Melanocyte transplantation to skin prepared by controlled PUVA-induced sunburn-like blistering for vitiligo treatment - A pilot clinical trial.

Vitiligo is a common acquired disease of pigment loss. In lesions recalcitrant to non-invasive treatment, transplantation of cultured autologous melanocytes is an emerging choice. Conventionally, the recipient site is often prepared by laser-mediated or mechanical dermabrasion. Such preparation procedures have disadvantages including prolonged transplantation duration, long period for reepithelialization and potential scarring. We propose a method of preparing recipient sites by psoralen and controlled ultraviolet A (PUVA)-induced blistering followed by transplanting suspended melanocytes. We introduced this method in 10 patients with segmental vitiligo on their recipient site 3 to 5 days before transplantation and blistering developed in 2 to 3 days afterwards. On the day of transplantation, the blister roof could be peeled off easily without bleeding and the recipient site preparation could be completed in 20 min. The recipient site became reepithelialized within 1 week. Progressive repigmentation was observed for up to 6 months, with an average of 65.06% repigmentation in the recipient site without scarring at the end of follow-up. Hence, preparation of the recipient site by controlled PUVA-induced sunburn-like blistering can potentially facilitate melanocyte transplantation and prevent scarring.

[Application of interventional respiratory techniques in the treatment of pulmonary bullae:an update].

Pulmonary bullae is a common complication of chronic obstructive pulmonary disease(COPD), causing the deterioration in lung function, leading to aggravated dyspnea and poor quality of life for patients. The traditional therapeutic approach for pulmonary bullae is bullectomy using surgical thoracoscopy. The disadvantage of this approach is the postoperative complications and high risk of recurrence in many patients. In addition, for some patients, due to the patient's physical conditions, such as poor lung function and other diseases, bullectomy could not be used. Therefore, new alternative approaches were urgently needed. In recent years, interventional respiratory technology has been trialed to treat pulmonary bulla all around the world and has achieved great success. In this paper, we reviewed the relevant clinical research progress of interventional respiratory medicine techniques in the treatment of pulmonary bullae.

Uso de apósitos con tecnología alveolar gelificante para cura de úlceras por presión / Usage of dressings with gelifying alveolar technology for pressure ulcer healing

Objetivo: Describir el proceso de cicatrización de dos úlceras por presión con el uso de apósitos con tecnología alveolar gelificante. Metodología: aplicación de las guías vigentes de tratamiento de las úlceras por presión. Resultados: Ambas úlceras evolucionaron progresivamente de manera favorable hasta conseguir su cicatrización a los 3 meses del inicio del tratamiento. Conclusiones: El uso de apósitos con tecnología alveolar gelificante, unido a la aplicación de las medidas preventivas, posturales e higiénico-dietéticas recomendadas en las guías de tratamiento de las úlceras por presión, fueron determinantes para el buen desarrollo del proceso de cicatrización de las lesiones

Aim: The aim was to describe the healing process of two pressure ulcers with the usage of dressings with gelifying alveolar technology. Methodology: Application of the current guidance about pressure ulcers treatment. Results: Both ulcers evolved progressively and favorably until reach their healing in three months from the beginning of the treatment. Conclusions: The usage of dressing with gelifying alveolar technology along with the application of preventive, postural and hygienicdietetic measures recommended by the guidance of pressure ulcers treatment, were essential for the good development of the healing process

Exantema fijo medicamentoso por paracetamol. Caso clínico con revisión bibliográfica / Fixed drug eruption with acetaminophen. Clinical case with bibliographic review

El exantema fijo medicamentoso es una toxicodermia caracterizada por la aparición de una lesión cutánea en forma de mácula de color rojizo o violáceo, redonda u oval, edematosa, bien delimitada, y que presenta recurrencias tras la administración del agente causal, generalmente un fármaco. Puede ser producido por una gran variedad de fármacos, entre ellos el paracetamol. El paracetamol es un medicamento con propiedades analgésicas y antipiréticas ampliamente conocido y utilizado por su amplio margen de seguridad y elevada biodisponibilidad. Sin embargo, se han descrito reacciones cutáneas adversas de diferentes tipos e intensidad tras su administración, fundamentalmente urticaria y angioedema, y con menor frecuencia eritema multiforme, necrólisis epidérmica tóxica, exantema fijo y púrpura de Henoch-Schönlein. Se presenta el caso de un usuario tipo con exantema fijo medicamentoso relacionado con el consumo de paracetamol. Se ha realizado una revisión bibliográfica sobre los diversos hallazgos clínicos y el diagnóstico diferencial entre las diferentes toxicodermias, así como el manejo y abordaje de las lesiones basado en el concepto TIME

Fixed drug eruption is a toxicodermia characterized by the appearance of a well-circumscribed reddish or violet, circular or oval, edematous skin lesion which can present recurrences after taking the causal agent, usually a drug. It can be produced by a wide variety of drugs, including acetaminophen. Acetaminophen is a drug with analgesic and antipyretic properties widely known and used for its wide range of safety and high bio-availability. However, different types and intensity of adverse skin reactions have been reported following administration, mainly urticaria and angioedema, and less frequently erythema multiforme, toxic epidermal necrolysis, fixed exanthema and Henoch-Schönlein purpura. We present the case of a role model user with fixed drug exanthema after acetaminophen consumption. A bibliographic review has been made on the various clinical findings and the differential diagnosis between different toxicodermias, as well as the management and approach of the lesions based on the TIME concept

Revisión con aguja asociada a mitomicina C en ampollas de filtración encapsuladas / Mitomycin C-associated needle revision in encapsulated filtering blebs

Objetivo: determinar la efectividad a mediano plazo de la revisión con aguja asociada a mitomicina C en la ampolla de filtración encapsulada postrabeculectomía.Métodos: estudio observacional descriptivo, prospectivo de serie de casos (30 ojos, 30 pacientes), con antecedentes de quiste de Tenon a corto plazo postrabeculectomía (1 mes-1 año). Se realizó revisión con aguja asociada a inyección subconjuntival MMC 0,01 por ciento hasta completar 3 dosis en días alternos. Se evaluaron la presión intraocular y el uso de colirios hipotensores preoperatorio y posoperatorio a la semana, 1 mes, 3 meses, 1 año y 2 años. Se definió éxito si la presión intraocular era menor de 21 mmHg sin colirio hipotensor (éxito total) y con colirios hipotensores (éxito parcial). Se registraron las complicaciones quirúrgicas. Resultados: hubo descenso significativo de la presión intraocular media preoperatoria de 27,06 ± 5,2 mmHg a 13,10 ± 3,65 mmHg, 14,83 ± 3,68 mmHg y 16,70 ± 3,38 mmHg a la semana, 1 y 3 meses posoperatorios respectivamente, y se mantuvo estable hasta 2 años (16,70 ± 2,18 mmHg); p< 0,001 para cada comparación preoperatorio vs. posoperatorio), lo que representó una reducción de la presión intraocular del 51,8 por ciento a la semana; 44,4 por ciento al mes y 37 por ciento hasta los 2 años. La media del número de colirios hipotensores se redujo significativamente de 2,0 ± 0,0 (preoperatorio) a 0,4 ± 0,0 (2 años posoperatorios), p< 0,001. El éxito fue total en el 70 por ciento de los casos y parcial en el 30 por ciento, tras 2 años posoperatorios. Las complicaciones fueron: hemorragia subconjuntival (100 por ciento de casos), atalamia (40 por ciento) y Seidel positivo (26,7 por ciento).Conclusiones: la revisión con aguja asociada a mitomicina C subconjuntival como tratamiento de la ampolla encapsulada, logra reducción del 37 por ciento de la presión intraocular durante los dos primeros años posoperatorios con un mínimo de complicaciones(AU)

Objective: to determine the medium-term effectiveness of subconjuntival mitomicyn-C associated to needle revision on encapsulated filtering bleb after trabeculectomy. Methods: prospective, descriptive and observational case series study (30 eyes, 30 patients) with a history of Tenon cyst after short term trabeculectomy (1month-1year). These patients underwent needle revision associated to subconjuntival 0,01 percent mitomycin injection to completing three doses in every other day. The intraocular pressure and the use of hypotensive drops preoperatively and postoperatively were evaluated seven days, one month, three months, one year and two years after the procedure. The success of intervention was defined as total when the intraocular pressure was less than 21mmHg without hypotensive drops and partial with hypotensive drops. Surgical complications were recorded. Results: the mean preoperative intraocular pressure decreased significantly from 27,06 ± 5,2 mmHg to 13,10 ± 3,3 mmHg, 14,83 ± 3,68 mmHg and 16,70 ± 3,38 mmHg one week, one month and three months after surgery and remained stable (16,70 ± 2,18 mmHg) for 2 years, p< 0,001 for each preoperative and postoperative comparison; this represented an intraocular pressure reduction of 51,8 percent; 44,4 percent and 37 percent after one week, one month, and up to 2 years, respectively. The mean number of hypotensive drops lowered significantly from 2,0 ± 0,0 (preoperative) to 0,4 ± 0,0 (two years after surgery), being p< 0,001. Total success was attained in 70 percent of cases and partial in 30 percent after 2 years. Surgical complications were subconjuntival haemorrhage (in all patients), atalamy (40 percent) and positive Seidel index (26,7 percent).Conclusion: subconjuntival mitomicyn-C injection-associated needle revision for encapsulated bleb reduces intraocular pressure by 37 % during the first 2 years after the procedure with minimal complications(AU)

Revisión con aguja asociada a mitomicina C en ampollas de filtración encapsuladas / Mitomycin C-associated needle revision in encapsulated filtering blebs

Objetivo: determinar la efectividad a mediano plazo de la revisión con aguja asociada a mitomicina C en la ampolla de filtración encapsulada postrabeculectomía. Métodos: estudio observacional descriptivo, prospectivo de serie de casos (30 ojos, 30 pacientes), con antecedentes de quiste de Tenon a corto plazo postrabeculectomía (1 mes-1 año). Se realizó revisión con aguja asociada a inyección subconjuntival MMC 0,01 % hasta completar 3 dosis en días alternos. Se evaluaron la presión intraocular y el uso de colirios hipotensores preoperatorio y posoperatorio a la semana, 1 mes, 3 meses, 1 año y 2 años. Se definió éxito si la presión intraocular era menor de 21 mmHg sin colirio hipotensor (éxito total) y con colirios hipotensores (éxito parcial). Se registraron las complicaciones quirúrgicas. Resultados: hubo descenso significativo de la presión intraocular media preoperatoria de 27,06 ± 5,2 mmHg a 13,10 ± 3,65 mmHg, 14,83 ± 3,68 mmHg y 16,70 ± 3,38 mmHg a la semana, 1 y 3 meses posoperatorios respectivamente, y se mantuvo estable hasta 2 años (16,70 ± 2,18 mmHg); p< 0,001 para cada comparación preoperatorio vs. posoperatorio), lo que representó una reducción de la presión intraocular del 51,8 por ciento a la semana; 44,4 por ciento al mes y 37 por ciento hasta los 2 años. La media del número de colirios hipotensores se redujo significativamente de 2,0 ± 0,0 (preoperatorio) a 0,4 ± 0,0 (2 años posoperatorios), p< 0,001. El éxito fue total en el 70 por ciento de los casos y parcial en el 30 por ciento, tras 2 años posoperatorios. Las complicaciones fueron: hemorragia subconjuntival (100 por ciento de casos), atalamia (40 por ciento) y Seidel positivo (26,7 por ciento). Conclusiones: la revisión con aguja asociada a mitomicina C subconjuntival como tratamiento de la ampolla encapsulada, logra reducción del 37 por ciento de la presión intraocular durante los dos primeros años posoperatorios con un mínimo de complicaciones(AU)

Objective: to determine the medium-term effectiveness of subconjuntival mitomicyn-C associated to needle revision on encapsulated filtering bleb after trabeculectomy. Methods: prospective, descriptive and observational case series study (30 eyes, 30 patients) with a history of Tenon cyst after short term trabeculectomy (1month-1year). These patients underwent needle revision associated to subconjuntival 0,01 percent mitomycin injection to completing three doses in every other day. The intraocular pressure and the use of hypotensive drops preoperatively and postoperatively were evaluated seven days, one month, three months, one year and two years after the procedure. The success of intervention was defined as total when the intraocular pressure was less than 21mmHg without hypotensive drops and partial with hypotensive drops. Surgical complications were recorded. Results: the mean preoperative intraocular pressure decreased significantly from 27,06 ± 5,2 mmHg to 13,10 ± 3,3 mmHg, 14,83 ± 3,68 mmHg and 16,70 ± 3,38 mmHg one week, one month and three months after surgery and remained stable (16,70 ± 2,18 mmHg) for 2 years, p< 0,001 for each preoperative and postoperative comparison; this represented an intraocular pressure reduction of 51,8 percent; 44,4 percent and 37 percent after one week, one month, and up to 2 years, respectively. The mean number of hypotensive drops lowered significantly from 2,0 ± 0,0 (preoperative) to 0,4 ± 0,0 (two years after surgery), being p< 0,001. Total success was attained in 70 percent of cases and partial in 30 percent after 2 years. Surgical complications were subconjuntival haemorrhage (in all patients), atalamy (40 percent) and positive Seidel index (26,7 percent). Conclusion: subconjuntival mitomicyn-C injection-associated needle revision for encapsulated bleb reduces intraocular pressure by 37 percent during the first 2 years after the procedure with minimal complications(AU)

Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva / Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft

INTRODUCCIÓN: En este estudio se com:para y evalúa la seguridad y los resultados clínicos de 3 técnicas para el manejo de las ampollas isquémicas hiperfiltrantes en glaucoma: el crosslinking con riboflavina (CXL) respecto al deslizamiento y el autotrasplante conjuntival. MÉTODOS: Se seleccionaron un total de 24 ojos de 18 pacientes con ampollas isquémicas intervenidos de cirugía filtrante de glaucoma entre 2012 y 2017. Fueron intervenidos de CXL mediante el uso de riboflavina (n = 4), autotrasplante conjuntival (n = 5) y deslizamiento conjuntival (n = 15). Se comparan los resultados de la presión intraocular (PIO) previa al procedimiento y a los 12 meses, así como de la agudeza visual y de la medicación antiglaucomatosa previa y a los 12 meses. RESULTADOS: Los 4 de la riboflavina pasaron de una PIO media previa de 12,11 ± 3,14 a una PIO al año de 12,32 ± 5,29 (p = 0,655). Los 5 ojos del autotrasplante de conjuntiva tuvieron una PIO previa media de 11,65 ± 5,76 y al año de 14,68 ± 7,21 (p = 0,273). Los 15 ojos tratados mediante deslizamiento conjuntival presentaron una PIO previa de 9,32 ± 5,34 y al año de 15,16 ± 9,24 (p = 0,021). No hubo efectos adversos ni complicaciones asociadas a ninguna de las 3 técnicas. CONCLUSIONES: El manejo de la ampolla isquémica hiperfiltrante resulta difícil. Los procedimientos quirúrgicos se asocian a incrementos tensionales y a necesidad de medicación, mientras que el CXL mediante el uso de riboflavina y radiación UV no parece tener un efecto sobre la revitalización de la ampolla

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3 techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n = 4), conjunctival autologous graft (n = 5), and conjunctival sliding (n = 15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4 eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P = .655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P = .273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P =. 021). There were no adverse effects or complications associated with any of the 3 techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalisation of the bleb

Púrpura de Schölein-Henoch ampollosa, una forma de presentación poco frecuente / Bullous Henoch Schölein purpura, an infrequent form of presentation

La púrpura de Schölein-Henoch (PSH) es la vasculitis sistémica más frecuente de la infancia. Al contrario que en adultos, la aparición de ampollas hemorrágicas en niños es infrecuente. Presentamos el caso de un varón de tres años de edad que acudió a Urgencias tras la aparición de forma aguda de lesiones ampollosas asociadas a púrpura palpable y afectación sistémica. El paciente precisó ingreso hospitalario y tratamiento sistémico con corticoides, con evolución favorable (AU)

Henoch Schölein Purpura (HSP) is the most common systemic vasculitis of childhood. In contrast to adults, the occurrence of blood blisters is uncommon in children. We report the case of a male 3 years old who came to the emergency room after the onset of an acute form of bullous lesions associated to palpable purpura and systemic involvement. The patient required hospitalization and systemic corticosteroid treatment, with favourable progress (AU)

Fitofotodermatite por Ruta graveolens com manifestação cutânea extensa / Phytophotodermatitis due to Ruta graveolens with extensive cutaneous manifestation

Dermatite de contato por planta ou fitodermatite é uma erupção cutânea resultante do contato com substâncias produzidas por diferentes espécies de vegetais. Ruta graveolens, popularmente conhecida como arruda, é uma planta da família das Rutaceae, que inclui algumas frutas cítricas, e contém inúmeras substâncias químicas fotossensíveis, incluindo os furocumarínicos. Relatamos um caso de reação de fitofototoxicidade grave em uma paciente que usou uma infusão de arruda pelas supostas qualidades ”místicas e purificadoras” da planta com extensa erupção cutânea.

Plant dermatitis or phytodermatitis is a cutaneous eruption resulting from contact with substances produced by different plant species. Ruta graveolens, popular known as common rue, is an herbal plant from the Rutaceae family, which includes the citrus fruits, and contains numerous photosensitizing substances, including furocoumarins. We report a severe case of phytophototoxicity reaction in a patient who used a common rue infusion because of its “powerful and purification” qualities.

Recién nacida con flictenas / Newborn with blisters

Presentamos el caso de una recién nacida con flictenas a las 48 horas de vida, que al cicatrizar presentan punteado blanquecino en forma de quistes de milium, por lo que se sospecha la posibilidad de una enfermedad ampollosa congénita. Finalmente, el Servicio de Dermatología confirma el diagnostico de epidermólisis ampollosa de Weber-Cockayne (AU)

The case o a newborn with blisters at 48 hours of life is reported. When healing, dotted whitish scar similar to milium cysts appear, so raising the possibility of a congenital bullous disease. Finally, the Dermatology Department confirms the diagnosis of Epidermolysis bullosa of Weber-Cockayne (AU)

Early transconjunctival needling revision with 5-fluorouracil versus medical treatment in encapsulated blebs: a 12-month prospective study

OBJECTIVE: To compare the efficacy of transconjunctival needling revision with 5-fluorouracil versus medical treatment in glaucomatous eyes with uncontrolled intraocular pressure due to encapsulated bleb after trabeculectomy. METHODS: Prospective, randomized, interventional study. A total of 40 eyes in 39 patients with elevated intraocular pressure and encapsulated blebs diagnosed at a maximum five months after primary trabeculectomy with mitomycin C were included. The eyes were randomized to either transconjunctival needling revision with 5- fluorouracil or medical treatment (hypotensive eyedrops). A maximum of two transconjunctival needling revisions per patient was allowed in the needling arm. All patients underwent follow-up for 12 months. Successful treatment was defined as an intraocular pressure ≤ 18 mmHg and a 20% reduction from baseline at the final follow-up. Clinicaltrial.gov: NCT01887223. RESULTS: Mean intraocular pressure at the final 12-month follow-up was lower in the transconjunctival needling revision group compared to the medical treatment group. Similar numbers of eyes reached the criteria for treatment success in both the transconjunctival needling revision group and the medical treatment group. CONCLUSIONS: Despite similar success rates in eyes randomized to transconjunctival needling revision with 5-fluorouracil compared to eyes receiving medical treatment, there was a significantly lower mean intraocular pressure at 12 months after transconjunctival needling revision. .

Imagen calcificada y dolor en hipocondrito derecho / Calcified image and pain in the right hypochondrium

Introducción: El cáncer de vesícula ocupa el 5° lugar de aparición de todos cánceres digestivos. En nuestro país es dos veces más frecuente que los tumores ubicados en la vía biliar principal intra o extrahepática. Objetivos: Reporte de caso y revisión bibliográfica. Reporte de Caso: Mujer de 52 años, sin antecedentes clínicos de relevancia, que consulta por dolor abdominal, náuseas y vómitos de 14 días de evolución. Se realiza una ecografía que evidencia engrosamiento parietal y litiasis vesicular. En el intraoperatorio se evidencia Vesícula en Porcelana con infiltración hepática a nivel del fondo.Discusión: Destacar la importancia de una correcta interpretación de las imágenes, a los fines de tomar la conducta que mayor beneficio representa para el paciente.

Introduction: Gallbladder cancer occupies the 5th place of occurrence among all digestive system cancers. In our country, it is twice more frequent than tumors of the intra or extrahepatic principal biliary tract. Objectives: Case report and literature review. Case Report: 52-year-old woman, with no relevant clinical history, with 14 days of abdominal pain, nausea and vomit. The ultrasound scan reveals parietal thickening and gallstones. During intrasurgical exploration, porcelain gallbladder is found, with hepatic infiltration at fundus. Discussion: To highlight the importance of a correct image interpretation, in order to choose the most beneficial treatment for the patient.

Imagen calcificada y dolor en hipocondrito derecho / Calcified image and pain in the right hypochondrium

Introducción: El cáncer de vesícula ocupa el 5° lugar de aparición de todos cánceres digestivos. En nuestro país es dos veces más frecuente que los tumores ubicados en la vía biliar principal intra o extrahepática. Objetivos: Reporte de caso y revisión bibliográfica. Reporte de Caso: Mujer de 52 años, sin antecedentes clínicos de relevancia, que consulta por dolor abdominal, náuseas y vómitos de 14 días de evolución. Se realiza una ecografía que evidencia engrosamiento parietal y litiasis vesicular. En el intraoperatorio se evidencia Vesícula en Porcelana con infiltración hepática a nivel del fondo.Discusión: Destacar la importancia de una correcta interpretación de las imágenes, a los fines de tomar la conducta que mayor beneficio representa para el paciente. (AU)

Introduction: Gallbladder cancer occupies the 5th place of occurrence among all digestive system cancers. In our country, it is twice more frequent than tumors of the intra or extrahepatic principal biliary tract. Objectives: Case report and literature review. Case Report: 52-year-old woman, with no relevant clinical history, with 14 days of abdominal pain, nausea and vomit. The ultrasound scan reveals parietal thickening and gallstones. During intrasurgical exploration, porcelain gallbladder is found, with hepatic infiltration at fundus. Discussion: To highlight the importance of a correct image interpretation, in order to choose the most beneficial treatment for the patient. (AU)

Revisión con agujas y uso de mitomicina C en bulas de filtración encapsuladas / Needle revision and use of Mitomycin-C to manage encapsulated filtering blebs

La trabeculectomía es uno de los tratamientos de elección en los pacientes con glaucoma. La causa más común de fallo de esta cirugía en su primer trimestre es la bula de filtración encapsulada. Usualmente es resultado de la proliferación fibrótica subconjuntival que lleva a fallo de la bula, como por ejemplo en los glaucomas traumáticos. La revisión con agujas y la mitomicina C constituyen una opción efectiva y relativamente segura para restaurar la función de la cirugía de filtración. Se presenta un paciente donde se restableció el flujo de humor acuso con este proceder(AU)

Trabeculectomy is the surgical treatment of choice for many patients with glaucoma. The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb. Generally, that results from scarring in the subconjunctival space with a resultant intrableb fibrosis and the development of a failed bleb, for example in traumatic glaucoma. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive the function of the filtration surgery. This was the case report of a patient whose aqueous humor flow was reestablished with this treatment(AU)

Penfigoide ampolloso / Bullous pemphigoid

El penfigoide ampolloso (PA) es una enfermedad cutánea ampollar subepidérmica autoinmunitaria que habitualmente se presenta en ancianos. Clásicamente el PA se caracteriza por presentar ampollas tensas, grandes en piel normal o eritematosa, con o sin prurito. Es difícil identificar al penfigoide ampollar prodrómico (PAP) o en estadio temprano. El PAP no se presenta con lesiones vesiculares o ampollar es como el penfigoide clásico. Se han publicado reportes en los que la enfermedad se manifiesta como prurito generalizado sin lesiones visibles, placas urticarianas, placas eritematosas, parches de eccema y dishidrosis, lesiones tipo prúrigo nodular, eritrodermia y lesiones vegetantes. Se reporta el caso de un paciente en la octava década de su vida que acude a nuestro servicio por presentar cuadro clínico e histopatológico de PA; mediante la anamnesis encontramos que debutó con la forma no ampollar del penfigoide, siendo tratado por diferentes diagnósticos sin mejoría hasta que presentó la fase ampollar clásica siendo el diagnóstico evidente. Presentamos este caso para tener en cuenta dentro del diagnóstico diferencialde aquellas lesiones inespecífica de curso tórpido, el estadio temprano del PA, pues un reconocimiento y tratamiento y temprano puede prevenir la progresión a PA clásico cuyo curso es crónico, con fases de exacerbaciones y remisiones espontáneas, que puede resultar en morbilidad significativa.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering skin disease that typically occurs in the elderly. Classically (BP) is characterized by tense blisters, large normal or erythematous skin, with or without pruritus. Itis difficult to identify the prodromal bullous pemphigoid(PBP) or early stage. The PBP is not presented with vesicular lesions or bullous pemphigoid such as classic. Reports have been published in which the disease manifests as generalized pruritus without visible lesions, urticarial plaques, erythematous plaques, patches of eczema and dyshidrosis, nodular prurigo-like lesions, erythroderma and vegetative lesions. We report the case of a patient inthe eighth decade of his life referred to our department to present clinical and histopathological picture bullouspemphigoid; through history we find that debuted with the bullous pemphigoid is not being treated for different diagnoses did not improve until presented by the classic blister stage diagnosis being evident. We present this case to account for the differential diagnosis of those injuries nonspecific chronic course, the early stage of the BP, asan early recognition and treatment can prevent progression to classical PA whose course is chronic, with periods of exacerbations and spontaneous remissions, which can result in significant morbidity.

Ceratopatia bolhosa: etiopatogênese e tratamento: [revisão] / Bullous keratopathy: etiopathogenesis and treatment: [review]

A ceratopatia bolhosa caracteriza-se pelo edema corneano estromal acompanhado de bolhas epiteliais e subepiteliais devido à perda de células e/ou alterações da junção endotelial. Nos casos mais avançados, ocorre espessamento do estroma e presença de fibrose subepitelial e vascularização corneana. Apresenta baixa de acuidade visual devido à diminuição da transparência da córnea e pode estar acompanhada de sensação de corpo estranho, lacrimejamento e dor devido as alterações epiteliais como a presença de bolhas íntegras ou rotas. Ceratite bolhosa é uma das principais causas de transplante de córnea em diferentes regiões e países. A principal etiologia é a perda de células endoteliais, principalmente após cirurgia de catarata e na distrofia endotelial de Fuchs. Sabe-se que atualmente há cerca de 20 milhões de pessoas com catarata no mundo, e esta complicação pode afetar 1 a 2 por cento das cirurgias de catarata. Este texto faz uma revisão sobre a etiopatogênese da ceratopatia bolhosa e sobre os tratamentos clínicos e cirúrgicos disponíveis para a doença.

Bullous keratopathy is characterized by corneal stromal edema with epithelial or subepithelial bullae due to cell loss and endothelial decompensation. In more advanced cases, subepithelial fibrosis, formation of a posterior collagenous layer or retrocorneal fibrous membrane, and corneal vascularization can occur. Decreased vision is present because the loss of corneal transparency with symptoms like tearing and pain caused by epithelial bullae that can rupture. Currently, bullous keratopathy is the most common indication for penetrating keratoplasty and regraft. The main etiology is the endothelial cell loss after ophthalmic surgeries as cataract surgery. Cataract affects approximately 20 million people worldwide, and this complication can occur in 1 to 2 percent of cataract surgeries. This study revised bullous keratopathy etiopathogenesis, clinical and surgical treatment available for this corneal disease.

Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.

Tratamiento de las ampollas en las quemaduras de segundo grado superficial. Revisión bibliográfica desde diferentes puntos de vista / Treatment of superficial second degree burn blisters: literature review from different points of view

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Anomalías congénitas del uréter y de la vejiga: diagnóstico radiológico / Congenital anomalies of the ureter and the bladder: radiological diagnosis

La evaluación de los pacientes con anomalías congénitas del tracto urinario inferior requiere frecuentemente múltiples modalidades de imagen para el diagnóstico y el planteamiento de la corrección quirúrgica. Este artículo revisa una serie de anomalías congénitas frecuentes e infrecuentes que afectan al uréter dista¡ y a la vejiga, e ilustra la eficacia de las placas simples, urografía, cistografía miccional y ecografía en el diagnóstico y manejo de estas alteraciones. Las anomalías del uréter distal incluyen ureteroceles simples, ureteroceles ectópicos y uréteres ectápicos en múltiples localizaciones. En las anomalías vesicales incluimos divertículos, duplicación vesical tanto en el plano frontal como sagital y anomalías del uraco tales como persistencia del uraco, quiste uracal y divertículo uracal. Las bases embriológicas y patológicas de los diferentes hallazgos radiográficos se discuten en los casos apropiados (AU)