[Thrombosis in vascular accesses for haemodialysis: rescue treatment using invasive vascular radiological techniques]. / Accesos vasculares para hemodiálisis trombosados: rescate mediante técnicas de radiología vascular intervencionista.

BACKGROUND: The purpose of this paper is to communicate our experience in the salvage of thrombosed haemodialysis vascular accesses using interventional radiology techniques. METHODS: In the last four years, we have treated, by radiological means, 101 thrombosed haemodialysis vascular accesses. There were 44 autologous arteriovenous fistulas (43.56%) and 57 PTFE grafts (56.44%). There were 69 men (68.3%) and 32 women (31.7%). The mean age was 67.73 years (range 33-84). The mean vascular access age was 23.79 months (range 1-132). Manual catheter-directed aspiration was used. Fragmented, triturated or pushed the thrombus against the pulmonary circulation was avoided in all cases. RESULTS: 78 accesses were salvaged (77.2%). Autologous fistulas average and PTFE grafts success rate were 84.44% and 71.42% respectively. Angioplasty in one or more lesions after thromboaspiration was performed in all accesses, except six (5.9%). Metallic endoprostheses were implanted in 14 accesses (13.9%). Mean follow-up was 9 months (range 0-44). Primary patency was 42.3% +/- 5 at 6 months and 32% +/- 4 at one year. Autologous fistulas patency was better than PTFE grafts patency (p < or =0,05). CONCLUSIONS: Our results suggest thrombosed autologous arteriovenous fistulas salvage is better than PTFE grafts. This justifies interventional radiology techniques in these situations.

Accesos vasculares para hemodialisis trombosados: rescate mediante tecnicas de radiologia vascular intervencionista / No disponible

Introducción: el objetivo de este trabajo es comunicar nuestra experiencia en el rescate o salvación de los accesos vasculares para hemodiálisis trombosados (fístulas autólogas e injertos protésicos) mediante técnicas de radiología vascular intervencionista. Material y métodos: en los últimos cuatro años hemos tratado radiológicamente 101 accesos vasculares para hemodiálisis trombosados, 44 fístulas autólogas (43,56%) y 57 injertos protésicos (56,44%). La distribución por sexos fue de 69 hombres (68,3%) y 32 mujeres (31,7%), con una edad media de 67,63 años (r: 33-84). La antigüedad media del acceso desde su realización quirúrgica fue de 23,79 meses (r: 1-132). La técnica de rescate fue la tromboaspiración manual con catéter con presión negativa. En ningún caso se han fragmentado, triturado o empujado los trombos hacia la circulación. Resultados: en total, se rescataron con éxito 78 accesos (77,2%). El porcentaje de éxito en las fístulas nativas fue del 84,44%, y el de injertos protésicos, del 71,42%. En todos los accesos, menos en seis (5,9%), se hizo angioplastia en una o en más lesiones tras la trombectomía. En 14 accesos (13,9%), se implantaron una o más endoprótesis metálicas (stent). El seguimiento medio fue de nueve meses (rango: 0-44). La permeabilidad primaria global fue de 42,3% ± 5 a los seis meses, y de 32% ± 4 al año. Por grupos, en las fístulas nativas las permeabilidades primarias fueron mejores que en los injertos protésicos (p <0,05). Conclusiones: en nuestra opinión, y basándonos en nuestra experiencia, los resultados de rescate de accesos vasculares trombosados son mejores en las fístulas autólogas que en los injertos protésicos. Los buenos resultados obtenidos justifican el rescate mediante técnicas de radiología intervencionista, independientemente del tiempo transcurrido de la trombosis (AU)

Background: The purpose of this paper is to communicate our experience in the salvage of thrombosed haemodialysis vascular accesses using interventional radiology techniques. Methods: In the last four years, we have treated, by radiological means, 101 thrombosed haemodialysis vascular accesses. There were 44 autologous arteriovenous fistulas (43.56%) and 57 PTFE grafts (56.44%). There were 69 men (68.3%) and 32 women (31.7%). The mean age was 67.73 years (range 33-84). The mean vascular access age was 23.79 months (range 1-132). Manual catheter-directed aspiration was used. Fragmented, triturated or pushed the thrombus against the pulmonary circulation was avoided in all cases. Results: 78 accesses were salvaged (77.2%). Autologous fistulas average and PTFE grafts success rate were 84.44% and 71.42% respectively. Angioplasty in one or more lesions after thromboaspiration was performed in all accesses, except six (5.9%). Metallic endoprostheses were implanted in 14 accesses (13.9%). Mean follow-up was 9 months (range 0-44). Primary patency was 42.3% ± 5 at 6 months and 32% ± 4 at one year. Autologous fistulas patency was better than PTFE grafts patency (p ≤0,05). Conclusions: Our results suggest thrombosed autologous arteriovenous fistulas salvage is better than PTFE grafts. This justifies interventional radiology techniques in these situations (AU)

[Endovascular treatment of arterial occlusive disease of the iliac arteries]. / Tratamiento endovascular de la enfermedad aterooclusiva de las arterias iliacas.

Atherosclerotic disease is one of the most important health problems in the United States and in the entire world. The endovascular techniques for the treatment of peripheral vascular disease have been investigated in recent years. This is a review of the literature of the endovascular techniques used in the treatment of occlusive iliac disease. Angioplasty has showed excellent results in concentric lesions, of less 5 cm of length with a technical success of 96%, primary patency of 90%, 81% and 72% at one, two and three years. The complication rate is 0.5% to 0.8% and the mortality rate is 0.2%. The use of stents has improved the success of arterial recanalization, with a technical success of 97%, and a primary patency of 90%, 84% and 71% at one, two and three years. Major complications appear in less than 1% of the cases. In conclusion the endovascular techniques have been proved to be the treatment of choice for certain selected forms of presentation of atherosclerotic disease in the iliac arteries, specifically short, focal lesions. The results have been excellent with less mortality and morbidity than surgery.

Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy.

BACKGROUND: The purpose of this study was to describe our experience in the conservative management of large rectus sheath hematoma (RSH) in patients undergoing anticoagulation therapy. METHODS: This is a retrospective study of the medical histories of 12 cases of RSH (11 female, one male; mean age = 67.6 years). Seven patients were taking oral anticoagulants, three were taking intravenous unfractionated heparin, and two were taking subcutaneous low-molecular-weight heparin. Six patients had a history of coughing fits. Ultrasound examination and computed tomography (CT) was performed in all cases. RESULTS: Clinically, the majority of patients presented acute abdominal pain, infraumbilical masses, and anemic syndrome. Ultrasonography demonstrated nine of the 12 cases of RSH, and CT showed the hematoma in all 12 cases. Type II (five cases) and type III (seven cases) indicate moderate and severe hematomas, respectively. Excessive anticoagulation was observed in eight cases, and coagulation within correct ranges was seen in the remaining four cases. In five patients the normalization of coagulation was achieved by administering vitamin K1 and fresh frozen plasma. All cases of type III hematoma required blood transfusion. Conservative treatment was effective in all cases. CONCLUSIONS: RSH must be suspected in women of advanced age undergoing treatment with anticoagulants who present the clinical triad of acute abdominal pain, infraumbilical mass, and anemic syndrome. CT is the examination of choice for the diagnosis of RSH. Early diagnosis of RSH permits conservative management, even in the case of large hematomas with hemodynamic repercussions and avoids unnecessary surgical intervention.

[Endourethral prosthesis in recurrent urethral stenosis. Long-term follow-up]. / Prótesis endouretrales en estenosis de uretra recidivada. Seguimiento a largo plazo.

OBJECTIVES: To describe our experience with urethral stents in the treatment of recurrent strictures. METHODS: From March 1991 to July 1992, 17 Wallstent and 1 Strecker self-expandable stents were implanted. Patient follow-up ranged from 11 to 40 months. The results were analyzed on the basis of the clinical, urodynamic, radiological and cystoscopic findings. RESULTS: Of the 18 patients in whom a urethral stent had been implanted, 2 (11.1%) required removal of the stent, 1 patient was lost to follow-up, 2 had died during follow-up from causes unrelated with the procedure. At 40 months follow-up, late complications were observed in 8 patients (47%): intraprosthetic excrescence, erectile disorders, pollakiuria, lithiasis, episodes of RAO, or incontinence. CONCLUSIONS: In our view, the implanted urethral stent is a valid alternative when other techniques are not feasible or have failed (dilatation, internal urethrotomy, urethroplasty...), but we should not forget the long-term complications.

[Rhodococcus equi pneumonia in patients with HIV infection: report of 2 cases and review of the literature]. / Neumonía por Rhodococcus equi en pacientes infectados por el HIV: presentación de 2 casos y revisión de la litertura.

BACKGROUND: Pneumonia by Rhodococcus equi is infrequent and is associated with patients with important immunosuppression. To date 66 cases of pneumonia by Rhodococcus equi in patients with HIV infection have been published. The diagnosis, problems in determining diagnosis and treatment are discussed. MATERIALS AND METHODS: Two new cases of pneumonia by Rhodococus equi in C3 stage patients with HIV infection are reported. Diagnosis was achieved by study of bronchoalveolar lavage samples with the Apy-Coryne method and gas chromatography. RESULTS: The two patients presented pneumonia, one of which was necrotizing pneumonia with localization in the upper left lung and in the lower right lung, respectively. The clinical manifestations were characterized by respiratory involvement of a subacute course with pleural involvement in both cases and hemoptisis in one. Prolonged, combined antibiotic treatment was administered with good response in both cases. One patient died at one year of diagnosis from consumptive syndrome while the other remains asymptomatic. CONCLUSIONS: Infection by Rhodococcus equi should be suspected in HIV patients with slow evolution pneumonia, especially in the pneumonia is necrotizing. Combined i.v. antibiotic treatment is recommended and followed from 3 to 5 months with an association including clarithromycin.

Percutaneous catheter drainage of breast abscesses.

Experiences with ultrasonically guided percutaneous catheter drainage of breast abscesses (BA) are presented. The 12 cases were: 10 non-lactating women, one lactating women, and one HIV-positive man. The percutaneous procedure employed was successful in all cases. The mean duration of drainage was 5 days post-catheter insertion. All percutaneous drainages and subsequent follow-up were performed in the outpatient clinic. No recurrence of BA was observed. Percutaneous drainage of BA is a simple, effective and economical technique. Its use is recommended as an alternative to surgical drainage.

Rectus sheath hematoma: diagnostic classification by CT.

A method of classification for hematomas of the rectus abdominis sheath (RSH) is proposed based on findings observed in CT in the 13 cases of RSH in the present study. Type I hematomas (five cases) are slight and do not require hospitalization. Type II (three cases) and type III (five cases) are moderate and severe hematomas, respectively, and do require hospitalization. The patients with type III hematomas were all undergoing anticoagulant therapy and presented with a picture of acute abdomen, and in all five cases blood transfusion was carried out. Ultrasonography and, in particular, CT permitted a correct diagnosis of RSH. RSH should be considered (anticoagulant therapy induced) in females with sudden abdominal pain to avoid unnecessary surgical intervention.

Urethral sonography in the diagnosis of penile and bulbar urethral stenosis.

Ultrasound was used in 25 patients for the study of penile (21) and bulbar (4) strictures and for the follow-up of 8 of these patients on whom dural urethroplasty was carried out. There was a good correlation with urethrography. Ultrasound has the added advantages of enabling study of the periurethral tissues without testicular irradiation, and safety and economy of the exploration.

A new apparatus for the localization of nonpalpable mammary lesions.

A new apparatus has been used for the localization of 46 nonpalpable mammary lesions seen in either of two radiological projections. This device compresses and immobilizes the breast independently of the mammography equipment and permits a three-dimensional localization of the lesion by using the technique of X-ray angulation. The results demonstrate the efficiency of the procedure. Transfixation of the lesions was established in 30 cases (65.2%), the guidewire passed very close to the lesion in 14 cases (30.4%), and in 2 cases (4.4%) the guidewire was seen to be less than 10 mm away from the lesion. Correct preoperative localization of the lesions permitted a correct diagnosis with minimal biopsies.

A useful projection for demonstrating the bifurcation of the pulmonary artery.

The demonstration of the pulmonary bifurcation is important in order to exclude pulmonary branch stenoses. The origin of the right and left pulmonary arteries can be demonstrated in the anteroposterior plane if cranial angulation is used. Depending on the course of the left pulmonary artery, the origin of the left pulmonary artery may not be seen in spite of the maximal cranial angulation. On the lateral plane without tube angulation the origin left pulmonary artery is commonly superimposed on the origin of the right pulmonary artery. If maximum caudal angulation is added to the steep left anterior oblique view, not only the left, but also the origin of the right pulmonary artery can be seen.

The incidence of myocardial bridges in heart transplants.

Coronary angiograms of 64 heart transplant patients were reviewed to determine the incidence of myocardial bridges. In 33% of the patients, myocardial bridges were detected, almost exclusively across the midportion of the left anterior descending coronary artery. The incidence is higher than previously reported in the literature and is thought to be related to increased stiffness and hypertrophy of the myocardium, which facilitates angiographic detection of myocardial bridges in the transplanted heart.