Long-term clinical outcome and survival predictors in patients with cirrhosis after 10-mm-covered transjugular intrahepatic portosystemic shunt / Resultados clínicos a largo plazo y predictores de la supervivencia de pacientes con cirrosis hepática tras inserción de prótesis recubierta transyugular intrahepática porto-sistémica dilatadas a 10mm

Background and aims: Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival. Methods: This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan–Meier method was used to measure survival and predictors of survival were identified with the Cox regression model. Results: A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/−9.9) and the median MELD was 13.3 (IQR 9.5–16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%. Conclusions: TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival.(AU)

Introducción: Los shunt intrahepático porto-sistémicos (TIPS) son utilizados con éxito en el tratamiento de las complicaciones de la hipertensión portal (HTP). Existe cierta controversia referente al diámetro dilatado. Los objetivos fueron analizar los resultados y las complicaciones derivadas de los TIPS en cirróticos, y determinar los factores predictores de la supervivencia. Métodos: Se trata de un estudio retrospectivo unicéntrico que incluyó pacientes cirróticos que recibieron un TIPS por HTP desde 2009 a octubre-2018. Se recogieron variables clínicas, demográficas y radiológicas. Se determinó la supervivencia mediante el método Kaplan-Meier y se identificaron los predictores de supervivencia con el modelo de regresión de Cox. Resultados: Se incluyeron 98 pacientes (78,6% varones). La media de edad fue de 58,5 años (DE ±9,9) y mediana de MELD 13,3 (RIC 9,5-16). Las indicaciones fueron ascitis refractaria (AR), hemorragia varicosa (HV) e hidrotórax hepático (HH). La mediana de supervivencia fue de 72 meses (AR 46,4; HV 68,5 y HH 64,7 meses) y la supervivencia libre de trasplante fue de 26 meses. El éxito técnico y clínico fue del 92,9 y 70,5%, respectivamente. La edad (HR 1,05), el éxito clínico (HR 0,33), el sodio (HR 0,92), la disfunción renal (HR 2,46) y la albúmina (HR 0,35) fueron factores predictivos de supervivencia. El 28,6% desarrolló encefalopatía hepática y un 16,3% presentó disfunción del TIPS. Conclusiones: Los TIPS con prótesis recubiertas dilatadas a 10mm son un tratamiento efectivo y seguro de las complicaciones derivadas de HTP en pacientes cirróticos. La edad, la disfunción renal, el sodio, la albúmina y el éxito clínico son factores independientes predictivos de la supervivencia a largo plazo.(AU)

Long-term clinical outcome and survival predictors in patients with cirrhosis after 10-mm-covered transjugular intrahepatic portosystemic shunt.

BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival. METHODS: This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan-Meier method was used to measure survival and predictors of survival were identified with the Cox regression model. RESULTS: A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/-9.9) and the median MELD was 13.3 (IQR 9.5-16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%. CONCLUSIONS: TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival.

True hepatic artery aneurysm.

We present to you an interesting case of a woman who presented abdominal pain in the Emergency room with an unexpected diagnosis of ruptured left intrahepatic artery aneurism. The patient had no history of invasive biliary procedures that could provoke her condition. Endovascular definitive treatment was carried out with full left hepatic artery embolization. No complication regarding the treatment was noticed and the patient recovery successfully.

True hepatic artery aneurysm

No disponible

Review of imaging techniques in the diagnosis of hepatocellular carcinoma in patients who require a liver transplant.

OBJECTIVES: The aim of the study was to retrospectively compare the diagnostic performance of ultrasound (US), contrast-enhanced multidetector computed tomography (MDCT) and contrast-enhanced MRI in cirrhotic patients who were candidates for liver transplantation. MATERIALS AND METHODS: A total of 273 consecutive patients with 218 hepatocellular carcinoma (HCC) nodules, who underwent imaging and subsequent transplantation, were examined. Diagnosis of HCC was based on explant correlation of the whole liver. Three different imaging data sets were evaluated: US, MDCT and MRI unenhanced and dynamic phases. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value, with corresponding 95% confidence intervals, were determined. Statistical analysis was performed for all lesions and for two lesion subgroups (≤2 and >2 cm). Preoperative tumour staging was analysed. RESULTS: Patient sensitivity to US, MDCT and MRI was 80.4, 81.1 and 90.5%, respectively. Specificity was 96.3, 96.2 and 82.1%. Combined US and MDCT improved sensitivity (88%) without significant loss in specificity (95.7%). Imaging tests resulted in accurate tumour staging in 83.4% of the patients. In per-nodule analysis, technique sensitivity was 55.6, 52.4 and 65.9%, respectively. Sensitivity figures improved when the nodule was larger than 2 cm. CONCLUSION: Combining imaging techniques is a good strategy for pretransplant HCC diagnosis and provides more accurate cancer staging in patients, which is necessary to decide the correct therapeutic approach.

Indicación y utilidad de la ecografía urgente en la sospecha de apendicitis aguda / Indication and usefulness of ultrasonography for suspected acute appendicitis at the emergency department

Objetivo: La apendicitis aguda es la patología quirúrgica aguda abdominal más frecuente. Su diagnóstico constituye uno de los problemas más habituales en los servicios de urgencias. El objetivo del presente estudio es evaluar la utilidad de la ecografía abdominal en el diagnóstico de esta entidad. Material y método: Estudio retrospectivo realizado entre enero y junio del 2004 de todas las consultas realizadas en el servicio de urgencias por dolor abdominal indicativo de probable abdomen agudo, en los que se realizó una ecografía abdominal para descartar apendicitis aguda. Resultados: Se realizaron 2.015 ecografías abdominales urgentes de las cuales 296 fueron solicitadas para descartar el diagnóstico de apendicitis aguda, de éstas 288 fueron valorables. En 52 pacientes la ecografía fue indicativa de apendicitis aguda. En 15 casos el diagnóstico ecográfico fue discordante con el diagnóstico final. En 6 pacientes el informe ecográfico de apendicitis no se confirmó a posteriori. En 9 casos la ecografía fue no diagnóstica pese al diagnóstico quirúrgico de apendicitis aguda. Con estos datos, el rendimiento global de la ecografía para el diagnóstico de apendicitis aguda, se tradujo en una sensibilidad del 83,7%, especificidad del 97,4%, valor predictivo positivo del87,7%, valor predictivo negativo del 96,2%.Conclusiones: El rendimiento global de la ecografía abdominal en el diagnóstico de apendicitis aguda en nuestro medio es aceptable. Debido a su accesibilidad y bajo costees la prueba idónea para el diagnóstico en urgencias, sobre todo en casos dudosos (AU)

Objective: The aim of the present study was to assess the usefulness of ultrasonography in the diagnosis of acute appendicitis. Material and methods: Retrospective study which included patients presented in the emergency department with abdominal pain of suspected acute abdominal disorder origin and remitted to undergone ultrasonography to rule out appendicitis from January to July 2004.Results: Among 2015 ultrasonography scans 296 were performed to exclude a diagnosis of acute appendicitis. 288could be interpreted and the diagnosis of acute appendicitis was established in 52. In 15 cases the ultrasonography and the definite diagnosis differed. Ultrasonography and surgical diagnosis were different in 6 patients. In 9 patients the ultrasonography was not diagnostic. Ultrasound sensitivity, specificity, positive predictive value, and negative predictive value were 83,7%, 97,4%, 87,7% and 96,2%, respectively. Conclusions: The global cost-effectiveness of ultrasonography to diagnose appendicitis is good. Due to its availability and its low cost, ultrasonography is an accurate test for the diagnosis of acute appendicitis in emergency departments, specially in uncertain cases (AU)