In this review article, we aimed to analyze the available data on the ocular manifestations of von Hippel-Lindau (VHL) disease. In this disease, the VHL protein becomes inactivated by germline mutations of the VHL tumor suppressor gene on chromosome 3p25-26, resulting in an overproduction of VEGF in non-hypoxic conditions. Ocular manifestations are expected in roughly half of VHL patients. Retinal capillary hemangioblastomas (RCHs) are the most commonly observed tumors in VHL and are often the initial manifestation of the disease. Ablative therapy, surgical resection, and pharmacotherapy have been implemented to control tumors. Left untreated, RCHs will often enlarge, emphasizing the importance of early diagnosis and treatment to preserve vision. Complications of enlarging peripheral or optic nerve tumors may be severe. Large RCHs may disrupt normal retinal architecture, eventually leading to exudative retinal detachment. Rarely, non-retinal manifestations, such as neovascularization of the iris or cornea, may progress to neovascular glaucoma and vision loss. Ablative therapy of larger tumors carries increasing risks and offers limited success, often necessitating surgical resection. Because this life-threatening disease is not routinely encountered in clinical practice, clinicians will benefit from our review which brings awareness to the ocular presentation of VHL and lifelong screening recommendations for diagnosed patients.

In this review article, we aimed to analyze the available data on pheochromocytomas and paragangliomas as it pertains to their not as well-recognized association with significant glycemic abnormalities in the preoperative, perioperative, and postoperative settings as well as how they should be managed clinically. Pheochromocytomas are rare adrenal tumors that account for about 0.1% of hypertension. Paragangliomas, on the other hand, are even less common and have fewer clinical manifestations. Both types of tumors may have unusual modes of presentation which can challenge even the most experienced clinicians and are easy to overlook, resulting in post-mortem diagnosis. We wish to draw further attention to the lifethreatening effects on glucose and insulin homeostasis that can occur in the form of hyperglycemic and hypoglycemic states. Hyperglycemia is a result of a glucose intolerant state created in the setting of catecholamine excess, which can present in the form of resistant diabetes, diabetic ketoacidosis (DKA), or even hyperglycemic hyperosmolar states (HHS). In many reported cases, these abnormalities resolve with resection of the tumor. However, past clinicians have also described a state of "reactive hypoglycemia" that can occur following tumor resection, further emphasizing the need for very close perioperative and postoperative monitoring. Severe hypoglycemia may also occur with inherited diseases linked to pheochromocytoma such as von Hippel-Lindau (VHL) disease as well as predominantly epinephrine-producing tumors, given some of the dramatic downstream effects of alpha and beta adrenoceptor agonization. While much of the data remains anecdotal, clinicians will benefit from the awareness of the protean manifestations of these tumors and the varied and lesser-known effects on glucose and insulin homeostasis.

Background: Antinuclear cytoplasmic antibodies (ANCA) are useful diagnostic serological markers for the most common forms of necrotising vasculitis. ANCA associated vasculitides represent distinctive clinicopathological categories-for example, Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, and idiopathic necrotising crescentic glomerulonephritis, collectively known as the small vessel pauci-immune vasculitides. Method: Three cases of ANCA associated pauci-immune retinal vasculitis are described. Their systemic features are described and the clinical significance of ANCA as a diagnostic test in relation to retinal vasculitis discussed. Results: These three cases represent a spectrum of clinical features associated with retinal vasculitis. Two cases have evolved into clinical recognisable entities as microscopic polyangiitis. Adherence to the international consensus statement on testing and reporting of ANCA is recommended and the authors speculate that the incidence of microscopic polyangiitis may be underestimated because of the underrecognition of systemic involvement in patients with retinal vasculitis. Conclusion: The receipt of a positive ANCA result should always raise the suspicion of a pauci-immune systemic vasculitis and prompt appropriate investigation. The authors emphasise the importance of the evaluation of systemic features in these patients with retinal vasculitis, enabling earlier recognition and thereby preventing significant morbidity and mortality.A ntineutrophil cytoplasmic autoantibodies (ANCA) are useful diagnostic serological markers for the most common forms of necrotising vasculitis providing a means of categorising vasculitides so that diagnostically shared pathological and clinical characteristics can be correlated.ANCA produce two immunostaining patterns on alcohol fixed neutrophils: a cytoplasmic (C-ANCA) and a perinuclear (P-ANCA) pattern. P-ANCA's main specificity is myeloperoxidase (MPO).1 C-ANCA is mainly produced by antibodies against PR3, a third serine protease from azurophilic myeloid granules.2 The international consensus statement on testing and reporting of ANCA was developed to minimise the technical difficulties of ANCA testing and its interpretation. It should be noted that systemic vasculitis may occur in the absence of a positive ANCA and, conversely, positive ANCAs may be found in the absence of vasculitis-for example, with infection and neoplasia. Receipt of a positive ANCA result should always raise the suspicion of a pauci-immune systemic vasculitis and prompt appropriate investigation. CASE REPORTSCase 1 A 35 year old woman presented with pain and blurring of vision in her right eye. She related systemic complaints of malaise, lethargy, weight loss, and intermittent night sweats. Blood pressure was normal, urinalysis demonstrating moderate haem ++.Examination demonstrated a right visual acuity of 3/60 (improving to 6/9 with pinhole). There were cells+ in the anterior chamber, the posterior segment demonstrating vitreous cells+++. Fundu...

Some thyroid cancers can come back after removal, so monitoring for recurrence is important. The thyroid gland is located in the lower front part of the neck above the breastbone and regulates metabolism through production of thyroid hormones (T 3 and T 4). Thyroid cancer is a malignant tumor ofthethyroidgland.Papillaryandfollicularthyroidcancersarethemost common types, and are known as differentiated thyroid cancers because they process iodine similarly to normal thyroid tissue. Surgery is the initial treatment for papillary or follicular thyroid cancers.