RESUMEN
This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.
Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Obstétrica/efectos adversos , Cesárea/efectos adversos , Síndrome de Horner/etiología , Adulto , Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Técnicas de Diagnóstico Neurológico , Femenino , Estudios de Seguimiento , Síndrome de Horner/diagnóstico , Humanos , Embarazo , Factores de TiempoRESUMEN
PURPOSE: To determine a suitable animal model for further characterization of the nasolacrimal drainage system. METHODS: A comprehensive Pubmed literature search was performed to locate articles pertaining to the histology or anatomy of the nasolacrimal drainage system in research animals. The histology of 2 nasolacrimal drainage systems of a cynomolgus monkey was also evaluated using hematoxylin-eosin stain. RESULTS: Sixteen articles were identified that describe the anatomy and/or histology of the nasolacrimal drainage system in rabbits, rats, pigs, sheep, goats, horses, deer, llamas, camels, apes, dogs, and cats, with significant homology between these models. Notable exceptions were found in rat histology and rabbit anatomy. In the few experiments using animal models to investigate the nasolacrimal drainage system, the rabbit model was the most commonly used system. Light microscopy of the cynomolgus monkey nasolacrimal drainage system revealed markedly similar anatomy and histology to that of humans. CONCLUSIONS: Literature review demonstrates a great deal of similarity in the anatomy and histology of the nasolacrimal drainage systems of 12 mammalian species. Although a common ophthalmic research animal, the rat model has significant histologic differences that prevent its use for comparison with the human lacrimal excretory system. Current literature suggests that despite anatomical variation, the rabbit animal model could potentially be used for further characterization of the nasolacrimal drainage system because it pertains to clinical applications in human patients. Preliminary light microscopy suggests that the cynomolgus monkey may be a superior model for nasolacrimal drainage research, but further studies are required.
Asunto(s)
Modelos Animales , Conducto Nasolagrimal/anatomía & histología , Animales , Camélidos del Nuevo Mundo , Camelus , Gatos , Ciervos , Perros , Cabras , Caballos , Humanos , Macaca fascicularis , Conejos , Ratas , Ovinos , PorcinosRESUMEN
An 11-year-old boy presented with right medial canthal swelling. He was initially diagnosed with dacryocystitis and treated with oral antibiotics, followed by incision and drainage of a presumed lacrimal sac abscess. Rapid recurrence of the swelling led to further clinical evaluation, including a maxillofacial CT, which revealed an extensive nasal and orbital mass that was consistent with embryonal rhabdomyosarcoma on histopathologic analysis. This represents an unusual case of rhabdomyosarcoma manifesting as acute dacryocystitis. Rhabdomyosarcoma should be considered in the differential diagnosis for acquired nasolacrimal obstruction and dacryocystitis in the pediatric population.