Mesenquimoma fibrocartilaginoso de hueso: caso clínico.

Se presenta un caso clínico de un mesenquimoma fibrocartilaginoso a nivel de tibia proximal. Se trata de una rara entidad anatomopatológica descrita por Dahlin en 1984. La lesión puede ser localmente agresiva y el tratamiento debe ser una resección tumoral amplia. Realizamos una revisión de la bibliografía, señalando las principales características de esta entidad poco frecuente.We report a case of fibrocartilaginous mesenchy- moma of bone located in proximal tibia. This is a rare bone tumor which was described in 1984 by Dahlin. The lesion may be locally aggresive and the treatment must be a wide resec- tion. The pertinent medical literature related to this uncom- mon entity has been reviewed

Necrosis del miembro superior tras administración de drogas vía arterial: caso clínico

La administración de drogas por vía parenteral puede causar complicaciones de variada intensidad que pueden llegar a comprometer la viabilidad no sólo de la extremidad, sino también la vida del paciente. Los mejores resultados terapéuticos se lograrían con un diagnóstico y tratamiento precoces. La amputación del miembro debe reservarse para necrosis establecidas y limitadas del mismo.The injection of drugs can cause complications of varying intensity which can compromise the viability of not only the limb but also the patient's life. The best therapeutic results can be achieved with early diagnosis and treatment. Amputation should be reserved for a demarcated gangrene

La opinión de los usuarios como oportunidad de mejora en atención primaria

ObjetivosDeterminar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes.DiseñoEvaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones.EmplazamientoCAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud.Participantes y contextoUsuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord.IntervencionesReorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas.Mediciones principalesVariables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa.ResultadosEntre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente.ConclusionesLa opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población.ObjectivesTo determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions.DesignResults evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed.LocationRambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute.Participants and contextUsers/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service.InterventionsReorganization of the family doctors’ agendas and reduction of bureaucratic tasks in the physicians’ offices.Principal measurementsRespondents sociodemographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment.ResultsAmong reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits.ConclusionsPatient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs

Hiperplasia angiolinfoide con eosinofilia: a propósito de una localización atípica en músculo trapecio

La hiperplasia angiolinfoide con eosinofilia es una patología poco frecuente de presentación clínica inespecífica que lleva a que rara vez se diagnostique antes del estudio histológico. Habitualmente afecta a piel y tejido celular subcutáneo siendo rara la localización extracutánea. Presentamos un caso clínico de una tumoración en una mujer de 46 años localizada a nivel del músculo trapecio; y revisamos las características histopatológicas y de tratamiento de esta patología.Angiolymphoid hyperplasia with eosinophilia is an uncommon condition with non-specific clinical symptoms that needs a histological study to have the diagnosis. Usually this lesion occurs in the skin and the subcutaneous tissue, with extracutaneous affection being rare. We describe a tumour affecting the trapezius muscle in a 40- year-old woman; and we review the histopathologic findings and the treatment of this pathology

Osteosarcoma perióstico: caso clínico

El osteosarcoma perióstico es un sarcoma raro que asienta en la superficie del hueso. Aunque algunos autores lo incluyen en los osteosarcomas yuxtacorticales sus peculiaridades clínicas, radiológicas y anatomopatológicas entre ellos que llevan a diferencias en el tratamiento y pronóstico le otorgan personalidad propia. Presentamos un caso clínico de osteosarcoma perióstico en un varón de 18 años, a nivel de fémur. Se realiza una revisión de la bibliografía, señalando las principales características de esta entidad.Periosteal osteosarcoma is a rare malignant neoplasm located on bone surface. Although some authors include it among juxtacortical osteosarcoma, its clinical feature, imaging studies findings and histologic patterns which lead to differences in the treatment and prognostic, give to it a peculiar identity. We report a case of an 18 years old man who had this tumour in his femur. We do a review of literature

Rotura del núcleo de polietileno en cotilo no cementado

La rotura del componente de polietileno de los cotilos en la prótesis total de cadera, es una complicación raramente descrita, sobre todo en artroplastias no cementadas. Presentamos un caso de rotura del polietileno en una prótesis total de cadera no cementada, revisando los 15 casos previamente publicados. Nuestro propósito es alertar sobre la posibilidad de esta infrecuente complicación.Fracture of the polyethylene liner of uncemented acetabular components is rarely mentioned in the literature. One case of fracture of the polyethylene liner is uncementeed his arthroplasty is described and we review 15 cases previously reported. The purpose of the report is to alert about this rare complication

Late Variscan, Permo-Carboniferous, Al-K plutonism in the South Portuguese Zone : El Crispinejo cordierite-bearing granite

The El Crispinejo granite forms part of a small, but distinctive late intrusive suite of cordierite-bearing peraluminous granites in the South Portuguese Zone (SPZ). This granite has the best outcrop relationships of the suite. It cross-cuts different members of the Sierra Norte Batholith of the SPZ and the Carboniferous Volcano-Sedimentary Complex of the Iberian Pyrite Belt, producing contact metamorphism. This late pluton has a high K content which results in a contrasting geophysical response (K-Th-U) with respect to the surrounding trondhjemitic granitoids of the TTG suite of the Sierra Norte Batholith. A concordant monazite-zircon U-Pb ID-TIMS age of 300.5 +0.5/-1.5Ma demonstrates Permo-Carboniferous age for this late Variscan magmatic event. The granite is associated with a series of ore showings (F-Pb-Zn and Sn-W) which are completely different from the nearby, massive sulphide and manganese ore deposits of the Iberian Pyrite Belt, indicating the unique character of this intrusion

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

Producción CientíficaSurgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. METHODS:In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscal-bearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. RESULTS:Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. CONCLUSIONS:We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinio

Clinical value of next generation sequencing of plasma cell-free DNA in gastrointestinal stromal tumors

[Background] Gastrointestinal stromal tumor (GIST) initiation and evolution is commonly framed by KIT/PDGFRA oncogenic activation, and in later stages by the polyclonal expansion of resistant subpopulations harboring KIT secondary mutations after the onset of imatinib resistance. Thus, circulating tumor (ct)DNA determination is expected to be an informative non-invasive dynamic biomarker in GIST patients.[Methods] We performed amplicon-based next-generation sequencing (NGS) across 60 clinically relevant genes in 37 plasma samples from 18 GIST patients collected prospectively. ctDNA alterations were compared with NGS of matched tumor tissue samples (obtained either simultaneously or at the time of diagnosis) and cross-validated with droplet digital PCR (ddPCR).[Results] We were able to identify cfDNA mutations in five out of 18 patients had detectable in at least one timepoint. Overall, NGS sensitivity for detection of cell-free (cf)DNA mutations in plasma was 28.6%, showing high concordance with ddPCR confirmation. We found that GIST had relatively low ctDNA shedding, and mutations were at low allele frequencies. ctDNA was detected only in GIST patients with advanced disease after imatinib failure, predicting tumor dynamics in serial monitoring. KIT secondary mutations were the only mechanism of resistance found across 10 imatinib-resistant GIST patients progressing to sunitinib or regorafenib.[Conclusions] ctDNA evaluation with amplicon-based NGS detects KIT primary and secondary mutations in metastatic GIST patients, particularly after imatinib progression. GIST exhibits low ctDNA shedding, but ctDNA monitoring, when positive, reflects tumor dynamics.This research is supported by a Fero Fellowship Award (C.S.), Asociación Española Contra el Cáncer (J.P. Barcelona) (C.S.), and ISCIII PI16/01371 (C.S.). C.S. and A.V. acknowledge to the Cellex Foundation for providing facilities and equipment