Síndrome de pinzamiento isquiofemoral: a propósito de una serie de 5 casos / Ischiofemoral impingement syndrome: A five-case series report

El dolor glúteo es un motivo frecuente de consulta médica en la práctica clínica diaria. Las causas son muy variadas, pudiendo encontrar entre aquellas que forman parte de su diagnóstico diferencial el síndrome de pinzamiento isquiofemoral. Este, incluido actualmente dentro de los síndromes de glúteo profundo, es consecuencia del atrapamiento de las estructuras neuromusculares englobadas entre el trocánter menor y la tuberosidad isquiática, lo que ocasiona un cuadro de dolor en la raíz del miembro inferior, con irradiación hacia el muslo o hacia la región glútea, y mala tolerancia a la deambulación y a la sedestación. La prueba diagnóstica fundamental es la resonancia magnética de cadera, y su manejo suele ser médico inicialmente. A pesar de no ser una entidad frecuente en las consultas de reumatología, tener esta patología en mente ayuda a mejorar su pronóstico, al poder ofrecer un tratamiento adecuado y precoz.(AU)

Gluteal pain is a frequent cause of medical attention in the daily clinical practice. It can be caused by multiple pathologies, being ischiofemoral impingement syndrome among those included in its differential diagnosis. Encompassed within the deep gluteal syndromes, this entity occurs as a consequence of the entrapment of the neuromuscular structures between the lesser femoral trochanter and the ischial tuberosity, causing pain in the root of the lower limb, with irradiation towards the thigh or the gluteal region and poor tolerance to deambulation and sedestation. The magnetic resonance imaging of the hip is fundamental for its diagnosis, and its management consists on medical treatment at onset. Despite not being a frequent diagnosis in the clinical practice in rheumatology, keeping it in mind helps improving its prognosis by establishing an early and adequate treatment.(AU)

Ischiofemoral impingement syndrome: A five-case series report.

Gluteal pain is a frequent cause of medical attention in the daily clinical practice. It can be caused by multiple pathologies, being ischiofemoral impingement syndrome among those included in its differential diagnosis. Encompassed within the deep gluteal syndromes, this entity occurs as a consequence of the entrapment of the neuromuscular structures between the lesser femoral trochanter and the ischial tuberosity, causing pain in the root of the lower limb, with irradiation towards the thigh or the gluteal region and poor tolerance to deambulation and sedestation. The magnetic resonance imaging of the hip is fundamental for its diagnosis, and its management consists on medical treatment at onset. Despite not being a frequent diagnosis in the clinical practice in Rheumatology, keeping it in mind helps improving its prognosis by establishing an early and adequate treatment.

Relationship between trabecular bone score, bone mineral density and vertebral fractures in patients with axial spondyloarthritis.

BACKGROUND: In patients with axial spondyloarthritis, vertebral fracture risk is elevated and not always correlated with bone mineral density (BMD). Trabecular bone score (TBS) may offer some advantages in the assessment of vertebral fracture risk in these patients. The primary objective of this study was to compare TBS and BMD between axial spondyloarthritis patients depending on their vertebral fracture status. Secondary objectives were to estimate the prevalence of morphometric vertebral fractures, and to explore factors associated with fracture, as well as the interference of syndesmophytes on BMD and TBS. METHODS: A cross-sectional study was conducted. Data were collected on demographic and clinical characteristics, lab results, imaging findings and treatment. Statistical analysis was performed using SPSS v.13 statistical software. RESULTS: Eighty-four patients (60 men and 24 women; mean age of 59 years) were included. Nearly half (47.6%) of them had lumbar syndesmophytes. The rate of morphometric fracture was 11.9%. TBS showed a higher area under the curve (0.89) than total hip, femoral neck and lumbar BMD (0.80, 0.78, and 0.70 respectively) for classifying patients regarding their fracture status. Nonetheless, the differences did not reach statistical significance. Syndesmophytes affected lumbar spine BMD (p < 0.001), but not hip BMD or TBS. Fractures were associated with TBS, total hip BMD, erythrocyte sedimentation rate and C-reactive protein levels. CONCLUSIONS: We identified decreased TBS and total hip BMD, as well as increased erythrocyte sedimentation rate and C-reactive protein levels as factors associated with morphometric vertebral fractures. Unlike lumbar spine BMD, TBS is not affected by the presence of syndesmophytes.

Tratamiento inicial del síndrome de vena cava superior de causa neoplásica mediante endoprótesis / Effectiveness of endovascular prostheses as initial treatment for superior vena cava syndrome of malignant cause

Fundamento y objetivo: El síndrome de vena cava superior (SVCS) se origina por la dificultad del retorno venoso, producida frecuentemente por un tumor invasor del mediastino. El objetivo de este estudio fue valorar la utilidad de las endoprótesis como tratamiento inicial del SVCS de causa maligna. Pacientes y método: Desde diciembre de 1996 hasta agosto de 2010 se remitieron 120 pacientes con SVCS para tratamiento percutáneo. Setenta y seis se hallaban en seguimiento oncológico y en 44 casos se desconocía un proceso tumoral. Realizamos un estudio prospectivo no concurrente de 113 pacientes sin tratamiento radioterápico o quimioterápico previo y en los que se optó por el tratamiento intravascular como primera opción. Resultados: Se trataron 102 varones y 11 mujeres, con una media de edad de 61,18 años (extremos 45-85). Las causas del SVCS fueron: neoplasia pulmonar (100 casos), metástasis pulmonares (6), compresión por adenopatías (6) y un tumor embrionario. Se implantaron 155 prótesis. Fue suficiente un stent en 75 pacientes, 2 stents en 34 y 3 en 4. El éxito técnico fue del 98,2%. La sintomatología desapareció por completo en 97 pacientes y parcialmente en 13. Como complicaciones destacaron: migración del stent (5), epistaxis (1) y hematoma inguinal pospunción (1). Setenta y tres pacientes tuvieron una supervivencia asintomática media de 210 días (permeabilidad primaria 75%, permeabilidad secundaria 52,9%). Conclusiones: El empleo de endoprótesis en el SVCS de causa maligna es un procedimiento seguro y eficaz que palía la obstrucción venosa, consigue la inmediata desaparición de los síntomas, permite la estadificación del tumor subyacente, facilita la instauración del mejor tratamiento y mejora la calidad de vida (AU)

Background and objective: Superior vena cava syndrome (SVCS) is caused by venous return obstruction often originated by an invading mediastinal tumour. Our objective was to evaluate the usefulness of stents as initial treatment for SVCS of malignant origin. Patients and methods: From December 1996 to August 2010, 120 patients with SVCS were referred for percutaneous treatment. Seventy-six were under oncological follow-up cases and in 44 cases the tumour was unknown. A non-concurrent prospective study was made of 113 patients without prior chemotherapy or radiotherapy, who opted for endovascular treatment as first option. Results: One hundred and two men and 11 women were treated, mean age 61.18 years old (range 45-85). SVCS causes included lung cancer (100), lung metastases (6), compression by enlarged lymph nodes (6), and an embryonic tumour. One hundred and fifty-five prostheses were implanted. One stent was enough in 75 patients, 2 stents in 34, and 3 in 4. Technical success rate was 98.2%. Symptoms disappeared completely in 97 patients and partially in 13. Complications were stent migration (5), epistaxis (1), and post-procedure groin hematoma (1). Seventy-three asymptomatic patients had a mean survival of 210 days (75% primary permeability and 52.9% secondary permeability). Conclusions: The use of stents in malignant SVCS is a safe and effective procedure for venous obstruction, leading to the immediate disappearance of symptoms, allowing the underlying tumour staging, facilitating the establishment of the best treatment and improving life quality (AU)

[Effectiveness of endovascular prostheses as initial treatment for superior vena cava syndrome of malignant cause]. / Tratamiento inicial del síndrome de vena cava superior de causa neoplásica mediante endoprótesis.

BACKGROUND AND OBJECTIVE: Superior vena cava syndrome (SVCS) is caused by venous return obstruction often originated by an invading mediastinal tumour. Our objective was to evaluate the usefulness of stents as initial treatment for SVCS of malignant origin. PATIENTS AND METHODS: From December 1996 to August 2010, 120 patients with SVCS were referred for percutaneous treatment. Seventy-six were under oncological follow-up cases and in 44 cases the tumour was unknown. A non-concurrent prospective study was made of 113 patients without prior chemotherapy or radiotherapy, who opted for endovascular treatment as first option. RESULTS: One hundred and two men and 11 women were treated, mean age 61.18 years old (range 45-85). SVCS causes included lung cancer (100), lung metastases (6), compression by enlarged lymph nodes (6), and an embryonic tumour. One hundred and fifty-five prostheses were implanted. One stent was enough in 75 patients, 2 stents in 34, and 3 in 4. Technical success rate was 98.2%. Symptoms disappeared completely in 97 patients and partially in 13. Complications were stent migration (5), epistaxis (1), and post-procedure groin hematoma (1). Seventy-three asymptomatic patients had a mean survival of 210 days (75% primary permeability and 52.9% secondary permeability). CONCLUSIONS: The use of stents in malignant SVCS is a safe and effective procedure for venous obstruction, leading to the immediate disappearance of symptoms, allowing the underlying tumour staging, facilitating the establishment of the best treatment and improving life quality.

[Cocaine-induced ischemic colitis in a high-risk patient treated conservatively]. / Colitis isquémica inducida por cocaína en un paciente de riesgo, tratada de forma conservadora.

Drug consumption is among the non-occlusive causes of ischemic colitis. We report a case of cocaine-induced ischemic colitis in a 34-year-old man who had undergone sigmoid resection and loop colostomy due to abdominal-pelvic injury 3 months previously. The patient presented with abdominal pain associated with diarrhea and slight transient fever of doubtful etiology and reported intranasal cocaine consumption. He was hemodynamically stable and showed no peritoneal irritation. Traces of blood were found in the colostomy bag. Colonoscopy showed ulcers and necrosis proximal to the stoma. Computed tomography angiography scan showed no abnormalities except filiform inferior mesenteric artery. The symptoms were self-limiting and the patient was discharged 3 days after admission. Subsequently the colostomy was closed without complications. A high degree of suspicion is required in young patients with abdominal pain not identified by conventional methods and a recent history of drug consumption.

Colitis isquémica inducida por cocaína en un paciente de riesgo, tratada de forma conservadora / Cocaine-induced ischemic colitis in a high-risk patient treated conservatively

Entre las causas no oclusivas de isquemia cólica están las inducidas farmacológicamente. Presentamos un caso de colitis isquémica provocada por consumo de cocaína en un paciente de 34 años de edad con antecedentes de traumatismo abdomino-pélvico tres meses antes, en el que se efectuó resección de sigma y colostomía en asa. Consultó por dolor abdominal asociado a diarrea y febrícula, y refería consumo de cocaína intranasal. Estaba hemodinámicamente estable y sin peritonismo, evidenciándose restos hemáticos en la bolsa de colostomía. Una colonoscopia objetivó úlceras y necrosis proximales al estoma y la angiotomografía no mostró hallazgos patológicos a excepción de una arteria mesentérica inferior filiforme. El cuadro fue autolimitado, y el paciente dado de al tercer día. Más adelante se reconstruyó el tránsito intestinal sin complicaciones. Debe existir un elevado grado de sospecha ante un dolor abdominal no filiado en pacientes jóvenes con antecedentes de consumo reciente de la droga (AU)

Drug consumption is among the non-occlusive causes of ischemic colitis. We report a case of cocaine-induced ischemic colitis in a 34-year-old man who had undergone sigmoid resection and loop colostomy due to abdominal-pelvic injury 3 months previously. The patient presented with abdominal pain associated with diarrhea and slight transient fever of doubtful etiology and reported intranasal cocaine consumption. He was hemodynamically stable and showed no peritoneal irritation. Traces of blood were found in the colostomy bag. Colonoscopy showed ulcers and necrosis proximal to the stoma. Computed tomography angiography scan showed no abnormalities except filiform inferior mesenteric artery. The symptoms were self-limiting and the patient was discharged 3 days after admission. Subsequently the colostomy was closed without complications. A high degree of suspicion is required in young patients with abdominal pain not identified by conventional methods and a recent history of drug consumption (AU)

Hematoma cervical y mediastínico secundario a rotura espontánea de tiroides / Cervical and Mediastinum Haematoma Secondary to Spontaneous Thyroid Rupture

Presentamos un caso de hemorragia espontánea de nódulo tiroideo con difusión del hematoma a espacios cervicales y mediastino, que debutó como una masa cervical de crecimiento progresivo, con afectación de la vía aérea y que requirió tratamiento quirúrgico para su control. El diagnóstico se realizó mediante ecografía y TAC cervicotorácico, aportando imágenes de gran utilidad para la determinación del punto de sangrado, así como extensión del proceso (AU)

We present a case of spontaneous haemorrhage of a thyroid nodule with diffusion of the haematoma to cervical spaces and mediastinum, which began as a progressive cervical mass affecting the airway and which required surgical treatment for control. The diagnosis was made using ultrasonography and cervicothoracic CT scan, giving high quality images to determine the site of bleeding as well as the extent of the process (AU)

[Cervical and mediastinum haematoma secondary to spontaneous thyroid rupture]. / Hematoma cervical y mediastínico secundario a rotura espontánea de tiroides.

We present a case of spontaneous haemorrhage of a thyroid nodule with diffusion of the haematoma to cervical spaces and mediastinum, which began as a progressive cervical mass affecting the airway and which required surgical treatment for control. The diagnosis was made using ultrasonography and cervicothoracic CT scan, giving high quality images to determine the site of bleeding as well as the extent of the process.

Describen la utilidad de la endoscopia virtual para diagnosticar enfermedades del tracto urinario superior / Virtual endoscopy in the diagnosis of upper urinary tract pathologies

Introducción: La patología del tracto urinario superior supone un reto diagnóstico para el urólogo. La aparición de nuevo hardware y software de adquisición y procesamiento de imágenes de tomografía computarizada (TC) ha hecho posible el desarrollo de técnicas como la que presentamos en este estudio. Material y métodos: Entre enero de 2005 y agosto de 2007 hemos incluido 57 urografías por tomografía computarizada (Uro-TC) realizadas en nuestro centro a pacientes con enfermedades del tracto urinario superior. Recogemos las indicaciones, los diagnósticos y comparamos los valores de validez interna y externa de la prueba con los de otras exploraciones radiológicas. Resultados: Realizamos un total de 57 exploraciones a 56 pacientes con edades entre los 38 y los 84 años en las que diagnosticamos 21 litiasis, 8 neoformaciones uroteliales, 2 pélvicas, 3 ureterales y 3 vesicales. En 6 pacientes con ureterohidronefrosis de etiología incierta en otras exploraciones conseguimos dilucidar la causa de la obstrucción. Diagnosticamos 2 litiasis durante el seguimiento de pacientes portadores de derivaciones urinarias, así como 5 casos de estenosis benigna. En 11 pacientes se diagnosticaron diferentes malformaciones congénitas. Los valores de validez interna de la prueba fueron superiores a los de las pruebas de imagen usadas convencionalmente para el diagnóstico de trastornos del tracto urinario superior. Conclusiones: La Uro-TC es una prueba eficiente, que está al alcance de la mayoría de centros en los que se disponga de la tecnología necesaria. Permite en casos seleccionados optimizar recursos sanitarios y agilizar el diagnóstico de la enfermedad urológica.

Litiasis sintomática en divertículo calicial / No disponible

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Correlación topográfica y anatomopatológica en los tumores de la región selar / Topographic and anatomopathological correlation in the sellar region tumors

La alta prevalencia de los macroadenomas hipofisarios en el mundo motivó la realización de esta investigación, cuyo objetivo fundamental fue demostrar el valor de la tomografía computadorizada en el diagnóstico presuntivo de la variedad histológica de los macroadenomas hipofisarios así como de otros tumores menos frecuentes de la región selar, teniendo en cuenta el cuadro clínico. Para ello se estudiaron 124 pacientes operados con el diagnóstico clínico y tomográfico de macroadenomas hipofisarios y otros tumores de la región selar. Se registró la edad, sexo, clínica, signos tomográficos, resultados anatomopatológicos posquirúrgicos. Se observó mayor incidencia de los adenomas hipofisarios (110), con predominio de los no secretores (41,1 %). El grueso de los pacientes se ubicó en las edades entre 30 y 50 años. El sexo femenino prevaleció en los adenomas adrenocorticotrópicos y los meningiomas, y el masculino en los productores de gonadotropina y prolactina. Dentro de los signos tomográficos, la erosión de las clinoides y el dorso selar, así como la hidrocefalia predominaron en los adenomas no secretores y los tumores no adenohipofisarios. Los adenomas productores de gonadotropina se destacaron en la erosión del piso y en el balonamiento selar al igual que los adrenocorticotrópicos. Las calcificaciones fueron frecuentes en los teratomas y craneofaringiomas, al igual que la captación no homogénea del contraste, la cual fue característica en estos casos como en los quistes de la bolsa de Rathke. La TC demostró ser de gran valor diagnóstico en los macroadenomas hipofisarios y otros tumores de la región selar teniendo en cuenta el cuadro clínico del paciente.

The high prevalence of hypophyseal macroadenomas worlwide motivated us to carry out this research, whose fundamental aim was to demonstrate the value of CT in the presumptive diagnosis of the histological variety of hypophyseal macroadenomas, as well as of other less frequent tumours of the sellar region, considering the clinical picture. To this end, 124 patients operated on with a clinical and tomographic diagnosis of hypophyseal macroadenomas and other tumours were studied. Age, sex, hospital stay, tomographic signs, and postsurgical anatomopathological results were registered. The highest incidence was found in the hypophyseal adenomas (110), with predominance of the non-secreting adenomas (41.1 %). Most of the patients were 30-50. The female sex prevailed in the adrenocorticotropic adenomas and meningiomas, and the male sex in gonadotropin and prolactin-producing adenomas. Within the tomographic signs the erosion of the clinoid and sellar dorsum, and hydrocephalus, predominated in the non-secreting adenomas and in the non-adenohypohyseal tumours. The gonadotropin-producing adenomas stood out in the erosion of the floor and in sellar ballooning as well as the adrenocorticotropic adenomas. The calcifications were more common in teratomas and craniopharyngiomas, as well as and the non-homogenous capture of the contrast agent, which was characteristic in these cases, as in Rathke's pouch cysts. CT showed its great diagnostic value in hypophyseal macroadenomas, and other tumours of the sellar region, taking into account the patient's clinical picture.

Feocromocitoma como causa de hemoptisis masiva / Pheochromocytoma as a cause of massive hemoptysis

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MRI of mandibular osteonecrosis secondary to bisphosphonates.

OBJECTIVE: Bisphosphonates are a group of drugs used in the treatment of oncology patients with bone metastases. However, in the past few years, osteonecrosis of the jaw has been reported as a serious complication of such treatment. The objective of this study was to examine the use of MRI in the assessment of bone lesions caused by this disease. MATERIALS AND METHODS: Fourteen patients were studied who had been treated with i.v. bisphosphonates and had developed focal lesions of osteonecrosis of the jaw. These patients were referred by the stomatology department of Hospital General Universitario de Valencia. We evaluated both the morphology and the behavior of the lesions in T1, STIR, and after the administration of gadolinium. RESULTS: Twenty-six focal lesions were detected clinically and 36 were detected radiologically. All the clinically detected focal lesions were visible on MRI. There were 15 focal lesions detected radiologically that were not detected on clinical examination. In all patients, it was possible to assess bone involvement and involvement of the bone marrow, soft tissues, sinuses, and mandibular canal as well as the presence of adenopathy. CONCLUSION: MRI is an effective tool in the assessment of osteonecrosis of the jaw. The significance of focal lesions detectable on radiologic examination but without clinical correlation and their progression over time remains to be determined.

Correlación tomográfica y clínica, pre y posquirúrgica en los tumores de la región selar / Pre- and postsurgical tomographic and clinical correlation in the tumors of the sellar region

La alta prevalencia de los macroadenomas hipofisarios en el mundo motivó la realización de esta investigación, cuyo objetivo fue demostrar el valor diagnóstico de la tomografía computadorizada y su utilidad para definir la técnica quirúrgica en estos casos. Para ello se estudiaron 124 pacientes operados con el diagnóstico clínico y tomográfico de macroadenomas hipofisarios y otros tumores de la región selar menos frecuentes. El 100 por ciento de los tumores con crecimiento C-E y C-D se abordaron por vía transcraneal y el 99 restante con crecimiento A, B ó C se utilizó la vía transesfenoidal. Las complicaciones tomográficas y clínicas fueron superiores en la primera vía y se destacaron los restos tumorales (40 por ciento), las recidivas (28 por ciento) y daño de los nervios craneales (28 por ciento). La mejoría clínica posoperatoria alcanzada fue ostensible al igual que el grado de control de los adenomas, lo cual demostró el alto valor diagnóstico de la tomografía computadorizada y su utilidad para trazar la estrategia quirúrgica correcta, esto muestra una alta sensibilidad en la detección de algunas complicaciones posoperatorias que se pueden valorar con este método.

The high prevalence of hypophyseal macroadenomas in the world motivated us to conduct this research aimed at demonstrating the value of computerized tomography and its usefulness to define the surgical technique in these cases. To this end, 124 patients operated on with the clinical tomographic diagnosis of hypophyseal macroadenomas and other tumors of the sellar region that were less common were studied. 100 percent of the tumors with C-E and C-D growth were approached by transcranial route, whereas in the other 99 with A, B or C growth, it was used the transsphenoidal route. The tomographic and clinical complications were higher in the first route, and the tumor debris (40 percent), the relapses (28 percent) and the damage of the cranial nerves (28 percent) stood out. The postoperative clinical improvement attained was significant the same as the degree of control of the adenomas, which showed the high diagnostic value of computerized tomography and its usefulness to establish the suitable surgical strategy. This shows a high sensitivity in the detection of some postoperative complications that may be assessed by using this method.