[Young patient with eyelid Merkel carcinoma: Mohs microsurgery versus exenteration]. / Paciente joven con carcinoma de Merkel palpebral: microcirugía de Mohs versus exenteración.

CASE REPORT: We present the case of a 47-year-old female suffering from progeria who developed an eyelid Merkel cell carcinoma (MCC) following cyclosporine treatment for a corneal transplant. She underwent excision of the lesion by Mohs micrographic surgery (MMS) and received adjuvant treatment with radiotherapy. Later she had a recurrent tumour for which a wide excision with orbital exenteration was performed. The patient was fit and well at the 24-month follow-up. DISCUSSION: MCC is an aggressive tumour that has a larger incidence in elderly people, women and immunosuppressed patients. Our approach with the patient must be global, avoiding risk factors in predisposed subjects. MMS seems unsuitable for the treatment of MCC; if tumour recurrence occurs a wide resection should be performed (Arch Soc Esp Oftalmol 2009; 84: 581-584).

[Outcomes of inferior access external dacryocystorhinostomy performed by residents]. / Resultados de la dacriocistorrinostomía externa vía inferior realizada por médicos residentes.

PURPOSE: To assess the outcomes of external dacryocystorhinostomy (DCREx) performed by residents at the Hospital Universitari de Bellvitge, comparing the cases operated on by residents and the cases operated on by staff surgeons. METHODS: We performed a retrospective study between January 2006 and December 2007 of all DCREx performed at our hospital. The operations involved 65 cases from 54 patients: 16 operations were performed by residents and 49 by staff surgeons. The cases were divided into two groups: cases operated on by residents and cases operated on by staff surgeons, and the following variables were studied: epidemiologic characteristics of the patients (age, sex), side of intervention, antecedents of lacrimal sac inflammation, type of anesthesia, intrasurgical and postsurgical complications and results. <> was defined as the possibility to pass physiologic serum through the lacrimal pathway and <> if the patient in addition was without symptoms of epiphora. RESULTS: The procedure was successful in 88% of cases: 80% were classified as <> while only 8% were considered <>. The operations performed by residents were successful in 81% of cases (75% <> and 6% <>), whereas staff surgeons achieved success in 90% of cases (82% <> - 8% <>). CONCLUSION: The results show that residents with suitable training and supervision can achieve good success rates approaching those of staff surgeon outcomes, without additional complications (Arch Soc Esp Oftalmol 2009; 84: 501-506).

Paciente joven con carcinoma de Merkel palpebral: microcirugía de Mohs versus exenteración / Young patient with eyelid Merkel carcinoma: Mohs microsurgery versus exenteration

Caso clínico: Se presenta el caso de una pacientede 47 años afecta de progeria que después de tratamientocon ciclosporina por trasplante corneal presentócarcinoma de Merkel (MCC) palpebral. Trasexéresis completa mediante cirugía de Mohs(MMS) y tratamiento adyuvante con radioterapia,recidivó y fue necesario realizar exenteración orbitaria.La paciente se encuentra asintomática tras 24meses de seguimiento.Discusión: El MCC es un tumor agresivo conmayor incidencia en ancianos, mujeres e inmunodeprimidos.Nuestra visión del enfermo debe ser globalevitando añadir factores de riesgo a pacientes yapredispuestos. La MMS parece desaconsejada en eltratamiento del MCC, debiendo realizar una excisiónradical si se produce recidiva(AU)

Case report: We present the case of a 47-year-oldfemale suffering from progeria who developed aneyelid Merkel cell carcinoma (MCC) followingcyclosporine treatment for a corneal transplant. Sheunderwent excision of the lesion by Mohs micrographicsurgery (MMS) and received adjuvant treatmentwith radiotherapy. Later she had a recurrenttumour for which a wide excision with orbital exenterationwas performed. The patient was fit and wellat the 24-month follow-up.Discussion: MCC is an aggressive tumour that hasa larger incidence in elderly people, women andimmunosuppressed patients. Our approach with thepatient must be global, avoiding risk factors in predisposedsubjects. MMS seems unsuitable for thetreatment of MCC; if tumour recurrence occurs awide resection should be performed(AU)

Resultados de la dacriocistorrinostomía externa vía inferior realizada por médicos residentes / Outcomes of inferior access external dacryocystorhinostomy performed by residents

Objetivo: Analizar los resultados de la dacriocistorrinostomíaexterna (DCREx) realizada por losmédicos residentes del Hospital Universitari deBellvitge, estudiando las diferencias de sus cirugíasrespecto a los médicos adjuntos.Métodos: Realizamos un estudio retrospectivoestudiando todas las DCREx realizadas entre enerode 2006 y diciembre de 2007 en nuestro centro quecorrespondieron a 65 cirugías de 54 pacientes, delas cuales 16 fueron realizadas por médicos residentesy 49 por los médicos adjuntos.Se constituyen dos grupos: casos intervenidos porlos médicos residentes y casos intervenidos por losmédicos adjuntos, y se estudian las siguientes variables:características epidemiológicas de los pacientesintervenidos (edad, sexo), lado de intervención,antecedente de inflamación del saco lagrimal, tipode anestesia empleada, complicaciones intraquirúrgicas,postquirúrgicas y resultados de la cirugía. Sedefine como «éxito anatómico» cuando se compruebala permeabilidad de la vía lagrimal al irrigarsuero, y «éxito funcional» cuando además elpaciente no refiere síntomas de epífora.Resultados: En el 88% de los casos se obtuvieronbuenos resultados: en un 80% de los casos se alcanzó éxito funcional y en un 8% sólo anatómico. En lascirugías realizadas por los médicos residentes se consiguióun éxito global del 81% (75% funcional-6%anatómico), frente al 90% de éxito global alcanzadopor los adjuntos (82% funcional-8% anatómico).Conclusión: Los resultados indican que con el adecuadoentrenamiento y supervisión, en la DCRExlos residentes pueden obtener tasas de éxito satisfactorias,muy próximas a las alcanzadas por losadjuntos, sin que exista un incremento en las complicaciones(AU)

Purpose: To assess the outcomes of external dacryocystorhinostomy(DCREx) performed by residentsat the Hospital Universitari de Bellvitge, comparingthe cases operated on by residents and thecases operated on by staff surgeons.Methods:We performed a retrospective study betweenJanuary 2006 and December 2007 of all DCRExperformed at our hospital. The operations involved 65cases from 54 patients: 16 operations were performedby residents and 49 by staff surgeons.The cases were divided into two groups: cases operatedon by residents and cases operated on by staffsurgeons, and the following variables were studied:epidemiologic characteristics of the patients (age,sex), side of intervention, antecedents of lacrimalsac inflammation, type of anesthesia, intrasurgicaland postsurgical complications and results. «Anatomicsuccess» was defined as the possibility to passphysiologic serum through the lacrimal pathwayand «functional success» if the patient in additionwas without symptoms of epiphora.Results: The procedure was successful in 88% ofcases: 80% were classified as «functional success»while only 8% were considered «anatomic success». The operations performed by residents were successful in 81% of cases (75% «functional success» and 6% «anatomic success»), whereas staffsurgeons achieved success in 90% of cases (82%«functional success» – 8% «anatomic success»).Conclusion: The results show that residents withsuitable training and supervision can achieve goodsuccess rates approaching those of staff surgeonoutcomes, without additional complications(AU)

[Paraneoplastic optic neuritis in an unknown small cell lung carcinoma defined by CRMP-5-IgG]. / Neuritis óptica paraneoplásica en carcinoma microcítico pulmonar desconocido definida por marcador CRMP-5-IgG.

CASE REPORT: The case of a 64-year-old patient with bilateral, progressive and painless diminution of visual acuity is presented. Ophthalmologic evaluation revealed optic neuritis and vitreous cells in both eyes, at different stages. Suspecting a paraneoplastic optic neuritis, the study of antibodies was requested. This showed positivity to the marker CRMP-5-IgG. After mediastinoscopy, a small cell lung carcinoma was diagnosed. DISCUSSION: Autoantibody CRMP-5-IgG defines a paraneoplastic entity of combined optic neuritis and vitreous inflammatory cells. The serological positivity avoids the vitreous biopsy and expedites the search for cancer. In our case, it allowed the diagnosis a previously unidentified tumor.