Metástasis intraoculares: comparación entre las formas de presentación clínica con tumor primario conocido y desconocido / Intraocular metastasis: comparison of clinical presentation with a known and unknown primary tumour

OBJETIVO: El objetivo del presente estudio es revisar la frecuencia de metástasis intraoculares como primera manifestación de enfermedad sistémica e identificar las características clínicas y tumorales. MÉTODOS: Estudio retrospectivo y consecutivo de casos diagnosticados como metástasis intraoculares en una unidad de referencia de tumores intraoculares entre 1993 y 2014. Se registraron las características generales, epidemiológicas y oftalmológicas. RESULTADOS: Entre 1993 y 2014, se diagnosticaron 21 pacientes con metástasis intraoculares. Edad media de 62,7 años (31-89). Se observó bilateralidad en 4 casos y localización coroidea en 20 casos. El tumor intraocular fue la primera manifestación de la enfermedad sistémica en 13 pacientes (61,9%). El tumor primario fue la mama en el 47,5% de los casos y el pulmón en el 23,8%. El diagnóstico del tumor primario se realizó mediante estudios sistémicos y solo un paciente requirió biopsia intraocular. Respecto al tratamiento, la mayoría de los casos se controlaron mediante terapia sistémica; 4 casos precisaron radioterapia externa adicional y solamente un caso, enucleación. No se encontraron diferencias clínicas entre los casos de cáncer sistémico conocido o desconocido, excepto respecto al desprendimiento de retina exudativo, más frecuente en el segundo grupo. CONCLUSIONES: Aunque las metástasis intraoculares son el tumor intraocular más frecuente, no son un motivo frecuente de consulta. En más de la mitad de los casos es la forma de presentación de una neoplasia sistémica desconocida como una masa intraocular solitaria no pigmentada. El diagnóstico precoz es crucial para establecer el tratamiento adecuado, preservar la función visual y mejorar el pronóstico vital del paciente

OBJECTIVE: The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics. METHODS: Retrospective study of consecutive cases diagnosed of intraocular metástasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded. RESULTS: A total of 21 patients, with a mean age 62.7 years (31-89) were diagnosed with intraocular metástasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group. CONCLUSIONS: Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient

Intraocular metastasis: comparison of clinical presentation with a known and unknown primary tumour. / Metástasis intraoculares: comparación entre las formas de presentación clínica con tumor primario conocido y desconocido.

OBJECTIVE: The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics. METHODS: Retrospective study of consecutive cases diagnosed of intraocular metástasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded. RESULTS: A total of 21 patients, with a mean age 62.7 years (31-89) were diagnosed with intraocular metástasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group. CONCLUSIONS: Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient.

Glaucoma melanomalítico secundario a melanoma de iris / Melanomalytic glaucoma secondary to iris melanoma

Caso clínico: Varón de 35 años con hipertensión ocular en el ojo derecho (OD). En segmento anterior se observó una masa melanótica. La presión intraocular (PIO) fue de 40mmHg en el OD. En la gonioscopia se observó una masa iridiana con extensión camerular. Se realizó biopsia escisional confirmando el diagnóstico de melanoma de iris y glaucoma melanomalítico. Se asoció tratamiento con braquiterapia epiescleral adyuvante. Discusión: A los pacientes que presentan glaucoma unilateral, con aumento de pigmentación en malla trabecular, es esencial realizar pruebas de imagen. La resección mediante iridectomía junto con braquiterapia adyuvante es eficaz en el control de la enfermedad (AU)

Clinical case: A 35-year-old male with unilateral ocular hypertension in the right eye (RE). Anterior segment examination of the RE showed a melanotic lesion. Intraocular pressure (IOP) was 40mmHg in RE. Gonioscopy revealed extension into the anterior chamber angle. Excisional biopsy was performed and consistent with iris melanoma and secondary melanomalytic glaucoma. Brachytherapy was performed as adjuvant therapy. Discussion: In patients presenting with unilateral glaucoma and increased pigmentation in the trabecular meshwork, it is crucial to perform imaging studies. Resection by iridectomy with adjuvant episcleral brachytherapy is effective in controlling the disease (AU)

Melanomalytic glaucoma secondary to iris melanoma. / Glaucoma melanomalítico secundario a melanoma de iris.

CLINICAL CASE: A 35-year-old male with unilateral ocular hypertension in the right eye (RE). Anterior segment examination of the RE showed a melanotic lesion. Intraocular pressure (IOP) was 40mmHg in RE. Gonioscopy revealed extension into the anterior chamber angle. Excisional biopsy was performed and consistent with iris melanoma and secondary melanomalytic glaucoma. Brachytherapy was performed as adjuvant therapy. DISCUSSION: In patients presenting with unilateral glaucoma and increased pigmentation in the trabecular meshwork, it is crucial to perform imaging studies. Resection by iridectomy with adjuvant episcleral brachytherapy is effective in controlling the disease.

Tumor pigmentado del cuerpo ciliar: ¿benigno o maligno? / Pigmented ciliary body tumours: benign or malignant?

Casos clínicos: Se presentan dos casos de mujeres con una tumoración pigmentada en cuerpo ciliar, un melanoma y un melanocitoma, con diferentes manifestaciones clínicas. La primera refiere disminución de agudeza visual asociada a la tumoración de reciente aparición, así como subluxación y opacificación sectorial cristaliniana. La segunda está asintomática y ha permanecido en observación más de 30 años. Discusión: Aunque al diagnóstico definitivo de un tumor pigmentado del cuerpo ciliar solo se llega a través del estudio anatomopatológico, el conjunto de características clínicas es determinante cuando se plantea un tratamiento conservador (AU)

Cases report: We report the cases of 2 women with a pigmented tumour in the ciliary body, one a melanocytoma and the other a melanoma, with different clinical manifestations. The first one presented with decreased visual acuity associated with recent growth of the tumour, as well as sectorial opacities of the lens and subluxation. The second one is asymptomatic and has been kept under observation for more than 30 years. Discussion: Although the definitive diagnosis of a pigmented tumour of the ciliary body is only achieved by the histopathology study, the group of clinical features is a determining factor when a conservative treatment is indicated (AU)

[Pigmented ciliary body tumours: benign or malignant?]. / Tumor pigmentado del cuerpo ciliar: ¿benigno o maligno?

CASES REPORT: We report the cases of 2 women with a pigmented tumour in the ciliary body, one a melanocytoma and the other a melanoma, with different clinical manifestations. The first one presented with decreased visual acuity associated with recent growth of the tumour, as well as sectorial opacities of the lens and subluxation. The second one is asymptomatic and has been kept under observation for more than 30 years. DISCUSSION: Although the definitive diagnosis of a pigmented tumour of the ciliary body is only achieved by the histopathology study, the group of clinical features is a determining factor when a conservative treatment is indicated.

Melanoma uveal: características clínicas, tratamiento y supervivencia en una serie de 500 pacientes / Uveal melanoma: Clinical characteristics, treatment and survival in a series of 500 patients

Objetivo: Analizar las características clínicas, tratamiento y supervivencia de los pacientes diagnosticados de melanoma uveal en una unidad de referencia de tumores intraoculares en un periodo de 20 años. Metodología: Se realizó un estudio prospectivo de 500 pacientes entre enero de 1992 y diciembre de 2011. Se recogieron las características clínicas del tumor y el tratamiento recibido en una base de datos en Microsoft@ Access@. Las variables numéricas se analizaron con medias de frecuencia y desviación estándar, y las cualitativas con tablas de media de frecuencia. Resultados: La edad media de la muestra fue de 62,19 años, siendo un 51,2% mujeres. Se diagnosticaron por la presencia de síntomas visuales el 64,2% de los casos. Los tumores eran pequeños en el 31,12% de los casos y grandes en el 23,09% según criterios del COMS. El color de iris fue el verde-avellana en el 44,2% de los ojos. El tratamiento inicial fue la braquiterapia epiescleral en el 42,4%. La mortalidad global fue del 17 y 31,3% y la específica por melanoma del 11,6 y 14,8%, a los 5 y 10 años, respectivamente. Conclusiones: En la serie estudiada los melanomas son más frecuentes en mujeres y en iris más oscuros comparados con estudios previos. Los tumores detectados son sintomáticos y en estadios poco avanzados, lo que permite tratamientos conservadores, siendo la braquiterapia el más importante. Se observa una disminución de la mortalidad específica por melanoma comparada con otras series publicadas. Sin embargo, son necesarios más estudios sobre los factores que influyen en la supervivencia (AU)

Objective: To analyse the clinical features, treatment and survival of uveal melanoma patients diagnosed in a referral Intraocular Tumours Unit over a twenty-year period. Methodology: A prospective study was performed including five hundred patients, diagnosed between January 1992 and December 2011. Clinical tumour characteristics and treatment were collected in a database in Microsoft@ Access@. The numeric variables were expressed as means of frequency and standard deviation, and the quantitative variables using frequency tables. Results: The mean age of the sample was 62.19 years, with 51.2% females, and 64.2% presented with symptoms. The tumours were small in 31.12% of cases, and large in 23.09%, according to COMS criteria. Hazel green was the iris colour in 42.2% of the cases. The initial treatment was episcleral brachytherapy in 42.4% of the total. The overall mortality ratewas 17% and 31.3%, and melanoma-related mortality rate was 11.6% and 14.8%, at 5 and10 years, respectively. Conclusions: In the serie studied melanomas were more frequent in women, and a higher proportion of darker irides were observed than in other previous studies. Mostof the tumours were diagnosed when they became symptomatic and in the early or medium stages, allowing conservative therapies to be used, with brachytherapy being the predominant treatment. The melanoma-related mortality appeared to be lower than previously data published. However, further studies are required on the factors influencing survival (AU)

[Uveal melanoma: clinical characteristics, treatment and survival in a series of 500 patients]. / Melanoma uveal: características clínicas, tratamiento y supervivencia en una serie de 500 pacientes.

OBJECTIVE: To analyse the clinical features, treatment and survival of uveal melanoma patients diagnosed in a referral Intraocular Tumours Unit over a twenty-year period. METHODOLOGY: A prospective study was performed including five hundred patients, diagnosed between January 1992 and December 2011. Clinical tumour characteristics and treatment were collected in a database in Microsoft@ Access@. The numeric variables were expressed as means of frequency and standard deviation, and the quantitative variables using frequency tables. RESULTS: The mean age of the sample was 62.19 years, with 51.2% females, and 64.2% presented with symptoms. The tumours were small in 31.12% of cases, and large in 23.09%, according to COMS criteria. Hazel green was the iris colour in 42.2% of the cases. The initial treatment was episcleral brachytherapy in 42.4% of the total. The overall mortality rate was 17% and 31.3%, and melanoma-related mortality rate was 11.6% and 14.8%, at 5 and 10 years, respectively. CONCLUSIONS: In the serie studied melanomas were more frequent in women, and a higher proportion of darker irides were observed than in other previous studies. Most of the tumours were diagnosed when they became symptomatic and in the early or medium stages, allowing conservative therapies to be used, with brachytherapy being the predominant treatment. The melanoma-related mortality appeared to be lower than previously data published. However, further studies are required on the factors influencing survival.

Episcleral brachytherapy for uveal melanoma: analysis of 136 cases

PURPOSE: To assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival. PATIENTS: Prospective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up. RESULTS: Among a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date. CONCLUSIONS: I-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients (AU)

Prevalence of ocular and oculodermal melanocytosis in Spanish population with uveal melanoma.

PURPOSE: The aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population. METHODS: Retrospective review of the medical records of patients with ODM among patients with UM. RESULTS: Ten (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after. CONCLUSIONS: ODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma.

AIMS: To evaluate episcleral plaque radiotherapy with high-dose (125)I for the treatment of circumscribed choroidal haemangioma (CCH). METHODS: A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with (125)I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications. RESULTS: Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8-14.3) mm and mean height was 4.4 (range 2.8-6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23-123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients. CONCLUSIONS: Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, (125)I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.

[Ocular retention in patients with uveal melanoma managed by a multimodality approach]. / Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal.

OBJECTIVE: to analyze ocular survival in eyes with uveal melanoma treated with conservative therapies, in a centre that applies all treatment modalities. METHODS: Patients diagnosed with uveal melanoma and treated between September 1990 and April 2007 were included in an historical cohorts study. RESULTS: 273 patients were included. 193 were treated with conservative treatments (70.69%) and 80 were enucleated as primary treatment. 14 patients were enucleated after conservative treatment (7.2%). Kaplan-Meier survival analysis showed an 88% survival probability of the eye in the first 5 years after conservative treatment and 83% at 10 years. CONCLUSIONS: Conservative treatments for uveal melanoma, especially brachitherapy, are safe and effective in relation to tumor control and rate of secondary effects.

Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal / Ocular retention in patients with uveal melanoma managed by a multimodality approach

Objetivo: Analizar la supervivencia de los globosoculares afectados de melanoma uveal sometidos atratamiento conservador, en un centro que aplicatodas las modalidades de tratamiento.Métodos: Se han incluido en el estudio los pacientesdiagnosticados de melanoma de úvea tratadosentre septiembre de 1990 y abril de 2007 en la unidadde Oncología Ocular del Hospital Clínico Universitariode Valladolid realizándose un estudio decohortes histórico.Resultados: De los 273 pacientes incluidos en elestudio, se trataron 193 pacientes con terapias conservadoras(70,69%), mientras que se enuclearon deforma primaria 80 (29,30%). Se enuclearon de formasecundaria 14 de los sometidos a tratamientoconservador (7,2%) El análisis de supervivencia deKaplan-Meier reveló que tras la aplicación de untratamiento conservador, la probabilidad de conservacióndel globo ocular a los 5 años es del 88% y alos 10 años es del 83%.Conclusiones: El presente estudio pone de manifiestola seguridad de los tratamientos conservadores en el melanoma uveal, especialmente de la braquiterapiaepiescleral, en cuanto a control local dela enfermedad y a tasa de efectos secundarios(AU)

Objective: to analyze ocular survival in eyes withuveal melanoma treated with conservative therapies,in a centre that applies all treatment modalities.Methods: Patients diagnosed with uveal melanomaand treated between September 1990 and April2007 were included in an historical cohorts study.Results: 273 patients were included. 193 were treatedwith conservative treatments (70.69%) and 80were enucleated as primary treatment. 14 patientswere enucleated after conservative treatment(7.2%). Kaplan-Meier survival analysis showed an88% survival probability of the eye in the first 5years after conservative treatment and 83% at 10years.Conclusions: Conservative treatments for uvealmelanoma, especially brachitherapy, are safe andeffective in relation to tumor control and rate ofsecondary effects(AU)

[Ocular hypertension as the principal indicator of onset of uveal melanoma]. / Hipertensión ocular como principal forma de presentación del melanoma uveal.

PURPOSE: To present a series of patients with uveal melanoma masquerading as ocular hypertension. METHODS: Patients diagnosed with uveal melanoma were reviewed, selecting those cases with initial presentation as secondary unilateral glaucoma. Clinical and histopathological information useful for prognosis was examined, such as anterior border localization, size and shape of the tumor, associated ocular pathology, cell type and degree of extraocular extension. RESULTS: Seven patients out of a total of 160 diagnosed with melanoma presented with ocular hypertension (4.3% of the total). Six tumors were large, with only one of them being middle-size. All cases had an associated asymmetric cataract on the affected side. Four cases had neovascular glaucoma, two pseudo-phacolytic glaucoma and the remaining case had invasion of the anterior chamber angle. All cases were unresponsive to medical treatment for glaucoma, due to the unsuspected tumor they harbored. Visual acuity was lower than 0.1 in the affected eye in all patients. Only one case had extraocular extension. A histopathologic examination performed in six cases showed that 3 tumors had epithelioid cellularity and also 3 had varying degrees of extrascleral extension. CONCLUSIONS: In patients presenting with the association of unilateral glaucoma and asymmetric cataract, it is crucial to perform imaging studies, such as ultrasound, in order to rule out the presence of an intraocular tumor, and to achieve an early diagnosis, improving the patient's prognosis and the morbidity of treatments.

Hipertensión ocular como principal forma de presentación del melanoma uveal / Ocular hypertension as the principal indicator of onset of uveal melanoma

Objetivo: Presentar una serie de casos de pacientes con melanoma uveal cuya forma de presentación fue la hipertensión ocular (HTO).Métodos: Se revisaron los pacientes con diagnóstico de melanoma uveal seleccionando los casos cuya forma inicial de presentación del tumor fuera un glaucoma unilateral secundario. Se examinaron los datos clínicos e histopatológicos de valor pronóstico como localización del borde anterior, tamaño y forma del tumor, patología ocular acompañante, tipo celular, y grado de extensión extraocular.Resultados: Siete pacientes de un total de 160 diagnosticados de melanoma se presentaron con hipertensión ocular (4,3% del total). Seis fueron melanomas uveales grandes y el restante de tamaño mediano. Todos mostraron una catarata asimétrica en el lado afecto. Cuatro se presentaron con glaucoma neovascular, dos como pseudoglaucoma facolítico y uno con invasión del ángulo de cámara anterior. Todos se encontraban bajo tratamiento médico de glaucoma sin buena respuesta, por no sospecharse hasta ese momento el tumor intraocular. La mejor AV corregida en el ojo afecto fue menor de 0,1 en todos los pacientes. Sólo uno de los casos presentaba extensión extraocular. La histopatología efectuada en seis de los casos mostró 3 tumores de celularidad epitelioide y también 3 con diferentes grados extensión extraescleral.Conclusión: En los pacientes que presenten el cuadro de glaucoma unilateral y catarata asimétrica, es fundamental la realización de técnicas de imagen, como la ecografía, que permitan descartar la presencia de un tumor intraocular, y para realizar el diagnóstico en estadios precoces, mejorando el pronóstico del paciente y la morbilidad de los tratamientos

Purpose: To present a series of patients with uveal melanoma masquerading as ocular hypertension.Methods: Patients diagnosed with uveal melanoma were reviewed, selecting those cases with initial presentation as secondary unilateral glaucoma. Clinical and hystopathological information useful for prognosis was examined, such as anterior border localization, size and shape of the tumor, associated ocular pathology, cell type and degree of extraocular extension.Results: Seven patients out of a total of 160 diagnosed with melanoma presented with ocular hypertension (4.3% of the total). Six tumors were large, with only one of them being middle-size. All cases had an associated asymmetric cataract on the affected side. Four cases had neovascular glaucoma, two pseudo-phacolytic glaucoma and the remaining case had invasion of the anterior chamber angle. All cases were unresponsive to medical treatment for glaucoma, due to the unsuspected tumor they harbored. Visual acuity was lower than 0.1 in the affected eye in all patients. Only one case had extraocular extension. A hystopathologic examination performed in six cases showed that 3 tumors had epithelioid cellularity and also 3 had varying degrees of extrascleral extension.Conclusions: In patients presenting with the association of unilateral glaucoma and asymmetric cataract, it is crucial to perform imaging studies, such as ultrasound, in order to rule out the presence of an intraocular tumor, and to achieve an early diagnosis, improving the patient’s prognosis and the morbidity of treatments

[Choroidal melanoma in ocular melanosis]. / Melanoma de coroides en melanosis óculi.

CASES: We present four cases of ocular melanosis. Choroidal melanoma was detected in all of them. Three eyes had decreased visual acuity and were enucleated because of their large, active tumours. In the fourth case the melanoma was detected in a routine examination and we were able to apply a preserving treatment with I125 brachytherapy. DISCUSSION: Melanosis oculi is often underestimated as a risk factor for uveal melanoma and glaucoma. Ophthalmic surveillance, every 6 or 12 months is important, in patients with ocular melanocytosis for early detection of high risk diseases.

Melanoma de coroides en melanosis óculi / Choroidal melanoma in ocular melanosis

Se presentan cuatro casos de pacientes con signos clínicos de melanosis óculi. En todos se diagnosticó melanoma de coroides. Tres acudieron con disminución de visión en ojo afecto y fueron enucleados por presentar tumores grandes y activos. En el cuarto caso el melanoma fue descubierto en una revisión rutinaria y se pudo aplicar un tratamiento conservador con braquiterapia con I125. Discusión: La melanosis óculi está infravalorada como factor de riesgo para melanoma y glaucoma. Es necesaria una revisión oftalmológica cada 6 ó 12 meses para la detección precoz de enfermedades de alto riesgo en estos pacientes (AU)

Toxicidad por sobredosis de mitomicina / Toxicity of mitomycin-C overdose

La toxicidad hematológica de la mitomicina C es tardía y puede aparecer meses después de la administración del fármaco. Es excepcional encontrar casos de toxicidad por sobredosis de mitomicina. Presentamos un caso de aplasia medular severa y prolongada tras sobredosificación de mitomicina-C. La dosis total acumulada (100 mg/m2) fue prácticamente el doble de la que se recomienda habitualmente y se administró con una pauta semanal a lo largo de cinco semanas. El paciente ingresó tres meses después de la primera dosis con deterioro del estado general, aplasia medular confirmada mediante biopsia y ascitis secundaria a recidiva abdominal de adenocarcinoma gástrico. La toxicidad hematológica se mantuvo durante los 69 días que duró el ingreso y no comenzó a recuperarse hasta casi cinco meses después de la primera dosis de mitomicina (AU)

Formación en el uso de opioides: ¿repercute en la práctica diaria? / Formation in opioid use: does it a ffect daily clinical practice?

Introducción: Muchos pacientes oncológicos no reciben aún un tratamiento analgésico adecuado. La formación del personal sanitario en el control del dolor debería ayudar a mejorar las pautas de tratamiento de estos enfermos .Material y métodos: Se analizan las horas lectivas impartidas en la Universidad de Valladolid en cursos de tercer ciclo de 1995 a 1999 sobre cuidados paliativos y control del dolor. Se revisa la cantidad de morfina y fentanilo administrados en este tiempo en el Hospital Universitario de Valladolid (HUV) y en la provincia de Valladolid .Resultados: El consumo de morfina y fentanilo en el Servicio de Oncología del HUV ha crecido de manera pareja a la asistencia de sus miembros a cursos de postgrado sobre medicina paliativa; desde 2446 dosis diarias definidas (DDD) en 1995, a 6156 DDD en 1999. El incremento ha sido proporcionalmente menor en el conjunto del HUV y prácticamente nulo en los Servicios dependientes de Medicina Interna. En la provincia el único cambio significativo aparece en 1999: el consumo de morfina y fentanilo era de 180,45 DDD por millón de habitantes y día en 1998 y creció a 490,57 en 1999; este gran aumento parece deberse únicamente a la difusión del fentanilo transdérmico. Conclusión: Los cursos universitarios de postgrado con formación específica en cuidados paliativos y control del dolor tienen una repercusión positiva pero muy limitada en el empleo de opioides (AU)

The reality of palliative care in Spain.

With the sponsorship of the Spanish Society of Palliative Care (SECPAL), two nation-wide studies from the University of Valladolid were carried out in 1996 and 1998 into the state of palliative care teams in Spain. This report is based on those studies and is the first overall analysis of the current situation of palliative care in Spain. A total of 143 programmes were identified and data were collected from 128 teams (89%): 53 were programmes with hospitalised patients, 75 for home-based patients and 15 were mixed programmes. From the activity data, provided by 75% of the teams, it may be estimated that each year 22,638 terminally ill patients receive palliative care attention. Of these, 18,021 (79.6%) are cancer sufferers. Of the patients who die from cancer each year in our country, 21.2% receive palliative care during the final weeks of life. More than 10 years have passed since the first teams in Spain started their work. The time has now come to recognize the reality of palliative care in our society and to adopt a national policy for terminally ill patients, in line with World Health Organization recommendations formulated in 1989.