Update of cartilaginous tumours according to the WHO classification 2020.

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.

Actualización de los tumores cartilaginosos según la clasificación de la OMS de 2020 / Update of cartilaginous tumours according to the WHO classification 2020

Los tumores cartilaginosos son un grupo amplio y heterogéneo de neoplasias caracterizadas por la presencia de una matriz condroide que presenta crecimiento lobular y patrones de calcificación en arcos y anillos o en palomitas de maíz. En RM destaca su hiperintensidad en las secuencias potenciadas en T2, y en las imágenes poscontraste, un relace lobulado o septal. En la clasificación de 2020 de la OMS, los tumores de estirpe condral se clasifican en benignos, intermedios o malignos. A pesar de los avances tecnológicos, siguen suponiendo un reto tanto para el radiólogo como para el patólogo, siendo la principal dificultad la diferenciación entre los tumores benignos y malignos, razón por la que requieren un abordaje multidisciplinar. Este trabajo recoge los principales cambios introducidos en la actualización de 2020, describe las características de imagen de los principales tumores cartilaginosos y proporciona las claves radiológicas para diferenciar entre tumores benignos y malignos.(AU)

Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.(AU)

Tratamiento anestésico de la corrección quirúrgica del encefalomielomeningocele en un neonato / No disponible

No disponible

Impact of the introduction of rapid HIV testing in the Voluntary Counselling and Testing sites network of Catalonia, Spain.

Rapid HIV antibody tests, which provide results within 15-60 minutes, can help reduce the number of unrecognized infections by improving access to testing facilities and increase the number of people tested who know their results. After an acceptability study, rapid HIV testing was first implemented in Catalonia in 2007 within the community-based Voluntary Counselling and Testing sites network. One year after implementation, an increase of 102.9% has been observed in the number of tests performed, ranging from 8.4% to 328.3% according to the site. Despite the important immediate impact of rapid HIV testing on the number of tests performed, there was no significant change in the proportion of tests that were positive. Rapid HIV testing can help increase access to testing, but it should be complemented with specific outreach programmes targeting the most vulnerable subgroups.

Bioabsorbable osteofixation devices in craniosynostosis. Clinical experience in 216 cases.

INTRODUCTION: The pursuit of bone fixation systems capable of affording appropriate stability for osteosynthesis has gone through several stages from the use of metal wires, plates, and screws to the current stage of bioabsorbable systems. In our Pediatric Neurosurgery Service and Craniofacial Surgery Unit we began employing these systems in June 1997. The object of this paper is to present a review of the bioabsorbable materials most commonly used in pediatric age, and more specifically in treating craniosynostosis, to describe the characteristics of each one of them and our experience. PATIENTS AND METHODS: From June 1997 to May 2006 we implanted bioabsorbable fixation systems in 216 patients diagnosed with craniosynostosis. Age at treatment ranged between 4 and 24 months (mean age 6.38 months). Brain computed tomography (CT) scans, and three-dimensional (3-D) reconstruction of CT scans were performed before and after treatment. An 82: 18 L-lactic acid: glycolic acid copolymer was used in 92.2% of these cases, and a 70:30 L-lactic acid: D-lactic acid copolymer was used in the remaining 7.8% of cases. The follow-up of the patients ranged between six months and five years. RESULTS: There was no displacement of bioabsorbable plates or screws in any case. In one case (0.46%), radiological imaging revealed osteolysis underneath the implant eight months after the surgical procedure. Prominences caused by the plates and screws employed were visible in two cases (0.93%). We found fractures in the osteosynthesis mesh in two patients (0.93%). Four patients (1.85%) presented local inflammation. No alterations of cranial morphology secondary to inadequate stability were observed. CONCLUSIONS: 1) Bioabsorbable fixation systems provide excellent stability during the bone "healing" period, without a higher complication rate than with other systems. 2) They help the bone grafts keep their remodeled shape. 3) They promote reossification by preventing the bone grafts from moving after osteosynthesis. 4) No interference with normal growth of the cranial vault has been observed.

Bioabsorbable osteofixation devices in craniosynostosis. Clinical experience in216 cases

Introduction: The pursuit of bone fixation systems capable of affording appropriate stability for osteosynthesis has gone through several stages from the use of metal wires, plates, and screws to the current stage of bioabsorbable systems. In our Pediatric Neurosurgery Service and Craniofacial Surgery Unit we began employing these systems in June 1997. The object of this paper is to present a review of the bioabsorbable materials most commonly used in pediatric age, and more specifically in treating craniosynostosis, to describe the characteristics of each one of them and our experience. Patients and methods: From June 1997 to May 2006 we implanted bioabsorbable fixation systems in 216 patients diagnosed with craniosynostosis. Age at treatment ranged between 4 and 24 months (mean age 6, 38 months). Brain computed tomography (CT) scans, and three-dimensional (3-D) reconstruction of CT scans were performed before and after treatment. An 82: 18 L-lactic acid: glycolic acid copolymer was used in 92.2% of these cases, and a 70:30 L-lactic acid: D-lactic acid copolymer was used in the remaining 7.8% of cases. The follow-up of the patients ranged between six months and five years. Results: There was no displacement of bioabsorbable plates or screws in any case. In one case (0.46%), radiological imaging revealed osteolysis underneath the implant eight months after the surgical procedure. Prominences caused by the plates and screws employed were visible in two cases (0.93%). We found fractures in the osteosynthesis mesh in two patients (0.93%). Four patients (1.85%) presented local inflammation. No alterations of cranial morphology secondary to inadequate stability were observed. Conclusions: 1) Bioabsorbable fixation systems provide excellent stability during the bone "healing" period, without a higher complication rate than with other systems. 2) They help the bone grafts keep their remodeled shape. 3) They promote reossification by preventing the bone grafts from moving after osteosynthesis. 4) No interference with normal growth of the cranial vault has been observed (AU)

Introducción: La búsqueda de sistemas de fijación ósea que proporcionen la estabilidad adecuada para favorecer una osteosíntesis, ha dado lugar a diferentes etapas. Desde la utilización de hilos de alambre, placas y tornillos metálicos hasta la etapa actual en la que se utilizan sistemas bioabsorbibles. En nuestro Servicio de Neurocirugía Pediátrica y Unidad de Cirugía Craneofacial comenzamos a utilizar estos sistemas en Junio de 1997. El objetivo de este trabajo es realizar una revisión de los materiales bioabsorbibles utilizados en la edad pediátrica, concretamente en craneosinostosis, aportando información sobre las características de cada uno de ellos y nuestra experiencia. Pacientes y métodos: Desde Junio de 1997 a Mayo de 2006, hemos utilizado sistemas de fijación bioabsobible en 216 pacientes diagnosticados de craneosinostosis. Las edades oscilaron entre 4 y 24 meses cuando se realizó el tratamiento (la edad media fue 6,38 meses). Todos los casos fueron estudiados con escáner cerebral y reconstrucción tridimensional antes y después del tratamiento. En el 92,2% de los casos el copolímero utilizado fue el formado por los ácidos L-Láctico y Glicolico en las proporciones de 82/18 y en el 7,8% restante el sistema formado por el copolímero de los ácidos L-Láctico y D-Láctico en la proporción de 70/30. El período de seguimiento ha oscilado entre 6 meses y 5 años. Resultados: No hubo desplazamientos de placas o tornillos bioabsorbibles en ningún caso. En un caso (0.46%), 8 meses después de la intervención se diagnosticó radiológicamente una imagen de osteolísis subyacente al implante. En dos pacientes (0.93%) se apreciaron relieves cutáneos debidos a las placas y tornillos utilizados. En dos casos (0.93%) fueron visibles a nivel frontal, prominencias por fracturas de las mallas de osteosíntesis. En cuatro ocasiones (1.85%) se apreciaron zonas de inflamación cutánea local. En ningún caso hemos observado alteraciones de la morfología craneal secundarias a una insuficiente estabilidad. Conclusiones: 1) Los sistemas de fijación bioabsorbibles proporcionan una estabilidad ideal durante la fase de “curación” ósea sin aumentar el porcentaje de complicaciones con respecto a los sistemas que previesen nuestra experiencia. 2) Favorecen el mantenimiento de la forma dada a los fragmentos óseos en la remodelación. 3) Facilitan la reosificación al impedir los movimientos de los fragmentos óseos una vez realizada la osteosíntesis. 4) No se han detectado interferencias con el crecimiento normal de la bóveda craneal (AU)

Enigmas y confusiones en el diagnóstico y tratamiento de la plagiocefalia posicional. Protocolo asistencial / Doubts and confusions in the diagnosis and treatment of positional plagiocephaly. Management protocol

Introducción La plagiocefalia posicional es actualmente la causa más frecuente de asistencia en una consulta de neurocirugía pediátrica, tanto en España como en todos los países occidentales. A ello se suma la considerable confusión existente en la literatura especializada en relación a aspectos como la terminología, conceptos fisiopatológicos, diagnóstico diferencial con la craneosinostosis y por supuesto en el tratamiento más adecuado que hay que seguir. Objetivos Intentar clarificar estos conceptos y además presentar un protocolo de asistencia que nos ha solicitado recientemente la Administración Sanitaria de la Comunidad de Madrid. Protocolo Pretende lograr la coordinación entre pediatras y neurocirujanos, así como conseguir una información precisa de los principales datos de esta patología para los familiares, pediatras y neurocirujanos. Material y métodos Se establecen una serie de datos de consenso. Los niños son clasificados en 3 grados de deformación (leve, moderada y grave) según los índices medidos en fotografías digitales. Además el proceso del diagnóstico y tratamiento tiene dos fases: fase pediátrica (hasta los 5 meses de edad) y fase neuroquirúrgica (desde los 5 meses de edad). Los niños serán enviados a neurocirugía después de haber sido tratados con tratamiento posicional y rehabilitación y solamente a partir de los 5 meses de edad. Las razones de todo ello son explicadas en el protocolo que define también las funciones y responsabilidades de cada especialista. Conclusiones El tratamiento que se propone es escalonado, comenzando por las medidas posicionales y de rehabilitación, seguidas de ortesis craneal y en último lugar del tratamiento quirúrgico

Introduction Positional plagiocephaly is currently the most frequent cause of consultation at pediatric neurosurgical departments in Spain and other western countries. There is considerable confusion in the literature on the terminology and physiopathology of this deformity, as well as its differential diagnosis with true synostosis and treatment recommendations. Objectives To clarify these concepts and present a protocol for the management of positional plagiocephaly, which was recently requested by the Health Administration of the Community of Madrid. Protocol The protocol aims to achieve coordination among pediatricians and neurosurgeons, as well as to provide precise information on this deformity for parents, pediatricians and neurosurgeons. Material and methods Previous consensus was reached on a series of data. Infants were classified into three categories of deformity (mild, moderate, severe) according to measurements on digital photographs. Diagnosis and treatment follows two phases: a pediatric phase (up to 5 months of age) and a neurosurgical phase (from 5 months onwards). Infants are referred to neurosurgical consultation only after being treated with postural changes and physiotherapy and only after reaching the age of 5 months. The reasons for this approach are explained in the protocol, which also defines the functions and responsibilities of each specialty. Conclusion The treatment proposed in the protocol is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment

Tratamiento anestésico de una paciente con hemoglobinuria paroxística nocturna sometida a cirugía de mama / Anesthetic treatment of paroxysmal nocturnal hemoglobinuria in a woman who underwent breast surgery

No disponible

No disponible

Influencia sobre los niveles de presión arterial de una intervención conductual y educativa dirigida al control del estrés y la modificación de hábitos de una muestra de hipertensos / The influence of blood pressure levels in a cognitive-behavioral programme for reducing stress and life habits in hipertension patients

Se evalúa el efecto sobre la presión arterial (PA) de un programa que combina estrategias educativas orientadas a la mejora de hábitos de vida y técnicas cognitivo-conductuales para reducir el estrés y aumentar el cumplimiento terapéutico en hipertensos. Participaron 80 pacientes, divididos en grupo-intervención y grupo-control, de la Unidad de Hipertensión del Hospital 12-de-Octubre (Madrid). Se evaluó el efecto del programa completo y del módulo de control de estrés sobre PA y otros parámetros: conocimiento de la enfermedad, cumplimiento farmacológico y dietético, niveles de ansiedad y estrés y calidad de vida. Los resultados muestran un mejor control de PA al final de la intervención así como mejoras en el seguimiento del tratamiento higiénico-dietético. Aparecen descensos en el nivel de estrés y ansiedad y un aumento de conocimientos de la enfermedad. No se encuentran mejoras, sin embargo, en adhesión a la práctica de ejercicio físico, ni modificaciones en calidad de vida

The effect of blood pressure (BP) levels on a program which combines educative actions in order to improve health behaviors related to hypertension, and cognitive-behavioral techniques for reducing stress and enhancing treatment compliance of hypertension patients is evaluated. 80 patients from the Hypertension Unit of the 12-de-Octubre Hospital (Madrid) divided into two groups (treatment and control groups) participated in the study. The effectiveness of the whole program as well as the module of stress control separately was evaluated over BP and other parameters: knowledge about the illness, pharmacological and diet compliance, level of anxiety and stress, and quality of life. Results show a better BP control after the treatment as well as an enhancement of the hygienic-diet compliance. There is also a decrease of anxiety and stress, and an increase of the knowledge about the illness. Nevertheless, there are no changes in physical exercise compliance nor in quality of life

[Education by participating in a diabetic food contest]. / Educar y participar a través de un concurso. Comida para diabéticos.

In order to investigate new methods to use to educate the general public and to foster changes in diet, a cooking course was organized by the "Las Fuentes Norte" Health Center in Zaragoza open to the entire population. 42.1% of the menus selected were prepared by diabetics. In these, their average composition was: 488.3 +/- 114 calories containing 30.7% proteins, 38.8% lipids, and 32.5% carbohydrates. 42.1% of the menus selected were prepared by people in families having no diabetics. In these, their average composition was: 332.8 +/- 114.4 calories containing 25% proteins, 29.9% lipids, and 50.1% carbohydrates. The remaining 15.8% of the menus selected were prepared by relatives of diabetics. In these, their average composition was: 528.1 +/- 237.9 calories containing 40.6% proteins, 45.3% lipids, and 14.1% carbohydrates. There was no finding bearing statistical importance among these groups which prepared these dishes. Analysis of the 1998 contest discovered that calories increased in the menus prepared by diabetics or their relatives; calories increased 101.1 and 330.7 respectively, and this bears statistical importance. In these same groups, lipids increased 11.2 and 25% respectively while carbohydrates dropped 11.2 and 29.6% respectively. In those menus prepared by persons having no diabetics in their families, lipids decreased 4.3% while carbohydrates increased 15.9%. The average number of calories in the 19 menus prepared was 1758.8 +/- 20.7. These menus contained an average of 20.8% proteins, 25.5% lipids, and 53.7% carbohydrates.

[Diabetic food competition. Another way of teaching]. / Concurso de comida para diabéticos. Otra forma de educar.

OBJECTIVE: To employ a different and appetizing method of food education. DESIGN: A descriptive, crossover, observational study. SETTING: Las Fuentes Norte Health Centre, Zaragoza, jointly with a civic centre in the neighbourhood. PARTICIPANTS: 54 people out of a population of 492,521 (over 15). One was excluded and 21 dishes were chosen. INTERVENTION: Composing posters with a day's complete menu, including one of the dishes chosen in each menu. Choice of the three best dishes presented. RESULTS: 18.8% of the dishes selected were proposed by diabetics (with a mean of 387.22 +/- 150.72 calories, SD 171.95, with 30.74% proteins, 25.59% lipids and 43.65% CH). 24.5% were proposed by carers (mean of 378.1 +/- 103.86 calories, SD 118.65, with 30.89% proteins, 31.11% lipids and 37.99% CH). 30% were proposed by members of diabetics' families (mean of 197.43 mame 149.33 calories, SD 152.38, with 36.3% proteins, 20.07% lipids and 43.61% CH). 26.5% of dishes bore no relationship to this disease (mean of 422.15 +/- 148.09 calories, SD 199.91 and 31.15% proteins, 34.23% lipids and 34.6% CH), with no statistical significance between the different groups. Using the data of the means calculated as a basis, we obtained a meal of 1,141.3 calories with 29.3% proteins, 29.6% lipids and 41.1% CH. CONCLUSIONS: Combining the results in one meal would not only give a high amount of calories, but a high proportion of proteins, mainly at the expense of CH.

[Treatment of sagital craniosynostosis (scaphocephaly) by means of immediate surgical correction]. / Tratamiento de la craneosinostosis sagital (escafocefalia), por medio de la corrección quirúrgica inmediata.

INTRODUCTION: From 1983 to 1994, a total of 86 patients having scaphocephaly were studied and treated in our Craniofacial Unit. The present study involves 60 patients treated between 1988 and 1994 which were operated upon with the same surgical technique and that which is currently being used in our department. The surgical approach and results are analyzed. CLINICAL MATERIAL AND METHODS: Patients having scaphocephaly represented 47.51% out of the total 181 children having craniosynostosis and craniofacial synostosis during this period. All of the patients were studied with computerized tomography, with 10 of them having continuous monitoring of their intracranial pressure. All children in this series were treated according to a new surgical technique that achieves an "immediate correction" of the malformation. RESULTS: No patient had abnormal neurological findings and intracranial pressure (ICP) was within normal limits in 0 out of 10 patients having continuous ICP monitoring. CONCLUSIONS: The minimal complications and the excellent cosmetic results have resulted in an optimal surgical technique. The importance of an early diagnosis and surgical treatment of sagittal synostosis is emphasized.

Intraocular hemorrhage in sudden increased intracranial pressure (Terson syndrome).

We examined 19 cases with SAH, 4 of which presented intraocular hemorrhages (retinal, subhyaloid and in vitreous). The mortality rate was 50% when the intraocular hemorrhages were present compared to 20% when they were absent.

Doxycycline in respiratory tract infections. Report of a retrospective study in Spain during the winter 1972-1973.

In the winter of 1972-1973 a multicentre trial of the treatment of upper and lower respiratory tract infections was carried out in Spain using doxycycline. 85 physicians participated in the study and treated 1,653 patients. The infections included acute bronchitis, acute exacerbation of chronic bronchitis, pneumonia, bronchopneumonia, tonsillitis, pharyngitis, trachetis, sinusitis, and otitis media. The majority of the patients were adult out-patients although some children and adolescents were included: 1,011 of the patients were male and 642 female. A number of the signs of respiratory infection such as temperature, cough, pain and inflammatory symptoms were examined. A rapid reduction in intensity and severity was noted in all of these parameters. Tolerance to the antibiotic was excellent. Only minor side-effects were reported and these were mild and mainly limited to the gastro-intestinal tract - in no case was treatment discontinued. The total number of side-effects was 37; they occurred in 31 out of the 1,653 patients. The overall evaluation of results showed a very good or good response in 85% of the patients. It appears from this multicentre study that the efficacy of doxycycline has in no way decreased over the 7 years of its extensive use in Spain. It remains a fast acting and effective antibiotic in upper and lower respiratory tract infections irrespective of age, sex or diagnosis.