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PubMed2006

[Foley balloon placement for maxillofacial fractures].

OBJECTIVES: The aim of the study was to evaluate the effectiveness of maxillary sinus Foley balloon placement in patients with maxillofacial fractures. PATIENTS AND METHODS: This study included 38 patients (10 females, 28 males; mean age 29.1+/-11.6; range 9 to 49 years) in whom Foley balloon placement and gauze packing were performed for blow-out, orbitozygomatic, or maxillary fractures. Sex and age distributions, etiology of trauma, localization of fractures, management, intraoperative and postoperative complications were evaluated. RESULTS: Eighteen patients had blow-out fractures, 15 patients had orbitozygomatic fractures, and five patients had Le Fort II-III fractures of the maxilla. Preoperatively, enophthalmos, diplopia, limited ocular motility, and facial asymmetry were found in 28.9%, 26.3%,18.4% and 65.8%, respectively. Sufficient maxillary sinus patency was obtained in 32 patients (84.2%). Enophthalmos, diplopia, limited ocular motility, and facial asymmetry were found in 13.2%, 7.9%, 5.3%, and 18.4% in the postoperative period, respectively. CONCLUSION: Maxillary Foley balloon placement should be preferred in the blow-out, orbitozygomatic, and maxillary fractures because it supports the orbital floor and provides sufficient maxillary sinus patency.

Adolescent↗
PubMed2006

[Infliximab in the treatment of Wegener's granulomatosis: case report].

PURPOSE: to evaluate the efficacy of monoclonal anti-tumor necrosis factor alpha antibody infliximab in treatment of refractory Wegene's granulomatosis. Clinical manifestations of Wegener's granulomatosis at the time of infliximab initiation were: proptosis of both eyes due to progressive retrobulbar granulomas, visual impairment, optic disc edema, progressive diplopia, sinus and renal involvement. The disease was refractory to a treatment with various immunosuppressants, including intravenous cyclophosphamide or high doses of mycophenolate mofetil in combination with corticosteroids. METHODS: Observational case report. RESULTS: the patient received six infusions of infliximab (3 mg/kg) in addition to low doses of oral cyclophosphamide and corticosteroids. The interval between the first two infusions was 1 week. The interval between the second and third infusions was 4 weeks, thereafter 8, 12 and 34 weeks. Following the third infusion of infliximab the remission of Wegener's granulomatosis was seen. After the regression of retrobulbar granulomas visual acuity increased, ocular motility improved, diplopia and optic disc edema decreased. Remission has been maintained for 17 months. Infliximab was well tolerated during the short-term follow-up. CONCLUSION: Infliximab successfully induced remission in case of sight-threatening Wegener's granulomatosis in our patient. It seems that infliximab provides more effective therapeutic option in treatment of Wegener's granulomatosis refractory to standard immunosuppression and offers better perspectives for patients with previously poor prognosis. Furthermore, it enables reducing the exposure to immunosuppressive drugs.

Antibodies, Monoclonal↗
PubMed2005

Topographical evaluation of the decentration of orthokeratology lenses.

PURPOSE: To evaluate the amount of lens decentration and various factors affecting decentration after orthokeratology lens wear and to observe the effect of decentration on the visual functions. METHODS: Two kinds of orthokeratology lenses were fitted to 270 eyes of 135 patients [initial mean refractive error: (-3.98+/-1.51)D]. Humphery Instruments ATLAS 990 was used for the computer-assisted analysis of corneal topographical maps. The examination of corneal topography was performed on patients before and after 6 months of wearing orthokeratology lenses. The amount of decentration of orthokeratology lenses was measured by finding the distance between center of optic zone and the pupil center. The factors influencing the amount of decentration were analyzed, including the initial refraction error, astigmatism, keratometry values, corneal eccentricity, and the diameter of lens. Visual symptoms including monocular diplopia, glare around lights were recorded to evaluate the effects of decentration on visual functions. RESULTS: The mean amount of decentration was (0.49+/-0.34) mm after one night's wear. The mean amount of decentration after 1 month, 3 months and 6 months was (0.57+/-0.41) mm, (0.55+/-0.48) mm and (0.59+/-0.39) mm, respectively. After one month, the amount of decentration was less than 0.50 mm in 51.1% eyes, 0.50-1.0 mm in 35.6% eyes and more than 1.00 mm in 13.3% eyes. The direction of decentration of more than 0.50 mm was mainly in the temporal quadrant (48.5%). Patients with greater initial astigmatism and smaller lenses showed greater decentration (P<0.05). There was no statistically significant difference in decentration between the two groups with different corneal eccentricities and keratometry values (P>0.05). The amount of decentration was greater in patients who complained of monocular diplopia and glare. CONCLUSIONS: The amount of decentration of orthokeratology depends on the initial refractive error, astigmatism and the design of orthokeratology lenses. Improvement in fitting technology and lens design can lead to reduced incidence of decentration and visual symptoms.

Adolescent↗
PubMed1991

Cerebellar lipoma: report of a case.

A patient with normal motor and intellectual development suffered headache; especially over the occipital area; and, blurring of vision for five months. Computerized tomography and magnetic resonance imaging of the brain showed a lipoma in the quadrigeminal/superior cerebellar cistern compressing of the aqueduct, inferior colliculus, and vermis. Using the modified sitting position, the tumor was almost totally removed via the infratentorial supracerebellar approach. Postoperative headache and blurring of vision had been improved, but ataxic gait and mild diplopia due to right superior oblique palsy was noted. Ataxic gait was disappeared in half a month and diplopia in two months respectively.

Adolescent↗
PubMed1990

[Aberrometry in the diagnosis of eye diseases].

Four methods (by means of Smirnova-Korniushina's aberrometer; with the help of aberroscope--Cherning's lattice; by presenting a figure of a cross; and by automatic refractometry through different portions of the pupil) were used for studying aberration of the optic system of the eye in 490 persons. Among them, 37 were healthy persons, 27--patients with ametropia of moderate degree, 24--with high myopia, 9--with astigmatism above 3.0 D, 16--with monocular diplopia, 327--with keratoconus, 7--with scars of the cornea, 21--with initial cataract, 47--after keratotomy. In norm and in ametropia to 6.0 D, a histogram of refraction distribution by the pupil has a small disperse and a pronounced peak, the Cherning's lattice is straight. In high myopia, the disperse of refraction increases, the peak is slightly pronounced, the lattice is curved along the margins. In astigmatism, the disperse of refraction is great, but there can be peaks. The whole lattice is curved. In monocular diplopia, two more peaks can be seen on the histogram. The lattice is greatly curved. In keratoconus, aberrometry without correction is possible only at the initial stage and shows a rather mixed picture. The histogram of refraction represents a low irregular row. In aberroscopy, the bands are greatly curved, frequently overstep the bounds of the frame that itself looses a form of a circle, becomes oval or polygonal. Contact correction improves the aberration picture considerably. In scars of the cornea, the lattice is distorted and infrequently repeats their forms. In initial cataract, the course of the bands becomes interrupted and rounded spots appear between them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[A case of transient bilateral primary oculomotor nerve paresis associated with head injury].

A 13-year-old boy, with no past medical history, was admitted after a car accident on October 29, 1989. On admission, he was alert. Physical examination revealed a bruise on the left frontal region, a fracture of right clavicula and right hemopneumothorax. He was treated with respirator due to dyspnea. On November 1, 1989, he was removed from respirator and expressed diplopia. Neurological examination showed bilateral ptosis, mild anisocoria, normal light reflex and horizontal gaze nystagmus in lateral gaze. Both eyes were deviated outward slightly in the primary position and showed inability to converge. The external ocular movements of both eyes were mildly limited in elevation and adduction. Ataxia was observed in bilateral upper extremities. Deep reflexes were normal and no pathological reflexes were observed. Brain CT scans showed no abnormality. On November 6, 1989, his ptosis and diplopia improved. On November 8, he was completely recovered. A magnetic resonance imaging on November 10 revealed no abnormality. We suggested that transient dysfunction of midbrain associated with head injury might cause transient bilateral primary oculomotor nerve paresis, nystagmus and ataxia.

Adolescent↗
PubMedDate not supplied

Adenoid cystic carcinoma of the nasopharynx. Case reports and literature review.

Adenoid cystic carcinoma of the nasopharynx is a rare disease with 34 previously reported cases in the literature. We report three additional cases with clinical presentation, treatment, and outcome. The presenting symptoms were facial pain in one case, middle ear effusion and epistaxis in another, and diplopia in the third. Radiotherapy was administered with relief of symptoms in all three cases. However, two patients with long-term follow-up developed local recurrence as well as distant metastases. The literature review showed that patients with this disease present with symptoms and signs such as insidious onset of facial pain, epistaxis, diplopia, and hearing loss. The final outcome, despite vigorous treatment, was dismal.

Adult↗
PubMed1987

[A case of basilar artery fenestration with recurrent attacks of vertebrobasilar insufficiency].

Fenestration of basilar artery is an uncommon vascular anomaly that is usually an incidental product on autopsy or angiography. None of the cases in the literature had clinical symptoms associated with this anomaly except for subarachnoid hemorrhage when accompanied with saccular aneurysm. We report a rare case of the basilar artery fenestration associated with clinical symptoms without any aneurysm. A 71-years-old male, who had been treated for labile hypertension and had had recurrent attacks of vertigo, nausea, sometimes diplopia or unsteady gait, for 5 years, was referred to our hospital on Sept. 13, 1985. One day prior to admission, he suddenly felt diplopia and vertigo and unsteady gait. His family noticed he was dysarthric. On admission, he was alert and normotensive. He complained of dysesthesia on the right half of the perioral region and his right fingers. A neurological examination showed a mild weakness and hyperactive deep tendon reflexes on his right leg. His motor coordination was almost normal, but he was unsteady when he stood on one foot with his eyes closed. Laboratory examinations were normal except for an elevated serum uric acid level. A chest x-ray film showed a sclerotic change of aorta and mild cardiomegaly. Left ventricular hypertrophy was observed on his ECG. His CT scans showed multiple lacunae and mild brain atrophy. On cerebral angiography, his basilar artery (BA) had a fenestration almost in its total length that divided the BA, like a duplication, into two components with a smaller diameter than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Exacerbation of a case of myasthenia gravis during therapeutic electric stimulation.

In patients with myasthenia gravis, vigorous exercise and electric stimulation produce weakness that is usually reversed by rest. We describe a case of persistent weakness in a 31-year-old woman with myasthenia gravis following therapeutic electric stimulation. She was injured in an automobile accident, with cervical and lumbar muscle strain diagnosed by a local emergency room physician. She consulted a chiropractor two days later because her symptoms had not abated. The chiropractic treatment of short-wave diathermy, high-voltage electric stimulation and spinal manipulation continued thrice weekly for six weeks. She then presented to her neurologist, complaining of persistent fatigue, weakness, increased diplopia, cervical and occipital pain, and disrupted sleep. Neck weakness had developed since her last visit. She was admitted to the hospital for evaluation. Neurologic exam showed no other abnormality of strength, sensation, or reflexes. The exacerbation of myasthenia responded to prednisone and increased pyridostigmine. After two months she required only her preinjury dose of pyridostigmine (60 mg q.d. p.r.n.) to prevent diplopia or fatigue, and her strength was normal. Repeated electrically induced muscle contraction is suspected of causing this exacerbation of myasthenia gravis.

Adult↗
PubMed1987

Treatment of carotid-cavernous fistulas with detachable balloon catheter occlusion.

Intravascular occlusion of traumatic carotid cavernous fistulas, originally performed under direct visualization with fascia and/or muscle, has evolved into the use of catheters with pressure-sensitive detachable balloons that can be deflated and repositioned prior to final inflation and separation from the catheter. The balloon is filled with contrast material and can be identified with follow-up x-rays. Proptosis is often relieved immediately after this treatment. Detailed pre- and posttreatment ophthalmic evaluations of three consecutive patients with carotid-cavernous fistulas successfully treated with detachable balloon occlusion with a minimum 1-year follow-up are presented. Indications and timing of treatment are discussed. Following blunt head trauma, these patients presented with proptosis, decreased vision, orbital bruit, conjunctival chemosis, diplopia, orbital pain, ocular pulsations and diplopia; they often complained of "a ringing" in the ear on the involved side.

Adult↗
PubMedDate not supplied

[Acetylcholine receptor antibody in D-penicillamine therapy].

Since 1978 a 63-year-old woman with rheumatoid arthritis received D-penicillamine (D-PA) in a daily dose of 250-500 mg (mean 300 mg/d). In 1982 the patient complained of diplopia for several days, the ophthalmological and neurological examinations three days later were normal. In July 1983 she developed a myasthenic syndrome, D-PA was stopped and treatment with mestinon was started. At this time anti-acetylcholine-receptor-antibodies (anti-AChR) were detectable in the patient's serum. The examination of sera stored at -80 degrees C since 1978 revealed anti-AChR existing since 1981 -1 1/2 years, however, before the temporary diplopia. Therefore in 13 other patients receiving D-PA for more than one year anti-AChR were examined. In two of these patients anti-AChR were found. The electroneurological tests were (still?) normal. The question arises whether anti-AChR should be measured routinely in patients with D-PA.

Aged↗
PubMed1986

Superior oblique myokymia: when treatment is necessary.

A 56-year-old woman presented with a 10-year history of torsional diplopia and right monocular oscillopsia. These symptoms, which had been intermittent at first, continued practically uninterrupted during the last 2 years. She was diagnosed as having superior oblique myokymia of the right eye. Adequate trials of oral carbamazepine, baclofen and phenytoin were unsuccessful in suppressing her symptoms. One year after her initial presentation, she underwent a right superior oblique tenectomy and a right inferior oblique recession. She eventually required a second operation on her other eye to cure her of an annoying diplopia on down-gaze.

Carbamazepine↗
PubMed1985

[Cerebral lymphoma associated with lesions of multiple sclerosis].

A 24 year-old man experienced a left retrobulbar neuritis which improved completely after 2 months of non-steroid antiinflammatory therapy. One month after the end of the treatment he developed a Korsakoff-like amnestic syndrome. Three months later he complained of horizontal diplopia. A CT Scan showed a diffuse enhancement of the periventricular areas, corpus callosum and fornix. Diplopia and CT scan abnormalities disappeared after the administration of tetracosactide. Subsequently a progressive worsening of the neurological condition developed, including a 1 1/2 syndrome of Fisher. In C.S.F. proteins ranged from 35 to 66 mg/dl, gammaglobulins from 4 to 5 per cent, cells from 2.2 to 6.8 per mm3 without abnormal cells. Rounded areas of enhancement were observed on CT scan in pons and right occipital lobe. Usual biological tests, abdominal echography and lymphography were normal. Death occurred 15 months after the onset of symptoms. Neuropathological examination showed: 1) a cerebral lymphoma of probable B origin with distinct masses in right occipital lobe and pontine tegmentum and a more diffuse perivascular infiltration on the left side in the amygdaloid nucleus, fourth temporal gyrus, sublenticular area, hypothalamus and in the right internal capsule; 2) multiple small clear-cut foci of demyelination with myelin-axonal dissociation bilaterally in the optic pathways, periventricular regions, corona radiata, cerebral and cerebellar white matter, sublenticular areas, temporal lobes, splenium of the corpus callosum and fornices with secondary atrophy of the mamillary bodies. Both recent and old plaques were observed. Inflammatory perivascular cuffing, when present, consisted of small nontumoral lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Primary intracranial endodermal sinus tumor with a skull base extension--a case report].

The authors described a case of primary intracranial endodermal sinus tumor (EST), and presented a review of 24 reported cases. From the middle of December 1981, this 15-year-old boy experienced progressive diplopia. At the other hospital, partial removal of the intrasellar tumor was performed by a left frontotemporal craniotomy approximately 2 months after the onset of symptoms. The histological diagnosis was suspected to be a pituitary adenoma, and thereafter, 60Co irradiation was carried out for about a month. On June 5th. 1982, the patient was admitted to the Kochi Medical School Hospital, because of increasing headache with diplopia, hoarseness, dysphagia and limitation of tongue movement. On admission, he had a small stature for his age with moderate diabetes insipidus. Neurological examination showed left abducens, glossopharyngeal and vagal nerve palsies in addition to bitemporal hemianopsia. CT scans revealed a heterogenously enhanced high density mass lesion behind the dorsum sellae with an extension from the upper clivus to the sphenoid sinus. Cerebral angiograms showed posterior displacement of the basilar artery. In the endocrinological examination, panhypopituitarism was recognized with a high level of serum alfa-fetoprotein (AFP). While, serum carcinoembryonic antigen (CEA) and human chorionic gonadotropin (HCG) were in normal range. On July 1st. 1982, a left suboccipital craniectomy was performed. The tumor existed mainly in the extradural space along the clivus, and only a small intradural portion of the tumor was excited.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Association of polymyositis, myasthenia, and thymoma. A case and review of the literature].

We report the case of a 51 years old woman with myositis, myasthenia gravis and thymoma. First apparent sign is myositis in 1976 but chest X ray show a mediastinal opacity and the patient reports an intermittent diplopia since 1973. The evolution of myositis occurs in two bouts in 1976 and 1981, Myasthenia gravis restricted to diplopia from 1973 to 1979 grow worse first alone then in association with increase of myositis signs in 1981. The mediastinal opacity seen on chest X ray in 1976 don't change and is revealed to be a thymoma at operation in 1981. After thymoma ablation myasthenic and myositis signs decrease. This pathologic association is found 24 times in literature and involves "giant cells" in muscle biopsy in about 50 p. 100 of cases and a myocarditis also with "giant cells". Those "giant cells" unusual in common myositis appears to have a prognostic value.

Adult↗
PubMed1983

Strabismus after retinal detachment surgery.

In conclusion, we can summarize our experience as follows: Exoplants oriented radially and wherever placed can be productive of important degrees of astigmatism and diplopia. In our experience, they are often associated with torsional diplopia; Surgery under the rectus muscles may be responsible for adhesions and limitations of excursion of the globe; Anteriorly placed exoplants, especially those placed under the rectus muscles and particularly temporally or below, are apt to erode the overlying muscle sheath and tendon; a muscle so eroded may sometimes be found reattached to the globe just posterior to the exoplant; Repeated surgical intervention, perhaps in association with careless or inaccurate closure of the periocular tissues, Tenon's fascia and conjunctiva, may be important factors in the production of strabismus; Factors which have not been responsible for strabismus as far as we can tell are encircling elements without exoplants and intraoperative detachment and reattachment of the extraocular muscles. I know of no instance where these alone have been productive of an important postoperative strabismus.

Adult↗
PubMed1984

[Trochlear neurinoma: case report].

A case of solitary neurinoma of the trochlear nerve was reported. The patient was a 37-year-old female, who had a sudden attack of right-sided temporal headache with nausea and vomiting on August 1, 1982. Headache was subsided in a few days but she had complained of diplopia since the episode. Ophthalmological examination revealed right superior oblique muscle palsy. She was neurologically free otherwise. CT scan, taken about three weeks after the onset, showed a solitary enhancing mass in the region of tentorial incisura on the right side. She was admitted to our clinic on August 24, 1982. Extensive work-up including polytomography, cerebral angiography, lumbar puncture, and so forth, revealed no abnormality. There were no cutaneous manifestations of von Recklinghausen's disease. Craniotomy was performed on October 28, 1982 and the tumor was totally removed by way of right subtemporal-transtentorial route. The tumor, size of which was 1.0 X 0.9 X 0.7 cm, was located just underneath the tentorial edge, and was adherent to it. The trochlear nerve was found incorporated in the tumor. Histological diagnosis was neurinoma of Antoni A type. Postoperatively, she was well and fully active, except for diplopia due to the sacrificed trochlear nerve.

Adult↗
PubMed1981

[The Tolosa-Hunt syndrome: report of a case with recurrent (9 times) painful ophthalmoplegia (author's transl)].

A 48-year-old woman was referred to the First Dept. of Int. Med., Nagasaki Univ. Sch. Med., in August, 1979, with a six-month history of recurrent episodes of right-sided painful ophthalmoplegia and diplopia. An epidode affected the right eye, lasted one to two weeks, and relapsed every month. On examination she had a complete ptosis on the right side and pain on the right eye. All extraocular muscle supplied by the 3rd nerve were paralysed. The pupils were equal in size both sides, reacting to light completely. Visual acuity was normal except myopia. All the other cranial nerves and the remainder of central nervous system was normal. Results of thyroid function tests and of lumbar puncture were normal. The glucose tolerance test showed a mild diabetic pattern. Blood and CSF cultures for bacteria, fungi, and acid-fast bacillus were negative. The skull, brain CT scan, and carotid angiogram were within normal limits. A tentative diagnosis of Tolosa-Hunt syndrome was made after an unproductive search for a cause for this woman's painful ophthalmoplegia and unsuccessful treatment of ophthalmoplegia with antibiotics or diet therapy for mild hyperglycemia. The patient was given prednisolone 30 mg daily orally when she had the 9th attack of painful ophthalmoplegia Pain, ptosis, and diplopia disappeared in 5 days and she did not show any recurrence of symptoms over the next 7 months.

Female↗