1/17. life-threatening giant mediastinal goiter: a surgical challenge.Mediastinal goiter is a well known benign disease, usually resectable through a cervical approach with minimal morbidity and mortality. Only occasionally a median sternotomy or a lateral thoracotomy may be required. The present case is worthy of presentation because of the exceptional dimension of the disease and the surgical challenge that it presented. In a 72-year-old woman a large intrathoracic goiter of the right thorax caused a severe dyspnoea due to an important contralateral mediastinal shift with compression of the lung, superior vena cava system and trachea. At surgical exploration, through a cervico-sternotomic approach, the mediastinal structures dislocation and the strong adherences between the anomalous neovascularized capsula of the mass and the surrounding structures, complicated the surgical dissection. An accidental lesion of the innominate artery required its reimplantation on the ascending aorta. An immense mass, was finally removed and pathological examination revealed a rare case of neovascularized, pseudosarcomatoid capsula among a benign hyperplastic proliferation. In spite of its benign nature, a giant goiter caused a life-threatening compression of the respiratory tract and lung parenchyma in this patient. The dimension of the lesions, the mediastinal anatomy alterations and the severe intraoperative haemorrhage represented major technical difficulties during surgical resection.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/17. Opaque coating of an intraocular lens and regression of iris neovascularization following injection of triamcinolone acetonide into the anterior chamber.A pseudophakic patient presented with a vitreous haemorrhage and iris neovascularization associated with proliferative diabetic retinopathy. vitrectomy with panretinal photocoagulation and intraocular gas tamponade of an iatrogenic break was performed. As an alternative to intravitreal injection into a gas-filled eye, triamcinolone acetonide was injected into the anterior chamber. Postoperatively, the visual acuity was reduced to light perception by an opaque coating of triamcinolone particles on the intraocular lens and iris which resolved over 2 months. By 4 months, the iris neovascularization had regressed completely. The use of intracameral triamcinolone in pseudophakic eyes may be associated with a transient loss of vision and prevent fundal visualization owing to triamcinolone coating of the intraocular lens.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/17. Massive choroidal haemorrhage as a complication of krypton red laser photocoagulation for disciform degeneration.A 78-year-old man with perifoveal subretinal neovascularization originally treated with krypton red laser was re-treated. An attempt was made to produce a "chalky white" burn at the site of the neovascular frond. Immediately after a burn, a brisk choroidal haemorrhage followed, apparently from a ruptured choroidal vessel. Bleeding occurred subretinally and into the vitreous, blinding the patient. While the krypton red laser carries advantages over the argon laser in the treatment of subretinal neovascular fronds, this case indicates that hard burns with the krypton laser carry a risk of massive subretinal haemorrhage.- - - - - - - - - - ranking = 9.1107519208003keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
4/17. Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy.Between 1960 and 1976 117 patients underwent pituitary implantation with yttrium-90 (90Y) for treatment of proliferative retinopathy at the Hammersmith Hospital, london. Mean age at operation was 35 /- 11 years (mean /- SD), and mean duration of diabetes 18.6 /- 10.0 years. Mean insulin dosage prior to implant was 67.2 /- 24 units, falling to 30.4 /- 14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to follow-up. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carried out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35 /- 10.5 years, and mean duration of diabetes 17.2 /- 8.7 years. visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7 /- 1.6 to 0.8 /- 1.2 (p less than 0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
5/17. Neovascularisation associated with posterior uveitis.Twenty-six patients (39 eyes) with retinal neovascularisation associated with ocular inflammation were identified from the retinal vasculitis clinic at St Thomas's Hospital. Eight patients had sarcoidosis, seven patients Behcet's disease, and 11 had idiopathic retinal vasculitis. Twenty-three patients had required systemic therapy to control the inflammation and 11 patients received laser photocoagulation. fluorescein angiography showed significant capillary closure in 15 eyes and diffuse microvascular leakage in the remaining 24 eyes. All patients had posterior vitreous detachment. The visual prognosis was good despite vitreous haemorrhage being the presenting feature in 22 eyes, and the new vessels resolved in 70% of cases. However, laser treatment was followed by a significant increase in cystoid macular oedema (p less than 0.01). This retrospective study suggests that medical therapy is the first line of treatment in this group of patients. Photocoagulation should be performed when the eye is quiet and should be reserved for patients with recurrent vitreous haemorrhages and significant capillary closure.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
6/17. Angle-closure glaucoma in a patient with systemic lupus erythematosus.A patient is described known with ITP, who developed an attack of angle-closure glaucoma secondary to posterior scleritis. This condition reacted well to corticosteroid treatment and antiglaucomaleus therapy serologically SLE was highly probable. In fundo there was the picture of a central retinal vein occlusion. Later the patient developed neovascularisation of the optic disc, which did not diminish after panretinal photocoagulation. In spite of cryocoagulation, a vitreous haemorrhage resulted.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/17. Clinical use of pentoxifylline in haemorrhagic disorders of the retina.The clinical effect of pentoxifylline, given orally at doses of 300 mg to 600 mg for 3 months, was studied in 20 patients (23 eyes) with retinal haemorrhage caused by disturbances of retinal circulation, i.e. branch and/or total obstruction of the central retinal vein, obstruction of the central retinal artery, diabetic retinopathy and polycytaemic retinopathy. Twenty-two similar patients (27 eyes) formed a control group and were treated primarily with conventional fibrinolytic agents only. It was found that in the group treated with pentoxifylline, there was significantly earlier absorption of the haemorrhage and significantly less appearance of neovascularization. In some cases, prominent improvement of the arm-to-retina circulation time and a marked decrease in avascular areas were obtained. The difference in the improvement of visual acuity between the group treated with pentoxifylline and controls was less pronounced. Screening tests for haemorrhagic disorders were carried out in the group treated with pentoxifylline before and after administration. No side-effects causing haemorrhagic disorders were found. These results suggest that pentoxifylline is effective in preventing retinal or intra-vitreal neovascularization caused by retinal ischaemia and in hastening recovery from these diseases.- - - - - - - - - - ranking = 5.1107519208003keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
8/17. Treatment of neovascularization secondary to branch retinal vein obstruction.Fifty patients who developed preretinal or papillary neovascularization following tributary vein occlusion were treated by laser photocoagulation. Areas of non-perfused retina within the distribution of the obstructed vein were identified by fluorescein angiography and ablated using moderately intense laser photocoagulation burns. In forty-six patients there was satisfactory atrophy of both preretinal and papillary neovascularization without further complication or vitreous haemorrhage. Four patients who responded poorly to laser photocoagulation did so either because areas of ischaemic retina were inadequately treated or because they were unamenable to laser photocoagulation e.g., sited in the parafoveal region. Ablation of ischaemic perimacular retina together with associated intraretinal microvascular abnormalities aided the resolution of macular oedema in 19 patients. No post-operative complications could be attributed to laser photocoagulation excepting the development of fine perimacular retinal folds in one patient.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/17. Unusual clinical and histopathological findings in ocular sarcoidosis.A 37-year-old Caucasian woman presented with a blind left eye and granulomatous panuveitis in the right eye. There was a subretinal neovascular membrane with haemorrhage beneath the macula and widespread subretinal lesions that were interpreted as choroidal granulomas in the right eye. A chest x-ray that showed diffuse pulmonary fibrosis without hilar lymphadenopathy was the only contributory clinical finding. Systemic and subconjunctival steroids and photocoagulation to the right macula brought about temporary remission. The painful left eye was enucleated. Histopathological examination revealed diffuse, noncaseating granulomas in the iris and ciliary body, retina, choroid, optic nerve, sclera and scleral emissaria, and inferior oblique muscle. A preretinal membrane was studied by electron microscopy. It was composed of a collagenous matrix containing fibroblasts and fibrous astrocytes. Some vessels, surrounded by a multilaminar basement membrane, revealed many features of normal retinal vasculature. Others were lined by markedly attenuated endothelial cells with occasional "open' junctions and fenestrations.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
10/17. Spontaneous peripheral chorioretinal neovascularisation in association with sickle cell anaemia.Chorioretinal neovascularisation was noted in the midperipheral fundus of a young black girl with sickle cell anaemia. Rapid-sequence fluorescein angiography showed choroidally fed neovascularisation in the centre of a large black sunburst (chorioretinal scar). We suspect that a massive midperipheral retinal haemorrhage from the sickle cell disease caused the sunburst and altered Bruch's membrane, thus allowing the ingrowth of choroidally fed vessels.- - - - - - - - - - ranking = 4.1107519208003keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
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