Lesión renal aguda en pacientes embarazadas menores de 20años con preeclampsia severa. Experiencia 2018-2019 de un hospital de alta especialidad de la ciudad de México / Acute kidney injury in pregnant patients under 20years of age with severe pre-eclampsia. Experience in a high specialty hospital in Mexico City in 2018-2019

Objetivo: Determinar la frecuencia, la evolución clínica, el tratamiento y el desenlace de la lesión renal aguda (LRA) en pacientes embarazadas con preeclampsia severa (PS) menores de 20años de edad. Material y método: Estudio observacional, transversal, retrospectivo y analítico en una serie de 23 pacientes embarazadas menores de 20años de edad con PS atendidas en la UCI de un hospital de alta especialidad de la ciudad de México durante los años 2018 y 2019. Se consultaron los expedientes para conocer la frecuencia de enfermas que desarrollaron LRA (creatinina sérica ≥1,1mg/dl), complicaciones, diuresis, tratamiento con fármacos, terapia de reemplazo, desenlace (recuperación, hemodiálisis) y mortalidad. Los resultados se compararon con los de enfermas de la serie que no presentaron LRA. Se utilizó estadística descriptiva, prueba U de Mann Whitney y prueba exacta de Fisher con el programa SPSS versión 20. Resultados: Veintidós enfermas tenían riñones nativos y una portaba injerto renal. La frecuencia de pacientes con LRA fue del 43,47% (n=10) con media de la creatinina sérica de 1,59±0,63mg/dl (límites 1,1 a 3,2) y diuresis de 0,91±0,74ml/kg/h. Las 23 enfermas recibieron furosemida como fármaco individual intravenoso (60,87%; n=14) o posterior a la infusión de solución NaCl 0,9% (39,13%; n=9). La LRA se recuperó en el 39,13% (n=9) y se precisó hemodiálisis en la paciente trasplantada (4,34%), con muerte materna del 0%. Conclusiones: La frecuencia de LRA fue elevada, con un solo caso que requirió hemodiálisis, sin mortalidad materna. El uso irrestricto de furosemida en todos los casos resultó relevante.(AU)

Objective: To determine the frequency, clinical course, treatment and outcome of acute kidney injury (AKI) in pregnant patients under 20years of age with severe preeclampsia (SP). Material and method: Observational, cross-sectional, retrospective and analytical study in a series of 23 pregnant patients under 20years of age with SP attended in the Intensive Care Unit (ICU) of a high specialty hospital in Mexico City during the years 2018 and 2019. Records were consulted to determine the frequency of patients that developed AKI (serum creatinine ≥1.1mg/dL), complications, diuresis, drug treatment, replacement therapy, outcome (recovery, haemodialysis), and mortality. The results were compared with those of the patients in the series that did not present with an AKI. Descriptive statistics, Mann Whitney U test and Fisher's exact test, using SPSS version 20, were used. Results: Twenty-two patients had native kidneys and one had a kidney graft. The frequency of patients with AKI was 43.47% (n=10) with mean serum creatinine 1.59±0.63mg/dL (range 1.1 to 3.2) and urine volume 0.91±0.74ml/kg/hour. All 23 patients received furosemide, as an individual drug intravenously 60.87% (n=14), and 39.13% (n=9) after the infusion of 0.9% NaCl solution. AKI recovered in 39.13% (n=9), and haemodialysis was performed in the transplanted patient (4.34%), with 0% maternal death. Conclusions: The frequency of AKI was high with only one case requiring haemodialysis, and no maternal mortality. The unrestricted use of furosemide in all cases was relevant.(AU)

Differentiation between Tuberculous and Pyogenic Spondylodiscitis: The Role of the Anterior Meningovertebral Ligament in Patients with Anterior Epidural Abscess.

BACKGROUND AND PURPOSE: Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. MATERIALS AND METHODS: This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample t tests and χ2 tests of independence were performed to evaluate the significance of the difference between the groups. RESULTS: Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (P < .001). The presence of an intact anterior meningovertebral ligament had 83.3% sensitivity and 100% specificity for tuberculous spondylodiscitis, a 100% positive predictive value, and a 97.2% negative predictive value. CONCLUSIONS: The presence of an intact anterior meningovertebral ligament has high sensitivity and specificity for tuberculous spondylodiscitis-associated epidural abscess, though these results should be validated in a larger sample.

Quantitative Evaluation of Medial Temporal Lobe Morphology in Children with Febrile Status Epilepticus: Results of the FEBSTAT Study.

BACKGROUND AND PURPOSE: The pathogenesis of febrile status epilepticus is poorly understood, but prior studies have suggested an association with temporal lobe abnormalities, including hippocampal malrotation. We used a quantitative morphometric method to assess the association between temporal lobe morphology and febrile status epilepticus. MATERIALS AND METHODS: Brain MR imaging was performed in children presenting with febrile status epilepticus and control subjects as part of the Consequences of Prolonged Febrile Seizures in Childhood study. Medial temporal lobe morphologic parameters were measured manually, including the distance of the hippocampus from the midline, hippocampal height:width ratio, hippocampal angle, collateral sulcus angle, and width of the temporal horn. RESULTS: Temporal lobe morphologic parameters were correlated with the presence of visual hippocampal malrotation; the strongest association was with left temporal horn width (P < .001; adjusted OR, 10.59). Multiple morphologic parameters correlated with febrile status epilepticus, encompassing both the right and left sides. This association was statistically strongest in the right temporal lobe, whereas hippocampal malrotation was almost exclusively left-sided in this cohort. The association between temporal lobe measurements and febrile status epilepticus persisted when the analysis was restricted to cases with visually normal imaging findings without hippocampal malrotation or other visually apparent abnormalities. CONCLUSIONS: Several component morphologic features of hippocampal malrotation are independently associated with febrile status epilepticus, even when complete hippocampal malrotation is absent. Unexpectedly, this association predominantly involves the right temporal lobe. These findings suggest that a spectrum of bilateral temporal lobe anomalies are associated with febrile status epilepticus in children. Hippocampal malrotation may represent a visually apparent subset of this spectrum.

Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist.

The year 1965 was critical for US health care policy. In that year, Medicare was created as part of the Social Security Act under President Lyndon B. Johnson after several earlier attempts by Presidents Franklin Roosevelt and Harry Truman. In 1966, the American Medical Association first published a set of standard terms and descriptors to document medical procedures, known as Current Procedural Terminology, or CPT. Fifty years later, though providers have certainly heard the term "CPT code," most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. This article will highlight this evolution, particularly as it relates to neuroradiology.

Effect of Immunosuppressive Therapy on Cardiovascular Risk Factor Prevalence in Kidney-Transplanted Children: Comparative Study.

BACKGROUND: Cardiovascular disease (CVD) is the second major cause of death in kidney-transplanted children. Cardiovascular risk factors (CVRF) prevalence after transplant may increase. The effect of immunosuppressive therapy has not been fully studied in children. The objective of the study was to measure and compare CVRF prevalence in kidney-transplanted children, depending of immunosuppressive therapy. METHODS: The study was an observational, transversal, retrospective, comparative study of pediatric patients transplanted at UMAE Hospital General Centro Medico La Raza. All patients were treated with prednisone and mycophenolic acid and any of cyclosporine, tacrolimus, or sirolimus. Demographic, clinical, and biochemical variables and immunosuppressive therapy were evaluated. We used analysis of variance, χ(2), and Fisher tests with the SPSS 18.0 statistical program. RESULTS: One hundred fifteen patients were studied. Sixty-five (56.5%) were male, and median age was 18.5 ± 2.3 years. Seventy-eight (67.2%) were transplanted from a living related donor. Prevalence of anemia and nephrotic proteinuria was significantly less in patients treated with tacrolimus. Those treated with cyclosporine had a significantly greater prevalence of increased LDL-cholesterol, increased serum phosphorus, and increased calcium-phosphorus. Those treated with tacrolimus had lower, not significant, prevalence of hypertension, hyperuricemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia, and low serum HDL-cholesterol than those treated with sirolimus and cyclosporine. In multivariate analysis, patients treated with cyclosporine had significantly more probability of increased phosphorus (OR, 10.65; 95% CI, 2.75-41.16, P = .001) and calcium-phosphorus (OR, 37.94; 95% CI, 3.45-416.17, P = .003) than those treated with tacrolimus. CONCLUSIONS: Patients treated with tacrolimus had less prevalence of CVRF than those treated with cyclosporine or sirolimus. Tacrolimus is the best immunosuppressive option to diminish CVRF in children after kidney transplantation.

Assessment of an introductory cervicocerebral catheter angiography learning program: a pilot study.

BACKGROUND AND PURPOSE: There is no standardized curriculum currently available at most institutions for establishing procedural competency in trainees performing cervicocerebral angiography. The purpose of this study was to evaluate a simple learning program to supplement the teaching of basic cervicocerebral angiography. MATERIALS AND METHODS: An 11-session interactive curriculum was implemented covering anatomic, clinical, and radiographic topics for the novice cervicocerebral angiographer. The target learner was the neuroradiology fellow. Data were gathered regarding fellow comfort level on topics relating to cervicocerebral angiography by using a 5-point Likert scale. Improvement in scores on knowledge-based questions after completion of the curriculum was calculated (McNemar test). Trainee-perceived utility of the program was also recorded by using a 5-point Likert scale. Focus sessions were held at the completion of the curriculum to gather feedback regarding the strengths and weaknesses of the program from participants. RESULTS: Ten subjects were enrolled in this pilot study for 3 years. Topics where participants reported a poor initial comfort level (4 or higher) included selection of injection rates and volumes and reformation of reverse-curve catheters. Trainees demonstrated a statistically significant change in the distribution of scores of 29.3% (49.4%-78.7% correct response rate, P < .0001). The average perceived utility was 1.5 (1 = most useful, 5 = least useful). CONCLUSIONS: This simple learning program was a useful adjunct to the training of fellows in diagnostic cervicocerebral angiography, resulting in quantitative improvements in knowledge.

Prevalence of hippocampal malrotation in a population without seizures.

BACKGROUND AND PURPOSE: Hippocampal malrotation (HIMAL) is a failure of hippocampal inversion that occurs during normal fetal development and has been seen on MR imaging examinations of people with epilepsy, but it has not been studied in patients without epilepsy. We intended to evaluate the prevalence of HIMAL in MR imaging examinations of patients without seizures to better understand the significance of HIMAL in the population with seizure. MATERIALS AND METHODS: A total of 497 MR imaging examinations with thin-section imaging through the temporal lobes of patients referred for conditions other than seizures were reviewed. The examinations were performed on 1.5T magnets. Sagittal T1-weighted and coronal T2-weighted images were used to evaluate each MR image for the distinctive features of HIMAL. As previously described in the literature, the criteria for HIMAL include unilateral involvement and incomplete rotation of a hippocampus that is normal in size and signal intensity but abnormally rounded in shape, with blurred inner structure. In addition, ipsilateral findings of an atypical collateral sulcus angle and atypical position and size of the fornix were noted. The corpus callosum is normal, and the temporal lobe remains normal in size, though the temporal horn may appear enlarged. RESULTS: None of the patients' examinations fulfilled all of the HIMAL criteria. Six studies satisfied 2 or more criteria, which included an abnormally rounded hippocampus and a vertical collateral sulcus. These HIMAL findings were all seen on the left. Forniceal asymmetry was the most prevalent abnormality, with 289 patients manifesting a low position of 1 fornix. CONCLUSIONS: Hippocampal malrotation is a rare finding in patients without seizures. HIMAL is therefore likely to be a pathologic finding.

Prescribing knowledge and skills of final year medical students in Nigeria.

OBJECTIVES: To assess the knowledge of final year medical students in Nigeria, about good prescribing and the application of this knowledge to their prescribing skills. MATERIALS AND METHODS: Thirty four final year medical students of the Lagos State University College of Medicine (LASUCOM), Ikeja, were interviewed with a structured questionnaire that assessed their knowledge on the principles of good prescribing. They were also requested to write a prescription, based on a paediatric clinical scenario of malaria and upper respiratory tract infection. The prescription was used to assess their prescribing skills. RESULTS: Thirty one (91.18%) students knew that rational prescribing involved prescribing correct dosage of an appropriate medicine formulation. Factors considered important by the students to prescribe rationally were: Potential benefit: risk ratio of a medicine - 33 (97.06%); good knowledge of pharmacology - 29 (85.29%) and pathophysiology of the disease to be treated - 24 (70.59%); and safety of an alternative medicine to be used - 24 (70.59%). An average of 3.71 medicines was prescribed for a child suspected to have malaria. Antimalarials (38.24%) and paracetamol (20%) were the most frequently prescribed medicines. The name and signature of the prescriber were available in 51.61% and 58.06% prescriptions, respectively. Less than 50% prescriptions had the name, case file number, age and gender of the patient. CONCLUSION: The final year medical students of LASUCOM would require theoretical and practical teaching of principles of rational prescribing to improve their prescribing knowledge and skills.

Deep brain reversible encephalopathy: association with secondary antiphospholipid antibody syndrome.

We present a case of a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome. The patient presented with acute right cerebellar infarction and clinical and imaging evidence of brain stem and bilateral thalamic encephalopathy that resolved completely.

Medical students' view on the methods of teaching pharmacology at the Lagos State University College of Medicine, Nigeria.

OBJECTIVE: This study was aimed at determining the perception of the medical students of a relatively new medical school in Nigeria about the teaching of Pharmacology, the best way of learning and retaining the subject. Suggestions on the ways of making pharmacology more interesting to them were also sought. METHODS: A total of forty eight 400 level medical students of the Lagos State University College of Medicine (LASUCOM), who were due to write 2nd Professional M.B; B.S degree examinations in 2007 and 26 successful older students that had passed the 2nd Professional M.B; B.S degree examinations in 2006, were interviewed with a structured questionnaire. Some of the questions were close-ended but the ones related to suggestion on impaired teaching of the subject were open-ended. The pharmacology lecturers were also interviewed with another questionnaire, different from the one used in interviewing the students, to assess their views on the non-inclusion of clinical pharmacology topics to the curriculum and to suggest ways of improving the teaching of the subject. RESULTS: Sixteen (41.02%) respondents and 26 (92.86%) successful older students wanted audiovisual aids teaching and inclusion of clinically oriented pharmacology lectures. Fourteen (35.89%) respondents respectively and all the successful older students wanted seminars and group discussions introduced into their programme. Over half (58.97%) of the respondents and all the successful older students wanted case studies and treatment as part of the regular teaching schedule, 20 (51.28%) respondents and 20 (76.92%) successful older students preferred inclusion of clinical pharmacology. Most of the students (respondents and older successful students) felt that special topics in clinical pharmacology should be taught both in the lectures and practical. CONCLUSION: Medical students are very willing to learn pharmacology from both clinical and therapeutic angles that encompass both theoretical and practical approaches. It is therefore imperative to modify the Pharmacology programme of the LASUCOM in line with the global trend.

Displasia mesenquimatosa de placenta / Placental mesenchymal dysplasia

Presentamos un caso clínico de displasia mesenquimatosa de placenta asociado a cistoadenoma seroso de páncreas fetal (AU)

New onset of body dysmorphic disorder following frontotemporal lesion.

The etiology and pathophysiology of body dysmorphic disorder (BDD) have not been delineated. The authors report a 24-year-old man who developed BDD at age 21 after an inflammatory brain process. Neuroimaging studies showed new atrophy in the frontotemporal region. The authors review cases from the literature with similar clinical features and neuroimaging findings as well as discuss the possible correlation between the neuroanatomic lesion and the clinical presentation of BDD in the patient.

Silent infarction as a risk factor for overt stroke in children with sickle cell anemia: a report from the Cooperative Study of Sickle Cell Disease.

OBJECTIVE: To determine whether children with homozygous sickle cell anemia (SCD) who have silent infarcts on magnetic resonance imaging (MRI) of the brain are at increased risk for overt stroke. METHODS: We selected patients with homozygous SCD who (1) enrolled in the Cooperative Study of Sickle Cell Disease (CSSCD) before age 6 months, (2) had at least 1 study-mandated brain MRI at age 6 years or older, and (3) had no overt stroke before a first MRI. MRI results and clinical and laboratory parameters were tested as predictors of stroke. RESULTS: Among 248 eligible patients, mean age at first MRI was 8.3 +/- 1.9 years, and mean follow-up after baseline MRI was 5.2 +/- 2.2 years. Five (8.1%) of 62 patients with silent infarct had strokes compared with 1 (0.5%) of 186 patients without prior silent infarct; incidence per 100 patient-years of follow-up was increased 14-fold (1.45 per 100 patient-years vs 0.11 per 100 patient-years, P =.006). Of several clinical and laboratory parameters examined, silent infarct was the strongest independent predictor of stroke (hazard ratio = 7.2, P =.027). CONCLUSIONS: Silent infarct identified at age 6 years or older is associated with increased stroke risk.

Orbital mucosa-associated lymphoid tissue (MALT)-type lymphoma in a patient with relapsing polychondritis.

Relapsing polychondritis is characterized by recurrent inflammation of the cartilaginous tissues of the ears, nose, peripheral joints, and the tracheobronchial tree. The eye is also a frequent target organ in relapsing polychondritis, and proptosis is a well-recognized manifestation of eye involvement. Similar to other rheumatologic diseases, an association of relapsing polychondritis with malignancy has been reported. We describe a patient with relapsing polychondritis who presented with exophthalmos. When treatment directed toward control of her underlying disease was only partially effective, further investigation revealed that she had an orbital mucosa-associated lymphoid tissue (MALT)-type B cell lymphoma. We hypothesize that the lymphoma resulted from malignant transformation of the relapsing polychondritis-induced inflammatory pseudotumor and emphasize that neoplastic disease should be considered in the differential diagnosis in patients with relapsing polychondritis presenting with exophthalmos.

Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization.

False aneurysm may occur from trauma to the floor of the mouth, including iatrogenic trauma from surgical procedures. This report will present a case of a pseudoaneurysm of the lingual artery following tonsillectomy. Development of lingual artery pseudoaneurysms can occur within a few hours following tonsillectomy. Angiography provides the diagnosis, and endovascular intervention is an efficient alternative to surgery for treatment of such aneurysm with low morbidity. Endovascular embolization with platinum coils is an effective means of controlling bleeding and avoiding surgical intervention.

Angiographic criteria reliably predict when carotid endarterectomy can be safely performed without a shunt.

BACKGROUND: Selective shunting during carotid endarterectomy is widely performed, but the optimal approach for predicting when a shunt is unnecessary remains uncertain. We evaluated the ability of preoperative cerebral angiography to predict when carotid endarterectomy could be safely performed without a shunt. STUDY DESIGN: Eighty-seven patients undergoing carotid endarterectomy between August 1991 and December 1997 had preoperative cerebral angiograms. The angiograms were evaluated for the presence of collateral flow from the contralateral carotid through the anterior communicating artery and from the posterior circulation through the posterior communicating artery. Patients then underwent endarterectomy and were selectively shunted based on somatosensory evoked potential changes. Internal carotid artery stump pressure was routinely measured in all patients. RESULTS: Nine patients (10%) had a shunt placed based on somatosensory evoked potential changes and none of the 87 patients had a perioperative (30 days) stroke. Angiography revealed that 36 patients (41%) had no cross-filling from the contralateral carotid through the anterior communicating artery. Nine of these patients (25%) required a shunt; none of the 51 patients with adequate cross-filling (p < 0.001) did. Furthermore, 94% of the patients without cross-filling but with a patent ipsilateral posterior communicating artery did not require a shunt using somatosensory evoked potential changes as the standard for shunt insertion. Stump pressure measurements (> or = 25 mmHg) or (> or = 50 mmHg) did not reliably exclude the need for a shunt. Only 2 of 15 patients with contralateral carotid occlusion and 1 of 16 patients with a prior ipsilateral stroke required shunts. CONCLUSIONS: In the presence of cross-filling from the contralateral carotid artery, shunt insertion was uniformly unnecessary. In addition, routine shunting of patients with previous ipsilateral strokes or contralateral carotid occlusion was not always necessary. Stump pressures were less sensitive than angiographic criteria in determining when a shunt was unnecessary. Evaluation of cross-filling from the contralateral carotid artery on preoperative angiography can predict with certainty which patients will not require a shunt.

Silent cerebral infarcts in sickle cell anemia: a risk factor analysis. The Cooperative Study of Sickle Cell Disease.

BACKGROUND: Silent infarcts have been reported in 17% of young patients with sickle cell disease and are associated with impaired performance on standardized psychometric tests. Risk factors for the development of these lesions have not been identified. METHODS: Investigators in the Cooperative Study of Sickle Cell Disease performed a brain magnetic resonance imaging scan on sickle cell anemia patients age 5.9 years and older who had been followed according to the protocols of the Cooperative Study since birth. Individuals with a known history of cerebrovascular accident were excluded from this analysis. Patients with and without silent infarctions were compared with regard to clinical and laboratory parameters. RESULTS: The study sample included 42 patients (18.3%) with silent infarcts. Patients who had silent infarcts were significantly more likely to have a clinical history of seizure and a lower painful event rate. Lower hemoglobin level, increased leukocyte count, elevated pocked red blood cell count, and SEN betaS globin gene haplotype were associated also with the presence of silent infarcts. There was no relationship between silent infarcts and platelet count, fetal hemoglobin level, reticulocyte percentage, serum aspartate aminotransferase level, total bilirubin concentration, blood pressure, growth parameters, or presence of alpha-thalassemia. A multivariate model for silent infarction identified the following as risk factors: low pain event rate, history of seizure, leukocyte count >/=11.8 x 10(9)/L, and the SEN betaS globin gene haplotype. CONCLUSIONS: Patients with risk factors for silent infarcts should be evaluated for cerebrovascular disease. If evidence of infarction is found, consideration must be given to therapeutic intervention. At present, the appropriate treatment has not been determined.

[Testicular granulocytic sarcoma as a form of relapse in a patient with acute megakaryoblastic leukemia]. / Sarcoma granulocítico testicular como forma de recaída en un paciente con leucemia aguda megacarioblástica.

Granulocytic sarcoma (GS) is a rare extramedullary tumor composed of myeloblasts and other granulocytic precursors. GS is mostly associated with myeloproliferative disorders, myelodysplastic syndromes and acute myeloid leukaemia. These tumors arise in the absence of leukaemia, at its initial diagnosis or at the time of recurrence. The most common sites of involvement are bone, skin, soft tissue and lymph node. Reports of GS in testis are very rare. We report an unusual case of GS in a patient with megakaryoblastic leukaemia arising in the left testis after four months in complete remission attained with low doses of Ara-C and granulomonocytic stimulating factor.