Hallazgos radiológicos en el síndrome de Rapunzel (tricobezoar) / No disponible

El síndrome de Rapunzel es una enfermedad muy rara que ocurre en pacientes mujeres jóvenes y niñas, con un trastorno de la personalidad. Consiste en la formación de un bezoar, generalmente tricobezoar en el estómago, conformación de una cola larga, generalmente pelo, que atraviesa el estómago y va a parar al duodeno yeyuno proximal, aunque a veces también se ha visto en el colon. Radiológicamente aparece en la placa simple como una ocupación y distensión estomacal, así como en la ecografía y la tomografía axial computarizada (TAC), que revelan la aparición de dicho cuerpo extraño en aproximadamente el 97 % de los casos. Presentamos un caso característico de una paciente con dolor abdominal de larga evolución, malestar general, hiporexia y astenia, además de presentar un bulto en el epigastrio. El tratamiento es quirúrgico y casi siempre se produce de forma urgente para evitar complicaciones, siendo la más grave la perforación intestinal (AU)

Rapunzel syndrome is a very rare disease that occurs in young women and girls, generally with a personality disorder. It consists in the formation of a bezoar inside the stomach. This is generally a trichobezoar, with the formation of a large tail that is usually hair that crosses the stomach and ends up in proximal jejunum duodenum, although it has sometimes been found in the colon. Radiologically, on a plain film of the abdomen, it is seen as a distended and filled stomach, and the ultrasound and CT scan shows the appearance of a foreign body in approximately 97% of the cases. We present a characteristic case of a female patient with long-term abdominal pain, general discomfort, hyporexia, and asthenia, as well as an epigastric lump. This condition is treated by surgery which is generally urgent in order to avoid complications, the most serious being intestinal perforation (AU)

Detección de calcificaciones mamarias arteriales mediante mamografía. ¿Se pueden considerar un factor de riesgo para la enfermedad cardiovascular? / Breast arterial calcifications detected at mammography. Could they be considered a risk factor of cardiovascular disease?

Fundamento. El hallazgo de calcificaciones arteriales en mamografías (CAM) realizadas con fines de detección precoz o diagnóstico es frecuente en edades superiores a 50- 55 años. Sin embargo, también es posible detectar este signo en mujeres más jóvenes. Nuestro objetivo fue analizar el valor de las CAM como indicador de riesgo cardiovascular en mujeres de 50 años o menores. Métodos. Comparamos dos grupos de 92 mujeres cada uno, el grupo problema (edad: 43,0 ± 5,3) que presentaba CAM y el grupo control (edad: 42,8 ± 4,7) cuyas integrantes no presentaban CAM. Las 184 mujeres respondieron a una encuesta sobre antecedentes personales y familiares de enfermedad cardiovascular (ECV) y sobre hábitos individuales relacionados con la ECV. También se les realizó una exploración física dirigida y varias determinaciones analíticas en sangre. Resultados. Ambos grupos presentaron diferencias en antecedentes familiares de ECV (p < 0,03), antecedentes personales de hipertensión arterial (p < 0,003), paridad (p < 0,001), lactancia (p < 0,02) y hábito tabáquico (p < 0,000). La exploración física mostró diferencias en las medidas de tensión arterial máxima (p < 0,007) y mínima (p < 0,01). Las diferencias analíticas presentaban significación para fibrinógeno (p < 0,003) y calcio (p < 0,02). No encontramos diferencias significativas en los demás parámetros evaluados. Conclusiones. Aunque son necesarios estudios prospectivos a largo plazo, nuestros resultados indican que la presencia de CAM en menores de 50 años se asocia con varios factores de riesgo de ECV. Por tanto, debería ser tenida en cuenta por radiólogos y médicos de familia de cara a la prevención de ECV, pues puede constituir un eficaz detector de riesgo (AU)

Background. The finding of breast arterial calcifications (BAC) in mammograms performed for screening or diagnostic purpose is common in women over 50-55 years. However, this sign may also be detected in younger women. Our aim was to evaluate the importance of BAC as a riskindicator of cardiovascular disease (CVD) in women under 50 years. Methods. We compared two groups of 92 women each: the problem group including women (age: 43.02 ± 5.3) with BAC and a control group with women (age: 42.8 ± 4.7) who did not have BAC. All of them answered a questionnaire including data on personal and familiar backgrounds of CVD and individual habits related to CVD. They also underwent a physical examination and some blood test measurements. Results. Both groups presented significant differences in familial background of CVD (p < 0.03), personal backgrounds of arterial hypertension (p < 0.003), parity (p < 0.001), months of lactation (p < 0.02) and smoking (p < 0.000). The physical examination revealed differences in both maximum (p < 0.007) and minimal (p < 0.01) arterial pressure values. There were also significant differences in fibrinogen (p < 0.003) and calcium (p < 0.02) values. No differences were found in the remaining parameters. Conclusions. Although prospective long-time studies are necessary, our results indicate that BAC in subjects under 50 years is associated to numerous CVD risk factors. Consequently, this finding should be taken into account by radiologists and family physicians regarding prevention of CVD because it can constitute an effective risk indicator (AU)

Angiomatosis cutaneovertebral medular (síndrome de Cobb) / Cutaneous vertebral medullary angiomatosis (Cobb syndrome)

No disponible

Persistent increase of PRL after oral contraceptive treatment. Alterations in dopaminergic regulation as possible etiology.

BACKGROUND: The mechanism involved in estrogen induced hyperprolactinemia is not completely known, although one of the possible theories suggest inhibition of dopaminergic tone. Our objective was to study the mechanism implied in the increment of PRL levels as a consequence of oral contraceptive treatment and possible modifications in TSH levels. MATERIAL AND METHODS: We performed a trial on 21 healthy women, nulliparas. We administered 35 microg of Etinil-Estradiol (EE) and 2 mg of Ciproterone Acetate (CA) for a period of 12 months. Stimulation tests with Metoclopramide and TRH were carried out before treatment, after 3, 6 and 12 months of treatment and finally 6 months after cessation of treatment. RESULTS: Basal levels of PRL (mean=12.62 ng/ml) increased significantly (p<0.05) during the year of treatment (mean12=17.04 ng/ml) and maintained higher levels 6 months after cessation (meanl8=17.53 ng/ml). Maximum values obtained in response to metoclopramide (mean1=154.78) were significantly higher after 12 months (mean12=173.29), persisting 6 months after cessation of treatment (mean18=245.28). We also observed significant differences in the maximum response of TSH to metoclopramide during the same period of study (mean6=2.45), (mean12=2.76) and (mean18=2.07) respectively (p<0.05). We did not find changes in PRL and TSH responses to TRH stimulation after a year of treatment with EE and CA. CONCLUSION: Treatment with EE (35 microg) and CA (2 mg) induces an increase in PRL levels that persist 6 months after cessation of treatment. Our results rule out the possibility that this increase in PRL is due to a decrease in dopaminergic tone or an increase in TRH sensitivity.

[Characteristics of the patient overusing on-demand general medical services]. / Características del paciente hiperfrecuentador de las consultas de demanda de medicina general.

OBJECTIVE: To determine the characteristics and reasons for consultation of the patient who over-uses on-demand general medical services. DESIGN: A case-control study of a sample of over-user patients and a control group of normal users. SETTING: The Chantrea Health Centre in Pamplona during 1991. PATIENTS AND OTHER PARTICIPANTS: An age and gender-stratified sample of 411 over user patients and a control group of normal users were selected. MAIN MEASUREMENTS AND RESULTS: Over-users corresponded to 5% to those attending. We found no significant differences for gender, but we did for age (p < 0.001), regarding the control group; 84% of over-users had a chronic associated pathology. Comparatively, over-users made more bureaucratic and prescription visits (35%) and attended less scheduled appointments. CONCLUSIONS: The over-users is associated to being older and especially to having a chronic pathology and not attending scheduled appointments.