Acro-osteólisis, hallazgos de imagen y posibles diagnósticos etiológicos / Acro-osteolysis, imaging findings and possible aetiological diagnoses

La acro-osteólisis es un hallazgo radiológico infrecuente caracterizado por una reabsorción o destrucción ósea que afecta típicamente a las falanges distales de la mano.Sus causas son múltiples. Puede estar asociada a enfermedades sistémicas, tener un origen familiar, ser idiopática o secundaria a agentes externos, por lo que el patrón radiográfico, la edad del paciente y una buena historia clínica serán claves para llegar a su diagnóstico etiológico.Presentamos el caso de una mujer de 40 años que consulta por dolor de aproximadamente 1 año de evolución a nivel de la región interfalángica distal del primer y segundo dedo de la mano derecha. Entre las pruebas complementarias realizadas durante el estudio, destaca la radiografía simple de la mano, donde se observa una reabsorción parcial en banda de la región media de la falange distal del primer y segundo dedo, compatible con acro-osteólisis.(AU)

Acro-osteolysis is a rare radiological finding characterized by bone resorption or destruction that typically affects the distal phalanges of the hand.There are many causes. The condition can be associated with systemic diseases, have a family origin or be idiopathic or secondary to external agents. Therefore, the radiographic pattern, the patient’s age in addition to a good clinical history will be key to diagnosing its aetiology.We report the case of a 40-year-old woman who consulted for pain of approximately one year clinical course at the level of the distal interphalangeal region of the first and second fingers of the right hand. Among the complementary test performed during the study the x-ray revealed a band-like partial resorption in the middle region of the distal phalanx of the first and second fingers, compatible with acro-osteolysis.(AU)

Trombosis venosa portal como manifestación de una mutación del Factor XII / Portal vein thrombosis as a manifestation of a factor XII mutation

La trombosis venosa abdominal es una forma poco común de enfermedad tromboembólica venosa en niños. Si bien las tasas de mortalidad son bajas, una proporción significativa de niños afectados pueden sufrir morbilidad a largo plazo. Entre sus etiologías, se sabe que existe asociación con trastornos protrombóticos, siendo poco frecuente la ausencia del factor XII. El tratamiento incluye anticoagulación y la resección quirúrgica de los órganos isquémicos con potencial trasplante posterior (AU)

Abdominal venous thrombosis is a rare form of venous thromboembolic disease in children. Although the associated mortality is low, a significant proportion of affected children suffer from long-term morbidity. Among its aetiologies, there is evidence of an association with prothrombotic disorders, absence of factor XII being an infrequent one. Treatment includes anticoagulant medication and surgical resection of the ischaemic organs, potentially followed by transplantation. (AU)

Dígito pélvico como hallazgo incidental y posibles diagnósticos diferenciales / Pelvic digit as an incidental finding and possible differential diagnoses

El dígito pélvico es un tipo de anomalía congénita benigna poco frecuente, que se localiza en la región coxofemoral, en relación con el ilion.A pesar de que suele ser asintomático, es importante conocer su existencia, así como los posibles diagnósticos diferenciales, ya que se puede encontrar como un hallazgo incidental en la radiografía simple.Se presenta el caso de un hombre, de 58 años, que acude a su médico de Atención Primaria (AP) por artralgias generalizadas, quien observa en la radiografía simple de cadera un hallazgo inusual, por lo que interconsulta al servicio de Radiodiagnóstico, donde se realiza el diagnóstico de dígito pélvico.(AU)

The pelvic digit is a rare benign congenital abnormality, located in the hip region, in regard to the ilium.Although usually asymptomatic, it is important to be aware of its existence as well as the possible differential diagnoses since it can be found as an incidental finding on plain x-ray.We report the case of a 58-year-old man who presented to his primary care physician because of generalized arthralgia. He observed an unusual finding on plain x-ray of the hip, whereby he consulted the radiology department, where pelvic digit was diagnosed.(AU)

Posteromedial Hypothalamic Deep Brain Stimulation for Refractory Aggressiveness in a Patient With Weaver Syndrome: Clinical, Technical Report and Operative Video.

BACKGROUND AND IMPORTANCE: Deep brain stimulation of the posteromedial hypothalamus (PMH DBS) appears to be an effective treatment for drug-resistant aggressiveness. Weaver syndrome (WS) is a rare genetic disorder in which patients develop some degree of intellectual disability and rarely severe behavioral alterations that may benefit from this procedure. CLINICAL PRESENTATION: We present the case of a 26-yr-old man diagnosed with WS presenting with uncontrollable self and heteroaggressiveness and disruptive behavior refractory to pharmacological treatment and under severe physical and mechanical restraining measures. The patient was successfully treated with bilateral PMH DBS resulting in affective improvement, greater tolerance for signs of affection, regularization in his sleep pattern and appetite disturbances at 12-mo follow-up. A detailed description and video of the procedure are presented, and a review of the clinical characteristics of WS and the utility and benefits of PMH DBS for refractory aggressiveness are reviewed. CONCLUSION: To our knowledge, this is the first case of refractory aggressiveness described in WS as well as the first patient with WS successfully treated with PMH DBS.

Enfermedad linfoproliferativa postrasplante tipo plasmocitoma sobre injerto renal / Plasmacytoma-like post-transplantation lymphoproliferative disorder in renal allograft

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Fascitis necrotizante secundaria a úlcera por presión / Necrotizing fasciitis secondary to pressure ulcer

La fascitis necrotizante es una infección agresiva y altamente destructiva de la fascia y el músculo con una alta morbimortalidad. Se suele presentar en pacientes inmunocomprometidos tales como VIH, diabéticos, oncológicos o trasplantados, siendo sus localizaciones más habituales las extremidades, pared abdominal y periné; en esta última localización recibe el nombre de gangrena de Fournier. Su asociación con úlceras de decúbito es infrecuente, relacionándose en la mayoría de las ocasiones con procesos osteomielíticos, traumatismos con heridas cutáneas o presencia de cuerpos extraños. Presentamos un caso clínico de un paciente con fascitis necrotizante secundaria a úlcera de decúbito. Nos parece interesante presentar las características clínicas, así como exponer los hallazgos radiológicos de esta entidad y, por otra parte, acentuar la importancia de un adecuado cuidado de las úlceras por presión, ya que pueden ser el origen de la fascitis necrotizante

Necrotizing fasciitis is an aggressive and highly destructive infection of the fasciae and muscles with high morbidity and mortality. It usually occurs in immunocompromised patients such as HIV, diabetic, oncology or transplant patients. Its most common locations are the extremities, abdominal wall and perineum; in this latter location it is called Fournier's gangrene. Its association with pressure ulcers is infrequent, being connected in most cases with osteomyelitic processes, traumas with skin wounds or presence of foreign bodies. We present the clinical case of a patient with necrotizing fasciitis secondary to pressure ulcer. We find it interesting to present the clinical characteristics as well as the radiological findings of this entity and, on the other hand, to emphasize the importance of an adequate care of pressure ulcers, since they can be the origin of necrotizing fasciitis

Invaginación intestinal como forma de presentación de linfoma no Hodgkin primario de colon en un paciente VIH positivo / Intussusception as clinical presentation of primary non-Hodgkin lymphoma of the colon in a HIV-patient

La invaginación (intususcepción) intestinal es una complicación poco frecuente en la población adulta, representando sólo del 1% al 5% de todas las causas de obstrucción intestinal. Es más frecuente en el intestino delgado, donde puede responder a causas inflamatorias, infecciosas o neoplásicas, y rara en el colon, en donde en el 50%-60% de los casos se origina en neoplasias subyacentes. El aparato digestivo es el sitio más común de localización de los linfoma no Hodgkin (LNH) extranodales, incluyendo del 5% al 20% del total de los mismos. Sin embargo, los LNH primarios del tracto gastrointestinal son entidades clínico-patológicas muy raras y representan sólo del 1% al 4% de todas las neoplasias del tubo digestivo. Los LNH primarios de colon son tumores muy infrecuentes y representan del 0,2% al 1,2% del total de las neoplasias colónicas. Se describe el caso de un paciente adulto con sida, que desarrolló una invaginación colónica secundaria a un linfoma difuso de grandes células B primario del colon transverso. Se revisan los hallazgos clínicos, imagenológicos e histopatológicos y se realiza una revisión de la literatura inglesa y española sobre este tema (AU)

Intestinal intussusception rarely occurs in the adult population and accounts only for 1% to 5% of all the causes of intestinal obstruction. This complication is more frequent in the small bowel and can be due to different aetiologies, including inflammatory, infectious or neoplastic diseases. Malignancies account for 50% to 60% of all cases of colon invagination. The gastrointestinal (GI) tract is the most common site for extra-nodal non-Hodgkin lymphomas (NHL), representing 5% to 20% of all the cases. However, primary NHL of the GI tract is a very infrequent clinic-pathological entity and accounts only for 1% to 4% of all the neoplasms of the GI tract. Primary NHL of the colon is a rare disease and it comprises only 0.2% to 1.2% of all colonic malignancies. Here we describe a case of an AIDS adult patient who developed an intussusception secondary to a primary large B cell lymphoma of the transverse colon. English and Spanish literature was reviewed (AU)

Intussusception as clinical presentation of primary non-Hodgkin lymphoma of the colon in a HIV-patient.

Intestinal intussusception rarely occurs in the adult population and accounts only for 1% to 5% of all the causes of intestinal obstruction. This complication is more frequent in the small bowel and can be due to different aetiologies, including inflammatory, infectious or neoplastic diseases. Malignancies account for 50% to 60% of all cases of colon invagination. The gastrointestinal (GI) tract is the most common site for extra-nodal non-Hodgkin lymphomas (NHL), representing 5% to 20% of all the cases. However, primary NHL of the GI tract is a very infrequent clinic-pathological entity and accounts only for 1% to 4% of all the neoplasms of the GI tract. Primary NHL of the colon is a rare disease and it comprises only 0.2% to 1.2% of all colonic malignancies. Here we describe a case of an AIDS adult patient who developed an intussusception secondary to a primary large B cell lymphoma of the transverse colon. English and Spanish literature was reviewed.

Determinantes de la asistencia irregular a consulta médica en pacientes con infección por el virus de la inmunodeficiencia humana: resultados de la Encuesta Hospitalaria de pacientes con el virus de la inmunodeficiencia humana, 2002-2012 / Factors determining irregular attendance to follow-up visits among human immunodeficiency virus patients: Results of the hospital survey of patients infected with human immunodeficiency virus

INTRODUCCIÓN: Describir la frecuencia de la asistencia irregular a consulta médica de pacientes con VIH y analizar sus determinantes. MÉTODOS: Estudio transversal realizado anualmente (2002-2012) en un día prefijado. Se recogen datos epidemiológicos, clínicos y conductuales de los pacientes con VIH (hospitalizados y ambulatorios) atendidos ese día en los hospitales públicos participantes. Se definió «asistencia irregular a consulta» como asistencia a consulta de forma esporádica, según la valoración del médico. Se realizó un análisis descriptivo, bivariante y multivariante de regresión logística para estimar los factores asociados a asistencia irregular a la consulta. RESULTADOS: En total se incluyeron 7.304 pacientes de los que el 13,7% acudían irregularmente a la consulta. La probabilidad de asistencia irregular aumentó en pacientes entre 25 y 49 años, subsaharianos o latinoamericanos, con menor nivel de estudios, aquellos sin domicilio fijo o que estaban en prisión, los que vivían solos o en establecimientos colectivos, los desempleados o jubilados, los que se infectaron por compartir material de inyección, los que no usaron condón en su última relación sexual y los inyectores activos. Por el contrario, los pacientes diagnosticados hacía menos de un año y los hombres homo/bisexuales tenían menor probabilidad de acudir irregularmente. CONCLUSIÓN: A pesar de la universalidad de nuestro sistema de salud existen variables sociales y demográficas que actúan como barreras para la asistencia a consulta, lo que puede comprometer la efectividad del tratamiento en determinados grupos de población. Estos determinantes deberían tenerse en cuenta a la hora de planificar políticas de control de la infección por el VIH

INTRODUCTION: To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS: One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. «Non-regular attendance to a follow-up visit» was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS: A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION: In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain

[Factors determining irregular attendance to follow-up visits among human immunodeficiency virus patients: results of the hospital survey of patients infected with human immunodeficiency virus]. / Determinantes de la asistencia irregular a consulta médica en pacientes con infección por el virus de la inmunodeficiencia humana: resultados de la Encuesta Hospitalaria de pacientes con el virus de la inmunodeficiencia humana, 2002-2012.

INTRODUCTION: To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS: One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS: A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION: In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain.

Composición corporal de jóvenes universitarios en relación a la salud / Body composition of young university in relation to health

En los últimos anos, la incidencia de trastornos metabólicos ha aumentado de manera alarmante, destacando que la serie de cambios influenciados por factores psicológicos, sociales, culturales y económicos que se producen el los jóvenes universitarios, podrían producir cambios morfológicos en su composición corporal debido al sedentarismo, por lo que objetivo de este estudio fue describir la composición corporal de jóvenes universitarios de ambos sexos en relación a la salud. Fueron evaluados 85 mujeres y 40 varones, conformando un total de 125 sujetos de 18 a 21 años. Se valoró las variables antropométricas de los pliegues cutáneos: bicipital, tricipital, subescapular, supra-iliaco, abdominal y pantorrilla (mm), así como los diámetros óseos del biestiloideo de la muñeca (m) y bicondíleo femoral (m). Las variables antropométricas fueron analizadas por medio de la estadística descriptiva de media aritmética (X) y desviación estándar (DE) y para determinar las diferencias entre ambos géneros se utilizó la prueba “t” de student para muestras independientes (p<0,0010). Los hallazgos muestran que los hombres presentan valores medios superiores de masa muscular, masa residual y masa ósea cuando fueron comparados con las mujeres. A su vez, las mujeres presentan valores superiores de masa grasa y porcentaje de grasa. Se observó que los hombres tienen una tendencia al sobrepeso (22.95±4,48%G) y las mujeres (32.85±3,69%G) a la obesidad. Se concluye que los sujetos de ambos sexos presentan diferencias propias de los patrones de dimorfismo sexual humano, así como tendencia al sobrepeso en los hombres y obesidad en las mujeres (AU)

In recent years, the incidence of metabolic disorders has increased dramatically, stressing that the number of changes influenced by psychological, social, cultural and economic factors that produce university students could produce morphological changes in body composition due to sedentary. So the objective of this study was to describe the body composition of young college students of both sexes in relation to health. Were evaluated 85 women and 40 men, making a total of 125 subjects 18 to 21 years. We evaluated anthropometric variables of skinfolds: biceps, triceps, subscapular, supra-iliac, abdominal and calf (mm) and diameters of bistyloid bone of the wrist (m) and femoral biepicondylar (m). The anthropometric variables were analyzed using descriptive statistics arithmetic mean (X) and standard deviation (SD) and to determine the differences between the genders, the test “t” of Student for independent samples (p < 0.0010). The findings show that men have higher average values of muscle mass, residual mass and bone mass when compared with women. In turn, women had higher levels of fat mass and fat percentage. It was noted that men have a tendency to be overweight (22.95 ± 4.48% BF) and women (32.85 ± 3.69% G) to obesity. We conclude that the people of both sexes show differences characteristic of the human sexual dimorphism patterns and trends of overweight and obesity in men and women (AU)