ABSTRACT
CASO CLÍNICO: Presentamos un caso de migración de aceite de silicona a través del nervio óptico, en un paciente diabético con desprendimiento de retina, y revisamos los posibles mecanismos etiológicos y sus implicaciones clínicas. DISCUSIÓN: La migración intracraneal del aceite de silicona es una complicación poco frecuente asociada al uso de este material como método sustitutivo tras la vitrectomía
CLINICAL CASE: We present a case of silicone oil migration trough the optic nerve in a diabetic patient with retinal detachment and review the etiologic mechanism and clinical implications. DISCUSSION: Intracranial silicone oil migration is an uncommon complication associated with silicone oil tamponade
Subject(s)
Humans , Male , Adult , Foreign-Body Migration/complications , Silicone Oils/adverse effects , Optic Nerve Injuries/chemically induced , Retinal Detachment/surgery , Vitrectomy , Retinal Detachment/complications , Glaucoma/complications , Intraocular Pressure , Diabetes Mellitus, Type 1/complications , Diabetic Retinopathy/complicationsABSTRACT
CLINICAL CASE: We present a case of silicone oil migration trough the optic nerve in a diabetic patient with retinal detachment and review the etiologic mechanism and clinical implications. DISCUSSION: Intracranial silicone oil migration is an uncommon complication associated with silicone oil tamponade.
Subject(s)
Diabetic Retinopathy/surgery , Extravasation of Diagnostic and Therapeutic Materials/diagnostic imaging , Optic Nerve , Postoperative Complications/diagnostic imaging , Retinal Detachment/surgery , Silicone Oils/adverse effects , Tomography, X-Ray Computed , Vitrectomy , Adult , Diabetes Mellitus, Type 1/complications , Diagnostic Errors , Extravasation of Diagnostic and Therapeutic Materials/diagnosis , Glaucoma/diagnosis , Humans , Lens Implantation, Intraocular , Male , Optic Nerve/diagnostic imaging , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Retinal Detachment/etiology , Silicone Oils/therapeutic use , Vitreoretinopathy, Proliferative/etiology , Vitreoretinopathy, Proliferative/surgeryABSTRACT
INTRODUCTION: Scopulariopsis is a common soil saprophyte. In the last years the infections caused by Scopulariopsis species have increased, included superficial and invasive mycoses. This fungi has been reported resistant in vitro to some antifungal agents, although there is little information about this. The aim of the study was to establish in vitro antifungal susceptibility of clinical isolates of Scopulariopsis species against to broad-spectrum antifungal agents. METHODS: A total of 28 Scopulariopsis strains (10 S. brevicaulis, 7 S. koningii, 3 S. acremonium, 3 S. candida, 3 S. flava, 1 S. brumptii and 1 S. fusca) were tested using Sensititre Yeast One and broth microdilution methods to determine the minimum inhibitory concentrations (MICs) to amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and 5-fluorocytosine, and minimun effective concentration (MECs) to anidulafungin, caspofungin and micafungin. RESULTS: Our data confirm the high in vitro resistance of Scopulariopsis to antifungal agents. Anidulafungin, caspofungin, micafungin (MICs ≥ 8 mg/L), 5-fluorocytosine (MICs ≥ 64 mg/L), and fluconazole (MICs ≥ 128 mg/L) were inactive in vitro in all species. MICs of amphotericin B (range 2 to ≥ 8 mg/L) and itraconazole (0.5 to ≥ 16 mg/L) were high. The best antifungal activity was observed for posaconazole and voriconazole (0.5 to ≥ 8 mg/L). With Sensititre Yeast One method MICs obtained slightly lower. Scopulariopsis candida, S. flava and S. fusca were the most resistant species, while S. acremonium and S. brevicaulis showed the lowest MICs. CONCLUSIONS: MICs of all tested antifungal agents for Scopulariopsis were very high. Infections caused by Scopulariopsis species may not respond to antifungal treatment. Voriconazole is the drug of choice for treatment. We consider it appropriate to add amphotericin B in serious infections.
Subject(s)
Antifungal Agents/therapeutic use , Mycoses/microbiology , Scopulariopsis/drug effects , Drug Resistance, Fungal , Humans , Microbial Sensitivity TestsABSTRACT
Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Hormone treatment is one of the key strategies in the management of metastatic breast cancer. Aromatase inhibitors (AI) have been extensively studied in this setting. This section summarizes the key data regarding the use of AI in advanced breast cancer. In postmenopausal women, AI are the first line of treatment for untreated patients, or those who had prior AI treatment and progress after 12 months of adjuvant therapy. A longer disease-free interval and absence of visceral disease is associated with a better response. If tumors recur in less than 12 months, it is recommended that tamoxifen (TAM) or the estrogen-receptor antagonist fulvestrant (FUL) treatment be initiated. In the second-line setting, the best option after progression is the administration of either FUL or TAM. In the third-line setting, reintroduction of AI is considered an acceptable option. In premenopausal women who have not received prior treatment or who have progressed after 12 months following adjuvant treatment, it is recommended to initiate therapy with a combination of TAM and a luteinizing hormone-releasing hormone (LHRH) analog. If there is treatment failure with the use of this combination, megestrol acetate or an LHRH agonist plus an AI may be reasonable alternatives. Intensive research is ongoing to understand the mechanisms of resistance to hormone therapy. In human epidermal growth factor receptor 2 positive-patients, combinations with HER2 antagonists are associated with significant clinical activity.
Subject(s)
Aromatase Inhibitors/administration & dosage , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Adult , Age Factors , Aged , Anastrozole , Androstadienes/administration & dosage , Androstadienes/adverse effects , Aromatase Inhibitors/adverse effects , Breast Neoplasms/mortality , Disease Management , Disease-Free Survival , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Delivery Systems , Estradiol/administration & dosage , Estradiol/adverse effects , Estradiol/analogs & derivatives , Female , Fulvestrant , Humans , Letrozole , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Metastasis , Nitriles/administration & dosage , Nitriles/adverse effects , Prognosis , Randomized Controlled Trials as Topic , Risk Assessment , Survival Analysis , Treatment Outcome , Triazoles/administration & dosage , Triazoles/adverse effectsABSTRACT
We present the case of a 60-year-old man with a primary pulmonary melanotic schwannoma treated with surgery and who developed an orbital and myocardial relapse 2 years after the initial diagnosis. Melanotic schwannomas are rare pigmented tumours that tend to arise from the peripheral nerves near the midline. A primary lung presentation, as in our case, is extremely rare. In more than half of cases, the Carney triad of myxomas of the heart, skin and breast, spotty pigmentation and endocrine hyperactivity is present. A thorough pathological study is pivotal for a correct diagnosis. The main differential diagnosis is with metastases of malignant melanoma. The biological behaviour is unpredictable. Treatment should include radical surgery if possible; the role of chemotherapy and radiotherapy is uncertain due to the rarity of the tumour (AU)
Subject(s)
Humans , Male , Middle Aged , Heart Neoplasms/secondary , Lung Neoplasms/pathology , Myocardium/pathology , Neurilemmoma/pathology , Neurilemmoma/secondary , Orbital Neoplasms/pathology , Orbital Neoplasms/secondary , Immunohistochemistry/methods , ImmunohistochemistryABSTRACT
PURPOSE: To identify clinical and biologic variables with significant impact on survival in patients with carcinomas of an unknown primary site (CUP) and to develop a simple prognostic model. PATIENTS AND METHODS: In this retrospective study, univariate and multivariate prognostic factors analyses were conducted in a population of 100 patients with CUP. Patients with features requiring well defined treatments had previously been excluded. RESULTS: Overall survival (OS) was significantly related to the following pretreatment adverse prognostic clinical factors: a poor performance status (2 or 3), weight loss more than 10% in the last six months, the presence of liver metastases and more than two metastatic sites. Two biological parameters predicted a significantly shorter survival: elevated serum levels of alkaline phosphatase and of lactate dehydrogenase. In the multivariate analysis, only two independent adverse prognostic parameters were retained: a poor performance status and the presence of liver metastases. We developed a prognostic model for OS based on the following subgroups: good prognosis (PS 0 or 1 and absence of liver metastases), intermediate prognosis (PS> or =2 or presence of liver metastases) and poor prognosis (PS> or =2 or presence of liver metastases). Median OS for the three groups was 10.8, 4 and 1.9 months respectively, p<0.0001. CONCLUSION: A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series.
Subject(s)
Carcinoma/diagnosis , Carcinoma/secondary , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/mortality , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/blood , Carcinoma/mortality , Female , Humans , Male , Models, Biological , Models, Statistical , Multivariate Analysis , Prognosis , Retrospective Studies , Serum Albumin/metabolism , Survival AnalysisABSTRACT
PURPOSE: To identify clinical and biologic variables with significant impact on survival in patients with carcinomas of an unknown primary site (CUP) and to develop a simple prognostic model. PATIENTS AND METHODS: In this retrospective study, univariate and multivariate prognostic factors analyses were conducted in a population of 100 patients with CUP. Patients with features requiring well defined treatments had previously been excluded. RESULTS: Overall survival (OS) was significantly related to the following pretreatment adverse prognostic clinical factors: a poor performance status (2 or 3), weight loss more than 10% in the last six months, the presence of liver metastases and more than two metastatic sites. Two biological parameters predicted a significantly shorter survival: elevated serum levels of alkaline phosphatase and of lactate dehydrogenase. In the multivariate analysis, only two independent adverse prognostic parameters were retained: a poor performance status and the presence of liver metastases. We developed a prognostic model for OS based on the following subgroups: good prognosis (PS 0 or 1 and absence of liver metastases), intermediate prognosis (PS> or =2 or presence of liver metastases) and poor prognosis (PS> or =2 or presence of liver metastases). Median OS for the three groups was 10.8, 4 and 1.9 months respectively, p<0.0001. CONCLUSION: A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma/diagnosis , Carcinoma/mortality , Carcinoma/secondary , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/mortality , Biomarkers, Tumor/analysis , Biomarkers, Tumor/blood , Models, Biological , Models, Statistical , Multivariate Analysis , Prognosis , Retrospective Studies , Serum Albumin/metabolism , Survival AnalysisABSTRACT
Este artículo analiza conceptos que influencian, en gran medida, la calidad de los servicios relacionados con la conducta humana como la motivación, la incentivación, el reconocimiento de méritos y la satisfacción profesional. El autor hace una reflexión que ayudará al director de equipos de atención primaria y a la adjunta de enfermería, que deben liderar equipos profesionales (AU)
Subject(s)
Humans , Job Satisfaction , Employee Incentive Plans , Health Personnel , Primary Health CareSubject(s)
Feeding Behavior , Feeding and Eating Disorders/diagnosis , Intestinal Diseases, Parasitic/diagnosis , Taeniasis/diagnosis , Adult , Chronic Disease , Diagnosis, Differential , Feeding and Eating Disorders/etiology , Female , Humans , Intestinal Diseases, Parasitic/complications , Taeniasis/complicationsABSTRACT
Hypoparathyroidism can exist due to one or more of the following pathogenic mechanisms: 1) Parathyroid Hormone (PTH) deficit, b) biologically inactive PTH, c) PTH antagonists and d) target tissues defects. Biologically inactive PTH secretion, also named pseudo-idiopathic hypoparathyroidism, is an exceptional cause of hypoparathyroidism. We report a case of a patient with this illness. A 71-year-old male with a past history of cataracts since he was 48 was admitted to our hospital. Laboratory data showed a total calcium of 4.82 mg/dl, ionized calcium of 2.72 mg/dl, serum phosphate 5.30 mg/dl, intact PTH 83 pg/ml (N 15-60), osteocalcin 2,4 ng/ml (N 9-30), tubular resorption of phosphate 96% and 1.25 di-hydroxycholecalciferol 7 pg/ml (N 18-78); creatinine and magnesium values were between normal limits. The Ellsworth-Howard test showed a normal response of both urinary c-AMP excretion and phosphaturia to PTH. We review the diagnostic clues of hypoparathyroidism and the value of the Ellsworth-Howard test in order to enable distinction between the several variants of the syndrome.
