1/23. Lingeous conjunctivitis with tracheal obstruction. A case report, with light and electron microscopy findings.A white male infant of 1 year had unilateral membranous conjunctivitis and severe laryngotracheobronchitis which required tracheostomy. Cultures from eye and throat swabs and of fluid suctioned through the tracheostomy grew many organisms, including H. influenzae, adenovirus type 3, and candida species, but he had no specific immunologic disturbance. Ligneous conjunctivitis was diagnosed. The infant's general condition responded slowly to intensive therapy but the membrane continued to slough off the regrow. The excised membrane contained massive subepithelial deposits of eosinophilic material and a moderately vascular chronic inflammatory-cell infiltrate with numerous mast cells in the perivascular spaces and the hyaline membrane. The conjunctivitis cleared when treated with topical sodium cromoglycate (Intal), a known inhibitor of mediator release from mast-cell granules. The success of Intal therapy in this case supports the theory that mast cells are involved in the pathogenesis of ligneous conjunctivitis.- - - - - - - - - - ranking = 1keywords = obstruction (Clic here for more details about this article) |
2/23. Ligneous conjunctivitis: biochemical evidence for hypofibrinolysis.Ligneous conjunctivitis (LC) is a rare disease of unknown etiology characterized by the growth of "woody" plaques on ocular and extraocular mucosa. These lesions are comprised of fibrin and both direct and indirect evidence implicates hypofibrinolysis as the primary defect in LC. To further elucidate the pathophysiology of LC we investigated the biochemical aspects of ligneous lesions with respect to the fibrinolytic system. Ligneous lesions were obtained from the right eye of a 15 year-old female patient with longstanding LC since age 2.5 year. Ligneous conjunctivitis in this patient has exhibited a chronic recurrent coarse and has involved multiple muscosal sites. Samples analyzed included an abundant mucoid thread from the conjunctival fornix and the ligneous plaque attached to the inferior tarsus. Samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to characterize protein profiles and by a variety of zymographic methods to visualize fibrinolytic enzymes. We found that mucoid and ligneous samples were distinct entities. Specifically, ligneous samples contained polypeptides with electrophoretic profiles characteristic of intact fibrin, and were replete in fibrin-bound tissue plasminogen activator (t-PA). Despite the presence of ample t-PA, ligneous samples were essentially devoid of fibrinolytic activity. In contrast, neither proteins nor t-PA could be detected in mucoid samples when fractionated by 7.5-15% SDS-PAGE or analyzed by fibrin zymography, respectively. Despite the absence of t-PA, mucoid samples were replete in fibrinolytic activity. This activity was plasminogen independent, heterogenous and inhibited by PMSF. Degradation profiles suggested that this activity represented in part alpha-chymotrypsin, consistent with this patient's treatment regime, as well as plasmin, elastase and an unidentified neutrophil-derived activity. Interestingly, ligneous samples contained both latent and activated forms of matrix metalloproteinase-9 (MMP-9), whereas mucoid samples contained predominantly activated forms of MMP-9. LC is characterized by defective fibrinolysis, despite the presence of ample t-PA and intact fibrin, and by an abundant mucoid thread which binds both endogenous and exogenous enzymes including serine protease(s) and collagenase(s). The implications of these results with respect to a role for exuberant mucus production or abnormal mucins in the development of a relative mucosal-site specific plasmin(ogen) deficiency is discussed.- - - - - - - - - - ranking = 0.02344968582829keywords = duct (Clic here for more details about this article) |
3/23. Otolaryngological manifestations of ligneous conjunctivitis.Ligneous conjunctivitis is a rare condition that can involve the mucous membranes of the upper and lower airways and temporal bone extensively. This can lead to life threatening airway obstruction. Involvement of the middle ear and mastoid may cause significant conductive hearing loss. This is the first reported case with temporal bone sections of ligneous conjunctivitis, and awareness of the associated obstructive hydrocephalus may prevent death in this condition. Evidence suggests that plasminogen deficiency may be a causative factor in ligneous conjunctivitis, and this finding may offer new prospects for management.- - - - - - - - - - ranking = 0.27344968582829keywords = obstruction, duct (Clic here for more details about this article) |
4/23. Tarsal-conjunctival disease associated with Wegener's granulomatosis.OBJECTIVE: To describe the clinical characteristics of tarsal-conjunctival disease in a cohort of patients with Wegener's granulomatosis (WG). DESIGN: Retrospective, case-controlled study. PARTICIPANTS: The medical records of 82 consecutive WG patients who underwent an eye examination between January 1996 and June 2002 at the National Institutes of health were reviewed. methods: Details of the ophthalmic examination, results of medical therapy, and histopathologic analysis results were recorded. Tarsal-conjunctival disease was defined by (1). conjunctival hyperemia and granuloma formation, areas of necrosis, or active fibrovascular changes in the tarsus or conjunctiva, or (2). evidence of inactive fibrovascular scar. The association of tarsal-conjunctival disease with major organ system involvement was assessed using Bayesian methods. MAIN OUTCOME MEASURES: The occurrence and clinical characteristics of tarsal-conjunctival disease in a cohort of patients with WG and associations with major organ system involvement. RESULTS: Tarsal-conjunctival disease occurred in 13 of 82 patients (16%) with WG examined over a 6.5-year period. The palpebral surface of the upper lid was involved most commonly, showing conjunctival hyperemia in seven patients, granulomatous lesions in three patients, tarsal-conjunctival necrosis in four patients, active fibrovascular proliferation in six patients, and inactive fibrous scar tissue in seven patients. Histopathologic analysis of eyelid biopsy specimens showed granulomatous inflammation, focal necrosis, and areas of occlusive vasculitis in the tarsus and conjunctiva. In reviewing the patterns of organ involvement in patients with and without tarsal-conjunctival disease, the association of subglottic stenosis and nasolacrimal duct obstruction with tarsal-conjunctival disease showed a high probability of clinical significance. CONCLUSIONS: Tarsal-conjunctival disease, a previously uncommon finding in patients with WG, was characterized by inflammation of the palpebral conjunctiva and tarsus followed by a fibrovascular proliferation and scar formation. Because of the important association of tarsal-conjunctival disease with subglottic stenosis, which can progress and lead to laryngeal obstruction and respiratory failure, patients with tarsal-conjunctival disease should be referred to an otolaryngologist for evaluation.- - - - - - - - - - ranking = 47.168626748029keywords = duct obstruction, obstruction, duct (Clic here for more details about this article) |
5/23. Sclerosing peritonitis and propranolol.Sclerosing peritonitis developed in a 43-year-old man with angina pectoris who had been receiving the beta-adrenergic receptor antagonist, propranolol. The patient had abdominal and back pain, weight loss, a midabdominal fullness, ascites, and evidence of partial small bowel obstruction. At surgery, the small bowel was distended and encased by dense fibrous tissue. Infectious and neoplastic causes of fibrosing peritoneal inflammation were excluded. The patient described in this report illustrates several features commonly experienced by individuals who developed sclerosing peritonitis associated with beta-adrenergic receptor blockade therapy. To my knowledge, the development of ascites and considerable ascitic fluid leukocytosis have not been described previously with this disorder.- - - - - - - - - - ranking = 0.25keywords = obstruction (Clic here for more details about this article) |
6/23. Ocular involvement in cutaneous leishmaniasis four cases with blepharoconjunctivitis.PURPOSE: To determine the rate of ocular involvement in cutaneous leishmaniasis (CL). methods: Nine hundred and eighty seven cutaneous leishmaniasis patients diagnosed and identified by clinical examination and parasitological methods in Harrankapi health Centre between January 1996 and November 1997 were examined at the Harran University School of medicine Eye Clinic, Sanliurfa, turkey. RESULTS: One thousand seven hundred and three CL lesions were identified in 987 patients (484 women and 503 men) with ages ranging from 0 to 78 years (mean /- SD 16.70 /- 13.47 years). A total of 33 lesions were located on the eyelid and in the periorbital region, making up 1.93% of all cutaneous lesions and 3.57% of facial lesions. In three cases with ocular involvement, blepharoconjunctivitis was identified, and in one case with ocular involvement, mechanical ptosis, lagophthalmos and blepharoconjunctivitis were identified. CONCLUSIONS: It was observed that the size of the lesions and their vicinity to the marginal free edge of the eyelid played an important role in the occurrence of ocular symptoms. It was concluded that many ocular findings could be missed because of the failure to conduct ophthalmological examination of CL cases with eyelid involvement, and hence, proper follow up and treatment may not be carried out.- - - - - - - - - - ranking = 0.02344968582829keywords = duct (Clic here for more details about this article) |
7/23. Masquerade syndrome: sebaceous carcinoma presenting as an unknown primary with pagetoid spread to the nasal cavity.Sebaceous carcinoma of the eyelid is an uncommon tumour with unusual modes of presentation. It can remain occult at the primary site, without producing any mass, masquerading as chronic blepharoconjunctivitis, while setting up metastases in the regional lymph nodes especially in the pre-auricular group. We report here a case that not only masqueraded as chronic blepharoconjunctivitis with nodal metastases from an 'unknown primary' in the neck, but whose tumour spread in a pagetoid manner along the nasolacrimal duct producing a nasal tumour that was believed to be the 'unknown primary'. This case emphasizes the need for ophthalmologists, ENT surgeons and pathologists to keep sebaceous carcinoma in mind while evaluating patients with chronic blepharoconjunctivitis and cervical node metastases from 'unknown primary'. Histological clues for picking up a sebaceous carcinoma at a metastatic site include a tumour with comedo or ductal growth pattern and intracytoplasmic lipid.- - - - - - - - - - ranking = 0.046899371656579keywords = duct (Clic here for more details about this article) |
8/23. Congenital hydrocephalus as a rare association with ligneous conjunctivitis and type I plasminogen deficiency.Severe type I plasminogen deficiency is the underlying cause of ligneous conjunctivitis (LC). Furthermore, pseudomembranes may also be found on other mucous membranes (gastrointestinal tract, bronchial system, genital tract). In very rare cases, congenital hydrocephalus has been associated with the more severe forms of the disease and may even precede LC. The pathophysiological mechanism is unclear at present. It is advisable to look for plasminogen deficiency in patients with congenital hydrocephalus, because obstruction of ventriculoperitoneal shunts is possible when such a condition is overlooked. Here, we report a case of LC with hydrocephalus. This report reemphasizes the association of LC with hydrocephalus which is not well known.- - - - - - - - - - ranking = 0.25keywords = obstruction (Clic here for more details about this article) |
9/23. conjunctiva philophthalmosis: a case report in thailand.A 31-year-old Thai woman, a resident of Mapthaphut, Rayong Province, eastern thailand, attended Rayong Provincial Hospital after suffering from consistent irritation of the eye for 5 days. Examination conducted by an ophthalmologist revealed a small worm moving on the conjunctiva of the right eye. The worm was removed and sent for identification. It was 2.9 mm in length, elongated oval, pharynx very large, ceca end close to the excretory pore, genital pore opens in front of the ventral sucker at the cecal bifurcation; it was identified as Philophthalmus sp., a trematode that parasitizes the eyes of birds. This is the first human case of Philophthalmus infection in thailand.- - - - - - - - - - ranking = 0.02344968582829keywords = duct (Clic here for more details about this article) |
10/23. Contact allergy to para-phenylenediamine in a permanent eyelash dye.We present the case of a 30-year-old atopic lady with a known history of intolerance to several materials, including dark stockings, who developed a severe dermatitis on the eyelids and peri-orbital regions, as well as a conjunctivitis after having her eyelashes tinted by a beautician with a permanent black eyelash and eyebrow dye (Combinal, Dr Temt laboratories, austria). patch tests revealed positive reactions to para-phenylenediamine (PPD), both diluted 0.01% and 1% in pet., to the eyelash dye (tested semiopen as is) and to some of the azo-dyes tested. The permanent eyelash dye did contain PPD, the use of which is illegal but seems to be a common practice. The patient had most probably been sensitized through nylon stockings containing azo-dyes, with PPD itself cross-reacting to them. With the growth in popularity of tattooing and permanent make-up, doctors should be aware of the new uses of this old allergen. Moreover, although many manufacturers have made great efforts to improve cosmetics concerning their safety, some of them remain uninformed about cosmetic legislation or do not respect it at all. Because many of these products are acquired via internet, lack of legislation about this shopping modality is also a serious problem.- - - - - - - - - - ranking = 0.02344968582829keywords = duct (Clic here for more details about this article) |
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