Obstrucción de la arteria ciliorretiniana durante el embarazo / Cilioretinal obstruction during pregnancy

Objetivos: Conocer la incidencia de obstrucción aislada de la arteria ciliorretiniana (OACR) en nuestra serie, a lo largo de 5 años, y describir la incidencia, evolución y secuelas oftalmológicas de esta entidad en el embarazo. Métodos: Estudio retrospectivo, descriptivo, observacional de serie de casos. Resultados: De los 135 pacientes diagnosticados de oclusión arterial retiniana del total de nuestra serie, 20 (14,8%) presentaban OACR, de los cuales 2 (1,48%) eran mujeres embarazadas. Caso 1: mujer embarazada de 34 años, con escotoma centrocecal y agudeza visual de 1 en ojo derecho. Fondo de ojo: exudado algodonoso en el haz papilomacular con edema retiniano y émbolos en una de las ramas de la arteria ciliorretiniana. A las 5 semanas el exudado y el edema habían desaparecido, con reducción del escotoma. Caso 2: mujer embarazada de 30 años, que presenta de forma brusca escotoma centrocecal en el ojo derecho con agudeza visual de 1. Fondo de ojo: exudación lipídica y mancha algodonosa en haz interpapilomacular secundarias a la OACR. A las 4 semanas habían desaparecido los hallazgos en fondo de ojo, con resolución completa de la sintomatología. Conclusiones: La etiología de la OACR suele estar relacionada con enfermedad carotídea u otros procesos tromboembólicos relacionados con estados de hipercoagulabilidad y autoinmunidad. El embarazo es considerado un estado de hipercoagulación, sin embargo, no se ha podido demostrar que se trate de un factor de riesgo per se para desarrollar embolia arterial. Por tanto, se necesitan estudios adicionales para conocer la correlación entre embarazo y OACR (AU)

Purpose: To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. Methods: A retrospective study of the medical records. Results: From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. Conclusions: The aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO (AU)

Cilioretinal obstruction during pregnancy. / Obstrucción de la arteria ciliorretiniana durante el embarazo.

PURPOSE: To determine the number of patients diagnosed over a 5-year period with isolated occlusion of the cilioretinal artery (CRAO) whilst pregnant, as well as to describe the outcomes and ophthalmological sequelae of this condition in pregnant woman. METHODS: A retrospective study of the medical records. RESULTS: From the 135 patients diagnosed with retinal arterial occlusion of all of our series, 20 (14.8%) had CRAO, and 2 (1.48%) of these were pregnant. Case 1: A 34 year-old pregnant woman with a centrocaecal scotoma and visual acuity of 20/20 in right eye. Fundus examination: A soft exudate in the papillomacular bundle with retinal oedema and embolism on a cilioretinal artery branch. The exudate and oedema disappeared after 5 weeks, and the scotoma was reduced. Case 2: A 30 year-old pregnant woman, with normal visual acuity in right eye, and a centrocaecal scotoma. Fundoscopy: An area of retinal interpapillomacular infarction due to cilioretinal artery occlusion. The fundus returned to normal in 4 weeks, with an improvement of the scotoma. CONCLUSIONS: The aetiology of CRAO is usually associated with carotid disease or other thromboembolic events related to hypercoagulable states and autoimmunity. Pregnancy is considered a hypercoagulable state, and it is not known if it is a risk factor for arterial embolism. Further studies are required to determine the correlation between pregnancy and CRAO.

[Recombinant activated factor VII used in a man with refractory bleeding from a stab wound injuring the liver and kidney]. / Factor VII activado recombinante en un paciente con hemorragia incoercible por lesión traumática hepatorrenal.

A 30-year-old man bled massively from a stab wound that injured his liver and right kidney and entered a life-threatening cycle of transfusion, hypothermia, coagulopathy, and rebleeding in spite of surgery and aggressive resuscitation. He was given a single dose of recombinant activated factor VII (rVIIa; NovoSeven, Novo Nordisk, Denmark) in a final attempt to save his life. The patient responded favorably, as bleeding stopped almost immediately and coagulation markers became normal. Clinical course following rVIIa administration was good. Severe bleeding in the trauma patient needing massive transfusion can become complicated by dilutional coagulopathy and hypothermia. Therapy with rVIIa is a promising aid to controlling bleeding in the repeatedly transfused patient who does not respond to standard replacement of blood products.

Factor VII activado recombinante en un paciente con hemorragia incoercible por lesión traumática hepatorrenal / Recombinant activated factor VII used in a man with refractory bleeding from a stab wound injuring the liver and Kidney

Un varón de 30 años con hemorragia masiva por herida de arma blanca que afectaba al hígado y riñón derecho, a pesar de la intervención quirúrgica y de una reanimación agresiva, inició un círculo vicioso de trasfusión, hipotermia, coagulopatía y resangrado en una situación clínica extrema. Se le administró una única dosis de factor VII recombinante activado (rVIIa; Novoseven, Novo Nordisk, Dinamarca) en un intento final de salvar su vida. El paciente respondió favorablemente con un cese casi inmediato del sangrado y con una corrección de los valores de coagulación y la evolución posterior fue satisfactoria. La hemorragia masiva en el paciente traumático que requiere trasfusión masiva de hemoderivados se puede complicar con una coagulopatía dilucional e hipotermia. El factor rVIIa es una terapia adyuvante prometedora para controlar el sangrado en el paciente politrasfundido que no responde a la reposición tradicional con hemoderivados (AU)

Lesion of the internal carotid artery caused by a car safety belt.

A description is given of a case of complete obstruction of the internal carotid in a patient wearing a lap-shoulder belt. This was presumed due to direct contusion of the vessel at the C2 level.