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Biomedical subjects

Larry Frohman

Publications and source records attributed to Larry Frohman.

9 recordsLinked to original sources
PubMed2004

Panophthalmitis due to clostridium septicum.

PURPOSE: To describe patient survival in a rare case of endogenous Clostridium septicum sepsis with panophthalmitis. DESIGN: Observational case report. METHODS: Both eyes of a female patient were examined in a hospital setting. RESULTS: A 68-year-old woman had right orbital pain, proptosis, panophthalmitis, mental confusion and fever for 2 days. Blood cultures were significant for Clostridium septicum. The patient did not improve after treatment with intravenous broad-spectrum antibiotics and the right eye was enucleated. The patient survived the acute infection and extensive systemic evaluation revealed an undiagnosed colon carcinoma that may have been responsible for colonization and vascular dissemination of Clostridium septicum. CONCLUSIONS: Clostridium septicum panophthalmitis and sepsis can be the presenting sign in patients with unsuspected malignancies, particularly colon cancer. Patients can survive the infection with aggressive therapy with systemic antibiotics combined with removal of the infected tissue.

Acute Disease↗
PubMed2004

Pituitary apoplexy occurring during large volume liposuction surgery.

A 50-year-old woman developed headache and right-sided ophthalmoplegia upon awakening from general anesthesia after liposuction surgery on her abdomen, hips, and thighs. Neuroimaging showed hemorrhage within a previously undiagnosed pituitary adenoma. The confirmatory surgical specimen contained areas of gross infarction and hemorrhage. The anesthesia record revealed intraoperative reduction of systolic blood pressure to 90 mm Hg for 30 minutes from a baseline of 120 mm Hg. This first reported case of pituitary apoplexy during liposuction surgery probably resulted from intraoperative hypotension attributed to a combination of general anesthesia, the use of subcutaneous lidocaine, sequestration of plasma in injured tissues, and blood loss.

Abdomen↗
PubMed2003

CT of orbital trauma.

In a patient with acute orbital trauma, visual acuity and extraocular muscle motility are the two most important ophthalmologic functions to be evaluated emergently. The assessment of these capabilities may sometimes be difficult due to the severity of the head injury, the extent of periorbital soft tissue edema, inadequate cooperation in alert patients, and a reduced level of consciousness in obtunded individuals. Consequently, computed tomography (CT) has come to play a major role in the orbital examination of acute trauma patients. In this study, in conjunction with clinical evaluation, we have sought to utilize CT to determine the various prevalences of the causes of decreased visual acuity and extraocular muscle motility resulting from orbital trauma. We retrospectively reviewed the records of all patients admitted to our emergency facility who, having suffered head trauma, underwent a CT study for diagnosis. CT examinations of the head using a multidetector scanner were performed from the base of the skull to the vertex at 5-mm intervals. Orbital CT was obtained when a routine CT of the head showed periorbital soft tissue edema and/or facial bone fractures. The orbital CT examination was performed using axial 1-mm and coronal 3-mm slices. Coronal reformation images were prepared if the patient was unable to tolerate the prone position for direct coronal imaging. The imaging findings were correlated with ophthalmologic observations. The orbit floor was the most common and the orbital roof the least common site of fracture of the bony coverings of the eye. Twenty-three patients suffered decreased visual acuity. In order of declining frequency, the causes of reduced vision consequent to trauma were retrobulbar hemorrhage, optic nerve thickening presumably secondary to edema, intraorbital emphysema, optic nerve impingement, detached retina and ruptured globe. Five patients had visual impairment without demonstratable radiographic abnormalities. The most common finding associated with diminished extraocular muscle motility was muscle impingement by fracture fragments, followed in decreasing frequency by thickened muscle due to edema or contusion, intraconal emphysema, muscle entrapment, and retrobulbar fat herniation. Six patients with decreased extraocular muscle activity had no abnormalities demonstrated on CT images. The overwhelming majority of patients with decreased visual acuity or reduced extraocular muscle motility consequent to trauma had abnormalities demonstrated by orbital CT. Hence, CT examinations should play a major role in the evaluation of the intraorbital contents in patients with orbital trauma.

Adolescent↗
PubMed2003

Autoimmune optic neuropathy with anticardiolipin antibody mimicking multiple sclerosis in a child.

PURPOSE: To demonstrate that autoimmune optic neuropathy (AON) may occur in the pediatric population. DESIGN: Interventional case report. METHODS: A 4-year-old developed four episodes of bilateral optic neuritis with mild concurrent weakness, ataxia, or dizziness; one episode of unilateral optic neuritis; and one episode of weakness over a period of 4 years. RESULTS: Autoimmune optic neuropathy was diagnosed because of the presence of anticardiolipin antibody and an abnormal skin biopsy with thrombin and immunoreactant deposition. She was treated with corticosteroids, aspirin, and gammaglobulin. This diminished the frequency and intensity of her attacks. CONCLUSION: This case represents the diagnosis and treatment of AON in a child.

Antibodies, Anticardiolipin↗
PubMed2002

Resolution of papilledema after neurosurgical decompression for primary Chiari I malformation.

PURPOSE: To report a causal relationship between Chiari I malformation and its rare, but recognized manifestation of bilateral papilledema. DESIGN: Interventional case series. METHODS: Four adult female patients (mean age, 48, age range 25-59 years) with bilateral papilledema, signs and symptoms of increased intracranial pressure, and cranial magnetic resonance imaging (MRI) evidence of a Chiari I malformation ranging from 7 to 22 mm of tonsillar herniation underwent suboccipital decompression. RESULTS: In all four patients, suboccipital decompression was followed by resolution of bilateral papilledema and signs and symptoms of increased intracranial pressure. CONCLUSION: Patients with bilateral papilledema and presumed pseudotumor cerebri require a cranial MRI to determine if they have a Chiari I malformation, because patients with increased intracranial pressure and papilledema from a Chiari I malformation may benefit from suboccipital decompression.

Adult↗
PubMedDate not supplied

Foggy vision.

A 53-year-old man with history of "foggy vision" was referred for neuro-ophthalmic consultation. His examination showed a right homonymous hemianopia detected with automated perimetry. Brain magnetic resonance imaging showed extensive enhancement of the structures in the sellar region and patchy meningeal enhancement. Blood workup was unremarkable. He eventually had bronchoscopy, which confirmed the diagnosis of sarcoidosis.

Azathioprine↗