[How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]. / Cómo reestructurar una Sección de Medicina Fetal en tiempos de pandemia COVID-19. Medidas de seguridad y limpieza de los equipos ecográficos.

During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.

[Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques]. / Seguimiento mediante técnicas de neuroimagen de los aneurismas cerebrales tratados por vía endovascular.

There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources.

Anisocoria as initial manifestation of multiple sclerosis. Use of 3 tesla magnetic resonance imaging. / Anisocoria como manifestación inicial de esclerosis múltiple. Utilidad de la resonancia magnética nuclear de 3 teslas.

A 21-year-old woman seen in this clinic with non-reactive mydriasis in the right eye that contracted with 1% pilocarpine. Cranial angio-CT and 1.5 T magnetic resonance imaging (MRI) did not detect any disease. Given a subsequent limitation of adduction, supraduction, and infarction of the right eye, a 3 T MRI was requested. This showed a lesion of the midbrain at the exit of the 3rd cranial nerve. After improvement, no new episodes were observed until 18 months later, when the patient presented with probable optic neuritis and systemic symptoms. At this time the 1.5 T MRI detected infratentorial and supratentorial demyelinating plaques. A subsequent lumbar puncture and clinic outcome confirmed the diagnosis of relapsing-remitting multiple sclerosis.

Towards an operational system for oil-spill forecast over Spanish waters: initial developments and implementation test.

The ESEOO Project, launched after the Prestige crisis, has boosted operational oceanography capacities in Spain, creating new operational oceanographic services and increasing synergies between these new operational tools and already existing systems. In consequence, the present preparedness to face an oil-spill crisis is enhanced, significantly improving the operational response regarding ocean, meteorological and oil-spill monitoring and forecasting. A key aspect of this progress has been the agreement between the scientific community and the Spanish Search and Rescue Institution (SASEMAR), significantly favoured within the ESEOO framework. Important achievements of this collaboration are: (1) the design of protocols that at the crisis time provide operational state-of-the-art information, derived from both forecasting and observing systems; (2) the establishment, in case of oil-spill crisis, of a new specialized unit, named USyP, to monitor and forecast the marine oceanographic situation, providing the required met-ocean and oil-spill information for the crisis managers. The oil-spill crisis scenario simulated during the international search and rescue Exercise "Gijón-2006", organized by SASEMAR, represented an excellent opportunity to test the capabilities and the effectiveness of this USyP unit, as well as the protocols established to analyze and transfer information. The results presented in this work illustrate the effectiveness of the operational approach, and constitute an encouraging and improved base to face oil-spill crisis.

[Accidental dural puncture during epidural injection of corticosteroids: a different approach?]. / Punción dural accidental en la infiltración epidural con corticoide. Un abordaje diferente?

We report 6 cases diagnosed with accidental dural puncture after epidural injection of corticosteroids for low back pain. All the patients reported postdural puncture headache during their stay in the postanesthetic recovery unit. For 3 patients, pain resolved with treatment given in the recovery unit. Two other patients also required mild analgesics for 1 week. In the last patient, a blood patch was used to treat incapacitating headache 22 days after the epidural procedure and mild analgesics were needed for 4 more weeks. It is important to establish a protocol for treating postdural puncture headache in pain clinics to facilitate decision making. Good physician-patient communication is necessary to avoid refusals for permission for other epidural techniques and to facilitate management of symptoms.

Re-resection for colorectal liver metastasis.

With the decreasing mortality and morbidity of liver resection in the last 10 years, a more aggressive approach has emerged against liver metastases of colorectal cancer. Repeat liver resection is being performed for patients with isolated liver recurrence following a first hepatectomy. Based on a 2-year experience of 55 repeat hepatic resections performed in 44 patients, the authors observed no operative mortality and a postoperative morbidity of 15% similar to that of first hepatectomies. Five-year survival rate is 44% following second hepatectomy. These results combined with the review of the literature demonstrate that rehapectomy may be performed safely and may provide the only chance of long-term remission in patients presenting with technically resectable liver recurrence in the absence of widespread extrahepatic disease.

[Treatment in spontaneous intracerebral haemorrhage. Analysis of Spanish clinical series]. / Tratamiento de la hemorragia intracerebral espontánea. Análisis de las series clínicas españolas.

OBJECTIVE: In the spontaneous intracerebral hemorrhage (SICH) there are a small number of unequivocally indicators of surgical or conservative treatment. DEVELOPMENT: An extensive bibliographic revision of studies of patients with spontaneous ICH admitted to Spanish Hospitals has been completed. Later on, studies related to analyses and results of mortality and functional state of surgical and conservative treatments of ICH were gathered. Using the Cochrane Collaboration Manual the methodological quality of the studies has been evaluated. CONCLUSIONS: The chosen studies were 25 clinical series. Only two studies comparing the surgical against the conservative treatment of supratentorial ICH has been found. The intrinsic methodological quality associated to this type of studies does not allow to establish valid conclusions on the efficacy of one treatment over another. Nonetheless it has utility considering that it reveals the chosen treatment and the outcomes in the published studies. We did not found studies evaluating the efficacy of both treatments in Spain with a prospective randomised design, with an adequate size, analysing mortality, dependency and quality of life of the affected patients. Therefore, our final conclusion is that given the importance of the information that could be extracted from these studies in order to design the more efficient treatment of ICH no delay to complete them can be admitted.

Repeat hepatectomy for colorectal liver metastases.

OBJECTIVE: The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival. SUMMARY BACKGROUND DATA: Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in an increasing number of patients. However, higher operative bleeding and increased morbidity have been reported after repeat hepatectomies, and the long-term benefit of these procedures needs to be evaluated. STUDY POPULATION: Sixty-four patients from a group of 243 patients resected for colorectal liver metastases were submitted to 83 repeat hepatectomies (64 second, 15 third, and 4 fourth hepatectomies). Combined extrahepatic surgery was performed in 21 (25%) of these 83 repeat hepatectomies. RESULTS: There was no intraoperative or postoperative mortality. Operative bleeding was not significantly increased in repeat hepatectomies as compared to first resections. Morbidity and duration of hospital stay were comparable to first hepatectomies. Overall and disease-free survival after a second hepatectomy were 60% and 42%, respectively, at 3 years and 41% and 26%, respectively, at 5 years. Factors of prognostic value on univariate analysis included the curative nature of first and second hepatectomies (p = 0.04 and p = 0.002, respectively), an interval between the two procedures of more than 1 year (p = 0.003), the number of recurrent tumors (p = 0.002), serum carcinoembryonic antigen levels (p = 0.03), and the presence of extrahepatic disease (p = 0.03). Only the curative nature of the second hepatectomy and an interval of more than 1 year between the two procedures were independently related to survival on multivariate analysis. CONCLUSIONS: Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies, with no mortality and comparable morbidity. Combined extrahepatic surgery can be required to achieve tumor eradication. Repeat hepatectomies appear worthwhile when potentially curative.