Effects of policosanol in the functional recovery of non-cardioembolic ischemic stroke hypertensive patients. / Efectos del policosanol en la recuperacion funcional de pacientes hipertensos con ictus isquemico no cardioembolico.

INTRODUCTION: Clinical studies results show that policosanol (20 mg/day) + aspirin therapy had benefits versus placebo + aspirin to patients with recent non-cardioembolic ischemic stroke. AIM: To analyze the policosanol treatment effects in the hypertensive patients included in two non-cardioembolic ischemic stroke recovery trials. PATIENTS AND METHODS: Hypertensive patients with a modified Rankin Scale (mRS) score 2 to 4 were randomized, within 30 days of onset, to policosanol + aspirin or placebo + aspirin, for six months. The primary outcome was mRS score reduction. RESULTS: One hundred forty two hypertensive patients (mean age: 66 years) were included in the analysis. Policosanol + aspirin decreased significantly the mRS score mean from the first interim check-up. The policosanol treatment effect did not wear off, on the contrary, even improved after six months therapy. More over, policosanol + aspirin (80.3%) treatment achieved significant results (mRS <= 1), whereas the placebo + aspirin did not (8.5%). Two patients discontinued and four (two from each group) referred mild adverse events. CONCLUSIONS: The treatment for six months with policosanol + aspirin in hypertensive patients who had suffered a non-cardioembolic ischemic stroke proved to be more effective than the placebo + aspirin treatment in the functional recovery of these patients.

TITLE: Efectos del policosanol en la recuperacion funcional de pacientes hipertensos con ictus isquemico no cardioembolico.Introduccion. Los resultados de los estudios clinicos muestran que el tratamiento con policosanol (20 mg/dia) + aspirina produce beneficios frente a placebo + aspirina en pacientes con ictus isquemico no cardioembolico reciente. Objetivo. Analizar los efectos del tratamiento con policosanol en pacientes hipertensos incluidos en dos ensayos de recuperacion de ictus isquemico no cardioembolico. Pacientes y metodos. Pacientes hipertensos que sufrieron un ictus en los 30 dias previos y que, con una puntuacion de 2 a 4 en la escala de Rankin modificada (mRS), se distribuyeron aleatoriamente en dos grupos y recibieron policosanol + aspirina o placebo + aspirina durante seis meses. La variable primaria de eficacia fue la reduccion de la puntuacion en la mRS. Resultados. Se incluyo a un total de 142 pacientes hipertensos (edad media: 66 años) en el analisis. El policosanol + aspirina disminuyo significativamente la puntuacion de la mRS desde el primer chequeo intermedio. El efecto del tratamiento con policosanol no desaparecio, sino que incluso mejoro despues de seis meses de tratamiento. El numero de pacientes que alcanzaron valores de la mRS <= 1 fue mayor en el grupo de policosanol + aspirina (80,3%) que en el de placebo + aspirina (8,5%). Dos pacientes causaron baja del estudio y cuatro (dos de cada grupo) refirieron efectos adversos leves. Conclusiones. El tratamiento durante seis meses con policosanol + aspirina a pacientes hipertensos que habian sufrido un ictus isquemico no cardioembolico demostro ser mas efectivo que el tratamiento con placebo + aspirina en su recuperacion funcional.

Variante genética del síndrome de Stickler / Genetic variant of Stickler's syndrome

Casos clínicos: Se remiten para estudio tres pacientes miopes de una misma familia por presentar vítreo degradado de manera severa, membranas ecuatoriales, hiperplasia del epitelio pigmentario de la retina, envainamiento vascular y esclerosis de predominio periférico. Se solicita estudio genético que confirma el diagnóstico de síndrome de Stickler con una variante en la mutación del gen COL2A1. Discusión: El síndrome de Stickler se debe sospechar en familias que presenten un fenotipo característico con sinéresis vítrea y las referidas alteraciones en la retina, pudiendo existir en ocasiones variantes genéticas que no expresan en su totalidad el fenotipo clásico (AU)

Cases reports: Three myopic components of a same family came for study because presented severely degraded vitreous, equatorial membranes, retinal pigment epithelium hyperplasia, vascular sheathed and sclerosis of peripheral predominance. A genetic study confirmed the diagnosis of Stickler syndrome with a variant in the mutation of the COL2A1 gene. Discussion: Stickler's syndrome should be suspected in families with a characteristic phenotype with vitreous syneresis and alterations in the retina, but there may be genetic variants that do not express the classic phenotype (AU)

Genetic variant of Stickler's syndrome. / Variante genética del síndrome de Stickler.

CASES REPORTS: Three myopic components of a same family came for study because presented severely degraded vitreous, equatorial membranes, retinal pigment epithelium hyperplasia, vascular sheathed and sclerosis of peripheral predominance. A genetic study confirmed the diagnosis of Stickler syndrome with a variant in the mutation of the COL2A1 gene. DISCUSSION: Stickler's syndrome should be suspected in families with a characteristic phenotype with vitreous syneresis and alterations in the retina, but there may be genetic variants that do not express the classic phenotype.

Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona / Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone

Casos clínicos: Se presentan los casos de 3 mujeres de 22, 36 y 55 años de edad con retinocoroidosis miópica bilateral. Las pacientes presentan disminución de agudeza visual unilateral, tonometría y biomicroscopia bilateral normal. En la funduscopia se evidencia maculopatía unilateral, y en la tomografía de coherencia óptica (OCT), mácula en cúpula con desprendimiento neurosensorial (DNS). Iniciado tratamiento con espironolactona, en todos los casos se comprueba mejoría por OCT. Discusión: Se discute el mecanismo etiopatogénico de la mácula en cúpula. La OCT se demuestra como técnica fundamental en el seguimiento de esta patología. Tras la evidencia mostrada, se postula tratamiento inicial con espironolactona (AU)

Cases reports: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. Discussion: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested (AU)

Edema macular en el postoperatorio de la cirugía no complicada de la catarata. Posible relación con el volumen de cefuroxima intracamerular / Macular oedema after uncomplicated cataract surgery. Possible relationship with the volume of intracameral cefuroxime

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Dome shaped macula associated with myopic retinochoroidosis. Use of spironolactone. / Mácula en cúpula asociada a la retinocoroidosis miópica. Utilidad de la espironolactona.

CASES REPORTS: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases. DISCUSSION: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested.

Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica / Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy

CASOS CLÍNICOS: Se presentan 2 casos clínicos de epiteliopatía difusa crónica (EDC) con respuesta favorable a espironolactona. En el primer paciente se visualizan regiones de desprendimiento neurosensorial (DNS), y en el segundo múltiples DNS, quistes intrarretinianos secundarios y desprendimiento del epitelio pigmentario de la retina. DISCUSIÓN: Tras el tratamiento con espironolactona, se observa mejoría de la agudeza visual y de las alteraciones estructurales en ambos pacientes (disminución del DNS y quistes intrarretinianos). Los fármacos antagonistas de los receptores de aldosterona usados para formas persistentes de coriorretinopatía central serosa (CRCS) tienen resultados alentadores, y podrían ser una alternativa terapéutica en la EDC

CASE REPORT: Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION: After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE

Dermatitis atópica: A propósito de un caso / Atopic dermatitis: About a case

Se trata de una adolescente femenina de 16 años de edad, natural de Cuyagua estado Aragua y procedente de la localidad, quien presenta desde hace cuatro meses aproximadamente, prurito intenso a nivel del complejo areola pezón y exudado, amarillento, no fétido, de moderada cantidad en ambas mamas. Refiere haber consultado a facultativo quien indica tratamiento, a base de oxacilina no presentando mejoría. Acude el día 05/04/16 al Centro Integral de Especialidades "Los Grillitos", CORPOSALUD. Municipio Mario Briceño Iragorry a consulta especializada. Al examen físico se evidencia: mamas simétricas, complejo areola pezón eritematoso, con zonas de descamación, exudado amarillento y a nivel de mama izquierda se extiende hasta piel del cuadrante ínfero interno; se indica realizar paraclínicos: ecosonograma mamario, hematología completa, VSG, PCR y se toma muestra para cultivo, de la misma manera se indica tratamiento con corticoides tópicos y antibióticoterapia (ciprofloxacina). Acude a control el 15/04/16 con evolución clínica satisfactoria y resultado de cultivo positivo para S. aureus, sensible a ciprofloxacina.

It is female 16-year-old native of Cuyagua state Aragua and from the town, who presents from four months about intense itching at the level of the nipple areola complex and not fetid yellowish exudate moderate amount of both breasts, which refers consultation with physician who indicates treatment based oxacillin presented no improvement. She goes on 5/4/16 at Integral Center specialty "The Grillitos" CORPOSALUD. Municipio Mario Briceño Iragorry a specialist consultation, physical examination is evident: symmetrical breasts, nipple areola complex erythematosus, with areas of desquamation and yellowish exudate, and level of left breast extends to skin internal bottom quadrant shown performing paraclinical: sonogram breast, complete blood count, ESR, CRP and sample is taken for cultivation, in the same way treatment with topical corticosteroids and antibiotics (ciprofloxacin) is indicated. Control goes to 04/15/16 with satisfactory clinical evolution resulting in positive culture for S. aureus sensitive to ciprofloxacin.

Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica / Bilateral solar retinopathy. Autofluorescence and optical coherence tomography

CASO CLÍNICO: Varón de 33 años, que refiere disminución de agudeza visual bilateral desde hace 5 años. No presenta antecedentes de interés. Militar de profesión y probable exposición ocular solar previa. Se aprecian en el fondo de ojo lesiones pigmentadas focales maculares, con alteración de la capa de los fotorreceptores a nivel foveal, evidenciada por tomografía de coherencia óptica (OCT) en varios sectores de la fóvea. DISCUSIÓN: La retinopatía solar está asociada a profesiones con exposición solar de riesgo. El diagnóstico está basado en la autofluorescencia y OCT macular que nos va a aportar datos fundamentales para establecer la causa

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause

Síndrome de Nicolau: a propósito de un caso / Nicolau Syndrome: About a case

Comunicamos una paciente femenina de 24 años de edad, natural y procedente de la localidad, quien consulta en el mes de enero de 2016 al Centro Integral de Especialidades “Los Grillitos”, CORPOSALUD. Municipio Mario Briceño Iragorry por presentar lesión ulcerosa a nivel de hemicadera derecha, cuya aparición fue posterior a la administración de medicamentos vía intramuscular (ampolla de amikacina). El tratamiento aplicado fue debido a una infección vaginal que presentó en el mes de septiembre 2015, cuyo cultivo resultó sensible a este antibiótico; comenzó a presentar un área endurecida color violáceo, hasta convertirse en una úlcera en el mes de diciembre 2015. Por este motivo, acude al médico quien indica ecosonograma de partes blandas (27/1/2016), informando: úlcera de 29 mm asociado a celulitis post infecciosa a administración medicamentosa, en hemicadera derecha y hematoma, organizado en hemicadera izquierda (0,25 cc); se realiza cultivo (27/1/2016) reportando presencia de Acinetobacter baumani complex sensible a la ciprofloxacina, la que se indica, observándose actualmente mejoría clínica de la lesión.

It is 24 years female patient age and naturally from the locality, who consults in January 2016 to Integral Center Specialty "The Grillitos" Corposalud. Municipio Mario Briceño Iragorry to present Injury ulcer type level right hemi hip whose appearance was after drug administration (vial amikacin) treatment applied due to a vaginal infection present in the month of September 2015 whose culture was sensitive to this antibiotic, he began to present purple colored hardened to become ulcerated area in December 2015. Which is why go to the doctor who said soft tissue sonography (01/27/2016) ulcer reporting 29 mm associated with post-infectious cellulitis to drug administration right hemi hip and a left organized hematoma (0.25 cc); culture (01.27.2016) is perform reporting presence of Acinetobacter baumani sensitive Ciprofloxacin treatment indicated Complex currently observed clinical improvement of the injury.

Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy. / Espironolactona, alternativa terapéutica en el tratamiento de la epiteliopatía difusa crónica.

CASE REPORT: Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION: After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE.

Bilateral solar retinopathy. Autofluorescence and optical coherence tomography. / Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica.

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause.

Resultados coste-efectividad del implante de dexametasona en edema macular / A cost-effectiveness study of dexamethasone implants in macular edema

OBJETIVO: Analizar el beneficio coste-efectividad del implante intravítreo de dexametasona (Ozurdex®, Allergan, Irvine, CA, EE. UU.) en sus aplicaciones clínicamente relevantes. MATERIAL Y MÉTODOS: Un total de 88 ojos de 86 pacientes con edema macular de > 300 μm medido mediante tomografía de coherencia óptica (Zeiss Cirrus, Dublín, CA, EE. UU.) fueron incluidos en este trabajo retrospectivo de 2 años, con un seguimiento mínimo de 6 meses. Se incluyeron 3 grupos de pacientes: el grupo 1 con edema macular en oclusión venosa retiniana, el grupo 2 con uveítis posterior no infecciosa y el grupo 3 con edema macular diabético, estando este fuera de indicación pero avalado por la literatura médica. Antes del implante y los días 1, 30, 60, 90 y 180 se evaluó la agudeza visual corregida (Snellen), espesor retiniano central, presión intraocular y biomicroscopia. Los análisis de coste-beneficio se tabularon por línea de visión ganada, comparando las principales alternativas terapéuticas, y se valoró el perfil de seguridad del implante intravítreo de dexametasona (Ozurdex®; Allergan, Irvine, CA, EE. UU.). RESULTADOS: Los resultados de este estudio no difirieron de los publicados por otros, en términos de mejoría de la agudeza visual en el 63,3% y del espesor macular central en el 97%. En los casos de recidiva, se produjo a los 120 días de media; la necesidad de retratamiento fue del 40,9%. Entre los efectos secundarios, el incremento de presión intraocular > 23 mm Hg se produjo en el 29,54%, controlándose con tratamiento tópico, excepto un 1,13% de los casos que requirieron tratamiento quirúrgico. El desarrollo de catarata fue del 44,7%, requiriendo cirugía un 10,6%. Los resultados del tratamiento mostraron una menor necesidad en la frecuencia del uso de Ozurdex® frente a otros tratamientos para el control de la enfermedad, convirtiéndose en una opción que permite el ahorro de costes. DISCUSIÓN: Los análisis coste-efectividad son clínicamente relevantes cuando se aplican estrategias terapéuticas en pacientes con edema macular. El implante de dexametasona intravítrea es una opción terapéutica segura y eficiente

OBJECTIVE: To analyze the cost-effectiveness and benefits of a dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA.) in its clinically relevant applications. MATERIAL AND METHODS: A total of 88 eyes of 86 patients with macular edema of > 300 μm measured by optical coherence tomography (Cirrus Zeiss, Dublin, CA, USA) were included in this two-year retrospective study, with a minimum of 6 months follow-up. The patients were divide into 3 groups: group 1 with macular edema in retinal vein occlusion, group 2 with non-infectious posterior uveitis, and group 3 with diabetic macular edema. The treatment was off-label but supported by the literature. Before implantation, and on days 1, 30, 60, 90 and 180, corrected visual acuity (Snellen), central retinal thickness, intraocular pressure and biomicroscopy were evaluated. The cost-benefit analysis was tabulated by line of visual acuity gained, comparing the main therapeutic alternatives and assessment of the safety profile of the dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA). RESULTS: The results of this study did not differ from the published studies, in terms of visual acuity improvement in 63.3% of cases, and with central macular thickness improvement in 97% of cases. There were relapses, which occurred after 120 days on average, and the need for retreatment was 40.9%. Increased intraocular pressure >23 mm Hg was among the side effects in 29.54%, and was controlled with topical treatment, except in 1.13% requiring surgical treatment. The development of cataract was 44.7%, and 10.6% required surgery. Treatment results showed less frequent use of Ozurdex® than other treatments for disease control, being a cost saving option. DISCUSSION: Cost-effectiveness analyses are clinically relevant when applying treatment strategies in patients with macular edema. Dexamethasone intravitreal implant appears to be a safe and efficient therapy

[A cost-effectiveness study of dexamethasone implants in macular edema]. / Resultados coste-efectividad del implante de dexametasona en edema macular.

OBJECTIVE: To analyze the cost-effectiveness and benefits of a dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA.) in its clinically relevant applications. MATERIAL AND METHODS: A total of 88 eyes of 86 patients with macular edema of > 300 µm measured by optical coherence tomography (Cirrus Zeiss, Dublin, CA, USA) were included in this two-year retrospective study, with a minimum of 6 months follow-up. The patients were divide into 3 groups: group 1 with macular edema in retinal vein occlusion, group 2 with non-infectious posterior uveitis, and group 3 with diabetic macular edema. The treatment was off-label but supported by the literature. Before implantation, and on days 1, 30, 60, 90 and 180, corrected visual acuity (Snellen), central retinal thickness, intraocular pressure and biomicroscopy were evaluated. The cost-benefit analysis was tabulated by line of visual acuity gained, comparing the main therapeutic alternatives and assessment of the safety profile of the dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA). RESULTS: The results of this study did not differ from the published studies, in terms of visual acuity improvement in 63.3% of cases, and with central macular thickness improvement in 97% of cases. There were relapses, which occurred after 120 days on average, and the need for retreatment was 40.9%. Increased intraocular pressure >23 mm Hg was among the side effects in 29.54%, and was controlled with topical treatment, except in 1.13% requiring surgical treatment. The development of cataract was 44.7%, and 10.6% required surgery. Treatment results showed less frequent use of Ozurdex® than other treatments for disease control, being a cost saving option. DISCUSSION: Cost-effectiveness analyses are clinically relevant when applying treatment strategies in patients with macular edema. Dexamethasone intravitreal implant appears to be a safe and efficient therapy.

Combinación de la anhidrasa carbónica tópica y sistémica en el tratamiento de la retinosquisis ligada al cromosoma X / A combination of topical and systemic carbonic anhydrase in the treatment of chromosome X-linked retinoschisis

CASO CLÍNICO: Varón de 17 años que desde el año 2000 refiere disminución progresiva de agudeza visual bilateral. Se observan en la retina máculas en patrón de «rueda de bicicleta». El electrorretinograma informa de disminución en la amplitud de la onda b. Los potenciales evocados visuales son normales. La tomografía de coherencia óptica muestra edema macular bilateral. Todo ello compatible con el diagnóstico de retinosquisis ligada al cromosoma X (RLX). DISCUSIÓN: Se realiza consejo genético y se explica el patrón de herencia ligada al X.Se instaura tratamiento con dorzolamida tópica y acetazolamida oral evidenciando una mejoría significativa del grosor macular

CASE REPORT: A 17 year-old male patient, who since 2000 has referred to a progressive bilateral decrease in visual acuity. A «bicycle wheel» macula pattern was observed in his retina. The electroretinogram showed a decrease in the b-wave amplitude. The visual evoked potentials were normal. Optical coherence tomography showed bilateral macular edema. All this supported the diagnosis of X-linked retinoschisis. DISCUSSION: Genetic counseling was given and the pattern of X-linked inheritance was explained. A significant improvement of the macular thickness was observed after treatment with topical dorzolamide and oral acetazolamide

Dermatitis por contacto y árnica montana: Presentación de un caso clínico, revisión y actualización. Ambulatorio. Los grillitos. Diciembre 2013, Maracay - Estado Aragua Venezuela / Dermatitis, contact and árnica montana: Presentation of a clinical case, revision and update. The grillitos clinic. December 2013, Maracay - Aragua Venezuela State

Comunicamos un caso de dermatitis por contacto severa debida al Árnica montana, en una paciente con antecedentes de hipertensión arterial tratada regularmente y controlada; se enfatiza la importancia de un control evolutivo, examen físico semiológico completo y los diagnósticos diferenciales, de estas variantes severas e infrecuentes.

The presentation of a case of irritant contact dermatitis in a patient with a history of high blood pressure regularly treated and controlled, who starts on 19.04.13 with fever of 39º5 which ceded with use of current antipyretic; accompanied by myalgia, retro-ocular pain, arthralgias, headache of strong intensity, complete haematology reports thrombocytopenia and leukocytosis at the expense of segmented, picture that remained for 48 hours; later is associated with stabbing pain and right lower limb rigidity. 22.04.13 presents increase in volume and signs of phlogosis of elevated erythematous edges that extends to the sural region, with blister on right twin region of approximately 10x10 cm with functional limitation of that member. The patient is hospitalized under the diagnosis of Bullous erysipelas, receives broad spectrum antibiotics to Gram +, Gram - and anaerobic. 29.04.13 blister hatches draining not foul-smelling yellowish secretion; it is cultivated and Gram, reporting no bacterial growth. Refers to Central Hospital of Maracay entering it with the diagnosis of cellulitis blistering, where it performed second Gram and cultivation reported without bacterial growth; they perform a biopsy which reports epidermal necrotic dermatitis superficial and deep compatible with dermatitis irritant contact. The case is reevaluated, interrogating again to the patient and the dermal symptoms coincide with the use of Árnica montana product (this data was not reported or questioned in the initial history). Update about the product reported that exists extensive reference on cases of dermatitis contact, mainly by the use of Árnica montana and one of its components; methylparaben, these cases have been reported by prolonged use of the product described as excited skin syndrome or angry back. The patient after to the second questioned referred the use of this product frequently for several years topically and even concerned using infusions of the flower of Árnica montana orally. It was decided to deal with steroids intravenously, resulting in evident improvement with egress to the fifth day and outpatient follow-up, which reported complete remission of picture.

Dermatitis por contacto y árnica montana: Presentación de un caso clínico, revisión y actualización. Ambulatorio. Los grillitos. Diciembre 2013, Maracay - Estado Aragua Venezuela / Dermatitis, contact and árnica montana: Presentation of a clinical case, revision and update. The grillitos clinic. December 2013, Maracay - Aragua Venezuela State

Comunicamos un caso de dermatitis por contacto severa debida al Arnica montana, en una paciente con antecedentes de hipertensión arterial tratada regularmente y controlada; se enfatiza la importancia de un control evolutivo, examen físico semiológico completo y los diagnósticos diferenciales, de estas variantes severas e infrecuentes.(AU)

The presentation of a case of irritant contact dermatitis in a patient with a history of high blood pressure regularly treated and controlled, who starts on 19.04.13 with fever of 39º5 which ceded with use of current antipyretic; accompanied by myalgia, retro-ocular pain, arthralgias, headache of strong intensity, complete haematology reports thrombocytopenia and leukocytosis at the expense of segmented, picture that remained for 48 hours; later is associated with stabbing pain and right lower limb rigidity. 22.04.13 presents increase in volume and signs of phlogosis of elevated erythematous edges that extends to the sural region, with blister on right twin region of approximately 10x10 cm with functional limitation of that member. The patient is hospitalized under the diagnosis of Bullous erysipelas, receives broad spectrum antibiotics to Gram +, Gram - and anaerobic. 29.04.13 blister hatches draining not foul-smelling yellowish secretion; it is cultivated and Gram, reporting no bacterial growth. Refers to Central Hospital of Maracay entering it with the diagnosis of cellulitis blistering, where it performed second Gram and cultivation reported without bacterial growth; they perform a biopsy which reports epidermal necrotic dermatitis superficial and deep compatible with dermatitis irritant contact. The case is reevaluated, interrogating again to the patient and the dermal symptoms coincide with the use of Arnica montana product (this data was not reported or questioned in the initial history). Update about the product reported that exists extensive reference on cases of dermatitis contact, mainly by the use of Arnica montana and one of its components; methylparaben, these cases have been reported by prolonged use of the product described as excited skin syndrome or angry back. The patient after to the second questioned referred the use of this product frequently for several years topically and even concerned using infusions of the flower of Arnica montana orally. It was decided to deal with steroids intravenously, resulting in evident improvement with egress to the fifth day and outpatient follow-up, which reported complete remission of picture.(AU)

A combination of topical and systemic carbonic anhydrase in the treatment of chromosome X-linked retinoschisis.

CASE REPORT: A 17 year-old male patient, who since 2000 has referred to a progressive bilateral decrease in visual acuity. A "bicycle wheel" macula pattern was observed in his retina. The electroretinogram showed a decrease in the b-wave amplitude. The visual evoked potentials were normal. Optical coherence tomography showed bilateral macular edema. All this supported the diagnosis of X-linked retinoschisis. DISCUSSION: Genetic counseling was given and the pattern of X-linked inheritance was explained. A significant improvement of the macular thickness was observed after treatment with topical dorzolamide and oral acetazolamide.