5-aminolevulinic acid fluorescence guided surgery for resection of cystic meningioma with bone invasion.

Meningiomas have a 5 year recurrence rate of 8%. Histological grade and extent of resection are the two main prognostic factors. Cystic meningiomas represent between 2 and 4% of meningiomas, and the complete resection rate in these cases is 62.7%. 5-ALA has been shown to be useful in detecting tumour remnants that could go unnoticed by the conventional microsurgical technique, thereby achieving more complete resections. We present the case of a 66-year-old patient with a frontal convexity meningioma, presenting with a cystic component and bone invasion, who was treated using 5-ALA fluorescence-guided surgery. Fluorescence emission from the tumour tissue allowed the areas of bone invasion and the cystic wall to be identified, achieving complete resection.

Intervenciones para la exploración del pie en pacientes diabéticos, en Atención Primaria: Una revisión sistemática de Guías de Práctica Clínica / Interventions for foot examination in diabetic patients in primary care: a review of clinical practice guidelines

Objetivo principal: Identificar la mejor evidencia disponible sobre inter venciones efectivas para la exploración y estratificación del PD. Metodología: Revisión de Guías de Práctica Clínica con recomendacio nes acerca de la exploración y estratifi cación del PD. Resultados principales: Recopi lamos las intervenciones que son más efectivas para diagnosticar precozmente el PD en A.P recogidas de 10 GPC. In cluyen la evaluación visual de los pies, la valoración de la neuropatía diabética pe riférica mediante monofilamento de Semmes-Weinstein de 10 g, diapasón de 128 Hz y exploración del reflejo aquíleo, y la valoración de la enfermedad arterial periférica mediante la palpación de pul sos periféricos y determinación del índice tobillo brazo. Posteriormente estratifica ción del riesgo de desarrollar un PD. Conclusión principal: La monitori zación de las extremidades inferiores debe formar parte de los planes de cui dados de los pacientes diabéticos. Se deberían establecer unidades especiali zadas en atención al PD y poder derivar desde AP a estos pacientes (AU)

Interventions for foot examination in diabetic patients in Primary Care: A review of Clinical Practice Guidelines Main objective: To identify the best available evidence on effective in terventions in the exploration and diag nosis of DF. Methodology: Review of the Clini cal Practice Guidelines with recommen dations on the exploration and stratifica tion of DF. Main results: We compiled the interventions that are most effective for early diagnosis of DF in P.C collected in 10 CPG. They include visual assessment of their feet, assessment of diabetic pe ripheral neuropathy using a 10-g Sem mes-Weinstein monofilament, 128-Hz tuning fork, and Achilles reflex testing, assessment of peripheral arterial disease by palpation of peripheral pulses, and determination of the ankle arm index Subsequently, risk stratification of deve loping DF. Main conclusion: Monitoring of the lower extremities should be part of the care plans for diabetic patients. Spe cialized units should be established for DF care and these patients should be able to be referred from PC (AU)

¿Qué intervenciones educativas son efectivas para prevenir el pie diabético? Una Revisión de Guías de Práctica Clínica / What educational interventions are effective in preventing diabetic foot? A review of clinical practice guidelines

Objetivo principal: Identificar la mejor evidencia disponible sobre inter venciones educativas que pueden ayu dar a prevenir la aparición del Pie Diabé tico (PD) en Atención Primaria (AP). Metodología: Revisión sistemáti ca de Guías de Práctica clínica (GPC) con recomendaciones acerca de inter venciones educativas para prevenir el PD. La búsqueda se ha llevado a cabo en bases de datos de fuentes terciarias, secundarias y primarias con los descrip tores Diabetes mellitus, Pie diabético y Educación en salud. Para evaluar la cali dad de las GPC encontradas se utilizó la herramienta AGREE II. Resultados: Fueron recopiladas las intervenciones educativas que, según las 10 GPC revisadas, pueden resultar más efectivas para prevenir la aparición del PD en AP. Estas recomendaciones, han sido incluidas como actividades de los NIC (Nursing Interventions Classifica tion) relacionados con el tema. Conclusión: El resultado principal de este trabajo indica que las interven ciones educativas para prevenir la apari ción del PD deben formar parte, de ma nera inexcusable, de los planes de cui dados en los pacientes diabéticos. Son unas intervenciones que parecen ser muy costo efectivas y que, estructuradas adecuadamente, pueden contribuir a disminuir la incidencia de PD y a reducir el número de amputaciones (AU)

Main objective: Identify the best available evidence on educational inter ventions that can help prevent the ap pearance of Diabetic Foot (DF) in Pri mary Care. Methodology: Systematic review on 10 Clinical Practice Guidelines (CPG) with recommendations on education to prevent the DF. The search was carried out in databases of tertiary, secondary and primary sources with the descriptors Diabetes mellitus, Diabetic foot and Health education. The AGREE II tool was used to assess the quality of the CPGs found. Results: Were compiled the edu cational interventions that, according to the revised 10 CPG’s, are more effective in preventing the appearance of DF in Primary Care. Have been included these recommendations as NIC (Nursing Inter ventions Classification) activities related to the topic. Conclusion: The main result of this work indicates that educational inter ventions to prevent the onset of DF mus inexcusably form part of the care plans for diabetic patients. These are interven tions that appear to be very cost-effecti ve, properly structured, will help reduce the incidence of DF and reduce the num ber of amputations (AU)

Efecto de la edad en el pronóstico de pacientes con traumatismo craneoencefálico sometidos a craneotomía: análisis de una serie quirúrgica / The effect of age on the prognosis of patients with traumatic brain injury who undergo a craniotomy: analysis of a surgical series

Introducción. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefálico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente.Objetivo. Valorar la asociación entre la edad y el pronóstico vital y funcional de pacientes intervenidos por TCE. Pacientes y métodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jóvenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriátricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las características demográficas y nosológicas de la población, y el pronóstico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociación lineal positiva tanto con la mortalidad intrahospitalaria como con la proporción de pacientes con pronóstico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la población de jóvenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriátricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos últimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronóstico funcional a los seis meses del 94,44%. Conclusión. El aumento de la edad es un factor determinante negativo mayor en el pronóstico de pacientes sometidos a craneotomía por TCE. Un conocimiento preciso de estos resultados y una adecuada discusión preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones (AU)

Introduction. In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. Aim. To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. Patients and methods. We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. Results. Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the ‘super geriatric’ patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. Conclusion. Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process (AU)

Fluorescence guided resection with 5-aminolevulinic acid of a pilomyxoid astrocytoma of the third ventricle / Resección guiada por fluorescencia con ácido 5-aminolevulínico de un astrocitoma pilomixoide del tercer ventrículo

Fluorescence-guided resection with 5-aminolevulinic acid has been shown to be useful in the resection of certain brain tumors other than high grade gliomas, facilitating the intraoperative differentiation of neoplastic tissue. The technique enables the surgeon to ensure that no tumor fragments remain, thereby achieving higher rates of complete resection. Tihan first described pilomyxoid astrocytomas in 1999. They are currently classified as grade II astrocytoma according to the WHO classification system and, because of their tendency to recur and their dissemination through the cerebrospinal fluid pathways, they are considered to be more aggressive than pilocytic astrocytoma. As a result, management of these tumors must be more aggressive, always aiming for complete macroscopic resection whenever possible. In this article, we present a case of pilomyxoid astrocytoma of the third ventricle in which the use of fluorescence-guided resection with 5-ALA facilitated complete resection. Imaging tests performed after five years revealed no signs of recurrence and no adjuvant radiotherapy or chemotherapy was required. This article also comprises a review of the literature concerning the characteristics and management of this tumor, which was recently considered to be a different histopathological entity

La resección guiada por fluorescencia con 5-ALA se ha mostrado útil en tumores diferentes a los gliomas de alto grado, permitiendo la diferenciación intraoperatoria del tejido tumoral. La técnica permite revisar el lecho quirúrgico para comprobar que no quedan fragmentos tumorales, consiguiéndose así mejorar las tasas de resección completa. El astrocitoma pilomixoide, descrito en 1999 por Tihan, se clasifica actualmente como un astrocitoma grado II en la clasificación de la OMS y es considerado como una variante con mayor agresividad que el astrocitoma pilocítico por su tendencia a la recidiva y a la diseminación por el líquido cefalorraquídeo. Por ello el tratamiento debe ser más agresivo, fundamentado en una resección macroscópicamente completa siempre que se pueda. En este artículo presentamos el caso de un astrocitoma pilomixoide del tercer ventrículo en el que la fluorescencia con 5-ALA permitió una resección completa, sin signos de recidiva en pruebas de imagen a los 5 años, sin haber precisado tratamiento complementario con radioterapia ni quimioterapia. Se hace además una revisión de la literatura acerca de las características y el manejo de este tumor recientemente considerado como una entidad histopatológica diferente

Fluorescence guided resection with 5-aminolevulinic acid of a pilomyxoid astrocytoma of the third ventricle.

Fluorescence-guided resection with 5-aminolevulinic acid has been shown to be useful in the resection of certain brain tumors other than high grade gliomas, facilitating the intraoperative differentiation of neoplastic tissue. The technique enables the surgeon to ensure that no tumor fragments remain, thereby achieving higher rates of complete resection. Tihan first described pilomyxoid astrocytomas in 1999. They are currently classified as grade II astrocytoma according to the WHO classification system and, because of their tendency to recur and their dissemination through the cerebrospinal fluid pathways, they are considered to be more aggressive than pilocytic astrocytoma. As a result, management of these tumors must be more aggressive, always aiming for complete macroscopic resection whenever possible. In this article, we present a case of pilomyxoid astrocytoma of the third ventricle in which the use of fluorescence-guided resection with 5-ALA facilitated complete resection. Imaging tests performed after five years revealed no signs of recurrence and no adjuvant radiotherapy or chemotherapy was required. This article also comprises a review of the literature concerning the characteristics and management of this tumor, which was recently considered to be a different histopathological entity.

Sarcoma de Ewing extraesquelético epidural. Caso clínico y revisión de la literatura / Epidural extraskeletal Ewing sarcoma. Case report and literature review

El sarcoma de Ewing es un tumor óseo maligno que en ocasiones presenta afectación extraesquelética, siendo rara la localización epidural. Presentamos el caso de una mujer de 45 años que presentó parestesias, debilidad progresiva y retención urinaria. La resonancia magnética mostró una masa epidural desde C6 a D3. Se realizó una laminectomía de C7 a D2 y exéresis parcial de la lesión. El estudio anatomopatológico fue compatible con sarcoma de Ewing. La paciente recibió quimioterapia y radioterapia, no existiendo evidencia de enfermedad a los 8 meses de seguimiento. Presentamos una revisión de la literatura de todos los casos publicados de sarcoma de Ewing extraesquelético con afectación epidural

Ewing sarcoma is a malignant tumour of the bone that sometimes presents extraskeletal involvement, with the epidural location being rare. We report the case of a 45-year-old woman with paresthesia, paresis and urinary retention. Magnetic resonance imaging showed an epidural mass from C6 to D3. Laminectomy from C7 to D2 and partial resection of the lesion was performed. Pathological analysis was consistent with Ewing sarcoma. The patient received chemotherapy and radiotherapy, without evidence of disease at 8 months follow-up. A review of the literature on all published cases of extraskeletal Ewing sarcoma with epidural involvement is presented

Tumor elusivo dorsal. Presentación de un caso excepcional y revisión de la bibliografía / Elusive thoracic spine tumour. Report of an exceptional case and literature review

Los tumores elusivos espinales han sido descritos en la literatura científica previamente. En la mayoría de los casos se trata de neurinomas de la cauda equina. Presentamos el caso de una mujer cuyo diagnóstico radiológico de presunción es el de neurinoma a nivel D10.Se decide extirpación microquirúrgica de la lesión, y tras la laminectomía, correctamente emplazada, no se encuentra el tumor. El reporte de tumores espinales intradurales extramedulares con desplazamiento en el espacio subaracnoideo es muy infrecuente, siendo a nivel dorsal excepcional. Es difícil predecir los casos en los que este extraño fenómeno pueda darse, pero parecen una constante los cambios en la clínica del paciente según la posición, el pequeño tamaño de la lesión y la escasa adherencia a estructuras vecinas. El neurocirujano debe disponer de los recursos necesarios para solventar una exploración en blanco tras la laminectomía, llegado el caso

Elusive tumours in the spine, most of them schwannomas of the cauda equina, have been reported very rarely. We present the case of a woman with a preoperative radiological diagnosis of schwannoma at D10 level in whom a laminectomy was performed to remove the tumour. Although the laminectomy was correctly positioned, there was no tumour upon opening the dura and the laminectomy had to be extended cephalad to find and remove the tumour. Mobile intradural extramedullary spinal tumours, the so-called «elusive tumours», occur very rarely, and it is exceptional when they are located in the thoracic spine. Knowing preoperatively which tumour is going to behave in this way is almost impossible. However, in the reported cases there are common features such as symptoms changing with different body positions, small tumour size and weak attachment to nearby structures. Neurosurgeons must be able to resolve this situation when confronted with a negative correctly-positioned laminectomy

[Elusive thoracic spine tumour. Report of an exceptional case and literature review]. / Tumor elusivo dorsal. Presentación de un caso excepcional y revisión de la bibliografía.

Elusive tumours in the spine, most of them schwannomas of the cauda equina, have been reported very rarely. We present the case of a woman with a preoperative radiological diagnosis of schwannoma at D10 level in whom a laminectomy was performed to remove the tumour. Although the laminectomy was correctly positioned, there was no tumour upon opening the dura and the laminectomy had to be extended cephalad to find and remove the tumour. Mobile intradural extramedullary spinal tumours, the so-called «elusive tumours¼, occur very rarely, and it is exceptional when they are located in the thoracic spine. Knowing preoperatively which tumour is going to behave in this way is almost impossible. However, in the reported cases there are common features such as symptoms changing with different body positions, small tumour size and weak attachment to nearby structures. Neurosurgeons must be able to resolve this situation when confronted with a negative correctly-positioned laminectomy.

[Epidural extraskeletal Ewing sarcoma. Case report and literature review]. / Sarcoma de Ewing extraesquelético epidural. Caso clínico y revisión de la literatura.

Ewing sarcoma is a malignant tumour of the bone that sometimes presents extraskeletal involvement, with the epidural location being rare. We report the case of a 45-year-old woman with paresthesia, paresis and urinary retention. Magnetic resonance imaging showed an epidural mass from C6 to D3. Laminectomy from C7 to D2 and partial resection of the lesion was performed. Pathological analysis was consistent with Ewing sarcoma. The patient received chemotherapy and radiotherapy, without evidence of disease at 8 months follow-up. A review of the literature on all published cases of extraskeletal Ewing sarcoma with epidural involvement is presented.