Resolution of epiphora with nasolacrimal stents: results of long-term follow-up in a multicenter prospective study.

PURPOSE: To evaluate in a prospective, multicenter setting the long-term effectiveness of polyurethane stents in the percutaneous management of epiphora. MATERIALS AND METHODS: Patients (n = 426; age range, 19-88 years, mean, 48; 91 men, 335 women) with severe epiphora had stents (470 eyes/496 stents) inserted to treat unilateral or bilateral and complete or partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 280 cases (59.5%) and chronic dacryocystitis in 190 (40.4%). The stent set designed by Song was used in all patients, and the original technique was slightly modified by us and conducted on an outpatient basis. RESULTS: The initial technical success rate of stent placement was 95%. The average time of the procedure was 6 minutes (range, 3-70). Resolution of epiphora was complete in 452 eyes and partial in 18. On follow-up (mean, 24 months; range, 1 week to 67 months), 340 of 496 stents remained patent (68.5%). Segregating primary patency by year of follow-up, the rates were 75.6%, 68.4%, 64.8%, 60.1%, and 59.2% in the first, second, third, fourth, and the current (67 months) years, respectively. Minor complications such as moderate pain (21 cases), epistaxis (75 cases), palpebral edema and hematoma (31 cases), and headache (four cases) and two acute dacryocystitis events were recorded. Of the 156 obstructed stents, 114 were withdrawn, and 49 of these patients remained asymptomatic for a mean of 27 months (secondary patency, 31.4%). After stent removal, the sac configuration was unchanged in 93 (81.5%), contracted in 11 (9.6%), and widened in 10 (8.8%) cases. CONCLUSIONS: The procedure is simple and safe, both in stent insertion and in withdrawal when occluded. The success rate was >75% in the short term and >55% in the long term. Although not totally without concerns, the technique is attractive for most patients who prefer not to undergo surgery or are unsuitable surgical candidates. Stent failure does not preclude subsequent treatment options and is an excellent first-line treatment of epiphora.

TC de las anomalías congénitas y adquiridas del bazo / CT of the congenital and spleen acquired abnormalities

Objetivo: El propósito de este trabajo es revisar las características radiológicas de las distintas entidades que pueden afectar al bazo, mediante la ilustración de la semiología que muestran en la tomografía computarizada (TC). Material y métodos: Revisamos 239 casos de patología esplénica ocurrida durante un periodo de 15 años (1985-1999). A todos los pacientes se les realizó TC sin y con contraste i.v. (intravenoso). Una gran mayoría de los pacientes fueron sometidos a esplenectomía realizándose correlación histológica.Conclusiones: La TC es la técnica de imagen de elección en el diagnóstico de las enfermedades esplénicas, ya que la ecografía aunque es una técnica muy sensible es poco específica (AU)