Central retinal artery occlusion (CRAO) - case report

Central retinal artery occlusion (CRAO) is an ophthalmic emergency, most commonly caused by an embolism, usually from the carotid arteries. It can be considered as an acute stroke of the eye, and is an ocular analogue of cerebral stroke. The incidence of CRAO is estimated to be 1 in 100 000 people. Risk factors include hypertension, carotid atherosclerosis, structural cardiac pathology, coronary heart disease, cerebral vascular accident, and diabetes mellitus. CRAO usually presents with a sudden, painless loss of vision. 52 - year old male was admitted to the Ophthalmology ER, reporting a painless monocular vision loss in a right eye for two days. After such a long time from the occurrence of symptoms, there weren’t any possible treatment methods for this patient, besides preventing future embolic events. Ophthalmological examination showed only a light perception in a right eye and vision in the left eye was 1.0. Patient was diagnosed to identify risk factors of CRAO: hypertension, hypercholesterolemia, atherosclerosis or thrombophilia. He was qualified for a careful observation for the atherosclerotic risk factors and educated, that in case of occurrence of the similar symptoms, he needs to report to a Ophthalmologist immediately. Currently, there are two main types of treating an acute non-arteritic CRAO: the first: ‘standard’, non-invasive method, and the second: using the thrombolytics deployed intravenously or intra-arterially. Unfortunately, they couldn’t be used to treat described patient, since he has already been in a late phase of CRAO

Disulfiram-alcohol reaction in 49 year old patient

Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used. We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy

Stent fracture as a complication of superficial femoral artery stenting – a case report

Introduction: Peripheral artery disease (PAD) is an atherosclerotic vascular disease that results in obstruction of blood flow in the arteries other than those in the coronary circulation. PAD is often located in lower extremities, with patients presenting symptoms of intermittent claudication or critical lower limb ischemia. Angioplasty and stent implantation are often used in the treatment of PAD. Although these methods are considered as a low invasive and low risk, some factors may limit stent patency in the future. The fracture of the implanted stent may be one of these. Case report: A 68 old man, long-term smoker, with a history of chronic limb ischemia and many vascular surgeries because of PAD was admitted to the hospital with symptoms of the acute limb ischemia. Angiography showed a fracture of the stent implanted during the earlier hospitalization, with a fragment displacement to the left external iliac artery. The patient was successfully treated with catheter-directed thrombolysis. Discussion: Stent fracture is usually asymptomatic, however, it may cause complications, such as restenosis, pseudoaneurysm, perforation of the vessel, and in-stent embolism. The cumulative incidence of the femoropopliteal stent fracture varies from 2 to 65% in several studies. Incidence increases with stent length and is significantly lower in the second generation of nitinol stents, that was designed to have enhanced flexibility and durability

Treatment of age related macular degeneration (AMD) currently and in the past

Age-related macular degeneration (AMD) is a disease that blurs the sharp, central vision you need for “straight-ahead” activities such as reading, sewing, and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain. AMD is an irreparable disorder, which mostly occurs among people after 50. Nowadays the pathogenesis of AMD is still not entirely clarified, however this disorder has multifactor background, which include interactions between genetic and environmental factors. AMD is divided into two forms: exudative (“wet”) and nonexudative (“dry”). The treatment of age-related macular degeneration depends on the stage of the disease progression. One of the first methods of treatment of exudative AMD was laser photocoagulation with argon laser. Currently, this kind of treatment is used in certain cases of neovascularization in extrafoveal area. Next elderly method of therapy of AMD was a photodynamic therapy (PDT) at year 2000. The treatment consist in intravenous injection of verteporfin and a laser at the same time. At 2002 was in use transpupillary thermotherapy (TTT). Last few years for treatment AMD is used antagonist of vascular endothelial growth factor (VEGF). We distinguish: pegatanib, ranibizumab, bevacizumab and aflibercept. Nowadays all of available methods do not eliminate causes of that disorder and in this connection currently treatment is still symptomatic. Apart from every mentioned method above, nutritional therapy is also essential and it decrease the risk of progression of AMD. The diet should contain products full of vitamin C,E, beta carotene, zinc and copper

Anxiety in children and adolescents with chronic kidney disease - multicenter national study results

Background/Aims: Chronic medical illness is a significant risk factor for the development of psychiatric disorders. The aims of the study were: to investigate the level of anxiety in children with chronic kidney disease (CKD) and to identify factors associated with the presence of that emotional problem. Methods: CKD children on hemodialysis (HD, n=22), peritoneal dialysis (PD, n=20,) and on conservative treatment (CT, n=95) were enrolled in the study. We used State-Trait Anxiety Inventory (STAI) for adolescents and STAI-C for children. Socio-demographic and physical factors were assessed. Results: There was a significantly higher level of anxiety-state among HD children (8-12 years) compared with other groups of participants of the same age and Polish population norms. The level of anxiety among adolescents (13-18 years), both anxiety-state and anxiety-trait, was significantly higher in the HD group compared with other groups, which did not differ among themselves. In the HD adolescents, there was a correlation between the anxiety-state and the duration of the disease as well as with the number of hospitalizations. PD adolescents in the mainstream education had higher levels of anxiety-state and anxiety-trait compared with home schooled patients. Conclusions: Even though children and adolescents with CKD are at risk of developing a variety of emotional disorders, the level of anxiety among the researched group, with the exception of HD patients, was not significantly different than the level of anxiety among healthy subjects. Adolescents on HD who present a high level of anxiety should undergo long-term psychological treatment

Disease-related social situation in family of children with chronic kidney disease - parents' assessment : a multicentre study

Introduction and Objective. Chronic kidney disease (CKD) in children burdens life of patients and their families. Little is known about parents` assessment of families’ social situation. However, the knowledge of the details of a patient’s and his family’s life standards might influence modification and optimization of applied therapy. Therefore, the main goal of the present study was to explore the selected elements of life situation of patients suffering with CKD as well as their parents, depending on the CKD stage and appropriate treatment. Materials and Methods. Cross-sectional national study was conducted. A total of 203 children with CKD and 388 their parent-proxies (196 women and 192 men) were enrolled into this study. Patient data and questionnaires filled by both parents, concerning social-demographic parameters and assessment of changes in families after CKD diagnosis in the child, were analysed. Results. CKD children are being brought up in proper families whose financial situation is not good. Children need help in process of education. Perception of current situation differed between both parents in the change of the income source, taking care of CKD child, change in social relations and evaluating relations with medical staff. Parents do not obtain proper support from social workers. Conclusion. Families of CKD children require support in area of financial and educational help for school children. The discrepancies in evaluation of family situation between mothers and fathers of ill children might be the source of conflicts possibly resulting in worsening the outcome for CKD children

Lower Back Pain, Blamed on Pregnancy, Ended Up with Worsening of Vision: A Case Report

A 51 year-old female was presented with worsening of vision in her right eye; left eye similar problem about one year earlier. Each time responded to methylprednisolone sodium succinate and her discharge diagnosis was the optic nerve neuropathy. The past medical history (PMHx) was remarkable for twenty years of hypertension, anemia of chronic disease and currently on hemodialysis due to her end stage renal disease (ESRD). The most notable part of PMHx was the sacral area pain since her pregnancy at age 28 which had never resolved until the radiational therapy for aneurysmal bone cyst (ABC) which was found in CT imaging. Since the lower back pain is a frequent complain in pregnancy and after deliveries, the complains were neglected until the tumor became unresectable. The radiation therapy produced the shrinkage of ABC, but caused renal injury leading to HTN and ESRD. At age approximately 48, the patient started experiencing worsening of her vision in her left eye, most likely in result of poorly controlled HTN while maintaining her normal vision in her right eye. As stated in the report, the patient was treated in our clinic for worsening of vision in her left eye followed by he vision worsening in her right eye within one year. During the most recent hospitalization a diagnosis of bilateral papilledema we established and left eye’s optic nerve head atrophy was confirmed using both OCT and MR imaging. We believe that ignoring common complaints can lead to uncommon complications causing the most severe consequences for our patients