Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. / Eficacia y seguridad de la radioembolización con 90Y en el tratamiento de metástasis hepáticas de tumores neuroendocrinos. Seguimiento a largo plazo y repercusión en la supervivencia.

INTRODUCTION AND OBJECTIVE: Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS: Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS: An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION: TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.

Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review.

BACKGROUND: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007. OBJECTIVES: To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH. SEARCH STRATEGY: A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library. SELECTION CRITERIA: All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases. DATA COLLECTION AND ANALYSIS: Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review. MAIN RESULTS: The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3-100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9-90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%). CONCLUSIONS: PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.

Diagnóstico y manejo de un seudoaneurisma iatrogénico tras atrioseptostomía percutánea en un neonato / Diagnosis and management of iatrogenic pseudoaneurysm after percutaneous atrioseptostomy in a neonate

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Cutaneous bronchobiliary fistula treated with Tissucol sealant.

Bronchobiliary fistula is a rare and is an uncommon but severe complication of hydatid disease of the liver. Treatment has traditionally been surgical resection, but embolization and stent placement have been described. The invasive method seems to be a key component of patient treatment. We describe a case of a 58-year-old woman who, 25 years before, had undergone surgery for a hydatid cyst. A total cystectomy without previous puncture or parasite extraction was carried out. The lower aspect of the cyst was found to be completely perforated over the biliary duct. During the postoperative course, the patient had subphrenic right-sided pleural effusion and biliary fistula that subsided with medical treatment. Afterward, the patient came to the outpatient area of our hospital complaining of leakage of purulent exudate through the cutaneous opening, pain located on the right hypochondrium radiating to the right hemithorax, malaise, fever, chronic cough, and occasional vomiting of bile. Fistulography revealed an anfractuous cavity communicating with a residual cystic cavity on the right hepatic lobe. We observed communication with the intrahepatic canaliculi. Computed tomographic scan revealed a fistulous tract on the anterior liver border through the abdominal wall. There were no posttreatment complications. The patient is asymptomatic.

Patología gástrica adquirida en la edad pediátrica y adolescencia: valoración radiológica / Acquired gastric disorders in the pediatric age and adolescence: radiologic evaluation

El objetivo de este artículo es comprender la embriología,la patología y los hallazgos radiológicosde un amplio espectro de enfermedades adquiridasque afectan al estómago durante la edad pediátricay la adolescencia, comprender la utilidad de cadatécnica de imagen que se puede aplicar en el manejode estas entidades y mostrar posibles errores ydiagnóstico diferenciales. La patología gástrica adquiridasupone una importante causa de morbilidaden la edad pediátrica y la adolescencia, requiriendofrecuentemente varias técnicas de imagen para sudiagnóstico y tratamiento. A pesar de que las manifestacionesclínicas deben considerarse, especialmenteen la edad pediátrica, este artículo analiza eilustra un amplio espectro de enfermedades adquiridas,frecuentes y no tan frecuentes, que afectan alestómago, enfatizando en sus manifestaciones radiológicas.Los temas específicos que tratamos incluyenestenosis hipertrófica de píloro (EHP), piloroespasmo,bezoares, varices gástricas, gastritis (enfermedadde Menetrier, gastritis infecciosa, gastritiseosinófila, enfermedad granulomatosa crónica, enfermedadde Crohn y gastritis química), tumores ylesiones pesudotumorales (pólipos, pseudotumor inflamatorio,teratoma, linfoma no Hodgkin, carcinoma,tumor estromal gastrointestinal, leiomioma, leiomioblastomay leiomiosarcoma). Este artículo proporcionauna visión general de estas anomalíascongénitas así como de la utilidad de las técnicas deimagen disponibles. Ya que muchas tienen una aparienciacaracterística, este artículo ayudará al lectora comprender mejor estas anomalías

The objective of this article is to understand theembriology, pathology, and imaging features of thewide spectrum of acquirde disorders involving thestomach in infants and children, to understand theutility of each imaging modality that can be appliedto the management of these conditions and to emphasisepitfalls and differential diagnosis of these entities.Acquired disorders affecting the stomach are asignificant cause of morbidity in infants and children,frequently requiring multiple imaging modalities todiagnose and plan treatment. Although clinical featuresmight be considered when facing stomach disordersup, especially in pediatric age, this articleanalyses and ilustrates a wide spectrum of usualand unusual acquired disorders that might involvethe stomach with emphasis on the radiological manifestations.Specific topics addressed include hypertrophicpyloric stenosis, pylorospasm, bezoars, gastricvarices, gastritis (Menetrier´s disease, infectiousgastritis, eosinophilic gastritis, chronic granulomatousdisease, Crohn´s disease and chemical gastritis),neoplasms and pseudotumoral lesions (polyps,inflammatory pseudotumor, teratoma, non-Hodgkinlymphoma, carcinoma, gastrointestinal stromal tumor, leiomyoma, leiomyoblastoma and leiomyosarcoma).This article provides an overview of these acquireddisorders as well as the utility of the imagingtechniques available. Because many of these disordershave a characteristic appearance, this exhibitwill help the reader to better understand these anomalies