Suprachoroidal hemorrhage due to Valsalva maneuver, importance of enhanced depth imaging optical coherence tomography in differential diagnosis.

We describe a case report of a spontaneous suprachoroidal hemorrhage, in which the enhanced depth imaging optical coherence tomography (OCT-EDI) is extremely useful in establish the differential diagnosis with a choroidal tumor. A 70 year-old woman was referred with a central scotoma after a Valsalva maneuver. In the posterior pole we observed a grey bilobed subretinal mass with the appearance of a choroidal tumor. OCT-EDI revealed an optically dark region with a scalloped anterior tumor contour and subretinal fluid, the choroicapillaris appeared to be intact and displaced anteriorly. The diagnosis was a suprachoroidal hemorrhage and it resolved in 12 weeks. Spontaneous suprachoroidal hemorrhage is a rare condition and it can resemble choroidal tumor. OCT-EDI is a very valuable tool in the differentiation of hemorrhage from tumors.

Hemorragia supracoroidea secundaria a maniobra de Valsalva, importancia de la tomografía de coherencia óptica de profundidad mejorada en el diagnóstico diferencial / Suprachoroidal hemorrhage due to Valsalva maneuver, importance of enhanced depth imaging optical coherence tomography in differential diagnosis

Presentamos el caso clínico de una hemorragia supracoroidea espontánea, en el que la tomografía de coherencia óptica de profundidad mejorada (OCT-EDI) resulta de gran utilidad para el diagnóstico diferencial con un tumor coroideo. Una mujer de 70 años con hipertensión arterial, acude por escotoma central tras maniobra de Valsalva. En el fondo de ojo observamos una masa bilobulada central, subretiniana y grisácea, que plantea diagnóstico diferencial con un tumor coroideo. En la OCT-EDI se observa una masa coroidea con superficie de tipo festoneado y líquido subretiniano, el tejido coriocapilar se encuentra desplazado anteriormente con apariencia normal. Diagnosticamos una hemorragia supracoroidea, que se resuelve espontáneamente en 12 semanas. La hemorragia supracoroidea espontánea es muy poco frecuente y presenta una imagen que puede ser confundida con un tumor coroideo, la OCT-EDI es la prueba de imagen más útil para el diagnóstico diferencial (AU)

We describe a case report of a spontaneous suprachoroidal hemorrhage, in which the enhanced depth imaging optical coherence tomography (OCT-EDI) is extremely useful in establish the differential diagnosis with a choroidal tumor. A 70 year-old woman was referred with a central scotoma after a Valsalva maneuver. In the posterior pole we observed a grey bilobed subretinal mass with the appearance of a choroidal tumor. OCT-EDI revealed an optically dark region with a scalloped anterior tumor contour and subretinal fluid, the choroicapillaris appeared to be intact and displaced anteriorly. The diagnosis was a suprachoroidal hemorrhage and it resolved in 12 weeks. Spontaneous suprachoroidal hemorrhage is a rare condition and it can resemble choroidal tumor. OCT-EDI is a very valuable tool in the differentiation of hemorrhage from tumors (AU)

Smart Sensors for Smart Grid Reliability.

Sensors for monitoring electrical parameters over an entire electricity network infrastructure play a fundamental role in protecting smart grids and improving the network's energy efficiency. When a short circuit takes place in a smart grid it has to be sensed as soon as possible to reduce its fault duration along the network and to reduce damage to the electricity infrastructure as well as personal injuries. Existing protection devices, which are used to sense the fault, range from classic analog electro-mechanics relays to modern intelligent electronic devices (IEDs). However, both types of devices have fixed adjustment settings (offline stage) and do not provide any coordination among them under real-time operation. In this paper, a new smart sensor is developed that offers the capability to update its adjustment settings during real-time operation, in coordination with the rest of the smart sensors spread over the network. The proposed sensor and the coordinated protection scheme were tested in a standard smart grid (IEEE 34-bus test system) under different short circuit scenarios and renewable energy penetration. Results suggest that the short-circuit fault sensed by the smart sensor is improved up to 80% and up to 64% compared with analog electromechanics relays and IEDs, respectively.

Retinopatía anular externa aguda asociada al virus de la inmunodeficiencia humana / Acute annular outer retinopathy associated with human immunodeficiency virus

Presentamos un caso de retinopatía anular externa aguda (acute annular outer retinopathy [AAOR]) en un paciente en el que se demostró positividad para el virus de la inmunodeficiencia humana (VIH). La etiología de la AAOR es desconocida, aunque se han sugerido como desencadenantes la infección viral o un mecanismo autoinmune. Nuestro caso es relevante por ser el primero descrito en un paciente con serología positiva para VIH. Aun así, desconocemos el papel que ha jugado la infección por VIH o la inmunosupresión secundaria en el desarrollo de la AAOR

A case of acute annular outer retinopathy (AAOR) is presented in a patient that was later proved to be positive for the human immunodeficiency virus (HIV). The aetiology of AAOR remains unknown, although a viral infection or an autoimmune mechanism has been suggested. The case presented here is noteworthy because it is the first case described in a patient with HIV positive serology. Even so, the precise role played by HIV infection or secondary immunosuppression in the development of the AAOR is not known

Acute annular outer retinopathy associated with human immunodeficiency virus. / Retinopatía anular externa aguda asociada al virus de la inmunodeficiencia humana.

A case of acute annular outer retinopathy (AAOR) is presented in a patient that was later proved to be positive for the human immunodeficiency virus (HIV). The aetiology of AAOR remains unknown, although a viral infection or an autoimmune mechanism has been suggested. The case presented here is noteworthy because it is the first case described in a patient with HIV positive serology. Even so, the precise role played by HIV infection or secondary immunosuppression in the development of the AAOR is not known.

La virtud odontológica / The dental virtue

Existe una relación más profunda entre la ética y la odontología de la que se suele ver. La odontología en sus ámbitos técnico, terapéutico e intervencionista es una disciplina práctica como la ética, aunque encaminadas hacia diferentes objetivos. Para cada una de éstas, como para cualquier otra actividad humana existe una virtud, una excelencia en su ejecución. El odontólogo debe buscar esta virtud en cada una de las actividades que realiza en su profesión.

Determinación de la actividad de la renina plasmática en pacientes con cor pulmonale secundario a enfermedad pulmonar obstructiva crónica / Plasmatic renin ativity in patients with cor pumlmonale

Se estudiaron 16 pacientes con diagnóstico de EPOC, 14 hombres y 2 mujeres, con edad promedio del 61 años (DE 5.8), todos con antecedentes de tabaquismo pesado (promedio de paquetes-año 88, DE 42), sin consumo actual de tabaco. La mayoría de los sujetos tenía enfermedad obstructiva moderada a severa (promedio del VEF1 predicho 50 por ciento DE 26 por ciento; relación VEF1 sobre CVF 51 por ciento, DE 15 por ciento) y la limitación funcional se consideró de moderada a severa, pues 13 pacientes tenían clase funcional 2 a 3. El compromiso de la oxigenación fué leve (Pa02 promedio 52, DE 7 mmHg), hipercapnia moderada (34.3 mmHg, DE 4.1) y el estado ácido base estaba en el rango normal (ph 7.40, DE 0.027; HC03 21.63, DE 2.5). Debido al diseño del trabajo, que no incluyó pacientes con hipertensión arterial sistémica, las cifras de presión sistólica (122, DE 12) y diastólica (76, DE 7) se encontraban dentro del rango normal. El estudio ecocardiográfico demostró hipertensión pulmonar moderada a severa en todos los pacientes, la presión sistólica pulmonar fue, en promedio, de 61 (DE 9.6) y la media pulmonar de 41.7 (DE 5,5) y 81 por ciento de los pacientes tenian disfunción diastólica del ventrículo izquierdo de leve a moderada. La función ventricular izquierda presentaba alteración diatólica en 87 por ciento de los sujetos, mientras que la función sistólica era completamente normal con una fracción de eyección de (59.7 por ciento DE 5.1) y el gasto cardiaco promedio fue de 5.76 It/min (DE 1.7). Todos los pacientes tenían actividades de renina plasmática normal, lo que significa que la prevalencia de hiperactividad del sistema renina angiotensina aldosterona sistémico es del 0 por ciento en estos pacientes.

Lateral ligamentous instability of the ankle: a method of surgical reconstruction by a modified Watson-Jones technique.

Forty-nine cases of lateral ligamentous instability of the ankle have been reviewed. Forty-one have been personally examined. Eight have been evaluated by questionnaire follow-up. The end results have been universally good. The results have been based on a subjective evaluation by the patient, 92% regarding the end results of the procedure to be excellent. In regard to function, 92% of the patients have been able to resume their preinjury activity. The evidence of instability of the ankle joint can be determined by preoperative x-ray examination. However, careful history and physical examination obviate the need for x-ray studies in most cases. Operative findings have confirmed our preoperative evaluation in all cases. The modification of the Watson-Jones procedure, using the peroneus longus, enables the operating surgeon use of a much greater tendon in reconstruction of the lateral ligamentous structures. No change in the function of the foot has been noted in the reported cases.