Neumoencéfalo, una revisión de literatura / Pneumocephalus, a literature review

El neumoencéfalo corresponde a la presencia de aire intracraneal y, en general, es asintomático y autolimitado. Puede ocurrir posterior a trauma, cirugía craneofacial, defectos congénitos, infección, neoplasia o de forma espontánea. El neumoencéfalo a tensión es una emergencia neuroquirúrgica, en la que se acumula aire intracraneal de forma continua que genera un efecto de masa. Clínicamente, se caracteriza por cefalea y un deterioro neurológico marcado. A pesar de ser poco frecuente, es relevante considerar el neumoencéfalo a tensión como una posible complicación en pacientes con antecedente de neurocirugía y/o cirugía otorrinolaringológica, debido a que es una patología potencialmente grave. El diagnóstico es clínico e imagenológico, y requiere de un alto índice de sospecha. Un manejo oportuno es relevante para prevenir la herniación y la muerte.

Pneumocephalus refers to the presence of air in the cranial cavity, and in general, is self-limited and asymptomatic. It can occur after trauma, craniofacial surgery, due to congenital defects, infection, neoplasia or spontaneously. Tension pneumocephalus is a neurosurgical emergency in which intracranial air accumulates continuously, causing a mass effect. It presents with headache and marked neurological deterioration. Despite being rare, it is relevant to consider tension pneumocephalus as a possible complication in patients with a history of neurosurgery and/or otolaryngology surgery, as it can be life-threatening. Diagnosis requires a high index of suspicion and imagenologic confirmation. Timely management is relevant to prevent herniation and death.

Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos / Post-surgical late pneumoencephalus, based on two cases

El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

Enfrentamiento de lesiones de cavidad oral: clasificación y diagnóstico diferencial / Assessment of oral cavity lesions: classification and differential diagnosis

Las lesiones de la cavidad oral corresponden a un hallazgo frecuente y muchas veces difíciles de diagnosticar. Su correcto reconocimiento podría ser clave en detectar patologías que podrían cambiar el pronóstico del paciente. El objetivo de esta revisión es describir una clasificación de las lesiones de la cavidad oral que permita ayudar al diagnóstico en la práctica clínica. Para esto, se detallan y se describen las lesiones, orientando al diagnóstico y a la necesidad de biopsiar. Para simplificar la orientación diagnóstica, las lesiones se clasifican en 2 grandes grupos: tumorales y no tumorales. Las lesiones no tumorales se subdividen en lesiones de la mucosa oral y lesiones de la lengua.

Lesions of the oral cavity are frequent and often difficult to diagnose. However, correct recognition could change the patient's prognosis. This review aims to describe a classification of oral mucosa lesions, to help the diagnosis in clinical practice. The lesions are described for this, guiding the diagnosis and the need for biopsy. To simplify the diagnostic orientation, the lesions are classified into two groups: tumor and non-tumor lesions. Non-tumor lesions are subdivided into lesions of the oral mucosa and lesions of the tongue.

Diagnóstico de otitis media con efusión en adultos / Diagnosis of otitis media with effusion in adults

La otitis media con efusión (OME) se define como la presencia de líquido en la cavidad del oído medio, sin signos ni síntomas de infección. Es una patología frecuente en niños, alcanzando una prevalencia del 14,8% en población de 4 a 16 años y su patogenia en este grupo se encuentra ampliamente estudiada. Sin embargo, en adultos su prevalencia es baja y, consecuentemente, su patogenia y mecanismos están menos dilucidados. El objetivo de esta revisión es describir la fisiopatología de la OME en adultos, describir sus etiologías y proponer un algoritmo de estudio diagnóstico adecuado.

Otitis media with effusion (OME), is defined as the presence of fluid in the middle ear, with no signs of acute infection. It is a frequent pathology in children, with a prevalence of 14.8% in the population between 4-16 years old, and its pathology has been widely studied in this group. However, its prevalence in adults is low; therefore, the pathology and mechanisms are less elucidated. The aim of this review is to describe the physio-pathology of the OME in adults, its etiology, and propose an algorithm for the proper diagnosis of this disease.

Validación de intervención psicoeducativa para mejorar el afrontamiento y adaptación de familiares en la UCI / Psychoeducational Intervention Validation to Improve Relatives in the ICU Coping and Adaptation / Validação de uma intervenção psicoeducativa para melhorar o enfrentamento e adaptação de familiares na UTI

Introducción: la hospitalización de una paciente afecta directamente el estado de salud de sus familiares, por lo tanto, se requiere de una intervención psicoeducativa que reduzca el efecto ocasionado en las familias para favorecer el afrontamiento y la adaptación. Objetivo: determinar los componentes con mayor consenso entre profesionales expertos para validar una intervención psicoeducativa que mejore el afrontamiento y la adaptación en familiares de pacientes hospitalizados en la Unidad de Cuidados Intensivos (UCI). Método: estudio cuantitativo y descriptivo realizado con la técnica Delphi, por medio de una única ronda entre profesionales de la salud con experiencia mayor a 2 años en atención a pacientes críticos o investigación en esta área. Resultados: se obtuvieron 14 ítems distribuidos de la siguiente manera: matriz de componentes (3 ítems) y protocolo de la intervención (11 ítems). El 7,14 % de los ítems logró un consenso total, el 85,7 % aceptable y solo el 7,14 % de los ítems no alcanzó un consenso. Conclusiones: los componentes, actividades y acciones propuestas en la intervención psicoeducativa a través de la matriz de componentes como el protocolo de intervención, según el consenso de expertos, es pertinente, congruente, factible y genera impacto, lo cual permite mejorar el afrontamiento y adaptación de familiares de pacientes hospitalizados en UCI. La intervención requiere ser validada por medio de una prueba piloto y un estudio cuasi-experimental que permita medir el impacto de estos resultados.

Introduction: A patient's hospitalization directly affects the health status of their relatives, therefore, a psychoeducational intervention is required to reduce the effect on families, favoring coping and adaptation. Objective: Determine the components with the highest consensus among experts to operationalize psychoeducational intervention that improves coping and adaptation in relatives of hospitalized patients in Intensive Care Units (ICU). Methodology: Primary quantitative and descriptive study, carried out using the Delphi technique, through a single round among health professionals with more than 2 years of experience in critical patient care or research in this area. Results: 14 items were obtained, distributed as follows: component matrix (3 items) and intervention protocol (11 items). 7.14 % of the items reached a total consensus, 85.7 % acceptable and only 7.14 % of the items did not reach a consensus. Conclusions: The components, activities and actions proposed in the psychoeducational intervention through the matrix of components, such as the intervention protocol, according to the consensus of experts proves to be pertinent, congruent, feasible, and generates impact. This allows to improve coping and adaptation of hospitalized patients in ICU's relatives. The intervention needs to be validated by means of a pilot test and a quasi-experimental study that allow measuring the impact of these results.

Introdução: A hospitalização de um paciente afeta diretamente o estado de saúde de seus familiares, portanto, é necessária uma intervenção psicoeducacional que reduza o efeito causado nas famílias, favorecendo o enfrentamento e a adaptação. Objetivo: Determinar os componentes de maior consenso entre os especialistas para operacionalizar a intervenção psicoeducacional que melhora o enfrentamento e a adaptação em familiares de pacientes internados em UTI. Metodologia: Estudo primário, quantitativo e descritivo, realizado pela técnica Delphi, por meio de rodada única, entre profissionais de saúde com mais de 2 anos de familia na assistência ao paciente crítico ou em pesquisa na área. Resultados: foram obtidos 14 itens, assim distribuídos: matriz de componentes (3 itens) e protocolo de intervenção (11 itens). 7,14 % dos itens alcançaram consenso total, 85,7 % aceitáveis e apenas 7,14 % dos itens não alcançaram consenso. Conclusões: Os componentes, atividades e ações propostas na intervenção psicoeducacional através da matriz de componentes como o protocolo de intervenção, segundo o consenso dos especialistas é pertinente, congruente, factível e gera impacto, o que permite melhorar o enfrentamento e adaptação dos familiares de pacientes internados em UTI. A intervenção familia ser validada por meio de um teste piloto e um estudo quase-experimental que permita mensurar o impacto desses resultados.

Carcinoma de células acinares de parótida: reporte de un caso y revisión de literatura / Acinic cell carcinoma of parotid: A case report and review of literature

Resumen Los tumores malignos de glándulas salivales (TMGS) constituyen un grupo infrecuente de cánceres de una gran variedad histológica. Dentro de las neoplasias de estirpe epitelial encontramos al carcinoma de células acinares (CCA), que representa entre un 6%-10% de todos los TMGS. No posee patrones clínicos ni radiológicos específicos, pero comparte características comunes con otros TMGS que serán discutidas a lo largo del reporte. Cabe destacar que en términos generales es un cáncer de bajo grado y poco recidivante, por lo que un tratamiento oportuno y un seguimiento estricto mejoran el pronóstico para este tipo de pacientes. Su diagnóstico se establece con evidencia histopatológica que confirme la presencia de diferenciación epitelial de tipo acinar. El tratamiento consiste en la exéresis tumoral con márgenes libres por parotidectomía suprafacial o total, asociado a vaciamiento cervical si se detecta compromiso nodal. Adicionalmente, se debe sugerir terapia adyuvante ante la presencia de un factor de mal pronóstico. Se presenta un caso y se realiza revisión de literatura.

Abstract Malignant salivary gland tumors (TMGS) constitute an infrequent group of cancers of a wide histological variety. Within the epithelial lineage neoplasms, we find acinar cell carcinoma that represent between 6%-10% of all TMGS. It does not have specific clinical or radiological patterns, but it shares common characteristics with other TMGS that will be discussed throughout the report. It should be noted that in general terms it is a low-grade cancer with low recurrence rates, so timely treatment and strict follow-up improve the prognosis for this type of patient. Its diagnosis is established with histopathological evidence that confirms the presence of acinar-type epithelial differentiation. Treatment consists of tumor excision with free margins by suprafacial or total parotidectomy, associated with cervical lymph node dissection if nodal locoregional metastasis is detected. Additionally, adjuvant therapy should be suggested in the presence of a poor prognostic factor. A case is presented and a literature review is carried out.

Síndrome de Tolosa-hunt: reporte de caso y revisión de la literatura / Tolosa-Hunt Syndrome: Case Report And Literature Review

El Síndrome de Tolosa-Hunt es una patología poco frecuente, definida como una inflamación granulomatosa idiopática del seno cavernoso o de la fisura orbitaria superior, caracterizado clínicamente por oftalmoplejía unilateral dolorosa, de evolución aguda o subaguda, asociada a anormalidades en la resonancia magnética de cerebro como el aumento en el volumen y la hipercaptación del medio de contraste del seno cavernoso comprometido. A continuación presentamos el caso de un paciente masculino de 23 años de edad quien consultó al Hospital Universitario del Valle por oftalmoplejía dolorosa de su ojo izquierdo, y en quien se concluyó la existencia de un Síndrome de Tolosa Hunt después de la realización estudios diagnósticos diferenciales exhaustivos.

The Tolosa-Hunt syndrome is an uncommon disease, described as an idiopathic granulomatous inflammation of the cavernous sinus or the superior orbital fissure. Its diagnosis is based on the presence of unilateral ophtalmoplegia associated with the enlargement and the enhanced contrast of the affected cavernus sinus in the MRI. We present the case of a 23-year-old man with ophthalmoplegia of the left eye, who was admitted to the Hospital Universitario del Valle. After performing extensive diagnostic studies, the Tolosa-Hunt syndrome was considered the cause of symptoms.

Patrones de riqueza altitudinal de Papilionidae, Pieridae y Nymphalidae (Lepidoptera: Rhopalocera) en áreas montañosas de México / Altitudinal richness patterns of Papilionidae, Pieridae and Nymphalidae (Lepidoptera) in Mexican mountain areas

Butterflies constitute an useful group to investigate biodiversity patterns in specific geographic areas. The aim of this study was to describe the altitudinal patterns distribution and to recognize the main grouping factors of these families. We conducted a comparative study between the butterfly fauna (Papilionidae, Pieridae and Nymphalidae) of five Mexican mountain ranges (Sierra de Manantlán, Sierra de Atoyac de Álvarez, Loxicha Region, Teocelo-Xalapa and Sierra de Juárez), that included 34 sites of altitudinal ranges from 100 to 2 820m. Data was obtained from the Zoology Museum of the National University of Mexico, and comprised more than 60 000 butterfly records of 398 taxa (subspecies level) proceeding during the last 35 years. Fauna similarity between localities were analyzed using a cluster analysis by Sorensen similarity coefficient. Species richness showed a general tendency to decrease with altitude; the main difference was found between the locality with higher altitude and the rest of the sites. The principal factors affecting the identified clusters followed this order: the location in Pacific or Atlantic slope, and location on a particular mountain range. Three altitudinal levels (low elevations, up to 1 200m; intermediate elevations, from 1 200 to 1 800m; and high elevations, from 1 800 to 2 500m) were described in accordance to their main characteristic taxa. While Neartic elements were common in the highest altitudinal floor, Neotropical taxa were common in the lowest one. It was more difficult to characterize the intermediate level in which a high number of localities were clustered; this intermediate level was characterized by the presence of some endemic species. The results suggest that historical factors are preeminent in butterfly fauna composition in these areas. Future studies may include other Mexican mountain areas to obtain more information on the different factors (latitude, altitude, slope) influencing biodiversity patterns.

Las mariposas diurnas integran uno de los grupos más utilizados para el reconocimiento y monitoreo de la diversidad de una biota. Se realizó un estudio comparativo de las faunas de mariposas de las familias Papilionidae, Pieridae y Nymphalidae de cinco áreas montañosas de México, situadas en las vertientes Atlántico y Pacífico: las sierras de Atoyac de Álvarez, Manantlán, Juárez, y las áreas de Teocelo-Xalapa y la región Loxicha, con un total de 34 localidades representativas de los cinco transectos altitudinales, que comprenden de los 300 a los 3 100m de altitud. Se observó una tendencia general a la disminución de la riqueza con la altitud. Se analizó la similitud entre el total de localidades mediante el índice de Sørensen, diferenciándose en primer lugar las dos estaciones de elevaciones superiores (sobre los 2 500msnm), caracterizadas por pobres lepidóptero-faunas. En el grupo principal (32 sitios) las principales agrupaciones se dan de acuerdo, en primer lugar, a la pertenencia a la vertiente pacífica o atlántica, evento más histórico que ecológico y, después, las estaciones de una misma sierra o según tres diferentes pisos altitudinales, que se caracterizan de acuerdo con los táxones predominantes.

Comparação da aptidão física relacionada à saúde de adultos de diferentes faixas etárias / Comparison of the health related physical fitness of adults of differents ages

O objetivo deste estudo foi investigar as possíveis diferenças nos níveis de aptidão física relacionada à saúde(AFRS) em homens e mulheres de diferentes faixas etárias. Fizeram parte da amostra 326 sujeitos (132 homens e 194 mulheres), não-praticantes de exercícios físicos regulares, que foram separados, de acordo com o sexo, em três grupos etários: 20-29 anos (G1), 30-39 anos (G2) e 40-49 anos (G3). Todos os sujeitos foram submetidos a medidas antropométricas e de desempenho motor (flexibilidade, resistência/força muscular e aptidão cardiorrespiratória). A análise estatística incluiu o teste de Levene para verificação da homogeneidade das variâncias, estatística descritiva, ANOVA de um fator (faixa etária) e o teste de Bonferroni. O nível de significância adotado foi de P<0,05. Os melhores níveis de aptidão física, tanto nos homens quanto nas mulheres, foram observados nos sujeitos mais jovens (G1), enquanto que os piores níveis foram encontrados nos sujeitos de idade mais avançada (G3). A variação da gordura corporal relativa do G1 para o G3 foi mais acentuada nos homens (34%) do que nas mulheres (16%). Em relação ao desempenho motor, as maiores diferenças percentuais entre G1 e G3 foram identificadas no teste abdominal modificado (39% vs. 22% para homens e mulheres, respectivamente) e flexão e extensão de braço (31% vs. 24% para homens e mulheres, respectivamente). Os resultados sugerem que existe uma tendência natural de redução dos níveis de AFRS com o avançar da idade, em indivíduos não praticantes de exercícios físicos regulares...

The objective of this study was to investigate possible differences in the levels of health related physical fi tnessof men and women of different ages. The sample comprised 326 people (132 men and 194 women) who did not perform regular physical exercise, and who were separated for analysis by sex and into three age groups: 20-29 years (G1), 30-39 years (G2) and 40-49 years (G3). All subjects underwent anthropometric measurements and motor performance testing(fl exibility, muscle resistance/strength and cardiorespiratory fi tness). Statistical analysis employed the Levene test to verify the homogeneity of variation, descriptive statistics, single factor ANOVA (age group) and the Bonferroni test. The signifi cancelevel adopted was p<0.05. The best levels of physical fi tness were observed among the youngest subjects (G1), irrespective of sex, while the worst fi tness levels were detected in the oldest subjects (G3). The variation in body fat from G1 to G3 was more accentuated among the men (34%) than among the women (16%). With relation to motor performance, the greatest percentage differences between G1 and G3 were detected by either modifi ed abdominal test (39% and 22%, for men andwomen respectively) and the arm fl exion and extension test (31% and 24%, for men and women respectively. The results suggest that among individuals who do not regularly practice physical exercise there is a natural tendency for health relatedphysical fi tness to reduce as age increases...

Correlación artroscópica interobservador entre la clasificación Outerbridge e ICRS en lesiones condrales de rodilla / Knee chondral lesions: is there a relation between the Outerbridge and the ICRS classifications?

Purpose: To determine if there is a correlation between the Outerbridge and ICRS classifications for chondral lesions. Materials and Methods: 145 patients with MRI diagnosis of at least 1 knee chondral lesion were prospectively included. Each cartilage injury found at arthroscopy was classified and recorded in a database independently and blindly by two surgeons, after each procedure. One surgeon used the Outerbridge, and the other one used the ICRS classification to record the findings. Chondrallesions were grouped in 1 of the 4 ICRS major types (i.e., types 1 a and 1 b were grouped as type 1). Results: 212 chondral lesions were found in 145 patients. The level of correlation between both classifications was 84.9% (p = 0.00). The strongest correlation was found in patellar lesions (95.7%). Conclusions: There is a high correlation between the Outerbridge and the major types of 'the ICRS classification of chondral lesions in knee arthroscopic surgery.

El objetivo de este estudio es determinar la correlación que existe entre la clasificación de Outerbridge e ICRS para las lesiones condrales en cirugía artroscópica de rodilla. Ciento cuarenta y cinco pacientes sometidos a artroscopía de rodilla, con al menos una lesión condral, fueron evaluados prospectivamente por 2 cirujanos. Uno de los cirujanos registró las lesiones con la clasificación de Outerbridge y el otro según JCRS, de manera independiente y en bases de datos separadas. Las lesiones de ICRS fueron agrupadas en uno de los 4 grandes grupos (ej: la y 1b como 1). Finalmente se registraron 212 lesiones condrales, siendo el grado de correlación entre ambas clasificaciones de un 84,9% (p = 0,00). Estos resultados deben ser tomados con cautela. Sólo pretende reportar una alta coincidencia entre los diferentes grupos de una clasificación simple (Outerbridge), con una más completa (ICRS), sin pretender reemplazar una por otra.

Priming rapacuronium: a comparison with rocuronium and mivacurium

The aim of this study is to present the pharmacodynamics of the priming principle using rapacuronium and a comparison with rocuronium and mivacurium. After induction, 120 patients were randomly allocated to six similar groups. Groups 1 and 2 received rapacuronium 1000 micrograms.Kg-1 as a bolus or primed with 100 micrograms.Kg-1. To groups 3 and 4, rocuronium 400 micrograms.Kg-1 were given as a bolus or primed with 60 micrograms.Kg-1, finally mivacurium 100 micrograms.Kg-1 was used for groups 5 and 6 by bolus or primed with 10 micrograms.Kg-1. Neuromuscular function was monitored by electromyography and it was demonstrated that time to 80 per cent blockade, is significantly shorter after priming: 137 (bolus) vs 101 seconds (priming) for rapacuronium, 160 vs 90 for rocuronium and 196 vs 118 for mivacurium. Onset time was also statistically accelerated by priming: 229 seconds vs 183, 289 vs 203 and 298 vs 252 respectively. No significant change was noticed in maximal blockade and clinical duration due to priming. During early onset, only the mivacurium patients showed a statistical difference in train of four fade between bolus and priming. In conclusion, priming hasten early and maximal effect produced by rapacuronium, rocuronium and mivacurium without any change in maximal blockade and clinical duration. Pre-synaptic effect does not explain consistently the mode of action of priming.