A 52-year-old man sought treatment for decreased vision in his right eye for 3 weeks. Visual acuity was 20/120. Examination revealed an elevated choroidal n evus at the posterior pole. Fluorescein and indocyanine gree...A 52-year-old man sought treatment for decreased vision in his right eye for 3 weeks. Visual acuity was 20/120. Examination revealed an elevated choroidal n evus at the posterior pole. Fluorescein and indocyanine green angiographies disc losed fibrovascular pigment epithelial detachment extending under the fovea. The patientwas treated by two sessions of photodynamic therapy with verteporfin. Vi sual acuity improved to 20/40. The fibrovascular pigment epithelial detachment a rea diminished and the fovea is clear of lesion. Seven months after the last tre atment, visual acuity remains stable. Photodynamic therapy with verteporfin coul d be an effective option for treating subfoveal choroidal neovascularization sec ondary to choroidal nevus.展开更多
To describe a rare case of rhinolith formation 21 years after dacryocystorhino stomy (DCR) with rubber gum and polyethylene tubing surgery. Interventional case report. A 23-year-old-woman underwent uneventful left DCR...To describe a rare case of rhinolith formation 21 years after dacryocystorhino stomy (DCR) with rubber gum and polyethylene tubing surgery. Interventional case report. A 23-year-old-woman underwent uneventful left DCR with rubber gum an d polyethylene tubing for chronic dacryocystitis. Twenty-one years later, she p resented with purulent rhinorrhea, nasal obstruction, and facial pain. Computed tomography revealed a radiopaque density in the left nasal cavity. A rubber gum foreign body embedded with granulation tissue and a huge rhinolith was removed e ndoscopically through the anterior nares. After surgery, the patient reported im mediate and complete relief of symptoms. Rhinoliths can develop progressively se veral years after DCR as a result of foreign body reaction to rubber gum or poly ethylene tubing. This rare complication should be ruled out in patients complain ing of purulent rhinorrhea who underwent DCR with tubing before the early 1980s.展开更多
Hereditary sensory and autonomie neuropathy type IV (HSAN IV) is caused by mu tations in the tyrosin kinase A (TrkA) gene, encoding for the high- affinity re ceptor of nerve growth factor (NGF). The NGF- TrkA system i...Hereditary sensory and autonomie neuropathy type IV (HSAN IV) is caused by mu tations in the tyrosin kinase A (TrkA) gene, encoding for the high- affinity re ceptor of nerve growth factor (NGF). The NGF- TrkA system is expressed in many endocrine glands. We hypothesized that HSAN IV represents a natural model for im paired NGF effect on the neuroendocrine system in humans. We have documented the clinical outcome of 31 HSAN IV patients in a single medical center, and investi gated their basal endocrine system status. The endocrine system response to thir st was compared between six patients and six healthy children. High rates of mor tality (22% ) and severe morbidity (30% ) have been found in HSAN IV patients. Hypothermia was noted in 40% of the patients and unexplained fever was observ ed in 56% . Subnormal adrenal function was demonstrated in six (30% ) of the p atients studied. Furthermore, we found lower plasma norepinephrine (NE) levels i n six HSAN IV patients compared with a control group after the thirst test. Our findings emphasize the importance of NGF- TrkA pathway in the physiology of the neuroendocrine system and its response to stress. Inadequate response to stress might contribute to the observed significant mortality, morbidity, and temperat ure instability in HSAN IV patients.展开更多
Objective: This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each ...Objective: This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each to perinatal HIV-1 transmission. Study design: In 227 HIV-infected women receiving intrapartum/neonatal nevirapine prophylaxis, we examined associations between fetal membrane histology, cord blood interleukin-6 (IL-6), and perinatal HIV-1 transmission. Results: Acute chorioamnionitis was present in 122 of 227 specimens; chronic chorioamnionitis in 64 of 227. There was a positive correlation between acute chorioamnionitis and labor length (r = 0.208; P = .002), time of ruptured membrane (r = 0.177; P = .008), and cord IL-6 (r = 0.390; P < .001). Chronic chorioamnionitis was associated with high viral load (P = .05) and low cord IL-6 (P < .001). Severe chronic chorioamnionitiswas associated with intrauterine HIV-1 transmission (odds ratio [OR] = 7.61; 95%CI = 1.04-85.5), but no correlation was demonstrated between acute chorioamnionitis and vertical transmission. Conclusion: In a setting of high perinatal nevirapine use, acute chorioamnionitis was not associated with vertical HIV-1 transmission. Risk for intrauterine transmission increased significantly when chronic chorioamnionitis was present.展开更多
文摘A 52-year-old man sought treatment for decreased vision in his right eye for 3 weeks. Visual acuity was 20/120. Examination revealed an elevated choroidal n evus at the posterior pole. Fluorescein and indocyanine green angiographies disc losed fibrovascular pigment epithelial detachment extending under the fovea. The patientwas treated by two sessions of photodynamic therapy with verteporfin. Vi sual acuity improved to 20/40. The fibrovascular pigment epithelial detachment a rea diminished and the fovea is clear of lesion. Seven months after the last tre atment, visual acuity remains stable. Photodynamic therapy with verteporfin coul d be an effective option for treating subfoveal choroidal neovascularization sec ondary to choroidal nevus.
文摘To describe a rare case of rhinolith formation 21 years after dacryocystorhino stomy (DCR) with rubber gum and polyethylene tubing surgery. Interventional case report. A 23-year-old-woman underwent uneventful left DCR with rubber gum an d polyethylene tubing for chronic dacryocystitis. Twenty-one years later, she p resented with purulent rhinorrhea, nasal obstruction, and facial pain. Computed tomography revealed a radiopaque density in the left nasal cavity. A rubber gum foreign body embedded with granulation tissue and a huge rhinolith was removed e ndoscopically through the anterior nares. After surgery, the patient reported im mediate and complete relief of symptoms. Rhinoliths can develop progressively se veral years after DCR as a result of foreign body reaction to rubber gum or poly ethylene tubing. This rare complication should be ruled out in patients complain ing of purulent rhinorrhea who underwent DCR with tubing before the early 1980s.
文摘Hereditary sensory and autonomie neuropathy type IV (HSAN IV) is caused by mu tations in the tyrosin kinase A (TrkA) gene, encoding for the high- affinity re ceptor of nerve growth factor (NGF). The NGF- TrkA system is expressed in many endocrine glands. We hypothesized that HSAN IV represents a natural model for im paired NGF effect on the neuroendocrine system in humans. We have documented the clinical outcome of 31 HSAN IV patients in a single medical center, and investi gated their basal endocrine system status. The endocrine system response to thir st was compared between six patients and six healthy children. High rates of mor tality (22% ) and severe morbidity (30% ) have been found in HSAN IV patients. Hypothermia was noted in 40% of the patients and unexplained fever was observ ed in 56% . Subnormal adrenal function was demonstrated in six (30% ) of the p atients studied. Furthermore, we found lower plasma norepinephrine (NE) levels i n six HSAN IV patients compared with a control group after the thirst test. Our findings emphasize the importance of NGF- TrkA pathway in the physiology of the neuroendocrine system and its response to stress. Inadequate response to stress might contribute to the observed significant mortality, morbidity, and temperat ure instability in HSAN IV patients.
文摘Objective: This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each to perinatal HIV-1 transmission. Study design: In 227 HIV-infected women receiving intrapartum/neonatal nevirapine prophylaxis, we examined associations between fetal membrane histology, cord blood interleukin-6 (IL-6), and perinatal HIV-1 transmission. Results: Acute chorioamnionitis was present in 122 of 227 specimens; chronic chorioamnionitis in 64 of 227. There was a positive correlation between acute chorioamnionitis and labor length (r = 0.208; P = .002), time of ruptured membrane (r = 0.177; P = .008), and cord IL-6 (r = 0.390; P < .001). Chronic chorioamnionitis was associated with high viral load (P = .05) and low cord IL-6 (P < .001). Severe chronic chorioamnionitiswas associated with intrauterine HIV-1 transmission (odds ratio [OR] = 7.61; 95%CI = 1.04-85.5), but no correlation was demonstrated between acute chorioamnionitis and vertical transmission. Conclusion: In a setting of high perinatal nevirapine use, acute chorioamnionitis was not associated with vertical HIV-1 transmission. Risk for intrauterine transmission increased significantly when chronic chorioamnionitis was present.
