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We describe a patient with membranoproliferative glomerulopathy associated with a mixed-cell germinal ovary tumor (embryonal and dysgerminoma components). Advanced renal failure ensued without remission of nephrotic syndrome after surgery. Five other cases of ovary tumor associated with glomerulopathy and reported in the literature are reviewed. The association between membranoproliferative glomerulonephritis and mixed-cell germinal ovary tumor has not been previously reported.

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Introducción: La mortalidad materna en nuestro país es muy alta; se estima entre 29 a 90 x 100.000 nacidos vivos; la preeclampsia-eclampsia representa alrededor del 36 por ciento de las defunciones, de las cuales la hemorragia cerebral es la principal causa de muerte; no se conoce el mecanismo fisiopatológico, especulando históricamente al vasoespasmo como el evento común en esta patología.Objetivo: Describir la velocidad de flujo sanguíneo cerebral en las pacientes con preeclampsia-eclampsia y compararlo con pacientes con embarazo normal. Material y métodos: Se diseñó una encuesta comparativa que incluyó a 116 pacientes con embarazo de 24 o más semanas, 76 pacientes sin patología previa o concomitante a la gestación (grupo A) y 40 pacientes con diagnóstico de preeclampsia-eclampsia (grupo 13), y previo consentimiento informado se les midió la velocidad de flujo sanguíneo cerebral y el índice de pulsatilidad en los principales vasos (arteria cerebral media, sifón carotídeo, arteria vertebral derechas e izquierdas, respectivamente, así como el tronco de la arteria basilar) a través de ventanas ultrasónicas convencionales (temporal, orbitaria y occipital) utilizando un equipo de Doppler pulsado (Trans-Sean EME 3-D Transcranial Doppler Scanner). Resultados: Los grupos comparados, como cabría esperar, mostraron gran diferencia por efecto de la presión arterial media; la velocidad de flujo sanguíneo cerebral y el índice de pulsatilidad comparativamente no mostró cambios importantes por efecto de esta patología; finalmente el análisis entre las pacientes con sintomatología neurológica tampoco mostró diferencias (U de Mann-Whitney). Conclusiones: La velocidad de flujo sanguíneo cerebral en los vasos estudiados se incrementa en pacientes con preeclampsia-eclampsia sin significacia estadística, por lo que inferimos que el vasoespasmo puede ser un evento fisiopatológico secundario y no la causa como se ha postulado hasta ahora (AU)

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While only a small proportion of adult-onset diabetic patients develop vision threatening retinopathy, this group makes up a major portion of those diabetics seeking ophthalmologic care. Fifty-three percent of patients having fundus photographs at the W.P. Beetham Eye Unit of the Joslin Clinic developed diabetes at the age of 20 or over, and almost 30% at the age of 40 or over. Twenty-two percent of all patients seen with proliferative retinopathy were in this latter group. Ten of 54 patients with proliferative retinopathy in the greater than or equal to 40 onset group were not taking insulin. The older onset patients who developed proliferative retinopathy did so after shorter durations of diabetes and with more visual disability than younger onset patients. Macular edema was more common in adult-onset patients, and its presence in a patient less than 50 years old was usually associated with proliferative or preproliferative retinopathy.

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The clinical and photographic records of patients with juvenile-onset diabetes and nonneurologic disc edema were reviewed to determine the natural history of the disease. Six female and two male patients, 14 to 40 years old, who had had diabetes for seven to 22 years had no visual complaints or mild blurring. All had 6/9 or better visual acuity and normal blood pressure. Visual fields were normal or showed an enlarged blind spot. The edematous discs had superficial, dilated, radially oriented, fluorescein-incontinent capillaries. Two patients had simultaneous neovascularization of the disc. Three received laser photocoagulation, and five received no therapy. In the seven followed up for six months or more, the edema resolved, resulting in 6/6 visual acuity. These findings suggest the edema resulted from a reversible vasculopathy that, due to few symptoms, may be more common than is presently appreciated.

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Patients with severe diabetic nephropathy often have diabetic retinopathy requiring eye surgery. During the course of their nephropathy, which was treated medically (group A, N = 34), with dialysis (group B, N = 18), or with renal transplantation (group C, N = 2), 54 diabetic patients have had eye surgery. The ophthalmologic procedures included cataract extraction, vitrectomy, scleral buckling, and cyclocryosurgery. The complications included postoperative hemorrhagic glaucoma and persistent retinal detachment. These were encountered in two patients of group A and in two of group B. All other cases showed uneventful intra- and postoperative courses. Major eye surgery can be performed safely during therapy for diabetic nephropathy, including hemodialysis with anticoagulation and transplantation with immunosuppression.

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