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1.
Medicine (Baltimore) ; 99(27): e21111, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629744

RESUMEN

RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.


Asunto(s)
Colangitis/complicaciones , Divertículo/complicaciones , Ictericia/etiología , Pancreatitis/complicaciones , Dolor Abdominal/etiología , Atrofia , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Coledocolitiasis/complicaciones , Colestasis/etiología , Colestasis/patología , Diverticulitis/complicaciones , Divertículo/patología , Divertículo/cirugía , Neoplasias Duodenales/patología , Femenino , Humanos , Indonesia/etnología , Enfermedades Pancreáticas/patología , Recurrencia , Esfinterotomía Transduodenal/métodos , Resultado del Tratamiento , Adulto Joven
2.
Clinics (Sao Paulo) ; 75: e1505, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32555945

RESUMEN

OBJECTIVES: Parkinson's disease (PD) and the parkinsonian variant of multiple system atrophy (MSA-P) are distinct neurodegenerative disorders that share similar clinical features of parkinsonism. The morphological alterations of these diseases have yet to be understood. The purpose of this study was to evaluate gray matter atrophy in PD and MSA-P using regions of interest (ROI)-based measurements and voxel-based morphometry (VBM). METHODS: We studied 41 patients with PD, 20 patients with MSA-P, and 39 controls matched for age, sex, and handedness using an improved T1-weighted sequence that eased gray matter segmentation. The gray matter volumes were measured using ROI and VBM. RESULTS: ROI volumetric measurements showed significantly reduced bilateral putamen volumes in MSA-P patients compared with those in PD patients and controls (p<0.05), and the volumes of the bilateral caudate nucleus were significantly reduced in both MSA-P and PD patients compared with those in the controls (p<0.05). VBM analysis revealed multifocal cortical and subcortical atrophy in both MSA-P and PD patients, and the volumes of the cerebellum and temporal lobes were remarkably reduced in MSA-P patients compared with the volumes in PD patients (p<0.05). CONCLUSIONS: Both PD and MSA-P are associated with gray matter atrophy, which mainly involves the bilateral putamen, caudate nucleus, cerebellum, and temporal lobes. ROI and VBM can be used to identify these morphological alterations, and VBM is more sensitive and repeatable and less time-consuming, which may have potential diagnostic value.


Asunto(s)
Atrofia/patología , Sustancia Gris/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Atrofia de Múltiples Sistemas/patología , Enfermedad de Parkinson/clasificación , Enfermedad de Parkinson/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Sustancia Gris/patología , Humanos , Masculino , Trastornos Parkinsonianos/patología , Curva ROC
3.
Artículo en Inglés | MEDLINE | ID: mdl-32559036

RESUMEN

This case report describes the minimally invasive full fixed rehabilitation of a totally edentulous severely atrophic mandible. The patient refused to undergo any other treatment, from the reconstructive surgery to the removable prosthesis, and asked for a fixed minimally invasive solution in the shortest possible time. Considering that the posterior mandibular bone was inadequate in height and that the interforaminal bone was only 4.3 to 5 mm in height, the patient received four 4-mm-ultrashort implants in the interforaminal area that were immediately loaded. Within all the limitations of this case report this procedure in this specific case appears successful through 2 years of loading.


Asunto(s)
Implantes Dentales , Arcada Edéntula/cirugía , Atrofia , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Humanos , Mandíbula/cirugía , Resultado del Tratamiento
4.
Rev Assoc Med Bras (1992) ; 66(3): 375-379, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32520161

RESUMEN

BACKGROUND: Symptomatic Chiari Type I Malformation (CM) is treated with posterior fossa decompression with or without duroplasty. We have noticed some cases with concomitant severe cerebellar ataxia due to cerebellar atrophy. The aim of this study is to review the literature of CM associated with severe cerebellar atrophy and discuss its potential physiopathology. METHODS: A systematic literature review in the Pubmed Database was performed using the following key-terms: "cerebellar atrophy Chiari", and "cerebellar degeneration Chiari". Articles reporting the presence of cerebellar degeneration/atrophy associated with CM were included. RESULTS: We found only six studies directly discussing the association of cerebellar atrophy with CM, with a total of seven cases. We added one case of our own practice for additional discussion. Only speculative causes were described to justify cerebellar atrophy. The potential causes of cerebellar atrophy were diffuse cerebellar ischemia from chronic compression of small vessels (the most mentioned speculative cause), chronic raised intracranial pressure due to CSF block, chronic venous hypertension, and association with platybasia with ventral compression of the brainstem resulting in injury of the inferior olivary nuclei leading to mutual trophic effects in the cerebellum. Additionally, it is not impossible to rule out a degenerative cause for cerebellar atrophy without a causative reason. CONCLUSIONS: Severe cerebellar atrophy is found in some patients with CM. Although chronic ischemia due to compression is the most presumed cause, other etiologies were proposed. The real reasons for cerebellar degeneration are not known. Further studies are necessary.


Asunto(s)
Malformación de Arnold-Chiari/fisiopatología , Enfermedades Cerebelosas/fisiopatología , Malformación de Arnold-Chiari/diagnóstico por imagen , Atrofia , Enfermedades Cerebelosas/diagnóstico por imagen , Cerebelo/anomalías , Cerebelo/fisiopatología , Cerebelo/cirugía , Descompresión Quirúrgica , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino
5.
Indian J Dent Res ; 31(2): 326-330, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32436918

RESUMEN

A patient who is suffering from complete loss of one eye or one phthisical eye due to injury, inflammation, or tumor experiences lot of physical and psychological trauma. Ocular prostheses are used in the management of a wide variety of acquired and congenital anopthalmia. Several techniques have been used in fitting and fabricating artificial eyes. These eyes can be prefabricated or custom made, but a prosthesis that is lifelike in appearance provides a sense of psychological security to the patient, which is better achieved with custom ocular prosthesis. This article discusses series of cases made by utilizing one of the latest techniques of iris duplication (digital imaging) and also aims at enhanced awareness of the cosmetic benefits of custom designed ocular prosthesis when compared with stock eye.


Asunto(s)
Ojo Artificial , Iris , Atrofia , Humanos , Diseño de Prótesis , Proyectos de Investigación
6.
PLoS One ; 15(5): e0232353, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32369500

RESUMEN

IMPORTANCE: Neovascular age-related macular degeneration (nAMD) is a leading cause of blindness with several intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents available for its management such as aflibercept, bevacizumab, and ranibizumab. However, direct comparisons between these three agents among the same patient population are limited. OBJECTIVE: To assess the rate and growth of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in eyes with nAMD treated with aflibercept, bevacizumab, and/or ranibizumab. METHOD: Retrospective cohort study of patients with treatment-naïve neovascular AMD seen at an academic hospital between October 2006 and February 2019. Study eyes were treated with intravitreal injections of aflibercept, bevacizumab, and/or ranibizumab and followed for two years. MAIN OUTCOMES AND MEASURES: cRORA prevalence, location, size, and growth rate. Eyes were imaged with Cirrus spectral domain optical coherence tomography (SD-OCT). Presence and size of cRORA were calculated using the FDA-approved Advanced RPE Analysis software. Linear regression models were used to correlate cRORA progression with baseline demographic and ocular characteristics, anti-VEGF drug, and number of injections. Unpaired t-tests, ANOVA, and linear regression models were computed with SAS 9.4. RESULTS: 197 eyes from 158 patients (mean age 78.9, 62.9% women) received an average of 13 anti-VEGF injections over 24 months. 22% developed new cRORA. Mean cRORA area increased from 1.71 mm2 to 2.93 mm2. At 24 months, eyes with 11+ injections had significantly less cRORA area (11+ injections, 4.02 mm2; ≤ 10 injections, 2.46 mm2; p = 0.01) and growth rate (11+ injections, 0.41 mm2/year; ≤ 10 injections, 1.05 mm2/year; p = 0.02). Choice of anti-VEGF drug yielded no significant difference in cRORA progression. CONCLUSIONS AND RELEVANCE: Treating nAMD with aflibercept, bevacizumab or ranibizumab demonstrated comparable cRORA development at 24 months. Number of injections inversely correlated with cRORA area and growth. These results warrant further investigation in the pathophysiology of cRORA in anti-VEGF treated eyes.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Degeneración Retiniana/tratamiento farmacológico , Degeneración Retiniana/patología , Epitelio Pigmentado de la Retina/efectos de los fármacos , Epitelio Pigmentado de la Retina/patología , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anciano , Anciano de 80 o más Años , Atrofia , Bevacizumab/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Interpretación de Imagen Asistida por Computador , Inyecciones Intravítreas , Masculino , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Degeneración Retiniana/diagnóstico por imagen , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento
7.
JAMA ; 323(13): 1277-1285, 2020 04 07.
Artículo en Inglés | MEDLINE | ID: mdl-32259229

RESUMEN

Importance: Celiac disease may be associated with a modest but persistent increased long-term mortality risk. It is uncertain whether this risk has changed in the era of wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food. Objective: To evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden. Design, Setting, and Participants: All individuals in Sweden with celiac disease diagnosed between 1969 and 2017 were identified through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort. Participants (n = 49 829) were observed starting on the day of the biopsy. The final date of follow-up was December 31, 2017. Exposures: Celiac disease was defined by the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden's 28 pathology departments. Each individual was matched with as many as 5 control participants in the general population by age, sex, county, and calendar period. Main Outcomes and Measures: The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality. Patients with celiac disease were compared with controls using stratified Cox proportional modeling, stratifying by year of diagnosis. Results: There were 49 829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n = 6596) died. Compared with controls (n = 246 426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, 1.2 per 1000 person-years; hazard ratio [HR], 1.21 [95% CI, 1.17-1.25]). The relative increase in mortality risk was present in all age groups and was greatest in those diagnosed in the age range of 18 to 39 years (1.9 vs 1.1 per 1000 person-years; HR, 1.69 [95% CI, 1.47-1.94]; P values for heterogeneity comparing 18-39 years with 40-59 years and with ≥60 years were both <.001). Individuals with celiac disease were at increased risk of death from cardiovascular disease (3.5 vs 3.4 per 1000 person-years; HR, 1.08 [95% CI, 1.02-1.13]), cancer (2.7 vs 2.2 per 1000 person-years; HR, 1.29 [95% CI, 1.22-1.36]), and respiratory disease (0.6 vs 0.5 per 1000 person-years; HR, 1.21 [95% CI, 1.08-1.37]). When compared with controls, the overall mortality risk was greatest in the first year after diagnosis (15.3 vs 6.5 per 1000 person-years; HR, 2.34 [95% CI, 2.14-2.55]) but persisted beyond 10 years after diagnosis (10.5 vs 10.1 per 1000 person-years; HR, 1.15 [95% CI, 1.10-1.20]). The mortality risk was likewise present for patients diagnosed during the years 2010-2017 (7.5 vs 5.5 per 1000 person-years; HR, 1.35 [95% CI, 1.21-1.51]). Conclusions and Relevance: In a Swedish population studied between 1969 and 2017, a diagnosis of celiac disease compared with the general population was associated with a small but statistically significant increased mortality risk.


Asunto(s)
Enfermedad Celíaca/mortalidad , Adolescente , Adulto , Factores de Edad , Atrofia , Enfermedades Cardiovasculares/mortalidad , Estudios de Casos y Controles , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/patología , Niño , Escolaridad , Femenino , Humanos , Intestino Delgado/patología , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Modelos de Riesgos Proporcionales , Enfermedades Respiratorias/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Suecia/epidemiología , Adulto Joven
8.
Compend Contin Educ Dent ; 41(4): 232-241, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32255655

RESUMEN

BACKGROUND: Treatment of the severely resorbed maxilla traditionally has been managed with such protocols as sinus elevation, bone and soft-tissue grafting, and osteotomy procedures. The use of zygomatic implants has made it possible to circumvent such procedures, allowing immediate loading of implants with fixed prostheses. OBJECTIVE: This study reports the success rate of 452 zygomatic implants placed and restored in 249 patients over 5 years in a multi-center setting. Additionally, case examples are presented. METHODS: The authors conducted a multi-center case series study. Inclusion criteria were ASA 1 or ASA 2, nonsmoking adults over age 30, fully or partially edentulous, with severely atrophic maxillae. These patients had zygomatic implants placed over a 5-year period with a follow-up of 5 years. The survival rate of these implants is described. RESULTS: A total of 249 patients, aged 34 to 80, had 452 zygomatic implants placed. Survival rate was 95% for quad zygoma; 99.1% for unilateral zygoma with additional premaxillary implants; 98.7% for bilateral single zygoma with additional premaxillary implants; and 100% for unilateral zygoma as a distal extension in implant-supported fixed prostheses. Overall implant survival rate was 97.6%. CONCLUSION: This study supports reports of zygomatic implants having a high success rate while allowing an array of ancillary procedures to be avoided. CLINICAL IMPLICATIONS: The use of zygomatic implants in the atrophic maxilla has shown to be a reliable treatment option for patients selecting to not undergo advanced bone-replacing protocols.


Asunto(s)
Implantes Dentales , Arcada Edéntula , Adulto , Anciano , Anciano de 80 o más Años , Atrofia , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Estudios de Seguimiento , Humanos , Maxilar , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
9.
Acta Neurol Taiwan ; 29(1): 1-4, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32285427

RESUMEN

PURPOSE: Neuromyelitis optica is an autoimmune disease characterized mainly by the involvement of the spinal cord and optic nerve. Clinical studies have identified the disease progression as the most important red flag. Previous researches showed that only 2% of patients with neuromyelitis optica experience a progressive course. On the other hand, neuromyelitis optica is rarely occurred in children. In the present study a case of neuromyelitis optica was reported in a female who suffered from progressive myelopathy in the course of the disease. CASE REPORT: The patient was a 30-year-old woman who has been affected to the disease at the age of 10 manifesting the quadriparesis. The patient also manifested optic neuritis twice. The disease became progressive at the age of 27. According to the results of the magnetic resonance imaging on spinal cord, severe atrophy was observed in the cervical and thoracic spine cord. The patient's antiaquaporin 4 antibody was positive. CONCLUSION: Neuromyelitis optica is an astrocytopathy disease characterized by debilitating attacks. A very small percentage of patients may suffer a progressive course. According to the reported cases, this progressive course may be completely variable symptomatically, including progressive myelopathy, progressive vision impairments, and progressive cognitive impairment.


Asunto(s)
Neuromielitis Óptica , Enfermedades de la Médula Espinal , Adulto , Atrofia , Femenino , Humanos , Imagen por Resonancia Magnética
10.
Brain ; 143(4): 1053-1056, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-32318733
11.
Maturitas ; 135: 34-39, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32252962

RESUMEN

OBJECTIVES: To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients. STUDY DESIGN: Patients affected by VVA were considered for the study. All women were treated using a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm probe, FemTouch™. Pain during different steps of the procedure (introduction, rotation and extraction of probe and laser impulse transmission) was evaluated on a 7-point Likert scale. The occurrence of side-effects was evaluated at the end of the procedure, and in the three-month follow-up (after the last treatment) complications were classified as 'early' (occurring within 30 days) or late (after 30 days). Participant satisfaction was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree). The institutional review board approved the study protocol. RESULTS: Fifty-three women were enrolled in the study. No severe complications occurred after a median follow-up of six months. One patient (1.9 %) reported dizziness immediately after treatment, which completely resolved within 15 min. A minor bleeding occurred related to tip introduction and rotation. One patient (1.9 %) aborted the procedure because of discomfort on probe introduction but decided to repeat the procedure after two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the procedure. The mean overall pain score at first treatment, evaluated on the 7-point Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean overall pain score (1.27; CI 95 % 0.83-1.71, p < 0.001) and pain scores related to probe introduction (0.54; CI 95 % 0.18-0.90, p = 0.001) and probe rotation (0.46; CI 95 % 0.12-0.90, p = 0.003) all statistically significantly decreased between the first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01; CI 95 % -0.06 - 0.20, p = 0.07) and extraction (0.08; CI 95 % -0.04-0.19, p = 0.31) did not change over the course of treatment. Overall, patient satisfaction with the procedure was high: 89.7 % of patients would highly (value 5-7) recommend the procedure and 94.9 % would be ready to repeat the procedure to maintain results. Discomfort related to treatment was lower than expected for 41 % of patients (value 5-7) and as expected for 48.7 % (value 3-4). CONCLUSION: Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications occurred. A minority of patients reported mild complications, but these resolved without the need for treatment. Most discomfort was related to probe introduction and rotation. Overall, patients were highly satisfied, and they would repeat laser treatment.


Asunto(s)
Dióxido de Carbono/uso terapéutico , Láseres de Gas/uso terapéutico , Enfermedades Vaginales/cirugía , Anciano , Atrofia/cirugía , Femenino , Humanos , Israel , Persona de Mediana Edad , Satisfacción del Paciente , Posmenopausia , Estudios Prospectivos , Resultado del Tratamiento , Vagina/patología , Vulva/patología
12.
Praxis (Bern 1994) ; 109(5): 355-359, 2020.
Artículo en Alemán | MEDLINE | ID: mdl-32233757

RESUMEN

Muscle Complaints - When to Evaluate Further? Abstract. Muscle complaints are frequently reported symptoms which can occur in the context of numerous and not always primary muscle diseases. Further diagnostic steps are not always warranted. The presence of distinct warning symptoms represents the base for further decision making. Warning symptoms include among others myalgia/weakness/atrophy/hypertrophy of distinct muscle groups, fasciculations, dysphagia, bulbar signs, abnormal reflexes, signs for a systemic autoimmune disorder/connective tissue disease or a persisting CK elevation (>1000 U/l) even in asymptomatic patients. Depending on the indication important diagnostic steps include lab tests, MRI, E(N)MG, specific endurance tests, muscle biopsy or genetic tests.


Asunto(s)
Enfermedades Autoinmunes , Enfermedades Musculares , Atrofia , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/diagnóstico , Biopsia , Humanos , Músculo Esquelético , Enfermedades Musculares/diagnóstico , Mialgia/etiología
13.
PLoS One ; 15(4): e0231225, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32243459

RESUMEN

INTRODUCTION: Progressive brain atrophy, development of T1-hypointense areas, and T2-fluid-attenuated inversion recovery (FLAIR)-hyperintense lesion formation in multiple sclerosis (MS) are popular volumetric data that are often utilized as clinical outcomes. However, the exact clinical interpretation of these volumetric data has not yet been fully established. METHODS: We enrolled 42 consecutive patients with MS who fulfilled the revised McDonald criteria of 2010. They were followed-up for more than 3 years from onset, and cross-sectional brain volumetry was performed. Patients with no brain lesions were excluded in advance from this study. For the brain volumetric data, we evaluated several parameters including age-adjusted gray-matter volume atrophy, age-adjusted white-matter volume atrophy, and T2-FLAIR lesion volume. The numbers of T1-hypointense and T2-FLAIR-hyperintense areas were also measured along the same timeline. The clinical data pertaining to disease duration, expanded disability status scale (EDSS), and MS severity score (MSSS) at the timing of volumetry were collected. RESULTS: Among the 42 patients with MS and brain lesions, the number of T1-hypointensity (rho = 0.51, p<0.001), gray-matter atrophy (rho = 0.40, p<0.01) and white-matter atrophy (rho = 0.49, p<0.001) correlated with the EDSS. T1-hypointensity count divided by FLAIR lesion volume correlated with the MSSS (rho = 0.60, p<0.001). Meanwhile, counts or volumes of FLAIR-hyperintense lesions were associated only with the times of past relapses, and did not correlate with present neurological disability level or ongoing disease activity. These findings were consistent regardless of the presence of spinal cord lesions. CONCLUSION: Numbers of T1-hypointensities and brain atrophy equally indicated the current neurological disability in MS. The number of T1-hypointensities divided by FLAIR lesion volume represented the clinical severity. The size or number of FLAIR lesions reflected earlier relapses but was not a good indicator of neurological disability or clinical severity.


Asunto(s)
Encéfalo/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Esclerosis Múltiple/diagnóstico por imagen , Adolescente , Adulto , Atrofia/patología , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Análisis de Regresión , Adulto Joven
15.
Cient. dent. (Ed. impr.) ; 17(1): 19-26, ene.-abr. 2020. ilus, graf
Artículo en Español | IBECS | ID: ibc-189745

RESUMEN

La pérdida ósea vertical en los sectores posteriores maxilares es un hecho frecuente tras la extracción dental. En muchas ocasiones para rehabilitar estas zonas podemos emplear técnicas de regeneración u optar por un abordaje más conservador con implantes cortos. En el presente caso clínico mostramos un caso rehabilitado bilateralmente con dos técnicas diferentes: elevación de seno y la inserción de implantes cortos, con un seguimiento de ocho años donde ambas técnicas han logrado resultados igualmente predecibles


Vertical bone loss in the posterior maxillary sectors is a frequent occurrence after tooth extraction. These areas can often be rehabilitated using regeneration techniques or by opting for a more conservative approach with short implants. The present clinical case shows bilateral rehabilitation with two different techniques: sinus lift and the insertion of short implants, with a follow-up of 8 years where both techniques have achieved equally predictable results


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Atrofia , Maxilar/cirugía , Elevación del Piso del Seno Maxilar/métodos , Implantes Dentales , Maxilar/patología , Diente Molar/patología , Radiografía Panorámica
16.
Cient. dent. (Ed. impr.) ; 17(1): 35-40, ene.-abr. 2020. ilus
Artículo en Español | IBECS | ID: ibc-189747

RESUMEN

Los implantes dentales constituyen una alternativa predecible para la rehabilitación de los maxilares edéntulos, sin embargo, el éxito del tratamiento puede ver-se comprometido cuando existen graves atrofias maxilares. Para el tratamiento de estos casos complejos, se han desarrolla-do técnicas de regeneración ósea, entre las que destacan la regeneración ósea guiada y los injertos en bloque. Dentro de estos últimos, cabe destacar la técnica de Khoury. Se trata de un procedimiento indicado para regenerar defectos horizontales y verticales, mediante la obtención de finas láminas de hueso autógeno procedentes de la línea oblicua externa mandibular. Se presenta un caso clínico de un gran defecto mandibular reconstruido con la técnica de Khoury, secundario a un fracaso implantológico que además ocasionó patología nerviosa


Dental implants constitute a predictable alternative for the rehabilitation of edentulous jaws. However, the success of the treatment can be limited when severe atrophic alveolar ridges are present. For the treatment of these complex cases, several regeneration techniques have been developed, such as guided bone regeneration and block grafts. Within the last, it should be noted the Khoury technique. It is a procedure indicated for the regeneration of horizontal and vertical defects, through the obtention of autologous graft in form of thin plates, derived from mandibular external oblique line.A clinical case is presented, that consists in a great mandibular defect which was reconstructed by the Khoury technique. The defect was secondary to an implant failure, which was also related with nervous pathology


Asunto(s)
Humanos , Masculino , Anciano , Regeneración Ósea , Atrofia/cirugía , Hipoestesia/cirugía , Fracaso de la Restauración Dental , Maxilar/cirugía , Elevación del Piso del Seno Maxilar/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Implantes Dentales , Resorción Ósea/patología , Boca Edéntula/cirugía
17.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(3): 329-333, 2020 Mar 10.
Artículo en Chino | MEDLINE | ID: mdl-32128753

RESUMEN

Glaucoma is a group of progressive optic neuropathies featuring retinal ganglion cell and axonal degeneration, which typically manifest as sunken atrophy of optic papilla and characteristic visual field defect. Genetic factors play an important role in the pathogenesis of glaucoma. This guideline mainly focuses on single gene mutation-related glaucoma by summarizing the pathogenic genes, disease diagnosis and clinical consultation of primary congenital glaucoma (PCG) and primary open-angle glaucoma (POAG), with an aim to regulate their molecular diagnosis, genetic counseling and treatment.


Asunto(s)
Glaucoma/diagnóstico , Glaucoma/genética , Glaucoma/terapia , Guías de Práctica Clínica como Asunto , Atrofia , Glaucoma de Ángulo Abierto , Humanos , Mutación , Disco Óptico , Enfermedades del Nervio Óptico
19.
Ann Hematol ; 99(5): 1121-1128, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32130472

RESUMEN

AIM:  To measure histological villous atrophy and to clarify the diagnostic accuracy of endoscopic villous atrophy in gastrointestinal graft-versus-host disease. METHODS:  Data for patients who underwent upper and/or lower endoscopic examinations after hematopoietic stem cell transplantation were retrospectively collected. In study 1, group A included 56 patients in whom GI-GVHD was histologically confirmed and group B included 60 patients in whom GI-GVHD was not histologically confirmed. Group C included 59 patients before HSCT. The lengths of villi and crypts in the duodenum and terminal ileum were histologically measured. In study 2, the diagnostic accuracies of villous atrophy of the duodenum and of the terminal ileum using magnifying endoscopy were evaluated. RESULTS:  In study 1, the lengths of villi and the villi/crypt (V/C) ratios of the duodenum and terminal ileum in group A were significantly smaller than those in the other groups (p < 0.05). V/C ratio was moderately correlated with clinical severity, histological grades, and endoscopic grades in the terminal ileum. In study 2, the diagnostic accuracies of magnified images for villous atrophy were 83.8% in the duodenum and 94.9% in the terminal ileum. CONCLUSION:  Magnifying endoscopy enables evaluation of villous atrophy and is useful for optical biopsy of GVHD.


Asunto(s)
Enfermedades Duodenales/patología , Duodeno/patología , Endoscopía Gastrointestinal , Enfermedad Injerto contra Huésped/patología , Trasplante de Células Madre Hematopoyéticas , Enfermedades del Íleon/patología , Íleon/patología , Mucosa Intestinal/patología , Adolescente , Adulto , Anciano , Aloinjertos , Atrofia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
20.
Dermatol Online J ; 26(1)2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-32155037

RESUMEN

Intralesional corticosteroids are associated with various, uncommon, local adverse events [1]. Atrophy and hypopigmentation most commonlyremain localized to sites of injection. However, outward radiation in a linear, streaky pattern has been reported and is termed "perilesional/perilymphatic hypopigmentation or atrophy [2]." We report a case of this rare adverse event.


Asunto(s)
Glucocorticoides/efectos adversos , Hipopigmentación/inducido químicamente , Piel/patología , Triamcinolona Acetonida/efectos adversos , Anciano , Atrofia/inducido químicamente , Glucocorticoides/administración & dosificación , Humanos , Inyecciones Intralesiones/efectos adversos , Masculino , Codo de Tenista/tratamiento farmacológico , Triamcinolona Acetonida/administración & dosificación
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