Twenty-five years after the first TIPS in Spain. / Veinticinco años tras los primeros TIPS en España.

The incorporation, 25 years ago, of transjugular intrahepatic portosystemic shunting, better known by the acronym TIPS, represents an indisputable improvement in the treatment and management of patients with symptoms due to portal hypertension. This article discusses the origins of the technique and the technical innovations that have been progressively added through the years. The implantation of coated stents, which protect the stent from processes in the parenchymal track that can lead to stenosis, have helped ensure long-term patency, thus reducing the need for reintervention. Solid evidence from valuable publications has situated TIPS at the forefront of the treatment options in a wide variety of clinical situations associated with portal hypertension.

[Direct embolization of stomal varices in portal hypertension after the treatment of liver metastases]. / Embolización directa de varices estomales en la hipertensión portal tras el tratamiento de metástasis hepáticas.

We present the case of a man with a history of colorectal carcinoma and metastatic liver involvement who developed portal hypertension and recurrent bleeding from stomal varices after treatment with intra-arterial oxaliplatin and radioembolization with yttrium-90 microspheres. The definitive treatment for the bleeding episodes was embolization of the varices with coils using a direct percutaneous approach.

[Indocyanine green angiography in angioid streaks]. / Angiografía verde indocianina en las estrías angioides.

PURPOSE: To define the findings of an indocyanine green angiographic study of angioid streaks and compare them with the ophthalmoscopic and fluorescein angiographic findings. PATIENTS AND METHODS: Twelve eyes of six patients with bilateral angioid streaks were examined by ophthalmoscopy, fluorescein angiography, and indocyanine green angiography. RESULTS: In the ophthalmoscopy, the streak colors ranged from brown in the early phases to orange in severe stages. The streaks already presented a hyperfluorescent pattern from the arterial phases in all of the eyes with the fluorescein angiography. Using the indocyanine green angiography filling of the choroidal veins, a hyperfluorescent pattern was observed in eight eyes with severe lesional changes and a hypofluorescent pattern in four eyes with an early stage of the disease. The angioid streaks were more clearly visualized by indocyanine green angiography. CONCLUSION: The indocyanine green angiography contributes to the diagnosis of angioid streaks. The indocyanine patterns seems to be correlated with the ophthalmoscopic features and degree of evolution of the disease. The indocyanine green angiography allows for the early detection of angioid streaks and diagnosis in young patients.

Angiografía verde indocianina en las estrías angioides / Indocyanine green angiography in angioid streaks

Objetivo: Definir los hallazgos con angiografía verde indocianina en el estudio de las estrías angioides y compararlos con los de la oftalmoscopia y angiografía fluoresceínica. Pacientes y métodos: En doce ojos de seis pacientes con estrías angioides bilaterales se realizan oftalmoscopia, angiografía fluoresceínica y angiografía verde indocianina. Resultados: En la oftalmoscopia la coloración de las estrías varía entre el marrón en fases precoces y el naranja en estadios graves. Con la fluoresceína presentan un patrón hiperfluorescente ya desde fases arteriales en todos los ojos. La angiografía verde indocianina en fases venosas muestra un patrón hiperfluorescente en ocho ojos con lesiones severas y un patrón hipofluorescente en cuatro ojos con estadios tempranos de la enfermedad. Las estrías angioides se visualizan mejor con la angiografía con verde indocianina. Conclusiones: La angiografía con verde indocianina contribuye al diagnóstico de las estrías angioides. Los patrones de indocianina parecen relacionarse con el aspecto oftalmoscópico de las estrías y con el grado de evolución de la enfermedad. La angiografía verde indocianina ayuda a realizar un diagnóstico precoz y en pacientes jóvenes (AU)

Partial splenic embolisation and improvement of hypersplenism before liver transplantation.

A case of partial splenic embolisation (PSE) that was performed in a girl with severe leucothrombocytopenia due to hypersplenism is described. Treatment with PSE is a safe and effective alternative to splenectomy that prevents clinical complications due to haematological disorders and improves hypersplenism before liver transplantation.

[Periportal adenitis secondary to abdominal tuberculosis. A CT study]. / Adenitis periportal secundaria a tuberculosis abdominal. Estudio mediante TC.

Isolated periportal tuberculous adenitis is rare. Computed tomography (TC) is the primary modality for its detection and evaluation. Although not definitive, in the presence of an appropriate clinical history and a positive purified protein derivative test, a diagnosis of periportal tuberculous lymphadenopathy may be suggested by CT by the presence of low-density enlarged porta hepatis lymph nodes with immediate postcontrast peripheral rim enhancement.

[A case of idiopathic retropneumoperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema]. / A propósito de un caso de retroneumoperitoneo, neumoperitoneo, neumomediastino y enfisema subcutáneo idiopáticos.

We present a case of retropneumoperitoneum , pneumoperitoneum , pneumomediastinum and subcutaneous emphysema in a caquectic 17 years old young man with an important depressive disorder . Several possible etiopathogenic factors are discussed, as well as the pathways of transmission of the pulmonary , mediastinic and abdominal gas.