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Biomedical subjects

G B Krohel

Publications and source records attributed to G B Krohel.

At least 19 recordsLinked to original sources
PubMed1989

Adult periorbital fibromatosis.

Three patients aged 15 to 40 years with fibromatosis of the periorbital region were studied. A history of acute onset, preceding trauma, and pain associated with a palpable mass were typical features. Rapid recurrence followed surgical excision. Misdiagnosis is common in this benign disease and may lead to unnecessary examinations for malignancy. Surgical excision or debulking of these masses is indicated for diagnosis and pain relief, but long-term follow-up indicates that these lesions will often spontaneously resolve with time.

Adolescent↗
PubMed1987

Astigmatism associated with adnexal masses in infancy.

High degrees of astigmatism are common in infants with hemangiomas but have not been well documented with other adnexal masses. We reviewed records of 65 patients (69 eyes) with chalazions, epibulbar or orbital dermoids, hemangiomas, and dacryoceles. Astigmatism greater than +1.25 diopters (as high as +5.50 diopters) was most commonly associated with dacryoceles (eight of 12 eyes) and with hemangiomas (14 of 17 eyes). Plus cylinder axes were consistently oriented toward the lesion, and astigmatism tended to resolve with resolution of the lesions. Only one of the 17 eyes with dermoids and two of the 23 eyes with chalazions had astigmatism. Anisometropic amblyopia has been a prominent concern in the treatment of infants with hemangiomas. Patients with dacryoceles may be at similar risk. Repeated cycloplegic refractions are important in determining appropriate treatment of adnexal masses.

Amblyopia↗
PubMed1986

Ocular Munchausen's syndrome.

Patients with contrived histories and/or self-induced physical abnormalities (Munchausen's syndrome) are often successful in deceiving physicians. We recently cared for four patients with ocular Munchausen's syndrome. Self-induced ocular manifestations included voluntary nystagmus, subconjunctival hemorrhages, chronic orbital emphysema requiring exenteration, corneal alkali burns, erosions and ulcerations, and abscesses of the periorbital area. Correct diagnoses of ocular Munchausen's syndrome were made only after extensive medical and surgical investigations. Suggestions for evaluation and treatment will also be discussed.

Adult↗
PubMed1986

Functional visual loss in children.

Twenty-three children (16 girls, 7 boys, aged 6-17 years) who presented with the specific complaint of blurred vision were diagnosed as having functional visual loss. Symptoms were intermittent in seven children. Associated signs and symptoms were common and included headaches, visual field loss, diplopia, micropsia, voluntary nystagmus, and spasm of the near reflex. Our treatment consisted of reassurance and follow-up. Resolution of symptoms occurred within 24 hours in one third and within two months in three-quarters of our patients. Parental support and encouragement were associated with more rapid resolution. Recurrence of symptoms and late onset of somatic complaints were rare. Conflicts related to family or school environment were common. Four children had been sexually or physically abused. Our experience suggests that, regardless of the duration or severity of symptoms, functional visual loss in children can usually be treated with reassurance. We believe that psychiatric referral is not necessary for most patients. Sexual or physical abuse should be considered as a possible predisposing factor.

Adolescent↗
PubMed1986

Posttraumatic convergence insufficiency.

Convergence insufficiency was encountered following closed head trauma in 23 patients. The most common complaints included difficulty reading and diplopia at near. The severity of the head trauma varied. There was no correlation between the severity of the head trauma and the severity of the convergence insufficiency. A normal near point of convergence was encountered in six of the 23 patients; all six patients had abnormal convergence reserves when measured with prisms. Treatment consisted primarily of convergence exercises and prisms. Bilateral medial rectus resections were required in two patients. Response to therapy was variable and often incomplete. The anatomic localization of convergence insufficiency secondary to head trauma remains unknown, although lesions in the occipital lobe and upper midbrain both seem capable of producing this syndrome.

Accidents, Traffic↗
PubMed1985

Localized orbital neurofibromas.

Of nine patients (five men and four women, 25 to 55 years old) with localized orbital neurofibromas, only one had other systemic findings consistent with neurofibromatosis. The neurofibromas originated from sensory nerves of the orbit, producing gradual proptosis with expansion of the orbital walls in most cases. Mild orbital discomfort occurred in some patients. Preoperative and postoperative anesthesia in the distribution of the involved sensory nerves was also encountered. Five patients had multiple tumors within the same orbit. Four patients had tumors or a pedicle of the tumor extending into the superior orbital fissure. Two patients were initially thought to have fibrotic pseudotumors. Surgical excision is the treatment of choice for these tumors.

Adult↗
PubMed1985

Inaccuracy of fine needle aspiration biopsy.

Fine needle aspiration biopsy (FNAB) of orbital tumors has been recently advocated as a reliable diagnostic modality. An accuracy rate of 92% has been claimed by some authors. This figure remains unproven as most patients have not undergone simultaneous pathologic examination. We recently performed FNAB on 34 patients at the time of surgical biopsy. The procedure was performed with direct visualization and the tissue was obtained and prepared as described by Kennerdell. A definitive surgical biopsy was then obtained and submitted for routine pathologic examination. Cytologic diagnosis has been accurate in less than half of the cases biopsied. Reliance on fine needle aspiration biopsy alone in some patients would have resulted in inappropriate therapy. Fine needle aspiration biopsy should be limited to strongly suspected cases of orbital metastases or secondary tumors.

Biopsy, Needle↗
PubMed1985

Calcifications in lesions of the fossa of the lacrimal gland.

It is frequently reported that calcification in the fossa of the lacrimal gland is a reliable sign of malignancy. We present a small, previously unreported series of lacrimal gland fossa calcifications, in which in three out of five cases the lesion was benign. Calcification can be a misleading radiographic sign and should not, in and of itself, be considered diagnostic of malignancy. This is important because proper preoperative diagnosis of lacrimal fossa tumors is essential as management differs.

Adult↗
PubMed1985

Central retinal artery occlusion following transfemoral cerebral angiography.

Whereas most ocular complications following cerebral angiography are benign and transient, central retinal artery occlusion following cerebral angiography produces severe permanent visual deficits in nearly 40% of patients. Physicians ordering and performing cerebral angiography should be aware of this complication, since immediate attention to patients with visual disturbance from central retinal artery occlusion may save useful vision. All previously reported cases of central retinal artery occlusion following cerebral angiography have occurred after direct percutaneous carotid angiography. We report a case of central retinal artery occlusion following transfemoral cerebral angiography using a #5 French catheter and meglumine iothalamate (Conray-60) contrast.

Arterial Occlusive Diseases↗