[Antenatal ultrasound diagnosis and neonatal results of the congenital cystic adenomatoid malformation of the lung]. / Diagnóstico ecográfico prenatal y resultados neonatales de la malformación adenomatoidea quística pulmonar.

INTRODUCTION: Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung di sease, and in the most of cases, prenatal diagnosis is feasible. There are discrepancies regarding pre natal management and postpartum treatment. OBJECTIVE: To analyze prenatally diagnosed CCAM in our hospitals, in order to evaluate ultrasound findings with fetal and postnatal evolution. PATIENTS AND METHOD: Retrospective study of all cases diagnosed prenatally by ultrasound between 2005 and 2016 in two reference hospitals. The ultrasounds were performed using high-resolution ultrasound scanners, Toshiba Xario and Voluson 730 Expert Pro, with follow-up from diagnosis to delivery. The variables analyzed included gestational age at diagnosis, the characteristics of the lung lesion, associated malformations, cytogenetic study, the evolution of pregnancy, type of delivery, presence of respiratory distress, need for complementary imaging tests, pediatric clinical course, and necessary postnatal treatments. It was considered a resolution the total disappearance of the lesion in the pre natal ultrasound or that the postnatal chest X-ray showed no lesion. RESULTS: 17 cases were prenatally diagnosed. The evolution ranges from the prenatal resolution of the lesion to the persistence after bir th. Three patients voluntarily decided to have an abortion due to ultrasound findings of poor progno sis. Of the fourteen remaining cases there were no cases of fetal or neonatal deaths, one case required surgery after birth and four patients had mild symptoms during the first year of life. One case of false negative with neonatal death has been reported which necropsy reported as CCAM type 0. Conclu sions: This pulmonary malformation presents good prognosis, excluding cases with fetal hydrops. Two-dimensional ultrasound is usually enough for diagnosis and follow-up. Computed tomography is the technique of choice to confirm the resolution of lesions after birth. Surgical treatment is pre ferable over conservative management, although it is unknown if the potential complications of this disease, even when asymptomatic, justify surgical morbidity.

Diagnóstico ecográfico prenatal y resultados neonatales de la malformación adenomatoidea quística pulmonar / Antenatal ultrasound diagnosis and neonatal results of the congenital cystic adenomatoid malformation of the lung

INTRODUCCIÓN: La malformación adenomatoidea quística (MAQ) es una patología congénita del pulmón poco frecuente y su diagnóstico prenatal es factible en la mayoría de los casos. Existen discrepancias en cuanto al manejo prenatal y tratamiento postparto. OBJETIVO: Analizar una serie de casos de MAQ diagnosticados prenatalmente, evaluando los hallazgos ecográficos y la evolución fetal y post natal. PACIENTES Y MÉTODO: Estudio retrospectivo de todos los casos diagnosticados prenatalmente por ecografìa entre 2005 y 2016 en dos hospitales de referencia. Los exámenes de ultrasonido fueron realizados utilizando ecógrafos de alta resolución, Toshiba Xario y Voluson 730 Expert Pro, con seguimiento desde el diagnóstico hasta el parto. Las variables analizadas incluyeron la edad gestacional en el momento del diagnóstico, las características de la lesión pulmonar, las malformaciones asocia das, el estudio citogenético, la evolución del embarazo, el tipo de parto, presencia de distrés respira torio, necesidad de pruebas de imagen complementarias, evolución clínica pediátrica y tratamientos postnatales necesarios. Se consideró resolución la desaparición total de la lesión ecográfica prenatal o que la radiografía torácica postnatal no mostrara lesión alguna. RESULTADOS: Se identificaron pre natalmente 17 casos. La evolución varía desde la resolución prenatal de la lesión hasta la persistencia de la misma tras el nacimiento. Tres pacientes decidieron abortar voluntariamente por hallazgos ecográficos de mal pronóstico. De los catorce casos restantes no hubo ningún caso de muerte fetal ni neonatal, un caso requirió cirugía tras el nacimiento y cuatro pacientes presentaron sintomatología leve durante el primer año de vida. Se ha reportado un caso de falso negativo con muerte neonatal, que la necropsia informó como MAQ tipo 0. CONCLUSIONES: Esta malformación pulmonar presenta buen pronóstico, excluyendo los casos con hidrops fetal. La ecografía bidimensional suele ser suficiente para el diagnóstico y el seguimiento. La tomografía computarizada es la técnica de elección para confirmar la resolución de las lesiones tras el nacimiento. El tratamiento quirúrgico es preferible sobre el manejo conservador, aunque se desconoce si las complicaciones potenciales de esta patología, aun siendo asintomática, justifican la morbilidad quirúrgica.

INTRODUCTION: Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung di sease, and in the most of cases, prenatal diagnosis is feasible. There are discrepancies regarding pre natal management and postpartum treatment. OBJECTIVE: To analyze prenatally diagnosed CCAM in our hospitals, in order to evaluate ultrasound findings with fetal and postnatal evolution. PATIENTS AND METHOD: Retrospective study of all cases diagnosed prenatally by ultrasound between 2005 and 2016 in two reference hospitals. The ultrasounds were performed using high-resolution ultrasound scanners, Toshiba Xario and Voluson 730 Expert Pro, with follow-up from diagnosis to delivery. The variables analyzed included gestational age at diagnosis, the characteristics of the lung lesion, associated malformations, cytogenetic study, the evolution of pregnancy, type of delivery, presence of respiratory distress, need for complementary imaging tests, pediatric clinical course, and necessary postnatal treatments. It was considered a resolution the total disappearance of the lesion in the pre natal ultrasound or that the postnatal chest X-ray showed no lesion. RESULTS: 17 cases were prenatally diagnosed. The evolution ranges from the prenatal resolution of the lesion to the persistence after bir th. Three patients voluntarily decided to have an abortion due to ultrasound findings of poor progno sis. Of the fourteen remaining cases there were no cases of fetal or neonatal deaths, one case required surgery after birth and four patients had mild symptoms during the first year of life. One case of false negative with neonatal death has been reported which necropsy reported as CCAM type 0. CONCLUSIONS: This pulmonary malformation presents good prognosis, excluding cases with fetal hydrops. Two-dimensional ultrasound is usually enough for diagnosis and follow-up. Computed tomography is the technique of choice to confirm the resolution of lesions after birth. Surgical treatment is pre ferable over conservative management, although it is unknown if the potential complications of this disease, even when asymptomatic, justify surgical morbidity.

Dural metastases in advanced prostate cancer: a case report and review of the literature.

Dural metastases from advanced prostate cancer are considered an uncommon diagnosis. However, autopsy studies show a high association between advanced prostate cancer and metastases to the meninges. Because the overall survival of advanced prostate cancer patients is expected to improve with the advent of new therapies, the incidence of clinically relevant dural metastases from prostate cancer will likely increase. We present a case of a heavily pre-treated castration-resistant prostate cancer patient who developed metastases to the duramater. This entity should be considered in the differential diagnosis of any patient with advanced castration-resistant prostate cancer and neurological symptoms. Clinicians should also be aware of the poor prognosis and survival rates associated with the condition.

Atrapamiento de un catéter epidural. Reconstrucción de imágenesde tomografía computarizada / Trapped epidural catheter: reconstruction of computed tomography images

El atrapamiento de un catéter epidural sin la formaciónde un nudo, es una complicación rara. Durante la colocaciónde un catéter epidural para el control del dolordurante el parto, se encontró una resistencia que impedíaajustar su posición dentro del espacio epidural. Un segundocatéter se colocó para realizar la analgesia durante elparto. Retirado el segundo catéter, se identificó en imágenesde tomografía computarizada que la punta del primercatéter se encontraba en una zona próxima a la articulacióninterapofisiaria derecha.En un nuevo intento no se logró su extracción. Ante esasituación, se introdujo una guía metálica por el lumen delcatéter, y con la paciente sentada en ligera flexión lateral dela columna, se traccionó suavemente del conjunto catéterguíalogrando su salida sin que su punta se fragmentara.La reconstrucción tridimensional de las imágenes nospermitió observar la punta del catéter y las característicasde las carillas articulares.Se discuten qué pautas seguir ante la dificultad de quitarun catéter epidural, qué pruebas de imagen son másadecuadas, y qué alternativas disponemos para lograr suextracción (AU)

A trapped epidural catheter without a knot is a rarecomplication. During placement of an epidural catheterfor analgesia during labor, resistance made it impossible toposition the catheter within the epidural space. A secondcatheter was inserted to provide the required analgesia.When the second catheter was removed, computedtomography (CT) revealed that the tip of the first catheterwas close to the the right facet joint space.A second attempt to extract the catheter failed. In lightof this situation, the patient was seated with the spineslightly bent to one side, a guidewire was inserted throughthe catheter lumen, and the catheter and guidewire weregently pulled; the catheter was extracted without causingthe tip to break up.Three-dimensional CT reconstruction allowed thecatheter tip and characteristics of the joint surfaces to beobserved.We discuss protcols and alternative strategies that canbe followed when an epidural catheter is difficult toremove, including the most appropriate images to use forguidance (AU)

[Trapped epidural catheter: reconstruction of computed tomography images]. / Atrapamiento de un catéter epidural. Reconstrucción de imágenes de tomografía computarizada.

A trapped epidural catheter without a knot is a rare complication. During placement of an epidural catheter for analgesia during labor, resistance made it impossible to position the catheter within the epidural space. A second catheter was inserted to provide the required analgesia. When the second catheter was removed, computed tomography (CT) revealed that the tip of the first catheter was close to the the right facet joint space. A second attempt to extract the catheter failed. In light of this situation, the patient was seated with the spine slightly bent to one side, a guidewire was inserted through the catheter lumen, and the catheter and guidewire were gently pulled; the catheter was extracted without causing the tip to break up. Three-dimensional CT reconstruction allowed the catheter tip and characteristics of the joint surfaces to be observed. We discuss protcols and alternative strategies that can be followed when an epidural catheter is difficult to remove, including the most appropriate images to use for guidance.

[Mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy]. / Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante.

OBJECTIVE: To evaluate the mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy. MATERIAL AND METHODS: From January 2000 to May 2005, a total of 99 breast cancer patients underwent neoadjuvant chemotherapy. Ten patients had microcalcifications on mammograms prior to treatment. We evaluated the evolution of the tumor and of the microcalcifications, correlating the imaging findings with the clinical and histological manifestations. RESULTS: Four different patterns of evolution were observed for the microcalcifications: the number of particles increased in two cases, remained stable in three, decreased in four, and in one patient the microcalcifications disappeared. The size of the tumor decreased in all cases. CONCLUSIONS: After neoadjuvant chemotherapy microcalcifications can evolve unpredictably and independently of tumor response.

[Neuroradiologic findings of glutaric aciduria type I]. / Hallazgos neurorradiológicos de la Acidosis Glutárica tipo I.

Glutaric aciduria type I is a rare disorder of organic acid metabolism caused by deficiency of glutaryl-CoA dehydrogenase, a mitochondrial enzyme. Improper degeneration of amino acids: tryptophan, lysine, and hydroxylysine, results in increased levels of glutaric acid, which typically becomes clinically manifest as an acute dystonic crisis in young children. Accumulation of glutaric acid causes neurotoxicity in the basal ganglia and fronto-temporal cortex which can lead to progressive dystonia, hypotonia, permanently impaired speech and seizures. Because dietary and drug therapy may alter the natural history of the disease, early diagnosis of such patients is critical. We report the magnetic resonance (MR) imaging findings in a 16 year-old girl with this disorder who presented with a chronic dystonic syndrome and previously diagnosed of brain paralysis. MR imaging demonstrated bilateral involvement of the putamina and periventricular white matter, and bilateral temporal atrophy and widened Silvian fissures.

[Adenoid cystic carcinoma of the breast]. / Carcinoma adenoide quístico de mama.

OBJECTIVE: To review the clinical presentation and imaging findings of adenoid cystic carcinoma (ACC). MATERIAL AND METHODS: We performed a retrospective study of the period between January 1990 and July 2004, comprising five cases of ACC of the breast, all in women, among 4,036 malignant lesions diagnosed (0.12%). We reviewed the available imaging studies (mammography in all five cases, ultrasound in four, and magnetic resonance in one). We also reviewed the clinical presentation and evolution in all patients. RESULTS: Three patients presented with palpable lesions. Mammographic findings consisted of irregular, ill-defined nodules in three cases, a well-defined rounded nodule in one, and an asymmetrical density in the other. No microcalcifications were observed in any case. Ultrasound examination showed ill-defined polylobulated nodules in three cases and a well-defined, rounded nodule with small cysts inside in the remaining case that showed intense vascularization in the Doppler study. The only case studied by magnetic resonance was seen as a rounded nodule that showed heterogeneous contrast uptake, well-defined margins, and an enhancement curve considered highly suspicious for malignancy. Treatment was tumorectomy together with radiotherapy in all cases. Four patients remain asymptomatic at present (mean follow-up = 64 months) and one presented lung and liver metastes twelve years after the diagnosis of ACC. CONCLUSION: ACC is an uncommon breast tumor with varied radiologic appearance, although moderately or highly suspicious lesions predominate. We consider the absence of microcalcifications in these tumors to be noteworthy. The prognosis is generally good, although the possibility of remote metastasis exists.

[Biopsy techniques for the diagnosis of non-palpable mammary lesions]. / Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables.

Facing a non-palpable mammary lesion requiring a diagnostic biopsy, consideration must be given to the most suitable guiding method for obtaining the latter. Three methods are employed at present: stereotaxy (basically in cases of microcalcifications), echography (above all in the nodules), and magnetic resonance (for lesions not made visible through the previous systems). The next step is to select the most suitable biopsy technique. The most classical and reliable technique is the surgical biopsy with prior marking using a metallic harpoon, but, besides its high cost, it has the drawback of being an aggressive technique for the diagnosis of a benign pathology. Numerous systems of puncture have been developed as alternatives. Puncture with a fine needle is technically simple to carry out and can provide good results in the mammary nodules, but the existence of positive and negative false results has progressively limited its use. As an alternative, the systems of biopsy with a broad needle have made it possible to obtain multiple cylinders with a high diagnostic reliability, above all in the case of mammary nodules. However, their use in microcalcifications continues to show negative false results. The arrival of systems of vacuum-assisted biopsy has made it possible to obtain cylinders of greater quality, above all in cases of microcalcifications. Finally, the systems of percutaneous resection biopsy by means of cannulas with a diameter of 22 mm make it possible to completely extract lesions of a size below that of the cannula, with a reliability similar to that of the surgical biopsy.