Hidrosálpinx en una niña prepuberal: un caso excepcional en la edad pediátrica / Hidrosalpinx in girl in pubertal age: An exceptional case in pediatric age

El hidrosálpinx consiste en una acumulación de líquido claro o seroso en la trompa de Falopio, debido a una obstrucción distal y a una dilatación de la misma. Es una entidad bien descrita, aunque infrecuente, sobre todo en mujeres sexualmente inactivas o prepúberes, puesto que la etiología principal del cuadro suele ser la enfermedad inflamatoria pélvica. Presentamos el caso de una niña de 11 años púber, en estadio II de Tanner, sin actividad sexual. En estas edades existen muy pocos casos descritos, y en la mayoría se encuentra una causa subyacente, aunque la patogenia es incierta. En el presente caso no encon-tramos ningún factor de riesgo para la aparición del hidrosálpinx, pero en revisiones de imagen posteriores, 3 meses después de la menarquia, se encontró un endometrioma. Lo excepcional del caso es precisamente la aparición de la malformación previa al endo-metrioma, si bien ambos procesos podrían estar condicionados por factores hormonales propios de la adolescencia

Hydrosalpinx consists of accumulation of clear or serous fluid in the fallopian tube, due to distal obstruction and dilatation of the same. It is a well-described but infrequent entity, especially in sexually inactive or prepubertal women, since the main etiology of the condition is usually pelvic inflammatory disease. We present the case of an 11-year-old pubertal girl (Tanner II) with no sexual activity. In these ages there are very few cases de-scribed and in all of them an underlying cause is found, although the pathogenesis is unclear. In our case, we did not find any risk factors for the appearance of hydrosalpinx, but in posterior image revisions, three months after menarche, an endometrioma was found, the exception being precisely the appearance of the malformation prior to the endometrioma, although both processes may be influenced by hormonal factors in adolescence

Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study.

BACKGROUND: Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS: A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS: Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION: The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.

Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal / Complementary role of magnetic resonance imaging in the study of the fetal urinary system

La patología urinaria es la anomalía que se detecta con mayor frecuencia en el estudio prenatal y representa del 30 al 50% del total de las anomalías estructurales en el nacimiento. Los trastornos más frecuentes son la dilatación del tracto urinario, las variantes del desarrollo, las enfermedades quísticas renales, la patología neoplásica renal y anomalías de la vejiga. Estas entidades pueden presentarse aisladas o asociadas a síndromes. Su evaluación se realiza con ecografía de forma rutinaria, y solo en aquellos casos en los que no sea concluyente se considera el estudio adicional con resonancia magnética (RM) fetal. Nuestro objetivo es exponer el potencial de la RM fetal como complemento a la ecografía en las enfermedades del sistema urinario fetal, analizando sus principales indicaciones y la información adicional que aporta en cada entidad, especialmente en la valoración de la funcionalidad renal mediante las secuencias de difusión (AU)

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences (AU)

Complementary role of magnetic resonance imaging in the study of the fetal urinary system.

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.

Obesity, metabolic syndrome and Mediterranean diet: Impact on depression outcome.

OBJECTIVE: Obesity, metabolic syndrome (MetS) and low adherence to Mediterranean diet are frequent in major depression patients and have been separately related with prognosis. The aim of this study is to analyse their predictive power on major depression outcome, at 6 and 12 months. METHODS: 273 Major depressive patients completed the Beck Depression Inventory for depressive symptoms and the 14-item Mediterranean diet adherence score. MetS was diagnosed according to the International Diabetes Federation (IDF). RESULTS: At the baseline Mediterranean diet adherence was inversely associated with depressive symptoms (p=0.007). Depression response was more likely in those patients with normal weight (p=0.006) and not MetS (p=0.013) but it was not associated with Mediterranean diet adherence (p=0.625). Those patients with MetS and obesity were less likely to improve symptoms of depression than patients with obesity but not MetS. CONCLUSIONS: Obesity and MetS, but not low adherence to the Mediterranean diet at baseline, predicted a poor outcome of depression at 12 months. Our study suggests that MetS is the key factor that impacts negatively in depression prognosis, rather than obesity or diet. If this finding is confirmed, clinicians should be aware about MetS diagnosis and treatment in overweight depressed patients, especially if outcome is not being satisfactory enough.

[New targets and new drugs in thoracic oncology]. / Nouvelles cibles et nouvelles molécules en oncologie thoracique.

A number of mechanisms that drive oncogenesis have been deciphered over the last 20 years. The main oncogenic factors in the field of thoracic oncology are mutations of EGFR, KRAS, and EML4-ALK translocation, which are most often reported in adenocarcinomas. However, new molecular targets have been highlighted recently including BRAF mutations, HER2 or PI3K, new translocations such as ROS1 or KIF5B-RET. Molecular abnormalities have also been identified in tumors other than adenocarcinoma (squamous and small cell carcinoma). Therapeutic strategies have been designed to inhibit these signaling pathways including monoclonal antibodies and tyrosine kinase inhibitors. Some of these molecules are now approved as therapies, others are currently undergoing testing in clinical trials. We here present a review of novel targeted agents for lung cancer.

Lifestyle change recommendations in major depression: Do they work?

BACKGROUND: Modifying some lifestyle factors can be useful in depression, at least as an adjuvant treatment. Combining different lifestyle interventions seems to be an adequate strategy to increase their antidepressant efficacy according with preliminary studies, but this issue has not been enough investigated. METHODS: The present study is a randomized, double-blinded, multicentre, two arm-parallel clinical trials, with a 12 month follow-up. The sample consisted of 273 Primary Care patients. Four combined hygienic-dietary written recommendations were given to the patients about diet, exercise, light exposure and sleep hygiene. RESULTS: Both active and control interventions were associated with improvement on BDI (Beck Depression Inventory) scores. However, there were not statistically significant differences (7.0 vs. 7.6; p=0.594). LIMITATIONS: We were unable to monitor whether patients carry out recommendations. Intervention could be too difficult to accomplish for depressed patients without enough support and supervision. CONCLUSIONS: Just giving written lifestyle recommendations are not enough for depressive patients to benefit from them, so perhaps lifestyle change recommendations work or do not work on Depression depending on how they are presented to patients and on monitoring systems of their implementation.

Tuberculosis espinal lumbosacra y craneocervical: un clásico imitador en dos localizaciones atípicas / Isolated spinal tuberculosis in the lumbosacral and cranio-cervical hinge regions: a classic copycat in two atypical regions

Two cases of spinal tuberculosis in atypical regions are presented; in the lumbosacral hinge and cranio-cervical regions respectively; focusing on the radiological appearance using Computed Tomography (CT) and Magnetic Resonance. With regard to these atypical presentations, the clinical history, epidemiology and radiology of spinal tuberculosis are reviewed.

Se presentan dos casos de tuberculosis espinal en localizaciones atípicas; la charnela lumbo-sacra y cráneo-cervical respectivamente; centrándonos en su aspecto radiológico por tomografía computarizada (TC) y resonancia magnética. A propósito de estas atípicas presentaciones se revisa la clínica, epidemiología y radiología de la tuberculosis en la columna vertebral.

Resonancia magnética de cuerpo entero en un caso de neuroblastoma abdominal oculto con síndrome opsoclonus-myoclonus / Whole-body magnetic resonance imaging in a patient with an occult abdominal neuroblastoma and opsoclonus-myoclonus syndrome

El síndrome opsoclonus-myoclonus es un trastorno neurológico raro. En la infancia su etiología es variable, aunque en un 40-80% de los casos se trata de una manifestación paraneoplásica, principalmente del neuroblastoma. Con un algoritmo diagnóstico controvertido en la búsqueda de un posible tumor primario, la resonancia magnética de cuerpo entero se vislumbra como una poderosa herramienta. Presentamos el caso de un varón de 2 años con manifestaciones de un síndrome opsoclonus-myoclonus al que se detectó un neuroblastoma retroperitoneal mediante esta técnica de imagen (AU)

Opsoclonus-myoclonus syndrome is a rare neurological disorder. In children, the etiology varies, although it is a paraneoplastic manifestation (mainly of neuroblastoma) in 40% to 80% of cases. Whole-body MRI promises to be a powerful tool in the search for a possible primary tumor in this condition for which the diagnostic algorithm is yet to be established. We present the case of a two-year-old boy with signs of opsoclonus-myoclonus syndrome in whom a retroperitoneal neuroblastoma was detected by whole-body MRI (AU)

Anestesia epidural continua en neonato: a propósito de un caso / Continuous epidural block in the neonate: Presentation a case

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[Whole-body magnetic resonance imaging in a patient with an occult abdominal neuroblastoma and opsoclonus-myoclonus syndrome]. / Resonancia magnética de cuerpo entero en un caso de neuroblastoma abdominal oculto con síndrome opsoclonus-myoclonus.

Opsoclonus-myoclonus syndrome is a rare neurological disorder. In children, the etiology varies, although it is a paraneoplastic manifestation (mainly of neuroblastoma) in 40% to 80% of cases. Whole-body MRI promises to be a powerful tool in the search for a possible primary tumor in this condition for which the diagnostic algorithm is yet to be established. We present the case of a two-year-old boy with signs of opsoclonus-myoclonus syndrome in whom a retroperitoneal neuroblastoma was detected by whole-body MRI.

Utilidad de la tomografía computarizada multidetector en la evaluación postoperatoria de cirugías de derivación urinaria / Usefulness of multidetector computed tomography in the postoperative evaluation of urinary diversion surgery

Las cirugías de derivación urinaria son procedimientos que cada vez son más frecuentes, ya que sus indicaciones no son sólo neoplásicas, siendo también útiles en el manejo de otras patologías. Debido a este incremento, no es infrecuente observar complicaciones secundarias, ya sean en el postoperatorio temprano (menos de 30 días después de la cirugía) o tardío (más de 30 días). Dentro de éstas tenemos alteraciones de la motilidad intestinal (íleo paralítico, obstrucción), fugas anastomóticas, colecciones líquidas (linfocele, urinoma, absceso), fístulas, herniación paraestomal, estenosis ureterales, litiasis y recurrencia tumoral. Dada la gran cantidad de técnicas quirúrgicas usadas en estos procedimientos, es importante conocer los cambios anatómicos resultantes, ocasionalmente de difícil valoración. La tomografía computarizada multidetector (TCMD) tiene gran utilidad en el estudio de estos pacientes, especialmente mediante las técnicas de reconstrucción multiplanar, representando adecuadamente las estructuras urinarias y extraurinarias afectadas, y sus relaciones con estructuras adyacentes, permitiendo identificarlas acertada y rápidamente.

Urinary diversion surgeries are procedures that are becoming more frequent, as their indications are not only neoplastic, being useful also in managing other diseases. Due to this increase, it is not uncommon to observe secondary complications, whether in the early postoperative period (less than 30 days after surgery) or later (more than 30 days). Within these are alterations in intestinal motility (paralytic ileus, blockage), anastomotic leaks, fluid collections (lymphocele, urinoma, abscess), fistulas, parastomal herniation, ureteral obstruction, urolithiasis and tumor recurrence. Given the large number of surgical techniques used in these procedures, it is important to know the resulting anatomical changes, occasionally difficult to evaluate. Multidetector computed tomography (MDCT) is of great use in the study of these patients, especially with multiplanar reconstruction techniques, adequately representing the affected urinary and extra-urinary structures, and their relationship to adjacent structures, enabling their accurate and quick identification.

Doppler ultrasonographic assessment of uterine arteries during normal canine puerperium.

The aim of this study was to describe Doppler ultrasonographic changes of uterine arteries during normal canine puerperium. Eight healthy, pure-bred bitches, were ultrasonographically assessed during the postpartum period on Days -3, 3, 10, 17, 24, 38, 52 and 80 (Day 0 defined as the day of parturition). Total horn diameters (TD) and endometrium thickness (E) were evaluated. Color Doppler was used to localize uterine arteries at both sides of the body and pulsed-wave Doppler was performed to obtain the waveforms. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured. Resistance index [(PSV-EDV)/PSV] was automatically calculated. Values of TD, E, PSV, EDV and RI were analyzed by repeated measures ANOVA followed by LSD test (SPSS 18.0; SPSS, Chicago, IL, USA). A correlation analysis was also carried out between RI and TD. A progressive decrease of TD (P<0.01) and E (P<0.01) was found in the course of the study. A gradual diminution of PSV (P<0.01) and EDV (P<0.01) and an increase of RI (P<0.01) were also found throughout the study period. The resistance index negatively correlated with TD (r=-0.46; P<0.01) and E (r=-0.44; P<0.01) while the ultrasonographic and vascular changes in this period are concurrent with regenerative changes in the glandular and epithelial structures of the uterus. It is concluded that uterine artery RI progressively increased during normal canine puerperium, associated to the two-dimensional ultrasonographic regression of the organ.

Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis

Objetivo. Valorar la utilidad de la biopsia selectiva del ganglio centinela (BGC) después de la quimioterapia neoadyuvante (QTN) en pacientes con cáncer de mama operable y axila positiva al diagnóstico. Material y métodos. Estudio prospectivo entre enero de 2008 y diciembre de 2012 en 52 pacientes, con una edad media de 50,7 años y con cáncer de mama infiltrante T1-3, N1, M0 (uno bilateral, 7 multifocales), tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en HER-2/neu positivas. El estatus axilar se estableció por la exploración física, la ecografía axilar y la punción ecoguiada de ganglios sospechosos. El día antes de la cirugía se inyectó periareolarmente 74-111 MBq de 99mTc-nanocoloide de albúmina. En todas se realizó una cirugía mamaria, una BGC y una linfadenectomía axilar. El GC se analizó por cortes de congelación, hematoxilina-eosina, inmunohistoquímica u OSNA. Resultados. Tamaño medio del tumor: 3,5 cm. Tipo histológico: 81,1% carcinoma ductal infiltrante. Respuesta completa al tumor primario: clínica 43,4%, patológica 41,5%. Ninguna de las pacientes presentó adenopatías axilares palpables después del tratamiento. Respuesta completa patológica axilar: 42,2%. El porcentaje de identificación del GC fue de 84,9%. En 6 de las 8 pacientes sin migración del nanocoloide la axila resultó positiva en el estudio anatomopatológico. En el 95,5% de los casos el GC determinó correctamente el estatus axilar. La tasa de falsos negativos fue de 8,3%. En el 68,2% de los casos el GC fue el único afectado de la axila. El número medio de GC identificados fue de 1,9 y el de ganglios axilares extirpados fue de 13,2. Conclusión. La BGC post-QTN es una técnica segura y factible en pacientes con cáncer de mama operable T1-3, N1 y axila clínicamente negativa después del tratamiento (AU)

Aim. To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). Material and methods. A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of 99mTc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). Results. Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. Conclusion. SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy (AU)

[Peripheral facial nerve palsy]. / La paralysie faciale périphérique.

Facial palsy can be defined as a decrease in function of the facial nerve, the primary motor nerve of the facial muscles. When the facial palsy is peripheral, it affects both the superior and inferior areas of the face as opposed to central palsies, which affect only the inferior portion. The main cause of peripheral facial palsies is Bell's palsy, which remains a diagnosis of exclusion. The prognosis is good in most cases. In cases with significant cosmetic sequelae, a variety of surgical procedures are available (such as hypoglossal-facial anastomosis, temporalis myoplasty and Tenzel external canthopexy) to rehabilitate facial aesthetics and function.

Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with operable breast cancer and positive axillary nodes at initial diagnosis.

AIM: To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS: A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). RESULTS: Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. CONCLUSION: SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.

Oval window niche height: quantitative evaluation with CT before stapes surgery for otosclerosis.

BACKGROUND AND PURPOSE: Stapes surgery for otosclerosis can be challenging when the oval window niche is narrow. We analyzed the reliability of CT to evaluate the height of the OWN and propose a quantitative criterion to distinguish normal and narrow OWNs. MATERIALS AND METHODS: Fifty-six patients were scheduled for primary stapes surgery and, with available preoperative CT scans, were prospectively enrolled in the study at a tertiary care hospital. OWN height was measured on coronal CT and qualitatively evaluated during surgery. CT findings and surgical observations were matched to determine the preoperative imaging criterion of a narrow OWN. RESULTS: OWN was found to be narrow during surgery in 8 of 56 patients (14%). On CT, mean OWN height measurement was 1.1 mm for the narrow group and 1.8 mm for the normal OWN surgical cases. The cutoff between normal and narrow OWN was computed at 1.3 mm by using discriminant analysis and at 1.4 mm with boxplot analysis. These CT cutoff values allowed a correct classification of "normal" and "narrow" OWN, compared with visual evaluation during surgery. CONCLUSIONS: Measurements of the OWN height provide an accurate and relevant evaluation of this region before otosclerosis surgery. A width below 1.4 mm should be considered at risk for technical difficulties during the stapes footplate approach.