Advances in the diagnosis of cutaneous malignant melanoma / 中国基层医药

Cutaneous malignant melanoma arises from the neural crest-derived melanocytes and is a highly malignant tumor with complex clinical and pathological manifestations. In recent years, its incidence rate is increasing gradually. It is one of the most common cutaneous malignant tumors. This paper reviews the advances of the diagnosis of cutaneous malignant melanoma.

The difference of lens thickness measured by immersion A-scan ultrasound versus Lenstar optical biometry in various types of cataract eyes and its clinical significance / 中华实验眼科杂志

Background Cataract is the main cause of global blindness,and surgery is the main method for the treatment of cataract,so precise preoperative parameters have an important significance for improving postoperative visual quality.Objective This study was to analyze the difference of lens thickness (LT) measured by immersion A-scan ultrasound versus optical biometry and consistency of these two methods in measuring the LT for different types of cataract eyes,and to investigate whether A-scan ultrasound for the LT measurement needs to correct the ultrasound speed parameter.Methods A reliability evaluation of diagnosis test was designed.The LT was measured on 143 cataract eyes using immersion A-scan ultrasound and Lenstar optical biometry in Tianjin Eye Hospital from September 2013 to May 2014.The eyes were assigned to nuclear cataract group (60 eyes of 50 patients),posterior subcapsular cataract group (40 eyes of 40 patients) and cortical cataract group (43 eyes of 43 patients) based on the types of cataract,and the hardness of nucleus was grade II in 20 eyes of 14 patients,grade Ⅲ in 20 eyes of 17 patients and grade Ⅳ in 20 eyes of 19 patients.The outcomes measured by immersion A-scan ultrasound versus Lenstar optical biometry were compared with paired t test,and the consistency between the two devices was analyzed by Bland-Altman agreement plot.This study complied with Helsinki declaration,and written informed consent was obtained from each patient prior to any examination.Results The mean LT value was (4.85± 0.39) mm from the immersion A-scan ultrasound and (4.74 ±0.37)mm from the Lenstar optical biometry,with a significant difference between the two devices (t =3.020,P =0.004).No significant differences were found in the LT values of the posterior subcapsular cataractous eyes and cortical cataractous eyes between the two devices (t=1.015,P =0.316;t =1.275,P =0.209).The LT values by immersion A-scan ultrasound were significantly higher in grade Ⅱ,Ⅲ and Ⅳ nuclear cataractous eyes than those by Lenstar optical biometry (t=2.175,2.378,2.383,all at P＜0.05).The outcome showed a good consistency in the posterior subcapsular cataractous eyes between the two measuring methods,with the 95％ limitation of agreement (LoA) from-0.21 to 0.18 mm.However,there were poor consistencies between the two measuring methods in the nuclear and cortical cataractous eyes,with the 95％ LoA from-0.64 to 0.43 mm and from-0.50 to 0.41 mm,respectively.Poor consistencies also were seen in grade Ⅱ,Ⅲ,Ⅳ nuclear cataractous eyes between the two measuring methods,and the 95％ LoA were-0.31 to 0.22 mm,-0.32 to 0.24mm and-1.09 to 0.62 mm,respectively.Conclusions There are differences in measuring LT of different types of cataractous eyes between immersion A-scan ultrasound and Lenstar optical biometry.The measuring values are higher by immersion A-scan ultrasound than those by Lenstar optical biometry,suggesting that the measurement of immersion A-scan ultrasound for LT of different types and nuclear hardness of cataractous eyes should correct the ultrasound speed parameters.

Intubación nasotraqueal con laringoscopio óptico airtraq en dos casos de braquiterapia oral / Nasotracheal intubation with Airtraq optical laryngoscope in two cases of oral brachytherapy

Nasotracheal intubation is usually the selected airway approach for oral and maxillofacial surgery to enable a free surgical field. It is an unusual intubation technique with a high success rate. However, it is not free from difficulties and complications in certain groups of patients, like those with oral, facial or cervical tumors. The Airtraq® laryngoscope (Prodol Meditec, Vizcaya, Spain) is an optical device that facilitates tracheal intubation through the indirect visualization of the vocal cords, avoiding the need to align the oral, pharyngeal and laryngeal axis. It has shown to be useful in various difficult airway (DA) scenarios. There is a version of the device to assist with the nasal intubation technique. Two oral brachytherapy treatment cases classified as DA are discussed; the nasotracheal intubation of the patient awake was successful using the Airtraq optical laryngoscope.

La intubación nasotraqueal suele ser el abordaje electivo de la vía aérea en cirugías orales y maxilofaciales, permitiendo así un campo quirúrgico libre. Se trata de una técnica de intubación poco habitual con alto índice de éxito. Sin embargo, no está exenta de dificultades y complicaciones en ciertos grupos de pacientes como aquellos con tumoraciones orales, faciales o cervicales. El laringoscopio Airtraq® (Prodol Meditec, Vizcaya, España) es un dispositivo óptico que facilita la intubación traqueal mediante la visualización indirecta de las cuerdas vocales, sin necesidad de conseguir la alineación de los ejes oral, faríngeo y laríngeo. Ha demostrado su utilidad en diferentes escenarios de vía aérea difícil (VAD). Existe una versión del mismo diseñada para asistir en la técnica de intubación nasal. Presentamos dos casos de tratamiento con braquiterapia oral, catalogados de VAD, cuya intubación nasotraqueal en paciente despierto fue realizada de forma exitosa mediante el laringoscopio óptico Airtraq.

Retinosis pigmentaria en baja visión / Retinitis pigmentosa in low vision

Objetivo: Valorar el comportamiento oftalmológico de la retinosis pigmentaria en la consulta de baja visión del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el año 2010. Métodos: Se realizó un estudio descriptivo, transversal de 27 pacientes con retinosis pigmentaria y baja visión. Se analizaron variables como: edad, sexo, examen oftalmológico que incluyó agudeza visual mejor corregida y campo visual. Se clasificaron los pacientes de acuerdo con el estadio clínico, debut de la enfermedad, ayudas ópticas y no ópticas más utilizadas. Los resultados fueron expresados en números de casos y valor porcentual. Se utilizó el estadígrafo x2 para el análisis y se aceptó como error tipo I una P menor o igual a 0,05. Resultados: Se observó que 85 % de los pacientes se encontraban en el intervalo de 15 a 45 años de edad. Predominó el estadio I y el debut precoz. La ayuda óptica más utilizada fue el microscopio, y no ópticas, la iluminación y los filtros. Conclusión: No existió relación en nuestro estudio entre la forma de debut de la enfermedad con el estadio clínico de los pacientes presumiblemente por el diagnóstico precoz de la enfermedad y el tratamiento oportuno. La rehabilitación visual fue aceptada en todos los casos estudiados.

Objective: To evaluate the behavior of Retinitis Pigmentosa in low vision service at “Ramón Pando Ferrer" Cuban Institute of Ophthalmology. Methods: A cross sectional study of 27 patients with retinitis pigmentosa and low vision was undertaken. The analyzed variables included age, sex, eye examination that included best-corrected visual acuity and visual field. Patients were classified according to clinical stage and disease onset and most used optical and non optical devices. The results were expressed in numbers of cases and percentages. The x2 statistic was used for the analysis of results. And Type I error was accepted as p= 0,05. Results: It was observed that 85 % of patients were in the 15 to 45 age group; the stage I and early onset predominated, the most widely used optical devices was the microscope, and the non-optical ones were lighting and filters. Conclusions: There was no relationship in our study between the onset of the disease and the clinical stage of patients, presumably due to early disease diagnosis and timely treatment. Visual rehabilitation was accepted in all studied cases.

Microdevice for aqueous humor drainage Maldonado Bas - Pförtner / Microdispositivo para drenaje de humor acuoso Maldonado Bas - Pförtner

PURPOSE: A microdevice for the treatment of refractory glaucoma is presented. The underlying concepts, its mechanisms of action and the surgical technique for implanting are explained and the results are analyzed. The microdevice was developed and the surgeries were performed at the Maldonado-Bas Eye Clinic (Cordoba, Argentina), under the rules established in the protocol approved by the provisions of the National Administration of Drugs, Food and Medical Technology 430/7. File No.:1-47-25-649-07-1. METHODS: In a prospective study, following the protocol, 16 eyes with refractory glaucoma were included and operated. Intraocular pressure <21mmHg with or without additional medication was considered successful. The follow-up was one year. Averages, percentages and their 95 percent confidence bands were calculated. Analysis of variance for repeated measures was used to compare averages. RESULTS: The average preoperative intraocular pressure was 32.81 mmHg, SD ± 10.94 mmHg in a range of 14 to 50 mmHg. The average post-surgical intraocular pressure at one year was 12.43 mmHg, SD ± 2.85 mmHg in a range of 7 to 19 mmHg. The difference between the pre-and post-surgery average intraocular pressure was 20.38 mmHg. The number of successes was 14 eyes (87.5 percent, confidence interval (CI) 95 percent 61.6 percent - 98.6 percent). The number of failures was two eyes (12.5 percent, CI 95 percent 1.43 percent - 38.4 percent). CONCLUSIONS: The results show that the microdevice is successful for the treatment of refractory glaucoma.

OBJETIVO: Se presenta un microdispositivo para el tratamiento del glaucoma refractario. Se explican los conceptos con los que fue desarrollado, su mecanismo de acción, la técnica quirúrgica para implantarlo y se analizan los resultados obtenidos. Realizado en la Clínica de ojos Maldonado-Bas (Córdoba- Argentina), bajo la reglamentación establecida en el protocolo aprobado por disposición de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica 430/7. Expediente:1-47-25-649-07-1. MÉTODOS: En un estudio prospectivo, según la reglamentación del protocolo se incluyeron e intervinieron 16 ojos con glaucoma refractario. Se consideró éxito presión intraocular <21mmHg con o sin medicación adicional. El seguimiento fue de un año. Se calcularon promedios, porcentajes y sus bandas de confianza del 95 por ciento según estuviera indicado. Para comparar promedios se empleó Análisis de la Varianza para mediciones repetidas. RESULTADOS: El promedio de la presión intraocular pre-quirúrgica fue de 32,81 mmHg, SD ± 10,94 mmHg con un rango entre 14 y 50 mmHg. La presión intraocular post-quirúrgica promedio al año fue de 12,43 mmHg, SD ± 2,85 mmHg con un rango entre 7 y 19 mmHg. La diferencia entre el promedio de la presión intraocular pre y pos-quirúrgica fue de 20,38 mmHg. El número de éxitos fue de 14 ojos (87,5 por ciento; IC95 por ciento 61,6 por ciento - 98,6 por ciento). El número de fracasos fue de dos ojos (12,5 por ciento; IC95 por ciento 1,43 por ciento - 38,4 por ciento). CONCLUSIONES: Los resultados demuestran que el microdispositivo es eficaz para el tratamiento del glaucoma refractario.

Intubación de paciente despierto con fibroscopio rígido bajo sedación con remifentanil / Rigid fiberscope intubation of a patient awake with remifentanil sedation

Introducción. Al elegir el manejo de un paciente con vía aérea difícil, conocida o sospechada, es importante plantearse alternativas de intervención. Varios algoritmos de manejo, recomiendan la intubación con paciente despierto, con laringoscopia directa o instrumentos ópticos. Los estiletes rígidos y semirrígidos son dispositivos ópticosdesarrollados para el manejo de la vía aérea difícil, que han mostrado ser rápidos, atraumáticos y confiables. Objetivos. Describir el uso de diferentes estrategias de abordaje de la vía aérea difícil en el escenario de cirugía urgente, al utilizar como una de las opciones de manejo el dispositivo Airway RIFL (rigid intubation fiberoptic laryngoscope). Metodología y resultados. Este es el caso de un paciente de 69 años, llevado de urgencia a cirugía para hemostasia de lesión neoplásica en tórax, considerado como vía aérea difícil por antecedente de múltiples resecciones de lesiones tumorales y radioterapia en vía aérea, con secuela de marcada deformidad facial. Intubación con estómago lleno. Se plantea como primera opción en el manejo de la via aérea el uso de anestesia tópica, sedación con remifentanil y laringoscopia directa, lo cual no es posible por limitada apertura oral: se intenta en tres ocasiones intubación nasal, la cual es fallida. Se decide intubación con el dispositivo Airway RIFL, la cual es exitosa. Conclusiones. Dentro del enfoque del paciente considerado como vía aérea difícil, contar con varias estrategias de manejo, la analgesia local y la sedación, permiten una excelente colaboraciónpor parte del paciente y una rápida intubación orotraqueal con fibroscopio rígido, incluso en escenarios de urgencia.

Introduction. When choosing the appropriate management for a difficult airway patient, either established or suspected, several intervention optionsshould be considered. Some management algorithms recommend awake intubation under direct laryngoscopy or optical instruments. Rigid and semi-rigid stylets are optical devices developed for managing the difficult airway that have proven to be fast, non-traumatic and reliable.Objectives. To describe the use of different strategies to approach the difficult airway in an emergency surgery, using the Airway RIFL (rigidintubation fiberoptic laryngoscope) as one of the options. Methodology and results. This is a case of a 69-yr old patient admitted to the ER for hemostasis and surgery of a chest neoplasia. The patient was considered a difficult airway patient because of a history of multiple tumor resectionsand radiotherapy in the airway, resulting in a notorious facial deformity. Intubation on a full stomach. Topical anesthesia was considered the first choice for airway management, remifentanil sedation and direct laryngoscopy but this is not possible due to a limited oral opening: three nasalintubation attempts were made but failed. Then it was decided to use the Airway RIFL device and the procedure was successful. Conclusions. When dealing with a difficult airway patient, having several management strategies at hand, local anesthesia and sedation,allow for excellent patient collaboration and a fast orotracheal intubation using a rigid fiberscope, even under emergency situations.