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Resumen Objetivo Evaluar retrospectivamente la eficacia y la seguridad de la radiofrecuencia (RF) percutanea para el tratamiento de tumores renales en pacientes de alto riesgo o con riesgo de padecer tumores renales multiples con un seguimiento a medio plazo a lo largo de un periodo de 10 anos. Material y metodos Entre 2005 y 2015, 87 pacientes (89 tumores) con una media de edad de 73,7 anos (desviacion estandar: 10,87) con riesgo quirurgico alto que presentaban tumores renales T1a y T1b fueron tratados mediante RF. Se excluyeron los pacientes sometidos a RF y embolizacion o ablacion con microondas. Se trataron carcinomas de celulas claras (43,6%), papilares (17,2%), cromofobos (10,3%), tumores quisticos (2,2%) y un angiomiolipoma (1,1%). El tamano medio de los tumores fue 2,6 cm. La tomografia computarizada y/o la ecografia se utilizaron para guiar el procedimiento. Se analizo la relacion entre la eficacia y la edad de los pacientes, el tipo de aguja, el origen de los pacientes, el tamano y localizacion tumoral, y el numero de sesiones necesarias para ablacionar el tumor. Se registraron las complicaciones. Resultados La RF se pudo realizar a todos los pacientes. La media de seguimiento fue de 32,1 meses. La eficacia fue de un 93,7%. El 87,5% de los pacientes requirieron una sola sesion, el 8%, 2 sesiones y el 4,5%, 3 sesiones. El unico factor asociado a una menor eficacia fue el tamano del tumor (p = 0,03). La tasa de complicaciones fue del 5,6%. Conclusiones La RF es eficaz y segura, con resultados comparables a los referidos en la literatura especializada.

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).

Radiological approach to cardiac tamponade Abstract Cardiac tamponade is a life-threatening medical emergency. The radiologist's role in the clinical management of patients with cardiac tamponade is usually minor and nearly always limited to the diagnostic process, and the condition is normally treated by other specialists. In this review, we aim to provide readers with the essential information to enable a complete diagnostic and therapeutic radiological approach. We emphasize US-guided percutaneous pericardial drainage; when performed correctly, this technique improves patients' symptoms immediately with minimal discomfort and a very low rate of complications.

Resumen La nueva ley de especialidades espanola ha corregido las limitaciones de la anterior sobre el tutor y sus funciones. Sin embargo sigue careciendo de una descripcion del papel del residente en su formacion. El Estatuto del Residente y el Programa de la Especialidad aportan mas informacion sobre este aspecto. La normativa establece que el residente no es un objeto pasivo en su formacion. Ademas de sus obligaciones laborales que incluyen la exclusividad laboral y el conocimiento y cumplimiento de los reglamentos y normas de funcionamiento de las instituciones en que esta integrado, el residente tiene el deber de formarse e ir adquiriendo progresivamente responsabilidades relativas a la especialidad. Esto incluye tambien una parte de formacion no asistencial, preparacion de sesiones, asistencia a comites, dominio de las nuevas tecnologias y la capacidad del residente de apoyarse en recursos on-line. Por otra parte, segun el Estatuto del Residente este es un miembro del servicio a todos los efectos, compartiendo los fines de este y de la institucion, estando obligado a ayudar al cumplimiento de sus objetivos. Y tambien a cumplir los objetivos de su programa de formacion y a tener una actitud activa en el aprendizaje. El residente es tan responsable del resultado final de su formacion como los especialistas del servicio en que se forma.

Vasculitis is an inflammatory destructive process affecting blood vessels. Pulmonary vasculitis may be secondary to other conditions or constitute a primary, and in most cases idiopathic, disorder. Underlying conditions in the secondary vasculitides are infectious diseases, connective tissue diseases, malignancies, and hypersensitivity disorders. The most widely used approach to classifying the primary vasculitides is based on the size of the affected vessels (large, medium, small). Thoracic involvement is most commonly seen with primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary small-vessel antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome). The radiologic manifestations of primary pulmonary vasculitis are extremely variable and include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations. Diffuse alveolar hemorrhage is a clinical syndrome that usually results from primary small-vessel vasculitis in the lungs. Although chest radiography is often the first imaging study performed in patients with pulmonary involvement by vasculitis, chest radiographs often fail to show the exact pattern and extent of thoracic involvement and CT is more useful in assessment of the thoracic findings. The pulmonary primary vasculitides are rare disorders, and their diagnoses are among the most demanding challenges in medicine because their signs and symptoms are nonspecific and overlap with those of infections, connective tissue diseases, and malignancies; thus, diagnosis of vasculitis relies on recognition of characteristic combinations of particular clinical, radiologic, laboratory, and histopathologic features.

Voiding urosonography (VUS) has proved to be a reliable method for the study of vesicoureteric reflux (VUR). Early reports considered it inadequate for imaging the male urethra. To determine the usefulness of contrast-enhanced VUS for the study of the urethra. A total of 208 children aged 2 days to 10 years underwent VUS to confirm or exclude VUR for different reasons (n = 150) or for follow-up (n = 58). Patients with unconfirmed suspicion of VUR (99 boys and 51 girls) also underwent VUS for the study of the urethra. Examinations were performed using a harmonic imaging mode specific for contrast (Levovist) enhancement. We used a 6–4-MHz convex probe and a transperineal and/or a transpelvic approach. The neck of the bladder and the entire urethra were visualized in all patients (n = 150). The male urethra was considered normal in 95 boys (95.95%). We diagnosed posterior urethral valves in two patients, diverticulum of the prostatic utricle in one, and diverticulum of the anterior urethra in one. All abnormal cases were confirmed using conventional voiding cystourethrography. VUS can replace voiding cystourethrography as the method of choice for the initial study of suspected VUR in children.

Vasculitis is a destructive inflammatory process affecting blood vessels. Pulmonary vasculitis may develop secondary to other conditions or constitute a primary idiopathic disorder. Thoracic involvement is most common in primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behcet disease) and primary antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome). Primary pulmonary vasculitides are rare, and their signs and symptoms are nonspecific, overlapping with those of infections, connective tissue diseases, and malignancies. The radiologic findings in primary pulmonary vasculitis vary widely and can include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations, among others. Diffuse alveolar hemorrhage usually results from primary small-vessel vasculitis in the lungs. To diagnose vasculitis, medical teams must recognize characteristic combinations of clinical, radiologic, laboratory, and histopathologic features.