-Plummer-Vinson Syndrome.

Plummer-Vinson Syndrome

- Synonyms:-

Chronic Pharyngo-oesophagitis or Patterson-Brown-Kelly's disease.

-Definition:-

Chronic inflammation of the mucous membrane of the hypopharynx and upper oesophagus.

-Aetiology:-

Unknown, may be iron deficiency anaemia, vitamin deficiency or autoimmune.

- Incidence:-

Commonly in females above 40 years.

-Pathology:-

Atrophic mucosa and submucosal fibrosis leading to formation of webs.

-Clinical picture:-

Symptoms: gradual progressive dysphagia.

Signs:-

• Angular stomatitis with fissured angles of the mouth
• glossitis: (smooth glazed dry tongue)
• glazed atrophic mucosa of the hypopharynx and upper oesophagus with mucosal webs
• splenomegaly
• spooning of the nails (Koilonychia).

-Investigations:-

• Blood picture shows hypochromic microcytic anaemia.
• Gastric secretions: achlorohydria due to atrophic gastritis may be caused by vit. B12 deficiency.
• Hypopharyngoscopy: web formation and stenosis.

- Complications:-

• Submucosal fibrosis leading to web formation and stenosis.
• Pre-cancerous leads to Post-cricoid carcinoma.

-Treatment:-

• Iron and vitamin B complex by injection.
• Repeated endoscopic dilatation.
• Regular follow up to detect early post-cricoid carcinoma.

Return to list of medical syndromes here.

- Herpes zoster oticus (Ramsey- Hunt syndrome).

Herpes zoster oticus

(Ramsey-Hunt syndrome)

-Aetiology:-

• herpes zoster viral infection of the geniculate ganglion of the facial nerve.
• It is caused by reactivation of herpes zoster virus that has previously caused chickenpox in the patient.

-Clinical picture:-

• Pain in and around the ear
• vesicles on the auricle and in the external auditory canal
• Lower motor neuron facial nerve paralysis due to affection of the geniculate ganglion of the facial nerve.
• May be associated with sensory-neural hearing loss and vertigo due to affection of the cochleo-vestibular nerve (Ramsey-Hunt syndrome).

-Treatment:-
1.Anti-viral therapy as acyclovir (oral and local).
2.Corticosteroids (oral and local) in severe cases with affection of the facial and or cochleo-vestibular nerves.

Return to list of medical syndromes here

- Investigations for diagnosis of poisoning.

Investigations for diagnosis of poisoning

There are general & toxicological measures ......

• ECG.
• Urea & electrolytes , lab glucose, anion gap /- lactate & osmolal gap.
• Liver function Tests & Clotting (paracetamol, anticoagulants).

• Arterial Blood Gases.

• Drug levels (at appropriate interval: Paracetamol, salicylates; others: theophylline, digoxin, lithium, anti-epileptics if it was likely that they had been taken).

• Comprehensive toxicology screens not normally indicated in the emergency treatment.
• Carboxyhaemoglobin levels if carbon monoxide suspected.
• Urinalysis , save sample for possible toxicological analysis.

• Rhabdomyolysis , save sample for possible toxicological analysis.

• Chest X-Ray if pulmonary oedema/aspiration suspected.

- Types of Poisoning.

• Deliberate متعمد
  
  • Overdose as self-harm or suicide attempt.إنتحار
  • Child abuse .
    
  • Munchhausen's syndrome :Factitious disorder, Hospital addiction syndrome(e.g psychic patient).
  • Third party (attempted homicide, terrorist, warfare).
  
  
• Accidental عن غير قصد
  • Most episodes of paediatric poisoning.
  • Dosage error.
  • Iatrogenic
  • Patient error
  • Recreational use.
  
  
• Environmental:
  • Plants
  • Food
  • Venomous stings/bites.
  
  
• Industrial exposures.

- cornea.

cornea

* Definition :

It is a colorless (transparent) structure

covering the anterior 1/6 of the eye ball.


*Development of the cornea:

• Surface ectoderm forms the epithelium of the cornea.
• Mesoderm gives rise to the corneal stroma.
• Neural crest cells gives rise to the corneal Endothelium.

**Characters of the cornea :-

- colorless (transparent) structure and has a smooth surface.

- A vascular structure.

- Highly innervated by non-myelinated trigeminal nerve fibers.

-The most powerful refractive media of the eye

( 42+ diopters ).

- Diameter :-

• Horizontal = 12mm 
• vertical = 11mm Why…?

Due to scleral overlapping on upper

& lower sides of the cornea.

- It is not uniformly curved How…?

>>the central or optical zone having a smaller radius of

curvature than the peripheral parts,and the

posterior surface is more strongly curved than the anterior.

>> Ant radius of curvature = 7.7 mm 

>> Post radius of curvature = 6.6 mm

>>Thus the cornea is thinner (0.6 mm) at its

center than near its margin (1 mm).

see you,

Dr Ibrahim