Biomedical subjects
Publications and source records attributed to T Lifshitz.
We describe the treatment of focal trachomatous trichiasis with argon green laser. We treated 70 eyelashes in 17 patients with 80% success and found this treatment modality convenient both for the patient and the practitioner.
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We report on the use of mitomycin drops after the surgical removal of pterygiums in 70 patients. Our results justify the use of mitomycin as a standard postoperative procedure in preference to other treatments.
Acute sinusitis remains the major cause of orbital cellulitis in children, despite the extensive use of antibiotics. Staging of orbital cellulitis on the basis of clinical signs is difficult but is easily achieved by computerized tomography. The CT findings in a series of 9 children with orbital cellulitis in different stages are reported. The information obtained by CT contributes to the selection of an adequate surgical approach, if a therapeutic trial with antibiotics fails.
Transient accommodative paresis and pupillary disturbances are some of the less known and uncommon complications of peripheral retinal laser treatment extending over at least one third of the retinal periphery. They are the result of damage by the laser applications to parasympathetic nerve fibers that lie beneath the coagulated area and innervate the ciliary body and iris sphincter. Six myopic patients who suffered from these complications following peripheral laser treatment for retinal tears are presented. A mechanism of direct damage to ciliary muscle fibers during photocoagulation is proposed.
A randomized, controlled study was conducted in 51 patients to investigate the effect of aspirin administration on traumatic hyphema. Aspirin tablets 500 mg tid were administered for seven days. Rebleeding was found in three of 23 eyes of patients who had received aspirin and in two of 28 eyes of control patients. This difference was not statistically significant (P = .405), proving that aspirin is not an important factor in rebleeding in patients with hyphema.
Neoplastic proliferation of the meibomian glands is most often characterized by a tarsal tumor of the eyelid conjunctiva, having the clinical appearance of a chalazion. As such, the tumor is frequently not recognized as a neoplasm and is treated conservatively as an inflammatory lesion. A protracted clinical course combined with repeated surgical excisions typify this slow-growing tumor of sebaceous gland cells. In addition to the usual features of polygonal cell shape, abundant cytoplasm, and numerous fat vacuoles, we describe the presence of a peculiar nuclear inclusion seen only in the parenchymal cells of this tumor, and having the appearance of concentric layers of electron-dense material surrounding an opaque electron lucent core.
A case of early childhood Coats's disease in a ten-month-old boy is presented. The lactic dehydrogenase aqueous:serum ratio was very high (6:1). A ratio higher than 3:1 in Coats's disease or in any other eye infection has never been reported except in cases of retinoblastoma. Since retinoblastoma does not always show calcification in x-rays, it may be concluded that in certain cases it would be impossible to discriminate between Coats's disease and retinoblastoma (except in pathologic analysis) with any available diagnostic tools.
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Findings by light and electron microscopy and histochemistry in three cases of myxoma of a nerve sheath are presented. The histochemical findings are compared with those obtained in identical studies done on two benign schwannomas, two neurofibromas, and a soft tissue myxoma. In addition, myxomatous changes in a peripheral nerve obtained at vagotomy were similarly studied. Morphologically, myxoma of the nerve sheath is a distinct neoplastic entity showing moderate cellular atypia and a characteristic tissue distribution. Histochemically, the neoplasm shows a mucopolysaccharide profile that categorizes it as a neoplasm of mesenchymal origin rich in highly sulfated acid mucins. Of particular note is its close histochemical similarity to a neurofibroma.
Herpetic infection is a common complication among immune suppressed patients following heart, kidney and bone marrow transplantations, in leukemia patients, in AIDS patients, and during treatment with cytotoxic drugs. In the cases described in the literature, oral acyclovir was recommended as a treatment for the acute infection, as well as for prophylaxis. Intravenous acyclovir is not a routine treatment for herpetic keratitis, but is recommended for cases of insufficient clinical response to oral treatment, and defective absorption of acyclovir by the gastrointestinal tract. We present a patient who underwent 4 liver transplantations, was treated regularly with immunosuppressive drugs, and who developed extensive herpetic keratitis. The keratitis was resistant to both topical ointment and oral acyclovir treatment. Recovery was only achieved following the intravenous administration of acyclovir. We recommend intravenous acyclovir treatment at a very early stage for immune suppressed patients with extensive herpes simplex keratitis.
PURPOSE: To describe a rare case of Rhodotorula rubra keratitis in a corneal graft, and to discuss the management of this unusual pathogen. METHODS: A 78-year-old debilitated man was treated for corneal abscess and descemetocele in his right eye. Urgent penetrating keratoplasty (PKP) with old donor material was performed. The patient underwent a new PKP when appropriate donor cornea was available. The graft was clear after the operation. Corneal cultures were negative. RESULTS: One month after the second PKP procedure, deep stromal infiltrate with hypopyon appeared. Cultures grew R. rubra. A third PKP operation was performed. Systemic and topical amphotericin B treatment was started. Six months after the last operation the graft remains clear. CONCLUSIONS: Rhodotorula keratitis is an extremely rare infection that should be considered in debilitated patients with persistent and progressive corneal infection despite adequate antibiotic therapy.
PURPOSE: To report three cases of varix of the vortex vein ampulla. METHODS: Observational small case series. During 2002, three patients were examined for suspected choroidal melanoma. In all cases, the lesions were located at the equator or the periphery. RESULTS: The lesions became more prominent when the eyes were positioned in the direction of the lesion, and disappeared when firm pressure by ultrasound probe was applied on the globe, while the eye was in primary position, or fundus was examined with a three-mirror Goldmann contact lens. These dynamic characteristics were also demonstrated by color Doppler imaging. CONCLUSIONS: Varix of the vortex vein ampulla is an extremely rare condition. This diagnosis should be considered when an elevated choroidal lesion disappears when the fundus is examined with contact lens.
PURPOSE: To report a rare case of Brucella meningitis with papilledema in a child and to discuss the findings of neurobrucellosis in children. METHODS: A 6-year-old girl was admitted with headache, fever, and vomiting for 1 week. Her family reported intake of raw unpasteurized goat's milk in the past. Meningeal signs were strongly positive. Bilateral moderate optic disc edema with flame-shaped hemorrhages was observed. RESULTS: The diagnosis of Brucella infection was established by positive blood culture for Brucella species, serum agglutination titer of antibodies to Brucella >1:160, and positive CSF culture. After treatment consisting of trimethoprim-sulfamethoxazole, rifampin, and doxycycline, the patient's condition gradually improved. One month later, the papilledema disappeared. One year after presentation, the patient remains free of symptoms. CONCLUSIONS: Brucella meningitis must be ruled out in symptomatic patients reporting ingestion of raw unpasteurized goat's milk. Papilledema is a frequent clinical feature, but irreversible visual impairment is extremely rare.
PURPOSE: To report a case of Burkitt's lymphoma (BL) in an HIV-positive patient presenting as complete third nerve palsy. METHODS: Interventional case report. A 34-year-old man presented with headache, left eye pain, diplopia, and complete ptosis of several hours' duration. Left eye examination disclosed complete third nerve palsy with pupillary involvement. Significant hepatomegalia was noted at physical examination and computed tomography (CT) scan of the abdomen showed multiple solid lesions. RESULTS: Liver biopsy was consistent with Burkitt's lymphoma. Bone marrow biopsy was normal. Brain imaging was normal. Work-up also revealed positivity for human immunodeficiency virus. Chemotherapy treatment was started. Two months later, ocular motility examination was normal. CONCLUSIONS: Although BL affects the central nervous system very rarely, BL should be considered in any immunosuppressed patient presenting with diplopia or ophthalmoparesis.
A 12-year-old hemophilic boy suffered from secondary glaucoma in his right eye due to total hyphema following trauma. An emergency operation was performed to evacuate the hyphema under a tight anti-hemophilic treatment. A careful postoperative treatment with factor VIII concentrate, antiglaucomatous drugs and aminocaproic acid was administered. Intraocular pressure returned to normal and remained so during the four months follow-up period. Visual acuity returned to 6/9 and there was no rebleeding into the anterior chamber. To the best of our knowledge, this is the first reported case of traumatic hyphema and of an operation to wash this hyphema in a hemophiliac. The dilemma of management of such a case is discussed.
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