Subject(s)
AIDS-Related Opportunistic Infections/parasitology , Acquired Immunodeficiency Syndrome/immunology , Antiretroviral Therapy, Highly Active/adverse effects , Uveitis/parasitology , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Amphotericin B/therapeutic use , Animals , Humans , Immunocompromised Host , Leishmania major/drug effects , Leishmania major/immunology , Male , Syndrome , Uveitis/drug therapy , Uveitis/immunologySubject(s)
HIV Infections/diagnosis , HIV-1 , Neuromyelitis Optica/diagnosis , Adult , Congo , Female , Humans , Retinal Necrosis Syndrome, Acute/diagnosisABSTRACT
OBJECTIVE: Because visual pathway lesions are a common complication of pituitary tumors, visual field examinations in patients with acromegaly were studied. Proportion and outcome of visual field defects in patients with acromegaly were evaluated. DESIGN: Large, retrospective case series. PARTICIPANTS: We reviewed 307 cases of acromegaly seen from 1951 through 1996 at a single referral center. METHODS: Kinetic visual field testing had been performed with the Goldmann perimeter, and the frequency of visual field defects and their correlation with other clinical manifestations and characteristics of the adenoma were examined. MAIN OUTCOME MEASURES: Repeat visual field examinations. RESULTS: Of the 307 patients included in the analysis, a visual field defect that could be attributed to the pituitary adenoma was observed in 62 (20.2%) during follow-up. Visual field defects were bilateral in 38 (61.3%) of these cases. Patients with visual field abnormalities were significantly younger (P = 0.04), had larger tumors (P < 0.001), had more suprasellar extensions (P < 0.001), and had higher levels of growth hormone in their serum (P = 0.04) than patients free of visual field defects. At the end of the follow-up period, visual field examination remained abnormal in 32 (10.4%). Return to a normal visual field examination after treatment was more frequently observed in patients who were less than 40 years of age at the time of diagnosis (P = 0.004). Secondary empty sella syndrome was the main cause of visual field defects after treatment. Abnormal visual field, either at the time of diagnosis or during follow-up, decreased from 27% of patients between 1951 and 1975 to 15.4% of patients between 1976 and 1996, when modern neuroimaging techniques became available. CONCLUSIONS: Endocrinologic and neuroimaging follow-up of patients with acromegaly should be accompanied by ophthalmic assessment. Factors predictive of visual field defects have been identified.
Subject(s)
Acromegaly/diagnosis , Adenoma, Acidophil/diagnosis , Pituitary Neoplasms/diagnosis , Vision Disorders/diagnosis , Visual Field Tests , Visual Fields , Acromegaly/blood , Acromegaly/complications , Acromegaly/therapy , Adenoma, Acidophil/blood , Adenoma, Acidophil/complications , Adenoma, Acidophil/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Empty Sella Syndrome/complications , Female , Human Growth Hormone/blood , Humans , Male , Middle Aged , Pituitary Neoplasms/blood , Pituitary Neoplasms/complications , Pituitary Neoplasms/therapy , Retrospective Studies , Vision Disorders/blood , Vision Disorders/etiology , Visual Pathways/pathologyABSTRACT
We report the first case of recurrent hepatitis secondary to a pituitary macroadenoma in a 55-year old man. Liver ischemia is thought to be the main consequence of episodes of acute adrenal insufficiency. Sudden acute adrenal insufficiency was due to enlargement of the sella content secondary to several microhemorrhages in the macroadenoma.
Subject(s)
Adenoma/complications , Hepatitis/etiology , Ischemia/etiology , Liver/blood supply , Pituitary Neoplasms/complications , Acute Disease , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/etiology , Humans , Male , Middle Aged , Recurrence , Transaminases/bloodABSTRACT
INTRODUCTION: The authors report the case of a patient who presented for 4 years recurrent anterior uveitis accompanied by asymptomatic tuberculous mediastinal lymphadenitis. EXEGESIS: CT scan of the chest showed the existence of mediastinal lymphadenopathy (< 1 cm). Mediastinoscopy with biopsy of the right laterotracheal lymph node was performed. The culture was positive for Mycobacterium tuberculosis, thus permitting the diagnosis of tuberculosis. CONCLUSION: This case report stresses the advantage of extensive etiological assessment when faced with unexplained uveitis; particularly it emphasizes the importance of investigating potential tuberculosis. The existence of granulomatous uveitis, a positive skin test, the ethnic origin, and mostly results of chest CT scan, were the rationale for the use of mediastinoscopy with lymph node biopsy to help guide diagnosis.
Subject(s)
Mediastinal Diseases/diagnosis , Mediastinoscopy , Tuberculosis, Lymph Node/diagnosis , Uveitis/microbiology , Adult , Female , Humans , Mediastinal Diseases/microbiology , Mycobacterium tuberculosis/isolation & purification , Recurrence , Tuberculosis, Lymph Node/microbiology , Uveitis/etiologySubject(s)
Eye Diseases/diagnosis , Eye Diseases/therapy , Adult , Arthritis/diagnosis , Arthritis/therapy , Behcet Syndrome/diagnosis , Behcet Syndrome/therapy , Conjunctivitis/diagnosis , Conjunctivitis/therapy , Diagnosis, Differential , Eye Infections/diagnosis , Eye Infections/therapy , Female , Humans , Inflammation , Keratitis/diagnosis , Keratitis/therapy , Male , Sarcoidosis/diagnosis , Sarcoidosis/therapy , Scleritis/diagnosis , Scleritis/therapy , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/therapy , Uveitis/diagnosis , Uveitis/therapyABSTRACT
PURPOSE: To assess the long term anatomic and functional follow-up of large relaxing retinotomies performed with liquid perfluorocarbon in severe vitreoretinal proliferation surgery. METHODS: A large relaxing retinotomy (more than 90 degrees) was realized in 40 eyes of 39 patients for anterior vitreoretinal proliferation (30 rhegmatogen retinal detachments, 8 intraocular foreign bodies, 2 ocular traumas). Follow-up was always longer than 6 months. Vitreoretinal proliferation secondary to ischemic or inflammatory retinopathy were excluded. The liquid perfluorocarbon was perfluorodecalin and was used for all eyes, as well as final intraocular tamponade by silicon oil ended every intervention. RESULTS: Sixty-seven % of patients had already had a former vitrectomy, and 75% a retinal surgery. Mean size retinectomy was 170 degrees. Nine patients underwent a new vitreoretinal procedure which included in 7 cases a necessary new retinectomy. Silicon oil could be removed in 55%, after a mean period of 6, 5 months. Mean time follow-up was 13 months. At the end of follow-up, 80% of retina were attached. Visual acuity remained low with 25% equal to 1/20 or more; 45% of eyes increased their acuity, 25% remained stable and 30% worsened. Main complications were epimacular proliferation, keratopathy and increased intraocular pressure. CONCLUSION: Relaxing retinotomies provide satisfying anatomic results and allow a preservation of some visual function. The use of liquid perfluorocarbons facilitates their realization. The initial size of retinectomy should be sufficient.