Wegener's granulomatosis: the relationship between ocular and systemic disease

OBJECTIVE

Wegener's granulomatosis (WG) is an etiologically obscure entity with multiple systemic manifestations. Ocular involvement is present in up to 58% of patients with WG. We describe a series of patients with ocular manifestations of WG to evaluate the presence of ocular lesions in the setting of systemic WG and to determine the value of ocular inflammation in the diagnosis of WG.

METHODS

A computerized database was used to generate a list of patients cared for in the Ocular Immunology Service of the Massachusetts Eye and Ear Infirmary during the 10 year period 1988-98 with a diagnosis of Wegener's granulomatosis. A detailed chart review was undertaken to determine demographic characteristics, history, initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment, total followup period, and final outcome.

RESULTS

Forty-seven patients diagnosed with WG were identified. Twenty-eight were women (59.6%), 19 were men (40.4%). The average age was 53 years (range 18-90). Patients were divided into 4 groups. Group I included 27 patients (57.4%) who had systemic disease first and who subsequently developed an ocular lesion. Group II included 3 patients (6.3%) who had ocular inflammation first and who then subsequently developed systemic manifestations of WG. Group III included 3 patients (6.3%) who presented due to ocular symptoms but, on initial evaluation by us, were found to have occult systemic manifestations consistent with WG or biopsy evidence of WG. Group IV included 14 patients (30%) with ocular lesions and no history or presence of systemic disease at their last followup visit.

CONCLUSION

Ocular inflammation can occur with or without obvious systemic manifestations of WG. It may represent the first sign of WG that enables the knowledgeable physician to diagnose this potentially lethal disease.

Dexamethasone for the prevention of postextubation airway obstruction: a prospective, randomized, double-blind, placebo-controlled trial

OBJECTIVE

To determine whether dexamethasone prevents postextubation airway obstruction in young children.

DESIGN

Prospective, randomized, double-blind, placebo-controlled study.

SETTING

Pediatric intensive care unit of a university teaching hospital.

PATIENTS

Sixty-six children, < 5 yrs of age, intubated and mechanically ventilated for > 48 hrs.

INTERVENTIONS

Patients were randomized to receive intravenous dexamethasone (0.5 mg/kg, maximum dose 10 mg) or saline, every 6 hrs for six doses, beginning 6 to 12 hrs before elective extubation.

MEASUREMENTS AND MAIN RESULTS

Dependent variables included the presence of stridor, Croup Score, and pulsus paradoxus at 10 mins, 6, 12, and 24 hrs after extubation; need for aerosolized racemic epinephrine and reintubation. The dexamethasone and placebo groups were similar in age (median 3 months [range 1 to 57] vs. 4 months [range 1 to 59], p = .6), frequency of underlying airway anomalies (3/33 vs. 3/33, p = 1.0), and duration of mechanical ventilation (median 3.3 days [range 2.1 to 39] vs. 3.5 days [range 2.1 to 15], p = .7). The dexamethasone group had a lower frequency of stridor, Croup Score, and pulsus paradoxus measurement at 10 mins and at 6 and 12 hrs after extubation. Fewer dexamethasone-treated patients required epinephrine aerosol (4/31 vs. 22/32, p < .0001) and reintubation (0/31 vs. 7/32, p < .01). Three patients exited the study early-one patient in the dexamethasone group had occult gastrointestinal hemorrhage and one patient in each group had hypertension.

CONCLUSION

Pretreatment with dexamethasone decreases the frequency of postextubation airway obstruction in children.

The effect of 1% povidone iodine as a pre-procedural mouthrinse in 20 patients with varying degrees of oral hygiene

This study is conducted to determine the different types of microorganisms found in the saliva of individuals with varying degrees of oral hygiene, also to determine the effectiveness of 1% Povidone Iodine (Betadine) 1% gargle oral antiseptic as a pre-procedural mouthrinse in individuals with varying degrees of oral hygiene, and lastly to be able to determine the duration of the effectiveness of the solution. The cheek mucosa of the patients are procured of saliva specimens without prior rinsing of 1% Povidone Iodine and the saliva sample obtained was placed on a test tube with thioglycollate culture media and was labelled. The patients are asked to rinse or to gargle immediately with 1% Povidone Iodine at full strength (20ml.) for about 30 seconds. After two hours, the cheek mucosa was then again swabbed and placed on the second test tube. After four hours, the same procedure was done and the saliva specimen obtained was labelled and placed on the third test tube. The result of this study revealed that 1% Povidone Iodine used as a pre-procedural mouthrinse has a bactericidal effect in the microorganism concentration resulting to the reduction of surviving microorganisms up to four hours which is the limitation of the study.