Magnetic resonance defecography versus videodefecography in the study of obstructed defecation syndrome: Is videodefecography still the test of choice after 50 years?

BACKGROUND: The aim of the present study was to evaluate the diagnostic accuracy of magnetic resonance (MR) defecography and compare it with videodefecography in the evaluation of obstructed defecation syndrome. METHODS: This was a prospective cohort test accuracy study conducted at one major tertiary referral center on patients with a diagnosis of obstructed defecation syndrome who were referred to the colorectal surgery clinic in a consecutive series from 2009 to 2012. All patients underwent a clinical examination, videodefecography, and MR defecography in the supine position. We analyzed diagnostic accuracy for MR defecography and performed an agreement analysis using Cohen's kappa index (κ) for each diagnostic imaging examination performed with videodefecography and MR defecography. RESULTS: We included 40 patients with Rome III diagnostic criteria of obstructed defecation syndrome. The degree of agreement between the two tests was as follows: almost perfect for anismus (κ = 0.88) and rectal prolapse (κ = 0.83), substantial for enterocele (κ = 0.80) and rectocele grade III (κ = 0.65), moderate for intussusception (κ = 0.50) and rectocele grade II (κ = 0.49), and slight for rectocele grade I (κ = 0.30) and excessive perineal descent (κ = 0.22). Eighteen cystoceles and 11 colpoceles were diagnosed only by MR defecography. Most patients (54%) stated that videodefecography was the more uncomfortable test. CONCLUSIONS: MR defecography could become the imaging test of choice for evaluating obstructed defecation syndrome.

Escleroterapia con etanol de las malformaciones vasculares de la cavidad oral / Alcohol sclerotherapy to treat vascular malformations in the oral cavity

Objetivo. Presentamos nuestra experiencia en la inyección intralesional de etanol como tratamiento único y efectivo de las malformaciones vasculares (MV) de la cavidad oral. Material y métodos. Se trataron 26 pacientes (12 varones y 14 mujeres) con malformaciones orales. El diagnóstico se estableció por los hallazgos clínicos (n = 26), los estudios de resonancia magnética (n = 19), de arteriografía (n = 5) y de flebografía percutánea por punción directa (n = 2). Para la esclerosis de las lesiones se empleó etanol absoluto mediante punción directa. Todas las intervenciones se realizaron con sedación profunda. Resultados. Se trataron 28 MV de diferentes tamaños, con una mediana de diámetro máximo de 24,5 mm (7-60), presentes en la cavidad oral durante una media de 13,6 años (0,2-54) en 26 pacientes. La mediana de edad fue de 44,5 años (12-87). Los criterios para el tratamiento de las malformaciones fueron: aumento de tamaño (n = 8), sangrado local (n = 11), riesgo de sangrado durante una extracción dental (n = 5), dolor (n = 1), trastorno estético (n = 3). Localización de las lesiones: 12 en la mucosa yugal, 5 en la encía vestibular, 6 en la mucosa labial, 3 en la lengua, una en la región pterigomandibular y una en el paladar. La dosis mediana de etanol fue de 3,2 ml. Veinte lesiones desaparecieron tras una única inyección, 5 tras 2 sesiones, 2 tras 3 sesiones, y una tras 5 sesiones. En 20 casos las lesiones desaparecieron, en 6 persistió una mácula azulada y en 2 persistió un efecto de masa. Los síntomas mejoraron en todos los pacientes. Las complicaciones asociadas a la escleroterapia intralesional fueron pasajeras: inflamación local, parestesia perioral en 2 pacientes, y necrosis de la mucosa yugal en uno. Conclusiones. La esclerosis con etanol es un procedimiento eficaz para el tratamiento de pacientes con MV de la cavidad oral (AU)

Objective: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. Material and methods: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. Results: The vascular malformations treated ranged from 7 mm to 60 mm (median: 24.5 mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2 mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. Conclusions: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity (AU)

Alcohol sclerotherapy to treat vascular malformations in the oral cavity.

OBJECTIVE: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. MATERIAL AND METHODS: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. RESULTS: The vascular malformations treated ranged from 7mm to 60mm (median: 24.5mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. CONCLUSIONS: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity.

Utilidad de la hidrografía por resonancia magnética en la diálisis peritoneal / Magnetic resonance hydrography in peritoneal dialysis

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[Cyst and pseudocyst lesions of the floor of the mouth with submental affectation]. / Lesiones quísticas y pseudoquísticas del suelo de la boca con afectación submentoniana. Diagnóstico diferencial y tratamiento.

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions of the floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity.

Lesiones quísticas y pseudoquísticas del suelo de la boca con afectación submentoniana / Cyst and pseudocyst lesions of the floor of the mouth with submental affectation

Pretendemos revisar los métodos diagnósticos que pueden ayudamos a diferenciar las lesiones quísticas de suelo de boca con afectación submentoniana, así como las peculiaridades de la técnica quirúrgica indicada en cada una de ellas.Presentamos dos casos que fueron diagnosticados de quistes epidermopides. En el diagnóstico diferencial deben ser considerados las ránulas, los lipomas y los linfangiomas. Se revisan el diagnóstico por la imágen, la punción-aspiración con aguja fina y el tratamiento de cada tumor. Ambos casos fueron intervenidos mediante un abordaje intraoral. Actualmente se encuentran libres de enfermedad después de al menos un año. El diagnóstico diferencial de las lesiones quísticas del suelo de la boca es importante porque la técnica quirúrgica recomendada no es exactamente la misma en todas ellas. La firmeza de la pared de los quistes dermoides permite su exéresis vía intraoral aún cuando presenten un gran tamaño. Para el tratamiento de las ránulas la mayoría de autores recomienda la exéresis de la glándula sublingual, a pesar de la morbilidad de dicha técnica

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions ofthe floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity

Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography diagnostic algorithm.

BACKGROUND: Magnetic resonance cholangiopancreatography is an accurate technique that can replace invasive diagnostic methods of the biliary and pancreatic duct. AIMS: Our aim was to assess sensitivity and specificity of magnetic resonance cholangiopancreatography and ultrasonography using the results of endoscopic retrograde cholangiopancreatography as reference, and to establish a diagnostic algorithm under which circumstances magnetic resonance cholangiopancreatography can replace endoscopic retrograde cholangiopancreatography. PATIENTS: Eighty-three patients with suspicion of biliary disease based on clinical, biochemical and ultrasonography findings were studied. METHODS: Ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed, comparing the results of the techniques for the determination of their sensitivity and specificity. RESULTS: Sensitivity and specificity results obtained by magnetic resonance cholangiopancreatography were: 100 and 92.8% when dilated ducts were detected (n=61); 97.4 and 97.2% in the diagnosis of choledocholithiasis (n=38); 100 and 96.7% in malignant lesions (n=14) and 81.8 and 98.4% when biliary ducts were normal. The percentage of images of diagnostic quality was 97.6%. Sensitivity and specificity achieved by ultrasonography was: 100 and 57.1% in detection of dilatation, 71 and 97.2% in choledocholithiasis, 92.8 and 96.7% in malignancy and 66.6 and 96.8% in normal ducts. CONCLUSIONS: Magnetic resonance cholangiopancreatography is a technique with high sensitivity and specificity in the evaluation of biliary ducts. Thus, magnetic resonance cholangiopancreatography may replace diagnostic endoscopic retrograde cholangiopancreatography for purely diagnostic purposes, following an initial clinical and ultrasonographic exam.

Seguimiento del páncreas endocrino tras una pancreatitis aguda de origen biliar. Estudio prospectivo / Follow-up of endocrine pancreatic function after acute biliary pancreatitis. Prospective study

Objetivo. Valorar si tras la pancreatitis aguda biliar existía una insuficiencia pancreática endocrina y si este posible déficit se relacionaba con la gravedad del episodio. Pacientes y métodos. Sesenta y tres pacientes con pancreatitis aguda biliar fueron estudiados prospectiva y consecutivamente, 46 mujeres (73 por ciento) y 17 varones (27 por ciento); 45 casos eran leves y 18, graves. Todos ellos fueron colecistectomizados, ninguno fue sometido a necrosectomía o pancreatectomía. Durante la fase aguda se valoró la gravedad siguiendo los criterios de Atlanta, la existencia de necrosis y su porcentaje determinado por tomografía computarizada dinámica. Durante el seguimiento se valoró la función pancreática endocrina al mes, a los 6 meses y al año del episodio de la pancreatitis aguda mediante diversos tests de función pancreática. Resultados. Al mes de la pancreatitis aguda biliar se detectaron alteraciones endocrinas en el 50 por ciento de los casos, disminuyendo al sexto mes al 30 por ciento, persistiendo al año de la pancreatitis aguda en el 25 por ciento de los pacientes; sin embargo, éstas no eran secundarias a la pancreatitis, puesto que el test de arginina presentaba valores dentro del rango de la normalidad. El análisis estadístico realizado a fin de valorar la relación existente entre la gravedad de la pancreatitis aguda y los diversos tests de función pancreática endocrina demostró que no existían diferencias significativas (p > 0,05).Conclusión. La función pancreática endocrina retorna a la normalidad después de un episodio de pancreatitis aguda de origen biliar tras haberse eliminado la causa primaria de la enfermedad, no detectándose alteración de la reserva funcional endocrina secundaria a la pancreatitis, y no existiendo relación entre dicha función y la gravedad de la enfermedad (AU)

[Usefulness of magnetic cholangioresonance in the study of hepatobiliary disease in patients adults with cystic fibrosis]. / Utilidad de la colangiorresonancia magnética en el estudio de la enfermedad hepatobiliar en pacientes adultos con fibrosis quística.

INTRODUCTION: Because alterations in the bile ducts found in cystic fibrosis mimic those found in primary sclerosing cholangitis, magnetic resonance cholangiography (MRC) could be a useful diagnosis technique, especially because it is non-invasive. MATERIAL AND METHODS: We prospectively studied 26 adult patients with cystic fibrosis. Of these, 11 had liver disease previously diagnosed on the basis of symptomatology, physical examination, liver function tests and abdominal ultrasound (group A) and 15 had no apparent liver disease (group B). In all patients liver function tests, abdominal ultrasound and MRC using 1.5 Teslas General Electric and Siemens systems were carried out. The images were interpreted blind by two radiologists with experience in the interpretation of biliary alterations in cystic fibrosis. RESULT: In 6 of the 11 patients in group A, MRC showed signs of liver cirrhosis (nodularity, irregular surface, splenomegaly, varicosity); 4 patients showed rose-colored images in the choledoch and intrahepatic ducts; of the 5 patients with previous non-cirrhotic liver disease, 2 showed rose-colored intrahepatic ducts, 2 showed dilatation of the intrahepatic ducts and 1 showed hepatosplenomegaly with hepatic steatosis. Of the 15 patients in group B, bile duct anomalies were found in 5. Of these, 3 showed rose-colored images of the hepatic ducts and/or choledoch, 1 showed stenosis of the common hepatic duct with rigidity of the intrahepatic ducts and 1 showed irregularities in the caliber of the intrahepatic ducts without dilatation, which were suspicious for intrahepatic lithiasis. CONCLUSIONS: MRC is a useful technique in the study of hepatobiliary disease in cystic fibrosis because it detected anomalies in all our patients previously diagnosed with liver disease and revealed ductal lesions not revealed by other non-invasive techniques.

New black blood pulse sequence for studies of the heart.

The black blood concept is based on the signal void principle of the sequences in Spin Echo, SE or FSE, which are very useful for studying the mediastinum and heart. In this setting, new sequences are continuously introduced to eliminate the artifacts caused by breathing and heart movements. One such sequence is the Double-IR preparation Black Blood FSE. We report our experience in 97 patients, using this new pulse sequence to evaluate cardiac pathology, and establish comparisons with the conventional Spin Echo sequences. The study comprises mediastinal disease and aorta and heart explorations. We consider this new Double-IR preparation FSE sequence to be an excellent choice for evaluating chest, mediastinal and cardiac images. The sequence offers improved spatial resolution of both the vessels and other chest structures with respect to conventional Spin Echo imaging. With the exception of patients presenting severe heart problems, or in the presence of intense bradycardia, the required 16 cycles in apnea are well tolerated. The purpose of the present study is to present our initial results with this new pulse sequence as applied to cardiac pathology, in comparison with conventional Spin Echo imaging.

Pathogenesis of anterior knee pain syndrome and functional patellofemoral instability in the active young.

Although it is universally accepted that patellofemoral malalignment is the main cause of anterior knee pain and functional patellar instability in the active young, the question remains to be answered: what is the mechanism whereby patellofemoral malalignment produces pain and instability? Currently, there are two theories to explain the origin of pain and instability in patients with patellofemoral malalignment: the neural theory and the mechanical theory. Both theories are not exclusive, but complementary. We believe it is the neural factor that precipitates the symptoms in patients with certain mechanical anomalies who also subject the knee to overuse.

[Computerized tomography in the detection of metastatic cervical lymph nodes]. / Tomografía computarizada en la detección de adenopatías cervicales metastásicas.

The accuracy of computed tomography (CT) in detecting cervical lymph node metastases was studied. Twenty patients with squamous carcinoma of the head and neck were selected. The results obtained by cervical palpation, CT and postoperative histological study were compared. Palpation had a sensitivity of 64% and specificity of 100%. CT had a sensitivity of 71% and specificity of 100%. The small gain in sensitivity does not justify the systematic use of CT to study cervical lymph nodes in head and neck squamous carcinoma.

[Acute pancreatitis and acquired immunodeficiency syndrome]. / Pancreatitis aguda y síndrome de inmunodeficiencia adquirida.

Viral acute pancreatitis in Human Immunodeficiency Virus (HIV) infected patients has been occasionally described. We studied nine patients with HIV antibodies and acute pancreatitis attributed to Cytomegalovirus and/or Cryptosporidium infection. In four patients the clinical picture was consistent with acute pancreatitis while in five clinical manifestations were unspecific, and diagnosis was based on ultrasonography and/or computed tomography findings. In the HIV infected patient pancreatic evaluation by imaging techniques may disclose acute pancreatitis even in the absence of abdominal pain.

Retention cysts of the rhinopharynx. A case report.

Cystic lesions of the rhinopharynx are infrequent and their differential diagnosis poses problems. A patient with a large lateral retention cyst of the rhinopharynx is described in which differential diagnosis with a cyst of the second branchial arch was considered. Magnetic resonance imaging showed a very characteristic image and proved more specific than computed tomography. Histopathological study of the surgical specimen established the diagnosis by revealing a cyst enclosed by a non-keratinized squamous epithelium.

[The diagnosis of aorticomesenteric duodenal compression by magnetic resonance angiography]. / Diagnóstico de la compresión duodenal aorto-mesentérica mediante angiografía por resonancia magnética.

The syndrome of duodenal obstruction by the mesenteric artery is an infrequent condition that nevertheless was too often diagnosed in the past. The development of modern imaging techniques has presently restricted the diagnosis of this syndrome. We report the case of a 21-year-old patient with superior mesenteric artery-induced duodenal compression syndrome secondary to malnutrition and loss of weight. Diagnosis was confirmed by the evaluation of bowel transit, CT Scan, NMR and angio-MR. Conservative treatment with total parenteral nutrition proved ineffective. Surgical sectioning of the ligament of Treitz and extensive mobilization of the duodenum (Strong's operation) was performed; outcome was unsatisfactory, however. A duodenojejunostomy was performed later, which finally solved the condition. We emphasize the diagnostic usefulness of CT Scan and angio-MR, and the favorable results afforded by duodenojejunostomy.