Sarcomas de partes blandas en la región del codo e influencia de sus particularidades anatómicas en su tratamiento. Experiencia en una Unidad de Tumores musculoesqueléticos / Soft tissue sarcomas in the elbow region and influence of their anatomical features in their treatment. Experience in the Unit of Musculoskeletal Tumours

ANTECEDENTES Y OBJETIVO: Los sarcomas de partes blandas se localizan excepcionalmente en la región del codo. El objetivo de este trabajo fue estudiar los sarcomas de partes blandas de la región del codo, sus características epidemiológicas e histopatológicas, particularidades anatómicas, tratamiento realizado y resultados obtenidos, en una Unidad de Tumores Musculoesqueléticos. MATERIALES Y MÉTODOS: Revisión retrospectiva de 10 pacientes con un seguimiento de 65,0 ± 11,9 (rango 21-132) meses con sarcoma de partes blandas situado en la región del codo, intervenidos en nuestro centro entre los años 2008 y 2016. RESULTADOS: La edad media fue de 60,8 ± 6,7 años. La histología más frecuente fue sarcoma pleomórfico indiferenciado. El 90% de los pacientes fueron sometidos a cirugía de preservación de extremidad. Tres pacientes fueron previamente intervenidos sin criterios oncológicos en otro centro, y esto se relacionó de forma estadísticamente significativa con requerir más de una cirugía para el control de la enfermedad. En cinco pacientes se obtuvo un margen R1 y en cinco R0. La radioterapia adyuvante se utilizó en siete casos. En cuatro pacientes se realizó cirugía posterior para control local o sistémico de la enfermedad. En tres casos se produjo recidiva local y en cinco se presentó enfermedad a distancia. CONCLUSIONES: La región del codo presenta dificultad para lograr márgenes amplios por la proximidad de estructuras neurovasculares, por lo que las terapias adyuvantes, neoadyuvantes (o ambas) podrían tener un papel importante para poder realizar una cirugía de preservación de la extremidad. Sería recomendable remitir estos tumores a unidades especializadas con equipos multidisciplinarios

BACKGROUND AND AIM: Soft tissue sarcomas are exceptionally located in the elbow region. The aim of this work was to study the soft tissue sarcomas of the elbow region, their epidemiological and histopathological characteristics, anatomical features, the treatment performed, and the results obtained, in a unit of musculoskeletal tumours. METHODS: Retrospective review of ten patients with a mean follow-up of 65.0 ± 11.9 (range 21-132) months with soft tissue sarcomas located in the elbow region operated in our centre between 2008 and 2016. RESULTS: Mean age was 60.8 ± 6.7 years. Undifferentiated pleomorphic sarcoma was the most frequent histological diagnosis. Limb preservation surgery was performed in 90% of patients. Three patients were previously operated without following surgical oncology guidelines in another hospital, and this was statistically related to the need for more than one surgery to control the disease. R1 margin was obtained in 5 patients and R0 in another 5. Adjuvant radiotherapy was used in 7 cases. In 4 patients, subsequent surgery was performed for local or systemic control of the disease. Local recurrence occurred in 3 cases and in 5 there was distant disease. CONCLUSION: The elbow region presents difficulty in achieving wide margins due to the proximity of neurovascular structures, adjuvant and / or neoadjuvant therapies could play an important role in performing limb preservation surgery. It would be advisable to refer these tumours to specialized units with multidisciplinary teams

Soft tissue sarcomas in the elbow region and influence of their anatomical features in their treatment. Experience in the Unit of Musculoskeletal Tumours. / Sarcomas de partes blandas en la región del codo e influencia de sus particularidades anatómicas en su tratamiento. Experiencia en una Unidad de Tumores musculoesqueléticos.

BACKGROUND AND AIM: Soft tissue sarcomas are exceptionally located in the elbow region. The aim of this work was to study the soft tissue sarcomas of the elbow region, their epidemiological and histopathological characteristics, anatomical features, the treatment performed, and the results obtained, in a unit of musculoskeletal tumours. METHODS: Retrospective review of ten patients with a mean follow-up of 65.0 ± 11.9 (range 21-132) months with soft tissue sarcomas located in the elbow region operated in our centre between 2008 and 2016. RESULTS: Mean age was 60.8 ± 6.7 years. Undifferentiated pleomorphic sarcoma was the most frequent histological diagnosis. Limb preservation surgery was performed in 90% of patients. Three patients were previously operated without following surgical oncology guidelines in another hospital, and this was statistically related to the need for more than one surgery to control the disease. R1 margin was obtained in 5 patients and R0 in another 5. Adjuvant radiotherapy was used in 7 cases. In 4 patients, subsequent surgery was performed for local or systemic control of the disease. Local recurrence occurred in 3 cases and in 5 there was distant disease. CONCLUSION: The elbow region presents difficulty in achieving wide margins due to the proximity of neurovascular structures, adjuvant and / or neoadjuvant therapies could play an important role in performing limb preservation surgery. It would be advisable to refer these tumours to specialized units with multidisciplinary teams.

Papel de la resonancia magnética en niños con hemangiomas lumbosacros y perineales: informe de 3 casos clínicos y revisión de la literatura / Role of Magnetic Resonance Image in Children with Lumbosacral and Perineal Hemangiomas: Case Reports and Review of the Literature

Los hemangiomas infantiles son los tumores benignos más frecuentes en la población pediátrica. Cuando afectan al área lumbar y perineal, algunos casos pueden asociarse a alguna malformación subyacente como una disrafia espinal oculta. El manejo de estos hemangiomas carece de consenso. Describimos 3 casos de niños con hemangiomas lumbosacros y perineales con anomalías en la resonancia magnética y revisamos la literatura para valorar qué pruebas y en qué momento se deben realizar para completar el estudio en estos pacientes. Por lo general, se solicita una ecografía lo más precozmente posible, ya que esta técnica no es posible realizarla una vez que los elementos espinales posteriores se han osificado, lo que generalmente ocurre a los 6 meses de edad. La resonancia magnética es la prueba de referencia para diagnosticar una disrafia espinal oculta. De acuerdo con la literatura, la edad media para este examen debe ser alrededor de los 6 meses, cuando la formación de grasa en el filum terminale se ha visto incrementada. En nuestra opinión, se debería realizar una resonancia magnética a los 6 meses de edad en todos los niños con hemangioma lumbar o perineal, independientemente del tamaño de la lesión, la ausencia de síntomas neurológicos o los resultados de la ecografía

Cutaneous hemangiomas are the most frequent benign tumors in children. When they affect the lumbar and perineal area some cases can be associated with an occult spinal dysraphism. The management of these hemangiomas lack consensus. We report 3 cases of children with lumbosacral and perineal hemangiomas with magnetic resonance image abnormalities and we review the literature to find out the type and timing of tests that should be performed to complete the study in these patients. Ultrasound is typically requested as young as possible, as this imaging technique is not possible 11 the posterior spinal elements have ossified. MRI is the gold standard for diagnosing occult spinal dysraphism. According to the literature, the mean age for MRI screening should be around 6 months, when the fat formation in the filum terminale is expanded. In our opinion, an MRI scan should be performed at 6 months of age in every children with lumbar or perineal hemangioma regardless the lesion size, neurological symptoms or the ultrasound results

Role of Magnetic Resonance Image in Children with Lumbosacral and Perineal Hemangiomas: Case Reports and Review of the Literature. / Papel de la resonancia magnética en niños con hemangiomas lumbosacros y perineales: informe de 3casos clínicos y revisión de la literatura.

Cutaneous hemangiomas are the most frequent benign tumors in children. When they affect the lumbar and perineal area some cases can be associated with an occult spinal dysraphism. The management of these hemangiomas lack consensus. We report 3 cases of children with lumbosacral and perineal hemangiomas with magnetic resonance image abnormalities and we review the literature to find out the type and timing of tests that should be performed to complete the study in these patients. Ultrasound is typically requested as young as possible, as this imaging technique is not possible 11the posterior spinal elements have ossified. MRI is the gold standard for diagnosing occult spinal dysraphism. According to the literature, the mean age for MRI screening should be around 6 months, when the fat formation in the filum terminale is expanded. In our opinion, an MRI scan should be performed at 6 months of age in every children with lumbar or perineal hemangioma regardless the lesion size, neurological symptoms or the ultrasound results.

Síndrome piramidal. A propósito de un caso / No disponible

Paciente de 46 años de edad, con antecedentes personalesde episodios de lumbalgia aguda en varias ocasiones, queacude a consulta de Atención Primaria por dolor de seis días de evolución localizado en la región glútea izquierda irradiado a miembro inferior ipsilateral. El dolor mejora con la sedestación y al inclinar el tronco hacia delante

The case is presented of a 46-year old patient with personal background of acute low back pain episodes on several occasions who came to the Primary Health Care consultation due to six-day long pain located in the left gluteal region that irradiated to the ipsilateral lower limb. The pain improved with sedation and tilting the trunk forward

Síncope de origen cardiogénico: síndrome de Wolff-Parkinson-White / Syncope of cardiogenic origin: Wolff-Parkinson-White syndrome

Presentamos a un paciente varón de 20 años de edad que acude a consulta de Atención Primaria por cuadros sincopales bruscos en relación con la práctica de ejercicio físico. Se le realiza electrocardiograma (ECG) y se objetiva la presencia de onda delta y PR corto, por lo que se sospecha la presencia de síndrome de Wolff-Parkinson-White (WPW) y se remite a las consultas de Cardiología

We present the case of a 20 year old male patient who came to the Primary Care clinic due to sudden syncope pictures in relationship with the practice of physical exercise. An ECG was done, observing the presence of delta wave and short PR. Thus, the presence of the WPW syndrome was suspected and the patient was referred to the Cardiology out-patient clinic