Should we consider paranasal and chest computed tomography in severe asthma patients?

BACKGROUND: It is essential to recognize and treat findings that can simulate or worsen symptoms to improve asthma control and thereby to reduce costs. Guidelines highlight a paranasal (PS) and chest computed tomography (CT) scan as a tool for disease evaluation and, although they suggest its indication in patients whom presentation is atypical, there are not well-defined criteria. OBJECTIVES: To describe the most common findings in the PS and chest CT in severe asthma patients and to analyse the characteristics of asthmatics with the finding of nasal polyps or bronchiectasis. METHODS: We retrospectively reviewed the medical records of 161 adults with confirmed severe asthma who had undergone to PS and/or chest CT. Clinical data from their electronic health record and the findings from a PS and/or chest CT within the last five years were collected. RESULTS: In the PS CT, 70.5% of patients presented mucous thickening and 46.7% presented nasal polyps. Both findings were associated with male gender and level of blood eosinophils. In chest CT, 28% of individuals showed atelectasis, 16.5% air trapping, 17.7% affectation of the small airway, 11.6% pulmonary infiltrates and 10.4% emphysema. Bronchiectasis were identified in 60.4% of subjects, who were older and had poorer lung function. CONCLUSION: Paranasal and thoracic computed tomography are important tools in the treatment of severe asthma because they allow us to detect highly prevalent findings in this disease that can lead to poorer control of it.

Retinal Sensitivity in Patients with Type I Diabetes without Retinopathy or with Minor Retinal Changes.

Objective: To evaluate the ability of short-wavelength automated perimetry (SWAP) for the detection of visual impairment in patients with type I diabetes without retinopathy or with minor retinal vascular changes. Design: Comparative cross-sectional study. Participants: 30 eyes of 30 healthy subjects and 73 eyes of 73 patients with type I diabetes mellitus were studied. Methods: Ophthalmic examination of diabetic patients showed no retinopathy or minimal changes (less than 5 microaneurisms in each eye) with no previous laser treatment. All patients were examined by means of the SWAP 24-2 strategy. Mean Deviation (MD) and Pattern Standard Deviation (PSD) were compared between both groups. Results: There were differences in the clusters of altered points between both groups (p=0.004). SWAP MD was lower in the diabetic group than in the controls (-2.89 dB vs. -0.20 dB, p<0.001). SWAP PSD also differed between both groups (2.50 dB in control group, 3.12 dB in the diabetic group, p=0.003). In the diabetic group, mean period from the onset of diabetes was 12.6±6.7 years and minimal vascular changes were observed in the retina of 18 eyes (24.7%), while 55 had no lesions (75.3%). No differences in SWAP changes were found between patients without and with minimal diabetic retinopathy. Conclusions: Retinal sensitivity assessed by SWAP is depressed in patients with type I diabetes regardless of the presence of retinal vascular changes.

Ranibizumab intravítreo en el tratamiento de membrana neovascular subretiniana en un caso de coroidopatía puntata interna / Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy

CASO CLÍNICO: Se presenta el caso de una mujer de 28 años con disminución de agudeza visual en ojo izquierdo (OI) que presentaba una imagen sugestiva de membrana neovascular subretiniana en OI y lesiones coriorretinianas bilaterales compatibles con coroidopatía punctata interna (PIC) que fue tratada con ranibizumab intravítreo, obteniendo excelentes resultados. DISCUSIÓN: Debe realizarse el diagnóstico diferencial de la PIC con el resto de «síndromes de puntos blancos» y con el síndrome de presunta histoplasmosis ocular (SPHO). Los fármacos anti-VEGF pueden ser una buena alternativa como tratamiento de este tipo de enfermedades cuando desarrollan una membrana neovascular subretiniana

CASE REPORT: We report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results. DISCUSSION: The differential diagnosis must be made between PIC and the rest of "white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane

In vitro vitamin K3 effect on conjunctival fibroblast migration and proliferation.

PURPOSE: To evaluate the dose effect of vitamin K3 on wound healing mechanisms. METHODS: Conjunctival fibroblasts were incubated for 24 hours. An artificial wound was made and the cells were incubated with fresh medium plus doses of vitamin K3 to be tested. Wound repair was monitored at 0, 18, 24, and 48 hours. Proliferation was measured in actively dividing cells by [(3)H]thymidine uptake. Six different groups were tested: group 1/no drugs added, group 2/ethanol 0.1%, group 3/vitamin K3 1 mg/L, group 4/vitamin K3 2 mg/L, group 5/vitamin K3 4 mg/L, and group 6/vitamin K3 6 mg/L. Each experiment was carried out in triplicate and 4 times. RESULTS: There were no differences among groups at the initial time. In vitro wound repair was slower in groups 4, 5, and 6. There were no differences between control and ethanol groups and between control and vitamin K3 1 mg/L groups. Fibroblast mitogenic activity was statistically decreased in all vitamin K groups; statistical differences were found among vitamin K3 1 mg/mL and higher doses too. In groups 5 and 6, cellular toxicity was presented. CONCLUSIONS: Vitamin K3 is able to inhibit fibroblast proliferation. Vitamin K3 2 mg/L or higher doses inhibit wound healing repair, exhibiting cellular toxicity at 4 and 6 mg/L.

[Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy]. / Ranibizumab intravítreo en el tratamiento de membrana neovascular subretiniana en un caso de coroidopatía puntata interna.

CASE REPORT: We report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results. DISCUSSION: The differential diagnosis must be made between PIC and the rest of "white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.

Fractura de cuerpo cavernoso: la ecografía en el diagnóstico de urgencia / Corpus cavernosum fracture: the ultrasound in the emergency diagnosis

Objetivo. Valorar la utilidad de los hallazgos ecográficos en la sospecha de fractura de pene. Material y métodos. Se revisan las ecografías de pene realizadas en urgencias entre julio de 2007 y agosto de 2009 por sospecha clínica de fractura del cuerpo cavernoso, comparando los hallazgos ecográficos (hematoma subcutáneo, hematoma perialbugínea, rotura de la albugínea y rotura de la fascia de Buck) con los quirúrgicos, y la evolución a medio plazo. Se calculan sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los hallazgos ecográficos para el diagnóstico de fractura del cuerpo cavernoso. Recogemos datos epidemiológicos de los casos revisados. Resultados. Se estudiaron a 12 pacientes, con edad media de 35,75 años. El origen más frecuente de la lesión es el traumatismo durante el acto sexual. Ecográficamente, presentaron un hematoma subcutáneo 9 pacientes, perialbugínea 11 sujetos y discontinuidad de la albugínea 6 pacientes. No se visualizaron roturas de la fascia de Buck. Siete fueron operados. En los 5 sujetos restantes se realizó manejo conservador. La evolución fue siempre satisfactoria. La identificación mediante ecografía de la discontinuidad de la albugínea mostró una S de 0, 83, E de 1, VPP de 1 y VPN de 0,83. Conclusión. Consideramos la ecografía como un procedimiento útil para diagnosticar la fractura de cuerpo cavernoso y que se puede proponer como de elección para confirmar la sospecha clínica. La identificación del punto exacto de rotura dirige y facilita la cirugía(AU)

Objective. The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. Material and methods. We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous haematoma, peri-albuginea haematoma, albuginea rupture and Buck¿s fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. Results. Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous haematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Buck¿s fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. Conclusion. We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure(AU)

[Corpus cavernosum fracture: the ultrasound in the emergency diagnosis]. / Fractura de cuerpo cavernoso: la ecografía en el diagnóstico de urgencia.

OBJECTIVE: The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. MATERIAL AND METHODS: We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous haematoma, peri-albuginea haematoma, albuginea rupture and Bucks fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. RESULTS: Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous haematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Bucks fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. CONCLUSION: We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure.

Correlación de la tomografía de coherencia óptica con la histología retiniana / Correlation of optical coherence tomography with retinal histology

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[Is H1N1 flu different from seasonal flu on initial plain chest films?]. / Gripe A ¿diferente de la gripe estacional?

OBJECTIVES: To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season. MATERIAL AND METHODS: All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients' age, sex, and previous disease. RESULTS: Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p<0.001) and fewer had prior disease (48 vs. 63; p<0.001). Plain films were acquired with patients in the standing position in 75 patients in the H1N1 group and in 77 in the seasonal flu group; pathological findings were present in nearly 50% of the patients in each group. The most common findings in the H1N1 group were multifocal patchy consolidations (41.2%; p<0.001) and peribronchial-vascular opacities (16.3%), whereas in the seasonal flu group the most common finding was consolidation in a single lobe (43.9%). CONCLUSION: We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger.

Gripe A ¿diferente de la gripe estacional? / Is H1N1 flu different from seasonal flu on initial plain chest films?

Objetivos. Determinar si existen diferencias en los hallazgos de la radiografía de tórax inicial entre un grupo de pacientes con gripe A y pacientes con síntomas gripales en periodo de gripe estacional. Material y métodos. La muestra está formada por pacientes que ingresan con síntomas gripales y a los que se les realiza radiografía de tórax en Urgencias. El grupo de estudio lo constituyen 95 pacientes con gripe A confirmada atendidos entre los meses de julio a diciembre de 2009 y el grupo control 98 pacientes con síntomas de gripe estacional atendidos en enero de 2009. Se analizan los hallazgos radiológicos, su distribución y localización, edad, sexo, enfermedad previa y proyecciones obtenidas. Resultados. El grupo de estudio presentó menor edad que el control (media 40,2 vs 50,9 años, p<0,001). Tienen enfermedad previa 48 pacientes del grupo de estudio y 63 del control (p<0,001). La radiografía se obtuvo en bipedestación en 75 pacientes del grupo de estudio y en 77 del control y muestra hallazgos patológicos en casi el 50% de los pacientes de cada grupo. Los hallazgos más frecuentes en el grupo de estudio son las consolidaciones parcheadas multifocales (41,2%, p<0,001) y las opacidades peribroncovasculares (16,3%). En el grupo control la lesión más frecuente es la consolidación de distribución lobar única (43,9%). Conclusión. Encontramos diferencias significativas entre los hallazgos radiológicos en los pacientes con gripe A (grave) y aquellos con síntomas gripales en periodo de gripe estacional, con mayor incidencia de consolidación de distribución parcheada multifocal en la gripe A y en pacientes más jóvenes (AU)

To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season. Material and methods All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients’ age, sex, and previous disease. Results. Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p<0.001) and fewer had prior disease (48 vs. 63; p<0.001). Plain films were acquired with patients in the standing position in 75 patients in the H1N1 group and in 77 in the seasonal flu group; pathological findings were present in nearly 50% of the patients in each group. The most common findings in the H1N1 group were multifocal patchy consolidations (41.2%; p<0.001) and peribronchial-vascular opacities (16.3%), whereas in the seasonal flu group the most common finding was consolidation in a single lobe (43.9%). Conclusion. We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger (AU)

Retinal degeneration in two lines of transgenic S334ter rats.

Aim of this study was to examine synaptic connectivity changes in the retina and the location and rate of apoptosis in transgenic S334ter line-3 and line-5 rats with photoreceptor degeneration. Heterozygous S334ter-line-3 and line-5 at P11-13, P30, P60, P90 and several control non-dystrophic rats (Long Evans and Sprague-Dawley) at P60, were studied anatomically by immunohistochemistry for various cell and synaptic markers, and by PNA and TUNEL label.- S334ter line-3 exhibited the fastest rate of degeneration with an early loss of photoreceptors, with 1-2 layers remaining at P30, and only cones left at P60. Line-5 had 4-5 layers left at P30, and very few rods left at P60-90. In both lines, horizontal cell processes (including dendrites and axon) were diminished at P11-13, showing gaps in the outer plexiform layer (OPL) at P60, and at P90, almost no terminal tips could be seen. Bipolar cells showed a retraction of their dendrites forming clusters along the OPL. Synaptic terminals of A-II amacrine cells in the IPL lost most of their parvalbumin-immunoreactivity. The apoptosis rate was different in both lines. Line-3 rats showed many photoreceptors affected at P11, occupying the innermost part of the outer nuclear layer. Line-5 showed a lower number of apoptotic cells within the same location at P13. In summary, the S334ter line-3 rat has a faster progression of degeneration than line-5. The horizontal and bipolar terminals are already affected at P11-P13 in both models. Apoptosis is related to the mutated rhodopsin transgene; the first photoreceptor cells affected are those close to the OPL.

Diagnostic value of CT, PET and combined PET/CT performed with low-dose unenhanced CT and full-dose enhanced CT in the initial staging of lymphoma.

AIM: The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma. METHODS: One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard. RESULTS: For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients. CONCLUSION: PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.

Bilateral Internuclear Ophthalmoplegia in a Patient with Devic's Neuromyelitis Optica.

An unusual presentation of Devic's neuromyelitis optica (NMO) disease associated with bilateral internuclear ophthalmoplegia (INO) is described. A 32-year-old pregnant patient was diagnosed with NMO. First symptoms were headache and sudden visual loss in her right eye (RE). Eighteen months ago, she reported other neurologic symptoms such as paresthesia. Based on her visual field, fundoscopy and Ishihara test, she was diagnosed with retrobulbar neuritis of the RE. After delivery, new neurologic symptoms resembling transverse myelitis appeared. She was treated with methylprednisolone and plasmapheresis, which improved her visual acuity; however, a sudden bilateral INO appeared, with adduction defect and nystagmus with abduction in both eyes. No improvement was obtained after treatment with azathioprine and rituximab. Paresis of the legs and the right arm persisted, but double vision and OIN gradually disappeared. At the end, the patient had a residual exophoria in the RE and nystagmus with abduction in the left eye. Prevalence of NMO is lower than one case per one million inhabitants, and it is not likely to affect the encephalic trunk; furthermore, bilateral INO in NMO is rare. Two major criteria and at least two of the three minor ones are required to confirm a NMO diagnosis, and our patient fulfilled these diagnosis criteria.

Comparación de mediciones de espesores maculares y de capa de fibras nerviosas de la retina (RFNL) en pacientes diabéticos tipo 2 con oct de dominio tiempo (Stratus OCT) y espectral (Cirrus OCT) / No disponible

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Intraretinal processing following photoreceptor rescue by non-retinal cells.

Royal College of Surgeon (RCS) rats undergo retinal degeneration due to the inability of retinal pigment epithelial (RPE) cells to phagocytose shed outer segments. We explored the effect of introducing Schwann cells to the subretinal space of RCS rats (before the onset of retinal degeneration), by relying on electroretinogram (ERG) recordings and correlative retinal morphology. Scotopic ERGs recorded from cell-injected eyes showed preserved amplitudes of mixed a-wave b-wave, rod b-waves, and cone b-waves over controls (sham-injected eyes); photopic b-wave amplitudes and critical flicker fusion were also improved. Normal retinal morphology was found in areas of retinas that had received cell injections. Since Schwann cells have no phagocytic properties, their therapeutic effect is best explained through a paracrine mechanism (secretion of factors that ensure photoreceptor survival).

[The usefulness of PET/CT in lung cancer]. / Utilidad de la PET/TC en el cáncer de pulmón.

Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.

Utilidad de la PET/TC en el cáncer de pulmón / The usefulness of PET/CT in lung cancer

El cáncer de pulmón es la causa más frecuente de mortalidad por cáncer. Para un manejo adecuado de estos pacientes es esencial realizar una estadificación precisa de la enfermedad. La tomografía por emisión de positrones (PET) y, más recientemente, la PET/tomografía computarizada (TC) se han introducido en los algoritmos diagnósticos de los pacientes oncológicos, debido a la valiosa información funcional que proporcionan. La técnica híbrida PET/TC adquiere en una sola sesión las imágenes anatómicas (TC) y metabólicas (PET), combinando los beneficios de cada modalidad y minimizando sus limitaciones.En este artículo se revisa el papel de la PET/TC en la estadificación del cáncer de pulmón, con énfasis en el carcinoma no microcítico, evaluando sus ventajas y limitaciones, así como otras aplicaciones como la planificación de la radioterapia (AU)

Lung cancer is the leading cause of cancer-related death. Accurate staging is essential forthe optimal management and treatment of these patients. Positron emission tomography(PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms foroncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET)images in a sing lesession,combining the benefits of each modality and minimizing their limitations.This article reviews the role of PET/CT in lung cancer staging, with emphasison non-smallcell carcinoma, evaluating the advantages and limitations of the technique. Otherapplications of the technique, such as planning radiotherapy, are also discussed (AU)