Confocal biomicroscopy in four patients with polychromatic corneal dystrophy. / Biomicroscopia confocal en 4 pacientes con distrofia corneal policromática.

INTRODUCTION: Polychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. CLINICAL CASES: Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicoloured brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. CONCLUSIONS: Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterised. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

Determination of inmune response and inflammation mediators in tears: Changes in dry eye and glaucoma as compared to healthy controls. / Determinación de mediadores de la respuesta inmune e inflamación en lágrimas: cambios en ojo seco y glaucoma frente a población sana.

OBJECTIVE: To determine the expression profile of immune response and inflammation (IRI) mediator molecules in tears from patients with dry eye (DE), and those suspected of having or have primary open-angle glaucoma (POAG) under treatment and compare them with healthy controls. METHODS: A prospective observational cohort study including 107 participants sub-divided into: healthy controls (CG; n=30), patients with DE (DEG; n=41) and patients suspected of having or have POAG and on hypotensive treatment (POAG-G; n=36). Tear samples were collected by capillary to be processed using a multi-immunoassay system based on flow cytometry (Luminex R-200 ®), in order to determine the interleukins (IL): 1ß, 2, 4, 5, 6, and 10, and the growth factors: Tumour necrosis alpha (TNF-α), vascular endothelial (VEGF), and granulocyte-macrophage colony stimulating- (GM-CSF). Data were processed using the SPSS 20.0 program. RESULTS: Molecules that significantly increased in tears from DEG vs. POAG-G patients were: IL-1 (P=.01), IL-6 (P=.004), IL-10 (P=.04), whereas VEGF significantly decreased in the DEG. The POAG-G showed significantly higher IL-6 values (P<.0001) as compared to the CG. When comparing both the DEG and POAG-G, significant differences were observed in tear expression of IL-4 (P=.004), IL-6 (P=.002), TNF-α (P=.03), GM-CSF (P=.03), and VEGF (P=.002). CONCLUSIONS: The increased expression of IRI mediators in tears from patients with DE or POAG strongly demonstrated the importance of immune response in both pathologies. However, the different molecules involved also suggest distinct signalling pathways for these processes that still require further research.

Chemopreventive potential of phenolic compounds in oral carcinogenesis.

OBJECTIVE: To evaluate the chemopreventive potential of phenolic compounds - potassium apigenin, cocoa, catechins, eriocitrin and rosmarinic acid in oral carcinogenesis induced in hamsters by means of the topical application of 7,12-dimethylbenz(a)anthracene(DMBA). STUDY DESIGN: An experimental study at the University of Murcia. METHODS: 50 male Syrian hamsters (Mesocricetus auratus) were divided into five groups of ten: Group I (control group): 0.5% DMBA; Group II: 0.5% DMBA+1.1mg/15ml potassium apigenin; Group III: 05% DMBA+2.5mg/15ml cocoa catechins; Group IV: 0.5% DMBA+6mg/15ml eriocitrin; Group V: 0.5% DMBA+1.3mg/15ml rosmarinic acid. The flavonoids were administered orally. All the animals were sacrificed after 12 weeks. Macroscopic, microscopic and immunohistochemical (PCNA and p53) analyses of the lesions were performed. RESULTS: All the groups treated with phenolic compounds showed lower incidences of tumour, greater differentiation and lower scores in the tumour invasion front grading system in comparison with the control group. Potassium apigenin and rosmarinic acid achieved the best results, the former considerably reduced the carcinoma tumour volumes developed and both significantly reduced the intensity and aggression of the tumours. Immunoexpression of PCNA and p53 were significantly altered during DMBA-induced oral carcinogenesis. CONCLUSIONS: Animals treated with phenolic compounds, particularly potassium apigenin and rosmarinic acid, showed a lower incidence of tumours.

Effect of the phenolic compounds apigenin and carnosic acid on oral carcinogenesis in hamster induced by DMBA.

OBJECTIVE: To investigate oral carcinogenesis in hamster induced by the topical application of 7,12-dimethyl benzanthracene (DMBA) to evaluate the different lesions produced and the possible preventive effects of the phenolic compounds apigenin (flavone) and carnosic acid (diterpene). MATERIALS AND METHODS: Thirty-two Syrian hamsters were divided into three groups: I: 0.5% DMBA (n = 12); II: 0.5% DMBA + potassium apigenin (n = 8); III: 0.5% DMBA + carnosic acid (n = 12). All the animals were sacrificed after 11 weeks, and a macroscopic and light microscopic study was made of the lesions. RESULTS: The largest number of neoplasms, showing the most aggressive biological behavior, corresponded to the control group. The group treated with potassium apigenin ranked second in tumor incidence, although the tumors were not very aggressive behavior. In the group treated with carnosic acid, only one malignancy was recorded, showing the smallest volume of all the recorded tumor lesions. CONCLUSIONS: Our findings indicate that both potassium apigenin and carnosic acid have chemoprotective effects against carcinogenesis induced by DMBA in hamster.

[Dry eye and quality of life]. / Ojo seco y calidad de vida.

PURPOSE: To evaluate the relation between dry eye severity and quality of life. METHODS: 40 participants (19 with dry eye and 21 normal controls) underwent slit-lamp examination and Schirmer test to evaluate dry eye severity. Quality of life was evaluated with OSDI (Ocular Surface Disease Index) and VFQ-25 (Visual Function Questionnaire-25). RESULTS: The OSDI total score was significantly greater in patients suffering dry eye. However, BUT (break-up time) and VFQ-25 total score were significantly lower than in control subjects. In dry eye patients several statistically significant correlations (p<0.05) were found: OSDI with VFQ-25 total score (r=-0.62), BUT with corneal staining (r=-0.50) and Schirmer (0.66), BUT with OSDI total score, OSDI-symptoms and OSDI-triggers (r=-0.56, -0.56, -0.60); corneal staining with OSDI total score and OSDI-symptoms (r=0.55, 0.54), BUT with VFQ-25 total score, VFQ-25 ocular pain, mental function and role function. (r=0.56, 0.51, 0.63, 0.56); corneal staining with VFQ-25 total score, VFQ-25 ocular pain and near vision (r=-0.57, -0.49, -0.62). CONCLUSION: Quality of life is decreased in patients with dry eye. OSDI and VFQ-25 questionnaires are valid instruments for measuring the impact of dry eye disease. BUT and corneal staining provide an indirect measurement of quality of life.

[0.1% dexamathasone and 1% rimexolone. A comparative study in the postoperative treatment after cataract extraction]. / Dexametasona al 0,1% versus rimexolona al 1%. Estudio comparativo en el postoperatorio de la cirugía de cataratas.

PURPOSE: To compare the efficiency and secondary effects of using 1% rimexolone or 0.1% dexamethasone as postoperative treatment for cataract surgery. MATERIALS AND METHODS: A prospective study performed on a cohort of 37 patients undergoing cataract surgery by phacoemulsification with no intraoperative complications at the Hospital Clínico San Carlos, Madrid. After surgery, 19 of the patients were randomly assigned to receive topical 0.1% dexamethasone (DEX group) as inflammatory treatment and the remaining 18 subjects were treated with 1% rimexolone ( RIMEX group) following the same regime. Twenty four hours and one month after surgery, visual acuity, conjunctival hyperaemia, anterior chamber cells, anterior chamber flare, intraocular pressure, corneal thickness and macular edema were determined in each patient. RESULTS: The repeated measures test performed on 24 hours and 1 month data revealed a significant difference between the two treatments in terms of Tyndall (p = 0.001) and flare (p= 0.034) values; these variables being lower in the dexamethasone group. No differences were observed in the remaining variables examined. CONCLUSIONS: Rimexolone is as efficient and safe as dexamethasone for the treatment of patients undergoing cataract extraction.

[Neurotrophic keratopathy management with cyanoacrylate tarsorraphy and autologous serum]. / Manejo de la queratopatía neurotrófica mediante tarsorrafia con cianoacrilato y suero autólogo.

PURPOSE/METHODS: Neurotrophic keratopathy is a degenerative corneal disease with a highly complex treatment caused by an impairment of corneal sensitivity. We report the case of a 47 year-old man with a refractory postherpetic neurotrophic keratopathy in his right eye and we discuss the treatment options. RESULTS/CONCLUSION: The combination of cyanoacrylate with temporary tarsorraphy along with the administration of topical autologous serum eyedrops and systemic tetracycline, allowed to control the progression of the disease and to regenerate the corneal surface. This unpublished therapeutic strategy might be an effective and safe alternative in the management of neurotrophic keratopathy (Arch Soc Esp Oftalmol 2003; 78: 119-122).

[Present and future of neurology in Spain]. / Presente y futuro de la neurología española.

This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.

[Intravitreal injection of triamcinolone acetonide in non infectious uveitis]. / Inyección intravítrea de triamcinolona acetónido en uveítis no infecciosas.

PURPOSE: Systemic immunosuppressants take more than two weeks before showing activity. Therefore corticosteroids remain the mainstay in the treatment of non infectious uveitis. The goal of this study is to assess results of the use of intravitreal triamcinolone acetonide in acute sight-threatening non-infectious uveitis. METHOD: Ten patients (4 idiopathic retinal vasculitis, 1 idiopathic panuveitis, 1 pars planitis and 4 Behçet disease) were treated. Triamcinolone acetonide 4 mg/0.1 ml was injected through pars plana. RESULTS: Pre-treatment visual acuity<0.1 and post-treatment visual acuity >0.6 after less than a week. Inflammation resolved completely in all cases. The only complications observed were transient ocular hypertension which was successfully treated in two patients with topical betablockers and a catact in one case. CONCLUSIONS: Intravitreal triamcinolone acetonide is effective in rapidly decreasing inflammation in acute sight threatening non infectious uveitis.

Residue levels, decline curves, and plantation distribution of procymidone in green beans grown in greenhouse.

Residue levels and degradation rates of procymidone residues were studied in green beans grown in a greenhouse. Experiments were planned to also assess the influence of planting density on the behavior of procymidone residues on this type of crop. The study was carried out in four random blocks considering three sub-blocks of different planting densities into each block. Plants were sprayed with Sumisclex 50 WP (1077.5 g of ai/ha) 52 days after the transplantation, and sampling was carried out daily during two different periods of 6 and 5 consecutive days, respectively, around the two harvest days (days 12 and 28 after the treatment). Residue levels of procymidone were determined by using the Luke extraction method and GC-NPD. The average residue levels of procymidone in the overall planting (mean of 12 determinations) were below 2 mg/kg (European maximum residue limit) for all the sampling days, obtaining values of 1.01 +/- 0.55 and 0.37 +/- 0.10 mg/kg, respectively, at the two harvest days. The decline behavior of procymidone residues in the overall plantation and in each block could be described as a pseudo-first-order reaction, obtaining half-life values (t(1/2)) of 10-11 days in all cases. The calculated residue level at the preharvest time (5 days) in the overall plantation was 1.7 mg/kg, but this value in the blocks depended on the block position along the greenhouse and ranged from 2.3 to 0.9 mg/kg. In this work, additional data on the residual behavior of the fungicide pyrazophos in green beans were also obtained.

Endothelial damage with cataract surgery techniques.

PURPOSE: To evaluate intraoperative endothelial damage after planned extracapsular cataract extraction (ECCE) with difference capsulotomy techniques and phacoemulsification. SETTING: San Carlos University Hospital, Castroviejo Institute, Madrid, Spain. METHODS: In this prospective, randomized study, 60 patients with senile cataract scheduled for cataract surgery were divided into three groups of 20 each: Group 1 had phacoemulsification; Group 2, planned ECCE with continuous curvilinear capsulorhexis; and Group 3, ECCE with letter-box capsulotomy. Preoperatively and 3 months postoperatively, endothelial cell density, percentage of hexagonality, and the cell size variation coefficient were determined by contact specular microscopy; endothelial permeability was examined by anterior segment fluorophotometry and central corneal thickness, by ultrasonic pachymetry. Results were analyzed using the two-tailed Student's t-test and analysis of variance. RESULTS: In all three groups, endothelial permeability and cell loss increased significantly from the preoperative values, but there were not significant differences among the postoperative values. Mean cell loss was 11.8% in Group 1, 12.8% in Group 2, and 10.1% in Group 3. There were no differences between the preoperative and postoperative morphometric indexes. Postoperative pachymetric measurements were not significant. CONCLUSIONS: Endothelial response was not statistically significantly different among the surgical techniques, although endothelial damage was lower in Group 3, which could indicate a protective effect of the anterior capsule during cataract extraction. Endothelial barrier function remained disturbed despite the apparent morphological stabilization.

Endothelial morphological and functional evaluation after cataract surgery.

PURPOSE: To assess endothelial barrier function, morphological appearance and corneal thickness three months after cataract surgery in order to evaluate intraoperative endothelial damage. METHODS: Endothelial permeability was examined by fluorophotometry, and contact specular microscopy and corneal pachymetry measurements were made in 40 patients (40 eyes) with senile, non-complicated cataracts one month before and three months after cataract surgery. Twenty eyes underwent uneventful phacoemulsification (Group 1) and 20 uneventful extracapsular cataract extraction (ECCE) with continuous curvilinear capsulotomy (Group 2). Results were analyzed using the two-tailed Student's t test, analysis of variance, and multifactorial and regression analysis. RESULTS: There was a significant postoperative increase in endothelial permeability in both groups (p < 0.001), but no real differences between the postoperative values (p = 0.07). Mean cell loss was 15.2% in ECCE and 18.3% in phacoemulsification (p = 0.4). There was a significant linear correlation between ultrasound time, cell loss and functional damage. Postoperative pachymetric measurements were not significant. CONCLUSIONS: Endothelial response showed no differences between the surgical techniques. Endothelial barrier function remained disturbed in spite of the apparent morphological stabilization. Corneal pachymetry is not useful for assessing postoperative endothelial changes.

[Latency times and preadmission procedures]. / Tiempos de latencia. Intervención prehospitalaria.

During focal cerebral ischemia, irreversible changes occur at the core of the lesion, whereas energy metabolism and ion homeostasis are preserved in the surrounding penumbra. Not all brain cells are killed at the start of a stroke; some are destroyed hours or days later, usually by toxins released during the early stages. Time is therefore the critical factor in treating acute ischemic stroke. Early management by the neurologist is associated to better functional outcome and shorter hospital stays. Patient evaluation and treatment must therefore take place as soon as possible.