Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

Objectives: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses.

Methods: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems.

Gastroesophageal junction leak with serious sepsis after gastric bypass: successful treatment with endoscopy-assisted intraluminal esophageal drainage and self-expandable covered metal stent.

We present a case of gastroesophageal junction leak after gastric bypass with serious sepsis and hemodynamic instability. Minimally invasive treatment was performed in two stages: initial sepsis control by lavage and endoscopy-assisted laparoscopic placement of an intraluminal esophageal drainage tube through the leak orifice; this was followed by definitive leak treatment with a self-expandable covered metal stent after achieving hemodynamic stability. Patient evolution was satisfactory without the need for open surgery.

Posttraumatic Intrasplenic Pseudoaneurysm with High-Flow Arteriovenous Fistula: New Lessons to Learn.

Intrasplenic pseudoaneurysm is a potentially lethal complication of abdominal trauma. We present the case of a 33-year-old patient with this particular complication diagnosed by CT-scan. Selective embolization was not possible due to its extraordinarily large size and finally splenectomy was performed.

[Localization of gastrointestinal bleeding from jejunal diverticuli by methylene blue dye].

Localization of digestive hemorrhage is essential for the management of this entity. However, management is difficult in the small bowel, where emergency situations are rare but may require surgery without precise location of the lesion. We present a case of hemorrhage caused by jejunal diverticulum diagnosed by angiography.

Multiple overlapped conical endoprostheses in a patient with aneurysmatic right aortic arch and aortic coarctation.

An aortic neck with a nonconstant diameter represents a challenge for endovascular treatment. We report our experience in a patient with right aortic arch, aneurysmatic aberrant subclavian artery, aortic coarctation, and a precoarctation aneurysm that was treated with surgery and endoprothestic procedures in two stages.

Selenium and cancer: some nutritional aspects.

The level of selenium in cancer patients is lower than that in control subjects. However, low selenium levels in body fluids can be due to the malnutrition observed in these patients. There is evidence from epidemiologic studies that high dietary selenium intakes and high selenium status in people are associated with lower cancer mortality.

Lack of relationship between plasma thrombomodulin and portal hypertension in alcoholic liver disease.

The present study was performed to analyze the relationship between portal hypertension and alterations of the endothelium-derived proteins thrombomodulin, plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1), which were determined in plasma samples of 28 alcoholic cirrhotic patients and 46 controls. Although cirrhotics showed lower levels of PAI-1, but higher thrombomodulin and t-PA levels than controls, no relationship was observed between thrombomodulin, t-PA or PAI-1 and portal pressure. Therefore, the hypothesis that splachnic endothelial damage secondary to portal hypertension leads to altered thrombomodulin, t-PA and PAI-1 levels in alcoholic cirrhosis is not supported by the results of this study.

Estimation of effective dose in some digital angiographic and interventional procedures.

In general, effective dose values for similar interventional vascular radiology (IVR) procedures are different. This is due to problems with the classification of radiological procedures, which make comparisons difficult. Patient size, examination technique and clinical condition as well as the skill of the medical radiologists also affect effective dose.

[Stasis priapism secondary to PGE1: transformation into high-flow priapism].

Since vasoactive agents were first introduced for the diagnosis and treatment of Erectile Dysfunction (ED), the most feared side effect has been priapism. The arrival of Prostaglandin E1 (PGE1) limited to a large extent the incidence of this complication due to its fast systemic and intracavernous metabolism. A case of stasis priapism following a low dose PGE1 injection (10 mcg) after 48 hours evolution and its surprising conversion to high flow priapism after the surgical procedures performed to solve this complication is presented here.

Transient hemolytic anemia after transjugular intrahepatic portosystemic stent shunt.

Management of variceal bleeding secondary to portal hypertension constitutes a challenging issue, particularly in child's C cirrhotic patients. Recently, transjugular placement of self-expanding metallic stents in the liver (TIPS), creating a shunt between the portal and hepatic branches has provided a safe and promising therapeutic approach in this clinical situation. We report here the case of a 66-year-old male cirrhotic patient who developed a moderately severe clinical picture of Coombsnegative hemolytic anemia (serum hemoglobin, 93 g/l, serum bilirubin 160.