Revista Medica Clinica Las Condes最新文献

The vitreous humor is a gel composed of extracellular matrix and water. It is one of the elements responsible for maintaining the transparency of the intraocular cavity, and thus, the transmission of light to the retina without interference. This transparency can be affected by physiological changes in its structure such as aging or myopia (primary etiology), as well as external or secondary causes (hemorrhage, increased cellularity or crystal deposits), causing vitreous opacities. The clinical expression of these opacities is the visualization of mobile spots in the visual field (myodesopsia or entopsia). The primary causes can usually be managed conservatively, if they do not involve retinal involvement, but in some cases they can considerably affect the quality of life. This can be assessed by objective methods such as: ultrasound, optical coherence tomography or laser scanning ophthalmoscopy, or subjective such as: quality of life or contrast sensitivity questionnaires. In these cases, interventional management with Nd:YAG laser therapy or vitrectomy can be considered.

Disseminated or multisystemic tuberculosis (DTB) is a rare form of presentation of the tuberculosis disease, representing 2-5% of all registered tuberculosis (TB) cases. A high index of clinical suspicion is required for its diagnosis, in addition to corroboration through bacteriological culture media, molecular methods and the characteristic histological patterns. This article presents the case of a patient with TBD, who debuted with adenomegaly in the right inguinal región. Histologically, a granulomatous process, with central necrosis was found. Since TB was not taken into account in differential diagnoses and samples were not sent for culture, the opportunity of an early diagnosis was missed resulting in the dissemination of the bacillus, with the appearance of tuberculous peritonitis and tuberculous gumma. Endometrial involvement may have been the primary focus. The patient did not present clinical or radiological lung involvement, and was HIV negative. She received anti-tuberculosis treatment for 9 months, per the current national scheme, with low doses of steroids for 30 days added at the five month mark, with satisfactory clinical evolution.

Among the tumor pathologies that can affect the orbit, meningiomas, be they primary or secondary, stand out. These tumors grow slowly, in the long term eventually compressing the optic nerve and other structures such as extra-ocular muscles and the eyeball. This translates into exophthalmos and chronic vision loss that can lead to blindness in the affected eye. The adequate clinical interpretation of this medical condition, associated with the use of neuroimaging, mainly computed tomography and magnetic resonance imaging, allow us to make a timely diagnosis. Treatment is primarily based on fractionated stereotactic radiotherapy when the tumor is advancing and the focus is on vision preservation. Surgery is indicated when vision has already been significantly lost or there is a threat of invasion of the optic chiasm. Chemotherapy treatment options are still under study. The vital prognosis of this pathology is good, but functionally it can leave significant sequelae depending on the behavior of the tumor, as well as how early we make its diagnosis.

The objective of this article is to comment on the current state of what is known about orbital meningiomas, their diagnosis and existing therapeutic alternatives.

The set of ocular discomforts associated with the use of screens is called Computer Visual Syndrome (CVS), and it is an increasingly frequent reason for consultation in clinical practice. The etiopathogenesis of CVS is multifactorial, so the use of different medications, supplements, filters, and devices to improve symptoms has been studied.

The use of screens produces an alteration of the ocular surface that increases the risk of presenting dry eye. On the one hand, among the studies carried out in this regard, the supplementation with omega-3 fatty acids, the use of artificial tears and mucin secretagogues have shown a statistically significant benefit in improving symptoms.

On the other hand, there is no scientific evidence to support the use of blue light filter lenses and despite the fact that berry extracts could produce an improvement in the symptoms of dry eye and visual fatigue, there is still a lack of consistent scientific evidence that demonstrates their benefit.

Lastly, taking periodic breaks, using proper body posture and avoiding long periods of screen use is recommended, the distance and orientation of the screen being relevant.

The objective of this article is to evaluate the scientific evidence that exists in this regard associated with CVS.

Temporomandibular joint arthroscopy, described by Dr. Ohnishi in 1976, has become a very useful therapeutic alternative in the treatment of temporomandibular joint (TMJ) pathologies due to its great versatility and low morbidity.

The pathologies of the TMJ are complex, due to their multifactorial origin, ranging from inflammatory joint disorders to degenerative pathologies with severe destruction of the anatomy of the TMJ.

Signs and symptoms are usually diverse, such as pain, alterations in mandibular dynamics, occlusal disorders, among others. These alterations significantly affect the quality of life.

There is no single and exclusive treatment to solve these pathologies, but a multimodal type of treatment has been established, with functional treatments in conjunction with surgical treatments, in the selected cases, being the best choice. TMJ arthroscopy, in the latter cases, is useful because it permits visualization of the joint through a minimally invasive treatment, reducing surgical morbidity as well as being highly versatile in treating different pathologies according to their complexity.

The aim of this article is to review the current status and advances of TMJ arthroscopy as a surgical treatment option for TMJ pathologies.

A 65-year-old woman, with diffuse large B-cell lymphoma and catastrophic respiratory failure due to COVID-19, requiring extracorporeal membrane oxygenation support. She developed macro agglutination and multisystem arterio-venous thrombosis. Which factor activated the coagulation cascade?

The SARS-CoV-2 pandemic outbreak, and its respective disease COVID-19, have affected the modality of care in health centers due to their confinement measures, limiting care exclusively to emergency cases such as trauma and infections of the maxillofacial territory. Prior to the COVID-19 pandemic, automobile accidents predominated as the causal factor for maxillofacial trauma, followed by aggression from third parties, falls and sports practice, among others. However, the implementation of quarantines and confinement, especially in underserved areas, limited displacement, generating a change in the habits of the population. Our objective is to determine if there was an epidemiological impact associated with fractures of the maxillofacial territory in terms of incidence, etiology, and clinical presentation.