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Pneumatosis coli due to pharmacological constipation

2013-02-26T01:35:54Z

Title: Pneumatosis coli due to pharmacological constipation Author(s) : Prieto, C. (César); Fernandez-Urien, I. (Ignacio); Sangro, B. (Bruno); Subtil, J.C. (José Carlos); Idoate, M.A. (Miguel A.); Cano, D. (David); Muñoz-Navas, M. (Miguel)

Gastroduodenal injury after radioembolization of hepatic tumors

2013-04-15T09:47:29Z

Title: Gastroduodenal injury after radioembolization of hepatic tumors Author(s) : Carretero, C. (Cristina); Muñoz-Navas, M. (Miguel); Betes, M.T. (María Teresa); Angos, R. (Ramón); Subtil, J.C. (José Carlos); Fernandez-Urien, I. (Ignacio); Riva, S. (Susana) de la; Sola, J. (Josu); Bilbao, J.I. (José I.); Luis, E. (Esther) de; Sangro, B. (Bruno) Abstract: Radioembolization is a new tool for the treatment of hepatic tumors that consists in the injection of biocompatible microspheres carrying radioisotopes into the hepatic artery or its branches. METHODS: We have performed radioembolization in 78 patients with hepatic tumors using resin-based microspheres loaded with yttrium-90. All patients were previously evaluated to minimize the risk of hazardous irradiation to nontarget organs and to obtain the data needed for dose calculation. RESULTS: We report a complication found in three cases (3.8%) that consists of abdominal pain resulting from gastroduodenal lesions and that had a chronic, insidious course. Microscopically, microspheres were detected in the specimens obtained from all affected gastric areas. Since these gastroduodenal lesions do not appear when nonradiating microspheres are injected in animals, lesions are likely to be due to radiation and not to an ischemic effect of vascular occlusion by spheres. CONCLUSIONS: We believe that a pretreatment evaluation that includes a more thorough scrutiny of the hepatic vascularization in search of small collaterals connecting to the gastroduodenal tract can help prevent this awkward complication

Reversible cerebral vasoconstriction syndrome induced by adrenaline

2012-12-13T01:12:51Z

Title: Reversible cerebral vasoconstriction syndrome induced by adrenaline Author(s) : Palma, J.A. (José A.); Fontes, A. (Ariadna); Irimia, P. (Pablo); Garcia-de-Eulate, R. (Reyes); Martinez-Vila, E. (Eduardo) Abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe thunderclap headaches and evidence of multifocal, segmental, reversible vasoconstrictions of the cerebral arteries. Several precipitating factors have been identified and reported, including the use of recreational substances or sympathomimetic drugs and the postpartum state. Case description: Here we present the case of a woman who developed RCVS after the administration of adrenaline (epinephrine) in the setting of an anaphylactic reaction during antibiotic allergy testing. Discussion: To our knowledge, this is the first reported case of RCVS following the administration of exogenous adrenaline. This case contributes to the understanding of the physiopathological mechanisms underlying reversible cerebral vasoconstriction

The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease

2012-12-13T01:36:27Z

Title: The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease Author(s) : Gonzalez-Redondo, R. (R.); Toledo, J. (Jon); Clavero, P. (P.); Lamet, I. (Isabel); Garcia-Garcia, D. (David); Garcia-de-Eulate, R. (Reyes); Martinez-Lage, P. (Pablo); Rodriguez-Oroz, M.C. (María Cruz) Abstract: White matter hyperintensities (WMHs) detected by magnetic resonance imaging (MRI) of the brain are associated with dementia and cognitive impairment in the general population and in Alzheimer's disease. Their effect in cognitive decline and dementia associated with Parkinson's disease (PD) is still unclear. METHODS: We studied the relationship between WMHs and cognitive state in 111 patients with PD classified as cognitively normal (n = 39), with a mild cognitive impairment (MCI) (n = 46) or dementia (n = 26), in a cross-sectional and follow-up study. Cognitive state was evaluated with a comprehensive neuropsychological battery, and WMHs were identified in FLAIR and T2-weighted MRI. The burden of WMHs was rated using the Scheltens scale. RESULTS: No differences in WMHs were found between the three groups in the cross-sectional study. A negative correlation was observed between semantic fluency and the subscore for WMHs in the frontal lobe. Of the 36 non-demented patients re-evaluated after a mean follow-up of 30 months, three patients converted into MCI and 5 into dementia. Progression of periventricular WMHs was associated with an increased conversion to dementia. A marginal association between the increase in total WMHs burden and worsening in the Mini Mental State Examination was encountered. CONCLUSIONS: White matter hyperintensities do not influence the cognitive status of patients with PD. Frontal WMHs have a negative impact on semantic fluency. Brain vascular burden may have an effect on cognitive impairment in patients with PD as WMHs increase overtime might increase the risk of conversion to dementia. This finding needs further confirmation in larger prospective studies.

Functional bold MRI: advantages of the 3 T vs. the 1.5 T

2012-12-13T01:36:27Z

Title: Functional bold MRI: advantages of the 3 T vs. the 1.5 T Author(s) : Garcia-de-Eulate, R. (Reyes); Garcia-Garcia, D. (David); Dominguez-Echavarri, P. (Pablo); Noguera, J.J. (José J.); Luis, E. (Esther) de; Rodriguez-Oroz, M.C. (María Cruz); Zubieta, J.L. (José L.) Abstract: We quantitatively evaluate the benefits of a higher field strength for functional brain MRI (fMRI) based on the blood oxygenation level-dependent contrast. The 3-T fMRI shows a higher sensitivity for the motor and somatosensory stimulation and more specific localization in the grey substance. The 3-T fMRI detects additional areas of activation with the motor paradigm.

Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables

2012-12-13T01:35:04Z

Title: Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables Author(s) : Pina, L. (Luis); Apesteguia, I. (I.); Luis, E. (Esther) de; Saenz-Banuelos, J. (J.); Zornoza, G. (Gerardo); Dominguez-Cunchillos, F. (F.) Abstract: Facing a non-palpable mammary lesion requiring a diagnostic biopsy, consideration must be given to the most suitable guiding method for obtaining the latter. Three methods are employed at present: stereotaxy (basically in cases of microcalcifications), echography (above all in the nodules), and magnetic resonance (for lesions not made visible through the previous systems). The next step is to select the most suitable biopsy technique. The most classical and reliable technique is the surgical biopsy with prior marking using a metallic harpoon, but, besides its high cost, it has the drawback of being an aggressive technique for the diagnosis of a benign pathology. Numerous systems of puncture have been developed as alternatives. Puncture with a fine needle is technically simple to carry out and can provide good results in the mammary nodules, but the existence of positive and negative false results has progressively limited its use. As an alternative, the systems of biopsy with a broad needle have made it possible to obtain multiple cylinders with a high diagnostic reliability, above all in the case of mammary nodules. However, their use in microcalcifications continues to show negative false results. The arrival of systems of vacuum-assisted biopsy has made it possible to obtain cylinders of greater quality, above all in cases of microcalcifications. Finally, the systems of percutaneous resection biopsy by means of cannulas with a diameter of 22 mm make it possible to completely extract lesions of a size below that of the cannula, with a reliability similar to that of the surgical biopsy.

Spinal dural arteriovenous fistula in a patient with gait disturbances

2012-12-13T01:36:35Z

Title: Spinal dural arteriovenous fistula in a patient with gait disturbances Author(s) : Saiz-Mendiguren, R. (R.); Garcia-Lallana, A. (A.); Garcia-de-Eulate, R. (Reyes); Dominguez-Echavarri, P. (Pablo); Martinez-Cuesta, A. (Antonio); Zubieta, J.L. (José L.)

Pneumocephalus mimicking cerebral cavernous malformations in MR susceptibility-weighted imaging

2012-12-13T01:36:21Z

Title: Pneumocephalus mimicking cerebral cavernous malformations in MR susceptibility-weighted imaging Author(s) : Palma, J.A. (José A.); Zubieta, J.L. (José L.); Dominguez-Echavarri, P. (Pablo); Garcia-de-Eulate, R. (Reyes)

Hallazgos neurorradiológicos de la Acidosis Glutárica tipo I

2012-12-13T01:36:02Z

Title: Hallazgos neurorradiológicos de la Acidosis Glutárica tipo I Author(s) : Luis, E. (Esther) de; Larrache, J. (Javier); Garcia-de-Eulate, R. (Reyes); Narbona, J. (Juan); Zubieta, J.L. (José L.) Abstract: Glutaric aciduria type I is a rare disorder of organic acid metabolism caused by deficiency of glutaryl-CoA dehydrogenase, a mitochondrial enzyme. Improper degeneration of amino acids: tryptophan, lysine, and hydroxylysine, results in increased levels of glutaric acid, which typically becomes clinically manifest as an acute dystonic crisis in young children. Accumulation of glutaric acid causes neurotoxicity in the basal ganglia and fronto-temporal cortex which can lead to progressive dystonia, hypotonia, permanently impaired speech and seizures. Because dietary and drug therapy may alter the natural history of the disease, early diagnosis of such patients is critical. We report the magnetic resonance (MR) imaging findings in a 16 year-old girl with this disorder who presented with a chronic dystonic syndrome and previously diagnosed of brain paralysis. MR imaging demonstrated bilateral involvement of the putamina and periventricular white matter, and bilateral temporal atrophy and widened Silvian fissures

Surgery guided by 5-aminolevulinic fluorescence in glioblastoma: volumetric analysis of extent of resection in singlecenter experience

2012-12-13T01:34:57Z

Title: Surgery guided by 5-aminolevulinic fluorescence in glioblastoma: volumetric analysis of extent of resection in singlecenter experience Author(s) : Diez-Valle, R. (Ricardo); Tejada, S. (Sonia); Idoate, M.A. (Miguel Ángel); Garcia-de-Eulate, R. (Reyes); Dominguez-Echavarri, P. (Pablo); Aristu-Mendioroz, J. (Javier) Abstract: We analyzed the efficacy and applicability of surgery guided by 5-aminolevulinic acid (ALA) fluorescence in consecutive patients with glioblastoma multiforme (GBM). Thirty-six patients with GBM were operated on using ALA fluorescence. Resections were performed using the fluorescent light to assess the right plane of dissection. In each case, biopsies with different fluorescent quality were taken from the tumor center, from the edges, and from the surrounding tissue. These samples were analyzed separately with hematoxylin-eosin examination and immunostaining against Ki67. Tumor volume was quantified with pre- and postoperative volumetric magnetic resonance imaging. Strong fluorescence identified solid tumor with 100% positive predictive value. Invaded tissue beyond the solid tumor mass was identified by vague fluorescence with 97% positive predictive value and 66% negative predictive value, measured against hematoxylin-eosin examination. All the contrast-enhancing volume was resected in 83.3% of the patients, all patients had resection over 98% of the volume and mean volume resected was 99.8%. One month after surgery there was no mortality, and new or increased neurological morbidity was 8.2%. The fluorescence induced by 5-aminolevulinic can help to achieve near total resection of enhancing tumor volume in most surgical cases of GBM. It is possible during surgery to obtain separate samples of the infiltrating cells from the tumor border

Hepatic abnormalities in patients with chronic granulomatous disease

2012-12-13T01:18:45Z

Title: Hepatic abnormalities in patients with chronic granulomatous disease Author(s) : Hussain, N. (Nadeem); Feld, J.J. (Jordan J.); Kleiner, D. (David); Hoofnagle, J.H. (Jay H.); Garcia-de-Eulate, R. (Reyes); Ahlawat, S. (Sushil); Koziel, D.E. (Deloris E.); Anderson, V. (Victoria); Hilligoss, D. (Dianne); Choyke, P.L. (Peter L.); Gallin, J.I. (John I.); Liang, T.J. (T. Jake); Malech, H. (Harry); Holland, S. (Steven); Heller, T. (Theo) Abstract: Chronic granulomatous disease (CGD) is a rare congenital disorder characterized by repeated bacterial and fungal infections. Aside from a high incidence of liver abscess, little is known about hepatic involvement in CGD. The aim of this study was to describe the spectrum of liver abnormalities seen in CGD. The charts of 194 patients with CGD followed at the NIH were reviewed, with a focus on liver abnormalities. Liver enzyme elevations occurred on at least one occasion in 73% of patients during a mean of 8.9 years of follow-up. ALT elevations were generally transient. Although transient alkaline phosphatase (ALP) elevations were also common, persistent ALP elevations lasting up to 17.6 years were seen in 25% of patients. Liver abscess occurred in 35% of patients. Drug-induced hepatotoxicity was documented in 15% of patients but likely occurred more frequently. Hepatomegaly was found in 34% and splenomegaly in 56% of patients. Liver histology showed granulomata in 75% and lobular hepatitis in 90% of specimens. Venopathy of the portal vein was common (80%) and associated with splenomegaly. Venopathy of the central vein was also common (63%) and was associated with the number of abscess episodes. Nodular regenerative hyperplasia (NRH) was seen in 9 patients, including 6 of 12 autopsy specimens. CONCLUSION: Liver enzyme abnormalities occur frequently in patients with CGD. In addition to liver abscesses and granulomata, drug hepatotoxicity is likely underappreciated. Vascular lesions such as venopathy and--to a lesser extent--NRH are common. The cause and clinical consequences of venopathy await prospective evaluation.

Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab. Initial experience

2012-12-13T01:09:49Z

Title: Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab. Initial experience Author(s) : Thukral, A. (Arpi); Thomasson, D.M. (David M.); Chow, C.K. (Catherine K.); Garcia-de-Eulate, R. (Reyes); Wedam, S.B. (Suparna B.); Gupta, S.N. (Sandeep N.); Wise, B.J. (Betty J.); Steinberg, S.M. (Seth M.); Liewehr, D.J. (David J.); Choyke, P.L. (Peter L.); Swain, S.M. (Sandra M.) Abstract: To retrospectively compare three dynamic contrast material-enhanced magnetic resonance (MR) imaging (dynamic MR imaging) analytic methods to determine the parameter or combination of parameters most strongly associated with changes in tumor microvasculature during treatment with bevacizumab alone and bevacizumab plus chemotherapy in patients with inflammatory or locally advanced breast cancer. MATERIALS AND METHODS: This study was conducted in accordance with the institutional review board of the National Cancer Institute and was compliant with the Privacy Act of 1974. Informed consent was obtained from all patients. Patients with inflammatory or locally advanced breast cancer were treated with one cycle of bevacizumab alone (cycle 1) followed by six cycles of combination bevacizumab and chemotherapy (cycles 2-7). Serial dynamic MR images were obtained, and the kinetic parameters measured by using three dynamic analytic MR methods (heuristic, Brix, and general kinetic models) and two region-of-interest strategies were compared by using two-sided statistical tests. A P value of .01 was required for significance. RESULTS: In 19 patients, with use of a whole-tumor region of interest, the authors observed a significant decrease in the median values of three parameters measured from baseline to cycle 1: forward transfer rate constant (Ktrans) (-34% relative change, P=.003), backflow compartmental rate constant extravascular and extracellular to plasma (Kep) (-15% relative change, P<.001), and integrated area under the gadolinium concentration curve (IAUGC) at 180 seconds (-23% relative change, P=.009). A trend toward differences in the heuristic slope of the washout curve between responders and nonresponders to therapy was observed after cycle 1 (bevacizumab alone, P=.02). The median relative change in slope of the wash-in curve from baseline to cycle 4 was significantly different between responders and nonresponders (P=.009). CONCLUSION: The dynamic contrast-enhanced MR parameters Ktrans, Kep, and IAUGC at 180 seconds appear to have the strongest association with early physiologic response to bevacizumab. Clinical trial registration no. NCT00016549

A case of labyrinthitis diagnosed with MRI

2012-12-12T11:31:52Z

Title: A case of labyrinthitis diagnosed with MRI Author(s) : Saiz-Mendiguren, R. (R.); Garcia-Lallana, A. (A.); Simon-Yarza, I. (Isabel); Slon, P. (P.); Etxano, J. (J.); Dominguez-Echavarri, P. (Pablo); Zubieta, J.L. (José L.); Garcia-de-Eulate, R. (Reyes)

Relationship between radiologic morphology of the bone lengthening formation and its complications

2012-11-24T01:10:09Z

Title: Relationship between radiologic morphology of the bone lengthening formation and its complications Author(s) : Forriol, F. (Francisco); Iglesias, A. (Alfonso); Arias, M. (Mercedes); Aquerreta, D. (Dámaso); Cañadell, J.M. (J. M.) Abstract: The objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition

Bone HDR brachytherapy in a patient with recurrent Ewing’s sarcoma of the acetabulum: Alternative to aggressive surgery

2012-11-22T01:10:25Z

Title: Bone HDR brachytherapy in a patient with recurrent Ewing’s sarcoma of the acetabulum: Alternative to aggressive surgery Author(s) : Martinez-Monge, R. (Rafael); Perez-Ochoa, A. (Ágata); San-Julian, M. (Mikel); Aquerreta, D. (Dámaso); Sierrasesumaga, L. (Luis) Abstract: A 17-year-old girl diagnosed with a previously irradiated, locally recurrent Ewing's sarcoma involving the puboischiatic rami and the adjacent acetabulum was referred to our institution for consideration of salvage hindquarter resection. A conservative resection with implantation of the acetabular remnant for high-dose rate brachytherapy was performed instead. The patient died 11 months after surgery without signs or symptoms of bony damage and retained the ability to walk for the remainder of her life.