IgE, blood eosinophils and FeNO are not enough for choosing a monoclonal therapy among the approved options in patients with type 2 severe asthma.

Type-2 inflammation is the most frequent endophenotype of asthma. Different biomarkers have been proposed to identify this inflammation because highly effective therapies have improved type-2 severe asthma control. We investigated the frequency of some biomarkers of type-2 inflammation (total IgE, sIgE, blood eosinophil, and FeNO) in the framework of severe asthma and assessed its ability to help us to choose the best biological therapy for each patient. Different scenarios (sensitivity analysis) were evaluated according to the biomarkers proposed for each biological therapy in 72 patients with type-2 severe asthma. Between 54.1% and 68% of patients could receive at least 2 different biological therapies and 34.7%-40.2% could receive any of the 3 types of therapies (anti-IgE, anti-eosinophil, anti-IL4). Biomarkers help to identify type-2 severe asthma but total IgE, sIgE, blood eosinophil, and FeNO are not enough to select 1 specific therapy. With the increasing arrival of new biological therapies, it is necessary to identify new biomarkers that allow us to improve our selection criteria for the best therapy for each patient or to construct a prediction rule.

Dual energy CT in the management of antiplatelet therapy in patients with acute ischemic stroke for carotid obstruction.

BACKGROUND AND PURPOSE: Acute tandem occlusions often require carotid stenting. Combination of mechanical and pharmacologic therapies in addition to antiplatelet drugs administered to prevent acute stent thrombosis might increase the risk of intracerebral hemorrhage. We present a protocol of antiplatelet regimen based on early post-procedural dual-energy CT (DE-CT). MATERIAL AND METHODS: Fifty consecutive stroke patients with tandem occlusions treated with acute carotid stenting after intracranial thrombectomy and TICI 2b/3 were reviewed. All patients received intravenous lysine acetylsalicylate during the procedure. Dual (aspirin+clopidogrel with or without clopidogrel load, groups A and B, respectively) or mono (aspirin) antiplatelet regimen (group C) was administered 12-24 h later according to brain DE-CT findings. Carotid ultrasonography was performed at 24 h and before discharge. We evaluated the rate of subsequent symptomatic intracranial hemorrhage (SICH) and acute stent thrombosis in each group. RESULTS: Between June 2014 and December 2016, 50 patients were included (mean age 66 years, 76% men, baseline NIHSS 16, median time from symptom onset to recanalization 266 min). According to DE-CT, 24 patients were assigned to group A, 19 to group B and 7 to group C (4 of them had SICH at that time). One patient suffered a subsequent SICH (belonging to group B). There was only one stent thrombosis without clinical repercussions in group B. CONCLUSIONS: DE-CT may contribute to select antiplatelet regimen after acute carotid stenting in tandem occlusions.

Analysis of endovascular treatment of ruptured microaneurysms compared with ruptured larger aneurysms.

OBJECTIVE: To retrospectively analyze the complications and outcome of the endovascular treatment of ruptured microaneurysms compared with the treatment of ruptured larger aneurysms. METHODS: 40 ruptured cerebral microaneurysms treated by endovascular techniques were selected retrospectively and compared with 207 larger ruptured cerebral aneurysms treated by endovascular techniques during the same time period. Medical charts and imaging studies were reviewed to analyze baseline clinical and epidemiologic characteristics, procedural complications, and clinical outcomes RESULTS: Cerebral microaneurysms had a higher incidence of intraoperative technical ruptures (13.5% vs 2.9%, p<0.005). The number of thromboembolic complications was not increased. Patient prognosis was similar for the two groups (mean modified Rankin Scale score 1.81 vs 2.09, p>0.1). CONCLUSIONS: Coiling of cerebral microaneurysms has a reasonable safety profile with good clinical outcomes, similar to coiling of larger aneurysms. In our experience, the systematic use of remodeling balloons, operator experience, and the ability to manage complications are the reasons for the satisfactory results.

Alergia e intolerancia a antiinflamatorios no esteroides: desensibilización exitosa en tres casos y revisión de la literatura / Allergy and intolerance to nonsteroidal antinflammatory drugs: successful desensitization in three cases

Los antiinflamatorios no esteroides son la segunda causa de reacciones a medicamentos después de los beta-lactámicos. La prevalencia de las reacciones a antiinflamatorios no esteroideos en la población general es de 0,1% a 0,3% y la prevalencia de anafilaxia inducida por ellos es de 0,01%. La intolerancia al ácido acetilsalicílico o a los antiinflamatorios no esteroides se presenta con síntomas como urticaria aguda, angioedema, crisis asmática, enfermedad respiratoria exacerbada por ácido acetilsalicílico y anafilaxia. Presentamos una revisión actualizada basada en tres casos de pacientes con intolerancia al ácido acetilsalicílico o a los antiinflamatorios no esteroideos que, por sus enfermedades concomitantes, requerían tratamiento permanente conácido acetilsalicílico. Después de someterlos a un protocolo de desensibilización rápida ácido acetilsalicílico en una unidad de cuidados intensivos, estos pacientes pudieron continuar recibiendo ácido acetilsalicílico diariamente sin efectos adversos.

Adverse reactions to nonsteroidal antinflammatory drugs are the second cause of reactions to drugs after beta-lactams. Prevalence of these reactions among general population is between 0.1-0.3%, and prevalence of nonsteroidal antinflammatory drug-induced anaphylaxis is 0.01%. Acetylsalicylic acid or nonsteroidal antinflammatory drug sensitivity can be manifested as acute urticaria, angioedema, acute asthma, acetylsalicylic acid exacerbated respiratory disease and anaphylaxis. An updated review based on three cases of patientes with acetylsalicylic acid or nonsteroidal antinflammatory drug intolerance is presented in which, because of their concomitant diseases, permanent treatment with acetylsalicylic acid was required. After undergoing a fast acetylsalicylic acid desentization protocol in an intensive care unit, these patients were able to receive daily acetylsalicylic acid doses without any adverse effects.

[Allergy and intolerance to nonsteroidal antinflammatory drugs: successful desensitization in three cases]. / Alergia e intolerancia a antiinflamatorios no esteroides: desensibilización exitosa en tres casos y revisión de la literatura.

Adverse reactions to nonsteroidal antinflammatory drugs are the second cause of reactions to drugs after beta-lactams. Prevalence of these reactions among general population is between 0.1-0.3%, and prevalence of nonsteroidal antinflammatory drug-induced anaphylaxis is 0.01%. Acetylsalicylic acid or nonsteroidal antinflammatory drug sensitivity can be manifested as acute urticaria, angioedema, acute asthma, acetylsalicylic acid exacerbated respiratory disease and anaphylaxis. An updated review based on three cases of patientes with acetylsalicylic acid or nonsteroidal antinflammatory drug intolerance is presented in which, because of their concomitant diseases, permanent treatment with acetylsalicylic acid was required. After undergoing a fast acetylsalicylic acid desentization protocol in an intensive care unit, these patients were able to receive daily acetylsalicylic acid doses without any adverse effects.

[Adrenal surgical pathology. Report of our cases and bibliographic review]. / Patología quirúrgica adrenal. Reporte de nuestra casuística y revisión bibliográfica.

OBJECTIVES: Adrenal masses have different presentations, from an incidentally diagnosed mass to a blooming Cushing's syndrome, this stimulated our interest to evaluate and describe our case series over the last 10 years, besides to perform a bibliographic update. METHODS: Retrospective and descriptive study of 22 patients suffering from adrenal masses, evaluating their clinical and radiological characteristics, functional disturbances, and histological diagnosis, emphasizing the first suspicion or finding suggesting adrenal disease. RESULTS: Men were more often affected than women in this series, 12 men vs. 10 women. Mean age was 51.2 years (33-71). Regarding side, 10 cases were right, 8 left and 2 presented bilateral disease, one of them bilateral adenoma and the other asynchronous renal carcinoma metastasis. The inverted "Y" morphology usually observed on CT scan was lost in 14 patients. Size varied between the following ranges: 2-4 cm--9 cases, 4-6 cm--12 cases, and one case of a gigantic cyst within the left hemi-abdomen. CONCLUSIONS: Results in our series are similar to those in the literature, adrenal masses are uncommon and despite their low incidence they have different clinical and a histological forms of presentation. 27% of them were incidental, which represents a significant percentage in comparison with other series. Adequate clinical and functional studies as well as their radiological characteristics will set the indication for adrenalectomy or follow-up. Most cases < 4 cm (7/9) were renal carcinoma metastasis or pheochromocytoma. Incidentally diagnosed cases have increased with the development of new imaging technologies as well as with more frequent use of them. The functional study of adrenal masses has suffered little change. Surgical treatment of these pathologies is suffering important changes with the advent of laparoscopic urologic surgery.

Patología quirúrgica adrenal. Reporte de nuestra casuística y revisión bibliográfica / Adrenal gland surgical pathology. Report of our case series and bibliographic review

OBJETIVOS: Desde una masa suprarrenal descubierta incidentalmente hasta el más típico y florido síndrome de Cushing, las masas suprarrenales tienen formas variables de presentación, esto despertó nuestro interés por valorar y describir nuestra casuística en los últimos 10 años, además, de una revisión de la literatura actual al respecto. MÉTODOS: Estudio retrospectivo y descriptivo de 22 pacientes afectos de masas suprarrenales, valorando las características clínicas, radiológicas, alteraciones funcionales y diagnóstico histológico, haciendo énfasis en la primera sospecha o hallazgo sugerente de patología adrenal. RESULTADOS: En nuestra serie los varones fueron más afectados que las mujeres Con relación 12/10 contra 10, la edad promedio fue de 51,2 años (33 - 71), en cuanto a la localización en 12 casos fue derecha y en 8 izquierda, en 2 casos se presentó enfermedad bilateral uno de ellos por adenoma bilateral y otro por metástasis de carcinoma renal de forma asincrónica. La morfología habitual en "Y" invertida observada en la TAC se perdió en 14 pacientes. El tamaño varió entre los siguientes intervalos 2 - 4 cms.9 casos, 4 - 6 cms. 12 casos y 1 caso con un gigantesco quiste en hemiabdomen izquierdo. CONCLUSIONES: Los resultados de nuestra serie son similares a los de la literatura, las masas suprarrenales son poco frecuentes y a pesar de su baja incidencia tienen diversas formas clínicas e histológicas de presentación. Un 27 por ciento de ellas fueron incidentales lo cual representa un porcentaje importante en comparación con otras series. Un adecuado estudio clínico y funcional así como las características radiológicas serán las que nos indiquen la necesidad de realizar suprarrenalectomía o seguimiento. La mayoría de casos < 4 cms. (7 de 9) fueron metástasis de carcinoma renal o feocromocitomas. Con el desarrollo de nueva tecnología en estudios de imagen, así como al mayor uso de las mismas, la patología incidental se ha incrementado. El estudio funcional de las masas suprarrenales ha sufrido pocos cambios. El tratamiento quirúrgico de esta patología esta sufriendo cambios importantes con el advenimiento de la cirugía urológica laparoscópica (AU)