1/4. Acute cerebellar syndrome, conjunctivitis, and hearing loss associated with low-dose cytarabine administration.An unusual reaction associated with chronic low-dose cytarabine is described. A 77-year-old man complained of three to four weeks of hearing loss and progressive inability to walk without assistance. He had received two courses of cytarabine 100 mg sc/wk for the management of myelofibrosis myeloid metaplasia over 21 months. He received a total of 3 g over seven months during his first course followed ten months later with a 1.2 g over four months. Conjunctivitis was also identified on physical examination at the time of his admission. He was admitted to the neurology service where a complete neurological work-up with consultations from the ophthalmology, audiology, hematology, and ear, nose, and throat services failed to identify a cause of his symptoms. cytarabine was discontinued on the suspicion that his symptoms were drug induced. The conjunctivitis resolved completely with ophthalmic antibiotics and corticosteroids. His hearing slowly improved over three to four weeks, and he was able to ambulate with a walker. He continued to improve at home although some hearing loss remained three months after his initial presentation. Although conjunctivitis and neurotoxicity are well-known complications of high-dose cytarabine, there are no prior reports of these reactions after low-dose therapy. hearing loss, which has not been previously reported with cytarabine alone, appears to be a new complication of cytarabine administration.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/4. Adverse external ocular effects of topical ophthalmic therapy: an epidemiologic, laboratory, and clinical study.New knowledge of adverse external ocular reactions to topical ophthalmic medications was obtained by means of a computerized epidemiologic study, laboratory studies, and clinical observations. Listed below are the major findings and conclusions that represent facts or concepts that were previously unknown, uncertain, misunderstood, or forgotten: The incidence of clinically important drug reactions among all cases was at least 13.09% and may have been as high as 16.02%. Among treated patients it was at least 16.26% to 19.90%. Taken together, drug reactions were the second most common external disease diagnosis. The incidence of each kind of drug reaction was determined. Toxic papillary reactions accounted for 79.10% of drug cases and 10.35% of all cases. Toxic papillary keratoconjunctivitis was the third most common single diagnosis. The following epidemiologic factors were found to be related to the development or presence of drug reactions: number and variety of treating practitioners, number of practitioners consulted, number of practitioners consulted who treated, specific ophthalmologist consulted (8.24% of ophthalmologists referred 39.55% of all drug cases and showed a tendency habitually to overtreat), number and kinds of patients' symptomatic complaints, number of medications prescribed and used, number of days of treatment, particular drugs and preservatives used (but not their strengths or vehicles), underlying (primary) diagnoses, and inaccuracy of referring ophthalmologists' diagnoses. patients with dry eyes were especially at risk for the development of toxic papillary reactions. Among all cases, the incidence of reactions to preservatives (mainly thimerosal) in contact lens solutions was 0.39% to 1.95%, depending on whether definite or probable cases, respectively, were considered. The incidence among the 54 patients who used daily-wear lenses (excluding extended-wear therapeutic and optical contacts) was 7.41% for definite reactions and 37.04% for probable ones. Factors relating to the development of papillary contact-lens reactions were daily wear, number of days of wear, and, especially, the preservatives to which the patients were exposed. Reactions occurred more often with soft lenses than with hard ones. Of patients with drug reactions, 5.22% had two different ones simultaneously. Coexisting reactions to pharmacologically active agents were also present in 15% of patients who reacted to preservatives in contact lens solutions. The ocular tissues that were affected by each kind of drug reaction were tabulated, and the relative degrees and sequences of involvement were discussed. The frequencies with which particular drugs, physical ag- - - - - - - - - - ranking = 0.066911611231112keywords = physical (Clic here for more details about this article) |
3/4. Differential diagnosis of pediatric conjunctivitis (red eye).Because eye injuries and diseases may potentially result in serious vision impairments, accurate diagnosis and treatment of ophthalmic conditions are imperative. A symptom common to eye impairments is conjunctivitis, or red eye, a commonly seen manifestation in an ambulatory pediatric population. Because conjunctivitis is caused by various etiologies, clinicians must derive a differential diagnosis. This article examines possible causes of conjunctivitis after the neonatal period in this population. Differential diagnosis is dependent on a complete history, distinct physical findings, and use of adjunct diagnostic tests. Treatment, which depends on a sound differential diagnosis, should be targeted according to the cause of the problem.- - - - - - - - - - ranking = 0.066911611231112keywords = physical (Clic here for more details about this article) |
4/4. Self-induced cicatricial conjunctivitis with symblephara.PURPOSE: Cicatricial conjunctivitis is an uncommon ocular finding with several possible origins. We report a patient whose obsessive-compulsive disorder involved constant self-induced mechanical trauma to the eyes, leading to bilateral cicatricial conjunctivitis. METHOD: Case report. RESULTS: Based on the history, physical examination, ocular surface scraping, and conjuctival biopsy, other causes of cicatrical conjunctivitis were ruled out, and a self-induced cause was confirmed. CONCLUSIONS: Inquiries pertaining to psychiatric history may be important in patients with cicatricial conjunctivitis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |