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High Grade tumor vs stroke. Utility of PET and MRI corregistration 高级别肿瘤vs中风。PET和MRI配准的应用
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.cc01
M. Cabrera-Martín, P. R. Fernández, M. Navas, P. Pérez-Segura, M. Y. Fuertes, J. B. Albacar, J. A. C. Sánchez, L. O. Medina, J. C. Delgado
Sometimes, the clinical presentation of a brain tumour mimics that of stroke or viceversa. In these cases it is useful to evaluate follow-up with MR. The coregistration of PET and MR images improves the diagnostic performance of both techniques. In the area of interest, FDG uptake of any degree, with reference to the adjacent brain tissue uptake, should be considered suggestive of tumor if it corresponds to brain injury in MR, even when the FDG uptake is equal to or lower than that of the normal cerebral cortex. We present a case in which coregistration of images from both techniques contributed to the differential diagnosis of stroke and high-grade glioma, whole-body PET/CT ruled out metastatic etiology, and the results led to surgery.
有时,脑瘤的临床表现与中风或反之亦然。在这些情况下,评估MR的随访是有用的。PET和MR图像的配准提高了这两种技术的诊断性能。在感兴趣的区域,任何程度的FDG摄取,参考邻近的脑组织摄取,如果它对应于MR中的脑损伤,即使FDG摄取等于或低于正常大脑皮层的摄取,也应被视为提示肿瘤。我们提出了一个病例,在该病例中,两种技术的图像配准有助于中风和高级别胶质瘤的鉴别诊断,全身PET/CT排除了转移性病因,结果导致了手术。
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引用次数: 0
An unusual case of acute abdomen: bilateral ovarian veins thrombophlebitis 一例罕见的急腹症:双侧卵巢静脉血栓性静脉炎
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.cc02
A. Oprişan, M. Solana
Postabortion ovarian vein septic thrombophlebitis is a very rare variety with high complication rates and it should be considered as a differential diagnosis for febrile abdominal pain syndrome in the post-abortion period. The contrast-enhanced CT or MRI have the highest sensitivity and specificity to diagnose the ovarian veins thrombi. The treatment it consists in a combination of anticoagulation therapy and antibiotics. In case that anticoagulation is contraindicated it´s recommended placing an inferior vena cava filter.
流产后卵巢静脉感染性血栓性静脉炎是一种非常罕见的疾病,并发症发生率很高,应将其视为流产后发热性腹痛综合征的鉴别诊断。增强CT或MRI对卵巢静脉血栓的诊断具有最高的敏感性和特异性。它的治疗包括抗凝治疗和抗生素的组合。如果抗凝是禁忌症,建议放置下腔静脉滤器。
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引用次数: 0
Treating anemia in chronic kidney disease. ¿An ongoing revolution? 慢性肾脏疾病贫血的治疗。一场正在进行的革命?
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.ed01
A. Ortiz, M. Sánchez-Niño
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引用次数: 0
Allergology and COVID19 pandemic 过敏症和covid - 19大流行
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.rev03
Tomás Chivato Pérez
The COVID19 pandemic produced by SARSCOV2 has changed and impacted all areas of Medicine, including Allergology. Professionals and patients have seen how this virus has affected the daily routine at different levels. In this article three relevant aspects will be reviewed. First, the epidemiological, clinical, diagnostic, therapeutic and preventive measures differences between rhinitis due to SARSCOV2 infection and allergic rhinitis due to pollen sensitization are described. Second, the impact of new technologies and digital transformation on the daily routine of Allergology at the care and teaching level is reviewed.Finally, an update of the vaccines against SARSCOV2 is carried out from the point of view of safety for the allergic patient.
严重急性呼吸系统综合征冠状病毒2型引起的新冠肺炎疫情已经改变并影响了医学的所有领域,包括过敏学。专业人员和患者已经看到这种病毒如何在不同程度上影响日常生活。本文将对三个相关方面进行综述。首先,介绍了由严重急性呼吸系统综合征2型感染引起的鼻炎和由花粉致敏引起的过敏性鼻炎在流行病学、临床、诊断、治疗和预防措施方面的差异。其次,回顾了新技术和数字化转型对护理和教学层面过敏学日常生活的影响。最后,从过敏患者的安全性角度对针对严重急性呼吸系统综合征2型的疫苗进行了更新。
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引用次数: 1
Bariatric and metabolic surgery during the COVID-19 crisis: strategies facing two pandemics 新冠肺炎危机期间的减肥和代谢手术:应对两种流行病的策略
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.rev05
Bibiana Lasses Martínez, Jana Dziakova, Antonio Torres
Since its first appearance in Wuhan at the end of 2019, the SARS-CoV-2 pandemic has brought serious repercussions worldwide, Spain being among the most affected countries. This health crisis resulted in the cancellation of surgeries pertaining to both malignant and benign pathologies, including bariatric and metabolic surgery. Patients with morbid obesity, besides their delay in surgical interventions, are at high risk of contracting severe COVID-19. For this reason, once the epidemiological situation has improved in our hospitals and the necessary resources become again available, this surgical activity should be progressively restarted. The goal of this paper is to review the published literature regarding the main perioperative recommendations concerning safe bariatric and metabolic surgery during the COVID-19 pandemic.
自2019年底首次出现在武汉以来,严重急性呼吸系统综合征冠状病毒2型疫情在全球范围内造成了严重影响,西班牙是受影响最严重的国家之一。这场健康危机导致恶性和良性疾病的手术被取消,包括减肥和代谢手术。病态肥胖患者除了延迟手术干预外,感染严重新冠肺炎的风险也很高。因此,一旦我们医院的流行病学状况有所改善,必要的资源再次可用,这种手术活动就应该逐步重启。本文的目的是回顾有关新冠肺炎大流行期间安全减肥和代谢手术的主要围手术期建议的已发表文献。
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引用次数: 0
Update of pancreas transplantation. Experience of the Hospital Doce de Octubre 胰腺移植的最新情况。10月12日医院的经验
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.rev06
C. Jiménez, E. Moreno, A. Manrique, A. Marcacuzco, Ó. Caso, I. Justo
Pancreas transplantation (PT) is considered as the only treatment that can convert a diabetic patient in a euglucemic state without the use of insulin or oral antidiabetic drugs. From 1996 to the end of 2016, more than 50,000 PT were performed in USA, and in Spain were performed 1.730 PT during the last 10 years. In this review we will perform an update of PT considering the introduction of several advances in the last years, adding our accumulated experience from the beginning of our program in the year 1995.The first PT was carried out in the Hospital of the University of Minnesota, and from that date several significant improvements have been introduced along the time due to advances in surgical technique in pancreas donors and recipients, perioperative management of patients, and introduction of more potent immunosuppressors able to reduce the rejection rate under 20%. Although PT is a therapy associated with a higher morbidity (pancreas graft thrombosis, systemic and intraabdominal infections, anastomotic leakages, etc.), currently most of the PT teams have obtained a rate of 93% of patient survival at 3-years, and between 78% and 83% of graft survival at 3-years.Additionally, the normal pancreas graft function is associated with an improvement of quality of life and most of complications related to diabetes, without the necessity to treat with antidiabetics drugs or insulin.
胰腺移植(PT)被认为是唯一可以在不使用胰岛素或口服降糖药的情况下将糖尿病患者转化为血糖状态的治疗方法。从1996年到2016年底,在美国进行了超过50,000例PT,在西班牙,在过去的10年里进行了1.730例PT。在这次审查中,我们将考虑到过去几年的一些进展,加上我们从1995年开始的项目积累的经验,对PT进行更新。第一例PT是在明尼苏达大学医院进行的,从那时起,由于胰腺供体和受体的手术技术的进步,患者的围手术期管理,以及引入更有效的免疫抑制剂将排异率降低到20%以下,一些重大的改进已经被引入。虽然PT是一种发病率较高的治疗方法(胰腺移植物血栓形成、全身和腹腔感染、吻合口漏等),但目前大多数PT团队的3年生存率为93%,3年移植物生存率为78% - 83%。此外,正常的胰腺移植功能与生活质量的改善和大多数与糖尿病相关的并发症有关,无需使用抗糖尿病药物或胰岛素治疗。
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引用次数: 0
Anti-CD19 CAR-T cell theraphy in pediatric patients with relapsed/refractory acute lymphoblastic leukemia. Experience at Hospital Infantil Universitario Niño Jesús 抗cd19 CAR-T细胞治疗小儿复发/难治性急性淋巴细胞白血病在医院婴儿大学Niño Jesús工作经验
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.rev07
B. Vergara, B. Herrero, L. Madero
Acute lymphoblastic leukemia (ALL) continues to be the most frequent neoplasm in childhood, with a 5-year survival rate ranging from 78 to 91%. The increase in the survival rate in the last 40 years has been 30 to 80%, with no comparable improvement in the case of relapsed or refractory ALL. It is for this very reason that there is currently research into innovative treatments, such as CAR-T cell therapy. This treatment involves the ex vivo genetic modification of the patient’s own T cells, enhancing their specificity and cytotoxicity against antigens present in the majority of blasts, such as CD19. In clinical trials carried out worldwide, positive results have been obtained in patients with refractory or relapsed ALL treated with CAR-T 19 therapy, with disease-free survival at one year in up to 50% of patients, and overall survival at one year of 76%. The first published report in Spain with respect to this treatment reproduces the results obtained in clinical trials. The results were reported in HNJS in 2020 involving 8 patients treated with CAR-T 19. Complete remission was observed in 87.5% of patients one month after infusion followed by an overall survival of 75% at the time of analysis (7.6 months mean follow-up duration across all the patients). To date, the most frequent side effects described with the use of this therapy in the short term are cytokine release syndrome and neurotoxicity. This innovative therapy, therefore, represents a paradigm shift in the survival of pediatric patients with relapsed or refractory ALL. Further studies and evidence of its effectiveness and the long-term follow-up of patients treated with this therapy are still needed, but the results to date are encouraging.
急性淋巴细胞白血病(ALL)仍然是儿童最常见的肿瘤,其5年生存率从78%到91%不等。在过去的40年里,生存率增加了30%到80%,而在复发或难治性ALL的病例中没有类似的改善。正是由于这个原因,目前正在研究诸如CAR-T细胞疗法等创新疗法。这种治疗包括对患者自身的T细胞进行体外遗传修饰,增强其特异性和细胞毒性,以对抗大多数细胞中存在的抗原,如CD19。在世界范围内进行的临床试验中,CAR-T 19治疗的难治性或复发性ALL患者获得了积极的结果,高达50%的患者一年无病生存率,一年总生存率为76%。在西班牙发表的关于这种治疗的第一份报告再现了在临床试验中获得的结果。该结果于2020年在HNJS上报道,涉及8名接受CAR-T 19治疗的患者。87.5%的患者在输注后1个月完全缓解,分析时总生存率为75%(所有患者的平均随访时间为7.6个月)。迄今为止,短期内使用这种疗法最常见的副作用是细胞因子释放综合征和神经毒性。因此,这种创新疗法代表了复发或难治性ALL患儿生存率的范式转变。该疗法的有效性和对患者的长期随访仍需进一步的研究和证据,但迄今为止的结果令人鼓舞。
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引用次数: 0
Determinants of selective neuronal vulnerability in Parkinson's disease 帕金森病中选择性神经元易感性的决定因素
Pub Date : 2021-08-31 DOI: 10.32440/ar.2021.138.02.rev01
N. L. Rey, J. Blesa, J. Obeso
Parkinson´s disease (PD) is the second most frequent neurodegenerative disease affecting the population older than 65 years old. This incidence will greatly increase due to the progressive aging of the population in the coming years. PD diagnosis is made when there is a 50-60% dopaminergic cell loss in the substantia nigra pars compacta (SNc) and the striatal dopamine loss reaches around 70-80%, coinciding with the onset of classical parkinsonian motor signs: tremor, rigidity and slowness of movement. A significant proportion of patients present non-motor symptoms, generally associated to disfunction of non-dopaminergic regions, which can appear before, around or after diagnosis (10-15 years). Therefore, in PD both dopaminergic and non-dopaminergic groups are affected, but the motor manifestations are the main reason for consultation and causes the greatest disability for many years.There is a large heterogeneity within dopaminergic neural groups in terms of morphology, metabolism, molecular pattern, protein accumulation, inflammation levels, protein expression, etc. In this review we discuss different factors that could explain the special vulnerability of certain dopaminergic neurons in the SNc. Knowledge on the mechanisms and underlying factors of this selective vulnerability of the ventrolateral dopaminergic neuros of the SNc is essential for developing neuromodulatory and/or neuroprotective therapies, leading in turn to halt or modify the neurodegenerative process in PD.
帕金森病(PD)是影响65岁以上人群的第二大常见神经退行性疾病。由于未来几年人口的逐步老龄化,这一发病率将大大增加。当黑质致密部(SNc)多巴胺能细胞丢失50-60%,纹状体多巴胺丢失约70-80%,并伴有典型帕金森运动体征:震颤、僵硬和运动缓慢时,诊断为PD。相当比例的患者出现非运动症状,通常与非多巴胺能区功能障碍有关,可出现在诊断前、前后或之后(10-15年)。因此,PD中多巴胺能组和非多巴胺能组均受影响,但运动表现是就诊的主要原因,也是多年来造成最大残疾的原因。多巴胺能神经群在形态、代谢、分子模式、蛋白质积累、炎症水平、蛋白质表达等方面存在很大的异质性。在这篇综述中,我们讨论了可能解释SNc中某些多巴胺能神经元特殊易感性的不同因素。了解SNc腹外侧多巴胺能神经的这种选择性易感性的机制和潜在因素对于开发神经调节和/或神经保护疗法至关重要,从而导致PD的神经退行性过程停止或改变。
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引用次数: 0
Splenectomy and sepsis 脾切除术与败血症
Pub Date : 2021-04-30 DOI: 10.32440/AR.2021.138.01.REV04
J. Montes
There is general consensus in accepting that splenic surgery may be associated with significant morbidity and mortality that appears due to an interrelation of circumstances. The most common complications of splenectomy are infectious nature with an incidence of up to 40%; among infections, in 5-7% of cases may occur the so-called overwhelming postsplenectomy infection, motivated by the loss of immune functions of the spleen.In this paper, together with a basic description of the structure and functions of the spleen, the most relevant aspects and preventive measures of this serious postsplenectomy sequel are exposed.
人们普遍认为,脾脏手术可能与严重的发病率和死亡率有关,这是由于环境的相互关系。脾切除术最常见的并发症是感染性并发症,发生率高达40%;在感染中,5-7%的病例可能发生所谓的脾切除术后压倒性感染,其动机是脾脏免疫功能的丧失。在本文中,结合对脾脏结构和功能的基本描述,揭示了这种严重的脾后切除后遗症的最相关方面和预防措施。
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引用次数: 0
Juan Valverde de Amusco in the medicine of the spanish Renaissance Juan Valverde de Amusco与西班牙文艺复兴时期的医学
Pub Date : 2021-04-30 DOI: 10.32440/AR.2021.138.01.REV09
R. Burgos Lázaro, N. Burgos Frías, JA Blázquez González, F. Gilsanz Rodríguez, G. Téllez de Peralta, JA Rodríguez Montes
The anatomical works of Juan Valverde de Amusco History of the composition of the human body, and De humani corporis fabrica by Andrés Vesalio were the two main references for anatomists and surgeons during the Renaissance.Valverde’s work is the result of the study on the corpse. It is composed of seven books and follows a descending architectural order, from head to toe, in the same way as Vesalius’ text. Valverde was accused of plagiarizing Vesalio’s De humani corporis fabrica, the criticisms came from northern Europe -Vesalio was born in Brussels-, the arguments used were lacking in solidity and more interested than with a scientific basis.It is paradoxical to see that Valverde’s work was better known in Europe than in Spain, despite being written in Spanish. The promulgation of the Real Pragmatic by Felipe II that prohibited studying in foreign universities contributed to this ignorance.
Juan Valverde de Amusco的解剖作品《人体组成史》和Andrés Vesalio的《人体组织》是文艺复兴时期解剖学家和外科医生的两本主要参考书。巴尔韦德的作品是对尸体研究的结果。它由七本书组成,遵循从头到脚的递减建筑顺序,与维萨留斯的文本相同。Valverde被指控抄袭了Vesalio的《De humani corporatis fabrica》,批评来自北欧——Vesalio出生于布鲁塞尔——所使用的论点缺乏坚实性,比科学依据更感兴趣。尽管巴尔韦德的作品是用西班牙语写成的,但在欧洲比在西班牙更为人所知,这是自相矛盾的。费利佩二世颁布的《真正的实用主义》禁止在外国大学学习,这也助长了这种无知。
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引用次数: 0
期刊
Anales de la Real Academia Nacional de Medicina
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