Photic maculopathy: A review of the literature (I). / Maculopatía fótica: revisión de la literatura (I).

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years, the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of this topic, the review is presented divided into two parts. In this first part solar maculopathy and welding arc maculopathy are presented.

Photic maculopathy: A review of the literature (ii). / Maculopatía fótica: revisión de la literatura (ii).

The human retina, as transducer of light energy, is especially exposed to light toxicity. Solar maculopathy has been the only form of photic maculopathy for millennia, often secondary to the observation of an eclipse. During the last century, technological advances have led to the appearance of new forms of photic maculopathy, related to the exposure to new forms of artificial light, such as welding devices and lasers. In recent years the general use of laser pointers has led to an upturn in interest in this pathology. The aim of this review is to offer an integrated view of the different types of photic maculopathy. Due to the extension of the topic, the review is presented divided into 2 parts. In this second part, atomic bomb maculopathy, laser maculopathy, iatrogenic forms of photic maculopathy, and foveomacular retinitis are presented.

Surprising characteristics of visual systems of invertebrates. / Curiosidades sobre el sistema visual de los invertebrados.

OBJECTIVE: To communicate relevant and striking aspects about the visual system of some close invertebrates. MATERIAL AND METHODS: Review of the related literature. RESULTS: The capacity of snails to regenerate a complete eye, the benefit of the oval shape of the compound eye of many flying insects as a way of stabilising the image during flight, the potential advantages related to the extreme refractive error that characterises the ocelli of many insects, as well as the ability to detect polarised light as a navigation system, are some of the surprising capabilities present in the small invertebrate eyes that are described in this work. CONCLUSIONS: The invertebrate eyes have capabilities and sensorial modalities that are not present in the human eye. The study of the eyes of these animals can help us to improve our understanding of our visual system, and inspire the development of optical devices.

Ocular residual astigmatism's effect on high myopic astigmatism LASIK surgery.

PURPOSE: To analyze the effect of ocular residual astigmatism (ORA) on the effectiveness of LASIK for treating high myopic astigmatism. METHODS: This is an observational, cross-sectional study. We studied 116 consecutive myopic eyes with -3 diopters (D) or more of astigmatism that underwent LASIK surgery. The magnitude of uncorrected residual refractive astigmatism 3 months postoperatively was measured. RESULTS: The mean preoperative cylinder was -4.0±0.83 D (range, -7.5 to -3 D) and the mean preoperative ORA was 0.82±0.5 D. The mean residual refractive cylinder 3 months postoperatively was -0.78±0.83 D (range, -3 to 0 D). No correlation was found between ORA and the refractive cylinder 3 months postoperatively (P=0.6). CONCLUSION: In eyes with high myopic astigmatism undergoing LASIK, ORA was not correlated with the residual postoperative cylinder.

Histerectomía laparoscópica. Revisión de 71 casos. Descripción de la técnica. Análisis de resultados y complicaciones / Laparoscopic hysterectomy: Revision of 71 cases. Description o the technique, analysis of results and complications

El objetivo de este trabajo es analizar los primeros 71 casos de Histerectomía Laparoscópica (HTL) y Anexohisterectomía Laparoscópica (AHTL) realizados en el Servicio de Ginecología de Clínica Güemes de Luján

[Impact of cataract surgery upon functional capacity of the elderly]. / Repercusión de la intervención de cataratas en la capacidad funcional del anciano.

PURPOSE: To determine the impact of cataract intervention on visual function of the elderly and on autonomy in daily activities, analyzing the influence of clinical and sociodemographic variables. METHODS: Observational and longitudinal study. 185 elderly patients having undergone cataract surgery were compared with 179 elderly patients on a surgical waiting list. The first group was evaluated prior to surgery and at 4 months post-intervention. Control group patients were evaluated at the same times, without having received surgery. For all subjects, the state of visual function was determined by the Activities of Daily Vision Scale (ADVS). Degree of dependence in carrying out basic daily activities, cognitive state and self-perception of vision were also measured. Other variables were visual acuity, other ocular diseases and sociodemographic characteristics. RESULTS: Amongst the elderly patients having undergone surgery, the proportion of subjects able to carry out basic activities 4 months post-intervention (60.7%) was very similar to the initial pre-intervention figure (62.2%). However, in the control group, the proportion (63.1%) diminished significantly at the 4-month mark (48.8%) (p= 0.0001). Of the intervened subjects, 75.7% demonstrated improved self-perception of vision after 4 months as opposed to 15.4% of the non-intervened patients (p= 0.00001). Post-intervention, the mean score on the ADVS rose from 51.0 S.D. 28.4 to 76.0 S.D. 25.4 (p < 0.001). In contrast, the control group's mean score dropped from 54.8 S.D. 24.8 to 46.5 S.D. 27.1 (p < 0.001). CONCLUSIONS: Cataract surgery in the elderly improves visual function and prevents loss of autonomy, delaying dependency in carrying out basic daily activities.

[Jejunal obstruction by metastasis of a renal adenocarcinoma]. / Obstrucción yeyunal por metástasis de adenocarcinoma renal.

OBJECTIVE: To describe a case of jejunal obstruction due to metastatic renal adenocarcinoma. METHODS: A 66-year-old male who underwent nephrectomy 23 months earlier developed jejunal obstruction due to metastasis of the renal adenocarcinoma. The literature is reviewed and the uncommon form and site of presentation of this case are underscored and the different treatments are discussed.

[Comparative study of determined biochemical parameters in semen of vasectomized and non-vasectomized subjects]. / Estudio comparativo de determinados parámetros bioquímicos en semen de sujetos vasectomizados y no vasectomizados.

OBJECTIVE: Biochemical parameters, fundamentally those of prostatic origin, were analyzed and compared to determine the semen composition of vasectomized and non-vasectomized subjects. METHODS: 100 ml of semen from each group (vasectomized and non-vasectomized) were obtained. After thawing, the pool was homogenized and 5 one-ml sample from each one were analyzed for the following biochemical parameters: gamma glutamyl transferase (GGT), lactic dehydrogenase (LDH), prostate acid phosphatase (PAP), prostate-specific antigen (PSA) and total protein (TP) in the seminal plasma. Determination of the foregoing biochemical parameters was performed automatically with autoanalyzers. RESULTS: The mean values for the vasectomized and non-vasectomized groups were respectively: a) GGT: 8890 +/- 811 and 5714 +/- 403 IU/L; b) LDH: 7045 +/- 879 and 2465 +/- 339 IU/L; c) PAP: 2,099,000 +/- 330,764 and 1,860,000 +/- 302,138 ng/ml; d) PSA: 953,000 +/- 154,715 and 1,018,000 +/- 119,685 ng/ml; total protein: 39,860 +/- 1094 and 37,900 +/- 5606 micrograms/ml. CONCLUSIONS: Analysis of the different biochemical parameters showed no statistically significant differences between the mean values for PAP, PSA and total protein for the vasectomized and non-vasectomized group, but statistically significant differences were found for GGT and LDH (p < 0.001).

Visceral leishmaniasis in patients infected with the human immunodeficiency virus.

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

[Colony-stimulating factors and HIV-related neoplasms]. / Factores estimulantes de colonias y neoplasias asociadas al VIH.

OBJECTIVE: it is analyzed a group of patients with HIV related malignancy treated with myelosuppressive therapy with granulocyte colony stimulating factor (G-CSF) to study the efficacy of hematopoietic growth factors in these subjects. PATIENTS AND METHODS: it was studied the clinical and hematological evolution of 20 patients with HIV related malignancy treated with standard dose of chemotherapy and 5 micrograms/Kg/day of G-CSF starting 24 hours after the completion of chemotherapy administration. It was done an epidemiological study and was determined haemoglobin level, and the number of leukocytes, monocytes, neutrophils, lymphocytes, CD4+ lymphocytes and platelets before and after the chemotherapy administration. RESULTS: all of the patients were men with mean age of 37 +/- 2 years. The mean of lymphocyte CD4+ count was 17 x 10(6)/l and the tumor was the first aids manifestation in 50% of the subjects. The mean days of hospitalization was 14 +/- 3 days. As the result of the G-CSF administration, the leucocyte and the neutrophil count was statistically elevated (p < 0.01) and the platelets, the lymphocytes and the monocytes were not statistically elevated. Only one patient had a severe adverse reaction. Seventeen patients (85%) are dead, but only in 3 the cause was an infectious disease. CONCLUSION: the use of G-CSF prophylactically can elevate the neutrophil count and avoid the apparition of febrile neutropenia in patients with HIV related malignancies.

[Non-Hodgkin's lymphomas associated with the acquired immunodeficiency syndrome. A multicenter clinical study of 77 cases]. / Linfomas no hodgkinianos asociados al síndrome de la inmunodeficiencia adquirida. Estudio clínico multicéntrico de 77 casos.

BACKGROUND: The aim of the present was to study the prevalence of non Hodgkin's lymphoma (NHL) in AIDS patients as well as the clinicopathologic characteristics, response to treatment and survival. METHODS: From January 1984 to January 1991, 77 patients with NHL associated with AIDS diagnosed in 9 hospitals in Madrid were retrospectively studied. RESULTS: Ninety-two per cent of the patients were men (mean age 30 years: range: 9-66 years), 62% were intravenous drug abusers and 20 (26%) homosexuals. Pathologic study determined that 62 (80%) patients had high grade NHL (44% small noncleaved), 17% immunoblastic and 20% unclassifiable, and 15 (20%) had intermediate grade (16% diffuse large cell) being all the cases of the B immunophenotype. Sixty-five per cent were in advanced stages and 69% had B symptoms. Extranodal localizations were present in 88%, bone marrow in 29% and CNS in 29%. Six cases had primary CNS lymphomas. 50% of the patients had less than 200 x 10(6)/l CD4 lymphocytes. Forty-seven patients were evaluable for response to chemotherapy: 12 (26%) showed a complete response 27 (57%) a partial response and 8 (17%) did not respond. Opportunistic infections developed in 18%. The estimated survival at 3 years was 14% (median 6 months). On univariate analysis the parameters related to the worst survival were: primary CNS lymphoma, liver involvement, lack of treatment response, LDH > or = 300 UI/l, alkaline phosphatase > or = 500 UI/l and ESR > or = 70 mm. CONCLUSIONS: Non Hodgkin's lymphomas associated with AIDS usually behave in an "aggressive" way with a high frequency of advanced stages, B symptoms, high grade histologic subtypes and extranodal involvement. Response to treatment is poor, bone marrow toxicity frequent and survival short.

[Cerebral ischemia secondary to embolism of an aorto-coronary graft. Angiographic findings]. / Isquemia cerebral secundaria a embolia de un injerto aorto-coronario. Evidencia angiográfica.

Ischemic stroke during or following cardiac catheterization may be secondary to diverses mechanisms. Formation and detachment of clots in the catheter wall and embolization of a breaked atheromatous lesion are most frequently. The visualization of clots free in the interior of bypass aortocoronary graft is extremely rare and poorly documented. With angiographic evidence we present a case of cerebral acute ischemia secondary to migration of an embolus from a saphenous vein aortocoronary bypass graft. This case shows a different mechanism of cerebral ischemia.

A prospective study of the risk of tuberculosis among HIV-infected patients.

OBJECTIVE: To evaluate the risk of developing active tuberculosis (TB) in a cohort of HIV-1-infected patients. METHODS: Prospective longitudinal follow-up of 839 HIV-infected patients, of whom 505 (60%) were parenteral drug users and 269 (32%) homosexual men. Tuberculin skin tests were performed at baseline and annually thereafter. Prophylaxis with isoniazid (300 mg daily for 9 months) was offered to those with a positive tuberculin test (induration > or = 5 mm). Diagnosis of TB was accepted if it could be confirmed microbiologically (acid-fast bacilli seen in Ziehl-Neelsen stains or grown in Lowenstein-Jensen cultures) or pathologically (presence of caseating granulomas) and patients had consistent clinical manifestations. RESULTS: Active TB developed in 23 out of the 733 (3.1%) patients with a negative tuberculin skin test after a mean follow-up of 16 +/- 11 months (range, 2-52 months), with an estimated cumulative probability of 1.5 and 7% after 1 and 3 years, respectively (or 2.4 per 100 patient-years). None of the 87 patients with a negative tuberculin test but a positive Multitest developed TB. Conversely, 106 patients had a positive tuberculin skin test (97 at baseline and nine who converted during follow-up). Active TB developed in seven out of the 26 not receiving prophylaxis or in whom prophylaxis had to be discontinued (16.2 per 100 patient-years), in four out of 61 patients 3-27 months after having completed 9 months of prophylaxis with isoniazid (8.9 per 100 patient-years) and in none of the 19 still receiving isoniazid. When TB was diagnosed, the mean CD4 lymphocyte count of the 34 patients who developed it during follow-up was 77 +/- 103 x 10(6)/l (range, 1-400 x 10(6)/l). CONCLUSIONS: Among HIV-infected patients in whom the tuberculin skin test is negative, the risk of developing active TB is sufficient to consider prophylaxis if the CD4 count falls below 400 x 10(6)/l, at least in those patients with skin anergy living in high-risk geographical areas such as Spain. When the tuberculin skin test was positive, isoniazid (9 months) provided a 45% protection beyond the period of its administration.

PIP: This study sought to evaluate the risk of developing active tuberculosis (TB) in a cohort of HIV-1-infected patients. A prospective longitudinal follow-up was carried out on 839 HIV-infected patients, of whom 505 (60%) were parenteral drug users and 269 (32%) were homosexual men. Tuberculin skin tests were performed at baseline and annually thereafter. Prophylaxis with isoniazid (300 mg daily for 9 months) was offered to those with a positive tuberculin test (induration or= 5 mm.). Diagnosis of TB was accepted if it could be confirmed microbiologically (acid-fast bacilli seen in Ziehl-Neelsen stains or grown in Lowenstein-Jensen cultures) or pathologically (presence of caseating granulomas) and patients had consistent clinical manifestations. Active TB developed in 23 of the 733 (3.1%) patients with a negative tuberculin skin test after a mean follow-up of 16 +or- 11 months (range, 2-52 months), with an estimated cumulative probability of 1.5 and 7% after 1 and 3 years, respectively (or 2.4 per 100 patient-years). None of the 87 patients with a negative tuberculin test, but a positive Multitest, developed TB. Conversely, 106 patients had a positive tuberculin skin test (97 at baseline and 9 who converted during follow-up). Active TB developed in 7 of the 26 not receiving prophylaxis or in whom prophylaxis had to be discontinued (16.2 per 100 patient-years), in 4 of 61 patients 3-27 months after having completed 9 months of prophylaxis with isoniazid (8.9 per 100 patient-years), and in none of the 19 still receiving isoniazid. When TB was diagnosed, the mean CD4 lymphocyte count of the 34 patients who developed it during follow-up was 77 +or- 103 x 106/L (range, 1-400 x 106/L). Among HIV-infected patients in whom the tuberculin skin test is negative, the risk of developing active TB is sufficient to consider prophylaxis if the CD4 count falls below 400 x 106/L, at least in those patients with skin anergy living in high-risk geographical areas such as Spain. When the tuberculin skin test was positive, isoniazid (9 months) provided a 45% protection beyond the period of its administration.

[Premature atherosclerosis in a 17-year-old male with diabetes mellitus and familial dyslipoproteinemia]. / Aterosclerosis prematura en un joven de 17 años con diabetes mellitus y una dislipoproteinemia familiar.

A 17-year-old male was admitted with an acute myocardial infarction. A coronarography showed 90% occlusion in of the descendent anterior artery. A coronary angioplasty was done with excellent response. As coronary risk factors he had diabetes mellitus for 5 years and dyslipidemia with a phenotype IIb and hypo-alpha-lipoproteinemia. The case is discussed in regard to the possible etiopathogenic causes for his premature atherosclerosis.

[The recurrence of a right atrial myxoma. Apropos a case]. / Recurrencia de mixoma de atrio derecho. A propósito de un caso.

Cardiac myxomas are the most frequent cardiac tumor and they have the capability for growing again years after resection. We have recently reviewed such cases at the Instituto Nacional de Cardiología "Ignacio Chávez" and no cases of recurrence of these tumors was detected. In this paper we inform a case that had recurrence of the tumoral mass 4 years after successful resection of the primary one. There were two masses in the right atrium of different sizes. To our knowledge this is the first case with this characteristic.

[Renal carcinoma and acquired cystic disease of the kidney in a patient after transplantation and under hemodialysis]. / Carcinoma renal y enfermedad quística adquirida del riñón en paciente trasplantado y en hemodiálisis.

Renal Acquired Cystic Disease (RACD) is a frequent entity in patients with a long standing renal failure under hemodialysis treatment. Incidence of a tumor pathology is higher in those patients than in the general population. A new case is presented and some possible etiopathologenical factors of RACD and neoplasias on such pathology are established.