Dissection of the temporal artery in a patient with giant cell arteritis.

A 74-year-old woman presented to her rheumatologist with classic symptoms of giant cell arteritis. The temporal arteries were strikingly swollen, warm, and erythematous. On biopsy of the right temporal artery, a focal dissection was found associated with a pan-arteritis and giant cells. Isolated temporal artery dissection in giant cell arteritis has not been reported previously. We propose that the unusually intense vascular inflammation may have weakened the vessel wall, so that the dissection occurred during the routine physical exam or biopsy. We believe this case illustrates that physicians should take special care in the examination of floridly inflamed vessels, because vigorous palpation might lead to dissection. In the case of patients with giant cell arteritis, dissection may result in an increased risk of ischemic complications, such as scalp necrosis.

Incidence of misdiagnosed and unsuspected choroidal melanomas. A 50-year experience.

The eye pathology files at Ohio State University, Columbus, were examined for a 50-year period to determine the percentage of misdiagnosis of uveal melanomas in three separate time periods (1931 through 1959, 1960 through 1969, and 1970 through 1981) and the percentage of unsuspected melanomas during these same periods. Of 395 eyes enucleated for choroidal melanoma, 369 had clear media. Histologic examination of these eyes showed that 13 (3.5%) did not contain a melanoma. The incidence of misdiagnosis decreased from 10.9% in 1931 through 1959 to 1.7% in 1960 through 1981. Of 411 choroidal melanomas present on histologic examination, 37 (9%) were unsuspected. All had opaque media. This percentage, when categorized by the aforementioned periods, decreased from 19.6% to 13.3% to 2.4%, respectively. These results confirm the reliability of indirect ophthalmoscopy, widely used since the 1960s, in the diagnosis of melanoma in the presence of clear media and the reliability of ultrasonography, used since 1970, in the diagnosis of melanoma in eyes with opaque media.

Candida endophthalmitis associated with total parenteral nutrition.

Candida albicans is the most common fungal infection which can occur in patients receiving total parenteral nutrition therapy. While rare, Candida endophthalmitis also can occur and must be considered as a potential risk of this treatment. Early detection and management of this disorder can alter the visual outcome for these patients. Systemic administration of amphotericin B and fluocytosine is the most common form of treatment for Candida endophthalmitis. In cases not responsive to systemic administration of antifungal agents, surgical management through pars plana vitrectomy can potentially eradicate the infection and preserve vision. We present a case of bilateral Candida endophthalmitis treated with amphotericin B and fluocytosine, and also with pars plana vitrectomy with the intracameral injection of amphotericin B into the anterior vitreous cavity. Systemic and intracameral use of antifungal drug therapy combined with vitrectomy restored useful vision to the patient.