Gran hematoma retrofaríngeo: manejo de la vía aérea con laringoscopio óptico Airtraq(R) / Large retropharyngeal haematoma. Airway management with Airtraq(R) laryngoscope

Un hematoma retrofaríngeo es una situación clínica que puede poner en peligro la vida por la potencial obstrucción de la vía aérea superior y que requiere un rápido diagnóstico. Puede presentarse clínicamente de diferentes formas, según el tamaño y la velocidad en su desarrollo. La primera medida a tener en cuenta es la protección y el manejo de la vía aérea que, en la mayoría de las veces, es una situación de vía aérea difícil. En la aparición de un hematoma retrofaríngeo puede existir un antecedente traumático previo, con o sin fractura cervical asociada. El tratamiento del hematoma en la mayoría de los casos es conservador, con una estrecha vigilancia hasta su reabsorción en 3-4 semanas, aunque en ocasiones precisa de evacuación quirúrgica. Presentamos el caso clínico de un paciente que desarrolló un gran hematoma retrofaríngeo tras traumatismo cervical menor y describimos el abordaje de la vía aérea mediante el uso del laringoscopio óptico desechable Airtraq(R)

Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq(R) disposable optical laryngoscope

Large retropharyngeal haematoma. Airway management with Airtraq® laryngoscope. / Gran hematoma retrofaríngeo: manejo de la vía aérea con laringoscopio óptico Airtraq®.

Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq® disposable optical laryngoscope.

Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study.

BACKGROUND AND PURPOSE: Data on the association between vertebral endplate changes and low back pain are contradictory. This study was designed to assess whether this association exists among Southern European subjects. MATERIALS AND METHODS: Patients in this study serving as cases were 35-50 years of age with low back pain lasting >90 days, for whom a lumbar MR imaging had been prescribed. Controls were subjects 35-50 years of age, having a cranial MR imaging for headache with normal findings, and no history of clinically relevant LBP. Two hundred forty cases and 64 controls were recruited consecutively in the radiology services across 6 cities in Spain. Imaging findings and subject characteristics were gathered through previously validated instruments. Radiologists who interpreted MRI were blinded to the subject characteristics. A multivariate logistic regression model was developed to assess the association of vertebral endplate changes with LBP, adjusting for sex, age, body mass index, lifetime exposure to smoking, physical activity, disk degeneration, and the interaction between disk degeneration and vertebral endplate changes. RESULTS: Vertebral endplate changes were found in 80.4% of the cases and in 87.5% of the controls. In the regression model, disk degeneration was the only variable showing a confounding effect. Results showed that after adjusting for disk degeneration, the presence of vertebral endplate changes is associated with the absence of chronic LBP (OR for LBP: 0.31; 95% CI, 0.10-0.95). CONCLUSIONS: In Southern European subjects, vertebral endplate changes are not associated with chronic LBP.

Influence of nomenclature in the interpretation of lumbar disk contour on MR imaging: a comparison of the agreement using the combined task force and the nordic nomenclatures.

BACKGROUND AND PURPOSE: The CTF nomenclature had not been tested in clinical practice. The purpose of this study was to compare the reliability and diagnostic confidence in the interpretation of disk contours on lumbar 1.5T MR imaging when using the CTF and the Nordic nomenclatures. MATERIALS AND METHODS: Five general radiologists from 3 hospitals blindly and independently assessed intravertebral herniations (Schmorl node) and disk contours on the lumbar MR imaging of 53 patients with low back pain, on 4 occasions. Measures were taken to minimize the risk of recall bias. The Nordic nomenclature was used for the first 2 assessments, and the CTF nomenclature, in the remaining 2. Radiologists had not previously used either of the 2 nomenclatures. κ statistics were calculated separately for reports deriving from each nomenclature and were categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), and poor (<0.00). RESULTS: Categorization of intra- and interobserver agreement was the same across nomenclatures. Intraobserver reliability was substantial for intravertebral herniations and disk contour abnormalities. Interobserver reliability was moderate for intravertebral herniations and fair to moderate for disk contour. CONCLUSIONS: In conditions close to clinical practice, regardless of the specific nomenclature used, a standardized nomenclature supports only moderate interobserver agreement. The Nordic nomenclature increases self-confidence in an individual observer's report but is less clear regarding the classification of disks as normal versus bulged.

Agreement in the interpretation of magnetic resonance images of the lumbar spine.

BACKGROUND: Correlation between clinical features and magnetic resonance imaging (MRI) findings is essential in low-back-pain patients. Most previous studies have analyzed concordance in the interpretation of lumbar MRI among a few radiologists who worked together. This may have overestimated concordance. PURPOSE: To evaluate intra- and interobserver agreement in the interpretation of lumbar MRI performed in an open 0.2 T system. MATERIAL AND METHODS: Seven radiologists from two different geographic settings in Spain interpreted the lumbar MRIs of 50 subjects representative of the general Danish population aged 40 years. The radiologists interpreted the images in routine clinical practice, having no knowledge of the clinical and demographic characteristics of the subjects and blinded to their colleagues' assessments. Six of the radiologists evaluated the same MRIs 14 days later, having no knowledge of the previous results. Data on the existence of disc degeneration, high-intensity zones, disc contour, Schmorl nodes, Modic changes, osteophytes, spondylolisthesis, and spinal stenosis were collected in the Nordic Modic Consensus Group Classification form. Intra- and interobserver agreement was analyzed for variables with a prevalence >or=10% and

Tumoración inguinal: una forma de presentación de la hidatidosis ósea. A propósito de un caso / Inguinal tumor: a rare occurrence of hydatid disease. A case report

La enfermedad hidatídica ósea es una entidad infrecuente que representa el 0,5-2,5% de todas las hidatidosis. Las vértebras son los huesos más comúnmente afectados (50%) seguidos de la pelvis (25%) y de los huesos largos (15-25%). Las manifestaciones clínicas aparecen cuando existe una gran destrucción ósea o complicaciones, por lo que el diagnóstico se realiza generalmente en estadios tardíos mediante técnicas de imagen y en ocasiones de manera intraoperatoria. El tratamiento en los casos operables es la extirpación quirúrgica pudiendo asociar tratamiento medico con albendazol. Presentamos el caso de un paciente con hidatidosis ósea, localizada en la pelvis, en ausencia de afectación de otros órganos. El paciente presenta como única manifestación clínica una tumoración inguinal derecha y es intervenido quirúrgicamente ante la sospecha de una hernia inguinal complicada con el hallazgo intraoperatorio de hidatidosis pélvica

Osseous hydatid disease is an infrequent entity that represents 0.5-2.5% of all hydatidoses. The vertebrae are the most commonly affected bones (50%), followed by the pelvis (25%) and the long bones (15-25%). The clinical manifestations appear when there is large scale osseous destruction or complications, which is why the diagnosis is generally made in late stages through imaging techniques and on occasion in an intra-operational form. Treatment in operable cases is by surgical extirpation, which can be associated with medical treatment with albendazol. We present the case of a patient with osseous hydatidosis, localised in the pelvis, with an absence of other affected organs. The only clinical manifestation presented by the patient was an inguinal tumour on the right side. The patient received a clinical intervention facing the suspicion of an inguinal hernia, complicated by the intra-operational discovery of pelvic hydatidosis

[Calcinosis cutis: on one case]. / Calcinosis cutis: a propósito de un caso.

We present the case of a woman of 72 years with high blood pressure evaluated in Surgery Outpatient Unit for overinfected and recurring pretibial cutaneous ulcers. In the radiographies of the extremity, calcifications were observed in soft parts and the biopsy showed calcified subepidermic nodules. Because of these findings, she was sent to Internal Medicine Consultations to complete the study. In the anamnesis, traumatism in the zone was ruled out, and was there consumption of calcium or phosphorous rich medicines; the physical exploration was normal, except for the lesions described previously. A study was requested to rule out any underlying pathology that might justify the clinical picture, without a possible etiological pathological cause in evidence. Given that the cutaneous calcinosis of the patient was not secondary to titular lesions, nor was there evidence of metabolic alterations or medical procedures that might justify it, and no lesions at another level were found, the diagnosis was established of idiopathic localised cutaneous calcinosis. It was treated with diltiazem.

Calcinosis cutis: a propósito de un caso / Calcinosis cutis: on one case

Presentamos el caso de una mujer hipertensa de 72 años que es valorada en Consultas de Cirugía por úlceras cutáneas pretibiales sobreinfectadas y recidivantes. En las radiografías de la extremidad se observan calcificaciones en partes blandas y la biopsia informa de nódulos subepidérmicos calcificados. Ante estos hallazgos es remitida a Consultas de Medicina Interna para completar estudio. En la anamnesis se descartan traumatismos en la zona y consumo de fármacos ricos en calcio o fósforo; la exploración física es normal, salvo lesiones previamente descritas. Se solicita estudio para descartar patología subyacente que pudiera justificar cuadro, sin evidenciarse posible causante. Dado que la calcicosis cutánea de la paciente no es secundaria a lesiones titulares, ni se evidencian alteraciones metabólicas ni procedimientos médicos que la justifiquen, y no se objetivan lesiones a otro nivel, se establece del diagnóstico de calcinosis cutánea localizada idiopatía. Se trató con diltiazem

We present the case of a woman of 72 years with high blood pressure evaluated in Surgery Outpatient Unit for overinfected and recurring pretibial cutaneous ulcers. In the radiographies of the extremity, calcifications were observed in soft parts and the biopsy showed calcified subepidermic nodules. Because of these findings, she was sent to Internal Medicine Consultations to complete the study. In the anamnesis, traumatism in the zone was ruled out, and was there consumption of calcium or phosphorous rich medicines; the physical exploration was normal, except for the lesions described previously. A study was requested to rule out any underlying pathology that might justify the clinical picture, without a possible etiological pathological cause in evidence. Given that the cutaneous calcinosis of the patient was not secondary to titular lesions, nor was there evidence of metabolic alterations or medical procedures that might justify it, and no lesions at another level were found, the diagnosis was established of idiopathic localised cutaneous calcinosis. It was treated with diltiazem

[Inguinal tumor: a rare occurrence of hydatid disease. A case report]. / Tumoración inguinal: una forma de presentación de la hidatidosis ósea. A propósito de un caso.

Osseous hydatid disease is an infrequent entity that represents 0.5-2.5% of all hydatidoses. The vertebrae are the most commonly affected bones (50%), followed by the pelvis (25%) and the long bones (15-25%). The clinical manifestations appear when there is large scale osseous destruction or complications, which is why the diagnosis is generally made in late stages through imaging techniques and on occasion in an intra-operational form. Treatment in operable cases is by surgical extirpation, which can be associated with medical treatment with albendazol. We present the case of a patient with osseous hydatidosis, localised in the pelvis, with an absence of other affected organs. The only clinical manifestation presented by the patient was an inguinal tumour on the right side. The patient received a clinical intervention facing the suspicion of an inguinal hernia, complicated by the intra-operational discovery of pelvic hydatidosis.

Trombosis venosa profunda de la extremidad superior: importancia de la TC / No disponible

No disponible

Dolor abdominal por rotura pancreática postraumática / Abdominal pain due to post-traumatic pancreas rupture

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Herniación encefálica / Encephalic herniation

No disponible

[Abdominal tuberculosis]. / Tuberculosis abdominal.

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli.

Tuberculosis abdominal / Abdominal tuberculosis

La tuberculosis abdominal cursa con un cuadro inespecífico, con difícil diagnóstico diferencial respecto a otras entidades de similar semiología. Presentamos el caso de un varón que ingresa por presentar dolor abdominal, pérdida progresiva y notoria de peso corporal y fiebre de dos meses de evolución. El cultivo de la biopsia de colon mostró presencia de bacilo de Koch

Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. ;;We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli

[Intestinal invagination in the adult secondary to jejunal lipoma]. / Invaginación intestinal en el adulto secundaria a lipoma yeyunal.

Small bowel intussusception is an unusual pathology in the adult. Most commonly, it is secondary to intestinal wall organic disorders. A complete small bowel obstruction is the most frequent clinical presentation, which requires emergency surgery in many cases. The preoperative diagnosis is infrequent. The best treatment is surgical resection.

Invaginación intestinal en el adulto secundaria a lipoma yeyunal / Intestinal invagination in the adult secondary to jejunal lipoma

La invaginación intestinal es una patología excepcionalen el adulto, generalmente secundaria a procesosorgánicos de la pared intestinal.La presentación clínica más frecuente es la obstrucciónintestinal mecánica completa que lleva en unnúmero elevado de casos a la intervención quirúrgicaurgente, por lo que el diagnóstico preoperatorio deesta patología es infrecuente.El tratamiento de elección es la resección quirúrgica

Small bowel intussuspeption is an unusualpathology in the adult. Most commonly, it is secondaryto intestinal wall organic disorders.A complete small bowel obstruction is the mostfrequent clinical presentation, which requiresemergency surgery in many cases. The preoperativediagnosis is infrequent.The best treatment is surgical resection