Effect of the vehicle on the topical itraconazole efficacy for treating corneal ulcers caused by Aspergillus fumigatus.

BACKGROUND: The clinical behaviour of mycotic keratitis is aggressive, and the options for treating it are limited. This poses a need to explore new options for efficacious, low-cost treatment. Recent evidence suggests that topical itraconazole may be useful for treating this entity and that it may be possible to improve its efficacy using a suitable vehicle. METHODS: We included 12 New Zealand white (NZW) rabbits (24 eyes). The rabbits were infected with pathogenic strains of Aspergillus fumigatus and subsequently randomized to receive every 2 h for 5 weeks two different preparations of topical itraconazole 1%. In group 1 (12 eyes), ricinus oil and in group 2 (12 eyes), Systane were used as vehicle. Rabbits were evaluated every week by a masked ophthalmologist to determine the treatment response. RESULTS: The size of the ulcers was similar in the two groups at the baseline: group 1: 12.7 +/- 2.7 mm (median 12.8, range 9.8-15.5 mm); and group 2: 12.3 +/- 3.1 mm (median 12.1, range 9.8-20.8; P = 0.67). Although both groups responded well to the treatment, the response was better in the group 2, especially in weeks 2 and 3: week 1: 12.7 +/- 2.7 vs. 9.3 +/- 4.61 mm (P = 0.1); week 2: 9.4 +/- 3.4 vs. 4.1 +/- 2.9 mm (P = 0.004); week 3: 5.0 +/- 3.4 vs. 1.7 +/- 1.0 mm (P = 0.004); week 4: 1.9 +/- 1.9 vs. 1.0 +/- 1.2 mm (P = 0.1); and week 5: 0.68 +/- 1.2 vs. 0.0 +/- 0.0 mm (P = 0.3). CONCLUSION: Topical itraconazole may be useful for treating corneal ulcers caused by Aspergillus fumigatus, and its efficacy seems to be related with the vehicle solubility.

Experiencia de manejo de lesiones naso-sinusales con el abordaje de "Desguante facial" en 76 casos / Experience in the management of sinonasal lesions with midfacial degloving aproach in 76 cases

En el presente trabajo, se describe la experiencia en el manejo de 76 patologías naso-sinusales en el abordaje de desguante facial, diagnosticados y tratados de 1990 a 1997 por el mismo cirujano. 27 casos (35 por ciento) fueron nasoangiofibromas y 16 (21 por ciento) papilomas invertidos. 69 casos (90 por ciento) presentaron como dato clínico principal obstrucción nasal. Dependiendo de la extensión y naturaleza de la lesión se necesitó acompañar éste abordaje con otro procedimiento agregado. Los pacientes que presentaron como diagnóstico final lesiones neoplásicas malignas fueron enviados oportunamente a tratamiento complementario con radioterapia, quimioterapia y/o rehabilitación. El abordaje de desguante facial nos proporciona una excelente exposición a cavidad nasal, senos paranasales, nasofaringe, y clivus, lo cual nos habla de la gran versatilidad de la técnica para resecar tanto lesiones neoplásicas benignas y malignas como lesiones no neoplásicas