Confocal biomicroscopy in four patients with polychromatic corneal dystrophy. / Biomicroscopia confocal en 4 pacientes con distrofia corneal policromática.

INTRODUCTION: Polychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. CLINICAL CASES: Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicoloured brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. CONCLUSIONS: Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterised. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

Colirios hipotensores: la historia interminable. ¿Hay que considerar algo más que los principios activos? / Hypotensive eyedrops: The neverending story. Should we consider more than active principles?

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Determinación de mediadores de la respuesta inmune e inflamación en lágrimas: cambios en ojo seco y glaucoma frente a población sana / Determination of inmune response and inflammation mediators in tears: Changes in dry eye and glaucoma as compared to healthy controls

OBJETIVO: Determinar el perfil de expresión de las moléculas mediadoras de inflamación y respuesta inmune (IRI) en lágrimas de pacientes con ojo seco (OS) y pacientes en tratamiento médico por sospecha o diagnóstico de glaucoma primario de ángulo abierto (GPAA) para compararlos con sujetos sanos. MÉTODO: Estudio prospectivo observacional de cohortes de 107 participantes subdivididos en: pacientes con OS (GOS; n=30), pacientes con sospecha o diagnóstico de GPAA con tratamiento hipotensor ocular (GGPAA; n=41) y controles sanos (GC; n=36). Se obtuvieron muestras de lágrimas mediante capilaridad para analizarlas mediante sistema de multiinmunoanálisis basado en citometría de flujo (Luminex R-200®), determinando diversas interleucinas (IL): 1β, 2, 4, 5, 6 y 10, y también los factores de necrosis tumoral alfa (TNF-α), de crecimiento endotelial vascular (VEGF) y de crecimiento de colonias de granulocitos y macrófagos (GM-CSF). Los datos se procesaron mediante el programa SPSS 20.0. RESULTADOS: Las moléculas que aumentaron significativamente en lágrimas de pacientes en el GOS versus GGPAA fueron: IL-1β (p = 0.01), IL-6 (p = 0,004), IL-10 (p = 0,04), mientras que el VEGF disminuyó significativamente en el GOS. El GGPAA mostró aumento significativo de IL-6 (p < 0,0001) frente al GC. Comparando GOS y GGPAA, observamos diferencias significativas para IL-4 (p = 0,004), IL-6 (p = 0,002), TNF-α (p = 0,03), GM-CSF (p = 0,03) y VEGF (p = 0,002). CONCLUSIONES: El aumento de expresión de los mediadores de IRI en lágrimas de pacientes con OS o GPAA demuestra la importancia de estos procesos en ambas enfermedades, aunque las distintas moléculas implicadas indican diferentes vías de señalización para ambas, que requieren más investigaciones

OBJECTIVE: To determine the expression profile of immune response and inflammation (IRI) mediator molecules in tears from patients with dry eye (DE), and those suspected of having or have primary open-angle glaucoma (POAG) under treatment and compare them with healthy controls. METHODS: A prospective observational cohort study including 107 participants sub-divided into: healthy controls (CG; n=30), patients with DE (DEG; n=41) and patients suspected of having or have POAG and on hypotensive treatment (POAG-G; n=36). Tear samples were collected by capillary to be processed using a multi-immunoassay system based on flow cytometry (Luminex R-200 ®), in order to determine the interleukins (IL): 1β, 2, 4, 5, 6, and 10, and the growth factors: Tumour necrosis alpha (TNF-α), vascular endothelial (VEGF), and granulocyte-macrophage colony stimulating- (GM-CSF). Data were processed using the SPSS 20.0 program. RESULTS: Molecules that significantly increased in tears from DEG vs. POAG-G patients were: IL-1 (P=.01), IL-6 (P=.004), IL-10 (P=.04), whereas VEGF significantly decreased in the DEG. The POAG-G showed significantly higher IL-6 values (P<.0001) as compared to the CG. When comparing both the DEG and POAG-G, significant differences were observed in tear expression of IL-4 (P=.004), IL-6 (P=.002), TNF-α (P=.03), GM-CSF (P=.03), and VEGF (P=.002). CONCLUSIONS: The increased expression of IRI mediators in tears from patients with DE or POAG strongly demonstrated the importance of immune response in both pathologies. However, the different molecules involved also suggest distinct signalling pathways for these processes that still require further research

Determination of inmune response and inflammation mediators in tears: Changes in dry eye and glaucoma as compared to healthy controls. / Determinación de mediadores de la respuesta inmune e inflamación en lágrimas: cambios en ojo seco y glaucoma frente a población sana.

OBJECTIVE: To determine the expression profile of immune response and inflammation (IRI) mediator molecules in tears from patients with dry eye (DE), and those suspected of having or have primary open-angle glaucoma (POAG) under treatment and compare them with healthy controls. METHODS: A prospective observational cohort study including 107 participants sub-divided into: healthy controls (CG; n=30), patients with DE (DEG; n=41) and patients suspected of having or have POAG and on hypotensive treatment (POAG-G; n=36). Tear samples were collected by capillary to be processed using a multi-immunoassay system based on flow cytometry (Luminex R-200 ®), in order to determine the interleukins (IL): 1ß, 2, 4, 5, 6, and 10, and the growth factors: Tumour necrosis alpha (TNF-α), vascular endothelial (VEGF), and granulocyte-macrophage colony stimulating- (GM-CSF). Data were processed using the SPSS 20.0 program. RESULTS: Molecules that significantly increased in tears from DEG vs. POAG-G patients were: IL-1 (P=.01), IL-6 (P=.004), IL-10 (P=.04), whereas VEGF significantly decreased in the DEG. The POAG-G showed significantly higher IL-6 values (P<.0001) as compared to the CG. When comparing both the DEG and POAG-G, significant differences were observed in tear expression of IL-4 (P=.004), IL-6 (P=.002), TNF-α (P=.03), GM-CSF (P=.03), and VEGF (P=.002). CONCLUSIONS: The increased expression of IRI mediators in tears from patients with DE or POAG strongly demonstrated the importance of immune response in both pathologies. However, the different molecules involved also suggest distinct signalling pathways for these processes that still require further research.

Epidemiología del síndrome pseudoexfoliativo: desmitificando leyendas con la mirada en el futuro / Epidemiology of pseudoexfoliation syndrome: Demystifying legends and looking to the future

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Chemopreventive potential of phenolic compounds in oral carcinogenesis.

OBJECTIVE: To evaluate the chemopreventive potential of phenolic compounds - potassium apigenin, cocoa, catechins, eriocitrin and rosmarinic acid in oral carcinogenesis induced in hamsters by means of the topical application of 7,12-dimethylbenz(a)anthracene(DMBA). STUDY DESIGN: An experimental study at the University of Murcia. METHODS: 50 male Syrian hamsters (Mesocricetus auratus) were divided into five groups of ten: Group I (control group): 0.5% DMBA; Group II: 0.5% DMBA+1.1mg/15ml potassium apigenin; Group III: 05% DMBA+2.5mg/15ml cocoa catechins; Group IV: 0.5% DMBA+6mg/15ml eriocitrin; Group V: 0.5% DMBA+1.3mg/15ml rosmarinic acid. The flavonoids were administered orally. All the animals were sacrificed after 12 weeks. Macroscopic, microscopic and immunohistochemical (PCNA and p53) analyses of the lesions were performed. RESULTS: All the groups treated with phenolic compounds showed lower incidences of tumour, greater differentiation and lower scores in the tumour invasion front grading system in comparison with the control group. Potassium apigenin and rosmarinic acid achieved the best results, the former considerably reduced the carcinoma tumour volumes developed and both significantly reduced the intensity and aggression of the tumours. Immunoexpression of PCNA and p53 were significantly altered during DMBA-induced oral carcinogenesis. CONCLUSIONS: Animals treated with phenolic compounds, particularly potassium apigenin and rosmarinic acid, showed a lower incidence of tumours.

Effect of the phenolic compounds apigenin and carnosic acid on oral carcinogenesis in hamster induced by DMBA.

OBJECTIVE: To investigate oral carcinogenesis in hamster induced by the topical application of 7,12-dimethyl benzanthracene (DMBA) to evaluate the different lesions produced and the possible preventive effects of the phenolic compounds apigenin (flavone) and carnosic acid (diterpene). MATERIALS AND METHODS: Thirty-two Syrian hamsters were divided into three groups: I: 0.5% DMBA (n = 12); II: 0.5% DMBA + potassium apigenin (n = 8); III: 0.5% DMBA + carnosic acid (n = 12). All the animals were sacrificed after 11 weeks, and a macroscopic and light microscopic study was made of the lesions. RESULTS: The largest number of neoplasms, showing the most aggressive biological behavior, corresponded to the control group. The group treated with potassium apigenin ranked second in tumor incidence, although the tumors were not very aggressive behavior. In the group treated with carnosic acid, only one malignancy was recorded, showing the smallest volume of all the recorded tumor lesions. CONCLUSIONS: Our findings indicate that both potassium apigenin and carnosic acid have chemoprotective effects against carcinogenesis induced by DMBA in hamster.

[Dry eye and quality of life]. / Ojo seco y calidad de vida.

PURPOSE: To evaluate the relation between dry eye severity and quality of life. METHODS: 40 participants (19 with dry eye and 21 normal controls) underwent slit-lamp examination and Schirmer test to evaluate dry eye severity. Quality of life was evaluated with OSDI (Ocular Surface Disease Index) and VFQ-25 (Visual Function Questionnaire-25). RESULTS: The OSDI total score was significantly greater in patients suffering dry eye. However, BUT (break-up time) and VFQ-25 total score were significantly lower than in control subjects. In dry eye patients several statistically significant correlations (p<0.05) were found: OSDI with VFQ-25 total score (r=-0.62), BUT with corneal staining (r=-0.50) and Schirmer (0.66), BUT with OSDI total score, OSDI-symptoms and OSDI-triggers (r=-0.56, -0.56, -0.60); corneal staining with OSDI total score and OSDI-symptoms (r=0.55, 0.54), BUT with VFQ-25 total score, VFQ-25 ocular pain, mental function and role function. (r=0.56, 0.51, 0.63, 0.56); corneal staining with VFQ-25 total score, VFQ-25 ocular pain and near vision (r=-0.57, -0.49, -0.62). CONCLUSION: Quality of life is decreased in patients with dry eye. OSDI and VFQ-25 questionnaires are valid instruments for measuring the impact of dry eye disease. BUT and corneal staining provide an indirect measurement of quality of life.

[0.1% dexamathasone and 1% rimexolone. A comparative study in the postoperative treatment after cataract extraction]. / Dexametasona al 0,1% versus rimexolona al 1%. Estudio comparativo en el postoperatorio de la cirugía de cataratas.

PURPOSE: To compare the efficiency and secondary effects of using 1% rimexolone or 0.1% dexamethasone as postoperative treatment for cataract surgery. MATERIALS AND METHODS: A prospective study performed on a cohort of 37 patients undergoing cataract surgery by phacoemulsification with no intraoperative complications at the Hospital Clínico San Carlos, Madrid. After surgery, 19 of the patients were randomly assigned to receive topical 0.1% dexamethasone (DEX group) as inflammatory treatment and the remaining 18 subjects were treated with 1% rimexolone ( RIMEX group) following the same regime. Twenty four hours and one month after surgery, visual acuity, conjunctival hyperaemia, anterior chamber cells, anterior chamber flare, intraocular pressure, corneal thickness and macular edema were determined in each patient. RESULTS: The repeated measures test performed on 24 hours and 1 month data revealed a significant difference between the two treatments in terms of Tyndall (p = 0.001) and flare (p= 0.034) values; these variables being lower in the dexamethasone group. No differences were observed in the remaining variables examined. CONCLUSIONS: Rimexolone is as efficient and safe as dexamethasone for the treatment of patients undergoing cataract extraction.

Dexametasona al 0, 1% versus rimexolona al 1%. Estudio comparativo en el postoperatorio de la cirugía de cataratas / 0.1% dexamathasone and 1% rimexolone. A comparative study in the postoperative treatment after cataract extraction

Objetivo: Comparar la eficacia y los efectos secundariosde la rimexolona 1% y de la dexametasona0,1% en el tratamiento postoperatorio de la cirugíade catarata.Material y métodos: Estudio de cohortes prospectivoen el que se ha seleccionado una muestra de 37pacientes intervenidos de cataratas mediante facoemulsificación,sin complicaciones intraoperatorias,en el Hospital Clínico San Carlos, y se han divididoen dos grupos. El grupo DEX, de 19 pacientes setrato con dexametasona al 0,1% tópica como tratamientoantiinflamatorio y el grupo RIMEX, de 18pacientes se trató con rimexolona 1% tópicasiguiendo la misma pauta en ambos casos. En todoslos pacientes se han estudiado la agudeza visual, lahiperemia conjuntival, las células en cámara anterior,el flare, la presión intraocular, el grosor cornealy la presencia de edema macular a las 24 horas y al mes de la cirugía. Resultados: Al comparar ambos fármacos medianteel test de medidas repetidas a las 24 horas y almes de la cirugía se obtuvieron diferencias estadísticamentesignificativas en el tyndall (p = 0,001) yen el flare (p= 0,034), siendo la reducción de éstosparámetros mayor en el grupo dexametasona, mientrasque no se observaron cambios significativos enel resto de los parámetros evaluados.Conclusiones: La Rimexolona ha resultado ser unfármaco útil y seguro, al igual que la dexametasona,como tratamiento postoperatorio de la cirugía de catarata(AU)

Purpose: To compare the efficiency and secondaryeffects of using 1% rimexolone or 0.1% dexamethasoneas postoperative treatment for cataract surgery.Materials and methods: A prospective study performedon a cohort of 37 patients undergoing cataractsurgery by phacoemulsification with no intraoperativecomplications at the Hospital Clínico SanCarlos, Madrid. After surgery, 19 of the patientswere randomly assigned to receive topical 0.1%dexamethasone (DEX group) as inflammatory treatmentand the remaining 18 subjects were treatedwith 1% rimexolone ( RIMEX group) following thesame regime. Twenty four hours and one monthafter surgery, visual acuity, conjunctival hyperaemia,anterior chamber cells, anterior chamber flare,intraocular pressure, corneal thickness and macularedema were determined in each patient.Results: The repeated measures test performed on24 hours and 1 month data revealed a significant difference between the two treatments in terms ofTyndall (p = 0.001) and flare (p= 0.034) values; thesevariables being lower in the dexamethasonegroup. No differences were observed in the remainingvariables examined.Conclusions: Rimexolone is as efficient and safe asdexamethasone for the treatment of patients undergoingcataract extraction(AU)

[Neurotrophic keratopathy management with cyanoacrylate tarsorraphy and autologous serum]. / Manejo de la queratopatía neurotrófica mediante tarsorrafia con cianoacrilato y suero autólogo.

PURPOSE/METHODS: Neurotrophic keratopathy is a degenerative corneal disease with a highly complex treatment caused by an impairment of corneal sensitivity. We report the case of a 47 year-old man with a refractory postherpetic neurotrophic keratopathy in his right eye and we discuss the treatment options. RESULTS/CONCLUSION: The combination of cyanoacrylate with temporary tarsorraphy along with the administration of topical autologous serum eyedrops and systemic tetracycline, allowed to control the progression of the disease and to regenerate the corneal surface. This unpublished therapeutic strategy might be an effective and safe alternative in the management of neurotrophic keratopathy (Arch Soc Esp Oftalmol 2003; 78: 119-122).

Manejo de la queratopatía neurotrófica mediante tarsorrafia con cianoacrilato y suero autólogo / Neurotrophic keratopathy management with cyanoacrylate tarsorraphy and autologous serum

Objetivo/método: La queratopatía neurotrófica es una patología corneal degenerativa de tratamiento complejo, causada por una alteración en la sensibilidad corneal. Presentamos el caso clínico de un varón de 47 años con una queratopatía neurotrófica postherpética refractaria en OD y discutimos las opciones de tratamiento actuales. Resultados/conclusiones: La combinación de la tarsorrafia temporal con cianoacrilato junto a la administración tópica de suero autólogo al 20 por ciento y sistémica de tetraciclina permitió controlar la progresión del proceso y regenerar la superficie epitelial. Esta asociación terapéutica no publicada podría constituir una alternativa eficaz y segura en la queratopatía neurotrófica (AU)

Purpose/Methods: Neurotrophic keratopathy is a degenerative corneal disease with a highly complex treatment caused by an impairment of corneal sensitivity. We report the case of a 47 year-old man with a refractory postherpetic neurotrophic keratopathy in his right eye and we discuss the treatment options. Results/Conclusion: The combination of cyanoacrylate with temporary tarsorraphy along with the administration of topical autologous serum eyedrops and systemic tetracycline, allowed to control the progression of the disease and to regenerate the corneal surface. This unpublished therapeutic strategy might be an effective and safe alternative in the management of neurotrophic keratopathy (AU)

Osteocondroma de la articulación atlantoccipital. Abordaje extremo lateral transcondilar. A propósito de un caso / Osteochondroma of the atlantooccipital joint. Extreme lateral transcondylar approach. A case description

Introducción. Se describe un paciente con diagnóstico de osteocondroma de la base del cráneo que interesa la articulación atlantoccipital con origen del cóndilo occipital, y muestra un crecimiento hacia el agujero magno, resecado por un abordaje extremo lateral transcondilar. Caso clínico. Paciente de 35 años de edad, crisis vertiginosa e inestabilidad para la marcha de un año de evolución, asociado a dolor cervical irradiado al miembro superior derecho, disfagia, cambios en la tonalidad de la voz y adormecimiento distal de las cuatro extremidades. Paciente en prono tres cuartos, con una incisión en la piel desde espinosa de C3 hasta 2 cm inferior a la punta del mastoides, en relación con la proyección de la apófisis transversa de C1, identificación temprana y rotación de la arteria vertebral; resección total del tumor (osteocondroma) con base en el cóndilo occipital derecho y crecimiento hacia el agujero magno, en el que se incluye la resección mayor de 1/3 posteromedial del cóndilo. Conclusiones. Los osteocondromas tienen las más variadas localizaciones, siendo el cóndilo uno de los lugares más infrecuentes dentro del hueso occipital. El abordaje realizado provee un acceso excelente a la región, específicamente a la articulación atlantoccipital, con un aumento de la amplitud y el ángulo de exposición respecto al abordaje suboccipital tradicional, que facilita la resección radical de la lesión, con ninguna retracción neural y sin complicaciones quirúrgicas (AU)

Introduction. We describe a patient diagnosed as suffering from a skull base osteochondroma which affected the atlantooccipital joint and originated in the occipital condyle. It also displayed a growth toward the foramen magnum, which was resected using an extreme lateral transcondylar approach. Case report. Patient aged 35, with a one-year history of vertiginous seizures and unsteady gait, associated with cervical pain that irradiated to the right upper extremity, dysphagia, changes in the tone of the voice and distal numbness of the four extremities. The patient was made to lie in the three quarter prone position and an incision was made in the skin from the C3 spinous apophysis to a point 2 cm below the end of the mastoid process, in relation with the transversal apophysis of C1. The intervention continued with early identification and rotation of the vertebral artery; total resection of the tumour (osteochondroma) with its base in the right occipital condyle and growth toward the foramen magnum, in which the greater resection of the posteromedial third of the condyle is included. Conclusions. The location of osteochondromas can vary widely, and the condyle is one of the least frequent places inside the occipital bone. The approach employed provides excellent access to the region, in particular to the atlantooccipital joint. The width and angle of exposition are increased as compared with the traditional suboccipital approach, which facilitates the radical resection of the lesion with no neural retraction and without any surgical complications (AU)

[Present and future of neurology in Spain]. / Presente y futuro de la neurología española.

This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.

[Intravitreal injection of triamcinolone acetonide in non infectious uveitis]. / Inyección intravítrea de triamcinolona acetónido en uveítis no infecciosas.

PURPOSE: Systemic immunosuppressants take more than two weeks before showing activity. Therefore corticosteroids remain the mainstay in the treatment of non infectious uveitis. The goal of this study is to assess results of the use of intravitreal triamcinolone acetonide in acute sight-threatening non-infectious uveitis. METHOD: Ten patients (4 idiopathic retinal vasculitis, 1 idiopathic panuveitis, 1 pars planitis and 4 Behçet disease) were treated. Triamcinolone acetonide 4 mg/0.1 ml was injected through pars plana. RESULTS: Pre-treatment visual acuity<0.1 and post-treatment visual acuity >0.6 after less than a week. Inflammation resolved completely in all cases. The only complications observed were transient ocular hypertension which was successfully treated in two patients with topical betablockers and a catact in one case. CONCLUSIONS: Intravitreal triamcinolone acetonide is effective in rapidly decreasing inflammation in acute sight threatening non infectious uveitis.

Inyección intravítrea de triamcinolona acetónido en uveítis no infecciosas / Intravitreal injection of triamcinolone acetonide in non infectious uveitis

Objetivo: Los inmunosupresores sistémicos tardan más de dos semanas en hacer efecto. Por lo que los corticoides son el arma principal en el tratamiento de las uveítis no infecciosas. El fin de este estudio es evaluar el empleo de triamcinolona acetónido por vía intravítrea en uveítis agudas graves no infecciosas. Métodos: Diez pacientes (4 vasculitis retinianas idiopáticas, 1 panuveítis idiopática, 1 pars planitis y 4 enfermedades de Behçet) fueron tratadas. Se inyectaron 4 mg en 0,1 mg de Triamcinolona acetónido a través de la partes plana. Resultados: Agudeza visual pretratamiento: 0,6 en menos de una semana. La inflamación se resolvió completamente en todos los casos. Las únicas complicaciones observadas fueron hipertensión ocular transitoria en dos casos que se controló con betabloqueantes tópicos y catarata en un caso. Conclusiones: La inyección intravítrea de triamcinolona acetónido es efectiva en disminuir rápidamente la inflamación en uveítis agudas graves no infecciosas (AU)