Objective: To study the impact of secondary mental disorders in patients affected with acromegaly and correlate them with quality of life (QoL) and disease status.Design: An observational transversal descriptive and comparative study that evaluates QoL's impact due to secondary mental disorders in affected Mexicans with acromegaly using AcroQoL and SF‐36 instruments. Correlation of the results with the disease's biochemical status was performed. According to Beck's scales, anxiety and depression analyses evaluate QoL's impact, and its gender variability is described.Results: Eighty‐five patients with diagnoses of acromegaly were included. The mean age was 43.18 years, 47 being women (55.29%). The mean age at diagnosis was 37.95 years, with no difference between men and women. AcroQoL and SF‐36 global and sub‐domain scores differed significantly between men and women, the latter having lower global and individual sub‐domain scores. The mean score of QoL, according to AcroQoL, is 59.40. In women, the mean values are less (55.13) than men (64.68), p = 0.021. The sub‐domain analyses’ scores in physical, appearance and social relationships were less in women (53.21; 47.34; 62.32) than men (62.68; 56.76; 73.87) p = 0.044, 0.069 and 0.013, respectively. Higher Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) scores correlated with lower QoL as assessed by global and individual sub‐domain scores. Women presented significantly higher BDI and BAI mean scores when compared to men regardless of their biochemical status. Anxiety (p = 0.027) and depression (p < 0.001) severity were higher in women compared to men.Conclusion: Correlations between female gender, depression/anxiety scores and QoL require further validation. There is much to be routinely done to improve secondary psychopathology in patients affected by this disease. The need for mental status screening at diagnosis should be emphasized to identify secondary mental illnesses to improve QoL with its treatment.

Background: Although the essential components of pain pathways have been identified, a thorough comprehension of the interactions necessary for creating focused treatments is still lacking. Such include more standardised methods for measuring pain in clinical and preclinical studies and more representative study populations. Objective: This review describes the essential neuroanatomy and neurophysiology of pain nociception and its relation with currently available neuroimaging methods focused on health professionals responsible for treating pain. Methods: Conduct a PubMed search of pain pathways using pain-related search terms, selecting the most relevant and updated information. Results: Current reviews of pain highlight the importance of their study in different areas from the cellular level, pain types, neuronal plasticity, ascending, descending, and integration pathways to their clinical evaluation and neuroimaging. Advanced neuroimaging techniques such as fMRI, PET, and MEG are used to better understand the neural mechanisms underlying pain processing and identify potential targets for pain therapy. Conclusions: The study of pain pathways and neuroimaging methods allows physicians to evaluate and facilitate decision-making related to the pathologies that cause chronic pain. Some identifiable issues include a better understanding of the relationship between pain and mental health, developing more effective interventions for chronic pain's psychological and emotional aspects, and better integrating data from different neuroimaging modalities for the clinical efficacy of new pain therapies.

The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.

Revista Médica Sinergia es una revista de acceso abierto con sede en Costa Rica. Su objetivo es difundir la produccion científica de todos los campos de la ciencia médica y afines, tenemos como mision llegar a ser una herramienta valiosa para la difusión de investigaciones en el área de salud a nivel internacional. Su área de cobertura temática, son los temas relacionados con la ciencia de la salud (medicina interna, ginecologia y obstetricia, cirugia, pediatria, etc.). Esto se lleva a cabo mediante publicaciones mensuales de artículos de revisiones bibliográficas, investigación, comunicación científica y reporte de casos. La revista va dirigida primordialmente al personal medico y ciencias relacionadas al área de la salud. Todos los artículos son originales, con temas de alto interés para la comunidad médica y para el área de la salud en general. The circle of Willis is a vascular network that supplies blood to the brain and surrounding structures. One of its main functions is to maintain the irrigation through the anastomoses when a certain condition compromises the flow of any of its branches. It is composed of the anterior cerebral, anterior communicating, internal carotid, posterior cerebral, and posterior communicating arteries. Its conformation varies in the population. More than 30-60% of people have a different composition than the usual, with hypoplasia of one or more vessels being the most common anatomical variant. This is defined as the existence of less than 1 mm of external caliber in the anterior communicating and posterior cerebral arteries and the arterial segments A1 of the anterior cerebral and P1 of the posterior cerebral arteries. The posterior cerebral artery is the most frequently hypoplastic, followed by the P1 segment of the posterior cerebral artery, the A1 segment of the anterior cerebral artery, and the anterior communicating artery. The formation of intracranial aneurysms is more common in the anterior communicating artery; and the unilateral predominance of the ACA trunk, aplasia/hypoplasia of the A2 segment, and hypoplasia of the A1 segment have been determined as risk factors for its appearance. This last variant constitutes the main risk factor for rupture of intracranial aneurysms of the anterior communicating artery, since it increases blood flow on the opposite side causing an increase in intramural pressure that favors the development of the aneurysm. El polígono de Willis es una red vascular que aporta sangre al cerebro y a las estructuras circundantes. Una de sus principales funciones es mantener la irrigación a través de las anastomosis, cuando se presenta alguna condición que compromete el flujo de alguna de sus ramas. Está compuesto por las arterias cerebral anterior, comunicante anterior, carótida interna, cerebral posterior y comunicante posterior. Su conformación varía en la población. Más del 30-60% de las personas presentan una composición distinta a la habitual, siendo la hipoplasia de uno o más vasos la variante anatómica más común. Esta se define como la existencia de menos de 1 mm de calibre externo en la comunicante anterior y cerebral posterior, y los segmentos arteriales A1 de la cerebral anterior y P1 de la cerebral posterior. La arteria cerebral posterior es la que se encuentra hipoplásica con mayor frecuencia, seguida del segmento P1 de la cerebral posterior, el segmento A1 de la cerebral anterior y la comunicante anterior. La formación de aneurismas intracraneales es más frecuente en la arteria comunicante anterior. Se han determinado como factores de riesgo para su aparición el predominio unilateral del tronco de la arteria cerebral anterior, la aplasia/hipoplasia del segmento A2, y la hipoplasia del segmento A1. Esta última variante constituye el principal factor riesgo para la ruptura de los aneurismas intracraneales de la arteria comunicante anterior, ya que aumenta el flujo sanguíneo en el lado opuesto y, con ello, provoca un incremento de la presión intramural que favorece el desarrollo del aneurisma.

It is important to understand the patient's vascular anatomy before treating cerebral aneurysms. The middle artery of the corpus callosum is one of the least common variations of the AComA complex. We describe the case of a 59-year-old woman who suffered a subarachnoid hemorrhage due to an AComA complex aneurysm that had ruptured. Fluorescein injection during the aneurysm clipping procedure revealed a partial obstruction of the middle artery, requiring repositioning of the clip. The vascular variations that our patients may exhibit at the time of aneurysm clipping must be kept in mind and understood.