Impacto Pronóstico De La Linfadenectomía Lumboaórtica En Carcinomatosis Peritoneal Ovárica / Lumboaortic Lymphadenectomy Prognostic Impact In Ovarian Peritoneal Carcinomatosis

INTRODUCCIÓN: El cáncer de ovario se acompaña de diseminación peritoneal en más de la mitad de los casos al diagnóstico. La afectación ganglionar es un factor añadido de mal pronóstico. La linfadenectomía lumboaórtica representa una opción terapéutica aunque existen discrepancias en la selección de pacientes y su impacto pronóstico. Se pretende evaluar algunos factores de riesgo de infiltración nodal para esta enfermedad y la influencia pronóstica de dicha linfadenectomía. PACIENTES Y MÉTODO: Estudio retrospectivo de 93 pacientes diagnosticadas de cáncer de ovario en estadio III entre 2006 y 2014. Un total de 52 (55,9%) enfermas sometidas a citorreducción completa u óptima se dividieron en dos grupos en ausencia o presencia de adenopatías retroperitoneales durante el diagnóstico preoperatorio, para analizar el objetivos del estudio. RESULTADOS: El análisis estadístico de variables clínicas e histopatológicas determinó relación de la prealbúmina (p = 0'027) y Ca125 (p = 0'048) con el riesgo de infiltración nodal. No se apreció un valor significativo en los parámetros relativos a la extensión peritoneal del cáncer. La linfadenectomía lumboaórtica mejoró la supervivencia libre de enfermedad (25'7±21'4 vs 35'6±22 meses) con relevancia estadística (p = 0'033) pero no presentó grandes variaciones en la supervivencia global (39'7±20'1 vs 41'9±20'8 meses). CONCLUSIONES: Un estado nutricional deteriorado y un Ca125 elevado podrían ser factores predictivos de afectación ganglionar. La linfadenectomía lumboaórtica podría incrementar la supervivencia libre de enfermedad ante una citorreducción adecuada y ausencia de complicaciones postquirúrgicas graves. Se necesitará un mayor reclutamiento de pacientes para conocer con más exactitud el patrón de enfermedad ganglionar a efectos de una indicación de linfadenectomía más selectiva

BACKGROUND: Ovarian cancer peritoneal spread is presented in more than half of the patients at diagnosis. Lymph node involvement is another poor prognostic factor. Lumboaortic lymphadenectomy is a therapeutic option under debate regarding patient selection and prognostic impact. Both possible nodal infiltration risk factors and lymphadenectomy prognostic influence are assessed for this form of disease. PATIENTS AND METHODS: Retrospective assessment of 93 patients diagnosed with stage III ovarian cancer between 2006 and 2014. A total of 52 (55.9%) patients undergoing complete or optimal cytoreduction were divided into two groups in the absence or presence of retroperitoneal adenopathies during preoperative diagnosis, to analyze the aims of the study. RESULTS: A sta-tistical analysis of clinical and histopathological factors showed a relationship from both prealbumin (p = 0.027) and Ca125 (p = 0.048) with respect to the risk of nodal infiltration. No significant value was found in the parameters related to the peritoneal spread of the cancer. Lumboaortic lymphadenectomy improved disease-free survival (25'7 ± 21'4 vs 35'6 ± 22 months) with statistical significance (p = 0.033) although no outstanding variations in overall survival (39'7 ± 20'1 vs 41'9 ± 20'8 months). CONCLUSIONS: A poor nutritional status and high Ca125 level could be predictive factors of lymph node involvement. Lumboaortic lymphadenectomy increases disease-free survival when a properly cytoreduction is possible without severe postoperative complications. A larger recruitment of patients will be needed to know more accurately the pattern of lymph node disease in order to perform a more selective indication for lymphadenectomy

La estimulación magnética transcraneal para el tratamiento de alucinaciones auditivas refractarias en niños y adolescentes / Transcranial magnetic stimulation for treating refractory auditory hallucinations in children and adolescents

La estimulación magnética transcraneal (EMT) es una técnica novedosa, no invasiva, que utiliza la fuerza electromagnética para alterar la excitabilidad neuronal. De manera que al contrario que el TEC (terapia electroconvulsiva) no requiere anestesia y el paciente permanece despierto y monitorizado clínicamente; y al contrario que en la estimulación del nervio vago o que en la estimulación cerebral profunda los electrodos no se insertan en el cerebro. Hasta la fecha se ha utilizado en el tratamiento de distintos trastornos neuropsiquiátricos y desde el 2008 ha sido aprobada por la FDA para el tratamiento de la depresión resistente sin síntomas psicóticos. La experiencia en esquizofrenia y otras psicosis es menor y como siempre hay muchos menos estudios en la población infantil y juvenil, pero como clínicos sabemos que el inicio de la patología psiquiátrica más grave ocurre en la infancia y la adolescencia y que la mitad de todos los trastornos mentales se inician antes de la mitad de la adolescencia. En pacientes tan jóvenes es especialmente importante encontrar tratamientos más efectivos y menos dañinos. La EMT representaría una alternativa interesante, ya que puede activar algunas regiones mientras que al mismo tiempo inhibe otras; de manera que hay estudios que explican mejoría de la sintomatología negativa de la esquizofrenia mediante la estimulación del córtex frontal dorsolateral. La eficacia en el tratamiento de las alucinaciones auditivas mediante la inhibición del córtex temporal izquierdo será revisada en este artículo

Transcranial magnetic stimulation (TMS) is a novel, non-invasive neuromodulatory technique that utilices electromagnetic force to alter neuronal excitability. Hence, unlikely ECT (electroconvulsive therapy) anaesthesia is not required and the individual remains awake and clinically monitored; and in contrast with vagus nerve stimulation and deep brain stimulation, electrodes will not be placed in the brain. To date, it has been applied to a range of neuropsychiatric disorders and since 2008 it has been approved by FDA for the management of resistant depression without psychotic symptoms. Experience in schizophrenia and other psychosis is lesser and as always there are fewer studies in children and adolescentes, but as clinicians we know that the first onset of the most serious mental disorders occurs in childhood or adolescence and half of all lifetime disorders start by the mid-teens. In so young patients is specially important finding more effective treatments and less harmful. TMS would represent an interesting therapeutic alternative since it can activate some regions while at the same time it can inhibit others: for example there are studies that explain improvent in negative symptoms through dorsolateral prefrontal cortex stimulation. Efficacy on auditory hallucinations by inhibition of left temporal cortex will be reviewed below

Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.

OBJECTIVES: Phrenic nerve pacing is a method of respiratory support that can replace mechanical ventilation in high-level cervical spinal cord injury patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury. DESIGN: This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present. PATIENTS: Cervical SCI patients with permanent respiratory support (PNP or MV). METHODS: Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life was assessed with SF-36 questionnaire, a general HRQL evaluation. RESULTS: One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning. CONCLUSIONS: PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.

Papel de la ecografía tridimensional en obstetricia / Three-dimensional ultrasound: role in obstetrics

La evaluación del estado fetal mediante ecografía se considera fundamentalen la práctica de la Obstetricia. Esta técnica ha venido arevolucionar el estudio del feto debido a su inocuidad y a la grancantidad de información útil que proporciona. En la década de losnoventa se introdujo la ecografía tridimensional y, más recientemente,la ecografía “en cuatro dimensiones”. En el presente artículo serevisan las indicaciones que puede tener la ecografía tridimensionalen la evaluación fetal y placentaria

Fetal evaluation by ultrasound is considered as essential in Obstetrics.This technique has dramatically improved our ability for fetalassessment. During the 90's three-dimensional ultrasound, and morerecently “four-dimensional” ultrasound, became available. In this articlecurrent state-of-the-art on the use of three-dimensional and fourdimensionalultrasound in Obstetrics will be reviewed

Validación inicial de la versión gallega del cuestionario de capacidades y dificultades (SDQ) / The initial validation study of the gallego version of the Strengths and Dificulties Questionnaire (SDQ)

Objetivos: El Cuestionario de Capacidades y Dificultades, el Strengths and Difficulties Questionnaire (SDQ en inglés, es un cuestionario de screening breve de psicopatología infantil. Este estudio supone el primer estudio de validación de cualquiera de las traducciones españolas del SDQ, la versión gallega. Método: Se procedió a la administración de las versiones en gallego del cuestionario a padres y profesores de 180 pacientes de consulta externa de edades comprendidas entre 4 y 16 años. De este total, 132 acudían a Unidades de Salud Mental Infanto-Juvenil, mientras que 48 fueron vistos por pediatras. Resultados: El cuestionario discriminó bien entre ambas muestras de pacientes psiquiátricos y pediátricos. En la muestra de pacientes psiquiátricos se encontró un alto nivel de concordancia entre el diagnóstico clínico y la predicción diagnóstica hecha por el cuestionario. Conclusiones: Estos hallazgos demuestran que esta traducción del SDQ tiene una validez satisfactoria al ser utilizada en España. El SDQ podría potencialmente ayudar a pediatras, profesores y trabajadores sociales a identificar aquellos niños que se podrían beneficiar de una derivación a los servicios especializados (AU)

El cuestionario de capacidades y dificultades / The Strengths and Dificulties Questionnaire

El Cuestionario de Capacidades y Dificultades, el Strengths and Difficulties Questionnaire (SDQ) en inglés, es una breve y útil medida de psicopatología aplicable a la población de 4 a 16 años. Aunque su publicación es de 1997, el cuestionario se encuentra disponible en más de cuarenta idiomas, incluyendo castellano, catalán, euskera y gallego. Este artículo es una breve introducción al SDQ, revisando sus principales características y resumiendo los principales estudios que han sido publicados al respecto (AU)

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury.

Acute acalculous cholecystitis (AAC) is a very serious complication which can be found in patients with multiple serious traumatic lesions ('polytrauma'). Very few patients have been reported in the literature with an acute spinal injury and associated AAC. We report seven patients with polytrauma and acute spinal cord injury who developed AAC. All had no complaint of the principal warning symptom: right upper quadrant abdominal pain. All presented with a palpable mass in this site and the laboratory results were compatible with cholestasis. The diagnosis of AAC was confirmed both by ultra sound and CT scanning. We discuss the possible precipitating factors and the treatment. One hundred and ninety one patients were admitted to the Intensive Care Unit in our Hospital with SCI over a period of 2 years, all of these in the acute stage. AAC was diagnosed in seven patients among them. Our purpose is to call attention to this clinical condition which can complicate the outcome of patients with multiple trauma and acute spinal cord injury. To date AAC in this group of patients has been infrequently described in the available literature.

Tracheostomy ventilation versus diaphragmatic pacemaker ventilation in high spinal cord injury.

We have made a retrospective comparative study of patients with spinal cord injury, nine with a diaphragmatic pacemaker and 13 with mechanical ventilation. Clinical outcome, cost and subjective satisfaction with both modalities have been evaluated. The functional status was the same with both types of treatment. Proper management of an electric wheelchair and optimal phonation were attained, respectively, in 100% and 89% of pacers and in 77% and 77% of mechanically ventilated. The rate of hospital discharge and satisfaction with the treatment were significantly better for pacers. The time devoted to ventilatory assistance and cost were also more favourable in this group.

[Simultaneous, bilateral and permanent ventilation with a diaphragm pacing in childhood: the implantation technique and indications]. / Ventilación permanente, bilateral y simultánea con marcapasos diafragmático en la infancia: Indicaciones y técnica de implante.

The acute effects of external stimulation were well demonstrated by the turn of the century, but the chronic application had to wait until the advent of the modern pacemaker technology. Since 1983 we have implanted bilateral diaphragm pacing in ten infants and adolescents with quadriplegia and central hypoventilation syndrome. The preferred site of implantation was the thoracic phrenic nerve. The electrophysiological status of the phrenic nerve function has before been determined in all patients. We have got bilateral and continuous ventilation, in all patients, but, in quadriplegics is necessary a conditioning period. Long term stimulation of the phrenic nerves to pace the diaphragm is an effective method of ventilatory support in selected cases.

Continuous respiratory support in quadriplegic children by bilateral phrenic nerve stimulation.

Three children, aged 6-10 years, in whom cervical cord injury at the C1-C2 level resulted in apnoea had bilateral implantation of diaphragm pacemakers. With periods of gradual conditioning of the diaphragm muscle to low frequency stimulation and slow respiratory rates they adapted to continuous ventilatory support by simultaneous stimulation of both hemidiaphragms without evidence of fatigue, so far for periods of 23-47 months.

Permanent artificial respiration by diaphragm pacemaker in tetraplegic children.

This is a study of two children, aged respectively 10 and 6 years, who sustained a spinal cord injury at the C1 C2, causing apnoea. After the bilateral implantation of diaphragm pacemakers and periods of conditioning, they were able to adapt to continuous and simultaneous full-time ventilatory support of both diaphragms without any sign of fatigue, for more than 24 and 11 months, respectively.