Analysis of invasive diagnostic techniques for pathological confirmation of pleural mesothelioma.

BACKGROUND AND OBJECTIVES: Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography. MATERIALS AND METHODS: Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis. RESULTS: Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%. CONCLUSIONS: In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.

[Nephrotoxicity due to iodine contrasts in computerized tomography studies of diabetic outpatients on metformin]. / Nefrotoxicidad por contrastes yodados en estudios de tomografía computarizada a pacientes ambulatoriso diabéticos en tratamiento con metformina.

BACKGROUND: To determine the incidence of contrast-induced nephropathy (CIN) among diabetic patients treated with Metformin who underwent computerized tomography (CT) scan with iodinated contrast media. METHODS: Prospective study of diabetic patients enrolled in a lactic acidosis prevention protocol in whom clinical and analytical follow up after CT scan with intravenous contrast was performed. RESULTS: In this study, 98 cases were collected. The incidence of CIN in diabetic patients without prior renal failure was 0%. In patients with previous renal failure the incidence of CIN was 4.7%. CONCLUSIONS: The risk of CIN in diabetic patients with no renal failure undergoing intravenous contrast administration is minimal. Recommendations to stop Metformin to avoid lactic acidosis in patients undergoing intravenous contrast administration may be restricted to patients with abnormal renal function.

Nefrotoxicidad por contrastes yodados en estudios de tomografía computarizada a pacientes ambulatorios diabéticos en tratamiento con metformina / Nephrotoxicity due to iodine contrasts in computerized tomography studies of diabetic outpatients on metformin

Fundamento. Determinar la incidencia de nefropatía inducida por contraste (NIC) en un grupo de pacientes diabéticos en tratamiento con metformina a los que se realiza un estudio de tomografía computarizada (TC)con contraste yodado intravenoso (civ). Material y Métodos. Estudio prospectivo de pacientes diabéticos incluidos en el protocolo para la prevención de la acidosis láctica a los que se hace seguimiento clínico y analítico tras la realización de una TC con civ. Resultados. Se recogieron 98 casos. En los pacientes sin insuficiencia renal previa la incidencia de NIC es del 0%. En los pacientes con insuficiencia renal previa la incidencia de NIC es del 4,7%. Conclusiones. El riesgo de NIC en pacientes diabéticos sin insuficiencia renal a los que se administra contraste yodado es mínimo. Las recomendaciones de retirar la metformina para evitar la acidosis láctica en pacientes a los que se administra civ se podría limitar a los pacientes con alteración de la función renal (AU)

Background. To determine the incidence of contrast induced nephropathy (CIN) among diabetic patients treated with Metformin who underwent computerized tomography (CT) scan with iodinated contrast media. Methods. Prospective study of diabetic patients enrolled in a lactic acidosis prevention protocol in whom clinical and analytical follow up after CT scan with intravenous contrast was performed. Results. In this study, 98 cases were collected. The incidence of CIN in diabetic patients without prior renal failure was 0%. In patients with previous renal failure the incidence of CIN was 4.7%. Conclusions. The risk of CIN in diabetic patients with no renal failure undergoing intravenous contrast administration is minimal. Recommendations to stop Metformin to avoid lactic acidosis in patients undergoing intravenous contrast administration may be restricted to patients with abnormal renal function (AU)

Realización de TAC flebografía indirecta en pacientes con sospecha clínica de tromboembolismo pulmonar: nuestra experiencia y posibles indicaciones de esta prueba / Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test

Objetivo. Nuestro objetivo es valorar la sensibilidad de la tomografía axial computarizada (TAC) flebografía indirecta para la valoración de trombosis venosa profunda, y establecer posibles indicaciones generales de esta técnica en los casos de sospecha de enfermedad tromboembólica. Material y métodos. Se estudian 76 casos con sospecha clínica de tromboembolismo pulmonar a los que se realizó angio-TAC de arterias pulmonares y TAC flebografía indirecta. Se correlacionan los hallazgos con ecografía de extremidades en 63 casos para determinar la sensibilidad de la prueba. Se analizan los casos en los que los hallazgos de la TAC flebografía indirecta variaron el manejo de los pacientes. Resultados. La concordancia con la ecografía fue del 92%. Se hizo el diagnóstico de enfermedad tromboembólica en el 40% de los casos. De ellos, la angio-TAC de arterias pulmonares fue positivo en el 80% de los casos y en el 20% restante sólo fue positiva la TAC flebografía. En 2 casos se objetivó en el estudio abdominal patología que varió el manejo clínico de los pacientes. Conclusiones. La TAC flebografía indirecta es una técnica sensible para la detección de trombosis venosa profunda en los casos de pacientes con sospecha clínica de tromboembolismo pulmonar. Puede acortar el tiempo diagnóstico, aumentar la exactitud diagnóstica y aportar otros datos clínicos que pueden ser importantes para el manejo de los pacientes. Su uso generalizado se ve limitado porque implica el uso de radiaciones ionizantes

Objective. Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease. Material and methods. We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient. Results. The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found. Conclusions. Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation

[Childhood cholelithiasis in a district hospital]. / Colelitiasis en la infancia en un Hospital de Area.

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.

Colelitiasis en la infancia en un Hospital de Área / Childhood cholelithiasis in a district hospital

Aunque la colelitiasis es un hallazgo infrecuente en niños, series recientes muestran un aumento en la frecuencia de detección de la misma. En el Hospital Reina Sofía de Tudela, se ha efectuado un estudio retrospectivo en niños diagnosticados de colelitiasis entre los años 1993 y 2005. Se detectaron 18 casos de colelitiasis y 3 casos de barro biliar. Entre los factores predisponentes de colelitiasis en este estudio encontramos prematuridad y nutrición parenteral (1), sepsis (2), obesidad (1), historia familiar de colelitiasis (1) e idiopáticos (11). A 2 pacientes que acudieron al hospital con clínica apendicular, se les detectaron litiasis biliares. Un individuo con barro biliar presentó como antecedente el tratamiento con ceftriaxona. La totalidad de pacientes fueron diagnosticados mediante ecografía, y en 12 de los 15 casos de colelitiasis en los que se disponía de radiografía simple, se detectaron las litiasis mediante esta técnica (80 % de los casos). Respecto a la clínica, los síntomas más frecuentes fueron dolor abdominal (7 casos), dolor abdominal y vómitos (5 casos), diarrea (1 caso). Dos pacientes acudieron con clínica apendicular. De los 18 niños diagnosticados de colelitiasis, en 2 casos se practicó colecistectomía mediante laparotomía y a 12 individuos se les efectuó colecistectomía por vía laparoscópica. Ninguno precisó tratamiento quirúrgico urgente. La litiasis biliar en la infancia es un hallazgo infrecuente pero no excepcional, que presenta frecuentemente sintomatología inespecífica. La radiología convencional es útil en la valoración de estos pacientes, pero la ecografía es la técnica idónea para detectar colelitiasis

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography

Placement of a colonic stent by percutaneous colostomy in a case of malignant stenosis.

We present a patient with disseminated stomach cancer who presented with symptoms of acute obstruction of the splenic flexure of the colon caused by tumor spread. During a first attempt to insert a colon stent through the anus under endoscopic guidance as final palliative therapy, it was not possible to reach the region of the stricture, and iatrogenic perforation of the descending colon occurred, which resolved favorably under conservative management. A second attempt to insert a stent was made via percutaneous puncture of the transverse colon, approaching the region of the stricture by a descending route. The procedure was completed without complications and the patient's symptoms improved. Stent placement via percutaneous puncture of the colon has not previously been described in the literature. It may be an alternate route in cases of proximal strictures in which access through the anus has been unsuccessful even with the aid of endoscopic guidance.

[Arachnoid metastasis of renal cell carcinoma: review of forms of tumor dissemination and review of its metastasis in the nervous system]. / Metástasis aracnoideas de un carcinoma de células renales: repaso de formas de diseminación del tumor y revision de sus metastásis en el sistema nervioso.

Contribution of one case of renal cells carcinoma, in an adult man, that during evolution developed arachnoid metastasis. The patient was first seen for a brain haemorrhage due to a bleeding metastasis. In later studies, a renal cells carcinoma was found to be the primary site of the brain condition. The evolution showed neurological manifestations in the limbs, and the arachnoid metastasis was detected. The paper includes imaging studies of the referred disease both al brain, renal and spinal level with CT and NMR studies. A revision is made of the different dissemination forms of renal cells tumours, as well as a review of the existing literature with regard to the nervous system metastasis. No case has been found in this review relative to spinal arachnoid dissemination.