Rendimiento del stent en el manejo de la obstrucción intestinal por cáncer de colon izquierdo. Estudio ambispectivo y unicéntrico / Stent performance in obstructive left colon cancer. Unicentric and cross-sectional study

Objetivo: Evaluar la eficacia, seguridad y resultados clínicos y oncológicos del stent colónico en la estrategia terapéutica inicial de la obstrucción intestinal por cáncer de colon izquierdo. Métodos: Estudio descriptivo y ambispectivo (2008-2018) de pacientes con diagnóstico clínico y radiológico de obstrucción neoplásica de colon izquierdo en los que se indicó colocación de stent, analizando los grupos de stent paliativo, stent como puente a cirugía y cirugía urgente por fallo o complicaciones del stent. Resultados: El estudio incluyó a 208 pacientes. La tasa de éxito técnico y clínico fue del 82,2 y del 74,5%, respectivamente, con perforación asociada en el 4,3% de la muestra. En el 32,2% el stent se comportó como puente a cirugía, mientras que el 28,4% de los pacientes precisaron intervención quirúrgica urgente. En el 39,4% el stent fue colocado con intención paliativa. La proporción de cirugía laparoscópica, resección oncológica, anastomosis primaria y ganglios obtenidos fue superior en los pacientes intervenidos mediante cirugía electiva frente a la urgente, con menor estancia postoperatoria y orbimortalidad postoperatoria grave. Los pacientes en estadio II-III con resección tumoral oncológica intervenidos de forma programada presentaron mayor supervivencia que aquellos intervenidos de urgencia (p = 0,001). Conclusiones: El tratamiento de la oclusión neoplásica de colon izquierdo mediante stent supone una estrategia eficaz para operar de forma electiva un número importante de pacientes y evita la colostomía en pacientes paliativos, aunque las complicaciones o el fracaso de la técnica conllevan cirugía urgente en casi un tercio de los pacientes

Objective: To evaluate the efficacy, safety and clinical and oncological results of colonic stents in the initial therapeutic strategy of obstructive left colon cancer. Methods: Descriptive and ambispective study (2008-2018) of patients with clinical and radiological diagnosis of neoplastic obstruction of the left colon in whom a colonic stent was indicated, analyzing the following groups: palliative stent, stent as bridge to surgery and urgent surgery in case of stent failure or complications. Results: The study included 208 patients. The technical and clinical success rates were 82.2% and 74.5%, respectively, with associated perforation in 4.3% of the sample. In 32.2%, the stent was placed as bridge to surgery, while 28.4% required urgent surgical intervention. The stent was placed with palliative intent in 39.4%. The proportion of laparoscopic surgery, oncological resection, primary anastomosis and lymph nodes resected were higher in patients undergoing elective surgery than in urgent surgery, with shorter postoperative stay and less severe postoperative morbidity and mortality. Stage II-III patients with oncological tumor resection who underwent elective surgery had increased survival compared to those who underwent urgent surgery (P = 0.001). Conclusions: Initial treatment of neoplastic obstruction of the left colon with a stent is an effective strategy in elective surgery and avoids permanent colostomy in palliative patients, although complications or stent failure lead to urgent surgery in almost one-third of patients

Obstrucción biliar secundaria a seudoaneurisma de la arteria gastroduodenal. Una inusual forma de presentación / Bile duct obstruction secondary to a pseudoaneurysm of the gastroduodenal artery. An unusual presentation

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Acute hyperammonemic encephalopathy due to a portosystemic shunt in a non-cirrhotic adult patient.

OBJECTIVE: To report a successfully treated hyperammonemia due to a portosystemic shunt in adult patient. DATA SOURCE: A patient with an altered mental status due to severe elevated ammonia level because of a portosystemic shunt. CONCLUSIONS: Hyperammonemia is not always related to liver failure in critically ill patients, but should be considered in all unknown origins of an altered mental status. A portosystemic shunt can be the responsible for this phenomenon, and it has a newly treatment technique named plug-assisted retrograde transvenous obliteration (PARTO), which can be quickly performed with high technical success rate and clinical efficacy for the treatment of the splenorenal and/or gastrorenal shunt.

Stent performance in obstructive left colon cancer. Unicentric and cross-sectional study. / Rendimiento del stent en el manejo de la obstrucción intestinal por cáncer de colon izquierdo. Estudio ambispectivo y unicéntrico.

OBJECTIVE: To evaluate the efficacy, safety and clinical and oncological results of colonic stents in the initial therapeutic strategy of obstructive left colon cancer. METHODS: Descriptive and ambispective study (2008-2018) of patients with clinical and radiological diagnosis of neoplastic obstruction of the left colon in whom a colonic stent was indicated, analyzing the following groups: palliative stent, stent as bridge to surgery and urgent surgery in case of stent failure or complications. RESULTS: The study included 208 patients. The technical and clinical success rates were 82.2% and 74.5%, respectively, with associated perforation in 4.3% of the sample. In 32.2%, the stent was placed as bridge to surgery, while 28.4% required urgent surgical intervention. The stent was placed with palliative intent in 39.4%. The proportion of laparoscopic surgery, oncological resection, primary anastomosis and lymph nodes resected were higher in patients undergoing elective surgery than in urgent surgery, with shorter postoperative stay and less severe postoperative morbidity and mortality. Stage II-III patients with oncological tumor resection who underwent elective surgery had increased survival compared to those who underwent urgent surgery (P=0.001). CONCLUSIONS: Initial treatment of neoplastic obstruction of the left colon with a stent is an effective strategy in elective surgery and avoids permanent colostomy in palliative patients, although complications or stent failure lead to urgent surgery in almost one-third of patients.

Utilidad de la urocinasa en el tratamiento de los abscesos intraabdominales mediante drenaje percutáneo / Utility of urokinase in percutaneous drainage treatment of intra-abdominal abscesses

Fundamento y objetivo: Analizar el resultado de la utilización de urocinasa en el drenaje percutáneo de abscesos intraabdominales. Pacientes y método: Estudio prospectivo y observacional de 50 pacientes con diagnóstico de absceso intraabdominal tratados en la Unidad de Radiología Intervencionista del Hospital Clínico Universitario de Zaragoza. Todos los procedimientos se realizaron con anestesia local y control ecográfico mediante la utilización de catéteres tipo Pigtail (12 a 14 Fr). Se realizó estudio bioquímico con determinación de pH y dímero D y estudio microbiológico del aspirado inicial. Ulteriormente, se administró una inyección de 10 cm3 de urocinasa (100.000 U) 3 veces al día durante al menos 3 días. Las variables de estudio incluyeron la tasa de resolución como variable principal así como otras variables, como epidemiológicas generales, índices de gravedad de Mannheim y Altona, características del absceso (localización, origen , pH, dímero D y estudio microbiológico), éxito técnico, estancia, días de tratamiento y mortalidad. Se realizó un estudio estadístico descriptivo general de todas las variables mediante el paquete estadístico G-Stat 2.0 para Windows. Resultados: La tasa de resolución fue del 86% y la tasa de éxito técnico del 100%; se realizó cirugía ulterior en 3 casos. La mortalidad fue del 8% (índice de peritonitis de Mannheim superior o igual a 13 e índice de peritonitis de Altona inferior o igual a –3,76). La media de tratamiento fue de 7 días y la media de estancia, de 12 días. Conclusiones: El tratamiento de los abscesos intraabdominales mediante drenaje percutáneo y lavados con urocinasa es un procedimiento seguro y reproducible, y obtiene resultados similares a los presentados en otros estudios (AU)

Background and objective: The aim of the study was to analyze the usefulness of the treatment with Urokinase (UK) in percutaneous drainage of intra-abdominal abscesses (IAA). Patients and Methods (AU) Prospective, observational study of 50 patients treated in the Interventional Radiology Unit from University Hospital Lozano Blesa .Zaragoza. Spain. All procedures were performed under local anesthesia and ultrasound control, using Pigtail catheters (12–14 F). PH , D-dimer determination and microbiological studies were done from the initial aspirated sample. Subsequently, we injected 10 cc of UK (100,000 IU) 3 times a day for 3 days at least. Variables study: Resolution (Principal variable). Other variables included epidemiological, specific prognostic indexes (Mannheim, Altona); types of abscesses (location/origin), pH, D-Dímer and microbiology. Technical success, days of treatment, stay and mortality were also analyzed. Results:Resolution: 86%; technical success: 100%; subsequent surgery: 3 cases. Mean treatment days: 7. Mean stay: 12 days. Death rate: 8% (PMI=/>13 and PIA II=/<−3,76). Conclusions: The treatment of IAA through percutaneous drainage and washed with urokinase, is a safe, feasible and reproducible technique. The outcomes are similar to those reported previously (AU)

[Utility of urokinase in percutaneous drainage treatment of intra-abdominal abscesses]. / Utilidad de la urocinasa en el tratamiento de los abscesos intraabdominales mediante drenaje percutáneo.

BACKGROUND AND OBJECTIVE: The aim of the study was to analyze the usefulness of the treatment with Urokinase (UK) in percutaneous drainage of intra-abdominal abscesses (IAA). PATIENTS AND METHODS: Prospective, observational study of 50 patients treated in the Interventional Radiology Unit from University Hospital Lozano Blesa .Zaragoza. Spain. All procedures were performed under local anesthesia and ultrasound control, using Pigtail catheters (12-14 F). PH , D-dimer determination and microbiological studies were done from the initial aspirated sample. Subsequently, we injected 10 cc of UK (100,000 IU) 3 times a day for 3 days at least. Variables study: RESOLUTION (Principal variable). Other variables included epidemiological, specific prognostic indexes (Mannheim, Altona); types of abscesses (location/origin), pH, D-Dímer and microbiology. Technical success, days of treatment, stay and mortality were also analyzed. RESOLUTION: 86%; technical success: 100%; subsequent surgery: 3 cases. Mean treatment days: 7. Mean stay: 12 days. Death rate: 8% (PMI=or>13 and PIA II=or<-3,76). CONCLUSIONS: The treatment of IAA through percutaneous drainage and washed with urokinase, is a safe, feasible and reproducible technique. The outcomes are similar to those reported previously.