Actualización del manejo de metástasis encefálicas / Metastasis management update encephalic

Brain metastases represent a critical stage of oncological disease and its frequency is increasing over the recent years. The treatment of brain metastases has moved from a conservative approach to an active management that should be individualized for each patient: in case of single brain metastasis, surgery or radiosurgery should be considered as first option of treatment; in case of multiple lesions, whole-brain radiotherapy is the standard of care. The aim of this review is to present general aspects including new approaches in management of patients with brain metastases.(AU)

Meningioma de la vaina del nervio óptico y tratamiento con radioterapia conformacional: reporte de un caso clínico tratado con largo seguimiento / Optic nerve sheath meningioma treated with radiation conformal therapy: clinical case report with long follow up

Introducción: Los meningiomas de la vaina del nervio óptico (MVNO) son tumores inusuales de la vía visual anterior. Sin tratamiento, el crecimiento del tumor lleva a pérdida visual progresiva hasta la ceguera debido a la compresión que ejerce sobre el nervio óptico. Presentación del caso: Paciente, sexo femenino, 42 años, sin antecedentes mórbidos, que en 1992, inicia cuadro de disminución de la agudeza visual del ojo izquierdo. La resonancia magnética (RM) cerebral informa una lesión expansiva fusiforme en relación a la vaina del nervio óptico izquierdo que lo engloba, altamente sugerente de MVNO. En esa ocasión se realiza exploración de órbita la cual resulta frustra, por lo que se decide observación con controles clínicos e imagenológicos anuales, permaneciendo estable. Aproximadamente diez años más tarde, en el lapso de un año, inicia agravación progresiva de la agudeza y campo visual, ptosis palpebral y alteraciones de la oculo-motilidad del ojo izquierdo, objetivadas por examen neuro-oftalmológico, por lo que se sospecha progresión de MVNO. Se solicita nueva RM que confirma crecimiento significativo del tumor. Se descarta nuevo abordaje quirúrgico por riesgo de mayor deterioro visual y se efectúa radioterapia conformacional con una dosis de 54 Gy. Actualmente, a la edad de 65 años, se cumplen 24 años de evolución, 13 post radioterapia, confirmándose estabilidad clínica y radiológica de MVNO. Discusión: La radioterapia, cuando se observa progresión de la enfermedad, ha demostrado ser una terapia eficaz para los MVNO, con menos complicaciones y con mejores resultados en la preservación de la función visual a largo plazo.

Introduction: Optic nerve sheath meningiomas (ONSM) are rare tumors of the anterior visual pathway. Without treatment, tumor growth leads to progressive loss of visual acuity and blindness due to optic nerve compression. Case report: Patient, female, 42 years without other morbility , begins in 1992 with decreased visual acuity of the left eye, magnetic resonance imaging (MRI) showed enlargement of the left optic nerve sheath, suggestive of ONSM. On that occasion, orbit exploration failed, so it was decided to follow up with annual clinical and imaging controls. About ten years later, begins with progressive deterioration of visual acuity and visual field , with ptosis and ocular motor palsy of the left eye, confirmed with neuro-ophtalmological examinations. MRI shows tumor progression. A new surgical approach was discarded by the risk of visual worsening. A conformal radiotherapy was performed with a fractionated 54 Gy dose. Today, at age 65, after 24 years of follow up,13 post radiation therapy. clinical and radiological stability of ONSM is confirmed. Discussion: Conformal radiotherapy has been shown as an effective therapy, with fewer complications and better outcomes in the preservation of visual function in the long term follow up.

Telemedicina, un aporte universitario / Telemedicine, a university contribution

The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”(OMS)(1) TM has been reported since 50 years (2) and recent developments like internet and transition and storage standards of digital imaging: DICOM(3) allowed to develop Teleradiology (TR) leading TM modality..TR consists in transformation, acquisition, storage of digital imaging and transmition at high speed to high resolution work stations to allow distant radiological diagnosis(4) . Chilean TR experience begins in 1995 (5) and the Chilean Health Minister has called to 4 public tenders in CT Scan reports since 2012(7,8). In 2015 the Faculty of Medicine created the Informatic and TM Center (CIMT) to work with the University of Chile Clinic Hospital (HCUCH) in TM, TR and telepsiquiatry, teledermatology, telecardiology, telemonitoring and specialist assistance.. A contribution in the HCUCH-TR development is the study of the factors involved in its success by the HOT-fit evaluation model(11).