[Treating iatrogenic pneumothorax with small-bore chest tube]. / Drenaje de neumotórax iatrogénico con catéter de calibre pequeño.

OBJECTIVE: To evaluate the feasibility of small-bore chest tube placement to treat pneumothorax caused by percutaneous procedures. MATERIAL AND METHODS: Between November 2004 and July 2006 we performed 151 interventional chest procedures (127 biopsies and 24 radiofrequency ablations) in 131 patients (25 women and 106 men; mean age, 63 years, range, 36-83 years). Fine needles (21-25 G) were used in 70 procedures and large core needles (14-20 G) were used in the remaining 81. Pneumothorax occurred in 16 diagnostic procedures (13 of these were treated with small-bore catheter placement) and in two radiofrequency procedures (both cases were treated with small-bore catheter placement). Chest tubes were placed immediately after pneumothorax occurred in all cases because the pneumothorax was greater than 20% or caused symptoms or occurred in patients with emphysema. RESULTS: Chest tubes were successfully placed without incidents in all cases and a Heimlich valve evacuated the air completely. Mean hospital stay was 43 hours (range, 24-72 hours). It was not necessary to place a larger-bore chest tube in any case. CONCLUSION: Small-bore chest tube placement is the treatment of choice for iatrogenic pneumothorax greater than 20% or less than 20% when symptomatic or occurring in patients with emphysema. The procedure is easy, effective, and well tolerated; furthermore, it shortens the hospital stay. The effectiveness of the procedure makes it possible to safely perform percutaneous procedures on patients with emphysema or difficult lesions and to finish an interventional procedure when pneumothorax occurs.

Drenaje de neumotórax iatrogénico con catéter de calibre pequeño / Treating iatrogenic pneumothorax with small-bore chest tube

Objetivo: evaluar la utilidad del drenaje de neumotórax con catéter de calibre pequeño tras la punción de lesiones torácicas. Material y métodos: desde noviembre de 2004 hasta julio de 2006 se realizaron 151 punciones torácicas en 131 pacientes (106 varones y 25 mujeres) con una media de edad de 63 años (36-83 años). Con fines diagnósticos se hicieron 127 punciones y los restantes 24 fueron tratamientos de termocoagulación con radiofrecuencia (RF). Se realizaron 70 punciones con aguja fina (21-25G) y 81 con aguja gruesa (14-20G). En los procedimientos diagnósticos se produjeron 16 neumotórax y se drenaron 13, y en los de RF hubo 2 neumotórax, y se drenaron ambos. El drenaje en todos los casos se realizó inmediatamente después de producirse, porque eran 20 % o presentaban síntomas, o siendo 20 % eran pacientes con enfisema. Resultados: en todos los pacientes pudo colocarse el catéter de drenaje sin incidencias, resolviendo el neumotórax con una válvula de Heimlich. El tiempo máximo de ingreso fue de 72 h, con una media de 43 h. En ningún caso se precisó colocar posteriormente un catéter de mayor calibre. Conclusión: el drenaje de neumotórax con catéter de calibre pequeño tras un procedimiento intervencionista torácico, es la técnica de elección cuando un neumotórax es 20 %, o el paciente está sintomático o tiene enfisema, porque su colocación no es difícil, es resolutivo, bien tolerado y acorta la estancia hospitalaria. Su resolución rápida permite puncionar pacientes con enfisema o lesiones difíciles con mayor seguridad y posibilita finalizar un procedimiento intervencionista si durante su realización se produce el neumotórax (AU)

Objective: to evaluate the feasibility of small-bore chest tube placement to treat pneumothorax caused by percutaneous procedures. Material and methods: between November 2004 and July 2006 we performed 151 interventional chest procedures (127 biopsies and 24 radiofrequency ablations) in 131 patients (25 women and 106 men; mean age, 63 years, range, 36-83 years). Fine needles (21-25 G) were used in 70 procedures and large core needles (14-20G) were used in the remaining 81. Pneumothorax occurred in 16 diagnostic procedures (13 of these were treated with small-bore catheter placement) and in two radiofrequency procedures (both cases were treated with small-bore catheter placement). Chest tubes were placed immediately after pneumothorax occurred in all cases because the pneumothorax was greater than 20 % or caused symptoms or occurred in patients with emphysema. Results: chest tubes were successfully placed without incidents in all cases and a Heimlich valve evacuated the air completely. Mean hospital stay was 43 hours (range, 24-72 hours). It was not necessary to place a larger-bore chest tube in any case. Conclusion: small-bore chest tube placement is the treatment of choice for iatrogenic pneumothorax greater than 20 % or less than 20 % when symptomatic or occurring in patients with emphysema. The procedure is easy, effective, and well tolerated; furthermore, it shortens the hospital stay. The effectiveness of the procedure makes it possible to safely perform percutaneous procedures on patients with emphysema or difficult lesions and to finish an interventional procedure when pneumothorax occurs (AU)

Evaluación de la arteriopatía de los miembros inferiores por tomografía computarizada multidetector comparada con la angiografía por sustracción digital / The evaluation of lower limb arteriopathy by multidetector computed tomography compared with digital subtraction angiography

Objetivos. Evaluar la eficacia diagnóstica de la angiografía por tomografía computarizada multidetector (ATCM) en la arteriopatía de miembros inferiores (MMII), comparándola con angiografía por sustracción digital (ASD). Material y métodos. Se estudiaron 24 pacientes con arteriopatía de MMII. Se realizaron ATCM (4 detectores) y ADS realizando doble lectura entre las dos técnicas. Los territorios vasculares se dividieron para facilitar el análisis. Se calcularon sensibilidad (S), especificidad (E), prevalencia, valor predictivo positivo y negativo (VPP, VPN) y concordancia (test de Kappa). En arterias de tercera porción se estudió el rendimiento diagnóstico del ATCM realizando una curva ROC. Resultados. El estudio ATCM para la evaluación de la patología arterial mostró: una S menor en el estudio de la arteria ilíaca primitiva y arteria ilíaca interna (S: 0,65 y 0,71) con E de 0,94 y de 1; en los demás territorios vasculares obtuvimos S próximas a 1, disminuyendo algo la E. La concordancia fue muy alta (kappa entre 0,62 y 1) en todos los territorios estudiados. La ATCM mostró más longitud de vaso que la ASD. En la tercera porción el mejor rendimiento diagnóstico (ROC) se obtuvo en la lectura de vasos patológicos. Conclusión. La ATCM presentó alta fiabilidad en el estudio de la arteriopatía de MMII, con alta concordancia respecto a la ASD. En vasos tortuosos la ATCM visualiza mal las lesiones, en cambio en vasos rectos y en tercera porción el estudio con ATCM visualiza más segmentos vasculares

Objectives. To evaluate the diagnostic efficacy of multidetector computed tomography angiography (MDCTA) in lower limb arteriopathy (LLA) by comparing it with digital subtraction angiography (DSA). Material and methods. Twenty-four patients with LLA were studied. All patients underwent MDCTA (four detectors) and DSA, with double reading between the two techniques. Vascular territories were divided to facilitate analysis. Sensitivity (S), specificity (Sp), prevalence, positive and negative predictive values (PPV, PNV), and concordance (Kappa test) were evaluated. In third-portion arteries, the diagnostic performance of MDCTA was evaluated using an ROC curve. Results. MDCTA study to evaluate arterial pathology showed: Lower sensitivity in the study of the internal iliac artery (S: 0.65 and 0.71) with Sp 0.94 and 1. In the other vascular territories, S approached 1, with a slight decrease in Sp. Concordance with DSA was very high (kappa between 0.62 and 1) in all of the territories studied. MDCTA showed greater vessel longitude than DSA. In the third portion, the best diagnostic performance (ROC) was obtained in the reading of pathological vessels. Conclusion. MDCTA was highly reliable in the study of LLA, with high concordance with DSA. In tortuous vessels, MDCTA depicted the lesions poorly; however, in straight vessels and third-portion vessels, MDCTA showed more vascular segments

[The evaluation of lower limb arteriopathy by multidetector computed tomography compared with digital subtraction angiography]. / Evaluación de la arteriopatía de los miembros inferiores por tomografía computarizada multidetector comparada con la angiografía por sustracción digital.

OBJECTIVE: To evaluate the diagnostic efficacy of multidetector computed tomography angiography (MDCTA) in lower limb arteriopathy (LLA) by comparing it with digital subtraction angiography (DSA). MATERIAL AND METHODS: Twenty-four patients with LLA were studied. All patients underwent MDCTA (four detectors) and DSA, with double reading between the two techniques. Vascular territories were divided to facilitate analysis. Sensitivity (S), specificity (Sp), prevalence, positive and negative predictive values (PPV, PNV), and concordance (Kappa test) were evaluated. In third-portion arteries, the diagnostic performance of MDCTA was evaluated using an ROC curve. RESULTS: MDCTA study to evaluate arterial pathology showed: Lower sensitivity in the study of the internal iliac artery (S: 0.65 and 0.71) with Sp 0.94 and 1. In the other vascular territories, S approached 1, with a slight decrease in Sp. Concordance with DSA was very high (kappa between 0.62 and 1) in all of the territories studied. MDCTA showed greater vessel longitude than DSA. In the third portion, the best diagnostic performance (ROC) was obtained in the reading of pathological vessels. CONCLUSION: MDCTA was highly reliable in the study of LLA, with high concordance with DSA. In tortuous vessels, MDCTA depicted the lesions poorly; however, in straight vessels and third-portion vessels, MDCTA showed more vascular segments.