Coats disease in a 3-week-old boy.

Coats disease is a rare, idiopathic retinal vasculopathy that predominantly affects males in the first decade of life. We report the case of a 3-week-old boy who presented with atypical rapidly progressing disease suggestive of Coats exudative vasculopathy. The eye developed retinal fibrosis and phthisis bulbi within 4 weeks. Retinoblastoma could not be ruled out, although histopathology after enucleation revealed no retinoblastoma. To our knowledge, this is the youngest case of Coats disease to be reported in the literature. This case highlights the wide variation in the clinical presentation of Coats disease and the difficulty in differentiating it from diffuse infiltrative retinoblastoma.

Autofluorescence imaging - a useful adjunct in imaging macular trauma.

Autofluorescence imaging is a rapid, noninvasive technique, with several applications becoming slowly integrated into ophthalmic clinical practice. We describe its use as a valuable tool for predicting the function of the retinal pigment epithelium following damage from blunt ocular trauma.

Skin problems related to the occupation of commercial fishing in North Carolina.

OBJECTIVE: Commercial fishing is one of the most dangerous professions with many of the occupational health problems related to the skin. This study elucidates the types of occupational skin disorders that occur in commercial fishermen in North Carolina. STUDY DESIGN/SETTINGS: Booths were set up offering free skin cancer screenings at various seafood festivals, a "blessing of the fleet" event and commercial fishing shows, which were located throughout eastern North Carolina from 2002-2004. When commercial fishermen were screened, they were asked about significant skin problems that they had experienced and were related to their occupation. They were specifically asked about their history of (1) cancerous and precancerous skin lesions, (2) eczemas, (3) superficial fungal infections, (4) bacterial infections of the skin, (5) traumatic injuries related to the skin, (6) bites and stings, (7) shocks from fish, and (8) skin problems related to environmental extremes. RESULTS: Eighty-one North Carolina watermen were screened: seven of the fishermen (9%) had at least one basal cell carcinoma, five (6%) had at least one squamous cell carcinoma, and no melanomas were detected. Many occupationally related skin disorders were noted on the historical survey, and some of the more dangerous of these included traumatic injuries related to fishing equipment, cutaneous cancers, fish bites, infections, stingray injuries, and man-of-war stings. LIMITATIONS: The sample population was comprised of volunteers, which limits generalizability, and some diagnoses were established retrospectively. CONCLUSIONS: There are a wide variety of skin disorders among commercial fishermen in North Carolina and healthcare professionals should be aware of these when working with watermen.

Methylene blue enhancement of resuscitation after refractory hemorrhagic shock.

BACKGROUND: Methylene blue has been used to treat hypovolemic states. This study evaluated prehospital resuscitation after refractory hemorrhagic shock with a combination of methylene blue and limited-volume lactated Ringer's solution. METHODS: After blood loss to a mean arterial pressure of 50 mm Hg in canines, refractory hemorrhagic shock was defined as minimal hemodynamic response to phenylephrine. Differential protocols included no treatment (control), methylene blue bolus, limited-volume lactated Ringer's solution, and combined methylene blue/lactated Ringer's solution therapies. Hemodynamic parameters were collected at baseline, during shock, during refractory hemorrhagic shock, and 30, 60, 90, and 120 minutes after treatment. Radiolabeled microspheres were used to measure end-organ perfusion and oxygen delivery. RESULTS: Methylene blue/lactated Ringer's resuscitation improved prehospital survival (p < 0.05), mean arterial pressure and cardiac output (p < 0.05), vital end-organ blood flow and oxygen delivery (p < 0.05), and decreased serum lactate levels (p < 0.05), as compared with the methylene blue and lactated Ringer's single therapies. CONCLUSIONS: Resuscitation after refractory hemorrhagic shock using a combination of methylene blue and limited-volume lactated Ringer's solution improves prehospital survival and hemodynamic stability and reduces ischemic damage in an acute setting. This form of therapy has been proved useful as a temporizing measure for resuscitation after refractory hemorrhagic shock in a canine model and warrants further study for its application to the hemorrhagic trauma patient.