Diagnostic ability of Humphrey perimetry, Octopus perimetry, and optical coherence tomography for glaucomatous optic neuropathy.

PurposeTo evaluate and compare the diagnostic accuracy of the Humphrey Field Analyzer (HFA), Octopus perimetry, and Cirrus OCT for glaucomatous optic neuropathy.MethodsEighty-eight healthy individuals and 150 open-angle glaucoma patients were consecutive and prospectively selected. Eligibility criteria for the glaucoma group were intraocular pressure ≥21 mm Hg and glaucomatous optic nerve head morphology. All subjects underwent a reliable standard automated perimetry with the HFA and Octopus perimeter, and were imaged with the Cirrus OCT. Receiver-operating characteristic (ROC) curves were plotted for the threshold values and main indices of the HFA and Octopus, the peripapillary retinal nerve fiber layer thicknesses, and the optic nerve head parameters. Sensitivities at 85 and 95% fixed-specificities were also calculated. The best areas under the ROC curves (AUCs) were compared using the DeLong method.ResultsIn the glaucoma group, mean deviation (MD) was -5.42±4.6 dB for HFA and 3.90±3.6 dB for Octopus. The MD of the HFA (0.966; P<0.001), mean sensitivity of the Octopus (0.941; P<0.001), and average cup-to-disc (C/D) ratio measured by the Cirrus OCT (0.958; P<0.001) had the largest AUCs for each test studied. There were no significant differences among them. Sensitivities at 95% fixed-specificity were 82% for pattern standard deviation of the HFA, 81.3% for average C/D ratio of OCT, and 80% for the MD of the Octopus.ConclusionsHFA, Octopus, and Cirrus OCT demonstrated similar diagnostic accuracies for glaucomatous optic neuropathy. Visual field and OCT provide supplementary information and thus these tests are not interchangeable.

The One Health approach for the management of an imported case of rabies in mainland Spain in 2013.

After more than 30 years without any reported cases of rabies in terrestrial carnivores in mainland Spain, an imported case was detected in June 2013 in Toledo. Although the infected dog was moved across different locations and had contact with humans and dogs, the incident was controlled within a few days. An epidemiological investigation was performed and rabies-free status in terrestrial carnivores in mainland Spain was restored six months after the incident. Key to the successful management of this case were the previous vaccination of susceptible animals in the affected area before the case was detected, the collaboration of different authorities in decision making, and the application of control measures according to national and international regulations and to the One Health concept.

[Noninvasive diagnosis of Takayasu's arteritis]. / Diagnóstico de la arteritis de Takayasu mediante técnicas no invasivas.

OBJECTIVES: Takayasu arteritis is a chronic inflammatory obliterative disease of the great vessels that mainly affects the aorta and its primary branches. In its early phase, the clinical presentation and laboratory tests are nonspecific, so accurate diagnosis frequently depends on imaging studies. The aim of this study was to review the main features of Takayasu's arteritis and the usefulness of different noninvasive imaging techniques in the early diagnosis and follow-up of this entity. MATERIAL AND METHODS: We included 12 patients diagnosed with Takayasu's arteritis at our center. We retrospectively reviewed the different imaging studies (color Doppler US, multislice CT, and magnetic resonance) employed in each case. RESULTS: The abdominal aorta and its main branches (renal arteries, superior mesenteric artery, and celiac trunk) were involved in 8 of the 12 patients studied. This involvement was detected as increased velocities in Doppler US that were suggestive of stenosis and was later confirmed on CT angiography and MR angiography. In four patients, CT angiography and MRI angiography demonstrated diffuse and homogeneous vessel wall thickening; in two patients, these techniques also showed enhancement of the thickened walls after contrast administration that suggested active inflammatory disease. Another frequent finding was supra-aortic trunk involvement, which was seen in six cases. CONCLUSION: Noninvasive imaging techniques are fundamental in the early diagnosis of patients with Takayasu's arteritis. CT angiography and MR angiography provide additional information about the inflammatory activity of the disease.

Diagnóstico de la arteritis de Takayasu mediante técnicas no invasivas / Noninvasive diagnosis of Takayasu´s arteritis

Objetivos: La arteritis de Takayasu es una enfermedad crónica, inflamatoria y obliterativa de los grandes vasos, con predilección por la aorta y sus ramas principales. La frecuente inespecificidad clínica y analítica hace que el diagnóstico final dependa, en gran medida, de los estudios de imagen. Este trabajo pretende revisar las manifestaciones de esta enfermedad, así como la utilidad de las distintas pruebas de imagen no invasivas en el diagnóstico y seguimiento de estos pacientes. Material y métodos: Se incluyen 12 pacientes diagnosticados de arteritis de Takayasu en nuestro centro, y se revisan retrospectivamente los distintos estudios de imagen realizados: ecografía Doppler color, tomografía computarizada (TC) multicorte y resonancia magnética (RM).Resultados: En 8 de los 12 pacientes revisados se detectó como alteración fundamental la afectación de la aorta abdominal y sus ramas principales (arterias renales, arteria mesentérica superior y tronco celíaco). Dicha afectación se detectó como un aumento de las velocidades en el estudio Doppler-color sugestivo de estenosis, que se confirmó con angio-TC y angio-RM. En 4 casos la angio-TC y la angio-RM mostraron engrosamiento difuso y homogéneo de la pared, en 2 de ellos se apreció captación de contraste, como signo sugestivo de inflamación activa. Otra manifestación frecuente fue la afectación de troncos supraaórticos, que se objetivó en 6 pacientes. Conclusión: Las técnicas de imagen no invasivas son fundamentales en el diagnóstico inicial de los pacientes con enfermedad de Takayasu. La angiografía por TC y RM aporta datos adicionales al ser una herramienta útil para valorar la actividad inflamatoria del proceso (AU)

Objectives: Takayasu arteritis is a chronic inflammatory obliterative disease of the great vessels that mainly affects the aorta and its primary branches. In its early phase, the clinical presentation and laboratory tests are nonspecific, so accurate diagnosis frequently depends on imaging studies. The aim of this study was to review the main features of Takayasu's arteritis and the usefulness of different noninvasive imaging techniques in the early diagnosis and follow-up of this entity. Material and methods: We included 12 patients diagnosed with Takayasu's arteritis at our center. We retrospectively reviewed the different imaging studies (color Doppler US, multislice CT, and magnetic resonance) employed in each case. Results: The abdominal aorta and its main branches (renal arteries, superior mesenteric artery, and celiac trunk) were involved in 8 of the 12 patients studied. This involvement was detected as increased velocities in Doppler US that were suggestive of stenosis and was later confirmed on CT angiography and MR angiography. In four patients, CT angiography and MRI angiography demonstrated diffuse and homogeneous vessel wall thickening; in two patients, these techniques also showed enhancement of the thickened walls after contrast administration that suggested active inflammatory disease. Another frequent finding was supra-aortic trunk involvement, which was seen in six cases. Conclusion: Noninvasive imaging techniques are fundamental in the early diagnosis of patients with Takayasu's arteritis. CT angiography and MR angiography provide additional information about the inflammatory activity of the disease (AU)

Reporte de caso fatal por perforación de divertículo de Meckel / Fatal case report due to perforation of Meckel’s diverticulum

El divertículo de Meckel es una anormalidad congénita del tracto grastrointestinal debida a la falta del cierre del conducto onfalomesentérico y sus complicaciones son raras en los adultos. Se presenta el caso de un hombre de 35 años, quien después de la ingesta de alcohol presentó dolor abdominal y fallece repentinamente. Se le realiza autopsia y estudios histopatológicos donde se evidenció hemoperitoneo masivo originado por la erosión de vasos sanguíneos secundarios a la ulceración de la pared del divertículo de Meckel localizado en el intestino delgado. Esta causa de muerte es infrecuente debido a que la complicación másusual del divertículo es la obstrucción.

Comparacion entre la tecnica de capilaridad y la biopsia aspiracion con aguja fina (BACAF) en nodulos de tiroides / Comparison between capillary technique and fine-needle aspiration biopsy (BACAF) in thyroid nodules

La biopsia aspiración con aguja fina de tiroides es el examen de elección en los nódulos tiroideos. Se realizó un estudio en el cual se comparó la técnica de capilaridad con la biopsia por aspiración con aguja fina (BACAF) en lesiones de tiroides.Se efectuaron en total 50 biopsias de tiroides. Sc encontró que los resultados de los extendidos citológicos preparados para cada método fueron comparables en calidad, cantidad y rendimiento diagnóstico. Las dos técnicas tuvieron una adecuada eficacia diagnóstica. Se concluyó que la capilaridad es un excelente método diagnóstico y combinado con el bacaf mejora la sensibilidad diagnóstica.

The thyroid Fine-Needle Aspiration Biopsy is the test of choice for thyroid nodules. We carried out a study to compare the Capillarity technique versus Fine-Needle Aspiration Biopsy (FNAB) in thyroid lesions. We performed 50 thyroid biopsies. We found that the results of the cytology smears prepared for cach technique were comparable in qualit, amount and diagnostic reward. Both techniques had an adequate diagnostic efficacy. We concluded that capillarity, is an excellent diagnostic method and combined with FNAB improves the diagnostic sensitivity.

Degeneración walleriana del haz corticoespinal tras hematoma cerebral espontáneo / No disponible

No disponible

Realce meningeo anormal en resonancia magnetica: correlacion clinico-radiologica en 34 pacientes / Abnormal meningeal enhacement in MRI

Introducción: El estudio de imágenes por Resonancia Magnética de las meninges ha permitido un avance significativo en el diagnóstico y manejo de las diferentes patologías que las comprometen, que incluyen trastornos de origen neoplásico, inflamatorio, infeccioso o iatrogénico; teniendo como principal hallazgo el realce anormal luego de la administración de contraste, cuyos hallazgos en imágenes se clasifican en realces de tipo paquimeníngeo o leptomeníngeo. Materiales y Métodos: Se recolectaron los estudios de Resonancia Magnética con medio de contraste del SNC con realce meníngeo anormal en un periodo de dos años, excluyendo los que tenían patología tumoral meníngea primaria. Se analizaron los hallazgos y se correlacionaron con la historia clínica para establecer la etiología y el tipo de realce, comparando los hallazgos en las secuencias T1 post gadolinio con la secuencia FLAIR, para determinar su diferencia. Resultados. La presencia de realce meníngeo anormal se correlacionó con infiltración neoplásica secundaria en 38 por ciento de los pacientes; con etiología iatrogénica en 30 por ciento ; con causas inflamatorias de tipo infeccioso en 20 por ciento y con otras causas 18 por ciento , entre las que se encontraron hematomas subdurales, síndrome de Sturge Weber, infarto cerebral y síndrome de Hipotensión endocraneana. Discusión. El tipo de realce no discrimina la etiología tumoral vs. no tumoral, destacándose que en los pacientes con causa iatrogénica predominó el tipo de realce dural mientras en los de causa infecciosa el de tipo subaracnoideo. La secuencia FLAIR es menos sensible que las secuencias T1 post gadolinio para la detección de anormalidad meníngea

Linfoma de Burkitt como presentacion de un trastorno linfoproliferativo post-trasplante / Burkitt lymphoma as post-transplantation Lymphoproliferative disorders

El linfoma de Burkitt es el linfoma no Hodgkin más común en niños. Aunque su etiología no se ha establecido claramente existe una clara asociación con alteraciones cromosómicas en pacientes inmunocompetentes y con la presencia de antígenos virales (virus de Ebstein Barr) en pacientes bajo terapia inmunosupresora post-trasplante. Dentro de este último grupo esta entidad es de gran importancia por hacer parte del espectro de los trastornos linfoproliferativos post-trasplante (TLPPT) los cuales aunque comparten similitudes en sus características clínica se imaginológicas con el grupo de pacientes inmunocompetentes, presentan manifestaciones propias según el órgano transplantado y la terapia inmunosupresora instaurada. Se presentan tres casos de Linfoma tipo Burkitt el primero de ellos en un paciente post-trasplante hepático y se compara con dos casos en pacientes inmunocompetentes. Se revisan los hallazgos por imágenes y diferencias de presentación

Patologia placentaria y del cordon umbilical por ultrasonido / Placental pathology and umbilical cord by ultrasound

La patología placentaria comprende una gran variedad de entidades que pueden ser detectadas en la mayoría de los casos mediante ultrasonido; el reconocimiento temprano de estas patologías evita posibles complicaciones maternofetales tardías. En este artículo se revisan las diferentes condiciones normales y patológicas de la placenta y del cordón umbilical, sus implicaciones clínicas, así como aspectos referentes a su embriología, anatomía, variantes normales y diagnóstico ultrasonográfico

[Tuberous angioma of the glans penis: treatment with laser and local anesthesia]. / Angioma tuberoso del glande del pene: tratamiento con láser y anestesia local.

A case of angioma tuberous of the glans penis treated with Neodymiun:Yag laser under local anesthesia in a eleven-years-old outpatient is reported. These lesions are extremely rare. Local excision of this tumor was accepted treatment, but we think that laser treatment (Neodymiun:Yag) is far superior to surgical excision and we think this treatment of choice. The particularity of the case we report, is aside the rarity, the possibility of treatment in an outpatient child, with local anesthesia and excellent tolerance.

Angioma tuberoso del glande del pene: tratamiento con láser y anestesia local / Angioma tuberous of the glans penis: treatment with laser and local anesthesia

Presentamos un caso de angioma tuberoso del glande del pene tratado con láser Neodimio: YAG, bajo anestesia local en un paciente ambulatorio de once años. Estas lesiones son extremadamente raras. La excisión local de este tumor es el tratamiento comúnmente aceptado, no obstante nosotros creemos que el tratamiento con láser Neodimio: YAG ofrece más beneficios que la extirpación quirúrgica, y pensamos que este es el tratamiento de elección. La particularidad de este caso que presentamos es, además de su rareza, la posibilidad de tratamiento ambulatorio en un niño con anestesia local y excelente tolerancia (AU)

[Studer-type orthotopic urinary bladder: our experience]. / Vejiga urinaria ortotópica tipo Studer: nuestra experiencia.

OBJECTIVE: To analyze the outcome, complications and functional results in patients undergoing bladder substitution with the Studer continent urinary pouch. METHODS: The clinical records of 6 male patients who underwent radical cystectomy for invasive bladder cancer and bladder substitution with the Studer reservoir at our hospital from January 1996 to February 2000 were reviewed. Patient mean age was 54.2 years and mean follow-up was 14 months. Follow-up evaluation included abdominopelvic CT, chest x-ray, urinalysis, blood biochemistry, venous gasometry and ultrasonography with evaluation of postvoid residual urine. RESULTS: Transitional cell carcinoma was found to be the most frequent histopathological type. Distribution by grade and pathological stage showed they were all high grade infiltrating tumors localized to the bladder. Four patients are free of disease, one died from metastatic disease and one patient with tumor progression and multiple lung metastases at two months' follow-up is currently on chemotherapy. The mean operating time was significantly longer for this procedure than for the non-continent Bricker urinary diversion (mean 7.2 hours vs 3.5 hours, respectively). The immediate postoperative complications were: ileus (> 7 days) in two patients, diarrhea (> 3 days) in two, occlusive ileus due to fecaloma in one, metabolic acidosis in one, wound seroma in one, and wound infection in two patients. The early and late postoperative complications were: incontinence for up to one month after removing the urethral catheter in three patients (two of these patients are still incontinent at two months' follow-up), wound infection in two and impotence in 6 patients. CONCLUSION: Reservoir function in the medium-term is good; spontaneous urethral micturition and continence are maintained. To achieve good results, patients should be followed carefully and should be given detailed information about postoperative care and management.

[Epidemic outbreak of 81 cases of brucellosis following the consumption of fresh cheese without pasteurization]. / Estudio de un brote epidémico de 81 casos de brucelosis consecutivo al consumo de queso fresco sin pasteurizar.

BACKGROUND: In spite of the great effort that has been made in recent years in Castilla-La Mancha to control brucelosis, a lack of awareness on the part of producers and consumers leads to major epidemic outbreak, such as the one described below. METHODS: A description of the outbreak is described and a study is conducted of cases and controls to determine the factors which are responsible for the epidemic. Unadjusted and adjusted Odds Ratios (O.R.) are obtained together with their confidence intervals, for the main epidemiological factors studied. RESULTS: A total of 81 cases of brucelosis were recorded in a period of 25 weeks. All the cases occurred in the same borough or were in some way linked to it. In the case and controls study no differences were found with regard to age, sex, contact with livestock or the consumption of pasteurised milk or cheese. A strong link was established between the illness and the consumption of home-made cottage cheese prepared by a small-scale producer in the borough, (O.R. = 311.9; C.I. = 95% = 41.48-12735)., whose livestock turned out to be infected with Brucella Mellitensis. CONCLUSIONS: This outbreak showed that in Spain, there is a risk of contracting brucelosis by consuming non-pasteurised dairy products, particularly cheese, when these are not subjected to the normal sanitary and health controls. The benefits of epidemiological research in the search for cases and determining the factors responsible for the outbreak are also demonstrated. An intensification of controls, the cleansing of the herds and flocks and health education in general, are suitable instruments for controlling this zoonosis in Spain.

[Validation of a screening instrument for studying the prevalence of cerebrovascular diseases in the Chilean population]. / Validación de un instrumento de tamizaje para el estudio de la prevalencia de enfermedades cerebrovasculares en la población chilena.

We assessed a screening instrument, adapted from a model suggested by WHO, aimed to perform population studies on the prevalence of cerebrovascular disease in Chile. Sixty-two subjects, 31 with cerebrovascular diseases and 31 without, were asked about symptoms and requested to do simple movements by trained interviewers. The results of the instrument were compared with a neurological examination performed by two specialists. Global sensitivity and specificity of the instrument, using WHO evaluation criteria, were 100 and 38.7% respectively. When three or more symptoms and one positive sign were considered as cutoff points, global specificity increased to 61% and sensitivity decreased to 93%. It is concluded that the present instrument is highly sensitive but lacks specificity.

[Dissection of vertebral artery: report of a case and review of the literature]. / Disección de arteria vertebral: presentación de un caso y revisión de la literatura.

Vertebral artery dissection seems to be a frequent cause of stroke in young adults. We report a 34 years old female that suffered a cardiac arrest while practicing aerobics, with complete recovery and four months later developed an acute Wallenberg's syndrome. Magnetic resonance imaging showed an infarction in the right posterolateral medulla oblongata and in the right cerebellar hemisphere. Angiography revealed an occlusion of the third segment (V3) of the right vertebral artery which was hypoplastic. The patient was anticoagulated with a favorable clinical outcome. A follow up angiography, performed six months later, showed an incomplete recanalization of the vessel. Vertebral artery dissection should be suspected in every patient with ischemic symptoms or signs related to the vertebrobasilar territory, specially in young or middle aged patients with a history of trauma. Magnetic resonance imaging and ultrasound-doppler examinations are the diagnostic test of choice.