Chronic cholangitides: Differential diagnosis and role of MRI. / Colangitis crónicas: diagnóstico diferencial y papel de la resonancia magnética.

The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis.

[Hypertensive urgencies: Description of clinical characteristics, management, variables associated with re-entry and short-term prognosis]. / Urgencias hipertensivas: descripción de características clínicas, manejo, variables asociadas a reconsulta y pronóstico a corto plazo.

OBJECTIVES: To describe the characteristics of hypertensive urgencies at the emergency department, as well as the variables associated with early re-admission (<7 days) and re-admission at one month (<30 days). METHODS: We conducted a descriptive, retrospective study of all patients who were admitted to the emergency department of a third level hospital during 2013. Subsequently, a case-control analysis was performed to analyze the group of patients with readmission. RESULTS: A total of 398 hypertensive urgencies were collected (32.4% men, mean age 67.75 years), which led to an incidence of 3.28/1000 visits. Eighty point nine percent had a previous history of hypertension, and the mean Charlson Index was 2.23. Headache was the most frequent symptom (49.1%), followed by dizziness/instability (29.5%) and nausea/vomiting (17.1%). Eighty point seven percent of the patients were prescribed pharmacological treatment. The rates of cardiovascular events or mortality at one month were low (2.26% and 0.25% respectively). Despite this, 7.53% and 11.31% of patients were readmitted in under 7 days or 30 days, respectively. The variables associated with readmission in the multivariate analysis were elevated systolic blood pressure in the first determination, previous hypertension and the presence of palpitations. CONCLUSIONS: Hypertensive emergencies are high-incidence conditions in the Emergency Department. In our study, patients with a prior diagnosis of hypertension and elevated systolic blood pressure at the first determination had a higher risk of re-entry and would be candidates for closer follow-up on discharge.

[Arterial hypertension during pregnancy: Always preeclampsia?] / Hipertensión arterial durante el embarazo: ¿siempre preeclampsia?

Cushing's syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushing's syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester.

Rapid assessment of nonlinear optical propagation effects in dielectrics.

Ultrafast laser processing applications need fast approaches to assess the nonlinear propagation of the laser beam in order to predict the optimal range of processing parameters in a wide variety of cases. We develop here a method based on the simple monitoring of the nonlinear beam shaping against numerical prediction. The numerical code solves the nonlinear Schrödinger equation with nonlinear absorption under simplified conditions by employing a state-of-the art computationally efficient approach. By comparing with experimental results we can rapidly estimate the nonlinear refractive index and nonlinear absorption coefficients of the material. The validity of this approach has been tested in a variety of experiments where nonlinearities play a key role, like spatial soliton shaping or fs-laser waveguide writing. The approach provides excellent results for propagated power densities for which free carrier generation effects can be neglected. Above such a threshold, the peculiarities of the nonlinear propagation of elliptical beams enable acquiring an instantaneous picture of the deposition of energy inside the material realistic enough to estimate the effective nonlinear refractive index and nonlinear absorption coefficients that can be used for predicting the spatial distribution of energy deposition inside the material and controlling the beam in the writing process.

[Ramsay-Hunt syndrome]. / Síndrome de Ramsay-Hunt.

Ramsay-Hunt syndrome is a peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear or in the mouth; it is caused by varicella zoster virus that affects the geniculate ganglion. The zoster oticus is the second most common cause of atraumatic peripheral facial paralysis. We present a review of zoster oticus identified in our hospital among 2001-2005. We show various atypical cases with multiple cranial nerve involvement; cerebellum and spinal cord was affected in one patient. 3/10 cases were complicated with pneumonia. So, we think that some grade of immunodeficiency may be present in these cases. Treatment with acyclovir and prednisone has been successfully to improve the outcome in the most of patients. Compared with Bell s palsy, patients with zoster oticus often have more severe paralysis at onset and are less likely to recover completely.

Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: an MRI and CT prospective study.

The possible relationship between the morphometric characteristics (condylar and temporomandibular joint (TMJ) disc position) of the TMJ and the TMJ clinical findings (normal versus TMJ disorders) in different types of dentofacial deformities was studied. Forty-eight patients with dentofacial deformities (96 TMJs) were investigated preoperatively and 10 patients (20 TMJs) without deformities were studied as a control group, clinically and radiographically, using computer tomography (CT) and magnetic resonance imaging (MRI), to assess the position of the mandibular condyle and the TMJ disc in the sagittal, coronal and horizontal planes. Fifteen of the 28 joints (53.6%) of patients diagnosed as class II dentofacial deformity had internal derangements and anteriorly displaced discs. The incidence of internal derangement in the class I and class III groups was lower (10%). An increased horizontal angle of the mandibular condyle and a posteriorly seated condyle were found in patients diagnosed as class II dentofacial deformity when compared with the control group. The rest of the patients studied showed no significant differences. The same results were encountered when the patients with moderate to severe TMJ pathology were studied, both clinically (using the Helkimo index modified by Athanasiou) and by MRI.

Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study.

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.

[Vascular complications in renal transplantation]. / Complicaciones vasculares en el trasplante renal.

Between the years 1979 and 1992 we a total of 479 renal transplants (RT) were performed. In 62 patients (12.9%) there were some clinically significant vascular complications. These have consisted of: 10 cases of arterial thrombosis (2%); 10 cases of venous thrombosis (2%); 5 cases of arterial and venous thrombosis (1%); 31 cases of arterial stenosis (6.5%); and 6 cases of acute haemorrhage originated at the vascular anastomosis level (1.2%). In all those cases with arterial or venous thrombosis, or both, it was necessary to perform transplantation. The arterial stenosis cases were treated with antihypertensive agents in 13 patients; with endoluminal percutaneous angioplasty (EPA) in other 13 patients and with surgery in 5. Both arterial stenosis and complications from their treatment resulted in 5 transplantations. In all cases with early post-surgical haemorrhage originated at the vascular anastomosis level, a surgical review and suture of bleeding site was performed. A total of 31 grafts (6.5%) were lost as a result of vascular complications.

Changes in the temporomandibular joint caused by the vertical facial pattern. Study on an experimental model.

An experimental model reproducing open bite or verticalized facial pattern was used to study its effect on the temporomandibular joints. 140 Wistar rats were used, divided into 3 groups: bilateral resection of the masseteric muscle, simulated muscular resection and control group. A series of radiological, morphological and histological tests were analyzed. The posterior rotation of the jaw caused by muscular resection although not producing a degenerative effect, did produce specific articular changes in the temporomandibular joint components.

[Cyst of the ejaculatory duct]. / Quiste de conducto eyaculador.

Presentation of a new case of cyst of the ejaculatory duct, diagnosed in a 49-year-old patient. Unspecific symptomatology, with hemospermia and urethrorrhagia of 6 months evolution. Diagnosis is reached by abdominal and transrectal ultrasound and deferent-vesiculography. Computerized Axial Tomography and Magnetic Nuclear Resonance are performed to document the case and for subsequent follow-up. No other associated malformations are found. Following failure of endoscopic surgery, the original approach, abdominal exeresis is performed with excellent evolution both in the immediate post-operative and at 1-year follow-up. Likely etiology and differential diagnosis from other male pelvic cysts are discussed. List of references on differential diagnosis and published cases in included.

[Percutaneous nephrolithotomy for coralliform lithiasis in a patient with bilateral triplicated ureters]. / Nefrolitotomía percutánea por litiasis coraliforme en paciente con triplicidad ureteral bilateral.

We report on a rare case of bilateral ureteral triplicity with a definitive urinary diversion (Brickner loop ureteroileostomy) who presented a staghorn stone in the upper calyx of the left kidney. The patient was submitted to percutaneous nephrolithotomy with direct access to the upper calyx of the anomalous kidney. We discuss the indication for this treatment, which resolved the lithiasis in a single session and with no complications. Furthermore, this treatment modality is compared with ESWL and open surgery, which we reserve for failures or those cases where the percutaneous approach is contraindicated. Percutaneous nephrolithotomy can be considered a therapeutic alternative for lithiasis in patients with congenital malformation and/or urinary diversion.

[Blind bifid ureter associated with duplicity and contralateral vesicoureteral reflux]. / Uréter bífido ciego asociado a duplicidad y reflujo vesicoureteral contralateral.

We report on a pediatric patient who was evaluated for recurrent episodes of urinary tract infection. Evaluation by IVP, cystography and retrograde ureteropyelography revealed a complete ureteral duplicity, grade II vesicoureteral reflux in the lower half of the left kidney and a blind bifid ureter arising at the distal third of the right ureter. This is an uncommon condition (about 150 cases have been reported) difficult to diagnose if undetected by conventional radiological evaluation and retrograde ureteropyelography may be required. It may be associated with urological or other types of malformations. It is generally asymptomatic and with scant consequences, thus treatment is initially conservative. Surgical excision of the blind bifid ureter is warranted only when complications present. In the present case, prophylactic antibiotic therapy was instituted. At one year follow up, the patient is asymptomatic and urine cultures are negative.