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PubMed1990

Unusual manifestations of child abuse.

Cases of child abuse are seen each day in the clinics, emergency departments, private offices, and public and private hospitals. Unusual presentations are intermixed with the straightforward, conventional, and well-understood cases. Fatal pepper aspiration, abdominal injuries ranging from rents in the liver and spleen, transection of the pancreas, and traumatic pseudocysts of that organ are described here. The triad of signs dubbed the "tin ear syndrome" consists of bruising of the ear, retinal hemorrhages, and cerebral edema. Toxic ingestions, mainly of cocaine, and its related paraphernalia are described in addition to peculiar tissue-specific microwave oven burns, an inflicted injury that rational minds find hard to comprehend. Finally, the bizarre syndrome of Münchausen by proxy is reviewed, and some understanding of the dynamics of this disorder has begun. Knowledge about these diagnostic oddities will enable us to intervene and attempt to alter the outcome in these dysfunctional families. The authors would welcome other case reports of unusual manifestations of child abuse, neglect, and child sexual abuse.

Child↗

PubMedDate not supplied

A review of the spectrum of clinical ocular fundus findings in P. falciparum malaria in African children with a proposed classification and grading system.

Ocular fundus pathology in Plasmodium falciparum malaria is common and has prognostic significance. We have made a collaborative effort to document the ocular features in several populations. Based on examination of 735 patients in Malawi, Kenya and The Gambia by direct and indirect ophthalmoscopy with dilated pupils, we have determined that the 5 distinct clinical features (in order of frequency) include retinal whitening, haemorrhages, unique vessel abnormalities, papilloedema, and cotton wool spots. Photographs and descriptions of these are presented, along with a proposed grading scheme.

Child↗

PubMedDate not supplied

A red eye and then a really red eye.

A 90-year-old woman presented with a 4-week history of a presumed infectious conjunctivitis resistant to topical antibiotic medications. Examination revealed tortuous, dilated conjunctival vessels in the right eye, retinal hemorrhages, and an orbital bruit suggestive of a carotid-cavernous sinus fistula (CCF). While awaiting a magnetic resonance imaging study, she returned to the clinic the next day with a painful, swollen right eye and an intraocular pressure of 69 mm Hg. A cerebral arteriogram confirmed a direct CCF. Because of the tortuosity of the systemic vascular anatomy, a right carotid artery cut-down with balloon occlusion was performed with successful closure of the fistula and prompt resolution of the orbital congestion. This case illustrates the spectrum of subtle to conspicuous ocular manifestations that can be seen in patients with CCF and its potential to present as an emergency. CCF should be included in the differential diagnosis of an "atypical" red eye. Recognition of arteriolized conjunctival vessels and auscultation of an orbital bruit raises the possibility of a CCF, requiring prompt diagnostic studies.

Aged↗

PubMedDate not supplied

Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake.

Battered/shaken baby syndrome is a clinical and pathologic diagnosis based on clinical examination, central nervous system dysfunction, and intracranial, optic nerve sheath, and retinal hemorrhages in infants under the age of three years. This report describes a case in which the battered/shaken baby syndrome was suspected because of an unusual parental reaction to an acute, mortal illness in their seven-week-old baby, as well as an acute intracranial hemorrhage coupled with the discovery of optic nerve sheath hemorrhages at necropsy. Thorough microscopic study, however, uncovered an unusual subarachnoid vascular malformation, the rupture of which led to the death of the infant. This case underscores the importance of complete postmortem examinations in cases of suspected child abuse, and teaches caution in jumping to hasty conclusions.

Battered Child Syndrome↗

PubMedDate not supplied

Acute subdural hematoma in infancy.

BACKGROUND: Acute subdural hematoma in infants is distinct from that occurring in older children or adults because of differences in mechanism, injury thresholds, and the frequency with which the question of nonaccidental injury is encountered. The purpose of this study is to analyze the clinical characteristics of acute subdural hematoma in infancy, to discover the common patterns of this trauma, and to outline the management principles within this group. METHODS: Medical records and films of 21 cases of infantile acute subdural hematoma were reviewed retrospectively. Diagnosis was made by computed tomography or magnetic resonance imaging. Medical records were reviewed for comparison of age, gender, cause of injury, clinical presentation, surgical management, and outcome. RESULTS: Twenty-one infants (9 girls and 12 boys) were identified with acute subdural hematoma, with ages ranging from 6 days to 12 months. The most common cause of injury was shaken baby syndrome. The most common clinical presentations were seizure, retinal hemorrhage, and consciousness disturbance. Eight patients with large subdural hematomas underwent craniotomy and evacuation of the blood clot. None of these patients developed chronic subdural hematoma. Thirteen patients with smaller subdural hematomas were treated conservatively. Among these patients, 11 developed chronic subdural hematomas 15 to 80 days (mean = 28 days) after the acute subdural hematomas. All patients with chronic subdural hematomas underwent burr hole and external drainage of the subdural hematoma. At follow-up, 13 (62%) had good recovery, 4 (19%) had moderate disability, 3 (14%) had severe disability, and 1 (5%) died. Based on GCS on admission, one (5%) had mild (GCS 13-15), 12 (57%) had moderate (GCS 9-12), and 8 (38%) had severe (GCS 8 or under) head injury. Good recovery was found in 100% (1/1), 75% (8/12), and 50% (4/8) of the patients with mild, moderate, and severe head injury, respectively. Sixty-three percent (5/8) of those patients undergoing operation for acute subdural hematomas and 62% (8/13) of those patients treated conservatively had good outcomes. CONCLUSIONS: Infantile acute subdural hematoma if treated conservatively or neglected, is an important cause of infantile chronic subdural hematoma. Early recognition and suitable treatment may improve the outcome of this injury. If treatment is delayed or the condition is undiagnosed, acute subdural hematoma may cause severe morbidity or even fatality.

Diagnosis, Differential↗

PubMed2000

A profile of the oro-facial injuries in child physical abuse at a children's hospital.

OBJECTIVE: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa. METHOD: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out. RESULTS: The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures. CONCLUSIONS: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.

Adolescent↗

PubMed1978

The effect of calcium dobesilate on nonproliferative diabetic retinopathy: a controlled study.

Two independent, double-masked, controlled studies were made to evaluate the efficacy of calcium dobesilate for the treatment of nonproliferative diabetic retinopathy. Forty-two patients underwent a six-month crossover evaluation while receiving calcium dobesilate (750 mg per day) and placebo in random order. Thirty-six patients received calcium dobesilate (1,000 mg per day) or placebo for one year. Evaluation by clinical examination, fluorescein angiography, angiography, and fundus photography failed to demonstrate any beneficial effect of calcium dobesilate.

Adult↗

PubMed1978

Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings.

Data from the Diabetic Retinopathy Study (DRS) show that photocoagulad inhibited the progression of retinopathy. These beneficial effects were noted to some degree in all those stages of diabetic retinopathy which were included in the Study. Some deleterious effects of treatment were also found, including losses of visual acuity and constriction of peripheral visual field. The risk of these harmful effects was considered acceptable in eyes with retinopathy in the moderate or severe retinopathy in the moderate or severe proliferative stage when the risk of severe visual loss without treatment was great. In early proliferative or severe nonproliferative retinopathy, when the risk of severe visual loss without treatment was less, the risks of harmful treatment effects assumed greater importance. In these earlier stages, DRS findings have not led to a clear choice between prompt treatment and deferral of treatment unless and until progression to a more severe stage occurs.

Argon↗

PubMed1979

Presumed phlebitis of the optic disc.

The clinical picture of unilateral disc edema suggests the presence of ocular, orbital, or intracranial disease. This report focuses on a poorly appreciated and often overlooked cause of unilateral disc edema, presumed phlebitis of the optic disc, along with a review of the literature. Typical case presentations are reviewed, and emphasis is placed on the neurophthalmologic approach to this entity. An appropriate diagnostic evaluation and indications for treatment are presented. Awareness of this syndrome can eliminate extensive neurodiagnostic procedures for the patient with a typical clinical picture.

Adult↗

PubMed1979

Infrequency of retinal neovascularization following central retinal vein occlusion.

Forty-eight patients with the clinical diagnosis of central retinal vein occlusion and ten surgically enulceated eyes with central retinal vein occlusion documented by histopathologic examination were studied and reviewed. Retinal neovascularization developed in only one of the ten eyes. Rubeosis iridis occurred in 14% (7) of the clinical cases and in all of the histopathologic cases. Ten eyes with neovascular glaucoma, enucleated following central retinal vein occlusion, showed absence of retinal endothelial cells. The absence of retinal capillary endothelial cells is significant in explaining the rare occurrence of retinal neovascularization following central retinal vein occlusion. However, the small number of cases may reflect a biased result. Further studies of more cases over a longer period are required to reach the final conclusion.

Humans↗

PubMed1982

Branch vein occlusion.

Explore the source record for details and available documents.

Fluorescein Angiography↗

PubMed1985

Complications associated with the use of the neodymium:YAG laser.

The neodymium:YAG laser was used in a consecutive series of 93 eyes. Diagnosis was opacified posterior capsule in 81 eyes of which 52 were pseudophakic, with cystoid macular edema and vitreous strands in eight eyes, pigmented anterior hyaloid in two eyes, opacified anterior capsular flap in one eye and vitreous strand blocking an anterior chamber tube shunt to an encircling band tube in one eye. Despite significant visual improvement and reduction of cystoid macular edema, a variety of complications were seen. These included pitting of the implant in 26 eyes and cracks in four, two of which developed a vitreitis. These occurred more frequently in our earlier cases. Also seen was elevated IOP in six eyes, pupillary block in two, vitreous face rupture in five, cystoid macular edema in four, hyphemas in four, corneal injury in two and acute peripheral retinal hemorrhage in one eye.

Cataract Extraction↗

PubMed1985

Cryotherapy for retinopathy of prematurity. A personal retrospective.

Six patients from 1975 to 1981 were treated by cryotherapy for active retinopathy and prematurity. One eye was treated, leaving the second eye as a control. Cryotherapy was applied just posterior to the demarcation line, under direct observation and utilizing the cataract probe. Conclusions from this experience are that in order to be effective, cryotherapy must be performed comparatively early in Stage III. Unfortunately, this would lead to treatment of many cases that would spontaneously regress. Treatment of late Stage III, rapidly progressive cases is not impressive.

Cryosurgery↗

PubMed1985

Computer-assisted spectral electroretinography in vitrectomy patients.

Computer-assisted spectral electroretinography (CASE), using full field stimulation in the presence of a rod saturating background light, has been found to be a useful means of evaluating retinal function in patients with vitreal opacities. By this means, cone electroretinograms (ERGs) to white as well as spectrally selective stimuli could easily be detected in 22 of 24 eyes with vitreal opacities obscuring any view of the fundus and with minimal or no detectable ERGs to standard single flash stimuli. The responses to spectral stimuli in the presence of a rod saturating background light provides a means of estimating the optical density of the opacity. The results indicate that most patients undergoing vitrectomy for such opacities have considerable superimposed retinal damage and that the opacities themselves are seldom sufficiently dense to decrease the ERG to any great extent. Five eyes studied before and after vitrectomy indicate that successful vitrectomy has no effect on the ERG. The results suggest that CASE may be a useful substitute to the bright flash ERG for evaluating global retinal function behind an opaque media.

Adolescent↗

PubMed1990

Toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome. Report of a case.

A 29-year-old man with acquired immune deficiency syndrome (AIDS) was found to have a retinochoroiditis and optic neuritis of his left eye. Results of fundus examination showed inflammatory and hemorrhagic retinal lesions consistent with retinitis due to cytomegalovirus infection. A computed tomographic (CT) scan demonstrated enlargement of the optic nerve. The eye was enucleated and results of histopathologic examination showed retinal necrosis with underlying choroiditis and an optic neuritis. Numerous encysted Toxoplasma gondii organisms were present in the retina and tachyzoites were present in the optic nerve. To the authors' knowledge this is the second histologically documented case of Toxoplasma optic neuritis in a patient with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Retinal pigment epithelial folds associated with retinal pigment epithelial detachment in macular degeneration.

The authors reviewed six eyes that had a shallow retinal pigment epithelial detachment with the retinal pigment epithelium (RPE) thrown into folds. A contraction of subpigment epithelial fibrovascular tissue causes a folding of the overlying, intimately adherent RPE. Retinal pigment epithelial folds are a sign of subretinal neovascularization and are another manifestation of age-related macular degeneration.

Aged↗

PubMed1991

Combined localized current field hyperthermia and irradiation for intraocular tumors.

Ten patients with large melanomas and one patient with recurrent retinoblastoma were treated with combined localized current field (LCF) hyperthermia and iodine 125 irradiation delivered by episcleral plaque. Tumors were heated to 43 degrees to 45 degrees C for 28 to 45 minutes. Localized current field hyperthermia when combined with irradiation appeared to induce rapid tumor necrosis. One eye enucleated 17 hours after treatment showed only focal necrosis of the melanoma, while another eye demonstrated extensive necrosis 60 hours after treatment. In all remaining eyes, tumor regression occurred within the first month of treatment. Complications included cataract formation in six eyes, hemorrhagic retinal detachment in five eyes, and phthisis in two eyes. Complications from combined therapy of large intraocular tumors in this series appeared to result from the rapid necrosis of the tumor and secondary intraocular inflammation. Intraocular temperature dosimetry measurements demonstrated a temperature gradient of not more than -0.23 degrees C/mm-1 per axial millimeter from the episcleral plaque surface to the apex of the tumor. The authors believe that LCF hyperthermia could be a suitable means of application of hyperthermia in patients with intraocular tumors if further modifications were performed to reduce ocular complications.

Brachytherapy↗

PubMed1997

Ocular ischemic syndrome.

PURPOSE: The purpose of the study is to investigate the clinical features and management of ocular ischemic syndrome (OIS) and factors influencing its development. INTERVENTION: The following interventions were used: detailed medical and ocular histories, complete ophthalmic evaluation including fluorescein angiography, internal carotid artery evaluation by duplex ultrasonography, and/or aortic arch angiography, management, and follow-up. MAIN OUTCOME MEASURES: The following outcome measures were considered: visual acuity, visual fields, intraocular pressure, anterior segment neovascularization and other abnormalities, lens, optic disc, retinal and choroidal changes, carotid artery stenosis or occlusion, diabetes mellitus, arterial hypertension, coronary artery disease, and cerebrovascular disease. RESULTS: Mean age of the 32 patients (39 eyes) with OIS was 68 +/- 8 years. Presenting visual symptoms included amaurosis fugax (15%) and/or gradual (28%) or sudden (41%) visual loss. At initial visit, eyes with OIS had visual acuity less than or equal to 20/400 in 64%, iris neovascularization (NV) in 87%, angle NV in 59%, intraocular pressure from 4 to 60 mmHg (median 18 mmHg), optic disc pale (40%) and/or cupped (19%) or edematous (8%), disc NV (13%), retinal NV (3%), marked retinal circulatory stasis (21%), and retinal hemorrhages (24%). Associated systemic diseases in these patients included diabetes mellitus (56%), arterial hypertension (50%), coronary artery disease (38%), and previous stroke or transient ischemic attack (31%); the incidence of diabetes, coronary artery disease, and cerebrovascular disease was much higher in patients with OIS than in the comparable general population, especially that of diabetes. Occlusion or severe stenosis (80%-99%) of the internal carotid artery was seen in 74% on the side of OIS. CONCLUSIONS: Ocular ischemic syndrome has a poor visual prognosis. However, the ophthalmologist's diagnosis may be crucial to the health of these patients, because OIS may be the presenting sign of serious cerebrovascular and ischemic heart diseases.

Aged↗