Abstract Background Epilepsy is a neurological disorder affecting over 50 million people worldwide, with a global incidence of 7.6 per 1,000 individuals. Mesial temporal lobe epilepsy (MTLE) is characterized by recurrent, unprovoked seizures originating in the temporal lobe. The standard surgical treatment is anterior temporal lobectomy; however, many patients are not suitable candidates due to the risk of adverse effects, including significant memory impairment, language deficits, bilateral temporal involvement, or reluctance to undergo resective surgery. This study aimed to evaluate the anticonvulsant effect of linear accelerator (LINAC)-based radiosurgery in patients with drug-resistant unilateral MTLE. Methods A prospective, single-center, exploratory pilot case series was conducted from March 1, 2017, to March 1, 2020, at the Hospital de Especialidades, Centro Médico Nacional de Occidente. Patients aged 18–65 years with a confirmed diagnosis of drug-resistant unilateral MTLE were enrolled. The primary outcome was defined as the achievement of complete freedom from disabling seizures (Engel Class I and ILAE Class 1) at 24 months post-radiosurgery. Secondary efficacy outcomes included achieving a ≥ 50% reduction in seizure frequency. The prescribed dose of 22 Gy was normalized to the 50% isodose line at the isocenter, ensuring ≥ 90% target coverage (V100 ≥ 90%) and a dose gradient < 10%, targeting the hippocampal head and anterior body. Results Seven patients were included. Median seizure frequency decreased from 12 seizures/month at baseline to 3.5 seizures/month at 24 months, corresponding to a median reduction of 75.6%.Longitudinal analysis demonstrated a significant reduction in seizure frequency over time (Friedman χ 2 = 14.62, p = 0.006), with significant differences between baseline and all follow-up periods (p = 0.018). No patient achieved seizure freedom. Kaplan–Meier analysis demonstrated that 71.4% of patients maintained a clinically meaningful seizure reduction (≥ 50% from baseline) throughout the 24-month follow-up. Patients with preoperative auras exhibited a median aura reduction of 60%, whereas de novo auras developed in three previously aura-free patients. Adverse events included visual field deficits in three patients (42.8%), psychiatric complications in two (28.6%), and clinically significant memory decline in one patient with pre-existing cognitive impairment. Conclusions LINAC-based stereotactic radiosurgery targeting the hippocampal head and anterior body achieved a clinically meaningful reduction in seizure frequency in selected patients with drug-resistant MTLE. However, complete seizure freedom was not achieved, and delayed adverse events were observed. Trial registration The study was approved by the ethics committee of the Hospital de Especialidades, Centro Médico Nacional de Occidente (approval number R-2017–1301-57).
Interstitial-lung-disease progression assessment and diagnosis via radiological findings on computed tomography images require significant time and effort from expert physicians. Accurate results from these analyses are critical for treatment decisions. Automatic semantic segmentation of radiological findings has been developed recently using convolutional neural networks (CNN). However, on the one hand, few works present individual performance scores for radiological findings that allow for accurately measuring fibrosis segmentation performances; on the other hand, the poorly annotated quality of available databases may mislead researcher observations. This study presents a CNN methodology employing three different architectures (U-net, LinkNet, and FPN) with transfer learning and data augmentation to enhance the performance in semantic segmentation of fibrosis-related radiological findings (FRF). In addition, considering the poor quality of manual CT tagging on available datasets, we use two alternative evaluation strategies, first using only the fibrosis region of interest. Second, re-tagging and validating the test set by an expert pulmonologist. Using DICOM images from the Interstitial Lung Diseases Database, the implemented approach achieves a Jaccard Score Index of 0.7355 with a standard deviation of 0.0699 and a Dice Similarity Coefficient of 0.8459 with a standard deviation of 0.0470 comparable to state-of-the-art performance in FRF semantic segmentation. Also, a visual evaluation of the images automatically tagged by our proposal was performed by a pulmonologist. Our proposed method successfully identifies these FRF areas, demonstrating its effectiveness. Also, the pulmonologist revealed discrepancies in the dataset tags, indicating deficiencies in FRF annotations.
Antecedentes: México tiene el 3.er lugar de la región latinoamericana en prevalencia de cáncer colorrectal (CCR). Uno de los métodos de detección para el CCR es la prueba de sangre oculta en heces (PSOH) para las personas con riesgo promedio. Las creencias sobre el CCR y los métodos de detección pueden influir sobre la adopción de los métodos de detección. Objetivo: Analizar la asociación entre los conocimientos, las variables sociodemográficas y las dimensiones de modelo de creencias de salud de acuerdo con las etapas de adopción de la PSOH en personas de 40 años o más. Método: Participaron 352 personas que respondieron la escala del modelo de creencias de salud para el CCR y la PSOH. Resultados: Se encontró una asociación significativa entre las etapas de adopción de la PSOH y el conocimiento de mé-todos diagnósticos para CCR (χ2: 56.6 [3]; p = 0.000), se obtuvieron diferencias significativas para las dimensiones del modelo de creencias excepto en la severidad percibida (p = 0.055). Conclusiones: Las creencias susceptibilidad, beneficios, las barreras, la autoeficacia percibida y la motivación para la salud son las que hacen la diferencia entre las etapas iniciales y avanzadas de adopción de la PSOH.
Introduction: Choledocholithiasis, the most frequent complication of cholelithiasis, is defined as the presence of stones in the common bile duct. Mirizzi syndrome, a rare complication of cholelithiasis, appears with the impaction of stones in Hartmann’s pouch. Large element choledocholithiasis is considered when stones measure ≥15 mm. Case Report: A 36-year-old female patient arrived at the emergency department presenting acute abdominal pain in the epigastrium, irradiated to the right hypochondrium accompanied by vomiting, choluria, and acholia. Hepatobiliary ultrasound showed cholelithiasis plus dilation of the bile ducts. Preoperative tests showed hyperbilirubinemia of 7.46 mg/dL with an obstructive pattern and alteration of liver function tests. Endoscopic retrograde cholangiopancreatography was performed and failed to mobilize the stone. During surgery a scleroatrophic gallbladder was identified without being able to identify the cystic duct and artery, suspecting a cholecystocholedochal fistula. A choledochotomy of 30 mm was performed to begin laparoscopic bile duct exploration. The extraction of 3 stones was achieved, the largest measuring 29 mm in diameter. Afterward, partial cholecystectomy was performed and a T-tube was placed through the choledochotomy. Intraoperative cholangiography was performed through a T-tube with adequate passage into the extrahepatic bile ducts toward the duodenum. Currently the patient is in her late postoperative period with a satisfactory evolution. Conclusion: Secondary choledocholithiasis is a common disease as a complication of chronic cholelithiasis that, thanks to multiple advances, has been easily resolved due to ERCP with sphincterotomy and balloon sweep. However, there are cases such as choledocholithiasis of large elements in which its resolution through ERCP is not feasible.
