Visual manifestations in giant cell arteritis: identification of risk factors from the ARTESER Registry.

OBJECTIVE: To determine the prevalence and predictive factors of visual manifestations in a large registry of patients with GCA. METHODS: ARTESER is a large Spanish multicentre registry supported by the Spanish Society of Rheumatology. It includes patients with GCA from across the entire country diagnosed between June 2013 and March 2019. The variables collected at diagnosis were demographics, clinical manifestations (including all visual manifestations), laboratory, temporal artery biopsy, and imaging findings (ultrasound, FDG-PET/CT, MRI angiography, CT angiography). Patients with and without visual involvement were compared in a bivariate analysis. Multivariate logistic regression was performed to determine potential predictive factors of visual manifestations. RESULTS: The study population comprised 1636 GCA patients, of whom 599 (36.6%) presented visual manifestations. Anterior ischemic optic neuropathy was the most frequent (n = 274 of 599; 45.7%) ocular complication. The independent predictors that increased the risk (OR; 95% confidence interval) of visual involvement were older age (1.027; 1.009-1.045) and jaw claudication (1.724; 1.325-2.243). The variables associated with a reduced risk were polymyalgia rheumatica (0.541; 0.414-0.708), fever (0.373; 0.264-0.527), longer symptom duration (0.946; 0.909-0.985), and higher erythrocyte sedimentation rate (ESR) (0.992; 0.988-0.997), common features of patients with large vessel-GCA. CONCLUSION: One-third of GCA patients present visual manifestations at diagnosis. Older age and jaw claudication are independent predictors of visual manifestations, whereas polymyalgia rheumatica, fever, longer symptom duration, and high ESR reduce the risk of visual involvement.

Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review.

OBJECTIVE: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. METHODS: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. RESULTS: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. CONCLUSION: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.

[Mediastinal sarcoidal reaction in follow up for seminoma]. / Reaccion sarcoidal mediastinal en el seguimiento de un paciente con seminoma.

Mediastinal sarcoidal reaction in follow up for seminoma. Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a semi-nomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis.

Expression of heme oxygenase-1 in non-small cell lung cancer (NSCLC) and its correlation with clinical data.

While changes in heme oxygenase (HO-1) in lung cancer have already been reported, conflicting results were obtained for enzyme expression in human lung cancer specimens. Therefore, the aim of this work was to study HO-1 expression in a large collection of human lung cancer samples. For this purpose, we analyzed the expression of HO-1 in an organized tissue microarray (TMA) and investigated its correlation with clinicopathological data. Ninety-six percent of tumor samples were positive for HO-1, and the expression of HO-1 was significantly higher in cancerous than in non-cancerous tissues. Importantly, HO-1 expression correlated with advanced stages and lymph node involvement. Additionally, quantitative RT-PCR in 18 pairs of human lung carcinomas and their adjacent non-malignant tissues was performed. Our results demonstrate that HO-1 protein is upregulated in epithelial malignant cells in NSCLC and its expression is associated with higher stages of the disease. Additionally, different subcellular localization is observed between tumor and adjacent non-malignant tissues.

Reacción sarcoidal mediastinal en el seguimiento de un paciente con seminoma / Mediastinal sarcoidal reaction in follow up for seminoma

El cáncer de células germinales de testículo es el modelo de neoplasia curable. Las complicaciones a largo plazo son bien conocidas y el seguimiento incluye la pesquisa no sólo de la recaída, sino también de la aparición de segundos tumores y secuelas del tratamiento empleado. Un aumento de la incidencia de lesiones con granulomas tipo sarcoidosis se ha descripto en las últimas dos décadas en pacientes curados quienes en el seguimiento se presentan con nódulos pulmonares o adenopatías mediastinales.Se presenta el caso clínico de un paciente de 28 años quien durante el seguimiento clínico por un tumor seminomatoso, muestra en la tomografía axial computada y radiografía de tórax la presencia de adenopatías en mediastino, sin evidencia de enfermedad en abdomen y pelvis, el otro testículo normal y marcadores negativos.Ante esta peculiar situación, se realiza mediastinoscopia diagnosticándose reacción sarcoidal en ganglio mediastinal. Durante el seguimiento de pacientes con tumores germinales de testículo la presencia de adenopatías mediastinales exige contar con el diagnóstico histológico y tener en cuenta a la sarcoidosis en el diagnóstico diferencial

Testicular germ cell tumors constitute a model for curable neoplasia. Long-term complications are well-known and follow-up includes not only awareness of relapse, but also of the development of secondary tumors and treatment sequelae. In the last two decades, an increase in sarcoidosis incidence has been described in cured patients, who at follow-up present lung nodules or mediastinal lymph nodes. A 28 year-old patient who, on clinical follow up of a seminomatous tumor, presented mediastinal lymph nodes on CT scan and chest x-ray, without evidence of disease in pelvis or abdomen is presented. His other testicle was normal and he had negative tumor markers. Because of this rare presentation, a mediastinoscopy was performed and sarcoidosis like reaction was diagnosed. During follow-up of patients with testicular germ cell tumors, the presence of mediastinal lymph nodes requires a histological diagnosis and sarcoidosis should be considered as differential diagnosis

Retroperitoneostomía en pancreatitis aguda grave: análisis de las indicaciones y complicaciones / Retroperitoneostomy in acute severe pancreatitis: indications and complications

Objetivo: Evaluar las indicaciones y la experiencia adquirida con la retroperitoneostomía con curaciones programadas en el tratamiento de pacientes con pancreatitis aguda grave. Lugar de aplicación: Clínica y Maternidad privada. Diseño: Estudio retrospectivo en una serie consecutiva de pacientes. Población: 18 pacientes portadores de pancreatitis aguda grave. Fueron intervenidos quirúrgicamente 16 de ellos. Resultados: La mortalidad fue del 25 por ciento. La morbilidad durante el tratamiento incluyó 3 eventos hemorrágicos, 2 fístulas duodenales, 1 fístula biliar, 1 fístula de colon y una necrosis de colon derecho. La complicación postoperatoria más frecuente fue la fístula pancreática. Conclusiones: La pancreatitis aguda grave es una enfermedad sistémica de difícil manejo. La indicación de la cirugía se basó en la evolución clínica del enfermo. La retroperitoneostomía con curaciones profundas y reiteradas ha modificado la morbimortalidad histórica de la enfermedad. La mortalidad se relacionó en forma estadísticamente significativa con la edad, con el número de órganos fallados y con los criterios de Ranson

Resecciones pulmonares mayores por via toracoscópica / Major pulmonary resections through thoracoscopy

Con el propósito de evaluar la factibilidad de realizar resecciones pulmonares anatómicas mayores por videotoracoscopía, se diseño un estudio experimental en perros. Fueron operados 10 perros adultos, con un peso promedio de 32.4 libras, a quienes se realizaron: 2 pneumonectomías (1 derecha, 1 izquierza) y 8 lobectomías (2 superiores derechas, 2 inferiores izquierdas y 2 inferiores derechas) En todos los casos las resecciones fueron practicadas con una técnica completamente videoendoscópica, sin ser asistidas con toracotomía de acceso. Las piezas de resección fueron extraídas de la cavidad torácica ampliando una de las incisiones de los puertos de trabajo. Seis animales (60/100) sobrevivieron y fueron liberados o utilizados para otros procedimientos. Cuatro fallecieron (40/100) transoperatoriamente, 2 por problemas anestésicos y 2 por accidentes fatales (hemorragia incontrolable por laceración de la arteria pulmonar superior y sección de un bronquio lobar). De acuerdo a nuestros resultados las lobectomías videotoracoscópicas son técnicamente posibles, las pneumonectomías son más difíciles y conllevan riesgos de accidentes operatorios fatales

Coledocoduodenoanastomosis laparoscópica (CDA) / Translaparoscopic choledochoduodenostomosis (TCD)

Se presentan 19 pacientes a los que se le intentó realizar una colédoco-duodeno anastomosis (C.D.A.) por laparoscopía, 7 por neoplasias cefalopancreáticas y 12 por litiasis coledociana con megacolédoco. En 17, el procedimiento fue exitoso por esta vía debiendo convertirse en 2 casos por adherencias y hemorragia. Dieciseis pacientes evolucionaron satisfactoriamente y uno debió ser reintervenido por vía convencional a los 19 días por presentar colección hemática subfrénica. La C.D.A., si bien requiere un alto entrenamiento en cirugía laparoscópica, se mostró factible, muy efectiva como derivación biliodigestiva y con las ventajas propias de los métodos miniinvasivos