Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Quantum interference oscillations of the superparamagnetic blocking in an Fe8 molecular nanomagnet.

We show that the dynamic magnetic susceptibility and the superparamagnetic blocking temperature of an Fe(8) single molecule magnet oscillate as a function of the magnetic field H(x) applied along its hard magnetic axis. These oscillations are associated with quantum interferences, tuned by H(x), between different spin tunneling paths linking two excited magnetic states. The oscillation period is determined by the quantum mixing between the ground S=10 and excited multiplets. These experiments enable us to quantify such mixing. We find that the weight of excited multiplets in the magnetic ground state of Fe(8) amounts to approximately 11.6%.

Influence of the interactions on the magnetotransport properties of Fe-Ag granular thin films.

Fe(x)Ag(100-x) granular thin films, 25 < or = x < or = 40, have been prepared by DC-Magnetron sputtering deposition. These samples are composed of small Fe nanoparticles (2.5-3 nm) embedded in an Ag matrix, and their size remains nearly constant with increasing Fe content. A crossover in the collective magnetic behaviour of the samples near x = 35, had been previously reported for these samples. In this article, we show that the transport and magnetotransport properties are clearly correlated with these magnetic behaviours, and that the resistivity, the magnetoresistance and the Hall resistivity depend on the nature of the most relevant interactions, dipolar or direct exchange, as a function of the thermal evolution and the Fe content.

Mitogen-activated protein kinase inhibitor-associated retinopathy (MEKAR). A clinical case.

Mitogen-activated protein kinase kinase (MEK) inhibitors have significantly improved the prognosis of various types of cancer such as metastatic melanoma. However, their use is usually associated with ocular side effects. A retinopathy associated with these agents (MEKAR) has been described, consisting of the development of neurosensory detachments, generally bilateral and multiple, similar to those that appear in the central serous chorioretinopathy (CSC). Generally, optical coherence tomography allows us to differentiate the two conditions. We present the case of a 55-year-old woman in treatment with a MEK inhibitor, who developed bilateral neurosensory detachments and blurred vision, which resolved with the discontinuance of the treatment due to tumour progression.

Magnetic dipolar ordering and quantum phase transition in an Fe8 molecular magnet.

We show that a crystal of mesoscopic Fe(8) single-molecule magnets is an experimental realization of the quantum Ising model in a transverse field, with dipolar interactions. Quantum annealing has enabled us to explore the quantum and classical phase transitions between the paramagnetic and ferromagnetic phases, at thermodynamical equilibrium. The phase diagram and critical exponents that we obtain agree with expectations for the mean-field universality class.

Recurrent pre-retinal haemorrhages associated with coagulation factor VII deficiency. / Hemorragias prerretinianas de repetición asociadas a déficit del factor VII de la coagulación.

The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favourable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages.

Papillophlebitis in a young male patient with Buerger's disease. / Papiloflebitis en varón joven con enfermedad de Buerger.

CLINICAL CASE: A 27-year-old male with sudden visual loss of OD. He had a past history of heavy smoking, as well as a chronic ischaemia of his left lower limb of one-year onset. This led to a diagnosis of Buerger's disease, which is an inflammatory thrombotic disorder that affects small and medium vessels. The visual acuity (VA) of OD was 0.9, and in the funduscopy a very congestive papilla was observed, along with venous tortuosity, scattered retinal haemorrhages, but without macular oedema. He progressed favourably, with a complete recovery of VA. DISCUSSION: Papillophlebitis may be an ocular complication of Buerger's disease.

Atypical presentation of Best Disease. / Presentación atípica de la enfermedad de Best.

CLINICAL CASE: A 43-year-old man was treated for reduced visual acuity, initially attributed to strabismic amblyopia. On fundus examination, bilateral neurosensory detachments (NSD) were observed in posterior pole, surrounded by deposits of lipofuscin. His 3-year-old son was also examined and circumscribed NSD was observed with the presence of pseudohypopyon in OD and a fibrosis scar in OS. The Arden ratio were decreased in electrooculography (EOG) in both patients, and genetic studies revealed a single mutation of the BEST1 gene. DISCUSSION: The existence of extensive bilateral NSD may be an unusual form of presentation of Best disease. Family history, EOG, and genetic study supported this diagnosis.

The Notch ligand DLL4 specifically marks human hematoendothelial progenitors and regulates their hematopoietic fate.

Notch signaling is essential for definitive hematopoiesis, but its role in human embryonic hematopoiesis is largely unknown. We show that in hESCs the expression of the Notch ligand DLL4 is induced during hematopoietic differentiation. We found that DLL4 is only expressed in a sub-population of bipotent hematoendothelial progenitors (HEPs) and segregates their hematopoietic versus endothelial potential. We demonstrate at the clonal level and through transcriptome analyses that DLL4(high) HEPs are enriched in endothelial potential, whereas DLL4(low/-) HEPs are committed to the hematopoietic lineage, albeit both populations still contain bipotent cells. Moreover, DLL4 stimulation enhances hematopoietic differentiation of HEPs and increases the amount of clonogenic hematopoietic progenitors. Confocal microscopy analysis of whole differentiating embryoid bodies revealed that DLL4(high) HEPs are located close to DLL4(low/-) HEPs, and at the base of clusters of CD45+ cells, resembling intra-aortic hematopoietic clusters found in mouse embryos. We propose a model for human embryonic hematopoiesis in which DLL4(low/-) cells within hemogenic endothelium receive Notch-activating signals from DLL4(high) cells, resulting in an endothelial-to-hematopoietic transition and their differentiation into CD45+ hematopoietic cells.

Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis.

BACKGROUND: Laparoscopic splenectomy (LS) has been demonstrated as an effective and safe treatment for hematological disorders requiring spleen removal, especially in cases of normal-sized spleens. However, although results are promising, long-term outcome data are lacking. We reviewed our clinical experience with LS in a series of 255 cases, with particular attention to the long-term outcome related to the disease process requiring LS. METHODS: From February 1993 to October 2003, LS was attempted in 255 patients (100 males and 155 females with a mean age of 45 +/- 19 years) and clinical information was recorded in a prospective database. Indications for splenectomy included idiopathic thrombocytopenic purpura (ITP) (n = 115), HIV-ITP (n = 9), Evans syndrome (n = 6), autoimmune hemolytic anemia (AIHA) (n = 13), hereditary spherocytosis (HS) (n = 19), hematologic malignancy (n = 66), thrombotic thrombocytopenic purpura (n = 1), and others (n = 26). Long-term postoperative follow-up evaluation was obtained through clinical notes, follow-up visits by the referring hematologist, and by phone interviews both with patients and with the referring hematologist. RESULTS: A total of 186 patients (73%) were available for a mean follow-up of 35 months (range, 1-104). Of the ITP patients, 87 (76%) were followed up, with a remission rate of 89% (complete remission in 75%). A similar remission rate was observed in ITP-HIV; in patients available for follow-up (78%), complete remission was achieved in 83%. In Evans, complete remission was achieved in all patients available for follow-up (67%). Clinical response for hemolytic disease ranged between 70% for AIHA and 100% for HS. In the malignant group, the late mortality rate was 22%. The mortality rate in the miscellaneous group was 5%. No cases of splenectomy-related sepsis occurred during follow-up. CONCLUSIONS: LS offers advantages for all types of splenic diseases requiring surgery. It provides not only good clinical short-term outcome but also satisfactory long-term hematological results.

[Nutritional status of the university student population in Galicia]. / Estado nutricional de una población de estudiantes universitarios de Galicia.

In this work we have investigated the dietary habits of 107 university students in Northwest Spain. From the different types of questionnaires that exist, the "24 hours recall" has been elected. Biochemical analysis were carried out in blood and urine to complete the nutritional study. Our results indicate that the distribution of energy intake over the day is generally acceptable though in many cases a bigger breakfast would be advisable. The results of blood and urine analysis were in all cases within the corresponding normal ranges which means that there aren't any evidence of pathological alteration.

[Consumption of lipids in the university population of Spain, evaluation of the hepatic profile and of serum cholesterol]. / Ingesta de lípidos en la población universitaria del noroeste de España, evaluación de su perfil hepático y del colesterol sérico.

In the present study we tried to characterise the diet of university students in Northwest Spain, paying particular attention to lipids and fibre intake. We administered a 24 hour recall dietary-habits questionnaire. Saturated and monounsaturated fats predominated, with the intake of polyunsaturated fatty acids being considerably lower. Mean daily cholesterol intake was in most cases in excess of the recommended maximum and mean fibre intake showed a considerable variation among individuals. The obtained hepatic profile is found within normal range. The calories provided by the diet result adapted in half of the studied population approximately, while the fourth part does not cover the recommended quantity. These results could be considered a risk in the future.

[Study of dietary habits of students in Galicia]. / Estudio de los hábitos alimentarios de estudiantes en Galicia.

The food habits of 168 university students in Galicia (a region in Northwest Spain) were investigated by means of a questionnaire. Alcohol consumption, smoking and frequency of physical exercise were also evaluated, and height, body weight and blood pressure were determined for all subjects. Our results show that in the diet of university students all groups of foods are present, and their frequency consumption is within the recommended intake by Health Authorities. Smoking and alcohol consumption is low among the study population.

Post-chemonucleolysis computed tomographic findings.

The CT findings observed 6 months and 2 years after chemonucleolysis in 50 and 34 patients are reported. Emphasis is placed on the persistence of the hernia image in nearly 70% of the cases, together with an increase in degenerative intradiscal signs and degeneration of the facet joints; however, this did not lead to poor results 2 years after chemonucleolysis.

[Meningitis and cerebrospinal liquid fistula as a complication from the surgery of endolymphatic sac]. / Meningitis y fístula de LCR como complicación de un caso de cirugía del saco endolinfático.

A 28 years old woman diagnosed of Méniére's disease was surgically treated with a drainage from endolymphatic system and a valve placed. Six years after surgery, the patient presented a bacteria meningitis an a cerebrospinal fluid leak to mastoid was found. New surgery was needed. Complications of endolymphatic system surgery, its treatment and frequency are discussed. This case is a very rare.

[Basosquamous carcinoma of the floor of the mouth]. / Carcinoma basaloide-escamoso de suelo de boca.

Basaloid-squamous cell carcinoma is a rare tumor characterized by Wain et al in 1986 as a separate pathological entity. In head and neck more than 100 cases have been reported, with a strong predilection for hypopharynx, base of tongue, and supraglotic larynx. This entity also has been described in nasal cavity, oesophagus, tonsils and oral cavity. Only 14 cases has been reported arising in the floor of the mouth, and none in our literature. We present a new case in floor of the mouth and clinicopathological features are emphasized. We have undertaken moreover a bibliographic review of this uncommon and aggressive neoplasm.

[Hemangiosarcoma of the nasal cavity]. / Hemangiosarcoma de fosas nasales.

Hemangiosarcoma is a rarely diagnosed in the nasal cavity and there are few reports in the ENT literature. The most interesting aspect of our 82-year-old male's case was that he presented all the findings characteristic of angiosarcoma, but the final post-mortem diagnosis was unexpected because of the poor information available until that moment.

[Malignant pleomorphic adenoma of the palate]. / Adenoma pleomorfo maligno del paladar.

Pleomorphic adenoma or mixed tumor is the most common benign neoplasm of the minor salivary glands. These tumors rarely have malignant features. Three varieties are differentiated by histological features and tumor behavior. Whether malignant tumors develop on benign adenomas or are malignant from onset is still not known. A malignant mixed tumor of the minor salivary glands of the palate is reported. The difficulty of histological diagnosis, in spite of immunohistochemical techniques, is emphasized and the surgical treatment is described.

[Acute retinal pigment epitheliitis. Diagnosis using optical coherence tomography]. / Epitelitis pigmentaria retiniana aguda. Diagnóstico mediante tomografía de coherencia óptica.

CASE REPORT: A 17 year-old female presented with a bilateral and acute visual loss. On ophthalmoscopic examination, there was a subfoveal deposit with a vitelliform appearance. Optical coherence tomography revealed a hyperreflective and homogeneous material located at the photoreceptor external segment layer. A month later, vision had spontaneously recovered and macular appearance was normalised. On tomography, the subretinal material had completely disappeared. DISCUSSION: Acute retinal pigment epitheliitis is a rare condition that usually causes a transient visual loss, with a good prognosis in young subjects.