Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch / Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy

CASO CLÍNICO: Presentamos el caso de una mujer de 64 años con agudeza visual de 20/40 en su ojo derecho, debida a una opacificación grisácea y plumosa con microquistes en el epitelio corneal, compatible con una distrofia epitelial de Lisch. Se trató secuencialmente con varios desbridamientos epiteliales, lente de contacto y mitomicina C, a pesar de los cuales, recidivaba. La extirpación de un sector limbar y el trasplante de limbo autólogo obtuvieron buenos resultados y sin recurrencia. CONCLUSIÓN: El trasplante autólogo de limbo tras extirpar la zona de limbo afectado puede ser considerado como una nueva opción terapéutica en el tratamiento de la distrofia epitelial de Lisch asimétrica, cuando otros tratamientos han fallado

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. Conclusions: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed

Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy. / Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch.

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. CONCLUSIONS: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed.

Keratitis caused by Absidia corymbifera in an immunocompetent male with no corneal injuries.

Case Report A healthy 55-years-old male went to emergency due to a white infiltrate in the left eye without corneal trauma which partially responds to antibiotic treatment. The infiltrate worsened by the use of topical steroids. Direct microscopic evaluation and Gram stain are a valuable diagnostic tool for the detection of Absidia filaments. There is a successful treatment with anphotericin and posaconazole. Discussion Keratitis caused by Zygomicetes are unusual. This is a rare condition in healthy patients with no corneal trauma. The treatment with amphotericin and posaconazole are synergistic against filamentous fungi.

Amblyopia secondary to iris cyst.

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.

Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK / Relationship between donor-receptor interface and visual acuity in DSAEK

Objetivo: Evaluar la relación entre la agudeza visual (AV) mejor corregida y la interfase donante-receptor resultante tras realizar una queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK). Métodos: Se revisaron 46 historias clínicas de pacientes intervenidos con técnica DSAEK, de las cuales cumplían criterios de inclusión 22 pacientes (dos de ellos con DSAEK bilateral). Todos ellos fueron intervenidos por un mismo oftalmólogo desde enero del 2010 hasta abril del 2011. Las indicaciones quirúrgicas fueron: queratopatía bullosa 19 (72,2%), distrofia endotelial de Fuchs tres (12,5%) y agotamiento endotelial tras queratoplastia previa dos (8,3%).Se recogió la AV preoperatoria y al tercer y sexto mes postoperatorio, comparándose en estas dos últimas la interfase existente entre donante y receptor tras DSAEK medida en cámara Scheimpflug de topógrafo corneal (Pentacam-HR, Oculus®, Wetzlar, Alemania). Resultados: Tras la cirugía con DSAEK, la mejora en la AV fue en 19 ojos al tercer mes y en 20 ojos al sexto mes postoperatorio (p < 0,001). Dicho cambio en la AV se comparó con la disminución de la densidad óptica de la interfase donante-receptor resultante, encontrando una relación positiva y significativa entre estas (Rho interfase 3 meses y cambio de AV 6 meses: 0,44; p < 0,001). Sin embargo, la interfase se relacionó negativa y significativamente con la AV (Rho 3 m: –0,41; p = 0,045). Además, los pacientes que presentaban un estroma más denso conseguían AV postoperatorias peores en términos relativos si se comparaban con los que presentaban un estroma menos dañado. Conclusiones: Los pacientes sometidos a DSAEK con AV prequirúrgicas peores experimentan una mejora visual mayor en valores absolutos y, sin embargo, alcanzarían una AV menor relativa que se podría relacionar con una interfase más refringente, como consecuencia de un estroma corneal preoperatorio más alterado (AU)

Objective: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). Methods: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty.The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam® model). Results: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P < 0.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P <0 .001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: –0.41, P = 0.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. Conclusions: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma (AU)

[Relationship between donor-receptor interface and visual acuity in DSAEK]. / Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK.

OBJECTIVE: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). METHODS: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty. The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam(®) model). RESULTS: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P<.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P<.001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: -0.41, P=.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. CONCLUSIONS: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma.

[Corneal toxicity due to amantadine]. / Toxicidad corneal por amantadina.

CASE REPORT: A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug. DISCUSSION: Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.

[Right primary iliac artery rupture during transurethral resection of bladder tumor]. / Rotura de la arteria ilíaca primitiva derecha durante la resección transuretral de un tumor vesical.

Injury to a large-caliber artery transurethral resection of a bladder tumor is a rare but serious complication. It is important that an anesthesiologist be able to detect such an injury, in order to include it among the many differential etiological diagnoses for shock. A 75-years-old man reported hematuria. An ultrasound image of the bladder showed many neoformations consistent with a diagnosis of multiple bladder neoplasms, and transurethral endoscopy was performed under subarachnoid anesthesia. Acute hypotension, bradycardia and shock developed 30 minutes into the procedure. The diagnosis was hypovolemic shock due to acute intraoperative hemorrhage, and exploratory laparotomy revealed an opening in the common iliac artery. The rupture was sutured. In spite of administration of crystalloids, colloids, blood products and vasoactive agents, a second operation was required due to hemodynamic instability. The patient died in the intensive care unit.

Rotura de la arteria ilíaca primitiva derecha durante la resección transuretral de un tumor vesical / Rupture of the right primitive iliac artery during transurethral resection of a bladder tumor

Un varón de 75 años consultó por hematuria. En la ecografía vesical destacaban numerosas neoformaciones compatibles con el diagnóstico de neoplasia vesical múltiple. Se realizó una exploración endoscópica transuretral bajo anestesia subaracnoidea. A los 30 minutos del comienzo de la misma el paciente presentó un cuadro brusco de hipotensión, bradicardia y shock. Tras llegar al diagnóstico de shock hipovolémico por hemorragia aguda intraoperatoria, se practicó laparotomía exploradora, hallándose un orificio en la arteria ilíaca común que se suturó. A pesar de la administración de cristaloides, coloides, hemoderivados y fármacos vasoactivos, la inestabilidad hemodinámica requirió una segunda intervención, falleciendo posteriormente el enfermo en la unidad de cuidados intensivos. La lesión de un vaso arterial de gran calibre durante la resección transuretral de un tumor vesical, es una complicación muy grave e infrecuente. Desde el punto de vista anestesiólogico es importante reconocerla para poder considerarla entre los múltiples diagnósticos diferenciales de la etiología del shock que pueden plantearse (AU)

Evaluación de las propiedades antioxidantes en concentrados de uva y frutas rojas / Evaluation of antioxidant properties of grape and berry concentrates

En el presente estudio se evaluaron las propiedades antioxidantes de zumos concentrados de uva, frambuesa, zarzamora, cereza y grosella, con el fin de caracterizar sus aptitudes para su empleo como materias primas en la elaboración de alimentos funcionales con alta actividad antioxidante. Para ello se determinaron por HPLC los contenidos en compuestos fenólicos y la actividad antioxidante total (AAT) por los métodos ABTS y FRAP. En lo relativo a los compuestos fenólicos, tanto su presencia como las cantidades medidas fueron variables de unas muestras a otras. En todos los concentrados analizados se identificaron antocianos y flavonoles, los ácidos cinámicos se detectaron en los concentrados de uva, cereza y grosella, mientras que los estilbenos sólo se cuantificaron en el zumo concentrado de uva y los ácidos elágicos en los de frambuesa y zarzamora. Los valores de AAT oscilaron entre 21’42 y 270 mmol de equivalentes Trolox/L, para el método ABTS y entre 62’5 y 385 mmol de equivalentes de Fe (II)/L, para el método FRAP. En ambos métodos la AAT siguió el siguiente orden de mayor a menor: Grosella>cereza>frambuesa>uva>zarzamora. En general, el contenido en compuestos fenólicos y las actividades antioxidantes de los concentrados de frutas rojas fueron muy superiores a las recogidas por diferentes autores para las frutas de origen en fresco y sus derivados. Los resultados obtenidos indican que estos concentrados de frutas pueden ser utilizados como ingredientes para el diseño de productos funcionales con alta actividad antioxidante y con efectos potencialmente beneficiosos para la salud del consumidor. (AU)

Postharvest induction modeling method using UV irradiation pulses for obtaining resveratrol-enriched table grapes: a new "functional" fruit?

A modeling method for the induction of resveratrol synthesis by UV irradiation pulses in Napoleon table grapes is proposed. The method is based on the combination of four main parameters: irradiation power (IW), irradiation time (IT), irradiation distance (ID), and number of elapsed days to achieve the highest resveratrol accumulation (D(m)). Maximum resveratrol content (11-fold higher than untreated grapes) was achieved using the combination: IW = 510 W, IT = 30 s, ID = 40 cm, and D(m) = 3 days. Sensory characteristics and main features of irradiated grapes (color, weight, firmness, flavor, size, ripening index and vitamin C content) remained unaltered after 1 week of storage. UV induction signal migrated to the hidden side of the grape skin with a delay of 3 days as compared to the directly irradiated side. Phenolic compounds were not detected in Napoleon grape flesh. Resveratrol content per standard serving (200 g) of irradiated grape was about 3 mg, an amount more than 10-fold higher than that of untreated Napoleon grapes. This means that a serving of irradiated grape (unpeeled) could supply the resveratrol content equivalent to 3 glasses of a red wine with high resveratrol content ( approximately 1 mg/glass). Therefore, controlled UV irradiation pulses are useful as a simple postharvest treatment (and alternative to genetic engineering) to obtain possible "functional" grapes (with enhanced health-promoting properties) as a dietary source of high resveratrol content.

Synthesis of the antioxidant hydroxytyrosol using tyrosinase as biocatalyst.

Hydroxytyrosol (HTyr), a natural ortho-diphenolic antioxidant with health-beneficial properties that mainly occurs in virgin olive oil and olive oil mill waste waters (also known as vegetative waters), has been enzymatically synthesized using mushroom tyrosinase. This o-diphenol (not commercially available) was obtained from its monophenolic precursor tyrosol (commercially available) in the presence of both tyrosinase and ascorbic acid. The reaction synthesis is continuous, easy to perform, and adaptable to a bioreactor for industrial purposes. The HTyr concentration is time-predicted, and the yield of reaction can be 100%. The synthesis method reported here is an alternative approach to obtain this compound in an environmentally friendly way.

Effect of wounding on phenolic enzymes in six minimally processed lettuce cultivars upon storage.

The effect of wounding on polyphenol oxidase (PPO), peroxidase (POD), and phenylalanine ammonia-lyase (PAL) was studied in six minimally processed lettuce (Lactuca sativa L.) cultivars upon storage for 7 days at 5 degrees C (Iceberg Mikonos (IM), I. Green Queen (IGQ), I. Asdrúbal (IA), Little Gem Sandra (LGS), Romaine Cazorla (RC), and R. Modelo (RM)). Wounding of lettuce tissue midribs (because of minimal processing) caused an exponential increase in PPO activity due to the activation process from latent to fully active PPO by following first order kinetics in the time range from 3.7 days (LGS) to 6.3 days (RC). However, total PPO activity (active plus latent) remained constant. Isoform pattern of PPO changed upon storage probably because of posttranslational processes. POD activity linearly increased with induction of new POD isoenzymes. PAL activity presented a typical bell-shaped induction pattern in four cultivars. Only IM and IGQ showed a second induction response which has not been previously described in the literature. IM was the cultivar most susceptible to browning and RC was the cultivar least susceptible. However, no clear correlation was observed between browning and any of the biochemical and physiological attributes investigated (PPO, PAL, and POD activities, total and individual phenols accumulation, and ascorbic acid content).

Effect of postharvest ultraviolet irradiation on resveratrol and other phenolics of cv. Napoleon table grapes.

In the skin of cv. Napoleon table grapes, the anthocyanins malvidin 3-glucoside (and its acetyl and p-coumaroyl derivatives), cyanidin 3-glucoside, peonidin 3-glucoside, cyanidin 3-glucoside, petunidin 3-glucoside, and delphinidin 3-glucoside were identified by HPLC-DAD-MS. In addition, quercetin 3-glucoside and 3-glucuronide, caffeoyltartaric, piceid, and resveratrol were also detected. The content of most phenolics remained quite constant during postharvest refrigerated storage (10 days at 0 degrees C) while the resveratrol derivatives increased 2-fold. Postharvest treatments of grapes with UVC and UVB light induced a large increase in resveratrol derivatives (3- and 2-fold, respectively). This means that a serving of mature Napoleon grapes (200 g) provides approximately 1 mg of resveratrol, which is in the range of the amount supplied by a glass of red wine. This can be increased to 2 or 3 mg of resveratrol per serving in grapes that have been irradiated with UVB or UVC, respectively. These results show that refrigerated storage and UV irradiation of table grapes can be beneficial in terms of increasing the content of potentially health-promoting phenolics.

[The self-measurement of blood glucose and mean glycemias in patients with diabetes mellitus]. / Automedición de la glucosa sanguínea y media de glucemias en pacientes con diabetes mellitus.

OBJECTIVE: To assess the influence that self-measurement of capillary blood glucose (SMBG) has on glucaemia control in patients with diabetes mellitus. DESIGN: Quasi-experimental before and after study. SETTING: Semi-urban health centre. PATIENTS: All diabetic patients, with at least two years of evolution, who used reactive strips for SMBG in 1996. MEASUREMENTS AND MAIN RESULTS: Mean values of base glucaemia in the SMBG study year were compared with those of the year before in 85 patients, 33 men and 52 women, with average age 62.38. Thirteen were type 1 and 72 type 2 diabetics, with a mean 15.61 years of evolution of the disease. A drop of -11.47 mg/dl (SD 44.32) was observed, which was significant (p < 0.05, CI 95%) in the overall results. In all the subgroups, except those treated with non-pharmacological measures, there were drops, ranging between -2.17 mg/dl and -17.01 mg/dl, which were significant in women, in patients with type 2 diabetes, in those who had received health education and in those treated with non-pharmacological measures plus insulin. CONCLUSIONS: Despite the limitations of this kind of study, our findings point towards a slightly better control of glucaemia levels in diabetic patients after SMBG. It is very doubtful whether it signifies any real improvement in managing the illness.

Intraoperative hemodilution is more cost-effective than preoperative autologous donation for patients undergoing procedures associated with a low risk for transfusion.

STUDY OBJECTIVE: To determine the utilization and cost of autologous blood that was donated preoperatively, and to compare it to the cost of employing intraoperative hemodilution to provide autologous blood for patients undergoing surgical procedures with a low risk for the need for transfusion. DESIGN: Retrospective chart review. SETTING: University medical center. PATIENTS: All ASA physical status I and II patients who underwent nononcologic gynecologic procedures and preoperatively donated autologous blood between July 1993 and June 1994. MEASUREMENTS AND MAIN RESULTS: The utilization and overall cost of predonated autologous blood was determined. The cost for employing intraoperative hemodilution and potential cost saving was then calculated. Of the 234 units of preoperatively donated autologous blood, 38 units were returned to patients who had an estimated blood loss of at least 500 ml, 32 units returned to patients who had an estimated blood loss less than 500 ml, and 164 units were wasted. No patient received allogeneic blood. The estimated total cost for all preoperatively donated autologous blood was $23,274.62. Employing hemodilution for those same patients would have cost $5,574.74, and resulted in a potential 75.6% savings. CONCLUSIONS: Inappropriate selection of patients for preoperative blood donation is costly. For those patients scheduled to undergo surgical procedures associated with a low probability for the need for blood transfusion, but who desire that autologous blood be available, hemodilution provides fresh whole blood, free from the possibility of processing or clerical errors, while decreasing blood bank utilization and affording substantial cost savings.

Chronic paroxysmal hemicrania in a young child: possible relation to ipsilateral occipital infarction.

We report a child with chronic paroxysmal hemicrania beginning at 3 years of age with more than 2 years of daily episodes. Indomethacin produced total relief. An ipsilateral, occipital hemorrhagic infarction, probably predating the headaches, may have contributed to their pathogenesis. This is an unusually early onset and persistent chronic paroxysmal hemicrania of possible symptomatic type.

Value of MRI in pediatric migraine.

Twenty four pediatric migraineurs were prospectively evaluated to determine if white matter hyperintensities were present on magnetic resonance imaging (MRI). None had white matter findings or brain abnormalities. Five had mucoperiosteal thickening of the paranasal sinuses, which were unrelated to the patients' clinical course. MRI white matter findings are probably not a common occurrence in pediatric migraineurs. In addition, MRI sinus findings are not necessarily related to a child's headache complaints.

Functional importance of ventricular enlargement and cortical atrophy in healthy subjects and alcoholics as assessed with PET, MR imaging, and neuropsychologic testing.

The authors assessed the relationship between ventricular enlargement, cortical atrophy, regional brain glucose metabolism, and neuropsychologic performance in 10 alcoholics and 10 control subjects. Regional brain glucose metabolism was measured with fluorine-18 fluorodeoxyglucose (FDG) and positron emission tomography (PET). Cortical atrophy and ventricular size were evaluated quantitatively with magnetic resonance (MR) imaging. Alcoholics had decreased brain glucose metabolism and more cortical atrophy but did not have significantly greater ventricular size than did control subjects. The degree of ventricular enlargement and of cortical atrophy was associated with decreased metabolism predominantly in the frontal cortices and subcortical structures in both alcoholics and control subjects. There were no significant correlations between neuropsychologic performance and MR imaging structural changes, whereas various subtest scores were significantly correlated with frontal lobe metabolism. These data show that F-18 FDG PET is a sensitive technique for detecting early functional changes in the brain due to alcohol and/or aging before structural changes can be detected with MR imaging.

MRI findings in children infected by Borrelia burgdorferi.

Cranial magnetic resonance imaging abnormalities were observed in 8 children (5 boys, 3 girls; ages 4-14 years) with neurologic problems following infection by Borrelia burgdorferi, the etiologic agent of Lyme disease. Neurologic features included headache (6), behavioral changes (5), facial palsy (2), papilledema (2), papilledema with diplopia (1), disturbance of sleep pattern (2), and carpal tunnel syndrome (1). Two MRI studies demonstrated multiple focal areas of increased signal intensity in white matter on long TR (both proton-density and T2-weighted) images.