Diagnosis and surgical management of orbital sparganosis.

PURPOSE/BACKGROUND: Orbital sparganosis represents an extremely rare condition with only a few cases being reported in literature. Here we describe cases of orbital sparganosis, including their etiology, clinical findings, and surgical outcomes. PATIENTS AND METHODS: A retrospective review was performed on patients with orbital sparganosis, who were treated at Zhongshan Ophthalmic Center, of Sun Yat-sen University, China between 2000 and 2012. RESULTS: Five patients (three males and two females, one right orbit and four left orbits) were identified. Their mean age was 14.8 years (range = 6-33 years). Four cases were contracted from eating raw snakes and fishes, or placing poultices of frog on open wounds. All cases showed a swelling and/or redness of the eyelid and conjunctiva, and a migrating inflammation was present in one of the cases. High levels of blood eosinophils were observed in three of these cases. Of the two patients examined using computed tomography, one showed a diffuse soft tissue infiltration and a punctate calcification, while one of the three patients examined using magnetic resonance imaging displayed an annular "tunnel sign" within the lesion. All patients underwent an anterior orbitotomy and the entire worm was removed with no surgical complications. CONCLUSIONS: Orbital sparganosis should be highly suspected in patients with a history of eating raw snakes and frogs, a migrating orbital inflammation and the presence of eosinophilia. Orbital imaging examinations play an important role in the diagnosis of orbital sparganosis. Surgical removal of the entire worm is required.

Severe pediatric Graves orbitopathy in adolescents of African origin.

This article reports on two cases of severe pediatric Graves orbitopathy (GO) in two adolescents of African origin. Two black male adolescents presented with highly active GO and signs of beginning compressive optic neuropathy. Neither of them were smokers nor had a family history of GO. Besides urgent referral to pediatric endocrinologists, intravenous methylprednisolon pulse therapy was initiated. In spite of the fluctuating thyroid hormone levels in the initial phase of antithyroid therapy, intravenous steroid administration stopped the progression of malignant GO rapidly in both of our patients without any considerable side effects. Although the course of GO during childhood is considered to be mild, severe, sight threatening GO-requiring immunosuppression-may occur at young age, as in the reported adolescent patients of African descent.

Orbital infection in New Zealand: increased incidence due to socioeconomic deprivation and ethnicity.

AIM: This study aimed to identify the relationship between the incidence of orbital infection, ethnicity and socioeconomic deprivation in New Zealand. METHOD: Cases admitted to all public hospitals in New Zealand with the ICD-10 diagnosis of acute inflammation of the orbit for a 9-year period were retrieved from the National Minimum Data Set. Incidence rates of acute infection of the orbit were correlated with socioeconomic deprivation (measured by New Zealand Deprivation Index) and ethnicity. RESULTS: There were 530 cases admitted with acute orbital inflammation over a 9-year period from 1 July 2000 to 30 June 2009. This study identified a significant association between orbital infection incidence and socioeconomic deprivation and ethnicity. Cases in the moderate deprivation group had 1.5 times the rate of the least deprived group and the most deprived group had 2.9 times the rate of orbital infection of the least deprived group. Maori had 1.9 times the rate of the European group, and Pacific people had 3.6 times the rate of European group. CONCLUSION: Greater socioeconomic deprivation, and ethnicity was associated with an increased incidence of orbital infection in New Zealand. The reasons why these associations exist are currently not clear.

The Pro 12 Ala PPAR gamma gene polymorphism: possible modifier of the activity and severity of thyroid-associated orbitopathy (TAO).

OBJECTIVE: The PPAR gamma transcription factor, is involved in both adipogenesis and inflammation, which have been implicated in the pathogenesis of thyroid-associated orbitopathy (TAO). The aim of this study was to explore the possibility that the Pro(12)Ala polymorphism of the PPAR gamma gene, associated with a modified transcriptional activity, might be affecting the severity of TAO. SUBJECTS AND DESIGN: We studied two cohorts of patients with Graves' disease (GD): Group 1 comprised 172 patients of Dutch ethnic origin with TAO, who attended the outpatients' clinic, Department of Endocrinology and Orbital Centre of the Academic Medical Centre, Amsterdam. Group 2 comprised 93 consecutive patients with GD of Greek ethnic origin, who did not have TAO. In group 1, exophthalmometry measurements, lid oedema, diplopia (n = 172) and clinical activity score (CAS) (n = 110), always assessed by the same group of three investigators, were recorded. Autoantibody levels were measured. RESULTS: Allele frequency was 11.5%. There was no difference in the distribution of the polymorphism between GD patients with and without TAO. Among group 1 patients proptosis was significantly lower in Pro(12)Ala carriers (20.1 +/- 3.3 vs. 22.1 +/- 3.1, P = 0.003, t-test). PPAR gamma polymorphism carriers had lower TSH-Rab levels (mean rank 61.8 vs. 83.2, P = 0.015) and lower CAS (available in 110 patients) (mean rank 38.9 vs. 55.4, P = 0.022, M-W-test). The frequency of the polymorphism decreased with increasing CAS (P = 0.023 linear by linear association). Multivariate analysis (step) showed that the association of either proptosis or CAS with the PPAR gamma gene variant remained significant when age, smoking and TSH-Rab levels were taken into account (P < 0.01). CONCLUSIONS: The distribution of the Pro(12)Ala PPAR gamma gene polymorphism is equally present in patients with GD with or without TAO. Among patients with TAO this polymorphism is associated with less-severe and less-active disease.