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Purpose Idiopathic intracranial hypertension (IIH) is a well-recognized disorder of unknown etiology associated with elevated intracranial pressure (ICP), normal neuroimaging, and normal cerebrospinal fluid (CSF) composition, found mostly among obese females of child-bearing age. The aim of this study is to investigate the clinical features of IIH in patients older than 40 years.Methods This is a retrospective chart review (1998–2007) of all consecutive patients older than 40 years who were diagnosed with IIH based on the Modified Dandy Criteria.Results Twenty three of the 200 IIH patients in the institutional database fulfilled study entry criteria. They included 22 females and one male whose mean age was 51.4 years (range 41–79). Coexisting systemic arterial hypertension was found in 13 (56.5%) patients. Seventeen patients (73.9%) had symptoms attributable to elevated ICP. The most common presenting symptoms were visual; mainly blurred vision and transient visual obscuration (15/17 patients, 88.23%). Eleven patients (64.7%) complained of headache, and another 4 (23.5%) of pulsatile intracranial noise. The average follow up period was 21.8 months.Conclusions The findings indicate that IIH among individuals older than 40 years of age may be underreported. These patients are more likely to present with systemic hypertension and with more visual disturbances, but with fewer complaints of headache than the younger IIH population. more...

PURPOSE: To describe the neuro-ophthalmic manifestations of patients with intracranial cavernous hemangiomas (cavernomas).Methods A retrospective review of all patients with intracranial cavernomas with neuro-ophthalmic manifestations who were treated at the Royal Adelaide Hospital in Australia between 1994 and 2004.Results There were nine patients (three men and six women), with a mean age of 39 years (range 22–61). There was one cerebellar lesion, two thalamic, four pontine, one midbrain/pontine, and one midbrain. Ophthalmic presentations included internuclear ophthalmoplegia (one patient), third cranial nerve (CN) palsy (one patient), fourth CN palsy (one patient), and sixth CN palsy (six patients). Three patients underwent extraocular muscle surgery, and six were treated medically or observed. In five patients the diplopia resolved, in three it was only mild, and in one patient no significant change was noted during the follow-up period.Conclusions Diplopia is the main neuro-ophthalmic manifestation of intracranial cavernomas. Sixth CN palsy is the most common cause. Neurosurgical or conservative treatment leads to improvement in most cases, and later use of spectacles or extraocular muscle surgery may lead to further improvement. more...

Purpose To analyze the microbiologic spectrum and patterns of resistance of infectious keratitis in patients treated at a tertiary hospital in South Australia.Methods Retrospective review of microbiology laboratory records of all patients with infectious keratitis who had corneal scrapings, from 1998 to 2003. All records were subsequently reviewed for Gram staining and culture results, as well as antibiotic sensitivity and resistance.Results Positive corneal cultures were obtained in 134 out of 211 patients who had corneal scrapings (63.5%). Coagulase negative Staphylococcus was the commonest pathogen identified (29.8% of positive cultures), followed by Staphylococcus aureus (18.7%), Pseudomonas aeruginosa (12.7%), Moraxella (6.7%), Streptococcus pneumonia (6.0%), and fungal keratitis (5.2%). In 43.3% of culture positive cases, the organisms were also identified in Gram stain, and in all these cases there was a full correlation between the two methods. In vitro sensitivities were highest for gentamicin. Fourteen cases (35%) of coagulase negative Staphylococcus were found to be resistant to cephazolin. No ciprofloxacin resistance was identified in all Pseudomonas isolates tested.Conclusions Staphylococcus species continue to be the commonest causative organism for infectious keratitis; however, there is an emerging resistance to cephazolin, which is commonly used as the first-line antibiotic for Gram-positive cocci. more...

AbstractPurpose: To describe ophthalmic manifestations in a series of patients with multiple myeloma (MM) and review the literature. Design: Retrospective case series. Methods: Review of all cases with ophthalmic manifestations of MM seen at the Department of Ophthalmology, Royal Adelaide Hospital, between 1987 and 2002. Results: Of all patients with MM who were managed at the Royal Adelaide Hospital in the study period, only 8 were referred to the Ophthalmology Department with ophthalmic manifestations. Five males and 3 females with a mean age of 61.25 years (range 42–78) who exhibited ophthalmic manifestations were studied. Six patients (75%) had known MM at the time of their ophthalmic evaluation. Four patients (50%) had neuro-ophthalmic symptoms resulting in diplopia or visual disturbances. Three patients (37.5%) presented with orbital involvement and 1 (12.5%) with hyperviscosity retinopathy. Five patients (62.5%) died within 2 months of their ophthalmic presentation. Conclusion: Ophthalmic manifestations of MM are uncommon and diverse. They may appear at the initial presentation of the disease or occur late in the disease process. Awareness of the possible manifestations may lead to an earlier diagnosis and have a positive influence on the disease course.Copyright © 2005 S. Karger AG, Basel more...

Patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy are traditionally considered to be at high risk for postoperative venous thromboembolic complications. A prospective deep venous thrombosis screening regimen was initiated at our medical center in 1990 following 2 cases of fatal pulmonary embolism that occurred after hospital discharge. During a 3-year period 245 consecutive patients undergoing radical retropubic prostatectomy for prostate cancer were screened postoperatively for lower extremity deep venous thrombosis using ultrasound duplex scanning with color Doppler flow imaging. The results were correlated only with the development of clinical deep venous thrombosis. No additional diagnostic modalities were used to confirm a normal venous system in asymptomatic patients. Venous thromboembolic complications were encountered in 9 of the 245 patients (3.6 percent). In 2 patients deep venous thrombosis was associated with nonfatal pulmonary embolism. Only 2 of the 9 cases of deep venous thrombosis were detected by color Doppler flow imaging screening. The striking decrease in the incidence of deep venous thrombosis following radical prostatectomy in the last decade and the low yield of screening at a single point in time may warrant reconsideration of the need for deep venous thrombosis screening among patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostate cancer. more...

Purpose To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO).METHODS This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 ±1.57 years (range 1–6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test.Results Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings.CONCLUSIONS The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient. more...

: We report a case of massive pulmonary embolus demonstrated on CT in a young woman presenting with dyspnea, with no known risk factors for embolism. Abdominal CT on further investigation showed a renal tumor invading the left renal vein and the inferior vena cava as the cause of the pulmonary embolus. In a patient presenting with pulmonary artery embolism without venous thrombosis, the differential diagnosis should include an occult tumor as the cause of the embolus. more...

A patient with a recent history of genitourinary tuberculosis, chronic renal failure and hemodialysis presented with a slow growing scrotal swelling that had enlarged during the last 3 years. Physical examination and sonography were suspicious for testicular tumor, and surgical exploration and inguinal orchiectomy were performed. Ultimately the mass proved to be a chronic hematocele, a rare complication of uremic coagulopathy and hemodialysis. Because hematocele may clinically and sonographically resemble a testicular tumor, the proper management of a complex multiseptated scrotal mass without obvious history suggestive of hematocele is surgical exploration and orchiectomy. Awareness of this common presentation may obviate orchiectomy. more...

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. more...

Purpose: Postoperative hyperamylasemia was evaluated in patients undergoing post-chemotherapy retroperitoneal lymph node dissection for testis cancer. Materials and Methods: Serum levels of amylase, lipase and bilirubin were evaluated prospectively in the immediate postoperative period in 39 consecutive patients who underwent post-chemotherapy retroperitoneal lymph node dissection. Results: Hyperamylasemia was found in 16 patients (41 percent), hyperlipasemia in 17 (43 percent) and hyperbilirubinemia in 9 (23 percent). Peak elevations were observed at 24 hours postoperatively and most returned to normal at 1 week. Elevation of these parameters was significantly associated with length and difficulty of the procedure. No patient demonstrated clinical acute pancreatitis. Conclusions: Extended retraction of the pancreas during post-chemotherapy retroperitoneal lymph node dissection may cause a minor reversible injury to the pancreas expressed as hyperamylasemia, hyperlipasemia and, rarely, jaundice. These findings are important to consider in the differential diagnosis of hyperamylasemia following post-chemotherapy retroperitoneal lymph node dissection. more...

Purpose: To investigate the issue of incidental appendectomy during urological surgery we retrospectively studied its consequences in 2 groups of urological patients. Materials and Methods: We studied 147 patients undergoing cystectomy and urinary diversion (group 1) and 200 undergoing primary retroperitoneal lymphadenectomy (group 2). Incidental appendectomy was performed in 122 (83 percent) and 114 (57 percent) patients, respectively. Results: The incidence of infectious complications in group 2 was significantly higher among patients who underwent incidental appendectomy compared to those without appendectomy (9.6 percent and 2.3 percent, respectively, p = 0.032). No difference was noted among the patients in group 1 (10.6 percent and 12.0 percent, respectively, p = 0.51). Conclusions: When evaluating the prophylactic merits, incidental appendectomy can be performed safely during radical cystectomy and urinary diversion. It is probably contraindicated in patients undergoing retroperitoneal lymphadenectomy for testis cancer due to the apparent added risk of infectious complications. more...

Circumcision can be fatal in hemophilia patients unless they are treated with the missing coagulation factor. We describe 10 severe hemophilia patients in whom circumcision was performed with local fibrin glue instead of infusion of factor concentrate. Of the 10 patients 3 had postoperative bleeding and only 2 of them required infusion of factor VIII concentrate. Fibrin glue is a useful treatment modality for circumcision in patients with bleeding diathesis, and it is safer and cheaper than the infusion of factor concentrate. more...

Abstract: In this report we present a case of eosinophilic cystitis with uncommon ultrasonographic focal appearance demonstrating the possible role of pelvic ultrasonography in detection and follow-up of selected cases of benign inflammatory bladder lesions. more...