Unilateral exophthalmos secondary to esophageal adenocarcinoma metastasis to the medial rectus muscle. / Exoftalmos unilateral secundario a metástasis en músculo recto interno de adenocarcinoma de esófago.

A case is presented on a 51 year-old man with stage IV oesophageal adenocarcinoma. The patient was referred by the Oncology Department urgently for a same-day assessment by an ophthalmologist due to two weeks of severe unilateral exophthalmos and binocular diplopia. A comprehensive eye exam revealed the presence of an axial non-reductive exophthalmos and a limitation in left eye levoduction. A computed tomography scan was performed that showed a multiple lobed, intra-and extra-conal, heterogeneous left orbital mass, that surrounded the internal rectus muscle, compatible with metastasis, as well as another small extraconal mass at the base of the contralateral orbit. Palliative radiotherapy was then indicated. Metastases in the extraocular muscles are a very rare finding, but should be suspected in a case of unilateral exophthalmos and, if necessary, refer the patient to have the corresponding complementary tests performed.

Psychometric analysis of questions associated with radiological images in the competitive examination for access to residency programs in Spain. / Análisis psicométrico de las preguntas asociadas a imágenes radiológicas en el examen para médico interno residente en España.

BACKGROUND AND OBJECTIVE: Psychometrics is a simple, intuitive approach used in educational research and in multiple-choice questionnaires. Since 2009, the competitive examination through which access to residency programs in Spain is determined (MIR) has included questions related to radiological images. The objective of this paper is to show the results of the psychometric analysis of these questions with the aim of comparing their degree of difficulty, discriminative capacity, and internal structure with respect to those of the other questions on the examination. MATERIAL AND METHODS: We analyzed all questions on the examination since 2009, classifying them as clinical cases with and without radiological images, clinical cases with and without non-radiological images, multiple choice questions, and negative questions. We used classical test theory and item response theory to assess the difficulty and degree of discrimination of the questions. RESULTS: Of 225 questions, between 11% and 15% of the questions included in the examinations were associated with images. The questions associated with radiological images were more difficult (corrected difficulty index, 0.51) and had worse discriminative capacity. The increased difficulty of radiological questions was associated with worse discriminative capacity, especially if the clinical information provided was inadequate or if the clinical information was contrary to the radiological concept or if there had never been any questions about the concept in previoous MIR examinations. CONCLUSIONS: To equalize the standards of the MIR examination, it is necessary to maintain an appropriate structure in devising radiology questions, with terms from the clinical context, appropriate use of distracters, and a lower level of difficulty, which could be achieved by using radiological images with typical radiological findings.

Acute sialadenitis as adverse reaction to iodinated contrast. / Sialoadenitis aguda bilateral como reacción adversa a contraste yodado.

Swelling of the salivary glands after administration of iodinated contrast is a very rare adverse reaction. Its etiology is not clear and although it has a benign course associated complications have been reported. We report two cases of acute bilateral sialadenitis after intravenous iodinated contrast in 60 and 63 year-old men who underwent a computed tomography scan in the previous days.

[Plexiform neurofibroma of the ileum and mesentery: an uncommon manifestation of neurofibromatosis type I]. / Neurofibroma plexiforme de íleon y mesenterio: una manifestación infrecuente de la enfermedad de Von Recklinghausen.

Plexiform neurofibroma is a tumor of the nerve trunks and their branches; it is considered virtually pathognomic of neurofibromatosis type 1. We present the case of a patient with neurofibromatosis type 1 and a plexiform neurofibroma involving the ileum and mesentery. This case is interesting because intestinal involvement by neurofibroma is rare and because the patient presented with symptomatic intestinal involvement that required surgery.

[Adrenal oncocytoma]. / Oncocitoma suprarrenal.

OBJECTIVE: To describe an additional case of adrenocortical oncocytoma that had been incidentally discovered. METHODS/RESULTS: A case of adrenocortical oncocytoma in a 30-year-old male is presented. Patient evaluation by US, CT and arteriography revealed a well-defined mass between the upper pole of the left kidney, spleen and stomach, that appeared to be of adrenal origin. Histopathological and ultrastructural studies revealed a benign adrenocortical oncocytoma with moderate cell atypia but with no signs of infiltration. CONCLUSION: Adrenocortical oncocytoma must be included in the differential diagnosis of solid adrenal tumors.