Exoftalmo unilateral por metástase orbitária de carcinoma de próstata Unilateral exophthalmos secondary to orbital metastatic carcinoma of the prostate: a case report

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José Carlos Corrêa Barbosa

1972-06-01

Full Text Available É relatado um caso de exoftalmo ou proptose unilateral direita, causado por metástase orbitária de carcinoma da próstata em paciente negro, na 6.ª década de vida, com evolução de 9 meses. O exame neuro-ocular revelou acentuada diminuição da agudeza visual, perturbação para visão de cores, perda da convergência, diminuição dos reflexos à luz e acomodação e restrição dos movimentos oculares. O paciente apresentava discreta disbasia esquerda por metástase no fêmur. Exames laboratoriais, radiológicos e a biópsia confirmaram a etiologia carcinomatosa da manifestação ocular.A case of right unilateral exophthalmos secondary to metastatic carcinoma of the prostate, in a 68 years old negro patient in which the ocular manifestation lasted 9 months is reported The extrinsic movements of the eye were limited. Pupils reacted slightly to light and accommodation. There was no ocular convergence. The vision of the right eye was blurred and there was mild color vision. The prostate was found to be petrous by touch specially in the right portion. The laboratory findings pointed to a prostatic carcinoma. Bone X-rays were strongly suggestive of metastatic tumour. The histological examination of the orbital tumour showed prostatic tumour cells.

Computed tomography and histopathological findings in pseudotumors of the orbit

International Nuclear Information System (INIS)

Ishibashi, Yasuhiko; Watanabe, Takao; Yoshimoto, Takashi; Suzuki, Jiro

1981-01-01

The CT scan findings of 4 cases of orbital tumor, in which transcranial orbital decompression was performed because of no improvement by medication, were reported. The first case was a 71-year-old female with exophthalmos, decreased vision and ocular movement disturbance of the left eye. CT scan demonstrated an abnormal high density area in the left retrobulbar region with a thickened medial rectal muscle. Specimens were taken from a thickened medial rectal muscle. The histological examination revealed angitis. The second case was a 38-year-old female with exophthalmos, blepharoptosis, chemosis, decreased vision and ocular movement disturbance of the left eye. CT scan showed exophthalmos of the left eye, but no focal abnormality. Specimens were taken from fatty tissue-in the left retrobulbar region. The histological examination revealed no abnormal inflammatory changes. The third case was a 37-year-old female with orbital pain, exophthalmos and ocular movement disturbance of the right eye. CT scan demonstrated a growing abnormal high density area in the right retrobulbar region. Specimens were taken from the abnormal tissue in the right retrobulbar region. The histological examination revealed inflammatory changes of muscle and nerve. The forth case was a 61-year-old male with diplopia and exophthalmos. CT scan demonstrated an abnormal high density area in the left retrobulbar region. Specimens were taken from an abnormal tissue in the left retrobulbar region lying against the lateral wall of the orbit. The histological examination revealed severe infiltrations with lymphocytes and plasma cells. Transcranial orbital decompression improved the exophthalmos and ocular movement in all cases. (author)

Computed tomography and histopathological findings in pseudotumors of the orbit

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Ishibashi, Y.; Watanabe, T.; Yoshimoto, T.; Suzuki, J. (Tohoku Univ., Sendai (Japan). School of Medicine)

1981-09-01

The CT scan findings of 4 cases of orbital tumor, in which transcranial orbital decompression was performed because of no improvement by medication, were reported. The first case was a 71-year-old female with exophthalmos, decreased vision and ocular movement disturbance of the left eye. CT scan demonstrated an abnormal high density area in the left retrobulbar region with a thickened medial rectal muscle. Specimens were taken from a thickened medial rectal muscle. The histological examination revealed angitis. The second case was a 38-year-old female with exophthalmos, blepharoptosis, chemosis, decreased vision and ocular movement disturbance of the left eye. CT scan showed exophthalmos of the left eye, but no focal abnormality. Specimens were taken from fatty tissue in the left retrobulbar region. The histological examination revealed no abnormal inflammatory changes. The third case was a 37-year-old female with orbital pain, exophthalmos and ocular movement disturbance of the right eye. CT scan demonstrated a growing abnormal high density area in the right retrobulbar region. Specimens were taken from the abnormal tissue in the right retrobulbar region. The histological examination revealed inflammatory changes of muscle and nerve. The forth case was a 61-year-old male with diplopia and exophthalmos. CT scan demonstrated an abnormal high density area in the left retrobulbar region. Specimens were taken from an abnormal tissue in the left retrobulbar region lying against the lateral wall of the orbit. The histological examination revealed severe infiltrations with lymphocytes and plasma cells. Transcranial orbital decompression improved the exophthalmos and ocular movement in all cases.

Expression level and clinical significance of IL-2, IL-6 and TGF-β in elderly patients with goiter and hyperthyroidism.

Science.gov (United States)

Lv, L-F; Jia, H-Y; Zhang, H-F; Hu, Y-X

2017-10-01

To investigate the level of expression and the clinical significance of IL-2 (interleukin-2), IL-6 (interleukin-6) and TGF-β (transforming growth factor-β) in elderly patients with goiter and hyperthyroidism. Gender, age, course of disease, BMI (Body Mass Index), serum FT3 (Free triiodothyronine-3), FT4 (Free triiodothyronine-4), TT3 (Total triiodothyronine-3), TT4 (Total triiodothyronine-4), TSH (Thyroid Stimulating Hormone) and clinical manifestations on admission and other general clinical data and laboratory examination results were collected and statistically analyzed as case group in 128 elderly patients with goiter and hyperthyroidism. Additional 128 over 60-year-old patients with hyperthyroidism were selected as control group. The thyroid tissue of these patients and the control group were examined by fine needle aspiration biopsy. The expressions of IL-2, IL-6, TGF-β of the thyroid tissue in all patients were detected by immunohistochemistry, qRT-PCR (Real-time Quantitative Polymerase Chain Reaction) and Western blot method respectively, and the statistical analysis was carried out. p hyperthyroidism and thyroid enlargement (p hyperthyroidism, and symptoms of exophthalmos, the level of expression of IL-6 was significantly higher than that of patients without exophthalmos (p hyperthyroidism and symptoms of exophthalmos, and the patients with goiter, hyperthyroidism without symptoms of exophthalmos, IL-2 and TGF-β expression level were not different (p > 0.05). The expression levels of IL-2, IL-6, and TGF-β were significantly increased in the patients with senile goiter and hyperthyroidism, but in the senile patients with goiter, hyperthyroidism and exophthalmos symptoms, IL-6 levels were significantly higher than those without exophthalmos. The use of IL-2, IL-6, and TGF-β is of great significance in the diagnosis of goiter with hyperthyroidism, especially for elderly patients with atypical clinical symptoms of hyperthyroidism.

A traumatic dural arteriovenous fistula between the inferolateral trunk of the internal carotid artery and the ophthalmic vein: A case of transvenous coil embolization via the facial vein

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Kim, Jun Young; Hong, Chang Ki; Suh, Sang Hyun [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Ik [Dept. of of Radiology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

2017-05-15

A 31-year-old man was admitted with exophthalmos. He suffered from progressive exophthalmos, bruit and conjunctival chemosis 7 days after head trauma caused by falling down. Cerebral angiography showed a dural arteriovenous fistula (DAVF) draining into the ophthalmic vein caused by tear in the inferolateral trunk, which is a rare presentation of traumatic DAVF. Selective transvenous coil embolization was performed via the facial vein without neurologic complications.

Radiation therapy of Graves' ophthalmopathy. 2; Therapy started time

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Kawamura, Toshinori; Koga, Sukehiko (Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine)

1994-04-01

The difference in the improvement of exophthalmos according to the period of starting radiation therapy was investigated for 26 patients of thyroid ophthalmopathy, also taking thyroidism during radiation into consideration. A 4 MV X-ray was used to a total dose of 20 Gy per 2 weeks. The treatment value tended to be better for the patients in whom the period from the appearance of exophthalmos in an euthyroid condition to the start of radiation was less than 12 months; those of a longer period showed poorer improvement. Radiation treatment of a hyperthyroid condition also showed poor results and it was thought it was not an adequately long enough period for the radiation to take effect. As a result, it was considered that the radiation therapy shall be advantageous if started within 12 months after the appearance of exophthalmos in an euthyroid condition. (author).

Orbital lymphoma associated with Graves’ disease: A case report

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Hajduković Zoran

2014-01-01

Full Text Available Introduction. The presence of bilateral exophthalmos and palpebral, periorbital edema associated with hyperthyroidism is most often considered as an initial sign of Graves’ ophthalmopathy. However, in up to 20% of cases, Graves’ ophthalmopathy might precede the occurrence of hyperthyroidism, which is very important to be considered in the differential diagnosis, especially if it is stated as unilateral. Among other less common causes of non-thyroid-related orbitopathy, orbital lymphoma represents rare conditions. We presented of a patient with Graves’ disease, initially manifested as bilateral orbitopathy and progressive unilateral exophthalmos caused by the marginal zone B-cell non-Hodgkin lymphoma of the orbit. Case report. A 64-yearold man with the 3-year history of bilateral Graves’ orbitopathy and hyperthyroidism underwent the left orbital decompression surgery due to the predominantly left, unilateral worsening of exophthalmos resistant to the previously applied glucocorticoid therapy. A year after the surgical treatment, a substantial exophthalmos of the left eye was again observed, signifying that other non-thyroid pathology could be involved. Orbital ultrasound was suggestive of primary orbital lymphoma, what was confirmed by orbital CT scan and the biopsy of the tumor tissue. Detailed examinations indicated that the marginal zone B-cell non-Hodgkin lymphoma extended to IV - B-b CS, IPI 3 (bone marrow infiltration: m+ orbit+. Upon the completion of the polychemiotherapy and the radiation treatment, a complete remission of the disease was achieved. Conclusion. Even when elements clearly indicate the presence of thyroid-related ophthalmopathy, disease deteriorating should raise a suspicion and always lead to imaging procedures to exclude malignancy.

Clinical Study on the Eye Changes in the Goiter Patients

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Ku, In Soo; Lee, Jung Sang; Lee, Kyung Ja; Choi, Kuen Chul; Ahn, Soo Byuk; Lee, Chang Kyu; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1969-03-15

742 cases of thyroid diseases treated at Radio-isotope Clinic, Seoul National University Hospital since October 1965 through July 1968 were analyzed. The patients were classified according to eye findings, as to Infiltrative, Non-infiltrative and No ophthalmopathy. Correlations between ophthalmo-logical findings and symptoms, BMR values and {sup 131}I uptake rate as well as response to medical treatment were carefully reviewed. Results obtained were as follows: 1) Among goitrous patients 44.5% with infiltrative ophthalmopathy, 24.1% with non-infiltrative ophthalmopathy totaling 68.6% of patients with one or more eye findings were found. Exophthalmos (44%) and visual disturbances (44%) comprised the highest incidence among eye signs. Most frequent eye symptoms were lid swelling (17.1%). 2) Female patients were predominant (91%). 3) Of cases with hyperthyroidism, after treatment with antithyroid drugs and radio-iodine therapy, general symptoms were improved in over 74%, whereas ophthalmopathy was not changed and in some cases the eye signs were aggravated. This tendency was more apparent in infiltrative ophthalmopathy. 4) Significant correlations between exophthalmos, BMR values and {sup 131}I uptake rate were found. Among the patients of same degree of exophthalmos, BMR values and {sup 131}I uptake rate showed the highest in non-infiltrative ophthalmos, BMR values and {sup 131}I uptake rate showed the highest in non-infiltrative ophthalmopathy, moderate in infiltrative ophthalmopathy and the lowest in no ophthalmopathy.

Clinical Study on the Eye Changes in the Goiter Patients

International Nuclear Information System (INIS)

Ku, In Soo; Lee, Jung Sang; Lee, Kyung Ja; Choi, Kuen Chul; Ahn, Soo Byuk; Lee, Chang Kyu; Lee, Mun Ho

1969-01-01

742 cases of thyroid diseases treated at Radio-isotope Clinic, Seoul National University Hospital since October 1965 through July 1968 were analyzed. The patients were classified according to eye findings, as to Infiltrative, Non-infiltrative and No ophthalmopathy. Correlations between ophthalmo-logical findings and symptoms, BMR values and 131 I uptake rate as well as response to medical treatment were carefully reviewed. Results obtained were as follows: 1) Among goitrous patients 44.5% with infiltrative ophthalmopathy, 24.1% with non-infiltrative ophthalmopathy totaling 68.6% of patients with one or more eye findings were found. Exophthalmos (44%) and visual disturbances (44%) comprised the highest incidence among eye signs. Most frequent eye symptoms were lid swelling (17.1%). 2) Female patients were predominant (91%). 3) Of cases with hyperthyroidism, after treatment with antithyroid drugs and radio-iodine therapy, general symptoms were improved in over 74%, whereas ophthalmopathy was not changed and in some cases the eye signs were aggravated. This tendency was more apparent in infiltrative ophthalmopathy. 4) Significant correlations between exophthalmos, BMR values and 131 I uptake rate were found. Among the patients of same degree of exophthalmos, BMR values and 131 I uptake rate showed the highest in non-infiltrative ophthalmos, BMR values and 131 I uptake rate showed the highest in non-infiltrative ophthalmopathy, moderate in infiltrative ophthalmopathy and the lowest in no ophthalmopathy.

Correlation of orbital muscle changes evaluated by magnetic resonance imaging and thyroid-stimulating antibody in patients with Graves' ophthalmopathy

International Nuclear Information System (INIS)

Nishikawa, M.; Yoshimura, M.; Inada, M.

1993-01-01

To evaluate the relationship between eye changes and autoantibody to the thyrotropin receptor in patients with Graves' disease, the authors evaluated the eye changes using magnetic resonance imaging and the results were correlated with thyroid-stimulating antibody, thyrotropin binding inhibitor immunoglobulin and thyroid growth activity. Subjects were 15 patients with Graves' disease who had Graves' ophthalmopathy, including exophthalmos and other signs and symptoms, and 9 patients without ophthalmopathy; all were maintained in a euthyroid state by antithyroid drugs. The thyrotropin-binding inhibitor imunoglobulin was measured by a kit, and thyroid-stimulating antibody and thyroid growth activity were evaluated by cyclic adenosine 3', 5'-monophosphate production and [ 3 H]thymidine incorporation, respectively, by cultured functional rat thyroid lined cells. The sum of the swelling ratios of the four extraocular muscles correlated well with the degree of exophthalmos. The thyrotropin-binding inhibitor immunoglobulin was positive in 9 out of 15 patients with ophthalmopathy; however, no correlation was observed between the activity and exophthalmos or muscle swelling. No significant correlation was observed between muscle changes and thyroid growth activity either. On the other hand, thyroid-stimulating antibody in Graves' patients with ophthalmopathy was significantly higher than that in patients without ophthalmopathy. Moreover, the level of the stimulating activity in Graves' patients with ophthalmopathy showed a significant positive correlation with the sum of the swelling ratios of the individual eight eye muscles. These results suggest that thyroid-stimulating antibody has a close relation to Graves' ophthalmopathy. 23 refs., 4 figs

Nasal encephalocele in a child with Beckwith-Wiedemann syndrome

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Broekman, Marike L. D.; Hoving, Eelco W.; Kho, Kuan H.; Speleman, Lucienne; Sen Han, K.; Hanlo, Patrick W.

Beckwith-Wiedemann syndrome (BWS) is a rare congenital syndrome characterized by gigantism, macroglossia, exophthalmos, postpartum hypoglycemia, and multiple midline defects such as omphalocele. The authors describe, to the best of their knowledge, the first case of a child in whom BWS was diagnosed

The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year)

NARCIS (Netherlands)

Zegers, Richard H. C.; Saeed, Peerooz; Wiersinga, Wilmar M.

2005-01-01

This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion,

A new lethal sclerosing bone dysplasia

International Nuclear Information System (INIS)

Kingston, H.M.; Freeman, J.S.; Hall, C.M.

1991-01-01

A neonate is described with a lethal sclerosing bone dysplasia associated with prenatal fractures and craniofacial abnormalities including microcephaly, exophthalmos, hypoplastic nose and mid-face, small jaw and nodular hyperplasia of the gums. Parental consanguinity suggests that an autosomal recessive mutation is the likely aetiology. (orig.)

Clinical experience of radiation therapy for Graves` ophthalmopathy

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Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo [Gunma Univ., Maebashi (Japan). School of Medicine

1996-11-01

The effect of radiation therapy for Graves` ophthalmopathy was evaluated. Ten patients with Graves` ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves` ophthalmopathy. (author)

Clinical experience of radiation therapy for Graves' ophthalmopathy

International Nuclear Information System (INIS)

Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo

1996-01-01

The effect of radiation therapy for Graves' ophthalmopathy was evaluated. Ten patients with Graves' ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves' ophthalmopathy. (author)

Exophthalmos due to odontogenic intraorbital abscess in Cebus apella.

Science.gov (United States)

Oriá, Arianne P; Pinna, Melissa H; Estrela-Lima, Alessandra; Junior, Deusdete G; Libório, Fernanda A; de Assis Dórea Neto, Francisco; Oliveira, Alberto V D; Nogueira, Marcos; Requião, Katia

2013-04-01

The accumulation of pus in the orbit originating from an infected dental root is classified as odontogenic intraorbital abscess. Clinical, laboratory, and image evaluation of a non-human primate was performed. The patient was cured after surgical therapy. This represents the first report of an odontogenic periodontal abscess in Cebus apella. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

A SOLITARY FIBROUS ORBITAL TUMOR IN A PATIENT WITH NEUROFIBROMATOSIS AND AN UTERINE CARCINOMA

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E. E. Grishina

2016-01-01

Full Text Available We present a rare combination of a solitary fibrous orbital tumor and uterine cancer in a  female patient with type I  neurofibromatosis. This 77-year old patient developed a  left painless exophthalmos within 2 years and decreased visual acuity of the left eye. At the age of 20  she was diagnosed with type I neurofibromatosis. Half a year ago she underwent hysteron-oophorectomy due to uterine adenocarcinoma. The visual acuity of her left eye was decreased to 0.3, with an increase of intraocular pressure to 30 mm Hg. She had a 13-mm left-sided exophthalmos with misplacement of the eye downwards and laterally at 40°. Reposition of the left eye was severely impaired, with limitation of the eye movements to all directions. Ophthalmoscopy showed optic disc discoloration and blunting of its inner border. The patient underwent trans-conjunctival orbitotomy, with removal of three encapsulated tumor nodules. Histological and immunochemical studies of the removed tissue identified solitary fibrous tumor of the left orbit with an undetermined malignant potential. In the post-operative period, visual acuity of the left eye was 0.2, with no exophthalmos and right position of the eye. There was a non-significant limitation of the left eye movement to the left and to the right. X-ray computed tomography confirmed radical tumor excision. Conclusion: Solitary fibrous tumor is a  rare orbital neoplasm. Nevertheless, it should be included into the differential diagnosis list of spin-cell orbital tumors. It is necessary to aim at tumor removal through the least traumatic orbital access. Relapsing course of the tumor is the rationale for a  long-term follow-up of patients after removal of solitary fibrous orbital tumor.

Treatment of Graves' disease and the course of ophthalmopathy

International Nuclear Information System (INIS)

Sridama, V.; DeGroot, L.J.

1989-01-01

Contradictory results have been obtained with regards to the effect of various treatment modes on the exacerbation of Graves' ophthalmopathy, probably because the number of patients in each study was small and some studies were analyzed only in relation to one type of treatment. To circument these problems, we studied the course of Graves' ophthalmopathy after various modes of therapy for thyrotoxicosis among 537 patients with Graves' disease. A total of 537 patients with Graves' disease were prospectively studied over an 11-year period. Thirty-one patients were lost to follow-up during the first six months after treatment and were excluded from the study. Of those remaining, 426 received one form of treatment, 79 received two kinds of therapy, and one received three kinds of therapy. Thus, surgical treatments numbered 164, radioactive iodine-131 ( 13 1I) treatments numbered 241, and medical treatments numbered 182. Ocular signs were considered improved or exacerbated by the following criteria: decrement or increment of the exophthalmos of 2 mm or more, improvement or deterioration of visual acuity, and regression or progression of extraocular muscle involvement causing diplopia. Among patients who did not have infiltrative ophthalmopathy before treatment, there was no difference in the occurrence of posttreatment exophthalmos in the surgically, medically, and 131I-treated patients (7.1%, 6.7%, and 4.9%, respectively). The incidence and the degree of progression of ophthalmopathy in patients who already had exophthalmos before treatment were similar in the medically, surgically, and 131I-treated groups (19.2%, 19.8%, and 22.7%, respectively). Most of the progression occurred in the posttreatment euthyroid stage. The incidence of improvement of ophthalmopathy was also similar 14.1%, 12.6%, and 12.3% in the medically, surgically, and 131I-treated patients

radiodiagnosis in ophthalmology with particular reference to proptosis

African Journals Online (AJOL)

1971-04-10

Apr 10, 1971 ... B., D.M.R.D., Senior Specialist, Department of Paediatric Radiology, Universiiy of Cape Town, and Red Cross. War Memorial Children's ... space has prevented the actual X-ray demonstration of many of the lesions which may .... exophthalmos of endocrinal origin; but any increase in height of 2 mm or more ...

A case of exorbitism in association with Wegener′s granulomatosis with renal involvement

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S Beji

2012-01-01

Full Text Available Wegener′s granulomatosis (WG is a necrotizing granulomatous vasculitis invol-ving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glo-merulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bila-teral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.

CT findings of orbital inflammatory diseases

International Nuclear Information System (INIS)

Kim, Jang Min; Shin, Hyun Joon; Kim, Jung Hyuk; Suh, Won Hyuck

1991-01-01

Twenty-nine patients with orbital inflammatory disease (OIDs) were retrospectively reviewed in order to analyze detailed CT findings which might aid in differentiating OIDs. This study comprised 18 pseudotumors, 5 thyroid ophthalmopathies, and 6 cases of orbital cellulitis. CT scans of the pseudotumors showed various findings such as exophthalmos, scleritis, myositis of the extraocular muscle (MOM), and bone lesion. Bone lesions of the pseudo tumors, which have been rarely reported, were present in 7 cases in our series. Bilateral exophthalmos, myositis, and retrobulbar fat deposition were readily detected by CT in thyroid ophthalmopathy, and, in addition, we found bone erosions involving the orbital apices in 2 cases. In orbital cellulitis, extraorbital soft tissue swelling and lateral displacement of the medial rectus muscle in cases with ethmoiditis were the most conspicuous features. In summary, because of the overlapping CT findings in OIDs, careful examination of CT findings regarding the mode of EOM involvement and the presence or absence of scleritis or sinusitis might help narrow down the differential diagnosis. A pseudotumor with bone lesions could be mistaken as a malignant lesion, and therefore it is necessary to correlate clinical features with CT findings for an accurate diagnosis

Evaluation of the patients with Grave’s ophthalmopathy after the corticosteroids treatment

OpenAIRE

Janićijević-Petrović Mirjana; Šarenac Tatjana; Srećković Sunčica; Petrović Marko; Vulović Dejan; Janićijević Katarina

2012-01-01

Background/Aim. Graves’ ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves’ disease. The treatment of Graves’ ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves’ ophthalmopathy treated with corticosteroids. Methods. Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujev...

Brainstem edema caused by traumatic carotid-cavernous fistula: A case report and review of the literature

OpenAIRE

YU, JINLU; GUO, YUNBAO; ZHAO, SHUJIE; XU, KAN

2015-01-01

Brainstem edema caused by traumatic carotid-cavernous fistula (TCCF) is rare, and there is little information available regarding its clinical characteristics. The present report describes the case of a 51-year-old man with TCCF, who presented with right exophthalmos and intracranial bruit for 1 week. One month prior to admission at hospital, he fractured the frontal and ethmoid sinuses. Digital subtraction angiography confirmed the diagnosis of TCCF, and magnetic resonance imaging (MRI) sugg...

Primary hydatid disease of the infratemporal fossa and the parotid gland

International Nuclear Information System (INIS)

Kalovidouris, A.; Gouliamos, A.; Andreou, I.; Levett, J.; Vlahos, I.; Papavasiliou, C.; Ioannovits, I.

1985-01-01

Hydatid disease should be considered in the differential diagnosis of lesions causing swelling of the parotid area or exophthalmos in patients originating from countries where the incidence of the disease is high. An unusual case of hydatid disease located in the infratemporal fossa and the anterior parotid region is presented. Computed Tomography is a valuable tool for establishment of the diagnosis, before any surgical approach to the lesion is initiated and for postoperative follow-up and evaluation. (orig.) [de

Primary hydatid disease of the infratemporal fossa and the parotid gland

Energy Technology Data Exchange (ETDEWEB)

Kalovidouris, A.; Gouliamos, A.; Andreou, I.; Levett, J.; Vlahos, I.; Papavasiliou, C.; Ioannovits, I.

1985-05-01

Hydatid disease should be considered in the differential diagnosis of lesions causing swelling of the parotid area or exophthalmos in patients originating from countries where the incidence of the disease is high. An unusual case of hydatid disease located in the infratemporal fossa and the anterior parotid region is presented. Computed Tomography is a valuable tool for establishment of the diagnosis, before any surgical approach to the lesion is initiated and for postoperative follow-up and evaluation.

Computed tomography in the examination of cranial disorders in small animals

International Nuclear Information System (INIS)

Wisniewski, S.

1999-01-01

This study deals with the evaluation of the use of computer tomography (CT) for the diagnosis of cranial disorders in 128 patients.Compared to conventional diagnostic techniques, with CT one is able to gather more information, especially about diseases of the facial cranium and central nervous system.Indications for the use of CT typically include symptoms like nasal discharge, exophthalmos, mastication disturbance, abnormal neurologic status, epileptiform seizures and conditions and diseases such as head trauma and otitis media

SEARCH FOR TARGET TISSUE IN THE EYE ORBIT FOR AUTOIMMUNE AGGRESSION OF THYROID ANTIBODIES IN ENDOCRINE OPHTHALMOPATHY

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V. G. Likhvantseva

2017-01-01

Full Text Available We searched for a possible target tissue in eye orbit for thyroid autoantibodies in endocrine ophthalmopathy (Graves’ disease, using correlation analysis method. We examined a group of 139 patients (278 eye orbits with thyroid-associated ophthalmopathy associated with diffuse toxic goiter. Serological parameters (antibodies to thyroid-stimulating hormone receptor; thyroglobulin, thyroid peroxidase were compared with instrumental diagnostic data (multi-layer CT, ultrasonography of eye orbit, and exophthalmometer, as well as clinical symptoms. Statistical correlation analysis enabled us to show different degrees of association between thyroid antibodies and clinical manifestations of Graves’ disease and eye orbit involvement. Especially, carriers of antibodies to TSH receptor and thyroglobulin (as compared to seronegative patients exhibited higher exophthalmos scores (19.16±0.26 mm, p < 0.001, and 19.41±0.40 mm, p < 0.05, respectively, and with total muscle index (2.42±0.05, p < 0.01, and 2.42±0.08, respectively. Meanwhile, eyelids in carriers of antibodies to TSH receptor and thyroid peroxidase proved to be more swollen (p < 0.001, p < 0.05, respectively. Carriage of antibodies to thyroglobulin was associated with synchronous involvement of two structures of the eye orbit: extraocular muscles and retrobulbar tissue, which is reflected by increase in the average ntegral exophthalmos index within the group.

Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

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Fadzillah Mohd-Tahir

2013-01-01

Full Text Available Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Post-operative cyst and orbital walls. A CT image analysis

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Fukuta, Masahiro (Takeda General Hospital, Aizuwakamatsu, Fukushima (Japan)); Iinuma, Toshitaka

1989-07-01

A set of coronal CT images obtained by 118 sides (109 cases) of post-operative cysts of maxilla, seen from 1982 to 1988, was analyzed as to the orbital wall affections. Coronal images were grouped into five consecutive planes, i.e. the first plane being the one which is 5 mm posterior to the nasion, and the other planes in successive orders each being 5 mm apart. The orbital walls were classified into inferior, medial, and transition of these two. The orbital wall affections were classified into dehiscence, thinned-out (less than 1 mm), and normal. The orbital signs and symptoms (epiphora, pain, asthenopia, visual loss, diplopia, and exophthalmos) were analyzed based upon the questionnaires by patients. The inferior wall affections (dehiscence and thinned-out) were seen most often (57%) at the third plane (2 cm posterior to the nasion). The orbital signs and symptoms in general were seen in half of the cases of which 20% were of grave (visual loss, diplopia and exophthalmos). These signs and symptoms were the more often, the more anterior the site of affections located. Grave signs and symptoms were seen at 2 to 2.5 cm posterior to the nasion when the orbital floor was affected and the inferior rectus were either pushed up or in direct contact with the cysts. (author).

Methotrexate for the Treatment of Thyroid Eye Disease

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Diego Strianese

2014-01-01

Full Text Available Background/Aim. To evaluate the efficacy of methotrexate for the treatment of thyroid eye disease (TED. Methods. 36 consecutive patients with active TED, previously treated with corticosteroids but stopped due to the occurrence of side effects, were commenced on methotrexate therapy. Two different weekly doses were administered depending on the weight of the patient (7.5 mg or 10 mg. Clinical activity score (7-CAS, visual acuity (VA, ocular motility, exophthalmos, and eyelid position were retrospectively evaluated at 3, 6, and 12 months and compared with baseline data. Results. There was a statistically significant improvement in 7-CAS at 3, 6, and 12 months after treatment (P<0.0001. There was no significant change in visual acuity. Ocular motility disturbances improved at 6 and 12 months (P<0.001. There was no significant change in exophthalmos (mean 24 mm, SD 3 mm or eyelid position (marginal reflex distance mean 6 mm, SD 1.5 mm during the follow-up period. No side effects were registered. Conclusions. Methotrexate therapy is effective in reducing CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. Eventually, it might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.

Sphenoid dysplasia in neurofibromatosis type 1: a new technique for repair.

Science.gov (United States)

Concezio, Di Rocco; Amir, Samii; Gianpiero, Tamburrini; Luca, Massimi; Mario, Giordano

2017-06-01

Sphenoid bone dysplasia in neurofibromatosis type 1 is characterized by progressive exophthalmos and facial disfiguration secondary to herniation of meningeal and cerebral structures. We describe a technique for reconstruction of the sphenoid defect apt at preventing or correcting the ocular globe dislocation. After placement of spinal cerebrospinal fluid drainage to reduce intracranial pressure, the temporal pole is posteriorly dislocated extradurally. The greater sphenoid wing defect is identified. A titanium mesh covered by lyophilized dura, modeled in a curved fashion, is interposed between the bone defect and the cerebro-meningeal structures with its convex surface over the retracted temporal pole. The particular configuration of the titanium mesh allows a self-maintaining position due to the pressure exerted by the brain over its convex central part with its lateral margins consequently pushed and self-anchored against the medial and lateral walls of the temporal fossa. Screw fixation is not needed. The technique utilized in four cases proved to be reliable at the long-term clinical and neuroradiological controls (6 to 19 years). Sphenoid bone dysplasia in NF1, resulting in proptosis and exophthalmos, is usually progressive. It can be surgically repaired using a curved titanium mesh with the convexity faced to the temporal pole that is in the opposite fashion from all the techniques previously introduced. When utilized early in life, the technique can prevent the occurrence of the orbital and facial disfiguration.

Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

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Liu, H M; Shih, H C; Huang, Y C; Wang, Y H [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

2001-05-01

We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

International Nuclear Information System (INIS)

Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H.

2001-01-01

We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

ATYPICAL PRESENTATION OF CRYPTOCOCCUS NEOFORMANS IN A KOALA (PHASCOLARCTOS CINEREUS): A MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY STUDY.

Science.gov (United States)

Martínez-Nevado, Eva; Alonso-Alegre, Elisa González; Martínez, M Ángeles Jiménez; Rodríguez-Álvaro, Alfonso; de Merlo, Elena Martínez; García, Juncal García; Real, Isabel García

2017-03-01

Cryptococcosis is a worldwide and potentially fatal mycosis documented in wild and captive koalas ( Phascolarctos cinereus ) caused by Cryptococcus neoformans . Though mainly a subclinical disease, when the nasal cavity is affected, epistaxis, mucopurulent nasal discharge, dyspnea, and facial distortion may occur. This report describes a case of cryptococcosis in a koala where unilateral exophthalmos was the only evident clinical sign and magnetic resonance imaging and computed tomography findings are described. Both advanced imaging techniques should be considered as standard and complementary techniques for nasal cavity evaluation in koalas.

Biphasic growth of orbital volume in Chinese children.

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Wei, Nan; Bi, Hua; Zhang, Bin; Li, Xue; Sun, Fengyuan; Qian, Xuehan

2017-09-01

The aim of this study was to map out the developmental curve of the orbital volume of Chinese children aged 1-15 years. CT scanning was performed on 109 children and the orbital volume, interlateral orbital rim distance (IORD), and extent of exophthalmos were measured on the CT images and plotted against age. The development of the orbit structure followed a biphasic pattern. The first growth phase was before 3 years and the second growth phase was between 7 years and 12 years of age. The growth speed in the first phase was about 3 times that of the second one (first vs second phase: 2.28 cm 3 /year vs 0.67 cm 3 /year for orbital volume, 5.01 mm/year vs 1.57 mm/year for IORD, 1.29 mm/year vs 0.42 mm/year for the exophthalmos). During development, there was no significant difference between the left and right orbits. There was no significant difference between boys and girls before 12 years of age. However, after 12 years of age, boys had significantly larger orbital volumes (22.16±2.28 cm 3 /year vs 18.57±1.16 cm 3 /year, pChinese children, the development of orbital volume follows a biphasic pattern and a sex difference becomes significant after the age of 12 years. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Diagnosis of Retrobulbar Round Cell Neoplasia in a Macaroni Penguin ( Eudyptes chrysolophus ) Through Use of Computed Tomography.

Science.gov (United States)

Woodhouse, Sarah J; Rose, Michelle; Desjardins, Danielle R; Agnew, Dalen W

2015-03-01

A 25-year-old female macaroni penguin (Eudyptes chrysolophus) was diagnosed with exophthalmos secondary to retrobulbar neoplasia through use of computed tomography (CT). Histopathologic examination of the mass supported a diagnosis of malignant round cell neoplasia. Immunohistochemical (IHC) labeling was applied to determine cell origin; the neoplastic cells did not label with T-cell marker CD3 or B-cell marker BLA.36 and could not be further characterized. The scleral ossicles precluded evaluation of the retrobulbar space by ultrasonography; therefore, CT scanning is recommended for examination of intraorbital structures in penguin and other avian species.

Apert′s Syndrome

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B K Sohi

1980-01-01

Full Text Available A case of Apert′s syndrome in a one year old female child is described and literature reviewed. She was the first born of a young couple. She had congenital syndactyl of toes and fingers, acro-cephalic skull, flat facies, exophthalmos, hypertelorism and greasy skin. In addition to the typical radiological features of this syndrome which the patient showed, thickened first metacarpals forked at the base were also seen. There were two phalanges for each toe. Calcification was seen intracranially. These radiological features have not been mentioned so far in the literature reviewed.

Hypofractionated radiotherapy for Graves' orbitopathy

International Nuclear Information System (INIS)

Heyd, R.; Herkstroeter, M.; Martin, T.; Zamboglou, N.; Strassmann, G.

2001-01-01

Background: Radiotherapy (RT) has been proven effective in the management of Graves' orbitopathy in numerous studies. Most commonly is the use of conventional fractionated RT and the value of hypofractionated irradiation has not been investigated. Materials and methods: The results in 33 euthyroid cases who underwent RT with a total dose of 21.0 Gy given in three weekly fractions of 3.0 Gy are retrospectively analyzed. The duration of symptoms ranged from 1-84 months and all of the cases had treatment failure after previous administration of corticosteroids. After a mean follow-up period of 33.6 months the overall results were assessed according to the criteria by Donaldson et al. and for evaluation of the clinical outcome a classification with the main criteria being eye-lid changes, exophthalmos, myopathy and eye nerve involvement was used. Results: At follow-up, the overall response to RT was 84.8% (28/33 cases). The analysis with the clinical classification demonstrated that in 19/33 (57.6%) cases occurred a decrease of eye lid changes and exophthalmos and 12/33 (36.4%) had a relief of myopathy. 2/33 cases (6.0%) developed an eye nerve compression causing the necessity of surgical decompression. 3/33 cases (9.0%) had a progression of at least of one of the single criteria of the score and therefore they were classified as non-responders. Conclusions: Hypofractionated RT has been proven effective for treatment of severe cases of Graves' orbitopathy in cases with a prolongated duration of symptoms. The comparison with literature data demonstrate that the results after hypofractionated RT are comparable to those obtained after conventional fractionated RT. (orig.)

Partial thickness autologus calvarial bone orbitocranioplasty for a sphenorbital encephalocele presenting as pulsatile exophthalmos

OpenAIRE

Trivedi, Adarsh; Garg, Amrish Kumar; Hiran, Subodh

2015-01-01

Basal encephalocele accounts only 1.5% of all encephaloceles. But Sphenorbital encephalocele is the rarest cause of herniation of brain into orbit leading to pulsatile exphothalmos. Authors presenting a case of sphenorbital encephalocele in a 16 yrs old girl successsfully managed by orbitcranioplasty by partilal thickness autologus calvarial bone graft.

Orbital involvement by non-Hodgkin lymphoma NK T cells.

Science.gov (United States)

Hervás-Ontiveros, A; España-Gregori, E; Hernández-Martínez, P; Vera-Sempere, F J; Díaz-Llopis, M

2014-11-01

The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

Pregnancy presenting as hyperthyroidism with negative urine pregnancy test.

Science.gov (United States)

Jindal, Rita; Deepak, Desh; Ghosh, Gopal Chandra; Gupta, Mamta

2014-05-20

A 22-year-old lactating mother presented with symptoms of uneasiness, palpitation, tachycardia and exophthalmos. She had an abdominal lump suggestive of 26 weeks uterine size but her urine pregnancy test was negative. Her thyroid profile was suggestive of hyperthyroidism. Gynaecological and ultrasonographic findings revealed a hydatidiform mole. She had a low β-human chorionic gonadotropin level that surprisingly increased after suction and evacuation. The paradoxical findings that appeared as erroneous laboratory results could be explained by the 'high-dose hook effect' after a review of literature. One week after the evacuation, the patient's thyroid profile and symptoms resolved completely without any treatment for hyperthyroidism. 2014 BMJ Publishing Group Ltd.

First results with a radioreceptor-assay (TRAK-Assay) for TSH-receptor-autoantibodies

International Nuclear Information System (INIS)

Becker, W.; Reiners, C.; Boerner, W.

1983-01-01

A new radioreceptor-assay (TRAK-assay) for autoantibodies against TSH-receptors was tested in 48 untreated thyrotoxic patients (26 regional autonomies, 22 toxic diffuse goiters). None of the 26 patients with regional autonomy showed positive autoantibody-titers. 4 patients with toxic diffuse goiter and thyrotoxic exophthalmos were TRAK-positive. Positive titers of microsomal and thyreoglobulin autoantibodies could be seen in 8 of 9 patients with positive TRAK-titers. In accordance with the conventional methods for detecting thyroid-stimulating immunoglobulins the new TRAK-assay seems to be suited for differentiating between immunogenic toxic diffuse goiter (Graves' disease) and goiter with disseminated autonomy as well as for prediction of relapse. (orig.) [de

The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year).

Science.gov (United States)

Zegers, Richard H C; Saeed, Peerooz; Wiersinga, Wilmar M

2005-12-01

This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion, caused by infectious disease, cannot be excluded, mild myopia, in combination with shallow orbits or combined with a genetic predilection, would be one possible explanation for Mozart's large eyes. Graves' orbitopathy, the ophthalmic manifestation of hyperthyroidism, or hypothyroidism have both been suggested to be the cause of Mozart's large eyes. However, these diseases are unlikely causes given their topical and systemic features.

Explore the Possibility of Early Clinical Diagnosis of Endocrine Ophthalmopathy Based on Eye Symptoms of Hyperthyroidism

Directory of Open Access Journals (Sweden)

V. G. Likhvantseva

2016-01-01

Full Text Available Purpose: to study the possibility of early clinical diagnosis of endocrine ophthalmopathy based on ocular symptoms of hyperthyroidism. Patients and methods: we analyzed the prevalence of ocular symptoms of hyperthyroidism in 139 patients (278 orbits with newly diagnosed endocrine ophthalmopathy (group 1, developed on the background of diffuse toxic goiter. The comparison group consisted of 80 patients (160 orbits with newly diagnosed diffuse toxic goiter with no radiographic evidence of endocrine ophthalmopathy (group 2. All patients were examined by an ophthalmologist and endocrinologist. We analyzed the prevalence of ocular symptoms of hyperthyroidism (symptom Dalrymple’, Mobius’, Zenger’, and combinations thereof, often encountered in diffuse toxic goiter, flowing with endocrine ophthalmopathy, and/or lack thereof - in the group of “thyrotoxic exophthalmos”. We took into account the frequency distribution of these clinical signs, and their combinations. We analyzed the clinical sensitivity and specificity of diagnosis based on the three most common symptoms, and their combinations, associated both with thyrotoxicosis and with endocrine ophthalmopathy. Results: Dalrymple’ symptom, is more common in thyrotoxic exophthalmos than with endocrine ophthalmopathy (compared to 100.0% versus 61.9 %, p<0,001. This suggests that Dalrymple’ symptom leads to over diagnosis aspect endocrine ophthalmopathy. It is obvious that it can be used to recognize and thyrotoxic exophthalmos hyperthyroidism, but you cann’t credibly claim based on orbit about the presence of the disease. In this aspect, the greatest practical interest to provide a comparative assessment of the frequency of detection of symptoms of Mobius’ and Zenger’ and their combinations in a population of endocrine ophthalmopathy and in the group of thyrotoxic exophthalmos. Significantly more symptoms Zenger’ and Mobius’ developed with endocrine ophthalmopathy (66,2% and 81

Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl

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Charlton RWilliam

2011-03-01

Full Text Available Graves' disease is less common in prepubertal than pubertal children, and initial presentation with thyroid storm is rare. We report an 11-year-old prepubertal Hispanic girl who presented with a one-day history of respiratory distress, fever, and dysphagia. She had exophthalmos, a diffuse bilateral goiter and was agitated, tachycardic, and hypertensive. Nasal swab was positive for respiratory syncytial virus (RSV. She was diagnosed with thyroid storm and admitted to the pediatric intensive care unit. While infection is a known precipitant of thyroid storm and RSV is a common pediatric infection, to the best of our knowledge, this is the first reported case of RSV infection apparently precipitating thyroid storm in a prepubertal child.

Extraocular myositis in a female puppy

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O. Adegboye

2015-04-01

Full Text Available Extraocular myositis (EOM is not commonly encountered in dogs. It is generally diagnosed based on clinical features of exophthalmos without third eyelid protrusion, pain or vision loss. The traditional treatment of choice is prednisolone. This report describes a case of a mixed-breed puppy with clinical signs consistent with EOM, the use of ascorbic acid as an adjuvant to traditional corticosteroid therapy and rapid resolution of the condition without recurrence. It also shows that prolapse of the third eyelid and ptosis of the lower eyelids are possible signs of EOM during recovery. This is the first report of this sort from Africa and therefore the report is of epidemiological significance.

[Clinical features of 39 children with head and neck rhabdomysarcoma in a single medical center, and treatment outcomes].

Science.gov (United States)

Zhang, Wei-Ling; Zhang, Yi; Huang, Dong-Sheng; Guo, Fang; Han, Tao

2012-11-01

To study the clinical features and treatment outcomes of head and neck rhabdomysarcoma (RMS) in children. The clinical data and results of follow-up visits for 39 children with head and neck RMS were retrospectively reviewed. The children (23 males and 16 females) with a median age of 6 years old (ranged 3 months to 14 years) were admitted to the Beijing Tongren Hospital between November, 2004 and November, 2010. The 39 children mainly presented with exophthalmos and eyelid swelling (56%, 22/39), rhinostegnosis and nasal bleeding (28%, 11/39) and check mass (15%, 6/39). Common primary sites were the eyelid and orbit (56%, 22/39), followed by the nasopharynx and ethmoid antrum (28%, 11/39). Thirty-seven of the 39 patients showed a definite pathologic type and the embryo type was the most common (89%, 33/37). Follow-up visits were carried out for 35 children, with a median follow-up time of 38 months (10-80 months). Of the 35 children, 4 cases received surgery alone, 1 case received chemotherapy alone, 12 cases received surgery plus chemotherapy, 2 cases received surgery plus radiochemotherapy, 13 cases received surgery, chemotherapy and radiochemotherapy (8 cases received 125I particles implants), 2 cases received surgery, chemotherapy, radiochemotherapy and autologous peripheral blood stem cells transplantation (APBSCT), and 1 case received chemotherapy and APBSCT. Seven cases relapsed and 5 cases died of brain metastasis. The total survival rate was 86% (30/35), the complete remission rate was 66% (23/35), and the partial remission rate was 20%. In the 8 cases receiving 125I particles implants, 6 survived without tumor. Exophthalmos and eyelid swelling are the main presentations in children with head and neck RMS. Common primary sites of this disease are the eye and nasopharynx. The most common pathologic type is embryo type. Comprehensive treatment, including chemotherapy, surgery, 125I particles implants and APBSCT therapy, can improve outcome.

Clinical Observation on Hyperthyroidism

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Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk [Kyungpook National University School of Medicine, Deagu (Korea, Republic of)

1969-09-15

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour {sup 131}I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB{sup 131}I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with {sup 131}I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With {sup 131}I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following {sup 131}I treatment myxedema occurred in 4 cases (3

Clinical Observation on Hyperthyroidism

International Nuclear Information System (INIS)

Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk

1969-01-01

A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour 131 I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB 131 I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with 131 I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With 131 I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following 131 I treatment myxedema occurred in 4 cases (3%) and reoccurrence in 9

Feasibility of tomotherapy for Graves' ophthalmopathy. Dosimetry comparison with conventional radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Nguyen, Nam P.; Krafft, Shane P. [Arizona Univ., Tucson, AZ (United States). Dept. of Radiation Oncology; Vos, Paul [East Carolina Univ., Greenville, NC (US). Dept. of Biostatistics] (and others)

2011-09-15

To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique. (orig.)

Radiation therapy of Graves' ophthalmopathy

Energy Technology Data Exchange (ETDEWEB)

Kawamura, Toshiki; Koga, Sukehiko; Anno, Hirofumi; Komai, Satoshi (Fujita-Gakuen Health Univ., Toyoake, Aichi (Japan))

1992-01-01

During the decade from 1978 to 1987, 20 patients with Graves' ophthalmopathy were treated with irradiation of 2000 cGy to the orbital tissue. We examined the effects of the therapy on 17 such patients. Exophthalmos tended to decrease. When the degree of deviation of the exophthalmic eye was small, the effect of therapy tended to be better than when it was large. Two cases that showed an increase in retrobulbar fatty tissue without thickening of the extraocular muscles did not respond as well as those that had thickening of the extraocular muscles. Diplopia tended to improve both subjectively and objectively. Ocular movement improved in 11 of the 17 patients. There were no serious radiation injuries after the radiation therapy, except for some transient swelling of the eyelid. (author).

Permanent Hypothyroidism after Radioactive Iodine(131I) Treatment in Diffuse Toxic Goiter

International Nuclear Information System (INIS)

Park, Soon Yang; Lee, Jung Sang; Lee, Hong Kyu; Koh, Chang Soon; Lee, Mun Ho

1977-01-01

Radioactive iodine (RAI), principally 131 I, effectively controls hyperthyroidism in the majority of patients. The subsequent development of hypothyroidism, however, has been of increasing concern since it was first pointed out by Chapman and Maloof in 1955. And the steady increase of late hypothyroidism during the passage of time was known with its relation with dosage of RAI. The authors have investigated the development of hypothyroidism in 935 patients with diffuse toxic goiter (DTG) who were treated with RAI ( 131 I) at the Seoul National University Hospital from 1960 to 1977 to reveal its relation with the number of RAI treatments, dosage of RAI, age of patients and exophthalmos with the following results. 1) The incidence of hypothyroidism by year after RAI therapy among 631 patients with DTG who were treated with single RAI regimen was 7.4% (1 year), 11.8% (2 year), 16.2% (3 year), 22.1% (4 year) and 25.5% (5 year), and that among 163 patients given multiple RAI treatments was 8.6% (1 year), 10.4% (2 year), 13.3% (3 year), 29.1% (4 year), and 54.1% (5 year) respectively showing much higher yearly increments from 4 years after RAI treatment in comparison with the former. 2) Among 550 patients in the lower dose group treated with single RAI regimen less than 5.0 mCi (Mean±S.D.: 4.3±0.6 mCi), the incidence of hypothyroidism by year after RAI treatment was 6.8% (1 year), 11.4% (2 year), 15.4% (3 year), while among 81 patients in the higher dose group given single RAI treatment not less than 5.5 mCi (Mean±S.D.: 6.3±0.5 mCi) it was 12.0% (1 year), 15.4% (2 year) and 20.4% (3 year) respectively. However, the duration till euthyroid state after RAI therapy in the two groups was 5.1±3.6 months and 4.8±2.8 months respectively showing no statistically significant difference (p>0.1). 4) The incidence of hypothyroidism after RAI treatment in patients younger than 30 years of age was 4.3% (1 year) and 7.7% (2 year); in patients from 30 years to 49 years of age, 5

Cephalic Tetanus from Penetrating Orbital Wound

Directory of Open Access Journals (Sweden)

Eloïse Guyennet

2009-01-01

Full Text Available Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.

Squamous cell carcinoma of the canine nasal cavity and frontal sinus: eight cases

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Rogers, K.S.; Walker, M.A.; Helman, R.G.

1996-01-01

Squamous cell carcinoma of the canine nasal cavity and frontal sinus was diagnosed in eight cases between May 1988 and April 1994. The most common presenting complaints were nasal discharge, including epistaxis; sneezing; and facial deformity or exophthalmos. Metastasis was not identified in any case, but bone lysis and invasion into tissues outside the nasal cavity were noted in five cases. Computed tomograms were performed in five cases and were more useful than radiographs in determining the extent of neoplastic involvement. Euthanasia was performed within one week of diagnosis in three cases at the owner's request; one case died at home within one month; and the remaining four cases were euthanized within eight months due to progressive clinical signs. The mean survival time in these eight cases was three months, with a range of zero weeks to eight months

Thyrotropin Binding Inhibiting Antibody (TBIAb) in Graves’ Disease

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Cho, Won Yong; Choi, Hyang Hee; Chun, Hun Jae; Ahn, Il-Min

1988-01-01

To determine the nature of TBIAb in Graves’ disease, TBIAb was measured and correlated to various clinical, thyroid functional indices and thyroid autoantibodies. The incidence of TBIAb in untreated Graves’ patients, patients in treatment and those in remission was 70.9%, 53.1% and 19.2%, respectively. With respect to clinical indices, there was no correlation between TBIAb and the presence of exophthalmos or periodic paralysis, onset age, diseage duration or sex, but goiter size on initial examination did show significant correlation (r=0.95). Regarding the indices of thyroid function, 20min 99m-Tc uptake (r=0.28), free T4 index (r=0.39) and free T3 index (r=0.40) were well correlated to TBIAb activity. Also Grave’s patients with strong antimicrosomal activity exhibited a high incidence of TBIAb positiveness. PMID:2908684

[Carl Adolph von Basedow--on the 200th anniversary of his birth].

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Meng, W

1999-04-01

Carl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel Dieu. In 1822, he settled in Merseburg as a physician. He was soon acclaimed as a genial and skilled helper in all branches of medical practice. He performed his own post-mortem examinations and published findings on a number of different diseases. His famous contribution in the thyroid field appeared in 1840 entitled "Exophthalmos due to hypertrophy of the cellular tissue in the orbit". Exophthalmos, goiter and palpitation of the heart have become known as the Merseburg Triad. In 1848, he published the autopsy findings on a patient who died from "exophthalmic cachexia". In Germany and some other countries, the disease was named as Morbus Basedow since 1858. In 1854 he pricked in his finger in the postmortem room when examining a patient who had died of typhus and he succumbed to septicemia at the early age of fifty-five. The date of his death was April 11, 1854. On April 14, he was laid in the Sixtus Cemetery in Merseburg. Basedow postulated that a wrong mixing of the blood manifested in cell tissue congestion and glandular vegetation cause the manifestations of disease. If we abstract our modern knowledge and accept circulating antibodies and disturbance of the immune balance as a dyscrasia as well as the proliferation of lymphocytic clones and local cellulary infiltration in terms of immune thyroiditis and autoimmune orbitopathy as cell tissue congestion and glandular vegetations, then doubt arise whether we have indeed made much progress in the last 150 years. At least, respect for the genius of the general physician Carl Adolph von Basedow is becoming greater. We may all hope that in the contributions and the discussions, we shall learn where we stand at the end of

[Carl Adolph von Basedow--150th anniversary of his death].

Science.gov (United States)

Meng, Wieland

2004-05-01

Carl Adolph von Basedow was the son of an aristocratic family and was born 1799 in Dessau. He was the grandson of the famous pedagogue Johann Bernhard Basedow. He studied medicine at the university of Halle and spent two years in the surgical service of Paris hospitals--the Charité and the Hôtel Dieu. In 1822, he settled in Merseburg as a physician. He was soon acclaimed as a genial and skilled helper in all branches of medical practice. He performed his own post-mortem examinations and published findings on a number of different diseases. His famous contribution in the thyroid field appeared in 1840 entitled "Exophthalmos due to hypertrophy of the cellular tissue in the orbit". Exophthalmos, goiter and palpitation of the heart have become known as the Merseburg Triad. In 1848, he published the autopsy findings on a patient who died from "exophthalmic cachexia". In Germany and some other countries, the disease was named as Morbus Basedow since 1858. In 1854 he pricked in his finger in the postmortem room when examining a patient who had died of typhus and he succumbed to septicemia at the early age of fifty-five. The date of his death was April 11, 1854. On April 14, he was laid in the Sixtus Cemetery in Merseburg. Basedow postulated that a wrong mixing of the blood manifested in cell tissue congestion and glandular vegetation cause the manifestations of disease. If we abstract our modern knowledge and accept circulating antibodies and disturbance of the immune balance as a dyscrasia as well as the proliferation of lymphocytic clones and local cellulary infiltration in terms of immune thyroiditis and autoimmune orbitopathy as cell tissue congestion and glandular vegetations, then doubt arise whether we have indeed made much progress in the last 150 years. At least, respect for the genius of the general physician Carl Adolph von Basedow is becoming greater. We may all hope that in the contributions and the discussions, we shall learn where we stand at the end of

Clinical characteristics of moderate-to-severe thyroid associated ophthalmopathy in 354 Chinese cases.

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Qian Li

Full Text Available Thyroid associated ophthalmopathy (TAO is an autoimmune inflammatory disorder which disfigures appearance, threatens vision, and results in a pronounced loss of quality of life. The diversity and ethnic difference of the disease manifestations have made it difficult to tailor therapies for each patient. Few studies have analyzed its characteristics in Chinese populations. We therefore enrolled 354 patients with moderate-to-severe TAO from February 2015 to July 2016. A single ophthalmologist consistently performed detailed ophthalmic examinations. Orbital computed tomography or magnetic resonance imaging scans were performed to verify enlarged extraocular muscles. Multiple linear regression was used to analyze the association between sex, age, smoking, family history of thyroid diseases, degree of proptosis and disease severity. The mean age of males (46.56±11.08 years was significantly higher than that of females (41.39±years, with a female-to-male ratio of 1.09. The females and males between 31~40 and 41~50 years, respectively, had the highest incidence of TAO. 81.48% of the patients suffered hyperthyroidism. TAO was diagnosed either after (47.17% or simultaneously with thyroid dysfunction (27.68%. Proptosis (91.24%, eyelid retraction (83.33%, together with eyelid swelling (79.38% and extraocular muscle enlargement (75.42%, were the most common clinical sign. 19.77% of patients manifested lower eyelid retraction. The mean values of exophthalmos and asymmetry on proptosis were 19.94±3.45mm and 2.18±2.06mm, respectively in males, 18.58±3.31mm and 1.61±1.53mm, respectively in females. The severity of disease was significantly associated with male, older age, smoking, family history of thyroid diseases and degree of proptosis. We found several differences in Chinese compared with White. The female-to-male ratio and mean value of exophthalmos were significantly lower than the data of White. Inferior and superior rectus became the most common

Modified lateral orbital wall decompression in Graves' orbitopathy using computer-assisted planning.

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Spalthoff, S; Jehn, P; Zimmerer, R; Rana, M; Gellrich, N-C; Dittmann, J

2018-02-01

Graves' orbitopathy, a condition seen in the autoimmune syndrome Graves' disease, affects the fatty tissue and muscles inside the orbit. Graves' orbitopathy is associated with increasing exophthalmos and sometimes leads to compressive dysthyroid optic neuropathy, resulting in progressive vision loss. Dysthyroid compressive optic neuropathy, functional problems, and cosmetic problems are the main indications for surgical decompression of the orbit, especially if conservative treatment has not led to a reduction in symptoms. Many surgical techniques are described in the literature. This article presents a modification of the lateral orbital wall osteotomy, involving the rotation and reduction of the osteotomized bone segment using preoperative planning, intraoperative computed navigation, and piezoelectric surgery. This new method combines the advantages of different techniques and appears to be a valid approach to the treatment of severe cases of Graves' orbitopathy. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Early orthodontic management of Crouzon Syndrome: a case report.

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Hlongwa, P

2009-03-01

Crouzon Syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Once the sutures become closed, growth potential to those sutures is restricted. However, multiple sutural synostoses frequently extend to premature fusion of skull base causing midfacial hypoplasia, shallow orbit, maxillary hypoplasia and occasional upper airway obstruction.The case of a 7-year-old South African black boy with Crouzon Syndrome is presented. He presented with characteristic triad of cranial deformity, maxillary hypoplasia and exophthalmos. The clinical, cephalometric features and initial orthodontic management of this patient are discussed as part of multidisciplinary management.

[A case of traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side].

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Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Otani, Naoki; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Sugawara, Takashi; Aoyagi, Chikashi; Suzuki, Go

2009-10-01

A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion. Three months after the head injury, he complained of tinnitus and exophthalmos. One year after the head injury, left external carotid angiograms showed a dural arteriovenous fistula fed by the left dilated middle meningeal artery and draining into the middle meningeal vein. Early filling of the sphenoparietal sinus, cavernous sinus, superior ophthalmic vein, and the cortical vein were also detected. Transarterial embolization of the left middle meningeal fistula was performed, resulting in the disappearance of the lesion. The postoperative course was uneventful.

Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

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E. G. Mendelevich

2015-01-01

Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

[Heart failure as early manifestation of neonatal hyperthyroidism. Case report].

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Alvarado S, Jorge Luis; Fernández V, Zhirly Andrea

2014-04-01

Neonatal hyperthyroidism is usually a self-limited condition frequently associated with transplacental passage of thyroid stimulating antibodies secondary to maternal autoimmune disorders. To timely detect mothers with this medical antecedents decreases the risk for fetal adverse events. To report a case of neonatal hyperthyroidism associated with intrauterine growth restriction and heart failure. A 36 week-old newborn with birth weight of 1,240 g. Symptoms were tachycardia, distal coldness, exophthalmos, hepatomegaly and tremors. Echocardiogram ruled out structural heart disorders. Due to maternal symptoms suggestive of hyperthyroidism, TSH tests were performed showing 0.01 ulU/ml, free T4 7.7 ng/dl, so the diagnosis of neonatal hyperthyroidism was confirmed. It was treated with methimazole and propanol, alleviating the symptoms and decreasing the levels of free T4. To know the maternal history helps identify and manage neonatal complications of hyperthyroidism. Heart failure and other cardiopulmonary disorders are determinants of mortality during early neonatal period. High-risk newborns should receive follow up assessments.

Clinical manifestations of primary hyperthyroidism in the elderly patients at the out-patient clinic of Srinagarind Hospital.

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Limpawattana, Panita; Sawanyawisut, Kittisak; Mahankanukrau, Ajanee; Wongwipaporn, Chaiyasit

2006-02-01

The authors reviewed the outpatient charts diagnosed as hyperthyroidism at Srinagarind Hospital from June 1998-June 2004. The objective was to compare the clinical features of hyperthyroidism in patients older and younger than 60 years old. There were 922 cases enrolled, 84 cases (9.11%) were 60 years old and above. The female: male ratio was 3.4:1 and 4:1 and the mean ages were 64.2 +/- 3.7 and 37.4 +/- 11.2 years old in the elder and younger group, respectively. The common presentations were dyspnea (94.1, 96.5%), weight loss (93.8, 87.9%) and palpitation (83.3, 93.1%) in the elder and younger, respectively. The more significant clinical presentations in the elder group were atrial fibrillation, weakness and anorexia whereas exophthalmos, goiter, heat intolerance and hyperhidrosis were not as frequent. Thus, the classic presentations often lacked in the elder group. Therefore, unexplained AF, weakness and anorexia should not exclude hyperthyroidism even with paucity of typical clinical features.

Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report

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Yueh-Hua Chung

2004-04-01

Full Text Available Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid-stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60-year-old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti-microsomal antibody titer (1:6,400. The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later. 131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.

[Orbital decompression in Grave's ophtalmopathy].

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Longueville, E

2010-01-01

Graves disease orbitopathy is a complex progressive inflammatory disease. Medical treatment remains in all cases the proposed treatment of choice. Surgical treatment by bone decompression can be considered as an emergency mainly in cases of optic neuropathy or ocular hypertension not being controlled medically or in post-traumatic exophthalmos stage. Emergency bone decompression eliminates compression or stretching of the optic nerve allowing visual recovery. The uncontrolled ocular hypertension will benefit from decompression. The normalization of intraocular pressure may be obtained by this surgery or if needed by the use of postoperative antiglaucoma drops or even filtration surgery. In all operated cases, the IOP was normalized with an average decrease of 7.71 mmHg and a cessation of eye drops in 3/7 cases. Regarding sequelae, our therapeutic strategy involves consecutively surgery of the orbit, extraocular muscles and eyelids. The orbital expansion gives excellent results on the cosmetic level and facilitates the implementation of subsequent actions.

Surgical decompression in endocrine orbitopathy. Visual evoked potential evaluation and effect on the optic nerve.

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Clauser, Luigi C; Tieghi, Riccardo; Galie', Manlio; Franco, Filippo; Carinci, Francesco

2012-10-01

Endocrine orbitopathy (EO) represents the most frequent and important extrathyroidal stigma of Graves disease. This chronic autoimmune condition involves the orbital contents, including extraocular muscles, periorbital connective-fatty tissue and lacrimal gland. The increase of fat tissue and the enlargement of extraocular muscles within the bony confines of the orbit leads to proptosis, and in the most severe cases optic neuropathy, caused by compression and stretching of the optic nerve. The congestion and the pressure of the enlarged muscles, constrict the nerve and can lead to reduced sight or loss of vision with the so called "orbital apex syndrome". Generally surgical treatment of EO, based on fat and/or orbital wall expansion, is possible and effective in improving exophthalmos and diplopia. Since there are limited reports focussing on optic neuropathy recovery after fat and/or orbital walls decompression the Authors decided to perform a retrospective analysis on a series of patients affected by EO. The study population was composed of 10 patients affected by EO and presenting to the Unit of Cranio Maxillofacial Surgery, Center for Craniofacial Deformities & Orbital Surgery St. Anna Hospital and University, Ferrara, Italy, for evaluation and treatment. A complete Visual Evoked Potentials (VEP) evaluation was performed. There were seven women and three men with a median age of 55 years. Optic nerve VEP amplitude and latency were recorded as normal or pathological. Abnormal results were scored as moderate, mild and severe. Differences in VEP pre and post-operatively were recorded as present or absent (i.e. VEP Delta). Pearson chi square test was applied. There were 20 operated orbits. The first VEP evaluation was performed 3.2 months before surgery and post-operative VEP control was done after a mean of 18.7 months. Fat decompression was performed in all cases and eight patients had also bony decompression. VEP amplitude and latency were affected in 10 and 15

Calcified tumours of the paranasal sinuses in three horses.

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Schaaf, K L; Kannegieter, N J; Lovell, D K

2007-11-01

Three horses, a 10-year-old Thoroughbred mare, a 9-year-old Thoroughbred gelding and a 6-year-old Arab gelding, with calcified tumours of the paranasal sinuses, are described. All horses presented with purulent nasal discharges and facial distortion. Exophthalmos, blepharospasm and ocular discharge were also a feature in individual horses. A presumptive diagnosis of a calcified tumour was made on the basis of clinical signs and radiographic and endoscopic findings. The tumours ranged from 15 to 25 cm in diameter. A large frontonasal bone flap was used to expose the tumours, which were cleaved into several pieces with an osteotome and removed. Histological examination of the masses identified cementomas in two cases and an osteoma in the third. Long term follow up from 18 months to 5 years after surgery indicated that there was no recurrence. This case series demonstrates that, although calcified tumours of the paranasal sinuses are rare in horses, they should be considered in the differential diagnosis of purulent nasal discharge, facial swelling and ocular distortion, and are amenable to surgical treatment.

Radioactive iodine ablation of Grave disease; Traitement ablatif par iode

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Taieb, D.; Tessonnier, L.; Nwatsock, F.J.; Mundler, O. [Service central de biophysique et de medecine nucleaire, centre hospitalo-universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, (France)

2009-05-15

The isotopic destruction by iodine of the thyroid body is an alternative to the surgery in the radical treatment of the Basedow disease, particularly for recurrent forms. Several strategies are possible in the use of iodine 131. between 2004 and 2008, 240 patients with a Basedow disease were treated in our service by an ablative activity of iodine 131 (555 MBq on average). the results are rather reproducible, that is to say a quasi constant hypothyroidism in the first three months. It appears important to underline that the ambulatory management of induced hypothyroidism is often unappropriated with too progressive introductions of LT4, leaving the patient in deep hypothyroidism during several weeks. The recurrences at short and middle term are very rare ( under 4%). A case of severe exophthalmos was observed. The other patients did not progressed with corticosteroids. The evolution of anti receptors autoantibodies of the TSH have been studying. to conclude, this kind of strategy is very efficient and reproducible, but needs an appropriate management of post therapy hypothyroidism, source of discomfort and potential morbidity. (N.C.)

[Successful treatment of hyperthyroidism simulating acute abdomen and psychosis].

Science.gov (United States)

Kósa, D; Patakfalvi, A; Györi, L

1992-07-19

A 49 years old female patient entered the surgical department because of epigastric and ileocoecal pains with the symptoms of acute abdomen. A surgical intervention was performed because of supposed appendicitis, but it was not verified. During the surgical observation the patient was confused and negativistic so she was transferred to the psychiatric department. Because of loss of 20 kg weight, high blood sedimentation and anaemia she was sent to our department with the suspicion of an organic disease. A moderate exophthalmos, glittering eyes and Graefe's sign was noted, therefore hyperthyroidism was diagnosed, which was proved by Kocher's blood picture, low serum cholesterol, extremely high T3 and T4 level, and iodine storage diagram. The antithyreotic treatment resulted a dramatic improvement in the extremely serious moreover hopeless case and after a long-term treatment the patient became symptom-free without complaints. Later because of regression of hyperthyreoidism and the growing nodular goitre the patient was treated on two occasions with radioactive iodine. At present the patient is in remission.

Disguised Thyroid Disorders

Science.gov (United States)

Tsao, John M.; Catz, Boris

1965-01-01

In six cases of hyperthyroidism and two of chronic thyroiditis herein described, the initial features of the diseases were misinterpreted as attributable to other kinds of illness such as myocardial infarction, gastrointestinal malignant disease, malabsorption syndrome, psychosis, simple exophthalmos and endemic goiter. The characteristic signs and symptoms of hyperthyroidism (in six patients) and chronic thyroiditis (in two patients) were present at the outset but were not identified. Intensive questioning and alertness were required to elicit these characteristics. The symptoms improved or disappeared after the true disease was controlled. In the studies of these cases, the usefulness of a number of laboratory tests was illustrated—thyroid suppression studies, 4 to 6-hour and 24-hour radioactive iodine uptake, T3 uptake by the red cells and determinations of 24-hour urine creatine, antithyroglobulin antibody titer and long-acting thyroid stimulating hormone. The manifestations of thyroid diseases are many and varied. The term “masked hyperthyroidism” may in part be a reflection of the “masked physician” unless he uses his clinical detective abilities. PMID:14347981

Effect of rectus recession combined with the rear suspension scleral fixation in patients with restrictive strabismus caused by thyroid associated ophthalmopathy

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Hai-Hua Qian

2016-04-01

Full Text Available AIM: To investigate the therapeutic effect of rectus recession combined with the rear suspension scleral fixation for patients with restrictive strabismus caused by thyroid associated ophthalmopathy(TAO. METHODS: The clinical data of 48 patients(71 eyeswith severe TAO were retrospective analyzed from January 2013 to January 2015.The patients with severe TAO were divided into the exophthalmos(EMgroup with 25 patients(35 eyes, compressive optic neuropathy(CONgroup with 12 patients(20 eyesand exposure keratopathy(EKgroup with 11 patients(16 eyes.The rectus recession combined with rear suspension scleral fixation treatment was performed in all patients. The visual acuity, clinical activity score(CAS, and diplopia situation of each group were recorded and compared preoperatively and at 6mo postoperatively. RESULTS: The postoperative best corrected visual acuity(BCVAof the three groups were significantly higher than those before operation(PPPPPCONCLUSION: Rectus recession combined with the rear suspension scleral fixation can help improve the restrictive strabismus caused by TAO, visual acuity, eyeballs to roll back, eliminate the diplopia and to improve the life quality of patients.

Peculiar Distribution of Tumorous Xanthomas in an Adult Case of Erdheim-Chester Disease Complicated by Atopic Dermatitis

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Yukako Murakami

2011-05-01

Full Text Available Erdheim-Chester disease is a rare non-Langerhans form of histiocytosis with multiple organ involvement. Approximately 20% of patients have xanthoma-like lesions, usually on the eyelids. We report a case of Erdheim-Chester disease in a 32-year-old male who showed peculiar xanthomatous skin lesions and also had atopic dermatitis. His skin manifestations included ring-like yellowish tumors on his periorbital regions, rope necklace-like tumors on his neck, and spindle-shaped tumors on his right preauricular region and cubital fossas. He also had exophthalmos and diabetes insipidus. Chronic eczematous lesions were present on the flexor aspect of his extremities, and his serum eosinophil numbers and immunoglobulin E levels were elevated. A histological examination of his right neck tumor showed foamy macrophages and touton-type giant cells, which were positive for CD68 and CD163 and negative for S-100 and CD1a. We suggest that the complication of atopic dermatitis may have contributed to the uncommon clinical features in this case.

A study on normal value of eyeball protrusion in Korean adult using CT

International Nuclear Information System (INIS)

Song, Chi Sung; Chang, Kee Hyun

1984-01-01

CT may be valuably used in determination of proptosis. Normal value of eyeball protrusion was measured in normal Koreans using CT. Among 86 Koreans, 26 have normal both eyes, but 60 have one normal eye with one abnormal eye (chiefly, proptosis and and eyeball tumor). The results of 112 eyes are as follows: Absolute measurement of 'a', that is, the distance between cornea and IZL (interzygomatic line) is 16.0±3.4 mm in male (for 63 eye), 15.7±4.0 mm in female for 49 eyes. Ratio of 'a' over 'A' (A-P diameter of eyeball) is 57±12% is male (for 63 eye), 57±14% in female (for 49 eye) Discrepancy of eyeball protrusion between both eyes is 0.67±1.5 mm (for 26 adults). Practically, normal range of eyeball prtotrusion ('a') is 12.6 mm < male < 19.4 mm, 11.7 mm < female < 19.7 mm. 'a/A' ratio over 70% and over 2mm discrepancy between both eyes are also suggested as genuine exophthalmos

A 3-year-old girl with Graves' disease with literature review

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Yo Han Ho

2014-09-01

Full Text Available Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3 and free thyroxine (free T4 were normal, whereas that of thyroid-stimulating hormone (TSH was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.

Hepatotoxicity induced by methimazole in a previously healthy patient.

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Gallelli, Luca; Staltari, Orietta; Palleria, Caterina; De Sarro, Giovambattista; Ferraro, Maria

2009-09-01

We report a case of hepatotoxicity induced by methimazole treatment in a patient affected by hyperthyroidism. A 54-year-old man, presented to our observation for palpitations, excessive sweating, weakness, heat intolerance and weight loss. On physical examination, his blood pressure was 140/90 mmHg and heart beat was 100/min regular. He had mild tremors and left exophthalmos. Laboratory test revealed a significant increase in serum thyroid hormone levels with a decrease in thyroid stimulating hormone levels. A diagnosis of hyperthyroidism was made and he began treatment with methimazole (30 mg/day). Fourteen days later, he returned for the development of scleral icterus, followed by dark urine, and abdominal pain in the right upper quadrant. Laboratory examinations and liver biopsy performed a diagnosis of cholestatic hepatitis, secondary to methimazole usage. Methimazole was promptly withdrawn and cholestyramine, ursodeoxycholic acid, and chlorpheniramine were given. After five days, abdominal pain resolved and laboratory parameters returned to normal. Naranjo probability scale indicated a probable relationship between hepatotoxicity and methimazole therapy. In conclusion physicians should be aware the risk of hepatotoxicity related with methimazole.

Reliability of exophthalmos measurement and the exophthalmometry value distribution in a healthy Dutch population and in Graves' patients. An exploratory study

NARCIS (Netherlands)

Mourits, M. P.; Lombardo, S. H. C.; van der Sluijs, F. A.; Fenton, S.

2004-01-01

AIM: The purpose of this study was to test the reliability of an exophthalmometer commonly used in the Netherlands; to determine the exophthalmometry value distribution with this instrument and to assess the upper exophthalmometry limits of normal in a healthy, adult, Caucasian, Dutch population.

Extra ocular muscles: A rare site of spread of breast cancer

International Nuclear Information System (INIS)

Fresco, R.; Suárez, L.; Saldombide, L.; Castillo, C.; Córdoba, A.; De Cola, A.; Santander, G.; Heinzen, S.; Touya, D.; Delgado, L.

2004-01-01

Orbital metastases are uncommon, with 50% of these secondary breast cancer. Within the orbit, the extra ocular muscles are one of the less frequently affected structures. Muscle involvement may be exclusive or contiguity. It is estimated that exclusive muscle involvement corresponds to 5% of all orbital metastases. Clinical cases: two cases of female patients with cancer are presented metastatic breast cancer, in the context of a lesion al progression install diplopia, exophthalmos and pto sis. In one of these it is found tomographic one expansive process in the right hamstring muscle that moves the eyeball and includes the optic nerve. In the second case it is an injury in the within the left superior rectums muscle without involvement of other structures. Yes Although none of the chaos possible pathological confirmation, in second one a remission of the nasal mucus and a complete response was achieved tomographic muscle injury after 3 rounds of chemotherapy. Conclusion: Although metastases are uncommon extra ocular muscles, This can be seen in patients with breast cancer and disorders visual and diplopia. On the anatomy of the orbit, small masses can cause significant functional impact

Corneal Opacity in Domestic Ducks Experimentally Infected With H5N1 Highly Pathogenic Avian Influenza Virus.

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Yamamoto, Y; Nakamura, K; Yamada, M; Mase, M

2016-01-01

Domestic ducks can be a key factor in the regional spread of H5N1 highly pathogenic avian influenza (HPAI) virus in Asia. The authors performed experimental infections to examine the relationship between corneal opacity and H5N1 HPAI virus infection in domestic ducks (Anas platyrhyncha var domestica). A total of 99 domestic ducks, including 3 control birds, were used in the study. In experiment 1, when domestic ducks were inoculated intranasally with 2 H5N1 HPAI viruses, corneal opacity appeared more frequently than neurologic signs and mortality. Corneal ulceration and exophthalmos were rare findings. Histopathologic examinations of the eyes of domestic ducks in experiment 2 revealed that corneal opacity was due to the loss of corneal endothelial cells and subsequent keratitis with edema. Influenza viral antigen was detected in corneal endothelial cells and some other ocular cells by immunohistochemistry. Results suggest that corneal opacity is a characteristic and frequent finding in domestic ducks infected with the H5N1 HPAI virus. Confirming this ocular change may improve the detection rate of infected domestic ducks in the field. © The Author(s) 2015.

A patient with Graves’ disease showing only psychiatric symptoms and negativity for both TSH receptor autoantibody and thyroid stimulating antibody

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Hamasaki Hidetaka

2012-12-01

Full Text Available Abstract Background Both thyroid stimulating hormone (TSH and thyroid stimulating antibody (TSAb negative Graves’s disease (GD is extremely rare. Here we present such a patient. Case presentation The patient was a 76-year-old woman who was diagnosed as having schizophrenia forty years ago. She did not show characteristic symptoms for hyperthyroidism, such as swelling of thyroid, exophthalmos, tachycardia and tremor, however, she showed only psychomotor agitation. Serum free triiodothyronine and free thyroxine levels were elevated and TSH level was suppressed, suggesting the existence of hyperthyroidism. However, both the first generation TSH receptor autoantibody (TRAb1 and the thyroid stimulating autoantibody (TSAb were negative. Slightly increased blood flow and swelling was detected by thyroid echography. Thyroid scintigraphy demonstrated diffuse and remarkably elevated uptake of 123I uptake. Finally, we diagnosed her as having GD. She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated. Discussion We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb. Thyroid autoantibody-negative GD is extremely rare. Thyroid scintigraphy was useful to diagnose such a patient.

Unilateral proptosis revealing a fronto-ethmoidal mucocele.

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Lajmi, Houda; Hmaied, Wassim; Ben Jalel, Wady; Ben Romdhane, Khaoula; Chelly, Zied; El Fekih, Lamia

2017-06-01

Backgroud: The fronto-ethmoidal mucocele is a benign condition leading commonly to limited eye movement or ocular pain but it could also induce visual acuity impairment by compressing the optic nerve Aim: To discuss, through a case report, different ophthalmologic manifestations of the fronto-ethmoidalmucocele. Reported case: A 46-years-old man with no general history consulted for a bilateral ocular redness and itching. He reported, however, a mild protrusion of his left globe evolving for oneyear. The clinical examination revealed a unilateral proptosis in the left eye with a discrete limitation of theadduction. A brain and orbital computer tomography (CT)and a magnetic resonance imaging(MRI)revealed a grade I exophthalmos caused by an oval formation of fluid density in the left anterior and posterior ethmoidal cells in addition to the frontal sinus,driving theeyeball and internal oculomotor muscles back and out.The patient was referred to otorhinolaryngology department for a precocious surgical management. The ophtalmologic manifestations of the disease depend on the location, the size of the formation and involvement of adjacent structures. The loss of vision and the apex syndrome due to the compressionof the ocular globe are the most serious complications.

Frontal intradiploic epidomoid cyst with orbital and out cerebral extension

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Fernandez Latorre, F.; Revert Ventura, A.; Diaz Ramon, C.; Arana, E.; Esteban Masanet, J.M.; Tortosa Giner, A.

1995-01-01

We studied six patients with exophthalmos and inferior displacement of the eyeball produced by orbital extension of a frontal intradiploic epidermoid cyst. All the patients were studied by conventional radiography five with CT and three with MR. Plain x-ray disclosed a single, well-defined lytic lesion with sclerosis margin, located in the outer supraorbital region of the frontal bone in all cases. CT revealed the intradiploic site of the lesion, its expansive nature, the state of the bone tables and demonstrated the existence of an intra orbital mass. MR showed a lesion with a greater signal intensity than LCR, similar to the white matter in T1-weighted sequences in two cases and hyperintense in a third. The lesions were hyperintense in T2-weighted sequences. The preoperative presumed diagnosis was established by means of plain radiography on the basis of site and the sclerosis ring surrounding the lesion. CT disclosed the bone structures and confirmed the existence of an intra orbital mass containing soft portions. The basic contribution of MR was in the assessment of the intracranial extension and in ruling out cerebral involvement.(Author)

Assessment of Normal Eyeball Protrusion Using Computed Tomographic Imaging and Three-Dimensional Reconstruction in Korean Adults.

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Shin, Kang-Jae; Gil, Young-Chun; Lee, Shin-Hyo; Kim, Jeong-Nam; Yoo, Ja-Young; Kim, Soon-Heum; Choi, Hyun-Gon; Shin, Hyun Jin; Koh, Ki-Seok; Song, Wu-Chul

2017-01-01

The aim of the present study was to assess normal eyeball protrusion from the orbital rim using two- and three-dimensional images and demonstrate the better suitability of CT images for assessment of exophthalmos. The facial computed tomographic (CT) images of Korean adults were acquired in sagittal and transverse views. The CT images were used in reconstructing three-dimensional volume of faces using computer software. The protrusion distances from orbital rims and the diameters of eyeballs were measured in the two views of the CT image and three-dimensional volume of the face. Relative exophthalmometry was calculated by the difference in protrusion distance between the right and left sides. The eyeball protrusion was 4.9 and 12.5 mm in sagittal and transverse views, respectively. The protrusion distances were 2.9 mm in the three-dimensional volume of face. There were no significant differences between right and left sides in the degree of protrusion, and the difference was within 2 mm in more than 90% of the subjects. The results of the present study will provide reliable criteria for precise diagnosis and postoperative monitoring using CT imaging of diseases such as thyroid-associated ophthalmopathy and orbital tumors.

Semiautomatic regional segmentation to measure orbital fat volumes in thyroid-associated ophthalmopathy. A validation study.

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Comerci, M; Elefante, A; Strianese, D; Senese, R; Bonavolontà, P; Alfano, B; Bonavolontà, B; Brunetti, A

2013-08-01

This study was designed to validate a novel semi-automated segmentation method to measure regional intra-orbital fat tissue volume in Graves' ophthalmopathy. Twenty-four orbits from 12 patients with Graves' ophthalmopathy, 24 orbits from 12 controls, ten orbits from five MRI study simulations and two orbits from a digital model were used. Following manual region of interest definition of the orbital volumes performed by two operators with different levels of expertise, an automated procedure calculated intra-orbital fat tissue volumes (global and regional, with automated definition of four quadrants). In patients with Graves' disease, clinical activity score and degree of exophthalmos were measured and correlated with intra-orbital fat volumes. Operator performance was evaluated and statistical analysis of the measurements was performed. Accurate intra-orbital fat volume measurements were obtained with coefficients of variation below 5%. The mean operator difference in total fat volume measurements was 0.56%. Patients had significantly higher intra-orbital fat volumes than controls (p<0.001 using Student's t test). Fat volumes and clinical score were significantly correlated (p<0.001). The semi-automated method described here can provide accurate, reproducible intra-orbital fat measurements with low inter-operator variation and good correlation with clinical data.

Piezosurgery for osteotomies in orbital surgery: Our experience and review of the literature

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Iacoangeli, Maurizio; Neri, Piergiorgio; Balercia, Paolo; Lupi, Ettore; Di Rienzo, Alessandro; Nocchi, Niccolò; Alvaro, Lorenzo; Scerrati, Massimo

2012-01-01

INTRODUCTION Piezoelectric bone surgery, simply known as Piezosurgery®, is a new promising technique for bone cutting based on ultrasonic microvibrations that allows to perform precise and thin osteotomies with soft tissue sparing. PRESENTATION OF CASE A 45-years-old woman presenting with progressive left ocular pain, diplopia on the lateral left gaze, and visible exophthalmos was admitted to our department. CT scan and MRI images documented a left supero-lateral orbital lesion. A left lateral orbitotomy using the piezoelectric scalpel was performed. The tumour (lacrimal gland lymphoma) was completely removed with no injuries to the orbital structures and with a perfect realignment of the bone stumps. DISCUSSION High powered pneumatic osteotome are commonly used to perform craniotomies. Large bone cutting groove and high temperatures developing at the contact site could produce an uneasy bone healing. The use of a piezoelectric scalpel allows to realize precise and thin osteotomies, facilitating craniotomy's borders ossification and avoiding injuries to non-osseous structures. CONCLUSION Widely used in Oral and Maxillofacial Surgery, Piezosurgery® can also be useful in neurosurgical approaches in order to obtain a faster bone flap re-ossification, a better aesthetic result, and a lower risks of dural layer and soft tissue damage. PMID:23276764

Atypical Complications of Graves’ Disease: A Case Report and Literature Review

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Khaled Ahmed Baagar

2017-01-01

Full Text Available Graves’ disease (GD may display uncommon manifestations. We report a patient with rare complications of GD and present a comprehensive literature review. A 35-year-old woman presented with a two-week history of dyspnea, palpitations, and edema. She had a raised jugular venous pressure, goiter, and exophthalmos. Laboratory tests showed pancytopenia, a raised alkaline phosphatase level, hyperbilirubinemia (mainly direct bilirubin, and hyperthyroidism [TSH: 46.08 pmol/L (reference values: 2.6–5.7]. Her thyroid uptake scan indicated GD. Echocardiography showed a high right ventricular systolic pressure: 60.16 mmHg. Lugol’s iodine, propranolol, cholestyramine, and dexamethasone were initiated. Hematologic investigations uncovered no reason for the pancytopenia; therefore, carbimazole was started. Workup for hepatic impairment and pulmonary hypertension (PH was negative. The patient became euthyroid after 3 months. Leukocyte and platelet counts and bilirubin levels normalized, and her hemoglobin and alkaline phosphatase levels and right ventricular systolic pressure (52.64 mmHg improved. This is the first reported single case of GD with the following three rare manifestations: pancytopenia, cholestatic liver injury, and PH with right-sided heart failure. With antithyroid drugs treatment, pancytopenia should resolve with euthyroidism, but PH and liver injury may take several months to resolve.

Outcome of thyroid associated ophthalmopathy treated by radiation therapy

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Abboud, Mirna; Arabi, Asma; Salti, Ibrahim; Geara, Fady

2011-01-01

Thyroid associated orbitopathy is a common manifestation of Graves disease. Many options can be considered for treatment. In this case series, we reviewed the medical records of 17 patients who received radiation therapy (RT) for GO in a tertiary care center between 1997 and 2007. All patients received 20 Gy to both orbits and 12 of them (71%) had already received one or more trials of steroid therapy prior to RT. After a median follow-up of 2 years, a subjective improvement in exophthalmos and vision was reported by all patients at the end of RT but only 3 patients reported a decrease in their diplopia immediately after therapy. Symptoms continued to improve with time in many patients: 22% had complete reversal of their symptoms and signs, and the remaining 78% had partial improvement. Two patients developed recurrent signs and symptoms, both of them were smokers who continued to smoke after treatment. About 60-65% of patients responded favorably to RT alone which increased to 87-97% when RT is combined with steroids. No patients developed late toxicity during the follow-up period. We conclude that RT is an effective treatment option in GO even in patients who failed previous treatment with steroids or surgical decompression. Based on our own clinical experiences and the literature data, the combination of RT and intravenous corticosteroid administration may improve the response rate

Osteosarcoma of the spheno-temporo-orbital bone: Imaging aspects of such unusual location

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ABDEL ILAH RAYAN ALAOUI BOUARRAQUI

2018-05-01

Full Text Available Osteosarcoma of the spheno-temporo-orbital bone is a very rare tumor. Despite the fact that primary osteogenic sarcomas are the most common bone neoplasm, their location in the skull bone is uncommon representing less than 2% of all skull tumors. We report the case of a 41-year-old woman, who has experienced periorbital pain with exophthalmos and left eye vision loss. Neuroimaging analysis including both brain computed tomography (CT-scan and Magnetic resonance imaging (MRI were performed. Although radiographic features of skull bone osteosarcomas are not specific, the combination of several radiographic features could lead to this diagnosis in such rare location. The final diagnosis was established by a trans-temporal biopsy with immunohistochemical study. Neurosurgical resection of the primary tumor was not possible given the important extent of the tumor and the involvement of adjacent structures, so the patient underwent conformational radiotherapy. The evolution was marked by local and metastatic progression. The patient received palliative chemotherapy and died few months later. The purpose of presenting this case is not only to report an uncommon malignancy of the skull bone, but also to provide imaging aspects of this rare location and to raise awareness among radiologists in order to consider this radiological entity as a differential diagnosis when a skull bone process is identified.

Computed tomography of tumors of paranasal sinuses and face

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Lee, Sun Wha [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

1982-09-15

The computed tomography can image both bone and soft tissue structures of paranasal sinuses and face and so CT has added an important new dimension to radiological evaluation of disease of paranasal sinuses and face. CT is more accurate method of staging of tumors and essential for therapeutic planning. The author studied 25 cases of proven tumors of paranasal sinuses and face during the period from October 1977 to August 1980 in Kyung Hee University Hospital. The results were as follows: 1. Among 14 females and 11 male, their age range was from 14 years to 65 year. 2. The distribution of tumors were mucocele, squamous cell carcinoma, metastatic carcinoma, meningioma, angiofibroma, Masson's hemangiosarcoma, fibrous dysplasia, neurogenic sarcoma, Schwannoma, hemangioma, epidermoid, transitional cell carcinoma and unknown. 3. Determination of location and extent of mucocele was easily done by CT. Thus in all cases of ethmoid mucocele, chief complaint of exophthalmos could be easily explained by identification of its extension into peripheral fat space of orbit. 4. It is our belief that CT was useful method to determine staging of tumors of paranasal sinuses and was essential in choosing appropriate treatment modality. 5. The contrast enhancement is generally not helpful in pathologic diagnosis of tumors but intracranial extension of tumors are clearly defined by contrast enhancement.

Pfeiffer syndrome

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Fryns Jean-Pierre

2006-06-01

Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

Tolerance of the visual apparatus to conventional therapeutic irradiation

International Nuclear Information System (INIS)

Parsons, J.T.; Bova, F.J.; Mendenhall, W.M.; Million, R.R.; Hood, I.

1991-01-01

This paper reports on the eye which is an externalized portion of the brain. The neural retina is a derivative and extension of the diencephalon, and the optic nerve is structurally and functionally a tract of the central nervous system (CNS) rather than a peripheral nerve. The clear aqueous fluid within the eye more closely resembles cerebrospinal fluid that any other body fluid, and the blood vessels of the retina are like those of the brain. Although primary tumors of the eye such as melanoma and retinoblastoma, and the optic nerve, such as glioma, are rare, tumors that involve tissues adjacent to these structures are relatively common. Because many of these tumors are best treated with irradiation, the visual apparatus frequently receives incidental irradiation. Tumors for which irradiation is usually employed include those of the nasal cavity and paranasal sinuses, nasopharynx, orbit (lymphomas), and the CNS (pituitary) as well as advanced cancers of the eyelid and periorbital skin. In a recent analysis of the University of Florida series of patients with tumors arising in the nasal cavity, ethmoid sinus, or sphenoid sinus, almost half of the patients had evidence of direct orbital invasion; in 20% of the patients, the invasion was of such a degree as to produce exophthalmos, blindness, or a palpable orbital mass. Irradiation of the eye and optic nerve may produce a variety of clinical problems

Rare human diseases: 9p deletion syndrome

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Galagan V.O.

2014-09-01

Full Text Available Objective of the study was to review the anamnesis, pheno - and genotype in patients with rare chromosome disorders such as 9p deletion syndrome. Genetic methods of investigation (clinical and genealogical, cytogenetic, FISH- method, paraclinical and instrumental methods of examination were used. Karyotyping was performed by the G-method of differential staining of chromosomes. Only three cases of pathology were diagnosed in the Medical Genetics Center over the last 10 years. By anamnesis data nobody in the probands’ families had bad habits, was exposed to occupational hazards, took part in the elimination of the Chernobyl accident or lived in contaminated areas. Clinical signs of diseases have not been identified in probands’ parents. All probands had trigonocephaly, bilateral epicanthal folds, ocular hypertelorism, downslanting palpebral fissures, long philtrum, flat face and nasal bridge, low set ears with malformed auricles. Two patients of three ones had exophthalmos, contracture of the second and third fingers, abnormal external genitalia. In all three cases there was monosomy of chromosome 9 of critical segment p 24. Normal karyotypes were seen in all parents, so there were three cases of new mutations of 9p deletion syndrome. Retardation of physical, psycho-spech, mental development in proband with or without congenital anomalies requires medical genetic counseling in a specialized institution. Cases of reproductive loss in anamnesis require cytogenetic investigation of fetal membranes and amniotic fluid.

Brain perfusion SPECT and FDG PET findings in a patient with ballism associated with hyperthyroidism

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Bae, Sang Kyun; Kim, Sang Jin [Pusan Paik Hospital, Pusan (Korea, Republic of)

2007-07-01

Ballism is a very rare presentation in association with hyperthyroidism. We describe a 22-year-old lady with episodes of recurrent ballism and hyperthyroidism. A 22-year-old lady was admitted to Neurology department because of sudden development of vigorous involuntary movement and dysarthria. She was diagnosed as hyperthyroidism at the age 12 and treated irregularly. She arrived at the emergency room because of sudden onset of involuntary movement. Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain was normal. Serum levels of thyroid hormone were increased (Free T4 3.15 ng/dl; normal range 0.93-1.71 ng/dl), whereas thyroid-stimulating hormone (TSH) was undetectable. The thyroid gland was diffusely enlarged and exophthalmos was found. She had been given antithyroid medication from local clinic but medicated irregularly. Technetium thyroid scan reveals diffusely enlarged thyroid with increased radioactivity. Radioiodine uptake in 24 hours was 71 %. Brain perfusion SPECT using Tc-99m ECD reveals asymmetrical perfusion pattern in basal ganglia. Brain PET using F-18 FDG reveals increased metabolism at both caudate nucleus and putamen. She was treated with radioiodine and involuntary movement was improved. There is only few report on ballism associated with hyperthyroidism and no report on functional brain imaging. Brain perfusion SPECT and FDG PET may give useful information about functional status of brain in patients with ballism associated with hyperthyroidism in case of normal anatomical finding on CT/MRI.

Síndrome de Noonan: Presentación de dos casos Noonan's syndrome: Presentation of two cases

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Lucy Pons Castro

2009-06-01

Full Text Available Se presentan las características oftalmológicas y clínicas de dos pacientes hermanos (hembra y varón con diagnóstico del síndrome de Noonan. Este es un trastorno genético que produce desarrollo anormal de múltiples partes del cuerpo. Se caracteriza por una serie de signos y particularidades físicas que pueden variar ampliamente en rango y severidad según los casos. Generalmente se transmite como un rasgo genético autosómico dominante. Los casos que presentamos se caracterizan por: estenosis valvular pulmonar, hipertelorismo, retardo mental moderado, aspecto típico de la cara con filtrum (surco vertical en el centro del labio superior, párpados gruesos, epicanto, exoftalmos y ptosis palpebral.The ophthalmological and clinical characteristics of two sibling patients (male and female diagnosed with Noonan´s syndrome were presented in this paper. This is a genetic disorder that causes abnormal development of many parts of the body. It is characterized by a series of signs and physical peculiarities that may widely vary in range and severity from one case to another. Generally, it is transmitted as a dominant autosomal genetic trait. The two cases had the following features: pulmonary valve stenosis, hypertelorism, moderate mental retardation, typical aspect of the individual's face with filtrum (vertical sulcus located in the center of the upper lip, thick eyelids, epicanthus, exophthalmos and palpebral ptosis

The Role of the Immune Response in the Pathogenesis of Thyroid Eye Disease: A Reassessment.

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James T Rosenbaum

Full Text Available Although thyroid eye disease is a common complication of Graves' disease, the pathogenesis of the orbital disease is poorly understood. Most authorities implicate the immune response as an important causal factor. We sought to clarify pathogenesis by using gene expression microarray.An international consortium of ocular pathologists and orbital surgeons contributed formalin fixed orbital biopsies. RNA was extracted from orbital tissue from 20 healthy controls, 25 patients with thyroid eye disease (TED, 25 patients with nonspecific orbital inflammation (NSOI, 7 patients with sarcoidosis and 6 patients with granulomatosis with polyangiitis (GPA. Tissue was divided into a discovery set and a validation set. Gene expression was quantified using Affymetrix U133 Plus 2.0 microarrays which include 54,000 probe sets.Principal component analysis showed that gene expression from tissue from patients with TED more closely resembled gene expression from healthy control tissue in comparison to gene expression characteristic of sarcoidosis, NSOI, or granulomatosis with polyangiitis. Unsupervised cluster dendrograms further indicated the similarity between TED and healthy controls. Heat maps based on gene expression for cytokines, chemokines, or their receptors showed that these inflammatory markers were associated with NSOI, sarcoidosis, or GPA much more frequently than with TED.This is the first study to compare gene expression in TED to gene expression associated with other causes of exophthalmos. The juxtaposition shows that inflammatory markers are far less characteristic of TED relative to other orbital inflammatory diseases.

Atypical Association of Ethmoidal Encephalocele and Hydrocephalus in an Adult Patient with Autosomal-Dominant Osteopetrosis Type I (ADO-I): A Case Report.

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Rossini, Zefferino; Castellani, Carlotta; Borsa, Stefano; Carrabba, Giorgio; Locatelli, Marco; Di Cristofori, Andrea

2016-05-01

Osteopetroses are a heterogeneous group of heritable disorders characterized by increased bone density as the result of defective osteoclast-mediated bone resorption. The autosomal-dominant osteopetrosis type I (ADO-I) is defined by the presence of osteosclerosis involving mainly the skull bones, variably associated with compression of the foramina of cranial nerves and vascular structures, hypertelorism, exophthalmos, and less commonly with hydrocephalus, pseudotumor, and Chiari malformation type I. We describe an adult patient with ADO-I presenting with an atypical association of clinical manifestations that required a tailored management. On admission, the patient complained about chronic headache, recurrent sinusitis, and postnasal drip. Findings of the examination didn't show clear signs of increased intracranial pressure, whereas imaging studies revealed thickening of the skull bones and an unexpected fistula associated with anterior ethmoidal meningoencephalocele. Some days after endoscopic transnasal closure of the fistula, a severe hypertensive hydrocephalus developed, which required a prompt ventriculoperitoneal shunt placement, complicated by a diffuse subarachnoid hemorrhage. The 6-month follow-up showed complete recovery. After reviewing the literature, we can confirm that ours was the second case of an adult ADO-I patient associated with anterior ethmoidal meningoencephalocele, the first one needing a combined treatment of the encephalocele and hydrocephalus. Because ADO-I is a rare disease with a wide spectrum of clinical manifestations, our case can represent a prototype for the future management of similar cases. Copyright © 2016. Published by Elsevier Inc.

Brain perfusion SPECT and FDG PET findings in a patient with ballism associated with hyperthyroidism

International Nuclear Information System (INIS)

Bae, Sang Kyun; Kim, Sang Jin

2007-01-01

Ballism is a very rare presentation in association with hyperthyroidism. We describe a 22-year-old lady with episodes of recurrent ballism and hyperthyroidism. A 22-year-old lady was admitted to Neurology department because of sudden development of vigorous involuntary movement and dysarthria. She was diagnosed as hyperthyroidism at the age 12 and treated irregularly. She arrived at the emergency room because of sudden onset of involuntary movement. Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain was normal. Serum levels of thyroid hormone were increased (Free T4 3.15 ng/dl; normal range 0.93-1.71 ng/dl), whereas thyroid-stimulating hormone (TSH) was undetectable. The thyroid gland was diffusely enlarged and exophthalmos was found. She had been given antithyroid medication from local clinic but medicated irregularly. Technetium thyroid scan reveals diffusely enlarged thyroid with increased radioactivity. Radioiodine uptake in 24 hours was 71 %. Brain perfusion SPECT using Tc-99m ECD reveals asymmetrical perfusion pattern in basal ganglia. Brain PET using F-18 FDG reveals increased metabolism at both caudate nucleus and putamen. She was treated with radioiodine and involuntary movement was improved. There is only few report on ballism associated with hyperthyroidism and no report on functional brain imaging. Brain perfusion SPECT and FDG PET may give useful information about functional status of brain in patients with ballism associated with hyperthyroidism in case of normal anatomical finding on CT/MRI

Graves' disease in children: long-term outcomes of medical therapy.

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Rabon, Shona; Burton, Amy M; White, Perrin C

2016-10-01

Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

The function and morphology of Meibomian glands in patients with thyroid eye disease: a preliminary study.

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Wang, Chia-Yu; Ho, Ren-Wen; Fang, Po-Chiung; Yu, Hun-Ju; Chien, Chun-Chih; Hsiao, Chang-Chun; Kuo, Ming-Tse

2018-04-12

To investigate function and morphology of the meibomian gland (MG) in patients with thyroid eye disease (TED). In this prospective case series study, patients with unilateral or bilateral TED were consecutively enrolled. The diagnosis of TED was based on the typical orbital findings and/or radiographic evidence. The disease activity of TED was classified according to the clinical activity score (CAS). Degrees of lagophthalmos and exophthalmos, blinking rates, and results of the Schirmer test 1 were also recorded. All patients completed the SPEED questionnaire and underwent MG assessment, including lipid layer thickness (LLT), MG dropout (MGd), and MG expression. In total 31 eyes from 17 patients with unilateral or bilateral TED were included. Patients were divided into inactive TED (CAS 0-1; 20 eyes from 11 patients) and active TED (CAS 2-3, 11 eyes from 6 patients) groups. MGd was significantly more severe in the active TED than the inactive TED group [Median (Inter-quartile region): 3.0 (2.0-3.0) vs. 2.0 (1.0-2.0) degree, P = 0.04]. However, patients with active TED had thicker LLT than those with inactive TED (90.0 [80.0-100.0] vs. 65.0 [47.8-82.5] nm, P = 0.02), and LLT was positively correlated with lagophthalmos (r = 0.37, P = 0.04). Patients with active TED had more severe MGd, but thicker LLT. Active TED may cause periglandular inflammation of MGs, leading to MGd, but compensatory secretion from residual MGs and lagophthalmos-induced forceful blinking might temporarily release more lipids over the tear film.

Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy

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Han, Ji Sung; Seo, Hyung Suk; Lee, Young Hen [Korea University Ansan Hospital, Department of Radiology, Ansan, Gyeonggido (Korea, Republic of); Lee, Hwa [Korea University Ansan Hospital, Department of Ophthalmology, Ansan (Korea, Republic of); Suh, Sang-il [Korea University Guro Hospital, Department of Radiology, Seoul (Korea, Republic of); Jeong, Eun-Kee; Sapkota, Nabraj [University of Utah, Utah Center for Advanced Imaging Research, Salt Lake City, UT (United States); Kim, Ki Joon [Nanoori Hospital, Department of Neurosurgery, Seoul (Korea, Republic of)

2016-12-15

To investigate the extraocular muscle (EOM) changes in thyroid-associated orbitopathy (TAO) on DTI and the correlations between DTI parameters and clinical features. Twenty TAO patients and 20 age- and sex-matched controls provided informed consent and were enrolled. Ten-directional DTI was acquired in orbit. Fractional anisotropy (FA), mean, axial, and radial diffusivities were obtained at medial and lateral EOMs in both orbits. EOM thickness was measured in patients using axial CT images. FA and diffusivities were compared between patients and controls. The relationships between DTI values and muscle thickness and exophthalmos were evaluated. DTI values compared between patients in active and inactive phases by clinical activity score of TAO. DTI values were also compared between acute and chronic stages by the duration of disease. In medial EOM, FA was significantly lower in patients (p < 0.001) and negatively correlated with muscle thickness (r = -0.604, p < 0.001). Radial diffusivity was significantly higher in patients (p = 0.010) and correlated with muscle thickness (r = 0.349, p = 0.027). In lateral EOM, DTI values did not differ between patients and controls. In the acute stage, the diffusivities of the medial rectus EOM were increased compared with the chronic stage. DTI values of the medial and lateral rectus EOM did not differ significantly between active and inactive phases. DTI can be used to diagnose TAO with FA and radial diffusivity change in EOM. Diffusivities can be used to differentiate acute and chronic stage of TAO. However, DTI values showed limitation in reflecting TAO activity according to the CAS. (orig.)

Clinical pathology observation on orbit IgG4 related disease

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Ji-Hua Guo

2015-09-01

Full Text Available AIM:To discuss clinical pathological features of orbit IgG4 related disease(IgG4-RD. METHODS: The clinical pathological materials of 23 patients(35 eyeswith orbit IgG4-RD were collected. They were observed in terms of histology and immunohistochemistry, and its clinical and pathologic characteristics were summarized. RESULTS: There were 23 patients(35 eyeswith orbit IgG4-RD(8 male patients, 9 eyes; 15 female patients, 26 eyes, with an average age of 52.1 year-old(from age 28 to 72. 19 patients(30 eyesoccured in lacrimal gland and 4 cases(5 eyesin other places, and they went to hospital for lacrimal gland cyst or exophthalmos. There were 11 cases in one side and 12 cases in both sides. The disease lasted from 1mo to 10a, averaging 27mo. It recureded in one patient(1 eyeafter 1mo. In general inspection: Gray nodular goiter, thin fibrous coat wrapping around the lacrimal gland could be observed. Histologic characteristics: lacrimal gland bubble and catheter group shrinked or even disappeared, substituted by lymphocyte, plasma cells and lymphoid follicle and accompanied with fibrosis. Immunohistochemical staining: IgG4 positive plasma cells of 23 cases(35 eyeswas >50/HPF, and IgG4/IgG ratio of positive plasma cells was >40%. CONCLUSION: Orbit IgG4-RD mainly occures in lacrimal gland tissue, and expression of IgG4 can be detected through histologic characteristics and immunohistochemical staining. IgG4-RD should be screened, prevented and treated in the early phase.

Spontaneous carotid-cavernous sinus fistula disappeared following cobalt 60 irradiation. Case report

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Satoh, Toru; Yamamoto, Yuji; Asari, Syoji (Matsuyama Shimin Hospital, Ehime (Japan))

1983-12-01

The authors reported a case of spontaneous carotid-cavernous sinus fistula fed by meningohypophyseal trunk of the internal carotid artery, that completely disappeared following cobalt 60 irradiation to the region of fistula (27 days; total dose, 4,100 rad). A 65-year-old man was admitted to our hospital on May 25, 1982, with a two-week history of progressive prominence of the left eye, diplopia on left lateral gaze, and continuous intracranial bruit. He first noted redness of the left eye without apparent cause such as head trauma. On admission, slight nonpulsative exophthalmos, periorbital edema, chemosis, and venous congestion of the conjunctiva of the left eye were noted. The pupils were reactive and equal in size, and the left abducent nerve palsy was observed. Fundoscopic examination disclosed to be normal. No bruit was heard over the left orbital region. Left carotid angiography on May 28 demonstrated dural internal carotid-cavernous sinus fistula fed by meningohypophyseal trunk, and drained into superior and inferior ophthalmic veins and basilar venous plexus. Though the patient was treated only conservatively, symptoms became worse to decrease visual acuity. On July 14, we started cobalt 60 irradiation to the region of fistula (27 days; total dose 4,100 rad). Symptoms gradually improved about halfway through irradiation. After completion of irradiation, almost complete improvement of visual and ocular symptoms was observed except the left abducent nerve palsy. Repeated angiography on Aug. 20 revealed complete disappearance of fistula. Three months after treatment, no recurrence of symptoms was observed and the abducent nerve palsy persisted without improvement.

Hipertiroidismo neonatal: presentación de 2 pacientes Neonatal hyperthyroidism: Report of 2 cases

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Pedro González Fernández

2002-08-01

Full Text Available Se presentaron 2 pacientes con diagnóstico de hipertiroidismo neonatal: uno del sexo masculino y otro del femenino; con antecedentes de ser hijos de madres con enfermedad de Graves; una de ellas se encontraba sin tratamiento, y con síntomas de hipertiroidismo y la otra con tratamiento y tenía controlada esa afección. Se realizó el diagnóstico por los antecedentes de ser hijos de madres con enfermedad de Graves Basedow; así como por las manifestaciones clínicas: bocio, exoftalmos, pérdida de peso, irritabilidad, taquicardia e insuficiencia cardíaca en uno de los pacientes. Según los exámenes de laboratorio realizados, se obtuvieron los resultados siguientes: T4 ³ 180 nmol/L y TSH 2 patients with diagnosis of neonatal hyperthyroidism, a male and a female, are presented. Their mothers suffer from Graves’ disease, one of them has no treatment and presents symptoms of hyperthyroidism, and the other is under treatment and her disease is under control. The diagnosis was made taking into account that they are children from mothers with Graves Basedow’ disease and the following clinical manifestations: goiter, exophthalmos, weight loss, irritability, tachycardia and cardiac insufficiency in one of the patients. The results of the laboratory tests for both patients were: T4 ³ l80 nmol/L and TSH < 1 U/L. Treatment with propylthiouracilo, propanolol and phenobarbital as well as general measures and digitalis therapy in the patient requiring it were indicated. A favorable evolution was observed in these 2 patients.

[Clinical feature of chronic compressive optic neuropathy without optic atrophy].

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Jiang, Libin; Shi, Jitong; Liu, Wendong; Kang, Jun; Wang, Ningli

2014-12-01

To investigate the clinical feature of the chronic compressive optic neuropathy without optic atrophy. Retrospective cases series study. The clinical data of 25 patients (37 eyes) with chronic compressive optic neuropathy without optic atrophy, treated in Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, from October, 2005 to March, 2014, were collected. Those patients had been showing visual symptoms for 6 months or longer, but missed diagnosed or misdiagnosed as other eye diseases due to their normal or slightly changed fundi. The collected data including visual acuities, visual fields, neuroimaging and/or pathologic diagnosis were analyzed. Among the 25 patients, there were 5 males and 20 females, and their ages range from 9 to 74 years [average (47.5 ± 13.4) years]. All patients suffered progressive impaired vision in single eye or both eyes, without exophthalmos or abnormal eye movements. Except one patient had a headache, other patients did not show systemic symptoms. The corrected visual acuities were between HM to 1.0, and their appearances of optic discs and colors of fundi were normal. After neuroimaging and/or pathological examination, it was proven that 14 patients suffered tuberculum sellae meningiomas, 5 patients with hypophysoma, 3 patient with optic nerve sheath meningioma in orbital apex, 1 patient with cavernous hemangioma, 1 patient with vascular malformation in orbital apex and 1 patient with optic nerve glioma. Among the 19 patients whose suffered occupied lesions of saddle area, 14 patients underwent visual field examinations, and only 4 patients showed classic visual field defects caused by optic chiasmal lesions. Occult progressive visual loss was the most important clinical feature of the disease.

One-Stage Treatment for Adult Patients With Crouzonoid Appearance by Orthognathic and Face Contouring Surgery.

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Kim, Byung Jun; Bae, Hahn Sol; Lee, Yoonho

2017-07-01

Crouzon syndrome is a rare genetic disorder with autosomal-dominant inheritance that shows a triad of hallmark characteristics: craniosynostosis, exophthalmos, and midface retrusion. General treatment protocol for patients with Crouzon syndrome has already been established, but there is no standard treatment strategy for adult patients with Crouzonoid appearance. The authors present clinical patients of 1-stage orthognathic and face contouring surgery to achieve functional and aesthetic improvement.One-stage surgery was performed in adult patients with Crouzonoid appearance without a history of facial surgery. Orthognathic 2-jaw surgery was first performed to treat class III malocclusion. Face contouring surgery was conducted next to improve the aesthetic appearance using midface augmentation with onlay rib bone graft, advancement genioplasty, augmentation rhinoplasty, and ancillary procedures such as neck lift, fat graft, or fillers.Five patients (2 men, 3 women) were enrolled in this study. The mean age at the time of surgery was 19.0 years. No specific surgery-related complications such as infection, nerve injury, or recurred malocclusion were observed during the 3.5 years of follow-up. Normal class I occlusion was reached in all patients. The frontonasal angle, nasolabial angle, and labiomental angle improved from 125.1° to 135.1° (P > 0.05), 60.9° to 86.3° (P = 0.018), and 146.3° to 125.0° (P = 0.018), respectively. The Global Aesthetic Improvement Scale score was 4.75 and 5.00 in frontal and profile views, respectively.One-stage orthognathic and face contouring surgery may be an effective surgical option with good postoperative functional and aesthetic improvement in adult patients with Crouzonoid appearance.

The Study on the Thyroid Disease

International Nuclear Information System (INIS)

Lee, Mun Ho

1982-01-01

Several recent advances in our knowledge of thyroid physiology have broad application to the diagnosis and management of thyroid disorders. For in the thyroid, more than other end-ocrine organs, pathophysiology can be translated directly into the diagnosis and management of thyroid disease. Graves' disease is a syndrome including goiter with hyperthyroidism, exophthalmos and dermatopathy. The pathogenesis of Graves' disease is not yet clearly identified, but various autoantibodies to the thyroid gland and immunapathalogic studied indicate that autoimmune processes are involved in the pathogenesis of the disease. The diagnosis and management of Graves' disease are largely dependent on radionuclide technique as radioimmunoassay, radioactive iodine therapy and so on. Several laboratory tests are also developed to determine the remission of this disease including TRH stimulation test, T 3 , suppression test and detection of thyroid stimulating immunoglobulins. Autoimmune thyroiditis is almost certainly a primary immunologic disease and the incidence tends to increase recently, mainly due to the application of biopsy technique is thyroid diseases. Thyroid nodules have been a great challenge to physicians because of the possibility of malignancy. But recently, cytologic examination of thyroid aspirate provides a very simple and also reliable diagnostic method in patients with thyroid nodules. In 163 patients with thyroid nodules, only 19.3% was revealed to be malignant. Therefore cytologic examination of thyroid aspirate and thyroid biopsy should be included in the diagnosis of nodular patients prior to surgical intervention. In this paper, a comprehensive review is presented on the pathogenesis, clinical features, laboratory findings and therapeutic modalities of various thyroid diseases on the basis of over 80 researches performed during the past 20 years at radioisotope clinic, Seoul National University Hospital.

Retrobulbar vs peribulbar regional anesthesia techniques using bupivacaine in dogs.

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Shilo-Benjamini, Yael; Pascoe, Peter J; Maggs, David J; Hollingsworth, Steven R; Strom, Ann R; Good, Kathryn L; Thomasy, Sara M; Kass, Philip H; Wisner, Erik R

2018-05-15

To compare the effectiveness of retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA) in dogs. Six adult mixed-breed dogs (18-24 kg). In a randomized, masked, crossover trial with a 10-day washout period, each dog was sedated with intravenously administered dexmedetomidine and administered 0.5% bupivacaine:iopamidol (4:1) as RBA (2 mL via a ventrolateral site) or PBA (5 mL divided equally between ventrolateral and dorsomedial sites). The contralateral eye acted as control. Injectate distribution was evaluated by computed tomography. Following intramuscularly administered atipamezole, corneal and periocular skin sensation, intraocular pressure (IOP), and ocular reflexes, and appearance were evaluated for 24 hours. Comparisons were performed with mixed-effects linear regression (IOP) or the exact Wilcoxon signed rank test (scores). Significance was set at P ≤ .05. Injectate distribution was intraconal in 2/6 RBA- and 4/6 PBA-injected eyes. Eyes undergoing PBA had significantly reduced lateral, ventral, and dorsal periocular skin sensation for 2-3 hours, and significantly reduced corneal sensitivity for 4 hours, relative to control eyes. Chemosis and exophthalmos occurred in 33%-40% of eyes undergoing RBA and 83%-100% eyes undergoing PBA but resolved within 14 hours. Anterior uveitis developed in 2/6 and 1/6 eyes of RBA and PBA, respectively, of them corneal ulcer developed in one eye of each treatment. Both resolved 1-3 days following medical treatment. Peribulbar injection produced notable anesthesia more reliably than did retrobulbar injection. Both techniques may produce adverse effects, although the uveitis/ulcer could have resulted from the contrast agent used. © 2018 American College of Veterinary Ophthalmologists.

[A case of pycnodysostosis--observation of the skull by CT scan].

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Anegawa, S; Bekki, Y; Furukawa, Y; Yokota, S; Torigoe, R

1987-07-01

A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows--proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtual loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorithm revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinuses and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethmoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfism. Pycnodysostosis is a generalized skeletal disease whose cardinal features are moderate generalized osteosclerosis and dwarfism. However, the detailed observation on the cranium by CT has not been reported. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification.(ABSTRACT TRUNCATED AT 250 WORDS)

Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients

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Kirsch, M. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Universitaetsklinikum Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Henkes, H.; Liebig, T.; Weber, W.; Golik, S.; Kuehne, D. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Esser, J. [Universitaetsklinikum Essen, Zentrum fuer Augenheilkunde, Essen (Germany)

2006-07-15

Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved. (orig.)

A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia

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Elayne Christinne Marcelino e Silva

2017-07-01

Full Text Available Introduction: Splenomegaly and pancytopenia are rare complications of Graves' disease with few reports in the literature about this association. The pathogenesis is unknown and immunological mechanisms seem to be involved. The possibility of hyperthyroidsm should always considered in patients with pancytopenia. Objective: Describe  clinical case of association between Grave's disease, splenomegaly and pancytopenia. Method: This is a case report, obtained through data from medical records of a reference hospital located in the city of Juazeiro do Norte, Ceara, Brazil. Case report: Patient, 46 years old, female, sought treatment at a reference hospital with abdominal pain that started two days earlier, prevalent in mesogastric region and left hypochondrium very intense and recurrent, associated with significant consuptive syndrome ( loss of 10 Kg in 4 months, asthenia, dyspnea on minimum exertion, irritability and fine tremor in extremitie. SHe denied fever, palpitations, heat intolerance, skin ou eye changes. A diffuse thyroid enlargement with the presence of thrill and murmur, digital clubbing, fixed and bright look, light exophthalmos and splenomegaly about 6 cm below the left costal margin were abserved after physical examination. Ultrasound examination (USG of the abdomen and CT scan showed moderate splenomegaly. Laboratory tests showed normocytic and normochromic anemia, leukocytosis and mild thrombocytopenia. Thyroid USG showed characteristic features of Graves' disease, a bone marrow biopsy revealed maturation preserved in all strains and lack of fibrosis and megakaryocytes present in normal number without atypia. treatment was set with propylthiouracil 300 mg a day and after the first revaluation after hospital discharge three weeks later a regression of splenomegaly has been observed. Conclusion: This case ilustrates the rare association between hyperthyroidism and splenomegaly with pancytopenia.

[Pediatric case series in an ophthalmic camp in Turkana (Kenya)].

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Noval, S; Cabrejas, L; Jarrín, E; Ruiz-Guerrero, M; Ciancas, E

2013-12-01

Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. To describe the pediatric population attended to in the last «Turkana Eye Project» Camp. Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

Inquiry about 131 Iodine use in Brazil; Inquerito sobre o uso do Iodo-131 no Brasil

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Albino, Claudio Cordeiro; Takahashi, Mirian Hideko; Senhorini Junior, Sidney; Graf, Hans [Parana Univ., Curitiba, PR (Brazil); Inst. de Diabetes e Endocrinologia de Maringa, PR (Brazil)]. E-mail: ccalbino@uol.com.br

2001-12-01

Radioactive iodine is an effective and widely accepted therapy for Graves disease (G D) and differentiated thyroid carcinoma (DTC), but there still are some controversies about the criteria for its use. To establish the present tendency for radioiodine indication, we have sent questionnaires for members of The Brazilian Society of Endocrinology and Latin American Thyroid Society, with 3 index cases: G D, toxic nodular goiter (TNG) and DTC. For each case, questions were proposed about diagnostic procedures and therapy with some clinical variants, which could modify the therapeutic choice. From the almost 2000 questionnaires sent only 82 replies (3.4%) were analyzed. Most of respondents defined themselves as general endocrinologists (85%), working in South and Southeast regions of Brazil (80%), with more than 20 years of professional activity and working mainly at University Hospitals (40%). In case index 1 (G D), 95% of the respondents used arrays of T 3, T 4 and TSH for the diagnosis and 25% added TRAb and thyroid scan. Antithyroid drugs (ATD) were the first choice for 72%, followed by radioiodine and surgery (26% and 1.3% respectively). None of clinical variants such as severe exophthalmos, older age or goiter size modified the therapy. In case 2 (TNG), radioiodine was the first therapy for 84% of professionals and the presence of compressive symptoms was the only variant that changed this tendency, when surgery was the main option. In case 3 (DTC), almost all indicated total thyroidectomy. Radioiodine for thyroid remnants was proposed by 45% of respondents, independent of residual uptake, while the remaining did so depending of different values of uptake, giving 30 to 100 mCI. These data show that radioiodine use is increasing for hyperthyroidism, but still less than observed in other countries and that we do not have uniformity for treatment of DTC. (author)

A case of pycnodysostosis

International Nuclear Information System (INIS)

Anegawa, Shigetaka; Bekki, Yoshiaki; Furukawa, Yasuhiro; Yokota, Seishi; Torigoe, Ryuichiro.

1987-01-01

A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows - proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtural loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorythum revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinussus and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethomoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfish. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification. Furthermore, sutures or synchondroses in the skull base were well-developed than those of the convex. So, it is considered that pycnodysostosis must be the neighboring entity of diseases such as achondroplastic dwarfism or cleidocranial dysplasia. (J.P.N.)

The Incidence of Hypothyroidism Following the Radioactive Iodine Treatment of Graves’ Disease and the Predictive Factors Influencing its Development

International Nuclear Information System (INIS)

Husseni, Maha Abd El-Kareem El-Sayed

2016-01-01

The purpose of this study is to evaluate and compare the incidence of hypothyroidism following different fixed radioactive iodine-131 ( 131 I) activities in the treatment of Graves’ disease (GD) and to investigate the predictive factors that may influence its occurrence. This retrospective analysis was performed on 272 patients with GD who were treated with 131 I, among whom 125 received 370 MBq and 147 received 555 MBq. The outcome was categorized as hypothyroidism, euthyroidism, and persistent hyperthyroidism. Multiple logistic regression analysis was performed to identify significant risk factors that affect the development of hypothyroidism. The incidence of hypothyroidism following the first low activity was 24.8% with a high treatment failure rate of 58.4%, compared with 48.3% and 32% following high activity. The overall cumulative incidence of hypothyroidism following repeated activities was 50.7%, out of which 73.9% occurred after the first activity and 20.3% after the second activity. The higher 131 I activity (P < 0.001) and average and mild enlargement of the thyroid gland (P = 0.004) were identified as significant independent factors that increase the rate of incidence of hypothyroidism (Odds ratios were 2.95 and 2.59). No correlation was found between the development of hypothyroidism and the factors such as age, gender, presence of exophthalmos, previous antithyroid medications, and the durations, and Technetium-99m (Tc-99m) pertechnetate thyroid uptake. In view of the high treatment failure rate after first low activity and lower post high activity hypothyroid incidence, high activity is recommended for GD patients, reserving the use of 370MBq for patients with average sized and mildly enlarged goiter; this increases patient convenience by avoiding multiple activities to achieve cure and long-term follow-up

Clinical outcome during the peri-operative (thyroidectomy) period of severely hyperthyroid patients with normalized pre-operative free-T4 levels: Importance of I-131 therapy as a part of pre-operative preparation

International Nuclear Information System (INIS)

Siguan-Crisaldo, M.A.L.; Mercado-Asis, L.B.

2005-01-01

Thyroidectomy is performed for hyperthyroidism on patients who do not respond to or are not compliant with medical therapy and in patients with very large goiters causing compressive symptoms. All thyrotoxic patients undergoing thyroidectomy usually are first treated with anti-thyroid drugs to normalize free thyroid hormone levels and render them euthyroid before surgery in order to prevent complications particularly thyroid storm and circulatory collapse. In this case series, we describe the clinical outcome during the perioperative (thyroidectomy) period of three severely hyperthyroid patients, two females and one male, with ages ranging from 13 to 38 years. All patients had grade III goiter, and only one had exophthalmos. The mean duration of goiter was 3.6 years. All of them were given preoperative treatment consisting of propylthiouracil (PTU) at 450-600 mg/day; iodone, 3 tablets daily and propranolol at 30-120 mg/day for one month. All of them had normalized preoperative thyroid function tests. In addition to the preoperative medications mentioned above, all three patients received radioactive iodine therapy before surgery. The first two patients received relatively low doses of 8.0 and 7.5 mCi of I-131 respectively. Unfortunately the first patient had supraventricular tachycardia (SVT), post skin cutting and the other one went into thyroid storm. The third patient who received a cumulative dose of 23.5 mCi of I-131 before surgery had an uneventful postoperative course. It is concluded that normalization of thyroid hormone parameters, especially free T4 is not sufficient for an uneventful and uncomplicated peri-thyroidectomy period in severely hyperthyroid patients with large goiters. Effective radioactive iodine therapy might prove to be helpful in inducing thyroid tissue fibrosis, thus leading to true clinical euthyroidism and excellent clinical course postoperatively. (author)

Clinical and radiological manifestations of paraneoplastic syndrome of bronchogenic carcinoma

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Goldner Branislav

2005-01-01

Full Text Available The objective of this study was to present some clinical and radiological manifestations of PNS in relation to bronchogenic carcinoma (BC and to evaluate the usefulness of imaging findings in the diagnosis of asymptomatic BC. In the study group of 204 patients (146 male and 58 female with proven bronchogenic carcinoma, PNS was present in 18 (8.62% patients. The patients with PNS were divided into two groups. The first one consisted of 13 (72.2% patients with symptoms related to primary tumours while the second one consisted of 5 (27.7% patients with symptoms, at initial appearance, indicative of disorders of other organs and systems. The predominant disorder was Lambert-Eaton Syndrome, associated with small-cell carcinoma. Endocrine manifestations included: inappropriate antidiuretic hormone production syndrome (small-cell carcinoma, a gonadotropin effect with gynaecomastia and testicular atrophy (planocellular carcinoma, small-cell carcinoma, a case of Cushing Syndrome (small-cell carcinoma, and hyper-calcaemia, due to the production of the parathyroid hormone-related peptide, which was associated with planocellular carcinoma. A rare case of bilateral exophthalmos was found as PNS at adenocarcinoma. Digital clubbing and hypertrophic osteoarthropathy (HO were associated with planocellular and adenocarcinoma, while clubbing was much more common than HO, especially among women. The differences between the two groups were related to the time of PNS appearance. In the first group, PNS occurred late on in the illness, while in the second group, PNS preceded the diagnosis of BC. Alternatively, the disappearance of a clinical or a radiological manifestation of PNS after surgery or chemotherapy may be an indicator of an improvement in health or PNS may be the first sign of illness recurrence. Radiological manifestations of PNS in asymptomatic patients may serve as a useful screen for identifying primary BC. In symptomatic patients, it may be an

The effects of radioiodine therapy on peripheral blood lymphocyte subpopulations in patients with Graves' disease. Preliminary report

International Nuclear Information System (INIS)

Turowska, M.D.; Rogowski, F.; Turowski, D.; Wysocka, J.

2002-01-01

Treatment of Graves' disease patients with radioactive iodide ( 131 I) is becoming the standard therapy in an increasing group of cases but can induce alterations in immune response, like increasing levels of thyroid autoantibodies, and, in part, exacerbation of ophthalmopathy. The aim of this study was to assess the changes in peripheral blood (PB) lymphocyte subpopulations after 131 I treatment of patients with Graves' disease. The study was carried out in a group of 30 patients with Graves' disease (23 f; 7 m) 49.5±10.0 years of age, 26 with different subjective ocular signs like gritty sensation, increased lacrimation, orbital pain, and exophthalmos. PB lymphocyte subsets were analysed by cytofluorometry, serum concentration of TSH and fT4 were evaluated before and 6 weeks after radioiodine treatment. After 131 I treatment a significant increase in CD3+, CD4+, CD3+HLA-DR+ and a decrease in CD19+ percentages of lymphocyte subsets were found in comparison with the initial evaluation. No significant changes in percentage of CD8+ and NK (CD3-CD16+ CD56+) cells were observed during this study. A significant increase in TSH and a slight decrease in fT4 concentration concentration took place in the 6th week after 131 I application. The patients without subjective improvement of ocular signs during the therapy initially had a percentage of CD3+, CD8+ lymphocytes which was significantly lower compared with those with regression of ocular signs observed after 131 I treatment. The changes in PB lymphocyte subsets caused by 131 I treatment of Graves' disease confirm the involvement of acquired cellular immunity after radiation damage of the thyroid gland. The decreased initial percentage of CD8+ and CD3+ lymphocytes could help make a prediction of ocular symptoms persisting after radioiodine treatment in some patients with ophthalmopathy. (author)

Case of pycnodysostosis. Observation of skull by CT scan

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Anegawa, Shigetaka; Bekki, Yoshiaki; Furukawa, Yasuhiro; Yokota, Seishi; Torigoe, Ryuichiro

1987-07-01

A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows - proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtural loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorythum revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinussus and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethomoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfish. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification. Furthermore, sutures or synchondroses in the skull base were well-developed than those of the convex. So, it is considered that pycnodysostosis must be the neighboring entity of diseases such as achondroplastic dwarfism or cleidocranial dysplasia. (J.P.N.).

Inquiry about 131 Iodine use in Brazil

International Nuclear Information System (INIS)

Albino, Claudio Cordeiro; Takahashi, Mirian Hideko; Senhorini Junior, Sidney; Graf, Hans

2001-01-01

Radioactive iodine is an effective and widely accepted therapy for Graves disease (G D) and differentiated thyroid carcinoma (DTC), but there still are some controversies about the criteria for its use. To establish the present tendency for radioiodine indication, we have sent questionnaires for members of The Brazilian Society of Endocrinology and Latin American Thyroid Society, with 3 index cases: G D, toxic nodular goiter (TNG) and DTC. For each case, questions were proposed about diagnostic procedures and therapy with some clinical variants, which could modify the therapeutic choice. From the almost 2000 questionnaires sent only 82 replies (3.4%) were analyzed. Most of respondents defined themselves as general endocrinologists (85%), working in South and Southeast regions of Brazil (80%), with more than 20 years of professional activity and working mainly at University Hospitals (40%). In case index 1 (G D), 95% of the respondents used arrays of T 3, T 4 and TSH for the diagnosis and 25% added TRAb and thyroid scan. Antithyroid drugs (ATD) were the first choice for 72%, followed by radioiodine and surgery (26% and 1.3% respectively). None of clinical variants such as severe exophthalmos, older age or goiter size modified the therapy. In case 2 (TNG), radioiodine was the first therapy for 84% of professionals and the presence of compressive symptoms was the only variant that changed this tendency, when surgery was the main option. In case 3 (DTC), almost all indicated total thyroidectomy. Radioiodine for thyroid remnants was proposed by 45% of respondents, independent of residual uptake, while the remaining did so depending of different values of uptake, giving 30 to 100 mCI. These data show that radioiodine use is increasing for hyperthyroidism, but still less than observed in other countries and that we do not have uniformity for treatment of DTC. (author)

[Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)].

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Diagne, Nafissatou; Faye, Atoumane; Ndao, Awa Cheikh; Djiba, Boundia; Kane, Baidy Sy; Ndongo, Souhaibou; Pouye, Abdoulaye

2016-01-01

Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.

Endovascular treatment for arterial injuries of skull base

International Nuclear Information System (INIS)

Li Tianxiao; Bai Weixing; Zai Suiting; Wang Ziliang; Xue Jiangyu

2008-01-01

Objective: To explore the role of endovascular techniques in treatment for arterial injuries of skull base. Methods: A total of 53 consecutive cases suffered from skull base arterial injuries were enrolled in our hospital from Oct 2004 to May 2007, including 44 male and 9 female cases with average age of 23.3 years. Thirty-nine cases presented with pulsatile exophthalmos and intracranial vascular murmur, cerchnus and dysphagia in another 9, epistaxis in the remaining 5 cases. Diagnosis of 39 carotid cavernous fistulae (CCF)and 14 carotid pseudoaneurysm were performed by angiography (DSA). Alternative endovascular procedures were performed depending on lesions characteristics and follow-up was done by telephone and outpatient work up. Results: Procedures were performed involving 56 carotid arteries in all 53 cases including 34 CCF with embolization of detachable balloon(33 cases), 3 with balloon and coils, and 3 by stent-graft placement. 8 carotid pseudoaneurysms were cured by parent artery occlusion with balloon, 2 experienced endovascular isolation with balloon and coils, and 4 with stent-graft. Follow-up for mean 9.5 months (range from 2 to 25 months) revealed that the chief symptoms of 45 cases (85%) were relieved within 6 months after the procedure but ocular movement and visual disorder remained in 8 cases (15%)till 12 months. Six pseudoaneurysms and 3 residual leak were found in reexamination, of which 2 cases underwent intervention again 2 and 3 months later due to dural arterial-venous fistula in cavernous sinus, respectively. Conclusions: Endovascular treatment is safe and effective therapeutic option with minimal invasion for skull base arterial injuries. Detachable balloon embolization is the first choice for CCF and carotid pseudoaneurysm. Spring coil packing and stent-graft implantation should be in alternation as combination for special cases. (authors)

Evaluation of the patients with Grave's ophthalmopathy after the corticosteroids treatment.

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Petrović, Mirjana Janićijević; Sarenac, Tatjana; Srećković, Suncica; Petrović, Marko; Vulović, Dejan; Janićijević, Katarina

2012-03-01

Graves' ophthalmopthy is one of the most common causes of exophthalmos as well as the most common manifestation of Graves' disease. The treatment of Graves' ophthalmopathy includes ophthalmological and endocrinological therapy. The aim of this study was to clinically evaluate the patients with Graves' ophthalmopathy treated with corticosteroids. Evaluation of 21 patients was performed in the Ophthalmology Clinic and Endocrinology Clinic, Clinical Centre Kragujevac, in the period from 2009 to 2010. They were treated with pulse doses of intravenous corticosteroids. They were referred to ophthalmologist by endocrinologist in euthyroid condition in the active phase of Graves' ophthalmopathy (ultrasonography of orbit findings and positive findings of antithyroid stimulating hormone receptor antibody--anti-TSH R Ab). The clinical activity score (CAS) and NO SPECS classification for evaluation of disease severity were used. Ophthalmological examination includes: best corrected visual acuity, slit-lamp exam, Hertels' test, direct ophthalmoscopy and ultrasonography of the orbit. According to our results 76.19% of the patients were female; mean age of the patients was 35.2 +/- 5.6 years. According to CAS classification after 6 months of the treatment recovery was shown in 23.81% of the patients, partial amelioration in 47.62% and no clinical amelioration in 28.57% of the patients. We achieved better results with male, young patients with high clinical activity score. Good results were observed after the first dose of corticosteroids, much better CAS after the third dose, which maintained until 6 months after the first treatment. Our results signify that intravenous pulse dose of corticosteroids treatment of the patients with Graves' ophthalmopthy is safe, comfortable, clinically justified and accessible for the clinicians and patients. Positive results are achieved after the first dose with increasing trend up to the third dose, which was maintained for the next three months.

A Study on the Clinical Diagnosis of Hyperthyroidism

International Nuclear Information System (INIS)

Ku, In Soo; Koh, Chang Soon; Lee, Mun Ho

1973-01-01

To attain a simple and reliable method of evaluating the thyroid function the reliability of the clinical manifestation and the conventional thyroid function tests in diagnosing the hyperthyroidism was studied. The subjects included 184 patients with hyperthyroidism and 66 cases with euthyroidism, who were treated at the Thyroid Clinic, Seoul National University Hospital, from July 1971 through August 1972. The observed results were as follows: l. In the cases of hyperthyroidism, 19% of the patients were male and 81% female; in the cases of euthyroidism, 7. 6% of the patients were male and 92. 4% female. The majority of the patients were in 2nd to 4th decades of their lives. 2. There were objective signs clearly manifested in hyperthyroidism which were rare or absent in the euthyroid state. These clinical signs included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor, and warm skin. In the hyperthyroid state 91. 3% of the cases manifested two or more of the above signs, whereas in the euthyroid state no patients manifested any two of the above signs. 3. The most frequent complaints of the patients with thyroid disease were palpitation, weight low, increased appetite, heat intolerance, perspiration, hunger feeling; nervousness, exertional dyapnea, etc. There was no clear difference in the incidence of the symptoms between hyperthyroidism and euthyroidism. 4. In the diagnosis of hyperthyroidism, the reliability of thyroid function tests was as follows: T 7 was 92. 4% reliable, 125 IT 3 resin uptake rate 91. 6% reliable, 131 I thyroid uptake rate in 24 hrs. 89. 4% reliable, serum T 4 level 85. 9% reliable and BMR 75. 5% reliable. Therefore the careful observation of the clinical manifestation of the disease is a simple and reliable way of making a correct diagnosis of either hyperthyroidism or euthymidism. 5. In hyperthyroidism there shows no correlationship between the results of the thyroid function test and clinical signs but a high BMR was

A Study on the Clinical Diagnosis of Hyperthyroidism

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Ku, In Soo; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1973-03-15

To attain a simple and reliable method of evaluating the thyroid function the reliability of the clinical manifestation and the conventional thyroid function tests in diagnosing the hyperthyroidism was studied. The subjects included 184 patients with hyperthyroidism and 66 cases with euthyroidism, who were treated at the Thyroid Clinic, Seoul National University Hospital, from July 1971 through August 1972. The observed results were as follows: l. In the cases of hyperthyroidism, 19% of the patients were male and 81% female; in the cases of euthyroidism, 7. 6% of the patients were male and 92. 4% female. The majority of the patients were in 2nd to 4th decades of their lives. 2. There were objective signs clearly manifested in hyperthyroidism which were rare or absent in the euthyroid state. These clinical signs included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor, and warm skin. In the hyperthyroid state 91. 3% of the cases manifested two or more of the above signs, whereas in the euthyroid state no patients manifested any two of the above signs. 3. The most frequent complaints of the patients with thyroid disease were palpitation, weight low, increased appetite, heat intolerance, perspiration, hunger feeling; nervousness, exertional dyapnea, etc. There was no clear difference in the incidence of the symptoms between hyperthyroidism and euthyroidism. 4. In the diagnosis of hyperthyroidism, the reliability of thyroid function tests was as follows: T{sub 7} was 92. 4% reliable, {sup 125}IT{sub 3} resin uptake rate 91. 6% reliable, {sup 131}I thyroid uptake rate in 24 hrs. 89. 4% reliable, serum T{sub 4} level 85. 9% reliable and BMR 75. 5% reliable. Therefore the careful observation of the clinical manifestation of the disease is a simple and reliable way of making a correct diagnosis of either hyperthyroidism or euthymidism. 5. In hyperthyroidism there shows no correlationship between the results of the thyroid function test and clinical

355 Ocular Muscles Myopathy Associated with Autoimmune Thyroiditis. Case Reports

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Vargas-Camaño, Eugenia; Castrejon-Vázquez, Isabel; Plazola-Hernández, Sara I.; Moguel-Ancheita, Silvia

2012-01-01

Background Thyroid-associated orbitopathy is commonly associated with Graves' disease with lid retraction, exophthalmos, and periorbital swelling, but rarely with autoimmune thyroiditis or euthyroid state. We reviewed 3 cases from our hospital whose antibodies to anti-receptor of TSH were normal. Methods Case 1: 60 year-old non-diabetic woman with bilateral glaucoma in treatment, recurrent media otitis and euthyroidism, acute onset of painless diplopia, and lid ptosis in the left eye. MRI of orbit showed increased size of the III right cranial pair and high levels of thyroid autoantibodies (Tab) anti-tiroglobulin (ATG) 115.1, anti-thyroid peroxidase (ATPO) 1751 U/mL. She started oral deflazacort 30 mg each 3 days. Sixty days later, complete remission of eye symptoms correlated with lower auto-antibodies level (ATG 19 ATPO 117). Case 2: 10 year-old girl. At age 8, she had diplopia, lid ptosis and limitations of upper gaze in the left eye. The neurological study discarded ocular myasthenia; with thyroid goitier, and hypothyrodism, she started oral levothyroxin. At age 10 with normal IRM Botulinic toxin was injected, without change. High levels of Tab were found, ATG 2723, ATPO 10.7. She started oral deflazacort 30 mg each 3 days, azathioprin 100 mg, daily. Actually, Tab levels are almost normal, but she remains with ocular alterations. Case 3: 56 year-old woman, Grave´s disease with exophtalmos in 1990, treated with I131 and immunosupression, with good outcome; obesity, hypertension and bilateral glaucoma in treatment. She suddenly presented diplopia and IV pair paresia of the right eye. A year later, ATb were found slightly elevated, ATG 100 years ATPO 227; despite prednisone 50 mg, each 3 days and azathioprin 150 mg/daily treatment, a surgical procedure was required for relieve the ocular symptoms. Results We found only 3 cases previously reported with this type of eye thyroid disease. Is important to note that awareness of this atypical form of orbitopathy

Thyrotoxic and pheochromocytoma multisystem crisis: a case report.

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Suzuki, Kodai; Miyake, Takahito; Okada, Hideshi; Yamaji, Fuminori; Kitagawa, Yuichiro; Fukuta, Tetsuya; Yasuda, Ryu; Tanaka, Yoshihito; Okamoto, Haruka; Nachi, Sho; Doi, Tomoaki; Yoshida, Takahiro; Kumada, Keisuke; Yoshida, Shozo; Ushikoshi, Hiroaki; Toyoda, Izumi; Ogura, Shinji

2017-06-23

Thyrotoxic crisis and pheochromocytoma multisystem crisis are rare, life-threatening, emergency endocrine diseases with various clinical manifestations. Here we report a case of a patient who simultaneously developed thyrotoxic crisis and pheochromocytoma multisystem crisis and required intensive cardiovascular management. A 60-year-old Asian man experienced nausea and vomiting, and subsequently developed dyspnea and cold sweats while farming. His serum free thyroxine, free triiodothyronine, and thyrotropin receptor antibody levels were elevated at 2.9 ng/dL, 7.2 pg/dL, and 4.7 IU/L, respectively. Serum thyrotropin levels were suppressed at less than 0.01 μIU/mL. Thyroid echography demonstrated no thyroid swelling (23 × 43 mm). A whole body computed tomography was performed for systemic evaluation. This revealed exophthalmos and a mass of size 57 × 64 mm in the anterior pararenal space. Based on these findings, we made an initial diagnosis of thyrotoxic crisis secondary to exacerbation of Grave's hyperthyroidism. Treatment was begun with an iodine agent at a dose of 36 mg/day, thiamazole at a dose of 30 mg/day, and hydrocortisone at a dose of 300 mg daily for 3 consecutive days. To control tachycardia, continuous intravenously administered propranolol and diltiazem infusions were given. At the same time, small doses of doxazosin and carvedilol were used for both alpha and beta adrenergic blockade. On hospital day 5, his blood pressure and serum catecholamine concentrations (adrenalin 42,365 pg/mL, dopamine 6409 pg/mL, noradrenalin 72,212 pg/mL) were still high despite higher beta blocker and calcium channel blocker doses. These findings contributed to the diagnosis of pheochromocytoma multisystem crisis with simultaneous thyrotoxic crisis. We increased the doses of doxazosin and carvedilol, which stabilized his hemodynamic status. On hospital day 16, metaiodobenzylguanidine scintigraphy showed high accumulation in the right adrenal gland tumor

Molecular identification and histopathological study of natural Streptococcus agalactiae infection in hybrid tilapia (Oreochromis niloticus).

Science.gov (United States)

Laith, A A; Ambak, Mohd Azmi; Hassan, Marina; Sheriff, Shahreza Md; Nadirah, Musa; Draman, Ahmad Shuhaimi; Wahab, Wahidah; Ibrahim, Wan Nurhafizah Wan; Aznan, Alia Syafiqah; Jabar, Amina; Najiah, Musa

2017-01-01

The main objective of this study was to emphasize on histopathological examinations and molecular identification of Streptococcus agalactiae isolated from natural infections in hybrid tilapia ( Oreochromis niloticus ) in Temerloh Pahang, Malaysia, as well as to determine the susceptibility of the pathogen strains to various currently available antimicrobial agents. The diseased fishes were observed for variable clinical signs including fin hemorrhages, alterations in behavior associated with erratic swimming, exophthalmia, and mortality. Tissue samples from the eyes, brain, kidney, liver, and spleen were taken for bacterial isolation. Identification of S. agalactiae was screened by biochemical methods and confirmed by VITEK 2 and 16S rRNA gene sequencing. The antibiogram profiling of the isolate was tested against 18 standard antibiotics included nitrofurantoin, flumequine, florfenicol, amoxylin, doxycycline, oleandomycin, tetracycline, ampicillin, lincomycin, colistin sulfate, oxolinic acid, novobiocin, spiramycin, erythromycin, fosfomycin, neomycin, gentamycin, and polymyxin B. The histopathological analysis of eyes, brain, liver, kidney, and spleen was observed for abnormalities related to S. agalactiae infection. The suspected colonies of S. agalactiae identified by biochemical methods was observed as Gram-positive chained cocci, β-hemolytic, and non-motile. The isolate was confirmed as S. agalactiae by VITEK 2 (99% similarity), reconfirmed by 16S rRNA gene sequencing (99% similarity) and deposited in GenBank with accession no. KT869025. The isolate was observed to be resistance to neomycin and gentamicin. The most consistent gross findings were marked hemorrhages, erosions of caudal fin, and exophthalmos. Microscopic examination confirmed the presence of marked congestion and infiltration of inflammatory cell in the eye, brain, kidney, liver, and spleen. Eye samples showed damage of the lens capsule, hyperemic and hemorrhagic choroid tissue, and retina

Molecular identification and histopathological study of natural Streptococcus agalactiae infection in hybrid tilapia (Oreochromis niloticus

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Laith Abdul Razzak

2017-01-01

Full Text Available Aim: The main objective of this study was to emphasize on histopathological examinations and molecular identification of Streptococcus agalactiae isolated from natural infections in hybrid tilapia (Oreochromis niloticus in Temerloh Pahang, Malaysia, as well as to determine the susceptibility of the pathogen strains to various currently available antimicrobial agents. Materials and Methods: The diseased fishes were observed for variable clinical signs including fin hemorrhages, alterations in behavior associated with erratic swimming, exophthalmia, and mortality. Tissue samples from the eyes, brain, kidney, liver, and spleen were taken for bacterial isolation. Identification of S. agalactiae was screened by biochemical methods and confirmed by VITEK 2 and 16S rRNA gene sequencing. The antibiogram profiling of the isolate was tested against 18 standard antibiotics included nitrofurantoin, flumequine, florfenicol, amoxylin, doxycycline, oleandomycin, tetracycline, ampicillin, lincomycin, colistin sulfate, oxolinic acid, novobiocin, spiramycin, erythromycin, fosfomycin, neomycin, gentamycin, and polymyxin B. The histopathological analysis of eyes, brain, liver, kidney, and spleen was observed for abnormalities related to S. agalactiae infection. Results: The suspected colonies of S. agalactiae identified by biochemical methods was observed as Gram-positive chained cocci, β-hemolytic, and non-motile. The isolate was confirmed as S. agalactiae by VITEK 2 (99% similarity, reconfirmed by 16S rRNA gene sequencing (99% similarity and deposited in GenBank with accession no. KT869025. The isolate was observed to be resistance to neomycin and gentamicin. The most consistent gross findings were marked hemorrhages, erosions of caudal fin, and exophthalmos. Microscopic examination confirmed the presence of marked congestion and infiltration of inflammatory cell in the eye, brain, kidney, liver, and spleen. Eye samples showed damage of the lens capsule

Computed tomography of the orbital tumors

International Nuclear Information System (INIS)

Choi, Jai Korl; Lee, Hwang Bok; Kang, Eun Young; Seol, Hae Young; Suh, Won Hyuck; Ahn, Byeong Yeob

1987-01-01

The development of computed tomography (CT) provided a noninvasive safe technique for imaging the orbit in any plane exquisitely demonstrating its normal anatomy as well as its pathologic process. The orbit is an ideal structure to be examined by CT because of large difference of absorption values between the intraorbital fat, muscle, optic nerve and vessels. In this study, the authors reviewed CT findings of 66 pathologically proven orbital tumors and tumorous conditions among the total of 98 cases who had taken orbital CT scan because if exophthalmos, ocular pain, diplopia and other ophthalmologic symptoms suggesting orbital masses during the period of 3 years. For the analysis of characteristic CT findings of the orbital lesions, all lesions are divided into 4 groups according to the site of origin, i.e., tumors arising in the eyeball (group 1); from intraconal space (group 2); from extraconal space (group 3); and from extraorbital regions (group 4). The results are as follows; 1.Extra tumor detection and localization was possible in 63 cases. Thus the detection rate was 95% with CT scan. 2.Among 36 males and 30 females, their age ranged from 10 months to 72 years. 3.Intraocular tumors (group 1) were 10 cases. Retinoblastoma occurred wholly in the young children under 5 years and combined with calcification in 57%. Choroidal melanoma occurred wholly in adults. 4.Intraconal tumors (group 2) were 9 cases. Vascular tumors (7 cases) were the most frequent and well enhancing mass. 5.The tumors arising in the extraconal region (group 3) were pseudotumor (12 cases), lymphoma (3 cases), dermoid cyst (4 cases), metastasis (2 cases), adenoid cystic carcinoma (1 case) and teratoma (1 case). A case of lymphoma demonstrating retrobulbar ill defined mass with scleral l thickening could not be differentiated from the pseudotumor which showing similar finding. 6.The lesions arising from extraorbital region (group 4) were PNS cancer (9 cases), mucocele (3 cases), lid cancer (4

A Clinical Study on 125IT3 Resin Uptake Rate and Serum Thyroxin(T4) in Hyperthyroidism

International Nuclear Information System (INIS)

MooN, Ern Soo; Park, Yoh Han; Cho, Chang Ho; Park, In Soo; Lee, Chong Suk; Lee, Hak Choong

1978-01-01

Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of 125 IT 3 resin uptake rate and serum thyroxine (T 4 ). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. 3) The most frequent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of 125 IT 3 resin uptake rate and serum T 4 level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, 125 IT 3 resin uptake rate was 49.15±9.94% (mean) and serum T 4 21.29±7.04 ug/dl (mean) in toxic diffuse goiter. In toxic multinodular goiter, 125 I T 3 resin uptake rate was 32.47±6.74% (mean) and serum T 4 level 11.03�

Computed tomography of the orbital tumors

Energy Technology Data Exchange (ETDEWEB)

Choi, Jai Korl; Lee, Hwang Bok; Kang, Eun Young; Seol, Hae Young; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of); Ahn, Byeong Yeob [Han Mi Hospital, Seoul (Korea, Republic of)

1987-04-15

The development of computed tomography (CT) provided a noninvasive safe technique for imaging the orbit in any plane exquisitely demonstrating its normal anatomy as well as its pathologic process. The orbit is an ideal structure to be examined by CT because of large difference of absorption values between the intraorbital fat, muscle, optic nerve and vessels. In this study, the authors reviewed CT findings of 66 pathologically proven orbital tumors and tumorous conditions among the total of 98 cases who had taken orbital CT scan because if exophthalmos, ocular pain, diplopia and other ophthalmologic symptoms suggesting orbital masses during the period of 3 years. For the analysis of characteristic CT findings of the orbital lesions, all lesions are divided into 4 groups according to the site of origin, i.e., tumors arising in the eyeball (group 1); from intraconal space (group 2); from extraconal space (group 3); and from extraorbital regions (group 4). The results are as follows; 1.Extra tumor detection and localization was possible in 63 cases. Thus the detection rate was 95% with CT scan. 2.Among 36 males and 30 females, their age ranged from 10 months to 72 years. 3.Intraocular tumors (group 1) were 10 cases. Retinoblastoma occurred wholly in the young children under 5 years and combined with calcification in 57%. Choroidal melanoma occurred wholly in adults. 4.Intraconal tumors (group 2) were 9 cases. Vascular tumors (7 cases) were the most frequent and well enhancing mass. 5.The tumors arising in the extraconal region (group 3) were pseudotumor (12 cases), lymphoma (3 cases), dermoid cyst (4 cases), metastasis (2 cases), adenoid cystic carcinoma (1 case) and teratoma (1 case). A case of lymphoma demonstrating retrobulbar ill defined mass with scleral l thickening could not be differentiated from the pseudotumor which showing similar finding. 6.The lesions arising from extraorbital region (group 4) were PNS cancer (9 cases), mucocele (3 cases), lid cancer (4

A Clinical Study on {sup 125}IT{sub 3} Resin Uptake Rate and Serum Thyroxin(T{sub 4}) in Hyperthyroidism

Energy Technology Data Exchange (ETDEWEB)

MooN, Ern Soo; Park, Yoh Han; Cho, Chang Ho; Park, In Soo; Lee, Chong Suk; Lee, Hak Choong [National Medical Center, Seoul (Korea, Republic of)

1978-09-15

Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of {sup 125}IT{sub 3} resin uptake rate and serum thyroxine (T{sub 4}). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. 3) The most frequent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of {sup 125}IT{sub 3} resin uptake rate and serum T{sub 4} level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, {sup 125}IT{sub 3} resin uptake rate was 49.15+-9.94% (mean) and serum T{sub 4} 21.29+-7.04 ug/dl (mean) in toxic diffuse goiter. In toxic multinodular goiter, {sup 125}I T{sub 3} resin uptake

Osteopetrose maligna: transplante de medula óssea Malignant osteopetrosis: bone marrow transplantation

Directory of Open Access Journals (Sweden)

Maria L. Borsato

2008-04-01

bone re-absorption also leads to macrocephaly, frontal bossing, hypertelorism, exophthalmos, increased intracranial pressure, retarded tooth eruption, retarded linear growth and psychomotor delay. Death occurs within the first years of life. The only curative therapy is allogeneic bone marrow transplantation with a HLA-identical donor, which restores hematopoiesis, monocyte-macrophage function and bone recovery, but there is no sensorial deficit restoration once present. The authors report two cases of allogeneic bone marrow transplant for infantile malignant osteopetrosis. The first child, on day 1260 after bone marrow transplantation (BMT, showed radiologic bone recovery and no progression of neurological deficits with a bone biopsy showing no signs of osteopetrosis. The second child showed signs of bone re-absorption and no progression of neurological deficits on day 700. The authors emphasize the importance of early diagnosis of osteopetrosis and the necessity of bone marrow transplantation before neurological deficits have begun.

Chemical contaminants, health indicators, and reproductive biomarker responses in fish from the Colorado River and its tributaries.

Science.gov (United States)

Hinck, Jo Ellen; Blazer, Vicki S; Denslow, Nancy D; Echols, Kathy R; Gross, Timothy S; May, Tom W; Anderson, Patrick J; Coyle, James J; Tillitt, Donald E

2007-06-01

showed evidence of contaminant exposure as indicated by fish health indicators and reproductive biomarker results. Multiple health indicators including altered body and organ weights and high health assessment index scores may be associated with elevated Se concentrations in fish from the Colorado River at Loma, Colorado and Needles. Although grossly visible external or internal lesions were found on most fish from some sites, histopathological analysis determined many of these to be inflammatory responses associated with parasites. Edema, exophthalmos, and cataracts were noted in fish from sites with elevated Se concentrations. Intersex fish were found at seven of 14 sites and included smallmouth bass (M. dolomieu), largemouth bass (M. salmoides), catfish, and carp and may indicate exposure to endocrine disrupting compounds. A high proportion of smallmouth bass from the Yampa River at Lay (70%) was intersex but the cause of this condition is unknown. Male carp, bass, and catfish with low concentrations of vitellogenin were common in the CRB. Comparatively high vitellogenin concentrations (>0.2 mg/mL) were measured in male bass from the Green River at Ouray NWR and the Colorado River at Imperial Dam and indicate exposure to estrogenic or anti-androgenic chemicals. Anomalous reproductive biomarkers including low GSI and gonadal abnormalities (calcifications, edema, and parasites) observed in fish downstream of Phoenix are likely related to the poor water-quality of the Gila River in this area.

Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

Directory of Open Access Journals (Sweden)

Levi González Rivero

2010-08-01

antitransglutaminase (tTGAb antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. OBJECTIVE: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. METHODS: in a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2 were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9%, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. CONCLUSIONS: in first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies.

美洲黑石斑鱼(Centropristis striata)“突眼症”的病原菌分离鉴定%Isolation and Classification of Exophthalmic Disease-Inducing Pathogenic Bacterium from Centropristis striata

Institute of Scientific and Technical Information of China (English)

陈建国; 陈超; 李炎璐; 孙曙光; 邵彦翔; 张廷廷; 刘莉; 孙涛

2017-01-01

.The strain named CJG01 was Gram-negative,bacillus and monotricha.The intramuscular injection experiment revealed that CJG01 was virulent to C.striata with LD50 value of2.67×105 CFU/ml.CJG01 could cause symptoms including larval exophthalmos,eyeball fall off,muscle ulceration,and fishbone exposure.Anatomical observation showed liver inflammation,splenic organ enlargement,kidney inflammation and yellow liquid in the intestine.The results of API 20NE rapid identification and related physiological and biochemical experiments showed that the growth temperature for CJG01 was 28℃-37℃,and the optimum temperature was 28℃.CJG01 could grow in TSB culture medium with 0-5％ salinity.It was sensitive to vibrio inhibitors O/129,was oxidase and ornithine decarboxylase positive,and was V-P negative.CJG01 could assimilate mannitol,maltose and malic acid,but not glucose,arabinose,mannose,decanoic acid,acetic acid,citric acid,benzene,etc.The strain shared similarities with Vibrio harveyi in biochemical and biophysical properties.Analysis of the 16S rDNA sequence and the phylogenetic tree suggested that CJG01 was highly similar to V.harveyi.Based on the results above,CJG01 was identified as V.harveyi.The chemotherapyeutant sensitivity test showed that CJG01 was insensitive to ampicillin,cephalosporins ammonia benzyl,cephalosporins,norfloxacin,penicillin,azithromycin,polymyxin B,etc.It was moderately sensitive to cefazolin,streptomycin,erythromycin,clarithromycin,etc.Novobiocin,neomycin,cefoperazone,ceftriaxone,gentamicin,cefoperazone,kanamycin,ofloxacin,ciprofloxacin,fleroxacin,furazolidone,rifampicin,ciprofloxacin,tetracycline,chloroamphenicol and minocycline could effectively inhibit the growth of CJG01.

The Technique and Dosimetry of Pituitary Implantation Using Sources of Y{sup 90}; Technique et Dosimetrie de l'Implantation de Sources d'Yttrium-90 dans l'Hypophyse; ДОЗИМЕТРИЯ ИМПЛАНТИРОВАННЫХ В ГИПОФИЗ ИГЛ ИТТРИЯ-90; Dosimetria de la Implantacion de Fuentes de {sup 90}Y en la Hipofisis

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Duggan, Mary H.; Jones, E.; Mallard, J. R. [Department of Physics, Hammersmith Hospital, London (United Kingdom); Joplin, G. F. [Department of Medicine, Postgraduate Medical School, London (United Kingdom)

1963-03-15

Pituitary ablation by needle implantation of Y{sup 90} is finding increasing use in the treatment of breast and prostatic cancer, as well as diabetic retinopathy, Cushing's disease, acromegaly, and perhaps exophthalmos in Graves' disease. Yttrium-90 is the most suitable radioisotope when complete ablation of the gland is sought. This is because only {beta}-particles are emitted, the maximum range (7mm) of which is comparable with the dimensions of the gland. The implantation of rods of standard activity into the gland, irrespective of its size, does not permit a standard dose level to be delivered to the gland and the method of implantation is to select the size and activity of the source to fit the dimensions of the gland in question. Thus consistency in procedure may be attempted from one implant to another. The shape of the gland and the mode of access to it is such that complete destruction may conveniently be obtained by implanting two.sources. Each source is a rod of sintered Y{sub 2}O{sub 3}, (2-mm diam., and of length cut to suit the individual gland length). The rod activity is also selected to suit the gland dimensions: typically, it is from 2 to 3 me. Radiation dose has been experimentally related to geometry and activity. Mix D wax is used as the tissue- equivalent absorber, film as the detector and a calibrated Sr{sup 90} source (which decays into Y{sup 90}) as the standard. One outcome of this work is that the pituitary gland requires a radiation dose of between 100 000 and 200 000 rad for necrosis and ablation. (author) [French] L'ablation de l'hypophyse par implantation d'aiguilles a l'yttrium-90 est de plus en plus utilisee dans le traitement du cancer du sein et de la prostate, comme dans celui de la retinite diabetique, de la maladie de Cushing, de l'acromegalie, et peut-etre de l'exophthalmie associee a la maladie de Graves. Lorsqu'on recherche l'ablation totale de la glande, l'yttrium- 90 est le radioisotope qui donne les meilleurs resultats