Masquerade syndrome in ocular surface squamous neoplasia / Síndrome mascarada em neoplasia escamosa da superfície ocular

ABSTRACT The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

RESUMO O objetivo é alertar a comunidade oftalmológica sobre uma manifestação atípica de neoplasia escamosa da superfície ocular (OSSN) que pode levar a um atraso no diagnóstico e tratamento, evoluindo com prognóstico reservado e significativas sequelas. Homem, imunocompetente, 61 anos com diagnóstico inicial de esclerite necrosante em olho direito há 3 meses, em tratamento com prednisona sistêmica porém com persistência da dor e baixa acuidade visual. Realizado biópsia conjuntival em região acometida e diagnosticado como neoplasia escamosa da superfície ocular invasiva. Evolui com invasão intraocular e orbital sendo submetido a exenteração. Assim sendo, deve-se suspeitar de síndrome mascarada frente a um paciente com lesões nódulo-ulcerativas da conjuntiva e esclera. Essa forma clínica pode ser mais agressiva, com maior chance de comprometimento intraocular e orbital. Quanto mais precoces o diagnóstico e o tratamento, melhor o prognóstico para o paciente.

Masquerade syndrome in ocular surface squamous neoplasia.

The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

Ocular Sporotrichosis.

PURPOSE: To present 10 cases of Parinaud oculoglandular syndrome caused by sporotrichosis. OBSERVATIONS: We report 10 cases of Parinaud oculoglandular syndrome after contact with domestic cats diagnosed with sporotrichosis. They all showed ocular hyperemia associated with unilateral tarsal conjunctival granulomas. After histopathological study and culture of the scrapings and conjunctival secretions, six patients were positive for Sporothrix schenkii and four had a presumed diagnosis of Parinaud oculoglandular syndrome due to sporotrichosis. Treatment with 200 mg/day of oral itraconazole was started, and all patients had a favorable therapeutic response. CONCLUSION AND IMPORTANCE: These case reports are essential for characterizing a rare etiology of Parinaud oculoglandular syndrome.

Nodular scleritis and granulomatous polyangiitis (Wegener) mimicking tuberculosis / Esclerite nodular e poliangiite granulomatosa (Wegener) mimetizando tuberculose

Granulomatous polyangiitis is a systemic disease that may affect any organ, with a predilection for the upper respiratory tract, lungs and kidneys. This article aims to report a case of a patient with atypical nodular scleritis as the initial manifestation of granulomatous polyangiitis (Wegener), mimicking a case of tuberculosis. The patient presented ocular hyperemia and lower progressive visual acuity for 1.5 years, followed by eye pain for two months. The patient had subpleural nodules with soft tissue density, increased pulmonary lymph nodes and discrete bilateral pleural thickening, with negative alcohol-resistant acid bacilli (BAAR). The histological diagnosis revealed a granulomatous vasculitis suggestive of non-infectious vasculitis (granulomatous polyangiitis). Cyclophosphamide pulse therapy was initiated.

Poliangiite granulomatosa é uma doença sistêmica que afeta qualquer órgão, com predileção pelo trato respiratório superior, pulmões e rins. Este artigo tem como objetivo relatar um caso atípico de uma paciente com esclerite nodular como manifestação inicial da poliangiite granulomatosa (Wegener), mimetizando um quadro de tuberculose. A paciente apresentou hiperemia ocular e baixa acuidade visual progressiva por 1,5 anos, seguido por dor ocular por dois meses. A paciente possuía nódulos subpleurais com densidade de partes moles, linfonodomegalia em janela aorto-pulmonar e espessamento pleural bilateral discreto, negativo para bacilos álcool-ácido resistentes (BAAR). O diagnóstico histológico revelou uma vasculite granulomatosa sugestiva de vasculite não infecciosa (poliangiite granulomatosa). Foi iniciada pulsoterapia com ciclofosfamida.

Patellofemoral instability: evaluation by magnetic resonance imaging / Instabilidade femoropatelar: avaliação por ressonância magnética

OBJECTIVE: To determine the contribution of magnetic resonance imaging (MRI) in evaluating patelofemoral instability. METHODS: 39 patients (45 knees) with patellar instability underwent knee magnetic resonance images between October 2009 and July 2011, at the Rede Lab's D'Or, in the city of Rio de Janeiro, State of Rio de Janeiro, were included. MRI were analyzed for the presence of bone, hyaline cartilage and soft-tissue abnormalities, as well as anatomic variants that may contribute to chronic patellar instability. RESULTS: The authors found, of the 45 knees analysed, bone changes in 44%, cartilaginous injuries in 64%, disruption of the medial patellofemoral ligament (MPFL) in 29% and joint morphology abnormalities in 73% patients. Meniscal tears were also identified in 2 (4%) patients and fibular fracture in one (2%) patient. CONCLUSION: MRI allowed the detection of predisposing factors that may contribute to the development of patellofemoral instability and the diagnosis of bone, hyaline cartilage, ligamentous and meniscal abnormalities. .

OBJETIVO: Determinar a contribuição da ressonância magnética (RM) na avaliação da instabilidade femoropatelar. MÉTODOS: Foram incluídos 39 pacientes (45 joelhos) com instabilidade femoropatelar, submetidos à RM do joelho entre outubro de 2009 e julho de 2011, na Rede Labs D'Or, Rio de Janeiro (RJ). Os resultados dos exames foram analisados quanto à presença de alterações ósseas, cartilaginosas e nas partes moles, além de alterações anatômicas que podem contribuir para a instabilidade patelar crônica. RESULTADOS: Os autores encontraram, nos 45 joelhos examinados, alterações ósseas em 44%, lesões da cartilagem em 64%, ruptura do ligamento patelofemoral medial (LPFM) em 29% e anormalidades da morfologia articular em 73% pacientes. Foram também identificadas lesões meniscais em dois (4%) pacientes e fratura da fíbula em um (2%) paciente. CONCLUSÃO: A RM permitiu a detecção de fatores predisponentes à instabilidade e o diagnóstico de lesões ósseas, cartilaginosas, meniscais e ligamentares. .

Patellofemoral Instability: Evaluation by Magnetic Resonance Imaging.

OBJECTIVE: To determine the contribution of magnetic resonance imaging (MRI) in evaluating patelofemoral instability. METHODS: 39 patients (45 knees) with patellar instability underwent knee magnetic resonance images between October 2009 and July 2011, at the Rede Lab's D'Or, in the city of Rio de Janeiro, State of Rio de Janeiro, were included. MRI were analyzed for the presence of bone, hyaline cartilage and soft-tissue abnormalities, as well as anatomic variants that may contribute to chronic patellar instability. RESULTS: The authors found, of the 45 knees analysed, bone changes in 44%, cartilaginous injuries in 64%, disruption of the medial patellofemoral ligament (MPFL) in 29% and joint morphology abnormalities in 73% patients. Meniscal tears were also identified in 2 (4%) patients and fibular fracture in one (2%) patient. CONCLUSION: MRI allowed the detection of predisposing factors that may contribute to the development of patellofemoral instability and the diagnosis of bone, hyaline cartilage, ligamentous and meniscal abnormalities.

Avaliação histopatológica dos efeitos colaterais do uso intraestromal de biguanida em córnea de coelhos / Histopathological assessment of side effects of the use of corneal intrastromal biguanide in rabbits

OBJETIVO: Observar os efeitos da injeção intraestromal de biguanida a 0,02%, 0,1% e 0,5% em córnea de coelhos. MÉTODOS: Experimento prospectivo duplo cego. Foram utilizados 8 coelhos, identificados aleatoreamente e divididos em 4 grupos de 2 coelhos cada, ocorrendo a administração intraestromal de 0,2ml do fármaco na córnea do olho direito. O primeiro grupo recebeu biguanida na concentração de 0,02%, o segundo grupo a 0,1%, o terceiro a 0,5% e o quarto grupo (controle) recebeu a injeção de placebo - Soro Fisiológico 0,9%. Um dos coelhos de cada grupo foi sacrificado no terceiro dia e o outro no décimo dia após a injeção da droga e tiveram os olhos direitos enucleados e submetidos a exame histopatológico. RESULTADOS: Os coelhos que receberam placebo e biguanida a 0,02% apresentaram tanto no terceiro quanto no décimo dia da aplicação, reação inflamatória muito discreta. O coelho sacrificado no terceiro dia após a injeção da droga a 0,1% apresentou infiltrado inflamatório discreto com neutrófilos e eosinófilos, porém no décimo dia houve necrose estromal, vascularização e infiltrado intenso. O terceiro grupo apresentou necrose estromal, infiltrado moderado de leucócitos e atrofia endotelial com leucócitos na câmara anterior ao terceiro dia, evoluindo com necrose estromal extensa, infiltrado moderado e atrofia endotelial e epitelial no décimo dia. CONCLUSÃO: A biguanida quando utilizada via estromal nas concentrações de 0,1% e 0,5% pode causar efeitos indesejáveis na córnea de coelho, o que nos desperta para a necessidade de estudos posteriores com amostra maior para a confirmação dos achados.

PURPOSE: Observe the effects of corneal intrastromal injection of biguanide at 0.02%, 0.1% and 0.5% in rabbits' eyes. METHODS: Doble blind prospective study. 8 rabbits were used, randomly identified and divided into 4 groups, with 2 rabbits each, with the administration of 0.2 ml of the drug via intrastromal, in the right eye. The first group received biguanide at a concentration of 0.02%, the second one at 0.1%, the third at 0.5% and the fourth group (control) was given a placebo injection - saline solution at 0.9%. One rabbit from each group was sacrificed on the third day and the remaining rabbits on the tenth day after the drug injection and had its right eyes enucleated and submitted to histopathological analysis. RESULTS: The rabbits that received placebo and biguanide at 0.02% presented, both on the third and the tenth day of the application, mild inflammation response. The rabbit sacrificed on the third day after the drug injection at 0.1% presented mild inflammatory infiltrate with neutrophils and eosinophils, although on the tenth day there was stromal necrosis, vascularization and intense infiltrate. The third group presented stromal necrosis, moderate infiltrate of leukocytes and endothelial atrophy with leukocytes in the anterior chamber on the third day, developing extensive stromal necrosis, moderate infiltrate and endothelial and epithelial atrophy on the t enth day. CONCLUSION: Biguanide when used at concentrations of 0.1% and 0.5% may cause adverse reactions in the rabbit's cornea, which arouses the necessity of further studies with a larger sample to confirm the findings.

RADIOGRAPHIC ASSESSMENT OF THE OPENING WEDGE PROXIMAL TIBIAL OSTEOTOMY.

OBJECTIVE: To radiographically evaluate individuals who underwent opening wedge proximal tibial osteotomy, with the aim of analyzing the proximal tibial slope in the frontal and sagittal planes, and the patellar height. METHOD: The study included 22 individuals who were operated at the National Traumatology and Orthopedics Institute (INTO) for correction of varus angular tibial deviation using the opening wedge osteotomy (OWO) technique with the Orthofix monolateral external fixator. Patients with OWO whose treatment was completed between January 2000 and December 2006 were analyzed. The measurement technique consisted of using anteroposterior radiographs with loading and lateral views with the operated knees flexed at 30°. RESULTS: There were no statistically significant differences between the pre and postoperative tibial slope and patellar height values in the patients evaluated. CONCLUSION: Opening wedge proximal tibial osteotomy is a technique that avoids the problems presented by high proximal tibial osteotomy, since it is done without causing changes to the extensor mechanism, ligament imbalance or distortions in the proximal tibia.

Avaliação radiográfica da osteotomia proximal de abertura gradual da tíbia / Radiographic assessment of the opening wedge proximal tibial osteotomy

OBJETIVO: Avaliar radiograficamente indivíduos submetidos à osteotomia de abertura gradual da tíbia proximal com o objetivo de analisar a inclinação tibial proximal no plano frontal e no plano sagital e a altura patelar. MÉTODO: Foram incluídos no estudo 22 indivíduos operados no Instituto Nacional de Traumatologia e Ortopedia (INTO) para correção do desvio angular em varo da tíbia pela técnica de osteotomia de abertura gradual (OAG) com fixador externo monolateral da Orthofix. Foram analisados pacientes submetidos à OAG com término de tratamento entre janeiro de 2000 e dezembro de 2006. A técnica utilizada para a mensuração dos valores foi obtida através de radiografias em AP com carga e perfil com flexão a 30º dos joelhos operados. RESULTADOS: Não houve diferenças entre os valores dos índices de altura patelar e inclinação tibial pré-operatórios e pós-operatórios de significância estatística nos pacientes avaliados. CONCLUSÃO: A osteotomia tibial de abertura gradual representa uma técnica que evita os problemas apresentados pela osteotomia tibial proximal alta, pois ela é realizada sem promover alterações do mecanismo extensor, desequilíbrio ligamentar ou distorções na tíbia proximal.

OBJETIVO: To radiographically evaluate patients who underwent opening wedge proximal tibial osteotomy in order to analyze the proximal tibial slope in the frontal plane, sagittal plane, and patellar height. METHOD: The study included 22 patients operated on at the Instituto Nacional de Traumatologia e Ortopedia (INTO) for the correction of varus angular tibial deviation using the opening wedge osteotomy (OWO) technique with the Orthofix monolateral external fixator. We analyzed patients with OWO having completed treatment between January 2000 and December 2006. Values were measured by using X-rays of the anteroposterior profile with load and lateral profile with 30º flexion of the operated knees. RESULTS: No statistically significant differences between the pre- and post-operative indices of tibial slope and patellar height in the patients were found. CONCLUSION: Opening wedge proximal tibial osteotomy is a technique that avoids the problems presented by high tibial osteotomy, as it is done without promoting changes in the extensor mechanism, ligament imbalance or deformities in the proximal tibia.

Ceratoconjuntivite cicatricial bilateral associada a líquen plano: relato de caso / Lichen planus leading to bilateral cicatrizing keratoconjunctivitis: case report

Descrevemos um caso de ceratoconjuntivite cicatricial bilateral em uma paciente portadora de líquen plano e apresentamos revisão da literatura mundial sobre esse assunto. Cicatrização conjuntival, com formação de simbléfaro, olho seco, infiltração corneana, neovascularização e afinamento foram os sinais observados. Diagnóstico foi baseado nos achados clínicos e biópsia, após exclusão das causas típicas de ceratoconjuntivite cicatricial.

To describe a case of bilateral cicatrizing keratoconjunctivitis in a patient with lichen planus and review the literature. Conjunctiva cicatrization with symblepharon formation, dry eye, corneal infiltration and neovascularization and thinning were the most observed prominent signs. Diagnosis was based on clinical findings and biopsy, after exclusion of typical causes of cicatricial keratoconjuntivitis.

[Lichen planus leading to bilateral cicatrizing keratoconjunctivitis: case report]. / Ceratoconjuntivite cicatricial bilateral associada a líquen plano: relato de caso.

To describe a case of bilateral cicatrizing keratoconjunctivitis in a patient with lichen planus and review the literature. Conjunctiva cicatrization with symblepharon formation, dry eye, corneal infiltration and neovascularization and thinning were the most observed prominent signs. Diagnosis was based on clinical findings and biopsy, after exclusion of typical causes of cicatricial keratoconjunctivitis.

Distrofia corneana amorfa posterior: relato de caso / Posterior amorphous corneal dystrophy: case report

O objetivo deste trabalho é alertar o oftalmologista da possibilidade de se deparar com casos raros de distrofias corneanas. Neste caso correlacionamos os achados clínicos da distrofia amorfa posterior com refração, topografia e biomicroscopia ultra-sônica.

The purpose of this paper is to warn the ophthalmologist about the possibility of facing rare cases of corneal dystrophies. Clinical findings of a case of posterior amorphous dystrophy were correlated with refraction, topography, and ultrasound biomicroscopy.

[Posterior amorphous corneal dystrophy: case report]. / Distrofia corneana amorfa posterior: relato de caso.

The purpose of this paper is to warn the ophthalmologist about the possibility of facing rare cases of corneal dystrophies. Clinical findings of a case of posterior amorphous dystrophy were correlated with refraction, topography, and ultrasound biomicroscopy.

[Phototherapeutic keratectomy (PTK) and bullous keratopathy: case report]. / Ceratectomia fototerapêutica (PTK) e ceratopatia bolhosa: relato de caso.

The objective is to evaluate the effects of phototherapeutic keratectomy (PTK) in bullous keratopathy patients. Phototherapeutic keratectomy was performed in a pseudophakic patient with corneal decompensation after lens extraction, with the excimer laser Nidek EC 5000 after manual corneal epithelial debridement. There was no pain after fifteen days the laser application and during the eight months of follow-up. Visual acuity was unchanged. The phototherapeutic keratectomy excimer laser must be considered one more alternative for pain treatment in bullous keratopathy of pseudophakic patients.

Ceratectomia fototerapêutica (PTK) e ceratopatia bolhosa: relato de caso / Phototherapeutic keratectomy (PTK) and bullous keratopathy: case report

O objetivo é avaliar os efeitos da ceratectomia fototerapêutica (PTK) em pacientes com ceratopatia bolhosa. Foi realizada ceratectomia fototerapêutica em paciente pseudofácico com descompensação corneana pós-facectomia, com excimer laser Nidek EC 5000, após debridamento epitelial manual. O paciente apresentou melhora da dor a partir do décimo quinto dia após a aplicação do laser e durante os oito meses de seguimento. Não houve melhora da acuidade visual. A realização de ceratectomia fototerapêutica deve ser considerada uma alternativa a mais no tratamento da dor em ceratopatia bolhosa de pseudofácicos.

[Second opinion in Ophthalmology]. / Segunda opinião em Oftalmologia.

PURPOSE: To evaluate the percentage of ophthalmologic patients who search for a second opinion and to verify the main reason for this search. METHODS: The methodology of the present study consists of a direct interview with 806 ophthalmologic patients, attended at a specialized hospital, through an adequately elaborated questionnaire, containing variables that can be related to the search for this second opinion. RESULTS: It was observed that 32% of the ophthalmologic patients ask for a second opinion and, of these, 31% search for other physicians in order to confirm the diagnosis. CONCLUSION: Most search for the second opinion in Ophthalmology is directly linked to the doctor/patient relationship. Such situation serves to warn the present professional teaching, pointing to the need for dedication, effort and greater investment in learning, regarding both the present and the future professionals. In addition, it is important to emphasize the necessity in improving the working conditions and wages. Maybe, the review of these aspects can contribute to decrease the mentioned problems.

Segunda opinião em Oftalmologia / Second opinion in Ophthalmology

OBJETIVO: Avaliar a porcentagem de pacientes oftalmológicos que buscam uma segunda opinião e verificar o principal motivo dessa busca. MÉTODOS: A metodologia da pesquisa consiste na entrevista direta de 806 pacientes oftalmológicos, atendidos em hospital especializado, por meio de um questionário elaborado, com variáveis que podem estar relacionadas à busca da segunda opinião. RESULTADOS: Observou-se que 32 por cento dos pacientes oftalmológicos solicitam a segunda opinião e destes, 31 por cento procuram outros médicos para confirmar diagnóstico. CONCLUSAO: A busca pela segunda opinião em Oftalmologia está diretamente vinculada, em sua maioria, à questão da relação médico/paciente. Tal situação serve de alerta para o atual ensino profissional, apontando a necessidade de dedicação, empenho e maior investimento no aprendizado, tanto dos atuais como dos futuros profissionais, no que diz respeito a essa questão. Ressalta-se também, a necessidade de melhorar as condições atuais de remuneração e trabalho. Talvez, a revisão desses conceitos possa contribuir para a diminuição desses problemas.

Avaliação dos Mecanismos de Lesão do Ligamento Cruzado Anterior no Futebol / Evaluation of Mechanisms of Anterior Cruciate Ligament Injuries In Soccer

Definir os principais mecanismos de lesão do ligamento cruzado anterior durante a prática do futebol

Análise Epidemiológica das Rupturas do Ligamento Cruzado Anterior em Pacientes Atendidos no Instituto Nacional de Tráumato-Ortopedia / Epidemiology of Anterior Cruciate Ligament Ruptures in Patients Treated at the National Institute of Orthopaedic and Trauma

A lesão do ligamento cruzado anterior permance como assunto de controvérsia no que diz respeito aos seus fatores de risco, história natural e opções de tratamento.Para elaborar estratégias de prevenção e melhoria no atendimento desses pacientes é fundamental a obtenção de informações sobre essa população