EpCAM y obstrucción microvascular en pacientes con un IAMCEST: estudio con resonancia magnética cardiaca / EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Introducción y objetivos: La obstrucción microvascular (OMV) se asocia negativamente con la estructura cardiaca y el pronóstico de los pacientes tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST). El factor epithelial cell adhesion molecule (EpCAM), implicado en la cohesión de las células epiteliales, está poco estudiado en el contexto de la OMV. Por ello, el objetivo de este estudio es evaluar en una cohorte de pacientes con IAMCEST la asociación entre la concentración de EpCAM circulante con la extensión de la OMV, determinada por resonancia magnética cardiaca (RMC), y la función sistólica en fases crónicas. Métodos: Se incluyó prospectivamente a 106 pacientes con un primer IAMCEST tratados con angioplastia primaria percutánea. La concentración sérica de EpCAM se determinó 24h tras la reperfusión coronaria. Se estudió a todos los pacientes mediante RMC a la semana y a los 6 meses del IAMCEST. Se evaluó la correlación entre los valores de EpCAM circulante con la OMV, los índices de función sistólica y la fracción de eyección del ventrículo izquierdo. Resultados: La media de edad de la cohorte era 59±13 años y el 76% eran varones. Se dicotomizó a los pacientes según la mediana de EpCAM (4,48 pg/ml). Se observó que los pacientes que tenían valores más bajos de EpCAM presentaban una mayor extensión de la OMV (p=0,021) y un mayor tamaño de infarto (p=0,019) en los estudios de RMC realizados 1 semana después del evento cardiovascular. Respecto a las variables de presentación, la concentración de EpCAM se asoció significativamente con la presencia de OMV en análisis de regresión logística binaria univariable (OR=0,58; IC95%, 0,38-0,88; p=0,011) y multivariable (OR=0,55; IC95%, 0,35-0,87; p=0,010). A pesar de que la OMV tiende a resolverse espontáneamente en fases crónicas, unos valores más bajos de EpCAM se correlacionaron con una peor función sistólica (AU)

Introduction and objectives: Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods: We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated. Results: The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043). Conclusions: EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI

Resonancia magnética cardiaca de estrés para predecir mortalidad y toma de decisiones: registro de 2.496 pacientes mayores con síndrome coronario crónico / Stress cardiac magnetic resonance for mortality prediction and decision-making: registry of 2496 elderly patients with chronic coronary syndrome

Introducción y objetivos: El tratamiento del paciente mayor con síndrome coronario crónico (SCC) es un reto. Se exploró el valor pronóstico y la utilidad para la toma de decisiones de la carga isquémica determinada mediante resonancia magnética cardiaca (RMC) de estrés con vasodilatador en pacientes mayores con SCC. Métodos: Se incluyó a 2.496 pacientes mayores de 70 años estudiados con una RMC de estrés con vasodilatador por SCC conocido o sospechado. La carga isquémica (número de segmentos con déficit de perfusión inducido por el estrés) se calculó siguiendo el modelo de 17 segmentos. Posteriormente se analizó de manera retrospectiva su asociación con la mortalidad por cualquier causa y el efecto de la revascularización guiada por la RMC. Resultados: Durante una mediana de seguimiento de 4,58 años, se registraron 430 muertes (17,2%). Una mayor carga isquémica fue un predictor independiente de mortalidad: razón de riesgos, 1,04; intervalos de confianza del 95%, 1,01-1,07 por cada segmento adicional isquémico; p=0,006). Esta asociación también ocurrió en los mayores de 80 años y en las mujeres (p<0,001). Se detectó una interacción entre la revascularización y la mortalidad hacia un efecto deletéreo a baja carga isquémica y un efecto protector en caso de isquemia grave. Conclusiones: La RMC de estrés es un valioso instrumento para la estratificación del riesgo de los pacientes de edad avanzada con SCC y puede contribuir a guiar la toma de decisiones en este contexto (AU)

Introduction and objectives: The management of elderly patients with chronic coronary syndrome (CCS) is challenging. We explored the prognostic value and usefulness for decision-making of ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS. Methods: The study group comprised 2496 patients older than 70 years who underwent vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Subsequently, we retrospectively analyzed its association with all-cause mortality and the effect of CMR-guided revascularization. Results: During a median follow-up of 4.58 years, there were 430 deaths (17.2%). A higher ischemic burden was an independent predictor of mortality (HR, 1.04; 95%CI, 1.01-1.07 for each additional ischemic segment; P=.006). This association was also found in patients older than 80 years and in women (P <.001). An interaction between revascularization and mortality was detected toward deleterious consequences at low ischemic burden and a protective effect in patients with extensive ischemia. Conclusions: Vasodilator stress CMR is a valuable tool to stratify risk in elderly patients with CCS and might be helpful to guide decision-making in this scenario (AU)

The design of a line velocity interferometer for any reflector for inertial confinement experiments on the Z-machine.

A line VISAR (Velocity Interferometer System for Any Reflector) has been designed and commissioned at the Sandia National Laboratory's Z-machine. The instrument consists of an F/2 collection system, beam transport, and an interferometer table that contains two Mach-Zehnder type interferometers and an eight channel Gated Optical Imaging (GOI) system. The VISAR probe laser operates at the 532 nm wavelength, and the GOI bandpass is 540-600 nm. The output of each interferometer is passed to an optical streak camera with four selectable sweep speeds. The system is designed with three interchangeable optics modules to select a full field of view of 1 mm, 2 mm, or 4 mm. The optical beam transport system connects the target image plane to the interferometers and the gated optical imagers. The target is integrated into a sacrificial final optics assembly that is integral to the transport beamline.

[Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1]. / Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1.

CLINICAL CASE: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. DISCUSSION: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis.

Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1 / Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1

Caso clínico: Varón de 69 años diagnosticado de leucemia mieloblástica aguda M1 en remisión completa, remitido a Oftalmología por cuadro de ojo rojo no doloroso. Biomicroscópicamente se observan lesiones sobreelevadas asalmonadas en conjuntiva tarsal superior de ojo derecho e inferior de ambos ojos. Mediante estudios histológicos e inmunohistoquímicos se confirma recidiva extramedular en forma de sarcoma mieloide en conjuntiva. El paciente fallece a los 3 meses de un fallo multiorgánico. Discusión: La recidiva extramedular de una leucemia puede presentarse como una manifestación ocular que conlleva una recurrencia de la leucemia, siendo esta de mal pronóstico(AU)

Clinical case: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. Discussion: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis(AU)

Cambios en la perfusión cerebral inducidos por etomidato en pacientes con epilepsia del lóbulo temporal / Changes in cerebral perfusión induced by etomidate in patients with temporal lobe epilepsy

Resumen. Introducción. La epilepsia es uno de los mayores trastornos neurológicos. Afecta a alrededor del 0,5-2% de la población mundial, y entre el 20-25% de los pacientes son resistentes a la medicación. Objetivo. Analizar la respuesta de la perfusión cerebral –valorada mediante tomografía simple por emisión de fotón único (SPECT)– y la actividad bioeléctrica –en scalp y región temporal mesial– a la aplicación de etomidato. Pacientes y métodos. Se estudiaron 10 pacientes evaluados prequirúrgicamente y estudiados mediante videoelectroencefalograma (video-EEG) con electrodos de foramen oval (EFO) y SPECT. Se administró etomidato (0,1 mg/kg de peso), seguido por 99mTc-HmPAO, durante el estudio en el video-EEG + EFO. Resultados. Los efectos secundarios consistieron en mioclonías (n = 7) y dolor moderado (n = 2). No se han observado efectos cardiovasculares o respiratorios significativos. La actividad bioeléctrica en scalp consistió en una actividad rápida inicial breve, seguida por un patrón delta generalizado e hipervoltado durante varios minutos. En la región irritativa, se observó un marcado incremento de la actividad interictal. La perfusión cerebral aumentó, en general en todas las áreas estudiadas, especialmente en la región temporal (lateral y mesial) y en las áreas talámicas. En la cola del hipocampo no epileptógeno, se ha observado el segundo mayor incremento en la perfusión cerebral, y es la única región que se diferencia de la contralateral. Conclusiones. La activación mediante etomidato da lugar a una respuesta específica y repetible sobre la actividad bioeléctrica. Además, la perfusión cerebral local muestra cambios relacionados directamente con la región epileptógena, y puede servir, por tanto, como herramienta diagnóstica en un futuro inmediato (AU)

Summary. Introduction. Epilepsy is one of the major neurological disorders, affecting roughly 0.5-2% of the world’s population and approximately 20-25% of patients are resistant to medication. Aim. To analyze the response of cerebral perfusion (assessed by SPECT) and bioelectrical activity (measured in scalp and mesial temporal region) to etomidate. Patients and methods. We studied 10 patients presurgically evaluated and studied by video-EEG with foramen ovale electrodes (EFO) and SPECT. Etomidate was administered (0.1 mg/kg), followed by 99mTc-HmPAO during the study in the video-EEG + EFO. Results. The side-effects consisted of myoclonus (n = 7) and moderate pain (n = 2). There had been no significant respiratory or cardiovascular effects. The bioelectrical activity in the scalp consisted in a brief initial rapid activity, followed by a generalized and hypervoltaged delta pattern for several minutes. In the epileptogenic zone, there was a marked increase of interictal activity. Increased cerebral perfusion was observed in all areas studied, especially in temporal region (mesial and lateral) areas and thalamus. In the tail of the non-epileptic hippocampus, we observed the second largest increase in cerebral perfusion, the only region that is different from contralateral area. Conclusions. Activation by etomidate induces a specific and repetitive response in the bioelectrical activity. In addition, cerebral perfusion changes directly related to the epileptogenic region may serve therefore as a diagnostic tool in the near future (AU)

[Changes in cerebral perfusion induced by etomidate in patients with temporal lobe epilepsy]. / Cambios en la perfusión cerebral inducidos por etomidato en pacientes con epilepsia del lóbulo temporal.

INTRODUCTION: Epilepsy is one of the major neurological disorders, affecting roughly 0.5-2% of the world's population and approximately 20-25% of patients are resistant to medication. AIM: To analyze the response of cerebral perfusion (assessed by SPECT) and bioelectrical activity (measured in scalp and mesial temporal region) to etomidate. PATIENTS AND METHODS: We studied 10 patients presurgically evaluated and studied by video-EEG with foramen ovale electrodes (EFO) and SPECT. Etomidate was administered (0.1 mg/kg), followed by (99)mTc-HmPAO during the study in the video-EEG + EFO. RESULTS: The side-effects consisted of myoclonus (n = 7) and moderate pain (n = 2). There had been no significant respiratory or cardiovascular effects. The bioelectrical activity in the scalp consisted in a brief initial rapid activity, followed by a generalized and hypervoltaged delta pattern for several minutes. In the epileptogenic zone, there was a marked increase of interictal activity. Increased cerebral perfusion was observed in all areas studied, especially in temporal region (mesial and lateral) areas and thalamus. In the tail of the non-epileptic hippocampus, we observed the second largest increase in cerebral perfusion, the only region that is different from contralateral area. CONCLUSIONS: Activation by etomidate induces a specific and repetitive response in the bioelectrical activity. In addition, cerebral perfusion changes directly related to the epileptogenic region may serve therefore as a diagnostic tool in the near future.

Comparative study of topical anaesthesia with lidocaine 2% vs levobupivacaine 0.75% in cataract surgery.

BACKGROUND: This study compared the efficacy of topical anaesthesia with levobupivacaine 0.75% vs lidocaine 2% during cataract surgery by phacoemulsification. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anaesthesia in cataract surgery. Two hundred and forty-six consecutive patients undergoing corneal phacoemulsification were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=126) or lidocaine 2% (n=120). The main outcome variables of the study were intraoperative and postoperative pain, requirement for additional anaesthesia, patient comfort and cooperation, surgeon satisfaction, and corneal epithelial toxicity induced by topical drugs. RESULTS: evobupivacaine 0.75% provided significantly better analgesia than lidocaine 2% during cataract surgery (P<0.001) at the end of surgery (P<0.002), and up to 30 min after surgery (P<0.001). There were no statistically significant differences between the two groups 5 h after surgery. Epithelial toxicity was similar in both groups, and patient comfort and surgeon assessment of patient cooperation were better in the levobupivacaine group. CONCLUSIONS: Topical anaesthesia with levobupivacaine 0.75% was more effective than lidocaine 2% in preventing pain and improving patient and surgeon comfort during cataract surgery, with similar toxicity.

Adenoma de célula madre acidófila: variante infrecuente de tumor hipofisario / Acidophil stem cell adenoma: an uncommon pituitary tumor

El adenoma de célula madre acidófila es un tumor hipofisario parcialmente diferenciado derivado del precursor común de células productoras de hormona de crecimiento y prolactina. Son poco frecuentes y clínicamente pueden presentarse como no funcionantes o asociar hiperprolactinemia. Se analizaron los hallazgos clínicos, inmunohistoquímicos y ultrastructurales de 3 casos de este tipo de adenoma hipofisario. Dos de ellos (2 varones, casos 1 y 3), comenzaron con clínica de compresión local y panhipopituitarismo, y el restante (mujer, caso 2), con amenorrea secundaria. Eran 3 macroadenomas hipofisarios, y en el caso 3 había invasión del seno cavernoso. En todos se detectó hiperprolactinemia y sólo en 1 (caso 3) se asociaba acromegalia. Dos de los pacientes fueron intervinenidos con abordaje transesfenoidal con extirpación completa, y no existió recidiva tumoral en el seguimiento posterior. El estudio inmunohistoquímico y la microscopia electrónica confirmaron el diagnóstico. La presentación clínica de nuestros casos es heterogénea. La extirpación completa del adenoma, si es posible, es el principal factor pronóstico (AU)

Acidophil stem cell adenoma is an incompletely differentiated pituitary neoplasm consisting of a single cell type, assumed to be a common progenitor of somatotropes and lactotropes. These tumors are uncommon and may appear clinically as non-functioning adenomas; varying degrees of hyperprolactinemia are present in most cases. In this series, clinical, histopathological, immunohistochemical and ultrastructural characteristics of three cases of stem cell adenoma are described. Two patients (two males, cases 1 and 3) presented with symptoms of local compression and panhypopituitarism. In the remaining patient (female, case 2) the pituitary tumor was detected because of secondary amenorrhea. The tumors consisted of three pituitary macroadenomas with invasion of the cavernous sinus only in case 3. Hyperprolactinemia was present in all three patients. Acromegaly was evident in one patient (case 3). Complete transsphenoidal removal was achieved in two patients who have shown no evidence of tumoral recurrence in subsequent follow-up. The diagnosis was confirmed by electron microscopy and immunohistochemical characteristics. In our series, the clinical features of the tumors were heterogeneous. If is possible, complete surgical removal confers a better prognosis (AU)

Protocol for mitomycin C use in glaucoma surgery.

PURPOSE: To evaluate the results of a protocol described for mitomycin C (MMC) use in trabeculectomy or combined surgery (phacoemulsification and trabeculectomy). METHODS: A total of 143 eyes (60 trabeculectomies and 83 combined surgeries) of 124 patients were divided into four groups: group 1 (without MMC); group 2 (with 0.1 mg/ml MMC); group 3 (with 0.2 mg/ml MMC), and group 4 (with 0.4 mg/ml MMC). Two-minute MMC was used in every case in groups 2, 3 and 4. The results were analysed after 1 year of follow-up. Intraocular pressure (IOP) and complications were evaluated. Successful IOP control was defined when IOP was <21 mmHg and <16 mmHg if advanced glaucoma was present, always without additional medical treatment. RESULTS: Mean preoperative IOP decreased from 24.60 mmHg (SD 1.40 mmHg) to 13.47 mmHg (SD 0.37 mmHg) (p < 0.00001), 12 months postoperatively. Control in IOP was achieved in 79.02% of eyes. No significant differences were found in final mean IOP values (p > 0.196) or in postoperative complications (p > 0.120) in groups 2, 3 and 4. CONCLUSION: With the protocol described, a selection of concentration of MMC has been made in different clinical forms of glaucoma. No significant differences in IOP control and postoperative complications were noticed among the groups.

Importancia del cribado del cáncer de mama en nuestro hospital / The importance of mammography screening in our area

El cáncer de mama actualmente es un problema de salud pública muy importante, los factores causantes son múltiples y algunos de ellos están en discusión; es fundamental que las pacientes sean conscientes de la importancia de la realización de pruebas de cribado para la detección precoz y para que el tratamiento de esa enfermedad sea lo más efectivo posible. Se está viendo la aparición de este cáncer en pacientes cada vez más jóvenes, por lo que se prevé que en un futuro próximo el intervalo de estudio sea más amplio (AU)

Actinomicosis en maxilar superior simulando hemangioma intraóseo

El diagnóstico de infección subaguda-crónica por Actinomices es a veces difícil y puede demorarse en el tiempo. Presentamos un caso de dicha infección en maxilar superior donde desde el comienzo fue erróneamente diagnosticado como hemangioma intraóseo. Destacamos la necesidad de pensar en dicha bacteria en todas aquellas lesiones en maxilar superior y mandíbula que por su clínica y/o forma de presentación no se ajusten a patrones nosológicos frecuentes (AU)

Mixoma del maxilar superior

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Evaluation of lectin staining in the diagnosis of fungal keratitis in an experimental rabbit model.

PURPOSE: To assess the sensitivity, specificity, and reliability of peroxidase labeled lectin staining in the diagnosis of fungal keratitis in an experimental rabbit model. METHODS: Fungal keratitis by Candida albicans, Aspergillus fumigatus, and Fusarium solani was induced in rabbits. WGA-peroxidase staining of 660 corneal sections was performed. Fungal staining was evaluated independently by two observers. The test sensitivity, specificity, and reliability indexes were calculated. RESULTS: The sensitivity of the lectin staining test for Candida albicans was 100% (95% CI: 93.51-100.00), and specificity was 100% (95% CI: 93.51-100.00). The sensitivity of the test for Aspergillus fumigatus was 96.36% (95% CI: 86.46-99.35), and specificity was 100% (95% CI: 93.51-100.00). The sensitivity of the test for Fusarium solani was 96.36% (95% CI: 86.46-99.35) and specificity was 96.15% (95% CI: 85.74-99.31). There was also a high degree of test-retest and inter-rater concordance for all three fungi tested. The test-retest k reliability indexes were 0.9455, 0.9636, and 0.8879, for Candida albicans, Aspergillus fumigatus, and Fusarium solani, respectively. The inter-rater k reliability indexes were 0.9636, 0.9818, and 0.9252, for Candida albicans, Aspergillus fumigatus, and Fusarium solani, respectively. CONCLUSIONS: WGA-peroxidase staining is a very sensitive, specific, and reliable test for the identification of fungi in an experimental rabbit model of fungal keratitis.

Pars planitis: epidemiology, treatment, and association with multiple sclerosis.

During retrospective and prospective studies, we attempted to determine the clinical characteristics, treatment, and visual outcome of patients with pars planitis and to evaluate the association between pars planitis and multiple sclerosis (MS). The retrospective study included 44 patients with pars planitis, who had been examined between October 1986 and January 1999. We analyzed age, sex, visual acuity (VA), median follow-up time, and medical and surgical treatments. The prospective study, which included 21 consecutive patients with pars planitis, was performed to determine the presence of MS. In the retrospective study, the mean patient age was 22.4 years (SD +/- 11.5) and the median follow-up was 34.9 months (SD +/- 27.2). Complications included macular edema (47.7%), vitreous opacities (38.6%), papillitis (38.6%), vasculitis (36.4%), and cataract (20.5%). Forty patients (90.9%) had a final bilateral VA better than 20/40. In the prospective study, magnetic resonance imaging (MRI) was performed. Demyelinating lesions were found in 10 (47.6%) of the 21 patients and relapsing-remitting clinically definite MS was diagnosed in seven (33.3%). With the exception of age, no significantly statistical differences were observed when the visual prognosis and the clinical and epidemiologic characteristics were compared between the two groups of patients with and without associated MS; a diagnosis of MS was more frequently made in patients over 25 years of age. With appropriate treatment, patients with pars planitis have a good visual prognosis. Because the presence of demyelinating lesions seems to be high among patients with pars planitis, MRI should be considered, especially in patients over 25 years of age.

Conjunctival biopsy in the diagnosis of ocular sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that can affect almost every organ in the body, particularly the lungs, skin, eyes, and thoracic lymph nodes. A definitive diagnosis of sarcoidosis requires that a biopsy be performed. A specimen can be obtained from any affected ocular structure, including conjunctiva, lacrimal gland, eyelid skin, and orbit. Among them, conjunctival biopsy has been suggested as a sensible and safe procedure for confirming suspected sarcoidosis. We describe three patients in whom ocular symptoms were the sole initial manifestations of sarcoidosis and who were diagnosed based on the results of a conjunctival biopsy. We also discuss the efficacy of and indications for conjunctival biopsy.

Fuchs' heterochromic iridocyclitis: a review of 26 cases.

UNLABELLED: Fuchs' heterochromic iridocyclitis (FHI), an unusual form of uveitis of unknown etiology, is frequently misdiagnosed. PURPOSE: To report the analysis of 26 patients (27 eyes) with FHI who were diagnosed and observed over a period of 1-7 years (mean: 3.42 +/- 2.2 years). METHODS: Ocular and systemic examinations were performed on all patients. RESULTS: The most common presenting symptom was visual deterioration (42.3%); one patient was affected bilaterally. Characteristic keratic precipitates (100%), cataracts (77.8%), and heterochromia (70.4%) were the major signs. Eleven eyes (40.7%) required cataract surgery. At the initial examination, four eyes (14.8%) had glaucoma, and no new cases of glaucoma developed during the follow-up period. One eye required filtration surgery. Vitrectomy was performed in two eyes (7.4%) because of vitreous opacities. Most patients (73.0%) did not require active treatment; pre- and postoperative anti-inflammatory treatment for cataract extraction was performed successfully to minimize the risk of inflammation. No severe uveitis was seen in any patient after surgery, but visual acuity did not improve greatly after cataract extraction; 54.5% eyes had visual acuity better than 20/40 before surgery, and 45.4% postoperatively. CONCLUSION: Posterior capsule opacification, glaucoma, and vitreous opacity were the major obstacles to visual rehabilitation after cataract surgery in patients with this type of uveitis.

Treatment of neck nodes after induction chemotherapy in patients with primary advanced tumours.

Responsiveness of neck nodes to induction chemotherapy often differs from that of the primary tumour. We have conducted a retrospective study to evaluate the results of treating the neck in a cohort of 350 patients with locally advanced (T3-4) head and neck carcinomas treated with radiation therapy at the primary location of the tumour after induction chemotherapy. One hundred and thirty-nine patients (40%) did not have neck nodes on diagnosis (N0). The treatment of the neck included surgery in 65 patients. Neck dissections were carried out before radiotherapy in 37 patients and after radiotherapy in 28 patients. The frequency of neck treatment failure was 24%. There was a tendency to better neck control when treatment included neck dissection, independently of the neck stage or response to chemotherapy. This tendency was statistically significant in patients with an advanced regional tumour (N2-3) who did not achieve a complete regional response after chemotherapy. In a multivariate analysis the variables that were related to the regional failure were the relapse of the tumour at the primary site, the neck stage (N), the type of treatment used in the neck, and the grade of regional response after induction chemotherapy. Our results lead us to suggest that after induction chemotherapy neck surgery is advisable in all cases with advanced regional disease (N2-3), independently of the grade of response achieved after induction chemotherapy, and is also advisable in N1 patients in whom induction chemotherapy does not achieve a complete response.

[Sertoli-Leydig-cell ovarian tumor with a retiform pattern and heterologous elements: a rare cause of virilization]. / Tumor ovárico de células de Sertoli-Leydig con patrón retiforme y elementos heterólogos: una rara causa de virilización.

The case is presented of a young female with virilization signs and total circulating testosterone levels above 4 ng/ml, without a concomitant increase in cortisol, 17 OH-progesterone, DHEA-S, or androstenedion levels. On CT scan exam a tumoral mass in the left ovary was observed with polycystic characteristics similar to those observed in ovarian cystadenoma, inspite of the fact that most androgenic ovarian tumors are solid. The pathological study revealed an ovarian Sertoli-Leydig tumor associated to a reticular pattern with heterologous chondroid and mucinoid elements of cystadenoma.