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

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

[Complicated spermatocele as a cause of scrotal mass with solid appearance. Ultrasonographic findings]. / Espermatocele complicado como causa de masa escrotal de aspecto solido. Hallazgos ecográficos.

We report an atypical case of spermatocele in which sonographic findings demonstrated an intraescrotal mass fixed to the testicle, apparently solid and with important vascularity, being these findings suspicious of malignant tumor. We recommend to include complicated spermatocele in the differential diagnosis of ecographically solid masses.

[The computerization of the clinical history in an internal medicine service]. / Informatización de la historia clínica en un servicio de medicina interna.

BACKGROUND: The following objectives were studied in the implementation of computerization in the registration of clinical histories: gather all the information obtainable from the patient, be able to up-date the information once introduced, use of the information by health care personnel, automatic carrying out of all routine reports, elaboration of hospital indexes, follow the conventional model of clinical history as much as possible and reasonable price. METHODS: The study was carried out in a 40-bed department of internal medicine in a county hospital. A mixed system of partial coding was used combined with free texts, the latter being with no limit of space. The clinical histories were structured in 9 groups which covered from personal data to complementary explorations. A personal computer compatible "AT" was employed. The program was designed and analyzed by internal medicine doctors using CLIPPER and language "C". RESULTS: The thousand one hundred histories were opened with the space occupied in the disc being of 7 Megabytes. Following the premise of: "write all data only once", the obtaining of all type of documents, indexes and listed was automatized facilitating the knowledge of the working of the department directly. Adaptation by medical personnel was good. CONCLUSIONS: The model presented achieved the previously mentioned aims of information gathering and up-dating, use of the information by hospital personnel, automatization of routine reports and indexes, the following of conventional models and economic feasibility. Computerization should not be imposed, must not represent more work and advantages should be obtained by its use.