This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.

Se presenta el caso de una paciente portadora de diabetes lipoatrófica generalizada con éxito reproductivo. Se analiza el tratamiento metabólico y el manejo perinatal. La instalación de infección intraamniótica determinó la interrupción del embarazo a las 28 semanas, con recién nacido de pretérmino adecuado para la edad gestacional, que evolucionó con distrés respiratorio prolongado, hemorragia subaracnoidea y enterocolitis necrotizante. El seguimiento al sexto mes de vida revela examen neurológico normal.

Objective. To evaluate a barium study of the upper gastrointestinal tract in early postoperative monitoring of bariatric surgery patients, recording the anatomical characteristics of the gastric remnant and the frequency of complications such as leakage of contrast and emptying difficulties. Materials and Methods. We retrospectively evaluated the barium study of the upper gastrointestinal tract performed in 168 patients after gastric bypass (GBP) and 98 patients after vertical subtotal gastrectomy (VSG). All evaluated examinations were performed in the first five days after surgery. Gastric remnant volume was registered in relation to the T12 vertebral body (only in GBP), the presence and site of contrast leakage and gastric remnant emptying difficulties. Results. The average age of patients undergoing GBP was 43 years, and 37 years for VSG. The average volume of gastric remnant of patients with GBP was 1.5 T12 vertebral bodies. Two GBP operated patients (1.2%) had leakage of the contrast medium at the level of the gastroenteric anastomosis; in VSG operated patients the contrast leakage occurred in 7 cases (7.1%), the most frequent site being the left side cephalic portion of the gastric remnant. All cases with contrast leakage were subsequently studied using computed tomography, finding the presence of wound dehiscence or fluid collections adjacent to the gastric remnant. Emptying difficulty was observed in 12 patients operated for GBP (7.1%); there was no record of this complication in patients undergoing VSG. Conclusion. The upper gastrointestinal barium study is useful in patients after bariatric surgery to assess the early postoperative anatomy and volume of the gastric remnant, as well as to detect possible complications. It is a simple test, which should be applied as a routine control in these patients.

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Introducción La hernia hiatal gigante (HHG) con estómago intratorácico es una enfermedad poco frecuente. Durante el último tiempo hemos visto casos con mayor frecuencia en pacientes añosos y obesos. Habitualmente estas hernias se asocian a rotación gástrica órgano-axial, y pueden presentar complicaciones como vólvulo, perforación u obstrucción gástrica. El estudio con imágenes, particularmente tomografía computada multidetector y estudio baritado esófagoestómago-duodeno, resultan fundamentales para el diagnóstico y caracterización de estas lesiones. El tratamiento es quirúrgico, sea por cirugía abierta o laparoscópica. Caso clínico: Paciente mujer, de 72 años, con antecedente de enfermedad pulmonar obstructiva crónica (EPOC)