Improvements in the management of patients with generalized pustular psoriasis in Spain: recommendations from a group of experts. / Mejoras en la atención al paciente con Psoriasis Pustulosa Generalizada en España: recomendaciones de un grupo de expertos.

This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n = 8), an expert panel (n = 15) and patients with GPP (n = 6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.

[A study of right-left shunt in transient global amnesia]. / Estudio de shunt derecha-izquierda en la amnesia global transitoria.

INTRODUCTION: Transient global amnesia (TGA) is a disorder of unknown aetiology. In recent studies, TGA was associated with a right to left shunt (RLS). We studied the presence of the RLS in patients with TGA and we compared this series with patients who had suffered a transient ischaemic attack (TIA). PATIENTS AND METHODS: We included 66 consecutive TGA patients. In these patients a transcranial Doppler was performed to determine the presence of a RLS. We collected data on the TGA episode, vascular risk factors, migraine history, recurrence of TGA and neuroimaging in patients with and without RLS. We compared the prevalence of the RLS in TGA series with 59 patients with TIA. RESULTS: The prevalence of RLS was 21.2% in patients with TGA. The RLS was associated with the migraine history (40% versus 13%; p = 0.014) and a Valsalva manoeuvre as a triggering factor (50% versus 14.5%; p = 0.022). A greater prevalence of RLS was detected in patients with TIA (55.9% versus 21.2%; p < 0.001). CONCLUSIONS: The RLS prevalence in TGA patients is similar to the general population but significantly lower than the prevalence in TIA patients. The association with a Valsalva manoeuvre as a precipitating factor in the TGA patients with RLS could play a role in the aetiopathogenesis of the TGA.

[Successful functional hemispherectomy in adult patients with refractory epilepsy]. / La hemisferectomía funcional también es eficaz en pacientes adultos con epilepsia catastrófica.

INTRODUCTION: Functional hemispherectomy is a surgical technique used to treat refractory epilepsies in the setting of extensive unilateral hemispheric lesions. Most series of hemispherectomies include mainly pediatric patients. METHODS: We report our series of four adult patients that have undergone functional hemispherectomy for their refractory epilepsy. Each one had a complete presurgical evaluation including video EEG, neuropsychological testing and anatomical and functional neuroimaging. In three of them, the epilepsy was secondary to a middle cerebral artery infarction. One patient had Rasmussen encephalitis. RESULTS: After surgery, three patents have become completely seizure free (follow up 13-26 months). The fourth patient has had more than 75% reduction in seizure frequency. All of them have had significant improvement in their quality of life. Early complications included an isolated tonic-clonic generalized seizure (one patient), and status epilepticus in another patients related to infection and use of meropenem. Only one patient has presented hemianopia as a permanent neurological deficit after surgery. CONCLUSIONS: Functional hemispherectomy is a good surgical option in the setting of large unilateral hemispheric lesions causing hemiparesis and intractable seizures, even in adult patients.

Valoración de la biopsia percutánea en el diagnóstico de las lesiones mamarias palpables / Evaluation of percutaneous biopsy in the diagnosis of palpable breast lesions

Estudio retrospectivo para evaluar la utilidad (sensibilidad, especificidad, valor predictivo positivo [VPP] y valor predictivo negativo [VPN], y fiabilidad diagnóstica) de la biopsia percutánea con aguja gruesa (BAG) en el diagnóstico de las lesiones mamarias palpables (160 casos), considerándola útil si permitió el diagnóstico definitivo sin necesidad de obtener muestra adicional de tejido. Revisamos la bibliografía al respecto y analizamos las ventajas e inconvenientes añadidos a la técnica (AU)

A cavernous haemangioma of breast in male: radiological-pathological correlation.

Vascular tumours of the breast are especially rare in men, and a majority of them are angiosarcomas. In fact, we found only four cases of haemangioma in males in the literature. We present a case of cavernous haemangioma in a male aged 48 years, and which commenced as a palpable mass. We performed differential diagnosis and radiological-pathological correlation. We established the correct classification of this case histologically, and decided on the definitive therapeutic approach.

Aspartame consumption in rats selectively bred for high versus low saccharin intake.

Whereas humans use aspartame as a sugar substitute, evidence to date from rats suggests that aspartame does not taste sweet or, more generally, hedonically positive to them. The present study provided a strong test of the appetitive properties of aspartame in rats by examining consumption of aspartame and, for comparison, several sugars by two lines of rats selectively bred for high (HiS) versus low (LoS) saccharin consumption. The HiS and LoS lines differed in consumption of fructose, glucose, sucrose, maltose, and saccharin solutions. Overall, the rats showed a weak but significant preference for aspartame. However, no line differences in aspartame consumption were observed. Thus, even among rats specifically bred on the basis of their responsiveness to sweet tastes, aspartame tastes minimally sweet or good.

[Prostatic malacoplakia. Clinical case]. / Malacoplaquia prostática. Caso clínico.

OBJECTIVE: A case of malakoplakia of the prostate is described. This uncommon localization and the problems encountered in making the histopathological differential diagnosis prompted us to report the present case. METHODS/RESULTS: Adenocarcinoma of the prostate was suspected. The patient was submitted to TURP. Histopathological analysis of the specimen disclosed malakoplakia of the prostate. CONCLUSION: The diagnosis of malakoplakia of the prostate is essentially histopathological and depends on the ability of the pathologist to identify the typical inclusion bodies described by Michaelis and Gutmann.

Enferemdad hemorroidal: tratamiento quirúrgico por la técnica de Fergusson / Hemorrhoidal disease: Fergusson's surgical technique

Entre enero de 1983 y enero de 1991 se llevo a cabo un estudio prospectivo de la enfermedad hemorroidal tratada quirurgicamente por la tecnica de Fergusson en la Clinica San Rafael de Santafe de Bogota, D.C. Se revisaron 132 historias clinicas de pacientes cuya edad promedio era de 40 años; al sexo masculino le correspondio un 48 por ciento y al femenino, el 52 por ciento. Se encontraron hemorroides mixtas en 70 pacientes (53 por ciento), internas en 51 (39 por ciento), y externas en 11 (8 por ciento). El motivo principal de consulta fue el sangrado, el cual se produjo en 34 pacientes (26 por ciento), y 66 enfermos (50 por ciento), acusaron estreñimiento como antecedente de importancia. A todos se les practicó rectosigmoidoscopia como estudio fundamental para definir la conducta, y a un 40 por ciento se les practicó colon por enema. El seguimiento se realizó entre 1 y 8 años, con un promedio de 5; se presentaron complicaciones en el 4 por ciento de los pacientes. Se presentan los resultados obtenidos y se discuten con relacion a la literatura mundial.

Tratamiento quirúrgico del quiste pilonidal: técnica semiabierta / Surgical treatment of pilonidal cysts, semi-open technique

Se evalua en forma prospectiva el protocolo de tratamiento del quiste pilonidal en 73 pacientes sometidos a cirugia en la Clinica San Rafael de Santafe de Bogota, D.C., entre enero de 1983 y enero de 1991. No se encontro predominio de sexo en la presentacion del quiste pilonidal y el promedio de edad fue de 24 años; la mayoria de los pacientes eran empleados; consultaron por dolor y secrecion; 35 (48 por ciento) mostraban masa; 55 (75 por ciento) presentaban un orificio de drenaje. Se sometieron a tratamiento quirurgico por la tecnica semiabierta (Mc. Fee) 58 pacientes (79 por ciento), de los cuales 1 (1.7 por ciento) tuvo complicaciones: infección de la herida quirurgica. Se analizan los resultados con otro informe de la literalura mundial.

[Candida albicans spondylodiscitis]. / Espondilodiscitis por Candida albicans.

Infections by Candida sp. have increased notably and cause not only local but also systemic infections. It is rarely mentioned as an etiologic agent of osteomyelitis. Two cases of candidiasic spondylodiscitis are presented with the first being in a 33 year old intravenous drug using male who consulted for mechanical lumbar pain. Spondylodiscitis L2-L3 was observed upon radiological study. Aspiration puncture was carried out and the cultures were negative. Surgical biopsy was performed with spondylodiscitis and an abscess in the spine being observed. C. albicans was isolated in the culture. Pathological study confirmed the diagnosis. Cutaneous and sternocostal involvement was also concommitantly presented. The patient was treated with amphotericin B with a favorable evolution. The second case was in a 35 year old male with burns over 65% of his body due to a laboral accident. Three months after admission the patient presented lumbar pain irradiating to the groin and thigh. Bone destruction of the second lumbar vertebra and an abscess of the right psoas were observed upon CT scan. Puncture biopsy was performed and C. albicans was isolated. Histopathologic study demonstrated osteomyelitis by Candida sp. Treatment with amphotericin B was started. Posteriorly urea and creatinine was raised. Treatment was continued with fluconazole with good therapeutic response.

Sarcomas de cabeza y cuello: revisión de 15 años del INC / Head and neck sarcomas: a 15 years revision at INC

El 92 por ciento de los tumores malignos de cabeza y cuello atendidos en el Instituto Nacional de Cancerologia son de origen epitelial. Otro tanto corresponde a los linfomas; los más raros, en consecuencia, son los sarcomas. La frecuencia de estos ultimas es minima cuando se compara con su contraparte benigna como los lipomas, fibromas, hemangiomas, etc. Durante los años de 1973 a 1988 se recibieron en el Servicio de Cabeza y Cuello del Instituto, 49 pacientes con sarcomas de tejidos blandos en dicha area. Se realizo una revision retrospectiva de nuestra experiencla; se encontraron 28 pacientes adultos y 21 niños. La distribucion anatomica más frecuente en los adultos fue la del cuello (32 por ciento) y en los niños fue la del macizo facial (61 por ciento). El 36 por ciento de los pacientes consultaron en estados avanzados de su enfermedad. La sobrevida a 5 años fue del 16 por ciento. La principal causa de muerte fue la recidiva local. Este estudio hace enfasis en el diagnostico precoz como principal factor pronostico. Se realiza una revision bibliográfica y se dan algunas pautas para el diagnostico y tratamiento de esta patologia.

[Cold tuberculous retropharyngeal abscess]. / Absceso frio retrofaringeo de estirpe tuberculosa.

The AA. present a report about a patient having a cold tuberculous abscess which symptomatologic manifested through dysphagia and cervico-brachialgia. Comments on the most remarkable aspects of these conditions.

[Initial otorhinolaryngologic lesions of lepromatous leprosy]. / Las lesiones otorrinolaringológicas iniciales de la lepra lepromatosa.

The paper deals with a topic rarely treated in the bibliography: a carrier of cutaneous and otolaryngologic lesions suspicious of lepromatous leprosy. The AA. made a survey of the typical ENT manifestations of the generalized disease--lepromatous leprosy--and recall the more characteristic diagnostic tests as well as the guide lines of the treatment.

D-penicillamine therapy associated with rapidly progressive glomerulonephritis.

A 55-year-old woman with advanced rheumatoid arthritis developed rapidly progressive glomerulonephritis with epithelial crescents and pulmonary hemorrhage following treatment with D-penicillamine. D-penicillamine was then withdrawn and a pulse therapy with methylprednisolone halted the progression of kidney and lung damage. We review the other cases previously reported and discuss pathogenesis and treatment of this rare condition.

Colgajo músculocutáneo del pectoral mayor: su utilización en cirugía reconstructiva de cabeza y cuello / Musculocutaneous flap of the pectoralis major muscle: its use in reconstructive surgery of the head and neck

Se revisa la experiencia obtenida en el Servicio de Cabeza y Cuello del Instituto Nacional de Cancerologia, con la mayor utilizacion del colgajo musculocutaneo del pectoral mayor, en el periodo comprendido entre enero de 1989 y diciembre de 1990. Esta tecnica fue utilizada en 18 pacientes; por la relativa facilidad de obtencion del colgajo y por su seguridad, se ha convertido en un elemento de primera eleccion en la reconstruccion de grandes defectos ocasionados por resecciones oncologicas masivas en cabeza y cuello. Se analizan sus indicaciones, se hace una descripcion de la tecnica quirurgica, se valoran las limitaciones y las complicaciones y se establece una comparacion de sus ventajas y desventajas con otros metodos reconstructivos.

[Colloid or mucinous adenocarcinoma of the prostate]. / Adenocarcinoma coloide o mucinoso de la próstata.

We report a mucinous or colloid adenocarcinoma of the prostate. Identification of this disease entity as such is strictly based on histological and immunohistochemical findings. Confusion as to the identification of this type of prostatic tumor results from its scant frequency (0.3%) and its being an exclusively morphological variant of the more common prostatic adenocarcinoma.