[Utilidad de la resonancia magnética dinámica para la evaluación de la inestabilidad disco-vertebral vs. la resonancia magnética estática]. / Utility of the dynamic magnetic resonance for the evaluation of disco-vertebral instability vs. static magnetic resonance.

INTRODUCTION: Dynamic magnetic resonance imaging (dMR) is useful to evaluate the unstable cervical spine; it evaluates soft components of the cervical spine and dynamic cervical movements. OBJECTIVE: To describe and analyze the frequency of presentation of herniated discs with static MRI and compare with dMR. METHOD: During December 2014 to February 2016, patients with cervicalgia and suspected cervical instability were evaluated. An observational, descriptive, cross-sectional study was performed, where images obtained in flexion and extension were analyzed using a device compatible with MRI. RESULTS: 29 patients entered the protocol, 7 were excluded. Average age: 50 years. Of the 22 patients, 154 intervertebral discs were evaluated, demonstrating 52 herniated discs, 78% were disc protrusions. Most affected level: C5 (31%). During the dynamic maneuvers it was shown that 30 were unstable, showing modification during the maneuvers of flexion and extension, 22 hernias remained stable. Five patients demonstrated bone instability of vertebral bodies. CONCLUSIONS: The dMR can be used in our environment since the acquisition cost is low and provides information for the evaluation of spinal disc instability showing findings not visible in sMR. Obtaining a relative risk of 16 and p < 0.05.

INTRODUCCIÓN: La resonancia magnética dinámica (RMd) es útil para evaluar la columna cervical inestable; evalúa componentes blandos de la columna cervical y movimientos dinámicos cervicales. OBJETIVO: Describir y analizar la frecuencia de presentación de hernias discales con resonancia magnética estática (RMe) y comparar con la RMd. MÉTODO: De diciembre de 2014 a febrero de 2016 se evaluaron pacientes con cervicalgia y sospecha de inestabilidad cervical. Se realizó un estudio observacional, descriptivo y transversal, en el que se analizaron imágenes obtenidas en flexión y extensión mediante un dispositivo compatible con la RM. RESULTADOS: 29 pacientes ingresaron al protocolo y 7 se excluyeron. Promedio de edad: 50 años. De los 22 pacientes, se evaluaron 154 discos intervertebrales, demostrando 52 hernias discales, y el 78% fueron protrusiones discales. Nivel más afectado: C5 (31%). Durante las maniobras dinámicas se demostró que 30 fueron inestables, mostrando modificación durante las maniobras de flexión y extensión; 22 hernias se mantuvieron estables. Cinco pacientes demostraron inestabilidad ósea de cuerpos vertebrales. CONCLUSIONES: La RMd puede utilizarse en nuestro medio, ya que el costo de adquisición es bajo y provee información para la evaluación de la inestabilidad del disco vertebral al mostrar hallazgos no visibles en la RMe. Se obtiene un riesgo relativo de 16 y una p < 0.05.

Efectos del Síndrome de Apneas-Hipopneas del Sueño sobre la calidad de vida y la somnolencia diurna / Obstructive Sleep Apnea Syndrome Effects on Quality of Life and Daytime Sleepiness

El objetivo de esta investigación fue evaluar en pacientes con Síndrome de Apneas-Hipopneas del Sueño (SAHS), la calidad de vida y el impacto de la somnolencia diurna. Se incluyeron 100 sujetos (50 pacientes con SAHS y 50 sujetos sanos) que respondieron al Cuestionario de Salud (SF-36), Cuestionario de Impacto Funcional del Sueño (FOSQ) y a la Escala de Somnolencia de Epworth (ESE). Respecto al grupo control, el grupo clínico mostró diferencias estadísticamente significativas (p < 0.05) en la mayoría de las variables estudiadas. Los factores más influyentes fueron el índice de masa corporal, el índice de apneas-hipopneas y el índice de desaturación. Este estudio demuestra la importante repercusión que el SAHS tiene en la calidad de vida de los pacientes.

The objective of this research was to evaluate quality of life and impact of daytime sleepiness in patients with Sleep Apnea/Hypopnea Syndrome (SAHS). 100 subjects were included: 50 patients with OSAS and 50 healthy subjects, who responded to the Short Form-36 Health Survey (SF-36), the Functional Outcomes of Sleep questionnaire (FOSQ) and the Epworth Sleepiness Scale (ESS). The comparison between clinical and control group showed statistically significant differences (p < 0.05) in most of the variables studied. The results found that body mass index, apnea-hypopnea index and desaturation index were the most important affecting factors. This study shows the great impact OSAS has on the quality of life of patients.

Human papillomavirus detection by PCR assay in a large series of high-grade squamous intraepithelial lesions with cytohistological correlation and follow-up.

OBJECTIVE: High-grade squamous intraepithelial lesions (HSIL) are the precursors of invasive cervical carcinomas and are generally associated with the integration of mucosotropic human papillomavirus (HPV) DNA into the host cell genome. Detection of HPV is easy to perform nowadays, even in laboratories with limited technological capacity, and follow-up procedures for patients with HSIL are well established. STUDY DESIGN: HPV detection was performed in a large group of patients with HSIL, and results were correlated with cytological, histological, and colposcopic findings. Discrepancies were examined and discussed. RESULTS: Conventional Papanicolaou (Pap) screening detected 446 HSIL (0.20%) in 218,906 cervical smears. HPV detection by PCR was positive in 339/358 (94.7%) patients. The strains involved were: HPV 16 in 180 patients (53.1%), HPV 18 in 35 (10.3%), HPV 31/33 in 27 (8%), HPV 6/11 in 10 (2.96%), and an unidentified type in 73 (30%). For the last 97 patients (2006-2007), HPV typing was expanded with the following results: HPV 52 was detected in 9 patients (9.2%), HPV 58 in 6 (6.1%), HPV 51 in 4 (4.1%), HPV 68 in 2 (2.0%), and HPV 39 in 1 (1.0%). The number of nonidentified patients dropped to 9 (9.4%); in addition, 14/97 (14.4%) patients were infected with 2 or more viral types. Finally, 19 (5.3%) patients were HPV negative. Colposcopy revealed minor changes in 59 patients (17.3%), major changes in 264 (77.6%), and normal findings in 17 (5.1%). A biopsy was taken in 331/446 patients, and the diagnosis of HSIL or overt malignancy was histologically confirmed in 281 (84.9%) patients: CIN II in 46, CIN III in 224, and histologically upgraded in 11 (6 microinvasive squamous carcinomas, 1 squamous carcinoma, 2 in situ endocervical adenocarcinomas, and 2 microinvasive endocervical adenocarcinomas). Thirty-five patients (10.6%) were downgraded to CIN I and 15 (4.5%) patients had a negative biopsy. Follow-up in the negative-biopsy patients confirmed the existence of SIL in 11 patients [1 HSIL and 10 low-grade squamous intraepithelial lesions (LSIL)] while 4 were considered false positives (atrophic changes, 2; reactive changes, 2). After treatment, 31/331 (9.36%) patients displayed recurrence (HSIL in 29 and LSIL in 2). The viral strains involved in patients with recurrence were HPV 16 in 16 patients (51.6%); HPV 18 in 4 (12.9%); HPV 16 and 18 in 1 (3.2%); HPV 31 in 1 (3.2%); HPV 52 in 1 (3.2%); HPV 18, 31, and 58 in 1 (3.2%); HPV 68 in 1 (3.2%); HPV 51 and 73 in 1 (3.2%), and an unidentified type in 5 (16.1%). Follow-up in 14/19 HSIL and HPV-negative patients confirmed the existence of cervical pathology. CONCLUSIONS: HPV detection improves diagnostic sensitivity and provides an ideal tool for monitoring the response to treatment in HSIL patients. The pathogenic relevance of HPV strain 18 may be greater than previously assumed.