revascularización carotídea se ha convertido en un tratamiento alternativo para la estenosis carotídea, siendo considerado en ocasiones el tratamiento de elección. El principal temor de dicha técnica es la embolización distal durante el procedimiento, habiéndose descrito otras complicaciones menos frecuentes como la disección, vasoespasmo e incluso la rotura arterial. Entre las complicaciones infrecuentes destacan el síndrome de hiperperfusión y más raramente la encefalopatía por extravasación de contraste. Presentamos a una paciente que fue sometida a angioplastia con colocación de stent por estenosis carotídea con signos de presencia cálcica que sufrió un cuadro semejante a un ictus de la arteria cerebral media derecha como consecuencia de extravasación del contraste tras rotura del balón de angioplastia, hecho no descrito previamente en la literatura

Angioplasty, with or without stent placement, as a carotid revascularisation technique, has become an alternative treatment for carotid stenosis, it being considered under certain circumstances the treatment of choice. The main concern about this technique is the distal embolisation during the procedure, while other, less frequent, complícations have also been described such as dissection, vasospasm or even arterial rupture. Some of the infrequent complications include the hyperperfusion syndrome, and, more exceptionally, cases of extravasation of the contrast medium. We present the case of a patient who was subjected to angioplasty and stent insertion due tocarotid stenosis with signs of calcification who suffered a stroke-like disorder in her right medial brain artery as a consequence of the extravasation of contrast medium after the rupture of the angioplasty balloon, a situation wich has never been described in the literature befote

[Extravasation of contrast medium after carotid stent with brain infarction symptoms]. / Extravasación de contraste tras stent carotídeo con clínica de infarto cerebral.

Angioplasty, with or without stent placement, as a carotid revascularisation technique, has become an alternative treatment for carotid stenosis, it being considered under certain circumstances the treatment of choice. The main concern about this technique is the distal embolisation during the procedure, while other, less frequent, complícations have also been described such as dissection, vasospasm or even arterial rupture. Some of the infrequent complications include the hyperperfusion syndrome, and, more exceptionally, cases of extravasation of the contrast medium. We present the case of a patient who was subjected to angioplasty and stent insertion due to carotid stenosis with signs of calcification who suffered a stroke-like disorder in her right medial brain artery as a consequence of the extravasation of contrast medium after the rupture of the angioplasty balloon, a situation which has never been described in the literature before.

[Carotid stenosis: appropriate diagnosis and treatment]. / Estenosis carotídea: cómo se diagnostica y se trata adecuadamente.

Ischemic cerebral infarcts represent a serious health problem with important social and economic repercussions in the western world. The presence of carotid stenosis is one of the main risk factors for the appearance of cerebral infarcts. Carotid stenosis represents a challenge for the medical community, both because of the enormous amount of scientific information available and because of the constant advances in diagnostic procedures and especially in revascularization techniques for treatment. General radiologists as well as those specializing in vascular pathology need to have ample knowledge of how to reach the diagnosis and of the different treatment options for this pathology if they are to play a successful role in multidisciplinary teams dealing with carotid stenosis. This update aims to present the basic information that we consider to be essential in a simple way to enable radiologists to meet this challenge.

Estenosis carotídea: cómo se diagnostica y se trata adecuadamente / Carotid stenosis: appropriate diagnosis and treatment

Los infartos isquémicos cerebrales suponen un grave problema sanitario y socio-económico en el mundo occidental. La presencia de estenosis carotídea es uno de los principales factores de riesgo prara la aparición de infartos cerebrales. La patología estenótica carotídea significa un reto para la comunidad médica tanto por la ingente cantidad de información científica existente sobre el tema como por la constante aparición de avances en los procedimientos diagnósticos y sobre todo en los tratamientos de revascularización. Tanto el radiólogo experto en patología vascular como el radiólogo general necesitan tener un conocimiento amplio de la forma de hacer el diagnóstico y también de los diferentes tipos de tratamiento de esta patología para poder integrarse con éxito en los grupos multidisciplinarios que se ocupan de la estenosis carotídea. En esta actualización pretendemos dar de una forma sencilla la información básica que consideramos imprescindible para cumplir con este objetivo

Ischemic cerebral infarcts represent a serious health problem with important social and economic repercussions in the western world. The presence of carotid stenosis is one of the main risk factors for the appearance of cerebral infarcts. Carotid stenosis represents a challenge for the medical community, both because of the enormous amount of scientific information available and because of the constant advances in diagnostic procedures and especially in revascularization techniques for treatment. General radiologists as well as those specializing in vascular pathology need to have ample knowledge of how to reach the diagnosis and of the different treatment options for this pathology if they are to play a successful role in multidisciplinary teams dealing with carotid stenosis. This update aims to present the basic information that we consider to be essential in a simple way to enable radiologists to meet this challenge

[Ischemic renal disease: revascularization or conservative treatment?]. / Nefropatía isquémica: revascularización o tratamiento médico conservador?

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.

Nefropatía isquémica: ¿revascularización o tratamiento médico conservador? / Ischemic renal disease: revascularization or conservative treatment?

La nefropatía isquémica es la enfermedad renal que origina insuficiencia renala través de la reducción de filtrado glomerular, a consecuencia de la alteraciónsignificativa del flujo arterial renal principal.Se valoran los factores etiopatogénicos de la nefropatía isquémica y de otrasnefropatías vasculares como la nefroangiosclerosis. Se revisan también sus factorespronósticos.La revascularización tendría que ser el mejor tratamiento de la nefropatía isquémica.Sin embargo, cuando las estenosis de las arterias renales son consecuenciade lesiones arteriosclerosas, al incidir esta enfermedad de manera generalen todo el organismo, no está tan claro que la revascularización sea la mejoropción terapéutica.Partiendo de poblaciones seleccionadas, no equiparables entre sí, nos proponemosestablecer el mejor tratamiento para cada una de ellas. Hemos podidocomprobar que la afectación arteriosclerosa de las arterias renales en nuestro contextoes una enfermedad predominante en pacientes varones con hábito tabáquico,y que el daño parenquimatoso renal atendiendo a la determinación de proteinuriaes parecido entre la verdadera nefropatía isquémica y la nefropatía vascularcon afectación arterial unilateral.Nuestros datos muestran que la edad es el único factor determinante de la opciónterapéutica a seguir y que el grado de insuficiencia renal crónica en el momentodel diagnóstico es índice pronóstico independiente de la nefropatía isquémica.La revascularización renal tiende a ser la mejor opción terapéutica enpoblación seleccionada afecta de nefropatía isquémica. La revascularización renalendovascular, en casos de afectación renal unilateral con insuficiencia renal, ofreceresultados más dudosos de efectividad, ya que dicha insuficiencia renal crónicasería atribuible a la afectación renal intraparenquimatosa

Ischemic nephropathy is recognized as a distinct cause of renal insufficiencyand it is defined as a significant reduction in glomerular filtration rate in patientswith hemodynamically significant renovascular occlusive disease.We argue the epidemiologic and clínical manifestations of atherosclerotic renovasculardisease, and we evaluate the pronostic agents.Published studies of the outcome of revascularization for renal-artery stenosishave been excellent, offering a durable patency and functional improvement butthey have had numerous limitations. The atherosclerosis is a systemic disease andit provides the general prognosis of patients.We conclude that ischemic renal disease is a nephropathy of smoker men, withproteinuria excretion similar to nephropathy with unilateral stenosis. The age ofpatients is the clinical feature that decide the treatment: surgery, angioplasty/stentor medical management.Comparative analysis of percutaneous transluminal angioplasty and operation forrenal revascularization and medically treated patients have proved that the advancedchronic renal insufficiency is associated with an unfavourable response oftreatment of the ischemic nephropathy. But, in this nephropathy the revascularizationcan be the better therapy for selected patients. The revascularization withangioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiencyhas a doubtful effectiveness, as the chronic renal failure is result ofnephroangiosclerosis

[Arteriovenous fistula: complication of renal biopsy. Superselective embolization]. / Fístula arteriovenosa: complicación de biopsia renal. Embolización supraselectiva.

The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves. Optimization of renal biopsy techniques aims not only at obtaining kidney tissue technically adequate for diagnosis, but at reducing biopsy-induced complications. When these complications are done, the new transvascular techniques can get the healing of fistula with the embolism by catheters. We describe the case of a 37-year-old woman who had chronic renal failure by a possible chronic glomerulonephritis. She developed deterioration of renal function after the percutaneous renal biopsy. An arteriovenous fistula of high flow was detected by Doppler ultrasound. Then, it was confirmed angiographically and closed by embolism's catheter without damage of renal tissue.

Fístula arteriovenosa: complicación de biopsia renal. Embolización supraselectiva / Arteriovenous fistula: complication of renal biopsy. Superselective embolization

Las fístulas arteriovenosas son una complicación conocida de las biopsias renales percutáneas de riñones nativos. Su incidencia parece ser baja y ha sido mencionada infrecuentemente en grandes series de biopsias. Suelen cerrar espontáneamente aunque existe un pequeño porcentaje de ellas que por presentar repercusión clínica con compromiso de la función renal precisarán intervención terapéutica activa. En la actualidad las técnicas endovasculares de embolización arterial supraselectiva constituyen una buena opción terapéutica con mínimas pérdidas de la función renal.Presentamos el caso de una mujer de 37 años, con insuficiencia renal secundaria a una glomerulopatía mesangial por C3, que presentó deterioro de la función renal y hematuria persistente tras la práctica de una biopsia renal percutánea. La ecografía doppler objetivó una fístula arteriovenosa de alto flujo, siendo confirmada por arteriografía. Se practicó una cateterización supraselectiva de la rema nutricia de la fístula con embolización de la misma; se comprobó su completa oclusión sin evidenciarse un infarto renal, tras control angiográfico posterior (AU)

Occult liver involvement by polyarteritis nodosa.

The diagnosis of panarteritis nodosa is usually difficult because of the variability of clinical manifestations. Herein is presented a case of occult liver involvement by polyarteritis nodosa. Several biopsies were performed but the diagnosis was made with the contribution of a hepatic arteriography.

[Angioplasty for intracranial internal carotid artery stenosis]. / Angioplastia de arteria carótida interna intracraneal.

INTRODUCTION: Percutaneous transluminal angioplastia has in recent years become an alternative to surgery and increasingly used for revascularization of the extracranial arteries in patients with cerebral ischemia. However, intracranial angioplasty is a technique which is still not widely used since it is technically more difficult and until now endoprotheses (stents) have not been available specifically designed for intracranial territory. CLINICAL CASE: A 73 year old patient with extensive extracranial and intracranial atheromatous lesions, multiple vascular risk factors and cardiac ischemia which contraindicated surgical treatment which was treated consecutively by angioplasty and angioplasty with implantation of stents in both carotid bifurcations. Subsequently, he was treated by angioplasty for a stenosing lesion of 90% of the right carotid siphon with clinical and hemodynamic repercussions. Following the procedure, which was well-tolerated by the patient, there was clinical and angiographic improvement and return to normal of the hemodynamic parameters measured by transcranial Doppler. CONCLUSIONS: Angioplasty is a technique which may be used in intracranial stenosing atheromatous lesions. Even without perfect angiographic correction, adequate blood flow is established in the hemodynamically affected lesions. As far as we know this is the first case of intracranial angioplasty of a lesion of the carotid siphon reported in Spain.

Balloon catheter sphincteroplasty and biliary stone expulsion into the duodenum in patients with an indwelling T tube.

BACKGROUND: To present an alternate approach for treating residual biliary stones in patients with indwelling T tube that uses the immature tract created by the T tube to carry out both sphincteroplasty and expulsion of the calculi with the same angioplasty balloon catheter. METHODS: This technique was performed in five patients. Access to the bile duct was through an 8-Fr T tube. First a guidewire was inserted and advanced beyond the obstructing stone to the duodenal lumen. The T tube was removed over the guidewire, and a balloon catheter was introduced. Sphincteroplasty was carried out. Then the balloon was deflated and retracted to a position proximal to the stone. It was then reinflated and used to push the stone, expelling it into the duodenum. RESULTS: In all cases, all biliary stones were expelled without pain, in a single session, and with no immediate complications. All patients showed rapid clinical and analytic improvement. During clinical and echographic follow-up of 2-22 months (mean = 12.4 months), there were no complications or relapses. CONCLUSIONS: Our limited experience indicates that sphincteroplasty and expulsion of biliary stones with angioplasty balloon catheters through the T tube immature tract is a simple, safe, low-cost technique that gives good results.

[Cost-effectiveness of and morbidity from digital subtraction angiography. A study of 5,817 cases]. / Coût--effectivité--morbidité de l'angiographie par soustraction numérique. Etude de 5817 cas.

This study was based on 5,817 patients examined by digital subtraction angiography (DSA) between 1984 and 1990. 5,209 patients received an intravenous injection of contrast agent and 608 received an intra-arterial injection. Digital subtraction angiography has become a routine procedure for the diagnosis of vascular disease in the various fields studied, as it provides images of diagnostic quality in 97% of cases: diagnostic quality of 95% after intravenous injection and 99% after intra-arterial injection. The morbidity is 1.65% for the intravenous route and 4.8% for the intra-arterial route. The morbidity of brachial artery catheterization is 5.5% DSA by intravenous injection is a low-risk angiographic technique which represents a major economy in terms of the cost of the examination and the examination time, a reduction of hospital stay and waiting lists; these advantages are very important in the current context of public health.