[Progressive Brown-Sequard syndrome secondary to idiopathic spinal cord herniation: clinico-radiological and surgical correlations]. / Síndrome de Brown-Séquard progresivo secundario a hernia medular idiopática: correlación clinicorradiológica y quirúrgica.

INTRODUCTION: Idiopathic medullary herniation is an infrequent disease, which shows up in clinical form as a progressive mielopathy, most commonly known as the Brown-Sequard syndrome. Its anatomical base is a dural defect where a portion of anterior spinal cord gets progressively incarcerated. The MRI and myelo-CT scan show a bending of the spinal cord in the form of a «bell tent¼ towards the anterior dural sheath at the mid-dorsal portion mainly. CASE REPORT: A 37 year old male, who was diagnosed of idiopathic medullary herniation and surgically treated by our own developed technique, reporting its neuroradiological, anatomo-surgical and clinical correlation. CONCLUSION: Treatment should be individualized, as no standard surgical technique has been established up to the present.

TITLE: Síndrome de Brown-Séquard progresivo secundario a hernia medular idiopática: correlación clinicorradiológica y quirúrgica.Introducción. La hernia medular idiopática es una patología infrecuente que cursa clínicamente con una mielopatía progresiva, la mayoría de las ocasiones en forma de síndrome de Brown-Séquard. Su base anatómica es un defecto dural por el que se incarcera progresivamente una porción del cordón medular anterior. La resonancia magnética y la mielotomografía demuestran un acodamiento medular en «tienda de campaña¼ hacia la cara anterior del estuche dural, a nivel dorsal medio fundamentalmente. Caso clínico. Varón de 37 años, diagnosticado de hernia medular idiopática e intervenido quirúrgicamente mediante una técnica propia; se demuestra su correlación neurorradiológica, anatomoquirúrgica y evolutiva. Conclusión. El tratamiento debe ser individualizado, pues no existe una técnica quirúrgica universalmente establecida.

Costes indirectos asociados al glioblastoma. Experiencia en un centro / Indirect costs associated with glioblastoma: Experience at one hospital

Introducción: El glioblastoma es el tumor cerebral más frecuente. A pesar de los avances en su tratamiento, el pronóstico sigue siendo pobre, con una supervivencia media en torno a los 14 meses. Los costes directos, aquellos asociados al diagnóstico y el tratamiento de la enfermedad, han sido descritos ampliamente. Los costes indirectos, aquellos derivados de la pérdida de productividad debido a la enfermedad, han sido descritos en escasas ocasiones. Material y método: Realizamos un estudio retrospectivo, incluyendo a los pacientes diagnosticados entre el 1 de enero del 2010 y el 31 de diciembre del 2013 de glioblastoma en el Hospital Universitario Donostia. Recogimos datos demográficos, relativos al tratamiento ofertado y la supervivencia. Calculamos los costes indirectos a través del método del capital humano, obteniendo datos de sujetos comparables según sexo y edad, y de mortalidad de la población general a través del Instituto Nacional de Estadística. Los salarios pasados fueron actualizados a euros de 2015 según la tasa de inflación interanual y los salarios futuros fueron descontados en un 3,5% anual en forma de interés compuesto. Resultados: Revisamos a 99 pacientes, 46 mujeres (edad media 63,53 años) y 53 hombres (edad media 59,94 años). En 29 pacientes se realizó una biopsia y en los 70 restantes se realizó una cirugía resectiva. La supervivencia global media fue de 18,092 meses. Los costes indirectos totales fueron de 11.080.762 Euros (2015). El coste indirecto medio por paciente fue de 111.926 Euros (2015). Discusión: A pesar de que el glioblastoma es un tipo relativamente poco frecuente de tumor, que supone el 4% de todos los tipos de cáncer, su mal pronóstico y sus posibles secuelas generan una mortalidad y morbilidad desproporcionadamente altas. Esto se traduce en unos costes indirectos muy elevados. El clínico debe ser consciente del impacto del glioblastoma en la sociedad y los costes indirectos deben ser tenidos en cuenta en los estudios de coste-efectividad para conocer las consecuencias globales de esta enfermedad (AU)

Introduction: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. Material and method: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. Results: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was Euros11 080 762 (2015). Mean indirect cost per patient was Euros 111 926 (2015). Discussion: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease (AU)

Indirect costs associated with glioblastoma: Experience at one hospital. / Costes indirectos asociados al glioblastoma. Experiencia en un centro.

INTRODUCTION: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. MATERIAL AND METHOD: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. RESULTS: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). DISCUSSION: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease.

Metástasis de carcinoma escamoso de laringe en seno cavernoso. Presentación de un caso / Surgical management in metastatic squamous cell carcinoma of the larynx to the cavernous sinus. Case report

La afectación del seno cavernoso en el cáncer laríngeo supone la presencia de una enfermedad en estadio avanzado y de corta supervivencia. El objetivo del trabajo es presentar un caso de un paciente diagnosticado de carcinoma escamoso de laringe. Se realizó una revisión en las bases de datos Medline, DOYMA y Scielo con las palabras "metástasis en seno cavernoso". Encontramos publicados 10 casos de carcinoma escamoso de laringe con metástasis en seno cavernoso. La supervivencia media de los 10 casos publicados en la literatura fue 4,1 meses, en nuestro caso 9 meses. Los pacientes que recibieron radioterapia mejoraron sintomáticamente. El diagnóstico en algunos casos sólo se confirmó en la realización de una necropsia. En este tipo de lesiones, la cirugía se utiliza para diagnóstico más que como una herramienta terapéutica (AU)

The spread to the cavernous sinus in laryngeal cancer means the presence of a disseminated disease and short survival. The aim of this paper is to report a case of laryngeal squamous carcinoma of the larynx. A search was conducted in the databases of Medline and SciELO DOYMA using the words "cavernous sinus metastasis". We found 10 published cases of laryngeal squamous carcinoma with metastasis to the cavernous sinus. The average survival of the 10 cases reported in the literature was 4.1 months; in our case it was 9 months. Patients who received radiotherapy improved symptomatically. In some cases the diagnosis was confirmed only after necropsy. In this type of lesions, surgery is used for diagnosis rather than as a therapeutic tool (AU)

[Multiple extraneural metastasis of glioblastoma multiforme].

INTRODUCTION: Glioblastoma multiforme is the most frequent primary tumor in the brain. Despite improvements in its surgical, chemotherapy and radiotherapy treatment, prognosis remains poor. Extracranial metastases of glioblastoma are a rare complication in this disease. Its appearance has been described in lung, liver, bone or lymph nodes. CASE REPORT: We describe the case of a 20 year-old patient who complained of a subacute-onset headache. In the MRI an enhancing right temporal lesion was detected suggesting a high grade glioma as first diagnosis. Surgery was performed, obtaining a gross total resection of the lesion. Our patient underwent adjuvant radiotherapy and chemotherapy treatment, according to our hospital's protocol. Five months after initial surgery our patient complained of chest pain and a hacking cough. A thoracic-abdominal-pelvic CT scan was obtained, which showed bilateral lung infiltrates with pleural effusion, a pancreatic nodule and several vertebral lytic lesions. The lung lesions were biopsied. The pathologic diagnosis was metastatic glioblastoma multiforme. The patient died eight months after initial diagnosis. CONCLUSION: Extracranial metastases of glioblastoma remain a rare event although its incidence is increasing, probably due to the improvement in survival among these patients and better imaging techniques. The mechanisms for extracranial dissemination of glioblastoma are not entirely known, as several theories exist in this regard. Physicians must be aware of this complication and keep it in mind as a differential diagnosis to improve the quality of life of our patients.

Multiple extraneural metastasis of glioblastoma multiforme / Metástasis extraneurales múltiples de glioblastoma multiforme

Introduction: Glioblastoma multiforme is the most frequent primary tumor in the brain. Despite improvements in its surgical, chemotherapy and radiotherapy treatment, prognosis remains poor. Extracranial metastases of glioblastoma are a rare complication in this disease. Its appearance has been described in lung, liver, bone or lymph nodes. Case report: We describe the case of a 20 year-old patient who complained of a subacute-onset headache. In the MRI an enhancing right temporal lesion was detected suggesting a high grade glioma as first diagnosis. Surgery was performed, obtaining a gross total resection of the lesion. Our patient underwent adjuvant radiotherapy and chemotherapy treatment, according to our hospital’s protocol. Five months after initial surgery our patient complained of chest pain and a hacking cough. A thoracicabdominal-pelvic CT scan was obtained, which showed bilateral lung infiltrates with pleural effusion, a pancreatic nodule and several vertebral lytic lesions. The lung lesions were biopsied. The pathologic diagnosis was metastatic glioblastoma multiforme. The patient died eight months after initial diagnosis. Conclusion: Extracranial metastases of glioblastoma remain a rare event although its incidence is increasing, probably due to the improvement in survival among these patients and better imaging techniques. The mechanisms for extracranial dissemination of glioblastoma are not entirely known, as several theories exist in this regard. Physicians must be aware of this complication and keep it in mind as a differential diagnosis to improve the quality of life of our patients (AU)

Fundamento: Los glioblastomas multiformes son los tumores cerebrales primarios más frecuentes. A pesar de los avances en su tratamiento quirúrgico, quimioterápico y radioterápico su pronóstico sigue siendo pobre. Las metástasis extracraneales de glioblastoma multiforme suponen una rara complicación dentro del curso de la enfermedad y ha sido descrita su aparición en distintas localizaciones como pulmón, hígado, hueso o ganglios linfáticos. Caso clínico: Presentamos el caso de una paciente de 20 años que consultó por un cuadro de evolución subaguda. Se obtuvo una RMN cerebral que demostró la presencia de una lesión temporal derecha, que sugería un glioma de alto grado como primera posibilidad diagnóstica. Se intervino a la paciente, realizando una resección macroscópicamente completa de la lesión. Se administró tratamiento radioterápico y quimioterápico adyuvante, de acuerdo con el protocolo de nuestro centro. Cinco meses después de la cirugía la paciente consultó por dolor torácio y tos seca. Se realizó un TAC toraco-abdomino-pélvico, que mostró la presencia de infiltrados pulmonares bilaterales con derrame pleural asociado, un nódulo pancreático y varias lesiones vertebrales líticas. Las lesiones pulmonares fueron biopsiadas. El diagnóstico anatomopatológico fue de metástasis de glioblastoma multiforme. La paciente falleció ocho meses después del diagnóstico inicial. Conclusiones: Las metástasis extracraneales de glioblastoma multiforme son un suceso poco frecuente, aunque su incidencia está aumentando en posible relación con el aumento de la supervivencia de nuestros pacientes. La aparición de esta complicación se asocia a un estado terminal de la enfermedad. A pesar de su baja frecuencia se debe mantener un alto nivel de sospecha en su diagnóstico para poder mejorar la calidad de vida de estos pacientes (AU)

[Surgical management in metastatic squamous cell carcinoma of the larynx to the cavernous sinus. Case report]. / Metástasis de carcinoma escamoso de laringe en seno cavernoso. Presentación de un caso.

The spread to the cavernous sinus in laryngeal cancer means the presence of a disseminated disease and short survival. The aim of this paper is to report a case of laryngeal squamous carcinoma of the larynx. A search was conducted in the databases of Medline and SciELO DOYMA using the words "cavernous sinus metastasis". We found 10 published cases of laryngeal squamous carcinoma with metastasis to the cavernous sinus. The average survival of the 10 cases reported in the literature was 4.1 months; in our case it was 9 months. Patients who received radiotherapy improved symptomatically. In some cases the diagnosis was confirmed only after necropsy. In this type of lesions, surgery is used for diagnosis rather than as a therapeutic tool.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital.

OBJECTIVES: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. MATERIALS AND METHODS: We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. RESULTS: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097 €, sig<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality. CONCLUSIONS: We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital

Objectives. To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service.Materials and methods. We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed.Results. We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097€, sig.<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality.Conclusions. We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications can improve quality of care and reduce costs (AU)

Objetivos. Analizar la relación entre la presencia de infección nosocomial y el resultado clínico final, la duración de la estancia y el coste del episodio en los pacientes diagnosticados de tumoración cerebral en nuestro servicio.Material y método. Realizamos un estudio retrospectivo incluyendo los pacientes ingresados en el Servicio de Neurocirugía del Hospital Universitario de Cruces con diagnostico de tumoración cerebral en el periodo comprendido entre el 1-1-2007 y el 31-12 del 2007. Recogimos variables demográficas, los microorganismos responsables y la localización de las distintas infecciones, el tiempo de ingreso y los costes de los distintos procedimientos médicos y quirúrgicos realizados.Resultados. Recogimos 139 pacientes, que acumularon un total de 210 episodios. Encontramos la presencia de infecciones nosocomiales en 34 episodios (16,25%). La localización mas frecuente fue la respiratoria, seguida del tracto urinario y la infección de herida quirúrgica. Encontramos unas diferencias significativas en la situación funcional al alta (sig <0.01), el coste medio de los episodios (17097€, sig.<0.01) y en la estancia media (15.45 días, sig.<0.01). No encontramos diferencias significativas con respecto a la mortalidad.Conclusiones. Encontramos asociaciones significativas entre la presencia de infección nosocomial, un peor resultado clínico, un mayor coste y una mayor estancia. Los gérmenes responsables y localizaciones fueron similares a las series previamente publicadas. A pesar de que la variabilidad en el diseño de los estudios recogidos en la literatura dificulta la interpretación y comparación de los resultados, las medidas destinadas a la prevención de esta complicación permiten simultáneamente mejorar la asistencia prestada, asi como reducir los costes generados por la enfermedad (AU)

[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

[Foreign body in the maxillary sinus. Apropos of a case]. / Cuerpo extraño de seno maxilar. A propósito de un caso.

It is described the case of an inflammatory maxillary sinus process, with both torpid evolution and post-traumatic etiology. The surgery proved the existence of a foreign body lodged in the maxillary sinus.