Nuestra experiencia en el tratamiento urgente de la hemorragia renal

Resumen: Introducción: Los casos de hemorragia renal que provocan un compromiso para la vida del paciente requieren de una cirugía urgente. Actualmente la cirugía endovascular es el tratamiento de primera elección. Objetivo: Revisar los pacientes con una hemorragia renal que fueron intervenidos de urgencia mediante una técnica endovascular en nuestro centro. Evaluar las causas de sangrado renal, el tratamiento realizado así como los resultados obtenidos. Material y métodos: Realizamos un estudio retrospectivo de pacientes consecutivos con sangrado renal y que fueron tratados con una técnica endovascular entre junio del 2012 y junio del 2017 en el Hospital Universitari Joan XXIII (Tarragona). Se recogieron los datos demográficos (edad, sexo, comorbilidad) y otras variables relacionadas (mecanismo de la lesión, la estabilidad hemodinámica y si estaba en tratamiento anticoagulante). También se analizaron los hallazgos encontrados en la angio-TAC, el tiempo transcurrido entre el diagnóstico y la realización de la cirugía, la técnica endovascular y el material utilizado, la extensión de parénquima embolizado y los resultados obtenidos. Resultados: Incluimos a 22 pacientes con una edad media de 63 años (19-85). Las causas de lesión fueron relacionadas con punción de una biopsia renal (n=7,31; 8%), sangrado de tumoraciones malignas renales (n=5; 22,7%), traumatismos (n=4; 18,2%), angiomiolipomas (n=2; 9,1%), sangrado espontáneo (n=2; 9,1%) y complicaciones quirúrgicas (n=2; 9,1%). En todos los casos la técnica endovascular realizada fue la embolización. El material utilizado fue: esferas (9,1%), coils (63,6%), esferas + coils (18,2%), esferas+oclusor (9,1%). En 17 de los casos (77,3%) se llevó a cabo una embolización selectiva y en 5 casos (22,7%) una embolización de todo el riñón. El éxito clínico y técnico fue del 100%. La mortalidad a los 30 días fue del 9,1%. Conclusión: Creemos que el tratamiento endovascular es una técnica efectiva para el control del sangrado renal y permite, en la mayoría de casos, la preservación de gran parte de parénquima renal. Abstract: Introduction: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. Objectives: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. Material and methods: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. Results: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. Conclusion: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved. Palabras clave: Embolización, Hemorragia, Riñón, Arteria renal, Keywords: Embolisation, Haemorrhage, Kidney, Renal arter

Bone marrow biopsy superiority over PET/CT in predicting progression-free survival in a homogeneously-treated cohort of diffuse large B-cell lymphoma.

Several studies have reported uneven results when evaluating the prognostic value of bone marrow biopsy (BMB) and PET/CT as part of the staging of diffuse large B-cell lymphoma (DLBCL). The heterogeneity of the inclusion criteria and not taking into account selection and collinearity biases in the analysis models might explain part of these discrepancies. To address this issue we have carried a retrospective multicenter study including 268 DLBCL patients with a BMB and a PET/CT available at diagnosis where we estimated both the prognosis impact and the diagnostic accuracy of each technique. Only patients treated with R-CHOP/21 as first line (n = 203) were included in the survival analysis. With a median follow-up of 25 months the estimated 3-year progression-free survival (PFS) and overall survival (OS) were 76.3% and 82.7% respectively. In a multivariate analysis designed to avoid a collinearity bias with IPI categories, BMB-BMI [bone marrow involvement](+) (HR: 3.6) and ECOG PS > 1 (HR: 2.9) were independently associated with a shorter PFS and three factors, age >60 years old (HR: 2.4), ECOG PS >1 (HR: 2.4), and abnormally elevated B2-microglobulin levels (HR: 2.2) were independently associated with a shorter OS. In our DLBCL cohort, treated with a uniform first-line chemotherapy regimen, BMI by BMB complemented performance status in predicting those patients with a higher risk for relapse or progression. In this cohort BMI by PET/CT could not independently predict a shorter PFS and/or OS