Retinal hemorrhages as one of complications of optic disc drusen during pregnancy.

INTRODUCTION: Drusen of the optic nerve head are relatively benign and asymptomatic. They represent retinal hyaline corpuscles resulting from impaired axoplasmic transport of the retinal ganglion cells of optic nerve in front of the lamina cribrosa. They are usually detected accidentally, during a routine ophthalmologic examination. Most patients with optic disc drusen are not aware of the deterioration of their eyesight because of the slow progression of visual field defects. Damage in visual acuity due to optic disc drusen is rare. CASE REPORT: A 27-year-old female patient in the sixth month of pregnancy visited an ophthalmologist because of a visual impairment described as the appearance of mist and shadows over her right eye. When first examined, her visual acuity in both eyes was 20/20. The retinal hemorrhages framing the bottom half of the optic nerve were seen. Complete laboratory and clinical testing as well as specific ophthalmic examinations (photofundus, computerized visual field, optical coherence tomography, and ultrasound) were performed to exclude systemic causes and they presented no risk for the pregnancy. Echosonographic examination confirmed the presence of bilateral optic nerve head drusen. CONCLUSION: Hemodynamic changes during pregnancy are possible factors for the development of optical disc and retinal hemorrhages. Since treatment of optic disc drusen is limited, recognition of optic nerve drusen as a cause of hemorrhage during pregnancy prevents unnecessary diagnostic and therapeutic interventions.

[Unilatelaral iris plateau syndrome after the use of ecstasy].

BACKGROUND: Courmon street name for 3,4-Methylenedioxymethamphetamine (MDMA) is ecstasy. This widely abused "recreational" drug causes both an increased release of monoamine neurotransmitters, including serotonine and dopamine, and an increased reuptake inhibition of serotonin. As a consequence, mydriasis and increased intraocular pressure (IOP) in predisposed patients occur. We present herein a rare case of acute increased IOP after use of ecstasy. CASE REPORT: A female patient, aged 38 years, visited doctor complaing of a decreased vision acuity and severe pain in the left eye and in the left part of the head. The initial treatment was urgent antiglaucomatous therapy followed by withdrawal of subjective problems of the patient and improvement of objective finding. History taking procedure revaled that just before the onset of the pain the patient had used ecstasy and had had similar "experience" 6 years ago after cocaine snorting. She had not been to a doctor although she had experienced sporadic migrenous pain. Previous medical records excavation of revealed optic disk (cup-to-dise C/D=06), Bjerum arcuate scotoma and iris plateau with narrow chamber angle (Scheie II-III) so the diagnosis was a rare unilateral iris plateau syndrome of the left eye. Although the patient was given some pieces of information about the dangerous and possible deadly consequences of psychoactive substanace abuse, she has not continue the treatment. CONCLUSION: Ecstasy abuse might cause a complete loss of vision, thus medicametous and surgical treatment are abligatory.

Clinical, histopathological and immunohistological study of lymphoid disorders in the parotid gland of patients with Sjögren's syndrome.

BACKGROUND/AIM: Sjögren's syndrome is a chronic autoimmune systemic disease characterized by polyglandular tissue destruction, leading to keratoconjunctivitis sicca and xerostomia. These patients have 44-fold increased risk of developing salivary gland lymphoma, of which 80% are marginal zone (MALT) type. Having in mind that criteria for distinguishing benign lymphoepithelial lesions from MALT lymphoma are obscure, the aim of this study was to provide practical information that could be integrated into diagnostic practice. METHODS: Among 32 parotidectomies, 27 cases were identified as having benign lymphoepithelial disorders and 5 cases low grade MALT lymphoma. Histological sections were stained routinely with hematoxylin and eosin (H&E and special stains. Immunohistochemical study was performed by LSAB2 method, by using primary antibodies for CD20, CD3, Kappa and Lambda light chains and Cytokeratin (Dako Denmark). RESULTS: The 27 patients with Sjögren's sialoadenitis (22 women and 5 men), and 5 patients with MALT lymphoma (only women) were included in this analysis. According to the Ann Harbor Classification, all patients with MALT lymphoma had stage IE. Both groups of patients had an indolent clinical course, except permanent, rapid parotid enlargement in the patients with MALT lymphoma. Histologically, the periductal lymphoid infiltrate, gradually extended to the acini, completely replacing them by a sea of polyclonal lymphocytes, immunoblasts, germinal centers and plasma cells (confirmed immunohistochemically), but sparing the ducts and preserving lobular appearance. The histological feature of salivary gland MALT lymphoma included heterogeneous B-cell infiltrate that totally or subtotally had effaced the normal glandular structure. Malign lymphoepithelial lesions, representing infiltration of the ductal and epithelial structures by monoclonal neoplastic B-cells, positive for CD20, were highlighted by antibody to cytokeratin. CONCLUSION: The optimal diagnosis of salivary gland MALT lymphoma requires careful integration of clinical, morphological and immunohistochemical results.