Analysis of invasive diagnostic techniques for pathological confirmation of pleural mesothelioma

BACKGROUND AND OBJECTIVES

Mesothelioma is an infrequent neoplasm with a poor prognosis that is related to exposure to asbestos and whose peak incidence in Europe is estimated from 2020. Its diagnosis is complex; imaging techniques and the performance of invasive pleural techniques being essential for pathological confirmation. The different diagnostic yields of these invasive techniques are collected in the medical literature. The present work consisted of reviewing how the definitive diagnosis of mesothelioma cases in our centre was reached to check if there was concordance with the data in the bibliography.

MATERIALS AND METHODS

Retrospective review of patients with a diagnosis of pleural mesothelioma in the period 2019-2021, analysing demographic data and exposure to asbestos, the semiology of the radiological findings and the invasive techniques performed to reach the diagnosis.

RESULTS

Twenty-six mesothelioma cases were reviewed. 22 men and 4 women. Median age 74 years. 9 patients had a history of asbestos exposure. Moderate-severe pleural effusion was the most frequent radiological finding (23/26). The sensitivity of the invasive techniques was as follows: Cytology 13%, biopsy without image guidance 11%, image-guided biopsy 93%, surgical biopsy 67%.

CONCLUSIONS

In our review, pleural biopsy performed with image guidance was the test that had the highest diagnostic yield, so it should be considered as the initial invasive test for the study of mesothelioma.

[Nephrotoxicity due to iodine contrasts in computerized tomography studies of diabetic outpatients on metformin]

BACKGROUND

To determine the incidence of contrast-induced nephropathy (CIN) among diabetic patients treated with Metformin who underwent computerized tomography (CT) scan with iodinated contrast media.

METHODS

Prospective study of diabetic patients enrolled in a lactic acidosis prevention protocol in whom clinical and analytical follow up after CT scan with intravenous contrast was performed.

RESULTS

In this study, 98 cases were collected. The incidence of CIN in diabetic patients without prior renal failure was 0%. In patients with previous renal failure the incidence of CIN was 4.7%.

CONCLUSIONS

The risk of CIN in diabetic patients with no renal failure undergoing intravenous contrast administration is minimal. Recommendations to stop Metformin to avoid lactic acidosis in patients undergoing intravenous contrast administration may be restricted to patients with abnormal renal function.

[Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test]

OBJECTIVE

Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease.

MATERIAL AND METHODS

We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient.

RESULTS

The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found.

CONCLUSIONS

Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation.

[Childhood cholelithiasis in a district hospital]

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.

Placement of a colonic stent by percutaneous colostomy in a case of malignant stenosis

We present a patient with disseminated stomach cancer who presented with symptoms of acute obstruction of the splenic flexure of the colon caused by tumor spread. During a first attempt to insert a colon stent through the anus under endoscopic guidance as final palliative therapy, it was not possible to reach the region of the stricture, and iatrogenic perforation of the descending colon occurred, which resolved favorably under conservative management. A second attempt to insert a stent was made via percutaneous puncture of the transverse colon, approaching the region of the stricture by a descending route. The procedure was completed without complications and the patient's symptoms improved. Stent placement via percutaneous puncture of the colon has not previously been described in the literature. It may be an alternate route in cases of proximal strictures in which access through the anus has been unsuccessful even with the aid of endoscopic guidance.

[Arachnoid metastasis of renal cell carcinoma: review of forms of tumor dissemination and review of its metastasis in the nervous system]

Contribution of one case of renal cells carcinoma, in an adult man, that during evolution developed arachnoid metastasis. The patient was first seen for a brain haemorrhage due to a bleeding metastasis. In later studies, a renal cells carcinoma was found to be the primary site of the brain condition. The evolution showed neurological manifestations in the limbs, and the arachnoid metastasis was detected. The paper includes imaging studies of the referred disease both al brain, renal and spinal level with CT and NMR studies. A revision is made of the different dissemination forms of renal cells tumours, as well as a review of the existing literature with regard to the nervous system metastasis. No case has been found in this review relative to spinal arachnoid dissemination.