ABSTRACT
Background: Immunotherapy increases overall response rate (ORR) and overall survival (OS) in patients with non-small-cell lung cancer (NSCLC). Prognostic and predictive factors are a high need. Patients and methods: Retrospective review of NSCLC patients treated with nivolumab was performed. Analyzed variables included age, sex, stage, performance status (PS), location of metastases, presence of tumour-related symptoms and comorbidities, number of metastasis locations, previous chemotherapy, anti-angiogenic and radiotherapy treatments, and analytical data from the standard blood count and biochemistry. Results: A total of 175 patients were included. Median age was 61.5 years, 73.1% were men, 77.7% were ECOG-PS 0-1, and 86.7% were included with stage IV disease. Histology was non-squamous in 77.1%. Sixty-five received nivolumab in second line (37.1%). Thirty-eight patients had brain metastasis (22%), and 39 (22.3%) liver metastasis and 126 (72%) had more than one metastatic location. The ORR was 15.7% with median Progression free survival (PFS) 2.8 months and median OS 5.81 months. Stage III vs IV and time since the beginning of the previous line of treatment ≥ 6 vs < 6 months were associated with better response. PS 2, time since the previous line of treatment < 6 vs ≥ 6 months, and more than one metastatic location were independently associated with shorter OS in multivariable analysis (7.8 vs 2.7 months, 11.2 vs 4.6 months, and 9.4 vs 5.1 month). Finally, time since the previous treatment < 6 vs ≥ 6 months and more than one metastatic location were independently associated with shorter PFS in multivariable analysis (4.3 vs 2.3 months and 4.7 vs 2.3 months). Conclusion: Poor PS, short period of time since the previous treatment, and more than one metastatic location were associated with poorer prognostic
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Subject(s)
Humans , Male , Female , Middle Aged , Aged , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Antibodies, Monoclonal, Humanized/pharmacokinetics , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/pathology , Retrospective Studies , Neoplasm Recurrence, Local/prevention & controlABSTRACT
CASO CLÍNICO: Mujer de 31 años, sin antecedentes de interés, que consulta por diminución de la visión en ambos ojos. Refiere haber consumido un comprimido de acetato de ulipristal 30 mg como anticonceptivo de urgencia 4 días antes de la aparición de los síntomas. A la exploración presenta una mejor agudeza visual corregida de 0,6 en el ojo derecho y de 0,8 en el ojo izquierdo (según test de Snellen) y un desprendimiento seroso macular bilateral. Se decide observación, y a los 15 días presenta una mejoría significativa funcional y anatómica del cuadro. Discusión: El acetato de ulipristal podría desencadenar coriorretinopatía serosa central por su efecto sobre los receptores de progesterona presentes en coroides y epitelio pigmentario de la retina
CASE REPORT The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30 mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium
Subject(s)
Humans , Female , Adult , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/chemically induced , Contraceptive Agents/adverse effects , Retinal Detachment/diagnostic imaging , Central Serous Chorioretinopathy/complications , Receptors, Progesterone/administration & dosage , AngiographyABSTRACT
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Subject(s)
Humans , Eye Diseases/history , Blepharoptosis , Mydriasis , Enophthalmos , Orbital Fractures , Paintings/historyABSTRACT
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Humans , Trachoma/history , Chlamydia trachomatis/pathogenicity , Sulfanilamides/therapeutic use , History of Medicine , Ophthalmology/historyABSTRACT
Ante un paciente con cáncer diferenciado de tiroides, el protocolo de tratamiento estándar a seguir es cirugía, ablación con 131Iodo (131I) de restos tiroideos y supresión de TSH. Pero en algunos casos, el tratamiento con 131I no es efectivo y deja de ser una opción terapéutica debido a la desdiferenciación celular con pérdida de la captación de 131I. Como otras opciones, se puede recurrir a tratamiento sistémico, si bien los pacientes no siempre son respondedores, pudiendo progresar la enfermedad y quedando sin opciones terapéuticas. Los tumores endocrinos pueden expresar receptores de la somatostatina, lo que se ha utilizado tanto para el diagnóstico como para su tratamiento mediante el marcaje de los análogos de la somatostatina con isótopos radiactivos. Presentamos el caso de una paciente con carcinoma folicular de tiroides yodorrefractario, con expresión de receptores de la somatostatina, tratada con 177Lu-DOTATATE, con excelente respuesta clínica y analítica (AU)
In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response (AU)
Subject(s)
Humans , Female , Middle Aged , Carcinoma/diagnosis , Carcinoma , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms , Radiopharmaceuticals/therapeutic use , Trace Elements/therapeutic use , Somatostatin/analogs & derivatives , Iodine/therapeutic use , Radiopharmaceuticals/analysis , Neuroendocrine Tumors/drug therapy , Neuroendocrine Tumors , Quality of Life , Nuclear Medicine/methodsABSTRACT
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Humans , Religion and Medicine , Saints , Ophthalmology/history , PaintingsABSTRACT
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Humans , Anterior Chamber/anatomy & histology , Densitometry , Ophthalmology/historyABSTRACT
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Humans , Anterior Chamber/anatomy & histology , Densitometry , Ophthalmology/historyABSTRACT
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Humans , Female , Aged , Macular Degeneration/diagnosis , Macular Degeneration/pathology , Macular Degeneration/therapy , Vision Disorders/complications , Vision Disorders/diagnosis , Vision Disorders/pathology , Diagnostic Techniques, Ophthalmological/instrumentation , Eye Diseases/complications , Eye Diseases/diagnosis , Eye Diseases/therapyABSTRACT
CASO CLÍNICO: Mujer de 75 años intervenida de catarata en ojo izquierdo, que presentaba a las 24 h una agudeza visual de 0,8. En la biomicroscopia destacaba un cuerpo extraño anclado al iris en sector nasal coincidente con la incisión principal de la facoemulsificación, que fue retirado en un segundo acto quirúrgico. Fue analizado e informado como estructura inerte de naturaleza plástica. DISCUSIÓN: Planteamos el posible origen de la presencia del resto plástico en el postoperatorio de la cirugía de la catarata. En este caso su naturaleza inerte no desencadenó mayor inflamación intraocular. Además, la estructura rígida favoreció su anclaje al iris evitando otras complicaciones. Deben extremarse las medidas preventivas en la cirugía de la catarata revisando incluso los instrumentos y accesorios al terminar la cirugía
CASE REPORT: a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic. DISCUSSION: The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure
Subject(s)
Humans , Female , Middle Aged , Eye Foreign Bodies/surgery , Eye Foreign Bodies , Phacoemulsification/instrumentation , Phacoemulsification/methods , Tomography, Optical Coherence/methods , Iris/injuries , Iris/surgery , Visual Acuity/physiology , Visual Acuity/radiation effects , Phacoemulsification/trends , Phacoemulsification , Cataract Extraction/methods , Cataract ExtractionABSTRACT
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Subject(s)
Humans , Male , Female , History, 16th Century , History, 17th Century , History, 19th Century , History, 20th Century , Glaucoma/history , Glaucoma/surgery , Filtering Surgery/history , Ophthalmologic Surgical Procedures/education , Ophthalmologic Surgical Procedures/history , Ophthalmologic Surgical Procedures/methods , Iris/pathology , Iris/surgery , Iris Diseases/history , Iris Diseases/surgeryABSTRACT
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Subject(s)
Humans , Male , Female , History, 18th Century , History, 19th Century , Diagnostic Techniques, Ophthalmological/history , Diagnostic Techniques, Ophthalmological/trends , Glaucoma/history , Glaucoma/surgery , Trabeculectomy/history , Trabeculectomy/methods , Ophthalmologic Surgical Procedures/history , Ophthalmology/historyABSTRACT
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Subject(s)
Child , Humans , Glaucoma/classification , Myopia, Degenerative/diagnosis , Manometry/methods , Gonioscopy/methods , Carbonic Anhydrase Inhibitors/therapeutic use , Carbonic Anhydrases/therapeutic use , Intraocular Pressure/physiology , Pilocarpine/therapeutic useABSTRACT
CASO CLÍNICO: Miope magna con cámara anterior estrecha que presentó cierre angular secundario a lorazepam. DISCUSIÓN: El cierre angular generalmente ocurre en pacientes predispuestos desencadenado por factores precipitantes. Muchos fármacos de uso rutinario en la práctica clínica podrían ejercer como factor responsable del cierre angular secundario
CASE REPORT: Myopic magna with narrow anterior chamber that presented with a secondary angle closure due to lorazepam. DISCUSSION: Angle closure usually occurs in predisposed patients and is triggered by precipitating factors. Many drugs routinely used in clinical practice could act as a factor responsible for the secondary angle closure
Subject(s)
Adult , Female , Humans , Myopia/chemically induced , Myopia/complications , Lorazepam/adverse effects , Lorazepam/therapeutic use , 26467 , Vision, Ocular , Vision Disorders/chemically induced , Vision Disorders/complications , Tomography, Optical Coherence/methods , Intraocular Pressure , Acetazolamide/therapeutic use , Ophthalmic Solutions/therapeutic use , Fundus Oculi , Tomography, Optical Coherence/instrumentation , Tomography, Optical CoherenceABSTRACT
Background: our aim was to measure the osmolality of several PN formulas at different component concentrations to determine if equations described in literature to calculate osmolarity accurately predict osmolalality in other experimental conditions different than these used to develop them. Methods: osmolality of 12 different types of PN solutions, 9 for central and 3 for peripheral perfusion were measured by using freezing point depression in cross-sectional study. We evaluated the agreement (Pearson correlation test) and differential bias between measured osmolality and calculated osmolarity for three different equations described in the literature: Pereira Da Silva, ASPEN Practice Manual and ASPEN guidelines. Results: mean ± SD osmolality of PN solutions was 1789 ± 256 (range 1 540 - 2 372) and 751 ± 64 mOsm/kg (range 689 - 817) for central and peripheral infusion, respectively. The osmolality of PN formulations was mainly due to glucose (r = 0.975) and amino acids (r = 0.948). All studied equations had a good correlation in the bivariate analysis (p = 0.000). All equations had a trend to underestimate the osmolality compared with the measured value. However, ASPEN guidelines equation overestimated the osmolality for peripheral PN. Conclusions: measurement of osmolality of peripheral PN solutions is important to reduce the risk of phlebitis. The different equations described previously show a good correlation between them although in general underestimate the osmolality (AU)
Objetivo: nuestro objetivo era medir la osmolaridad de varias fórmulas de nutrición parenteral (NP) compuestas por diferentes componentes para determinar si las ecuaciones para calcular la osmolaridad de la solución, descritas en la literatura, predicen su osmolalidad en la práctica clínica. Método: se midió mediante osmometría la osmolalidad de 12 fórmulas de NP diferentes: 9 para acceso venoso central y 3 para acceso periférico, en un estudio transversal. Se analizó el acuerdo (test de correlación de Pearson) y las diferencias entre la osmolalidad medida y la osmolaridad calculada mediante tres fórmulas diferentes: ecuación de Pereira Da Silva, ecuación del manual de práctica clínica de ASPEN y ecuación de las guías de ASPEN. Resultados: la media ± desviación estándar de las soluciones era 1.789 ± 256 (rango 1.540 - 2.372) y 751 ± 64 mOsm/kg (rango 689 - 817) para perfusión central y periférica, respectivamente. La osmolalidad era debida principalmente a la glucosa (r = 0,975) y a los aminoacidos (r = 0,948). Todas las ecuaciones presentaban una buena correlación en el análisis bivariante (p = 0,000). Todas las ecuaciones tendían a infraestimar la osmolalidad, en comparación con el valor medido. Sin embargo, la ecuación de las guías de la ASPEN sobreestimaba la osmolalidad de las NP periféricas. Conclusiones: conocer la osmolaridad de la solución de NP periférica es importante para reducir el riesgo de flebitis. Las diferentes ecuaciones descritas en la literatura muestran una buena correlación entre ellas, aunque en general infraestiman la osmolalidad (AU)
Subject(s)
Humans , Parenteral Nutrition/methods , Parenteral Nutrition Solutions/pharmacology , Osmolar Concentration , Phlebitis/prevention & control , Risk Factors , Nutritional Support/methods , Nutrition Disorders/diet therapyABSTRACT
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Subject(s)
Female , Humans , Male , Persistent Hyperplastic Primary Vitreous/diagnosis , Persistent Hyperplastic Primary Vitreous/physiopathology , Persistent Hyperplastic Primary Vitreous , Lens Capsule, Crystalline/pathology , Lens Capsule, Crystalline , Ophthalmia Neonatorum/embryology , Ophthalmia Neonatorum/pathology , Diagnosis, Differential , Papilledema/embryology , Papilledema/pathologyABSTRACT
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Subject(s)
Child , Female , Humans , Male , Young Adult , Burkitt Lymphoma/complications , Papilledema/complications , Papilledema , Headache/complications , Headache/diagnosis , Intraocular Pressure/genetics , Intraocular Pressure/immunology , Diagnosis, Differential , Immunologic Deficiency Syndromes/complications , Translocation, Genetic , Malaria/complications , Malaria/embryology , Asthenia/complications , Anorexia/complications , Visual AcuityABSTRACT
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Subject(s)
Aged , Humans , Male , Hallucinations/diagnosis , Diagnosis, Differential , Sleep Initiation and Maintenance Disorders/complications , Sleep Initiation and Maintenance Disorders/physiopathology , Hallucinations/etiology , Dementia/complications , Dementia/physiopathology , Delirium/complications , Glaucoma/complicationsABSTRACT
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Subject(s)
Humans , Eye/blood supply , Persistent Hyperplastic Primary Vitreous/physiopathology , Incidental FindingsABSTRACT
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