Hemorragia coroidea expulsiva espontánea. Caso clínico / Spontaneous expulsive choroidal hemorrhage. Case report

CASO CLÍNICO: Se presenta el caso de una paciente de 85 años de edad, procedente de un centro geriátrico, que acudió a urgencias con un cuadro de hemorragia ocular masiva aparentemente de forma espontánea en ojo izquierdo (OI). No había constancia de antecedentes oftalmológicos en su historial clínico. La paciente refería haber sido operada de catarata en ambos ojos hacía más de 25 años y llevar varios años sin visión por el OI. DISCUSIÓN: La hemorragia coroidea expulsiva espontánea (HCEE) no quirúrgica es una entidad clínica devastadora muy rara. Los factores predisponentes implicados en su desarrollo incluyen: edad avanzada, enfermedades vasculares (arterioesclerosis sobre todo), glaucoma y daño corneal severo

CLINICAL CASE: A case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. DISCUSSION: Non-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage

[Spontaneous expulsive choroidal hemorrhage. Case report]. / Hemorragia coroidea expulsiva espontánea. Caso clínico.

CLINICAL CASE: A case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. DISCUSSION: Non-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage.

Interobserver reliability of store-and-forward teledermatology in a clinical practice setting.

INTRODUCTION AND OBJECTIVES: Although many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study. MATERIAL AND METHODS: Patients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF. RESULTS: In total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied. In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P < .001), diagnostic confidence (P<.001), felt need for conventional consultation (P<.001), and the quality of the clinical record (P=.013). CONCLUSION: The interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.

Pilomatrixomas múltiples / Multiple pilomatricomas

El pilomatrixoma es un tumor benigno, relativamente frecuente, que deriva de las células de la matriz del pelo. En general aparece en la infancia comoun nódulo duro localizado en la cabeza y cuello. Suelen estar cubiertos por una superficie epidérmica normal pero en ocasiones es anetodérmica. Lamayoría de los pilomatrixomas son solitarios y raramente aparecen como lesiones múltiples. La presencia de pilomatrixomas múltiples puede ser esporádica,familiar o asociarse a enfermedades de las cuales solo está bien documentado con la enfermedad de Steinert. Presentamos un nuevo caso depilomatrixomas múltiples esporádicos, siendo uno de ellos anetodérmico y revisamos la literatura (AU)

Pilomatricoma is a relatively common benign neoplasm of hair matrix cells, which typically presents as a firm skin-colored nodule on the head and neckin young people. Sometimes the overlying skin may be anetodermic. While most lesions are solitary, multiple pilomatricomas may be present. Multiplepilomatricoma may be sporadic, familial o associated to myotonic dystrophy. The association of multiple pilomatricomas with myotonic dystrophy iswell documented. We report a case of multiple and sporadic pilomatricomas, being one of them anetodermic and review literature (AU)

Cirugía de cataratas: punto de vista de algunos oftalmólogos / Cataract Surgery: Viewpoints of some Ophthalmologists

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[Congenital Horner's syndrome associated to varicella]. / Síndrome de Horner congénito por varicela.

CASE REPORT: We present a case of congenital Horner's Syndrome in a four year-old boy. The patient was referred from the Dermatology ward after a check up for malformations present from birth on the left upper limb. A significant factor was determined: a varicella related infection in the mother during the 12th week of pregnancy. Blood tests confirmed a diagnosis of congenital varicella syndrome. DISCUSSION: Congenital Horner's Syndrome is a rare entity, caused mainly by traumatic deliveries. Very rarely it is produced by severe lesions, such as neuroblastoma or viral infections as varicella. In our case, condition was associated to ipsilateral malformations of the upper limb, which is typical from congenital varicella syndrome apparently due to radiculopathy produced by the virus.

Síndrome de horner congénito por varicela / Congenital horner's syndrome associated to varicella

Caso clínico: Se presenta el caso de un niño de 4 años de edad con el diagnóstico de síndrome de Horner congénito. Fue remitido por el servicio de Dermatología donde estaba siendo revisado por presentar malformaciones en miembro superior izquierdo desde el nacimiento. Destacaba el antecedente de varicela materna en la 12 semana de gestación. La serología de sangre confirmó el diagnóstico de síndrome de varicela congénita. Discusión: El síndrome de Horner congénito es una entidad muy poco frecuente cuya causa principal es la historia de parto traumático. Muy raramente se produce por lesiones graves, como el neuroblastoma, y por infecciones virales, como la varicela. En nuestro caso se asociaba a lesiones malformativas de miembro superior ipsilateral que son muy características del síndrome de varicela congénita, al parecer por una radiculopatía producida por el virus (AU)