Glaucoma avanzado. Guía de práctica clínica / Advanced glaucoma. Clinical practice guideline

objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

Advanced glaucoma. Clinical practice guideline.

OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Neurooftalmología en la obra de Oliver Sacks: las auras visuales / Neuro-ophthalmology in Oliver Sacks books: Visual auras

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Estudio mediante biomicroscopia ultrasónica de pacientes intervenidos de esclerectomía profunda no perforante con implante supraciliar / An ultrasound biomicroscopy study after deep sclerectomy with supraciliary implant

OBJETIVO: Evaluar a pacientes 24 meses después de ser intervenidos mediante esclerectomía profunda no perforante (EPNP) con implante supraciliar y determinar la existencia de factores predictivos de la eficacia de la técnica mediante la exploración biomicroscópica (BMU). MATERIAL Y MÉTODOS: Se incluyen 26 ojos de 23 pacientes explorados con UBM 24 meses después de ser intervenidos mediante EPNP con implante de hema supraciliar. RESULTADOS: Se ha encontrado un descenso significativo de la presión intraocular (PIO) de 25,6 ± 6,4 mmHg a 16,2 ± 3,4 mmHg y en el número de medicaciones antiglaucomatosas de 2,5 ± 0,6 por paciente a 0,5 ± 0,5 (p < 0,001). No se evidenciaron cambios significativos en la agudeza visual. Mediante BMU no se ha podido correlacionar la PIO con el diámetro horizontal (r = −0,05; p = 0,71) ni vertical (r = −0,1; p = 0,63) del lago intraescleral, su altura (r = 0,28; p = 0,25) ni volumen (r = −0,08; p = 0,79), el grosor de la MBTD (r = −0,07; p = 0,73) ni su longitud (r = 0,39; p = 0,13), la presencia de ampolla filtrante (p = 0,3) ni de un área hipogénica en el espacio supracoroideo (p = 0,2). CONCLUSIONES: La inserción del implante de hema en el espacio supraciliar durante la cirugía no perforante del glaucoma es segura y efectiva en el glaucoma de ángulo abierto (GAA) pero no hemos podido establecer factores

OBJETIVE: To evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM). MATERIAL AND METHODS: This study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. RESULTS: There was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=−.05: P=.71) and vertical diameter (r=−.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=−.08; P=.79), the thickness (r=−.07;P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24). CONCLUSIONS: The insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study

An ultrasound biomicroscopy study after deep sclerectomy with supraciliary implant.

OBJECTIVE: To evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM) MATERIAL AND METHODS: This study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. RESULTS: There was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=-.05: P=.71) and vertical diameter (r=-.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=-.08; P=.79), the thickness (r=-.07; P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24). CONCLUSIONS: The insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study.

Diagnostic yield and safety of capsule endoscopy.

INTRODUCTION: the capsule endoscopy (CE), from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. MATERIAL AND METHODS: retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique. One took to end a descriptive and analytical analysis. RESULTS: there was achieved a total of 416 explorations in 388 patients. The obscure gastrointestinal bleeding was the most frequent indication (83.30%) followed by suspected Crohn s disease (7.5%). Angiodisplasia was the endoscopic lesion more frequently detected (42.2%), especially, in patients with digestive bleeding of obscure origin (OR 3.13 p < 0.001), followed by the flebectasia (10.6%) and the ulcer suspicious of Crohn s disease (9.9%). The global diagnostic yield as for the detection of injuries was 77.34% with a case of "not defecation of the capsule" and therefore need of laparotomy. CONCLUSIONS: the capsule endoscopy is a technique consolidated and as his potential is known, his indications are extended. The obscure gastrointestinal bleeding is the most frequent indication and the angiodisplasia the most identified injury. Once known his diagnostic yield, larger studies are needed that assess the influence of capsule endoscopy on clinical outcoumes.

Rendimiento diagnóstico seguridad de la cápsula endoscópica / Diagnostic yield and safety of capsule endoscopy

Introducción: la cápsula endoscópica desde su aprobación seha convertido en un procedimiento diagnóstico de primera líneapara el estudio del intestino delgado. El objetivo del estudio es exponerla experiencia desde la implantación de esta técnica ennuestro hospital.Material y métodos: se hizo una revisión retrospectiva de losestudios realizados en el Servicio de Endoscopia. Se recogió encada caso la edad, sexo, motivo de consulta, procedimientos diagnósticosprevios, diagnósticos endoscópicos e incidencias inherentesa la técnica y se llevó a cabo un análisis descriptivo y analítico.Resultados: se realizaron un total de 416 exploraciones en388 pacientes. La hemorragia digestiva de origen oscuro fue la indicaciónmás frecuente (83,30%) seguida de la sospecha de enfermedadde Crohn (7,5%). La angiodisplasia fue la lesión endoscópicamás detectada (42,2%) cuando se analizó la hemorragiadigestiva oscura (OR 3.13 p < 0,001) seguida de la flebectasia(10,6%) y las úlceras sugerentes de enfermedad de Crohn (9,9%).La rentabilidad global en cuanto a la detección de lesiones fue del77,34% con un caso de “no defecación de la cápsula” y por lotanto de necesidad de laparotomía.Conclusiones: la cápsula endoscópica es una técnica consolidaday a medida que se conoce su potencial, se van ampliando susindicaciones. La hemorragia digestiva de origen oscuro es la indicaciónmás frecuente y la angiodisplasia la lesión más identificada.Una vez conocida su eficacia diagnóstica se hace necesario determinarmediante estudios a gran escala y con metodología precisala rentabilidad clínica de la misma

Introduction: the capsule endoscopy (CE), from his approval,has become a first line diagnostic procedure for the study of thesmall bowel disease. The aim of this study is to report our experiencesince the implantation of this technique in our hospital.Material and methods: retrospective review of the CE undertakenin Department of Endoscopy. There was gathered inevery case the age, sex, motive of consultation, previous diagnosticprocedures, capsule endoscopy findings and complication ofthe technique. One took to end a descriptive and analytical analysis.Results: there was achieved a total of 416 explorations in388 patients. The obscure gastrointestinal bleeding was the mostfrequent indication (83.30%) followed by suspected Crohn's disease(7.5%). Angiodisplasia was the endoscopic lesion more frequentlydetected (42.2%), especially, in patients with digestivebleeding of obscure origin (OR 3.13 p < 0.001), followed by theflebectasia (10.6%) and the ulcer suspicious of Crohn´s disease(9.9%). The global diagnostic yield as for the detection of injurieswas 77.34% with a case of “not defecation of the capsule” andtherefore need of laparotomy.Conclusions: the capsule endoscopy is a technique consolidatedand as his potential is known, his indications are extended.The obscure gastrointestinal bleeding is the most frequent indicationand the angiodisplasia the most identified injury. Once knownhis diagnostic yield, larger studies are needed that assess the influenceof capsule endoscopy on clinical outcoumes

Síndrome del nevus gomoso azul (blue rubber bleb nevus) diagnosticado por cápsula endoscópica / Blue rubber bled nevus syndrome diagnosed bu capsule endoscopy

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Hepatitis C: diagnóstico y prevención desde la consulta de atención primaria / Hepatitis C: diagnosis and prevention in primary care consultations

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Hepatitis C, infección por el virus de la inmunodeficiencia humana y retraso en el diagnóstico / Hepatitis C, HIV infection and delay in diagnosis

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Metástasis tardía de un hipernefroma en la ampolla de Vater / Late ampullary region metastasis from renal cell carcinoma

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Endoscopic ultrasonography features of calcified gastric cancer.

Calcifications are a rare finding described in benign and malignant tumors located in any site of the body. Their presence in stomach and colon carcinomas is very rare. Most of the cases described are mucinous adenocarcinomas. We present the case of one patient with this disease studied with endoscopic ultrasonography. There were punctate calcifications in the submucosa layer that tended to take on a crown-like shape in the outer-most area, producing an acoustic shadow. The pathological study of the surgical specimen showed amorphic calcifications inside some mucin lakes. More cases need to be studied with this technique in order to define their endosonographic characteristics.

[Analysis of opinions, attitudes and knowledge of physicians of health centers of Valencia concerning efficacy and efficiency of drug prescriptions]. / Análisis de las opiniones, actitudes y conocimientos de los médicos de los centros de salud de Valencia sobre la eficacia y la eficiencia en la prescripción de medicamentos.

OBJECTIVE: To find the views, attitudes and knowledge of Primary Care doctors concerning the efficacy and efficiency of medical prescription. DESIGN: Descriptive, crossover study. SETTING: 10 Health Centres in the city of Valencia. PARTICIPANTS: The 115 doctors, both general and family practitioners, working at these centres. INTERVENTIONS: A survey gathered information on the doctors' views about the appropriateness of considering price when prescribing, on their assessment of ten strategies aimed at improving prescription efficiency, and their understanding of the efficacy and cost of certain medicines used in Primary Care. RESULTS: 1. 81% of those surveyed stated that prescription costs had to be considered at the moment of deciding patient treatment. 2. 70.4% of their opinions of the efficacy of medicines, as measured by the Intrinsic Therapeutic Value, were accurate. 3. 41% of the prices estimated by doctors were correct. There was a tendency to undervalue prices and to eliminate differences between products of identical composition. 4. In the area of strategies to improve prescription efficiency, doctors clearly favoured training strategies (prescription guidelines or in-work training) over strategies involving "assuming economic risks" (pharmacy self-management...).

[Pain and jaundice secondary to hemobilia resolved by ERCP and endoscopic sphincterectomy]. / Dolor e ictericia secundario a hemobilia resuelto mediante CPRE y esfinterectomía endoscópica.

We report the case of a patient with hemobilia resulting from a liver biopsy where the performance of the endoscopic sphincterectomy solved the jaundice and the pain of the patient. ERCP has been used previously in the diagnosis of biliary and pancreatic tumors that manifested themselves as an hemobilia. The therapeutic utilization of endoscopic sphincterotomy had been described rarely in this type of bleedings. We recommend endoscopic retrograde cholangiopancreatography and sphincterotomy in the cases of hemobilia with severe abdominal pain resulting from the accumulation of clots inside the biliary tract.