Case report: A rare case of cyclodialysis after cataract surgery managed exclusively with medical therapy.

We present the case of a 68-year-old female who presented with a substantial cyclodialysis after phacoemulsification identified by anterior segment optical coherence tomography and ultrasound biomicroscopy. Gonioscopy is challenging because of its shallow anterior chamber. Due to lack of response to topical steroids and refusal by the patient for surgical treatment, topical steroids were tapered, and cycloplegic was initiated. After two weeks, the cyclodialysis cleft was closed on optical coherence tomography persisting residual subchoroidal fluid, topical treatment was mantained. Despite of this, visual acuity and hypotony were restored. Finally at 2 months visit subchoroidal fluid was reabsorbed and patient was discharged. Clinics should consider the possibility of cyclodialysis in cases of unjustified hypotony during postoperative period. In addition, we recommend performing anterior segment imaging which includes ultrasound biomicroscopy and optical coherence tomography, when the evaluation of angular structures is unfeasible. Finally, we propose medical management for severe cyclodialysis as the first option considering anti-inflammatory drugs could perpetrate the separation between scleral spur and ciliary muscle.

Metabolite collision cross section prediction without energy-minimized structures.

Matching experimental ion mobility-mass spectrometry data to computationally-generated collision cross section (CCS) values enables more confident metabolite identifications. Here, we show for the first time that accurately predicting CCS values with simple models for the largest library of metabolite cross sections is indeed possible, achieving a root mean square error of 7.0 Å2 (median error of ∼2%) using linear methods accesible to most researchers. A comparison on the performance of 2D vs. 3D molecular descriptors for the purposes of CCS prediction is also presented for the first time, enabling CCS prediction without a priori knowledge of the metabolite's energy-minimized structure.

Chronic fluid misdirection syndrome of aqueous humor after phacoemulsification: diagnosis, treatment and asscociated factors. / Síndrome de mala dirección del humor acuoso crónico tras facoemulsificación: diagnóstico, tratamiento y factores a tener en cuenta.

The chronic fluid misdirection syndrome of aqueous humor is a rare and serious condition if not treated promptly. The case is presented of a woman attending the emergency department with an intraocular pressure of 43.00mmHg and shallow anterior chamber in her left eye. As clinical history of interest, she had cataract surgery in that eye several weeks before. Following the suspicion of malignant glaucoma, a capsulotomy and iridotomy were performed with an unfavourable outcome. For this reason, it was decided to perform a central vitrectomy, but the patient did not respond to this surgical treatment either. A second surgery was then performed with peripheral vitrectomy, anterior hyaloidectomy, zonulectomy, and iridectomy, obtaining good results. Finally, a decrease in intraocular pressure, and an opening of camerular angle were achieved. Thus, if malignant glaucoma is not resolved in medical consultation with iridotomy and capsulotomy, a vitrectomy, creating a unique chamber that restores the fluid mechanics of the aqueous humor, will be needed.

Collision cross section predictions using 2-dimensional molecular descriptors.

Traditional methods for deriving computationally-generated collision cross sections for comparisons with ion mobility-mass spectrometry data require 3-dimensional energy-minimized structures and are often time consuming, preventing high throughput implementation. Here, we introduce a method to predict ion mobility collision cross sections of lipids and peptide analogs important in prebiotic chemistry and other fields. Using less than 100 2-D molecular descriptors this approach resulted in prediction errors of less than 2%.

Asian genotypes of dengue virus 4 in Brazil.

Dengue virus, commonly transmitted by mosquitoes, causes a human disease of significant social impact and presents a serious public health problem in Brazil. This report describes the unusual emergence of DENV-4 in northern Brazil after a nearly 30-year-long absence. DENV-4 genotype I is of Asian origin and was identified in the serum of patients receiving treatment at a hospital serving the Salvador area (Brazilian state of Bahia). The identification of dengue virus serotypes through molecular and phylogenetic analysis is essential for predicting disease severity or fatal illness, principally in endemic countries such as Brazil.

Estudio de las consultas extraoficiales en un hospital de tercer nivel / Analysis of Unofficial Consultations in a Tertiary-Level Hospital

Introducción: Los dermatólogos somos demandados a diario, en nuestro centro de trabajo, por pacientes sin cita reglada (acompañantes de pacientes, médicos de otras especialidades, trabajadores del centro, etc.). Objetivos: Descripción de los pacientes demandantes, los motivos de consulta, la gravedad de la patología consultada, la actitud diagnóstico-terapéutica y asistencial de los profesionales demandados. Resultados: El paciente modelo sería una mujer enfermera de mediana edad que consulta por primera vez por una lesión tumoral melanocítica benigna. En general el dermatólogo tomará una actitud terapéutica empírica o informadora y considera que la atención prestada es similar a un paciente con cita reglada. Conclusiones: Las consultas no regladas, aunque suelen ser por patología banal, suponen una carga asistencial en la práctica diaria (AU)

Background: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). Objectives: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. Results: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. Conclusions: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice (AU)

[Analysis of unofficial consultations in a tertiary-level hospital]. / Estudio de las consultas extraoficiales en un hospital de tercer nivel.

BACKGROUND: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). OBJECTIVES: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. RESULTS: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. CONCLUSIONS: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice.

[Descriptive study of the costs of diagnosis and treatment of cutaneous melanoma]. / Estudio de descripción de costes sobre el diagnóstico y tratamiento del melanoma cutáneo.

INTRODUCTION: Every year, health expenditure in Spain increases and, with it, the resources dedicated to cancer treatment. Cutaneous melanoma is the skin cancer with the highest morbidity and mortality. OBJECTIVES: We performed a descriptive study of the costs, based on a theoretical model, to determine the healthcare expenditure for patients with cutaneous melanoma; the objective was to define the overall costs (direct and indirect) of the diagnostic and treatment process of cutaneous melanoma, divided into different stages or diagnostic-therapeutic steps, and the possible variations in these costs. MATERIAL AND METHODS: For this purpose, we used the Andalusian analytical accountancy program of hospitals and districts (COAN-hyd) and the total costs module of the COAN for 2007, applied to the protocol we use in the melanoma unit of our hospital. CONCLUSIONS: The most important conclusions were that the greatest health care expenditure was observed inpatients with more advanced melanomas, with a poor prognosis. Management of the diagnostic-therapeutic process by dermatologists, the appropriate use of complementary tests, and operations performed by dermatologists reduce costs.

Elastosis perforante serpiginosa en pacientecon enfermedad de Wilson tratadacon penicilamina / Elastoris perforans serpiginosa in a patient with Wilson’s disease treated

La Elastosis Perforante Serpiginosa pertenece al grupo de enfermedades perforantes, es una patología poco frecuente que aparece en edades tempranas,infancia o edad adulta precoz. Casi la mitad de los casos se relacionan con diferentes alteraciones genéticas o tratamientos prolongados con penicilamina.Las lesiones son pápulas queratósicas de 2-5mm que se disponen con un patrón serpiginoso o anular, siendo el cuello y flexuras las localizaciones másfrecuentes. Las principales características anatomopatológicas son la hiperplasia y la eliminación transepidérmica de tejido elástico.Presentamos una paciente de 48 años, con Enfermedad de Wilson en tratamiento con D-penicilamina, que consultó por lesiones anulares de repeticióny resolución espontánea (AU)

Elastosis Perforans Serpiginosa belongs to perforating diseases of the skin. It is a rare condition that appears in early ages, childhood or early adult age.Almost half of the cases are related to different genetic alterations or prolonged treatments with penicillamine.The lesions are queratotic papules of 2-5mm with serpiginous or annular pattern, and the neck and the flexures are the most frequent locations. Theprincipal anatomopathologic characteristics are hiperplasic and transepidermal elimination of elastic fiber.We show a patient with 48 years old, with Wilson’s disease in treatment with D-penicillamine, who consulted by annular repetitive lesions and spontaneousresolution (AU)

[Simultaneous suprasellar and pineal germinoma: a case report]. / Germinoma pineal y supraselar sincrónico: a propósito de un caso.

INTRODUCTION: Tumours in the pineal region are rare (0.3-2.7%) and most of the ones that do occur are germ cell tumours, of which germinoma is the most frequent. They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). The main aim of this study is to review the differential diagnosis of neoplasias in the pineal region. CASE REPORT: Here we report the case of a 20-year-old male who was admitted to hospital due to irregularities affecting the field of vision, with clinical signs and symptoms of panhypopituitarism and normal levels of tumour markers in blood and cerebrospinal fluid. Magnetic resonance imaging of the craniospinal axis was performed and results showed the presence of two masses with significant enhancement, one located in the pineal region with a signal similar to that of grey matter and the other in the hypothalamus, which had a more heterogeneous aspect with cystic areas inside it. Imaging with paramagnetic contrast agents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location. CONCLUSIONS: Magnetic resonance imaging plays a decisive role in establishing the diagnosis and therapy plan. The imaging factors that must be taken into account are the origin of the mass, heterogeneity, contrast enhancement, presence of fat or calcium, a signal similar to that of grey matter and possible dissemination, above all into the subarachnoid space. The patient's medical record (age, sex or tumour markers) must also be taken into consideration.