Relationship of hypertensive retinopathy to thoracic aortic atherosclerosis in patients with severe arterial hypertension.

Arterial hypertension complicated with atherosclerosis presents the most common cause of death in hypertensive patients. Eyes suffer vascular damage as a result of high blood pressure (BP) and these changes can be detected by funduscopy, although its role has recently been questioned. The aims of this study were to assess the prevalence of atherosclerotic plaques and other disorders of thoracic aorta by transesophageal echocardiography (TEE) in patients with severe arterial hypertension of at least 1 year duration and to analyze the association between aortic atherosclerotic plaques and hypertensive retinopathy. This was a prospective TEE study conducted on 56 hypertensive patients from September 2008 to January 2010. Mean patient age was 62.8 ± 8.2 years and 67.86% of them were women. Aortic atherosclerotic plaques were found on 96.4% of patients, whereas hypertensive retinopathy was present on 94.6% of them. The mean thickness of maximal atherosclerotic plaque found on each patient was 4.3 ± 1.9 mm and 28.6% of patients had ulcerative plaques, while descending aorta was the most common location of the lesions. Grade 1 and 2 hypertensive retinopathy was diagnosed in 14.3% and 80.3% of patients, respectively. Hypertensive retinopathy correlated highly with aortic atherosclerotic score (r = 0.76, p < 0.0001), as it correlated significantly with aortic plaque thickness (r = 0.69, p < 0.0001). Application of funduscopy should be encouraged since it is a noninvasive procedure that provides a good window of retinal arterioles. Hypertensive retinopathy, even in mild forms, should serve as a marker of atherosclerosis elsewhere in the organism.

Alternating esotropia and surgical correction in both eyes.

Strabismus is an eye deviation, when both eyes cannot be directed at the same time towards the object that is being viewed. Strabismus is observed in approximately 25% of children under 3 years of age, and in approximately 3% of all children. There were 77 patients involved in this study, with Esotropia alternans, that had surgical operations at the Ophthalmology Clinic, University Clinical Centre of Kosova (UCCK), from 2005-2006. Patients were divided in two groups: 1. Researched group--involving 33 patients that had surgical interventions for weakening the functions of the inner straight muscle in both eyes, and 2. Control Group--involving 44 patients that had surgical interventions in one eye intervening in two muscles with contrary actions--the inner straight muscle, weakening it in retro position, and the outer straight muscle, strengthening its function through myectomy. Medium value of the objective angle after the operation, in distance of 6 meters, in the patients with Esotropia alternans from the Experimental group was 6.5 delta dyoptry (standard deviation 1.9 delta dyoptry). In the Control Group, the medium value of the objective angle was 9.3 delta dyoptry (standard deviation 3.6 delta dyoptry), with significant distinction (p < 0.01). There were 16.9% patients with Esotropia alternans who had complications during the operation. In the Experimental group, complication occurred in 4 patients, or 12.1% during the surgery. It the Control Group, complications were observed in 9 patients, or 20.5%, without significant difference between the groups.

Late diagnosis of Marfan syndrome with fatal outcome in a young male patient: a case report.

INTRODUCTION: Marfan syndrome is a heritable disorder of the connective tissue that affects many organ systems. However, the most serious complication in patients with Marfan syndrome is progressive aortic root dilation, which may lead to aortic dissection, rupture or aortic regurgitation. Prevention of these life threatening complications is of major importance. CASE PRESENTATION: We report here a case of a 34-year-old, Caucasian male diagnosed for the first time with Marfan syndrome. He required medical attention due to his chest pain that resulted as a consequence of strenuous physical effort. Medical examinations revealed severe aortic root enlargement and aortic intramural hematoma. Patient ended-up fatally during open heart surgery. CONCLUSION: It is very important to recognize on time Marfan syndrome, as preventive actions that should be undertaken can avoid its serious consequences.