Estimulación cerebral profunda combinada del núcleo subtalámico y el globo pálido interno en la enfermedad de Parkinson / Combined subthalamic nucleus and globus pallidus internus deep brain stimulation in Parkinson’s disease

Introducción: La estimulación cerebral profunda (ECP) del núcleo subtalámico (NST) y el globo pálido interno (GPi) son los principales abordajes quirúrgicos en la enfermedad de Parkinson avanzada. La estimulación suele aplicarse de forma bilateral en la misma estructura cerebral. Sin embargo, cuando diferentes síntomas motores se presentan concomitantemente en el mismo paciente, la modulación simultánea de diferentes estructuras cerebrales puede ser una alternativa eficaz. Caso clínico: Presentamos un paciente con enfermedad de Parkinson avanzada en el que se realizó ECP combinada en NST y el GPi. La ECP del NST izquierdo controló de manera óptima la sintomatología del hemicuerpo derecho, mientras que las discinesias problemáticas que presentaba en el hemicuerpo izquierdo se redujeron con éxito mediante la estimulación del GPi derecho. Discusión. La estimulación combinada del NST/GPi puede considerarse un enfoque neuroquirúrgico adecuado cuando surge una sintomatología motora desafiante en pacientes con enfermedad de Parkinson avanzada.(AU)

Introduction: Subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) are the main surgical approaches for advanced Parkinson’s disease. Stimulation is usually applied bilaterally in the same brain structure. However, when various motor symptoms concomitantly present in the same patient, simultaneous modulation of different brain structures may be a suitable alternative. Case report: We present a patient with advanced Parkinson’s disease with a combined DBS neurosurgery. Left STN DBS optimally controlled the off right hemibody symptomatology while left side troublesome dyskinesias were successfully relieved by right GPi stimulation. Discussion: Combined STN/GPi stimulation can be considered a suitable approach when challenging motor symptomatology arises in advanced Parkinson’s disease patients.(AU)

Combined subthalamic nucleus and globus pallidus internus deep brain stimulation in Parkinson's disease. / Estimulación cerebral profunda combinada del núcleo subtalámico y el globo pálido interno en la enfermedad de Parkinson.

INTRODUCTION: Subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) are the main surgical approaches for advanced Parkinson's disease. Stimulation is usually applied bilaterally in the same brain structure. However, when various motor symptoms concomitantly present in the same patient, simultaneous modulation of different brain structures may be a suitable alternative. CASE REPORT: We present a patient with advanced Parkinson's disease with a combined DBS neurosurgery. Left STN DBS optimally controlled the off right hemibody symptomatology while left side troublesome dyskinesias were successfully relieved by right GPi stimulation. DISCUSSION: Combined STN/GPi stimulation can be considered a suitable approach when challenging motor symptomatology arises in advanced Parkinson's disease patients.

TITLE: Estimulación cerebral profunda combinada del núcleo subtalámico y el globo pálido interno en la enfermedad de Parkinson.Introducción. La estimulación cerebral profunda (ECP) del núcleo subtalámico (NST) y el globo pálido interno (GPi) son los principales abordajes quirúrgicos en la enfermedad de Parkinson avanzada. La estimulación suele aplicarse de forma bilateral en la misma estructura cerebral. Sin embargo, cuando diferentes síntomas motores se presentan concomitantemente en el mismo paciente, la modulación simultánea de diferentes estructuras cerebrales puede ser una alternativa eficaz. Caso clínico. Presentamos un paciente con enfermedad de Parkinson avanzada en el que se realizó ECP combinada en NST y el GPi. La ECP del NST izquierdo controló de manera óptima la sintomatología del hemicuerpo derecho, mientras que las discinesias problemáticas que presentaba en el hemicuerpo izquierdo se redujeron con éxito mediante la estimulación del GPi derecho. Discusión. La estimulación combinada del NST/GPi puede considerarse un enfoque neuroquirúrgico adecuado cuando surge una sintomatología motora desafiante en pacientes con enfermedad de Parkinson avanzada.

Caracterización molecular de células progenitoras del parénquima subcortical cerebral humano adulto / Molecular characterization of progenitor cells from subcortical parenchyma of adult human brain

Objetivo: Caracterizar los patrones de expresión de marcadores de indiferenciación y diferenciación y las alteraciones morfológicas de las células progenitoras procedentes de parénquima cerebral humano adulto a lo largo de los pases en cultivo, evaluando su potencial para ser empleadas como fuente de progenitores de oligodendrocitos. Materiales y Métodos: Las células progenitoras se aislaron a partir de dos muestras obtenidas de pacientes sometidos a exéresis temporal por epilepsia. Para comprobar la evolución de los niveles de expresión de marcadores moleculares de diferenciación e indiferenciación en dichas células, se procedió a la extracción de ARNm en cada pase y a su estudio mediante RT-PCR. Se llevó a cabo un análisis de su capacidad proliferativa mediante inmunocitoquímica y un estudio de la evolución morfológica mediante microscopía. Resultados: Las células mostraron capacidad proliferativa durante los primeros pases en cultivo. Además, detectamos la expresión de marcadores de indiferenciación y diferenciación temprana a oligodendrocitos. Conclusión: Las células progenitoras aisladas de parénquima subcortical de cerebro humano pueden ser susceptibles de diferenciación a oligodendrocitos maduros, aunque en protocolos de diferenciación sólo deberían utilizarse pases tempranos (AU)

Objetive: characterize the behavior of progenitor cells isolated from subcortical parenchyma of human brain in culture. We have analyzed the changes in expression patterns of differentiation/undifferentiation markers as well as cell morphology along the passages and evaluated the potential to be further used as oligodendrocyte progenitors source. Material and Methods: We isolated progenitor cells from two different samples of subcortical parenchyma human brain of patients suffering from epilepsy. Cells were kept in culture until they became quiescent/senescent. Every other passages RNAs were isolated and checked for the expression of differentiation and undifferentiation markers by using RT-PCR. Proliferation was also addressed by RT-PCR and immunocytochemistry. We carried out cell morphology studies on semithin and ultrathin sections of cells. Results: We observed decreasing proliferative capacity of both two cell lines which became quiescent/senescent around passages 8-10. We detected the expression of either undifferentiation or early neural and oligodendrocytes differentiation markers. Conclusions: As for the expression of molecular markers, progenitor cells isolated from subcortical parenchyma of human brain have the potential to differentiate into mature oligodendrocytes (AU)

[Long-term paratesticular leiomyosarcoma. Conceptual and literature review]. / Leiomiosarcoma paratesticular de larga evolución. Revisión conceptual y de la literatura.

INTRODUCTION: To know the incidence and clinical and pathologic characteristics of the paratesticular leiomyosarcoma (LMS) with the contribution of a case of long evolution, studying the histopathologic criteria that must be valued for this type of tumours. MATERIAL AND METHODS: A 73-year-old patient includes for study with scrotal tumour present left side for 30 months. Histopathologic and imunohistochemical study is realized. Of equal form there is realized a bibliographical search of this type of tumours and their different subtypes across Medline and of not index-linked search. RESULTS: Our case is the second of greater evolution of international literature, first in greater of 60 years and one of those of smaller mitotic index (1 x 50 cga). Nevertheless, his atipia, tumorlike necrosis next to 50% of the injury and its pleomorphic properties, as well as his inmunophenotypic characterization corresponds with a well differentiated LMS, degree 1 (French Federation Cancer). We have found only 107 published cases of this type of sarcomas, of them 5 in our country, which gives to a profile of the low incidence of these tumours, that within sarcomas 1% do not reach. We included the clinical and pathologic profile of such. CONCLUSIONS: The long evolution of a paratesticular tumour and the absence of metastasis does not exclude its malignancy. The low incident of the LMSs in this location, implies that a protocol of actuation validate for such does not exist. We considered of great importance, its creation on the part of urologist, oncologists, radiologists and pathologists like he took control of located in retroperitoneal cavity and deep soft tissues.

Leiomiosarcoma paratesticular de larga evolución. Revisión conceptual y de la literatura / Long-term paratesticular leiomiosarcoma. Conceptual and literature review

Introducción: Conocer la incidencia y características clínico patológicas del leiomiosarcoma (LMS) paratesticular con la aportación de un caso de larga evolución, estudiando los criterios histopatológicos que deben valorarse en este tipo deneoplasias. Material y métodos: Se incluye para estudio un paciente de 73 años con tumoración escrotal izquierda presente desde hace 30 meses. Se realiza estudio histopatológico e inmunohistoquímico. De igual forma se realiza un examen bibliográfico de este tipo de tumores y sus diferentes subtipos a través de Medline y de búsqueda no indexada. Resultados: Nuestro caso es el segundo de mayor evolución de la literatura internacional, el primero en mayores de 60 años y uno de los de menor índice mitótico (1 x 50 cga). Sin embargo, su atipia, necrosis tumoral próxima al 50% de la lesión y su pleomorfismo, así como su inmunofenotipo se corresponde con un LMS bien diferenciado grado 1 (French Federation Cancer).Hemos encontrado tan solo 107 casos publicados de este tipo de sarcomas, de ellos 5 en nuestro país, lo que da un perfil de la baja incidencia de estas neoplasias, que dentro de los sarcomas no alcanzan el 1%. Incluimos el perfil clínico patológico de los mismos. Conclusiones: La larga evolución de una tumoración paratesticular y la ausencia de metástasis no excluye su malignidad. La baja incidencia de los LMSs en esta localización implica que no exista un protocolo de actuación consensuado para los mismos. Consideramos de gran importancia su creación por parte de urólogos, oncólogos, radiólogos y patólogos al igual que se hizo con los localizados en retroperitoneo y tejidos blandos profundos (AU)

Introduction: To know the incidence and clinical and pathologic characteristics of the paratesticular leiomyosarcoma (LMS) with the contribution of a case of long evolution, studying the histopathologic criteria that must be valued for this type of tumours. Material and metods: A 73-year-old patient includes for study with scrotal tumour present left side for 30 months. Histopathologic and imunohistochemical study is realized. Of equal form there is realized a bibliographical search of this type of tumours and their different subtypes across Medline and of not index-linked search. Results: Our case is the second of greater evolution of international literature, first in greater of 60 years and one of those of smaller mitotic index (1 x 50 cga). Nevertheless, his atipia, tumor like necrosis next to 50% of the injury and its pleomorphic properties, as well as his inmunophenotypic characterization corresponds with a well differentiated LMS, degree 1 (French Federation Cancer).We have found only 107 published cases of this type of sarcomas, of them 5 in our country, which gives to a profile of the low incidence of these tumours, that within sarcomas 1% do not reach. We included the clinical and pathologic profile of such. Conclusions: The long evolution of a paratesticular tumour and the absence of metastasis does not exclude its malignancy. The low incident of the LMSs in this location, implies that a protocol of actuation validate for such does not exist. We considered of great importance, its creation on the part of urologist, oncologists, radiologists and pathologists like he took control of located in retroperitoneal cavity and deep soft tissues (AU)

[Epididymis trombosed hemangioma in old patient. Presentation of 1 case with conceptual review and of the literature]. / Hemangioma epididimario trombosado en paciente mayor. Presentación de 1 caso con revisión conceptual y de la literatura.

INTRODUCTION: Though theoretically in the paratesticular region one can develop any type of benign tumour of soft tissues, they are the lipomas, leiomyomas and adenomatoid tumours the most usual whereas the hemangiomas are less common. We contribute a new case of epididymis intrascrotal hemangioma (HI), valuing the bibliography that allows us to know the incidence and clinic-pathologic characteristics of these tumours. MATERIAL AND METHOD: A 74-year-old patient includes for study with right scrotal tumour, who is practised orchiectomy. Hystopathologic study is realized. Of equal form there is realized a bibliographical examination of this type of tumours across Medline and of not index-linked search with conceptual review and of the literature. RESULTS: The injury corresponds with a HI cavernous trombosed of epididymis with testicular parenchyma respected. Your hystopathologic diagnosis does not present problems, whereas the clinical one and ultrasonographic study, reaches the whole spectrum of tumours, benign and malignant of soft tissues. The number of intrascrotal hemangiomas of epididymis described in the literature is very limited. CONCLUSIONS: The scrotal tumours are necessary a preoperatory clinical and sonographic study completely, in spite of the fact that they are diagnosed the majority after your surgical removal. The complex system of the tissues on the zone paratesticular implies that the differential enclosed diagnosis does not allow to differentiate, malignant tumours of benign. The low incident of many of these masses has determined the mistake of standardized protocols for your diagnosis but also for their unified treatment.

Fibrohistiocitoma maligno «inflamatorio» de cordón espermático con infiltración sobre leioma inguinal. Presentación de 1 caso con revisión conceptual y de la literatura / Inflammatory malignant fibrous histiocytoma of the spermatic cord infiltrating an inguinal leiomyoma. Case report with conceptual and bibliographic reviews

Objetivo: Estudiar los fibrohistiocitomas malignos (FHM) paratesticulares desde el punto de vista clínico-histológico, inmunohistoquímico y su histogénesis. Métodos: A través de Medline y búsqueda no indexada de la literatura científica internacional hemos encontrado un total de 77 casos de FHM paratesticulares que globalmente plantean problemas diagnósticos, terminológicos y terapeúticos. Resultado: Incluímos el caso número 78 de FHM de cordón espermático que presenta unas especiales características (no descritas hasta la fecha) de fistulización cutánea e infiltración de un leiomioma inguinal, con confirmación histológica e inmunohistoquímica. Realizamos una revisión conceptual de este tipo de neoplasias incluyendo la valoración de las contradicciones y reclasificaciones que ha sufrido desde su primera descripción, lo que hace que sean subestimados y su prevalencia real en las series internacionales sea muy variable: del 7 al 37% de los sarcomas paratesticulares. También, el hecho de su baja incidencia ha condicionado una carencia de protocolos de diagnóstico y tratamiento. Conclusiones: Los tumores paratesticulares, aunque infrecuentes, tienen una alta tasa de malignidad. El concepto de FHM ha variado a lo largo de los últimos 15 años. Hoy, este término, es sinónimo de sarcoma pleomórfico indiferenciado y ha llegado a ser un diagnóstico de exclusión (Vimentina + / CD 68 + -ocasionalmente- sin diferencias ultraestructurales), reservándose el subtipo inflamatorio para aquellos que tienen un componente inflamatorio e histiocítico. Es imprescindible en esta localización la realización de una biopsia intraoperatoria, ya que incluso es difícil precisar preoperatoriamente, si una lesión es benigna o maligna. El diagnóstico diferencial tan solo se resuelve tras el estudio microscópico e inmunohistoquímico. Un leiomioma próximo a esta localización (inguinal) podría diagnosticarse y confundirse con un nódulo del FHM principal. Su inmunofenotipo nos permitió diagnosticarlo no solo como leiomioma (marcadores de actinas y desmina positivos), sino también observar la infiltración por el FHM (AU)

Objectives: To study paratesticular malignant fibrous histiocytomas (FHM) from the clinical, histological, immunohistochemical and histogenetic, point of view. Methods: Through Medline and not index-linked search of international scientific literature we have found a total of 77 cases of paratesticular FHM that globally create diagnostic, terminological and therapeutic problems. Results: We include the case number 78 of FHM of spermatic cord, that presents a few special characteristics (not described before) of cutaneous fistula and infiltration of an inguinal leiomyoma, with histological and immunohistochemical confirmation. We performed a conceptual review of this type of tumours, including the evaluation of contradictions and reclassifications that has undergone from its first description, which causes that they are underestimated and their real prevalence in international series is very variable: from 7 to 37 % of paratesticular sarcomas. Also, the fact of their low incidence has determined the lack of protocols for diagnosis and treatment. Conclusions: Paratesticular tumours, although infrequent, have a high rate of malignancy. The FHM concept has varied throughout the last 15 years. Today, this term is synonymous of pleomorphic undifferentiated sarcoma and has been an exclusion diagnosis (Vimentin [+] / CD 68 [+] -occasionally- without ultrastructural differences), reserving the inflammatory subtype for which they have an inflammatory and histiocytic component. The accomplishment of an intraoperatory biopsy is essential in this location, since it is even difficult to know preoperatively, if a lesion is benign or malignant. The differential diagnosis is only solved after microscopic and inmunohistochemical study. Leiomyoma next to this location (inguinal) could be diagnosed and confused with a nodule of the main FHM. Their immunophenotype allowed us to diagnose it not only as leiomyoma (myogenic markers were positive -non skeletal muscle-), but also to observe the infiltration by the FHM (AU)

Hemangioma epididimario trombosado en paciente mayor. Presentación de 1 caso con revisión conceptual y de la literatura / Epididymis trombosed hemangioma in old patient. Presentation of 1 case with conceptual review and of the literature

Introducción: Aunque teóricamente en la región para testicular puede desarrollarse cualquier tipo de tumor benigno de tejidos blandos, son los lipomas, leiomiomas y tumores adenomatoides los más frecuentes, mientras que los hemangiomas son menos comunes. Aportamos un nuevo caso de hemangioma intraescrotal (H I), localizado en epidídimo, valorando la bibliografía que nos permita conocer la incidencia y características clínico patológicas de estos tumores. Material y métodos: Se incluye para estudio un paciente de 74 años con tumoración escrotal derecha, a quien se practica orquiectomía. Se realiza estudio histopatológico. De igual forma se realiza un examen bibliográfico de este tipo de tumores a través de Medline y de búsqueda no indexada con revisión conceptual y de la literatura. Resultados: Se corresponde la lesión con un HI cavernoso trombosado de epidídimo con parénquima testicular respetado. Su diagnóstico histopatológico no presenta problemas, mientras que el clínico y ultrasonográfico, alcanza todo el espectro de tumores de partes blandas, benignos y malignos. El número de hemangiomas intraescrotales epididimarios descritos en la literatura es muy reducido. Conclusiones: Los tumores escrotales, precisan de un estudio preoperatorio clínico y ecográfico completo, a pesar de que la mayoria son diagnosticados tras su extirpación quirúrgica. El complejo sistema tisular de la zona paratesticular implica que el diagnóstico diferencial incluso no permita diferenciar tumores malignos de benignos. La baja incidencia de muchas de estas neoplasias ha condicionado la falta de protocolos estandarizados para su diagnóstico pero también para su tratamiento unificado (AU)

Introduction: Though theoretically in the para testicular region one can develop any type of benign tumour of soft tissues, they are the lipomas, leiomyomas and adenomatoid tumours the most usual whereas the hemangiomas are less common. We contribute a new case of epididymis intrascrotal hemangioma (H I), valuing the bibliography that allows us to know the incidence and clinic-pathologic characteristics of these tumours. Material and Metod: A 74-year-old patient includes for study with right scrotal tumour, who is practised orchiectomy. Hystopathologic study is realized. Of equal form there is realized a bibliographical examination of this type of tumour sacross Medline and of not index-linked search with conceptual review and of the literature. Results: The injury corresponds with a HI cavernous trombosed of epididymis with testicular parenchyma respected. Your hystopathologic diagnosis does not present problems, whereas the clinical one and ultrasonographic study, reaches the whole spectrum of tumours, benign and malignant of soft tissues. The number of intrascrotal hemangiomas of epididymis described in the literature is very limited. Conclusions: The scrotal tumours are necessary a preoperatory clinical and sonographic study completely, in spite of the fact that they are diagnosed the majority after your surgical removal. The complex system of the tissues on the zone paratesticular implies that the differential enclosed diagnosis does not allow to differentiate, malignant tumours of benign. The low incident of many of these masses has determined the mistake of standardized protocols for your diagnosis but also for their unified treatment (AU)

Neonatal juvenile xanthogranuloma. Report of a case with fine needle aspiration cytologic findings in a soft tissue mass.

BACKGROUND: Juvenile xanthogranuloma is an infrequent, benign histiocytic lesion, the recognition and diagnosis of which by fine needle aspiration biopsy are important for ascertaining whether a case will have a benign course or spontaneous regression. CASE: A case of juvenile xanthogranuloma was located in the upper lip of a newborn male. CONCLUSION: Juvenile xanthogranuloma has characteristic cytologic features that may allow recognition in fine needle aspiration cytology smears.

Intraductal papillary-mucinous tumors: an entity which is infrequent and difficult to diagnose.

BACKGROUND/AIMS: Intraductal papillary-mucinous tumor of the pancreas is currently considered to be a tumor which is an entity of its own, different from classic pancreatic ductal carcinoma. It is basically characterized by slow growth and low malignancy potential, as well as by the production of mucin. The aim of this study is to contribute to world literature some clarification of its natural history, clinical presentation, the most useful diagnostic tests, methods of detection of stromal invasion and handling of treatment. METHODOLOGY: Of 297 pancreatectomies undertaken at the "12 de Octubre" hospital between May 1985 and January 1998, only 1 case of Intraductal papillary-mucinous tumor was found. We have revised 127 cases published in 10 series over the last 10 years. We also contribute a review of our own case. RESULTS: These tumors, which are very infrequent, produce non-specific symptoms, with long latency periods from the first symptom up to stromal invasion. Endoscopic retrograde cholangiopancreatography showed alterations in 100% of cases where this was undertaken. Tumor-related mortality was zero amongst patients with non-invasive tumor who underwent surgery. None of the cases published presented upper gastrointestinal hemorrhage. This indicated the correct surgery and led us to our diagnosis. CONCLUSIONS: We confirm the low frequency and difficulty of diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography, the difficulty of early detection of stromal invasion, and the high survival rate in cases where resection is done before this occurs. Early diagnosis and treatment is therefore of utmost importance.

[The therapeutic use of pulmonary surfactant in neonatal hyaline membrane disease]. / Uso terapéutico del surfactante pulmonar en la enfermedad de membrana hialina neonatal.

Preliminary report of our experience with the therapeutic use of pulmonary surfactant in newborn infants of less than 30 weeks gestation with hyaline membrane disease. The use of pulmonary surfactant was held under the "rescue" modality, with up to 36 hours of postnatal life. The blood gas changes are described and the assisted ventilation progress, as well as the general response on the clinical condition of each case. Discussion in centered in the risk of use and in the criteria for prescribing the therapeutic pulmonary surfactant. It is concluded that meeting the recommended requirements for its use, the pulmonary surfactant is a therapeutic alternative in the treatment of hyaline membrane disease in newborn infants of less than 33 weeks gestation, being different the immediate ventilatory response in terms of therapeutic control, with one or other forms of pulmonary exogenous surfactant, without differences in the final result.