Fístula ureteroiliaca como complicación de colocación de catéter JJ / Ureteroiliac fistula as a JJ catheter placement complication

Introducción:la colocación de un catéter JJ es una maniobra urológica habitual. Pese a su relativa sencillez, esta técnica puede asociar complicaciones.Caso clínico:se presenta un caso de fístula ureteroiliaca, una de las complicaciones más infrecuentes. Se trata de una mujer de 69 años con antecedentes de carcinoma de cérvix tratado con cirugía y radioterapia pélvica, atrofia obstructiva del riñón izquierdo, y atrapamiento ureteral derecho, que precisaba recambios periódicos de su catéter ureteral derecho. Durante el último recambio se objetivó sangrado activo y hematuria procedente del uréter. Tras estudio mediante TAC, ureterorrenoscopia y arteriografía se diagnosticó una fístula ureteroiliaca. Mediante punción percutánea ecoguiada femoral derecha, se implantó un stent recubierto de 8 x 57 mm (Begraft®) en la arteria iliaca externa derecha, con corrección instantánea del sangrado.Discusión:la fístula ureteroiliaca es una complicación inusual tras la colocación de un catéter JJ. Se ha realizado una revisión de casos publicados sobre esta patología y se observan antecedentes de historia quirúrgica vascular y/u oncológica y tratamiento radioterápico pélvico previo en todos ellos. Tras esta revisión se concluye que el tratamiento endovascular es de primera elección, pues se trata de un abordaje mínimamente invasivo que ofrece opciones de diagnóstico y tratamiento de manera rápida y eficaz.(AU)

Introduction:the placement of a JJ catheter is a common urological maneuver. Despite its relative simplicity, this technique can have complications associated.Case report:we present a case of a 69-year-old woman who developed a ureteroiliac fistula, one of the rarest complications after the placement of a JJ catheter. She had a history of cervix carcinoma treated with surgery and pelvic radiotherapy, with only one functional kidney due to obstructive atrophy of the left kidney, and right ureteral obstruction, and she required periodic replacement of her right ureteral catheter. During the last replacement, active bleeding and hematuria coming from the right ureter was observed; the study was completed with CT, ureterorenoscopy and arteriography, diagnosing a right ureteroiliac fistula. Using ultrasound-guided right femoral percutaneous puncture, an 8 x 57 mm coated stent (Begraft®) was implanted in the right proximal external iliac artery, with instant correction of the bleeding.Discussion:ureteroiliac fistula is an unusual complication after the placement of a JJ catheter. We performed a review of published cases and history of pelvic surgery and/or radiotherapy was described in all of them. We can conclude that endovascular treatment is currently the first-line management of ureteroiliac fistula. It is a minimally invasive approach that offers fast and effective diagnostic and treatment options.(AU)

Endovascular Treatment of Descending Thoracic Aortic Pathology: Results of the Regis-TEVAR Study.

BACKGROUND: Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology. The objective of this study was to analyze indications and results of thoracic endovascular aortic repair (TEVAR) in vascular surgery units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS: From 2012 to 2016, a total of 287 patients from 11 vascular surgery units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival, and reintervention rate. The following indications for TEVAR were also analyzed: aortic dissections, thoracic aneurysms, traumatisms, and intramural hematomas or penetrating ulcers, as well as results and postoperative complications in accordance with each indication. RESULTS: Of the 287 TEVAR performed (239 men, mean age 64.1 ± 14.1 years), 155 were because of aortic aneurysm (54%), 90 because of type B aortic dissection (31.4%), 36 because of traumatic aortic rupture (12.5%), and 6 because of penetrating ulcers or intramural hematomas (2.1%). Overall mortality at 30 days was 11.5% (18.5% in urgent and 5.3% in elective), being higher in dissections (13.3%). The median actuarial survival was 73% at 4 years. The stroke rate was 3.1%, and the rate of spinal cord ischemia was 4.9%. Aortic reoperations were necessary in 23 patients (8.1%). CONCLUSIONS: This registry provides complete and reliable information on real clinical practice of TEVAR in Spain, with results similar to international series of open surgery. In accordance with these data, TEVAR can be performed with acceptable morbidity and mortality and with low rates of postoperative complications.

Rendimiento de las metanefrinas libres plasmáticas en el diagnóstico de los feocromocitomas y paragangliomas en la población asturiana / Performance of plasma free metanephrines in diagnosis of pheochromocytomas and paragangliomas in the population of Asturias

Introducción: Los feocromocitomas y paragangliomas son tumores poco frecuentes cuyos síntomas más conocidos son hipertensión arterial, palpitaciones, cefalea y diaforesis. Sin embargo, su identificación clínica no es fácil. Por ello, se utilizan pruebas bioquímicas que permitan un diagnóstico precoz, destacando las metanefrinas. El objetivo de este estudio fue evaluar el rendimiento diagnóstico de las metanefrinas libres plasmáticas (MLP) y verificar la transferibilidad de los valores de referencia utilizados. Métodos: Las MLP fueron cuantificadas mediante cromatografía líquida de alta resolución acoplada a espectrometría de masas. Otras pruebas bioquímicas evaluadas (catecolaminas en plasma, metanefrinas, catecolaminas y ácido vanilmandélico en orina) fueron analizadas por cromatografía líquida de alta resolución con detección electroquímica. Se revisaron las solicitudes de dichas pruebas del 01/09/2015 al 31/10/2017 y se estimaron los valores de referencia (documento EP28-A3c) y los parámetros de variabilidad biológica (método de Fraser) de las MLP. Resultados: Se estudiaron 1.279 pacientes (61,3% mujeres), con edades entre 0-90 años, incluyendo 19 casos de feocromocitoma/paraganglioma. Las solicitudes bioquímicas fueron: MLP (n=662), catecolaminas urinarias (n=589), metanefrinas urinarias (n=586), ácido vanilmandélico urinario (n=513) y catecolaminas plasmáticas (n=228). Las pruebas con mayor sensibilidad fueron las metanefrinas fraccionadas urinarias (91,7%) y las MLP (82,4%). Cuando se comparó el rendimiento en pacientes con ambas pruebas (n=243), estas detectaron los mismos casos (90,9%), pero las MLP fueron más específicas (93,5 vs. 88,8%). Para la normetanefrina plasmática se observó una asociación significativa con la edad (rho=0,19; p<0,0001). Conclusión: Las MLP y las metanefrinas fraccionadas urinarias son las pruebas bioquímicas que ofrecen un mayor rendimiento en el diagnóstico de los feocromocitomas/paragangliomas

Introduction: Pheochromocytoma and paraganglioma are uncommon tumors whose best known symptoms include high blood pressure, palpitations, headache, and sweating. Clinical identification is not easy, however, and requires biochemical tests that allow for early diagnosis, including measurement of metanephrines levels. The aim of this study was to assess the diagnostic performance of plasma free metanephrines (PMETs) and to verify the transferability of the reference values used. Methods: PMETs levels were measured by liquid chromatography coupled to tandem mass spectrometry. Other biochemical tests evaluated (plasma catecholamine, urine metanephrine, catecholamine and vanilmandelic acid levels) were performed by liquid chromatography with electrochemical detection. Requests of these tests from 01/09/2015 to 31/10/2017 were reviewed, and both the reference values (document EP28-A3c) and the parameters of biological variation (Fraser method) for PMETs were estimated. Results: The study sample consisted of 1,279 patients (61.3% females) aged 0-90 years, including 19 with pheochromocytoma/paraganglioma. Tests requested included: PMETs (n=662), catecholamines (n=589), metanephrines (n=586), and vanilmandelic acid (n=513) in urine, and plasma catecholamines (n=228). Tests with higher sensitivity were urinary fractionated metanephrines (91.7%) and PMETs (82.4%). When performance was compared in patients with both tests (n=243), they detected the same number of tumors (90.9%), but PMETs showed greater specificity (93.5% vs 88.8%). Plasma normetanephrine levels showed a significant association with age (rho=0.19, P<.0001). Conclusion: PMETs and urinary fractionated metanephrines are the biochemical tests with better performance in diagnosis of pheochromocytomas/paragangliomas

Performance of plasma free metanephrines in diagnosis of pheochromocytomas and paragangliomas in the population of Asturias. / Rendimiento de las metanefrinas libres plasmáticas en el diagnóstico de los feocromocitomas y paragangliomas en la población asturiana.

INTRODUCTION: Pheochromocytoma and paraganglioma are uncommon tumors whose best known symptoms include high blood pressure, palpitations, headache, and sweating. Clinical identification is not easy, however, and requires biochemical tests that allow for early diagnosis, including measurement of metanephrines levels. The aim of this study was to assess the diagnostic performance of plasma free metanephrines (PMETs) and to verify the transferability of the reference values used. METHODS: PMETs levels were measured by liquid chromatography coupled to tandem mass spectrometry. Other biochemical tests evaluated (plasma catecholamine, urine metanephrine, catecholamine and vanilmandelic acid levels) were performed by liquid chromatography with electrochemical detection. Requests of these tests from 01/09/2015 to 31/10/2017 were reviewed, and both the reference values (document EP28-A3c) and the parameters of biological variation (Fraser method) for PMETs were estimated. RESULTS: The study sample consisted of 1,279 patients (61.3% females) aged 0-90 years, including 19 with pheochromocytoma/paraganglioma. Tests requested included: PMETs (n=662), catecholamines (n=589), metanephrines (n=586), and vanilmandelic acid (n=513) in urine, and plasma catecholamines (n=228). Tests with higher sensitivity were urinary fractionated metanephrines (91.7%) and PMETs (82.4%). When performance was compared in patients with both tests (n=243), they detected the same number of tumors (90.9%), but PMETs showed greater specificity (93.5% vs 88.8%). Plasma normetanephrine levels showed a significant association with age (rho=0.19, P<.0001). CONCLUSION: PMETs and urinary fractionated metanephrines are the biochemical tests with better performance in diagnosis of pheochromocytomas/paragangliomas.

Estado nutricional de yodo en la población escolar asturiana / Iodine nutritional status in Asturian schoolchildren

Introducción: El déficit de yodo es considerado un problema de salud pública. El estado nutricional de yodo de una población debería determinarse periódicamente. Objetivo: Conocer el estado de nutrición de yodo en Asturias y su relación con el uso de sal yodada y con otros parámetros sociodemográficos y nutricionales. Material y métodos: Estudio observacional descriptivo en una muestra aleatorizada de población escolar de 5 a 14 años, determinando yoduria mediante cromatografía líquida de alta resolución. Previamente, la familia de cada niño respondía una encuesta sobre consumo de lácteos, pescado, sal yodada y datos sociodemográficos. Resultados: Se estudió a 705 escolares (51,1% niñas), con una edad media de 9,9 años (DE 2,6). La yoduria media fue 204,1μg/L (DE 120,6), la mediana 180,7μg/L (P25-P75: 124-252,3μg/L; rango intercuartílico 128,3μg/L), en un total de 620 determinaciones válidas. La proporción de niños con yodurias<100μg/L fue del 16,6% del total y con yodurias muy bajas (<20μg/L) del 0,2%. Se consumía sal yodada en el 69,3% de los hogares y todos los comedores escolares la utilizaban. El consumo de lácteos se relacionó significativamente con la yoduria (p<0,0005). Conclusión: La nutrición de yodo en escolares asturianos es adecuada, aunque aún queda lejos el objetivo del 90% de consumo de sal yodada en los hogares. El adecuado estado de nutrición de yodo podría deberse a otras fuentes, como el consumo de lácteos. Son necesarias campañas de salud pública para fomentar el consumo de sal yodada en nuestra población, así como la evaluación periódica del estado nutricional de yodo (AU)

Introduction: Iodine deficiency is a public health problem, and iodine nutritional status should therefore be regularly measured. Objective: To ascertain iodine nutritional status in Asturias and its relation to use of iodized salt and to other sociodemographic and nutritional parameters. Material and methods: A descriptive, observational study was conducted in a random sample of schoolchildren aged 5 to 14 years, in whom urinary iodine levels were measured by high-performance liquid chromatography. Families completed a survey on use of iodized salt, consumption of dairy products and fish, and sociodemographic data. Results: The study sample consisted of 705 schoolchildren (51.1% females) with a mean age of 9.9 years (SD 2.6). In a total of 620 valid measurements, mean urinary iodine level was 204.1 μg/L (SD 120.6), while the median value was 180.7 μg/L (P25-P75: 124-252.3 μg/L, interquartile range 128.3 μg/L). Urinary iodine levels were <100 μg/L in 16.6% of children, and very low (<20 μg/L) in 0.2%. Iodized salt was used in 69.3% of all households, and in all school canteens. Consumption of dairy products was significantly associated to urinary iodine levels (P<.0005). Conclusion: Iodine nutrition of Asturian schoolchildren is adequate, although the target of use of iodized salt in 90% of households is still far away. Adequate iodine nutrition may be due to other sources, such as dairy products. Public health campaigns are required to promote iodized salt consumption. Regular assessment of iodine nutritional status is also needed (AU)

Iodine nutritional status in Asturian schoolchildren. / Estado nutricional de yodo en la población escolar asturiana.

INTRODUCTION: Iodine deficiency is a public health problem, and iodine nutritional status should therefore be regularly measured. OBJECTIVE: To ascertain iodine nutritional status in Asturias and its relation to use of iodized salt and to other sociodemographic and nutritional parameters. MATERIAL AND METHODS: A descriptive, observational study was conducted in a random sample of schoolchildren aged 5 to 14 years, in whom urinary iodine levels were measured by high-performance liquid chromatography. Families completed a survey on use of iodized salt, consumption of dairy products and fish, and sociodemographic data. RESULTS: The study sample consisted of 705 schoolchildren (51.1% females) with a mean age of 9.9 years (SD 2.6). In a total of 620 valid measurements, mean urinary iodine level was 204.1 µg/L (SD 120.6), while the median value was 180.7 µg/L (P25-P75: 124-252.3 µg/L, interquartile range 128.3 µg/L). Urinary iodine levels were <100 µg/L in 16.6% of children, and very low (<20 µg/L) in 0.2%. Iodized salt was used in 69.3% of all households, and in all school canteens. Consumption of dairy products was significantly associated to urinary iodine levels (P<.0005). CONCLUSION: Iodine nutrition of Asturian schoolchildren is adequate, although the target of use of iodized salt in 90% of households is still far away. Adequate iodine nutrition may be due to other sources, such as dairy products. Public health campaigns are required to promote iodized salt consumption. Regular assessment of iodine nutritional status is also needed.

Nutrición de yodo en mujeres embarazadas del área de Oviedo. ¿Es necesaria la suplementación con yodo? / Iodine nutrition in pregnant women from Oviedo area. Is iodine supplementation necessary?

INTRODUCCIÓN Y OBJETIVO: En Asturias, donde la deficiencia de yodo fue erradicada en los escolares en el año 2000, persistía una deficiencia de yodo en las mujeres embarazadas, por lo que se les recomendaba la utilización de suplementos yodados. El objetivo de este estudio es conocer la nutrición de yodo de las mujeres embarazadas de nuestra área y la necesidad o no de suplementos yodados. MATERIAL Y MÉTODOS: Durante mayo y junio de 2013 hemos estudiado la nutrición de yodo y la función tiroidea en el primer trimestre del embarazo de 173 mujeres del área sanitaria de Oviedo. RESULTADOS: La mediana de la yoduria fue 197 μg/L. Tomaban suplementos yodados el 47% de las mujeres, con una mediana de yoduria superior a la de las que no tomaban suplementos yodados (247 vs 138 μg/L; <0,001) y también una TSH superior (2,30 vs 1,94 mU/L), aunque no significativamente diferente. La yoduria fue también superior en las mujeres que tomaban más de 2 raciones de productos lácteos (mediana: 230 μg/L) que en aquellas que tomaban menos de 2 raciones (mediana: 191 μg/L). Dentro del grupo de mujeres que no tomaban suplementos yodados, aquellas que utilizaban habitualmente sal yodada en la cocina (47%), tenían una mediana de yoduria de 190 μg/L, indicativa de suficiencia de yodo. CONCLUSIÓN: En la actualidad los suplementos yodados serían innecesarios en las mujeres embarazadas de nuestra entorno que consumen de forma habitual sal yodada y la recomendación en estos casos debería ser la de continuar utilizando la sal yodada en la cantidad recomendada en la gestación, así como consumir al menos dos raciones diarias de leche o productos lácteos

BACKGROUND AND OBJECTIVE: In Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed. MATERIAL AND METHODS: Throughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo. RESULTS: The median urinary iodine was 197 μg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 μg/L; p < .001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 μg/L) than those who took less (median: 191 μg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190 μg/L indicating iodine sufficiency. CONCLUSIONS: Iodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products

Iodine nutrition in pregnant women from Oviedo area. Is iodine supplementation necessary?

BACKGROUND AND OBJECTIVE: In Asturias, where iodine deficiency was eradicated in school children by the year 2000, iodine deficiency persisted in pregnant women, who were recommended to use of iodine supplementation. The aim of this study was to determine the iodine nutrition of pregnant women in our area and whether or not iodine supplements are needed. MATERIAL AND METHODS: Throughout May and June 2013 we studied the iodine nutrition and thyroid function during the first trimester of pregnancy in 173 women in the health area of Oviedo. RESULTS: The median urinary iodine was 197 µg/L. Iodinated supplements were used by 47% of women, which had a yoduria median higher than those not taking iodinated supplements (247 vs. 138 µg/L; p<.001), and also a higher TSH (2.30 vs 1.94 mU/L) although not significantly different. Yoduria was also higher in women who took more than 2 servings of dairy products (median: 230 µg/L) than those who took less (median: 191 µg/L). Within the group of women who were not taking iodine supplements, those regularly using iodized salt in the kitchen (47%) had a median urinary iodine concentration of 190µg/L indicating iodine sufficiency. CONCLUSIONS: Iodinated supplements seem unnecessary nowadays in pregnant women of Oviedo who regularly take iodized salt and our recommendation in these cases should be to continue the use of iodized salt in the recommended amounts during pregnancy and consume at least two daily servings of milk or dairy products.