Disseminated aspergillosis presenting with endophthalmitis. A case report and a review of the literature

A patient with idiopathic thrombocytosis developed sudden loss of vision in his left eye secondary to endophthalmitis caused by Aspergillus flavus. He subsequently manifested other symptoms and signs of disseminated infection, and eventually died despite prompt initiation of appropriate parenteral antifungal therapy. A period of profound, iatrogenic neutropenia preceded the development of his terminal infection. Previously reported cases of hematogenously acquired Aspergillus endophthalmitis are reviewed, and approaches to diagnosis and management are discussed. The frequency of eye involvement in cases of disseminated aspergillosis is unknown, but it may be greater than appreciated previously.     

Comparison of myocardial temperatures with multidose cardioplegia versus single-dose cardioplegia and myocardial surface cooling during coronary artery bypass grafting

Myocardial hypothermia with multidose cardioplegia has not been compared with single-dose cardioplegia and myocardial surface cooling with a cooling jacket in patients having coronary artery bypass grafting. In this study, 20 patients with three-vessel disease undergoing coronary bypass at 28 degrees C with bicaval cannulation, caval tapes, and pulmonary artery venting (4.9 +/- 0.7 grafts per patient) were prospectively randomized equally into group I (multidose cardioplegia) and group II (single-dose cardioplegia with a cooling jacket). The initial dose of cardioplegic solution was 1000 ml. Group I then received 500 ml of cardioplegic solution every 20 minutes, delivered into the aortic root and available grafts. In group II, after the cardioplegic solution had been administered, a cooling jacket covering the right and left ventricles was applied. In both groups temperatures were recorded every 30 seconds at five ventricular sites: (1) right ventricular epicardium; (2) right ventricular myocardium or cavity, 7 mm; (3) left ventricular epicardium; (4) left ventricular myocardium or cavity, 15 mm; and (5) septum, 20 mm. Group mean temperatures at each site at various times were compared within each group and between the two groups by analysis of variance. Aortic crossclamp time was 60.3 +/- 12.1 minutes in group I and 52.8 +/- 7.3 minutes in group II (p = 0.12); cardiopulmonary bypass time was 103.7 +/- 11.1 minutes in group I versus 87.7 +/- 12.7 minutes in group II (p less than 0.01). One minute after the cardioplegic solution was initially given, temperatures between groups at each site were not statistically different, but left ventricular epicardial temperatures within both groups were significantly higher than in the other four sites. Nineteen minutes after administration of the cardioplegic solution, temperatures in group I at all sites were higher than in group II. Similarly, throughout the entire period of aortic crossclamping, mean temperatures (except left ventricular myocardial site), maximum temperatures, and percentage of time all temperatures were 15 degrees C or higher were greater in group I than in group II. The following conclusions can be reached: 1. Initial myocardial cooling with 1000 ml of cardioplegic solution is not significantly limited by coronary artery disease but is suboptimal (16 degrees or 17 degrees C) in the inferior left ventricular epicardium because of continual warming from the aorta and subdiaphragmatic viscera. 2. Without myocardial surface cooling, excessive external myocardial rewarming to 18 degrees to 22 degrees C occurs within 20 minutes at all sites after delivery of the cardioplegic solution.(ABSTRACT TRUNCATED AT 400 WORDS)     

Photodynamic therapy for intracranial neoplasms

Primary malignant glial neoplasms of the central nervous system have a dismal 2-yr prognosis. An innovative approach to these formidable lesions is photodynamic therapy that employs a chemotherapeutic photosensitizing agent in combination with wavelength specific light to produce cytotoxic reactions capable of destroying neoplastic tissues. Animal and initial clinical studies of the application of photodynamic therapy to intracranial neoplasms have been promising. Parameters to optimize the efficacy of this treatment are under investigation. A review of the preclinical and clinical studies of photodynamic therapy for intracranial neoplasms is described.     

Age-related glucose metabolism alterations in nondiabetic and potentially diabetic women

The incidence of pathological glucose tolerance was investigated in women of three age groups: 20–39, 40–59 and over 60 yr, by means of oral glucose tolerance tests and the Danowski Index. The incidence was found to be significantly higher in older women: thus an age-related deterioration of glucose metabolism was confirmed.The women in each age group were further divided into “healthy” nondiabetic and “potentially diabetic” women. The parameter of “potential diabetes” was found to be associated to a greater extent with age-related glucose tolerance deterioration than advancing age alone.The existing theories for the etiology of carbohydrate metabolism alteration in older women are reviewed.It is suggested that in view of the age-related deterioration of glucose metabolism, a new normal range of glucose tolerance should be established in an ageing population.     

Rhinorrhea associated with intracranial cholesteatomas and an “empty sella”

Three related disorders in the same patient, namely bilateral primary intracranial cholesteatomas, an “empty sella” syndrome, and a cerebrospinal rhinorrhea are reported. No previous report of bilateral symmetrical cholesteatomas has been made, though single intracranial cholesteatomas have frequently been recorded in medical literature. The “empty sella” syndrome is generally considered to be from a herniation of the subarachnoid into the sella through a deficient diaphragma sella, and was first defined by Ommaya in 1968. Non-traumatic (spontaneous) rhinorrhea remains an uncommon disease initially described in 1826. Experience of the individual otolaryngologist is limited in this region because of infrequent occurrence and because definitive treatment is directed to other specialties. On the other hand, the ear, nose and throat physician may be the first to interpret a drainage from the nose. With this in mind, the etiologic, clinical and management factors in the present case are discussed.