scholarly journals Candidemia with Ocular Manifestrations: A Review of 26 Cases in a University Hospital in Japan

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S88-S88
Author(s):  
Tohru Takata ◽  
Yoshinobu Yoshimura ◽  
Yumiko Obata ◽  
Atsushi Togawa ◽  
Yasushi Takamatsu
Keyword(s):  
Medical Records ◽  
Major Complication ◽  
Visual Outcome ◽  
University Hospital ◽  
Ocular Involvement ◽  
Central Venous ◽  
Ocular Manifestations ◽  
Incidence Risk ◽  
Eye Involvement

Abstract Background Ocular candidiasis is a major complication of candidemia; however, many remains unknown for the incidence, risk factors, and outcome of eye involvement. Methods We retrospectively reviewed the medical records and obtained information related to fungal infection and its management, and visual outcome at Fukuoka University Hospital from 2000 to 2016. Results Of 143 patients with candidemia for whom an ophthalmology consult was requested, 26 had findings consistent with the diagnosis of ocular candidiasis. Patients with ocular candidiasis were mostly infected with Candida albicans (n = 20), followed by C. glabrata (n = 4), and C. tropicalis (n = 2). In contrast, only one patient infected with C. parapsilosis had ocular involvement although the number of the patients with C. parapsilosis candidemia was second the most among candidemia. No difference was seen for the β-d-glucan in patients with or without ocular candidiasis (128.6 vs. 106.1, P = 0.654). All of the isolates other than C. glabrata were susceptible to fluconazole. In all of 23 patients with existing central venous cathers, CVCs were removed after the diagnosis of candidemia. Four-week mortality rate in patients with ocular candidiasis was 16.7% (three of 18 patients) which was not significantly different from that in patients without ocular manifestations. All treated patients were confirmed for clearance of candidemia, received systemic antifungals, and improved for visual outcome or remained stable, and no patients complicated visual loss without surgical treatment. Therapy with micafungin or caspofungin followed by fluconazole (12 patients) was successful in all patients. Conclusion Ocular involvement occurred in 18% of patients with candidemia, and treatment with echinocandins followed by fluconazole was successful in most cases with follow-up. Disclosures T. Takata, Taisho Toyama Pharma: Speaker’s Bureau, Speaker honorarium

scholarly journals Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths

2020 ◽  
Vol 48 (8) ◽  
pp. 771-777
Author(s):  
Maria Pekkola ◽  
Minna Tikkanen ◽  
Mikko Loukovaara ◽  
Jouko Lohi ◽  
Jorma Paavonen ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Causes Of Death ◽  
Postmortem Examination ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Common Cause ◽  
Examination Protocol

AbstractBackgroundStillbirth often remains unexplained, mostly due to a lack of any postmortem examination or one that is incomplete and misinterpreted.MethodsThis retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland, and comprised 214 antepartum singleton stillbirths from 2003 to 2015. Maternal and fetal characteristics and the results of the systematic postmortem examination protocol were collected from medical records. Causes of death were divided into 10 specific categories. Re-evaluation of the postmortem examination results followed.ResultsBased on our systematic protocol, the cause of death was originally defined and reported as such to parents in 133 (62.1%) cases. Re-evaluation of the postmortem examination results revealed the cause of death in an additional 43 (20.1%) cases, with only 23 (10.7%) cases remaining truly unexplained. The most common cause of stillbirth was placental insufficiency in 56 (26.2%) cases. A higher proportion of stillbirths that occurred at ≥39 gestational weeks remained unexplained compared to those that occurred earlier (24.1% vs. 8.6%) (P = 0.02).ConclusionA standardized postmortem examination and a re-evaluation of the results reduced the rate of unexplained stillbirth. Better knowledge of causes of death may have a major impact on the follow-up and outcome of subsequent pregnancies. Also, closer examination and better interpretation of postmortem findings is time-consuming but well worth the effort in order to provide better counseling for the grieving parents.

scholarly journals Vogt-Koyanagi-Harada syndrome: Experience in a Belgian university hospital and review of the literature

2017 ◽  
Vol 4 (2) ◽  
pp. 53
Author(s):  
Liza Sels ◽  
Joachim Van Calster ◽  
Steven Vanderschueren ◽  
Liesbet Henckaerts
Keyword(s):  
Diagnostic Yield ◽  
Immunosuppressive Treatment ◽  
University Hospital ◽  
Multisystem Disorder ◽  
Timely Initiation ◽  
Ocular Manifestations ◽  
Time To Recurrence ◽  
Skin Symptoms ◽  
Lymphocytic Meningitis

Introduction: The Vogt-Koyanagi-Harada syndrome (VKHS) is rare in Europe. Bilateral panuveitis is the defining characteristic, but the disease can affect other tissues containing melanin, such as the inner ear, the meninges, and the skin. Therefore, patients may present not only to ophthalmologists, but also to internists, dermatologists, ENT-physicians and neurologists. Early and aggressive immunosuppressive treatment is necessary in order to prevent permanent visual loss or systemic complications.Objective: We retrospectively studied 12 patients diagnosed and treated in a specialized uveitis clinic in Leuven (Belgium) between 2005 and 2013, and we compared our data with literature.Results:  The most common extra-ocular manifestations were neurological, with headache (100%) and lymphocytic meningitis (75%) as main findings. Tinnitus was present in 50%, and vertigo in 42%. Vitiligo was the most frequent dermatological manifestation and present in 42%. Uveitis recurred in 67% of patients with 1 to 4 relapses per patient and a median time to recurrence of 6 months (range 1-11). Normal visual acuity was seen in 75% of patients at the end of follow-up (5 to 60 months), but 3 patients had at least some degree of permanent visual impairment in at least one eye.Conclusion: VKHS is a rare, multisystem disorder, characterized by bilateral uveitis and variable neurologic, auditory and skin symptoms. A lumbar puncture increases the diagnostic yield. A fast diagnosis allows timely initiation of adequate therapy, and If treated correctly, VKHS has a favorable prognosis. It is unclear if initial intravenous therapy improves frequency and time to remission.

Provocation of Pseudoseizures by Psychiatric Interview during EEG and Video Monitoring

1992 ◽  
Vol 22 (2) ◽  
pp. 131-140 ◽  
Author(s):  
Lewis M. Cohen ◽  
George F. Howard ◽  
Bruce Bongar
Keyword(s):  
Medical Records ◽  
Diagnostic Technique ◽  
Video Monitoring ◽  
University Hospital ◽  
Psychiatric Consultation ◽  
Psychiatric Interview ◽  
Telephone Interviews ◽  
Intractable Seizures ◽  
A New Technique

Objective: This paper discusses a new technique for diagnosing pseudoseizures. The technique consists of an intensive psychiatric interview designed to provoke a pseudoseizure during EEG and video monitoring. We wished to determine the overall efficacy of the technique and learn how our patients felt about having undergone the procedure. We were also interested in whether their seizures persisted approximately three years later. Method: We reviewed medical records and conducted telephone interviews with thirty of thirty-two patients who had previously undergone the procedure as part of an evaluation for unusual or intractable seizures. All evaluations had been performed on a university hospital neurology service. The patients were consecutive referrals to the consultative psychiatry service for suspicion of pseudoseizures. Results: Nineteen of the thirty-two patients interviewed had a pseudoseizure under EEG and video monitoring. Of the thirty reached by telephone for follow-up, twenty-two recalled the procedure as helpful or benign. None regarded the overall psychiatric consultation negatively. Among the patients who had exhibited pseudoseizures there was a variety of psychiatric diagnoses with a preponderance of personality disorders. Two thirds of those patients without coexisting epilepsy stopped having seizures or rarely had seizures following their evaluations. Conclusions: The diagnostic technique described here is useful in patients with possible pseudoseizures. It does not appear to be harmful when employed as part of a comprehensive psychiatric consultation. How it may compare with other methods of pseudoseizure diagnosis will have to be determined by further study.

scholarly journals Diagnosis and Treatment of Tuberous Sclerosis Manifestations in Children: A Multicenter Study

2018 ◽  
Vol 49 (03) ◽  
pp. 193-199 ◽  
Author(s):  
Daniel Ebrahimi-Fakhari ◽  
Ludwig Gortner ◽  
Martin Poryo ◽  
Michael Zemlin ◽  
Alfons Macaya-Ruiz ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Interquartile Range ◽  
University Hospital ◽  
Cardiac Rhabdomyoma ◽  
Cutaneous Manifestations ◽  
Ocular Manifestations ◽  
Made In

AbstractTuberous sclerosis complex (TSC) is a genetic disease with a significant morbidity and mortality. We conducted a retrospective analysis of two cohorts (Vall d'Hebron University Hospital [HVH], Barcelona, Spain, 1982–2015, and at Saarland University Medical Center [UKS], Homburg, Germany, 1998–2015) to assess prevalence and treatment of TSC associated manifestations and to evaluate if the follow-up was in line with published recommendations. This was considered if more than 15% of patients did not receive adequate examination with regard to potential organ involvement. A definite diagnosis was made in 52 patients (96%), and a possible diagnosis was made in 2 patients (4%). Thirty-four (63%) patients were from HVH and 20 (37%) from UKS. Median age at first presentation was 6 months (interquartile range: 0–38 months), and median time of follow-up was 6 years (interquartile range: 2–13 years). Clinical symptoms that led to a diagnosis of TSC were cardiac rhabdomyoma (22/54), epilepsy (20/54), and cutaneous manifestations (4/54). Assessment of neuropsychiatric, renal, and ocular manifestations was inadequate in both hospitals, whereas cutaneous manifestation was inadequate at UKS only. Our data demonstrate insufficient examinations in a substantial number of TSC patients with regard to neuropsychiatric, renal, ocular, and cutaneous manifestations. The recently published guidelines may prove valuable in establishing a more comprehensive approach.

scholarly journals Epidemiology of keratitis/scleritis-related endophthalmitis in a university hospital in Thailand

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dhanach Dhirachaikulpanich ◽  
Kunravitch Soraprajum ◽  
Sutasinee Boonsopon ◽  
Warinyupa Pinitpuwadol ◽  
Preeyachan Lourthai ◽  
...  
Keyword(s):  
Associated Factors ◽  
Fungal Infections ◽  
Visual Outcome ◽  
University Hospital ◽  
Initial Visit ◽  
Hand Motion ◽  
Clinical Presentations ◽  
The Mean ◽  
The Tropics

AbstractTo demonstrate the demographics, associated factors, clinical presentations, microbiology, management, visual outcome and complications of keratitis/scleritis-related endophthalmitis (KSE). A retrospective chart of all endophthalmitis patients diagnosed between September 2001 and August 2011 was reviewed. Only endophthalmitis cases with previous corneal or scleral infection were included in the study. The patients were followed until losing vision or eyeball, becoming phthisis, or the end of 2018. Eighty-seven patients with KSE were identified, all unilateral. The mean age was 56.4 ± 21.4 years. There was a slight male predilection (55 patients, 63.2%). The mean follow-up time was 50 ± 149 weeks. The causative pathogens were identified in 35 patients (40.2%), with the highest frequency being bacteria. The most common bacterium was Pseudomonas aeruginosa (n = 13), and the most common fungus was Aspergillus sp. (n = 5). Fifteen patients achieved (17.2%) final visual acuity (VA) of hand motion or better after treatment. Eyeball removal was performed in 61 (70.1%) patients. From multivariate analysis, the only prognostic factor for poor final VA (worse than hand motion, HM) was poor VA (worse than HM) at the initial visit (relative risk 1.97, 95% confidence interval 1.15–3.36, p = 0.013). KSE is uncommon but has a devastating outcome. We found that the patient’s initial VA was the only predictor for their final vision. P. aeruginosa was the most common identifiable organism in this study. However, several fungal infections were recognised. These findings should raise awareness for treatment of KSE in the tropics.

scholarly journals Clinical outcome after liver resection for colorectal versus non-colorectal metastasis: a comparative study

2018 ◽  
Vol 5 (2) ◽  
pp. 390
Author(s):  
Ashraf M. El-Badry ◽  
Omar Abdelraheem
Keyword(s):  
Liver Resection ◽  
Postoperative Complications ◽  
Clinical Outcome ◽  
Medical Records ◽  
Multivisceral Resection ◽  
University Hospital ◽  
Significant Difference ◽  
Complication Score ◽  
Primary Neoplasm

Background: Liver resection is the only curative treatment option for specific types of metastatic neoplasms. Comparative studies on the clinical outcome of liver resection for colorectal liver metastasis (CRLM) and non CRLM (N-CRLM) in Egypt remain inadequate.Methods: Medical records of patients who underwent liver metastasectomy (April 2013-May 2017) at Sohag University Hospital were reviewed. Patients were categorized according to the origin of the primary tumor into CRLM versus N-CRLM. Demographic, clinical, operative and histopathologic data, postoperative surgical complications and survival were analyzed.Results: Twenty-six patients (15 CRLM and 11 N-CRLM) were retrospectively enrolled. N-CRLM group comprised metastatic gall bladder (6), pancreas (2), breast (1) lung (1) and recurrent ovarian (1) cancers. There was no significant difference regarding age or gender predilection. The complication score in CRLM group was not significantly different compared with N-CRLM patients. However, subgroups of multivisceral resections showed significantly higher grades of postoperative complications compared with sole liver resection in both groups. Elderly patients (>70-year-old) exhibited high risk of morbidity compared with younger patients. Early post-operative mortality within the first month was 7.7% (2 patients died, one per each group). After a mean follow up of 32 months, the overall survival rate among patients with CRLM and N-CRLM was 75% and 64% respectively.Conclusions: Liver resection for CRLM and N-CRLM can be safely accomplished. Multivisceral resection and advanced age were associated with increased severity of postoperative complications irrespective of the location of primary neoplasm.

scholarly journals Ocular Involvement in Hereditary Amyloidosis

Genes ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 955
Author(s):  
Angelo Maria Minnella ◽  
Roberta Rissotto ◽  
Elena Antoniazzi ◽  
Marco Di Girolamo ◽  
Marco Luigetti ◽  
...  
Keyword(s):  
Local Level ◽  
Retinal Pigment ◽  
Diagnostic Delay ◽  
Amyloid Deposition ◽  
Retinal Pigment Epithelial Cells ◽  
Ocular Involvement ◽  
Transthyretin Amyloidosis ◽  
Systemic Involvement ◽  
Ocular Manifestations ◽  
Eye Involvement

The term amyloidosis describes a group of rare diseases caused by protein conformation abnormalities resulting in extracellular deposition and accumulation of insoluble fibrillar aggregates. So far, 36 amyloid precursor proteins have been identified, and each one is responsible for a specific disease entity. Transthyretin amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, due to the deposition of transthyretin (TTR), which is a transport protein mainly synthesized in the liver but also in the retinal pigment epithelial cells. ATTRv amyloidosis may be misdiagnosed with several other conditions, resulting in a significant diagnostic delay. Gelsolin and keratoepithelin are other proteins that, when mutated, are responsible for a systemic amyloid disease with significant ocular manifestations that not infrequently appear before systemic involvement. The main signs of ocular amyloid deposition are in the cornea, irido-corneal angle and vitreous, causing complications related to vasculopathy and neuropathy at the local level. This review aims at describing the main biochemical, histopathological and clinical features of systemic amyloidosis associated with eye involvement, with particular emphasis on the inherited forms. We discuss currently available treatments, focusing on ocular involvement and specific ophthalmologic management and highlighting the importance of a prompt treatment for the potential sight-threatening complications derived from amyloid deposition in ocular tissues.

Feline ophthalmomyiasis externa caused by Cuterebra larvae: four cases (2005–2020)

2021 ◽  
pp. 1098612X2110130
Author(s):  
Brittany N Schlesener ◽  
Elizabeth A Peck ◽  
Eric M Teplitz ◽  
Filipe Espinheira Gomes ◽  
Dwight D Bowman ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Signs ◽  
Case Series ◽  
University Hospital ◽  
Nictitating Membrane ◽  
Cornell University ◽  
Unilateral Disease ◽  
The Right ◽  
Lost To Follow Up

Case series summary Described are four cats diagnosed with ophthalmomyiasis externa caused by Cuterebra larvae. Medical records were retrospectively reviewed to identify cats with ophthalmomyiasis externa between 2005 and 2020 at Cornell University Hospital for Animals. Signalment, history, clinical and diagnostic findings, treatment and outcome were recorded. All cats were young (< 3 years of age), had outdoor access and were initially examined during the summer months. All cases had unilateral disease with the right eye affected. Two cases had nictitating membrane lesions and two had orbital disease. Concurrent superficial corneal ulceration was present in three cats. Two cats suffered from pyrexia, suspected secondary to inflammation from the larval infestation. Successful larval removal was performed in all cats, which resulted in improvement of discomfort and clinical signs. A corneal ulcer persisted in one cat, which was lost to follow-up prior to ulcer resolution. Parasite identification confirmed Cuterebra species infestation in all cases. Relevance and novel information To the authors’ knowledge, this is the first report of feline ophthalmomyiasis externa caused by Cuterebra species. Parasite removal was successful in restoring comfort and resolving clinical signs in all cats with adequate follow-up information.

scholarly journals CLINICAL CHARACTERISTICS AND MANAGEMENT OF OCULAR TOXOPLASMOSIS

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Ovi Sofia ◽  
Rizqi Wahyu Hariyono
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Visual Outcome ◽  
Posterior Uveitis ◽  
Ocular Toxoplasmosis ◽  
High Seroprevalence ◽  
Tertiary Referral Hospital ◽  
Blurred Vision ◽  
Outcome Type

Introduction: Ocular toxoplasmosis is a major cause of infectious posterior uveitis worldwide. There was no exact number of ocular toxoplasmosis prevalence in Indonesia, but Indonesia was considered to have high seroprevalence in Southeast Asian. This study is conducted to determine clinical characteristics and management of ocular toxoplasmosis at outpatient clinic of Dr. Saiful Anwar General Hospital, a tertiary referral hospital in Malang, East Java. Methods : This was retrospective study. We reviewed the medical records of patients with ocular toxoplasmosis and collected the data associated with age, sex, laterality, visual outcome, type of lesions, serum serological titers, therapeutic regimens, and complications. Result : There were 48 eyes from 38 patients included in this study, mostly were female (66%) with mean age was 33,5 years. Unilateral infection (71%) was more frequent than bilateral cases (39%). Active lesions were found more than cicatrical lesions (56,25%). Most patients with active diseases had unilateral lesion (87,5%). The most common presenting complain was blurred vision (73%). Most of lesions (22 eyes; 81,4%) were located on macular region. All of patients have positive IgG antitoxoplasma serum. There were 22 patients received oral Trimethoprim-Sulfamethoxazole and steroid. Visual acuity improved in 6 patients at the end of follow-up period. Complications of retinal detachment and choroidal neovascularization were found in 3 patients. Conclusion : Active ocular toxoplasmosis is more likely to be unilateral infection with main presenting complain is  blurred vision. Most of our patients show good responses to oral trimethoprim-sulfamethoxazole and steroid.

Risk factors, demographics and clinical profile of Acanthamoeba keratitis in Melbourne: an 18-year retrospective study

2017 ◽  
Vol 102 (5) ◽  
pp. 687-691 ◽  
Author(s):  
Matthew Hao Lee ◽  
Robin Geoffrey Abell ◽  
Biswadev Mitra ◽  
Merv Ferdinands ◽  
Rasik B Vajpayee
Keyword(s):  
Risk Factors ◽  
Early Recognition ◽  
Visual Outcome ◽  
Signs And Symptoms ◽  
Acanthamoeba Keratitis ◽  
Late Diagnosis ◽  
Surgical Interventions ◽  
Incidence Risk ◽  
Final Visual Outcome

PurposeTo assess incidence, risk factors, presentation and final visual outcome of patients with Acanthamoebakeratitis (AK) treated at the Royal Victorian Eye and Ear Hospital (RVEEH), Melbourne, Australia, over an 18-year period.MethodsA retrospective review of all cases of AK managed at RVEEH between January 1998 and May 2016 was performed. Data collected included age, gender, affected eye, signs and symptoms, time between symptoms and diagnosis, risk factors, presenting and final visual acuity (VA), investigations, medical treatment, surgical interventions and length of follow-up.ResultsA total of 36 eyes affected by AK in 34 patients were identified. There were 26 cases diagnosed early (<30 days) and 10 were diagnosed late (≥30 days). There were 31 (86.1%) cases associated with contact lens (CL). Signs associated with early AK included epithelial infiltrates, while signs of late AK included uveitis, ring infiltrate, endothelial plaque and corneal thinning (p<0.05). Surgical treatment was required in seven cases (19.4%). There were 29 (80.6%) cases that reported improved VA. Median best corrected final VA was worse in patients with late diagnosis (logarithm of minimal angle of resolution (logMAR) 0.5, IQR: 0.2–0.8), compared with patients with early diagnosis (logMAR 0.0, IQR: 0.0–0.3; p=0.01). Late diagnosis was associated with a prolonged disease period.ConclusionAK was an uncommon cause of severe keratitis and was associated commonly with CL. Patients with late diagnosis had worse presenting and final VAs as well as a prolonged disease period, indicating need for early recognition and management.

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