Long-Term Outcome of Staged Socket Surgery for Acquired Anophthalmos.

PURPOSE: To evaluate long-term outcomes of staged volume rehabilitation for acquired anophthalmos. METHODS: Case-note review of patients who had preceding i) eye removal without implant, ii) eye removal with an intraconal implant, but ball-related problems, or iii) removal of exposed implant. Secondary interventions were a) a first-time ball implant, b) dermis-fat graft, c) ball repositioning, d) ball replacement after prior removal, or e) orbital floor implantation. RESULTS: Secondary volume-augmenting surgery was performed in 175 sockets at a mean age of 42.7 years (range 2-91), with 62% secondary ball implants, 3% dermis-fat grafts, 6% ball repositioning, 19% ball replacement after prior removal for exposure, and 10% having orbital floor implantation. After this surgery, further volume enhancement was required in 21% of sockets, this being 40% for spheres ≤18 mm diameter, in contrast to 6% for those ≥20 mm ( p < 0.001). Exposure or malposition of the secondary implant occurred in 8% (12/151) and was unrelated to implant type, size, wrapping, or prior irradiation. Tertiary surgery addressed lining deficiency (18%) or eyelid malposition (25%). Overall, 92/175 (53%) had tertiary surgery to improve cosmesis and comfort, with 49% (36/92) being related to small implants. At a mean follow-up of 9.1 years, 82% of sockets had adequate volume, 79% had excellent lining, and 93% were comfortable. Prosthetic fit was satisfactory in 96% of cases, and 97% reported improved cosmesis. CONCLUSION: Over half of the sockets having planned 2-stage volume enhancement may need further procedures, especially after small-volume secondary implants, but, with meticulous surgery, reasonable long-term results can be achieved with few complications.

Evaluación de la interacción de capecitabina con inhibidores de la bomba de protones en pacientes con cáncer de colon metastásico / Evaluation of the interaction of capecitabin with proton pump inhibitors in patients with metastatic colon cáncer

Objetivo: Evaluar el impacto clínico que la interacción de capecitabina con inhibidores de la bomba de protones (IBP) puede tener sobre la efectividad del tratamiento de mantenimiento en pacientes con cáncer de colon metastásico (CCm). Material y métodos: Estudio retrospectivo, observacional descriptivo que incluyó a todos los pacientes con CCm tratados con capecitabina sola o en combinación entre enero 2013-diciembre 2016. Los pacientes fueron divididos en dos grupos según si fueron o no tratados con IBP concomitantemente con capecitabina. Se evaluaron variables demográficas, farmacológicas y clínicas, siendo la supervivencia libre de progresión (SLP) la variable elegida para evaluar el impacto clínico de la interacción. Resultados: Se incluyeron 150 pacientes. De ellos, el 57,33% varones, media de edad 70,10±12,06 años; el 55,33% tuvieron un ECOG 1 y el 58,67% utilizaron IBP. Un 39,33% fueron tratados con capecitabina en monoterapia, 31,33% CapeOx, y 20% capecitabina+bevacizumab y 9,33% CapeOx+bevacizumab. El 53,33% tuvo un tratamiento basado en capecitabina en primera línea, la frecuencia de variaciones de tratamiento fue de 42,0% reducción de dosis, 38,0% retraso, y 12% interrupción tratamiento. El 78,0% presentó alguna toxicidad, destacando 34,67% diarrea y 30,0% (síndrome mano-pie). La SLP media fue de 6,69 vs 6,0 meses (HR=0,97; IC95% 0,68-1,39; p=0,87) en favor de los pacientes que no utilizaron IBP, aunque la relación fue no significativa. Conclusiones: En la población estudiada, los pacientes con CCm que recibieron tratamiento de mantenimiento basado en capecitabina y que utilizaron IBP simultáneamente, presentaron una tendencia no significativa a la disminución de la SLP. (AU)

Objective: To evaluate the clinical impact that the interaction of capecitabine with proton pump inhibitors (PPIs) may have on the effectiveness of maintenance treatment in patients with metastatic colon cancer (mCC). Material and methods: Retrospective, observational, descriptive study that included all patients with CCm treated with capecitabine alone or in combination between January 2013-December 2016. The patients were divided into two groups according to whether or not they were treated with PPIs concomitantly with capecitabine. Demographic, pharmacological and clinical variables were evaluated, with progression free survival (PFS) being the variable chosen to evaluate the clinical impact of interaction. Results:150 patients were included. Of them, 57.33% were men, mean age 70.10±12.06 years; 55.33% had an ECOG 1 and 58.67% used it in PPIs. 39.33% were treated with capecitabine in monotherapy, 31.33% CapeOx, and 20% capecitabine+bevacizumab and 9.33% CapeOx+bevacizumab. 53.33% had a first-line capecitabine-based treatment, the frequency of treatment variations was 42.0% dose reduction, 38.0% delay, and 12% treatment interruption. 78.0% presented any toxicity, (highlighting 34.67% diarrhea and 30.0% hand-foot syndrome). The mean PFS was 6.69 vs 6.0 months (HR=0.97; 95% CI 0.68-1.39; p=0.87) in favor of patients who did not use IBP, although the relationship was not significant. Conclusions: In the population studied, patients with mCC who received maintenance treatment based on capecitabine and who used PPIs simultaneously, showed a non-significant trend towards a decrease in PFS. (AU)

Orbital inflammatory disease.

Orbital inflammatory disease (OID), commonly known as orbital pseudotumour, is an inflammatory disease of unknown cause. It has different forms of presentation and different degrees of severity. Its variable nature is the main cause for this disease to be misdiagnosed and misclassified. The prognosis of OID depends on the tissues affected and the histology. OID usually responds favourably to systemic steroid treatment. However, empiric steroids may mask other underlying diseases that respond well to this treatment as well, namely, IgG4-related disease or lymphoproliferative disorders. This fact has led to controversy among various authors as some recommend performing a biopsy in most of the cases, whereas others defend that this procedure should only be performed if the patient has not responded to empiric steroid treatment. Although steroids have been the mainstream treatment of OID, the side effects, relapse rates and lack of response in some cases have resulted in them being replaced by immunosuppressive and immunomodulator therapies that currently stand as a key steroid-sparing treatment option, in addition to radiotherapy and surgery. The aim of this review is to update the evidence on the diagnosis and treatment of OID.

Enfermedad inflamatoria orbitaria idiopática / Orbital inflammatory disease

La enfermedad inflamatoria orbitaria idiopática (EIOI), comúnmente conocida como pseudotumor orbitario, es una enfermedad inflamatoria de etiología desconocida. Sus síntomas pueden ser muy variables tanto en intensidad, gravedad, formas de presentación o gravedad. Esta heterogeneidad ha condicionado que sea una entidad difícil de definir y clasificar. El pronóstico de la EIOI depende de su localización, presentación e histología. La EIOI suele responder favorablemente a los corticoides sistémicos, sin embargo, este hecho puede hacer que la entidad sea confundida con otras enfermedades que también tienen buena respuesta a corticoides, como la enfermedad relacionada con la IgG4 y las enfermedades linfoproliferativas. Esta controversia ha alzado una polémica entre autores que defienden la realización de biopsia previa al tratamiento en la mayoría de los casos, frente a otros que afirman que la biopsia debe indicarse en lesiones que no responden adecuadamente al tratamiento médico empírico. Si bien los corticoides se sitúan como los protagonistas de la EIOI, los efectos secundarios, las tasas de recidivas y la falta de respuesta de algunos subtipos han permitido el paso a agentes inmunosupresores e inmunomoduladores que ocupan un escalón fundamental en la terapia combinada o ahorradora de corticoides, junto con la radioterapia y la cirugía. El objetivo de esta revisión es actualizar la evidencia sobre el diagnóstico y tratamiento de la EIOI.

Orbital inflammatory disease (OID), commonly known as orbital pseudotumour, is an inflammatory disease of unknown cause. It has different forms of presentation and different degrees of severity. Its variable nature is the main cause for this disease to be misdiagnosed and misclassified. The prognosis of OID depends on the tissues affected and the histology. OID usually responds favourably to systemic steroid treatment. However, empiric steroids may mask other underlying diseases that respond well to this treatment as well, namely, IgG4-related disease or lymphoproliferative disorders. This fact has led to controversy among various authors as some recommend performing a biopsy in most of the cases, whereas others defend that this procedure should only be performed if the patient has not responded to empiric steroid treatment. Although steroids have been the mainstream treatment of OID, the side effects, relapse rates and lack of response in some cases have resulted in them being replaced by immunosuppressive and immunomodulator therapies that currently stand as a key steroid-sparing treatment option, in addition to radiotherapy and surgery. The aim of this review is to update the evidence on the diagnosis and treatment of OID.

Variabilidad en el registro de alergias entre niveles asistenciales / Variability in allergies registration between care levels

Objetivo: El objetivo del estudio es comparar el grado de coincidencia en el registro de alergias entre las aplicaciones informáticas de los distintos niveles asistenciales (atención primaria y hospitalaria).Métodos: Estudio observacional descriptivo retrospectivo de 2 meses de duración en el que participaron todas las unidades clínicas con prescripción electrónica. Se incluyó en el estudio a todos los pacientes ingresados con al menos una alergia registrada en la aplicación informática hospitalaria. Se cuantificó el porcentaje de alergias registradas en hospital, atención primaria o ambas.Resultados: Se incluyeron 723 pacientes en los que se registraron 1.280 alergias. El ratio de alergias por paciente fue 1,77. La media de edad fue 62±37 años y el 58,37% eran mujeres. El 80,47% de las alergias registradas fueron farmacológicas.De manera global el 42,11% de todas las alergias fueron registradas en ambas aplicaciones. El 21,20% de las alergias no farmacológicas y el 47,18% de las alergias farmacológicas fueron registradas en ambas aplicaciones. Del total de las alergias farmacológicas detectadas en el estudio, el 68,08% estaban registradas en atención primaria y el 79,13% en atención hospitalaria. Respecto al total de las alergias no farmacológicas el 37,20% estaban registradas en atención primaria y el 84% en la aplicación de atención hospitalaria. Conclusiones: En nuestro estudio hemos encontrado una gran variabilidad en el registro de alergias en los diferentes niveles asistenciales. En menos de la mitad de los casos se registra la alergia en ambos niveles. (AU)

This study aims at comparing the coincidence degree between different allergy-recording computer applications that can be found in distinct levels of the health care system (primary care and hospital care).Methods: Two-month retrospective descriptive and observational study for analyzed records in Clinical Units equipped by electronic prescription. All in-patients who had at least one allergy record registered in the hospital computer application were included in the study. The percentage of allergies registered in hospital, primary care or both applications was quantified.Results: 723 patients were included, among whom 1,280 allergies were recorded. The allergy ratio per patient was 1.77. The average age was 62±37 years and 58.37% were women. 80.47% of the recorded allergies were drug-related.42.11% of global allergies were registered in both applications. 21.20% of non-drug-related allergies and 47.18% of drug-related allergies were registered in both applications. According to the total of drug allergies detected in the study, 68.08% were registered in primary care and 79.13% in hospital care. Regarding to the total of non-drug-related allergies, 37.20% were registered in primary care and 84% in hospital care.Conclusions: Our study reported a high variability in the allergy registration between the different levels of the care health system. Less than the half of allergy cases are registered in both care levels studied. (AU)

[Impact of a quality improvement plan on the validation of drug prescriptions on the safety of the hospitalised patient]. / Impacto de un plan de mejora de calidad en la validación de la prescripción de fármacos sobre la seguridad de los pacientes hospitalizados.

BACKGROUND AND OBJECTIVES: Medication errors are the most common adverse events in healthcare. Pharmaceutical validation (PV) seeks to reduce them. The aims of this study were to assess the impact of the introduction of an automated tool for the validation (VPAT) of the high clinical relevance drugs prescription (HCRD) over time of pharmaceutical intervention (PI), and to quantify the number of medication errors detected before and after its implementation. MATERIAL AND METHODS: A two phase retrospective-observational single centre study was designed. A pre-intervention phase (Pre-P): PV of beds with Unit Dose Dispensing (October 2015 - February 2016), was followed by a post-intervention phase (Post-P): PV using a VPAT of HCRD in hospital patients (October 2016 - February 2017). HCRD were selected from the list of high-risk drugs of Institute for Safe Medication Practices. The data was obtained from the PI record (Access®) and the computerised prescription. The variables collected were: age and gender of the patients included, data of drugs prescription, and time to PI. RESULTS: A total of 477 PI were analysed in 404 patients, with a mean age of 65.9±19.5 years (53.22% women). The mean time up to PI was 25.6±24.72h in the Pre-P, and 18.87±20.44h in the Post-P (P=0.01). In Pre-P, 106 PI were performed (35.85% prevention of adverse reactions) compared to 371 PI (39.62% medication reconciliation) in Post-P. CONCLUSIONS: The VPAT enabled a greater number of medication errors to be detected and intervened in hospitalised patients, with a significantly reduced time to PI.

¿Qué haría usted ante un paciente con síndrome de Horner? / What would you do in front of a patient with a Horner syndrome?

El síndrome de Horner (SH) se caracteriza por ptosis palpebral, miosis pupilar y anhidrosis. Se debe a una interrupción de la vía oculosimpática. Las etiologías son múltiples incluyendo tumorales, traumáticas, iatrogénicas o vasculares. En ocasiones representa una urgencia médica. Para su diagnóstico se usan los test de colirios, como cocaína, hidroxianfetamina o apraclonidina, y pruebas de neuroimagen para establecer la etiología. Presentamos un caso de un SH asociado a bocio multinodular. Se trata de una paciente de 63 años derivada por ptosis palpebral derecha de 4 meses de evolución. En la exploración se objetivó miosis, por lo que se sospechó un SH. Reinterrogando a la paciente esta refirió antecedente de bocio multinodular benigno. Las exploraciones farmacológicas y de neuroimagen confirmaron el diagnóstico de sospecha de SH secundario a la enfermedad tiroidea

Horner's syndrome (HS) occurs when there is disruption to the oculosympathetic pathway. Its features include eyelid ptosis, miosis and anhidrosis. The aetiology of this syndrome is varied and includes tumours, trauma, vascular disease and iatrogenic. Different pharmacologic tests are used for diagnosis, such as cocaine, hydroxyamphetamine and apraclonidine; while neuroimaging helps elucidating the aetiology. We present a case of a 63-year-old female referred to our service with a 4-month history of right eyelid ptosis. During examination right miosis was noted. The patient reported a history of multinodular goiter. Pharmacologic tests and neuroimaging confirmed the diagnosis of HS secondary to thyroid disease

[What would you do in front of a patient with a Horner syndrome?] / ¿Qué haría usted ante un paciente con síndrome de Horner?

Horner's syndrome (HS) occurs when there is disruption to the oculosympathetic pathway. Its features include eyelid ptosis, miosis and anhidrosis. The aetiology of this syndrome is varied and includes tumours, trauma, vascular disease and iatrogenic. Different pharmacologic tests are used for diagnosis, such as cocaine, hydroxyamphetamine and apraclonidine; while neuroimaging helps elucidating the aetiology. We present a case of a 63-year-old female referred to our service with a 4-month history of right eyelid ptosis. During examination right miosis was noted. The patient reported a history of multinodular goiter. Pharmacologic tests and neuroimaging confirmed the diagnosis of HS secondary to thyroid disease.

Color vision impairment in multiple sclerosis points to retinal ganglion cell damage.

Multiple Sclerosis (MS) results in color vision impairment regardless of optic neuritis (ON). The exact location of injury remains undefined. The objective of this study is to identify the region leading to dyschromatopsia in MS patients' NON-eyes. We evaluated Spearman correlations between color vision and measures of different regions in the afferent visual pathway in 106 MS patients. Regions with significant correlations were included in logistic regression models to assess their independent role in dyschromatopsia. We evaluated color vision with Hardy-Rand-Rittler plates and retinal damage using Optical Coherence Tomography. We ran SIENAX to measure Normalized Brain Parenchymal Volume (NBPV), FIRST for thalamus volume and Freesurfer for visual cortex areas. We found moderate, significant correlations between color vision and macular retinal nerve fiber layer (rho = 0.289, p = 0.003), ganglion cell complex (GCC = GCIP) (rho = 0.353, p < 0.001), thalamus (rho = 0.361, p < 0.001), and lesion volume within the optic radiations (rho = -0.230, p = 0.030). Only GCC thickness remained significant (p = 0.023) in the logistic regression model. In the final model including lesion load and NBPV as markers of diffuse neuroaxonal damage, GCC remained associated with dyschromatopsia [OR = 0.88 95 % CI (0.80-0.97) p = 0.016]. This association remained significant when we also added sex, age, and disease duration as covariates in the regression model. Dyschromatopsia in NON-eyes is due to damage of retinal ganglion cells (RGC) in MS. Color vision can serve as a marker of RGC damage in MS.

The visual pathway as a model to understand brain damage in multiple sclerosis.

Patients with multiple sclerosis (MS) almost always experience effects in the visual pathway; and thus, visual dysfunction is not only common but also highly relevant. The visual pathway represents a model of acute focal central nervous system (CNS) damage, through acute optic neuritis and retinal periphlebitis, as well as a model of chronic, diffuse CNS damage through chronic retinopathy and optic neuropathy. The optic pathway can be accurately evaluated in detail, due to the availability of highly sensitive imaging techniques (e.g. magnetic resonance imaging or optical coherent tomography) or electrophysiological tests (multifocal visual evoked potentials or electroretinography). These techniques allow the interactions between the different processes at play to be evaluated, such as inflammation, demyelination, axonal damage and neurodegeneration. Moreover, these features mean that the visual pathway can be used as a model to test new neuroprotective or regenerative therapies.

[Neuro-ophthalmological manifestations of pituitary adenomas. The usefulness of optical coherence tomography]. / Manifestaciones neurooftalmológicas de los adenomas hipofisarios. Valor de la tomografía de coherencia óptica.

INTRODUCTION: Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. AIM: To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. DEVELOPMENT: This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clinic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations of such tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles in English. Apart from oculomotor disorders and other less common findings, visual field defects stand out as the guiding symptom of this condition. CONCLUSIONS: Improved diagnostic techniques are allowing pituitary tumours to be detected at increasingly earlier stages, but cases are still seen with neuro-ophthalmological symptoms as the presenting symptoms. Familiarity with these syndromes is crucial. In addition to the clinical and visual field examination, optical coherence tomography is particularly useful for the diagnosis and follow-up of these patients. Prospective studies are needed to establish factors for predicting the visual recovery in these patients.

Manifestaciones neurooftalmológicas de los adenomas hipofisarios. Valor de la tomografía de coherencia óptica / Neuro-ophthalmological manifestations of pituitary adenomas. The usefulness of optical coherence tomography

Introducción. Los adenomas hipofisarios son una patología frecuente. Requieren un tratamiento multidisciplinario entre varios especialistas. Sus manifestaciones neurooftalmológicas son muy variadas, y en ocasiones aparecen como síntoma de presentación. Objetivo. Reunir los principales signos y síntomas oftalmológicos de estos tumores, para que todo especialista sospeche esta patología cuando se encuentre ante alguno de ellos. Desarrollo. Esta revisión se ha desarrollado sobre la base de la experiencia clínica de la unidad de neurooftalmología del Hospital Clínic de Barcelona, con más de 350 pacientes afectos de tumores hipofisarios. Asimismo, se ha realizado una búsqueda bibliográfica en Medline de los artículos publicadossobre adenomas hipofisarios en lengua castellana e inglesa. Se centró principalmente en aquéllos que se referían a las manifestaciones oftalmológicas de dichos tumores. Se encontraron numerosos artículos referentes a manifestaciones oftalmológicas aisladas de estos tumores, muchas de ellas como inicio. También se encontraron artículos de revisión en lengua inglesa.Aparte de las alteraciones oculomotoras y otros hallazgos menos frecuentes, destacan las alteraciones campimétricas como síntoma guía de esta patología. Conclusiones. Los tumores hipofisarios se detectan cada vez más temprano debido a la mejora en las técnicas diagnósticas, pero aún se observan casos con síntomas neurooftalmológicos como inicio. Resulta crucialel conocimiento de estos síndromes. Además de la exploración clínica y la campimetría, la tomografía de coherencia óptica resulta de gran valor para el diagnóstico y el seguimiento de estos pacientes. Se necesitan estudios prospectivos para establecerfactores pronósticos de recuperación visual en estos pacientes

Introduction. Pituitary adenomas are a frequently occurring pathology that require multidisciplinary management by several different specialists. Their neuro-ophthalmological manifestations vary widely and sometimes appear as the presenting symptom. Aim. To gather the main ophthalmological signs and symptoms of these tumours so that specialists who find themselves before any of them will suspect this pathology. Development. This survey was based on the clinical experience of the neuro-ophthalmological unit at the Hospital Clínic de Barcelona, with over 350 patients who had suffered from pituitary tumours. A bibliographical search was also carried out on Medline for papers published on pituitary adenomas in the literature in both English and Spanish. We focused mainly on those that reported on the ophthalmological manifestations ofsuch tumours. A number of articles were found dealing with isolated ophthalmological manifestations of these tumours, many of them as presenting symptoms. We also found review articles in English. Apart from oculomotor disorders and other less common findings, visual field defects stand out as the guiding symptom of this condition. Conclusions. Improved diagnostictechniques are allowing pituitary tumours to be detected at increasingly earlier stages, but cases are still seen with neuroophthalmological symptoms as the presenting symptoms. Familiarity with these syndromes is crucial. In addition to the clinical and visual field examination, optical coherence tomography is particularly useful for the diagnosis and follow-up ofthese patients. Prospective studies are needed to establish factors for predicting the visual recovery in these patients