¿Cómo diagnosticamos la diverticulitis aguda? Resultados de una encuesta nacional sobre el papel de las técnicas de imagen / How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques

Introducción: La elección de las técnicas de imagen en el diagnóstico de la diverticulitis aguda (DA) es un motivo de controversia. Los objetivos del estudio fueron conocer las preferencias de los radiólogos y el grado de utilización de las distintas técnicas en su manejo radiológico. Métodos: Se difundió una encuesta por Internet a través de la Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA) y Twitter, con preguntas sobre ámbito de trabajo, protocolización, preferencias personales y la realidad asistencial en el manejo radiológico de la DA. Resultados: Se obtuvieron 186 respuestas. El 72% de los radiólogos encuestados trabaja en servicios organizados por «órgano y sistema» (S-OS). Existe protocolo de manejo de DA en un el 48% de los servicios, siendo en el 47,5% la ecografía la técnica de inicio. El 73% de los encuestados cree que la ecografía debería ser la primera opción diagnóstica, pero en realidad esto solo se efectúa en un 24% de los servicios, realizándose tomografía computarizada en el 32,8%, con diferencias significativas en horario de guardia. La clasificación más utilizada es la de Hinchey (75%). El 96% de los encuestados desearía un consenso de especialidad para utilizar la misma clasificación. Existe mayor tasa de protocolización, utilización de clasificaciones y mayor creencia en la ecografía como técnica inicial en S-OS y en hospitales con más de 500 camas. Conclusiones: Hay una gran variabilidad en el manejo radiológico de la DA, con divergencias en los protocolos utilizados y entre las opiniones de los radiólogos y la práctica clínica real.(AU)

Introduction: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists’ preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. Methods: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents’ working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. Results: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with>500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. Conclusions: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists’ opinions, and actual clinical practice.(AU)

How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques.

INTRODUCTION: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists' preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. METHODS: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents' working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. RESULTS: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with >500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. CONCLUSIONS: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists' opinions, and actual clinical practice.

Critical review of HCC imaging in the multidisciplinary setting: treatment allocation and evaluation of response.

Imaging has not only an established role in screening and diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver inflammatory diseases, but also a crucial importance for patient stratification and treatment allocation, as well as for assessing treatment response. In the setting of increasing therapeutic options for HCC, the Barcelona Clinic Liver Cancer (BCLC) system still remains the most appropriate way to select candidate cohorts for best treatments. This classification takes into account the imaging information on tumor burden and extension, liver function, and cancer-related symptoms, stratifying patients in five risk categories (Stages 0, A, B, C and D) associated with different treatment options. Still now, there are no clear roles for biomarkers use in treatment allocation. The increasing use of locoregional non-surgical therapies in the different stages is highly dependent on reliable evaluation of treatment response, in particular when they are used with curative intention or for downstaging at liver transplantation re-assessment. Moreover, objective response (OR) has emerged as an important imaging biomarker, providing information on tumor biology, which can contribute for further prognostic assessment. Current guidelines for OR assessment recommend only the measurement of viable tumor according to mRECIST criteria, with further classification into complete response, partial response, stable disease or progressive disease. Either computed tomography (CT) or magnetic resonance (MR) imaging can be used for this purpose, and the Liver Imaging Reporting and Data System (LI-RADS) committee has recently provided some guidance for reporting after locoregional therapies. Nevertheless, imaging pitfalls resulting from treatment-related changes can impact with the correct evaluation of treatment response, especially after transarterial radioembolization (TARE). Volume criteria and emerging imaging techniques might also contribute for a better refinement in the assessment of treatment response and monitoring. As the role of imaging deeply expands in the multidisciplinary assessment of HCC, our main objective in this review is to discuss state-of-the-art decision-making aspects for treatment allocation and provide guidance for treatment response evaluation.

Compact self-illuminated image upconversion system based on intracavity second-harmonic generation.

We present an image upconversion system based on intracavity Type II second-harmonic generation to create an image in the visible spectrum of a target illuminated by an infrared laser. The system has the novelty of being self-illuminated. It uses some fractional leaking power of the infrared laser to illuminate a target located in the object focal plane of the system, and to couple back a created infrared target image to an intracavity nonlinear crystal, where it mixes with the cavity laser beam to obtain a second-harmonic image, visible with a silicon CCD camera. For a proof of concept, we have built a system based on a diode-pumped Nd3+:YVO4 continuous-wave (cw) laser and an intracavity KTP crystal to upconvert 1342 nm target images to 671 nm. The upconverted cw power allowed us to capture real-time video in a standard nonintensified CCD camera, with 2.5 W of a diode pump.

IR-to-visible image upconverter under nonlinear crystal thermal gradient operation.

In this work we study the enhancement of the field-of-view of an infrared image up-converter by means of a thermal gradient in a PPLN crystal. Our work focuses on compact upconverters, in which both a short PPLN crystal length and high numerical aperture lenses are employed. We found a qualitative increase in both wavelength and angular tolerances, compared to a constant temperature upconverter, which makes it necessary a correct IR wavelength allocation in order to effectively increase the up-converted area.

Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia.

PURPOSE: Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH). METHODS: Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%. RESULTS: The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%). CONCLUSIONS: Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.

IR Image upconversion using band-limited ASE illumination fiber sources.

We study the field-of-view (FOV) of an upconversion imaging system that employs an Amplified Spontaneous Emission (ASE) fiber source to illuminate a transmission target. As an intermediate case between narrowband laser and thermal illumination, an ASE fiber source allows for higher spectral intensity than thermal illumination and still keeps a broad wavelength spectrum to take advantage of an increased non-collinear phase-matching angle acceptance that enlarges the FOV of the upconversion system when compared to using narrowband laser illumination. A model is presented to predict the angular acceptance of the upconverter in terms of focusing and ASE spectral width and allocation. The model is experimentally checked in case of 1550-630 nm upconversion.

Intra-cavity upconversion to 631 nm of images illuminated by an eye-safe ASE source at 1550 nm.

We report an image wavelength upconversion system. The system mixes an incoming image at around 1550 nm (eye-safe region) illuminated by an amplified spontaneous emission (ASE) fiber source with a Gaussian beam at 1064 nm generated in a continuous-wave diode-pumped Nd(3+):GdVO(4) laser. Mixing takes place in a periodically poled lithium niobate (PPLN) crystal placed intra-cavity. The upconverted image obtained by sum-frequency mixing falls around the 631 nm red spectral region, well within the spectral response of standard silicon focal plane array bi-dimensional sensors, commonly used in charge-coupled device (CCD) or complementary metal-oxide-semiconductor (CMOS) video cameras, and of most image intensifiers. The use of ASE illumination benefits from a noticeable increase in the field of view (FOV) that can be upconverted with regard to using coherent laser illumination. The upconverted power allows us to capture real-time video in a standard nonintensified CCD camera.

Validación de un cuestionario de conocimientos sobre la hipertensión / Validation of a hypertension knowledge questionnaire

INTRODUCCIÓN: La hipertensión arterial es una enfermedad crónica, siendo la principal desencadenante de las enfermedades cardiovasculares. Las intervenciones educativas destinadas a aumentar sus conocimientos pueden contribuir a que los pacientes hipertensos cambien los hábitos de vida poco saludables y a optimizar el cumplimiento terapéutico, favoreciendo un mejor control de la presión arterial. Para ello es necesario contar con un instrumento fiable con el que poder evaluar la eficacia de estas intervenciones. Objetivo Validar un cuestionario de conocimientos sobre la hipertensión (CSH) en castellano para evaluar el conocimiento y la comprensión que tienen los pacientes en este contexto. Material y métodos1) Adaptación del cuestionario existente. 2) Grupos de discusión para unificar criterios y consulta con expertos. 3) Prueba piloto de la comprensión del cuestionario. 4) Fiabilidad a través de la consistencia interna (alfa de Cronbach) y la sensibilidad al cambio (test de McNemar). Resultado Cuestionario definitivo desarrollado en 9 bloques que incluyen conocimientos sobre la hipertensión, los factores de riesgo asociados a la misma, los riesgos de la hipertensión, la dieta, el ejercicio y la medicación. Participaron 60 pacientes, 30 personas de centros de atención primaria y 30 de centros especializados. La edad media fue de 60 ańos; el 57% (n = 34) fueron mujeres. El alfa de Cronbach fue de 0,799.ConclusiónEl cuestionario desarrollado en este estudio es una herramienta fiable y fácil para evaluar el nivel de conocimientos sobre la hipertensión de los pacientes hipertensos, siendo especialmente útil para evaluar la eficacia de la educación terapéutica

INTRODUCTION: Hypertension is a chronic disorder and is the main cause of cardiovascular disease. Educational interventions designed to increase knowledge may help hypertensive patients to change unhealthy lifestyles and optimize treatment adherence, thus facilitating better blood pressure control. Consequently, a reliable tool is required to evaluate the effectiveness of theseinterventions. OBJECTIVE: To validate a hypertension knowledge questionnaire in Spanish to assess patients 'knowledge and understanding of this disorder. MATERIAL AND METHODS: 1) Adaptation of an existing questionnaire. 2) Focus groups to unify criteria and consultation with experts. 3) Pilot test to evaluate comprehension of the questionnaire. 4) Reliability through internal consistency (Cronbach's alpha) and sensitivity to change(McNemar test).RESULTS: A final questionnaire was developed in 9 blocks, which included knowledge of hypertension, associated risk factors, risks of hypertension, diet, exercise, and medication. Sixty patients participated: 30 were from primary care centers and the remaining 30 were from specialized centers. The mean age of the participants was 60 years, and 57% (n = 34) were women. Cronbach's alpha was 0.799. CONCLUSION: The questionnaire developed in this study is a reliable and easily applied tool to assess knowledge about hypertension in hypertensive patients. This questionnaire is especially useful to evaluate the effectiveness of therapeutic patient education

Variación de tamaño de la hiperplasia nodular focal mediante resonancia magnética / Variations in the size of focal nodular hyperplasia on magnetic resonance imaging

Objetivo. Evaluar los cambios en el tamaño de la hiperplasia nodular focal (HNF) mediante seguimiento a largo plazo con resonancia magnética (RM). Material y métodos. Se revisaron 44 HNF de 30 pacientes, estudiadas mediante RM con al menos 2 estudios separados como mínimo 12 meses. Se midió (en mm) el diámetro mayor de la lesión en las imágenes transversales de RM con contraste, calculándose el porcentaje de variación como la diferencia entre el diámetro máximo en el seguimiento respecto al diámetro máximo inicial. Se definió como variación significativa de tamaño un porcentaje de variación superior al 20%. Se analizaron los factores hormonales predisponentes. Resultados. La media del intervalo de tiempo entre las 2 pruebas de imagen fue de 35 ± 2 meses (rango: 12-94). La mayoría de las lesiones (80%) permanecieron estables durante el seguimiento, y solo 9 de las 44 lesiones (20%) mostraron una variación significativa de su diámetro. Siete de ellas (16%) disminuyeron de tamaño y 2 (4%) aumentaron, con variaciones que alcanzaron hasta el doble del tamaño inicial. El cambio de tamaño no se pudo relacionar con el embarazo, la menopausia ni el uso de anticonceptivos orales o corticoides. Conclusión. Los cambios de tamaño de la HNF durante el seguimiento son relativamente frecuentes y no deben disuadir de este diagnóstico. Estas variaciones parecen independientes de los factores hormonales considerados como predisponentes (AU)

Objective: To evaluate the changes in the size of focal nodular hyperplasia (FNH) during long- term magnetic resonance imaging (MRI) follow-up. Material and methods: We reviewed 44 FNHs in 30 patients studied with MRI with at least two MRI studies at least 12 months apart. We measured the largest diameter of the lesion (in mm) in contrast-enhanced axial images and calculated the percentage of variation as the difference between the maximum diameter in the follow-up and the maximum diameter in the initial study. We defined significant variation in size as variation greater than 20%. We also analyzed predisposing hormonal factors. Results: The mean interval between the two imaging studies was 35 ± 2 months (range: 12-94). Most lesions (80%) remained stable during follow-up. Only 9 of the 44 lesions (20%) showed a significant variation in diameter: 7 (16%) decreased in size and 2 (4%) increased, with variations that reached the double of the initial size. The change in size was not related to pregnancy, menopause, or the use of birth control pills or corticoids. Conclusion: Changes in the size of FNHs during follow-up are relatively common and should not lead to a change in the diagnosis. These variations in size seem to be independent of hormonal factors that are considered to predispose (AU)

Enterografía por resonancia magnética: técnica e indicaciones. Hallazgos en la enfermedad de Crohn / Magnetic resonance enterography: technique and indications. Findings in Crohn's disease

Tradicionalmente, la radiología con contraste oral o la enteroclisis han sido las técnicas de elección para valorar el intestino delgado, que han destacado por la excelente visualización del patrón mucoso. Sin embargo, la ausencia de información extraluminal y el empleo de radiaciones ionizantes han relegado a estas exploraciones en favor de las técnicas seccionales, que permiten visualizar la cavidad abdominal con gran resolución. La enterografía por resonancia magnética es una técnica sencilla, sin radiaciones ionizantes, que permite obtener imágenes de calidad si se consigue distender bien la luz intestinal mediante la administración oral de sustancias no reabsorbibles, minimizar el peristaltismo y establecer un protocolo que incluya secuencias con contraste intravenoso. Estas propiedades se pueden utilizar en los enfermos de enfermedad de Crohn para conseguir una gran precisión diagnóstica cuando se valora la actividad de la enfermedad y monitorizar el tratamiento, para descartar la obstrucción intestinal y los tumores del intestino delgado, y en los pacientes pediátricos por su inocuidad(AU)

Radiology with oral contrast, or enteroclysis, have traditionally been the techniques of choice in the examination of the small intestine, due to the excellent visualisation of the mucosal pattern. However, the absence of extra-luminal information and the use of ionising radiation have replaced these examinations with sectional techniques which enable the abdominal cavity to be viewed with good resolution. Magnetic resonance enterography is a simple technique, with no ionising radiation, provided quality images, distends the intestinal lumen well by the administration of non-reabsorbable oral substances, minimises peristalsis, and establishes a protocol which includes sequences with intravenous contrast. These properties can be used in patients with Crohn's disease, achieving good diagnostic precision in the assessment of activity and monitoring of treatment, in intestinal obstruction, in the suspicion of small intestine tumours, and in paediatric patients due to it being harmless(AU)

Variations in the size of focal nodular hyperplasia on magnetic resonance imaging.

OBJECTIVE: To evaluate the changes in the size of focal nodular hyperplasia (FNH) during long-term magnetic resonance imaging (MRI) follow-up. MATERIAL AND METHODS: We reviewed 44 FNHs in 30 patients studied with MRI with at least two MRI studies at least 12 months apart. We measured the largest diameter of the lesion (inmm) in contrast-enhanced axial images and calculated the percentage of variation as the difference between the maximum diameter in the follow-up and the maximum diameter in the initial study. We defined significant variation in size as variation greater than 20%. We also analyzed predisposing hormonal factors. RESULTS: The mean interval between the two imaging studies was 35±2 months (range: 12-94). Most lesions (80%) remained stable during follow-up. Only 9 of the 44 lesions (20%) showed a significant variation in diameter: 7 (16%) decreased in size and 2 (4%) increased, with variations that reached the double of the initial size. The change in size was not related to pregnancy, menopause, or the use of birth control pills or corticoids. CONCLUSION: Changes in the size of FNHs during follow-up are relatively common and should not lead to a change in the diagnosis. These variations in size seem to be independent of hormonal factors that are considered to predispose.

[Magnetic resonance enterography: technique and indications. Findings in Crohn's disease]. / Enterografía por resonancia magnética: técnica e indicaciones. Hallazgos en la enfermedad de Crohn.

Radiology with oral contrast, or enteroclysis, have traditionally been the techniques of choice in the examination of the small intestine, due to the excellent visualisation of the mucosal pattern. However, the absence of extra-luminal information and the use of ionising radiation have replaced these examinations with sectional techniques which enable the abdominal cavity to be viewed with good resolution. Magnetic resonance enterography is a simple technique, with no ionising radiation, provided quality images, distends the intestinal lumen well by the administration of non-reabsorbable oral substances, minimises peristalsis, and establishes a protocol which includes sequences with intravenous contrast. These properties can be used in patients with Crohn's disease, achieving good diagnostic precision in the assessment of activity and monitoring of treatment, in intestinal obstruction, in the suspicion of small intestine tumours, and in paediatric patients due to it being harmless.

Electro-optic control of a PPLN-unpoled LiNbO3 boundary for low-voltage Q switching of an intracavity frequency-doubled Nd3+:YVO4 laser.

We present a simple technique to integrate an electro-optic Q switch in a periodically poled bulk lithium niobate crystal bounded by two unpoled (monodomain) regions. The technique exploits the high sensitivity to low applied electric fields of the total internal reflection condition in the periodic poled-unpoled boundary for the small grazing incidence angles associated with the diffraction of a focused Gaussian beam that propagates in the periodically poled region with its axis parallel to the boundary. When the arrangement is placed intracavity to a 1064 nm diode-pumped Nd(3+):YVO(4) laser, it performs simultaneously as a Q switch and as a second-harmonic generator, with Q switching starting at applied voltages as low as 1 V over a 500 microm thickness and with no additional optical elements.

Dual-wavelength green laser with a 4.5 THz frequency difference based on self-frequency- doubling in Nd3+ -doped aperiodically poled lithium niobate.

We report a dual-wavelength continuous-wave laser at 542.4 and 546.8 nm based on an Nd(3+)-doped aperiodically poled lithium niobate crystal. Two fundamental infrared (IR) wavelengths at 1084.8 and 1093.6 nm are simultaneously oscillated and self-frequency-doubled to green. The aperiodic domain distribution patterned in the crystal allows for quasi-phase matched self-frequency-doubling of both IR fundamentals while avoiding their sum-frequency mixing.

Utilidad de la resonancia magnética en la evaluación local del cáncer de mama: impacto en el cambio de actitud terapéutica en una serie prospectiva de 338 pacientes / No disponible

Introducción: la estadificación del cáncer de mama implicareunir información no sólo sobre el tamaño del tumor principal,sino también sobre la presencia de multifocalidad, multicentricidad,bilateralidad, componente intraductal extenso oextensión al complejo areola-pezón. El objetivo de nuestro estudioes validar la técnica en nuestro entorno asistencial y evaluarel impacto que la RM de mama con contraste ha tenido sobre338 pacientes consecutivas con diagnóstico de cáncer demama en el proceso de la toma de decisión del modelo de tratamiento.Como objetivo secundario se plantea la correlaciónde los hallazgos de la RM con los hallazgos histopatológicos.Material y métodos: estudiamos con RM a 338 pacientesconsecutivas con diagnóstico de cáncer de mama antes de decidircuál era el abordaje terapéutico más adecuado. La intenciónterapéutica se registró antes y después de cada estudio deRM. Se calculó la sensibilidad, la especificidad, el valor predictivopositivo y el valor predictivo negativo de la RM para lesionesadicionales, así como el coeficiente de correlación linealde Pearson para el diámetro del tumor índice o principal.Resultados: en 145 pacientes (42%) se identificaron 164lesiones adicionales, de las cuales 87 (53%) fueron malignas,28 (17%) fueron benignas, 35 (21,3%) se catalogaron comoprobablemente benignas, en 6 (3,6%) no se alcanzó un diagnósticofinal y 8 (4,9%) no quedaron incluidas en la pieza quirúrgicao bien desaparecieron tras la quimioterapia neoadyuvante.Estos hallazgos implicaron un cambio en la actitudterapéutica en 82 pacientes (24,2%). Este cambio se confirmócon los resultados de la anatomía patológica como correcto en69 paciente (20,4%) y como incorrecto o innecesario en 13pacientes (3,8%). El coeficiente de correlación de Pearson resultóser fuertemente positivo (r = 0,784) cuando se compararonlos resultados de la RM y la anatomía patológica...(AU)

Background: breast cancer staging implies gathering informationnot only on the size of the main tumour, but also onmultifocality, multicentricity, bilaterality, presence of an extensiveintraductal component and extension to the nipple-areolarcomplex. The objective of our study is to demonstrate thatbreast magnetic resonance (MR) is the modality of choice inthe staging of breast cancer patients due to the fact that it addsinformation capable of modifying the therapeutic approach inthese patients. A secondary objective is to validate our resultsin our clinical environment.Material and methods: 338 consecutive patients with abreast cancer diagnosis were studied with breast MR beforedeciding the most appropiate therapeutic approach. Therapeuticintention was registered before and after each MRstudy. Sensibility, specificity, postive predictive value (PPV)and negative predictive value (NPV) of MR for additional lesionswas calculated and Pearson's linear correlation coefficientwas calculated for the index lesion diameter.Results: 164 additional lesions were found in 145 patients(42%) of which 87 (53%) were malignant, 28 (17%) were benign,35 (21,3%) were probable benign, 6 (3,6%) had no diagnosisand 8 (4,9%) were not included in the surgical specimenor else dissappeared after neoadjuvant chemotherapy. Thesefindings implied change in therapeutic approach in 82 patients(24,2%). These change was pathologically validated ascorrect in 69 patients (20,4%) and as unnecessary or incorrectin 13 patients (3,8%). Pearson's linear correlation coefficientwas strongly positive (r = 0,784) when MR and pathology resultswere compared. Sensibility, specificity, PPV and NPV ofMR for additional lesions was 90,6, 55,2, 75,7 and 79,5%respectively...(AU)

Estado actual de la formación de residentes de cirugía general en Colombia / Current state of general surgical training programs in Colombia

Introducción: La formación y certificación de Cirujanos es una preocupación creciente en los programas de Cirugía en Colombia, sin embargo no existe un diagnostico de la situación actual que permita un ajuste a los cambios constantes. Describimos en términos de carga académica y laboral el estado actual de los programas de residencia de Cirugía General inicialmente en la ciudad de Bogotá y en una segunda fase extenderlo al resto del país, desde la perspectiva de los residentes. Materiales y métodos: Se aplicó una encuesta a los residentes activos de Cirugía General en Bogotá y se tabularon los resultados en una base de datos Excel. Resultados: Se obtuvo información completa del 97.6 porciento de la población de residentes de Cirugía General en Bogotá, Clasificándola en cuatro variables: Datos sociodemográficos, información asistencial y académica, satisfacción y expectativa laboral. Conclusiones: El análisis de los datos muestra que los residentes de cirugía General se encuentran satisfechos con el programa donde realizan su especialización, sin embargo, no disponen de facilidades para que la investigación clínica termine en publicaciones, y el bienestar de los residentes no es una prioridad.

[Maternal-fetal staphylococcal toxic shock syndrome with chorioamniotitis]. / Choc toxique staphylococcique maternofoetal sur chorioamniotite.

We report a rare case of mother-infant pair with Staphylococcal Toxic Shock Syndrome (TSS). A term neonate was born by caesarean section for maternal septic syndrome during per-partum. He presented with respiratory distress complicated by pulmonary hypertension, skin rash, and multiple organ system involvement. Staphylococcus aureus was isolated from placenta, surface swabs and gastric aspirate. He received adapted antibiotics, respiratory support by high frequency ventilation and NO. The mother had shock, skin rash and inflammatory syndrome. Outcome was good in both cases. The isolate produced enterotoxin C and L. Shock, exanthematous disease and multi-organ involvement complicating a staphylococcal infection in neonate must lead to suspect a TSS.

Tumores Gástricos Estromales / Stromal gastric tumors

Los tumores gástricos de origen estromal constituyen un grupo especial de lesiones cuya definición patológica se ha establecido recientemente dada la evolución en las técnicas de análisis patológico. A pesar de su infrecuente presentación, es importante para el cirujano conocer su clasificación, características biológicas y las modalidades de tratamiento existente...

[The relation between the clinical symptoms and the findings on magnetic resonance in children with periventricular leukomalacia]. / Relación entre los síntomas clínicos y los hallazgos en resonancia magnética en niños con leucomalacia periventricular.

OBJECTIVES: To assess whether there is a relationship between the various clinical symptoms and imaging findings on MR in children with periventricular leukomalacia (PVLM). PATIENTS AND METHODS: We made a retrospective study of 41 consecutive paediatric patients, 19 boys and 22 girls, with an average age of 30.5+/-19 months (range 8 84 months) who had been diagnosed as having PVLM and studied using MR, recording imaging, clinical and epidemiological data. RESULTS: The MR images showed areas of gliosis in all the children (few foci in 68.3% and multiple foci in 31.7%), with cysts in 22%. The changes were seen mainly in the parietal and occipital regions, were bilateral and symmetrical in 80.5%, with ventricular dilatation in 75.6%, atrophy of the parenchyma in 48.8%, Wallerian degeneration in 7.3%, delay in myelination in 31.7%, lesions in the optic radiations in 9.8%, thalamus 12.2% and anomalous venous drainage in 2.4%. The overall degree of involvement on MR was severe in 43.9%, moderate in 31,7% and mild in 24.4%. There was a history of perinatal foetal distress in 56.8%, hyaline membrane disease in 40.5%, intracranial hemorrhage in 35.1%, psychomotor retardation in 58.5%, motor retardation in 29.3%, and squint in 22%. A significant relationship was found only between acute foetal distress and lateralization of the lesions (p= 0.038) and the presence of parenchymatous cysts (p= 0.024). CONCLUSION: The patients with a history of foetal distress had a greater tendency to symmetrical, bilateral involvement with cysts in the white matter of the brain. It was not possible to establish a model for classification of the overall involvement using MR and the data recorded. The imaging findings were not related overall to the patients symptoms.