Compartiendo cuidados urológicos (Sharing Care): un nuevo modelo para mejorar la calidad, la seguridad y los cuidados del paciente / No disponible

No disponible

Acalasia: a propósito de un caso / Achalasia: a case presentation

La acalasia de esófago corresponde al trastorno primario más común de la motilidad esofágica. Se caracteriza por la falta de relajación del esfínter esofágico inferior (EEI) durante la deglución con la consiguiente falta de peristaltismo del esófago. Es fácilmente identificable por la sintomatología típica con la que cursa, confirmándose con métodos diagnósticos específicos. Por ello es importante la colaboración entre atención primaria y atención especializada. Exponemos un caso cuyos resultados terapéuticos fueron óptimos (AU)

Achalasia of the oesophagus for the most common primary disorder of oesophageal motility. It is characterized by the lack of lower oesophageal sphincter relaxation during swallowing with the consequent lack of oesophageal peristalsis. It is easily identifiable by its typical clinical course, being confirmed with specific diagnostic methods. For this reason, collaboration between primary care and the specialist is important. The following is a case that obtained optimal therapeutic results (AU)

Autodilatación uretral tras cirugía radicalde próstata / No disponible

Esta comunicación está basada en la experiencia adquirida en la consulta de enfermería urológica con pacientes que presentan estenosisde uretra, tras ser intervenidos de prostatectomía radical. A través del adiestramiento en la autodilatación conseguimos que el pacienteparticipe de una forma activa en su autocuidado, logrando así que sea más autónomo, con más confianza en sí mismo y mejorando sucalidad de vida. Se trata de un estudio descriptivo y retrospectivo basado principalmente en nuestra experiencia, ya que existe muy pocabibliografía en autodilatación uretral tras prostatectomía radical. Los resultados obtenidos con la autodilatación son muy favorables tantopara el paciente como para la institución, por lo que potenciamos mucho esta técnica, obteniendo una buena relación coste-beneficio (AU)

This communication is based on acquired experience in urological nursing practice of urological with patients who present urethra stenosis,after being operated on radical prostatectomy. Through the training about selfdilation, we get the patient to share an active form in theirselfcare, thus managing more autonomy, with more confidence in themselfs and improving their life quality. It is a descriptive and retrospectivestudy based mainly on our experience, since there is very few bibliography about urethral selfdilation after radical prostatectomy.The results obtained with selfdilation are very favorable for the patient as well as for the institution, therefore we promote this techniquea lot, obtaining good cost-profit relation (AU)

[Tuberculosis of the breast: imaging findings in two patients]. / Tuberculosis mamaria. Descripción de los hallazgos de imagen en dos pacientes.

Diagnosis of breast tuberculosis is difficult and rare in western countries. We describe two cases of mammary tuberculosis, with mastitis as clinical feature that fail to heal despite antibiotic therapy. Mammographic findings showed a large opacity involving the entire breast in case 1, and a focal asymmetric density with irregular margins in case 2. Sonographic findings revealed in both cases hypoechoic nodules with fistulous tracks and axillary lymph nodes. Magnetic resonance was performed in one case, which showed parenchymal asymmetry with heterogeneous enhancement including irregular internal ring enhancement. Fine needle aspiration cytology revealed inflammatory cells in first case and atypical cells in second case. Core needle biopsy was performed in both cases to rule out malignant lesions. Acid-fast bacilli were negative in both patients while polymerase chain reaction was positive in one case. There was a good clinical response to antituberculosis therapy.

Tuberculosis mamaria. Descripción de los hallazgos de imagen en dos pacientes / Tuberculosis of the breast: imaging findings in two patients

El diagnóstico de tuberculosis mamaria es difícil y raro en nuestro medio. Presentamos dos casos de tuberculosis mamaria que cursaron como mastitis agudas con mala respuesta al tratamiento. Los hallazgos mamográficos consistieron en un caso en un aumento generalizado de la densidad de la mama, con desestructuración de su arquitectura, y en el otro en una densidad asimétrica de bordes mal definidos. La ecografía mostró en ambos nódulos hipoecoicos tractos fistulosos y adenopatías axilares. Se realizó resonancia magnética en un caso, demostrando una asimetría parenquimatosa con realce heterogéneo y zonas internas de captación irregular en anillo. La punción-aspiración con aguja fina mostró células inflamatorias en un caso y células atípicas en el otro. Se realizó biopsia con aguja gruesa que descartó lesiones malignas en ambos. Las tinciones de Ziehl-Neelsen fueron negativas, y en un caso la prueba de detección de genoma de M. tuberculosis fue positiva. Las lesiones desaparecieron tras el tratamiento con tuberculostáticos

Diagnosis of breast tuberculosis is difficult and rare inwestern countries. We describe two cases of mammary tuberculosis, with mastitis as clinical feature that fail to heal despite antibiotic therapy. Mammographic findings showed a large opacity involving the entire breast in case 1, and a focal asymmetric density with irregular margins in case 2. Sonographic findings revealed in both cases hypoechoic nodules with fistulous tracks and axillary lymph nodes. Magnetic resonancewas performed in one case, which showed parenchymalasymmetry with heterogeneous enhancement includingirregular internal ring enhancement. Fine needle aspiration cytology revealed inflammatory cells in first case and atypical cells in second case. Core needle biopsy was performed in both cases to rule out malignant lesions. Acid-fast bacilli were negative in both patients while polymerase chain reaction was positive in one case. There was a good clinical response to antituberculosis therapy

Metastasis to the breast from extramammary malignancies: a report of four cases and a review of literature.

Breast metastases from extramammary tumours are rare with few cases reported. Four cases of metastasis to the breast are presented and the diagnostic problems of this condition are reviewed. Correlation between the histology of primary tumour and the cytology of breast metastatic tumour can avoid the surgical breast biopsy and unnecessary mastectomy. Metastasis to the breast has poor prognosis.

Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography.

PURPOSE: To evaluate short-term follow-up of nonpalpable probably benign lesions in a 2-year mammographic screening. MATERIALS AND METHODS: Of 13,790 women aged 45-65 years who underwent first-round screening, 795 (5.8%) underwent short-term mammographic follow-up (every 6 months for 2 years) of nonpalpable probably benign lesions (eg, masses, focal asymmetric densities, and calcifications) previously assessed at an additional imaging evaluation, including ultrasonography. When no changes were found at short-term mammographic follow-up, women were assigned to the 2-year screening interval. Needle localization and surgical biopsy were performed when the lesion progressed (was enlarged or had an increased number or size of calcifications or modification of their initial characteristics). The effectiveness of this approach was evaluated with statistical analysis. RESULTS: Of 795 lesions, 788 (99%) remained stable, and seven (1%) had changes prompting surgical biopsy. Two cancers (0.3%), one microinvasive intraductal carcinoma and one 7-mm invasive ductal carcinoma without positive nodes, were found. Four of the five benign histologic results were probably benign calcifications with progression at short-term follow-up. The sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 99%, 99%, 29%, and 100%, respectively. CONCLUSION: The benign nature of most nonpalpable probably benign lesions can be typified with short-term mammographic follow-up. This approach permitted identification of a few low-stage carcinomas, but progression in the probably benign calcifications was usually unrelated to malignancy.

La citología estereotáxica en las lesiones de mama no palpables: correlación histológica en 100 casos consecutivos / Stereotactic cytology in nonpalpable breast lesions: histological correlation in 100 consecutive cases

Introducción: El objetivo de este trabajo es valorar la eficacia de la citología estereotáxica en el diagnóstico del cáncer de mama no palpable. Material y métodos: Se correlacionan de forma retrospectiva los hallazgos citológicos con los resultados histológicos en 100 lesiones de mama no palpables, que fueron detectadas de forma consecutiva mediante mamografía de screening y que posteriormente fueron biopsiadas mediante cirugía. Resultados: Cuando se incluyen los resultados no representativos en los cálculos de eficacia, los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión global del método son 0,64 0,23 0,88 0,50 y 0,50, respectivamente. En presencia del material citológico valorable se identifican correctamente el 85 por ciento (45/53) de las lesiones histológicamente malignas y atípicas. Conclusiones: Considerando sus limitaciones, la citología estereotáxica es un método útil en el diagnóstico de las lesiones de mama no palpables. La biopsia quirúrgica debe indicarse valorando siempre conjuntamente los hallazgos mamográficos con los resultados citológicos (AU)

Breast cancer screening: first round in the population-based program in Valencia, Spain. Collaborative Group of Readers of the Breast Cancer Screening Program of the Valencia Community.

PURPOSE: To analyze the results of round 1 of the population-based Valencia Breast Cancer Screening Program. MATERIALS AND METHODS: In this program, 78,224 (72.98%) of the 107,178 women invited (aged 45-65 years) underwent screening. Complementary views were obtained in 5,771 women (7.38%). Among the total population studied, 3,502 (4.48%) underwent short-term mammographic follow-up studies; 3,898 (4.98%) underwent additional studies and treatment at hospitals. Five hundred eighty-seven women (0.75%) underwent biopsy. RESULTS: Cancer was detected in 334 patients (4.27 cancers per 1,000 women [3.24 per 1,000 women aged 45-49 years, 6.30 per 1,000 women aged 60-65 years]; six patients with lobular carcinoma in situ excluded). The estimated sensitivity was 89%; specificity, 99%. The positive predictive value of mammography was 8.56%; of mammography with additional examinations, 26.82%; and of biopsy, 56.89%. Forty-one patients (12.28%) had ductal carcinoma in situ; 284 (85.03%) had infiltrating carcinoma. In 73 (25.70%) of the 284 patients, infiltrating carcinomas were smaller than 1 cm. Two hundred twenty-five patients (76.27%) had no lymph node involvement. One hundred seventy-nine (61.09%) had stage 0 or 1 cancer. CONCLUSION: Results are consistent with other published results; differences are due to methods and patient population characteristics.

[Secondary arterial hypertension in type I neurofibromatosis (NF-1). Findings in 6 patients]. / Hipertensión arterial secundaria en la neurofibromatosis tipo I (NF-1). Hallazgos en seis pacientes.

With the aim to analyze the association of Type I Neurofibromatosis with secondary arterial hypertension, a retrospective study has been performed on 36 patients, diagnosed of pheochromocytoma (n = 12) and/or renal artery stenosis (n = 25), finding in 6 of them diagnostic criteria of Type I neurofibromatosis, of these 4 showed pheochromocytoma, 1 renal artery stenosis and 1 pheochromocytoma plus renal artery stenosis. CAT and angiography were the best diagnostic imaging methods to confirm clinic and biological suspicion of adrenal tumor of renal artery stenosis. It is recommended the systematized study of patients with NF-1 together with their relatives who phenotypically show some illness stigma, or with arterial hypertension resistant to conventional treatment.

Lipoma of the liver: US, CT, and MRI appearance.

A case of hepatic lipoma is reported. Since the sonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings are characteristic, we believe more aggressive diagnostic procedures are not necessary.