Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients.

OBJECTIVE: To evaluate adalimumab therapy in refractory uveitis. DESIGN: Prospective case series. PARTICIPANTS: A total of 131 patients with refractory uveitis and intolerance or failure to respond to prednisone and at least 1 other systemic immunosuppressive drug participated. INTERVENTION: Patients received a 40 mg adalimumab subcutaneous injection every other week for 6 months. The associated immunosuppressants were tapered after administering 3 adalimumab injections (week 6). MAIN OUTCOME MEASURES: Degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), immunosuppression load (as defined by Nussenblatt et al), visual acuity (logarithm of the minimal angle of resolution [logMAR]), and macular thickness (optical coherence tomography). RESULTS: There were 61 men and 70 women (mean age, 27.3 years). The most common causes were juvenile idiopathic arthritis in 39 patients, pars planitis in 16 patients, and Behçet's disease in 13 patients. Twenty-seven patients had uveitis of idiopathic origin. Inflammation in the anterior chamber was present in 82% of patients and in the vitreous cavity in 59% of patients. Anterior chamber inflammation and vitreous inflammation decreased significantly (P < 0.001) from a mean of 1.51 and 1.03 at baseline to 0.25 and 0.14, respectively, at 6 months. Macular thickness was 296 (102) µ at baseline versus 240 (36) µ at the 6-month visit (P < 0.001). Visual acuity improved by -0.3 logMAR in 32 of 150 eyes (21.3%) and worsened by +0.3 logMAR (-15 letters) in 5 eyes (3.3%). The dose of corticosteroids also decreased from 0.74 (3.50) to 0.20 (0.57) mg/kg/day (P < 0.001). Cystoid macular edema, which was present in 40 eyes at baseline, showed complete resolution in 28 eyes at 6 months. The mean suppression load decreased significantly (8.81 [5.05] vs 5.40 [4.43]; P < 0.001). Six months after the initiation of the study, 111 patients (85%) were able to reduce at least 50% of their baseline immunosuppression load. Only 9 patients (6.9%) had severe relapses during the 6 months of follow-up. CONCLUSIONS: Adalimumab seems to be well tolerated and helpful in decreasing inflammatory activity in refractory uveitis and may reduce steroid requirement. Further controlled studies of adalimumab for uveitis are warranted.

Lesiones mamarias infraclínicas positivas para cáncer halladas en el período comprendido entre los años 1992 y 2000. Nuestra experiencia / Infraclinic positive breast lesions found in the period between 1992 and 2000. Our experience

Estudio retrospectivo sobre 185 biopsias radioquirúrgicas, realizadas mediante la aguja localizador (arpón) sobre un total de 8.374 pacientes asistidas en un servicio de diagnóstico en patología mamaria, durante el período comprendido entre septiembre del año 1992 y septiembre del año 2000. Los objetivos fueron analizar la histopatología y demostrar que la mamografía sigue siendo el mejor método para el diagnóstico precoz del cáncer de mama. Se evaluaron las imágenes mamográficas, la edad y el resultado histopatológico. Resultados: el 38,4% (n=71) de las biopsias resultaron positivas para cáncer y el 61,6% (n=114) fueron negativas. La imagen radiológica más biopsiada correspondió a microcalcificaciones (51,9%) y el módulo con borde irregular (11,9%). Para el carcinoma: microcalcificación (43,7%) y densificación irregular (16,9%). Los grupos etáreos más afectados fueron: 51 a 60 años (31%) y 41 a 50 años (30%). El resultado histopatológico fue: carcinomas in situ (9.8%) y carcinomas infiltrantes (90.2%). Conclusiones: la mamografía es el método ideal para diagnosticar lesiones subclínicas.

This is a retrospective study of 185 radiosurgical biopsies performed using a localizing needle (harpoon-needle) from a total of 8,374 patients treated at a breast pathology diagnostic service between September 1992 and September 2000. The objectives of this study are to analyze the histopathology and demonstrate that mammographies are still the best method for early diagnosis of breast cancer. Mammographic images, age, and histopathological results were assessed. Thus, the following results were obtained: 38.4% (n=71) of biopsies were cancer positive and 61.6% (n=114) were cancer negative. The most common radiologic images on which biopsies were performed, were microcalcifications (51.9%) and irregular-edge nodes (11.9%). In the case of carcinoma, the most common findings were microcalcifications (43.7%) and irregular densification (16.9%). The most affected groups were in the following age ranges: 51-60 years (31%) and 41-50 years (30%). The histopathological results were carcinomas in situ (9.8%) and infiltrative carcinomas (90.2%). In conclusion, mammography is the ideal method for diagnosis of subclinical lesions.