Úlcera de Mooren: 30 años de seguimiento / Mooren's ulcer: 30 years of follow-up

CASO CLÍNICO: Mujer de 33 años de raza blanca que consultó por sensación de cuerpo extraño, epífora y dolor intenso, de un mes de evolución, en ambos ojos (AO). El examen biomicroscópico objetivó una úlcera corneal periférica bilateral. Precisó tratamiento con inmunomoduladores y fue intervenida en el ojo izquierdo de queratoplastia en corona semi-circular, queratoplastia penetrante, conjuntivo-córneo-escleroplastia, recubrimiento de mucosa bucal, osteo-queratoprótesis tibial y, finalmente, de desprendimiento de retina. DISCUSIÓN: La úlcera de Mooren es una afección corneal inmunológica que requiere tratamiento inmunomodulador, reservándose el quirúrgico ante el riesgo inminente de perforación, cuando esta ha ocurrido, o en los casos de necrosis aguda

CASE REPORT: A 33-year-old Caucasian female presented with epiphora, ocular pain, and foreign body sensation in both eyes for one month. Examination revealed bilateral peripheral corneal ulcers. The patient had been treated with immunomodulators, and she was treated in the left eye with peripheral semi-circular keratoplasty, penetrating keratoplasty, conjunctival-corneal-scleroplasty, buccal mucosal graft, tibial osteo-keratoprosthesis and finally, retinal detachment. DISCUSSION: Mooren's ulcer is an immunological corneal disease. This lesion must be treated initially with immunomodulators. Surgical treatment should be considered when a risk of corneal perforation is present, when the perforation appears, or under acute necrosis

Mooren's ulcer: 30 years of follow-up. / Úlcera de Mooren: 30 años de seguimiento.

CASE REPORT: A 33-year-old Caucasian female presented with epiphora, ocular pain, and foreign body sensation in both eyes for one month. Examination revealed bilateral peripheral corneal ulcers. The patient had been treated with immunomodulators, and she was treated in the left eye with peripheral semi-circular keratoplasty, penetrating keratoplasty, conjunctival-corneal-scleroplasty, buccal mucosal graft, tibial osteo-keratoprosthesis and finally, retinal detachment. DISCUSSION: Mooren's ulcer is an immunological corneal disease. This lesion must be treated initially with immunomodulators. Surgical treatment should be considered when a risk of corneal perforation is present, when the perforation appears, or under acute necrosis.

Evaluation of a hybrid vertical membrane bioreactor (HVMBR) for wastewater treatment.

A new hybrid membrane bioreactor (HMBR) has been developed to obtain a compact module, with a small footprint and low requirement for aeration. The aim of this research was to assess its performance. The system consists of a single vertical reactor with a filtration membrane unit and, above this, a sponge fixed bed as support medium. The aeration system is located under the membrane unit, allowing for membrane cleaning, oxygenation, biofilm thickness control and bulk liquid mixing. Operated under continuous aeration, a bench-scale reactor (70 L) was fed with pre-treated, raw (unsettled) municipal wastewater. BOD(5) and suspended solids removal efficiencies (96 and 99% respectively) were comparable to those obtained with other membrane bioreactors (MBRs). Total nitrogen removal efficiencies of 80% were achieved, which is better than those obtained in other HMBRs and similar to the values reached using more complex MBRs with extra anoxic tanks, intermittent aeration or internal deflectors.

Distribution of the concentration of heavy metals associated with the sediment particles accumulated on road surfaces.

The heavy metal pollution caused by road run-off water constitutes a problem in urban areas. The metallic load associated with road sediment must be determined in order to study its impact in drainage systems and receiving waters, and to perfect the design of prevention systems. This paper presents data regarding the sediment collected on road surfaces in the city of Torrelavega (northern Spain) during a period of 65 days (132 samples). Two sample types were collected: vacuum-dried samples and those swept up following vacuuming. The sediment loading (g m(-2)), particle size distribution (63-2800 microm) and heavy metal concentrations were determined. The data showed that the concentration of heavy metals tends to increase with the reduction in the particle diameter (exponential tendency). The concentrations ofPb, Zn, Cu, Cr, Ni, Cd, Fe, Mn and Co in the size fraction <63 microm were 350, 630, 124, 57, 56, 38, 3231, 374 and 51 mg kg(-1), respectively (average traffic density: 3800 vehicles day(-1)). By increasing the residence time of the sediment, the concentration increases, whereas the ratio of the concentration between the different size fractions decreases. The concentration across the road diminishes when the distance between the roadway and the sampling siteincreases; when the distance increases, the ratio between size fractions for heavy metal concentrations increases. Finally, the main sources of heavy metals are the particles detached by braking (brake pads) and tyre wear (rubber), and are associated with particle sizes <125 microm.

Particle size distribution of accumulated sediments on an urban road in rainy weather.

The study of the behavior of deposited sediments on an urban surface serves to determine its characteristics of build-up, in dry periods, and of wash-off, during a rain event. Thus, these can be used later to indicate the presence of pollutants in an area. This paper presents data regarding the sediment collected on a road surface in the city of Torrelavega in northern Spain during a period of 65 days during which 132 samples were collected. The rainfall during the sampling period corresponded to 29% of the total rainfall registered in the same year. Two types of sediment collection samples were obtained: vacuumed dry samples (free load) and those swept up following vacuuming (fixed load). For each type of collected sample, the sediment loading, particle size distribution in seven fractions and moisture were determined. The data showed that the sediment loading (g m(-2)) and vacuumed availability of the load that was more strongly adhered to the surface, "fixed load", increases with the number of dry days. The particle size distribution of the collected sediment tended to be finer with the increase in number of dry days. Particle sizes less than 125 microm presented the greater rate of accumulation in dry weather and those less than 500 microm, the greater susceptibility to being washed off during a storm event.

[Severe hypophosphataemia after starting parenteral nutrition in a patient with an intestinal fistula]. / Hipofosfatemia grave tras el inicio de nutrición parenteral en una paciente con fístula intestinal.

Hypophosphataemia is a complication that may appear in undernourished patients who are given nutrition by either enteral or parenteral means. It is associated with several clinical manifestations, including cardiological, neurological and haematological conditions of note, and may potentially be even life-threatening. It is therefore mandatory to ensure prevention and follow-up in those patients at risk of suffering this condition, taking into account the considerable morbidity and mortality associated with it.

Adenoma ovárico de células de Leydig: una rara causa devirilización asociada a factores de riesgo cardiovascular / Leydig cell ovarian adenoma: a rare cause of virilization associated with cardiovascular risk factors

La masculinización de la mujer adulta ovirilismo es un trastorno endocrino infrecuente debido a un exceso de secreción androgénica causado por tumores adrenales u ováricos 1. Dentro de estos últimos, los más comunes son los de células de Sertoli-Leydig (androblastomas), si bien otros tipos patológicos, como los tumores de la granulosa-teca, de células hiliares, de células lipoideas y de restos adrenales, también pueden generar el cuadro1. Presentamos un caso clínico de virilización debido a un adenoma de células de Leydig, un tumor ovárico raro que sólo representa un 0,1% de los tumores ováricos. Describimos su asociación con factores de riesgo cardiovascular y el efecto de la corrección permanente del hiperandrogenismo sobre los mismos (AU)

Detention storage volume for combined sewer overflow into a river.

This article discusses the storage volume needed in a combined sewer system tank in order to preserve the water quality. There are a lot of design criteria which do not take into account the conditions of the receiving water, and as a result are inappropriate. A model was used to simulate the performance of a theoretical combined sewer system where a tank was located downstream. Results were obtained from the overflows produced by the rain recorded in Santander (Spain) for 11 years, with several combinations of storage volume and treatment capacity in the wastewater treatment plant. Quality criteria were also proposed for faecal coliforms, BOD, and total nitrogen to evaluate the effects from the overflows in the river water quality. Equations have been obtained which relate the number of overflows, the storage volume and the treatment plant capacity. The bacteriological pollution, quantified by means of faecal coliforms, was the analytical parameter which produced the most adverse effects in the river, so that more storage volume is needed (45 to 180 m3 ha(-1) net) than with other simulated pollutants (5 to 50 m3 ha(-1) net for BOD, and less than 4 m3 ha(-1) net for the total nitrogen). The increase in the treatment plant's capacity, from two to three times the flow in dry weather, reduces the impact on the river water in a more effective way, allowing a reduction of up to 65% in the number of overflows rather than increasing the storage volume.

Hemorrhage complicating YAG laser feeder vessel coagulation of cornea vascularization.

A neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used in the thermal mode to coagulate blood vessels in a patient with a vascularized corneal leukoma in an attempt to reduce neovascularization before penetrating keratoplasty. Occlusion of the feeder artery at the periphery was followed by a large stromal hemorrhage. A successful keratoplasty was performed 2 days later.