Ocular pathology in The Parable of the Blind Leading the Blind and other paintings by Pieter Bruegel.

Pieter Bruegel the Elder (c.1525-1569) was a well-known 16th century painter who created many realistic canvases related to daily activities of common people of his time. The degree of realism he utilized in his paintings provided a great deal of information about life in the second half the 16th century. He was very talented not only in detailing the human faces in his paintings, but also in reflecting their states of mind. Bruegel's detail has allowed physicians over the years to critically analyze medical conditions in his paintings. This article summarizes certain ophthalmologic diseases depicted by Bruegel. The paper focuses largely on Bruegel's masterpiece, The Parable of the Blind Leading the Blind, because it is perhaps the painter's best known work, and it depicts six blind men, each appearing to suffer from a different cause of blindness. Some other works and their eye pathologies, such as the Adoration of the Magi and The Yawner, are also discussed.     

Radiation absorption properties of orbital implants

A 5-year-old girl presented with a large swelling measuring 50 × 35 mm in the left upper lid. The mass was firm to hard in consistency. Fine-needle aspiration showed a few spindle-shaped cells arranged in clusters. The mass was excised in toto and the histopathological examination revealed dermatofibroma, which is an extremely rare condition affecting the eyelid.     

Effect of topical corticosteroids on goblet-cell density in an alkali-burn model.

Conjunctival alkali burns result in a loss of goblet cells in the acute postinjury period. A deficiency of goblet cells and their primary product, mucin, is associated with both short- and long-term ocular sequelas. We evaluated the effect of topical corticosteroids on goblet-cell density in a prospective, randomized, controlled trial using 24 eyes of 12 adult albino rabbits in which a standard conjunctival burn was made. The treatment group was found to have 97.38 goblet cells per unit area of conjunctiva; the control group had 65.81 goblet cells per unit area of conjunctiva. This was a statistically significant difference (P less than .02). These results suggest that topical steroids are beneficial in suppressing goblet-cell loss after a conjunctival alkali burn.     

Speed bump-induced spinal column injury

INTRODUCTION: Compression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion. CASE REPORT: Five cases were injured in the inner city buses after passing onto speed bumps are presented. On presentation, four patients complained of severe pain in the thoracolumbar region, while in the other patient, physical examination revealed pain and tenderness on the neck. No neurologic deficit was noted except for one patient with tenderness on thoracic spines. Examination of the thoracolumbar X-ray and computed tomography displayed compression fractures in four patients. Other laboratory data obtained on admission were within normal limits. Posterior instrumentation was applied to three patients. All patients recovered well except for the one with cervical fracture. CONCLUSION: Drivers should be strongly warned and educated on the potential hazards of traversing past such bumps in roads too fast and such barriers should be built regarding tested standards.     

Spontaneous internal jugular vein thrombosis: a case report

Internal jugular vein thrombosis (IJVT) is an elusive vascular disease that is rarely seen, with potentially lethal complications such as sepsis and pulmonary embolism. Spontaneous IJVT is considered when no apparent predisposing cause of thrombosis is present. A previously healthy, 31-year-old woman presented to the university-based emergency department because of painless swelling in the right anterior side of her neck. Physical examination revealed a painless, soft and immobile mass in the right anterior side of her neck beneath the sternocleidomastoid muscle, without hyperemia or local heat. On ultrasonographic examination, a hyperechogenic mass was visualized around the thoracic entrance of the right internal jugular vein, which was suggestive of a thrombus. The patient was administered intravenous antibiotic and low-molecular-weight heparin followed by oral coumadin as anticoagulant therapy. Her complaints were relieved within 5 days. She was completely well after 6 months. Venous thrombosis generally results from impaired blood flow locally or systemically that leads to activation of coagulation. Primary care physicians should sustain a high index of suspicion in patients who present with undiagnosed swelling in the neck, or other signs and symptoms attributed to IJVT.     

Seeing the invisible: painless aortic dissection in the emergency setting

Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department.     

A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience

Between 1993 and 2004, patients with antidepressant poisoning admitted to an emergency department (ED) were analysed retrospectively with regard to demographics, clinical findings and treatment attempts. Age, gender, suicide attempts, classification of antidepressants, Glasgow Coma Scale (GCS) score, ECG findings, need for endotracheal intubation, follow-up period and Antidepressant Overdose Risk Assessment (ADORA) criteria were analysed by SPSS software. A total of 356 antidepressant poisoning cases were evaluated. Tricyclic antidepressants (TCA), especially opipramol and amitriptyline, were the most common agents (58.4%). The most frequent ECG finding was sinus tachycardia (40.7%, n=145). Endotracheal intubation was required in 9.6% of cases. Patients with TCA ingestion had a longer observation time in the ED, abnormal ECG findings, abnormal physical examination findings and more ADORA criteria, than patients who ingested selective serotonin re-uptake inhibitors (SSRI) (P = 0.008, P = 0.008, P < 0.001, P < 0.001). It was found that the patients who ingested TCA (P = 0.001), poisoned with amitriptyline (P = 0.001), patients with GCS scores of 8 and less (P = 0.001), patients with two or more ADORA criteria (P = 0.001), with seizures (P = 0.001), with abnormal ECG (P = 0.012), and patients with a history of two or more suicide attempts were intubated more frequently. Suicide attempts, classification of the antidepressant, ECG findings, seizure, GCS score and number of detected ADORA criteria affect the need for intubation in patients with antidepressant poisoning.     

Conjunctival biopsy of anophthalmic socket in sarcoidosis

A case of sarcoidosis was diagnosed by a random conjunctival biopsy from an anophthalmic socket. A 22-year-old black female patient presented with anterior and posterior uveitis and subconjunctival nodules in the left eye. Her right eye was enucleated due to a penetrating injury 3 years before admission. Biopsy of subconjunctival nodules in the left eye failed to demonstrate granulomatous inflammation; however, a random conjunctival biopsy from the normal-appearing anophthalmic socket conjunctiva revealed noncaseating granulomas. Conjunctival biopsy is a safe, cost-effective means of diagnosis in sarcoidosis suspects. To our knowledge, this is the first reported case of sarcoidosis confirmed with random conjunctival biopsy from an anophthalmic socket.     

Orbital invasion with prolactinoma: a clinical review of four patients

PURPOSE: To present four patients with invasive prolactin-secreting pituitary adenomas extending in the orbit. METHODS: Retrospective, noncomparative case series. RESULTS: In all cases, the tumor was a large, invasive prolactin-secreting adenoma. In three cases, significant permanent vision loss occurred and severe disfigurement resulted; two of these patients died of tumor-related complications. In one case, the tumor responded well to medical treatment, and the orbital symptoms improved significantly. CONCLUSION: Although it is rare for a pituitary adenoma to invade the orbit, devastating consequences to the integrity of the globe and ocular adnexa may result. Therefore, early recognition and proper treatment of orbital pituitary tumors are of utmost importance to minimize ocular and orbital damage.