The American journal of medicine
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Review Case Reports
The ocular manifestations of Wegener's granulomatosis. Fifteen years experience and review of the literature.
Ocular manifestations of Wegener's granulomatosis may occur secondary to contiguous granulomatous sinusitis or as a result of focal vasculitis. Contiguous granulomatous sinus disease causes nasolacrimal duct obstruction, proptosis and ocular muscle or optic nerve involvement. ⋯ A review of 29 cases of Wegener's granulomatosis and three cases of lymphomatoid granulomatosis studied over the past 15 years at the National Institute of Allergy and Infectious Diseases (NIAID) disclosed single or multiple ocular manifestations of disease in 15 patients (47 per cent). The pattern of ocular disease, its relationship to systemic involvement, diagnostic methods and the response to therapy are discussed.
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In two patients with terminal renal failure, manifestations of disease developed in multiple organ systems. One had a previous diagnosis of multiple myeloma with kappa light chain proteinemia and proteinuria. ⋯ Clinical and pathologic correlations suggest that the retention and tissue deposition of light chains produced the organ dysfunction, inasmuch as free kappa light chain determinants were demonstrated histologically in the clinically affected organs. The deposition in these patients may be an extreme example of a common but previously unrecognized form of plasma cell dyscrasia.
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The present appraisal indicates that blood pressure patterns in adolescence differ from those in adulthood and that the design of hypertension detection programs needs to be modified for this age group. Routine blood pressure screening within the school system would appear to be the most effective means for early detection of hypertension. Links with established hypertension clinics, preferably within an adolescent unit, should be forged so that health preservation becomes a meaningful part of the educational process. Although primary hypertension has been documented in the adolescent age group, the incidence is unknown and careful diagnostic evaluation is warranted until our knowledge of its characteristics is more fully expanded.