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array:24 [ "pii" => "S217357861400050X" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.03.007" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "610" "copyright" => "AEU" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:584-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 277 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 194 "PDF" => 71 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480613003896" "issn" => "02104806" "doi" => "10.1016/j.acuro.2013.12.001" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "610" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:584-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 569 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 319 "PDF" => 241 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Estudio de seguridad de la biopsia renal percutánea con aguja de calibre 16<span class="elsevierStyleHsp" style=""></span>G" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "588" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle: A safety study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 923 "Ancho" => 1661 "Tamanyo" => 72761 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relación de complicaciones.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Guerrero-Ramos, F. Villacampa-Aubá, E. Jiménez-Alcaide, L. García-González, I.A. Ospina-Galeano, F. de la Rosa-Kehrmann, A. Rodríguez-Antolín, J. Passas-Martínez, R. Díaz-González" "autores" => array:9 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Guerrero-Ramos" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Villacampa-Aubá" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Jiménez-Alcaide" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "García-González" ] 4 => array:2 [ "nombre" => "I.A." "apellidos" => "Ospina-Galeano" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "de la Rosa-Kehrmann" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Antolín" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Passas-Martínez" ] 8 => array:2 [ "nombre" => "R." "apellidos" => "Díaz-González" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357861400050X" "doi" => "10.1016/j.acuroe.2014.03.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357861400050X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613003896?idApp=UINPBA00004N" "url" => "/02104806/0000003800000009/v1_201410280110/S0210480613003896/v1_201410280110/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578614000511" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.03.008" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "618" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:589-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 255 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 162 "PDF" => 83 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Home-based treadmill training improved seminal quality in adults with type 2 diabetes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "589" "paginaFinal" => "593" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El entrenamiento en tapiz rodante a domicilio mejora la calidad seminal en adultos con diabetes de tipo 2" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Rosety-Rodriguez, J.M. Rosety, G. Fornieles, M.A. Rosety, A.J. Diaz, I. Rosety, A. Rodríguez-Pareja, F.J. Ordonez, S. Elosegui" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Rosety-Rodriguez" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Rosety" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Fornieles" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Rosety" ] 4 => array:2 [ "nombre" => "A.J." "apellidos" => "Diaz" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Rosety" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Pareja" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Rosety" ] 8 => array:2 [ "nombre" => "F.J." "apellidos" => "Ordonez" ] 9 => array:2 [ "nombre" => "S." "apellidos" => "Elosegui" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480614000217" "doi" => "10.1016/j.acuro.2013.10.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614000217?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000511?idApp=UINPBA00004N" "url" => "/21735786/0000003800000009/v1_201410250047/S2173578614000511/v1_201410250047/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578614001383" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.09.007" "estado" => "S300" "fechaPublicacion" => "2014-11-01" "aid" => "667" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:576-83" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 547 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 351 "PDF" => 183 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "576" "paginaFinal" => "583" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio comparativo entre cirugía retrógrada intrarrenal y micro-nefrolitotomía percutánea en el tratamiento de la litiasis renal de tamaño intermedio" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 664 "Ancho" => 996 "Tamanyo" => 99701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Almost imperceptible 8<span class="elsevierStyleHsp" style=""></span>Ch microperc incision after the surgery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Ramón de Fata, A. García-Tello, G. Andrés, C. Redondo, E. Meilán, H. Gimbernat, J.C. Angulo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Ramón de Fata" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "García-Tello" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Andrés" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Redondo" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Meilán" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Gimbernat" ] 6 => array:2 [ "nombre" => "J.C." "apellidos" => "Angulo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480614001478" "doi" => "10.1016/j.acuro.2014.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480614001478?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614001383?idApp=UINPBA00004N" "url" => "/21735786/0000003800000009/v1_201410250047/S2173578614001383/v1_201410250047/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle: A safety study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "588" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Guerrero-Ramos, F. Villacampa-Aubá, E. Jiménez-Alcaide, L. García-González, I.A. Ospina-Galeano, F. de la Rosa-Kehrmann, A. Rodríguez-Antolín, J. Passas-Martínez, R. Díaz-González" "autores" => array:9 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Guerrero-Ramos" "email" => array:1 [ 0 => "felixguerrero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Villacampa-Aubá" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Jiménez-Alcaide" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "García-González" ] 4 => array:2 [ "nombre" => "I.A." "apellidos" => "Ospina-Galeano" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "de la Rosa-Kehrmann" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez-Antolín" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Passas-Martínez" ] 8 => array:2 [ "nombre" => "R." "apellidos" => "Díaz-González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de seguridad de la biopsia renal percutánea con aguja de caliber 16<span class="elsevierStyleHsp" style=""></span>G" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 923 "Ancho" => 1661 "Tamanyo" => 75976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relationship of complications.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background and objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">The percutaneous biopsy of native kidneys is a technique that has been employed for several decades for the diagnosis of medical renal diseases. The technique was first described in 1951,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> although its variant in the prone position (similar to the method we know today) was described in 1955 by Muehrcke et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Since then, this technique has been simplified and continuously improved. However, in the last three decades, the technique has undergone its two more significant changes: the use of ultrasound and the automatic biopsy gun.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Percutaneous renal biopsy has traditionally been rejected in the diagnostic regimen of renal masses for 3 main reasons: the risk of disseminating tumor cells through a puncture trajectory,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> the technique's questionable diagnostic yield and the complications resulting from the procedure. These issues have brought into question the appropriateness (in terms of risk-benefit) of the percutaneous renal biopsy of renal masses.</p><p id="par0015" class="elsevierStylePara elsevierViewall">However, percutaneous renal biopsy is a well-established technique for ascertaining renal disease in standard clinical practice. There is currently little discussion concerning its effectiveness in the diagnosis of renal diseases, which according to the literature is above 90%.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,10</span></a> Furthermore, various studies have demonstrated the safety of the technique, with a rate of major complications of approximately 5–7% in virtually all of the studies.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,11,12</span></a> In the last two decades, there have been no reported complications requiring nephrectomy or surgery as a result of the use of the ultrasound-guided automated biopsy gun, and there has been only 1 death related to the technique.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since the widespread use of imaging techniques, there has been a spectacular increase in the incidence of renal masses, a large proportion of which are small (smaller than 4<span class="elsevierStyleHsp" style=""></span>cm). These masses create the most controversy in urological forums, given that a rate of histological benignity of up to 20% has been reported in those that are suspected of malignancy due to imaging techniques.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> For this reason, in recent years there has been a return to the discussion of implementing percutaneous renal biopsy as a routine procedure in the diagnosis of small renal masses. Although problems are infrequent, this technique is not without complications and morbidity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to perform a descriptive study of the complications and results of orthotopic renal biopsies indicated for medical reasons and conducted in our department. We conduct these biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needles, one of the thickest used currently,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> which in theory entail a greater risk of morbidity. Furthermore, given the current controversial status of renal mass biopsy, we performed a review to evaluate the role of percutaneous renal biopsy in the diagnosis of renal masses.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective review of 180 consecutive cases of orthotopic ultrasound-guided renal biopsies performed by nephrological indication in our department between January 2008 and May 2010. According to our renal biopsy protocol, the patient is admitted the day before the procedure and undergoes laboratory tests (blood count, biochemistry and coagulation). After the biopsy, the patient remains for 24–48<span class="elsevierStyleHsp" style=""></span>h under observation, with the first 24<span class="elsevierStyleHsp" style=""></span>hours in bed rest. For patients with renal failure and to prevent the deleterious effects of associated uremic thrombopathy, desmopressin acetate (Minurin<span class="elsevierStyleSup">®</span>) is administered intravenously 1 hour before the operation at a dose of 0.4<span class="elsevierStyleHsp" style=""></span>μg per kg of body weight, diluted in 50<span class="elsevierStyleHsp" style=""></span>cc of physiological saline at 0.9%, to be passed in 30<span class="elsevierStyleHsp" style=""></span>min. After administering local anesthesia with mepivacaine at a concentration of 1%, the technique is performed under ultrasound control and with a guide adapted to the transducer, using a 16<span class="elsevierStyleHsp" style=""></span>G needle attached to a Bard<span class="elsevierStyleSup">®</span> automated biopsy gun. We collected a number of patient demographic variables (age, history, serum creatinine readings, coagulation parameters, etc.), as well as the early complications resulting from the procedure and the approach adopted for each complication, if applicable. We studied the rate of complications and the relationship between risk factors and the onset of complications. To assess the relationship among hypertension, anticoagulation or antiplatelet therapy and complications, we used the chi-squared test.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The mean age of our patients was 55.8 years (range, 18–88 years), with a mean of 2.49 cores per intervention (range: 1–7 cores). The most common indications are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most common elements in the patients’ history are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. In our series, we found that 5.6% of the patients had undergone anticoagulation therapy, and 10.6% had undergone antiplatelet therapy. The overall rate of complications was 5.6% (the complications are detailed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Only 3 (1.67%) of the 180 patients required an interventional approach due to procedural complications: 2 embolizations for retroperitoneal hematoma (1.1%) and 1 for anemia secondary to hematuria (0.6%). There was no need for surgery, and there were no deaths resulting from the procedure. There was no relationship (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) between hypertension and complications (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09), prior anticoagulation therapy and complications (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.099) or prior antiplatelet therapy and complications (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.603). Only 2.8% of the biopsies presented insufficient material for the diagnosis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Orthotopic ultrasound-guided renal biopsy with a 16<span class="elsevierStyleHsp" style=""></span>G needle is a safe technique in our center and has a low rate of complications, even in patients with prior risk factors or coagulation disorders, provided these are corrected appropriately prior to the procedure. There are few publications that evaluate the results of renal biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needles. The results of our study therefore strengthen the available evidence.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> With the rate of complications described, there is no question about this technique's safety, which thereby allows us to broaden its indications, even for renal mass biopsies.</p><p id="par0045" class="elsevierStylePara elsevierViewall">At present, small renal masses (smaller than 4<span class="elsevierStyleHsp" style=""></span>cm) constitute 48–66% of all newly diagnosed renal cancers.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,17</span></a> Of these, up to 20% present histological criteria of benignity and 60% are low-grade renal cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, the percutaneous biopsy of small renal masses remains highly questioned among urologists, only 5% of whom indicate that they perform the procedure more or less routinely.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The three main reasons for rejecting the biopsy of small renal masses are the safety of the technique, the diagnostic yield and the risk of tumor dissemination over the course of the puncture trajectory. In terms of safety, the data submitted in this study clearly support the view that the procedure presents an acceptable risk, even when performed with a 16<span class="elsevierStyleHsp" style=""></span>G needle.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of yield, our series obtained a 97.2% diagnostic yield, although our study is limited in that the yield was achieved with kidneys with medical nephropathies and not renal masses. In the case of renal mass biopsies, the diagnostic yield rates described in the literature are approximately 95%.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This yield is greater for the diagnosis of benignity than of malignancy, with less precision in the assignment of tumor grade in cases of malignancy.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Occasionally, the diagnostic reliability is limited by the presence of areas of central necrosis or inflammatory infiltrates associated with the tumor. This problem could be minimized by obtaining (in addition to the central cores) at least 2 cores from the periphery of the mass.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Furthermore, the incorporation of new techniques developed in molecular biology-based diagnosis, if they can be applied to the material obtained from biopsies, could contribute to increasing our ability to individually stratify the risk for each patient and, consequently, adopt the most appropriate management for each patient.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> A number of authors have reported the possibility of optimizing the yield of the biopsy using a repeat biopsy, for cases that are initially negative, with satisfactory diagnostic rates in the second biopsy of approximately 83.3%.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In terms of the dissemination of tumor cells over the course of the puncture trajectory, there have been numerous studies that have estimated the dissemination in negligible percentages, varying between 0.009% and 0.01%.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a> Even in cases of transitional cell tumor histology and despite a number of reported cases,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> this risk is negligible. Therefore, the hypothetical possibility of dissemination as the result of the biopsy should not preclude performing the biopsy.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The current discussion focuses on the indications of renal mass biopsy, whether this technique has the ability to change the approach to management when dealing with small renal masses and whether it should be included in diagnostic and therapeutic algorithms.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28–30</span></a> At present and depending on the available evidence, the use of biopsies for renal masses smaller than 4<span class="elsevierStyleHsp" style=""></span>cm can be recommended for the following cases<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0070" class="elsevierStylePara elsevierViewall">As support for imaging tests in the differential diagnosis of benignity versus malignancy, adjusting the treatment to the result.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0075" class="elsevierStylePara elsevierViewall">In metastatic renal masses, to determine the histological type and choose the ideal treatment.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">In the context of the emergence of new ablative techniques for the local treatment of small renal tumors, directed to minimize the loss of nephron mass associated with surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In these cases, renal mass biopsy is included in the diagnosis section of management protocols and plays an important role in the monitoring of the disease.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Lastly, renal mass biopsy maintains its role in the diagnosis of potential renal metastases of other tumors.</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">As in other solid tumors (breast, lung, prostate, etc.), biopsy is a standard procedure prior to treatment.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Its application in renal tumor disease remains a challenge among urologists. In recent years, there has been an enormous amount of interest in the subject and a considerable number of studies, many of them of unquestionable quality. The standardization of the technique and, with it, a paradigm shift in the management of renal tumors are therefore probably just a matter of time.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Based on the results of our study and the available literature, ultrasound-guided percutaneous renal biopsy is a safe technique with a high diagnostic yield, even in patients with risk factors, if these factors are properly corrected prior to the procedure. This fact, along with the change in scenario of renal cancer (a considerable majority of small and incidentally diagnosed tumors) we are experiencing, leads us to a new concept in the management of this cancer, in which renal mass biopsy plays a key role.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres378206" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec357260" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres378207" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción y objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec357259" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background and objectives" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-26" "fechaAceptado" => "2013-12-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec357260" "palabras" => array:3 [ 0 => "Kidney" 1 => "Biopsy" 2 => "Safety" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec357259" "palabras" => array:3 [ 0 => "Riñón" 1 => "Biopsia" 2 => "Seguridad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The development of percutaneous renal biopsy as a routine diagnostic procedure for renal masses has been the topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective was to carry out a descriptive study about the complications and outcomes of orthotopic kidney biopsies with 16<span class="elsevierStyleHsp" style=""></span>G needle.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service from January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16<span class="elsevierStyleHsp" style=""></span>G needle). Data on multiple clinical variables, early post-procedure complications and renal biopsy management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean age of the subjects was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.09), previous anticoagulation (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.099) or previous antiaggregation (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.603) and complications was demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Percutaneous ultrasound-guided renal biopsy with 16<span class="elsevierStyleHsp" style=""></span>G needle is a safe technique with high diagnostic performance.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recientemente se vuelve a discutir sobre la implantación de la biopsia renal percutánea como procedimiento rutinario en el diagnóstico de masas renales. Sin embargo, aunque infrecuentes, esta técnica no está exenta de complicaciones y morbilidad. Nuestro objetivo es realizar un estudio descriptivo de las complicaciones y resultados de las biopsias renales ortotópicas con aguja de 16<span class="elsevierStyleHsp" style=""></span>G.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Llevamos a cabo una revisión retrospectiva de 180 biopsias renales ortotópicas ecodirigidas realizadas en nuestro servicio entre enero de 2008 y mayo de 2010. La técnica se realiza utilizando una aguja de diámetro 16<span class="elsevierStyleHsp" style=""></span>G acoplada a una pistola automática. Se recogen múltiples variables clínicas, así como las complicaciones tempranas derivadas del procedimiento y la actitud adoptada respecto a ellas. Se estudió la tasa de complicaciones, así como la relación entre factores de riesgo y aparición de complicaciones.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 55,8 años, obteniéndose una media de 2,49 cilindros por intervención. La tasa global de complicaciones fue del 5,6%. Únicamente en 3 (1,67%) pacientes de los 180 fue necesaria una actitud intervencionista derivada de complicación del procedimiento. No hubo necesidad de intervenciones quirúrgicas ni se produjeron fallecimientos derivados del procedimiento. No se demostró relación entre HTA (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,09), anticoagulación previa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,099) o antiagregación previa (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,603) y complicaciones. El 2,8% de las biopsias presentaron material insuficiente para el diagnóstico.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La biopsia renal percutánea ecodirigida con aguja de 16<span class="elsevierStyleHsp" style=""></span>G es una técnica segura y con una rentabilidad diagnóstica elevada.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guerrero-Ramos F, Villacampa-Aubá F, Jiménez-Alcaide E, García-González L, Ospina-Galeano IA, de la Rosa-Kehrmann F, et al. Estudio de seguridad de la biopsia renal percutánea con aguja de caliber 16<span class="elsevierStyleHsp" style=""></span>G. Actas Urol Esp. 2014;38:584–588.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 923 "Ancho" => 1661 "Tamanyo" => 75976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relationship of complications.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nephrotic syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proteinuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic disease (lupus, vasculitis, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab575314.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Indications for orthotopic renal biopsy.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type 2 diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiplatelet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticoagulation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vasculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab575313.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relationship of personal medical history.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Complications rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiplatelet (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.603 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticoagulation (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.099 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>119) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.090 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>180) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab575312.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Relationship between risk factors and complications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ 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