Síndrome de cauda equina posterior a la administración por vía subaracnoidea de bupivacaina hiperbárica al 0, 75 % / Cauda equina syndrome following subarachnoid administration of hyperbaric bupivacaine 0. 75 %

El síndrome de cauda equina es una patología poco frecuente en el área de anestesiología. Esta se caracteriza por presentar un conjunto de signos y síntomas que involucran: dolor, disminución o abolición de la fuerza muscular, disfunción de esfínteres e hipoestesia de silla de montar. El objetivo del presente trabajo es presentar y discutir el caso clínico de una paciente con diagnóstico de síndrome de cauda equina posterior a la administración por vía subaracnoidea de bupivacaina al 0,75 % hiperbárica. Se trata de paciente femenina de 42 años a quien se le realizó cesárea segmentaria y salpingectomia bilateral con bloqueo anestésico subaracnoideo; y quien posteriormente a las dieciséis horas del posoperatorio presentó: disminución de la fuerza muscular de miembros inferiores e hipoestesia de región de silla de montar, reflejo rotuliano: 0/4 bilateral y retención urinaria. Se le inicia tratamiento farmacológico y fisiátrico inmediatamente establecido el diagnóstico de síndrome de cauda equina. La paciente fue dada de alta el día diez del posoperatorio, con disminución significativa de la clínica antes descrita, evidenciándose posteriormente retención urinaria por lo que requirió sondaje vesical intermitente. Una vez establecido el diagnostico se instaló inmediatamente tratamiento farmacológico y fisiátrico para dar una oportuna resolución de la patología(AU)

Cauda equina syndrome is a rare pathology in the area of anesthesiology. This is characterized by presenting a set of signs and symptoms that involve: pain, decrease or abolition of muscle strength, sphincter dysfunction and saddle hypoesthesia. The objective of this work is to present and discuss the clinical case of a patient with a diagnosis of cauda equina syndrome after the administration of hyperbaric 0.75% bupivacaine via the subarachnoid route. This is a 42-year-old female patient who underwent segmental cesarean section and bilateral salpingectomy with subarachnoid anesthetic block; and who subsequently at sixteen hours postoperatively presented: decreased muscle strength, lower limbs and hypoesthesia of the saddle region, knee jerk reflex: bilateral 0/4 and urinary retention. Pharmacological and physical treatment was started immediately, the diagnosis of cauda equina syndrome was established. The patient was discharged on postoperative day 10, with a significant decrease in the symptoms described above, later evidence of urinary retention, requiring intermittent bladder catheterization. Once the diagnosis was established, pharmacological and physiatric treatment was immediately installed to give a timely resolution of the pathology(AU)

Low-dose CT: a useful and accessible tool for the early diagnosis of lung cancer in selected populations.

OBJECTIVE: An evaluation is made of the effectiveness of low-dose computed tomography (LDCT) in diagnosing early stage lung cancer in the Autonomous Community of Madrid (Spain). METHODS: The study comprised subjects over 50 years of age who were active smokers (or who had stopped smoking up to 6 months previously) who smoked more than 30 cigarettes daily for at least 15 years, or 20 cigarettes daily for 20 years, or more than 10packs/year and in contact with asbestos at work. The study group was evaluated using LDCT. For all participants in whom LDCT showed no pathological findings, or in those cases classified as benign, a new LDCT scan was performed 2 years after the first. In case of doubt regarding the benign nature of the findings, an assessment algorithm was applied. RESULTS: Among the initial 482 candidates in the study group, 466 LDCT scans were performed at baseline, revealing 9 extrapulmonary lesions and 114 pulmonary lesions in 98 subjects. The latter raised diagnostic doubts in 32 cases; of these, 15 were confirmed as benign by high resolution computed tomography (HRCT). In the remaining 17 cases, stage IAp adenocarcinoma was diagnosed at baseline (0.2%). With LDCT after 2 years, an additional four adenocarcinomas were diagnosed-all in stage IAp (0.98%). The complete study, including prevalence cut-off and incidence calculation after 2 years, resulted in the diagnosis of five cancers (1.1%) and two false positive cases (28%). CONCLUSIONS: The use of low-dose computed tomography in risk groups is valid for the early diagnosis of bronchogenic cancer. Nevertheless, significant problems remain, particularly those associated with false positive interpretations. The results of randomized studies on lung cancer mortality such as the US NLST trial and the Dutch-Belgian NELSON trial have to be awaited before any conclusion regarding the effectiveness of LDCT screening can be drawn.

Valoración de calidad de imagen y dosis en exámenes de tomografía computarizada helicoidal de abdomen y de pelvis en pacientes con linfoma / Evaluation of image quality and dose in abdominal and pelvic helical CT in patients with lymphoma

Objetivo: Valorar la calidad de los exámenes de tomografía computarizada (TC) de abdomen y de pelvis para la indicación de linfoma, de acuerdo con los criterios propuestos en la Guía de la Comisión Europea (CE). Material y métodos: Los criterios se evaluaron en una muestra de 100 pacientes, procedentes de cinco hospitales públicos de la Comunidad de Madrid, estudiados mediante TC helicoidal de corte único. Cinco radiólogos, uno de cada centro participante en el estudio, evaluaron de forma independiente el cumplimiento de los criterios de imagen en los exámenes seleccionados. Se ha definido el indice de calidad de imagen (ICI) para el examen completo de abdomen y pelvis. En paralelo se efectuaron medición de las dosis para estimar los valores del índice de dosis en TC (IDTC), producto de dosis por longitud (PDL) y dosis efectiva (E). Resultados: Se ha encontrado un alto cumplimiento de los criterios de imagen individual en el abdomen. En la pelvis el cumplimiento ha sido menor, especialmente para tres criterios. El ICI por centro se encuentra entre el 83 y el 92%, con grados variables de desviación interna. Los valores medios de IDTCw por centro estuvieron entre 16 y 23 mGy; los de PDL entre 430 y 750 mGy/cm, y la dosis efectiva entre 7 y 12 mSv. En general, no se ha encontrado correlación entre el ICI y la dosis al paciente (PDL) en la totalidad de la muestra (r = 0,04) ni por centros (r ¾ 0,36). Conclusiones: Se ha confirmado la utilidad de los criterios de calidad de la CE. Se ha elaborado una lista única de criterios de calidad de imagen y sugerimos niveles de dosis de referencia para exámenes de TC de abdomen-pelvis en pacientes con linfoma

Objective: The aim of this study is to evaluate the quality of pelvic and abdominal CT images performed for lymphoma according to the criteria proposed in the European Commission Guidelines on radiation imaging.( En castellano dice: la Guia de la Comisión Europea. Lo que pasa es que hay muchas guias publicadas por la Comisión: aseguranse que sea esta la citada) Material and methods: The criteria were evaluated in a sample of 100 patients attended at five public hospitals in the Autonomous Community of Madrid. All patients underwent single-slice helical CT studies. Fulfillment of the imaging criteria in the selected images was evaluated by five radiologists, one from each center, working independently. The Index of Image Quality (IIQ) was determined for the complete abdominal and pelvic examination. The dose was also measured to estimate the values of the CT Dose Index (CTDIw), Dose by Length Product (DLP), and effective dose (E). Results: A high rate of fulfillment of the criteria was found for individual abdominal images. In the pelvis, the rate of fulfillment was lower, especially for three criteria. The IIQ for each center was between 83%-92%, with variable degrees of internal deviation. The mean values of CTDIw per center were between 16-23 mGy; DLP values were between 430 and 750 mGy cm, and the effective dose was 7-12 mSv. In general, no correlation was found between IIQ and dose per patient, either for the entire sample (r = 0.04) or by centers (r£0.36). Conclusions: The utility of the European Union's Quality Criteria was confirmed. We have elaborated a single list of criteria of image quality and suggest reference dosage levels for abdominal-pelvic CT examinations in patients with lymphoma