Insuficiencia de convergencia con diplopía: tratamiento quirúrgico en adultos / Convergence insufficiency with diplopia: Surgical treatment in adults

Propósito Estudiar los resultados del mini plegamiento central del recto medial (RM) en las insuficiencias de convergencia de adultos con diplopía. Método Análisis retrospectivo de una muestra de 9 casos (7 mujeres). Se recogieron los datos de la dosis de plegamiento del RM, la hipercorrección inmediata posquirúrgica y al final del seguimiento, la desviación final de cerca y de lejos, la diplopía y el tiempo de seguimiento desde la cirugía. Se consideró buen resultado la desaparición de la diplopía, mejoría de los síntomas y una exotropía final de cerca ≤8dioptrías prismáticas (dp). Resultados Se realizó un mini-plegamiento central del RM en 9 pacientes (8 unilaterales). Edad media: 58,66 años (SD: 21,39). La media de la desviación preoperatoria de cerca fue de 16,22 (±2,99) dp y de lejos 6,88 (±4) dp. Se registró hipercorrección en visión lejana en 5 casos que se resolvió a los 3 meses después de la operación. No hubo hipercorrección en visión de cerca excepto en un caso. Ninguno de los casos operados presentó hipercorrección al final del seguimiento. La desviación horizontal final fue ≤8dp en visión cercana, excepto en 3 casos (media: 6,22). Los síntomas y la diplopía se resolvieron en 8 casos. El seguimiento medio fue de 10,33 meses. Conclusión El mini-plegamiento central de 1 o 2 músculos rectos mediales puede mejorar los síntomas y signos de exotropía asociados a la insuficiencia de convergencia cuando los ejercicios y los prismas son rechazados por los pacientes o cuando estos abordajes no han resuelto el problema (AU)

Objective To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. Methods The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. Results A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (± SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (± 2.9) pd and distance preoperative deviation: 6.88 (± 4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. Conclusion Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem (AU)

Convergence insufficiency with diplopia: Surgical treatment in adults.

OBJECTIVE: To study the outcomes of treatment with central mini-plication of the medial rectus (MR) muscles in adult convergence insufficiency with diplopia. METHODS: The study sample comprised 9 cases (7 women). The length of MR plication was collected. Other variables reported were postsurgical deviation, overcorrections in the early postoperative period and at the end of follow-up, final horizontal deviation at near and at distance vision, diplopia, and mean follow-up from surgery. Surgical outcome was considered to be favorable when diplopia and symptoms were resolved and final exotropia at near was ≤8 pd at the end of follow-up. RESULTS: A central mini-plication of the MR was performed in 9 patients (8 unilateral). Mean (±SD) age was 58.66 (21.39) years. Mean near preoperative deviation: 16.22 (±2.9) pd and distance preoperative deviation: 6.88 (±4) pd Overcorrection at distance vision was recorded in 5 cases; this resolved by 3 months postoperatively. There was not overcorrection at near vision except one case. None of the cases operated on had overcorrection at the end of follow-up. The final horizontal deviation was ≤8 pd at near vision, except for 3 cases (mean: 6.22). Symptoms and diplopia resolved in 8 cases. The mean follow-up was 10.33 months. CONCLUSION: Central mini-plication of 1 or 2 medial rectus muscles can improve the symptoms and signs of exotropia associated with convergence insufficiency when exercises and the prisms are rejected by the patients and when these approaches have not solved the problem.

Effect of Trichoderma on horticultural seedlings' growth promotion depending on inoculum and substrate type.

AIMS: The biostimulant effect of Trichoderma spp. on horticultural crops are highly variable. Thus, practical use of Trichoderma sp. requires feasible formulated products and suitable substrates. METHODS AND RESULTS: This study evaluates the survival and the growth-promotion effect of a Trichoderma saturnisporum rice formulation compared with a nonformulated conidia suspension (seven treatments in total), on tomato, pepper and cucumber seedlings grown in two substrates: (i) rich in organic matter (OM) and (ii) mineral substrate without OM. The results showed beneficial effects on seedling growth in the OM-rich substrate when T. saturnisporum rice formulation (mainly at maximum concentration) was applied, but the effects were opposite when the mineral substrate without OM was used. The effects were closely linked to the level of inoculum in the substrate, which was greater upon application of the formulated inoculum as opposed to the nonformulated one. CONCLUSIONS: The use of rice to prepare the inoculum of T. saturnisporum seems to be promising for seedling growth in the nursery when it is applied in a substrate that is rich in organic matter, but it must be considered that under certain conditions of food shortage, Trichoderma sp. could show pathogenicity to seedlings. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides evidence of the complexity inherent in the use of micro-organisms in agriculture, while also confirming that the activity of the biofertilizers based on Trichoderma depends on the type of inoculum and its concentration, as well as the properties of the medium in which the fungi develop. Further studies assessing the effectiveness or possible pathogenicity of Trichoderma in different soils under greenhouse conditions must be addressed.

Estimación semiautomática de la densidad mamaria con DM-Scan / Semiautomatic estimation of breast density with DM-Scan software

Objetivo. Evaluar la reproducibilidad del cálculo de la densidad mamaria con la aplicación informática DM-Scan, basada en la segmentación semiautomática del tejido fibroglandular, y compararla con la de la inspección visual. Material y métodos. El estudio incluyó 655 mamografías digitales directas en proyección cráneo-caudal. Tres expertos radiólogos analizaron la densidad de las mamografías con DM-Scan, y se calcularon las concordancias inter e intraobservador entre pares de radiólogos para las escalas Boyd y BI-RADS®, utilizando el índice de correlación intraclase. Las concordancias se compararon con las obtenidas previamente para la inspección visual, en el mismo conjunto de imágenes, utilizando el índice Kappa. Resultados. Con el análisis visual, la concordancia media interobservador fue de 0,876 (IC 95%: 0,873-0,879) para la escala de Boyd, y 0,823 (IC 95%: 0,818-0,829) para la clasificación BI-RADS®. La concordancia intraobservador fue de 0,813 (IC 95%: 0,796-0,829) para la escala de Boyd, y 0,770 (IC 95%: 0,742-0,797) para la clasificación BI-RADS®. Con DM-Scan, la concordancia media inter e intraobservador fue de 0,92, notablemente superior a las concordancias de la clasificación visual. Conclusión. El cálculo de la densidad mamaria con la aplicación semiautomática DM-Scan es más fiable y reproducible, y disminuye la subjetividad y variabilidad de la estimación visual (AU)

Objective. To evaluate the reproducibility of the calculation of breast density with DM-Scan software, which is based on the semiautomatic segmentation of fibroglandular tissue, and to compare it with the reproducibility of estimation by visual inspection. Material and methods. The study included 655 direct digital mammograms acquired using craniocaudal projections. Three experienced radiologists analyzed the density of the mammograms using DM-Scan, and the inter- and intra-observer agreement between pairs of radiologists for the Boyd and BI-RADS® scales were calculated using the intraclass correlation coefficient. The Kappa index was used to compare the inter- and intra-observer agreements with those obtained previously for visual inspection in the same set of images. Results. For visual inspection, the mean interobserver agreement was 0,876 (95% CI: 0,873-0,879) on the Boyd scale and 0,823 (95% CI: 0,818-0,829) on the BI-RADS® scale. The mean intraobserver agreement was 0,813 (95% CI: 0,796-0,829) on the Boyd scale and 0,770 (95% CI: 0,742-0,797) on the BI-RADS® scale. For DM-Scan, the mean inter- and intra-observer agreement was 0,92, considerably higher than the agreement for visual inspection. Conclusion. The semiautomatic calculation of breast density using DM-Scan software is more reliable and reproducible than visual estimation and reduces the subjectivity and variability in determining breast density (AU)

Semiautomatic estimation of breast density with DM-Scan software.

OBJECTIVE: To evaluate the reproducibility of the calculation of breast density with DM-Scan software, which is based on the semiautomatic segmentation of fibroglandular tissue, and to compare it with the reproducibility of estimation by visual inspection. MATERIAL AND METHODS: The study included 655 direct digital mammograms acquired using craniocaudal projections. Three experienced radiologists analyzed the density of the mammograms using DM-Scan, and the inter- and intra-observer agreement between pairs of radiologists for the Boyd and BI-RADS® scales were calculated using the intraclass correlation coefficient. The Kappa index was used to compare the inter- and intra-observer agreements with those obtained previously for visual inspection in the same set of images. RESULTS: For visual inspection, the mean interobserver agreement was 0,876 (95% CI: 0,873-0,879) on the Boyd scale and 0,823 (95% CI: 0,818-0,829) on the BI-RADS® scale. The mean intraobserver agreement was 0,813 (95% CI: 0,796-0,829) on the Boyd scale and 0,770 (95% CI: 0,742-0,797) on the BI-RADS® scale. For DM-Scan, the mean inter- and intra-observer agreement was 0,92, considerably higher than the agreement for visual inspection. CONCLUSION: The semiautomatic calculation of breast density using DM-Scan software is more reliable and reproducible than visual estimation and reduces the subjectivity and variability in determining breast density.

Valoración clínica y radiológica de las prótesis unicompartimentales de rodilla implantadas con técnica mínimamente invasiva / Clinical and radiological assessment of unicompartmental knee prostheses implanted with a minimally invasive technique

Objetivos: Valorar la posición radiológica y el resultado clínico a corto plazo de una serie de prótesis unicompartimentales de rodilla implantadas mediante mínima incisión. Material y método: Revisión retrospectiva de las primeras 44 artroplastias de este tipo realizadas en el servicio de este hospital con un seguimiento mínimo de un año. Se analizó la relación existente entre el resultado obtenido según la escala de la American Knee Society y la edad del sujeto, el sexo, el índice de masa corporal (IMC), el diagnóstico, el número de cirugías previas y 25 variables radiológicas registradas a partir de proyecciones anteroposterior, lateral y axial. Se determinaron, a su vez, los errores en el posicionamiento de cada uno de los componentes en todos los planos. Resultados: Se encontraron resultados significativamente peores cuanto mayor era el IMC (coeficiente de correlación [r] = −0,42; p = 0,01) y cuanto mayor era el grado de inclinación posterior del componente tibial (r = −0,34; p = 0,02), estadísticamente a partir de los 8° (t = −2,15; p = 0,04). La mayor variabilidad en la colocación protésica se encontró en el grado de rotación del componente tibial en el plano axial y en el grado de flexoextensión del femoral en el plano sagital. La experiencia quirúrgica es determinante en la implantación correcta de la prótesis, y se han demostrado menores errores de forma significativa cuanto mayor número de cirugías se realizara (t = 2,06; p = 0,04). Conclusiones: La prótesis unicondílea de rodilla es una alternativa terapéutica atractiva para la enfermedad unicompartimental, aunque es técnicamente demandante y necesita una curva de aprendizaje obligada. Además de una buena selección del sujeto, la implantación correcta de los componentes resulta fundamental para un resultado final satisfactorio (AU)

Purpose: To assess the radiological position and the short-term clinical outcome of a series of unicompartmental knee prostheses implanted through a small incision. Materials and methods: Retrospective review of the first 44 arthroplasties of this kind performed in our Department with a minimum 1-year follow-up. The study includes an analysis of the relationship between the result obtained in terms of the American Knee Society score and the patients´ age, gender, body mass index, diagnosis, number of previous surgeries and 25 radiological variables recorded on the basis of anteroposterior, lateral and axial views. Any errors in the positioning of each of the components on the different planes were also determined. Results: The results obtained are significantly poorer the higher the body mass index (r=−0.42; P=.01) and the higher the degree of posterior inclination of the tibial component (r=−0.34; P=.02); this difference is statistically significant from 8° (t=−2.15; P=.04) onwards. The greatest variability in terms of prosthetic placement is found in the degree of rotation of the tibial component on the axial plane and in the flexion-extension of the femoral component on the sagittal plane. Surgical expertise is crucial when it comes to sound prosthetic placement, with significantly fewer errors being committed by surgeons who perform the procedure habitually (t=2.06; P=.04). Conclusions: Unicondylar knee replacement is an attractive yet technically demanding therapeutic alternative for unicompartmental pathology, which is associated to a mandatory learning curve. In addition to appropriate patient selection, correct implant placement is crucial to obtain a satisfactory end result (AU)

Fatty acid composition and carcass characteristics of growing lambs fed diets containing palm oil supplements.

Thirty 45-day-old male Ojalada lambs were used to investigate the effect of palm oil (as such or in the form of calcium soap) on carcass characteristics and fat composition. Dietary palm oil did not significantly affect dorsal fat thickness, carcass fatness or carcass conformation. The palm oil supplement did not affect C16:0 levels in intramuscular and subcutaneous fat, but did increase the percentage of C16:0 and reduce PUFA and MUFA content in internal fat depots. Supplementation with palm oil in the form of calcium soap did not cause significant differences in the composition of intramuscular fat. Subcutaneous and perirenal fat of lambs fed treatments including palm oil as such contained higher levels of some saturated fatty acids than that of those fed fat in the form of calcium soap. Mesenteric fat of lambs that received calcium soap had less % C18:1 and more % C18:3 than that of those given palm oil.

Determination of the precision of the fatty acid analysis of Iberian pig fat by gas chromatography. Results of a mini collaborative study.

A collaborative study was carried out to determine the repeatability (error in each laboratory) and reproducibility (error between the different laboratories) of the fatty acid analysis of Iberian pig fat by gas chromatography. To do this, a comparison was made, in accordance with the ISO 5725-2 procedure, of the weight percentage (%) of the main fatty acids (C16:0, C18:0, C18:1 and C18:2) in 60 samples, determined by six laboratories. The results obtained for the relative standard deviation of the repeatability (0.56, 0.49, 0.29, and 0.69%) and for the relative standard deviation of the reproducibility (3.04, 3.54, 1.78 and 2.86%) show that the accuracy obtained is adequate for this analysis method, and in the same order or even higher than that obtained by other authors in similar samples. The differences between the results obtained on using two extraction methods of liquid fat from subcutaneous adipose tissue were recorded with no significant differences being observed between them.

[Rhodococcus equi pneumonia in patients with HIV infection: report of 2 cases and review of the literature]. / Neumonía por Rhodococcus equi en pacientes infectados por el HIV: presentación de 2 casos y revisión de la litertura.

BACKGROUND: Pneumonia by Rhodococcus equi is infrequent and is associated with patients with important immunosuppression. To date 66 cases of pneumonia by Rhodococcus equi in patients with HIV infection have been published. The diagnosis, problems in determining diagnosis and treatment are discussed. MATERIALS AND METHODS: Two new cases of pneumonia by Rhodococus equi in C3 stage patients with HIV infection are reported. Diagnosis was achieved by study of bronchoalveolar lavage samples with the Apy-Coryne method and gas chromatography. RESULTS: The two patients presented pneumonia, one of which was necrotizing pneumonia with localization in the upper left lung and in the lower right lung, respectively. The clinical manifestations were characterized by respiratory involvement of a subacute course with pleural involvement in both cases and hemoptisis in one. Prolonged, combined antibiotic treatment was administered with good response in both cases. One patient died at one year of diagnosis from consumptive syndrome while the other remains asymptomatic. CONCLUSIONS: Infection by Rhodococcus equi should be suspected in HIV patients with slow evolution pneumonia, especially in the pneumonia is necrotizing. Combined i.v. antibiotic treatment is recommended and followed from 3 to 5 months with an association including clarithromycin.

Percutaneous catheter drainage of breast abscesses.

Experiences with ultrasonically guided percutaneous catheter drainage of breast abscesses (BA) are presented. The 12 cases were: 10 non-lactating women, one lactating women, and one HIV-positive man. The percutaneous procedure employed was successful in all cases. The mean duration of drainage was 5 days post-catheter insertion. All percutaneous drainages and subsequent follow-up were performed in the outpatient clinic. No recurrence of BA was observed. Percutaneous drainage of BA is a simple, effective and economical technique. Its use is recommended as an alternative to surgical drainage.

Rectus sheath hematoma: diagnostic classification by CT.

A method of classification for hematomas of the rectus abdominis sheath (RSH) is proposed based on findings observed in CT in the 13 cases of RSH in the present study. Type I hematomas (five cases) are slight and do not require hospitalization. Type II (three cases) and type III (five cases) are moderate and severe hematomas, respectively, and do require hospitalization. The patients with type III hematomas were all undergoing anticoagulant therapy and presented with a picture of acute abdomen, and in all five cases blood transfusion was carried out. Ultrasonography and, in particular, CT permitted a correct diagnosis of RSH. RSH should be considered (anticoagulant therapy induced) in females with sudden abdominal pain to avoid unnecessary surgical intervention.