Técnicas de Neuroimagenología en la Cuantificación de la Neuroplasticidad en Pacientes con Enfermedad Vascular Cerebral / Neuroimaging Techniques for Neuroplasticity Quantification in Stroke Patients

RESUMEN Las técnicas de neuroimagenología otorgan información relevante del estado funcional y anatómico del cerebro humano. Esta información es particularmente importante cuando existe una lesión cerebral causada por alguna patología, tal como la enfermedad vascular cerebral (EVC). En pacientes afectados por esta enfermedad, se ha determinado que la neuroplasticidad es el mecanismo principal de recuperación de la función motora perdida. Debido a la alta prevalencia de la EVC a nivel mundial y especialmente en países en vías de desarrollo, es necesario continuar investigando los mecanismos de recuperación involucrados en esta patología. La resonancia magnética funcional (RMF) y la imagenología por tensor de difusión (ITD) son dos de las técnicas de neuroimagenología más utilizadas con este fin. La RMF permite analizar la actividad neuronal generada al ejecutar tareas de movimiento, mientras que la ITD proporciona información estructural de la anatomía cerebral. En esta revisión narrativa, se presentan diversos estudios que han utilizado estas técnicas de neuroimagenología en la cuantificación de los cambios de neuroplasticidad en pacientes con EVC tras participar en algún programa de neurorrehabilitación. Comprender mejor estos cambios de neuroplasticidad permitiría diseñar esquemas de rehabilitación que proporcionen un mayor beneficio a los pacientes con EVC.

ABSTRACT Neuroimaging techniques provide relevant information of the functional and anatomical status of the human brain. This information is of particular importance when a pathology, like stroke, produces a brain injury. In stroke patients, it has been determined that neuroplasticity is the primary recovery mechanism of the lost motor function. Due to worldwide high prevalence, especially in developing countries, it is necessary to continue the research of the recovery mechanisms involved in this pathology. To this end, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) are two of the most used neuroimaging techniques. In stroke patients, fMRI allows the analysis of the neural activity produced by the execution of motor tasks, whereas DTI provides structural information of the brain anatomy. In this narrative review, multiple studies that employ these neuroimaging techniques for quantification of neuroplasticity changes in stroke patients after undergoing a neurorehabilitation program are presented. Better understanding of these neuroplasticity changes would allow researchers to design and provide more beneficial rehabilitation schemes to stroke patients.

The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity.

Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS: 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS: Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION: Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.

The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity / La elevada carga clínica de la osteoartritis erosiva de mano está asociada con hallazgos clínicos, dolor y severidad radiográfica

Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. Methods: 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen–Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. Results: Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. Conclusion: Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.(AU)

Existen estudios sobre el impacto clínico de la osteoartritis erosiva de mano (OAEM) en términos de dolor y función articular. Pocos estudios han evaluado la asociación de las características clínicas del paciente con OAEM con la presencia de enfermedad radiográfica más grave. El objetivo fue evaluar las características clínicas y radiográficas en OAEM comparándolas con osteoartritis de mano no erosiva (OANEM), examinar el dolor y deterioro funcional entre OAEM y OANEM y correlacionar el deterioro funcional con los hallazgos clínicos, dolor y severidad radiográfica. Métodos: Se incluyeron 62 pacientes con OAEM y 52 con OANEM. El dolor se evaluó con Escala Visual Análoga (EVA) y el subdominio de dolor de AUSCAN. La capacidad funcional se evaluó con Health Assessment Questionaire (HAQ) relativo a la función de la mano y AUSCAN. Las radiografías se evaluaron con la escala de Kallman y las erosiones subcondrales con el método Verbruggen-Veys. Se utilizó t de Student para comparar datos cuantitativos, χ2 para variables categóricas, pruebas de Pearson o Spearman para evaluar la correlación. Resultados: Los pacientes con OAEM presentaron niveles significativamente más altos de dolor en EVA y el subdominio de dolor de AUSCAN (p<0,01) y de deterioro funcional por HAQ y Índice de manos de Osteoartritis Australiano/Canadiense (AUSCAN) (p<0,01). En OAEM, VAS correlacionó positivamente con las escalas HAQ y AUSCAN (rho=0,68 y 0,77). En OANEM, VAS se correlacionó positiva y fuertemente con HAQ y AUSCAN (rho=0,84 y 0,89). Los nódulos, puntuación de Kallman y erosiones mostraron una correlación positiva pero débil con HAQ y AUSCAN en ambos grupos. Conclusión: Los participantes con osteoartritis erosiva y no erosiva de mano presentaron deterioro funcional, pero el subtipo erosivo presentó mayor carga clínica y daño articular. La mayor carga clínica fue atribuida al dolor.(AU)

The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity.

Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS: 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS: Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION: Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.

Gota tofácea en la columna lumbar causando radiculopatía / Tophaceous gout in the lumbar spine causing radiculopathy

Los depósitos de tofos en columna lumbar son una condición rara. Presentamos el caso de un varón de 44 años con dolor lumbar y radiculopatía. Las radiografías mostraron espondilolistesis lítica de L5, la resonancia magnética (RM) imagen hipointensa en T1 y heterogénea en T2 localizado en el espacio interespinoso L4-L5 y en articulación facetaria izquierda que invade el neuroforamen izquierdo. El ultrasonido de rodilla izquierda (RI) evidenció «doble contorno» del cóndilo femoral medial. Se realizó laminectomía descompresiva y artrodesis de L5-S1, el estudio histopatológico reportó material amorfo con reacción de células gigantes multinucleadas de tipo a cuerpo extraño

Tophaceous deposits in lumbar spine is considered a rare condition. We report the case of a 44-year-old patient with low back pain and radiculopathy. Radiographs revealed lytic spondylolisthesis in L5. Magnetic resonance imaging showed hypointense signal on T1 and a heterogeneous signal on T2 located in the L4-L5 interspinous space and in the left facet joint that invades left neuroforamen. The left knee ultrasound showed «double contour» of the medial femoral condyle. Decompressive laminectomy with arthrodesis at the level of L5-S1 was performed. The histological examination revealed amorphous material with a foreign body giant cell reaction

Tophaceous Gout in the Lumbar Spine Causing Radiculopathy. / Gota tofácea en la columna lumbar causando radiculopatía.

Tophaceous deposits in lumbar spine is considered a rare condition. We report the case of a 44-year-old patient with low back pain and radiculopathy. Radiographs revealed lytic spondylolisthesis in L5. Magnetic resonance imaging showed hypointense signal on T1 and a heterogeneous signal on T2 located in the L4-L5 interspinous space and in the left facet joint that invades left neuroforamen. The left knee ultrasound showed «double contour¼ of the medial femoral condyle. Decompressive laminectomy with arthrodesis at the level of L5-S1 was performed. The histological examination revealed amorphous material with a foreign body giant cell reaction.

Displasia progresiva seudorreumatoide. Desorden genético raro que simula artritis idiopática juvenil / Pseudorheumatoid dysplasia. A rare genetic disorder simulating juvenile idiopathic arthritis

Adolescente con displasia progresiva seudorreumatoide, desorden autosómico recesivo que puede ser diagnosticado inicialmente como artritis idiopática juvenil(AU)

We present the case of a teenage patient with progressive pseudorheumatoid dysplasia, an autosomal recessive disorder that may be initially misdiagnosed as juvenile idiopathic arthritis(AU)

Pseudorheumatoid dysplasia. A rare genetic disorder simulating juvenile idiopathic arthritis.

We present the case of a teenage patient with progressive pseudorheumatoid dysplasia, an autosomal recessive disorder that may be initially misdiagnosed as juvenile idiopathic arthritis.

[Arthritis: an unusual and anticipatory clinical presentation of pediatric acute lymphoblastic leukemia. A case report]. / Artritis: presentación clínica infrecuente y anticipatoriade la leucemia aguda linfoblástica en niños. Informe de un caso.

BACKGROUND: Acute lymphoblastic leukemia initially shows osteoarticular manifestations. However, it is rare that it shows juvenile idiopathic arthritis (JIA) symptoms. CLINICAL CASE: A child with acute lymphoblastic leukemia initially misdiagnosed with malignant neoplasia and septic arthritis, and later on with juvenile idiopathic arthritis. The child had persistent articular pain and swelling despite treatment. Six months later, a full blood count revealed leukopenia and neutropenia with lymphocytosis. A bone marrow aspirate confirmed pre-B acute lymphoblastic leukemia with hypodyploidia. CONCLUSION: This case initially showed typical signs of arthritis, and a diagnosis of acute lymphoblastic leukemia was ruled out, since the those clinical features and hematologic alterations characterizing this hematologic neoplasia.

Pan-American League of Associations for Rheumatology (PANLAR) recommendations and guidelines for musculoskeletal ultrasound training in the Americas for rheumatologists.

OBJECTIVE: To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. METHODS: A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. RESULTS: General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. CONCLUSION: A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

Hamartoma fibroso de la infancia: informe de un caso / Fibrous hamartoma of infancy: case report

Introducción: El hamartoma fibroso de la infancia es una proliferación benigna de los tejidos blandos, de presentación infrecuente; 91 % de los casos ocurre durante el primer año de edad y afecta más frecuentemente al sexo masculino. Se caracteriza por ser una lesión subcutánea de morfología característica con patrón de crecimiento organoide trifásico. Caso clínico: Lactante masculino de seis meses de edad, con tumor en la región plantar medial del pie izquierdo, el cual fue resecado completamente. En el estudio histopatológico se informó como hamartoma fibroso de la infancia. Conclusiones: Puede localizarse en cualquier sitio anatómico, aunque 5 a 10 % afecta las extremidades inferiores existen pocos casos informados en el pie. En biopsias pequeñas es importante su diagnóstico diferencial con otras lesiones fibroadiposas para el adecuado tratamiento. La resección quirúrgica amplia con márgenes libres de lesión confiere un buen pronóstico a los pacientes.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is an infrequent benign proliferation of the soft tissues. Ninety one percent of cases occur during the first year of life. FHI is characterized as a subcutaneous lesion with characteristic morphology with a triphasic organoid growth pattern. CLINICAL CASE: We present the case of a 6-month-old male infant with a tumor in the medial plantar region of the left foot, which was completely withered. Histopathological study reported a fibrous hamartoma of infancy. CONCLUSIONS: Fibrous hamartoma of infancy most frequently affects males. It may be localized at any anatomic site, although 5-10% of cases affect the lower limbs. Few cases are reported in the foot. This is a lesion with a characteristic morphological pattern; however, in small biopsies, its differential diagnosis is important with other fibroadipose lesions for appropriate treatment. Ample surgical resection with lesion-free borders confers a good prognosis for these patients.

Fibrous hamartoma of infancy. Case report.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is an infrequent benign proliferation of the soft tissues. Ninety one percent of cases occur during the first year of life. FHI is characterized as a subcutaneous lesion with characteristic morphology with a triphasic organoid growth pattern. CLINICAL CASE: We present the case of a 6-month-old male infant with a tumor in the medial plantar region of the left foot, which was completely withered. Histopathological study reported a fibrous hamartoma of infancy. CONCLUSIONS: Fibrous hamartoma of infancy most frequently affects males. It may be localized at any anatomic site, although 5-10% of cases affect the lower limbs. Few cases are reported in the foot. This is a lesion with a characteristic morphological pattern; however, in small biopsies, its differential diagnosis is important with other fibroadipose lesions for appropriate treatment. Ample surgical resection with lesion-free borders confers a good prognosis for these patients.

[Tendon sheath lipoma associated with quadriceps tendon rupture. Case report]. / Lipoma de la vaina tendinosa asociado a ruptura de tendón del cuadríceps. Informe de un caso.

BACKGROUND: Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE: We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS: We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.

Lipoma de la vaina tendinosa asociado a ruptura de tendón del cuadríceps: informe de un caso / Tendon sheath lipoma associated with quadriceps tendon rupture: case report

BACKGROUND: Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE: We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS: We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.