Fluid Retention Associated with Imatinib Treatment in Patients with Gastrointestinal Stromal Tumor: Quantitative Radiologic Assessment and Implications for Management

OBJECTIVE: We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. MATERIALS AND METHODS: In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. RESULTS: The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. CONCLUSION: Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.

Chlorambucil and ascorbic acid-mediated anticancer activity and hematological toxicity in Dalton's ascites lymphoma-bearing mice.

Chlorambucil is an anticancer drug with alkylating and immunosuppressive activities. Considering various reports on the possible antioxidant/protective functions of ascorbic acid (vitamin C), it was aimed at to explore the modulatory effect of ascorbic acid on therapeutic efficacy and toxicity induced by chlorambucil. Dalton’s ascites lymphoma tumor serially maintained in Swiss albino mice were used for the present experiments. The result of antitumor activity showed that combination treatment with ascorbic acid and chlorambucil exhibited enhanced antitumor activity with 170% increase in life span (ILS), which is significantly higher as compared to chlorambucil alone (ILS 140%). Analysis of apoptosis in Dalton’s lymphoma tumor cells revealed a significantly higher apoptotic index after combination treatment as compared to chlorambucil alone. Blood hemoglobin content, erythrocytes and leukocytes counts were decreased after chlorambucil treatment, however, overall recovery in these hematological values was noted after combination treatment. Chlorambucil treatment also caused morphological abnormalities in red blood cells, majority of which include acanthocytes, burr and microcystis. Combination treatment of mice with ascorbic acid plus chlorambucil showed less histopathological changes in kidney as compared to chlorambucil treatment alone, thus, ascorbic acid is effective in reducing chlorambucil-induced renal toxicity in the hosts. Based on the results, for further devel­opment, hopefully into the clinical usage, the administration of ascorbic acid in combination with chlorambucil may be recommended.

Mesotelioma maligno difuso primario de peritoneo / Primary diffuse malignant peritoneal mesothelioma

El mesotelioma peritoneal maligno es una neoplasia de presentación infrecuente, de curso insidioso, sintomática y de presentación poco específica en fase avanzada, de difícil diagnóstico y alta letalidad. Es la neoplasia más común de la serosa peritoneal, ocupando el segundo lugar de localización de los mesoteliomas, después del mesotelioma pleural. Es más frecuente en hombres, en mayores de 60 años y se ha relacionado en un 80% a la exposición crónica al asbesto. Generalmente su primera manifestación es ascitis, que se acompaña de dolor abdominal, astenia, hiporexia y pérdida de peso. Se puede diagnosticar a través del estudio histológico e inmunohistoquímico de líquido ascítico, biopsia peritoneal, y como métodos complementarios, TC de Abdomen y CT-PET. Presentamos el caso de un paciente masculino de 70 años de edad, con antecedente de adenocarcinoma prostático tratado con radioterapia y bloqueo hormonal, en remisión, Cardiopatía Isquémica e Hipertensiva en condición post-Bypass coronario, quien consulta por disnea, ascitis, hiporexia, astenia, con evidencia de líquido ascítico hemorrágico y GASA de bajo gradiente.

Malignant peritoneal mesothelioma is an infrequent neoplasm, of insidious course, symptomatic presentation and usually is diagnosed at an advanced stage diagnosis. It is the most common malignancy of the peritoneum and the the second location of mesothelioma, preceded by pleural mesothelioma. It is more common in men older than 60 year sand has been linked in 80% to chronic exposure to asbestos. Usually ascites, abdominal pain, fatigue, decreased appetite and weight loss are the first signs. It can be diagnosed through histological and immunohistochemical study of ascitic fluid, peritoneal biopsy, abdominal CT and CT-PET. We report the case of a male patient. 70 years with a history of heart disease and prostatic carcinoma treated with radiotherapy and immunosupressive therapy, who consults with dyspnea, ascites, hyporexia, fatigue and evidence of hemorrhagic ascites.

Síndrome de Ballantyne: caso clínico / Ballantyne syndrome: a case report

Se describe un caso de síndrome de Ballantyne de una paciente de 33 años con embarazo de 33 semanas quien consultó por presentar edema en miembros inferiores, cefalea y escotomas. La ecografía fetal demostró la presencia de feto único en presentación cefálica, edema de cuero cabelludo, hidronefrosis, gran cantidad de líquido en cavidad abdominal y torácica fetal acompañado de compresión del corazón y los pulmones hacia la columna vertebral, realizándose el diagnóstico de hidrops fetal. Se realizó cesárea por sufrimiento fetal agudo obteniendo un recién nacido con edema generalizado. El examen patológico de la placenta confirmó el diagnóstico por la presencia de vellosidades hidrópicas e inmadurasAU)

A case of Ballantyne syndrome is described in a 33 years-old patient with a 33 weeks pregnancy who consulted for presenting lower limbs edema, headache and blurred vision. Fetal ultrasonography showed the presence of cephalic unique fetus, scalp edema, hydronephrosis, large amount of fluid in fetal abdominal and thoracic cavities accompanied with hearth and lungs compression to spinal cord, diagnosing fetal hydrops. Cesarean section was performed due to acute fetal distress obtaining a newborn with generalized edema. Pathological examination of placenta confirmed the presence on hydropic and immature placental villi

Neonatal bladder rupture.

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic cause such as umbilical catheterization. The present study describes the case of a 27-day old infant with ascites due to bladder perforation secondary to bladder wall necrosis as a result of severe urinary tract infection. The baby was treated aggressively with antibiotics and underwent successful surgical repair of the perforation.

Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

OBJECTIVE: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. MATERIALS AND METHODS: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. RESULTS: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. CONCLUSION: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP / Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome

OBJETIVOS: Descrever os achados hepáticos na ressonância magnética em puérperas estáveis com síndrome HELLP. MÉTODOS: Realizou-se um estudo descritivo, do tipo série de casos, envolvendo 40 puérperas internadas na UTI obstétrica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP), com diagnóstico de síndrome HELLP completa (presentes todas as alterações laboratoriais) e incompleta (uma ou mais alterações laboratoriais, porém sem todos os critérios diagnósticos) no período de agosto de 2005 a julho de 2006. RESULTADOS: A idade média foi de 26,8 ± 6,4 anos, com idade gestacional média no parto de 34 semanas. A ressonância magnética foi realizada entre oito e 96 horas depois do diagnóstico de síndrome HELLP (média de 56 + 31horas). O achado mais freqüente foi ascite em 20 por cento (n = 8), seguindo-se derrame pleural (17,5 por cento) e esteatose hepática (7,5 por cento). A intensidade de sinal periportal foi normal em todos os casos e não se observaram casos de isquemia/infarto hepático ou de hematoma parenquimatoso ou subcapsular. CONCLUSÃO: Os achados da ressonância magnética pós-parto em puérperas estáveis com síndrome HELLP foram inespecíficos e, na presente série, não foram encontradas lesões importantes como hematoma parenquimatoso ou subcapsular, representando risco de vida para a paciente. Os resultados encontrados não corroboram a utilização desse exame de rotina para o seguimento de pacientes com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 ± 6.4 years and gestational age at delivery was 34 ± 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 ± 31 h). The most frequent findings were ascitis in 20 percent (n = 8), pleural effusion in 17.5 percent and hepatic steatosis in 7.5 percent. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

Lysophosphatidic acid induces cell migration through the selective activation of Akt1

Akt plays pivotal roles in many physiological responses including growth, proliferation, survival, metabolism, and migration. In the current studies, we have evaluated the isoform-specific role of akt in lysophosphatidic acid (LPA)-induced cell migration. Ascites from ovarian cancer patients (AOCP) induced mouse embryo fibroblast (MEF) cell migration in a dose-dependent manner. On the other hand, ascites from liver cirrhosis patients (ALCP) did not induce MEF cell migration. AOCP-induced MEF cell migration was completely blocked by pre-treatment of cells with LPA receptor antagonist, Ki16425. Both LPA- and AOCP-induced MEF cell migration was completely attenuated by PI3K inhibitor, LY294002. Furthermore, cells lacking Akt1 displayed defect in LPA-induced cell migration. Re-expression of Akt1 in DKO (Akt1(-/-)Akt2(-/-)) cells restored LPA-induced cell migration, whereas re-expression of Akt2 in DKO cells could not restore the LPA-induced cell migration. Finally, Akt1 was selectively phosphorylated by LPA and AOCP stimulation. These results suggest that LPA is a major factor responsible for AOCP-induced cell migration and signaling specificity of Akt1 may dictate LPA-induced cell migration.

Budd chiari syndrome: a rare complication of renal cancer

A 52 years old lady was admitted with 2 weeks history of abdominal distension and drowsiness. Laboratory workup confirmed the presence of de-compensated liver disease with negative viral serology. Abdominal ultrasound and CT abdomen revealed tumour in right kidney with tumour thrombus extending in inferior vena cava and hepatic vein resulting in Budd Chiari syndrome and ascites. Patient was managed with medications only due to advanced liver disease

Percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites

Percutaneous needle peritoneal biopsy in diagnosis of exudative ascites has gained wide acceptance and many workers have utilized it with a high diagnostic yield and no significant complications. Present study has been carried out to determine the efficacy of percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites of unknown aetiology. It is a descriptive case study conducted in Medical 'C' Unit, Lady Reading Hospital, Postgraduate Medical Institute, Khyber Medical University Peshawar over a period of 2 years, i.e., from Nov, 2003 to December 2005. A total of 45 patients having unexplained exudative ascites underwent blind needle peritoneal biopsy. The biopsy specimen was subjected to histopathology. Ascitic fluid was also obtained for analysis. Post biopsy patients were observed for 24 hours for any untoward complications. A total of 45 patients [17 male and 28 female] with age range from 20 to 65 years and having exudative ascites were studied. The commonest presentation of our patients was abdominal distension [93.3%], pain abdomen [46.67%], fever [44.4%] and weight loss [33.3%]. Histopathology of the peritoneal biopsies was reported as follows. Eighteen cases [40%] showed non specific chronic inflammation, 10 [22.2%] cases showed caseating granulomatous inflammation suggestive of tuberculosis and 6 [13.3%] cases showed metastatic adenocarcinoma. In one patient peritoneal mesothelioma was reported. In the remaining10 patients [22.2%] biopsies were either non representative or inconclusive. The ascitic fluid showed predominantly lymphocytes in 86.6% of cases. Only three patients were reported to be having atypical cells on fluid cytology. The procedure was found safe. No patient was lost due to complications related to the procedure. Only one patient had evidence of intra peritoneal bleed. The commonest problem post biopsy was pain [91.1%] and mild swelling [53.3%] at biopsy site. Peritoneal biopsy is fairly safe and inexpensive procedure with good diagnostic efficacy in patients with undiagnosed exudative ascites

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

BACKGROUD: Protein-calorie malnutrition is a frequent finding in patients with chronic liver disease, but investigations of nutritional status have been rarely performed in individuals seen at outpatient clinics AIM: To evaluate the nutritional status of patients with alcoholic and nonalcoholic cirrhosis, attended for the first time at a reference outpatient clinic for liver diseases. PATIENTS AND METHODS: A total of 300 consecutive patients attended at the outpatient clinics of a reference center for liver diseases were investigated. Anthropometric evaluation was performed by the usual parameters: triceps skinfold, arm circumference and arm muscle circumference. Biochemical parameters included creatinine/height index, serum albumin and lymphocytes count. The nutritional diagnosis was based on the PCM score proposed by Mendenhall et al. Food intake was retrospectively evaluated using 24-hour dietary recall data. RESULTS: About 71 percent of the patients studied were chronic alcohol abusers, whereas in 29 percent cirrhosis was of nonalcoholic etiology. Independently of the disease etiology 75.3 percent of the patients showed some degree of protein-calorie malnutrition, which was moderate or severe in 38.3 percent of them. More advanced protein-calorie malnutrition degrees were associated with lower energy and protein intake. The prevalence of moderate or severe protein-calorie malnutrition was higher in patients classified as Child-Pugh C than in patients classified as Child-Pugh A (21 percent x 58 percent, respectively). Regarding sexual differences, fat reserves, evaluated by triceps skinfold, were more depleted in females than in males (48.6 percent x 26.6 percent) regardless of the etiology of the cirrhosis, whereas muscle reserves (arm muscle circumference) were more depleted in males (43.4 percent x 13.4 percent) regardless of the etiology of cirrhosis. In contrast, cirrhosis of alcoholic etiology was determinant in reducing arm...

RACIONAL: A desnutrição calórica e protéica é achado freqüente em pacientes com doença hepática. Poucas investigações da desnutrição calórica e protéica têm sido realizadas em pacientes atendidos em ambulatório OBJETIVO: Avaliar o estado nutricional de pacientes com cirrose hepática (alcoolistas e não-alcoolistas), atendidos na primeira consulta em ambulatório de referência para doenças hepáticas. PACIENTES E MÉTODOS: Trezentos pacientes consecutivamente atendidos pela primeira vez em ambulatório de doenças hepáticas foram incluídos neste estudo. Os mesmos foram submetidos a avaliação nutricional que constou de antropometria: dobra cutânea do tríceps, circunferência do braço e circunferência muscular do braço, e bioquímica: índice creatinina/altura, albumina sérica e contagem total de linfócitos. O diagnóstico do estado nutricional foi baseado pelo escore de desnutrição calórica e protéica proposto por Mendenhall e colaboradores e a ingestão alimentar por recordatório de 24 h RESULTADOS: Setenta e um porcento dos pacientes cirróticos estudados foram de causa alcoólica e 29 por cento não-alcoólica. Independentemente da causa, a prevalência de desnutrição calórica e protéica foi de 75,3 por cento, sendo que 38.3 por cento deles já a apresentavam moderada e grave. Os pacientes com desnutrição calórica e protéica moderada e grave apresentavam pior ingestão de proteína e energia. A prevalência de moderada e grave foi mais elevada nos pacientes classificados como Child-Pugh C do que nos pacientes classificados como Child-Pugh A (21 por cento x 58 por cento, respectivamente). Em função das variáveis sexo e causa, as reservas de gordura, avaliadas pela dobra cutânea do tríceps, estiveram mais depletadas em mulheres cirróticas que nos homens cirróticos (48,6 por cento x 26,6 por cento). Já as reservas musculares, avaliadas por circunferência muscular do braço, estiveram mais depletadas em homens cirróticos (43,4 por cento x 13,4 por cento), independentemente...

Ascites and eosinophilic colitis in a young patient

A 32-year-old man presented with 3-weeks history of abdominal pain and distention. Physical examination showed ascites, with no stigmata of chronic liver disease. Cytological preparations from the ascitic fluid showed a heavy population of mature eosinophils. Histological examination of colonic biopsies revealed a heavy expansion of the mucosa by sheaths of eosinophils. On the following days, the peripheral eosinophilia, ascites and abdominal pain resolved spontaneously

Detection of Malignant Cells in Pleural Fluid or Ascites by CD44v8-10/CD44v10 competitive RT-PCR

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.

Historia de las manifestaciones gastrointestinales del lupus eritematoso sistemico / History of the gastrointestinal manifestations in systemic lupus erythematosus

En este articulo revisamos la historia de las manifestaciones gastrointestinales en el Lupus Eritematoso Sistemico desde el siglo XIX hasta nuestros dias, recorriendo cada uno de los organos involucrados en este sistema y haciendo especial mencion de la gastropatia, enteritis, ileitis, sindrome de malabsorcion, vasculitis y vasculopatia intestinal, trombosis mesenterica, pancreatitis, ascitis, peritonitis, hepatitis autoinmune, entre otros

Frequência de adenocarcinomas em derrames cavitários / Frequency of adenocarcinomas in serious effusions

Objetivo. Identificação de freqüência de adenocarcinomas de diferentes sítios primários em derrames cavitários. Material e Métodos. Foram estudados 2.317 casos: 1.146 de derrame pleural (943 mulheres e 203 homens), 1.168 de ascite (727 mulheres e 441 homens) e três pericárdio (duas mulheres e um homem) e realizada análise retrospectiva dos prontuários dos pacientes e correlação dos achados clínico-laboratoriais. Resultados. Os sítios primários mais freqüentes em derrames pleurais foram: mama (N=586 - 51,1 por cento), pulmão (N=185 - 16,1 por cento: 102 homens e 83 mulheres), ovário (N=124 - 10,8 por cento); em ascites: estômago (N=473 - 40,5 por cento: 300 homens e 173 mulheres), ovário (N=306 - 26,2 por cento) e mama (N=83 - 7,1 por cento). Desses, 555 casos foram citologicamente positivos para malignidade em derrames pleurais, 541 em ascite e dois em pericárdio. Os sítios primários mais freqüentes em derrames pleurais citologicamente positivos foram: mama (N=288 - 51,9 por cento), pulmão (N=92, 16,6 por cento: 45 homens e 47 mulheres) e ovário (N=54, 9,7 por cento); e, em ascites: ovário (N=205 - 37,9 por cento), estômago (N=202, 37,3 por cento: 119 homens e 83 mulheres) e mama (N=31 - 6,8 por cento). Em 47 derrames pleurais (8,5 por cento) e 37 ascites (6,8 por cento), a origem dos adenocarcinomas persistiu indeterminada. Conclusão. As freqüências estabelecidas poderão, em associação e dados clínicos, orientar a investigação dos sítios primários de adenocarcinomas metastáticos.

Diuresis versus therapeutic abdominal paracentesis: effects on ascitic fluid interleukin-1, opsonic activity and complement

Twenty-four patients were randomly allocated to two groups: Group A included 12 patients treated with spironolactone [200-400 mg/day] and group B included 12 patients treated twice weekly with 34 l paracentesis for two weeks. Ascitic fluid samples from all patients were analyzed for total protein and albumin concentrations. C3 and IL-1 beta levels and OA at the beginning and two weeks after treatment. The results indicated that IL-1 beta, an immunoregulatory cytokine that stimulates a variety of cells that function as effector of immune response towards antigens, was significantly decreased following paracentesis, while it remained almost stable among the diuretic treated patients. The ascitic fluid OA and C3 concentrations increased significantly in diuretic treated patients [P <0.05]; while, patients treated with paracentesis had significantly decreased C3 concentration, and their ascitic fluid OA remained stable

Systemic, portal and renal hemodynamics in patients with schistosomal hepatic fibrosis and ascites: role of glucagon

In the present study, systemic, portal and renal hemodynamics were assessed using Doppler flowmetry in 24 patients with schistosomal hepatic fibrosis [SHF] [12 of them had ascites due to portal hypertension and 12 were non ascitic] and in 12 healthy subjects. Also, renal function tests, fractional sodium exertion [FENa] and plasma level of glucagon, an endogenous vasodilator were determined in all patients and healthy subjects. Based on the results it can be concluded that peripheral arterial vasodilatation particularly in the splanchnic area is the trigerring signal for sodium retention and ascites formation in patients with SHF. Hyperglucagonemia might contribute to the occurrence of these hemodynamic abnormalities although it is not only vasoactive factor. Meanwhile, renal hypoperfusion and vasoconstriction is a feature of patients with SHF even in the early stages of the disease. Considering these hemodynamic changes, the use of vasoactive drugs in the management of ascites should be carefully studied in the future

Biopsia hepática percutánea en el paciente adulto / Liver biopsy diagnostic in adult

La biopsia hepática percutánea continúa siendo un método diagnóstico y de evaluación terapéutica ampliamente utilizado en la práctica médica contemporánea. Bien indicada y con un conocimiento adecuado de la técnica, ofrece un margen de seguridad importante, por lo que puede llevarse a cabo en casi todos los pacientes con enfermedad hepática. A lo largo de los años en nuestro hospital se ha acumulado una gran experiencia en este procedimiento por lo que en este trabajo se hace una revisión de las indicaciones y contraindicaciones, además de describirse los tipos de agujas que existen y la técnica que debe emplearse