[Magnetic resonance diagnosis of ankylosing spondylitis and evaluation of the response to treatment]. / Diagnóstico y valoración de la respuesta al tratamiento mediante resonancia magnética en la espondilitis anquilosante.

OBJECTIVE: To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment. MATERIAL AND METHODS: We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumab treatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection. RESULTS: Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreased ASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvement was seen in three. CONCLUSIONS: MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective.

Diagnóstico y valoración de la respuesta al tratamiento mediante resonancia magnética en la espondilitis anquilosante / Magnetic resonance diagnosis of ankylosing spondylitis and evaluation of the response to treatment

Objetivo. Mostrar el papel de la resonancia magnética en el diagnóstico precoz de la espondilitis anquilosante y su posible utilidad en la valoración de la respuesta al tratamiento.Material y métodos. Se describen los hallazgos en resonancia magnética (secuencias STIR y T1 con contraste paramagnético) en 13 pacientes diagnosticados de espondilitis anquilosante que reciben tratamiento con adalimumab. Se realiza una resonancia magnética basal al comienzo del estudio y otra a los seis meses, describiendo los hallazgos obtenidos y valorando cuantitativamente la afectación vertebral (con el sistema de puntuación ASspiMRI-a), la afectación sacroilíaca y de la articulación coxofemoral.Resultados. La afectación inflamatoria se demostró en 12 pacientes en forma de hiperintensidad de señal en STIR y captación de contraste en secuencias T1. Tras la administración del tratamiento 12 pacientes mostraron una disminución de la puntuación ASspiMRIa, y una menor afectación en ASI y coxofemorales. En el paciente restante la puntuación no se modificó. Dos pacientes presentaban afectación de elementos posteriores vertebrales y en tres pacientes se apreció afectación discal.Conclusiones. La resonancia magnética abre nuevas posibilidades para el manejo de los pacientes con espondilitis anquilosante. Por un lado, permite el diagnóstico precoz, ahorrando al paciente años de tratamientos de prueba y ahorrando al sistema sanitario el coste de múltiples pruebas diagnósticas para intentar explicar los síntomas que presentan dichos enfermos. Por otro lado, permite una valoración rápida y objetiva de la respuesta al tratamiento, por lo que el paso a un nuevo escalón terapéutico más agresivo se podrá realizar con mayor celeridad, evitando tratamientos poco efectivos

Objective. To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment.Material and methods. We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumabtreatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection.Results. Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreasedASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvementwas seen in three.Conclusions. MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective

[Acute liver failure in a hospital with a liver transplantation program]. / Fallo hepático agudo en un hospital con programa de trasplante hepático.

INTRODUCTION: Acute hepatic failure (AHF) is an uncommon entity but with high mortality. Liver transplantation has improved prognosis but is an aggressive treatment with high risk. Currently, there are no accurate criteria to differentiate between irreversible AHF and the possibility of hepatic regeneration. The aim of this study is to review the clinical characteristics indicating transplantation and the outcome of AHF in patients at our institution. PATIENTS AND METHOD: Descriptive and retrospective study of cases of AHF at our institution in the last 3 years. RESULTS: Eleven patients were studied. Mortality was lower in transplant recipients (23%; 2 out of 8) than in non-transplanted patients (67%; 2 out 3). Hepatic regeneration occurred in one patient. Overall mortality was 36% with a perioperative mortality of 13%. CONCLUSION: The indication of hepatic transplantation in patients with a poor prognosis, early stage acute liver failure, and a low grade of encephalopathy, and prior to the development of multiorgan failure could improve the results of transplantation and reduce perioperative mortality.