1/152. Acute encephalopathy with bilateral striatal necrosis: favourable response to corticosteroid therapy.A case of acute encephalopathy with selective bilateral symmetrical striatal lesions is reported. The patient was a previously healthy 4-year-old boy who became obtunded after a febrile illness and fell into a state of delirium with severe pain in the feet. He showed abnormal postures: hyperextension of the neck and upper limbs and extreme flexion of both lower limbs, and abnormal involuntary movements of the limbs: tremor, athetotic movement and right hemiballismus. Analysis of serum antibody titres suggested recent primary infection of herpes simplex type 1 (HSV-1). Cranial T2-weighted magnetic resonance imaging (MRI) demonstrated areas of high-signal intensity involving the whole basal ganglia bilaterally. He showed rapid clinical improvement after the initiation of corticosteroid therapy; complete clinical recovery was noted 3 months after the onset. Serial MRI studies demonstrated a rapid reduction of the lesions, resulting in only slight T2-hyperintense areas in both caudate nuclei. The pathogenesis of the disorder remains unknown, though an autoimmune mechanism has been speculated. The clinical and laboratory findings in this case suggested a possible role of HSV-1 in the pathomechanism of the disorder and a beneficial effect of early corticosteroid therapy.- - - - - - - - - - ranking = 1keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
2/152. Midterm follow-up of necrotic bleb excision and advancement of the fornical conjunctiva.mitomycin C has improved the success rate of glaucoma filtering surgery in patients at high risk for surgical failure. However chronic hypotony is marked by decreased vision and a late-onset leaking bleb after filtration surgery using mitomycin C. Bleb excision and conjunctival advancement is the method of choice to repair bleb leakage and chronic hypotony. Five eyes from five patients were received glaucoma filtration surgery with topical mitomycin C. All of the patients' blebs were avascular and transparent. The reasons for bleb excision were two spontaneous bleb leaks, two traumatic bleb leaks and one case of severe irritation. The mean follow-up period was 18.4 /- 8.3 months (ten to 29 months). Cataract surgery was combined in one eye. Postoperative intraocular pressure (IOP) increased from 2.3 /- 1.5 mmHg to 9.5 /- 3.7 mmHg at nine months postoperatively in four eyes. It went from 28 mmHg to 40 mmHg in one patient with uveitis, for whom a second trabeculectomy with mitomycin C; 0.4 mg/ml for 3 minutes, was performed. After surgery, IOP decreased to 4 mmHg in three months. Postoperative visual acuity improved four snellen lines in three eyes. A partially avascular bleb recurred in three eyes, a corneal bleb in one eye and blepharoptosis, which disappeared spontaneously at four months postoperatively, in one eye. Necrotic bleb excision and advancement of fornical conjunctiva were useful methods to increase IOP and to improve visual acuity for the patient experiencing irritation symptoms, and for leaking blebs, and hypotonic maculopathy.- - - - - - - - - - ranking = 0.00081344088480733keywords = ocular (Clic here for more details about this article) |
3/152. Bilateral necrotizing scleritis and blindness in the myelodysplastic syndrome presumably due to relapsing polychondritis.PURPOSE: The purpose of this study was to report a case of bilateral blindness, bilateral necrotizing scleritis, and bilateral deafness in a patient with myelodysplastic syndrome (MDS). In such a patient, the possibility of relapsing polychondritis (RPC) associated with MDS must be considered. CASE REPORT/methods: A 66-year-old patient suffered from myelodysplastic syndrome (MDS). Shortly before his death, he became bilaterally blind and deaf. A biopsy was taken from the conjunctiva and the bone marrow, and both eyes were obtained after death for further investigation. Findings of the clinical and laboratory work-up for the patient's hematologic disorder as well as an examination of the eyes by light microscopy and immunohistochemistry are presented. RESULTS: Ocular sections showed a diffuse necrotizing scleritis with moderate uveitis and no identifiable infectious agent. Neither was there any evidence of a leukemic infiltration. The deafness had been due to inner ear failure, and the patient died of a cardiac failure. CONCLUSIONS: Non-infectious scleritis associated with inner ear deafness is a strong indication of relapsing polychondritis (RPC). Furthermore, RPC can be associated with MDS. Thus, in addition to leukemic infiltration and infection involving ocular structures, ophthalmologists and otolargyngologists should be aware of the association between MDS and RPC and the potential complications.- - - - - - - - - - ranking = 0.00081344088480733keywords = ocular (Clic here for more details about this article) |
4/152. Graft failure in human donor corneas due to transmission of herpes simplex virus.AIM: To report the clinical consequences of contamination of human donor corneas by herpes simplex virus (HSV) in organ culture. methods: Two patients without previous history of ocular HSV infection underwent penetrating keratoplasty (PK), one for keratoconus and the other for fuchs' endothelial dystrophy. One patient suffered primary graft failure while the other developed a persistent epithelial defect, ultimately resulting in graft failure. Viral culture of swabs taken from both corneas during the early postoperative period was undertaken. The failed donor corneas were examined histopathologically by immunohistochemistry (IHC) for HSV-1 antigens, transmission electron microscopy (TEM), and by polymerase chain reaction (PCR) for HSV dna. Both failed corneas were replaced within 6 weeks of the initial surgery. The records of the fellow donor corneas were also examined for evidence of infection. RESULTS: HSV was cultured from both corneas during the early postoperative period. histology of both donor corneas demonstrated a thickened corneal stroma with widespread necrosis of keratocytes and loss of endothelial cells. IHC showed keratocytes positive with antibodies to HSV-1 antigens. TEM demonstrated HSV-like viral particles within degenerating keratocytes. PCR performed on the failed corneal grafts was positive for HSV-1 dna, whereas PCR performed on the excised host corneal buttons was negative in both patients. Records of the fellow donor corneas showed that one cornea was successfully transplanted into another recipient after 18 days in organ culture, whilst the other was discarded because of extensive endothelial cell necrosis noted after 15 days in organ culture. CONCLUSION: HSV within a donor cornea may cause endothelial destruction in organ culture and both primary graft failure and ulcerative keratitis after transplantation. Endothelial necrosis of a donor cornea in culture also raises the possibility of HSV infection within the fellow cornea.- - - - - - - - - - ranking = 5.0223332542592keywords = herpes simplex, simplex, herpes, keratitis, ocular (Clic here for more details about this article) |
5/152. association of herpes simplex virus encephalitis and paraneoplastic encephalitis - a clinico-pathological study.A 57 year-old woman developed acute limbic encephalitis and brainstem dysfunction. Anti-HU antibodies were repeatedly detected in serum and CSF. Postmortem examination showed necrotic and hemorrhagic lesions in the temporal lobes characteristic of herpes simplex virus encephalitis, which was confirmed by immunocytochemistry, and Purkinje cell loss with proliferation of Bergman glia and myelin loss in the external aspect of the dentate nuclei characteristic of paraneoplastic encephalitis. PCR-assay performed on temporal tissue extracts was positive for HSV-1. There was no identifiable neoplasm. This unusual association raises the possibility of a link between the two diseases.- - - - - - - - - - ranking = 5keywords = herpes simplex, simplex, herpes (Clic here for more details about this article) |
6/152. Necrotizing conjunctival ulceration following subconjunctival depot methylprednisolone injection.To report the occurrence of a necrotizing conjunctival ulcer at the site of methylprednisolone injection. A 35-year-old woman underwent a routine extracapsular cataract extraction. Subconjunctival methylprednisolone acetate (Depo-Medrol, Pharmacia & Upjohn, Kalamazoo, MI) was injected at the end of the operation. A necrotizing conjunctival ulcer developed at the site of injection. Necrotic tissue and remnants of the drug were excised, and the conjunctiva healed within 10 days. Postoperative subconjunctival injection of methylprednisolone may cause necrosis and ulceration of the overlying conjunctiva. Subconjunctival and subtendon corticosteroid injections are commonly used in various inflammatory ocular conditions and prophylactically after intraocular operations. We describe a case of conjunctival necrosis at the site of injection, an adverse effect that has been previously reported in only 1 case in the ophthalmological literature.- - - - - - - - - - ranking = 0.0016268817696147keywords = ocular (Clic here for more details about this article) |
7/152. Microvascular submandibular gland transfer for severe cases of keratoconjunctivitis sicca.Free submandibular salivary gland transfer was investigated as a surgical method for the treatment of severe keratoconjunctivitis sicca. In an animal model, we examined the tolerance of warm ischemia of the submandibular gland. After temporary interruption of the blood supply (1 to 6 hours), the morphologic changes in the submandibular gland were analyzed histologically and immunohistochemically in 41 rabbits. From 1.5 hours ischemia onward, an increasing structural damage of the parenchyma with emphasis on the secretory cells was seen. Six hours of ischemia caused total necrosis of the salivary gland. Our clinical experience includes 24 highly selected patients suffering from keratoconjunctivitis sicca, in whom we transferred 31 autologous submandibular glands to the temple for permanent autologous tear substitution within the past 4 years. The glands were implanted into a pocket prepared in the temporalis muscle, and the nourishing vessels were anastomosed to the superficial temporal artery and vein. The submandibular duct was implanted into the upper lateral conjunctival fornix. The transferred glands were left denervated. In addition to the clinical examination, scintigraphy with Tc 99m pertechnetate was used to document the graft's viability after the transfer. Viable incorporation with longstanding secretory function occurred in 26 of the 30 transplanted denervated salivary glands. The resulting lubrication of the treated eyes was irregular for up to 3 months in almost even case. One year after surgery, all patients with a viable transplant developed at least occasional epiphora, which was surgically managed by reducing the size of the graft in 10 patients. No severe side effects were seen in this series. The ophthalmologic evaluation of the method included the assessment of dry eye symptoms and of the volume and quality of ocular lubrication (Schirmer test, fluorescein break-up time), the pathology of the ocular surface (rose bengal staining), and the need for pharmaceutical tear substitutes. One year after surgery, 18 of 27 cases assessed were judged as significantly improved by these tests.- - - - - - - - - - ranking = 0.0016268817696147keywords = ocular (Clic here for more details about this article) |
8/152. Fatal infectious mononucleosis. association with liver necrosis and herpes-like virus particles.A 20-year-old woman died of infectious mononucleosis associated with extensive hepatic necrosis with herpes-type inclusions within nuclei of remaining liver cells. Electron microscopical examination of these liver cells showed intranuclear and occasional intracytoplasmic herpes-like virus. This case supports the concept that a herpes-like virus, or a structurally closely related agent, is the etiological agent of infectious mononucleosis.- - - - - - - - - - ranking = 0.53997397903818keywords = herpes (Clic here for more details about this article) |
9/152. Herpesvirus infection of seborrheic keratoses.We present three examples of patients with seborrheic keratoses complicated by necrotizing herpesvirus infection. Two patients had localized cutaneous herpetic infections, and the third patient had a generalized cutaneous herpesvirus infection. Two of the lesions were thought to be squamous cell carcinoma. The third was clinically identified as inflamed seborrheic keratosis. Herpesvirus infection was not clinically suspected in two of the patients. The histologic changes were similar in all cases. Epidermal proliferation was accompanied by hyperkeratosis and pseudo horn cyst formation. Extensive keratinocyte necrosis was present along with balloon degeneration of keratinocytes, herpetic viral inclusions, and multinucleated giant cells. Viral lesions of molluscum contagiosum and human papillomavirus have been observed in benign skin proliferations. Nevertheless, we were unable to find descriptions of herpesvirus involvement in seborrheic keratosis in a medline search. Necrotic seborrheic keratoses should be carefully examined for the possibility of herpesvirus infection, a condition that may be improved by prompt medical intervention as demonstrated in one of our cases.- - - - - - - - - - ranking = 0.30855655945039keywords = herpes (Clic here for more details about this article) |
10/152. Central necrotic lamellar inflammation after laser in situ keratomileusis.PURPOSE: To report four cases of corneal interface complications that occurred after excimer laser in situ keratomileusis (LASIK). methods: Four eyes of three patients underwent technically uneventful LASIK. RESULTS: One day after LASIK, patients presented with severe pain, blurred vision, conjunctival infection, and diffuse opacity at the interface. Two days after LASIK, significant features were central opacity, striae in the flap, loss of uncorrected and best spectacle-corrected visual acuity, and corneal sensitivity. The findings did not improve by using drugs or by lifting the flap and irrigating the bed. The central opacity partially resolved over 8 to 12 months, leaving a hyperopic shift (one patient), striae (one patient), and loss of two or more lines of best spectacle-corrected visual acuity (three patients). CONCLUSION: This severe central inflammation after LASIK could be an extreme manifestation of diffuse lamellar keratitis.- - - - - - - - - - ranking = 0.021519813374384keywords = keratitis (Clic here for more details about this article) |
| | Next -> |