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John R. Samples - One of the best experts on this subject based on the ideXlab platform.

  • Low-tension Glaucoma in Identical Twins
    American Journal of Ophthalmology, 1992
    Co-Authors: Steven Ofner, John R. Samples
    Abstract:

    Inquiries to Steven Ofner, M.D., Eugene Eye Care Associates, P.C., 1415 Pearl St., Eugene, OR 97401. Congenital glaucoma in identical twins has been observed, as has primary open-angle glaucoma in monozygotic twin pairs, but lowtension glaucoma in identical twins has not been well documented. In a large study of twins with chronic open-angle glaucoma, 29 monozygotic and 79 dizygotic pairs were studied. In another large study of the incidence of ocular disease in twins, low-tension glaucoma was not described. However, intraocular pressure criteria were probably part of the study. An autosomal dominant form of low-tension glaucoma has been previously described. We managed a case of low-tension glaucoma in identical twins. A 44-year-old woman was referred for examination after routine automated perimetry disclosed an abnormality in the visual field. Her ocular and medical history were noncontributory. Her identical twin sister was also healthy. Ocular examination showed a visual acuity of 20/20 in both eyes. The left eye had an afferent pupillary defect. There were inferior iris transillumination defects in both eyes without Krukenberg's spindles. Gonioscopy showed the iridocorneal angle to be open 360 degrees to the scierai spur with mild trabecular pigmentation. The optic disk had a cup/disk ratio of 0.7 in both eyes, with a Splinter Hemorrhage at the disk margin in the superotemporal portion of the left eye. Static threshold perimetry disclosed a dense inferonasal step in the left eye that corresponded with the disk Hemorrhage. The visual field in the right eye showed an inferonasal depression of retinal sensitivity. The highest intraocular pressure measured was 21 mm Hg in both eyes during an all-day diurnal curve study. The lowest intraocular pressures were 16 mm Hg in the right eye and 17 mm Hg in the left eye. Intraocular pressure decreased to 13 mm Hg in the right eye and 15 mm Hg in the left eye while the patient was instilling timolol 0.5% twice a day in both eyes. Subsequently, the patient's asymptomatic, identical twin sister was examined. Results of her ocular examination were similar to those of her twin sister, except her pupillary responses were normal. No iris transillumination defects were noted. The optic disk showed a cup/disk ratio of 0.7, with some sloping temporally in both eyes. A large Splinter Hemorrhage was present superotemporally in the right eye, which was contralateral to the eye of her twin sister. Results of static threshold perimetry were normal in the left eye, but showed an inferonasal defect in the right eye. Results of magnetic resonance imaging of the brain and orbits with gadolinium contrast were within normal limits as were results of a complete physical examination and carotid artery duplex scanning for each twin sister. The highest intraocular pressures measured were 21 mm Hg in the right eye and 19 mm Hg in the left eye during an all-day diurnal curve study. The lowest intraocular pressures were 18 mm Hg in the right eye and 15 mm Hg in the left eye. The

Philip R. Cohen - One of the best experts on this subject based on the ideXlab platform.

  • Longitudinal Erythronychia
    American Journal of Clinical Dermatology, 2011
    Co-Authors: Philip R. Cohen
    Abstract:

    Longitudinal erythronychia is a linear red band on the nail plate that originates at the proximal nail fold, traverses the lunula, and extends to the free edge of the nail plate. Longitudinal erythronychia is classified based upon the number of nails affected and the number of red streaks present on each nail as follows: type Ia (monodactylous — single band), type Ib (monodactylous — bifid bands), type IIa (polydactylous — single band), and type IIb (polydactylous — multiple bands). Associated morphologic findings that can be present at the distal tip of the nailwith longitudinal erythronychia include fragility, onycholysis, Splinter Hemorrhage, splitting, subungual keratosis, thinning, and V-shaped nick. Some patients with longitudinal erythronychia seek medical evaluation because of pain in the associated distal digit; however, the linear red nail plate dyschromia is often asymptomatic and the individual is concerned about the cosmetic appearance or distal nail fragility. Longitudinal erythronychia can be a clinical manifestation of an underlying local or systemic condition. Benign tumors (glomus tumor, onychopapilloma, and warty dyskeratoma), malignant neoplasms (malignant melanoma and squamous cell carcinoma), and other conditions (hemiplegia and postsurgical scar) can be associated with monodactylous longitudinal erythronychia or it may be idiopathic or the initial stage of polydactylous longitudinal erythronychia-associated systemic conditions. Polydactylous longitudinal erythronychia ismost commonly reported in patients with Darier disease (keratosis follicularis); other associated conditions include acantholytic dyskeratotic epidermal nevus, acantholytic epidermolysis bullosa, acrokeratosis verruciformis of Hopf, amyloidosis, graft-versus-host disease, lichen planus, and pseudobulbar syndrome. Polydactylous longitudinal erythronychia has also been observed as an idiopathic finding. Biopsy of the nail matrix and nail bed may be necessary to establish the diagnosis of a longitudinal erythronychia-associated condition. Indeed, a biopsy should be seriously considered in patients aged more than 50 years who present with a monodactylous longitudinal red band to exclude squamous cell carcinoma. Treatment of longitudinal erythronychia depends on the etiology. For patients with longitudinal erythronychia- associated discomfort or severe nail splitting, a surgical excision may provide not only the underlying diagnosis of the nail dyschromia, but also relief of related symptoms.

Steven Ofner - One of the best experts on this subject based on the ideXlab platform.

  • Low-tension Glaucoma in Identical Twins
    American Journal of Ophthalmology, 1992
    Co-Authors: Steven Ofner, John R. Samples
    Abstract:

    Inquiries to Steven Ofner, M.D., Eugene Eye Care Associates, P.C., 1415 Pearl St., Eugene, OR 97401. Congenital glaucoma in identical twins has been observed, as has primary open-angle glaucoma in monozygotic twin pairs, but lowtension glaucoma in identical twins has not been well documented. In a large study of twins with chronic open-angle glaucoma, 29 monozygotic and 79 dizygotic pairs were studied. In another large study of the incidence of ocular disease in twins, low-tension glaucoma was not described. However, intraocular pressure criteria were probably part of the study. An autosomal dominant form of low-tension glaucoma has been previously described. We managed a case of low-tension glaucoma in identical twins. A 44-year-old woman was referred for examination after routine automated perimetry disclosed an abnormality in the visual field. Her ocular and medical history were noncontributory. Her identical twin sister was also healthy. Ocular examination showed a visual acuity of 20/20 in both eyes. The left eye had an afferent pupillary defect. There were inferior iris transillumination defects in both eyes without Krukenberg's spindles. Gonioscopy showed the iridocorneal angle to be open 360 degrees to the scierai spur with mild trabecular pigmentation. The optic disk had a cup/disk ratio of 0.7 in both eyes, with a Splinter Hemorrhage at the disk margin in the superotemporal portion of the left eye. Static threshold perimetry disclosed a dense inferonasal step in the left eye that corresponded with the disk Hemorrhage. The visual field in the right eye showed an inferonasal depression of retinal sensitivity. The highest intraocular pressure measured was 21 mm Hg in both eyes during an all-day diurnal curve study. The lowest intraocular pressures were 16 mm Hg in the right eye and 17 mm Hg in the left eye. Intraocular pressure decreased to 13 mm Hg in the right eye and 15 mm Hg in the left eye while the patient was instilling timolol 0.5% twice a day in both eyes. Subsequently, the patient's asymptomatic, identical twin sister was examined. Results of her ocular examination were similar to those of her twin sister, except her pupillary responses were normal. No iris transillumination defects were noted. The optic disk showed a cup/disk ratio of 0.7, with some sloping temporally in both eyes. A large Splinter Hemorrhage was present superotemporally in the right eye, which was contralateral to the eye of her twin sister. Results of static threshold perimetry were normal in the left eye, but showed an inferonasal defect in the right eye. Results of magnetic resonance imaging of the brain and orbits with gadolinium contrast were within normal limits as were results of a complete physical examination and carotid artery duplex scanning for each twin sister. The highest intraocular pressures measured were 21 mm Hg in the right eye and 19 mm Hg in the left eye during an all-day diurnal curve study. The lowest intraocular pressures were 18 mm Hg in the right eye and 15 mm Hg in the left eye. The

Andreia Leverone - One of the best experts on this subject based on the ideXlab platform.

  • dermatoscopy of nail lichen planus
    International Journal of Dermatology, 2013
    Co-Authors: Robertha Nakamura, Ariane Aimee Abrego Broce, Diana Paola Cantillo Palencia, Natalia Isabel Anaya Ortiz, Andreia Leverone
    Abstract:

    Background  Nail lichen planus affects 10% of all patients with lichen planus. It is a severe disease that may lead to destruction of the nail plate. It affects fingernails more than toenails. Early diagnosis is important due to its aggressive behavior. Histopathology should be carried out, but in many occasions it is not enough to come to a conclusive diagnosis. Dermatoscopy, a complementary tool, has proven to be useful in its diagnosis, management, and prognosis. Currently, there is very little data regarding dermatoscopy of nail lichen planus. Methods  Dermatoscopic photographic data of 11 patients having 79 nails affected with nail lichen planus, seen in a specialized nail disease facility, were selected and analyzed. The data was confirmed with histopathological analysis. Results  Dermatoscopy showed abnormalities of the nail matrix, with trachyonychia in 40.51% and pitting in 34.18%. As to nail bed anomalies, there was chromonychia in 55.70%, fragmentation of body of nail in 50.63%, Splinter Hemorrhage in 35.44%, onycholysis in 27.85%, and subungual keratosis in 7.59%. Concerning anomalies that involved nail matrix, bed, and perionychial region altogether, there were longitudinal streaks in 82.28% and anonychia in 1.27%. Paronychia was present in 31.65% of the cases. Conclusion  Considering that nail lichen planus is an underdiagnosed disease with severe consequences, early diagnosis is essential. This descriptive study of dermatoscopic characteristics of nail lichen planus would highlight some key changes in the course of the disease that will contribute to early diagnostic suspicion, early treatment, and could improve prognosis.

  • dermatoscopy of nail lichen planus
    International Journal of Dermatology, 2013
    Co-Authors: Robertha Nakamura, Ariane Aimee Abrego Broce, Diana Paola Cantillo Palencia, Natalia Isabel Anaya Ortiz, Andreia Leverone
    Abstract:

    Background  Nail lichen planus affects 10% of all patients with lichen planus. It is a severe disease that may lead to destruction of the nail plate. It affects fingernails more than toenails. Early diagnosis is important due to its aggressive behavior. Histopathology should be carried out, but in many occasions it is not enough to come to a conclusive diagnosis. Dermatoscopy, a complementary tool, has proven to be useful in its diagnosis, management, and prognosis. Currently, there is very little data regarding dermatoscopy of nail lichen planus. Methods  Dermatoscopic photographic data of 11 patients having 79 nails affected with nail lichen planus, seen in a specialized nail disease facility, were selected and analyzed. The data was confirmed with histopathological analysis. Results  Dermatoscopy showed abnormalities of the nail matrix, with trachyonychia in 40.51% and pitting in 34.18%. As to nail bed anomalies, there was chromonychia in 55.70%, fragmentation of body of nail in 50.63%, Splinter Hemorrhage in 35.44%, onycholysis in 27.85%, and subungual keratosis in 7.59%. Concerning anomalies that involved nail matrix, bed, and perionychial region altogether, there were longitudinal streaks in 82.28% and anonychia in 1.27%. Paronychia was present in 31.65% of the cases. Conclusion  Considering that nail lichen planus is an underdiagnosed disease with severe consequences, early diagnosis is essential. This descriptive study of dermatoscopic characteristics of nail lichen planus would highlight some key changes in the course of the disease that will contribute to early diagnostic suspicion, early treatment, and could improve prognosis.

Daniel L. Stulberg - One of the best experts on this subject based on the ideXlab platform.

  • Nail Abnormalities: Clues to Systemic Disease
    American Family Physician, 2004
    Co-Authors: Robert S. Fawcett, Sean Linford, Daniel L. Stulberg
    Abstract:

    : The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. Koilonychia, or "spoon-shaped" nails, may stimulate a work-up for hemochromatosis or anemia. In the absence of trauma or psoriasis, onycholysis should prompt a search for symptoms of hyperthyroidism. The finding of Beau's lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud's disease. In patients with Muehrcke's lines, albumin levels should be checked, and a work-up done if the level is low. Splinter Hemorrhage in patients with heart murmur and unexplained fever can herald endocarditis. Patients with telangiectasia, koilonychia, or pitting of the nails may have connective tissue disorders.