Drug-coated balloon therapy for in-stent restenosis in patients with iliofemoral deep vein thrombosis: A single-arm observational study.

BACKGROUND: Iliofemoral deep vein thrombosis (IFDVT) causes severe symptoms and affect the quality of life to a great extent. Endovascular thrombectomy and stent implantation have been a feasible strategie to alleviate the signs and symptoms of IFDVT. However, venous in-stent restenosis (ISR) has become an emerging non-negligible problem. METHODS: To evaluate the histological characteristics of venous ISR, neointima of arterial and venous ISR patients were collected and examed. To explore the effect of drug-coated balloon (DCB) on venous ISR lesions, we conducted a single-center retrospective case series study involving IFDVT patients with ISR after venous stenting who were treated with paclitaxel-coated balloon dilatation. RESULTS: We found a collagen-rich matrix but not elastin, as well as fewer cells and less neovascularization in venous intimal hyperplasia compared with neointima in arteries. Thirteen IFDVT patients were involved in the study, with average preoperative stenosis degree of 87.69% ± 13.48%. After intervention, the stenosis degree was significantly reduced to 14.6% ± 14.36% immediately (p < 0.0001) and to 16.54% ± 15.73% during follow-up (p < 0.0001). During follow-up, the VEINES-QOL scores (p < 0.0001), VEINES-Sym scores (p < 0.0001), and Villalta scores (p = 0.04) of patients was improved significantly compared with those before intervention. No major adverse events were observed. CONCLUSIONS: The use of DCB may have a positive effect in the treatment of venous ISR by targeting intimal hyperplasia. Moreover, the application of DCB dilatation in IFDVT stenting patients with ISR is deemed safe and effective.

Interval Colorectal Cancer in Inflammatory Bowel Disease: A Review.

Inflammatory bowel disease (IBD) increases the risk of dysplasia and colorectal cancer (CRC). Moreover, colitis-associated CRC is responsible for a disproportionate number of CRC-related mortality. For this reason, societies recommend screening and surveillance colonoscopy as the standard of care for patients with ulcerative colitis and Crohn's colitis. Nonetheless, interval cancer defined as CRC detected within the appropriate surveillance interval might still occur despite following guideline recommendations. Even though there is limited data on risk factors associated with interval CRC in IBD, patient and disease-associated factors and technical aspects of the surveillance might play a role. This review aims to provide information on the epidemiology of interval CRC in IBD, the factors that might be associated with its occurrence, and the challenges of CRC screening and dysplasia management in patients with IBD.

Transfer RNA-derived small RNA tRF-Glu-CTC attenuates neointimal formation via inhibition of fibromodulin.

Neointimal hyperplasia is a pathological vascular remodeling caused by abnormal proliferation and migration of subintimal vascular smooth muscle cells (VSMCs) following intimal injury. There is increasing evidence that tRNA-derived small RNA (tsRNA) plays an important role in vascular remodeling. The purpose of this study is to search for tsRNAs signature of neointima formation and to explore their potential functions. The balloon injury model of rat common carotid artery was replicated to induce intimal hyperplasia, and the differentially expressed tsRNAs (DE-tsRNAs) in arteries with intimal hyperplasia were screened by small RNA sequencing and tsRNA library. A total of 24 DE-tsRNAs were found in the vessels with intimal hyperplasia by small RNA sequencing. In vitro, tRF-Glu-CTC inhibited the expression of fibromodulin (FMOD) in VSMCs, which is a negative modulator of TGF-ß1 activity. tRF-Glu-CTC also increased VSMC proliferation and migration. In vivo experiments showed that inhibition of tRF-Glu-CTC expression after balloon injury of rat carotid artery can reduce the neointimal area. In conclusion, tRF-Glu-CTC expression is increased after vascular injury and inhibits FMOD expression in VSMCs, which influences neointima formation. On the other hand, reducing the expression of tRF-Glu-CTC after vascular injury may be a potential approach to prevent vascular stenosis.

[Ascending colon cancer with submucosal tumor-like morphology arising near ileal valve lipohyperplasia:a case report].

An 89-year-old man was diagnosed with a submucosal tumor suspected to be a lipoma and was followed up for 6 years. The patient was admitted to the hospital because of increased tumor size and morphological changes despite negative bioptic findings. The lesion was diagnosed as an advanced adenocarcinoma of the ascending colon (cT3N0M0, cStage IIa). Laparoscopic-assisted right hemicolectomy with D3 lymph node dissection was performed. Pathological diagnosis of a surgically resected specimen revealed adenocarcinoma with lipohyperplasia (pT3N2aM0, pStage IIIb). Reports of colon cancer accompanied by colonic lipomas or lipohyperplasia are limited. This case showed an interesting submucosal tumor-like morphology because the cancer developed at the base of the lipohyperplasia and grew and spread below it.

[The use of a urethral catheter with an ultrasound-induced biopolymer drug coating for the prevention of recurrent bladder neck sclerosis in patients after endoscopic treatment of benign prostate hyperplasia].

Recurrent bladder neck sclerosis is one of the common complications of endoscopic treatment of benign prostate hyperplasia, which often leads to multiple re-operations, including complex open and laparoscopic reconstructive procedures. One of the most promising minimally invasive methods for preventing recurrence of bladder neck sclerosis is balloon dilatation under transrectal ultrasound guidance. To improve the results of using this technique, a urethral catheter with a biopolymer coating, capable of depositing a drug and eluting it under the influence of diagnostic ultrasound, was proposed.

Gestational gigantomastia complicated by pseudo-angiomatous stromal hyperplasia - a multidisciplinary management approach.

SUMMARY: Gestational gigantomastia is a rare condition typified by disproportionate bilateral breast enlargement in pregnant women, resulting in skin thinning, ulceration, and bleeding. Less than sixty cases have been documented worldwide, and only one other in South Africa. Pseudo-angiomatous stromal hyperplasia (PASH) is a rare benign proliferation of stromal tissue in a tumorous or diffuse pattern. This, to the best of our knowledge, is the first published case, a 27-year-old human immunodeficiency virus (HIV) positive woman, to present with both conditions concurrently. Medical management with cabergoline was initiated and, seven months post-delivery, a novel Goldilocks mastectomy was performed with acceptable outcomes.

High-definition chromoendoscopy results in more significant dysplasia detection than white light endoscopy with random biopsies in ulcerative colitis patients: A single-center retrospective study.

The goal of this study was to determine whether high-definition white light endoscopy with random biopsies (HD-WLR) or chromoendoscopy (HDCE) yielded a higher dysplasia detection rate in ulcerative colitis patients. Ulcerative colitis (UC) patients have a 2.4-fold increased future risk of developing colorectal cancer compared to the general population and require careful dysplasia screening modalities. Both HD-WLR and HDCE are regularly used, and recent guidelines do not suggest a preference. UC patients who underwent dysplasia surveillance at our site between January 2019 and 2021 were retrospectively reviewed. We calculated the dysplasia detection rate of both techniques at the first CRC screening colonoscopy. Eighteen dysplastic lesions were detected in total, 3 by HD-WLR and fifteen by HDCE. Dysplasia was detected in 4% (3/75) and 20% (15/75) of UC patients by HD-WLR and HDCE respectively, with significantly fewer biopsies (4.44 ±â€…4.3 vs 29.1 ±â€…13.0) required using the former. HD-WLR detected 2 polypoid and one non-polypoid lesion, while HDCE detected eleven polypoid and 4 non-polypoid lesions. No invisible dysplasia or colorectal cancer was detected. Screening was performed at 10.8 ±â€…4.8 and 9.72 ±â€…3.05 years following UC diagnosis for HDCE and HD-WLR respectively. Median withdrawal time was 9.0 ±â€…2.7 minutes (HD-WLR) vs 9.6 + 3.9 minutes (HDCE). HDCE is associated with higher dysplasia detection rates compared to HD-WLR in a UC patient population. Given the former technique is less tedious and costly, our findings complement existing studies that suggest HDCE may be considered over HD-WLR for UC dysplasia surveillance.

Endogenous Zinc-Ion-Triggered In Situ Gelation Enables Zn Capture to Reprogram Benign Hyperplastic Prostate Microenvironment and Shrink Prostate.

Benign prostatic hyperplasia (BPH) as the leading cause of urination disorder is still a refractory disease, and there have no satisfied drugs or treatment protocols yet. With identifying excessive Zn2+ , inflammation, and oxidative stress as the etiology of aberrant hyperplasia, an injectable sodium alginate (SA) and glycyrrhizic acid (GA)-interconnected hydrogels (SAGA) featuring Zn2+ -triggered in situ gelation are developed to load lonidamine for reprogramming prostate microenvironment and treating BPH. Herein, SAGA hydrogels can crosslink with Zn2+ in BPH via coordination chelation and switch free Zn2+ to bound ones, consequently alleviating Zn2+ -arisen inflammation and glycolysis. Beyond capturing Zn2+ , GA with intrinsic immunoregulatory property can also alleviate local inflammation and scavenge reactive oxygen species (ROS). Intriguingly, Zn2+ chelation-bridged interconnection in SAGA enhances its mechanical property and regulates the degradation rate to enable continuous lonidamine release, favoring hyperplastic acini apoptosis and further inhibiting glycolysis. These multiple actions cooperatively reprogram BPH microenvironment to alleviate characteristic symptoms of BPH and shrink prostate. RNA sequencing reveals that chemotaxis, glycolysis, and tumor necrosis factor (TNF) inflammation-related pathways associated with M1-like phenotype polarization are discerned as the action rationales of such endogenous Zn2+ -triggered in situ hydrogels, providing a candidate avenue to treat BPH.

Pseudocarcinomatous Hyperplasia of Tubal Mucosa Associated With Chronic Salpingitis - Clinical And Pathological Challenge: A Case Report.

Pseudocarcinomatous hyperplasia of the tubal mucosa is a rare, reactive response to an underlying inflammatory or neoplastic process. We present a case of pseudocarcinomatous hyperplasia in a 26-year-old woman with clinical symptomatology of pelvic inflammatory disease, and a normal serum Ca 125-level (30 U/ml). The ultrasound finding showed presence of hydrosalpinx characterized with unilateral tubal enlargement in sausage-like shape that arose from the upper lateral margin of the uterus. The young age of the patient, presence of chronic inflammation, epithelial hyperplasia with unremarkable nuclear atypia and mitosis facilitated the right diagnosis. Pseudocarcinomatous hyperplasia can mimic neoplastic processes clinically and pathologically. Differential morphological and clinical features should be considered to ensure accurate diagnosis and proper management.

Comparison of bipolar radiofrequency thermotherapy and transurethral prostate resection in treatment of benign prostate hyperplasia.

OBJECTIVES: Lower urinary tract symptoms due to benign prostatic hyperplasia in men increase with aging. Risks related to anesthesia and surgery have led a search for alternative treatments. Bipolar radiofrequency (RF) thermotherapy is one of the methods adopted in patients with high surgical risks. The aim of this study is to compare the effect of bipolar RF thermotherapy and transurethral resection of the prostate (TURP) methods on voiding symptoms and on post-operative complication rates especially in patients carrying high surgical risks. METHODS: Pre-operative, post-operative 1st and 6th month International Prostate Symptom Score (IPSS), Qmax, quality of life, prostate volumes, and postoperative complications of the patients underwent TURP and RF for benign prostatic hyperplasia (BPH) were compared. RESULTS: In the RF group, the pre-operative median IPSS was 30, prostate volume 41.5 cc, post-void residual (PVR) 80 ml, and Qmax is 5.85 ml/s.; In the TURP group, these were 29, 40 cc, 85 ml, and 5.3 ml/sec, respectively. In the Bipolar RF group, post-operative 1st- and 6th-month median values were IPSS 18, 21; prostate volume 40, 40; PVR 40, 35; Qmax 10.9, 9.15 and in the TURP group IPSS 9, 8; prostate volume 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectively. CONCLUSION: Bipolar RF thermotherapy is an applicable treatment method for BPH patients with high surgical risks.

OBJETIVOS: La termoterapia bipolar por radiofrecuencia es uno de los métodos adoptados en pacientes con alto riesgo quirúrgico. El objetivo de este estudio es comparar el efecto de la termoterapia de radiofrecuencia bipolar y los métodos de RTUP en los síntomas de vaciado y en las tasas de complicaciones posoperatorias, especialmente en pacientes con alto riesgo quirúrgico. MÉTODOS: Se compararon el IPSS, el Qmax, la calidad de vida, los volúmenes de próstata y las complicaciones posoperatorias de los pacientes sometidos a RTUP y RF para la HBP preoperatorios, posoperatorios al primer y sexto mes. RESULTADOS: En el grupo de RF, la mediana preoperatoria del IPSS fue de 30, el volumen prostático de 41.5 cc, el PVR de 80 ml y el Qmax de 5.85 ml/seg.; En el grupo RTUP estos fueron 29, 40 cc, 85 ml y 5.3 ml/seg, respectivamente. En el grupo de RF bipolar, los valores medianos postoperatorios del primer y sexto mes fueron IPSS 18, 21; volumen de próstata 40, 40; PVR 40, 35; Qmax 10.9, 9.15 y en el grupo TURP IPSS 9, 8; volumen de próstata 20, 20; PVR 30, 10; Qmax 17.25, 19.1, respectivamente. CONCLUSIÓN: La termoterapia de RF bipolar es un método de tratamiento aplicable para pacientes con HPB con alto riesgo quirúrgico.

Taquipnea persistente como manifestación inicial de hiperplasia de células neuroendocrinas: reporte de un caso clínico / Persistent tachypnea as initial manifestation of hyperplasia of neuroendocrine cells: case report

Se realiza revisión de la literatura y presentación de un caso clínico de Hiperplasia de Células Neuroendocrinas en paciente lactante masculino que inicia su padecimiento a los 3 meses de vida con dificultad respiratoria caracterizada por retracciones subcostales y taquipnea persistente, posterior-mente a los 8 meses de edad se agrega hipoxemia respirando aire ambiente que requiere uso de oxígeno suplementario continuo. Tiene antecedente de tres hospitalizaciones, con diagnóstico de Bronquiolitis y Neumonía atípica, realizándose panel viral respiratorio con reporte negativo. El paciente persiste con sintomatología respiratoria a pesar de tratamientos médicos, por lo que se deriva a neumología pediátrica, unidad de enfermedad pulmonar intersticial del lactante, iniciando protocolo de estudio, se realiza tomografía tórax de alta resolución, que evidencia imágenes en vidrio despulido en lóbulo medio y región lingular, además de atrapamiento aéreo. Se concluye el diagnóstico de Hiperplasia de Células neuroendocrinas con base a la clínica y hallazgos tomográficos. La Hiperplasia de Células Neuroendocrinas es una patología pulmonar intersticial poco frecuente, cuyo diagnóstico es clínico y radiológico, en la minoría de los casos se requiere biopsia pulmonar para confirmación. Puede ser fácilmente confundida con otras enfermedades respiratorias comunes, por lo que es importante sospecharla para realizar un diagnóstico precoz. La mayor parte de los casos evolucionan con declinación de los síntomas, mejorando espontáneamente en los primeros años de vida.

A review of the literature and presentation of a clinical case of Neuroendocrine Cell Hyperplasia in a male infant patient who begins his condition at 3 months of age with respiratory distress characterized by subcostal retractions and persistent tachypnea is presented. After 8 months of age hypoxemia is added requiring continuous oxygen therapy. He has a history of three hospitalizations, with a diagnosis of bronchiolitis and atypical pneumonia, respiratory viral panel has a negative report. The patient persists with respiratory symptoms despite medical treatments, so it is referred to pediatric pulmonology, initiating study protocol for interstitial lung disease of the infant. A high resolution chest tomography is performed, which evidences images in polished glass in the middle lobe and lingular region, in addition to air entrapment. The diagnosis of neuroendocrine cell hyperplasia is concluded based on clinical and tomographic findings. Neuroendocrine Cell Hyperplasia is a rare interstitial pulmonary pathology, whose diagnosis is clinical and radiological. Lung biopsy is required only in the minority of cases for confirming diagnosis. It can be easily confused with other common respiratory diseases, so it is important to suspect it to make an early diagnosis. Most cases evolve with decline in symptoms, improving spontaneously in the first years of life.

Importância do diagnóstico por imagem em pacientes com sangramento uterino anormal / Importance of diagnostic imaging in patients with abnormal uterine bleeding

O sangramento uterino anormal é diagnóstico sindrômico comum no consultório do ginecologista e pode comprometer substancialmente a qualidade de vida. O objetivo no diagnóstico de sangramento uterino anormal é distinguir pacientes com causas estruturais (anatômicas), como pólipo, adenomiose, leiomioma, malignidade e hiperplasia, de pacientes que apresentam anatomia normal, nas quais o sangramento pode ser devido a alteração dos mecanismos de coagulação, distúrbios ovulatórios, distúrbios primários do endométrio, iatrogenia, ou ter outra causa não classificada. O diagnóstico se inicia a partir de anamnese detalhada e exame físico geral e ginecológico completos, seguidos da solicitação de exames complementares (laboratoriais e de imagem), conforme indicado. O exame de imagem de primeira linha para identificação das causas estruturais inclui a ultrassonografia pélvica. Histerossonografia, histeroscopia, ressonância magnética e amostragem endometrial para exame de anatomia patológica são opções que podem ser incluídas no diagnóstico a depender da necessidade. O objetivo deste artigo é apresentar a relevância dos exames de imagem na investigação das causas de sangramento uterino anormal.

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office and may substantially affect quality of life. The aim in the diagnosis of abnormal uterine bleeding is to distinguish women with anatomic causes such as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia from women with normal anatomy where the cause may be coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified. Diagnosis begins with a thorough history and physical examination followed by appropriate laboratory and imaging tests as indicated. The primary imaging test for the identification of anatomic causes include ultrasonography. Saline infusion sonohysterography, magnetic resonance, hysteroscopy, endometrial sampling are options that can be included in the diagnosis depending on the need. The aim of this article is to present the relevance of imaging exams in the investigation of the causes of abnormal uterine bleeding.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension / 中华心血管病杂志

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension / 中华心血管病杂志

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

Clinical Characterization of Patients with Ovarian Mass Combined with Dysplasia of Secondary Sexual Characteristics / 中国医学科学院学报

Objective To investigate the clinical characteristics of preadolescent and adolescent female patients with ovarian mass combined with dysplasia of secondary sexual characteristics. Methods This study retrospectively analyzed 18 cases of ovarian mass combined with dysplasia of secondary sexual characteristics aged 0-19 years admitted to Peking Union Medical College Hospital from January 2012 to November 2019.By analyzing the clinical manifestations,surgical methods,postoperative pathology,therapies and prognosis of the cases,we summarized the diagnosis and treatment ideas. Results Among the 18 cases,7(7/18,38.9%)developed secondary sex signs before puberty,including 5 cases showing precocity(including 2 cases of juvenile granulosa cell tumor,1 case of gonadoblastoma,1 case of ovarian follicular cyst,and 1 case of 46,XY simple gonadal dysplasia combined with dysgerminoma)and 2 cases presenting masculine manifestations(1 case of steroid cell tumor and 1 case of sclerosing stromal tumor).The rest 11(11/18,61.1%)cases showed abnormal development of secondary sexual characteristics during puberty,including 8 cases with masculine manifestations or abnormal menstruation after menarche(7 cases with sex cord stromal cell tumor and 1 case with cystic granulosa cell tumor),2 cases with primary amenorrhea(1 case with androgen insensitivity syndrome combined with testicular sertoli cell tumor and 1 case with endometriosis cyst combined with reproductive tract malformation),and 1 case diagnosed as 46,XX gonadal dysplasia with serous cystadenoma and no secondary sexual development during puberty. Conclusions Sex hormone levels should be actively tested in the case of prepubertal secondary sexual characteristics appearing early,pubertal secondary sexual characteristics being abnormal(underdevelopment),and/or menstrual abnormalities.Imaging examination should be performed to exclude ovarian organic lesions,and chromosome karyotype analysis should be performed if necessary.The diagnosis of ovarian mass in preadolescent and adolescent females with related symptoms should first be alerted to cord stromal cell tumor.It is recommended to rule out the possibility of combined reproductive tract malformation in the adolescent patients with primary amenorrhea.Chromosome examination should be conducted to rule out the possibility of gonadal dysplasia in the adolescent patients with primary amenorrhea and/or no development of secondary sexual characteristics.

Manejo clínico de la lengua negra vellosa / Black hairy tongue: clinical management

No disponible

Leucotrienos urinarios en pacientes pediátricos con trastorno respiratorio del sueño secundario a hiperplasia adenoamigdalina / Urinary leukotrienes in pediatric patients with sleep disordered breathing secondary to adenotonsillar hypertrophy

RESUMEN Introducción: El trastorno respiratorio del sueño (TRS) afecta al 2% a 3% de la población pediátrica, siendo la hiperplasia adenoamigdalina (HAA) su principal causa. Se ha observado un aumento en los niveles de leucotrienos excretados en orina (LTU) en estos pacientes, los cuales se correlacionarían con la severidad de la enfermedad. Objetivo: Determinar el nivel de LTU en niños con TRS e HAA antes y después de adenoamigdalectomía (AA), y en controles sanos. Correlacionar los niveles de LTU con los síntomas de TRS. Material y método: Estudio prospectivo. Se incluyeron pacientes con TRS e HAA (n =12) y controles sanos (n =12). Se determinó la concentración de LTU en ambos grupos de forma basal y un mes después de cirugía en el grupo con TRS. Resultados: No hubo diferencias en los niveles de LTU antes y después de AA. Tampoco existieron diferencias entre el grupo control y grupo TRS previo a la cirugía. No se encontró asociación entre LTU y la severidad de síntomas respiratorios. Conclusión: Los LTU no se encuentran elevados en pacientes con TRS e HAA, no disminuyen luego de AA y no se correlacionan con la severidad de los síntomas. La medición de LTU no sería una herramienta útil en la evaluación de pacientes con TRS. Nuevos estudios son necesarios para evaluar el rol de los leucotrienos en esta enfermedad.

ABSTRACT Introduction: Sleep disorder breathing (SDB) affects 2%-3% of the pediatric population, being adenotonsillar hyperplasia (ATH) its main cause. An increase in the levels of urinary leukotrienes (ULT) has been measured in these patients, which could be correlated with the severity of the disease. Aim: To determine the level of ULT in children with SDB and ATH before and after adenotonsillectomy, and healthy controls. To correlate the levels of ULT with symptoms of SDB. Material and method: prospective study. SDB and ATH patients (n =12) and healthy controls (n =12) were included. The concentration of ULT in both groups was determined, before surgery and after a month of surgery. Results: There were no differences in the levels of ULT before and after tonsillectomy in the studied group. There were also no differences between the control group and the SDB group. No association was observed between the level of ULT and the severity of respiratory symptoms. Conclusions: ULT are not elevated in patients with SDB and ATH and they do not decrease after adenotonsillectomy. ULT are not correlated with the severity of the symptoms of SDB. The measurement of ULT would not be a useful tool in the evaluation of patients with SDB. New studies are needed to assess the role of the role of leukotrienes in this disease.

Low-grade dysplasia in Barrett's esophagus: A problematic diagnosis / Displasia de bajo grado en el esófago de Barrett: un diagnóstico problemático

Although low-grade dysplasia (LGD) in Barrett's esophagus (BE) is a histopathological diagnosis based on different histological abnormalities, it is still problematic for different reasons. Patients without confirmed diagnosis of LGD undergo unnecessary and intensified follow-up where the risk of progression is low in the majority of cases. In contrast, the presence of confirmed LGD indicates a high risk of progression. In this article we try to address these reasons focusing on re-confirmation of LGD diagnosis, interobserver agreement, and persistent confirmed LGD. The progression risk of LGD to high-grade dysplasia and esophageal adenocarcinoma will also be reviewed. (AU)

Aunque la displasia de bajo grado (DBG) en el esófago de Barrett (EB) es un diagnóstico histopatológico basado en diferentes anomalías histológicas, este no deja de ser problemático por diferentes razones. Los pacientes sin diagnóstico confirmado de DBG se someten a un seguimiento innecesario e intensificado donde el riesgo de progresión es bajo en la mayoría de los casos. Por el contrario, la presencia de DBG confirmada indica un alto riesgo de progresión. En este artículo tratamos de abordar estas razones centrándonos en la reconfirmación del diagnóstico de la DBG, la concordancia entre observadores y la DBG confirmada y persistente. También se revisará el riesgo de progresión de la DBG a displasia de alto grado y adenocarcinoma esofágico. (AU)

Manifestación inicial atípica de una poliposis poco frecuente, el síndrome de Cowden / Unusual presenting manifestation of a rare polyposis, Cowden syndrome

No disponible

Does it «ring» a Brunner’s gland bell?

No disponible