RESUMEN

The upper urinary tract is the most common human organ system affected by congenital anomalies. A Horseshoe kidney is a fusion anomaly, it can be described as a fusion across the midline of 2 distinct functioning kidneys. The incidence of renal tumors in a Horseshoe kidney is higher than in the normal population. We present a 60-year-old male patient with a history of Horseshoe kidney and a diagnosis of clear cell renal cell carcinoma who underwent a combined therapeutic approach, guided by interventional radiology. This approach involved selective transarterial embolization and microwave ablation. Three months after surgery and with abdominal MRI follow-up, there is evidence of a non-viable tumor, indicating a favorable response to the intervention.

RESUMEN

Ovarian lesions represent a diagnostic challenge for the radiologist and should be approached according to the patient's age, menstrual cycle, and imaging characteristics. These lesions can be cystic, mixed, or solid-predominant structures. Generally, the occurrence of benign lesions surpasses that of malignant ones at a ratio of 3:1. However, within infantile and juvenile age groups, this becomes an infrequent occurrence, making up only about 5% of ovarian tumor cases. This case report sheds light on a unique scenario involving a pediatric patient who harbored 2 benign tumors simultaneously: a mature cystic teratoma and a serous cystadenoma.

RESUMEN

Physicians are facing a growing challenge in characterizing suspicious pulmonary lesions through biopsy. Video thoracoscopic surgery is crucial for conducting surgical biopsies of these nodules. However, accurately identifying small pulmonary nodules, tiny, subsolid, and deep ones, remains a significant challenge due to the absence of digital palpation. One proposed technique for localization involves using a harpoon, initially designed for mammary nodules but also applied to pulmonary nodules. In cases involving solitary pulmonary nodules, histologic characterization is often necessary also accurate descriptions through computed tomography and the patient's clinical and epidemiologic context allow for a presumptive diagnosis. In this case, during an abdominal CT scan, a 49-year-old female patient was serendipitously found to have a ground-glass infiltrate in the anteromedial segment of the lower lobe of her left lung. Despite presenting with normal lung auscultation on physical examination, the increasing prevalence of subsolid lung nodules, combined with the contemporary era of minimally invasive surgery, prompted the medical team to employ CT-guided harpoon marking for precise lesion localization. Subsequent pathology analysis confirmed the presence of lepidic pattern adenocarcinoma. This case underscores the efficacy of the CT-guided harpoon marking approach, which significantly enhances surgical precision. Such precision is paramount in formulating individualized treatment strategies and follow-up plans for patients with similar clinical presentations.

RESUMEN

Portal hypertension is a frequent syndrome characterized by an increased portal pressure gradient. The relevance of portal hypertension derives from the frequency and severity of its complications. Rectal varicose is relatively common in portal hypertension patients with meager bleeding rates; However, rectal variceal bleeding is a complicated and sometimes life-threatening condition. The management of rectal variceal bleeding has yet to be adequately established. Endoscopy, surgery, or transjugular intrahepatic portosystemic shunt placement (TIPS) can be performed in patients with gastrointestinal bleeding secondary to portal hypertension due to different etiologies. We present a successful case of direct abdominal percutaneous embolization of multiple and tortuous superior rectal varicose via the inferior mesenteric vein in a 7-year-old female patient with refractory rectal variceal bleeding, not susceptible to endoscopic, surgical, or TIPS management.

RESUMEN

Penile trauma is uncommon, with an incidence of 1/175,000 cases in emergency departments worldwide. Less frequent, there may be cases of penile fracture with the penis in a flaccid state and also develop vascular lesions such as rupture of the cavernous artery, pseudoaneurysms, and arterio-cavernous fistulas. We present a case of a 32-year-old male patient with the perineum and pelvis blunt trauma after a motorbike accident with a secondary bilateral arterio-cavernous fistula treated with retrograde embolization through the arch of cavernous arteries.

RESUMEN

Introducción. Las listas de espera para cirugía de alta prevalencia son producto de una limitada oferta ante una elevada demanda de jornadas quirúrgicas. Tienen un impacto sobre las condiciones médicas de los pacientes y la consulta por urgencias. Como respuesta, se han incorporado los espacios quirúrgicos adicionales en horarios no convencionales. Su creciente implementación, aunque controversial, se reconoce cada vez más como una nueva normalidad en cirugía. Hay una limitada documentación de la efectividad de la medida, debido a la complejidad e intereses de los participantes. Métodos. Se analizó desde una posición crítica y reflexiva la perspectiva de los actores involucrados en un programa de cirugía en horario extendido, estableciendo las posibles barreras y los elementos facilitadores de una política enfocada a procedimientos en horario no convencional. Asimismo, se describen posibles oportunidades de investigación en el tema. Discusión. Los programas quirúrgicos en horarios no convencionales implican un análisis de los determinantes de su factibilidad y éxito para establecer la pertinencia de su implementación. La disponibilidad de las salas de cirugía, una estandarización de los procedimientos y una cultura de seguridad institucional implementada por la normativa vigente, favorecen estas acciones operacionales. Los aspectos económicos del prestador y del asegurador inciden en la planeación y ejecución de esta modalidad de trabajo. Conclusión. La realización segura y el éxito de un programa de cirugía en horario no convencional dependen de la posibilidad de alinear los intereses de los actores participantes en el proceso

Introduction. Waiting lists for high-prevalence surgeries are the product of limited supply due to a high demand for surgical days. They have an impact on patients' medical conditions and emergency consultation. In response, additional surgical spaces have been incorporated at unconventional times. Its growing implementation, although controversial, is increasingly recognized as a new normal in surgery. There is limited documentation of the effectiveness of the measure due to the complexity and interests of the participants. Methods. The perspective of the actors involved in an extended hours surgery program was analyzed from a critical and reflective position, establishing the possible barriers, and facilitating elements of a policy focused on procedures during unconventional hours. Possible research opportunities on the topic are also described. Discussion. Surgical programs at unconventional times involve an analysis of the determinants of their feasibility and success to establish the relevance of implementation. The availability of operating rooms, a standardization of procedures and a culture of institutional security implemented by current regulations, favor these operational actions. The economic aspects of the provider and the insurer affect the planning and execution of this type of work. Conclusion. The safe realization and success of a surgical program in unconventional hours depend on the possibility of aligning the interests of the actors involved in the process

Asunto(s)

RESUMEN

Bioaugmentation has many applications as a bioremediation technique. It is usually performed by bacteria but microalgal consortia also have great potential for bioremediation. This study evaluated the ability of a microbial consortium with predominance of microalgae (MCPM) to decontaminate the water of the Mallorquín tropical swamp. The Mallorquín Swamp is a natural water reservoir, essential for the ecological and hydric balance of the region, as well as for the fishermen, but has received sewage for more than 20 years. Microalgae for bioremediation purposes were isolated from the swamp, selected, cultured in bioreactors, and poured back into the Mallorquín waters. After bioaugmentation, there was a significant reduction in the BOD5 (98%), nitrates (58%), enterococci (92%), and total coliforms (100%). Notably, despite the MCPM bioaugmentation, the original richness and abundance of phytoplankton in the Mallorquín swamp was not disrupted. These results confirm the benefits of phycoremediation as an effective tool for on-site bioremediation of natural water bodies and show an effective phycoremediation at a large scale without altering the autochthonous microalgae community. This constitutes the first report of a successful MCPM intervention performed at this scale in a natural swamp in Colombia. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-021-00990-y.

RESUMEN

Polymyxin resistance in Klebsiella pneumoniae has been attributed to mutations in mgrB, phoPQ, pmrAB, and crrAB and to the presence of mcr plasmid-mediated genes. Herein, we describe the molecular characteristics of 24 polymyxin- and carbapenem-resistant K. pneumoniae isolates recovered from six Colombian cities between 2009 and 2019. Minimum inhibitory concentrations (MICs) to polymyxin were confirmed by broth microdilution, and whole-genome sequencing was performed to determine sequence type, resistome, and mutations in the genes related to polymyxin resistance, as well the presence of mcr. The results showed high-level resistance to polymyxin (MICs ≥ 4 µg/mL). blaKPC-3 was present in the majority of isolates (17/24; 71%), followed by blaKPC-2 (6/24; 25%) and blaNDM-1 (1/24; 4%). Most isolates belonged to the CG258 (17/24; 71%) and presented amino acid substitutions in PmrB (22/24; 92%) and CrrB (15/24; 63%); mutations in mgrB occurred in only five isolates (21%). Additional mutations in pmrA, crrA, and phoPQ nor any of the mcr resistance genes were identified. In conclusion, we found clonal dissemination of polymyxin and carbapenem-resistant K. pneumoniae isolates in Colombia, mainly associated with CG258 and blaKPC-3. Surveillance of this multidrug-resistant clone is warranted due to the limited therapeutic options for the treatment of carbapenem-resistant K. pneumoniae infections.

RESUMEN

OBJECTIVE: To analyze retrospectively the safety and effectiveness of percutaneous microwave ablation of solid renal tumors, and also review different approach techniques. METHODS: It is a retrospective study approved by the ethics committee of both hospitals. 14 tumors with a mean size of 37 mm (12-50 mm) were treated in a single session, under general anesthesia and with CT guidance, in 14 patients (9 men) with a mean age of 66 years, using the ablation system AMICA by different approaches (trans pulmonary, trans peritoneal and retroperitoneal). A biopsy was performed with a core needle to 13 of them prior to ablation in the same session. CT abdominal follow-up was performed (with and without i.v. contrast) at 1, 3, 6, 12, 18 and 24 months after ablation. Changes in serum creatinine levels pre- and post-ablation were also analyzed. RESULTS: The average follow-up time was 16.5 months (3-28 months) and we obtained complete response in 100% of the treated tumors. Only two minor complications were observed: one self-limited perirenal hemorrhage and one asymptomatic hydronephrosis, in the two patients to whom we did a transpulmonary approach, without pneumothorax in any of them. CONCLUSION: Percutaneous ablation of renal tumors seems to be a safe and effective technique, either via transpulmonary, transperitoneal or retroperitoneal approach, depending on tumor location. KEY POINTS: • Microwave ablation produces coagulation necrosis. • The sink effect is smaller in microwave ablation. • Microwave ablation seems to be safe and effective. • The type of approach is not correlated with major complications (Clavien > o =II).

Asunto(s)

RESUMEN

OBJETIVO: Analizar retrospectivamente la seguridad y eficacia de la ablación percutánea por microondas de tumores sólidos renales, así como revisar diferentes técnicas de abordaje. MÉTODOS: Es un estudio retrospectivo aprobado por el comité de ética de ambos hospitales en donde se trató en una única sesión, con anestesia general y con guía por TC 14 tumores con tamaño promedio de 37mm (12-50mm, desviación estandar 10,9) en 14 pacientes (9 varones) con una edad media de 66 años y con el sistema de ablación AMICA por diferentes vías de abordaje (transpulmonar, transperitoneal y retroperitoneal). En 13 de ellos se realizó previo a la ablación y en la misma sesión biopsia con aguja gruesa. Se realizó seguimiento mediante TC abdominal (sin y con contraste i.v.) al mes de la ablación y posteriormente a los 3, 6, 12, 18 y 24 meses posterior a la ablación. Se analizó también la modificación de los niveles de creatinina sérica pre- y post-ablación. RESULTADOS: El tiempo medio de seguimiento fue de 16,5 meses (3-28 meses) y obtuvimos respuesta completa en el 100% de los tumores tratados con tasa de supervivencia global del 100% a los 2 años y de supervivencia libre de la enfermedad del 100% a los 3 meses del tratamiento sin aparición de metástasis en las imágenes de seguimiento. Sólo observamos dos complicaciones menores Clavien-Dindo I: hemorragia perirrenal autolimitada e hidronefrosis asintomática, en los dos pacientes donde realizamos abordaje transpulmonar, sin neumotórax en ninguno de ellos. CONCLUSIÓN: La ablación percutánea de tumores renales parece una técnica segura y eficaz, ya sea por vía transpulmonar, transperitoneal o retroperitoneal según la localización del tumor. Puntos Clave: · La ablación con microondas produce necrosis por coagulación. · El efecto de sumidero es menor en la ablación con microondas. · La ablación con microondas parece ser segura y efectiva. · El tipo de abordaje no se correlaciona con complicaciones mayores (Clavien>o = II)

OBJECTIVE: To analyze retrospectively the safety and effectiveness of percutaneous microwave ablation of solid renal tumors, and also review different approach techniques. METHODS: It is a retrospective study approved by the ethics committee of both hospitals. 14 tumors with a mean size of 37 mm (12-50 mm) were treated in a single session, under general anesthesia and with CT guidance, in 14 patients (9 men) with a mean age of 66 years, using the ablation system AMICA by different approaches (trans pulmonary, trans peritoneal and retroperitoneal). A biopsy was performed with a core needle to 13 of them prior to ablation in the same session. CT abdominal follow-up was performed (with and without i.v. contrast) at 1, 3, 6, 12, 18 and 24 months after ablation. Changes in serum creatinine levels pre- and post-ablation were also analyzed. RESULTS: The average follow-up time was 16.5 months (3-28 months) and we obtained complete response in 100% of the treated tumors. Only two minor complications were observed: one self-limited perirenal hemorrhage and one asymptomatic hydronephrosis, in the two patients to whom we did a transpulmonary approach, without neumothorax in any of them. CONCLUSION: Percutaneous ablation of renal tumors seems to be a safe and effective technique, either via transpulmonary, transperitoneal or retroperitoneal approach, depending on tumor location

Asunto(s)

RESUMEN

El trasplante de hígado es un método terapéutico efectivo para el tratamiento de múltiples enfermedades hepáticas terminales irreversibles, tanto agudas como crónicas. Los avances en la terapia inmunosupresora, la técnica quirúrgica y el cuidado perioperatorio han mejorado el pronóstico de los pacientes sometidos a este procedimiento. La ecografía con evaluación Doppler es el método de imagen más utilizado para valorar a estos pacientes, tanto en la etapa inicial como en el seguimiento a largo plazo. Tiene como ventajas estar ampliamente disponible, la posibilidad de volverse portátil, no generar efectos secundarios y no asociarse con efectos por radiación ionizante. Permite realizar una valoración anatómica en escala de grises y funcional con la evaluación del flujo de las diferentes anastomosis vasculares. Es el método diagnóstico ideal ante la sospecha de complicaciones vasculares. Las complicaciones más comunes y con más importancia clínica son las vasculares: trombosis arterial, trombosis venosa, estenosis, fístulas. También se encuentran complicaciones de la anastomosis biliar, las colecciones, las neoplasias y el rechazo. En este artículo se revisan los hallazgos normales y anormales en el Doppler de los pacientes sometidos a trasplante de hígado.

Liver transplantation is an effective therapeutic method for treatment of multiple irreversible terminal liver disease, both acute and chronic. Advances in immunosuppressive therapy, surgical technique and post-surgical care have improved the prognosis of patients undergoing this procedure. The ultrasound with Doppler assessment is the image method which is most commonly used to assess these patients, both in the initial phase and during long-term follow-up. The advantages of ultrasound Doppler are the following: It is widely available, it can be portable, it does not cause sideeffects, and it is not associated with ionizing radiation effects. In addition, it also allows an anatomical assessment of grey and functional scales, with flow evaluation of different vascular complications. The most common complications during liver transplantation, as well as the ones with the highest clinical importance are vascular complications: arterial thrombosis, venous thrombosis, stenosis, fistulas. In addition, one can find complications of biliary anastomosis, as well as collections, neoplasms and rejection. Normal and abnormal Doppler findings in patients undergoing liver transplantation are reviewed in this article.

Asunto(s)

RESUMEN

Objetivo: Determinar la efectividad de un protocolo de sedación endorrectal con tiopental sódico en niños a quienes se les practicaron estudios de imágenes diagnósticas en una clínica de cuarto nivel de complejidad. Materiales y método: Estudio observacional de serie de casos entre enero y marzo del 2004 en la Fundación Clínica Valle del Lili. Se incluyeron todos los sujetos pediátricos entre tres meses y ocho años de edad que requerían estudios de imágenes diagnósticas. Se administró tiopental sódico endorrectal a dosis de 25-40 mg/kg. Se definió como sedación exitosa aquella con la cual se terminó completamente el estudio o con mínimo de artificios. Se evaluaron sedación y eventos adversos secundarios. Resultados: La población del estudio fue de 103 niños, con una mediana de edad de dos años. El estudio logró terminarse exitosamente en 97 de los pacientes. En 98 de los casos se logró sedación antes de veinte minutos y el estudio se inició el 96 de las veces en los siguientes quince minutos. Se encontraron diferencias estadísticamente significativas entre quienes estuvieron en vigilia antes del estudio y quienes no respecto a interrupción de la sedación. El evento adverso más frecuente fue diarrea en trece pacientes y en cinco de ellos hubo necesidad de dosis de rescate de la sedación. Hubo dos casos de sialorrea y uno de vómito que resolvieron espontáneamente. Conclusiones: El protocolo de sedación con tiopental sódico por vía endorrectal es un procedimiento seguro y efectivo para la realización de estudios de imágenes diagnósticas en la población pediátrica de nuestra institución.

Asunto(s)