Resonancia magnética en la valoración de las conexiones venosas pulmonares anómalas / Magnetic resonance imaging in the assessment of anomalous pulmonary venous connections

Objetivo. El objetivo de este artículo es ilustrar los hallazgos morfológicos y funcionales en resonancia magnética (RM) de las conexiones venosas pulmonares anómalas congénitas, incluyendo las totales y parciales, y de las complicaciones posquirúrgicas más frecuentes. Conclusión. Los hallazgos en RM son fundamentales para definir el tipo de conexión venosa pulmonar anómala congénita, decidir el tratamiento, planificar la cirugía y detectar las complicaciones posquirúrgicas (AU)

Objective. To illustrate the morphological and functional magnetic resonance findings for total and partial anomalous pulmonary venous connections as well as of the most common complications after surgery. Conclusion. The magnetic resonance findings are fundamental in defining the type of anomalous connection, deciding on the treatment, planning the surgery, and detecting postsurgical complications (AU)

Hallazgos de imagen de las masas cardíacas (parte II): tumores malignos y lesiones pseudotumorales / Imaging findings in cardiac masses (part II): malignant tumors and pseudotumors

Los tumores cardíacos malignos son menos frecuentes que los tumores benignos; pueden ser primarios y secundarios. Los secundarios o metastásicos son entre 20 y 40 veces más frecuentes que los primarios, con una incidencia estimada del 0,05%. Las lesiones pseudotumorales no neoplásicas pueden presentarse como masas cardíacas con características de imagen que pueden plantear el diagnóstico con neoplasias. El objetivo de este trabajo es presentar los tumores cardíacos malignos y las lesiones pseudotumorales haciendo hincapié en los hallazgos en TC y RM y en las características que permiten diferenciarlos de los tumores cardíacos benignos (AU)

Malignant heart tumors are less common than benign ones. They can be primary or secondary. Secondary or metastatic heart tumors are 20 to 40 times more common than primary malignant heart tumors, which have an estimated incidence of 0.05%. Non-neoplastic pseudotumors can present as cardiac masses, with imaging characteristics than can suggest the diagnosis of a tumor. The aim of this article is to describe and illustrate malignant heart tumors and pseudotumors, stressing the CT and MRI findings that make it possible to differentiate them from benign cardiac tumors (AU)

[Imaging findings in cardiac masses. Part II: malignant tumors and pseudotumors]. / Hallazgos de imagen de las masas cardíacas. parte II: tumores malignos y lesiones pseudotumorales.

Malignant heart tumors are less common than benign ones. They can be primary or secondary. Secondary or metastatic heart tumors are 20 to 40 times more common than primary malignant heart tumors, which have an estimated incidence of 0.05%. Non-neoplastic pseudotumors can present as cardiac masses, with imaging characteristics than can suggest the diagnosis of a tumor. The aim of this article is to describe and illustrate malignant heart tumors and pseudotumors, stressing the CT and MRI findings that make it possible to differentiate them from benign cardiac tumors.

Magnetic resonance imaging in the assessment of anomalous pulmonary venous connections.

OBJECTIVE: To illustrate the morphological and functional magnetic resonance findings for total and partial anomalous pulmonary venous connections as well as of the most common complications after surgery. CONCLUSION: The magnetic resonance findings are fundamental in defining the type of anomalous connection, deciding on the treatment, planning the surgery, and detecting postsurgical complications.

Hallazgos de imagen de las masas cardíacas (parte I): protocolo de estudio y tumores benignos / Imaging findings in cardiac masses (Part I ): study protocol and benign tumors

Las masas cardíacas son un reto diagnóstico porque las decisiones terapéuticas se basan en los hallazgos de las técnicas de imagen. La ecocardiografía, la resonancia magnética (RM) y la tomografía computarizada (TC) son fundamentales para la detección, caracterización, estadificación y planificación del tratamiento. La mayoría de los tumores primarios son benignos; los más frecuentes son el mixoma, el fibroelastoma papilar y el lipoma. La localización del tumor y sus características en la TC y la RM orientan el diagnóstico etiológico en la mayor parte de los casos. Se describen los protocolos de estudio de TC y RM de las masas cardíacas, así como los hallazgos morfológicos, las localizaciones preferentes y las características más útiles para caracterizar las masas cardíacas benignas y establecer el diagnóstico diferencial con los tumores cardíacos malignos y las lesiones pseudotumorales no neoplásicas (AU)

Cardiac masses represent a diagnostic challenge because decisions about treatment are based on imaging techniques. Echocardiography, magnetic resonance (MR) and computed tomography (CT) are fundamental for the detection, characterization, and staging of cardiac masses as well as for planning their treatment. Most primary cardiac tumors are benign; myxomas, papillary fibroelastomas, and lipomas are the most common. The location of the tumors and its characteristics on CT and MR orient the etiologic diagnosis in most cases. This article describes the protocols for CT and MR studies of cardiac masses as well as the morphologic findings, predominant locations, and most useful characteristics for characterizing benign cardiac masses and establishing the differential diagnosis with malignant cardiac tumors and non-neoplastic pseudotumors (AU)

Imaging findings in cardiac masses (Part I): study protocol and benign tumors.

Cardiac masses represent a diagnostic challenge because decisions about treatment are based on imaging techniques. Echocardiography, magnetic resonance (MR) and computed tomography (CT) are fundamental for the detection, characterization, and staging of cardiac masses as well as for planning their treatment. Most primary cardiac tumors are benign; myxomas, papillary fibroelastomas, and lipomas are the most common. The location of the tumors and its characteristics on CT and MR orient the etiologic diagnosis in most cases. This article describes the protocols for CT and MR studies of cardiac masses as well as the morphologic findings, predominant locations, and most useful characteristics for characterizing benign cardiac masses and establishing the differential diagnosis with malignant cardiac tumors and non-neoplastic pseudotumors.

Extravasación de medios de contraste intravenosos en el sitio de la punción: Protocolo de actuación / Extravasation of contrast media at the puncture site: Strategies for managment

La incidencia de extravasación de medios de contraste en el sitio de la punción venosa ha aumentado con el uso generalizado de los inyectores automáticos. La mayoría de las extravasaciones solo ocasionan edema y eritema leves. Sin embargo, en algunos casos pueden originar lesiones cutáneas graves e incluso llegar a provocar un síndrome compartimental. Las lesiones por extravasación suelen resolverse espontáneamente y con tratamiento conservador. A pesar de que las complicaciones de las extravasaciones son bien conocidas, es común que los criterios de actuación y el tratamiento, basados en la bibliografía o en preferencias individuales, sean variables, sin un protocolo de actuación institucional. En este trabajo revisamos la incidencia, los factores de riesgo, las manifestaciones clínicas y las opciones de prevención y tratamiento de las extravasaciones de medios de contraste en los tejidos blandos y presentamos un protocolo de actuación, que es el utilizado en nuestro centro hospitalario (AU)

The incidence of contrast medium extravasation at the venipuncture site has increased with the generalized use of automatic injectors. Most extravasations only cause slight edema and erythema. Nevertheless, in some cases extravasation can result in severe skin lesions or even in compartment syndrome. Lesions caused by extravasation usually resolve spontaneously with conservative treatment. Although the complications of extravasation are well known, institutional protocols are normally lacking and the criteria for taking action and the type of treatment, whether based on the literature or personal preferences, tend to vary. In this article, we review the incidence, risk factors, clinical manifestations, and options for preventing and treating contrast medium extravasation in soft tissues. Finally, we present the protocol we use to manage extravasation at our hospital (AU)

[Extravasation of contrast media at the puncture site: Strategies for managment]. / Extravasación de medios de contraste intravenosos en el sitio de la punción: Protocolo de actuación.

The incidence of contrast medium extravasation at the venipuncture site has increased with the generalized use of automatic injectors. Most extravasations only cause slight edema and erythema. Nevertheless, in some cases extravasation can result in severe skin lesions or even in compartment syndrome. Lesions caused by extravasation usually resolve spontaneously with conservative treatment. Although the complications of extravasation are well known, institutional protocols are normally lacking and the criteria for taking action and the type of treatment, whether based on the literature or personal preferences, tend to vary. In this article, we review the incidence, risk factors, clinical manifestations, and options for preventing and treating contrast medium extravasation in soft tissues. Finally, we present the protocol we use to manage extravasation at our hospital.

Formación continuada. Cómo redactar preguntas con opciones de respuesta múltiple / Continuing medical education: How to write multiple choice questions

La evaluación de la competencia profesional en medicina es una tarea difícil pero indispensable porque permite, en diferentes momentos y desde distintas perspectivas, valorar en qué medida se han adquirido los conocimientos, habilidades, actitudes y valores necesarios para el ejercicio profesional. Las pruebas basadas en preguntas de opciones múltiples han sido y son, una de las herramientas más útiles y utilizadas para evaluar de forma objetiva el aprendizaje en medicina. Cuando están bien diseñadas y se aplican de forma correcta, además de estimular el aprendizaje, pueden incluso medir habilidades cognitivas superiores. Redactar un cuestionario de preguntas con opciones de respuesta múltiple es una tarea difícil que requiere conocimientos sobre la materia que se ha de valorar, aprendizaje de una metodología y tiempo para su elaboración. El objetivo de este trabajo es revisar lo que las preguntas de opciones múltiples pueden evaluar, las reglas y normas que deben tenerse en cuenta para su redacción, los distintos formatos que pueden utilizarse, los errores más frecuentes que suelen cometerse en su elaboración y como analizar los resultados de los exámenes para poder verificar su calidad (AU)

Evaluating professional competence in medicine is a difficult but indispensable task because it makes it possible to evaluate, at different times and from different perspectives, the extent to which the knowledge, skills, and values required for exercising the profession have been acquired. Tests based on multiple choice questions have been and continue to be among the most useful tools for objectively evaluating learning in medicine. When these tests are well designed and correctly used, they can stimulate learning and even measure higher cognitive skills. Designing a multiple choice test is a difficult task that requires knowledge of the material to be tested and of the methodology of test preparation as well as time to prepare the test. The aim of this article is to review what can be evaluated through multiple choice tests, the rules and guidelines that should be taken into account when writing multiple choice questions, the different formats that can be used, the most common errors in elaborating multiple choice tests, and how to analyze the results of the test to verify its quality (AU)

[Continuing medical education: how to write multiple choice questions]. / Formación continuada. Cómo redactar preguntas con opciones de respuesta múltiple.

Evaluating professional competence in medicine is a difficult but indispensable task because it makes it possible to evaluate, at different times and from different perspectives, the extent to which the knowledge, skills, and values required for exercising the profession have been acquired. Tests based on multiple choice questions have been and continue to be among the most useful tools for objectively evaluating learning in medicine. When these tests are well designed and correctly used, they can stimulate learning and even measure higher cognitive skills. Designing a multiple choice test is a difficult task that requires knowledge of the material to be tested and of the methodology of test preparation as well as time to prepare the test. The aim of this article is to review what can be evaluated through multiple choice tests, the rules and guidelines that should be taken into account when writing multiple choice questions, the different formats that can be used, the most common errors in elaborating multiple choice tests, and how to analyze the results of the test to verify its quality.

Tumores articulares y periarticulares: diagnóstico diferencial con resonancia magnética / Articular and periarticular tumors: differential diagnosis using magnetic resonance imaging

Conocer el diagnóstico diferencial de los tumores articulares y periarticulares y las alteraciones en la resonancia magnética (RM) que pueden sugerir su diagnóstico es importante porque la mayoría se presentan como una monoartritis crónica con signos, síntomas y alteraciones en las pruebas de laboratorio inespecíficas. La RM define el origen anatómico y las características tisulares de los tumores articulares y periarticulares y permite realizar un diagnóstico específico en la mayoría de los casos. Es importante analizar los hallazgos de la RM junto a los de la radiografía porque ayuda a caracterizar los tumores mineralizados (AU)

Most patients with articular or periarticular tumors present with chronic monoarthritis and nonspecific alterations on laboratory tests; thus, it is important to know the changes on magnetic resonance imaging (MRI) that can suggest their diagnosis and the differential diagnosis of these tumors. MRI defines the anatomic origin and the tissue characteristics of articular and periarticular tumors, making it possible to reach a specific diagnosis in most cases. It is important to evaluate the MRI findings together with the plain-film findings because this helps in the characterization of mineralized tumors (AU)

[Articular and periarticular tumors: differential diagnosis using magnetic resonance imaging]. / Tumores articulares y periarticulares: diagnóstico diferencial con resonancia magnética.

Most patients with articular or periarticular tumors present with chronic monoarthritis and nonspecific alterations on laboratory tests; thus, it is important to know the changes on magnetic resonance imaging (MRI) that can suggest their diagnosis and the differential diagnosis of these tumors. MRI defines the anatomic origin and the tissue characteristics of articular and periarticular tumors, making it possible to reach a specific diagnosis in most cases. It is important to evaluate the MRI findings together with the plain-film findings because this helps in the characterization of mineralized tumors.

Ampolla conjuntival en el contexto de pénfigo vulgar: a propósito de un caso / Conjuctival blistering assocated with pemphigus vulgaris: report of a case

Caso clínico: Un paciente con una ampolla conjuntival fue diagnosticado de pénfigo vulgar mediante técnicas de inmunofluorescencia en biopsia conjuntival.Discusión: El pénfigo vulgar es una enfermedad autoinmune grave pero poco frecuente que produce ampollas en piel y membranas mucosas. La afectación ocular es poco común e incluye conjuntivitis y erosiones palpebrales. Ampollas y erosiones conjuntivales asociadas no han sido aún descritas en la literatura. Se llega al diagnóstico mediante técnicas de inmunofluorescencia directa realizada en biopsias de tejido afectado. La mortalidad es elevada si no es diagnosticada y tratada adecuadamente

Clinical case: A patient with a conjunctival blister was diagnosed with pemphigus vulgaris by immunofluorescence tests performed on a conjunctival biopsy. Discussion: Pemphigus vulgaris is an uncommon but serious autoimmune disease that produces blisters of the skin and mucous membranes. Ocular findings are rare, but include conjunctivitis and marginal eyelid erosions. Conjunctival blisters and erosions related to this condition have not been previously reported in the literature. This diagnosis can be made through direct immunofluorescence tests performed on biopsy samples of affected tissue. Unless the condition is properly diagnosed and treated, it has a high mortality