[Sarcoidosis of the optic nerve]. / Sarcoidosis del nervio óptico.

UNLABELLED: PURPOSE/MATERIAL AND METHOD: The present study shows two patients with ophthalmic sarcoid neuropathy without any physical evidence of systemic disease. The first patient (male, age 59) showed optic disk granuloma in his left eye and optic atrophy in his right eye. The second patient (female, age 45) suffered bilateral papilledema. RESULTS/CONCLUSION: Optic neuropathy in sarcoidosis occurs in 5% of patients but it is not generally identified as a sarcoid disease. Optic nerve disease appears as papilledema, atrophy, papillitis, infiltration or retrobulbar neuritis. Ocular abnormalities may be an initial finding in sarcoidosis.

Sarcoidosis del nervio óptico / Sarcoidosis of the optic nerve

Objetivo/Método: En este trabajo se describen dos pacientes con neuropatía óptica por sarcoidosis sin clínica sistémica evidente. El primer paciente (varón, 59 años) se presentó con un granuloma en la papila del ojo izquierdo y atrofia óptica en el derecho. El segundo paciente (mujer, 45 años) presentó un papiledema bilateral. Resultados/Conclusión: La neuropatía óptica en la sarcoidosis ocurre en el 5 por ciento de los pacientes, pero generalmente no se reconoce como una manifestación de dicha enfermedad. La neuropatía óptica se puede presentar como papiledema, atrofia, papilitis, infiltración y neuritis retrobulbar (AU)

[Diplopia as the first manifestation of Lyme disease]. / Diplopía como primera manifestación de la enfermedad de Lyme.

CASE REPORT: We report a case of Lyme disease with diplopia as the first manifestation, without systemic symptoms in contrast with other cases of this disease. The serodiagnosis was confirmed by ELISA analysis and evaluation of cerebrospinal fluid (CSF) antibodies. Symptoms readily vanished after the introduction of antibiotherapy. DISCUSSION: Lyme disease is an infectious multi-systemic disorder caused by Borrelia burgdorferi. Neuro-ophthalmological manifestations occur during the second stage of the illness in extremely variable clinical forms.

Diplopía como primera manifestación de la enfermedad de Lyme / Diplopia as the first manifestation of Lyme disease

Se presenta un caso de enfermedad de Lyme con diplopía como la primera manifestación del proceso sin síntomas sistémicos de presentación, en contra de lo publicado en otros casos de esta enfermedad. El serodiagnóstico se confirmó con el test ELISA y con la determinación de los anticuerpos en el líquido cefalorraquídeo (LCR). Los síntomas fueron desapareciendo después de la instauración del tratamiento antibiótico.Discusión: La enfermedad de Lyme es una enfermedad multisistémica causada por Borrelia burgdorferi. Las manifestaciones neuro-oftalmológicas ocurren durante el segundo estadio de la enfermedad y con una expresión clínica tremendamente variable (AU)

[Renal-coloboma syndrome]. / Síndrome renal-coloboma.

CASE REPORT: We describe a woman with optic disc pit and bilateral renal hypoplasia as a papillorenal syndrome. DNA analysis for PAX2 mutations revealed a heterozygous mutation (nucleotide 619 in exon 9). A first uncle and a cousin had the same PAX2 mutation. DISCUSSION: The association of optic nerve colobomas and renal anomalies comprises a autosomal dominant syndrome for mutations in the PAX2 gene. Ophthalmic and renal diseases are highly variable; the ophthalmologist must check for a renal problem when a coloboma is detected.

Síndrome renal-coloboma / Renal-coloboma syndrome

Caso Clínico: Describimos el caso de una mujer con foseta papilar y una hipolasia renal bilateral, como síndrome papilorrenal. El análisis del DNA para las mutaciones del PAX2 determinó una mutación heterocigota (nucleótido 619 del exon 9). Un tío y un primo carnal eran portadores de la misma mutación en el PAX2.Discusión: La asociación de colobomas del nervio óptico y anomalías renales forman parte de un síndrome autosómico dominante por mutaciones en el gen PAX2. La expresión de la enfermedad oftalmológica y renal es muy variable; los oftalmólogos deben chequear la función renal cuando un coloboma sea detectado (AU)

Case report: We describe a woman with optic disc pit and bilateral renal hypoplasia as a papillorenal syndrome. DNA analysis for PAX2 mutations revealed a heterozygous mutation (nucleotide 619 in exon 9). A first uncle and a cousin had the same PAX2 mutation. Discussion: The association of optic nerve colobomas and renal anomalies comprises a autosomal dominant syndrome for mutations in the PAX2 gene. Ophthalmic and renal diseases are highly variable; the ophthalmologist must check for a renal problem when a coloboma is detected (Arch Soc Esp Oftalmol 2002; 77: 635-638) (AU)

[Ophthalmologic vascular occlusions and oral contraceptives]. / Accidentes vasculares en oftalmología y anticonceptivos orales.

UNLABELLED: PURPOSE/MATERIAL AND METHOD: We present two cases of vascular ocular occlusion occurring during oral contraceptive use. Different contraceptive related risk factors are discussed. RESULTS/CONCLUSIONS: Although ocular complications are rare, they should be kept in mind since these drugs (contraceptives) are not recommended when vascular occlusion risk factors are present.

Accidentes vasculares en oftalmología y anticonceptivos orales / Ophthalmologic vascular occlusions and oral contraceptives

Objetivo/Método: Presentamos dos casos clínicos de accidente vascular retiniano en mujeres que tomaban anticonceptivos. Se discuten diferentes factores de riesgo asociados a los anticonceptivos. Resultados/Conclusiones: Aunque las complicaciones oculares por anticonceptivos son raras, se deben tener presentes en estos pacientes evitando su utilización cuando existan factores de riesgo de oclusión vascular (AU)

[The safety of the treatment of an acute myocardial infarct by immediate intravenous fibrinolysis in the regional hospital environment]. / Seguridad del tratamiento del infarto agudo de miocardio mediante fibrinólisis intravenosa inmediata en el ámbito hospitalario comarcal.

INTRODUCTION AND OBJECTIVES: Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital. METHODS: We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital. RESULTS: 23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission). CONCLUSION: On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.