Relevancia de la PET/TC con [18F]FDG en la detección de enfermedad localizada en el colon en pacientes estudiados por bacteriemia o endocarditis infecciosa causadas por microorganismos enteropatógenos / Relevance of [18F]FDG-PET/CT in the detection of colon pathology in patients studied by bacteriemia or infectious endocarditis caused by enteropathogenic microorganisms

Objetivo La asociación entre la endocarditis infecciosa (EI) por Streptococcus gallolyticus y las lesiones malignas del tracto gastrointestinal está bien descrita. Asumimos que otros microorganismos enteropatógenos, como el Streptococcus viridans y Enterococcus faecalis también pueden estar relacionados con la enfermedad colorrectal. Nuestro objetivo fue determinar la frecuencia de depósitos focales de la [18F]FDG en localización colorrectal, sugestivos de lesiones tumorales, y su correlación con la enfermedad de colon y recto en pacientes con infección causada por diferentes microorganismos comensales del tracto gastrointestinal. Métodos Examinamos retrospectivamente 61 pacientes con diagnóstico de bacteriemia y de EI (posible o concluyente) según los criterios de Duke y causada por microorganismos enteropatógenos, y que fueron sometidos a una PET/TC de cuerpo entero con [18F]FDG en nuestra institución. Buscamos depósitos de la [18F]FDG en localización colorrectal, así como la presencia de lesiones morfológicas. A todos los pacientes con EI se les realizó una colonoscopia completa y los resultados histológicos se clasificaron según 4 grupos: lesión maligna, lesión premaligna, lesión benigna y ausencia de lesión. Se evaluó la correlación existente entre los hallazgos de la PET/TC con [18F]FDG y el diagnóstico histopatológico y el microorganismo implicado. Resultados La PET/TC detectó 20 depósitos de [18F]FDG en localización colorrectal (32,79%-OR: 47,28), 2 de ellos en pacientes con bacteriemia (16,7%) confirmados como lesiones malignas y premalignas y 18 en el grupo con EI (36,6%), 17 de ellos correspondientes a enfermedad colorrectal: 11 lesiones malignas, 5 premalignas y una benigna. En el subgrupo con EI la colonoscopia detectó lesiones colorrectales en el 51,02% de los pacientes: 11 malignas, 8 premalignas y 6 benignas. En el subgrupo de Streptococcus spp. se detectó una mayor incidencia de depósitos de [18F]FDG en localización colorrectal (AU)

Objective Association between Streptococcus gallolyticus infective endocarditis (IE) and malignant lesions of the gastrointestinal tract is well described. We hypothesize that other enteropathogenic microorganisms, such as Streptococcus viridans and Enterococcus faecalis are also related with colorectal pathology. Our aim is to determine the frequency of focal colorectal FDG deposits, suggestive of tumoral lesions and their correlation with colorectal pathology, in patients with infection caused by different commensal microorganisms of the gastrointestinal tract. Methods We retrospectively examined 61 patients diagnosed with bacteremia (BSI) and IE (possible or definite) according to Duke's criteria, caused by enteropathogenic microorganisms, who underwent a full-body [18F]FDG-PET/CT in our institution. We looked for colorrectal FDG deposits and morphological lesions. All IE patients underwent a complete colonoscopy and the histological results were classified into four groups: malignant lesion, premalignant lesion, benign lesion and no lesion. We evaluated the correlation between the findings of the [18F]FDG-PET/CT with the histopathological diagnosis and the involved microorganism. Results PET/CT detected 20 colorectal FDG deposits (32.79%-OR: 47.28), 2 within bacteriemic patients (16.7%) confirmed as malignant and premalignant lesions and 18 in IE group (36.6%), 17 of them corresponding to colorrectal pathology: 11 malignant, 5 premalignant and 1 benign lesions. In the IE subgroup, the colonoscopy detected colorectal lesions in 51.02% of the patients: 11 malignant, 8 premalignant and 6 benign. We found a higher incidence of colorectal FDG deposits in Streptococcus spp. subgroup. Regarding the anatomopathological colonic findings there was a predominance of patients affected by S. viridans, followed by E. faecalis and S. gallolyticus (AU)

Enfermeras comunitarias, cuidamos personas, gestionamos cuidados / Community nurses, we care people, we manage care

Este artículo reflexiona sobre la Gestión de Cuidados y la atención a las personas que realizan las enfermeras comunitarias; su aportación y valor, tanto para la profesión como para la sociedad. A lo largo de los casi 40 años de la Atención Primaria, las enfermeras comunitarias han logrado un gran desarrollo de la profesión y de sus competencias (nivel universitario, especialización, prescripción). Sin embargo, todavía quedan pendientes cuestiones como regular las competencias enfermeras, el reconocimiento social del trabajo que se realiza, así como ocupar una posición visible y de manera continuada en la política de los sistemas de salud. En esa dirección se debe trabajar ahora para intentar dar respuesta a las necesidades actuales de la población que nada tienen que ver con las de hace unas décadas.comienza un tiempo de cambio para la Atención Primaria y las enfermeras comunitarias debemos liderarlo

This article reflects on the Care Management and the attention to the people who carry out the community nurses, their contribution and value both for the profession and for society. Throughout the almost 40 years of Primary Care, community nurses have achieved a great development of the profession and its competences (university level, specialization, prescription). However, there are still outstanding issues such as regulating nursing competencies, social recognition of the work being done as well as occupying a visible and continuous position in the health systems policy. In that direction we must work now to try to respond to the current needs of the population, that have nothing to do with those of a few decades ago. A time of change for Primary Care begins and community nurses must be leading it

Downstaging de carcinoma hepatocelular bilobar tras radioembolización con microesferas de 90Y como puente al trasplante hepático / Downstaging of bilobar hepatocellular carcinoma after radioembolization with 90Y microspheres as a bridge to liver transplantation

La radioembolización hepática con 90Y es una terapia locorregional cada vez más ampliamente empleada en el tratamiento del carcinoma hepatocelular. Recientemente, se ha descrito su potencial beneficio como tratamiento de downstaging, logrando una disminución de la carga tumoral que permite rescatar a los pacientes para tratamientos más radicales como el trasplante hepático. Presentamos el caso de un paciente con el diagnóstico de carcinoma hepatocelular estadio intermedio de la Barcelona Clinic Liver Cancer (BCLC), multicéntrico y bilobar, en quien el tratamiento de radioembolización con 90Y consiguió una adecuada respuesta radiológica, reduciéndose de forma muy significativa la carga tumoral, permitiendo su rescate con trasplante hepático (AU)

Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation (AU)

Downstaging of bilobar hepatocellular carcinoma after radioembolization with 90Y microspheres as a bridge to liver transplantation. / Downstaging de carcinoma hepatocelular bilobar tras radioembolización con microesferas de 90Y como puente al trasplante hepático.

Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.

Neuraxial analgesia in a pregnant woman with Fowler's syndrome and sacral neuromodulation.

We report the anesthetic management of a 16-year-old woman with Fowler's syndrome who became pregnant three years after sacral neuromodulation was initiated for treatment of the condition. Multidisciplinary consensus was to switch off the neurostimulator during pregnancy, and attempt vaginal delivery with a neuraxial block. When the patient was admitted for labor, an epidural catheter was placed successfully. The patient had a normal vaginal delivery. Sacral neuromodulation was restarted uneventfully in the early puerperium and the Fowler's syndrome remains well controlled. The baby continues to develop normally three years after delivery.

Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral? / A prospective study to determine the real value of mesenteric 18F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?

Objetivo. Determinar el comportamiento metabólico de la paniculitis mesentérica (PM), los posibles patrones de presentación en la imagen 18F-FDG-PET/TAC y conocer si es una técnica diagnóstica fiable para diferenciar enfermedad tumoral y patología inflamatoria en este contexto. Material y métodos. Dos mil seiscientas sesenta y seis exploraciones PET/TAC fueron evaluadas de forma prospectiva desde abril de 2012 hasta agosto de 2013. Se incluyeron en nuestro estudio a 30 pacientes (37 exploraciones) que presentaban signos radiológicos de PM, 8 mujeres y 22 hombres, con edades comprendidas entre 39 y 81 años. Según la captación de 18F-FDG en las lesiones mesentéricas, expresado como SUVmax, los pacientes fueron clasificados en dos grupos: Grupo A: conformado por 10 pacientes con captación aumentada, SUVmax ≥ 2 o superior a la actividad hallada en el tejido mesentérico sano circundante y Grupo B (conformado por 20 pacientes): SUVmax < 2 o indistinguible del tejido sano. Resultados. En el 80% de los pacientes del Grupo A (media de SUVmax 7,11) no se demostraron criterios de afectación tumoral mesentérica durante un seguimiento medio de 13 meses (falsos positivos), exceptuando a dos pacientes de este grupo que sí mostraron signos de afectación tumoral (SUVmax 7,57 y 9,46), obteniéndose un valor predictivo positivo de 49,79%. En el 100% de los pacientes del Grupo B se confirmó ausencia de afectación tumoral mesentérica. Conclusiones. Ante la presencia de signos radiológicos de PM, un aumento del metabolismo glucídico, incluso intenso y focal en estas lesiones, aunque no excluye la posibilidad de afectación tumoral, puede corresponder, con una alta probabilidad, a actividad inflamatoria (AU)

Aim. To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in 18F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. Material and methods. A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the 18F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax < 2 or indistinguishable from healthy tissue. Results. No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. Conclusions. The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity (AU)

[A prospective study to determine the real value of mesenteric ¹8F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?]. / Estudio prospectivo para determinar el valor real de la captación de ¹8F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.

Utilidad de la cirugía radioguiada en la esplenosis / Utility of radioguided surgery in splenosis

La esplenosis es un hallazgo frecuente tras las la rotura traumática del bazo o esplenectomía terapéutica, definiéndose como un autotrasplante heterotópico del bazo por la superficie y cavidad peritoneal. En pacientes esplenectomizados por enfermedad hematológica, la esplenosis puede llevar a recidiva de la enfermedad. Presentamos un caso de esplenosis en un paciente con púrpura trombocitopénica idiopática (PTI) que presentó una recidiva tras esplenectomía. Para su localización se realizaron pruebas de imagen convencional y gammagrafía con hematíes desnaturalizados marcados con 99mTc, donde se apreciaron al menos 5 focos esplénicos. Dada la difícil localización intraoperatoria de dichos nódulos, se practicó cirugía radioguiada, con excelente localización y extirpación de los nódulos conocidos y de múltiples implantes peritoneales de tamaño milimétrico no visualizados previamente. Concluimos que la cirugía radioguiada es una excelente herramienta para la localización de focos de esplenosis peritoneal de difícil acceso y visualización, evitando así una recurrencia precoz de la enfermedad (AU)

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with 99mTc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease (AU)

[Utility of radioguided surgery in splenosis]. / Utilidad de la cirugía radioguiada en la esplenosis.

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.

[Usefulness of 18F-FDG PET-CT in the presurgical assessment of malignant pleural mesothelioma treated with neoadjuvant chemotherapy]. / Utilidad de la PET-TAC 18F-FDG en la valoración prequirúrgica del mesotelioma pleural maligno tras quimioterapia neoadyuvante.

Malignant pleural mesothelioma is a relatively rare, but highly aggressive, tumor, associated to exposure to asbestos, with a life expectancy between 9 and 17 months. Chest pain and dyspnea are the most frequent symptoms. The most commonly used therapy is surgery accompanied by chemotherapy. Preoperative assessment, after chemotherapy, has been done using magnetic resonance imaging and computed tomography (CT). However, these techniques cannot predict early response to therapy, because of the slow structural change of the tumor. The aim of this case report is to review and learn about the growing use of PET-CT imaging with (18)F-FDG in the preoperative staging of malignant pleural mesothelioma and its influence in selecting the most appropriate type of surgery.

Análisis de la rotación del implante femoral en prótesis de rodilla con navegación / Analysis of femoral implant rotation in computerized navigation guided knee arthroplasty

Objetivo. Valorar la línea condílea posterior como referencia, en los 23 casos intervenidos de artroplastia total de rodilla con modelo Natural II durante el año 2003-2004, con sistema de navegación Navitrack (Centerpulse). Material y Métodos: Estudio prospectivo en una serie consecutiva de 23 casos de artrosis de rodilla. Se ha revisado la muestra siguiento el programa Orthocom: sexo, edad, lado, diagnóstico, alineación preoperatoria (eje anatómico), Ahlbäck, técnica quirúrgica. Se han analizado las medidas realizadas con el sistema Navitrack en cuanto a la línea condílea posterior (LCP), línea epicondílea (LE), y línea de Whiteside ó anteroposterior (LAP). Se analiza el ángulo LE-LCP con referencia la LCP (11 casos), en 3 casos fracasa la misma, encontrando una distorsión del ángulo LAP-LE. Tomando como referencia la LAP (12 casos), en 6 casos hay desviación del ángulo LE-LCP. Conclusiones: Con la cirugía protésica de rodilla asistida con navegador vamos a personalizar las referencias anatómicas que van a determinar la rotación femoral. Nos permite colocar la rotación deseada, sin limitaciones de posición propios de la instrumentación manual. Tenemos que pensar que existe una gran variabilidad anatómica. Existe una gran controversia en cuantoa qué referencia anatómica se utiliza para determinar la rotación femoral. Se ha demostrado que la línea AP es la referencia morfológica que menos varía, y tambie´n un buen punto para controlar el centraje rotuliano

Objectives: The purposeof this study was to review the posterior condylar line as a reference, in 23 patients with total knee arthroplasty Natural II between 2003 and 2004, by surgical navigation system Navitrack (Centerpulse). Material and Methods: Prospective analysis of 23 consecutive patients who underwent knee arthroplasty. We reviewed the cases following the Othocom database: sex, age, side, pathology, the preoperative anatomical axis, Ahlbäck, surgical technique. We have studied the references obtained by the Navitrack: posterior condylar line (LCP), transepicondylar line (LE) and the anteroposterior (LAP) or Whiteside line. We measured the LE-LCP angle following the LAP reference and the LAP-LE angle following the LCP reference. Results: Following the LCP reference (11 cases), in 3 cases it is not a reliable reference with a LAP-LE angle distorted. Following the LAP referente (12 cases), in 6 cases the LE-LCP angle was desviated. Conclusions: With the use of surgical navigation in knee arthroplasty we are going to personalize the anatomic references that help us to navigation in knee arthroplasty we are going to personalize the anatomic references that help us to determine the correct rotational alignment of the femoral component. We can choose the rotation that we want without the limitations of the position of manual instrumental alignment. The shape of the distal femur varies among individuals. To choise an anatomical reference to determine the correct femoral component rotational alignment is controversial. The results suggest that the AP line is a more reproducible landmark and a good point to optimise the patellofemoral kinematics

Osteosíntesis de fracturas del fémur distal con placas LISS / Distal femoral fractures; treatment with less invasive stabilitation system (L. I. S. S.)

Las fracturas del fémur distal son complejas en su tratamiento y asocian múltiples complicaciones evolutivas com pseudoartrosis, callos viciosos, gonartrosis o infección secundaria a cirugía abierta agresiva, por lo que han surgido las osteosíntesis mínimamente invasivas dentro de las cuales se sitúa la placa LISS. Analizamos los resultados tras 10 meses de seguimiento de 14 pacientes con fractura del fémur distal tratados con placa LISS. Los tiempos de consolidación no fueron muy divergentes respecto a series mayores, la incidencia de retrasos de consolidación y callos viciosos, baja. No hubo pseudoartrosis, fracasos del material, aflojamientos, infecciones, tromboembolismos ni algodistrofias. Por ello, consideramos que los resultados obtenidos con este implante son satisfactorios

The treatment of the distal femoral fractures is difficult in order to the surgery and múltiple complications, like pseudoartrosis,c allus vicious, gonartrosis or infection because open surgery. So that it has arised the minimun invasive system of osteosynthesis like LISS plate. We have assessed outcomes in 14 patients with distal femoral fractures treated with that implant. The mean follow up was 10 months. The times of consolidation was similar than other bigger series of patients and low incidence of delayed consolidation and callus vicious. There has not been any case of pseudoartrosis, failure of implant, loosenin, infections, tromboembolism or algodystrophia, so that considered that we has obtained good results

Análisis de la rotación del implante femoral en prótesis de rodilla con navegación / Analysis of femoral implant rotation in computerized navigation-guided knee arthroplasty

Objetivo. Valorar la línea condílea posterior (LCP) como referencia, en 23 casos intervenidos de artroplastia total de rodilla. Material y método. Estudio prospectivo en una serie consecutiva de 23 casos de artrosis de rodilla. Se analizaron las medidas realizadas con un sistema de navegación de la LCP, línea epicondílea (LE) y línea de Whiteside o anteroposterior (LAP), y el ángulo LE-LCP con referencia LAP y el ángulo LAP-LE con referencia LCP. Resultados. Tomando como referencia la LCP (11 casos), en tres casos fracasó, encontrando una distorsión del ángulo LAP-LE. Tomando como referencia la LAP (12 casos), en 6 casos hubo desviación del ángulo LE-LCP. Conclusiones. Con la cirugía protésica de rodilla asistida con navegador vamos a personalizar las referencias anatómicas que van a determinar la rotación femoral. Nos permite colocar la rotación deseada, sin limitaciones de posición propias de la instrumentación manual. Tenemos que pensar que existe una gran variabilidad anatómica. Existe una gran controversia en cuanto a qué referencia anatómica se utiliza para determinar la rotación femoral. Se ha demostrado que la LAP es la referencia morfológica que menos varía, y también un buen punto para controlar el centraje rotuliano

Aim. To assess the posterior condylar line as an anatomic reference in 23 patients who underwent total knee arthroplasty. Materials and methods. Prospective study of a consecutive series of 23 patients with knee osteoarthritis. Measurements made with a computerized navigation system of the posterior condylar line (PCL), epicondylar line (EL), Whiteside or anteroposterior line (APL), EL-PCL angle with reference to APL, and APL-EL angle with reference to PCL were analyzed. Results. With reference to the PCL (11 patients), arthroplasty failed in three patients, resulting in distortion of the APL-EL angle. With reference to APL (12 cases), 6 patients showed deviation of the EL-PCL angle. Conclusions. Computerized navigation-assisted knee arthroplasty makes it possible to personalize the anatomic references determining femoral rotation. It allowed us to position the target rotation with none of the positioning limitations typical of manual instrumentation. We must take into consideration the importance of anatomic variability. The anatomic reference to be used to determine femoral rotation is under debate. It has been shown that APL is the morphologic reference with the least variation, and a good reference for controlling patellar centering