Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome

OBJECTIVE: To determine the conjunctival bacterial flora present in patients with Stevens-Johnson syndrome. METHODS: A prospective study of the conjunctival bacterial flora was performed in 41 eyes of 22 patients with Stevens-Johnson syndrome. The information gathered included the patient's sex and age, the duration of disease, the cause of Stevens-Johnson syndrome, and treatments. Scrapings of the inferior conjunctival fornix were performed in both eyes. Fourteen days before scraping, the patients were asked to interrupt all topical medication and start using 0.5% nonpreserved methylcellulose. The microbiological evaluation included microorganism identification and determination of antibiotic sensitivity. RESULTS: Of 22 patients (41 eyes), 14 (64%) were females, and eight (36%) were males. The mean age was 33.2 years, and the mean duration of disease was 15.6 years. Visual acuity ranged from light perception to 20/25 (1.57 logMar). The treatment received by most patients consisted of tear substitutes, topical antibiotics, and contact lenses. Bacterial identification was positive in 39 eyes (95%) and negative in two eyes (5%). Gram-positive cocci accounted for 55.5% of the microorganisms, whereas gram-positive bacilli and gram-negative bacilli accounted for 19% and 25.5%, respectively. Half of the patients (54%) had multiple bacterial species in their flora, and only one bacterial species was identified in the other half. Resistant bacteria were isolated from four eyes. The antibiotic sensitivity results for the Streptococcus group showed the lowest sensitivity and the highest microbial resistance identified. CONCLUSION: Patients with Stevens-Johnson syndrome have a diverse conjunctival flora that includes many pathogenic species. .

Metástase orbitária como único achado em paciente com hepatocarcinoma: relato de caso / An unusual orbital metastatic lesion: the only finding in a case of hepatocellular carcinoma: case report

Metástases orbitárias de hepatocarcinoma (HCC) são raras. Os autores têm o objetivo de relatar o caso de um paciente que apresentou metástase orbitária como único achado de um HCC. Paciente masculino, 57 anos, apresentando massa em região temporal direita, associada à proptose, dor e hiperemia. Os exames de imagem revelaram volumosa massa em região temporal, estendendo-se para fossa temporal com destruição da parede orbitária e extensão intracraniana. A tomografia computadorizada de abdome demonstrou tumor primário no fígado. Foi realizada biópsia incisional através de uma orbitotomia anterior cujo estudo anátomo-patológico diagnosticou lesão metastática de hepatocarcinoma. O estudo imuno-histoquímico com marcador para CAM 5.2 e CEA foi positivo. A avaliação sistêmica não revelou outras lesões. O tumor evoluiu com rápido crescimento com óbito 15 meses após o diagnóstico. Metástases orbitárias do carcinoma hepatocelular são raras. Nosso caso foi relevante não só pela raridade desta lesão orbitária, como também pela ausência de outras lesões metastáticas e de sintomas sistêmicos.

Orbital metastasis of hepatocellular carcinoma is rare. We report an unusual orbital metastatic lesion as the only finding in a case of hepatocellular carcinoma. A 57-year-old man presented with a 6-month history of orbital painful right orbital mass, associated with proptosis. Computed tomography of the orbits showed an orbital soft tissue mass leading to bone erosion and intracranial invasion. Computed tomography of the adbomen showed a focal perfusion abnormality in the left lobe of the liver. Incisional biopsy was performed and the histopathologic examination of the specimen confirmed the diagnosis. The patient died 15 months after the initial presentation. COMENTS: This is a rare case of orbital metastasis of hepatocellular carcinoma. There was no another metastatic lesion and the patient reported only ophthalmological symptoms.

Comparação da medida da espessura corneana central com os métodos de microscopia especular e paquimetria ultrassônica / Comparison of central corneal thickness measurements with specular microscopic pachymetry

Objetivo: Comparar a medida da espessura corneana central (ECC) obtida com a microscopia especular de não-contato e o paquímetro ultrassônico em indivíduos saudáveis. Métodos:A espessura corneana central foi medida em 80 olhos de 80 indivíduos saudáveis com os métodos de microscopia especular de não-contato (Pocket II Quantel medical), seguido da paquimetria ultrassônica de contato (Topcon SP-2000P). Pacientes com doenças oculares, usuários de lente de contato ou história de cirurgia refrativaforam excluídos do estudo. A análise estatística foi realizada através do teste t pareado de Student para determinar a significância da ECC entre os dois instrumentos. Resultados: A média da espessura corneana central foi 524.60 µm (DP ± 29.98) quando usado a paquimetria ultrassônica, e 507.25 µm (DP ± 29.82) com a microscopia especular de não-contato. A diferença entre os dois instrumentos foi 17.35 µm (DP ± 6.069). As medidas da microscopia especular de não-contato foram significativamente menores (p< 0,0001) que as medidas ultrassônicas. Conclusão: A medida da espessura corneana central apresentou valores maiores quando avaliada com o paquímetro ultrassônico em comparação com as medidas da microscopia especular de não-contato.

Purpose: To compare central corneal thickness (CCT) measurements obtained by non-contact specular microscopic and ultrasound pachymeter in normal humansubjects. Methods: Central corneal thickness was measured in 80 right eyes of 80 healthy subjects with a non-contact specular microscope (Pocket II Quantel medical) and ultrasound pachymeter (Topcon SP-2000P). Patients with ocular disease, contact lens wearers or refractive surgerywere excluded. Paired Student t-test was used to determine significance of CCT between the two instruments.Results: Mean central corneal thickness was 524.60 µm (SD ± 29.98) when using the ultrasound pachymeter, and507.25 µm (SD ± 29.82) with the non-contact specular microscope. The difference between the instruments was17.35 µm (SD ± 6.069). The non-contact specular microscope measurements were significantly smaller (p< 0,0001) than the ultrasound measurements.Conclusion:The measurement of central corneal thickness had greater values with the ultrasonic pachymeter than non-contactspecular microscope measurements.