1/29. Radiculomyelitis following acute haemorrhagic conjunctivitis.The clinical manifestations and natural history of radiculomyelitis following a newly reported disease--acute haemorrhagic conjunctivitis (AHC)--have been studied in 33 patients in taiwan, and the following observations made: All the patients in this series were adults at ages ranging from 21 to 55 years; the salient initial neurological manifestations were radicular pains and acute flaccid paralysis which developed from five to thirty-seven days after the onset of AHC. In some patients, signs and symptoms indicating involvement of the meninges, cranial nerves and the white matter of the cord were observed; motor paralysis was the most striking feature during the whole clinical course; it consisted of flaccid asymmetrical weakness in one or more limbs, usually being more severe in the lower limbs than in the upper, and often more proximal than distal. Atrophy in the severely affected muscles usually became apparent in the second or third week of the weakness; the prognosis regarding the return of function in the affected muscles was dependent on the severity of the involvement. Permanent incapacitation due to paralysis and muscular atrophy in the affected proximal muscles of lower limbs was the main sequel in severe cases. The pattern and prognosis of flaccid motor paralysis were reminiscent of acute poliomyelitis in which the anterior horn cells of the spinal cord are mainly involved. Pleocytosis ranging from 11 to 270 per mm3 was noted in the majority of the patients when the cerebrospinal fluid was examined within the first three weeks from the onset of neurological symptoms; the total protein level was raised invariably from the second week onwards in all specimens, and remained so throughout the subsequent course as long as the seventh week or later. Tissue culture neutralization tests were performed on the sera from 9 patients; significant rises in the antibody titres (greater than or equal to 1:16) to AHC virus antigens were found in 8 cases, and in 2 of them a fourfold rise in the paired sera was noted. The differentiation of this syndrome from poliomyelitis and from guillain-barre syndrome, the relative freedom of children from neurological complications of AHC and the aetiological relationship of AHC virus to the syndrome have been discussed. It is concluded that this unusual neurological syndrome is caused by the neurovirulent properties of the AHC virus.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/29. Rhinoconjunctivitis and asthma provoked by Asticot maggots.Asticot maggots are used as bait by anglers fishing the rivers, reservoirs and coastal waters of spain. We report the case of a male patient, a keen angler, who used this bait on weekends and suffered allergic reactions that affected his conjunctiva and respiratory system for years. Other baits (earthworms, Eisemia foetida) did not elicit this reaction. In order to confirm the allergic reaction, we used maggots in vivo in the Prick Test, obtaining a positive reaction in 15 to 30 minutes. The patient also had an allergic reaction to house dust mites in prick test. To a lesser extent, he also was sensitive to certain grass pollens (Lollium perenne) and seafood (prawns and squid).- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
3/29. Cicatrizing conjunctivitis associated with paraneoplastic lichen planus.PURPOSE: To report two cases of cicatrizing conjunctivitis associated with paraneoplastic lichen planus. methods: case reports. RESULTS: Two patients were examined because of redness and discomfort in both eyes. A 63-year-old woman with follicular, small-cleaved cell lymphoma had cicatrizing conjunctivitis, stomatitis, vulvitis, and skin lesions. A 25-year-old man with malignant thymoma had cicatrizing conjunctivitis, erosive stomatitis, and penile papules. Histopathologic studies of conjunctiva and skin biopsy specimens in the first patient and labial biopsy specimens in the second revealed lichen planus. CONCLUSION: Paraneoplastic lichen planus is a possible cause of cicatrizing conjunctivitis associated with inflammatory skin and mucous membrane disease.- - - - - - - - - - ranking = 172.3274476143keywords = discomfort (Clic here for more details about this article) |
4/29. Effective treatment with topical cyclosporin A of a patient with cogan syndrome.The purpose of this report is to describe the effective treatment of severe anterior segment inflammation due to cogan syndrome through the use of topical administration of cyclosporin A. A 47-year-old female patient had been experiencing headaches and difficulties with her vision. Subsequent examination revealed the sudden onset of bilateral conjunctival injection and swelling of bilateral auricles. Despite the multiple treatment (systemic and topical corticosteroid and antibiotic therapy), necrotizing scleritis had appeared bilaterally and the scleral wall was thinning. Topical administration of 1% cyclosporin A was applied to both eyes 4 times a day. After 2 months of this therapy, the epithelial tissue covered the necrotizing tissue and her symptom of ocular pain was relieved and her corrected visual acuity was improved. This is the first case exhibiting that topical cyclosporin A is an effective treatment for severe anterior segment inflammation associated with cogan syndrome.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/29. Ligneous conjunctivitis: a case report.BACKGROUND: Ligneous conjunctivitis is a rare condition characterized by chronic, recurrent conjunctivitis associated with pseudomembrane, and it may involve other mucous membranes in the mouth, nasopharynx, trachea, and vagina. We examined and treated a case of presumed ligneous conjunctivitis. CASE: The patient was a 10-year-old boy. His chief complaints were visual impairment, discomfort, and discharge, but no itching in his eyes. His upper eyelids appeared thick without swelling. He had a past history of surgery for lid entropion. His two siblings had similar follicular conjunctivitis. OBSERVATIONS: This case exhibited several characteristics of ligneous conjunctivitis, such as large follicles, recurrent pseudomembrane and normal level IgE in the serum. Indispensable characteristics of vernal keratoconjunctivitis, strong itching, and extensive papillary formation, were not found. In spite of the lack of woody hardness of the conjunctiva, other clinical findings led to the diagnosis of ligneous conjunctivitis. Definite histological diagnosis was not obtained, because of the lack of common histological characteristics among previously reported cases with ligneous conjunctivitis. The boy had developed corticosteroid glaucoma after instillation of dexamethasone 0.1% for 7 months at a previous time. We successfully treated this case with combined instillation of fluorometholon and cyclosporin after trabeculotomy. CONCLUSIONS: Ligneous conjunctivitis must be considered as one type of differential diagnosis of vernal keratoconjunctivitis. Cyclosporin is an effective alternative for the treatment of ligneous conjunctivitis, especially in a case with a possible history of corticosteroid glaucoma.- - - - - - - - - - ranking = 172.3274476143keywords = discomfort (Clic here for more details about this article) |
6/29. Medical acupuncture enhances standard wilderness medical care: a case study from the Inca Trail, Machu Picchu, peru, April 2, 1997.This case report shows the integration of medical acupuncture into the standard medical care of a wilderness emergency situation. Despite conventional medical attention, a trekker suffering from an extremely painful conjunctivitis continued to suffer severe eye pain. The addition of medical acupuncture to his care resolved his eye pain promptly, enabling him to continue his trekking activities without further distress. acupuncture has many potential applications to enhance the effects of standard medical care in wilderness and third world travel settings.- - - - - - - - - - ranking = 3keywords = pain (Clic here for more details about this article) |
7/29. Two siblings with tyrosinaemia type 2.We report on two siblings with tyrosinaemia type 2, a 6-year-old girl and her 3.5-year-old brother with a main complaint of painful palmo-plantar hyperkeratosis. The boy presented also conjunctival injection, photophobia, lacrimation and conjunctivitis. blood tyrosine levels were increased in both patients, 150.6 and 202.3 micro mol/dl, respectively (reference value: 5.8 /-2.2 micro mol/dl). After 1 month of dietary treatment with low protein, low phenylalanine and tyrosine, tyrosine levels decreased to 37.7 and 65.6 micro mol/dl, respectively; the cutaneous lesions improved in both of them, and conjunctivitis disappeared. CONCLUSION: the association of bilateral ulcero-conjunctivitis with photophobia and palmo-plantar hyperkeratosis since early infancy is the clue to the diagnosis of tyrosinaemia type 2.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/29. Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome.PURPOSE: To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma. DESIGN: A small, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 12 patients (8 female and 4 male, aged 21-84 years) who were urgently reported or referred with a variety of diagnoses resulting from acute onset of red, painful eye. Four eyes had corneal transplants, two were recovering from herpetic keratitis, two had undergone cataract surgery or a laser in situ keratomileusis procedure, one had a corneal neurotrophic ulcer, and one used a contact lens. All the patients had received new medications (ophthalmic ointments in nine patients, topical drops in three patients) within 1 week before onset of symptoms. INTERVENTION: Assessment of method of self-administration of topical medication, evaluation of the ocular surface lesion, and patient education. MAIN OUTCOME MEASURES: association of patient behavior with ocular surface lesions. RESULTS: All 12 patients presented red, painful eyes, congested lower palpebral conjunctiva, epithelial conjunctival erosions, and episcleritis. In all patients, direct contact of the tube or bottle-tip with the affected area of the conjunctiva was ascertained by inspection. Instructions on proper method of drug administration and eye patching with lubrication were followed, within 2 weeks, by healing of conjunctival lesions. CONCLUSIONS: Drug containers may cause nonintentional conjunctival trauma and simulate severe ocular disorders. physicians should be aware of this diagnosis in any case of prolonged and unexplained ocular irritation and should instruct patients as to the proper instillation of topical ophthalmic medications.- - - - - - - - - - ranking = 3keywords = pain (Clic here for more details about this article) |
9/29. Sclerosing peritonitis and propranolol.Sclerosing peritonitis developed in a 43-year-old man with angina pectoris who had been receiving the beta-adrenergic receptor antagonist, propranolol. The patient had abdominal and back pain, weight loss, a midabdominal fullness, ascites, and evidence of partial small bowel obstruction. At surgery, the small bowel was distended and encased by dense fibrous tissue. Infectious and neoplastic causes of fibrosing peritoneal inflammation were excluded. The patient described in this report illustrates several features commonly experienced by individuals who developed sclerosing peritonitis associated with beta-adrenergic receptor blockade therapy. To my knowledge, the development of ascites and considerable ascitic fluid leukocytosis have not been described previously with this disorder.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
10/29. Oral lichen planus: an unusual cause of facial and abducens nerve paralysis associated with conjunctival and oesophageal involvement.lichen planus (LP) is a T-cell-mediated disorder that may involve the skin, nails and mucosal surfaces. Conjunctival, laryngeal and oesophageal involvement were reported to be extremely rare manifestations of the disease. In this report, we present an oral LP case who complained of severe burning pain on his tongue and oral mucosa caused by ulcerative lesions and associated with conjunctival, laryngeal and oesophageal involvement. In addition, neurological examination revealed facial and abducens nerve palsy. To the best of our knowledge, we are presenting the first case of erosive oral LP associated with facial and abducens nerve paralysis. Although this association may be coincidental, according to an immunological concept proposed to explain the pathogenesis of Bell's palsy, degranulation of mast cells activated by complement or specific allergens with the release of histamine and other substances were to be presented responsible from nerve oedema, ischaemia and paralysis. As mast cell mediators are likely to be involved in the immunopathogenesis of OLP, we think that the cause of facial and bilateral abducens nerve palsy could be explained by the same mechanism. This case is a good example of the need for team work in lichen planus patients undergoing interdisciplinary consultations.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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