Cavitación coroidea asociada a coloboma macular. Estudio multimodal. Imagen en face / Choroid cavitation associated with macular coloboma. Multimodal study. Image en face

La cavitación intracoroidea es un hallazgo identificado con OCT descrito inicialmente en pacientes miopes, pero también aparece en pacientes no miopes. Puede presentarse tanto en el área peripapilar como en el polo posterior. El coloboma macular es un defecto del desarrollo embrionario del polo posterior, y en la OCT estructural es imprescindible la ausencia del epitelio pigmentario de la retina y de los vasos coroideos para su diagnóstico. Este caso presenta la cavitación intracoroidea circunscribiendo el coloboma macular, en ausencia de membrana intercalar. La imagen en face permite valorar la relación entre ambas estructuras, así como la magnitud de las mismas. (AU)

Intrachoroidal cavitation is a finding identified with OCT initially described in myopic patients, it also appears in non-myopic patients. It can occur in both the peripapillary area and the posterior pole. Macular coloboma is a defect of embryonic development of the posterior pole, in structural OCT the absence of the retinal pigment epithelium and choroidal vessels is essential. In this case, intrachoroidal cavitation circumscribes the macular coloboma, in the absence of an intercalary membrane. The face image allows us to assess the relationship between the two structures as well as their magnitude. (AU)

Neumatocele traumático: una presentación inusual del trauma cerrado de tórax en paciente de 21 años / Traumatic pneumatocele: an unusual presentation of blunt chest trauma in a 21-year-old patient

El neumatocele traumático, o pseudoquiste pulmonar traumático, es una complicación infrecuente del trauma cerrado de tórax, caracterizada por lesiones cavitadas únicas o múltiples de paredes fibrosas bien delimitadas, sin revestimiento epitelial. Representa un reto diagnóstico ante la prevalencia de etiologías más frecuentes de cavitación pulmonar, presentación clínica inespecífica y el carácter subreportado de la patología. Se presenta el caso de un paciente de 21 años, con cuadro clínico de fiebre y dolor torácico posterior a traumatismo contuso por accidente en motocicleta, con identificación de una lesión cavitada rodeada de vidrio esmerilado, ubicada en lóbulo superior derecho en tomografía de tórax. Se ofreció tratamiento antibiótico ante la sospecha clínica de sobreinfección. Sin embargo, se atribuyó la alteración pseudoquística pulmonar al antecedente traumático. En ocasiones las cavitaciones pulmonares postrauma no son identificadas en la atención inicial, por ende, es fundamental la evaluación clínica e imagenológica subsecuente.

Traumatic pneumatocele, or traumatic pulmonary pseudocyst, is a rare complication of blunt chest trauma, characterized by multiple or unique cavitary lesions, with well-defined fibrous walls without epithelial lining. It represents a diagnostic challenge due to the higher prevalence of other etiologies of lung cavities, nonspecific clinical features and the under-reported nature of this pathology. We present the case of a 21-year-old male with fever and chest pain after a blunt chest trauma in a motorcycle accident, with identification of a cavity in the right upper lobe, surrounded by ground glass opacities. Antibiotic therapy was administered after clinical suspicion of superinfection, however, the cavitary lesion was attributed to the trauma. Occasionally, traumatic pulmonary pseudocysts are not identified during initial assessment, therefore, clinical and imagenologic follow-up is essential.

Cavitaciones pulmonares, complicación tardía de la COVID-19 / Pulmonary cavitations, late complication of COVID-19

La aparición de complicaciones graves, como el neumotórax o las cavitaciones pulmonares, en pacientes con infecciones recientes por el SARS-CoV-2 aumenta la morbi-mortalidad, y supone un reto diseñar la estrategia terapéutica más adecuada que permita mejorar su pronóstico. Las cavitaciones pulmonares se suelen asociar a complicaciones secundarias como la hemoptisis y el neumotórax, y confieren mal pronóstico. Se presenta el caso de dos pacientes con enfermedad COVID-19 confirmada por PCR nasofaríngea y que, tras evolución inicialmente satisfactoria, reingresaron con afectación pulmonar compatible con cavitaciones pulmonares y con insuficiencia respiratoria. Las lesiones cavitadas pulmonares en pacientes que hayan sufrido COVID-19 deben identificarse de forma precoz y realizar las determinaciones y cultivos necesarios para descartar sobreinfecciones añadidas que puedan empeorar el pronóstico.(AU)

Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.(AU)

A map of neutrophil granules by proteomics / Mapa dos neutrófilos por proteômica (OU) Mapa dos grânulos do neutrófilo por proteômica

Neutrophils are polymorphonuclear leukocytes that play a key role in the organism defense. These cells enroll in a range of actions to ensure pathogen elimination and orchestrate both innate and adaptative immune responses. The main physiological structures of neutrophils are their storage organelles that are essential since the cells activation and participate in all their functions. The storage organelles are divided into 2 types: granules and secretory vesicles. The granules are subdivided into azurophilic, specific and gelatinase. The granules are distinguished by their protein content, and since they play an important role on the neutrophil function, the knowledge of the proteins stored in these organelles can help to better understand these cells. Some proteins are present in high abundance and are used as markers for each storage organelle. These proteins are myeloperoxidase (MPO) for azurophil granules, neutrophil gelatinase associated with lipocalin-2 (NGAL) and lactoferrin (LTF) for specific granules, matrix metalloproteinase-9 (MMP9) for gelatinase granules and alkaline phosphatase (AP) for secretory vesicles. The isolation of neutrophils granules, however, is challenging and the existing procedures rely on large sample volumes, about 400 mL of peripheral blood or 3 x 108 neutrophils, not allowing for multiple biological and technical replicates. Therefore, the aim of this study was to develop a miniaturized neutrophil granules isolation method and to use biochemical assays, mass spectrometry-based proteomics and a machine learning approach to investigate the protein content of the neutrophils storage organelles. With that in mind, 40 mL of the peripheral blood of three apparently healthy volunteers were collected. The neutrophils were isolated, disrupted using nitrogen cavitation and organelles were fractionated with a discontinuous 3-layer Percoll density gradient. The presence of granules markers in each fraction was assessed using western blot , gelatin zymography and enzymatic assays. The isolation was proven successful and allowed for a reasonable separation of all neutrophils storage organelles in a gradient of less than 1 mL, about 37 times smaller than the methodsdescribed in the literature. Moreover, mass spectrometry-based proteomics identified 369 proteins in at least 3 of the 5 samples, and using a machine learning strategy, the localization of 140 proteins was predicted with confidence. Furthermore, this study was the first to investigate the proteome of neutrophil granules using technical and biological replicates, creating a reliable database for further studies. In conclusion, the developed miniaturized method is reproducible, cheaper, and reliable. In addition, it provides a resource for further studies exploring neutrophil granules protein content and mobilization during activation with different stimuli

Neutrófilos são leucócitos polimorfonucleares que possuem papel fundamental na defesa do organismo. Essas células desempenham diversas ações a fim de assegurar a eliminação de um patógeno e, além disso, orquestram a resposta imune inata e adaptativa. O conjunto composto pelos grânulos de armazenamento e as vesículas secretórias compõe a principal estrutura fisiológica dos neutrófilos. Estes componentes são essenciais desde a ativação celular, participando de todas as funcionalidades desta célula. Os grânulos são subdivididos em azurófilos, específicos e gelatinase. Eles podem ser distinguidos por meio de seu conteúdo proteico e, como são importantes na funcionalidade dos neutrófilos, identificar quais proteínas são armazenadas nestas organelas é imprescindível para entender melhor essa célula como um todo. Algumas proteínas, estão presentes de forma abundante e, portanto, são utilizadas como marcadores dos grânulos. Tais proteínas são mieloperoxidase (MPO) para os grânulos azurófilos, gelatinase de neutrófilo associada a lipocalina (NGAL) e lactoferrina (LTF) para os específicos, metaloproteinase de matrix 9 (MMP9) para os grânulos de gelatinase e fosfatase alcalina (AP) para as vesículas secretórias. Isolar estas estruturas, no entanto, é desafiador visto que os protocolos existentes na literatura utilizam grandes volumes de amostra, cerca de 400 mL de sangue ou 3 x 108 neutrófilos, para apenas um isolamento, impedindo a realização de replicatas técnicas e biológicas. Desta forma, o objetivo do presente estudo foi desenvolver um protocolo miniaturizado de isolamento dos grânulos neutrofílicos e utilizar métodos bioquímicos, de proteômica e machine learning para investigar o conteúdo proteico destas estruturas celulares. Para isto, 40 mL de sangue periférico de três voluntários aparentemente saudáveis foi coletado. Os neutrófilos foram então isolados, lisados com cavitação de nitrogênio e o fracionamento subcelular foi realizado baseado em um gradiente descontínuo de 3 camadas de Percoll. O método de isolamento foi avaliado através da investigação dos marcadores utilizando western blotting (WB), zimografia de gelatina e ensaios enzimáticos em cada fração coletada. O isolamento demonstrou-se eficiente e permitiu uma ótima separação dos grânulosem um gradiente menor que 1 mL, cerca de 37 vezes menor que os métodos atualmente descritos na literatura. Além disso, a análise proteômica foi capaz de identificar 369 proteínas presentes em pelo menos 3 das 5 réplicas investigadas e, utilizando ferramentas de machine learning, 140 proteínas foram classificadas como pertencentes a um dos tipos de grânulos ou vesícula secretória com alto nível de confiabilidade. Por fim, o presente estudo foi o primeiro a investigar o proteoma dos grânulos utilizando replicatas técnicas e biológicas, criando e fornecendo uma base de dados robusta que poderá ser utilizada em estudos futuros. Conclui-se, portanto, que a metodologia miniaturizada desenvolvida é eficaz, reprodutível e mais barata, além de permitir estudos mais complexos e profundos sobre o proteoma dos grânulos dos neutrófilos em diferentes momentos celulares, tais como quando ativados via estímulos distintos

Avaliação da atividade antimicrobiana da cavitação do sistema piezoelétrico sobre Candida albicans / Evaluation of the antimicrobial activity of the piezoelectric system cavitation on Candida albicans

A busca pela otimização dos resultados clínicos, levou ao desenvolvimento de novas tecnologias. O Sistema Piezoelétrico Odontológico (SPO), tem sido cada vez mais difundido e sua principal característica é o fenômeno da cavitação, que é o processo de vaporização, geração de bolhas e sua implosão subsequente. Tais fenômenos acústicos estão diretamente relacionados a lise das membranas celulares dos MO. O objetivo deste estudo foi investigar o fenômeno da cavitação do sistema piezoelétrico, em diferentes potências de ativação, em relação ao efeito antimicrobiano sobre Candida albicans. Para a execução do trabalho, foi utilizado o aparelho DENTSURG. Foi utilizada a cepa padrão de Candida albicans (18060), mantidas em freezer a -80ºC no Laboratório de Microbiologia e Imunologia do ICT UNESP. Para ativação de Candida albicans a cepa foi cultivada em ágar Sabouraud com cloranfenicol e incubada em estufa por 24 horas a 37°C. Após preparo dos MO, 100µL das células padronizadas foram adicionadas em placas de 24 poços e após essa etapa, um único operador treinado realizou a ativação, com os diferentes protocolos de ativação. Posteriormente, foram realizadas diluições seriadas que foram semeadas em placas contendo meios de cultura específicos e então foi determinado o número de Unidade Formadoras de Colônias por mililitro (UFC/mL). Após análise estatística os resultados mostraram que o grupo 1 (potência de 6,5W) e o grupo 2 (potência de 7,5W) não apresentaram diferença significativa. Não houve diferença do grupo em que houve a ativação do microrganismo, em relação ao grupo controle. Já o grupo 3 (potência de 13,6W) apresentou diferença significante, havendo diferença significativa do grupo em que houve a ativação do microrganismo. Com base nos resultados obtidos, conclui-se que uma potência mais elevada é mais eficaz na ação antimicrobiana de C. albicans. (AU)

The search for the optimization of clinical results led to the development of new technologies. The Dental Piezoelectric System (SPO) has been increasingly widespread and its main feature is the phenomenon of cavitation, which is the process of vaporization, generation of bubbles and their subsequent implosion. Such acoustic phenomena are directly related to the lysis of OM cell membranes. The aim of this study was to investigate the phenomenon of cavitation of the piezoelectric system, at different activation potencies, in relation to the antimicrobial effect on Candida albicans. To carry out the work, the DENTSURG device was used. A standard strain of Candida albicans (18060) was used, kept in a freezer at -80ºC in the Laboratory of Microbiology and Immunology of ICT UNESP. For Candida albicans activation, the strain was grown on Sabouraud agar with chloramphenicol and incubated in an oven for 24 h at 37°C. After OM preparation, 100µL of standardized cells were added in 24-well plates and after this step, a single trained operator performed the activation, with the different activation protocols. Subsequently, serial dilutions were performed and seeded in plates containing specific culture media and then the number of Colony Forming Units per milliliter (CFU/mL) was determined. After statistical analysis, the results showed that group 1 (6.5W power) and group 2 (7.5W power) showed no significant difference. There was no difference between the group in which the microorganism was activated and the control group. Group 3 (13.6W power) showed a significant difference, with a significant difference between the group in which the microorganism was activated. Based on the results obtained, it is concluded that a higher power is more effective in the antimicrobial action of C. albicans (AU)

Tuberculosis pulmonar cavitaria una presentación inusual en pediatría / Cavitary pulmonary tuberculosis an unusual presentation in pediatrics

Se presenta el caso de una paciente femenina de 5 años quien fue ingresada en el Hospital Nacional Benjamín Bloom, por presentar tos y fiebre persistente de 3 semanas, previo al ingreso en el centro hospitalario, la paciente curso con gastroenteritis aguda por lo que en el Hospital Nacional Zacamil, se sospechó fiebre tifoidea sin embargo al continuar febril y con tos fue transferida al hospital, durante el ingreso hospitalario se realizó el estudio para confirmar enfermedad tuberculosa presentando: prueba mantoux positiva (13 milimetros), radiografía de tórax con cavitación apical izquierda, baciloscopias positivas (16 puntos de los criterios de Stegen y Toledo), también se realizó una tomografía axial torácica computarizada que mostro lesión cavitada a nivel del lóbulo superior izquierdo segmento apical posterior de paredes gruesas tabicadas. Iniciando tratamiento con 4 fármacos antituberculosos (isoniacida, rifampicina, pirazinamida y etambutol), y posterior al egreso hospitalario el paciente continuo con el tratamiento durante 6 meses y presentando evolución clínica satisfactoria

We present the case of a 5-year-old female patient who was admitted to the Benjamin Bloom National Hospital, due to a 3-week persistent cough and fever, prior to admission to the hospital, the patient had acute gastroenteritis, so in the Hospital Nacional Zacamil, typhoid fever was suspected, however, as she continued to febrile and with a cough, she was transferred to the hospital, during hospital admission a study was carried out to confirm tuberculosis disease, presenting: positive mantoux test (13 millimeters), chest x-ray with left apical cavitation , positive smear microscopy (16 points of the Stegen and Toledo criteria), a computed thoracic axial tomography was also performed, which showed a cavitated lesion at the level of the upper left lobe posterior apical segment with thick septate walls. Starting treatment with 4 anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol), and after hospital discharge the patient continued with the treatment for 6 months and presenting satisfactory clinical evolution

Enfoque del paciente con cavitación pulmonar / Approach to the patient with lung cavitation / Enfoque do paciente com cavitação pulmonar

Cavitation is a common finding in lung images, secondary to infectious, inflammatory, tumor, and autoimmune conditions, the former being the most common cause in all levels of care and geography. The diagnostic approach must be judicious, integrating the image, with the patient's medical history, personal history, and exposures, as well as the time of evolution of the symptoms; which are key elements for the approach. It is always essential to integrate the clinical findings with the laboratory and the pathology in order to reach an accurate diagnosis and timely treatment, since the isolated image is not enough, given the multiple etiologies described and variety of presentation that make this radiological sign only a premise to the confirmation of an underlying disease.

Una cavitación es un hallazgo común en imágenes pulmonares, secundaria a condiciones infecciosas, inflamatorias, tumorales y autoinmunes, siendo las primeras la causa más común en todos los niveles de atención y geográficos. El abordaje diagnóstico debe ser riguroso, integrando la imagen con la historia clínica del paciente, sus antecedentes personales y exposiciones, así como el tiempo de evolución de los síntomas; estos son elementos clave para el enfoque. Siempre es fundamental integrar los hallazgos clínicos con el laboratorio y la patología para llegar a un diagnóstico preciso y a un tratamiento oportuno, pues la imagen aislada no es suficiente, dadas las múltiples etiologías descritas y la variedad de presentación que hacen de este signo radiológico solo una premisa a la confirmación de una enfermedad subyacente.

Uma cavitação é uma descoberta comum em imagens pulmonares, secundária a condições infecciosas, inflamatórias, tumorais e autoimunes, sendo as primeiras a causa mais comum em todos os níveis de atenção e geográficos. A abordagem diagnóstica deve ser rigorosa, integrando a imagem com a história clínica do paciente, seus antecedentes pessoais e exposições, assim como o tempo de evolução dos sintomas; estes são elementos chave para o enfoque. Sempre é fundamental integrar as descobertas clínicas com o laboratório e a patologia para chegar a um diagnóstico preciso e a um tratamento oportuno, pois a imagem isolada não é suficiente, dadas as múltiplas etiologias descritas e a variedade de apresentação que fazem deste signo radiológico só uma premissa à confirmação de uma doença subjacente.

Eminencia ganglionar: Anatomía y patología en resonancia magnética fetal / Ganglionic Eminence: Anatomy and Pathology in Fetal MRI

Se presentan dos casos de resonancia magnética (RM) fetal en los que se detectan anomalías de las eminencias ganglionares (EG): un caso en una gestación única y otro en una gestación gemelar con solo uno de los fetos afectado. Las alteraciones en las eminencias ganglionares son entidades poco frecuentes, con muy pocos casos publicados, tanto por RM como por ecografía fetal, que suelen asociarse con alteraciones neurológicas graves. Se describen los hallazgos por RM de la patología de las EG en estos dos casos, no visibles en la ecografía previa.

We present two cases of fetal MRI where anomalies of the ganglionic eminences (GE) are detected, one case in a single pregnancy and another in a twin gestation with only one of the affected fetuses. Alterations in the ganglionic eminences are rare entities, with very few published cases, both by MRI and fetal ultrasound, which are usually associated with severe neurological alterations. The MR findings of the pathology of the GE in these two cases are described. These findings were not visible on the previous ultrasound.

Cavitación pulmonar por Mycobacterium malmoense: diagnóstico por lavado broncoalveolar tras instilación percutánea de suero salino / Pulmonary cavity due to Mycobacterium malmoense: Diagnosis with bronchoalveolar lavage following percutaneous instillation of normal saline

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Cavitación de adenocarcinoma de pulmón como respuesta al tratamiento con bevacizumab / Cavitating lung cancer as response to bevacizumab treatment

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Cavitación y fístula enterocólica de gran calibre secundaria a adenocarcinoma de colon izquierdo / Rectosigmoid carcinoma presenting with a large small bowel fistula

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Efectos del ultrasonido de alta potencia en la adiposidad localizada / Effects of high power ultrasound in localized subcutaneous adiposity

Objetivo: El objetivo de este estudio fue analizar los efectos de la ultracavitación de alta frecuencia (UCV-AF) sobre la adiposidad localizada abdominal. Material y método: Se realizó un estudio descriptivo sobre 40 pacientes. Para evaluar los efectos del tratamiento sobre el tejido adiposo, se consideraron el peso corporal, la circunferencia abdominal, la plicometría y la ecografía. Se realizaron 8 sesiones de UCV-AF durante 2 meses, frecuencia: 3MHz, con una potencia de 30 vatios, ciclo de trabajo del 100%, durante 15 min. El área de tratamiento fue de 10 cm2. Resultados: Los promedios pre y postratamiento del peso corporal, la circunferencia abdominal, la plicometría y la ecografía fueron 66,88 y 66,85 kg, 86,24 y 81,93 cm, 34,825 y 26,825 mm, y 1,925 mm y 1,692 mm, respectivamente. El análisis estadístico no mostró diferencias significativas en el peso corporal (p < 0,8444, t = 0,1976) pero en la circunferencia, la plicometría y la ecografía las diferencias fueron extremadamente significativas: p < 0,0001, t = 10,594; p < 0,0001, t = 10,241; p < 0,0001, t = 6,030, respectivamente. Conclusiones: El tratamiento UCV-AF provocó una disminución significativa del tejido adiposo abdominal a través de la reducción de la circunferencia, plicometría y en la ecografía, sin generar cambios en el peso corporal

Objective: The aim of this study was to analyze the effects of high frequency ultracavitation (UCV-HF) on localized abdominal fat tissue. Material and method: A descriptive study was conducted on 40 patients. Body weight, abdominal circumference, plicometry and diagnostic ultrasound were used to measure the effects of the treatment on fat tissue. Eight sessions of UCV-HF were applied in a period of 2 months. requency: 3MHz, and 30 watts, a duty cycle of 100%, for 15minutes. The treatment area was 10 cm2. Results: The pre-and post-treatment weight, abdominal circumference, diagnostic ultrasound and plicometry average was 66.88 and 66.85 Kg, 86.24 and 81.93 cm, 34.825 and 26.825 mm, 1.925 and 1.692 mm, respectively. The statistical analysis did not show significant differences in body weight (P < 0.8444, P = 0.1976). However, the differences in the circumference, plicometry and diagnostic ultrasound the difference were extremely significant: P < 0.0001, t = 10.594; P < 0.0001, t = 10.241; P < 0.0001, t = 6.030 respectively. Conclusions: The UCV-HF resulted in a significant decrease of abdominal fat tissue by reducing circumference, plicomety and fat thickness, without significant changes in body weight

Gestación gemelar en paciente con malformación de Arnold-Chiari tipo I asociada a siringomielia / Twin pregnancy in a patient with arnold-chiari malformation type I Associated with syringomyelia

La siringomielia es una enfermedad neurológica infrecuente, con una prevalencia aproximada de uno por cada 100.000 personas; su asociación con embarazo es aún más rara. Presentamos un caso clínico inusual en el que a una paciente con malformación de Arnold-Chiari tipo I asociada a siringomielia y gestación gemelar se le realizó a las 39 semanas una cesárea electiva con anestesia general. Debido a los pocos casos publicados de gestación en pacientes con siringomielia y malformación de Arnold-Chiari tipo I existe poca evidencia respecto al manejo de estas pacientes, por lo que se debe optar por una discusión multidisciplinar con todos los miembros del equipo médico involucrado (AU)

Syringomyelia is a rare neurological disease with a prevalence of approximately one per 100,000 people; its association with pregnancy is unusual. We present a rare case in which a patient with Arnold-Chiari type I malformation, syringomyelia, and a twin pregnancy underwent an elective cesarean section at 39 weeks under general anesthesia. Because there have been few published reports of pregnancy in patients with syringomyelia and Arnold-Chiari type I malformation, evidence is scarce on the management of these patients. Therefore, coordinated decisions involving several medical specialties is recommended (AU)

Excavación intracoroidea peripapilar en miopía patológica / Peripapillary intrachoroidal cavitation in pathological myopia

CASO CLÍNICO: Mujer de 54 años, miope magna, que presentaba una lesión sobreelevada y blanco-amarillenta en la parte inferior del conus miópico de su ojo izquierdo. La tomografía de coherencia óptica (OCT) mostró un espacio hiporreflectivo intracoroideo. En la angiografía con fluoresceína (AFG) se apreciaba una hipofluorescencia precoz con tinción tardía, sin fuga del contraste. DISCUSIÓN: El reconocimiento de la «excavación intracoroidea peripapilar» como una entidad propia asociada a la miopía patológica es importante para evitar la confusión con otras posibles lesiones retinianas susceptibles de más estudios y tratamiento

CASE REPORT: A 54 year old woman with pathological myopia, presented with an elevated, yellowish-white lesion at the inferior border of the myopic conus in her left eye. The optical coherence tomography (OCT) demonstrated an intrachoroidal hyporeflective space. The fluorescein angiography examination (FA) showed early hypofluorescence with delayed staining, with no leakage of contrast. DISCUSSION: Recognition of «peripapillary intrachoroidal cavitation» as an own entity associated with pathological myopia is important to avoid confusion with other possible retinal lesions which require further investigation and treatment

Neumotórax recidivante como forma de presentación de tuberculosis pulmonar postprimaria / Recurrent pneumothorax presenting as post-primary pulmonary tuberculosis

Introducción: La tuberculosis postprimaria se produce por una reactivación de la enfermedad años después del contacto inicial. Es infrecuente en la infancia. Afecta a los lóbulos pulmonares superiores produciendo cavitaciones, y habitualmente cursa sin adenopatías. Caso clínico: Se presenta el caso de una paciente de 11 años de edad, con un neumotórax recidivante secundario a una tuberculosis cavitada. La fiebre persistió durante 2 meses tras el inicio de tratamiento. La paciente precisó una resección parcial del lóbulo superior izquierdo debido a una fístula broncopleural. Tras 6 meses de tratamiento tuberculostático presentó una recidiva. Conclusiones: La tuberculosis postprimaria puede aparecer en adolescentes y causar lesiones pulmonares graves que precisen resección quirúrgica. Los enfermos tienen una gran capacidad infectante. La respuesta al tratamiento es lenta debido a la elevada concentración bacilífera de las cavernas. La baciloscopia puede tardar meses en negativizarse. El tratamiento tuberculostático debe administrarse durante, al menos, 9 meses, y puede ser necesario prolongar la fase de inducción (AU)

Introduction: Post-primary tuberculosis is caused by reactivation of the disease years after the initial contact. It is rare in childhood. Affects upper lung lobes producing cavitations and usually presents without lymphadenopathy. Case report: We report the case of an eleven years-old patient with recurrent pneumothorax secondary to cavitated tuberculosis. The fever persisted two months after initiation of treatment. Partial resection of the left upper lobe was required due to bronchopleural fistula. After completing six months of tuberculosis treatment the infection relapsed. Conclusions: Post-primary tuberculosis can occur in adolescents and cause severe lung injury requiring surgical resection. Patients have a high capacity of spread disease. Treatment response is slow due to the high bacilliferous concentration on the caves. The baciloscopy may take months to become negative. Tuberculostatic treatment should be administered for at least, nine months and may be necessary to extend the induction phase (AU)

Efeitos da ultracavitação no tecido adiposo de coelhos / Ultra-cavitation effect in adipose tissue of rabbits

A ultracavitação (UC) é um recurso que utiliza os efeitos doultrassom de alta potência nas células adiposas. O objetivo desteestudo foi investigar os efeitos da UC no tecido adiposo de coelhos.Trata-se de um estudo experimental, randomizado e controlado, comamostra de 12 coelhos albinos, pesos de ± 3 kg divididos em 3 gruposde 4 animais, os quais foram submetidos a uma dieta de cafeteriapara aumentar o tecido adiposo dos animais e, posteriormente,receberam uma aplicação de UC na região ventral. Os animais dogrupo 1 (G1) não receberam aplicação da UC, do grupo 2(G2)receberam 3 minutos, 30 W, modo contínuo a 100% cada 2 ERAS= 441,02 J/cm2, o grupo 3 (G3) 7 minutos, 30 W, modo contínuoa 100% cada 2 ERAS = 1029 J/cm2. Após 24 horas foi realizadaa biópsia. Em seguida, foram confeccionadas lâminas histológicase efetuada a contagem de adipócitos por campos em cada lamina.Foram aplicados os testes de ANOVA com post de Bonferroni. Aanálise qualitativa das lâminas histológicas resultou na diminuiçãodo número de adipócitos, da espessura da derme, ocorrendo destruiçãodas células adiposas ao mesmo tempo em que foi percebida amanutenção da integridade de estruturas circunvizinhas. Na análisequantitativa, os resultados estatísticos não apresentaram reduçãosignificativa provavelmente pelo número pequeno da amostra.

The ultra-cavitation (UC) is a feature that uses the effects ofhigh power ultrasound in adipocyte cell. The aim of this study wasto investigate the effects of UC in the adipose tissue of rabbits.It was an experimental, randomized controlled trial. The samplewas composed of 12 albino rabbits, weight 3 kg roughly, dividedinto 3 groups of 4 animals, which received UC application in theventral region, based on the following parameters: The animals ingroup 1 did not received application of UC, the animals in group2 received an application of 3 minutes, with power of 30 W, continuousmode, at 100% every 2 = 441.02 ERAS J/cm2. The animalsin group 3 received an application for 7 minutes, with power of 30W, continuous mode at 100% every 2 ERAS = 1029 J/cm2. Thenhistological slides were made and the adipocytes counted per fieldsin each slide. ANOVA tests were applied with Bonferroni post.The qualitative analysis of histological slides showed decrease ofthe number of adipocytes, decrease of the thickness of the dermis,occurring fat cell destruction at the same time that was perceivedthe integrity of the surrounding structures. In quantitative analysis,statistical results did not show significant reduction, probably bysmall number of the sample.

Tratamiento de adiposidades localizadas mediante técnicas no quirúrgicas / Techniques for the treatment of localized fat without surgery

Introducción: Las técnicas no quirúrgicas para el tratamiento de la grasa localizada tienen la finalidad de disminuir el espesor del tejido adiposo subcutáneo sin necesidad de extracción de la grasa, circunstancia que las diferencia de los procedimientos quirúrgicos. Objetivos: Evaluar la efectividad de las técnicas físicas y químicas (ultrasonidos focalizados de alta intensidad, cavitación, láser lipólisis e hidrolipoclasia con suero hipoosmolar) en el tratamiento de las adiposidades localizadas. Métodos: Se trataron 106 pacientes con adiposidades localizadas en flancos, abdomen y/o caderas. Realizamos los siguientes procedimientos: hidrolipoclasia hipoosmolar, hidrolipoclasia más cavitación, ultrasonidos focalizados de alta intensidad, láser lipólisis (sin aspiración) y cavitación. Se indicaron prendas de compresión durante las 72 horas posteriores a los tratamientos y los pacientes no realizaron dieta ni otros tratamientos. Resultados: Todos los pacientes presentaron disminución de las medidas de circunferencia de cintura y cadera sin cambios significativos en el peso. La disminución del espesor del tejido graso medido con ecografía fue de un 15% en caderas, un 12% en flancos y un23% en abdomen. Discusión: Las técnicas no quirúrgicas para el tratamiento de la grasa localizada ocasionan reducción del espesor del tejido graso tratado. Conclusiones: Los resultados obtenidos nos permiten concluir que estos procedimientos son una alternativa a la liposucción en adiposidades de pequeño volumen, en casos seleccionados y regiones determinadas, suelen ser necesarias varias sesiones y deberían realizarse estudios a largo plazo. Hemos observado un mayor porcentaje de complicaciones con el láser lipólisiss in succión, razón por la cual esta técnica solo debe utilizarse como técnica de liposucción asistida por láser (AU)

Introduction: The new techniques for the treatment of localized fat without surgery take advantage of the application of physical and/or chemical methods that are minimally invasive and can be carried out in an ambulatory way. The aim of these techniques is to diminish the thickness of subcutaneous adipose tissue without needing the extraction of the damaged fat. Objective: To assess physical and/or chemical methods ( ultrasound, laser lipolysis, and hipoosmolarhydrolipoclasia) for body contouring. Methods: 106 patients with localized fat in flanks, abdomen and/or hips were selected. The following procedures were implemented: hipoosmolar hydrolipoclasia, ultrasonic hydrolipoclasia (with cavitation), cavitation, laser lipolysis and high intensity focused ultrasound. All the patients used compressive garments during the 72 hours after the treatment. They neither follow any diet nor other treatments. Results: All the patients presented a decrease in the hip and waist measurements without significant changes in the weight. This loss of fat measurement with B Mode Echography was 15% in the hips, 12% in the flanks and 23% in the abdomen. Discussion: The techniques for the treatment of localized fat without surgery mentioned above are effective in reducing localized adiposities. Conclusion: The results showed that these techniques are effective in reducing localized adiposities. Are an alternative for lipoaspiration in small volume adiposities in selected cases and in defined areas of the body. Given the variability of the responses, several sessions may be required and the patients should be informed about it. A higher percentage of complication was found with laser lipolysis without aspiration that is why this technique should only be used as a lipoaspiration assisted by laser. Further studies should be realized in the future (AU)

Tuberculosis de tipo adulto en los niños / Adult-type tuberculosis in children

One of the fascinating aspects of childhood tuberculosis (TB) is the diverse spectrum of pathology, which necessitates accurate disease classification. This manuscript provides a brief overview of the disease diversity observed in children with TB, with particular emphasis on adult-type TB. Cavitary disease in children may result from three distinct pathologic processes; 1) poor containment within the Ghon focus (mainly very young and/or immune compromised children), 2) aspiration of virulent bacilli following eruption of a diseased lymph node into an airway with resultant caseating pneumonia and parenchymal destruction (mainly children < 5 yrs of age), and 3) from adulttype disease (mainly children > 10 yrs of age). The exact pathological mechanism underlying adult-type disease remains uncertain. The combination of a destructive cell mediated immune response together with increased organism survival and proliferation in the lung apices, may initiate a vicious circle of parenchymal destruction. This hypothesis may explain the sudden emergence of adult-type disease around puberty, as well as the typical anatomical location of the lung cavities. Most children with adult-type disease are sputum smear-positive and can be diagnosed with routine sputum smear microscopy at primary health care level. Due to the high organism load the same treatment rationale used in adults with sputum smear-positive TB would apply, which justifies the use of four drugs during the initial intensive phase. These children pose a considerable transmission risk, particularly in congregate settings such as schools, and screening of close contacts should also be considered

Uno de los aspectos fascinantes de la tuberculosis (TB) infantil es el amplio espectro de las alteraciones histopatológicas, lo que requiere una clasificación precisa de los hallazgos. Este manuscrito proporciona un breve panorama general de la diversidad de presentaciones clínicas observadas en los niños con TB y hace hincapié particularmente en la TB que imita las formas del adulto. La enfermedad cavitaria en los niños puede ser el resultado de tres procesos anatomopatológicos distintos: 1) la escasa limitación dentro del foco de Ghon (principalmente en los niños muy pequeños o inmunocomprometidos), 2) la aspiración de bacilos virulentos luego de la erupción de una adenopatía en una vía aérea con neumonía caseosa consiguiente y destrucción del parénquima (principalmente en los menores de 5 años) y 3) la enfermedad de tipo adulto (principalmente en los niños mayores de 10 años). Es incierto aún el mecanismo fisiopatológico exacto subyacente a la enfermedad de tipo adulto. La combinación de una intensa respuesta inmune mediada por células junto con la mayor supervivencia y proliferación del microorganismo en los vértices pulmonares puede iniciar un círculo vicioso de destrucción parenquimatosa. Esta hipótesis puede explicar la aparición súbita de la enfermedad de tipo adulto alrededor de la pubertad, así como la localización anatómica típica de las cavidades pulmonares. La mayoría de los niños con enfermedad de tipo adulto tienen frotis de esputo positivos y el diagnóstico se puede realizar con la microscopia de rutina del frotis de esputo en la atención primaria. Debido a la gran carga de microorganismos se debe aplicar el mismo fundamento terapéutico utilizado en los adultos con TB con frotis de esputo positivo, lo cual justifica el uso de cuatro drogas durante la fase intensiva inicial. Estos niños plantean un riesgo considerable de transmisión, sobre todo en comunidades cerradas como las escuelas y también se debe considerar la pesquisa de los contactos cercanos