Herida crónica digital: ¿quiste epidermoide, osteomielitis o ambos? Presentación de dos casos clínicos y revisión de la literatura / Chronic digital wound: epidermoid cyst, osteomyelitis or both? Presentation of two clinical cases and review of the literature

Resumen: Introducción: ante una herida crónica a nivel digital se plantea el diagnóstico diferencial entre osteomielitis o tumor primario. No es infrecuente la coexistencia entre osteomielitis y quiste óseo epidermoide. Material y métodos: en este artículo describimos dos casos de quistes epidermoides en falange distal de la mano asociados a osteomielitis y se presenta una revisión de la literatura. Resultados: tanto la osteomielitis como el quiste óseo epidermoide se han relacionado con la presencia de un traumatismo previo en el sitio de la lesión, alteraciones ungueales y signos flogóticos crónicos, por lo que es importante llegar a un diagnóstico certero mediante un estudio anatomopatológico y realizar un buen desbridamiento quirúrgico que asegure la curación de ambas entidades. Conclusiones: el desbridamiento quirúrgico asociado a curetaje y relleno del defecto óseo con sustituto óseo por medio de antibiótico es una buena opción terapéutica en el tratamiento de estas lesiones.

Abstract: Introduction: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon. Material and methods: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented. Results: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities. Conclusions: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

[Chronic digital wound: epidermoid cyst, osteomyelitis or both? Presentation of two clinical cases and review of the literature]. / Herida crónica digital: ¿quiste epidermoide, osteomielitis o ambos? Presentación de dos casos clínicos y revisión de la literatura.

INTRODUCTION: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon. MATERIAL AND METHODS: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented. RESULTS: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities. CONCLUSIONS: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

INTRODUCCIÓN: ante una herida crónica a nivel digital se plantea el diagnóstico diferencial entre osteomielitis o tumor primario. No es infrecuente la coexistencia entre osteomielitis y quiste óseo epidermoide. MATERIAL Y MÉTODOS: en este artículo describimos dos casos de quistes epidermoides en falange distal de la mano asociados a osteomielitis y se presenta una revisión de la literatura. RESULTADOS: tanto la osteomielitis como el quiste óseo epidermoide se han relacionado con la presencia de un traumatismo previo en el sitio de la lesión, alteraciones ungueales y signos flogóticos crónicos, por lo que es importante llegar a un diagnóstico certero mediante un estudio anatomopatológico y realizar un buen desbridamiento quirúrgico que asegure la curación de ambas entidades. CONCLUSIONES: el desbridamiento quirúrgico asociado a curetaje y relleno del defecto óseo con sustituto óseo por medio de antibiótico es una buena opción terapéutica en el tratamiento de estas lesiones.

Distribution of genetic polymorphisms associated with hepatitis C virus (HCV) antiviral response in a multiethnic and admixed population.

The prevalence of genetic polymorphisms identified as predictors of therapeutic-induced hepatitis C virus (HCV) clearance differs among ethnic groups. However, there is a paucity of information about their prevalence in South American populations, whose genetic background is highly admixed. Hence, single-nucleotide polymorphisms rs12979860, rs1127354 and rs7270101 were characterized in 1350 healthy individuals, and ethnicity was assessed in 259 randomly selected samples. The frequency of rs12979860CC, associated to HCV treatment response, and rs1127354nonCC, related to protection against hemolytic anemia, were significantly higher among individuals with maternal and paternal Non-native American haplogroups (64.5% and 24.2%), intermediate among admixed samples (44.1% and 20.4%) and the lowest for individuals with Native American ancestry (30.4% and 6.5%). This is the first systematic study focused on analyzing HCV predictors of antiviral response and ethnicity in South American populations. The characterization of these variants is critical to evaluate the risk-benefit of antiviral treatment according to the patient ancestry in admixed populations.

Demographically corrected norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in monolingual Spanish speakers from the U.S.-Mexico border region.

The large number of primary Spanish speakers both in the United States and the world makes it imperative that appropriate neuropsychological assessment instruments be available to serve the needs of these populations. In this article we describe the norming process for Spanish speakers from the U.S.-Mexico border region on the Brief Visuospatial Memory Test-revised and the Hopkins Verbal Learning Test-revised. We computed the rates of impairment that would be obtained by applying the original published norms for these tests to raw scores from the normative sample, and found substantial overestimates compared to expected rates. As expected, these overestimates were most salient at the lowest levels of education, given the under-representation of poorly educated subjects in the original normative samples. Results suggest that demographically corrected norms derived from healthy Spanish-speaking adults with a broad range of education, are less likely to result in diagnostic errors. At minimum, demographic corrections for the tests in question should include the influence of literacy or education, in addition to the traditional adjustments for age. Because the age range of our sample was limited, the norms presented should not be applied to elderly populations.

Neuropsychological comparisons of Spanish-speaking participants from the U.S.-Mexico border region versus Spain.

Two samples of participants from the U.S.-Mexico Borderland (N = 185) versus Spain (N = 205) were compared on 16 Spanish-language neuropsychological measures. In most measures the two samples obtained similar results. There were some significant main effects of place of birth and some significant interactions between education and place of birth. Differences between the samples diminished with increasing levels of education. Within the Borderland sample, percent of life span spent in the U.S. and bilingual status were correlated with performance in some tests. Increased percent of life span spent in the U.S. was negatively correlated with performance on a Spanish word-generation task, and positively correlated with performance on the Wisconsin Card Sorting Test. Bilingual Borderland participants performed significantly better than monolingual speakers in learning a list of words. We suggest that the most likely causes for the observed interaction effects are documented regional differences in early SES-related nutrition, medical care, quality of educational experiences, and general socioeconomic conditions.

Neuropsychology with Spanish speakers: language use and proficiency issues for test development.

The practice of neuropsychological assessment with Spanish speakers is hampered by language inadequacy in test translations and adaptations. The authors advance some ideas on how such testing materials have made their way into our field and suggest some ways to minimize such problems in the future.

Long-term prognosis in surgically treated intracranial aneurysms. Part 1: Mortality.

A series of 265 consecutive cases of intracranial aneurysm were reviewed to assess mortality and its causes. Preoperative and postoperative factors were considered in isolation and in combination. The mortality rate was 20%. Postoperative generalized vasospasm was found to be the major cause of mortality. Advanced age, hypertension, and a poor neurological state at operation were associated with poor results. The study emphasizes the importance of considering variables in combination rather than singly in the assessment of prognosis.

Long-term prognosis in surgically treated intracranial aneurysms. Part 2: Morbidity.

An evaluation of long-term results following aneurysm surgery is presented. Five different outcome measures are used in a population of 204 survivors followed for a minimum of 18 months and a maximum of 5 1/2 years. The findings show that 1) results vary dependeing on the outcome measure used, and 2) outcome can be predicted with a considerable degree of accuracy using preoperative and early postoperative variables. The most important predictive factors were postoperative vasospasm, age, systemic blood pressure on admission, and preoperative neurological status. The results are compared with a control group.

Surgical mortality in an aneurysm population: effects of age, blood pressure and preoperative neurological state.

The mortality of 256 patients surgically treated for ruptured intracranial aneurysms was assessed with regard to age, systemic blood pressure on admission and preoperative neurological state. Increasing age, hypertension, and a poor neurological state (both singly and in combination) were found to influence surgical results dramatically. It is suggested that preoperative treatment of hypertension, and delay of operation in those patients aged over 50 years or hypertensive, as well as waiting for the neurological state to improve prior to operation, may lead to better results.

Measuring the duration of post traumatic amnesia.

A simple quantitative test is described for measuring the duration of post-traumatic amnesia. It was used in a study of 336 patients with closed head injury; and the results matched closely the independent estimates of experienced neurosurgeons. A systematic procedure of this kind is clinically useful in its sensitivity to fluctuations or deterioration in the patient's mental state. It could also be used with advantage in multi-centre research by providing a standard criterion for the assessment of post-traumatic amnesia.

Recovery curves in a visual search task.

A visual search task was administered to eighteen neurosurgical patients and fourteen control subjects on four occasions over a period of six months. Improvement occurred during the first five postoperative weeks but there was evidence of persistent impairment when patient performance was compared to control performance - the comparison makes use of a simple mathematical model.