Tocilizumab as first treatment option in optic neuropathy secondary to Graves' orbitopathy.

Dysthyroid optic neuropathy (DON) is one of the complications that can affect Graves' orbitopathy (GO) patients. Its prevalence is estimated at less than 5%. It is usually treated with intravenous steroids, radiotherapy or orbital decompression. Tocilizumab has been proposed as a treatment option in cases of GO refractory to steroid treatment, with good clinical results. Our aim is to report the case of a patient with optic neuropathy secondary to GO treated with tocilizumab as primary treatment option.

Purtscher-like retinopathy following carotid angioplasty and stenting in the treatment of severe carotid stenosis.

We present a case of Purtscher-like retinopathy (PLR) following carotid angioplasty and stenting (CAS). A 56-year-old man with a history of severe stenosis of the left carotid artery and treated by CAS refers acute and painless visual loss on the left eye (OS) 48 h after the procedure. Funduscopic examination showed cotton wool spots and intraretinal hemorrhages confined to the peripapillary and posterior pole of the OS. The optical coherence tomography (OCT) showed retinal thickening and hyperintense lesions in the inner nuclear layer retina.

Childhood family stress and adult resilience in a sample of depressed patients.

BACKGROUND: The aim of this study is to explore the effect of childhood family stress on depression, personal, and social resilience in depressed patients. METHODS: We assessed childhood family stress (RFQ), depression (BSI, depression subscale), and resilience (RSA) in 152 depressed patients, 70 males, and 82 females. We calculated the 33rd and 66th percentiles of RFQ scores to divide the sample among Low, Medium, and High RFQ subgroups. A one-way ANOVA has been carried out to explore the differences between the variables in the subgroups. Finally, two regression analyses with depression, as the dependent variable, and resilience, divided for stress-sensitive and no stress-sensitive factors as independent variables, have been implemented. RESULTS: The one-way ANOVA showed that the Low subgroup had a positive profile, the Medium had an intermediate profile, while the High had a negative one for depression, personal (structured style and social competence), and interpersonal (social resources) resilience. The other factors (perception of self, planned future, and family cohesion) did not show differences in the subgroups, suggesting they are no stress sensitive. Regression analysis showed that no stress-sensitive factors have a constant and significant predictive value for depression in all subgroups; while, stress-sensitive ones showed a growing predictive value for depression from Low to Medium, but not in High, suggesting a ceiling effect. LIMITATIONS: The use of self-report measures, the cross-sectional nature of the study, and the lack of a non-clinical and/or outpatient samples. CONCLUSIONS: This study provides a contribution to the understanding of the effect of childhood family stress on adult resilience and depression.

[Hydroxyethyl starch to protect renal function in laparoscopic surgery]. / Uso de hidroxietil almidón (Voluven) como protección de la función renal en cirugía laparoscópica.

OBJECTIVE: To evaluate the effect of prehydration with hydroxyethyl starch 130/0.4 (Voluven) compared to lactated Ringer solution in laparoscopic cholecystectomy. PATIENTS AND METHODS: We performed a randomized single-blind clinical trial on patients classified as ASA 1 and 2. The exclusion criteria were hypertension, kidney failure, treatment with diuretics or other antihypertensive drugs, diabetes, and use of nonsteroidal anti-inflammatory drugs. Balanced general anesthesia with remifentanil and sevoflurane was used. The total volume of administered fluids (including prehydration) was 2 mL x kg(-1) x h(-1) fasting plus 5 mL x kg(-1) x h(-1) during surgery. Group 1 was prehydrated 30 minutes before surgery with 500 mL of lactated Ringer solution in group 1; in group 2 the same quantity of Voluven was used. Ringer solution was used in both groups to provide additional fluids. Blood pressure was kept within 20% above or below baseline values. Standard anesthetic monitoring was performed. Intraoperative diuresis and creatinine clearance were recorded. The groups were compared using the t test; a P value of 05 or less was considered significant. RESULTS: Twenty-nine patients were enrolled in the study. Diuresis and creatinine clearance were significantly higher in the group that received prehydration with Voluven. The mean (SD) creatinine clearance rate was 176.44 (1433) mL x min(-1) in group 1 and 61.90 (6.6) mL x min(-1) in group 2 (P = .036). The mean volume of urine excreted was 1.71 (0.06) mL x kg(-1) x h(-1) in group 1 and 0.47 (0.02) mL x kg(-1) x h(-1) in group 2 (P = .017). CONCLUSION: Prehydration with Voluven can be an effective measure for protecting renal function against the adverse effects of pneumoperitoneum in laparoscopic surgery.

Periorbital necrotising fasciitis secondary to scratching. / Fascitis necrosante periorbitaria secundaria a rascado.

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.

[Blepharitis related to Cetuximab treatment in an advanced colorectal cancer patient]. / Blefaritis asociada al tratamiento con Cetuximab en adenocarcinoma colorrectal avanzado.

CASE REPORT: A 52-year-old woman with advanced colorectal cancer was referred to us for treatment of Cetuximab-related ocular side-effects. DISCUSSION: Cetuximab is a monoclonal antibody that specifically blocks epidermal growth factor receptor activity. It has recently been approved to treat some tumors such as metastatic colorectal cancer and some ORL cancers. Tolerance to it seems to be better than that to the classic chemotherapeutic agents. However it has several side-effects. Cetuximab-related eyelid toxicity has been recently described, though the pathogenesis has not yet been clearly established.

[Dacryocystitis caused by Candida lusitaniae]. / Dacriocistitis por Candida Lusitaniae.

CASE REPORT: We report the case of a 60-year-old woman with recurrent dacryocystitis of the right lacrimal sac. She did not recover after medical treatment, nor after dacryocystorhinostomy with canalicular intubation. She also had dacryocystitis on the left side. The material that was obtained during surgery was grown in a culture medium and Candida Lusitaniae was identified as the responsible organism. All symptoms disappeared after topical treatment with amphotericin B and dacryocystorhinostomy. DISCUSSION: Dacryocystitis caused by Candida Lusitaniae is very rare. We should always consider whether Candida Lusitaniae is responsible for the primary infection or is the agent resulting from a superadded infection caused by previous antibiotic therapy.

[Pyogenic granuloma following Smart Plug insertion]. / Granuloma piógeno en tapones lagrimales Smart Plug.

CASE REPORT: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. DISCUSSION: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug.

Proptosis as initial manifestation of Burkitt's lymphoma with orbital involvement. / Proptosis como manifestación inicial de linfoma de Burkitt con afectación orbitaria.

CASE PRESENTATION: A 35-year-old woman without any known systemic disorder presented with a complaint of painful and rapidly increasing proptosis in her right eye. Based on the clinical, radiological, analytical and ophthalmological assessments, the diagnosis made was Burkitt's lymphoma in acquired immunodeficiency syndrome. CONCLUSION: Proptosis can be an unusual way of presenting with Burkitt's lymphoma associated with acquired immunodeficiency. This differential diagnosis is important because confirmation leads to a change in the vital prognosis of the patient.

Salicylic acid determination in cow urine and drugs using a bienzymatic sensor.

An enzymatic biosensor was developed for salicylic acid (salicylate ion) determined using a Clark type gas diffusion electrode and two enzymes (tyrosinase and salicylate hydroxylase) entrapped in a cellulose triacetate membrane. After optimization, the method was applied to the determination of salicylic acid in cow urine. Relatively good recoveries were achieved, between about 83% and 109%, using the calibration curve, and acceptable precision (R.S.D. about 8%). The method is now being tested for the determination of salicylic acid contained in commercially available drug specialities or galenic products. So far agreement with nominal values has been found to be between 75% and 110% with a R.S.D. of less than 8%.

[An optic nerve tumor in von Hippel-Lindau disease, masquerading as a retinal hemangioma]. / Angioma retiniano como síndrome mascarada de tumor del nervio óptico en la enfermedad de von Hippel-Lindau.

CLINICAL CASE: A 35-year-old man with a family history of von Hippel-Lindau disease was diagnosed to have two retinal hemangiomas in the right eye and another in the left eye. The hemangiomas were treated with cryotherapy and laser photocoagulation respectively. Despite apparent good resolution of the retinal lesions, progressive visual loss was observed. An MRI was then performed and showed bilateral tumoral lesions of the optic nerve compatible with a glioma, meningioma or hemangioblastoma. Currently the visual acuity in his right eye is hand movement, and is 0.6 in the left eye. DISCUSSION: The presence of the retinal hemangiomas delayed the diagnosis of an optic nerve tumor in this patient.

[Juvenile nasopharyngeal angiofibroma with orbital extension]. / Angiofibroma nasofaríngeo juvenil con extensión orbitaria.

CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis.

Metastatic anterior chamber non-Hodgkin lymphoma in a patient with acquired immunodeficiency syndrome.

PURPOSE: To alert ophthalmologists to the possibility of metastatic anterior chamber intraocular non-Hodgkin lymphoma in patients with acquired immunodeficiency syndrome (AIDS). METHODS: We examined a 19-year-old man with AIDS who had an anterior uveitis with pseudohypopyon and a history of 2 months of malaise. A specimen of the lesion was obtained with a 25-gauge needle for pathologic examination. RESULTS: Systemic exploration showed hepatomegaly. Abdominal computed tomography showed multiple lesions in the liver and spleen. Fine-needle aspiration disclosed a high-grade non-Hodgkin lymphoma. The result of a fine-needle aspiration obtained from a lesion in the anterior chamber was consistent with the same diagnosis. CONCLUSION: An anterior chamber pseudohypopyon with uveitis can be the manifesting sign of a systemic lymphoma in a patient with AIDS and requires a thorough systemic evaluation.

Central retinal vein thrombosis associated with prothrombin 20210G/A gene variant.

We describe a patient with central retinal vein thrombosis associated with the prothrombin gene 20210G/A. The associated risk factors and the patient's personal and family history of thrombosis are dealt with. In addition, the literature on the cases reported up to now is reviewed as is the prevalence of this new mutation in patients with central retinal vein thrombosis.

Branch retinal vein occlusion associated with the 20210 G-to-A prothrombin variant.

PURPOSE: To describe a case of branch retinal vein occlusion (BRVO) in a patient who tested positive for the 20210 A allele of the prothrombin (PT) gene. METHODS: A 48-year-old man had visual loss in the right eye secondary to BRVO confirmed by ophthalmoscopy and fluorescein angiography. His medical history was not remarkable for common risk factors for retinal occlusive diseases. RESULTS: Laboratory tests for hypercoagulability were positive for PT 20210 A variant. The patient's family tested negative for the PT variant. CONCLUSIONS: Laboratory tests for coagulopathy, including the PT 20210 A variant, should be added to the examination of patients with central or BRVO, especially if most common risk factors for thrombosis have been excluded.

Identification of different types of imperial age marble finds using instrumental chemical analysis and pattern recognition analysis.

A physical-chemical characterisation of several marbles frequently used in ancient times for artistic or decorative purposes was performed in support the work of historians and restorers. The data were obtained using several different types of instrumental chemical methods (Thermogravimetry, Differential Thermal Analysis, X-ray Diffractometry and ICP Plasma Emission Spectroscopy) and have been summarised in short tables. The data have already proved useful in the identification of a small number of finds (statues or architectonic elements) from Ancient Rome (Imperial Age, 2nd-3nd cent. A.D.) for the purpose of which also a well-known pattern recognition analysis software package was used for data processing. In practice, the research showed that an organised set of chemical data obtained using several modern instrumental methods can provide a valid basis for the reasonably rapid and reliable identification of the type of marble used to make artistic artifacts that have not yet been subjected to typological study.

[CT scan efficiency in emergency room diagnosis for optic neuropathy due to trauma]. / Eficacia de la tomografía computerizada (T.A.C.) en el diagnóstico urgente de la neuropatía óptica traumática.

PURPOSE: To define radiological patterns for Traumatic Optic Neuropathy (TON), which is of special concern for patients suffering of poor awareness when exploration of visual function is needed. We also studied final visual acuity in connection with the early radiological findings. METHOD: 14 optic neuropathies due to trauma, with their emergency requested CT Scan and evolution of visual acuity are reported. RESULTS: 76.9% of the patients showed radiological findings suggesting a TON, 23% consisted in intraorbitary hematic collections, 15% comprised avulsions of optic disc, 15% showed intraorbitary bony fragments and only 15% showed optic canal fractures. CONCLUSIONS: We report the radiological findings suggesting a TON which concerns the polytraumatized patients. Together with the clinical exploration, CT Scan becomes the most important method for the assessment of TON in emergency settings. In cases of avulsion of the optic nerve, visual acuity was regarded as no light perception by the patients, while in others this perception varied.

[Terson syndrome associated with a carotid-ophthalmic giant aneurysm]. / Síndrome de Terson asociado a aneurisma carótido-oftálmica gigante.

UNLABELLED: PURPOSE/MATERIAL AND METHOD: A case of a 42 year-old woman presenting headache, vomiting and loss of consciousness of sudden onset. Upon testing right eye presented amaurosis while left eye showed a visual acuity of 20/50. RESULTS/CONCLUSION: Brain angiography showed a right sided giant carotid aneurysm at the ophthalmic artery area. Globe fundus in left eye showed vitreal and intra-retinal hemorrhage appearing in retinal posterior pole and periphery of the retina. Subarachnoidal hemorrhage accompanied by intra-vitreal bleeding is known as Terson's Syndrome. Peculiarities of this clinical case are discussed in this paper.

[Conjunctival microbiological study in corneo-schleral prosthesis users]. / Estudio microbiológico de la conjuntiva en portadores de prótesis esclero-corneales.

PURPOSE: To evaluate conjunctival bacterial flora in carrier patients of corneo-schleral prosthesis, both in the affected and fellow eye. MATERIAL AND METHOD: Samples were obtained from twenty-six corneo-schleral prosthesis carriers and smear from both eyes were cultured. Samples were taken from 24 patients as controls. RESULTS: Significant growth of potentially pathogen bacteria was observed in the corneo-schleral prosthesis and fellow eyes compared to controls. CONCLUSION: Conjunctival bacterial flora showed variations in the eyes of controls, corneo-schleral prosthesis and fellow eyes groups.