Valor de la resonancia magnética en la evaluación del compromiso del margen de resección circunferencial en pacientes con cáncer rectal Value of the magnetic resonance imaging in the assessment of the circumferential resection margin (CRM) in patients with rectal cancer

Propósito: Determinar si la RM puede predecir el compromiso tumoral del margen de resección circunferencial (MRC) en pacientes con cáncer de recto. Material y Métodos: Entre abril del 2005 y marzo del 2008, se evaluaron por resonancia magnética (RM), en forma consecutiva, 70 pacientes (40 M y 30 H, edad promedio de 64 años, rango de 34-78 años), con diagnóstico endoscópico y por biopsia de cáncer rectal inferior o medio. Se realizó una RM sin contraste E.V. en un equipo Siemens Avanto 1.5T, con bobina phase array de superficie. Se efectuaron secuencias con cortes finos ponderadas en T2 (TR¬|TE 4200|88, espesor de 3mm, gap 0, matriz de 256 x 256, FOV de 150x150 mm) en los planos axial, sagital y coronal. Los pacientes recibieron un enema rectal de 150 ml de glicerina previo al examen. No se realizó insuflación colónica ni administración de antiespasmódicos. Se midió la distancia más corta desde el borde del tumor hasta el MRC. Una distancia &#8804; 2 mm en el plano axial se consideró como compromiso del MRC. Resultados: El MRC fue &#8804; 2 mm tanto por RM como por anatomía patológica en 26 pacientes. En 8 casos, el MRC fue menor por RM que por anatomía patológica. En 32 pacientes el MRC estaba respetado por ambas metodologías diagnósticas y 4 pacientes fueron considerados positivos para compromiso del MRC en histología pero negativos por RM. La sensibilidad, especificidad, valor predictivo positivo y negativo de la RM para el compromiso tumoral del MRC fue de 86%, 80%, 76% y 88% respectivamente. Conclusión: La RM brinda información confiable del compromiso tumoral del MRC en pacientes con cáncer rectal, aportando una ayuda en la evaluación de este factor pronóstico de riesgo en pacientes previo al tratamiento quirúrgico.<br>Purpose: To determine whether magnetic resonance imaging (MRI) can predict tumor involvement of the circumferential resection margin (CRM) in patients with rectal cancer. Materials and methods: Between april 2005 and march 2008, 70 consecutive patients (mean age 64, range 34-78 years), 40 F and 30 M, with endoscopy and biopsy- proven middle and lower rectal cancer. Non contrast enhanced MRI was performed on a Siemens Avanto 1.5 T. A phased array coil was used and T2 weighted thin section sequences (TR/TE 4200/88, slice thickness 3mm, gap 0, matrix 256 x 256, field of view 150 x 150 mm) were performed in axial, sagittal and coronal orientations. Patients received a 150 ml glycerin enema before examination. No air insufflations or intramuscular antispasmodic was used. The shortest distance from the tumor edge to the circumferential margin was measured. A distance &#8804; 2 mm, analyzed in axial slices, was considered as definition of circumferential margin involvement. Results: The CRM was 2 mm in both MRI and histopathological findings in 26 patients. In 8 cases the CRM was shorter on MRI than in histopathological sections. In 32 patients the CRM was respected in both exams and 4 patients were considered positive on histopathological findings but negative in MRI. The sensitivity, specificity, positive and negative predictive values for prediction of tumor involvement of CRM were 86%, 80%, 76% and 88%, respectively. Conclusions: MRI gives reliable information on tumor involvement of the CRM in patients with rectal cancer. This may provide accurate identification of an important prognostic risk factor in patients prior to surgical treatment

Disfunciones miccionales luego de la modificación en la técnica de inserción del sling transobturador de acceso externo

Objetivo: Evaluar la curación de la incontinencia urinaria de estrés y las disfuncionesmiccionales postoperatorias observadas mediante una modificación en la técnica de insercióndel sling transobturatriz.Material y Métodos: Estudio prospectivo exploratorio con asignación alternada, comparando latécnica clásica con la modificada. La modificación consistió en realizar una incisión vaginal en Uinvertida en lugar de la clásica vertical. Las pacientes fueron evaluadas clínicamente con interrogatorio,examen urogenital, ecografía transvaginal y RMN dinámica.Resultados: Se iIncluyeron 57 pacientes. Ambos grupos fueron de características similares. Edadpromedio 59,5 años. Seguimiento entre 3 y 15 meses. Los resultados de curación y posicionamientodel sling fueron similares. La tasa de disfunciones de la micción fue significativamente menor en elgrupo de cirugía modificada (12 % vs 72 %

Prevalence of Cardiac Abnormalities in Fabry Disease: a large CMR study in Argentina

Background: Cardiovascular magnetic resonance (CMR) can measure cardiac structure, function and characterize myocardial tissue. The full potential of CMR for Fabry disease (FD) is yet to be defined. The objective of the present work was to assess the clinical utility of CMR for the detection and classification of cardiac involvement in patients with FD. Methods This is retrospective observational study of CMR scans performed in 99 unique FD patients from 2 hospitals in Argentina between April 2005 and October 2013. Diagnosis of FD was confirmed by measurement of alpha galactosidase A activity on plasma and peripheral leukocytes (males) or genetic testing (females). Results Ninety nine FD patients (61 females and 38 males), mean age 35 SD 15 years, underwent CMR. Cardiac involvement was present in 55% of cases. Left ventricular hypertrophy (LVH) was present in 44% and left ventricular (LV) impairment in 8% (mean left ventricular ejection fraction 49%, range 40-54%). Late gadolinium enhancement (LGE) was present in 33% of cases and was more common with age and when LVH was present. Of the LVH patients, 59% had LGE compared to 13% without LVH (p<0.001). Conclusions CMR is a useful diagnostic tool in detecting and classifying cardiac involvement of FD, including the detection of patients with LGE before LVH occurs

Ectopic growth hormone-releasing hormone secretion by a metastatic bronchial carcinoid tumor: a case with a non hypophysial intracranial tumor that shrank during long acting octreotide treatment

Ectopic acromegaly represents less than 1% of the reported cases of acromegaly. Although clinical improvement is common after treatment with somatostatin (SMS) analogs, the biochemical response and tumor size of the growth hormone-releasing hormone (GHRH)-producing tumor and its metastases are less predictable. Subject A 36-year-old male was referred because of a 3-year history of acromegaly related symptoms. He had undergone lung surgery in 1987 for a "benign" carcinoid tumor. Endocrine evaluation confirmed acromegaly Plasma IGF-1: 984 ng/ml (63-380), GH: 49.8 ng/ml (<5). MRI showed a large mass in the left cerebellopontine angle and diffuse pituitary hyperplasia. Pulmonary, liver and bone metastases were shown by chest and abdominal CT scans. Ectopic GHRH secretion was suspected. Methods Measurement of circulating GHRH levels by fluorescence immunoassay levels and immunohistochemical study of the primary lung tumor and metastatic tissue with anti-GHRH and anti-somatostatin receptor type 2 (sst2A) antibodies. Results Basal plasma GHRH: 4654 pg/ml (<100). Pathological study of liver and bone biopsy material and lung tissue removed 19 years earlier was consistent with an atypical carcinoid producing GHRH and exhibiting sst2A receptor expression. Treatment with octreotide LAR 20-40 mg q. month resulted in normalization of plasma IGF-1 levels. Circulating GHRH levels decreased dramatically. The size of the left prepontine cistern mass, with SMS receptors shown by a radiolabeled pentetreotide scan, decreased by 80% after 18 months of therapy. Total regression of pituitary enlargement was also observed. No changes were observed in lung and liver metastases. After 24 months of therapy the patient is asymptomatic and living a full and active life

Diagnostic Value of Cardiac Magnetic Resonance in Patients with Frequent Ventricular Arrhythmia and Normal Doppler Echocardiography

La arritmia ventricular frecuente (AVF) puede ser una alteración eléctrica primaria, o estar asociada a una cardiopatía. El impacto pronóstico y terapéutico depende  de la presencia de cardiopatía estructural. . El ecocardiograma doppler transtorácico ha sido el estudio complementario más importante para evaluar la presencia de alteraciones estructurales cardíacas. El objetivo de nuestro estudio consiste en determinar la capacidad de la resonancia magnética cardíaca (RMC) para detectar alteraciones estructurales a nivel cardíaco en pacientes con ecocardiograma doppler normal y conocer la incidencia de eventos cardiovasculares adversos en el seguimiento. Se incluyeron 66 pacientes consecutivos con arritmia ventricular frecuente definido como extrasístoles ventriculares > 5000 en un registro de Holter de 24 hs, taquicardia ventricular o muerte súbita resucitada con ecocardiograma doppler normal. A todos los pacientes se les realizó una resonancia magnética cardíaca con protocolo para evaluar miocardiopatías. El 57% de los pacientes presentó alguna alteración estructural, siendo las patologías diagnosticadas más prevalente: la secuela de miocarditis, el miocardio no compactado y la secuela de infarto subendocárdico.  En el seguimiento medio de  24 ± 22 meses, la incidencia de eventos cardiovasculares adversos fue 6.06%. El número de extrasístoles ventriculares fue mayor en aquellos pacientes con resonancia anormal. Este trabajo demuestra que en pacientes con arritmia ventricular frecuente con ecocardiograma doppler normal, la realización de una resonancia magnética cardíaca con gadolinio permite detectar en más de la mitad de los casos alguna alteración estructural.IntroductionFrequent ventricular arrhythmia can be a primary electrical disturbance or may beassociated to cardiomyopathy. The prognostic and therapeutic impact depends onthe presence of structural heart disease. Transthoracic Doppler echocardiographyhas been the most important complementary study to evaluate the presence of cardiacstructural abnormalities.ObjectivesThe aims of this study were to determine the ability of cardiac magnetic resonanceimaging to detect structural heart disease in patients with normal Doppler echocardiogramand to assess the incidence of adverse cardiovascular events during followup.MethodsThe study included 66 consecutive patients with frequent ventricular arrhythmiadefined as > 5000 ventricular extrasystoles in 24-hour Holter monitoring, ventriculartachycardia or resuscitated cardiac respiratory arrest with normal Dopplerechocardiogram. All patients underwent cardiac magnetic resonance imaging to assesscardiomyopathies.ResultsFifty-seven percent of patients had structural heart disease. The most prevalentdiagnosed pathologies were myocarditis sequelae, non-compacted myocardium andsubendocardial infarction scar. At mean follow-up of 24 ± 22 months, the incidenceof adverse cardiovascular events was 6.06 %. The number of ventricular extrasystoleswas higher in patients with abnormal cardiac magnetic resonance.DiscussionThis work demonstrates that in patients with frequent ventricular arrhythmia andnormal Doppler echocardiogram, gadolinium cardiac magnetic resonance imagingcan detect structural heart disease in more than half of the cases. Patients with frequentventricular arrhythmia during Holter monitoring, normal Doppler echocardiogramand mild alterations in the magnetic resonance present low risk of cardiovascularevents