Toxicidad corneal por exposición a palitoxina / Toxic corneal reaction due to exposure to palytoxin

Describir un caso de toxicidad corneal secundaria a exposición a palitoxina. Un hombre de 42 años acude por dolor y visión borrosa en su ojo derecho de una semana de evolución. Como antecedente destaca la entrada de un líquido procedente de un coral (Palythoa sp). En la biomicroscopia se observa un infiltrado central en forma de anillo de 4 × 6mm sin defecto epitelial y con microinfiltrados subepiteliales satélites. Después de 2 meses de tratamiento tópico con esteroides se resuelve el infiltrado, pero persiste una fibrosis y adelgazamiento estromal paracentral. La palitoxina es un potente vasoconstrictor que daña el gradiente iónico de las células provocando muerte celular. Es crucial retirar la toxina e iniciar una terapia intensiva con corticoides tópicos lo antes posible. Asimismo, teniendo en cuenta los efectos adversos oculares y sistémicos, sería conveniente informar a la población de su existencia y regular la distribución de este tipo de corales

A case is presented of corneal toxicity after exposure to palytoxin. A 42 year-old man came with symptoms of pain and blurred vision in his right eye. He reported that a zoanthid coral from a saltwater aquarium had squirted into his eye. Slit-lamp examination showed a prominent central ring infiltrate of 4 × 6mm without epithelial defect and satellite sub-epithelial micro-infiltrates. After 2 months of topical treatment with steroids, the stromal ring infiltrate was resolved, but a stromal thinning and residual fibrosis remained. Palytoxin is a potent vasoconstrictor that damages the ionic gradient of the cells, causing cell death. It is crucial to remove the toxin and start an aggressive topical therapy as soon as possible. In addition, considering the potential ocular and systemic adverse effects that this toxin can produce, it would be advisable to inform people of its existence and regulate the distribution of this type of corals

Toxic corneal reaction due to exposure to palytoxin. / Toxicidad corneal por exposición a palitoxina.

A case is presented of corneal toxicity after exposure to palytoxin. A 42 year-old man came with symptoms of pain and blurred vision in his right eye. He reported that a zoanthid coral from a saltwater aquarium had squirted into his eye. Slit-lamp examination showed a prominent central ring infiltrate of 4×6mm without epithelial defect and satellite sub-epithelial micro-infiltrates. After 2 months of topical treatment with steroids, the stromal ring infiltrate was resolved, but a stromal thinning and residual fibrosis remained. Palytoxin is a potent vasoconstrictor that damages the ionic gradient of the cells, causing cell death. It is crucial to remove the toxin and start an aggressive topical therapy as soon as possible. In addition, considering the potential ocular and systemic adverse effects that this toxin can produce, it would be advisable to inform people of its existence and regulate the distribution of this type of corals.

Escleroqueratoplastia terapéutica sectorial de grosor completo en queratitis fúngica recurrente / Therapeutic sectorial full-thickness sclero-keratoplasty for recurrent fungal keratitis

OBJETIVO: Comunicar el manejo de una queratitis fúngica recurrente severa, que requirió repetidas queratoplastias penetrantes. A pesar de los múltiples tratamientos antifúngicos tópicos, intraoculares y sistémicos, una infiltración micótica superotemporal repetidamente penetraba y descompensaba al trasplante corneal. Los cultivos preoperatorios y operatorios aislaron al mismo organismo, Fusarium spp. DISCUSIÓN: La infección corneal que se expande a la esclera o a las estructuras del ángulo interno es la causa más frecuente de recurrencia en la queratitis fúngica después del trasplante de córnea. En estos casos, la escleroqueratoplastia sectorial de grosor completo del sitio sospechoso de recurrencia, asociada a una queratoplastia penetrante central, debería ser una técnica quirúrgica a considerar ya que permite una eliminación definitiva de la infección con excelentes resultados de agudeza visual final. Ninguna complicación postoperatoria ha sido registrada en este caso

OBJECTIVE: To report the management of a severe and recurrent fungal keratitis that required repeated penetrating keratoplasties. Despite multiple topical, intraocular and systemic antifungal treatments, superotemporal hyphal infiltration repeatedly penetrated the corneal transplant causing continuous recurrences. Cultures collected before and during surgery isolated the same organism, Fusarium spp. CONCLUSION: Corneal infection extending to the sclera and internal angle structures is the main cause of recurrence of fungal keratitis after corneal transplantation. Sectorial full-thickness sclero-keratoplasty combined with a central penetrating keratoplasty should be a surgical technique to be considered in cases where these locations are suspected to be the source of recurrence. It enables a definitive elimination of the infection, with excellent final visual acuities. No postoperative complications were reported in this case

Therapeutic sectorial full-thickness sclero-keratoplasty for recurrent fungal keratitis.

OBJECTIVE: To report the management of a severe and recurrent fungal keratitis that required repeated penetrating keratoplasties. Despite multiple topical, intraocular and systemic antifungal treatments, superotemporal hyphal infiltration repeatedly penetrated the corneal transplant causing continuous recurrences. Cultures collected before and during surgery isolated the same organism, Fusarium spp. CONCLUSION: Corneal infection extending to the sclera and internal angle structures is the main cause of recurrence of fungal keratitis after corneal transplantation. Sectorial full-thickness sclero-keratoplasty combined with a central penetrating keratoplasty should be a surgical technique to be considered in cases where these locations are suspected to be the source of recurrence. It enables a definitive elimination of the infection, with excellent final visual acuities. No postoperative complications were reported in this case.

Obesidad: concepto, clasificación y diagnóstico / Obesity: concept, classification and diagnosis

La obesidad es una enfermedad crónica que se caracteriza por un aumento de la masa grasa y en consecuencia por un aumento de peso. Existe, pues, un aumento de las reservas energéticas del organismo en forma de grasa. El término crónico se le aplica debido a que forma parte del grupo de enfermedades que no podemos curar con el arsenal terapéutico del que se dispone en la actualidad. Desde un punto de vista antropométrico, que es el habitualmente utilizado en clínica, se considera obesa a una persona con un Índice de Masa Corporal igual o superior a 30 kg/m2. Para poder valorar la obesidad se deben tener en cuenta no sólo los aspectos antropométricos sino también los posibles factores genéticos; hay que investigar las causas de la enfermedad y comprobar la posible existencia de complicaciones y enfermedades asociadas. El tratamiento siempre deberá ser personalizado y adaptado a las características y a las comorbilidades que presente el enfermo. Los criterios dominantes favorables a la intervención terapéutica en la obesidad se basan, especialmente, en la demostración de que con una pérdida moderada de peso corporal (5-10 por ciento) se puede conseguir una notable mejoría en la comorbilidad asociada a la obesidad y en la calidad de vida del paciente obeso (AU)

[Obesity: concept, classification and diagnosis]. / Obesidad: concepto, clasificación y diagnóstico.

Obesity is a chronic disease that is characterised by an increase of fat mass and as a result by an increase in weight. There is therefore an increase in the energy reserves of the organism in the form of fat. The term chronic is applied due to its forming part of the group of diseases that we are unable to cure with the therapeutic arsenal that is now available. From an anthropometric point of view, which is habitually used in the clinic, a person is considered to be obese with a Body Mass Index equal to or higher than 30 kg/m2. To be able to evaluate obesity account must be taken not only of the anthropometric aspects but also of the possible genetic factors; the causes of the disease must be studied and the possible existence of associated complications and diseases must be checked. Treatment must always be personalised and adapted to the characteristics and comorbidities presented by the patient. The dominant criteria favourable to therapeutic intervention in obesity are especially based on the demonstration that with a moderate loss of body weight (5-10 %) a notable improvement can be obtained in the comorbidity associated with obesity and in the quality of life of the obese patient.

[Severe obesity: its surgical treatment in 120 patients. The results and a prospective focus]. / Obesidad severa: tratamiento quirúrgico en 120 pacientes. Resultados y enfoque prospectivo.

Severe or morbid obesity (M.O.) is a pathological state which is very difficult to treat by non-surgical means. It is defined internationally on the basis of anthropometric measurements when a body mass index (BMI) of 40 kg/m2 is exceeded. In such cases, the pathological increase in body fat influences patient mortality and morbidity. The present state of bariatric surgery is reviewed in the series presented. The guidelines are submitted which are currently used as an approach to surgery, and the reasons are set out used by the authors, on the base of 5 years' experience and more than 110 patients operated on (ringed vertical gastroplasty-RVG, inflatable silicone gastric band, Salmon's technique) in a prospective approach to new surgical projects. The series presented is divided into two groups. It is shown that not all the severely obese (SMO) (BMI > 50 kg/m2) respond adequately to a simple restrictive technique (RVG) notwithstanding very considerable weight loss. Other techniques are currently under consideration for this group. It is concluded that bariatric surgery demonstrates effective and permanent results if the right technique is used on the patient selected.

Postural variation of the maximum inspiratory and expiratory pressures in obese patients.

Evaluating whether weight is a factor responsible for the decrease of muscle force in the supine position with respect to the upright and sitting positions, we measured maximum inspiratory and expiratory pressures (PImax and PEmax) in these postures in ten obese patients (age 38.7 +/- 9.1 years; height 168.7 +/- 8.9 cm; and weight 139.3 +/- 28.4 kg) and ten normal control subjects (age 38.4 +/- 8.2 years; height 169.3 +/- 7.9 cm and weight 66.9 +/- 11.9 kg.) In both study groups, PImax and PEmax values decreased in the supine posture with respect to upright and sitting positions. Differences between pressures in the various postures were similar for both groups with the exception of PEmax in obese females. The decrease in PEmax values from the sitting to supine positions was greater in obese than control females. Weight, sex and postural changes can influence the generation of maximal expiratory force.