An overlap case of Parry朢omberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity

Parry朢omberg syndrome (PRS) may overlap localized scleroderma (morphea) lesions with linear depression (en coup de sabre [ECDS]). Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

Clinical spectrum, diagnostic criteria, and polymerase chain reaction of aqueous humor in viral and toxoplasma detection in Fuchs’ uveitis syndrome.

Aim: The aim of this study is to describe the clinical features and diagnostic criteria of Fuchs’ uveitis (FU) and to determine whether it has an association with virus and toxoplasma in the aqueous humor during cataract surgery. Setting and Design: This is a prospective, case–control study. Materials and Methods: Patients with FU (n = 25), anterior uveitis (n = 15), and no uveitis (normal) (n = 50) were included based on predefined inclusion and exclusion criteria for all three groups. Polymerase chain reaction (PCR) of aqueous humor and serum for rubella, herpes simplex virus (HSV), cytomegalovirus (CMV), varicella‑zoster virus (VZV), and toxoplasma was done using conventional uniplex PCR. Statistical Analysis: It was done using SPSS software using Chi‑square test for categorical variables, and P < 0.05 was considered statistically significant. Results: Ninety patients were enrolled in the study in three groups, comparable for age, gender, and laterality of ocular involvement. All patients had diffuse keratic precipitates in FU group (P = 0001) with none having posterior synechiae (P = 0.046) which was statistically significant when compared to anterior uveitis patients. Iris nodules were noted in one case in both groups. Serum and aqueous PCR was negative for detection of VZV, CMV, toxoplasma, and rubella in all groups. PCR for HSV was positive in one patient in “normal” group but was not statistically significant. Conclusion: Our study shows that diagnosis of FU is mainly clinical. There appears to be no role of aqueous humor testing for viruses by PCR to aid in etiological diagnosis.

Delirium / Delirium

Delirium é uma apresentação comum de distúrbios agudos na população geriátrica. Tem sido associado a um pior prognóstico, aumento de permanência hospitalar e dos custos, bem como maiores taxas de morbidade e mortalidade entre os idosos. Os fatores predisponentes e precipitantes são hoje mais conhecidos e estão associados aos cuidados hospitalares.Estudos controlados demonstram que intervenções preventivas podem reduzir de 30% a 40% a incidência de delirium, essas intervenções estão essencialmente ligadas a melhor qualidade no cuidado hospitalar. Este artigo revisa recentes estudos sobre epidemiologia, diagnóstico, fisiopatologia, tratamento e prevenção do delirium na população idosa.

A Case of Grant`s Syndrome

Grant`s syndrome is an uncommon form of secondary open angle glaucoma in which trabecular precipitates without significant anterior chamber inflammation is characteristic and gonioscopy may often reveal irregular peripheral anterior synechiae which often attach to the trabecular precipitates. Grant`s syndrome may be confused with primary open angle glaucoma and glaucomacyclitic crisis. However primary open angle glaucoma has no trabecular precipitates and glaucomacyclitic crisis has no trabecular precipitates and peripheral anterior synechia. We have experienced one case of Grant`s syndrome in which elevated intraocular pressure was present associated with inflammatory precipitates on the trabecular meshwork and peripheral anterior synechia without significant anterior chamber inflammation. We report this case with review of available literature.

A Case of Grant`s Syndrome

Grant`s syndrome is an uncommon form of secondary open angle glaucoma in which trabecular precipitates without significant anterior chamber inflammation is characteristic and gonioscopy may often reveal irregular peripheral anterior synechiae which often attach to the trabecular precipitates. Grant`s syndrome may be confused with primary open angle glaucoma and glaucomacyclitic crisis. However primary open angle glaucoma has no trabecular precipitates and glaucomacyclitic crisis has no trabecular precipitates and peripheral anterior synechia. We have experienced one case of Grant`s syndrome in which elevated intraocular pressure was present associated with inflammatory precipitates on the trabecular meshwork and peripheral anterior synechia without significant anterior chamber inflammation. We report this case with review of available literature.

Biomicroscopic Examination of Precipitates on the intraocular Lens

We studied the foregin body reaction to the implanted intraocular lens(IOL) and IOL acceptance in the patient's eye by biomicroscopic examination of precipitates on the IOL surface in 432 cases. We divided the cellular and pigment precipitates of the posterior chamber lens(PCL) showed grade 3 until seven days postoperative and then slowly decreased; but, that of the anterior chamber lens(ACL) persisted a little longer. Pigment precipitates on ACL was less than that of PCL, and pigment precipitates stayed longer than cellular precipitates. Round, bipolar small cellular precipitates seem to be identical to fibroblast-like cells, and large, irregular shaped cellular precipitates seem to be foreign body giant cells. A large number of foreign body giant cells precipitated and persisted longer in cases of prolonged postoperative inflammation.

Biomicroscopic Examination of Precipitates on the intraocular Lens

We studied the foregin body reaction to the implanted intraocular lens(IOL) and IOL acceptance in the patient's eye by biomicroscopic examination of precipitates on the IOL surface in 432 cases. We divided the cellular and pigment precipitates of the posterior chamber lens(PCL) showed grade 3 until seven days postoperative and then slowly decreased; but, that of the anterior chamber lens(ACL) persisted a little longer. Pigment precipitates on ACL was less than that of PCL, and pigment precipitates stayed longer than cellular precipitates. Round, bipolar small cellular precipitates seem to be identical to fibroblast-like cells, and large, irregular shaped cellular precipitates seem to be foreign body giant cells. A large number of foreign body giant cells precipitated and persisted longer in cases of prolonged postoperative inflammation.