Fractura de cuerpo cavernoso: la ecografía en el diagnóstico de urgencia / Corpus cavernosum fracture: the ultrasound in the emergency diagnosis

Objetivo. Valorar la utilidad de los hallazgos ecográficos en la sospecha de fractura de pene. Material y métodos. Se revisan las ecografías de pene realizadas en urgencias entre julio de 2007 y agosto de 2009 por sospecha clínica de fractura del cuerpo cavernoso, comparando los hallazgos ecográficos (hematoma subcutáneo, hematoma perialbugínea, rotura de la albugínea y rotura de la fascia de Buck) con los quirúrgicos, y la evolución a medio plazo. Se calculan sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los hallazgos ecográficos para el diagnóstico de fractura del cuerpo cavernoso. Recogemos datos epidemiológicos de los casos revisados. Resultados. Se estudiaron a 12 pacientes, con edad media de 35,75 años. El origen más frecuente de la lesión es el traumatismo durante el acto sexual. Ecográficamente, presentaron un hematoma subcutáneo 9 pacientes, perialbugínea 11 sujetos y discontinuidad de la albugínea 6 pacientes. No se visualizaron roturas de la fascia de Buck. Siete fueron operados. En los 5 sujetos restantes se realizó manejo conservador. La evolución fue siempre satisfactoria. La identificación mediante ecografía de la discontinuidad de la albugínea mostró una S de 0, 83, E de 1, VPP de 1 y VPN de 0,83. Conclusión. Consideramos la ecografía como un procedimiento útil para diagnosticar la fractura de cuerpo cavernoso y que se puede proponer como de elección para confirmar la sospecha clínica. La identificación del punto exacto de rotura dirige y facilita la cirugía(AU)

Objective. The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. Material and methods. We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous haematoma, peri-albuginea haematoma, albuginea rupture and Buck¿s fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. Results. Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous haematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Buck¿s fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. Conclusion. We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure(AU)

[Corpus cavernosum fracture: the ultrasound in the emergency diagnosis]. / Fractura de cuerpo cavernoso: la ecografía en el diagnóstico de urgencia.

OBJECTIVE: The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. MATERIAL AND METHODS: We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous haematoma, peri-albuginea haematoma, albuginea rupture and Bucks fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. RESULTS: Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous haematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Bucks fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. CONCLUSION: We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure.

[Symptomatic paroxysmal dystonia (non-kinesigenic forms): two new cases]. / Distonía paroxística sintomática (variedad acinesigénica): dos nuevos casos.

We report two new cases of symptomatic paroxysmal non-kinesigenic dystonia. The first is a 68-year-old woman with paroxysmal spontaneous dystonic spasms in her right arm lasting 1 minute. They occurred 1-2/day, a few months after a cerebral infarction (left internal capsule and left lenticular nucleus) which occurred 6 years ago. The second is a 30-year-old woman with a 7-year-history of spontaneous dystonic postures (flexion spasms) in her left arm lasting 15 minutes and occurring monthly. In this case an Arnold-Chiari malformation with cervical syringomyelia was discovered.

[Idiopathic cervical plexopathy]. / Plexopatía cervical idiopática.

We describe a 26 year-old woman with cervical plexopathy with damage of left superficial or cutaneous branches, and left cervical sensory dorsal rami. Picture began acutely and vanished few days later. We ruled out known etiologies like traumatisms, tumours and surgical and anaesthetic complicated procedures, therefore the patient suffered an idiopathic cervical plexopathy. We hypothesize two possibilities for this clinical picture: an autoimmune reaction or a muscular entrapment.