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Biomedical subjects

P Kestelyn

Publications and source records attributed to P Kestelyn.

At least 37 records · Page 2Linked to original sources
PubMed1994

Uveitis-glaucoma-hyphema syndrome: a late complication of posterior chamber lenses.

The uveitis-glaucoma-hyphema (UGH) syndrome is a triad that rarely occurs in the late postoperative period after an extracapsular cataract extraction (ECCE) with implantation of a posterior chamber (PC) intraocular lens (IOL). Surgical techniques as well as IOL design can influence the incidence of the UGH syndrome. We describe two patients who developed an UGH syndrome respectively 5 and 6 years after an ECCE with implantation of a flexible closed-loop one-plane PC IOL of the Anis type. Intraoperatively, an envelope technique had been used. Although no tears had occurred, an asymmetrical bag-sulcus fixation of the IOL had been obtained, with manifest upward decentration of the IOL, probably eroding the ciliary sulcus by its closed loops, acting as a semi-rigid system.

Aged↗
PubMed1993

Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome.

The present study was undertaken to determine the nature and the prevalence of ophthalmic manifestations of infections with Cryptococcus neoformans in human immunodeficiency virus seropositive patients and to analyze whether the presence or absence of ocular signs is associated with improved survival. Eighty human immunodeficiency virus seropositive patients with cryptococcal infection were enrolled. We observed papilledema in 26 of the 80 patients (32.5%). Visual loss and abducens nerve palsy occurred in seven patients (9%). Only two patients (2.5%) had optic atrophy. Visual loss caused by optic nerve involvement was less frequent among the 62 patients treated with oral conazoles exclusively than among the 18 patients who had received amphotericin B or a combination of amphotericin B and conazoles. Actual invasion of the intraocular structures with Cryptococcus neoformans was an uncommon complication in our series. In addition to the ocular manifestations attributable to cryptococcal disease, human immunodeficiency virus-related retinopathy was present in nearly half of the patients. Cytomegalovirus retinitis was diagnosed in four patients (5%). The 26 patients (32.5%) with papilledema had a median survival of 182 days vs 160 days for the patients without papilledema. The median survival for 18 patients (22.5%) with cotton-wool spots was 102 days vs 186 days for those without cotton-wool spots. The differences between these subgroups were not statistically significant.

AIDS-Related Opportunistic Infections↗
PubMed1993

Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae from Rwanda, 1984-1990.

A total of 383 clinical isolates of Streptococcus pneumoniae, obtained from an equal number of patients in Kigali, Rwanda, was tested for resistance to penicillin G with a 1 microgram oxacillin disc. Of these isolates, 99 (25.8%) showed reduced zones of inhibition. By means of an agar dilution method, 21% all isolates were confirmed as relatively resistant (MIC > or = 0.12- < or = 1.0 mg/l) strains of Streptococcus pneumoniae (RRSP). A high degree of resistance to penicillin G (MIC > or = 2 mg/l) was not observed. Resistance to chloramphenicol (MIC > or = 8 mg/l) was found in 31% RRSP and in 6% penicillin susceptible strains (PSSP). Doxycycline resistance was common in both RRSP and PSSP strains. All isolates remained fully susceptible to erythromycin. Children more often harboured a strain giving a reduced inhibition zone than did adults (74/230 versus 25/153; P = 0.0005). A total of 32 serotypes or serogroups were identified, seven of them relating to 64.8% all isolates typed. Of all the isolates 84% belonged to a serotype represented in the 23-valent vaccine or to a cross-reacting serotype. Serotype 25, not included in the vaccine, accounted for 10.7% typed isolates from adults but only for 2.0% typed isolates from children. Results of susceptibility testing and clinical experience suggest that penicillin G, ampicillin and chloramphenicol should not be used alone as empirical treatment for pneumococcal meningitis in patients in Rwanda.

Adult↗
PubMed1993

Primary corneal epithelial dysplasia (corneal intraepithelial neoplasia).

A 49 year-old man consulted in March 1980 for pain, eyestrain and decreased vision at the right eye. He presented a slightly elevated and transparent lesion, strictly limited to the corneal epithelium and treated with eyedrops until November 1980. The patient was seen again 12 years later in October 1992 with still the same complaints and a practically unchanged corneal lesion. The diagnosis of primary corneal epithelial dysplasia (Corneal Intraepithelial Neoplasia-Corin) was made and the abnormal epithelium completely removed under local anesthesia. After the operation the cornea became normal again and the patient free of complaints. The authors discuss the clinical symptoms, pathology, pathogeny and treatment of primary corneal epithelial dysplasia (Corneal Intraepithelial Neoplasia-Corin).

Carcinoma in Situ↗
PubMed1993

Congenital ectropion uveae with glaucoma.

Congenital ectropion uveae (CEU) is a rare, non progressive anomaly characterised by the presence of iris pigment epithelium on the anterior surface, an anterior iris insertion, dysgenesis of the drainage angle and glaucoma. The condition is characteristically unilateral and rarely hereditary. The current theory of development arrest is discussed. We report three cases with CEU of which two already developed glaucoma. All patients with CEU should be carefully examined periodically to detect glaucoma.

Child↗
PubMed1993

Merkel cell carcinoma of the eyelid. A clinicopathological case report.

Merkel cell carcinoma, a neuroendocrine tumor, is a highly invasive cutaneous neoplasm, which rarely affects the eyelids. This tumor must be treated aggressively to minimize the changes of local recurrence and regional or distant metastasis. In this paper, we describe a 78-year-old woman who had two recurrences of this neoplasm after consecutive local excisions. We describe the histopathological findings and emphasize the differential diagnosis with other neoplasms, as the therapeutic approach is different.

Aged↗
PubMed1993

A rare case of chronic papillary conjunctivitis diagnosed after several years of evolution. Clinical and pathological findings.

A man with a 2.5 year history of chronic papillary conjunctivitis was diagnosed as having "floppy eyelid syndrome". This syndrome, first described in 1981, is characterized by loose upper eyelids that evert readily on elevation of the lid, a chronic papillary conjunctivitis and a soft rubbery tarsus. The condition is resistant to any form of medical treatment but responds well to a horizontal lid shortening procedure. The etiology is unknown but the present report suggests that an abnormality of the structure of the orbicularis muscle may play a role.

Blepharoptosis↗
PubMed1993

Natural history and visual outcome in patients with APMPPE.

We undertook a retrospective study of the files of 21 patients (42 affected eyes) with acute posterior multifocal placoid pigment epitheliopathy to obtain details on the natural history of the disease and on the functional and visual outcome (mean follow up: 17 months). The final visual acuities were 8/10 or better in 34 eyes (81.0%), 7/10 to 2/10 in 6 eyes (14.2%) and 1/10 in two eyes (4.8%). Although the final visual acuity was good in most eyes, 24 eyes (57.2%) were still symptomatic due to scotomas (33.3%), metamorphosia (21.4%), decreased vision (16.6%), floaters (4.8%) and chronic redness (2.4%). Recurrences did not occur in this group of patients. Electrophysiological and color vision tests were performed in the initial phase of the disease, but we found no correlation between the test results and the final visual acuity.

Adolescent↗
PubMed1993

Further African cases of rhinosporidiosis.

Thirteen African cases of rhinosporidiosis are reported from Burundi, Rwanda, Tanzania, Chad and Zaire. They include the first reported cases from Burundi and from Rwanda and the first African case, outside nose and eye, localized on the urethral orifice in a Zairian male.

Adolescent↗
PubMed1992

Radiation-induced optic neuropathy.

Radiation-induced optic neuropathy is a well-known complication of cranial radiotherapy. We describe four cases. In two cases, the diagnosis was made on MRI. After administration of Gadolinium-DTPA, there was an enhanced captation at the level of the optic nerve. In addition we reviewed 47 cases reported in the literature. Visual prognosis is less than 1/10 in 78% of affected eyes. In case of associated brain necrosis, the mortality rate is 62%.

Adult↗
PubMed1991

Clinical and endocrinologic manifestations in perinatally human immunodeficiency virus type 1--Infected children aged 5 years or older.

Sixteen human immunodeficiency virus type 1 (HIV-1)-seropositive children aged 5 to 12 years (nine girls and seven boys), born to HIV-1-infected mothers, were diagnosed between 1984 and 1987 in Kigali, Rwanda. They were compared with a group of age- and sex-matched HIV-1-seronegative children consecutively selected from the outpatient department. Two subjects were asymptomatic. Chronic cough was the most frequent symptom (seven of 16 patients). The most common signs were short stature (12 of 16 patients), low weight for age (seven of 16 patients), chronic parotitis (eight of 16 patients), persistent generalized lymphadenopathy (seven of 16 patients), and pulmonary tuberculosis (four of 16 patients). Lymphoid interstitial pneumonitis was diagnosed on radiologic grounds in five of 16 patients. Evidence of perivasculitis in the fundus was noted in three of 16 patients. Two children died during the study period (mean duration of follow-up, 40 months; range, 27 to 62 months); none of the other children had life-threatening infection or loss of developmental milestones. Immunologic assessment in the 16 children revealed high levels of IgG, decreased CD4+/CD8+ ratio, and skin test anergy. Endocrinologic investigations revealed normal thyroid function and normal basal human growth hormone levels but low basal insulinlike growth factor I levels (0.21 +/- 0.07 vs 0.44 +/- 0.20 U/mL for controls). In Kigali, perinatally HIV-1-infected children surviving beyond 5 years of age often present with moderate signs and symptoms, principally pulmonary involvement, chronic parotitis, and persistent generalized lymphadenopathy. Short stature is the major clinical manifestation in these patients and may be due, in part, to low growth hormone secretion rather than to malnutrition.

Body Height↗
PubMed1990

Treatment of gonococcal conjunctivitis with a single intramuscular injection of cefotaxime.

Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum. The problem is aggravated by the emergence of penicillinase-producing strains of N. gonorrhoeae (PPNG). Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period. Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy. One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms. Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment). Twelve isolates of N. gonorrhoeae were found to be PPNG strains. At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage. Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains. The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.

Cefotaxime↗
PubMed1989

Treatment of adult gonococcal keratoconjunctivitis with oral norfloxacin.

We evaluated the efficacy of oral norfloxacin in 15 patients with culture-proven gonococcal eye disease caused by Neisseria gonorrhoeae. The first seven patients received 1,200 mg of oral norfloxacin for three consecutive days. The other eight patients were each treated with a single oral dose of 1,200 mg of norfloxacin. All control cultures were negative, and there was no progression of the corneal lesions after treatment was initiated. No adverse effects were observed. The results of this study suggested that a single dose of oral norfloxacin may be a valuable alternative to the currently recommended treatment regimens for gonococcal eye disease because it combines high efficacy and low toxicity with low cost and excellent patient compliance.

Administration, Oral↗
PubMed1988

Single-dose cefotaxime intramuscularly cures gonococcal ophthalmia neonatorum.

Nine neonates with culture proved gonococcal ophthalmia neonatorum were treated with a single intramuscular injection of 100 mg/kg of cefotaxime without topical antibiotic therapy. Five of the nine strains were penicillinase-producing Neisseria gonorrhoeae. All nine cases were clinically and microbiologically cured, and no side effects were observed.

Cefotaxime↗