1141/1795. Luetic hydrops--diagnosis and therapy. Nine patients presenting at the Shea Clinic over the past eight years with a history of fluctuant hearing loss were subsequently found to have neurosyphilis. Treatment has consisted of penicillin, given by various routes, oral steroids and vasodilator therapy. We have, based on recent investigations, begun using high dose intravenous penicillin in this regimen. Results have been encouraging in two patients, with rapid improvement in hearing. A protocol outline for diagnosis and therapy of syphilis is included in the discussion. ( info) |
1142/1795. Compression of the inferior caval vein--a rare complication of a large non-parasitic liver cyst. A patient with massive edema of the legs and scrotum is presented in whom non-parasitic cysts of the liver were found. Surgical evacuation of one large lobulated liver cyst completely relieved the patient of his edema. It is concluded that in this patient the peripheral edema was caused solely by cystic obstruction of the inferior caval vein. ( info) |
1143/1795. Maternal deaths associated with postpartum vulvar edema. Reported are three maternal deaths in four patients who presented with a similar syndrome following a normal antepartum course and normal labor and delivery managed by regional or local anesthesia and midline or proctoepisiotomy. Beginning about the second postpartum day, the patients developed unilateral perineal edema and induration which progressed to generalized vulvar, vaginal, perineal, and gluteal edema and induration. These patients developed marked leukocytosis, fever, and ultimately vascular collapse; three of them died. The one patient who survived had a similar course except for vascular collapse. Unilateral vulvar induration and edema associated with fever and marked leukocytosis are ominous signs. Aggressive treatment should include the use of multiple antibiotic, crystaloid, colloid, and steroid drugs and appropriate monitoring. By this report we hope to bring attention to this rare but lethal syndrome. ( info) |
1144/1795. Acute retinal pigment epitheliitis with macular edema. A 34-year-old white woman developed acute loss of central vision in the left eye due to a multifocal inflammatory disturbance of the retinal pigment epithelium in the macula. Subretinal and intraretinal fluorescein leakage were noted in the acute stage. Vision subsequently improved to normal; however, residual spots of depigmentation remained. ( info) |
| A 9-year-old black boy was admitted to the hospital for treatment of herpes zoster involving the trigeminal nerve distribution on the left half of his face. Consulting examination of his eye on the involved side revealed moderate iritis as well as papillitis and diffuse retinitis. ( info) |
1146/1795. The Shulman syndrome: report of a further case. A 53-year-old woman developed swelling of her hands after strenuous sport. Soon her feet became affected and the swelling spread up the arms and legs making arm movement and walking difficult. No Raynaud's phenomenon appeared or other features of systemic sclerosis. There was eosinophilia and hypergammaglobulinaemia in the peripheral blood. Histological examination of the skin showed an increase in the collagen bundles in the dermis extending down to the adipose tissue. The fascia showed dense fibrous tissue with a perivascular infiltrate of lymphocytes, a few plasma cells and eosinophils. Immunohistology of the skin and fascia were negative for IgA, IgG, IgM, C3, CIq and fibrin. After 4 weeks of prednisolone 40 mg daily there was a great improvement. This continued with further corticosteroid therapy. ( info) |
1147/1795. Increased attenuation value in a hydropic gallbladder. A case is presented in which the presence of sludge in a hydropic gallbladder altered both the usual sonographic and computed tomographic appearance of the gallbladder. ( info) |
1148/1795. Traumatic simulated Brown's syndrome: a case report. A case report of a simulated Brown's tendon sheath syndrome is presented which masks as an orbital floor fracture with entrapment. Despite a positive forced traction test, additional diagnostic information such as a normal tomographic exam of the orbital floor, vertical saccadic up gaze velocity measurements consistent with edema and hemorrhage, greater limitation to elevation in adduction than abduction, and tenderness and soft tissue injury in the region of the trochlea, persuaded us to conservatively manage this case. It behooves the ophthalmologist to consider a temporary superior restrictive phenomenon produced by edema prior to any surgical approach to improve elevation of the globe. ( info) |
1149/1795. Traumatic retinal pigment epithelial edema. A 17-year-old girl was struct in the right eye by a mortarboard tossed into the air during high school graduation exercises. She suffered commotio retinae with damage to the retinal pigment epithelium and macular hole formation. Fluorescein angiography in the acute stages revealed diffuse staining at the level of the pigment epithelium. Five months later, the areas of abnormal staining had undergone depigmentation and dye no longer accumulated in the pigment epithelial layer. The fluorescein findings in traumatic retinal pigment epithelial edema are unusual. ( info) |
| A 34-year-old man had a six-month history of bilateral visual loss that was secondary to cystoid macular edema, which was assumed to be secondary to neurosyphilis on the basis of cerebrospinal fluid serology, cell count, and protein. Good visual acuity was recovered with systemic corticosteroids only after they were used in combination with antitreponemal therapy. This is the first report, to the best of our knowledge, of cystoid macular edema as the primary sign of neurosyphilis documented by fluorescein angiography. ( info) |