Fascitis necrosante periorbitaria secundaria a rascado / Periorbital necrotising fasciitis secondary to scratching

Mujer de 80 años sin antecedentes médicos que consulta por empeoramiento de picor y dolor palpebral derecho tras la picadura de un insecto. Presenta zonas de laceración por rascado en los párpados, que evolucionan a placas de necrosis fibrinoide durante las primeras 24 horas. Se cultivan las lesiones, demostrando Streptococcus pyogenes y Staphylococcus aureus. Se ingresa a la paciente con diagnóstico de fascitis necrosante periorbitaria para tratamiento intravenoso con ceftriaxona, linezolid y desbridamiento quirúrgico urgente. Permanece ingresada durante 17 días; se le realizan curas diarias consistentes en desbridamiento de restos necróticos, limpieza con clorhexidina y curas con pomadas de mupirocina, sulfadiazina y miconazol. Sufre síndrome de shock tóxico estreptocócico, del que se recupera durante la primera semana de ingreso. A las 2 semanas se le realiza reconstrucción plapebral con autoinjerto de piel de espesor total preauricular en el párpado superior y avance malar lateral en el párpado inferior, con adecuado resultado cosmético y funcional

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24 hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained

Periorbital necrotising fasciitis secondary to scratching. / Fascitis necrosante periorbitaria secundaria a rascado.

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.

Imagen multimodal no invasiva en rotura coroidea secundaria a explosión de petardo / Multimodal non-invasive imaging in choroidal rupture secondary to a firework explosión

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Retinal pigment epithelial tears.

A retinal pigment epithelial (RPE) tear is a well-known complication of retinal pigment epithelial detachments (PED) and may cause a significant visual impairment. The most common cause is a vascularized PED in patients with exudative age-related macular degeneration (AMD). The development of diagnostic imaging techniques brings us closer to the etiology and pathophysiological mechanisms of this entity, offering us new strategies for treatment and follow-up. The advent of intravitreal antiangiogenic treatment (anti-VEGF) has led to an increase in the number of reported cases of RPE tears, which are an important vision-limiting factor during treatment. However, RPE tears may occur spontaneously or as a consequence of thermal laser treatment, photodynamic therapy or anti-VEGF therapy. It is accepted that the mechanism of RPE tears is multifactorial. The optimization of the functional outcome of this complication has been described with continuous treatment with antiangiogenic drugs. The goal of the present review is to evaluate the incidence, risk factors and treatment of RPE tears.

Membrana neovascular asociada a drusas del nervio óptico en edad pediátrica: a propósito de un caso / Optic nerve head drusen associated with neovascular membrane in a child: a case report

Objetivo: Describir los resultados anatómicos y funcionales obtenidos en un caso de neovascularización coroidea asociada a drusas papilares tras tratamiento antiangiogénico intravítreo. Caso clínico: Paciente varón de 8 años con diagnóstico de membrana neovascular en ojo derecho asociada a drusas papilares bilaterales. La agudeza visual al comienzo fue de cuenta dedos, mejorando hasta 0,4 tras tratamiento antiangiogénico. Se obtuvo una consolidación completa de la lesión sin complicaciones asociadas derivadas del tratamiento. Discusión/Conclusiones: El empleo de terapia antiangiogénica ha resultado efectivo y no se han evidenciado efectos secundarios en el tratamiento de membrana neovascular asociada a drusas en edad pediátrica

Purpose: To describe the anatomical and functional results of intravitreal antiangiogenic treatment in optic nerve head drusen associated with choroidal neovascularisation. Case report: An 8 year-old male patient with a diagnosis of neovascular membrane in the right eye associated with bilateral optic nerve head drusen. Best-corrected visual acuity (BCVA) was by counting fingers in the right eye and improved to 0.4 after antiangiogenic treatment. A complete consolidation of the lesion was observed with no associated complications arising from the treatment. Discussion/Conclusions: Antiangiogenic treatment is an effective option, and no side-effects have been observed in treatment of neovascular tissue associated with optic disc drusen in children

Optic nerve head drusen associated with neovascular membrane in a child: a case report. / Membrana neovascular asociada a drusas del nervio óptico en edad pediátrica: a propósito de un caso.

PURPOSE: To describe the anatomical and functional results of intravitreal antiangiogenic treatment in optic nerve head drusen associated with choroidal neovascularisation. CASE REPORT: An 8 year-old male patient with a diagnosis of neovascular membrane in the right eye associated with bilateral optic nerve head drusen. Best-corrected visual acuity (BCVA) was by counting fingers in the right eye and improved to 0.4 after antiangiogenic treatment. A complete consolidation of the lesion was observed with no associated complications arising from the treatment. DISCUSSION/CONCLUSIONS: Antiangiogenic treatment is an effective option, and no side-effects have been observed in treatment of neovascular tissue associated with optic disc drusen in children.

Iridoplastia periférica con láser argón y tomografía de coherencia óptica de segmento anterior en el manejo del cierre angular agudo del siglo XXI / Argon laser peripheral iridoplasty and anterior segment optical coherence tomography in the management of acute angle closure in the 21st century

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Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento / Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment

Objetivo. La mastopatía diabética (MD) es una complicación infrecuente de la diabetes mellitus de larga evolución, que plantea el diagnóstico diferencial con el cáncer de mama. Se estudian la presentación clínica y evolución de la MD, los hallazgos radiológicos, la histología y el tratamiento en los pacientes diagnosticados en nuestro hospital. Material y métodos. Se incluyen 6 pacientes diabéticos insulinodependientes con MD, 5 mujeres y un varón, diagnosticados en un periodo de 11 años. El estudio radiológico se realiza con mamografía, ecografía y resonancia magnética (RM). Se obtiene en todos los casos un diagnóstico anatomopatológico definitivo con biopsia con aguja gruesa o quirúrgica. No se recurre en ningún caso a punción-aspiración con aguja fina. Se lleva a cabo un seguimiento clínico en un periodo medio de 7 años. Resultados. La presentación clínica más frecuente es el nódulo palpable (67%). Los hallazgos radiológicos son: en la mamografía, la asimetría de densidad (50%), en la ecografía un nódulo/masa sólido, hipoecoico, de 1-5cm, mal definido, con sombra acústica y sin señal Doppler (50%) y en la RM el realce tras la administración de contraste (66%). El hallazgo anatomopatológico más frecuente es la mastitis linfocítica en estadios iniciales (83%). Se realiza un tratamiento quirúrgico en todos los pacientes (100%). Conclusiones. La MD es una enfermedad poco frecuente que plantea el diagnóstico diferencial con el cáncer de mama. Su diagnóstico es complejo, pues requiere el conocimiento de los antecedentes personales del paciente, la clínica, la exploración física y los hallazgos radiológicos e histológicos. El tratamiento quirúrgico conservador es de elección, porque no se obtiene respuesta con el tratamiento médico (AU)

Objective. Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. Material and methods. In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7years. Results. The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). Conclusions. Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment (AU)

[Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment]. / Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento.

OBJECTIVE: Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. MATERIAL AND METHODS: In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7 years. RESULTS: The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). CONCLUSIONS: Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment.

Octopamine promotes rhythmicity but not synchrony in a bilateral pair of bursting motor neurons in the feeding circuit of Aplysia.

Octopamine-like immunoreactivity was localized to a limited number (<40) of neurons in the Aplysia central nervous system, including three neurons in the paired buccal ganglia (BG) that control feeding movements. Application of octopamine (OA) to the BG circuit produced concentration-dependent (10(-8)-10(-4) mol l(-1)) modulatory actions on the spontaneous burst activity of the bilaterally paired B67 pharyngeal motor neurons (MNs). OA increased B67's burst duration and the number of impulses per burst. These effects reflected actions of OA on the intrinsic tetrodotoxin-resistant driver potential (DP) that underlies B67 bursting. In addition to its effects on B67's burst parameters, OA also increased the rate and regularity of burst timing. Although the bilaterally paired B67 MNs both exhibited rhythmic bursting in the presence of OA, they did not become synchronized. In this respect, the response to OA differed from that of dopamine, another modulator of the feeding motor network, which produces both rhythmicity and synchrony of bursting in the paired B67 neurons. It is proposed that modulators can regulate burst synchrony of MNs by exerting a dual control over their intrinsic rhythmicity and their reciprocal capacity to generate membrane potential perturbations. In this simple system, dopaminergic and octopaminergic modulation could influence whether pharyngeal contractions occur in a bilaterally synchronous or asynchronous fashion.

[US-guided localization of non-palpable breast cancer and sentinel node using 99mTechnetium-albumin colloid]. / Localización ecodirigida del cáncer de mama no palpable y del ganglio centinela con 99mtecnecio-coloide de albúmina.

OBJECTIVE: Surgery on non-palpable breast lesions is becoming increasingly common and new techniques for preoperative lesion localization have appeared. Radio-guided occult lesion localization (ROLL) enables malignant or probably malignant non-palpable breast lesions to be located and biopsy of the sentinel node to be performed (SNOLL: sentinel node and occult lesion localization). MATERIAL AND METHODS: Included were 118 patients with malignant or probably malignant non-palpable breast lesions visible on ultrasonography in whom radio-guided lesion resection and sentinel node biopsy were indicated. 99mTechnetium-albumin colloid was injected into the periphery of the lesion under ultrasonographic guidance and all patients underwent preoperative scintigraphy. RESULTS: From November 2001 to December 2004, 118 patients were included. All patients underwent conservative surgery, with the non-palpable lesion being located in all cases (100% lesion detection rate). The histological diagnoses were: 81 invasive ductal carcinomas (68.64%), 7 infiltrating lobular carcinomas (5.93%), 5 mixed-type carcinomas (4.24%), 17 carcinomas in situ (14.40%), and 8 other invasive carcinomas (6.78%). The sentinel node was detected in 98.41%. DISCUSSION AND CONCLUSIONS: Radio-guided ROLL surgery on non-palpable lesions located under ultrasonographic guidance is a simple, fast technique that enables the lesion to be safely excised. Both ROLL and SNOLL can be carried out in the same intervention with a single ultrasound-guided injection of 99mTechnetium-albumin colloid with satisfactory results.

Localización ecodirigida del cáncer de mama no palpable y del ganglio centinela con 99mtecnecio-coloide de albúmina / US-guided localization of non-palpable breast cancer and sentinel node using 99mtechnetium-albumin colloid

Objetivo. La cirugía de lesiones no palpables de mama va en aumento y han aparecido nuevas técnicas de localización preoperatoria. La técnica ecodirigida denominada ROLL (radioguided occult lesion localisation) permite localizar las lesiones de mama no palpables malignas o probablemente malignas y la biopsia del ganglio centinela (sentinel node and occult lesion localisation [SNOLL]).Material y métodos. Se incluyen 118 pacientes con lesiones de mama no palpables malignas o probablemente malignas visibles con ecografía, en las que está indicada la exéresis radioguiada de la lesión y la biopsia del ganglio centinela. Se inyecta con control ecográfico 99mtecnecio- coloide de albúmina en la periferia de la lesión y se realiza gammagrafía preoperatoria en todos los casos.Resultados. Desde noviembre del 2001 hasta diciembre del 2004 se incluyen 118 pacientes. En todas se realiza cirugía conservadora, localizando la lesión no palpable en todos los casos (tasa de detección de la lesión del 100%). El resultado anatomopatológico es: 81 carcinomas ductales infiltrantes (68,64%), 7 carcinomas lobulillares infiltrantes (5,93%), 5 carcinomas mixtos (4,24%), 17 carcinomas in situ (14,40%) y 8 otros carcinomas infiltrantes (6,78%). La detección del ganglio centinela es posible en un 98,41%.Discusión y conclusiones. La cirugía radioguiada ROLL de lesiones no palpables de mama localizadas con control ecográfico es una técnica sencilla y rápida que permite la exéresis de la lesión con seguridad. Se pueden realizar tanto ROLL como SNOLL en la misma intervención con una única inyección ecodirigida de 99mtecnecio-coloide de albúmina con resultados satisfactorios

Objective. Surgery on non-palpable breast lesions is becoming increasingly common and new techniques for preoperative lesion localization have appeared. Radio-guided occult lesion localization (ROLL) enables malignant or probably malignant non-palpable breast lesions to be located and biopsy of the sentinel node to be performed (SNOLL: sentinel node and occult lesion localization).Material and methods. Included were 118 patients with malignant or probably malignant non-palpable breast lesions visible on ultrasonography in whom radio-guided lesion resection and sentinel node biopsy were indicated. 99mTechnetium-albumin colloid was injected into the periphery of the lesion under ultrasonographic guidance and all patients underwent preoperative scintigraphy.Results. From November 2001 to December 2004, 118 patients were included. All patients underwent conservative surgery, with the non- lpable lesion being located in all cases (100% lesion detection rate). The histological diagnoses were: 81 invasive ductal carcinomas (68.64%), 7 infiltrating lobular carcinomas (5.93%), 5 mixed-type carcinomas (4.24%), 17 carcinomas in situ (14.40%), and 8 other invasive carcinomas (6.78%). The sentinel node was detected in 98.41%.Discussion and conclusions. Radio-guided ROLL surgery on nonpalpable lesions located under ultrasonographic guidance is a simple, fast technique that enables the lesion to be safely excised. Both ROLL and SNOLL can be carried out in the same intervention with a single ultrasound-guided injection of 99mTechnetium-albumin colloid with satisfactory results

Utilidad de la resonancia magnética en la evaluación local del cáncer de mama: impacto en el cambio de actitud terapéutica en una serie prospectiva de 338 pacientes / No disponible

Introducción: la estadificación del cáncer de mama implicareunir información no sólo sobre el tamaño del tumor principal,sino también sobre la presencia de multifocalidad, multicentricidad,bilateralidad, componente intraductal extenso oextensión al complejo areola-pezón. El objetivo de nuestro estudioes validar la técnica en nuestro entorno asistencial y evaluarel impacto que la RM de mama con contraste ha tenido sobre338 pacientes consecutivas con diagnóstico de cáncer demama en el proceso de la toma de decisión del modelo de tratamiento.Como objetivo secundario se plantea la correlaciónde los hallazgos de la RM con los hallazgos histopatológicos.Material y métodos: estudiamos con RM a 338 pacientesconsecutivas con diagnóstico de cáncer de mama antes de decidircuál era el abordaje terapéutico más adecuado. La intenciónterapéutica se registró antes y después de cada estudio deRM. Se calculó la sensibilidad, la especificidad, el valor predictivopositivo y el valor predictivo negativo de la RM para lesionesadicionales, así como el coeficiente de correlación linealde Pearson para el diámetro del tumor índice o principal.Resultados: en 145 pacientes (42%) se identificaron 164lesiones adicionales, de las cuales 87 (53%) fueron malignas,28 (17%) fueron benignas, 35 (21,3%) se catalogaron comoprobablemente benignas, en 6 (3,6%) no se alcanzó un diagnósticofinal y 8 (4,9%) no quedaron incluidas en la pieza quirúrgicao bien desaparecieron tras la quimioterapia neoadyuvante.Estos hallazgos implicaron un cambio en la actitudterapéutica en 82 pacientes (24,2%). Este cambio se confirmócon los resultados de la anatomía patológica como correcto en69 paciente (20,4%) y como incorrecto o innecesario en 13pacientes (3,8%). El coeficiente de correlación de Pearson resultóser fuertemente positivo (r = 0,784) cuando se compararonlos resultados de la RM y la anatomía patológica...(AU)

Background: breast cancer staging implies gathering informationnot only on the size of the main tumour, but also onmultifocality, multicentricity, bilaterality, presence of an extensiveintraductal component and extension to the nipple-areolarcomplex. The objective of our study is to demonstrate thatbreast magnetic resonance (MR) is the modality of choice inthe staging of breast cancer patients due to the fact that it addsinformation capable of modifying the therapeutic approach inthese patients. A secondary objective is to validate our resultsin our clinical environment.Material and methods: 338 consecutive patients with abreast cancer diagnosis were studied with breast MR beforedeciding the most appropiate therapeutic approach. Therapeuticintention was registered before and after each MRstudy. Sensibility, specificity, postive predictive value (PPV)and negative predictive value (NPV) of MR for additional lesionswas calculated and Pearson's linear correlation coefficientwas calculated for the index lesion diameter.Results: 164 additional lesions were found in 145 patients(42%) of which 87 (53%) were malignant, 28 (17%) were benign,35 (21,3%) were probable benign, 6 (3,6%) had no diagnosisand 8 (4,9%) were not included in the surgical specimenor else dissappeared after neoadjuvant chemotherapy. Thesefindings implied change in therapeutic approach in 82 patients(24,2%). These change was pathologically validated ascorrect in 69 patients (20,4%) and as unnecessary or incorrectin 13 patients (3,8%). Pearson's linear correlation coefficientwas strongly positive (r = 0,784) when MR and pathology resultswere compared. Sensibility, specificity, PPV and NPV ofMR for additional lesions was 90,6, 55,2, 75,7 and 79,5%respectively...(AU)

Punción aspiración con aguja fina en lesiones mamarias probablemente benignas o malignas por radiografía / Fine-needle aspiration in breast lesions radiologically classified as probably bening or probably malignant

Objetivo: El propósito de nuestro trabajo es evaluar la validez de la punción aspiración con aguja fina (PAAF) en nuestro medio en dos grupos definidos por la clasificación radiográfica como lesiones probablemente benignas (PB) o probablemente malignas (PM). Material y Métodos: Se estudian retrospectivamente 96 lesiones mamarias, 55 clasificadas como PB y 41 como PM. En todas se realizó PAAF y se obtuvo comprobación histológica. Resultados: En las citologías de los 55 pacientes con lesión mamaria PB, encontramos en seis casos material insuficiente, 37 benignas, nueve sospechosas de malignidad y tres positivas. Se realizó estudio comparativo entre el informe citológico y el histológico. Hubo tres falsos negativos (FN) y dos falsos positivos (FP). Se obtuvo una especificidad del 99 por ciento y un valor predictivo negativo (VPN) del 92 por ciento. En las citologías de los 41 pacientes con lesión mamamria PM, encontramos cinco casos de material insuficiente, 21 positivas, nueve sospechosas de malignidad y seis negativas. Se realizó estudio comparativo entre el informe citológico y el histológico. Hubo dos FP y dos FN. Se obtuvo una sensibilidad y un valor predictivo positivo (VPP) del 93 por ciento. Conclusiones: Ante una lesión clasificada por radiografía como PB, la PAAF puede considerarse una buena alternativa frente a los controles radiológicos periódicos. Las lesiones clasificadas por radiografía como PM precisan biopsia para evitar los FN que existen con la PAAF (AU)