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Morcillo AB, Huerga C, Bayón J, López A, Corredoira E, Hernández T, Novo JR, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E, Alejo L. ASSESSMENT OF OCCUPATIONAL EXPOSURE IN THE MAIN PAEDIATRIC INTERVENTIONAL RADIOLOGY PROCEDURES. Radiat Prot Dosimetry 2022; 198:386-392. [PMID: 35512690 DOI: 10.1093/rpd/ncac064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study is to evaluate the personal dose equivalent Hp(10) in the most frequent (non-cardiac) paediatric interventional radiology (PIR) procedures: central venous catheters (CVC), hepatic/biliary and sclerotherapy interventions. i2 active solid-state dosemeters placed over the lead apron were used to monitor the exposure of three interventional radiologists over 18 months. A database was created to register all procedures performed by each radiologist (including the type of procedure and the kerma-area product, PKA). The mean Hp(10) per procedure for CVC, sclerotherapy and hepatic/biliary interventions was respectively 0.01 ± 0.01 mSv, 0.18 ± 0.13 mSv and 0.12 ± 0.06 mSv (k = 2). A similar value of Hp(10)/PKA was found despite the type of procedure or the patient weight (~10 μSv/Gy·cm2). There was high variability among individual interventions, probably due to the variable level of complexity, which led to uncertainties in the measurements' mean higher than those associated with the dosemeter's angular and energy dependence. i2 therefore proved suitable for monitoring Hp(10) in PIR procedures.
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Affiliation(s)
- Ana B Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Antonio López
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan R Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María D Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
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Morcillo AB, Alejo L, Huerga C, Bayón J, Marín A, Corredoira E, Novo JR, Hernández T, Ponce MD, Garzón G, Vañó E, Guibelalde E. Occupational doses to the eye lens in pediatric and adult noncardiac interventional radiology procedures. Med Phys 2021; 48:1956-1966. [PMID: 33544901 DOI: 10.1002/mp.14753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To assess occupational lens exposure in a mixed interventional radiology department, comparing pediatric and adult procedures. To analyze the correlation between the lens dose and the doses measured at the chest and collar level and the kerma-area product (PKA ). METHODS For 17 months, three radiologists performing both pediatric and adult interventions were monitored by means of 14 dosimeters per worker: 12 single-point optically stimulated luminescent (OSL) dosimeters calibrated in terms of Hp (0.07) were placed on the inside and outside of two pairs of lead glasses, one for pediatric procedures and one for adult interventions; another whole-body OSL dosimeter calibrated in terms of Hp (10) was placed over the thyroid shield; finally, an additional active solid-state dosimeter, also calibrated for Hp (10), was worn on the chest, over the apron. Furthermore, a database was created to register the demographic and dosimetric data of the procedures, as well as the name of the radiologist acting as first operator. RESULTS For the three radiologists, who performed 276-338 procedures/year (20% pediatric), cumulative annual doses to the left bare eye exceeded 20 mSv (21-61 mSv). Considering the glasses' protection, annual doses exceeded 6 mSv (13-48 mSv) for both eyes. No important differences were observed in lens dose per procedure between pediatric and adult interventions (0.16 vs 0.18, 0.12 vs 0.09, and 0.07 vs 0.07 mSv), although lens dose per PKA was 4.1-4.5 times higher in pediatrics (5.8 vs 1.3, 3.3 vs 0.8, and 2.6 vs 0.6 µSv/Gy·cm2 ) despite a similar use of the ceiling-suspended screen. Lens doses were highly correlated with collar readings (with Pearson coefficients [r] ranging from 0.86 to 0.98) and with chest readings (with r ranging from 0.75 to 0.93). However, slopes of the linear regressions varied greatly among radiologists. CONCLUSIONS There is real risk of exceeding the occupational dose limit to the eye lens in mixed interventional radiology rooms if radiation protection tools are not used properly. Regular monitoring of the lens dose is recommended, given lens exposure might easily exceed 6 mSv/yr. Using a collar dosimeter for this purpose might be suitable if it is preceded by an individualized regression analysis. The same radiation protection measures should be applied to interventional radiologists regardless of whether they are treating pediatric or adult patients.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Alberto Marín
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, Madrid, 28040, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, Madrid, 28040, Spain
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Pascual-Tejerina V, Sánchez-Recalde A, Garzón G, Zamorano JL. A novel transcatheter technique to treat of post-coarctation aneurysm with device occlusion of the aortic arch and descending aorta in a patient with an extra-anatomic bypass. Eur Heart J 2020; 41:2412-2413. [PMID: 31562529 DOI: 10.1093/eurheartj/ehz670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Angel Sánchez-Recalde
- Cardiology Department, University Hospital Ramón y Cajal, Ctra de Colmenar Viejo Km. 9, 100, 28034 Madrid, Spain
| | - Gonzalo Garzón
- Radiology Department, University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José L Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Ctra de Colmenar Viejo Km. 9, 100, 28034 Madrid, Spain
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Morcillo AB, Alejo L, Huerga C, Bayón J, Obesso A, Corredoira E, Novo JR, Hernández T, Ponce MD, Fernández L, Rodríguez R, Garzón G, Vañó E, Guibelalde E. Local diagnostic reference levels for paediatric non-cardiac interventional radiology procedures. Phys Med 2020; 72:1-6. [PMID: 32179406 DOI: 10.1016/j.ejmp.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish local diagnostic reference levels (DRLs) for non-cardiac interventional procedures in paediatrics. METHODS The type of procedure, the patient's weight and age and dose-related data from 279 interventions was recorded in a database completed by interventional radiologists, radiographers and technicians of the Medical Physics department. These procedures were classified into 14 categories and 6 weight ranges. Local DRLs were proposed for those ranges in which a sample of at least 15 patients could be gathered and were calculated as the third quartile (Q3) of the air kerma-area product (PKA) values. The Q3 of the fluoroscopy time (FT) and number of digital subtraction angiography (DSA) images were also obtained. Finally, the correlation between PKA and weight was analysed. RESULTS Local DRLs are proposed for three types of procedures: hepatic/biliary interventions (5-15 kg, 1304 cGy·cm2; 15-30 kg, 2121 cGy·cm2), sclerotherapy procedures (15-30 kg, 704 cGy·cm2; 30-50 kg, 4049 cGy·cm2; 50-80 kg, 3734 cGy·cm2) and central venous catheter (CVC) procedures (5-15 kg, 84 cGy·cm2). Hepatic/biliary interventions showed a moderate correlation (r = 0.61), while sclerotherapy procedures presented a poor correlation (r = 0.34) between PKA and weight, possibly due to the PKA dependence on the complexity level. Regarding CVC procedures, a clearly higher correlation was found when the fluoroscopy PKA value was normalised to the FT (r = 0.85 vs r = 0.35). CONCLUSIONS The results support the feasibility of establishing DRLs for the most common procedures (sclerotherapy, hepatic/biliary and CVC interventions) despite the small number of paediatric interventions.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Alba Obesso
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Lucía Fernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Ricardo Rodríguez
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, 28040 Madrid, Spain
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Obesso A, Alejo L, Huerga C, Sánchez-Muñoz F, Corredoira E, Fernández-Prieto A, Frutos R, Marín B, Garzón G, Peralta J, Ubeda C, Guibelalde E. Eye lens radiation exposure in paediatric interventional treatment of retinoblastoma. Sci Rep 2019; 9:20113. [PMID: 31882988 PMCID: PMC6934545 DOI: 10.1038/s41598-019-56623-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Retinoblastoma represents 3% of cancers in children under fifteen years of age. The standard paediatric treatment for saving the affected eye is supraselective intra-arterial chemotherapy performed in interventional rooms. In order to address the radiation toxicity due to the angiography, the aim of this study was to determine the typical dose value corresponding to the procedure, estimate the paediatric patients’ eye lens dose and study the relationship between dose indicators and dose to the lens. An automatic dose management software was installed in two interventional rooms to obtain the distribution of the dose indicators kerma-area product and reference-point air kerma, getting a typical value 16 Gy·cm2 and 130 mGy, respectively (n = 35). The eye lens dose estimates were obtained with photoluminescent dosimeters placed on the patient’s eyelids. In the left eye, the entrance surface air kerma was 44.23 ± 2.66 mGy, and 12.72 ± 0.89 mGy in the right eye (n = 10). There was a positive correlation between dose to the lens per procedure and dose indicators, with R2 > 0.65 for both eyes. Based on this information, the threshold for the onset of radiation-induce cataracts (500 mGy) will be exceeded if the treatment is performed for more than 8 sessions.
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Affiliation(s)
- A Obesso
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - L Alejo
- Medical Physics Department, La Paz University Hospital, Madrid, Spain.
| | - C Huerga
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - F Sánchez-Muñoz
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | - E Corredoira
- Medical Physics Department, La Paz University Hospital, Madrid, Spain
| | | | - R Frutos
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - B Marín
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - G Garzón
- Neuroradiology Department, La Paz University Hospital, Madrid, Spain
| | - J Peralta
- Paediatric Ophthalmology Department, La Paz University Hospital, Madrid, Spain
| | - C Ubeda
- Medical Technology Department Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - E Guibelalde
- Radiology Department, Complutense University, Madrid, Spain
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Garzón G. Interaction of the lewis acid HSO3F with the compound IrCl(CO) (PPh3)2 and the synthesis of transition metal hydride complexes. Eclet Quim J 2018. [DOI: 10.26850/1678-4618eqj.v4.1.1979.p33-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Herrero A, Pinillos J, Sabio P, Martín JL, Garzón G, Gil Á. [Level at which control objectives are reached in patients in different population groups with type 2 diabetes]. Semergen 2016; 43:550-556. [PMID: 27889132 DOI: 10.1016/j.semerg.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/13/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is evidence of increased macro- and micro-vascular risk in diabetic patients. The objective of this study was to determine the level of control in patients in different population groups with type 2 diabetes. MATERIAL AND METHODS DESIGN Descriptive cross-sectional study. LOCATION Primary care. Madrid Health Service. Year: 2014. SUBJECTS Patients over 14 years with type 2 diabetes. Number of patientes: n=6674. MEASUREMENTS Variables on the degree of control (HbA1c, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL-c) and variables on patient characteristics (demographic, other cardiovascular risk factors, complications). RESULTS The mean age of patients with controlled HbA1c was 67.8 years vs. 62.9 years in the uncontrolled (P<.001). Patients diagnosed with hypertension have a higher percentage of control with respect to the undiagnosed in HbA1c, SBP, DBP and LDL-c: 51 vs. 37%, 62 vs. 43%, 75 vs. 47% and 57 vs. 44% respectively; diagnosed with dyslipidaemia: 51 vs. 39%, 60 vs. 49%, 70 vs. 56% and 56 vs. 46%. With a diagnosis of macroangiopathy: 46 vs. 45%, 58 vs. 54%, 71 vs. 62% and 15 vs. 60%. All differences were statistically significant (P<.001). Over 50% of patients without a diagnosis of hypertension had an SBP> 140mmHg or DBP> 90mmHg. Over 25% of patients with hypertension or DL and uncontrolled levels were not receiving drug treatment. CONCLUSION Control was improved in all groups, especially in younger patients, with particularly high cardiovascular risk by the presence of other cardiovascular risk factors or macroangiopathy. A significant percentage of patients with uncontrolled BP and cLDL were not diagnosed or receiving drug treatment.
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Affiliation(s)
- A Herrero
- Universidad Rey Juan Carlos, Madrid, España.
| | - J Pinillos
- Servicio de neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - P Sabio
- Servicio de urgencias, Hospital Universitario del Henares, Madrid, España
| | - J L Martín
- Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - G Garzón
- Universidad Rey Juan Carlos, Madrid, España
| | - Á Gil
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
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Herrero A, Garzón G, Gil A, García I, Vargas E, Torres N. [Control of cardiovascular risk factors among patients with diabetes with and without cardiovascular disease]. Semergen 2014; 41:354-61. [PMID: 25163908 DOI: 10.1016/j.semerg.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/13/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is evidence that cardiovascular goals are beneficial in diabetes. OBJECTIVE To determine the distribution of cardiovascular risk levels in patients with diabetes and the clinical interventions they have received. DESIGN Descriptive cross-sectional study. SETTING SERMAS (Madrid) 2010. SUBJECTS All patients with diabetes. (n=41,096). MAIN MEASUREMENTS Patients in primary or secondary prevention, metabolic and cardiovascular risk factors control, pharmacological and non-pharmacological interventions. Patient and professional variables. RESULTS Around one-fifth (21.5%) (95%CI: 21.1% -21.9%) in secondary prevention (very high cardiovascular risk). HbA1c was under control in 31% (95%CI: 30.1%-32%), with 49.9% (95%CI: 48.8%-50.9%) with BP under control, and 39.4% (95% CI: 38.4%-40.4%) with LDL controlled. Only 8.9% (95%CI: 8.3%-9.5%) had a well-controlled HdA1c, BP and LDL, and in 19.8% (95%CI: 19%-20.6%) none of these were under control. Of those with an uncontrolled BP, 23.6% (95% CI: 23.2%-24%) had antihypertensive drugs. There was better control in patients older than 70 years, and those who lived in an urban center, or a lower number of patients per day. CONCLUSION In diabetic patients with very high cardiovascular risk (secondary prevention), just half of them had good control of cardiovascular risk factors (BP and LDL). An association was found between better control and older than 70, urban center or lower number of patients per day. This suggests developing strategies to promote a comprehensive control of cardiovascular risk factors in diabetic patients in secondary prevention.
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Affiliation(s)
- A Herrero
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España.
| | - G Garzón
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - A Gil
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | - I García
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - E Vargas
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
| | - N Torres
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud, Madrid, España
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Ramírez E, Tong HY, Fiandor A, Martín-Hervás C, Rivero D, Oñate M, Rueda C, Cabañas R, Moro M, Tapia M, Fernández A, Morón S, Herrero A, Garzón G, Quirce S, Frías J. Hypersensitivity reactions to contrast media injections: a nested case-control study. Ann Allergy Asthma Immunol 2014; 113:488-9.e5. [PMID: 25155086 DOI: 10.1016/j.anai.2014.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Elena Ramírez
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Hoi Y Tong
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ana Fiandor
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Daniela Rivero
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Oñate
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Cristina Rueda
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Rosario Cabañas
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Moro
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Mar Tapia
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Amelia Fernández
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sara Morón
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Alicia Herrero
- Department of Pharmacy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Gonzalo Garzón
- Department of Radiology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Jesús Frías
- Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
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Martí M, Artigas JM, Garzón G, Álvarez-Sala R, Soto JA. Acute Lower Intestinal Bleeding: Feasibility and Diagnostic Performance of CT Angiography. Radiology 2012; 262:109-16. [DOI: 10.1148/radiol.11110326] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
This case is the first report of slow-growing pseudoaneurysm after vessel dissection secondary to two stents implantation into classic Blalock Taussig shunt in a patient with pulmonary atresia and ventricular septal defect. Pseudoaneurysm was successfully excluded by a percutaneous approach with self-expandable stent graft deployment from the aorta to the middle of the Blalock Taussig shunt. Nearly 3 years after the procedure, the classic BT is patent, and there were no restenosis or thrombosis in spite of the very long length of the stented segment.
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Affiliation(s)
- Angel Sanchez-Recalde
- Unidad de Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain.
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Martí M, Pinilla I, Baudraxler F, Simón MJ, Garzón G. A case of acute abdominal aortic dissection caused by blunt trauma. Emerg Radiol 2006; 12:182-5. [PMID: 16738931 DOI: 10.1007/s10140-006-0473-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/16/2005] [Indexed: 11/28/2022]
Abstract
We present the case of an 18-year-old man involved in a fall with blunt abdominal trauma. The patient had hypovolemic shock and findings of an acute abdomen. Initial computed tomography (CT) showed pulmonary contusion, pneumohemothorax, hemoperitoneum, hepatic contusion, right kidney laceration and vascular avulsion, rupture of the mesenteric vein, rupture of the right rectus muscle with bowel hernia, and infrarenal aortic dissection. There were no signs of limb or medullar ischemia. After hemodynamic stabilization and surgical repair of the associated lesions, the dissection was successfully treated with a self-expanding aortic Wallstent. Postprocedure CT showed a well-positioned patent stent and the patient was discharged asymptomatic. Percutaneous endovascular stent implantation is minimally invasive and seems to be a safe treatment for traumatic dissection of the abdominal aorta.
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Affiliation(s)
- Milagros Martí
- Radiology Department, Hospital Universitario La Paz, Paseo Castellana 261, Madrid 28046, Spain
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Abstract
Aneurysmal diseases of the thoracic aorta are life-threatening conditions. In such cases, stent-graft treatment has been proposed as an alternative to surgery. The morbidity and mortality associated with endovascular repair are significantly lower than those associated with open surgery. In the largest surgical series, the mortality ranged from 5% to 20%. In studies of endovascular repair, the 30-day mortality was 0%-20% and the periprocedural stroke rate was 0%-7%. Often, open surgery is prohibited in patients with these high-risk lesions; thus, in many cases endovascular treatment is the only alternative. Thoracic aortic diseases that can be treated with endovascular stent-graft placement include aneurysms, dissection, traumatic rupture, traumatic pseudoaneurysms, intramural hematoma, penetrating atherosclerotic ulcers, and aortic rupture. Thorough preprocedure imaging is essential for selecting patients, choosing the stent-graft devices, and planning the intervention. Prerequisites for endovascular stent-graft placement are an adequate neck for graft attachment and adequate vascular access. When the ascending aorta or aortic arch is involved, surgical and endovascular procedures can be combined and performed simultaneously, allowing treatment of a wider range of cases. An experienced interdisciplinary team is needed to manage such cases.
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Affiliation(s)
- Gonzalo Garzón
- Department of Radiology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
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15
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Máiz L, Girón R, Martínez MT, Prados C, Escobar H, Garzón G, Sánchez J, Mingo A, Blázquez J. [Life-threatening hemoptysis in cystic fibrosis: clinical characteristics and management in 36 episodes]. Med Clin (Barc) 2002; 118:299-301. [PMID: 11888498 DOI: 10.1016/s0025-7753(02)72365-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Our goal was to evaluate the clinical characteristics and management of life-threatening hemoptysis in patients with cystic fibrosis (CF). PATIENTS AND METHOD We included adult CF patients followed up at the Cystic Fibrosis Units of the Autonomous Community of Madrid who had life-threatening hemoptysis from June 1990 to December 1999. RESULTS Twelve CF patients (4 females) developed 36 episodes of life-threatening hemoptysis (30 massive and 6 recurrent). Lung disease was moderate to severe. Sputum cultures revealed Pseudomonas aeruginosa in 10 patients. Thirteen episodes (36%) resolved upon antibiotic treatment and 3 (8%) after antibiotic therapy and bronchoscopy. Bronchial artery embolization (BAE) was performed in 20 of 36 events. Immediate technique success was achieved in 80% episodes (16 of 20) after one session, 85% (17/20) after two sessions, and 95% (19/20) after three sessions. No major complications associated with the procedure were seen. The overall recurrence rate per episode was 69% (24 of 35 episodes in 6 patients) with a mean time of recurrence of 13 months. There were no massive hemoptysis-associated deaths during the follow-up. CONCLUSIONS Life-threatening hemoptysis is a frequent complication in CF patients who have moderate or severe lung disease. When conservative therapeutic measures (including antibiotics) fail to control it, BAE should be performed. When performed by expert professionals, BAE is effective and safe to immediate control of life-threatening hemoptysis in patients with CF.
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Affiliation(s)
- Luis Máiz
- Servicio de Neumología, Unidad de Fibrosis Quística, Hospital Ramón y Cajal, Spain.
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16
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López Santamaría M, Gámez M, Murcia J, Frauca E, Hierro L, Camarena C, de la Vega A, Díaz M, Jara P, Prieto C, Berrocal T, Garzón G, Tovar J. [Pre-hepatic portal hypertension as a late complication of liver transplantation in children]. Cir Pediatr 2001; 14:135-8. [PMID: 12601959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
UNLABELLED In the long-term after liver transplantation (LT), some children develop prehepatic portal hypertension (PPH) and raise problems not very well known yet; many of the lessons learned with the management of these patients may be useful outside the LT. AIM 1. To analyze the incidence and risk factors of PPH after LT. 2. To evaluate the results with the different treatments used. METHODS Retrospective study over 164 children surviving more than 1 year after LT. Univariant analysis of possible risk factors associated and multivariant (logistic regression), for those that had significance in the univariant analysis. Other factors associated are analyzed as well as the indications and results of two types of treatment: percutaneous pneumatic dilatation and surgical shunt (splenorenal and Rex shunt). RESULTS 9 children developed symptomatic PPH (hemorrhage in 8, ascites in 1), associated to lymphoproliferative post-LT disease in 2, and to anastomotic biliary stricture in 1. The age at first LT (children under 1 year old), weight (below 10 kg), and need of retransplantation (reLT) were in the univariant analysis the associated variables with increased risk of PPH. The diagnosis (biliary atresia) and the emergency status of the LT were almost significative. In the multivariant analysis, the need of reLT is the only independent variable that increases the risk (relative risk: 4.5, confidence interval 95%: 1.29-18.87). At diagnosis 3 cases showed portal estenosis, and 5 showed absence of permeability with cavernomatous transformation. The PPH was caused in one case because of the esplenic vein disconnection (treatment not required at the moment); the three cases of portal estenosis were dilated percutaneously with success, and 2 of the 5 cases with portal thrombosis have been surgically shunted: one by an splenorenal shunt and the other by a Rex shunt (first case done in Spain); the other 3 cases are stable waiting for a surgical solution. The hepatic function is normal in the 9 cases. CONCLUSIONS The PPH can complicate the prognostic of the pediatric LT in the long term. The treatment depends on the permeability of the portal trunk. Whenever possible, percutaneous dilatation should be attempted; should surgery be required, the Rex shunt is the best option.
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Affiliation(s)
- M López Santamaría
- Dpto. de Cirugía Pediátrica, Unidad de Trasplantes Digestivos, Hospital Universitario La Paz, Madrid
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17
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Prados C, Máiz L, Antelo C, Baranda F, Blázquez J, Borro JM, Gartner S, Garzón G, Girón R, de Gracia J, Lago J, Lama R, Martínez MT, Moreno A, Oliveira C, Pérez Frías J, Solé A, Salcedo A. [Cystic fibrosis: consensus on the treatment of pneumothorax and massive hemoptysis and on the indications for lung transplantation]. Arch Bronconeumol 2000; 36:411-6. [PMID: 11000930 DOI: 10.1016/s0300-2896(15)30141-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C Prados
- Servicio de Neumología, Hospital La Paz, Madrid
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18
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Sevilla J, Alvarez MT, Hernández D, Canales M, De Bustos JG, Magallón M, Garzón G, Hernández-Navarro F. Therapeutic embolization and surgical excision of haemophilic pseudotumour. Haemophilia 1999; 5:360-3. [PMID: 10583519 DOI: 10.1046/j.1365-2516.1999.00330.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haemophilic pseudotumour is a rare complication of haemophilia. Few cases of iliac haemophilic pseudotumour have been reported in the literature. These tumours can act as a focus for infection and cause cutaneous fistulas. When they present perforations and infections of endogenous origin their course is usually fatal. Suitable treatment has been investigated on numerous occasions, most of the literature agreeing that the only curative treatment is surgical resection. We present a case of haemophilic pseudotumour of the iliac and caecum with cutaneous fistulas, with a septic process of endogenous origin. It was treated with surgical resection after performing arterial embolization to reduce the vascularization of the pseudotumour, thereby reducing its size and the risk of bleeding complications during surgery.
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Affiliation(s)
- J Sevilla
- Hemophilia Unit, Hematology Service, Hospital General La Paz, Madrid, Spain
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19
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López Santamaría M, Gámez M, Murcia J, Hierro L, Camarena C, de la Vega A, Frauca E, Jara P, Berrocal T, Prieto C, Garzón G, Tovar J. [Pediatric liver transplantation: now the patients are different and the problems are different as well]. Cir Pediatr 1999; 12:75-9. [PMID: 10570860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
AIM 1. To show how in a program of pediatric liver transplantation (PLT) with 12 years of experience, the continuous use of technical innovations has allowed to improve the results and to treat the most complex cases. 2. To point out that when the immediate results of the transplant improve and the evolution time get longer, the late complications become the main source of concern. MATERIAL AND METHODS The graft survival and the incidence of early surgical complications was compared between the first 100 PLT and the last 100 PLT (Total 235 PLT). The patients survival was also compared between the first and the last 5 years. In every case it was analyzed the age and weight of the children at the time of the transplant and the type of graft (full or reduced liver). The incidence of late complications in the global series was also analyzed, especially the posttransplant lymphoproliferative disease (PTLD) and the late biliary and vascular complications. RESULTS There are significant differences between the first 100 PLT and the last 100 PLT in relation with the age of the patients (6.8 +/- 0.6 vs 4.2 +/- 0.5 years), the number of children younger than 1 year (4 vs 28), weight (22.4 +/- 1.2 vs 16.9 +/- 1.7 kg), number of PLT in children under 10 kg (7 vs 43), use of reduction techniques (7 vs 49), rate of hepatic artery thrombosis (12% vs 3%), and rate of early biliary complications (13% vs 4%). The 5 years survival of the graft was 51% in the first 100 PLT vs 65% in the last 100 PLT, and the 5 years patients survival was 70.1% in the first 5 years of the program vs 79.6% in the last 5 years. Among the late complications in the global series, 13 cases of PTLD (2 deaths) have special relevance, 6 cases of late anastomotic biliary stricture, 4 cases of portal stenosis, 1 arterial thrombosis, 1 death due to a fulminant sepsis and another death because of a colitis with multiple hepatic abscess. CONCLUSIONS 1. The result of PLT improve, despite of the fact that in the last years the difficulty of the surgical procedures have increased (the patients are younger, with less weight and the reduction techniques are used more frequently). 2. The late complications have a significant influence in the prognosis, being that influence not completely established yet.
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20
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López-Santamaria M, Martinez L, Hierro L, Gamez M, Murcia J, Camarena C, De la Vega A, Frauca E, Jara P, Diaz M, Berrocal T, Prieto C, Garzón G, Tovar JA. Late biliary complications in pediatric liver transplantation. J Pediatr Surg 1999; 34:316-20. [PMID: 10052813 DOI: 10.1016/s0022-3468(99)90199-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to review the biliary complications occurring in late follow-up after liver transplantation in children. METHODS The medical records of 135 children who received orthotopic liver transplantations (OLT) and had graft survival of more than 1 year were reviewed. Technical variants using a reduced-size graft were applied in 32 (23.7%). For biliary reconstruction, 15 patients had choledochocholedochostomy and 120 a Roux-en-Y loop. Biliary reoperation in the early post-OLT period was needed in 24 patients (17.7%). Routine checking of liver function and duplex Doppler ultrasonography (DDS) were performed during the follow-up period, which averaged 58 months. Late biliary complication was defined as that occurring after the first hospital discharge. RESULTS Late biliary complications occurred in 18 children (13.3%); 16 showed symptoms or analytical disturbances in liver function tests. The Diagnoses included uncomplicated cholangitis (n = 6), anastomotic biliary stricture (n = 7), ischaemic damage of the biliary tree (n = 3) including one late (28 months) hepatic artery thrombosis leading to an intrahepatic biloma. and bile leak after T-tube removal (n = 2). The six children with uncomplicated cholangitis had no repeat episodes in follow-up despite persistent aerobilia. Six patients affected by anastomotic strictures were treated successfully with percutaneous dilatation and, if present, stone removal. Persisting dysfunction and cholangitis occurred in one case affected by ischaemic biliary disease. Biliary leaks after T tube removal settled spontaneously. Risk factors for late biliary complications were determined. There was no relation to the cold ischaemia time, type of graft or biliary reconstruction, or previous early post-OLT biliary reoperation. Aerobilia (affecting 21.5% of OLT patients) was related to cholangitis (P = .001). CONCLUSIONS Anastomotic strictures, reflux of intestinal contents via the Roux-en-Y loop, and residual ischaemic damage led to late biliary complications in 12% of paediatric OLT patients. Evidence of biliary dilatation on DDS may be delayed in anastomotic strictures; in these cases the results of percutaneous treatment were excellent. Children with aerobilia have and increased risk of cholangitis.
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Affiliation(s)
- M López-Santamaria
- Department of Pediatric Surgery, Childrens Hospital La Paz, Madrid, Spain
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