8 Unexpected retinopathy in a patient presenting with bilateral optic disc swelling

A 12-year-old boy presented with 5 day history of blurry vision, 'wobbly eyes', tinnitus and difficulty seeing at night. Local ophthalmology noted bilateral optic disc swelling and referred him urgently for neurological investigations.Clinical Findings: At presentation VA was RE 0.00 and LE 0.2 with normal Ishihara colour vision. His extraocular movements were full without manifest strabismus. Fundoscopy showed bilateral optic disc swelling. Electrophysiology unexpectedly revealed a functionally cone isolated retina with markedly abnormal rod function. Pattern VEPs indicated bilateral macular pathway dysfunction affecting left eye more than right eye. Wide field imaging showed bilateral diffusely scattered yellow-white flecks in the midperiphery of each eye. His kinetic visual fields were moderately restricted bilaterally. MRI showed a Chiari 1 malformation with cerebellar tonsil herniation, but LP opening pressure was normal.Differential diagnosis included RDH5 retinopathy or vitamin A deficiency. On questioning he reported a diet restricted to only meat and biscuits. His vitamin A levels were subnormal at 0.14 umol/L (reference range 0.9-2.5umol/l) and he was started on high-dose Vitamin A supplements.Four months after supplementation retinal appearances had normalised, the rod ERGs recovered, nyctalopia and visual field restriction resolved. PVEPs had improved but an element of LE macular pathway dysfunction remained. Optic disc swelling settled leaving mild temporal pallor, particularly of the LE with some RNFL loss.It is important to recognise nutritional Vitamin A deficiency in children as prompt recognition and treatment can improve symptoms, reverse retinal pathology which we have demonstrated with electrophysiological findings.

9 MOG associated encephalitis presenting as idiopathic intracranial hypertension

A young Caucasian male (7y) with normal BMI was atypical for his provisional diagnosis of Idiopathic Intracranial Hypertension (IIH), that resolved following a Lumbar Puncture (LP). At 8y he presented with a 2-week history of headaches and vomiting that started some weeks after flu vaccination and an upper respiratory infection.Visual Acuity (VA) and colour vision were normal. Ocular motility was full. Fundoscopy and OCT showed recurrence of papilloedema, with enlarged blind spots on Kinetic perimetry.LP opening pressure was 30cm H2O and CSF white cells were elevated (23). Repeat brain and spine imaging showed new white matter signal changes in keeping with neuroinflammation, as well as enhancement of the left optic nerve extending to the chiasm and optic tract. VA, colour vision and pupillary reactions remained normal.Pattern VEP peak times were prolonged from the left eye compared to right eye to small check widths, consistent with relative macular-cortex pathway dysfunction. Hemifield PVEPs were slightly prolonged and reduced from the bitemporal fields indicating chiasmal dysfunction. Normal PERGs excluded PVEP delay associated with primary RGC disease.Further investigations showed oligoclonal band and serum-MOG antibody positivity.Management: Initial treatment with Acetazolamide 125mg bd for a week, following LP, was changed to IV methylprednisolone followed by oral prednisolone.Symptoms improved significantly following LP and steroid treatment. He will be followed in a Demyelination Clinic.MOG-associated disease has been reported with raised intracranial pressure and should be considered especially in children with atypical clinical phenotype for IIH.

Complementary and alternative medicine use in patients with gynecological cancers in Europe

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) specifically in women with gynecological cancer. The design of the study was of a descriptive cross-sectional survey using a 27-item questionnaire. The study was conducted in 11 countries in Europe as part of a larger project. Data were available from 72 gynecological cancer patients. Among the participants, 40.3% used CAM after the diagnosis with cancer. The most popular CAM modalities used were herbal medicine (34.5%), relaxation techniques (21.4%), and vitamins/minerals (20.7%). A very high level of satisfaction with CAM use was reported. Patients used CAM to increase the body's ability to fight the cancer or to improve physical and emotional well-being. The main sources of information about CAM were informal (friends/family or the media). It is important to discuss CAM use with gynecological cancer patients, as they frequently use it and such use may have implications for clinical practice.

Complementary and alternative medicine use in patients with head and neck cancers in Europe

The aim of the present study was to examine the patterns of complementary and alternative medicine (CAM) use in a sample of head and neck cancer patients, forming part of a larger study. A cross-sectional survey design was used collecting data through a descriptive 27-item questionnaire in nine countries in Europe. The participants were 75 patients with head and neck cancers. The prevalence rate of CAM use was 22.7%. The most common therapies used were herbal medicine (47%), medicinal teas (23.5%), use of vitamins/minerals (11.8%) and visualization (11.8%). Use of CAM dramatically increased after the diagnosis with cancer (i.e. eightfold increase in the use of herbs). A profile of CAM users was not evident in this sample. Patients used CAM for a variety of reasons together, with counteracting the ill effects from cancer and its treatment being the most common one. Information about CAM was obtained mostly from friends and family. As one in five head and neck cancer patients use CAM it is important that clinicians explore practices with their patients, improve communication about CAM with them and assist those who want to use CAM in using appropriate and safe therapies.

Complementary and alternative medicine use in patients with gynecological cancers in Europe

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) specifically in women with gynecological cancer. The design of the study was of a descriptive cross-sectional survey using a 27-item questionnaire. The study was conducted in 11 countries in Europe as part of a larger project. Data were available from 72 gynecological cancer patients. Among the participants, 40.3% used CAM after the diagnosis with cancer. The most popular CAM modalities used were herbal medicine (34.5%), relaxation techniques (21.4%), and vitamins/minerals (20.7%). A very high level of satisfaction with CAM use was reported. Patients used CAM to increase the body's ability to fight the cancer or to improve physical and emotional well-being. The main sources of information about CAM were informal (friends/family or the media). It is important to discuss CAM use with gynecological cancer patients, as they frequently use it and such use may have implications for clinical practice.

Use of complementary and alternative medicine in cancer patients: a European survey

BACKGROUND

The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries.

METHODS

A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients.

RESULTS

Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient.

CONCLUSIONS

It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

Greek parents' reactions, difficulties and resources in childhood leukaemia at the time of diagnosis

Open-ended interviews were used to examine parental psychological reactions, difficulties and resources during the period following the diagnosis of childhood leukaemia. Data were obtained from 71 randomly selected mothers and fathers of children diagnosed with leukaemia at least 3 months prior to the study. The content analysis revealed a wide diversity of parental responses including many of the defensive mechanisms described in the literature such as shock, denial, anxiety and guilt. The most difficult factors for the parents to deal with during the initial period were the psychological upset and the financial burden. Problems associated with relating to others and to the health care system were also identified. Hope, social support and the marital relationship were the most helpful resources in managing the multifaceted problems caused by the diagnosis. Forty-five per cent of the participants felt that the quality of their marital relationship was improved, whereas fewer reported that the diagnosis seriously disturbed their marriage. Spouses were found to adopt symmetrical rather than complementary ways of responding to and coping with the event. Nurses have a key role in assessing the individual parent, the marital unit and the entire family system and planning appropriate interventions.