Checklist: Neck computed tomography in non-traumatic emergencies.

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.

Lista de verificación: tomografía computarizada de cuello en urgencias no traumáticas / Checklist: Neck computed tomography in non-traumatic emergencies

A los pacientes que acuden a urgencias con síntomas inflamatorio/infecciosos a nivel cervical o con masas que pueden comprometer el tracto aerodigestivo o las estructuras vasculares, es necesario hacerles una tomografía computarizada (TC) de cuello con contraste. Su interpretación radiológica se ve dificultada por la complejidad anatómica y la interrelación fisiopatológica entre los diferentes sistemas que lo componen, en un área de estudio relativamente pequeña. Estudios recientes proponen realizar una evaluación sistemática de las estructuras cervicales, utilizando para ello un listado de verificación de 7 elementos, para identificar correctamente la patología, y detectar los hallazgos incidentales que pueden interferir en el manejo del paciente. El objetivo de este trabajo es revisar los hallazgos de la TC en la patología no traumática del cuello en urgencias siguiendo una lectura sistemática, tras la cual se pueda realizar un informe radiológico estructurado, completo y conciso.(AU)

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.(AU)

Resumen ejecutivo: Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente con diabetes mellitus 2020. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición / Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN). Las recomendaciones se formularon según el sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 28 de febrero de 2020. En este resumen ejecutivo incluimos la evidencia reciente incorporada desde 2013. El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus.

To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013. The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. / Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Como prevenir y tratar las hipoglucemias farmacológicas / How to prevent and treat pharmacological hypoglycemias

Mujer de 58 años con diabetes tipo 2 diagnosticada hace 3 años, en tratamiento con metformina 850mg cada 12h y glimepirida 4mg cada 24h. Tras iniciar glimepirida hace 9 meses ha incrementado 5kg su peso habitual, y presenta hipoglucemias frecuentes que han afectado a su capacidad para conducir. Su índice de masa corporal es 35,5kg/m2. Presenta además hipertensión arterial en tratamiento con telmisartán e hidroclorotiazida con adecuado control, e hipercolesterolemia en tratamiento con atorvastatina 40mg/día. Acude a consulta para revisión, aporta fondo de ojo, con resultado normal y resultados de la analítica que muestra una HbA1c de 7,0%, microalbuminuria negativa, colesterol total 149mg/dl, HDL colesterol 52mg/dl, LDL colesterol 98mg/dl y triglicéridos 123mg/dl. La tensión arterial es de 129/81mmHg, no presenta hipotensión ortostática, y la exploración neurológica periférica en miembros inferiores es normal. En resumen, se trata de una paciente joven, con una diabetes tipo 2 y obesidad, sin complicaciones crónicas, y con hipoglucemias frecuentes ¿Cómo deber ser evaluada y tratada esta paciente? (AU)

A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850mg every 12hours and glimepiride 4mg every 24hours. After the initiation of glimepiride 9 months before her weight has increased 5kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5kg/m2. She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40mg every 24hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149mg/dl, HDL cholesterol 52mg/dl, LDL cholesterol 98mg/dl and triglycerides 123mg/dl. Her blood pressure is 129/81mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated? (AU)

How to prevent and treat pharmacological hypoglycemias.

A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated?

Exostosis costal como causa de hemoptisis / No disponible

No disponible

Liraglutida en el tratamiento de la diabetes tipo 2: recomendaciones para una mejor selecci¨®n de los pacientes, desde una visi¨®n multidisciplinar / Liraglutide in the treatment of type 2 diabetes: recommendations for better patients¡¯ selection from a multidisciplinary approach

Liraglutida es el primer an¨¢logo humano del p¨¦ptidosimilar al glucag¨®n tipo 1 (GLP-1) administrado unavez al d¨ªa, y con el que presenta una homolog¨ªa del97%. El f¨¢rmaco ha sido recientemente aprobadopor la European Medicines Agency y por la Food andDrug Administration para su uso en el tratamiento dela diabetes mellitus tipo 2. La aprobaci¨®n inicial espara su uso una vez al d¨ªa en combinaci¨®n, bien conmetformina o con una sulfonilurea, as¨ª como encombinaci¨®n con metformina m¨¢s una sulfonilurea ouna tiazolidindiona. En Estados Unidos, tambi¨¦n est¨¢indicada en monoterapia. Los resultados del programade estudios LEAD (Liraglutide Effect and Action inDiabetes) demuest ran que liraglutida disminuye deforma significativa la hemoglobina glucosilada(HbA1c) con muy bajo riesgo de hipoglucemia. El tratamientocon liraglutida tambi¨¦n se asocia con unap¨¦rdida de peso signifi cativa y mantenida en el tiempo,disminuci¨®n de la presi¨®n arterial sist¨®lica, mejor¨ªade la funci¨®n de las c¨¦lulas ¦Â y reducci¨®n deotros factores de riesgo cardiovascular. En este art¨ªculose revisa la evidencia m¨¢s actualizada obtenidadel programa LEAD, centr¨¢ndose en consideracionespr¨¢cticas sobre la manera de utilizar de forma ¨®ptimaesta nueva terapia para la diabetes mellitus tipo 2(AU)

Liraglutide is the first once daily human glucagonlikepeptide-1 (GLP-1) analogue, with a 97% homology.Liraglutide has recently been approved bythe European Medicines Agency and by the Foodand Drug Administration to be used in the medicalmanagement of type 2 diabetes mellitus. Initial approvalis for be using in combination with metformin,a sulphonylurea or a combination of metforminwith a sulphonylurea or thiazolidinedione. Monotherapywith liraglutide is also approved in UnitedStates. Results from the LEAD (Liraglutide Effectand Action in Diabetes) clinical trials programmeshow that liraglutide significantly lowers HbA1c, witha very low risk of hypoglycemia. Liraglutide treatmentwas also associated with significant and sustainedweight loss, decreased systolic blood pressure,improved ¦Â-cell function, and reductions inother cardiovascular risk markers. In this article wereview the most up-to-date evidence emanatingfrom the LEAD programme, focussing on practicalconsiderations on how to optimally use this new therapyfor type 2 diabetes mellitus(AU)

Pseudoabsceso cerebral en meningitis neonatal por Enterobacter agglomerans / Cerebral pseudo-abscess in neonatal meningitis due to Enterobacter agglomerans

No disponible

Effects of raloxifene therapy on circulating osteoprotegerin and RANK ligand levels in post-menopausal osteoporosis.

Previous in vitro studies suggest that the anti-resorptive effect of raloxifene might be mediated by changes in several cytokines involved in the bone remodeling process. In this context, the osteoprotegerin (OPG)- receptor activator of NF kappa B ligand (RANKL) system is considered a key component in the osteoclastogenesis regulation. The aim of this study was to determine the effects of raloxifene treatment on serum concentrations of OPG, receptor RANKL and its relationship with biochemical markers of bone turnover and bone mineral density (BMD) in previously untreated women with post-menopausal osteoporosis. We selected 47 post-menopausal women (mean age 63+/-7 yr) with densitometric criteria of osteoporosis. We determined at baseline, 3, 6, and 12 months anthropometric parameters, biochemical markers of bone turnover, serum levels of 25(OH) D, serum levels of OPG and RANKL. BMD (dual-energy x-ray absorptiometry) in lumbar spine (LS) femoral neck and total hip was measured at baseline and 12 months after raloxifene (60 mg/day) treatment. Serum levels of OPG decreased in the 3rd and 6th month of treatment (p<0.001) and returned to basal levels in the 12th month. There was a significant decrease of RANKL levels and OPG/RANKL ratio after 1 yr of raloxifene treatment. In addition, BMD in LS increased significantly (2.5%) in the 12th month of treatment (p=0.031). Finally, the biochemical markers of bone turnover (total alkaline phosphatase, bone alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase, urine cross-linked carboxi-terminal telopeptide of type I collagen) decreased significantly from the 3rd month of treatment. In conclusion, our results support the hypothesis that raloxifene may inhibit osteoclast activity, at least partly modulating the OPG-RANKL system.

Endovascular treatment of a pseudoaneurysm of the descending palatine artery after orthognathic surgery: technical note.

We report the clinical presentation (relapsing epistaxis after Le Fort I osteotomy), craniofacial digital subtraction angiography findings, and endovascular embolization through a microcatheter, in a 26-year-old patient with a pseudoaneurysm of the descending palatine artery.

Paragangliomas de la cauda equina, a propósito de dos casos / Paragangliomas of the cauda equina: report of two cases

Los paragangliomas extraadrenales que afectan a la médula espinal no son frecuentes y suelen manifestarse como una compresión intradural de la cauda equina. Presentamos dos casos de paraganglioma de la cauda equina de características y comportamiento distintos, y revisamos los aspectos clínicos e histopatológicos de este tumor, así como el diagnóstico, tratamiento y pronós¬tico. Existen casos con una elevadísima vascularización tumoral que impide la extirpación completa de la lesión, lo cual es el tratamiento de elección de estos tumores. La realización de laminotomía osteoplástica y ecografía intraoperatoria son de gran utilidad en el abordaje de lesiones intradurales como el paraganglioma (AU)

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compres-sion of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma (AU)

[Paragangliomas of the cauda equina: report of two cases]. / Paragangliomas de la cauda equina: a propósito de dos casos.

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.

Importancia del IGF-I en el metabolismo óseo / Importance of IGF-I in bone metabolism

No disponible

Performance of quantitative ultrasound in the discrimination of prevalent osteoporotic fractures in a bone metabolic unit.

There is a growing interest in ultrasound evaluation of bone status as an alternative to the measurement with dual X-ray absorptiometry (DXA), due to its low cost, portability, and nonionizing radiation. The aim of our study was to investigate the relation among DXA, QUS, clinical, anthropometric, and lifestyle factors, and to determine QUS cutoff values in order to discriminate fractures in patients referred to the Bone Metabolic Unit at an Endocrinology Service. We studied 300 patients (281 females and 19 males; age 58 +/- 11 years) referred for evaluation of osteoporosis. In all cases we determined basic anthropometric parameters, a clinical history including previous osteoporotic fractures and risk factors for osteoporosis, and QUS parameters in calcaneus (Hologic Sahara), and BMD in lumbar spine (LS) and femoral neck (FN), by DXA (Hologic QDR 1000). Using the WHO densitometric criteria, 37, 46.7, and 16.3% of our population were osteoporotic, osteopenic, and normal, respectively. A QUI T-score

Prevención y tratamiento de la osteoporosis / Prevention and treatment of osteoporosis

No disponible

Performance of COLIA1 polymorphism and bone turnover markers to identify postmenopausal women with prevalent vertebral fractures.

Some studies have suggested that bone turnover markers (BTM) and collagen type I alpha 1 gene (COLIA1) may be useful in the prediction of rates of future bone loss, and may therefore provide information about fracture risk. Our study aimed to examine the association of the COLIA1 genotype with the risk of vertebral fracture and to investigate the predictive value of this genetic factor in comparison with bone mineral density (BMD) and BTM, in ambulatory postmenopausal Spanish women. We determined the COLIA1 polymorphism by polymerase chain reaction, BMD by dual-energy X-ray absorptiometry and BTM in 43 postmenopausal women with prevalent vertebral fracture and a control group of 101 postmenopausal women without fracture. There was a significant overrepresentation of the 'T' allele in fractured women ( p = 0.029). BTM exhibited no differences between women with or without fractures or COLIA1 genotype groups. After adjusting for all other variables, the osteoporosis densitometric criteria variable was the most strongly associated with fracture (OR = 5 [1.8-13.3]) followed by COLIA1 (OR = 2.1 [1-4.3] per copy of the 'T' allele). Our study shows that COLIA1 is associated with prevalent vertebral fracture independently of bone mass, and the performance of this genetic factor to assess prevalent vertebral fracture is better than bone turnover markers.