RESUMO
The disorder known as orbital pseudotumor and its related syndromes of myositis and dacryoadenitis continue to be a source of controversy in terms of histopathologic classification and approach to diagnosis and management. This review references recent papers regarding these issues.
Assuntos
Pseudotumor Orbitário , Dacriocistite/complicações , Dacriocistite/diagnóstico , Dacriocistite/terapia , Glucocorticoides/uso terapêutico , Humanos , Miosite/complicações , Miosite/diagnóstico , Miosite/terapia , Músculos Oculomotores/patologia , Pseudotumor Orbitário/classificação , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/etiologia , Pseudotumor Orbitário/terapia , Radioterapia Adjuvante , SíndromeRESUMO
We examined a 32-year-old, previously healthy man who developed episodic bilateral visual impairment and confusion. Coincident hyperammonemia led to the diagnosis of ornithine transcarbamoylase deficiency, which was established by enzymatic analysis of a liver biopsy specimen. The available data were insufficient to determine if the metabolic derangement impaired vision at the level of the optic nerves or at the cerebral level.
Assuntos
Doença da Deficiência de Ornitina Carbomoiltransferase , Transtornos da Visão/complicações , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios X , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/patologiaRESUMO
A train of gated stimuli scanning the entire vulnerable period was delivered to the right anterior or left posterior ventricular surface to study the ventricular fibrillation threshold in anesthetized and vagotomized dogs. Heart rate was held constant by atrial pacing. Measurements were obtained in control conditions and after surgical removal of one stellate ganglion. To avoid the shortcomings associated with an irreversible procedure like stellectomy, control fibrillation threshold measurements were also alternated with determinations during reversible blockade by cooling of one stellate ganglion. The results were similar with both techniques. In nine animals, ablation or cooling of the left stellate ganglion increased ventricular fibrillation threshold by 72 +/- 35 (mean +/- standard deviation) percent compared with control values (P less than 0.001). By contrast, in 11 animals, ablation or cooling of the right stellate ganglion lowered the threshold by 48 +/- 14 percent compared with control values (P less than 0.001). Electrode location did not influence the results. The observed changes depended solely upon unilateral removal of cardiac sympathetic activity and were not demonstrable if such activity was low. These results suggest that right and left cardiac sympathetic nerves may have different and specific effects on cardiac excitability. They also contribute to the understanding of the pathogenesis of the long Q-T syndrome (characterized by episodes of ventricular fibrillation associated with increased sympathetic activity) and increase the rationale for left stellectomy as the specific treatment for this illness. Left stellectomy, by raising the ventricular fibrillation threshold, may also represent an alternative measure in patients at high risk of sudden death from ventricular arrhythmias resistant to medical therapy.
