A hitherto undescribed benign mesenchymal polyp of the gallbladder: edematous angiomyolipoma-like polyp.

We report a case of two peculiar gallbladder polyps in a sixty-four year old male who presented with symptomatic cholelithiasis. Cholecystectomy was performed, which revealed two polyps measuring 0.6 cm and 1.9 cm, located in the body of the gallbladder. Microscopic examination of the polyps showed composite mesenchymal lesions with vascular proliferation of small-to-medium sized arterioles, myoid stroma, and lipomatous periphery. The myoid component was characterized by wisps of bland smooth muscle fibers loosely separated by proteinaceous and focally myxoid matrix. The surface of the polyps was lined by a single layer of bland epithelial cells. The unique histomorphologic features differentiate the lesions from other known mesenchymal polyps of the gallbladder. We propose the name "edematous angiomyolipoma-like polyp" for these rare lesions given their histomorphologic similarity to angiomyolipoma. (Acta gastroenterol. belg., 2016, 79, 371-374).

[Recommendations for optimising the treatment of multiple sclerosis in Latin America]. / Recomendaciones para la optimización del tratamiento de la esclerosis múltiple en Latinoamérica.

INTRODUCTION: Multiple sclerosis (MS) is the most common primary demyelinating disease affecting the central nervous system. In recent years the development of new drugs that have been shown to modify the natural history of MS have had a substantial impact on the treatment of the disease. AIMS: To harmonise and integrate the evidence available on optimising the treatment of patients with MS. DEVELOPMENT: In order to fulfil our main aim, a group of experts from different Latin American countries drew up a list of statements related to the use of immunomodulatory agents in the different clinical forms of the disease and the strategies that should be considered in cases in which the therapeutic response was suboptimal. Each of the participants used a structured scale to express the extent to which he or she agreed or disagreed, and a consensus was considered to have been reached when acceptance of each of the statements was equal to or higher than 80%. CONCLUSIONS: These recommendations will provide neurologists with the tools needed to make decisions that optimise the treatment of MS patients.

Recomendaciones para la optimización del tratamiento de la esclerosis múltiple en Latinoamérica / Recommendations for optimising the treatment of multiple sclerosis in Latin America

Introducción. La esclerosis múltiple (EM) es la enfermedad desmielinizante primaria más común que afecta al sistema nervioso central. Durante los últimos años ha impactado sustancialmente en el tratamiento de la EM el desarrollo de nuevos fármacos que han demostrado modificar la evolución natural de la enfermedad. Objetivo. Armonizar e integrar la evidencia disponible en la actualidad respecto a la optimización del tratamiento de los pacientes con EM. Desarrollo. A fin de cumplir con el objetivo propuesto, un grupo de expertos pertenecientes a diferentes países de Latinoamérica confeccionó una lista de enunciados relacionados con el uso de agentes inmunomoduladores en las distintas formas clínicas de la enfermedad y las estrategias que se deben considerar en aquellos casos en los que la respuesta terapéutica fuera subóptima. Utilizando una escala estructurada, cada uno de los participantes expresó su grado de acuerdo o desacuerdo, pudiendo alcanzarse un consenso cuando la aceptación para cada uno de los enunciados era igual o mayor al 80%. Conclusión. Estas recomendaciones proporcionarán al médico neurólogo las herramientas necesarias para la toma de decisiones que optimicen el tratamiento de los pacientes con EM

Introduction. Multiple sclerosis (MS) is the most common primary demyelinating disease affecting the central nervous system. In recent years the development of new drugs that have been shown to modify the natural history of MS have had a substantial impact on the treatment of the disease. Aims. To harmonise and integrate the evidence available on optimising the treatment of patients with MS. Development. In order to fulfil our main aim, a group of experts from different Latin American countries drew up a list of statements related to the use of immunomodulatory agents in the different clinical forms of the disease and the strategies that should be considered in cases in which the therapeutic response was suboptimal. Each of the participants used a structured scale to express the extent to which he or she agreed or disagreed, and a consensus was considered to have been reached when acceptance of each of the statements was equal to or higher than 80%. Conclusions. These recommendations will provide neurologists with the tools needed to make decisions that optimise the treatment of MS patients

[The treatment of multiple sclerosis in Latin America: current practice and optimal standards. The findings of a survey among neurologists at an interactive workshop]. / Tratamiento de la esclerosis múltiple en Latinoamérica: práctica actual y estándares óptimos. Resultados de una encuesta a neurólogos durante un taller interactivo.

INTRODUCTION: Considerable progress has been made in the treatment of patients with relapsing-remitting multiple sclerosis (MS) over the last decade. Exactly how these changes are reflected in daily practice, however, is still not very well known. AIM: To hold interactive workshops so as to be able to evaluate the opinions of Latin-American neurologists about the therapeutic decisions taken with regard to MS. MATERIALS AND METHODS: By means of an interactive voting system, professionals attending each workshop replied to ten pre-established questions about when to start treatment, the use of magnetic resonance imaging (MRI) to supervise treatment, the definition of therapeutic failure and the role of treatment using immunosuppressants. The results were compared with those obtained in similar workshops attended by European and North American neurologists held six months earlier. RESULTS: The use of immunomodulators was considered to be useful in isolated demyelinating syndromes, as 40-50% endorsed their use in clinically stable patients. MRI was seen to be the most sensitive method of monitoring the effectiveness of the therapy -70.6% of them proposed the application of annual scans, which suggests a more frequent use in Latin America than in Europe or the USA. On defining therapeutic failure, the clinical criteria were more important than the MRI scan, and a switch from beta interferons to glatiramer acetate or vice versa was recommended. Treatment with immunosuppressants was considered to be useful in reducing the accumulated disability, but there was no agreement on how to use them. In Latin America, decisions about when to begin treatment seem to lie somewhere between the more favourable posture adopted in USA and the more conservative stance in Europe. CONCLUSIONS: This survey reflects the controversies that affect the therapeutic decisions concerning MS in Latin America and highlights the areas in which more data are needed to optimise the standards of treatment.

Tratamiento de la esclerosis múltiple en Latinoamérica: práctica actual y estándares óptimos. Resultados de una encuesta a neurólogos durante un taller interactivo / The treatment of multiple sclerosis in latin america: current practice and optimal standards. The findings of a survey among neurologists at an interactive workshop

Introducción. El tratamiento de los pacientes con esclerosis múltiple (EM) remitente-recurrente ha mostrado adelantos considerables en la última década. Sin embargo, la manera en que estos cambios se reflejan en la práctica diaria aún no se conoce bien. Objetivo. Evaluar las opiniones de neurólogos latinoamericanos sobre las decisiones terapéuticas en la EM mediante talleres interactivos. Materiales y métodos. Mediante un sistema de votación interactiva, cada taller contestó a diez preguntas preestablecidas sobre cuándo iniciar tratamiento, el uso de la resonancia magnética(RM) como supervisión del tratamiento, la definición del fracaso terapéutico y el papel de los tratamientos inmunosupresores. Se compararon los resultados con talleres similares entre neurólogos europeos y norteamericanos realizados seis meses antes. Resultados. Se consideró útil el uso de inmunomoduladores en los síndromes desmielinizantes aislados, el 40-50% apoyó su uso en pacientes clínicamente estables. La RM se consideró el método más sensible para monitorizar la eficacia terapéutica, el 70,6% propuso escáneres anuales, lo que sugiere un uso más frecuente en Latinoamérica que en Europa o EE. UU. Al definir el fracaso terapéutico, los criterios clínicos fueron más importantes que la RM, y se recomendó un cambio de interferones beta al acetato de glatiramero o viceversa. El tratamiento inmunosupresor fue considerado útil para disminuir la discapacidad acumulada, sin consensuar en cómo utilizarlos. En Latinoamérica, cuándo iniciar tratamiento parece tener una postura intermedia entre la favorecedora en EE. UU. Y otra más conservadora en Europa. Conclusión. Esta encuesta refleja las controversias que afectan a las decisiones terapéuticas en EM en Latinoamérica y resalta las áreas en las cuales son necesarios más datos para optimizar los estándares de tratamiento (AU)

Introduction. Considerable progress has been made in the treatment of patients with relapsing-remitting multiplesclerosis (MS) over the last decade. Exactly how these changes are reflected in daily practice, however, is still not very well known. Aims. To hold interactive workshops so as to be able to evaluate the opinions of Latin-American neurologists about the therapeutic decisions taken with regard to MS. Materials and methods. By means of an interactive voting system, professionals attending each workshop replied to ten pre-established questions about when to start treatment, the use of magnetic resonance imaging (MRI) to supervise treatment, the definition of therapeutic failure and the role of treatment using immuno suppressants. The results were compared with those obtained in similar workshops attended by European and North American neurologists held six months earlier. Results. The use of immunomodulators was considered to be useful in isolated demyelinating syndromes, as 40-50% endorsed their use in clinically stable patients. MRI was seen to be the most sensitive method of monitoring the effectiveness of the therapy –70.6% of them proposed the application of annual scans, which suggests a more frequent use in Latin America than in Europe or the USA. On defining therapeutic failure, the clinical criteria were more important than the MRI scan, and a switch from beta interferons to glatiramer acetate or vice versa was recommended. Treatment with immunosuppressants was considered to be useful in reducing the accumulated disability, but there was no agreement on how to use them. In Latin America, decisions about when to begin treatment seem to lie somewhere between the more favourable posture adopted in USA and the more conservative stance in Europe. Conclusions. This survey reflects the controversies that affect the therapeutic decisions concerning MS in Latin America and highlights the areas in which more data are needed to optimise the standards of treatment (AU)