Compresión medular dorsal por tofos gotosos: presentación de un caso y revisión de la bibliografía / Medullar thoracic compression by tophaceous gout: presentation of a case and review of the literature

Introducción. La afectación de la columna vertebral en la gota es una complicación extremadamente infrecuente. La dorsalgia y la cuadriplejía son algunas manifestaciones que se pueden presentar, aunque estos síntomas se ven con más frecuencia en otras patologías más prevalentes, como los tumores medulares. Caso clínico. Se presenta un caso inusual de compresión medular dorsal en D10-D11 causado por el depósito extradural de material tofáceo en una paciente de 52 años con gota tofácea crónica incontrolada. Además de un tratamiento médico intensivo, la paciente requirió cirugía (hemilaminectomía y descompresión medular) y rehabilitación posterior. La evolución general y neurológica fue satisfactoria (AU)

Introduction. Spine involvement in gout is an extremely uncommon complication. Dorsalgia and quadriplegia are some manifestations that may occur, although these symptoms are seen more frequently in other more prevalent pathologies, such as spinal tumors. Case report. We present an unusual case of thoracic spinal cord compression at T10-T11 level caused by the extradural deposit of tophaceous material in a 52-year-old woman with uncontrolled chronic tophaceous gout. In addition to intensive medical treatment, the patient required surgery (hemilaminectomy and spinal decompression) and subsequent rehabilitation. Overall and neurological evolution were satisfactory (AU)

Vasoactive Intestinal Peptide in Early Spondyloarthritis: Low Serum Levels as a Potential Biomarker for Disease Severity.

Spondyloarthritis (SpA) is a family of inflammatory diseases sharing clinical, genetic, and radiological features. While crucial for tailoring early interventions, validated prognostic biomarkers are scarce in SpA. We analyze the correlation between serum levels of vasoactive intestinal peptide (VIP) and disease activity/severity in patients with early chronic inflammatory back pain. The study population comprised 54 patients enrolled in our early chronic inflammatory back pain register. We collected demographic information, clinical data, laboratory data, and imaging findings. VIP levels were measured by enzyme immunoassay in serum samples from 162 visits. The association between independent variables and VIP levels was analyzed using longitudinal multivariate analysis nested by patient and visit. No significant differences were observed in VIP levels between these two groups. Lower levels of VIP were significantly associated with a higher Bath Ankylosing Spondylitis Disease Activity Index (BASFI) score, presence of bone edema in magnetic resonance imaging (MRI) scan, and lower hemoglobin levels. Coexistence of cutaneous psoriasis was independently associated with lower VIP levels, and similar trend was observed for enthesitis. We conclude that SpA patients with low serum VIP levels had worse 2-year disease outcome, suggesting that serum VIP levels could be a valid prognostic biomarker.

Control de calidad sobre los parámetros de justificación clínica en las peticiones de resonancia magnética / Quality control of the clinical parameters for justifying requests for magnetic resonance imaging

Objetivo: Estudiar el grado de cumplimiento por parte de los peticionarios clínicos, de los diferentes apartados en las solicitudes de resonancia magnética (RM), especialmente la justificación de la prueba y su grado de coincidencia con los resultados obtenidos. Material y métodos: Revisamos 500 peticiones de RM elegidas al azar en un área de Madrid. Se valoró la cumplimentación de: servicio que lo solicita, datos clínicos, datos de exploración física, juicio clínico, datos radiológicos previos, si es o no estudio de extensión y tipo de exploración solicitada. Si la RM confirmaba la sospecha clínica se consideró el resultado coincidente, en caso contrario se consideró no coincidente y se valoró la presencia de hallazgos no sospechados. Resultados: Las peticiones en las que se especificaban datos clínicos fueron el 82%, con datos de la exploración del paciente el 23% y con un juicio clínico expresado en el volante el 59%. No constaban datos clínicos, datos de la exploración ni juicio clínico en un 2,8% del total. El grado de coincidencia por servicios fue: 68,5% en neurocirugía, 63,1% en traumatología, 43,1% en neurología y 14,2% en otorrinolaringología. Por exploraciones fue: 70,8% para la rodilla, 60,6% para la columna lumbar, 53,5% para la columna cervical y 50% para la RM cerebral. De las 182 RM cerebrales, 118 (64,8%) tenían juicio clínico y 77 (65,3%) fueron coincidentes. De las RM de columna lumbar, 42 (38,5%) tenían juicio clínico y 28 (66,7%) eran coincidentes. En 89 RM de rodilla 66 (74,2%) tenían juicio clínico y de éstas, 45 (68,2%) eran coincidentes. En RM de columna cervical 19 (42,2%) tenían juicio clínico y 23 (53,5%) fueron coincidentes. Conclusión: El mejor grado de coincidencia se encontró en los estudios de rodilla. Aunque el número de solicitudes sin datos clínicos, datos de la exploración y juicio clínico es relativamente bajo, es importante que concienciemos a nuestros médicos peticionarios para que este tipo de solicitudes desaparezca, ya que el rendimiento de la prueba aumentará

Objective: To evaluate the degree of compliance by referring physicians in various aspects related to requests for magnetic resonance imaging (MRI) studies. Special attention is given to justification for the study and the degree of concordance with the results obtained. Material and methods: We reviewed 500 randomly selected requests for MRI in the area of Madrid. The following factors were evaluated: requesting department, clinical data, findings at physical examination, clinical judgment, previous imaging findings, whether or not the study is an additional examination, and type of study requested. If MRI findings confirmed clinical suspicion, the result was considered concordant; otherwise, the result was considered discrepant and findings of unsuspected pathology were evaluated. Results: Clinical data were provided along with 82% of the requests, with 23% reporting the findings at clinical examination and approximately 59% expressing clinical judgment. No clinical data, findings at clinical examination, or clinical judgment were provided in 2.8% of requests. The degree of concordance by requesting department was: 68.5% for neurosurgery, 63.1% for traumatology, 43.1% for neurology, and 14.2% for otorhinolaryngology; by type of examination: 70.8% for the knee, 60.6% for the lumbar spine, 53.5% for the cervical spine, and 50% for cerebral MRI. Clinical judgment was provided in 118 (64.8%) of the 182 requests for cerebral MRI studies and the findings were concordant in 77 (65.3%). Clinical judgment was provided in 42 (38.5%) of the requests for MRI studies of the lumbar spine and the findings were concordant in 28 (66.7%). Clinical judgment was provided in 66 (74.2%) requests for MRI studies of the knee and the findings were concordant in 45 (68.2%). Clinical judgment was provided in 19 (42.2%) requests for MRI studies of the cervical spine and the findings were concordant in 23 (53.5%). Conclusion: The highest degree of concordance was found in MRI studies of the knee. Although the number of requests in which no clinical data, no findings at clinical examination, and no clinical judgment were expressed is relatively low, it is important to make requesting physicians aware that this type of request must be eliminated in order to improve diagnostic yield