RESUMEN
KEY MESSAGES: Visual acuity is the most used method to assess visual function in children. Contrast sensitivity complements the information provided for visual acuity, but it is not commonly used in clinical practice. Digital devices are increasingly used as a method to evaluate visual function, due to multiple advantages. Testing with these devices can improve the evaluation of visual development in children from a few months of age. Visual acuity and contrast sensitivity tests, using eye tracking technology, are able to measure visual function in children across a wide range of ages, objectively, quickly and without need of an experienced examiner. PURPOSE: To report age-normative values for grating visual acuity and contrast sensitivity in healthy children using a digital device with eye tracking technology and to validate the grating acuity test. METHODS: In the first project of the study, we examined healthy children aged between 6 months and 7 years with normal ophthalmological assessment. Grating visual acuity (VA) and contrast sensitivity (CS) were assessed using a preferential gaze paradigm with a DIVE (Device for an Integral Visual Examination) assisted with eye tracking technology to provide age norms. For the validation project, we compared LEA grating test (LGT) with DIVE VA in a group of children aged between 6 months and 4 years with normal and abnormal visual development. RESULTS: Fifty-seven children (2.86 ± 1.55 years) were examined with DIVE VA test and 44 successfully completed DIVE CS test (3.06 ± 1.41 years). Both, VA and CS values increased with age, mainly along the first two years of life. Sixty-nine patients (1.34 ± 0.61 years) were included in the DIVE VA test validation. The mean difference between LGT and DIVE VA was - 1.05 ± 4.54 cpd with 95% limits of agreement (LoA) of - 9.95-7.84 cpd. Agreement between the two tests was higher in children younger than 1 year with a mean difference of - 0.19 ± 4.02 cpd. CONCLUSIONS: DIVE is an automatic, objective and reliable tool to assess several visual function parameters in children, and it has good agreement with classical VA tests, especially for the first stage of life.
Asunto(s)
Sensibilidad de Contraste , Oftalmología , Niño , Tecnología de Seguimiento Ocular , Humanos , Lactante , Pruebas de Visión/métodos , Agudeza VisualRESUMEN
The current study aims to analyse technical-tactical performance indicators during elite 3x3 basketball games. To do so, the start, development and end of 315 attacking phases were examined using an observational tool during four games of the 3x3 Men's World Cup 2017. The results showed that efficacy from the 6.75 m line and the fast breaks made after defensive rebound were the performance indicators that best discriminated winning and losing teams. During set plays, the best percentages of efficacy were achieved with group-tactical situations involving the three players on court, and mainly with the use of off-ball screens. Coaches when preparing competitions and training drills can use these findings to increase team and players performance.(AU)
Asunto(s)
Humanos , Masculino , Baloncesto , Atletas , Rendimiento Atlético , Rendimiento Físico Funcional , Deportes , Indicadores (Estadística) , Psicología del Deporte , Medicina PreventivaRESUMEN
Graft failure, regimen-related toxicity and graft-versus-host disease (GVHD) are the critical barriers to unrelated donor transplants for aplastic anaemia (AA). We investigated the use of a novel conditioning regimen consisting of alemtuzumab (humanized CD52 antibody), fludarabine and cyclophosphamide in seven patients with AA, who underwent bone marrow transplant procedure using matched unrelated donors. The aetiology of AA was acquired (n=3), Fanconi's (n=3) and congenital (n=1). Median age was 13 years (range 8-35). All the donors were fully matched for HLA class I and II antigens using high-resolution typing. All the patients engrafted at a median of 18 days (range 13-35). Two patients died of transplant-related complications: one of adenovirus disease and the other developed extensive chronic GVHD of skin followed by cytomegalovirus (CMV) disease. Three patients developed Grade II acute GVHD disease (GVHD); none had Grade III-IV acute GVHD. Of the six evaluable patients, only one developed chronic GVHD. We conclude that this conditioning regimen for unrelated donor transplants for AA is sufficiently immunosuppressive to allow stable engraftment and appears to have a favourable impact on the incidence and severity of GVHD, warranting further investigation.
Asunto(s)
Anemia Aplásica/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Trasplante de Médula Ósea/métodos , Donantes de Tejidos , Vidarabina/análogos & derivados , Adolescente , Adulto , Alemtuzumab , Anemia Aplásica/complicaciones , Anemia Aplásica/etiología , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Anticuerpos Antineoplásicos/administración & dosificación , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/inmunología , Niño , Ciclofosfamida/administración & dosificación , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/patología , Prueba de Histocompatibilidad , Humanos , Terapia de Inmunosupresión , Incidencia , Resultado del Tratamiento , Vidarabina/administración & dosificaciónRESUMEN
Thalidomide was used to treat acute (n=21) or chronic (n=59) graft-vs-host disease (GVHD) in 80 haematopoietic stem cell allograft recipients after failure to respond to the combination of cyclosporine and corticosteroids with or without other agents. The median time to onset of acute GVHD was 11 days, and thalidomide was started at a median of 48 days post transplant. In addition to corticosteroids and cyclosporine, 13 patients had also received other agents before thalidomide. None of the patients responded and all died of acute GVHD. For chronic GVHD (limited in 13, extensive in 46), thalidomide was started at a median of 385 days post transplant. In addition to corticosteroids and cyclosporine, 34 patients received azathioprine concomitantly. In all patients, thalidomide was added to the ongoing immunosuppressive regimen. The median duration of therapy with thalidomide was 60 days (range, 11-1210; <2 weeks in 11). In total, 13 patients (22%) had complete response, eight (14%) partial response and 38 (64%) no response. Response rates were comparable for limited (39%) and extensive (33%) chronic GVHD. At a median of 53 months, 19 patients are alive, 13 without evidence of chronic GVHD. Survival was significantly better in patients who responded to thalidomide. The principal causes of death were progressive chronic GVHD (n=29) and relapsed leukaemia (n=7). In conclusion, thalidomide has no activity in acute GVHD, but has some activity in chronic GVHD in combination with other agents.
Asunto(s)
Enfermedad Injerto contra Huésped/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Talidomida/uso terapéutico , Enfermedad Aguda , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Niño , Preescolar , Enfermedad Crónica , Ciclosporina/uso terapéutico , Femenino , Enfermedad Injerto contra Huésped/mortalidad , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/mortalidad , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/métodos , Trasplante de Células Madre Hematopoyéticas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Análisis de Supervivencia , Trasplante HomólogoRESUMEN
Twenty-one paediatric patients (11 males and 10 females) received a CD34-selected partially matched related donor transplant for malignant (16 cases) and non-malignant conditions (five cases). The average cell dose was 11.13 x 10(6)/kg. Fifteen of 16 patients with malignant conditions and one with non-malignant disease received total body irradiation plus cyclophosphamide. Three of 5 patients with non-malignant conditions and one with leukaemia, received busulphan plus cyclophosphamide. One patient with Fanconi anaemia received 100 mg/kg of cyclophosphamide. Fludarabine (25 mg/m(2)/day for 5 days) was administered prior to all these regimens. Additionally, anti-lymphocyte gamma-globulin (12.5 mg/kg/day) was administered from day -2 to day +2. Three (15%) patients failed to achieve complete chimaerism (CC). These patients received a second cell infusion. Two of them achieved CC. In the third patient, the percentage of donor cells was increased. The likelihood for engraftment was not related to the cell dose received. Acute graft-versus-host disease (GVHD) occurred in nine patients but only one developed GVHD >grade II. Eight patients developed active viral infections, which resolved after treatment. Patients receiving cell doses higher than our average had a significantly faster CD3 and CD4 cell recovery and experienced a lower incidence of viral infections. After 480 +/- 255 days of median follow-up, 16/21 patients are alive and well and have CC. Three patients died of leukaemic relapse and a fourth from progression of his disease (adreno-leuko-dystrophy). We conclude that partially matched related donors are a feasible source of haemopoietic progenitor cells for transplantation for patients without matched familial or unrelated donors.
Asunto(s)
Suero Antilinfocítico/administración & dosificación , Histocompatibilidad/inmunología , Trasplante de Células Madre de Sangre Periférica/métodos , Vidarabina/análogos & derivados , Vidarabina/administración & dosificación , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Niño , Preescolar , Estudios de Factibilidad , Femenino , Supervivencia de Injerto , Enfermedad Injerto contra Huésped , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/mortalidad , Enfermedades Hematológicas/terapia , Hematopoyesis , Humanos , Inmunosupresores/administración & dosificación , Masculino , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Trasplante de Células Madre de Sangre Periférica/mortalidad , Acondicionamiento Pretrasplante/métodos , Trasplante Homólogo , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe three cases of interaction between miconazole oral gel and acenocoumarol, manifested as an increase in the international normalized ratio (INR). CASE SUMMARIES: Three patients (62-year-old woman, 89-year-old woman, 43-year-old man) following oral antithrombotic treatment with acenocoumarol for different pathologies were diagnosed with oral candidiasis and started miconazole oral gel. In all cases, the previous INR values were repeatedly within the therapeutic range. The following routine monitoring of the antithrombotic therapy showed a marked increase in anticoagulant activity in all cases, which returned to the therapeutic range after miconazole was withdrawn. None of the patients needed substantial changes in their habitual dosages of acenocoumarol in subsequent measurements of the INR to stay within the therapeutic range. DISCUSSION: We report three cases in which a possible interaction between miconazole oral gel and acenocoumarol is suggested by the chronological relationship between the introduction of miconazole and an increase in the INR. Miconazole exerts its fungistatic action by inhibiting some isoenzymes of the fungal cytochrome P450 system. Oral mucosa inflammation (as in oral candidiasis) may enhance its transmucosal absorption. In this setting, cytochrome P450 isoenzymes belonging to the host may be inhibited too. This mechanism provides an explanation for different interactions observed with miconazole oral gel. CONCLUSIONS: Miconazole oral gel enhances acenocoumarol anticoagulant activity. Although we did not observe major bleeding complications, we suggest the use of other families of antifungal drugs, such as nystatin, to treat oral candidiasis in patients taking acenocoumarol.
Asunto(s)
Acenocumarol/farmacología , Anticoagulantes/farmacología , Antifúngicos/farmacología , Miconazol/farmacología , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/administración & dosificación , Candidiasis Bucal/tratamiento farmacológico , Sinergismo Farmacológico , Femenino , Geles , Humanos , Relación Normalizada Internacional , Masculino , Miconazol/administración & dosificación , Persona de Mediana EdadRESUMEN
Lupus anticoagulant antibodies have never been reported to disappear after either allogeneic or autologous bone marrow transplantation in humans. We report the first case of disappearance of lupus anticoagulant antibodies in a patient without systemic lupus erythematosus or clinical evidence of other autoimmune disorders, who received an allogeneic bone marrow transplant as treatment for chronic myeloid leukemia. Although marrow transplantation is not a recognized therapy for antiphospholipid syndrome, our observation should be considered another example of the capability of intensive chemo-radiotherapy followed by stem cell transplantation to ablate a pathologic marrow clone resulting in an autoimmune disorder and improve, or even cure, some severe autoimmune diseases.
Asunto(s)
Trasplante de Médula Ósea , Leucemia Mielógena Crónica BCR-ABL Positiva/inmunología , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Inhibidor de Coagulación del Lupus/sangre , Adulto , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/sangre , Trasplante HomólogoRESUMEN
BACKGROUND: No consensus exists about the management of iatrogenically induced excessive hypocoagulability episodes. OBJECTIVE: To compare the two most common therapeutic approaches in such situations (discontinuation of the oral anticoagulant vs. low-dose subcutaneous vitamin K1) when acenocoumarol is the normally used anticoagulant. PATIENTS AND METHODS: The study was retrospective and comparative. Patients received antithrombotic therapy using acenocoumarol. Anticoagulant plasmatic activity was assessed through the international normalized ratio (INR) recorded from December 1994 to December 1997 at two medical centers. RESULTS: INR is brought faster to a safe range in patients treated with low-dose vitamin K1 (p = 0.01). Their long-term behavior is also more stable and predictable and no resistance to the oral anticoagulant was found. CONCLUSION: Low-dose vitamin K1 is a safer therapeutic option compared to simply withholding the oral anticoagulant. Its best scheme of administration, however, has yet to be defined.
Asunto(s)
Acenocumarol/uso terapéutico , Anticoagulantes/uso terapéutico , Antifibrinolíticos/administración & dosificación , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Vitamina K 1/administración & dosificación , Administración Oral , Anciano , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A 52-year-old male diagnosed with acute myeloid leukemia (AML) developed an invasive middle-ear mucormycosis during the neutropenic period after consolidation chemotherapy which resolved successfully with surgery and antifungal therapy. The patient underwent autologous peripheral blood stem cell transplantation (APBSCT) in first complete remission with antifungal prophylaxis with liposomal amphotericin B (AmB). There was no clinical, radiological or microbiological data of mycotic reactivation. This is the first reported stem cell transplantation (SCT) in a patient with prior invasive mucormycosis.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Mucormicosis/tratamiento farmacológico , Neutropenia/terapia , Otitis Media Supurativa/tratamiento farmacológico , Enfermedad Aguda , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Citarabina/administración & dosificación , Citarabina/efectos adversos , Parálisis Facial/etiología , Humanos , Idarrubicina/administración & dosificación , Idarrubicina/efectos adversos , Leucemia Mieloide/complicaciones , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Mitoxantrona/administración & dosificación , Mitoxantrona/efectos adversos , Mucormicosis/complicaciones , Mucormicosis/cirugía , Miringoplastia , Neutropenia/inducido químicamente , Neutropenia/complicaciones , Otitis Media Supurativa/complicaciones , Otitis Media Supurativa/cirugía , Inducción de Remisión , Acondicionamiento Pretrasplante , Trasplante AutólogoRESUMEN
We report four patients with chronic myeloid leukemia (CML) that showed poor graft function after a non-T-depleted bone marrow transplantation (BMT) from an HLA-compatible sibling donor and who were successfully treated with splenectomy. Conditioning was done with cyclophosphamide (CY) and total body irradiation (TBI) without additional splenic irradiation. Three patients had enlarged spleens before BMT. The nucleated cell dose infused ranged from 2.3-3.2 x 10(8)/kg. Bone marrow (BM) examination prior to splenectomy showed BM aplasia (three cases) or hypocellularity (one case). At splenectomy no patient had evidence of cytomegalovirus (CMV) infection or severe acute GVHD; and three patients had moderately enlarged spleens. All patients were transfusion dependent. Complete hematological recovery was obtained in all patients. BM cellularity was normal 1 month after splenectomy. Complete chimerism of donor origin was documented. The four patients are alive (+16 to +58 months after BMT). Thus, in patients with CML, a poor graft function may be successfully corrected by splenectomy.
Asunto(s)
Trasplante de Médula Ósea , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Esplenectomía , Adulto , Médula Ósea/patología , Humanos , Masculino , Persona de Mediana Edad , Bazo/patología , Trasplante HomólogoRESUMEN
Record of one case of chronic bilateral maxillary sinusitis operated following the classical procedure of Caldwell-Luc. The histopathological check up of the removed tissue showed a salivary gland ectopia. After perusal of the bibliography and not having find another similar case we are convinced of the exceptional of our instance. We comment about the steps comply to attain the diagnosis, the management and the postoperative course as well. We suggest for this entity the denominate "salivary cystic sinusitis" or "cystic glandular ectopia maxillaris".
Asunto(s)
Quistes/fisiopatología , Seno Maxilar/fisiopatología , Glándulas Salivales/anomalías , Glándulas Salivales/fisiopatología , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The pleomorphic adenoma is the most common neoplasm of the salivary glands, especially the parotid. It can also be originated from minor salivary glands and may appear in nasal cavities and paranasal cavities. We showed a case of pleomorphic adenoma of nasal septum and, at the same time, we reviewed all related bibliography.
Asunto(s)
Adenoma Pleomórfico/diagnóstico , Neoplasias Nasales/diagnóstico , Adenoma Pleomórfico/patología , Adulto , Femenino , Humanos , Tabique Nasal , Neoplasias Nasales/patologíaAsunto(s)
Otitis Externa , Aspirina/análogos & derivados , Aspirina/uso terapéutico , Ceftazidima/uso terapéutico , Niño , Humanos , Lisina/análogos & derivados , Lisina/uso terapéutico , Masculino , Otitis Externa/diagnóstico por imagen , Otitis Externa/tratamiento farmacológico , Prednisolona/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
A case of multilocular renal cyst (MRC) is reported in a hypertensive patient in whom the IVP had disclosed a left renal mass. The ultrasound and CT workup revealed a well-defined, solid renal mass that was angiographically hypovascular. Cytologic examination of the specimen obtained by fine needle aspiration biopsy yielded no conclusive data. A left radical nephrectomy was performed. The histologic diagnosis was that of multilocular renal cyst. At 42 months the patient remains hypertensive with no evidence of tumor recurrence. We discuss the diagnostic criteria of MRC and the difficulty in making the differential diagnosis from renal carcinoma, and describe the histologic features of MRC that permit us to distinguish this disease entity from other renal tumors or dysplastic disease with different biologic significance.
Asunto(s)
Enfermedades Renales Poliquísticas/patología , Carcinoma de Células Renales/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias Renales/diagnóstico , Masculino , Persona de Mediana Edad , Nefrectomía , Enfermedades Renales Poliquísticas/diagnóstico , Enfermedades Renales Poliquísticas/cirugíaRESUMEN
The esthesioneuroblastoma is a rare tumor localized in nose and sinus with difficult diagnosis (aspect like undifferentiated carcinoma and lymphosarcoma) local malignant. We have 2 cases in our hospital whose treatment and evolution is good. We have revised the diagnosis and treatment in these diseases.
Asunto(s)
Tumores Neuroectodérmicos Periféricos Primitivos/terapia , Neoplasias Nasales/terapia , Niño , Femenino , Humanos , Persona de Mediana Edad , Cavidad Nasal , Tumores Neuroectodérmicos Periféricos Primitivos/radioterapia , Tumores Neuroectodérmicos Periféricos Primitivos/cirugía , Neoplasias Nasales/radioterapia , Neoplasias Nasales/cirugíaRESUMEN
We analyzed a series of 202 renal adenocarcinomas, 164 of which were submitted to radical nephrectomy. Pathological analyses of 150 adrenal glands revealed ipsilateral adrenal metastasis in 4 cases, 3 of these coexisting with other distant metastases. The primary tumors in these 4 cases were highly undifferentiated and in the advanced local tumor stage; the only case with solitary adrenal metastasis survived 15 months. The present study and data reported in the literature indicate that ipsilateral adrenalectomy should be performed in addition to radical nephrectomy only in renal tumors of the upper pole, those localized at other sites but whose size indicate the possibility of tumor spreading to the adjacent adrenal gland, or when a suspicious mass in the adrenal gland is evidenced by the preliminary workup or during surgery.
Asunto(s)
Adenocarcinoma/cirugía , Adrenalectomía/métodos , Neoplasias Renales/cirugía , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Terapia Combinada , Femenino , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Rayos XRESUMEN
Two cases of renal trauma are described herein. The diagnostic work up revealed the patients had solitary kidney. Trauma was classified as grade 1 and 2 and a conservative approach was adopted. The patient with grade 2 trauma was submitted to surgery one month following treatment. Preservation of the renal unit was achieved in both patients. Patient follow up at 16 years revealed no complications or sequelae from the injury. The diagnostic and therapeutic aspects of renal trauma in patients with solitary kidney are discussed.
Asunto(s)
Riñón/lesiones , Accidentes , Adulto , Femenino , Hematuria/diagnóstico , Humanos , Riñón/anomalías , Riñón/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Though rare the malignant otitis externa must be borne in mind because in its precocious diagnosis is based the success of the management. Elderly people, diabetics and immunodepressed are especially exposed. The CAT is basic in order to detect the spreading of the process. The patient being admitted at a Medical center, the antibiotherapy started at once with Ceftazidine, 2 g every 12 hours via i.v. The exeresis of the e.e.ca proves sometimes necessary after control of the infection. This procedure assures the healing and prevent the recurrences some times seen. But when infection disappears owing to the success of the antibiotherapy in 2-3 weeks; the culture for Pseudomonas is negative 3 weeks later; and the previous CAT showed no spreading to the tympanal bone, the surgery must be discarded. The process is considered over when the culture for Pseudomonas aeruginosa is negative, but review of the patients is compulsory at least during half a year.
Asunto(s)
Otitis Externa/terapia , Infecciones por Pseudomonas/terapia , Anciano , Antibacterianos , Terapia Combinada , Diabetes Mellitus Tipo 1/complicaciones , Quimioterapia Combinada/uso terapéutico , Femenino , Granuloma/etiología , Granuloma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Otitis Externa/diagnóstico , Otitis Externa/etiología , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/etiologíaRESUMEN
The mucous melanoma is a rare affection which has a very poor prognosis by its difficult diagnosis and unsatisfactory treatment. We have a patient with mucous melanoma nasal, which has been studied (clinic evolution, diagnosis and treatment) in our Hospital.