Manifestaciones otológicas en los niños con ictiosis congénitas autosómicas recesivas / Otologic Manifestations of Autosomal Recessive Congenital Ichthyosis in Children

INTRODUCCIÓN: Las complicaciones otológicas asociadas a las ictiosis congénitas autosómicas recesivas (ICAR) no sindrómicas, apenas han sido estudiadas en la literatura. OBJETIVO: Conocer la frecuencia y el tipo de manifestaciones otológicas de los pacientes diagnosticados de ICAR, actualmente en seguimiento en la unidad de dermatología pediátrica de nuestro hospital. MATERIAL Y MÉTODO: Se estudió de forma prospectiva la presencia de los siguientes parámetros: dolor, prurito ótico, acúfenos, otitis, tapón de cerumen, acúmulo de restos epiteliales y sordera. Se recogió en la anamnesis las medidas de higiene diaria, tratamientos tópicos o intervenciones médico-quirúrgicas requeridas y la periodicidad con la que los pacientes habían consultado a un especialista de otorrinolaringología (ORL). En todos los casos se realizaron otoscopia y pruebas auditivas. RESULTADOS: Se estudiaron 10 pacientes, 2 con fenotipo de bebé colodión autorresolutivo y 8 con ictiosis. Un 100% (8/8) de los pacientes con ictiosis referían algún síntoma o signo en la anamnesis, en el 75% (6/8) se observaron anomalías en la exploración del conducto auditivo externo y en el 25% (2/8) se objetivó sordera de conducción, que en un caso se consiguió revertir. Nuestro trabajo está limitado por el escaso número de pacientes, todos menores de 19 años. CONCLUSIONES: Es fundamental la participación conjunta del dermatólogo y del especialista de ORL en el manejo de los pacientes con ictiosis para establecer las mejores medidas terapéuticas y preventivas. Se precisan más estudios que determinen la frecuencia de la afectación otológica, su repercusión en la calidad de vida y la periodicidad mínima idónea de visitas al especialista de ORL

BACKGROUND: Few studies have investigated ear involvement in nonsyndromic autosomal recessive congenital ichthyosis (ARCI). OBJECTIVES: To assess the type and frequency of otologic manifestations of ARCI in patients under follow-up at the pediatric dermatology department of our hospital. MATERIALS AND METHODS: We prospectively studied the presence of ear pain, ear itching, tinnitus, otitis, cerumen impaction, accumulation of epithelial debris, and hearing loss. Daily hygiene measures, topical treatments, medical-surgical interventions, and frequency of visits to an ear, nose, and throat (ENT) specialist were noted in the patients' medical records. Ear examination and hearing tests were performed in all cases. RESULTS: Ten patients were studied: 2 had a self-healing collodion baby phenotype and 8 had ichthyosis. There was mention of otologic manifestations in the records of all 8 patients with ichthyosis (100%); 6 of these patients (75%) had abnormalities in the external auditory canal examination and 2 (25%) had conductive hearing loss. Our findings are limited by the small number of patients studied, all of whom were younger than 19 years. CONCLUSIONS: The involvement of both dermatologists and ENT specialists in the management of patients with ichthyosis is crucial to ensure the application of the best therapeutic and preventive measures. More studies are needed to assess the prevalence and impact on quality of life of ear involvement in patients with ichthyosis and to determine the optimal interval between ENT visits for these patients

Otologic Manifestations of Autosomal Recessive Congenital Ichthyosis in Children.

BACKGROUND: Few studies have investigated ear involvement in nonsyndromic autosomal recessive congenital ichthyosis (ARCI). OBJECTIVES: To assess the type and frequency of otologic manifestations of ARCI in patients under follow-up at the pediatric dermatology department of our hospital. MATERIALS AND METHODS: We prospectively studied the presence of ear pain, ear itching, tinnitus, otitis, cerumen impaction, accumulation of epithelial debris, and hearing loss. Daily hygiene measures, topical treatments, medical-surgical interventions, and frequency of visits to an ear, nose, and throat (ENT) specialist were noted in the patients' medical records. Ear examination and hearing tests were performed in all cases. RESULTS: Ten patients were studied: 2 had a self-healing collodion baby phenotype and 8 had ichthyosis. There was mention of otologic manifestations in the records of all 8 patients with ichthyosis (100%); 6 of these patients (75%) had abnormalities in the external auditory canal examination and 2 (25%) had conductive hearing loss. Our findings are limited by the small number of patients studied, all of whom were younger than 19 years. CONCLUSIONS: The involvement of both dermatologists and ENT specialists in the management of patients with ichthyosis is crucial to ensure the application of the best therapeutic and preventive measures. More studies are needed to assess the prevalence and impact on quality of life of ear involvement in patients with ichthyosis and to determine the optimal interval between ENT visits for these patients.

Paciente bipolar dual: un reto terapéutico / Dual diagnosis patient: a therapeutic challenge

Objetivo. Analizar el caso clínico de una paciente con trastorno bipolar y trastorno por uso de sustancias. Material y métodos. Se examina el caso clínico de una mujer de 50 años con diagnóstico de trastorno bipolar tipo II e historia de inestabilidad afectiva desde la adolescencia, que presenta consumo de benzodiacepinas con patrón de dependencia y de analgésicos con patrón de abuso, en el contexto de cefaleas de tipo migrañoso. Resultados. Se inicia la desintoxicación mediante el cambio de benzodiacepinas de vida media corta a otras de vida media larga. Posteriormente se inicia la reducción de la dosis, lenta y progresivamente. En el proceso, la paciente presenta diversos cuadros de desestabilización afectiva de predominio mixto, por lo que es necesario disminuir la pauta antidepresiva y demorar el descenso de la pauta benzodiacepínica. Se pospone la disminución de la pauta analgésica y se incluye en el programa de patología dual ambulatorio. Conclusiones. Las reagudizaciones del trastorno bipolar pueden dificultar el proceso de desintoxicación y deshabituación de sustancias, lo que es un problema habitual en los pacientes duales. La dependencia de benzodiacepinas y analgésicos puede enmascarar o modificar la sintomatología típica de los episodios maníacos o depresivos que la paciente pudiera tener en la evolución natural del trastorno bipolar. El diagnóstico dual implica, una mayor frecuencia de sintomatología mixta y una mayor predisposición al viraje a manía con antidepresivos, que en los pacientes bipolares no duales. Los pacientes bipolares duales deben ser evaluados y tratados con mucha precaución debido a las dificultades que habitualmente comporta su manejo (AU)

Objective. To analyze the case of a patient with bipolar disorder and substance use disorder. Material and methods. We evaluate the case of a 50-year-old woman with a diagnosis of bipolar disorder type II and a history of emotional instability from adolescence, who presented benzodiazepine dependence and abuse of analgesics in context of migraine headaches. Results. Detoxification process was started by changing the short half-life benzodiazepines to long half-life ones. Thereafter, the patient began a slow, gradual reduction in the use. During the process, the patient presented with various categories of affective destabilization of mixed dominance, which made it necessary to reduce the pattern of antidepressant and delay a greater drop in the standard benzodiazepines. Decrease of the analgesic dose was postponed and the patient was included in the out-patient dual diagnosis program. Conclusions. Bipolar relapses can hinder the process of detoxification and rehabilitation, which is a common problem in individual dual patients. Benzodiazepines and analgesics dependence or abuse can mask or modify typical manic symptoms or depressive episodes that the patient might have in the natural history of bipolar disorder. Dual diagnosis means a higher frequency of joint symptoms and a higher predisposition for switching to mania state with antidepressants than in non-dual bipolar patients. Patients with bipolar dual diagnosis must be evaluated and treated with great caution due to the difficulties that their management usually entails (AU)

[The morphometric changes of chronic ischemia in the hepatocyte. An experimental study in the rat]. / Alteraciones morfométricas de la isquemia crónica sobre el hepatocito. Estudio experimental en la rata.

The effects of chronic ischemia on the rat hepatocyte are morphometrically analyzed in the present study. Rats Wistar-Lewis are used. Rats underwent a stenosis of the celiac artery by using a metallic guide. The interval between the experimentation until the sacrifice was 15, 30, 90, 180, and 360 days. We have performed a morphometric study using a semiautomated image analyzer system (VIDS III, Analytical Measuring Systems). Morphological disturbances in the chronic ischemia periods above mentioned can be measured: an increase in the hepatocyte area starting from 90 days of experimentation and also an increase in the hepatocyte perimeter starting from 30 days of ischemia. On the other hand, both the nuclear area and the nuclear perimeter are increased in every period studied. The number of hepatocytes per microscopic field doesn't show any change in relation to ischemia time. Cellular swelling suggests some degree of cellular hypoxia in contradiction with other observations.