[Reversible primary empty sella. Case report]. / Silla turca vacía primaria reversible. A propósito de un caso.

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSF shunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sella may be an indicator of normal intracranial pressure in these cases.

Silla turca vacía primaria reversible. A propósito de un caso / Reversible primary empty sella. Case report

Se presenta el caso de un niña de 13 años con un aumento del tamaño de la hipófisis sugerente de adenoma que, tras un episodio de hidrocefalia aguda, desarrolló en la RM una silla turca vacía parcial.Tras la colocación de una derivación de líquido cefalorraquídeo, se normalizó la presión intracraneal y la hipófisis volvió a ocupar todo el espacio de la fosa sellar. Se discute la posibilidad de que en la silla turca vacía primaria con hipertensión intracraneal crónica idiopática, esté implicada una atrofia isquémica de la adenohipófisis que impide la recuperación del volumen glandular tras la restauración de la PIC a los niveles normales. La reversión de la silla turca vacía es un indicador de la normalización de la PIC (AU)

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSFshunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sell a may bean indicator of normal intracranial pressure in these cases (AU)

[Postsurgical pituitary apoplexy. Report of two cases]. / Apoplejía tumoral hipofisaria posquirúrgica. A propósito de dos casos.

We report two cases of large macroadenomas that, after a transsphenoidal partial resection, suffered necrosis and swelling of the residual tumor, with increase of its volume, compression of neighboring structures and neurological deterioration. The literature is reviewed looking for possible pathophysiological mechanism and prevention.

Apoplejía tumoral hipofisaria posquirúrgica. A propósito de dos casos / Postsurgical pituitary apoplexy. Report of two cases

Se presentan dos casos de macroadenomas nofuncionantes grandes que, tras su extirpación parcialpor vía transesfenoidal, sufrieron un infarto delresto tumoral residual, con resultado de aumento desu volumen, compresión de las estructuras vecinas ydeterioro neurológico de los pacientes. Ambos fueronreintervenidos por vía transcraneal para conseguirla extirpación completa de sus tumores. Se revisa labibliografía en busca de las claves para prevenir estacomplicación (AU)

We report two cases of large macroadenomasthat, after a transsphenoidal partial resection, sufferednecrosis and swelling of the residual tumor, withincrease of its volume, compression of neighboringstructures and neurological deterioration. The literatureis reviewed looking for possible pathophysiologicalmechanism and prevention (AU)

[Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature]. / Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos.

Two cases of pituitary apoplexy occurring after spinal anaesthesia are described. Both presented with headache and III par palsy, one of them with additional visual disturbance and hyponatremia. A bibliographical review has been done, looking for early diagnostic keys. We propose the arterial hypotension as a possible pathogenetic mechanism of pituitary adenoma apoplexy.

Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos / Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature

Se presentan dos casos clínicos de apoplejía hipofisaria tras anestesia espinal, ambos con cefalea y unaparálisis del III par craneal. Uno de ellos con alteraciónvisual adicional e hiponatremia. Se revisa la bibliografíaen busca de las claves para un diagnóstico precozy se propone la hipotensión arterial como mecanismopatogénico de la apoplejía (AU)

Two cases of pituitary apoplexy occurring afterspinal anaesthesia are described. Both presented withheadache and III par palsy, one of them with additionalvisual disturbance and hyponatremia. A bibliographicalreview has been done, looking for early diagnostickeys. We propose the arterial hypotension as a possiblepathogenetic mechanism of pituitary adenoma apoplexy (AU)

[Cerebellopontine angle meningeal melanocytoma: a benign tumor?]. / Melanocitoma meníngeo del ángulo pontocerebeloso: un tumor benigno?

We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management.

Melanocitoma meníngeo del ángulo pontocerebeloso, ¿Un tumor benigno? / Cerebellopontine angle meningeal melanocytoma: a benign tumor?

Se presenta un paciente con un raro melanocitoma meníngeo del ángulo pontocerebeloso que, tras su extirpación quirúrgica radical, evolucionó en el plazo de un año hacia una melanomatosis meníngea fulminante. Se realiza una revisión bibliográfica en busca de las claves para hacer una aproximación diagnóstica preoperatoria de este tipo de tumor y obtener información sobre su tratamiento y manejo postoperatorio (AU)

We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management (AU)

[Primary empty sella: symptoms, physiopathology, diagnosis and treatement]. / Silla turca vacía primaria: clínica, fisiopatología y tratamiento.

Bibliographical review on the primary empty sella: concept, symptomatology, diagnosis, physiopathology and management.

Silla turca vacía primaria: clínica, fisiopatología y tratamiento / Primary empty sella: symptoms, physiopathology, diagnosis and treatement

En este artículo se revisa el concepto, clínica,fisiopatología y manejo de la silla turca vacía primariay los distintos problemas que plantea, a la luz de labibliografía que se ha considerado más relevante sobreel tema (AU)

Bibliographical review on the primary empty sella:concept, symptomatology, diagnosis, physiopathologyand management

Abscesos cerebrales: análisis de factores pronóstico e influencia del tratamiento antibiótico protocolizado en su evolución / Brain abscess. Evaluation of prognostic factors: does the use of antibiotic prescribing protocols improve outcome?

Objetivos: Analizamos los factores pronósticos asociados a mortalidad en pacientes con absceso cerebral (AC) y la influencia del tratamiento antibiótico protocolizado (PA). Pacientes y Métodos: estudio observacional en un hospital universitario (1975-2005). El tratamiento antibiótico empírico se realizó sin PA (Periodo I -PI-, 1975-1983; n = 33) y de acuerdo a PA diseñado por los Servicios de MI-Infecciosas y Neurocirugía a partir de 1983 (Periodo II -PII-; n = 71); valoramos la influencia del Protocolo Terapéutico en la curación de los enfermos. Resultados: se evaluaron 104 pacientes (edad media 45 años; rango12-86); el origen del AC se identificó en 89% y en 76% hubo confirmación microbiológica. Mortalidad, 16,3% (17/104); se asociaron de forma estadísticamente significativa a mayor mortalidad: edad > 40 años, enfermedad de base últimamente fatal, situación clínica inicial crítica-mala, presencia de alteración del estado de conciencia y tratamiento empíricono adecuado. No hubo diferencias estadísticamente significativas en las características epidemiológicas, clínicas, radiológicas o microbiológicas de los pacientes correspondientes al PI y al PII, excepto en edad (> 40años, 36% en PI y 62% en PII); si hubo diferencias en curaciones, 60% vs 77% (p < 0,05); recidivas 21 vs. 7% (p < 0,05) y mortalidad 18 vs.15,4% (p > 0,05) en PI y PII, respectivamente. Conclusiones: La edad, enfermedad de base últimamente fatal, gravedad clínica inicial, presencia de alteración del nivel de conciencia y el tratamiento antibiótico empírico inadecuado son los principales factores pronósticos asociados a mayor mortalidad en pacientes con AC. La prescripción del tratamiento empírico de acuerdo con un PA consensuado se asoció con mayor porcentaje de curaciones y menor número de recidivas

Background: the aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). Patients and Methods: observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From1976 to 1983 (Period I), antibiotic treatment was not done according toany internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. Results: 104 patients with BA were included (mean age 45 years;range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p <0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p >0.05), in Period I and II respectively. Conclusions: main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequateempirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates

[Brain abscess. Evaluation of prognostic factors: does the use of antibiotic prescribing protocols improve outcome?]. / Abscesos cerebrales: análisis de factores pronóstico e influencia del tratamiento antibiótico protocolizado en su evolución.

BACKGROUND: the aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). PATIENTS AND METHODS: observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From 1976 to 1983 (Period I), antibiotic treatment was not done according to any internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. RESULTS: 104 patients with BA were included (mean age 45 years; range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p < 0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p > 0.05), in Period I and II respectively. CONCLUSIONS: main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates.

[Aesthetic and visual dynamics of the presentation. Basic concepts]. / Estética y dinámica visual de la presentación científica. Conceptos básicos.

Aesthetic and dynamic aspects of scientific presentations have been scarcely discussed in the medical literature. In this work, basic concepts regarding colour, management, hierarchical disposition of the text, and graphics' animations are briefly described to allow an harmonic and balanced exposition of the visual presentation.

Estética y dinámica visual de la presentación científica. Conceptos básicos / Aesthetic and visual dynamics of the presentation. Basic concepts

La estética y dinámica visual de la presentación científica es, con frecuencia, un tema para el que se dispone de poco tiempo en nuestro ejercicio profesional. En este artículo se desarrollan conceptos básicos referentes al manejo del color, jerarquía plástica del texto y animación de los gráficos, con normas para que la exposición sea armónica y equilibrada desde el punto de vista visual

A esthetic and dynamic aspects of scientific presentationshave been scarcely discussed in the medical literature. In this work, basic concepts regarding colour, management, hierarchical disposition of the text, and graphics’ animations are briefly described to allow an harmonic and balanced exposition of the visual presentation