Assessment of beliefs and attitudes about electroconvulsive therapy posted on Twitter: An observational study.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective and safe medical procedure that mainly indicated for depression, but is also indicated for patients with other conditions. However, ECT is among the most stigmatized and controversial treatments in medicine. Our objective was to examine social media contents on Twitter related to ECT to identify and evaluate public views on the matter. METHODS: We collected Twitter posts in English and Spanish mentioning ECT between January 1, 2019 and October 31, 2020. Identified tweets were subject to a mixed method quantitative-qualitative content and sentiment analysis combining manual and semi-supervised natural language processing machine-learning analyses. Such analyses identified the distribution of tweets, their public interest (retweets and likes per tweet), and sentiment for the observed different categories of Twitter users and contents. RESULTS: "Healthcare providers" users produced more tweets (25%) than "people with lived experience" and their "relatives" (including family members and close friends or acquaintances) (10% combined), and were the main publishers of "medical" content (mostly related to ECT's main indications). However, more than half of the total tweets had "joke or trivializing" contents, and such had a higher like and retweet ratio. Among those tweets manifesting personal opinions on ECT, around 75% of them had a negative sentiment. CONCLUSIONS: Mixed method analysis of social media contents on Twitter offers a novel perspective to examine public opinion on ECT, and our results show attitudes more negative than those reflected in studies using surveys and other traditional methods.

Avoided crossings and dynamical tunneling close to excited-state quantum phase transitions.

Using the Wehrl entropy, we study the delocalization in phase space of energy eigenstates in the vicinity of avoided crossings in the Lipkin-Meshkov-Glick model. These avoided crossings, appearing at intermediate energies in a certain parameter region of the model, originate classically from pairs of trajectories lying in different phase-space regions which, contrary to the low-energy regime, are not connected by the discrete parity symmetry of the model. As coupling parameters are varied, a sudden increase of the Wehrl entropy is observed for eigenstates participating in avoided crossings that are close to the critical energy of the excited-state quantum phase transition. This allows us to detect when an avoided crossing is accompanied by a superposition of the pair of classical trajectories in the Husimi function of eigenstates. This superposition yields an enhancement of dynamical tunneling, which is observed by considering initial Bloch states that evolve partially into the partner region of the paired classical trajectories, thus breaking the quantum-classical correspondence in the evolution of observables.

Topical imiquimod 5% as an alternative therapy in periocular basal cell carcinoma in two patients with surgical contraindication. / Imiquimod 5% tópico como terapia alternativa en carcinoma basocelular periocular en 2 pacientes con contraindicación quirúrgica.

CLINICAL CASES: The cases are presented of two patients with periocular basal cell carcinoma of the eyelid who received topical imiquimod 5%, with a good response. Both had a functional state that contraindicated surgical treatment. CONCLUSION: Imiquimod cream 5% was shown to be an effective alternative to surgical treatment of periocular basal cell carcinoma, especially in those cases where surgery is not possible.

Role of antiphospholipid score and anti-ß2-glycoprotein I Domain I autoantibodies in the diagnosis of antiphospholipid syndrome.

BACKGROUND: Antiphospholipid syndrome (APS) is characterized by the presence circulating antiphospholipid (aPL) antibodies in patients with thrombosis or pregnancy morbidity. Recently it has been shown that multiple positive results define a higher risk of clinical manifestation in APS patients. However, utilizing combined results generates challenges for a physician. Therefore, the antiphospholipid score. (aPL-S), a new variable that encompasses all aPL assays, has been described. We analyze clinical performance of different aPL-Ss based on ELISA or chemiluminescent immunoassays (CIAs). METHODS: A total of 39 patients and 77 controls were included in this study. All patients were tested for lupus anticoagulant (LAC). In addition, IgM/IgG anticardiolipin (aCL) and anti-ß2 glycoprotein 1 (aß2GP1) autoantibodies were tested by ELISA and CIA. Anti-ß2GP1 Domain 1 IgG (D1) autoantibodies were tested by CIA. Three aPL-Ss were calculated (ELISA, CIA and CIA with D1 instead of ß2GP1 IgG) using the Otomo equation: aPL-S=5×exp([OR]-5)/4. RESULTS: IgG assays showed a good correlation while IgM assays showed moderate correlation. The relative risk of having clinical manifestation of APS was calculated for each aPL test. All three aPL-Ss were higher in individuals with thrombosis or pregnancy morbidity than in those without APS manifestations (p<0.001) and the prevalence of APS manifestations increased with increasing aPL-Ss. CONCLUSION: The CIAs are comparable with the ELISAs for the detection of aPL antibodies. aß2GPI-D1 antibodies seem to represent a strong indicator for clinical manifestations of APS. Any of the aPL-Ss studied represents a useful quantitative index for APS diagnosis and could be helpful to physicians in managing APS.

Sarcoma mieloide orbitario en el adulto: a propósito de un caso / Orbital meyeloid sacoma in the adult: report of a case

Caso clínico. Varón de 50 años con antecedentes de leucemia mieloide aguda atendido por una masa orbitaria izquierda. Los estudios histológicos del tumor biopsiado revelan un sarcoma mieloide. Tras tratamiento radioterápico y quimioterapia, el paciente permanece estable. Conclusiones. El sarcoma mieloide orbitario es un tumor raro en el paciente adulto, pero que debido a sus implicaciones sistémicas, ha de tenerse en cuenta en el diagnóstico de una masa orbitaria, en especial en pacientes hematológicos (AU)

Clinical case: 50 years old male patient with history of acute myeloid leukemia who is assisted because of a mass in his left orbit. Histological studies of the biopsied tumor reveal a myeloid sarcoma. After radiotherapy and chemotherapy, the patient remains stable. Conclusions. Orbital myeloid sarcoma is a rare tumor among adult patients, but because of its systemic implications, it should be considered in the diagnosis of an orbital mass, specially in the case of hematological patients (AU)

Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES / The costs of stroke in Spain by aetiology: the CONOCES study protocol

Introducción: Los pacientes con ictus asociado a fibrilación auricular no valvular (FANV) constituyen un grupo específico con gran repercusión social y económica. El objetivo principal del estudio CONOCES, cuyo protocolo se presenta en ese trabajo, es comparar los costes del infarto cerebral en los pacientes con FANV frente a los pacientes sin FANV en el ámbito sanitario español ingresados en unidades de ictus, utilizando la perspectiva de la sociedad. Materiales y métodos: CONOCES es un estudio epidemiológico, observacional, naturalístico, prospectivo y multicéntrico de los costes de la enfermedad, en una muestra de pacientes que ha sufrido un ictus establecido e ingresado en una unidad de ictus, en el ámbito sanitario español. El periodo de seguimiento será de 12 meses. Se recogerán variables sociodemográficas, clínicas, la escala de ictus del NIH, el nivel de discapacidad, el grado de dependencia funcional mediante la escala de Rankin modificada y el consumo de recursos sanitarios (hospitalización en el primer episodio, reingresos, rehabilitación ambulatoria, material ortoprotésico, medicación para la prevención secundaria, consultas médicas, atención de enfermería, servicios sociales de atención formal). También se registrará la renta mensual estimada, la pérdida de productividad laboral y la calidad de vida relacionada con la salud con el cuestionario genérico EQ-5D. Por último se entrevistará directamente al cuidador para conocer la pérdida de productividad, los cuidados informales prestados y la sobrecarga del cuidador. Resultados y conclusiones: La aportación del estudio CONOCES permitirá profundizar en las diferencias del impacto tanto económico como clínico del ictus en función de su asociación con la FANV (AU)

Introduction: Patients with stroke associated with non-valvular atrial fibrillation (NVAF) are a specific group, and their disease has a considerable social and economic impact. The primary objective of the CONOCES study, the protocol of which is presented here, is to compare the costs of stroke in NVAF patients to those of patients without NVAF in Spanish stroke units from a societal perspective. Materials and methods: CONOCES is an epidemiological, observational, naturalistic, prospective, multicentre study of the cost of the illness in a sample of patients who have suffered a stroke and were admitted to a Spanish stroke unit. During a 12-month follow-up period, we record sociodemographic and clinical variables, score on the NIH stroke scale, level of disability, degree of functional dependency according to the modified Rankin scale, and use of healthcare resources (hospitalisation at the time of the first episode, readmissions, outpatient rehabilitation, orthotic and/or prosthetic material, medication for secondary prevention, medical check-ups, nursing care and formal social care services). Estimated monthly income, lost work productivity and health-related quality of life measured with the generic EQ-5D questionnaire are also recorded. We also administer a direct interview to the caregiver to determine loss of productivity, informal care, and caregiver burden. Results and conclusions: The CONOCES study will provide more in-depth information about the economic and clinical impact of stroke according to whether or not it is associated with NVAF (AU)

The costs of stroke in Spain by aetiology: the CONOCES study protocol.

INTRODUCTION: Patients with stroke associated with non-valvular atrial fibrillation (NVAF) are a specific group, and their disease has a considerable social and economic impact. The primary objective of the CONOCES study, the protocol of which is presented here, is to compare the costs of stroke in NVAF patients to those of patients without NVAF in Spanish stroke units from a societal perspective. MATERIALS AND METHODS: CONOCES is an epidemiological, observational, naturalistic, prospective, multicentre study of the cost of the illness in a sample of patients who have suffered a stroke and were admitted to a Spanish stroke unit. During a 12-month follow-up period, we record sociodemographic and clinical variables, score on the NIH stroke scale, level of disability, degree of functional dependency according to the modified Rankin scale, and use of healthcare resources (hospitalisation at the time of the first episode, readmissions, outpatient rehabilitation, orthotic and/or prosthetic material, medication for secondary prevention, medical check-ups, nursing care and formal social care services). Estimated monthly income, lost work productivity and health-related quality of life measured with the generic EQ-5D questionnaire are also recorded. We also administer a direct interview to the caregiver to determine loss of productivity, informal care, and caregiver burden. RESULTS AND CONCLUSIONS: The CONOCES study will provide more in-depth information about the economic and clinical impact of stroke according to whether or not it is associated with NVAF.

El sueño en el primer año de vida: ¿cómo lo enfocamos? / leeping in the first year of life: How do we address it?

No disponible

Detección de deficiencia de yodo en el sur de España mediante el cribado del hipotiroidismo congénito / Using newborn congenital hypothyroidism screening specimens to detect iodine deficiency in three regions of Spain

Introducción: Se midió hipertirotropinemia neonatal en 3 provincias del sur de España y se analizó la repercusión de una posible deficiencia de yodo en un programa de cribado de hipotiroidismo congénito (CH, congenital hypothyroidism). Material y métodos: El estudio comprende 113.108 recién nacidos que se dividieron en 2 grupos según el momento en que se extrajo la muestra para el cribado. En 78.646 se recogió después de las 48h de vida y en 34.462 se obtuvo en el momento del nacimiento del cordón umbilical (muestras precoces). Los recién nacidos procedían de las provincias de Sevilla, Huelva y Córdoba. La tirotropina (TSH) se midió por fluorimetría a tiempo discriminado. Resultados: El porcentaje de hipertirotropinemia neonatal fue superior en Huelva (5,2%) que en Sevilla (1%) (p<0,001), hecho constatado igualmente en el grupo de muestras precoces (Huelva: 5,3%; Sevilla: 1,9%, y Córdoba: 1,7%: p<0,001). En este último grupo, el 0,3 y el 0,2% de los recién nacidos de Sevilla y Córdoba, respectivamente, presentaron TSH >20mUI/l y 10 recién nacidos tuvieron que localizarse por cada recién nacido con CH. En Huelva hubo que llamar a 17 recién nacidos por caso detectado. Conclusiones: La distribución heterogénea de las concentraciones de TSH en los recién nacidos de las 3 áreas geográficas parece indicar una ingesta de yodo irregular y deficiente. La extracción de muestras precoces más una posible deficiencia de yodo incrementa el número de falsos positivos en el programa de cribado neonatal de CH (AU)

Background: Neonatal hyperthyrotropinemia by measurements of thyrotropin (TSH) concentrations has been assessed in three different areas of Spain. The repercussions of a possible iodine deficiency in a congenital hypothyroidism screening program have also been analysed. Material and Methods: The study comprised 113,108 newborns, which were divided into two groups according to the time of blood sampling. In 78,646 newborns heel blood samples were obtained after 48h whereas in 34,462 newborns, samples were obtained at birth from the umbilical cord (early samples). Newborns came from three areas of the south of Spain, Seville, Huelva and Cordoba. TSH concentrations were measured by time-resolved fluoroimmunoassay. Results: The percentage of hyperthyrotropinemia was greater in Huelva (5.2%) than Seville (1.0%) (p<0.001), similar to that observed in early samples, which was higher in Huelva (5.3%) than in Seville (1.9%) and Cordoba (1.7%) (p<0.001). In the early samples group, 0.3% and 0.2% of the newborns from Seville and Cordoba respectively, had TSH >20mIU/L and 10 infants should have been recalled for a new sample for each case detected. While in Huelva 17 infants (0.9%) were recalled per case detected. Conclusions: The heterogeneous distribution of TSH concentrations in newborns from several geographical areas appears to indicate an irregular and deficient iodine intake. Using early samples and a possible iodine deficiency, increase false positive results in a Neonatal Screening Program of congenital hypothyroidism (AU)

[Thrombosis of the cavernous sinus following prone-position spinal surgery in a patient with factor V Leiden]. / Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden.

INTRODUCTION: Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. CASE REPORT: A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. CONCLUSIONS: The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient.

Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden / Thrombosis os the carvenous sinus following prone-position spinal surgery in a patient with factor y leiden

Introducción. La trombosis del seno cavernoso no infecciosa ha sido descrita en ocasiones como complicación tras la realización de procedimientos neuroquirúrgicos y, en un caso, después de llevarla a cabo en decúbito prono. El factor V de Leiden es un factor de riesgo genético para presentar una enfermedad trombótica venosa intracraneal. Presentamos el caso de un paciente que sufre una trombosis del seno cavernoso tras una cirugía prolongada en decúbito prono y en quien se descubrió una mutación del factor V de Leiden en estado heterocigoto. Caso clínico. Varón de 64 años de edad, con hipertensión arterial como único factor de riesgo vascular conocido, quien, tras una intervención quirúrgica prolongada en decúbito prono, presentó una amaurosis en el ojo izquierdo acompañada, en las horas posteriores, de dolor ocular, equimosis conjuntival, proptosis y abolición de la motórica ocular extrínseca. Una angiografía confirmó la existencia de una trombosis del seno cavernoso. Se instauró tratamiento con heparinas de bajo peso molecular sin que se produjeran otros tipos de complicaciones. El paciente recuperó paulatinamente la motórica ocular extrínseca, pero no la agudeza visual. En el estudio de hipercoagulabilidad realizado posteriormente se encontró una mutación heterocigota para el factor V de Leiden. Conclusión. La coexistencia de un factor de riesgo para presentar una enfermedad trombótica venosa junto con un fenómeno mecánico, de estasis venosa, a causa de la posición quirúrgica, explican la complicación que presentó el paciente (AU)

Introduction. Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. Case report. A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. Conclusions. The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient (AU)

[Intestinal endometriosis]. / Endometriosis intestinal.

Endometriosis is a chronic, benign gynaecological disorder that is frequent in women of a child-bearing age. It is estimated that there is some degree of endometriosis in as many as 15% of pre-menopausal women, associated with a history of infertility, caesarean antecedents, dysmenorrhoea and abnormality in uterine bleeding. It is believed to be due to the rise of menstrual contents through the Fallopian tubes (retrograde menstruation). In the intestinal affectation, the colon is the segment most frequently affected, above all at the rectosigmoidal level. The clinical features are unspecific, with abdominal pain the most frequent and/or pelvic pain of a cholic type that coincides with, or is exacerbated by, menstruation. Differential diagnosis includes intestinal inflammatory disease, diverticulitis, ischemic colitis and neoplastic processes, with the definitive diagnosis being anatomopathological. With respect to treatment, this will depend on the clinical features and the age of the patient, as well as her wishes with regard to pregnancy.

Disfunción ventricular transitoria o síndrome de Tako-Tsubo. A Propósito de un caso / Transient ventricular dysfunction or Tako-Tsubo syndrome. Report of a case

El síndrome de Tako-Tsubo, o disfunción ventricular transitoria, es una entidad que se caracteriza por ser clínicamente indistinguible del síndrome coronario agudo, con elevación enzimática y extensa acinesia anterior, pero sin alteraciones significativas en las arterias coronarias y con recuperación de las alteraciones segmentarias en las semanas siguientes. Presentamos el caso de un paciente ingresado en nuestro servicio que cumplía las características diagnósticas de este síndrome (AU)

The Tako-Tsubo syndrome, or transient ventricular dysfunction, is a clinical entity that is characterised by being clinically indistinguishable from acute coronary syndrome, with increased enzyme levels and extensive anterior akynesia, but without significant changes in the coronary arteries and with recovery of the segmental changes within the few ensuing weeks. We report the case of a patient admitted to our Service who fulfilled the diagnostic features for this condition (AU)

La ventilación mecánica no invasiva domiciliaria en el paciente EPOC / Non-invasive home mechanical ventilation in the COPD patient

Fundamento. El potencial beneficio de la ventilación mecánica no invasiva en los pacientes EPOC clínicamente estables no es aún bien conocido ni ha sido suficientemente estudiado. Se pretende valorar si la ventilación mecánica no invasiva beneficia a estos pacientes.Material y métodos. Se realiza un estudio transversal valorando la aplicación de la ventilación mecánica no invasiva (BIPAP) domiciliaria durante el descanso nocturno en 23 pacientes EPOC, los cuales se caracterizaban por presentar hipercapnia en la gasometría arterial basal realizada durante la estabilidad clínica. Se realizan revisiones clínicas, gasométricas y espirométricas a los 3, 6 y 12 meses de instaurar dicha terapia. Así mismo se evalúa el número de ingresos por agudización de la patología respiratoria subyacente durante un año.Resultados. Los pacientes incluidos en el estudio tenían una media de edad de 68,83 años. El 60,9% presentaban grado severo de EPOC. El 69,6% del total de la muestra recibían previamente oxigenoterapia continua domiciliaria; de ellos el 75% presentaban EPOC severa o muy severa. Durante el período de tiempo del estudio se objetivó un descenso en el número de ingresos hospitalarios por agudización (0,61±0,15 ingresos anuales de media) respecto al mismo período de tiempo previo a la ventilación mecánica no invasiva (1,07±0,16 ingresos de media) resultando más beneficiados los que presentaban previamente un mayor número de ingresos y los que asociaban comorbilidad. También se aprecia disminución de la presión arterial de dióxido de carbono (PaCO2) en la mayoría de los casos, principalmente aquellos que presentaban al inicio del estudio una PaCO2>63,32 mm de Hg; dicha mejoría se aprecia desde los primeros tres meses de tratamiento

Background. The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients.Methods. A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year.Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61±0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07±0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment

[Non-invasive home mechanical ventilation in the COPD patient]. / La ventilación mecánica no invasiva domiciliaria en el paciente EPOC.

BACKGROUND: The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients. METHODS: A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year. Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61+/-0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07+/-0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment.

Metástasis coroidea de carcinoma renal / Choroidal metastasis from renal cell carcinoma

Caso clínico: Hombre de 52 años que acudió a urgencias por disminución progresiva de su visión en el ojo derecho. Como antecedentes había tenido nefrectomía derecha por carcinoma renal 7 años antes y neumonectomía derecha por metástasis 3 meses antes. En la funduscopia se observaba una masa coroidea en ojo derecho, compatible con metástasis. Se realizó enucleación. Durante un año permaneció sin progresión pero en los últimos seis meses ya ha aparecido. Discusión: Las metástasis coroideas de carcinoma renal son infrecuentes y pueden ocurrir varios años después de la curación del primario. Su sintomatología es variable y su aspecto poco característico por lo que puede dificultar su diagnóstico diferencial(AU)

Case report: A fifty-two year-old man who came to our emergency room because of gradual loss of vision in his right eye. He had suffered right nefrectomy for renal cell carcinoma seven years previously and pneumectomy for metastasis in his right lung three months ago. In the fundus examination a choroidal mass was found in his right eye, suggesting metastasis. Treatment was enucleation of the affected eye. During the first year there was no progression, but in the last six months it has re-appeared. Discussion: Choroidal metastasis of renal cell carcinoma is rare and can appear years after treating the primary tumour. Its symptoms are variable, and its shape is not very characteristic so it can be difficult to make a differential diagnosis(AU)

[Orbit xanthogranulomatosis. Erdheim-Chester disease]. / Xantogranulomatosis orbitaria. Enfermedad de Erdheim-Chester.

CASE REPORT: A patient was studied because of upper lid bilateral edema and xanthelasmae-like lesions after three years of evolution. During the ophthalmologic examination orange-yellowish lesions and two symmetrical tumours were observed on the temporal part of both upper lids. Corticoid-therapy was undertaken which reduced the size of the tumours, however the size increased again after the discontinuation of treatment. A biopsy was performed and lid xanthogranulomatosis was diagnosed. Other systemic examinations were normal. DISCUSSION: Erdheim-Chester disease is a xanthogranulomatosis that can affect ocular and periorbital structures. Combination of xanthelasmae-like lesions and bilateral orbital masses should make us consider this process and try to locate any associated systemic conditions.

Xantogranulomatosis orbitaria: Enfermedad de Erdheim-Chester / Orbit xanthogranulomatosis. Erdheim-Chester disease

Caso clínico: Paciente con edema bilateral de párpados superiores y lesiones similares a xantelasmas de tres años de evolución. La exploración oftalmológica mostraba dos tumoraciones temporales simétricas en ambos párpados superiores con lesiones naranjo-amarillentas. Se pautaron corticoides que hicieron disminuir el tamaño de las tumoraciones, con recidiva de los mismos al suspender dicha medicación. La biopsia reveló una xantogranulomatosis palpebral. El resto de las exploraciones sistémicas fueron normales. Discusión: La enfermedad de Erdheim-Chester es una xantogranulomatosis que puede afectar a las estructuras oculares y periorbitarias. La combinación de lesiones similares a xantelasmas y masas orbitarias bilaterales deben hacernos pensar en este proceso y buscar la posible afectación sistémica(AU)

Case report: A patient was studied because of upper lid bilateral edema and xanthelasmae-like lesions after three years of evolution. During the ophthalmologic examination orange-yellowish lesions and two symmetrical tumours were observed on the temporal part of both upper lids. Corticoid-therapy was undertaken which reduced the size of the tumours, however the size increased again after the discontinuation of treatment. A biopsy was performed and lid xanthogranulomatosis was diagnosed. Other systemic examinations were normal. Discussion: Erdheim-Chester disease is a xanthogranulomatosis that can affect ocular and periorbital structures. Combination of xanthelasmae-like lesions and bilateral orbital masses should make us consider this process and try to locate any associated systemic conditions(AU)

[Choroidal metastasis from renal cell carcinoma]. / Metástasis coroidea de carcinoma renal.

CASE REPORT: A fifty-two year-old man who came to our emergency room because of gradual loss of vision in his right eye. He had suffered right nefrectomy for renal cell carcinoma seven years previously and pneumectomy for metastasis in his right lung three months ago. In the fundus examination a choroidal mass was found in his right eye, suggesting metastasis. Treatment was enucleation of the affected eye. During the first year there was no progression, but in the last six months it has re-appeared. DISCUSSION: Choroidal metastasis of renal cell carcinoma is rare and can appear years after treating the primary tumour. Its symptoms are variable, and its shape is not very characteristic so it can be difficult to make a differential diagnosis.

Antidisialosyl antibodies in chronic idiopathic ataxic neuropathy.

Antidisialosyl antibodies were found in two out of 13 patients with chronic idiopathic ataxic neuropathy (CIAN) and not in 32 patients with different sensory neuropathies of known cause. This finding confirms the association of antidisialosyl antibodies and CIAN regardless of the absence of the M band. These antibodies may have pathogenic relevance; however, larger series are needed to establish their clinical significance.