Non-arteritic anterior ischemic optic neuropathy as the only manifestation of a malignant hypertensive crisis: Report of a case.

Non-arteritic anterior ischemic optic neuropathy (NAION) is after glaucoma the most common optic neuropathy in patients over 50 years. It is known that high blood pressure (HBP) is an important risk factor for the development of NAION. It is also known that malignant arterial hypertension (MAH) could be accompanied by optic disc edema. However, MAH has not classically been considered a cause of NAION. We report the case of a 32-year-old patient who presented irreversible visual loss with a pattern compatible with NAION as the only manifestation of a hypertensive crisis.

Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinomatosis.

BACKGROUND AND OBJECTIVES: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective but complex treatment for peritoneal metastasis (PM). Our objective was to identify risk factors for postoperative morbidity and mortality following CRS-HIPEC. METHODS: Retrospective study of prospectively collected data of patients undergoing CRS-HIPEC for PM arises from colorectal cancer between January 2008 and December 2017. Perioperative variables were correlated with morbidity outcomes using a logistic regression model. RESULTS: Sixty-seven patients underwent CRS-HIPEC, and overall morbidity and mortality were 31.3% and 4.5% respectively. Major morbidity rate was 19.4%; 7.5% of patients were re-operated. Intraoperative blood transfusion (p = 0.01), liver resection (p < 0.01), and intestinal anastomosis (p < 0.01) were associated with a higher morbidity in univariate analysis. A multivariate analysis identified blood transfusion and liver resection as independent risk factors (OR 3.66, IC 1.13-16.54; OR 4.33, IC 1.17-11.46, respectively). Extension of visceral resection did not correlate with morbidity. Patients with lymph-node infiltration had a higher major complication rate (p = 0.01). CONCLUSIONS: CRS-HIPEC is a feasible treatment for colorectal PM with an acceptable morbi-mortality rate in experienced centers. In our study, digestive anastomosis, perioperative blood transfusion, hepatic resection, and lymph-node infiltration were associated with higher morbidity rates.

Vesicular transport and secretion of penicillin G in Penicillium rubens P2-32-T.

The compartmentalization of penicillin G biosynthesis in Penicillium rubens has been extensively studied. However, how this compound is secreted has not been completely elucidated, although its transport could be of the vesicular type. This work was aimed at observing vesicles and penicillin secretion and proposing a hypothetical model for their compartmentalization and secretion. For this purpose, a high-penicillin-producing strain (P. rubens P2-32-T) was compared by transmission electron microscopy (TEM) and atomic force microscopy (AFM) with a null-producing strain (P. rubens npe10) in 24- and 48-h cultures. The results showed multivesicular bodies and secretory vesicles, suggesting that P. rubens transports and secretes penicillin G through vesicular excretion.

Pharmacokinetic variations of nimesulide in mongrel dogs according to age.

The purpose of this research was to investigate the possible variations to the pharmacokinetics of nimesulide by the effect of age using an animal model. An experimental, analytical, prospective and longitudinal study in five dogs, from birth to 730 days of age was carried out. Nimesulide blood levels were measured in different months; concentrations were determined by HPLC-UV. Pharmacokinetic parameters were calculated by using the WinNonlin software. There were statistically significant differences (p <0.05) in most of the pharmacokinetic parameters between study of 6 months against the other three studies in different ages. Changes in the pharmacokinetic parameters of nimesulide as a result of age, are determined by the growing and maturation of the animals. Resulting data suggest that nimesulide can be used safely as a long-term analgesic in dogs, but, the dosing regimens in humans should be different when administered at early age.

Goal-directed therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective observational study.

BACKGROUND: Cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in peritoneal carcinomatosis treatment causes significant hemodynamic, metabolic, and hematological alterations. Studies on the anesthetic intraoperative management are heterogeneous and scarce. There is a great heterogeneity in the anesthetic management of CRS and HIPEC. The aim of this study is to analyze perioperative hemodynamic goal-directed management and to evaluate the complications arisen until the seventh postoperative day. METHODS: Prospective, observational study of all CRS and HIPEC patients from March 2014 to May 2017. Hemodynamic and clinical parameters were registered during surgery and the first 3 postoperative days. We correlated intraoperative data with the postoperative course until the seventh day. RESULTS: A total of 92 patients were included in the study (age 58.5 ± 10.9 years, 47% colorectal carcinoma, and 38% ovarian carcinoma). Peritoneal Carcinomatosis Index (PCI) (median and ranges) was 10 [0-39]. Cardiac Index (CI) 3.15 l/min-1/m-2 [1.79-5.60]) and Systolic Volume Variation (SVV) (10% [3%-17%]) remained within the values of normality in all surgery phases. A large difference was observed between the minimum and maximum ranges of fluid therapy administered (median 9.8 ml/kg/h [5.3-24.3]), showing a great interindividual variation in the fluids requirement. A direct relationship was observed between PCI and surgery duration, fluid therapy, and intraoperative transfusion percentage (p < 0.02). CONCLUSIONS: There is a great variability in the intraoperative fluid therapy needs of the patients. SVV monitoring makes it possible to adjust the fluid therapy needs in each surgery phase. The use of a hemodynamic goal-directed anesthetic protocol in CRS and HIPEC enables to individually adjust the fluid therapy, avoiding over-hydration and ensuring hemodynamic stability in all surgery phases.

Discrepancy between bone density and bone material strength index in three siblings with Camurati-Engelmann disease.

Camurati-Engelmann (CE) is a very rare disease affecting one in every million persons worldwide. It is characterized by an enlargement of long bones. We aimed to assess bone characteristics in three siblings with different tools. Even if there was an excess of bone density, quality seemed to be deteriorated. INTRODUCTION: CE disease is a rare monogenic disorder affecting approximately one in every million persons worldwide. It is mainly characterized by a progressive hyperostosis of the periosteum and endosteum of the diaphysis of long bones. Limited data are available about bone characteristics in these patients. In three siblings with CE disease, we aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) and material characteristics at tissue level using bone impact reference point indentation. METHODS: Clinical data were collected and a general laboratory workup was performed. At the lumbar spine and hip, BMD and TBS were measured using DXA imaging. Bone material strength index (BMSi) was measured by bone impact microindentation using an Osteoprobe instrument. RESULTS: All three cases had densitometric values consistent with high bone mass (sum of Z-score at the lumbar spine and hip > 4). Hip BMD was extremely high in all three siblings at both total hip and femoral neck, while at the lumbar spine, two of them had normal values but the third again had very high BMD. TBS values were in the normal range. In contrast, BMSi measurements were at low or very low levels, compared with normal controls. CONCLUSION: Despite strikingly increased BMD and normal microarchitecture, BMSi is affected in patients with CE. Microindentation could be an appropriate tool for assessing bone fragility in these patients. Bone disease in this group of patients requires further study to better understand the underlying regulatory mechanisms and their alterations.

Cambios precoces en la tomografía de coherencia óptica en un niño con maculopatía inducida por puntero láser / Early changes in optic coherence tomography in a child with laser pointer maculopathy

CASO CLÍNICO: Niño de 9 años de edad, que refiere pérdida visual en su ojo derecho, después de jugar con un puntero láser. En la primera exploración (12 h después) la agudeza visual (AV) era 0,15, la fóvea presentaba una lesión hipopigmentada, y la tomografía de coherencia óptica (OCT) demuestra la presencia de bandas hiperreflectivas verticales. Al cabo de 6 meses, la AV había mejorado a 0,5 y se aprecia en la OCT un área bien definida de interrupción de la retina externa. Discusión: Un inadecuado uso de los punteros láser, puede producir pérdida visual severa e irreversible

CASE REPORT: A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12 hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well defined area of outer retinal layer disruption. Discussion: An inadequate use of laser pointers can induce severe and permanent visual loss

Early changes in optic coherence tomography in a child with laser pointer maculopathy. / Cambios precoces en la tomografía de coherencia óptica en un niño con maculopatía inducida por puntero láser.

CASE REPORT: A 9-year-old boy referred due to visual loss in his right eye after playing with a laser pointer. In the first visit (12hours later) visual acuity (VA) was 0.15. A hypopigmented lesion was present in the fovea, and optic coherence tomography (OCT) showed vertical hyper-reflective bands. In the last visit (6 months later), VA had improved to 0.5, and OCT showed a well-defined area of outer retinal layer disruption. DISCUSSION: An inadequate use of laser pointers can induce severe and permanent visual loss.

LASIK y ablación de superficie en pacientes tratados con amiodarona / LASIK and surface ablation in patients treated with amiodarone

OBJETIVO: Determinar los resultados anatómicos y funcionales de los pacientes intervenidos con cirugía refractiva corneal que estaban en tratamiento con amiodarona, la cual ha sido considerada como una posible contraindicación en estas intervenciones. MATERIAL Y MÉTODOS: Se ha realizado un estudio observacional retrospectivo. Los pacientes se incluyeron consecutivamente. Se incluyó a todos los pacientes que tomaban amiodarona y fueron operados mediante LASIK o ablación de superficie entre enero de 2003 y diciembre de 2014. Se pretenden describir los resultados funcionales (visuales y refractivos). RESULTADOS: Se incluyó a un total de 20 pacientes (33 ojos). No se encontraron complicaciones intraoperatorias o postoperatorias significativas. CONCLUSIONES: En nuestra experiencia los pacientes tratados con amiodarona e intervenidos mediante LASIK o ablación de superficie no presentaron complicaciones clínicas significativas. La contraindicación absoluta por tomar determinadas medicaciones sistémicas debería ser reconsiderada

OBJECTIVE: To determine the anatomical and functional outcomes of corneal refractive surgery in patients on amiodarone, a drug listed as being contraindicated in patients undergoing this procedure. MATERIAL AND METHODS: A retrospective observational study was conducted on all consecutive patients who took amiodarone and who underwent LASIK or surface ablation from January 2003 to December 2014. Functional (visual and refractive) outcomes are described. RESULTS: A total of 20 patients (33 eyes) were included. No significant intraoperative or postoperative complications were found. CONCLUSIONS: In our experience, LASIK and surface ablation did not produce significant clinical complications in selected patients taking amiodarone. The absolute exclusion of certain systemic medications should be reconsidered

LASIK and surface ablation in patients treated with amiodarone. / LASIK y ablación de superficie en pacientes tratados con amiodarona.

OBJECTIVE: To determine the anatomical and functional outcomes of corneal refractive surgery in patients on amiodarone, a drug listed as being contraindicated in patients undergoing this procedure. MATERIAL AND METHODS: A retrospective observational study was conducted on all consecutive patients who took amiodarone and who underwent LASIK or surface ablation from January 2003 to December 2014. Functional (visual and refractive) outcomes are described. RESULTS: A total of 20 patients (33 eyes) were included. No significant intraoperative or postoperative complications were found. CONCLUSIONS: In our experience, LASIK and surface ablation did not produce significant clinical complications in selected patients taking amiodarone. The absolute exclusion of certain systemic medications should be reconsidered.

Myo1g is an active player in maintaining cell stiffness in B-lymphocytes.

B-lymphocytes are migrating cells that specialize in antigen presentation, antibody secretion, and endocytosis; these processes implicate the modulation of plasma membrane elasticity. Cell stiffness is a force generated by the interaction between the actin-cytoskeleton and the plasma membrane, which requires the participation of several proteins. These proteins include class I myosins, which are now considered to play a role in controlling membrane-cytoskeleton interactions. In this study, we identified the motor protein Myosin 1g (Myo1g) as a mediator of this phenomenon. The absence of Myo1g decreased the cell stiffness, affecting cell adhesion, cell spreading, phagocytosis, and endocytosis in B-lymphocytes. The results described here reveal a novel molecular mechanism by which Myo1g mediates and regulates cell stiffness in B-lymphocytes. © 2016 Wiley Periodicals, Inc.

Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo / Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study

OBJETIVO: Determinar la incidencia y los factores de riesgo implicados en el desarrollo de las tres principales complicaciones capsulares postoperatorias: opacificación de cápsula posterior (OCP), síndrome de distensión capsular (SDC) y fimosis de la cápsula anterior (FCA). Sujetos, material y métodos: Estudio de cohortes retrospectivo. Se incluyó a 801 pacientes operados mediante cirugía de catarata en el Servicio de Oftalmología del Hospital del Henares (Madrid), entre el 2 de marzo de 2009 y el 28 de febrero de 2010. La historia clínica electrónica fue revisada durante el mes de julio de 2012. La OCP se estudió utilizando el método de Kaplan-Meier (log rank test). RESULTADOS: Un total de 167 pacientes desarrollaron OCP. No se pudo demostrar asociación entre la OCP y edad, sexo, diabetes mellitus, técnica de facoemulsificación, modelo de lente intraocular (LIO), consumo de tamsulosina, grado de síndrome de iris flácido intraoperatorio, glaucoma ni la degeneración macular asociada a la edad. Tres pacientes desarrollaron SDC, todos ellos habían recibido una LIO Akreos Adapt AO® (Bausch & Lomb). Dos de ellos eran varones jóvenes, con diagnóstico de catarata subcapular posterior. Tres pacientes desarrollaron FCA, dos de ellos habían recibido una LIO MicroSlim® (PhysIOL). CONCLUSIONES: No pudo demostrarse asociación de la OCP con ninguna de las variables estudiadas. El sexo masculino, la edad joven, la catarata subcapsular posterior y las LIO grandes no anguladas como la Akreos Adapt AO®podrían asociarse al desarrollo de SDC. Las LIO de microincisión, como la MicroSlim®, podrían asociarse al desarrollo de FCA

OBJECTIVE: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). Subjects, material and methods: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). RESULTS: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO® (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim® IOL (PhysIOL). CONCLUSIONS: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO® could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim®) are implanted

[Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study]. / Opacificación de la cápsula posterior, síndrome de distensión capsular y síndrome de fimosis de la cápsula anterior: estudio de cohortes retrospectivo.

OBJECTIVE: To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP). SUBJECTS, MATERIAL AND METHODS: A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test). RESULTS: A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO(®) (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim(®) IOL (PhysIOL). CONCLUSIONS: No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO(®) could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim(®)) are implanted.

Central hydrogen sulphide mediates ventilatory responses to hypercapnia in adult conscious rats.

AIM: Hydrogen sulphide (H2S) is endogenously produced and plays an important role as a modulator of neuronal functions; however, its modulatory role in the central CO2 chemoreception is unknown. The aim of the present study was to assess the role of endogenously produced H2S in the ventilatory response to hypercapnia in adult conscious rats. METHODS: Cystathionine ß-synthase (CBS) and cystathionine γ-lyase (CSE) inhibitors (aminooxyacetate: AOA and propargylglycine: PAG respectively) and a H2S donor (sodium sulphide: Na2S) were microinjected into the fourth ventricle (4V). Ventilation (V̇(E)), oxygen consumption (V̇O2) and body temperature were recorded before (room air) and during a 30-min CO2 exposure (hypercapnia, 7% CO2). Endogenous H2S levels were measured in the nucleus tractus solitarius (NTS). RESULTS: Microinjection of Na2S (H2S donor), AOA (CBS inhibitor) or PAG (CSE inhibitor) did not affect baseline of the measured variables compared to control group (vehicle). In all experimental groups, hypercapnia elicited an increase in V̇(E). However, AOA microinjection, but not PAG, attenuated the ventilatory response to hypercapnia (P < 0.05), whereas Na2S elicited a slight, not significant, enhancement. Moreover, endogenous H2S levels were found higher in the NTS after hypercapnia (P < 0.05) compared to room air (normoxia) condition. CONCLUSION: There are a few reports on the role of gaseous transmitters in the control of breathing. Importantly, the present data suggest that endogenous H2S via the CBS-H2S pathway mediates the ventilatory response to hypercapnia playing an excitatory role.