[Prophylaxis and treatment of respiratory distress syndrome with different surfactants]. / Profilaxis y tratamiento del síndrome de distrés respiratorio con diferentes surfactantes.

BACKGROUND: Etiological treatment of respiratory distress syndrome due to lung immaturity with exogenous surfactant is of proven efficacy. However, it is not clear whether all the exogenous surfactants available, both natural and synthetic, are of equal efficacy. OBJECTIVE: To evaluate whether there is any evidence to support the efficacy of one exogenous surfactant over that of the others in the prophylaxis and treatment of respiratory distress syndrome. METHODS: To identify all the comparative studies of tensoactive compounds, an intensive bibliographic search was performed in several databases. RESULTS: Data was found to corroborate that natural surfactants improve oxygenation more rapidly than synthetic surfactants. Natural surfactants also have lower complication and mortality rates. Of the two natural surfactants available in Spain, the porcine-derived surfactant (poractant-alfa) seems to present some advantages over the bovine-derived surfactant (beractant), such as faster action, expressed as a more favourable PaO2/PAO2 ratio during the first 24 hours of treatment. There is also a trend indicating that newborns treated with porcine surfactant have a lower overall mortality rate (3 %) compared with those treated with bovine surfactant (12.5 %). CONCLUSION: No scientific evidence supports the current use of commercialised synthetic surfactants. The porcine-derived surfactant can be considered as the preparation of choice, although additional studies confirming this finding would be useful.

Profilaxis y tratamiento del síndrome de distrés respiratorio con diferentes surfactantes / Prophylaxis and treatment of respiratory distress syndrome with different surfactants

Antecedentes: El tratamiento etiológico del síndrome de distrés respiratorio (SDR) por inmadurez pulmonar con surfactante exógeno es una estrategia de demostrada eficacia. Sin embargo, la eficacia relativa de los diversos preparados tensiactivos, de origen natural o sintético, puede no ser similar. Objetivo: Evaluar si existe evidencia de que algún preparado o preparados tensiactivos puede considerarse más eficaz en el tratamiento y profilaxis del SDR. Métodos: Se realizó una búsqueda bibliográfica pormenorizada en las diversas bases de datos existentes, para identificar todos los estudios comparativos entre los diversos preparados tensiactivos. Resultados: Existen datos que corroboran que los surfactantes de origen natural producen una más rápida mejoría de la oxigenación, en comparación a los de origen sintético. También se ha observado una menor tasa de complicaciones y de mortalidad con el empleo de surfactantes naturales. De los dos surfactantes naturales comercializados en España, el de origen porcino (poractant alfa) parece presentar ventajas sobre el de origen bovino (beractant), como es una mayor rapidez de actuación, expresada en una relación PaO2/PAO2 más favorable, en las primeras 24 h de tratamiento. Existe también una tendencia a que los enfermos tratados con surfactante porcino tengan una menor tasa de mortalidad global (3%) frente a los tratados con surfactante bovino (12,5%).Conclusión: No existe razón científica alguna que apoye el uso de los surfactantes sintéticos comercializados en la actualidad. El surfactante natural de origen porcino podría considerarse de primera elección, si bien sería conveniente disponer de estudios adicionales que confirmaran este hecho (AU)

[Profile of health professionals from Lleida regarding health education]. / Perfil de los profesionales de la salud de Lleida respecto a la educación para la salud (EpS).

OBJECTIVE: To know the health professional profile in the province of Lleida with regard to health education. DESIGN: Observational transversal study. SETTING: All the medicine, nursery and social work colleges in the province of Lleida (3060). PARTICIPANTS: Bachelors in medicine (208), graduates in nursery (252), graduates in social work (64). INTERVENTION: A postal survey was send to the private address. The questions were about personal and job characteristics related to activities in health education. RESULTS: The response percentage was 48.1%. The association between the training in health education (28.2%-39.8%) and the realization of activities in health education (44.6%-57%) is significant. The realization of activities in health education is also associated with the resources disposition (CC = 0.3177, p < 0.01), and the job place (CC = 0.3155, p < 0.01). CONCLUSIONS: The assistance to health education courses and the adequacy of resources suppose better participation in activities related to health education.

[The value of images in diagnosis of neuron migration disorders]. / Valor de la imagen en el diagnóstico de los trastornos de la migración neuronal.

OBJECTIVE: To present the fitest classification and the imaging peculiarities of the malformations of cortical development, most of which have been related with the epilepsy origin. METHODS: The study is based on an anatomical-histological classification scheme that shows three great groups of malformations of cortical development: 1. Malformations due to abnormal neuronal and glial proliferation. 2. Malformations due to abnormal neuronal migration. 3. Malformations due to abnormal cortical organization. RESULTS: The result of these abnormalities of the cortical development is the presence of several anatomical histological entities, actually perfectly identified by the magnetic resonance (MR), especially with the new high resolution methods. The most frequent entities, such as polymicrogyria, lissencephaly, pachygyria, schizencephaly, cerebral heterotopia (cortical, subcortical or subependymal), and other rarer types are reviewed according with the numerous references of the literature and the findings observed in the cases of our series of about one hundred patients which includes cases of every type of malformation. CONCLUSION: MR is a conclusive study in order to identify and classify the malformations of cortical development, most of which are associated with neurological disturbances: epilepsy, mental retardation, language and/or behavioral problems or motor dysfunction.

[The Leydig-cell testicular tumor. A case report with magnetic resonance images]. / Tumor testicular de células de Leydig. Presentación de un caso con imágenes por resonancia magnética.

OBJECTIVE: An additional case of testicular Leydig cell tumor in a young man is reported. The clinical presentation included gynecomastia and a testicular mass. METHODS/RESULTS: Hormonal studies, testicular US and high resolution MRI were performed before orchidectomy. The histopathological findings were consistent with Leydig cell tumor. A CT scan revealed no metastasis. The patient is clinically disease-free 18 months after orchidectomy. CONCLUSION: High resolution MRI must be performed only when clinic and US findings are discordant.

[Spectroscopic magnetic resonance in hemimegalencephalus]. / Resonancia magnética espectroscópica en la hemimegalencefalia.

INTRODUCTION: Hemimegalencephalus (HM) is a disorder of cerebral migration characterized by the overdevelopment of one cerebral hemisphere. It is usually associated with pachygyria, gliosis and neurone loss. We present a study using stereoscopic magnetic resonance (SMR) in a case of HM confirmed by the pathologist. CLINICAL CASE: A girl with right HM had hemigeneralized crisis since birth. A selective right temporoccipital cortectomy was done when she was two and a half years old. The resected piece showed thickening and absence of cortical striation, neurone loss, gliosis, giant neurones and heterotopias. After a symptom-free period the crises reappeared as right fronto-parietal epileptiform anomalies. When she was four years old SMR was done to compare this area with the corresponding area of the radiologically normal left hemisphere. Comparative study showed a marked drop in N-acetyl-aspartate (NAA), glutamate (Glu) and Gaba, and increased choline (Col) and inositol (Ino). We found no difference in the creatinine levels. CONCLUSIONS: The histological findings are in concordance with the levels of metabolites found in the affected hemisphere. The drop in NAA and Glu is related to neurone loss and the increase in glial cells, and the increase in Col and Ino with increase in membranes metabolism, as is observed in the gliosis. SMR is an advance in the identification and grading of changes seen on conventional MR, when establishing the prognosis and choice of treatment in HM.

Hemangiomas of the head, neck, and chest with associated vascular and brain anomalies: a complex neurocutaneous syndrome.

PURPOSE: To describe the vascular and nonvascular intracranial and extracranial anomalies associated with hemangiomas and vascular malformations of the face, neck, and/or chest. METHODS: Seventeen patients had a physical examination and imaging studies consisting of one or more of the following: pneumoencephalography, conventional carotid and vertebral arteriography, CT, MR imaging, and MR angiography. RESULTS: Conventional arteriography revealed persistence of the trigeminal artery in 5 cases, absence of internal or external carotid and/or vertebral arteries in 11 cases, persistence of intervertebral arteries in 1 case, deformities of the aortic arch in 3 cases, and anomalies of the intracranial arteries in 3 cases. MR angiography revealed persistence of the trigeminal artery in 1 case in which conventional arteriography failed to show the malformation, and permitted visualization of narrowing of the intracranial arteries. CT and MR imaging showed a cerebellar anomaly in 8 cases and cerebral cortical dysplasia with cerebral hemispheric hypoplasia in 1 case. Vascular and nonvascular anomalies appeared ipsilateral to the external vascular abnormalities in most cases. CONCLUSION: This study demonstrates the association of cutaneous angiomas with anomalies affecting intracranial and extracranial arteries, the cerebellum, and, less frequently, the cerebral hemispheres and aortic arch. This association constitutes a relatively frequent neurocutaneous disorder, which we call the cutaneous hemangioma-vascular complex syndrome.

Incontinentia pigmenti: MR demonstration of brain changes.

PURPOSE: To describe the MR findings in eight girls and women with incontinentia pigmenti, from two families. Four had skin lesions and neurologic disease, and four had only skin lesions. METHODS: Eight patients had physical examination, family history, electroencephalogram and MR examination of the brain. MR was repeated in the two cases with more severe changes several years after the first study. RESULTS: MR revealed brain changes only in the four patients who had neurologic disease associated with the cutaneous lesions of incontinentia pigmenti. Abnormalities were located in the cerebral hemisphere contralateral to the most affected side of the body. In two cases, the MR changes were subjacent to the scalp areas where the most severe cutaneous lesions were located in the neonatal period. Hypoplasia of the corpus callosum, probably secondary to atrophy of one or both cerebral hemispheres, and abnormal signal and atrophy of the lateral regions of one of the cerebellar hemispheres also were found in all four cases. Although the changes were seen in both the T1- and T2-weighted images, they were most evident in the latter. The four patients in the fourth stage who had only cutaneous lesions without neurologic problems did not reveal any MR abnormalities. CONCLUSIONS: This study demonstrates MR signal changes and focal atrophy of the cerebrum, cerebellum, and corpus callosum in patients with incontinentia pigmenti and neurologic disorders. The MR images appear normal in patients with incontinentia pigmenti who have no neurologic abnormalities.

Burkitt's lymphoma presenting as Tolosa-Hunt syndrome.

An 11-year-old girl presented with acute, severe symptoms resembling Tolosa-Hunt syndrome. Response to corticosteroids was rapid and satisfactory, but of short duration. Cranial magnetic resonance imaging demonstrated a supra- and parasellar mass and the abdominal ultrasound demonstrated a round tumor. Histopathologic study of the abdominal mass revealed Burkitt's lymphoma.

[Magnetic resonance in malformations of the central nervous system]. / La resonancia magnética en las malformaciones del sistema nervioso central.

Comments are made over a number of patients with malformations of the central nervous system, who have undergone magnetic resonance studies. Descriptions are made of the anatomic findings and their characteristics, and emphasis is given to the advantage magnetic resonance studies offer in patients with brain malformations.