ABSTRACT
Testing the pupillary response is a quick and valuable diagnostic measure for certain neurological and ophthalmological diseases in patients. The pupillary response can aid in localizing abnormalities in important parts of the visual system and brainstem, provided that the tests are executed and interpreted correctly. When an abnormal pupillary response is found, it is important to differentiate between an afferent problem (eyeball, retina, optical nerve), brain stem pathology, or an efferent problem (parasympathetic fibers of the oculomotor nerve, iris sphincter muscle). We describe the technique of the ophthalmological examination, the normal neurophysiology and the possible abnormal pupil responses in patients with intact and decreased consciousness.
Subject(s)
Diagnostic Techniques, Ophthalmological , Eye Diseases , Pupil/physiology , Reflex, Pupillary/physiology , Visual Pathways , Diagnosis, Differential , Eye Diseases/diagnosis , Eye Diseases/physiopathology , Humans , Visual Pathways/physiology , Visual Pathways/physiopathologyABSTRACT
INTRODUCTION: Sarcoidosis is a non-caseating, granulomatous disease of incompletely understood aetiology that can affect nearly all organs including the liver. Hepatic involvement is thought to occur in 50-90% of patients but may remain undiagnosed in many cases. Evidence-based guidelines for the treatment of sarcoidosis of the liver are lacking. Patients usually receive no treatment or are treated pragmatically with corticosteroids. However, treatment with systemic corticosteroids has had mixed results. The use of ursodeoxycholic acid (UDCA) in the treatment of sarcoidosis-associated cholestasis has been reported by several groups, and is empirically prescribed to sarcoidosis patients with hepatic involvement. METHODS: The effect of UDCA on symptoms and serum liver tests was investigated in a retrospective cohort study in which hepatic sarcoidosis patients had received either no treatment, prednisolone treatment or UDCA treatment. For all patients, laboratory results on ASAT, ALAT, AP and GGT were collected. Patients described the severity of their symptoms before and after treatment on a numerical scale. RESULTS: A total of 17 patients participated in the study. Serum liver tests in the group treated with UDCA had improved as compared with the other groups. Also, symptomatic improvement of pruritus and fatigue was reported in the group treated with UDCA. CONCLUSION: This retrospective cohort study supports the empirical first-line use of UDCA in the treatment of sarcoidosis of the liver, especially in symptomatic patients. Prospective randomised trials are needed to adequately support this concept.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Liver Diseases/drug therapy , Prednisolone/therapeutic use , Sarcoidosis/drug therapy , Ursodeoxycholic Acid/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Cholagogues and Choleretics/therapeutic use , Fatigue/etiology , Female , Humans , Liver/chemistry , Liver/drug effects , Liver Diseases/blood , Liver Diseases/complications , Male , Middle Aged , Pruritus/etiology , Sarcoidosis/blood , Sarcoidosis/complications , Treatment OutcomeABSTRACT
Emerging pathophysiologic insights are leading to novel approaches to treating fibrosing cholangiopathies. The current treatment, using ursodeoxycholic acid (UDCA), may slow the progression of some chronic cholangiopathies but cannot heal them. Apart from immunosuppressive interventions aimed at minimizing immune-mediated damage, the use of specific modifiers of hepatobiliary secretory and cytoprotective mechanisms may eventually give rise to a new class of disease-modifying anti-cholangiofibrotic drugs.
