Ricardo Rodríguez

Jejuno–ileal diverticulitis with localized perforation: CT and US findings

PURPOSE To describe the computed tomography and ultrasound findings of five cases of small bowel diverticulitis with localized perforation. MATERIAL AND METHODS Our database, from April 2003 to August 2007, was reviewed and five cases of small bowel diverticulitis were identified. RESULTS Jejuno-ileal diverticulitis with covered perforation usually presents as wall thickening of a small bowel loop and an adjacent inflammatory mass containing air bubbles. CONCLUSION Small bowel diverticula are rare and mostly asymptomatic. They become clinically relevant when complications arise, such as diverticulitis. The symptoms of jejuno-ileal diverticulitis are non-specific and the diagnosis is performed mainly by imaging studies.

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: First year of experience

OBJECTIVE to describe the experience at two tertiary centres during the first year of use of magnetic resonance enterography (MRE) for the management of Crohns disease (CD): indications and influence of the technique in clinical decision making. MATERIALS AND METHODS retrospective descriptive study in which patients who underwent MRE were included consecutively. Epidemiological and clinical data were collected from the patients, as well as the indication for the study and how it influenced clinical decision making in the 10 days following the radiological study. RESULTS 24 MREs were performed in suspected CD and 126 known CD; partial bowel obstruction in 53 patients (42%), monitoring of medical treatment in 34 (27%), due to incomplete ileocolonoscopy in 16 (13%), extension study of the small intestine in 15 (12%) and suspected complicated CD in 8 patients (6%). The MRE influenced in a change in treatment in 83 (55.3%) patients: 16 (10.7%) started with immunosuppressants, 41 (27.3%) with anti-TNFα were started on or switched, 15 (10%) were ordered surgery and in 3 (2%) changed from combined therapy to monotherapy. The MRE had less influence on clinical decision making in the group in which the indication was suspected CD (p < 0.05). CONCLUSIONS the use of MRE helped on decision making in more than half of patients, especially with regards to decisions related to the use of biological therapies and the indication for surgery. MRE was less useful in suspected CD patients.

Role of computed tomography on large B-cell non-Hodgkin’s lymphoma follow-up and the risk of radiation-induced neoplasm: A retrospective cohort study

INTRODUCTION To evaluate the role of surveillance computed tomography (CT) in detection of tumor relapse after complete remission for large-cell lymphoma and to estimate the cancer risk related to those examinations. MATERIALS AND METHODS We retrospectively identified the cases of large-cell lymphoma diagnosed at our institution during a fifteen years period. We extracted from charts the information needed. Agreement between clinical and radiological evaluation for relapse detection was determined with index kappa and McNemar tests. We analysed the surveillance CT examinations performed to the patients in complete remission with no recurrence during the follow-up period and we estimated the life attributable risk (LAR) of radiation-induced cancer above base line using the approach of the Biological Effects of Ionizing Radiation (BEIR) VII. RESULTS 184 patients with biopsy confirmed large-cell lymphoma were included. Complete remission was attained in 125 patients. After a median follow-up of 93.73 months, 97 of them remain in remission. Relapse was confirmed in 28 patients; only 3 of them were asymptomatic. Kappa and McNemar analyses revealed good agreement for diagnosis of recurrence and significant difference for exclusion of relapse. Patients in remission received a median of 6 surveillance CT examinations. Fifty-seven patients had total cumulative doses greater than 100mSv. The mean increase in estimated radiation-induced cancer risk was 0.5%. CONCLUSION Our results suggest that periodic CT examinations have a limited role in detecting relapse in large-cell lymphoma as the clinical surveillance dictates the patient management.

Shestov, L. "Apoteosis de lo infundado". Hermida Editores. Madrid, 2015.

719 contextuales que pudieran afectarle. Específicamente esto puede comprobarse cuando se nos detalla como Herrera intenta iluminar el pensamiento de Luria mediante concepciones de Cordovero. También podría darse el caso cuando se nos presentan las posibles razones contextuales que podrían justificar la clase de concepción de asistencia divina que se presenta en Puerta del Cielo. Hallamos una situación semejante cuando se nos aclaran aspectos de carácter teórico, cómo el método metafórico empleado por Herrera o la aproximación a la Causa Primera mediante negaciones –siguiendo a Ficino. A ello debemos añadir todo un seguido de notas a lo largo de la obra por parte del editor que resultan extremadamente útiles ya sea aclarándonos conceptos, transcripciones o resaltando ciertos aspectos del pensamiento del autor y su vinculación a otros pensadores. Con lo dicho hasta aquí, hemos podido esbozar a grandes rasgos el contenido básico que podemos hallar en Puerta del Cielo. Como cabe esperar, la obra abarca un conjunto de cuestiones mucho más amplio de lo que hemos presentado. Sin embargo hemos podido introducir algunas de las cuestiones de mayor importancia además de resaltar las ventajas que posee está edición en concreto.

Valoración de calidad de imagen y dosis en exámenes de tomografía computarizada helicoidal de abdomen y de pelvis en pacientes con linfoma

Objective: The aim of this study is to evaluate the quality of pelvic and abdominal CT images performed for lymphoma according to the criteria proposed in the European Commission Guidelines on radiation imaging. (En castellano dice: la Guia de la Comision Europea. Lo que pasa es que hay muchas guias publicadas por la Comision: aseguranse que sea esta la citada) Material and methods: The criteria were evaluated in a sample of 100 patients attended at five public hospitals in the Autonomous Community of Madrid. All patients underwent single-slice helical CT studies. Fulfillment of the imaging criteria in the selected images was evaluated by five radiologists, one from each center, working independently. The Index of Image Quality (IIQ) was determined for the complete abdominal and pelvic examination. The dose was also measured to estimate the values of the CT Dose Index (CTDIw), Dose by Length Product (DLP), and effective dose (E). Results: A high rate of fulfillment of the criteria was found for individual abdominal images. In the pelvis, the rate of fulfillment was lower, especially for three criteria. The IIQ for each center was between 83%-92%, with variable degrees of internal deviation. The mean values of CTDIw per center were between 16-23 mGy; DLP values were between 430 and 750 mGy cm, and the effective dose was 7-12 mSv. In general, no correlation was found between IIQ and dose per patient, either for the entire sample (r = 0.04) or by centers (r£0.36). Conclusions: The utility of the European Unions Quality Criteria was confirmed. We have elaborated a single list of criteria of image quality and suggest reference dosage levels for abdominal-pelvic CT examinations in patients with lymphoma.