[Bronchoplastic surgery: tumorectomy in principal left bronchial tube in a 5-month old child]. / Cirugía broncoplástica: tumorectomía en bronquio principal izquierdo en una niña de 5 meses.

INTRODUCTION: Resection of bronchial tumors usually needs resection of the lung parenchyma ventilated by the ill bronchus. Surgery over a developing child must preserve the biggest amount of lung parenchyma as possible. We show a complete resection of a benign tumor from the left main-stem bronchus, without pneumonectomy. MATERIALS AND METHODS: Case report RESULTS: A 5 month girl presented with left hypoventilation. No significant previous dates. After bronchoscopy (with negative biopsy), chest radiograph and CT, she was diagnosed of a tumor in the mainstem left bronchus (20 x 15 mm) without metastatic extension. A sleeve resection of the tumor, with carinal reconstruction was performed. It was done under unipulmonary ventilation, with selective bronchial intubation. The patient was extubated in the operating room and the hospital stay was of 5 days. Follow up bronchoscopies shows no anastomotic stricture neither leakage. The patient is doing well 2 years after surgery. CONCLUSIONS: With this report and others in literature we can say that is possible to resect bronchial tumors in infancy without parenchymal resections.

Cirugía broncoplástica: tumorectomía en bronquioprincipal izquierdo en una niña de 5 meses / Bronchoplastic surgery: tumorectomy in principal left bronchial tube in a 5-month old child 5-month old child

Introducción y objetivo. La extirpación de tumores bronquiales suele requerir la exéresis del prénquima ventilado por el bronquio afecto. En el niño en desarrollo debemos conservar la mayor cantidad posible a de parénquima pulmonar. Presentamos la resección completas in neumonectomía de un tumor en bronquio principal izquierdo que infiltraba la carina. Material y método. Caso clínico. Resultados. Niña de 5 meses que acude por hipoventilación izquierda. Sin antecedentes de interés. Tras exploración broncoscópica, con biopsias no diagnósticas, Rx y TAC se diagnostica de tumoración endo y exoluminal en bronquio principal izquierdo (20x15 mm) sin extensión metastásica. Se realiza extirpación quirúrgica en manguito, reconstruyendo la carina con una plastia deslizada (anastomosis broncobronco-traqueal). Se realiza la intervención bajo ventilación unipulmonar (intubación selectiva). Extubación en quirófano y alta en 5 días. Anatomíapatológica: tumor miofibroblástico inflamatorio. Los controles broncoscópicos posteriores no muestran estenosis ni dehiscencias enla anastomosis. La situación clínica de la paciente a los dos años de seguimiento es excelente. Conclusiones. Acompañando este caso con otros descritos en la literatura, podemos afi rmar que es posible la resección de tumores bronquiales, conservando el parénquima en niños (AU)

Introduction. Resection of bronchial tumors usually needs resection of the lung parenchyma ventilated by the ill bronchus. Surgery over ad eveloping child must preserve the biggest amount of lung parenchyma as possible. We show a complete resection of a benign tumor from the left main-stem bronchus, without pneumonectomy. Materials and methods. Case report Results. A 5 month girl presented with left hypoventilation. No significant previous dates. After bronchoscopy (with negative biopsy),chest radiograph and CT, she was diagnosed of a tumor in the main stem left bronchus (20x15 mm) without metastatic extension. A sleeve resection of the tumor, with carinal reconstruction was performed. It was done under unipulmonary ventilation, with selective bronchial intubation. The patient was extubated in the operating room and the hospital stay was of 5 days. Follow up bronchoscopies shows no anastomotic stricture neither leakage. The patient is doing well 2 years after surgery. Conclusions. With this report and others in literature we can say that is possible to resect bronchial tumors in infancy without parenchymal resections (AU)

[Management of pediatric iatrogenic tracheobronchial lesions in pediatric patients]. / Manejo de las lesiones traqueobronquiales pediátricas iatrogénicas en pacientes pediátricos.

AIM: To present our experience in the management of three cases of tracheobronchial iatrogenic injuries and the literature revision about this pathology. MATERIAL AND METHODS: We present 3 patients treated in our center with tracehobronchial iatrogenic injuries since 2005. RESULTS: Case 1. 8 year old boy who present cervical, mediastinal and facial emphysema after foreign body extraction. After 9 days of conservative management without endotracheal intubation all emphysema remited, and the bronchial injury healed. Case 2. 1 month old toddler who presented after cardiovascular surgery and endotracheal tube extraction dyspnea and hypoxia. Fibrobronchoscopy showed subglotic posterior tracheal disrupture. Fifteen-day endotracheal intubation throughout the injury was enough management on this patient. One month later the tracheal injury was completely healed. Case 3. 5 year old girl with tracheobronchial iatrogenic injury after orotracheal intubation who developed neumothorax and subcutaneous emphysema. After fiteen-day conservative management without intubation the injury healed. CONCLUSION: After iatrogenic tracheobronchial injury suspicion there were confirmed by fibrobronchoscopy. Conservative treatment in this patients was successful. Orotracheal intubation prevented air leaking through the tracheal injury allowing complete healing of the trachea. Bronchial injuries healed without needing intubation or mechanical ventilation. Articles reviewed recommend surgical treatment in those cases who had complete or large airway disrupture or in those who were misdiagnosed.

Fine-needle aspiration cytopathology in the diagnosis of Wilms tumor.

BACKGROUND/PURPOSE The International Society of Paediatric Oncology (SIOP) protocol for Wilms tumor (WT) includes preoperative chemotherapy as the initial approach. However, an inadequate treatment may be performed in case of histological misdiagnosis. We evaluated the impact of fine-needle aspiration cytopathology (FNAC) in the diagnosis of unilateral WT in our group of patients. MATERIALS AND METHODS A retrospective descriptive study of patients with diagnosis of unilateral WT who underwent FNAC prior to neoadjuvant chemotherapy between 1993 and 2009 was performed. We reviewed the cytological diagnosis obtained by ultrasound-guided FNAC and the histological correlation with the resected specimens. RESULTS FNAC was performed in 66 patients with unilateral WT. In 57 of the 58 patients with positive FNAC for WT, the final diagnosis was correct (PPV: 98.2%). In 8 cases with negative FNAC for WT, the final diagnosis was positive for WT in 3 patients (NPV: 62.5%). Sensitivity was 95% and specificity was 83.3%. No complications were found associated with the procedure, except for an episode of haematuria, which resolved spontaneously. CONCLUSIONS FNAC is a useful and feasible technique in children that may confirm the suspected diagnosis of unilateral WT, avoiding inadequate preoperative chemotherapy in case of a non-Wilms renal tumor.

Fine-needle aspiration cytopathology in the diagnosis of Wilms tumor

BACKGROUND/PURPOSE The International Society of Paediatric Oncology (SIOP) protocol for Wilms tumor (WT) includes preoperative chemotherapy as the initial approach. However, an inadequate treatment may be performed in case of histological misdiagnosis. We evaluated the impact of fine-needle aspiration cytopathology (FNAC) in the diagnosis of unilateral WT in our group of patients. MATERIALS AND METHODS A retrospective descriptive study of patients with diagnosis of unilateral WT who underwent FNAC prior to neoadjuvant chemotherapy between 1993 and 2009 was performed. We reviewed the cytological diagnosis obtained by ultrasound-guided FNAC and the histological correlation with the resected specimens. RESULTS FNAC was performed in 66 patients with unilateral WT. In 57 of the 58 patients with positive FNAC for WT, the final diagnosis was correct (PPV: 98.2%). In 8 cases with negative FNAC for WT, the final diagnosis was positive for WT in 3 patients (NPV: 62.5%). Sensitivity was 95% and specificity was 83.3%. No complications were found associated with the procedure, except for an episode of haematuria, which resolved spontaneously. CONCLUSIONS FNAC is a useful and feasible technique in children that may confirm the suspected diagnosis of unilateral WT, avoiding inadequate preoperative chemotherapy in case of a non-Wilms renal tumor (AU)

Manejo de las lesiones traqueobronquiales pediátricasiatrogénicas en pacientes pediátricos / Management of pediatric iatrogenic tracheobronchial lesions in pediatric patients

Objetivos. Presentar nuestra experiencia en tres casos de lesiones traqueobronquiales traumáticas y la revisión de la literatura. Material y método. Presentamos 3 pacientes tratados conservadoramente por lesiones traqueobronquiales traumáticas durante los últimos5 años en nuestro centro. Resultados. Caso 1. Niño de 8 años de edad que, tras extracción de cuerpo extraño en bronquio principal derecho, presenta enfisemafacial, cervical y mediastínico. Tras 9 días de manejo conservador, el enfisema remitió y la lesión bronquial se resolvió espontáneamente. Caso 2. Lactante de 1 mes de vida que en el postoperatorio de trasposición de grandes vasos presenta disnea e hipoxia tras la extracción de tubo endotraqueal. La fibrobroncoscopia mostró ruptura traqueal subglótica posterior. La intubación endotraque al sorteando el defecto durante 15 días permitió la resolución de la lesión. Un mes después latráquea se encontraba íntegra y sin estenosis. Caso 3. Niña de 5 años de edad con ruptura iatrogénica de la tráqueatras intubación orotraqueal que desarrolló neumotórax, neumomediastino y enfisema subcutáneo. Tras 15 días de manejo conservador se observó la cura de la lesión. Conclusiones. Al sospechar las lesiones traqueobronquiales traumáticas, estas fueron confirmadas por fibrobroncoscopia. El tratamiento conservador en estos pacientes fue exitoso. La intubación endotraquealdistal a la lesión traqueal permitió una cura completa del defecto previniendo la fuga de aire a través de éste. La lesión bronquial se resolviós in necesidad de ventilación mecánica. La literatura revisada recomienda el tratamiento quirúrgico en los casos de lesiones completas oextensas de las vías aéreas y en las lesiones con diagnóstico tardío (AU)

Aim. To present our experience in the management of three cases of tracheobronchial iatrogenic injuries and the literature revision about this pathology. Material and methods. We present 3 patients treated in our center with tracehobronchial iatrogenic injuries since 2005.Results. Case 1. 8 year old boy who present cervical, mediastinal and facial emphysema after foreign body extraction. After 9 days of conservative management without endotracheal intubation all emphysemaremited, and the bronchial injury healed. Case 2. 1 month old toddler who presented after cardiovascular surgery and endotracheal tube extraction dyspnea and hypoxia. Fibrobronchoscopy showed subglotic posterior tracheal disrupture. Fifteen-dayendotracheal intubation throughout the injury was enough management on this patient. One month later the tracheal injury was completely healed. Case 3. 5 year old girl with tracheobronchial iatrogenic injury afterorotracheal intubation who developed neumothorax and subcutaneous emphysema. After fiteen-day conservative management without intubation the injury healed. Conclusion. After iatrogenic tracheobronchial injury suspicion there were confirmed by fibro bronchoscopy. Conservative treatment in this patients was successful. Orotracheal intubation prevented air leaking through the tracheal injury allowing complete healing of the trachea. Bronchial injuries healed without needing intubation or mechanical ventilation. Articles reviewed recommend surgical treatment in those cases who had complete or large airway disrupture or in those who were misdiagnosed (AU)

Análisis comparativo entre la técnica de Seldinger vs. disección abierta en la implantación de reservorios intravenosos / Comparative analysis between the seldinger technique vs. open dissection in the implantation of intravenous reservoirs

Objetivo. Analizar ventajas y desventajas de la técnica de Seldinger (TS) frente a la disección abierta (DA) en la implantación de reservorios intravenosos (RIVS), comparando tiempos quirúrgicos y complicaciones. Material y Método. Realizamos un estudio analítico retrospectivo tipo cohortes históricas, comparando nuestra experiencia en la implantación de RIVS por DA y por TS. Analizamos parámetros clínicos, quirúrgicos, destacando el tiempo operatorio y las complicaciones intra/postoperatorias. Resultados. Analizamos 193 RIVS (119 DA, 74 TS) implantados principalmente para quimioterapia (83,41%). El tiempo quirúrgico utilizado en procedimientos únicos fue de 72,85 ± 29,35 minutos para DA frente a 62,83 ± 20,08 minutos el Seldinger (p<0,05). No hubo diferencias operador-dependientes. No se encontraron diferencias estadísticamente significativas entre las poblaciones de las dos cohortes estudiadas ni en el porcentaje de complicaciones. Los RIVS de mayor tamaño presentaron una media mayor de necrosis de piel (p>0,05) en cambio, los de menor tamaño presentaron mayor tasa de infección (16%sobre 7,7% p>0,05). Tanto en la TS (51,67 vs 98,14 min) como en la DA (78,56 vs 123,61 min) el tiempo operatorio fue menor en los accesos venosos izquierdos. (d =171 vs i =19) Tras complicaciones se retiró el RIVS en 121 días de media. Conclusiones. La TS disminuyó la perdida definitiva de los accesos venosos intervenidos, pudiendo reutilizar la misma vena para la colocación de RIVS posteriores. La TS reduce el tiempo quirúrgico, sin incrementarse las complicaciones. El acceso venoso izquierdo no implica mayor tiempo quirúrgico. Las complicaciones podrían estar en relación al tamaño del RIVS (AU)

Objective. To analyze advantages and disadvantages between Seldinger’s technique (ST) and surgical dissection (SD) on intravenous sport-a-caths comparing surgical parameters as time and complications. Material and Method. An analytic retrospective study involving historic cohorts was realized, comparing our surgical experience on port-a-cath implantation with Seldinger technique or surgical dissection. Statistical analysis was made reflecting clinical and surgical parameters, such as surgical time length and intra/postoperative complications. Results. 193 Port-a-caths were analyzed (119 SD, 74 ST), mainly placed for chemotherapy treatment (83.41%). Surgical time length expended at single procedures was 72.85 ± 29.35 minutes for SD and62.83 ± 20.08 minutes for ST (p<0.05). There were none operator dependent differences. Statistically significant differences were not found between the two cohort’s populations, neither at complications percentages. Greater-sized port-a-caths presented a higher average of skin necrosis (p>0.05) however, lower-sized port-a-caths showed a high eraverage of infection (16% upon 7.7% p>0.05). Both ST (51.67 vs.98.14 min) and SD (78.56 vs. 123.61 min) showed lower surgical time length at left venous accesses (d =171 vs. i =19). Average in days for the extraction of port-a-caths with regard to complications was 121 days. Conclusion: Seldinger technique reduced the definitive lost of surgical dissected venous accesses, being possible further utilization of the same vein for subsequent port-a-caths. Seldinger technique reduces surgical time length without increasing complication’s rate. Left venous access does not imply higher surgical time length. Complications maybe related with port-a-cath’s size (AU)

Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides / Evaluation of urodynamics and continence in bladder augmentations with sigmoids

Objetivo. Queremos evaluar nuestra experiencia en las cistoplastias con sigmoides en el manejo de la dilatación del tracto urinario superior y la incontinencia urinaria. Material y métodos. Realizamos un estudio descriptivo retrospectivo de las ampliaciones realizadas con sigmoides (1994-2009). Analizamos parámetros clínicos, quirúrgicos y especialmente urodinámicos, pre/postcistoplastia. Resultados. Hemos realizado 30 cistoplastias con una edad de 10,24años (3-15 años), siguiéndose 8 años (9 meses-15 años). El diagnóstico de base era la vejiga neurógena (63,3%), siendo la indicación principal para la ampliación la afectación del tracto urinario superior 43,3%)y la incontinencia. El procedimiento se asoció a la colocación de esfínter artificial (30%), estoma tipo Mitrofan off (30%) o reimplante ureteral(30%), No existiendo ninguna complicación (..) (AU)

Aim. To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. Material and methods. Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodynamic and surgical parameters. Results. We have make 30 cistoplasties with a mean age of 10.24years (3-15 years) with a mean follow up of 8 years (9 months-15 years).The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofan off or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low (..) (AU)

[Comparative analysis between the Seldinger technique vs. open dissection in the implantation of intravenous reservoirs]. / Análisis comparativo entre la técnica de Seldinger vs. disección abierta en la implantación de reservorios intravenosos.

OBJECTIVE: To analyze advantages and disadvantages between Seldinger's technique (ST) and surgical dissection (SD) on intravenous port-a-caths comparing surgical parameters as time and complications. MATERIAL AND METHOD: An analytic retrospective study involving historic cohorts was realized, comparing our surgical experience on port-a-cath implantation with Seldinger technique or surgical dissection. Statistical analysis was made reflecting clinical and surgical parameters, such as surgical time length and intra/postoperative complications. RESULTS: 193 Port-a-caths were analyzed (119 SD, 74 ST), mainly placed for chemotherapy treatment (83.41%). Surgical time length expended at single procedures was 72.85 +/- 29.35 minutes for SD and 62.83 +/- 20.08 minutes for ST (p < 0.05). There were none operator-dependent differences. Statistically significant differences were not found between the two cohort's populations, neither at complications percentages. Greater-sized port-a-caths presented a higher average of skin necrosis (p > 0.05) however, lower-sized port-a-caths showed a higher average of infection (16% upon 7.7% p > 0.05). Both ST (51.67 vs. 98.14 min) and SD (78.56 vs. 123.61 min) showed lower surgical time length at left venous accesses (d = 171 vs. i = 19). Average in days for the extraction of port-a-caths with regard to complications was 121 days. CONCLUSION: Seldinger technique reduced the definitive lost of surgical dissected venous accesses, being possible further utilization of the same vein for subsequent port-a-caths. Seldinger technique reduces surgical time length without increasing complication's rate. Left venous access does not imply higher surgical time length. Complications may be related with port-a-cath's size.

[Evaluation of urodynamics and continence in bladder augmentations with sigmoids]. / Evaluación urodinámica y de la continencia en las ampliaciones vesicales con sigmoides.

AIM: To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence. MATERIAL AND METHODS: Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodinamic and surgical parameters. RESULTS: We have make 30 cistoplasties with a mean age of 10.24 years (3-15 years) with a mean follow up of 8 years (9 months-15 years). The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofanoff or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low capacity, high pression and low compliance. After surgery, urodinamic parameters improve. During follow up, continence improve with more intermittent clean catheterism (median 4/day). Vesical lithiasis was more common late complication with nor acute abdominal surgical illness nor malignancy; 2 patients finished in renal transplantation. Evolution was positive in 66%, and negative in 18,5%. CONCLUSIONS: Sigmoid augmentation cystoplasty is a good technique, that allows urodinamic and continence improvement. The conscience in the importance of intermittent catheterisms reduces the incidence of complications.

[Temporal relationship between gastroesophageal reflux and cardiorespiratory events]. / Relación temporal entre el episodio cardiorrespiratorio y reflujo gastroesofágico.

UNLABELLED: The acid and non acidic gastroesophageal reflux can trigger apnoea, desaturation and bradicardia events, as well as chronic pulmonary pathology due to microaspirations, whereas the acute or chronic airway closing increase the intrathoracic pressure, triggering the reflux. Our aims were to measurement in preterms newborn the correlations between cardiorespiratory events and gastroesophageal reflux, find out the direction of this relation, identify the patients with association GER->CRE and decide the suitability of antireflux surgery. METHOD: The study was made in the Motility Unit and in the Intensive Neonatal Care Unit, to preterms newborns without associated pathology except apnoea and/or bradicardia and/or desaturation. MATERIAL: 3 hours manometry study in the Motility Unit. 24 hours impedance, pH and cardiorespiratory parameters monitoring (respiratory and cardiac frequent, O2 saturation and CO2) in Intensive Neonatal Care Unit. We characterised the gastroesophageal barrier, all the reflux events and the association between GER and CRE. RESULTS: We made 28 records to 28 patients with CRE. The average of the total number of reflux was 61 (22,25-103,00), 29,2% acid reflux and 70,8% weakly acidic. 12 patients had some GER associated with CRE but in only 2 cases was statistically significant (Sympton index: SI; Sympton Sensitivity Index: SSI) (SI > or = 50%; SSI > or = 10%). The surgical management was successfully in these two babies and nowadays they are asymptomatic. CONCLUSION: There is not any general association between GER and CRE, nevertheless, in a little percentage of patients, this relationship is fulfilled and it is possible to measurement with impedance, pH and cardiorespiratory parameters. In these cases, the surgical management is the right treatment.

Relación temporal entre el episodio cardiorrespiratorio y reflujo gastroesofágico / Temporal relaionship between gastroesophageal reflux and cardiorespiratory events

El reflujo gastroesofágico ácido y no-ácido puede desencadenar episodios de apnea, de desaturación y de bradicardia, así como patología pulmonar crónica debido a las microaspiraciones, mientras que el cierre agudo o crónico de las vías aéreas aumenta la presión intratorácica, favoreciendo el reflujo. Objetivos. Nuestros objetivos fueron comprobar en recién nacidos pretérminos (RNPT) con sintomatología cardiorrespiratoria, si ésta tiene relación con el episodio de reflujo y el sentido de la misma e identificarlos casos en los que ésta asociación se produzca, tratándolos médico-quirúrgicamente. Metodología. El estudio se realiza en la Unidad de motilidad Intestinal y Unidad de cuidados intensivos (UCI) neonatal, a RNPT sin patología asociada excepto apnea y/o bradicardia y/o desaturación. Material. Manometría + Impedanciometría (IM) durante 3 horas en la Unidad de Motilidad. IM+ pH+ monitorización cardiorrespiratoria(FR, FC, SO2 y ETCO2) durante 24h en la unidad de cuidados intensivos neonatal. Se determinaron las características manométricas de la barrera antirreflujo, identificación de todos los episodios de reflujo y relación episodio de reflujo-síntoma cardiorrespiratorio. Resultados. Realizamos 28 estudios en neonatos pretérminos con bradicardia, apneas y desaturaciones. La media del número total de reflujos fue de 61 (22,25-103,00), de los que el 29,2 % representan los reflujos ácidos y el 70,8 % restante son débilmente ácidos. En 12 de los 28estudios realizados se encontraron episodios cardiorrespiratorios asociados a reflujo gastroesofágico, aunque tan sólo en 2 se encontró una relación estadísticamente significativa entre ellos (Symptom index: SI; Symptom Sensitivity Index: SSI) (SI >= 50%; SSI >= 10%). En ambos casos los pacientes se han intervenido quirúrgicamente con éxito, sin volverá presentar los síntomas cardiorrespiratorios. Conclusiones. No existe asociación generalizada entre reflujo gastroesofágico y episodios cardiorrespiratorios, sin embargo, en una escaso porcentaje de pacientes, ésta relación se cumple y se puede tratar de manera justificada mediante el estudio con impedancia, pH y constantes respiratorias. En estos casos, la intervención quirúrgica precoz es el tratamiento de elección (AU)

The acid and non acidic gastroesophageal reflux can trigger apnoea, desaturation and bradicardia events, as well as chronic pulmonary pathology due to microaspirations, whereas the acute or chronic airway closing increase the intrathoracic pressure, triggering the reflux. Our aims were to measurement in preterms new born the correlations between cardiorespiratory events and gastroesophageal reflux, find out the direction of this relation, identify the patients with association GER->CRE and decide the suitability of antireflux surgery. Method. The study was made in the Motility Unit and in the Intensive Neonatal Care Unit, to preterms newborns without associated pathology except apnoea and/or bradicardia and/or desaturation. Material. 3 hours manometry study in the Motility Unit. 24 hours impedance, pH and cardiorespiratory parameters monitoring (respiratory and cardiac frequent, O2 saturation and CO2) in Intensive Neonatal Care Unit. We characterised the gastroesophageal barrier, all the reflux events and the association between GER and CRE. Results. We made 28 records to 28 patients with CRE. The average of the total number of reflux was 61(22,25-103,00), 29,2% acid reflux and 70,8% weakly acidic. 12 patients had some GER associated with CRE but in only 2 cases was statistically significant (Symptonindex: SI; Sympton Sensitivity Index: SSI) (SI >= 50%; SSI >= 10%).The surgical management was successfully in these two babies and nowadays they are asymptomatic. Conclusion. There is not any general association between GER and CRE, nevertheless, in a little percentage of patients, this relationship is fulfilled and it is possible to measurement with impedance, pH and cardiorespiratory parameters. In these cases, the surgical management is the right treatment (AU)

[Essential mixed cryoglobulinemia as a cause of ischemic cerebrovascular accident]. / Crioglobulinemia mixta esencial como causa de accidente cerebrovascular isquémico.

INTRODUCTION: Involvement of the central nervous system in patients with essential mixed cryoglobulinaemia is rare, and there are few cases described in the medical literature. Moreover, the mechanism by which lesions are produced in the central nervous system is still not clear. CLINICAL CASE: We describe the case of a 35 year old woman who presented with dysarthria, weakness and paraesthesia of her left limbs and left central facial paralysis of sudden onset. Vascular studies showed the presence of IgG-IgM polyclonal positive cryoglobulins and polymerase chain reaction (PCR) showed hepatitis C virus to be present. Cerebral magnetic resonance showed ischemic lesions in the tail of the right caudate nucleus and right corona radiata and the posteromedial part of the right putamen. Other investigations were negative or normal. CONCLUSIONS: In young patients with cerebral vascular pathology the possibility of hepatitis C and essential mixed cryoglobulinemia should be considered, especially when the transaminases are raised as in our patient. We consider that the physiopathological mechanisms must be related to factors which determine a prothrombotic state in the arterial bed involved.

[Transient global amnesia and vascular risk factors]. / Amnesia global transitoria y factores de riesgo vascular.

INTRODUCTION: Transient global amnesia (TGA) is a clinical syndrome determined by an episode of less than 24 hours consisting of temporo-spatial disorientation with retrograde and anterograde amnesia followed by complete recovery. OBJECTIVES: To determine whether the presence or absence of vascular risk factors (VRF) in patients with TGA is associated with different clinical data and/or examination findings. PATIENTS AND METHODS: A retrospective study was made of two groups of 13 and 12 patients with TGA, who presented with and without VRF, respectively. The following variables were determined: VRF, age, a previous history of migraine, triggering factors, duration and repetition of the episodes, associated neurological symptoms and findings obtained by neuroimaging, eco-Doppler of the supra-aortic trunks and transcranial Doppler. The data were subjected to statistical analysis by univariate analysis with Fischer's exact probability test. RESULTS: The statistical studies showed no significant differences between the variables obtained in the two groups of patients. CONCLUSIONS: Transient global amnesia has been particularly related to migraine, epilepsy and cerebral vascular pathology, although its aetiology has not been fully determined. In this study we compare clinical data between the two groups of patients with and without VRF who have had TGA. The lack of significant differences between them tends to rule out a vascular aetiology as the sole cause of this syndrome. Recently Leao's propagated depression has been suggested as the physiopathological mechanism involved. According to this theory, the vascular pathology might act as the trigger but probably not as the aetiological factor. The findings of our study may support this thesis.

Amnesia global transitoria y factores de riesgo vascular / Transient global amnesia and vascular risk factors

Introducción. La amnesia global transitoria (AGT) es un síndrome clínico determinado por un episodio de duración inferior a 24 horas consistente en desorientación temporospacial, amnesia retrógrada y anterógrada, con total recuperación posterior. Objetivos. Determinar si la presencia o ausencia de factores de riesgo vascular (FRV) en pacientes con AGT se asocia con datos clínicos y/o exploratorios diferentes. Pacientes y métodos. Estudio retrospectivo de dos grupos de 13 y 12 pacientes con AGT, que presentaban o no FRV, respectivamente. Se determinaron las variables: FRV, edad, antecedentes de migraña, factores desencadenantes, duración y repetición de los episodios, síntomas neurológicos asociados y hallazgos obtenidos mediante neuroimagen, eco-Doppler de troncos supraórticos y Doppler transcraneal. Los datos obtenidos fueron sometidos a estudio estadístico mediante análisis univariante con el test de probabilidad exacta de Fisher. Resultados. Los estudios estadísticos no mostraron diferencias significativas de las variables obtenidas entre los grupos de pacientes. Conclusiones. La AGT se ha relacionado preferentemente con la migraña, epilepsia y con la patología vascular cerebral, aunque su etiología no ha sido totalmente determinada. En el presente estudio se comparan los datos clínicos entre dos grupos de pacientes con y sin FRV que han sufrido AGT. La ausencia de diferencias significativas entre ambos inclina a desestimar la etiología vascular como único origen de este síndrome. Se ha propuesto recientemente como mecanismo fisiopatológico la depresión propagada de Leao. Según esta teoría, la patología vascular podría actuar como desencadenante, pero no probablemente como factor etiológico. Los hallazgos del presente estudio podrían apoyar esta tesis (AU)

Introduction. Transient global amnesia (TGA) is a clinical syndrome determined by an episode of less than 24 hours consisting of temporo-spatial disorientation with retrograde and anterograde amnesia followed by complete recovery. Objectives. To determine whether the presence or absence of vascular risk factors (VRF) in patients with TGA is associated with different clinical data and/or examination findings. Patients and methods. A retrospective study was made of two groups of 13 and 12 patients with TGA, who presented with and without VRF, respectively. The following variables were determined: VRF, age, a previous history of migraine, triggering factors, duration and repetition of the episodes, associated neurological symptoms and findings obtained by neuroimaging, eco-Doppler of the supra-aortic trunks and transcranial Doppler. The data were subjected to statistical analysis by univariate analysis with Fischer’s exact probability test. Results. The statistical studies showed no significant differences between the variables obtained in the two groups of patients. Conclusions. Transient global amnesia has been particularly related to migraine, epilepsy and cerebral vascular pathology, although its aetiology has not been fully determined. In this study we compare clinical data between the two groups of patients with and without VRF who have had TGA. The lack of significant differences between them tends to rule out a vascular aetiology as the sole cause of this syndrome. Recently Leao’s propagated depression has been suggested as the physiopathological mechanism involved. According to this theory, the vascular pathology might act as the trigger but probably not as the aetiological factor. The findings of our study may support this thesis (AU)

Crioglobulinemia mixta esencial como causa de accidente cerebrovascular isquémico / Essential mixed cryoglobulinaemia as a cause of ischemic cerebrovascular accident

Introduction. Involvement of the central nervous system in patients with essential mixed cryoglobulinaemia is rare, and there are few cases described in the medical literature. Moreover, the mechanism by which lesions are produced in the central nervous system is still not clear. Clinical case. We describe the case of a 35 year old woman who presented with dysarthria, weakness and paraesthesia of her left limbs and left central facial paralysis of sudden onset. Vascular studies showed the presence of IgG- IgM polyclonal positive cryoglobulins and polymerase chain reaction (PCR) showed hepatitis C virus to be present. Cerebral magnetic resonance showed ischemic lesions in the tail of the right caudate nucleus and right corona radiata and the posteromedial part of the right putamen. Other investigations were negative or normal. Conclusions. In young patients with cerebral vascular pathology the possibility of hepatitis C and essential mixed cryoglobulinemia should be considered, especially when the transaminases are raised as in our patient. We consider that the physiopathological mechanisms must be related to factors which determine a prothrombotic state in the arterial bed involved (AU)

Introducción. La afectación del sistema nervioso central en pacientes con crioglobulinemia mixta esencial es rara, y son escasos los casos descritos en la literatura médica. Asimismo no se ha podido establecer de manera concluyente los mecanismos de lesión del sistema nervioso central. Caso clínico. Presentamos el caso de una mujer de 35 años que presentó un cuadro de disartria, debilidad y parestesias en las extremidades izquierdas, y paresia facial central izquierda de instauración brusca. En el estudio vascular se hallaron crioglobulinas positivas policlonales IgG- IgM y la reacción en cadena de la polimerasa (PCR) para el virus de la hepatitis C fue positiva. La resonancia magnética cerebral puso de manifiesto lesiones isquémicas en la cola del núcleo caudado y corona radiada derechas, y en la porción posteromedial del putamen derecho. El resto del estudio fue negativo o dentro de la normalidad. Conclusiones. En pacientes jóvenes con patología vascular cerebral habrá que considerar la hepatitis C y la crioglobulinemia mixta esencial, sobre todo si existe elevación de las transaminasas como en nuestro caso. Nosotros planteamos que el mecanismo fisiopatológico debe estar en relación con factores (AU)