Complicaciones en la evolución de los hemangiomas y malformaciones vasculares

The differentiation of haemangiomas and vascular malformations is histological, clinical and prognostic. Although the majority of haemangiomas evolve towards spontaneous resolution, as many as 10% of cases can develop complications with ulceration, pain and haemorrhaging. Besides, the localisation of haemangiomas in the head and neck, next to vital structures, can compromise their functions. Hence, compression of the airway might be a vital emergency. Periorbital haemangiomas can give rise to amblyopia due to sensory deprivation or due to a restrictive strabismus. Lumbosacral haemangiomas must be studied with Nuclear Magnetic Resonance because of their frequent association with alterations in the midline at the level of the spine, anus, genitals or kidneys. Amongst visceral haemangiomas, hepatic haemangiomas are the most serious due to their association with congestive cardiac insufficiency. The association of extensive facial haemangiomas with anomalies of the central nervous system, vascular, cardiac, ocular and sternal anomalies, is denominated PHACE syndrome and is frequently complicated by mental deficiency, convulsions or ictus. Vascular malformations of trigeminal localisation are associated in up to 15% of cases with glaucoma or choroidal or leptomeningeal haemangiomas (Sturge- Weber syndrome). Combined vascular malformations localised in the extremities can become complicated with thrombophlebitis, regional osteolysis and even distant thromboembolisms (Klippel-Treneaunay Syndrome). On the other hand, there is a coagulopathy due to consumption (Kassabach-Merrit Syndrome) that can complicate some vascular tumours such as the Kaposiform haemangioendothelioma and the tufted angioma. Finally, the complications of the treatments employed are reviewed

Vascular risk factors in primary open angle glaucoma

To determine whether cardiovascular risk factors distribution differ between primary open-angle glaucoma (POAG) and control subjects. To assess the strength of this association in POAG. To analyze the most frequent pathology in this group of patients for a better selection of medical treatment. METHODS: Observational cross-sectional study in patients with a diagnosis of POAG. Fifty glaucoma patients were selected with consecutive sampling between those who had been admitted to an tertiary hospital by any reason and compared with fifty admitted to the same hospital patients without POAG diagnosis in the same period of time. The variables age, sex, the reason for admission to hospital classified by diagnosis related group (DRG) and diagnostic mayor criteria (DMC), treatment for glaucoma, stroke, diabetes mellitus, high blood pressure, ischaemic cardiopathy, Raynaud phenomenon, low blood pressure, hypercholesterolemia and tobacco were investigated. RESULTS: An association was found between POAG and stroke (prevalence ratio=2.16;CI al 95%=1.01-2.20; p=0.074*), low blood pressure (prevalence ratio=5; CI=1.14-2.63; p=0.092*) and high blood pressure (prevalence ratio=1.35; p=0.16) but it didn't reach to the statistical level of signification. No association with the remaining variables was found with this size sample. The most frequent reason for hospital admission in the study group were respiratory and circulatory system disease. Circulatory (24 y 22% respectively)with the pneumonia the most frequent DRG (10%). In the control group, the most frequent reason were circulatory and respiratory system disease (24 y 16% respectively). The chronic obstructive airway disease (COAD) was the most frequent DRG in this group (6%). The vascular risk factors most frequently found in both of the groups was high blood pressure (54 and 40% ) and the stroke (26-12%). The medical glaucoma treatment in these patients were the beta-blockers only (24.3%) or in association (18.9%). CONCLUSIONS: POAG is associated with stroke and blood pressure variations (high and low). The respiratory (pneumonia and COAD) and circulatory system diseases (congestive heart failure-CHF- and ischaemic cardiopathy) are the most frequently mortality cause in this group of patients. The most frequent medical therapy used for glaucoma are the beta-blockers which are contraindicated in COAD and CHF patients

Multivariate aging properties of epoch times of nonhomogeneous processes

AbstractThe purpose of this paper is to give conditions on the parameters of nonhomogeneous Poisson and nonhomogeneous pure birth processes, under which the corresponding random vector of the first n epoch times has some multivariate stochastic properties. These results provide an inside to understand the effect of the time over the occurrence of events in such processes. Some applications of these results are given

New stochastic comparisons based on tail value at risk measures

In this article we provide a new criterion for the comparison of claims, when we have conditional claims arising in stop loss contracts or contracts with franchise deductible. These stochastic comparisons are made on the basis of the Tail Value at Risk (also known as conditional tail expectation), just for a fixed level and beyond. In particular, we explain the interest of comparing these quantities, study some preservation properties and, in addition, we provide sufficient conditions for its study. Finally we illustrate its usefulness with some examples.The research of Félix Belzunce is funded by the Ministerio de Economía, Industria y Competitividad (Spain) under grant MTM2016-79943-P (AEI/FEDER, UE). Alba M. Franco-Pereira acknowledges support received from the Ministerio de Economía y Competitividad (Spain) under grant MTM2017-89422-P and has received financial support from the Xunta de Galicia (Centro Singular de Investigación de Galicia accreditation 2016-2019) and the European Union (European Regional Development Fund - ERDF). She also acknowledges funding from Banco Santander and Complutense University of Madrid (project PR26/16-5B-1). Julio Mulero wants to acknowledge the support received from the Conselleria d’Educació, Investigació, Cultura i Esport (Generalitat de la Comunitat Valenciana) under grant GV/2017/015 and the Ministerio de Economía, Industria y Competitividad (Spain) under grant MTM2016-79943-P (AEI/FEDER, UE)

Stochastic comparisons of nonhomogeneous processes

The purpose of this paper is to describe various conditions on the parameters of pairs of nonhomogeneous Poisson or birth processes under which the corresponding epoch or inter-epoch times are stochastically ordered in various senses. We derive results involving the usual stochastic order, the multivariate hazard rate order, the multivariate likelihood ratio order, and the multivariate mean residual life order. A sample of applications involving generalized Yule processes, load-sharing models, and minimal repairs in reliability theory, illustrate the usefulness of the new results

Cadmium, manganese, nickel and lead contents in surface sediments of the lower Ulla River and its estuary (northwest Spain)

The authors determined the total contents of cadmium, manganese, nickel and lead in 16 surface sediment samples along the last 7 km of the Ulla River and in its estuary. Prior to chemical analysis, the grain-size fractions below 500, 63 and 2 μm were separated. The metal concentrations were analysed in the fraction below 63 μm, and in selected samples from the clay fraction ( 2 μm). The soil samples were digested with a HF + HNO₃ + HCl mixture and the total concentrations of Cd, Mn, Ni and Pb were analysed with the AAS method. The highest contents of metals were found in the riverine sediments, near the town of Padrón, and in the estuary. The enrichment of metals in the sediments was mainly related to the proximity of the industrial sources, and to the fine particles transported and deposited in the sediments. The Ni and Mn contents found are considered very high, at some points reaching values of up to 357 mg kg⁻¹ and 2 110 mg kg⁻¹, respectively. Lead and Cd were mainly found within the range considered as natural background levels in the sediments of the Galician rias, with concentrations of 25-68 mg kg⁻¹ for Pb and 0.01-0.92 mg kg⁻¹ for Cd. The lower part of the Ulla River and its estuary present: l) moderate to high contamination levels of Mn and Ni; 2) moderate Pb pollution levels; and 3) no Cd contamination. The highest concentrations of metals were obtained in the river, near the wastewater discharges, and in the estuary, associated with fine particles.El contenido total de cadmio, manganeso, níquel y plomo se determinó en 16 muestras de sedimentos superficiales a lo largo de los últimos 7 km del río Ulla y en su estuario. Previamente a los análisis químicos, se realizó la separación granulométrica de los sedimentos en las fracciones inferiores a 500, 63 y 2 μm. La concentración de metales se determinó en la fracción inferior a 63 μm y, para algunas muestras, en la fracción arcilla ( 2 μm). La digestión del sedimento se realizó en una mezcla ácida de HF + HNO₃ + HCl y se analizó la concentración total de Cd, Mn, Ni y Pb por espectroscopia de absorción atómica. Los contenidos más altos en metales se encontraron en los sedimentos del río, en las inmediaciones de Padrón y en los del estuario. El enriquecimiento de los sedimentos en metales se ha relacionado con la proximidad a las zonas industriales y con el material fino transportado y depositado en los sedimentos. Se han encontrado contenidos muy altos de Ni y Mn con valores de 357 mg kg⁻¹ y 2 110 mg kg⁻¹, respectivamente. Las concentraciones de Cd y Pb son comparables a los valores establecidos como niveles naturales en los sedimentos de las rías gallegas: 25-68 mg kg⁻¹ para el Pb y 0.01-0.92 mg kg⁻¹ para el Cd. El sedimento de la parte baja del río Ulla y su estuario presentan niveles moderados-altos de contaminación para Mn y Ni, moderados para Pb y nulos para Cd. Las mayores concentraciones de estos metales en el sedimento fueron medidas asociadas con las fracciones finas ( 63 μm): cerca de Padrón, zona de influencia fluvial y, también, aunque con valores más bajos, en la desembocadura del Ulla, zona de influencia marina.Instituto Español de Oceanografí

The in vivo location of edge-wear in hip arthroplasties : combining pre-revision 3D CT imaging with retrieval analysis

AIMS: Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. METHODS: 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. RESULTS: Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. CONCLUSION: The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning. Cite this article: Bone Joint Res 2021;10(10):639-649

Oftalmopatía tiroidea: determinación de parámetros de actividad clínica de la oftalmopatía tiroidea como factor pronóstico de respuesta al tratamiento inmunosupresor

Objective: To determine the usefulness of the clinical, biochemical and thyroid imaging parameters in patients with thyroid-associated ophthalmopathy, in predicting their response to immunosuppressive treatment. Methods: This retrospective study of 16 patients with thyroid ophthalmopathy considered a number of variables including sex, age, thyroid hormone levels, treatment of the thyroid dysfunction, clinical activity score (CAS), severity (NOSPECS) of the ophthalmopathy, signs in standardized A-mode ultrasonography, in CAT and/or NMR, and previously used treatments and their effectiveness. Results: The average age of the patients was 50.81 (S.D: 11.89) years; there were 5 males (31.3%) and 11 females (68.8%). The ophthalmopathy was classified as active in 10/16 patients (62.5%) and inactive in 6/16 (37.5%); and as moderate in 9/16 (56.25%) and severe in 7/16 (43.75%) according to the severity defined in NOSPECS. Ultrasonography was diagnostic in 100% of the cases. The severity decreased significantly (p ≤ 0.05), however the clinical activity decrease did not reach significance (p=0.38) during immunosuppressive therapy. Better results were obtained during treatment of patients with a higher CAS (p=0.04) and in those with more severe ophthalmopathy (p=0.02). There was a tendency for the patients with higher levels of TSI to respond better to the treatment (p=0.06). Conclusions: The CAS is the best parameter to quantify the activity of the disease and predicting the response to treatment. The higher the CAS and the more severe the ophthalmopathy, the better the response to treatment. No association existed between thyroid function and the activity or severity of the ophthalmopathy; or the effectiveness of treatmen

Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana

Clinical cases: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. Discussion: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRV

The 4G/5G PAI-1 polymorphism influences the endothelial response to IL-1 and the modulatory effect of pravastatin

BACKGROUND: Increased plasminogen activator inhibitor (PAI-1) levels lead to impaired fibrinolytic function associated with higher cardiovascular risk. PAI-1 expression may be regulated by different inflammatory cytokines such as interleukin-1alpha (IL-1). Several polymorphisms have been described in the PAI-1 gene. AIM: We examined the influence of the 4G/5G polymorphism in the promoter region on IL-1alpha-induced PAI-1 expression by human umbilical vein endothelial cells (HUVEC) in presence or absence of pravastatin. METHODS AND RESULTS: Genotyped HUVEC were incubated with IL-1alpha (500 U mL(-1)) in presence or absence of pravastatin (1-10 microm). PAI-1 expression was analyzed by real time polymerase chain reaction (PCR), and PAI-1 antigen measured in supernatants by ELISA. IL-1alpha increased PAI-1 secretion in a genotype-dependent manner, and higher values were observed for 4G/4G compared with both 4G/5G and 5G/5G cultures (P < 0.05). Preincubation of HUVEC with 10 microm pravastatin significantly reduced IL-1-induced PAI-1 expression in 4G/4G HUVEC compared with untreated cultures (177.5% +/- 24.5% vs. 257.9% +/- 39.0%, P < 0.05). Pravastatin also attenuated the amount of secreted PAI-1 by 4G/4G HUVEC after IL-1 stimulation (5020.6 +/- 165.7 ng mL(-1) vs. 4261.1 +/- 309.8 ng mL(-1), P < 0.05). This effect was prevented by coincubation with mevalonate, indicating a dependence on HMG-CoA reductase inhibition. CONCLUSIONS: The endothelial 4G/5G PAI-1 genotype influences the PAI-1 response to IL-1alpha and the modulatory effect of pravastatin. As increased PAI-1 levels have been linked to cardiovascular disease the observed endothelial modulation by pravastatin may have potential clinical implications