Cambios hemodinámicos posligadura con bandas de varices esofágicas: un estudio de cohortes / No disponible

INTRODUCCIÓN: existe controversia sobre la necesidad de mantener el tratamiento vasoconstrictor tras lograr una adecuada hemostasia mediante ligadura endoscópica, en la hemorragia aguda por varices esofágicas. Dado que es muy complejo hacer un gradiente "pre y posligadura urgente" en el sangrante por varices, nuestro objetivo es conocer las variaciones hemodinámicas tras la terapia endoscópica, midiendo un gradiente venoso hepático "pre" y otro 24 horas "posprocedimiento" en los cirróticos con ligadura programada como profilaxis de la hemorragia varicosa. MATERIAL Y MÉTODOS: estudio prospectivo, de cohorte, unicéntrico. Los pacientes, en protocolo de erradicación endoscópica, fueron sometidos a un gradiente de presión venosa hepática basal (GPVH PRE), sin modificar su tratamiento habitual con beta-bloqueantes. Después, se procedió a ligadura endoscópica, según guías de práctica clínica. Tras 24 horas del procedimiento, se realizó una segunda medida de presiones (GPVH POST). RESULTADOS: 30 pacientes. Las medianas de los GPVH PRE y POST ligadura fueron 16,5 mmHg (14-20) y 19,5 mmHg (17-21) respectivamente, con un aumento significativo tras el procedimiento (p < 0,001). Las variaciones porcentuales de presión portal, según cifra de gradiente basal (12, 16 y 20 mmHg), eran mayores en pacientes con menor GVPH frente a mayor GPVH basal en cualquiera de las categorías comparadas (p = 0,087, p = 0,016 y p < 0,001, respectivamente). En nuestra serie, el 36,7 % de los pacientes presentó un incremento de gradiente ≥ 20 % tras la ligadura. CONCLUSIÓN: la ligadura con bandas de varices esofágicas condiciona un aumento de presión portal, al menos transitorio, objetivado mediante gradiente de presión venosa hepática

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Hemodynamic changes after endoscopic variceal ligation: a cohort study.

BACKGROUND: there is controversy about the need to maintain vasoconstrictor treatment after adequate haemostasis is achieved through endoscopic band ligation (EBL) in bleeding esophageal varices (BEV). Measuring a "before and after urgent-EBL" hepatic venous pressure gradient (HVPG) in acute variceal hemorrhage is very difficult. Thus, the goal of this study was to determine hemodynamic variations after an EBL session. A "before" HVPG (PRE) was performed and another one 24 hours "after-ligation" (POST), in cirrhotic patients undergoing endoscopic band ligation as BEV prophylaxis. PATIENTS AND METHODS: this was a single-center, cohort, prospective study. Patients followed a program of repeated sessions of EBL until eradication of their varices and underwent a basal hepatic venous pressure gradient (PRE HVPG), without changing their usual treatment with beta-blockers. Subsequently, an endoscopic ligation session was performed, following the clinical practices guidelines. A second pressure measurement (POST HVPG) was taken 24 hours after the endoscopic treatment. RESULTS: 30 patients were included. PRE and POST HVPG median results were 16.5 mmHg (14-20) and 19.5 mmHg (17-21), respectively, with a significant increase after the procedure (p < 0.001). Percentage variations in portal pressure, based on the baseline gradient values (12, 16 and 20 mmHg), were higher for patients with a lower basal HVPG versus a higher HVPG for any of the categories compared (p = 0.087, p = 0.016 and p < 0.001, respectively). In our series, 36.7 % of patients showed a ≥ 20 % gradient increase after ligation. CONCLUSION: endoscopic band ligation causes an increase in portal pressure, at least for a transitional period, determined by the hepatic venous pressure gradient.

Cement fragment from hip arthroplasty causing deep femoral artery pseudoaneurysm.

An 81-year-old woman who had undergone total hip arthroplasty 12 years earlier presented with a painful spontaneous hematoma in the proximal left thigh. A left hip radiograph showed a displaced cement fragment from the acetabular component of the hip prosthesis. Computed tomography confirmed an extruded cement fragment causing a large pseudoaneurysm of the deep femoral artery. The patient underwent successful percutaneous embolization of the pseudoaneurysm with coils.

Realce vertebral secundario a congestión venosa en paciente con trombosis de la vena innominada: una causa de falsas metástasis óseas escleróticas / Vertebral Enhancement due to Venous Congestion in a Patient with Innominate Venous Thrombosis: A Cause of False Sclerotic Bone Metastases

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CT and MR Unilateral Brain Features Secondary to Nonketotic Hyperglycemia Presenting as Hemichorea-Hemiballism.

Hemichorea-hemiballism is an unusual hyperkinetic movement disorder characterized by continuous involuntary movements of an entire limb or both limbs on one side of the body. The acute onset of this disorder occurs with an insult in contralateral basal ganglia. Ischemic events represent the most common cause. Nonketotic hyperglycemia comes in second place. Nonketotic hyperglycemic hemichorea-hemiballism (NHH) is a rare cause of unilateral brain abnormalities on imaging studies confined to basal ganglia (mainly putaminal region as well as caudate nucleus). Subtle hyperdensity in striatal region can be found on CT studies whereas brain MR imaging typically shows T1 hyperintensity and T2 hypointensity in the basal ganglia contralateral to the movements. Diagnosis is based on both glucose levels and neuroimaging findings. Elevated blood glucose and hemoglobin A1c levels occur with poorly controlled diabetes. In this case report, our aim is to present neuroimaging CT and MR unilateral findings in an elderly woman secondary to nonketotic hyperglycemia presenting as hemichorea-hemiballism.

Hallazgos radiológicos de la neumonía lipoidea exógena en pacientes laringectomizados / Exogenous Lipoid Pneumonia in Laryngectomy Patients: Radiological Findings

La neumonía lipoidea exógena (NLE) es una patología inusual (incidencia del 1-2,5%), frecuentemente infradiagnosticada, causada por la aspiración y la acumulación de lípidos de origen exógeno dentro de los alvéolos pulmonares. Se han descrito casos por inhalación de lubricantes en fosas nasales y orofaringe, aspiración de aceites minerales contenidos en laxantes en pacientes con trastornos alimentarios, aplicación de brillo de labios, exposición profesional a parafina líquida o aceites minerales («comedores de fuego», uso industrial en lavado de maquinaria, talleres de automóviles, pinturas plásticas, etc.) y aplicación de vaselina en la inserción de sondas nasogástricas y en el cuidado de traqueotomías en pacientes traqueotomizados. Radiológicamente la NLE suele presentarse como consolidaciones peribronquiales de baja atenuación y opacidades en vidrio deslustrado con una distribución preferentemente bibasal. Presentamos 5 casos de pacientes laringectomizados de larga evolución con diagnóstico de NLE que admitían el uso de vaselina en el cuidado del estoma traqueal

Exogenous lipoid pneumonia (ELP) is a rare (incidence 1.0%-2.5%), often under-diagnosed disease, caused by the aspiration and accumulation of exogenous lipids within the pulmonary alveoli. Various cases have beendescribeddue to inhalationoflubricants via thenasalpassages andoropharynx, aspirationofmineral oils in laxatives in patients with eating disorders, application of lip gloss, occupational exposure to liquid paraffin or mineral oils ('fire-eaters', industrial use in washing of machinery, automobile workshops, plastic paints, etc.) and application of Vaseline during the insertion of nasogastric tubes and in the care of tracheotomy patients. ELP usually presents radiologically as areas of low-attenuation peribronchial consolidation and ground glass opacities, with a predominantly bibasal distribution. We present 5 cases of long-standing laryngectomy patients diagnosed with ELP who admitted using Vaseline in their tracheal stoma care

Tuberculosis of the manubriosternal joint and concurrent asymptomatic active pulmonary tuberculosis in a patient presenting with a chest wall mass.

A 62-year-old woman presented to our hospital with an anterior chest wall swelling. Computed tomography (CT) and magnetic resonance imaging showed findings consistent with an infectious arthritis of the manubriosternal joint, and CT images also demonstrated multiple centrilobular nodules in both lungs, suggesting an infectious bronchiolitis. A CT-guided fine needle aspiration of a presternal mass yielded growth of Mycobacterium tuberculosis. Bronchoalveolar lavage confirmed an active pulmonary tuberculosis. Septic arthritis of the manubriosternal joint is exceedingly rare.

Exogenous Lipoid Pneumonia in Laryngectomy Patients: Radiological Findings.

Exogenous lipoid pneumonia (ELP) is a rare (incidence 1.0%-2.5%), often under-diagnosed disease, caused by the aspiration and accumulation of exogenous lipids within the pulmonary alveoli. Various cases have been described due to inhalation of lubricants via the nasal passages and oropharynx, aspiration of mineral oils in laxatives in patients with eating disorders, application of lip gloss, occupational exposure to liquid paraffin or mineral oils ("fire-eaters", industrial use in washing of machinery, automobile workshops, plastic paints, etc.) and application of Vaseline during the insertion of nasogastric tubes and in the care of tracheotomy patients. ELP usually presents radiologically as areas of low-attenuation peribronchial consolidation and ground glass opacities, with a predominantly bibasal distribution. We present 5 cases of long-standing laryngectomy patients diagnosed with ELP who admitted using Vaseline in their tracheal stoma care.