IgG4-related disease: a disease we probably often overlook.

IgG4-related disease (IgG4-RD) is an increasingly recognised entity characterised by tumefied lesions that can affect multiple organs. Awareness of IgG4-RD is important, as it has been shown to mimic other diseases and may result in irreversible organ damage if not treated. If suspected, immunostaining for IgG4-positive plasma cells is essential for diagnosis and revision of old biopsies may be necessary.

Control de la temperatura perioperatoria: encuesta sobre las prácticas actuales / Perioperative temperature control: survey on current practices

Introducción. La prevención de la hipotermia perioperatoria disminuye la morbimortalidad y el coste hospitalario. Este estudio evaluó su nivel de aplicación en 3 hospitales universitarios españoles de tercer nivel. Material y métodos. Una encuesta entre anestesiólogos evaluó la importancia estimada y la práctica clínica en materias de prevención de la hipotermia perioperatoria. Los resultados se compararon en función de la experiencia. Una p < 0,05 fue considerada significativa. Resultados. Ciento dieciséis anestesiólogos contestaron a la encuesta, 48 (41,3%) residentes, 32 (27,6%) adjuntos de menos de 10 años de experiencia, y 36 (31,1%) adjuntos de 10 o más años de experiencia. La prevención de la hipotermia fue evaluada con 7,49 ± 1,79 puntos en una escala de importancia de 0 a 10, sin diferencias entre grupos (p = 0,58). Los adjuntos recién graduados valoraban la temperatura al final de la intervención más que el resto de anestesiólogos (p = 0,02). El calentador de sueros, junto con una manta convectiva fue la medida de prevención más habitual (47%). Solo un 20% de los encuestados monitorizaban la temperatura intra-operatoria, aunque un 75% lo consideraban un parámetro importante. Ninguna unidad disponía de un protocolo de prevención de hipotermia. Discusión y conclusión. A pesar de no existir protocolos de prevención, los anestesiólogos son conscientes de la importancia de la normotermia perioperatoria, pero aún no influye suficiente en su manejo peri-operatorio para diagnosticar y prevenir la hipotermia. Una armonización a nivel local, regional y nacional podría mejorar estas prácticas en el futuro (AU)

Introduction. Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. Material and methods. A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. Results. A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. Discussion and conclusion. Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future (AU)

Perioperative temperature control: Survey on current practices.

INTRODUCTION: Prevention of perioperative hypothermia decreases morbidity and mortality, as well as hospital costs. This study was conducted to evaluate the level of implementation of protocols in 3 tertiary Spanish University Hospitals. MATERIAL AND METHODS: A survey among anaesthesiologists assessed estimated importance and clinical practice in terms of prevention of perioperative hypothermia. Results were compared depending on their experience. P<.05 was considered significant. RESULTS: A total of 116 anaesthesiologists answered the survey, of whom 48 (41.3%) were residents, 32 (27.6%) were staff with less than 10 years of experience, and 36 (31.1%) staff with 10 years or more of experience, In a 0-10 importance scale, prevention of hypothermia was scored 7.49±1,79, with no difference between groups (P=.58). Younger staff were more concerned of the end surgery temperature than other colleagues (P=.02). The most usual practice was a combination warming the intravenous fluids and an electric blanket (55%). Only 20% of the anaesthesiologists monitored temperature intra-operatively, even though 75% considered it an important parameter. No unit had a written protocol for prevention of perioperative hypothermia. DISCUSSION AND CONCLUSION: Despite the absence of prevention protocols, the anaesthesiologists were aware of the importance maintaining a normal peri-operative temperature, but this awareness is still not enough to influence their perioperative management to diagnose and prevent hypothermia. A harmonisation of practice at local, regional and national level could improve this practice in the future.

Follow-up of patients with previous treatment for coarctation of the thoracic aorta: comparison between contrast-enhanced MR angiography and fast spin-echo MR imaging.

Regular follow-up is required in patients with previous intervention for coarctation of the aorta to detect recoarctation or aneurysm formation. In this study we describe the findings encountered on routine follow-up exams and we compare the use of contrast-enhanced 3D MR angiography (CE MRA) with fast spin-echo MRI (FSE) to study the thoracic aorta after previous intervention. In 51 consecutive patients previously treated for aortic coarctation, 74 MR studies of the thoracic aorta were performed during a 2-year period using CE MRA and FSE MRI. The thoracic aorta was evaluated for abnormalities of course, caliber, shape, and pathology of side branches. The CE MRA and FSE MRI studies were evaluated side by side by consensus of two reviewers evaluating which MR technique depicted the abnormalities of the thoracic aorta the best. Of 74 exams, six clinically important abnormalities were found: four aneurysms and two restenoses. Two small pseudoaneurysms were missed on the FSE studies. Contrast-enhanced MRA was judged to visualize aortic abnormalities better than FSE (47 of 74 MR studies) especially for the transverse aortic arch, coarctation site, left subclavian artery, and aortic arch configuration. For the ascending aorta and distal descending aorta, CE MRA and FSE performed equally well. Aortic diameters measured at four levels in the first 18 MRI studies showed no significant differences in diameter when measured by FSE or CE MRA (p = not significant). Clinically important abnormalities, such as aneurysm formation and restenosis, can be present years after treatment for aortic coarctation. In the regular follow-up of these patients, CE MRA may provide additional diagnostic information compared with FSE and should be included as part of the routine exam.

MRI diagnosis of osteomyelitis of the cuboid bone in two infants.

We describe two infants in whom MRI diagnosed osteomyelitis of the cuboid bone when conventional X-rays were negative. Neoplastic, traumatic and ischaemic aetiologies could be excluded with the initial MR examinations.

The use of preoperative fistulography in patients with a second branchial cleft anomaly.

The preoperative fistulography used in cases of second branchial cleft anomalies is an effective method of showing the exact anatomy and topography of these fistulas in the neck. This visualisation is very important because the only therapeutic solution is complete surgical resection. This method is easy to perform and is painless. We report two patients with branchiogenic anomalies. The diagnosis was established by fistulography and histological examination.

Rehabilitación sexual: experiencia en 157 pacientes con impotencia post traumática / Sexual rehabilitation: experience in 157 patients with post-traumatic impotence

Se muestra en forma global la experiencia obtenida en 10 años de manejo de pacientes que presentaron alteración de su relación de pareja por falla sexual masculina (erección o eyaculación precoz severa). La etiología de la impotencia fue: lesión medular 114 pacientes (75 por ciento), fractura de pelvis 32 pacientes (20 por ciento), secuela de TEC 11 pacientes (7 por ciento). En los pacientes sin clara etiología orgánica se realizó un estudio de ecotomografía duplex de arterias cavernosas con drogas vasoactivas. La rehabilitación sexual se planteó en base a un esquema de complejidad progresiva y se manejó en forma multidisciplinaria. Como tratamiento para recuperar la erección se ofreció autoinyección de fármacos intracavernosos. Como alternativa también el uso de aparatos de vacío. Cuando estas medidas no fueron efectivas o fallaron en el tiempo se ofreció, un implante protésico. Este esquema ha resuelto el 97 por ciento de nuestros enfermos y ha sido ampliamente aceptado por ellos y sus parejas

Strecker stent placement in the superior mesenteric artery for recurrent ischemic colitis.

We report on a case of recurrent superior mesenteric artery (SMA) stenosis with symptomatic mesenteric angina after SMA angioplasty. Stent placement of postostial atherosclerotic disease was proposed, with successful result. Moderate aortic protrusion was noted. Feasibility of PTA and stenting of mesenteric stenoses become increasingly obvious, but long term follow-up studies still have to provide sufficient results on clinical outcome and possible complications.

Aortic coarctation associated with an aberrant right subclavian artery.

We report a case of aortic coarctation associated with an aberrant right subclavian artery in a young male who was investigated for hypertension. Angiography, CT examination with multiplanar reconstruction and MRI were useful in delineating the extension of the coarctation and the exact anatomy of the aberrant right subclavian artery.

Diagnóstico precoz del cáncer de próstata, rol de la biopsia transrectal ecoguiada / Early diagnosis of prostatic cancer: echo-guided transrectal biopsy role

Tras la implementación de un esquema de diagnóstico precoz del cáncer de próstata se realizaron 183 biopsias transrectales ecoguiadas. Siete pacientes necesitaron biopsias repatidas, dos de los cuales mostraron un cáncer en la tercera biopsia. Se diagnóstico cáncer en el 32.8 por ciento de las biopsias, mientras que el 64.5 por ciento tuvo HPB. El 10 por ciento de los cánceres diagnósticados tenía APE menor a 5 mg/ml y en dos casos el APE fue normal. En esta serie resultaron tener un cáncer el 8.3 por ciennto de los biopsiados por Tacto Rectal alterado, y el 23.1 por ciento de los biopsiados por APE elevado, 56 por ciento de los biopsiados por tacto y APE alterado y 63.4 por ciento de los biopsiados por tacto, antígeno y densidad alterados. El APE se correlaciona con la Etapa Patológica y no hubo ningún cáncer localizado con APE por sobre 11 mg/ml. La biopsia transrectal fue muy bien tolerada por los pacientes: cinco (2.7 por ciento) presentaron una prostatitis aguda febril que se manejó medicamente y no hubo complicaciones hemorrágicas. Con este enfoque hemos incrementado marcadamente la detección del carcinoma localizado

Enfoque multidisciplinario para la rehabilitación de las disfunciones sexuales post-traumáticas / Multidisciplinary rehabilitation approach for post-traumatic sex dysfunction

La rehabilitación sexual ocupa un lugar importante en el manejo del lesionado medular. Se describe el método y resultados del tratamiento de 62 casos (60 hombres y 2 mujeres) con lesión medular. En 29 pacientes (47%) bastó con una entrevista destinada a aclarar dudas, todos los hombres (27 de los 29 casos) tenían erecciones útiles y no necesitaron tratamiento específico. Otros 27 hombres se trataron sin inyección de Papaverina, consiguiendo erección eficiente en 23 (85% de eficiencia). Sólo 2 de los 60 pacientes de sexo masculino (3%) han requerido prótesis. En total se ha obtenido rehabilitación satisfactoria en 53 de 63 pacientes (85,5%)