Improved predictive diagnosis of diabetic macular edema based on hybrid models: An observational study.

Diabetic Macular Edema (DME) is the most common sight-threatening complication of type 2 diabetes. Optical Coherence Tomography (OCT) is the most useful imaging technique to diagnose, follow up, and evaluate treatments for DME. However, OCT exam and devices are expensive and unavailable in all clinics in low- and middle-income countries. Our primary goal was therefore to develop an alternative method to OCT for DME diagnosis by introducing spectral information derived from spontaneous electroretinogram (ERG) signals as a single input or combined with fundus that is much more widespread. Baseline ERGs were recorded in 233 patients and transformed into scalograms and spectrograms via Wavelet and Fourier transforms, respectively. Using transfer learning, distinct Convolutional Neural Networks (CNN) were trained as classifiers for DME using OCT, scalogram, spectrogram, and eye fundus images. Input data were randomly split into training and test sets with a proportion of 80 %-20 %, respectively. The top performers for each input type were selected, OpticNet-71 for OCT, DenseNet-201 for eye fundus, and non-evoked ERG-derived scalograms, to generate a combined model by assigning different weights for each of the selected models. Model validation was performed using a dataset alien to the training phase of the models. None of the models powered by mock ERG-derived input performed well. In contrast, hybrid models showed better results, in particular, the model powered by eye fundus combined with mock ERG-derived information with a 91 % AUC and 86 % F1-score, and the model powered by OCT and mock ERG-derived scalogram images with a 93 % AUC and 89 % F1-score. These data show that the spontaneous ERG-derived input adds predictive value to the fundus- and OCT-based models to diagnose DME, except for the sensitivity of the OCT model which remains the same. The inclusion of mock ERG signals, which have recently been shown to take only 5 min to record in daylight conditions, therefore represents a potential improvement over existing OCT-based models, as well as a reliable and cost-effective alternative when combined with the fundus, especially in underserved areas, to predict DME.

Hipertensión arterial: tratamiento con valsartán y valsartán/hidroclorotiazida / Treatment of high blood pressure with Valsartan and Valsartan with Hydrochlorothiazide

Objetivo: evaluar la eficacia y seguridad de valsartán y valsartán/hidroclorotiazida para el tratamiento de la hipertensión arterial leve y moderada. Material y métodos: estudio abierto, prospectivo. A 95 pacientes entre 18 a 80 años de edad con hipertensión leve y moderada, se les indicó suspender el tratamiento farmacológico anti-hipertensivo durante dos semanas. Al terminar dicho periodo, 76 fueron tratados durante cuatro semanas con 80 mg de valsartán al día. Los pacientes que alcanzaron presión arterial diastólica (PAD) < 90 mm Hg se mantuvieron con el mismo esquema terapéutico cuatro semanas más; los demás cambiaron a una combinación de 80 mg de valsartán + 12.5 mg de hidroclorotiazida, por cuatro semanas.Resultados: en la cuarta semana, 63 por ciento de los pacientes tratados con valsartán alcanzaron < 90 mm Hg; tres pacientes salieron del estudio en esta etapa y 25 recibieron la combinación durante cuatro semanas. En la visita final todos los pacientes alcanzaron PAD < 90 mm Hg. Ambos tratamientos lograron disminuciones significativas de la presión arterial. Un paciente en el grupo de terapia combinada abandonó el seguimiento. No se informaron alteraciones en las pruebas de laboratorio.Conclusiones: 80 mg de valsartán al día son eficaces en más de 60 por ciento de los pacientes con hipertensión leve y moderada. La combinación con hidroclorotiazida es eficaz en quienes no responden a un solo fármaco. Ambos esquemas son seguros.

Ureteropelvic urinary extravasation due to iliac artery aneurysm.

We report a case of left-sided hydronephrosis and ureteropelvic urinary extravasation due to a large left iliac artery aneurysm. Urinoma was diagnosed preoperatively by contrast-enhanced computed tomography. The patient was successfully treated by percutaneous nephrostomy and ureteral double J stent placement followed by staged operative repair.

Hereditary telangiectasia and multiple pulmonary arteriovenous fistulas. Clinical deterioration during pregnancy.

We describe the effect of pregnancy on a woman with multiple pulmonary arteriovenous fistula. Pregnancy was terminated at 35 weeks' gestation because of severe hypoxemia. During the early postpartum period, the intrapulmonary shunt fraction enlarged, and hypoxemia worsened, necessitating emergency resection of the A-V fistula. Pregnancy may increase the intrapulmonary shunt fraction in patients with multiple pulmonary arteriovenous fistula through its effect on plasma volume and produce life-threatening hypoxemia near term or in the early postpartum period.

Mediastinal cutaneous fistulae arising as a complication of major cardiac surgery: the value of sinography and injection of methylene blue in their radical excision and immediate repair.

The management of chronic sternal wound infections is a difficult problem. Fistulography can be extremely useful in defining the extent of the infection. Staining the fistula with methylene blue aids the surgeon in the operative dissection and removal of infected material. A technique of reconstruction is described using an omental flap to fill in the retrosternal space and partially de-epithelialised pectoralis major myocutaneous flaps to cover the sternum.

Management of fusiform ascending aortic aneurysms.

Thirteen patients had elective surgical treatment of fusiform ascending aortic aneurysms at Strong Memorial and Rochester General Hospitals from 1970 to 1978. There were 8 men and 5 women ranging in age from 51 to 78 years (mean, 61 years). Nine patients underwent composite tube graft and aortic valve replacement, 3 had aortic valve replacement plus supracoronary tube grafts, and 1 had aortic valve replacement plus aneurysmorrhaphy. Coronary reimplantation alone or combined with saphenous vein bypasses was fashioned in 10 patients. Potassium cardioplegia was considered a useful adjunct in 6 patients. Two early deaths accounted for an operative mortality of 15.4%. There were 3 late deaths. Eight patients are alive and well 2 to 109 months after operation.