Carcinoma sebáceo simulando un chalazión en paciente joven / Sebaceous carcinoma mimicking a chalazion in a young patient

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Respuesta de los autores: Consideraciones sobre el electrorretinograma negativo / Author's reply: Considerations on the negative electroretinogram

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La utilidad diagnóstica del electrorretinograma negativo / The diagnostic usefulness of the negative electroretinogram

La respuesta negativa del electrorretinograma de campo completo se define como una disminución de la onda b con conservación de la onda a (ratio b/a<1) en la respuesta combinada de conos y bastones. La presencia de este patrón denota una alteración en las células bipolares, en las células de Müller o en la transmisión del estímulo fotorreceptor-células bipolares, con preservación de la función de conos y bastones. Este hallazgo puede verse de forma bilateral y simétrica en diferentes enfermedades hereditarias como la ceguera nocturna estacionaria congénita, la retinosquisis juvenil ligada a X y las distrofias musculares de Duchenne y Becker. Por otro lado, también se puede encontrar de forma unilateral en enfermedades adquiridas como algunos tipos de retinitis inmunomediadas (retinocoroiditis en perdigonada o Birdshot), retinopatías autoinmunes, retinopatía asociada a cáncer/melanoma o toxicidad retiniana. El objetivo de esta revisión es resumir las características de las afecciones en las que puede observarse este hallazgo, de gran utilidad en el diagnóstico diferencial de enfermedades de la retina (AU)

The definition of the negative response of the full field electroretinogram is the presence of a b-wave with less amplitude than the a-wave (b/a ratio<1) in the combined response of cones and rods. The presence of this pattern reflects an alteration in the bipolar cells, the Müller cells, or in the transmission of the stimulus from the photoreceptors to the bipolar cells, with preserved photoreceptor function. This finding can be seen bilaterally and symmetrically in different hereditary conditions, such as congenital stationary night blindness, juvenile X-linked retinoschisis, and Duchenne and Becker muscular dystrophies. On the other hand, it can also be found unilaterally (or asymmetrically) in acquired pathologies, such as some types of immuno-mediated retinitis (Birdshot retinochoroiditis), autoimmune retinopathies, cancer/melanoma associated retinopathy, or retinal toxicity. The objective of this review is to summarise the characteristics of the pathologies in which this finding can be observed, in order to highlight its usefulness in the differential diagnosis of retinal conditions (AU)

The diagnostic usefulness of the negative electroretinogram. / La utilidad diagnóstica del electrorretinograma negativo.

The definition of the negative response of the full field electroretinogram is the presence of a b-wave with less amplitude than the a-wave (b/a ratio<1) in the combined response of cones and rods. The presence of this pattern reflects an alteration in the bipolar cells, the Müller cells, or in the transmission of the stimulus from the photoreceptors to the bipolar cells, with preserved photoreceptor function. This finding can be seen bilaterally and symmetrically in different hereditary conditions, such as congenital stationary night blindness, juvenile X-linked retinoschisis, and Duchenne and Becker muscular dystrophies. On the other hand, it can also be found unilaterally (or asymmetrically) in acquired pathologies, such as some types of immuno-mediated retinitis (Birdshot retinochoroiditis), autoimmune retinopathies, cancer/melanoma associated retinopathy, or retinal toxicity. The objective of this review is to summarise the characteristics of the pathologies in which this finding can be observed, in order to highlight its usefulness in the differential diagnosis of retinal conditions.

[Adverse events caused by activated charcoal in an emergency services survey]. / Encuesta sobre los eventos adversos relacionados con el uso de carbón activado en urgencias y emergencias.

BACKGROUND: There are few studies in Spain on the use of activated charcoal (AC) in acute poisoning via the digestive tract, and more specifically on its protocol and adverse events following its administration. The aim of this article is to know the experience in the use of AC by doctors and nurses of the Spanish emergency services. METHOD: Survey developed using Google Docs to health professionals in emergency services. RESULTS: Three hundred and sixty-four questionnaires were received, 52% of them from doctors. Catheterization prior to the use of AC in 74.5% of patients was performed, and did not use a catheter in 13%. The application of AC was considered correct in 37.4%, and overall it was used in 92.4% of cases. The lateral safety position was used in 46.2%, antiemetics in 86.5% and isolation of the airway in case of coma (GCS<8) in 60%. The most described adverse events were vomiting of AC (61%), epixtasis when the catheter was positioned (51.1%), and its incorrect positioning (36%). Inhaling vomit occurred in 11.8% and inhaling carbon in 4.7%. Seven point one percent stated that the adverse events had been life-threatening to patients. No relation was found between the protocol and serious or life-threatening adverse events, nor between these latter and clinical safety measures. CONCLUSIONS: The incidence of adverse events according to the information provided by professionals in this survey of clinical practice might be higher than the incidence found in the literature.

Encuesta sobre los eventos adversos relacionados con el uso de carbón activado en urgencias y emergencias / Adverse events caused by activated charcoal in an emergency services survey

Fundamento: Existen pocos estudios en España sobre el uso de carbón activado (CA) en las intoxicaciones agudas por vía digestiva, y más concretamente sobre su protocolización y eventos adversos tras su administración. Este trabajo tiene como objetivo conocer la experiencia en el uso de CA, por los médicos y enfermeros de los servicios de urgencias y emergencias españoles. Método: Diseño de una encuesta a profesionales sanitarios de urgencias y emergencias, mediante la aplicación informática Google Docs. Resultados: Ser recibieron 364 encuestas, de ellas un 52% procedentes de facultativos. Contestaron realizar sondaje previo al uso de CA el 74,5%, y no utilizar sonda en el 13% de los pacientes. Se consideró correcta la aplicación de CA en un 37,4%, usándose globalmente en un 92,4% de los casos. La posición lateral de seguridad manifestaron usarla el 46,2%, antieméticos el 86,5% y aislaban la vía aérea en caso de coma (GCS<8) el 60%. Los eventos adversos más descritos fueron los vómitos de CA (61%), la epixtasis al colocar la sonda (51,1%) y la incorrecta colocación de la misma (36%). La broncoaspiración de vómitos les ocurrió al 11,8% y de carbón al 4,7%. Un 7,1% manifestó que los eventos adversos habían supuesto riesgo vital para los pacientes. No se halló relación entre protocolización de la asistencia y eventos adversos graves o riesgo vital, ni entre éstos y las medidas de seguridad clínica. Conclusiones: La incidencia de eventos adversos, en función de lo manifestado por los profesionales en esta encuesta sobre su práctica clínica, podría ser superior a las que se encuentran en la literatura (AU)

Background: There are few studies in Spain on the use of activated charcoal (AC) in acute poisoning via the digestive tract, and more specifically on its protocol and adverse events following its administration. The aim of this article is to know the experience in the use of AC by doctors and nurses of the Spanish emergency services. Method: Survey developed using Google Docs to health professionals in emergency services. Results: Three hundred and sixty-four questionnaires were received, 52% of them from doctors. Catheterization prior to the use of AC in 74.5% of patients was performed, and did not use a catheter in 13%. The application of AC was considered correct in 37.4%, and overall it was used in 92.4% of cases. The lateral safety position was used in 46.2%, antiemetics in 86.5% and isolation of the airway in case of coma (GCS<8) in 60%. The most described adverse events were vomiting of AC (61%), epixtasis when the catheter was positioned (51.1%), and its incorrect positioning (36%). Inhaling vomit occurred in 11.8% and inhaling carbon in 4.7%. Seven point one percent stated that the adverse events had been life-threatening to patients. No relation was found between the protocol and serious or life-threatening adverse events, nor between these latter and clinical safety measures. Conclusions: The incidence of adverse events according to the information provided by professionals in this survey of clinical practice might be higher than the incidence found in the literature (AU)