[The role of ocular perfusion pressure in the course of primary open angle glaucoma in patients with systemic hypertension]. / Rolul presiunii de perfuzie oculara în evolutia glaucomului primitv cu unghi deschis la pacientii diagnosticati cu hipertensiune arteriala.

UNLABELLED: Ocular perfusion pressure (OPP) is an estimate for the local intraocular blood flow, calculated as difference between the objective values for the diastolic or systolic systemic blood pressure (SBP) and intraocular pressure (IOP). Primary Open Angle Glaucoma (POAG) is an eye disorder that affects the optic nerve (ON) with progressive damage to full eye sight loss, being associated, but not always, with high intraocular pressure (IOP). AIM: Numerous studies have pointed out that the intraocular vascular impairments could be a consequence of a broader, systemic blood flow alteration. As OPP, as an estimate, engulfs both SBP and IOP, it could be used to better evaluate the presence and evolution for POAG. MATERIAL AND METHODS: 26 POAG treated patients were included over one year time frame, with an age between 44 and 80. Three eye exams were made in the beginning, at 6 and 12 months interval, data being collected for: IOP, visual field test, OPP, OCT, retinal examination and SBP. RESULTS: Although the treatment for high blood pressure was initiated, no major change was acknowledged in the median value for SBP (a mild drop in the systolic blood pressure from 127.5 mmHg to 125.8 mmHg). However, after the initiation of the POAG treatment a major improvement in the OPP could be established (a significant increase for the diastolic OPP from 58.9 mmHg to 64.2 mmHg). CONCLUSIONS: This study suggests that OPP as an estimate for the real ocular blood flow, that includes both SBP and IOP, could be used to better predict POAG and also guide the effectiveness of its treatment.

Apyrexic Brucella melitensis aortic valve endocarditis.

The case of a young shepherd with Brucella melitensis aortic valve endocarditis is presented. His illness ran an afebrile course and was also complicated by disseminated intravascular coagulation (DIC), nephritis, hepatitis and peritonitis, all of which responded well to supportive measures and a combination of tetracycline, trimethoprim-sulphamethoxazole and amikacin sulphate. The fact that even the most severe case of brucellosis can present without fever is stressed.

The nature of human brucellosis in Kuwait: study of 379 cases.

Three hundred seventy-nine Kuwaiti patients with brucellosis were admitted to Adan General Hospital, Kuwait, during the period 1984-1985. Of these 231 were males and 148 were females. Diagnosis was based on symptoms and signs compatible with the disease and on the detection of significantly elevated antibody titer and/or positive blood culture. The primary means of exposure were the consumption of raw milk and contact with goats, sheep, or camels. Patients most frequently presented with fever (91%), chills (40%), sweats (39%), gastrointestinal symptoms (30%), headache (23%), respiratory symptoms (23%), and musculoskeletal symptoms (22%). The major signs were osteoarticular involvement (37%), hepatosplenomegaly (27%), and lymphadenopathy (9%). Different regimens of treatment were used, but the highest rate of cure was achieved with triple therapy--tetracycline, streptomycin, and rifampin.

Osteoarticular complications of brucellosis: a study of 169 cases.

Of 452 patients with brucellosis, 169 (111 male and 58 female) had osteoarticular complications. Brucella melitensis was isolated from the blood in 7.7% of the cases. Fever, chills, arthralgia, backache, high levels of C-reactive protein, positive rheumatoid factor, and splenomegaly were more frequent in osteoarticular brucellosis than in nonosteoarticular disease. Arthritis occurred in the hip joint in 90 cases (53%), knees in 61 (36%), sacroiliacs in 33 (20%), ankles in 25 (15%), elbows in nine (5.3%), shoulders in eight (5%), wrists in six (3.5%), and sternoclavicular arthritis occurred in three cases (1.8%). Spondylitis occurred in 10 cases (6%), osteomyelitis in four (2.4%), and tendinitis or bursitis in two (1.2%). Treatment with tetracycline or trimethoprim-sulfamethoxazole (TMP-SMZ) alone (four to eight weeks) or in combination with streptomycin (two to four weeks) resulted in a relapse rate of 16.6%. No relapses occurred in seven patients treated with repeated four- to six-weeks courses of rifampin plus tetracycline or TMP-SMZ plus streptomycin.

Clinical categories of neurobrucellosis. A report on 19 cases.

Brucellosis rarely can present with involvement restricted to the nervous system. We describe a total of 19 cases of neurobrucellosis in whom the clinical presentation lay in three distinct categories. The first was an acute presentation with meningoencephalitis. The disease also presented in a chronic form where the brunt of the illness can either be in the peripheral or the central nervous system (CNS). The chronic peripheral form is that of a proximal polyradiculoneuropathy. The central form is that of diffuse CNS involvement, predominantly with myelitis or cerebellar involvement with or without cranial nerve palsies. Although the two chronic forms, 'peripheral' and 'central', are distinct, some overlap is possible. This was not observed for the acute form. The pathology of the three presentations may be different, being a direct effect of infection in the acute form, and an immune-related process, possibly demyelinating in nature, in the chronic forms. The response to treatment in the acute and chronic forms is also different, being much better in the acute form. Awareness of the condition and performance of the appropriate serological tests will differentiate neurobrucellosis from other chronic CNS infections, especially tuberculosis and neurosyphilis.

Autosomally inherited recessive spastic ataxia, macular corneal dystrophy, congenital cataracts, myopia and vertically oval temporally tilted discs. Report of a Bedouin family--a new syndrome.

A Bedouin family is described with an unusual form of spinocerebellar degeneration. Spastic ataxia was found to be associated with congenital cataracts, macular corneal dystrophy and non-axial myopia, in the absence of retardation of somatic or mental maturation. Immunological abnormalities were common. Genetic analysis revealed that the pedigree is expressing the transmission and segregation of a single mutant autosomal recessive gene.

Brucella meningitis: presentation, diagnosis and treatment--a prospective study of ten cases.

Diagnosis of brucella meningitis was made in 10 patients by serological tests on blood and cerebrospinal fluid using Rose Bengal, standard agglutination, indirect immunofluorescent and enzyme-linked immunosorbent assay (ELISA) tests and by blood and CSF culture. All patients had significantly elevated antibody titres. In three Br. melitensis was isolated both from blood and CSF and in a further three from blood only. Eight patients were 30 years old or less and seven were female. Seven patients had a history of contact with livestock and had consumed raw milk. Meningitis occurred in five, meningoencephalitis with hemiplegia in one, paraplegia and cranial nerve palsies in one and psychosis and/or nightmares in three. Transient Parkinsonism was seen in one patient and generalized rigidity and non-Parkinsonian tremors in another. Computerized tomography revealed ventricular dilation in one patient and punctate hyperdense, non-enhancing shadows in the lentiform nuclei in two others. Treatment with a combination of tetracycline, rifampicin and streptomycin was successful.

Behçet's disease in Kuwait, Arabia. A report of 29 cases and a review.

Twenty-nine patients with Behçet's disease were studied. Of these, 17 patients were followed up for a mean duration of 37 months and 12 for a mean of 18 months. Male to female ratio was 3.1:1. Of the 29 patients, 26 were Arab, 2 Asian and 1 Black African. The prevalence in the country was 2.1:100,000 population, in Kuwaitis 1.58:100,000, in non-Kuwaiti Arabs, 2.9:100,000 and in non-Arabs, 1.35:100,000 population. The frequencies of the various manifestations were: oral ulcers, 100%; genital ulcers, 93%; skin manifestations, 76%; arthropathy and ocular disease, 69% each; psychiatric disorders, 38%; vascular complications and positive Pathergy test, 34% each; gastrointestinal symptoms, 21%; oesophageal and CNS involvement, 14% each; and peritonism, renal and pulmonary involvement, 7% each. Kuwaiti bedouins seemed to be resistant to the disease, probably due to environmental and/or dietary factors. The hot arid climate of the Gulf had no effect on the course of the disease once it had developed.

Neurological and cardiac complications of carcinoma of the breast. Case report.

A case is presented of a young female with a paraneoplastic subacute cerebellar degeneration, parkinsonian syndrome, autonomic disturbance, profound depression, myopathy and cardiomyopathy. Her paraneoplastic affection preceded the actual detection of carcinoma of the breast by nine months. Block dissection of the carcinoma resulted in alleviation of her muscle weakness and a return of the electrocardiogram to normal.

Cutaneous necrotizing vasculitis complicating Takayasu's arteritis with a review of cutaneous manifestations.

We report a case of a 32-year-old man with chronic active Takayasu's arteritis complicated by cutaneous necrotizing vasculitis. Symptoms of the early phase of his disease coexisted with complications of the late phase.