Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case

A 13-year-old was admitted to our clinic complaining about a vision loss of over 2 weeks. Bilateral optic disc edema, peripapillary flame-shaped hemorrhages, macular star pattern exudates, and cotton wool spots were found in fundoscopic examination. The OCT exam showed bilaterally serous retinal detachments in sub-foveal region with intraretinal exudates. A pediatric examination found a high systemic hypertension of 230/140 mm Hg, and laboratory tests revealed increased levels of plasmatic and urinary catecholamines. An abdominal MRI showed a left suprarenal pheochromocytoma and the child underwent an adrenalectomy urgently. Informed patient consent was obtained from legal guardians to publish clinical images. Malignant hypertension (MHT) as a result of a pheochromocytoma is an extremely rare condition in childhood. MHT crisis represents a potential life-threatening event and an immediate treatment can prevent a multi-organ failure, including the eyes. An early diagnosis of MHT by fundus examination can lead to a completely favorable ophthalmological evolution and entirely functional recovery

Desarrollo tecnológico con aplicación en terapias fotodinámicas para el tratamiento de lesiones de la piel

La terapia fotodinámica es un tratamiento de primera línea para ciertas lesiones de la piel como la queratosis actínica (QA). Con tales fines se emplean emisores de luz con alto costo de adquisición y mantenimiento. El Departamento de Bioingeniería, del Centro de Microscopía Electrónica de la Facultad de Ciencias Médicas, Universidad Nacional de Córdoba (UNC), desarrolló una nueva versión de dispositivo emisor, de bajo costo de fabricación, que emite luz pulsada intensa y es capaz de irradiar luz roja (630 nm) y azul (405 nm). Este dispositivo es potencialmente útil en el tratamiento de QA y carcinoma basocelular. Por otra parte el Departamento de Farmacia de la Facultad de Ciencias Químicas, UNC, ha formulado el compuesto basado en el ácido α- aminolevulínico (ALA) que es el precursor del agente fotosensibilizador protoporfirina IX, habilitado por la ANMAT en presentaciones similares, y la Farmacia Central del Hospital Nacional de Clínicas (HNC) de la UNC, efectuó la preparación del medicamento como formulación magistral y extemporánea al 20%. Todas estas dependencias internas de la UNC articularon en la ejecución de un proyecto de Innovación Tecnológica, financiado por la SECYT-UNC, a los fines de completar las etapas de desarrollo y los estudios necesarios, para poder utilizar el equipamiento y el medicamento para terapias en el mencionado hospital. El presente trabajo aborda de manera particular, los resultados preliminares obtenidos en el estudio clínico, realizado en el área de Dermatología del HNC. Cabe destacar que como parte del proyecto, se pretende la construcción en serie del dispositivo emisor a través de la Institución Contraparte participante del proyecto, que es una reconocida empresa local fabricante de equipamiento médico.publishedVersio

Der Einfluss von intravitrealem Aflibercept auf das retinale Gefäßkaliber bei Patienten mit diabetischem Makulaödem

Diabetic retinopathy is characterised by impaired retinal vascular autoregulation with signs of early retinal hyperperfusion and subsequent capillary drop out and peripheral ischemia. Initial retinal vascular dilation indicates disease progression and subsequent constriction signals a proliferative state. In this pilot study, we examined the effect of intravitreal aflibercept on retinal vessel diameter in patients with diabetic macular oedema

Isolated Internal Ophthalmoplegia from Posterior Cerebral Artery Neurovascular Conflict

We report a rare case of recurrent isolated internal ophthalmoplegia attributed to oculomotor nerve (CN III) compression by the posterior cerebral artery (PCA). A 30-year-old female patient presented with recurrent right-sided headaches, right periorbital pain, and slight anisocoria. Slit-lamp examination revealed normal anterior and posterior segments except for vermiform movements of the right pupil with a temporal hyporeactive flat area. Tonic pupils were ruled out with pilocarpine 0.1% testing. Suspecting an internal ophthalmoplegia, magnetic resonance imaging was ordered which demonstrated the right CN III indented by the PCA, fulfilling the criteria of a neurovascular conflict. The evaluation of unilateral mydriasis from internal ophthalmoplegia should prompt neuroimaging with exclusion of aneurysmal or compressive lesions. CN III palsy can rarely be caused by vascular anatomical variants because of the proximity of the posterior intracranial circulation and CN III. Newer, more precise imaging techniques will better help characterize neurovascular conflicts presenting as cranial nerve palsies

Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serous Chorioretinopathy

Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Introduction: Variation of respiratory care is described between centers around the world.The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. Methods:We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. Results: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. Conclusions. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement. \ua9 Mattioli 1885