Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control.

PURPOSE: To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure. MATERIAL AND METHODS: Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2). RESULTS: Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment. CONCLUSIONS: Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.

A multi-residue pesticide determination in fatty food commodities by modified QuEChERS approach and gas chromatography-tandem mass spectrometry.

A QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) based multi-residue method has been developed and validated for the extraction and determination of pesticides in fatty matrices by gas chromatography tandem mass spectrometry. Extraction and clean-up were performed according to QuEChERS principles widely used for non-fatty matrices, with main difference, a higher solvent/sample- ratio followed by a 6-fold preconcentration step, ensuring good extractability and sensitivity. A validation according to SANTE guidelines was performed using a olive and sunflower oils mixture 1:1, w/w as representative matrix, at 2 concentration levels (5 and 50 µg/kg) targeting 176 GC-amenable pesticides. Most compounds fulfilled the validation criteria, with a limit of quantification of 5 µg/kg for 137 compounds , and of 50 µg/kg for 24 compounds. Afterwards, the method performance was tested in six different fatty matrices with 73-90% of the analytes fulfilling the performance criteria at 5 µg/kg depending on the matrix.

Quantification of folpet and phthalimide in food by gas chromatography and mass spectrometry: Overcoming potential analytical artefacts.

Accurate quantification of folpet is problematic because it degrades into phthalimide during sample preparation and analysis by gas chromatography (GC). Thus, EU regulation was recently modified to include phthalimide in the folpet residue definition. However, recent studies have shown that phthalimide could also be generated from different sources, which could lead to an overestimation of the phthalimide content and therefore to false positives. GC coupled with either negative chemical ionisation and single quadrupole mass spectrometry, or electron ionisation with triple quadrupole mass spectrometry (GC-EI-MS/MS), were evaluated for the determination of folpet and phthalimide in food. Both methods were validated in 4 different matrices namely apple puree, rice flour, raspberry puree and infant formula. Better selectivity and precision were obtained with GC-EI-MS/MS. Negligible amounts of phthalimide was found in blank matrices, and validation results met the SANTE/11813/2017 criteria in all matrices at the LOQ concentration levels by using GC-EI-MS/MS.

Determination of pesticides in fatty matrices using gel permeation clean-up followed by GC-MS/MS and LC-MS/MS analysis: A comparison of low- and high-pressure gel permeation columns.

Two low-pressure columns (Bio-Beads SX-3) and three high-pressure GPC columns were compared for clean-up of a wide range of pesticides in fatty matrices of vegetable or animal origin. The GPC fractions were analyzed by GC-MS/MS and LC-MS/MS without additional clean-up. The performance of the GPC clean-up on the five column types was compared in terms of solvent consumption, lipid removal, pesticide recovery and repeatability. It was found that for fatty matrices, mainly consisting of high molecular weight triglycerides i.e. most vegetable oils and animal fats, good fractionation is obtained for the majority of the pesticides. On the other hand, for fats and oils containing relatively high amounts of low molecular weight triglycerides, i.e. butter fat and palm kernel oil, none of the columns provided sufficient clean-up and cause interferences and system contamination, especially in the case of GC-MS/MS analysis. For the latter case, best results in terms of lipid removal and pesticide recovery were obtained on a set (2×300mmlength) of narrow bore (7.5mm ID) columns packed with 5µm PL Gel material. Column loadability is, however, much lower on that set of columns compared the other evaluated GPC columns, impairing overall method sensitivity.

Method optimization and validation for the determination of eight sulfonamides in chicken muscle and eggs by modified QuEChERS and liquid chromatography with fluorescence detection.

A simple, effective and reliable method for the determination of eight sulfonamide antibiotics (sulfadiazine, sulfapiridine, sulfamerazine, sulfamethazine, sulfachloropiridazine, sulfamethoxazole, sulfadoxine, sulfadimethoxin) in chicken muscle and eggs by liquid chromatography and fluorescence detection has been developed and validated. Sulfonamides do not present native fluorescence, however their direct determination was achieved by on-line post-column photochemical derivatization by UV irradiation. Sample treatment was based on QuEChERS with several modifications depending on the matrix. Egg extracts were cleaned-up using PSA for the dispersive solid phase extraction step. On the other hand, a new clean-up sorbent, Supel™ QuE Z-Sep(+), has been successfully applied in chicken muscle extract and has proved to be effective for interference removal from this matrix. Under optimum conditions, recoveries from 65.9 to 88.1%, relative standard deviations lower than 10% (except for sulfachloropiridazine), and limits of quantification (LOQs) from 14 to 85 µg kg(-1) were achieved. Thus, the method complies with current European requirements.

The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach.

Despite aggressive efforts to cure head and neck cancer patients, including altered fractionation and the addition of chemotherapy to radiation, locoregional recurrence remains a serious issue to face in clinical practice. Indeed, recurrent and second primary tumors occurring in previously irradiated area are common clinical challenge. Whenever possible, patients are advised to undergo salvage surgery. Nevertheless, few patients are suitable candidates for curative resection. In such cases, chemotherapy alone has traditionally been considered, with a poor response rate. It has been questioned whether re-irradiation toxicity outweighs the potential benefits, considering that the median survival of re-irradiated patients marginally exceeds the benefits observed with chemotherapy alone. However, full-dose re-irradiation is a viable treatment option, offering long-term survival for selected patients. Moreover, several prognostic factors should be considered for patients undergoing re-irradiation, such as basic patient characteristics, performance status, the location and extension of recurrent disease, patient co-morbidities, current speech and swallowing function, the interval from the initial radiation therapy to recurrence, previously received doses by critical structures and prior treatment toxicity. Nevertheless, several questions remain unanswered. The purpose of this review is to evaluate the major issues in the field of re-irradiation regarding the current evidence. Therefore, the major selection criteria and new treatment strategies are discussed to define the ideal candidates to undergo re-irradiation and describe a practical approach to these patients. Given the limited evidence in this field, the optimal treatment of recurrent and second primary cancers remains to be defined. Future prospective study of this approach is warranted.

[Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation]. / Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada.

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

Modificación de la posición horizontal con el plegamiento unilateral del músculo recto inferior para el tratamiento quirúrgico de la desviación vertical disociada / Modification of horizontal position with unilateral tucking of inferior rectus muscle in the surgical treatment of dissociated vertical deviation

Introducción: La cirugía de reforzamiento unilateral del recto inferior es una alternativa terapéutica en el tratamiento quirúrgico de la desviación vertical disociada (DVD), indicada en casos de DVD muy asimétrica con mala visión monocular. Dado que el músculo recto inferior tiene como acción secundaria la aducción, al realizar un reforzamiento amplio de éste puede modificarse hacia adentro la posición horizontal. El objetivo del presente estudio fue conocer la modificación de la posición horizontal después del plegamiento monocular en U del músculo recto inferior del ojo con mala visión. Material y métodos: Se realizó plegamiento del recto inferior monocular en 10 pacientes con DVD espontánea, sin cirugía horizontal y mala visión monocular; se llevó a cabo seguimiento mínimo de seis meses. Se cuantificó la magnitud de la desviación horizontal en dioptrías prismáticas (dp) en el pre y posoperatorio. El análisis estadístico se realizó con U de Mann- Whitney, con nivel de significancia de 0.05. Resultados: La desviación preoperatoria osciló entre 20 dp de exotropía y 10 dp de endotropía (± 10.34); en el posoperatorio, de 12 dp de exotropía a 15 dp de endotropía (± 7.82). La posición horizontal se modificó entre 2 y 15 dp hacia adentro, con una media de 9.4 ± 3.70 dp (p = 0.03). Conclusiones: El reforzamiento monocular del recto inferior modifica 9.4 dp en promedio la posición horizontal hacia adentro.(aU)

BACKGROUND: Unilateral tucking of the inferior rectus muscle is a therapeutic alternative in the surgical treatment of dissociated vertical deviation (DVD). It is usually performed in asymmetric DVD associated with monocular low vision. Adduction is a secondary action of the inferior rectus muscle. If excessive reinforcement is done, the horizontal position can be modified toward esotropia. We undertook this study to evaluate the horizontal position modification after unilateral tucking of the inferior rectus muscle. METHODS: Unilateral tucking of the inferior rectus muscle was done in 10 patients with spontaneous DVD, without horizontal surgery and poor monocular vision. Follow-up was done for 6 months. Horizontal deviation in prism diopters (PD) was measured. For statistical analysis, Mann-Whitney U test was used with a significance level of 0.05. RESULTS: Preoperatively, horizontal deviation was between 20 PD of exotropia and 10 PD of esotropia (+/-10.34 SD). Postoperatively, horizontal deviation was between 12 PD of exotropia and 15 PD of esotropia (+/-7.82 SD). Horizontal deviation was modified between 2 and 15 PD towards esotropia, on average 9.4 PD (+/-3.70 SD) ( p = 0.03). CONCLUSIONS: Monocular inferior rectus muscle reinforcement modifies the horizontal position on average 9.4 PD towards esotropia.

[Results with botulinum toxin in patients with esotropia and psychomotor deficit]. / Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor.

OBJECTIVE: We undertook this study to evaluate the results of the treatment with botulinum toxin in patients with esotropia and psychomotor delay. METHODS: Patients with esotropia and delayed psychomotor development, in rehabilitation therapy and without previous surgery were included. A complete ophthalmological and strabismological exploration was performed including cycloplegic refraction with atropine 1%. Botulinum toxin was applied under sedation in both internal recti. Results were evaluated 1 week, 1 month, 3 and 6 months and after 1 year of application. The reinjection was decided if a 25 DP esotropia or greater was obtained before 3 months of the first application. A good result was considered in patients who had 10 DP of deviation and variability <10 DP. RESULTS: Thirty two patients were included. There were 14 were women and 18 men with an age range from 5 months to 5 years (average 16.8 months). Eighteen patients had variability in the angle of deviation from 20 to 45 DP of esotropia and 14 without variability with an average of 39.12 DP. Thirteen patients were reinjected. A good result was obtained in 10 patients, fair in 17 patients and poor in 5 patients due to persistence of variability in four cases and 15 DP hypertropia in one. CONCLUSIONS: Application of botulinum toxin is a therapeutic alternative in patients with esotropia and psychomotor delay.

Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor / Results with botulinum toxin in patients with esotropia and psychomotor deficit

Objetivo: Evaluar los resultados del tratamiento con toxina botulínica en pacientes con endotropía y retraso psicomotor. Material y métodos: Se incluyeron pacientes con endotropía y retraso del desarrollo psicomotor menores de siete años, en tratamiento de rehabilitación y sin cirugía previa. Se les realizó exploración oftalmológica y estrabológica completa incluyendo cicloplejía con atropina a 1 %. Se aplicó toxina botulínica en ambos rectos internos bajo sedación y se evaluaron los resultados a la semana, al mes, a los tres y seis meses y al año. Se decidió reinyección si se obtuvo endotropía residual mayor de 25 dioptrías (dp) antes de los tres meses de la primera aplicación. Se consideró un buen resultado cuando hubo desviación dentro de las 10 dp y variabilidad menor o igual a 10 dp. Resultados: Se incluyeron 32 pacientes, 14 mujeres y 18 hombres. El rango de edad era de cinco meses a cinco años, con un promedio de 16.8 meses. Se encontraron 18 pacientes con variabilidad en el ángulo de desviación de 20 a 45 dp de endotropía y 14 sin variabilidad, con un promedio de 39.12 dp. Se reinyectaron 13 pacientes. En 10 pacientes hubo buen resultado, en 17 regular y en cinco malo. Los malos resultados fueron por persistencia de variabilidad importante en cuatro pacientes y en uno hipertropía mayor de 15 dp.Conclusiones: La aplicación de toxina botulínica es una alternativa terapéutica en pacientes con endotropía y retraso psicomotor.

OBJECTIVE: We undertook this study to evaluate the results of the treatment with botulinum toxin in patients with esotropia and psychomotor delay. METHODS: Patients with esotropia and delayed psychomotor development, in rehabilitation therapy and without previous surgery were included. A complete ophthalmological and strabismological exploration was performed including cycloplegic refraction with atropine 1%. Botulinum toxin was applied under sedation in both internal recti. Results were evaluated 1 week, 1 month, 3 and 6 months and after 1 year of application. The reinjection was decided if a 25 DP esotropia or greater was obtained before 3 months of the first application. A good result was considered in patients who had 10 DP of deviation and variability <10 DP. RESULTS: Thirty two patients were included. There were 14 were women and 18 men with an age range from 5 months to 5 years (average 16.8 months). Eighteen patients had variability in the angle of deviation from 20 to 45 DP of esotropia and 14 without variability with an average of 39.12 DP. Thirteen patients were reinjected. A good result was obtained in 10 patients, fair in 17 patients and poor in 5 patients due to persistence of variability in four cases and 15 DP hypertropia in one. CONCLUSIONS: Application of botulinum toxin is a therapeutic alternative in patients with esotropia and psychomotor delay.

Determination of N-methylcarbamate pesticides in water and vegetable samples by HPLC with post-column chemiluminescence detection using the luminol reaction.

In this paper we proposed a reverse high performance liquid chromatography method for the simultaneous determination of three N-methylcarbamates (NMCs) named carbofuran, carbaryl and methiocarb, using the post-column chemiluminescence (CL) detection with the luminol reaction. This method is based on the enhancing effect of these analytes on the CL emission generated by the oxidation of luminol with potassium permanganate in alkaline medium. The separation was reached in less than 14 min using a C18 column and an isocratic binary mobile phase consisting of acetonitrile:water (50:50, v/v) pumped at a flow rate of 1 mL min(-1). CL reagents (luminol and KMnO(4)) were incorporated by means of a peristaltic pump and were firstly mixed using a three-way connector. Then this stream was mixed with the eluate using another three-way connector just before reaching the detection cell. The optimization of variables affecting the CL reaction (reaction medium, concentration, flow rate of reagents and distance between both connectors) were optimized by means of experimental designs. Ethiofencarb, a NMC which has nowadays fallen into disuse was used as internal standard. For the analysis of theses pesticides in real water samples a pre-treatment step consisting of solid phase extraction (SPE) was conducted in order to reach sensitivity levels below the legal maximum concentration permitted. In the case of vegetable sample, SPE was used for matrix cleaning purpose.

Targeting cancer stem cells with monoclonal antibodies: a new perspective in cancer therapy and diagnosis.

This review discusses some of the impacts that biotechnology, genomics and nanotechnology convergence should have on future cancer management, in particular, the development of innovative diagnostic and therapeutic approaches based on monoclonal antibodies (mAbs) and cancer stem cells. Emergent therapeutic strategies in cancer have been focusing on the use of mAbs to stimulate an immune response against tumors, to block signaling pathways, or to refine delivery of cytotoxic agents. Now that cancer stem cells are being identified and characterized in different tumor types, their relevance to cancer physiopathology is becoming evident, making them natural targets for mAb development. Cancer stem cells are postulated to be responsible for tumor development, metastasis and relapse after conventional therapies. Therefore, mAbs targeting specific antigens and related pathways altered in cancer stem cells should facilitate earlier diagnosis through molecular imaging techniques and more efficient destruction of tumor initiating cells, thus improving clinical outcome.

[Clinical classification of variable angle exotrophy]. / Clasificación clínica de la exotropía de ángulo variable.

BACKGROUND: Variable exotropia is determined by a series of mechanisms that provide different clinical characteristics to outline individual therapy. There is no specific categorization that can identify such an entity. A clinical classification is proposed that includes different clinical features in accordance with the mechanisms involved in the variability genesis of such exotropias. METHODS: Patients with a diagnosis of variable angle exotropia without previous surgery were included. A complete ophthalmic and strabismus exploration was performed. Variability characteristics were studied and grouped by entries in the classification proposed. RESULTS: Ninety patients were examined from the Pediatric Ophthalmology and Strabismus Unit of the General Hospital of Mexico O.D., with a diagnosis of variable angle exotropia. The following forms of presentations were found: secondary variable angle exotropia due to neurological alteration in 32 cases (35.5%), secondary variable angle exotropia due to monocular bad vision in 19 cases (21.2%), dissociated horizontal deviation in 14 cases (15.5%), mixed variable angle exotropia in 22 cases (4.5%) and primary variable angle exotropia in 3 cases (3.33%). CONCLUSIONS: This classification allows categorization of all patients of variable angle exotropia into proposed categories. The most common mechanism responsible for variability is neurological alteration. Primary variable angle exotropias are rare and are present in a minimum percentage.

[Unilateral tucking of the inferior rectus muscle for dissociated vertical deviation]. / Plegamiento del recto inferior unilateral para el tratamiento de la desviación vertical disociada.

BACKGROUND: There are several options for the treatment of dissociated vertical deviation (DVD). The most discouraging results are those cases of poor vision. The fold of the inferior rectus is presented as a therapeutic option for poor vision. METHODS: Patients with spontaneous DVD and monocular poor vision were included. A maximum folding of the inferior rectus was performed only in the eye with poor vision. Evaluation of the spontaneity and magnitude of the DVD was done in the pre- and postoperatively with a minimum 6-month follow up. RESULTS: Nineteen patients were included, finding a decrease in the spontaneity (p = 0.05) and the magnitude of the DVD (p = 0.01) at the maximum follow-up time. Limitation of the elevation of 2+ was observed in the immediate postoperative period in all cases. The limitation remained in 16 patients. In two patients, hypotropia of 5 DP was observed in the primary position. No cases of alteration of the lower palpebral position were observed. CONCLUSIONS: Unilateral maximum tucking of the inferior rectus muscle decreases the magnitude and spontaneity of DVD.

Correlación objetivo-cosmética del resultado de la cirugía para la corrección del estrabismo horizontal / Correlation objective-cosmetic outcome of surgery for horizontal strabismus correction

Introducción: Los resultados del tratamiento del estrabismo se reportan generalmente como buenos cuando se encuentran dentro de las 10 DP de desviación postoperatoria de hipo o hipercorrección. Objetivo: La justificación del presente estudio es conocer el grado de correlación existente entre el aspecto cosmético subjetivo y la medición objetiva en dioptrías prismáticas en el resultado del tratamiento quirúrgico del estrabismo. Material y método: Se realizó un estudio prospectivo incluyendo a aquellos pacientes con estrabismo horizontal a quienes se les hubiese practicado un procedimiento quirúrgico correctivo. Aleatoriamente se solicitó a uno de los cuatro médicos oftalmólogos especialistas en estrabismo que emitiera un concepto subjetivo sobre el resultado quirúrgico basado en la siguiente escala: E excelente: aparente ortoposición; B bueno: desviación pequeña; R regular: desviación mediana (notoria); y M malo: desviación grande. Después se procedió a documentar el estudio clínico objetivo, para relacionarlos. Resultados: Se incluyeron 79 pacientes. La evaluación subjetiva mostró que 39 casos presentaban una aparente ortoposición (E) (49,37 por ciento), 29 una desviación pequeña (B) (36,71 por ciento), 10 una desviación mediana (R) (12,66 por ciento), y 1 solo caso una desviación grande (M) (1,26 por ciento). En la evaluación objetiva se encontraron 49 pacientes (62,03 por ciento) dentro de las 10 DP de desviación postquirúrgica. Conclusiones: En la evaluación del resultado quirúrgico para la corrección de los estrabismos es importante tomar en cuenta otros factores diferentes a la medición clínica objetiva y absoluta de las 10 DP desde la ortoposición.

Introduction: Surgical results in strabismus are generally considered good if the post operative if the post operative deviation is within 10 prismatic diopters of orthotropia. Purpose: To investigate correlation between subjective cosmetic and objective measurements in surgical results. Material and Methods: Prospective study including all horizontal strabismus patients on which a surgical procedure was performed. One of four strabologists was asked randomly to judge subjetivelly the surgical result based on the following scale. E: Excellent, apparent orthotropia; B: Good, small deviation; R: Regular, notorious deviation; and M: Bad, evident deviation. This assessment was then correlated with the objective clinical evaluation of patients. Results: 79 patients were included. Subjective evaluation showed that 39 had apparent oethotropia (E= 49.37 percent), 29 a small deviation (G= 36.71 percent), 10 a noticiable deviation ( R= 12.66 percent) and only one case a big deviation (B= 1.26 percent). Objective evaluation showed that 49 patients (62.03 percent) were within 10 prismatic diopeters of alignement. Conclusion: It is important to consider factors other than objective measurements (< 10 PD) in the evaluation of strabismus surgical results.

[Treatment of spontaneous dissociated vertical deviation with the pharmacological penalization of the fixing eye]. / Tratamiento de la desviación vertical disociada espontánea con penalización farmacológica del ojo fijador.

BACKGROUND: Dissociated vertical deviation (DVD) is a common innervational entity frequently found in patients with congenital endotropia. It is characterized as being bilateral, asymmetric, and to a greater extent, in the non-fixating eye. It can be compensatory or non-compensatory. In the majority of cases, surgery is the treatment of choice, but spontaneous appearance of DVD is a common occurrence after surgery, sometimes to a degree similar to that prior to surgery. OBJECTIVE: Our aim was to evaluate the behavior of dissociated vertical deviation with penalization of the fixating eye. MATERIAL AND METHODS: An experimental and longitudinal study was conducted in which patients with spontaneous DVD were included, whether or not associated with horizontal deviation, with or without previous surgery. Atropine (1%) was applied every 24 h in the fixating eye for 3 months and DVD presence, magnitude, and spontaneity were evaluated at 15 days, 1 month, 3 months, and 1 month after penalization suspension. RESULTS: Eight patients were included. DVD magnitude decreased with penalization (p = 0.02) and remained unchanged when atropine was suspended (p = 0.6). With regard to decompensatory phases, DVD shifted from spontaneous to non-spontaneous during penalization (p = 0.01); when this was eliminated, deviation showed decompensation again (p = 0.03). CONCLUSIONS: Fixating eye penalization with 1% atropine reduces DVD magnitude and decompensatory phases during follow-up.

Frecuencia de las desviaciones verticales asociadas a los estrabismos secundarios / Frecuency of the vertical deviations associated to sensory strabismus

Se determinó la frecuencia de las alteraciones verticales en los estrabismos secundarios y la relación con el tipo de desviación horizontal.Se incluyeron 89 pacientes con diagnóstico de estrabismo secundario, dividiéndose en dos grupos de acuerdo a la dirección de la desviación horizontal, comparando las alteraciones verticales encontradas en ambos grupos. La información se analizó mediante porcentajes y la prueba exacta de Fisher.De los 89 pacientes, 49 eran del sexo femenino y 40 del masculino con un promedio de edad de 18.25 años. En el 79 por ciento se encontró exotropia y en el 21 por ciento endotropia. En el grupo de exotropias se observó algún tipo de alteración vertical en el 81 por ciento de los casos y de ésta la más frecuente fue la hiperfunción de los cuatro músculos oblicuos en el 36 por ciento. En el 68 por ciento de las endotropias se observó alteración vertical, siendo la más frecuente la hiperfunción bilateral de los oblicuos inferiores en el 11 por ciento. No se encontró diferencia en la frecuencia de alteraciones verticales entre endotropias y exotropias (p = 0.2). La hiperfunción de los cuatro oblicuos es característica de las exotropias (p = 0.01). La alteración vertical monocular se encontró exclusivamente en el ojo desviado, independientemente del tipo de la desviación horizontal asociada (p = 0.03).En esta serie la exotropia fue el estrabismo secundario más frecuente, asociado a la hiperfunción de los cuatro músculos oblicuos y la alteración vertical que con mayor frecuencia se encontró en las endotropias fue la hiperfunción bilateral de los oblicuos inferiores.

Alteraciones de la movilidad ocular en paralisis cerebral / Alterations of ocular motility in cerebral palsy

Introducción y objetivo. El estrabismo es una de las alteraciones oftalmológicas más frecuentes en los pacientes con parálisis cerebral (PC). El objetivo de este estudio fue determinar el tipo, frecuencia y características del estrabismo en pacientes con diangnóstico confirmado de PC. Pacientes y método. Se realizó un estudio prospectivo, longitudinal y descriptivo en pacientes con diagnóstico confirmado de PC, se estudiaron el tipo, frecuencia y características del estrabismo y se correlacionó con el tipo y severidad de la parálisis cerebral. Resultados. Se estudiaron 140 pacientes, el promedio de edad fue de 5.7 años con un recorrido de 1 a 15 años, la alteración topográfica más frecuente fue la cuadriplejia en un 75 por ciento de los casos, la parálisis fue espástica en el 67 por ciento. Se encontró algún tipo de alteración de la movilidad ocular en el 67 por ciento. La alteración predominante fue la exotropia en 58 (62 por ciento), siguiendo en orden de frecuencia las endotropias en 19 (20 por ciento) y cuadros paralíticos en 11 (12 por ciento). Se observó variabilidad en el ángulo de la desviación en el 48 porciento de los casos. No se encontró correlación entre el tipo y la severidad de la PC y las alteraciones de la movilidad ocular. Conclusión. La presencia de exotropia con variabilidad en la magnitud del ángulo de la desviación en los pacientes con PC es la alteración predominante de la movilidad ocular

Comportamiento de la relación de convergencia acomodativa sobre acomodación (CA/A) en la endotropía acomodativa secundaria a hipermetropía / Clinical characteristics of accommodative convergence accommodation ratio in accommodative esotropia (AC/A)

Introducción. Existe controversia en el comportamiento de la relación de CA/A. Para muchos autores es ingénita e inmutable, para otros esta relación puede modificarse como un mecanismo corrector de las ametropías y de la desviación ocular. Con el objeto de estudiar si existe cambio de la relación de CA/A después del uso de la correción hipermetrópica, se decidió realizar este estudio. Pacientes y método. Se incluyeron pacientes con diagnóstico de endotropía acomodativa secundaria a hipermetropía, de ambos sexos, menores de 40 años, que no hubieran utilizado graduación hipermetrópica y sin antecedente de cirugía de estrabismo. En la exploración estrabológica se determinó la presencia de desviación y se cuantificó la magnitud de la misma en la posición primaria de cerca y lejos; se midió la relación de CA/A mediante el método del gradiente y se determinó la hipermetropía mediante ciclopejia. Se prescribió la graduación hipermetrópica, y se volvió a cuantificar la relación de CA/A mínimo tres meses después del uso de la correción óptica. Resultados. Se estudiaron 26 pacientes, 14 del sexo femenino y 12 del masculino, el recorrido de edad fue de los 12 meses a los 18 años con un promedio de 6.2 años. La relación de CA/A inicial fue de 3/1 en 21 pacientes; mayor en 4 y menor en 1. En la evaluación final la relación de CA/A se modificó en 20 pacientes aumentando en 17 y disminuyendo en 3 (p=0.01). Sin embargo, desde el punto de vista clínico al variación sólo fue importante en 5 pacientes. Conclusiones. La relación de CA/A sí se modifica después del uso de la correción hipermetrópica óptima. No existe una correlación exacta entre el valor cuantitativo de la relación de CA/A, el monto de la hipermetropía y la respuesta clínica al uso de la correlación óptica