Terapias intravítreas en degeneración macular asociada a la edad no neovascular con fluido intrarretiniano o subretiniano / Intravitreal therapies for non-neovascular age-related macular degeneration with intraretinal or subretinal fluid

OBJETIVO: Evaluar la eficacia de las terapias intravítreas en casos de degeneración macular asociada a la edad (DMAE) atrófica con fluido intra- o subretiniano. MÉTODOS: Revisamos, de forma retrospectiva, las características de pacientes diagnosticados de DMAE atrófica con fluido intra- o subretiniano. Examinamos las retinografías y las imágenes de tomografía de coherencia óptica de dominio espectral analizando en ellas la presencia de fluido y su densidad. Descartamos la existencia de neovascularización coroidea mediante angiografía con fluoresceína o con verde de indocianina. RESULTADOS: Se incluyeron 14 ojos de 13 pacientes con una edad media de 72,64 años y un seguimiento medio de 80,5 semanas. Se observó fluido intrarretiniano en 6 ojos (42,9%) y fluido subretiniano en 8 ojos (57,1%). Este fluido era de alta densidad en 4 de ellos (28,5%) y de baja densidad en los otros 4 ojos (28,5%). La mejor agudeza visual corregida evaluada mediante la escala de Snellen mejoró de 0,37 inicialmente a 0,56 en la visita final (p = 0,002). El grosor macular central (en micras) disminuyó de forma significativa de 291,0 μm al inicio a 228,9μm en la visita final (p≤0,001). Del total, 8 ojos recibieron ranibizumab, 5 ojos recibieron bevacizumab y un ojo recibió triamcinolona intravítrea. CONCLUSIONES: La DMAE atrófica puede presentarse con fluido intra- o subretiniano en ausencia de neovascularización coroidea. Son necesarios estudios adicionales para analizar el valor de estos hallazgos como factor de riesgo en el desarrollo de formas avanzadas de DMAE, así como la eficacia de las terapias intravítreas

OBJECTIVE: To evaluate the efficacy of intravitreal therapies in cases of atrophic age-related macular degeneration (AMD) with subretinal or intraretinal fluid. METHODS: A retrospective review was made of the clinical charts of patients diagnosed with atrophic AMD with subretinal or intraretinal fluid. Fundus photographs and spectral-domain optical coherence tomography images were examined, and an analysis was made on the presence of fluid and its density. Neovascularisation was ruled out by fluorescein and/or indocyanine green angiography. RESULTS: The study included 14 eyes from 13 patients with a mean age of 72.64 years and a mean follow-up of 80.5 weeks. Intraretinal fluid was observed in 6 eyes (42.9%), while subretinal fluid was shown in 8 eyes (57.1%), with high density in 4 eyes (28.5%), and low density in 4 eyes (28.5%). Snellen best-corrected visual acuity improved from 0.37 at baseline to 0.56 at the final visit (P=.002). Central subfield thickness (microns) significantly decreased (P<.001) from 291.0 at baseline to 228.9 at the final visit. Eight eyes received ranibizumab, 5 eyes received bevacizumab, and one case received triamcinolone. CONCLUSIONS: Cases of atrophic AMD may present with subretinal or intraretinal fluid in the absence Neovascularisation. Further studies are required to analyse the value of this finding as a risk factor of developing advanced forms of AMD, as well as the efficacy of intravitreal therapies

Intravitreal therapies for non-neovascular age-related macular degeneration with intraretinal or subretinal fluid. / Terapias intravítreas en degeneración macular asociada a la edad no neovascular con fluido intrarretiniano o subretiniano.

OBJECTIVE: To evaluate the efficacy of intravitreal therapies in cases of atrophic age-related macular degeneration (AMD) with subretinal or intraretinal fluid. METHODS: A retrospective review was made of the clinical charts of patients diagnosed with atrophic AMD with subretinal or intraretinal fluid. Fundus photographs and spectral-domain optical coherence tomography images were examined, and an analysis was made on the presence of fluid and its density. Neovascularisation was ruled out by fluorescein and/or indocyanine green angiography. RESULTS: The study included 14 eyes from 13 patients with a mean age of 72.64 years and a mean follow-up of 80.5 weeks. Intraretinal fluid was observed in 6 eyes (42.9%), while subretinal fluid was shown in 8 eyes (57.1%), with high density in 4 eyes (28.5%), and low density in 4 eyes (28.5%). Snellen best-corrected visual acuity improved from 0.37 at baseline to 0.56 at the final visit (P=.002). Central subfield thickness (microns) significantly decreased (P<.001) from 291.0 at baseline to 228.9 at the final visit. Eight eyes received ranibizumab, 5eyes received bevacizumab, and one case received triamcinolone. CONCLUSIONS: Cases of atrophic AMD may present with subretinal or intraretinal fluid in the absence Neovascularisation. Further studies are required to analyse the value of this finding as a risk factor of developing advanced forms of AMD, as well as the efficacy of intravitreal therapies.

Rhegmatogenous retinal detachment treatment guidelines.

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.

Guías de tratamiento del desprendimiento de retina rhegmatógeno / Rhegmatogenous retinal detachment treatment guidelines

El objetivo de esta guía es describir unas directrices generales del proceso seguido por el cirujano oftalmólogo desde el diagnóstico del desprendimiento de retina, pasando por su evaluación preoperatoria, hasta su tratamiento, complicaciones intra y postoperatorias, fracaso o recidiva del desprendimiento de retina rhegmatógeno, y las posibles alternativas terapéuticas en cada caso. También describiremos el tratamiento del desprendimiento de retina traumático por su importancia y peculiaridades. Se sugieren líneas de tratamiento o profilaxis para las diferentes situaciones del desprendimiento de retina en base a la variables encontradas, a la experiencia de los cirujanos oftalmólogos de la comisión que las ha redactado, y a la revisión bibliográfica con los distintos niveles de evidencia, pero no pretende establecer criterios de obligado cumplimiento, sobre todo considerando que el desprendimiento de retina tiene amplias posibilidades de tratamiento, y que la experiencia del cirujano en una u otra técnica va a ser fundamental en la obtención del mejor resultado quirúrgico. Como guías que son, solamente pretenden asesorar al cirujano en la práctica diaria, dejando en sus manos y en su experiencia la mejor opción terapéutica(AU)

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons’ experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience(AU)

Hamartomas mamarios. Incidencia en la comarca del Bages de Barcelona / Breast hamartomas. Incidence in the Bages region of Barcelona

El hamartoma mamario es una lesión poco frecuente en la mama que habitualmente aparece como un tumor palpable, si bien y a propósito de las mamografías de cribado, también se puede encontrar como una lesión no palpable.Radiológicamente puede plantear el diagnóstico diferencial con el fibroadenoma y el tumor Phyllodes, y en algunos casos con una lesión infiltrante. Una biopsia será siempre necesaria para confirmar el diagnóstico.Aportamos nuestra experiencia de 9 hamartomas diagnosticados en nuestra comarca de enero de 1994 hasta junio de 2001.Si el diagnóstico queda bien documentado no es necesario el tratamiento quirúrgico. (AU)

Fine-needle aspiration of chromophobe renal-cell carcinoma metastatic to the thyroid gland.

Chromophobe renal cell carcinoma is an unusual variant of renal carcinoma that has less aggressive behavior than clear cell carcinomas. There are few documented cases of metastases, none of which occurred in the thyroid gland. A case is presented of chromophobe renal cell carcinoma metastatic to the thyroid eight years after right nephrectomy, suspected by FNA-biopsy and confirmed histologically. Although metastases of chromophobe renal cell carcinoma are rare, they may also present in thyroid, even many years after primary tumor diagnosis, just like clear cell carcinomas. Even though the FNA cytology of chromophobe renal cell carcinoma has distinctive features, in the context of the thyroid, it can be mistaken for a primary tumor of that organ. In our case, the history of a previous renal tumor was essential in suggesting a metastatic lesion, and histologic and ultrastructural features allowed its precise identification.

Cutaneous metastatic adenocarcinoma of gallbladder origin: report of a case and review of the literature.

In the English literature, there have only been seven reports of metastasis from cancer of the gallbladder to the skin. This is the report of a 75-year-old woman who developed cutaneous metastasis from an adenocarcinoma of the gallbladder which was confirmed histologically. We report the uncommon metastatic potential of gallbladder carcinoma to the skin.

[Chronic atrophic gastritis, hypergastinemia and gastric carcinoid tumor]. / Gastritis crónica atrófica, hipergastrinemia y tumor carcinoide gástrico.

We report a case of a gastric carcinoid tumor in an anemic woman with chronic atrophic gastritis and hypergastrinemia. An antrectomy with excision of a carcinoid tumor was performed; afterwards, gastrinemia was normal. Gastric carcinoids were considered uncommon gastric cancers; however, in recent years they have been studied with increasing interest because, as in chronic atrophic gastritis, it has been suggested that they might be produced by prolonged hypergastrinemia associated with therapeutic use of gastric acid supressors. We discuss the gastrin hypothesis, the different clinical types of gastric carcinoids and its therapeutical management.

[Granulocytic sarcoma: unusual form of presentation for acute nonlymphoblastic leukemia]. / Sarcoma granulocítico: Forma infrecuente de presentación de la leucemia aguda no linfoblástica.

A case of acute non-lymphoblastic leukaemia is reported which appeared as granulocytic sarcoma (GS) with no leukaemic expression in peripheral blood. Aside of the patient's advanced age, the rarity of this entity at the onset of ANLL and the location of the tumour, on the back of the patient's left upper thigh are outstanding features. The difficult diagnosis of such non-leukaemic cases is also stressed here, with regard to the differential diagnosis with non-Hodgkin's lymphoma (NHL). It is concluded that the incidence of GS as a tumour of soft tissues in the extremities is more common in patients over 75 years of age, its frequency being 17-fold that of NHL for the same age and location.

[Cryptococcosis with exclusive cutaneous presentation in a patient with AIDS]. / Criptococosis de presentación exclusivamente cutánea en un paciente con SIDA.

We report an exclusively cutaneous case of cryptococcosis, which is exceptional. He was a 33 years old patient with the acquired immunodeficiency syndrome who presented with an ulcer-necrotic lesion at the nasal wings with a long and torpid evolution. Finally, culture and biopsy were diagnostic of cryptococcosis. We ruled out affection of other organs and the cryptococcal antigen was negative in serum and cerebrospinal fluid. The patient was treated with fluconazole and had a good clinical course. Its emphasized the scarcity of this form of presentation as well as the lack of specificity of its lesions and the necessity of ruling out other locations once the fungus is isolated in the skin. Diagnosis is simple through skin biopsy and culture. Its important to determine the cryptococcal antigen. We comment on the current approaches to treatment during acute and maintenance phases, after the appearance of the new imidazolic compounds such as fluconazole.

[Undifferentiated carcinoma of nasopharyngeal type sitting in the hypopharynx]. / Carcinoma indiferenciado tipo nasofaríngeo, localizado en hipofaringe. A propósito de un caso.

Nasopharyngeal-like carcinoma is an extremely rare tumor when localised in the laryngopharyngeal mucosa. Only 10 of such tumors could be found by the AA. in the medical literature. They report this additional case in which the radiotherapy plus the chemotherapy have controlled, till now, the primary disease and its spreading to the cervical lymph nodes.

[Malignant Mediterranean boutonneuse fever. Septic shock of unknown origin?]. / Fiebre botonosa mediterránea maligna. Shock séptico de origen desconocido?

Mediterranean Botonous Fever (MBF) is an infectious disease which provokes multisystemic vasculitis due to endothelial proliferation of rickettsia conorii. Its incidence, in our environment, has greatly increased during the last years being endemic in many large cities and their surrounding suburbs. In some cases its evolution is specially malignant resulting in septic shock, adult respiratory distress syndrome, and multiorgan failure. The purpose of this communication is to present a new case of malignant MBF with a bad evolution factor which has not been previously referred to, which is the persistence of vector ticks in the inoculation spot.

[Necrotizing vasculitis with predominant kidney involvement]. / Vasculitis necrotizante con predominio de afección renal.

We report five patients with necrotizing vasculitis with predominant renal involvement; the diagnostic and therapeutics was effected completely at regional hospital. We detach: a) the clinical presentation's forms with rapidly progressive renal failure with microscopic hematuria and minimal proteinuria; b) the biopsy of kidney with necrotizing vasculitis or necrotizing glomerulonephritis (microscopic polyarteritis). We review the necrotizing vasculitis with predominant renal involvement in its pathogenic, clinical and histological aspects, and we insist that the diagnostic and early treatment are fundamental for prognostic's improvement of these patients. We conclude that this diagnostic and treatment can be made in regional hospitals with sensible physicians by the theme.

Papillary-cystic neoplasm of the pancreas. Report of two cases and review of the literature.

Two cases of papillary-cystic neoplasm of the pancreas are reported in women aged 22 and 23 years. The patient in the first case presented with acute abdominal pain and hemoperitoneum. This form of presentation has not been previously reported. This type of pancreatic tumor is very rare, exclusively affecting young women, and has a good prognosis despite its various histologic features, which suggest a malignant appearance. The authors consider this neoplasm as having an acinar origin because in the cells of one of the patients we observed ultrastructurally the presence of abundant rough endoplasmatic reticulum with formation of annulate lamellae and a few prezymogen granules.