Influencia de las alteraciones del ciclo menstrual en el trabajo / Influence of changes in the menstrual cycle in work

La elevada prevalencia de la sintomatología propia de los cambios hormonales fisiológicos que se producen durante el ciclo menstrual ocasiona, con frecuencia, cierta discriminación de la población femenina en el mundo laboral. En este artículo se recoge un estudio realizado sobre 417 trabajadoras en las que se ha evaluado el impacto de estos cambios sobre el absentismo laboral y su relación con el tipo de actividad laboral, obteniéndose valores muy discretos, que en absoluto fundamentan esta actitud

The high prevalence of symptoms attributable to the physiological hormonal changes occurring in the course of the menstrual cycle rather often causes a certain degree of discrimination against the female population in the labour environment. We report the results of a study performed on 417 female workers in which the impact of those changes on occupational absenteeism and their relationship to the type of occupational activity were addressed. The results were discrete and do not at all warrant the said discriminative attitude

[Space-occupying cerebellar infarcts: surgical or conservative treatment?]. / Infarto cerebeloso expansivo: tratamiento quirúrgico o conservador?

INTRODUCTION: Space-occupying cerebellar infarcts (SOCI) make up a subgroup within the ischemic pathologies of the brain which are generally well tolerated clinically and usually respond well to medical treatment. Yet, in some cases, due to their volume and localisation, they can be accompanied by a progressive deterioration that requires surgical treatment. We report the clinical cases of two patients with SOCI that illustrate both therapeutic alternatives. CASE REPORTS: We describe the case of a 65-year-old male patient with vertiginous syndrome, inability to walk and headache. Computerised axial tomography (CAT) scanning showed a SOCI in the left hemisphere that displaced the 4th ventricle, effaced the cisterns and gave rise to the hydrocephalus. The patient improved clinically with medical treatment and a week later was able to walk unaided. We also describe the case of a 75-year-old female patient with symptoms of deterioration in the level of consciousness. CAT and magnetic resonance scans showed an extensive SOCI in the right hemisphere with displacement of the 4th ventricle, effacement of the perimesencephalic cisterns and triventricular hydrocephalus. A suboccipital craniectomy was performed, along with excision of any necrotic material and duroplasty. At 24 h the patient expressed herself coherently and followed orders. She presented ataxia and dysmetry on the right-hand side following the operation, which were compensated with rehabilitating therapy. CONCLUSIONS: Our clinical case reports illustrate the alternatives available when dealing with patients with cerebellar infarct that show expanding clinical-radiological characteristics. These patients must be carefully controlled because of the risk of clinical deterioration, in which case timely surgical intervention can increase their survival.

[Multiseptated arachnoid cyst treated with fenestration after valvular insufficiency in an adult. ]. / Quiste aracnoideo multitabicado tratado con fenestración tras insuficienci valcular en un adulto.

Treatment of symptomatic arachnoid cysts is based on two procedures: cyst fenestration versus derivation of CSF. Multiseptated cysts represent a very special group. We present the case of a 75 year old woman with a symptomatic multiseptated arachnoid cyst, developing subacute bleeding in one of the cavities. Final diagnosis was obtained after MRI. CSF derivation became insufficient with clear improvement after fenestration and communication to subarachnoid space.

Quiste aracnoideo multitabicado tratado con fenestración tras insuficiencia valvular en un adulto / Multiseptated arachnoid cyst treated with fenestration after valvular insufficience in an Adult

El tratamiento de los quistes aracnoideos sintomáticos se basa en dos opciones principalmente: su fenestración y comunicación con las cisternas subaracnoideas o la derivación mediante un sistema valvular. Los quistes multitabicados por su propia naturaleza, suponen un grupo con características particulares. Presentamos el caso de una paciente de 75 años con un quiste aracnoideo multitabicado sintomático, con sangrado subagudo en una de sus cavidades. El diagnóstico final se alcanzó tras la realización de una RM. El quiste cambió poco con una derivación cisto-peritoneal, observándose una posterior mejoría clínica tras su fenestración al espacio subaracnoideo (AU)

[Cauda syndrome due to spinal stenosis and diskytis in two different spinal levels. Diagnosis using myelo-TC]. / Síndrome de cause secundario a estenosis y discitis en dos diferentes niveles raquídeos, diagnóstico por mielo-TC

We report a case of a 75 year old man presenting with paraparesis, urinary incontinence and saddle anesthesia evolving after several months and severe lumbalgia and bad general status which developed fewdays before admission. CT-scan showed spondilosis with lytic lesion at L5-S1 level. MR1 was not performed because the patient had a pacemaker. A myelo-CT study was performed showing a complete stop at L4-L5 level together with L5-S1 diskytis. Laminectomy of L5 and discectomy L5-S1 was performed obtaining tissue sample diagnostic of diskytis and osteomyelitis. Our patient had two lesions at two different levels with two independent syndromic appearence. Myelo-CT played an important diagnostic role in this case because MRI study could not be obtained.

Síndrome de cauda secundario a estenosis y discitis en dos diferentes niveles raquídeos, diagnóstico por mielo-TC / Cauda syndrome due to spinal stenosis and diskytis in two different spinal levels. Diagnosis using myelo-TC

Presentamos el caso de un paciente de 71 años de edad con clínica de paraparesia de varios meses de evolución incontinencia urinaria y anestesia en silla de montar, asociado a intensa lumbalgia y deterioro del estado general de varios días de evolución. La TC de raquis lumbosacro demuestra espondilodiscartrosis con lesión línea L5-S1. El estudio de resonancia magné-tica (RM) no pudo realizarse dado que el paciente era portador de marcapasos. La realización de mielo-TC permitió apreciar stop completo a nivel L4-L5 asociado a discitis L5-Sl. Se llevó a cabo descompresión L4-LS y discectomía LS-S1 obteniéndose una muestra compatible con discitis y osteomielitis. El presente caso tiene la originalidad de asociar dos lesiones en dos niveles distintos con cuadros clínicos independientes. Por otro lado la dificultad asociada de no poder realizar RM hizo de la mielo-TC un arma diagnóstica de gran utilidad (AU)

[Cerebral neuroblastomas: diagnosis and treatment]. / Neuroblastoma cerebral: diagnóstico y tratamiento.

AIMS: To review the literature on cerebral neuroblastomas (CN), including their anatomopathological filiation, clinical characteristics together with those they display in imaging studies, and the different therapeutic options with their prognosis. METHOD: Cerebral neuroblastomas belong to the group of primitive neuroectodermal tumours (PNET), also known as cerebral meduloblastomas or supratentorial PNET. They originate in the supratentorial compartment and histologically they are in the WHO grade IV. They display unspecific clinical features and in imaging studies they behave like solid masses with a cystic or necrotic component, often with calcifications. Microscopically they are made up of undifferentiated or poorly differentiated neuroepithelial cells. CN express synaptophysin and other neuroendocrine markers, which can only be studied by performing neuronal differentiation analyses. First choice treatment is surgery performed as radically as possible associated with chemotherapy or whole brain radiotherapy. Results vary greatly according to age and the degree to which the lesion has spread. Worse prognoses have been described for children under 2 years old than for those above that age. Survival rate at 3 years of age, including paediatric patients, is 60%. CONCLUSIONS: CN are not very frequent tumours, whose clinical characteristics and those displayed by imaging techniques are unspecific. Treatment must involve radical excision associated with chemotherapy or radiotherapy.

Neuroblastoma cerebral:diagnóstico y tratamiento / Cerebral neuroblastomas: diagnosis and treatment

Objetivo. Revisión de la literatura sobre los neuroblastomas cerebrales (NC), incluida su filiación anatomopatológica, sus características clínicas y en los estudios de imagen y las diversas opciones terapéuticas con su pronóstico. Desarrollo. Los neuroblastomas cerebrales pertenecen al grupo de los tumores neuroectodérmicos primitivos (TNEP), también conocidos como meduloblastomas cerebrales o TNEP supratentoriales. Se originan en el compartimento supratentorial e histológicamente corresponden a un grado IV de la OMS. Presentan clínica inespecífica y en los estudios de imagen se comportan como masas sólidas con componente quístico o necrótico, a menudo con calcificaciones. Microscópicamente están formados por células neuroepiteliales indiferenciadas o pobremente diferenciadas. Los NC expresan sinaptofisina y otros marcadores neuroendocrinos, para cuyo estudio es necesario la realización de análisis de diferenciación neuronal. El tratamiento de elección es la cirugía lo más radical posible asociada a quimioterapia o radioterapia holocraneal, con resultados muy diversos en función de la edad y el grado de extensión de la lesión. Se ha descrito un peor pronóstico en niños menores de 2 años que en mayores. La supervivencia a los 3 años, incluidos los pacientes pediátricos, es del 60 por ciento. Conclusiones. Los NC son tumores poco frecuentes con características clínicas y de imagen poco específicas, para cuyo tratamiento debe realizarse una exéresis radical asociado a quimioterapia o radioterapia (AU)

Mechanism of suppression of the depressed lymphocyte response in lung cancer patients.

We studied the function of monocyte-mediated suppression in the proliferative responses of depressed T-cells of patients with advanced lung cancer, with both local (Stage III) and extrapulmonary metastasis (Stage IV). The mononuclear cells of 13 non-treated patients showed a significant drop in proliferation upon stimulation with suboptimum, optimum and supraoptimum doses with regards to normal controls (p less than 0.001). On treating T-cells with indomethacin, lymphoblastic transformation increased in both groups (patients and controls), but was significantly greater in the patient group (p less than 0.001). The lipopolysaccharide (LPS) exerted an inhibitory effect on the suppressor cells of normal individuals, yet failed to do so in the case of patients treated either with or without indomethacin. The stimulation of the patients mononuclear cells with PWM failed to increase proliferation, and was not affected by either indomethacin of LPS. Our conclusions are as follows: Patients with lung cancer present a drop in mononuclear cell proliferation when stimulated with PHA; This phenomenon may be due to an exacerbation of the immune systems suppressor function; One of the suppressor mechanisms is prostaglandin-dependent and mediated by monocytes; The B-cells have no relevant functions.