[Scintigraphy with 99MTc-HMPAO labeled leukocytes and computed tomography in the diagnosis of vascular graft infection. A comparative study]. / Gammagrafía con leucocitos marcados con HMPAO-99mTc y tomografía computarizada en el diagnóstico de infección de prótesis vascular. Estudio comparativo*

The purpose of this work was to compare the results obtained with a scitigraphy using 99mTc-HMPAO labeled leukocyte and a computed tomography (CT) in the diagnosis of vascular graft infection (VGI). We carried out 22 studies with both scintigraphy and CT in 20 patients with vascular grafts with VGI suspicion. One patient had two grafts, thus a total of 23 grafts were analyzed. In addition, 6 control studies were performed. The persistent increase in leukocyte uptake in the graft area was considered as evidence of VGI and the scintigraphy with HMPAO-99mTc labeled leukocytes. For the CT, the presence of perigraft fluid and/or gas collection in the graft bed was also considered to be evidence of VGI. The total number of VGI was 12. The VGI diagnosis was confirmed by culture in all cases. The sensitivity and specificity of the scintigraphy in the diagnosis of VGI was 100%, while the CT has a sensitivity of 58% and specificity of 91%. Five grafts presented pseudoaneurysm in distal aorto-bifemoral graft anastomosis. All theses cases were detected with CT and only one patient with pseudoaneurysms showed scintigraphic evidence of VGI. In addition, both techniques detected two soft tissue infections associated with cutaneous fistulae, one case of abdominal abscess and another of acute diverticulitis. The scintigraphy was also pathologic in one infection of the surgical wound while that the CT was negative. In conclusion, although both techniques are useful to evaluate patients with suspicion of VGI, the scintigraphy with 99m-Tc-HMPAO labeled leukocytes has been shown to be more sensitive than the CT in the assessment of patients with VGI suspicion.

[Percutaneous and surgical gastrostomies: our clinical experience in enteral nutrition]. / Gastrostomía percutánea y quirúrgica: experiencia clínica en nutrición enteral.

Percutaneous gastrostomy (PG) was performed on 18 patients and 11 patients were subjected to surgical gastrostomy (SG) in the HCU of Zaragoza from October 1990 to November 1991. Involvement of the high digestive tract was the most common finding: 11 patients had CA of the oesophagus and stomach, 2 suffered from extrinsic pressure of the oesophagus due to metastatic adenopathy of a lung and breast tumour and 9 patients had CA of the larynx with total dysphagia. Another less common indication in our series, although still of great importance, was a severe involvement of the CMS, which made oral nutrition impossible due to functional dysphagia. Due to the long-term nature of this pathology, feeding by nasogastric tube was not considered. This was the case of 4 patients. The duration of enteral nutritional in the patients' home was 112.8 +/- 61 days with PG and 37 +/- 26 days with SG (p: 0.007). The incidence of complications was 33% in PG and 73% in SG, and for both techniques, the most common complication was blockage of the tube. Percutaneous gastrostomy is a simple technique, with no surgical risks involved, but with the benefits of traditional surgical techniques which, despite the small number of cases recorded, has very few complications both with regard to placing and afterwards, and also enables the patient to receive nutrients earlier than would be the case with traditional surgical techniques during prolonged periods at the patient's home.

Multiple cerebral hydatid cysts.

A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-right displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A computed tomography (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondary hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratentorial cyst. The patient rejected any surgical intervention.