Colangitis crónicas: diagnóstico diferencial y papel de la resonancia magnética / Chronic cholangitides: differential diagnosis and role of MRI

Las colangitis crónicas idiopáticas son un grupo de enfermedades hepatobiliares, de probable origen autoinmune, que suelen ser asintomáticas en sus estadios iniciales y pueden evolucionar hacia cirrosis hepática. La sospecha se establece al encontrar elevación de las enzimas de colestasis en analíticas de sangre. Entre las colangitis idiopáticas, la más frecuente es la colangitis esclerosante primaria, asociada a la enfermedad inflamatoria intestinal y que conlleva una incidencia aumentada de neoplasias hepatobiliares y del tubo digestivo. Es importante establecer el diagnóstico diferencial con la colangitis asociada a IgG4, la colangitis biliar primaria y colangitis secundarias, puesto que el manejo terapéutico es diferente. La colangiopancreatografía por resonancia magnética (CPRM) es la mejor prueba para la valoración de la vía biliar intrahepática y extrahepática, y el estudio de RM proporciona información sobre el hígado y el resto de los órganos abdominales. Un adecuado protocolo de CPRM y el conocimiento de los distintos hallazgos colangiográficos característicos de cada entidad son esenciales para alcanzar un diagnóstico correcto

The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis

Chronic cholangitides: Differential diagnosis and role of MRI. / Colangitis crónicas: diagnóstico diferencial y papel de la resonancia magnética.

The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis.

Urgencias hipertensivas: descripción de características clínicas, manejo, variables asociadas a reconsulta y pronóstico a corto plazo / Hypertensive urgencies: Description of clinical characteristics, management, variables associated with re-entry and short-term prognosis

Objetivos: Describir las características de las urgencias hipertensivas atendidas en un Servicio de Urgencias, así como las variables asociadas a reconsulta precoz (< 7 días) y al mes (< 30 días). Métodos: Se realizó un estudio descriptivo, retrospectivo de todos los pacientes atendidos en el Servicio de Urgencias de un hospital de tercer nivel durante el año 2013. Posteriormente se realizó un análisis de casos-control para analizar el grupo de pacientes con reconsulta. Resultados: Se analizaron un total de 398 urgencias hipertensivas (32,4% hombres, edad media 67,8 años) lo que representó una incidencia de 3,28/1.000 visitas. Un 80,9% eran hipertensos previamente, siendo 2,23 la media de Índice de Charlson. La cefalea fue el síntoma más frecuente (49,1%), seguida del mareo/inestabilidad (29,5%) y las náuseas/vómitos (17,1%). Un 80,7% de los pacientes recibieron tratamiento farmacológico. Las tasas de eventos cardiovasculares o mortalidad al mes fueron bajas (2,26% y 0,25% respectivamente). Pese a ello, un 7,53% y un 11,31% de los pacientes reingresaron antes de 7 días o 30 días, respectivamente. Las variables asociadas a reconsulta en el análisis multivariante fueron la presión arterial sistólica elevada en la primera determinación, la hipertensión arterial previa y la presencia de palpitaciones. Conclusiones: Las urgencias hipertensivas son entidades de elevada incidencia en los Servicios de Urgencias. En nuestro estudio, los individuos con diagnóstico previo de hipertensión arterial y la presión arterial sistólica elevada en la primera determinación tienen mayor riesgo de reconsulta y serían candidatos a un seguimiento más estrecho al alta

Objectives: To describe the characteristics of hypertensive urgencies at the emergency department, as well as the variables associated with early re-admission (<7 days) and re-admission at one month (<30 days). Methods: We conducted a descriptive, retrospective study of all patients who were admitted to the emergency department of a third level hospital during 2013. Subsequently, a case-control analysis was performed to analyze the group of patients with readmission. Results: A total of 398 hypertensive urgencies were collected (32.4% men, mean age 67.75 years), which led to an incidence of 3.28/1000 visits. Eighty point nine percent had a previous history of hypertension, and the mean Charlson Index was 2.23. Headache was the most frequent symptom (49.1%), followed by dizziness/instability (29.5%) and nausea/vomiting (17.1%). Eighty point seven percent of the patients were prescribed pharmacological treatment. The rates of cardiovascular events or mortality at one month were low (2.26% and 0.25% respectively). Despite this, 7.53% and 11.31% of patients were readmitted in under 7 days or 30 days, respectively. The variables associated with readmission in the multivariate analysis were elevated systolic blood pressure in the first determination, previous hypertension and the presence of palpitations. Conclusions: Hypertensive emergencies are high-incidence conditions in the Emergency Department. In our study, patients with a prior diagnosis of hypertension and elevated systolic blood pressure at the first determination had a higher risk of re-entry and would be candidates for closer follow-up on discharge

[Hypertensive urgencies: Description of clinical characteristics, management, variables associated with re-entry and short-term prognosis]. / Urgencias hipertensivas: descripción de características clínicas, manejo, variables asociadas a reconsulta y pronóstico a corto plazo.

OBJECTIVES: To describe the characteristics of hypertensive urgencies at the emergency department, as well as the variables associated with early re-admission (<7 days) and re-admission at one month (<30 days). METHODS: We conducted a descriptive, retrospective study of all patients who were admitted to the emergency department of a third level hospital during 2013. Subsequently, a case-control analysis was performed to analyze the group of patients with readmission. RESULTS: A total of 398 hypertensive urgencies were collected (32.4% men, mean age 67.75 years), which led to an incidence of 3.28/1000 visits. Eighty point nine percent had a previous history of hypertension, and the mean Charlson Index was 2.23. Headache was the most frequent symptom (49.1%), followed by dizziness/instability (29.5%) and nausea/vomiting (17.1%). Eighty point seven percent of the patients were prescribed pharmacological treatment. The rates of cardiovascular events or mortality at one month were low (2.26% and 0.25% respectively). Despite this, 7.53% and 11.31% of patients were readmitted in under 7 days or 30 days, respectively. The variables associated with readmission in the multivariate analysis were elevated systolic blood pressure in the first determination, previous hypertension and the presence of palpitations. CONCLUSIONS: Hypertensive emergencies are high-incidence conditions in the Emergency Department. In our study, patients with a prior diagnosis of hypertension and elevated systolic blood pressure at the first determination had a higher risk of re-entry and would be candidates for closer follow-up on discharge.

Hipertensión arterial durante el embarazo: ¿siempre preeclampsia? / Arterial hypertension during pregnancy: Always preeclampsia?

El síndrome de Cushing es una enfermedad poco frecuente durante el embarazo, pero se asocia a complicaciones maternas y fetales graves. La etiología más frecuente durante el embarazo es el adenoma suprarrenal, y cifras de cortisol libre en orina por encima de 3 veces el límite superior de la normalidad, por lo general, indican síndrome de Cushing durante el embarazo. El tratamiento de elección es quirúrgico, y el momento ideal para la cirugía es antes del tercer trimestre

Cushing's syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushing's syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester

[Arterial hypertension during pregnancy: Always preeclampsia?] / Hipertensión arterial durante el embarazo: ¿siempre preeclampsia?

Cushing's syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushing's syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester.

Se acerca el invierno: el riesgo recurrente de la intoxicación por monóxido de carbono / Winter is coming: the recurring risk of carbon monoxide poisoning

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Rapid assessment of nonlinear optical propagation effects in dielectrics.

Ultrafast laser processing applications need fast approaches to assess the nonlinear propagation of the laser beam in order to predict the optimal range of processing parameters in a wide variety of cases. We develop here a method based on the simple monitoring of the nonlinear beam shaping against numerical prediction. The numerical code solves the nonlinear Schrödinger equation with nonlinear absorption under simplified conditions by employing a state-of-the art computationally efficient approach. By comparing with experimental results we can rapidly estimate the nonlinear refractive index and nonlinear absorption coefficients of the material. The validity of this approach has been tested in a variety of experiments where nonlinearities play a key role, like spatial soliton shaping or fs-laser waveguide writing. The approach provides excellent results for propagated power densities for which free carrier generation effects can be neglected. Above such a threshold, the peculiarities of the nonlinear propagation of elliptical beams enable acquiring an instantaneous picture of the deposition of energy inside the material realistic enough to estimate the effective nonlinear refractive index and nonlinear absorption coefficients that can be used for predicting the spatial distribution of energy deposition inside the material and controlling the beam in the writing process.

[Ramsay-Hunt syndrome]. / Síndrome de Ramsay-Hunt.

Ramsay-Hunt syndrome is a peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear or in the mouth; it is caused by varicella zoster virus that affects the geniculate ganglion. The zoster oticus is the second most common cause of atraumatic peripheral facial paralysis. We present a review of zoster oticus identified in our hospital among 2001-2005. We show various atypical cases with multiple cranial nerve involvement; cerebellum and spinal cord was affected in one patient. 3/10 cases were complicated with pneumonia. So, we think that some grade of immunodeficiency may be present in these cases. Treatment with acyclovir and prednisone has been successfully to improve the outcome in the most of patients. Compared with Bell s palsy, patients with zoster oticus often have more severe paralysis at onset and are less likely to recover completely.

Osteotomía subcondílea en el tratamiento de las deformidades mandibulares / S.rbeondylar osteotomy in the treatment of mandibular deformites

La corrección quirúrgica del prognatismo mediante intervenciones en las ramas ascendentes de la mandíbula, fue la opción que sustituyó a las técnicas de ostectomíasquereducían el volumen mandibularo más exactamente la longitud del cuerpo bilateralmente. Se realizan osteotomías subcondíleas oblícuas por encima de la espina de Spix, preservando el paquete vásculo-nervioso que, partiendo de la escotadura sgmoidea, llegan al borde posterior de la mandíbula. Desde el año 1974 hemos empleado la técnica subcondílea oblicua (OSO) por vía intraoral en 367 casos para la corrección del prognatismo (AU)

25 Aniversario de la Especialidad de Cirugía Oral y Maxilofacial / 25th Aniversary of the speciality of oral and maxilofacial surgery

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Sensibilización cutánea e identificación de ácaros en las viviendas de una población de alérgicos en la provincia de Huelva / Skin sensitisation to mites and mite identification in the homes of an allergic population in the Huelva province

Fundamento y objetivos: Los ácaros domésticos suponen una de las causas de sensibilización y asma más comunes en la mayor parte del mundo. Se analiza la prevalencia de la sensibilización cutánea a las diferentes familias de ácaros y la presencia de éstos en las viviendas de una población de pacientes alérgicos a ácaros en la provincia de Huelva. Material y métodos: Se realizan pruebas cutáneas frente a 4 ácaros de la familia Pyroglyphidae y 5 de las familias Acaridae y Glyciphagidae, además de recoger muestras de polvo de las viviendas, en una muestra de pacientes con patología por sensibilización a ácaros. Resultados: De los 157 pacientes estudiados, el 74,5 por ciento entregaron una muestra de polvo de su domicilio, de las cuales en 86 (73,5 por ciento) se identificaron al menos un tipo de ácaro. Dermatophagoides pteronyssinus fue el ácaro más identificado; apareció en 80 muestras (93 por ciento de muestras positivas), de las cuales 79 correspondieron a pacientes sensibilizados a ese ácaro. Glycypaghus domesticus y Tyrophagus putrescentiae se identificaron en 37 y 21 muestras, respectivamente, pero sin encontrarse relación con la sensibilización cutánea. Ciento cuatro pacientes (66,2 por ciento) presentaban una prueba cutánea positiva al menos a uno de los ácaros de almacén, entre los que Tyrophagus putrescentiae fue el más frecuente. Existió una relación de dependencia entre los cuatro ácaros domésticos y también entre los cinco ácaros de almacén estudiados; sin embargo, esta relación desaparecía cuando se comparaba Dermatophagoides pteronyssinus con los ácaros de almacén. Conclusiones: Se evidencia una elevada sensibilización cutánea a los ácaros de la familia no Pyroglyphidae en esta región; sin embargo, la ausencia de relación entre la sensibilización cutánea y la presencia de esta familia acarina en las viviendas, nos hace pensar que la mayoría de las sensibilizaciones a estos ácaros se deben a la existencia de una reactividad cruzada con Dermatophagoides pteronyssinus, sin descartar la presencia de algunos casos de multisensibilización (AU)

Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: an MRI and CT prospective study.

The possible relationship between the morphometric characteristics (condylar and temporomandibular joint (TMJ) disc position) of the TMJ and the TMJ clinical findings (normal versus TMJ disorders) in different types of dentofacial deformities was studied. Forty-eight patients with dentofacial deformities (96 TMJs) were investigated preoperatively and 10 patients (20 TMJs) without deformities were studied as a control group, clinically and radiographically, using computer tomography (CT) and magnetic resonance imaging (MRI), to assess the position of the mandibular condyle and the TMJ disc in the sagittal, coronal and horizontal planes. Fifteen of the 28 joints (53.6%) of patients diagnosed as class II dentofacial deformity had internal derangements and anteriorly displaced discs. The incidence of internal derangement in the class I and class III groups was lower (10%). An increased horizontal angle of the mandibular condyle and a posteriorly seated condyle were found in patients diagnosed as class II dentofacial deformity when compared with the control group. The rest of the patients studied showed no significant differences. The same results were encountered when the patients with moderate to severe TMJ pathology were studied, both clinically (using the Helkimo index modified by Athanasiou) and by MRI.

Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study.

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.