Trombosis venosa ovárica bilateral idiopática / Idiopathic bilateral ovarian vein thrombosis

La trombosis de la vena ovárica es una afección poco frecuente asociada a estados de hipercoagulabilidad, generalmente en el período puerperal. Presentamos un caso de trombosis bilateral idiopática de la vena ovárica en una mujer con dolor abdominal bajo (AU)

Ovarian vein thrombosis is an uncommon condition associated with hypercoagulatedstatus, generally in the puerperal period. We report a case of idiopathic bilateral ovarian veinthrombosis in a woman with lower abdominal pain (AU)

[Arteriographic correlation in 30 patients with renal vascular disease diagnosed with multislice CT]. / Correlación arteriográfica en 30 pacientes con patología vascular renal diagnosticada mediante TC multicorte.

OBJECTIVE: To determine the usefulness of multislice computed tomography (MSCT) in the evaluation of renal vascular disease against a gold standard of digital subtraction angiography (DSA). MATERIAL AND METHODS: We evaluated 30 patients with arterial hypertension and/or kidney failure that underwent MSCT to rule out a vascular cause and DSA to confirm a vascular cause suspected at MSCT. MSCT examinations were performed on a 10-detector scanner with intravenous administration of 80 ml of iodinated contrast (300 mg iodine/ml) at a flow rate of 5 ml/s. A total of 71 renal arteries, 56 main and 15 accessory, were evaluated. Arterial stenoses were classified as: grade 0 (normal artery), grade I (stenosis < 50%), grade II (> or = 50% and < 70%), grade III (> or = 70%), grade IV (occlusion). Stenosis > or = grade II was considered hemodynamically significant. RESULTS: The findings at MSCT and DSA were identical in 56 (78.8%) renal arteries; MSCT overestimated the degree of stenosis in 13 (18.3%) cases. All grade III stenoses were detected at MSCT. In the diagnosis of hemodynamically significant stenosis, MSCT had a sensitivity of 96.5%, specificity 78.5%, accuracy 85.9%, positive predictive value 75.6%, and negative predictive value 97%. CONCLUSIONS: MSCT is a good noninvasive imaging technique for the evaluation of renal vessels; it is useful for screening patients with kidney disease to rule out potentially treatable vascular causes.

Massive reversible pulmonary cysts in a patient with AIDS.

We report the case of a patient with AIDS who presented with bilateral, massive pulmonary cystic disease and pneumothorax presumably caused by Pneumocystis carinii which responded to treatment with cotrimoxazole. Follow-up with sequential chest X-rays and computed tomography scans showed a progressive improvement in the lung cysts which had resolved almost completely 11 months later. Several theories have been proposed to explain the cavitary lesions in this infection. The course observed in our patient suggests that a non-destructive mechanism was responsible for his lung cysts.

[The gammagraphic diagnosis of acute pulmonary thromboembolism]. / Diagnóstico gammagráfico del tromboembolismo pulmonar agudo.

We aimed to determine the prevalence of acute pulmonary embolism (APE) in our population and to establish the diagnostic reliability of pulmonary scintigraphy (PS), as well as the influence of the clinical context (CC). During a 2-year prospective study, patients were diagnosed by either pulmonary angiography or normal-perfusion PS. A diagnosis of APE was made in 73 (75%) of a total of 97 patients. In the group of 58 patients diagnosed by ventilation/perfusion (V/Q) PS, 33 were classified as "highly probably" having APE; 32 of these in fact had the syndrome (sensitivity 88%, specificity 94%). Combining the "highly probable" patients with the "highly suspected" patients diagnosed by ventilation/perfusion PS, we obtained a sensitivity of 51% and specificity of 100%. Ventilation scintigrams were unobtainable in 28 older patients with greater dyspnea and tachypnea, who were unable to perform the maneuvers. Of the 21 "highly probable" patients as assessed by PS, 19 were diagnosed as having APE (sensitivity 86%, specificity 85%). Combining the "highly probable" patients with the "highly suspected" group, we obtained a sensitivity of 32% and specificity of 100%. Normal perfusion PS excludes clinically relevant APE. "Intermediate" or "slight" probability PS results, even when combined with CC, have no diagnostic validity.

[Pyogenic liver abscess. Study of 20 patients treated with percutaneous drainage]. / Abscesos hepáticos piógenos. Estudio de 20 pacientes tratados mediante drenaje percutáneo.

We conducted a descriptive study of pyogenous hepatic abscesses (PHA) and their treatment with percutaneous drainage and antibiotherapy in the general hospital of Galdácano between 1989 and 1992. We assessed prevalence, clinical characteristics, responses to treatment, evolution and complications. We studied 20 PHAs in adults confirmed through puncture guided with echography and/or computerized tomography. We considered as causal germs those isolated in the abscess and/or hemocultures. All the patients were treated with catheter drainage and antibiotics. After discharge, follow-up and regular TC controls were performed at least for 6 months. The average age of the patients was 56 +/- 3 years and the men/women rate was 2.5:1. The most frequent origin of the infection was cholecystitis/cholangitis in 50% of patients and hydatidic cysts in 20%. Twelve patients had isolated abscess and 8 patients, multiple abscesses. The diagnostic sensitivity was 95% for the echography and 100% for CAT. The most frequent germs were E. Coli, Streptococcus, K. pneumoniae and Salmonella spp. In three cases, it was not possible to bacteriologically identified the germ. After drainage, the abscesses disappeared in 16 patients. The average duration of percutaneous drainage was 10 days. Three patients required surgery after drainage due to complications or incomplete drainage; two other patients required extirpation of hydatidic cysts. The mortality rate was 10%, although it was not related to PHA. We did not observe any differences between isolated or multiple abscesses with regard to prognosis. The drainage guided by echography and/or CT, associated to antibiotic therapy, is a successful technique for the treatment of PHAs in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psoas abscess. The diagnostic and therapeutic considerations in 5 patients]. / Absceso de psoas. Consideraciones diagnósticas y terapéuticas en cinco pacientes.

Five cases of psoas abscesses are discussed, four pyogenes and one tuberculous, the current etiology of this process, together with its pathogenesis and clinical manifestations are discussed. In all of them the guided punction through Computerized Axial Tomography (CAT) has been the way to diagnose and treat the process. Utility of this technique considering both aspects is discussed because it allows to determine the etiology and avoids the surgical drainage; even tough this therapy should be individualized in each case, probably is in primary staphylococci abscesses where this therapeutic option is best indicated.