Uso de un nuevo protocolo clínico fotográfico-computacional en el registro de la fluorescencia visible inducida por radiación ultravioleta en dientes humanos / Use of a new clinical photographic-computational protocol to register the ultraviolet-induced visible fluorescence in human teeth

RESUMEN: Los dientes humanos experimentan fluorescencia visible al ser sometidos a radiación ultravioleta, la cual varía de color a medida que el diente envejece. Objetivo: el presente estudio buscó desarrollar un protocolo clínico sencillo usando fotografía digital y análisis computacional para determinar la fluorescencia visible inducida por radiación ultravioleta (FVIUV) en dientes anteriores de pacientes de distintos grupos etarios. Materiales y Métodos: 35 participantes de 5 grupos etarios fueron reclutados. 70 incisivos centrales superiores fueron fotografiados utilizando como fuente de iluminación luz UV. Cada imagen obtenida fue analizada con el software computacional ImageJ para obtener las coordenadas de color en el espacio CIELab para la corona completa. Los datos obtenidos fueron analizados mediante las pruebas estadísticas de ANOVA y post-hoc de Tukey HSD. Resultados: Se obtuvieron las magnitudes de FVIUV en las tres dimensiones del espacio de color CIELab en la corona completa. Esta FVIUV se manifestó en el espectro del color verdeazulado para todos los grupos etarios, los cuales presentaron diferencias de saturación y luminosidad según tramo etario. Conclusiones: El protocolo aplicado en presente estudio permitió la cuantificación de la FVIUV dentaria en distintos grupos etarios.

ABSTRACT: Human teeth experience visible fluorescence when subjected to ultraviolet radiation, which varies in color as the tooth ages. Objective: The present study sought to develop a simple clinical protocol using digital photography and computational analysis to determine the difference in visible fluorescence induced by ultraviolet radiation (FVIUV) in anterior teeth of patients of different age groups. Materials and Methods: 35 participants from five age groups were recruited. 70 upper central incisors were photographed using UV light as the illumination source. Each image obtained was analyzed with ImageJ computer software to obtain the color coordinates in CIELab space for the entire crown. The data obtained was analyzed using the ANOVA and Tukey HSD post-hoc statistical tests. Results: Visible fluorescence magnitudes were obtained in the three dimensions of the CIELab color space in the complete crown. This FVIUV was registered in the spectrum of the blue-green color for all age groups, which presented differences in saturation and luminosity according to age group. Conclusions: The protocol applied in this study allowed the quantification of dental FVIUV in different age groups.

Estafiloma peripapilar, presentación clínica y diagnósticos diferenciales en anomalías congénitas de nervio óptico / Peripapillary staphyloma, clinical presentation, and differential diagnoses in congenital optic nerve anomalies

Un paciente de 3 meses con sospecha de estrabismo presenta al examen una gran anisometropía con -9.50 esfera en su ojo izquierdo y al fondo de ojo destaca una papila alterada similar a la papila de Morning-Glory. Las anomalías congénitas de nervio óptico (ACNO) son un grupo de condiciones que se presentan clínicamente como baja agudeza visual, estrabismo y/o nistagmus. El diagnóstico dife-rencial es clínico y complejo por la sobre posición morfológica entre estas. Los principales diagnósticos diferenciales son la papila deMorning-Glory, el coloboma y la hipoplasia de nervio óptico. Se recomienda manejo multidisciplinario por sus asociaciones sistémicas.

A 3-month-old patient with a suspicion of strabismus on examination has a great anisometropia with -9.50 sphere in his left eye and at the fundus examination an altered papilla similar to the Morning-Glory papilla. Congenital optic nerve abnormalities (ANOC) are a group of conditions that present clinically as low visual acuity, strabismus, and nystagmus. The differential diagnosis is clinical and complex due to the morphological position between them. The main differential diagnoses are the Morning-Glory papilla, the coloboma, and optic nerve hypoplasia. Multidisciplinary management is recommended for its systemic associations.

Paquimeningitis relacionada con IgG4 y la visión. Reporte de caso / Ophthalmological manifestations of IgG4-related pachymeningitis. A case repor

Introducción: la inmunoglobulina G4 es un subtipo de inmunoglobulina G que corresponde a menos del 5% del total de inmunoglo-bulinas. Niveles elevados de esta molécula se han asociado con el desarrollo de diferentes patologías. Método: presentación de caso clínico. Resultados: se presenta el caso de una mujer de 51 años que consultó por disminución de agudeza visual, escotoma central en ojo izquierdo y edema de papila bilateral. Se encontraron signos compatibles con paquimeningitis en la resonancia nuclear magnética. También presentó aumento de presión de apertura en la punción lumbar. En el estudio de laboratorio se observó un aumento en los niveles plasmáticos de IgG4, lo cual llevó al diagnóstico de paquimeningitis relacionada con IgG4. La paciente fue tratada con corticoides y azatioprina, con excelente evolución posterior al normalizar agudeza visual y campos visuales. Conclusión: en este artículo se describen tres elementos importantes a considerar en estos pacientes: pérdida de visión, edema de discos ópticos y cambios en campo visual.

Introduction: G4 immunoglobulin is 5% of total immunoglobulins in plasma. Elevated levels of this protein are associated with several diseases. Methods: clinical case report. Results: we report a case of a 51-year-old woman who presented with loss of vision, a central scotoma over her left eye and bilateral optic disc edema. She had findings compatible with pachymeningitis based on magnetic resonance imaging. She also exhibited an increased opening pressure in lumbar puncture. In the laboratory workup, we found a two-fold increase in IgG4 levels, which led to a diagnosis of pachymeningitis related to IgG4. The patient was treated accordingly with corticosteroids and azathioprine. The patient experienced excellent progression with complete recovery of her visual acuity and normalization of the visual fields. Conclusion: there is three elements to consider in these patients: vision loss, optic disc edema and visual field changes.

Paresia recurrente de sexto nervio craneano asociado a hipoplasia de sexto nervio / Recurrent paresis of sixth cranial nerve associated with sixth nerve hypoplasia

La paresia de sexto nervio craneano recurrente es una entidad ampliamente conocida en la población pediátrica que ha sido asociado a múltiples etiologías, siendo las más frecuentes las infecciones virales o postinmunizaciones. A continuación, exponemos el caso de una niña de 5 años que presenta 2 episodios de déficit de abducción del ojo izquierdo debido a paresia de sexto nervio craneano, que se resolvieron espontáneamente. El estudio con resonancia magnética reveló hipoplasia del sexto nervio craneano izquierdo.(AU)

Recurrent sixth nerve palsy is a well-known entity in pediatric population associated to multiple causes, most frequently viral infection or immunization. We report a case of a 5 years old girl who presents two episodes of left abduction deficit due to sixth nerve palsy that partially resolved spontaneously. A magnetic resonance imaging study revealed a hypoplastic left sixth nerve.(AU)

An unusual case of congenital primitive neuroectodermal tumor with ocular metastasis.

Primitive neuroectodermal tumor (PNET) is most common in the second decade of life. Congenital PNET is very rare. Ocular metastasis of PNET is likewise exceedingly rare; with only 5 previously published cases. We report an unusual congenital PNET of the face, which metastasized to subcutis, eyes, and brain. The primary tumor responded to chemotherapy (vincristine/doxorubicin/cyclophosphamide) with metachronous progression of ocular lesions. A therapeutic trial of intraocular bevacizumab showed no efficacy on intraocular lesions. Eventually the patient developed cerebral metastasis, and second line therapy with topotecan/cyclophosphamide was initiated. The tumor progressed and the patient died after acute herniation.

Cellular inflammation in nonarteritic anterior ischemic optic neuropathy and its primate model.

OBJECTIVE: To correlate potential inflammatory responses in nonarteritic anterior ischemic optic neuropathy (NAION) with a lesion possessing many physiologic and histologic similarities from a model of nonhuman primate NAION (pNAION). METHODS: Using immunohistochemistry and confocal microscopic analysis, we evaluated the relative numbers of inflammatory cell types in the single available clinical specimen of early NAION (21 days after event). We correlated this with the temporal inflammatory response occurring in optic nerve tissue at different times following pNAION induction. RESULTS: In pNAION, there is a previously unsuspected infiltration of polymorphonuclear leukocytes occurring almost immediately after infarct induction, followed by invasion of ED1+ extrinsic macrophages, which peaks 5 weeks after infarct. Intrinsic microglia accumulate up to 70 days after induction in the area of primary axonal loss. The analyzed human NAION specimen was similar to 21-day pNAION tissue, with extrinsic macrophages and intrinsic microglial cells in the region of focal axon loss. CONCLUSIONS: Cellular inflammation plays a major early role following white-matter (optic nerve) infarct, with both polymorphonuclear leukocyte and macrophage function involved in debris elimination and tissue remodeling. The optic nerve in NAION and its primate model are associated with early cellular inflammation, previously unsuspected, that may contribute to postinfarct optic nerve damage.

Anterior segment complications after diode laser photocoagulation for prethreshold retinopathy of prematurity.

PURPOSE: To evaluate anterior segment complication rates in eyes treated for prethreshold versus threshold retinopathy of prematurity (ROP) and look for potential risk factors. DESIGN: Retrospective, observational case series study. METHODS: All patients treated with diode laser for ROP between 1995 and 2007 were identified. A total of 259 eyes of 184 patients were studied, 120 eyes in the pretheshold group and 139 eyes in the threshold group. We compare baseline characteristics, treatment parameters, ocular complications, and structural outcomes after treatment. The main outcome measured was anterior segment complication rates in eyes treated for prethreshold versus threshold ROP and we looked for potential risk factors. RESULTS: Thirteen of 120 eyes treated at prethreshold had anterior segment complications versus 0 of 139 treated at threshold (P < .01). All eyes developed post-laser hyphema, 3 with elevated intraocular pressure. Three eyes developed cataract (2 requiring cataract extraction); 1 required treatment for band keratopathy. The mean postmenstrual age at treatment was significantly different between the prethreshold and threshold groups (36.6 vs 37.9 weeks, P = .03); eyes with anterior segment complications were treated at mean postmenstrual age of 35.7 weeks. No difference was found based on gestationtal age at birth, birth weight, zone, stage, or number of laser spots for eyes with anterior segment complications. Most anterior segment complications (77%) resolved without long-term sequelae. CONCLUSIONS: Younger postmenstrual age at laser treatment may be related to an increased risk of anterior segment complications, which should be recognized and managed appropriately.

Short tag noose technique for optional and late suture adjustment in strabismus surgery.

OBJECTIVE: To present and evaluate a new technique that allows the second-stage suture adjustment in strabismus surgery to be skipped or delayed if the immediate postoperative alignment is satisfactory. METHODS: The "short tag noose" technique replaces long sutures with short tags that can be left under the conjunctiva after adjustment. Retrospectively, the medical records of all patients treated by a single surgeon with this approach between January 1, 2005, and December 31, 2008, were evaluated for success rate (< or =10 prism diopters [PD] horizontal and < or =6 PD vertical), reoperation rate, and complications. RESULTS: Of 120 procedures reviewed, 27 (22.5%) were performed in children; 97 procedures (80.8%) were performed in patients with complex strabismus. Mean follow-up was 6 months. The success rate was 81.0% for horizontal strabismus and 70.7% for vertical strabismus at 2 months. The reoperation rate was 10.0% for horizontal strabismus and 19.0% for vertical strabismus. The noose slipped in 1 patient (0.8%) and was corrected by readjustment on day 4. Two patients (1.7%) required in-office excision of cysts or granulomas. CONCLUSIONS: The short tag noose technique simplifies the logistics of suture adjustment and avoids the need for sedation in children who do not require adjustment. It provides the ability to defer adjustment for days after surgery.

Effects of natural flavones and flavonols on the kinase activity of Cdk5.

A number of natural and synthetic flavonoids have been assessed previously with regard to their effects on the activity of cyclin-dependent kinases (Cdk1 and -2) related to the inhibition of cell cycle progression. On the other hand, the Cdk5/p35 system is of major importance in neuronal migration phenomena and brain development, and its deregulation is implicated in neurodegenerative diseases, particularly Alzheimer's. Here we show that some natural flavonoids inhibit the activity of the Cdk5/p35 system in the micromolar range, while others are practically inactive. Ring B-unsubstituted and highly methoxylated flavones were inactive or gave irreproducible results, and 6-methoxyapigenin and 6-methoxyluteolin were the most potent Cdk5 complex inhibitors within this series, while the common flavonols kaempferol and quercetin showed intermediate behavior. The reported crystal structure of the Cdk5 complex with its activator p25 was used for docking studies, which also led to the identification of the two 6-methoxyflavones, kaempferol and quercetin, as well as the untested 6-methoxy derivatives of kaempferol and quercetin and the corresponding 6-hydroxy analogues as compounds exhibiting a good fit to the active site of the enzyme.