Ocular manifestations in subacute bacterial endocarditis

Subacute Bacterial Endocarditis [SBE] is a flammable bacterial infection of the endocardium and usually builds on a pre-existing heart disease. Ocular events are a particularly rare complication that occurs in a child. A 10 year old patient having a history of recurrent tonsillitis and hospitalized in pediatric for kidney failure, shows a decrease in visual acuity reduced to finger counting at 1 meter. Ophthalmologic examination revealed papilledema, premacular hemorrhage, Roth spots and several intraretinal hemorrhages in both eyes and the presence of a segmental vasculitis in the left eye. Under etiological assessement, a transthoracic echocardiography was performed retaining the diagnosis of infective endocarditis. Blood culture isolated viridans streptococci. The patient received appropriate systemic antibiotics. Two months later, the evolution was marked by the recovery of visual acuity to 10/10 and net regression both papilledema as hemorrhagic lesions. Although rheumatic fever has become an exceptional condition in developed countries, it may still be a rheumatic valve that is grafted sepsis. In infective endocarditis, several ophthalmologic manifestations have been described in the literature. They result for most of infectious emboli in the retinal vessels and in some cases may reveal endocarditis. Besides vital prognosis engaged in bacterial endocarditis, visual functional prognosis may also be threatened by serious eye damage. Thus, an eye examination

[Acanthamoeba keratitis]

Prognosis for Acanthamoeba is worse than for many other types of infectious keratitis. Treatment is difficult especially in advanced stages and it may result in permanent visual impairment or blindness. However, especially if caught early, satisfactory outcomes can certainly be achieved. The purpose was to evaluate the clinical features in five patients diagnosed in our department between 2007 and 2011. Risk factors, clinical diagnosis and therapeutic characteristics were studied retrospectively in this study. All patients were referred in a second or third intention. These are three women and two men with a mean age of 38.5 years admitted for corneal abcess in 3 cases and pseudendritic keratitis in 2 others. The risk factors found were: contact lens wear in 2 cases, contact with contaminated water in 2 cases and the laboratory tests revealed an unrecognized diabetes in a case. Corneal sampling allowed the isolation of Acanthamoeba in 3 cases and in two cases the diagnosis was made by Polymerase Chain Reaction. All patients received broad-spectrum antibiotics and Hexamidine. ketoconazole was associated in 3 cases and Polyhexamethylene biguanide [PHMB] in 1 case. Evolution was marked by panophthalmitis and eyeball phthysis in 1 case, corneal opacity with neovascularization in two cases justifying a corneal graft. Regression with ad integrum recovery was observed in 2 cases of epithelial keratitis. The incidence of Acanthamoeba keratitis varies from one country to another between 0.15 and 1.4 per million inhabitants. Acanthamoeba are naturally occurring amoeba [tiny, one-celled animals] commonly found in water sources, such as tap water, well water, hot tubs, and soil and sewage systems. Contact lenses are still responsible for the majority of cases [2 cases] despite knowledge of this now well-established major risk factor and its preventive measures including strict hygiene for the maintenance of contact lenses. Medical treatment is very disappointing in advanced forms [3 cases]. The dramatic consequences of this complication justify a systematic treatment against amoeba in each case of suspected diagnosis. Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome

Role of radionuclide bone scanning in early detection of metastasis in mandibulofacial bones

The metastatic tumours in the lower jaw is far less frequent than primary tumour. There is a wide variety of a late stage of primary tumours elsewhere in the body which metastatize in the mandible as cancer in breast, thyroid gland, prostate, lungs and kidneys. By conventional radiography it is difficult to recognize any metastatic foci in the mandible. The bone scanning by scintigraphy is an important method for staging the cancer and demonstration of metastatic lesion in the bone before it is evident radiographically. The aim of this study is to reveal the major role of scintigraphy in early detection of mandibular metastasis from body cancer. Thirty cancer patients were selected from El-Kasr El Eini Center of Raditation Onocology and Nuclear Medicine. Each case subjected for radiographic examination and radionuclide bone scanning of the skull. The results showed a marked superiority of scintigraphy in early demonstrating of mandibulofacial bones metastasis than in x-ray where the radiographic changes in the bone are discernible only where there has been an increase or decrease in calcium content around 50%. So it is recommended to utilize bone imaging in examination of the mandible in patients with body cancer before using radiography

Results of treatment and survival of 231 patients with stage III bronchogenic carcinoma

Two hundred and thirty one patients with stage III Bronchogenic Carcinoma had been studied at NEMROCK [1974 1985]. 82% of patients had non small cell lung cancer, while 18% of patients had small cell lung cancer. 29% of patients received radiation therapy alone and 30% of patients received chemotherapy, while 41% of patients received combination of chemo and radiotherapy complete remission after treatment was obtained in 19.5% of patients, all of them received combined modality of treatment with a mean duration of response 10.5 +/- 11 months. There was a better 18 months survival for the patients received combined treatment modality as compared with other groups, and the difference was significant P < 0. 05]

Response of 23 cases of primary reticulum cell sarcoma of bone to radiotherapy and 5 year survival

Twenty-three cases of primary reticulum cell sarcoma of bone [PRCSB] representing 5.05% of all primary bone tumors [455 cases] were seen in NEMORCK during the period from 1965 till 1979 inclusive. 16/23 of the series occurred in the age group 10 to 30 years, and only 4 cases were above the age of 44. The mean age was 30.9 years. The male to female ratio was 1.3:1, with an age incidence slightly higher in males than in females. 18/23 cases were located primarily in the long tubular bones, and 5 cases in flat bones. Pain was the dominating symptom in almost all the patient at presentation, and local swelling was associated with pain in over half the cases. Pathological fracture showed a relatively high figure, compared to other series. 10/23 cases had metastasis at presentation, 7 of them to regional lymph nodes, and 3 cases had distant metastasis [stage IV]. The overall disease free survival at 5 years was 60.9% [14/23], 4 cases were alive with local recurrence, 3 cases died of the disease, and 2 cases were lost to follow-up. No local failures were observed when the local tumor dose was 60 Grays. Doses up to 50 G were followed by local recurrence in every case