Acute retinal pigment epitheliitis (ARPE). A case report.

A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE). ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments.

Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso / Acute retinal pigment epitheliitis (ARPE). A case report

Mujer de 35 años de edad que acudió a urgencias por pérdida de visión en ojo izquierdo. Presentaba una lesión de aspecto amarillento subfoveal que, en la tomografía de coherencia óptica (OCT), se correspondía con una lesión hiperreflectiva desde la capa nuclear externa hasta el epitelio pigmentario de la retina. La lesión se reabsorbió a las 6 semanas dejando una discontinuidad en la línea de los fotorreceptores y del epitelio pigmentario de la retina. La paciente fue diagnosticada de epitelitis pigmentaria retiniana aguda (EPRA). Debido a que la EPRA es una enfermedad autolimitada en el tiempo y de buen pronóstico, queremos recalcar la importancia del diagnóstico correcto mediante la funduscopia, OCT y angiofluoresceingrafía para evitar tratamientos innecesarios (AU)

A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE). ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments (AU)

Acute retinal pigment epitheliitis (ARPE). A case report. / Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso.

A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE). ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments.

Calcificaciones esclerocoroideas como hallazgo casual / Sclerochoroidal calcification as casual finding

La calcificación esclerocoroidea (CEC) es infrecuente y benigna. Se suele detectar en una exploración rutinaria hallándose múltiples lesiones blanco-amarillentas en el ecuador temporal superior de la retina en varones de mediana edad y ancianos. Se expone el caso de un paciente varón de 79 años de edad que presentó en una revisión rutinaria glaucoma pseudoexfoliativo en el ojo derecho, así como lesiones subretinianas blanco-amarillentas sobreelevadas en la región ecuatorial temporal superior en ambos ojos. Tras instaurar tratamiento hipotensor y realizarse autofluorescencia, tomografía de coherencia óptica (OCT), ecografía, tomografía computarizada (TC) ocular y analítica completa, se diagnosticó de CEC idiopáticas. La CEC requiere un estudio oftalmológico y sistémico completo porque puede asociar enfermedad endocrina. También se recomienda el seguimiento evolutivo periódico y descartar posibles complicaciones como la atrofia del epitelio pigmentario suprayacente, desprendimiento seroso, o la aparición de neovascularización. Debe realizarse el diagnóstico diferencial con lesiones benignas y malignas para evitar tratamientos innecesarios

Sclerochoroidal calcification (SCC) is uncommon and benign. It is usually detected in a routine examination, finding multiple yellow-white lesions in the upper temporal region of the retina in middle-aged and elderly men. A case report is presented of a 79 year-old male patient, who during a routine examination with a pseudoexfoliative glaucoma in the right eye, as well as raised white-yellow subretinal lesions in the upper temporal region in both eyes. After establishing hypotensive treatment and performing autofluorescence, optical coherence tomography (OCT), ultrasound, ocular computed tomography (CT) and complete laboratory analysis, idiopathic SCC was diagnosed. SCC requires a complete ophthalmological and systemic study as it can be associated with endocrine disease. Periodic follow-up is also recommended, as well as to rule out possible complications, such as atrophy of the overlying pigment epithelium, serous detachment, or the appearance of neovascularization. The differential diagnosis should be made of benign and malignant lesions, in order to avoid unnecessary treatment

Sclerochoroidal calcification as casual finding. / Calcificaciones esclerocoroideas como hallazgo casual.

Sclerochoroidal calcification (SCC) is uncommon and benign. It is usually detected in a routine examination, finding multiple yellow-white lesions in the upper temporal region of the retina in middle-aged and elderly men. A case report is presented of a 79 year-old male patient, who during a routine examination with a pseudoexfoliative glaucoma in the right eye, as well as raised white-yellow subretinal lesions in the upper temporal region in both eyes. After establishing hypotensive treatment and performing autofluorescence, optical coherence tomography (OCT), ultrasound, ocular computed tomography (CT) and complete laboratory analysis, idiopathic SCC was diagnosed. SCC requires a complete ophthalmological and systemic study as it can be associated with endocrine disease. Periodic follow-up is also recommended, as well as to rule out possible complications, such as atrophy of the overlying pigment epithelium, serous detachment, or the appearance of neovascularization. The differential diagnosis should be made of benign and malignant lesions, in order to avoid unnecessary treatment.

Basal 18F-FDG PET/CT in follicular lymphoma: a comparison of metabolic and clinical variables in the prognostic assessment / Valor de la 18F-FDG PET/TC basal en el linfoma folicular: comparación de las variables metabólicas y clínicas en la valoración pronóstica

Aim. To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging 18F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL). Methods. 82 patients with FL, a 18F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied. Results. The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p<0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk. Conclusion. The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work (AU)

Objetivo. Analizar la relación entre las variables clínicas relativas al pronóstico y la carga tumoral y las variables obtenidas en la 18F-FDG PET/TC de estadificación, así como su valor pronóstico para el linfoma folicular (LF). Métodos. Se realizó un estudio retrospectivo de 82 pacientes con LF, 18F-FDG PET/TC en el momento del diagnóstico y seguimiento mínimo de 12 meses. Se evaluaron las variables clínicas (grado tumoral, Índice pronóstico internacional para el linfoma folicular (FLIPI) y carga tumoral). Se analizaron las variables metabólicas tales como SUVmax en las lesiones más hipermetabólicas, localizaciones extralinfáticas, número de localizaciones ganglionares afectas, afectación de la médula ósea, estadio PET y diámetro de la lesión hipermetabólica de mayor tamaño, a fin de establecer una puntuación PET y clasificar los estudios en riesgo bajo, medio y elevado. Se compararon las variables clínicas y metabólicas (incluyendo el riesgo metabólico) y se estudió la relación entre todas las variables y la supervivencia libre de enfermedad (SLE). Resultados. El 28% de los pacientes tenían un tumor de alto grado. El 30,5% tenía un riesgo bajo de FLIPI, el 29,3% un grado intermedio y el 40,2% un riesgo elevado. El 42,7% presentó una elevada carga tumoral. La PET/TC fue positiva en el 94% de los pacientes. El grado del tumor no reflejó una relación significativa con la variable metabólica. El riesgo de FLIPI y la carga tumoral guardaron relaciones estadísticas con SUVmax y la puntuación PET (p<0,008 y p=0,003, respectivamente). Con respecto a la SLE, se detectaron diferencias significativas para el estadio PET y el riesgo FLIPI (p=0,015 y p=0,047, respectivamente). El riesgo FLIPI fue el único factor predictivo significativo en el análisis de regresión, con un cociente de riesgo instantáneo (HR) de 5,13 entre alto y bajo riesgo. Conclusión. La presente investigación resalta la considerable relación entre las variables metabólicas obtenidas con FDG PET/TC y las variables clínicas, aunque su objetivo como factor independiente de pronóstico no ha sido demostrado en el presente estudio (AU)

Basal (18)F-FDG PET/CT in follicular lymphoma: A comparison of metabolic and clinical variables in the prognostic assessment.

AIM: To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging (18)F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL). METHODS: 82 patients with FL, a (18)F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied. RESULTS: The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p<0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk. CONCLUSION: The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work.

[Response to presurgical stress in outpatient surgery: effects on lymphocyte populations of psychological treatment to prevent surgical anxiety]. / Respuesta al estrés prequirúrgico en la cirugía sin ingreso: efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica.

OBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n = 37) or experimental group (n = 37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgery.

Respuesta al estrés prequirúrgico en la cirugía sin ingreso: efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica / Response to presurgical stress in outpatient surgery: effects on lymphocyte populations of psychological treatment to prevent surgical anxiety

OBJETIVO: Estudio prospectivo randomizado para averiguar el efecto de un programa de psicoprofilaxis quirúrgica sobre las poblaciones linfocitarias en sujetos que van a ser tratados con cirugía sin ingreso. MATERIAL Y MÉTODOS: Se estudiaron 74 pacientes que iban a ser tratados en la Unidad de Cirugía Mayor Ambulatoria del Hospital Universitario de Albacete. Los pacientes se asignaron de forma aleatoria a un grupo control (n=37) o a un grupo experimental (n= 37). Se consideraron dos momentos: basal (consulta preoperatoria) y antequirófano (antes de comenzar la cirugia). En el grupo experimental se realizó un procedimiento de psicoprofilaxis que consistía en una entrevista, un video y un boletín de información peroperatoria y entrenamiento en habilidades para controlar la ansiedad. Se midieron con pruebas psicométricas los niveles de ansiedad de estado (STAI) y salud general (Goldberg), así como las poblaciones linfocitarias (linfocitos totales, CD 3, CD 4, CD 4RA, CD 4RO, CD 8, CD 56, CD 19 y CD 57). Los valores observados se expresaron como media aritmética y su desviación estándar. RESULTADOS: En el grupo con psicoprofilaxis quirúrgica los niveles de CD 19 (linfocitos B) disminuyeron significativamente menos respecto al control en el antequirófano. No se encontraron diferencias en las demás variables estudiadas entre ambos grupos. CONCLUSIONES: La psicoprofilaxis en pacientes de cirugía ambulatoria previene la disminución de las células B antes de la cirugía

OBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n=37) or experimental group (n=37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgeryOBJECTIVE: To determine the effect of a psychological stress control intervention on lymphocyte populations in patients preparing for outpatient surgery. PATIENTS AND METHODS: A prospective randomized controlled trial enrolling 74 patients scheduled for major outpatient surgery at the Hospital Universitario de Albacete in Spain. The patients were randomized to a control (n=37) or experimental group (n=37). Measurements were recorded at baseline (preoperative visit) and before entering the operating room (just before surgery). The experimental group received treatment in a psychological stress control program consisting of an interview, watching a video, provision of informative literature about the operation and techniques for controlling anxiety. Anxiety was measured with the State-Trait Anxiety Inventory. The General Health Questionnaire (Goldberg) was applied, and lymphocyte populations were assessed (total white cell count; CD3, CD4, CD4RA, CD4RO, CD8, CD56, CD19, and CD56 lymphocyte counts). Values were expressed as means (SD). RESULTS: The group that received psychological stress prevention therapy had significantly lower CD19 (B lymphocyte) cell counts than did the control group just before surgery. No differences were found between the groups for any other variables. CONCLUSIONS: Psychological stress control therapy prevents a decrease in B cell populations before outpatient surgery

[Severe hemolytic anemia caused by anti-AB in renal transplantation with minor ABO incompatibility]. / Anemia hemolítica grave por anti-AB en trasplante renal con incompatibilidad menor ABO.

A 54 year-old woman subjected to renal transplant with minor ABO incompatibility developed clinically severe anti-AB haemolytic anaemia. On the 13th day after transplantation the patient had: haemoglobin, 7.5 g/dL, unconjugated bilirubin, 393 mumol/L (23 mg/dL), and undetectable haptoglobin levels. Positive direct antihuman globulin test was found, and an IgG antibody capable of binding complement and with anti-AB specificity was found upon studying the eluate. Immunosuppressive therapy improved the clinical picture, although antibodies could still be detected one month later. Clinically significant immune haemolysis after renal transplantation appears in about 10-15% of those cases having antibodies against the host's antigens. The peak red-cell destruction is seen one to two weeks after grafting, and haemolytic signs may last for about three weeks. Although self-limited, this condition may achieve high severity. The duration and severity of haemolysis depend upon the density of antigen sites on the surface of the host's red-cells, his secretor trait, the presence or absence of complement activation and the immunosuppressive therapy including cyclosporin. Several cases of anti-A and anti-B specificity have been reported, but anti-AB specificity had not been previously found; this fact is probably related to the scarce interest paid to its search thus far.