Luis Meneses Q

Factores de riesgo de daño renal permanente en niños con infección del tracto urinario

Background: In children, urinary tract infection (UTI) is a very common disease, and can cause permanent kidney damage. Aim: To determine risk factors for permanent kidney damage, in children with UTI. Patients and methods: In 337 children with UTI (237 female, mean age 4,2 years) a static renal scintigraphy was performed to assess the presence of permanent kidney damage. The history of vesicoureteral reflux and number of episodes of UTI was obtained. Results: One hundred three children had a history of one episode of infection and the rest had recurrent infections. Permanent kidney damage was observed in 161 children (48%). This damage was observed in 39% of children of less than one year of age, in 43% of children aged 1 to 5 years of age and in 58% of children older than 5 years (p=0.02). Sixty three percent of 122 children with vesicoureteral reflux had permanent kidney damage, compared with 27% of children without this condition (p <0.001). Likewise, damage was observed in 36% of children with one episode of infection and 47% of children with recurrent infections (p <0.01). No gender differences were observed. Conclusions: Vesicoureteral reflux, recurrence of UTI and age are associated with permanent renal damage in children with UTI (Rev Med Chile 2002; 130: 1147-53)

UTILIZACIÓN DE LA RESONANCIA MAGNÉTICA CON CONTRASTE DE FASE PARA EL DIAGNÓSTICO DEL SÍNDROME DE CONGESTIÓN PELVIANA

Introduction: Pelvic Congestion Syndrome (PCS) is produced by anomalous flow in ovarian veins. Direct venography (DV) is the gold-standard for diagnosis. PhaseContrast Magnetic Resonance Angiography (PC-MRA) appears as an alternative that would permit a morphological and functional assessment. The purpose of the study was to evaluate the usefulness of flow velocity (measured with PC-MRA) as a diag nostic criterion and also to compare it with the DV technique. Patients and methods: We prospectively included 8 female patients with clinical suspicion of PCS who were referred for undergoing DV over a six-month period. PC-MRA examinations were performed in all of them. Slow anterograde or retrograde flow were the diagnostic criteria. Sensitivity, specificity, PPV, and NPV were also calculated. Results: Data from 16 veins were analized by means of a home-made software written in Matlab. There were 12 abnormal and 4 normal veins according to DV results. All the abnormal veins were correctly identified by MR-PC. Two veins (corresponding to the same patient) were considered as normal in accordance with DV results, whereas the PC-MRA analysis revealed them as abnormal veins. This patient presented with PCS typical symptoms. Sensitivity and specificity values were 100 and 50%, respectively, whereas PPV and NPV values were 86 and 100%, respectively. Conclusion: PC-MRA is a useful diagnostic tool for patients with clinical suspicion of PCS and could avoid unnecessary invasive procedures.

COLITIS ISQUÉMICA NO OCLUSIVA GANGRENOSA: CRITERIOS DIAGNÓSTICOS CON TOMOGRAFIA COMPUTADA MULTIDETECTOR

Introduccion: La isquemia constituye la principal causa de colitis en pacientes mayores de 50 anos. La mayor parte de los casos cursa un cuadro autolimitado, de buen pronostico. Existe un subgrupo de pacientes que presentan isquemia transmural con necrosis parietal y mortalidad determinada por peritonitis y sepsis secundaria. Objetivo: Documentar los hallazgos lu minales, parietales y peritoneales en pacientes con necrosis colonica de etiologia isquemica, que permitan un diagnostico oportuno. Material y Metodos: Revision retrospectiva de fichas clinicas y estudios tomograficos de doce pacientes (7 hombres, 5 mujeres) cuyas edades varian entre los 46-91 anos (promedio: 70.3 anos) con necrosis secundaria a colitis isquemica (Cl) no oclusiva, documentando el status del paciente (ambulatorio, hospitalizado), factores de riesgo y sintomas al ingreso. Los doce pacientes fueron sometidos a tomografia computada multidetector (TCMD). Resultados: Seis pacientes consultaron al servicio de urgencia por dolor abdominal y 6 debutaron durante hospitalizacion por otra causa. La evaluacion parietal demostro ausencia de impregnacion en 11/12 casos (91.6%) y neumatosis mural o vascular en 5/12 casos (41.6%). Engrosa-miento parietal fue visible en 4/12 casos (33%) y gas pericolonico en 3/12 casos (25%). Considerando el ileo y la alteracion de la densidad del tejido adiposo pericolonico como hallazgos inespecificos, en 3/12 pacientes (25%) la ausencia de impregnacion mural del colon era el unico marcador de lesion parietal severa. Conclusion: Signos clasicos de Cl como engrosamiento parietal son infrecuentes de encontrar en casos avanzados con gangrena mural. La falta de impregnacion parietal post contraste se correlaciona con la presencia de necrosis y puede ser el unico marcador tomografico de lesion isquemica transmural irreversible del colon, en ausencia de neumatosis o evidencias de perforacion intestinal

Tratamiento endoluminal de disección aguda complicada en aorta descendente: Comunicación de un caso

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic (Rev Med Chile 2006; 134: 1024-9). (Key words: Aortic aneurysm, thoracic; Aortic rupture; Blood vessel prosthesis)

Hidronefrosis del recién nacido: Cintigrafía renal dinámica con Tc99m MAG3 durante el primer mes de vida

Background: The early and accurate diagnosis of obstructive uropathy in the newborn, prevents secondary complications and kidney damage. Aim: To study the usefulness of Tc99M MAG3 diuretic renogram in newborns with hydronephrosis. Material and methods: Forty newborns, aged 1 to 30 days, with hydronephrosis, were studied. A Tc99M MAG3 diuretic renogram (DR) was done and its results were compared with clinical features and other imaging studies. Each kidney and its ureter, were considered a renal unit. Results: Seventy six renal units were evaluated. Twenty six were normal on prenatal ultrasound examination and DR. In 11 of the 50 renal units with hydronephrosis, renal function was impaired. Thus, it was impossible to obtain an excretory curve. In 17 of the 39 remaining renal units, the absence of obstructive uropathy was demonstrated clinically. In 16 of these, the DR showed absence of obstruction. In 20 of 21 renal units with confirmed obstructive uropathy, DR showed an obstructive pattern. Conclusions: In newborns, there is an adequate Tc99M MAG3 uptake and diuretic response. Thus, DR becomes a good functional assessment method in newborns with hydronephrosis (Rev Med Chile 2003; 131: 251-8).

Incidencia, factores de riesgo y tratamiento de las complicaciones biliares del trasplante hepático*

Abstract Biliary tract complications after liver transplantation Introduction: Biliary tract complications (BC) are cause of mortality after liver transplantation (LT). There are different treatment alternatives for this complication. Aim: to determinate incidence, risk factors and treatment of biliary complications after LT. Materials and Methods: A retrospective descriptive cohort of patients undergoing LT between March 1994 and March 2009. Risk factors and incidence for BC were ex-plored. Also the BC impact on overall survival on LT patients was assessed. We used SPSS 15.0 for statistical analysis and considered a significant p value less than 0.05. Results: 107 LT were performed in 102 patients. In 30 (28%) there was some biliary complication. Ten (33.3%) were early complications (< 3 months) and 20 (66.7%) were late (≥ 3 month). Anastomotic stricture was the more frequent BC. The gender male recipient, the cold ischemic time and biliary reconstruction technique without tutor were associated with an increased risk for BC. Endoscopic treatment of biliary stricture was successful in 91% of cases at one year follow up. Three (10%) patients died due to BC or their long-term treatment.

EMBOLIZACIÓN DE ARTERIAS UTERINAS EN EL TRATAMIENTO DE MIOMAS UTERINOS SINTOMÁTICOS

SUMMARY Uterine fibroids may cause menorrhagia, infertility and a pressure effect over other pelvic organs. Uterine artery embolization (UAE) is a minimally invasive technique for treating fibroids. It has become a therapeutic alternative to hysterectomy and multiple myomectomy, for the treatment of symptomatic uterine fibroids in women do not wishing maintain their fertility. This technique consist in occluding both uterine arteries injecting small particles to cause infarction of fibroids, reducing their size and control bleeding and mass symptoms. This communication presents one of the first cases treated in our country by UAE with good symptoms control at one year follow-up.

Tromboembolismo pulmonar con compromiso hemodinámico: Tratamiento con trombólisis farmacológica y fragmentación mecánica. Caso clínico

Pulmonary Embolism (PE) has a wide clinical spectrum. It isimperative to detect patients with a high risk to develop right ventricular failure, because this isthe main cause of death in patients with massive PE. In this group of patients, invasive therapiesto relieve pulmonary obstruction and right ventricle overload should be used as soon as possible.We report a 85 years old male with massive PE treated with pharmacological thrombolysis andmechanical fragmentation with an angioplasty balloon. Pulmonary perfusion improvedsignificantly. Afterwards, systemic anticoagulation was started and an inferior vena cava filterwas installed percutaneously. The patient was discharged in good conditions, five days afteradmission (Rev Med Chile 2005; 133: 1477-82).(

USO Y ABUSO DEL ESTUDIO RADIOLOGICO DE ESOFAGO, ESTOMAGO Y DUODENO EN PACIENTES PEDIATRICOS: NECESIDAD DE UNA ADECUADA NORMATIVA Y DE UNA ESTANDARIZACION DEL EXAMEN

Introduccion: El rol de la radiografia de esofago, estomago y duodeno (RxEED) en el estudio del nino con vomitos y en especial, en la pesquisa del reflujo gastroesofagico (RGE), en nuestro medio, es confuso. El RGE es una condicion generalmente fisiologica que se manifiesta como regurgitacion habitual en el lactante menor. La academia Americana de Pediatria considera la RxEED como un procedimiento util para la evaluacion de anormalidades anatomicas y reitera que en los lactantes con vomitos y regurgitacion, la historia clinica y el examen fisico son suficientes para formular diagnostico, reconocer complicaciones e iniciar tratamiento. Los radiologos estamos efectuando examenes muchas veces innecesarios y molestos para los ninos, cuyos resultados no son adecuadamente interpretados, ya sea por desconocimiento de los medicos solicitantes o por una errada normativa legal en cuanto a la extension de licencia maternal. Se debe agregar que estamos haciendo uso inadecuado de radiacion ionizante. Objetivos: Este trabajo persigue analizar la confusion sobre la utilidad e indicaciones de la RxEED en el estudio del nino con vomitos o regurgitacion, la inadecuada indicacion medica de este y la errada normativa vigente que obliga a los ninos a ser sometidos a este estudio para extender una licencia postnatal de las madres. Se propone ademas, un intento para estandarizar la tecnica de examen y establecer un consenso en cuanto a sus indicaciones e interpretacion. Pacientes y Metodo: En forma prospectiva, se incluyo en este estudio a 190 ninos, menores de 1 ano, estudiados en forma consecutiva con RxEED en nuestro Hospital Clinico, desde el 1° de Abril hasta el 30 de Septiembre del 2004. En cada caso se consigno numerosos antecedentes, incluyendo la tecnica del examen, el cuadro clinico, el motivo del examen y un cuestionario a los padres. Resultados:Este estudio revelo que la mayor parte de los ninos referidos para RxEED, eran lactantes que solamente presentaban regurgitacion y/o vomitos, sin complicaciones de ninguna especie y en la gran mayoria no existia una indicacion medica real. Un 79% de los pacientes fue referido por vomitos o regurgitacion y en un 6% no se especificaron causas. Solo en un 4% se sospecho un trastorno de la deglucion, que podria justificar el examen. En 46 casos (24%), la madre estaba ya con licencia debido al RGE de su hijo al momento del examen y en 39 de ellas (85%) el examen se solicito por vomitos o regurgitacion, con una mediana de edad de cuatro meses. Los hijos de las 114 madres que no estaban con licencia fueron referidos al estudio por vomitos o regurgitacion en un 62% de los casos y la mediana de edad fue de tres meses. Treinta de estas 114 madres (26%) concurrieron al examen para obtener una probable concesion de licencia para su trabajo, en caso que se documentara RGE en sus hijos. En 81 pacientes hubo RGE en el examen y en tres se comprobo una alteracion en la deglucion. En ningun paciente se documento anormalidad anatomica del esofago, del estomago, ni alteraciones evidentes del vaciamiento gastrico. Conclusiones: Nuestros resultados comprueban que el uso de la RxEED en el nino, ha sido notablemente desvirtuado en nuestro medio, tanto desde el punto de vista medico como social, siendo solicitado sin causas medicas justificadas en la inmensa mayoria de los casos y su indicacion solo sirve de pretexto para documentar una condicion fisiologica con el fin de conceder licencias de trabajo maternales. La normativa vigente deberia se modificada para extender el periodo de licencia maternal postnatal a todas las madres sin excepcion o bien buscar otras herramienta que permita reconocer los casos que realmente requieren una extension de ella, y liberar a los radiologos de estar involucrados en una practica eticamente discutible. Es necesario ademas estandarizar la tecnica de la RxEED, en nuestro medio, para lo cual se hace una proposicion.