Landolt Ring-Shaped Epithelial Keratopathy: A Novel Corneal Disease in a Non-Japanese White Patient.

PURPOSE: Landolt ring-shaped epithelial keratopathy is a corneal disease that has only been reported in 11 Japanese patients in 2014.1 We describe the first case of Landolt ring-shaped epithelial keratopathy in the United States in a patient of European background. METHODS: This is a single case report with longitudinal care. RESULTS: A 35-year-old White patient presented with a history of ocular burning, photophobia, and decreased vision. Corneal examination showed bilateral and asymmetric microcystic lesions in a unique Landolt ring (or the letter "C") shape, distributed randomly in the epithelium. Confocal microscopy revealed cellular ballooning and hyperreflective opacities in the basal layer of the corneal epithelium. The patient has had multiple recurrences of her symptoms year-round, each lasting 4 to 8 days. Topical treatment with cyclosporine, steroids, and lubrication resolved her symptoms but without complete resolution of signs on examination. CONCLUSIONS: Our patient's clinical signs and symptoms are similar to those described previously in 11 Japanese patients. However, unlike those patients, our patient demonstrates symptomatic response to topical treatment, no seasonal association to her condition, and to date, incomplete resolution of her disease after more than 2 years. This case highlights that Landolt ring-shaped epithelial keratopathy, a novel corneal disease of unclear origin, has relevance outside of the Japanese population.

Conjunctival Lesions Secondary to Systemic Varicella Zoster Virus Infection.

Purpose: To report and present images of a case in which discrete conjunctival lesions developed in the setting of primary varicella zoster virus infection (ie, chickenpox). Methods: Case report and literature review. Results: This report describes a young, unvaccinated male who developed an acutely painful, red eye in the setting of disseminated primary varicella zoster infection. The cutaneous rash was widespread and included lesions on both eyelids. The patient was found to have multiple discrete de-epithelialized lesions involving the palpebral and bulbar conjunctiva. Throughout the disease course, good visual function was maintained and there was no evidence of intraocular involvement. The ocular surface lesions resolved without sequelae after 1 week of treatment with topical antibiotic ointment. Conclusions: Primary varicella zoster infection is an increasingly rare phenomenon in the setting of widespread vaccination. However, unvaccinated or undervaccinated individuals and other at-risk populations remain susceptible to developing severe infections. This case of chickenpox involved discrete conjunctival lesions that resolved without sequelae after conservative treatment with topical antibiotic ointment. While serious ophthalmic complications are uncommon in primary varicella infection, clinicians should be aware of the potential for ocular morbidity in this increasingly rare condition.

A review of magnetic resonance enterography based Crohn's disease activity indices in paediatric patients.

Magnetic resonance enterography (MRE) is a commonly used method for non-invasive diagnosing and following of inflammatory bowel disease (IBD). Numerous reviews that compare and discuss MRE-based Crohn's disease (CD) activity indices for adults have been published; however, no reviews of this kind have been published for children. Following a PubMed database literature search (January 2008 - November 2021), out of 316 research papers, 10 original papers about MRE-CD activity indices were included in the analysis. Four MRE-based scoring systems were discussed: Magnetic Resonance Index of Activity (MARIA), the Crohn's Disease Magnetic Resonance Imaging Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS) and the Visual Analogue Scale (VAS). This review revealed that in the last 13 years, studies have proven that MRE-based CD activity indices correspond with endoscopic findings and clinical scores of CD activity.

Clinical usefulness of the Mucosal Inflammation Noninvasive Index in newly diagnosed paediatric Crohn's disease patients.

Introduction: Mucosal healing (MH) has become a therapeutic goal in Crohn's Disease (CD), but its frequent evaluation in endoscopic examination is fraught with several limitations. There is an increasing demand to replace invasive procedures with noninvasive markers of CD. Aim: To assess the clinical importance of the recently developed Mucosal Inflammation Noninvasive Index (MINI) in newly diagnosed paediatric Crohn's Disease patients. Material and methods: Out of 60 consecutive newly diagnosed paediatric CD patients, 55 were enrolled in the study. The study examined the relationship between Simple Endoscopic Score for CD (SES-CD), Paediatric Crohn's Disease Activity Index (PCDAI), laboratory findings and the newly developed MINI index. Results: Out of the 55 paediatric patients involved in the study, ileocolonoscopy was successful in 42 patients. In this group there was a strong positive correlation between MINI and PCDAI (R = 0.61; p < 0.001) and a moderate positive correlation between MINI and SES-CD (R = 0.39; p = 0.011). MINI score of 17 points or more indicated severe CD (defined as SES-CD ≥ 16 points) with a diagnostic sensitivity of 90% but with a low specificity of 50%. There were 13 (23%) patients in whom ileocecal valve intubation was not achieved, and in this group the correlation between MINI and PCDAI was also strong (R = 0.66; p = 0.014). Conclusions: The newly developed MINI index is a simple and intuitive clinimetric score that can be considered a useful tool in assessing mucosal inflammation among newly diagnosed paediatric CD patients.

Bordetella Holmesii: An Unusual Cause of Endogenous Endophthalmitis in a Patient With Sickle Cell Disease.

Purpose: This case report describes a rare organism causing endogenous endophthalmitis in a patient with sickle cell disease. Methods: A case report was conducted. Results: A 41-year-old man with sickle cell disease presented with acute onset of blurry vision of the right eye. His visual acuity was counting fingers in the right eye and 20/20 in the left eye. He had ophthalmic findings of hypopyon and vitritis in the right eye, consistent with endophthalmitis. He was treated with intravitreal and systemic antibiotics. Vitreous cultures grew Bordetella holmesii. His visual acuity at follow-up visits improved to 20/40 in the setting of improved vitritis. Conclusions: This is the first case describing B holmesii, a rare causative organism of endogenous endophthalmitis, in a patient with sickle cell disease. More studies are needed to improve the early detection and treatment of this unusual organism.

[Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process]. / Partizipative Entscheidungsfindung (PEF) mit chronischen Schmerzpatienten. Der Patient als Partner im medizinischen Entscheidungsprozess.

Fibromyalgia syndrome (FMS) is an exemplary condition of chronic widespread pain that is difficult to control and often leads to frustration and resignation on the part of both the patient and the doctor. Shared decision making (SDM) could be a means to facilitate doctor-patient interaction and might therefore influence therapeutic decisions taken. We conducted a prospective study to evaluate the effects of SDM with FMS patients. We developed a communication train-ing program for physicians and a computer-based information tool on FMS for patients. The study included 133 FMS patients. Intervention group I (IG I) was treated by communication-trained doctors and had access to a computer-based information tool on FMS,intervention group II (IG II) was treated by standard doctors and received the information tool, and the control group (CG) was treated by standard doctors and got no additional information. All three groups we-re offered the same evidence-based treatment options for FMS. Patients of the IGs were more willing to become involved in exercise, to enroll in integrated group therapy for FMS patients (IGTF), and to take analgesics. Patients of the CG preferred anti-depressants. More patients from IG II and CG opted for relaxation techniques. Patients in IG I and IG II choose significantly more therapeutic options than patients in the CG. SDM is one means to increase FMS patients' readiness for treatment. Especially the element of providing sufficient medical information seems to account for this effect. The readiness to enroll in physical activities, to take analgesics, and to participate in psychotherapeutic elements was most likely to be raised through SDM.

[Bleedings during the third term: which complications?]. / Emorragie del terzo trimestre: quali complicanze?

BACKGROUND: The aim of this research was to study the maternal and prenatal complications which may occur in the abruptio placentae and in placenta praevia. METHODS: All the patients who were hospitalized in the Obstetrics and Gynaecology Department of the Policlinico Umberto I, from January 1993 to July 2000 have been studied. Moreover, a comparative study between the onset of complications of the two pathologies considered and the ones found in a control group was carried out. We found 62 cases of placenta previa and 48 cases of abruptio placentae. The total amount of childbirths was 6861, so the incidence of abruptio placentae was 0.007%, while the incidence of placenta previa was 0.009%. RESULTS: The results show that the most frequent maternal complication, in both pathologies, was haemorrhage. We did not find any statistically meaningful difference between the percentage of haemorrhage in the two pathologies ( p=0.0608), but we noted a higher percentage of haemorrhage compared to the control group. The number of hysterectomies was higher in patients with placenta previa compared to patients with abruptio placentae. The most frequent fetal complication was premature birth, significantly more frequent than in the control population (p=0.0210). CONCLUSIONS: As a matter of fact, we can affirm that, in all its clinical manifestations abruptio placentae is a more dangerous disease than the placenta previa, except in the complications of the discharge of the afterbirth and of the postpartum, where haemorrhage and uterus atony lead to a great number of hysterectomies.

[Stark's method of cesarean section. Advantages compared to the traditional method]. / Taglio cesareo secondo Stark. Vantaggi rispetto al taglio cesareo tradizionale.

BACKGROUND AND AIM: The increased incidence of caesarean section has led, over the past few years, to the revision of surgical methods in order to reduce fetus extraction time and the total costs of surgery, without detracting from cosmetic advantages. Stark devised a surgical technique for this purpose which aims to reduce operating trauma and duration of surgery and to ensure a faster recovery and greater well being. METHODS: We performed a retrospective study in all patients undergoing caesarean section using Stark's technique and we evaluated their postoperative progress based on body temperature and any complications involving the suture (infections, hematoma, adhesions, pain). The results were compared to those obtained by other authors using traditional caesarean section. RESULTS: It was found that patients undergoing traditional caesarean section showed an incidence of wound infection which was higher than that observed in the Stark group (8.75%). Likewise, in relation to the onset of hypothermia, only 3 cases (3.75%) were observed in this study. CONCLUSIONS: Reduced short- and long-term maternal morbidity was obtained using this technique, together with a lower incidence of febrile morbidity and wound infection, less pain and a decreased risk of visceral adhesion.

[Modifications to the technic of cesarean section after Stark]. / Modifiche alla tecnica del taglio cesareo secondo Stark.

BACKGROUND: As the operating births (caesarean section) increase, many surgical equipes have been compelled to revise operating techniques in order to reduce fetus extraction times and the whole expense of operation without renouncing, at the same time to beauty advantages. With Stark technique, that we have modified, we have obtained all these aims, improving at the same time patients' postoperative course as well succeeding to extract the fetus in about five minutes. In the '70 Cohen explained the utility of a transiliac incision allowing the access to abdominal cavity with rectus muscles unsticking in an area in which these muscles should present a less adhesiveness. METHODS: Since 1988 Stark has used Cohen's technique changing however uterus closing times, peritoneal membranes and abdominal walls. Our technique is different since we performed the incision according to Pfannestiel. RESULTS: The times are considerably reduced to 4.8 minutes for fetus extraction and in postoperative time the complications are drastically reduced too (infection, pain, hematoma, adhesions). CONCLUSIONS: Therefore we can surely say that this kind of technique can be used with success in all gynaecological surgery, in extrauterine pregnancies and adnexial tumefactions (not malignant). Personal opinion is that spinal anesthesia is the best analgesic technique.

[Management of female genital HPV infections by the LEEP method (Loop Electrosurgical Excisional Procedure)]. / Trattamento delle infezioni da HPV del tratto genitale femminile con metodica LEEP.

METHOD: Two different groups of women have been selected: group A (120 patients), affected by genital warts and ectropion, treated only with destructive therapy by means of LEEP (Loop Electrosurgical Excisional Procedure) with spheric electrod, while group B (20 patients), of which two affected by CIN I and resistant to other treatments for a period longer than 12 months, and 18 patients with a histologic diagnosis of CIN II, CINIII/HPV, treated with conization by LEEP method. After therapy, a follow-up has been carried out, with colposcopic, cytologic, histologic control, scheduled 1-3-6-12 months after therapy. RESULTS: The results proved positive, since recovery in the two groups (A and B), after treatment, has been 100% with no complications, verified by follow-up after 12 months. CONCLUSIONS: The introduction of LEEP, represents a simple alternative, fast, painless practical, at a minimum cost to the patient and the community, devoid of complications, without general anaesthesia in the treatment of CIN as well as of genital warts, substituting in this last case the loop with a sphere electrode. Moreover, it does not affect the function, as well as the anatomy of the organ, a primary factor is young patients desiring children. This technique permits to obtain at the end of the operation one or more tissue fragments to be used for histological examinations, with free margins from necrotic border, assuring the integrity of the tissue, and thus leading a correct diagnosis.

[Antiphospholipid syndrome in obstetrics]. / Sindrome da anticorpi antifosfolipidi in ostetricia.

BACKGROUND: The purpose of this study was to verify the frequency of antiphospholipid syndrome in pregnancy associated with fetal wastage and maternal hypertension. The antiphospholipid antibody syndrome is a clinical syndrome of venous and arterial thrombotic events, recurrent pregnancy loss, and thrombocytopenia associated with two autoantibodies: the lupus anticoagulant (LAC) and anticardiolipin antibody (ACA). METHODS: A group of 83 pregnant patients with recurrent fetal loss or with maternal hypertension for the presence of autoantibodies has been studied. None of the patients had systemic lupus erythematosus or any other autoimmune disease such as sclerodermia, myasthenia, autoimmune thrombocytopenic purpura. The patients have been divided into two groups: a) 45 women with fetal wastage history; b) 38 women with maternal hypertension. RESULTS: The prevalence of autoantibodies in the first group reaches 31.1% (14/45 patients). Two of these 14 patients (14.3%) had fetal loss (one with treatment and one without). 12 of this 14 patients (85.7%) had a normal delivery and all with treatment. Two treatment scheme were used in this study: one with aspirin and another with aspirin and prednisone. In the group of 45 patients there were 34 normal deliveries: 27 (79.5%) pregnancies were treated with aspirin and 7 (20.6%) were treated with aspirin and prednisone. There were 11 fetal loss and 9 (81.1%) in patients without treatment and 2 (18.2%) in treated pregnancies. The prevalence of autoantibodies in the second group reaches 21%. CONCLUSIONS: In conclusions, it can be suggested that treatment strategies for the prevention of fetal loss in the antiphospholipid syndrome are warranted because treatment appears to alter fetal outcome favorably.