Síndrome de 'hubris' en neurocirugía. Réplica / Hubris syndrome in neurosurgery. Reply

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Diverse Behavior in 18F-Fluorocholine PET/CT of Brain Tumors in Patients With Neurofibromatosis Type 1.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that causes CNS tumors in around 20% of patients, being pilocytic astrocytomas (PA), and particularly optic pathway gliomas (OPG), the most common. We present three cases of NF1 patients referred for F-fluorocholine PET/CT because of suspected glioma in the setting of ongoing FUMEGA (Functional and Metabolic Glioma Analysis) trial. One case turned out to be a WHO grade I ganglioglioma; the second was a high grade glioma; and the last one (negative in PET) a probable low-grade glioma.

Síndrome de "Hubris" en neurocirugía / Hubris syndrome in neurosurgery

Introducción. El síndrome de "hubris" (SH) es un trastorno psiquiátrico adquirido que afecta a personas que ejercen el poder en cualquiera de sus formas. Se ha descrito en multitud de campos, desde la política a las finanzas. La relación médico-paciente también es una relación de poder. La falta de humildad y empatía en su ejercicio puede hacer que cualidades como la confianza y seguridad en uno mismo se transformen en soberbia, arrogancia y prepotencia características del médico con SH. Objetivos. Identificar los síntomas del SH en el entorno médico que faciliten su diagnóstico y ayudar a las organizaciones sanitarias a anticipar y mitigar sus consecuencias. Desarrollo. Se analizan los criterios diagnósticos del SH descritos inicialmente en mandatarios políticos con responsabilidades de gobierno, y se trasladan al ámbito médico neuroquirúrgico. Se describen dos formas de SH médico y se proponen diez criterios diagnósticos válidos para cualquier relación médico-paciente. Conclusiones. El SH es un trastorno psiquiátrico adquirido desencadenado por el poder y potenciado por el éxito, fácilmente reconocible a diario en facultativos de nuestro entorno más próximo. Es necesario identificar precozmente estas conductas médicas para mitigar sus consecuencias

Introduction. Hubris syndrome (HS) is an acquired psychiatric disorder that affects people who exercise power in any of its forms. It has been reported in many fields, from politics to finance. The physician-patient relationship is also one of power. A lack of humbleness and empathy in this situation can lead to qualities such as self-confidence and self-assurance becoming pride, arrogance and high-handedness, which characterise a doctor suffering from HS. Aims. To identify the symptoms of HS in the medical setting that make it easier to diagnose and to help healthcare organisations anticipate and mitigate its consequences. Development. The diagnostic criteria for HS initially reported in political leaders with government responsibilities are analysed and transferred to the medical field of neurosurgery. Two forms of medical HS are described and ten diagnostic criteria are proposed that are valid for any physician-patient relationship. Conclusions. HS is an acquired psychiatric disorder that is triggered by power and enhanced by success, and can easily be observed on a daily basis in physicians working in settings that are very close to us. Early identification of these medical behaviours is necessary to be able to mitigate their consequences

Lo que puede esconder una meralgia parestésica: tumor renal como causa infrecuente / What meralgia paresthetica can hide: renal tumor as an infrequent cause

La meralgia parestésica es una mononeuropatía del nervio femorocutáneo con una presentación clínica característica, usualmente secundaria a lesión o atrapamiento en algún punto de su recorrido, siendo más habitual las producidas a nivel inguinal. Sin embargo, se publican casos excepcionales asociados a compresiones originadas por masas ocupantes de espacio a nivel retroperitoneal, por lo que se debería ampliar su estudio con pruebas de imagen ante dicho cuadro clínico. A continuación presentamos un caso asociado a un tumor renal(AU)

Meralgia paresthetica is a mononeuropathy of the femoral cutaneous nerve with characteristic findings, usually secondary to injury or compression, being most common in the inguinal area. Exceptional cases associated with compressions caused by abdominal or pelvic tumors have been published, so it is always advisable to extend the study with imaging tests. We present a case associated with a renal tumor(AU)

What meralgia paresthetica can hide: renal tumor as an infrequent cause.

Meralgia paresthetica is a mononeuropathy of the femoral cutaneous nerve with characteristic findings, usually secondary to injury or compression, being most common in the inguinal area. Exceptional cases associated with compressions caused by abdominal or pelvic tumors have been published, so it is always advisable to extend the study with imaging tests. We present a case associated with a renal tumor.

Cierre primario en ROG. Colgajos e injertos mucogingivales / Primary closure in GBR. Mucogingival flaps and grafts

La regeneración ósea guiada (ROG), es el proceso mediante el cual intentamos inducir la regeneración del tejido óseo en una zona que ha sufrido una pérdida del mismo. Se basa en el principio de exclusión celular cuyo objetivo es mantener al margen de un defecto óseo a las células del epitelio y el conectivo gingival. La colonización de estas células ocurre de forma mucho más rápida que la llevada a cabo por los osteoblastos. Mantener dichas células al margen permite que esa zona "vacía" se rellene de tejido óseo y no de epitelio y conectivo gingival. El principio de exclusión celular exige una serie de condiciones entre las que se encuentra el cierre primario de la herida. Para garantizar dicho cierre, tenemos una serie de pautas a seguir que garanticen la aproximación pasiva de los márgenes de la herida: una forma determinada de realizar las incisiones, unos diseños concretos de colgajos o injertos y formas de suturarlos específicas. Es el cumplimiento de dichas pautas, lo que hace de la ROG un tratamiento de éxito predecible (AU)

Guided Bone Regeneration (GBR) is the process by which we try to induce the regeneration of bone tissue in an area that has suffered bone loss. It is based on the cellular exclusion principle, the objective of which is to keep epithelium cells and the cells of gingival connective tissue away from bone defects. The colonisation of these cells occurs much more rapidly than by osteoblasts. Keeping the cells away allows this "empty" area to be filled with bone tissue and not with epithelium and gingival connective tissue. The cellular exclusion principle requires a series of conditions including the primary closure of the wound. To guarantee closure, there are a series of guidelines that must be followed to ensure the passive approximation of the edges of the wound: a specific way of making the incisions, specific designs of flaps and grafts, and specific ways to suture them. Compliance with these guidelines shall ensure the success of the GBR treatment (AU)

Juvenile mycosis fungoides treated with bexarotene and PUVA.

A 14-year-old Caucasian boy presented with a 4-month history of a slightly pruritic eruption that began on the hips and later extended to the trunk and upper and lower limbs. The patient did not present fever, weight loss, or asthenia. Physical examination revealed multiple, red, desquamative, oval patches with areas of healthy skin between them, which covered nearly 50% of the body surface area. The palms, soles, face, and mucosa were not affected. In addition, he presented two violet-colored infiltrated plaques on the left thigh and right buttock (Fig. 1). There were multiple, > 1 cm, freely mobile, axillary and inguinal nodes. In follow-up, the patient developed two red-colored, mobile, well-delimited cutaneous nodules of 2.5 cm in diameter in the right hemithorax and lumbar area. The lumbar nodule regressed spontaneously before treatment. The clinical diagnosis was mycosis fungoides. We obtained three skin biopsies, one from a patch lesion and the others from a nodule; the third was sent to a reference hospital to determine the rearrangement. Histologic examination was similar in the three biopsies and revealed an atypical lymphoid infiltrate in the superficial dermis with epidermotropism and a tumoral nodule of atypical, small-sized lymphocytes in the deep dermis and subcutaneous level (Fig. 2). The atypical infiltrate was CD3+, CD4+, CD8-, T-cell intracellular antigen (TIA)+/-, Epstein-Barr-encoded RNA (EBER)-, and CD56-. The biopsy of one left axillary adenopathy was compatible with mycosis fungoides (Fig. 3). Amongst the additional tests carried out was a blood analysis showing 5300 leukocytes (neutrophils, 35%; lymphocytes, 40.7%; monocytes, 16.8%; eosinophils, 6.40%) without Sézary cells, normal lactate dehydrogenase (LDH), immunoglobulin E (IgE) of 497 U/mL (normal, 3-100 U/mL), and beta2-microglobulin of 3.09 mg/L (normal, 1.64 +/- 0.58 mg/L). A bone marrow study and a thoraco-abdomino-pelvic scan were normal. The rearrangement in the skin was monoclonal, whereas in peripheral blood and lymph nodes it was polyclonal. With the diagnosis of mycosis fungoides stage IVA (according to the TNM classification), treatment was initiated with psoralen plus ultraviolet light A (PUVA), three times a week, plus oral bexarotene at a dose of 300 mg/m2/day. The parents were informed that this treatment was not approved for this age group and informed consent was obtained. The clinical tolerance to bexarotene was very good, although low doses of atorvastatin (10 mg/day) and 75-100 mg of thyroxine were needed to control the expected adverse reactions to oral retinoid. After 32 sessions of PUVA and 6 months of treatment with oral bexarotene, the skin patches regressed, except for the plaque on the left buttock and the nodule on the right hemithorax (Fig. 4). There was no evidence of lymphadenopathy clinically or via sonographic evaluation. Bexarotene was discontinued after patient clearance and resolution of adenopathies. Nevertheless, 5 months after discontinuation of oral treatment, the patient developed multiple, scaling, nonconfluent macules on the trunk and arms affecting almost 30% of the body surface area, which disappeared with the application of methylprednisolone aceponate. He did not present significant lymphadenopathies.

Preparaciones digitales en los servicios de Anatomía Patológica (II). Análisis de soluciones existentes / Digital slides in Pathology Departments (II). An analysis of existing solutions

Introducción: Las soluciones tecnológicas para la realización de preparaciones digitales son muy diversas y se pueden clasificar en dos grandes grupos: microscopios robotizados y escáneres. Comparación entre sistemas: En este artículo, se comentan los aspectos técnicos que ofrecen 28 sistemas de microscopía digital (microscopios robotizados o escáneres) disponibles en el mercado. Se describen las características más relevantes de los dispositivos de escaneado, las cámaras empleadas, la velocidad y calidad de las imágenes, los tipos de ficheros y compresión y las soluciones de visualización de preparaciones digitales, incluyendo herramientas de ayuda al diagnóstico. Conclusiones: La mayoría de las soluciones permiten digitalizar una preparación completa, con un objetivo 40x y con la calidad máxima en, aproximadamente, una hora. La calidad de imagen que ofrecen los sistemas actuales es adecuada para fines asistenciales, docentes y de investigación (AU)

Introduction: The technological solutions for whole slide scanning are very diverse and they have been classified into motorized microscopes and scanners. Comparison of existing systems: This article describes technical aspects of 28 different digital microscopy systems. The most relevant characteristics of the scanning devices are described, including the cameras used, the speed of digitization and the image quality. Other aspects, such as the file format, the compression techniques, and the solutions for visualization of digital slides, including diagnosis-aided tools are also taken into consideration. Conclusions: Most of the analyzed systems allow digitizing a complete slide using with a 40x objective, with the best quality available in, approximately, an hour. The image quality of the current virtual microscopy systems is suitable for clinical, educational and research purposes (AU)

Xantomas planos normolipémicos y micosis fungoide / Normolipemic plane xanthomas and mycosis fungoides

Los xantomas planos difusos normolipémicos se caracterizan por la presencia de placas amarillentas en párpados, cuello, parte superior del tronco, glúteos y flexuras. En la histología se objetivan histiocitos espumosos en la dermis. Aproximadamente la mitad de los casos se asocia a trastornos hematológicos. Raramente se han descrito en el contexto de linfomas cutáneos de células T. Presentamos el caso de una paciente con micosis fungoide tumoral que desarrolló xantomas planos normolipémicos coincidiendo con la aparición de nuevas lesiones de linfoma. Revisamos la literatura inglesa sobre la rara asociación de xantomas y linfomas cutáneos de células T

Diffuse normolipemic plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks and flexures. Histology shows foamy histiocytes in the dermis. Approximately half of all cases are associated with hematological disorders. On rare occasions, they have been described in the context of cutaneous T-cell lymphomas. We present the case of a female patient with tumor-stage mycosis fungoides who developed normolipemic plane xanthomas coinciding with the appearance of new lymphoma lesions. We review English-language literature regarding the rare association of xanthomas and cutaneous T-cell lymphomas

Preparaciones digitales en los servicios de Anatomía Patológica (I). Aspectos básicos de imagen digital / Digital slides in Pathology Departments (I). A review of basic aspects in digital imaging

La digitalización total de preparaciones microscópicasde citologías, biopsias y autopsias es una realidad hoy día,gracias a los avances en los sistemas informáticos. Esta evoluciónhacia la imagen digital conlleva la necesidad de disponerde conocimientos básicos de esta nueva forma de gestionarla imagen médica. Estos conocimientos permiten alpatólogo comprender mejor el funcionamiento de los llamadossistemas de microscopía virtual. En este artículo se revisanlos aspectos de imagen digital relacionados con la calidadde las preparaciones virtuales o digitales, como ladimensión en píxeles, resolución espacial, tamaño de ficheros,sistema de compresión, formatos de fichero y rangodinámico. Se concluye que el uso eficaz de la microscopíadigital tendrá importantes beneficios en los servicios deAnatomía Patológica

The development of complete slide digitization systemsin Pathology has become possible thanks to recent advancesin computing systems. The efficient use of these digital slidesystems can be achieved with a basic knowledge of digitalimaging. This article reviews the main concepts relatedto quality in Pathology virtual slide images, such as imagesize in pixels, spatial resolution, file size, compressionmethods, file formats, and dynamic range. It is concludedthat the efficient use of digital microscopy can offer importantbenefits to Pathology departments

[Normolipemic plane xanthomas and mycosis fungoides]. / Xantomas planos normolipémicos y micosis fungoide.

Diffuse normolipemic plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks and flexures. Histology shows foamy histiocytes in the dermis. Approximately half of all cases are associated with hematological disorders. On rare occasions, they have been described in the context of cutaneous T-cell lymphomas. We present the case of a female patient with tumor-stage mycosis fungoides who developed normolipemic plane xanthomas coinciding with the appearance of new lymphoma lesions. We review English-language literature regarding the rare association of xanthomas and cutaneous T-cell lymphomas.

Varón diabético con insuficiencia respiratoria e infiltrados alvéolointersticiales bilaterales / Respiratory insufficiency with bilateral alveolo-interstitial infiltrates in a diabetic male

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