Indeterminate pulmonary nodules and prior malignancy: survival and recurrence after surgery in newly diagnosed stage I non-small cell lung cancer.

Background: Surgical excision biopsy remains the only reliable option in most cases of indeterminate pulmonary nodules, particularly in cancer survivors for whom surgery provides local control of pulmonary metastasis and the best chance of cure for early-stage lung cancer. Nevertheless, unnecessary surgeries remain a concern and the prognosis of newly diagnosed lung cancer might be influenced by the history of previous malignancy. We aimed to analyze the outcomes of resected indeterminate pulmonary nodules in patients with and without previous malignancy, and the impact of prior cancer history on survival and recurrence in stage I non-small cell lung cancer (NSCLC) patients. Methods: We retrospectively studied 176 resected indeterminate pulmonary nodules from 169 patients (58% with and 42% without previous cancer). Recurrence and overall survival (OS) were analyzed in newly diagnosed stage I NSCLC using the Kaplan-Meier method and Cox proportional hazard models. Results: The rate of benign lesions was 15.3% (9.6% in the previous cancer group and 23.6% in the no previous cancer group). In stage I NSCLC patients (n=86), previous malignancy was associated with recurrence (P<0.001) but not OS (P=0.23). Chronic obstructive pulmonary disease and visceral pleural invasion were associated with impaired OS and recurrence. Mediastinal lymph node removal was associated with better OS. Conclusions: The rate of benign resections among indeterminate pulmonary nodules in the no-previous cancer group more than doubled that of the previous cancer group and, in newly diagnosed stage I NSCLC patients, recurrence was independently associated with prior cancer. Therefore, in this setting, a history of previous malignancy should be taken into consideration when identifying patients at risk of tumor recurrence.

Voice-sparing cricotracheal resection.

The treatment of benign subglottic stenoses can be challenging. It requires an experienced multidisciplinary team. It is important to define the aetiology, severity and number/types of any pretreatments of the stenosis. Short-term symptom relief can be achieved with endoscopic techniques; however, this relief comes at the price of a high likelihood of restenosis, which often is more severe than the original stenosis. Successful long-term treatment of subglottic stenosis can be achieved by surgical resection in most cases.  Cricotracheal resection is the established standard technique to treat subglottic stenosis. In patients with advanced disease, it can be extended by a dorsal mucosectomy, a lateral cricoplasty or a partial anterior laryngeal split in order to remove the entire diseased area. In this video tutorial, we describe a modification of cricotracheal resection. In this technique for an extended resection, the cricoid arch is partially preserved. In addition to restoring sufficient airway width, this modification has the advantage that the cricothyroid joint remains intact. Therefore, the reduction in the pitch and volume of the voice associated with the standard resection techniques is avoided.

Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers.

OBJECTIVE: To compare images from early and delayed phases of contrast-enhanced thoracic CT for assessing pleural thickening or nodules in a series of patients with malignant pleural effusions. METHODS: Blinded images from 36 patients with malignant pleural effusions showing pleural lesions in both early (35 s delayed) and delayed (70 s delayed) phases of thoracic and abdominal contrast-enhanced CT scan were retrospectively assessed by six observers. First, images were individually scored in a six-point scale grading the quality of visualization of pleural findings such as pleural thickening or nodules. This was followed by a paired analysis, where the readers had to choose the one showing the highest quality between two images presented together corresponding to both phases of the same patient showing the same pleural lesion. When possible, contrast attenuation of the abnormal pleura was measured. Statistical analysis was performed by using paired t-test and χ 2. RESULTS: Mean attenuation of pleural lesions was significantly higher in the delayed phase (76.0 ± 25.1 vs 57.5 ± 20.7, p < 0.001). Mean score and score of individual images was statistically significant better for the delayed phase for all observers. In the paired analysis, all the readers preferred the delayed phase over the early phase in 77.8 to 91.7% of the cases. CONCLUSION: Delayed phase of contrast-enhanced CT is preferable to early phase for evaluating pleural findings. Advances in knowledge: Pleural attenuation is greater for the delayed phase compared with the early phase of contrast-enhanced chest CT. In the pairwise comparison, all the observers prefer the delayed phase over the early phase for pleural evaluation.

Aproximación diagnóstica y terapéutica de las crisis hipertensivas / Diagnostic and therapeutic approach to the hypertensive crisis

La hipertensión arterial es un problema de elevada prevalencia en la población mundial. Las crisis hipertensivas son las formas agudas de presentación y representan un motivo frecuente de consulta en urgencias y atención primaria. Las crisis hipertensivas se dividen en emergencias hipertensivas y urgencias hipertensivas, según exista o no daño agudo en órgano diana, respectivamente. Cada situación tiene un pronóstico y tratamiento diferente, siendo las emergencias hipertensivas potencialmente graves, requiriendo por lo general reducciones rápidas de la presión arterial. Por el contrario, las urgencias hipertensivas podrían ser tratadas ambulatoriamente, reduciendo la presión arterial en horas o días. En un número elevado de pacientes que consultan por una crisis hipertensiva no existen antecedentes de diagnóstico de hipertensión arterial, por lo que es importante incrementar los controles periódicos de la presión arterial en la comunidad

High blood pressure is a problem with elevated prevalence in the world population. The acute forms of presentation are "hypertensive crises", which represent a frequent cause for emergency room and primary care consultations. Hypertensive crises are divided into hypertensive emergencies and hypertensive urgencies, depending on whether or not there is acute damage to the target organ, respectively. Each situation has a different prognosis and treatment. More specifically, hypertensive emergencies are potentially serious and usually require rapid reductions in blood pressure, whereas hypertensive urgencies can be treated as outpatients by reducing blood pressure in hours or days. A significant number of patients who consult medical professionals regarding a hypertensive crisis do not have a prior diagnosis of hypertension; therefore, it is important to periodically monitor blood pressure levels in the community

Diagnostic and therapeutic approach to the hypertensive crisis. / Aproximación diagnóstica y terapéutica de las crisis hipertensivas.

High blood pressure is a problem with elevated prevalence in the world population. The acute forms of presentation are "hypertensive crises," which represent a frequent cause for emergency room and primary care consultations. Hypertensive crises are divided into hypertensive emergencies and hypertensive urgencies, depending on whether or not there is acute damage to the target organ, respectively. Each situation has a different prognosis and treatment. More specifically, hypertensive emergencies are potentially serious and usually require rapid reductions in blood pressure, whereas hypertensive urgencies can be treated as outpatients by reducing blood pressure in hours or days. A significant number of patients who consult medical professionals regarding a hypertensive crisis do not have a prior diagnosis of hypertension; therefore, it is important to periodically monitor blood pressure levels in the community.

Efectos específicos de la rehabilitación cognitiva en pacientes con esclerosis múltiple remitente-recidivante / Specific effects of cognitive rehabilitation in relapsing-remitting multiple sclerosis patients

Fundamento y objetivo: se ha demostrado la existencia de deterioro cognitivo en pacientes con esclerosis múltiple. Este estudio pretende comprobar si es posible generar mejoras en la capacidad atencional de estos pacientes y analizar si esta mejora es generalizable a más de un mecanismo atencional. Material y método: se distribuyó en dos grupos a 26 pacientes con esclerosis múltiple remitente-recidivante (EMRR): un grupo de tratamiento que participó en un programa de estimulación basado en el Attention Process Training durante 3 meses, y otro grupo control patológico que no recibió el programa. Completaron el estudio 18 controles sanos. Los beneficios de la aplicación del programa se evaluaron empleando dos pruebas computarizadas de evaluación, una de atención sostenida y otra de atención selectiva. Resultados: los pacientes del grupo de tratamiento mostraron mejoras en los tiempos de reacción tras la aplicación del programa solo en la tarea de atención selectiva. No se encontró ninguna mejora en la tarea de atención sostenida. Conclusiones: únicamente en la tarea de atención selectiva se obtuvo una mejora significativa en pacientes con EMRR. Esta asimetría en los beneficios del programa de estimulación cognitiva muestra las dificultades en la generalización de los beneficios a todos los mecanismos atencionales y el alto grado de especificidad en la rehabilitación de las funciones cognitivas (AU)

Background and objective: Cognitive impairment in patients with multiple sclerosis has been shown vastly. The aim of this study was to assess whether it is possible to generate improvements in attentional capacity of these patients, and to determine whether this improvement is generalizable to more than one attentional mechanism. Materials and method: 26 patients with relapsing-remitting multiple sclerosis (RRMS) were distributed in two groups. A treatment group who participated in a stimulation program based on the Attention Process Training program for three months. And another pathological control group who did not receive the program. 18 healthy controls completed the study. The benefits of implementing the program were evaluated using two computerized evaluation tasks, a sustained attention one and another of selective attention. Results: Patients in the treatment group showed improvements in reaction times after application of the program only in the selective attention task. No improvement was found in the sustained attention task. Conclusions: Only the selective attention task showed a significant improvement in patients with RRMS. This asymmetry in the benefits of cognitive stimulation program shows the difficulties in generalizing the benefits to all attentional mechanisms, as well as the high degree of specificity in the rehabilitation of cognitive functions (AU)