Triamcinolone and bevacizumab as adjunctive therapies to panretinal photocoagulation for proliferative diabetic retinopathy.

Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P = 0.064), 1.11 (P = 0.000), and 1.11 (P = 0.002), and there was a mean loss of 2,6 (P = 0.055), 3.9 (P = 0.011), and 0.9 letters (P = 0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P = 0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.

Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results.

AIM: To describe the anatomical and visual outcome of subfoveal and juxtafoveal choroidal neovascularization (CNV) in highly myopic eyes treated by intravitreal bevacizumab. METHODS: Prospective, nonrandomized, multicentric, interventional pilot study. Twenty-six highly myopic eyes from 25 patients with subfoveal and juxtafoveal CNV were treated by three monthly intravitreal injections with 1.25 mg bevacizumab. Patients were evaluated for best-corrected visual acuity (BCVA) and optical coherence tomography at baseline and then monthly. Fluorescein angiography was performed at baseline and at month 3. RESULTS: Patients averaged 49.5 years of age (SD 16.0, range 29-82). Five patients were male and 20 were female. BCVA at baseline averaged 20/62 (range 20/200-20/32) and 20/38 (range 20/160-20/20) at month 6. Average central foveal thickness was 282.4 microm (SD 68.3, range 168-447) at baseline and 224.0 microm (SD 46, range 132-294) at month 6. Fifteen eyes were naïve for treatment and 11 eyes had been previously treated by photodynamic therapy (PDT) (average 2.5 PDT sessions). Leakage from CNV had ceased in all eyes at month 3 and CNV was still closed at month 6. Neither ocular nor systemic safety issues appeared during the follow-up. CONCLUSIONS: Intravitreal bevacizumab seems to be an effective and safe therapeutic procedure to treat subfoveal and juxtafoveal CNV in highly myopic eyes. Further studies are required to verify the efficacy and usefulness of this therapy compared with established treatments for this condition.

[Emergency contraception: user's profile in primary care emergency services]. / Anticoncepción de emergencia: perfil de la usuaria en servicios de urgencias de atención primaria.

OBJECTIVES: To establish the emergency contraception (EC) users profile and whether she perceives this type of contraception as an emergency. Design. Cross sectorial study (over one year period: March 2002-March 2003). SETTING: Emergency Services in Primary Care. Usera and Carabanchel; 11th Area; Madrid. PARTICIPANTS: Women requesting EC in these centres. MAIN OUTCOME MEASURES: A questionary was filled out for all participants with their age, how many hours had spent since sexual intercourse took place (within 24 h), usual method of contraception used, previous use of EC, level of education, and reason for this request. RESULTS: 89 women. Drops out: 0. Average age: 23.7+/-48 years (range: 16-40 years). 79.8% of them came to medical emergency services in less than 24 h after sexual intercourse. Usual anticonceptive method was the condom (88.8%), 2.2% used hormones, 9% no contraceptive method at all and none of them had used the intrauterine device. 34.8% were previous users of EC. Education levels: 2.2% of women only could read and write, elementary school (37.1%), secondary school (34.8%) and high school (25.8%). Reasons for requesting EC: 91% condom failure, 7.9% not to have used any contraceptive method, and 1.1% wrong use of natural birth control methods. Among the women who had went to the emergency services within the 24 h of the sexual intercourse the 77.4% of all of them had requested EC previously and the 93% of those had requested EC for the first time (P=.032). Likewise all of them with high school level and who could write and read, the 93.9% with elementary school level, and the 71% with secondary studies went to the emergency services within the 24 h of the non protected sexual intercourse (P=.05). CONCLUSIONS: Most of the women were young, they perceived the unprotected sexual intercourses as an emergency, the condom was the most frequently used anticonceptive method, they requested EC due to condom breakage. In 1/3 of the cases the EC had been requested previously and this group and the young women with secondary studies one were who requested it later.

Anticoncepción de emergencia: perfil de la usuaria en servicios de urgencias de atención primaria / Emergency contraception users profile in primary care emergency services

Objetivos. Establecer el perfil de la solicitante de anticoncepción de emergencia (AE) y su percepción de este tipo de anticoncepción como una urgencia. Diseño. Estudio descriptivo transversal de un año de duración (marzo de 2002 a marzo de 2003).Emplazamiento. Servicios de Urgencia de Atención Primaria de Usera y Carabanchel, Área 11 de Madrid. Participantes. Mujeres solicitantes de AE en estos centros. Mediciones principales. Encuesta, contestada por todas las solicitantes, en que se recogían: edad, horas desde el coito (punto de corte: 24 h), método anticonceptivo habitual, uso anterior de AE, nivel de estudios y motivo de solicitud. Resultados. Solicitaron AE 89 mujeres, con una edad media de 23,7 ñ 4,8 años (rango: 16-40 años). El 79,8 por ciento la solicitó antes de que hubieran transcurrido 24 h desde el coito. El 88,8 por ciento utilizaba el preservativo como método de anticoncepción habitual, el 2,2 por ciento usaba anticonceptivos hormonales y el 9 por ciento no empleaba ningún método; ninguna utilizaba el dispositivo intrauterino. El 34,8 por ciento había recurrido con anterioridad a la AE. Por lo que se refiere a la instrucción académica, el 2,2 por ciento tenía un nivel de alfabetización, el 37,1 por ciento había cursado estudios primarios, el 34,8 por ciento secundarios y el 25,8 por ciento universitarios. En cuanto a los motivos de solicitud, en un 91 por ciento de los casos fue por fallos del preservativo, en un 7,9 por ciento por haber mantenido relaciones sin protección y en un 1,1 por ciento por uso incorrecto de métodos naturales. Acudieron al consultorio antes de 24 h poscoito el 77,4 por ciento de todas las mujeres que habían solicitado AE previamente, y el 93 por ciento de las que la demandaban por primera vez (p = 0,032), así como el 100 por ciento de las universitarias y del grupo de alfabetización, el 93,9 por ciento de las mujeres con estudios primarios y el 71 por ciento con estudios secundarios (p = 0,005). Conclusiones. La mayoría de las mujeres que solicitaron AE eran jóvenes, percibían los coitos desprotegidos como urgencias, utilizaban preservativo como anticonceptivo habitual y la rotura de éste fue el motivo por el que solicitaron la AE. Un tercio de ellas habían utilizado AE previamente, y fue este grupo, junto con el de jóvenes con estudios secundarios, las que consultaron más tardíamente (AU)

[Record of neurological emergencies at a tertiary care hospital]. / Registro de urgencias neurológicas en un hospital de tercer nivel.

INTRODUCTION AND OBJECTIVE: There is a progressive increase in the demand for multidisciplinary attention from the Emergency Medical Services. The objective of this study was to determine the proportion of neurological conditions in the total hospital emergency workload, their demographic composition and medical needs. PATIENTS AND METHODS: We present an observational study of a cohort of histories of neurological emergencies at a tertiary hospital during a period of one year. RESULTS: On analysis of all emergencies, 1,592 were neurological conditions. The duty neurologist was consulted in 87.9% of the cases. The average age was 59, and the majority were women (56.3%). Maximum demand was between 14.00 and 19.59 hours. Monday was the day of the week when most were seen. The commonest causes of consultation were change in strength or language, headache and epileptic crises. The complementary investigation done most frequently was a blood test. Cerebral CT scan were done in 31.9% of the patients. The diagnoses most often made, as a group, were cerebrovascular disease followed by epilepsy and headache. The majority of the patients were referred to Primary Care Centres or for neurological consultation. When the patients were grouped according to the specialties with doctors on duty, the second largest group were seen by the emergency neurologist at our hospital. CONCLUSION: In view of the above results, we consider the presence of a neurologist in the Emergency Department to be fully justified.

[What sort of stroke requires patient admittance to the hospital? Factors for deciding on hospitalization]. / Cómo es el ictus del paciente que ingresamos? Factores de decisión en la hospitalización.

OBJECTIVE: To study main factors determining medical decision in admitting patients with acute cerebrovascular disease (ACVD). PATIENTS AND METHODS: This is an observational and transversal study. We analyze a hospitalary cohort made by all consecutive patients with ACVD coming to Emergency Room to Hospital Universitario de la Princesa during 1 year. Neurologist on call made on his/her own decision to admit the patient to hospital. Clinical and epidemiological characteristics of those patients admitted with those who went home are compared. RESULTS: 517 patients were studied, 147 had transient ischemic attacks (TIA) and 370 had a stroke, 12.3% TIA and 68.4% stroke patients were hospitalized. Age, Canadian Stroke Scale (CSS) on admission, subtype of stroke, atrial fibrillation and abnormal EKG, old lesions in CT, previous TIA and/or CVD, diminished conscious level, orientation and language, sphincter control and evolution time greater than 48 hours were statistically significative in deciding admission. Logistic regression analysis (84.2% total predictive value) showed independent predictive value in age, CSS, previous CVD and some subtypes of stroke (ischemic non lacunar and hemorrhage). CONCLUSIONS: We hospitalize younger patients, with a worse clinical condition and overall hemorrhagic stroke. The percentage of admissions among TIA patients is low. On the other hand, date, time and physicians-team features do not affect the percentage of admissions.

[Predictive mortality factors and the development of major complications in non-traumatic subarachnoid hemorrhage]. / Factores predictores de mortalidad y de desarrollo de complicaciones mayores en la hemorragia subaracnoidea no traumática.

Our aim was to analyze death prognostic factors in the first six months or the development of major neurological complications (delayed brain ischaemia and rebleeding) or general complications (cardiorespiratory, hydroelectrolytic or infectious) in non-traumatic subarachnoid haemorrhage. We carried out an observational study of a historical cohort of 111 patients admitted consecutively to our Centre between 1986 and 1992 and who were diagnosed as having subarachnoid haemorrhage based upon clinical data and confirmed in all cases by brain computerized tomography (CT) scan and/or lumbar puncture. Clinical variables upon admission were collected prospectively and radiological data were obtained retrospectively. We performed a logistic regression analysis which showed as significant predictive variables for death in the first six months a score on the Hunt-Hess scale greater than 2, a score on the Glassow scale of less than 9, female, aged over 50 and rebleeding. As predictive factors for delayed brain ischaemia we identified the female sex and the existence of earlier general complications. In the development of rebleeding a significant predictive factor was high blood pressure antecedents although this may have been controlled upon admission. For the appearance of general complications, significant predictive factors were more than 2 on the Hunt-Hess scale and hypertension antecedents. The use of these predictive parameters may help evaluate a prognosis in subarachnoid haemorrhage patients and also help make decisions in the management of this pathology.

Normalization of the delano diagram.

A normalization of the Delano y, y diagram is proposed in which the y heights are normalized by the entrance pupil height, the y heights by the image height. The normalization constants are expressed in terms of the system parameters, and it is seen that the reduced distances become normalized by the focal length of the system, the marginal ray reduced angles by the numerical aperture of the system, the chief ray angles by the field aperture, and the powers by the total power of the system. It is also shown that any number of refractions and transfers will not affect this normalization, but a stop or conjugate shift will destroy it, and renormalization then becomes necessary.