Letters to the Editor

Hemorrhagic pyogenic granuloma after internal hordeolum Dear Editor, Pyogenic granuloma is a slow growing proliferation of granulation tissue caused by surgery trauma and infection. Pain, rapid enlargement and bleeding after unimportant traumas are the main characteristics of these lesions. At pyogenic granuloma conjunctiva, it is a benign lesion that is seen frequently at mucosa and skin. The reasons that bring the patients to the doctor are lesion bleeding and the pain occurred by the mass. They can be detected easily due to their fast growth, bleeding due to tiny traumas, and without any reason.[1] A woman patient aged 39 applied to our clinic with the complaint of growing mass and bleeding like leakages at her left eye upper lid during the past two months [Figure 1]. During the previous tracks of case it was identified as hordeolum interna. There was no surgery and trauma history experienced. At the ophthalmologic examination of the case, right and left eye vision was 1.0, fundus examination for both eyes was normal, and intraocular pressure at right was 13 mmHg (Appl) and at left eye was 14 mmHg (Appl), and at slit‑lamp examination, right eye findings were normal, at left eye upper lid temporal in there was a bleeding mass of 0.8 × 0.7 × 0.5 cm dimension. For the case the routine surgery operation preparations completed and performed local anesthesia with lidocaine HCL to the upper lid. We put chalasion clamp to the upper lid and put 8/0 vicryl and one suture to the stalk of mass. The lesion was made dissection above the suture. It was cauterized and eye was closed. The piece obtained after the surgery is presented at Figure 2. After the pathologic analysis, it became consistent with the pyogenic granuloma.

Figure 1: Before operation

Figure 2: The piece obtained after surgery

Departments of Ophthalmology, 1Pathology and 3Internal Medicine, School of Medicine, Harran University, Sanliurfa, 2Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey

Pyogenic granuloma is an acquired hemangioma that can occur due to different etiologies despite the consideration that it has relation with infection in relation to pyogenic expression in its name, and criotherapy and curettage are the main strategies for its treatment.[2,3] It should be kept in mind that pyogenic granulomas at the eye can occur without trauma and surgery intervention. Our case happened after the internal hordeolum.  Ali Akal, Tugba Goncu, Sezen Kocarslan1, Isa Yuvaci2, Yudum Yuce2, Emine Pangal2, Ufuk Ozkan, Turgay Ulas3

Address for correspondence: Dr. Ali Akal, Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa, Turkey. E‑mail: [email protected]


Pastor‑Paskal F, Avino‑Martinez J, Espana‑Gregori E, Alcocer‑Yuste P. Pyogenic granuloma following Smart Plug Insertion. Arch Soc Esp Oftalmol 2007;82:653‑5.

International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 4 | Oct-Dec 2014


Letters to the Editor 2. 3.

Metts  J. Common complications of body piercing. West J Med 2002;176:85‑6. Jafarian F, Powell J, Kokta V, Champagne M, Hatami A, McCuaig C, et al. Malignant melanoma in childhood and adolescence: Report of 13 cases. J Am Acad Dermatol 2005;53:816‑22.

Access this article online Website: www.ijciis.org

Quick Response Code:

DOI: 10.4103/2229-5151.147540

Critical care medicine education in Middle East, FCCS/BASIC course, common purpose, different method Sir, Fundamental Critical Care Support (FCCS) course was started in 1990s by the society of critical care medicine (SCCM) [1] ; it is now active in more than 100 countries. So far, it has been presented in several countries in Middle East such as Iran, Iraq and Jordan with plentiful participants. [2] Basic Assessment and Support in Intensive Care (BASIC) is a course, which was originally developed by Charles Gomersall and his colleagues at the Chinese University of Hong Kong, and since has been endorsed by European society of intensive care medicine (ECISM) and the intensive care society (ICS). While, the courses have been developed by two completely different systems[3], however, the aim of both courses is to teach non‑intensivists to rapidly assess seriously ill patients, identify and respond to significant changes in the unstable patients, and provide initial treatment and organ support. The BASIC course is run worldwide in over 30 different countries mostly in East Asia and Middle East. There are assumptions regarding the content, modules and expansion of these courses. The FCCS has costs for both traditional and online formats; however, instructors do not ask for money in many cases[4] such as Professor Janice Zimmerman instructing in Iran (Tehran) in 2010. Besides, pricing options are tiered, based on the country in which FCCS course is held. In BASIC course, information is supplemented with a free course manual and CD sent out prior to course commencement (approximately four weeks prior to the course start date). Basic collaboration has some educational resources as Very BASIC, BASIC, Pediatric BASIC, Beyond BASIC and BASIC Developing Healthcare Systems (DHS). Basic course supposed to be free registration, while it is not cost free in some instances. In BASIC course held in Iran (Shiraz) 2013, Dr Hussain Al Rahma (|head of Emirates, Intensive Care Society) instruct with no charge. Moreover, FCCS do not get any sponsors from private companies in courses, lecture slides, and textbooks; thus, have no conflict of interests. BASIC course do get sponsors 318

for its courses use them in their slides, textbooks and in the course meeting. Both FCCS and BASIC courses consist of lectures, skills stations and workshops, Pre‑and post‑course multiple‑choice questions (MCQs) to assure mastery of the participants in educational content (Achieve a score >70% in FCCS and >75% in BASIC). FCCS has 3 types: Traditional, online and self‑directed. Textbooks and slides are well‑established materials in traditional and online FCCS. On the other hand, BASIC course materials are more diverse and slides are more figurative. Sessions and lectures are more flexible for instructors and contain open question and answers in BASIC course. Although, online lectures and learning management system is presented only in FCCS not BASIC courses at the moment; however, online courses is not well received in Middle East or resource‑limited countries, which demonstrate preference of physicians for traditional courses. The mainstay of FCCS and BASIC courses are mainly fundamental management principles of intensive care; however, BASIC course presents some aspects of advanced intensive care such as subclavian vein catheterization, which seems overwhelming for such basic course. FCCS course is more restricted to only fundamental and instructors mostly stick to the slides and textbook content instead of open discussion in BASIC course. In conclusion, FCCS and BASIC courses are both well received among physicians in Middle East. Although, these two courses have some differences in content and method, both have common purpose and a great value in countries, in which there are not enough number of intensivists. It seems that FCCS course are well designed and more standard path to learn critical care medicine with less conflict of interest. Seyed Mohammadreza Hashemian, Ata Mahmoodpoor1, Seyed Amir Mohajerani, Hamidreza Jamaati

International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 4 | Oct-Dec 2014

Copyright of International Journal of Critical Illness & Injury Science is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Hemorrhagic pyogenic granuloma after internal hordeolum.

Hemorrhagic pyogenic granuloma after internal hordeolum. - PDF Download Free
723KB Sizes 0 Downloads 17 Views