Utilidad de las secuencias funcionales por resonancia magnética en el estudio de los tumores óseos y de partes blandas. Revisión imaginológica / Difusion and Functional Sequences: Utility in the Study of Bone and Soft Tissue Tumors. Pictorial Review

La resonancia magnética es la técnica de imagen de elección para diagnosticar, caracterizar, estadificar, realizar el seguimiento y valorar la respuesta al tratamiento de los tumores musculoesqueléticos. Para estos fines se utilizan las secuencias convencionales. Desde hace algunos años se han comenzado a implementar nuevas técnicas avanzadas, como la secuencia en fase y fase opuesta, difusión, perfusión y espectroscopia, que en conjunto se denominan técnicas funcionales, las cuales proporcionan información más específica del comportamiento, fisiología, metabolismo y biología molecular del tumor. Estas secuencias son no invasivas, aportan información adicional cualitativa, cuantitativa, metabólica y vascular por lo que deberían utilizarse de manera rutinaria en el momento de realizar el diagnóstico y, especialmente, en el seguimiento de los tumores óseos y de partes blandas. En este artículo se revisa la técnica de dichas secuencias, particularmente la secuencia de difusión, mediante casos ilustrativos de nuestros hospitales: Hospital Pablo Tobón Uribe y Hospital Universitario Quirón Salud de Madrid. También se revisarán las aplicaciones e importancia de un análisis combinado de estas nuevas herramientas, que aportarán información adicional para adecuada caracterización, enfoque diagnóstico y respuesta al tratamiento de las lesiones tumorales en el sistema musculoesquelético

Magnetic resonance imaging (MR) is the preferred technique for the diagnosis, characterization, staging, follow-up and assessment of response to treatment of musculoskeletal tumors. Conventional sequences help to classify these lesions. Recently new evolving functional MR sequences with advanced techniques have been implemented, such as phase sequence, opposite phase, diffusion, perfusion and spectroscopy, which provide specific information about the behavior, physiology, metabolism and molecular biology of the tumor. These sequences are non-invasive and provide additional qualitative, quantitative, metabolic and vascular information, making them important for the diagnosis and monitoring of bone and soft tissue tumors. This article reviews the technique of these sequences, particualrly the diffusion technique, using illustrative cases from the Hospital Pablo Tobon Uribe (Medellin ­ Colombia) and the University Hospital Quirón Salud (Madrid ­ Spain). We aim to review the utility and importance of a combined analysis of these new tools, which will provide additional information for adequate characterization, diagnosis and response to treatment of tumor lesions in the musculoskeletal system.

Short version of the "instrument for assessment of stress in nursing students" in the Brazilian reality / Versão reduzida do "instrumento de avaliação de estresse em estudantes de enfermagem" na realidade brasileira / Versión reducida del "instrumento de evaluación de estrés en estudiantes de enfermería" en la realidad brasilera

ABSTRACT Goal: validate a short version of the Instrument for assessment of stress in nursing students in the Brazilian reality. Method: Methodological study conducted with 1047 nursing students from five Brazilian institutions, who answered the 30 items initially distributed in eight domains. Data were analyzed in the R Statistical Package and in the latent variable analysis, using exploratory and confirmatory factor analyses, Cronbach's alpha and item-total correlation. Results: The short version of the instrument had 19 items distributed into four domains: Environment, Professional Training, Theoretical Activities and Performance of Practical Activities. The confirmatory analysis showed absolute and parsimony fit to the proposed model with satisfactory residual levels. Alpha values ​​per factor ranged from 0.736 (Environment) to 0.842 (Performance of Practical Activities). Conclusion: The short version of the instrument has construct validity and reliability for application to Brazilian nursing undergraduates at any stage of the course.

RESUMO Objetivo: validar uma versão reduzida do Instrumento de avaliação de estresse em estudantes de enfermagem, na realidade brasileira. Método: Estudo metodológico realizado com 1047 universitários de enfermagem de cinco instituições brasileiras, que responderam aos 30 itens do instrumento distribuídos inicialmente em oito domínios. Analisou-se os dados no Pacote estatístico R e no latent variable analysis empregando-se análises fatoriais exploratória e confirmatória, alfa de Cronbach e correlação item-total. Resultados: A versão reduzida do instrumento apresentou 19 itens distribuídos em quatro domínios: Ambiente, Formação profissional, Atividades Teóricas e Realização de Atividades Práticas. A análise confirmatória demonstrou ajuste absoluto e de parcimônia ao modelo proposto, com níveis de resíduos satisfatórios. Os valores de Alfa por fator variaram de 0,736 (Ambiente) a 0,842 (Realização de Atividades Práticas). Conclusão: A versão reduzida do instrumento apresenta validade de constructo e confiabilidade para aplicação em universitários de enfermagem brasileiros que estão presentes em qualquer fase do curso.

RESUMEN Objetivo: validar una versión reducida del Instrumento de evaluación de estrés en estudiantes de enfermería, en la realidad brasilera. Método: Estudio metodológico realizado con 1047 universitarios de enfermería de cinco instituciones brasileras, que respondieron a los 30 ítems del instrumento distribuidos inicialmente en oito dominios. Se analizaron los datos en el Paquete estadístico R y en el latent variable analysis empleándose análisis factoriales exploratorios y confirmatorios, alfa de Cronbach y correlación ítem-total. Resultados: La versión reducida del instrumento presentó 19 ítems distribuidos en cuatro dominios: Ambiente, Formación profesional, Actividades Teóricas y Realización de Actividades Prácticas. El análisis confirmatorio demostró ajuste absoluto y de parsimonia al modelo propuesto, con niveles de residuos satisfactorios. Los valores de Alfa por factor variaron de 0,736 (Ambiente) a 0,842 (Realización de Actividades Prácticas). Conclusión: La versión reducida del instrumento presenta validad de constructo y confiabilidad para aplicación en universitarios de enfermería brasileros que están presentes en cualquier fase del curso.

Sarcoma sinovial monofásico de tipo fibroblástico. Evaluación diagnóstica por RM y postratamiento mediante ADC: Presentación de un caso / Monophasic Fibroblastic Synovial Sarcoma. Diagnostic and Post-Treatment Assessment by MRI and ADC: Case Report

El sarcoma sinovial representa entre el 2 al 10 % de todas las malignidades primarias de tejidos blandos, situándose en el cuarto lugar en frecuencia de los sarcomas de tejidos blandos. Es una neoplasia clasificada por la WHO (World Health Organization) bajo la categoría de tumores de diferenciación incierta, considerándose una malignidad entre intermedio y alto grado. El tratamiento estándar es la escisión quirúrgica, sin embargo, por su alta recurrencia y en los casos en que se asocia a metástasis o márgenes positivos después de la resección, se han planteado otros tratamientos como la quimio y radioterapia. La imaginología juega un papel importante en el diagnóstico, la estadificación y evaluación de la respuesta al tratamiento. Nuevas técnicas como el uso de difusión y mapas de ADC (Apparent Diffusion Coefficient, o coeficiente de difusión aparente) en resonancia magnética (RM) son útiles para evaluar las lesiones tumorales y la respuesta al tratamiento. En este artículo se presenta el caso de un paciente con un sarcoma sinovial monofásico, el diagnóstico por imágenes y evaluación del tratamiento mediante técnicas avanzadas de resonancia magnética como la difusión

Synovial sarcomas represent 2 to 10% of all the primary tissue malignancies and occupy the fourth place in the list of most common soft tissue sarcomas. According to the World Health Organization (WHO), this neoplasm is classified under the category of tumors of uncertain differentiation and is considered an intermediate to high-grade malignancy. Although the standard treatment is surgical excision, alternative treatments such as radiotherapy and chemotherapy have been proposed due to its high rate of recurrence in cases when it is associated with metastasis or positive resection margins. Imaging plays a key role in the diagnosis, staging and assessment of treatment of this disease. New techniques in Magnetic Resonance Imaging such as diffusion and Apparent Diffusion Coefficient (ADC) mapping are useful to further characterize these neoplastic lesions and to assess treatment response. In this article we present a patient with monophasic synovial sarcoma in which the use of these new imaging techniques was essential for the diagnosis and evaluation post-treatment.

Síndrome del ligamento arcuato medio concomitante con síndrome de cascanueces. Presentación de un caso / Concomitant Medium Arcuate Ligament Syndrome with Nutcracker Syndrome. A Case Report

El síndrome del ligamento arcuato medio y el síndrome de cascanueces son entidades raras, con baja prevalencia, a menudo subdiagnosticadas y asintomáticas en la mayoría de las ocasiones. Se presenta el caso de una paciente con ambas entidades, lo cual probablemente le genera dolor abdominal como síntoma común.

The Arcuate ligament syndrome and the Nutcracker syndrome are rare disorders, with low prevalence, commonly underdiagnosed and asymptomatic in most cases. We present the case of a female patient with both syndromes, which probably causes her abdominal pain as a common symptom.

Adaptação Cultural da Hardiness Scale (HS) / Cross-cultural Adaptation of Hardiness Scale (HS)

Hardiness é um conceito que está cada vez mais sendo usado com a finalidade de explicar as possíveis diferenças individuais no enfrentamento do stress. Os instrumentos de medida de hardiness são em língua inglesa, dos quais optou-se pela adaptação cultural da Hardiness Scale, original dos Estados Unidos da América, de autoria de Bartone, Ursano, Wright e Ingraham (1989). Sua finalidade é avaliar o quanto de atitudes Hardy as pessoas têm no enfrentamento de situações estressantes. É uma escala do tipo Likert, com escores que variam de 0 (nada verdadeiro) a 3 (totalmente verdadeiro), possui 30 itens que são distribuídos em três domínios (Compromisso, Controle e Desafio). Os objetivos deste estudo foram realizar a adaptação cultural da Hardiness Scale para a língua portuguesa do Brasil; avaliar a validade de construto e a confiabilidade da versão adaptada. As etapas propostas por Ferrer et al (1996) foram obedecidas, a saber: 1. Tradução para língua portuguesa (Consenso: Versão I em Português); 2. Avaliação pelo Comitê de Revisão (Versão II em Português); 3. Retradução (Back translation); 4. Avaliação semântica dos itens (Versão III em Português); 5. Pré-teste (Versão Final Português) e 6. Análise das propriedades da medida adaptada. A coleta de dados da aplicação do instrumento foi realizada junto aos enfermeiros do serviço público de saúde de dois municípios do interior do estado de São Paulo, totalizando 71 participantes. A confiabilidade interna medida com o uso deAlpha de Cronbach obteve os seguintes valores: para a composição da escala foi de 0,732, enquanto que os domínios apresentaram alfa de 0,683 para Compromisso, 0,632 para Controle e 0,441 para Desafio. Na análise da Escala de Hardiness adaptada quanto à validade de construto obteve-se relação positiva e significante com o Inventário de Estratégias de Coping de Folkman e Lazarus, e negativa e significante ) com o Inventário de Depressão de Beck. Pode-se concluir que a Escala de Hardiness apresenta-se adaptada para a língua portuguesa do Brasil, com consistência interna satisfatória e validade de construto na população estudada e seus achados corroboram com a literatura corrente.

Hardiness is a concept that is increasingly being used in order to explain possible individual differences in the coping of stress. The instruments for measuring hardiness are in English language and of witch opted for the cultural adaptation of the Hardiness Scale, original United States of America, by Bartone, Ursano, Wright and Ingraham (1989). Its purpose is to assess how much Hardy attitudes the people have in coping with stressful situations. It is a Likert-type scale, with scores ranging from 0 (not true) to 3 (completely true), it contains 30 items that are distributed in three domains (Commitment, Control and Challenge). The objectives of this study were to perform cultural adaptation of the Hardiness Scale into Portuguese of Brazil, to evaluate the reliability and construct validity of the adapted version. The steps proposed by Ferrer et al. (1996) were followed, namely: 1. Translation to Portuguese language (Consensus: Version I in Portuguese), 2. Evaluation by the Committee of Review (Version II in Portuguese), 3. Back translation, 4. Semantics evaluation of the items (Version III in Portuguese), 5. Pre-test (Final Version Portuguese) and 6. Analysis of the properties of the adapted measure. The data from the application of the instrument was conducted with nurses from the public health service in two cities country side of São Paulo State, totalizing 71 participants. The internal reliability measured by use of Cronbach\'s Alpha achieved the followingvalues: for the composition of the scale was .732, while the areas showed Commitment to .683, .632 for Control and 0.441 to Challenge. In the analysis of the adapted Hardiness Scale concerning the validity of construct obtained significant and positive relation with the Inventory of Coping Strategies of Folkman and Lazarus, and negative and significant with the Beck Depression Inventory. It can be concluded that the Hardiness Scale, it is adapted to the Portuguese language of Brazil, with satisfactory internal consistency and construct validity in the studied population and its findings corroborate with current literature.

Efecto de la lectura de material de autoayuda sobre algunas variables psicológicas en una muestra no clínica / Effects of sel-help book reading on some psychological variables in a non-clinic sample

En las últimas décadas se ha producido un importante auge en el uso de la literatura de autoayuda. El presente estudio evalúa los efectos de la lectura de un manual de autoayuda sobre la ansiedad, el temor a la evaluación negativa, las creencias disfuncionales y la asertividad

Delayed hemodynamic monitoring with pulmonary artery catheter is a non-essential care in severe sepsis and septico shock

Objective: Prompt adequate antibiotic therapy, eradication of infection, fluids and vasoactive drugs are themain strategies for initial resuscitation of septic shock. Once initial resuscitative efforts are not effective,invasive hemodynamic monitoring (HM) with pulmonary artery catheter (PAC) has been frequently used toguide filling pressures and optimal doses of vasoactive agents. However, the evidence of benefit from PACuse in septic shock is still a matter of debate. We aimed to determine whether early compared to delayplacement of PAC could have influenced outcome.Methods: Retrospective analysis in a 24-bed general ICU tertiary care university hospital. From January 1999to December 2000, patients admitted with severe sepsis and septic shock and having a PAC inserted werestudied. Early invasive HM was defined whenever a PAC was placed in the first 48 hours, and delayedinvasive HM was placed more than 48 hours after the diagnosis of severe sepsis or septic shock. Organ failurewas defined as a SOFA score of > 3 points.Results. Among 104 patients submitted to invasive monitoring with PAC, 56 patients had sepsis. Fifty-twopatients with severe sepsis (5, 9.6 por cento) and septic shock (47, 90.4 por cento) were enrolled. Thirty-six patients (69 por cento) hadearly HM and 16 (21 por cento) delayed HM. Overall in-hospital mortality was 69 por cento. The groups had similar APACHEII score (18.6 ± 8.0, early HM; 18.5 ± 3.8, delayed HM), SOFA score (9.4 ± 3.2, early HM; 9.9 ± 4.4, delayed HM)and number of organs failure (1.6 ± 0.9, early HM; 1.8 ± 1.4, delayed HM) at the onset of severe sepsis/septicshock. The in-hospital mortality rate was significantly higher in delayed HM group (87.5 por cento) compared withearly HM (61.3 por cento) (RR: 0.70, CI 95 por cento 0.50-0.96, p < 0.05). Compared with delayed HM, early HM patientsreceived significantly higher amount of fluids (10.3 ± 3.6 L vs 6.8 ± 3.5 L, p = 0.002) within 48 hours from onsetof severe sepsis/septic shock.Conclusion. Delayed monitoring with PAC patients with severe sepsis/septic shock is associated with a veryhigh risk of death and might be considered a non-essential care.