Seroprevalence for measles among healthcare workers in Madrid, Spain.

BACKGROUND: Immunity of healthcare workers (HCWs) against measles is a particular concern. They are more likely to contract it than the general population due to their occupational exposure which may cause a nosocomial outbreak. AIM: To assess the measles immune status of HCWs at five Spanish university hospitals. PATIENTS AND METHODS: Serologic testing (IgG) for measles by chemiluminescence indirect immunoassay (CLIA) was carried out prospectively and consecutively in HCWs from five university hospitals. All HCWs were classified into four epidemiological groups: vaccinated individuals, those with a history of measles disease, subjects with no history of measles or vaccination, and those who did not know whether they had measles or were vaccinated, and into five professional categories: physicians, nurses, nursing assistants, other clinical workers and non-clinical workers. A logistic regression model was constructed to identify the factors independently associated with immunity to measles. RESULTS: The study group was composed of 2157 HCWs. 89% had protective antibodies against measles. Of the 238 non-immune HCWs, 199 (83.6%) had been vaccinated, compared with 1084 of the 1919 (56.5%) immune individuals (P<0.0001). The parameters significantly predictive of having protective antibodies against measles were: older age (P<0.0001), epidemiological status (P=0.0002, mainly past measles disease), and professional category (P=0.02, in particular nurses). CONCLUSION: This study shows that HCWs, including those previously vaccinated, are currently at risk of measles and suggests that those with a natural history of infection are better protected. Therefore, knowledge and maintenance of immunity to measles are an essential part of infection control among HCWs.

Experience in colorectal surgery at a quaternary care hospital in Bogotá, Colombia.

INTRODUCTION AND AIMS: Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital. MATERIALS AND METHODS: An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia. RESULTS: Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%. CONCLUSION: Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity.

Manejo mínimamente invasivo del síndrome de Mirizzi Va: Reporte de casos y revisión narrativa de la literatura / Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature

Introducción El síndrome de Mirizzi (SM) es una patología infrecuente que es un reto para el cirujano. En el manejo quirúrgico, el abordaje abierto o el laparoscópico es un punto de discusión debido a la distorsión anatómica que se presenta. El objetivo de este estudio es analizar nuestra experiencia en el manejo laparoscópico de esta condición en el tipo Va. Materiales Realizamos un estudio descriptivo retrospectivo de pacientes con diagnóstico de SM tipo Va y tratados por abordaje laparoscópico, entre el 2014 y 2019, en dos centros de alto volumen de Bogotá, Colombia. Resultados Se evaluaron 1.073 pacientes que presentaron complicaciones por cálculos biliares, de los cuales 16 fueron diagnosticados con SM tipo Va. El 75% eran femeninos y el 25% masculinos; el 80% presentó ictericia y el 90% dolor abdominal. Doce pacientes presentaron fístula colecistoduodenal y cuatro fístula colecistocólica. Todos se manejaron de manera laparoscópica, en el 100% se logró realizar colecistectomía total y resección de fístula con cierre primario. La tasa de conversión fue del 0%, no hubo reingresos ni reintervención. El periodo de seguimiento fue de 18 meses. Conclusión El manejo laparoscópico en el SM es posible y seguro, teniendo en cuenta la experiencia del grupo quirúrgico y realizando una adecuada selección de los pacientes (AU)

Introduction Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. Methods We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. Results 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. Conclusion Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome (AU)

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Giant retroperitoneal liposarcoma surgical management.

Retroperitoneal liposarcomas are very infrequent retroperitoneal malignant tumours. Most patients complain of palpable abdominal mass and only half present with abdominal pain. With haematogenous spread they can reach, mainly, lungs and liver, but only in 10% of cases. Here we report the presentation and surgical treatment of a giant massive retroperitoneal liposarcoma in a 53-year-old man.

Thoracoscopic management of congenital esophageal stenosis secondary to tracheobronchial remnant in pediatric patients. / Manejo toracoscópico en estenosis esofágica congénita secundaria a remanente traqueobronquial, en población pediátrica.

INTRODUCTION: Congenital esophageal stenosis (CES) is an extremely rare pathology in children, with an incidence of 1/25,000-50,000 live births. According to its histopathological classification, there are three types of CES: fibromuscular hyperplasia, membranous diaphragm, and tracheobronchial remnants. CLINICAL CASE: We present the clinical case of a 39-month-old male patient diagnosed with CES secondary to tracheobronchial remnants, with multiple vomit and reflux episodes since he was 4 months old. He was admitted at the emergency department with respiratory distress. An upper GI endoscopy and an esophagogram were initially carried out. Stenosis resection and thoracoscopic esophageal anastomosis were performed. CONCLUSIONS: Tracheobronchial remnants are the second most common presentation of congenital esophageal stenosis. They can be managed through dilatations or surgery according to etiology.

INTRODUCCION: La estenosis congénita de esófago es una patología extremadamente rara en niños, con una incidencia de 1/25.000-50.000 nacimientos. Según la clasificación histopatológica se encuentran tres tipos: hiperplasia fibromuscular, diafragma membranoso y remanentes traqueobronquiales. CASO CLINICO: Se presenta un caso clínico de un paciente masculino de 39 meses con diagnóstico de estenosis congénita del esófago secundario a remanentes traqueobronquiales, que presentó múltiples episodios de vómito y reflujo desde los 4 meses del nacimiento. Ingresó en el Servicio de Urgencias por presentar signos de dificultad respiratoria, realizándosele estudios iniciales de endoscopia de vías digestivas altas y esofagograma. Se practicó resección de estenosis y anastomosis esofágica toracoscópica. CONCLUSIONES: Los remanentes traqueobronquiales son la segunda causa de presentación de la estenosis esofágica congénita. El manejo de esta patología puede ser de dos formas, ya sea por medio de dilataciones o quirúrgico, y la elección de una u otra va a depender de su etiología.

Manejo toracoscópico en estenosis esofágicacongénita secundaria a remanente traqueobronquial, en población pediátrica / Thoracoscopic management of congenital esophageal stenosis secondary to tracheobronchial remnant in pediatric patients

Introducción: La estenosis congénita de esófago es una patologíaextremadamente rara en niños, con una incidencia de 1/25.000-50.000nacimientos. Según la clasificación histopatológica se encuentran trestipos: hiperplasia fibromuscular, diafragma membranoso y remanentestraqueobronquiales. Caso clínico: Se presenta un caso clínico de un paciente mascu-lino de 39 meses con diagnóstico de estenosis congénita del esófagosecundario a remanentes traqueobronquiales, que presentó múltiplesepisodios de vómito y reflujo desde los 4 meses del nacimiento. Ingresóen el Servicio de Urgencias por presentar signos de dificultad respira-toria, realizándosele estudios iniciales de endoscopia de vías digestivasaltas y esofagograma. Se practicó resección de estenosis y anastomosisesofágica toracoscópica. Conclusiones: Los remanentes traqueobronquiales son la segundacausa de presentación de la estenosis esofágica congénita. El manejo deesta patología puede ser de dos formas, ya sea por medio de dilatacioneso quirúrgico, y la elección de una u otra va a depender de su etiología.(AU)

Introduction: Congenital esophageal stenosis (CES) is an extremelyrare pathology in children, with an incidence of 1/25,000-50,000 livebirths. According to its histopathological classification, there are threetypes of CES: fibromuscular hyperplasia, membranous diaphragm, andtracheobronchial remnants. Clinical case: We present the clinical case of a 39-month-old malepatient diagnosed with CES secondary to tracheobronchial remnants, withmultiple vomit and reflux episodes since he was 4 months old. He wasadmitted at the emergency department with respiratory distress. An upper GI endoscopy and an esophagogram were initially carried out. Stenosisresection and thoracoscopic esophageal anastomosis were performed. Conclusions: Tracheobronchial remnants are the second most com-mon presentation of congenital esophageal stenosis. They can be man-aged through dilatations or surgery according to etiology.(AU)

Early presentation of post-intubation tracheoesophageal fistula with severe tracheal stenosis in COVID-19 patient.

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.

Multidisciplinary management of giant cervicothoracic cutaneous squamous cell carcinoma.

INTRODUCTION: Cutaneus squamous cell carcinoma (SCC) is the second most common type of nonmelanoma skin cancer. SCC is a malignant neoplasm of the skin characterized by aberrant proliferation of keratinocytes. PRESENTATION CASE: We report multidisciplinary surgical management of a 36-year-old male who presented with a huge cutaneous protruding tumor of the cervicothoracic wall. Clinically, he presented with a growing mass on the anterior cervicothoracic wall 3 years ago. Microscopic examination revealed SCC. He underwent complete excision of the lesion. The patient neglected attending our oncological department for receiving chemotherapy. Today, one year after surgery, he is alive without evidence of disease recurrence. DISCUSSION: SCC treatment depends on location of the lesion, involvement of neighboring structures, functional level of the patient, and the patient's acceptance of the proposed management strategy. CONCLUSION: We conclude that SCC can grow to a huge size if left untreated. Surgery by a multidisciplinary surgical team is the primary mode of treatment, followed by chemotherapy if necessary.

Modulation of the Wnt pathway through inhibition of CLK2 and DYRK1A by lorecivivint as a novel, potentially disease-modifying approach for knee osteoarthritis treatment.

OBJECTIVES: Wnt pathway upregulation contributes to knee osteoarthritis (OA) through osteoblast differentiation, increased catabolic enzymes, and inflammation. The small-molecule Wnt pathway inhibitor, lorecivivint (SM04690), which previously demonstrated chondrogenesis and cartilage protection in an animal OA model, was evaluated to elucidate its mechanism of action. DESIGN: Biochemical assays measured kinase activity. Western blots measured protein phosphorylation in human mesenchymal stem cells (hMSCs), chondrocytes, and synovial fibroblasts. siRNA knockdown effects in hMSCs and BEAS-2B cells on Wnt pathway, chondrogenic genes, and LPS-induced inflammatory cytokines was measured by qPCR. In vivo anti-inflammation, pain, and function were evaluated following single intra-articular (IA) lorecivivint or vehicle injection in the monosodium iodoacetate (MIA)-induced rat OA model. RESULTS: Lorecivivint inhibited intranuclear kinases CDC-like kinase 2 (CLK2) and dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). Lorecivivint inhibited CLK2-mediated phosphorylation of serine/arginine-rich (SR) splicing factors and DYRK1A-mediated phosphorylation of SIRT1 and FOXO1. siRNA knockdowns identified a role for CLK2 and DYRK1A in Wnt pathway modulation without affecting ß-catenin with CLK2 inhibition inducing early chondrogenesis and DYRK1A inhibition enhancing mature chondrocyte function. NF-κB and STAT3 inhibition by lorecivivint reduced inflammation. DYRK1A knockdown was sufficient for anti-inflammatory effects, while combined DYRK1A/CLK2 knockdown enhanced this effect. In the MIA model, lorecivivint inhibited production of inflammatory cytokines and cartilage degradative enzymes, resulting in increased joint cartilage, decreased pain, and improved weight-bearing function. CONCLUSIONS: Lorecivivint inhibition of CLK2 and DYRK1A suggested a novel mechanism for Wnt pathway inhibition, enhancing chondrogenesis, chondrocyte function, and anti-inflammation. Lorecivivint shows potential to modify structure and improve symptoms of knee OA.

"It has cost me a lot to adapt to here": The divergence of real acculturation from ideal acculturation impacts Latinx immigrants' psychosocial wellbeing.

The wellbeing of Latinx immigrants in the United States varies widely. Immigrants' changes and maintenance of their cultures, a process known as acculturation, has been postulated to explain differences in wellbeing. However, the mechanisms by which acculturation impacts wellbeing are not fully understood. This study sought to understand the relation between acculturation and wellbeing through a person-environment fit lens, with the hypothesis that the better immigrants can acculturate in ways they prefer (e.g., taking on the practices, values, and identifications they desire), the better their self-reported wellbeing. An explanatory mixed-method approach was used to examine this hypothesis. Four hundred thirty-eight Latinx immigrants (ages 18-77, M = 37.88) who had lived in the United States for less than a year to 55 years (M = 16.75 years) completed survey measures in Arizona, New Mexico, Maryland, and Virginia. A subset (n = 73) participated in 12 focus groups. The sample included naturalized citizens (31.0%) along with authorized (33.2%) and unauthorized (35.8%) immigrants, and matched community immigration patterns. Data were analyzed through path analyses and constructivist grounded theory methods. Results indicated that the better Latinx immigrants could acculturate in the ways they preferred, the better their wellbeing. This relation was explained, in part, through lower levels of acculturative stress. This research suggests that practitioners and policymakers should consider ways to support immigrants to acculturate in the ways they desire as opposed to solely focusing their efforts on particular acculturation strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Congestión nasal como síntoma autonómico acompañante de crisis migrañosas / Nasal congestion as an autonomic symptom accompanying migraine attacks

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Preventative laparoscopic repair of Petersen's space following gastric bypass surgery reduces the incidence of Petersen's hernia: a comparative study.

INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.

[Nasal congestion as an autonomic symptom accompanying migraine attacks]. / Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

TITLE: Congestion nasal como sintoma autonomico acompañante de crisis migranosas.

A small-molecule inhibitor of the Wnt pathway (SM04690) as a potential disease modifying agent for the treatment of osteoarthritis of the knee.

OBJECTIVES: Osteoarthritis (OA) is a degenerative disease characterized by loss of cartilage and increased subchondral bone within synovial joints. Wnt signaling affects the pathogenesis of OA as this pathway modulates both the differentiation of osteoblasts and chondrocytes, and production of catabolic proteases. A novel small-molecule Wnt pathway inhibitor, SM04690, was evaluated in a series of in vitro and in vivo animal studies to determine its effects on chondrogenesis, cartilage protection and synovial-lined joint pathology. DESIGN: A high-throughput screen was performed using a cell-based reporter assay for Wnt pathway activity to develop a small molecule designated SM04690. Its properties were evaluated in bone-marrow-derived human mesenchymal stem cells (hMSCs) to assess chondrocyte differentiation and effects on cartilage catabolism by immunocytochemistry and gene expression, and glycosaminoglycan breakdown. In vivo effects of SM04690 on Wnt signaling, cartilage regeneration and protection were measured using biochemical and histopathological techniques in a rodent acute cruciate ligament tear and partial medial meniscectomy (ACLT + pMMx) OA model. RESULTS: SM04690 induced hMSC differentiation into mature, functional chondrocytes and decreased cartilage catabolic marker levels compared to vehicle. A single SM04690 intra-articular (IA) injection was efficacious in a rodent OA model, with increased cartilage thickness, evidence for cartilage regeneration, and protection from cartilage catabolism observed, resulting in significantly improved Osteoarthritis Research Society International (OARSI) histology scores and biomarkers, compared to vehicle. CONCLUSIONS: SM04690 induced chondrogenesis and appeared to inhibit joint destruction in a rat OA model, and is a candidate for a potential disease modifying therapy for OA.

Características clínicas de la migraña vestibular: consideraciones en una serie de 41 pacientes / Clinical characteristics of vestibular migraine: considerations in a series of 41 patients

Introducción. Tras años de debates sobre su enfoque desde las cefaleas y su denominación, la migraña vestibular ha sido recientemente incluida en el apéndice de investigación de la III edición de la Clasificación Internacional de Cefaleas. Objetivo. Analizar las características de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y métodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demográficas y características tanto de la migraña como de los síntomas vestibulares, y se excluyen los casos con otras patologías otorrinolaringológicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusión. Dieciséis pacientes (39%) reunían criterios de migraña crónica y dos (4,9%) presentaban auras visuales. Los síntomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrían en un 74,6% de los episodios de migraña. El vértigo se describía como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El síntoma más frecuente fue el vértigo posicional (n = 25; 61%), seguido del inducido por movimientos cefálicos (n = 18; 43,9%) y el espontáneo (n = 15; 36,6%). Como síntomas acompañantes se observaron acúfenos (n = 12; 29,3%) y plétora aural (n = 8; 19,5%). Conclusión. La identificación de síntomas compatibles con una migraña vestibular no es excepcional en los pacientes que acuden a una unidad de cefaleas; se trata de pacientes en los que el vértigo no suele interferir en sus actividades habituales (AU)

Introduction. After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. Aim. To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. Patients and methods. Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. Results. The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). Conclusion. It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo (AU)

[Clinical characteristics of vestibular migraine: considerations in a series of 41 patients]. / Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.

INTRODUCTION: After years of debate about its being approached from headaches and its denomination, vestibular migraine has recently been included in the research appendix of the 3rd edition of the International Headache Classification. AIM: To analyse the characteristics of a series of patients with vestibular migraine who visited because of headaches. PATIENTS AND METHODS: Our sample consisted of patients who were attended in a headache unit between January 2014 and December 2015. The demographic variables and the characteristics of both migraine and vestibular symptoms were considered, and cases with other otorhinolaryngological conditions were excluded. RESULTS: The sample was finally made up of 41 patients (11 males, 30 females) with a mean age of 31.8 ± 13.3 years at the time they were included in the study. Sixteen patients (39%) met criteria for chronic migraine and two (4.9%) presented visual auras. The vestibular symptoms were considered severe in eight cases (19.5%) and occurred in 74.6% of the migraine attacks. Vertigo was described as internal in 18 cases (43.9%), external in 22 (53.7%) and mixed in one case (2.4%). The most frequent symptom was positional vertigo (n = 25; 61%), followed by that induced by head movements (n = 18; 43.9%) and spontaneous (n = 15; 36.6%). Accompanying symptoms included tinnitus (n = 12; 29.3%) and a feeling of fullness in the ear (n = 8; 19.5%). CONCLUSION: It is not uncommon to identify symptoms consistent with vestibular migraine in patients who visit a headache unit; they are patients whose day-to-day activities are not usually affected by their vertigo.

TITLE: Caracteristicas clinicas de la migraña vestibular: consideraciones en una serie de 41 pacientes.Introduccion. Tras años de debates sobre su enfoque desde las cefaleas y su denominacion, la migraña vestibular ha sido recientemente incluida en el apendice de investigacion de la III edicion de la Clasificacion Internacional de Cefaleas. Objetivo. Analizar las caracteristicas de una serie de pacientes con migraña vestibular en los que el motivo de consulta fue la cefalea. Pacientes y metodos. Pacientes atendidos en una unidad de cefaleas entre enero de 2014 y diciembre de 2015. Se consideran las variables demograficas y caracteristicas tanto de la migraña como de los sintomas vestibulares, y se excluyen los casos con otras patologias otorrinolaringologicas. Resultados. Se incluyen 41 pacientes (11 varones, 30 mujeres) con una edad media de 31,8 ± 13,3 años en el momento de la inclusion. Dieciseis pacientes (39%) reunian criterios de migraña cronica y dos (4,9%) presentaban auras visuales. Los sintomas vestibulares fueron considerados graves en ocho casos (19,5%) y ocurrian en un 74,6% de los episodios de migraña. El vertigo se describia como interno en 18 casos (43,9%), externo en 22 (53,7%) y mixto en uno (2,4%). El sintoma mas frecuente fue el vertigo posicional (n = 25; 61%), seguido del inducido por movimientos cefalicos (n = 18; 43,9%) y el espontaneo (n = 15; 36,6%). Como sintomas acompañantes se observaron acufenos (n = 12; 29,3%) y pletora aural (n = 8; 19,5%). Conclusion. La identificacion de sintomas compatibles con una migraña vestibular no es excepcional en los pacientes que acuden a una unidad de cefaleas; se trata de pacientes en los que el vertigo no suele interferir en sus actividades habituales.

Burning mouth syndrome: Clinical description, pathophysiological approach, and a new therapeutic option. / Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica.

INTRODUCTION: Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. METHODS: We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. RESULTS: Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. CONCLUSIONS: Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity.

Encefalopatía posterior reversible con disociación clinicorradiológica / Posterior reversible encephalopathy with clinicoradiological dissociation

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