Perfil clínico de pacientes dermatológicos encaminhados para avaliação oftalmológica / Clinical profile of dermatological patients referred to ophthalmological evaluation

RESUMO Objetivo: Analisar o perfil clínico de pacientes em acompanhamento dermatológico encaminhados para avaliação oftalmológica. Métodos: A amostra foi composta de pacientes dermatológicos encaminhados para avaliação oftalmológica, nos anos de 2016 e de 2017. Estudou-se a concomitância de doenças dermatológicas com as afecções oftalmológicas por meio da coleta simultânea do histórico dermatológico (prontuários registrados com dados gerais e diagnóstico) e de dados da consulta oftalmológica após o encaminhamento. Resultados: Foram avaliados pela oftalmologia 224 pacientes, sendo 65% do sexo feminino, 80% caucasianos, com idade variando entre 1 mês e 85 anos. As situações cujo encaminhamento foi mais prevalente foram psoríase, lúpus, vitiligo e rosácea (18,3%, 13,8%, 12,9% e 10,7%, respectivamente). Fototerapia crônica e uso de hidroxicloroquina representaram 35,7% e 22,3% dos pacientes. Casos de neurofibromatose, micose fungoide, líquen plano, neoplasias de pele, atopias, pênfigo e esclerodermia também estiveram presentes. Cegueira legal foi detectada em 6%, e deficiências visuais ligadas a afecções dermatológicas foram verificadas em 16,5% dos casos. As alterações oculares mais prevalentes foram catarata (18,9%), blefarite (15,9%), pterígio (5,3%) e conjuntivite (5,3%). Conclusão: Encontrou-se elevada frequência de alterações oftalmológicas em uma população de pacientes com doenças dermatológicas. Assim, o estudo e a análise de manifestações oculares em pacientes dermatológicos podem auxiliar na detecção precoce e na prevenção de complicações.

ABSTRACT Objective: To analyze the clinical profile of patients under dermatological care and referred to ophthalmological evaluation. Methods: The sample comprised dermatology patients referred to ophthalmological evaluation in 2016 and 2017. The simultaneous occurrence of skin and ophthalmic diseases was studied, by collecting dermatological history (medical records containing general data and diagnosis) and ophthalmic consultation data following referral. Results: A total of 224 patients were assessed, 65% were female, 80% were white, and age varied between one month and 85 years. The conditions more often referred were psoriasis, lupus, vitiligo and rosacea (18.3%, 13.8%, 12.9% and 10.7%, respectively). Chronic phototherapy and use of hydroxychloroquine were observed in 35.7% and 22.3% of patients, respectively. Cases of neurofibromatosis, mycosis fungoides, lichen planus, skin cancer, atopic dermatitis, pemphigus and scleroderma were also reported. Legal blindness was detected in 6% and visual impairment related to skin conditions in 16.5% of patients. The most prevalent ocular changes were cataracts (18.9%), blepharitis (15.9%), pterygium (5.3%) and conjunctivitis (5.3%). Conclusion: A high frequency of ophthalmic changes in a population of dermatological patients was found. In this context, studying and analyzing ocular manifestations in dermatological patients could be useful in early detection and prevention of complications.

Manifestaciones oculares en artritis reumatoide juvenil / Juvenile rheumatoid arthritis and ocular manifestations

La artritis reumatoide juvenile (ARJ) es considerada como la enfermedad del tejido conectivo más frecuente en la infancia. La incidencia de manifestaciones oculares, es variable y ha sido reportado entre 5 y 24 por ciento. La iridociclitis que se desarrolla en los pacientes con ARJ, es la alteración más grave y puede llevar a los niños a la pérdida total de la visión. El objetivo de este estudio fue conocer la frecuencia y tipo de manifestaciones oculares en pacientes con ARJ en nuestro medio. Se realizó un estudio descriptivo y trasversal. Se analizaron 30 pacientes con diagnóstico de ARJ con edad promedio de inicio de 10.2 años (2-5 años), evaluación promedio de la enfermedad de 4.6 años (3 meses-35 años). En este estudio la frecuencia de alteraciones oculares fue de 40 por ciento (12 pacientes). Sin embargo, no todas las alteraciones encontradas se asociarion a la presencia de ARJ. La queratoconjuntivitis sieca se presentó en el 23 por ciento (7 pacientes) y en ningún caso se detectó iridociclitis aguda o crónica. La presencia de daño ocular en estos pacientes pudiera depender de otros factores (genéticos, ambientales, etc.) aunque la evaluación periódica no detecte patología grave; se pueden encontrar alteraciones menos mediante vigilancia y seguimiento oportunos

Anestesia retrobulbar com catéter flexível de teflon em pacientes com comprimento axial ocular aumentado / Retrobulbar anesthesia with a flexible teflon catheter in patients with increased axial ocular lengt

Dentre as complicaçöes associadas à anestesia retrobulbar e peribulbar, perfuraçäo do globo ocular parece ser das mais importantes. Recente estudo ultrassonográfico demonstrou que, em pacientes submetidos à anestesia retrobulbar para cirurgia de catarata com comprimento axial normal, a ponta da agulha usada para injeçäo retrobulbar se encontrava muito próxima do globo ocular, as vezes até indentando sua parede. Tal fato pode se tornar extremamente perigosos em olhos com comprimento axial aumentado, como nos altos míopes. Demonstramos a eficácia e segurança do uso da técnica de anestesia retrobulbar com catéter flexível de Teflon em 15 pacientes com comprimento axial ocular ântero-posterior aumentado e candidatos à facectomia

Pérdida de peso relacionada con el uso prolongado de difosfato de cloroquina / Relationship with weight loss and the use of chloroquine

La cloroquina es un medicamento útil para el tratamiento de enfermedades reumáticas pero puede ocasionar una serie de efectos secundarios que han hecho que su uso sea limitado. Entre estos efectos secundarios se encuentran principalmente los efectos tóxicos oculares que llegan a ser muy graves y otros menores como los dermatológicos, gastrointestinales y neurológicos; sin embargo, la pérdida de peso no se porta como una manifestación importante. En este trabajo, se reporta a un grupo de 12 pacientes que estuvieron recibiendo difosfato de cloroquina (11 con diagnóstico de artritis reumatoide del adulto y 1 con lupus eritematoso generalizado), los cuales presentaron diverso grado de pérdida de peso que pudiera tener relación en forma directa con la administración del medicamento. Este efecto secundario ha sido referido en la literatura pero su freucencia exacta no está bien determinada, ni su mecanismo de acción, pero consideramos que es importante reportar este efecto, tomarlos en cuenta y bajo ciertas circunstancias determinar si la pérdida de peso está en relación con la enfermedad de base, con el uso de otras drogas que el paciente recibe de manera simultánea o definitivamente secundaria a la administración de cloroquina

Toxoplasmosis congénita: un problema vigente en Chile: análisis de 15 casos clínicos / Congenital toxoplasmosis: a current problem in Chile: analysis of 15 clinical cases

Se analiza el problema de la toxoplasmosis congénita mediante el estudio de quince casos, cuatro lactantes con infección aguda y once niños con compromiso acular. La importancia del reconocimiento oportuno de la infección en el recién nacido y lactante, basada en la sospecha clínica (síndrome de TORCH y examen de fondo de ojo) y el diagnóstico serológico precoz que confirma la etiología, se discute en relación con el efecto curativo del tratamiento específico. La mayoría de los casos se diagnosticaron y trataron en forma tardía. En cinco niños tratados precozmente se obtuvo resultado satisfactorio, evitándose la muerte del recién nacido, disminuyendo el desarrollo de la infección y la aparición de reactivaciones, aunque persistieron secuelas a nivel del SNC. En los casos restantes, se observó sólo un efecto parcial del tratamiento. Se concluye que la toxoplasmosis congénita es un problema vigente en Chile y que la mayoría de los casos no se diagnostican oportunamente. Se recomienda intensificar su detección a nivel clínico, porque se dispone de drogas específicas que, aplicadas en forma precoz, pueden prevenir o aminorar el desarrollo de secuelas en el SNC

Carbon monoxide poisoning.

Carbon monoxide poisoning has received little attention in th pediatric literature, although it is not uncommon in children. With the advent of alternative energy sources, such as woodburning stoves, one might predict an increase in its incidence over the next few years. Carbon monoxide poisoning is well described in the adult medical, surgical, neurologic, and psychiatric literature. It can cause a severe encephalopathy and have cardiovascular, pulmonary, muscular, renal, cutaneous, visual, and auditory manifestations. In this review a case of severe carbon monoxide poisoning with complications is presented.

Abetalipoproteinemia. Report of two cases and review of therapy.

The clinical presentation and course of abetalipoproteinemia in two male patients, a child and an adult, are described. Apoprotein B was absent in both cases and each patient had > 50% acanthocytes present on peripheral blood smear. Family studies revealed normal lipid profiles in the parents of both patients, which is consistent with the usual autosomal recessive inheritance of this disorder. In addition to a low-fat diet, both patients have been maintained on high doses of vitamins A and E. In the adult patient, detailed evaluations over a five-year period have failed to show any progression of neurological disease while maintained on high-dose vitamins. The role of supplemental vitamins A and E in the therapy of abetalipoprotenemia is discussed.

An evaluation of iridology.

Iridology is an analysis of health based on examination of the iris of the eye. One hundred forty-three patients had photographs taken of both eyes. Nine-five patients were free of kidney disease, defined as a creatinine level of less than 1.2 mg/dL (mean, 0.8 mg/dL), and 48 had kidney disease severe enough to raise the plasma creatinine level to 1.5 mg/dL or greater (mean, 6.5 mg/dL). Three ophthalmologists and three iridologists viewed the slides in a randomized sequence without knowledge of the number of patients in the two categories or any information about patient history. Iridology had no clinical or statistically significant ability to detect the presence of kidney disease. Iridology was neither selective nor specific, and the likelihood of correct detection was statistically no better than chance.

Thalamic tumors in childhood. Clinical, laboratory, and therapeutic considerations.

Eighteen cases of primary thalamic tumor occurring in children (ages 2 1/2 to 12 1/2 years) were studied retrospectively. Among the clinical features of this group that contrasted with adults having similar tumors were a shorter duration of symptoms before diagnosis and a higher incidence of motor abnormalities in the early illness. In several cases, symptoms and signs usually associated with cerebellar disorders predominated. Arteriography or gas encephalography or both were diagnostic in all but two cases. The electroencephalogram, abnormal in slightly more than 70% of the cases, suggested a thalamic mass in more than one third. A highly specific EEG feature was the presence of spindles while patients were awake. In 15 cases there was some evidence of ventricular dilation and nine of these later required shunts. In addition to shunting procedures, therapy included x-ray therapy alone or with craniotomy or craniotomy alone.

Antazoline phosphate and naphazoline hydrochloride, singly and in combination for the treatment of allergic conjunctivitis-a controlled, double-blind clinical trial.

A controlled, double-blind comparison of naphalzoline hydrochloride 0.05%, antazoline phosphate 0.5%, a combination of both components and a placebo was performed on 51 ragweed sensitive patients presenting allergic conjunctivitis. Evaluation of response at various times after instillation of medication for lacrimation, conjunctival inflammation, pruritus, photophobia and pain showed naphazoline hydrochloride, antazoline phosphate and the combination product superior to placebo. The combination product was statistically significantly superior for conjunctival inflammation and photophobia. The need for post-challenge treatment with epinephrine hydrochloride was significantly less in those eyes treated with the combination product. demonstrating prophylactic efficacy.

Blast injury of the chest. A review of the problem and its treatment.

Primary blast injury of the chest is a potentially lethal entity. Immersion blast is even more damaging than that incurred out of water. Illustrative cases of a group of patients injured by an underwater explosion are presented. The pathogenesis, clinical manifestations and diagnosis of the entity are described. Complications include arterial occlusion by air emboli, affecting the central nervous system and heart, and respiratory insufficiency and failure. Conventional management of respiratory failure with intermittent positive pressure breathing may further aggravate the air embolism. An attempt to circumvent this conflict with the aid of the membrane oxygenator and hyperbaric facilities is discussed. It is suggested that expeditious compression with oxygen in a one-man chamber might be the most favorable emergency measure, to be followed later by more extensive and definitive treatment in a major hospital equipped for such contingencies.