[Recognition and follow-up of the atypical naevus: benign marker or precursor of melanoma?] / Herkenning en follow-up van de atypische naevus.

Dysplastic (atypical) naevi have long been subject to discussion with regard to their nature; even their existence has been doubted. Recently, the atypical naevus has been formally identified by molecular genetic characteristics as an intermediate lesion between banal naevi and melanoma. However, the atypical naevus, as long as it is stable and asymptomatic, is regarded as a benign lesion that does not warrant excision. Atypical naevi can occur in families in which melanoma is prevalent, and those patients need to be included in regular surveillance by a dermatologist. Two male 30-year-old patients who presented with atypical naevi in different contexts are used as illustrations in this clinical lesson.

[A critical analysis of neuroimaging studies in relation to cognitive performance in multiple sclerosis patients]. / Análisis crítico de los estudios de neuroimagen en relación con el rendimiento cognitivo en pacientes con esclerosis múltiple.

Studying the cognitive impairment of multiple sclerosis (MS) patients is fundamental for a global understanding of this disease. Neuroimaging techniques might provide crucial data about the nature of this deficit and their progression. Accordingly to this idea, over the last years there has been a marked increase in the number of studies devoted to explore the possible relationship between the cognitive alterations of this clinical population and different sorts of neuropathological indexes provided by both, classical as well as by more recently developed techniques. The results of the studies using structural information provided by structural techniques, have revealed the important role of atrophic processes in the aethiology of cognitive decline in MS patients. However, this information needs to be complemented with newer indexes of neuropathological alterations in 'apparently normal' gray and white matter. On the other hand, functional magnetic resonance imaging studies have provided clear evidence of the existence and functional significance of neuroplastic processes that can mask the relationship between morphological markers of tissue damage and cognitive performance of MS patients. Those neuroplastic processes need to be taken into account as they might compensate the cognitive decline of this clinical population. In summary, the present review tries to provide a critic and integrative view of different studies assessing the relationship between cognitive impairment in MS patients and different kinds of information provided by neuroimaging techniques.

Hallux valgus y cirugía mayor ambulatoria / Hallux valgus and outpatient major surgery

Objetivo. Demostrar la eficacia de la unidad de cirugía mayor ambulatoria (CMA) en el coste-proceso de la patología hallux valgus en la gestión de los recursos sanitarios. Material y método. Se analizó el proceso hallux valgus en pacientes intervenidos durante el año 1995 mediante ingreso rutinario y en el año 1999 a través de ingreso por la unidad de CMA bajo los parámetros de coste por proceso de acuerdo con la unidad ponderada asistencial (UPA) y la calidad asistencial evaluando el dolor, nauseas o vómitos, fiebre, sangrado y grado de satisfacción en las primeras 24 horas. Resultados. Se objetivó que el coste por proceso en los pacientes ingresados de forma rutinaria fue de 2,5 UPA médicas frente a 0,25 UPA médicas en los ingresados por CMA, no encontrándose diferencias en cuanto a los parámetros evaluados en el control de calidad. Conclusiones. El proceso hallux valgus debe incluirse dentro de la cartera de servicios de Traumatología en la unidad de CMA, ya que reduce de una forma considerable el coste sanitario. No se apreció ninguna diferencia en relación con la calidad asistencial y el grado de satisfacción en los pacientes intervenidos mediante CMA o mediante ingreso convencional. Es esencial la correcta selección del paciente, la información que se le ofrece y la motivación de los profesionales (AU)