Biomedical subjects
Publications and source records attributed to A R Berger.
This paper describes three cases of vasoproliferative tumours of the retina including histopathology in one. The clinical presentation, differential diagnosis and treatment modalities are discussed with a brief review of the literature.
PURPOSE: To investigate the safety of aircraft flight for patients with small volumes of residual postoperative intraocular gas. DESIGN: Nonrandomized comparative trial. PARTICIPANTS: Seventeen eyes (nine gas filled and eight control eyes) of nine patients and one eye of one control subject were tested. METHODS: Patients with postoperative intraocular gas and the control subject were tested in the controlled environment of a hypobaric chamber to simulate the cabin depressurization associated with a typical commercial aircraft flight. Before, during, and after a simulated flight, the intraocular pressure (IOP) in the gas-containing and contralateral eyes was tested using the Perkins (Edinburgh, UK) and Tono-Pen XL (Jacksonville, FL) tonometers. MAIN OUTCOME MEASURES: The absolute and percentage change in IOP with varied cabin pressurization. RESULTS: Of the nine patients with intraocular gas, seven had 10% to 15% gas volume and two had 20% gas volume. In the 10% to 15% gas volume group, the IOP rose by an average of 109% from baseline during ascent to an average cabin altitude of 7429 feet above sea level. The IOP dropped to an average of 30% above baseline IOP during the cruise phase and further decreased to an average of 38% below baseline IOP on return to baseline altitude. In the 20% gas volume group, the IOP rose by an average of 84% from baseline during ascent to an average cabin altitude of 3400 feet above sea level. The IOP dropped to an average of 42% below baseline IOP on return to baseline altitude. The IOP in the contralateral control eyes did not vary with altitude changes. No patient experienced pain or visual loss during the experiments. CONCLUSIONS: Our results demonstrate that IOP may rise significantly in gas-filled eyes during simulated air flight, supporting the current conservative recommendation against air travel for most patients with intraocular gas bubbles. Further testing is warranted to develop a more objective measure of intraocular gas volume estimation and to define better the tolerability of aircraft flight for patients with intraocular gas.
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BACKGROUND: Nucleoside analogue reverse transcriptase inhibitors are a critical component of antiretroviral therapy in HIV-infected persons. Several of these medications cause painful, dose-limiting peripheral neuropathy (PN), which may develop earlier and more intensely in persons with preexisting neuropathy. The prevalence of baseline peripheral neuropathy in injection drug users (IDUs), one of the largest populations of HIV-infected persons, has not been described, yet has important implications for the selection of antiretroviral therapy. METHODS: The authors performed a cross-sectional study of PN in 212 HIV-seronegative and HIV-seropositive IDUs using detailed neurologic histories, physical examinations, quantitative electrophysiologic study, and quantitative sensory testing. Data were used to assign patients to one of four positive categories of PN or one of two negative categories. RESULTS: PN was present in 24.5% of HIV-seronegative IDUs, three to four times the reported frequency for HIV-seronegative persons in the general or male homosexual population. PN was present in 32.1% of HIV-seropositive patients. PN was axonal in nature and associated with increased age and alcohol use. PN was asymptomatic in 81% of HIV-seronegative and 71% of HIV-seropositive patients with PN. CONCLUSIONS: There is a high prevalence of PN in HIV-seronegative IDUs. Although these PNs do not seem to predispose HIV-seropositive IDUs to HIV-related PN, they may increase the likelihood of iatrogenic neuropathy. Intravenous drug users may need more diligent monitoring when administered nucleoside analogues than patients in risk groups with lower endemic rates of PN.
We compared the frequencies and types of motor conduction abnormalities found in peroneal and tibial nerves of patients with either L5/S1 radiculopathies (n = 47) or axonal polyneuropathies (n = 49). In axonal neuropathies, compound muscle action potentials (CMAPs) were more likely to be either unobtainable or, if present, of low amplitude, prolonged in distal latency or both. F responses were more often absent, impersistent, or prolonged in minimal latency. In contrast, CMAPs in lumbosacral radiculopathies were more likely to be normal in both amplitude and distal latency. The most frequent F-response abnormality in radiculopathies was a prolonged maximum-minimum latency range rather than abnormalities of minimal latency or persistence. Logistic regression analysis demonstrated that different patterns of motor conduction abnormalities result from lumbosacral radiculopathy and distal axonopathies. The model was able to correctly classify disease state in 76% of subjects with a sensitivity of 74% and specificity of 80%.
BACKGROUND: In our institution the occurrence of endophthalmitis related to intraocular foreign bodies has been rare. In this review we analyse the outcome of eyes with retained intraocular foreign bodies presenting to two vitreoretinal surgeons over nearly 7 years. METHODS: Review of the records of 26 patients who presented to two surgeons in a tertiary care vitreoretinal service in Toronto between January 1989 and November 1995. Information documented included mechanism of injury, time from injury to definitive surgery, entry site, presence of vitreous hemorrhage, type of surgery performed, initial and final visual acuity, and development of endophthalmitis. RESULTS: All the injuries occurred in male patients, with a mean age of 36.1 (range 15 to 55) years. Most of the injuries occurred in the workplace, and in most cases (17 [65.4%]) the mechanism of injury was "metal on metal." The entry site was via a perforating wound of the cornea in 16 cases (61.5%). Almost all cases were repaired within 48 hours by means of pars plana vitrectomy. Concurrent lensectomy was required in 18 cases (69.2%) for lens damage at the time of the original injury. Vitreous hemorrhage was present in 22 cases (84.6%). One patient (3.8%) manifested clinically apparent endophthalmitis, which responded to intravitreal antibiotic therapy. Nineteen eyes (73.1%) had a final visual acuity of 6/24 or better. Eyes with coexisting or subsequent retinal detachment had significantly worse vision than those without retinal detachment (p < 0.001). INTERPRETATION: The incidence of endophthalmitis in our series is lower than that in other published series. Prompt definitive treatment was associated with a good prognosis in most cases.
Patients with non-Hodgkin's lymphoma may develop retinal or choroidal lesions during the course of their disease. New immunosuppressive therapies currently used in reticuloendothelial malignancies have increased the incidence of opportunistic infections in this patient population. The differentiation of lymphomatous infiltration from opportunistic infection as a cause of chorioretinal infiltrates is critical, as the treatments are fundamentally different. We report a case of a patient with non-Hodgkin's lymphoma who developed a chorioretinal infiltrate that was initially thought to represent progressive disease. The patient received radiation treatment appropriate for intraocular lymphoma. The lesion progressed further and after reevaluation a diagnosis of cytomegalovirus retinitis was made and therapy initiated. Review of the literature for intraocular lymphoma and cytomegalovirus retinitis is provided and diagnostic strategies are described. We recommend analysis of intraocular fluid when there is difficulty in clinically differentiating intraocular lymphoma from opportunistic infection.
OBJECTIVE: To assess the sensitivities and specificities of velocity differences between median mixed nerve conduction across the wrist (Medmxpw) and (I) median mixed nerve conduction in the forearm (Medmxf) and (II) palm to D2 sensory conduction (MedpD2). DESIGN AND METHODS: We prospectively studied 67 limbs of patients with clinically definite carpal tunnel syndrome (CTS). Medmxf and Medmxpw were performed by stimulating the median nerve at the elbow and palm respectively and recording at the proximal wrist crease. We also compared conventional median sensory (D2-wrist) and mixed (palm-wrist) tests in all patients. Thirty limbs of asymptomatic subjects served as normal controls and 21 limbs of subjects with other neuropathies served as diseased controls; control data was collected prospectively. RESULTS: The sensitivity of the MedpD2-Medmxpw difference (0.87) was significantly greater than that of the Medmxf-Medmxpw difference (0.61, P < 0.001). Both tests were similar and highly specific (0.98 and 0.96, respectively). CONCLUSIONS: The MedpD2-Medmxpw study is among the most sensitive and specific electrophysiologic tests for CTS.
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BACKGROUND AND OBJECTIVES: The authors describe a technique for hemorrhage drainage following glaucoma surgery that uses an anterior chamber maintainer to minimize risk to the anterior lens capsule. PATIENTS AND METHODS: Two patients had suprachoroidal hemorrhages following filtration surgery. Because their eyes were phakic, an anterior chamber maintainer, as opposed to a 23-gauge butterfly needle, was used for aqueous replacement during hemorrhage drainage. RESULTS: The maintainer provided a stable anterior chamber environment during both drainage procedures. No damage to anterior chamber structures occurred, and the postoperative course was unremarkable in both patients. CONCLUSIONS: The use of a sharp-tipped infusion cannula may be contraindicated for the phakic patient who has a suprachoroidal hemorrhage. The anterior chamber maintainer is a useful alternative instrument in such cases.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is usually characterized by prominent motor deficits. A pure sensory presentation, labeled chronic sensory demyelinating neuropathy (CSDN), has been reported, but it is unclear if this neuropathy is a distinct clinical and immunologic entity or merely the sensory presentation of the more usual sensorimotor CIDP. We describe 5 patients with what initially appeared to be CSDN; 3 subsequently developed substantial weakness coincident with the electrophysiologic appearance of multifocal motor conduction block. These cases indicate that, in some cases, CSDN may be a transitional clinical stage of CIDP in which the more usual sensorimotor deficits develop later. Immune-based therapy, including intravenous immunoglobulin, was found to be effective in both the pure sensory and sensorimotor types.
PURPOSE: To report unusual and heretofore unreported visually damaging manifestations of severe central serous chorioretinopathy. METHODS: Case studies. RESULTS: Each of six male patients (average age, 40 years) had a form of severe central serous chorioretinopathy with at least one eye containing fibrin in the subretinal space that then developed into a subretinal fibrotic scar. Scar formation was followed by a tenting up of the macula, vascularization of the fibrosis (subretinal neovascularization), or a retinal pigment epithelial rip. Four of the seven eyes with subretinal fibrosis had severe visual loss (20/400 or worse). CONCLUSION: Subretinal fibrin and other extracellular matrix molecules appear to stimulate the retinal pigment epithelium to undergo fibrous metaplasia, which results in subretinal fibrotic scar formation and other sequelae, all of which can lead to severe visual loss.
We evaluated the effectiveness of low-dose, short-term oral prednisone in ameliorating the pain and other symptoms of carpal tunnel syndrome (CTS) in a randomized, double-blind, placebo-controlled study of patients with mild to moderate CTS. Prednisone, in doses of 20 mg daily for the first week and 10 mg daily for the second week, resulted in significant improvement in global symptom scores. The effect was rapid, but gradually waned over 8 weeks of observation. This approach may provide a treatment alternative in the short-term, conservative management of CTS.
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