Trombectomía mecánica en un ictus isquémico debido a embolia cerebral cálcica / Mechanical thrombectomy during ischaemic stroke due to a calcified cerebral embolism

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[Validation of supra-aortic trunks ultrasound in the diagnosis of atherosclerotic disease of the internal carotid artery. Comparison of the results with angiography]. / Validación del estudio ultrasonológico de troncos supraaórticos en el diagnóstico de la enfermedad aterosclerótica de la arteria carótida interna. Comparación de los resultados con los de angiografía.

INTRODUCTION: Arteriosclerosis of the extra-cranial arteries is believed to be responsible for almost one-third of all ischaemic strokes. The sound diagnosis of the degree of stenosis is essential in deciding the best therapeutic strategy. Although cerebral angiography is considered the reference technique, ultrasound study (UST) is a more readily available, non-invasive and well-established procedure for quantifying carotid stenosis. However, on being a dependent exploratory technique, it is recommended that each laboratory validates its results against angiography. OBJECTIVES: To establish the validity of the neuro-ultrasound study in our laboratory for use in the diagnosis of extracranial atheromatous disease, and determine its capacity to quantify the degree of stenosis in the internal carotid artery. MATERIAL AND METHODS: A retrospective study of patients with extracranial carotid atheromatous disease, in whom the diagnostic process was carried out with carotid ultrasound as well as supra-aortic trunk digital-subtraction angiography. RESULTS: A total of 254 carotids were evaluated and the degree of stenosis being classified into > 50%, 70-99% and 100%. The UST for the first group had a sensitivity (Se) of 97%, a specificity (Sp) of 90%, a positive predictive value (PPV) of 94.6% and a negative predictive value (NPV) of 94.2%. The second group had an Se of 96.4%, Sp 93%; PPV 94.4% and NPV 95.4%. The respective values for carotid occlusion were, 85%, 96.8%, 80% and 97.8%. CONCLUSIONS: Our data validates the ability of UST performed in our Laboratory to diagnose the degree of carotid stenosis.

Validación del estudio ultrasonológico de troncos supraaórticos en el diagnóstico de la enfermedad aterosclerótica de la arteria carótida interna. Comparación de los resultados con los de angiografía / Validation of supra-aortic trunks ultrasound in the diagnosis of atherosclerotic disease of the internal carotid artery. Comparison of the results with angiography

Introducción: Se considera que la arteriosclerosis de las arterias extracraneales causa casi un tercio de los ictus isquémicos. El diagnóstico certero del grado de estenosis es fundamental para indicar la mejor estrategia terapéutica. Si bien la angiografía cerebral se considera la técnica de referencia, el estudio ultrasonográfico (EUS) es un procedimiento más disponible, no invasivo y bien establecido en la cuantificación de la estenosis carotídea. Sin embargo, al ser una técnica dependiente del explorador, se recomienda que cada laboratorio valide sus resultados frente a la angiografía. Objetivos: Establecer, en nuestro laboratorio, la validez del estudio neurosonológico en el diagnóstico de la enfermedad ateromatosa extracraneal y determinar su capacidad para cuantificar el grado de estenosis de la arteria carótida interna. Material y métodos: Estudio retrospectivo de los pacientes con enfermedad ateromatosa carotídea extracraneal en cuyo proceso diagnóstico se realizó tanto ultrasonografía carotídea como angiografía por sustracción digital de troncos supraaórticos. Resultados: Se evaluaron 254 carótidas clasificando el grado de estenosis en > 50%, 70-99% y 100%. Para el primer grupo el EUS obtuvo una sensibilidad del 97%, una especificidad del 90%, un valor predictivo positivo (VPP) del 94,6% y un VP negativo (VPN) del 94,2%. En el segundo grupo, se obtuvo: sensibilidad, 96,4%; especificidad, 93%; VPP, 94,4%, y VPN, 95,4%. Para la oclusión carotídea los valores respectivos fueron del 85, el 96,8, el 80 y el 97,8%. Conclusiones: Nuestros datos validan la capacidad del EUS realizado en nuestro laboratorio para el diagnóstico del grado de estenosis carotídea (AU)

Introduction: Arteriosclerosis of the extra-cranial arteries is believed to be responsible for almost one-third of all ischaemic strokes. The sound diagnosis of the degree of stenosis is essential in deciding the best therapeutic strategy. Although cerebral angiography is considered the reference technique, ultrasound study (UST) is a more readily available, non-invasive and well-established procedure for quantifying carotid stenosis. However, on being a dependent exploratory technique, it is recommended that each laboratory validates its results against angiography. Objetives: To establish the validity of the neuro-ultrasound study in our laboratory for use in the diagnosis of extracranial atheromatous disease, and determine its capacity to quantify the degree of stenosis in the internal carotid artery. Material and methods: A retrospective study of patients with extracranial carotid atheromatous disease, in whom the diagnostic process was carried out with carotid ultrasound as well as supra-aortic trunk digital-subtraction angiography. Results: A total of 254 carotids were evaluated and the degree of stenosis being classified into > 50%, 70-99% and 100%. The UST for the first group had a sensitivity (Se) of 97%, a specificity (Sp) of 90%, a positive predictive value (PPV) of 94.6% and a negative predictive value (NPV) of 94.2%. The second group had an Se of 96.4%, Sp 93%; PPV 94.4% and NPV 95.4%. The respective values for carotid occlusion were, 85%, 96.8%, 80% and 97.8%. Conclusions: Our data validates the ability of UST performed in our Laboratory to diagnose the degree of carotid stenosis (AU)

Unilateral rhinorrhea and nasal obstruction in an adult.

BACKGROUND: choanal atresia is an uncommon malformation, consisting of congenital blockage of one of both choanae. Symptomatology varies according to the type of atresia and the age of the patient. The bilateral, or complete, form presents in newborns as respiratory distress while unilateral, or incomplete, forms present in older children or adults. CASE REPORT: a 16-year-old girl presented with a lifelong history of right-sided nasal blockage and unilateral watery rhinorrhea. The rhinorrhea increased when the patient bent her head forward. Treatment with antihistamines and topical nasal corticosteroid sprays produced little improvement. The patient's previous medical history was unremarkable except for the expulsion of a coagulated mass through the right nostril a few days after birth, and event that provoked her symptoms. Physical examination was normal except for excoriation of the right external nasal margin. Anterior rhinoscopy revealed watery rhinorrhea, erythematous mucosa in the right nasal cavity and deviated nasal septum. No nasal masses or polyps were found. Physical examination confirmed the absence of ventilation in the right nasal airway and nasal endoscopy indicated right choanal obstruction. DIAGNOSTIC TEST: skin prick tests with aeroallergens were positive for grass pollen and negative for all other allergens tested (mites, moulds, latex, and epithelia). Total IgE was normal (9 IU/ml). No eosinophilia was detected in the nasal secretion specimen. The results of laboratory tests including complete blood count and differential, erythrocyte sedimentation rate, and biochemical parameters were normal. The glucose level in nasal secretion was 4.6 mg/dl. X-rays of the paranasal sinuses and cavum showed no anomalies. Axial fine-cut computed tomography scans (3 3 mm) revealed choanal obstruction with bony and membranous components. CONCLUSIONS: a diagnosis of congenital choanal atresia should be considered in cases of unilateral blockage and rhinorrhea. Nasal endoscopy and computed tomography scans are essential to establish diagnosis.

Unilateral rhinorrhea and nasal obstruction in an adult

Background: choanal atresia is an uncommon malformation, consisting of congenital blockage of one of both choanae. Symptomatology varies according to the type of atresia and the age of the patient. The bilateral, or complete, form presents in newborns as respiratory distress while unilateral, or incomplete, forms present in older children or adults. Case report: a 16-year-old girl presented with a lifelong history of right-sided nasal blockage and unilateral watery rhinorrhea. The rhinorrhea increased when the patient bent her head forward. Treatment with antihistamines and topical nasal corticosteroid sprays produced little improvement. The patient's previous medical history was unremarkable except for the expulsion of a coagulated mass through the right nostril a few days after birth, and event that provoked her symptoms. Physical examination was normal except for excoriation of the right external nasal margin. Anterior rhinoscopy revealed watery rhinorrhea, erythematous mucosa in the right nasal cavity and deviated nasal septum. No nasal masses or polyps were found. Physical examination confirmed the absense of ventilation in the right nasal airway and nasal endoscopy indicated right choanal obstruction. Diagnostic test: skin prick tests with aeroallergens were positive for grass pollen and negative for all other allergens tested (mites, moulds, latex, and epithelia). Total IgE was normal (9 IU/ml). No eosinophilia was detected in the nasal secretion specimen. The results of laboratory tests including complete blood count and differential, erythrocyte sedimentation rate, and biochemical parameters were normal. The glucose level in nasal secretion was 4.6 mg/dl. X-rays of the paranasal sinuses and cavum showed no anomalies. Axial fine-cut computed tomography scans (3 ¥ 3 mm) revealed choanal obstruction with bony and membranous components. Conclusions: a diagnosis of congenital choanal atresia should be considered in cases of unilateral blockage and rhinorrhea. Nasal endoscopy and computed tomography scans are essential to establish diagnosis (AU)

Introducción: la atresia de coanas es una malformación infrecuente que consiste en una obstrucción congénita de una o ambas coanas. La sintomatología varía según el tipo de atresia y la edad del paciente. La forma bilateral completa se manifiesta en el recién nacido con un distrés respiratorio, mientras que las formas unilaterales o incompletas pueden diagnosticarse en niños más mayores o adultos.Caso clínico: mujer de 16 años de edad, enviada para estudio por presentar una historia de larga evolución de obstrucción nasal derecha y rinorrea acuosa unilateral. La rinorrea aumentaba al inclinar la cabeza hacia delante. Poca mejoría a pesar de tratamiento con antihistamínicos y corticoides tópicos. No refería antecedentes personales de interés salvo la expulsión de un coágulo a través de la fosa nasal derecha pocos días después del nacimiento a raíz del cual comenzaron los síntomas. La exploración clínica era normal salvo excoriación del vestíbulo nasal derecho.La rinoscopia anterior mostraba rinorrea acuosa, mucosa nasal eritematosa en la fosa nasal derecha y desviación del tabique nasal. No se observaron masas ni pólipos. El examen clínico permitió confirmar la usencia de ventilación en la fosa nasal derecha y la exploración mediante endoscopia nasal reveló la obstrucción de la coana derecha.Pruebas diagnósticas: los tests cutáneos con neumoalergenos inhalantes fueron positivos para pólenes de gramíneas y negativos para el resto de los alergenos testados (ácaros, hongos, epitelios y látex). IgE total normal (9 UI/ml). Eosinofilia nasal negativa. Hemograma, VSG y parámetros bioquímicos normales. Cifras de glucosa en la secreción nasal 4,6 mg/dl (normal). Rx de senos paranasales y cavum sin hallazgos. TAC de senos paranasales de cortes finos (3 3) demuestra la obstrucción de la coana derecha que presenta un componente óseo y membranoso.Conclusiones: el diagnóstico de la atresia congénita de coanas unilateral debe ser considerado en los casos de obstrucción nasal y rinorrea unilaterales. La endoscopia nasal y la TAC de senos paranasales son fundamentales para el diagnóstico (AU)

[Spontaneous rupture of hydrocele: an unusual complication]. / Rotura espontánea de hidrocele: una complicación inusual.

Description of a case report of a male patient with a long standing pressure hydrocele that underwent spontaneous rupture while doing farm work although there was no previous trauma. The clinical signs were minimal scrotal discomfort, disappearance of turgescence and late ecchymosis and localized edema in penis and scrotum.

[Bilaterally synchronous mixed germ cell testicular tumor]. / Tumor testicular de células germinales mixto de aparición bilateral sincrónico.

OBJECTIVE: To report an uncommon case of bilateral synchronous mixed testicular germ cell tumor. METHODS: A young male had consulted at our urological services for a unilateral enlarged testis. A testicular tumor was suspected; scrotal US was performed, testicular tumor markers were determined and complementary studies to determine tumor extension were performed. RESULTS: The US findings suggested a chronic inflammatory condition with bilateral diffuse infiltration, tuberculosis was discarded and bilateral testicular tumor was suspected, which was confirmed by bilateral intraoperative biopsy. A bilateral radical orchidectomy was performed. Adjuvant chemotherapy with cisplatin, VP-16 and bleomycin was administered after bilateral radical orchidectomy due to the attending risk factors for tumor recurrence. The patient is disease-free one year postoperatively. CONCLUSIONS: Bilateral synchronous testicular germ cell tumors are rare. Scrotal US is a simple, noninvasive and efficient diagnostic imaging method; however, it does not provide pathognomonic images that could indicate the histological nature of the tumor.

[Abdomino-scrotal hydrocele, an unusual disease, review of the literature, and report of a new case]. / Hidrocele abdomino-escrotal, una rara patologia, revisión de literatura y aportación de un nuevo caso.

Abdominal-scrotal hydrocele is an uncommon lesion, most specially during childhood. It is an entity, though, that should be included in the differential diagnosis of abdominal masses in children, and also considered as a likely cause of ureterohydronephrosis. Diagnosis is arrived at through ultrasound, CAT and occasional excretory urography. Radical surgical excision using inguinal access is the recommended approach, but sometimes the inguinoabdominal or pure abdominal approaches can be performed. Following surgical ablation the cure is complete, and includes remission of the ureterohydronephrosis when present. This paper reviews the literature, presents one case and discusses both the diagnostic possibilities and therapeutic alternatives.