Embolia cerebral cálcica: presentación de una serie de 9 casos y revisión de la literatura / Calcified cerebral embolism: a 9 case series and review of the literature

Objetivo: Las embolias cerebrales cálcicas (ECC) representan una causa de ictus poco descrita e infradiagnosticada, que puede ser la primera manifestación de una enfermedad vascular o cardíaca. El objetivo del presente trabajo es describir las características de las ECC en una serie de casos y revisar la literatura. Pacientes y métodos: Tres centros hospitalarios aportaron casos al trabajo. Se evaluaron los métodos diagnósticos, las características de neuroimagen, la fuente embólica, el tratamiento y el pronóstico de los pacientes con ECC. Resultados: Se recogieron un total de 9 casos con ECC espontánea como causa de ictus isquémico agudo. Todos afectaron a la arteria cerebral media y se estudiaron mediante TC. Se encontró una posible fuente cálcica en 6 pacientes (66,6%): carotídea en 3 (33,3%) y cardíaca en otros 3 (33,3%) pacientes. Solo un paciente se trató en la fase aguda mediante trombectomía y solo un 11% tuvieron un mRS ≤ 2 a los 3 meses. Conclusiones: Las ECC son más frecuentes de lo que se creía en el pasado y, aunque siguen siendo comúnmente infradiagnosticadas, tienen una gran relevancia pronóstica a la hora de dirigir el estudio etiológico del ictus. (AU)

Objective: Calcified cerebral embolism (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. Our purpose is to describe the characteristics of CCE in a series of 9 cases and review the literature on the subject. Patients and methods: We included patients with CCE from 3 different hospitals. We described the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients. Results: We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originated in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified ranking scale scores ≤ 2 at 3 months. Conclusions: CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke. (AU)

Calcified cerebral embolism: a 9-case series and review of the literature.

OBJECTIVE: Calcified cerebral embolus (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. We describe the characteristics of CCE in a series of 9 cases and review the literature on the subject. PATIENTS AND METHODS: We included patients with CCE from 3 different hospitals. We describe the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients. RESULTS: We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originating in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified Ranking Scale scores ≤ 2 at 3 months. CONCLUSIONS: CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke.

Non-linear dynamics and self-similarity in the rupture of ultra-thin viscoelastic liquid coatings.

The influence of viscoelasticity on the dewetting of ultrathin polymer films is unraveled by means of theory and numerical simulations in the inertialess limit. Three viscoelastic models are employed to analyse the dynamics of the film, namely the Oldroyd-B, Giesekus, and FENE-P models. We revisit the linear stability analysis first derived by [Tomar et al., Eur. Phys. J. E., 2006, 20, 185-200] for a Jeffrey's film to conclude that all three models formally share the same dispersion relation. For times close to the rupture singularity, the self-similar regime recently discovered [Moreno-Boza et al., Phys. Rev. Fluids, 2020, 5, 014002], where the dimensionless minimum film thickness scales with the dimensionless time until rupture as hmin = 0.665τ1/3, is asymptotically established independently of the rheological model. The spatial structure of the flow is characterised by a Newtonian core and a thin viscoelastic boundary layer at the free surface, where polymeric stresses become singular as τ → 0. The Deborah number and the solvent-to-total viscosity ratio affect the rupture time but not the length scale of the resulting dewetting pattern and asymptotic flow structure close to rupture, which is thus shown to be universal. Our three-dimensional simulations lead us to conclude that bulk viscoelasticity alone does not explain the experimental observations of dewetting of polymeric films near the glass transition.

Universal Thinning of Liquid Filaments under Dominant Surface Forces.

Theory and numerical simulations of the thinning of liquid threads at high superficial concentration of surfactants suggest the existence of an asymptotic regime where surface tension balances surface viscous stresses, leading to an exponential thinning with an e-fold time F(Θ)(3µ_{s}+κ_{s})/σ, where µ_{s} and κ_{s} are the surface shear and dilatational viscosity coefficients, σ is the interfacial tension, Θ=κ_{s}/µ_{s}, and F(Θ) is a universal function. The potential use of this phenomenon to measure the surface viscosity coefficients is discussed.

Calcified cerebral embolism: a 9 case series and review of the literature. / Embolia cerebral cálcica: presentación de una serie de 9 casos y revisión de la literatura.

OBJECTIVE: Calcified cerebral embolism (CCE), a rarely reported and underdiagnosed cause of stroke, may be the first manifestation of a vascular or cardiac disease. Our purpose is to describe the characteristics of CCE in a series of 9 cases and review the literature on the subject. PATIENTS AND METHODS: We included patients with CCE from 3 different hospitals. We described the diagnostic approach, neuroimaging findings, origin of the embolism, treatment, and prognosis of these patients. RESULTS: We identified a total of 9 patients presenting spontaneous CCE as the cause of acute ischaemic stroke. In all cases, the middle cerebral artery was affected; all patients underwent CT. A possible calcific source was found in 6 patients (66.6%), originated in the carotid arteries in 3 (33.3%) and in the heart in the other 3 patients (33.3%). Only one patient was treated in the acute phase (trombectomy) and only 11% of patients had modified ranking scale scores ≤ 2 at 3 months. CONCLUSIONS: CCE is more frequent than previously thought and, although the condition continues to be underdiagnosed, it is of considerable prognostic relevance in the aetiological study of stroke.

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.

[Cognitive impairment in a 35 years-old male]. / Deterioro cognitivo en varón de 35 años.

Cognitive impairment is a syndrome with multiple causes, presenting frequently neuropsychiatric symptoms. In these cases, the psychiatrist role is essential, including both diagnosis and therapy.HIV-associated dementia usually includes psychiatric symptoms, even in the absence of neurological symptoms in initial stages. Moreover, the prolonged life span of patients with HIV leaves the possibility that prevalence or HIV-associated neurologic disease increases in coming years. We report a case of a HIV male with insidious cognitive impairment, making diagnosis difficult due to ambiguous symptoms. The patient begins with depressive symptoms and slightly develops cognitive impairment. The presence of cognitive impairment in a young person must alert us think about HIV pathology, because it is one of the leading causes of dementia in the young.

Deterioro cognitivo en varón de 35 años / Cognitive impairment in a 35 years-old male

El deterioro cognitivo es un síndrome que puede deberse a múltiples causas, presentando frecuentemente síntomas neuropsiquiátricos añadidos. En esos casos, el papel del psiquiatra es fundamental, tanto en la vertiente diagnóstica como terapéutica.El complejo demencia-sida generalmente incluye síntomas psiquiátricos, incluso en ausencia de síntomas neurológicos en las fases iniciales.Además, la mayor esperanza de vida de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) probablemente conllevará un aumento de la prevalencia de los trastornos neurológicos asociados al VIH en los próximos años.Presentamos un caso de un varón infectado por VIH que presenta un deterioro cognitivo insidioso, que dificulta el diagnóstico inicial debido a la presencia de síntomas ambiguos. El paciente comienza con síntomas depresivos y lentamente progresa hacia un deterioro cognitivo.La presencia de deterioro cognitivo en una persona joven nos debe hacer descartar patología asociada a VIH, ya que ésta es en la actualidad una de las causas principales de demencia entre los jóvenes (AU)

[Multinational European project and multicenter Spanish study of quality improvement of assistance on consultation-liaison psychiatry in general hospital: clinical profile in Spain]. / El proyecto multinacional europeo y multicéntrico español de mejora de calidad asistencial en psiquiatría de enlace en el hospital general: el perfil clínico en España.

BACKGROUND: In the frame of the European study on quality assurance in consultation liaison psychiatry and psychosomatics (supported by the BIOMED 1 program), the clinical <> of consultation-liaison psychiatry units pertaining to six Spanish general hospitals is analyzed. PATIENTS AND METHOD: A sample of 3. 608 consecutive patients referred to the consultation-liaison psychiatry units of five public general hospitals (Clínico of Zaragoza, Clínico of Barcelona, General of Alicante, Ramón y Cajal of Madrid, Princesa of Madrid) and one private gynecological hospital (Dexeus of Barcelona) was studied. The data were recorded with a standardized instrument (CL-BDoK-P), validated in a previous study. RESULTS: Consult request took place 10.6 days (on average) after the patients admission (<>), half the requests were urgent, and psychiatric consultants examined the patients 1.9 days (on average) after the request (<>). The most frequent reasons for referral were current psychiatric symptoms (50.3%), unexplained physical symptoms (15.2%), substance abuse (9.2%), psychiatric history (8.5%), suicide risk (6%) and coping with illness (5.8%). The main referral services were internal medicine (17.5%), traumatology (7.5%) and general surgery (7.3%). An important clinical activity is documented in patients frequently considered to be <>, with broad spectrum diagnostic and interventions processes and both in-hospital and out-patient follow-up. However, some problems were also detected in the clinical <>. CONCLUSIONS: The results outline the clinical importance of Spanish consultation-liaison psychiatry in the general hospital, but the possibility of improving its efficiency through the implementation of integrative models, organizational changes and modern models of <> is also emphasized.