Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8GBq (0.7-6.4GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

Radioembolización en hepatocarcinoma: a propósito de 53 casos / Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases

Objetivo Contribuir con la presentación de los resultados de nuestro estudio a ampliar la evidencia científica sobre el empleo de la radioembolización en el manejo de pacientes con hepatocarcinoma. Material y método Se trata de una revisión retrospectiva realizada en nuestro centro que incluye a 53 pacientes con hepatocarcinoma tratados con radioembolización. Los pacientes fueron clasificados según el algoritmo del BCLC (Barcelona Clinic Liver Cancer) y de forma pormenorizada por su estado funcional siguiendo la clasificación de Child-Pugh. Se realizó un estudio de supervivencia siguiendo la metodología de Kaplan-Meier. Se empleó el método de regresión de Cox para la determinación de parámetros clínicos significativos, incluyendo dosis administradas en los parámetros estudiados. Resultados La serie evaluada comprende a pacientes con una media de edad de 60 años (rango 28-86). Se llevaron a cabo un total de 61 procedimientos. La actividad media administrada fue de 2,8 GBq (0,7-6,4 GBq), administrando una dosis media en tumor de 229,9 Gy (74-425,9 Gy). El tiempo libre de progresión fue de 6,7 meses desde el momento del tratamiento y la supervivencia global fue de 12,8 meses. La clasificación de los pacientes según BCLC (p=0,848) y Child-Pugh (p=0,252) no resultó significativa respecto al tiempo libre de enfermedad. Los parámetros clínicos que resultaron con diferencias significativas en cuanto a supervivencia global fueron los niveles de bilirrubina (p<0.001) y las cifras de transaminasas (GOT) pretratamiento (p=0.022), la subclasificación Child-Pugh (p=0.003) y la dosis recibida por el tumor (p=0,001). Tan solo uno de los pacientes tratados presentó un efecto adverso grave, con fallo hepático posterapia y resultado de muerte... (AU)

Objective To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. Material and methods This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. Results Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. Conclusions Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines. (AU)

Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases. / Radioembolización de hepatocarcinomas: a propósito de 53 casos.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

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.

Computed tomographic screening of pulmonary arterial hypertension in candidates for lung transplantation.

INTRODUCTION: Computed tomography (CT) is essential to evaluate candidates for lung transplantation (LT) We sought to correlate identification of pulmonary arterial hypertension (PAH) via CT to echocardiographic (Eco) and/or hemodynamic observations (Hd) as well as the pathological findings (Path) at posttransplant pneumonectomy. MATERIALS AND METHODS: The study included 24 consecutive months follow-up of 71 patients who were referred for LT evaluation with 54 undergoing LT. Study parameters included CT [diameter of the principal pulmonary artery (PPA) >or= 29 mm), PPA/diameter of the ascending aorta (AA) ratio > 1; diameter of the lobar artery (LA)/diameter of the lobar bronchiole (LB) ratio > 1 in three or more lobes; thickening of the anterosuperior pericardial recess (>15 mm); mosaic lung density pattern]; PAPs via Eco and/or Hd, and findings Path of PAH. Statistical analysis included chi-square and Pearson correlation coefficient. RESULTS: Thirty-five patients had PAH. Significant relationships (P < .05) were observed between PAH (Eco and/or Hd) and PPA, PPA/AA, and LA/LB. The sensitivity of the finding PPA >or= 29 mm was 65.9%, and 85.7% when combined with LA/LB > 1. In the Path study, 14/54 patients revealed alterations compatible with PAH. Significant relationships (P < .05) were observed between PAH via Path and PPA (CT) and between PAH via Path and PAH (Eco and/or Hd). CONCLUSIONS: CT is useful for the detection of PAH. Findings of PAH via CT were indicative of the need for further confirmatory studies. In contrast, the absence of findings with CT does not exclude the possible presence of PAH.

Successful recovery after disseminated infection due to mycobacterium abscessus in a lung transplant patient: subcutaneous nodule as first manifestation--a case report.

Mycobacterium abscessus infection following lung transplantation (LT) has been described in a few cases. It is characterized by a variable initial location and subsequent course in this special risk group of patients, particularly those with cystic fibrosis (CF). Herein we have presented the case of a patient subjected to LT due to CF, who 1 year after transplantation developed a subcutaneous nodule produced by M abscessus, with subsequent hematogenous spread as well as bronchial and bone marrow involvement. Antecedents prior to LT included Staphylococcus aureus colonization and sputum positivity for Aspergillus fumigatus and Scedosporium apioespermum. Treatment with ciprofloxacin and linezolid was started on the basis of the antibiogram findings. The latter antibiotic was replaced by clarithromycin for 6 months. Two years later, the patient remains asymptomatic with respiratory function parameters in the normal range. The infected patient described herein was our only case with sepsis and multisystemic spread. The important mortality among such cases reported in the literature makes early diagnosis and treatment essential.

Lymphoproliferative disease after lung and heart-lung transplantation: first description in Spain.

Lymphoproliferative syndromes are the most common tumors in transplant recipients. More than 90% of posttransplantation lymphoproliferative syndromes (PTLS) are considered to be associated with Epstein-Barr virus, and 86% are of the B-cell line. Histopathology ranges from polymorphic-reactive to monomorphic forms. Clonality should be studied using molecular biology techniques. Clinically, a differentiation is usually made between early PTLS (occurring within 1 year after transplantation) and late PTLS, which occur as localized or disseminated nodal lymphomas. In localized forms, immunosuppression should be discontinued or decreased, and the involved area should be subsequently resected or irradiated. In disseminated cases, immunosuppression should be decreased and administration of acyclovir/ganciclovir should be considered. If this is not effective, treatment should be started with anti-CD20 monoclonal antibodies (rituximab). If no response occurs, use of chemotherapy, possibly with interferon, should be considered. Our aim was to report the incidence, clinical signs, and treatment in a series of patients undergoing lung transplantation (LTx).

Taponamiento cardíaco por pseudoaneurisma aórtico fistulizado a ventrículo derecho / Cardiac tamponade due to aortic pseudoaneurysm with right ventricular fistula

Una mujer de 69 años, portadora de una prótesis valvular aórtica por insuficiencia aórtica de origen reumático, presentó un taponamiento cardíaco súbito provocado por la rotura de un pseudoaneurisma de aorta ascendente originada en la sutura de aortotomía realizada 10 años atrás. El taponamiento cursó con síncope, ausencia de pulso central acompañado de parada ventilatoria. El episodio fue presenciado permitiendo iniciar con rapidez las maniobras de reanimación cardiopulmonar hasta la recuperación hemodinámica. Tras la reposición de volumen intravascular y la perfusión de catecolaminas se realizó una ecocardiografía transesofágica que demostró el derrame pericárdico y la existencia de flujo entre la aorta y el ventrículo derecho. La actuación quirúrgica, mediante esternotomía exploradora urgente, reparó la cavidad aneurismática y una rara fístula al ventrículo derecho. La evolución cardiovascular fue satisfactoria, si bien las complicaciones respiratorias prolongaron la estancia hospitalaria por la presencia de hipoxemia grave, derrame pleural y neumonía con cultivos positivos para Pseudomona aeruginosa, Acinetobacter spp y Aspergillus flavus en aspirado traqueal y lavado broncoalveolar. Resaltamos que la inmediata aplicación de las maniobras de reanimación evitó la instauración de fracasos orgánicos y permitió una recuperación global satisfactoria tras la cirugía, a pesar de la presencia inicial de factores pronósticos de elevada mortalidad (AU)

[Cardiac tamponade caused by aortic pseudoaneurysm with fistula in the right ventricle]. / Taponamiento cardíaco por pseudoaneurisma aórtico fistulizado a ventrículo derecho.

A 69-year-old woman, with an aortic replacement valve for rheumatic aortic insufficiency suffered a sudden cardiac tamponade caused by a ruptured pseudoaneurysm of the ascending aorta which had its origin in the suture of the aorta performed 10 years earlier. The cardiac tamponade presented as syncope, absent central pulse, and respiratory failure. Hemodynamic variables recovered with early detection and start of cardiopulmonary resuscitation maneuvers. After fluids were replaced and following catecholamine treatment, a transesophageal echocardiogram revealed a pseudoaneurysm and continuous flow between the aorta and the right ventricle. The aneurysm and an unusual right ventricular fistula were repaired surgically through an emergency exploratory sternotomy. Cardiovascular recovery was satisfactory although hospital discharge was delayed because of pulmonary complications leading to severe hypoxia, pleural effusion, and pneumonia, with tracheal aspirate and bronchoalveolar lavage cultures positive for Pseudomonas aeruginosa, Acinetobacter spp, and Aspergillus flavus. We stress that immediate start of cardiopulmonary resuscitation prevented multiorgan failure and allowed for satisfactory recovery from surgery in spite of the presence of risk factors for mortality.