Rare atypical presentation of phacolytic glaucoma as non-resolving microbial keratitis with endophthalmitis

Phacolytic glaucoma (PLG) is a rare complication of hypermature senile cataract. Delayed presentation of PLG may make its diagnosis and management difficult and worsen its prognosis. A woman aged 75 years complaining of sleep disturbing pain and inaccurate projection of rays oculus dextrus (OD) was referred to our centre for management of non-resolving microbial keratitis with endophthalmitis. Ultrasound biomicroscopy revealed 360° peripheral anterior synechiae, swollen crystalline lens and hyperechoic granules filling anterior chamber. A diagnosis of PLG and lens-induced uveitis was made and cataract was extracted after control of intraocular pressure (IOP). The patient was left aphakic. There was complete resolution of pain after surgery and at 3 months follow-up the IOP was controlled without any antiglaucoma medications. Rarely, secondary corneal opacification from long-standing pathological changes in PLG may mimic non-resolving microbial keratitis with endophthalmitis and requires a high index of suspicion for appropriate diagnosis and management.

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Management of a pseudo-aneurysm in the hepatic artery after a laparoscopic cholecystectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0182 ◽

2016 ◽

Vol 98 (7) ◽

pp. 456-460 ◽

Cited By ~ 5

Author(s):

MP Senthilkumar ◽

N Battula ◽

MTPR Perera ◽

R Marudanayagam ◽

J Isaac ◽

...

Keyword(s):

Computed Tomography ◽

Laparoscopic Cholecystectomy ◽

Hepatic Artery ◽

Computed Tomography Angiography ◽

Rare Complication ◽

Artery Pseudoaneurysm ◽

Pseudo Aneurysm ◽

High Index Of Suspicion ◽

Time Of Presentation

Introduction Symptomatic hepatic-artery pseudoaneurysm (HAP) after bile-duct injury (BDI) is a rare complication with a varied (but clinically urgent) presentation. Methods A prospectively maintained database of all patients with BDI at laparoscopic cholecystectomy (LC) referred to a tertiary specialist hepatobiliary centre between 1992 and 2011 was searched systematically to identify patients with a symptomatic HAP. Care and outcome of these patients was studied. Results Eight (6 men) of 236 patients with BDI (3.4%) with a median age of 65 (range: 54?6) years presented with symptomatic HAP. Median time of presentation of the HAP from the index LC was 31 (range: 13?16) days. Bleeding was the dominant presentation in 7 patients. One patient presented late (>2 years) with abdominal pain alone. Computed tomography angiography was the most useful investigation. Angioembolisation was successful in 7 patients. One patient died, and another patient developed liver infarction. Three patients (38%) developed biliary strictures after embolisation. Seven patients are alive and well at a median follow-up of 66 months. Conclusions Presentation of HAP is often delayed. A high index of suspicion is necessary for the diagnosis. Computed tomography angiography is the first-line investigation and selective angioembolisation can yield successful outcomes.

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Retracted: Diagnostic Dilemma of a Diaphragmatic Hernia

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v4i3.327 ◽

2018 ◽

Vol 4 (3) ◽

Author(s):

Salman Yahya ◽

Sonia Zafar ◽

Hafsa S. Babar

Keyword(s):

Diaphragmatic Hernia ◽

Turning Point ◽

Rare Complication ◽

Young Male ◽

Acute Ischemia ◽

Radiological Findings ◽

Diagnostic Dilemma ◽

High Index Of Suspicion ◽

Disease Free

Diaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management.

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Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

BMJ Case Reports ◽

10.1136/bcr-2020-235986 ◽

2020 ◽

Vol 13 (12) ◽

pp. e235986

Author(s):

Alexander Tindale ◽

James Jackson ◽

Darina Kohoutova ◽

Panagiotis Vlavianos

Keyword(s):

Portal Vein ◽

Complete Resolution ◽

Chylous Ascites ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Portal Vein Stenosis ◽

First Case ◽

Vein Stenosis ◽

Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

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P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis

BJS Open ◽

10.1093/bjsopen/zrab032.033 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Chan Hee Koh ◽

Danyal Z Khan ◽

Ronneil Digpal ◽

Hugo Layard Horsfall ◽

Hani J Marcus ◽

...

Keyword(s):

Clinical Practice ◽

Cushing’S Disease ◽

Meta Analysis ◽

A Priori ◽

Pituitary Surgery ◽

Serum Cortisol ◽

Cushing's Disease ◽

Diagnosis And Management ◽

Over Time

Abstract Introduction The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field. Methods Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates. Results Our screening returned 159 papers. The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months. Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up. Conclusion We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.

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Ibuprofen-Induced Aseptic Meningitis in a Male Adolescent with Intracranial Hypertension and Visual Impairment: A Case Report

Case Reports in Neurology ◽

10.1159/000514091 ◽

2021 ◽

Vol 13 (1) ◽

pp. 233-238

Author(s):

Seyed Mohammad Mousavi Mirzaei ◽

Zahra Ahmadi

Keyword(s):

Visual Impairment ◽

Intracranial Hypertension ◽

Aseptic Meningitis ◽

Rare Complication ◽

Clinical Signs ◽

Male Adolescent ◽

Drug Induced ◽

Blurred Vision ◽

Inflammatory Drugs

Drug-induced aseptic meningitis (DIAM) is a rare complication of certain drugs, most commonly reported with ibuprofen use. The present study reports on a male adolescent with intracranial hypertension and visual impairment accompanied by DIAM. We present a 16-year-old male patient who after ibuprofen consumption displayed headache, fever, photophobia, and blurred vision following heavy exercises. Examination of cerebrospinal fluid showed a mononuclear pleocytosis and an increase in protein concentration. Other examinations had normal results. The development of common clinical signs following ibuprofen use reflected DIAM. The patient’s vision was found to improve with supportive care and stopping of the drug during follow-up. Given the widespread use of nonsteroidal anti-inflammatory drugs and the fact that these drugs are the most common cause of DIAM, the probability of occurrence of this event should be always kept in mind, and screening for autoimmune diseases in these patients is of great importance.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000538 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000538

Author(s):

Alejandra Tepox-Padrón ◽

Rafael Ambrosio Bernal-Mendez ◽

Gilberto Duarte-Medrano ◽

Adriana Fabiola Romano-Munive ◽

Milton Mairena-Valle ◽

...

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Endoscopic Ultrasound ◽

Complete Resolution ◽

Diagnostic Yield ◽

Recurrent Pancreatitis ◽

Mucinous Neoplasm ◽

Possible Cause ◽

Symptoms And Signs

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.ObjectivesTo determine the diagnostic yield of EUS in IARP.DesignA retrospective study was performed in patients with IARP evaluated by EUS between January 2009 and December 2016. Follow-up assessments of acute pancreatitis recurrence were carried out.ResultsSeventy-three patients with 102 EUS procedures were included. EUS was able to identify the cause of IARP in 55 patients (75.3%). The most common findings were chronic pancreatitis in 27 patients (49.1%), followed by lithiasic pathology in 24 patients (43.6%), and intraductal papillary mucinous neoplasm in four patients (7.3%). A directed treatment against EUS findings had a protective tendency associated with the final resolution of recurrence. There were no complications reported.ConclusionEUS performed in patients with IARP helped to identify a possible cause in 2/3 of the cases. The majority of patients have a treatable disease.

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Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90208-w ◽

1993 ◽

Vol 18 (1) ◽

pp. 115-118 ◽

Cited By ~ 16

Author(s):

J. STEVENSON ◽

I. W. R. ANDERSON

Keyword(s):

Emergency Department ◽

Complete Resolution ◽

Wound Care ◽

Duration Of Treatment ◽

Mean Delay ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

The Mean ◽

Careful Assessment

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.

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Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

Ocular Oncology and Pathology ◽

10.1159/000512030 ◽

2021 ◽

pp. 1-9

Author(s):

Biljana Kuzmanović Elabjer ◽

Mladen Bušić ◽

Andrej Pleše ◽

Mirjana Bjeloš ◽

Daliborka Miletić ◽

...

Keyword(s):

Uveal Melanoma ◽

Tumor Regression ◽

Corneal Thickness ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Close Monitoring ◽

Single Institution ◽

Retrospective Case ◽

Caucasian Patients

Introduction: Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective: Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods: This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results: The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion: The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

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Neural sheath tumors of major nerves

Journal of Neurosurgery ◽

10.3171/jns.1994.81.3.0362 ◽

1994 ◽

Vol 81 (3) ◽

pp. 362-373 ◽

Cited By ~ 166

Author(s):

Thomas R. Donner ◽

Rand M. Voorhies ◽

David G. Kline

Keyword(s):

Motor Function ◽

Complete Resolution ◽

Von Recklinghausen’S Disease ◽

Total Removal ◽

Von Recklinghausen's Disease ◽

Plexiform Neurofibromas ◽

Pain Syndromes ◽

Recklinghausen's Disease ◽

Recklinghausen’S Disease

✓ Over a 22-year period, operations were performed on 263 patients for 288 primary benign tumors of major peripheral nerves. The tumors included 85 schwannomas, 197 neurofibromas, and six plexiform neurofibromas. Total removal was achieved in 83 of the 85 schwannomas, and 76 of these patients were available for follow-up evaluation. Motor function either improved or was unchanged in 87% of these patients and 85% of those with pain in the distribution of the involved nerve had either total or partial resolution of their symptoms. Of the neurofibromas, 123 occurred in 121 patients without von Recklinghausen's disease. All tumors within this group were completely excised using a fascicular approach to the tumor. Of the 99 patients available for follow-up evaluation, 90% had either improved or unchanged motor function and 88% had partial or complete resolution of pain syndromes. Fifty-nine patients with von Recklinghausen's disease had 80 tumors removed: 74 fusiform tumors (58 of which were completely removed) and six plexiform tumors. Forty-eight of the 58 patients with gross total removal of fusiform tumors were available for follow-up evaluation, of whom 83% had improved or unchanged motor function and 74% had partial or complete resolution of pain syndromes. All six patients with plexiform tumors had progression of symptoms postoperatively. One brachial plexus schwannoma recurred and was re-excised without subsequent recurrence at the 5-year follow-up evaluation. Several incompletely excised plexiform neurofibromas have recurred with a symptomatic presentation.

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