Carolina Cisneros Serrano

Percutaneous treatment of intrabdominal abscess: urokinase versus saline serum in 100 cases using two surgical scoring systems in a randomized trial

The purpose of this study was to assess whether regular instillation of urokinase during abscess drainage leads to an improved outcome compared to saline irrigation alone. One hundred patients referred for image-guided abdominal abscess drainage were randomized between thrice daily urokinase instillation or saline irrigation alone. At the end of the study, patient medical records were reviewed to determine drainage, study group, Altona (PIA II) and Mannheim (MPI) scoring, duration of drainage, procedure-related complications, hospital stay duration, and clinical outcome. The technical success rate of the percutaneous abscess drainage was 100%. The success or failure of abscess remission did not differ significantly between groups (success rate of 91.5% in the urokinase group vs. 88.8% in the saline group; failure rate was of 8.5 vs. 21.2%, respectively); however, days of drainage, main hospital stay, and overall costs were significantly reduced in patients treated with urokinase compared to the control group (P < 0.05). No adverse effects from urokinase were observed. Surgical scores were a useful homogeneity factor, and MPI showed a good correlation with prognosis, while PIA results did not have a significant correlation. For drainage of complex abscesses (loculations, hemorrhage, viscous material), fibrinolytics safely accelerate drainage and recovery, reducing the length of the hospital stay and, therefore, the total cost.

Laparoscopic Demonstration of Vena Cava Wall Penetration by Inferior Vena Cava Filters in an Ovine Model

PURPOSE To verify the penetration of struts and hooks of two inferior vena cava (IVC) filters (Günther tulip retrievable filter [GTF] and Celect filter) through the vena cava wall and to assess local or systemic complications resulting from this penetration. MATERIALS AND METHODS Eight IVC filters were placed in the IVC of four ewes for 30 days (1 GTF and 1 Celect filter in each ewe). Angiographic and laparoscopic examinations of the animals were performed to demonstrate the penetration through the vena cava wall, and the filters were removed under laparoscopic control. Specimens were extracted for anatomicopathological and histologic examination. RESULTS Two-projection cavography showed a filter leg seemingly out of the vena cava in 19 of 32 legs (59.3%). Laparoscopy showed 7 real penetrating legs (5 Celect filters and 2 GTFs) out of the 14 legs that could be identified by laparoscopy owing to technique limitations. Neither laparoscopy nor necropsy showed any sign of wall hemorrhage or other injuries. Histologic examination showed intimal remodeling and slight thickening of adventitial tissue around filter legs. CONCLUSIONS GTFs and Celect filters can produce a real penetration 1 month after implantation. This penetration did not lead to any complications in the IVC or surrounding tissues and did not compromise the subjects health in any of the studied cases.

¿Cuál es el tiempo límite para retirar un filtro de vena cava? Filtros opcionales de vena cava inferior:: recuperación 90 días después de su implantación. Modelo ovino

Objetivo Estudiar la posibilidad y la seguridad de recuperar filtros opcionales de vena cava Gunther-Tulip (FGT) a los 90 dias de su implantacion inicial en un modelo animal ovino. Material y metodos Se implantaron 30 FGT en otras tantas ovejas hembras y se intento recuperarlos 90 dias despues de su implantacion. Se realizo cavografia convencional en todos los casos antes y despues de la recuperacion, para evaluar la permeabilidad de la vena cava. Se obtuvieron medidas de la vena cava y se documento la presencia de complicaciones relativas a la implantacion y recuperacion del filtro de vena cava inferior (VCI). Se midio la fuerza requerida para recuperar los filtros de vena cava con un dinamometro comercial modificado y adaptado al equipo de recuperacion de FGT. El estudio histologico se centro en la pared de la VCI. Resultados La implantacion se efectuo con exito en todos los casos (100%). Una oveja desarrollo un pequeno foco de trombosis en una de las patas del filtro y otra presento un trombo pequeno en el interior del filtro. Se intento la recuperacion del filtro en las 30 ovejas y, excepto en un caso, el resultado fue satisfactorio (96,6%). En la recuperacion de los 30 FGT, la fuerza necesaria para desenganchar las patas del filtro de la VCI fue menor de 12 newtons (N). No se observo ninguna complicacion en los cavogramas ni en la autopsia. Se observaron diferentes grados de fibrosis en el estudio histologico. Conclusiones En un modelo animal ovino, la recuperacion de FGT a los 90 dias de su implantacion es posible, segura y facil, y requiere poca fuerza (mediana: 4,2 N).

Stents traqueales metálicos autoexpandibles. Estudio comparativo de 3 tipos diferentes de stents en un modelo animal

INTRODUCTION The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). MATERIAL AND METHODS Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multi-slice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. RESULTS The DES group had the longest stenosis (20.51±14.08mm vs. 5.84±12.43 and 6.57±6.54mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs. 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant). CONCLUSIONS The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis.

On Studying the Interaction Between Different Stent Models and Rabbit Tracheal Tissue: Numerical, Endoscopic and Histological Comparison

Stenting technique is employed worldwide for treating atherosclerotic vessel and tracheal stenosis. Both diseases can be treated by means of metallic stents which present advantages but are affected by the main problem of restenosis of the stented area. In this study we have built a rabbit trachea numerical model and we have analyzed it before and after insertion and opening of two types of commercial stent: a Zilver® FlexTM Stent and a WallStentTM. In experimental parallel work, two types of stent were implanted in 30 New Zealand rabbits divided in two groups of 10 animals corresponding to each stent type and a third group made up of 10 animals without stent. The tracheal wall response was assessed by means of computerized tomography by endoscopy, macroscopic findings and histopathological study 90 days after stent deployment. Three idealized trachea models, one model for each group, were created in order to perform the computational study. The animal model was used to validate the numerical findings and to attempt to find qualitative correlations between numerical and experimental results. Experimental findings such as inflammation, granuloma and abnormal tissue growth, assessed from histomorphometric analyses were compared with derived numerical parameters such as wall shear stress (WSS) and maximum principal stress. The direct comparison of these parameters and the biological response supports the hypothesis that WSS and tensile stresses may lead to a greater tracheal epithelium response within the stented region, with the latter seeming to have the dominant role. This study may be helpful for improving stent design and demonstrates the feasibility offered by in-silico investigated tracheal structural and fluid dynamics.

Removal of Retrievable Inferior Vena Cava Filters 90 Days After Implantation in an Ovine Model: Is There a Time Limit for Removal?

OBJECTIVE To study the feasibility and safety of removing retrievable Günther-Tulip vena cava filters (GTFs) 90 days after their implantation in an ovine model. MATERIAL AND METHODS Thirty GTFs were implanted in 30 ewes and retrieval was attempted at 90 days. Conventional cavography was performed in all cases before and after retrieval in order to evaluate inferior vena cava patency and record dimensions. The presence of complications related to placement and retrieval of the filter from the inferior vena cava was also recorded. The force required to remove the filters was measured using a modified commercial dynamometer adapted to the GTF retrieval set. Histologic study focused on the inferior vena cava wall. RESULTS Implantation was performed successfully in all cases (100%). One ewe developed a small focus of thrombosis around 1 of the legs of the filter and another presented a small thrombus within the filter. Retrieval of the filter was attempted in all 30 sheep at 90 days and the result was satisfactory in all but 1 case (96.6%). None of the GTFs required a force greater than 12 N to disengage the hooks of the filter from the wall. No complications were detected on venacavography or at autopsy. Variable degrees of fibrosis were observed in the histologic study. CONCLUSIONS Retrieval of GTFs 90 days after implantation in an ovine model was feasible, safe, and easy, and required little force (median, 4.2 N).

Interventional radiology treatment for pulmonary embolism

Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach. This review will summarize the available endovascular treatments and the different techniques with its indications and outcomes.

Stent‐induced tracheal stenosis can be predicted by IL‐8 expression in rabbits

Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behaviour of three commercially available stents in vivo (rabbits) and in vitro (coculture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker.

Nonsutured Hotz–Celsus technique performed by CO2 laser in two dogs and two cats

It is described a new version of modified Hotz-Celsus technique performed in four patients, two cats and two dogs. The surgery was carried out using CO(2) laser in order to avoid bleeding and decrease the anesthetic time. Besides, the wound created was not sutured and it healed by secondary intention without any complication. As a conclusion, this modification is a successful alternative to treat entropion in a safe and fast way.

Novedades en asma: revisión de las publicaciones del último año en archivos de bronconeumología

Resumen El interes por la investigacion en asma de los neumologos espanoles va en linea ascendente. En el ultimo ano han aparecido en archivos de bronconeumologia 22 articulos sobre asma, 6 mas que en el ano anterior, y se presentaron 56 comunicaciones al Congreso Nacional de la SEPAR, publicadas en el numero especial de la revista, lo que representa un 60% mas que en el congreso del ano anterior. Se realiza una revision critica de todos estos articulos. Los originales aportan nuevos conocimientos epidemiologicos, clinicos y de investigacion basica. Merece mencion especial la publicacion de 2 guias de practica clinica, la Guia Espanola para el Manejo del Asma 2009 (GEMA) y la Guia ALERTA-2 para el manejo de la exacerbacion asmatica; las 2 suponen no solo una actualizacion de su contenido, sino tambien un cambio en la metodologia en su elaboracion que mejora su calidad cientifica.