Correlation of ductus arteriosus length and morphology between computed tomographic angiography and catheter angiography and their relation to ductal stent length.

BACKGROUND: Patent ductus arteriosus (PDA) stent placement in infants with ductal-dependent pulmonary blood flow is being increasingly used in clinical practice. OBJECTIVE: To correlate computed tomographic (CT) angiography morphology and length of the PDA with catheter angiography and its relation to eventual PDA stent length. MATERIALS AND METHODS: We retrospectively identified all pediatric patients who underwent PDA stenting at our institute from 2004 to 2018. We included children who had CT angiography prior to stenting. PDA length was measured by a radiologist blinded to the catheter angiography data, using Syngo-via post-processing software (Siemens, Erlangen, Germany). Vessel centerline technique was used. We measured the actual length of the duct as well as straight length between aortic and pulmonary ends. PDA morphology tortuosity index was classified as straight (Type I), mildly tortuous with 1 turn (Type II) and tortuous with >1 turn (Type III), and the PDA origin was noted. The PDA was also measured and morphology classified on catheter angiography by an interventional cardiologist blinded to the CT angiography findings. We compared the CT angiography and catheter angiography lengths, straight lengths and stent length using scatter plots and intraclass correlation coefficient (ICC). RESULTS: A total of 83 children who had PDA stenting were identified, of whom 17 had prior CT angiography. Fifteen of these were neonates. There was agreement between CT angiography and catheter angiography regarding the PDA morphology tortuosity index in 94% of cases and PDA origin in 100% of cases. There was moderate agreement between CT angiography and catheter angiography actual and straight PDA lengths, with ICC coefficients of 0.65 and 0.68, respectively. There was moderate agreement between CT angiography actual length, CT angiography straight length, catheter angiography actual length and eventual stented PDA length, with ICCs of 0.57, 0.67 and 0.73, respectively. There was poor agreement between catheter angiography straight length and eventual stented PDA length, with an ICC of 0.39. CONCLUSION: PDA length and morphology description on CT angiography correlates well with catheter angiography and can be a reliable guide for the interventional cardiologist in decision-making regarding appropriate choice of PDA stent length.

MRI measured liver stiffness does not predict focal liver lesions after the Fontan operation.

BACKGROUND: Focal liver lesions are common in children and adults after Fontan procedures. OBJECTIVE: To explore the relationship between liver shear stiffness, using magnetic resonance (MR) elastography, and the presence of focal liver lesions in patients after Fontan procedures (total cavopulmonary anastomosis). MATERIALS AND METHODS: The retrospective study was approved by the institutional review board and the requirement for informed consent was waived. By searching institutional electronic medical records, we identified all patients with a history of Fontan palliation of congenital heart disease who had undergone same-day liver MR elastography and liver MRI without and with intravenous contrast material between January 2012 and December 2017. Using imaging reports, patients were placed into two groups: 1) no focal liver lesions and 2) one or more focal liver lesions. Patient age, sex, mean liver shear stiffness (kPa) and maximum single anatomical level liver shear stiffness (kPa) were recorded. The Mann-Whitney U test was used to compare age and liver stiffness between groups, while the Fisher exact test was used to assess the impact of gender on liver lesions. RESULTS: Forty-eight patients met study inclusion criteria; 33 (69%) had one or more focal liver lesions. The median age was 20.0 years (IQR [interquartile range]: 10.8-29.1 years) for patients without liver lesions and 19.9 years (IQR: 17.2-27.0 years) for patients with liver lesions (P=0.49). Eleven of 21 male patients (52.4%) had liver lesions compared to 22 of 27 female patients (81.5%) (P=0.058). Mean (4.62 kPa [IQR: 4.10-5.59 kPa] vs. 4.10 kPa [IQR: 3.44-4.80 kPa]; P=0.02) and maximum (5.53 kPa [IQR: 4.64-6.56 kPa] vs. 4.50 kPa [IQR: 3.82-5.35 kPa]; P=0.009) liver stiffness were significantly higher in patients without liver lesions as compared to patients with liver lesions. CONCLUSION: Our study demonstrated a significant negative association between focal liver lesions and increased liver stiffness in patients following Fontan procedures.

Putting it all together: established and emerging MRI techniques for detecting and measuring liver fibrosis.

Chronic injury to the liver leads to inflammation and hepatocyte necrosis, which when untreated can lead to myofibroblast activation and fibrogenesis with deposition of fibrous tissue. Over time, liver fibrosis can accumulate and lead to cirrhosis and end-stage liver disease with associated portal hypertension and liver failure. Detection and accurate measurement of the severity of liver fibrosis are important for assessing disease severity and progression, directing patient management, and establishing prognosis. Liver biopsy, generally considered the clinical standard of reference for detecting and measuring liver fibrosis, is invasive and has limitations, including sampling error, relatively high cost, and possible complications. For these reasons, liver biopsy is suboptimal for fibrosis screening, longitudinal monitoring, and assessing therapeutic efficacy. A variety of established and emerging qualitative and quantitative noninvasive MRI methods for detecting and staging liver fibrosis might ultimately serve these purposes. In this article, we review multiple MRI methods for detecting and measuring liver fibrosis and discuss the diagnostic performance and specific strengths and limitations of the various techniques.

Detection of the G3 genotype of Echinococcus granulosus from hydatid cysts of Chilean cattle using COX1 and ND1 mitochondrial markers.

For a deeper understanding of the phylogenetic relationships of Echinococcus genotypes and species in different intermediate hosts, we analyzed samples from human and bovine hydatid cysts. For this, segments of the cytochrome oxidase (COX1) and NADH dehydrogenase (ND1) mitochondrial genes were used. To obtain sufficient amounts of the ND1 marker to be sequenced properly, a new variant of the PCR assay was implemented. Phylogenetic analysis with both markers showed that most of the analyzed samples correspond to genotype G1. However, a sample from cysts of a bovine lung (Q21), with the COX1 marker, was grouped in a node together with a sample belonging to genotype G3. In the phylogenetic tree obtained with the ND1 marker, this sample was grouped with sequences of genotypes G3, G2, and G4. Analyzing the single nucleotide polymorphic (SNP) sites of both markers, it was observed that the Q21 sequence is almost identical to the G3 sequence and differ in only one SNP from the G2 sequence, and is completely different from G4. These results are noteworthy, since neither G2 nor G3 genotypes have been described previously in Chile, raising the possibility that the G3 genotype is present in these latitudes. This information is highly relevant; it can be employed to uncover additional unknown details of transmission cycles of this important parasite.

Assessing the role of habitat, climate, and anthropization gradients on terrestrial mammal diversity in the western Mediterranean basin.

Mammal species globally exhibit distribution patterns conditioned by environmental conditions and human impact. The Mediterranean basin provides an ideal system to study these effects due to its diverse climate, and habitat conditions. In this work, we aim to assess the impact of landscape heterogeneity and anthropization degree on terrestrial mammal diversity in this region. Accordingly, we deployed over 300 camera traps across 28 sites for 3 months. Detected mammal species (weighing more than 1kg) were classified as domestic carnivores, domestic ungulates, wild carnivores, wild ungulates, lagomorphs, and large rodents. Alpha and beta diversity were calculated for each group and all wild mammals. Simple linear regressions and multimodal analysis were conducted between mammal diversities and climate, environmental conditions, landscape heterogeneity, and anthropization degree variables. Redundancy analyses were performed to identify variables and species determining the mammalian community composition. Indexes measuring landscape heterogeneity, anthropization degree, and its 30-year change did not correlate with mammal diversity. However, the difference in elevation within sites and domestic carnivore abundance showed a significant positive correlation with some of the diversity indexes. Nonetheless, rainfall and mean elevation factors generally showed the highest correlation with mammal diversity. Instead, a few influential species, including generalists and open-habitat specialists, highlighted the importance of conserving open areas, as well as the importance of the Pyrenees region as a key habitat for certain species. Therefore, climatic variables emerged as the key determinants of mammal diversity, highlighting climate change as a potential threat to mammal diversity in this area.

Assessment of cortical bone with clinical and ultrashort echo time sequences.

We describe the use of ultrashort echo time (UTE) sequences and fast spin echo sequences to assess cortical bone using a clinical 3T scanner. Regular two- and three-dimensional UTE sequences were used to image both bound and free water in cortical bone. Adiabatic inversion recovery prepared UTE sequences were used to image water bound to the organic matrix. Two-dimensional fast spin echo sequences were used to image free water. Regular UTE sequences were used together with bicomponent analysis to measure T*2s and relative fractions of bound and free water components in cortical bone. Inversion recovery prepared UTE sequences were used to measure the T*2 of bound water. Saturation recovery UTE sequences were used to measure the T1 of bone water. Eight cadaveric human cortical bone samples and a lower leg specimen were studied. Preliminary results show two distinct components in UTE detected signal decay, a single component in inversion recovery prepared UTE detected signal decay, and a single component in saturation recovery UTE detected signal recovery. Regular UTE sequences appear to depict both bound and free water in cortical bone. Inversion recovery prepared UTE sequences appear to depict water bound to the organic matrix. Two-dimensional fast spin echo sequences appear to depict bone structure corresponding to free water in large pores.

Update on the Role of Imaging in Staging of Common Pediatric Abdominal Tumors.

Neuroblastoma, Wilms tumor, and hepatoblastoma are the most common pediatric abdominal malignancies. Management of these diseases is a multidisciplinary process that continues to evolve based on the results of international collaborative trials and advances in understanding of tumor biology. Each of these tumors has unique characteristics and behavior which are reflected in their respective staging systems. It is important for clinicians involved in the care of children with abdominal malignancies to be familiar with current staging guidelines and imaging recommendations. This article reviews the current role of imaging in the management of these common pediatric abdominal malignancies, with emphasis on initial staging.

Meniscal calcifications: morphologic and quantitative evaluation by using 2D inversion-recovery ultrashort echo time and 3D ultrashort echo time 3.0-T MR imaging techniques--feasibility study.

PURPOSE: To assess the ability of ultrashort echo time (UTE) magnetic resonance (MR) imaging techniques to enable morphologic assessment of different types of meniscal calcifications, to compare these sequences with standard clinical sequences, and to perform T2* measurements of meniscal calcifications. MATERIALS AND METHODS: This study was exempted by the institutional review board, and informed consent was not required. Ten human cadaveric menisci were imaged with high-spatial-resolution radiography and 3.0-T MR imaging by using morphologic (T1-weighted fast spin-echo [FSE], T2-weighted FSE, proton density [PD]-weighted FSE, two-dimensional [2D] fast spoiled gradient-echo [FSPGR], three-dimensional [3D] FSPGR, and 3D UTE) and quantitative (2D inversion-recovery [IR] UTE and 3D UTE) sequences. The menisci were divided into thirds for regional analysis. Morphologic assessment was performed with MR imaging; MR imaging findings were correlated with radiographs. Calcifications were classified as punctate, linear, or globular. T2* measurements were performed by manual placement of regions of interest (ROIs) in calcifications and by automatically creating ROIs in the surrounding tissues. Mixed-effects linear regression was used to determine variations in T2* as a function of region, morphology, and tissue type. RESULTS: The two globular calcifications were visualized with all sequences. For punctate (n=21) and linear (n=21) calcifications, respectively, visibility rates were as follows: 9.5% for both with the T1-weighted FSE sequence, 0% for both with the T2-weighted FSE sequence, 19.0% and 23.8% with the PD-weighted FSE sequence, 0% for both with the 2D IR UTE sequence, 100% for both with the 3D UTE sequence, and 100% for both with the 3D FSPGR sequence. T2* values were significantly lower for calcifications than for the surrounding meniscal tissue (P<.001). There was a trend of globular calcifications having lower T2* values than other morphologies (P=.08). With the 2D IR UTE technique, the T2* of the globular calcifications tended to be lower than with the 3D UTE technique (0.13-0.16 vs 1.32-3.03 msec) (P=.14, analysis of variance). CONCLUSION: UTE MR imaging sequences may allow morphologic as well as quantitative evaluation of meniscal calcifications.

Ultrashort echo time imaging with bicomponent analysis.

Biological tissues frequently contain different water compartments, and these often have distinct transverse relaxation times. Quantification of these may be problematic on clinical scanners because spin echo sequences usually have initial echo times that are too long to accurately quantify shorter relaxation time components. In this study, an ultrashort echo time pulse sequence was used together with bicomponent analysis to quantify both the short and long T(2) components in tissues of the musculoskeletal system. Feasibility studies were performed using numerical simulation, and on phantoms and in vitro tissues including bovine cortical bone, ligaments, menisci, tendons, and articular cartilage. The simulation and phantom studies demonstrated that this technique can quantify T(2) * and fractions of the short and long T(2) components. The tissues studies showed two distinct components with short T(2) *s ranging from 0.3 ms for bovine cortical bone to 2.1 ms for menisci, and long T(2) *s ranging from 2.9 ms for bovine cortical bone to 35.0 ms for articular cartilage. The short T(2) * fraction ranged from 18.5% for patella cartilage to 80.9% for ligaments. The results show that ultrashort echo time imaging with bicomponent analysis can quantify the short and long T(2) water components in vitro in musculoskeletal tissues.

Ultrashort echo time spectroscopic imaging (UTESI): an efficient method for quantifying bound and free water.

Biological tissues usually contain distinct water compartments with different transverse relaxation times. In this study, two-dimensional, multi-slice, ultrashort echo time spectroscopic imaging (UTESI) was used with bi-component analysis to detect bound and free water components in musculoskeletal tissues. Feasibility studies were performed using numerical simulation. Imaging was performed on bovine cortical bone, human cadaveric menisci and the Achilles' tendons of volunteers. The simulation study demonstrated that UTESI, together with bi-component analysis, could reliably quantify both T(2)* and fractions of the short and long (2)* components. The in vitro and in vivo studies each took less than 14 min. The bound water components showed a short T(2)* of ~0.3 ms for bovine bone, ~1.8 ms for meniscus and ~0.6 ms for the Achilles' tendon. The free water components showed about an order of magnitude longer T(2)* values, with ~2 ms for bovine bone, ~14 ms for meniscus and ~8 ms for the Achilles' tendon. Bound water fractions of up to ~76% for bovine bone, 50% for meniscus and ~75% for the Achilles' tendon were measured. The corresponding free water components were up to ~24% for bovine bone, 50% for meniscus and ~25% for the Achilles' tendon by volume. These results demonstrate that UTESI, combined with bi-component analysis, can quantify the bound and free water components in musculoskeletal tissues in clinically realistic times.

Ultrashort TE MR imaging of bovine cortical bone: the effect of water loss on the T1 and T2* relaxation times.

The effects of water loss on the T1 and T2* of bovine cortical bone were investigated using ultrashort echo time sequences with signals excited either by a short hard pulse or by two longer half pulses. Nine bovine femur samples were prepared and sequentially air- and oven-dried. On average 3.42% of bone by weight was lost after air-drying for 3 days, with another 5.98% of bone weight loss after oven-drying at 100°C for 24 h. T1 and T2* were measured after every 1% decrease in weight, with 9-10% bone weight loss at the termination of the drying process. After both forms of drying, the overall T1 decreased 33% from 153±18 ms to 102±17 ms when measured using the hard pulse and from 186±25 ms to 122±23 ms when using the half pulses. T2* decreased by 45-50% from 368±29 µs to 201±19 µs using the hard pulse and from 379±35 µs to 191±17 µs using the half pulses. A steady decrease of 26-31% was observed in both T1 and T2* with the first 3-4% bone water loss after air-drying. Oven-drying at 100°C for 24 h resulted on an additional 4% T1 reduction but 25% T2* reduction.

Optimizing MR signal contrast of the temporomandibular joint disk.

PURPOSE: To use a tissue specific algorithm to numerically optimize UTE sequence parameters to maximize contrast within temporomandibular joint (TMJ) donor tissue. MATERIALS AND METHODS: A TMJ specimen tissue block was sectioned in a true sagittal plane and imaged at 3 Tesla (T) using UTE pulse sequences with dual echo subtraction. The MR tissue properties (PD, T(2) , T(2) *, and T(1) ) were measured and subsequently used to calculate the optimum sequences parameters (repetition time [TR], echo time [TE], and θ). RESULTS: It was found that the main contrast available in the TMJ could be obtained from T(2) (or T(2) *) contrast. With the first echo time fixed at 8 µs and using TR = 200 ms, the optimum parameters were found to be: θ ≈ 60°, and TE2 ≈ 15 ms, when the second echo is acquired using a gradient echo and θ ≈ 120°, and TE2 ≈ 15 ms, when the second echo is acquired using a spin echo. CONCLUSION: Our results show that MR signal contrast can be optimized between tissues in a systematic manner. The MR contrast within the TMJ was successfully optimized with facile delineation between disc and soft tissues.

Comparison of T1rho measurements in agarose phantoms and human patellar cartilage using 2D multislice spiral and 3D magnetization prepared partitioned k-space spoiled gradient-echo snapshot techniques at 3 T.

OBJECTIVE: The purpose of this article is to compare in vitro T1rho measurements in agarose phantoms and articular cartilage specimens using 2D multislice spiral and 3D magnetization prepared partitioned k-space spoiled gradient-echo snapshot MRI sequences. MATERIALS AND METHODS: Six phantoms (agarose concentration, 2%, 3%, and 4%; n = 2 each) and 10 axially sliced patellar specimens from five cadaveric donors were scanned at 3 T. T1rho-weighted images were acquired using 2D spiral and 3D magnetization prepared partitioned k-space spoiled gradient-echo snapshot sequences. Regions of interest were analyzed to measure T1rho values centrally within phantoms, to evaluate effects of pulse sequence and agarose concentration. In patellar specimens, regions of interest were analyzed to measure T1rho values with respect to anatomic location (the medial and lateral facets and the median ridge in deep and superficial halves of the cartilage) as well as location that exhibited magic angle effect in proton density-weighted images, to evaluate the effects of pulse sequence, anatomic location, and magic angle. RESULTS: In phantoms, T1rho values were similar (p = 0.9) between sequences but decreased significantly (p < 0.001), from ∼55 to ∼29 milliseconds, as agarose concentration increased from 2% to 4%. In cartilage specimens, T1rho values were also similar between sequences (p = 0.3) but were significantly higher (p < 0.001) in the superficial layer (95-120 milliseconds) compared with the deep layer (45-75 milliseconds). CONCLUSION: T1rho measurements of human patellar cartilage specimens and agarose phantoms using 2D spiral and 3D magnetization prepared partitioned k-space spoiled gradient-echo snapshot sequences gave similar values. Lower T1rho values for phantoms with higher agarose concentrations and proteoglycan concentrations that are higher in deeper layers of cartilage than in superficial layers suggest that our method is sensitive to concentration of macromolecules in biologic tissues.

Ultrashort TE T1rho (UTE T1rho) imaging of the Achilles tendon and meniscus.

In this study, we report the use of a novel ultrashort echo time T(1)rhoT(1) sequence that combines a spin-lock preparation pulse with a two-dimensional ultrashort echo time sequence of a nominal echo time 8 microsec. The ultrashort echo time-T(1)rho sequence was employed to quantify T(1)rho in short T(2) tissues including the Achilles tendon and the meniscus. T(1)rho dispersion was investigated by varying the spin-lock field strength. Preliminary results on six cadaveric ankle specimens and five healthy volunteers show that the ultrashort echo time-T(1)rho sequence provides high signal and contrast for both the Achilles tendon and the meniscus. The mean T(1)rho of the Achilles tendon ranged from 3.06 +/- 0.51 msec for healthy volunteers to 5.22 +/- 0.58 msec for cadaveric specimens. T(1)rho increased to 8.99 +/- 0.24 msec in one specimen with tendon degeneration. A mean T(1)rho of 7.98 +/- 1.43 msec was observed in the meniscus of the healthy volunteers. There was significant T(1)rho dispersion in both the Achilles tendon and the meniscus. Mean T(1)rho increased from 2.06 +/- 0.23 to 7.85 +/- 0.74 msec in normal Achilles tendon and from 7.08 +/- 0.64 to 13.42 +/- 0.93 msec in normal meniscus when the spin-lock field was increased from 250 to 1,000 Hz.

Usos y vías de administración de la lidocaína en oftalmología

La lidocaína es el anestésico local más utilizado a nivel mundial para la cirugía de catarata. También se usa de manera común en otras intervenciones quirúrgicas oftalmológicas del segmento anterior, la superficie del globo ocular, los párpados y vías lagrimales, así como en el segmento posterior del ojo. Esta revisión pretende brindar una actualización sobre las principales características, los efectos y vías de administración de la lidocaína usada en la oftalmología. Se realizó una búsqueda sistemática sobre el tema en publicaciones científicas indexadas en bases de datos, cuya información recopilada se resumió en este trabajo. La lidocaína se presenta en múltiples formas farmacéuticas, con variedad en concentración y formulación. Por lo general, para inyección se usan las concentraciones al 0,5 %, 1 % y 2 %, para anestesia tópica en gel al 2 % y en solución oftálmica al 4 %. Su efecto como anestésico local es bien conocido, a nivel ocular se puede conseguir a través de inyecciones perioculares e intraoculares o mediante su aplicación tópica. Este efecto anestésico de la lidocaína ofrece cierta capacidad de dilatación pupilar, el cual se ha estudiado y aprovechado con frecuencia en los últimos años. Hoy día se encuentran en estudio otros efectos de la lidocaína a nivel local y sistémico. Los usos de la lidocaína en la oftalmología actual, están respaldados fundamentalmente por su eficacia y seguridad comprobadas en el tiempo.

Lidocaine is the most widely used local anesthetic worldwide for cataract surgery. It is also commonly used in other ophthalmic surgical procedures of the anterior segment, surface of the eyeball, eyelids and lacrimal ducts, as well as in the posterior segment of the eye. This review aims to provide an update on the main characteristics, effects and ways of administering lidocaine used in ophthalmology. A systematic search on the subject was carried out in scientific publications indexed in databases, the information collected was summarized in this work. Lidocaine comes in multiple pharmaceutical forms, with a variety of concentrations and formulations. Generally, 0.5%, 1% and 2% concentrations are used for injection, 2% for topical anesthesia in gel and 4% in ophthalmic solution. Its effect as a local anesthetic is well known, at ocular level it can be achieved through periocular and intraocular injections or by topical application. This anesthetic effect of lidocaine offers some pupillary dilation capacity, which has been frequently studied and exploited in recent years. Other local and systemic effects of lidocaine are currently under study. The uses of lidocaine in ophthalmology today are supported primarily by its time-tested efficacy and safety.

Pérdida de células endoteliales después de cirugía de catarata por facoemulsificación

Objetivo: Determinar la pérdida celular endotelial corneal posterior a la cirugía de catarata por técnica de facoemulsificación. Métodos: Se realizó un estudio descriptivo de intervención prospectivo y longitudinal. Se estudiaron 51 ojos operados de catarata por la técnica de facochop. Se les realizó microscopia endotelial pre- y posoperatoria a los tres y seis meses de la intervención. También se estudiaron los parámetros facodinámicos. Resultados: La edad promedio fue de 66,7 ± 11,7 años, predominó el sexo femenino (53,7 %). Se observó una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata. El porcentaje de pérdida de células endoteliales posterior a la intervención fue de 19,6 ± 0,8 %. El tiempo total de ultrasonido medio fue de 11,8 ± 4,5 seg mientras el tiempo efectivo de facoemulsificación tuvo una media de 0,008 ± 0,001 seg. Conclusiones: El recuento de células endoteliales corneales muestra una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata, el porcentaje de pérdida de células endoteliales corneales a los seis meses posterior está dentro de los límites normales y se observa relación de dependencia entre el tiempo efectivo de facoemulsificación y el porcentaje de pérdida de células endoteliales.

Objective: To determine the loss of corneal endothelial cell after cataract surgery by the phacoemulsification technique. Methods: A prospective, longitudinal, descriptive and interventional study was conducted. Fifty-one eyes operated on for cataract by the phacoemulsification technique were studied. Preoperative, as well as postoperative endothelial microscopy at three and six months after the cataract surgery, was performed. Phacodynamic parameters were also studied. Results: The mean age was 66.7 ± 11.7 years and there was a predominance of the female sex (53.7%). A significant decrease in the mean values of cell density and hexagonality was observed at three and six months after the cataract surgery. The percentage of endothelial cell loss after surgery was 19.6% ± 0.8%. The mean total ultrasound time was 11.8 ± 4.5 secs, while the effective phacoemulsification time had a mean of 0.008 ± 0.001 secs. Conclusions: The count of corneal endothelial cell shows a significant decrease in the mean values of cell density and hexagonality at three and six months after the cataract surgery; the percentage of corneal endothelial cell loss at six months is within normal limits; and a dependent relationship is observed between the effective phacoemulsification time and the percentage of endothelial cell loss.

Resultados de la cirugía de catarata en pacientes longevos / Outcomes of Cataract Surgery in Long-lived Patients

Objetivo: Evaluar los resultados clínico-quirúrgicos de la cirugía de catarata del primer ojo y su efecto en la calidad de vida de pacientes longevos. Métodos: Se realizó una investigación longitudinal prospectiva, del tipo series de casos en pacientes de 80 y más años de edad (longevos) sometidos a cirugía de catarata en un primer ojo con implante de lente intraocular. Se compararon los resultados visuales y la calidad de vida autopercibida, antes y después de la cirugía. Se identificaron las causas oculares en los casos con impedimento visual posoperatorio. Resultados: Se estudiaron 88 pacientes con una edad promedio de 87,97 años. Predominaron los pacientes femeninos (63,63 por ciento), de color de piel blanca (75 por ciento), con hipertensión arterial (61,36 por ciento) y diabetes mellitus (23,86 por ciento). El 18,18 por ciento tenía antecedentes oculares de glaucoma. Se utilizó la facoemulsificación en el 52,27 por ciento como técnica quirúrgica. El síndrome de iris fláccido intraoperatorio y la hipertensión ocular fueron las complicaciones intraoperatorias más frecuentes. El edema corneal predominó como complicación posquirúrgica (10,2 por ciento). La función visual (agudeza visual sin corrección y agudeza visual mejor corregida), así como la calidad de vida autopercibida mejoraron significativamente en el posoperatorio (p < 0,001). La degeneración macular asociada a la edad y la membrana epiretiniana fueron las principales causas, en ese orden, de impedimento visual posoperatorio. Conclusiones: La cirugía de catarata del primer ojo mejora la función visual y la calidad de vida autopercibida de pacientes longevos. La degeneración macular asociada a la edad es la principal causa del impedimento visual posoperatorio de estos pacientes(AU)

Objective: To evaluate the clinical-surgical outcomes of cataract surgery of the first eye and its effect on quality of life in long-lived patients. Methods: A prospective, longitudinal, case series type investigation was performed in patients 80 years of age and older (long-lived) who underwent first eye cataract surgery with intraocular lens implantation. Visual outcomes and self-perceived quality of life before and after surgery were compared. Ocular causes were identified in cases with postoperative visual impairment. Results: We studied 88 patients with an average age of 87.97 years. Female patients predominated (63.63 percent), with white skin color (75 percent), with arterial hypertension (61.36 percent) and diabetes mellitus (23.86 percent). 18,18 percent had an ocular history of glaucoma. Phacoemulsification was used as a surgical technique in 52.27 percent. Intraoperative flaccid iris syndrome and ocular hypertension were the most frequent intraoperative complications. Corneal edema predominated as a postoperative complication (10.2 percent). Visual function (uncorrected visual acuity and best corrected visual acuity) as well as self-perceived quality of life improved significantly postoperatively (p < 0.001). Age-related macular degeneration and epiretinal membrane were the main causes, in that order, of postoperative visual impairment. Conclusions: First eye cataract surgery improves visual function and self-perceived quality of life in long-lived patients. Age-related macular degeneration is the main cause of postoperative visual impairment in these patients(AU)

Spinal Cord Anatomy and Clinical Syndromes.

We review the anatomy of the spinal cord, providing correlation with key functional and clinically relevant neural pathways, as well as magnetic resonance imaging. Peripherally, the main descending (corticospinal tract) and ascending (gracilis or cuneatus fasciculi and spinothalamic tracts) pathways compose the white matter. Centrally, the gray matter can be divided into multiple laminae. Laminae 1-5 carry sensitive neuron information in the posterior horn, and lamina 9 carries most lower motor neuron information in the anterior horn. Damage to the unilateral corticospinal tract (upper motor neuron information) or gracillis-cuneatus fasciculi (touch and vibration) correlates with ipsilateral clinical findings, whereas damage to unilateral spinothalamic tract (pain-temperature) correlates with contralateral clinical findings. Damage to commissural fibers correlates with a suspended bilateral "girdle" sensory level. Autonomic dysfunction is expected when there is bilateral cord involvement.

Comparación entre las mediciones biométricas del IOL Master 500 y el Pentacam AXL en la biometría ocular / Comparison of biometric measurements taken with IOL Master 500 and Pentacam AXL for ocular biometry

Objetivo: Comparar las mediciones biométricas realizadas con el IOL Master 500 y el Pentacam AXL. Métodos: Se realizó un estudio transversal en 99 ojos de 99 pacientes miopes con criterio de cirugía fotoablativa, atendidos en el período de enero del año 2019 a enero de 2020, en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Las variables estudiadas fueron edad, sexo, equivalente esférico y características biométricas preoperatorias (longitud axial, profundidad de la cámara anterior y queratometrías), así como su relación, aportadas automáticamente por el IOL Master 500 y el Pentacam AXL para evitar los factores dependientes del operador. El análisis estadístico se realizó con la Prueba t para datos pareados, utilizando una significación del 95 por ciento. Una diferencia con un valor de p < 0,05 fue considerado estadísticamente significativo. Resultados: El 60,61 por ciento de los pacientes eran de sexo femenino y el 39,39 por ciento del masculino, con una edad promedio de 25,67 ± 4,30 años. Se analizaron 51 ojos derechos y 48 izquierdos. El equivalente esférico medio fue de -3,30 ± 1,53 dioptrías. No hubo diferencia estadísticamente significativa entre los valores biométricos (longitud axial, profundidad de la cámara anterior y queratometrías) obtenidos con el IOL Master 500, en comparación con los del Pentacam-AXL (p > 0,05). Conclusión: Las mediciones biométricas (longitud axial, profundidad de la cámara anterior y queratometrías) obtenidas con el IOL Master 500 y el Pentacam-AXL son similares(AU)

Objective: Compare biometric measurements taken with IOL Master 500 and Pentacam AXL. Methods: A cross-sectional study was conducted of 99 eyes of 99 myopic patients with indication of photoablative surgery attending the Refractive Surgery Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2019 to January 2020. The variables analyzed were age, sex, spherical equivalent and preoperative biometric characteristics (axial length, anterior chamber depth and keratometries) and the relationship to one another, automatically supplied by IOL Master 500 and Pentacam AXL to avoid operator-dependent factors. Statistical analysis was based on the paired T-test with a significance level of 95%. A difference with a p-value < 0.05 was considered to be statistically significant. Results: Of the patients studied, 60.61 percent were female and 39.39 percent were male; mean age was 25.67± 4.30 years. A total 51 right eyes and 48 left eyes were analyzed. Mean spherical equivalent was -3.30 ± 1.53 diopters. No statistically significant difference was found between the biometric values (axial length, anterior chamber depth and keratometries) obtained with IOL Master 500 versus Pentacam AXL (p > 0.05). Conclusion: Similar biometric measurements (axial length, anterior chamber depth and keratometries) are obtained with IOL Master 500 and Pentacam AXL(AU)

Complicaciones posoperatorias inmediatas en pacientes diabéticos tipo 2 operados de catarata por la técnica de facochop / Immediate postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery

Objetivo: Describir la posible presencia de complicaciones posoperatorias en pacientes diabéticos tipo 2, operados de catarata por la técnica de facochop. Métodos: Se realizó un estudio observacional, descriptivo, y longitudinal prospectivo, con 128 pacientes diabéticos (168 ojos) operados de catarata en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre septiembre del año 2017 y diciembre de 2018. Las variables clínicas y epidemiológicas objeto del estudio fueron la edad, el sexo, el color de la piel, la queratometría, la profundidad de la cámara, la longitud axial, la dureza del cristalino, la presión intraocular pre- y posoperatoria y las complicaciones posoperatorias en las primeras 72 horas. Resultados: En el estudio predominaron las mujeres (63,3 por ciento), de piel blanca (74,2 por ciento), quienes presentaron ojos biométricamente normales, con una diferencia estadísticamente significativa. La presión intraocular aumentó a las 24 horas de la cirugía. De los 128 pacientes diabéticos tipo 2 operados de catarata senil por la técnica de facochop, se pudo determinar que el promedio y la desviación estándar de la edad se ubicaron en los 69,49 ± 8,96 años, y osciló entre los 50 y 88 años. Conclusiones: Las complicaciones posoperatorias más frecuentes son el edema corneal y la uveítis. Es significativamente más probable encontrar la uveítis posquirúrgica en pacientes menores de 70 años, y el edema corneal en quienes sobrepasan esta edad(AU)

Objective: Describe the possible presence of postoperative complications in type 2 diabetic patients undergoing phaco chop cataract surgery. Methods: An observational prospective longitudinal descriptive study was conducted of 128 diabetic patients (168 eyes) undergoing cataract surgery at the Center for Ocular Microsurgery of Ramón Pando Ferrer Cuban Institute of Ophthalmology from September 2017 to December 2018. The clinical and epidemiological variables analyzed were age, sex, skin color, keratometry, chamber depth, axial length, crystalline hardness, pre- and postoperative intraocular pressure, and postoperative complications in the first 72 hours. Results: A predominance was found of women (63.3 percent) of white skin color (74.2 percent) and biometrically normal eyes, with a statistically significant difference. Intraocular pressure rose 24 hours after surgery. Mean age and standard deviation were 69.49 ± 8.96 years, range of 50-88 years, in the 128 type 2 diabetic patients undergoing senile cataract surgery by the phaco chop technique. Conclusions: The most common postoperative complications are corneal edema and uveitis. It is significantly more probable to find postsurgical uveitis in patients aged under 70 years and corneal edema in patients aged over 70 years(AU)