BACKGROUND: Sequential visual field testing is an extremely helpful adjunct to ophthalmoscopy and fundus photography in the management of cytomegalovirus (CMV) retinitis with the antiviral agents ganciclovir or foscarnet in patients with the acquired immune deficiency syndrome (AIDS). The authors studied the visual field defects found in a series of 110 patients with AIDS and CMV retinitis. METHODS: Ophthalmoscopy and fundus photography were performed on all patients. Visual field analysis was performed with either tangent screen, Goldmann kinetic, or Humphrey automated static perimetry. RESULTS: Of 166 eyes in 110 patients with CMV retinitis, visual field defects were present initially in 92 (55%) eyes of 78 (70%) patients, and ultimately in 97 (53%) eyes of 90 patients in whom follow-up was available. Stabilization of visual field defects was indicative of controlled retinitis. CONCLUSION: Sequential visual field testing will confirm ophthalmoscopic evidence of successful antiviral treatment of CMV retinitis and will corroborate very early progression of previously controlled retinitis.

AIDS-Related Opportunistic Infections↗

PubMed1989

Endogenous bacterial retinitis in AIDS.

We studied two patients, one with histologically confirmed endogenous bacterial retinitis associated with the acquired immunodeficiency syndrome and a second with ophthalmoscopically identical findings who also responded to antibiotic treatment. Both patients had focal, discrete patches of retinitis that enlarged slowly over weeks and ultimately accumulated large amounts of subretinal fluid and retinal exudate. One patient underwent retinal biopsy after systemic and vitreous cultures were negative. Histopathologic sections showed necrotic retina infiltrated with multiple histiocytes containing intracytoplasmic, iodine-positive, pleomorphic, encapsulated bacterial forms. The organism was not grown from the retinal biopsy specimen. Treatment with antibiotics resulted in improved vision in both patients. Our results indicate that endogenous bacterial infection should be considered in the differential diagnosis of retinitis associated with the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗

PubMed1985

Pancreatic masses that angiographically simulate intrasplenic lesions.

Major improvements in the resolving power of computed tomography and ultrasound over the last decade have greatly improved the preoperative evaluation of abdominal masses. Angiography is, however, still often required for vascular mapping and assistance in the differential diagnosis. Although the site of origin of an avascular, intrasplenic mass may be the spleen, our experience and review of the literature indicates that such primary or secondary splenic masses are relatively rare. A primary pancreatic mass often a pseudocyst is a more frequent cause and should figure prominently in the differential diagnosis.

Adult↗

PubMed1985

Granulomatous uveitis in neurological disease.

Five women with granulomatous uveitis were diagnosed as having probable multiple sclerosis. Three of the women developed curious iris nodules that resolved with topical prednisolone acetate treatment. The association of granulomatous type uveitis, with or without iris nodules, should alert the ophthalmologist to inquire about neurological symptoms attributable to multiple sclerosis.

Adult↗

PubMed1984

Formed visual hallucinations after metrizamide myelography.

About 12 hours after 77-year-old woman underwent metrizamide myelography of the posterior fossa to elucidate the cause of downbeat nystagmus, she developed formed visual hallucinations consisting primarily of brightly colored geometric shapes, cloud formations, and human figures. Her white blood cell count was 26,000/mm3 and her serum creatine phosphokinase level was markedly increased to 438 units/liter. Two days later, the hallucinations had subsided, the white blood cell count had decreased to 17,000/mm3, and the serum creatine phosphokinase level had decreased to 105 units/liter. The hallucinations were probably caused by penetration of the metrizamide into the temporal lobe and visual association cortex.

Aged↗

PubMed1984

Coexistent intrauterine and ectopic pregnancy: a reevaluation.

Retrospective analysis of ectopic pregnancies occurring in the past 36 months at the Beth Israel Hospital yielded two cases of concomitant intra- and extrauterine gestation. The incidence of coexistent intrauterine and ectopic pregnancy in this sample is 1/6,778, or 0.015% of all pregnancies. We report these cases and two additional cases from another institution (Leonard Morse Hospital). We postulate that simultaneous intrauterine and ectopic pregnancy may be more common than previous statistics indicate.

Adult↗

PubMed1982

Culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome.

A 35-year-old homosexual man with cytomegalovirus viremia developed retinitis. He also had a new syndrome consisting of a persistent T-lymphocyte deficit, pneumocystis pneumonia, recurrent Candida albicans esophagitis, skin ulcerations caused by herpes simplex virus, Type 2, disseminated Mycobacterium avium-intracellulare infection, and molluscum contagiosum. Histopathologic examination revealed bilateral necrotizing retinitis with virions in retinal, choroidal, and optic nerve tissues. Postmortem cultures of retina and vitreous were positive for cytomegalovirus.

Acquired Immunodeficiency Syndrome↗

PubMed1980

Transluminal dilatation for subclavian steal syndrome.

Explore the source record for details and available documents.

Aged↗

PubMed1979

Percutaneous iliofemoral angioplasty via the contralateral femoral artery.

Using a flexible balloon catheter, transluminal angioplasty of the lower extremities may be performed via a puncture of the contralateral extremity. Five cases which illustrate the usefulness of this technique are presented. It provides access to lesions not amenable to ipsilateral puncture, avoids the need to compress the dilated artery, and decreases the risk of significant hematoma formation.

Aged↗

PubMed1979

Microfibrillar collagen hemostat: a new transcatheter embolization agent.

Nine patients underwent transcatheter embolization with a suspension of microfibrillar collagen hemostat (MCH). Four of the patients had large vascular renal tumors, and two had bleeding bladder carcinomas. There was one case each of bleeding rectal tumor, bleeding esophageal varices, and arteriovenous malformation of the shoulder. MCH was highly thrombogenic and could be injected through very small catheters. It was highly effective as an occlusive agent and was able to penetrate the small end-arteries of a lesion. Its main disadvantage is that if normal tissues are inadvertently embolized, there is a risk of ischemic complication.

Adult↗

PubMed1978

The effects of minor degrees of obliquity on the lateral chest radiograph.

Minor degrees of obliquity affect the appearance of the lateral chest radiograph. For 100 normal subjects we compared findings on three left lateral projections: the "straight lateral", rotation of the subject's right side 10 degrees anterior ("right anterior"), and rotation of the patient's right side 10 degrees posterior ("right posterior"). A number of structures appeared generally best seen in the "right anterior" lateral projection, less well seen in the "straight posterior" lateral projection and least well seen in "right posterior" lateral projection. These structures were the epicardial fat stripe and pericardial line, the anterior margin of the ascending aorta, the hilar vessels, the origins of the upper lobe bronchi, and the posterior wall of the bronchus intermedius. The heart appeared largest in the "right anterior" lateral view, while in the "right posterior" lateral view it appeared smallest (whether assessed subjectively or by measurement of posterior left ventricular overlap of the inferior vena cava). Similarly, the hilar vascular shadows and major bronchi were most prominent when rotated apart in the "right anterior" projection and least prominent when more nearly superimposed in the "right posterior" projection. Slight rotation showed no significant effect on the anteroposterior diameter of the trachea, the width of the left pulmonary artery, or the diameters of the upper lobe bronchi. The azygos vein and a well visualized posterior tracheal band were seen in a few patients. They tended to be best and most frequently seen in the "right posterior" lateral view. Either obliquity tended to improve delimeation of the anterior pleural margins and the costophrenic angles. This was also true for the interlobar fissures, but confusing superimposition shadows were less likely in the "right anterior" than the "right posterior" lateral radiograph.

Aortography↗

PubMed1977

Selective renal artery embolization. Treatment of acute renovascular hypertension.

A critically ill patient with severe renovascular hypertension following surgical repair of an aortic dissection was treated by percutaneous selective embolization of the ischemic kidney. Correction of the hypertension and subsequent complete recovery of the patient resulted.

Acute Disease↗

PubMed1967

Pyramidal bodies in RA synovial fluid.

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Arthritis, Rheumatoid↗