AIM:To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications. METHODS:This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, threedimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas. RESULTS:The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm 2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm 2 (IR) during the Valsalva (P s < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (P s < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva. CONCLUSION:Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant de-

Caval morphology and hemodynamics are clearly affected by Valsalva maneuvers. A physiological reduction of IVC cross-sectional area is associated with higher risk of filter penetration, despite short dwell times. Physiologic data should be used to improve future filter designs to remain safely implanted over longer dwell times.

Prostate Artery Embolization (PAE) is a technically demanding new treatment optionfor Benign Prostatic Hyperplasia (BPH). We present a case of radiation-induced dermitis in a 63-year-old patient after a technically successful PAE, due to high radiation exposure and long procedural time. Anatomical and technical aspects are discussed, as well as recommendations to decrease radiation exposure in these procedures. KeywordsProstatic artery embolization, benign prostatic hyperplasia, radiation exposure, radiodermitis, complications. INTRODUCTIONRecently, PAE has been adopted for the treatment of low-urinary tract symptoms (LUTS) due to BPH. Previous studies have established PAE as a safe and effective treatment, associated with reduction in prostate volume, significant symptom reduction, and improvement of functional and clinical outcomes (1-3). However, PAE requires a well-trained interventional radiologist because of the complex prostatic vascular anatomy and the potential for complications in elderly patients with atherosclerosis, very thin prostatic arteries and comorbidities. Moreover, these features can lead to major radiation exposure during the procedure.To authors' knowledge, no case of radiation exposure complication has been reported so far in this type of procedure. Herein, we describe a case of radiodermitis following a technically successful PAE and discuss specific aspects related. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 3 which was especially difficult due to atherosclerosis ( Figure 1). An important anastomosis between the left prostatic lobe artery and the dorsal penile artery was then identified, and selective occlusion with a platinum microcoil was performed (Axium detachable coil system. Ev3 Micro Therapeutics, Inc, USA) in order to avoid non-target embolization ( Figure 2). After that, we embolized bilaterally to total stasis with 300-500 μm Embosphere ® Microspheres (Biosphere Medical, Roissy, France), avoiding reflux of embolic agent to undesired arteries. Page 1 of 18Procedure lasted 310 minutes, with 72 minutes of total fluoroscopy time.Measurements of radiation exposure demonstrated a Kerma-area-product of 8023949 mGy . cm 2 and an effective-dose of 9.8 Sv.Within 12 days of follow-up, patient developed an erythematous lesion in the lower back/sacral area, associated with skin edema and pigmentation, characterizing radiodermitis. Related symptoms included local pain and pruritus. Local treatment with an urea-based lotion, thrice a day for 15 days (Ureadin. Laboratorios Isdin. Barcelona, Spain) was initiated with progressive improvement of lesion aspect and symptomatology, and after 60 days there was just a small area of skin atrophy (figure 3). Regarding LUTS, an important improvement was observed since the first month of follow-up, characterized by reduction of IPSS and QoL scores. Within 3 months, micciona...

Background: With the number of centenarians increasing exponentially in Spain, a deeper knowledge of their socio-demographic, clinical, and healthcare use characteristics is important to better understand the health profile of the very elderly. Methods: We conducted a retrospective, cross-sectional observational study in the EpiChron Cohort (Aragón, Spain) aimed at analyzing the socio-demographic, clinical, drug use and healthcare use characteristics of 1680 centenarians during 2011-2015, using data from electronic health records and clinical-administrative databases. Results: Spanish centenarians (79.1% women) had 101.6 years on average. Approximately 80% of centenarians suffered from multimorbidity, with an average of 4.0 chronic conditions; 50% were exposed to polypharmacy, with an average of 4.8 medications; only 6% of centenarians were free of chronic diseases and only 7% were not on medication. Centenarians presented a cardio-cerebrovascular pattern in which hypertension, heart failure, cerebrovascular disease and dementia were the most frequent conditions. Primary care was the most frequently visited healthcare level (79% of them), followed by medical specialist consultations (23%), hospitalizations (13%), and emergency service use (9%). Conclusions: Multimorbidity is the rule rather than the exception in Spanish centenarians. Addressing medical care in the very elderly from a holistic geriatric view is critical in order to preserve their health, and avoid the negative effects of polypharmacy.

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