Luis Meneses

Gastric Cancer after Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed surgical procedures for morbid obesity. Several complications that may develop in the short- and long-term have been reported. We present a patient who presented with cancer in the bypassed stomach 8 years after RYGBP. Although the development of this lesion is rare and only a few cases have been reported, there are aspects worthy of discussion. Several monitoring, diagnostic and therapeutic alternatives are analyzed.

Carotid artery dissection: endovascular treatment. Report of 12 patients.

The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents.

Hepatic encephalopathy in a liver transplant recipient with stable liver function

Postshunt hepatic encephalopathy after liver transplantation (LT) is an infrequent condition and is commonly associated with portal occlusion or stenosis and the presence of a patent portosystemic shunt. Portal vein stenosis (PVS) or thrombosis (PVT) are uncommon complications after LT. The overall frequency of both complications is reported to be less than 3%. When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in approximately 50% of the cases and mainly diagnosed by a routine ultrasound. Symptomatic postshunt hepatic encephalopathy (HE) is a very infrequent condition after LT that has been scarcely reported in the literature. We present here the case of a liver recipient with normal graft function who presented with hepatic encephalopathy 3 months after LT with stable liver function but a severe portal stenosis and the presence of a spontaneous portosystemic shunt whose successful endovascular treatment was followed by the complete resolution of the HE.

Determinaciones de niveles de creatina y lípidos mediante espectroscopia por resonancia magnética en miocardio de pacientes con insuficiencia cardiaca no isquémica

Heart failure (HF) is characterized, among other features, by the development of alterations in myocardial energy metabolism, involving a decrease in glucose utilization and increased free fatty acid uptake by cardiomyocytes, associated with decreased deposits of high-energy phosphates (creatine phosphate/ creatine transporter). Magnetic resonance (MR) imaging allows a direct and noninvasive assessment of myocardial metabolites.

Evaluación prospectiva de la venografía mediante angioTC en el diagnóstico de enfermedad tromboembólica

BACKGROUND CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism. AIM To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64-slice multidetector tomography. MATERIAL AND METHODS Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered. RESULTS A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36%) and isolated in the rest. Thirty five of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10%) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30%) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT. CONCLUSIONS The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors.

Enhancement of Visual Perception with Use of Dynamic Cues

UNLABELLED Institutional review board approval and signed informed consent were not needed, as medical images included in public databases were used in this study. The purpose of this study was to improve the detection of microcalcifications on mammograms and lung nodules on chest radiographs by using the dynamic cues algorithm and the motion and flickering sensitivity of the human visual system (HVS). Different sets of mammograms from the Mammographic Image Analysis Society database and chest radiographs from the Japanese Society of Radiological Technology database were presented statically, as is standard, and in a video sequence generated with the dynamic cues algorithm. Nine observers were asked to rate the presence of abnormalities with a five-point scale (1, definitely not present; 5, definitely present). The data were analyzed with receiver operating characteristic (ROC) techniques and the Dorfman-Berbaum-Metz method. The video sequence generated with the dynamic cues algorithm increased the rate of detection of microcalcifications by 10.2% (P = .002) compared with that obtained with the standard static method, as measured by the area under the ROC curve. Similar results were obtained for lung nodules, with an increase of 12.3% (P = .0054). The increase in the rate of correct detection did not come just from the image contrast change produced by the algorithm but also from the fact that image frames generated with the dynamic cues algorithm were put together in a video sequence so that the motion sensitivity of the HVS could be used to facilitate the detection of low-contrast objects. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/250/2/551/DC1.

Resonancia magnética cardíaca con perfusión stress: Utilidad clínica y relación con coronariografía convencional

Resumen: Introduccion: La resonancia magnetica cardiaca (RMC) es una herramienta no invasiva, libre de radia-cion que permite una evaluacion global del corazon. Una de las potencialidades son los estudios de perfu-sion miocardica con stress. Objetivo: Presentar nuestra experiencia de RMC con stress (RMCS) su correlacion con la coronariografia convencional (CC) y su relacion con eventos clinicos. Metodo: En forma prospectiva se incluyeron en un re-gistro todos los pacientes sometidos a RMCS en nues-tro servicio entre Enero 2007 y Abril 2009.Todos los pacientes fueron sometidos a RMCS anali-zando anatomia, estructura, funcion global y segmen-taria, perfusion stress/reposo y viabilidad miocardica. Los examenes fueron realizados en resonadores 1.5 T, en apnea de ± 10 segundos, con gatilleo ECG retros-pectivo y con uso de Gadolinio endovenoso para las fases de perfusion y viabilidad El estudio de stress se realizo con inyeccion de adenosina ev (140ug/kg/min) tras lo cual se adquirieron las imagenes y comparadas con la fase de reposo. El estudio de viabilidad se realizo a continuacion de la fase de reposo. Se consideraron como RMCS positivas aquellas con areas de hipoper-fusion en stress que se recuperaron en reposo. En aque-llos pacientes que fueron sometidos a CC dentro de los 3 meses de realizado la RMCS, se realizo correlacion entre ambos metodos, considerando presencia y loca-lizacion de la enfermedad coronaria. Se consideraron significativas las lesiones ≥70% de estenosis luminal.

TIPSS Procedure in the Treatment of a Single Patient After Recent Heart Transplantation Because of Refractory Ascites Due to Cardiac Cirrhosis

We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient’s respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.

Quimioembolización hepática en el manejo terapéutico del hepatocarcinoma. Reporte de dos casos

Chemoembolization is a therapeutic alternative for those patients with hepatocarcinoma that cannot be excised surgically or that are waiting a liver allograft. We report two patients with hepatocarcinoma who were subjected to chemoembolization. A 65 years old male with a chronic liver disease and right lobe hepatocarcinoma, waiting for a liver transplantation, was subjected to two sessions, of chemoembolization four weeks apart. A magnetic resonance showed a 80% reduction of tumor volume one month later. A 72 years old diabetic male with an alcoholic liver disease with two hepatocarcinoma in the right lobe was subjected to two sessions of chemoembolization, separated by four weeks. A magnetic resonance one month later showed the absence of blood flow in both lesions, suggesting complete necrosis.