Case report: A rare case of cyclodialysis after cataract surgery managed exclusively with medical therapy.

We present the case of a 68-year-old female who presented with a substantial cyclodialysis after phacoemulsification identified by anterior segment optical coherence tomography and ultrasound biomicroscopy. Gonioscopy is challenging because of its shallow anterior chamber. Due to lack of response to topical steroids and refusal by the patient for surgical treatment, topical steroids were tapered, and cycloplegic was initiated. After two weeks, the cyclodialysis cleft was closed on optical coherence tomography persisting residual subchoroidal fluid, topical treatment was mantained. Despite of this, visual acuity and hypotony were restored. Finally at 2 months visit subchoroidal fluid was reabsorbed and patient was discharged. Clinics should consider the possibility of cyclodialysis in cases of unjustified hypotony during postoperative period. In addition, we recommend performing anterior segment imaging which includes ultrasound biomicroscopy and optical coherence tomography, when the evaluation of angular structures is unfeasible. Finally, we propose medical management for severe cyclodialysis as the first option considering anti-inflammatory drugs could perpetrate the separation between scleral spur and ciliary muscle.

Chronic fluid misdirection syndrome of aqueous humor after phacoemulsification: diagnosis, treatment and asscociated factors. / Síndrome de mala dirección del humor acuoso crónico tras facoemulsificación: diagnóstico, tratamiento y factores a tener en cuenta.

The chronic fluid misdirection syndrome of aqueous humor is a rare and serious condition if not treated promptly. The case is presented of a woman attending the emergency department with an intraocular pressure of 43.00mmHg and shallow anterior chamber in her left eye. As clinical history of interest, she had cataract surgery in that eye several weeks before. Following the suspicion of malignant glaucoma, a capsulotomy and iridotomy were performed with an unfavourable outcome. For this reason, it was decided to perform a central vitrectomy, but the patient did not respond to this surgical treatment either. A second surgery was then performed with peripheral vitrectomy, anterior hyaloidectomy, zonulectomy, and iridectomy, obtaining good results. Finally, a decrease in intraocular pressure, and an opening of camerular angle were achieved. Thus, if malignant glaucoma is not resolved in medical consultation with iridotomy and capsulotomy, a vitrectomy, creating a unique chamber that restores the fluid mechanics of the aqueous humor, will be needed.

[Update of diabetic retinopathy for Primary Care physicians: Towards an improvement of telematic medicine]. / Actualización de la retinopatía diabética para médicos de atención primaria: hacia una mejora de la medicina telemática.

Diabetic retinopathy (DR) is considered the most common cause of blindness in the working-age population in industrialised countries, with diabetic macular oedema being the most common reason of decreased visual acuity in diabetics. According to the results of large multicentre studies, blindness prevention for RD involves conducting periodic check-ups, which include examinations of the back of the eye, so they can be treated in time. The use of non-mydriatic cameras and telemedicine have been shown to be useful in this regard (sensitivity>80% and specificity>90%). If this procedure is followed, the first retinography should be performed 5 years from diagnosis in type 1 diabetics and immediately after diagnosis in type 2 diabetics. Therefore the role of the Primary Care physician is crucial to enable early diagnosis of this disease.

[Effectiveness of Bacillus sphaericus strain 2362 on larvae of Anopheles nuñeztovari]. / Evaluación de la efectividad de Bacillus sphaericus cepa 2362 sobre larvas de Anopheles nuñeztovari. Mérida, Venezuela.

A study, under laboratory and field conditions, was conducted to evaluate the effectiveness, persistence in the time and some factors that can affect the larvicidal action of the Griselef formulation of the sporogenous bacteria Bacillus sphaericus strain 2362, on the larvae population of the Anopheles nuñeztovari Gabaldón, the main malaria vector in western Venezuela. The degree of susceptibility of this species to the Bacillus sphaericus was determined to be at a LD50 in 0.07 ppm a LD95 in 0.69 ppm. The pH ranges of the water, as tested in the laboratory, showed that values between 7.0 and 9.0 did not affect the action of the larvicide, producing more than 95% of mortality after 72 hours of observation. Under controlled field conditions, the high susceptibility of the An. nuñeztovari larvae to the larvicidal action of the product was demonstrated. With a dose of 5 ml/m2, a 100% mortality was obtained after 72 hours of exposure. In the field, it was determined that after 12 hours, solar radiation decreased the effectiveness of the B. sphaericus in 30% and that the presence of vegetation reduced the biolarvicidal effect between 5 and 12%. Under natural field conditions, it was shown that the larvicide was effective, since a 100% larval mortality was obtained in the two treated breeding places. This effect persisted up to 4 months of observation, with more than 85% of larvae reduction, showing that it is capable or remaining in the natural environment.

Biliary sludge: a well defined sonographic entity.

OBJECTIVES: Identify the present of biliary sludge (BS) in our patients, since different authors have concluded that this entity may be an etiologic agent of biliary colic, gallbladder stones and some complications such as acute pancreatitis and acalculous cholecystitis. METHODS: We reviewed retrospectively the abdominal sonographic reports of 2802 patients of our gastroenterologic unit, with an average age of 40.5 years. The variables of the protocol were: gallbladder stones, BS and acute and chronic gallbladder inflammation. RESULTS: Considering the mentioned criteria, we entered to the study 2682 patients, 17.8% (n = 479) had lithiasis, 13.2% (n = 356) had BS, 2% (n = 54) had acute gallbladder inflammation and 2.3% (n = 64) had chronic gallbladder inflammation. Of the group of patients with BS 42.7% (n = 152) were female and 57.3% (n = 204) were males. 52% of the patients with BS were between the ages of 26 to 45 years. CONCLUSIONS: In our study we found an important prevalence of BS that was over 13% which is higher than the results reported by additional series. Its early sonographic detection, follow-up, removal of precipitating factors and treatment are all adequate measures in order to achieve its elimination.

Papiloma escamoso de esofago (PEE): reporte de un caso y revision de literatura / Esophageal squamous papilloma: a case report and literature revision

Se relata un caso de Papiloma Escamoso de Esófago (PEE) en una paciente de 90 años. Esta patología es de carácter benigno y por lo general es un hallazgo endoscópico. Sólo existen 150 casos relatados en la literaura médica mundial. Su tratamiento consiste en resección endoscópica con asa diatérmica o un tratamiento conservador de observación más control endoscópico periódico de acuerdo al tipo de paciente. (AU)

Papiloma escamoso de esofago (PEE): reporte de un caso y revision de literatura / Esophageal squamous papilloma: a case report and literature revision

Se relata un caso de Papiloma Escamoso de Esófago (PEE) en una paciente de 90 años. Esta patología es de carácter benigno y por lo general es un hallazgo endoscópico. Sólo existen 150 casos relatados en la literaura médica mundial. Su tratamiento consiste en resección endoscópica con asa diatérmica o un tratamiento conservador de observación más control endoscópico periódico de acuerdo al tipo de paciente.

Syphilitic rectal ulcer associated with perforation of the hard palate: case report.

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advice six years later with the former complication. He tested positive for syphilis and appropriate treatment was performed. In addition, the ORL department recommended a palate prosthesis.

[Esophageal squamous papilloma: a case report and review of the literature]. / Papiloma escamoso de esófago (PEE): reporte de un caso y revisión de literatura.

We report a case of an esophagic squamous papilloma (SP) in a 90 year old patient. This pathology is benign and its diagnosis is generally a finding during an upper digestive endoscopy. Only 150 cases have been reported in the world's medical literature. Treatment consists in an endoscopic resection with diathermic snare or a conservative approach with periodical endoscopic control and observation depending of the type of patient.

Syphilitic rectal ulcer associated with perforation of the hard palate: case report

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advise six years later with the former complication. He tested positive for syphilis and appropiate treatment was performed. In addition, the ORL department recommended a palate prosthesis. (AU)

Syphilitic rectal ulcer associated with perforation of the hard palate: case report

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advise six years later with the former complication. He tested positive for syphilis and appropiate treatment was performed. In addition, the ORL department recommended a palate prosthesis.