ABSTRACT
Se trata de un hombre de 45 años con cierre angular y miopía aguda bilateral tras inicio de tratamiento con topiramato por dependencia al alcohol y la heroína. La tomografía de coherencia óptica Visante(R) y la ecografía ocular muestran efusión ciliocoroidea bilateral como mecanismo fisiopatológico. El tratamiento consistió en la retirada del topiramato, y la utilización de hipotensores oculares, ciclopléjico y corticoides tópicos, con lo cual se resolvió el síndrome de efusión ciliocoroidea. La tomografía de coherencia óptica Visante(R) y la ecografía ocular son herramientas útiles en el diagnóstico y seguimiento de los pacientes con cierre angular y miopía en el contexto del síndrome de efusión ciliocoroidea secundario a topiramato. Debido al amplio espectro de indicaciones de esta medicación, tanto el personal sanitario que lo indica como los oftalmólogos, deben conocer las posibles manifestaciones oculares atribuidas a este medicamento
A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante(R) OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante(R) OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug
Subject(s)
Humans , Male , Middle Aged , Anticonvulsants/adverse effects , Microscopy, Acoustic/methods , Tomography, Optical Coherence/methods , Topiramate/adverse effects , Adrenal Cortex Hormones/therapeutic use , Alcoholism , Follow-Up Studies , Glaucoma, Angle-Closure/chemically induced , Glaucoma, Angle-Closure/diagnostic imaging , Glaucoma, Angle-Closure/drug therapy , Heroin Dependence , Mydriatics/therapeutic use , Myopia/chemically induced , Myopia/drug therapyABSTRACT
A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.
Subject(s)
Anticonvulsants/adverse effects , Choroidal Effusions/diagnostic imaging , Microscopy, Acoustic/methods , Tomography, Optical Coherence/methods , Topiramate/adverse effects , Adrenal Cortex Hormones/therapeutic use , Alcoholism , Choroidal Effusions/complications , Choroidal Effusions/drug therapy , Follow-Up Studies , Glaucoma, Angle-Closure/chemically induced , Glaucoma, Angle-Closure/diagnostic imaging , Glaucoma, Angle-Closure/drug therapy , Heroin Dependence , Humans , Male , Middle Aged , Mydriatics/therapeutic use , Myopia/chemically induced , Myopia/drug therapyABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Osmolar Concentration , Graft vs Host Disease/complications , Graft vs Host Disease/diagnosis , Xerophthalmia/complications , Ophthalmic Solutions/therapeutic use , Graft vs Host Disease/physiopathology , Graft vs Host Disease , Ophthalmic Solutions , Lubricant Eye Drops/therapeutic useSubject(s)
Dry Eye Syndromes/drug therapy , Graft vs Host Disease/complications , Lubricant Eye Drops/therapeutic use , Dry Eye Syndromes/etiology , Dry Eye Syndromes/physiopathology , Humans , Hypotonic Solutions/therapeutic use , Osmolar Concentration , Surface Properties , Tears/chemistry , Tears/physiology , Tomography, Optical CoherenceABSTRACT
No disponible
Subject(s)
Adult , Humans , Male , Pheochromocytoma/diagnosis , Pheochromocytoma/pathology , Hypertension/complications , Hypertension/diagnosis , Vomiting/diagnosis , Retinal Hemorrhage/complications , Hypertensive Retinopathy/complications , Hypertensive Retinopathy/diagnosis , Pheochromocytoma/complications , Pheochromocytoma , Hypertension/classification , Hypertension/prevention & control , Vomiting/enzymology , Vomiting/metabolism , Retinal Hemorrhage/metabolism , Headache/pathologyABSTRACT
A novel influenza virus emerged in the United States in spring 2009, rapidly becoming a global pandemic. Children were disproportionally affected by the novel influenza A(H1N1) pandemic virus [A(H1N1)pdm]. This retrospective electronic medical record review study aimed to identify clinical predictors of disease severity of influenza A(HIN1)pdm infection in paediatric patients. Disease severity was defined on an increasing three-level scale from non-hospitalized, hospitalized, and admitted to the intensive care unit (ICU). From April 2009 to June 2010, 696 children presented to Texas Children's Hospital's emergency department, 38% were hospitalized, and 17% were admitted to the ICU. Presenting symptoms associated with severe influenza were dyspnoea [odds ratio (OR) 5·82], tachycardia (OR 2·61) and fatigue (OR 1·96). Pre-existing health conditions associated with disease severity included seizure disorder (OR 4·71), obesity (OR 3·28), lung disease (OR 2·84), premature birth (OR 2·53), haematological disease (OR 2·22), and developmental delay (OR 2·20). According to model fitness tests, presenting symptoms were more likely to predict severe influenza than underlying medical conditions. However, both are important risk factors. Recognition of clinical characteristics associated with severe disease can be used for triaging case management of children during future influenza outbreaks.
Subject(s)
Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Influenza, Human/pathology , Pandemics , Severity of Illness Index , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Influenza, Human/virology , Male , Prognosis , Retrospective Studies , Risk Factors , Texas/epidemiologyABSTRACT
CASO CLÍNICO: Varón de 21 años con historia de exoftalmos izquierdo y diplopía de 2 semanas de evolución. La resonancia magnética mostró una lesión muy vascularizada etmoido-orbitaria con invasión de base del cráneo anterior y extensión orbitaria. La biopsia etmoidal confirmó un tejido fibrovascular compatible con angiofibroma. DISCUSIÓN: El angiofibroma nasofaríngeo juvenil (ANJ) es un tumor benigno con características locales de malignidad debido a su capacidad de invadir áreas adyacentes. En nuestro caso, el comienzo se presenta con manifestaciones de extensión orbitaria. Consideramos necesario un conocimiento amplio y un abordaje multidisciplinario con el fin de mejorar el pronóstico
CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis
Subject(s)
Humans , Male , Young Adult , Angiofibroma/chemically induced , Angiofibroma/pathology , Nasopharyngeal Neoplasms/chemically induced , Nasopharyngeal Neoplasms/pathology , Eye Neoplasms/drug therapy , Eye Neoplasms/radiotherapy , Exophthalmos/congenital , Exophthalmos/metabolism , Head and Neck Neoplasms/diagnosis , Angiofibroma/diagnosis , Angiofibroma/prevention & control , Nasopharyngeal Neoplasms/diagnosis , Nasopharyngeal Neoplasms/metabolism , Eye Neoplasms/complications , Eye Neoplasms/surgery , Exophthalmos/complications , Exophthalmos/surgery , Head and Neck Neoplasms/drug therapyABSTRACT
CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis.
Subject(s)
Angiofibroma/pathology , Nasopharyngeal Neoplasms/pathology , Orbit/pathology , Angiofibroma/diagnostic imaging , Angiofibroma/radiotherapy , Angiofibroma/surgery , Biopsy , Cerebral Angiography , Combined Modality Therapy , Diplopia/etiology , Ethmoid Bone/diagnostic imaging , Ethmoid Bone/pathology , Exophthalmos/etiology , Humans , Magnetic Resonance Imaging , Male , Maxillary Artery/diagnostic imaging , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/surgery , Neoplasm Invasiveness , Ophthalmic Artery/diagnostic imaging , Orbit/diagnostic imaging , Skull Base/diagnostic imaging , Skull Base/pathology , Young AdultSubject(s)
Adrenal Gland Neoplasms/complications , Hypertensive Retinopathy/etiology , Pheochromocytoma/complications , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Adult , Emergencies , Headache/etiology , Humans , Hyperhidrosis/etiology , Hypertension, Malignant/etiology , Hypertensive Retinopathy/diagnostic imaging , Magnetic Resonance Imaging , Male , Pheochromocytoma/diagnosis , Pheochromocytoma/diagnostic imaging , Pheochromocytoma/surgery , Remission Induction , Retinal Hemorrhage/etiology , Tomography, Optical CoherenceABSTRACT
CASO CLÍNICO: Una mujer de 73 años se presenta con historia de molestias inespecíficas y fotofobia en ambos ojos (AO) de un año de evolución. A la exploración se observa un simbléfaron bilateral y acortamiento de fondos de saco. El análisis inmunohistoquímico (IHQ) confirma la presencia de un depósito lineal de Ig G, Ig M y C3 a lo largo de la membrana basal conjuntival. Ante el diagnóstico de penfigoide ocular cicatricial (POC) se pauta tratamiento sistémico mediante metotrexato (MTX) subcutáneo. DISCUSIÓN: Consideramos dicho tratamiento una alternativa inmunosupresora inicial muy eficaz en pacientes con inflamación conjuntival moderada y en casos de rápida progresión
CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression
Subject(s)
Humans , Female , Aged , Methotrexate/therapeutic use , Pemphigoid, Benign Mucous Membrane/drug therapy , Conjunctivitis/drug therapy , Immunoglobulin G/analysis , Immunoglobulin M/analysisABSTRACT
CASO CLÍNICO: Un varón de 37 años se presenta por una historia de obstrucción nasal con rinorrea derecha, cefalea, hipoacusia y exoftalmos derecho de 4 meses de evolución. La RM revela la ocupación de senos etmoidales y maxilares por tejido inflamatorio con extensión hacia la región orbitaria. La biopsia confirma un linfoma no Hodgkin de células T natural killer (NK). DISCUSIÓN: El linfoma no Hodgkin T NK es un tumor infrecuente en el área orbitaria que precisa de una precoz detección así como de una atención multidisciplinaria para asegurar un seguimiento y tratamiento adecuados
CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment
Subject(s)
Humans , Male , Adult , Lymphoma, Non-Hodgkin/pathology , Eye Neoplasms/pathology , Lymphoma, Extranodal NK-T-Cell/pathology , Exophthalmos/etiology , Nasal Obstruction/etiology , Rhinitis/etiologyABSTRACT
No disponible
Subject(s)
Humans , Blepharitis/drug therapy , Ether/therapeutic use , Mites/pathogenicity , Ivermectin/therapeutic useABSTRACT
CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment.
Subject(s)
Ethmoid Sinus/pathology , Lymphoma, Extranodal NK-T-Cell/pathology , Maxillary Sinus/pathology , Orbit/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Bone Marrow/pathology , Cisplatin/administration & dosage , Cytarabine/administration & dosage , Ethmoid Sinus/diagnostic imaging , Etoposide/administration & dosage , Exophthalmos/etiology , Fatal Outcome , Humans , Lymphoma, Extranodal NK-T-Cell/complications , Lymphoma, Extranodal NK-T-Cell/diagnostic imaging , Lymphoma, Extranodal NK-T-Cell/drug therapy , Male , Maxillary Sinus/diagnostic imaging , Methylprednisolone/administration & dosage , Nasal Obstruction/etiology , Neoplasm Recurrence, Local , Orbit/diagnostic imaging , Salvage Therapy , Tomography, X-Ray ComputedSubject(s)
Acaricides/therapeutic use , Blepharitis/drug therapy , Ether/therapeutic use , Ivermectin/therapeutic use , Mite Infestations/drug therapy , Acaricides/administration & dosage , Acaricides/pharmacology , Administration, Topical , Blepharitis/parasitology , Drug Resistance , Ether/administration & dosage , Humans , Ivermectin/pharmacology , Male , Middle Aged , Mite Infestations/parasitologyABSTRACT
CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression.
Subject(s)
Immunosuppressive Agents/therapeutic use , Methotrexate/therapeutic use , Pemphigoid, Benign Mucous Membrane/drug therapy , Aged , Basement Membrane/immunology , Complement C3/analysis , Conjunctiva/pathology , Female , Humans , Hyperemia/etiology , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Keratitis/etiology , Pemphigoid, Benign Mucous Membrane/complications , Pemphigoid, Benign Mucous Membrane/diagnosis , Pemphigoid, Benign Mucous Membrane/immunologyABSTRACT
No disponible
Subject(s)
Humans , Ocular Hypertension/physiopathology , Glaucoma/physiopathology , Blood Pressure Monitoring, Ambulatory/methodsSubject(s)
Glaucoma, Open-Angle/physiopathology , Monitoring, Physiologic/instrumentation , Tonometry, Ocular/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Circadian Rhythm/physiology , Glaucoma, Open-Angle/drug therapy , Humans , Middle Aged , Monitoring, Physiologic/methods , Ophthalmic Solutions , Tonometry, Ocular/methods , Young AdultABSTRACT
OBJECTIVE: Variation in the serotonin transporter gene (SLC6A4) promoter region has been shown to influence depression in persons who have been exposed to a number of stressful life events. METHOD: We evaluated whether genetic variation in 5-HTTLPR, influences current depression, lifetime history of depression and quantitative measures of depression in persons with chronic psychotic disorders. This is an association study of a genetic variant with quantitative and categorical definitions of depression conducted in the southwest US, Mexico and Costa Rica. We analyzed 260 subjects with a history of psychosis, from a sample of 129 families. RESULTS: We found that persons carrying at least one short allele had a statistically significant increased lifetime risk for depressive syndromes (P < 0.02, odds ratio 2.18, 95% CI 1.10-4.20). CONCLUSION: The 'ss' or 'sl' genotype at the 5-HTTLPR promoter polymorphic locus increases the risk of psychotic individuals to develop major depression during the course of their illness.
Subject(s)
Depressive Disorder/genetics , Polymorphism, Genetic/genetics , Psychotic Disorders/genetics , Serotonin Plasma Membrane Transport Proteins/genetics , Adult , Alleles , Chronic Disease , Comorbidity , Costa Rica/epidemiology , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Female , Genetic Predisposition to Disease/epidemiology , Genetic Predisposition to Disease/genetics , Humans , Male , Mexico/epidemiology , Odds Ratio , Psychiatric Status Rating Scales/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Risk Factors , Severity of Illness Index , Time , United States/epidemiologyABSTRACT
Sixteen ADHD children and a control group were asked to reproduce the varying time duration of successively presented visual stimuli. Time estimation was poorer in ADHD children, who showed more impulsive errors. ERPs exhibited similar grand-mean waveforms for both groups during the estimating period, but they were significantly different during the reproducing stage, when an early positive wave over frontal regions characterized the control group, interpreted as memory-guided motor output, followed by a slow negativity probably reflecting an inhibitory motor closure process, both probably involving central executive networks that seem to be improperly activated in ADHD children.
