José Antonio Fernández

Subcutaneous ports in the radiology suite: an effective and safe procedure for care in cancer patients

The purpose of the study is to present our experience and compare the results of the three types of ports used as a central venous access and performed in the radiology suite. Between March 1989 and November 1993 we performed 288 implantations (100 Implantofix Seldinger, 100 plastic Hickman port, and 88 stainless steel Port-a-cath) for chemotherapeutic treatment on the same number of patients diagnosed as having cancer. In all cases access was obtained via a subclavian vein (the left one in 185 cases and the right one in 103). All the system ports were implanted in the radiology suite. In all cases the procedure was successfully performed. Complications occurred in 26.3% of cases, most notably thrombosis in 13 cases (4.5%) and infection in 12 cases (4.1%). Duration of the port systems placement varied between 17 and 1467 days (a mean of 315 days). A total of 133 systems have been removed to date, 80 (60.%) due to termination of chemotherapy, and 53(40%) for treatment of complications. Significant differences (complications and port duration time) were not observed between the three types of reservoir used. Subcutaneous ports are safe, comfortable, and effective devices for central venous access.

Transcatheter intracavitary fibrinolysis of loculated pleural effusions: experience in 102 patients.

AbstractPurpose: To assess the efficacy of intrapleural urokinase instillation through smll-caliber catheters for the treatment of loculate and/or septate effusions. Methods: We inserted small-caliber catheters (8.2 Fr) in 102 patients with septate and/or loculate pleural effusions using ultrasonographic guidance. Urokinase (100,000 IU/2 hr, 3 times a day) was instilled through the catheter until the effusion resolved and D-dimer levels were <500 ng/ml. Patients were enrolled regardless of the etiology of the pleural effusion provided there were no contraindications for the use of urokinase. D-dimer levels were determined before and after treatment. Follow-up was performed by chest radiograph and sonography at 1 day, 7 days, and every 30 days thereafter for 6 months. Results: Successful catheter placement was achieved in all cases. The mean time catheters stayed in place was 5.7 days and the mean dose of drug instilled was 690,000 IU. Pleural effusion drainage was complete at the first assessment in all patients. Failure of the treatment, with recurrent effusion at 30 days, occurred in six patients (5.8%). Complete resolution without sequelae was observed in 19 patients (19.6%). In 75 cases (73.5%) resolution was partial, with pleural thickening (>2 mm). Two patients died from unrelated causes within 30 days after catheter placement. Complications were seen in 13 patients (12.74%): hydropneumothorax, nine cases (8.82%); infection of the puncture point, three cases (2.94%); and adverse reaction, one case (0.98%). No further treatment was required. Conclusions: The use of intrapleural fibrinolytic agents delivered through small-caliber catheters for the treatment of loculate and/or septate pleural effusion is a simple, effective, minimally invasive and inexpensive procedure that can prevent sequelae and shorten drainage time.

Seguimiento clínico y por medios de imagen a largo plazo de los filtros de vena cava inferior. Estudio transversal

Hemos realizado un estudio transversal con el fin de evaluar los hallazgos morfologicos, incidencias y complicaciones observadas en 77 filtros de vena cava inferior implantados en 75 pacientes desde abril de 1990 hasta enero de 1994. El tiempo de seguimiento de los pacientes oscilo entre los 3 y los 61 meses (media, 38,5 meses), realizando encuesta telefonica, evaluacion clinica, iliocavografia y, en algunos casos, ecografia-Doppler y tomografia computarizada (TC). Los hallazgos observados demostraron trombosis de vena cava en el 38% de los casos, edemas en EE1I en el 63,4% de los casos, angulacion > 15° en 8 pacientes, defecto de apertura en 4 pacientes, fibrosis de vena cava con estenosis en 2 casos y perforacion de vena cava inferior en 3 pacientes. Segun nuestro estudio si bien la incidencia de la trombosis de VCI posfiltro es mas alta que la sospechada habitualmente, la trascendencia clinica resulta irrelevante.

Jugular venous malformation in an 8-year-old boy: treatment with endovascular sclerotherapy.

Abstract An 8-year-old male presented with a mass in the left supraclavicular region first noted 3 months earlier and which gradually became more prominent. Ultrasound showed a lobular, well-delineated hypoechoic lesion which increased in size on Valsalva manoeuvre. Doppler waveform analysis suggested a slow flow vascular lesion. Venography showed a saccular, multilobular venous malformation which connected with the external jugular and subclavian veins. With an angiographic catheter, the venous malformation was treated by endovascular sclerotherapy. Four weeks later, ultrasonography showed a resolution of the lesion. Conclusion Endovascular sclerotherapy appears to be an effective and safe treatment for jugular venous malformation.

Estado actual y experiencia clínica en el tratamiento de las estenosis traqueobronquiales con prótesis metálicas autoexpandibles

La aparicion de una estenosis sintomatica en el arbol bronquial puede provocar a los pacientes una situacion de alto riesgo vital por asfixia. La implantacion de protesis ( stents ) metalicas puede resolver la estenosis de una forma paliativa y aliviar el estado clinico de estos pacientes. Evaluamos la efectividad de las protesis metalicas expandibles como metodo terapeutico en diferentes tipos de estenosis traqueobronquiales. Se han implantado en la sala de radiologia intervencionista (RI), bajo control fluoroscopico y endoscopico, un total de 16 protesis metalicas autoexpandibles tipo Wallstent en 16 pacientes con estenosis traqueobronquiales (12 malignas y 4 benignas). Las protesis fueron ubicadas en el lugar correcto, sin apreciarse complicaciones, obteniendose una mejoria clinica inmediata en todos los pacientes. Tres pacientes con estenosis postintubacion necesitaron tratamiento adicional con laser endoscopico durante el control evolutivo. Todos los pacientes con patologia de origen maligno fallecieron por su enfermedad de base, manteniendose sin sintomatologia traqueal y con su luz permeable. Las protesis metalicas constituyen una alternativa terapeutica paliativa valida en las estenosis traqueobronquiales malignas.

Actinomicosis osteoarticular y retroperitoneal. A propósito de un caso

La actinomicosis es una infeccion bacteriana granulomatosa cronica con tendencia a formar abscesos y fistulas cutaneas. Su agente patoge-no mas frecuente es Actinomices israelii, que habitualmente es un co-mensal de la boca y del tracto gastrointestinal humanos. La actinomi-cosis retroperitoneal es rara, y aun mas inusual la afectacion osea y articular. Presentamos un caso de actinomicosis retroperitoneal y osteoarticu-lar, y efectuamos una evision de la bibliografia.

Filtros de vena cava inferior LGM. Experiencia y seguimiento en 40 pacientes

La enfermedad tromboembolica pulmonar (TEP) supone una patologia grave con grandes implicaciones en morbimortalidad que casi siempre tiene como punto de partida una trombosis venosa profunda. En ocasiones, el diagnostico de trombosis venosa profunda (TVP) plantea como alternativa terapeutica la opcion del implante de un filtro percutaneo para interrupcion de vena cava inferior. Presentamos nuestra experiencia con 40 filtros de LGM (Braun Company) describiendo aspectos tecnicos, factores evolutivos y resultados.