[Cancer: Communicating the diagnosis and prognosis]. / Cáncer: comunicar el diagnóstico y el pronóstico.

The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.

[An earlier diagnosis of depression]. / Diagnostica la depresión antes.

Data of the last decade indicate that, in the Western world and also in Spain, an important part of general practicioners' consultations are related to mental health, but depression is consistently underdiagnosed. Causes are lack of time and back-up, as well as lack of specific training. In Spain, there is no national health service primary care database with actualized clinical information as to mental health. There is evident clinical interest in a more agile diagnostic, resulting from a recollection of data from voluntary selective screening and continuing evaluation of adult depression along the model used by other National Health Systems.

Causas orgánicas y comórbidas de la depresión: el primer paso / Organic and comorbid causes of depression: a first step

Los objetivos de este trabajo son: a) obtener una orientación clínica en cuanto a las «otras» causas de la sintomatología depresiva, apoyadas por la evidencia actual, y que principalmente son causas médicas; eventos vitales; deficiencias de vitaminas, minerales y relacionadas con la dieta; y hormonas; y b) reflejar en un listado de referencia clínica las más frecuentes «otras» causas, así como la preferencia de tratamiento (médico/dietético, antidepresivos o psicológico) que resulta de la evidencia disponible. Se ejecutó una búsqueda en Medline, Cochrane y otras bases de datos primarias desde el 4 de octubre de 2010 hasta el 27 de abril de 2011, sin límites de idiomas, con las palabras clave: depression; organic; comorbid; medication; life events; hormones; vitamin; mineral; diet; disease; además de búsquedas avanzadas en cada asunto aparecido y posiblemente relacionado. El número total de estudios contemplados: 3.211; el número total revisados: 301, con criterios de relevancia, fecha del estudio o de la revisión, tamaño y tipo del estudio, y estatus de la publicación. Se abstrajeron los datos sobre la base de su relevancia y uso clínicos probables. Los resultados principales fueron indicaciones apoyadas por la evidencia en cuanto a estas otras causas de la sintomatología depresiva que justifican un cribado temprano, y atención y tratamiento posiblemente antes del comienzo de la terapia antidepresiva o psicológica. Conclusión preliminar Aparece una razón fundamental y clínica para el cribado temprano de un número de causas de síntomas depresivos, basadas en la evidencia, para las que existen formas sencillas de verificación. En varios casos el tratamiento clínico puede ser sencillo con mejoras rápidas de los síntomas. Tanto los pacientes como los sistemas públicos de salud podrían beneficiarse de que se estableciera, por medio de un protocolo pretratamiento y en momento temprano, una posible presencia de causas biológicas o comórbidas de los síntomas depresivos. Una respuesta mejorada gracias a estas medidas de bajo coste podría reducir el riesgo de suicidio (AU)

The primary objective of this review is to obtain a clinical orientation as to evidence-supported common «other» causes of depressive symptomatology, which predominantly are: medical issues; life events; vitamin, mineral and diet-related deficiencies; and hormones. A secondary goal was to reflect those more frequent "other" causes in a checklist for clinical use, comprising also the preferred treatment (medical/dietary, antidepressants, or psychological) resulting from the available evidence. Medline, Cochrane and main related databases were searched from 4th October 2010 to 27th April 2011, no language limits, with keywords: depression; organic; comorbid; medication; life events; hormones; vitamin; mineral; diet; disease; as well as further searches into each upcoming possibly related issue. Total studies contemplated: 3.211; total studies reviewed: 301, with criteria of relevancy; date of study or review; size and type; journal status. Data were abstracted based upon probable clinical relevancy and use. The main results obtained were evidence-supported indications as to these other causes of depressive symptomatology, that warrant early screening, attention and treatment, possibly before antidepressant or psychological therapy is started. Preliminary conclusion There appears to be a clinical rationale for early checking of a number of evidence-based causes of depressive symptoms for which first-line testing is readily available. In several cases clinical treatment may be simple, and improvements in depressive symptoms rapidly obtainable. Using a pre-treatrment protocol, both patients and health systems could benefit from biological and comorbid causes of depressive symptoms being established early. An enhanced response to low-cost corrective measures can decrease the risk of suicide (AU)

[Organic and comorbid causes of depression: a first step]. / Causas orgánicas y comórbidas de la depresión: el primer paso.

The primary objective of this review is to obtain a clinical orientation as to evidence-supported common «other¼ causes of depressive symptomatology, which predominantly are: medical issues; life events; vitamin, mineral and diet-related deficiencies; and hormones. A secondary goal was to reflect those more frequent "other" causes in a checklist for clinical use, comprising also the preferred treatment (medical/dietary, antidepressants, or psychological) resulting from the available evidence. Medline, Cochrane and main related databases were searched from 4(th) October 2010 to 27(th) April 2011, no language limits, with keywords: depression; organic; comorbid; medication; life events; hormones; vitamin; mineral; diet; disease; as well as further searches into each upcoming possibly related issue. Total studies contemplated: 3.211; total studies reviewed: 301, with criteria of relevancy; date of study or review; size and type; journal status. Data were abstracted based upon probable clinical relevancy and use. The main results obtained were evidence-supported indications as to these other causes of depressive symptomatology, that warrant early screening, attention and treatment, possibly before antidepressant or psychological therapy is started. PRELIMINARY CONCLUSION: There appears to be a clinical rationale for early checking of a number of evidence-based causes of depressive symptoms for which first-line testing is readily available. In several cases clinical treatment may be simple, and improvements in depressive symptoms rapidly obtainable. Using a pre-treatment protocol, both patients and health systems could benefit from biological and comorbid causes of depressive symptoms being established early. An enhanced response to low-cost corrective measures can decrease the risk of suicide.

[An optic nerve glioma in a 4-month-old child]. / Gliome du nerf optique chez un enfant de 4 mois.

The optic nerve glioma is a relatively rare pathology in children and only a few cases have been described in infants. This paper reports the symptoms of this exceptional case in a 4-month-old child and reviews the differential diagnoses at this age. Finally, we discuss the diagnosis and therapeutic possibilities.

Terapéutica en AP. El tratamiento con dehidroepiandrosterona de la depresión resistente a los antidepresivos / Therapy in primary health care. DHEA treatment of anti-depressantresistant depression

La dehidroepiandrosterona (DHEA) es una hormona involucrada en la ansiedad y la depresión. Sus niveles correlacionan positivamente con la resistencia a estas enfermedades. Sin embargo, en España no suele prestarse mucha atención a los niveles de DHEA, ni se complementa la carencia que se manifiesta paulatinamente desde la mediana edad. Los suplementos de DHEA no están autorizados por el Ministerio de Sanidad, con lo cual la importación ilegal con sus riesgos en cuanto a la calidad del producto se está abriendo camino. La evidencia no justifica esta prohibición y los estudios estadounidenses más recientes confirman su efectividad en depresión, tanto menor como mayor, especialmente en la depresión resistente a los antidepresivos, sobre todo en los adultos mayores. La determinación de niveles hormonales en saliva tiene claras ventajas clínicas pero en España sólo se practica en contados centros o laboratorios

Dehydroepiandrosterone (DHEA) is a hormone that is involved in stress and in depression. Its levels correlate positively with resistance to these disorders. However, in Spain not much attention is paid to DHEA levels nor is its deficiency that gradually appears in middle age compensated. DHEA supplements are not authorized for sale by the Ministry of Health. This induces illegal importation with the inherent risks as to the quality of the product. The available evidence does not justify this prohibition and recent U.S. studies have confirmed its efficacy in minor and major depression, especially in midlife-onset antidepressant resistant depression. The analysis of hormones in saliva has clear clinical advantages. However, only a few clinical centers or laboratories offer this in Spain

[Idiopathic intrahepatic portosytemic shunts in 4 children]. / Anastomoses portosystémiques intrahépatiques idiopathiques: à propos de 4 observations.

Intrahepatic portosystemic anastomoses are macroscopic communications between the venous portal system and the systemic circulation and located partly in the liver. We report 4 new cases of type II shunts, which illustrate the circumstances of the diagnosis of these exceptional anomalies. For 2 children, the diagnosis was done antenataly by US and spontaneous involution in a few months was observed. In the third case the malformation was evidenced fortuitously at 3 weeks of life, and this 6-year-old child remains completely asymptomatic so far. Then, in the fourth case, a cerebral venous thrombosis was fortuitously and antenatally evidenced in an otherwise uneventful pregnancy and portosystemic shunt was demonstrated postnataly in the extensive work up of the neonate.

Detectar la depresión antes, durante y después de la gestación con el perfil anímico del embarazo / Detecting depression before, during and after pregnancy with the pregnancy mood profile

Las depresiones anteparto y posparto son condiciones médicas nada excepcionales que afectan de forma negativa a madre e hijo, y necesitan ser detectadas lo antes posible para evitar o limitar el uso de tratamientos farmacológicos con posibles efectos colaterales. Sólo la depresión posparto tiene entidad clínica propia reconocida, aunque existen razones sólidas para que la depresión relacionada con la gestación, en todos sus estadios, se considere una enfermedad propia por las consecuencias posiblemente graves sobre madre e hijo. El autor revisa los datos actuales que justifican una mayor atención por parte del tocólogo a la apariencia de síntomas depresivos desde los primeros momentos de la concepción y gestación. A tal fin ha propuesto un protocolo estadístico sencillo con que se confecciona un "perfil anímico del embarazo". Este perfil ayudaría en el tratamiento adecuado de la depresión anteparto y posparto y serviría como un preaviso de suicidio posparto (AU)

Medir la depresión con la razón cortisol/DHEA / Measuring depression with the cortisol/dehydroepiandrosterone (DHEA) ratio

No disponible

La gradación del efecto placebo. Un estudio N=1, doble ciego, con belladona homeopática 30C / Grading the placebo effect. A N=1, double blind study with homeopathic belladonna 30C

El concepto ‘placebo’ se ha convertido de una caja de sastre para efectos no comprendidos a una categoría científica de efectos no-específicos pero contrastables. Este cambio paradigmático convirtió el placebo en un elemento objeto de investigación clínica en condiciones controladas. Un resultado intrigante de las investigaciones recientes es que se perfilan diferentes categorías o clases de placebo según su grado de eficacia y la supuesta procedencia de esta influencia. Los resultados del presente estudio indican una diferente influencia entre un placebo neutro y un placebo homeopático, con lo cual parece confirmarse una necesaria diferenciación entre tipos de placebo (AU)

LADD syndrome in five members of a three-generation family and prenatal diagnosis.

We describe five members of a three generation family with lacrimo-auriculo-dento-digital (LADD) syndrome. The circumstances in which the diagnosis was reached and the details of the case reports underline the great variability of expression of this syndrome and show that caution should be taken in genetic counselling. Prenatal ultrasound should be offered to families at risk so that severe forms of the syndrome, in which termination of pregnancy can be considered, are early detected.

Anatomic basis of pathology of the urachus.

The urachus, derived partly from the allantoic canal, tethers the apex of the bladder to the umbilical ring. This vestigial structure, though constant in man, is formed by a whole series of embryologic mechanisms which are still controversial. Total or partial persistence of the lumen of the urachal canal, when sufficiently extensive, becomes manifested by characteristic clinical features. Moreover, it is frequently associated with malformational urogenital involvement, which must be routinely sought. The sole form of treatment consists of total surgical excision of the urachus.

Malignant pleural tumor in a child mimicking a mesothelioma.

Malignant tumors of pleural origin are rare in childhood and difficult to diagnose. We report a case in a white 11 1/2-year-old girl who presented with a bulky tumour in the basal left lung field. There was an area of osteolysis at the ventral extremity of the 9th left rib allowing excision of the tumor by lateral thoracotomy. Macroscopically the operation was satisfactory. Despite two complementary excisions, chemotherapy with Vin-Caepi and consolidation chemotherapy followed by bone-marrow autograft, left pleural metastases appeared two years later. A second operation, a new course of chemotherapy with stage IV SIOP MMT, followed by a second bone-marrow graft and mediastinal radio-therapy, resulted in remission. At the time of this report, after three and a half years of evolution, the child's condition is satisfactory and she leads a normal life without treatment. A probable diagnosis of pleural mesothelioma was arrived at by elimination. This kind of tumour, without specific markers, is difficult to distinguish from small-round-cell tumors. Evolution is unpredictable and often rapidly fatal. Although these tumors generally have a weak response to chemo- and radiotherapy, we think that close follow-up and active therapy, rapidly initiated at the slightest sign, can improve the quality of life of the patients and increase their survival.

[Radiographic study of the lumbar spine bearing weight in weight lifters]. / Etude radiographique du rachis lombaire en charge chez l'haltérophile.

Radiographies of lumbar spine at rest in standing position and upon a force of 100kg were undertaken in 19 young sportsmen. If comparison between two pictures demonstrated important modification in few subjects, statistical study shown only little variations. Clinical studies in weight lifters demonstrated effectively few lesions with a good training, it's possible to modifiate pelvic orientation and this pelvic support permits a optimal posture for the lumbar spine.

[Non-traumatic circumscribed myositis ossificans in the femoral region]. / Myosite ossifiante circonscrite non traumatique de la région fémorale.

The authors report the main clinical and radiographic aspects of non-traumatic circumscribed myositis ossificans in a 12 year-old child. These observations provide useful information for making a diagnosis. CT scan showed the presence of two distinct areas, a lucent central area and a dense outer area whose appearance suggest the presence of calcium. The main differential diagnosis concerned tumors in the soft bone tissue which necessitated regular clinical and paraclinical follow-up.

Spondylitis and osteomyelitis caused by Kingella kingae in children.

Two cases of documented osteoarticular infections caused by Kingella kingae in children are reported. The main bacteriological characteristics and antibiotic susceptibilities of these two isolates are described. The pathology of K. kingae, particularly in bones and joints, is reviewed.