Cardiovascular diagnostic methods in patients with diabetes mellitus. A review.

Cardiovascular diseases are the most common cause of mortality in the world. Currently, type 2 diabetes mellitus (T2DM) is one of the main risk factors for major adverse cardiovascular events. T2DM patients have a four-fold higher risk of developing heart failure and 10 to 12 times higher mortality. Echocardiography in all its modalities is the best clinical tool for heart failure diagnosis, since it provides static and dynamic images of the heart that allow to identify structural and functional changes, such as pressure variations, flow changes, left ventricular ejection fraction and myocardial surfaces anatomical remodeling.

Las enfermedades cardiovasculares constituyen la causa más común de mortalidad en el mundo. Actualmente, la diabetes mellitus tipo 2 (DM2) representa uno de los principales factores de riesgo de eventos adversos cardiovasculares mayores. Los pacientes que las padecen tienen un riesgo cuatro veces mayor de desarrollar insuficiencia cardíaca y una mortalidad de 10 a 12 veces mayor. La ecocardiografía en todas sus modalidades es la mejor herramienta clínica para el diagnóstico de la insuficiencia cardíaca, ya que proporciona imágenes estáticas y dinámicas del corazón que permiten identificar cambios estructurales y funcionales, como alteraciones en las presiones, cambios de flujo, fracción de expulsión del ventrículo izquierdo y remodelación anatómica de las superficies miocárdicas.

Radiological evaluation of response to treatment in hepatobiliary fascioliasis.

PURPOSE: In this study, we aimed to evaluate the computed tomography (CT) findings of Fasciola hepatica infestations on initial and follow-up imagings after treatment, and also to describe the role of CT during diagnosis. METHODS: In this retrospective study, patients with a diagnosis of fascioliasis by clinical and laboratory examination who underwent initial and follow-up contrast-enhanced abdominal CT scans after treatment (a single oral dose of 10mg/kg Triclabendazole) were included. The CT scans were evaluated regarding liver and spleen sizes, portal and splenic vein diameters, involved hepatic segment numbers and involvement patterns, the presence of focal perihepatic hyperdensity, gallbladder wall thickening, dilatation of the intrahepatic biliary tract, periportal-right subdiaphragmatic lymphadenopathy, hepatic subcapsular and intra-abdominal bleeding, and perihepatic/intraabdominal free fluid. Initial (pre-treatment) and post-treatment CT scans (average 25 months after the treatment) were compared with for these features. RESULTS: A total of 36 patients with a mean age of 39.28±14.64 [15-83] years, were included in this study. After treatment, marked improvement in liver parenchymal involvement, biliary system findings, hepatomegaly-splenomegaly, periportal-peridiaphragmatic lymphadenopathy, and hepatic subcapsular hematoma were detected and focal perihepatic hyperdensity, free intraperitoneal fluid disappeared. CONCLUSION: Contrast-enhanced abdominal CT can be used in the diagnosis and post-treatment follow-up of fascioliasis. Awareness of intrahepatic/extrahepatic lesions and all the complications of fascioliasis can greatly aid the diagnosis and also evaluation of the response to treatment.

Tomographic behavior of pneumonia caused by SARS-CoV-2.

BACKGROUND: From the first report of the respiratory disease caused by SARS-Cov-2 towards the end of 2019, in Wuhan, China, to June 8, 2020, 6,931,000 people had been affected in the world, and 113,619 in Mexico, where there is a lack of literature describing the tomographic behavior of this disease throughout its evolution and its correlation with patient clinical data. OBJECTIVE: To identify, describe and classify the manifestations detected on chest computed tomography images of patients with pneumonia caused by SARS-CoV-2. METHOD: Hospitalized patients with RT-PCR-confirmed SARS-CoV-2 infection and who underwent a plain chest tomography were included. RESULTS: The most common tomographic patterns were ground glass opacity, consolidation, cobblestone pattern and mixed pattern, with peripheral and subpleural distribution and bilateral involvement in up to 95 %. Subpleural bands that distorted the architecture were identified in up to 62 % of patients, with an average of seven days of evolution. The most common extrapulmonary finding was an increase in pulmonary artery transverse axis. CONCLUSION: Knowing the behavior of this type of pneumonia allows becoming familiarized with the characteristic tomographic patterns, in order to aid timely detection and treatment.

INTRODUCCIÓN: Desde el primer reporte de la enfermedad respiratoria causada por SARS-Cov-2 a finales de 2019, en Wuhan, China, hasta el 8 de junio de 2020, habían sido afectadas 6 931 000 personas en el mundo y 113 619 en México, donde se carece de informes que describan el comportamiento tomográfico de esta enfermedad a lo largo de su evolución y su correlación con los datos clínicos del paciente. OBJETIVO: Identificar, describir y clasificar las manifestaciones en las imágenes de tomografía de tórax de pacientes con neumonía causada por SARS-CoV-2. MÉTODO: Se incluyeron pacientes hospitalizados con infección por SARS-CoV-2 confirmada mediante PCR-TR y en quienes se realizó tomografía simple de tórax. RESULTADOS: Los patrones tomográficos más comunes fueron opacidad de vidrio despulido, consolidación, empedrado y patrón mixto, con distribución periférica, subpleural y afectación bilateral hasta en 95 %. Se identificaron bandas subpleurales que distorsionaban la arquitectura hasta en 62 % de los pacientes, con un promedio de siete días de evolución. El aumento del eje transverso de la arteria pulmonar constituyó el hallazgo extrapulmonar más frecuente. CONCLUSIÓN: Conocer el comportamiento de este tipo de neumonía permite la familiarización con los patrones tomográficos característicos, con el fin de coadyuvar a la detección y tratamiento oportunos.

Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines.

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.

The radiologist's role in the management of papillary renal cell carcinoma. / Carcinoma papilar de células renales: el papel del radiólogo en su manejo.

Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.

Association of coffee intake and its polyphenols with mammographic findings in women who visited the Brazilian Public Health Service.

Introduction: Objective: this study aimed to evaluate if there is an association of intake of coffee and its polyphenols with mammographic findings in women treated at a breast care service unit of the Unified Health System (SUS), Brazil. Research methods and procedures: this was a cross-sectional study with 532 women treated at a health service. The participants were divided according to their mammographic reports into two groups: without and with altered findings. Two 24-h dietary recalls were applied and coffee consumption was categorized into three groups (less than 1 cup, 1 to 3 cups, and more than 3 cups). Phenolic acids were determined using the Phenol Explorer program. The intake of polyphenols was calculated by adding the values obtained from the total amount of coffee consumed during the day. The Multiple Source Method (MSM) was applied to analyze the usual intake. Results: of the 532 women, 178 (33.5 %) had altered mammographic findings. The participants' average daily coffee intake was 193.4 mL. No significant association was found between coffee consumption and mammographic findings. However, it was found that the second tertile of polyphenols was a protective factor for breast changes. Conclusion: Coffee polyphenols are protective against breast changes in the group evaluated and, thus, can help prevent breast cancer.

Introducción: Objetivo: este estudio tuvo como objetivo evaluar si existe una asociación de la ingesta de café y sus polifenoles con los hallazgos mamográficos de mujeres tratadas en una unidad de patología mamaria del Sistema Unificado de Salud (SUS), Brasil. Métodos y procedimientos de investigación: este fue un estudio transversal con 532 mujeres tratadas en un servicio de salud. Las participantes se dividieron de acuerdo con sus informes mamográficos en dos grupos: sin y con hallazgos alterados. Se aplicaron dos registros dietéticos de 24 horas y el consumo de café se clasificó en tres grupos (menos de 1 taza, 1 a 3 tazas y más de 3 tazas). Los ácidos fenólicos se determinaron utilizando el programa Phenol Explorer. La ingesta de polifenoles se calculó sumando los valores obtenidos de la cantidad total de café consumido durante el día. Se aplicó el método de fuentes múltiples (MSM) para analizar la ingesta habitual. Resultados: de las 532 mujeres, 178 (33,5 %) tenían hallazgos mamográficos alterados. La ingesta diaria promedio de café de los participantes fue de 193,4 ml. No se encontró una asociación significativa entre el consumo de café y los hallazgos mamográficos. Sin embargo, se encontró que el segundo tercil de polifenoles era un factor protector para los cambios mamarios. Conclusión: los polifenoles del café son protectores contra los cambios mamarios en el grupo evaluado y, por lo tanto, podrían ayudar a prevenir el cáncer de mama.

Neonatal Dermatologic Findings in Uruguay: Epidemiology and Predisposing Factors. / Epidemiología y factores predisponentes de los hallazgos dermatológicos en neonatos de Uruguay.

BACKGROUND: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. OBJECTIVES: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. METHODS: Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. RESULTS: A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimum-maximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent. CONCLUSIONS: All neonates have skin characteristics that are part of their adaptation to extrauterine life. Most are benign and transient. Maternal age, type of delivery, and certain neonatal factors such as gestational age, birth weight, sex, and ethnicity are associated with specific findings.

Mielolipoma retroperitoneal perirrenal: reporte de un caso.

El mielolipoma es un tumor benigno de baja incidencia cuya localización más frecuente son las glándulas suprarrenales. Histológicamente se caracteriza por células con precursores mieloides y eritroides mezcladas con tejido adiposo maduro. El diagnóstico en general es incidental en una prueba de imagen. Clínicamente cursa asintomático, aunque los de mayor tamaño tienen más riesgo de complicaciones como sangrado o efecto de masa. Los hallazgos incidentales < 4 cm se deben controlar con imágenes; los > 7 cm, o que generen síntomas, deben ser tratados de forma quirúrgica. Se reporta un caso de mielolipoma extrasuprarrenal en un paciente de 78 años.Myelolipoma is a relatively rare benign tumor which is most commonly located in the adrenal glands. Histologically is characterized by eritroid and myeloid precursor cells intermixed with mature adipose tissue. The diagnosis is generally incidental in abdominal imaging studies. Clinically most are asymptomatic, nevertheless larger tumors are at greater risk for complications such as hemorrhage or compression of surrounding structures. Incidental findings smaller than 4 cm should be followed-up by imaging. Tumors measuring more than 7 cm or those that are symptomatic a surgical approach is mandated. We present the case of a 78-year-old man with an extra-adrenal myelolipoma.

Normal and transitory ultrasonography findings in the immediate postoperative period after liver transplantation. / Hallazgos ecográficos transitorios y normales en el postoperatorio inmediato del trasplante hepático.

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications.

Differences between patients with isolated GH deficiency based on findings in brain magnetic resonance imaging.

INTRODUCTION: Protocol for prescribing hormone replacement therapy in isolated growth hormone (GH) deficiency includes magnetic resonance imaging of the brain. There is controversy on the frequency of structural pituitary abnormalities and on the importance of abnormal MRI findings on prognosis and response to GH replacement. METHODS: A descriptive, retrospective study of children of both sexes aged 0-14 years, who had undergone brain MRI, diagnosed with isolated GH deficiency at a tertiary hospital in the past 14 years, aimed at reporting the frequency of abnormal MRI findings in isolated GH deficiency, and to establish whether differences exist in height diagnosis and evolution according to MRI findings. MRI findings were also compared with the findings reported in healthy children in order to establish incidence. RESULTS: 96 patients were studied, of whom 74/96 (77%) reached adult age. Abnormal MRI findings were seen in 11.5% of them (8/11 of pituitary origin). No brain or pituitary tumor was seen in any case. Patients with abnormal images had a mean age at treatment start of 8 years, a target height of -0.8SD, and a final height of 1.04SD, while patients with normal MRI findings had an age at treatment start of 10 years old, a target height of -1.44SD, and a final height of -1.75SD, with statistically significant differences. CONCLUSIONS: Patients with abnormal MRI findings show a more favorable response to GH replacement therapy.

Metastases to the breast, an uncommon diagnosis: what do radiologists need to know? / Metástasis en la mama, un diagnóstico infrecuente. ¿Qué deben saber los radiólogos?

OBJECTIVE: To analyze the imaging characteristics of histologically diagnosed metastases to the breast. MATERIAL AND METHODS: We selected patients histologically diagnosed with metastases to the breast in our diagnostic and interventional breast imaging unit between March 2010 and September 2018. RESULTS: A total of 9 patients (all women; mean age, 60 y; age range, 28-89 y) were diagnosed with metastases to the breast. In 1 (11.11%) case, the primary disease was diagnosed from the breast lesion. The primary tumors were melanoma (n=5), neuroendocrine tumor (n=2, one from the small bowel and one from the cervix), lung adenocarcinoma (n=1), and ovarian cancer (n=1). The clinical and imaging manifestations depend on the type of dissemination of disease and can simulate benign and malignant primary breast lesions. CONCLUSION: There is no specific imaging pattern for metastases to the breast that would help to orient the diagnosis. It is important to consider this etiological possibility if the patient has a history of a primary tumor in another organ.

Cáncer incidental de vesícula: incidencia y factores asociados en pacientes de una institución de la ciudad de Medellín / Incidental gallbladder cancer: Incidence and associated factors in patients from an institution in the city of Medellín

Introducción. El cáncer de vesícula biliar es una de las neoplasias más frecuentes de la vía biliar y la mayoría de los casos se diagnostican de forma incidental o en estadios avanzados. En Colombia existen pocas publicaciones acerca de la prevalencia y características clínicas de pacientes con cáncer insospechado de vesícula biliar. El objetivo de este trabajo fue actualizar la información existente. Métodos. Estudio de tipo transversal basado en registros médicos. Como variable de resultado se definió el hallazgo incidental de patología maligna reportado por un patólogo y el subtipo histológico. Se midieron variables demográficas, clínicas y quirúrgicas. Se calcularon OR con sus respectivos intervalos de confianza (IC95%). Resultados. De los 2630 casos analizados, en cuatro se hizo diagnóstico de cáncer incidental de vesícula, con una prevalencia del 0,15 %. Se encontraron como características asociadas al cáncer incidental de vesícula, la edad, el antecedente de cáncer y la presencia de pólipos. Conclusiones. Esta es una patología poco frecuente en la población evaluada, lo que permite afirmar que no es necesario realizar estudios prequirúrgicos más amplios de forma rutinaria, a menos que el paciente presente alguno de los factores asociados.

Introduction. Gallbladder cancer is one of the most common neoplasms of the bile duct and most cases are diagnosed incidentally or in advanced stages. In Colombia, there are few publications about the prevalence and clinical characteristics of patients with unsuspected gallbladder cancer. The objective of this work was to update the existing information. Methods. Cross-sectional study based on medical records. The incidental finding of malignant pathology reported and the histological subtype were defined as the outcome variable. Demographic, clinical and surgical variables were measured. ORs were calculated with their respective 95% CI. Results. Of the 2630 cases analyzed, four were diagnosed with incidental gallbladder cancer, with a prevalence of 0.15%. Characteristics associated with incidental gallbladder cancer were age, history of cancer and the presence of polyps. Conclusions. This is a rare pathology in the population evaluated, which allows us to recommend that it is not necessary to routinely perform more extensive presurgical studies, unless the patient presents any of the associated factors.

Enfermedad de Lhermitte-Duclos y síndrome de Cowden. Reporte de un caso / Lhermitte-Duclos Disease and Cowden Syndrome. A Case Report

Presentación del caso. Se trata de una paciente femenina de 45 años con antecedentes de hipertensión arterial y múltiples cirugías por cáncer, entre ellas, cáncer de tiroides, carcinoma de parótida, cáncer de mama y cáncer endometrial. De manera incidental se identificó una lesión en el hemisferio cerebeloso derecho en una tomografía de senos paranasales, que fue confirmada a través de una resonancia magnética cerebral. La lesión presentaba una apariencia estriada, característica de gangliocitoma displásico del cerebelo o enfermedad de Lhermitte-Duclos. Considerando los antecedentes de diversos tipos de cáncer y los criterios de diagnóstico propuestos por el Consorcio Internacional Cowden y la Red Nacional Integral del Cáncer, se estableció el diagnóstico de síndrome de Cowden que había pasado desapercibido hasta el momento. Intervención terapéutica. Posteriormente, la paciente fue hospitalizada debido al crecimiento de una masa metastásica en el hemicuello derecho con afectación del plexo braquial, adenopatías cervicales, infraclaviculares y axilares derechas. Evolución clínica. En la actualidad, se encuentra recibiendo tratamiento paliativo con el objetivo de controlar los síntomas y mejorar su calidad de vida, ya que expresó su negativa a someterse a una intervención quirúrgica de resección tumoral

Case presentation. The report is of a 45-year-old female patient with a history of high blood pressure and multiple surgeries for cancer, including thyroid cancer, parotid carcinoma, breast cancer, and endometrial cancer. Incidentally, a lesion in the right cerebellar hemisphere was identified in a tomography of the paranasal sinuses, which was later confirmed in a brain magnetic resonance. The lesion had a striated appearance, characteristic of dysplastic gangliocytoma of the cerebellum or Lhermitte-Duclos disease. Considering the history of various types of cancer and the diagnostic criteria proposed by the International Cowden Consortium and the National Comprehensive Cancer Network, the diagnosis of Cowden syndrome, which had gone unnoticed until now, was established. Treatment. Subsequently, the patient was hospitalized due to the growth of a metastatic mass in the right hemicollar with involvement of the brachial plexus, cervical, infraclavicular, and right axillary lymph nodes. Outcome. She is receiving palliative treatment to control the symptoms and improve her quality of life, since she expressed her refusal to undergo tumor resection surgery

Tumor sólido pseudopapilar de páncreas. Reporte de caso / Solid pseudopapillary tumor of the pancreas. Case report

Introducción. La neoplasia sólida pseudopapilar de páncreas, también conocida como tumor de Frantz, es una patología poco frecuente, que comprende menos del 3 % de los tumores pancreáticos, y la mayor incidencia se observa en mujeres jóvenes entre la segunda y tercera década de la vida. Su etiología es desconocida. El tratamiento de elección es la resección quirúrgica sin linfadenectomía cuando se encuentra bien localizado. Inclusive aún cuando hay evidencia de metástasis o invasión local, el manejo quirúrgico sigue siendo el tratamiento de elección. Caso clínico. Mujer de 24 años de edad, con masa abdominal palpable, dolorosa, de tres semanas de evolución. La tomografía computarizada mencionó como presunción diagnóstica un tumor de origen pancreático. En la laparotomía se encontró una masa dependiente del cuerpo del páncreas. Se realizó pancreatectomía distal radical con esplenectomía y omentectomía parcial en bloque. Resultados. Durante la cirugía no se presentaron complicaciones y hasta el sexto mes de seguimiento, la evolución fue adecuada y sin recidiva tumoral. Conclusiones. Ante la presencia de masa abdominal, con compromiso pancreático documentado por tomografía computarizada, se debe considerar el diagnóstico de neoplasia sólida pseudopapilar de páncreas, o tumor de Frantz. El tumor de Frantz es una entidad poco frecuente que generalmente se diagnostica de forma incidental o por síntomas inespecíficos en estadios avanzados. El diagnóstico y manejo de esta neoplasia representa un reto y la resección quirúrgica continúa siendo el tratamiento indicado.

Introduction. Solid pseudopapillary neoplasia of the pancreas, also known as Frantz tumor, is a rare pathology, comprising less than 3% of pancreatic tumors, and the highest incidence is observed in young women between the second and third decades of life. Its etiology is unknown. The treatment of choice is surgical resection without lymphadenectomy when it is well located. Even when there is evidence of metastasis or local invasion, surgical management remains the treatment of choice. Clinical case. A 24-year-old woman presented with a palpable, painful abdominal mass of three weeks' duration. The computed tomography mentioned a tumor of pancreatic origin as a presumptive diagnosis. At laparotomy, a mass dependent on the body of the pancreas was found. Radical distal pancreatectomy with splenectomy and en bloc partial omentectomy was performed. Results. During the surgery there were no complications and until the sixth month of follow-up, the evolution was adequate and without tumor recurrence. Conclusions. In the presence of an abdominal mass, with pancreatic involvement documented by computed tomography, the diagnosis of solid pseudopapillary neoplasia of the pancreas, or Frantz tumor, should be considered, which must be treated surgically. Frantz tumor is a rare entity that is generally diagnosed incidentally or due to nonspecific symptoms in advanced stages. The diagnosis and management of this neoplasia represents a challenge and surgical resection continues to be the indicated treatment.

Characterisation of laryngo-pharyngeal reflux disease in old and ageing patients. / Caracterización de la enfermedad por reflujo faringolaríngeo en pacientes de edad avanzada y ancianos.

OBJECTIVES: To characterize laryngo-pharyngeal reflux (LPR) in patients over 60 years of age. METHODS: Retrospective review of patients over 60 years of age with symptoms suspicious of LPR, seen from 2005 to 2014 at an ENT Department of an academic hospital. Eighty-five consecutive patients (54 females, 31 males) who had completed a dual-sensor 24-hour pH-metry were included (considered "gold-standard" in LPR diagnosis). Body mass index, and reflux information and interventions were revised. pH-metries were evaluated according to DeMeester & Johnson's criteria. Symptoms were assessed according to the Reflux Symptom Index (RSI) and classified as abnormal if score was ≥13. A naso-fibro-laryngoscopy enabled findings to be documented according to the Reflux Finding Score (RFS), and they were classified as abnormal if the score was ≥7. RESULTS: The patients' mean age was 67 years. A positive pH-metry was present in 70 patients (82.5%). Fifty patients (59%) had abnormal body mass index, and almost 90% of them had an abnormal pH-metry. Mean RSI score was 9.8, with abnormal results in 24 patients (28%). Only 20 patients (23%) with abnormal RSI had a positive pH-metry. Posterior commissure hypertrophy was the most common finding (90% of patients). Mean RFS score was 9.07, with abnormal results in 69 patients (81%). Sixty-one patients (70%) with abnormal RFS had a positive pH-metry. Only 18 patients (20%) had coincidental abnormal pH-metry, RSI, and RFS. CONCLUSIONS: In ageing patients, abnormal body mass index is strongly associated with abnormal pH-metry. RSI is a weak indicator of LPR, whereas RFS has a moderate value.

Hallazgos incidentales en medicina genómica / Incidental Findings in Genomic Medicine

Las técnicas de Biología Molecular de última generación, como es la secuenciación masiva en paralelo o NGS (Next Generation Sequencing), permite obtener gran cantidad de información genómica, la cual muchas veces va más allá de la detección de una variante patogénica en un gen que explique la patología (hallazgo primario). Es así como surgió desde hace años la discusión internacional respecto a la decisión a tomar frente a los hallazgos secundarios accionables, es decir, aquellos hallazgos de variantes clasificadas como patogénicas o probablemente patogénicas que no están relacionadas con el fenotipo del paciente, pero que tiene alguna medida preventiva o tratamiento posible y, por lo tanto, podría ser de utilidad para la salud del paciente. Luego de revisar la bibliografía internacional y debatir entre los expertos del Hospital de Pediatría Garrahan, se logró establecer una política institucional y reforzar el hecho de que se trata de una disciplina multidisciplinaria. Así, fue posible definir que solo se atenderá las cuestiones relacionadas con la edad pediátrica, dejando para un tratamiento posterior aquellas variantes detectadas en genes que sean accionables en edad adulta. En el Hospital Garrahan, ha sido posible definir claramente cómo proceder frente a los hallazgos secundarios, al adaptar el consentimiento informado a esta necesidad, definiendo cuándo serán informados, y sabiendo que serán buscados intencionalmente en los genes clínicamente accionables enlistados en la última publicación del American College of Medical Genetics and Genomics, siempre y cuando el paciente/padre/tutor lo consienta (AU)

The latest generation of molecular biology techniques, including massive parallel sequencing or NGS (Next Generation Sequencing), allows us to obtain a whealth of genomic information, which often goes beyond the detection of a pathogenic variant in a gene that explains the pathology (primary finding). As a result, an international discussion has arisen over the years regarding the decision-making concerning actionable secondary findings, it means, those findings of variants classified as pathogenic or probably pathogenic that are not related to the patient's phenotype, but which have some possible preventive measure or treatment and, therefore, could be useful for the patient's health. After reviewing the international literature and discussing among the experts of the Hospital de Pediatría Garrahan, an institutional policy was established and the concept that this is a multidisciplinary discipline was reinforced. Consequently, it has been defined that only issues related to children will be addressed, reserving those variants detected in genes that are actionable in adulthood for later treatment. At Garrahan Hospital, we were able to clearly define how to proceed with secondary findings by adapting the informed consent to this need, defining when they will be reported, and knowing that they will be intentionally searched for in the clinically actionable genes listed in the latest publication of the American College of Medical Genetics and Genomics, as long as the patient/parent/guardian consents (AU)

Hallazgos por tomografía en pacientes confirmados con SARS-CoV-2 y síndrome de distrés respiratorio agudo / Tomography findings in patients confirmed with SARS-CoV-2 and acute respiratory distress syndrome

Resumen Objetivos: Describir los patrones tomográficos de afectación pulmonar en pacientes con SARS-CoV2 y SDRA. Materiales y Métodos: Estudio retrospectivo, transversal y analítico. Pacientes atendidos en Hospital Regional de Alta Especialidad de Ciudad Victoria "Bicentenario 2010" (HRAEV), con diagnóstico confirmado de COVID-19 por RT-PCR y que contaran con tomografía computarizada de tórax realizada en la institución en el periodo comprendido de 1 marzo de 2020 a 31 julio de 2020. Se realizó un análisis descriptivo y analítico. Resultados: Se analizaron estudios de tomografía de 44 pacientes hospitalizados en HRAEV que cursaron con SDRA y requirieron IOT, de los cuales el 72.7% fueron del sexo masculino, la edad promedio fue de 64 años, de los cuales 47.7% cursaba con Diabetes Mellitus, 63.6 % con Hipertensión Arterial Sistémica 43.1% y con algún grado de sobrepeso u obesidad. Conclusiones: El hallazgo tomográfico característico de los pacientes con SDRA fue mixto de tipo vidrio despulido y consolidación con una afectación severa y generalizada.

Abstract Objective: Describe the tomographic patterns of lung involvement in patients with SARS-CoV2 and ARDS. Materials and methods: Retrospective, cross-sectional and analytical study. Patients treated at the Regional High Specialty Hospital of Ciudad Victoria "Bicentenario 2010" (HRAEV), with a confirmed diagnosis of COVID-19 by RT-PCR and who had a chest computed tomography performed at the institution in the period from March 1, 2020 to July 31, 2020. A descriptive and analytical analysis was carried out. Results: Tomography studies of 44 patients hospitalized in HRAEV who had ARDS and required IOT were analyzed, of which 72.7% were male, the average age was 64 years, of which 47.7% had Diabetes Mellitus, 63.6% with Systemic Arterial Hypertension and 43.1% with some degree of overweight or obesity. Conclusions: The characteristic tomographic finding of patients with ARDS was a mixed type of ground glass and consolidation with severe and generalized involvement. A high mortality rate was observed in these patients with OTI up to 70%.

Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography. / Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina.

INTRODUCTION AND OBJECTIVES: Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate. METHODS: According to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner. RESULTS: The total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%. CONCLUSION: It is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies.

Patrón inflamatorio de las vías aéreas en pacientes fumadores con enfermedad pulmonar obstructiva crónica / Inflammatory pattern of the airways in COPD smokers

Introducción: La enfermedad pulmonar obstructiva crónica cursa con un patrón inflamatorio en la vía aérea que incluye neutrófilos, macrófagos, linfocitos, los cuales se pueden obtener mediante un cepillado bronquial citológico. Objetivos: Identificar patrón inflamatorio según células inflamatorias presentes en la vía aérea, mediante el cepillado bronquial citológico e índice tabáquico de paquetes/año en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Se realizó un estudio descriptivo transversal en pacientes con enfermedad pulmonar obstructiva crónica, que concurrieron al Hospital Neumológico Benéfico-Jurídico, en el período comprendido de junio de 2018 a junio de 2019, con indicación para la realización de fibrobroncoscopía con cepillado bronquial. Resultados: El 53,1 por ciento de los pacientes corresponden al sexo masculino. Un 46,1 por ciento presentó un índice tabáquico de paquetes/año entre 21-40. Predominaron las criptas y estrías como hallazgos broncoscópicos con un 51 por ciento y 40,8 por ciento respectivamente en pacientes con índice paquetes/año mayor que 40. De los pacientes con índice paquetes/año mayor de 40 (13 para un 26,5 por ciento) presentaron hiperplasia de células basales. El 46,9 por ciento de los pacientes presentaron un patrón inflamatorio neutrofílica. Conclusiones: Se identificaron a los pacientes con EPOC que presentaron patrón inflamatorio neutrofílica en la vía aérea y elevado índice tabáquico y desde el punto de vista broncoscópico tienen varios hallazgos que sugieren cronicidad(AU)

Introduction: Chronic obstructive pulmonary disease presents with an inflammatory pattern in the airway that includes neutrophils, macrophages, and lymphocytes, which can be obtained by cytological bronchial brushing. Objectives: To identify inflammatory pattern according to inflammatory cells present in the airway, through cytological bronchial brushing and smoking rate of packs/year in patients with chronic obstructive pulmonary disease. Methods: A cross-sectional descriptive study was carried out in patients with chronic obstructive pulmonary disease, who attended Benefico-Jurídico Pneumological Hospital, from June 2018 to June 2019, with an indication for fiberoptic bronchoscopy with bronchial brushing. Results: 53.1percent of the patients correspond to the male sex. 46.1percent ad a smoking rate of packs/year between 21-40. Crypts and striae predominated as bronchoscopic findings with 51percent and 40.8percent respectively in patients with a pack/year index greater than 40. Patients with a pack/year index greater than 40 (13 for 26.5percent) showed basal cell hyperplasia. 46.9percent of the patients had a neutrophilic inflammatory pattern. Conclusions: Patients with COPD who had a neutrophilic inflammatory pattern in the airway and high smoking index were identified, and from the bronchoscopic point of view they have several findings that suggest chronicity(AU)

Cambios morfométricos en pacientes con enfermedad renal crónica fallecidos relacionados con diabetes mellitus, hipertensión arterial y obesidad

Fundamento: la enfermedad renal crónica ha incrementado su incidencia, no existen estudios en Cuba ni en la provincia sobre morfometría renal en pacientes con enfermedad renal crónica a los que se les ha practicado autopsia. Objetivo: determinar variaciones morfométricas renales en pacientes fallecidos a los que se les ha practicado autopsia en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Método se realizó un estudio descriptivo, longitudinal y retrospectivo. El universo lo conformaron 85 pacientes fallecidos a los que se les practicó autopsia y que tenían diagnóstico clínico de enfermedad renal crónica en cualquier estadio. Se trabajó con el total del universo. Las variables estudiadas fueron: edad, sexo, peso y talla para el cálculo del índice de masa corporal, antecedentes patológicos personales, el estadio clínico de la enfermedad renal crónica y la morfometría renal a cada órgano por separado, las mensuraciones realizadas fueron: peso, diámetro longitudinal, diámetro transversal, espesor o grosor de la corteza renal. Los datos se procesaron en el paquete estadístico de SSPS v. 11.5 presentándose tablas en números absolutos y porcientos. Resultados predominó el sexo femenino, en edades entre 70-79 años, con estadio clínico I y IV de la enfermedad renal crónica, los obesos representaron el 57,6 %, los hipertensos el 67,1 % y los diabéticos el 25,8 %. Hubo disminución de todas las variables morfométricas en ambos riñones, destacándose el espesor de la corteza renal. Conclusiones: existió relación entre la hipertensión, la diabetes mellitus y la obesidad con las variables morfométricas renales.

Background: chronic kidney disease has increased its incidence, there are no studies in Cuba or in the province on renal morphometry in patients with chronic kidney disease who have undergone autopsy. Objective: to determine renal morphometric variations in deceased patients who have undergone autopsy at the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos. Method: a descriptive, longitudinal and retrospective study was carried out. The universe was made up of 85 deceased patients who underwent autopsy with a clinical diagnosis of chronic kidney disease at any stage. We worked with the whole universe. The variables studied were: age, sex, weight and height for the calculation of the body mass index, personal pathological history, the clinical stage of chronic kidney disease and renal morphometry to each organ separately, the measurements made were: weight, longitudinal diameter, transverse diameter, thickness or thickness of the renal cortex. The data was processed in the statistical package of SSPS v. 11.5 presenting tables in absolute numbers and percentages. Results: the female sex predominated, aged between 70-79 years, with clinical stage I and IV of chronic kidney disease, the obese represented 57.6 %, the hypertensive 67.1 % and the diabetic 25.8 %. There was a decrease in all morphometric variables in both kidneys, highlighting the thickness of the renal cortex. Conclusions: there was a relationship between hypertension, diabetes mellitus and obesity with renal morphometric variables.