RESUMO
ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.
RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Capsulotomia Posterior/métodos , Cápsula do Cristalino/cirurgia , Doenças do Cristalino/cirurgia , Doenças do Cristalino/etiologia , Complicações Pós-Operatórias/cirurgia , Síndrome , Acuidade Visual , Resultado do Tratamento , Tomografia de Coerência Óptica , Transtornos de Início Tardio/etiologia , Cápsula do Cristalino/diagnóstico por imagem , Doenças do Cristalino/diagnóstico por imagem , Lentes Intraoculares/efeitos adversosRESUMO
Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.
Assuntos
Cápsula do Cristalino/cirurgia , Doenças do Cristalino/etiologia , Doenças do Cristalino/cirurgia , Facoemulsificação/efeitos adversos , Capsulotomia Posterior/métodos , Feminino , Humanos , Transtornos de Início Tardio/etiologia , Cápsula do Cristalino/diagnóstico por imagem , Doenças do Cristalino/diagnóstico por imagem , Lentes Intraoculares/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Síndrome , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade VisualRESUMO
OBJECTIVE: Different biological mechanisms may underlie depression beginning in early life (early-onset) and depression beginning later in life (late-onset). Although the relation between inflammation and depression has been studied extensively, the distinct role of inflammation in early and late-onset depression in older patients has not been addressed before. In the cross-sectional part of this study, we explored differences in levels of circulating inflammatory markers and cytokine levels in lipopolysaccharide (LPS) stimulated whole blood between older subjects with a late-life onset depression (≥60 years) and older subjects with an early-onset depression (<60 years). Secondly, in a 2-year follow-up study, we examined if circulating and stimulated inflammatory markers influenced the change in Inventory of Depressive Symptomatology (IDS) scores, and if this relation was different for early- and late-onset depression. METHODS: The study was part of the Netherlands Study of Depression in Older Persons (NESDO). We included 350 patients, all aged 60 and older, with a depressive episode in the previous 6 months: 119 with a late-onset depression and 231 with an early-onset depression. Blood samples were collected and CRP, IL-6, NGAL, GDF15, and, LPS plasma levels were determined and whole blood was LPS stimulated and cytokine levels IL-1ß, IL-6, TNFα, IFNγ, IL-10, and IL-1 receptor antagonist (IL-1ra) were determined. RESULTS: After adjustment for demographics, health indicators, and medication use, increased plasma CRP levels were more strongly associated with late-onset depression than early-onset depression (OR [95% CI]: 1.43 [1.05-1.94]). In the longitudinal analyses, higher circulating IL-6 levels were associated with a significantly slower decline in IDS scores in the crude and the adjusted models (p ≤ 0.027). This relation was not different between late- and early-onset depression. Other circulating and stimulated inflammatory markers were not associated with late- and/or early-onset depression. CONCLUSIONS: This study provides preliminary evidence that low-grade inflammation is more strongly associated with late-onset than early-onset depression in older adults, suggesting a distinct inflammatory etiology for late-onset depression. Cytokine production capacity did not distinguish between early- and late-onset depression.
Assuntos
Depressão/etiologia , Depressão/fisiopatologia , Inflamação/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa , Estudos Transversais , Citocinas/análise , Citocinas/sangue , Depressão/sangue , Transtorno Depressivo/sangue , Transtorno Depressivo/fisiopatologia , Feminino , Fator 15 de Diferenciação de Crescimento/análise , Fator 15 de Diferenciação de Crescimento/sangue , Humanos , Inflamação/sangue , Interleucina-1beta/análise , Interleucina-1beta/sangue , Interleucina-6/análise , Interleucina-6/sangue , Transtornos de Início Tardio/etiologia , Transtornos de Início Tardio/fisiopatologia , Lipocalina-2/análise , Lipocalina-2/sangue , Lipopolissacarídeos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangueRESUMO
When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.
O lobo frontal, quando afetado, pode provocar alterações importantes do comportamento, principalmente na função executiva: planejamento, tomada de decisões, juízo e autopercepção. Contudo, as alterações podem ser de outra natureza, caracterizando-se por marcada indiferença e apatia. É relatado aqui o caso de uma paciente de 81 anos, com alterações súbitas do comportamento, que foram interpretadas inicialmente como um quadro confusional agudo de natureza infecciosa, mas que se mostraram provocadas por uma lesão isquêmica na região frontal.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia Encefálica/complicações , Lobo Frontal/irrigação sanguínea , Transtornos de Início Tardio/etiologia , Transtornos Psicóticos/etiologia , Isquemia Encefálica , Confusão/etiologia , Transtornos do Humor/etiologia , SíndromeRESUMO
When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.
Assuntos
Isquemia Encefálica/complicações , Lobo Frontal/irrigação sanguínea , Transtornos de Início Tardio/etiologia , Transtornos Psicóticos/etiologia , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Confusão/etiologia , Feminino , Humanos , Transtornos do Humor/etiologia , Radiografia , SíndromeRESUMO
Kidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention.
Assuntos
Broncopatias/etiologia , Fístula Cutânea/etiologia , Cálculos Renais/complicações , Transtornos de Início Tardio/etiologia , Doenças Musculares/etiologia , Músculos Psoas , Fístula Urinária/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Pielonefrite Xantogranulomatosa , Tomografia Computadorizada por Raios XRESUMO
ABSTRACTKidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention.