Uveitis

2013 ◽  
Author(s):  
Mahmoud A. Khaimi
Keyword(s):  
Anterior Chamber ◽  
Late Onset ◽  
Early Recognition ◽  
Rare Condition ◽  
Conjunctival Injection ◽  
Diverse Range ◽  
Delayed Onset ◽  
Appropriate Treatment ◽  
Body Sensation ◽  
Filtering Procedure

Delayed-onset postoperative inflammation can result from a diverse range of factors, such as blebitis, bleb-related endophthalmitis, underlying uveitis, mitomycin-C mediated inflammation, herpes infection, phaco-anaphylactic and phacogenic uveitis, intraocular lens (IOL) chafing of the iris, and sympathetic ophthalmia. Delayed postoperative uveitis is defined as inflammation occurring 6 weeks or later postoperatively and is a rare condition that may occur following a glaucoma filtering procedure. Currently, there are very few documented cases of this condition. Even though it is rare, it is important to differentiate the infectious sources of delayed-onset postoperative uveitis after glaucoma filtering surgery from those that are noninfectious so that the appropriate treatment is administered. Infectious cases of uveitis should be considered first. The most common form of late-onset postoperative uveitis after a filtering procedure is blebitis . Brown and colleagues were the first to use the term “blebitis” to describe a limited infection centered around a bleb with or without anterior chamber reaction and no vitreous involvement. In contrast, on the other end of the spectrum, is bleb-related endophthalmitis , which is characterized by a more fulminant course with anterior chamber reaction and the presence of vitritis. Blebitis and bleb-related endophthalmitis typically manifest several months to years after the surgery. Blebitis may often be a precursor to bleb-related endophthalmitis, and early recognition of late-onset bleb-related infections should be taken seriously and promptly treated to avoid severe ocular and visual sequelae. Both forms of bleb-related infection can be differentiated by the extent of ocular inflammation. Patients with blebitis typically complain of redness, foreign body sensation, pain, photophobia, and conjunctival discharge. The conjunctiva around the bleb is also significantly injected. Additionally, the bleb itself usually has a whitish or chalky appearance with or without an epithelial defect. The anterior chamber may have variable degrees of reaction, and a hypopyon may be present in the anterior chamber as well as in the bleb itself. Conversely, patients with bleb-related endophthalmitis typically present with a more fulminant course, which includes rapidly deteriorating vision, redness, pain, and diffuse conjunctival injection. Vitritis, while absent in blebitis, is present in bleb-related endophthalmitis.

Endophthalmitis

2013 ◽  
Author(s):  
John T. Lind ◽  
Steven J. Gedde
Keyword(s):  
Risk Factor ◽  
Anterior Chamber ◽  
Case Control ◽  
Filtering Surgery ◽  
Delayed Onset ◽  
Appropriate Treatment ◽  
Bleb Leak ◽  
Antifibrotic Agents ◽  
Ocular Signs ◽  
Control Study

Bleb-related endophthalmitis is one of the most visually devastating complications of glaucoma filtering surgery. Endophthalmitis associated with a functioning filtering bleb may develop months or years postoperatively. Early postoperative endophthalmitis occurs within 6 weeks following the surgery, and late endophthalmitis occurs after this 6-week window. Early detection and rapid institution of appropriate treatment is important in optimizing outcomes and preserving vision. Blebitis is defined as an infection localized to the bleb and surrounding tissues, including the anterior chamber. Blebitis lacks vitreous involvement. Ocular signs of blebitis may include hyperemia around the bleb site, focal infiltrate in the bleb, bleb purulence, and anterior chamber reaction. Bleb-related endophthalmitis encompasses the findings of blebitis with concurrent vitreous inflammation. The presence of vitreous inflammation differentiates bleb-related endophthalmitis from blebitis (Figure 24.1). Risk factors for bleb-related infections are listed in Table 24.1. Bleb morphology and the presence of a bleb leak affect the risk of blebitis or endophthalmitis. Bleb leaks have been identified as the single most important risk factor for the development of bleb-related infections. In a case-control study by Soltau et al, Seidel-positive bleb leaks increased the risk of bleb infection nearly 26-fold. A multicenter study also found that a bleb leak is a major risk factor for blebitis and endopthalmitis. In a review of 20 endophthalmitis cases, 55% of the patients (11 patients) had a Seidel-positive leak following filtering surgery, and three-quarters (15 patients) were noted to have a thin or avascular bleb. Recurrent bleb leaks were observed in over a third of the patients. Song et al found that bleb leaks occurred in 27% of eyes (13 of 49 eyes) with delayed-onset bleb-related endophthalmitis. It is recommended that the clinician routinely monitor patients for bleb leaks and make appropriate interventions to resolve the leak once it is identified. The advent of antifibrotic agents has improved the success rate of traditional filtering surgery but has also increased the incidence of bleb-related infections. Greenfield et al demonstrated that mitomycin-C (MMC) increases the risk of bleb leak.

scholarly journals Primary Malignant Melanoma of the Vagina without Metastasis: A Rare Case and Review of Literature

2020 ◽  
Author(s):  
Wilson Bizimana ◽  
Gloria Akimana ◽  
Arthur Semedo Insumbo ◽  
Hounayda Jerguigue ◽  
Rachida Latib ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Patient Survival ◽  
Rare Condition ◽  
Primary Malignant Melanoma ◽  
Imaging Features ◽  
Review Of Literature ◽  
Pelvic Magnetic Resonance Imaging ◽  
Improve Patient Survival ◽  
Appropriate Treatment ◽  
Improve Patient

AbstractMalignant melanoma of vagina is a rare condition. Its histogenesis has been debated and the positive diagnosis is based on immunohistochemistry. Pelvic magnetic resonance imaging remains the gold standard for assessing locoregional extension status and post-treatment surveillance of melanoma of vagina. The observation concerned a 53-year-old woman with no specific history who presented a primary malignant melanoma of vagina without secondary locations. To date, the case is the second one reported in the literature. Early diagnosis of the malignant melanoma of vagina may improve patient survival because late diagnoses are punctuated by poor prognosis. We have presented epidemiological with etiopathogenic characteristics and described all imaging features to stage the tumor and to conduct the appropriate treatment.

Eagle Syndrome: an underdiagnosed cause of orofacial pain

2021 ◽  
Vol 14 (1) ◽  
pp. e238161
Author(s):  
João Ferreira de Barros ◽  
Maria Vieira Rodrigues ◽  
Leonor Aurélio Barroso ◽  
Isabel Cruz Amado
Keyword(s):  
Orofacial Pain ◽  
Rare Condition ◽  
Styloid Process ◽  
High Clinical Suspicion ◽  
Body Sensation ◽  
Cervical Approach ◽  
Considerable Length ◽  
Eagle Syndrome

Eagle Syndrome (ES), also termed stylohyoid syndrome or styloid syndrome, is a rare condition characterised by a cluster of symptoms related to an elongation of the styloid process (SP) of the temporal bone. These may range from mild pharyngeal foreign body sensation and dysphagia to severe orofacial pain. High clinical suspicion is necessary owing to the unspecific clinical picture and limited diagnostic clues. Until a definitive diagnosis is achieved, these patients may develop symptoms which significantly impact their quality of life. The aim of this article is to report a case of ES in which a considerable length of SP was documented. Diagnosis was made years after the initial complaints and several medical workups by different specialties. Surgical resection of the elongated process by cervical approach was the adopted treatment modality. Patient recovery and follow-up was satisfactory, with remission of the afflicting symptoms.

scholarly journals Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunadi ◽  
Dian Nirmala Sirait ◽  
Aditya Rifqi Fauzi ◽  
Ninditya Nugroho ◽  
Fadil Fahri ◽  
...  
Keyword(s):  
Ct Scan ◽  
Necrotizing Enterocolitis ◽  
Intestinal Inflammation ◽  
Late Onset ◽  
Gastrointestinal Disease ◽  
Early Recognition ◽  
Ileocecal Valve ◽  
Abdominal Distention ◽  
Clinical Deterioration ◽  
Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

Can Early Onset Schizophrenia be Prevented by Early Recognition and Treatment?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
F. Resch ◽  
P. Parzer ◽  
R. Oelkers-Ax ◽  
R. Brunner
Keyword(s):  
Late Onset ◽  
Early Recognition ◽  
Event Related Potentials ◽  
Subjective Experiences ◽  
Prodromal Phase ◽  
Basic Symptoms ◽  
Delayed Initiation ◽  
Adult Psychiatry ◽  
Related Potentials ◽  
Psychotic Features

In adult psychiatry early recognition and treatment of schizophrenia has become a major goal because of manifold evidence of a relation between delayed initiation of treatment and an unfavourable developmental course. The duration of untreated psychosis (DUP) seems to be significantly prolonged in adolescents compared to adults due to both a protracted sub-threshold development of psychotic features and the failure of families and health professionals to take seriously the initial signs of psychosis that mimic quasi normal adolescent emotional perturbations. Although in adults studies have shown a subset of prodromal signs and attenuated psychotic features to have predictive evidence for the development of schizophrenia, these symptoms however seem of limited specificity in adolescence. Basic symptoms represent subjective experiences of the prodromal phase and will be presented in a sample of schizophrenic adolescents in comparison to non-psychotic patients and normal controls. Results reveal that basic symptoms do not show any specificity for schizophrenia, but schizophrenics present with higher amounts of basic symptoms in the prodromal phase compared to non-psychotic controls. For early recognition a combination of psychopathological and biological markers seems fruitful. First data on perceptual closure and event related potentials of the optic system will be presented that seem to differentiate between early and late onset schizophrenia.

scholarly journals Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus

2016 ◽  
Vol 8 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Prajwal Boddu ◽  
Mojtaba Nadiri ◽  
Owais Malik
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Clinical History ◽  
The Elderly ◽  
Direct Immunofluorescence ◽  
Systemic Lupus ◽  
Diverse Range ◽  
American College Of Rheumatology ◽  
Type Vii Collagen

Vesiculobullous eruptions in the elderly represent a diverse range of varying pathophysiologies and can present a significant clinical dilemma to the diagnostician. Diagnosis requires a careful review of clinical history, attention to detail on physical and histomorphological examination, and appropriate immunofluorescence testing. We describe the case of a 73-year-old female who presented to our hospital with a painful blistering skin rash developed over 2 days. Examination of the skin was remarkable for numerous flaccid hemorrhagic bullae on a normal-appearing nonerythematous skin involving both the upper and lower extremities. Histopathology of the biopsy lesion showed interface change at the epidermo-dermal region with subepidermal blister formation, mild dermal fibrosis, and sparse interstitial neutrophilic infiltrate. Immunohistological analysis was significant for positive IgG basement membrane zone antibodies with a dermal pattern of localization on direct immunofluorescence and positive IgG antinuclear antibodies on indirect immunofluorescence. Evidence of antibodies to type VII collagen suggested the diagnosis of epidermolysis bullosa acquisita versus bullous systemic lupus erythematosus (BSLE). A diagnosis of BSLE was made based on positive American College of Rheumatology criteria, acquired vesiculo-bullous eruptions with compatible histopathological and immunofluorescence findings. This case illustrates one of many difficulties a physician encounters while arriving at a diagnosis from a myriad of immunobullous dermatoses. Also, it is important for internists and dermatologists alike to be aware of and differentiate this uncommon and nonspecific cutaneous SLE manifestation from a myriad of disorders presenting with vesiculobullous skin eruptions in the elderly.

scholarly journals Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000740
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Late Onset ◽  
Early Recognition ◽  
Neonatal Outcomes ◽  
P Value ◽  
Prolonged Hospitalisation ◽  
Increased Risk ◽  
Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

scholarly journals Adventitial cystic disease of the radial artery

2018 ◽  
Vol 17 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Adriano Carvalho Guimarães ◽  
Ricardo Herkenhoff Moreira ◽  
Walter Junior Boim de Araujo
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Replacement Therapy ◽  
Radial Artery ◽  
Cystic Lesion ◽  
White Male ◽  
Rare Condition ◽  
Cystic Disease ◽  
Adventitial Cystic Disease ◽  
Appropriate Treatment ◽  
History Of

Abstract Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.

scholarly journals A rare case of mobile ball-like mass in right atrium associated with dilated cardiomyopathy

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Jing Dong ◽  
◽  
Yiqun Gao ◽  
Shunji Liang ◽  
Guorong Deng ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Right Atrium ◽  
Early Recognition ◽  
Therapeutic Option ◽  
Venous Pressure ◽  
Rare Condition ◽  
Good Clinical Condition ◽  
Mobile Mass ◽  
2D Echocardiogram ◽  
The Right

Mobile thrombus in the Right Atrium (RA) is a rare condition. Here, we described a case of a 59-year-old male who presented in emergency room with complaints of progressively worsening dyspnea for 7 years. He was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed ventricular tachycardia. After successfully electrical defibrillation, an urgent 2D echocardiogram was obtained and revealed the enlargement of all heart chambers and a ball-like, mobile mass in the right atrium. An emergent CT scan revealed no sign of pulmonary embolism. Based on morphological features on echocardiogram, we highly suspected it as RA thrombus. The patient was treated with anticoagulant therapy comprising of low molecular heparin and warfarin since he rejected surgical treatment. Repeat echocardiogram was performed 7 days after anticoagulant therapy and showed disappearance of the RA mass. He was subsequently maintained on warfarin (INR=2.4- 3.0) and other medications for heart failure. The patient was followed up as outpatient and kept in good clinical condition. We concluded that early recognition of this rare situation and prompt management can help in preventing life-threatening complications, and anticoagulant therapy was a therapeutic option for RA thrombus.

scholarly journals A Rare Prostate Pathology: Mantle Cell Lymphoma: A Case Report and Literature Review

2021 ◽  
Author(s):  
Selman Ünal ◽  
Halil Uzundal ◽  
Turker Soydaş ◽  
Asım Özayar ◽  
Arslan Ardıçoğlu ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Specific Antigen ◽  
Rare Condition ◽  
Additional Treatment ◽  
Appropriate Treatment ◽  
Histopathologic Diagnosis ◽  
Mantle Cell ◽  
Secondary Lymphoma

Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.

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