Papilomatosis nasal-sinusal: diagnóstico endoscópico

Entre las diferentes neoformaciones benignas tanto de los senos nasales como paranasales, los papilomas invertidos pueden considerarse un caso clínico de particular interés por sus peculiaridades patogenéticas. Los papilomas invertidos son en verdad, tumores benignos con capacidades erosivas elevadas (consecuencias de la necrosis por compresión ósea), potencialidades degenerativas y una inclinación elevada a reaparecer de una forma más severa. Se requiere una objetividad endoscópica precisa debido a la especificidad de los síntomas mediante exploración (epistasis, obstrucción respiratoria, rinorrea mucosa purulenta) con vistas a probar: 1. las características morfológicas macroscópicas, a menudo patognomónicas; 2. el origen, por lo general, de la pared lateral de la nariz; 3. la manifestación de los senos y 4. el posible origen multifocal. El empleo de técnicas endoscópicas combinadas con medios tanto flexibles como inflexibles, ha permitido un diagnóstico y un tratamiento de elevada calidad. El uso de fibras ópticas, ha permitido investigar todas las cavidades sinusales por la nariz y la nasofaringe, al superar los límites del diagnóstico tradicional. El endoscopio flexible permitió un estudio más completo de las cavidades nasales y permitió la posibilidad de tomar fácilmente biopsia con el mínimo de malestar para el paciente. El uso de la endoscopia rígida, ha permitido alcanzar una mejor calidad de la imagen con un alto nivel de resolución y brillantez, aun cuando la habilidad y la tolerabilidad limitadas han causado a menudo, especialmente en las pruebas preoperatorias, un examen incompleto. Pensamos que es correcto aseverar que si bien el diagnóstico por imagen (TC) es el procedimiento seleccionado, la evolución tecnológica de las fibras ópticas (rígidas y flexibles) ha cambiado el enfoque de diagnóstico de tales afecciones que requieren siempre una evaluación endoscópica bimodal completaAmong the different benign neoformations of the nasal and paranasal sinuses, the inverted papillomas may be considered as a clinical case of particular interest due to its pathogenetic peculiarities. Inverted papillomas are, in fact, benign tumors with elevated erosive capacities (as a consequence of necrosis by osteal compression), degenerative potentialities and a marked inclination to reappear in a more severe form. Accurate endoscopic objectivity is required because of the specificity of the symptoms by scanning (epistasis, respiratory obstruction, mucous purulent rhinorrea) in order to prove: l. the macroscopic morphological characteristics, which are often pathognomonic; 2. the origin, generally, of the lateral wall of the nose; 3. the manifestation of the sinuses and 4. the possible multifocal origin. The use of combined endoscopic techniques with flexible and unflexible means has allowed to have a high quality diagnosis and treatment. The use of optic fibres has made possible to investigate all the sinusal cavities by the nose and nasopharynx, on exceeding the limits of the traditional diagnosis. The flexible endoscope allowed to conduct a more complete study of nasal cavities and gave the possiility to make a biopsy with the minimum of annoyance for the patient. The use of rigid endoscopy has permitted to get an image with a better quality and with a high level of resolution and brightness, even when the limited ability and tolerability has often caused , specially in the peoperative tests, an incomplete examination. We think it is correct to asseverate that though the imaging diagnosis (CT) is the selected procedure, the technological evolution of the optic fibres (rigid and flexible) has changed the diagnosis approach of such affections that always require a complete bimodal endoscopic evaluatio

Evaluación del adenoidismo en los niños: imagen endoscópica

El adenoidismo es un síndrome complejo cuya causa principal se identifica generalmente con la hiperplasia de las amígdalas y la nasofaringe, pero abarca también diversos aparatos y estructuras que aún cuando se encuentran lejos de la nasofaringe, se relacionan funcionalmente con ella. Las afecciones locales caracterizadas por obstrucción nasal y rinorrea a menudo purulentas, se asocian con enfermedades de los senos (sinusitis), con afecciones del oído (otalgia, otorrea serosa o serosa-purulenta o ambas cosas, así como hipoacusia), con enfermedades de la laringe (disfonía y afonía), con afecciones de las vías respiratorias inferiores (tos, bronquitis recurrente), con enfermedades de los huesos de la cara (paladar ojival, deficiencia de la oclusión dental), así como con afecciones sistémicas (apnea del sueño, OSAS). La endoscopia de fibra óptica es la prueba de selección para valorar la calidad y la extensión de la hipertrofia de las adenoidesAdenoidism is a complex syndrome whose main cause is generally identified with hyperplasia of the tonsils and nasopharynx, but it also involves diverse systems and structures that even when they are not close to the nasopharynx are functionally related to it. The local affections characterized by usually purulent nasal obstruction and rhinorrea are associated with diseases of the sinuses (sinusitis), with affections of the ear (otalgia, serous or serouspurulent otorrhoea or both, as well as hypoacusia), with larynx diseases (dysphonia and aphonia), with affections of the lower airways (cough, recurrent bronchitis), with face bone diseases (ogival palate, deficiency of dental oclussion), as well as systemic affections (sleep apnea, OSAS). The optic fibre endoscopy is the selection test to asses the quality and extension of adenoids hypertroph

Trazodone: a multifunctional antidepressant. Evaluation of its properties and real-world use

none9noneAlessandro Cuomo, Angelo Bianchetti, Annachiara Cagnin, Domenico De Berardis, Ignazio Di Fazio, Raffaele Antonelli Incalzi, Camillo Marra, Francesca Neviani, Ferdinando NicolettiCuomo, Alessandro; Bianchetti, Angelo; Cagnin, Annachiara; De Berardis, Domenico; Di Fazio, Ignazio; Antonelli Incalzi, Raffaele; Marra, Camillo; Neviani, Francesca; Nicoletti, Ferdinand

Do neurosurgeons follow the guidelines? A world-based survey on severe traumatic brain injury

Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two European surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in the management of severe TBI patients, comparing low- and high-income, and adherence to the BTF guidelines

Assessment of the incremental diagnostic value of florbetapir F 18 imaging in patients with cognitive impairment: The incremental diagnostic value of amyloid PET with [ 18 F]-florbetapir (INDIA-FBP) study

Importance Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. Objective To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. Design, Setting, and Participants The Incremental Diagnostic Value of Amyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairment were evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15% and 85%. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosis was made, diagnostic confidence was estimated, and drug treatment was provided. At the time of this workup, an amyloid PET/computed tomographic scan was performed, and the result was communicated to physicians after workup completion. Physicians were asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The study was conducted from August 5, 2013, to December 31, 2014. Main Outcomes and Measures Primary outcomes were prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. Results Of the 228 participants, 107 (46%) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79%) having both a previous diagnosis of AD and an amyloid-negative scan (P\u2009<\u2009.001) and in 16 (53%) of those with non-AD diagnoses and an amyloid-positive scan (P\u2009<\u2009.001). Diagnostic confidence in AD diagnosis increased by 15.2% in amyloid-positive (P\u2009<\u2009.001; effect size Cohen d\u2009=\u20091.04) and decreased by 29.9% in amyloid-negative (P\u2009<\u2009.001; d\u2009=\u2009 121.19) scans. Acetylcholinesterase inhibitors and memantine hydrochloride were introduced in 61 (65.6%) patients with positive scan results who had not previously received those drugs, and the use of the drugs was discontinued in 6 (33.3%) patients with negative scan results who were receiving those drugs (P\u2009<\u2009.001). Conclusions and Relevance Amyloid PET in addition to routine assessment in patients with cognitive impairment has a significant effect on diagnosis, diagnostic confidence, and drug treatment. The effect on health outcomes, such as morbidity and mortality, remains to be assessed

Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention