Enfermedad inmunomediada del oído interno: contribución de nuevas herramientas diagnósticas para su caracterización

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 09-03-2018Esta tesis tiene embargado el acceso al texto completo hasta el 09-09-2019The main goal of this investigation is to provide a new insight towards possible diagnostic tools such as Magnetic Resonance Imaging (MRI) and PET scan (Positron Emission Tomography) to characterize immune-mediated inner ear disease (IMIED). A retrospective case review study design, analyzing patients with IMIED was carried out. Sixty-seven patients suspected of having an IMIED (primary or secondary) were studied. Twenty-eight patients referred a sudden hearing loss as form of presentation and 39 a fluctuating hearing loss. Twenty-seven patients underwent an MRI of the temporal bone with previous intratympanic Gadolinium observing endolymphatic hydrops (EH) in 13 patients. A PET scan was performed on 30 patients being altered in 17 of them. Initial and treatment for recurrences included mainly corticosteroids: intratympanic, intravenous, oral or the combination of two or three of them. IMIED lacks a specific serological marker and it may show different clinical presentations, mimicking diverse inner ear disorders. Fluctuating hearing loss has been the most frequent presentation in the present study. Intratympanic gadolinium (IT Gd) MRI has reported EH in a group of patients mainly affected by primary IMIED. PET has provided the diagnosis of unknown or underestimated secondary IMIED. In conclusion, both IT Gd MRI and PET have shown to be diagnostic tools that can facilitate the characterization of this entity

Utility and limitations of metabolic parameters in head and neck cancer: finding a practical segmentation method

Purpose: Although metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have shown good prognostic value in head and neck cancer (HNC), there are still many issues to resolve before their potential application in standard clinical practice. The purpose of this study was to compare the discrimination ability of two relevant segmentation methods in HNC and to evaluate the potential benefit of adding lymph nodes’ metabolism (LNM) to the measurements. Methods: We retrospectively analyzed a recently published database of 62 patients with HNC treated with chemoradiotherapy. MTV and TLG were measured using an absolute threshold of SUV2.5. Comparison analysis with previously published background-level threshold (BLT) results was done through Concordance index (C-index) in eight prognostic models. Results: BLT obtained better C-index values in five out of the eight models. The addition of LNM improved C-index values in six of the prognostic models. Conclusion: We found a potential benefit in adding LNM to the main tumor measurements, as well as in using a BLT for MTV segmentation compared to the most commonly used SUV2.5 threshold. Despite its limitations, this study suggests a practical and simple manner to use these parameters in standard clinical practice, aiming to help elaborate a general consensusOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Natur

Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID-19 patients

International audienceObjective: COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive, reliable and easy-to-perform olfactory test for the screening of suspected COVID-19 patients. Study design: Phase I was a case–control study and Phase II a transversal descriptive study. Subjects and methods: Olfaction was assessed with the ethyl alcohol threshold test and symptoms with visual analogue scales. The study was designed in two phases: In Phase I, we compared confirmed COVID-19 patients and healthy controls. In Phase II, patients with suspected COVID-19 infection referred for testing were studied. Results: 275 participants were included in Phase I, 135 in Phase II. The ROC curve showed an AUC of 0.749 in Phase I, 0.737 in Phase II. The cutoff value which offered the highest amount of correctly classified patients was ≥ 2 (10% alcohol) for all age intervals. The odds ratio was 8.19 in Phase I, 6.56 in Phase II with a 75% sensitivity. When cases report normal sense of smell (VAS < 4), it misdiagnoses 57.89% of patients detected by the alcohol threshold test. Conclusion: The olfactory loss assessed with the alcohol threshold test has shown high sensitivity and odds ratio in both patients with confirmed COVID-19 illness and participants with suspected SARS-CoV-2 infection