Complete Clinical History Research Articles

CLINICOHISTOPATHOLOGICAL PROFILE OF NASAL AND SINONASAL LESIONS: A STUDY FROM CENTRAL INDIA

Background: Nasal and sinonasal lesions comprise common as well as rarest rare lesions. This region being a site of histopathologically diverse lesions, interests pathologists.
 Objectives: The study aimed to find out incidence of nasal and sinonasal lesion with frequency of non-neoplastic, neoplastic lesions, to study spectrum of lesions histopathologically along with correlation of clinical and radiology findings.
 Material and methods: It was a 2 year retrospective observational study involving 102 cases from January 2012 to December 2013 carried out at Government medical college, Nagpur.
 Study included all specimens received as nasal and sinonasal lesions. Complete clinical history and radiological findings were correlated with histopathology findings.
 Results: Nasal and sinonasal lesions are rare having 1.07 % incidence rate. Majority of patients of nonneoplastic and benign neoplastic category belonged to 11-20 age group while malignancies were common in 41-50 age group. We encountered more neoplastic lesions (53.92%) compared to nonneoplastic lesion (46.08%). Male to female ratio was 1.5:1. Sensitivity, specificity and diagnostic accuracy of clinical diagnosis was 94.73%, 97.67 % and 96 % respectively while positive predictive value and negative predictive value was 98.18 % and 93.33 %. p value was 0.317. Discordance in clinic-histopathological diagnosis was in 5.88 %
 Conclusion: Though there was good correlation between clinicoradiology findings and histopathology, however in 5.88% discordant cases histopathology diagnosis led to significant alteration of treatment plan proving key role of histopathology diagnosis.
 Keywords: Benign, Central India, Clinicohistopathology, Profile, Malignant, Nasal, Sinonasal.

Comparative study of outcome of retrograde intramedullary nailing and locking compression plating of distal femoral fractures in adults

Fractures in the elderly are often challenging due to osteoporotic bone and co-morbidities and long term disability can occur. Surgery is the standard mode of treatment and hence a quick surgical treatment for early weight bearing and mobilization is required in order to prevent long term complications due to prolonged bed rest. All patients were documented prospectively, complete demographic details and clinical history was obtained. Clinical and radiographic evaluation was done in all the patients. Informed consent was taken and all patients were treated with DFLCP and retrograde nailing randomly. Duration of hospitalization was documented and follow up was done for 2 years. In this study, fracture union time was12-24 weeks with among the patients of the DLFP group with 75 percent have union and was 12-24weeks among the patients of the retrograde nailing group with union occurring in 80 percent of patients respectively. Significant results were obtained while comparing the mean fracture union time among the patients of the two study groups. In our study, follow up was done up to 2 years with 60% of patients followed up to 15 months in both the groups.

Impact of PSMA PET/CT in prostate cancer patient’s clinical management: a pictorial essay of interesting cases with histologic confirmation

Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) has a significant impact on prostate cancer (PCa) patient’s clinical management. PSMA PET/CT has changed both the paradigm of metastases spread pathway, and the PSMA specificity for detecting PCa lesions. Currently, it is accepted that PCa can spread to cervical and mediastinal lymph nodes without other intermediate lesions. PSMA expression in non-prostate cancers or benign lesions is known as well. However, information about PSMA functional specificity in clinical practice is still missing. A retrospective analysis of PSMA PET/CT studies was done to select relevant clinical cases with complete clinical history, histology results and follow-up information. Each clinical case was organized from a holistic perspective, including clinical information, 68Ga-PSMA PET/CT images, pathology results and clinical outcome. Nine clinical cases were selected to illustrate synchronous primary cancers (gastric gastrointestinal stromal tumours and clear cell renal cell carcinoma), atypical sites of PCa metastases (thyroid, liver, cervical and mediastinal lymph nodes) and some examples of PCa lung metastases with discordant PSMA findings between PET/CT examinations and immunohistochemistry. In this pictorial essay and review, the meaning of high PSMA expression in neovasculature and uncommon PCa metastatic spread were addressed. Furthermore, recent information about the possible explanation of (1) PCa metastases without PSMA expression due to dedifferentiation and specific PCa subtypes, and (2) some discordant findings on PSMA expression evaluated by PET/CT and immunohistochemistry related to the anti-PSMA antibody used in each technique is presented.

A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

SIDS associated RYR2 p.Arg2267His variant may lack pathogenicity

Sudden infant death syndrome (SIDS) is the sudden death of an infant under 1 year of age that remains unexplained after death scene and medicolegal investigation, including a complete autopsy and clinical history review. The fatal event typically occurs during sleep and heart rhythm during the event is rarely documented. Large series which have utilized molecular autopsy show that long QT syndrome (LQTS) associated cardiac channel mutations contribute to between 5 and 10% of SIDS deaths. In addition, rare novel RYR2 variants have been identified in SIDS victims. Given the lack of a phenotype, the pathogenicity of these variants is inferred from in vitro studies. We report a family with 5 members (mother and 4 children) who are carriers of a rare RYR2 variant (c.6800G > A, p.Arg2267His [Exon: 45], heterozygous) which has previously been identified in a SIDS victim and shown to confer a gain-of-function CPVT phenotype in vitro. All of these 5 family members including the mother (age range 7 to 41 years) have had negative exercise stress tests, echocardiograms and Holter monitors. These findings suggest that caution should be exercised in inferring pathogenicity of rare RYR2 variants based on in vitro functional data which does not always translate to human phenotype.

Tobacco related oral cavity lesions, scrape cytology with histopathological correlation: A 5 year study at tertiary level hospital in Mumbai

Tobacco related oral cavity lesions, scrape cytology with histopathological correlation: A 5 year study at tertiary level hospital in Mumbai - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.024, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Type II acquired cutis laxa associated with recurrent urticarial vasculitis: brief report

BackgroundCutis laxa is a connective tissue disease characterized by loose, wrinkled, and redundant skin. It is either inherited or acquired. In most cases, acquired cutis laxa is associated with neoplasms, drugs, and autoimmune diseases. We present a rare case of acquired cutis laxa following a recurrent urticaria-like eruption in the absence of an autoimmune disease, neoplasm, drugs and or syndrome.Case presentationWe report a case of a 45-year-old Chinese lady with a 1-year history of widespread pruritic urticarial eruption and a 6-month history of progressive skin wrinkling. On examination, the patient appeared older than her actual age, with apparent wrinkling on the mid-torso with generalized smooth, erythematous macules and wheals. A family history of similar conditions was absent. Biopsy revealed hypersensitivity and atrophy. Following the Food and Drug Administration (FDA) guidelines, we administered antihistamines, which relieved the itching, but her hyperpigmentation and cutis laxa never improved.ConclusionOur case shows that the decrease of elastic fibers may be associated with the infiltration of inflammatory cells in the dermis. This supports the hypothesis that chemical mediators may play a major role in the destruction of elastic fibers, thus causing cutis laxa. In addition, we advise practitioners to take a complete clinical and family history to determine if the condition is inherited or acquired.

Increased erythrocyte osmotic fragility in hypothyroidism

Hypothyroidism a quite common thyroid disorder is often associated with anemia. Osmotic fragility is altered with an alteration of the thyroid profile. Hypothyroidism induced reduction of membrane cholesterol and compromised the activity of Na+K+ATPase and increased peroxidation of membrane lipids appear to be responsible for damaging the red blood corpuscle (RBC) membranes which alter the permeability of themembrane and thus ionic environment within the cell. The objective of this study was to evaluate the relation between the association of hypothyroidism and RBC membrane lipid peroxidation in the development of increased RBC osmotic fragility. A complete clinical history and biochemical investigations, including thyroid function tests namely, thyroid -stimulating hormone (TSH) and free T4 (fT4), RBC membrane osmotic fragility test by gradient concentration of NaCl, and RBC membrane peroxidation using thiobarbituric acid reactive substances (TBARS) tests were performed among thirty two hypothyroidism patients and healthy controls. Serum TSH & TBARS in the RBC membrane were significantly higher (P <0.001) than healthy controls which also showed a significant positive correlation (r =0.8, P =0.01) when compared without grouping. Osmotic fragility of RBC was found significantly increased among hypothyroid patients (P <0.001) at NaCl conc. of 0.3%, 0.4%, 0.5% & (P <0.05) at NaCl conc. of 0.6%. In conclusion, the results indicated that RBC osmotic fragility increases significantly in hypothyroidism possibility due to increased membrane lipid peroxidation as observed in the study.

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients.

Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

Incidence of adverse drug reactions in patients taking anti-tuberculosis treatment

Background: High incidence of infection has caused a large number of morbidity and mortality which is partly due to serious adverse reactions induced by Anti-Tuberculosis (Anti-TB) drugs. In present prospective study an attempt is made to estimate the incidence and risk factor for ADRs among patients treated for tuberculosis.Methods: All the new patients starting their treatment with selected six DOT center were enrolled in study. All patient's complete clinical history was recorded. They were followed regularly for occurrence of ADR till end of their treatment.Results: Total of 108 patients (67 male and 41 female) had taken and completed their treatment during the study period (March 2007 - April 2008) and were observed for occurrence of ADR during their treatment period. Out of total108, 28 patients (25.9%) experienced one of the ADR, out of 28 patients, 12 (42.85%) patients developed GIT intolerance, and hepatitis was seen in 8 (28.57%) patients, while 4 (14.48%) patients developed skin reactions. Only 3 (7.14%) patient developed dizziness and loss of balance, which was relieved by reduction of dose of streptomycin.Conclusions: With close monitoring and on time action, RNTCP DOTs regimens can be safely and successfully administrated.

Trypanosoma cruzi infection associated with atypical clinical manifestation during the acute phase of the Chagas disease

BackgroundChagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña’s sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman.MethodsEvaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR.ResultsSkin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative.ConclusionsWe present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues.

1375. Laboratory Abnormalities Among Patients with Pulmonary Mycobacterium avium Complex Infections

BackgroundLimited data are available regarding laboratory abnormalities in patients with pulmonary Mycobacterium avium complex (MAC) disease.MethodsWe included patients without cystic fibrosis who had pulmonary MAC and met ATS/IDSA disease criteria from the Northwest NTM Biobank with a complete blood count (CBC) 6 months prior and up to 30 days after study enrollment. The biobank is a cohort of patients with Nontuberculous mycobacterium (NTM) infections identified through statewide laboratory surveillance and OHSU regional referral NTM clinic; a complete clinical history is collected by chart review at enrollment. We evaluated the proportion of pulmonary MAC patients with abnormal laboratory tests. We examined differences using a chi-square test between patients who were antimycobacterial treatment naïve, on therapy at enrollment or previously treated, in addition to cavitary and non-cavitary disease and those who also had previous sputum isolation of additional organisms (co-isolation).Results147 patients had CBCs available; 112 (76.2%) were female with a median age of 69 years (22–88 years). 64 (43.5%) were antimycobacterial treatment naïve, 65 (44.2%) were on therapy at enrollment and 18 (12.2%) were previously treated. Lymphocyte count was below normal in 105 (73.4%) patients; 70 (49.3%) had lymphocyte counts below 1500 cells/mL and 27 (18.9%) were lymphopenic. Elevated monocyte percent was seen in 54 (37.2%) patients. Lymphopenia was more common in those on therapy, P = 0.01. There were no predominant laboratory abnormalities in 108 patients with metabolic panels. 34 patients had a c-reactive protein (CRP) collected, which was elevated, after age and gender correction, in 31 patients (91.2%). There was no significant difference between treatment groups. Eleven patients had cavitary disease with no differences in laboratory values compared with those with non-cavitary disease. Patients with co-isolation were more likely to be anemic (P = 0.03), have thrombocytosis (P = 0.04) and were less likely to have a monocytosis (P = 0.03).ConclusionA large proportion of patients with pulmonary MAC disease have low lymphocyte counts, elevated monocyte percent and CRP. Further evaluation of the meaning of these abnormalities as well as changes during therapy is needed. Disclosures All authors: No reported disclosures.

Acanthosis Nigricans in the Knuckles of Infants: A Novel Clinical Marker of High Metabolic Risk.

IntroductionAcanthosis nigricans (AN) is an early clinical sign of insulin resistance (IR) primarily in adults. The prevalence and association of AN and IR in infants, however, remains uncertain. We aimed to describe the prevalence of AN and its association with IR in a group of Latin-American infants.MethodsWe studied a random sample of 227 healthy infants between 9 and 24 months of age. After a complete clinical history was obtained and a physical examination was performed, fasting plasma glucose and serum insulin were measured. Three blinded evaluators assessed AN in each patient. Infants with AN were categorized as cases. The HOMA-IR index cutoffs of ≥ 90th and ≥ 95th percentiles were considered IR.ResultsThere were 49 infants with AN (21.6%) (cases) and 178 without AN (78.4%) (controls). Cases had a significantly higher mean serum insulin, fasting plasma glucose, and HOMA-IR levels of 3.67 ± 2.56 µU/ml vs. 2.42 ± 1.45 µU/ml, P = 0.005; 84.2 ± 12.6 mg/dL vs. 77 ± SD 9.9 mg/dL, P ≤ 0.001; HOMA-IR 0.77 ± 0.54 vs. 0.46 ± 0.28, P ≤ 0.001, respectively. More cases than controls presented HOMA-IR levels ≥ 95th percentile (cases 18.4%; controls 0.5%, P ≤ 0.001) and ≥ 90th percentile (cases 32.7%; controls 1.6%, P ≤ 0.001). AN in the knuckles had a high sensitivity and a negative predictive value (NPV) for detecting patients with HOMA-IR levels above the 95th percentile (sensitivity 90%; NPV 99.4%) and above the 90th percentile (sensitivity 84.2%; NPV 98.3%).ConclusionAN in the knuckles is a prevalent, non-invasive, costless, and reliable screening clinical tool that can be used for early detection of infants with IR and a high metabolic risk.

Comorbid conditions in individuals assessed by SPECT: Study of a reference cardiology center in Mexico City

BackgroundThere is an increasing prevalence of comorbidities in patients with ischemic heart disease (IHD) in developing countries. The aim of this work is to assess the prevalence of comorbidities and associated factors for IHD among patients at a reference cardiology center. Design and MethodsThis was a cross-sectional study. A complete clinical history which focused on the main comorbidities, previous myocardial infarction, and the main reason of referral was assessed. A single-photon emission computed tomography (SPECT) myocardial perfusion study (MPS) with two protocols was performed. ResultsWe included 1998 patients, 64.2% male, median age 63 (I.R.: 56–71) years. 1514 (75.8%) subjects had at least one associated comorbidity. The main comorbidity was diabetes (T2D) (772: 38.6%), followed by systemic hypertension (737: 36.9%), smoking (518: 25.9%), and dyslipidemia (517: 25.9%). 806 (40.3%) had histories of previous myocardial infarctions. The main cause of referral was angina (923: 46.2%). We identified 1330 (66.5%) abnormal MPS. 460 (23%) had ischemia, 292 (14.6%) infarction, and 578 (28.9%) ischemia and infarction. ConclusionAn increased prevalence of comorbidities was found in patients who were studied in the Nuclear Cardiology Department (NCD): most of them had traditional risk factors attributable to myocardial infarction. A great percentage were newly diagnosed with both ischemia and infarction.

Characterization of ECG Pattern in Children Attending Pediatric Arrhythmia Clinic in Sohag University Hospital: A prospective hospital based study

Background: refers to any change from the normal sequence of electrical impulses. Cardiac arrhythmias have been classified into tachycardia and bradycardia. Pediatric arrhythmias account for approximately 55 per 100,000 patients evaluated in pediatric emergency departments. Sinus tachycardia is by far the most commonly reported arrhythmia, followed by supraventricular tachycardia (SVT) which represents about 13%, and bradycardia accounting for about 6% of all cases Objective: To characterize patients attending pediatric arrhythmia outpatient clinic as regards the presence of cardiac rhythm abnormalities, the pattern of cardiac rhythm abnormalities and the impact of diagnosis and treatment on the patient morbidity.Methods: This prospective observational study was conducted on 500 pediatric patients from October 2016 to September 2017 in the Pediatric arrhythmia outpatient Clinics of the Pediatric Department. All patients in this study were subjected to complete clinical history including the cause of the referral, complete clinical examinations and twelve leads ECG. The following investigations were requested when indicated and its results were included in the study: Serum electrolyte, Echocardiography, Holter cardiac rhythm monitoring and Electrophysiological studies (EPS), and finally data was analyzed by SPSS software.

Acute Headache in the Emergency Setting.

Acute headache is a common symptom and is reported by approximately 2%-4% of patients who present to the emergency department. Many abnormalities manifest with headache as the first symptom, and it is crucial to obtain a patient's complete clinical history for correct diagnosis. Headache onset, duration, and severity; risk factors such as hypertension, immunosuppression, or malignancy; and the presence of focal neurologic deficits or systemic symptoms may aid the radiologist in deciding whether imaging is appropriate and which modality to choose. Imaging findings are more likely to be abnormal in patients with a "thunderclap" headache than in those with headaches of lesser severity. The causes of headache in the emergency setting are various. They may manifest at imaging as subarachnoid hemorrhage (ruptured aneurysm, reversible vasoconstriction syndrome, or pituitary apoplexy), parenchymal hemorrhage (hypertension, ruptured arteriovenous malformation, cerebral amyloid angiopathy, dural arteriovenous fistula, or sinus thrombosis), or parenchymal edema (posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, sinus thrombosis, or encephalitis). Alterations in intracranial pressure that are related to idiopathic intracranial hypertension or spontaneous intracranial hypotension and prior lumbar puncture or epidural injection may manifest with specific imaging findings. With accumulating knowledge of disease pathophysiology, radiologists have started to play a more central role in making the correct diagnosis. This article reviews multiple causes of acute headache and their characteristic appearances at multimodality imaging and familiarizes the reader with current concepts in imaging.Online supplemental material is available for this article.©RSNA, 2019.

Analysis of CT Scans Findings in Seizures Patients: An Observational Study

Background: Seizures may occur in up to 10% of the population. There is general consensus that adults with an unprovoked first seizure should have brain imaging with either CT or MRI primarily to identify any process that may be responsible for the seizure. Hence; under the light of above mentioned data, the present study was planned for assessing CT scans and their findings in seizures patients. Subjects and Methods: All the patients reporting with the history of seizure disorder were admitted to the emergency department and were treated accordingly. Complete past medical and clinical history of all the patients was obtained. In all the patients, EEG was done and findings of the EEG were correlated with the final diagnosis.&nbsp; In all the patients CT scan was done. Diagnosis was confirmed after correlating the clinical findings of all the patients with clinical history and microbiological investigation reports.&nbsp; All the results were analyzed by SPSS software .Results: Tuberculoma was found to be present among in 18 patients with partial seizures. Cerebral infarct was found to be present in 10 patients with partial seizures and among 15 patients with generalized seizures. Focal cerebral edema was found to be present in 10 patients with partial seizures. Diffuse cerebral edema was found to be present in 13 patients with generalized seizures. Brain tumour was found to be present among 6 patients with partial seizures. Calcifications were found to be present in 4 patients with partial seizures and 10 patients with generalized seizures. Conclusion: CT is sensitive for detection of neural lesions and is advocated in seizure patients. However; further studies are recommended.

Secondary (Duret) brainstem haemorrhage may not always represent a fatal event

Background. Secondary brainstem haemorrhage (eponymously called Duret haemorrhage) is a well-known complication of transtentorial brain herniation or of rapid decompression of intracranial space. It is considered to be a consequence of arterial rupture, venous infarction or ischemia-reperfusion injury and it is regarded as a harbinger of an unfavourable outcome for the patient. Despite this, several case reports describing good outcome after Duret haemorrhage preceded by evacuation of an expansive traumatic intracranial mass lesion, an episode of intracranial hypotension or lumbar drainage have been published.Case description. We present four cases of patients with secondary brainstem haemorrhage linked to an episode of intracranial hypertension due to various reasons who were treated at our clinic. The first patient suffered a small brainstem haemorrhage that was described on his initial CT scan presumably as a result of massive intracranial expansion caused by an acute subdural haematoma and this Duret haemorrhage markedly expanded after the subdural haematoma was evacuated by means of a decompressive craniectomy. The next two patients developed Duret haemorrhage after the evacuation of intracranial haematomas. The fourth patient presented with posttraumatic cerebral oedema complicated by a subtle Duret haemorrhage displayed on his initial CT scan and this bleeding remained stable even after a bilateral decompressive craniectomy. One patient passed away, one remained in a persistent coma and two survived with a light neurological deficit.Conclusions. However ominous a newly discovered Duret haemorrhage may be, it alone should not discourage us from the further intensive treatment of our patients as their outcome may considerably vary. The extent of this bleeding, type and severity of underlying brain injury and complete clinical status and history of our patients should all be taken into account when deciding about patients’ prognosis.

Protocolo diagnóstico de la insuficiencia renal crónica

The most common suspicious findings of chronic renal insufficiency (CRI) are chronic elevation in serum creatinine or progressive decline in glomerular filtration rate (< 60ml/minute/1.73 m2). Complete clinical history (personal and familial history and CRI risk factors) has to be performed in case of CRI suspicion. The identification of etiological agents, signs and symptoms is the goal of anamnesis. The following complementary tests have to be performed: blood test, urine test and renal ultrasound. Firstly, in order to discard obstructive condition and to identify structural abnormalities, renal ultrasound is carried out. Next, blood and urine tests must be done. All these three tests are necessary to achieve the diagnosis of CRI.

Enfermedades cerebelosas

The etiology of cerebellar diseases has a wide range of causes. Diagnosis begins with a complete clinical history and examination. A deep knowledge of cerebellum anatomy and function is essential, as well as to know the age of the patient and the onset of symptoms. Direct diagnosis is achieved in some cases; however laboratory and genetic tests, and neuroimaging test are required, among others. Treatable causes must always be identified both in the neurological emergencies and in the chronic forms. Support treatments and symptomatic pharmacological therapies should also be part of the treatment. Genetic counselling is indicated for inherited causes, ensuring adequate communication and understanding of the practical and ethical aspects of the process.