This 5 year old girl presented to our hospital’s emergency department with complaints of blood stained tears and pain. The attending emergency medical physician placed an emergency call to me for examination and management of the case. During the time, I took to reach the hospital; the emergency medical officer had irrigated the patient’s conjunctival sacs with normal saline and applied Polyfax eye ointment.
The patient was brought in by her parents. According to the parents, the patient was seen by a general physician at his clinic for fever, who on examination found her eyes slightly congested and prescribed Methachlor eye ointment (chloramphenicol 5mg/g+ dexamethasone 1mg/g) and Novophenicol eye drop (Chloramphenicol 0.5%). He also had prescribed syrup Cefim DS (Cefixime 200mg/5ml) and syrup Brufen for fever. Almost 30 minutes after the instillation of the first drop and ointment application, her mother saw blood flowing out of her eyes.
She did not have any ocular or family ocular history. She had no known drug allergies. Her family medical history was insignificant. Her medical history had been significant for fever since last 24 hours for which her parents sought the opinion of the general physician.
The patient, as well as her parents, was anxious about the condition and patient did not cooperate during the exam. Her visual acuities were 6/7.5 (0.8 decimal) OU. Her Extraocular motitlies were full without any evidence of heterotropia or heterophoria. Her pupils were equally round and reactive without any RAPD. Her lids were slightly swollen externally. There was mixed papillary and follicular reaction OU, inflamed cruncles OU and multiple small subconjunctival hemorrhages OU, on slit lamp biomicroscopy. Lid eversion OU w...
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...z AT, Aker S. Pyogenic granuloma of the lacrimal sac. Int Ophthalmol. 2009;29:57-60.
41. Yazici B, Ucan G, Adim SB. Cavernous hemangioma of the conjunctiva: case report. Ophthal Plast Reconstr Surg. 2011;27:27-8.
42. Lopez-Prats MJ, Sanz Marco E, Hidalgo-Mora JJ, Garcia-Delpech S, Diaz-Llopis M. Bleeding Follicular Conjunctivitis due to Influenza H1N1 Virus. Journal of Ophthalmology. 2010;2010.
43. LAGNADO R, ALWITRY A, DUA HS. Follicular Conjunctivitis 2006. Available from: http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v4/v4c007.html.
44. Toxic Conjunctivitis [cited 2014 28-5-14]. Available from: http://legacy.revoptom.com/handbook/SECT13a.HTM.
45. Viral Conjunctivitis. Available from: http://legacy.revoptom.com/handbook/sect2b.htm.
46. Lam RF, Lai JSM, Ng JSK, Rao SK, Law RWK, Lam DSC. Topical chloramphenicol for eye infections. HKMJ. 2002;8(1):44-7.
Adae Cynthia’s husband telephoned Dr. Avera about Cynthia’s hospitalization and relayed that she was suffering from continuing pain. Upon Dr. Avera's recommendation that he should transport his wife to the Middletown Regional Hospital emergency room, where Cynthia was seen by Tao Nguyen, M.D. They started by giving Cynthia a CT scan of her chest and head, which ended up being negative result for pulmonary embolism but it did reveal a sinus infection. Dr. Nguyen requested copies of her medical records from Clinton memorial hospital but Clinton’s record department was closed for the weekend. Dr. Nguyen discussed Cynthia’s case with Dr. Avera and instructed her to follow up with Dr. Avera on Monday, July 3. She was discharged with a prescription for pain medication. On the same day laboratory reported to a resident on duty that Cynthia’s blood cultures were showing gram positive cocci in clusters. The next day the laboratory reported to Dr.Pesante the Cynthia’s blood cultures were positive for staphylococcus aureus. Neither the resident on duty nor Dr. Pesante contacted Dr. Bain or the attending physician on-call about Cynthia’s blood culture results. The trial court found it unclear whether any Clinton memorial hospital employee attempted to contact appellees or Dr. Avera. Dr. Avera said if he would have learned of the positive blood culture she would have admitted her immediately to hospital and would have empirically started her on antibiotics and then
The New England Journal of Medicine -- February 1, 1996 -- Vol. 334, No. 5
Gas in 1968 described Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) as being a condition that caused acute and rapid loss of central vision due to multiple pale lesions at the level of Retinal pigment epithelium (RPE) in the posterior pole. (1) It is a self-limiting condition which recovers spontaneously over a three weeks period leaving residual pigment epithelial alterations.(2) The typical features in acute phase include cream colored placoid lesions at the level of RPE, early hypofluorescence and late hyperfluorescence of the lesions on Fundus fluorescein angiography (FFA).(2) It is usually followed by a viral flu like prodrome in 1/3 of the patients. Neurological manifestations of APMPPE include Headaches being commonest while others are paraesthesias, vertigo, psychosis and more severe complications, Cerebrospinal fluid pleocytosis stroke and cerebral vasculitis.(3, 4) Association of APMPPE with systemic Vasculitis in the patients with positive perinuclear antineutrophil cytoplasmic antibody has been reported.(5, 6) Other systemic inflammatory diseases suggesting an underlying immune mediated or an inflammatory mechanism include erythema nodosum,(7-9) juvenile rheumatoid arthritis,(10) thyroiditis,(11, 12) nephritis,(5, 6, 13) ulcerative colitis(14) and Adenoviral infections(15) . Many granulomatous diseases have documented associations with APMPPE, including Wegener’s granulomatosis,(16-18) Pulmonary tuberculosis(19) and Sarcoidosis.
Loss of vision in one or both eyes
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Glaucoma is a disease of the eye and it is fluid pressure within the eye rises and if the eye is left untreated the patient might lose vision or maybe even blind. But this disease is generally affects both eyes but although one of their eyes may have more severe signs or symptoms then the other eye. When you have glaucoma there are small spaces in the front of the eye and they are called anterior chamber. There is clear liquid that flows in and out of the anterior chamber and the fluid nourishes and bathes nearby the tissues. And if the patient has glaucoma the fluid dose not drain like it should drain but the fluid drains out of the eye. And this may lead to fluid build up and pressure inside the rises of the eye. Unless the pressure is brought down and controlled and the optic nerves and some of the other parts of the eye might become damaged leading to ...
Philip Mortimer BMJ: British Medical Journal , Vol. 321, No. 7269 (Nov. 4, 2000) , p. 1123
Smith brings his 4-year-old to your office with chief complaints of right ear pain, sneezing, mild cough, and low-grade fever of 100 degrees for the last 72 hours. Today, the child is alert, cooperative, and well hydrated. You note a mildly erythemic throat with no exudate, both ears mild pink tympanic membrane with good movement, lungs clear. You diagnose an acute upper respiratory infection, probably viral in nature. Mr. Smith is states that the family is planning a trip out of town starting tomorrow and would like an antibiotic just in case.
Mrs. Jones was admitted to the hospital for evaluation due to hyperglycemia related to diabetes. Her blood sugar was 350 and her physical exam revealed dry skin and mucous membranes.
The children had incurred numerous needles and painful hospital admissions, investigations, and procedures because of a false story and factitious signs...the falsification was not by the patient themselves but by another person "acting on their behalf" which is a proxy (502).
The theoretical part describes the newest findings of the pathogenesis, overview over the typical clinical picture, most common diagnostic methods, especially OCB investigation, and clasical and modern threatments of the disease.
After many years of battling migraine headaches, she had decided to try something new. The doctors tell her everything is okay with her. MRI shows no abnormality but the
... Medicine. 3rd ed. Vol.3. Detroit: Gale, 2006.2139-2141. Gale Virtual Reference Library. Web. 3 Apr. 2014.
Most medical errors come from human errors. Before defining medical error, we should have a good understanding of human error. As a human in our everyday life we are prone to make mistakes such as using ointment...
Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. (2009) Medical Progress Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection