Frederick M. Fellin

Distinguishing post-treatment changes from recurrent disease in cholangiocarcinoma: a case report

IntroductionThree-dimensional techniques for radiotherapy have expanded possibilities for partial volume liver radiotherapy. Characteristic, transient radiographic changes can occur in the absence of clinical radiation-induced liver disease after hepatic radiotherapy and must be distinguished from local recurrence.Case presentationIn this report, we describe computed tomography changes after chemoradiotherapy for cholangiocarcinoma as an example of collaboration to determine the clinical significance of the radiographic finding.ConclusionBecause of improved three-dimensional, conformal radiotherapy techniques, consultation across disciplines may be necessary to interpret post-treatment imaging findings.

Cardiac Dysrhythmias Associated with Ophthalmic Atropine

Atropine sulfate, a mydriatic and cycloplegic agent, is frequently used in patients undergoing glaucoma surgery. Trabeculectomy with peripheral iridectomy is the most common glaucoma surgery performed to decrease intraocular pressure and preserve vision. Systemic absorption of ophthalmic atropine does occur and may result in toxic and adverse side effects. Cardiac dysrhythmias are one of the major adverse reactions. This case study reviews three patients who had a trabeculectomy for glaucoma and received ophthalmic atropine. One patient received both systemic and ocular atropine. Two patients developed atrial fibrillation and one a supraventricular tachycardia. Two patients required admission to a cardiac intensive care unit for management of the dysrhythmia and a third reverted to normal sinus rhythm spontaneously. The cardiac effects of ophthalmic atropine should be considered in the preoperative and postoperative assessment of patients with dysrhythmias.