Introduction: A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. Methods: A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. Results: 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. Conclusions: Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.

Background: The 3D-REAL-IR MRI sequence allows for an in vivo visualization of endolymphatic hydrops. Qualitative assessment methods of the severity of vestibular and cochlear hydrops are the most commonly used. Methods: A quantitative volumetric measurement of vestibular EH in patients with definite unilateral Meniere's disease using the 3D-REAL-IR sequence and the calculation of the endolymphatic ratio (ELR) was intended. Results: Volumetric calculations of the vestibules, vestibular endolymph and vestibular ELR are performed in 96 patients with unilateral Meniere's disease and correlated with classic qualitative grading scales. Conclusions: Quantitative volumetric measurement of vestibular hydrops using the 3D-REAL-IR sequence is feasible and reproducible in daily clinical practice. Vestibular ELR values exceeding 60% defined radiologically significant vestibular hydrops, while values below 30% defined radiologically non-significant vestibular hydrops.

Purpose: To assess the clinical outcomes of transcatheter arterial embolization (TAE) for secondary stiff shoulder (SSS). Materials and Methods: This is a retrospective analysis of prospectively collected data performed between January 2017 and December 2019. This study comprised 25 patients (20 women and 5 men; median age, 49 years; range 27-59) with SSS resistant to conservative management during at least 3 months. The median time of stiffness was 12 months. The etiology of SSS was postoperative in 14 patients (56%) and posttraumatic in the remaining 11 patients (44%). Periods of immobilization in all patients were associated. TAE was performed, and technical aspects, adverse events, changes for pain, and physical examination before and 6 months after TAE were assessed. Results: Abnormal vessels were observed in 20 of 25 (80%) of the procedures. Transitory cutaneous erythema was noted in 4 patients treated after TAE. Significant differences were observed in the median pain visual analog scale reduction between before and 6 months after TAE (8 vs 2, P <.001). Shoulder mobility significantly improved in both flexion and abduction degrees between before and at 6 months after TAE in (70 degrees vs 150 degrees; P <.001). No symptoms of recurrence appeared. Conclusions: TAE can result in pain reduction and mobility improvement in patients with SSS refractory to conservative therapy.

Purpose To evaluate the mid-term clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis (AC) resistant to medical treatments. Materials and Methods This is a prospective analysis performed between February 2016 and February 2020. Inclusion criteria for TAE were shoulder pain, restriction of movement and no response to conservative treatment for at least 3 months. Demographic variables, risk factors, technical aspects, adverse events, changes by visual analogue scale (VAS) for pain and physical examination before and after TAE were assessed. Results This study included 40 patients with AC (35 women and 5 men; mean age 50 +/- 9 years old). Abnormal vessels were observed in 31/40 (77.5%) procedures. As embolic agent, imipenem/cilastatin was used. The mean follow-up was 21.2 +/- 10.5 months. Significant differences were obtained in terms of pain reduction before and 6 months after TAE with the median visual analogue scale (VAS) of 8 vs. 0.5, P = 0.0001. Substantial differences were found regarding mobility in flexion and abduction before and 6 months after embolization, respectively (79.5 degrees +/- 18.5 degrees vs. 133 degrees +/- 24.5 degrees, P = 0.0001; 72.4 degrees +/- 18.8 degrees vs. 129.7 degrees +/- 27.9 degrees, P = 0.0001). No complications occurred. Complete recovery was obtained in 37/40 (92.5%) patients and partial recovery in 2/40 (5%). No clinical recurrence appeared. Conclusions Clinical results of transcatheter arterial embolization with imipenem/cilastatin are effective and stable in the mid-term follow-up for patients presenting with AC resistant to conservative treatments.

Objective: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. Conclusion: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.

Durante los últimos años, la Cirugía Biliopancreática ha sufrido importantes cambios, entre los que la vía de abordaje ha podido ser uno de los más relevantes, junto a los avances en el tratamiento oncológico, la mínima invasión y los modernos métodos diagnósticos disponibles en los últimos años; todos ellos quedan reflejados en este documento, lo que le convierte en una guía actualizada, de fácil manejo y muy útil para cirujanos en formación en esta área de superespecialización de la cirugía digestiva, con el claro objetivo de resolver los retos que nuestra profesión nos pone en el camino. Cada día son más frecuentes los hallazgos incidentales en el páncreas y en las vías biliares, que requieren la aplicación de algoritmos diagnósticos y de decisiones terapéuticas que, en muchas ocasiones, precisan de un conocimiento profundo de la enfermedad, tecnología diagnóstica específica y experiencia quirúrgica en esta área; de ahí que el desarrollo de unidades de referencia en Cirugía Hepatobiliopancreática, donde se manejan un elevado número de casos, haya llevado a la baja morbimortalidad relacionada con procedimientos complejos. Estos hechos, añadidos al aumento de la prevalencia epidemiológica de la patología biliopancreática, constituyen una verdadera atracción para los cirujanos generales, a los que estos documentos sirven de guía para poner en práctica algunos de los procedimientos en función de su complejidad y del hospital en el que desempeñan su actividad.