Steroid glaucoma

Glucocorticosteroids are widely used in clinical and ophthalmic practice, but their unjustifi ed and uncontrollable use is unacceptable. Prescription of steroids has to be controlled strictly and the level of intraocular pressure must be diagnosed, because one of the signifi cant side eff ect of steroids is increased intraocular pressure level and, as a result, the development of glaucomatous optic neuropathy. This review deals with the pathogenesis of an increase in the level of intraocular pressure against various forms of glucocorticosteroids intake, describes the time and duration of their ocular-hypertensive eff ect. The available data on the features of the clinical picture of steroid glaucoma, depending on the routes of their entry, have been studied in detail. The tactics of treating patients with ocular hypertension or a proven case of steroid glaucoma are described.

Diffuse Necrotizing Myelitis following Intracystic Bleomycin Chemotherapy for Craniopharyngioma

A child with recurrent adamantinomatous craniopharyngioma was treated with surgery and radiosurgery followed by 12 cycles of intracystic bleomycin injections. One month after treatment, he developed progressive lower extremity paresthesia, pain, wide-based gait, and urinary incontinence. MR imaging showed extensive T2 hyperintensity, enlargement, and enhancement extending from the medulla to the lower thoracic spinal cord. Spinal cord biopsy showed necrotizing myelitis. To our knowledge, this is the first histologically proven case of bleomycin spinal cord neurotoxicity.

Multidetector computed tomography imaging of squamous cell carcinoma of buccal mucosa

<p>This study aims at describing the role of multidetector computed tomography (MDCT) and CT imaging findings in evaluation of squamous cell carcinoma of buccal mucosa and its staging. Retrospective study of 40 patients who underwent MDCT and were histopathogically proven case of squamous cell carcinoma (SCC) of buccal mucosa patients were included in the study. Plain, arterial, venous phase and puff cheek CT cuts were taken from base of skull till clavicle. The imaging findings in squamous cell carcinoma (SCC) of the oral cavity allow the radiologist to accurately determine the extent and staging of disease thereby help clinicians plan appropriate treatment. 40 such patients were done in which majority of them are male patients-27 as compared to female patients-13. Among these 40 patients, 20 patients had stage IVB cancer, 13 patients had stage IVA, 5 patients had stage II and 2 patients had stage I cancer. No patient included in our study had stage III. Patients’ recovery will depend on how early the cancer is found and staging gives an idea of patients’ possible outcomes. MDCT is non-invasive and cost-effective investigation which helps in evaluating squamous cell carcinoma of buccal mucosa and determines its stage of buccal cancer and guide the therapy accordingly.</p>

Transperineal Ultrasonographic and Magnetic Resonance Imaging Findings of Vaginal Adenosis

Background: Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. Case report: A gravida 46-year-old woman was presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or magnetic resonance imaging (MRI) findings have not been described in English literature previously. Conclusion: Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.

Rotating Cement Heads Improve Results of Zonal Isolation in Colombia

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 198970, “Casing Rotating Cement Heads: A Custom-Fit Solution To Improve Zonal Isolation Results In Colombia—A Field-Proven Case,” by Jose Vela, SPE, Henry Arias, and Edwin Sanchez, Ecopetrol, prepared for the 2020 SPE Latin American and Caribbean Petroleum Engineering Conference, held virtually 27–31 July. The paper has not been peer reviewed. In the current challenging drilling environment, effective annular zonal isolation is required for long-term integrity. Among proven cementing practices, casing rotation has been widely applied to liners but not as commonly to full casing strings. The complete paper describes the use of custom-fit rotating cement heads (RCH) to improve cementing results. Cementing Practices in Colombia The following methods of cementing, described in detail in the complete paper, are applied currently in Colombia: - Preflushes and spacers - Slurry design - Casing standoff - Borehole conditioning - Mud circulation and conditioning - Casing movement during the cement job - Monitor job parameters compared with design - Pressure testing and surface-equipment installation Most of these best cementing practices have been followed on a daily basis for all production and intermediate casing. Rotation practice has been widely applied to liners but not for casing strings. This observation led to the introduction of RCH, a technology that arose as the most- appropriate link to connect the top drive or rig prime mover with the casing so that rotation for a full string of casing could be achieved. RCH Use and Implementation Before the implementation of RCH, cement evaluation logs did not show the expected response. Evidence of fluid channeling and fluid contamination was very common, and fair casing to cement bonds was a concern, particularly in washed-out sections and very long cement columns. RCH provides a technical solution for the need to rotate the casing strings while maintaining best practices common to all cement jobs. Rotation has shown to be mandatory for intermediate and production casing to obtain a better log response by enhancing displacement fluid efficiency and mud removal. Well-design and cement objectives vary according to regional sedimentary basins around the country. In the Llanos Basin, the intermediate casing shoe integrity and the isolation of the T1 sand unit are primary objectives; the most-common wellbore problems are the presence of very washed-out sections in front of the E3 and E4 shale formations. The T1 sand unit is located between them and is prone to water or gas influx. Next, the production section is drilled with a lighter mud so that a high negative differential pressure is induced around the casing shoe once the shoe track is drilled. If shoe integrity is not suitable, an influx can be promoted when drilling the productive zone.

An autopsy-proven case of Corticobasal degeneration heralded by Pontine infarction

Background Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. Case presentation A 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration. Conclusions The case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.

Proven Fatal Invasive Aspergillosis in a Patient With COVID-19 and Staphylococcus aureus Pneumonia

There is increasing attention for opportunistic pathogens such as Aspergillus fumigatus complicating SARS-CoV-2 infections in the critically ill. For invasive fungal disease, establishing a clear diagnosis can be challenging due to the invasiveness of diagnostic procedures required for a proven case. Here we present one of the first proven cases of COVID-19-associated pulmonary aspergillosis by positive culture of post-mortem lung biopsy.