LEFT ATRIAL FUNCTION AND VOLUME BY MAGNETIC RESONANCE IN PATIENTS WITH HEREDITARY AMYLOIDOSIS.

BACKGROUND: Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]). METHODS: All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated. RESULTS: Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions. CONCLUSIONS: Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

[Spontaneous pneumothorax due to pulmonary coccidioidomycosis]. / Neumotórax espontáneo secundario a coccidioidomicosis pulmonar.

Coccidioidomycosis is a systemic infection caused by the soil fungus Coccidioides immitis. It is endemic in northern Mexico and the southwest part of the United States. Radiologic manifestations are varied. Rupture of a coccidioidal pulmonary cavity with subsequent pneumothorax is a rare clinical event, even in endemic areas. We present a case with a brief review of this rare condition.

[Principles and technique of magnetic resonance guided focused ultrasound surgery (MRgFUS) in the treatment of uterine fibroids]. / Principios y técnica de la cirugía con ultrasonido focalizado guiada con resonancia magnética (MRgFUS) en el tratamiento de los miomas uterinos.

Uterine fibroids are a significant source of morbidity for women of reproductive age, and can result in substantial symptoms affecting their quality of life. Definitive treatment has traditionally been a myomectomy, but increasingly women are not prepared to undergo such an invasive procedure for a benign and usually self-limiting condition. Focused ultrasound ablation is one of the least invasive treatment options outside medical therapy and does not require an anesthetic.Magnetic resonance guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging guidance for therapy and thermal feedback provided by magnetic resonance imaging. This paper provides an overview of the MRgFUS technique, including a brief description of the treatment system, guidelines for selection of patients and follow-up, and a comparison with other treatment techniques.

Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease.

Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/µL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.

Bilateral Proximal Forearm Transplantation: Case Report at 7 Years.

BACKGROUND: Although return of function has been reported in patients undergoing proximal forearm transplantations (PFTs), reports of long-term function are limited. In this study, we evaluated the clinical progress and function 7 years postoperatively in a patient who underwent bilateral PFT. CASE PRESENTATION: A 58-year-old man underwent bilateral PFT in May 2012. Transplantation involved all of the flexor and extensor muscles of the forearm. Neurorrhaphies of the median, ulnar, and radial nerves were epineural and 7 cm proximal to the elbow. Immunosuppressive maintenance medications during the first 3 years postoperatively were tacrolimus, mycophenolate, and steroids, and later, tacrolimus, sirolimus, and steroids. Forearm function was evaluated annually using the Disabilities of the Arm, Shoulder, and Hand; Carroll; Hand Transplantation Score System; Short Form-36; and Kapandji scales. We also evaluated his grip and pinch force. RESULTS: Postoperatively, the patient developed hypertriglyceridemia and systemic hypertension. He experienced 6 acute rejections, and none were resistant to steroids. Motor function findings in his right/left hand were: grip strength: 10/13 kg; key pinch: 3/3 kg; Kapandji score: 6/9 of 10; Carroll score: 66/80; Hand Transplantation Score System score: 90/94. His preoperative Disabilities of the Arm, Shoulder, and Hand score was 50 versus 18, postoperatively; his Short Form-36 score was 90. This function improved in relation with the function reported in the second year. CONCLUSIONS: Seven years following PFT, the patient gained limb strength with a functional elbow and wrist, although with diminished digital dexterity and sensation. Based on data presented by other programs and our own experience, PFT is indicated for select patients.

[Multidetector computed tomography of coronary arteries: state of the art. Second part: clinical applications]. / Tomografía computada multidetector de arterias coronarias: estado del arte. Parte II: Aplicaciones clínicas.

At the beginning of the evaluation of Coronary Artery Disease (CAD), Coronary Multidetector Computed Tomography (MDCT) was exclusively used to detect calcified plaques in coronary arteries through the Calcium Score, whose value by itself is limited. Nowadays, thanks to the technological advancements, potential clinical applications, with this method, include detection of coronary arterial stenosis, assessment of coronary bridges, and evaluation of anomalous coronaries. The intraluminal coronary stent evaluation is not possible yet, but this might become possible with the new-generation scanners. At the moment, the published results seem to be promising, nonetheless, the enthusiasm generated by this method should be accompanied by adequate training, as well as by its validation and certification.

[Computer multidetector tomography of coronary arteries. State-of-the-art. Part 1. Technical aspects]. / Tomografía computada multidetector de arterias coronarias: estado del arte. Parte I: aspectos técnicos.

The study of atherosclerotic disease in coronary arteries is fundamental since it is the first cause of death in the Western hemisphere. The gold standard for its diagnosis is invasive angiography, but it contributes to an increase in costs for this group of patients. Nowadays fourth generation computed tomography (CT) equipments can construct acquisition data of up to 256 images in only 400 milliseconds (ms), which is 900 to 1000 times faster than first generation apparatus. CT multidetector (CTMD) is the noninvasive choice diagnosis method for a vascular evaluation of the thorax. Its role in the study of the heart was limited, but today it is possible to obtain three-dimensional heart and whole body images in only seconds. CTMD is a fast, low-cost, noninvasive method that generates cardiac and extra cardiac images without adjacent structure interference. The higher temporal resolution due to an increase of the gantry's rotation and new reconstruction algorithms, as well as its higher spatial resolution and elevated time acquisition due to the presence of more detectors, have permitted CTMD to give significantly better and precise diagnosis of coronary arteries.

[A review of current concepts in evidence-based radiology]. / Conceptos actuales en la radiología basada en evidencias. Revisión.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. " Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.

BACKGROUND: Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire. METHODS: We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012. RESULTS: At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes. CONCLUSIONS: Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.

Left atrial function and volume by magnetic resonance in patients with hereditary amyloidosis

ABSTRACT Background Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]) Methods All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated Results Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions Conclusions Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Radiographic outcome in Hispanic early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs.

OBJECTIVES: To determine rates of incident erosive disease in early rheumatoid arthritis patients, to identify baseline predictors and to evaluate erosion's impact on patient-reported outcomes. METHODS: 82 patients with ≤ 12 months of disease duration, ≥ 3 years of follow-up and conventional treatment were included. Consecutive evaluations assessed swollen and tender joint counts, treatment and comorbidity, acute reactant-phase determinations and patient-reported outcomes. Digitized radiographs of the hands and feet were obtained at baseline and yearly thereafter. RA was defined as erosive when at least one unequivocal cortical bone defect was detected. Descriptive statistics and Cox regression analysis were performed. RESULTS: At baseline, 71 of the patients were ♀, population median (range) age was of 38.7 (16-78.2) years, 58 patients had antibodies and all the patients had active disease and substantial disability. Follow-up cohort was of 299.3 person-years. At last follow-up (49 ± 13.8 months), 28 patients developed erosions. Erosion's location was the feet, in 12 patients. Incident rates of erosive disease at one, two, three and four years were of 8.1, 12.8, 13.8 and 5.6 per 100 person-years, respectively. Higher C-reactive protein (HR: 1.20, 95%CI: 1.04-1.4, p=0.01) and positive antibodies (HR: 5.09, 95%CI: 1.08-23.86, p=0.04) were baseline predictors of incident erosive disease. Erosions had minor impact on patient-reported outcomes. CONCLUSION: Rheumatoid arthritis patients with antibodies and higher C reactive protein at baseline are at risk for incident erosions which appear most frequently at the feet. Up to 1/3 patients conventionally treated develop incident erosions, which minimally impact function.

Hypervascular synovitis and American College of Rheumatology Classification Criteria as predictors of radiographic damage in early rheumatoid arthritis.

UNLABELLED: To investigate if serial clinical and ultrasound evaluations differ between early rheumatoid arthritis patients who do or do not develop erosive disease and to identify predictors of erosions. METHODS: Patients with at least 7 consecutive 2-monthly clinical and 3 consecutive 6-monthly ultrasound evaluations were included. Ultrasound (gray scale and power Doppler) assessed synovitis, power Doppler-positive synovitis (PD+) and power Doppler-negative synovitis (PD-) in each of 14 joints of the dominant hand. After 1 and 2 years, erosive disease was defined according to digitized radiography. Areas under the curve (AUCs) for serial assessments were calculated. Multivariate logistic regression analysis was performed. RESULTS: Seventy-one and 38 patients completed 1- and 2-year consecutive assessments. After 2 years (21.5 +/- 6.2 months), 13 patients developed erosions. At baseline, nonerosive patients had shorter duration of symptoms to RA diagnosis, lower number of the American College of Rheumatology (ACR) classification criteria, lesser synovitis and PD+ synovitis than erosive patients. At follow-up, erosive and nonerosive patients showed similar AUC for clinical, serological, and treatment parameters; erosive patients had higher AUCs for synovitis and PD+ synovitis than nonerosive patients. In the multivariate model, the amount of PD+ synovitis (odds ratio, 1.3; 95% confidence interval, 1.11-1.51; P = 0.001) and more ACR classification criteria (odds ratio, 2.3; 95% confidence interval, 1.05-5.02; P = 0.04), both at baseline, predicted erosive disease. CONCLUSIONS: Serial Power Doppler ultrasonography-assessed synovitis was greater in patients who developed erosions than in those who did not. More power Doppler positive (hypervascular) synovitis and more ACR classification criteria, both at baseline, were the only predictors of erosions.

Cor triatriatum dexter: Uso de resonancia magnética cardiovascular en su diagnóstico a propósito de un caso / Useful of cardiovascular magnetic resonance in diagnosis of cor triatriatum dexter: Case report

El Cor triatriatum dexter es una patología rara, los principales datos obtenidos se han presentado únicamente como reporte de casos posterior al diagnóstico postmortem, así al encontrar esta patología durante el estudio de resonancia magnética de un paciente con estenosis pulmonar severa, que es enviado para valoración de la función ventricular derecha, sin reporte de Cor triatriatum en otros estudios de imagen, parte el interés del análisis y revisión de la literatura. La incidencia de Cor triatriatum dexter comprende aproximadamente el 0.025% de los casos de las cardiopatías congénitas y es el resultado de la persistencia de las valvas embriónicas del seno venoso. Durante el estudio de resonancia en imágenes de spin-eco se observa la membrana que divide la aurícula derecha, además que durante un primer paso de contraste se corrobora que esta membrana está fenestrada al observar flujo turbulento entre la aurícula verdadera y la falsa, además de que la resonancia magnética permitió la adecuada evaluación de la función ventricular derecha. Aunque el Cor triatriatum es poco común, suele acompañar a la estenosis pulmonar, la resonancia magnética permitió su adecuada evaluación gracias a su resolución, con lo que podemos confirmar su importancia en la valoración de cardiopatías congénitas.

The Cor triatriatum dexter is a strange pathology, the main data have been obtained only like case report postmortem study, when we find this pathology during the magnetic resonance study of a patient with severe pulmonary stenosis, who were send for evaluation of right ventricular function, without report of Cor triatriatum in other image studies, it increase the interest of the analysis and revision of the literature. The incidence of Cor triatriatum dexter is approximately 0.025% of the cases of the congenital heart disease and it is the result of the persistence of the embryonic valve of the venous sine. During the magnetic resonance study, in images of spin-echo is observed the membrane that divides the right atrium, also that during a first-pass contrast is corroborated that this membrane is fenestrated when observing turbulent flow among the true atrium and the false one, besides that the magnetic resonance allowed the appropriate evaluation of the right ventricular function. Although the Cor triatriatum is not very common it usually accompanies the pulmonary stenosis, the magnetic resonance allowed its appropriate evaluation thanks to its resolution, we can confirm its importance in the valuation of congenital heart disease.

Tomografía computada multidetector de arterias coronarias: estado del arte. Parte II: Aplicaciones clínicas / Multidetector computed tomography of coronary arteries: state of the art. Second part: clinical applications

At the beginning of the evaluation of Coronary Artery Disease (CAD), Coronary Multidetector Computed Tomography (MDCT) was exclusively used to detect calcified plaques in coronary arteries through the Calcium Score, whose value by itself is limited. Nowadays, thanks to the technological advancements, potential clinical applications, with this method, include detection of coronary arterial stenosis, assessment of coronary bridges, and evaluation of anomalous coronaries. The intraluminal coronary stent evaluation is not possible yet, but this might become possible with the new-generation scanners. At the moment, the published results seem to be promising, nonetheless, the enthusiasm generated by this method should be accompanied by adequate training, as well as by its validation and certification.

Conceptos actuales en la radiología basada en evidencias: revisión / A review of current concepts in evidence-based radiology

La medicina basada en evidencias (MBE) se fundamenta en un descubrimiento sistemático, evaluación crítica y utilización de la investigación actual publicada en la literatura médica, para la toma de decisiones referentes al cuidado de un paciente individual o políticas de salud. En la radiología (incluyendo sus ramas diagnóstica y terapéutica), los principios y práctica de una MBE han recibido atención limitada. En esta breve revisión, presentamos algunos conceptos básicos de cómo implementar una radiología basada en evidencias y los conceptos y etapas de la MBE y el metaanálisis con enfoque en la radiología basada en evidencias. Se identifican las aplicaciones de ésta en la práctica, la educación y la investigación, y las habilidades requeridas. La aplicación de los principios de la MBE en el diagnóstico por imagen facilita la interpretación de los estudios y sustenta una evaluación bien dirigida. Esta revisión será útil para radiólogos en cualquier etapa de su entrenamiento o desarrollo profesional, con el fin de estimular una práctica radiológica basada en evidencias, especialmente en países en desarrollo.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough." Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Tomografía computada multidetector de arterias coronarias: estado del arte. Parte I: aspectos técnicos / Computer multidetector tomography of coronary arteries: state-of-the-art. Part 1: technical aspects

The study of atherosclerotic disease in coronary arteries is fundamental since it is the first cause of death in the Western hemisphere. The gold standard for its diagnosis is invasive angiography, but it contributes to an increase in costs for this group of patients. Nowadays fourth generation computed tomography (CT) equipments can construct acquisition data of up to 256 images in only 400 milliseconds (ms), which is 900 to 1000 times faster than first generation apparatus. CT multidetector (CTMD) is the noninvasive choice diagnosis method for a vascular evaluation of the thorax. Its role in the study of the heart was limited, but today it is possible to obtain three-dimensional heart and whole body images in only seconds. CTMD is a fast, low-cost, noninvasive method that generates cardiac and extra cardiac images without adjacent structure interference. The higher temporal resolution due to an increase of the gantry's rotation and new reconstruction algorithms, as well as its higher spatial resolution and elevated time acquisition due to the presence of more detectors, have permitted CTMD to give significantly better and precise diagnosis of coronary arteries.

Enfermedad quística de la vía biliar: diagnóstico por imagen / Imaging of cystic disease of the biliary tree

La enfermedad quística de la vía biliar también llamada quiste del colédoco, es una enfermedad rara en países occidentales, prevaleciendo en países orientales como Japón y China. Puede ser detectada por ultrasonido, tomografía computada y resonancia magnética, sin embargo, la colangiografía directa por vía percutánea o endoscópica es el método de elección para hacer el diagnóstico. En este trabajo, los autores describen los tipos anatómicos de enfermedad quística de la vía biliar con sus hallazgos de imagen y se propone añadir a la clasificación un sexto tipo que llamamos VI

Manifestaciones en la imagen de los trastornos gastrointestinales en los pacientes con SIDA / Imaging of gastrointestinal manifestations of AIDS

Se realizó una revisión de las alteraciones del aparato digestivo en los pacientes con SIDA, con el objeto de presentar las manifestaciones por imagen más frecuentes en este grupo de pacientes. El tracto gastrointestinal es el órgano blanco más frecuentemente afectado por los microorganismos oportunistas, después del aparato respiratorio cuando existe afección del duodeno, debe sospecharse infección por Cryptosporidium; éste, junto con el Cytomegalovirus en menor frecuencia, son los dos microorganismos responsables de la colangitis relacionada con el SIDA. La colitis por Cytomegalovirus, es la única en los pacientes con SIDA; la afección focal del hígado por linfoma, es cuatro veces más frecuente en los pacientes con el Síndrome de Inmunodeficiencia Adquirida, comparándose con el linfoma no relacionado con el SIDA. En la infiltración difusa del hígado o del bazo por linfoma, los focos menores de un centímetro son mejor demostrados por el ultrasonido que por tomografía computada. Debido a la alta frecuencia de adenopatía retroperitoneal o mesentérica en los pacientes con SIDA, la tomografía computada es el método primario de evaluación importante en la mayoría de los pacientes.