ABSTRACT
PURPOSE: To describe signs and symptoms of latex allergy associated with the use of the TonoPen (Mentor, Norwell, Massachusetts) in a patient with severe latex allergy. METHODS: Case report. In a 13-year-old girl with a history of severe latex allergy, intraocular pressure was obtained with a TonoPen. RESULTS: TonoPen covers that contained latex induced agitation, bilateral conjunctival injection, eyelid erythema, and eyelid edema in this latex-allergic patient. Use of a fingertip from a sterile nonlatex glove provided accurate intraocular pressure measurements with the tono-pen, without a local or systemic reaction. CONCLUSION: In patients with latex allergies, TonoPen covers that contain latex may induce a substantial local and systemic reaction.
Subject(s)
Conjunctival Diseases/etiology , Disposable Equipment , Eyelid Diseases/etiology , Latex Hypersensitivity/etiology , Latex/adverse effects , Tonometry, Ocular/instrumentation , Adolescent , Conjunctival Diseases/diagnosis , Edema/diagnosis , Edema/etiology , Erythema/diagnosis , Erythema/etiology , Eyelid Diseases/diagnosis , Female , Humans , Intraocular Pressure , Latex Hypersensitivity/diagnosisABSTRACT
Encephalocraniocutaneous lipomatosis is a congenital neurocutaneous syndrome with epibulbar choristomas and connective tissue nevi of the eyelids as common ophthalmic manifestations. Systemic manifestations occur ipsilateral to the ocular lesions and include lipomas of the cranium and central nervous system, alopecia of the scalp, and abnormalities of the central nervous system. We treated a child with encephalocraniocutaneous lipomatosis who required removal of an epibulbar choristoma. Pathologic evaluation of the epibulbar choristoma in our patient showed the presence of ectopic lacrimal gland tissue and cartilage. Encephalocraniocutaneous lipomatosis should be considered, together with Goldenhar's syndrome and sebaceous nevus syndrome, in the differential diagnosis of conditions associated with epibulbar choristomas.
Subject(s)
Central Nervous System Diseases/pathology , Eyelid Diseases/pathology , Lipomatosis/pathology , Nevus/pathology , Skin Neoplasms/pathology , Cartilage , Choristoma/pathology , Eye Diseases/pathology , Humans , Infant, Newborn , Lacrimal Apparatus , Male , Muscle, SmoothABSTRACT
We reviewed cases of histopathologically verified orbital tumors in children at our institution over 60 years to determine the distribution of various pathologic processes and trends over time. We studied the medical records and pathology specimens from 340 patients aged 18 years or younger who underwent biopsy for orbital mass from 1932 through 1991. The most common tumors were cysts (79 of 340, 23.2%), vascular lesions (60 of 340, 17.6%), optic nerve and meningeal neoplasms (56 of 340, 16.5%), inflammatory masses (29 of 340, 8.5%), osseous and fibrocystic lesions (27 of 340, 7.9%), and rhabdomyosarcomas (24 of 340, 7.1%). The overall frequency of malignancies was 18.2% (62 of 340): 11.5% (39) were primary tumors and 6.8% (23) were secondary and metastatic. The frequency of orbital malignancies was 25.4% (36 of 142) in the first 30 years (1932 through 1961) and 13.1% (26 of 198) in the second 30 years (1962 through 1991). The percentage of primary orbital malignancies was almost identical during the first and second periods (11.9% [17 of 142] and 11.1% [22 of 198], respectively). However, secondary and metastatic orbital neoplasms occurred in 13.4% (19 of 142) of the patients during the first 30 years and in only 2.0% (four of 198) during the second 30 years. The frequency of primary orbital malignancies in biopsy material remained the same over 60 years. However, the overall incidence of orbital biopsy specimens containing a malignancy decreased as a result of a reduction in the number of secondary and metastatic neoplasms that underwent biopsy.
Subject(s)
Orbital Neoplasms/pathology , Child , Child, Preschool , Female , Humans , Infant , Male , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/physiopathology , Retrospective Studies , Skull/diagnostic imaging , Tomography, X-Ray Computed , Visual Acuity/physiologyABSTRACT
A 40-year-old man presented with a left optic neuropathy. Magnetic resonance imaging demonstrated a contrast-enhancing mass along the course of the left trigeminal nerve and in the region of the left cavernous sinus with suprasellar extension. Preoperatively, he had a serum polyclonal gammopathy. Pathologic diagnosis was an intracranial plasma cell granuloma. The patient responded to high-dose steroids with resolution of his optic neuropathy, marked decrease in the size of the mass, and resolution of the serum polyclonal gammopathy. Intracranial plasma cell granuloma is a rare lesion; only 11 cases have been described in the literature. Almost half of the patients presented with vision loss as their chief complaint.
Subject(s)
Brain Diseases/diagnosis , Granuloma, Plasma Cell/diagnosis , Optic Nerve Diseases/diagnosis , Adult , Brain Diseases/drug therapy , Brain Diseases/surgery , Diagnosis, Differential , Granuloma, Plasma Cell/drug therapy , Granuloma, Plasma Cell/surgery , Humans , Magnetic Resonance Imaging , Male , Optic Nerve Diseases/drug therapy , Prednisone/therapeutic use , Trigeminal Nerve/pathologyABSTRACT
Confrontation visual fields have limited value in testing paracentral vision. We have used a four-meter confrontation test for several years at the Mayo Clinic for screening of the central field. This test can identify paracentral scotomas and macular sparing in a homonymous hemianopia. The optics of this technique parallel those of the two-meter tangent screen examination in which a scotoma is greatly enlarged by doubling the test distance. Although in common usage by some neuro-ophthalmologists, this simple technique is useful as an office screening device for evaluating paracentral vision.
Subject(s)
Vision Tests/methods , Visual Fields , Adult , Female , Hemianopsia/diagnosis , Humans , Scotoma/diagnosisABSTRACT
Between January 1966 and December 1988, 160 pediatric patients (age range, 0 to 17 years) were seen at the Mayo Clinic with an acquired oculomotor (35 patients), trochlear (19 patients), abducent (88 patients), or multiple (18 patients) cranial nerve palsy. The clinical findings in the 160 pediatric patients were compared with the results obtained in other reviews of cranial nerve palsies in the pediatric age group and with the adult Mayo Clinic patients with acquired cranial nerve palsies. Trauma was the most common reason for an acquired cranial nerve palsy in our pediatric group. The percentage of patients with an acquired cranial nerve palsy resulting from trauma was significantly greater in the pediatric group (42.5%) than in adults (15.4%) (P < .01). The difference between the percentage of adults (15.2%) and pediatric patients (16.9%) with a cranial nerve palsy secondary to a neoplasm was not statistically significant (P = .28).
Subject(s)
Abducens Nerve , Oculomotor Nerve Diseases/etiology , Paralysis/etiology , Trochlear Nerve , Adolescent , Adult , Child , Child, Preschool , Cranial Nerve Diseases/etiology , Female , Humans , Infant , Infant, Newborn , Male , Neoplasms/complications , Wounds and Injuries/complicationsABSTRACT
The 4-m confrontation visual field test has been successfully used at the Mayo Clinic for many years in addition to the standard 0.5-m confrontation visual field test. The 4-m confrontation visual field test is a test of macular function and can identify small central or paracentral scotomas that the examiner may not find when the patient is tested only at 0.5 m. Also, macular sparing in homonymous hemianopias and quadrantanopias may be identified with the 4-m confrontation visual field test. We recommend use of this confrontation visual field test, in addition to the standard 0.5-m confrontation visual field test, on appropriately selected patients to obtain the most information possible by confrontation visual field tests.
Subject(s)
Vision Disorders/diagnosis , Vision Tests/methods , Visual Fields , Hemianopsia/diagnosis , Humans , Scotoma/diagnosisABSTRACT
We tested the effects of the calcium antagonists lanthanum, diltiazem, and flunarizine on the development of atherosclerosis in rabbits fed a 2% cholesterol diet. The drugs were given orally and were well tolerated. In the cholesterol control animals, 52.2% of the thoracic aortic intimal surface was Sudan IV positive. This was reduced by 37% (p less than 0.05) with lanthanum, 37% (p less than 0.05) with diltiazem, and 34% (p less than or equal to 0.06) with flunarizine. In all cholesterol-fed animals, the intramural, but not subepicardial, coronary arteries were severely diseased. The extent and distribution of this disease were not altered by the various drug interventions. Thus, the calcium antagonists lanthanum, diltiazem, and flunarizine suppress atherogenesis of the rabbit aorta but have no effect on the extent or distribution of atherosclerosis in the intramural coronary arteries.
