Embolización intraarterial selectiva como tratamiento de la patología hemorroidal / Selective intra-arterial embolization to treat hemorrhoids

OBJETIVO: El objetivo de este trabajo es presentar nuestros resultados, describiendo la técnica utilizada en el tratamiento endovascular de las hemorroides. MATERIAL Y MÉTODO: La embolización se realizó mediante punción de la arteria femoral derecha o vía arteria radial, y se cateterizó la arteria mesentérica inferior (AMI) accediéndose a la arteria rectal superior con un microcatéter (2,7 F) con el que cateterizábamos cada rama distal, ocluyéndolas distalmente con partículas de PVA (300-500 micras), y proximalmente con coils de 2-3mm. Los pacientes recibieron el alta a las 24 horas, al mes se les evaluó clínicamente y se les realizó una anoscopia. RESULTADOS: El estudio incluye 20 pacientes. (4 mujeres y 16 hombres), edad media de 61,85 años (27-81), con seguimiento medio de 10,6 meses (rango de 28-2 meses). El éxito técnico fue del 90% (18/20) y el éxito clínico de 83,4% (15/18); un paciente requirió nueva embolización de la arteria rectal media y dos pacientes requirieron cirugía. La recuperación fue prácticamente indolora. Al mes todos referían gran satisfacción y la anoscopia demostraba importante mejoría de las hemorroides. No hubo complicaciones secundarias a la embolización. CONCLUSIONES: Los resultados iniciales sugieren que la ESARS es un procedimiento seguro e indoloro, bien tolerado que evita el trauma anorrectal, y recuperación inmediata del paciente

OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500μm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately

Selective intra-arterial embolization to treat hemorrhoids. / Embolización intraarterial selectiva como tratamiento de la patología hemorroidal.

OBJECTIVE: To present our results and describe the technique used for the endovascular treatment of hemorrhoids. MATERIAL AND METHODS: We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolize each distal branch distally with PVA particles (300-500µm) and proximally with coils (2-3mm). Patients were discharged 24hours after the procedure and clinically followed up at one month by anoscopy. RESULTS: We included 20 patients (4 women and 16 men; mean age, 61.85 years (27-81 years); mean follow-up, 10.6 months (28-2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolization of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the hemorrhoids. There were no complications secondary to embolization. CONCLUSIONS: Our initial results suggest that selective intra-arterial embolization is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.

Utilidad de la resonancia magnética en la valoración postquirúrgica de pacientes con prótesis hidráulica de pene / Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses

Objetivo. Describir los tipos de prótesis de pene y sus componentes, revisar el protocolo de adquisición adecuado en resonancia magnética (RM), describir los hallazgos de imagen normales y las posibles complicaciones en pacientes con prótesis hidráulica de pene. Conclusión. Las prótesis hidráulicas tricompartimentales de pene son el último eslabón en la cadena terapéutica de la disfunción eréctil. Pueden presentar complicaciones, que se clasifican en no infecciosas vinculadas a la técnica quirúrgica, infecciosas y por fallo mecánico del dispositivo. La RM es la técnica de imagen más adecuada en la evaluación postquirúrgica de las prótesis de pene. Se realiza con secuencias de alta resolución espacial con la prótesis en reposo y en los tres planos del espacio, y se repite la adquisición triplanar con la prótesis activada (AU)

Objective. To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. Conclusion. Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated (AU)

Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses. / Utilidad de la resonancia magnética en la valoración postquirúrgica de pacientes con prótesis hidráulica de pene.

OBJECTIVE: To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. CONCLUSION: Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial / Neonatal ovarian cysts: ultrasound assessment and differential diagnosis

Los quistes de ovario son los quistes abdominales más frecuentes en fetos y neonatos de sexo femenino. La ecografía es la técnica de imagen de elección para su diagnóstico, ya que permite además distinguirlos de otras lesiones quísticas. Aunque la mayoría de quistes de ovario neonatales (QON) involucionan en el transcurso de los primeros meses de vida, pueden presentar complicaciones durante el periodo fetal o posnatal. Las manifestaciones ecográficas de los QON van a estar en función de las mismas. El manejo es controvertido, con la tendencia actual de esperar y ver. Describimos las diferentes formas de presentación de los QON con sus patrones ecográficos y complicaciones, su diagnóstico diferencial con otras lesiones abdominales quísticas y, finalmente, su manejo terapéutico (AU)

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts (AU)

Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. / Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial.

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts.

A case report of recurrent adult-onset xanthogranuloma: is the radiotherapy a treatment option?

Adult-onset xanthogranuloma (AOX) is one of the four uncommon syndromes called adult xanthogranulomatous disease (AXD), which is diagnosed by characteristic histopathology. AXD is rare and heterogeneous group of entities that can affect multiple organ systems. Orbital involvement is included in the xanthogranulomatous disease although less prevalent. This work focuses on the use of external beam radiotherapy in the control of local symptoms of periocular manifestation of AOX as case report and literature review.