Why has cyanocobalamin not been withdrawn?
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Biomedical subjects
Publications and source records attributed to C I Phillips.
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In a 1-day, 1-dose, double-masked, randomised trial, with each of 12 patients acting as his/her own control, atenolol drops 4% (a selective beta1-adrenergic blocker) produced a significantly greater fall in ocular tension measured by applanation than did adrenaline drops 1% (P is less than 0.01 Wilcoxon matched pairs signed ranks test). The mean differences, which favoured atenolol, between the falls in pressure produced by these 2 drugs at 1.5 hours, 3.5 hours, 5.5 hours, and 7 hours after instillation of the drops was 2.1, 4.6, 4.0, and 3.6 mmHg, respectively. Long-term studies would be required before any conclusion was justified about the relative merits of these 2 drugs in the treatment of glaucoma. There was no significant difference between the ocular hypotensive effects of atenolol-then-adrenaline and adrenaline-then-atenolol. It was disappointing that the expected adjuvant effect of atenolol's preceding adrenaline was not found-rather the reverse. Atenolol alone, however, was significantly better than atenolol-then-adrenaline (P is less than 0.02 Wilcoxon matched pairs signed ranks test), and there was also some indication that it was superior to adrenaline-then-atenolol. The response to adrenaline did not differ markedly from the response to the combination in either order.
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A 60-year-old man had variable visual acuity especially in the right eye for 2 years. The right field of vision showed a hemianopic defect on the nasal side (in addition to reduced visual acuity which was due to nuclear cataract). A localized posterior cortical cataract on the temporal side of the right lens accounted for the nasal field defect since the defect disappeared almost completely on dilatation of the pupil, and completely after cataract extraction. Asymmetrical opacities in the optical media far enough anterior or posterior to the plane of the pupil will produce asymmetrical field defects. (An opacity close to the plane of the pupil will produce concentric constriction.)
Ultrasonication and aspiration is a recently developed method of lens extraction. We have attempted todetermine whether extraction by this procedure is total or partial and, if so, whether certain regions or components are preferentially removed, and also whether the contents of the lens are physico-chemically modified by the process of extraction. The water-soluble and urea-soluble protein fractions from the ultrasonicated lenses and the contra-lateral intact lenses of six rabbits were analysed by isoelectric focusing. Differences are found in the crystallin content which indicate that extraction is frequently non-representative and that beta- and gamma- crystallins are modified by the process.
Ten patients in the age range 2 to 22 years are described who had operations initially for squint in childhood. Nine had had concomitant convergent strabismus and one divergent. All presented again in adult life with a cosmetic complaint, but two also had diplopia. Reoperations were done, age range 14 to 43. These ten were all the "late reoperations" for squint which were done during the four year period 1972 to 1976 by one consultant (C.I.P.). Technically these late reoperations were not difficult, through the amount of change predictable in position of the eyeball could be only approximate. Recession +/- advancement +/- resection of horizontal recti were done in all cases. In one case no medial rectus was identified attached to the eyeball; a mass of tissue behind the caruncle was mobilised and sutured to the globe with resultant good movement. To avoid tethering of the eye by scarred conjunctiva, vertical conjunctival incisions were often converted at suturing to (see article) shaped wounds. The absence of any new cases of diplopia (the two who had it preoperatively retained it without aggravation) is attributed to the fact that all cases were under-corrected, i.e., no convergent or divergent squint was converted into a divergent or convergent squint respectively, so that the non-corresponding image remained within the area of suppression, which probably extends only to the vertical meridian in a squinting eye.
The ocular hypotensive effect of single oral doses of (a) atenolol (50 mg), (b) acetazolamide (500 mg), (c) atenolol (50 mg) and acetazolamide (500 mg) in combination, and (d) vehicle (inert tablets) were compared in 8 patients with glaucoma. In this single-dose, double-masked trial the combination was observed as most effective in reducing ocular tension. Both the combination and atenolol performed markedly better than vehicle. That acetazolamide did not reduce ocular tension significantly more than vehicle is probably explained by relatively low initial ocular tensions. There was no evidence of interaction between atenolol and acetazolamide in this study. Acetazolamide probably remains the first-choice oral medication for glaucoma. It is cautiously suggested that beta-blocking drugs may have a future therapeutic role, but longer-term studies on larger numbers will be required to establish this.
Guttae atenolol 4% (Tenormin), a pure beta1-blocking (i.e., cardioselective) drug, produced a median overall fall of 5-6 mmHg (range 3-2 to 13-2 mmHg) in the first tonometrised eyes of 7 patients with open-angle glaucoma or ocular hypertension and 1 with closed-angle glaucoma (off any treatment for the whole of the day preceding each test day) after allowance for an 'effect' of guttae saline 0-9%, in a double-masked, cross-over trial. By a Wilcoxon matched pairs rank test this was significant at the P less than 0-05 level. The median overall fall of 3-5 mmHg (range 0-8 to 10-8 mmHg) in the second-tonometrised eyes of 7 patients (1 of the 8 contributed only 1 eye) was also significant (P less than 0-05). In 2 patients who had been treated with guttae atenolol 4% daily 3 X for 1 and 2 months there is evidence that, on replacing the atenolol 4% with saline 0-9%, a rise of pressure of around 3 mmHg occurred 2 and 3 and 5 days later, i.e., the drug still retained its effectivity (slightly reduced) after 1 and 2 months.
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A series of 21 patients with herpetic corneal ulcers was treated by photodynamic inactivation (using a single application of neutral red 1 per cent solution followed by a 15-min exposure to a 40 watt light of 440--550 nm), carbolization, or idoxuridine (IDU) ointment. No significant difference was found in the number that healed, the mean healing time, or the number of recurrences after any of the three treatments.
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After a short period of intensive training, a general practitioner successfully replaced a senior house officer (SHO) in the accident and emergency department of an eye hospital on one morning a week for a year. An unbiased observer compared the performance of the general practitioner after one year with that of a full-time SHO who had had 17 months' experience; their performances were about equal. Although a sessional general practitioner costs about 28% more than an SHO, the real cost is much less because undue length of service as an SHO or change to another specialty (because of the SHO surplus) delays achievement of a permanent grade. Continuity is a great advantage of the general practitioner. Replacement of some SHOs by general practitioners would reduce the surplus of SHOs with poor promotion prospects. The commonest diagnoses were Meibomian cysts (18%), corneal foreign bodies (20%), corneal abrasions (12%), and conjunctivitis (8%).
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The extraction of the rabbit lens is described using a 25 G irrigating needle and a 22 G aspirating needle; at the latter's bevelled tip lens fragmentation occurs due to the longitudinal ultrasonic vibrations generated there--an 'acoustic horn' causes the tip to vibrate with large amplitudes. The use of small needles allows considerable manoeuvrability in the anterior chamber and usually eliminates the need for corneal suturing. Push-pull coupled syringes equate the volume of irrigation with that of aspiration. This procedure makes possible lens extraction through an aperture in the anterior capsule of the rabbit's lens and a similar machine is being constructed for trial on human cataract.
In a controlled double-blind cross-over trial in 10 patients comprising six with open-angle glaucoma, three with closed-angle glaucoma, and one with ocular hypertension, a single oral dose of atenolol (50 mg) was significantly more effective than propranolol (40 mg) in reducing ocular tension.
In a controlled, randomized trial in 45 cataract operations a new synthetic absorbable suture (8-0 monofilament Vicryl, made by Ethicon), was compared with monofilament nylon or virgin silk normally used. There was a higher incidence of early complications-hyphaema, shallow anterior chamber, and choroidal detachment (15-4 per cent v. 0 per cent)-with the absorbable suture. But these differences were not significant at the 0-05 level and might well disappear with more operative experience, particularly the modified technique of knot-tying. In handling qualities Vicryl was superior to both 10-0 monofilament nylon and 8-0 virgin silk with the exception of knot-tying, in which it was inferior to 8-0 virgin silk. Vicryl is considered to be a useful absorbable suture in cataract surgery but knot-tying requires modification of technique.