Eye lens radiation exposure in paediatric interventional treatment of retinoblastoma.

Retinoblastoma represents 3% of cancers in children under fifteen years of age. The standard paediatric treatment for saving the affected eye is supraselective intra-arterial chemotherapy performed in interventional rooms. In order to address the radiation toxicity due to the angiography, the aim of this study was to determine the typical dose value corresponding to the procedure, estimate the paediatric patients' eye lens dose and study the relationship between dose indicators and dose to the lens. An automatic dose management software was installed in two interventional rooms to obtain the distribution of the dose indicators kerma-area product and reference-point air kerma, getting a typical value 16 Gy·cm2 and 130 mGy, respectively (n = 35). The eye lens dose estimates were obtained with photoluminescent dosimeters placed on the patient's eyelids. In the left eye, the entrance surface air kerma was 44.23 ± 2.66 mGy, and 12.72 ± 0.89 mGy in the right eye (n = 10). There was a positive correlation between dose to the lens per procedure and dose indicators, with R2 > 0.65 for both eyes. Based on this information, the threshold for the onset of radiation-induce cataracts (500 mGy) will be exceeded if the treatment is performed for more than 8 sessions.

A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience.

BACKGROUND AND PURPOSE: The complexity and expense of endovascular treatment (EVT) for acute ischaemic stroke (AIS) can present difficulties in bringing this approach closer to the patients. A collaborative node was implemented involving three stroke centres (SCs) within the Madrid Stroke Network to provide round-the-clock access to EVT for AIS. METHODS: A weekly schedule was established to ensure that at least one SC was 'on-call' to provide EVT for all those with moderate to severe AIS due to large vessel occlusion, >4.5 h from symptom onset, or within this time-window but with contraindication to, or failure of, systemic thrombolysis. The time-window for treatment was 8 h for anterior circulation stroke and <24 h in posterior stroke. Outcomes measured were re-canalization rates, modified Rankin Scale (mRS) score at 3 months, mortality and symptomatic intra-cranial haemorrhage (SICH). RESULTS: Over a 2-year period (2012-2013), 303 candidate patients with AIS were considered for EVT as per protocol, and 196 (65%) received treatment. Reasons for non-treatment were significant improvement (14%), spontaneous re-canalization (26%), clinical worsening (9%) or radiological criteria of established infarction (31%). Re-canalization rate amongst treated patients was 80%. Median delay from symptom onset to re-canalization was 323 min (p25; p75 percentiles 255; 430). Mortality was 11%; independence (mRS 0-2) was 58%; SICH was 3%. CONCLUSIONS: Implementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes.

Estudio Cualitativo: uso de la guía para la estimación del riesgo cardiovascular global en la práctica clínica / Pesquisa Qualitativa: Uso Dos Guias Para A Estimativa De Risco Cardiovascular Global Na Prá- Tica Clínica / Qualitative Study: The Use Of The Guidelines For The Assessment Of Absolute Cardiovascular Disease Risk In Clinical Pracice

El Ministerio de Salud, a través del Programa Remediar y con la participación de 24 Facultades de Medicina, implementa un Programa de Capacitación en Terapéutica Racional de Atención Primaria de la Salud (TRAPS) destinado a médicos/as que se desempeñan en el primer nivel de atención (PNA). En el Curso sobre Riesgo Cardiovascular Global (RCVG) se promueve la utilización de la Guía de la OMS adaptada para Argentina para la estimación del riesgo. Objetivo. Presentar los resultados de un estudio cualitativo que indaga, entre los profesionales que habían asistido al curso, el conocimiento y la utilización de la Guía. Material y Método. Población: médicos/as que se desempeñan en Centros de Salud en las provincias de Catamarca y La Rioja...

The Ministry of Health, through a Program called “Remediar” and with the participationof 24 Schools of Medicine, is implementing a Training Program on Rational Therapeuticsin Primary Health Care intended for doctors working in the fi rst level of care. In theCourse on Absolute Cardiovascular Disease Risk (ACVDR), the use of WHO Guidelinesfor the Assessment of Risk adapted for Argentina is promoted.Objective: To present the results of a qualitative study enquiring professionals who attendedthe course, regarding the knowledge and use of the Guidelines.Material and Method: Semi-structured deep interviews to explore dimensions such as patient-doctorrelationship, the approach to people with cardiovascular disease risk and thefactors involved in the process of patient care.Population: Doctors who work in Health Centers in the provinces of Catamarca and LaRioja and took the course on ACVDR.Results: Interviews took place between...

O Ministério da Saúde, por meio do Programa “Remediar” e com a participação de 24Faculdades de Medicina, implementa um Programa de Treinamento sobre Terapêutica Racionalde CuIdados Primários da Saúde (TRAPS) para médicos as que servem no primeiro nível de cuidados (PNA). No curso sobre Risco Cardiovascular Global (RCVG) é promovidaa utilização do Guia da OMS adaptado para a Argentina para a estimativa de risco.Escopo: Apresentar os resultados de um estudo qualitativo que questiona, entre os profi ssionaisque participaram do curso, sobre o conhecimento e o uso do Guia.Material e métodos: Entrevistas em profundidade semi-estruturadas, através das quais sãopesquisadas as dimensões, tais como relação médico-paciente, a abordagem de pessoascom risco cardiovascular e dos fatores institucionais envolvidos no processo dos cuidadosPopulação: Médicos que trabalham em centros de saúde nas províncias de Catamarca e LaRioja, e que fi zeram o curso em RCVG...

Uso racional de medicamentos: Evaluación de un curso de capacitación / Uso racional de medicamentos: avaliação de um curso de formação / Rational use of drugs: assessment of a training course

El Programa Remediar del Ministerio de Salud de la Naciónimplementó, entre 2006 y 2008 un Curso en Uso Racionalde Medicamentos destinado a médicos y odontólogos quese desempeñaban en los Centros de Atención Primaria dela Salud que recibían el botiquín con los medicamentosdel Programa Remediar. El Curso tenía como propósitogeneral promover el uso racional de medicamentos entrelos profesionales prescriptores del primer nivel de atención.Se establecieron acuerdos entre el Ministerio de Salud de laNación (MSAL), los Ministerios de Salud Provinciales y 23Facultades de Medicina. La política del MSAL fue involucrara la comunidad académica en un trabajo conjunto orientadoa jerarquizar la Atención Primaria de la Salud (APS). Elcurso se dictó para tres cohortes, en total 4463 profesionalesiniciaron el curso y 2776 lo completaron aprobando unexamen final. Funcionaron 118 sedes-aulas; participarontodas las jurisdicciones del país. El curso URM fue evaluadopor el Área de Monitoreo y Evaluación del Remediar usandolos registros de datos administrativos sobre rendimientoacadémico por provincia y realizando 15 grupos focales endistintas localidades. El objetivo del presente artículo es dara conocer la metodología utilizada y los resultados obtenidos en la Evaluación del Curso URM con el propósito de hacer un a contribución para elmejoramiento de futuras intervenciones.

Remediar Program of the National Ministry of Health implemented between 2006 and 2008Rational Use of Drugs’ Courses for doctors and dentists who worked in the Primary CareCenters Health receiving the kit with medicines from Remediar. The training was intendedgenerally to promote rational use of medicines for professional primary care prescribers.Agreements were established between the National Health Ministry, Provincial HealthMinistries and 23 medical schools. The Health Ministry policy was to involve the academiccommunity in a joint effort aimed at prioritizing the Primary Health Care. The course washeld for three cohorts, totaling 4463 professional, 2776 started the course and completed itby passing a final exam. They ran 118 seats of classrooms, involving all jurisdictions. URMCourse was evaluated by the Monitoring and Evaluation Area using administrative data onacademic performance by province and conducting 15 focus groups in different locations.The aim of this paper is to present the methodology used and the results obtained in theURM Course Evaluation in order to make a contribution to improve future interventions.

Fístula arteriovenosa postraumática: tratamiento endovascular. Revisión de la literatura y presentación de un caso clínico / Endovascular treatment of a post-traumatic arterio-venous fistula: presentation of a clinical case and literature review

Las fístulas arteriovenosas en la cabeza y el cuello son entidades poco frecuentes. La mayoría es secundaria a heridas penetrantes por arma blanca. Se describe el tratamiento exitoso mediante cirugía endovascular de una fístula postraumática tras una herida penetrante entre la arteria maxilar interna izquierda y la vena yugular externa. A través de este caso clínico y la revisión de la literatura se ilustran las causas, manifestaciones, estudio radiológico y tratamiento de una fístula postraumática entre la arteria maxilar interna y la vena yugular externa. A través de este caso clínico se demuestra la utilidad de los procedimientos endovasculares en el tratamiento de estas complicaciones(AU)

Traumatic arteriovenous fistulas of the head and neck region are uncommon. The majority are due to penetration of blunt injury. We describe a successful endovascular treatment of a posttraumatic fistula between the left maxillary artery and the external jugular vein due to a penetration injury. This case and a review of the literature illustrate the causes, manifestations, image studies and treatment for a posttraumatic fistula between the maxillary artery and the external jugular vein. This case demonstrate the utility of endovascular treatment of head and neck injuries complications(AU)

Lesión órbito-craneal penetrante tras traumatismo palpebral mínimo: a propósito de un caso / Penetrating orbitocranial injury after trivial eyelid trauma: a case report

Caso clínico: Presentamos un varón en estado de embriaguez con una hemorragia cerebral asociada a una herida palpebral mínima tras agresión con objeto metálico. Discusión: Una aparente lesión palpebral banal puede acompañarse de lesiones cerebrales graves. Es fundamental hacer un correcto diagnóstico diferencial entre embriaguez y daño orgánico, dadas las repercusiones que puede conllevar, tanto a nivel clínico como médico-legal

Case report: We report a patient who, while in a drunken state, sustained a cerebral hemorrhage associated with an apparently trivial eyelid injury after an aggressive attack with a metallic object. Discussion: Any apparently trivial eyelid injury may be associated with serious cerebral lesions. Making a correct diagnosis that distinguishes between that of drunkenness and an organic injury is essential, because failure to do so may result in both clinical and legal repercussions

[Penetrating orbitocranial injury after trivial eyelid trauma: a case report]. / Lesión órbito-craneal penetrante tras traumatismo palpebral mínimo: a propósito de un caso.

CASE REPORT: We report a patient who, while in a drunken state, sustained a cerebral hemorrhage associated with an apparently trivial eyelid injury after an aggressive attack with a metallic object. DISCUSSION: Any apparently trivial eyelid injury may be associated with serious cerebral lesions. Making a correct diagnosis that distinguishes between that of drunkenness and an organic injury is essential, because failure to do so may result in both clinical and legal repercussions.

Endovascular treatment of a pseudoaneurysm of the descending palatine artery after orthognathic surgery: technical note.

We report the clinical presentation (relapsing epistaxis after Le Fort I osteotomy), craniofacial digital subtraction angiography findings, and endovascular embolization through a microcatheter, in a 26-year-old patient with a pseudoaneurysm of the descending palatine artery.

Paragangliomas de la cauda equina, a propósito de dos casos / Paragangliomas of the cauda equina: report of two cases

Los paragangliomas extraadrenales que afectan a la médula espinal no son frecuentes y suelen manifestarse como una compresión intradural de la cauda equina. Presentamos dos casos de paraganglioma de la cauda equina de características y comportamiento distintos, y revisamos los aspectos clínicos e histopatológicos de este tumor, así como el diagnóstico, tratamiento y pronós¬tico. Existen casos con una elevadísima vascularización tumoral que impide la extirpación completa de la lesión, lo cual es el tratamiento de elección de estos tumores. La realización de laminotomía osteoplástica y ecografía intraoperatoria son de gran utilidad en el abordaje de lesiones intradurales como el paraganglioma (AU)

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compres-sion of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma (AU)

[Treatment of nasolacrimal duct obstruction with Song's stent. Long term efficacy]. / Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song. Eficacia a largo plazo.

PURPOSE: To evaluate the long-term efficacy (5 years) of Song's stent in the treatment of naso-lachrymal duct obstruction. MATERIALS AND METHODS: We examined Song's stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. CLINICAL PRESENTATION: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. RESULTS: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. CONCLUSIONS: Song's stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency.

Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song: Eficacia a largo plazo / Treatment of nasolacrimal duct obstruction with songs stent. Long term efficacy

Objetivo: Evaluar la eficacia a largo plazo (5 años) de la prótesis nasolagrimal de Song en el tratamiento de la obstrucción del conducto naso-lagrimal. Material y métodos: Se estudiaron 64 ojos (62 pacientes) con prótesis de Song por obstrucción del conducto naso-lagrimal (CNL), 48 mujeres y 14 hombres de edad media 60 años DE 13,17. El lado más frecuentemente obstruido fue el derecho (62,5%), siendo en el ojo izquierdo de 37,5%; y el tipo de obstrucción en la dacriocistografía: unión CNL-saco 82,8%, CNL distal 10,9%, CNL medio 3,1%, y proximal y completo, ambos del 1,6%. La clínica previa más frecuente fue la epífora (96,8%), dacriocistitis aguda (67,2%), conjuntivitis de repetición (25%) y mucocele (17,2%). El tiempo medio de seguimiento fue de 25,23 meses (máximo 53 y mínimo 2). Resultados: Durante el seguimiento se retiraron 13 prótesis y recambiaron 2. Al final siguen permeables 43 (67,2%); la epífora se redujo al 32,8% y el número de episodios de dacriocistitis aguda, conjuntivitis de repetición y mucocele se redujo al 1,6%. El 73,5% de los encuestados manifestaron una mejoría subjetiva. La complicación intraoperatoria más frecuente fue la epístaxis (15,6%) y dolor (14,1%), y de las post-operatorias la obstrucción en 22 casos, con un tiempo medio de 8,6 meses. Conclusiones: La prótesis de Song es una opción útil y rápida en el tratamiento de las obstrucciones del CNL. Pese a no ser eficaz en todos, produce una mejoría sintomática en la mayoría, permitiendo evitar la cirugía. No obstante, se requieren lavados periódicos para mantener su permeabilidad(AU)

Purpose: To evaluate the long-term efficacy (5 years) of Songs stent in the treatment of naso-lachrymal duct obstruction. Materials and methods: We examined Songs stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. Clinical presentation: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. Results: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. Conclusions: Songs stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency(AU)

[Paragangliomas of the cauda equina: report of two cases]. / Paragangliomas de la cauda equina: a propósito de dos casos.

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.

[Bilateral carotid occlusion in young woman. Clinical and hemodynamic ocular results]. / Oclusión carotídea en mujer joven. Consecuencias oculares clínicas y hemodinámicas.

CASE REPORT: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes. DISCUSSION: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient's risk of stroke and death.

Oclusión carotídea en mujer joven. Consecuencias oculares clínicas y hemodinámicas / Bilateral carotid occlusion in young woman. Clinical and hemodynamic ocular results

Caso clínico: Describimos el caso de una mujer de 44 años, fumadora de 60 cig./día y con antecedentes de hipertiroidismo. Presentó un síndrome de isquemia ocular en ambos ojos (AO) por oclusión de carótidas internas que originó un flujo retrógrado en ambas arterias oftálmicas, produciendo un fenómeno de robo caracterizado por un shunt a los circuitos intracraneales de baja resistencia y una reducción en el aporte sanguíneo a los ojos. Discusión: Los pacientes jóvenes con obstrucción carotídea bilateral severa tienen mayor riesgo de desarrollar un síndrome de isquemia ocular, mientras este flujo retrógrado parece reducir su riesgo de infarto cerebral o muerte (AU)

Case report: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes. Discussion: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient’s risk of stroke and death (AU)

Gastric incarceration and perforation following posttraumatic diaphragmatic hernia.

We report the case of a 36-year-old male patient who developed gastric incarceration and perforation in a diaphragmatic hernia 8 months after an automobile accident. During emergency surgery, protrusion of the stomach into the thoracic cavity and perforation on the anterior aspect of the stomach were noted. The gastric perforation and the diaphragmatic defect were closed. During the postoperative course, the patient developed sepsis and coagulopathy that subsided following medical therapy. In order to prevent severe complications, surgery is indicated as soon as conclusive diagnosis is made.

Periosteal glomus tumor of the femur: a case report.

Osseous abnormalities produced by glomus tumors located in soft tissues of the periungual region have been described. More rare is the location of a glomus tumor within bone, which usually is located in the phalanx of the fingers. However, to the authors' knowledge, there is no previous description of a glomus tumor located in a periosteal location of a long bone. A 50-year-old man with a glomus tumor in a periosteal location of the lower metaphysis of the femur without neoplastic erosion of the cortical surface is reported. Magnetic resonance imaging and intraoperative ultrasonography were needed to locate the lesion.

[Extrahepatic portal vein aneurysm and recurrent cholestasis]. / Aneurisma de la vena porta extrahepática y colestasis recidivante.

Aneurysm of the portal vein is quite infrequent and its clinical manifestations is variable. The association between aneurysm of the extrahepatic portal vein and recurring obstructive jaundice has only been described on one occasion, one where there was also portal hypertension. One case of aneurysm of extrahepatic portal vein associated with recurring cholestasis is described. The diagnosis was performed via echography and abdominal TAC and confirmed by portal venography. There was no evidence of hepatopathy or portal hypertension. Possibly, the displacement of the biliary tract the portal vein is a contributing factor to recurring cholestasis in the present case.