Brain MRI features of postdural puncture headache.

BACKGROUND: Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary intracranial hypotension syndrome (IHS).The aim of this study was to document the radiological findings specific to PDPH with brain MRI and to determine whether these findings differed from those described in the third edition of the International Headache Society's International Classification of Headache Disorders (ICHD-3). METHODS: Thirty patients who were diagnosed with PDPH based on the ICHD-3 clinical criteria were enrolled in the study and signed the informed consent form approved by our hospital ethics committee. Their symptoms were recorded and they underwent brain MRI before and after the administration of a gadolinium-based contrast agent within 48-72 hours after the onset of their orthostatic headache. RESULTS: All patients with PDPH presented with MRI features of pachymeningeal enhancement. The thickness of the pachymeningeal enhancement varied from 0.6 mm to 4.1 mm, with a mean of 1.6 mm+0.8.No cases of brain sagging were observed. 4 of the 30 patients presented with intracranial subdural fluid collections, 7 presented with pneumocephalus and 7 pituitary gland enlargement. CONCLUSIONS: The radiological characteristics of IHS and PDPH are most likely the result of compensatory mechanisms in response to decreased cerebrospinal fluid pressure. The acute nature of PDPH probably causes its radiological MRI characteristics to differ from those of IHS, given that no brain sagging could be demonstrated.

Bromhidrosis por trimetilaminuria. Dificultades en su diagnóstico y tratamiento / Bromhidrosis caused by trimethylaminuria. Difficulties in its diagnosis and treatment

La trimetilaminuria es una causa de bromhidrosis, que hay que tener en cuenta en niños prepúberes con un desarrollo normal. Su relación con la ingesta, sobre todo de pescado marino, nos hará sospechar su existencia, que deberemos confirmar mediante el análisis de la excreción urinaria de trimetilamina y el estudio genético. Presentamos cuatro casos de trimetilaminuria donde se analizan y discuten las fórmulas más empleadas para valorar una excreción urinaria aumentada de trimetilamina, su correlación con la gravedad del cuadro y con el rendimiento de las pruebas genéticas. Por último, se describen los tratamientos empleados y se realiza una propuesta de tratamiento, basada en las recomendaciones dietéticas y en el asesoramiento a los padres para un mejor conocimiento y manejo de la enfermedad (AU)

Trimethylaminuria is a cause of bromhidrosis to be considered in pre-pubertal children, with normal development. Its relation with the ingestion, especially of marine fish, will make us suspect its existence that we will have to confirm by means of the analysis of the urinary excretion of trimetilamine and the genetic study. We present four cases of trimethylaminuria where the most used formulas to assess increased urinary excretion of trimethylamine are analysed and discussed, as well as their correlation with the severity of the disease and with the performance of genetic tests. Finally, the used treatments are described, and a treatment proposal is made, based on dietary recommendations and advices to parents for a better understanding and management of the disease (AU)

Video-Assisted Thoracic Surgical Repair of the Airway.

We communicate the first reported application of video-assisted thoracic surgery for early repair of a postintubation tracheal laceration. The patient was a 60-year-old man. After an initial unsuccessful approach with conservative measures, surgical repair was indicated. The patient underwent 2-port video-assisted thoracic surgery for direct tracheal repair using a 3-0 resorbable monofilament running suture and two reinforcing X-stitches. Bronchoscopic control after 2 and 4 weeks showed complete restoration of the airway, with no complication.

Aphorisms and short phrases as pieces of knowledge in the pedagogical framework of the andalusian school of public health.

BACKGROUND: Bearing in mind the philosophical pedagogical significance of short phrases for the training of researchers in the health care ambit, we hence have studied the aphorisms and striking phrases expressed during the epidemiology course at the Andalusian School of Public Health. METHODS: Belonging to the qualitative type and applied through the establishment of a multidisciplinary focus group made up of ten post-graduated students, where one of them acted as a moderator. The collection of information lasted four months. Information was classified in two ways: Firstly, aphorisms and short phrases with a pedagogical impact; and secondly, data with statistical, epidemiological, epistemological, pragmatic, or heuristic component, and for scientific diffusion. It was decided to perform a triangulation that included a descriptive presentation and a basic categorical analysis. The two teachers with a highest interpretative load have been identified . RESULTS: A total of 127 elements, regarded as of interest by the focus group, were collected. Forty-four of them (34.6%) were aphorisms, and 83 were short phrases with a pedagogical load (65.3%). Most of all them were classified as statistical elements (35.4%) followed by epistemological (21.3%) and epidemiological (15.7%) elements. There was no tendency towards aphorisms or short phrases (P > 0.05) among the teachers with more informative representation. CONCLUSION: There has been a tilt in the contents towards the statistical area to the detriment of the epidemiological one. Concept maps have visualized classifications. This sort of qualitative analysis helps the researcher review contents acquired during his/her training process.

Percentiles de riesgo coronario: una nueva forma de adaptar las escalas de riesgo. Estudio ERVPA / Coronary risk percentiles: a new method to adapt risk functions. ERVPA study

Introducción. Existen diversas ecuaciones de cálculo de riesgo cardiovascular y adaptaciones a nuestro medio para evitar la valoración del riesgo exagerada o defectuosa. Se proponen los percentiles de riesgo como una nueva forma de adaptar las escalas de riesgo coronario. Material y método. Estudio transversal de prevalencia de factores de riesgo cardiovascular en Palencia (ERVPA: estudio de riesgo vascular en Palencia). Se han valorado las variables necesarias para calcular el riesgo coronario de 514 sujetos de 20 a 79 años de la población general, estudiados en los centros de salud de Palencia. Se ha calculado el riesgo coronario según las ecuaciones originales del estudio de Framingham y las adaptaciones de los estudios REGICOR y DORICA. Se han calculado los percentiles con las ecuaciones y el coeficiente de correlación de Spearman para cada par de ecuaciones y los coeficientes kappa de concordancia. Resultados. Las ecuaciones originales han ofrecido los riesgos más elevados. Los resultados con las ecuaciones del estudio REGICOR han sido los más bajos. Si se comparan los percentiles, las 2 ecuaciones ofrecen exactamente los mismos percentiles para cada sujeto. El coeficiente de correlación ordinal entre cualquier par de ecuaciones es 1. Calculados los percentiles, es posible extrapolar el riesgo de un sujeto joven a la edad de 60 años o a cualquier otra edad, según su percentil. Conclusiones. La adopción de los percentiles de riesgo como método de valoración del riesgo cardiovascular permite la adaptación local de cualquier ecuación de riesgo. Los percentiles permiten extrapolar el riesgo absoluto (AU)

Introduction. There are several scales or equations for calculating cardiovascular risk that can be adapted to a particular population to try to avoid over, or under-estimation of risk. We propose risk percentiles as a new method of adapting coronary risk scoring systems to our population. Material and method. A cross sectional study of the prevalence of cardiovascular risk factors in the province of Palencia in Spain (ERVPA: Cardiovascular Risk Study in Palencia) was conducted. The variables used to calculate coronary risk were evaluated in 514 subjects aged 20-79 years old from the general population in health centers in Palencia. Coronary risk was measured with the Framingham-Wilson, REGICOR and DORICA equations. Percentiles were calculated and compared with every couple of equations and Spearman's correlation coefficient and kappa agreement coefficient were calculated. Results. The highest scores were found using the Framingham equation and the lowest scores were found with the REGICOR equation. On comparing the percentiles, the concordance between equations was absolute. The ordinal correlation coefficient was 1 between any two equations. Calculation of the percentiles allows coronary risk in young subjects to be extrapolated to the age of 60 years or to any other age. Conclusions. Adopting risk percentiles as a method of coronary risk evaluation enables any risk equation to be adapted to a particular area. Risk percentiles allow us to extrapolate absolute risk for any age (AU)