Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático / Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach

Las fracturas faciales, relacionadas frecuentemente con accidentes de tráfico, agresiones, accidentes laborales o caídas, constituyen un considerable número de urgencias en nuestros hospitales y asocian, además, una elevada morbimortalidad. La tomografía computarizada multidetector es la técnica de imagen de elección por su amplia disponibilidad y rapidez, y porque permite tanto la caracterización de las fracturas faciales como de las complicaciones asociadas, incluyendo las de localización craneal. Es, por tanto, fundamental para orientar el manejo clínico y la planificación quirúrgica. En este trabajo se describe la anatomía radiológica de la región facial, destacando la importancia de los contrafuertes o arbotantes faciales, se ilustran los hallazgos característicos en las fracturas faciales, y se indican los puntos clave necesarios para su abordaje estructurado al realizar el correspondiente informe radiológico

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report

Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach. / Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático.

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report.

Paraganglioma carotídeo maligno. A propósito de un caso / Malignant carotid paraganglioma: a case report

Los tumores del cuerpo carotídeo son neoplasias poco frecuentes, de lento crecimiento, muy destructivos y vascularizados, que tienen un origen neuroectodérmico. Los tumores malignos representan el 5-13% de los casos y presentan un comportamiento agresivo local con infiltración de los ganglios linfáticos adyacentes o metástasis a distancia. Presentamos el caso de un varón de 60 años al que en el estudio por dolor y parestesias en miembro superior se le realiza una resonancia magnética donde se visualiza una gran tumoración en el espacio carotídeo izquierdo, la cual se biopsió obteniendo el diagnóstico histológico de paraganglioma. Al realizar el estudio de extensión se identificó la presencia de metástasis pulmonares y óseas, lo que confirma la malignidad del tumor

Tumors of the carotid body are uncommon neoplasms that originate in the neuroectoderm. These tumors are slow growing but well vascularized and very destructive. Between 5% and 13% of carotid body tumors are malignant, behaving aggressively at the local level, invading the adjacent lymph nodes, and resulting in remote metastases. We present the case of a 60-year-old man who was examined for pain and paresthesias in his arm. Magnetic resonance imaging showed a large tumor in the left carotid space. Histologic study of a biopsy specimen from the tumor revealed that it was a paraganglioma. Further studies to determine the extent of disease detected metastases in bone and lung, confirming the tumor's malignancy

Malignant carotid paraganglioma: a case report. / Paraganglioma carotídeo maligno. A propósito de un caso.

Tumors of the carotid body are uncommon neoplasms that originate in the neuroectoderm. These tumors are slow growing but well vascularized and very destructive. Between 5% and 13% of carotid body tumors are malignant, behaving aggressively at the local level, invading the adjacent lymph nodes, and resulting in remote metastases. We present the case of a 60-year-old man who was examined for pain and paresthesias in his arm. Magnetic resonance imaging showed a large tumor in the left carotid space. Histologic study of a biopsy specimen from the tumor revealed that it was a paraganglioma. Further studies to determine the extent of disease detected metastases in bone and lung, confirming the tumor's malignancy.

[Well-differentiated basal cell adenocarcinoma of the lacrimal sac: a case report]. / Adenocarcinoma de células basales del saco lacrimal bien diferenciado. A propósito de un caso.

Basal cell adenocarcinoma is a rare tumor first considered to be a separate entity by the WHO in 1991. The mean age of presentation is 48 years and it does not affect one gender more than the other. It normally follows an insidious course with nonspecific signs and symptoms. We present a case of adenocarcinoma of the lacrimal sac diagnosed at histological study. We show the CT, MRI, and histological findings. We discuss the differential diagnosis and treatment for this tumor.

Adenocarcinoma de células basales del saco lacrimal bien diferenciado. A propósito de un caso / Well-differentiated basal cell adenocarcinoma of the lacrimal sac: a case report

El adenocarcinoma de células basales es un tumor raro y descrito por la Organización Mundial de la Salud (OMS) en 1991 como entidad propia1,2. La edad media de presentación es de 48 años y no muestra predominio sexual. El curso es insidioso con signos y síntomas inespecíficos. Presentamos un caso de adenocarcinoma de saco lacrimal, cuyo diagnóstico se realizó por anatomía patológica. Mostramos los hallazgos de tomografía computarizada, resonancia magnética y anatomía patológica. Se comenta el diagnóstico diferencial y el tratamiento

Basal cell adenocarcinoma is a rare tumor first considered to be a separate entity by the WHO in 1991. The mean age of presentation is 48 years and it does not affect one gender more than the other. It normally follows an insidious course with nonspecific signs and symptoms. We present a case of adenocarcinoma of the lacrimal sac diagnosed at histological study. We show the CT, MRI, and histological findings. We discuss the differential diagnosis and treatment for this tumor

Fracturas de peñasco. Nuestra experiencia: 1999-2004 / Petrous bone fracture. Our experience: 1999-2004

Objetivo: Realizar una revisión de las fracturas de peñasco ocurridas en los últimos 5 años (1999-2004) en nuestro hospital, su manejo, control y análisis de los factores implicados. Analizar los protocolos de actuación y la bibliografía actual. Material y métodos: Se revisan 266 fracturas de hueso temporal, 74 con implicación del peñasco. Se analizan estas fracturas en función de la distribución por sexo, gravedad del traumatismo, clínica otorrinolaringológica debut, mecanismo traumático de producción, y hallazgos radiológicos. Se discuten minuciosamente los resultados y se comparan con la bibliografía actual. Concluciones: Las fracturas de peñasco se han de sospechar siempre en los pacientes con antecedente de traumatismo craneoencefálico (TCE) especialmente en los de gravedad moderada a grave y sobre todo si hay otorragia. Es necesaria una estrecha colaboración entre los servicios de neurocirugía, radiología y ORL para un adecuado manejo, valoración y seguimiento de los pacientes

Objective: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. Material and methods: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. Conclussions: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients

[Petrous bone fracture. Our experience: 1999-2004]. / Fracturas de peñasco. Nuestra experiencia: 1999-2004.

OBJECTIVE: To review the petrous bone fractures during the last five years (1999-2004) in our hospital, its manage, control, and analysis onf the associated factors. To analyse the managing protocoles and current bibliography. MATERIAL AND METHODS: We review 266 temporal bone fractures, 74 with petrous bone association. We analyse these fractures by sex distribution, injurie severity, otorhinolaryngological clinical findings, production mechanism and radiological findings. The cases are discussed and compared with current bibliography. CONCLUSIONS: Petrous bone fractures must be always suspected in patients with head trauma, specially if it associates severity and otorrhagia. It is necessary a deep colaboration between neurosurgeons, radiologists and otorhinolaryngologists to obtain a good management, control and follow up of the patients.

[Clinical and subclinical hyperthyroidism: two faces of the coin?]. / Hipotiroidismo clínico y subclínico: dos caras de una moneda?

We have made a prospective study of 23 patients diagnosed of subclinical hypothyroidism and 45 of overt hypothyroidism, aged 68.3-70.3 years and with a mean illness of 4.5 and 6.5 years respectively. It has been proved a higher prevalence of females in both groups. The most frequent clinical symptoms, similar in both groups, were fatigue, constipation and dyspnea. The most repeated initial diagnosis at the entry were prymary hypothyroidism, heart failure, hypertensive urgencies and stroke. We have found differences of statistical significance between the Free Thyroxine (fT4), triiodothyronine (T3), total serum cholesterol (CT), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and thyrotropin (TSH) initial and ending serum levels in patients with overt hypothyroidism (p < 0.05). We only have found significant differences in TSH serum levels in patients with subclinical hypothyroidism. The antithyroglobulin and antimicrobial antibodies, have been both positive in two and one patient respectively. Both are more useful as a predictor than their diagnostic value. The levothyroxine (L-T4) daily dose needed to normalize the TSH serum concentration, was lesser in subclinical hypothyroidism (71.8 micrograms opposite 107 micrograms-p < 0.001). We didn't find significant differences between the different groups in the time necessary for normalizing TSH. It seems that the L-T4 therapy should be started in all patients with subclinical hypothyroidism and TSH > or = 10 microU/ml or with TSH > 5 and goiter or with thyroid antibodies. The aim to reach is to normalize the TSH serum levels. The mean daily necessary L-T4 dose is 50-100 micrograms.