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1.
Graefes Arch Clin Exp Ophthalmol ; 261(11): 3097-3111, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37103622

RESUMEN

PURPOSE: To provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK). METHODS: A literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review. RESULTS: Complications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome. CONCLUSION: It is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes.

2.
Eur J Nucl Med Mol Imaging ; 48(8): 2466-2475, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33416957

RESUMEN

AIM: Total thyroidectomy and risk-adapted 131-radioiodine therapy (RaIT) are the treatments of choice in differentiated thyroid cancer (DTC) patients. The response to treatments is assessed 6-12 months after RaIT. However, thyroglobulin (Tg) values obtained just before RaIT also provide reliable informations on patients'outcome. As available data were mostly obtained in hypothyroid status, we evaluated the predictive role of preablation-Tg in patients underwent RaIT after rhTSH stimulation. MATERIAL AND METHODS: We enrolled 299 low-to-intermediate risk DTC patients underwent rhTSH-stimulated RaIT (standard protocol). Serum Tg levels were measured before rhTSH administration (basal Tg), before RaIT (early-stimulated Tg), and 2 days after RaIT (late-stimulated Tg). The early response assessment was done 12 months after RaIT according to 2015 American Thyroid Association (2015 ATA) criteria. RESULTS: Most patients (277/299, 92.6%) had an excellent response (ER) to RaIT, while 15/299 (5.1%) and 7/299 (2.3%) patients showed biochemical incomplete/indeterminate response or persistent structural disease, respectively. At receiver operating characteristic analysis, the optimal cutoff to predict ER was set at 1.55 (AUC = 0.792), 2.6 (AUC = 0.931), and 4.9 (AUC = 0.874) ng/mL, for basal, early-, and late-stimulated Tg, respectively. The overall sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for basal, early-, and late-stimulated Tg were 50%, 96.7%, 93.3%, 55%, and 96.1%; 90.9%, 84.5%, 84.9%, 31.7%, and 99.1%; and 90.9%, 71.8%, 73.2%, 20.4%, and 99%, respectively. In univariate and multivariate logistic regression analysis, early-stimulated Tg cutoff resulted as an independent prognostic marker for predicting ER regardless of gender, age, histotype, histological variant, tumor size, risk classification, and stage of disease. CONCLUSION: Early-stimulated Tg is a reliable diagnostic tool for predicting the response to primary treatment of DTC.


Asunto(s)
Neoplasias de la Tiroides , Tirotropina Alfa , Humanos , Radioisótopos de Yodo , Tiroglobulina , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tirotropina
3.
J Cell Physiol ; 233(3): 1791-1795, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28696030

RESUMEN

BAG3 is a member of human BAG (Bcl-2-associated athanogene) proteins and plays a role in apoptosis, cell adhesion, cytoskeleton remodeling, and autophagy. The aim of this study was to evaluate BAG3 levels in healthy subjects, hypertensive patients, and hypertensive diabetic patients. We enrolled 209 Caucasian adults, of both sex, 18-75 years of age, 77 were healthy controls, 62 were affected by hypertension, and 70 were affected by hypertension and type 2 diabetes. All patients underwent an assessment that included medical history, physical examination, vital signs, a 12-lead electrocardiogram, measurements of systolic (SBP), and diastolic blood pressure (DBP), heart rate (HR), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c ), triglycerides (TG), transaminases, high sensitivity C-reactive protein (Hs-CRP), and BAG3. We observed higher blood pressure values in hypertensive, and hypertensive diabetic patients compared to controls. As expected, FPG and HbA1c were higher in diabetic hypertensive patients, compared to the other two groups. No Tg levels differences were recorded among the three groups. Hs-CRP was higher in diabetic hypertensive patients compared to healthy subjects. Finally, BAG3 levels were higher in hypertensives, and hypertensive diabetic patients compared to controls. We observed higher levels of BAG3 in hypertensive patients compared to healthy controls, and even higher levels in hypertensive diabetic patients compared to healthy subjects. This paper could be the first of a long way to identify potential involvement of deregulated BAG3 levels in cardiometabolic diseases.


Asunto(s)
Proteínas Adaptadoras Transductoras de Señales/metabolismo , Proteínas Reguladoras de la Apoptosis/metabolismo , Diabetes Mellitus Tipo 2/fisiopatología , Hipertensión/fisiopatología , Adolescente , Adulto , Anciano , Glucemia/metabolismo , Presión Sanguínea/fisiología , Proteína C-Reactiva/metabolismo , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
4.
Int J Mol Sci ; 18(3)2017 03 06.
Artículo en Inglés | MEDLINE | ID: mdl-28272312
5.
Int J Mol Sci ; 18(2)2017 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-28178209

RESUMEN

The aim of this study was to evaluate the efficacy and safety of an anti-hypercholesterolemic agent containing Berberis aristata, Silybum marianum and monacolin K and KA in a sample of Caucasian patients at low cardiovascular risk according to Framingham score. The primary outcome was to evaluate the effects of this nutraceutical combination on lipid profile; the secondary outcome was to evaluate the effect on some inflammatory markers, in particular high sensitivity C-reactive protein and tumor necrosis factor-α interleukin-6. One hundred and forty-three patients were randomized to placebo or Berberol® K, once a day, during the dinner, for 3 months, in a randomized, double-blind, placebo-controlled trial. We recorded a significant reduction of fasting plasma glucose with Berberol® K compared to placebo (-12.2%, p < 0.05). Moreover, we recorded an increase of fasting plasma insulin with Berberol® K both compared to baseline and to placebo (+9.9%, p < 0.05). Accordingly, the homeostasis model assessment (HOMA) index obtained after treatment with Berberol® K was lower than the one in the placebo group (-2.8%, p < 0.05). No variations of lipid profile were observed with placebo, while there was a significant decrease of total cholesterol (-20.5%, p < 0.05), triglycerides (-17.7%, p < 0.05), and low density lipoprotein (LDL) cholestero (-27.8%, p < 0.05) with Berberol® K, compared to placebo. There was a decrease of high sensitivity C-reactive protein (-30.8%, p < 0.05), and interleukin-6 (-25.0%, p < 0.05), with Berberol® K compared to placebo. In conclusion, combining different hypocholesterolemic nutraceutical agents such as Berberis aristata, Silybum marianum and monacolin K and KA could be effective and safe to obtain a reduction of lipid profile and an improvement of inflammatory parameters.


Asunto(s)
Anticolesterolemiantes/administración & dosificación , Enfermedades Cardiovasculares/tratamiento farmacológico , Lovastatina/administración & dosificación , Extractos Vegetales/administración & dosificación , Adulto , Berberis/química , Biomarcadores , Glucemia , Enfermedades Cardiovasculares/metabolismo , Combinación de Medicamentos , Femenino , Humanos , Mediadores de Inflamación/metabolismo , Insulina/metabolismo , Lípidos/sangre , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
6.
Int J Mol Sci ; 17(11)2016 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-27801825

RESUMEN

The aim of this study was to evaluate the effect of a food supplement containing α-lipoic acid and of a placebo on glyco-metabolic control and on oxidative stress markers in type 2 diabetics. We randomized 105 diabetics to either a supplementation containing 600 mg of α-lipoic acid, 165 mg of L-carnosin, 7.5 mg of zinc, and vitamins of group B, or a placebo, for three months. We evaluated body mass index, fasting plasma glucose (FPG), post-prandial-glucose (PPG), glycated hemoglobin (HbA1c), fasting plasma insulin (FPI), HOMA-index (HOMA-IR), lipid profile, high sensitivity C-reactive protein (Hs-CRP), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA). There was a reduction of FPG, PPG, and HbA1c with the food supplement containing α-lipoic acid compared with a baseline, and with the placebo. Concerning lipid profile, we observed a reduction of LDL-C, and Tg with the food supplement, compared with both the baseline, and the placebo. There was a reduction of Hs-CRP with the food supplement containing α-lipoic acid, both compared with the baseline and the placebo. An increase of SOD, and GSH-Px, and a decrease of MDA were reached by the food supplement containing α-lipoic acid, both compared with the baseline and the placebo. We can conclude that the food supplement containing α-lipoic acid, L-carnosin, zinc, and vitamins of group B improved glycemic control, lipid profile, and anti-oxidative stress markers.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Suplementos Dietéticos , Inflamación/dietoterapia , Estrés Oxidativo/efectos de los fármacos , Adulto , Biomarcadores/sangre , Glucemia , Índice de Masa Corporal , Peso Corporal , Proteína C-Reactiva/metabolismo , Carnosina/administración & dosificación , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/patología , Femenino , Glutatión Peroxidasa/sangre , Hemoglobina Glucada/metabolismo , Humanos , Inflamación/sangre , Inflamación/patología , Resistencia a la Insulina/genética , Metabolismo de los Lípidos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Ácido Tióctico/administración & dosificación , Zinc/administración & dosificación
7.
Mediators Inflamm ; 2013: 971758, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24288446

RESUMEN

Cystoid macular oedema (CMO) is a major cause of reduced vision following intraocular surgery. Although the aetiology of CMO is not completely clarified, intraocular inflammation is known to play a major role in its development. The macula may develop cytotoxic oedema when the primary lesion and fluid accumulation occur in the parenchymatous cells (intracellular oedema) or vasogenic oedema when the primary defect occurs in the blood-retinal barrier and leads to extracellular fluid accumulation (extracellular oedema). We report on the mechanisms of CMO formation after pars plana vitrectomy and associated surgical procedures and discuss possible therapeutic approaches.


Asunto(s)
Inflamación/patología , Edema Macular/etiología , Edema Macular/inmunología , Vitrectomía/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Barrera Hematorretinal , Extracción de Catarata/efectos adversos , Humanos , Cristalino/cirugía , Edema Macular/prevención & control , Retina/cirugía , Siliconas/química , Uveítis/cirugía
8.
Eur J Ophthalmol ; 33(5): 1892-1897, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36809907

RESUMEN

PURPOSE: To evaluate the difference in Descemet Membrane Endothelial Keratoplasty (DMEK) graft detachment rate comparing superior versus temporal main incision approach. METHODS: Retrospective comparative study on patients who underwent DMEK surgery for Fuchs endothelial dystrophy or bullous keratopathy with main wound incision performed at either 90° in the superior approach, or at 180°/0° in the temporal approach. All main incisions were secured with a single 10-0 nylon suture at the end of surgery. Data collected were donor age and gender, endothelial cell counts, graft diameter, recipient age and gender, indication for transplant, surgeon grade, re-bubbling rate, air fill in the anterior chamber (AC) at day one and intra- and early postoperative complications. RESULTS: 187 eyes were included in the study. 99 eyes had DMEK surgery with superior approach, while 88 eyes had temporal approach. The two groups had no differences in donor age and sex, endothelial cell counts, graft diameter, recipient age and sex, indication for transplant, surgeon grade, and air fill in the anterior chamber at day one. Re-bubbling rate was 38.4% for surgeries performed with superior access and 29.5% for those with temporal access(p = 0.186). After exclusion of patients with intraoperative and/or postoperative complication, the difference in re-bubbling rate was higher, although non-significant (37.5% and 25% for superior and temporal approach respectively, p = 0.098). CONCLUSION: The temporal approach in DMEK showed a trend towards a clinically significant lower rate of post-operative re-bubbling compared to the superior approach, however, no statistically significant difference was noted comparing the two approaches, which both remain feasible options in DMEK surgery.


Asunto(s)
Queratoplastia Endotelial de la Lámina Limitante Posterior , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Queratoplastia Endotelial de la Lámina Limitante Posterior/efectos adversos , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Lámina Limitante Posterior , Endotelio Corneal/trasplante , Distrofia Endotelial de Fuchs/cirugía , Agudeza Visual , Supervivencia de Injerto , Resultado del Tratamiento
9.
Eur J Ophthalmol ; 33(5): NP60-NP62, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36163691

RESUMEN

PURPOSE: To report a case of sutureless scleral-fixated (SSF) Carlevale intraocular lens (IOL) opacification following Descemet stripping automated endothelial keratoplasty (DSAEK) surgery. METHODS: An 82-year-old man underwent combined SSF Carlevale IOL implant and DSAEK surgery for aphakic endothelial decompensation. Surgery was uneventful, while the postoperative period was complicated by multiple graft detachments requiring re-bubbling. After four re-bubbling procedures, the corneal graft attached and cleared over time. RESULTS: 29 months after combined SSF IOL implant and DSAEK surgery, the patient presented with decreased vision due to IOL opacification affecting the visual axis. CONCLUSION: Although combined SSF IOL and DSAEK surgery is an overall safe and effective procedure for aphakic endothelial decompensation, risk of IOL opacification due to anterior chamber air injection is higher when using hydrophilic IOLs and in cases requiring multiple re-bubbling, therefore, intraocular lens material should be chosen after considering the risks and benefits.


Asunto(s)
Queratoplastia Endotelial de la Lámina Limitante Posterior , Lentes Intraoculares , Facoemulsificación , Masculino , Humanos , Anciano de 80 o más Años , Implantación de Lentes Intraoculares/efectos adversos , Queratoplastia Endotelial de la Lámina Limitante Posterior/efectos adversos , Lentes Intraoculares/efectos adversos , Complicaciones Posoperatorias , Facoemulsificación/efectos adversos , Trastornos de la Visión , Estudios Retrospectivos
10.
Eur J Ophthalmol ; 33(4): 1746-1749, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36799549

RESUMEN

PURPOSE: To report how to manage and prevent the incomplete laser cut and following uncut tags of anterior capsular lens, performed using the selective laser capsulotomy. METHODS: We describe three possible approaches: peeling the anterior capsulotomy disc with forceps, breaking the tags using the cystotomy needle tip, or cutting them using a 23-G vitrectomy scissors. RESULTS: Using the 23-G vitrectomy scissors resulted in no complication. Peeling the anterior capsulotomy using the forceps instead caused zonular stress with subsequent risks of zonular dialysis, whereas using the cystotomy needle tip resulted in irregular capsulotomy rim and weakness all along the capsulotomy edge where micro tears caused a tear during the rest of cataract surgery. CONCLUSION: Incomplete laser cut and subsequent discontinuous capsulotomy results in the presence of multiple tags which create strong adherence between the central capsulotomy disc and the peripheral capsule. Key steps of the procedure to prevent an incomplete laser cut, which are the anterior lens capsule staining and laser beam focusing, and how to correctly manage them, which may shorten the learning curve and enhance the outcomes.


Asunto(s)
Cápsula Anterior del Cristalino , Extracción de Catarata , Terapia por Láser , Humanos , Capsulorrexis/métodos , Terapia por Láser/métodos , Extracción de Catarata/efectos adversos , Extracción de Catarata/métodos , Cápsula Anterior del Cristalino/cirugía , Rayos Láser
11.
BioTech (Basel) ; 12(2)2023 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-37366796

RESUMEN

The ocular surface is a complex structure that includes cornea, conjunctiva, limbus, and tear film, and is critical for maintaining visual function. When the ocular-surface integrity is altered by a disease, conventional therapies usually rely on topical drops or tissue replacement with more invasive procedures, such as corneal transplants. However, in the last years, regeneration therapies have emerged as a promising approach to repair the damaged ocular surface by stimulating cell proliferation and restoring the eye homeostasis and function. This article reviews the different strategies employed in ocular-surface regeneration, including cell-based therapies, growth-factor-based therapies, and tissue-engineering approaches. Dry eye and neurotrophic keratopathy diseases can be treated with nerve-growth factors to stimulate the limbal stem-cell proliferation and the corneal nerve regeneration, whereas conjunctival autograft or amniotic membrane are used in subjects with corneal limbus dysfunction, such as limbal stem-cell deficiency or pterygium. Further, new therapies are available for patients with corneal endothelium diseases to promote the expansion and migration of cells without the need of corneal keratoplasty. Finally, gene therapy is a promising new frontier of regeneration medicine that can modify the gene expression and, potentially, restore the corneal transparency by reducing fibrosis and neovascularization, as well as by stimulating stem-cell proliferation and tissue regeneration.

12.
Surv Ophthalmol ; 68(4): 794-808, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36379301

RESUMEN

Congenital aniridia is a rare, panocular disorder with a main phenotypic characteristic of a partial or complete absence of the iris existing alongside other ocular morbidities such as cataract, keratopathy, optic nerve and foveal hypoplasia, and nystagmus. The iris abnormality, however, often leads to symptoms such as photophobia, glare, and decreased visual acuity, as well as cosmetic dissatisfaction. Current management options for the iris deficit include colored iris contact lenses, corneal tattooing, and tinted contact lenses. Symptoms arising from small iris defects can be resolved with surgical management using micro-tying suture techniques such as McCannel or Siepser. Currently, larger iris defects can be treated with artificial iris implants. New prosthetic options range from colored intraocular lenses to flexible custom-made silicone iris implants. With a range of therapeutic options available and given the challenges of multiple comorbidities in aniridia, we evaluate the literature relating to the use of artificial iris implants in congenital aniridia, with a focus on the different surgical implantation techniques, the clinical outcomes achieved, complications occurred, and risk of bias of the studies included.


Asunto(s)
Aniridia , Lentes Intraoculares , Humanos , Agudeza Visual , Aniridia/cirugía , Aniridia/complicaciones , Iris/cirugía , Lentes Intraoculares/efectos adversos , Implantación de Prótesis/efectos adversos , Trastornos de la Visión/etiología
13.
Acta Ophthalmol ; 101(2): e205-e214, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36120722

RESUMEN

PURPOSE: To evaluate anterior segment optical coherence tomography (AS-OCT) features of Descemet's membrane endothelial keratoplasty (DMEK) grafts associated with graft attachment worsening over time. METHODS: Retrospective case series on patients who received uncomplicated DMEK surgery and for whom subsequent AS-OCT data were available for analysis. Patients' demographics and surgical details were collected. AS-OCT was analysed for graft detachment axial extension, presence of posterior stromal ripples, quadrant involvement (location and number), degree of detachment extension, peripheral roll, presence and amount of air in the anterior chamber (AC). Features associated with re-bubbling and graft detachment worsening over time were identified. RESULTS: A total of 147 patients with a mean age of 70.8 ± 9.8 years (63% females) were included. AS-OCT was performed at 2.9 ± 2.4 days after surgery. AS-OCT factors associated with re-bubbling were posterior stromal ripples (p = 0.004) and detachment axial extension (p < 0.001). At first follow-up, of the 147 DMEK, 67 showed complete attachment and 80 partial detachment. In those cases of initially completely attached grafts, posterior stromal ripples were associated with the risk of subsequent graft detachment (p = 0.014) together with recipient age (p = 0.043), phaco-combined surgery (p = 0.018) and AS-OCT timing (p = 0.033); while, in the initially partially detached grafts, detachment worsening was associated with posterior stromal ripples (p = 0.025), detachment axial extension (p = 0.003), degrees of detachment involvement (p = 0.029), peripheral roll-in shape (p = 0.033) and presence of air in the AC (p = 0.032). Relative risk (RR) of graft detachment worsening in patients with moderate/severe posterior stromal ripples was 1.75 (95% CI = 1.09-2.81). CONCLUSION: Posterior stromal ripples and detachment axial extension >1/3 of graft surface area were the main risk factors for detachment worsening over time, and patients showing these features should be monitored closely to identify the need for re-bubbling at an early stage, thus improving surgical outcomes.


Asunto(s)
Lámina Limitante Posterior , Queratoplastia Endotelial de la Lámina Limitante Posterior , Femenino , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Lámina Limitante Posterior/cirugía , Estudios Retrospectivos , Queratoplastia Endotelial de la Lámina Limitante Posterior/efectos adversos , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Agudeza Visual , Cámara Anterior , Endotelio Corneal/trasplante
14.
J Clin Med ; 12(10)2023 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-37240568

RESUMEN

Astigmatism is a visually significant condition that can develop after keratoplasty. The management of post-keratoplasty astigmatism can be performed both when transplant sutures are in place and when they have been removed. Fundamental for astigmatism management is its identification and characterization in terms of type, amount, and direction. Commonly, post-keratoplasty astigmatism is evaluated through corneal tomography or topo-aberrometry; however, many other techniques can be used in case these instruments are not readily available. Here, we describe several low-tech and high-tech techniques used for post-keratoplasty astigmatism detection in order to quickly understand if it contributes to low vision quality and to determine its characteristics. The management of post-keratoplasty astigmatism through suture manipulation is also described.

15.
Acta Ophthalmol ; 101(1): e14-e25, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35751171

RESUMEN

Descemet membrane endothelial keratoplasty (DMEK) is a popular procedure for the treatment of corneal endothelial diseases mainly targeting Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). Although DMEK has multiple advantages, it is challenging in terms of graft preparation and delivery. One of the crucial factors of DMEK graft preparation is determining the size of the graft. Evaluating risks and benefits of transplanting larger or smaller grafts compared with the descemetorhexis performed following a standard DMEK procedure thus becomes important. Advanced techniques like pre-loaded DMEK requires pre-selection of graft diameter without physical examination of the eye making it more challenging. Therefore, recognizing the benefits of graft size and the number of transplanted endothelial cells becomes essential. Smaller DMEK grafts have been preferred and accepted for grafting. Larger diameter grafts have advantages but can be challenging due to higher detachment rates. We thus aim to review the challenges of preparing and delivering DMEK tissues with small or large diameter based on selected descemetorhexis area, discuss the outcomes based on different graft sizes, highlight related complications and suggest which cases may benefit from adopting smaller or larger graft size.


Asunto(s)
Queratoplastia Endotelial de la Lámina Limitante Posterior , Distrofia Endotelial de Fuchs , Humanos , Lámina Limitante Posterior/cirugía , Endotelio Corneal/cirugía , Células Endoteliales , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Agudeza Visual , Distrofia Endotelial de Fuchs/cirugía , Estudios Retrospectivos
16.
Cancers (Basel) ; 15(8)2023 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-37190170

RESUMEN

Background: In differentiated thyroid cancer (DTC) patients, the response to initial treatments is evaluated 6-12 months after radioiodine therapy (RIT) according to the 2015 American Thyroid Association (2015 ATA) criteria. In selected patients, diagnostic 131-radioiodine whole-body scintigraphy (Dx-WBS) is recommended. We evaluated the diagnostic performance of 123I-Dx-WBS-SPECT/CT imaging in detecting incomplete structural responses in the early follow-up of DTC patients and, additionally, derived optimized basal-Tg value as a yardstick for scintigraphic imaging. Methods: We reviewed the records of 124 low or intermediate-risk DTC patients with negative anti-thyroglobulin antibody. All patients had undergone (near)-total-thyroidectomy followed by RIT. The response to initial treatments was evaluated 6-12 months after RIT. Results: According to the 2015 ATA criteria, 87, 19 and 18 DTC patients were classified to have excellent response (ER), indeterminate/incomplete biochemical response (BIndR/BIR) or structural incomplete response (SIR), respectively. Among patients with less than ER, 18 had a positive 123I-Dx-WBS-SPECT/CT. Metastatic disease at 123I-Dx-WBS-SPECT/CT mainly involved lymph nodes within the central compartment, and corresponding neck ultrasound examinations were negative. The ROC curve analysis was performed to define the best basal-Tg cut-off (i.e., 0.39 ng/mL; AUC = 0.852) able to discriminate patients with and without positive 123I-Dx-WBS-SPECT/CT, respectively. The overall sensitivity, specificity, accuracy, PPV and NPV were 77.8%, 89.6%, 87.9%, 56.0% and 95.9%, respectively. Basal-Tg cut-off was an independent risk factor for having a positive 123I-Dx-WBS-SPECT/CT. Conclusion:123I-Dx-WBS-SPECT/CT identified lymph node metastases in 14/37 patients with less than ER and a negative neck ultrasound, thus modifying the management of such patients. The diagnostic performance of 123I-Dx-WBS-SPECT/CT significantly increased in patients with basal-Tg values ≥ 0.39 ng/mL.

17.
Surv Ophthalmol ; 68(6): 1129-1152, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37392969

RESUMEN

Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of the Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques, such as faster visual rehabilitation, better final visual acuity due to minimal optical interface effects, lower risk of allograft rejection, and less long-term dependence on topical steroids. Despite all its advantages, DMEK has been found to be more challenging than other corneal transplantation techniques, and its steep learning curve appears to be an obstacle to its widespread use and adoption by corneal surgeons worldwide. DMEK surgical training laboratories (wet labs) provide a window of opportunity for surgeons to learn, prepare, manipulate, and deliver these grafts in a risk-free environment. Wet labs are a significant learning tool, especially for those institutions that have limited tissue availability in their local centers. We provide a step-by-step guide for preparing DMEK grafts using different techniques on human and nonhuman models with instructional videos. This article should eventually help the trainees and the educators understand the requirements for performing DMEK and conducting a DMEK wet lab and develop their skills and interests from a wide variety of available techniques.


Asunto(s)
Enfermedades de la Córnea , Queratoplastia Endotelial de la Lámina Limitante Posterior , Humanos , Lámina Limitante Posterior/cirugía , Laboratorios , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Córnea/cirugía , Endotelio Corneal/cirugía , Enfermedades de la Córnea/cirugía
18.
Diagnostics (Basel) ; 13(6)2023 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-36980482

RESUMEN

Prostate cancer (PCa) is the most frequently diagnosed cancer worldwide and the second most common cause of cancer-related deaths among men. Progress in molecular imaging has magnified its clinical management; however, an unmet clinical need involves the identification of new imaging biomarkers that complement the gold standard of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) in cases of clinically significant PCa that do not express PSMA. Fibroblast activation protein (FAP) is a type II transmembrane serine overexpressed in many solid cancers that can be imaged through quinoline-based PET tracers derived from an FAP inhibitor (FAPi). Preliminary results of FAPi application in PCa (in PSMA-negative lesions, and in comparison with fluorodeoxyglucose-FDG) are now available in the literature. FAP-targeting ligands for PCa are not limited to detection, but could also include therapeutic applications. In this preliminary review, we provide an overview of the clinical applications of FAPi ligands in PCa, summarising the main results and highlighting contemporary strengths and limitations.

19.
Endocr J ; 59(7): 611-9, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22572549

RESUMEN

The aim of this study was to evaluate the glyco-metabolic profile among type 2 diabetic patients with erectile dysfunction (ED). We evaluated 88 type 2 diabetic males, aged 62.78 ± 9.26 years. We administered patients the IIEF (International Index of Erectile Function) questionnaire to assess erectile function, organ function, sexual desire, and satisfaction level during and after the sexual intercourse and the SAS (self-rating anxiety scale) and SDS (self-rating depression scale) questionnaires to evaluate anxiety and depression. We evaluated: BMI, abdominal circumference, glycated hemoglobin (HbA(1c)), fasting plasma glucose (FPG), fasting plasma insulin (FPI), HOMA index, lipid profile, testosterone, free testosterone, dihydrotestosterone, and sex hormone binding globulin (SHBG). The IIEF questionnaire showed that in the examined sample there were 50 patients (56.8%) affected by ED, and 38 patients (43.2%) without ED. Comparing the two groups, 57.9% of patients without ED, and 70.0% of patients with ED were smokers, and the difference between the two groups was significant (p<0.05). Furthermore, 23.7% of patients without ED, and 38.0% of patients with ED had a history of chronic ischemic heart disease (p<0.05 between the two groups). Patients with ED were older, and, surprisingly, had lower levels of HbA(1c). Furthermore, patients with ED had higher levels of FPI, and lower levels of testosterone and dihydrotestosterone. The prevalence of ED in Italian type 2 diabetic males with mean age of 62 years is about 56% and it is linked to higher levels of FPI, but lower levels of HbA(1c), free testosterone and dihydrotestosterone.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Disfunción Eréctil/complicaciones , Disfunción Eréctil/metabolismo , Metaboloma/fisiología , Anciano , Ansiedad/complicaciones , Ansiedad/diagnóstico , Ansiedad/epidemiología , Estudios de Casos y Controles , Ensayos Clínicos como Asunto , Depresión/complicaciones , Depresión/diagnóstico , Depresión/epidemiología , Diabetes Mellitus Tipo 2/sangre , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/metabolismo , Disfunción Eréctil/sangre , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Autoevaluación (Psicología) , Encuestas y Cuestionarios , Testosterona/sangre
20.
Ocul Immunol Inflamm ; 30(5): 1286-1288, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35653651

RESUMEN

PURPOSE: The purpose of this article is to report a case of sudden onset ischemic retinal central vein occlusion after a second dose of COVID-19 adenoviral vector vaccine. CASE REPORT/OBSERVATIONS: A 54-year-old woman with systemic arterial hypertension developed ischemic central retinal vein occlusion in her right eye on day 2 after the second dose of COVID-19 adenoviral vector vaccine ChAdOx1 nCoV-19/ AZD1222, Oxford-AstraZeneca. CONCLUSION: Adenoviral vector vaccine promotes both cellular and humoral immune responses, increasing the level of inflammatory cytokines. These cytokines are the same implied in the possible pathogenesis of central retinal vein occlusion. Subsequently, we recommend informing patients at risk of possible ocular adverse events, which require urgent evaluation.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Oclusión de la Vena Retiniana , Femenino , Humanos , Persona de Mediana Edad , ChAdOx1 nCoV-19 , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Citocinas , Oclusión de la Vena Retiniana/inducido químicamente , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/tratamiento farmacológico
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