Biopsia del músculo recto lateral orbitario como diagnóstico de cáncer de mama metastásico no conocido / Lateral rectus muscle biopsy as diagnosis of unknown metastatic breast cancer

Mujer de 58 años sin antecedentes médicos de interés que consulta por diplopía binocular de una semana de evolución, asociada a dolor costal, disnea, astenia intensa y pérdida de peso de 2 meses de evolución. En la analítica de urgencia presenta hipercalcemia, insuficiencia renal y bicitopenia, y en la radiografía de tórax de urgencias se observan múltiples imágenes osteoclásticas que orientan inicialmente a mieloma múltiple con afectación extraósea. Además del estudio correspondiente, ante la diplopía horizontal se realiza TC craneal sin contraste, donde se observa una lesión adyacente a la pared lateral de la órbita izquierda, de densidad de partes blandas, que incluye el músculo recto externo y ejerce efecto masa sobre el nervio óptico desplazándolo medialmente. Además se observan múltiples lesiones líticas de distribución difusa en la calota, con patrón permeativo "en sal y pimienta". Se procede a la biopsia del músculo recto lateral y ósea de ala sacra, obteniendo como resultado metástasis de carcinoma compatible con origen mamario. Presentamos un caso atípico de diplopía horizontal en el contexto de una paciente con un cuadro constitucional severo sin diagnóstico establecido, en el que la biopsia del recto lateral, junto con la biopsia de médula ósea, son claves a la hora del diagnóstico de confirmación

The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis

Lateral rectus muscle biopsy as diagnosis of unknown metastatic breast cancer. / Biopsia del músculo recto lateral orbitario como diagnóstico de cáncer de mama metastásico no conocido.

The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis.

Oftalmomiasis externa por Dermatobia hominis. A propósito de un caso / External ophthalmomyiasis due to Dermatobia hominis. A case report

Mujer de 46 años, sin antecedentes de interés, natural de Honduras y residente en España desde hace un mes y medio. Acude a urgencias por inflamación del párpado superior del ojo derecho, con zona que simula absceso. Se procede a drenado del mismo (sin obtener apenas contenido purulento), se prescribe tratamiento con antibióticos y antiinflamatorios tópicos y orales. A la semana siguiente acude con mejoría del cuadro inflamatorio, pero con molestias y erosiones corneales. Tras eversión del párpado superior se observa parásito tipo «gusano» emergiendo del tarso. Se completa extracción del mismo con pinza, identificándose como Dermatobia hominis (Dh) mediante examen en fresco. La evolución posterior de la paciente resultó favorable. DISCUSIÓN: La celulitis preseptal en pacientes procedentes de zonas tropicales y subtropicales puede ser causada por Dh

A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm» type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by DH

Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal / Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate

CASO CLÍNICO: Mujer de 31 años, sin antecedentes de interés, que consulta por diminución de la visión en ambos ojos. Refiere haber consumido un comprimido de acetato de ulipristal 30 mg como anticonceptivo de urgencia 4 días antes de la aparición de los síntomas. A la exploración presenta una mejor agudeza visual corregida de 0,6 en el ojo derecho y de 0,8 en el ojo izquierdo (según test de Snellen) y un desprendimiento seroso macular bilateral. Se decide observación, y a los 15 días presenta una mejoría significativa funcional y anatómica del cuadro. Discusión: El acetato de ulipristal podría desencadenar coriorretinopatía serosa central por su efecto sobre los receptores de progesterona presentes en coroides y epitelio pigmentario de la retina

CASE REPORT The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30 mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium

Queratitis secundaria a Fusarium spp. en España 2012-2014 / Keratitis secondary to Fusarium spp. in Spain 2012-2014

OBJETIVO: Describir las características clinicoepidemiológicas de una serie de casos de queratitis fúngica asociada con Fusarium spp., en España durante los años 2012 a 2014. MÉTODOS: Estudio retrospectivo de una serie de casos. Se identificaron los centros sanitarios que se encontraban en las capitales provinciales (n = 250), obteniéndose una muestra aleatoria sistemática del 10%. Se les preguntó si habían presentado casos de queratitis por Fusarium spp. caracterizados mediante métodos microbiológicos, 23 centros respondieron, detectando casos en 14 de ellos, aceptando participar 13, completando el estudio 11 instituciones, a los que se les envió el cuestionario previamente validado. Las variables analizadas fueron: edad, sexo, residencia habitual, profesión, antecedentes patológicos y médicos (enfermedades sistémicas y oculares previas, cirugías oculares previas) y su evolución. RESULTADOS: La tasa de respuesta fue del 92%, identificando 23 casos de Fusarium spp.; 21 casos (91,3%) vivían en zonas urbanas. Los profesionales fueron los más afectados por la enfermedad (chef, administrativo, técnico) con 13 casos (56,5%). Las pautas de tratamiento establecidas antes de la confirmación de la infección evidenciaron el uso combinado de antibióticos tópicos asociados a agentes antivirales y/o antifúngicos, siendo el principal factor de riesgo el uso de lentes de contacto (86,9%). DISCUSIÓN: Es una enfermedad poco frecuente en nuestro medio, un gran porcentaje de las personas residían en áreas urbanas y su trabajo se realizaba en entornos cerrados, enfocando la atención en los microtraumas causados por el uso de lentes de contacto

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n = 250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses

External ophthalmomyiasis due to Dermatobia hominis. A case report. / Oftalmomiasis externa por Dermatobia hominis. A propósito de un caso.

CLINICAL CASE: A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm¼ type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh.

Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate. / Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal.

CASE REPORT: The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium.

Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.

Coriorretinopatía serosa central recidivante y crónica. Estudio del espesor retiniano al mes del tratamiento con una inyección de bevacizumab intravítreo / Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection

Propósito: Evaluar la eficacia de la inyección intravítrea de bevacizumab en pacientes diagnosticados de coriorretinopatía serosa central crónica. Método: Estudio de ocho pacientes con corioretinopatía serosa central tratada con inyección intravitrea de bevacizumab. Se incluye la agudeza visual con la escala de Snellen y el grosor de la mácula, ambas pre- y post-inyección. Resultados: La edad media de los pacientes fue de 50,25 años. El estudio se evaluó al cabo de un mes de evolución. La agudeza visual previa media fue de 0,431±0,249 líneas de visión y la posterior a la inyección fue de 0,631±0,310 líneas de visión (P=0,017). El grosor medio de la mácula fue de 351,25±78,492 μm y post-tratamiento de 183,50±22,640 μm (P=0,012).Conclusión: El bevacizumab intravítreo puede ser una alternativa en los pacientes con coriorretinopatía serosa central ya que existe una mejoría objetiva tanto de la agudeza visual como del grosor macular objetivado con tomografía de coherencia óptica(AU)

Purpose: To evaluate the efficacy of intavitreal injection of bevacizumab in patients with chronic central serous chorioretinopathy. Methods: A study of 8 patients with central serous chorioretinopathy who were treated with intravitreal injection of bevacizumab. We studied the visual acuity with Snellenis method and the foveal thickness, before and after the injection. Results: The mean age of the patients was 50.25 years. After one month of follow-up, visual acuity before the injection was 0.431±0.249 vision lines and after was 0.631±0.310 vision lines (P=.017).The foveal thickness was 351.25±78.492μm and after treatment was 183.50±22.640μm (P=.012). Conclusions: Intravitreal bevacizumab can be an alternative treatment in patients with serous central chorioretinopathy as it leads to a better objective visual acuity and foveal thickness with optical coherence tomography(AU)

[Recurrent and chronic central serous chorioretinopathy. Retina thickness evaluation one month after intravitreal bevacizumab injection]. / Coriorretinopatía serosa central recidivante y crónica. Estudio del espesor retiniano al mes del tratamiento con una inyección de bevacizumab intravítreo.

PURPOSE: To evaluate the efficacy of intavitreal injection of bevacizumab in patients with chronic central serous chorioretinopathy. METHODS: A study of 8 patients with central serous chorioretinopathy who were treated with intravitreal injection of bevacizumab. We studied the visual acuity with Snellens method and the foveal thickness, before and after the injection. RESULTS: The mean age of the patients was 50.25 years. After one month of follow-up, visual acuity before the injection was 0.431 ± 0.249 vision lines and after was 0.631 ± 0.310 vision lines (P=.017).The foveal thickness was 351.25 ± 78.492 µm and after treatment was 183.50 ± 22.640 µm (P=.012). CONCLUSIONS: Intravitreal bevacizumab can be an alternative treatment in patients with serous central chorioretinopathy as it leads to a better objective visual acuity and foveal thickness with optical coherence tomography.

[Retinal nerve fiber layer thickness analysis in children from 6 to 9 years of age]. / Análisis del espesor de la capa de fibras nerviosas en niños de 6 a 9 años.

PURPOSE: To establish a database of scanning laser polarimetry (GDx) parameters for children between 6 and 9 years of age and compare the results at each age. METHODS: The retinal nerve layer thickness of 116 children from one school was evaluated with GDx and the results were analyzed for each age and for the entire group to determinate the normal range for that population. RESULTS: In the global analysis of the software-derived GDx parameters, we obtained a TSNIT average of 59.43 (IC95% 58.41-60.45), a superior average of 71.35 (IC95% 69.99-72.70), an inferior average of 70.08 (IC95% 68.71-71.45), and a TSNIT Std. Deviation of 25.11 (IC95% 24.36-25.86). The results from the analysis for age were similar to the global results. CONCLUSIONS: Given the low level of cooperation required, GDx can be used without problem to study the retinal nerve fiber layer in 6-9-year-old children. GDx could provide objective information about the state of development of the retinal nerve fiber layer during this period of life.

Análisis del espesor de la capa de fibras nerviosas en niños de 6 a 9 años / Retinal nerve fiber layer thickness analysis in children from 6 to 9 years of age

Objetivo: Establecer una base de datos para el GDx-VCC representativa para nuestra población de entre 6 a 9 años y analizar los datos obtenidos por rango de edades. Método: Se analizó la densidad de la CFN mediante oftalmoscopía de barrido con láser (GDx) a 116 niños procedentes de un único colegio y los resultados fueron sometidos a estudio estadístico por edades y en global a fin de determinar el rango de valores considerable como la normalidad para esa población y las posibles diferencias entre ellos. Resultados: En el análisis global por cuadrantes de los datos estudiados por el GDx se encontró un promedio TSNIT de 59,43 (IC95% 58,41-60,45); superior de 71,35 (IC95% 69,99-72,70); inferior de 70,08 (IC95% 68,71-71,45) y una desviación estándar TSNIT de 25,11 (IC95% 24,36-25,86). En el análisis por edades se observan valores medios por cuadrantes comparables a los del global. Conclusiones: El estudio de la CFN mediante GDx se puede realizar sin problema en la población infantil de 6 a 9 años dada la mínima colaboración requerida, obteniendo así datos objetivos sobre su estado y desarrollo durante estas edades

Purpose: To establish a database of scanning laser polarimetry (GDx) parameters for children between 6 and 9 years of age and compare the results at each age. Methods: The retinal nerve layer thickness of 116 children from one school was evaluated with GDx and the results were analyzed for each age and for the entire group to determinate the normal range for that population. Results: In the global analysis of the software-derived GDx parameters, we obtained a TSNIT average of 59.43 (IC95% 58.41-60.45), a superior average of 71.35 (IC95% 69.99-72.70), an inferior average of 70.08 (IC95% 68.71-71.45), and a TSNIT Std. Deviation of 25.11 (IC95% 24.36-25.86). The results from the analysis for age were similar to the global results. Conclusions: Given the low level of cooperation required, GDx can be used without problem to study the retinal nerve fiber layer in 6-9-year-old children. GDx could provide objective information about the state of development of the retinal nerve fiber layer during this period of life

[Limbal relaxing incisions and cataract surgery: our experience]. / Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia.

PURPOSE: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). METHODS: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism>or=1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. RESULTS: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). CONCLUSIONS: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity.

[Simultaneous botulism in two brothers addicted to cocaine]. / Botulismo simultáneo en dos hermanos cocainómanos.

INTRODUCTION: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. CLINICAL CASE: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. DISCUSSION: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause.

Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia / Limbal relaxing incidions and cataract surgery: our experience

Objetivo: Evaluar la reducción del astigmatismo corneal preexistente en la cirugía de catarata mediante incisiones limbares relajantes (ILRs). Método: Estudio prospectivo de dos grupos de pacientes (tratamiento y control) con astigmatismo prequirúrgico ³1D. Los 30 pacientes del grupo control fueron sometidos a facoemulsificación por incisión temporal en córnea clara y los 32 pacientes del grupo tratamiento a ILRs junto a facoemulsificación por incisión temporal en córnea clara. Se usó el test de Holladay para valorar la eficacia del tratamiento. Asimismo, presentamos un pequeño estudio de la prevalencia y distribución del astigmatismo en nuestra población de trabajo. Resultados: El seguimiento promedio de los 62 pacientes fue de 3 meses, con un cambio astigmático medio a los 3 meses de -0.55D (-0,75 a -0,35) en el grupo tratamiento y de 0.04D (-0,3 a 0,3) en el grupo control (p<,000). Conclusiones: Las ILRs son un método sencillo y efectivo para conseguir reducir el astigmatismo previo durante la cirugía de catarata y con ello la dependencia de gafa

Purpose: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). Methods: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism ³1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. Results: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). Conclusions: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity

Botulismo simultáneo en dos hermanos cocainómanos / Simultaneous botulism in two brothers addicted to cocaine

Introducción: El botulismo es poco frecuente en la actualidad. La toxina botulínica produce una parálisis muscular progresiva que puede producir la muerte del paciente por parada de los músculos respiratorios. Caso clínico: Dos pacientes hermanos, adictos a la cocaína, acudieron al Servicio de Urgencias por disminución de la agudeza visual cercana, con midriasis bilateral. A los dos días presentaban, además, ptosis palpebral, disfunción asimétrica de la motilidad ocular extrínseca, y vómito. Discusión: Ante la presencia de una parálisis de la acomodación con una midriasis bilateral que responde a pilocarpina, se debe considerar el botulismo como una posible etiología

Introduction: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. Clinical case: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. Discussion: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause

[Octreotide scintigraphy in thyroid orbitopathy]. / Gammagrafía con octreótido en la orbitopatía distiroidea.

INTRODUCTION: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. OBJECTIVE: To evaluate the efficiency of (111) In-Octreotide scintigraphy in the identification of orbital activity in Graves' disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. METHODS: We studied a group of eighteen patients with symptomatic Graves' ophthalmopathy of between two months and four years duration. We injected 6 mCi of (111) In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. RESULTS: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. CONCLUSION: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues.

Gammagrafía con octreótido en la orbitopatía distiroidea / Octreotide Scintigraphy in Thyroid Orbitopathy

Introducción: La enfermedad de Graves es una enfermedad de base autoinmune en la cual existe una infiltración por linfocitos activados en el tejido retroorbitario. Estos linfocitos activados se caracterizan por aumentar la expresión de receptores de somatostatina en su superficie que median la respuesta inflamatoria. Objetivo: Valorar la efectividad de la gammagrafía con 111In-octreótido en la identificación de actividad orbitaria en la Enfermedad de Graves y valorar qué pacientes son subsidiarios de recibir tratamiento con análogos de la somatostatina, así como su evolución con el tratamiento, según un protocolo establecido con el Servicio de Medicina Nuclear. Métodos: Se estudió un grupo de dieciocho pacientes con oftalmopatía tiroidea sintomática de dos meses a cuatro años de evolución. Se les inyectó 6 mCi de 111In-octreótido vía endovenosa siendo estudiados mediante SPECT a las cuatro y veinticuatro horas. Cuatro enfermos, todos en fase activa, mostraron captación orbitaria, por lo que fueron tratados con lanreotida 60 mg cada quince días. Se controló a estos pacientes a los tres meses con un nuevo estudio clínico-gammagráfico. Resultados: En nuestra serie, de los cuatro pacientes que presentaron receptores, todos ellos con evolución menor de dieciséis meses, tres respondieron bien al tratamiento según la valoración posterior. Conclusión: La gammagrafía con octreótido es un procedimiento útil que diferencia las fases activas, subsidiarias de tratamiento inmunosupresor, en pacientes con oftalmopatía tiroidea. El tratamiento con análogos de la somatostatina fue eficaz en nuestra serie

Introduction: Graves' disease, which has an autoimmune basis, is associated with the infiltration of activated lymphocytes into the retrobulbar tissues of the eye. These activated lymphocytes express somatostatin receptors on their surface which mediate the inflammatory response. Objective: To evaluate the efficiency of 111In-Octreotide scintigraphy in the identification of orbital activity in Graves’ disease and the usefulness of treatment with a somatostatin analogue, based on a pre-established protocol within the Nuclear Medicine Department. Methods: We studied a group of eighteen patients with symptomatic Graves’ ophthalmopathy of between two months and four years duration. We injected 6 mCi of 111In-Octreotide parenterally, and performed scintigraphy four and twenty-four hours later. Four patients, all in the active phase, showed orbital somatostatin receptors, for which they were treated with lanreotide 60 mg every fifteen days for three months. Patients were reviewed after 3 months treatment with a further scintigraphy and clinical study. Results: In our study all four treated patients had less than sixteen months of ophthalmopathy, and three responded well to the treatment. Conclusion: Scintigraphy with Octreotide is a useful procedure allowing identification of patients in the active phase of the ophthalmopathy who are likely to respond well to treatment with somatostatin analogues

[Somatostatin analogue treatment in Graves' ophthalmopathy: a case report]. / Tratamiento de la enfermedad de Graves con análogos de la somatostatina: caso clínico.

CASE REPORT: The effect of a somatostatin analogue in a patient with Graves' ophthalmopathy is presented, including data on the dose requirements and the results of therapy. DISCUSSION: There are few effective options for the management of Graves' ophthalmopathy, a cell-mediated immune co-morbidity of thyroid disease. Somatostatin analogues inhibit lymphocyte proliferation and activation, and accumulate in the orbital tissue during the active ophthalmopathy. Because of this, such therapy is able to inactivate the ophthalmopathy without complications occurring.

Tratamiento de la enfermedad de Graves con análogos de la somatostatina: caso clínico / Somatostatin analogue treatment in Graves' ophthalmopathy: a case report

Caso clínico: Se presenta la evolución de un paciente con oftalmopatía de Graves (OG) tratado con análogos de la somatostatina, así como las indicaciones, pauta y resultados obtenidos. Discusión: Son pocas las opciones terapéuticas efectivas para el manejo de la oftalmopatía asociada a disfunción tiroidea de origen autoinmune. Los análogos de la somatostatina inhiben la proliferación y activación de los linfocitos, y se acumulan en el tejido orbitario durante la fase activa de la enfermedad oftálmica. Así, nos permitieron en el caso presentado llegar a la fase inactiva de la enfermedad sin secuelas importantes

Case report: The effect of a somatostat in analogue in a patient with Graves' ophthalmopathy is presented, including data on the dose requirements and the results of therapy. Discussion: There are few effective options for the management of Graves' ophthalmopathy, a cell mediated immune comorbidity of thyroid disease. Somatostatin analogues inhibit lymphocyte proliferation and activation, and accumulate in the orbital tissue during the active ophthalmopathy. Because of this, such therapy is able to inactivate the ophthalmopathy without complications occurring