Orbitopatía tiroidea enmascara una fístula carótido-cavernosa. Presentación de un caso / Thyroid orbitopathy masked a carotid-cavernous fistula. Case report

Mujer de 73 años que acude a consulta con diagnóstico de hipertiroidismo de 8 meses de evolución. Desde entonces comenzó con hiperemia y proptosis ocular. En la exploración se observa exoftalmos bilateral de predominio derecho, ligera hiperemia conjuntival en ojo derecho asociada a vasos epiesclerales aumentados en su calibre con forma de cabeza de medusa. Tomografía computada con recto inferior aumentado de calibre sin datos de compresión de nervio óptico. En el estudio doppler de órbita se encuentra un flujo arteriorizado sobre la vena oftálmica superior con un posible diagnóstico de fístula carótido-cavernosa. La orbitopatía tiroidea relacionada a una fístula carótido-cavernosa es una asociación infrecuente, ya que los datos clínicos de una de las patologías pueden enmascarar a la otra, por lo que es importante el conocimiento de ambas enfermedades para su correcto diagnóstico y tratamiento multidisciplinario

The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Computed tomography showed enlarged inferior rectus with no signs of ocular nerve or ophthalmic superior vein compression. In the orbital Doppler ultrasound scan, there was an arterialised flow over the superior ophthalmic vein, giving a possible diagnosis of cavernous carotid. Thyroid orbitopathy with a cavernous carotid fistula is an unusual combination in which the clinical signs of both pathologies can mask the complete diagnosis; thus it is important to be acquainted with both pathologies for their correct management and multidisciplinary treatment

Thyroid orbitopathy masked a carotid-cavernous fistula. Case report. / Orbitopatía tiroidea enmascara una fístula carótido-cavernosa. Presentación de un caso.

The case concerns a 73 year-old female with a diagnosis of hyperthyroidism of 8 months onset. Since then, she has suffered hyperaemia and ocular proptosis. Bilateral exophthalmos was observed in the physical examination, along with mild conjunctival hyperaemia in the right eye associated with dilated episcleral vessels. Computed tomography showed enlarged inferior rectus with no signs of ocular nerve or ophthalmic superior vein compression. In the orbital Doppler ultrasound scan, there was an arterialised flow over the superior ophthalmic vein, giving a possible diagnosis of cavernous carotid. Thyroid orbitopathy with a cavernous carotid fistula is an unusual combination in which the clinical signs of both pathologies can mask the complete diagnosis; thus it is important to be acquainted with both pathologies for their correct management and multidisciplinary treatment.

Binocularidad en pacientes con endotropía totalmente acomodativa / Sensorial status in patients with pure accomodative esotropia

OBJETIVO: Evaluar la binocularidad en pacientes con endotropía totalmente acomodativa. MATERIAL Y MÉTODOS: Estudio ambispectivo de pacientes con endotropía totalmente acomodativa que se encontraron en ortotropía con el uso de su corrección óptica. RESULTADOS: Se incluyeron 67 pacientes, la media de la edad de inicio de la desviación fue 3,68±1,28 años, la magnitud de desviación de lejos y cerca fue 19 ± 8,8 DP y 18,71± 10,61 DP respectivamente, la agudeza visual en ojo derecho fue 0,183 ± 0,11 logMAR, en el ojo izquierdo fue 0,188 ± 0,12 logMAR. La media del equivalente esférico fue +5,50 dioptrías, la media de la relación CA/A fue 5,19 ± 0,92 Δ/1. El 90% de los pacientes tuvo estereopsis cercana: 42% tuvieron estereopsis igual o mejor de 70 segundos de arco y 81% tuvieron estereopsis igual o mejor a 400 segundos de arco, siendo la media 205 segundos de arco. El 85% de los pacientes tuvo estereopsis lejana: 16% tuvieron estereopsis igual a 70 segundos de arco y 66% tuvieron estereopsis igual o mejor a 400 segundos de arco siendo la media 334,9 segundos de arco. No hubo correlación estadísticamente significativa entre la magnitud de desviación y la estereopsis al usar su corrección. CONCLUSIONES: Este estudio ha detectado que existe un compromiso importante de la sensorialidad a pesar de un adecuado y oportuno tratamiento, y aún con una baja frecuencia de ambliopía

OBJECTIVE: To evaluate the sensorial status in patients with pure accommodative esotropia. MATERIAL AND METHODS: Ambispective study, patients with pure accommodative esotropia that were found in orthotropy when using its correction glasses were included. RESULTS: 67 patients were included, mean age was 3.68±1.28 years, the near and far ocular deviation was 19±8.8 PD and 18.71±10.61 PD respectively. The visual acuity in the right eye was 0.183 ±0.11 logMAR, in the left eye was 0.188±0.12 logMAR. The average spherical equivalent was +5.50 diopters, for the right eye was +5.46 ±1.61 diopters and for the left eye +5.71 v±1.6 diopters. The average AC/A ratio was 5.19±0.92 Δ/1. 90% of the patients had a grade of near stereopsis: 42% had stereopsis equal or better to 70 arc seconds and 81% had stereopsis equal or better to 400 arc seconds, having an average of 205 arc seconds. 85% of the patients had some grade of far stereopsis: 16% had stereopsis equal or better to 70 arc seconds and 66% had a stereopsis equal or better to 400 arc seconds, having an average of 334.9 arc seconds. There was not statistically significant correlation between the grade of deviation and the stereopsis when using its correction. CONCLUSIONS: This study has detected that the sensorial status is compromised even with adequate and appropriate treatment, nevertheless, there is a low frequency of amblyopia

Sensorial status in patients with pure accomodative esotropia. / Binocularidad en pacientes con endotropía totalmente acomodativa.

OBJECTIVE: To evaluate the sensorial status in patients with pure accommodative esotropia. MATERIAL AND METHODS: Ambispective study, patients with pure accommodative esotropia that were found in orthotropy when using its correction glasses were included. RESULTS: 67 patients were included, mean age was 3.68±1.28 years, the near and far ocular deviation was 19±8.8 PD and 18.71±10.61 PD respectively. The visual acuity in the right eye was 0.183 ±0.11 logMAR, in the left eye was 0.188±0.12 logMAR. The average spherical equivalent was +5.50 diopters, for the right eye was +5.46 ±1.61 diopters and for the left eye +5.71 v±1.6 diopters. The average AC/A ratio was 5.19±0.92 Δ/1. 90% of the patients had a grade of near stereopsis: 42% had stereopsis equal or better to 70 arc seconds and 81% had stereopsis equal or better to 400 arc seconds, having an average of 205 arc seconds. 85% of the patients had some grade of far stereopsis: 16% had stereopsis equal or better to 70 arc seconds and 66% had a stereopsis equal or better to 400 arc seconds, having an average of 334.9 arc seconds. There was not statistically significant correlation between the grade of deviation and the stereopsis when using its correction. CONCLUSIONS: This study has detected that the sensorial status is compromised even with adequate and appropriate treatment, nevertheless, there is a low frequency of amblyopia.

Uso de toxina botulínica A en el tratamiento de las endotropías parcialmente acomodativas / Botulinum toxin type A as treatment of partially accommodative esotropia

OBJETIVO: Determinar la efectividad de la toxina botulínica (TB) tipo A aplicada en ambos rectos mediales en pacientes con endotropía parcialmente acomodativa (ETPA). Se evaluó la desviación residual y su estabilidad a 18 meses de seguimiento. MÉTODO: Estudio analítico prospectivo, cuasi experimental. Se estudió una cohorte de 21 pacientes con uso de refracción ciclopléjica total con desviación residual igual o mayor a 14 DP. Se realizó aplicación de TB en ambos rectos mediales, 5 U de TB para desviaciones residuales mayores de 18 DP y 2,5 U para desviaciones residuales menores. El análisis incluyó regresión logística entre variables para considerar factores predictivos. RESULTADOS: Se incluyeron 21 pacientes, 33,3% pacientes (n = 7) del género masculino y 66,6% (n = 14) del género femenino. La capacidad visual promedio fue de -0,28 ±0,25 logMAR ojo derecho (rango 0 a -1) y -0,2 ± 0,31 logMAR ojo izquierdo (rango 0 a -1,3). El ángulo de endodesviación promedio previo a la aplicación de TB se encontró de 40,95 ± 8,6 DP sin corrección y de 22,3 ±7,99 DP con corrección. Los principales efectos secundarios fueron: ptosis 14,2% (n = 3), diplopía 23,8% (n = 5) y desviaciones verticales 33% (n = 7). Al año de seguimiento el 85,71% de pacientes tuvieron un resultado bueno con endotropía menor a 12 DP. Estos porcentajes disminuyeron a los 18 meses de seguimiento al 71,43%. CONCLUSIONES: El uso de TB tipo A permite obtener un resultado motor bueno a 18 meses en la mayoría de los pacientes. No se demostraron factores predictivos para el pronóstico

OBJECTIVE: To determine the effectiveness of a botulinum toxin type A injection in both medial rectus muscles in patients with partially accommodative esotropia. Residual deviation and stability of strabismus were evaluated at 18 months follow up. METHOD: A prospective, analytical, quasi-experimental study was conducted on a cohort of 21 patients who underwent total cycloplegic refraction and with a residual deviation of at least 14 DP. A botulinum toxin type A dose of 5 IU was injected into each medial rectus muscle for a residual deviation greater than 18 DP, with a dose of 2.5 IU being used for a deviation between 14 and 18 DP. Multivariate logistic regression analyses were performed to relate residual deviation to variables recorded as potential predictors. RESULTS: A total of 21 patients were included, 33.3% (n = 7) males and 66.6% (n = 14) females. Mean visual acuity was -.28 ± .25 logMAR for right eye (range 0 to -1) and -.42 ± .31 logMAR for left eye (range 0 to -1.3). Mean angle of residual deviation before application of botulinum toxin was 40.95 ± 8.6 DP without spectacles correction, and 22.3 ± 7.99 DP with full cycloplegic refraction. Adverse effects were ptosis in 14.2% (n = 3), diplopia 23.8% (n = 5), and vertical deviation in 33% (n = 7). One patient had a poor outcome, therefore required surgical treatment. At one year follow up, 85.71% of patients showed good results with esotropia of 12 DP or less, dropping to 71.43% at 18 months of follow up. CONCLUSION: Botulinum toxin type A is an effective long-term treatment with a good response in 71.43% of patients. No predictors of good response were demonstrated

Botulinum toxin type A as treatment of partially accommodative esotropia.

OBJECTIVE: To determine the effectiveness of a botulinum toxin type A injection in both medial rectus muscles in patients with partially accommodative esotropia. Residual deviation and stability of strabismus were evaluated at 18 months follow up. METHOD: A prospective, analytical, quasi-experimental study was conducted on a cohort of 21 patients who underwent total cycloplegic refraction and with a residual deviation of at least 14 DP. A botulinum toxin type A dose of 5 IU was injected into each medial rectus muscle for a residual deviation greater than 18 DP, with a dose of 2.5 IU being used for a deviation between 14 and 18 DP. Multivariate logistic regression analyses were performed to relate residual deviation to variables recorded as potential predictors. RESULTS: A total of 21 patients were included, 33.3% (n=7) males and 66.6% (n=14) females. Mean visual acuity was -.28±.25 logMAR for right eye (range 0 to -1) and -.42±.31 logMAR for left eye (range 0 to -1.3). Mean angle of residual deviation before application of botulinum toxin was 40.95±8.6DP without spectacles correction, and 22.3±7.99 DP with full cycloplegic refraction. Adverse effects were ptosis in 14.2% (n=3), diplopia 23.8% (n=5), and vertical deviation in 33% (n=7). One patient had a poor outcome, therefore required surgical treatment. At one year follow up, 85.71% of patients showed good results with esotropia of 12 DP or less, dropping to 71.43% at 18 months of follow up. CONCLUSION: Botulinum toxin type A is an effective long-term treatment with a good response in 71.43% of patients. No predictors of good response were demonstrated.

[Embryonal rhabdomyosarcoma of spermatic cord and prostatic adenocarcinoma. Case report and review of the literature]. / Rabdomiosarcoma embrionario del cordón espermático asociado a adenocarcinoma prostatico. Presentación de un caso y revisión de la literatura.

We present a tumor developed from spermatic cord structures. The histology (rhabdomyosarcoma), the age of the patient and its association with a prostatic adenocarcinoma has developed this case report. Histopathological singularity and regional treatment choice are the two key points of this case.

Rabdomiosarcoma embrionario del cordón espermático asociado a adenocarcinoma prostatico. Presentación de un caso y revisión de la literatura / Embryonal rhabdomyosarcoma of spermatic cord and prostatic adenocarcinoma. Case report and review of the literature

Presentamos el caso de una tumoración derivada de estructuras del cordón espermático. La histología (rabdomiosarcoma), la edad de presentación (adulta) y la asociación con un cáncer de próstata motivó esta nota clínica. La especificidad del estudio anatomopatológico e inmunohistoquímico y el planteamiento del tratamiento regional son los dos aspectos claves del caso (AU)

We present a tumor developed from spermatic cord structures. The histology (rhabdomyosarcoma), the age of the patient and its association with a prostatic adenocarcinoma has developed this case report. Histopathological singularity and regional treatment choice are the two key points of this case (AU)

[Cystic multilocular nephroma. Report of a case]. / Nefroma multilocular quístico. Presentación de un caso.

We present a new case of multilocular cystic nephroma, and a review of literature. If C.T. diagnoses a cystic disease we apply the Bosniak classification. Multilocular cystic nephroma appears as a cystic disease, separately fibrous thin walls, with or without calcifications. We have to make a distinctive diagnosis between RCC and multilocular. Definitive diagnosis is always histological.

Nefroma multilocular quístico. Presentación de un caso / Multilocular cystic nephroma. A new case presentation

Presentamos un nuevo caso de nefroma multilocular quístico y se realiza revisión de la literatura. Ante una lesión quística compleja diagnosticada por T.C. aplicamos la clasificación de Bosniak. El nefroma multilocular se presenta en forma de lesión quística múltiple separada por tabiques fibrosos, con o sin calcificaciones, por lo que plantea el diagnóstico diferencial entre CCR y nefroma multiquístico. El diagnóstico definitivo es histológico (AU)

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[Kidney annulment and bladder lithiasis secondary to ureteral catheter]. / Anulación renal y litiasis vesical secundaria a catéter ureteral.

We reported a case of a kidney annulment and bladder stone secondary a foreign body (ureteral stent). We review all the cases of urinary stone secondary a foreign bodies.

Anulación renal y litiasis vesical secundaria a catéter ureteral / Kidney annulment and bladder stone secondary and ureteral stent

Presentamos un caso de anulación renal y litiasis vesical secundaria a la presencia prolongada de un catéter ureteral.Revisamos los casos de litiasis urinaria secundaria a cuerpos extraños (AU)