HOW I DO IT: Cushing's disease-selective adenomectomy via an endoscopic transsphenoidal approach.

BACKGROUND: An ACTH-secreting pituitary adenoma is the most common cause of excessive endogenous glucocorticoid production resulting in Cushing's Syndrome. A multidisciplinary approach is paramount. Selective adenomectomy is the treatment of choice. METHOD: Endoscopic transnasal transsphenoidal approach to the tumour, along with techniques for resection, are demonstrated. CONCLUSION: Endoscopic transsphenoidal approaches with its magnified view of the pituitary gland allows precise microsurgical dissection during selective adenomectomy. This technique increases the possibility of proving a gross total resection, leading to clinical and biochemical cure in these patients.

Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System / Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System

Introducción y objetivos: La enfermedad digestiva es una de las comorbilidades más frecuentes en niños con parálisis cerebral infantil (PCI). Nuestro objetivo es analizar el estado nutricional de los pacientes con PCI, la prevalencia de disfagia según la afectación motriz (GMFCS) y su repercusión en la calidad de vida.Material y métodosEstudio descriptivo transversal y abierto en pacientes con PCI seguidos en un hospital terciario de la Comunidad de Madrid mediante una entrevista estructurada y la clasificación de la disfagia según la escala Eating and Drinking Ability Classification System (EDACS). Recogimos datos demográficos y antropométricos y relacionamos el nivel de disfagia con el nivel funcional según el Gross Motor Function Classification System (GMFCS).ResultadosLa muestra incluyó 44 pacientes (65,9% varones), con una edad media de 9,34 ± 5 años y un IMC de 18,5 ± 4,9. El 43% tenía limitaciones en seguridad y/o eficiencia (EDACS > II). El porcentaje de pacientes afectados fue mayor cuanto más extensa desde el punto de vista topográfico fue la PCI (tetraparesia 60%), más variada la semiología clínica (87% en formas mixtas) y peor el nivel funcional (100% en GMFCS V). La repercusión nutricional aumentó con puntuaciones más altas en EDACS y GMFCS.ConclusionesPresentamos el primer estudio sobre la utilidad de la escala EDACS en una muestra representativa de niños y adolescentes españoles con PCI. Los resultados deben hacernos reflexionar sobre la importancia del cribado de disfagia en estos pacientes, independientemente del grado de afectación motriz y la necesidad de una intervención precoz para evitar sus principales consecuencias: desnutrición (hipocrecimiento, déficit de micronutrientes, osteopenia, etc.), microaspiraciones o infecciones de repetición que empeoran el estado neurológico. (AU)

Introduction and objectives: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life.Material and methodsWe conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS).ResultsOur sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores.ConclusionsThis is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients’ neurological status. (AU)

Nutritional status and prevalence of dysphagia in cerebral palsy: usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of out-patients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Revisión sistemática sobre la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino para el tratamiento de la cefalea crónica en racimos refractaria / Systematic review of the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion for the treatment of refractory chronic cluster headache

Introducción: El objetivo es evaluar la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino (GEP) para el tratamiento de la cefalea en racimos crónica refractaria al tratamiento.DesarrolloRevisión sistemática de la literatura científica. Se identificaron estudios mediante una búsqueda en diferentes bases de datos. Las estrategias de búsqueda se realizaron hasta el 31 de octubre de 2016, incluyendo ensayos clínicos, revisiones sistemáticas o metaanálisis, informes de evaluación de tecnologías sanitarias y guías de práctica clínica que recogieran medidas de eficacia/efectividad o efectos adversos asociados al tratamiento. Se excluyeron estudios de cohortes, casos y controles, series de casos, revisiones narrativas, cartas al director, artículos de opinión, editoriales y estudios duplicados o desfasados por estudios posteriores de la misma institución. Respecto a la eficacia, los resultados son positivos tras la estimulación del GEP en relación con el alivio de dolor, el número de episodios, el uso de la medicación o la calidad de vida del paciente. En relación con la seguridad, hay un número importante de efectos adversos en los primeros 30 días de la intervención y en algunos pacientes fue necesaria la retirada del dispositivo. Los datos de seguimiento son a corto plazo y escasos.ConclusionesLos resultados resultan prometedores a pesar de que la evidencia disponible es limitada. Consideramos fundamental continuar con la investigación sobre la seguridad y eficacia de los neuroestimuladores del GEP en la cefalea en racimos crónica. En aquellos casos en que pueda estar indicada la intervención, el tratamiento debería realizarse supervisado en un estudio de monitorización. (AU)

Introduction: This study aimed to assess the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion (SPG) in the treatment of refractory chronic cluster headache.DevelopmentVarious medical databases were used to perform a systematic review of the scientific literature. The search for articles continued until 31 October 2016, and included clinical trials, systematic reviews and/or meta-analyses, health technology assessment reports, and clinical practice guidelines that included measurements of efficiency/effectiveness or adverse effects associated with the treatment. The review excluded cohort studies, case-control studies, case series, literature reviews, letters to the editor, opinion pieces, editorials, and studies that had been duplicated or outdated by later publications from the same institution. Regarding effectiveness, we found that SPG stimulation had positive results for pain relief, attack frequency, medication use, and patients’ quality of life. In the results regarding safety, we found a significant number of adverse events in the first 30 days following the intervention. Removal of the device was necessary in some patients. Little follow-up data, and no long-term data, is available.ConclusionsThese results are promising, despite the limited evidence available. We consider it essential for research to continue into the safety and efficacy of SPG stimulation for patients with refractory chronic cluster headache. In cases where this intervention may be indicated, treatment should be closely monitored. (AU)

Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System. / Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level>II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Diabetes mellitus tipo LADA y cetoacidosis: reflexiones a partir de un caso clínico / Latent autoimmune diabetes in adults and ketoacidosis: a clinical case

No disponible

Radioterapia hipofraccionada versus radioterapia convencional en cáncer de próstata: una revisión sistemática sobre eficacia y seguridad / Hypofractionated radiation therapy versus conventional radiation therapy in prostate cancer: A systematic review of its safety and efficacy

Contexto: Nuevas alternativas terapéuticas pueden mejorar la eficacia y seguridad del tratamiento del cáncer de próstata. Objetivo. Evaluar si la radioterapia hipofraccionada conlleva mejor eficacia y seguridad en el tratamiento del cáncer de próstata. Adquisición de la evidencia Revisión sistemática de la literatura con búsqueda en Pubmed, Cochrane Libarry, CRD, ClinicalTrials y Euroscan, recogiéndose indicadores de efectividad y seguridad. Síntesis de la evidencia: Se incluyeron 2 revisiones sistemáticas y un ensayo clínico. En relación con la eficacia existe una gran heterogeneidad entre los estudios, y no se encuentran resultados concluyentes de la superioridad de la opción hipofraccionada sobre la normofraccionada. En relación con la seguridad no se encuentran diferencias significativas en la aparición de complicaciones genitourinarias agudas entre ambos tratamientos. Sin embargo, una de las revisiones encuentra más complicaciones gastrointestinales agudas en los pacientes tratados con radioterapia hipofraccionada. En las complicaciones a largo plazo no se encuentran diferencias significativas según el tipo de radioterapia utilizada, aunque los estudios presentan limitaciones. Conclusiones: Hasta el momento no existen resultados concluyentes que demuestren que la radioterapia hipofraccionada es más eficaz o segura que la normofraccionada en el tratamiento del cáncer de próstata localizado

Context: New therapeutic alternatives can improve the safety and efficacy of prostate cancer treatment. Objectives: To assess whether hypofractionated radiation therapy results in better safety and efficacy in the treatment of prostate cancer. Acquisition of evidence: Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, ClinicalTrials and EuroScan, collecting indicators of safety and efficacy. Synthesis of the evidence: We included 2 systematic reviews and a clinical trial. In terms of efficacy, there is considerable heterogeneity among the studies, and no conclusive results were found concerning the superiority of the hypofractionated option over the normal fractionated option. In terms of safety, there were no significant differences in the onset of acute genitourinary complications between the 2 treatments. However, one of the reviews found more acute gastrointestinal complications in patients treated with hypofractionated radiation therapy. There were no significant differences in long-term complications based on the type of radiation therapy used, although the studies did have limitations. Conclusions: To date, there are no conclusive results that show that hypofractionated radiation therapy is more effective or safer than normal fractionated radiation therapy in the treatment of localized prostate cancer

Results from the monitoring use programme for endovascular repair of abdominal aortic aneurysms in Spain.

AIM: The aim of this study was to present the results from the Monitoring Use Programme (MUP) for endovascular repair (ER) of abdominal aortic aneurysms (AAA) using stent grafts in Spain, carried out to determine the procedure's effectiveness and safety. METHODS: This was a follow-up study carried out through a multicentric-case registry between 2001-2003. Variables were grouped into: 1) general information, 2) postoperative period and 3) follow-up period. RESULTS: The study enrolled 740 cases (97% males), from 32 hospitals. Mean age of patients was 72.7+/-7.3 years. Mean AAA diameter was 59.5+/-13.7 mm. Forty-seven percent of patients required additional intervention procedures; 19% patients presented intervention complications (53% were endoleaks). The endovascular intervention could not be completed in 6 patients, and in 2 patients the operation was changed to conventional surgery; 24% patients suffered, mostly minor, postoperative complications. Between 4-24 months, follow-up was normal in 81-85% cases with the most common complication being endoleaks (7%). After 24 months, and especially after 37, reinterventions and complications, in particular angulation and stent migration, increased, mainly associated to the Vanguard device. After 37 months, an increase in AAA size was observed. Among patients with preoperative AAA<50 mm, there was a greater proportion of individuals requiring additional procedures (60% vs 41%, P<0.01), suffering postoperative complications (26% vs 24%), and presenting more leaks (71% vs 52%), than among patients with AAA >or= 50 mm. CONCLUSIONS: ER of AAA shows favourable results in the short/medium term with regards to procedure safety and effectiveness. The appearance of some complications and increase in AAA size 2-3 years after ER raises the need for caution. Care should be taken when considering ER of small AAA.

Diferencias en los factores relacionados con el uso de la mamografía en las mujeres españolas en los años 1994 y 2000 (*) / Differences in the factors related to the use of mammograms among spanish women in 1994 and 2000

Fundamento: La mamografía de cribado es el procedimientomás efectivo para la detección precoz del cáncer de mama. El objetivodel presente estudio es conocer las diferencias en los factores relacionadoscon el uso de mamografía en 1994 y en 2000 en las mujeresespañolas de 40-70 años, y en aquéllas con al menos una mamografíaen los dos años previos.Método: Comparación de los resultados de dos encuestas realizadasen 1994 y en 2000 en sendas muestras de mujeres representativasde las mujeres españolas de 40-70 años (3.218 en 1994 y 2.409en 2000). Se analizaron variables sociodemográficas, socio-sanitariasy de actitudes e información de la mujer.Resultados: De 1994 a 2000 se encuentran diferencias estadísticamentesignificativas en las actitudes, destacando la intención dehacerse una mamografía en el futuro (96% en 2000 vs 79% en 1994)(p<0,0001). El porcentaje de realización de la prueba en el grupo de51-65 años es de 59% en 2000 vs 50% en 1994.Conclusiones: El perfil de las mujeres españolas ha cambiado de1994 a 2000, aunque las mujeres que se habían realizado una mamografíapresentan características sociodemográficas y socio-sanitariassimilares. No obstante, en el año 2000 la mamografía se realiza enmayor medida en el grupo de 51-65 años de edad y las mujeres muestranactitudes más positivas ante la mamografía

Background: The screening mammography is the most highlyeffective procedure for early breast cancer detection. This study isaimed at ascertaining the differences in the factors related to Spanishwomen 40-70 years of age having had mammograms in 1994and 2000 and among those having had at least one mammogramwithin the two years prior.Method: Comparison of the results of two surveys conducted in1994 and 2000, each on samples of women representative of Spanishwomen 40-70 years of age (3,218 in 1994 and 2,409 in 2000). Ananalysis was made of sociodemographic, sociosanitary and thewomen's attitude and awareness-related variables.Results: Statistically significant differences were found between1994 and 2000, the intention of having a mammogram in the future(96% in 2000 vs. 79% in 1994) (p<0.0001). A total of 59% of the 51-65 age group had a mammogram in 2000, as compared to the 50%who had one in 1994.Conclusions: The profile of Spanish women has undergone achange from 1994 to 2000, although those women who had had amammogram were of similar sociodemographic and sociosanitarycharacteristics. However, the screening is being done to a greaterextent on the age 51-65 age group in 2000, and the women are showingmore positive attitudes toward having a mammogram

Spermatic cord torsion after testicular fixation. A different surgical approach and a revision of current techniques.

We present a technique for testicular fixation, based on the development of a new anatomical structure formed exclusively by the visceral and the parietal tunica vaginalis; our pre-clinical experience with this technique performed in guinea pigs and a clinical casuistic of 100 operations in 69 patients (age range: newborns to 25 years, mean 101.43 months) where the principal indications were unilateral torsion, testicular descent and contralateral fixation after orchiectomy. Postoperative follow-up ranged between 4 months and 204 months with a mean of 14.304 months. At their final follow-up, all patients presented normal testicular size, shape, consistency, sensitivity, mobility and intrascrotal position; no patient complained of symptoms related to the operation. The discussion also includes 48 cases of failed testicular fixation which were performed with sutures, vaginal adhesions or dartos-pouch techniques, as reported by 30 different authors. Ages of patients at the primary operation ranged from 3 years to 34 years (mean 14.381 years), at the secondary operation from 10 years to 40 years (mean 19.298 years) and the interval between them ranged from 5 days to 27 years (mean 53.773 months). The causes of the failures, which led us to consider them as unreliable, were absorption of cicatricial tissue, serosal regeneration and loosening of sutures. The sequelae included testicular atrophies, orchiectomies and severely damaged testicles.

[Visual evoked potentials in children with tension headaches and migraine]. / Potenciales evocados visuales en niños con cefalea tensional y migraña.

OBJECTIVE: To determine whether visual evoked potentials (VEP) change, and to what degree, in different types of headache (migraine with or without aura, or tension headache). PATIENTS AND METHODS: We made a transversal study of 78 children (aged 3-14 years) studied between March 1997 and August 1998, classified into three groups according to HIS diagnostic criteria of 1988 and HIS-R 1997. A VEP of geometric pattern was done using the recording technique recommended by the International Society in their standards for VEP and the reference values were used for an amplitude of less than 5 microV and a latency of P100 +/- 15 ms. The qualitative variable was frequency, and the quantitative variables were the mean and the standard deviation. We studied the association between qualitative variables using the chi-squared test and the differences in means between the groups with ANOVA. All differences were considered to be statistically significant when p < 0.05. RESULTS: Girls made up 55%, with an average age of 8.84 years and a standard deviation of 3 years. There were no statistically significant differences in the mean of the VEP findings between the different types of headache with regard to amplitude (p = 0.975) and latency (p = 0.941). Neither were there any significant differences in the response to VEP in the different types of headache as far as sex and age were concerned, with p = 0.268 and p = 0.147 respectively. CONCLUSION: Our results show no statistically significant differences and do not support the idea of using VEP as a neurophysiological method for studying headaches and differentiating the various types.

Torsión de trompa de fallopio y/o ovario en niñas y adolescentes: controversias en diagnóstico y tratamiento / Adnexal torsion in little girls and adolescents

La torsión de trompa de fallopio y/o ovario en niñas y adolescentes está descripta como patología poco frecuente, generalmente asociada a otras patologías y de diagnóstico y tratamiento oportuno difícil. Relatamos nuestra experiencia con 4 pacientes en 8 meses destacando la frecuencia con respecto a la apendicectomías en el mismo período, las características clínicas y ecográficas y el tratamiento quirúrgico implementado. Como describimoa a continuación no hallamos en nuestras pacientes quistes o tumores asociados. La ecografía resultó muy útil para el diagnóstico en los casos de dolor abdominal dudoso y la laparoscopia fue la técnica quirúrgica de elección. Se destaca la discordancia entre el aspecto macroscópico del órgano torsionado y la anatomía patológica. La fijación se reserva a las torsiones recidivantes o de anexo único (AU)

Torsión de trompa de fallopio y/o ovario en niñas y adolescentes: controversias en diagnóstico y tratamiento / Adnexal torsion in little girls and adolescents

La torsión de trompa de fallopio y/o ovario en niñas y adolescentes está descripta como patología poco frecuente, generalmente asociada a otras patologías y de diagnóstico y tratamiento oportuno difícil. Relatamos nuestra experiencia con 4 pacientes en 8 meses destacando la frecuencia con respecto a la apendicectomías en el mismo período, las características clínicas y ecográficas y el tratamiento quirúrgico implementado. Como describimoa a continuación no hallamos en nuestras pacientes quistes o tumores asociados. La ecografía resultó muy útil para el diagnóstico en los casos de dolor abdominal dudoso y la laparoscopia fue la técnica quirúrgica de elección. Se destaca la discordancia entre el aspecto macroscópico del órgano torsionado y la anatomía patológica. La fijación se reserva a las torsiones recidivantes o de anexo único

Teratoma cervical del recién nacido: Tratamiento y táctica quirúrgica / Cervical teratoma in the neonate:Treatment and chirurgical approach

El teratoma cervical en el recién nacido es una entidad poco frecuente .Se presenta un paciente con una forma gigante del tumor y su esquema terapéutico.El diagnóstico precoz, la intubación orotraqueal, la cirugía adecuada sin demora y el seguimiento a largo plazo con determinación de la curva de alfa-fetoproteína, definen la sobrevida de estos pacientes

Teratoma cervical del recién nacido: Tratamiento y táctica quirúrgica / Cervical teratoma in the neonate:Treatment and chirurgical approach

El teratoma cervical en el recién nacido es una entidad poco frecuente .Se presenta un paciente con una forma gigante del tumor y su esquema terapéutico.El diagnóstico precoz, la intubación orotraqueal, la cirugía adecuada sin demora y el seguimiento a largo plazo con determinación de la curva de alfa-fetoproteína, definen la sobrevida de estos pacientes