1/6. Avascular necrosis in the femoral head secondary to bone marrow infarction in a patient with graft-versus-host disease after unrelated bone marrow transplantation.We previously reported a case of bone marrow infarction attributable to acute graft-versus-host disease (GVHD) in a patient with acute lymphoblastic leukemia after unrelated bone marrow transplantation (BMT). Although the bone marrow infarction-induced arthralgia in this patient improved, severe arthralgia appeared again with exacerbation of chronic GVHD, and the arthralgia was strongly correlated with the clinical course of chronic GVHD, i.e., the course of symptoms such as dermal and hepatic GVHD and ocular dryness. Finally, the patient developed avascular necrosis (AVN) in the right femoral head. serum interleukin (IL)-6 and IL-10 levels were high at the onset of arthralgia but low during remission, and levels of interferon-gamma were undetectable throughout the period of arthralgia. Based on the clinical course and these data, chronic GVHD was thought to have been the major cause of the AVN. Since IL-10 antagonizes various other cytokines that induce GVHD, the increase in IL-10 might have inhibited the development of GVHD.- - - - - - - - - - ranking = 1keywords = dryness (Clic here for more details about this article) |
2/6. Sight and comfort: complex procedures in end-stage stevens-johnson syndrome.BACKGROUND: We describe our complex surgical techniques in the management of a patient with end-stage ocular surface disease from stevens-johnson syndrome. methods AND RESULTS: Her severe discomfort due to absolute ocular dryness in the right eye was successfully treated with submandibular gland autotransplantation. Impending loss of the left eye due to repeated perforation and infection was prevented with a penetrating corneal graft covered by a new modification of a Cutler-Beard-type full-thickness lower lid skin advancement-flap. Visual rehabilitation was achieved by means of osteo-odonto-keratoprosthesis. CONCLUSION: The procedures described allow the preservation of eyes doomed for enucleation, relief from severe discomfort and rehabilitation from corneal blindness. Due to their complex nature they require the collaborative subspecialist surgical skills of opthalmologists and maxillofacial surgeons.- - - - - - - - - - ranking = 1keywords = dryness (Clic here for more details about this article) |
3/6. Congenital reduplication of the lacrimal punctum and canaliculus in a patient with dry eye.A healthy 60-year-old woman presented with bilateral dry eye syndrome that was more pronounced in the right eye than in the left eye. Two patent independent supernumerary puncta and canaliculi were found in the right upper eyelid. This condition may explain the more severe dryness in her right eye. Successful punctum occlusion was accompanied by marked resolution of symptoms in both eyes.- - - - - - - - - - ranking = 1keywords = dryness (Clic here for more details about this article) |
4/6. The correction of unilateral aphakia in children treated for orbital rhabdomyosarcoma.The survival rate of children with localized orbital rhabdomyosarcoma is now greater than 90% 3 years after diagnosis as a result of advances in radiation and chemotherapy. Ninety percent of these children develop cataracts within 1 to 4 years after the completion of radiotherapy. The correction of aphakia in these children is complicated by the concurrent keratoconjunctivitis and dryness associated with radiotherapy. Three patients with a diagnosis of orbital rhabdomyosarcoma underwent treatment for uniocular cataract. Two of the patients were unable to use extended wear contact lenses. Both underwent epikeratophakia with poor results. One patient who had clinically significant ocular drying prior to cataract extraction underwent successful implantation of an intraocular lens as a primary procedure, with excellent visual results. Clinicians should be aware of the difficulties associated with contact lens wear and epikeratophakia tissue lenses in children who have had high doses of radiation for orbital rhabdomyosarcoma. Such patients are probably best served by primary intraocular lens implantation or by preservation of the posterior capsule at the time of cataract extraction to allow secondary lens implantation if contact lens wear is unsuccessful.- - - - - - - - - - ranking = 1keywords = dryness (Clic here for more details about this article) |
5/6. The forgotten cause of sicca complex; sarcoidosis.sarcoidosis is a chronic systemic disease of unknown cause with prominent symptoms from the respiratory system. It can occasionally affect the exocrine glands presenting with xerophthalmia and xerostomia similar to sjogren's syndrome. We present 5 such patients who visited our rheumatology clinic complaining of dry eyes and mouth. Investigation for xerophthalmia and xerostomia showed positive rose bengal tests in all patients, positive Schirmer's I tests in 4 and decreased parotid flow rate in 3. Minor salivary gland biopsy showed noncaseating granulomas compatible with sarcoidosis in 3. In the other 2 patients the diagnosis was obtained with transbronchial lung biopsy that revealed noncaseating granulomas. Transbronchial lung biopsy also showed granulomas in 2 patients with positive minor salivary gland biopsy. Our results suggest that sarcoidosis can present with initial symptoms of dry eyes and dry mouth. When this happens, transbronchial and minor salivary gland biopsy are very valuable in differentiating sarcoidosis from sjogren's syndrome.- - - - - - - - - - ranking = 4.5660574750918E-5keywords = mouth (Clic here for more details about this article) |
6/6. vitamin a in stevens-johnson syndrome.A 9-year-old boy was admitted to the Pediatric Department with high fever, severe photophobia, and a rash on his face, eyelids, and neck. Two days before admission he received injections of penicillin. During the night his general condition worsened, and his fever rose to 40 degrees C. He began to hallucinate, and clear fluid-filled blisters appeared on his skin and mouth. Severe photophobic epiphora, conjunctival injection, and punctate keratitis were also observed. Several hours after local administration of corticosteroids and antibiotic eye drops, his eyelids swelled severely, the corneas became covered by pseudomembranes, and later, in attempting to open the eyelids, the skin peeled off and the eye lashes fell out. Treatment consisted of artificial tear eye drops, and intravenous antibiotics and steroids. His condition improved gradually, visual acuity became 6/15 in both eyes, and a superficial punctate staining of the cornea was observed. The Schirimer test showed lacrimal hyposecretion. A tarsal conjunctival biopsy showed a complete absence of goblet cells. vitamin a was administered topically and systemically. After three months of treatment with vitamin a, tear secretion was almost normal, and conjunctival biopsy indicated a regeneration of goblet cells.- - - - - - - - - - ranking = 2.2830287375459E-5keywords = mouth (Clic here for more details about this article) |